[Infectious meningitis in the adult: 3-year clinical experience]. / Meningitis infecciosas del adulto: experiencia clínica de tres años.

In order to establish the epidemiologic features of infectious meningitis in the adult population in our environment, the experience of the Department of Neurology of the Hospital del Rey during the 3-year period, from 1984 to 1986, has been analyzed. Three-hundred-ninety episodes were handled, of which, 51% were acute bacterial meningitis, 45% were acute lymphocytic meningitis, 26% were tuberculous meningitis, 1% were brucellar meningitis and 0.5% were due to Candida albicans. Acute bacterial meningitis predominated in winter, whereas acute lymphocytic meningitis predominated in summer (p less than 0.001). Forty-seven percent of acute bacterial meningitis were due to Neisseria meningitidis and 14.5% of acute lymphocytic meningitis with virologic study, were due to Herpesviridae. The mortality rate of acute bacterial meningitis was 8.5% and that of tuberculous meningitis was 10%. In order to emphasize the importance of these processes, the main epidemiologic data are compared with that of other studies.

Rapid gas-chromatographic microdetermination of soluphylline in serum.

A nitrogen-specific gas-chromatographic method is described for the quantitative analysis of soluphylline without the need for derivatization or evaporation of solvent, and using only 50 microliters of serum. The analysis is performed isothermally on a silicone stationary phase, 2% SP 2250 DA (Supelco). After a single neutral extraction with ethyl acetate containing the internal standard (beta-hydroxypropyl theophylline), an aliquot of the organic solvent is injected directly into the gas chromatograph. The detector sensitivity (least measurable amount) for soluphylline was 1 ng.

Can a single measurement of carbamazepine suffice for therapeutic monitoring?

Using fluorescence polarization immunoassay, we measured the peak and trough concentrations of total and free carbamazepine in serum and saliva from 33 epileptic children. We found that, except for patients who show side effects, measurement of trough values in a single sample, collected after an overnight fast and before the morning dose, sufficiently estimates clinical response. Moreover, total carbamazepine is as informative as free carbamazepine.

[Epileptic vomiting]. / Le vomissement épileptique.

A 17 year-old girl was suffering complex partial seizures, secondary generalized epilepsy and seizures manifested only by vomiting. The neurological, laboratory, radiological studies and the brain CT were normal. The EEG recording of an ictal vomiting showed bisynchronous spike-and-wave and sharp slow-wave discharges. An interictal paroxysmal focus of the right temporo-occipital region appeared at the EEG and a marked photoconvulsant effect was induced by light stimulation. The patient remained seizure-free for the last 4 years on carbamazepine therapy. The authors suggest the vomiting fits originate from the epileptic discharges on the Ammon's horn. The depths of the temporal lobe appear clearly involved in this type of seizures and the rolandic and pre-rolandic neighboring areas are attended too.

Primary reading epilepsy.

In six cases of reflex epilepsy, the seizures were triggered by reading or elaborating a verbal utterance, and were accompanied on EEG by focal or generalized epileptiform activity. The seizures were controlled with clonazepam in four cases and by sodium valproate in two cases. We speculate that the disturbance has a cortical origin and is triggered by neural processes involved in the elaboration of language.

Startle epilepsy: a clinical study.

Twelve patients with perinatal anoxic encephalopathy, 1 with encephalitis, and 1 with Down's syndrome had startle epilepsy. Hemiparesis, startle-induced seizures involving the hemiparetic side, focal electroencephalographic abnormalities, and unilateral lesions evident on computed tomographic scan were found in 6 patients, all of whom responded favorably to carbamazepine. The remaining 8 patients had severe intellectual impairment, bilateral motor deficits, generalized startle-induced seizures, diffuse and lasting electroencephalographic abnormalities, and widespread cerebral lesions evident on computed tomographic scan. Of these, 2 patients with Lennox-Gastaut syndrome responded to clonazepam, 4 others responded to valproic acid, and 2 others, with predominantly focal hemispheric lesions, improved on a regimen of carbamazepine.

[Occipital spike-wave with and without benign epilepsy in the child]. / La pointe-onde occipitale avec et sans épilepsie bénigne chez l'enfant.

We describe 31 children with runs of high amplitude and variable frequency spike-and-wave discharges on the occipito-postero-temporal regions at the EEG. This characteristic EEG pattern can be seen on the posterior areas of one or both hemispheres only when the eyes are closed. A functional spike-wave focus of temporo-rolandic localization also occurred in 13 cases. Clinically, 10 children were seizure-free with minimal brain dysfunction in 8 of them. Of these, only 4 patients suffered from febrile convulsions while the 17 other patients were undergoing treatment for visual, motor or vegetative partial seizures, and even generalized fits. The prognosis of this essentially functional childhood epilepsy was good under phenobarbital therapy in almost all of our cases. This benign occipital epilepsy is related to childhood epilepsy with rolandic paroxysms.

EEG subclinical paroxysmal rhythmic activity.

We studied 33 non-epileptic adults presenting with subclinical paroxysmal rhythmic activity (SPRA) on EEG examination. Sixteen patients showed the psychomotor-variant pattern described by GIBBS et al. in 1963. Seventeen patients presented a Naquet-type pattern (Naquet et al., 1961). Regardless of SPRA type, patients had similar non-specific neuropsychiatric symptoms. Only 3 patients were diagnosed as having a neurological disorder, this being dementia. Mode of onset, appearance and location of SPRA, amplitude, duration and response to sensory stimuli were identical in all patients studied. Several patients with Naquet-type discharges presented Gibbs' patterns as well. Gibbs' pattern is analogous to the longer lasting, intermediate phase of Naquet-type SPRA. We believe that both these types of SPRA may manifest a common electro-encephalographic phenomenon, and are not necessarily related to cerebral circulatory insufficiency.

Hyperekplexia: a syndrome of pathological startle responses.

We describe a family and three sporadic cases of startle disease, or hyperekplexia. Sudden unexpected noises caused the patients to fall rigidly, often injuring themselves but retaining consciousness. This unusual entity differs from startle epilepsy and cataplexy. Clonazepam proved ineffective in three patients. Valproic acid, 5-hydroxytryptophan, or piracetam markedly reduced the abnormal startle in three patients.

Familial photosensitive epilepsy: effectiveness of clonazepam.

We describe the clinical features of a family with photosensitive epilepsy, followed for 13 years. Generalized paroxysmal discharges induced by photic stimulation appeared in all 9 siblings. Generalized seizures, myoclonic jerks, and absences appeared in variable combination in 7 of them who on clonazepam remained free from seizures for a seven-year follow-up period. On EEG the paroxysmal abnormalities induced by photic stimulation abated during clonazepam medication.

Nocardia asteroides primary cerebral abscess and secondary meningitis.

A rare case of primary cerebral abscess due to Nocardia asteroides, and its surgical removal, are described. Postoperative meningitis caused by the same fungi was succesfully cured with sulphadiazine and cycloserine. The nocardial disease, its neurological complications, and therapy are reviewed.