V. A. Sironi

Interictal acute psychoses in temporal lobe epilepsy during withdrawal of anticonvulsant therapy.

Acute interictal psychotic attacks during withdrawal of medication are described in two patients with temporal lobe epilepsy submitted to depth EEG study with a view to surgical treatment. The patients were on chronic treatment with clonazepam associated in one with phenobarbitone and in the other with phenobarbitone plus carbamazepine. Our observations suggest that the acute withdrawal of clonazepam, the plasma levels of which were monitored may play a part in producing psychotic attacks characterised by dysphoric manifestations, irritability, aggressiveness, anxiety, and hallucinations. These symptoms could be interpreted as a withdrawal syndrome.

Sleepwalking in Italian Operas: A Window on Popular and Scientific Knowledge on Sleep Disorders in the 19th Century

There is little knowledge on sleepwalking in ancient times even though it is a very common condition. The aim of this report is to describe the backgrounds of medical knowledge on somnambulism in the 19th century, a key period in the development of neurosciences, by analysing its representation in two famous Italian operas: La Sonnambula by Vincenzo Bellini and Macbeth by Giuseppe Verdi. The 19th-century operas may be considered as a crossing point between the popular and intellectual world because they mirror popular answers to phenomena that were still awaiting scientific explanations. Shakespeare’s play Macbeth was also considered. In Shakespeare’s play and in Verdi’s Macbeth, sleepwalking is looked upon as a neuropsychiatric disorder, a manifestation of internal anxiety. In La Sonnambula by Bellini, this condition is considered as common disorder that anticipates scientific theories. The analysed Italian operas provide two different views on sleepwalking, probably because they are based on texts belonging to different periods. Their examination allows one to understand the gradual evolution of theories on sleepwalking, from demoniac possession to mental disorder and sleep disease. At the same time, this analysis throws some light on the history of psychological illnesses.

Arousal Effects of Electrical Deep Brain Stimulation in Hypnosis

Abstract In an earlier study, DeBenedittis and Sironi (1986) demonstrated that during depth EEC studies, electrophysiological correlates of hypnotic behavior emphasize the role of the limbic system in mediating the trance experience. In the case of a young man who was affected by medically resistant temporal lobe epilepsy and who was a potential candidate for surgical treatment, diagnostic depth EEG in hypnotic and non-hypnotic conditions offered a unique opportunity to stimulate limbic structures. This permitted an evaluation of the subjective and behavioral responses, as well as of the electrophysiological correlates. During hypnosis, repeated stimulations of the left and the right amygdala produced arousal from the hypnotic state each time, whereas the stimulation of other cerebral structures (e.g., temporal neocortex, Ammons horn) or pseudostimulations were ineffective on the hypnotic state. These data represent the first experimental, controlled evidence of the amygdalas effects on the arousal from...

Differences between the concentrations of antiepileptic drugs in normal and pathological human brain

SummaryThe concentrations of antiepileptic drugs in histologically normal and pathological brain tissues were investigated in 6 patients submitted to surgery. No significant difference for phenobarbital and phenytoin was found between normal and scar tissue, whereas there was a trend to concentration in tumour tissue (meningioma and glioma) of phenobarbital, phenytoin and carbamazepine. Alteration in the vascular supply and pathological changes at cellular and subcellular levels could be responsible for the differences in the distribution of the drugs. The possible clinical relevance of the preferential concentration of the drugs in tumour tissue is discussed.

Somnambulism in Verdi's Macbeth and Bellini's La Sonnambula

The arts can provide unique ways for determining how people not directly involved in medicine were viewing and informing others about physical and mental disorders. With operas, one need only think about how various perturbations of madness have been portrayed. Somnambulism has long been a particularly perplexing disorder, both to physicians and the laity, and it features in a number of operas. Two mid-nineteenth-century masterpieces are examined in detail in this contribution: Verdis Macbeth and Bellinis La Sonnambula. In the former, the sleepwalking scene is faithful to what Shakespeares had written early in the seventeenth century, a time of witchcraft, superstition, and the belief that nocturnal wanderings might be caused by guilt. In Bellinis opera, in contrast, the victim is an innocent girl who suffers from a quirk of nature, hence eliciting sympathy and compassion. By examining the early literature on somnambulism and comparing this disorder in these operas, we can see how thinking about this condition has changed and, more generally, how music was helping to generate new ways of thinking about specific diseases and medicine.

Depth-EEG in Stereotactic Biopsy

This paper presents the results of the use of depth electrode mapping of EEG signals in and around the lesions to be biopsied in 40 patients. The correlation between histological findings and depth-EEG patterns are discussed. Special emphasis is placed on cases with hypodense CT lesions which were usually large and confined to one or more cerebral lobes, did not enhance with contrast media, were angiographically silent, and manifested clinically with occasional epileptic fits.