A neurologist looks at mind and brain: "the enchanted loom".

For a long time, before we developed an appreciation of the neuroanatomy and neurophysiology of the brain, there was uncertainty as to the nature and source of the human mind. Philosophers linked the mind to mythical "humors" that controlled the human body, and others speculated that the mind was associated with "life-force" or soul. Few felt that there was a relation between the human mind and brain, but they had to wait for the Age of Enlightenment and scientific discovery in the 18th and 19th centuries to establish a clear association between the two.

Neurologic conditions: assessing medical fitness to drive.

Clinicians are often asked to make an assessment on whether a patient is medically fit to drive, even though few have been formally trained in this area. Driving is a complex task that requires having adequate operational, cognitive and higher executive functions that work together. These functions can be compromised to a greater or lesser extent in neurological disorders, such as stroke, traumatic brain injury, peripheral neuropathy, dementia, Parkinson's disease and epilepsy.

Sleep, sleep disorders and motor vehicle crashes.

There is wide consensus that drowsiness and sleep during driving put the driver and others at high risk for motor vehicle crashes. A large percentage of both private automobile and commercial vehicle crashes and crash fatalities are associated with the sleepy driver each year. Sleepiness in persons without sleep disorders may occur from potentially preventable causes such as sleep deprivation, drinking alcohol or taking sedative medications.

Epilepsy and driving regulations in Wisconsin.

Driving regulations in the state of Wisconsin have evolved. In 1987, changes in these regulations focused the problem on loss of consciousness and bodily control of drivers rather than on specific diagnostic entities such as epilepsy or diabetes mellitus. Current Wisconsin law encompasses loss of consciousness or events affecting bodily control, no matter what the cause.

Epilepsy and traffic safety.

We previously reported that drivers with epilepsy have somewhat higher age-adjusted rates of traffic accidents and moving violations than do drivers without epilepsy. We attempted to identify medical and other factors contributing to this increase. Medical records of 241 drivers with a history of seizures, representing essentially all such persons from a contiguous seven ZIP postal code area served by the Marshfield Clinic were studied.

Seizure disorders, diabetes mellitus, and cerebrovascular disease. Considerations for older drivers.

For those conditions in which loss of consciousness is the main issue, such as epilepsy, factors that contribute to risk of seizure recurrence are central to the determination of driver safety. Thus, high- and low-risk groups may be identified and factors that contribute to high risk checked. These factors also serve to develop a program to reduce such risk in the future.

Automobile driving and epilepsy: a medical perspective.

The risks of persons with controlled seizure disorders for traffic safety are reviewed. Previous studies provide insufficient and inaccurate data on this subject. Moreover, the advances in diagnosis and treatment of epilepsy and the improved safety and technology of automobiles and roads have made previous studies out of date and inapplicable to current circumstances.

The effect of epilepsy or diabetes mellitus on the risk of automobile accidents.

Background: Previous studies of possible associations between chronic medical conditions and traffic safety have been inconsistent and subject to bias because of the incomplete identification of affected persons. Recent advances in the diagnosis and management of epilepsy and diabetes mellitus have improved the control of these disorders and suggest a need to reexamine the risk of traffic mishaps among patients with these conditions.

Methods: We conducted a population-based retrospective cohort study of 30,420 subjects 16 to 90 years of age, with and without epilepsy or diabetes mellitus.

Eye movement patterns in REM sleep.

Eye movements in 6 healthy men and women were studied for recurrent patterns during REM sleep. The REM periods of nocturnal polysomnograms, on 2 consecutive nights, were analyzed in each subject. A discrete scale from 1 to 8 was used to record each eye position.

Evaluation and treatment of headache. Practical approach to a common symptom.

Chronic headache pain has many causes but is generally attributed to one of three mechanisms: muscular contraction, vascular inflammation, or traction or inflammation of pain-sensitive structures. Because of the wide variety of headache types and the often-confusing terminology and classification systems in use, evaluation of headache can be difficult. A step-by-step approach to patient workup, including patient history, physical examination, and appropriate tests, can help the physician pinpoint the underlying problem and determine appropriate therapy.

Granulocyte dysfunction and myotonic dystrophy.

A 52-year-old Caucasian male with typical features of myotonic dystrophy (MD) developed a lung abscess and was found to have a mild atypical cyclic neutropenia. Granulocyte function testing revealed a defect in phagocytosis, bactericidal activity and chemotaxis. The defects were less severe at the nadir of the granulocyte counts.

Persistent vegetative state. Review and report of electrodiagnostic studies in eight cases.

Of 81 comatose patients studied for two years, eight entered the persistent vegetative state (PVS), of whom four died and four survived. Clinically, all eight showed characteristic findings of wakefulness without cognitive function. Electrodiagnostic studies were characterized by (1) electroencephalograms that showed a range of patterns that were unchanged from the comatose through the vegetative state, (2) normal brainstem auditory evoked responses, (3) median somatosensory evoked responses that showed prolonged central conduction time, and (4) diminishing amplitude of the N20 response.

Sleep disturbances and severity of Huntington's disease.

We studied sleep functions in two patients with mild and five with moderately severe Huntington's disease. In mild disease there was chorea, but intelligence, mental function, and sleep were all normal. In moderately severe disease, intelligence and mental function were also affected, and there was a sleep disturbance characterized by prolonged sleep-onset latency, increased interspersed wakefulness, and reduced sleep efficiency.

Cerebrospinal fluid monoclonal gammopathy in multiple myeloma and Waldenström's macroglobulinemia.

Serum ratios of monoclonal immunoglobulin (Ig) to total protein, monoclonal immunoglobulin to albumin, CSF/serum Ig-albumin index, and CSF to serum monoclonal immunoglobulin were obtained in 21 patients with multiple myeloma and 2 with Waldenström's macroglobulinemia. Twelve patients (3 with CNS complications) showed CSF monoclonal proteins similar to their serum. CSF IgA levels above 10 mg/dl, IgG levels above 25 mg/dl, CSF-serum IgG ratios above 0.

Neuropsychological testing of Huntington's patients. Clues to progression.

A battery of neuropsychological and academic tests was administered to 16 patients with Huntington's chorea, several of whom received multiple testings. Generalized mental impairment was evident for most of the present sample of patients, but performance IQ was more affected than verbal IQ. Comparisons of impairments on the different tasks relative to expectations for normal adults suggest that measures requiring psychomotor problem solving, sequencing, and memory were most impaired.

Spindle coma: incidence, clinicopathologic correlates, and prognostic value.

Three hundred seventy comatose patients were studied clinically and electrographically. Of these, 5.7% showed the "spindle coma" electroencephalogram (EEG) pattern.