[Success of psychotherapy referral of a psychosomatic consultation service among neurologic inpatients]. / Erfolg von Psychotherapieempfehlungen bei psychosomatischen Konsiliarpatienten einer neurologischen Station.

OBJECTIVES: This study investigates the success of recommendations for psychotherapy given in a psychosomatic consultation service to neurological inpatients. METHODS: In 2005, a subset of 401 (55.7 %) former neurologic inpatients from the initial sample of 720 who underwent psychosomatic consultation between 1999 and 2004 completed follow-up questionnaires to telephone interviews. RESULTS: 279 (69.6 %) participants stated that they had received a recommendation for in- or outpatient psychotherapy during the psychosomatic consultation. Of these, 152 (54.5 %) followed this recommendation. No differences in age, gender, familial status, initial symptoms, and diagnoses were detected between those who underwent psychotherapy and those who did not. Patients who underwent psychotherapy reported significant improvement of symptoms, less impairment, and less disability. CONCLUSIONS: A psychosomatic consultation may be a useful adjunct to neurological diagnostics in order to determine the correct diagnosis and therapy for patients with pseudo-neurological symptoms or evidence of psychological problems.

Night-time bradyarrhythmia in a patient with mild obstructive sleep apnea syndrome is reversed with CPAP treatment.

Nocturnal cardiac arrhythmia is a common clinical feature of obstructive sleep apnea syndrome. Pathologically relevant rhythm disturbances such as atrioventricular block or ventricular tachycardia are known to occur mainly in patients with a high apnea-hypopnea index and marked oxygen desaturation. We report on a patient with mild obstructive sleep apnea syndrome who nevertheless showed intermittent second-degree atrioventricular block during stages of rapid eye movement sleep-associated hypopneas. Cardiac arrhythmia was reversed with the initiation of nasal continuous positive airway pressure treatment. Based on this case report and taking into account known facts from the literature, the finding of intermittent second-degree atrioventricular block in our patient with mild obstructive sleep apnea syndrome supports careful evaluation of electrocardiogram recording acquired during polysomnography in all patients with suspected obstructive sleep apnea syndrome.

Learning of tactile frequency discrimination in humans.

Learning is based on the remodeling of neural connections in the brain. The purpose of the present study was to examine the extent to which training-induced improvements in tactile frequency discrimination in humans are correlated with an increase of cortical representations in the primary somatosensory cortex. Healthy male subjects (n = 16) were trained in a tactile frequency discrimination task of the left ring finger. During the first 15 days of training, there was a steep improvement in frequency discrimination, which generalized from the trained finger to its homologue on the opposite hand, and to a lesser extent, to the other fingers on both hands. During the following 15 days of training, there was only a minor improvement in tactile frequency discrimination. Retention of improved performance in frequency discrimination 30 days after training was demonstrated for all digits. Cortical finger representation in the primary somatosensory cortex, as measured by magnetic source imaging, did not change during training. Because of the generalized training effect and the lack of detectable increase in the cortical field evoked from the trained finger, we assume that skill improvement was mediated predominantly by regions outside the primary somatosensory cortex.

Therapy of Sneddon syndrome.

We report the case of a young woman with progressive cognitive decline and epilepsy. She showed ischemic cerebrovascular disease and proximal livedo racemosa. Antiphospholipid antibody (aPL) could not be detected and there were no microemboli on continuous transcranial Doppler ultrasonography monitoring. Histology of cerebral vessels showed intimal hyperplasia in small leptomeningeal venous vessels and micronecrosis of grey and white matter. We subsequently made the diagnosis of aPL-negative Sneddon Syndrome (SNS). Anticoagulation with warfarin could not be initiated because of a drug-resistant epilepsy with the risk of falls and subsequent bleeding; immunosuppression with steroids and azathioprine was ineffective, as was initial antiplatelet therapy with clopidogrel alone. However, when we intensified antiplatelet therapy by combining clopidogrel and ASS, a slowing of disease progression, as assessed by neuropsychological testing and magnetic resonance imaging, was noted on a follow-up after 6 months. Therapeutic options in SNS in both aPL-positive and aPL-negative patients with SNS are discussed.

Late onset postpartum eclampsia: a rare and difficult diagnosis.

Late postpartum eclampsia without the classical pre-eclamptic signs oedema, proteinuria and hypertension is a rarely noticed complication of pregnancy. In three patients eclampsia started no earlier than 6, 8 and 11 days postpartum. Seizures were preceded by headache, vomiting, visual disturbance or impaired level of consciousness. One patient suffered a series of seizures making neurointensive care necessary. In another patient the clinical course was complicated by an additional Guillain-Barré syndrome. Aside from the typical parieto-occipital lesions brain MRI showed cerebellar hyperintensities on T2 weighted sequences as well as abnormalities on diffusion weighted images in one patient. In all patients neurological deficits and MRI findings were reversible.

Phantom sensations following acute pain.

In human amputees with painful phantom sensations, mislocalizations of tactile stimuli to the phantom increase with the amount of cortical representational reorganization and the extent of phantom pain. A similar phenomenon was incidentally encountered in healthy subjects. For reasons unrelated to the question of mislocalization, we performed a study involving the application of experimental acute pain to the hand followed by non-noxious tactile stimulation of the ipsilateral lip. During lip stimulation, two out of six subjects spontaneously reported perceiving an additional phantom-like sensation in the hand synchronously to the non-noxious lip stimulation. Similar, although more diffuse, phantom sensations were observed in two out of seven additional subjects who were then tested specifically for this effect. The observation is compatible with a pain-induced hyperresponsiveness of the cortical hand area to somatotopically adjacent inputs from the lip. This suggests that, even in the absence of deafferentation, pain can lead to a representational reorganization.