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Biomedical subjects

W T Blume

Publications and source records attributed to W T Blume.

12 recordsLinked to original sources
PubMed1992

Sexual abuse and psychiatric symptoms in an epileptic population.

One hundred and seven consecutive patients attending the outpatient epilepsy clinic at a teaching general hospital were assessed by clinical interview for a history of sexual abuse. Questionnaires dealing with overall psychiatric symptomatology i.e., (SCL-90), (TSC-40) and depression (ZSRDS) were also used. The majority of subjects were single (60%), living at home (76.6%) and had an average age of 29 years. The mean duration of epilepsy was 18.8 years and the seizures were controlled with medication in 65.2% of patients. Ten (9.3%) of the subjects had been sexually abused. This frequency of sexual abuse is lower than in the general population and among psychiatric patients. The specific form of sexual abuse consisted of sexual intercourse (n = 4), fondling (n = 4) and oral sex (n = 2). The sexually abused subjects had significantly higher scores on the anxiety subscale of the SCL-90 and depression score on the ZSRDS than non-abused subjects.

Adolescent↗
PubMed1992

Seizures involving secondary sensory and related areas.

Five patients with seizures involving the secondary sensory and/or related areas (SSRA) are presented. Four of five experienced ictal numbness and/or tingling bilaterally and/or axially; this involved fingertips (three patients), lips (two), tongue (two), and was diffuse in one. The fifth patient experienced bilateral ictal pain. Associated ictal symptoms implicating adjacent regions appeared in all five patients, including contralateral clonic movements (two patients), hypersalivation (two), taste (one), vocalization (two), dysphagia (one), and contralateral sensory march (one). Two patients had ictal symptoms suggestive of adjacent temporal lobe involvement. By history, the SSRA was involved at seizure onset in four and by spread in one. All five patients had electroencephalogram (EEG) or subdural EEG supportive evidence of SSRA involvement: ictal (three) and interictal (three). Three patients had lesions in this area shown by magnetic resonance imaging or computerized tomography and all three had histologically proven glial tumours. Relevant experimental physiological and anatomical data are reviewed.

Adult↗
PubMed1992

Temporal lobectomy for intractable epilepsy in patients over age 45 years.

Surgical management of uncontrolled focal epilepsy is most commonly carried out in young adults with good results, but there has been some doubt about the effectiveness of cortical resection in older individuals. We assessed the outcome of temporal lobectomy done after age 45 years in 20 patients with intractable epilepsy followed for more than 2 years after surgery. During a mean follow-up of 5 years, six patients (30%) were seizure-free following surgery and seven (35%) had greater than 90% reduction in seizure frequency. This compares with an outcome of 40% seizure-free and 44% with greater than 90% seizure reduction in 68 younger patients aged 17 to 45 years; the differences do not achieve statistical significance. The outcome was better for complex partial seizures than for secondarily generalized seizures. Complications were no greater than in the younger patients. The findings indicate that surgery is an effective treatment alternative for intractable temporal lobe epilepsy in older patients since two of three of these patients will obtain satisfactory seizure control.

Age Factors↗
PubMed1992

Uncontrolled epilepsy in children.

Intractable seizures in any age indicates (1) the continued presence of an unacceptable quantity of seizures despite reasonable medical and social management or (2) seizure eradication at the expense of medication toxicity. The incidence of seizures deemed unacceptable depends on their nature, the patient's life-style, physiological and social consequences of uncontrolled seizures, and the promise of surgical alleviation. The true value of surgery should increase as candidates and surgical sites can be more accurately selected, the necessary (and unnecessary) diagnostic tests better identified, and all aspects of its effects objectively evaluated in follow-up.

Adaptation, Psychological↗
PubMed1979

Chronic progressive myelopathy: investigation with CSF electrophoresis, evoked potentials, and CT scan.

Chronic progressive myelopathy (CPM) is a difficult clinical problem. Many patients who present with CPM turn out to have a spinal form of multiple sclerosis (MS), but until there is clear lesion dissemination, a definite clinical diagnosis cannot be made. We have looked for MS-related abnormalities in 72 patients with CPM. The mean age of onset was 42 years, mean duration was ten years, and mean Kurtzke disability rating was 4.5. Studies performed were cerebrospinal fluid electrophoresis for oligoclonal banding, pattern-reversal visual evoked responses, blink reflex latencies, and computerized axial tomography. Oligoclonal banding was found in 32 patients (44%), patterned visual evoked responses were abnormal in 32 (44%), and blink latencies were abnormal in 40 (56%). A least one of these studies was abnormal in 61 patients (85%) and at least two in 48 (66%). The CT scan was abnormal in 38 )53%), 36 with atrophy and 3 with low-density or enhancing lesions. These results suggest that at least 44% of patients with CPM may have MS that could be diagnosed by oligoclonal bands. Other physiological tests suggesting diffuse or disseminated disease bring the total to 85%. Only autopsy follow-up will tell us the exact diagnostic accuracy of these studies in this complex syndrome.

Adult↗
PubMed1978

Clinical and electroencephalographic correlates of the multiple independent spike foci pattern in children.

The multiple independent spike foci (MISF) pattern on electroencephalograms occurred in 4.2% of 1,500 recordings obtained from patients between the ages of 6 months and 15 years. Among the 63 patients with MISF, 53 (84%) had a seizure disorder and 48 (76%) had generalized motor seizures. Half the study group had daily seizures and half had more than one type of attack. Sixty-eight percent of MISF patients were intellectually subnormal. The intellectual status varied according to age at seizure onset, findings on clinical neurological examination, incidence of spikes in the recording, number of spike foci, and presence of excessive delta activity.

Adolescent↗
PubMed1978

A clinically effective spike recognition program: its use at electrocorticography.

This automated system detects spikes when the first derivative value of the EEG or ECoG signal exceeds a user-determined threshold twice, with reversal of direction, within 30--80 msec. The EEGer selects this threshold by his assessment of the system's initial performance in a recording situation. By combining the spike detecting abilities of both the EEGer and computer, two tasks can be accomplished on-line for 16-channel EEG or ECoG: (1) localization of the origin of widely synchronous spikes, and (2) assessment of the relative quantities of spikes emanating from several active regions. This system achieved a human-computer correlation ranging from 0.79 to 0.84.

Action Potentials↗
PubMed1976

Generalized sharp and slow wave and electrodecremental seizure pattern in subacute sclerosing panencephalitis.

Although subacute sclerosing panencephalitis (SSPE) often presents with a characteristic EEG pattern, a 13-year-old boy with a confirmed diagnosis of SSPE had several EEG features that are unusual for this condition, namely, generalized sharp and slow wave (slow spike and wave) discharges during the waking record, an electrodecremental pattern associated with clinical seizures, and activation of the typical periodic complexes of SSPE only during sleep.

Adolescent↗
PubMed1975

Cardiac monitoring and demand pacemaker in Guillain-Barré syndrome.

Life-threatening alterations of respiratory and cardiovascular functions may complicate the course of severe Guillain-Barre syndrome. Cardiac arrest, fore-warned by episodes of bradycardia or other arrhythmia, may occur despite adequately assisted respirations. A patient with Guillain-Barre syndrome required tracheostomy and ventilatory assistance. Continuous cardiac monitoring revealed that tracheal aspiration provoked an idioventricular rhythm of 40 beats per minute, which reverted to sinus rhythm after the procedure. To prevent cardiac arrest during the transition from idioventricular to sinus rhythm, a demand pacemaker was inserted into the right ventricle. Set to activate if the rate fell below 65 beats per minute, the pacemaker functioned both during and between tracheal aspiration procedures. Cardiac monitoring in severe cases of Guillain-Barre syndrome may detect potentially lethal arrhythmias that may then be avoided by a demand pacemaker.

Child↗