Hypersomnia associated with a focal pontine lesion.

A 50-year-old woman developed intractable excessive sleepiness after undergoing the surgical removal of a brainstem cholesteatoma. The 24-hour ambulatory monitoring revealed a normal architecture of sleep contents, with 62.7% of the time spent in sleep. Auditory and somatosensory evoked responses showed abnormal patterns. The MRI scan of her brain showed an extensive nonprogressive lesion in the brainstem. We speculate that the problem underlying the patient's hypersomnia is a defect in the ascending reticular activating system (ARAS) rather than in the REM and NREM sleep mechanisms.

Surgical treatment of epilepsy: three- to six-year follow-up of eleven patients with pharmacologically uncontrolled complex partial seizures.

There are an estimated 100,000 epileptic patients whose response to pharmacologic treatment is unsatisfactory. We report 11 patients with complex partial seizures who were selected for surgical treatment after adequate trials on antiepileptic medication failed. Immediate improvement-no further seizures or reduced frequency of occurrence and severity-was sustained at 3- to 6-year follow-up, and 7 patients were driving, 10 were working, and all were enjoying a better quality of life. Likely candidates for temporal lobectomy or resection of epileptogenic cerebral cortical lesions are those with a single focus of seizure discharge on video-EEG monitoring. If this focus is remote from language or motor areas, and if there is no interference with memory and recall after intracarotid amobarbital injection ipsilateral to the intended surgery, good results can be expected in the majority of such patients. We discuss patient selection and evaluation, and encourage surgical treatment where the indications can be established.

Cerebral cortical isolation in infantile neuroaxonal dystrophy.

Three patients with infantile neuroaxonal dystrophy (INAD, Seitelberger's disease) studied between ages 2 and 5 years, with the characteristic electroencephalographic pattern of high-voltage, fast (16-24 c/sec) rhythms and absence of reactivity on eye-opening or closure (Radermecker and Dumon-Radermecker 1972), also showed no changes in response to intermittent photic stimulation and absence of evoked potentials to flashes, clicks or median nerve stimuli. Although some theta rhythms and delta activity appeared during drowsiness and sleep, the fast rhythms persisted as the dominant feature. There were no central transients or K-complexes. When the patients cried, with hyperventilation, and also during breath-holding spells, slow rhythms appeared and the fast rhythm was reduced. These findings are interpreted as evidence of cerebral cortex isolation, the fast rhythm representing the spontaneous ("idling") activity of the cortex largely disconnected from subcortical or remote cortical influences by the slowly progressive, selective degeneration of axons, characteristic of the pathology of INAD, but the cortex remains responsive to chemical influences. These electrophysiological features become established furing the third year of age, prior EEGs being normal and later ones showing paroxysmal and other abnormal features in addition to the fast rhythm.

Electroencephalographic findings in patients with mild Parkinson's disease treated with L-dopa and placebo.

The prognostic value of electroencephalograms in patients with early or mild Parkinson's disease treated with L-dopa is discussed. Fifteen patients with early or mild Parkinson's disease were studied clinically and electroencephalographically while receiving L-dopa or placebo treatment. Only a low incidence (four patients, 27%) of EEG abnormality was found. These patients showed only mild improvement: in three cases, the improvement followed an initial worsening in the first three months. Only one (13%) of the patients with a normal EEG became worse or failed to improve. The potential use of EED data in parkinsonism is discussed.

Tuberculous meningitis in children during the isoniazid era.

Fifty-nine cases of tuberculous meningitis in children seen at the Charity Hospital at New Orleans since the addition of isoniazid to the therapy in 1952 are reviewed. Fourteen of the children died during hopsitalization. At discharge 21 children had complete or nearly complete clinical recovery. Follow-up of 21 available long-term survivors revealed a significant number with neurologic and social disabilities. The endemicity of tuberculous infections in the households of the children and factors responsible for transmission of tubercle bacilli from an adult source are reported. The importance of chemoprophylaxis and public health measures in eliminating this disease are stressed.