Sixteen patients with narcolepsy and cataplexy were treated with gamma-hydroxybutyrate (GHB) given at night and tailored to achieve as continuous a night's sleep as possible. The dosage usually consisted of 1.5-2.25 gm orally at bedtime and then one or two further 1.0-1.5 gm doses with awakenings during the night, and totaled about 50 mg /kg. Apart from one patient who took only the bedtime dose, the subjective quality of night sleep improved in all patients and the number of irresistable daytime attacks of sleep and cataplexy substantially diminished. Some residual daytime drowsiness remained and this usually responded well to low doses of methylphenidate. Improvement has been maintained for up to 20 months without the development of tolerance. Two patients experienced adverse side effects necessitating withdrawal of GHB treatment, but no serious toxic effects have occurred.

One hundred and eleven cases of syncope or loss of consciousness are analyzed. Most are of obscure nature while some illustrate features of syncope that deserve further scrutiny. The cases are divided into six groups: 1) Resembling cardiac syncope (30 cases); 2) vasovagal syncope (22 cases); 3) features of both cardiac and vasovagal syncope (12 cases); 4) orthostatic hypotensive (29 cases); 5) akinetic seizure? (12 cases); and 6) miscellaneous (5 cases). Some groups are subdivided according to the circumstances surrounding the spells, for example, seated eating, nocturnal, associated with bowel movement, response to anticonvulsant therapy, etc. The following conclusions seem warranted: 1) The evidence favors the existence of a type of akinetic seizure resembling cardiac syncope; 2) loss of consciousness while seated eating (prandial syncope) may comprise a syndrome; 3) syncope related to bowel movement or abdominal pain is a striking association; 4)sporadic nocturnal syncope due to temporary hyp or e activity ofbaroreceptors is not sufficiently recognized; 5) alcohol ingestion may precipitate orthostatic hy-poreactivity of baroreceptors is not sufficiently recognized; 5) alcohol ingestion may precipitate orthostatic hypotension. Familial syncope, syncope proneness and cold drink syncope are illustrated.

Thirty-nine epileptic patients underwent pulmonary function testing. Twenty-one of these patients, ranging in age from 16 to 44 years, had taken diphenylhydantoin (DPH) for 2 to 17 years. Eighteen patients, who had taken other anticonvulsants for similar time periods served as controls. Five patients in the DPH group had lung volume abnormalities, four had abnormal airway function, and five had abnormalities of alveolar gas mixing. One patient in the control group had lung volume abnormalities, two had abnormal airway function, and five had abnormalities of alveolar gas mixing. Statistical analysis revealed no significant differences between the groups, or between either group and predicted values.

Unilateral lesions in the area of the loci coeruleus and subcoeruleus in the cat are associated with a significant and sustained decrease of noradrenaline (NA) in the ipsilateral cerebral cortex without any important change in the concentrations of NA in the contralateral cortex and in the spinal cord of both sides. The serotonin (5-HT) concentrations of the spinal cord and cerebral cortex of both sides remained unchanged in the same groups of animals. Bilateral lesions in the same area result also in a marked decrease of NA in the cerebral cortex of both sides. The latter lesions also result in slight decreases of NA in the hypothalamus and of NA and 5-HT in the spinal cord but the NA and 5-HT concentrations of the stria-turn and thalamus and the 5-H T concentrations of the cerebral cortex and hypothalamus are unmodified by such lesions. Unilateral lesions of the area immediately rostral to the locus coeruleus (praelocus lesions) result in a very significant decrease of NA in the ipsilateral cerebral cortex without any change of NA in the contralateral cerebral cortex and spinal cord of both sides. Similar lesions produced bilaterally in another group of cats resulted in marked decreases of NA in the cerebral cortex of both sides and a slight decrease of NA in the thalamus without any change of NA in the striatum, hypothalamus and spinal cord and of 5-HT in the cerebral cortex. In the same group of animals with lesions which, however, extended more closely to the midline than in cats with locus coeruleus lesions, 5-HT is markedly decreased in the striatum and thalamus and slightly decreased in the hypothalamus and spinal cord.

These results support the view that the noradrenergie coeruleo-cortical pathway is made up of fibers which originate in the loci coeruleus and subcoeruleus and pre-dominently end ipsilaterally to their origin in the cerebral cortex. Ascending NA fibers ending in the thalamus appear to originate from NA neurons located more laterally in the upper pons and more specifically at the level of the parabrachial nuclei.

Valproic acid in therapeutic doses was used in the treatment of postanoxic intention myoclonus. Disappearance of the myoclonus occurred with marked improvement in the electroencephalogram. No significant side effects were noted. Hepatic function tests were monitored. Determination of valproic acid plasma levels was used to guide therapy. Levels above 55 ßg were generally required. The patient remains free of myoclonus after four and one half months.

Study of 100 children with grand mal convulsive disorders and 100 medically healthy children of matching age showed significantly lower plasma levels of vitamin E in the former (means 632.2 ± 17.3 and 822.5 ± 2\.Zßg/dl respectively; p < 0.001). This finding accords with the ability to prevent seizures in rodents by giving a-tocopherol before exposing them to a convulsion-inducing environment.

The results are reported of single muscle fiber uptake of tritiated leucine in muscle biopsy material from Duchenne dystrophy and Charcot-Marie Tooth disease. The uptake in the two conditions is compared and suggests that the previously reported increase in synthesis of cytoplasmic proteins in muscular dystrophy are probably related to regenerative efforts by the muscle fibers.

Using radioimmunoassay, the levels of plasma cortisol of 23 patients with multiple sclerosis and 10 control subjects were determined at three or more times over a one-year period. The status of the disease was ascertained by neurological examination at the same time. Twelve of the patients were considered stable because they showed no changes in their disease status during the year. The remaining 11 patients were designated active since each had one or more relapses. The levels of cortisol of the control and stable groups remained relatively constant during the one-year period, but the levels of the active group fluctuated significantly more than either of the other two groups. Furthermore the active patients who had more than one episode had the greatest fluctuation in their cortisol levels. The fluctuations could indicate some endocrinologie al aberration in patients with active multiple sclerosis or may be secondary to the influence of the disease.

Clinical and pathological findings in two cases of degenerative progressive myoclonic epilepsy (PME) are described. The clinically difficult task of differentiating a “cerebellar” tremor from an action myoclonus is emphasized. Simultaneous elect roencephalography and electrokymography was done, using capacity to ground transients for recording hand movements. This method was found useful in corroborating the cerebellar nature of the remaining disorder, after successful treatment of the myoclonic element with anticonvulsants.

A new introducer system for subcutaneous placement of shunt tubings is described. The advantages of this system over previous introducers are discussed.

All those related to the medical profession are familiar with the term “resuscitation” which usually means restoration of normal cardio-respira-tory activity in someone who has suffered from the effects of severely impaired functions of these two organs.

The concept of “brain resuscitation” has emerged during the past few years and to the best of our knowledge the term was probably first coined by SAFAR (1977). This term is used more freely by anesthetists. Neuro-surgeons, when they relieve otherwise fatal herniations of the brain, are not in the habit of calling the effort resuscitation. Since, in our opinion, the term brain resuscitation focuses attention on a set of measures in an acute catastrophic situation, we would like to support its use.