Differential cognitive and behavioral effects of carbamazepine and lamotrigine.

BACKGROUND: The relative cognitive and behavioral effects of lamotrigine compared with the older standard antiepileptic drugs (AED) are uncertain. OBJECTIVE: To directly compare the cognitive and behavioral effects of carbamazepine and lamotrigine. METHODS: The cognitive and behavioral effects of carbamazepine and lamotrigine were assessed in 25 healthy adults using a double-blind, randomized crossover design with two 10-week treatment periods. During each treatment condition, subjects received either lamotrigine (150 mg/day) or carbamazepine (mean 696 mg/day) adjusted to a dose to achieve midrange standard therapeutic blood levels (mean 7.6 microg/mL). Subjects were tested at the end of each AED treatment period and in three drug-free conditions (two pretreatment baselines and a final posttreatment period [1 month after last AED]). The neuropsychological test battery included 19 measures yielding 40 total variables. RESULTS: Direct comparison of the two AED revealed significantly better performance on 19 (48%) variables for lamotrigine but none for carbamazepine. Differences spanned both objective cognitive and subjective behavioral measures, including cognitive speed, memory, graphomotor coding, neurotoxic symptoms, mood factors, sedation, perception of cognitive performance, and other quality-of-life perceptions. Comparison of carbamazepine with the nondrug average revealed significantly better performance for nondrug average on 24 (62%) variables but none for carbamazepine. Comparison of lamotrigine with nondrug average revealed better performance on one (2.5%) variable for nondrug average and on one (2.5%) variable for lamotrigine. CONCLUSION: Lamotrigine produces significantly fewer untoward cognitive and behavioral effects than carbamazepine at the dosages used in this study.

Cognitive deficits in epilepsy and contribution to psychopathology.

Although most patients with epilepsy lead normal lives with few or no cognitive or psychiatric alterations, a substantial minority of epilepsy patients experience neurobehavioral problems that can significantly disrupt employment, school, family life, and other aspects of daily living. This article provides a comprehensive review of neurobehavioral changes seen in patients with epilepsy, including cognitive dysfunction and psychiatric disturbances. The cognitive problems most commonly found are deficits in attention, concentration, memory, and word finding. Psychopathology in epilepsy may be manifested as depression, anxiety, psychoses, and/or aberrant personality traits. Risk factors for cognitive and psychiatric changes, etiology of cognitive deficits, localizing patterns, cognitive effects of antiepileptic drugs, and treatment suggestions are also presented.

Psychological predictors of glycemic change with relaxation training in non-insulin-dependent diabetes mellitus.

BACKGROUND: Previous findings are unclear regarding the possible glycemic benefits of applying behavioral relaxation training in non-insulin-dependent diabetes mellitus (NIDDM). METHODS: Subjects with NIDDM were randomized to relaxation training (6 sessions of progressive muscle relaxation and imagery, n = 12) or control treatment (routine medical care, n = 10). Physiological measures were total glycosylated hemoglobin (GHb) and area under the 2-hour oral-glucose-tolerance curve (AUC). Psychological measures of generalized distress, anxiety and daily stress were also administered. All subjects were assessed before and after the 8-week intervention, and again at 16 weeks of long-term follow-up. RESULTS: There were no postintervention group differences in physiological variables. Highly distressed subjects and those who rated their glucose as more stress responsive tended to practice relaxation less between sessions. Within the treated group only, lower preintervention stress responsivity was associated with greater improvement in GHb, and lower anxiety and distress levels predicted long-term improvement in AUC. CONCLUSIONS: It remains unclear whether relaxation training produces glycemic benefits in NIDDM. Perhaps the least anxious and stress-responsive patients only benefit from group-based relaxation training, whereas anxious individuals require intensive individually administered interventions.

Charles Bonnet syndrome: an early marker for dementia?

OBJECTIVE: To clarify the neuropsychological function in patients with Charles Bonnet Syndrome. DESIGN: Control group comparison study. SETTING: University of Chicago Hospitals. PARTICIPANTS: The neuropsychological function of 15 older adults with presenting complaints of visual hallucinations who met criteria for Charles Bonnet Syndrome (CBS) were compared with 11 demographically matched controls to determine if there was any evidence of functional brain impairment. CBS patients were screened for focal brain lesions and epileptic disturbance via MRI and EEG and also received pattern visual evoked potentials and ophthalmological examinations. MEASUREMENTS: Scores from the Wechsler Adult Intelligence Scale-Revised, Mattis Dementia Rating Scale, Wechsler Memory Scale, and the Auditory Verbal Learning Test were compared. RESULTS: Significant differences were found between the two groups on the neuropsychological measures. Moreover, 14 of 14 subjects had ocular abnormalities and six of eight had abnormal age-corrected pattern visual evoked potentials indicative of dysfunction in the visual system. CONCLUSIONS: The results of the study indicate that patients diagnosed with Charles Bonnet Syndrome evidence neuropsychological changes commonly associated with the early stages of dementia. Therefore, in patients with impaired vision, the appearance of cognitive deficits, albeit subtle, occur with the onset of visual hallucinations. We propose that isolated visual hallucinations in the older adult may be an indication of the early stages of dementia.

[Arthroscopy in trauma related anterior dislocation of the shoulder]. / Artroskopia w urazowym przednim zwichnieciu stawu ramiennego.

Arthroscopy allows for noninvasive management for certain lesions resulting from traumatic anterior dislocation of the shoulder. Primary reconstruction of the labrum and ligamentous complex prevents recurrence of the dislocation. Encouraging results after arthroscopic procedures make them an attractive alternative for traditional conservative management.

[Arthroscopy of the elbow joint]. / Artroskopia stawu lokciowego.

A series of 31 patients who had elbow arthroscopy has been reviewed. Good results have been achieved after removal of loose bodies or post-traumatic hematoma. A danger of injury to periarticular structures due to the use of arthroscopic instruments, especially with pathologically decreased joint volume has been pointed out.

[Treatment of traumatic spondylolisthesis of the axis]. / Leczenie urazowego kregozmyku obrotnika.

Classification of hangman's fracture according to Levine has been presented. The classification enables individualization of the management depending on the mechanism of the injury. A series of 37 patients with traumatic spondylolisthesis of the axis has been analyzed. Skull traction in flexion injury cases led to the increased dislocation.

[Fracture of the dens--conservative or surgical treatment?]. / Zlamania zeba obrotnika--leczenie zachowawcze czy operacyjne?

An analysis of 28 cases of dens fracture has shown that conservative treatment is generally sufficient in Anderson type I and type III fractures. In type II fractures surgical treatment is indicated, especially if the fracture is dislocated, complicated by neurological impairment or has occurred in the elderly.