Tauopathien – eine neue Kategorie degenerativer HirnerkrankungenLeserbrief zu Der Nervenarzt (2001) 72:78–85

Ohne Zusammenfassung     

Temporale Enzephalozelen – eine neue Ursache von Temporallappenepilepsien?

Clinical Epileptology - Temporale Enzephalozelen sind bisher nur in wenigen Fällen als Ursache von symptomatischen Epilepsien beschrieben worden. Zunehmende Beschreibungen in Fallserien weisen...     

Myoklonus – eine Orientierungshilfe

The puzzling variety of myoclonus is a diagnostic and therapeutic challenge. Early in the diagnostic work-up of myoclonus, electrophysiologic investigations should clarify whether it is myoclonus or not, and whether there are topographic clues, clinical or electrophysiological, to the generating structure. Such clues would influence both the laboratory strategies or neuroimaging investigations aimed at the underlying disease and the selection of drugs to suppress myoclonus.     

Vorschlag für eine neue patientenorientierte Epilepsieklassifikation

The recent proposal by the ILAE Task Force for Epilepsy Classification is a multiaxial, syndrome-oriented approach. Epilepsy syndromes--at least as defined by the ILAE Task Force--group patients according to multiple, usually poorly defined parameters. As a result, these syndromes frequently show significant overlap and may change with patient age. We propose a five-dimensional and patient-oriented approach to epilepsy classification. This approach shifts away from syndrome orientation, using independent criteria in each of the five dimensions similarly to the diagnostic process in general neurology. The main dimensions of this new classification consist of (1) localizing the epileptogenic zone, (2) semiology of the seizure, (3) etiology, (4) seizure frequency, and (5) related medical conditions. These dimensions characterize all information necessary for patient management, are independent parameters, and include information more pertinent than the ILAE axes with regard to patient management. All cases can be classified according to this five-dimensional system, even at initial encounter when no detailed test results are available. Information from clinical tests such as MRI and EEG are translated into the best possible working hypothesis at the time of classification, allowing increased precision of the classification as additional information becomes available.     

Ueber eine neue Form hereditären Nervenleidens

Ohne Zusammenfassung     

Psychodrama und Neurobiologie – eine Begegnung

Psychodrama and Neurobiology – an EncounterThe knowledge about dynamic procedures in the brain has rapidly grown in the last years, particulary through the application of new research methods. Quite a number of publications address the influence of neurobiological findings on psychotherapy. Important results of neurobiological research like flexibility and adaptability of the brain (neuroplasticity and neurogenesis) are explained as well as some human genetic aspects of personal behaviour and finally the research on memory and its influence on psychotherapy. While doing so the central role of empathy for any social interaction is given a separate paragraph. Following up to this, the author poses the question of the neurobiological effects on psychotherapy. Finally, the author tries to appreciate the looming importance of these results for psychodrama in short.     

Entwicklungsneurologie – vernetzte Medizin und neue Perspektiven

Developmental neurology is one of the major areas of neuropediatrics and is among other things (legally) responsible for monitoring the motor, cognitive and psychosocial development of all infants using standardized monitoring investigations. The special focus is on infants born at risk and/or due to premature birth before 32 weeks of gestation or a birth weight less than 1500?g. Early diagnosis of deviations from normal, age-related development is a prerequisite for early interventions, which may positively influence development and the long-term biopsychosocial prognosis of the patients. This article illustrates the available methods in developmental neurology with a focus on recent developments. Particular attention is paid to the predictive value of general movements (GM). The current development of markerless automated detection of spontaneous movements using conventional depth imaging cameras is demonstrated. Differences in spontaneous movements in infants at the age of 12 weeks are illustrated and discussed exemplified by three patients (healthy versus genetic syndrome versus cerebral palsy).     

Epilepsie – neue Diagnostik,alte Medikamente?

Background

Recent advances in the field of epilepsy genetics have led to an increased fraction of patients with epilepsies where the etiology of the disease could be identified. Nevertheless, there is some criticism regarding the use of epilepsy genetics because in many cases the identification of a pathogenetic mutation does not lead to an adaptation of therapy or to an improved prognosis. In addition, the interpretation of genetic results might be complicated due to the considerable numbers of variants of unclear significance.

Objective

This publication presents the arguments in favour of a broad use of genetic investigations for children with epilepsies. Several diseases where a genetic diagnosis does in fact have direct therapeutic consequences are mentioned. In addition, the indirect impact of an established etiology, encompassing the avoidance of unnecessary diagnostic measures, possibility of genetic counselling, and the easing of the psychologic burden for the caregivers, should not be underestimated.

Conclusion

The arguments in favour of broad genetic diagnostics prevail notwithstanding the lack of relevant new developments regarding the therapy.

     

Geriatrie – eine interdisziplinäre Herausforderung

The care of elderly patients will continue to challenge the healthcare system over the next decades. As a rule geriatric patients suffer from multimorbidities with complex disease patterns, and the ability to cope with everyday life is severely reduced. Treatment is provided by a multiprofessional geriatric team, and the primary goal is improvement of functional status, quality of life in the social environment and autonomy by employing a holistic approach. In Germany geriatric care is provided by physicians from various medical specialties (e.g. general practitioners, internists, neurologists and psychiatrists). In the training for the subspecialty clinical geriatrics, these specialties enjoy equal rights. Recent efforts to establish a qualification as physician for internal medicine and geriatrics have initiated a discussion to make the suitability for qualification as a geriatrician dependent on the medical specialty. Geriatric patients benefit from multidisciplinary cooperation. Neurologists possess great expertise in the treatment of patients with dementia, depression, delirium, consequences of degenerative spinal cord diseases and vertebral bone fractures, stroke, Parkinson’s syndrome, epileptic seizures, vertigo and dizziness, neuropathies, lesions of peripheral nerves and in the multimodal therapy of pain. To function in a position of responsibility in a geriatric department, neurologists need skills in general internal medicine. These are acquired either on a geriatric ward or during specialization as a neurologist by full time secondment to large neurological or interdisciplinary intensive care units.     

Anna und das Pferd – eine Falldarstellung

Nonverbal-procedural interventions (Topel, Nonverbale Interaktionen im therapeutischen Prozess: Selbst- und interaktive Regulierung mit aggressiven Kindern und Jugendlichen. Feedback-Studie zur Qualitätssicherung in der Kinder- und Jugendlichenpsychotherapie. Unveröffentlichte Dissertation, Universität Ulm, 2004) and mutual, bidirectional ?embodiment“ (Leuzinger-Bohleber und Pfeifer, In: Embodiment, Vandenhoek & Ruprecht, Göttingen, 39–74, 2013) are shown in a psychoanalytic treatment of an eleven year old girl with enuresis with help of a model scene (Lichtenberg et al., Das Selbst und seine motivationalen Systeme, Brandes & Apsel, Frankfurt a. M., 2000). Repair in the attachment occurred in a mother-child-therapy, based on psychoanalytic self psychology (Kohut, The restoration of the self, International Universities Press, Madison, 1977), knowledge about empirical infant research (Psychoanal Study Child 6:7–46, 2005), mentalization (Allen und Fonagy, Handbook of mentalization-based treatment, Wiley, Chichester, 2006; Fonagy, http://www.youtube.com, 2013; Holmes, Sichere Bindung und psychodynamische Therapie, Klett Cotta, Stuttgart, 2012; Verheugt-Pleiter et al., In: Mentalizing in child therapy. Karnac, London, 2008) and animal assisted psychotherapy (Topel und Lachmann, Selbstpsychologie 38:406–423, 2009).     

Kupfermangel – eine behandelbare Ursache der Myelopathie

Copper deficiency myelopathy is an important and treatable differential diagnosis of vitamin B12 deficiency, of degenerative diseases presenting with the cardinal sign ataxia, and less often of motor neuron diseases. We report a 30-year-old female who presented with progressive gait disorder and sensory disturbances in her feet. Neurological examination showed tetraparesis with spastic ataxia. Laboratory investigations showed malabsorption, anemia, and leukopenia. Further extensive diagnostic investigations revealed copper deficiency due to malabsorption as the probable cause of the neurological deterioration. After oral copper substitution was started, the progression of her neurological symptoms could be stopped.     

Charité 91. Schritte in eine neue Zeit

Clinical Epileptology - Auch über 160 Jahre nach der ersten kasuistischen und über 60 Jahre nach der ersten detaillierten syndromatologischen Beschreibung sind viele...     

Trauma und Geschlecht – eine Annäherung

In the last twenty-five years the term “trauma” has become the focus of public attention. The political commitment of the Holocaust survivors, the women’s movement, and the survivors of Vietnam has essentially contributed to this awareness. The relation between the violence exerted and the gender of the offender and the victim, which was still an issue in these political movements, has, however, disappeared over last few years. In the first part of this article, I am going to make a connection between gender and psychodrama theory. In the second part, I am presenting different ways of dealing with traumatic experiences in adulthood. I am going to work out how the act of violence itself and how the symptoms of the posttraumatic stress disorder can be handled within the frame of in their gender codification.     

Inzidenz des Status epilepticus – eine rezente populationsbasierte Studie

Clinical Epileptology - Die Inzidenz des Status epilepticus erlaubt im Rahmen von Public Health eine Abschätzung der notwendigen Ressourcen in Gesundheitssystemen. Weiters ist die Inzidenz...     

Biopsychosoziale Auswirkungen herzchirurgischer Eingriffe – eine relevante konsiliarpsychiatrische Herausforderung

Zunehmend st?rker ist ein klinisches Engagement des Konsiliarpsychiaters in herzchirurgischen Stationen gefordert. In diesem Kontext sind eine Reihe von Untersuchungen zur psychiatrischen Komorbidit?t und gesundheitsbezogenen Lebensqualit?t bei Patienten nach Herz-operation unter Einsatz der Herz-Lungen-Maschine im Kurzzeit-, Mittelzeit- und Langzeitverlauf zu berücksichtigen. In der Zusammenschau kann festgehalten werden, dass Monate nach dem koronarchirurgischen Eingriff (CABG) die betroffenen Patienten signifikant verbesserte Lebensqualit?tswerte im Vergleich zu den Werten unmittelbar vor der Herzoperation zeigen. Andererseits finden sich Einbu?en in der gesundheitsbezogenen Lebensqualit?t bei denjenigen CABG-operierten Patienten, welche unter Depressionen, posttraumatischen Belastungssyndromen oder kognitiven Defiziten im Kurzzeit-, Mittelzeit- und Langzeitverlauf leiden. Folglich raten wir frühzeitig zu einer umf?nglichen bio-psycho-sozialen Diagnostik und Therapie von CABG-operierten Patienten. Hierbei ist eine enge Zusammenarbeit zwischen Herzchirurgen, Konsiliarpsychiatern, medizinischen Psychologen, Psychotherapeuten, klinischen Psychologen und Internisten wesentlich.     

Kamptokormia – eine segmentale Dystonie Vorschlag einer neuen Definition für eine alte Krankheit

Camptocormia is defined as a forced posture with a forward-bent trunk which appears during standing and sitting. It was first described in 1818 by Brodie. In the last 100 years, numerous cases were observed. A psychogenic origin was presumed in most cases. We describe four patients with typical symptoms of camptocormia who present with the clinical and electromyographical criteria of a segmental dystonia. A new classification of camptocormia is proposed including (1) the primary form, a segmental dystonia of the abdominal wall muscles and (2) secondary forms. Among other conditions (psychogenic disorder, neurosis, myopathy, myositis, Parkinson's disease, multiple-system atrophy, thoracolumbar kyphosis, paraneoplastic syndrome), camptocormia is to be considered in essential tremor. A combination of dystonia of the abdominal wall muscles and essential tremor seems possible.     

Über eine neue Methode zur Erzeugung von stereotypen Mikroembolien im Gehirn der Katze

Zusammenfassung Es wird über eine neue Methode zur Erzeugung von Mikroembolien des Gehirns mit festen Partikelchen aus Hostalen PP in einer konstanten Korngröße zwischen 30 und 37 berichtet.Gegenüber anderen Versuchen bietet diese Methode den Vorteil sowohl einer exakten Bestimmung der injizierbaren Emboli als auch einer gleichmäßigen Verteilung der Partikelchen in Rinde und Mark. Dadurch können stereotype Läsionen erzeugt werden, die morphologische, physiologische, klinische, pharmakologische und andere Untersuchungen gestatten.

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Summary A new method for producing microembolies in the brain using solid particles of Hostalen PP of constant granule size between 30 and 37 is reported.In comparison to other experiments this method allows a more exact definition of the emboli to be injected as well as a symmetrical distribution of the particles within cortex and white matter. Stereotypical lesions can thus be produced, which permit further morphological, physiological, clinical, pharmacological and other investigations.

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