Biomedical subjects
Publications and source records attributed to Z A Sayeed.
This communication considers a patient with episodic muscle spasms. Pharmacological intervention and electrophysiological studies provided adequate evidence confirming the diagnosis of stiff person syndrome. Electrophysiological studies in present communication similar to earlier reports, confirmed once again the autonomous state of the anterior horn cell in this disease process.
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OBJECTIVE: The efficacy of a short-course regimen in the treatment of brain tuberculoma and computerised tomography (CT) scan appearance before, during and after antituberculosis treatment was studied in a controlled clinical trial. DESIGN: Patients aged over 5 years with tuberculoma of the brain diagnosed by CT scan were randomly allocated to one of the following 2 regimens: Regimen 1: rifampicin, isoniazid and pyrazinamide daily for an initial 3 months followed by rifampicin and isoniazid twice-weekly for 6 months. Regimen 2: rifampicin, isoniazid and pyrazinamide thrice-weekly for an initial 3 months followed by rifampicin and isoniazid twice-weekly for 6 months. The patients were followed intensively for 2 years from the start of treatment. RESULTS: Of the 108 patients analysed (regimen 1: 56, regimen 2: 52), at the end of treatment clinical status was normal in 91% in regimen 1 and 88% in regimen 2. Of the 91 patients with scan assessments, CT scan lesions disappeared at 24 months in 77% of 47 patients in regimen 1 and 80% of 44 in regimen 2, and in both groups 88% of the patients were clinically normal. None had relapses requiring treatment. CONCLUSIONS: Short-course regimens of 9 months' duration are effective in the treatment of tuberculoma of the brain; clinical recovery was faster than scan clearance.
Thirty seven patients with Guillain Barre syndrome were studied. The most common electrophysiologic abnormalities were delayed or absent Median nerve F wave (93.3%), increase in posterior tibial nerve distal latency (91.9%) and delayed or absent posterior tibial nerve F waves (83.9%). Slowing of nerve conduction was associated with the F wave abnormality and distal latency prolongation in most cases. There was no definite relationship between the results of electrophysiological studies and the clinical grade. 15 patients were treated with steroids, 10 with plasmapheresis, 8 with both steroids and plasmapheresis and 3 with immunoglobulins. There was a greater degree of improvement in patients treated with plasmapheresis.
During 1983-7 a clinical diagnosis of subacute sclerosing panencephalitis (SSPE) was confirmed by the detection of measles virus haemagglutination inhibiting antibody in the cerebrospinal fluid (CSF) in 81 subjects resident in Tamilnadu. The antibody titre (reciprocol of the end-point dilution) in the CSF ranged from 2 to 32 and in the sera from 8 to 2048. The CSF:serum ratios of titres were 1:4-1:64 in 80 cases and 1:128 in one case. The median age at onset of SSPE was 10 years and 97% of cases were diagnosed at stage 2 and beyond. Based on the geographic distribution of 72 cases in an estimated population of 8.4 million, the annual incidence of SSPE was calculated to be 2.14 per million population, or 4.3 cases per million children below 20 years. Assuming that only 10% of all cases would have reached the level of laboratory diagnosis, the incidence may be as high as 21 cases per million population.
Five patients with neuroleptic malignant syndrome (NMS) are described. The syndrome developed earlier and took longer to resolve in patients with schizophrenic disorders. Deterioration in the level of consciousness presented earlier than rigidity and fever in all five patients and was thus considered a major criterion. A significant proportion of the patients showed abnormalities of gaze. In four of the five patients spontaneous recovery occurred without the need for specific drugs.
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Five patients with a moderate to severe degree of Sydenham's chorea were treated with sodium valproate for their involuntary movements. Within a week of commencement of treatment, the choreic movements disappeared completely. Sodium valproate appears to be a promising drug in the management of Sydenham's chorea.
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This communication reports biochemical findings in 7 patients with anterior horn cell disease. The diagnosis was confirmed by evidence of denervation in the EMG and mukle biopsy with normal motor conduction velocities. In 4 of these patients, upper extremities were involved in a symmetrical fashion. In 1, the upper and lower extremities were involved in a symmetrical fashion. In the other 2, one upper or lower extremity were respectively involved in isolation. Pyramidal tract signs were evident in 2 patients of this group. Seventh cranial nerve and 12th cranial nerve involvement were seen in 2 patients. None of the patients manifested 8th cranial nerve dysfunction. All of these 7 patients showed elevation of raised fasting plasma lactate, with normal plasma citrate and plasma pyruvate values. This is in contrast to the altered citrate and pyruvate levels described by other workers in other cases of anterior horn cell disease. The significant biochemical relationship are discussed.
Thirty-two patients with clinical evidence of anterior horn cell dysfunction are descirbed. This group of patients could be divided into those with bulbar dysfunction, and those without. Eighth cranial nerve involvement was seen in 10%. The commonest perpheral distribution seen was symmetrical involvement of all four extremities. During the period of follow-up (1 to 5 years) none of the patients without bulbar dysfunction initially developed such symptoms. In all these patients electromyographic evidence of anterior horn cell disease was confirmed. The motor nerve conduction velocities in all of these patients were normal. None of them showed signs of pyramidal tract involvement. Muscle biopsy showed evidence of group fibre atrophy in 10 cases, was normal in 3, and showed a myopathic pattern in 1. Sural nerve biopsy obtained in a single patient was considered histologically normal. Plasma citrate and plasma pyruvate levels obtained in 5 patients of this group, showed elevated values for plasma citrate with normal plasma pyruvate levels. Conspicuous absence of pyramidal signs, elevated plasma citrate, normal plasma pyruvate values and the extremely slow progression suggest that this group of patients are different from other varieties of anterior horn cell dysfunction previously described.
Mean motor conduction velocity of posterior tibial nerves was significantly reduced in epileptic patients treated with diphenylhydantoin formore than 10 years or in patients with serum diphenylhydantoin level above 20 mug/ml. Subnormal serum folate was not responsible for this reduction and clinical peripheral neuropathy was infrequent.
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