The term short-term saccadic adaptation (STSA) captures our ability to unconsciously move the endpoint of a saccade to the final position of a visual target that has jumped to a new location during the saccade. STSA depends on the integrity of the cerebellar vermis. We tested the hypothesis that STSA reflects the working of a cerebellar mechanism needed to avoid 'fatigue', a gradual drop in saccade amplitude during a long series of stereotypic saccades. To this end we compared the kinematics of saccades of 14 patients suffering from different forms of cerebellar disease with those of controls in two tests of STSA and a test of saccadic resilience. Controls showed an increase in saccade amplitude (SA) for outward adaptation, prompted by outward target shifts, due to an increase in saccade duration (SD) in the face of constant peak velocity (PV). The decrease in SA due to inward adaptation was, contrariwise, accompanied by a drop in PV and SD. Whereas patients with intact vermis did not differ from controls, those with vermal pathology lacked outward adaptation: SD remained constant, as did SA and PV. In contrast, vermal patients demonstrated a significant decrease in SA, paralleled by a decrease in PV but mostly unaltered SD in the inward adaptation experiment as well as in the resilience test. These findings support the notion that inward adaptation is at least partially based on uncompensated fatigue. On the other hand, outward adaptation reflects an active mechanism for the compensation of fatigue, residing in the cerebellum.

Patients with glioma present with complex palliative care needs throughout their disease trajectory. The life-limiting nature of gliomas and the presence of specific symptoms related to neurological deterioration necessitate an appropriate and early palliative care approach. The multidisciplinary palliative care task force of the European Association of Neuro-Oncology did a systematic review of the available scientific literature to formulate the best possible evidence-based recommendations for the palliative care of adult patients with glioma, with the aim to reduce symptom burden and improve the quality of life of patients and their caregivers, particularly in the end-of-life phase. When recommendations could not be made because of the scarcity of evidence, the task force either used evidence from studies of patients with systemic cancer or formulated expert opinion. Areas of palliative care that currently lack evidence and thus deserve attention for further research are fatigue, disorders of behaviour and mood, interventions for the needs of caregivers, and timing of advance care planning.

Cerebellar ataxic gait is characterized by unsteady movements and variable gait patterns. Previous studies have successfully identified pathological changes of balance-related gait parameters. However, it has been difficult to demonstrate deficits of joint coordination and the control of limb dynamics. This has motivated the hypothesis that cerebellar ataxic gait might be affected predominantly by balance impairments. We investigated the influences of different types of cerebellar dysfunction on the gait patterns of patients suffering from degenerative cerebellar disease (13 patients, five females, 50.4 +/- 14.4 years). Walking patterns were quantitatively analysed combining standard gait measures and novel measures for the characterization of the spatial and the temporal variability of intra-joint coordination patterns. The temporal variability of gait patterns was significantly correlated with a subscale of the clinical ataxia scale (ICARS) that rates deficits of the control of limb dynamics and intra-limb coordination for goal-directed movements. This suggests that common cerebellar mechanisms might be involved in coordination during voluntary limb control and ataxic gait. The tested standard gait parameters correlated predominantly with clinical measures for balance-related abnormalities. These results imply that ataxic gait is influenced by both balance-related impairments and deficits related to limb control and intra-limb coordination. Applying the same analysis to gait patterns from patients with peripheral vestibular failure (six patients, four females, 47.8 +/- 14.3 years) and Parkinson's disease (eight patients, two females, 60.7 +/- 10.6 years), we found comparable abnormalities in balance-related gait parameters and general gait variability, but significantly lower increases of temporal variability. This implies that increased temporal variability of intra-limb coordination is a specific characteristic of cerebellar dysfunction, which does not arise for other movement disorders that also cause balance deficits and increased gait variability.

Background: The needs of patients feeling severely affected by multiple sclerosis (MS) have rarely been investigated. However this is essential information to know before care can be improved, including adding palliative care (PC) services where helpful. Since it remains unclear at what point specialized palliative care should begin for this patient group, this study focuses on needs in general. Objective: The objective was to explore the subjectively unmet needs of patients feeling severely affected by MS. Methods: The study used a qualitative cross-sectional approach for needs assessment. Fifteen patients selfreporting feeling severely affected by MS were recruited and interviewed using a combination of purposive and convenience sampling (five were accompanied by a caregiver relative). Interviews were recorded and transcribed verbatim, followed by qualitative content analysis. Results: Unmet needs were identified in the main categories ''support of family and friends,'' ''health care services,'' ''managing everyday life,'' and ''maintaining biographical continuity.'' Patients expressed the desire for more support from their families and to be viewed as distinct individuals. They see a substantial deficit in the physician-patient relationship and in the coordination of services. A decrease in expressed unmet needs was found for patients more severely affected and less socially integrated. Conclusions: To address the unmet needs of severely affected MS patients, health care services need to be improved and linked with existing PC services. Special attention is required to form supporting professionalpatient relationships. Multiprofessional services should be accessible for patients, while integrating relatives. All services should have an individual approach to provide needs-tailored support.

To determine the role of non-cancer palliative care in inpatient services in Germany, data from the Hospice and Palliative Care Evaluation (HOPE) were analysed. Since 1999, a three-month census has been conducted annually in German palliative care units. Pooled data from 2002-2005 were tested for differences between non-cancer patients (NCs) and cancer patients (Cs). A total of 4182 patients (NC: 3.5%; C: 96.5%) were documented; functional status (using Eastern Cooperative Oncology Group (ECOG) measures) in NCs was lower compared to Cs (p ¼ 0.009). NCs suffered more often from dyspnoea (40%; C: 29%; p ¼ 0.004), weakness (92,3%; C: 84,5%; p ¼ 0.011) and tiredness (75.4%; C: 66.7%; p ¼ 0.03) and less from nausea (17.1%; C: 28.9%; p ¼ 0.002), vomiting (8.2%; C: 19.4%; p ¼ 0.001) or loss of appetite (55.5%; C: 67.9%; p ¼ 0.002). There were no differences in pain and constipation. Other problems (nursing, psychological) were more frequent for NCs, in particular the need for support in the activities of daily life (90.3%; C: 72.8%; p < 0.001) and disorientation/confusion (32.1%; C: 17.2%; p < 0.001). There were no differences in social problems. NCs are still rare in specialized inpatient palliative care institutions in Germany. The palliative care needs in patients with nonmalignant disease will challenge the health care system as the workload for these services will grow over proportionally.

This study investigated the influence of spatial cueing (valid/invalid/no cue) on visual discrimination in human and non-human primates. We employed a spatial resolution task which required the accurate discrimination of the orientation of a Landolt "C" ring. The C appeared as single target in specific retinal locations while subjects maintained fixation of a central fixation point. The minimal discernable size of the "C" (=acuity threshold) was determined as a function of cue condition, retinal eccentricity (3 degrees -15 degrees ), and stimulus onset asynchrony (SOA) (200-1100 ms). For both species, we found consistent benefits from spatial cueing with differences in absolute thresholds ranging from 6% to 25%. These differences increased with retinal eccentricity and decreased with longer SOAs. Further experiments performed with humans only, showed that the effect of spatial cueing on visual discrimination is independent of spatial uncertainty, i.e. the number of possible target locations (2 versus 4), but fades with longer target presentation times. From our results we draw the following conclusions. (i) Since sensory noise and spatial uncertainty was small in our tasks, spatial shifts of attention involve signal enhancement in both, human and non-human primates. (ii) The similarity of the results obtained for humans and macaque monkeys indicates that the latter may serve as a suitable model system in studies trying to tackle the neural underpinnings of attentional control. (iii) In order to elicit robust effects on visual discrimination by spatial shifts of attention, a paradigm comprising short SOAs (approximately 200 ms) and target presentation times (approximately 150 ms), and retinal eccentricities larger than approximately 9 degrees seems most promising.

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Background: Research has only started recently to specifically concentrate on the group of patients severely affected by multiple sclerosis (MS). Aim: The aim of this study was to assess the perception on patients' unmet needs by healthcare professionals. Methods: Focus groups and expert interviews were recorded, transcribed verbatim and analysed by qualitative content analysis.