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Objective: To determine the prevalence and predictors of psychiatric dizziness and to measure functional impairment associated with dizziness.Design: Consecutive outpatients with a chief complaint of dizziness.Setting: Four outpatient clinics at a military teaching hospital.Patients: 100 dizzy patients and 25 control patients.Measurements and Main Results: Structured psychiatric interviews were conducted using the Diagnostic Interview Schedule, and functional status was assessed with the Sickness Impact Profile and the 20-item MOS (Medical Outcomes Study) Short-Form. Psychiatric disorders were a primary or contributory cause of dizziness for 40% of the dizzy patients. Compared with the control patients, the dizzy patients had a higher lifetime (46% vs 32%) as well as recent (37% vs 20%) prevalence of axis I disorders. The greatest differences were in disorders of depression and somatization. The dizzy patients had a higher lifetime prevalence (23% vs 8%) as well as recent history (11% vs 0%) of major depression or dysthymia. Also, somatization disorders were strikingly more common among the dizzy patients than among the control patients (37% vs 8%, p = 0.005), with the dizzy patients reporting more than three times as many psychiatric or unexplained physical symptoms (5.2 vs 1.5). Age < 40 years, related complaints of weakness or headaches, and dizziness provoked by hyperventilation or standing were independent predictors of psychiatric dizziness. The dizzy patients reported moderate functional impairment, which was most severe among those with psychiatric disorders.Conclusions: Persistent dizziness is associated with increased functional impairment and psychiatric comorbidity, particularly depression and somatization. Moreover, psychiatric disorders aggravate the impairment that occurs with dizziness alone. [ABSTRACT FROM AUTHOR]

The accepted standard treatment of relapsing multiple sclerosis consists of medications for disease symptoms, including treatment for acute exacerbations. However, currently there is no therapy that alters the progression of physical disability associated with this disease. The purpose of this study was to determine whether interferon beta-1a could slow the progressive, irreversible, neurological disability of relapsing multiple sclerosis. Three hundred one patients with relapsing multiple sclerosis were randomized into a double-blinded, placebo-controlled, multicenter phase III trial of interferon beta-1a. Interferon beta-1a, 6.0 million units (30 micrograms¿, was administered by intramuscular injection weekly. The primary outcome variable was time to sustained disability progression of at least 1.0 point on the Kurtzke Expanded Disability Status Scale (EDSS). Interferon beta-1a treatment produced a significant delay in time to sustained EDSS progression (p = 0.02). The Kaplan-Meier estimate of the proportion of patients progressing by the end of 104 weeks was 34.9% in the placebo group and 21.9% in the interferon beta-1a-treated group. Patients treated with interferon beta-1a also had significantly fewer exacerbations (p = 0.03) and a significantly lower number and volume of gadolinium-enhanced brain lesions on magnetic resonance images (p-values ranging between 0.02 and 0.05). Over 2 years, the annual exacerbation rate was 0.90 in placebo-treated patients versus 0.61 in interferon beta-1a-treated patients. There were no major adverse events related to treatment. Interferon beta-1a had a significant beneficial impact in relapsing multiple sclerosis patients by reducing the accumulation of permanent physical disability, exacerbation frequency, and disease activity measured by gadolinium-enhanced lesions on brain magnetic resonance images. This treatment may alter the fundamental course of relapsing multiple sclerosis.

Objective: To determine the prevalence and predictors of psychiatric dizziness and to measure functional impairment associated with dizziness., Design: Consecutive outpatients with a chief complaint of dizziness., Setting: Four outpatient clinics at a military teaching hospital., Patients: 100 dizzy patients and 25 control patients., Measurements and Main Results: Structured psychiatric interviews were conducted using the Diagnostic Interview Schedule, and functional status was assessed with the Sickness Impact Profile and the 20-item MOS (Medical Outcomes Study) Short-Form. Psychiatric disorders were a primary or contributory cause of dizziness for 40% of the dizzy patients. Compared with the control patients, the dizzy patients had a higher lifetime (46% vs 32%) as well as recent (37% vs 20%) prevalence of axis I disorders. The greatest differences were in disorders of depression and somatization. The dizzy patients had a higher lifetime prevalence (23% vs 8%) as well as recent history (11% vs 0%) of major depression or dysthymia. Also, somatization disorders were strikingly more common among the dizzy patients than among the control patients (37% vs 8%, p = 0.005), with the dizzy patients reporting more than three times as many psychiatric or unexplained physical symptoms (5.2 vs 1.5). Age < 40 years, related complaints of weakness or headaches, and dizziness provoked by hyperventilation or standing were independent predictors of psychiatric dizziness. The dizzy patients reported moderate functional impairment, which was most severe among those with psychiatric disorders., Conclusions: Persistent dizziness is associated with increased functional impairment and psychiatric comorbidity, particularly depression and somatization. Moreover, psychiatric disorders aggravate the impairment that occurs with dizziness alone.

Tonic pupils developed in two patients with malignancies outside the nervous system. Symptoms and signs of more generalized somatic and autonomic nervous system involvement were also present. Although the exact morphologic basis for autonomic dysfunction in patients with paraneoplastic neurologic deterioration is uncertain, recent studies suggest that in some cases an autoimmune mechanism is responsible and may be directed against autonomic ganglion cells.

Medical students at two teaching institutions were given an objective list containing information thought to be of maximum neurological teaching value. The usefulness of the objective list was assessed by giving the students pre- and post-tests containing questions that were derived from the objective list. Irrespective of the disparity in the clinical teaching programme, there was no significant difference between test scores of students who rotated at the two institutions. Comparison of pre- and post-test scores showed a highly significant improvement (P less than 0.005) in test scores. An objective list should be part of an effective undergraduate teaching programme in neurology.