Carcinogenicity of chloroform.

Chloroform is carcinogenic in rats, mice, and probably in dogs. Chloroform induced carcinomas of the liver and kidney and malignant tumors in other organs in rats and mice. Liver neoplasms have been described in three strains of mice. Carcinomas of the kidney were found in a first study in mice and in the repeat of that study. Dogs given chloroform developed neoplasms of the liver as well as in other organs. Rats given chloroform also developed toxic changes, particularly male rats, as a result of treatment. These lesions included interstitial fibrosis of the kidney; polyarteritis of the mesenteric, pancreatic, and other arterioles and arteries; and atrophy of the testes. These toxic changes may have interfered with the development of neoplasms in male rats

Consciousness in non-epileptic attack disorder

Non-epileptic attack disorder (NEAD) is one of the most important differential diagnoses of epilepsy. Impairment of consciousness is the key feature of non-epileptic attacks (NEAs). The first half of this review summarises the clinical research literature featuring observations relating to consciousness in NEAD. The second half places this evidence in the wider context of the recent discourse on consciousness in neuroscience and the philosophy of mind. We argue that studies of consciousness should not only distinguish between the ‘level’ and ‘content’ of consciousness but also between ‘phenomenal consciousness’ (consciousness of states it somehow “feels to be like”) and ‘access consciousness’ (having certain ‘higher’ cognitive processes at one’s disposal). The existing evidence shows that there is a great intra- and interindividual variability of NEA experience. However, in most NEAs phenomenal experience – and, as a precondition for that experience, vigilance or wakefulness – is reduced to a lesser degree than in those epileptic seizures involving impairment of consciousness. In fact, complete loss of “consciousness” is the exception rather than the rule in NEAs. Patients, as well as external observers, may have a tendency to overestimate impairments of consciousness during the seizures

What patients say about living with psychogenic nonepileptic seizures: A systematic synthesis of qualitative studies.

PURPOSE: This is a narrative systematic synthesis of qualitative research investigating patients' accounts of living with psychogenic nonepileptic seizures (PNES). Qualitative methodologies allow patients to share lived experiences in their own words. The examination of patients' own accounts is likely to offer revealing insights into a poorly understood, heterogeneous disorder. METHODS: We identified 21 separate studies about PNES published after 1996 and based on analyses of patients' own words. Papers were synthesised inductively and deductively using an iterative approach. RESULTS: Five key themes emerged from the synthesis of studies capturing accounts from over 220 patients, reflecting experiences of seizure events, diagnosis, treatment and management, emotional events, and impact on daily life. Patients with PNES discussed the phenomenology of their seizures differently from those with epilepsy. PNES were experientially heterogeneous. Many patients shared a sense of uncertainty surrounding PNES, often resisting psychological explanations. Negative experiences with healthcare professionals were common. Patients seeking validation of their experiences often reported feeling ignored or doubted. Many reported past or current stressful events. Some demonstrated insight into their methods of emotional processing. PNES were described as a significant burden associated with financial and psychosocial losses. CONCLUSIONS: Qualitative studies have produced helpful insights into patients' experiences of living with PNES, but many patient groups (men, young people, elderly, non-Western patients) are underrepresented in studies carried out to date. Research capturing these patient groups and using new methods of data collection and qualitative analysis could help to deepen our understanding of this disorder

Medicine and the media: the ethics of virtual medical encounters

The expansion of new forms of public media, including social media, exposes clinicians to more illness experiences/narratives than ever before and increases the range of ways to interact with the people depicted. Existing professional regulations and ethics codes offer very limited guidance for such situations. We discuss the ethics of responding to such scenarios through presenting three cases of clinicians encountering television or social media stories involving potential unmet healthcare needs. We offer a structured framework for health workers to think through their responses to such situations, based around four key questions for the clinician to deliberate upon: who is vulnerable to harm; what can be done; who is best placed to do it; and what could go wrong? We illustrate the application of this framework to our three cases

Correlates of health-related quality of life in adults with psychogenic nonepileptic seizures: A systematic review

Psychogenic nonepileptic seizures (PNES) often have a debilitating effect on patients’ lives. Patients, family members, and clinicians have yet to fully understand the mechanisms and treatment of this disorder. Although reviews exist about epileptic seizures, there have been no systematic reviews of studies focusing on the impact of PNES. This review considers research on factors associated with the health-related quality of life (HRQoL) of patients with PNES. Searches of Medline, PsycINFO, CINAHL, and Cochrane Library were conducted. Search terms identified studies that examined factors associated with HRQoL in PNES. Factors fell into three categories: (1) seizure and somatic factors, (2) psychological factors, and (3) coping strategies and family functioning. Fourteen articles were included. The majority of studies were cross-sectional and were of weak to moderate quality. Depressive symptoms were negatively associated with HRQoL. Other factors associated with poorer HRQoL included dissociation, somatic symptoms, escape-avoidance coping strategies, and family dysfunction. Variables such as seizure frequency and demographic factors were not significantly associated with HRQoL. Psychological and interpersonal factors, not seizure reduction, are important for the HRQoL of patients with PNES. The avoidance of emotions is proposed as a perpetuating factor in the difficulties associated with poorer HRQoL. A biopsychosocial approach has relevance for both the clinical and theoretical understanding of PNES. Larger scale research on psychological and relational factors is needed to inform therapeutic approaches to enhance HRQoL in patients with PNES

The role of companions in outpatient seizure clinic interactions: A pilot study

Purpose: This study explored contributions that patients' companions (seizure witnesses) make to interactions in the seizure clinic and whether the nature of the companions' interactional contributions can help with the differentiation of epilepsy and psychogenic nonepileptic seizures (PNES). Methods: Conversation analysis methods were used to examine video recordings and transcripts of neurologists' interactions with patients referred to a specialist seizure clinic and their companions. Results: The companions' behavior correlated with interactional features previously observed to distinguish patients with epilepsy from patients with PNES. Patients with PNES, but not those with epilepsy, tended to exhibit interactional resistance to the doctor's efforts to find out more about their seizure experiences and, thereby, encouraged greater interactional contribution from companions. Conclusion: The contributions that companions make (in part, prompted by patient's interactional behavior) may provide additional diagnostic pointers in this clinical setting, and a number of candidate features that may help clinicians distinguish between epilepsy and PNES when the patient is accompanied by a seizure witness are described. However, companion contributions may limit the doctor's ability to identify linguistic and interactional features with previously demonstrated diagnostic potential in the conversational contributions made by patients themselves. To help offset potential diagnostic losses, doctors may need to explicitly discuss the role of the companion in the consultation when a seizure witness (or another companion) accompanies the patient