http://exhibits.library.stonybrook.edu/mfp/files/original/28aed725bd962e9157c7c69f4288d4bc.pdf 4773191698066e277d182eed7b8cfd80 PDF Text Text Danuary l, 1978 Melvin Muroff, Ph.D. l2 Harcourt Scarsdale , Road NY Ref: Hayden Harman, age Dear Mel, 8 Wwv-m-wrwv-mr wwm “war-war— m w vw-.mwm;.u.. Wu sum—7:»: I have read the (dated 12/6/77) of the patient, file and reviewed the Hayden Harman. EEG record The EEG record is well done and includes alert, photic and stimulation hyperventilation sections. These show mell modulated dominant alpha activity of relatively low voltage. Slow frequencies are not prominent, nor are they stimulated by hyperventilation in undue amounts. I concur in hhe report by Dr. Scheinberg that this record does not show any abnormality inconsistent with the patient's age. We should note, however, that an important part of the EEG capability was not used, that of sleep recording. Numerous authors, notably Gibbs and his students, have repeatedly emphasized thp significance of such recording particularly in young patients in whom one is seeking evidence of dysrhythmia. rest of the file is replete with evidence of cerebral dysfunction, particularly the report of the observations by Dr. Ballweg. These data, combined with the behavior and the reports in the psychological tests (see particularly the figure drawn by the child) are evidence of dysfunction. Unfortunatley, it is not possible to determine from these data whether the dysfunction is episodic. The most conservative approach to problems of this dimension is the conbined pharmacologic~psychologic. The former provides The an opportunity to alter one may be fortunate in cerebral functions, and with proper manipulation, affecting the functions favorably. Two courses are available: a trial of an anticonvulsant, such as diphenylhydantoin (Dialantin) in doses up to 300 mg/day; or a psychostimulant, either methylphenidate (Ritalin) or dextroamphetamine (Dexedrine). I favor the use of methylphenydate as it has a better safety margin. The use of these drugs should be combined with sessions with the child and on occasion, with the parents, to assist in the adjustments necessary in helping a child whose �mm [Jp— n... ‘vw “r Dr. Melvin Muroff ........ January 1, 1978 ............. page 2 ..mww.aw-nw.w<~wu, achievements may not be as good as his or his family's aspirations. If there is a choice in the sequence of drugs to be tried, would depend on the clinical findings as your best guide. Since you already have noted the similarity of this boy's problems to those seen in others helped by diphenylhydantoin, I would encourage its I trial first. If there is a special need to verify the possibility of dysrhythmia further, then a sleep EEG could be obtained. If the laboratory at Lawrence Hospital is reluctant to carry this out, I would suggest you enquire whether Dr. Fred Struve of the Hillside Hospital is willing to do the test for you. He is a Gibbs' student and one of the best analysts of clinical sleep EEG records in the region. The other is Dr. Eli Goldenson at the New York Neurological Institute. I trust these are helpful. for the success of this child'd treatment. comments My best wishes Sincerely yours, Fink, M.D. Professor of Psychiatry Max � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Correspondence Text A resource consisting primarily of words for reading. 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