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The purpose of this two-part review is to explain current drug treatment in part I and discuss investigational drug therapy and miscellaneous drugs in the management of parkinsonism in part II. The medical approach to this disease is still based on the imbalance between a deficiency of dopamine and a functional increase in acetylcholine. Anticholinergic agents are used to treat the tremors in the early stages of the disease.

The effects of two different oral charcoal suspensions on the elimination of a 200 mg/70 kg, 1 h intravenous (i.v.) infusion of phenobarbital and the tolerances of the two regimens were determined in a randomized crossover study in six healthy male volunteers. Phenobarbital was given i.v. alone or together with 105 g of oral activated charcoal suspension or with 105 g of a commercially available sorbitol-charcoal suspension over a 36-h period. A 13–34 decrease in the area under the serum concentration time curve (AUC) for 0–60 h occurred with the administration of the activated charcoal, and a 19–52 decrease occurred with the commercial sorbitol-charcoal regimen. The mean apparent systemic clearance of total phenobarbital increased from 0.089 ± 0.019 ml/min/kg to 0.141 ± 0.029 and 0.146 ± 0.036 ml/min/kg with the charcoal and sorbitol-charcoal treatments, respectively. No significant change in the fraction of phenobarbital bound to protein was detected. The charcoal regimen caused constipation in one subject. All subjects taking the sorbitol-charcoal preparation experienced diarrhea: there were no changes in electrolytes with either charcoal suspension. All subjects preferred the sorbitol-charcoal preparation.

A 70-year-old man with myasthenia gravis received a single intramuscular injection of colistimethate sodium (150 mg) for a urinary tract infection. He developed a respiratory arrest with a complete flaccid paralysis three hours later. All muscles but those associated with respiration improved rapidly following intramuscular neostigmine methylsulfate (2 mg) and intravenous edrophonium chloride (10 mg) administration. A combination of ventilation support and anticholinesterase therapy brought about recovery in 11 days. Carbenicillin effectively eradicated the Pseudomonas infection without causing neuromuscular impairment.

ALTHOUGH cases of agnosia for sound and music have been reported for more than 80 years,1-10 such defects were invariably observed to be associated with at least a mild impairment in language recognition, ie, auditory verbal agnosia. According to Nielsen,11 only one case of an agnosia for sounds without evidence of aphasia either in the history or in the present clinical picture has so far been on record. This patient was a 52-year-old Mexican man who was examined with the aid of an interpreter.12 An older vascular lesion had caused a left hemiparesis in this patient, and a more recent lesion resulted in a total loss of light perception, disorientation in space, loss of ability to visualize, incapacity to form nonlanguage concepts through sensory impressions, and unawareness of the left side of the body. The patient denied the loss of vision and in doing so would, eg,

• Difficulty in correlating EEG abnormalities with clinical seizures is emphasized in this case report of an epileptic patient with electrical status epilepticus and normal behavior. In addition, the usefulness of dichotic listening tests in the identification of subtle perceptive and expressive impairments is illustrated in this same patient at a time of noncompliance with anticonvulsant therapy.

This book celebrates the centenary of Sir William Gower's classic work, Epilepsy and Other Chronic Convulsive Diseases. Twenty British authors have prepared 26 timely and concise chapters that consider the relationship of mental disorders and epilepsy. Contributors include neurologists, neurophysiologists, psychiatrists, and social workers.Historical conceptions and misconceptions relating epilepsy and mind are well reviewed in the initial chapter, which is followed by a discussion of the classification and phenomenology of the psychiatric disorders of epilepsy. After that, the specific psychiatric concerns of depression, anxiety, suicide, personality and behavior disorders, hysteria, and psychoses are considered as they relate to epilepsy. One chapter is devoted to the management of seizures associated with psychological disorders, and another to psychotropic drugs in the management of epilepsy.Cognitive impairment and mental retardation are considered in the epileptic patient. Long-term outcome of temporal lobe epilepsy is reviewed. Chapters dealing with the limbic system, EEGs and

The author has written his views with regard to drug therapy for status epilepticus and supported them with more than 300 references that deal with experimental and clinical reports. General measures of treatment receive attention, but the "primary emphasis is directed in considerable detail at the use of antiepileptic drugs. These are discussed on the basis of current insights, with regard to their indications, actions, dosage, methods of administration, and side effects. Advantages and disadvantages are considered for each drug. Several of the medications that are discussed are not available in the United States. The benzodiazepine lorazepam receives only brief mention, as this monograph was published in 1979.Therapy is outlined in relation to the categories of generalized convulsive, generalized nonconvulsive, unilateral, and partial status epilepticus. Discussion of eclamptic status and the prophylaxis of status epilepticus is included. Special cautions are given with regard to drug therapy in relation to