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PSYCHOMOTOR EPILEPSY
700 90 days from the start of treatment. Apparently pulmonary tuberculosis of all types was included ; 17 had minimal, 118 moderately advanced, and 197 far
advanced disease. There were four main treatment groups : Group A were treated for periods ranging from 30 to 89 days with doses varying between 0-5 and 1-4 g. streptomycin daily ; group B were treated for a similar period with 1-6-3-0 g. daily ; group c were treated for 90 days or more with 0-5-1-4 g. daily ; and group D were treated for a similar period with 1-5-3-0 g. daily. The size of these groups was unequal, with 124 patients in the first group, and 46, 89, and 73 in the other three. The distribution of lesions in the groups was also unequal: group A included less than 40% of patients with an acute type of disease, and group B over 60% ; in up to 10% the type of disease was not stated. Moreover, each of the eight clinical investigators seems to have had the right to choose one or several of the treatment groups as he pleased. The duration of observation in the four groups was 182, 234, 264, and 294 days. The results have been analysed on the basis of radiological and other assessments made by the clinicians in charge of the patients ; and the statistics were compiled centrally by the staff of the U.S. Public Health Service. The main analysis shows greatest clinical and radiological improvement in the groups receiving the largest dosage. Unfortunately, however, the multiple inequalities between the groups are so important that it seems, on reading the summaried report, that no conclusion is justified. The analysis is followed by a long chapter of discussion at a high level, of the order one has come to expect from the authors of this report. They make wise general evaluations of the scope of streptomycin therapy which should be very useful to clinicians handling this drug. They also make reservations concerning the results of the analysis ; but these scarcely redeem the fact that a project involving considerable effort by experienced clinicians has yielded little save impressions. These impressions would have been as easily gained without an organised trial. The value of a planned investigation depends on the quality of the planning. PSYCHOMOTOR
EPILEPSY
THE psychomotor attack is all too often wrongly diagnosed in practice. The mental symptoms may be interpreted as evidences of hysteria or of a schizoid psychosis, or, if the underlying epileptic basis is perceived, the attacks may be regarded as a form of petit mal. (The latter term, indeed, is commonly used to cover any and every epileptic manifestation except the complete major fit.) An electro-encephalographic approach to the study of these attacks is reported by Gibbs et al.1 The Boston school were the first to claim a typical E.E.G. picture for this type of fit, and their paper attempts a more elaborate definition of the psychomotor type of discharge. Verbal description is, however, at best clumsy, and recognition of this type of dysrhythmia in its many variations can, they saYi50e attained only by experience. Of 300 cases selected solely on the basis of a typical E.E.G. abnormality, over 90% proved to have clinical psychomotor attacks characterised by amnesia, confusion, and some retention of consciousness, with purposeful, but poorly coordinated, movements, usually simple and repetitive. (Unfortunately it is not stated what proportion of patients with clinical attacks do not show the appropriate E.E.G. abnormality.) In inter-seizure periods severe personality disorders were common, and some of the patients were classified as psychotic. Hypersomnolence, irrespective of medication, was often present.
In the
E.E.G.
the disturbance
1. Gibbs, E. L., Gibbs, F. A., 1948, 60, 331.
was
Fuster, B.
found to arise in the Arch. Neurol. Psychiat.
anterior
temporal area-sometimes on the right side, sometimes on the left, and sometimes on both-and the focus showed up best during sleep, natural or induced. Only one patient in seven had neurological signs or aura suggesting involvement of the temporal lobe, and a history of head injury in the temporal region was rarely obtained. A history of epilepsy in near relatives, on the other hand, was noted in 4-5% of the cases-an incidence higher than that found by Lennox et a1.2 in idiopathic epilepsy generally. The important deduction is made that this type of focus is heritable. Personality disorders are much- commoner in association with psychomotor attacks than with grand mal or petit mal, and it seems reasonable therefore to attribute much of the so called " epileptic personality " to disturbances in the anterior temporal area. An interesting confirmation of this has been provided by Belinson3 who found, by E.E.G. standards, psychomotor manifestations more than three times as often in epileptics living in institutions than in epileptics living in the community. The associated behaviour difficulties, rather than the number and severity of fits or the degree of retardation, were no doubt the main cause for admission to an institution. This and other distinctive features in Belinson’s E.E.G. records of epileptic patients in institutions, emphasise once again the necessity of defining as exactly as possible, the selective factors at work in determining the composition of any group of patients to be submitted to investigation.
COÖRDINATING
MEDICAL CONGRESSES
A Council for the Coordination of Medical Science Congresses was formed at a conference of non-governmental organisations held in Brussels this month under the joint aegis of W.H.O. and UNESCO. The council, whose permanent headquarters are to be in Brussels, will suggest appropriate places and dates for medical congresses, and enable scientists in related branches to attend particular gatherings without duplication and unnecessary expense ; subsidies may be granted to those wishing to attend. The organisers hope that the establishment of the council will cause future congresses to be held in parts of the world which have hitherto been neglected as meeting-places. The council also proposes to study conference techniques, and to help congresses by offering such services as translation, interpretation, and record-making, and by publishing proceedings. The work is to be financed through dues contributed by nongovernmental organisations, while W.H.O. and UNESCO will contribute the cost of various services. The chairman of the executive committee is Prof. Joseph Maisin, director of the Cancer Institute of Belgium. THIS week the President of the United States introduces to Congress his National Health Bill. It will offer complete medical care for about 85 million wageearners, and will tax them and their employers an average of 1 I/,%. Reporting this, a correspondent of the Manchester Guardian (April 19) quotes a statement that the cost of bringing a further 20 million citizens into a health and social-security programme will be a tax increase of about 50% on the pay-rolls of those middleclass employees now insured. Lord MoRAN has been re-elected president of the Royal College of Physicians of London for the ninth year in succession. Dr. J. R. CURRIE, emeritus professor of public health in the University of Glasgow, died in Edinburgh on April 13. Dr. J. W. BONE, treasurer of the General Medical Council and formerly of the British Medical Association. died on April 14 at the age of 79. _
2. Lennox, W. G., Gibbs, E. L., Gibbs, F. A. Ibid, 1940, 44, 1155. 3. Belinson, L. Amer. J. ment. Deficiency, 1947, 52, 9.
advanced disease. There were four main treatment groups : Group A were treated for periods ranging from 30 to 89 days with doses varying between 0-5 and 1-4 g. streptomycin daily ; group B were treated for a similar period with 1-6-3-0 g. daily ; group c were treated for 90 days or more with 0-5-1-4 g. daily ; and group D were treated for a similar period with 1-5-3-0 g. daily. The size of these groups was unequal, with 124 patients in the first group, and 46, 89, and 73 in the other three. The distribution of lesions in the groups was also unequal: group A included less than 40% of patients with an acute type of disease, and group B over 60% ; in up to 10% the type of disease was not stated. Moreover, each of the eight clinical investigators seems to have had the right to choose one or several of the treatment groups as he pleased. The duration of observation in the four groups was 182, 234, 264, and 294 days. The results have been analysed on the basis of radiological and other assessments made by the clinicians in charge of the patients ; and the statistics were compiled centrally by the staff of the U.S. Public Health Service. The main analysis shows greatest clinical and radiological improvement in the groups receiving the largest dosage. Unfortunately, however, the multiple inequalities between the groups are so important that it seems, on reading the summaried report, that no conclusion is justified. The analysis is followed by a long chapter of discussion at a high level, of the order one has come to expect from the authors of this report. They make wise general evaluations of the scope of streptomycin therapy which should be very useful to clinicians handling this drug. They also make reservations concerning the results of the analysis ; but these scarcely redeem the fact that a project involving considerable effort by experienced clinicians has yielded little save impressions. These impressions would have been as easily gained without an organised trial. The value of a planned investigation depends on the quality of the planning. PSYCHOMOTOR
EPILEPSY
THE psychomotor attack is all too often wrongly diagnosed in practice. The mental symptoms may be interpreted as evidences of hysteria or of a schizoid psychosis, or, if the underlying epileptic basis is perceived, the attacks may be regarded as a form of petit mal. (The latter term, indeed, is commonly used to cover any and every epileptic manifestation except the complete major fit.) An electro-encephalographic approach to the study of these attacks is reported by Gibbs et al.1 The Boston school were the first to claim a typical E.E.G. picture for this type of fit, and their paper attempts a more elaborate definition of the psychomotor type of discharge. Verbal description is, however, at best clumsy, and recognition of this type of dysrhythmia in its many variations can, they saYi50e attained only by experience. Of 300 cases selected solely on the basis of a typical E.E.G. abnormality, over 90% proved to have clinical psychomotor attacks characterised by amnesia, confusion, and some retention of consciousness, with purposeful, but poorly coordinated, movements, usually simple and repetitive. (Unfortunately it is not stated what proportion of patients with clinical attacks do not show the appropriate E.E.G. abnormality.) In inter-seizure periods severe personality disorders were common, and some of the patients were classified as psychotic. Hypersomnolence, irrespective of medication, was often present.
In the
E.E.G.
the disturbance
1. Gibbs, E. L., Gibbs, F. A., 1948, 60, 331.
was
Fuster, B.
found to arise in the Arch. Neurol. Psychiat.
anterior
temporal area-sometimes on the right side, sometimes on the left, and sometimes on both-and the focus showed up best during sleep, natural or induced. Only one patient in seven had neurological signs or aura suggesting involvement of the temporal lobe, and a history of head injury in the temporal region was rarely obtained. A history of epilepsy in near relatives, on the other hand, was noted in 4-5% of the cases-an incidence higher than that found by Lennox et a1.2 in idiopathic epilepsy generally. The important deduction is made that this type of focus is heritable. Personality disorders are much- commoner in association with psychomotor attacks than with grand mal or petit mal, and it seems reasonable therefore to attribute much of the so called " epileptic personality " to disturbances in the anterior temporal area. An interesting confirmation of this has been provided by Belinson3 who found, by E.E.G. standards, psychomotor manifestations more than three times as often in epileptics living in institutions than in epileptics living in the community. The associated behaviour difficulties, rather than the number and severity of fits or the degree of retardation, were no doubt the main cause for admission to an institution. This and other distinctive features in Belinson’s E.E.G. records of epileptic patients in institutions, emphasise once again the necessity of defining as exactly as possible, the selective factors at work in determining the composition of any group of patients to be submitted to investigation.
COÖRDINATING
MEDICAL CONGRESSES
A Council for the Coordination of Medical Science Congresses was formed at a conference of non-governmental organisations held in Brussels this month under the joint aegis of W.H.O. and UNESCO. The council, whose permanent headquarters are to be in Brussels, will suggest appropriate places and dates for medical congresses, and enable scientists in related branches to attend particular gatherings without duplication and unnecessary expense ; subsidies may be granted to those wishing to attend. The organisers hope that the establishment of the council will cause future congresses to be held in parts of the world which have hitherto been neglected as meeting-places. The council also proposes to study conference techniques, and to help congresses by offering such services as translation, interpretation, and record-making, and by publishing proceedings. The work is to be financed through dues contributed by nongovernmental organisations, while W.H.O. and UNESCO will contribute the cost of various services. The chairman of the executive committee is Prof. Joseph Maisin, director of the Cancer Institute of Belgium. THIS week the President of the United States introduces to Congress his National Health Bill. It will offer complete medical care for about 85 million wageearners, and will tax them and their employers an average of 1 I/,%. Reporting this, a correspondent of the Manchester Guardian (April 19) quotes a statement that the cost of bringing a further 20 million citizens into a health and social-security programme will be a tax increase of about 50% on the pay-rolls of those middleclass employees now insured. Lord MoRAN has been re-elected president of the Royal College of Physicians of London for the ninth year in succession. Dr. J. R. CURRIE, emeritus professor of public health in the University of Glasgow, died in Edinburgh on April 13. Dr. J. W. BONE, treasurer of the General Medical Council and formerly of the British Medical Association. died on April 14 at the age of 79. _
2. Lennox, W. G., Gibbs, E. L., Gibbs, F. A. Ibid, 1940, 44, 1155. 3. Belinson, L. Amer. J. ment. Deficiency, 1947, 52, 9.