Charles Dickens and epilepsy.

Through some characters in his novels, Charles Dickens recorded observations on the nature of epileptic seizures, their causes and provocation, and their consequences. Three of his main characters, Monks, Guster, and Bradley Headstone, had seizures which Dickens realistically described.

Charles Dickens: observer of sleep and its disorders.

Using the characters of his novels as the canvas, Charles Dickens painted vivid word pictures of a variety of manifestations of sleep and its disorders. These were presumably based on the author's own experiences and those of family and friends. Dickens was, himself, a self-confessed episodic insomniac. For this he devised the unique therapy of long night walks. This article illustrates, by a few selected quotations, this hitherto unpublicized aspect of the author's life and works.

Motor neuron disease in blacks. Epidemiological observations in Natal.

A series of 86 black, Indian and white patients with motor neuron disease were analysed retrospectively. Although the material does not allow statistically valid conclusions, there are sufficient cases among blacks to allow two prima facie observations in this population group: (i) motor neuron disease has an earlier age of onset than in whites and Indians; and (ii) more patients come from peripheral and rural areas than would be expected in prevailing circumstances.

Parkinson's disease in blacks. Observations on epidemiology in Natal.

Black patients with idiopathic Parkinson's disease (PD) present for neurological consultation much less frequently than white or Indian patients. That this is due to true rarity of PD among blacks is suggested by the observation that blacks with motor neuron disease and secondary parkinsonism are treated in numbers comparable with whites and Indians. These conclusions are derived from a series of 2,638 inpatient neurological consultations and from data on levodopa usage in three major hospitals in Durban. Lower life expectancy and failure of old people to attend hospital may be factors in the apparent low prevalence of PD among blacks, but other undetermined factors must play a part.

Seventy black epileptics. Cysticercosis, computed tomography and electro-encephalography.

Computed tomography (CT) in a group of 70 black patients with epilepsy showed cerebral cysticercosis in 30%, with signs of activity in 12.9%. The possibility of effective treatment in active cysticercosis makes CT an important investigation of epilepsy in this population. Electro-encephalography is of some practical value in patients in whom CT is negative.

Ulcerative colitis and interstitial myositis.

Amongst the protean extra-intestinal manifestations of inflammatory bowel disease, scant mention is made of muscle involvement. This report outlines the clinical features, electrodiagnostic and muscle biopsy findings in a patient with ulcerative colitis who developed progressive proximal muscle weakness. The demonstration of interstitial myositis is discussed in relation to his underlying disease.

Schistosomiasis (Bilharzia) of the spinal cord: case reports and clinical profile.

Eight cases of schistosomiasis of the spinal cord are described. These fall into two groups. Four patients had clinical and myelographic evidence of lesions in the conus medullaris and were found to have bilharzial granulomas at operation. Four patients had normal or equivocal myelographic appearances, but the coincidence of unexplained lower cord or cauda equina lesions with evidence of bilharzia led to the presumed diagnosis of spinal cord bilharzia. These patients, together with data from 39 cases reported in the world literature since 1969, have been used to compile a clinical profile of this condition. The clinical picture is the product of two types of reaction to bilharzial infestation, granuloma and necrotic myelitis, affecting the lower cord and cauda equina in varying proportions. Granuloma is the better defined entity because it is diagnosed following operation and biopsy. Myelitis is seldom proved and its diagnosis depends on circumstantial evidence. Both S. mansoni and S. haematobium may be responsible for either type.

Brainstem encephalitis or the Miller Fisher syndrome--a variant of acute idiopathic polyneuropathy. Case reports.

A syndrome comprising ophthalmoplegia, ataxia and areflexia was described by Miller Fisher in 1956. While some consider it to be a benign variety of acute idiopathic (Guillain-Barré) polyneuropathy, there are reports of the need for ventilatory support and of the benefits of plasmapheresis. Two further cases are described. The first patient was seen in 1972 and was well 10 years later. The second patient gave cause for concern and might have benefitted from plasmapheresis, but nevertheless he recovered spontaneously. Miller Fisher believed that the pathological process was located in the peripheral nerve, but others have produced evidence that the cranial nerve nuclei and central connections within the brainstem are involved.

Unexplained spastic paraplegia.

Of 330 Black patients admitted to hospital with paraplegia, the causes in 33 remained unexplained after investigation. These patients had features of predominant corticospinal tract degeneration with lesser degrees of sensory loss. This series of patients is similar to some reported previously from South Africa and from other tropical countries. Among several possible causes the most likely is a toxic dietary factor.