Association of dietary factors and selected plasma variables with sex hormone-binding globulin in rural Chinese women.

Sex hormone-binding globulin (SHBG) is an important regulator of plasma sex steroids as well as a sensitive indicator of insulin resistance. SHBG may be an important diagnostic measure of risk for pathologies associated with insulin resistance syndrome (IRS) such as non-insulin-dependent diabetes mellitus (NIDDM), obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. In women, SHBG is also implicated in diverse pathologies such as cancers of steroid-sensitive tissues and hirsutism. Data from an ongoing ecological study linking diet and health in rural China were analyzed to determine the relation of selected plasma variables and diet to plasma concentrations of SHBG. All data represent county mean values, pooled by age and sex, to assess the relation between biochemical and lifestyle characteristics and disease-specific mortality rates at the county level. The study sample consisted of 3250 Chinese women between the ages of 35 and 64 y living in 65 widely dispersed rural counties. Consumption patterns for 21 different food groups were derived from a food-frequency questionnaire and a 3-d dietary survey and subsequently compared. Correlation analyses of county mean values demonstrated a significant association between SHBG and insulin, testosterone, triacylglycerols, body mass index, age at menarche, and several foods. In regression analyses, after adjustments, the strongest predictors of SHBG concentrations were the dietary intake of rice (beta = 0.42, P < 0.01), fish (beta = 0.34, P < 0.05), millet (beta = -0.27, P < 0.01), and wheat (beta = -0.34, P < 0.01). When insulin, testosterone, and triacylglycerols were added to the model only triacylglycerols (beta = -0.26, P < 0.05) remained a significant independent predictor of SHBG. Additional analyses suggested that the consumption of green vegetables was modestly positively correlated with SHBG and negatively with insulin values. Consumption of rice and fish in particular appeared to favorably influence the principle plasma variables associated with a reduction in the risk for IRS pathologies.

Magnetic resonance imaging, electroencephalogram, and selected neuropsychological testing in staged corpus callosotomy.

A 21-year-old man with medically intractable secondarily generalized atonic seizures underwent a corpus callosotomy on Nov 5, 1981. Though improved, the falling seizures persisted. In January 1984, magnetic resonance imaging (MRI) documented that the anterior quarter of the corpus callosum remained intact. In March, the patient underwent a completion of the callosotomy, at which time the MRI findings were corroborated. Since the second surgery, a further improvement in seizure control has been observed. Use of MRI can document both noninvasively and in vivo the extent of corpus callosotomy. The implications of selected neurophysiologic and neuropsychological findings are also discussed.

Ictal characteristics of pseudoseizures.

The spontaneous pseudoseizures resembling tonic-clonic seizures in 25 patients were recorded on simultaneous videotape and electroencephalograms and were compared with the seizures recorded from 25 patients with true tonic-clonic epileptic events. The goal of the comparison was to identify bedside clinical criteria to assist in differentiating between the two groups. The variables of age, sex, and selected physical manifestations of the events were compared for the two groups by appropriate statistical methods, including a multivariate step-wise discriminate analysis. Significant differences between the two groups of seizures were identified for several variables, and most strikingly for the character of upper and lower extremity movements, the time of vocalization during the event, the character of pelvic movements, and the nature of body tone during the events. Useful bedside criteria for distinguishing a pseudoseizure from a tonic-clonic seizure were identified.

Valproic acid loading during intensive monitoring.

Of 35 patients who had generalized tonic-clonic seizures during antiepileptic drug therapy withdrawal, "loading" with valproic acid was effective in limiting these seizures in 32 patients. A loading dose of approximately 12.5 mg/kg was used. This dose resulted in valproic acid levels between 284 and 458 mumol/L (41 and 66 mg/L) 1.5 hours after "loading" in six of the eight patients in whom serum concentrations were measured.

Induction of speech arrest and counting errors with rapid-rate transcranial magnetic stimulation.

Six adult epileptic patients underwent rapid-rate transcranial magnetic stimulation (rTMS) at stimulation rates of up to 25 Hz with an 11-cm water-cooled round coil held flat on the scalp, centered over 15 different positions on each side of the scalp. The trains of stimuli were for 10 seconds while the patients counted aloud. rTMS centered over D5 or D7 induced reproducible speech arrest in all patients and counting errors in three when applied at lower intensities. There were no such speech disturbances by rTMS centered over the different positions on the right side. Intracarotid amobarbital test (IAT) demonstrated left hemispheric language dominance in all patients. Lateralization of speech arrest induced by rTMS correlated with the IAT results and may be helpful for noninvasive determination of hemispheric language dominance.

Prolonged postictal encephalopathy.

Eleven patients (6 males, 5 females; ages 7.5 to 40 years, mean 27.8) had prolonged postictal confusion lasting from 4 to 10 days. During that time, the EEG showed a typical encephalopathic pattern. Comprehensive evaluation ruled out the possibility of metabolic, toxic, drug-related, or ongoing nonconvulsive status epilepticus. We have designated this syndrome as prolonged postictal encephalopathy (PPIE). Nine of 11 patients were mildly to borderline mentally retarded. Ten had previous episodes of status epilepticus. Nine of 11 had minimal structural abnormalities (mainly diffuse cortical atrophy). Nine patients had multiple recurrent episodes of PPIE. All episodes occurred following a cluster of seizures: in 8 patients after a cluster of generalized tonic-clonic seizures, in 2 after complex partial seizures, and in 1 patient after a cluster of atypical absence seizures. This series suggests that vulnerability to develop PPIE exists in patients with diffuse structural abnormalities, mild to borderline mental retardation, a history of status epilepticus, and a tendency of seizures to cluster.

The prognostic value of residual spikes in the postexcision electrocorticogram after temporal lobectomy.

We correlated the postresection electrocorticograms (ECoGs) of 80 patients who underwent temporal lobectomy under general anesthesia for treatment of intractable complex partial seizures with surgical results in three groups: seizure/aura free (32 patients), auras only (16 patients), and one or more postoperative seizures (32 patients) at mean follow-up times of 34, 31, and 38 months, respectively. Spontaneous "residual spikes," ie, present after all resections, were present in 47% of patients who had no postoperative seizures or auras. However, they occurred in 72% of patients with any postoperative seizures (p less than 0.05). The location (convexity, mesial, or edge of resections) or the distribution (unifocal versus multifocal) of the residual spikes was not of prognostic value. Quantitative studies in 5-minute epochs of the postexcision ECoGs did not reveal a significant difference in the morphology of the residual spikes, ie, the amplitude or firing pattern (single versus polyspike), in the three groups. The group with postoperative seizures showed a higher number of spikes per epoch (greater than or equal to 50), but it was not significant. Although the study shows that patients with residual spikes may have good prognosis, they are at significantly higher risk for postoperative seizures as compared with those without residual spikes. The possibility that intensity of firing of residual spikes may be an additional predictor of outcome warrants further study.

Malaria in Nicaragua: community-based control efforts and the impact of war.

This descriptive study of temporal trends and geographical distribution examines the effects of prolonged low-intensity warfare on the community-based malaria control efforts. Nicaragua's post-1979 malaria control programme is based on community participation in health education and in mosquito breeding site drainage, expanded case finding, and increased availability of chemotherapy. Mosquito resistance and increasing costs have forced a reduction in the use of residual pesticides. The number of reported malaria cases in the country fell from 25,465 in 1980 to 15,702 in 1984, while the ratio of blood smears to total population increased from 86 to 137 per 1000 people. Malaria incidence in the eight states of the country under heaviest military attack in the current war was compared to incidence in the eight states least affected by the war. In the war zone there was a 17% excess in cases from August 1983-April 1985 above a 1974-82 baseline average, while there was a 62% decline in the number of cases in the non-war zone.

Clinical evaluation of a depth electroencephalography electrode.

Stereo depth electroencephalography (EEG) is of proven benefit in lateralizing and localizing seizure origin in select cases of epilepsy. There are potential hazards and technical considerations inherent with depth EEG, however, that have limited the general applicability of this technique. A new depth EEG electrode with materials and design features that facilitate safe insertion and artifact-free recording has been developed. The design features and technique for inserting the electrode are described. The electrode was evaluated during 2600 hours of implantation and recording in seven patients. With the use of stereotactic techniques, the electrode could be positioned accurately within precise anatomical landmarks such as the amygdaloid nucleus and the hippocampus. After insertion, no hemorrhage or edema was detected along the electrode tracts by third generation computed tomographic scanning. There was no evidence of pyrogenicity or infection. Electrode migration was not observed. A large electrical field could be sampled because of the relatively large surface of the cylindrical depth electrode contacts.

Supplementation patterns in marathon runners.

The purpose of the present investigation was to study the use of supplements in a large group of endurance runners (no. = 347) who had participated in the 1987 Los Angeles Marathon. Three-day dietary records were analyzed for nutrient content and supplement usage. The runners' supplementation patterns with respect to demographics, dietary quality, training habits, and race performance were investigated. In general, no significant associations were found between supplement use and the aforementioned variables. Use of supplements, especially vitamins C and E, calcium, and zinc, increased with age (p less than .05). Daily use of at least one type of supplement was reported by 29% of the runners; 48% reported use of at least one type of supplement within the 3-day period.

Routine EEG vs. intensive monitoring in the evaluation of intractable epilepsy.

Appropriate treatment of patients with intractable seizures requires precise identification of the type (or types) of seizure the patient experiences and correlation of this information with data from electroencephalography localizing the focus of the seizure in the brain. For such patients, the technique of "intensive monitoring" has gained rapid acceptance in the past several years as the investigative method of choice.Intensive monitoring usually entails prolonged electroencephalographic recording with simultaneous videotaping of the patient. Another common technique is prolonged monitoring of the patient's electroencephalogram (EEG) by radiotelemetry, during which time the patient is closely observed by trained personnel for suspected seizures.To compare the quality of information obtained from intensive monitoring with that from careful routine electroencephalography, the authors reviewed the medical records of 100 consecutive patients who had received both kinds of study after being referred for treatment in the special Epilepsy Treatment Unit of the University of Minnesota's Comprehensive Epilepsy Program (CEP).Success of each method was defined by ability to record an actual seizure. The routine EEG examination recorded actual seizures in 7 percent of patients in the study. With video EEG, following careful withdrawal of anticonvulsant drugs, seizures were recorded in 70 percent of patients. Telemetered EEG recorded seizure activity in 50 percent of those patients for whom the other two methods had failed to detect seizures.Intensive monitoring revealed that 60 percent of patients for whom the routine EEG study had recorded only one seizure type actually suffered from two or more types. Clinical diagnosis was changed in 84 percent of the patients. In this study, intensive monitoring was found to be far superior to the routine EEG examination as an aid to precise diagnosis of intractable seizure disorders.

Transcranial magnetic stimulation.

Multiple techniques are vying for establishing the new gold standard for functional cortical mapping, displacing that of the currently invasive and risk-prone techniques of subdural electrode arrays and intraoperative electrical stimulation mapping. Transcranial magnetic stimulation holds promise for functional localization of primary motor areas and speech areas, and possibly even other higher cortical functions. The technique is economical, especially when compared with the cost of functional magnetic resonance imaging and positron emission tomography. It can be performed effectively and safely in patients with epilepsy.

Presurgical assessment and surgical treatment for epilepsy.

In the last ten years, dramatic advances in surgical treatment options and techniques have allowed surgical intervention for patients who would otherwise not have been considered as surgical candidates. In this article, a multidisciplinary, logical decision algorithm for a rational approach to surgical treatments is outlined. A carefully considered hierarchy is presented that provides for maximized seizure improvement outcomes. Topics presented include temporal lobectomy, detailed discussion of dominant temporal lobectomy and speech-sparing techniques, neocortical resection, the use of subdural electrode array, depth electrodes, and strip electrodes, multiple subpinal transection, vagus nerve stimulation, and corpus callosotomy. The application of these various techniques to maximize surgical outcome are discussed.

Side effect profiles and behavioral consequences of antiepileptic medications.

In 1991, Dodrill carefully reviewed the behavioral effects of antiepileptic drugs (AEDs) and concluded: "The area of behavioral effects of antiepileptic drugs is poorly defined, lacks recognized and validated methods of assessment, and has suffered from a number of methodological limitations, especially including the use of experimental designs which have led to the contamination of drug effects and subject effects" (1). He further observed that the best controlled study showed that the behavioral effects of AEDs were quite limited; the benzodiazepines had the most consistently favorable effect, but were of limited utility in epilepsy, because they were not typically administered on a long-term basis; carbamazepine was associated with a favorable behavior change, but this change was seen most consistently in nonepileptic subjects; relatively few studies of valproic acid had been conducted; phenytoin was not associated with either a consistently positive or consistently negative change; and the barbiturates were clearly associated with the most negative behavior change. Since Dodrill's review, eight new AEDs have been approved by the Food and Drug Administration (FDA) for use in the United States, thereby dramatically increasing the therapeutic options for patients with epilepsy. These new drugs also increase the complexity of choosing the ideal drug for any given patient. Certainly a critical component of the decision to initiate or continue a specific treatment is the side effect profile of the medication. In clinical practice, behavioral and cognitive side effects of the older AEDs are significant concerns. This paper reviews the clinically important behavioral and cognitive side effects of the more commonly used, established AEDs as well as the newer AEDs within the limits of currently available published peer-reviewed literature and clinical experience. Particular emphasis is given to subpopulations at risk.