Schmidt-Lanterman's incisures--the principal target of autoimmune attack in demyelinating Guillain-Barré syndrome?

We used immunocytochemical staining of peripheral (trigeminal) nerve to screen sera of patients with Guillain-Barré syndrome (GBS) for the presence of autoantibodies, using sera from patients with other neurological diseases and healthy volunteers as controls. Most sera mildly reacted with axons, myelin sheaths, or sensory neurons without correlation to a specific disease. A characteristic staining, however, was found in 23 demyelinating cases (89%) out of 26 investigated GBS sera. With these sera, dark, oval and often paired small blobs were observed throughout the sections. A similar picture was rarely observed with sera from patients with other disorders or healthy controls. Using immunocytochemical marker proteins and high light microscopic resolution, the blobs were identified as Schmidt-Lanterman's incisures (SLIs). Further investigations will be necessary to identify the corresponding antigen and to answer the question, whether these antibodies represent an epiphenomenon or play a role in the causative mechanism of the disease.

[Encephalopathies caused by valproate]. / Enzephalopathien durch Valproat.

Valproic acid (VPA)-induced encephalopathy is a rarely considered side effect, with somnolence, reduced motor activity and severe deterioration of cognitive and behavioural abilities. In accordance with the increasing clinical importance of valproate clinical symptoms, causes and possibilities of treatment are reviewed by reporting on two cases of valproate-induced encephalopathy. In comparison to VPA intoxication, which is associated to increased VPA blood levels, the mechanisms of encephalopathy may include interactions of the hepatic enzymes, a direct toxic effect on the cerebral receptors, as well as drug interactions, a paradoxical epileptogenic effect and metabolic interactions. In most cases withdrawal of VPA produces regression of the symptoms within a few days; the role of L-carnitin or citrullin supplementation in clinical treatment remains unclear.

Intraspinal endometriosis as a possible cause of recurrent back pain and leg monoparesis.

Recurrent back pain and leg monoparesis in a 38 year old woman could be traced back to a focus of intraspinal endometriosis. Upon admission, neurological examination revealed multiple sensory deficits and a proximal spastic paresis of the left leg. The patient complained about backache, which spontaneously disappeared some days later. History taking disclosed a relationship between the transient symptomatology and the menstrual cycle. Magnetic resonance imaging of the spine demonstrated a signal-intense intraspinal structure at the Th 8/9 level on the 25th day of the menstrual cycle. On follow-up examination at the beginning of the cycle the previously detected structure had vanished. Intraspinal endometriosis was confirmed by gynecological demonstration of additional endometriosis of the left ovary as well as positive response to treatment with a gonadotrophin releasing hormone analog.