Results of intervention for lupus patients with self-perceived cognitive difficulties.

The authors developed an 8-week psychoeducational group intervention for patients with systemic lupus erythematosus (SLE) who reported cognitive dysfunction but were not globally impaired on neuropsychological testing. Results of a nonrandomized, uncontrolled pilot study of this program in 17 women with SLE suggest that metamemory and memory self-efficacy improve after participation. One hundred percent retention throughout the study further suggests that patients with SLE are willing and capable of successfully completing the program.

Melatonin: a significant contributor to the pathogenesis of migraine.

It is generally accepted that migraine is caused by a primary biochemical disorder of the central nervous system involving neurotransmitters, specifically serotonin. The pathogenetic mechanism triggered by external and internal stimuli is not well explained or understood. This article points to the possibility that the pineal gland, a primary source of central serotonin and melatonin, contributes significantly to migraine attacks.

Generalization of treatment: a multicontext approach to cognitive perceptual impairment in adults with brain injury.

Cognitive perceptual remedial approaches used by occupational therapists in the treatment of adults with brain injury have been criticized because of claims that the effects are not generalizable. Little information is available, however, that can guide the therapist in directly addressing the generalization process. This paper proposes a multicontext treatment approach that uses five components identified in the cognitive psychology literature as being critical to the process of generalization: (a) use of multiple environments, (b) identification of criteria for transfer, (c) metacognitive training, (d) emphasis on processing strategies, and (e) use of meaningful activities. A case report is used to illustrate this treatment approach.

Visual perception of objects: an approach to assessment and intervention.

This paper proposes an alternative to the deficit-specific approach that has been used to guide the visual perceptual assessment and treatment of brain-injured adults. Recent theoretical advances in visual object perception are combined with a cognitive rehabilitation model to provide a framework for occupational therapy assessment and treatment of object-processing dysfunction. Assessment guidelines are presented that emphasize the analysis of residual function by specifying the task conditions that influence visual perception. A case study illustrates clinical application of this approach. Implications for research are discussed.

Recording eye movements and vestibular tests utilizing EEG equipment.

Abnormalities of spontaneous eye movements occur frequently in patients with neurological diseases, and abnormalities of eye movements induced by vestibular and optokinetic stimulations have great diagnostic value. Their amplitude, frequency, duration, direction, and rhythmicity can be graphically recorded utilizing EEG equipment, and their speed can be easily calculated. The author emphasizes that eye movements can and should be studied in EEG laboratories, since neurologists are well prepared for the interpretation of the electrooculographic (and electronystagmography) data.

Cognitive rehabilitation: a model for occupational therapy.

A theoretical model that provides a foundation for understanding function and dysfunction in cognition and perception is needed as a prerequisite for the development of effective assessment and treatment tools to be used with the brain-injured adult. Such a model and clear definitions are absent in the occupational therapy literature on adult brain function and dysfunction. This paper represents a cognitive rehabilitation model adapted for occupational therapy from the fields of neuropsychology and cognitive psychology. Differentiation of terms, an overview of the model's theory, and evaluation principles are discussed. Cognitive rehabilitation is presented from an information processing perspective. Three other treatment approaches identified in the literature are discussed and compared with cognitive rehabilitation.

Selection of electrophysiological tests in patients with suspected multiple sclerosis.

If we accept the criteria set by McDonald and Halliday and by the Boston University WorkShop that one of the two lesions in patients with multiple sclerosis may be determined by electrophysiological tests and if we recognize that medical economics sets a limit to indiscriminate use of tests for clinical purposes, we need to pay particular attention to the selection of diagnostic tests. If we accept that certain anatomical predilections of plaques at the onset of multiple sclerosis correlate to a limited extent with long-term prognosis as suggested by Kurtzke, Rosati and Visscher, particularly with the relation to the disability and mortality, we need to pay more attention to the discovery of symptoms and signs as soon as possible utilizing clinical and laboratory data. As of now, the frequency of symptoms and signs at the onset of multiple sclerosis, with minor variations, seem to indicate that motor signs (pyramidal and cerebellar) head the list. Electrophysiological tests are specific for certain anatomical systems. The sensitivity of each test varies, but in most series electrooculography and electronystagmography offer the greater sensitivity. This is because of the significant interconnections between the pyramidal, cerebellar, vestibular and the oculomotor systems. This report underlines the importance of these two electrophysiological tests for the diagnosis of suspected multiple sclerosis.

Is migraine due to a deficiency of pineal melatonin?

Recent clinical observations favor the theory that migraine is caused by a primary injury of cerebral neurons with secondary involvement of intracranial and extracranial blood vessels. The primary injury is attributed to disruption of cerebral neurotransmitters and particularly the neuroadrenergic and serotonergic systems. These theories have not explained the importance of environmental factors, which so frequently trigger migraine. The author suggests that the pineal gland, which is outside the CNS unprotected by blood brain barrier and sensitive to external stimuli, could act as the intermediate causative factor of migraine, via a derangement of melatonin.

Functional amaurosis: diagnostic value of electronystagmography.

Hysterical and malingered blindness may be distinguished from organic ocular and cortical blindness by a variety of clinical and electrophysiological tests. This report discusses the limitations of these tests and emphasizes the objective superiority of a new test which utilizes the electronystagmographic technique. This test is based on the principle that visual input blocks nystagmus induced by vestibular stimulations: the presence of nystagmus suppression will indicate that blindness is either hysterical or malingered.

Fatal myoglobinuric renal failure in a patient with tardive dyskinesia.

A patient with severe tardive dyskinesia developed fatal myoglobinuric renal failure. Myoglobinuria has followed other forms of extreme muscular exertion, but has not been previously reported consequent to tardive dyskinesia. Antipsychotic medication should be used to treat severe tardive dyskinesia when alternative forms of therapy are ineffective and discontinuing therapy might otherwise lead to an exacerbation of symptoms with life-threatening complications.

Treatment of myoclonic dystonia with transcutaneous electrical nerve stimulation.

The use of a transcutaneous nerve stimulator yielded positive results in a condition marked by involuntary movements (tremors and myoclonias) and dystonia. In the absence of clues to the pathophysiology of the myoclonus and dystonia, it is argued that transcutaneous stimulation induces an action on the neurotransmitters that inhibits neuromuscular function.

Study of nystagmus suppression in the Rotatory Tests.

Thirty one healthy subjects ranging in age between 21 and 50, participated voluntarily in the following experiment: they underwent programmed sequential alternating rotations, while their nystagmus was recorded by way of electronystagmography. The direction of rotation was changed every minute, and the total rotation time was 36 minutes. The subjects were rotated under external conditions which were altered every six minutes; these conditions included the following: 1. Rotation in the light with visual fixation and convergence. 2. Rotation in the light with visual fixation without convergence (one eye closed, the other looking at the target). 3. Rotation in the light without visual fixation (both eyes covered by a shade or by Frenzel's glasses). 4. Rotation in the dark without convergence (looking straight ahead). 5. Rotation in the dark with convergence (looking at the thumb, closely placed in front of the nose). The purpose of the experiment was to study the phenomenon of nystagmus suppression observed with visual fixation and often attributed to cortical activity. The conclusion of the study is that nystagmus may be suppressed by light alone as well as by visual stimuli, convergence and proprioceptive stimuli. The inference is that the mechanism involves brain stem reflexes and not necessarily visual cortex activity.

Is there nystagmus habituation to angular acceleration in man?

10 healthy volunteers, ranging in age from 20 to 30 years, were subjected to rotatory stimulation at 1 degree, 2 degrees and 4 degrees/s2 acceleration and deceleration, repeated four times at weekly intervals. Nystagmus was recorded with electronystagmography. Slow-phase velocity and the total numbers of nystagmic spikes were analyzed. There was no evidence for habituation in this experiment, which is in agreement with the majority of previous publications.

Medial frontal cortex infarction and the alien hand sign.

Two right-handed patients with infarction involving the left medial frontal cortex are described. Both patients exhibited a form of transcortical motor aphasia and a psychomotor disturbance involving the right arm characterized by forced grasping, motor perseveration, and the presence of apparently purposeful movements that appeared to be dissociated from conscious volition. The latter feature is noted to be identical to the alien hand sign as described in the left arm of commissurotomized patients and patients with callosal neoplasm or infarction. It is suggested that the observed dissociation of conscious intention from purposeful movement may be related to dysfunction of the medial frontal cortex contralateral to the impaired extremity as much as to hemispheric disconnection.

Common migraine and vestibular function. Electronystagmographic study and pathogenesis.

Even though "classic migraine" and "complicated migraine" may be diagnosed readily, "common migraine" may be easily confused with other types of vascular headaches. This differential diagnosis is of great importance for the appropriate choice of drug therapy. It is frequently stated that family history of migraine and history of motion sickness in childhood suggest that a periodic vascular headache is most likely of migrainous origin; although this statement applies to ophthalmoplegic and hemiplegic migraine, it is doubtful that it applies to common migraine. In fact, in a pilot study of patients with common migraine, we have observed that family history and history of motion sickness in childhood did not contribute to the diagnosis. Vestibular dysfunctions are frequently associated with migraine including the common type. Utilizing labyrinthine tests with the aid of electronystagmography, abnormalities of labyrinth function were demonstrated in 80% of patients with common migraine who had no history of vertigo or of other otological and neurological disorders.