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Background: Among the current proposals for the upcoming reform of forensic addiction treatment according to Sect. 64 of the German Criminal Code (StGB), that of the DGPPN stands out as the most far-reaching. Among other things, it calls for making the ordering of the measure dependent on the consent of the defendant and the regular and voluntary demonstration of the willingness to undergo treatment. Prior to treatment in a forensic addiction facility, those affected should reliably participate in addiction-specific treatment offers in the prison setting.

Aims: A critical reflection on the key assumptions and implications of this reform proposal with respect to treatment motivation and the right or ability to self-determination.

Material and methods: These assumptions are analyzed and discussed from psychiatric, medical-ethical and legal-normative perspectives.

Results and discussion: Neither the setting nor the resources of a prison seem to make it a suitable place for the motivationally critical phases of (probationary) addiction treatment. The approach that only those who have previously demonstrated therapy motivation in word and deed should have the "advantage" of forensic withdrawal therapy, would not do justice to the complexity of substance use disorders and would lead to an overestimation of the already elusive concept of therapy motivation in the context of this disorder. Also, from an ethical perspective, self-determination in forensic addiction patients appears too understudied, both conceptually and empirically, to justify such a far-reaching approach. On a normative level, the new approach would remove an effective special prevention instrument from the hand and create an imbalance in the structure of sanctions.

From shell shock tremors to TikTok tics, functional movement disorders have long been assumed to be motor expressions of emotional turmoil. However, psychodynamic explanations are increasingly complemented by neurophysiological findings, meaning that specialized physiotherapy is gaining in importance alongside psychotherapy. Still, there is no disease-specific outcome measure that adequately assesses patient-relevant aspects of this heterogeneous condition. Such a questionnaire was developed and its content was validated in a multistage development process. The relevance and comprehensibility of the items were first evaluated by a panel of experts and then by affected patients, and questions and possible response categories were adjusted accordingly. The resultant revised questionnaire yields good content-related validity and thus allows, for the first time, a quantification of the subjective complaints and implications associated with functional movement disorders. The next step will be a multicenter study to analyze the psychometric properties and factorial structure of this new instrument.

Catechol O‑methyltransferase (COMT) inhibitors have been established in the treatment of Parkinson's disease for more than 20 years. They are considered the medication of choice for treating motor fluctuations. The available COMT inhibitors, entacapone, opicapone and tolcapone, differ pharmacokinetically in terms of their half-lives with implications for the dose frequency, in their indication requirements and in their spectrum of side effects, including diarrhea and yellow discoloration of urine. Many patients with motor fluctuations are currently not treated with COMT inhibitors and are, therefore, unlikely to receive individually optimized drug treatment. This manuscript summarizes the results of a working group including several Parkinson's disease experts, in which the value of COMT inhibitors was critically discussed.

Some 90 years after the beginning of the Nazi regime, the German Neurological Society (DGN) commissioned an investigation into the extent to which persecution, expulsion and extermination during the "Third Reich" also affected neurologists. In total, the biographies of 61 mostly Jewish physicians and scientists, of whom more than 70% were members of the neurological association of the time, could be analyzed. Most of them emigrated, a few remained in Germany or Austria despite persecution, and nine died in the Holocaust or by suicide. The racistically motivated expulsion affected all age groups, especially those who were 30-60 years old in "middle" positions. In close connection with Nazi legislation, three waves of emigration can be distinguished (1933-1934, 1935-1937, 1938-1939) and the clearly preferred destination country was the USA (64.7%). Younger age, knowledge of a universal language, reliable family and academic connections as well as internationally recognized publications, could make it easier to start a career in the country of exile. It was not uncommon for those who were involved in neurological fields before emigration to turn to basic science or psychiatry afterwards. The general "brain-drain"/"brain gain" hypothesis must be expanded by analyses on the biographical microlevel in order to illustrate the difficulties emigrants encountered when trying to start a new career and to publicize a sometimes unsuccessful acculturation. Not a single neurologist returned to Germany and, as far as can be assessed, any compensation, if at all was low. The critical assessment of the racistically motivated persecution between 1933 and 1945 can today be an occasion for the DGN and its members to reflect on collegiality as a value as well as to become more aware of structurally related discrimination and injustice and to counteract it in a timely manner.

With the implementation of the Law for the Restoration of the Professional Civil Service (1933), including the Third Implementation Decree (1934), the Regulation for Obtaining a Teaching License (1934) and the Law for the Dismissal and Transfer of University Teachers (1935), the National Socialist (NS) government created legislative instruments to ban university staff (from lecturers to full professors) labelled as Jewish or considered politically unwanted from teaching and research. Whereas around 20% of the staff at the universities were affected by these measures after 1933, at various medical faculties the figures reached 30-40% and at neurological departments and institutes sometimes up to 90%. Student Nazi activists played a significant role in expelling faculty members from office. As beneficiaries of the expulsions, young doctors often improved their career prospects and established professors remained silent out of political conviction, opportunism or fear. A (self) coordination (Gleichschaltung) with immediate or gradual exclusion of "non-Aryan" members and boards is documented for numerous medical organizations and associations (e.g. Deutscher Ärztevereinsbund, Hartmannbund, German Medical Women's Association, Association of Statutory Health Insurance Physicians) as well as for scientific academies (e.g. Leopoldina) and research societies (Kaiser Wilhelm Institutes, German Research Foundation). The NS-loyal Society of German Neurologists and Psychiatrists, which had been founded in 1935, tolerated "Jewish" members until 1938. As a whole, the picture that emerged from everyday medical (and neurological) practice is one of drastic changes that massively affected not only the lives of many doctors but also the moral standards in terms of patient care, teaching, research and collegiality.

In order to provide a deeper understanding of the mechanisms and background leading to the persecution and expulsion, particularly of physicians labelled as "Jewish" in Nazi Germany, this article outlines their gradual disenfranchisement, through laws and decrees in the years 1933-1939. As the publicly visible terror immediately after the Nazi takeover was rejected in large parts of society, the regime resorted early on to supposedly legal forms of exclusion. With the Law for the Restoration of the Professional Civil Service of 7 April 1933, "non-Aryan" (§ 3) and politically unreliable (§ 4) persons could be removed from office, if necessary, even without any further comment (§ 6). However, regulations for long-standing civil servants as well as the "front-line fighter privilege" reduced the desired effect, e.g. in university medicine in a way that was not intended by those in power. The Reich Citizenship Law of 1935, as part of the so-called Nuremberg Laws introduced the criterion of "German blood". This resulted in a second large wave of dismissals. Outside the universities, a plethora of further defamatory legal norms, from the regulation on the approval of physicians for activities with the health insurances and the Law on Honorary Appointments (both in 1933), the so-called Flag Decree (1937) and withdrawal of the approbation (1938), aimed at the gradual "elimination" of Jewish physicians, which for many of them ended in extermination in the Holocaust. This practice implemented over years was based on a jurisdiction devised especially for that purpose and in hindsight it has been perfectly defined as "legal injustice".

In the 1920s, the situation of neuropsychiatry in Frankfurt was characterized by the rivalry between two institutions (Edinger Institute and University Neurology Clinic), two subdisciplines (neurology and psychiatry), and the physicians Kurt Goldstein (1878-1965) and Karl Kleist (1879-1960). After the National Socialists' assumption of power, university neuropsychiatric institutions in Frankfurt showed the highest number of dismissed university teachers and personnel in the German Reich. In neurology and psychiatry alone the university lost almost 50% of the personnel. Among those persecuted on racist grounds was Leo Alexander (1905-1985), who carried out genetic studies before 1933, prepared the "Alexander Reports" on behalf of the Allies after the Second World War, and was one of the prosecution counselors in the Nuremberg Doctors' Trial. His colleague Walther Riese (1890-1976) fled via France also to the USA and dedicated himself to the historical and ethical principles of neurology. Alice Rosenstein (1898-1991) was the first woman to specialize in neuroradiology and neurosurgery. In contrast to her male colleagues who were also dismissed in 1933, she committed herself to psychiatry after her arrival in North America and belonged to the early campaigners for the rights of homosexuals. Ernst (1905-1965) and Berta (1906-1995) Scharrer finally left Germany because of the prevailing political climate in the country. They excelled as co-founders of neuroendocrinology and neuroimmunology on the other side of the Atlantic.

Austria's so-called annexation (Anschluss) to Germany from March 1938 was followed by the ousting of "Jewish" doctors out of Vienna which happened faster and with more brutality than in the "Old Reich". According to National Socialist (NS) criteria, 92% of the neurologists at Vienna University were understood as being "non-Aryan". Victims of these expulsions were prominent figures, such as the head of the Neurological Institute Otto Marburg (1874-1949), a renowned multiple sclerosis researcher, and his pupil Ern(e)st Spiegel (1895-1985), a pioneer of stereotaxis. Similar to Berlin, nonuniversity departments of neurology were run by doctors who served as professors at the university, e.g., Josef Gerstmann (1878-1967) and his assistant Ilya Mark Scheinker (1902-1954). While these four continued their careers in the USA, the founder of neuroradiology Arthur Schüller (1874-1957) was able to flee to Australia. Hans Hoff (1897-1969) was part of the small group of returning emigrants, who in 1950 was appointed as the chair of psychiatry and neurology. The fate of the neurologists Ernst Sträussler (1872-1959) and Erwin Stransky (1877-1962) appears to be exceptional: both were dismissed and banned from teaching and practicing, but being married to "Aryan" wives spared them further persecution. Overall, within a short period of time neurology in Vienna lost a large number of its highly respected clinicians and researchers. Some of them refined their ideas and innovations abroad after 1945.

In Hamburg, the National Socialists' racially motivated exclusion principally hit neurologists from two institutions: the Eppendorf Neurological Clinic (director until 1934 Max Nonne) and the Psychiatric and Neurological Clinic of Friedrichsberg State Hospital (director Wilhelm Weygandt). The chief physician of the neurological department of Barmbek Hospital, Heinrich Embden (1871-1941), who had been trained by Nonne, emigrated to Brazil, whereas Friedrich Wohlwill (1881-1958), another Nonne pupil who had been a pathologist at St Georg since 1924, lived for many years in Lisbon, before he found a new scientific home at the Harvard Medical School. The cerebrospinal fluid researcher Victor Kafka (1881-1955), a Freemason and intermittent member of the Communist Party, was briefly in so-called protective custody (Schutzhaft) in Fuhlsbüttel then fled via Norway to Sweden. Hermann Josephy (1887-1960) and Walter R. Kirschbaum (1894-1982), both imprisoned in the Sachsenhausen concentration camp after the November pogroms in 1938, could successfully continue their professional careers in Chicago. Richard Loewenberg (1898-1954) first opted to continue his career in China, then changed his mind and also went to the USA after the Japanese invasion. With the exception of the latter all were full members of the Society of German Neurologists. The broad scope of their research work clearly illustrates that in addition to clinical core competence, former neurologists could intensively follow scientific interests in the neighboring disciplines of pathology, serology, and psychiatry.

Myalgia describes pain in the skeletal muscles. According to the current German clinical guidelines from 2020 (AWMF register number: 030/051), the initial diagnostic assessment consists of the anamnesis, clinical examination, electrophysiological examination and standard laboratory tests. Additional special examinations, such as molecular genetic investigations, special laboratory tests, medical imaging and muscle biopsy are only needed in certain cases. This article focuses on rare neurological diseases that are classically associated with myalgia. In this context etiologically different diseases are considered, whereby some genetically linked diseases (fascioscapulohumeral dystrophy, FSHD, dystrophia myotonica, McArdle's disease, Pompe's disease, limb girdle muscular dystrophy) are contrasted with diseases with an (auto)immune-related pathogenesis (stiff-person syndrome, Isaacs syndrome). The aspects relevant for the diagnosis are particularly highlighted. The therapeutic aspects of the diseases are not part of this article.