Behavioral disorders: The ‘blind spot’ of neurology and psychiatry

Behavioral disorders occupy the crossroads between neurology and psychiatry, and emerging disorders, such as frontotemporal lobar degeneration of genetic origin and autoimmune encephalitis, can present with both neurological and psychiatric signs. Thus, the primary aim of this introductory article is to review frequently encountered behavioral clinical features, such as apathy and agitation, and their related syndromes, including frontal and anterior temporal syndromes. These behavioral states and their underlying etiologies are also here illustrated with clinical case reports. In addition, this review highlights the idea that in order to progress in the understanding and management of behavioral disorders, there needs to be a strong interest towards developing new forms of cooperation between neurologists, psychiatrists and neuroscientists, such as those who work at university-based hospital neuropsychiatric clinical units.     

Santiago Ramón y Cajal and the Spanish school of neurology

Advances in neurology are now possible thanks to the endeavours of a few scientists who in the past laid firm foundations for the study of the nervous system. Santiago Ramón y Cajal (1852-1934) was one such pioneer of brain exploration and is acknowledged as the founder of modern neuroscience. He described the structure and organisation of virtually all parts of the nervous system and developed theories, including the neuron doctrine and the law of functional polarisation, that are the cornerstones of neuroscience. In addition to devoting his life to research, Ramón y Cajal was a dedicated teacher and mentor and created a school that greatly contributed to the flourishing of neurology.     

Klaus Joachim Zülch: Partner to neurosurgery,advocate of neurology and the neuropathological basis

Klaus Joachim Zülch (1910-1988) since 1959 head of a department of the german Max-Planck-Society, deeply influenced the neurological sciences in post-war Germany. The department with the name Abteilung für allgemeine Neurologie (i.e. department of general neurology) constituted a section of the renowned Max-Planck-Institut für Hirnforschung (i.e. institute for brain research) and found its place in Cologne. At the same time he was in charge of the local neurology unit of the municipal Cologne hospital, on the right Rhine riverside in K?ln (Cologne) Merheim. In this double position he was able to focus his work as a neurologist on the major issues of this specialty, that at this time were not in the center of neurological interest: The connection of basic science i.e. morphology with important themes such as raised intracranial pressure, brain swelling and edema, brain and spinal chord circulation disturbances, head injuries and - in the first line - tumors of the central nervous system. This broad approach to essential issues in the field was probably due to his upbringing in german neurological tradition. His first contact with this specialty took place in Otfrid Foersters neurological clinic in Breslau, today in Poland, before World War II. Otfrid Foerster, a neurological encyclopedist, exerted a deep influence upon Klaus Joachim Zülch lifelong. Here he also came in contact with Percieval Bailey with whom he shared the obsession to classify brain tumors since then. This preoccupation became fruitful when he started collaboration with Wilhelm T?nnis 1936 at the time still in Würzburg. The collaboration continued, when T?nnis moved to Berlin, during and after World War II up to 1959, when Klaus Joachim Zülch became head of the mentioned department of the german Max-Planck-society. At this time, important contributions already existed concerning brain injuries, brain edema and tumor classification. The couple Wilhelm T?nnis and Klaus Joachim Zülch may well be compared to the team formed by Harvey Cushing and Percieval Bailey. Their respective philosophies were equally identical, namely to classify tumors of the central nervous system through a pragmatic approach that would facilitate the communication between neuropathologist, neurosurgeon, neurologist and of course be ultimately as helpful as possible to the patient. Since 1959 Zülchs research turned to the topics of brain hypoxia, circulatory disturbances and stroke, notwithstanding that his interest remained with the other items, whenever new or old questions came up. The occupation with tumors became even once more intense when the WHO installed a reference center for brain tumor classification at his place in Cologne. In the new field of brain circulation, Klaus Joachim Zülch tried once again to bring basic science and clinical practise together and to draw the neurologists attention upon these frequent and important conditions, a development that gained increasing importance under the heading of "stroke unit" in our days. Klaus Joachim Zülch therefore may be regarded as neurologist ahead of his time trying to cover the epidemiologically important and frequent themes and establishing equal partnership with neurosurgery The connection with the scientific basis, i.e. morphology in different variations at the time under a common roof was crucial in his understanding of the work as neurologist.     

A review of: “Clinical neurology of aging”

Abstract

Martin L. Albert (Ed.): Clinical Neurology of Aging. Oxford University Press, New York, 1984. 544 pages. ISBN 0-19-503287-x. $55.00.     

Sniffing out the contributions of the olfactory tubercle to the sense of smell: Hedonics, sensory integration, and more?

Since its designation in 1896 as a putative olfactory structure, the olfactory tubercle has received little attention in terms of elucidating its role in the processing and perception of odors. Instead, research on the olfactory tubercle has mostly focused on its relationship with the reward system. Here we provide a comprehensive review of research on the olfactory tubercle—with an emphasis on the likely role of this region in olfactory processing and its contributions to perception. Further, we propose several testable hypotheses regarding the likely involvement of the olfactory tubercle in both basic (odor detection, discrimination, parallel processing of olfactory information) and higher-order (social odor processing, hedonics, multi-modal integration) functions. Together, the information within this review highlights an understudied yet potentially critical component in central odor processing.     

Hyperoxia preconditioning: the next frontier in neurology?

Oxygen is indispensable for all aerobic organisms and has become one of the most widely used therapeutic agents. Currently, oxygen not only is applied in the treatment of diseases, but becomes a modality for the prevention of some diseases. Hyperoxia preconditioning with normobaric or hyperbaric oxygen has been found to be protective in some diseases in several animal models and clinical trials. Currently, investigators pay increasing attention to the application of hyperoxia preconditioning in the prevention of common neurological diseases, and encouraging effectiveness has been achieved. In the present short review, we briefly described the development, application and mechanisms of hyperoxia preconditioning in the neurology, and the issues in future application of hyperoxia preconditioning were also proposed.     

Criteria for the neuropathological diagnosis of dementing disorders: routes out of the swamp?

There are several consensus criteria for both the clinical and neuropathological diagnosis of different types of dementias. The clinical diagnostic accuracy using revised research criteria and newly developed biomarkers (MRI, PET, CSF analysis, genetic markers) ranges from 65 to 96% (for Alzheimer disease) with a specificity of diagnostic criteria versus other dementias of 23–88%. Neuropathological assessment of dementing disorders using immunohistochemistry, molecular biologic and genetic methods can achieve a diagnosis/classification, based on the homogeneous definitions, harmonized inter-laboratory methods and standards for the assessment of nervous system lesions, in about 99%, without, however, being able to clarify the causes/etiology of most of these disorders. Further prospective and concerted clinicopathological studies using revised methodological and validated protocols and uniform techniques are required to establish the nature, distribution pattern and grades of lesions and; thus, to overcome the limitations of the current diagnostic framework. By data fusion this my allow their more uniform application and correlation with the clinical data in order to approach a diagnostic “gold standard”, and to create generally accepted criteria for differentiating cognitive disorders from healthy brain aging. The detection of disease-specific pathologies will be indispensable to determinate the efficacy of new therapy options.     

Recommendations for prophylactic treatment of migraine: Consensus of the Sociedade Brasileira de Cefaléia

The Brazilian Headache Society assigned an Ad Hoc Committee with the purpose of establishing a consensus about prophylactic treatment for migraine and of elaborating recommendations for professionals. The recommendations of the Committee are based in evidences of the world medical literature and on the personal experience of the members, respecting the reality of the existing medication resources in our country.     

Neurohagiography. Lamberto Caesaraugustanus,the cephalophoric: holy patron of Spanish neurology?

Until now Neurology has lacked a patron saint who, taking the most advantage of the rich cultural tradition inherited from our past and independently of the religious ideology of each one, can be helpful approach in the neurologist figure to different people. An Ad Hoc Committee from the Neurology History Study Group of the SEN has researched the medical hagiography with any kind of neurological relationship (neurohagiography), in order to make a hagiography study of every saint related to our speciality, with the added luck of proposing a patron for Neurology with hispanic origin. In this pioneer study of historiographic research different documents related with the medical hagiography have been studied, especially the Index ac Status Causarum, and information coming from different national ecclesiastic archives. A total of 342 saints share the patronage of 137 diseases, of which a 27,7% are related in some way to Neurology. Headache constitutes the prime cause of the invocations, with 20 saints. Another 11 saints plead for epilepsy; to these we also must add another six for so called possessed patients. Therefore, two of the three main causes of invocation (headache, fever and epilepsy) come up to chronic processes. Of all the saints with a hispanic origin candidates to the patronage of the neurologists San Lamberto Caesaraugustanus stands out, who died in the year 303 during Diocletian persecution. Belonging to the selected standing of "cephalophoric martyrs" (those beheahed who carry their own head in their hands), he was able to walk an important distance (about six kilometres) with his head split from the body, a fact only understood as a suprahuman phenomenon thanks to which he has becomes the brain transplant pioneer.     

Parents’ Phubbing and Cyberbullying Perpetration Among Adolescents: the Mediation of Anxiety and the Moderation of Zhong-Yong Thinking

International Journal of Mental Health and Addiction - Extant research has indicated that parents’ phubbing negatively affects adolescent development. However, no research to date has...     

Nutrition and the risk for Parkinson’s disease: review of the literature

The etiology of Parkinson's disease (PD), the second most common movement disorder, is still unclear. A genetic vulnerability, even in idiopathic PD seems likely. Additional factors like endo- and exotoxins are proposed to contribute to the induction and in some cases possibly acceleration of the disorder. Among the epidemiological risk factors dietary components are being broadly discussed. Moreover, there is a growing awareness of the population concerning possibly preventive dietary habits. However, dietary factors are difficult to assess. This review gives an overview on epidemiological studies addressing a possible relation of dietary compounds and the risk for PD.     

Genetics of Alzheimer’s Disease: the Importance of Polygenic and Epistatic Components

Purpose of Review

We aimed to summarize the recent advances in genetic findings of Alzheimer’s disease (AD), focusing on traditional single-marker and gene approaches and non-traditional ones, i.e., polygenic and epistatic components.

Recent Findings

Genetic studies have progressed over the last few decades from linkage to genome-wide association studies (GWAS), and most recently studies utilizing high-throughput sequencing. So far, GWASs have identified several common variants characterized by small effect sizes (besides APOE-ε4). Sequencing has facilitated the study of rare variants with larger effects. Nevertheless, missing heritability for AD remains extensive; a possible explanation might lie in the existence of polygenic and epistatic components.

Summary

We review findings achieved by single-marker approaches, but also polygenic and epistatic associations. The latter two are critical, yet-underexplored mechanisms. Genes involved in complex diseases are likely regulated by mechanisms and pathways involving many other genes, an aspect potentially missed by traditional approaches.