ABSTRACT
BACKGROUND: Deep brain stimulation of the internal global pallidus (GPi) and the subthalamic nucleus (STN) has become a treatment alternative in advanced PD. Although the effects of GPi stimulation have been examined recently, little is known about STN stimulation effects on motor cortex excitability. METHODS: The effects of STN stimulation were studied in eight patients with advanced PD using paired-pulse transcranial magnetic stimulation (TMS) in comparison with healthy control subjects. Motor evoked potentials following paired-pulse TMS (interstimulus interval 3 ms to test for corticocortical inhibition vs 13 ms for facilitation) have been recorded from the extensor carpi radialis and its functional antagonist, the flexor carpi radialis muscle. Silent period (SP) was also determined. Patients were examined under four conditions: medication "off"/stimulator "off" vs medication "on"/stimulator "off" vs medication "off"/stimulator "on" vs medication "on"/stimulator "on." RESULTS: Although the mean values for intracortical inhibition (ICI) were not significantly different, data variation was smaller and levels of significance higher with the STN stimulator switched "on," suggesting that ICI was more consistent. SP during stimulator "on"/medication "on" was longer than during stimulator "off"/medication "off." Motor performance as indicated by a finger-tapping test and Unified PD Rating Scale III was significantly better with dopaminergic medication and further improved with stimulator "on." CONCLUSIONS: Results suggest an effect of subthalamic nucleus stimulation on intracortical inhibitory mechanisms. This hypothesis could at least partially explain a more consistent depression of motor evoked potentials following inhibiting paired-pulse transcranial magnetic stimulation, a longer silent period (under stimulator "on"/medication "on"), and a reduction of akinesia and rigidity leading to a better motor performance in subthalamic nucleus-stimulated patients.
Subject(s)
Electric Stimulation Therapy , Motor Cortex/physiology , Parkinson Disease/therapy , Subthalamic Nucleus/physiology , Aged , Female , Fingers , Globus Pallidus/physiology , Humans , Magnetics , Male , Middle Aged , Movement , Parkinson Disease/diagnosis , Parkinson Disease/physiopathologySubject(s)
Brain/physiology , Child Development/physiology , Psychology, Child , Female , Humans , Infant , Infant, Newborn , Mental Processes/physiology , PregnancyABSTRACT
A vaccination complication is only to be recognized if, taking into consideration the incubation time, the clinical picture coincides with that of spontaneous poliomyelitis. Apart from exceptional cases, virological studies are only of importance for the assessment if they are carried out in the acute or subacute stages. Only six out of more than 150 cases could be accepted as vaccination complications.
Subject(s)
Poliovirus Vaccine, Oral/adverse effects , Vaccination/adverse effects , Adolescent , Adult , Child , Child, Preschool , Encephalomyelitis/etiology , Encephalomyelitis, Acute Disseminated/etiology , Expert Testimony , Facial Paralysis/etiology , Female , Humans , Infant , Male , Meningoencephalitis/diagnosis , Middle Aged , Paraplegia/etiology , Poliomyelitis/diagnosis , Poliomyelitis/etiology , Polyneuropathies/etiology , Polyradiculopathy/etiology , Seizures/etiologyABSTRACT
The decrease of infant mortality and the dramatic reduction of infectious diseases including Tuberculosis and Poliomyelitis have changed the problems in pediatrics. Today, sick children, who formerly had to be hospitalised are treated by the practitioner. In the hospitals, physicians are more dealing with chronic and malign diseases, where in addition, problems of psychological guidance of these children and their parents are of importance. Pediatrics should deal with all aspects of child welfare and development directly or indirectly related to health.
