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Robert Shavelle

Publications and source records attributed to Robert Shavelle.

5 recordsLinked to original sources
PubMed2004

Decline in function and life expectancy of older persons with cerebral palsy.

The authors studied the pattern of functional abilities and decline of skills in adults with cerebral palsy. The data source was the California Developmental Disabilities data base, which included 904 subjects of age 60. For those individuals who are mobile when they become adults, there is a marked decline in ambulation, especially in late adulthood, and few of the 60 year-olds who walked well preserved this skill over the following 15 years. Older subjects frequently also lost the ability to dress themselves. Many other skills, however, seemed to be well preserved, including speech, self-feeding and the ability to order meals in public. Whereas the great majority of young adults lived in their families' home or in small private group homes, 18% of the 60 year-olds lived independently or semi-independently, and 41% resided in facilities providing a higher level of medical care. Survival rates of the ambulatory older adults were only moderately worse than the general population. Survival was, however, much poorer among those who had lost mobility.

Activities of Daily Living↗
PubMed2003

Excess mortality in remote symptomatic epilepsy.

BACKGROUND: Published estimates of excess mortality associated with epilepsy vary greatly. How much, if any, of the excess is attributable to the seizures themselves as opposed to an underlying condition causing the epilepsy is not clear from the literature. This article offers evidence that epilepsy per se is associated with excess mortality. The excess varies according to severity and frequency of seizures. MATERIALS AND METHODS: The authors studied mortality rates of developmentally disabled persons in California with and without epilepsy. In order to focus on the effect on mortality risk of epilepsy per se, they included only persons with good motor function (able to walk and climb stairs) and at worst moderate mental retardation (MR). The data were 506,204 person-years and 1523 deaths among 80,682 California subjects of age 5 to 65 years during the 1988-1999 study period. Mortality rates for persons with epilepsy were compared to rates for persons with no history of epilepsy. RESULTS: Mortality rates were higher for persons with epilepsy than for those without. Excess death rates (EDRs) varied according to type and frequency of seizures. Combined EDRs were 6 (deaths per 1000 person-years) for persons with recent (< 12 months) history of status epilepticus, 5 for recent history of generalized tonic-clonic (GTC) seizures, 3 for recent history of seizures but no recent GTC seizures, and less than 1 for a history of seizures but no recent events. CONCLUSIONS: The data presented here are evidence that epilepsy per se is associated with increased mortality. The EDRs reported here may be better measures of excess mortality due to epilepsy than previously published estimates.

Adolescent↗
PubMed2002

Coronary calcium scanning adds incremental value to patients with positive stress tests.

BACKGROUND: The sensitivity of coronary calcification by electron beam tomography (EBT) for the detection of coronary atherosclerosis is well-established. Combining the anatomic information of EBT with the functional information of stress testing might reduce the high false-positive result rate seen with treadmill stress test (TMST) alone. No studies have reported the additive value of a negative EBT result (no coronary calcium) for excluding obstructive coronary artery disease (OCAD) in patients with a positive TMST result. This study evaluated the negative predictive value and potential clinical utility of EBT to identify patients with a falsely abnormal TMST. METHODS: A coronary calcium score was determined by EBT for 153 symptomatic patients who underwent coronary angiography because of a positive TMST. The sensitivity, specificity, and predictive values of EBT were determined. A multiple logistic regression analysis compared conventional cardiac risk factors with coronary calcification by EBT for predicting OCAD. A receiver operating characteristic curve was generated plotting sensitivity versus false-positive rate. RESULTS: The false-positive rate of the TMST compared with angiography was 27% (41 of 153). The sensitivity of a nonzero coronary calcium score for OCAD was 98% (110 of 112), with a negative predictive value of 93%. According to multiple logistic regression, coronary calcification by EBT was a stronger predictor of OCAD than any conventional cardiac risk factor. EBT calcium added incremental value to the results of the TMST. Receiver operating characteristic curve analysis found an area under the curve of 0.91 (P <.001). CONCLUSIONS: The absence of coronary calcification by EBT reliably identified patients with a false-positive TMST result. The combination of EBT with TMST is a potentially useful diagnostic strategy to reduce the number of false-positive test results.

Area Under Curve↗