Papers by Robin Gilmore MD
Seizures and Antiepileptic Drug Use in Transplant Patients
Neurologic Clinics, May 1, 1988
Seizures may occur as an isolated manifestation of an acute encephalopathy or, less frequently, r... more Seizures may occur as an isolated manifestation of an acute encephalopathy or, less frequently, recur as a manifestation of epilepsy in transplant patients. Determining which of these is the case will lead to appropriate treatment. The selection of the antiepileptic drug (AED) will depend on the patient's type of seizure, general medical condition, and transplant type and also depend on the consideration of potential adverse effects of individual AEDs.
Recognizing problems of the aging spine
PubMed, Nov 1, 1980
Anosognosia for hemiplegia
Neurology, Dec 1, 1995
Objective: To test the personal neglect hypothesis of anosognosia for hemiplegia (AHP) using sele... more Objective: To test the personal neglect hypothesis of anosognosia for hemiplegia (AHP) using selective anesthesia of the right hemisphere. Background: Although AHP most commonly follows right-hemisphere injury, the mechanism responsible for this hemispheric asymmetry has not been entirely elucidated. Because denial of ownership of parts on the contralesional side of one's body (personal neglect) also more commonly follows right-hemisphere damage, personal neglect might account for AHP. Design/Methods: AHP and personal neglect were assessed in 20 patients during right intracarotid barbiturate infusion. With vision restricted to the central field, patients were randomly presented with either their own hands or those of examiners matched for size, gender, and race. Patients were asked to read numbers placed on the hands to establish that hemianopia did not confound hand recognition. Results: All subjects correctly read the numbers on all trials. Only 4 of 20 subjects misidentified their hands and denied awareness of left hemiplegia. All errors occurred for the left hand, indicating personal neglect. However, the 16 subjects without personal neglect also demonstrated AHP. Conclusion: Because AHP and personal neglect are dissociable, personal neglect cannot completely account for AHP.NEUROLOGY 1995;45: 2195-2199
NeuroImage, 1998
We performed several tMRI motor and sensory stimulation paradigms on a 28 yearold, right handed, ... more We performed several tMRI motor and sensory stimulation paradigms on a 28 yearold, right handed, white female who presented 6 weeks prior with new onset generalized seizures while working as a secretary. The generalized seizure was followed by several partial seizures during which timethe patient became aphasic. Initial workup included a routine MR scan that demonstrated a large tumor situated subjacent tothe motor cortex extending alongthe posterior inferior portion ofthe right frontal lobe into the right insulawith medial extension deforming the midline. Subsequent stereotactic needle biopsy demonstrated a slow growing (2% proliferative fraction) oligodendroglioma. Neurological
Seizures
Textbook of Neurointensive Care, 2013
Neurology, 1995
Article abstract—Hashimoto's encephalopathy (HE) is a steroid-responsive relapsing disorder t... more Article abstract—Hashimoto's encephalopathy (HE) is a steroid-responsive relapsing disorder that frequently presents with seizures and diffuse EEG abnormalities. We report the EEG findings in seven patients with encephalopathy, seizures, or both, associated with elevated antithyroid antibodies. There were several combinations of findings within the same patient and between patients. The EEGs of five patients had generalized slowing or frontal rhythmic slowing; two also had triphasic waves and one had periodic sharp waves. Three had focal left temporal slowing. HE is heterogeneous clinically and electrographically. A high level of suspicion is necessary to establish the diagnosis.
Valproate-associated carnitine deficiency and malignant cerebral edema in the absence of hepatic failure
International journal of clinical pharmacology and therapeutics, 1997
We describe a 27-year-old woman who developed encephalopathy and cerebral edema during treatment ... more We describe a 27-year-old woman who developed encephalopathy and cerebral edema during treatment of refractory complex partial seizures that included acute administration of valproate (VPA) at a dosage of 35 mg/kg per day. Multiple random VPA levels were within therapeutic range, and results of liver function studies did not show evidence of hepatic failure. Cerebral computerized tomography (CT) showed evidence of massive cerebral edema with central herniation. Just prior to death, plasma levels of free and acyl carnitines were markedly decreased. Analysis of urinary organic acids showed increased excretion of lactate, but a normal distribution of VPA metabolites. Carnitine deficiency may predispose patients to the development of coma and life-threatening cerebral edema associated with acute administration of VPA, even in the absence of concomitant hepatic failure. We suggest specific guidelines for the evaluation and management of altered consciousness in patients with seizures rec...
Anosognosia and confabulation during the Wada test
Neurology, 1997
Feinberg et al. proposed that right-hemisphere-damaged stroke patients with anosognosia for hemip... more Feinberg et al. proposed that right-hemisphere-damaged stroke patients with anosognosia for hemiplegia (AHP) confabulate seeing stimuli on the left side but those without AHP admit to having inadequate visual information. This study examines the relationship between AHP and confabulation using selective anesthesia of the cerebral hemispheres. Seventeen patients with intractable epilepsy were tested during intracarotid methohexital infusion. For half of the trials, subjects were stimulated on their paretic hand with a material (sandpaper, metal, or cloth), and for the remaining trials they were not stimulated. The subjects were trained to use a pointing response to indicate if they been stimulated and the type of material they had felt. Admission of uncertainty was defined as pointing to a question mark. Confabulation was defined as any material response to a no-touch trial. During anesthesia of either hemisphere, subjects with and without AHP confabulated responses. The AHP and non-...
Neurology, Feb 1, 1995
Previous studies have demonstrated asymmetric hemispheric contributions to deficit awareness duri... more Previous studies have demonstrated asymmetric hemispheric contributions to deficit awareness during hemisphere inactivation with intracarotid barbiturate infusion (Wada studies). These observations provide insight into the neuropsychological basis of anosognosia for hemiparesis (AHP), arguing against earlier explanations based upon psychological denial, global cognitive disturbance, or emotional indifference. Although prior Wada studies equated AHP after the procedure with AHP during the period of deficit, a selective memory failure could also account for these findings. We, therefore, assessed the occurrence of AHP during and after right-hemisphere inactivation in a group of epilepsy patients undergoing preoperative Wada testing. Because aphasia obscures assessment of deficit awareness during left carotid studies, we compared the frequency of AHP between right-and left-hemisphere inactivation only after recovery. As noted in earlier reports, AHP was present significantly more often after right-than left-hemisphere inactivation. The proportions of subjects with AHP during right-hemisphere anesthesia compared with the proportion of subjects with AHP after the procedure were statistically equivalent, suggesting that the AHP observed after right-hemisphere anesthesia results from true failure of deficit awareness rather than inability to recall the deficit.
Anosognosia during Wada testing
Neurology, Apr 1, 1992
Anosognosia, the verbally explicit denial of hemiplegia, is more often reported after right- than... more Anosognosia, the verbally explicit denial of hemiplegia, is more often reported after right- than left-hemisphere lesions. However, this asymmetric incidence of anosognosia may be artifactual and related to the aphasia that often accompanies left-hemisphere lesions. Anosognosia has been attributed to psychological denial and the emotional changes associated with hemispheric dysfunction. Eight consecutive patients undergoing intracarotid barbiturate (methohexital) injections as part of their presurgical evaluations for intractable epilepsy were assessed for anosognosia after their hemiplegia and aphasia had cleared. After their left-hemisphere anesthesia, all subjects recalled both their motor and language deficits. However, after right-hemisphere anesthesia, none of the eight patients recalled their hemiplegia. These results suggest that anosognosia is more often associated with right- rather than left-hemisphere dysfunction and that it cannot be attributed to either psychological denial or the emotional changes associated with hemispheric dysfunction.
Neurology, 1995
The stroke literature indicates that the explicit denial of hemiplegia, a form of anosognosia, is... more The stroke literature indicates that the explicit denial of hemiplegia, a form of anosognosia, is associated more commonly with right-than left-hemisphere lesions. Some investigators have suggested that this asymmetry may be an artifact and that the aphasia that often accompanies left-hemisphere dysfunction may mask some instances of anosognosia. Mechanisms suggested for anosognosia have been either "global" or "modular" in nature. Mechanisms posited in global explanations include psychological denial and general mental deterioration; modular explanations include feedback and feedforward theories. Videotapes of 54 patients with medically intractable seizures who had selective barbiturate anesthesia (Wada test) as part of their evaluation for seizure surgery were assessed for anosognosia of hemiplegia and aphasia after hemispheric anesthesia had worn off. The results suggest that, although aphasia may confound the reported rate of anosognosia for hemiplegia following left-hemisphere dysfunction, the frequency of anosognosia for hemiplegia is still higher with right-than left-side dysfunction. Anosognosia for hemiplegia and aphasia were dissociable, providing support for the postulate that awareness of dysfunction is mediated by a modular system.
Effects of Clinical Laser on Superficial Nerve Conduction
American Journal of Neuroradiology, 1993
Neonatal Paralytic Poliomyelitis
Archives of neurology, Feb 1, 1986
Neonatal poliomyelitis, which was rare even when poliomyelitis was widespread, has not been repor... more Neonatal poliomyelitis, which was rare even when poliomyelitis was widespread, has not been reported in the United States since use of live oral poliovirus vaccine (Sabin's vaccine) became widespread. We report a child who became symptomatic with apnea at 18 days of age and who subsequently developed a permanent monoparesis. Serologic and cultural evidence indicated the virus as poliovirus vaccine type. Another infant who received live oral poliovirus vaccine was probably the source of the infecting virus. Recognition that poliovirus infection can still occur in the United States and an understanding of the serologic, cultural, and typing tests required to substantiate this diagnosis are needed so that such patients will be accurately diagnosed.
Neurology, Aug 22, 2000
Article abstract-Holmes noted that with hemispheric injuries proprioceptive disturbances were mor... more Article abstract-Holmes noted that with hemispheric injuries proprioceptive disturbances were more marked in the distal than proximal limb segments and proposed that this difference was related to the size of cortical sensory representations. An alternative hypothesis is that sensation from distal segments projects to the contralateral hemisphere and sensation from proximal segments projects to both hemispheres. Selective hemispheric anesthesia was used to test these alternative hypotheses and revealed a decrement in distal but not proximal proprioception with hemispheric anesthesia, thereby supporting the bilateral projection hypothesis.
Apraxia during Wada testing
Neurology, Jul 1, 1995
Apraxia is the loss of the ability to perform learned skilled movements correctly. In right-hande... more Apraxia is the loss of the ability to perform learned skilled movements correctly. In right-handers, apraxia and aphasia are most frequently associated with left-hemisphere lesions. When they are dissociated, however, aphasia is more common in the absence of apraxia than vice versa. There are two hypotheses that can account for this discrepancy: (1) in right-handers, praxis is more likely than language to be mediated by the right hemisphere, or (2) the left-hemisphere network that mediates language is either more widely distributed than the network that mediates praxis or is more likely to be in the middle cerebral artery distribution. We studied apraxia in a group of right-handers undergoing selective hemispheric anesthesia, or Wada testing. All nine subjects had language lateralized to the left hemisphere, and seven of the nine had praxis lateralized to the left hemisphere. Two of the subjects had praxis bilaterally represented. Although our data suggest that speech and praxis functions tend to be lateralized to the left hemisphere in most right-handers, praxis appears to be more distributed between the hemispheres than speech-language functions. Furthermore, an analysis of the types of errors made during praxis testing suggests differential roles of the hemispheres in praxis functions.
Electroencephalography and Clinical Neurophysiology, Sep 1, 1989
Features of the Geriatric EEG: Age-Dependent Incidence of POSTS
Clinical electroencephalography, 1985
Positive occipital sharp transients of sleep (POSTS) are well recognized as a normal electroencep... more Positive occipital sharp transients of sleep (POSTS) are well recognized as a normal electroencephalographic phenomenon in young to middle-aged persons, but little comment has been made concerning their occurrence in geriatric age groups. This study encompassing 365 electroencephalograms, showing POSTS among patients aged 22 to 86 years, demonstrates that the presence of POSTS is not an age limited occurrence, but extends over a wide age range into the later decades of life. Though the incidence of POSTS declined with advancing age, the diminution was not striking until after age 70. POSTS appeared only in normal and mildly abnormal EEGs. POSTS did not occur in markedly abnormal EEGs, and thus they resemble other features of normal sleep including sleep spindles and K-complexes.
Journal of Neuroimaging, Apr 1, 1996
The T1-weighted volumetric magnetic resonance images of 31 patients with intractable temporal lob... more The T1-weighted volumetric magnetic resonance images of 31 patients with intractable temporal lobe epilepsy, and 13 control subjects matched for age and sex, were subjected to semiautomated threshold analysis. The method used proved to be relatively fast and reliable. An index of temporal lobe interhemispheric asymmetry was extracted by thresholding high-signal (white matter) pixels. Patients had significantly more asymmetri
Somatosensory Evoked Potentials in Pediatrics—Abnormal
Elsevier eBooks, 2006
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Papers by Robin Gilmore MD