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Query: UMLS:C0036572 (seizures)
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From 1977 to 1981, the intravenous use of a pentazocine/tripelennamine combination (T's and Blues) has become a major drug abuse problem in the city of St. Louis, Missouri, U.S.A. There has been a continuous increase in the involvement of these drugs in (a) sudden and violent deaths (62 homicides, 7 fatal intoxications), (b) emergency room visits (137 in 1980), (c) admissions to drug treatment programs (7.7% in 1978 up to 64% in 1981), and (d) police laboratory cases (100 in 1977 - 78 up to 700 in 1981). Initial popularity of the drugs was related to the decline in the quality of street heroin (2.5% in 1977 reduced to 0.5% by 1979) and the lack of strict legal controls. Serious adverse reactions include clonic-tonic seizures and pulmonary foreign body granulomatosis. Ethanol and diazepam were present in 53% and 10% of T's and Blues medical examiner's cases, respectively (n = 70). Addicts are usually black males, 20 - 30 years old, from impoverished areas of the city. The drugs are available to the illicit trade through theft or diversion from legitimate sources.
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PMID:Pentazocine/tripelennamine (T's and blues) abuse: a five year survey of St. Louis, Missouri. 716 38

This discussion addresses the questions of the parinatal, neonatal, and infant health and development of children born to adolescent mothers as related to other biologic and social factors. Medical and legislative plans for adolescent mothers and their infants must be based on assessment of both mortality and morbidity of the infants born to adolescent mothers. Focus here is on neonatal data on 55,711 pregnancies collected by the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke; neonatal data from the University of Kansas Medical Center covering 4000 pregnancies, 770 of which were gestations in teenage mothers; and obstetric, perinatal, and neonatal data concerning 6087 pregnancies in 1976, 1977, and 1978 at the Regional Perinatal Center at the University of Rochester. Ample evidence suggests a strong association between maternal age and birth weight. In particular, Hardy and Mellits found a higher frequency of low birth weight infants born to young black women. Interactions with other variables, including parity, clearly illustrate that firstborn infants are lighter than subsequent infants up to a maternal age of 35. Hoffman et al. have demonstrated that American women 18 years and under show a tendency to have infants of shorter gestational age than women 19-24 years of age. Cigarette smoking, alcohol and drug abuse, prolonged rupture of membranes, seizure disorders, and gonorrhea were significantly more frequently diagnosed in teenage mothers. The studies showed that behavioral and medical complications in the mothers were more powerful determinants of infants born with weight of less than 2500 gm than maternal age alone. In sum, when maternal and fetal growth retarding factors are taken into account among mothers of specific age categories, no biologic disadvantage appears unique to adolescent mothers. Findings fail to support the often expressed view that the mother's biologic immaturity is the main factor responsible for excessive fetal and neonatal deaths in infants born to very young mothers. Proportionately more infants born to adolescent mothers required admission to the intensive care or special care nurseries at the University of Rochester hospital than did infants born to mothers in their 20s (15.77% versus 13.9%). The data suggest that the mothering skills and child rearing practices of adolescent childbearing women have yet to be evaluated adequately.
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PMID:The infants of adolescent mothers. 736 May 10

The goal of this study was to investigate the factors that could predict prognosis in 51 premature infants with positive sharp waves on their EEGs (gestational age 23-36 wks) with 114 tracings. Follow-up clinical examinations were conducted, up to 10 yrs later. Death occurred in 18%, from a non-CNS cause, either sepsis or a congenital cardiac or pulmonary defect. A severe outcome was seen in 8% and was related to maternal i.v. drug abuse (IVDA) and the presence of many positive sharp waves. A moderate outcome, noted in 29%, was associated with a Grade III-IV intracerebral hemorrhage (ICH) or periventricular leukomalacia (PVL) and maternal IVDA. A mild outcome seen in 20% was related to infrequent positive sharp waves, vaginal delivery and an improving EEG over time, while a normal outcome (26%) was also related to infrequent discharges, a normalized EEG over time, a normal sonogram and the absence of clinical seizures. The addition of negative sharp waves to the positive ones and the addition of central to temporal positive sharp waves were associated less often with a normal outcome. The general conclusion of this study was that various aspects of positive sharp waves in premature infants, in addition to other factors, can be used to predict outcome in these neonates.
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PMID:The use of the EEG to predict outcome in premature infants with positive sharp waves. 781 91

Over a 3-year period, 15 patients with severe hyponatremia were referred to our emergency room from a nearby psychiatric institution. This article reports on 36 episodes of symptomatic hyponatremia in those 15 patients. All but two of the patients were receiving antipsychotic medications; one patient was taking a nonsteroidal anti-inflammatory drug, and one patient was taking an oral hypoglycemic agent. Thirteen patients were chronic schizophrenics, one had a bipolar depressive disorder with psychotic features, and one patient had no psychiatric disorder. Patients presented with seizures, change in mental status, and vegetative symptoms (nausea, vomiting, and diarrhea) associated with hyponatremia and water intoxication. Exacerbation of the patients' underlying illness, psychogenic polydipsia, compulsive smoking, alcoholic cirrhosis, drug abuse, and neuroleptic and other medications are thought to be the major causes of acute hyponatremia in these patients.
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PMID:Symptomatic hyponatremia associated with psychosis, medications, and smoking. 809 75

Benzodiazepine dependence is a frequent complication of regular prescriptions for 4 weeks or longer, occurring in almost one-third of patients. Although it is also manifested by tolerance to drug effects and occasional drug seeking behaviour, particularly in those prone to drug abuse, most dependence is characterised by a withdrawal syndrome on stopping treatment. The withdrawal syndrome includes symptoms of anxiety and those of perceptual disturbance such as depersonalisation, hypersensitivity of all major senses, dysphoria and (rarely) epileptic seizures and psychotic episodes. Risk factors for dependence include high dosage, use of more potent and short acting benzodiazepines, long duration of therapy and dependent premorbid personality characteristics. If none of these apply, benzodiazepines can be prescribed with safety.
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PMID:Benzodiazepine dependence. Avoidance and withdrawal. 810 17

Alcohol-related seizures have been recognized since the time of Hippocrates. Most such seizures are related to acute abstinence from chronic, high doses of alcohol use. Increasing use of illicit drugs, especially cocaine, has dramatically increased the incidence of acute drug-toxicity-related seizures. In cases of alcohol- or drug-related seizures, occult structural and infectious causes must be ruled out. Treatment usually focuses on management of the alcohol or drug abuse. Rarely are anticonvulsants indicated.
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PMID:Seizures. 837 43

1. The relationship between abnormal cerebral lateralization and overt aggressive behavior was examined in 41 violent psychiatric patients in a maximum-security hospital. 2. Cerebral lateralization was measured using the Finger Oscillation Test from the Halstead-Reitan Neuropsychological Battery, and aggressive behavior was measured during a six-month period of hospitalization using the Overt Aggression Scale. 3. Patients with the most abnormal pattern of lateralization exhibited the highest frequency as well as the highest severity of overt aggressive behavior. This pattern could not be explained by the influence of age, race, IQ, history of head trauma, brain damage, or psychiatric diagnosis. History of seizures, alcohol abuse, and drug abuse, however, were found to be intervening variables in the lateralization-aggression link. Once their influence was removed using analysis of covariance, there was no relationship between lateralization and aggression. 4. The results suggest that it is unlikely that there is a direct causal relationship between abnormal lateralization and aggressive behavior.
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PMID:Abnormal lateralization in finger tapping and overt aggressive behavior. 847 21

Thirty-one patients (26 males, 5 females) with mean age 35 +/- 19 years (range 8 to 85 years) were diagnosed as non-traumatic rhabdomyolysis by clinical findings and elevation of serum creatine kinase (CK) between January 1989 and December 1993. Causes, laboratory measures, clinical courses, and outcome were reviewed retrospectively. Drug abuse, seizure, and excessive activity are the most common etiologies for non-traumatic rhabdomyolysis. Twelve patients presented with muscular pain and seven patients with muscle weakness. Twenty eight patients had urinalysis and five of them (18%) had negative orthotolidine dipstick test. Only seven patients (25%) were detected positive orthotolidine test without microscopic hematuria. Patients with acute renal failure had higher levels of potassium and uric acid. The patients who developed acute renal failure after admission had significantly higher levels of uric acid. The peak levels of CK did not correlate with development of acute renal failure. There was no episode of hyercalcemia. Seventeen patients (55%) had acute renal failure. Hemodialysis was required in nine cases. All survivors recovered with normal renal function except one who needed maintenance hemodialysis after two months follow-up. Two patients died of multi-organ failure and sepsis.
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PMID:Non-traumatic rhabdomyolysis and acute renal failure. 893 69

A. Digital EEG is an established substitute for recording, reviewing, and storing a paper EEG record. It is a clear technical advance over previous paper methods. It is highly recommended. (Class III evidence, Type C recommendation). B. EEG brain mapping and other advanced QEEG techniques should be used only by physicians highly skilled in clinical EEG, and only as an adjunct to and in conjunction with traditional EEG interpretation. These tests may be clinically useful only for patients who have been well selected on the basis of their clinical presentation. C. Certain quantitative EEG techniques are considered established as an addition to digital EEG in: C.1. Epilepsy: For screening for possible epileptic spikes or seizures in long-term EEG monitoring or ambulatory recording to facilitate subsequent expert visual EEG interpretation. (Class I and II evidence, Type A recommendation as a practice guideline). C.2. OR and ICU monitoring: For continuous EEG monitoring by frequency-trending to detect early, acute intracranial complications in the OR or ICU, and for screening for possible epileptic seizures in high-risk ICU patients. (Class II evidence, Type B recommendation as a practice option). D. Certain quantitative EEG techniques are considered possibly useful practice options as an addition to digital EEG in: D.1. Epilepsy: For topographic voltage and dipole analysis in presurgical evaluations. (Class II evidence, Type B recommendation). D.2. Cerebrovascular Disease: Based on Class II and III evidence, QEEG in expert hands may possibly be useful in evaluating certain patients with symptoms of cerebrovascular disease whose neuroimaging and routine EEG studies are not conclusive. (Type B recommendation). D.3. Dementia: Routine EEG has long been an established test used in evaluations of dementia and encephalopathy when the diagnosis remains unresolved after initial clinical evaluation. In occasional clinical evaluations, QEEG frequency analysis may be a useful adjunct to interpretation of the routine EEG when used in expert hands. (Class II and III evidence as a possibly useful test, Type B recommendation). E. On the basis of current clinical literature, opinions of most experts, and proposed rationales for their use, QEEG remains investigational for clinical use in postconcussion syndrome, mild or moderate head injury, learning disability, attention disorders, schizophrenia, depression, alcoholism, and drug abuse. (Class II and III evidence, Type D recommendation). F. On the basis of clinical and scientific evidence, opinions of most experts, and the technical and methodologic shortcomings, QEEG is not recommended for use in civil or criminal judicial proceedings. (Strong Class III evidence, Type E recommendation). G. Because of the very substantial risk of erroneous interpretations, it is unacceptable for any EEG brain mapping or other QEEG techniques to be used clinically by those who are not physicians highly skilled in clinical EEG interpretation. (Strong Class III evidence, Type E recommendation).
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PMID:Assessment of digital EEG, quantitative EEG, and EEG brain mapping: report of the American Academy of Neurology and the American Clinical Neurophysiology Society. 922 9

Since illicit drug use is by definition illegal, the tasks of measuring incidence and prevalence and charting the course of the epidemic have fallen to survey researchers over the past 30 years. Although survey methods have obvious advantages over indirect measures such as arrests, seizures, and treatment admissions, they are frequently criticized because the rely on valid self-reporting of sensitive and highly stigmatized behavior. Validation studies conducted before the mid-1980s involving known samples of drug users or urinalysis techniques suggested that drug use was fairly accurately reported in self-report surveys. However, more recent validation studies conducted with criminal justice and former treatment clients using improved urinalysis techniques and hair analyses demonstrate that self-report methods miss a lot of recent drug use. A review of the research literature suggests that neither self-reports nor bioassays are wholly accurate, and both have inherent problems. However, because self-report measures are necessary to understand the complexity of causal and correlational attributes of drug abuse, it is necessary to determine what can be done to improve valid self-reporting. This chapter examines the research literature on validation studies to provide an overview of what is known about the accuracy of self-reported drug use.
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PMID:The validity of self-reported drug use in survey research: an overview and critique of research methods. 924 55


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