Faculty Bibliography

Six patients with complex partial seizures in whom the first or most prominent manifestation was cardiovascular are described. 'Anginal pain,' which was usually atypical, developed in five patients (mean age 34), although three were admitted to coronary care units; sinus tachycardia developed in one, sinus bradycardia leading to syncope developed in one, and a cluster of symptoms suggestive of pheochromocytoma developed in one. The causal relationship between complex partial seizures and these symptoms is based on clinical history, electrodiagnostic studies indicating epilepsy (in five of six cases) without changes of myocardial ischemia, and response to anticonvulsant but not antianginal medications. Complex partial seizures that present with cardiovascular and other visceral symptoms represent an underdiagnosed, treatable disorder

While an increase in aggression has frequently been reported in association with temporal lobe epilepsy, the validity of this behavioral observation and the relationship of specific aggressive behavior to electrophysiologic abnormality in the human limbic system remain unclear. Case reports of five patients document the clinical importance of aggressive behavior, especially during the interictal period, in patients with temporal lobe epilepsy. Aggressiveness was often encountered together with other deepened emotions and changes in behavior previously described as an interictal behavior syndrome. Variations among the individual patients may clarify the neuroanatomical mechanisms leading to aggression and suggest specific therapeutic interventions

Alterations of the dopaminergic system are well documented in Gilles de la Tourette's syndrome (TS). Dopamine (DA)-receptor blockers often relieve symptoms, whereas DA agonists acutely exacerbate them. The cluster of symptoms and known localization of lesions in encephalitis lethargica (EL), together with studies on the anatomy of vocalization, suggest that damage to the periaqueductal gray and midbrain tegmentum may be involved in TS. Pharmacologic findings in patients with TS and EL suggest that oculogyric crises and obsessions are associated with diminished DA levels and the development of supersensitive DA receptors, and that tics occur when these receptors are stimulated

We reviewed all documented cases of spontaneous seizures that followed convulsive therapy. Nineteen studies provided information in 81 cases. The average annual incidence of spontaneous seizures was 114 per 100,000, 5 times more frequent than an age-adjusted nonpsychiatric cohort. Host susceptibility rather than treatment features influenced seizure development. A longer latency to first seizure was associated with greater likelihood of seizure recurrence, a relationship also observed in posttraumatic epilepsy

A man with a grade II astrocytoma in the medial frontal lobe exhibited complex partial seizures, with the aura being a feeling of extreme embarrassment. This previously unreported ictus suggests that an electric discharge in the prefrontal cortex may produce the opposite effect of prefrontal lesions, in which there is a lack of insight and an absence of the capacity for embarrassment

We have studied the effect of cyclophosphamide (CY) administration on the subsequent in vitro antibody response in the mouse. Treatment with a low dose (20 mg/kg) of CY four days before culture results in an increased IgM response to the T-independent antigen trinitrophenylated polyacrylamide (TNP-PAA), without affecting the background response of unstimulated cultures. This suggests that CY treatment eliminates a short-lived suppressor cell, involved in the regulation of the in vitro B cell response. In contrast, the same regimen decreases the ability of nude mouse spleen cells to respond to TNP-PAA, showing that the target of CY-enhancing effect is a mature T cell. The increased response observed in conventional mice should be the result of a balance between the direct suppressive effect of CY on B cells and the elimination of a suppresor T cell, the latter phenomenon being of predominant significance in our conditions. The target of CY-enhancing effect is nonadherent to plastic, but adherent to Sephadex G-10 columns