Blinded evaluation confirms long-term asymmetric effect of unilateral thalamotomy or subthalamotomy on tremor in Parkinson's disease.

In the past, stereotactic surgery was a regular treatment for prominent unilateral tremor in Parkinson's disease (PD), but follow-up studies were usually short-term and always unblinded. We examined 17 PD patients in long-term follow-up (mean, 10.9 years after surgery) and used videotapes and the Unified Parkinson's Disease Rating Scale to blindly compare tremor ipsilateral and contralateral to the side of surgery. Since the patients were specifically selected for stereotactic surgery because of asymmetric tremor, and the surgical side chosen was contralateral to the predominant tremor, a sign of long-term efficacy would be current postoperative reversal of tremor side predominance. Upper extremity tremor was significantly better contralateral to the surgery compared with the ipsilateral side. We conclude that stereotactic surgery improved the absolute magnitude of tremor or ameliorated its rate of progression. Since asymmetric bradykinesia and dyskinesia were not a prerequisite for the choice of surgical side, we cannot make any conclusion about long-term impact of surgery on these features.

Surprise finding 5 years after stereotactic amygdalotomy.

Before extinction of an epileptogenic focus exclusion of an intracranial tumor or an angioma by EEG, isotope and contrast medium diagnosis must be attempted. A case history is presented of a patient in whom a malignant glioma was discovered 5 years after stereotactic treatment for epilepsy.

Stimulation of conus-epiconus with pisces. Further indications.

Stimulation by epidurally implanted bipolar electrodes placed upon the conus and epiconus, not only reduces pain, but also sensitive and vegetative sensations. Seven patients suffered from pain in the sacral and coccygeal region as in coccygodynia, also from sensitive and vegetative discomforts in the perineum, anus, rectum, bladder and vagina. Introduced between L 2/3, the tips of the electrodes were placed between the levels of D 10 and L 1 (6 patients) and between D 7 and D 8 (1 patient), the optimal location was found by stimulation. The stimulation was tested in procumbent standing or sitting positions before fixing the electrodes. In all 7 patients there was a reduction of symptoms.

A new apparatus to avoid certain complications in stereotactic operations at the upper cervical spinal cord.

An electronic apparatus was developed which measures the effective current flow of the monophasic stimulation pulses while the tip of the electrode is passing through the tissue. This current flow can be observed as a function of time on the screen of a cathode ray tube.

Clinical interpretation of difference in motor facial innervation before, during and after stereotactic brain operations.

Stereotactic brain operations performed in the ventrolateral thalamic nucleus area and in the subthalamus can produce very difference effects upon motor facial innervation depending on the voluntary motricity and the degree of tonicity and emotion or combination of the two.

Application of SCS for movement disorders and spasticity.

20 patients with movement disorders and spasticity were treated with SCS to decrease tonus and improve impaired motor function. 12 patients with multiple sclerosis had gait disorders and slight up to considerable increase in tonus. We observed quantitative changes in diminution of spasticity, voluntary motor function, bladder function, lessening of ataxia and pain relief. During a follow-up of up to 4 years no deterioration in the patients' condition could be observed. 11 patients reported a more fluent gait in 6 cases accompanied by a decrease in tonus. Increase in tonus and deterioration of gait pattern were observed after break down of the stimulation. Although the indications for electrostimulation still remains uncertain in some cases with definite diagnosis without any progressive character of the disease and without severe neurological disturbances improvement can be obtained.

Experience with spinal cord stimulation (SCS) in the management of chronic pain in a traumatic transverse lesion syndrome.

Epidural electrical stimulation of the spinal cord by means of percutaneously implanted electrodes was successfully used in cases of traumatic paraplegia with chronic pain, more particularly if vegetative components predominated. Out of seven patients treated in our clinic six reported a good or very good outcome of the stimulation over follow-up periods up to six years. On account of the good effect on chronic pain the use of this stimulation procedure is indicated and justified before considering any destructive operative measures.

Acute spinal epidural empyema. Observations from seven cases.

Seven cases with an acute epidural spinal empyema are presented. The best results are observed in cases with early treatment. Since this rare condition is not widely known and swift diagnosis and treatment is imperative, it is stressed that immediate referral of the patient with back pain and any signs of infection in addition to commencing neurological abnormalities to a neurological unit for myelography can be vital or can at least reduce the risk of permanent paraplegia.