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2.
J Neurol Neurosurg Psychiatry ; 56(11): 1217-8, 1993 Nov.
Article in English | MEDLINE | ID: mdl-8229034

ABSTRACT

An 18-month double-blind treatment of multiple sclerosis with low dose oral methotrexate showed it to be well tolerated and suggested effectiveness in exacerbating-remitting MS but not in the exacerbating progressive and chronic progressive stages.


Subject(s)
Methotrexate/administration & dosage , Multiple Sclerosis/drug therapy , Administration, Oral , Adult , Double-Blind Method , Female , Humans , Male , Placebos
3.
J Neurol Sci ; 114(2): 128-37, 1993 Feb.
Article in English | MEDLINE | ID: mdl-8445393

ABSTRACT

A stroke registry was developed to determine the value of various clinical data in distinguishing lacunar from large vessel infarctions. Adequate localization was achieved in 98% of 246 patients with brain infarcts. These and 30 transient ischemic attack patients were followed for a median of 1082 days (range 2-1657). Follow-up data on TIA patients were invalidated by evidence of serious underreporting of TIAs in our general population. Among 212 male patients with cerebral infarcts not due to cardiogenic embolism, syphilis, migraine, vasculitis, or other unusual etiologies, 1-, 12-, and 36-month recurrence rates were 23%, 31% and 39% among patients with large vessel anterior circulation infarcts; 15%, 20% and 28% among patients with large vessel posterior circulation infarcts; and 8%, 16% and 21% among patients with lacunar anterior circulation infarcts, respectively. Six patients with posterior circulation lacunes did not experience recurrence. Comparative case fatality data were also compiled. Large vessel infarcts tended to be followed by further large vessel infarcts, usually in the same vascular distribution, whereas lacunar infarcts were not predictive of the type or location of subsequent events.


Subject(s)
Cerebral Infarction/physiopathology , Cerebrovascular Disorders/epidemiology , Ischemic Attack, Transient/physiopathology , Cerebral Arteries/pathology , Cerebral Infarction/classification , Cerebrovascular Disorders/etiology , Female , Follow-Up Studies , Humans , Ischemic Attack, Transient/classification , Life Tables , Male , Registries , Time Factors
5.
Neurology ; 38(4): 645-6, 1988 Apr.
Article in English | MEDLINE | ID: mdl-3352927

ABSTRACT

A door-to-door survey of Parkinson's disease (PD) in Copiah County, Mississippi, using a pretested screening procedure (with a high sensitivity for detecting PD), followed by examination of all positives by a senior neurologist, revealed similar prevalence ratios for blacks and whites. The same procedure was applied in the community of Igbo-Ora, Nigeria, a black population of West Africa. To assure uniformity in the procedures and application of the diagnostic criteria, a neurologist from each survey site visited the other site. Among a black population of 3,521 over age 39 in Copiah County, there were 12 cases of PD, with an age-adjusted prevalence ratio of 341/100,000. The comparable figures for Igbo-Ora were as follows: population over age 39 = 3,412; cases of PD = 2; age-adjusted prevalence ratio = 67/100,000.


Subject(s)
Black or African American , Parkinson Disease/epidemiology , Black People , Humans , Mississippi , Nigeria , Rural Population
6.
J Clin Epidemiol ; 41(4): 339-45, 1988.
Article in English | MEDLINE | ID: mdl-3258358

ABSTRACT

This article addresses three questions to be answered during the planning of prevalence surveys of chronic disorders in geographically defined populations: (a) Should personal interviews be used alone (i.e. without accompanying physical examinations) to find and confirm cases in a household population? (b) As an alternative means of identifying cases, is it adequate to review patient records from hospitals and clinics serving the population to be surveyed? (c) Should population members residing in institutions of long-term care be made ineligible for the anticipated survey? Data on major neurologic disorders, obtained from the Copiah County Study, are used to suggest caution in answering any of these questions in the affirmative, since in particular circumstances the consequences for the intended research may be serious or even disastrous. For example, with 42% of Parkinson's disease cases diagnosed for the first time during the study, a casefinding approach solely through medical-care providers would have been highly questionable for that disorder.


Subject(s)
Cross-Sectional Studies , Epidemiologic Methods , Nervous System Diseases/epidemiology , Cerebrovascular Disorders/diagnosis , Cerebrovascular Disorders/epidemiology , Epilepsy/diagnosis , Epilepsy/epidemiology , Female , Humans , Institutionalization , Interviews as Topic , Male , Medical Records , Methods , Mississippi , Parkinson Disease/diagnosis , Parkinson Disease/epidemiology , Physical Examination , Research Design
7.
South Med J ; 80(3): 339-43, 1987 Mar.
Article in English | MEDLINE | ID: mdl-3824020

ABSTRACT

To determine the prevalence of frequently occurring neurologic disorders in a biracial population, a survey of households and chronic care institutions was carried out for all residents of Copiah County, Mississippi. Along with a complete census, interviews were held using extensive questions about diagnoses, signs, and symptoms of neurologic disorders. More than 97% of eligible households participated, comprising 23,842 persons (49% black, 50% white, 1% other). Persons with responses suggesting one or more of these disorders were examined by a neurologist who used defined diagnostic criteria. Age-adjusted prevalence ratios for cerebral palsy, epilepsy, stroke, and severe dementia were somewhat higher in blacks than in whites, while the age-adjusted prevalence ratio for essential tremor was slightly higher in whites. For Parkinson's disease, there was no difference in age-adjusted prevalence ratios between the races.


Subject(s)
Black People , Nervous System Diseases/epidemiology , White People , Cerebral Palsy/epidemiology , Cerebrovascular Disorders/epidemiology , Dementia/epidemiology , Epilepsy/epidemiology , Female , Humans , Male , Mississippi , Parkinson Disease/epidemiology , Tremor/epidemiology
9.
Arch Neurol ; 43(10): 1000-3, 1986 Oct.
Article in English | MEDLINE | ID: mdl-3753260

ABSTRACT

The prevalence of functional disability in persons with cerebral palsy, epilepsy, stroke, Parkinson's disease, and severe dementia was assessed in a survey of every household in Copiah County, Mississippi, and all chronic-care institutions serving that county. Of the 23,842 residents evaluated, 246 had moderate to severe functional impairment accompanied by one or more of the aforementioned neurological disorders; 108 were not fully ambulatory; 59 required constant supervision because of cognitive difficulties; 54 were having at least one afebrile seizure monthly; and 25 experienced some combination of these impairments. Overall, prevalence ratios for these impairments increased markedly with age.


Subject(s)
Cognition Disorders/epidemiology , Movement Disorders/epidemiology , Nervous System Diseases/complications , Seizures/epidemiology , Age Factors , Black People , Female , Humans , Male , Mississippi , Nervous System Diseases/epidemiology , Sex Factors , White People
10.
Arch Neurol ; 43(6): 565-8, 1986 Jun.
Article in English | MEDLINE | ID: mdl-3718282

ABSTRACT

Separate surveys of households and chronic-care facilities were conducted in Copiah County, Mississippi. The household survey included screening interviews and a complete census. Board-certified neurologists, using defined diagnostic criteria, examined all consenting persons who were either eligible residents of the chronic-care facilities or household members with interview responses suggestive of stroke. In all, 250 stroke survivors were identified, yielding (as of Jan 1, 1978) a point prevalence ratio of 1,060 per 100,000 inhabitants. Age-adjusted prevalence ratios were higher for men and for blacks. Age-specific prevalence ratios increased with advancing age. Nearly 20% of identified stroke survivors had not received inpatient care for that condition.


Subject(s)
Black or African American , Cerebrovascular Disorders/epidemiology , White People , Adolescent , Adult , Age Factors , Aged , Child , Child, Preschool , Female , Health Surveys , Hospitalization , Humans , Infant , Male , Middle Aged , Mississippi , Sex Factors
12.
Epilepsia ; 27(1): 66-75, 1986.
Article in English | MEDLINE | ID: mdl-3948820

ABSTRACT

A need for prevalence information emphasizing racial differences prompted a door-to-door survey of all residents of Copiah County, Mississippi. The fieldwork involved a complete census and an extensive screening questionnaire inquiring about diagnoses, signs, and symptoms of neurologic disease. Residents who lived in institutions or had screening responses suggestive of epilepsy were requested to have an examination by neurologists who used defined diagnostic criteria. Prevalence day was 1 January 1978, and the survey yielded prevalence ratios of 1,043/100,000 inhabitants for epilepsy and 678/100,000 inhabitants for active epilepsy. Age-adjusted prevalence ratios were somewhat higher for males and for blacks. Of the 246 identified cases of epilepsy, 37% were judged symptomatic. The leading (putative) cause was head trauma, especially among white males. About 57% of the 246 cases had been evaluated previously by a neurologist or neurosurgeon, while 7% had never been evaluated medically before the survey.


Subject(s)
Epilepsy/epidemiology , Adolescent , Adult , Age Factors , Aged , Black People , Child , Child, Preschool , Epidemiologic Methods , Epilepsy/etiology , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Sex Factors , United States , White People
13.
Arch Neurol ; 42(8): 740-3, 1985 Aug.
Article in English | MEDLINE | ID: mdl-4026605

ABSTRACT

The purpose of this investigation was to document the prevalence of severe dementia among different racial groups residing in the same community--Copiah County, Mississippi. Both household and institutionalized populations were included. For either sex, the prevalence ratios of all severe dementia and clinically diagnosed severe senile dementia of the Alzheimer's type were at least as large among blacks as among whites. For either race, the corresponding prevalence ratios were greater in females. For each race and sex, the corresponding prevalence ratios increased with advancing age. Finally, in the population studied, approximately 1% of individuals 40 years old or older had severe dementia. This figure increased to 7% for individuals 80 years old or older.


Subject(s)
Black People , Dementia/epidemiology , White People , Adult , Aged , Dementia/diagnosis , Female , Humans , Male , Middle Aged , Mississippi , Risk
14.
Neurology ; 35(6): 841-5, 1985 Jun.
Article in English | MEDLINE | ID: mdl-4000484

ABSTRACT

A door-to-door survey of major neurologic disorders was conducted in the essentially biracial population of Copiah County, MS, using a pretested screening questionnaire. All those suspected of having Parkinson's disease were requested to have a neurologic examination by board-certified neurologists. The study also included those living in institutions. The prevalence of Parkinson's disease (age 40+) was 347 per 100,000 inhabitants. No substantial differences in the age-adjusted prevalence ratios by race or by sex were found in the population studied. Age-specific prevalence ratios for Parkinson's disease increase with advancing age. Over 40% of identified cases were newly diagnosed during the study.


Subject(s)
Black People , Parkinson Disease/epidemiology , White People , Adult , Age Factors , Aged , Female , Humans , Male , Mass Screening , Middle Aged , Mississippi , Sex Factors , Surveys and Questionnaires
15.
Dev Med Child Neurol ; 26(2): 195-9, 1984 Apr.
Article in English | MEDLINE | ID: mdl-6609856

ABSTRACT

As part of a door-to-door survey of major neurological disorders, the prevalence of cerebral palsy was ascertained in the institutionalized and non-institutionalized biracial population of Copiah County, Mississippi. The over-all prevalence ratio was 212 per 100,000 inhabitants. For whites, as for blacks, males had a higher prevalence ratio than females. For both sexes, blacks had a higher prevalence ratio, but the race difference was not striking. Prevalence ratios declined with age. Other findings are presented on clinical features and degree of disability.


Subject(s)
Black or African American , Cerebral Palsy/epidemiology , Adolescent , Adult , Age Factors , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Infant , Male , Middle Aged , Mississippi , Sex Factors
16.
Arch Neurol ; 39(12): 750-1, 1982 Dec.
Article in English | MEDLINE | ID: mdl-7138316

ABSTRACT

This investigation determined the prevalence of essential tremor in a US population. The findings were derived from a large-scale morbidity survey conducted in a rural, biracial Mississippi county (Copiah County). Both the household and the institutionalized populations of the county were included. Results were limited to persons 40 years old or older. Prevalence ratios were higher for women than for men and were higher for whites than for blacks. Age-specific prevalence ratios generally increased with age. The overall prevalence ratio was 414.6 per 100,000 inhabitants.


Subject(s)
Tremor/epidemiology , Adult , Aged , Black People , Female , Humans , Male , Middle Aged , Mississippi , Risk , White People
17.
Stroke ; 13(4): 488-91, 1982.
Article in English | MEDLINE | ID: mdl-7101349

ABSTRACT

The diagnosis of intracerebral hemorrhage (ICH) has become precise with the advent of computerized tomography (CT). Little, however, is known concerning the long-term prognosis. Seventy consecutive patients with primary intracerebral hemorrhage (all known etiologies except hypertension excluded) proven by CT scan were studied. Follow up, averaging 2 1/2 years, was successful in all cases. The status of alertness, EKG, and clinical impression on admission were significant prognostic factors. As expected, mortality increased with size of the hematoma and ventricular rupture. Acute in hospital mortality was 40%. Another 17% died during the long-term follow up, but none of them from cerebrovascular disease. Ninety-two percent of the survivors were ambulatory at follow up. Hypertensive intracerebral hemorrhages, unlike aneurysms, rarely, if ever, rebleed. Patients are not likely to have a second bleed in another location. Hypertensive intracerebral hemorrhage is more common in blacks, especially young adult males with severe hypertension, but overall mortality is lower than thought prior to the CT scan. Most survivors can achieve independence and deserve aggression rehabilitation efforts.


Subject(s)
Cerebral Hemorrhage/diagnostic imaging , Hypertension/complications , Cerebral Hemorrhage/complications , Cerebral Hemorrhage/mortality , Follow-Up Studies , Humans , Tomography, X-Ray Computed
20.
JAMA ; 240(8): 742-6, 1978 Aug 25.
Article in English | MEDLINE | ID: mdl-671702

ABSTRACT

A total of 969 (73%) of 1,328 patients with cases of suspected transient ischemic attacks (TIAs) who came to six institutions during a 21-month period were followed up. Factors were identified and prospectively analyzed for risk for further TIAs, stroke, and deatn. A history of multiple carotid artery TIAs was significantly related to further TIAs. A single TIA placed the patient at greater risk for early infarction. Older age, male sex, and unreliability to take dangerous medication were risk factors for cerebral infarction. Anticoagulant therapy, older age, male sex, diabetes mellitus, heart disease, abnormal ECG, and poor surgical risk were factors for death. The increased mortality associated with anticoagulants was confined to the older age group. While white patients treated with antiplatelet-aggregating agents had a lower mortality than those treated otherwise, this was not true amont black patients.


Subject(s)
Cerebrovascular Disorders/epidemiology , Intracranial Embolism and Thrombosis/epidemiology , Ischemic Attack, Transient/epidemiology , Age Factors , Aged , Anticoagulants/adverse effects , Black People , Carotid Artery Diseases/complications , Diabetes Complications , Female , Heart Diseases/complications , Hospitalization , Humans , Ischemic Attack, Transient/mortality , Male , Middle Aged , Risk , Sex Factors , United States , White People
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