Anthony Hopkins

THE FIRST SEIZURE IN ADULT LIFE: Value of Clinical Features, Electroencephalography, and Computerised Tomographic Scanning in Prediction of Seizure Recurrence

408 adults (age 16 and over) were followed up after their initial seizure. The actuarial risk of recurrence was highest in the early weeks. For those seen within the first week, the risk of recurrence was 52% by the end of 3 years. In univariate analysis, the only clinical variable that was associated with recurrence was the time of day at which the initial seizure occurred. There was a tendency, that did not reach statistical significance, for younger age (less than 50 years) and a family history of seizures of any type, including febrile convulsions, to be associated with recurrence. Such risk factors appear to be additive, so that the risk of recurrence at 1 year for a subject with all three factors is about three times that of a subject with none of them. Sex, type of seizure, and features of the electroencephalogram were not of predictive value. Computerised tomographic scanning revealed tumours in 3% of subjects, and these individuals were particularly likely to have recurrent seizures.

HOW DOCTORS DEAL WITH EPILEPSY

All of those adults with epilepsy on the lists of 17 general practitioners in Metropolitan London were identified. 87% of these agreed to be separately interviewed in their homes by a neurologist and a sociologist. The vast majority had been referred to hospital for investigation, and their hospital notes were inspected. The pattern of care suggests unnecessary referral, unnecessary electroencephalography, inadequate communication of the diagnosis, inadequate medication, and follow-up supervision not related to patient need.

AUTONOMIC NEUROPATHY OF ACUTE ONSET

Abstract Acute autonomic failure of unknown origin in two patients is described. In one, postural fainting, paralysis of accommodation, and failure of sweating and lacrimation were prominent features; in the other paralytic ileus developed in association with other features of autonomic paralysis. There were no features of a peripheral motor or sensory neuropathy. One patient made a good recovery after a few weeks. The other has required long-term parasympathomimetic drugs.

Patients' satisfaction with communication in neurological outpatient clinics

Abstract A study is reported of patients attending neurological outpatient clinics with a primary symptom of headache not due to structural disease. Patients were interviewed shortly after their hospital visit and one year after the referral and their views about communication from the doctor were obtained. Approximately one-quarter of patients expressed serious critical comments on this subject. No socio-demographic variable predicted this negative response. However, two groups of patients with particular needs were found to be significantly more critical. Otherwise concerns about information in the sample were limited. Dissatisfaction with communication was found to be significantly related to subsequent non-compliance.

Effects of referral to a specialist for headache.

Patients consulting neurological outpatient clinics for headaches that were found not to be due to a serious structural lesion were followed up one year afterwards. Considerable improvement in symptoms was found in the sample. This was only partly attributable to any medical treatment received at the clinics or subsecquently from a general practitioner. Improvement was associated with previously expressed satisfaction with the clinic consultation, and a nonspecific ‘placebo’ response is postulated.

PRETENDING TO BE UNCONSCIOUS

Abstract Six patients who pretended to be unconscious, as a symptom of various different psychiatric illnesses, are described. The main difference between real and simulated coma is the discrepancy, in simulated coma, between the lack of response to any stimulus and the preservation of normal reflex function. Many complex radiological and biochemical investigations were carried out on these patients.

An attempt to explain the mechanism of drop attacks

We have investigated the possibility that a delay in long-loop (transcortical) reflexes might be responsible for the occurrence of drop attacks which occur in middle-aged women without disturbance of consciousness. We have not been able to confirm this suggestion. However, using simple Newtonian principles, we calculate how far the subject may fall before a long-loop reflex can be generated in the quadriceps muscle. We suggest that in some subjects tension cannot be generated sufficiently quickly to maintain the erect posture. This hypothesis provides a link between subjects who experience drop attacks due to overt muscle weakness and subjects without physical signs.

Numerical Coding for Types of Seizure Based on the Clinical and Electroencephalographical Classification of Epileptic Seizures

A three‐digit code of types of epileptic seizure is described for use in a punched card system. The code makes use of all available information about a patient. It is internally consistent and is based entirely on the Clinical and Electroencephalographical Classification of Epileptic Seizures.

Book Review: Clinical Uses of Cerebral, Brainstem and Spinal Somatosensory Evoked PotentialsClinical Uses of Cerebral, Brainstem and Spinal Somatosensory Evoked Potentials (Progress in Clinical Neurophysiology, vol 7) DesmedtJ E (ed) pp 354 SFr 138 Basel: Karger1979

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Book Review: Scientific Aspects of AcupunctureScientific Aspects of AcupunctureMannFelix pp 77£3.95Heinemann1977

Nuclear Medicine, Clinical and Technological Bases. J T Andrews & M Jean Milne pp 468 £18.75 John Wiley & Sons 1977 Nuclear Medicine requires the involvement of personnel from medical and nonmedical disciplines. This book is written for the training of nonmedical persons physics technicians, radiographers, nurses, pharmacists and others who are essential to the proper functioning of a clinical radioisotope service. It is based on a course of lectures for a diploma course in medical nucleography by Dr Andrews, the Director of the Department of Nuclear Medicine at the Royal Melbourne Hospital, and by the Head Radiographer in his department. The high quality of this book is a reflection of the fact that nuclear medicine is properly organized in Australia as a result of its recognition in training programmes associated with the Royal Australian College of Physicians. The book has twenty-three chapters, thirteen of which arc devoted to anatomy, physiology, pathology and clinical diseases affecting the various systems of the body. The other chapters cover the basic principles of radiation as applied to measurement, imaging techniques, laboratory techniques and radioisotope therapy. The book is well produced and well illustrated. I recommend this book for nonmedical persons working in departments providing a radioisotope service for patients. Medical students and doctors will also find it useful in order to understand the principles behind the increasing variety of radioisotope procedures used in clinical work.