Multicentre European study of thalamic stimulation for parkinsonian tremor: a 6 year follow-up.

AIM: To evaluate the results of ventral intermediate (Vim) thalamic deep brain stimulation (DBS) in patients with tremor predominant Parkinson's disease (PD) at 6 years post surgery. METHODS: This was a prolonged follow-up study of 38 patients from eight centres who participated in a multicentre study, the 1 year results of which have been published previously. Total scores as well as scores for individual items of the motor part and the disability part of the Unified Parkinson's Disease Rating Scale were used for evaluation. RESULTS: Tremor was still effectively controlled by DBS and appendicular rigidity and akinesia remained stable compared with baseline. Axial scores (speech, gait and postural instability), however, worsened, and in parallel the initial improvement in activities of daily living scores at the 1 year follow-up had disappeared at 6 years, despite sustained improvement of tremor. Remarkably, neither daily doses of dopaminergic medication nor fluctuations and dyskinesias had changed at 6 years compared with baseline in this particular patient group. CONCLUSION: This study confirms that patients with tremor dominant PD who do not present with fluctuations and dyskinesias may have a relatively benign progression of the disease. Vim DBS, although having no effect on akinesia and rigidity, is a relatively lenient surgical procedure and may still have a place for long term symptomatic control of PD tremor in selected patients.

Physiological effects of selective tibial neurotomy on lower limb spasticity.

OBJECTIVES: To assess by electrophysiology the effect of tibial selective neurotomy on muscle imbalance of the spastic ankle. METHOD: The amplitudes of the H reflexes, M responses (muscle contractions recorded after stimulation of the tibial nerve), and Hmax:Mmax ratio were recorded in 12 patients with chronic lower limb spasticity, before and one month after tibial selective neurotomy. Recordings were done on medial and lateral gastrocnemius and soleus muscles. Clinical evaluation was done with both global (Held's score) and analytical tests (step measurements, gait velocity, and ankle angulation during active and passive movements). RESULTS: After neurotomy, gait improved in all patients. Held's score of spasticity was better in all patients. Active dorsiflexion of the ankle was unchanged in three patients, but the others improved by 5 degrees to 12 degrees. Hmax, Mmax, and Hmax:Mmax ratios were lower. The Hmax on the gastrocnemius muscle, clinical strength, Mmax of all the muscles, and Hmax:Mmax ratio for the soleus and lateral gastrocnemius muscle were significantly lower after surgery. CONCLUSION: There was an improvement of clinical and electrophysiological spastic indices after selective tibial neurotomy. Neurotomy acted not only on motor neurons by decreasing strength, but also the reflex enlargement by decreasing sensory afferents.

[Neuropsychological testing of 5 patients with Parkinson's disease before and after neuron graft]. / Examen neuropsychologique de 5 patients Parkinsoniens avant et après greffe neuronale.

Five patients with idiopathic PD were followed by neuropsychological tests after brain fetal neuronal transplantation. The following tests were used in order to assess memory as well as visuospatial and frontal functions: MMSE, Mattis Scale, Wisconsin Card Sorting Test, Stroop task, word fluency tasks, 15-objects test, WAIS-R (Digit span, Arithmetic, Block design, Pictures completion, Pictures arrangement), learning of 15 words of Rey, WMS-R (Logical memory) and Visual memory of L. Israël. The same tests were performed before, then one year following the transplantation. Pooled data did not show any significant difference between pre and post-operative tests. Individual results varied among patients: 2 remained unchanged, 1 had a pathological deterioration which increased after one year, 1 had some frontal symptoms whereas the last patient improved. Our data confirm that this surgical procedure do not induce permanent neuropsychological deficits, but do not indicate at the present time any clear effect of dopamine reinnervation on cognitive functions.

[Cephalic cancer pain controlled by intraventricular administration of morphine and clonidine]. / Douleurs céphaliques néoplasiques contrôlées par administration intraventriculaire de morphine et de clonidine.

A 47-year-old woman suffered from a pharyngeal cancer causing pain only poorly relieved by high doses of oral morphine. Oral administration was switched to the intracerebroventricular (ICV) route but pain relief was only transient despite a daily dosage up to 1.5 mg of morphine. Finally an effective pain relief was achieved with increasing doses of clonidine (5 to 30 micrograms) in combination with morphine (1.5 mg) by ICV route. Neither arterial hypotension nor sedation occurred and the patient recovered transiently a better quality of life.

Bilateral motor improvement and alteration of L-dopa effect in two patients with Parkinson's disease following intrastriatal transplantation of foetal ventral mesencephalon.

Several recent reports have suggested that foetal ventral mesencephalic transplants could alleviate motor symptoms in patients with Parkinson's disease. Expectations of future success must be clarified by precise analysis of the extent and limitation of recovery associated with an assessment of function of the graft using [18F]fluorodopa (18F-dopa) PET. Two patients with idiopathic Parkinson's disease, severely impaired despite optimal medication, have been followed 10 and 17 months after stereotaxic unilateral intrastriatal transplantation of neural cells dissociated from human foetal ventral mesencephalon. Analysis of the clinical evolution complied with the protocol established in the 'Core Assessment Program for Intracerebral Transplantation'. Both patients have benefited from the transplantation in their daily activities and in motor timed tests, although they still exhibit parkinsonian symptoms and require L-dopa therapy. This is associated with a gradual increase in 18F-dopa uptake at the site of grafting. There are two major clinical changes: (i) a bilateral motor improvement for the speed of movements (the quality of movements improved almost exclusively on the side contralateral to the graft); (ii) a change in the outcome of the L-dopa treatment as exemplified by a postoperative transient period of heavy dyskinesias and subsequent additive actions of the two treatments. These results confirm that neural transplantation may be useful for patients with Parkinson's disease. The improvement recorded on the side ipsilateral to the graft does not match that observed on the contralateral side and it is proposed that bilateral transplantation may be necessary. The existence of a transient postoperative period of heavy dyskinesias suggests that the patients may benefit from a controlled decrease of L-dopa intake after grafting.

[Cerebral tomoscintigraphy with N-isopropyl-p-I123-iodoamphetamine. Value in cerebral ischemic pathology]. / Tomoscintigraphie cérébrale utilisant la P. iodo I123N isopropyl-amphétamine. Intérêt en pathologie ischémique cérébrale.

Thirty patients with previous cerebral ischaemic accident were explored by both computerized tomography (CT) and radionuclide tomography after injection of 123I-labelled N-isopropyl-iodo-amphetamine. All lesions that were visible at CT were also visible at radionuclide tomography. However, in 7 patients with normal CT results the latter method showed areas of cerebral activity anatomically correlated with neurological signs or vascular lesions. Cerebellar diaschisis was observed in 50% of established lesions in the carotid territory. Radionuclide tomography therefore appears as a very sensitive method to be used in ischaemic pathology with transient or regressive accidents.

Cerebral toxoplasmosis in acquired immuno deficiency syndrome. A comparative assisted tomographic and neuropathological study of a case.

Authors report a case of fatal CNS toxoplasmosis in a young homosexual man suffering from Kaposi angio-sarcoma. This paper is principally concerned with CT scan and neuropathological correlations.

[Computed tomography of the head in gunshot wounds. Thirty-three cases (author's transl)]. / Le pronostic des plaies crâniocérébrales par balle en pratique civile. Série de trente-trois cas étudiés par la tomodensitométrie.

The authors report a series of 33 cases of craniocerebral lesions secondary to projectiles injuries studied by means of CT scan. Ct scans demonstrate the path of the missile, destructions of deep cerebral parenchyma, dissections of with matter (intra-cerebral bubble) and reactive oedema. Prognostic incidence of CT is discussed. CT scan helps to choose the best therapeutic approach as regards each particular case.

[Cholesteatoma of Bichat's fissure. Observations apropos of a case]. / Cholestéatome de la fente de Bichat. Remarques à propos d'un cas.

Four reasons are evoked for presenting a case of cholesteatoma of Bichat's fissure: --its symptomatology, specific to the site of the lesion, and previously demonstrated by Gros and Vlahovitch; --its appearance on computed tomography, still relatively unknown because of the rare nature of these lesions; --the open discussions still being conducted as to the "parasellar" qualification adopted by J. Lepoire and B. Pertuiset for this localization; --and the debated question as to the best surgical approach.

[Tumoral medullary compressions in malignant hemopathy (a 28 cases review (author's transl)]. / Compressions médullaires tumorales dans les hémopathies malignes. A propos de 28 observations.

The authors reviewed 28 cases of tumoral medullary compressions in malignant hemopathy. At once they point out 2 groups according to the fact that this compression is or not the revealing symptom of the disease. With regard to different data, that is to say, preoperative clinical examination with complementary investigations, and then results obtained from decompressive laminectomy followed or not with complementary therapy; the elements of the functional prognosis are analysed. They insist on frequency of medullary compression in a neuro surgical environment, as the revealing symptom of the hematologic disease and its immediate decompressive therapy is emphasized.