Hypothalamic deep brain stimulation for cluster headache: experience from a new multicase series

Deep brain stimulation (DBS) of the posterior hypothalamus was found to be effective in the treatment of drug-resistant chronic cluster headache. We report the results of a multicentre case series of six patients with chronic cluster headache in whom a DBS in the posterior hypothalamus was performed. Electrodes were implanted stereotactically in the ipsilateral posterior hypothalamus according to published coordinates 2 mm lateral, 3 mm posterior and 5 mm inferior referenced to the mid-AC-PC line. Microelectrode recordings at the target revealed single unit activity with a mean discharge rate of 17 Hz (range 13–35 Hz, n  = 4). Out of six patients, four showed a profound decrease of their attack frequency and pain intensity on the visual analogue scale during the first 6 months. Of these, one patient was attack free for 6 months under neurostimulation before returning to the baseline which led to abortion of the DBS. Two patients had experienced only a marginal, non-significant decrease within the first weeks under neurostimulation before returning to their former attack frequency. After a mean follow-up of 17 months, three patients are almost completely attack free, whereas three patients can be considered as treatment failures. The stimulation was well tolerated and stimulation-related side-effects were not observed on long term. DBS of the posterior inferior hypothalamus is an effective therapeutic option in a subset of patients. Future controlled multicentre trials will need to confirm this open-label experience and should help to better define predictive factors for non-responders.     

Zur Pathologie und Behandlung der Peroneussehnenluxation

Ohne Zusammenfassung     

Noise reduction of renograms: a new algorithm applied to simulated renograms for evaluation of the renal retention function.

Physiological information about an organ may be assessed from the retention function as derived by deconvolution analysis. However, noise in data may cause distortion of the retention curve and potentially induce methodological errors. To take full advantage of all parts of the retention function, i.e. even the vascular part, we have developed a non-linear noise reduction algorithm. The algorithm is an adaptive polynomial fit (APF) in a sliding segment over the renogram to be deconvoluted. Each segment is modelled by the lowest polynomial resulting in a root of mean square error lower than a pre-set value. APF was tested in comparison with conventional repetitive 1:2:1 smoothing and rectangular window smoothing, using a set of simulated retention functions and corresponding renograms with superimposed artificial noise. The outcome was evaluated by comparing the generated retention functions with the simulated ones. The conventional smoothing algorithms, as well as APF, induced some distortion of the retention function, but the deviation from the true retention function is essentially lower in the case of APF. In addition, APF seems to be more robust in cases of essentially reduced renal function and thereby relative high noise levels. APF reduces noise in data, leading to retention functions with reliable information in terms of a tracer's first passage, uptake and outflow.     

Leucine aminopeptidase activity in adults ofPomphorhynchus laevis (Acanthocephala): a histochemical study

In frozen sections of the acanthocephalanPomphorhynchys laevis, which is a frequent intestinal parasite of cyprinid and salmonid fishes, leucine aminopeptidase (APase) was localized histochemically in outer parts of the presomal bulbus as well as in all layers and most nuclei of the metasomal body wall. Enzyme activity visualized at pH 6.5 usingl-leucyl-4-methoxy-2-naphtylamide as the substrate was also associated with ovarian balls, immature larvae, and the testes. The results are discussed with respect to the possible function of APases and the proposed sites of amino acid uptake in tissues ofP. laevis.     

Deep brain stimulation for the treatment of Parkinson's disease.

Deep brain stimulation (DBS) is increasingly accepted as an adjunct therapy for Parkinson's disease (PD). It is considered a surgical treatment alternative for patients with intractable tremor or for those patients who are affected by long-term complications of levodopa therapy such as motor fluctuations and severe dyskinesias. Thalamic stimulation in the ventral intermediate nucleus (Vim) leads to a marked reduction of contralateral tremor but has no beneficial effect on other symptoms of Parkinson's disease. The subthalamic nucleus (STN) and the internal segment of the globus pallidus (GPi) are targeted for the treatment of advanced Parkinson's disease. Several studies have proven the efficacy of STN-DBS and GPi-DBS in alleviating off motor symptoms and dyskinesias. Sub-thalamic nucleus deep brain stimulation is currently considered superior to GPi-DBS because the antiakinetic effect seems to be more pronounced, allows a more marked reduction of antiparkinsonian medication, and requires less stimulation energy. More recently, however, a number of reports on possible psychiatric and behavioral side effects of STN-DBS have been a matter of concern. Given the chronic nature of PD and the noncurative approach of DBS, both targets will need to be reevaluated on the basis of their long-term efficacy and their impact on quality of life. Despite the rapidly increasing numbers of DBS procedures, surprisingly few controlled clinical trials are available that address important clinical issues such as: When should DBS be applied during the course of disease? Which patients should be selected? Which target should be considered? Which guidelines should be followed during postoperative care? Here is summarized the available evidence on DBS as a therapeutic tool for the treatment of Parkinson's disease and the current state of debate on open issues.     

Therapeutic electrical procedures in recurring, drug refractory tachycardias. I. Antitachycardiac implantable pacemaker systems

In 9 Patients with medicamentously therapy-refractory tachycardias (twice paroxysmal AV-node-reentry tachycardia, four times paroxysmal orthrodromic reentry tachycardia in the WPW-syndrome, once paroxysmal atrial reentry tachycardia, twice recurrent ventricular tachycardia) after adequate electrophysiological testings antitachycardiac pacemakers able to activate the patients were implanted. In these cases the implantable tachyblocker TUR-RFP-01 was used in 4 cases for the highly frequent volley atrial stimulation, in 2 cases for the more highly frequent volley ventricular stimulation. In 3 patients the interruption of the tachycardia was performed by ventricular underdrive stimulation by means of putting the magnet on a conventional R-wave-inhibited ventricular pacemaker. In all cases the recurrent tachycardias could reliably be terminated by the patients themselves by activation of the antitachycardiac systems (duration of the follow-up period 3-14 months, on an average 10.7 +/- 3.4 months); only in one case in the further course a change of the stimulation parameters was necessary which were carefully tested at the beginning. On account of the danger of the acceleration of the tachycardia and of the evocation of ventricular fibrillation, respectively, should, however, be performed highly frequent ventricular stimulations for the termination of ventricular tachycardias only in readiness for defibrillation.