Journal of neurology
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Journal of neurology · May 2002
Clinical TrialSubthalamic nucleus stimulation in Parkinson's disease: clinical evaluation of 18 patients.
The aim of the present study was to assess the efficacy and safety of chronic subthalamic nucleus deep-brain stimulation (STN-DBS) in patients with Parkinson's disease (PD). 18 consecutive severely affected PD patients were included (mean age, SD: 56.9+/-6 years; mean disease duration: 13.5+/-4.4 years). All the patients were evaluated clinically before and 6 months after the surgical procedure using the Unified Parkinson's Disease Rating Scale (UPDRS). Additionally, a 12 months follow-up was available in 14 patients. ⋯ Side effects comprised lower limb phlebitis (n = 2), pulmonary embolism (n = 1), depression (n = 6), dysarthria and freezing (n = 1), sialorrhea and drooling (n = 1), postural imbalance (n = 1), transient paresthesias and dyskinesias. This study confirms the great value of subthalamic nucleus stimulation in the treatment of intractable PD. Some adverse events such as depression may be taken into account in the inclusion criteria and also in the post-operative outcome.
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Journal of neurology · May 2002
A sudden arterial blood pressure decrease is compensated by an increase in intracranial blood volume.
A sudden decrease in arterial blood pressure (ABP) will cause the intracranial blood volume (IBV) to rise, despite the fact that arterial cerebral blood flow decreases. The aim of this study was to test the hypothesis that the increase in IBV is caused by a relative decrease of intracranial venous outflow. ⋯ In intact CA, a steep decrease of ABP results in an increase of intracranial blood volume. The transformation of our IBV data by means of the human intracranial pressure-volume relationship results in an excellent agreement with previously reported ICP increases of 10 mmHg. The increase in intracranial blood volume might be of clinical relevance in orthostatic dysregulation by increasing the ischemic tolerance of the brain before cerebral autoregulation becomes effective.
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We report two patients with blepharospasm that appeared during the recovery phase of Bell's palsy. It is well known that hemifacial spasm occasionally appears after Bell's palsy; however, blepharospasm associated with Bell's palsy has been rarely reported so far. ⋯ We speculate that corneal irritation caused by lagophthalmos contributes to the induction of blepharospasm. Another speculation is that abnormal afferent input from the paralyzed side contributes to the abnormal sensitization of the blink reflex, thereby facilitating the induction of abnormal facial motor outputs such as blepharospasm.
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Journal of neurology · Feb 2002
The relationship between lesion and normal appearing brain tissue abnormalities in early relapsing remitting multiple sclerosis.
In multiple sclerosis (MS), pathological changes have been found both in macroscopic lesions and normal appearing tissue. Magnetisation transfer ratio (MTR) and T1 relaxation time are abnormal in normal appearing tissues in established MS. This study used these MR techniques in early MS to study normal appearing tissues and lesions. The purpose was to determine whether abnormalities are already detectable in normal appearing tissues in early MS, and if so how they correlate with lesion characteristics. ⋯ This study reveals quantitative MR abnormalities in both NAWM and NAGM in early RR MS, with more extensive changes in the former. The lack of correlation between NAWM and lesion abnormalities suggests that they have developed by at least partly independent mechanisms. T1 may be more sensitive than MTR in detecting subtle pathological changes in NAWM and NAGM.