bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation between sympotom fatigue and muscular fatigue in multiple sclerosis
Authors: Iriarte Jorge , de Castro Purificación
Published: March 2003

The symptom of fatigue is a frequent complaint in multiple sclerosis (MS) patients. Signs of fatigability have been documented in these patients as well. However, correlation with signs of objective fatigue had not been clariffied in MS. The aim of this study was to assertain the existence of muscular fatigue in multiple seclerosis patients. and to find out if there is a correlation between the subjective symptom of fatigue and muscular fatigue.

Fifty MS patients and 50 age and sex matched volunteers were studied using isometric and isotonic tests using the dominant hand. Strength was studied in the baseline condition and also after recovery of either an isotonic (experimentA) or isometric effort (experiment B). Maximum strength, strength in relationship to weight, slope of fatigability in 11 consecutive contraction, and strength and duration of a maximum effort were calculated. Fatigue as a symptom was measured using the Fatigue Severity Scale (FSS) and the Fatigue Descriptive Scale (FDS). Non‐parametric techniques were used for the statistical analysis.

Patient with MS had less isometric and isotonic strength, but the recovery was the same as recovery in the control group. There was a negative linear correlation between the symptom of fatigue and the baseline strength.

In conclusion, this study supports the existence of signs of muscular fatigue in MS patients. However, the recovery after exercise is normal. The corelation between the baseline scores in strength and the symptom of fatigue sugest that the same cause (probably pyramid deficits) may be involved in both of them.
Influence of learning to read and write on the morphology of the corpus callosum
Authors: Castro‐Caldas A. , Miranda P. Cavaleiro , Carmo I. , Reis A. , Leote F. , Ribeiro C. , Ducla‐Soares E.
Published: March 2003

Variations in the individual anatomy of the corpus callosum have been reported in several conditions. There seem to be genetic influencing factors, but it is impossible to rule out some environmental ones. This study focuses on the question of the environmental factors, using formal learning to read and write as the main difference in the groups to be compared. Based on magnetic resonance imaging sagital images, the contour of the corpus callosum (CC) of 41 carefully selected women (18 illiterate and 23 literate) was digitized. The comparison between the two groups showed a small difference in the region of the CC where parietal fibres are thought to cross. This region is thinner in illiterate subjects. As illiteracy in this group is the result of social constraints, and the two groups that were compared are well matched for other cultural and pragmatic aspects than literacy, the results are interpreted as showing the possible influence of formal learning to read and write, on the biological development of the brain.
Magnetic resonance outcome of new enhancing lesions in patients with relapsing‐remitting multiple sclerosis
Authors: Ciccarelli Olga , Giugni Elisabetta , Paolillo Andrea , Mainero Caterina , Gasperini Claudio , Bastianello Stefano , Pozzilli Carlo
Published: March 2003

The aim of the study was to monitor the natural history of new enhancing lesions in multiple sclerosis (MS) by means of serial gadolinium‐enhanced magnetic resonance imaging (MRI). Out of the 63 new enhancing lesions seen on the baseline scan, belonging to 26 relapsing‐remitting MS patients, 26 (40%), nine (14%) and four (6%) lesions showed persisting enhancement at first, second and third follow‐up scan, respectively. At the end of 5 months of follow‐up, 58 (92%) of the new enhancing lesions were detected as T2 hyperintensities, 24 (38%) as T1 hypointensities ('black holes'), and five lesions (8%) disappeared in both T2 and T1 weighted images. Duration of gadolinium enhancement of at least two consecutive scans significantly influenced the development of ‘black holes’. No significant correlation was observed between volume, location, configuration of enhancement at baseline and final outcome of the lesion. In individual cases, different evolution of new enhancing lesions was observed at the same time.

In conclusion, this study documented that different outcomes of new lesions are unrelated either to the individual patient or to the baseline MRI characteristics. However, prolonged blood–brain‐barrier disruption as shown by persisting enhancement significantly influences the lesion outcome.
Neuroimaging in amyotrophic lateral sclerosis
Authors: Comi Giancarlo , Rovaris Marco , Leocani Letizia
Published: March 2003

Amyotrophic lateral sclerosis (ALS) is a chronic degenerative disorder of unknown etiology affecting the motor system. Conventional and non‐conventional neuroimaging techniques can provide essential help both to increase the confidence in ALS diagnosis and to assess the disease evolution. Signal abnormalities at the level of the motor crotex and the corticospinal tract on conventional T2‐weighted magnetic resonance (MR> images are a potentially useful marker of ALS pathology. However, the prognostic value of these conventional MR abnormalities is still hampered by their low pathological specificity. Non‐conventional MR techniques with a higher pathological specificity, such as MR spectroscopy, magnetization transfer imaging and diffusion‐weighted imaging, seem to have some potential not only for ALS diagnosis, but also for monitoring disease evolution either naturally or when modified by experimental treatments.
Early differentiation of cardioembolic from atherothrombotic cerebral infarction: a multivariate analysis
Authors: Arboix Adriá , Oliveres Montserrat , Massons Juan , Pujades Ramón , García‐Eroles Luis
Published: March 2003

The aim of this study was to determine factors predictive of cerebral infarction subtype from clinical data collected within 48 h of neurologic deficit. All cardioembolic (n= 231) and atherothrombotic infarctions (n= 369) included in prospective stroke registry of the Sagrat Cor‐Alianza Hospital of Barcelona were analysed. Demographic characteristics, anamnestic findings, cerebrovascular risk factors and clinical data of patients with embolic stroke and patients with thrombotic infarction were compared. Predictors of stroke subtype were assessed by means of a logistic regression model based on 16 clinical variables. After multivariate analysis, atrial dysrhythmia and sudden onset to maximal deficit were significant predictors of embolic stroke, whereas hypertension, chronic obstructive pulmonary disease, diabetes, hypercholesterolemia and/or hypertriglyceridemia and age were independent predictive factors of atherothrombotic stroke. Setting a cut‐off point of 0.50 for predicting mechanism of stroke on admission resulted in a sensitivity of 76% specificity of 87% and total correct classification of 83%. Clinical features alone that are observed at stroke onset can help to distinguish cardioembolic from atherothrombotic infarctions.
LDL receptor mutations and ApoB mutations are not risk factors for ischemic cerebrovascular disease of the young, but lipids and lipoproteins are
Authors: Frikke‐Schmidt Ruth , Arlien‐Søborg Peter , Thorsen Sixtus , Jensen Henrik Kjærulf , Vorstrup Sissel
Published: March 2003

Background: The genetic background for ischemic cerebrovascular disease of the young and the role of lipids and lipoproteins as risk factors are not clear. Methods: We determined five LDL receptor mutations (Trp23Stop, Trp66Gly, Trp556Ser, 313+1G → A, 1846‐1G → A) and three apolipoprotein B mutations (Arg3500Gln, Arg3500Trp, Arg3531Cys), and other risk factors for ischemic cerebrovascular disease in 80 patients (36 women, 44 men) with onset of disease before the age of 50 years compared with 3366 individuals from a general population sample within the same age range. Results: None of the patients were carriers of mutations in the LDL receptor (Trp23Stop, Trp66Gly, Trp556Ser, 313+1G → A, 1846 – 1G → A) or the apolipoprotein B gene (Arg3500Gln, Arg3500Trp, Arg3531Cys) associated with hypercholesterolemia. However, on univariate analysis as well as on logistic regression analysis allowing for age and gender, plasma cholesterol (OR 1.4; P < 0.0005), HDL‐cholesterol (OR 0.4; P < 0.005), diabetes (OR 5.8; P < 0.0001), and hypertension (OR 3.9; P < 0.001) were significant predictors of ischemic cerebrovascular disease. Conclusions: The five most common LDL receptor mutations in Danish patients with familial hypercholesterolemia and three mutations in the apolipoprotein B gene did not predispose to ischemic cerebrovascular disease of the young. However, cholesterol and HDL‐cholesterol are important risk factors for ischemic cerebrovascular disease of the young in the present study. The elevation in cholesterol could in some patients be due to rare LDL receptor mutations not tested for, and could in other patients be multifactorial in origin.
Familial occurrence of cerebral arteriovenous malformation in sisters: case report * and review of the literature
Authors: Herzig R. , Burval S. , Vladyka V. , Janouskova L. , Krivanek P. , Krupka B. , Vlachova I. , Urbanek K.
Published: March 2003

Cerebral arteriovenous malformations (AVMs) are considered to be congenital disorders. However, their familial occurrence has so far been described in only 19 families in the literature. The authors report on two cases in one family and review the literature. A 45‐year‐old female subject with sudden onset of headache and vomiting due to a subarachnoid haemorrhage from a small AVM in the posterior part of the corpus callosum near the midline on the left side was studied. Irradiation of the AVM using Leksell’s gamma knife led to its complete obliteration. Her older sister presented with temporal seizures at the age of 49 and later also with left hemiparesis, left hemihypaesthesia and dizziness – caused by a large AVM in the right temporal lobe. This AVM was treated by a combination of embolization and irradiation by the Leksell’s gamma knife.
Cramping pain and prolonged elevation of serum creatine kinase levels in a patient with Guillain–Barré syndrome following Campylobacter jejuni enteritis
Authors: Satoh J. , Okada K. , Kishi T. , Nagayama S. , Kuroda Y.
Published: March 2003

We describe a patient with Guillain–Barré syndrome (GBS) following Campylobacter jejuni enteritis, accompanied with severe cramping pain and a marked increase in serum creatine kinase (CK) levels. Both conditions became evident three weeks after the onset of GBS and continued for longer than one month. In this patient, it is possible that rapid extensive denervation due to severe axonal degeneration of motor nerve terminals might have caused hyperexcitability in regional muscles, leading to recurrent muscle cramps and persistent release of muscular CK.
‘Herald hemiparesis’ of basilar artery occlusion: early recognition by transcranial Doppler ultrasound
Authors: Montaner J. , Molina C. , Alvarez‐Sabin J. , Codina A.
Published: March 2003

A transient hemiparesis may be ocassionally present at an early stage of the thrombosis of the basilar artery (herald hemiparesis). We report on one of these cases and the valuable role of transcranial Doppler ultrasound (TCD) to the early detection of the stroke‐in‐evolution. TCD in the emergency room is a good tool to assess a basilar occlusion, searching for direct (absence of signal at the basilar artery) and indirect (reversal flow of the pre‐communicating segment the of posterior cerebral artery through the posterior communicating artery) signs. Early recognition and treatment of this condition could avoid the development of the full syndrome of the basilar artery thrombosis.
Recurrent atrial fibrillation associated with pulse administration of high doses of methylprednysolone: a possible prophylactic treatment
Authors: Moretti R. , Torre P. , Antonello R. M. , Zorzon M. , Cazzato G.
Published: March 2003

Dear Sir,
Similar subcortical pattern of cognitive impairment in AIDS patients with and without dementia
Authors: Suarez S. V. , Stankoff B. , Conquy L. , Rosenblum O. , Seilhean D. , Arvanitakis Z. , Lazarini F. , Bricaire F. , Lubetzki C. , Hauw J.‐J. , Dubois B.
Published: March 2003

The aim of this study was to develop a series of neuropsychological tests that define the cortical and subcortical features of cognitive impairment and the characteristics of memory in demented and mildly cognitively impaired AIDS patients. We attempted to establish a usable method to assess and determine the type and degree of cognitive impairment in individual AIDS patients.

We examined 53 patients without central nervous system opportunistic infections. A short battery included two scales of global efficiency (the Mattis dementia rating scale and the Mini Mental State Examination), a psychomotor speed test, an executive control assessment and explicit memory evaluation. Patients were categorized into four groups based on their score on both the Mattis dementia rating scale and the DSM‐IV criteria: (1) asymptomatic; (2) having AIDS without cognitive impairment; (3) having AIDS with mild cognitive impairment; and (4) having AIDS dementia. Patients with mildly impaired cognition demonstrated slowed thinking, abnormal initiation and conceptualization, and memory impairment. AIDS dementia patients had slower motor activity and memory recall was more severely affected. The short neuropsychological battery was able to characterize modified cognitive performances in both severely and mildly cognitively impaired AIDS patients. The subcortical pattern of the memory disorder was obvious, regardless of the degree of cognitive impairment.
Effects of oestrogen replacement therapy on pattern reversal visual evoked potentials
Authors: Yilmaz H. , Erkin E. , Mavioglu H. , Laçin S.
Published: March 2003

As a result of a regression in the ovarian functions, oestrogen level in circulation during the menopause drops to 1/50 of its value in the normal reproductive cycle. Excitatory oestrogen increases the sensitivity of the central nervous system to catecholamines by changing the opening frequency of voltage‐related L‐type calcium channels and augmenting the effect of glutamate; in addition it inhibits the formation of gamma‐amino butyric acid (GABA) by the inhibition of glutamate decarboxylase enzyme. It is argued that oestrogen increases transmission in the optic pathways and that oestrogen is responsible for the shorter latency values and higher amplitudes of visual evoked potentials in women. We recorded the monocular pattern reversal visual evoked potentials (PRVEP) of both eyes of 54 post‐menopausal women before treatment and of 30 of them after replacement therapy with Tibolon, and of 24 women receiving placebo treatment. The explicit values of P100 latency of right and left eyes before treatment were 98.8 ± 3.5 and 99.0 ± 3.3 ms, respectively. The explicit values of P100 latency of right and left eyes after placebo treatment were 98.6 ± 3.7 and 98.8 ± 4.0, respectively. The explicit values of P100 latency of right and left eyes after replacement treatment were 94.6 ± 3.7 and 94.8 ± 4.0, respectively. We found a statistically significant decrease in the mean PRVEP latencies and a statistically significant increase in mean amplitudes after replacement treatment (P < 0.001) compared with those before treatment and those after placebo treatment. We attributed the changes in PRVEP values after replacement treatment to the action of Tibolon, which acted as a natural sex steroid and speeded the visual transmission time via the widespread receptors in the central nervous system. It is concluded that PRVEP is an objective electrophysiological assessment method in evaluating the efficiency of hormone replacement therapy in post‐menopausal women.
Decreased mRNA expression of TNF‐α and IL‐10 in non‐stimulated peripheral blood mononuclear cells in myasthenia gravis
Authors: Huang W.‐X. , Huang P. , Fredrikson S. , Pirskanen R. , Hillert J.
Published: March 2003

Myasthenia gravis (MG) is characterized by T cell‐dependent autoantibodies to the acetylcholine receptor on the post‐synaptic membrane of the neuromuscular junction. The production of autoantibodies is regulated by T cells via cytokines. To investigate the involvement of interferon gamma (IFN‐γ), tumour necrosis factor alpha (TNF‐α), interleukin‐4 (IL‐4) and interleukin‐10 (IL‐10) in MG, the mRNA levels of these cytokines in peripheral blood mononuclear cells without stimulation in vitro were quantified by competitive reverse transcription polymerase chain reaction technique. The mRNA level of TNF‐α was significantly lower (P = 0.0004) in the overall group of MG patients compared with controls. IL‐10 was also lower in MG patients (P = 0.008), most markedly in non‐thymectomized patients (P = 0.016). There were no significant differences in IFN‐γ and IL‐4 between patients and healthy controls, but the mRNA levels of IL‐4 in non‐thymectomized patients was significantly lower than in controls (P = 0.02) and in thymectomized patients (P = 0.03). These results, reflecting the in vivo expression pattern of these cytokines in the periphery, suggest an altered cytokine expression at the systemic level in MG.
Diagnostic instruments forCreutzfeldt–Jacob’s disease
Authors: Moretti R. , Torre P. , Nasuelli D. , Ferretti G. , Antonello R. M. , Povolato M. , Geatti O. , Cazzato G.
Published: March 2003

Dear Sir,
Gabapentin in acute painful diabetic neuropathy
Authors: Porta‐Etessam J. , García‐Morales I. , Martínez‐Salio A. , Berbel A. , Benito‐León J.
Published: March 2003

Sir, Acute painful diabetic neuropathy (APDN) is an uncommon syndrome originally recognized by Ellenberg (1974) and termed ‘diabetic neuropathic cachexia’. It has been described in diabetic patients and also in females with diabetes and anorexia nervosa (Steele et al., 1987). Its clinical features consist in an unremitting burning pain in the lower limbs, which is more troublesome at night (Thomas and Griffin, 1995). We present the case of a woman with APDN who improved and became asymptomatic with low doses of gabapentin.
Botulinum toxin type A and other botulinum toxin serotypes: a comparative review of biochemical and pharmacological actions
Authors: Aoki K. R. , Guyer B.
Published: March 2003

Botulinum toxin type A is an important therapeutic agent for the treatment of movement and other disorders. As the clinical uses of botulinum toxin type A expand, it is increasingly important to understand the biochemical and pharmacological actions of this toxin, as well as those of other botulinum toxin serotypes (B‐G). Botulinum neurotoxin serotypes exhibit differences in neurotoxin complex protein size, percentage of neurotoxin in the activated or nicked form, intracellular protein target, and potency. These properties differ even between preparations that contain the same botulinum toxin serotype due to variations in product formulations. As demonstrated in preclinical and clinical studies, these differences result in a unique combination of efficacy, duration of action, safety, and antigenic potential for each botulinum neurotoxin preparation.
Is the genetic liability in multifactorial disorders higher in concordant than discordant monozygotic twin pairs? A population‐based family twin study of migraine without aura
Authors: Gervil M. , Ulrich V. , Kaprio J. , Russell M. B.
Published: March 2003

Migraine without aura (MO) is a multifactorial disorder. Expression of a disorder with multifactorial inheritance depends on the genetic liability and on environmental factors. A high liability is reflected by a high frequency of affected relatives. We have previously shown that monozygotic (MZ) twin pairs have a significant higher concordance of MO than dizygotic twin pairs. The incomplete concordance among MZ twin pairs may be due to a lower genetic liability among discordant than concordant MZ twin pairs. The present study analysed the genetic liability in MZ twin pairs concordant and discordant for MO by the population‐relative risk of MO among parents and siblings.

The twin pairs were from the population‐based Danish Twin Register. First‐degree relatives of 29 concordant and 34 discordant MZ twin pairs were blindly telephone interviewed by a physician. The participation rate of the eligible first‐degree relatives was 96%.

The population‐relative risk of MO among parents and siblings was 2.73 (2.39–3.06) in concordant and 2.37 (2.03–2.71) in discordant MZ twin pairs. The relative risk of MO was significantly higher in female first‐degree relatives of concordant than of discordant MZ male and female twin pairs. An opposite effect was observed in male first‐degree relatives, although this was not significant for male first‐degree relatives of female MZ twin pairs.

The present study found no statistically significant difference in genetic liability to MO among concordant and discordant MZ twin pairs. However, a difference in genetic liability among MZ and DZ twin pairs is anticipated to be small. Thus, it may be possible to show the effect in a larger study population or by investigating a more frequent trait than MO.
Calcitonin gene‐related peptide levels during nitric oxide‐induced headache in patients with chronic tension‐type headache
Authors: Ashina M. , Bendtsen L. , Jensen R. , Schifter S. , Olesen J.
Published: March 2003

It has been proposed that nitric oxide (NO) induced headache in primary headaches may be associated with release of calcitonin gene‐related peptide (CGRP). In the present study we aimed to investigate plasma levels of CGRP during headache induced by the NO donor glyceryl trinitrate (GTN) in 16 patients with chronic tension‐type headache and 16 healthy controls. The subjects were randomly allocated to receive 0.5 μg/kg/min GTN or placebo over 20 min on two headache‐free days. Blood samples were collected at baseline, 10, 20 and 60 min after start of infusion. Both patients and controls developed significantly stronger immediate headache on the GTN day than on the placebo day and the headache was significantly more pronounced in patients than in controls. There was no difference between the area under the CGRP curve (AUCCGRP) on GTN vs. placebo day in either patients (P=0.65) or controls (P=0.48). The AUCCGRP recorded on the GTN day did not differ between patients and controls (P=0.36). Both in patients and controls, CGRP levels changed significantly over time, on both the GTN and placebo days (P < 0.05). The present study indicates that NO‐induced immediate headache is not associated with release of CGRP.
Lateralization of motor circuits and handedness during finger movements
Authors: Solodkin A. , Hlustik P. , Noll D. C. , Small S. L.
Published: March 2003

Although functional lateralization in the human brain has been studied intensively, there remains significant controversy over the brain mechanisms that instantiate it. The main objective of the present study is to characterize the regions associated with the generation of different movements by the fingers of both hands by right‐ and left‐handed people. Thirteen right‐ and left‐handers were studied using blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) during performance of single and sequential finger movement tasks. We used single‐shot whole‐brain spiral fMRI to map the functional components of the motor system during these tasks. Regions of interest included the primary motor and sensory cortices, the pre‐motor cortices and the cerebellum.

Sequential movements were associated with intense brain activation in several bilateral regions, whereas single movements were associated with less activation in fewer regions, but with greater laterality. Right‐ and left‐handers differed in their pattern of activation, sharing a pattern of activation on simple movements but responding differently to sequential movements. On simple movements, the brain activation patterns of left‐ and right‐handers were similar in volume, number of areas and laterality. By contrast, on sequential movement, left‐handers activated larger volumes and a larger number of brain areas than right‐handers, and showed significantly less brain lateralization.

These results highlight differences in the functional organization of motor areas in right‐ and left‐handed people. The discrepancies that might reflect differences in the network features of motor systems in these two groups, could also determine differences in motor activity that occur during recovery from injury (e.g. after stroke).
A new method to investigate brain stem structural–functional correlations using digital post‐processing MRI – reliability in ischemic internuclear ophthalmoplegia
Authors: Marx J. J. , Thoemke F. , Fitzek S. , Vucurevic G. , Fitzek C. , Mika‐Gruettner A. , Urban P. P. , Stoeter P. , Hopf H. C.
Published: March 2003

We investigated the reliability of a new digital post‐processing magnetic resonance imaging (MRI) technique in ischemic brain stem lesions to identify relations of the lesion to anatomical brain stem structures. The target was a medial longitudinal fasciculus (MLF) lesion, which was evident from ipsilateral internuclear ophthalmoplegia (INO). Sixteen patients with acute unilateral INO and an isolated acute brain stem lesion in T2‐ and EPI‐diffusion weighted MRI within 2 days after the onset of symptoms were studied. The MRI slice direction was parallel and perpendicular to a slice selection of a stereotactic anatomical atlas. The individual slices were normalized and projected in the digitalized atlas. The eye movement disorder was monitored by electro‐oculography. In all patients with clinical or subclinical electro‐oculographically documented INO and MRI proven brain stem infarction the lesion covered or at least partially overlapped the ipsilateral MLF at one or more atlas levels. We conclude that digital post‐processing MRI with normalizing and projecting brain stem lesions in an anatomical atlas is a reliable method to demonstrate the anatomical structures involved by the lesion. Combined with electrophysiological brain stem testing, this method may be a useful tool to identify incompletely understood pathways mediating brain stem reflexes or the generators of evoked potentials.
MR findings in subacute combined degeneration of the spinal cord caused by nitrous oxide anaesthesia – two cases
Authors: Ilniczky S. , Jelencsik I. , Kenéz J. , Szirmai I.
Published: March 2003

Vitamin B12 deficiency causes haematological and neurological diseases. Subacute combined degeneration (SCD) of the spinal cord is characterized by degeneration of the posterior and lateral columns.

We report two cases of SCD induced by nitrous oxide (N2O) anaesthesia. In both cases magnetic resonance imaging (MRI) of the spinal cord showed symmetric, reversible changes in the posterior columns, correlating well with patients’ symptoms.
Serum uric acid levels in multiple sclerosis patients correlate with activity of disease and blood–brain barrier dysfunction
Authors: Toncev G. , Milicic B. , Toncev S. , Samardzic G.
Published: March 2003

Several findings suggest lower levels of serum uric acid in multiple sclerosis (MS) patients. The aim of this study is to investigate relationships of uric acid serum levels in relapse–remitting (RR) MS patients with clinical activity of disease and blood–brain barrier (BBB) condition. Sixty‐three definite RRMS patients and 40 controls divided into two groups: 20 healthy donors and 20 patients with other inflammatory neurological diseases (OINDs) were analysed. By using a quantitative enzymatic assay according to the manufacture's protocol and a commercial uric acid standard solution, serum uric acid levels were measured and the results were standardized. To investigate BBB function, magnetic resonance imaging after administration of gadolinium was used. MS patients were found to have significantly lower serum uric acid levels (193.89 ± 49.05 μmol/l; mean value ±SD) in comparison with healthy donors (292.7 ± 58.65 μmol/l; P=0.000) and OIND patients (242.7 ± 46.66 μmol/l; P=0.001). We found that MS patients with relapse had significantly lower serum uric acid levels (161.49 ± 23.61 μmol/l) than MS patients with remission (234.39 ± 41.96 μmol/l; P=0.000) and more over, MS patients with BBB disruption had significantly lower serum uric acid levels (163.95 ± 26.07 μmol/l) than those with normal BBB (252.48 ± 25.94 μmol/l; P=0.000). Further, we also found that serum uric acid level independently correlated with disease activity, BBB disruption, and gender. These results indicate that lower uric acid levels in MS patients are associated with relapse and suggest that uric acid might be beneficial in the treatment of MS.
Education, occupation, and perception of health amongst previous polio patients compared to their siblings
Authors: Farbu E. , Gilhus N. E.
Published: March 2003

Patients with previous polio represent a challenge for neurological rehabilitation. We examined 168 previous polio patients and 239 of their siblings, the patients either from the 1950–1954 epidemic cohort, or from a cohort of hospital‐admitted rehabilitation patients. Ninety‐four paralytic patients and 74 non‐paralytic patients were included. All patients and siblings answered the same questionnaires for socioeconomic and health factors and chi‐square comparisons were performed. Previous polio did not affect the level of education. Both patients and siblings rated their educational options to have been good. Significantly less patients were full‐time employed at the age of 40 years compared to their siblings (P=0.015). This was the result of a lower full‐time employment rate amongst the paralytic patients, only 52% of this group being employed full‐time. Male patients and paralytic patients reported to have experienced reduced professional options. More patients were living alone compared to their siblings (P=0.035). The perception of general health was lower amongst patients than siblings, as was assessment of total life situation and patients reported more frequently symptoms like pain and tiredness. In conclusion, previous polio had not lowered the polio patients' educational status, but fewer patients were employed full‐time at the age of 40 years.
Functional MRI of the visual cortex and visual testing in patients with previous optic neuritis
Authors: Langkilde A. R. , Frederiksen J. L. , Rostrup E. , Larsson H. B. W.
Published: March 2003

The volume of cortical activation as detected by functional magnetic resonance imaging (fMRI) in the visual cortex has previously been shown to be reduced following optic neuritis (ON). In order to understand the cause of this change, we studied the cortical activation, both the size of the activated area and the signal change following ON, and compared the results with results of neuroophthalmological testing. We studied nine patients with previous acute ON and 10 healthy persons served as controls using fMRI with visual stimulation. In addition to a reduced activated volume, patients showed a reduced blood oxygenation level dependent (BOLD) signal increase and a greater asymmetry in the visual cortex, compared with controls. The volume of visual cortical activation was significantly correlated to the result of the contrast sensitivity test. The BOLD signal increase correlated significantly to both the results of the contrast sensitivity test and to the Snellen visual acuity. Our results indicate that fMRI is a useful method for the study of ON, even in cases where the visual acuity is severely impaired. The reduction in activated volume could be explained as a reduced neuronal input; however, the greater asymmetry might point to a cortical reorganization as a consequence of neuronal damage. Future fMRI studies in ON will add to the understanding of the neural adaptive behaviour following ON.
EFNS guideline on mild traumatic brain injury: report of an EFNS task force
Authors: Vos P. E. , Battistin L. , Birbamer G. , Gerstenbrand F. , Potapov A. , Prevec T. , Stepan Ch. A. , Traubner P. , Twijnstra A. , Vecsei L. , Wild K. von
Published: March 2003

In 1999, a Task Force on Mild Traumatic Brain Injury (MTBI) was set up under the auspices of the European Federation of Neurological Societies. Its aim was to propose an acceptable uniform nomenclature for MTBI and definition of MTBI, and to develop a set of rules to guide initial management with respect to ancillary investigations, hospital admission, observation and follow‐up.
Visual deficits in a patient with `kaleidoscopic disintegration of the visual world'
Authors: Vaina L. M. , Cowey A. , LeMay M. , Bienfang D. C. , Kikinis R.
Published: March 2003

We describe psychophysical, neuropsychological and neuro‐ophthalmological studies of visual abilities in a patient who, following a right hemisphere stroke, had difficulty in combining parts of objects into a whole and in reading. Strikingly, her perceptual problems were accentuated when the objects moved or when she moved. Formal testing showed that her main deficits were in depth perception, various tasks of motion and object recognition of degraded stimuli. But low‐level detection and discrimination of form and color were normal. Despite her deficits in visual motion and degraded static‐object recognition, her visual recognition of `biological motion' stimuli was normal. Structural magnetic resonance imaging revealed an infarct in the ventro‐medial occipito‐temporal region, extending ventro‐laterally and leading to a `kaleidoscopic disintegration of visible objects'.
Nitric oxide metabolites and interleukin‐6 in cerebrospinal fluid from multiple sclerosis patients
Authors: Miljkovic Dj. , Drulovic J. , Trajkovic V. , Mesaros S. , Dujmovic I. , Maksimovic D. , Samardzic T. , Stojsavljevic N. , Levic Z. , Mostarica Stojkovic M.
Published: March 2003

Interleukin‐6 (IL‐6) and nitric oxide (NO) are implicated in the pathology of multiple sclerosis (MS). We have investigated the levels of these mediators in the cerebrospinal fluid (CSF) from 50 patients with MS and 23 control subjects. Mean CSF IL‐6 level was higher in the total MS group in comparison with controls, but not significantly, whilst the difference between patients with stable MS and controls reached the level of statistical significance. Mean CSF nitrite/nitrate level was significantly higher in the total MS group compared with the control group, as well as in active MS patients versus controls. There was significant difference neither in the mean CSF IL‐6 nor in nitrite/nitrate levels between active and stable MS patients. Interestingly, we observed a significant negative correlation between IL‐6 and nitrite/nitrate levels in the CSF in the total MS group. Such a trend existed in both subgroups with active and stable MS, but without reaching the level of statistical significance. Our data further support the involvement of IL‐6 and NO in ongoing pathological processes in MS, suggesting their potential interplay within the central nervous system in this disease.
Paroxysmal kinesigenic choreoathetosis because of cryptogenic myelitis. Remission with carbamazepine and the pathogenetic role of altered sodium channels
Authors: Bonev V. I. , Gledhill R. F.
Published: March 2003

Lesions of the spinal cord causing paroxysmal kinesigenic choreoathetosis are rare and most of the reported cases have been because of multiple sclerosis. We now describe this movement disorder occurring in a patient who developed a myelitis of unknown aetiology. A typically striking remission followed treatment with carbamazepine. It is suggested that the effect of the drug and the disorder itself may both be explained on the basis of altered sodium channels.
Molecular genetic analysis of the α‐synuclein and the parkin gene in Parkinson's disease in Finland
Authors: Autere J. M. , Hiltunen M. J. , Mannermaa A. J. , Jäkälä P. A. , Hartikainen P. H. , Majamaa K. , Alafuzoff I. , Soininen H. S.
Published: March 2003

Two mutations in the α‐synuclein gene and various mutations in the parkin gene are associated with familial Parkinson's disease (PD). The present study was performed to analyse if mutations in these genes could be detected in Finnish patients with familial PD. The subjects comprised 22 unrelated patients with familial PD. The molecular genetic analysis consisted of sequence analysis of the non‐coding and coding exons of the α‐synuclein gene and screening of eight point mutations in the parkin gene. In addition, a total of 67 controls and 45 patients with sporadic PD were included in the association analysis on polymorphism of the α‐synuclein gene. Screened point mutations in the parkin gene were not detected. Sequencing of the coding exons 2–6 of the α‐synuclein gene did not reveal any mutations or polymorphisms. However, three novel alterations in the T10A7 sequence at the 5′ end of the non‐coding exon 1′ of the α‐synuclein gene were found. The frequencies of the exon 1′ polymorphic genotypes or alleles between familial PD patients and control subjects revealed no statistically significant differences. No association for sporadic PD was observed. The results do not support a role for the α‐synuclein gene or point mutations of the parkin gene in familial PD in our sample.
The trend in public attitudes in the Czech Republic towards persons with epilepsy
Authors: Novotná I. , Rektor I.
Published: March 2003

This study evaluates trends in public familiarity with and attitudes towards people with epilepsy over a 16‐year time‐period.

A survey exploring the Czech public's attitudes towards and knowledge of epilepsy used a modified version of a questionnaire first used in the USA in 1949, and in the Federal Republic of Germany beginning in 1968. This survey was carried out for the first time in the Czech Republic (then Czechoslovakia) in 1981, and then again in 1984. There was no significant difference between the 1981 and 1984 responses. A slightly modified questionnaire was used in 1997–1998, with evaluable responses gathered from 235 people. In comparison with the 1981 study, people's acquaintance with epilepsy was significantly higher in 1997–1998. In 1997–1998, about 94% of the people surveyed had some information about epilepsy (78% in 1981). Intolerance towards children with epilepsy dropped from 29 to 13%. About 30% of the people surveyed considered epilepsy to be a mental disease (50% in 1981). Employment of people with epilepsy was recommended by 74% (42% in 1981). In contrast with the situation about 16 years earlier, there were fewer important differences from the results of similar surveys taken in other European countries. However, the answers concerning the willingness to help a person having a seizure show that, despite certain progress, the quality of information that the Czech population has is not fully satisfactory.
The correlation between cerebral glucose metabolism and benzodiazepine receptor density in the acute vegetative state
Authors: Rudolf J. , Sobesky J. , Ghaemi M. , Heiss W.‐D.
Published: March 2003

This paper compares the results of parallel positron emission tomography (PET) studies of regional cerebral glucose metabolism with the radiotracer 18F‐fluorodeoxyglucose (FDG) and benzodiazepine receptor (BZR) density by PET using the BZR ligand 11C‐flumazenil (FMZ), a tracer of neuronal integrity, in nine patients with acute vegetative state (AVS, duration <1 month). Overall glucose utilization was significantly reduced in AVS in comparison with age‐matched controls (global metabolic rate for glucose 26 μmol/100 g/min in AVS vs. 31 μmol/100 g/min in controls). FMZ‐PET demonstrated a considerable reduction of BZR binding sites in all cortical regions that grossly corresponded to the extent of reduction of cerebral glucose metabolism assessed with FDG‐PET, whilst the cerebellum was spared from neuronal loss. In controls, cortical relative flumazenil binding was not lower than five times the average white matter activity, whilst in AVS, nearly all values were below this threshold. There was no relevant overlap of the data of relative flumazenil binding between both groups. The comparison of FDG‐ and FMZ‐PET findings in AVS demonstrates that alterations of cerebral glucose consumption do not represent mere functional inactivation, but irreversible structural brain damage.
The importance of educational and psychological factors in Parkinson's disease quality of life
Authors: Cubo E. , Rojo A. , Ramos S. , Quintana S. , Gonzalez M. , Kompoliti K. , Aguilar M.
Published: March 2003

Objective:  To define the factors correlated with quality of life (QoL) in patients with idiopathic Parkinson's disease (PD).

Background:  PD has a substantial impact on QoL. Although several clinical factors have been associated with QoL in PD, the influence of patient's education still remains controversial.

Methodology:  A consecutive series of patients with PD were examined using the unified Parkinson's Disease Rating Scale (UPDRS part I, II, III), Schwab and England (SE), and Hoehn and Yahr stage (H&Y). QoL was rated with the PDQ‐39, cognition with the Mini‐Mental State examination (MMSE), and the presence of depressive symptoms with the geriatric depression scale (GDS). Patient's characteristics, estimated cumulative levodopa dose (CLD), UPDRS, H&Y, MMSE and GDS were correlated with the PDQ‐39 using univariate and multiple regression analysis.

Results:  A total of one hundred 58 patients (68 men, 90 women) with a mean age of 65.6 ± 9.3 years, PD duration of 8.1 ± 10.6 years, and education of 6.6 ± 3.9 years were included. The mean PDQ‐39 was 48.8 ± 27.8, mean MMSE was 25.7 ± 4, and mean GDS was 11.7 ± 6.8. Using stepwise multiple regression analysis, the most important predictive factors were depression, UPDRS part I, UPDRS part II, and educational background, which accounted for a 61% of the variability of the PDQ‐39 scores.

Conclusions:  In our PD sample, educational, behavioural, and psychological factors influenced life satisfaction more than physical ones.
Physical therapy in spasticity
Authors: Richardson D.
Published: March 2003

Physiotherapists are part of the rehabilitation team involved in the management of adult spasticity. Physical therapy is one part of the armoury in the fight against this disabling symptom of the upper motor neurone syndrome. Identifying the physiological changes brought about by physical therapy or physiotherapy, is difficult. As with many interventions in rehabilitation, this area is poorly studied and, until recently, there was little or no evidence for its effectiveness. The aim of this presentation is to identify key components of a physiotherapy approach and outline specific techniques. The key components considered are: education of the patient and their carers; the `intervention cycle' – involving accurate assessment, careful measurement, intervention and evaluation; accurate goal setting and a staged stepwise approach over prolonged periods. The specific techniques used include treatments targeted at: muscle length changes, muscle strengthening and functional performance. Broadly these techniques can be divided into biomechanical, cognitive and neurophysiological, each being interdependent on the others. Physiotherapy combined with the other available treatments should meet the challenge arising from adult spasticity.
Magnetization transfer MRI in multiple sclerosis and other central nervous system disorders
Authors: Filippi M.
Published: March 2003

The present review summarizes the major contributions given by magnetization transfer‐magnetic resonance imaging to provide an accurate in vivo picture of the heterogeneity of central nervous system pathology and, ultimately, to improve our ability to monitor the evolution of various neurological conditions.
Motor‐axonal polyneuropathy associated with hepatitis C virus
Authors: Costa J. , Resende C. , De Carvalho M.
Published: March 2003

The association between hepatitis C virus (HCV) infection, the presence of mixed cryoglobulinemia and peripheral neuropathy is well‐documented (Apartis et al., 1996). HCV is the chief cause of essential mixed cryoglobulinemia (type II cryoglobulinemia) with cryoglobulins present in up to half of patients with HCV infection (Akriviadis et al., 1997). More recently it has been stated that peripheral polyneuropathy may be associated with HCV chronic infection without mixed cryoglobulinemia (Lidove et al., 2001).

Patients usually present with a clinical and electrophysiology – predominantly sensory axonopathies (Apartis et al., 1996; Heckmann et al., 1999) or less frequently with fulminating vasculitis and mononeuropathy multiplex syndrome (David et al., 1996) – especially when associated with cryoglobulinemia.

We report, for the first time, the association between pure motor‐axonal polyneuropathy and HCV infection without cryoglobulinemia.
Coexistence of Pupillary and Heart Sympathergic Asymmetries in Cluster Headache
Authors: Boccuni Maria , Morace Giorgio , Pietrini Umberto , Porciani Maria Cristiana , Fanciullacci Marcello , Sicuteri Federigo
Published: March 2003

Ten cluster headache patients and 10 healthy controls were subjected to electrocardiographic and pupillometric procedures in a search for cardiac and pupillary sympathergic asymmetry. Sympathergic stimulation was provoked by hyperventilation and by instilling tyramine into both eyes. In the control group, hyperventilation changed neither the T-wave form and polarity nor the QTc. Tyramine provoked an equal mydriasis on the two sides. In cluster headache sufferers, hyperventilation produced changes in the T-wave form and polarity as well as an increase of the QTc due to a disproportionate shortening of the R-R and Q-T intervals. An unequal mydriasis was noted after tyramine instillation due to less marked response on the symptomatic side. The observed electrocardiographic abnormalities are considered an expression of an asynchronous repolarization attributed to a sympathergic asymmetry. It is postulated that both the cardiac and pupillary sympathetic imbalance associated with cluster headache are central in origin.
Sleep Apnea in Cluster Headache
Authors: Kudrow Lee , McGinty Dennis J , Phillips Elliott R , Stevenson Michael
Published: March 2003

The impetus to study sleep changes in a cluster population arose from a recent hypothesis that predicted the finding of sleep apnea in this disorder. It holds that cluster attacks may occur in response to oxygen desaturation. Proposed mechanisms involve impairment of carotid body activity secondary to hypothalamic-vasomotor regulatory dysfunction. Five chronic and five episodic cluster patients underwent nocturnal polysomnography, utilizing standard equipment for monitoring sleep status, cardiac activity, nasal and buccal air flow change, chest and abdominal breathing, muscle activity and oxygen saturation. All episodic patients and one of five chronic patients were found to have sleep apnea (60%). Mean apneas per hour during NREM sleep were similar to that of REM sleep; 26.7 and 28.2, respectively. Six patients with sleep apnea experienced 14 cluster headache attacks during the study period. Eight attacks (57%) followed episodes of oxygen desaturation ranging from 65% to 85%. In the sleep apnea group, 8 out of 14 attacks (57%) were associated with REM; three without, and five following oxygen desaturation. Of the non-apnea group, all of whom had chronic cluster headache, none of 5 attacks were associated with oxygen desaturation, and only 2/5 attacks occurred in relation to REM. Thus, our study showed that sleep apnea was a common finding in a randomly selected group of episodic cluster patients; and most nocturnal attacks were preceded by oxyhemoglobin desaturation and REM-related. These findings were uncommon in the chronic cluster group.
Alpha Rhythm in Classical Migraine (Migraine with Aura): Abnormalities in the Headache-Free Interval
Authors: Nyrke Timo , Kangasniemi Pentti , Lang Heikki
Published: March 2003

The alpha rhythm of 18 patients with classical migraine (migraine with aura) was studied by EEG spectrum analysis for evidence of neural abnormalities during the asymptomatic period. The temporal relationship of the findings to attacks was studied by serial records in 11 cases. Increased frequency dispersion and frequency asymmetries of the alpha rhythm were found. The records were, however, mostly normal when separated from attacks by at least 10 asymptomatic days. The abnormalities increased significantly before the onset of prodromal symptoms and clearly outlasted the headache phase. The results give evidence of a fluctuating asymmetric neural disorder in classical migraine.