Showing papers in "Journal of Neurology, Neurosurgery, and Psychiatry in 1986"
TL;DR: Two-hundred and seventeen patients from a total population of 343 patients with arteriovenous malformations, were managed without surgery, and using life survival analyses, there was a 42% risk of haemorrhage, 29% chance of death, 18% riskof epilepsy, and a 27%risk of having a neurological handicap by 20 years after diagnosis in unoperated patients.
Abstract: Two-hundred and seventeen patients from a total population of 343 patients with arteriovenous malformations, were managed without surgery. Follow up was for a mean of 10.4 years. Using life survival analyses, there was a 42% risk of haemorrhage, 29% risk of death, 18% risk of epilepsy and a 27% risk of having a neurological handicap by 20 years after diagnosis in unoperated patients.
721 citations
TL;DR: Persisting severe deficits, in some cases worse than at 1 year, were primarily psychological and behavioural, although minor physical deficits, for example in vision, were also common.
Abstract: A close relative of each of 42 severely head injured patients was interviewed at 5 years after injury, following initial study at 3, 6, and 12 months. Persisting severe deficits, in some cases worse than at 1 year, were primarily psychological and behavioural, although minor physical deficits, for example in vision, were also common. Relatives were under great strain; significantly more so than at 1 year. The best predictor of strain in the relative was the magnitude of behavioural and personality change in the patient.
600 citations
TL;DR: Clinicians must maintain a high index of suspicion in the "at risk" group of patients, particularly alcoholics, to make the diagnosis of the Wernicke-Korsakoff syndrome and Investigations of thiamine status may be helpful and if the diagnosis is suspected, parenteralThiamine should be given.
Abstract: A recent necropsy study has shown that 80% of patients with the Wernicke-Korsakoff syndrome were not diagnosed as such during life. Review of the clinical signs of these cases revealed that only 16% had the classical clinical triad and 19% had no documented clinical signs. The incidence of clinical signs in this and other retrospective pathological studies is very different from that of prospective clinical studies. This discrepancy may relate to "missed" clinical signs but the magnitude of the difference suggests that at least some cases of the Wernicke-Korsakoff syndrome may be the end result of repeated subclinical episodes of vitamin B1 deficiency. In order to make the diagnosis, clinicians must maintain a high index of suspicion in the "at risk" group of patients, particularly alcoholics. Investigations of thiamine status may be helpful and if the diagnosis is suspected, parenteral thiamine should be given.
572 citations
TL;DR: Results indicate that single minor head injury in persons with no prior compromising condition is associated with mild but probably clinically non-significant difficulties at 1 month after injury, however, disruptions of everyday activities are extensive with other system injuries significantly contributing to these problems.
Abstract: Twenty subjects with minor head injury were compared to an uninjured group at 1 and 12 months after injury on a battery of neuropsychological and psychosocial measures. The results indicate that single minor head injury in persons with no prior compromising condition is associated with mild but probably clinically non-significant difficulties at 1 month after injury. Disruptions of everyday activities, however, are extensive with other system injuries significantly contributing to these problems. Recent reports in the literature may represent overestimation of head injury related losses due to lack of control for the effects of pre-injury characteristics and other system injuries.
488 citations
TL;DR: Qualitatively, both the Parkinson's disease and the arthritis groups had depression characterised by pessimism and hopelessness, decreased motivation and drive, and increased concern with health, while the negative affective feelings of guilt, self-blame and worthlessness were absent in both patient groups.
Abstract: Depression is a common feature of Parkinson's disease, a fact of both clinical and theoretical significance. Assessment of depression in Parkinson's disease is complicated by overlapping symptomatology in the two conditions, making global assessments based on observer or self-ratings of doubtful validity. The present study aimed to provide both a quantitative and qualitative description of the nature of the depressive changes found in Parkinson's disease as compared with normal elderly subjects and arthritis patients. As with previous studies, the patients with Parkinson's disease scored significantly higher than normal controls on various self-ratings of depression and anxiety but, in this study, did not differ from those with arthritis. Qualitatively, both the Parkinson's disease and the arthritis groups had depression characterised by pessimism and hopelessness, decreased motivation and drive, and increased concern with health. In contrast, the negative affective feelings of guilt, self-blame and worthlessness were absent in both patient groups. This pattern of depression was significantly associated with severity of illness and functional disability. However, these factors account for only a modest proportion of the variability in test scores. Probable unexplored factors are individual differences in coping style and availability of support.
381 citations
TL;DR: Aphasia was associated with more severe disability, and with a less good recovery of social activities, but did not cause any measurable increase in stress upon carers.
Abstract: Data relating to 976 patients registered as suffering an acute stroke has been analysed to determine the natural history of speech disturbance: these patients came from a community survey of 215,000 people over a 28 month period. Of the 545 patients assessed within 7 days of stroke, 24% were aphasic and 28% unassessable. At 3 weeks, when over 90% of survivors were tested, 20% of those tested had aphasia. At 6 months only 12% of survivors had significant aphasia, but 44% of patients and 57% of carers thought speech was abnormal. Of those aphasic within 7 days, 40% remained so at 6 months; 60% of those aphasic at 3 weeks remained so. There was a high correlation between early and late aphasia scores. Aphasia was associated with more severe disability (degree of limb weakness, loss of function, loss of IQ), and with a less good recovery of social activities, but did not cause any measurable increase in stress upon carers. In a Health District of 250,000 people, about 60 patients each year may be referred for speech therapy after an acute stroke.
376 citations
TL;DR: The capacity of the striatum to retain tracer was severely impaired in patients compared to controls and this may reflect a reduction of striatal dopamine storage in Parkinson's disease.
Abstract: L-[18F] fluorodopa was administered in trace amounts intravenously to healthy control subjects and to patients with Parkinson's disease. Striatal uptake of radioactivity was measured using positron emission tomography. The capacity of the striatum to retain tracer was severely impaired in patients compared to controls. This may reflect a reduction of striatal dopamine storage in Parkinson's disease. Patients showing the "on/off" phenomenon had an even greater decrease of striatal storage capacity.
361 citations
TL;DR: The first 50 patients who have received sacral anterior root stimulator implants are presented, with follow-up of from 1 to 9 years, and 39 are alive and 43 are regularly using their implants for micturition.
Abstract: The first 50 patients who have received sacral anterior root stimulator implants are presented, with follow-up of from 1 to 9 years. Forty-nine are alive and 43 are regularly using their implants for micturition. Of the 49 living, 39 are "very pleased, without significant reservations", six are pleased on balance but have reservations, and four are dissatisfied. Residual urine volumes are substantially reduced in all patients who are using their implants. Ten of the 12 female patients and the majority of male patients have become continent. The voiding pressure in implant-driven micturition can be regulated by adjusting the stimulus parameters, and is always kept below 90 cm H2O. Of seven patients with ureteric reflux before operation, four have ceased to reflux and the other three are unchanged. Changes in the radiographic appearances of the bladder have been favourable or zero, but there have been two cases of deterioration in the upper urinary tracts. Significant harmful effects have been CSF leaks, urinary infections following post-operative urodynamic study, and accidental damage to roots. Anterior roots nearly always recover from accidental damage, and posterior roots do not.
324 citations
TL;DR: Spinal cord potentials produced by high voltage electrical stimulation of the scalp over the motor cortex were recorded intraoperatively from bipolar electrodes inserted into the epidural space of patients undergoing corrective surgery for scoliosis to be a useful adjunct to conventional monitoring of the sensory pathways during surgery.
Abstract: Spinal cord potentials produced by high voltage electrical stimulation of the scalp over the motor cortex were recorded intraoperatively from bipolar electrodes inserted into the epidural space of eleven patients undergoing corrective surgery for scoliosis. Responses to single stimuli could be recorded from the cord at all levels from cervical to low thoracic regions. The potentials were larger in the cervical than in the thoracic region and sometimes were followed by later waves at high stimulation intensities. Conduction velocity in large corticomotoneuron fibres was estimated to be between 50-74 ms-1 in different patients. This technique for monitoring motor tract function may be a useful adjunct to conventional monitoring of the sensory pathways during surgery.
324 citations
TL;DR: The use of percutaneous stimulation for twitch superimposition in the human quadriceps has been compared with stimulation via the femoral nerve and inhibition was demonstrated in patients with muscle pain and joint pathology and in subjects with a previous history of knee or joint injury.
Abstract: The use of percutaneous stimulation for twitch superimposition in the human quadriceps has been compared with stimulation via the femoral nerve. It was found that the relationship between the extra force generated by the twitch and the level of voluntary contraction was independent of the percentage of the muscle stimulated. The technique was used to study activation of the quadriceps and biceps in a group of young healthy adults, and quadriceps activation in patients with musculo-skeletal disorders. The majority of subjects could fully activate their muscles during brief isometric contractions. Inhibition was demonstrated in patients with muscle pain and joint pathology and in subjects with a previous history of knee or joint injury. The technique is easy to use and provides a simple way of detecting inhibition where it might not be anticipated, such as in the absence of pain. Where inhibition is demonstrated the technique can be used to predict approximately the maximum force available.
307 citations
TL;DR: Although patients produced faster wrist movements when on medication than when off, the change was relatively small compared with the change seen in their overall clinical rating, and changes in the velocity of movements at a single joint are not a good reflection of the overall clinical state of patients with Parkinson's disease.
Abstract: Rapid wrist flexion movements were studied in a group of 10 patients with Parkinson's disease both on and off their normal drug therapy, and were compared with the same movements made by a group of eight normal individuals. When normal subjects made movements through 60 degrees, the first agonist burst of EMG activity in the wrist flexor muscles was longer and larger than that seen in movements of 15 degrees. If a large opposing load of 2.2 Nm was added, this also increased the size and duration of the first agonist EMG burst. Although the movements made by the patients were slower than those of normals, the size and duration of the first agonist EMG burst changed with movement size and added load in the normal way. This shows that patients can produce large, long bursts of EMG activity, but that there is a failure to match these parameters appropriately to the size of movement required. The effect of levodopa therapy on the movements was not dramatic. Although patients produced faster wrist movements when on medication than when off, the change was relatively small compared with the change seen in their overall clinical rating. Changes in the velocity of movements at a single joint are not a good reflection of the overall clinical state of patients with Parkinson's disease.
TL;DR: The pattern of correlations suggests that the dementia of Alzheimer's disease is largely a reflection of the state of large cortical neurons, and it is argued that abnormalities in the latter may not be directly related to primary loss of cholinergic neurons in the subcortex.
Abstract: In a study of 17 patients with histologically proven Alzheimer's disease the relationship between psychological, pathological and chemical measures of disorder was examined. Severity of dementia, determined by mental test performance, correlated highly with pathological change in large cortical neurons (cell loss and reduction in nuclear and nucleolar volume and cytoplasmic RNA content), to a lesser extent with cortical senile plaque and neurofibrillary tangle frequency and reduction in acetylcholine (ACh) synthesis, and not with reduction in choline acetyltransferase (CAT) activity. A strongly significant relationship was demonstrated between cell loss and reductions in nuclear and nucleolar volume and cytoplasmic RNA content. Reduction in CAT activity and senile plaque frequency were significantly correlated, thereby linking changes in the sub-cortical projection system of the nucleus basalis with the cortical pathology. The pattern of correlations suggests that the dementia of Alzheimer's disease is largely a reflection of the state of large cortical neurons, and it is argued that abnormalities in the latter may not be directly related to primary loss of cholinergic neurons in the subcortex.
TL;DR: The analysis showed that the two polyneuropathies are likely to be separate entities that can be distinguished in most instances by the predisposing illness, electrophysiological features and cerebrospinal fluid results.
Abstract: A polyneuropathy of varying severity has been observed in association with sepsis and critical illness in 15 patients. Since clinical evaluation is often difficult, electrophysiological studies provided definitive evidence for polyneuropathy. These revealed reductions in the amplitudes of compound muscle and sensory nerve action potentials, the most marked abnormality. Near-nerve recordings confirmed such reductions for sensory fibres. Needle electromyography revealed signs of denervation of limb muscles. Phrenic nerve conduction and needle electromyographic studies of chest wall muscles suggested that the polyneuropathy partially explained difficulties in weaning patients from the ventilator, an early clinical sign. No defect in neuromuscular transmission was demonstrated, despite the use of aminoglycoside antibiotics in some patients. In those who survived the critical illness, clinical and electrophysiological improvement occurred. The 15 critically ill polyneuropathy patients were compared with 16 Guillain-Barre syndrome patients observed during the same period. The analysis showed that the two polyneuropathies are likely to be separate entities that can be distinguished in most instances by the predisposing illness, electrophysiological features and cerebrospinal fluid results.
TL;DR: This study on 1062 epileptic patients who had 4007 split screen video EEG investigations revealed that the relation to generalised epilepsy is even more close than generally believed.
Abstract: Photosensitivity is the most common mode of seizure precipitation. It is age-related, more frequent in females, and most often found in generalised epilepsies. Little is known about its relation to individual epileptic syndromes. This study on 1062 epileptic patients who had 4007 split screen video EEG investigations revealed that the relation to generalised epilepsy is even more close than generally believed. Versive seizures with visual hallucinations was the only focal seizure type related to photosensitivity. Of the syndromes of generalised epilepsy, only childhood absence epilepsy, juvenile myoclonic epilepsy, and epilepsy with grand mal on awakening were related to photosensitivity. The closest correlation was with juvenile myoclonic epilepsy. This is confirmed by a relation to the poly-spike wave pattern, and by an increase of myoclonic seizures by intermittent light stimuli. No relation was found with early childhood syndromes of generalised epilepsy, or generalised tonic-clonic seizures in the evening, or, most remarkably, with juvenile absence epilepsy. In generalised epilepsies with onset around puberty, photosensitivity could thus act as a pathoplastic factor. The female preponderance in both childhood absences and photosensitivity could be due to the same unknown factor.
TL;DR: The findings support the notion that the "cerebral atrophies" represent a heterogeneous group of conditions, and have relevance for the clinical diagnosis of presenile dementia.
Abstract: In a prospective study of 24 patients with presenile dementia associated with cerebral atrophy, clinical and psychological characteristics of patients' disorder were examined in relation to pathological and chemical findings obtained from tissue analysis following cerebral biopsy. The histological features of Alzheimer's disease were found in 75% of cases, but not in 25%. Distinctive patterns of neuropsychological breakdown emerged allowing clinical grouping of patients. While clinical patterns were helpful in differentiating Alzheimer's disease from non-Alzheimer's disease, there was not an absolute concordance between clinical and patho-chemical groupings. The findings, which support the notion that the "cerebral atrophies" represent a heterogeneous group of conditions, have relevance for the clinical diagnosis of presenile dementia.
TL;DR: In this series disinhibition of sexual activity and hypersexuality followed medial basal-frontal or diencephalic injury, which contrasted with the patients demonstrating altered sexual preference whose injuries involved limbic system structures.
Abstract: Eight patients are described in whom either hypersexuality (four cases) or change in sexual preference (four cases) occurred following brain injury. In this series disinhibition of sexual activity and hypersexuality followed medial basal-frontal or diencephalic injury. This contrasted with the patients demonstrating altered sexual preference whose injuries involved limbic system structures. In some patients altered sexual behaviour may be the presenting or dominant feature of brain injury.
TL;DR: Nocturnal paroxysmal dystonia represents a syndrome of sleep-related motor attacks which comprises two variants, respectively characterised by short and long-lasting seizures.
Abstract: Sleep-related seizures characterised by choreoathetoid, dystonic and ballic movements occurred in 12 patients, repeatedly each night and over a period of years. The nocturnal attacks were short-lasting, responded well to carbamazepine and were sometimes associated with clearly or possibly epileptic seizures during night- or daytime. They resembled the paroxysmal kinesigenic dystonias of wakefulness. Similar dystonic-dyskinetic attacks, but of long duration and unresponsive to medication, were also observed in two other patients, in one 20 years before the onset of clinically apparent Huntington's chorea. Nocturnal paroxysmal dystonia represents a syndrome of sleep-related motor attacks which comprises two variants, respectively characterised by short and long-lasting seizures. Its precise nosological definition still awaits elucidation.
TL;DR: The effect of progesterone deficit on seizure susceptibility before menstrual bleeding is discussed, and the need of serum anticonvulsant level determination during the premenstrual phase in epileptic women is suggested.
Abstract: The excretion of three oestrogen fractions and progesterone metabolites in 64 female epileptic patients was determined during the menstrual cycle, and in 50 women of this sample serum phenytoin and phenobarbitone levels were measured. A significant decrease of both hormones in epileptic patients was found as compared to a control group. The variations in serum phenytoin levels were greater in females with so-called catamenial epilepsy with a marked fall of drug levels between days 27 and 28 corresponding with an increase of seizure frequency. The effect of progesterone deficit on seizure susceptibility before menstrual bleeding is discussed, and the need of serum anticonvulsant level determination during the premenstrual phase in epileptic women is suggested.
TL;DR: It is established that patients with word deafness who have had formal testing of linguistic and non-linguistic sound comprehension and musical abilities always demonstrated a more pervasive auditory agnosia and the term "word deafness" should be retained for this syndrome.
Abstract: Since its original description the diagnosis of word deafness has been greatly expanded. Confusion has arisen with regard to the usage of the related terms pure word deafness, auditory agnosia, and cortical deafness. Three new cases of word deafness are presented including one case with CT and necropsy correlation. These cases are compared with 34 previously reported cases of various cortical auditory disorders. Our review establishes that patients with word deafness who have had formal testing of linguistic and non-linguistic sound comprehension and musical abilities always demonstrated a more pervasive auditory agnosia. Despite the spectrum of auditory deficits and associated language abnormalities, patients with word deafness share common features including aetiology, pathology, clinical presentation and course. These common features justify inclusion of heterogeneous cortical auditory disorders under the rubric of word deafness. Despite some limitations the term "word deafness" should be retained for this syndrome, since inability to comprehend spoken words is the most distinctive clinical deficit. Word deafness is most frequently caused by cerebrovascular accidents of presumed cardiac embolisation, with bitemporal cortico-subcortical lesions. The sequence of cerebral injury is not predictive of resulting auditory deficits. Impairment of musical abilities parallels the severity of the auditory disorder.
TL;DR: The accumulated experience of the catatonic syndrome is presented and the prognosis was excellent, except for the few patients who presented with the acute and rapidly progressive form of the syndrome which led to acute renal failure.
Abstract: Karl Ludwig Kahlbaum was the first to describe catatonia in 1868. There has been a tendency to consider catatonia as a psychiatric disease despite many case reports demonstrating a wide range of medical and neurological as well as psychiatric causes. We present our accumulated experience of the catatonic syndrome. Most cases (36%) were associated with affective illness but five cases (20%) had a defined organic disorder. A significant minority had no identifiable cause and there was only one case of schizophrenia. The idiopathic and affective groups had a high incidence of recurrent catatonic episodes and many had a family history of a similar problem. The prognosis was excellent, except for the few patients who presented with the acute and rapidly progressive form of the syndrome which led to acute renal failure.
TL;DR: Three out of ten consecutive patients presenting with suspected cervical headache were found to suffer pain mediated by the third occipital nerve and stemming from a C2-3 zygapophysial joint.
Abstract: One of the putative causes of headache is osteoarthritis of the C2-3 zygapophysial joint. A technique for blocking the third occipital nerve which innervates this joint was devised and used as a screening procedure for headache mediated by this nerve. Seven out of ten consecutive patients presenting with suspected cervical headache were found to suffer pain mediated by the third occipital nerve and stemming from a C2-3 zygapophysial joint. Because third occipital headache may be indistinguishable clinically from tension or other forms of headache, third occipital nerve blocks are advocated as means of establishing this largely unrecognised diagnosis.
TL;DR: A necropsy study of 159 elderly patients drawn mainly from a prospectively assessed geriatric hospital population was carried out to investigate the relationship of cerebral amyloid angiopathy to Alzheimer's disease, other CNS disease and ageing.
Abstract: A necropsy study of 159 elderly patients drawn mainly from a prospectively assessed geriatric hospital population was carried out to investigate the relationship of cerebral amyloid angiopathy to Alzheimer's disease, other CNS disease and ageing. About half the patients were demented and the majority of these had Alzheimer's disease. In Alzheimer's disease there was an incidence of cerebral amyloid angiopathy of 82%. Among the other groups of patients, both demented and non-demented, the incidence of cerebral amyloid angiopathy was a little over 30%, and remained constant between 60 and 102 years of age.
TL;DR: Pulsed wave 2 MHz Doppler with acoustical focusing was used to obtain blood flow velocity recordings through the intact cranium in patients with occlusive disease of major intracranial arteries, finding a clear inverse relationship existed between angiographical residual lumen diameter and flow velocity.
Abstract: Pulsed wave 2 MHz Doppler with acoustical focusing was used to obtain blood flow velocity recordings through the intact cranium in 11 patients with occlusive disease of major intracranial arteries. Increased blood flow velocities were recorded from stenoses of the carotid siphon and of the middle cerebral, anterior cerebral and basilar arteries. A clear, inverse relationship existed between angiographical residual lumen diameter and flow velocity. The Kendall rank correlation coefficient (Tau) was -0.89 (p = 0.0001). Transcranial Doppler is a useful means for evaluating patients with this disorder.
TL;DR: These sections include papers on: immunogenic sites on MBP; the role of lipids in immunisation; the use of liposomes in treatment of experimental allergic encephalitis; the presence of soluble factors including oligoclonal Ig in the CSF and serum in multiple sclerosis and experimental allergicEncephalitis.
Abstract: Other sections include papers on: immunogenic sites on MBP; the role of lipids in immunisation; the use of liposomes in treatment of experimental allergic encephalitis; the presence of soluble factors including oligoclonal Ig in the CSF and serum in multiple sclerosis and experimental allergic encephalitis. A major problem with multiple sclerosis research is that clinical multiple sclerosis may represent a final common pathway of pathogenic reactions which have been initiated by a variety of genetic and environmental causes. As EC Alvord Jr points out, the early stages of multiple sclerosis are essentially unknown. Consequently much work on experimental allergic encephalitis concentrates on understanding and preventing relapses. However, multiple sclerosis may really be a progressive disease, with relapses merely the tip of the iceberg. Hopefully the new immunological techniques such as cell cloning and molecular genetic analysis will define the role of immunity in this disorder. This should facilitate analysis of the other genetic and environmental factors which are at present elusive.
TL;DR: The petit mal epilepsies: their treatment with Tridione, and the EEG in evaluation of disorders affecting the brain diffusely.
Abstract: 'Yamamoto M, Hosokawa K. Triphasic spikewave stupor in portal-systemic encephalopathy: a case report. J Neurol Neurosurg Psychiatry 1985:48:386-7. 2Bickford RG, Butt HR. Hepatic coma: the electroencephalographic pattern. J Clin Invest 1955:34:790-9. 3Spehlmann R. EEG Primer. Amsterdam: Elsevier/North Holland Biomedical Press, 1981:327. 4Saunders MG, Westmoreland BF. The EEG in evaluation of disorders affecting the brain diffusely. In: Klass DW, Daly DD, eds. Current Practice of Clinical Electroencephalography. New York: Raven Press, 1979:352-7. sNiedermeyer E, Khalifeh R. Petit mal status (\"spike-wave stupor\"). Epilepsia 1965: 6:250-62. 6Hosokawa K, Booker HE, Okumura N, etal. Spike-wave stupor. Folia Psychiatr Neurol Jpn 1970:24:37-47. 7Kellaway P, Chao D. Prolonged status epilepticus in petit mal. Electroencephalogr Clin Neurophysiol 1955:7:145. 8Lennox WG. The petit mal epilepsies: their treatment with Tridione. JAMA 1945: 129:1069-74. 9Sato S. Generalized seizures: absence. In: Dreifuss FE, ed. Pediatric Epileptology. Boston: John Wright-PSG, 1983:65-91. '° Feldman RG. Management ofunderlying causes and precipitating factors of epilepsy. In: Brown TR, Feldman RG, eds. Epilepsy: Diagnosis and Management. Boston: Little, Brown and Company, 1983:129-38.
TL;DR: It is concluded that patients with Parkinson's disease have difficulty in maintaining such sets of motor programs or skills that are modified to suit the task currently in hand.
Abstract: Twelve patients with Parkinson's disease learned two novel skills in which they had to track a target by moving a joystick. In task 1 they had to learn to anticipate the movements of a semi predictable target. In task 2 they had to learn a novel control system in which the movements of the joystick were mirror reversed in relation to the computer screen. On each task they performed two sessions of three minutes continuous practice separated by a 10 minute rest. In both tasks the patients performed much worse than the controls, but showed clear evidence of learning, particularly after the ten minute rest. Detailed examination of their performance suggested that the skill was becoming automatic, releasing attention for aspects of the task that could not be learned. The major difference from the controls appeared during the first minute of each practice session when the controls showed a marked improvement in performance while the patients did not. We suggest that this rapid but temporary improvement in performance reflects the acquisition of a motor "set" whereby existing motor programs or skills are modified to suit the task currently in hand. We concluded that patients with Parkinson's disease have difficulty in maintaining such sets.
TL;DR: MRI is a sensitive method for the demonstration of clinically unsuspected lesions in patients with uncomplicated optic neuritis and the evoked potentials suggested the presence of lesions outside the visual system in 30% of adult patients.
Abstract: Thirty five adults and two children with clinically isolated optic neuritis were examined by magnetic resonance imaging (MRI) to determine the presence of disseminated lesions within the brain at presentation and to compare these findings with the results of evoked potential studies. Of the adult patients, 61% showed lesions on the scans whereas the evoked potentials suggested the presence of lesions outside the visual system in 30%. MRI is a sensitive method for the demonstration of clinically unsuspected lesions in patients with uncomplicated optic neuritis.
TL;DR: Results give support to the hypothesis that prolonged medication may contribute to the metabolic hypofrontal pattern seen in patients with schizophrenia.
Abstract: Positron emission tomography (PET) with 11C-2-deoxyglucose (11DG) was used to compare regional brain metabolism in four patients with chronic schizophrenia who had no history of psychotropic medication and in 12 normal controls. Patients had a second PET scan after an injection of thiothixene to evaluate the effects of acute neuroleptics on glucose metabolism. The patients showed higher glucose metabolic values than the normals and did not show the metabolic hypofrontality reported in chronic medicated patients with schizophrenia. Administration of the neuroleptic did not have a significant effect in the metabolic pattern of the patients. These results give support to the hypothesis that prolonged medication may contribute to the metabolic hypofrontal pattern seen in patients with schizophrenia.
TL;DR: Axonal stimulation has proved to be a relatively easy and reliable method for routine estimation of neuromuscular jitter, provided that the resolution of time measurement is better than 2 microseconds, so that low jitter due to occasional direct muscle fibre stimulation is not mistaken for a normal reading.
Abstract: This single fibre EMG study compares the standard method of neuromuscular jitter measurement in voluntarily activated muscle to that by intramuscular electrical stimulation of motor axons in a group of normal subjects. The latter method avoids the interdischarge interval-dependent jitter, as well as a possible failure to recognise split muscle fibres. The mean MCD on axonal stimulation was only 5.2 microseconds less than in the voluntary activation study and was thus 8% more than theoretically expected for single motor end plates. The difference could be due to an axonal jitter and some other factors. Axonal stimulation has proved to be a relatively easy and reliable method for routine estimation of neuromuscular jitter, provided that the resolution of time measurement is better than 2 microseconds, so that low jitter due to occasional direct muscle fibre stimulation is not mistaken for a normal reading. The upper normal limits for the extensor digitorum communis muscle suggested by the present study are 40 microseconds (individual muscle fibres) and 25 microseconds (mean of 30 muscle fibres).
TL;DR: It is concluded that the timing of associated postural adjustments is normal in Parkinson's disease, although their size may be decreased.
Abstract: Postural activity in muscles of the back and legs associated with voluntary forward elevation of the arm at the shoulder with the subject standing was examined in 14 patients with Parkinson's disease and nine normal individuals. The time of onset of EMG activity in each of the postural muscles, relative to the onset of activity in the prime mover, was the same for both patient and normal groups and did not depend on load. The amplitude of the EMG bursts and their frequency of occurrence, was less in patients off drug treatment and immobile, than when mobile on therapy. We conclude that the timing of associated postural adjustments is normal in Parkinson's disease, although their size may be decreased.