[Treatment of involuntary movements by electrolysis in the internal capsule of the corresponding contingent of the extrapyramidal tract].
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Anterior capsular stimulation induces some improvement in severe treatment-resistant OCD patients. At this stage, not all stimulation-induced effects can be explained. The effects are a valuable source for further neurophysiologic and neuroanatomic research. It was reassuring that when the group of Drs Rasmussen, Greenberg, and Friehs in Providence and the group of Drs Rezai, Montgomery, and Malone in Cleveland started to operate on OCD patients using exactly the same technique, similar effects were seen in the patients. The authors still want to stress that anterior capsular stimulation remains investigational and needs optimization, especially to try to solve the problem of the short battery life of the stimulators.
Isolated NADPH-diaphorase (NADPH-d)-positive neurons were demonstrated in the nuclei of human dorsal thalamus and nucleus reticularis. Staining of NADPH-d-positive neurons with all their processes and preceding study of neurons of dorsal thalamus using Golgi method enabled the identification of their types and their determination as sparsely-branched cells. Main types of efferent densely-branched neurons had no demonstrable NADPH-d activity. NADPH-d-positive neurons were represented by reticular neurons and by one type of short-axon interneurons. Capsula interna contains numerous NADPH-d-positive reticular neurons. NADPH-d-positive cells forming contacts with blood vessels were found. Thus, NADPH-d-positive cells of dorsal thalamus, reticular nucleus and capsula interna appear to be evolutionally more ancient and structurally less complex.
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Chronic electrical stimulation instead of bilateral capsulotomy was done in four selected patients with long-standing treatment-resistant obsessive-compulsive disorder. In three of them beneficial effects were observed.
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OBJECTIVES: Recovery from focal motor pathway lesions may be associated with a functional reorganisation of cortical motor areas. Previous studies of the relation between structural brain damage and the functional consequences have employed MRI and CT, which provide limited structural information. The recent development of diffusion tensor imaging (DTI) now provides quantitative measures of fibre tract integrity and orientation. The objective was to use DTI and functional MRI (fMRI) to determine the mechanisms underlying the excellent recovery found after a penetrating injury to the right capsular region. METHODS: DTI and fMRI were performed on the patient described; DTI was performed on five normal controls. RESULTS: The injury resulted in a left hemiplegia which resolved fully over several weeks. When studied 18 months later there was no pyramidal weakness, a mild hemidystonia, and sensory disturbance. fMRI activation maps showed contralateral primary and supplementary motor cortex activation during tapping of each hand; smaller ipsilateral primary motor areas were activated by the recovered hand only. DTI disclosed preserved structural integrity and orientation in the posterior capsular limb by contrast with the disrupted structure in the anterior limb on the injured side. CONCLUSIONS: The findings suggest that the main recovery mechanism was a preservation of the integrity and orientation of pyramidal tract fibres. The fMRI studies do not suggest substantial reorganisation of the motor cortex, although ipsilateral pathways may have contributed to the recovery. The initial deficit was probably due to reversible local factors including oedema and mass effect; permanent damage to fibre tracts in the anterior capsular limb may account for the persistent sensory deficit. This study shows for the first time the potential value of combining fMRI and DTI together to investigate mechanisms of recovery and persistent deficit in an individual patient.
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With the aid of a computer graphic technique, data gathered from exploratory stimulation of the diencephalon in 130 stereotactic operative procedures indicate that some sensory fibers in the capsule are parallel to motor fibers at basal thalamic levels and occupy a position medial to motor fibers. In addition, stimulus responses which probably represent thalamocortical projections from S II somesthetic thalamus were found to lie in a capsular zone rostral to the motor bundle. The organization of S I somesthetic thalamus was found to agree with the previous finding of Tasker et al. and some of these fibers project within the motor bundle to cortical motor areas.
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