On ethylene oxide neurotoxicity: report of two cases of peripheral neuropathy.

Two cases of clinically and electromyographically proven ethylene oxide neuropathy occurred among 12 workers at the Lecco Hospital Sterilization Center. Cessation of exposure to the gas, which had lasted for two years, was followed by swift remission of the symptoms and complete normalisation of the EMG record at follow-up six months later. The paucity of published data on the subject may well mean that the real risk of ethylene oxide toxicity is being underrated.

Paroxysmal kinesigenic choreoathetosis. Case report.

A case of sporadic, idiopathic, paroxysmal kinesigenic choreoathetosis is described. The frequent attacks triggered by the initial phase of voluntary movement responded well to treatment with diphenylhydantoin. The nosological, etiopathogenetic, clinical and therapeutic aspects of paroxysmal choreoathetosis are discussed and the literature reviewed.

[Hypothyroid neuropathy. Description 2 cases]. / In tema di neuropatia ipotiroidea. Descrizione di due casi.

Although neurological complications of hypothyroidism are well recognized, scanty data, to the best of our knowledge, are available about peripheral neuropathies in this condition. The electrographic studies so far performed are nearly all devoted to the well known association myxoedema-carpal tunnel syndrome. Our data concern two patients affected by neuropathy in hypothyroidism, presenting diffuse anomalies of electrographic parameters (motor and sensitive nerve conduction velocity, F-wave, H-reflex, H-index); and, in one of these cases, a marked segmental demyelination and axonal degenerations were disclosed by pathological examination of sural nerve (according to Dyck and Lambert, 1970; Shirabe and coll., 1975).

The significance of cyclic EEG changes in Creutzfeldt-Jakob disease: prognostic value of their course in 9 patients.

The diagnostic value of the EEG in Creutzfeldt-Jakob disease is based not only on the presence of a typical pattern of periodic discharges but also on the appearance of cyclic changes in the EEG. The pattern of the cyclic EEG changes was analysed in 9 patients with Creutzfeldt-Jakob disease. The changes appear when the level of wakefulness is reduced. The alternating pattern rate increases as the disease progresses and accounts for as much as 100 per cent of the tracing when the patient is in coma. During the cyclic changes the cardiorespiratory rate is always higher in phase A than in phase B. Hypertonic fits and most myoclonic jerks are present only in the A-phase, whereas partial myoclonus and fasciculations are present in both phases. The cyclic change pattern in Creutzfeldt-Jakob disease reveals a progressive. The cyclic change pattern in Creutzfeldt-Jakob disease reveals a progressive, serious involvement of the waking system.

[Epilepsy in later life: seizures persisting after the age of 60]. / L'epilessia nella terza età: persistenza delle crisi dopo i 60 anni.

In a group of 657 epileptic patients there were 51 presenting with fits even after having reached the age of 60. The onset of seizures dated back to the first 20 years in 15 patients between 20 and 40 years in 15 and between 40 and 60 years in 21. In 67% of the cases it was possible to determine the cause of seizures. The aetiology was unevenly distributed within each group. In the first group (up to 20 years) the P.G.E. forms prevail. In the second (up to 40 years) post traumatic epilepsy and inflammatory processes were predominant, while in the third (up to 60 years) vascular and tumoral pathology seem to be prevalent. 43% of the patients showed paroxysmal abnormalities in the EEG and these were still present even after to age of 60 years in more than fifty per cent. After the age of 60 we found no case of benign epilepsy amenable to complete recovery. Patients older than 60 present epilepsies of mild severity. In symptomatic epilepsies the lesional factors were not subject to evolution and the epileptogenic focuses were stable and persistent. In partial epilepsy there were more cases of complex symptomatology (86%) than cases of elementary symptomatology (14%) The evolution of seizures in old age is considered together with the importance of all factors influencing recurrency.

[Poligraphy during awakeness and sleep in patients with epilepsia partialis continua]. / Studio poligrafico in veglia e durante il sonno in due casi di epilessia parziale continua.

Report is made of two patients with Epilepsia Partialis Continua (E.P.C.) from brain organic damage (since carcinoma metastasis and localized ischemia). Clinical EEG, neuroradiological and anatomo-pathological and therapeutical problems are dealth with the light of a review on previous papers. The EEG by itself is assumed as a not sufficient neurophysiological mean. Long time poligraphic enregistrations during awakeness and sleep havae, on the contrary, produced interesting data. The continuous and localized more or less rhythmic myoclonus, which are the distinctive feature in the E.P.C., were in both the patients confined to the first two fingers of their hands; the more they decreased the deeper was sleep (phase II and III-IV) and almost disappeared in the REM phase. Thus poligraphic enregistrations for E.P.C. patients are maintained as very significant.

[Epilepsy in the third age: seizures presenting after the age of 60 years (author's transl)]. / L'epilessia nella terza eta': crisi ad insorgenza dopo i 60 anni.

In a group of 400 epileptic inpatients of the Neurological Clinic of Parma, 82 were over 60 years of age. Only 59 of them presented fits for the first time after the 60th year of age and in 78% of these, a definite anatomical damage could be demonstrated (neuroradiological investigations). One half of the epileptic syndromes with known etiology were thought to be related to cerebrovascular disease, but only few cases followed a stroke with persistent neurological symptoms. Intracranial space-occupying lesions were found to be the cause of epilepsy in 17% of cases. Partial epileptic seizures, secondarily generalized seizures, clinical signs of neurological damage, slow focal changes in the E.E.G. were the main features of this group of patients. In 22% of cases, miscellaneous causes were found: head injuries, exogenous intoxications due to accidental or iatrogenic ingestion, or alcoholic abuse. Relatively frequent were the seizures appearing in the course of degenerative or slow viruses induced encephalopathies. In 22% no demonstrable cause was found. Adequate follow-up may help us to discover etiological factors which at present are not obvious, but some form of idiopathic epilepsy with onset in this age range cannot be definitively ruled out. Only in 15% of cases interictal E.E.G. changes consisted in specific generalized or focal paroxysmal discharges (spikes, polyspikes, polyspike-and-wave). In about half of the cases the interictal E.E.G. failed to provide valuable informations, but an ictal E.E.G. could be obtained in 13 cases out of 59.

[Epilepsy and the driver's license]. / Epilessia e patente di guida.

143 older than 18 years epileptic patients have been considered under the concers of their driving licence. The 33,5% of them was already in hold it. Epilepsy was under different clinical forms. The majority of the subjects would suffer from generalized primary suizures, otherwise from partial fits, either elementar or complex. Subjects who already had the licence (37 over 75 men and 15 over 68 women) were presenting most scanty crisis, or since one year had non suffered from any at all. The frequency of crisis was very low for all the patients who had presented epilepsy before beingin permitted to drive; no question had been raised for them. Subjects without licence (25 men over 42 and 18 women over 53) had not been permitted to drive because of their illness. This group was mainly composed by patients either suffering from epilectic cerebropaty from very frequent fits, or from both. It is maintained as reasonable that italian laws conform to those within other E.E.C. countries for what concerns driving licence for epileptics; these patients, whether controlled, are assumed as well capable as accountable in mastering their condition, even when driving.

[Use of EEG response following intravenous diazepam administration in the etiologic diagnosis of brain lesions]. / Contributo critico all'utilizzazione della reattività E.E.G. dopo somministrazione intravenosa in Diazepam nella diagnosi eziologica delle lesioni cerebrali.

The authors take into consideration the reactivity of the E.E. Graphic focal anomalies to the i.v. infusion of 10 mg Diazepam. The cases includ 28 patients (15 with cerebral neoplasia, 8 with severe vascular accident, 5 with light vascular accident); among these, 19 showed typical E.E. Graphic focuses after administration of Diapezam, like those previously described by Weber and other Authors. Subjects with severe cerebral lesions and in the third age, after i.v. administration of 10 mg Diazepam showed vegetative disorders (hypotension, tachycardia or bradycardia, apnoea, periodic respiration). The reliability of the reactivity of the EEG focal anomalies to i.v. administration of Diazepam is confuted and the risks of such a methodology in subjects with severe cerebral damage or in the third age, are pointed out.