Articles: function.
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Gray matter loss in cortical regions is a normal ageing process for the healthy brain. There have been few studies on the process of ageing of the brain in chronic neurological disorders. ⋯ The results indicate that in contrast to healthy subjects, migraineurs show a lack of thinning in the insula by age. The functional significance of the lack of thinning is unknown, but it may contribute to the overall cortical hyperexcitability of the migraine brain because the region is tightly involved in a number of major brain networks involved in interoception, salience, nociception, and autonomic function, including the default mode network.
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Visceral pain is a particularly difficult symptom to manage in patients with irritable bowel syndrome (IBS). Our aim was to examine whether noninvasive neurostimulation applied to the motor cortex or lumbosacral region can modulate human visceral sensation. Sixteen healthy adult volunteers and 10 patients with IBS were evaluated. ⋯ When applied to patients with IBS, rectal pain thresholds were increased across all time points after both 1-Hz rLSMS and 10-Hz repetitive transcranial magnetic stimulation (P < 0.05) compared with sham. The application of magnetoelectric stimuli to the cortical and lumbosacral areas modulates visceral sensation in healthy subjects and patients with IBS. This proof-of-concept study provides supportive evidence for neurostimulation in managing functional gastrointestinal disorders.
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Multicenter Study
Natural history of multiple system atrophy in the USA: a prospective cohort study.
Multiple system atrophy is a rare, fatal neurodegenerative disorder with symptoms of autonomic failure plus parkinsonism, cerebellar ataxia, or both. We report results of the first prospective natural history study of multiple system atrophy in the USA, and the effects of phenotype and autonomic failure on prognosis. ⋯ US National Institutes of Health, Mayo Clinic, and Kathy Shih Memorial Foundation.
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Randomized Controlled Trial Comparative Study
[Efficacy of epidural steroid injections for chronic lumbar pain syndromes without neurological deficits : A randomized, double blind study as part of a multimodal treatment concept].
Chronic lumbar pain syndromes without neurological deficits are generated by a multitude of causes. Functional, morphological and psychosocial factors are discussed. In many cases a diseased intervertebral disc is found on radiological examination but the clinical relevance of these findings is not clear. For this study it was postulated that a diseased disc results in a local inflammatory reaction therefore causing pain and impairing treatability of patients. An epidural injection of steroids can reduce inflammation and therefore improve treatability and ultimately treatment outcome. ⋯ After the epidural injection the decrease in pain and increase in treatability was statistically significant. The mechanism of the improvement is not clear and should be examined further. The epidural injection of a steroid in this subgroup of patients did not lead to a clinical improvement in the outcome.
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In Germany approximately 3000 body organs are transplanted annually. In general, all artificially ventilated patients with diagnosed brain death are potential organ donors. All German hospitals are obliged to report potential organ donors and be actively involved in the organ donation process. ⋯ Brain death is associated with complex pathophysiological changes in cardiopulmonary function as well as fluid, electrolyte and metabolic homeostasis. In the case of diagnosed brain death and with permission for organ donation, a precise organ-protective therapy is initiated, essentially focussing on optimal organ perfusion and oxygenation. The quality of organ protection has a direct influence on the outcome of transplantation.