1/3. Selective mutism and obsessive compulsive disorders associated with zonisamide.We treated 27 children with idiopathic epilepsy with zonisamide monotherapy over a period of 2 years and observed behaviour disturbances in a prospective study. In all cases, seizure control was excellent; however, two cases (7.4%) had behaviour disturbances. The first (Case 1) was a 14-year-old girl with partial epilepsy which began at age 4 years. Zonisamide was administered at age 6 years, which was effective against her seizures, but selective mutism, violent behaviour, and lack of concentration developed at age 10 years. The second (Case 2) was a 15-year-old girl with generalized tonic-clonic seizures which began at age 10 years. Zonisamide was also effective against her seizures, but obsessive compulsive disorders (OCD) developed at age 13 years. The patients have had no other physical or mental problems and decreasing the dosage of zonisamide reduced the problems. There are few reports of behaviour disturbances provoked by zonisamide monotherapy in epileptic children who are neither physically nor mentally disturbed. While problems can develop several years later, in the present study, decreasing the zonisamide dosage maintained adequate prevention of seizures and eliminated the behaviour disturbances. Zonisamide is still a useful anticonvulsant for epileptic seizures, but physicians should be wary of its adverse behavioural side effects, which may arise several years later.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/3. A Vietnamese man with selective mutism: the relevance of multiple interacting 'cultures' in clinical psychiatry.Multiple cultural variables have effects on the psychobiology and behavioral manifestations of illness, as do patient and physician perceptions of illness. The interaction among these variables is at the heart of clinical psychiatry. This case of a Vietnamese man with selective mutism underscores the relevance of the 'cultures' of medicine, psychiatry, and war and trauma on the manifestations of illness and illness perceptions by patient and physician. The discussion focuses on how these cultures interact and play a crucial role in formulating diagnosis and treatment planning. Suggestions are given for shifts in medical education that will encourage relevant cultural paradigms to make their way into educational and clinical systems, which in turn should improve cultural competence in clinical psychiatry.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/3. Mute postseizure patient: an unusual manifestation of Todd's phenomenon.patients who manifest neurologic deficits after a seizure can present an interesting challenge to emergency physicians, particularly when the deficits are not those normally associated with Todd's phenomenon. Although Todd's phenomenon is known to result in a wide variety of transient focal deficits, we find no case report in the medical literature of this entity resulting in mutism. We present a case of a 51-year-old woman with transient mutism and hemiparesis caused by Todd's phenomenon. We also review some of the neuroanatomic and neurophysiologic issues relating to the etiology of Todd's phenomenon, as well as alternative management strategies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |