Clinical Neuroscience

[Valium (Diazepam) effects on epileptic crises and certain epileptic mechanisms]

HALÁSZ P.1, MOLNÁR Gy.1, HIDASI J.1

SEPTEMBER 01, 1967

Clinical Neuroscience - 1967;20(09)

[In addition to the generally observed good effect, we observed one case in which Valium worsened the epileptic mechanism (case 6). This observation seems to contradict the many reports in the literature that Valium has a good effect in petit mal and spike-wave mechanism. However, a distinction should be made between the different spike-wave mechanisms. In our other patient (case 3) we also observed a beneficial effect of Valium in spike-wave mechanism. However, this latter case was a spike-wave variant, slow spike-wave pattern. However, our case 6 showed a classic 3 c/s spike-wave pattern with clinical absances. It is not clear from the literature whether Valium is effective in all 3 c/s spike-wave mechanisms. Further experience in this direction is needed. Apart from the neuroleptic effect, no other "side effects" were observed. ]

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  1. Debreceni Orvostudományi Egyetem Ideg-és Elmegyógyászati Klinikája

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Clinical Neuroscience

[Effect of anxiety on Achilles tendon reflex semi-relaxation time]

FEJÉR Arthur

[In states of anxiety, the duration of the f. r. i. of the Achilles reflex decreases, although the decrease rarely reaches the extent of the decrease in f. r. i. induced by hyperthyroidism. Both placebo injections and exam situations cause a decrease in f.r.i., but the latter effect is several times greater than the former. In a patient in a state of anxiety, 10 mg. Frenolone i.m. 1 hour after the sedative effect, a significant increase in f.r. i. is observed. This effect is significantly greater than that observed in normal controls after administration of the same dose of the drug. In hyperthyroid patients, the f.r. i. of 10 mg. Frenolone hardly alters the effect. The different behaviour of normal controls and hyperthyroid subjects from anxious patients is presumably due to the fact that Frenolone only favourably affects the central arousal associated with anxiety. During psychopharmacon therapy of anxious neurotic and psychotic patients, a gradual elongation of f.r. i. is observed as the patients calm down. This provides an opportunity to objectively monitor the effect of the therapy. ]

Clinical Neuroscience

[Data for the Autogen Training methodology and indicative questions]

KORONKAI Bertalan, HORVÁTH Szabolcs

[The authors outline the main factors involved in the development, practice and spread of AT. They briefly describe Schultz's classical method. They describe in more detail the methodology they developed, which they applied to groups of 6-10 patients and in which they attach great importance to suggestive support. They share their experience with AT treatment, which they find useful for AT indicatio: all personality types except H and I are suitable for learning the exercises. Of the psychic symptoms, mood disorders, feelings of insecurity, inner tension and anxiety in particular improved, and of the autonomic disorders, sweating, tremor, hypertension, enteral disturbances, insomnia and cephalgia responded most favourably. Based on their experience, they discuss the current and perspectivicus possibilities of AT in their department. In their opinion, a gradual diffusion of AT treatment can be expected due to its advantages over other psychotherapeutic methodologies and for the practical and theoretical reasons discussed. ]

Clinical Neuroscience

[Persistent expansive-productive confabulatory image after contusio cerebri]

POHL Ödön, HAITS Géza

[The authors describe a 35-year-old male patient who developed a specific expansive confabulosis after contusio cerebri, which persisted and even progressed after the other symptoms of amnestic syndrome had resolved. The patient was re-examined 21 months after his first admission: the confabulosis persisted and was embedded in the symptoms of personality development suggestive of post-traumatic encephalopathy. The authors refer to their previous communication describing the medical history of four of their patients. Their new case analysis confirms their earlier findings and provides a catamnestic data set for this rare form of posttraumatic confabulosis. ]

Clinical Neuroscience

[Diffuse demyelinating giant cell reticulomascoma metastases ]

ÉDER Mária

[In a circumscribed case of metastatic reticulum sarcoma, severe oedema and demyelination were observed in both hemispheres. In the clinical picture, local symptoms attributable to the direct effect of the tumour were accompanied by bilateral hemisphaerial white matter lesions. In all cases of brain tumours, but especially in sarcoma metastases, bilateral symptoms should be considered not only bilateral tumour formation but also bilateral white matter oedema-necrosis.]

Clinical Neuroscience

[On current problems in psychiatric methodology]

PETHŐ Bertalan

[Science is a systematically structured system. Today, the scientific status of psychiatry is threatened by the lack of a unified system for the many different views and schools of thought. The main reason for this critical situation is the lack of clarity of methodological problems. The methodological problem, taking into account its historical development, can be briefly outlined as follows. ]

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Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

Clinical Neuroscience

Cases of inborn errors of metabolism diagnosed in children with autism

CAKAR Emel Nafiye, YILMAZBAS Pınar

Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.

Clinical Neuroscience

[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]