Deutsche Zeitschrift für Nervenheilkunde

In recent years, new neuroimaging techniques have revived interest in syringomyelia with respect to indications and results of surgery. Fifty patients, 36 of whom underwent surgery, have been reviewed. All patients but 3 underwent a new clinical assessment and 33 of them were also neurophysiologically investigated. In approximately one-third of the non-surgically treated patients the clinical course was benign. In 26 of the surgically treated patients an improvement was noted at the short-term assessment both for spasticity and pain, but in most of them it was not maintained in the medium term. Therefore, an accurate selection of the patients to be treated surgically is strongly recommended, particularly when the natural history of the disease is considered. Decompression of the posterior fossa seems to give the best results, yet no curative surgical treatment has been devised to date.

Restless legs syndrome (RLS) is a frequent sleep disorder with a prevalence of 5 % to 15 % in Caucasion populations. Dopaminergic treatment is known to reduce sensorimotor RLS symptoms and is approved for RLS, but not all patients ask for treatment. About 2 % to 3 % of patients presenting to a primary care physician require RLS-specific treatment. The overall treatment preference of RLS sufferers, however, is still unknown. The aim of this study was to assess the prevalence and treatment preference in patients with previously diagnosed and those with yet undiagnosed RLS in a population-based survey in Germany. Cross-sectional health survey with face-to-face interviews with 1312 participants in the Dortmund Health Study. RLS was assessed with standardized, validated questions addressing the four minimal diagnostic criteria for RLS defined by the International Restless Legs Syndrome Study Group. Participants were aged 25 to 75 years and were randomly selected from the city register. The overall prevalence of individuals with a known doctor diagnosis of RLS was 2.3 %. In addition, 6.5 % fulfilled the four minimal criteria but did not know about this diagnosis yielding an overall prevalence of 8.8 %. Prevalence was higher in women (10.2 %) and German descendents (9.2 %) compared to men (7.1 %) and migrants (6.7 %). Almost 60 % of all RLS cases reported symptoms at least once a week. 33.3 % of cases with a known RLS diagnosis and 14.1 % with an unknown diagnosis had an RLS treatment wish. The latter is determined by knowledge of the diagnosis, daily symptoms, diabetes and sleep disturbance. About every fourth RLS case knows about the diagnosis and overall every fifth RLS case wishes medication to effectively reduce symptoms, corresponding to 1.6 % of the whole study population.

Bei einem Krankengut von 407 Kindern und Erwachsenen mit eitriger Meningitis ist die relative Krampfhäufigkeit der Kinder signifikant größer. Es ergeben sich keine wesentlichen Unterschiede zwischen einzelnen Meningitisformen. Da Letalität und Hyperthermien als Kriterien für die Schwere der Erkrankungen keine Unterschiede in den untersuchten Altersstufen aufweisen, wird als Ursache der Häufung meningitischer Krämpfe im Kindesalter eine besondere Krampfbereitschaft derselben diskutiert und unter Bezugnahme auf Ergebnisse der elektrencephalographischen Forschung erörtert.

Giant cell arteritis, which is probably due to disturbed immune mechanisms, has a spectrum of clinical symptoms in elderly people. In nearly all cases such general signs as loss of appetite, loss of weight and fever are present. The sedimentation rate is almost without exception about 100 mm in the first hour. The two most frequent and typical clinical syndromes are polymyalgia rheumatica and cranial arteritis. The polymyalgia rheumatica is characterized by periarticular pain which is mostly symmetrical and accentuated in the shoulder girdle. Increasingly severe temporal headache and ocular disturbances are found with cranial arteritis in more than 50% of cases. A combination of both diseases is frequent. Other arterial branches are rarely involved. The course of the disease is over a period of 1 1/2 to 2 years. Treatment with corticosteroids is indicated mainly because of the severe ocular complications with blindness. It should begin immediately, be intensive and last over a long period. Regular followup is necessary over several years in order to avoid relapses.

Symptomatic attacks or seizures associated with cardiac arrhythmias may cause difficulty in differential diagnosis. Two patients are reported in whom disturbances of cardiac conduction induced attacks which clinically resembled attacks of psychogenic and epileptic origin and were abolished after implantation of a demand-type pacemaker. A third patient is described who had epileptic seizures resulting in cardiac arrhythmias. In the differential diagnosis of these cases, simultaneous ambulatory EEG and ECG recording was essential.

Freezing of gait (FOG) is considered one of the most disturbing and least understood symptoms in Parkinson’s disease (PD). The reported prevalence rates of FOG in PD vary widely, ranging from 5 to 85.9%. We conducted a systematic review and meta-analysis to provide a reliable estimate of the average point prevalence of FOG in PD, and we further investigated the study characteristics that might have influenced the estimate. We searched different databases to identify studies that report the prevalence of FOG in PD or include relevant raw data for further calculation. The last inclusion date was February 20, 2020. The modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was used for the quality assessment, and articles that met the predefined criteria were included in the quantitative analysis. Sixty-six studies were selected from 3392 references. A weighted prevalence of 50.6% in 9072 PD patients experienced FOG based on the special questionnaires (the FOG-Q and NFOG-Q), which was about twice as high as that assessed by the specific items of the clinical rating scales (UPDRS item2.14 and MDS-UPDRS item3.11) (23.2%) or simple clinical questions (25.4%). The weighted prevalence was 37.9% for early stage (≤ 5 years) and 64.6% for advanced stage (≥ 9 years). Moreover, a higher prevalence was calculated from the population-based studies than that in multicenter and single-center studies (47.3% vs. 33.5% and 37.1%, respectively). The result from this systematic review confirms that FOG is very common in PD and its prevalence is usually underestimated in hospital settings. Importantly, a more accurate assessment of FOG in future clinical researches would involve the use of special FOG scale rather than a single item on a scale or a general clinical inquiry.

An 36 Kaninchen wurden Untersuchungen über die Veränderungen der hirnelektrischen Lichtreizbeantwortung nach umschriebener substantieller Hirnverletzung ausgeführt und folgende Ergebnisse gewonnen: Die Ergebnisse machen wahrscheinlich, daß örtliche Zirkulationsstörungen keine wesentliche Bedeutung für das Zustandekommen der posttraumatischen Latenzverkürzung haben. Auch die Aktivierung hirnelektrischer Phänomene durch Phenothiazine und Barbiturate bleibt darauf ohne Einfluß. Die Verstärkung und Verlängerung der posttraumatischen Latenzverkürzung unter Novocain kann möglicherweise für eine zentralerregende Wirkung dieses Medikaments sprechen.