eLetters

620 e-Letters

  • Thecoperitoneal shunts for the treatment of  syringomyelia associated with adhesive arachnoiditis.
    Milind S Deogaonkar

    Dear Editor

    Chang et al.[1] give an excellent analysis of pathophysiology of syringomyelia associated with adhesive arachnoiditis (SAA). This is a complex problem with a very few effective treatment options. In countries like India where tuberculous arachnoiditis is an often seen entity, SAA can frustrate the treating neurosurgeon. As suggested in article subarachnoid bypass is a feasible alternative. We...

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  • Placing nasogastric tubes in stroke patients with dysphagia
    Shinji Teramoto

    Dear Editor

    Because patients who have had an acute stroke often have dysphagia and tube feeding becomes necessary, the simple and comfort method for placing nasogastric tubes by inducing the swallowing reflex is identical.[1,2]

    The "reflex placement" method is originally based on our study. Our reflex method, i.e. simple swallowing provocation test (SPT) is easy, safe, and is independent of the patient's a...

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  • Authors' reply
    Tetsuro Ago

    Dear Editor

    We thank Dr Derakhshan for his comments [1] regarding our report.[2]

    Dr Derakhshan discusses the hypothesis that all movements are initiated from the major hemisphere,[3] which may be closely related to handedness. In neural right handers, the command of movement may originate in the left hemisphere. In cases of left hand movement, the command originated from the dominant hemisphere is once tran...

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  • Personality does not reliably distinguish epileptic from non-epileptic seizures
    Ludger Tebartz van Elst

    Dear Editor

    In their very interesting paper on the assessment of personality in patients with epileptic (ES) and psychogenic non-epileptic seizures (PNES) Reuber and colleagues conclude that maladaptive personality in patients with PNES is common, reminiscent of Borderline Personality Disorder (BPD) in a large subgroup and can be distinguished from non-clinical controls and patients with epilepsy alone.[1]

    H...

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  • Endozepine stupor or recurrent stupor due to covert administration of brotizolam?
    Akira Hirata

    Dear Editor

    Benzodiazepines are now the most prescribed group of psychoactive drugs, and their safety for therapeutic use has been established, but there also is the potential for abuse and addiction.[1]

    Endozepine stupor (ES) is characterized by repeated, spontaneous stuporous attacks lasting several hours or days, and responsiveness to flumazenil without administration of benzodiazepine. ES is caused by...

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  • Persistent vegetative state after severe head injury: we should not generalize
    Wakoto Matsuda

    Dear Editor

    We greatly appreciate the considerable and thoughtful comments offered by Boris Kotchoubey and his interest in our report of three cases in a persistent vegetative state (PVS) after severe head injury, who recovered from a prolonged disturbance of consciousness after the administration of levodopa.[1]

    As author points it out, PVS patient present a wide range of neurological symptoms and syndro...

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  • Making matters worse, ipsilaterally: A new explanation
    Iraj Derakhshan

    Dear Editor

    The Short Report by Ago and colleagues,[1] describing deterioration of pre-existing left hemiparesis by a subsequent ipsilateral hemispheric insult, contains a laterality-indexed aspect related to motor control in humans, not addressed by the authors.

    Cases similar to their patient are on record.[2] The explanation of the laterality indexed bilateral activation of motor cortices (or, as in...

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  • Persistent vegetative state: Should we generalize?
    Boris Kotchoubey

    Dear Editor

    Matsuda et al.[1] reported three cases of patients with traumatic persistent vegetative state (PVS), in which an active treatment with levodopa, starting after 3, 7, and 12 months, respectively, resulted in fast recovery of consciousness.

    All three patients had parkinsonian symptoms and MRI evidence of the damage to the substantia nigra or ventral tegmental area. This is an astonishing r...

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  • Difficult and recurrent meningitis
    O Jolobe

    Dear Editor

    Regarding Ginsberg's article: Difficult and recurrent.[1]

    The rationale underlying the author's use of a frequent dosing regimen for antibiotics in acute bacterial meningitis is a sound one, namely to compensate for the eventuality of missed doses,[1] the latter being one of the realities in a service tightly stretched for manpower. The unequivocal recommendation for a 4-hour dosing regime f...

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  • Depressive symptoms and cognitive decline
    Edward H Reynolds

    Dear Editpor

    I read with interest that Wilson et al.[1] have confirmed an association between depressive symptoms and subsequent cognitive decline in a large defined community followed prospectively for an average of 5.3 years. The various possible explanations were discussed by Stewart.[2]

    I wish to draw attention to one possible biological model of the risk factor or prodromal interpretation of th...

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