[Changes in disordered motor skills in depressed right handed patients due to antidepressive therapy]. / Veränderungen der gestörten motorischen Wendigkeit bei depressiven, rechtshändigen Patienten durch antidepressive Therapie.

30 right-handed male and female inpatients with Major Depression diagnosed with the Diagnostic and Statistical Manual of Mental Disorders, revised Third Edition, (DSM-III-R) were investigated with reference to the retarded motor activity of their dominant hand. The treatment included antidepressants, neuroleptics and tranquilizers. The tests (handedness test, HDT; a test showing evaluation for the degree of depression, TSD; a test for mood disturbance, EWL) were carried out at the onset of drug treatment (t1) and after improvement of the depression (t2). Both motor retardation and the scores of the depressivity-tests ameliorated significantly.

Penumbra around chronic cerebral infarction?

In a series of 13 patients with cerebrovascular occlusive disease regional cerebral blood flow (rCBF) measurements (two-dimensional intravenous 133Xe clearance method) and quantitative EEG analysis (sensorimotor rhythms) as well as electronic measurement of handforce were performed before and during intravenous infusion of 1 microgram kg/min of one of the lipophilic dihydropyridine calcium channel blocker nimodipine (Nimotop). The aim of the study was to test the hypothesis of the existence of hypoperfusion (ischaemic penumbra) in the surroundings of chronic cerebral infarcts. All 3 parameters improved in one patient. Sensorimotor rhythms increased in 5 patients, rCBF in 3. EEG and rCBF improved in 2 patients. In 3 instances, a redistribution of rCBF in favour of the peri-infarct zone was noted (significant increase of rCBF from 35 +/- 2 SEM to 53 +/- 4 ml/100 g/min (p less than 0.01), whereas rCBF fell from 61 +/- 5 to 46 +/- 2 ml/100 g/min on a collimator remote from the infarct but in the infarcted hemisphere. The parallel improvement of rCBF and EEG in brain regions surrounding chronic infarcts in 3 patients was interpreted as functional improvement as a consequence of nimodipine-induced normalization of peri-infarct hypoperfusion, i.e. reversal of flow-dependent neuronal silence and/or dysfunction.

The effects of haemodialysis on cerebral blood flow.

Cerebral blood flow (CBF ml/100g/min) was measured by 133Xenon in 24 patients before and after haemodialysis (HD) and in 27 normal persons. A wide scatter of the absolute CBF values were observed to correlate with the haematocrit, whereas blood pressure, pCO2 and weight loss during HD did not. Before HD, when compared with the control group, the patients showed a distinct elevation of CBF due to the severe anaemia of this group. Though there was only a slight increase in haematocrit post-dialysis a return to normal of the post-dialysis CBF was observed. In order to achieve comparative data the CBF values were corrected mathematically to a normal haemoglobin (160g/L) and the adjusted mean pre-dialysis CBF value was within the normal range and decreased to the lowest limit of normal after HD. A significant decline in CBF was observed with increasing age and length of time on HD. When compared with normal the age-dependent decline was about twice as high and showed a 10-fold decrease with the time on HD treatment. When we grouped the patients with regard to the CBF values the following results were obtained: in eight patients CBF was elevated before HD and showed a return to normal after HD. These were younger patients with greater predialysis over-hydration and lower blood pressure. A distinctly reduced CBF was observed in nine patients and remained unchanged after HD. This group included older patients with a higher blood pressure. The reaction of CBF suggests three types of patients with different vascular reactivity to fluid excess: young normotensive patients with high vascular fluid storage capacity, patients with hypertensive vascular reactivity and patients with vascular damage.