Daniel S. Feldman

Temporal lobectomy for partial complex seizures Evaluation, results, and 1‐year follow‐up

Twenty-six patients were evaluated for temporal lobectomy. Fourteen underwent initial monitoring with electrodes in the amygdala and hippocampus bilaterally. Twelve had initial monitoring with scalp and sphenoidal electrodes. Four had conclusive localization without depth electrodes. Twenty-three patients underwent lobectomy. At 1-year minimum follow-up, 15 were seizure free. Five had greater than 90% reduction in seizure frequency. Complications of depth electrodes were one hemorrhage and one abscess. One patient developed impaired memory following surgery. Temporal lobectomy is effective in well-selected patients. Depth electrodes localize seizure onset from mesial temporal structures. Scalp and sphenoidal recording may be sufficient in some cases.

Behavioral Effects of Kainic Acid Administration on the Immature Brain

Summary: Prepubescent male rats with an amygdaloid electrode in place were administered kainic acid (KA) intraperitoneally (i.p.) while controls received phosphate‐buffered saline (PBS). All KA‐treated animals developed status epilepticus with bilateral forelimb clonus and ictal discharges on the EEC The rats were then tested as adults for learning, memory, emotionality, social interaction, and activity level using the T maze, water maze, handling test, home cage intruder test, and open field test. KA‐treated rats learned at a slower, rate in the water maze and T maze than the controls. In addition, KA‐treated rats had evidence of impaired memory during spatial bias testing in the water maze. In the home cage intruder test, KA‐treated animals were more submissive and less aggressive than control animals. Finally, KA‐treated animals were significantly more active than control animals in the open field test. This study demonstrates that KA administration to the immature brain, in a convulsant dose, results in permanent changes in behavior, learning, and memory.

Plasma lipoproteins in cortical versus lacunar infarction.

We investigated the relation of plasma lipids to the risk for ischemic stroke by comparing clinical and biochemical characteristics of survivors of cortical (n = 48) and lacunar (n = 36) brain infarction. By analysis of variance, no differences were observed in the concentrations of total cholesterol, triglycerides, low density lipoprotein cholesterol, very low density lipoprotein cholesterol, or apoproteins A1 and B. Patients with lacunar infarction, however, had higher concentrations of high density lipoprotein (HDL)-cholesterol than patients with cortical stroke. This HDL-cholesterol difference was due primarily to a strikingly low HDL-cholesterol content in white patients with cortical stroke. These data suggest that previously demonstrated differences in HDL-cholesterol concentrations between patients with ischemic stroke and control subjects without stroke may apply to patients with cortical but not lacunar infarction. Separation of cerebral infarction into subtypes based on mechanism may help clarify lipid-related risk factors in cerebrovascular disease.

Biochemical, Endocrine, and Mineral Effects of Indapamide in Black Women

Black women with established essential hypertension, without renal insufficiency or diabetes mellitus, were withdrawn from their usual antihypertensive therapy for 2–3 weeks prior to entry into a study to evaluate pertinent biochemical and mineral effects of indapamide treatment. Twenty patients with a sitting diastolic blood pressure greater than 90 mm Hg had baseline measurements of plasma total cholesterol, HDL cholesterol, triglycerides, glucose, uric acid, potassium, magnesium, calcium, selenium, renin, norepinephrine, whole blood ionized calcium, and glycosylated hemoglobin. Low‐density lipoprotein (LDL) cholesterol was calculated by the Friedewald equation. The patients were placed on a fixed daily dose of 2.5 mg indapamide. Blood pressure and blood tests were repeated at 4, 8, and 12 weeks of treatment. The systolic and diastolic blood pressure were both lowered significantly at week 12. Plasma renin activity was significantly increased. There was no significant change in norepinephrine, glucose, glycosylated hemoglobin, uric acid, ionized calcium, calcium, triglycerides, potassium, magnesium, or selenium. Total cholesterol increased with an increase in both high‐density lipoprotein (HDL) and LDL cholesterol; however, these increases did not alter significantly either the total/HDL cholesterol or LDL/HDL cholesterol ratios. It is concluded that 2.5 mg of indapamide per day effectively lowers blood pressure with no significant adverse metabolic effects.

Vitamin A in Hypercholesterolemia

This study evaluated the relationship between plasma vitamin A and cholesterol in 48 patients with hypercholesterolemia studied before and after treatment with a cholesterollowering diet, with or without lipid-lowering medication. Plasma vitamin A levels were higher in hypercholesterolemic subjects than in healthy controls (2.58 ± 0.15 vs. 1.82 ± 0.14 mmol/L, p = 0.025) despite similar values for retinol binding protein (RBP). Successful cholesterol lowering, defined as > 25% reduction in low density lipoprotein cholesterol, was achieved in 16 patients. In this subset, plasma vitamin A declined from 3.00 ± 0.32 (pretreatment) to 2.34 ± 0.15 mmol/L (post treatment; p = 0.018). A nonsignificant increase in RBP was observed, resulting in a significant decrease in the molar ratio of vitamin A to RBP (1.05 ± 0.06 vs. 0.80 ± 0.05, p = 0.013). These data suggest an interaction between vitamin A and cholesterol that is independent of the transport mechanisms for vitamin A in association with chylomicrons (post absorptive) and with RBP. Further examinations of the form or forms of vitamin A (retinol, retinyl ester), its distribution within the plasma lipoproteins, and the mechanisms of origin and removal are warranted to explain these findings

Auditory P3 correlates of phonemic and semantic processing

Auditory evoked potentials were recorded in twelve healthy subjects using phonemic and semantic word tasks. The late positive component (P3), analogous to tonal P300, varied as a function of cognitive task with increased latency and amplitude associated with semantic processing. These data are consistent with levels of processing theories in which semantic analysis is associated with a greater elaboration of stimulus evaluation.

Conjugated dihydroxy bile salt inhibition of glucose influx in rat jejunumin vitro

Effects of bile salts on intestinal glucose transfer differ in diverse animal preparations exposed to various bile acids. Radiolabeled glucose influx into rat jejunum in vitro was studied in buffer and compared to taurodeoxycholate, taurochenodeoxycholate, taurocholate, and deoxycholate. Jejunum was obtained from intact, bile-diverted, and colestipoltreated rats and in similar categories after abdominal x-irradiation. Taurodeoxycholate but not taurocholate inhibited glucose influx only in bile-fistula and colestipol-treated rats. Bile diversion increased and colestipol decreased glucose uptake from buffer. Added inhibitory effects of irradiation and bile salts were seen in bile-fistula animals. These data suggest that normal exposure to bile is chronically inhibiting jejunal glucose transport and that dihydroxy bile salts are responsible for this effect. They do not provide an explanation for the role of bile in the intestinal radiation syndrome.

Transfer following rapid kindling in the prepubescent rat

In order to investigate the transfer effect following rapid kindling in the immature animal, prepubescent rats were initially kindled in the amygdala using interstimulus intervals of 5 min followed by transfer kindling in the contralateral amygdala at age 100 days using twice daily kindling. A second group of rats were kindled in the prepubescent period with hourly stimulations followed by transfer kindling at age 100 days using twice daily stimulations. A control group underwent sham-kindling in the prepubescent period followed by twice daily kindling at age 100 days. While a transfer effect was seen in both the rapidly kindled and hourly kindled groups, the transfer effect was greater in the animals kindled with the longer interstimulus interval. While rapid kindling produces a long-standing change in brain excitability, the effect is less pronounced than with hourly kindling techniques.

Construction of the annual meeting program of the Academy

Six hundred of 912 papers submitted were accepted for presentation at the 1983 Annual Meeting of the AAN. A statistical study of scoring by individual members of the Committee showed significant mean score differences. A normalization procedure for scoring was compared with the actual meeting scores and selections. A substantial difference in 3 of 19 program categories and lesser changes in 14 others occurred. It is no longer feasible for each submission to be evaluated by all committee members. Four readers per paper and normalization of scores will result in a program reflecting the broad interests of the Academy membership.