Romanian journal of neurology and psychiatry = Revue roumaine de neurologie et psychiatrie最新文献

The aim of the present study was to investigate the role of amino acids in the increased seizure susceptibility induced by withdrawal of antiepileptic drugs (AEDs). Fifty white Wistar rats treated with AEDs and 30 controls were used. The animals were previously exposed to the acoustic stimulus and only the non responsive were used. The administered AEDs were morphosuximide, ethosuximide, phenobarbital, valproate and gluthetimide. The treatment was discontinued after 2 weeks. The acoustic stimulation was repeated after 2-4 days of abstention. The animals were sacrificed and the amino acids glutamate, aspartate, GABA, glycine and serine were determined in the cortex and the brain stem. The withdrawal of AEDs induced seizure susceptibility in 71% of the rats treated with phenobarbital and in 76% of those receiving morphosuximide. A significant increase of glutamate levels was found in the brain stem following withdrawal of both morphosuximide and ethosuximide. The level of GABA was elevated in the brain stem after valproate and morphosuximide withdrawal. The increase of glutamate concentration can be correlated with the increased seizure susceptibility. The unexpected rise of the GABA level could be interpreted as a compensatory inhibitory mechanism.

This study carried out clinical, electrophysiological and morphological investigations (sural nerve and gastrocnemius muscle biopsies) in a group of 47 patients with neuromuscular disease of a certain or supposed degenerative origin and a late onset (over the age of 30 yrs.). It aimed the evidence of the eventual particularities of such diseases with a delayed onset. The equal involvement of sexes, the insidious onset, the clinical picture similar to that of the corresponding diseases with an onset at the usual age were observed. Regardless of the age, some interesting associations of the polyneuropathy with other diseases or its presence with in these diseases (Parkinsonism, Addison's disease, multiple symmetrical lipomatosis, etc.) were noticed, too. Electrophysiological examinations showed no particularities. Neither did the muscular morphological picture in most of the cases presenting neurogenic lesions with a moderate intensity. The sural nerve biopsy evidenced in 70% of the cases a moderately intense neuropathy of an axonal type ("dying back"), with or without secondary lesions of segmental demyelination and with the signs of a live regenerative activity.

Intraorbital metastases are rare. Tumors that metastasize more frequently in the orbit are: tumors of the breast, thyroid, prostate, spinocellular epithelioma, urinary bladder and Ewing sarcoma with an orbital location. The dominant feature of intraorbital metastases is exophthalmos. Ten cases of intraorbital metastasis are presented, histopathologically confirmed following operation. There are also 3 cases with intraorbital metastases histopathologically nonconfirmed during operation but which were included in a metastatic syndrome.

Catecholamine (CA) response to exercise was studied in patients with common (16 cases) or classic (7 cases) migraine as well as in subjects with lumbar disc disease (20 control cases). In migrainous patients exercise induced constantly a rise in epinephrine (E) urinary excretion and a depression in norepinephrine (NE) excretion; the post-exercise E excretion represented the double or the treble of basal E excretion. In controls the pattern of CA response to exercise was opposite to that noted in migraineurs: the exercise induced in almost all controls an augmentation in NE excretion and a depression in E excretion. The pattern of CA response to exercise of migrainous patients is similar to that noted in them after light exposure. As such patients responded by an E discharge to both exercise and light exposure, two conditions preceding quite often the onset of migraine attack, the data suggest the participation of this biochemical abnormality in the pathogeny of migraine. The interpretation is also supported by our previous data demonstrating that the antimigraine drugs are able to prevent the E discharge induced in migrainous patients by light exposure.

The velocimetric complexes of vertebral arteries were studied following up 4 parameters of the frequency spectrum: peak of systolic velocity-PSV; end systolic velocity-ESV; mean diastolic velocity MDV; end diastolic velocity EDV. According to this study, it seems that MDV related to PSV is more indicated than EDV to appreciate cerebrovascular resistance. The increase of MDV related to the systolic velocity is more constant and ample from segment V1 to segment V3, compared with the increase of EDV. Thus, to appreciate circulatory resistance at downgrade, instead of Pourcelot value, there can be used the relation MDV/PSV or their difference related to PSV because MDV follows the variations PSV more exactly than EDV.

The sensory symptoms and the involvement of the sensory tracts in amyotrophic lateral sclerosis (ALS) were much debated by various authors. The SEPs were studied in 10 patients with ALS by percutaneous stimulation of the median and tibial nerves. The SEPs were recorded at: Erb's point, cervical level (CII), lumbar level (L1) and parietal level. The peripheral sensory and motor nerve conduction were normal, excluding the spondylotic origin of altered SEPs found in these patients. There were 9 patients with abnormal parietal SEPs to the tibial nerve stimulation, usually bilateral. Abnormal cervical potential (N13) to the median stimulation was noted in 7 cases of whom 3 had also abnormal parietal SEPs. The most severe abnormalities were obtained in the 5 patients with fast advancing ALS and notably to the tibial nerve stimulation. Our results confirm the findings of other authors and reflect physiological dysfunction in the sensory system in a disease considered so far as restricted to the motor system.

We studied a family with nine of twenty members affected with Charcot-Marie-Tooth disease type 1A (CMT1A). The proband and her four affected sibs showed no duplication of the 17p11.2-17p12 (CMT region). Two of the proband's affected daughters three affected grandchildren showed duplication of the PMB-22 gene and of the marker VAW409R3 but not of the markers VAW412B3 and EW401. Pulsed field gel electrophoresis (PFGE) revealed a 220 kb SacII fragment in one CMTIA patient with duplication instead of a 500 kb SacII fragment as previously reported. Our findings suggest a smaller size of the duplication in this CMT1A family. The disease segregates with the same haplotype in both duplicated and nonduplicated CMT1A patients. The clinical phenotype showed more severe weakness with earlier onset and motor nerve conduction velocities were characterized by more significant slowing in the patients with duplication than in the patients who did not show duplication.

The compensatory role of the contralateral hemisphere in patients with unilateral hemispheric lesions was investigated by a test consisting of learning a maze explored with the index finger commanded by the normal hemisphere. In patients with lesions of the left hemisphere training of the left hand was followed by a better performance of the right hand demonstrating an interhemispheric transfer. The inactivation of the nondominant hemisphere by intracarotid amobarbital injection in aphasic patients is followed by worsening of the verbal performance. This demonstrates the possible compensatory role of the nondominant hemisphere in patients with aphasia. The results are considered to be manifestations of the functional plasticity of the brain.