Treatment of epilepsy in the multiply handicapped

The medical management of epilepsy in the multi-handicapped patient requires careful evaluation, classification, and pharmacologic treatment. It is estimated that 20-40% of patients with mental retardation and cerebral palsy have epilepsy. This review reports the clinical trial data and personal experience related to the use of newer AEDs in the chronic management of epilepsy syndromes in children and adults, as well as information available on the treatment of seizures in individuals with mental retardation and associated handicaps. Furthermore, clusters of seizures, prolonged seizures and status epilepticus are more commonly seen in the multiply handicapped and mentally retarded population and require special attention. The new antiepileptic drugs felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate, vigabatrin and zonisamide show specific advantage in some multiply handicapped patients, be it for seizure control or medication tolerance. Furthermore, new modalities of treatment for prolonged seizures allow better efficacy both outside of hospital and within hospital facilities. The treatment of epilepsy in multi-handicapped and retarded adults and children has significantly advanced in the past few years, and much of this improvement can be attributed to improved knowledge and monitoring of new antiepileptic drugs. Conventional anticonvulsants remain first line therapy for most clinicians, but newer AEDs must broaden the therapeutic option and do allow improved therapy for some multiply handicapped patients.     

The tactual horizontal-vertical illusion depends on radial motion of the entire arm

Wesought to clarify the causes of the tactual horizontal-vertical illusion, where vertical lines are overestimated as compared with horizontals in Land inverted-T figures. Experiment 1 did not use L or inverted-T figures, but examined continuous or bisected horizontal and vertical lines. It was expected that bisected lines would be perceived as shorter than continuous lines, as in the inverted-T figure in the horizontal-vertical illusion. Experiment 1 showed that the illusion could not be explained solely by bisection, since illusory effects were similar for continuous and bisected vertical and horizontal lines. Experiments 2 and 3 showed that the illusory effects were dependent upon stimulus size and scanning strategy. Overestimation of the vertical was minimal or absent for the smallest patterns, where it was proposed that stimuli were explored by finger movement, with flexion at the wrist. Larger stimuli induce whole-arm motions, and illusory effects were found in conditions requiring radial arm motion. The illusion was weakened or eliminated in Experiment 4 when subjects were forced to examine stimuli with finger-and-hand motion alone, that is, their elbows were kept down on the table surface, and they were prevented from making radial arm motions. Whole-arm motion damaged performance and induced perceptual error. The experiments support the hypothesis that overestimation of the vertical in the tactual horizontal-vertical illusion derives from radial scanning by the entire arm.     

The voice problems of stutterers: A practical approach from clinical experience

Voice disorders, which may be caused by the stuttering problem, have been noted in at least one-third of stutterers seen. Basically, stutterers have false speech images that normal speech is perfect and without natural dysfluencies (repetitions, pauses, etc.). Many stutterers also have erroneous vocal images of how they should or should not sound. Both images control speech and voice. Clinical experience indicates that vocal rehabilitation should be used in conjunction with speech therapy for many stutterers.     

The quality of the analyst's attention

Compiled and edited from lectures on psychoanalytic technique given by the late Karen Horney at the American Institute for Psychoanalysis during the years 1946, 1950, 1951, and 1952. Further lectures in this series will appear in subsequent issues of the Journal.     

Are you listening? Exploring a developmental knowledge–action dissociation in a speech interpretation task

Young children sometimes act inappropriately despite appearing to know what to do. Dissociations of this kind raise important questions about the organization and development of knowledge and action systems. The present study investigated a knowledge–action dissociation in 6–year–olds performing a speech interpretation task and tested the hypothesis that knowledge–action dissociations stem from a general difficulty resolving conflicting cues. When knowledge and action measures were equated in terms of the amount of conflict that needed to be resolved for a correct response, children’s knowledge no longer appeared to outstrip their ability to act appropriately. Implications of the findings for competing views of knowledge representation and knowledge–action system organization are discussed.