ACTH-induced seizures in an infant with West syndrome.

We report seizures induced by adrenocorticotropic hormone (ACTH), which were demonstrated clinically and electro-encephalographically, in a severely handicapped 7-month-old infant with West syndrome due to perinatal hypoxicischemic encephalopathy. Although tonic spasms (original seizures) decreased soon after starting ACTH treatment, new brief tonic seizures, somewhat more slowly motioned than the original tonic spasms, frequently appeared only during sleep after consecutive ACTH injections for 11 days, in place of the tonic spasms seen in the waking state. After discontinuation of ACTH therapy with the last injection on the 16th day, the brief tonic seizures began to decrease and finally disappeared in 8 days. Ictal EEG of new brief tonic seizures revealed diffuse fast spiky wave bursts, 50-150 microV and 10-20 c/s, with a duration of 0.5-4 seconds, which were different from attenuation associated with low voltage rhythmic fast activity corresponding to tonic spasms, the original seizures. Therefore, we considered that the new brief tonic seizures, which appeared only during sleep in the course of ACTH therapy, were ACTH-induced seizures.

[Ictal electroencephalographic recordings of patients with seizure].

We analyzed the ictal electroencephalographies (EEGs) in 75 seizures of 73 patients. Eighty percent of the patients were below the age of 20. The seizures consisted of 35 generalized seizures, 24 partial seizures and 16 pseudoseizures. The ictal EEG of true seizures showed changes with a spike in 23 cases, and change without spike (eg. rhythmic activity, desynchronization) in 32 cases. Four ictal records could not be evaluated due to artifacts. Because half of the patients with pseudoseizures also had epilepsy, their ictal EEG examinations were very useful. The ictal EEG examination could be performed successfully on 96% of the patients with a seizure frequency of more than six a day, 52% of them with one to five seizures a day and eleven percent of them with less than one seizure a day. Seventy-five percent of ictal EEG recordings were performed when the patient was awake. The cassette of electrodes, originally made in our department, was very useful in recording the ictal EEG of children when they were awake.

[Methods of sleep induction for EEG recordings: comparison between three hypnotics and natural sleep].

We compared the effects of three oral hypnotics, monosodium trichloroethyl phosphate (MTP), chloral hydrate (CH), and pentobarbital calcium (PTB), to those of non-medication on wake-sleep states and sleep activation of epileptic seizure discharges. The subjects consisted of 410 epileptics and 171 non-epileptic outpatients (mean age: 12.5 years) of the Department of Pediatrics, Nagoya City University Hospital. Complete EEG records including awake and sleep states were obtained in 230/241 (95%) of patients with MTP, 20/22 (91%) of those with CH, 72/85 (85%) of those with PTB, and 225/233 (97%) of those without any hypnotics. There were no statistically significant differences in the effect of sleep induction among the four groups. Sleep activation effects were observed in 25% of patients with natural sleep and 35% of those with induced sleep. There was no statistical difference (p > 0.05). These results suggested MTP, CH, and PTB are useful hypnotics for sleep EEG recordings.

[Public music concerts in a psychiatric hospital: effects on public opinion and as therapy for patients].

We investigate the effects of music therapy concerts, which were held 60 times over a four year period, 1992 to 1996, in Geiyo Psychiatric Hospital, Kochi Prefecture and found that; 1) Musicians who performed at the concerts were not only from Kochi prefecture but also from other prefectures (10 times) and from four foreign countries (7 times). 2) Live concerts in a small hall had a positive influence on patients and drew the patient's attention and interest away from their hallucinations and delusions to the real world. Moreover, the concerts provided the patients with chances to acquire social graces such as being well-groomed. 3) Explanations by the musicians, interviews with the musicians and the seasonal choruses accompanied by the musicians were helpful to give the patients motives for recovering communication skills and to interact with society. 4) Inquiries to the patients about the concerts indicated discrepancies between the poor observed estimations during the concerts (83.3%) and the good subjective impressions expressed by the patients (82.0%), suggesting that the patients were not good at expressing their internal emotions through facial expressions or attitudes. 5) Many citizens including children came to the concerts and/or gave aid to the hospital because the concerts were open to the public and we suggest that this contributed to improving the general publics' image of psychiatric hospitals. Questionnaires revealed that 90% of people in a control group had a bad image of psychiatric hospitals in Japan, but only 32% of the members of the general public who attended our concerts had a bad image of psychiatric hospitals. In addition, the revolving ratio of the hospital beds rose from 0.4 to 1.2 over the four years, which also suggests a beneficial effect on the patients.

[Changes in serum levels of alkaline phosphatase, calcium, and inorganic phosphate following antiepileptic therapy (author's transl)].

Relationship of antiepileptics to serum alkaline phosphatase (ALP), serum calcium (Ca) and inorganic phosphate (P) were studied in 172 epileptic patients treated with antiepileptics for clarifying the related factors to produce osteomalacia following antiepileptics administration. Laboratory findings of ALP, Ca, and P were compared with normal value and determined as abnormal by exceeding the normal limit (mean +2SD (ALP), mean-2SD (Ca, P)). The following results were obtained: 1) In the 172 patients, 20 cases (11.6%) showed abnormal value of ALP, 12 cases (7.0%) of Ca and 41 cases (23.8%) of P (Single abnormal groups). On the other hand, 47 cases (27.3%) were found abnormal in two or three of ALP, Ca and P (Combined abnormal group). The rest 52 cases (30.2%) of the patients showed all normal value (Normal group). 2) Abnormal value of ALP and/or Ca were observed mostly before 20 years of age. The patients with abnormal P were more distributed in age than others. 3) The earlier and/or the longer administration of antiepileptics is prone to produce the more abnormal value. 4) Acetazolamide, metharbital, primidone, carbamazepine and mephobarbital were more used in combined group than in normal group, and polypharmaceutical use of these antiepileptics was supposed to be related to the abnormality of ALP, Ca and P. There was no different use of diphenyl-hydantoin and phenobarbital in frequency and amount between combined group and normal group. 5) Mental retardation and epileptic personality changes were observed more frequently in combined abnormal group than in normal group. 6) No significant relations were observed between clinical seizure types, seizure frequencies and abnormal laboratory findings.

Expectancy-related cerebral potentials associated with voluntary time estimation and omitted stimulus.

Expectancy-related and nonexpectancy-related cerebral potentials associated with stimuli and omitted stimuli were recorded in 7 normal subjects. The stimuli were constantly delivered to the right median nerve and the interstimulus interval was set at 7 seconds. When the subject counted to estimate the interstimulus interval correctly, a slow negative deflection appeared about one second prior to both the stimuli and the omitted stimuli. In the case of the omitted stimulus, this expectancy-related negative potential (ENP) returned to the base line after several hundred msec. When the stimuli were delivered, the amplitude of the P300 was much higher when the subject was paying attention to the stimuli than when he was not. The scalp distribution of the ENP was rather anterior to the P300. No ENP appeared when the subject was not paying attention to the stimuli or the omitted stimuli, or when the stimuli were delivered at a random rate.

Movement-related cerebral potentials in schizophrenics.

Measures concerning the P2 component of movement-related cerebral potentials (MPs) (the time from the trigger produced by key-tapping to the onset of P2: T-N latency, the width of P2: N-P interval, and the amplitude of P2: N-P amplitude) and various clinical factors of 36 schizophrenics were studied and statistically compared with those of 35 normal subjects. Concerning the P2 component, 22/36 of the schizophrenics showed abnormal findings. These three measures, especially the N-P interval, are significantly related to various clinical symptoms at the stage when the MPs were recorded but are not related to the previous worst stage. The chronicity of schizophrenic illness influenced each measure of the T-N latency and N-P interval, both of which were significantly longer than those of the normal subjects. The pressure strength, the velocity of key-tapping, the duration of muscular contraction, (namely the manner of key-tapping) and the daily dosage of neuroleptics did not affect the P2 component. These results suggest that 1) the P2 component of MPs is related to certain brain functions as a signal of information processing concerning action and not to the peripheral feed-back mechanism and 2) abnormal waveforms of the MPs found in pathological psychiatric conditions of schizophrenia may be a reflection of disturbances of the central mechanism concerning action, attention and volition.

Kinetics of growth and elemental sulfur oxidation in batch culture of thiobacillus ferrooxidans.

The kinetics of oxidation of elemental sulfur by Thiobacillus ferrooxidans in a batch reactor was followed by measuring the concentration of adsorbed cells on the sulfur surface, the concentration of free cells in liquid medium, and the amount of sulfur oxidized. As the elemental sulfur was oxidized to sulfate, the liquid-phase concentration of free cells continued to increase with time, whereas the surface concentration of adsorbed cells per unit weight of sulfur approached a limiting value, i.e., the maximum adsorption capacity. During sulfur oxidation, there was a close correlation between the concentrations of adsorbed and free cells, and these data were well correlated with the Langmuir isotherm. The observed rates of batch growth and sulfur oxidation were consistent with a kinetic model, assuming that the growth rate of batch growth and sulfur oxidation were consistent with a kinetic model. Assuming that the growth rate of adsorbed bacteria is proportional to the product of the concentration of adsorbed cells and the fraction of adsorption sites unoccupied by cells. The kinetic and stoichiometric parameters appearing in the model were evaluated using the experimental data and were compared with parameters determined previously for a few metal sulfides.

Anterior-posterior relationships of EEG in photosensitive subjects: coherence and cross-phase-spectral analysis.

Coherence and cross-phase-spectral analysis of EEG were applied to photo-sensitive subjects to investigate the mechanism of the generalization of photo-induced paroxysms. Coherence values were high between frontal (F) and central (C) in resting records and between F-C in EEGs revealing harmonic responses, where the coherence values of F-O (occipital) were also high, and the waves of F preceded those of O. In cases of occipital-localized 3/6 Hz (poly) spike-waves, discharges of O preceded those of F. During the stage of generalized paroxysms, discharges were highly cohered between all electrodes. Discharges of F preceded those of O, and appeared to play as a generator. Two conditions with clinical symptoms had higher frequencies (greater than or equal to 12 Hz) and shorter time lags (less than or equal to 5 msec) than conditions without symptoms.

Three cases of chronic bromisoval intoxication: clinical symptoms and application of energy dispersive X-ray analysis (EDX) to detect bromine in serum, urine and cerebrospinal fluid.

Bromisoval has been used as a hypnotic for the past several decades, and its abuse was known to cause various neurological as well as psychiatric symptoms. Three patients showed a variety of symptoms which could not be explained neuroanatomically: nystagmus, gait disturbance and hyperreflexia of the limbs in all the cases, dysarthria, double vision, hypotonia, ataxic gait and disturbance of consciousness occasionally and auditory agnosia in one case. For the purpose of determining the diagnosis, an energy dispersive X-ray microanalysis (EDX) was used to detect bromine. Five microliters of specimens were placed on the carbon-coated mesh, and using a TN-2000 analyzer, characteristic X-ray peaks of bromine were detected in the serum, urine and cerebrospinal fluid. The sensitivity to detect bromine in the serum was 30 micrograms/ml.