Primary focal dystonia: evidence for distinct neuropsychiatric and personality profiles.

BACKGROUND: Primary focal dystonia (PFD) is characterised by motor symptoms. Frequent co-occurrence of abnormal mental conditions has been mentioned for decades but is less well defined. In this study, prevalence rates of psychiatric disorders, personality disorders and traits in a large cohort of patients with PFD were evaluated. METHODS: Prevalence rates of clinical psychiatric diagnoses in 86 PFD patients were compared with a population based sample (n = 3943) using a multiple regression approach. Furthermore, participants were evaluated for personality traits with the 5 Factor Personality Inventory. RESULTS: Lifetime prevalence for any psychiatric or personality disorder was 70.9%. More specifically, axis I disorders occurred at a 4.5-fold increased chance. Highest odds ratios were found for social phobia (OR 21.6), agoraphobia (OR 16.7) and panic disorder (OR 11.5). Furthermore, an increased prevalence rate of 32.6% for anxious personality disorders comprising obsessive-compulsive (22.1%) and avoidant personality disorders (16.3%) were found. Except for social phobia, psychiatric disorders manifested prior to the occurrence of dystonia symptoms. In the self-rating of personality traits, PFD patients demonstrated pronounced agreeableness, conscientiousness and reduced openness. CONCLUSIONS: Patients with PFD show distinct neuropsychiatric and personality profiles of the anxiety spectrum. PFD should therefore be viewed as a neuropsychiatric disorder rather than a pure movement disorder.

Comparison of open versus percutaneous pedicle screw insertion in a sheep model.

Minimally invasive surgery has become more and more important for the treatment of traumatic spine fractures. Besides, some clinical studies, objective data regarding the possible lower damage to the surrounding tissue of the spine is still missing. Here we report a sheep model where we compared a percutaneous versus an open approach for dorsal instrumentation with pedicle screws to the spine. Twelve skeletally mature sheep underwent bilateral pedicle screw fixation at the L4-L6 level. Forty-eight pedicle screws were bilaterally inserted into the pedicles and connected with rods using either an open dorsal standard or a percutaneous approach. Operation time, blood flow, compartment pressure, radiation time, loss of blood, laboratory findings and EMG were evaluated to objectify possible advantages for the percutaneous operation technique. Loss of blood and the distribution of CK-MM as a marker for muscle damage were significantly lower in the percutaneous group. However, radiation time was significantly longer in the percutaneous group. Other parameters like compartment pressure, blood flow and also measurement of the EMG at different time points did not reveal significant differences. Based on the results we found in the present study, percutaneous screw insertion can bring moderate advantages but it should be noted that essential functional deficits to the muscle could not be detected.

Plasma amino acids in ecstasy users.

Recreational use of the illegal drug "ecstasy" has increased dramatically in recent years. We have measured 33 different plasma amino acids in ecstasy users and controls. Significant differences were found for phosphoserine, glutamate, citrulline, methionine, tyrosine and histidine. Resembling changes in the plasma amino acids have been described in acute transient polymorphous psychosis. Thus, alterations in plasma - methionine and phosphoserine or other amino acids could be involved in the psychical symptoms produced by MDMA.

[Continuous EEG for monitoring on the neurological intensive care unit. New applications and uses for therapeutic decision making]. / Kontinuierliches EEG zum Monitoring auf der neurologischen Intensivstation. Neue Einsatzmöglichkeiten und Nutzen für therapeutische Entscheidungen.

Fifteen patients at our neurological intensive care unit were monitored with continuous EEG (cEEG: 10 channels EEG and ECG) for a total of 109 days. Primary indications for monitoring were nonconvulsive seizures in patients with altered consciousness (AC, n = 9) and control of therapy in generalized/partial status epilepticus (SE, n = 5). The cEEG findings influenced therapeutic management of patients in almost 50% of monitoring days (50/109), with decisive decisions (changes in medication) being made in 31/109 days. In 5/9 patients with AC, cEEG revealed findings that could not be demonstrated in previous EEG recordings. Identification of repetitive, nonepileptic, involuntary movements was guided by cEEG in four patients. Aside from the established application of cEEG monitoring in SE, the usefulness of clarifying the differential diagnosis in patients with AC was demonstrated particularly by the finding of nonconvulsive seizures in three patients. In two of these, intermittent EEG recordings did not demonstrate the seizures.