[Physostigmine in treatment of cerebellar ataxia]. / Physostigmin in der Behandlung von Kleinhirnataxien.

Cerebellar ataxias are still a challenging problem for neurologists, and to this day there exists no medical, physiotherapeutic, psychot-erapeutic or surgical therapy which constantly leads to a reduction of ataxic symptoms. In the pathophysiology of cerebellar ataxia a cholinergic defect has often been described. In a double-blind, cross-over study with 14 patients with cerebellar ataxia and an open follow-up, long-term study with 21 patients, the clinical effects of physostigmine capsules in doses up to 10 mg per day were studied. Moreover, a transdermal application (physostigmine patch) was developed, achieving constant physostigmine plasma levels for 24 h. Of 14 patients treated with physostigmine during the double-blind, cross-over study, nine could correctly distinguish between verum and placebo. They all showed small but constant improvements, clearly experienced by the patients. With the physostigmine patch, 12 of 14 patients improved. Thirteen of 14 patients decided to take part in open follow-up studies with physostigmine, and most of them preferred the physostigmine patch as long-term medication. To date, 21 patients with cerebellar ataxia have been treated with physostigmine. As far as we can judge at the end of a treatment period of at least 2 years, the progression of the disease could be stopped in 17 of 21 patients. These patients reported small but constant effects, and none wants to live without the physostigmine patch.

["Expected motivation" in managing illness. A difficult social medicine-forensic problem]. / Zur Frage der "zumutbaren Willensanspannung" bei der Uberwindung eines Leidens. Ein schwieriges sozialmedizinisch-gutachterliches Problem.

The question if a patient can "reasonably be expected to make an effort of will" is of considerable importance when it comes to the psychological assessment of patients under social legislation as well as for private insurances. The problem in this connection is to what extent a human being can reasonably be expected to develop willpower in order to partially or completely overcome his mental/psychosomatic/painful illness with own effort. Even for a neurologist and psychiatrist it is difficult to answer this question, because "willpower or weakness of will" can neither be measured objectively nor can they be determined with the help of psychological tests. We must rather take a decision on the basis of the many years of experience we gained in dealing with patients and our knowledge of various types of personalities, of acquired organic processes of the brain, as well as of an existing social network. Taking all this into account, we must state whether a patient is able to take decisions of will or not. Being the result of an assessment, such a statement is of enormous significance for the patient as far as social and financial aspects are concerned.

VEP, physiological and psychological circadian variations in humans.

Amplitudes and latencies of components of visual evoked potentials (VEPs) were analysed during the 24-h cycle in humans. Circadian variations of other physiological parameters (oral temperature, urine volume and urinary potassium excretion) and of psychomotor performance (grip strength, tapping rate, visual reaction time and performance on a letter cancellation test) were also assessed. Eight male volunteers (aged 20-34 years) were tested twice over a period of 30 h. Test sessions took place every 3 h (1100 hours, 1400 hours etc.). VEPs were elicited by checkerboard pattern reversals. Significant circadian variations in the VEPs were found for the latencies of the P100 and N140 components, which were longest between 2 a.m. and 5 a.m. (P100: 103 ms; N140: 138 ms) and shortest at about 5 p.m. (P100: 97 ms; N140: 130 ms). Pronounced circadian variations were also observed in physiological parameters and in psychomotor performance measures. Circadian variation of oral temperature was correlated with the 24-h profiles of most of the other variables. Time courses of VEP latencies and oral temperature were moderately negatively correlated. However, from the data presented it seems premature to conclude that there is a common pacemaker for the circadian variations of the different parameters investigated.

[Change in subjective well being and physical complaints in multiple sclerosis patients within the scope of inpatient therapy lasting several weeks]. / Die Veränderung von subjektiver Befindlichkeit und körperlichen Beschwerden bei Multiple Sklerose-Patienten im Rahmen einer mehrwöchigen stationären Therapie.

At the beginning and the end of a 4 to 6 weeks hospital treatment 141 patients with multiple sclerosis were investigated in order to measure changes in subjective well-being and reported symptoms. For this purpose we used self-rating scales (v. Zerssen's "Befindlichkeits-Skala" (state of well-being scale) and "Beschwerden-Liste" (complaints list). Data from treatment onset, as well as changes during treatment, were correlated with age, age at illness onset, duration of illness, disability score and neurological deficit, but also with differences in treatments and with social characteristics. At the time of discharge from hospital, two-thirds of the MS patients reported relief of symptoms, and three-quarters showed a much better general sense of well-being. In general a subdepressive state was found initially, and a normal relaxed mood at time of discharge. ACTH improved the patients well-being to a much greater extent when compared with matched MS patients without ACTH therapy. Reading aids for those with impaired vision, and especially relief of bladder dysfunction (which was found in 80% of the patients) led to an enhanced general sense of well-being, while ACTH did not lead to any greater relief of illness symptoms.

Evaluation of infratentorial atrophy by computed tomography.

Eight parameters of cranial computed tomograms were examined from 121 controls, 33 patients suffering from paleocerebellar atrophy and 53 with widespread cerebellar atrophy. With the aid of step-by-step linear discriminant analysis the most important parameters were found and their normal and limiting values were calculated. With the help of correlation analysis the correlation between normal values and the age of the controls was investigated.

[Differential diagnosis of infratentorial atrophies by computed tomography (author's transl)]. / Computertomographische Differentialdiagnose infratentorieller Atrophien.

Computed tomographical findings are documented for 140 patients with different cerebellar atrophic or heredodegenerative processes. There are idiopathic cerebellar atrophies, so called alcoholic and paraneoplastic cerebellar atrophies, cerebellar atrophies associated with nutritional deficiency diseases or intake of diphenylhydantoin. Further, there are patients suffering from Friedreich's ataxia. Nonne-Marie's spastic ataxia, olivo-ponto-cerebellar atrophy and various other diseases. With the aid of CT individual patterns of atrophy can be recognized. The method therefore, helps to distinguish the above mentioned diseases from each other and also distinguishes them from inflammatory, cerebrovascular or neoplastic processes.

[Tiapride therapy of centrally produced dyskinesia. Examination of the serum levels of protein, LH and FSH (author's transl)]. / Zur Therapie zentralbedingter Bewegungsanomalien mit Tiaprid. Untersuchung des Serumspiegels von Prolactin, LH and FSH.

The effect of N-(2-diethylaminoethyl)-2-methoxy-5-(methylsulfonyl)-benzamide hydrochloride (tiapride, Tiapridex), a dopamine antagonist, on the serum levels of prolactin, luteinising hormone (LH) and follicle-stimulating hormone (FSH) was studied on 20 healthy individuals and 10 patients with dyskinesia resulting from extrapyramidal disorders. Daily doses of 300 mg in healthy subjects and 300-800 mg in patients with dyskinesia resulted from CNS disorders, were found to increase serum prolactin levels without causing amenorrhoea or galactorrhoea. The drug seemed to have no effect on LH and FSH concentrations in the serum.

[Glutamate and GABA concentration in the brain and cerebrospinal fluid of rats treated with phosphatidylcholine]. / Glutamat- und GABA-Konzentration in Gehirn und Liquor Cerebrospinalis von Ratten unter Behandlung mit Phosphatidylcholin.

Phosphatidylcholine increases CNS concentrations of acetylcholine. In rats we investigated whether or not phosphatidylcholine also influences the neurotransmitters glutamate and GABA. In 17 rats 1.5 gram/kg Lethicon perorally was administered daily for 2 weeks, 15 rats served as controls. In tissue from frontal cortex, striatum, substantia nigra, cerebellar cortex no significant differences between treated and untreated animals were found in glutamate or GABA concentrations. A central nervous interaction between the cholinergic system and the neurotransmitters glutamate and GABA, therefore, could not be demonstrated after 2 weeks of phosphatidylcholine intake.

Cranial computerized tomography in spinocerebellar atrophies.

Cranial computerized tomography was carried out in 110 patients with cerebellar ataxia [53 with Friedreich's ataxia, 4 with Marie's spastic ataxia, 51 with cerebellar atrophy, and 2 patients with olivopontocerebellar atrophy). In CT scans, cerebellar atrophies are found to be of various localization and partially of characteristic distribution. CT, therefore, greatly helps to distinguish different types of cerebellar and spinocerebellar atrophies and allows the differentiation of cerebellar atrophies of various origins from other diseases, such as multiple sclerosis.

[A computer oculographic and electroencephalographic double-blind study including well-being for determining changed vigilance under therapy with tiapride]. / Eine computerokulographische und elektroenzephalographische Doppelblindstudie unter Einbeziehung der Befindlichkeit zuer Erfassung von Vigilanzänderungen unter einer Tiaprid-Medikation.

Owing to its specific action on the dopaminergic neurons of the corpus striatum, which has been demonstrated in animal experiments. N-[2-(diethylamino)ethyl]-5-(methyl-sulfonyl)-o-anisamide (tiapride, Tiapridex) a recently developed drug from the family of the benzamides, appears to be particularly suited for the treatment of motor disorders resulting from extrapyramidal effects. In a double-blind study, the action of the drug on the vigilance of 16 normal subjects was compared with that of diazepam and a placebo. A minor reduction in vigilance was seen in the EOG and EEG following administration of 100 mg three times daily. However, this effect would not be expected to impair general performance or behaviour in traffic. With regard to self-assessment (existential orientation scale, list of complaints), no change was noted in male individuals receiving tiapride, while female test persons exhibited a slight tendency toward feeling low, though their mood remained above the limits of depression.

[Computerized tomography in atrophy of the posterior fossa (author's transl)]. / Computer-Tomografie bei Atrophien im Bereich der hinteren Schädelgrube.

Cranial computerized tomography was carried out in 69 patients with cerebellar ataxia (45 with Friedreich's ataxia, 4 with Marie's spastic ataxia, 14 with cerebellar atrophy, and one patient with olivo-pontocerebellar atrophy). In CT scans cerebellar atrophy is found to be of various localisation and partially of characteristic distribution. CT, therefore, greatly helps to distinguish different types of cerebellar and spino-cerebellar atrophy and also distinguishes separate cerebellar atrophy of various origin from other diseases like multiple sclerosis.