[Theory of cognition and natural philosophy in neurology. The principle of localization in the debate between Viktor von Weizsäcker, Kurt Goldstein, and Otfrid Foerster in 1930]. / Die Krise der Neurologie in erkenntnistheoretischer Weise. Kontroverse zwischen Viktor von Weizsäcker, Kurt Goldstein und Otfrid Foerster zum Lokalisationsprinzip 1930.

Restitution after brain damage was the leading topic in 1930 at the 20th annual meeting of the Society of German Neurologists in Dresden, Germany. One of the "nonanatomic" presentations was held by Viktor von Weizsäcker about modifications in neurological function. Finally the presentation by Kurt Goldstein about restitution after damage of the brain cortex, strongly supported by Weizsäcker, was the starting point for controversies on the significance of natural scientific methods in the field of neurology. Goldstein and Weizsäcker favored the idea that function can be understood only if we consider it in light of the whole organism. However, the president of the Society of German Neurologists, Otfrid Foerster, was mainly influenced by the overall concept of the structure of the peripheral nervous system and - as Weizsäcker indirectly blamed - came to inadequate conclusions by transferring these concepts to the entire nervous system. In contrast Weizsäcker and Goldstein suggested analyzing pathological phenomena not only according to classical physiology, i.e. isolated data acquired by the dissecting method of natural science. Weizsäcker stressed hermeneutic views concerning the mind: body relationship in a phenomenologically oriented medical anthropology. Some years later Foerster linked up with Weizsäcker's position. Goldstein established the new method, the so-called holistic, organismic approach, which he carried on after emigrating to the U.S.A. in 1935. The Heidelberg School around Weizsäcker tried during the following years to liberate neurology from the ideology of materialistic reductionism without however reducing it to simple psychology. The doctrine of neurons and principles of saltatory conduction as basic and descriptive instruments in neurology were not to be questioned. In 1941 Weizsäcker succeeded Foerster as Professor of Neurology at the University of Breslau and Director of the Neurological Research Institute. His literary work "The Circle of Form. Theory of the Unity of Movement and Perception" and Goldstein's "The Organism. A Holistic Approach to Biology derived from Pathological Data in Man" [new edn. by Oliver Sacks, Zone Books, New York, 1995] obtained paradigm values which had their beginnings in Dresden in 1930. "The crisis in biology in the matter of theory of cognition and natural philosophy" was already then obvious and still can be found in present discussion about the relationship between neurosciences and humanities. Weizsäcker increased his focus on medical anthropology by taking a full professorship of general clinical medicine in 1946 in Heidelberg. It is not without reason that Weizsäcker is recognized as a founder of psychosomatic medicine.

Conversion from carbamazepine or oxcarbazepine to topiramate in adolescents and adults with epilepsy.

OBJECTIVE: To explore effectiveness, tolerability and changes in quality of life in patients with epilepsy converting to topiramate (TPM) from carbamazepine (CBZ) or oxcarbazepine (OXC) due to insufficient effectiveness and/or tolerability. METHODS: A multicenter, open-label, non-interventional trial was used to examine patients (> or = 12 years) with epilepsy, changing to TPM monotherapy from baseline mono- or combination therapy with CBZ or OXC. TPM was added to the existing antiepileptic drug (AED) treatment and started at a dose of 25 mg once daily. The dose was titrated up with 25 mg/day increments, once every 1-2 weeks, until a final dose between 50 and 200 mg/day was reached. On the basis of clinical judgment, the treating physician decided whether or not the existing AED treatment with CBZ or OXC could then be withdrawn. Type and number of seizures, preferred TPM dose, quality of life (QOLIE-10 questionnaire), subjective perception of improvement and adverse events (AE) were documented. RESULTS: 140 patients (53.5% women, mean age 47 years) decided to switch to TPM due to insufficient effectiveness (75% of patients) and/or poor tolerability (80%) of the CBZ/OXC treatment. Average duration of follow-up was 24 weeks with an overall discontinuation rate of 19.3%, mainly due to AEs (12.1%). At study endpoint, the intended shift to TPM monotherapy was achieved in 73% of patients at a median TPM dose of 100 mg/day. A seizure reduction of > or = 50% was achieved in 91% of patients in the last scheduled period (weeks 12-26); 62% of patients entering that period remained seizure free. Quality of life at endpoint improved significantly when compared with baseline for all domains of QOLIE-10 (P < 0.001). Most frequent AEs (reported by > or = 5% of patients) were paresthesia (9.3%), weight loss (7.9%), convulsions (5.7%) and memory disorders (5.0%). CONCLUSION: In patients with epilepsy, previously not satisfactorily treated with CBZ or OXC, conversion to TPM may result in an improvement in seizure control as well as in quality of life.

[Horner's syndrome occurring with spontaneous pneumothorax. A case report]. / Horner-Syndrom bei spontanem Pneumothorax - Ein Fallbericht -

Horner syndrome is defined as homolateral miosis, ptosis and enophthalmus, and occurs after a lesion of central or peripheral sympathetic pathways. The syndrome is mentioned as side effect for example with dysraphias, the Wallenberg syndrome, ischemic stroke of the middle cerebral artery, mediastinal tumors or iatrogen after pneumothorax interventions. We recently observed a patient with a transient significant miosis, without ptosis and enophthalmus, which we interpreted as an incomplete manifestation of a Horner syndrome occurring with spontaneous pneumothorax.