Optoelectronic movement analysis in Parkinson's disease: effect of selegiline on the disability in de novo parkinsonian patients--a pilot study.

New opto-electronic camera systems permit easy quantification of the motor performance during natural acts in freely moving humans. We used a simple test movement (PLM test) to quantify the disturbance in the postural (P), locomotor (L) and manual (M) part of the body movement and the coordination of the different movement phases into a smooth motor act. The test movement time was used to quantify the overall performance. With this technique we have measured the effects of selegiline on the degree of parkinsonism in a double-blind, placebo-controlled pilot study of 5 de novo patients with Parkinson's disease. There was a clear trend that selegiline was superior to placebo in reducing the test movement time.

The role of alertness in organic brain syndromes.

We examined 35 patients, aged from 37 to 76 years, with impairment of intellectual functions due to normotensive hydrocephalus of varied origin. Axial tomography showed an enlarged ventricular system, with or without cortical atrophy. As a rule, the patients having no cortical atrophy displayed a significantly lower alertness level than the patients with cortical atrophy, who were more alert. Because the clinical picture was similar in both subgroups, it was postulated that the impairment of cortical function due to organic lesions resulted in symptoms similar to those due to chronic decrease of alertness. According to this hypothesis, there are two types of symptoms in patients with organic brain syndromes, one type being dependent on the alertness decrease and not on the organic lesion itself. Although the two types cannot be easily distinguished during clinical examination, the prognosis is substantially different for "organic" and "functional" symptoms. The hypothesis was supported by observations in 19 patients selected for ventriculoperitoneal shunt operation. Reexamination 3 months after the operation showed that the improvement was not related to changes in the organic substrate, i.e., to the diminished size of the lateral ventricles and of the third ventricle. On the other hand, the clinical improvement was significantly correlated to the increase of the alertness level after treatment.

A population-based study on motor performance and white matter lesions in older women.

OBJECTIVE: To investigate the relationship between motor performance and white matter lesions (WMLs) on computed tomography (CT) of the brain in older women. DESIGN: Cross-sectional study. SETTING: Population-based study in Göteborg, Sweden. PARTICIPANTS: A total of 248 women aged 70, 74, and 78 years. MEASUREMENTS: Motor performance was measured by a Postural-Locomotion-Manual (PLM) test using an optoelectronic technique. WMLs on CT scans were rated as no, mild, moderate, or severe. RESULTS: White matter lesions were associated with impaired mobility of the lower extremities, that is, prolonged locomotion phase in the PLM test. This association was also present after controlling for age, hypertension, coronary heart disease, stroke, diabetes mellitus, chronic bronchitis, intermittent claudication, and smoking. CONCLUSIONS: Cerebral white matter lesions may contribute to motor impairments in older adults.

A population-based study on brain atrophy and motor performance in elderly women.

BACKGROUND: Brain atrophy is a common neuroimaging finding in healthy elderly individuals as well as in patients with movement-related disorders. The relationship between brain atrophy and motor changes has not been frequently reported. This study investigates this relationship. METHODS: A population-based sample of women (N = 238), aged 70, 74, and 78 years, living in Göteborg, Sweden, participated in this study. Motor performance was measured by a laboratory test, the Postural-Locomotion-Manual test, which precisely measures the subject's mobility of lower and upper extremities using an optoelectronic technique. Cortical and central atrophy were rated on computerized tomographic (CT) scans of the brain. RESULTS: In bivariate analysis, temporal lobe atrophy, high sylvian fissure ratio, and high bicaudate ratio were correlated with impaired mobility. The association between temporal lobe atrophy and high sylvian fissure ratio and poor mobility remained after controlling for age, smoking, coronary heart disease, diabetes mellitus, hypertension, and white matter lesions on CT scans. CONCLUSIONS: Our results suggest that temporal lobe atrophy, which is often seen on brain imaging in elderly persons, might be an important brain abnormality related to motor impairments in elderly women. Further studies to investigate this relationship and its underlying mechanisms are needed.

EEG abnormalities in dementia reflect the parietal lobe syndrome.

The aim of this study was to investigate to what extent the examination of regional syndromes can improve EEG diagnostics in dementia. The study was based on 77 patients, aged between 47 and 83 years, with a dementia disease in accordance with the DSM-III-R criteria. The clinical examination was refined using a so-called stepwise clinical status analysis to estimate the occurrence and intensity of the parietal lobe syndrome, the frontal lobe syndrome, the subcortical syndrome and the less-regionalised global syndrome. In the same time period, the patients were examined electroencephalographically and the recordings were assessed both visually and by means of spectrum analysis. It was found that the intensity of the parietal lobe syndrome was correlated more strongly to the EEG slow activity as compared to the other regional syndromes. Thus, it can be expected that the EEG will be most valuable in the early-onset type of Alzheimer's disease, in which the parietal syndrome is dominant, giving information regarding the degree of dementia and suggesting a possible interference with depression. The results of the study can probably explain some discrepancies between the EEG findings and the results of clinical examination in other forms of dementia.

Reduction of plasma homocysteine and serum methylmalonate concentrations in apparently healthy elderly subjects after treatment with folic acid, vitamin B12 and vitamin B6: a randomised trial.

OBJECTIVES: To investigate, in an elderly population: (1) the effects of oral B-vitamin therapy on P-tHcys, S-MMA and Hb/MCV, (2) the appropriate decision limit for 'high' metabolite concentrations and (3) the estimated prevalence of vitamin B(12)/folate deficiency on the basis of different decision limits. DESIGN: Double-blind placebo-controlled intervention study. SETTING: Outpatient clinic. SUBJECTS: A total of 209 community-dwelling subjects, median age 76 y (range 70-93) y. INTERVENTION: Four months of oral daily supplementation with 0.5 mg cyanocobalamin, 0.8 mg folic acid and 3 mg vitamin B(6). RESULTS: High P- tHcys was found in 64% of men and 45% of women, high S-MMA in 11% of both. Vitamin B(12) deficiency was observed in 7.2% and folate deficiency in 11% of all subjects. Health-related upper reference limits for the metabolites at the start were higher than the laboratory's upper reference limits. The latter were, however, similar to those of the vitamin replete group. There was a significant decrease in P-tHcys (P<0.001) and S-MMA (P=0.009) after 4 months of vitamin treatment. In a multivariate analysis, the P-Hcys change correlated positively with baseline P-tHcys and inversely with baseline P-folate and transferrin saturation (Fe/TIBC ratio). The S-MMA change correlated with baseline S-MMA and inversely with baseline vitamin B(12) and age. CONCLUSIONS: Suboptimal vitamin status is an important cause of elevated P-tHcys and S-MMA in apparently healthy elderly subjects. Oral B-vitamin therapy is an effective and convenient way to normalise P-tHcys and S-MMA.

EEG patterns in various subgroups of endogenous depression.

Twenty-three patients with major depressive disorders were examined clinically, biochemically and electroencephalographically before antidepressive treatment was initiated. EEG characteristics were related to clinical items and to a serotonin re-uptake indicator. The results suggested that at least three definable EEG patterns were associated with certain specific features of major depressive disorders. Thus, an EEG pattern characterized by increased beta activity was associated with the recurrent type of depression. Another EEG pattern, with signs of decreased alertness, was present in patients with insomnia, agitation and in those without depression in their families. A significant correlation was also found between the alertness indicator and the serotonin accumulation rate. The third type of EEG feature was represented by interhemispheric asymmetry in the EEG which could be seen in patients with high scores of anxiety. The results suggest that the EEG findings may be helpful in defining various subgroups of major depressive disorders.

Changes in intrafollicular pressure in the rat ovary by nitric oxide and by alteration of systemic blood pressure.

BACKGROUND: ovulation is associated with degradation of the follicular apex vasodilatation and increased permeability of ovarian vessels. These changes may maintain or increase intrafollicular pressure (IFP) at ovulation to cause rupture of the follicular wall. OBJECTIVE: to investigate the possible regulation of IFP during the ovulatory process. STUDY DESIGN: immature Sprague-Dawley rats were primed with pregnant mare serum gonadotrophin (PMSG; 10IU) and given hCG (10IU) 48h later. The ovary was exposed 48-60h after PMSG, micropipette inserted into the Graafian follicle and the IFP measured at three time periods: preovulatory (PO) 48h after PMSG; midovulatory (MO) 4-7h after hCG; late ovulatory (LO) 9-12h after hCG. The offset of the nitric oxide synthase (NOS) inhibitor L-arginine methyl ester (L-NAME), the alpha(1)-adrenoceptor agonist phenylephrine and the beta-adrenoceptor agonist isoprenaline were tested. RESULTS: phenylephrine given i.v. increased the systemic blood pressure, and significantly decreased the IFP in the LO phase (78% of pre-treatment value). Local administration of phenylephrine or isoprenaline (1ml of 1.5-15 microM) by superfusion over the ovary did not change the IFP. Local administration of L-NAME (1ml of 2 microM) significantly lowered (P<0.05) the IFP in the MO and LO phases, but was without effect in the PO phase. CONCLUSION: this study reveals that IFP regulation may be related to changes of the systemic blood pressure and that NO may be one local ovarian mediator in IFP regulation.

EEG changes measured by spectrum analysis under hyperbaric conditions.

The EEG activity was followed during simulated diving to 20 m depth. Altogether 49 EEG records of 5 min length were taken in 5 divers breathing compressed air in a close system. No significant changes of the EEG could be found during either compression or decompression if only conventional indicators, such as the amplitude of theta activity, were tested. However, a complex "normality ratio," based on multivariate analysis of a normal material, was capable of showing significant impairment of the brain activity during the decompression. The indicator has been designed to reflect the abnormality level rather than the short-lasting EEG changes, the latter being mostly dependent on the alertness fluctuations. The EEG changes associated with alertness fluctuations were assessed separately by means of a specific "alertness indicator" and a prominent alertness increase was found during both compression and decompression phases of the diving experiment.

[Quantitative EEG in depression (author's transl)]. / Intérêt de l'electroencéphalogramme quantitatif dans la dépression.

Evaluation of the treatment in clinical psychiatry is mostly based on the rating of mental symptoms prior and after treatment. There is an obvious need to supplement clinical observations by objective measurements. Based on EEG automatic analysis, three methods which appeared to be valuable in investigating patients with affective psychosis, are briefly reviewed. 1) The EEG drug profile, indicating changes of the EEG frequency pattern, which varies proportionally to the psychoactive properties of the drug and its metabolites. 2) The fluctuations of the vigilance level which monitor the sedative/excitatory effect of drugs. 3) The interhemispheral assymetry which is related to the intensity of depression.

[An incorrect diagnosis of an arterial injury]. / Mylná diagnostika tepenného poranení.

The authors give an account of the interesting clinical development of a primarily erroneously diagnosed and inadequately treated arterial injury caused by a splint. They emphasize the necessity of angiographic examination and truthful recording in the surgical protocol.