Egon Stenager

Ventriculostomy-related infections—an epidemiological study

SummaryIn a prospective study involving a total of 87 ventriculostomies, ventriculostomy-related infections (based upon a bacteriological definition) developed in 15 patients (17.2 per cent). Intraventricular haemorrhage was related to a higher infection rate. Infection was most frequent within the first days after the external ventricular drain (EVD) was inserted. There was no relation between infection and the number of manipulations of the EVD or antibiotic treatment during the time of EVD placement.

Mortality in patients with Parkinson's disease

Introduction– After the introduction of L‐dopa the mortality rate in Parkinsons disease (PD) patients has changed, but is still higher than in the background population. Material & methods– Mortality, age at death and cause of death in a group of PD patients compared with the background population were studied. The diagnosis on the death certificate were registered. The material consisted of 458 patients who in a period 1.4.1973–31.10.1991 were registered as having PD. Results– Death in the period amounted to 253 patients. Median age of death was 77.29 years for men and 79.11 years for women. In the background population the median age at death was 80.69 years for men and 84.37 years for women. The SMR for men was 1.92 and for women 2.47. Infections, in particular lung infections, and heart diseases were the most common causes of death. Seventy percent of the death certificates had PD as a diagnosis. Conclusion– It is likely that several factors can influence the changed mortality of PD: more effective treatment, changing diagnostic practice, and inter‐disease competition.

Risk Factors for Suicide in Multiple Sclerosis

BACKGROUNDnThe purpose of the present study was to identify risk factors for suicide in patients with multiple sclerosis (MS).nnnMETHODSnThe study is based on available information about MS patients identified in the Danish MS Registry (DMSR) with onset in the period 1950-1985. We compared the MS suicides with the 1950-1985 onset cohort patients in the DSMR as to distribution of age at onset, presenting symptoms, and time from onset to diagnosis. We reviewed sociodemographic data, age of onset, the course of the disease, recent deterioration, type of deterioration, Kurtzke Disability Status Scale (DSS) score, previous mental disorder, type of mental disorder, previous suicide attempts, expression of suicidal intentions, circumstances at suicide, and suicide method for all MS patients who had committed suicide. In order to characterize MS suicides with respect to risk factors, comparisons were made for male and female suicides and for various groups of MS suicides according to disability status.nnnRESULTSnThe male suicide patients were characterized by a tendency to commit suicide in the age interval 40-49 years, by the use of a violent suicide method, by previous suicidal behaviour, by a previous mental disorder, by recent deterioration of MS, and by a moderate disability. For women the characteristics were less distinct. Patients with a severe course of MS had been subjected to more risk factors before the suicide than patients with a moderate course of the disease.nnnCONCLUSIONnCareful counselling and good information on all aspects of the disease, especially in the first stages and at time of progression, could be an instrument of prevention of suicides in MS patients. Furthermore, recognition and treatment of depression and pain is important.

Effect of pregnancy on the prognosis for multiple sclerosis. A 5-year follow up investigation.

Introduction ‐ The purpose of the study was to evaluate the effect of pregnancy and childbirth on the longterm prognosis for women with multiple sclerosis (MS). Method and material ‐ A cohort of 39 women with definite MS were identified on 1.1.1986 using a reproducible selection method. The investigation was initiated in 1986 when handicap was evaluated by Kurtzke Disability Status Score (DSS). At a 5‐year follow up 4 had died and 6 could not participate. There were 29 women in the investigation of whom 7 were childless, 10 had onset of MS at least 6 months after last childbirth, and 12 had onset of MS before or in connection with childbirth. Age and disease duration of the group was uniform. Result ‐ At follow up the DSS significantly deteriorated (p = 0.008). The deterioration was seen particularly for childless women (p = 0.03) and women with onset of MS before or in connection with childbirth (p = 0.005).

Sexual function in multiple sclerosis. A 5-year follow-up study

Sexual dysfunction is known to occur in multiple sclerosis (MS). The purpose of the study is to describe the change in sexual function and symptoms in a longitudinal study. Forty-nine patients (27 females, 22 males) with definite MS were interviewed and examined with 5 years interval. The number of patients with sexual dysfunction increased significantly (p=0.009) and involved females and males equally. Males usually had 1 or two symptoms of sexual dysfunction, while females frequently had 2 or more symptoms. It is concluded that the risk of sexual dysfunction increases over time. Further studies in treatment possibilities are needed.SommarioÈ noto che disfunzioni sessuali possono verificarsi in pazienti con sclerosi multipla (SM). Questo studio si propone di descriverne loccorrenza attraverso una analisi longitudinale. Quarantanove pazienti (27 femmine e 22 maschi) con SM definita sono stati intervistati ed esaminati due volte a 5 anni di distanza. Il numero di pazienti con disfunzioni sessuali risultò significativamente aumentato (p=0.009) senza significative differenze tra maschi e femmine. I maschi presentavano usualmente uno o due sintomi di disfunzione sessuale mentre le femmine ne avevano frequentemente due o più. Si conclude che il rischio di disfunzioni sessuali aumenta nel tempo. Ulteriori studi sono necessari sulle possibilità di trattamento.

Treatment of Ventriculostomy-related Infections

SummaryThe results of the treatment of 15 cases of ventriculitis related to the use of external ventricular drainage are presented. A review of the literature on the treatment of cerebrospinal fluid shunt infections combined with our data suggest the following treatment of venticulostomy-related ventriculitis: 1. Antibiotic treatment according to the resistance pattern of the infecting microorganism and 2. Removal or replacement of the ventricular drain. 3. One should wait for bacteriological cure before implanting a permanent internal drainage system.

Multiple Sclerosis: The Impact of Physical Impairment and Cognitive Dysfunction on Social and Sparetime Activities

In a cross-sectional investigation of 116 patients with multiple sclerosis, the social and sparetime activities of the patient were assessed by both patient and his/her family. The assessments were correlated to physical disability which showed that particularly those who were moderately disabled suffered from severe psychosocial strain. The literature shows that the strain becomes even more severe in certain periods of progression of the disease with the result that psychosomatic conditions arise.

A note on the treatment of drummer Bock: an early Danish account of multiple sclerosis?

Multiple sclerosis (MS) was first presented in a clinical setting in 1838. In this paper the presentation and treatment of a transient hemiparesis in a drummer in 1789 is discussed. This may have been an early case of MS and presents evidence against the theory that MS is an infectious disease beginning in the 19th century.

Multiple sclerosis: symptom equivalent to delayed visual evoked potential latency

Abstract An investigation on the correlation between ability to read TV subtitles and the duration of visual evoked potential (VEP) latency in 14 patients with definite multiple sclerosis (MS), indicated that VEP latency in patients unable to read the TV subtitles was significantly delayed in comparison to that of patients who mastered this task.