Orthostatic tremor (OT) is a disabling movement disorder associated with postural and gait impairment in the elderly. Medical therapy often yields insufficient benefit. We report the clinical and electrophysiological data on two patients with medication-refractory OT treated with deep brain stimulation of the ventral intermediate thalamic nucleus (Vim DBS). Patient 1 underwent bilateral deep brain stimulation (DBS) and Patient 2 unilateral Vim DBS following 28 and 30 years of disease duration, respectively. Both patients showed increased latency to symptom onset after rising from a seated position, improved tolerance for prolonged standing, and slower crescendo of tremor severity when remaining upright. Postoperative evaluation demonstrated decreased amplitude of electromyographic activity with persistence of well-defined oscillatory behavior showing strong coherence at 15 Hz between all muscles tested in the upper and lower limbs. Postural sway was unchanged. Clinical benefits have been sustained for over 18 months in Patient 1, and receded after 3 months in Patient 2. These findings support the consideration of bilateral Vim DBS implantation as a therapeutic option in patients with medically refractory OT. Further efficacy studies on chronic stimulation to disrupt the abnormal oscillatory activity in this disorder are warranted.
Ventriculoperitoneal shunt placement superseded tighter control of vascular risk factors, as judged by the patient's response to continuous lumbar drainage.
Classified independently 150 neuropsychiatric referrals into Definite (DBD), Suspected (SDB) or NO Brain Damage (NDB) groups on the basis of non‐neuropsychological evaluative data. Each S was examined with a brief, 2‐hour neuropsychologic screening battery, and the test data were analyzed by a stepwise linear discriminant function program. Statistical classifications were compared with criteria for NBD vs. SBD + DBD and for SBD vs. DBD groupings. Hit rates ranged from 95% for the former to 81.7% for the latter, with low false positives and negatives. Hit and miss rates were not as strong in a validation step, but exceeded chance levels.
This paper reviews the research literature on MMPI assessment of functional versus organic low back pain (LBP). Research is described in three categories: (a) the relationship between psychopathology as measured by the MMPI and low back pain, (b) MMPI speciality scales, and (c) surgical outcomes. Research, to date, has suffered from methodological problems which has limited generalizations to clinical population. It is suggested, however, that the MMPI can be effectively used with LBP patients, but should not be the only data used in such assessments. Cautions are noted regarding use of the speciality scales.
These results seem to indicate that Jastak's AQ measure adds little prognostic value to measures of I&. 4. J.\STAIC, J. A rigorous criterion of feeblemindedness.
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