We
e would like to dedicate this book to our families. To Nora Frenkiel, Emma, Alexander, Lenna and Martin Kaplan, and Donna Fisher Preface ix Acknowledgments xi Contributors xiii Introduction Approach to the Diagnosis of Possible Seizure 1 Robert T. Wechsler, MD, PhD and Robert S. Fisher, MD, PhD SECTION I GENERAL CONSIDERATIONS INVESTIGATION, ANATOMY, AND EPILEPTIC NONEPILEPTIC DIAGNOSTIC DILEMMAS 1. Electroencephalography in the Diagnosis of Nonepileptic and Epileptic Conditions 15 2....
Paroxysmal Torticollis
Torticollis is an abnormal sustained posture of the head and neck in which the head tilts to one side and the face rotates to the opposite side. In paroxysmal torticollis, the events begin and end suddenly. The attacks can be brief or prolonged. The child is alert and responsive during an attack although the patient may appear uncomfortable and irritable. The EEG is normal during the event. The etiology of the attacks is unknown, although both a focal dystonia and labyrinth dysfunction have...
Paul B Pritchard III MD
rolactin PRL is a peptide secreted II by acidophilic pituitary lactomorph I cells under the dual control of a dopaminergic prolactin inhibiting factor PIF and serotonergic prolactin releasing factor PRF . Thyrotropin releasing factor TRF promotes the release of PRL and thryrotopin TSH , whereas estrogen releases PRL via direct stimulation of the pituitary 1 . Normal adults exhibit little change in serum PRL during waking hours, except for brief elevations after naps 2 . Multiple nocturnal PRL...
Changes In Serum Prolactin With Brain Stimulation
The first recognition of episodic hyperprolactinemia induced by seizures were the observations of investigators 11 who were seeking endocrine profiles to predict which patients would benefit from a full course of electrocon-vulsive therapy ECT . Although endocrine changes did not predict the likelihood of successful ECT in women with depression, reproducible elevations in serum PRL followed ECT. ECT produces similar endocrine changes in schizophrenics 12,13 . Subsequent to the ECT reports,...
Paroxysmal Dyskinesia
In 1981, Lugaresi and Cirignota described a group of patients who had brief nocturnal episodes characterized by tonic or dystonic spasms and violent movements 36 . All had normal interictal and ictal EEGs, and all responded favorably to carbamazepine. The authors proposed three possible mechanisms for these events i pavor nocturnus ii epileptic seizure or iii paroxysmal dystonia. Similar cases, with many variations, have been described by others 37-40 , usually under the moniker, paroxysmal...
Vasovagal Syncope
Vasovagal syncope is the most familiar and predominant form of neurally mediated syncope. If classical reflex anoxic seizures with reflex asystolic syncope represent a fairly pure vagal attack, vasovagal syncope involves a vasodepressor component with variable vagal accompaniment. Episodes may begin in infancy, sometimes with reflex anoxic seizures, and thereafter are seen at all ages, becoming most dramatic perhaps in old age 21 . Tables in medical textbooks or works of epileptol-ogy tend to...
Benign Neonatal Sleep Myoclonus BNSM
The major importance of benign neonatal sleep myoclonus 92 is that it may be misdiagnosed as epilepsy and even treated with such heavy doses of antiepileptic medication that the neonate ends up in the intensive care unit on a ventilator 1 . Recognition is easy for someone who has seen a videotape of the condition in which the baby has repetitive, usually rhythmic but possibly arrhythmic, jerks of one or more limbs only during sleep. In some instances, there is a report of the occasional jerk in...
Gratification Including Infantile Masturbation and Stereotypies
More or less pleasurable behavior, apparently similar to masturbation, may be seen from infancy onwards, more so in preschool girls, but also in boys 78 . Rhythmic hip flexion and adduction may be accompanied by a distant expression and perhaps somnolence thereafter. Manual stimulation of the genitalia does not seem necessary. The diagnosis of infantile masturbation is more difficult when the infant or young child seems unhappy during the rhythmic movements. The relative frequency of events and...