[Therapy of myasthenia gravis]. / Die Therapie der Myasthenia gravis.

The treatment of myasthenia gravis is a difficult entity. We especially discuss the immunosuppressive treatment with regard to the literature. In patients with thymoma all authors agree in thymectomy. In generalized myasthenia, even without thymoma, thymectomy should be performed in "younger" patients. In "elderly" patients thymectomy as treatment of choice is controversial. The basis of immunsuppressive therapy are corticosteroids, additionally azathioprine can be given considering the delay in response and the major side effects. As today, cyclophosphamide and cyclosporine A are too toxic for routine use, except third choice in therapy resistant patients as ultima ratio. The procedure of choice in myasthenic crisis is plasma exchange if the patient tolerates it. Alternatively intravenous immunoglobulin should be given. In pure ocular myasthenia treatment is controversial in the literature. In the last few years there is a tendency to treat this form early like generalized myasthenia, especially in young patients, to prevent generalization.

[Recurrent retrobulbar neuritis and extensive myelitis: MS or optic neuromyelitis?]. / Rezidivierende Retrobulbärneuritiden und ausgedehnte Myelitiden: MS oder Neuromyelitis optica Devic?

Two female patients with recurrent optic neuritis and severe myelitis were described. In the first patient the illness began with recurrent myelitis, in the second one with optic neuritis. In both patients spinal MRI showed extensive enhancing lesions of the cervical respectively thoracic spinal cord. An initial cranial MRI was normal. In the first patient an MRJ demonstrated after several years lesions not typical for multiple sclerosis. In both patients cerebrospinal fluid showed especially mononuclear pleocytosis with cell counts between 11 and 126/microliter and severely elevated total protein, while intrathecal oligoclonal bands were not found. During exacerbations in both patients ENA-autoantibody-screening was positive. Intravenous treatment with methylprednisolone improved the clinical situation for some time. In both patients cyclophosphamide at a dose of 100 mg daily had to be given due to relapsing neurological deficits.

Volumetric development of the fetal telencephalon, cerebral cortex, diencephalon, and rhombencephalon including the cerebellum in man.

Fresh volumes of the human telencephalon, cerebral cortex, diencephalon, and of the rhombencephalon including cerebellum were determined in a series of 10 normal specimens ranging in age from 63 to 176 days after conception. The volumetric growth of these parts shows a nonlinear dependence on age with a smaller increase during the 3d ontogenetic month and a stronger increase from the 4th month on. These data were analyzed together with previous measurements of 28 brains taken from the Yakovlev Collection in Washington, D.C., and the Vogt Collection in Düsseldorf. These brains range in age from 137 to 22,900 days after conception. These samples were reproduced in a model using sigmoid logistic functions. The entire brain and all analyzed parts show a monotonous growth. The individual regions develop heterochronously. The diencephalon is the first part to reach its ideal volume, with a main growth spurt between 100 and 420 days after conception. The rhombencephalon including the cerebellum is the last, with its main growth spurt between 240 and 650 days after conception. The growth of the entire brain is determined to a great extent by that of the telencephalon, having a main growth spurt between 175 and 580 days after conception. The prenatal growth is described separately with the asymmetric sigmoid function according to Gompertz. This yields a better approximation of the data collected from the early prenatal period.

Naturally occurring neurologic disease in a fallow deer infected with meningeal worms.

Neurologic disease resulting from infection with Parelaphostrongylus tenuis was diagnosed in a fallow deer (Dama dama) from Georgia, with clinical signs and histopathologic lesions similar to those reported for other accidental hosts of P. tenuis. Early fifth stage parasites were found in the spinal meninges and immature parasites were found in the neural parenchyma, but none were recovered from the brain and cranial meninges.