Clinical Neuroscience



NOVEMBER 30, 2006

Clinical Neuroscience - 2006;59(11-12)

[Objective - To investigate the pathomechanism of essential (ET) and parkinsonian tremor (PT) by studying the correlation between tremor severity and movement-related beta rhythm changes of the human electroencephalogram. Patients and methods - We recorded the electroencephalogram of 10 patients with essential tremor, 10 with Parkinsonian tremor and 10 controls. In a preliminary session we determined the side with lower and higher tremor intensity (T+, T++ respectively), using accelerometry. Subjects pressed an on-off switch in a self-paced manner with left and right thumb. After digitalization of the EEG from Cz, C3, C4 electrodes, the movement reactive beta frequency (MRBF), its minimum/maximum peak power values and their latencies triggered to movement offset were determined. Results - The time course and amplitude of movement related beta desynchronization (ERD) were similar in each group regardless of tremor intensity. In ET tremor severity did not influence post-movement beta synchronization (PMBS) amplitude (PMBSET+=100.98±48.874%, PMBSET++=135.1±92.87%; p=0.231), however it was significantly delayed after the movement of the more tremulous hand (latPMBSET+=1.26±0.566 s, latPMBSET++= 1.57±0.565 s, p=0.003). In the PT group on the side of pronounced tremor the amplitude of PMBS decreased but it was not delayed, compared to the less affected hand (PMBSPT+=115.19±72.131%, PMBSPT++= 77.84±53.101%, p=0.0028; latPMBSPT+=1.4±0.74 s, latPMBSPT++=1.25±0.797 s, p=0.191). In controls the power and latency of PMBS was similar on both sides. Conclusions - The results suggest that neuronal mechanisms underlying PMBS generation are differently affected by ET and PT. Investigation of PMBS might be used for the differential diagnosis of essential tremor and Parkinson's disease.]



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Clinical Neuroscience


FEKETE Tamás Fülöp, VERES Róbert, NYÁRY István

[Herniation of the meninges through a defect of the spinal canal is a spinal meningocele, and is usually located dorsally in the lumbosacral region. Meningoceles are usually part of a complex developmental disorder, or of a systemic disease, or it can be iatrogenic, as well. We report a very rare case of a true anterior thoracic meningocele.]

Clinical Neuroscience


VARGA Hedvig, PÁRDUTZ Árpád, TAJTI János, VÉCSEI László, JEAN Schoenen

[Migraine is one of the most common neurological disorder affecting up to 14% of the population. The disease shows sexual dimorphism, thus gonadal steroids may play an important role in its patophysiology. One model of migraine headache is the systemic administration of nitric oxide (NO) donor nitroglycerin (NTG), which triggers a delayed attack without aura in many migraine patients but not in healthy volunteers. NTG is also able to activate the neurons of the caudal trigeminal nucleus in the rat. In our review we summarise the effect of NTG on the expression of some molecules, in the superficial laminae of the spinal portion of trigeminal nucleus caudalis, which play an important role in the pathomechanism of headaches, and the modulatory effect of chronic estradiol treatment. Our data show that NTG was able to modify all the examined substances in the caudal trigeminal nucleus, while chronic estradiol treatment abolished this effect. These data may help to understand the mechanisms by which estrogens influence trigeminal nociception and how nitric oxide triggers migraine attacks.]

Clinical Neuroscience



[Introducion - The multiple sclerosis functional composite (MSFC) has been recommended by the National Multiple Sclerosis Society as a new clinical outcome measure. It is based on measurements in three clinical dimensions: leg function/ambulation (timed 25-foot walk), arm function (9 hole peg test) and cognitive function (paced auditory serial addition test). Scores on component measures are converted to standard scores (Z-scores), that reflect patient performance. This method has not yet been introduced into routine clinical practice. Patients and methods - Since March 2000 over the five years period the MSFC calculation was applied to 17 patients with relapsing-remitting multiple sclerosis (age mean: 37.4±10.8 years, duration of the disease: 5.5±4.9 years, EDSS: 2.7±1.4) seen at the neuroimmunological outpatient clinic to evaluate its usefulness and its correlation with the traditionally applied expanded disability status scale (EDSS). Thirteen patients received immunomodulatory treatment (interferon beta and glatiramer acetate), one patient received immunosuppressant therapy (azathioprine), and there was a patient, to whom developed secondary - progressive phase and we changed the interferon treatment to mitoxantrone. MSFC and EDSS were measured at 3., 6., 9, 12., 18 and 60 months of follow-up. Results - The prospective study confirmed a strong correlation between EDSS and MSFC in multiple sclerosis. The MSFC was more sensitive to clinical changes than EDSS. Our results after 18 months of follow up are already published. After five years arm/hand function and leg function/ambulation were the most sensitive mesures for disease progression. In contrast with the literature we did not experience correlation with cognitive changes. Consequences - We demonstrated strong correlation between MSFC and EDSS after a longer period. MSFC is a simple method, suitable for follow-up of multiple sclerosis patients in everyday clinical practice.]

Clinical Neuroscience



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Clinical Neuroscience



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Clinical Neuroscience

Vestibular evoked myogenic potential responses in Parkinson’s disease


Background - Our objectives were to determine the differences in the vestibular evoked myogenic potential (VEMP) responses in patients diagnosed with early staged idiopathic Parkinson’s disease (PD) compared to the normal population and evaluate the vestibular system disorder causing balance-posture disorders. Second aim of this study was to investigate caloric test responses particularly in early staged PD compared to normal popu­lation. Material and methods - Thirty patients (14 females and 16 males; mean age, 60.6 ± 13.1 years) diagnosed with idiopathic PD and 28 healthy subjects (20 males and 8 females; mean age, 59.1 ± 6.4 years) were included. The patient and control groups were subdivided according to their age, gender and the patient group was subdivided according to onset time of the Parkinson symptoms, Hoehn-Yahr staging. The subgroups were compared for VEMP and caloric test responses. Results - There were no significant differences between the study and control groups for right and left VEMP measurements. Patients over 60 years and under 60 years did not show significant differences in terms of right and left mean VEMP measurements. However, P1 amplitude was significantly lower in patients over 60 years old (P = .004). Gender, disease duration, BERG balance scale and Hoehn-Yahr stage had no effect on the VEMP amplitudes. There was no significant correlation with the side of Parkinsonian symptoms to the side of canal paresis (P = .566) and the side on which no VEMP response was obtained in caloric test. Conclusion - VEMP responses were not different between PD and healthy subjects. VEMP P1 amplitude was decreased with age in PD group. Canal paresis and symptoms side were not statistically correlated in caloric test.

Clinical Neuroscience

[Earlier and more efficiently: the role of deep brain stimulation for parkinson’s disease preserving the working capabilities]

DELI Gabriella, BALÁS István, KOMOLY Sámuel, DÓCZI Tamás, JANSZKY József, ASCHERMANN Zsuzsanna, NAGY Ferenc, BOSNYÁK Edit, KOVÁCS Norbert

[Background – The recently published “EarlyStim” study demonstrated that deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD) with early fluctuations is superior to the optimal pharmacological treatment in improving the quality of life and motor symptoms, and preserving sociocultural position. Our retrospective investigation aimed to evaluate if DBS therapy was able to preserve the working capabilities of our patients. Methods – We reviewed the data of 39 young (<60 years-old) PD patients who underwent subthalamic DBS implantation at University of Pécs and had at least two years follow-up. Patients were categorized into two groups based on their working capabilities: Patients with active job (“Job+” group, n=15) and retired patients (without active job, “Job-” group, n=24). Severity of motor symptoms (UPDRS part 3), quality of life (EQ-5D) and presence of active job were evaluated one and two years after the operation. Results – As far as the severity of motor symptoms were concerned, similar (approximately 50%) improvement was achieved in both groups. However, the postoperative quality of life was significantly better in the Job+ group. Majority (12/15, 80%) of Job+ group members were able to preserve their job two years after the operation. However, only a minimal portion (1/24, 4.2%) of the Job- group members was able to return to the world of active employees (p<0.01, McNemar test). Conclusion – Although our retrospective study has several limitations, our results fit well with the conclusions of “EarlyStim” study. Both of them suggest that with optimal timing of DBS implantation we may preserve the working capabilities of our patients.]

Lege Artis Medicinae

[Parkinson’s disease from the perspective of general practice]

KOVÁCS Norbert

[Due to the recent developments in medicine, Parkinson’s disease became a relatively well-treatable condition. Recently the working abilities and the health-related quality of life of our patients dramatically improved by the application of optimal pharmacological and functional neurosurgical treatment options. Despite of these good progresses, the curative treatment option is still warranted. The aim of this review article is to present those pharmacological, neurosurgical and other treatments, which can improve the condition and quality of life of the patients. We also discuss the major concerns important for general practitioners including the assessment of driving abilities.]

Clinical Neuroscience

[Neuropsychological outcome following bilateral pallidotomy in patients with Parkinson's disease]


[Introduction - Although significant improvement of motor function following bilateral pallidotomy for the treatment of Parkinsons's disease has been proved, the cognitive sequalae have not been clearly defined. There are recurrent loops interconnecting specific areas of the frontal cortex and the basal ganglia, suggesting the continuity or complementary functioning between these areas. Patients and methods - Pre- and postoperative cognitive function was evaluated in 19 Parkinsonian patients who underwent bilateral pallidotomy in order to clarify its effects on cognitive function. All patients were evaluated one day before the procedure and 12+ months after surgery using neuropsychological tests (Raven Progressive Matrices and Bergen Facial Recognition Test). Proper performance in these tests requires reasoning, abstraction and spatial memory, involving strongly the frontal functions. These functions could be described in terms of the ”working memory” concept. Hand Mental Rotation Test was used as comparing task not involving frontal functions. Scores were analyzed by Student’s t-test. Results - Modest improvement was observed in these cognitive functions as assessed by Raven Progressive Matrices (p<0.0688) and a significant change in the complex parts of Bergen Facial Recognition Test (p<0.0547; p<0.0468) was also noticed, but no change was registered in mental rotation tasks. Conclusion - Present data revealed that bilateral pallidotomy is associated with modest and long-lasting improvement in tasks involving the ”working memory”.]

Clinical Neuroscience

Evaluation of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in essential tremor

TAK Zeynal Abidin Ali, SENGUL Yildizhan

Introduction - Although essential tremor (ET) is the most common cause of tremor, the pathology and underlying mechanisms have not fully understood yet. In addition to kinetic tremor, patients may present several types of tremor, gait ataxia, hearing deficits and eye movement abnormalities. Non-motor symptoms and signs have also added to definition of ET. There is significant evidence indicating the neurodegenerative nature of the disease. New studies indicate that inflammation may have a place in the etiology. The neutrophil-to lymphocyte ratio (NLR) and the platelet-to lymphocyte ratio (PLR) have recently begun to be used as a marker of systemic inflammation. Our study aims at finding a clue for systemic inflammation in ET. Methods - 67 patients with ET and 40 healthy controls were recruited for the study. The total white blood cells (WBC), absolute neutrophil count, lymphocyte count and platelet count were retrieved. The NLR was calculated by dividing the neutrophil count by the lymphocyte count and the PLR was calculated by dividing the platelet count by the lymphocyte count. Results - Patient and control groups were similar in terms of age and gender. The mean age of patient group was 25.29 ± 8.24 years and that of control group was 26.77 ± 6.73 years. The NLRs were 1.85 ± 0.58 in the patient group and 1.96 ± 0.53 in the control group. For the patient group and the control group the PLRs were 103.52 ±32.80 and 91.26 ± 31.57 respectively. There were no statistically significant differences between the participants for both NLR and PLR. Conclusion - The pathophysiological mechanism for essential tremor (ET) remains unclear. However, there is an increasing amount of research being conducted on the subject. Discussions about ET’s definition as a neurodegenerative disease are ongoing. Although previous studies showed that neuroinflammation could be a part of etiology of disease, this study has failed to demonstrate systemic inflammation in ET.