Palle Juul-Jensen

Natural History of Epileptic Seizures

Summary: Since 1963 a continuous registration of patients with epileptic seizures has been carried out in Greater Aarhus, Denmark. This registration has been attempted by means of medical records dating back to 1940. On the basis of the established prevalence and the calculated cumulated incidence, we have tried to describe the natural history of the different types of epilepsy. The prevalence of all types of epileptic seizures (including febrile convulsions) has been found to be 2,441/100,000, whereas for patients with the diagnosis of epilepsy the rate is 1,274/100,000. The study describes the natural history of the different types of epilepsy. In addition, the risk‐increasing effect of a febrile convulsive seizure on the development of epilepsy is analyzed.

Neurological, electroencephalographic and neuropsychological examination of 53 former amateur boxers.

The purpose of the present study was to reveal possible neurological sequelae of amateur boxing after the introduction of modern medical supervision and safety precautions.

Electroencephalographic Alterations During Intoxication with Sodium Valproate:A Case Report

Summary: A case of severe valproic acid poisoning with coma and insufficient respiration is reported. The clinical condition and EEG changes are presented. The patient recovered completely, and the toxicity of sodium valproate to the brain and the liver in severe intoxication is discussed.

TREATMENT OF SPASTICITY BY SUBARACHNOID PHENOLGLYCERIN.

SINCE a number of British inve~tigatorsl-~ reported good effect on spasticity by intrathecal injection of phenol, the interest in this treatment has been great because it opened a possibility of relieving severe spasticity in patients in whom conservative therapy had proved inadequate. Viewed in relation to surgical measures for the relief of spasticity, the easy and rapid performance of this method, which does not add further stress to the often severely incapacitated patients, seems attractive. The interest taken in the method was further stimulated by the results of animal experiments4q5 which showed that phenol exerts a greater effect on thin than on thick fibers. The vigorous effect on the tonus-bearing gamma fibers 04 the anterior roots accompanied by a weaker effect on the alpha fibers mediating volitional motor control opened a possibility of appreciable relief of the spasticity without any essential increase in the degree of paresis. In 1961 we began to use subarachnoid injection of phenolglycerin in the treatment of severe spasticity of the legs, and, as the first results were promising,e we continued the treatment in selective cases. An account is given below both of the immediate effect of the phenol injections and of the results of a follow-up study, which gives a possibility of assessing the long-term effect and frequency of complications.

INTRATHECAL PHENOL IN THE TREATMENT OF SPASTICITY

Severe degrees of spasticity are relatively insusceptible to physical and medical therapy, for which reason destructive surgical or chemical measures may occasionally be indicated. In such cases, Nathan (1959) and Kelly Ci? Gautier-Smith (1959) successfully used intrathecal injection of phenol in an attempt to obtain chemical rhizotomy of the anterior roots by a method originally introduced by Muher (1955, 1957) for the relief of severe pain in incurable cancer. Animal experiments (Zggo C3 Wulsh 1960, Nathan €3 Sears 1960) have shown that small nerve fibres are more susceptible to the action of phenol than the large ones, and that the effect is reversible within certain limits. By a suitable quantitative action on the anterior roots by phenol it should therefore be possible selectively to block the small spasticity-mediating gamma fibres without a disturbance of voluntary movements by a simultaneous block of the large alpha motor fibres. In view of the clinical and experimental studies just mentioned we found it justified to make an attempt to damp the spasticity in human beings by a phenol block of the gamma system, and the experience so far gained in the treatment of paraplegic patients is reported below.

PSYCHOLOGICAL EVALUATION OF INTELLIGENCE AND PERSONALITY IN PARKINSONISM BEFORE AND AFTER STEREOTAXIC SURGERY

In a series of Parkinsonian patients subjected to stereotaxic surgery, the mental function was studied by means of psychological tests. The purpose was to throw light on the possible postoperative mental changes which together with fear of speech disturbances seem to be the most important contra‐indications for neurosurgical treatment. In the study, 41 patients operated on for Parkinsonism were subjected to preoperative and postoperative psychological tests (average observation period 8.7 months). Bilateral operation was performed in seven cases. The mean age of the patients was 60 years. The tests used were the Wechsler Adult Intelligence Scale and the Rorschach test. In the series as a whole, no significant quantitative changes in the postoperative mental function were revealed by the two tests. The Rorschach test revealed as an interesting finding that all the Parkinsonian patients preoperatively showed some mental reduction and that there was no significant difference between the patients with paralysis agitans and those with postencephalitic Parkinsonism. Slight postoperative changes, viz. a diminished and more rigid activity, were demonstrated in three clinical groups: patients subjected to operation on the globus pallidus, patients with postencephalitic Parkinsonism, and those with unilateral affection in the dominant hemisphere. The results of the study thus seem to indicate that a certain reluctance should be exercised in offering stereotaxic surgery to postencephalitic patients and to those with unilateral affection in the dominant hemisphere. Apart from this, it seems justified to conclude that in patients who otherwise meet the indications, the risk of postoperative mental impairment does not constitute a contra‐indication for this type of surgery.

Somatostatin in the treatment of patients with extrapyramidal disorders and patients with EEG abnormalities

The growth hormone release inhibiting hormone acts probably both as a true hypophysiotropic hormone and as a neuroregulatory substance. Neurophysiological studies have shown that somatostatin is a CNS depressant. Somatostatin might therefore be of therapeutic significance in neurological diseases.

NEUROLOGICAL BLADDER DYSFUNCTION

In many neurological disorders, difficulty in bladder control is a frequent complication. The treatment of this complication is of great importance in the neurological rehabilitation, since bladder dysfunction exerts an enormous influence on the daily life and social adjustment of the patient. In this paper, the various types of neurological bladder dysfunction are discussed in the light of cystometry, and anatomical and physiological aspects of the bladder and micturition forming the basis for the classification are considered.

Socio-medical problems of epileptics. A preliminary report.

Excluding disability pensioners and married women, a series of 736 adult epileptics revealed only 23 patients with occupational difficulties solely due to epilepsy. It was found that both the psychological constitution and the severity and type of epilepsy are of importance in the social adjustment of the patients.

Vocational training of epileptics.

In 52 patients, who during the period from 1945 to 1958 received financial support for vocational training from the Danish Disability Insurance Tribunal, this training was completed with success only in 16 (or 31%). The series seemed to be very suitable for rehabilitation, since all the patients had been closely examined and adjudged before any aid was granted. The results of the follow‐up study must therefore be said to be highly disappointing. Accordingly, strict criteria must be applied in the selection of epileptics who are to be admitted to the rehabilitation centres which will be established in this country (Denmark) in the near future.