101
|
Gashlan M, Loy-English I, Ventureyra EC, Keene D. Predictors of seizure outcome following cortical resection in pediatric and adolescent patients with medically refractory epilepsy. Childs Nerv Syst 1999; 15:45-50; discussion 50-1. [PMID: 10066019 DOI: 10.1007/s003810050326] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Several preoperative clinical variables have been reported to have value as predictors of seizure outcome following the surgical resection of epileptogenic focus in adults who have had medically refractory epilepsy. The present paper reports the results of a retrospective review of the ability of these variables to predict seizure outcome in a group of pediatric patients who had medically refractory epilepsy and underwent surgical resection of an epileptogenic focus at the Children's Hospital of Eastern Ontario. Variables in this review included age at first seizure, age at time of surgery, duration of seizures, seizure type, sex, family history, etiology, level of intelligence, EEG data, results of imaging studies, findings on examination of the central nervous system, and location and site of surgical resection. We found 64 patients who met the entry criteria for this review. Normal intelligence and tumor as etiology were associated with a good postoperative seizure outcome in patients who had a temporal resection; no variables had positive correlation with outcome in the extratemporal group. Caution must be used in the extrapolation of data and inclusion of studies of predictors of seizure outcome for adults to pediatric age groups.
Collapse
|
102
|
Keene D, Ventureyra EC. Epilepsy surgery for 5- to 18-year old patients with medically refractory epilepsy--is it cost efficient? Childs Nerv Syst 1999; 15:52-4; discussion 55. [PMID: 10066020 DOI: 10.1007/s003810050328] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study was designed to examine the question of whether cortical resection for children and adolescents with medically refractory epilepsy was less costly and more effective than the medical alternative. The study design used a decision analysis model. Data on outcome probabilities were based on literature review and local experience. The time span of the study was 25 years. Though the initial costs for the surgically treated group were significantly greater than those for the medical group, the time-cost lines intersected at 14 years after surgery. Surgery remained cheaper thereafter.
Collapse
|
103
|
Keene D, Ewan G, Jawad A. A depressed refugee who 'aches all over'. THE PRACTITIONER 1998; 242:605-7, 609, 612 passim. [PMID: 10534876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
|
104
|
Hsu E, Keene D, Ventureyra E, Matzinger MA, Jimenez C, Wang HS, Grimard L. Bone marrow metastasis in astrocytic gliomata. J Neurooncol 1998; 37:285-93. [PMID: 9524086 DOI: 10.1023/a:1005909127196] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
With the increasing survival time of many pediatric patients with malignancies, unexpected symptoms or signs require diligent search for rare complications or second cancers related to the disease or treatment. We recently encountered a patient with extensive glioblastoma multiforme who developed pancytopenia six months after completion of treatment with craniospinal radiation and chemotherapy with etoposide and cyclophosphamide. Bone marrow aspirate and biopsy confirmed bone marrow metastasis from the brain tumor. He showed good partial remission with chemotherapy with carmustine and cis-platinum as demonstrated by serial bone marrow aspirate for cytology and cytogenetics and enjoyed good quality of life for eight months. 14 other patients with astrocytic glioma, two of whom are children, are reported in the literature to have diffuse bone marrow metastasis. Therefore, in patients with malignant astrocytic tumor, bone marrow metastasis, though not common, should be considered when bone pain or cytopenias occur, especially when prolonged.
Collapse
|
105
|
Wein T, Andermann F, Andermann E, Dubeau F, Keene D, Rourke-Frew F, Silver K. Paroxysmal kinesigenic choreoathetosis. Neurology 1997. [DOI: 10.1212/wnl.49.2.642-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
106
|
Wein T, Andermann F, Silver K, Dubeau F, Andermann E, Rourke-Frew F, Keene D. Exquisite sensitivity of paroxysmal kinesigenic choreoathetosis to carbamazepine. Neurology 1996; 47:1104-6. [PMID: 8857757 DOI: 10.1212/wnl.47.4.1104-a] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
|
107
|
Ballo R, Viljoen D, Machado M, Keene D, Horton W, Fredlund V, Jacobs M, Martell R, Beighton P, Ramesar R. Mseleni joint disease--a molecular genetic approach to defining the aetiology. S Afr Med J 1996; 86:956-8. [PMID: 8823421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Mseleni joint disease (MJD) is an unusual form of progressive and widespread degenerative osteoarthropathy that has been identified in several hundred people in the remote Mseleni region of northern Zululand. Affected individuals experience articular discomfort in childhood and may be seriously handicapped as adults, often requiring prosthetic hip joint replacement. Although the condition clusters in families, there is no evidence of Mendelian inheritance and assessment of affected kindreds has not shown any evidence of genomic imprinting. To date our molecular work-up has entailed the study of 47 affected individuals from MJD kindreds to investigate familial predisposition based on the inheritance of a subset of markers and/or genes on the human genome, particularly those associated with the cartilage matrix. In addition, we have collected blood specimens form 111 unaffected but unrelated individuals from the same population group in order to determine whether any relationship exists between genetic components of the human leucocyte antigen (HLA) system and the MJD phenotype. Our investigations show the following: (i) there is no association between MJD and the HLA system which has previously been associated with non-Mendelian genetic conditions; (ii) COL2A1, which has been implicated in some forms of spondylo-epiphyseal dysplasia, may be involved in at least a subset of MJD patients; and (iii) type VI collagen is overabundant in degenerated hip joint cartilage.
Collapse
|
108
|
Scheffer IE, Bhatia KP, Lopes-Cendes I, Fish DR, Marsden CD, Andermann E, Andermann F, Desbiens R, Keene D, Cendes F. Autosomal dominant nocturnal frontal lobe epilepsy. A distinctive clinical disorder. Brain 1995; 118 ( Pt 1):61-73. [PMID: 7895015 DOI: 10.1093/brain/118.1.61] [Citation(s) in RCA: 400] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The disorder of autosomal dominant nocturnal frontal lobe epilepsy has recently been identified, and is now delineated in detail. A phenotypically homogeneous group of five families from Australia, Britain and Canada, containing 47 affected individuals, was studied. The largest family contained 25 affected individuals spanning six generations. This disorder is characterized by clusters of brief nocturnal motor seizures, with hyperkinetic or tonic manifestations. Subjects often experienced an aura, and remained aware throughout the attacks. Seizures occurred in clusters (mean eight attacks/night) typically as the individual dozed, or shortly before awakening. The epilepsy usually began in childhood, and persisted through adult life, with considerable intra-family variation in severity. Seizures were often misdiagnosed as benign nocturnal parasomnias, psychiatric and medical disorders. Interictal EEG studies were unhelpful. Ictal video-EEG studies showed that the attacks were partial seizures with frontal lobe seizure semiology. Neuro-imaging was normal. Carbamazepine monotherapy was frequently effective. This disorder showed autosomal dominant inheritance. Recognition of this entity is clinically important for diagnosis, appropriate therapy and genetic counselling. Moreover, this disorder now offers an opportunity to identify a gene for partial epilepsy.
Collapse
|
109
|
Maddox K, Garofalo S, Smith C, Keene D, Zeleny-Pooley M, Ellard J, de Crombrugghe B, Horton W. Transgenic mice expressing a type II collagen mutation at G574→A resemble a case of human hypochondrogenesis with an identical mutation. Matrix Biol 1994. [DOI: 10.1016/0945-053x(94)90152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
110
|
Sandell L, Nalin A, Morris N, Keene D. Temporal and spatial expression of type II procollagen splice forms during avian skin differentiation. Matrix Biol 1994. [DOI: 10.1016/0945-053x(94)90058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
111
|
Abstract
Cerebral vasculitis and clinically important myocardial inflammation are rare in juvenile dermatomyositis. We report a previously healthy 6-year-old girl with dermatomyositis who died after a fulminating clinical deterioration. Postmortem examination of the heart revealed characteristic endothelial tubuloreticular aggregates and evidence of capillary necrosis and secondary thrombosis, associated with extensive hemorrhagic myocardial necrosis. Endothelial necrosis was also evident in the cerebrocortical capillaries.
Collapse
|
112
|
|
113
|
McGrath PJ, Humphreys P, Keene D, Goodman JT, Lascelles MA, Cunningham JS, Firestone P. The efficacy and efficiency of a self-administered treatment for adolescent migraine. Pain 1992; 49:321-324. [PMID: 1408297 DOI: 10.1016/0304-3959(92)90238-7] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Migraine headaches are frequent in adolescents. Although many adolescents are adequately treated palliatively with analgesics, an important subgroup requires prophylactic treatment. Medical treatments for adolescents with frequent severe headaches is often problematic. Prophylactic pharmacological treatments are often shunned by adolescents and their parents because of concern over drug usage. Moreover, propranolol, the most widely used prophylactic drug with adults, is frequently not effective. Psychological interventions are effective but are costly and often not available. A randomized controlled trial was undertaken to evaluate the efficacy and efficiency of a predominantly self-administered treatment that could be delivered in a very cost-efficient format. Eighty seven adolescents (63 females and 24 males) ranging in age from 11 to 18 years were randomly assigned to receive a self-administered treatment, the same treatment delivered by a therapist or a control treatment. Self-administered and clinic treatment were equally effective and superior to the control treatment. However, the self-administered treatment was substantially more efficient. Both active treatments were durable at 1-year follow-up.
Collapse
|
114
|
Keene D, Whiting S, Humphreys P, Jacob P. Flunarizine as a supplementary medication in refractory childhood epilepsy: a double-blind crossover study. Neurol Sci 1989; 16:191-3. [PMID: 2731087 DOI: 10.1017/s0317167100028882] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We report a double blinded cross-over study involving Flunarizine versus placebo in the treatment of refractory childhood epilepsy. The patients studied were between the ages of 2 and 18; and were having more than 4 seizures per month not responsive to regular anticonvulsant medications. Of the 34 patients treated, 8 had a 50% decrease in their seizures during the placebo phase, 5 had a 50% decrease during the Flunarizine phase, and 1 patient had a 50% increase in seizures while taking Flunarizine. The remaining 25 patients showed no change in seizure activity in either phase. Patients having partial seizures with secondary generalization tended to do better on Flunarizine than those with other seizure types. Monitoring serum Flunarizine levels showed no significant difference between patients having improved seizure control and those who were unimproved. No significant side effects were noted with this medication, nor were any significant drug interactions noted.
Collapse
|
115
|
McGrath PJ, Humphreys P, Goodman JT, Keene D, Firestone P, Jacob P, Cunningham SJ. Relaxation prophylaxis for childhood migraine: a randomized placebo-controlled trial. Dev Med Child Neurol 1988; 30:626-31. [PMID: 3229560 DOI: 10.1111/j.1469-8749.1988.tb04800.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A randomized controlled trial was used to evaluate the effectiveness of relaxation training in the treatment of paediatric migraine. Relaxation training was compared with-two control groups (psychological placebo and 'own best efforts') in a total of 99 children and adolescents with frequent migraine. Daily recording of the headaches following treatment, three months after treatment and at the one-year follow-up indicated that all three treatments were equally effective. The importance of the use of adequate control conditions which generate equivalent expectancies in pain treatment research was confirmed.
Collapse
|
116
|
Stuss DT, Kates MH, Poirier CA, Hylton D, Humphreys P, Keene D, Laflèche G. Evaluation of information-processing speed and neuropsychological functioning in patients with myotonic dystrophy. J Clin Exp Neuropsychol 1987; 9:131-46. [PMID: 3558745 DOI: 10.1080/01688638708405353] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Patients with myotonic dystrophy (MD) were compared to a control group, matched to the patients in important demographic variables including IQ, on the Sternberg Memory Scanning procedure, to investigate the hypothesis of a selective change in speed of information processing in MD patients. The neuropsychological functioning of these MD patients was also compared to normative data to provide a descriptive picture of their abilities; these results were correlated to the factors of age of onset and duration of the disease. Finally, the MD patients were also compared to the defined control group on the neuropsychological measures. There was little evidence of selective slowness of information processing or particular deficit independent of overall IQ. Neuropsychologically, the MD patients as a group performed at the low average level. There was, however, a wide range of abilities, suggesting that MD patients are not a unitary group in terms of neuropsychological functioning. Age of onset of the disease was important, at least for certain results. Further research of the neuropsychological functioning of MD patients must account for the wide range of results, with more precise measures of actual onset of the disease and muscular weakness, in a longitudinal evaluation.
Collapse
|
117
|
Richter IL, McGrath PJ, Humphreys PJ, Goodman JT, Firestone P, Keene D. Cognitive and relaxation treatment of paediatric migraine. Pain 1986; 25:195-203. [PMID: 3523394 DOI: 10.1016/0304-3959(86)90093-x] [Citation(s) in RCA: 99] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The present study compared the efficacy of two active treatments, relaxation training and cognitive coping, with a non-specific placebo control in the treatment of 42 children and adolescents with migraine. The first treatment is a simplified version of progressive deep muscle relaxation; the second, a form of cognitive restructuring involving the alteration of dysfunctional thought processes. The results demonstrated that each active treatment was superior to the non-specific intervention in reducing overall headache activity and frequency but not duration or intensity. There were no differences between the experimental groups, and both continued to improve through a 16-week follow-up period, but the control group did not. Initial level of headache severity was an important factor in treatment outcome, with children with severe headaches responding better than those with milder headaches. Possible reasons for the differential treatment effects are discussed, and the implications for future research are considered.
Collapse
|
118
|
Abstract
The ganglioglioma, a mixed tumor with neuronal and glial elements, occurs occasionally in children and young adults. Its incidence, clinical presentation, radiological features, and natural history have not been clearly defined. A review of 111 primary brain tumors treated at our institution shows that 9.0% were gangliogliomas. The temporal lobe was the most common site involved. All patients presented with seizures but were neurologically intact. The CT scan showed a partially calcified mass, frequently isodense or nearly so, with minimal enhancement. Complete removal produced dramatic improvement in seizure control. Radiotherapy and/or chemotherapy are reserved for tumors showing malignant changes in the astrocytic component. Patients with chronic epilepsy, or whose seizures escape control despite anticonvulsants, should be examined with this tumor in mind. Following removal of these low-grade temporal lobe tumors, fewer seizures are seen, and the long-term prognosis is very good.
Collapse
|
119
|
Dorenbaum D, Cappelli M, Keene D, McGrath PJ. Use of a child behavior checklist in the psychosocial assessment of children with epilepsy. Clin Pediatr (Phila) 1985; 24:634-7. [PMID: 3902308 DOI: 10.1177/000992288502401106] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Children with epilepsy are faced with many of the same psychosocial stressors as other chronically ill children, and a proper assessment is vital. The purpose of this study was to determine whether the Child Behavior Checklist of Achenbach and Edelbrock could be used as a practical and objective tool for evaluating the psychosocial needs of children with epilepsy. Thirty-eight children were randomly selected from the Neurology outpatient clinic at the Children's Hospital of Eastern Ontario. Questionnaires were completed by the mothers during their waiting period. Results demonstrated the highest risk of maladjustment was within social functioning. As children reach adolescence, adjustment problems are mostly related to school. Although as a group, our sample did not differ from norms for behavior problems, there was evidence to suggest behavioral maladjustment for individual children. The checklist appears to be a good screening tool for maladjustment that could be included as part of the pediatrician's comprehensive assessment of children with epilepsy.
Collapse
|
120
|
Pearl M, Fishkind D, Mooseker M, Keene D, Keller T. Studies on the spectrin-like protein from the intestinal brush border, TW 260/240, and characterization of its interaction with the cytoskeleton and actin. J Cell Biol 1984; 98:66-78. [PMID: 6538573 PMCID: PMC2112984 DOI: 10.1083/jcb.98.1.66] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The terminal web of the intestinal brush border contains a spectrin-like protein, TW 260/240 (Glenney, J. R., Jr., P. Glenney, M. Osborne, and K. Weber, 1982, Cell, 28:843-854.) that interconnects the "rootlet" ends of microvillar filament bundles in the terminal web (Hirokawa, N., R. E. Cheng, and M. Willard, 1983, Cell, 32:953-965; Glenney J. R., P. Glenney, and K. Weber, 1983, J. Cell Biol., 96:1491-1496). We have investigated further the structural properties of TW 260/240 and the interaction of this protein with actin. Salt extraction of TW 260/240 from isolated brush borders results in a loss of terminal web cross-linkers primarily from the apical zone directly beneath the plasma membrane. Morphological studies on purified TW 260/240 using the rotary shadowing technique confirm earlier results that this protein is spectrin-like and is in the tetrameric state in buffers of low ionic strength. However, examination of TW 260/240 tetramers by negative staining revealed a molecule much straighter and more uniform in diameter than rotary-shadowed molecules. At salt concentrations at (150 mM KCl) and above (300 mM KCl) the physiological range, we observed a partial dissociation of tetramers into dimers that occurred at both 0 degree and 37 degrees C. We also observed (in the presence of 75 mM KCl) a concentration-dependent self-association of TW 260/240 into sedimentable aggregates. We have studied the interaction of TW 260/240 with actin using techniques of co-sedimentation, viscometry, and both light and electron microscopy. We observed that TW 260/240 can bind and cross-link actin filaments and that this interaction is salt- and pH-dependent. Under optimum conditions (25-75 mM KCl, at pH 7.0) TW 260/240 cross-linked F-actin into long, large-diameter bundles. The filaments within these bundles were tightly packed but loosely ordered. At higher pH (7.5) such bundles were not observed, although binding and cross-linking were detectable by co-sedimentation and viscometry. At higher salt (greater than 150 mM KCl), the binding of TW 260/240 to actin was inhibited. The presence of skeletal muscle tropomyosin had no significant effect on the salt-dependent binding of TW 260/240 to F-actin.
Collapse
|
121
|
Loyter A, Scangos G, Juricek D, Keene D, Ruddle FH. Mechanisms of DNA entry into mammalian cells. II. Phagocytosis of calcium phosphate DNA co-precipitate visualized by electron microscopy. Exp Cell Res 1982; 139:223-34. [PMID: 7084316 DOI: 10.1016/0014-4827(82)90336-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
122
|
Dale RM, Duesing JH, Keene D. Supercoiled mitochondrial DNAs from plant tissue culture cells. Nucleic Acids Res 1981; 9:4583-93. [PMID: 7301584 PMCID: PMC327460 DOI: 10.1093/nar/9.18.4583] [Citation(s) in RCA: 39] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Supercoiled mitochondrial DNA (mtDNA) has been isolated in preparative amounts from five different plant species and compared on agarose gels. The gels reveal considerable mtDNA size heterogeneity within each species as well as substantial differences in the range and frequency of the mtDNA size classes among the different plants. The two lowest size classes of three of the plants have been extracted and their molecular weights determined. Comparison of two N. tabacum W38 culture lines has revealed significant differences in their mtDNA size classes. However, despite the totally different supercoil patterns, these two lines have almost identical restriction digests. The availability of preparative amounts of separated mtDNA size classes will make it possible to carry out a detailed analysis of plant mitochondrial genomes.
Collapse
|