In the past, stereotactic surgery was a regular treatment for prominent unilateral tremor in Parkinson's disease (PD), but follow-up studies were usually short-term and always unblinded. We examined 17 PD patients in long-term follow-up (mean, 10.9 years after surgery) and used videotapes and the Unified Parkinson's Disease Rating Scale to blindly compare tremor ipsilateral and contralateral to the side of surgery. Since the patients were specifically selected for stereotactic surgery because of asymmetric tremor, and the surgical side chosen was contralateral to the predominant tremor, a sign of long-term efficacy would be current postoperative reversal of tremor side predominance. Upper extremity tremor was significantly better contralateral to the surgery compared with the ipsilateral side. We conclude that stereotactic surgery improved the absolute magnitude of tremor or ameliorated its rate of progression. Since asymmetric bradykinesia and dyskinesia were not a prerequisite for the choice of surgical side, we cannot make any conclusion about long-term impact of surgery on these features.
Zum Zwecke eines statistischen Oberblicks über die klinischen Daten des lumbalen Bandscheibenvorfalls haben wir die Fälle, die im Laufe eines Jahres vom 1. 1. 1963 bis 31. 12. 1963 an der Neurochirurgischen Universitätsklinik Köln operativ behandelt wurden, zusammengestellt.Es handelt sich um 144 Patienten, 84 Männer und 60 Frauen. In 72 Fällen war der Vorfall links, in 56 rechts und in 16 Fällen medial gelegen. Von den 144 Bandscheibenvorfällen fanden sich der Häufigkeit nach 70 in Höhe L 4/5, 64 in Höhe L 5/5 1, 9 in Höhe L 3/4 und 1 in Höhe L 2/3 (Abb. 1).Weitaus am häufigsten werden durch Bandscheibenvorfall bedingte Wurzelkompressionssyndrome im Lumbalbereich angetroffen, die im Initialstadium noch keine segmentale Symptomatik aufzuweisen brauchen. Gegenüber den zervikalen wurden sie nach Angaben des Schrifttums hier in einer Häufigkeit von etwa 95% angetroffen. übereinstimmend sind auch die Angaben, daß die beiden letzten Lendenbandscheiben am häufigsten betroffen sind. Ober 90% aller operativ bestätigten Bandscheibenvorfälle finden sich in dieser Höhe (DANDY 1943, BRADFORD 1950, UNANDERSCHARIN 1951, AITKEN 1952, PENZHOLZ 1956.Heruntergeladen von: Universite Laval. Urheberrechtlich geschützt.
Epidural electrical stimulation of the spinal cord by means of percutaneously implanted electrodes was successfully used in cases of traumatic paraplegia with chronic pain, more particularly if vegetative components predominated. Out of seven patients treated in our clinic six reported a good or very good outcome of the stimulation over follow-up periods up to six years. On account of the good effect on chronic pain the use of this stimulation procedure is indicated and justified before considering any destructive operative measures.
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