[Cryopallidotomy in Parkinson disease. Effect on somatosensory potentials]. / Kriopallidotomia w chorobie Parkinsona. Wplyw na potencjaly somatosensoryczne.

The paper reports 4-years results of a pilot study concerning the influence of a stereotactic pallidotomy on somatosensory evoked potentials in idiopathic Parkinson's disease. Potentials were recorded through the scalp surface from sensorimotor cortex of both hemispheres. Amplitudes and latencies of early and late waves were compared before and after the surgery. The surgery was recommended after 4 years of L-dopa therapy when bradykinesia and rigidity of right leg led to gait difficulty and postural instability. The dominant features of the syndrome were accompanied by tremor, micrography, chorea and lower responsiveness to L-dopa. Following the surgery a clear improvement of motor activity was observed. Increase of 20-90 ms waves amplitudes and P45 latency prolongation of 6-11 ms appeared due to the attenuation of pallidal inhibition exerted upon the thalamo-cortical transmission and a new arrangement of a cortical motor program. These electrophysiological changes, correlated with a clinical amelioration, may indicate as a favourable prognosis for a patient. Five months after pallidotomy a slight decrease of amplitudes occurred in relation to the previous examinations. Four years after surgery increase of most amplitudes and latencies and reconfiguration of later waves were related to deterioration of clinical course and worsening of left-side signs. We believe that somatosensory evoked potentials change may be a sensible indicator of motor state in Parkinson's disease. As far as we know the present study is one of the first presentation of somatosensory evoked potentials after pallidotomy.

[Somatosensory evoked potentials in a patient with Parkinson's disease before and after cryothalamotomy]. / Somatosensoryczne potencjaly wywolane rejestrowane w chorobie Parkinsona przed i po kriotalamotomii.

To document changes in SEPs in PD we have chosen a patient with the idiopathic form of the disease. Because of drug intolerance and progressively deteriorating clinical course she was selected for thalamotomy. Before the operation we recorded oscillations in the range of 150-300 Hz superimposed on SEP over the area of the right hand cortical representation, an a low amplitude of the N20-P25-N34 components. Eight weeks after left thalamotomy the amplitude of oscillations recorded over the left hemisphere diminished. A new wave, P65, appeared and similar SEPs were seen in the right hemisphere ipsilateral to the stimulated median nerve. Following stimulation of the left median nerve unchanged SEPs were observed only in the right hemisphere. Sixteen weeks after the operation, SEPs from the left hemisphere had a similar sequence as before the procedure. There was a clear increase in amplitude of long latency waves recorded from the left scalp. Changes in SEP polarity and amplitude following operation are attributed to plastic reorganization of cortical connections.

[The effect of stereotaxic injuries on the medial temporal brain structures on memorization of successively or simultaneously presented material]. / Wplyw stereotaktycznych uszkodzen przysrodkowych struktur skroniowych mózgu na zapamietywanie materialu prezentowanego w sposób sukcesywny i symultatywny.

Effect of stereotaxic injuries to the medial temporal brain structures on memorization of material presented successively or simultaneously was studied. The study aimed at testing whether stereotaxic damage to the hippocampus and amygdala results in a memory deficit and whether functions subserved by those structures depend on type and organization of the memorized material. The results indicate that even small damage to the medial temporal lobe structures may result in a deficit in memorization ability. The greatest impairment was observed for successive presentation of nonverbal stimuli.

[Automatic analysis of frequency spectrum in localization of topography of epileptic discharges at early stages of the disease]. / Automatyczna analiza widma czestotliwosci przy ustalaniu topografii wyladowan padaczkowych we wczesnym stadium choroby.

The authors present the value of frequency spectrum analysis in the method of cerebral mapping for the diagnosis and localization of epileptic focus. The patient aged 17 years showed atypical clinical symptoms. The study made possible confirmation of epilepsy, demonstration of two independent epileptogenic foci, and correlation of the atypical clinical syndrome with the location of the foci. The results are presented on topographic maps of the brain.

[Brain mapping in atonic epileptic attacks with consciousness disorders at school age]. / Mózgowy maping w padaczkowych napadach atonicznych z zaburzeniami swiadomosci, wieku szkolnego.

The paper presents the results of the analysis of atonic epileptic seizures with application of brain mapping eeg. The views to date on the pathogenesis of atonic seizures could be based on the assumptions of centrencephalic epilepsy voiced by Penfield and Jasper. The present investigations and electrophysiological-clinical observations support, however, contrary to the concept of Penfield and Jasper, the cortical origin of these seizures. The discussion on the clinical forms of atonic seizures in epilepsy, confirmed by analysis of brain mapping in the domain of frequencies and amplitude distribution, in the form of brain topograms, allows for the concept of cortical origin of these seizures with the probability of localisation of the epileptic focus, as in here presented case, in the anterior right paramedial frontal region of the brain.

[Brain mapping in Parkinson disease treated by cryothalamotomy]. / Mózgowy maping w chorobie Parkinsona u osób leczonych kriotalamotomia.

Brain mapping of the cerebral bioelectric activity was done by the BEAM method in 20 patients with Parkinson's disease treated by cryothalamotomy. Conventional egg examinations demonstrating relatively small changes of the type of local asymmetry of frequencies and/or amplitudes, sporadic focal changes, and sporadic generalized and disseminated generalized changes were analysed in a computer system in the domain of frequency and time. Brain mapping demonstrated very distinctly the asymmetry in the frequency bands alpha and beta. On the operated side a regular alpha rhythm of lower frequency but higher amplitude dominated in the brain hemisphere. On the intact side a quick beta rhythm prevailed and an irregular alpha rhythm was noticeable. This phenomenon described by analysis in the domain of frequency confirms the unilateral synchronizing influence of thalamotomy on the bioelectric activity of the operated brain hemisphere and may correlate with the functional motor improvement noted in the operated subjects. In three cases with a longer course of the disease analysis in the frequency domain demonstrated the presence of generalized diffused slow waves in both frontal regions. These changes correlated with mental insufficiency of the examined patients.

[The process of learning verbal material in patients with various damaged cerebral structures]. / Proces uczenia sie materialu slownego u chorych z uszkodzeniami róznych struktur mózgowych.

The results are described of a study of the process of verbal material learning and its recall after distraction in 20 patients with involuntary movements treated by thalamotomy, and in 20 epileptic patients treated by amygdalotomy and hippocampotomy. In both groups learning difficulties had been noted already before the operation. In postoperative tests these difficulties were found to have increased immediately after the surgical intervention in patients with lesions in the left cerebral hemisphere. On the other hand, late after the operation they were particularly pronounced after lesions placed in the right thalamus. Disturbances of material recall after distraction were shown in both groups independently of the side of the lesion.

Parkinson's syndrome induced in cats by the use of 6-hydroxydopamine. Observations of behavior and motor disorders.

The possibility of inducing Parkinson's syndrome in cats was investigated in three kinds of lesions: by microinjection of 6-hydroxy dopamine (6-OHDA) into the pars compacta of substantia nigra (SNC), bilateral injection into the SNC and globus pallidus (GP) and into the SNC and caput nuclei caudati (NC). In all three kinds of lesions of the dopaminergic system disturbances of behavior involving specially the motor system were obtained, corresponding to the parkinsonism syndrome--in the form of bradykinesia-akinesia, increased muscle tonus of plastic type, vegetative disorders (sialorrhea, pupils) and psychic disorders such as lack of interest in the surroundings and food. The character of the enhanced muscle tonus typical for extrapyramidal disturbances was confirmed by EMG examination. The parkinsonism-like syndrome induced in the cats was transient and receded after several weeks.

[Effect of dehydrobenzperidol (DHB) on cortical and thalamic somatosensory evoked potentials in patients with muscle dystonia]. / Wplyw dehydrobenzperidolu (dhb) na korowe i wzgórzowe somatosensoryczne potencjaly wywolane rejestrowane u chorych w dystoniach miesniowych.

Investigations of somatosensory evoked potentials in patients with muscular dystonia meet with difficulties due to abnormal muscle tone and dyskinesia producing myogenic artifacts deforming potentials recorded after their evoking. For obtaining better conditions for recording of somatosensory evoked potentials single dose of DHB was used. Somatosensory evoked potentials were recorded before and after operations and during stereotactic thalamotomy of the complex of the VL nucleus in the thalamus. The authors report the results of investigations in the above mentioned three periods of treatment in hospital. The results suggest the hypothesis that DHB affects the cerebellofugal transmission organizing the proper muscle tone.

[Ballism syndromes treated by cryothalamotomy]. / Zespoly balizmu leczone kriotalamotomia.

Two cases of ballism of different aetiology and clinical manifestations are reported. One of them was a typical case of hemiballism with exceptionally violent hyperkineses leading to injuries to extremities. The syndrome developed after stroke. Cryothalamotomy caused regression of violent hyperkineses and made possible resuming of independent life. In another case, less certain with respect to aetiology, the patient had bilateral ballism with preponderance of the right side and with falling. Unilateral (left sided cryothalamotomy caused a significant improvement of contralateral hyperkineses and even of ipsilateral hyperkineses so that the patient could walk and eat. In most cases ballism requires surgical treatment with thalamotomy and in case of hemiballism this treatment makes possible complete regression of violent hyperkineses.

[Verbal, visual and aural memory in the early postoperative period in patients treated by thalamotomy]. / Pamiec slowna wzrokowa i sluchowa we wczesnym okresie pooperacyjnym u chorych leczonych talamotomia.

Verbal memory and learning ability were determined before the operation and immediately 3-4 weeks after stereotactic surgery in 11 patients with extrapyramidal motor disturbances treated by ventrolateral (VL and Vim) thalamotomy. Preoperative examinations demonstrated disturbances of short-term verbal memory with narrowing of its extent and increased susceptibility of the trace to interference. Long-term memory was disturbed also, with presence of difficulties in recall and difficulties in memorization of verbal materials. Directly after the operation, in relation to the preoperative testing, increased disturbances were demonstrated in all stages of verbal memory, after damage to the border area of VL and Vim nuclei in the left as well as in the right thalamus. It was possible to detect some functional differentiation between thalamic lesions, with a tendency for increased disturbances of short-term verbal visual memory after right-sided thalamotomy and verbal auditory memory after left-sided thalamotomy.

[Effect of diazepam on somatosensory evoked potentials]. / Wplyw diazepamu na somatosensoryczne potencjaly wywolane.

Somatosensory evoked potentials (SEP) were recorded in 15 patients with extrapyramidal disturbances after intravenous administration of 10 mg of diazepam (Relanium, Polfa). Cortical SEP were recorded before and after operations and thalamic SEP were recorded during stereotaxic interventions on thalamic nuclei VL and Vim. The results demonstrated that diazepam had a significant positive influence on the recording of SEP, eliminating muscular artifacts caused by increased muscular tonus and extrapyramidal tremor. Diazepam had no evident effect on the SEP and caused no changes of the short-latency specific cortical SEP. This effect was, however, evident on the later components of the SEP and it seemed to affect mainly the N63 wave whose amplitude was always reduced or absent. In the postoperative investigations the cortical SEP in the hemisphere operated on (contralateral to the site of stimulation) were reduced in the phase of short-latency components. In the ipsilateral hemisphere the cortical SEP remained similar to the normal ones, and after diazepam their amplitude was markedly reduced. Intraoperatively recorded thalamic SEP showed after diazepam a considerable decrease of the amplitude of all components, sometimes the curve was completely flat, including the specific phase of the potential. On the other hand, diazepam failed to extinguish cortical SEP which showed even a greater amplitude of short-latency and long-latency components than in the records obtained without this drug, with the exception of disappearing N63 component.

[Writer's cramp syndrome treated successfully by thalamotomy]. / Zespoly kurczu pisarskiego leczone pomyslnie talamotomia.

In the literature the prevalent until now opinion was that writer's cramp was a disturbance of psychic origin or an occupational neurosis. However, the authors treated successfully three cases of this syndrome with thalamotomy in the years 1976-1982. Two cases were in subject with right-handedness who had graphospasm with evidence of increasing difficulty in writing until complete impossibility of further writing, after several years postural and intentional tremor appeared, and dystonic symptoms developed in the right foot. The third cases had a history of 16 years of writer's cramp and after years symptoms of right-sided dystonia with involuntary movements of the right upper extremity and continuous tics and spams of the facial muscles. After thalamotomy in all cases writer's cramp, tremors and involuntary movements disappeared, writing became again possible and the efficiency of right extremities returned. The described cases of writer's clamp were focal forms of dystonia which became generalized after years. The indications to stereotaxic treatment in these syndromes should be established much earlier.

[Cryohypophysectomy in acromegaly and gigantism by the stereotaxic method]. / Kriohipofizotomia w akromegalii i gigantyzmie metoda stereotaktyczna.

The authors report results of surgical treatment of 30 patients treated by cryohypophysectomy by the stereotactic method through the nose and sphenoid sinus in the years 1967-1979. The material included 28 cases of acromegaly and 2 cases of gigantism. The pathological manifestations in acromegaly and gigantism were analysed for demonstration which of them can regress after surgical treatment. The results of hormonal determinations, particularly the levels of growth hormone, 17-KS and hydroxysteroids, as well as blood glucose curves, were compared before and after cryohypophysectomy and their normalization was observed after the operation. There was principally no need for substitutive treatment after surgical treatment with the exception of 4 cases in which this treatment was given during several postoperative months. The indications to this method of therapy include cases of acromegaly and gigantism with presence of active intrasellar adenomas. Patients should be referred for treatment early before development of skeletal deformities.

[Processes of verbal memory in patients with involuntary movements treated by thalamotomy]. / Przebieg procesów pamieci slownej u chorych z ruchami mimowolnymi leczonych talamotomia.

The authors tested verbal memory and learning in 15 patients with motor disturbances treated by ventrolateral thalamotomy before operation and late after it, after a mean time of 5.8 years. Disturbances of verbal memory in the form of retrieval of information from the memory stores and disturbances of learning of verbal material were found already before the operation. In comparative investigations late after the operation greater disturbances of verbal memory were observed with disturbances of verbal retrieval from memory stores after damage to the VL nucleus in the left as well as right thalamus. On the other hand, no decrease of the mental efficiency of these patients was demonstrated.

[Computerized infusion test. II. Clinical use]. / Skomputeryzowany test infuzyjny. II. Zastosowanie kliniczne.

In 39 patients with intracranial lesions the resorption resistance was measured using an own computerized infusion test. A high usefulness of this test was demonstrated in the diagnosis of hydrocephalus and for establishing indications to ventriculocardiac valve implantation. In patients after craniocerebral injuries a rise was observed of the resorption resistance immediately after trauma in cases with subarachnoid haemorrhage. Later on, this resistance decreased gradually reaching a stable value after 1-2 years. Data obtained in the infusion test make possible establishing of optimal intracranial pressure and choice of an appropriate valve. The determination can be performed intraoperatively.

[Effect of cryosurgery of the thalamic nuclei on somatosensory evoked potentials]. / Wplyw kriochirurgicznych uszkodzen jader wzgórzowych na somatosensoryczne potencjaly wywolane.

Somatosensory evoked potentials were recorded in two groups of patients with extrapyramidal syndromes including: 1) parkinsonian syndromes, 2) spasmodic torticollis. In the first group stereotactic lesions were produced at the borderline between VOp and Vim nuclei, and in the second group they were situated in VOa and VOi thalamic nuclei. Short-latency components of the potentials were analysed assuming that they were the specific parts of the somatosensory potential and their value was doubtless, in contrast to the late latency components. It was found that stereotaxic lesions the VOa and VOp thalamic nuclei caused no disappearance of the short-latency potentials but reduced their amplitude. In cases with oscillation potentials recorded before the operation, they disappeared after the operation and this disappearance was correlated with clinical improvement.

[Thalamic somatosensory potentials after peripheral stimulation and cortical somatosensory potentials after electric stimulation of thalamic nuclei VOa and VOp (preliminary report)]. / Somatosensoryczne potencjaly wzgórzowe po draznieniu obwodowym oraz somatosensoryczne potencjaly korowe po elektrycznym draznieniu jader VOa I VOp wzgórza (doniesienie wstepne).

In patients with extrapyramidal syndromes thalamic action potentials were recorded during operations with a five-point brain electrode and in the same cases somatosensory evoked potentials were recorded from the skull. Thalamic potentials were recorded after peripheral stimulation, and evoked potentials from the skull were recorded after electrostimulation of thalamic nuclei VOa and VOp. At the thalamic level a short-latency positive-negative potential had a maximal amplitude in one only lead, which confirmed sharp projection of body surface into various thalamic nuclei. Somatosensory evoked potentials recorded from the skull in response to stimulation of thalamic nuclei were usually biphasic and stimulation of VOa and VOp nuclei gave potentials with similar configuration of phases. This confirms the divergence of the projection fibres from the thalamus to the cortex.