Risks of electronic publishing.
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Baclofen↗
Biomedical subjects
D Dressler
Publications and source records attributed to D Dressler.
[Botulinum toxin therapy in rehabilitation neurology].
Intramuscular injections of botulinum toxin (BT) induce a localized, long-lasting paresis of the target muscle that can be graded by the BT dose administered and that is free of major side effects. With this profile, BT can be used for symptomatic treatment of various disorders caused by pathological muscle hyperactivities. These disorders occur frequently in patients in institutions for neurological rehabilitation. They are difficult to treat with conventional methods, can cause major suffering and induce substantial costs for our health care system. In the present study we therefore sought to delineate the use of BT in rehabilitative neurology. Regardless of the etiology of the particular muscle hyperactivity syndrome, five main indication groups are identified: (1) improvement of function of the hyperactive muscles; (2) relief of pain in the hyperactive muscles; (3) improvement of patient care; (4) avoidance of sequelae in joints, tendons, ligaments, and teeth; (5) various special indications.
Adult↗
[Dystonia as the cause of pharyngolaryngeal motility disorders].
Dystonia as cause of pharyngo-laryngeal motility disorders has not been adequately considered in most clinical ENT practices. This case study of a patient with spasmodic torticollis, Meige's syndrome and pharyngo-laryngeal motility disorder was found to be due to dystonia as the underlying cause. The possibility of local symptomatic therapy with botulinum toxin injections has currently provided the physician with an effective means for alleviating the disorder.
Botulinum Toxins↗
A potential noninvasive neurobiological test for Alzheimer's disease.
Currently Alzheimer's disease, which affects more than 20 million people worldwide, can only be definitely diagnosed by histological examination of brain tissue obtained at autopsy or biopsy. There is a great need for an early, noninvasive, sensitive, and easily administered diagnostic test of Alzheimer's disease. Here it is reported that patients diagnosed with probable Alzheimer's disease by standard clinical criteria exhibited a marked hypersensitivity in their pupil dilation response to a cholinergic antagonist, tropicamide, placed in their eyes. It was possible to distinguish 18 of 19 individuals (95%) either clinically diagnosed with Alzheimer's disease or classified as suspect Alzheimer's individuals by neuropsychological screening from 30 of 32 normal elderly controls (94%).
Aged↗
The syndrome of painful legs and moving toes.
The clinical presentation, symptoms, and signs in 20 new patients with the painful legs and moving toes syndrome are presented. Painful legs and moving toes may develop in the setting of spinal cord and cauda equina trauma, lumbar root lesions, injuries to bony or soft tissues of the feet, and peripheral neuropathy. In 4 of the 20 cases in the present study, no definite cause was found. Pain preceded the onset of toe movements in 18 cases, but in 2 the reverse sequence occurred. The pain had many of the characteristics of causalgia, but none of the patients exhibited the full picture of reflex sympathetic dystrophy, and peripheral trauma was the trigger in only 5 cases. Several patients reported that the occurrence of toe movements was closely related to the pain, although abolition of pain with lumbar sympathetic blocks was not necessarily associated with disappearance of the movements. Several features suggest a central origin for the movements. Symptoms may begin on one side and become bilateral; movements may be momentarily suppressed by voluntary action or exacerbated by changing posture; and electromyography reveals complex patterns of rhythmic activity with normal recruitment of motor units involving several myotomes. Three other patients with similar moving toes but no pain are also described. The occurrence of similar movements in the absence of pain raises the possibility that these cases represent examples at one end of a spectrum of disorders, with pain alone (causalgia) at the other end and the syndrome of painful legs and moving toes in between.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Dyskinesias possibly induced by norpseudoephedrine.
We report two case histories of previously healthy patients who both developed persistent dyskinetic syndromes (spasmodic torticollis and cranial dystonia, respectively) following the intake of norpseudoephedrine (NPE) as an appetite suppressant. The symptoms took a chronic course even after NPE intake was discontinued. Similar drug-induced dyskinesias have been described for amphetamine and neuroleptic drugs. This side effect has, however, not yet been reported for NPE, which is pharmacologically related to amphetamine. One of the patients may also have had multiple sclerosis. Structural lesions in the basal ganglia area might predispose the development of such a movement disorder. The potential relationship between NPE intake and the development of dyskinesia is discussed. Appetite suppressants, often taken without the neurologist's knowledge, may be the cause of dyskinetic syndromes.
Adult↗
Effects of clozapine on CSF homovanillic acid in spasmodic torticollis.
We studied the effect of the atypical neuroleptic clozapine (CLO) on homovanillic acid (HVA) in cerebrospinal fluid (CSF) in five patients with spasmocid torticollis. Lumbar puncture was performed before and on the seventh day of CLO treatment. Although an HVA elevation was to be expected because of the antidopaminergic action of CLO, statistical analysis failed to reveal any significant increase of HVA under CLO treatment. Thus significance of CSF HVA may be less important for the description of antidopaminergic action of neuroleptics than previously assumed.
Adult↗
Clozapine treatment of spasmodic torticollis.
We report a trial of clozapine (CLO) in patients with spasmodic torticollis (ST). In an open-design trial we treated five patients with adult-onset ST with CLO (300 mg/d) over 12 weeks and one patient over 3 weeks. We videotaped the patients three times (before and at the end of CLO treatment, and 2 weeks after CLO withdrawal) according to a standardized protocol. At the end of the treatment period, CLO plasma concentrations ranged from 67 to 371 ng/ml. In all six patients, analysis of the video ratings and patients' self-assessments failed to reveal any improvement of ST. These preliminary results fail to confirm any therapeutic benefit of CLO in the treatment of ST.
Adult↗
Nerve growth factor induces neuron-like differentiation of an insulin-secreting pancreatic beta cell line.
Nerve growth factor (NGF) is the best understood of a class of trophic proteins that are important for the survival of neurons and the elaboration of their characteristic processes. Here we demonstrate that RINm5F, a rat insulinoma cell line representing an early stage in pancreatic beta cell differentiation, expresses both the Trk and p75 NGF receptors and responds to NGF by extending neurite-like (neurofilament-containing) processes. NGF treatment of RINm5F cells also induces the expression of genes normally responsive to NGF in neurons, including the NGF-1A gene. Inasmuch as pancreatic beta cells arise from the embryonic endoderm, these results suggest that NGF may play a wider role during development than previously thought-a role not restricted to cells of neuroectodermal origin--and that endocrine and neuronal cells share a developmental pathway. The specific effect of NGF on an early pancreatic beta cell line also suggests that this neurotrophic factor might form the basis of a therapeutic treatment for some types of diabetes by inducing the proliferative differentiation of islet cells.
Animals↗
Transcranial electric and magnetic stimulation of the leg area of the human motor cortex: single motor unit and surface EMG responses in the tibialis anterior muscle.
We compared single motor unit and surface EMG responses in the active right tibialis anterior following anodal electrical or magnetic stimulation of the motor cortex over the vertex. Magnetic stimulation used a monophasic current pulse through a circular coil centred 3 cm anterior to the vertex. Lowest threshold magnetic stimulation occurred when the current in the coil flowed from the left to the right side at the posterior rim of the coil. Such stimulation produced single unit and surface EMG responses which had the same latency as those produced by anodal electric stimulation. If the direction of the magnetic stimulating current was reversed, response latencies became more variable from unit to unit, and on average they occurred 1.0 +/- 0.5 msec later. In single motor units anodal and magnetic post-stimulus time histogram (PSTH) peaks had the same duration. This was similar to the duration of the PSTH peaks produced by a single low intensity stimulus given to the common peroneal nerve. We conclude that magnetic stimulation can produce direct activation of corticospinal neurones to the tibialis anterior if the direction of induced current flow is optimal. This projection is likely to be either monosynaptic or oligosynaptic.
Adult↗
Systemic effect of local botulinum toxin injections unmasks subclinical Lambert-Eaton myasthenic syndrome.
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Adenocarcinoma↗
The involvement of proteases, protease inhibitors, and an acute phase response in Alzheimer's disease.
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Acute-Phase Reaction↗
Effect of digital nerve stimuli on responses to electrical or magnetic stimulation of the human brain.
1. Reflexes were elicited in the first dorsal interosseous muscle of seven normal subjects by electrical stimulation of the digital nerves of the index finger at 3 times perceptual threshold while subjects maintained a constant voluntary contraction of the muscle. The average response in the surface-rectified electromyogram (EMG) consisted of an early inhibitory (I1) component followed by a later excitation (E2). 2. Low intensity anodal electrical or magnetic scalp stimuli were given over the motor cortex in order to elicit muscle responses within the period of the I1 and E2 reflex components. 3. Compared with control responses elicited in the absence of digital nerve stimulation, responses to electrical cortex stimulation were suppressed in the I1 period and facilitated during the E2 period of the reflex. In contrast, responses evoked by magnetic stimulation were suppressed during I1 and also for the first 10 ms or so of the E2 response. Magnetically evoked responses were facilitated during the later part of the E2 reflex. 4. Similar effects were seen when the probability of firing of single motor units was studied. 5. In three subjects, small taps were given to the abducted index finger in order to stretch the first dorsal interosseous muscle and evoke reflexes which were of comparable size to the E2 reflex evoked by digital nerve stimulation. In contrast to the experiments in which digital nerve stimuli were given, responses evoked by magnetic stimulation over motor cortex were facilitated at all times during the course of the reflex evoked when the muscle was stretched. 6. We conclude that single electrical stimuli applied to the digital nerves can reduce for a short period the excitability of motor cortex to magnetic stimulation. This occurs at a time when the same stimulus is evoking an excitatory (E2) reflex in the average surface-rectified EMG.
Adult↗
[Gilles-de-la-Tourette syndrome].
Gilles de la Tourette's syndrome, a combination of multiple chronic tics and vocalizations, usually first occurring during childhood, is described in its history, symptomatology, genetics, etiology and therapy. Traditionally TS has been viewed either as an organic or as a psychogenic disorder. We propose an integrative concept combining both aspects. During a vulnerable phase in childhood a hypersensitivity of dopamine 2-receptors, induced by gene defects or perinatal trauma, leads to a lack of suppression of subcortical programs which discharge as tics. Tics are modified by multiple psychological contents (aggressive or sexual impulses, imitation of others) which tend to become independent of their origin. Severity of tics in the course of the illness is often dependent on the emotional status of the patient. Recent research focuses on the search for a major gene locus and the relationship between dopamine-receptor hypersensibility and the disturbances of other neurotransmitter systems (norepinephrine, serotonin, endorphin).
Combined Modality Therapy↗
Further observations on the facilitation of muscle responses to cortical stimulation by voluntary contraction.
The effect of voluntary contraction on the discharge of single motor units following electrical and magnetic stimulation of the motor cortex was examined using the post-stimulus time histogram (PSTH) technique. The latencies of responses in single motor units of the first dorsal interosseous muscle to cortical stimulation were 2-4 msec shorter when the muscle was contracting than when at rest in 9 of 10 units studied. These latency differences are comparable with those recorded by surface electromyography for compound muscle action potentials following cortical stimulation in relaxed and active muscles. The new findings are that the intensity of cortical stimulation required to discharge a resting motor unit to produce a single PSTH peak produced multiple PSTH peaks when the same unit was contracting. The timing of the PSTH peak of relaxed motor unit discharge corresponded to one of the later PSTH peaks (usually the second) when the motor unit was voluntarily activated. These findings are in keeping with our previous suggestions that the longer latency of responses in relaxed muscles is due to the time taken for temporal summation of multiple descending corticospinal volleys at the cortico-motoneurone synapse. Facilitation produced by voluntary contraction occurs at least in part at the level of the spinal cord by lowering motoneurone threshold to enable discharge on the initial descending volley. The higher threshold of relaxed muscles is related to the higher intensities of stimulation needed to recruit multiple descending volleys and discharge resting motoneurones.
Adult↗
Hyperkinesias after hypoglossofacial nerve anastomosis--treatment with botulinum toxin.
Hypoglossofacial nerve anastomosis is a successful method for restoration of facial nerve function. Facial hyperkinesis, however, are a common side effect of this therapy and have been a major therapeutical problem ever since. We are reporting a patient whose facial hyperkinesias responded favourably to botulinum toxin carefully injected into the most affected muscles. EMG studies are illustrating the effect of botulinum toxin on the facial hyperkinesias as well as on voluntary muscle activation.
Anastomosis, Surgical↗
Safety aspects of transcranial brain stimulation in man tested by single photon emission-computed tomography.
Single photon emission-computed tomography (SPECT) using 99mTc-labelled hexamethylpropyleneamine oxime (99mTc-HMPAO), a new method to visualize regional cerebral blood flow (rCBF) and epileptogenic foci, was used to study acute and long-term effects of transcranial brain stimulation. Magnetic and electric brain stimulation increase rCBF not more than voluntary muscle activation mimicking the motor effects of transcranial brain stimulation. Focal rCBF increase, typical for epileptogenic foci, or other pathological findings could not be detected even when the subject had received several thousand stimulations in the past. Transcranial brain stimulation does not produce rCBF patterns indicating acute or chronic adverse effects.
Adult↗
Botulinum toxin to suppress hyperkinesias after hypoglossal-facial nerve anastomosis.
Facial hyperkinesias are a common side effect of hypoglossal-facial nerve anastomoses. We report a patient whose facial hyperkinesias were suppressed by botulinum toxin injections a treatment recently introduced in the therapy of craniocervical dystonias. EMG studies are used to document the effect of botulinum toxin on the facial hyperkinesias as well as on voluntary muscle activation.
Anastomosis, Surgical↗