Atypical parkinsonian syndromes (APS) such as multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration are characterized by poor response to antiparkinsonian medication and rapid clinical deterioration. We used SPECT and [123I]beta-CIT as a label of dopamine transporters to study the progression of presynaptic dopaminergic degeneration in Parkinson's disease (PD) and APS. Twenty-four PD patients with short disease duration (2.4 +/- 1.5 years), 12 PD patients with long disease duration (9.2 +/- 2.6 years), 10 patients with APS (disease duration 2.1 +/- 1.5 years), and nine patients with essential tremor (ET) underwent sequential [123I]beta-CIT SPECT imaging with an interval of 25.5 +/- 10.3 (13-63) months. The age-related decline of striatal beta-CIT binding was studied cross-sectionally in 30 healthy subjects. The ratio of striatum/cerebellum -1 at 20 hours after tracer injection, reflecting specific-to-nondisplaceable binding, was used as the primary SPECT outcome measure. At scan 1, striatal beta-CIT binding was reduced in PD patients with short disease duration (-42% compared with age-corrected normal values) and long disease duration (-51%), and APS (-36%), but normal in ET. During the observation period striatal beta-CIT binding significantly declined in patients with APS (14.9% per year) and short duration PD (7.1% per year), whereas PD patients with long disease duration and patients with ET showed no significant change of striatal beta-CIT binding between scans 1 and 2. The relative annual reduction from age-corrected normal values at the time of scan 1 was significantly higher in patients with APS than in PD patients with short disease duration (9.6 vs. 4.3%, P = 0.004). These results demonstrate a rapid decline of striatal beta-CIT binding in patients with atypical parkinsonian syndromes, exceeding the reduction in PD. The dopaminergic degeneration in PD appears to slow down during the course of the disease. SPECT with [123I]beta-CIT is a sensitive marker of disease progression in parkinsonian disorders.

Complaints about a bad quality of sleep could be used as a screening method in the exploration of patients' quality of life (QoL).

A group of young patients with insulin-dependent diabetes mellitus (n = 14; 8 men, 6 women; 33.1 ± 8.9 years) were examined by topographic EEG mapping under normoglycemic and hypoglycemic conditions (glucose levels after intravenous insulin injection down to 32.6 ± 7.6 mg/dl). From the clinical aspect, 7 of them had a good and 7 had a poor awareness of hypoglycemia. During hypoglycemia, a decrease in alpha activity (p < 0.05), an increase in delta (p < 0.05), and especially in theta activity (p < 0.05) were found. The most sensitive parameter was the alpha/theta ratio. In the range of slight hypoglycemia (50-60 mg/dl) the increase in delta and theta activity showed a topographic maximum in lateral frontal regions. During deep hypoglycemia there was a topographic maximum of slow frequencies in posterior parts of the brain (centrotemporal to parieto-occipital regions). The differences between the group with good and with poor awareness of hypoglycemia were most pronounced during slight hypoglycemia in C3, C4, and Pz (p < 0.05). At lower glucose levels group distinction was no longer possible. These EEG changes correspond to a temporary organic brain syndrome.

No abstract

No abstract

No abstract

Serum lipids were determined in 97 patients (56 men, 41 women; ages 42 +/- 15 years) undergoing long-term anticonvulsive treatment (longer than 6 months). The total group showed increased total cholesterol, decreased high-density lipoprotein HDL cholesterol, an increased ratio of total to HDL cholesterol, and decreased apolipoprotein A1 and B values compared to population means. Considering males and females separately, all differences were significant (P < 0.01) in men, whereas in women only the differences in HDL cholesterol, ratio of total to HDL cholesterol, and apolipoproteins A1 and B reached the level of statistical significance. Considering the different anticonvulsant groups, cholesterol was significantly increased only in phenytoin-treated males; HDL cholesterol was significantly lowered and the ratio of total to HDL cholesterol significantly increased in all groups. Apolipoprotein A1 levels were significantly decreased in phenytoin-treated females and valproate-treated patients of both sexes. Apolipoprotein B levels were significantly decreased in all groups except carbamazepine-treated males. Especially in men treated with anticonvulsants these lipid levels may be considered a risk factor for atherosclerosis.

Multiple Sclerosis Society Task Force. 2 The MSFC is increasingly being applied as outcome measure in MS clinical trials, even though so far no study has addressed the issue of what represents a meaningful change in the score. Schwid et al. 3 showed that a 20% change in both the T25WT and the 9HPT can be considered significant (i.e., indicates a true change). Elaborating on that finding, we investigated what impact a 20% change in each of these tests has on the MSFC. Therefore, we calculated the change in MSFC score induced by 20% improvement or worsening on the T25WT and then the 9HPT while leaving the scores for the other MSFC tests unchanged. For the calculation of the Z-scores and the MSFC, we used the reference values of the Task Force. 3 For reasons of comparability, we used the baseline values of the TWT and 9HPT that were used in the figure by Schwid et al. 1 Moreover, this range of values represents what is most commonly encountered in clinical practice.The figure shows that over almost the whole range of baseline values, as compared with the 9HPT, the same relative deterioration (20%) in absolute value of the T25WT has far less impact on the overall MSFC score. To give just one example: whereas a 20% worsening of the 9HPT from close to normal baseline values (left side of the figure) results in a MSFC change of approximately 0.3, the same 20% worsening in that range of the T25WT results in a MSFC change of only 0.06. In addition, it can be seen that, in contrast to the situation with regard to the T25WT, a 20% improvement in absolute 9HPT value results in a larger absolute change in MSFC score than a 20% worsening. These phenomena are due to the mathematical background of the MSFC as well as the relative difference in standard deviation of the T25WT vs the 9HPT. The message we want to convey with this letter is that even though Schwid and colleagues 1 have now established that for two of the three quantitative functional tests that determine the MSFC a 20% change can be considered to reflect a real difference, it still is not at all clear what represents a reliable change in the overall MSFC score. Defining how changes in MSFC scores should be interpreted and what represents a meaningful change in MSFC still remains a major challenge that has to be addressed in future studies. Reply from the Authors:We appreciate the comments of Uitdehaag et al., and agree with their interest in applying our results to improve interpretation of the MS Functional Composite (MSFC). We fully support the decision by the National MS Society Clinical Outcomes Assessment Task Force to move from the ordinal measures traditionally used to assess impairment/disability in MS clinical trials toward quantitative functional tests. 4 We and others have demonstrated that quantitative tests such as the timed 25feet walk (T25FW) and 9-hole peg test (9HPT) provide more detailed information about impairment/disability than ordinal scales, potentially conferring superior sensitivity to changes in function. As with any continuous scale, ...