Report of the Task Force on pre-graduate education in Europe of the education committee of the European Federation of Neurological Societies Composition of the task force of the education committee on pre-graduate education.

BACKGROUND AND PURPOSE: The demographical evolution and the technological revolution seen in the last decades, in developed countries, have dramatically changed the practice of Neurology. However, the academic curriculum in many medical schools has not been updated accordingly over many of the European Countries. The Education Committee of the European Federation of Neurological Societies (EFNS) implemented in 2000 a Task Force on pre-graduate education trying to give guidelines to adequate pre-graduate education to the present status. METHODS AND DISCUSSION: Based on the results of two questionnaires, the first sent to the delegates of the EFNS and to the delegates of the European Board of Neurology, and the second answered by the Task Force members themselves, this paper describes the Task Force recommendations aimed to improve Neurology Education in the Medical Schools. These recommendations are also discussed with the analyses of the current bibliography available.

Early sympathetic hyperactivity in Huntington's disease.

To investigate whether Huntington's disease (HD) affects autonomic nervous system (ANS) functioning 33 subjects with positive genetic test results were studied. The subjects were classified according to Shoulson and Fahn (S&F) HD disability scale into three subgroups: subgroup 1 (eight asymptomatic gene carriers), subgroup 2 (13 mildly disabled HD patients) and subgroup 3 (eight moderately and four severely disabled HD patients). A battery of cardiovascular autonomic tests (Valsalva maneuver, deep breathing test, sustained handgrip test, orthostatic test) and the spectral analysis of heart rate variability (HRV) were performed. The results were compared with a group of matched controls. In subgroup 1, there was a higher power of low-frequency band (LFB) (P < 0.05). In subgroup 2 a higher power of LFB was detected, LFB/high-frequency band (HFB) coefficient was increased and the blood pressure response to sustained handgrip was elevated (P < 0.05). Subgroup 3 showed significantly lower blood pressure response to sustained handgrip, lower respiratory (P < 0.05) and orthostatic ratio (P < 0.01). Our results suggest that sympathetic hyperfunction is present in asymptomatic gene carriers and mildly disabled HD patients. Contrary to that, ANS hypofunction was found in advanced HD patients.

The deterioration of cardiovascular reflexes in Parkinson's disease.

OBJECTIVES: We have investigated the deterioration of cardiovascular reflexes in Parkinson's disease. PATIENTS AND METHODS: In a group of 20 patients with Parkinson's disease (PD) and in a group of 10 age-matched control subjects a battery of cardiovascular reflex (CVR) tests (Valsalva manoeuvre, deep breathing test, handgrip test, orthostatic test) was repeated after 3 years. RESULTS: In PD patients at deep breathing test, at Valsalva manoeuvre and at orthostatic test the heart rate response decreased significantly (P<0.05). The impairment of systolic and diastolic blood pressure response at orthostatic test was significant as well (P < 0.005). At hand grip test no significant changes in heart rate and blood pressure response were found. In control subjects only heart rate response at orthostatic test decreased significantly after 3 years. CONCLUSION: Our results show progression of an impairment of sympathetic and parasympathetic control of the cardiovascular functions in patients with PD over a period of 3 years.

The influence of the type, duration, severity and levodopa treatment of Parkinson's disease on cardiovascular autonomic responses.

The influence of the type, duration, severity and levodopa treatment of Parkinson's disease on autonomic involvement has been assessed. The Valsalva manoeuvre, deep breathing, handgrip and orthostatic tests were performed in 50 patients with Parkinson's disease and in a control group of 30 healthy subjects. No attempt was made to classify further patients with parkinsonian features into groups such as the Shy-Drager syndrome or multiple system atrophy. All test results were significantly smaller in patients than in healthy subjects. The diastolic pressure increase during handgrip was significantly smaller in akinetic-rigid than in tremor-akinetic-rigid type patients. The Valsalva ratio and orthostatic test results were significantly smaller in patients with longer duration than in those with shorter duration of disease. All test results except those of the orthostatic test were significantly smaller in patients with the more severe form than in those with the less severe form of disease. Comparing test results of levodopa-treated and -untreated patients no significant differences were found. Our studies in parkinsonian patients suggest that (1) sympathetic impairment is more pronounced in akinetic-rigid than in tremor-akinetic-rigid type patients; (2) sympathetic impairment occurs early, whereas parasympathetic impairment develops later; (3) sympathetic and parasympathetic impairment parallels the severity of disease; (4) orthostatic parameters are more duration-sensitive than severity-sensitive; (5) chronic levodopa treatment does not markedly influence cardiovascular autonomic responses.

Autonomic function testing in patients with tension-type headache.

Autonomic nervous system function was studied in 51 patients with tension-type headache. The Valsalva manoeuvre, deep breathing test, sustained handgrip test, orthostatic test and spectral analysis of heart rate variability in the supine and standing positions were performed in a group of 51 patients of both sexes aged 21 to 50 years and in an age-matched control group of 45 healthy volunteers. Diastolic blood pressure increase and particularly heart rate increase during sustained handgrip were significantly reduced in the headache group, when compared to the control group, while the results of the remaining tests did not significantly differ between the control and headache groups. No significant differences were found between the episodic (19 patients) and chronic (32 patients) tension-type headache subgroups. It is concluded that sympathetic function is impaired in tension-type headache patients.