Ernst A. Rodin

A comparison of the effectiveness of primidone versus carbamazepine in epileptic outpatients.

Prior to the release of carbamazepine for the treatment of patients with psychomotor and grand mal seizures, primidone was regarded as the drug of choice for these disorders, especially when combined with diphenylhydantoin (DPH). It was, therefore, of interest to compare the effectiveness of carbamazepine against primidone when added to a therapeutic dose of DPH. Forty-five patients completed a 6-month study with each patient serving as his own control. The patients were initially stabilized on therapeutic doses of DPH and one of the test compounds, while all other medications were withdrawn. After 3 months of treatment, they were transferred onto the other drug for a second 3-month period. Extensive laboratory testing, including anticonvulsant levels, electroencephalograms, and neuropsychological evaluations, was performed. For the most part, the patients remained on outpatient status, returning for reports of seizure frequency, side effects, and laboratory studies every 14 days. The study was conducted in a single blind fashion by the treating neurologists; double blind by the electroencephalographer and psychologists. The results indicated that the two drugs did not differ in their effectiveness on seizure control. There were somewhat more side effects—none serious—with carbamazepine than with primidone. The EEG showed increased fast activity with primidone and increased &thetas; activity with carbamazepine. There was no difference in regard to decrease of electroencephalographic seizure discharges. The patients showed more impairment on a repeatable neuropsychological test battery with primidone than with carbamazepine, and they also showed an increase on the psychopathic deviate scale of the Minnesota Multiphasic Inventory. Depressive feelings, when present, lessened while under treatment with carbamazepine. The results suggest that patients with the seizure types under consideration and who do not respond to DPH alone or to a DPH-phenobarbital combination can be placed on either carbamazepine or primidone while phenobarbital is discontinued. A patient who is intellectually and emotionally intact with no past history of behavioral disturbances may do better on primidone than carbamazepine, because this drug gives fewer side effects. On the other hand, those patients who have a past history of emotional and/or intellectual disturbances may profit more from carbamazepine.

The reality of death experiences. A personal perspective.

In recent years, there has been a marked increase in reports of the subjective experience of individuals in severe life-threatening circumstances. These have been used to suggest that scientific facts are now in agreement with religious beliefs as to the survival of the personality after physical death. This paper presents a personal death experience viewed by the author as a “subjective reality.” This is contrasted with “shared subjective reality,” i.e., commonly held beliefs among groups of individuals which do not necessarily lend themselves to scientific verification and scientifically derived objective reality. Subjectively real death experiences are regarded as corollary to a toxic psychosis. The content of the psychosis, which is not under voluntary control, determines the subjective experience of having entered either heaven or hell.

Megimide and metrazol A comparison of their convulsant properties in man and cat

The report by Shaw et al. (1954) on the effectiveness of Megimide

Effects of Photic Stimulation During Sleep A Study of Normal Subjects and Epileptic Patients

IN 1934 Adrian and Matthewsl observed that if a rhythmically flashing light was shined in the eyes of a subject, waves having the same frequency as the flashing light appeared in the electroencephalogram. This phenomenon has been called “photic driving.” It appears maximally in the occipital and parietal regions and usually as a bilaterally s y m metrical rhythm. However, the term “photic driving” is not entirely satisfactory, since to some authors it has implied a response intimately linked with alpha rhythm mechanisms. As this hypothesis has not been substantiated as yet, in this study we have used the term “photic response” which does not necessarily imply any connection with alpha rhythms. The observations of Adrian and Matthews have been extended by a number of a u t h o r ~ . ~ ~ In general, when brief pulses of light are flashed in the eye at relatively slow rates (less than one flash per second), complex polyphasic responses can be recorded from electrodes placed in the occipital regions of the skull. As the flash rate is increased, the responses tend to fuse and assume more sinusoidal forms. The shapes of the sinusoidal forms may be distorted by the presence of harmonic or subharmonic frequencies of the flash rate. Photic responses may be seen over a wide range of frequencies, and they frequently persist after closure of the eyes, although under those circumstances recognition may be difficult because of mixture with spontaneous alpha rhythms. Another important effect of photic stimulation is the initiation of convulsive manifestations in certain individuals. These may take the form of myoclonic jerkings, petit ma1 attacks, or generalized convulsions.s-s In some patients the degree of sensitivity to light is such that

Clorazepate therapy for refractory seizures

We treated 61 patients with seizures refractory to conventional anticonvulsants by adding clorazepate to their regimen. There was some improvement of seizure control, but no overall improvement in the electroencephalogram. Improvement of seizure control was not significantly related to seizure type. No significant side effects, drug interactions, or laboratory abnormalities were noted with doses up to 3 mg per kilogram per day.

An Electroencephalographic Syndrome Which Correlates with Severe Disruption of the Personality Structure

SINCE THE ADVENT of electroencephalography as a tool for diagnosis and research, a great many efforts have been made toward establishing direct relationshi c between function of the brain a s revealecf by electroencephalographic tracings and normal or abnormal behavior of the individual. The results of these studies in regard to normal behavior have been rather disappointing up to the present, although a great deal of data have been accumulated. Most of this work has been aptly summarized recently by Ellingson.’ In regard to correlations between abnormal electroencephalograms and abnormal behavior, the group of illnesses termed convulsive disorders appeared to be the most important one by far. I t was noted very early that, in most instances, a sudden change in the electrical events of the brain led to predictable behavioral alterations in the patient. These behavior changes might be a grand ma1 seizure, a petit ma1 attack, a complex psychomotor episode, or other focal seizures corresponding to the area of the brain which is temporarily deranged in its function. The group of patients who suffered from temporal lobe seizures proved most interesting for the study of abnormal behavior in relation to altered electrical activity of the brain because of the marked varieties of subjective and objective changes in the patient. Furthermore, it is fortuitous that most patients retain consciousness for a certain period of time and are able to describe their difficulties after the termination of the seizure or in some instances even during it. These subjective experiences were soon noted to be very similar to those experienced by “psychotic” or “psychoneurotic” patients. The main differences are that they are of much shorter duration in the seizure patient and that they tend to be repetitive, by which is meant that usually the same type of symptoms tend to recur in the seizures, although there are some very definite exceptions. It was found that a considerable proportion of patients with temporal lobe seizures also have, independent of their attacks, a large measure of psychiatric difficulties which prevent them from leading useful lives or allow for only a marginal social