[The effect of plasmapheresis and other immunomodulating therapies on the course of severe Guillain-Barré syndrome]. / Plazmaferézis és kombinált immunmoduláns terápia hatása súlyos tünetekkel járó Guillain-Barré-szindrómás betegek kórlefolyására.

Clinical datas of 20 patients with severe Guillain-Barre syndrome were evaluated retrospectively. The diagnosis was established on the electrophysiological and histopathological examinations (electroneurography, electromyography, sural nerve and muscle biopsy) and the analysis of the cerebrospinal fluid. All of the patients were treated with plasma exchange and some of them with other immunomodulant therapies (intravenous immunoglobuline, steroid, cyclophosphamide), too. To judge the clinical state correctly we used the modified Rankin scale. The patient's follow up went on for maximum 4 years. The improvement was satisfactory in 7 cases (35%) and good in 6 patients (30%). The last 6 patients had pure motor neuropathy. Six patients (30%) remained in severe residual condition. All of them had long-term course of disease, serious sensory symptoms and predominantly axonal degeneration of the peripheral nerves. One patient had died. The plasma exchanges were well tolerated, without any serious adverse event. This therapy would be safe and effective help in Guillain-Barre syndrome.

Study of central motor functions using magnetic stimulation in Parkinson's disease.

The pathophysiological abnormalities, the contribution of activity of facilitatory and inhibitory systems to muscle rigidity and hypokinesia in Parkinson's disease are not clarified in details. Transcranial magnetic stimulation of the motor cortex may provide useful data on the functional state of motor output of the central motor structures and on the functional condition of the intracerebral motor network. The abnormalities of the central motor functions and the modifying effect of L-dopa treatment in Parkinson's disease are the objectives of our study. Patients with Parkinson's disease were examined before and after L-dopa treatment. Transcranial and cervical magnetic stimulation were performed and the latency and amplitude of the motor evoked potentials from the first dorsal interosseus muscle, the central motor conduction time and the duration of cortical inhibition were measured. The motor latency and the silent period in patients before treatment were significantly shorter than those of the age-matched healthy controls. After six months of L-dopa substitution both motor latencies and silent periods increased and approached the normal values. The observed changes are thought to be in relation to the mechanisms originating in the basal ganglia and acting through inhibitory thalamo-cortical connections at cortical level and through rubro- and reticulospinal pathways at the level of spinal inhibitory neurons. The transcranial magnetic stimulation is a suitable method to assess the efficiency of drugs in patients with Parkinson's disease.