Status cataplecticus misdiagnosed as recurrent syncope.

A 76-year-old patient, since the age of 45, presented with frequent attacks often triggered by emotional stimuli and characterised by forward head drop and a fall to the ground without loss of consciousness. Clinically these episodes were misinterpreted as pseudoseizures and treated with clomipramine for more than 20 years. In spite of this chronic therapy, during the last year, the attacks presented with a daily recurrence and, moreover, after arbitrary clomipramine withdrawal, they increased in frequency until they became subcontinuous. Videopolygraphic analysis, multiple sleep latency test (MSLT) and human leukocyte antigen (HLA) association studies were suggestive of narcolepsy and the recurrent episodes, diagnosed as status cataplecticus, recovered after citalopram administration.

Epilepsy associated with hypocalcemia: description of a family.

The unusual occurrence of epilepsy and hypocalcemia in the same family is described. Epilepsy was present in three siblings (convulsive generalized in two females and partial in one male). All six family members had calcium ion, plasmatic phosphorus, plasmatic and erythrocytic potassium, urine calcium and phosphate concentration below the normal levels. Altered values of calcium-induced potassium membrane permeability were found in three subjects (two of them also affected by epilepsy). The assumption that alterations of membrane structure or function play an essential role in determining familial epilepsy and that the normal "set point" for calcium is genetically determined in familial hypocalcemia could explain the concomitance of both pathologies to some extent.

Complex partial status epilepticus simulating an ischemic insult: case report.

A patient presenting complex partial status epilepticus (CPSE) had a clinical history and neurological picture on admission that mimicked a cerebrovascular insult. On admission she was confused and totally unresponsive to verbal stimuli. EEG showed high voltage paroxysmal activity on the left hemisphere, prominent on the temporoccipital leads and tending to spread to the opposite regions. Intravenous diazepam led to resolution of the clinical and EEG picture within 24 hours, only a medium voltage slow wave focus being present on the left temporal regions. CPSE should be considered whenever a prolonged impairment of consciousness is present. Only accurate EEG recordings permit correct diagnosis in doubtful cases.

Synergistic anticonvulsant effect of valproic acid and ethosuximide on pentylenetetrazole-induced epileptic phenomena in rats.

The possible synergistic effect of valproic acid and ethosuximide in combination on pentylenetetrazole-induced epilepsy was investigated in rats. Valproic acid and ethosuximide administered intraperitoneally both showed dose-dependent anti-epileptic activity towards pentylenetetrazole-induced myoclonias and tonic-clonic seizures. The valproic acid-ethosuximide combination had a synergistic pharmacological effect. Against myoclonias combined valproic acid-ethosuximide produced a non-significant decrease in the effective dose of both drugs compared with treatment with either drug alone. In the case of tonic-clonic seizures the protective effect against the seizures was significantly increased by combined treatment compared with treatment with either drug alone. Neither plasma concentrations nor any other pharmacokinetic parameters were significantly changed when the same doses of valproic acid and ethosuximide were given, singly or in combination.

Tuberculous meningitis: a retrospective survey of 22 cases.

Clinical and biological findings likely to constitute prognostic factors were analyzed in a retrospective survey of 22 cases of tuberculous meningitis. In particular, associations between clinical and biological findings (clinical grade on admission, normal and abnormal CSF protein and glucose values) and outcome of illness were sought. On admission 16 patients had altered consciousness, 11 hemiparesis and 7 sixth cranial nerve paresis. Meningeal signs were present in all subjects. 7 had a positive culture for Mycobacterium tuberculosis. 9 patients recovered completely, 7 had serious late sequelae, 6 died. Prognosis appeared to be correlated to neurological status at admission.

Amyotrophic lateral sclerosis: an epidemiological study in the Province of Messina, Italy, 1976-1985.

An epidemiological investigation of 41 subjects with amyotrophic lateral sclerosis observed in the Province of Messina during 1976-1985 was performed. The incidence was 0.61/100,000 and the prevalence 2.48/100,000 inhabitants. The illness was found to be prevalent in males. The atrophic type occurred in 17 subjects, the bulbar type in 23 cases and the pseudo-polyneuritic form in only one patient. The mean age on the onset was 57.29 +/- 10.55 years. The duration of the illness was significantly higher in patients with atrophic type (p less than 0.01). No significant difference between occupation and development of the disease was found. Among all patients 12.19% presented evidence of trauma, but traumatic events were equally present in a control group.

Pentylenetetrazol-induced spike wave discharges in rats: a polygraphic study.

14 male Wistar rats were studied, before and after pentylenetetrazol (PTZ) 20 mg/kg i.p., since a petit mal-like electroclinical pattern, either spontaneous or PTZ-induced was recently described in a breeding station where this strain is raised. In particular, surface EEG, muscular, respiratory and cardiac activities were recorded in order to detect possible clinical-electroencephalographic correlations. Spontaneous epileptic phenomena were never observed. In all the animals PTZ-induced short, usually generalized and synchronous spike wave discharges often concomitant with rhythmic twitches of the vibrissae. Epileptic bursts were related to arousal level, disappearing during motor behavior and arousing stimuli. Moreover individual discharges could be interrupted by a sudden noise. Photosensitivity was not present. Muscular tone and autonomic functions were not affected. The features of PTZ-induced generalized nonconvulsive seizures in rats are compared to those of cat penicillin epilepsy and human petit mal.

Interictal EEG pattern in rabbit penicillin epilepsy.

The effects of Na-penicillin G (1,000,000 I.U./kg i.v.) were studied in 28 rabbits implanted with surface and deep electrodes in the medial (mT) and lateral (lT) nuclei of the thalamus and in the cornu Ammonis dorsalis (CAd). Attention was focused on interictal spike activity, cortical spindle activity and spikes-spindles relationship. A multifocal interictal EEG pattern, represented by cortical and thalamic spikes, was observed in 20 animals. A clear association between cortical spikes and spindles occurred almost constantly. Moreover a statistically significant increase in the average duration of spindles without changes in the average frequency was noticed. Seizure discharges had always a focal start and secondary generalization. The EEG features of parenteral penicillin epilepsy in the rabbit appeared to be more similar to those of the rat than to those of the cat. The spindle activity changes and the paroxysmal spike activity can be interpreted as two independent penicillin induced features appearing during raised cortical excitability periods.

The effects of penicillin on the ECoG of rabbit.

The effects of non-convulsive doses of i.v. penicillin (1.100.000/1.300.000 I.U./Kg) on the ECoG of rabbits was studied. A tendency to an increase in spindling activity together with the presence of characteristic penicillin spikes, polyspikes and spike and wave complexes often preceding or intermixed to the spindling activity, was the most prominent finding. These data indicate that spindles and penicillin induced spikes show a straight correlation and seem consistent with the hypothesis that spindles have a facilitant effect on epileptic discharges.

Antidyskinetic properties of estrogens.

There is mounting evidence that several gonadal hormones may influence central nervous system. In particular, it has been found that estrogens display an antidopaminergic activity at the level of the extrapyramidal motor system. In this line we have investigated behavioral and biochemical parameters related to nigrostriatal DAergic function. Results obtained further indicate that estrogens display an antidopaminergic activity, by acting on nigrostriatal postsynaptic DAergic receptors. These results may suggest an antidyskinetic activity of estrogens.

[Influence of anti-epileptic drugs on blood lipid parameters: preliminary data]. / Influenza dei farmaci antiepilettici su alcuni parametri lipemici: dati preliminari.

Total cholesterol, free cholesterol, HDL cholesterol, LDL cholesterol and triglycerides have been assayed in serum of 42 epileptic patients in chronic therapy (21 in monotherapy and 21 in polytherapy) in comparison with 21 normal controls. Free cholesterol showed an highly significant increase in epileptics, in whom triglycerides appeared very reduced. In contrast to previous reports of a large increase of HDL cholesterol in phenitoin treated patients, only a not significant increase was found. The other parameters appeared unchanged. No differencies could be detected among monotherapy and polytherapy or among the singles monotherapies (phenobarbital, diphenylhydantoin and carbamazepine).