[Diagnosis and therapy of neuroborreliosis. On the hunt for the "great imitator"]. / Diagnostik und Therapie der Neuroborreliose. Auf der Jagd nach dem "grossen imitator".

Neurological manifestations are characteristic of stage 2 and stage 3 borreliosis. In stage 2, some 15% of the patients have neurological symptoms expressed as a triad of aseptic meningitis, cranial neuritis and radiculitis. Stage 3--chronic neuroborreliosis affects some 5% of untreated patients. The condition has its onset at the earliest 6 months after the infection, and is characterized by encephalopathic symptoms, such as fatigue, sleep and memory disturbances, and depressive states. Further manifestations of this stage may be Lyme polyneuropathy, in rare cases also progressive borrelia encephalomyelitis and cerebrovascular neuroborreliosis. The treatment of choice is intravenous administration of cephalosporins over 2-4 weeks. The success of treatment should be assessed on the basis of the clinical course rather than on laboratory results. Patience is required in the treatment of the post-Lyme syndrome, characterized by residual symptoms, recurrences or a relapsing course.

[Drug therapy of hemiballism. Review of the literature and personal observations]. / Medikamentöse Therapie des Ballismus. Literaturübersicht und eigene Beobachtungen.

Hemiballism is a rare hyperkinetic disorder which is characterized by irregular vigorous rotatory movements of the limbs of one side of the body. The disabling and exhausting movements with their high risk of severe injuries require an acute drug treatment. However, there are no common guidelines for the treatment of this disorder. Therefore we reviewed the available literature to establish a concept for a rational symptomatic drug treatment. Furthermore, own observations in 6 patients with hemiballism of different origins are reported.

[Brain function monitoring]. / Hirnfunktionsmonitoring.

EEG and multimodal evoked potentials are currently the most frequently used methods of brain functioning monitoring in severely acute primary or secondary brain damage. Development or regression of brain function disturbances can be reliably assessed in this way. The methods are suitable for early diagnosis of intracranial complications and contribute to diagnosis of irreversible loss of cerebral function. They are also useful for early prognosis assessment. EEG and evoked potentials can be monitored at the bed-site. If there are no technical facilities for long-term EEG monitoring, repeated conventional single tracings are of value in these cases. When both the acoustic evoked brain stem potentials and the early somatosensory potentials are to be examined, the possibility exists to differentiate between hemispheric and brain stem damage and to use these results for prognosis assessment.

[Electrolyte disorders, EEG changes and epileptic seizures in alcohol withdrawal delirium]. / Elektrolytstörungen, EEG-Veränderungen und epileptische Anfälle beim Alkoholentzugsdelir.

For 180 patients suffering alcohol-withdrawal induced delirium, electrolytic concentration in the serum of Na, K, Ca, and Mg was determined in the early withdrawal phase, and the electroencephalograms of 95 delirium patients evaluated in respect of local and diffuse changes and epileptic activity, and compared in delirium patients with and without initial seizures. Delirium patients who had initial seizures suffered significantly longer-lasting periods of delirium and significantly more frequent electrolytic changes in the form of hypomagnesemia and hypopotassemia (hypokalemia). There was no significant difference in the EEG changes. A temporary metabolic disorder in the initial phase of the two-phase withdrawal process should be assumed to be the cause of seizures during alcohol withdrawal, and the pathogenetic significance of hypomagnesemia and hypopotassemia should be taken into consideration.

[Simulated alcoholic delirium]. / Das simulierte Alkoholdelir.

Of 200 diagnosed cases of alcoholic delirium 5 (= 2.5%) involved, from the differential diagnostic viewpoint, simulation of alcoholic delirium with all the symptoms involved. The symptoms of the simulation case are compared with the acute symptoms, and points in common to all simulation cases are presented: Definite alcoholic anamnesis, wide experience of treatment for alcohol abuse, dynamics of a pronounced purposeful action when social complications are imminent and course of the symptoms when the interview turns to simulation. In connection with therapy, special attention is drawn to Distraneurin treatment, which is not indicated in such cases.

[Sleep polygraphic studies in the preliminary stages of delirium tremens]. / Schlafpolygraphische Untersuchungen im Vorfeld des Delirium tremens.

On the basis of sleep-polygraphic examinations of twelve alcoholics over a period of six days is given on the sleep behaviour during alcohol withdrawal. The study showed the withdrawal symptoms described in the literature, such as withdrawal insomnia, REM rebound and persisting shortening of the deep sleep time, in ten patients whereas in two cases the examinations had to be interrupted in the third night because of a withdrawal delirium. In these cases, however, an almost 100 per cent REM occurrence was seen from the first night. The significance of these findings with respect to an early prediction of the outbreak of the delirium and for the pathogenesis of the delirium in general is discussed.

[EEG changes with leponex medication]. / EEG-Veränderungen unter Leponexmedikation.

Clozapin holds pharmacologically and clinically a special position among psychoactive drugs. By means of EEG examinations in 25 patients without and with Clozapin it could have been proved statistically that the distinctly marked changes can unambigously traced back to Clozapin medication. These role is in regard to localization explainable by pharmacologically assumed brain stem efficiency of the medicament. The increase of beta activity which was also found and which is not typical for neuroleptics can be explained in connection with the central anticholinerg action component.

[Clinical experiences with noxiptilin]. / Klinische Erfahrungen mit Noxiptilin

Noxiptilin (Elronon) proved to be a good bipolar thymoleptic agent in the clinical test at 3 special clinics. Its stimulating effect on the psychomotor function is more pronounced than its sedative action. Therefore, in cases with the anxious, agitated depressive syndrome the additional therapy with a neuroleptic agent or a sedative tranquilizer may be favourable. N. is well tolerated even at a higher age. The side effects are the same as those of other known thymoleptics.