Psychological factors and long-term tinnitus handicap in vestibular schwannoma patients after retrosigmoid microsurgery - a cross-sectional study.

OBJECTIVE: This study aimed to investigate the connection between psychological factors and postoperative tinnitus in vestibular schwannoma (VS) patients following retrosigmoid microsurgery. DESIGN: Cross-sectional study. STUDY SAMPLE: Ninety-three VS patients participated, completing questionnaires on demographics, tinnitus severity (THI-12), personality traits (TIPI-G), dizziness impact (DHI), perceived health benefits (GBI), somatisation tendencies (SOMS-2), and psychological distress (HADS-D). Our analysis involved Mann-Whitney U-tests, Spearman's rank-order correlations, and false discovery rate correction. RESULTS: Most participants reported postoperative tinnitus (77/93), with 41 experiencing it preoperatively. Emotional stability correlated negatively with tinnitus presence, while tinnitus severity was associated with emotional distress. Preoperative somatisation tendencies were also positively linked to tinnitus severity. Postoperative Tinnitus was further linked to reduced perceived health benefits and increased anxiety and depression levels. Notably, age and gender showed no significant associations. CONCLUSION: This study uncovers the interplay between postoperative tinnitus and psychological factors in VS patients, highlighting emotional and cognitive dimensions. Tailored psychological interventions addressing tinnitus's psychosomatic impact may enhance patients quality of life.

[Botulinum toxin therapy for spasmodic torticollis: medical and non-medical adjunct treatment]. / Botulinum-Toxin-Therapie bei Torticollis spasmodicus: Medizinische und nichtmedizinische Begleitbehandlungen.

BACKGROUND: Spasmodic torticollis patients were investigated with respect to the number of adjunct treatments used before and after the introduction of botulinum toxin therapy (Btx). The study was designed in a similar way to an earlier investigation by Birner et al. (Nervenarzt 70:903-908, 1999). MATERIAL AND METHODS: A total of 247 patients with idiopathic spasmodic torticollis were assessed at three time points for the diagnosis: before 1988 (n = 63), between 1989 and 1998 (n = 107) and after 1999 (n = 77). RESULTS: Independent of the year of diagnosis patients underwent a mean of 14.3 different treatments. In addition to Btx most of the patients were subjected to massage, physiotherapy, medication and a large number of non-medical treatments including praying. No associations to clinical or personal variables were found. Those patients with emotional disorders prior to onset of dystonia displayed a higher rate of medical and non-medical treatments in addition to Btx. CONCLUSIONS: The results confirmed those found by Birner et al.. In order to enhance compliance patients should undergo psychoeducation with respect to illness behaviour and specific history taking with respect to emotional disorders prior to dystonia.

Deep brain stimulation for movement disorders and its neuropsychological implications.

Deep brain stimulation (DBS) has gained increasing attention as a therapy for movement disorders. Neuropsychological alterations can accompany the disease evolution and medical therapy of PD. Also, interfering abruptly with the biological balance by means of a surgical intervention into complex circuits with motor but also cognitive and limbic functions, could potentially cause severe problems. Because cognitive or emotional impairments may have an even stronger impact on quality of life, than motor symptoms, care must be taken to perform surgery in the safest possible way to exclude adverse effects in these domains. Detailed neuropsychological evaluations may become helpful to further understand the mechanisms underlying some aspects of the clinical pictures both pre- and postoperatively and to define risk populations, that should be excluded from this intervention.

Remote memory in patients with acute brain injuries.

Remote memory was investigated in an unselected sample of 26 patients with either unilateral tumours in the temporal lobes or traumatic brain injuries. Six patients underwent excisions within the left temporal lobe, and nine patients were operated on within the right temporal lobe. In both groups, patients with excisions including and sparing the hippocampal formation were studied. Their performance was compared to that of 11 patients with moderate to severe head trauma and to a normative sample of 214 healthy controls. Remote memory was assessed using a famous events test with items of extremely low salience that had been proven to be of low difficulty for those old enough at the time of the event's actuality. The results show severely disturbed retrograde memory functions in the left temporal tumour group. These patients achieved similar scores to patients with severe traumatic brain injury. Right hemispheric patients showed a pattern of results comparable to that of healthy controls. The strongest effects were in the free recall part of the test. In most of the patients, no graded memory loss was observable. No consistent association to recent memory function could be identified. Since most of the remote memory test items used denoted famous names which were cued by rich semantic information, the type of deficit seen may be best understood in terms of a specific dysfunction of the semantic stores containing information about famous proper names.

Remote memory in Parkinson's disease and senile dementia.

Remote memory for public events was investigated in 14 demented patients with Parkinson's disease (PD), 14 non-demented PD patients, and 14 controls. These groups were compared with 16 demented patients with dementia that was due to Alzheimer or was of vascular origin (SDAVT), and with a group of elderly controls. The two demented groups were of a different age but displayed a comparable degree of dementia. Remote memory was assessed using a 'famous events' questionnaire with items both of comparable salience and difficulty. Results showed severely impaired retrograde memory functions in the two demented groups for both recall and recognition with non-demented PD patients performing similar to the controls. Remote memory impairments extended 30-40 years without any temporal graded memory losses. Non-demented PD patients and controls showed an inferior free recall performance, especially for the remote past. The two PD groups benefited from recognition to the same extent as the controls, whereas the improvement for SDAVT patients was inferior when compared to their elderly controls. In contrast to SDAVT patients, anterograde memory was associated with remote memory for specific decades in demented PD patients. The results are interpreted with respect to an underlying retrieval deficit with a superimposed anterograde impairment common to both types of dementia and an additional loss of storage sites in SDAVT patients.

Risk factors for pulmonary barotrauma in divers.

STUDY OBJECTIVES: Pulmonary barotrauma (PBT) of ascent is a feared complication in compressed air diving. Although certain respiratory conditions are thought to increase the risk of suffering PBT and thus should preclude diving, in most cases of PBT, risk factors are described as not being present. The purpose of our study was to evaluate factors that possibly cause PBT. DESIGN: We analyzed 15 consecutive cases of PBT with respect to dive factors, clinical and radiologic features, and lung function. They were compared with 15 cases of decompression sickness without PBT, which appeared in the same period. RESULTS: Clinical features of PBT were arterial gas embolism (n=13), mediastinal emphysema (n=1), and pneumothorax (n=1). CT of the chest (performed in 12 cases) revealed subpleural emphysematous blebs in 5 cases that were not detected in preinjury and postinjury chest radiographs. A comparison of predive lung function between groups showed significantly lower midexpiratory flow rates at 50% and 25% of vital capacity in PBT patients (p<0.05 and p<0.02, respectively). CONCLUSIONS: These results indicate that divers with preexisting small lung cysts and/or end-expiratory flow limitation may be at risk of PBT.

Spatial information transfer from virtual to real versions of the Kiel locomotor maze.

The Kiel locomotor maze requires participants to choose five targets from among 20 locations marked by small red lights on the floor of a dimly lit circular environment having four wall-mounted extramaze cues and two intramaze cues at floor level. In the present study, acquisition of the real task was examined in 11-year-old children following prior accurate training in a virtual version, following misleading virtual training, or following no training. The virtual version was displayed on a desk-top computer monitor. Acquisition testing in the real maze was either locomotor or non-locomotor. Good transfer was achieved from virtual to real versions. Children's exploration of the real maze prior to real maze acquisition training revealed a clear transfer of spatial information previously learned in the virtual version. Children taught the correct target configuration in the simulation made fewer errors and more rapid, confident responses to targets in the real maze than children given no training. However, acquisition was also better following misleading training than no training, suggesting that a non-specific components of performance also transferred. Male superiority was only seen following misleading training, which was interpreted in terms of male superiority in mental rotation. After acquisition, a single probe trial was performed, in which proximal cues and participants' starting position were rotated, but this had equivalent effects on all groups' performance. It is clear that transfer of spatial information occurs from the simulated Kiel maze to the real version. This has implications for its use in diagnosis and training.

Impairment of visuospatial function in idiopathic spasmodic torticollis.

We studied visuospatial function in 15 patients with idiopathic spasmodic torticollis (ST) and 15 age- and sex-matched controls. All subjects underwent a battery of visuospatial tests, assessing different functional components of spatial ability. The performance of ST patients on tasks of spatial perception did not significantly differ from that of normal subjects, but patients performed significantly worse on spatial tasks requiring mental manipulation of personal space. This distinct pattern of visuospatial impairment may result from basal ganglia dysfunction.

Heterogeneity of biofeedback training effects in spasmodic torticollis: a single-case approach.

Data from 184 biofeedback sessions are presented, in which 10 subjects with spasmodic torticollis had been trained to reduce pathologic activity in the hypertrophied sternocleidomastoid muscle. Each session was conducted as a single case experiment with nine successive trials. Attempts were made to distinguish motor learning processes which can be elicited independently from the biofeedback-condition from the effects of specific biofeedback information. Results showed dramatic decreases of muscle activity under biofeedback. Contrary to expectation, action potentials did not decrease across a course of 14 training sessions. Instead, effects were exhibited in an all-or-none fashion early in the training. Single-case ARIMA intervention analysis has shown that in 59% of the sessions EMG decreases demonstrated under biofeedback could be elicited prior to biofeedback in a condition of instructed control. Case studies revealed complex interactions of instructed control, specific biofeedback effects, unspecific effects of the biofeedback setting, and cognitive processes. Effects obtained within experimental sessions varied highly between subjects. Results are discussed in terms of newer concepts of basal ganglia dysfunction, and conclusions for the use of biofeedback paradigms in torticollis subjects are outlined.

Children's spatial behavior is differentially affected after traumatic brain injury.

Spatial behavior in 20 children with severe traumatic brain injury (TBI) and 20 healthy controls was investigated using the Kiel Locomotor Maze. Children had to remember defined locations in an experimental chamber with completely controlled intra- and extra-maze cues until learning criterion was reached. In a second experiment, spatial orientation strategies were assessed. Children with TBI were shown to be impaired in spatial learning and spatial memory. Spatial orientation was found to be deficient even in cases where spatial learning and memory proved to be unimpaired, especially in tasks that demanded the use of relational place strategies. Children who suffered a TBI at an early age proved to be more severely impaired in spatial learning and orientation than older children.

Development of spatial memory and spatial orientation in preschoolers and primary school children.

The present study addresses the question of what kind of information children use when orientating in new environments, if given proximal and distal landmarks, and how spatial memory develops in the investigated age groups. Ten 5-year-old, ten 7-year-old and ten 10-year-old children were presented with the 'Kiel Locomotor Maze', containing features of the Radial Arm Maze and the Morris Water Maze, in order to assess spatial memory and orientation. Children had to learn to approach baited locations only. Task difficulty was equated with respect to the children's age. Training was given until the children reached criterion. During testing, the maze configuration and response requirements were systematically altered, including response rotation, cue rotation, cue deletion and response rotation with cue deletion in order to assess the spatial strategies used by the children. During training and testing, working-memory errors (WM), reference-memory errors (RM) and working-reference memory errors (WR) were recorded. As expected, no difference between age groups appeared during training, thus confirming comparable task difficulty across age groups. During testing, age groups differed significantly with regard to the orientation strategy used. The 5-year-olds were bound to a cue strategy, orientating towards local, proximal cues. The 10-year-olds mastered all tasks, thus displaying a place strategy, being able to use distal cues for orientation, and were even able to do so after being rotated 180 degrees. The 7-year-olds proved to be at an age of transition: five of them were bound to a cue strategy, five children were able to adopt a place strategy. The differences in the orientation strategies used by children of different age groups was reflected by the sum of errors they made, also by RM. WM were found to be rare, especially in older children. We conclude that preschoolers use a cue strategy, that the development of place strategies occurs during primary school age and seems to be complete by the age of 10 years.

Memory deficits at 0.6 MPa ambient air pressure.

We investigated the effects of an elevated ambient air pressure of 0.6 MPa on verbal memory performance. Twenty-four experienced divers were compressed in a dry hyperbaric chamber to pressures equivalent to 0.5 meters of seawater (msw) (n = 12) and 50 msw (n = 12). Verbal memory was assessed by free recall and recognition of visually presented word lists. The testing procedure specified learning and testing at surface, learning at surface and testing at depth, learning and testing at depth, and learning at depth and testing at surface. Non-specific stress was assessed by measurement of salivary cortisol, heart rate, and subjective stress before, during, and after the dives. The 50-msw dive group showed a significant decrease of free recall performance when the material was learned at depth (P < 0.01). However, only postdive recall of material learned at depth remained significantly impaired (P < 0.05), whereas recognition performance was normal. For both groups no significant effects of depth on the investigated stress indices were obtained. These results are taken as evidence that inert gas narcosis may interfere with encoding and/or retrieval of verbal information, although the possibility that other stressors in the hyperbaric environment contributed to these deficits cannot be eliminated entirely.

A device for functional residual capacity controlled biofeedback of respiratory resistance.

A computer-aided procedure is presented providing subjects with analogous visual feedback of respiratory resistance, which is continuously measured using the forced oscillation method. Simultaneous pneumotachographical control of the breathing volume curve makes it possible to prevent reinforcement for decreases of respiratory resistance which are due to increases of functional residual capacity (FRC). Lung hyperinflation is an unsuitable way to reduce respiratory resistance; if it occurs, feedback is interrupted until the subject decreases his FRC to its initial level. Analysis of the data of 15 adult asthmatic subjects which underwent a 12-sessions feedback training showed that no substantial changes of FRC appeared within feedback trials. Advantages of this new biofeedback technique compared to other procedures are discussed with regard to volume control and feedback signal.

Visuospatial functions in patients with spasmodic torticollis.

Visuospatial functions were studied in 18 patients with spasmodic torticollis and 18 matched controls. Subjects were examined with respect to their judgement of the subjective vertical, personal and extrapersonal orientation, the discrimination of left and right, the ability to judge angles and distances, and a drawing task. Patients showed marked deficits in extrapersonal orientation and atypical displacement errors to the right when requested to set the subjective vertical. Results were largely independent of the clinical characteristics of the disease. The pattern of results was attributed to a subtle attention deficit underlying complex measures of visuospatial functions. This may reflect a discrete dysfunction of the striatal-frontal circuits at least in a subgroup of patients.

A new procedure for assessment of proprioception.

A new method for the assessment of proprioception was developed and tested with 40 healthy subjects on two facial muscles (i.e., masseter and zygomatic muscles). The experiment was repeated after 3 1/2 months. In our study, proprioception was studied with respect to sensations arising from the muscle spindles and tendon organs. Therefore, myesthesia was investigated, which was assessed by the correspondence between a voluntary muscle contraction and its immediate replication. Good perception was defined by a small integral of differences, standardized by duration and intensity of the contraction, and its replication. Results show that this measure is independent of the characteristics of muscle activation. In concordance with our hypothesis, myesthesia was superior in a muscle richly supplied with muscle spindles and afferent fibers (i.e., masseter muscle), to that for a muscle less prepared for afferent information processing (i.e., zygomatus major).

Ageing and spatial reversal learning in humans: findings from a virtual water maze.

Deterioration in spatial memory with normal ageing is well accepted. Animal research has shown spatial reversal learning to be most vulnerable to pathological changes in the brain, but this has never been tested in humans. We studied ninety participants (52% females, 20-80 yrs) in a virtual water maze with a reversal learning procedure. Neuropsychological functioning, mood and personality were assessed to control moderator effects. For data analysis, participants were subdivided post hoc into groups aged 20-24, 25-34, 35-44, 45-64 and 65-80 yrs. Initial spatial learning occurred in all age groups but 65-80-yrs-olds never reached the level of younger participants. When tested for delayed recall of spatial memory, younger people frequented the target area but those over 65 yrs did not. In spatial reversal learning, age groups over 45 yrs were deficient and the 65-80-yrs-olds showed no evidence of reversal. Spatial measures were associated with neuropsychological functioning. Extraversion and measures of depression moderated the age effect on the learning index with older introverted and non-depressed individuals showing better results. Measures of anxiety moderated the age effect on reversal learning with older people having higher anxiety scores showing a preserved reversal learning capability. Results confirmed age to be a major factor in spatial tasks but further showed neuropsychological functioning, psycho-affective determinants and personality traits to be significant predictors of individual differences.

Focal lesions of human hippocampal CA1 neurons in transient global amnesia impair place memory.

A critical role in place learning has been attributed to place cells within the cornu ammonis 1 (CA1) sector of the hippocampus in rodents. The role of CA1 cells in the human hippocampus with regard to place learning remains elusive. Using a virtual Morris water maze, we investigated patients with acute transient global amnesia (TGA), a rare self-limiting dysfunction of the hippocampal system. Fourteen individuals with selective and focal lesions in the CA1 sector of the hippocampus showed a profound impairment in place learning. The size of the lesions and the duration of the TGA correlated with the deficit in the performance.

Subtle cognitive dysfunction in adult onset myotonic dystrophy type 1 (DM1) and type 2 (DM2).

The authors performed neuropsychological testing in 21 patients with myotonic dystrophy type 1 (DM1) and 21 with type 2 (DM2) and healthy controls. They detected no general cognitive deficit in either DM1 or DM2, but compared to controls, both groups of patients were inferior in tests of prefrontal functioning. Patient groups did not differ in any measure. Mood status was not related to neuropsychological performance. This is consistent with findings of executive dysfunction in both DM1 and DM2.

Conditional-associative learning in eating disorders: a comparison with OCD.

The acquisition of conditional associations using neutral and individually threatening verbal stimuli was assessed in 16 females with anorexia nervosa (AN), obsessive-compulsive disorder (OCD), bulimia nervosa and normal controls, respectively. Groups did not differ in terms of age, sex, intelligence, depression, verbal memory and verbal fluency measures. Patients and controls were widely comparable on tests assessing neuropsychological functioning. In the conditional-associative learning (CAL)-task only anorectic and OCD-patients displayed an impaired performance with neutral material but not with individually threatening material. Such a deficit was not evident in bulimics or in normal controls. These findings support the assumptions from functional neuroimaging investigations in AN and OCD and provide evidence that obsessive and compulsive behavior could have its origin within common neurobiological dysfunctions. The CAL possibly serves as a functional correlate of a neurophysiological dysfunction in obsessive-compulsive spectrum disorders.

Perception of dyspnea during histamine- and methacholine-induced bronchoconstriction.

BACKGROUND: Perception of dyspnea is poorly related to bronchoconstriction and may be influenced by distinct psychophysiologic stimuli. OBJECTIVE: This study compared the perceived psychophysiologic changes during histamine- and methacholine-induced bronchoconstriction using verbal as well as nonverbal assessment techniques. METHODS: Perception of dyspnea was studied during induced bronchoconstriction in 40 atopic subjects randomly ascribed to either histamine (n = 20) or methacholine (n = 20) bronchial challenge. A 100% increase in specific airway resistance (sR(aw)) indicated airway hyperresponsiveness (AHR). Dyspnea was verbally assessed by the Borg Scale (BS) and the Asthma Symptom Checklist (ASL). A hand dynamometer (HD) served for nonverbal assessment. Both challenge groups did not differ significantly with respect to age, anthropometric data, smoking and lung function before challenge. RESULTS: AHR did not differ between groups but groups differed significantly with respect to the number of symptoms and to symptom intensity reported after challenge. Subjects who underwent the histamine challenge scored significantly higher on both measures derived from the ASL. BS ratings and HD scores correlated significantly but were not significantly related to the degree of AHR. Accurate and poor perceivers could be discriminated by analysis of the relationship between BS and sR(aw). CONCLUSIONS: These findings suggest that perception of induced dyspnea differs between histamine and methacholine when assessed by a symptom report.