A family with an atonic variant of paroxysmal kinesigenic choreoathetosis and hypercalcitoninemia.

We report a family with an incompletely atonic variant of paroxysmal kinesigenic choreoathetosis (PKC). Three members of the family experienced attacks of muscle weakness which resembled the choreoathetotic attacks that occur in PKC in terms of their kinesigenicity and duration, clarity of consciousness during the attacks, good therapeutic response to low doses of phenytoin, and familial transmission, but differed from choreoathetotic attacks in PKC in that they were atonic. All three affected individuals were hypercalcitoninemic.

Effects of TJ-960 on Sternberg's paradigm results in epileptic patients.

OBJECTIVES: This study is aimed at investigating the effects of TJ-960 on cognitive function in epileptic patients. Sternberg's paradigm was used to examine the change in cognitive function, especially short-term memory, resulting from administration of TJ-960, along with the effects of the drug on seizures. SUBJECTS: The subjects of this investigation were 26 epileptic outpatients (14 males and 12 females; average age: 35 +/- 11 years old) of the Saitama Medical School Hospital, the Tokyo Medical and Dental University Hospital and the Tokyo University Hospital. The controls were 17 other epileptic outpatients (12 males and 5 females; average age: 40 +/- 12 years old) of the same hospitals. METHODS: The subjects were administered 7.5 g of TJ-960 per day for 8 weeks in addition to their previous medications. Immediately before the beginning of drug administration, and again after 8 weeks of administration, they were examined, using Sternberg's paradigm. The controls were examined at intervals of 8 weeks in the same manner as the subjects (i.e., no change in regimen). RESULTS: After 8 weeks of treatment with TJ-960, 8 of the subjects exhibited a greater than 25% decrease in the number of seizures. Seventeen cases showed no change, and one case showed exacerbation. The correct reaction times for Sternberg's paradigm in the group administered TJ-960 were 955 +/- 307 ms at the time of the first examination and 881 +/- 277 ms at the time of the second, and those of the control group were 845 +/- 288 ms for the first examination and 829 +/- 269 ms for the second. As these figures show, the correct reaction time was significantly shortened between the first and second examinations in the TJ-960 group. No change was exhibited in the sample reaction time between the first and second examination in either group. The difference in alpha wave power of the occipital region before and after the TJ-960 administration was significantly greater in the patients who showed improvement in Sternberg's paradigm as compared to the patients who remained unchanged in Sternberg's paradigm. In addition, the results for the theta wave power were opposite to those of alpha waves. As mentioned above, TJ-960 was presumed to have the effect of improving the cognitive function in epileptic patients.

Compensatory function of central dopaminergic system for suppressing psychic seizures--repeated plasma homovanillic acid measurement in refractory temporal lobe epilepsy.

Repeatedly measured plasma homovanillic acid concentration, as a clinically available index of central dopaminergic activity in a patient with temporal lobe epilepsy during a drug-free period, was significantly correlated with seizure frequency in the week immediately following, but not preceding, blood sampling days. This result suggests a compensatory function of the dopaminergic system in suppressing refractory psychic seizures.

Diagnostic reliability and significance of irregular beta patterns.

We designated EEGs with marked and irregular beta waves in basic patterns as "irregular beta patterns" on the basis that these patterns are related with particular symptoms such as dysphoria, irritability and autonomic symptoms and they implicate choice of therapeutic agents. Because of good response to antiepileptic agents in patients with "irregular beta patterns" along with EEG characteristics, we hypothesized that the prevalence of "irregular beta patterns" is higher in epileptics than in other psychiatric patients. In the present study, we tested this hypothesis, investigating actual frequencies of these patterns among different diagnostic categories for all patients whose EEG were recorded in all the first-visit patients to the Outpatient Clinic, Department of Neuropsychiatry of the Tokyo University Hospital during one year period of 1986. Before starting this investigation, we checked the interrater reliability for these patterns. Therefore, two studies are reported here. In Study 1, five raters judged 98 EEG recordings blindly (43 epileptics and 55 healthy subjects). As a result, the generalized Kappa of 0.473 was obtained, indicating our agreement level was moderate or fair. This result lends support to our contention that irregular beta patterns are reliably judged. In Study 2, we judged the EEG recordings (137 schizophrenics, 62 affective disorders, 43 epileptics and 55 healthy controls) and calculated the prevalence rate of "irregular beta patterns" among the diagnostic categories. The results show that the prevalence rates of "irregular beta patterns" among psychiatric disorders and normal controls were 13% (18/137) in schizophrenics, 11% (7/62) in affective disorders, 14% (6/43) in epileptics and 4% (2/55) in healthy controls. These rates did not differ significantly among the three disorders. Thus, our hypothesis was not supported. The clinical significance of these patterns is discussed.

Psychiatric patients showing irregular beta activities in EEGs and treatment with antiepileptic drugs: a report of 15 cases.

Fifteen psychiatric cases are reported who were clinically diagnosed as schizophrenic, affective disorders, or neurotic, but resisted standard medication regimens, all showing irregular beta activities on EEGs. The cases tended to display symptoms in common, such as dysphoria, emotional instability or frequent physical complaints. These characteristic symptoms share something mutually with the symptoms shown in some epileptic patients or psychiatric patients with epileptic EEG abnormalities without clinical seizures. Antiepileptic drugs seemed more specifically effective to the above symptoms. More than half of these cases showed improvement on EEG findings such as a decrease in irregular beta activities and an increase in rhythmicity or regularity of alpha activities along with clinical improvement with the administration of adjunctive antiepileptic drugs. These results suggest that the adjunctive administration of antiepileptic drugs to patients with irregular beta activities on EEGs is clinically useful and an EEG examination has much value in psychiatric practice to find the criteria of drug therapy.