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Phamnguyen TJ, Szekely A, Swinburn S, Babu S, Boland-Freitas R, Reutens D, Wolfe N. Usefulness and yield of routine electroencephalogram: a retrospective study. Intern Med J 2023; 53:236-241. [PMID: 34611977 DOI: 10.1111/imj.15556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The electroencephalogram (EEG) is a common diagnostic tool used to investigate patients for various indications including seizure disorders. AIMS To investigate factors that predict the presence of epileptiform abnormalities on EEG and review the common indications for ordering an EEG. METHODS We retrospectively reviewed all routine adult EEG performed in a hospital over a 6-month period. Data collated included patient demographics, clinical indication for EEG, setting in which EEG was performed, activation procedures utilised, history of epilepsy, and whether the patient was on antiepileptic medication. Our primary objective was to evaluate the factors that were predictive of an EEG with epileptiform abnormalities. RESULTS Two hundred and thirty-nine routine EEG were included with indications, including first seizure (25.9%), known epilepsy (25.1%), cognitive change (15.9%), syncope (15.0%), movement disorder (6.7%), psychogenic non-epileptic events (5.4%), unresponsiveness/intensive care unit (4.6%) and psychiatric presentation (1.3%). Most (48.1%) EEG were normal; 8.9% of the EEG demonstrated epileptiform abnormalities. Using multivariate logistic regression, three variables proved significant in predicting an EEG with epileptiform abnormalities. Any seizure as an indication (first seizure or seizure in known epileptic), increasing patient age, and EEG conducted in an inpatient setting and within 48 h of seizure event were all statistically more likely to yield epileptiform abnormalities on EEG. CONCLUSIONS Our findings suggest that careful selection of patients based on appropriate indications for EEG referral would likely improve the yield of an EEG. Depending on the indication, a normal EEG result can be of similar usefulness to an abnormal EEG demonstrating epileptiform abnormalities.
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Affiliation(s)
- Thienan John Phamnguyen
- Neurology Department, Blacktown Hospital, Sydney, New South Wales, Australia.,Neurology Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Centre for Advanced Imaging, University of Queensland, Brisbane, Queensland, Australia
| | - Alison Szekely
- Neurology Department, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Samuel Swinburn
- Neurology Department, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Sangamithra Babu
- Neurology Department, Blacktown Hospital, Sydney, New South Wales, Australia.,Neurology Department, Westmead Hospital, Sydney, New South Wales, Australia
| | | | - David Reutens
- Neurology Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Centre for Advanced Imaging, University of Queensland, Brisbane, Queensland, Australia
| | - Nigel Wolfe
- Neurology Department, Blacktown Hospital, Sydney, New South Wales, Australia.,Neurology Department, Westmead Hospital, Sydney, New South Wales, Australia
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2
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Bhat A, Chen HHL, Khanna S, Mahajan V, Gupta A, Burdusel C, Wolfe N, Lee L, Gan GCH, Dobbins T, MacIntyre CR, Tan TC. Diagnostic And Prognostic Value Of Left Atrial Function In Identification Of Cardioembolism And Prediction Of Outcomes In Patients With Cryptogenic Stroke. J Am Soc Echocardiogr 2022; 35:1064-1076. [PMID: 35691457 DOI: 10.1016/j.echo.2022.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 05/15/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Strokes of undetermined source, commonly termed cryptogenic stroke (CS), account for a significant proportion of ischemic stroke etiology and have high rates of stroke recurrence. The heterogeneous etiology of CS makes decisions regarding treatment for such patients challenging. We sought to evaluate the diagnostic and prognostic value of left atrial (LA) function in identification of cardioembolism and prediction of outcomes in patients with CS. METHODS Consecutive patients admitted to our tertiary institution with ischemic stroke or transient ischemic attack (TIA) who underwent transthoracic echocardiography were recruited with comprehensive evaluation of LA metrics including LA strain. Ischemic strokes / TIAs were classified as non-cardioembolic, cryptogenic and cardioembolic. A total of 709 patients (66.0±15.1 years, 55% male) were recruited. 291 patients had CS, 189 had non-cardioembolic stroke and 229 had cardioembolic stroke. Patients with CS were followed for 20.0±13.8 months for recurrent ischemic stroke / TIA. RESULTS Receiver-operating characteristic curves showed LA reservoir (LASr) and contractile (LASct) strains to be strong discriminators of cardioembolic strokes and log rank tests showed both measures to be significantly associated with the distribution of time to recurrent ischemic stroke / TIA in patients with CS. Multivariable hazards models showed LASr and LASct to be independent predictors of recurrent ischemic stroke / TIA in CS patients in addition to eGFR and active smoking. CONCLUSIONS LASr and LASct were strong discriminators of cardioembolic stroke and independently predicted recurrent ischemic stroke / TIA in patients with CS. Use of LA strain may improve risk stratification and decision-making in patients with CS, with particular regards to prolonged ambulatory heart rhythm monitoring and/or empiric anticoagulation.
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Affiliation(s)
- Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Sydney, NSW 2148, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia; School of Medicine, Western Sydney University, Sydney, NSW 2148, Australia
| | - Henry H L Chen
- Department of Cardiology, Blacktown Hospital, Sydney, NSW 2148, Australia
| | - Shaun Khanna
- Department of Cardiology, Blacktown Hospital, Sydney, NSW 2148, Australia
| | - Vipul Mahajan
- Department of Cardiology, Blacktown Hospital, Sydney, NSW 2148, Australia
| | - Arnav Gupta
- Department of Cardiology, Blacktown Hospital, Sydney, NSW 2148, Australia
| | - Camelia Burdusel
- Stroke, Rehabilitation & Aged Care Services, Blacktown Hospital, Sydney, NSW 2148, Australia
| | - Nigel Wolfe
- Stroke, Rehabilitation & Aged Care Services, Blacktown Hospital, Sydney, NSW 2148, Australia
| | - Lina Lee
- Stroke, Rehabilitation & Aged Care Services, Blacktown Hospital, Sydney, NSW 2148, Australia
| | - Gary C H Gan
- Department of Cardiology, Blacktown Hospital, Sydney, NSW 2148, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia; School of Medicine, Western Sydney University, Sydney, NSW 2148, Australia
| | - Timothy Dobbins
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - C Raina MacIntyre
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, Sydney, NSW 2148, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia; School of Medicine, Western Sydney University, Sydney, NSW 2148, Australia.
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Martin AJ, Strathdee J, Wolfe N. Coexistent anti-GFAP and anti-MOG antibodies presenting with isolated meningitis and papillitis: more support for overlapping pathophysiology. BMJ Neurol Open 2022; 4:e000236. [PMID: 35402916 PMCID: PMC8948407 DOI: 10.1136/bmjno-2021-000236] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/04/2022] Open
Abstract
Background Anti-myelin oligodendrocyte glycoprotein (MOG)-associated disorders are heterogeneous and associated predominantly with central nervous system demyelination. Anti-glial fibrillar acidic protein (GFAP) conditions are much rarer and involve meningoencephalomyelitis with papillitis in addition to characteristic imaging findings and are generally a severe condition. Multiple autoantibodies can exist in patients and may support overlapping pathophysiological mechanisms. The co-occurrence of MOG and GFAP antibodies, however, is rare, with only two cases previously reported. Case A 53-year-old man presented with headache and fevers, with quick resolution, though with the later development of asymptomatic papillitis. He had a full recovery without the need for immunotherapy. He underwent extensive investigations and was found to have both anti-GFAP and anti-MOG antibodies in the cerebrospinal fluid. Extensive other immunological and infectious investigations were negative. Imaging was largely unremarkable. Conclusions This is the third case of overlapping anti-GFAP and anti-MOG antibody-associated syndrome of self-limited lymphocytic meningitis, serving to expand the phenotype. Clinicians should consider testing for GFAP and MOG antibodies in otherwise unexplained meningitis, particularly with associated papillitis. This case may also help provide future insights into the pathophysiology of each condition.
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Affiliation(s)
- Andrew J Martin
- Neurology Department, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - James Strathdee
- Neurology Department, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Nigel Wolfe
- Neurology Department, Blacktown Hospital, Blacktown, New South Wales, Australia
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Martin A, Brown DA, Wolfe N. Dengue-Associated Postinfectious Meningoencephalomyelitis With Positive Anti-GFAP Antibody. Neurol Clin Pract 2021; 11:e926-e928. [PMID: 34992985 DOI: 10.1212/cpj.0000000000000790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/05/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Andrew Martin
- Neurology Department (AM), Westmead Hospital, NSW, Australia; Sydney Medical School (AM), University of Sydney, NSW, Australia; ICPMR (DAB), NSW Health Pathology, Westmead Hospital, NSW, Australia; Westmead Institute for Medical Research (DAB), University of Sydney, NSW, Australia; and Neurology Department (NW), Blacktown Hospital, NSW, Australia
| | - David A Brown
- Neurology Department (AM), Westmead Hospital, NSW, Australia; Sydney Medical School (AM), University of Sydney, NSW, Australia; ICPMR (DAB), NSW Health Pathology, Westmead Hospital, NSW, Australia; Westmead Institute for Medical Research (DAB), University of Sydney, NSW, Australia; and Neurology Department (NW), Blacktown Hospital, NSW, Australia
| | - Nigel Wolfe
- Neurology Department (AM), Westmead Hospital, NSW, Australia; Sydney Medical School (AM), University of Sydney, NSW, Australia; ICPMR (DAB), NSW Health Pathology, Westmead Hospital, NSW, Australia; Westmead Institute for Medical Research (DAB), University of Sydney, NSW, Australia; and Neurology Department (NW), Blacktown Hospital, NSW, Australia
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5
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Bhat A, Mahajan V, Wolfe N. Implicit bias in stroke care: A recurring old problem in the rising incidence of young stroke. J Clin Neurosci 2021; 85:27-35. [PMID: 33581786 DOI: 10.1016/j.jocn.2020.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/02/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
Stroke is a leading cause of morbidity and mortality worldwide. Although the majority of strokes affect the elderly, the incidence of stroke in young patients is on the rise. Prompt recognition of stroke symptoms and time critical therapies play a key role in management and prognosis of this condition. This is especially critical in young stroke patients, for whom delays in early recognition and treatment can result in many years of disability with associated social and financial burden. Misdiagnosis and unwarranted variation in treatment of stroke in young patients is problematic. Clinician implicit bias, the unconscious and unintentional process of judgement in healthcare decision-making, is a contributor to the short-falls in outcomes in this population. Interventions in this process have been shown to improve clinical outcomes in young stroke patients and represent an active area of study.
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Affiliation(s)
- Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Sydney, NSW 2148, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Vipul Mahajan
- Department of Cardiology, Blacktown Hospital, Sydney, NSW 2148, Australia
| | - Nigel Wolfe
- Department of Neurology, Blacktown Hospital, Sydney, NSW 2148, Australia
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Bhat A, Chen H, Khanna S, Mahajan V, Gupta A, Burdusel C, Wolfe N, Lee L, Gan G, Dobbins T, MacIntyre C, Tan T. Diagnostic and Prognostic Value of Novel Echocardiographic Biomarkers in Identification of Cardioembolism and Prediction of Outcomes in Patients with Stroke of Undetermined Source. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wolfe N, Mitchell JD, Brown DL. P3584Optimal medical therapy improves survival in patients with ischaemic cardiomyopathy: an analysis of the STICH trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Prior studies have demonstrated underuse of optimal medical therapy (OMT) in patients with coronary artery disease (CAD) after revascularization. However, there are limited studies assessing compliance with OMT on long-term survival in patients with CAD and no studies evaluating the impact of OMT in patients with severe CAD and reduced left ventricular (LV) function. The Surgical Treatment for Ischaemic Heart Failure (STICH) Trial was a randomized clinical trial that compared coronary-artery bypass grafting (CABG) with medical therapy versus medical therapy alone in the treatment of ischemic cardiomyopathy.
Purpose
This study sought to determine compliance with OMT over time and the impact of OMT compliance on survival in patients with or without revascularization.
Methods
STICH was a multicenter, randomized clinical trial of patients with an LV ejection fraction of 35% or less and CAD amenable to CABG who were randomized to CABG plus medical therapy (N=610) or medical therapy alone (N=602). A medication history was obtained at hospital discharge or 30 days after enrollment, 1 year, 5 years, and 10 years. OMT was defined as the combination of at least 1 antiplatelet drug, a statin, a beta-blocker, and an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. The primary outcome was all-cause mortality. Comparison of mortality between the OMT and non-OMT groups was performed using multivariate Cox regression modeling with OMT as a time-dependent covariate.
Results
Of the 1212 patients randomized, at a median follow-up of 9.8 years, all-cause mortality was 58.9% in the CABG group and 66.1% in the medical therapy group. In the CABG arm, 63.6% of patients were on OMT throughout the study period compared to 66.5% of patients in the medical therapy arm (p=0.3). Those on OMT were younger (59.6 vs. 61.4 years, p<0.001); were more often in NYHA class I-II (67.4% vs. 56%, p<0.001); and lower rates of atrial fibrillation (9.4% vs. 18.1%, p<0.001), current smoking (18.6% vs. 24.5%, p=0.015), and depression (4.8% vs. 8.8%, p=0.005). Those on OMT had higher rates of hyperlipidemia (63.8% vs. 54.4%, p=0.001) and prior myocardial infarction (79.4% vs. 73.1%, p=0.01). There was no difference in sex, diabetes, and hypertension between those on OMT and non-OMT. In multivariate survival analysis, OMT was associated with a significant reduction in mortality (adjusted hazard ratio, 0.69; 95% confidence interval, 0.58–0.81; p<0.001). The treatment effect with OMT (31% relative reduction in mortality over 10 years) was numerically greater than the treatment effect of CABG (24% relative reduction in mortality with CABG versus medical therapy alone).
Conclusions
OMT improves long-term survival in patients with ischaemic cardiomyopathy regardless of revascularization status. Strategies to improve OMT use and adherence in this population is needed to maximize survival.
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Affiliation(s)
- N Wolfe
- Washington University School of Medicine, Cardiovascular Division, St. Louis, United States of America
| | - J D Mitchell
- Washington University School of Medicine, Cardiovascular Division, St. Louis, United States of America
| | - D L Brown
- Washington University School of Medicine, Cardiovascular Division, St. Louis, United States of America
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Nagaratnam S, Chang FCF, Tsui DS, Mahant N, Wolfe N, Kim SD, Ha AD, Griffith JM, Fung VSC. 034 Prospective study of 24-hour levodopa-carbidopa intestinal gel therapy for unresponsive freezing of gait. J Neurol Psychiatry 2019. [DOI: 10.1136/jnnp-2019-anzan.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionWe report a prospective, open-label study of 24-hour levodopa-carbidopa intestinal gel (LCIG) as treatment for levodopa ‘unresponsive’ freezing of gait (FOG) associated with Parkinson’s disease.Method14 patients with disabling FOG, documented as being levodopa ‘unresponsive’ following dose cycle assessment, were commenced on continuous 24-hour infusion LCIG therapy with the night-time rate at 50–80% of the daytime infusion rate. Patients underwent baseline and 6 months gait assessments, documentation of their falls frequency and completed FOG questionnaires. The statistical analysis was performed with SPSS 25 software (IBM), using Wilcoxon Signed Rank test and p < 0.05 was set as statistically significant.ResultThe fall frequency score reduced from 3 to 1 at 6 months (p=0.011), The FOG questionnaire was 19.3±1.5 at baseline and reduced to 16.0±1.7, at 6 months, respectively (p=0.039). The mean 360 degree turn time was not significantly changed (p=0.77). The daytime LCIG infusion rate was not significantly different before and after 24-hour LCIG therapy (p=0.315). 7 subjects developed visual hallucinations, one required temporary withdrawal from 24-hour LCIG, but as FOG worsened on 16-hour LCIG, he elected to recommence 24-hour LCIG infusion with improvement in FOG with a reduction in falls. 1 subject had postural hypotension which was ameliorated after adjustment of LCIG infusion rate.ConclusionWe provide further evidence that 24-hour LCIG therapy can reduce levodopa ‘unresponsive’ FOG and associated falls.
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Morales-Briceño H, Chang FCF, Wong C, Mallawaarachchi A, Wolfe N, Pellegrino da Silva R, Hakonarson H, Sandaradura SA, Guo Y, Christodoulou J, Lagopoulos J, Grattan-Smith P, Fung VSC. Paroxysmal dyskinesias with drowsiness and thalamic lesions in GABA transaminase deficiency. Neurology 2019; 92:94-97. [PMID: 30617166 DOI: 10.1212/wnl.0000000000006744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 10/02/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Hugo Morales-Briceño
- From the Movement Disorders Unit (H.M.-B., F.C., N.W., V.S.C.F.) and Epilepsy Unit (C.W.), Neurology Department, and Department of Clinical Genetics (A.M., S.A.S.), Westmead Hospital, Australia; Center for Applied Genomics (R.P.d.S., H.H., Y.G.), Children's Hospital of Philadelphia, PA; Discipline of Paediatrics and Child Health (S.A.S.) and Sydney Medical School (H.M.-B., F.C., V.S.C.F.), University of Sydney; Murdoch Children's Research Institute (J.C.), Melbourne; Department of Paediatrics (J.C.), Melbourne Medical School, University of Melbourne; Sunshine Coast Mind and Neuroscience (J.L.), Thompson Institute, University of the Sunshine Coast, Sippy Downs; and Department of Neurology (P.G.-S.), Children's Hospital at Westmead, Sydney, Australia
| | - Florence C F Chang
- From the Movement Disorders Unit (H.M.-B., F.C., N.W., V.S.C.F.) and Epilepsy Unit (C.W.), Neurology Department, and Department of Clinical Genetics (A.M., S.A.S.), Westmead Hospital, Australia; Center for Applied Genomics (R.P.d.S., H.H., Y.G.), Children's Hospital of Philadelphia, PA; Discipline of Paediatrics and Child Health (S.A.S.) and Sydney Medical School (H.M.-B., F.C., V.S.C.F.), University of Sydney; Murdoch Children's Research Institute (J.C.), Melbourne; Department of Paediatrics (J.C.), Melbourne Medical School, University of Melbourne; Sunshine Coast Mind and Neuroscience (J.L.), Thompson Institute, University of the Sunshine Coast, Sippy Downs; and Department of Neurology (P.G.-S.), Children's Hospital at Westmead, Sydney, Australia
| | - Chong Wong
- From the Movement Disorders Unit (H.M.-B., F.C., N.W., V.S.C.F.) and Epilepsy Unit (C.W.), Neurology Department, and Department of Clinical Genetics (A.M., S.A.S.), Westmead Hospital, Australia; Center for Applied Genomics (R.P.d.S., H.H., Y.G.), Children's Hospital of Philadelphia, PA; Discipline of Paediatrics and Child Health (S.A.S.) and Sydney Medical School (H.M.-B., F.C., V.S.C.F.), University of Sydney; Murdoch Children's Research Institute (J.C.), Melbourne; Department of Paediatrics (J.C.), Melbourne Medical School, University of Melbourne; Sunshine Coast Mind and Neuroscience (J.L.), Thompson Institute, University of the Sunshine Coast, Sippy Downs; and Department of Neurology (P.G.-S.), Children's Hospital at Westmead, Sydney, Australia
| | - Amali Mallawaarachchi
- From the Movement Disorders Unit (H.M.-B., F.C., N.W., V.S.C.F.) and Epilepsy Unit (C.W.), Neurology Department, and Department of Clinical Genetics (A.M., S.A.S.), Westmead Hospital, Australia; Center for Applied Genomics (R.P.d.S., H.H., Y.G.), Children's Hospital of Philadelphia, PA; Discipline of Paediatrics and Child Health (S.A.S.) and Sydney Medical School (H.M.-B., F.C., V.S.C.F.), University of Sydney; Murdoch Children's Research Institute (J.C.), Melbourne; Department of Paediatrics (J.C.), Melbourne Medical School, University of Melbourne; Sunshine Coast Mind and Neuroscience (J.L.), Thompson Institute, University of the Sunshine Coast, Sippy Downs; and Department of Neurology (P.G.-S.), Children's Hospital at Westmead, Sydney, Australia
| | - Nigel Wolfe
- From the Movement Disorders Unit (H.M.-B., F.C., N.W., V.S.C.F.) and Epilepsy Unit (C.W.), Neurology Department, and Department of Clinical Genetics (A.M., S.A.S.), Westmead Hospital, Australia; Center for Applied Genomics (R.P.d.S., H.H., Y.G.), Children's Hospital of Philadelphia, PA; Discipline of Paediatrics and Child Health (S.A.S.) and Sydney Medical School (H.M.-B., F.C., V.S.C.F.), University of Sydney; Murdoch Children's Research Institute (J.C.), Melbourne; Department of Paediatrics (J.C.), Melbourne Medical School, University of Melbourne; Sunshine Coast Mind and Neuroscience (J.L.), Thompson Institute, University of the Sunshine Coast, Sippy Downs; and Department of Neurology (P.G.-S.), Children's Hospital at Westmead, Sydney, Australia
| | - Renata Pellegrino da Silva
- From the Movement Disorders Unit (H.M.-B., F.C., N.W., V.S.C.F.) and Epilepsy Unit (C.W.), Neurology Department, and Department of Clinical Genetics (A.M., S.A.S.), Westmead Hospital, Australia; Center for Applied Genomics (R.P.d.S., H.H., Y.G.), Children's Hospital of Philadelphia, PA; Discipline of Paediatrics and Child Health (S.A.S.) and Sydney Medical School (H.M.-B., F.C., V.S.C.F.), University of Sydney; Murdoch Children's Research Institute (J.C.), Melbourne; Department of Paediatrics (J.C.), Melbourne Medical School, University of Melbourne; Sunshine Coast Mind and Neuroscience (J.L.), Thompson Institute, University of the Sunshine Coast, Sippy Downs; and Department of Neurology (P.G.-S.), Children's Hospital at Westmead, Sydney, Australia
| | - Hakon Hakonarson
- From the Movement Disorders Unit (H.M.-B., F.C., N.W., V.S.C.F.) and Epilepsy Unit (C.W.), Neurology Department, and Department of Clinical Genetics (A.M., S.A.S.), Westmead Hospital, Australia; Center for Applied Genomics (R.P.d.S., H.H., Y.G.), Children's Hospital of Philadelphia, PA; Discipline of Paediatrics and Child Health (S.A.S.) and Sydney Medical School (H.M.-B., F.C., V.S.C.F.), University of Sydney; Murdoch Children's Research Institute (J.C.), Melbourne; Department of Paediatrics (J.C.), Melbourne Medical School, University of Melbourne; Sunshine Coast Mind and Neuroscience (J.L.), Thompson Institute, University of the Sunshine Coast, Sippy Downs; and Department of Neurology (P.G.-S.), Children's Hospital at Westmead, Sydney, Australia
| | - Sarah Annabella Sandaradura
- From the Movement Disorders Unit (H.M.-B., F.C., N.W., V.S.C.F.) and Epilepsy Unit (C.W.), Neurology Department, and Department of Clinical Genetics (A.M., S.A.S.), Westmead Hospital, Australia; Center for Applied Genomics (R.P.d.S., H.H., Y.G.), Children's Hospital of Philadelphia, PA; Discipline of Paediatrics and Child Health (S.A.S.) and Sydney Medical School (H.M.-B., F.C., V.S.C.F.), University of Sydney; Murdoch Children's Research Institute (J.C.), Melbourne; Department of Paediatrics (J.C.), Melbourne Medical School, University of Melbourne; Sunshine Coast Mind and Neuroscience (J.L.), Thompson Institute, University of the Sunshine Coast, Sippy Downs; and Department of Neurology (P.G.-S.), Children's Hospital at Westmead, Sydney, Australia
| | - Yiran Guo
- From the Movement Disorders Unit (H.M.-B., F.C., N.W., V.S.C.F.) and Epilepsy Unit (C.W.), Neurology Department, and Department of Clinical Genetics (A.M., S.A.S.), Westmead Hospital, Australia; Center for Applied Genomics (R.P.d.S., H.H., Y.G.), Children's Hospital of Philadelphia, PA; Discipline of Paediatrics and Child Health (S.A.S.) and Sydney Medical School (H.M.-B., F.C., V.S.C.F.), University of Sydney; Murdoch Children's Research Institute (J.C.), Melbourne; Department of Paediatrics (J.C.), Melbourne Medical School, University of Melbourne; Sunshine Coast Mind and Neuroscience (J.L.), Thompson Institute, University of the Sunshine Coast, Sippy Downs; and Department of Neurology (P.G.-S.), Children's Hospital at Westmead, Sydney, Australia
| | - John Christodoulou
- From the Movement Disorders Unit (H.M.-B., F.C., N.W., V.S.C.F.) and Epilepsy Unit (C.W.), Neurology Department, and Department of Clinical Genetics (A.M., S.A.S.), Westmead Hospital, Australia; Center for Applied Genomics (R.P.d.S., H.H., Y.G.), Children's Hospital of Philadelphia, PA; Discipline of Paediatrics and Child Health (S.A.S.) and Sydney Medical School (H.M.-B., F.C., V.S.C.F.), University of Sydney; Murdoch Children's Research Institute (J.C.), Melbourne; Department of Paediatrics (J.C.), Melbourne Medical School, University of Melbourne; Sunshine Coast Mind and Neuroscience (J.L.), Thompson Institute, University of the Sunshine Coast, Sippy Downs; and Department of Neurology (P.G.-S.), Children's Hospital at Westmead, Sydney, Australia
| | - Jim Lagopoulos
- From the Movement Disorders Unit (H.M.-B., F.C., N.W., V.S.C.F.) and Epilepsy Unit (C.W.), Neurology Department, and Department of Clinical Genetics (A.M., S.A.S.), Westmead Hospital, Australia; Center for Applied Genomics (R.P.d.S., H.H., Y.G.), Children's Hospital of Philadelphia, PA; Discipline of Paediatrics and Child Health (S.A.S.) and Sydney Medical School (H.M.-B., F.C., V.S.C.F.), University of Sydney; Murdoch Children's Research Institute (J.C.), Melbourne; Department of Paediatrics (J.C.), Melbourne Medical School, University of Melbourne; Sunshine Coast Mind and Neuroscience (J.L.), Thompson Institute, University of the Sunshine Coast, Sippy Downs; and Department of Neurology (P.G.-S.), Children's Hospital at Westmead, Sydney, Australia
| | - Padraic Grattan-Smith
- From the Movement Disorders Unit (H.M.-B., F.C., N.W., V.S.C.F.) and Epilepsy Unit (C.W.), Neurology Department, and Department of Clinical Genetics (A.M., S.A.S.), Westmead Hospital, Australia; Center for Applied Genomics (R.P.d.S., H.H., Y.G.), Children's Hospital of Philadelphia, PA; Discipline of Paediatrics and Child Health (S.A.S.) and Sydney Medical School (H.M.-B., F.C., V.S.C.F.), University of Sydney; Murdoch Children's Research Institute (J.C.), Melbourne; Department of Paediatrics (J.C.), Melbourne Medical School, University of Melbourne; Sunshine Coast Mind and Neuroscience (J.L.), Thompson Institute, University of the Sunshine Coast, Sippy Downs; and Department of Neurology (P.G.-S.), Children's Hospital at Westmead, Sydney, Australia
| | - Victor S C Fung
- From the Movement Disorders Unit (H.M.-B., F.C., N.W., V.S.C.F.) and Epilepsy Unit (C.W.), Neurology Department, and Department of Clinical Genetics (A.M., S.A.S.), Westmead Hospital, Australia; Center for Applied Genomics (R.P.d.S., H.H., Y.G.), Children's Hospital of Philadelphia, PA; Discipline of Paediatrics and Child Health (S.A.S.) and Sydney Medical School (H.M.-B., F.C., V.S.C.F.), University of Sydney; Murdoch Children's Research Institute (J.C.), Melbourne; Department of Paediatrics (J.C.), Melbourne Medical School, University of Melbourne; Sunshine Coast Mind and Neuroscience (J.L.), Thompson Institute, University of the Sunshine Coast, Sippy Downs; and Department of Neurology (P.G.-S.), Children's Hospital at Westmead, Sydney, Australia.
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Duma SR, Mahant N, Ha A, Kim S, Phu A, Stewart K, Waugh MC, Wolfe N, Russell DC, Owler B, Krause M, Fung VSC. 078 Deep brain stimulation (DBS) for dyskinetic cerebral palsy: a pilot study. J Neurol Psychiatry 2018. [DOI: 10.1136/jnnp-2018-anzan.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
IntroductionDeep brain stimulation (DBS) targeting the internal segment of the globus pallidus (GPi) is effective for several forms of dystonia, particularly idiopathic isolated dystonia. DBS may also be helpful for some causes of chorea and other hyperkinetic disorders. A minority of people with cerebral palsy (CP) have dystonia or choreoathetoid movements (labelled dyskinetic CP). Treatment options to improve function for this group are limited. We aimed to investigate whether DBS is effective in reducing symptoms and improving function in dyskinetic CP.MethodsThis study was a randomised, placebo-controlled, double-blinded, crossover trial. Four participants (2M:2F, aged 11–48 year) with dyskinetic CP were included between 2010–2011. Participants underwent GPi DBS implantation and were randomised to active or sham stimulation for 3 months, following which their DBS stimulation was switched for a further 3 months. The Bourke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used to rate the severity of dystonia at baseline, 3 months after initial treatment; and 3 months after crossover treatment. The study was terminated early due to slow recruitment.ResultsOne participant had a reduction in BFMDRS score with active stimulation; this participant was the oldest and had the mildest BFMDRS score. The remainder of the participants had either no change or a slight increase in BFMDRS score. Despite this, in longer-term follow-up, 3 participants reported symptomatic improvement and continue active DBS treatment 7–8 years post-surgery.ConclusionWe did not identify a benefit of GPi DBS for dyskinetic CP in our randomised controlled trial. However, 3 participants have had symptomatic improvement on long-term follow-up, consistent with other reports of benefit with GPi DBS. Limiting factors of the study include small sample size, participant heterogeneity and study design. It was noted that the final (efficacious) stimulation parameters required open label programming to achieve and were outside of those permitted by the protocol.
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12
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Abstract
Ocular flutter is a dramatic clinical sign that poses multiple diagnostic considerations. The case description outlines a well young male that presented with ocular flutter and truncal ataxia. The clinical syndrome was subsequently attributed to enteroviral rhombencephalitis. The mechanism and neuroanatomical correlates are discussed, and potential treatments considered.
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Affiliation(s)
- Michael Fong
- Department of Neurology, Blacktown Hospital, Blacktown, NSW, Australia; Blacktown Clinical School, University of Western Sydney, Blacktown, NSW, Australia; Department of Neurology, Prince of Wales Hospital, Randwick, NSW, Australia.
| | - Sangamithra Babu
- Department of Neurology, Blacktown Hospital, Blacktown, NSW, Australia
| | - Nigel Wolfe
- Department of Neurology, Blacktown Hospital, Blacktown, NSW, Australia
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14
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Ghose A, Nordal R, Lim G, Wolfe N, Easaw J, Husain S. Patterns of Tumor Recurrence following Concurrent Radiation and Temozolomide Treatment for Glioblastoma Multiforme. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Pearce A, Wolfe N, Wright P, Angyalfi S. CT Based Planning for Stage I Seminoma: The Importance of Coverage of the Ipsilateral Psoas. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.1061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Taylor M, Wolfe N, Lau H, Hayashi R. 167 Time is money: A comparative time and motion study of intensity modulated radiation therapy versus three dimensional conformal radiation therapy for head and neck cancer. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80908-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Pudney D, Wolfe N, Trotter T, Craighead P, Dunscombe P. 50 A comparative study of four planning techniques for irradiation of the whole breast. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80791-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Pollack RJ, Kiszewski A, Armstrong P, Hahn C, Wolfe N, Rahman HA, Laserson K, Telford SR, Spielman A. Differential permethrin susceptibility of head lice sampled in the United States and Borneo. Arch Pediatr Adolesc Med 1999; 153:969-73. [PMID: 10482215 DOI: 10.1001/archpedi.153.9.969] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Pediculiasis is treated aggressively in the United States, mainly with permethrin- and pyrethrin-containing pediculicides. Increasingly frequent anecdotal reports of treatment failure suggest the emergence of insecticidal resistance by these lice. OBJECTIVE To confirm or refute the susceptibility of head lice sampled in the United States to permethrin. DESIGN Survey. Head lice were removed from children residing where pediculicides are readily available and where such products are essentially unknown. Their survival was compared following exposure to residues of graded doses of permethrin in an in vitro bioassay. SETTING School children from Massachusetts, Idaho, and Sabah (Malaysian Borneo). SUBJECTS In the United States, 75 children aged 5 to 8 years. In Sabah, 59 boys aged 6 to 13 years. Virtually all sampled US children had previously been treated with pediculicides containing pyrethrins or permethrin; none of the Sabahan children were so exposed. MAIN OUTCOME MEASURE Survival of head lice exposed to permethrin. RESULTS Permethrin did not affect head lice sampled from chronically infested US children who had previously been treated for pediculiasis. The slope of the dose-response regression line for these lice did not differ significantly from zero (P = .66). This pediculicide immobilized lice sampled in Sabah. Mortality correlated closely with permethrin concentration (P = .008). CONCLUSIONS Head lice in the United States are less susceptible to permethrin than are those in Sabah. The pyrethroid susceptibility of the general population of head lice in the United States, however, remains poorly defined. Accordingly, these relatively safe over-the-counter preparations may remain the pediculicides of choice for newly recognized louse infestations.
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Affiliation(s)
- R J Pollack
- Harvard School of Public Health, Boston, Mass. 02115, USA.
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19
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Abstract
Eighteen patients with Alzheimer's disease were studied with positron emission tomographic measurements of regional cerebral metabolism of glucose. All patients were initially diagnosed and evaluated, underwent positron emission tomography, and then were followed with annual reevaluations, at which time the Mini-Mental State Examination (MMSE) was performed. Patients were followed for an average of 2.5 years, and the rate of cognitive decline was calculated by determining the rate of change in the MMSE score defined as the MMSE score at the initial evaluation minus the MMSE score at the last examination, divided by the number of months between testing. The regional cerebral metabolic rates for glucose determined at the time of the first MMSE were then regressed on these changes in scores. Results showed that glucose metabolic rates in posterior temporal and primary visual cortex regions were significantly correlated with the subsequent rate of cognitive deterioration. These associations were not confounded by age, length of follow-up, baseline MMSE score, or education. Stratification on gender suggested that these associations were much stronger in women than in men. These results replicate previous findings showing that functional brain imaging is predictive of the rate of cognitive decline in Alzheimer's disease.
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Affiliation(s)
- W J Jagust
- Department of Neurology, University of California, Davis, USA
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20
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Wolfe N, Reed BR, Eberling JL, Jagust WJ. Temporal lobe perfusion on single photon emission computed tomography predicts the rate of cognitive decline in Alzheimer's disease. Arch Neurol 1995; 52:257-62. [PMID: 7872878 DOI: 10.1001/archneur.1995.00540270049018] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To examine the ability of relative regional cerebral blood flow as measured by single photon emission computed tomography to predict longitudinal course of cognitive decline in Alzheimer's disease. DESIGN Single photon emission computed tomography using the blood flow tracer 123I-N-isopropyl-p-iodoamphetamine was performed at initial evaluation and was used to predict the rate of cognitive decline over a follow-up period from 1 to 4 years. SETTING Outpatient university dementia clinic and center for functional imaging. PARTICIPANTS Twenty-nine patients met National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for probably or possible AD. RESULTS Temporal lobe regional cerebral blood flow ratio at initial evaluation correlated with rate of decline in Mini-Mental State Examination over the longitudinal follow-up. Temporal regional cerebral blood flow ratio also predicted rate of decline of specific memory measures on the California Verbal Learning Test. Neither parietal nor frontal ratios predicted rate of cognitive decline. Dorsolateral frontal hypoperfusion was associated with the emergence of perseverative behaviors over time. Age, prior dementia duration, estimated prior rate of decline, and initial severity did not predict rate of cognitive decline. CONCLUSION Results suggest that regional perfusion on single photon emission computed tomography may predict cognitive decline in Alzheimer's disease better than these demographic and course variables.
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Affiliation(s)
- N Wolfe
- Department of Neurology, University of California, Davis-Northern California Alzheimer's Disease Center, Berkeley
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21
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Abstract
Performance profiles of patients with different dementia syndromes (Alzheimer's disease and Parkinson's disease) were compared with each other and with those of neurologically impaired and healthy individuals without dementia on a new instrument for screening dementia, the Cross-Cultural Cognitive Examination (CCCE). The CCCE measures discriminated reliably between nondemented and demented patients, regardless of etiology. Comparisons between dementia groups found that dementia patients with Parkinson's disease (PD) showed more severe psychomotor slowing and depression, compared with patients with Alzheimer's disease, who showed more impaired recall of recently learned verbal information and verbal abstract reasoning. The CCCE also distinguished between the motor and affective symptoms that are common to all PD patients and the dementia symptoms that occur in some PD patients. These results provide further support for the clinical utility of the CCCE for discriminating dementia from normal cognitive functioning and for initial identification of different dementia syndromes.
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Affiliation(s)
- G Glosser
- Department of Neurology, Graduate Hospital, Philadelphia, Pennsylvania 19146
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22
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Abstract
There have been several reports of decreased regional cerebral metabolic rates for glucose (rCMRglc) in Parkinson's disease (PD), although others find no differences between PD patients and controls. Differences in the cognitive status of the PD patients may account for some of these inconsistencies. We report the results of a PET study using 18F-fluorodeoxyglucose (FDG) to measure rCMRglc in eight nondemented PD patients, six of whom were receiving dopaminergic medications, and eight age-matched control subjects. We scanned one tomographic level through the temporal lobes that included both temporal neocortex and mesial temporal cortex, and one tomographic level through the basal ganglia that included frontal and parietal cortex. Previously determined rate constants and an operational equation were used to determine rCMRglc. On average, rCMRglc values were 23% below control values for all regions studied, with the greatest differences in posterior brain regions (visual association cortex, primary visual cortex, and parietal cortex) and thalamus. These results indicate that PD patients may show neocortical hypometabolism, especially in posterior brain regions, in the absence of any demonstrable cognitive deficits.
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Affiliation(s)
- J L Eberling
- Department of Neurology, University of California, Davis
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Abstract
OBJECTIVE The goal of this study was to characterize the cumulative effects of multiple strokes on cognition. DESIGN We conducted a prospective, longitudinal case study with neuropsychological, neurological, and radiological evaluations. SETTING Research was conducted at the Boston (Mass) Veterans Administration Medical Center, Neurology Service, on successive inpatient hospital admissions. PATIENT We followed up a 66-year-old right-handed man with multiple subcortical lacunae during a 3.5-year period during which he suffered two additional cortical infarctions. MAIN OUTCOME MEASURES Each evaluation included approximately 3 hours of neuropsychological testing spanning a range of cognitive domains (attention, language, memory, visuospatial functions, response inhibition, and mental flexibility), full neurological examination, and computed tomographic scan. RESULTS The patient's stepwise cognitive decline was characterized by unexpected exacerbation of "frontal" neurobehavioral features following the occurrence of two posterior cortical lesions. At initial evaluation, the computed tomographic scan showed bilateral subcortical lacunae in basal ganglia and periventricular white matter, and symptoms included dysarthria and perseveration. The second evaluation, following a left posterior parietal lesion, revealed a range of new frontal features, including impulsivity, pull-to-stimulus, and difficulty shifting set. Following a subsequent right occipital infarct, further frontal lobe impairments emerged: forced grasp reflex and incontinence. CONCLUSIONS We hypothesize that the cumulative effects of infarcts were synergistic. That is, the posterior cortical infarcts elicited frontal features that would not be expected from a simple sum of these lesions' effects.
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Affiliation(s)
- N Wolfe
- Department of Neurology, University of California at Davis, School of Medicine, Berkeley
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Glosser G, Wolfe N, Albert ML, Lavine L, Steele JC, Calne DB, Schoenberg BS. Cross-cultural cognitive examination: validation of a dementia screening instrument for neuroepidemiological research. J Am Geriatr Soc 1993; 41:931-9. [PMID: 8409180 DOI: 10.1111/j.1532-5415.1993.tb06758.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Validation of a new instrument for screening dementia, the Cross Cultural Cognitive Examination (CCCE), is described. DESIGN Criterion and concurrent validation and cross-cultural comparison of a new instrument. PARTICIPANTS All individuals over the age of 40 in a village in southern Guam participated in a door-to-door survey. Alzheimer's and Parkinson's Disease patients and healthy controls aged 40-90 participated in the US mainland study. MEASUREMENTS The CCCE was administered to all subjects. Effects of age, language, education, and gender on test performances and social-cultural differences were assessed. Concurrent validation of the test with respect to other well accepted screening instruments was determined. RESULTS High specificity (> 94%) and sensitivity (> 99%) for detecting dementia were found in Guam and US mainland samples, and these were not biased by differences in gender, linguistic preference, education, or cultural background. Sensitivity and specificity of the CCCE matched or exceeded that of already accepted dementia screening instruments. CONCLUSIONS These validation studies support the usefulness of the CCCE for identifying patients with generalized dementia, rather than focal types of cognitive impairment, quickly and reliably in cross-cultural neuroepidemiological research.
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Affiliation(s)
- G Glosser
- Department of Neurology, Boston University School of Medicine, Massachusetts
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26
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Wolfe N, Imai Y, Otani C, Nagatani H, Hasegawa K, Sugimoto K, Tanaka Y, Kuroda Y, Glosser G, Albert ML. Criterion validity of the cross-cultural cognitive examination in Japan. J Gerontol 1992; 47:P289-91. [PMID: 1624708 DOI: 10.1093/geronj/47.4.p289] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Criterion validity of a two-stage Cross-Cultural Cognitive Examination (CCCE) designed for epidemiologic use was evaluated in Japanese subjects by comparison with a physician's DSM-III-R diagnosis of dementia and the Hasegawa Dementia Rating Scale (the standard Japanese instrument similar to the Mini-Mental State Exam). We report on 188 subjects tested in three locations in Japan: Tokyo area, Ise, and Osaka. Subjects ranged in age (50-93 years) and education (1-22 years) and included neurology outpatients, community volunteers, and inpatients. The CCCE was 97.4% specific for dementia, with sensitivity of 88%. The correlation with the Hasegawa scale was significant (r(175) = .8230, p less than .0001). Diagnosis using the CCCE showed good validity when compared with Japanese criteria for dementia. If the instrument could be shown to be reliable and more "culture fair" than the currently available tests, it may be useful in cross-cultural epidemiologic studies of dementia.
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Affiliation(s)
- N Wolfe
- University of California, Davis-Northern California Alzheimer's Disease Center, Alta Bates Medical Center, Berkeley
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27
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Wolfe N, Katz DI, Albert ML, Almozlino A, Durso R, Smith MC, Volicer L. Neuropsychological profile linked to low dopamine: in Alzheimer's disease, major depression, and Parkinson's disease. J Neurol Neurosurg Psychiatry 1990; 53:915-7. [PMID: 2266376 PMCID: PMC488258 DOI: 10.1136/jnnp.53.10.915] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A distinct pattern of neuropsychological deficits was associated with low homovanillic acid (HVA) in the cerebrospinal fluid of 21 patients with: Alzheimer's disease (9), Parkinson's disease (8) and major depressive disorders (4). Regardless of clinical diagnosis, patients with low HVA were slower on a test of efficiency of processing timed information, and showed greater benefit from semantic structure on a verbal fluency task than patients with high HVA. However, low HVA subjects were not significantly impaired on confrontation naming (Boston Naming Test). Across three diagnostic groups, patients with lower HVA also tended to have more extrapyramidal motor signs and were significantly more depressed. These results demonstrate a significant relationship between specific neuro-behavioural deficits and dopaminergic activity which cuts across traditional diagnostic categories.
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Affiliation(s)
- N Wolfe
- Department of Neurology, Boston University School of Medicine, Massachusetts
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Abstract
Consensus has not been achieved regarding the impact of multiple cerebral infarcts on neurobehavioral status. To evaluate cognitive function in patients with multiple cerebral infarcts, we administered a comprehensive neuropsychological test battery to 23 consecutive male patients with clinical and brain computed tomographic findings consistent with at least two separate areas of cerebral infarction. Based on brain computed tomographic findings, patients were classified as having either mixed (n = 12) or lacunar (n = 11) infarcts. Results of these two groups were compared with those of 11 age-, sex-, and education-matched controls with no clinical or brain computed tomographic evidence of cerebrovascular disease. The mixed group had significantly lower mean scores than the controls for every cognitive domain tested. The lacune group showed cognitive impairment on most neuropsychological measures but did not differ from the controls in the attention domain. Although some degree of cognitive impairment was detected by the neuropsychological test battery in virtually every patient, only seven of 23 (30%) had Mini-Mental State Examination scores indicating dementia (less than 24). We conclude that virtually every patient with multiple cerebral infarcts has some degree of cognitive impairment but that only a minority can be classified as demented if the Mini-Mental State Examination is used as the primary defining examination.
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Affiliation(s)
- V L Babikian
- Department of Neurology, Boston University School of Medicine, Massachusetts
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Abstract
To characterize cognitive impairments following multiple subcortical lacunar infarcts (lacunes), we prospectively compared the neuropsychological performance of 11 subjects with multiple lacunes with 11 medical control subjects matched for age and education who had no clinical or computed tomographic evidence of central nervous system disease. Subjects with multiple subcortical lacunes displayed neuropsychological signs of frontal system dysfunction, even though only 27% met the criteria for clinical diagnosis of dementia. They exhibited significant deficits in shifting mental set, response inhibition, and executive function. In addition, they were more often rated apathetic on a behavior-rating scale. We propose a continuum of cognitive impairments in lacunar states, ranging from frontal systems impairment to dementia.
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Affiliation(s)
- N Wolfe
- Department of Neurology, Boston University School of Medicine, MA
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Wolfe N, Gelenberg AJ, Lydiard RB. Alpha 2-adrenergic receptor sensitivity in depressed patients: relation between 3H-yohimbine binding to platelet membranes and clonidine-induced hypotension. Biol Psychiatry 1989; 25:382-92. [PMID: 2539204 DOI: 10.1016/0006-3223(89)90191-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Alpha 2-adrenergic receptor changes during antidepressant treatment were studied using 3H-yohimbine binding to human platelet membranes and clonidine-induced hypotension. Twenty-six patients with major depressive disorder (MDD) participated for 4-6 weeks in a trial of imipramine (2.5 mg/kg/day), tyrosine (100 mg/kg/day), or placebo. Alpha 2-adrenergic receptors measured by 3H-yohimbine binding were not significantly changed following antidepressant treatment. Similarly, clonidine-induced hypotension did not differ significantly following treatment. No measure of alpha 2-adrenergic receptor sensitivity was significantly correlated with clinical improvement. The correlation between platelet receptor binding and clonidine-induced hypotension was not statistically significant, even though both tests are considered to be measures of alpha 2-adrenoceptor sensitivity.
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Affiliation(s)
- N Wolfe
- Department of Psychology, Harvard University Cambridge, MA 02138
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31
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Rainero I, Kaye JA, May C, Durso R, Katz DI, Albert ML, Wolfe N, Pinessi L, Friedland RP, Rapoport SI. Alpha-melanocyte-stimulating hormonelike immunoreactivity is increased in cerebrospinal fluid of patients with Parkinson's disease. Arch Neurol 1988; 45:1224-7. [PMID: 2847695 DOI: 10.1001/archneur.1988.00520350062017] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We measured alpha-melanocyte-stimulating hormonelike immunoreactivity in cerebrospinal fluid of 12 healthy control subjects and nine patients with Parkinson's disease, four of whom had never been treated. Mean cerebrospinal fluid alpha-melanocyte-stimulating hormonelike immunoreactivity concentration was two-fold greater in parkinsonian patients (44.1 +/- 9.3 [SD] pg/mL) as compared with control subjects (21.8 +/- 10.0 pg/mL). No significant correlation was found between cerebrospinal fluid alpha-melanocyte-stimulating hormonelike immunoreactivity concentrations and patient age, disease severity, or duration of disease. These results suggest a functional relation between dopaminergic and melanotropinergic systems in the human brain.
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Affiliation(s)
- I Rainero
- Laboratory of Neurosciences, National Institute on Aging, Bethesda, Md 20892
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Abstract
Specific binding to alpha 2-adrenergic receptors was studied in the platelets of 31 patients with major depressive disorder and 18 normal controls using the selective antagonist 3H-yohimbine. Receptor density for depressed patients (Bmax = 88 +/- SD 45.1 fmoles/mg) was not significantly lower than that for controls (124 +/- SD 78.1 fmoles/mg). The affinity of the receptor for yohimbine was significantly greater in depressed patients (Kd = 1.05 +/- SD 0.47 nM) than in controls (Kd = 1.47 +/- SD 0.63 nM). This is consistent with the hypothesis of increased alpha 2-adrenergic receptor sensitivity in depressive disorders. Past studies of alpha 2-adrenergic receptors on platelets are reviewed, and the importance of designing studies with sufficient statistical power is discussed.
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Keller MB, Shapiro RW, Lavori PW, Wolfe N. Recovery in major depressive disorder: analysis with the life table and regression models. Arch Gen Psychiatry 1982; 39:905-10. [PMID: 7103679 DOI: 10.1001/archpsyc.1982.04290080025004] [Citation(s) in RCA: 194] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Regression models and life tables were used to describe the phenomenon of recovery from major depressive disorder for 101 patients in a naturalistic study in which treatment was not controlled by the investigators. Time to recovery from the onset of the episode was protracted, as only about 50% of patients recovered by one year. Annual rates of recovery then declined steadily to 28% in the second year, 22% in the third year, and 18% in the fourth year. In contrast, speed of recovery from entry into the study was more rapid, and 63% of patients recovered by four months. The recovery rates were about 20% each month for the first four months and then declined sharply for the remaining months of the one-year follow-up. Several clinical variables were statistically significant predictors of recovery when measured from entry into the study: superimposition of the acute episode on a chronic underlying depression, acuteness of onset of he depression, and severity of depression for the subgroup of patients without superimposed illness.
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Abstract
With the use of life tables to describe time while patients were well and subsequent rates of relapse for 75 patients after their recovery from an episodes of major depressive disorder in naturalistic study, a high risk of relapse was detected shortly after recovery. Twenty-four percent of patients relapsed within 12 weeks at risk, and 12% of patients relapsed with four weeks at risk. The presence of an underlying chronic depression and three or more previous affective episodes predicted a statistically significant increase in the rate of relapse. These data were used to develop an exponential model of relapse probability for a subgroup of the study population.
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