Lama M. Chahine

The changing face of neurosyphilis

The incidence of syphilis has increased over the past decade, particularly among HIV-positive patients, and the presenting clinical features have changed since the beginning of the HIV epidemic. The clinical manifestations of neurosyphilis are protean, and include acute stroke. In patients with HIV, the diagnosis and treatment of neurosyphilis is challenging. We review the clinical presentation, pathophysiology, and treatment of neurosyphilis, with emphasis on neurosyphilis in the HIV population, and neurosyphilis as a cause of acute stroke.

Validation of the Arabic version of the short Geriatric Depression Scale (GDS-15)

BACKGROUND This study aimed to examine the validity and reliability of an Arabic version of the 15-item Geriatric Depression Scale (GDS-15). METHODS 121 community-dwelling older adults and primary care patients aged 60 and above participated in this study. Older adults with dementia, those with thyroid dysfunction, and hearing or speech impairments were excluded. Test-retest reliability was examined by re-administering the translated GDS-15 to a subset of 38 participants at least seven days after the initial interview. RESULTS The Arabic GDS-15 had good psychometric properties, but the best properties were reported for the 7/8 cutoff. Cronbachs alpha as a measure of internal consistency reliability was high (0.88) and kappa ranged from 0.57 to 0.75. The performance of the GDS-15 was equally good for both community-dwelling older adults and those in primary care settings, and for both forms of the GDS (examiner administered vs. self-administered). CONCLUSION The Arabic GDS is a useful measure to assess depression among community-dwelling older adults and primary care patients who do not have dementia. Because of the use of formal Arabic, GDS-15 can be widely used with all Arabic-speaking people.

The Elderly Safety Imperative and Antipsychotic Usage

&NA; Behavioral and psychotic symptoms are common problems in older adults, and as the population ages, understanding the benefits and risks of antipsychotic usage is increasingly important. In this age group, psychotic symptoms may occur in patients with dementia or as part of schizophrenia, mood disorders, delirium, or delusional disorder. Various antipsychotics have been studied in older adults with psychotic symptoms, demonstrating mixed, but real, benefit, especially in relation to carefully selected patients. Caution is required because of the potential side effects and risks, which include increased mortality and cardiovascular and cerebrovascular events. This article reviews the use of antipsychotics in older adults, with emphasis on the risks and side effects, particularly in dementia patients with behavioral and psychotic symptoms.

Du rire aux larmes: pathological laughing and crying in patients with traumatic brain injury and treatment with lamotrigine.

Pathologic laughter and crying (PLC) is the involuntary occurrence of laughter and crying in the absence of a corresponding change in affect. PLC resulting from structural brain damage in patients with traumatic brain injury can be the cause of substantial social dysfunction in these patients. The use of lamotrigine as an antiepileptic drug and mood stabilizer is well established; its use in PLC has been reported only once during treatment following a stroke. We present here four young patients with pathological laughter and/or pathological crying following traumatic brain injury who were successfully treated with lamotrigine. Data supporting the use of lamotrigine in the treatment of PLC following traumatic brain injury and the neuroanatomy of pathological laughing are briefly reviewed.

The Use of Selective Serotonin Reuptake Inhibitors in Elderly Patients

&NA; Depression is common among the elderly, and several factors need to be taken into account in selecting the appropriate antidepressant in this age group. Various physiologic changes occur in individuals as they age, potentially leading to changes in the pharmacodynamic and pharmacokinetic properties of drugs in elderly individuals. The efficacy of various medications, their side‐effect profiles, and the potential for drug‐drug interactions may differ in older patients compared to younger ones. The selective serotonin reuptake inhibitors (SSRIs), which are seen as being among the first‐line agents for treatment of depression in elderly patients, have been shown to be effective but carry with them side effects and drug‐drug interactions that warrant special attention when these medications are prescribed to older individuals. This review focuses on the pharmacology of SSRIs in elderly patients and on practical issues related to using these medications.

Restless legs syndrome: a review.

Restless legs syndrome (RLS) is a sensorimotor disorder characterized by an irresistible urge to move the limbs accompanied by uncomfortable sensations, leading to sleep disturbances. It is associated with psychiatric comorbidities and a decreased quality of life. RLS is common and most severe among females and the elderly. It may be primary or secondary to other conditions and may be familial. Linkage to several chromosomal loci have been demonstrated. The pathogenesis of RLS involves dopaminergic dysfunction, iron metabolism, and abnormalities in supraspinal inhibition. The mainstay of RLS therapy are dopamine agonists or levodopa. This article reviews the clinical characteristics, epidemiology, diagnosis, pathogenesis, and treatment of RLS.

Essential Tremor After Ipsilateral Cerebellar Hemispherectomy: Support for the Thalamus as the Central Oscillator

Essential tremor is a long-recognized and common movement disorder, yet controversy still surrounds its pathophysiology. The olivo-cerebello-thalamo-cortical pathway has been implicated in the genesis of essential tremor, and the inferior olive has been considered the central oscillator driving the peripheral tremor. We present the case of a patient who developed essential tremor ipsilateral to cerebellar hemispherectomy and propose that the central oscillator in patients with essential tremor may not be the inferior olive in all cases, but rather the nucleus ventralis intermedius of the thalamus.

Update on mental health care in Lebanon.

Sir, In 2005–2007 we surveyed mental health services in Lebanon [1]. At the time, we found a paucity of community-based mental health services, deficiencies in education programmes for professionals and the public, misallocation of health care finances, and lack of a clear governmental policy on delivery of mental health services and prevention of mental illness. Several barriers related to the government, patients, and physicians were identified, and solutions to address them, and to move Lebanon forward in meeting World Health Organization (WHO) recommendations for action on mental health, were proposed. Four years have now passed since our survey. While we have not conducted further formal investigations as to the state of mental health care in Lebanon at this time, we would like to provide some updated points. From 2005–2008, the Lebanese population grew by approximately 400 000. In 2008, approximately LL 3.7 trillion (US

The Bane of a Silent Illness: When Wilson's Disease Takes its Course

2.45 billion) were spent on health care [2] compared to 3.5 trillion in 2005 [1]. Total expenditure on health was 8.8% of the gross domestic product (GDP) [2]. This accounted for 11.7% of governmental expenditure that year. The majority of health care expenditure was from the private sector rather than the government, with the former contributing 53.9% of total health expenditure and the latter 46.1% [2]. Out-of-pocket expenditures constituted 11.7% of total health expenditure. Therefore, as compared to 3 years earlier, total government expenditure on health care increased, but private sector expenditure was greater. Private household expenditure has apparently declined [2]. Regarding the availability and cost of medications, shortages in essential medications such as antipsychotics and mood stabilizers continue to occur intermittently. The cost of some medications has significantly declined, particularly generic medications, whereas others have become more expensive. Previously reported costs were based on 2007 prices [1]. Updated costs of maintenance therapy for an episode of mania, depression or psychosis as of 2009 include: clomipramime LL 25 200 (US

Benign pediatric localization-related epilepsies

16.8), lithium (Camcolit®) LL 252 000 (US