Duchenne MD — This form has an early childhood onset, often between ages 2 and 6. It’s typified by generalized weakness and muscle wasting affecting the limbs and trunk. The calves are often enlarged. The disease progresses slowly but affects all voluntary muscles and survival is rare beyond the late 20s.
Becker MD — This disease has an onset in adolescence or adulthood and is similar to Duchenne MD with less severe symptoms. It can affect the heart and has a slower more variable course. Patients often survive well into mid- to late- adulthood.
Myotonic Dystrophy (DM) — Often called Steinert’s disease, this form is diagnosed from childhood through middle age. It includes general weakness and muscle wasting in the face, feet, hands and neck in the beginning. Patients may experience delayed relaxation after contracting muscles and the progression is slow.

Juvenile Spinal Muscular Atrophy — Also known as Kugelberg-Welander disease, this is usually diagnosed when the patient is between 1 and 15 years of age. Its symptoms include weakness in the hips, legs, shoulders and arms.

It has a slow progression, but a wheelchair is often necessary in later life.
The Muscular Dystrophy Association includes more than 230 support groups across the country and it offers summer camps for children. Find out more at the Muscular Dystrophy Association Web site.

Your wife should have already received a thorough neurological workup. If questions still remain — including the possibility of any psychological condition, including Munchausen’s syndrome — I’d recommend a thorough psychological evaluation as well. You may want to consult with a psychologist or other mental health professional experienced in the assessment and treatment of abuse and trauma survivors, to make sure any possible dissociative condition can be diagnosed or ruled out. Such a psychological evaluation may provide additional treatment recommendations.

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A. I can’t say for sure what is causing — or is related to — your wife’s seizures without evaluating her personally. But it sounds as though someone — whether a medical or mental health professional, I don’t know — is wondering whether your wife’s seizures are psychological in origin.

You say the seizures “seem to be related to epilepsy” but are atypical. Since she’s been hospitalized four times, I’ll assume that EEGs have been performed and anticonvulsant medication has been tried without much success. It is true that people can have seizures of nonepileptic origin, sometimes called pseudoseizures, and some people fake seizures outright (almost any condition can be faked, at least behaviorally). Some of those people might be considered to have Munchausen’s syndrome (called “factitious disorder” in the current psychiatric diagnostic manual), or be flat-out faking for some kind of secondary gain. (For more detail on Munchausen’s syndrome, see my earlier column on this topic.)

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In every case, it’s an emergency. Affected areas of the brain can begin to die within minutes, causing permanent damage to speech, vision, and movement.

Smokers, people over 65, men, African-Americans, and those with a family history of stroke all have a higher than usual chance of having a stroke.

Women using birth control pills have a greater risk of stroke if they also smoke. The risk is even higher if they are over 35 or have high blood pressure.

Depending on the location and the damage caused by a stroke, many people recover fully following physical or occupational therapy, combined with other treatment and lifestyle changes to prevent recurrences.

Despite our improved understanding of the disease, a number of controversies surrounding the treatment of chronic hepatitis C still exist. The role of this symposium is to address some of these controversies and unanswered questions. Today you will hear a discussion of the use of surrogate markers in treatment and management of hepatitis C, about difficult-to-treat patient populations and some alternative treatment regimens in development, the effect of interferon on the risk of liver disease progression to hepatocellular carcinoma and how to best treat hepatitis C patients with cirrhosis.

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It is estimated that about 4 million Americans or about 2% of the population are infected with the hepatitis C virus. Following acute infection, up to 75 to 85% of patients develop chronic hepatitis C, predisposing them to chronic complicated liver disease and, in some instances, premature death due to cirrhosis and hepatocellular cancer. Indeed, HCV-related chronic liver disease contributes to about 8,000 to 10,000 deaths in the US each year.

The substantial public health and financial implications of HCV infection are only now being fully appreciated. Since most HCV-infected individuals in the US are between the ages of 30 and 49 years, the impact of HCV infection on health care costs in the future will be considerable as these individuals grow older and their disease progresses. A recent analysis estimated that by the year 2008, the continued maturation of the current cases of chronic HCV infection would result in a 61% increase in cirrhosis, 279% increase in decompensated patients, 68% increase in hepatocellular carcinoma, 528% increase in the need for liver transplantation and a 223% increase in liver-related deaths as compared with 1998.

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sudden high fever (102 to as high as 105 degrees); followed by an abrupt bloom of a red, spotty, slightly raised rash
decreased appetite
mild diarrhea
slight cough
runny nose
mild irritability, and drowsiness
swollen glands (rarely)

Sometimes, convulsions occur from the high fever. While the convulsions do not indictate serious neurologic disease.

they can be frightening to witness and should be reported to your physician right away.

In the power sports group (n=12) the more active twin had 2,300 hours of lifting over a 13.8 years, while the less active had only 200 hours over 1.1 year.

Both groups were interviewed about any back symptoms, and MRI scans were made of the lower thoracic and lumbar spine. Experts scored images of each of the 12 joints of the spine for amount of degeneration, and scores were compared between the less- and more-active twins.

The bottom line, in general, was that no significant differences in spinal disk degeneration were found between the less-active and the more-active in endurance activities. And, the researchers saw less degeneration throughout the thoracic and lumbar spine of the weightlifters than they had expected. The power sports seemed to be responsible for some greater degeneration in the lower thoracic region but not in the lumbar (low back) region.

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Some people who exercise a lifetime do have joint problems in older ages. Others do not. Some think the exercise has protected their joints and kept them from the pain of osteoarthritis or disk degeneration. It has been hard for exercise professionals to give any strong warnings or encouragement about the long-term effect on joints of vigorous weight-bearing exercise, although almost everyone knows that one who abstains from exercise will risk many health problems in later life.

A recent study from Finland (Medicine & Science in Sports & Exercise, Oct. 1997) should help relax some of the fears of exercise impact. Past studies have been confounded by genetic differences (regardless of what they do, some people are more likely than others to develop joint problems). The Finn’s study concentrated on identical twin pairs who had very different exercise histories over their 35- to 69-year lifetimes.

From a remarkable database that identified virtually every twin in Finland, the investigators found 154 pairs that had different exercise histories. From this group, they isolated those who had the greatest differences in activity within the pair for endurance activities and power sports.

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