Postpolio syndrome--response to deprenyl (selegiline).

Two patients with postpolio syndrome are presented. The first case developed mild Parkinson's syndrome, for which she was treated with a levodopa/carbidopa combination followed by the institution of deprenyl. An unexpected improvement in the symptoms of postpolio syndrome was noted. The second patient who was unaffected by Parkinson's syndrome was started on deprenyl alone and reported a similar improvement in symptomatology.

Cognitive and behavioral aspects of brain-injury rehabilitation.

The most exciting area in current neurologic rehabilitation concerns cognitive remediation following brain injury. The experimental substrate upon which such rehabilitation rests is not yet firm, but results to date are suggestive of a positive effect, if not in specific cognitive ability, at least in functional and behavioral outcome. As more controlled studies are performed and as improved neuropsychological, behavioral, and social measures are developed, it can be anticipated that improved patient selection and therapeutic intervention will emerge. Also, as we gain further understanding of the molecular and cellular consequences of brain injury, it is not unreasonable to expect improved pharmacologic therapy of the various sequelae of brain injury. It would be remiss, however, to not close by extolling the best means of injury treatment, that is, prevention.

Evoked potential testing in relatives of multiple sclerosis patients.

Evoked potential (EP) tests were obtained in 110 neurologically normal first-degree relatives of patients with multiple sclerosis. Visual EP tests were performed in all relatives; brainstem auditory and median nerve somatosensory EP tests were performed in 67 relatives. The relatives had a mean visual EP P100 latency that was significantly longer than that for normal subjects controlled for age and gender. Asymmetries were seen in results from individual MS relatives, including interocular visual EP P100 differences of up to 14 ms, and interarm somatosensory Erb-N18 differences of up to 3.0 ms. We identified 19 pairs of patients and relatives who were HLA identical and 18 other pairs who were HLA double nonmatched. EP asymmetries were seen more often in the HLA identical siblings than in the HLA double patients, especially if they share HLA types with the patients. Since less than 2% of siblings of MS patients would be expected to eventually develop clinical MS, these small subclinical electrophysiological changes are not expected to be a sign of the future appearance of clinical MS. Clinicians should be aware not to overinterpret small EP changes in relatives of MS patients.

Somatosensory evoked potential testing in multiple sclerosis.

Evoked potentials can be elicited by electrical stimulation of the median nerve or other locations. Recordings can be made of the electrical signals at the peripheral nerve, plexus, spinal cord, brainstem, and hemispheric levels. When the stimulation and recording techniques are kept constant, the evoked potentials can be used to measure pathophysiological abnormalities in MS and other conditions. Evoked potentials are abnormal in most persons with MS, which helps to establish the diagnosis. These techniques also hold promise of value in clinical trials of possible MS therapies and as an aid in the epidemiological and genetic studies of MS.

Visual evoked responses in patients with multiple sclerosis.

The visual evoked response (VER) was evaluated in a series of multiple sclerosis patients and normal subjects. The data showed significant delays in wave peak latencies among the patient evoked responses. The prolonged latencies correlated closely with visual impairment; however, even patients with a previous history of visual impairment, but with no deficits noticeable on examination at the time of study, showed a delay in wave peak latencies. The results further suggest that the VER is primarily altered when there are central field defects.