Psychophysiological correlates of dissociation, handedness, and hemispheric lateralization

Dissociation involves a disruption of typically integrated functions including consciousness, information perception, and memory; however, dissociation may not always be of a pathologic nature. Increasingly, studies are identifying relations between inconsistent handedness, mixed hemispheric lateralization, and dissociative symptomatology in both clinical and nonclinical populations. The current study explored whether a nonclinical sample of individuals scoring high in dissociation would display an inconsistent handedness in conjunction with a left hemispheric lateralization as measured by electroencephalography. Twenty-seven participants (12 males and 15 females) aged between 20 and 59 years (M = 29.1 year, SD = 11.2 years), completed the Dissociative Experiences Scale and Waterloo Handedness Questionnaire Revised after determining laterality. As predicted, inconsistently handed participants scoring high in dissociation displayed left hemispheric lateralization across frontal, central, and parietal regions. Conversely, right lateralization was found within Delta frequency band across temporal regions. The study provides a good framework for future research investigating the neurophysiological correlates underpinning dissociative symptomatology.     

Male diabetes mellitus and assisted reproduction treatment outcome

The long-held view that diabetes has little effect on male reproductive function has been challenged by findings that the condition influences fertility in numerous previously undetected ways. This retrospective chart review of 3000 couples determined the incidence of couples with a male diabetic seeking assisted reproduction treatment and assessed any relationship between male diabetes and IVF/intracytoplasmic sperm injection (ICSI) outcome. Eight (2.7%) couples were found with a diabetic male partner, of which 18 couples underwent assisted reproduction treatment (five IVF, 12 ICSI, one both), with fertilization rates (IVF 68%, ICSI 62%) similar to non-diabetic patients (IVF 70%, ICSI 71%) and no difference in embryo quality. Two men had retrograde ejaculation and two were azoospermic. Other than reduced sperm motility, the remaining 14 had normal World Health Organization semen parameters. Embryo transfers produced one pregnancy (5% combined IVF/ICSI pregnancy rate/cycle) giving a lower-than-expected rate (28.8%). The pregnancy rate from seven FETs (29%) was comparable to the expected (21.3%). Compared with non-diabetics, approximately three times more couples with diabetic men sought treatment, with a larger percentage having 'unexplained' infertility. Fertilization rates and embryo quality did not differ but pregnancy rates were lower in couples with a diabetic male.     

Redefining response in overactive bladder syndrome

OBJECTIVE: To evaluate three potential definitions of treatment response in overactive bladder (OAB) syndrome, based on the International Continence Society (ICS) definition of OAB, using pooled data from two large clinical trials of the antimuscarinic agent solifenacin succinate. PATIENTS AND METHODS: As the ICS definition of OAB does not rely on urodynamic observations for a diagnosis, the use of composite endpoints, such as in the definitions examined here, might provide a more relevant measure of patient benefits. Each definition was tested to assess the impact of pharmacotherapy, comparing treatment response rates based on composite endpoints. Responder definitions were validated based on the impact on quality of life (QoL). Pooled data from two 12-week multinational, multicentre, double-blind randomized studies of solifenacin, a once-daily oral antimuscarinic for treating OAB symptoms, were used for this analysis. Based on the symptom data from these studies (episodes of urgency, incontinence, nocturia and voiding frequency per 24 h), response was defined as being: (i) a reduction by half or more in all baseline symptoms; (ii) a reduction by half or more in urgency and at least one other symptom; or (iii) resolution of urgency episodes and at least one other symptom. Health-related QoL changes were recorded using the King's Health Questionnaire (KHQ). RESULTS: Solifenacin at 5 mg or 10 mg once daily resulted in significantly higher response rates than with placebo, irrespective of the definition of a responder (P < or = 0.001). When assessing the most challenging definition of response (resolution of urgency and at least one other symptom), solifenacin at 5 mg and 10 mg resulted in 20% and 25% of patients, respectively, meeting the response criteria, vs 12% of placebo-treated patients (P < or = 0.001 for both solifenacin doses). For all three definitions of response, responders showed greater improvements in all KHQ domains than did nonresponders, and the differences were statistically significant. CONCLUSIONS: The two strictest definitions of response (halving or more in all baseline symptoms or resolution of urgency and more than one other symptom) appeared to capture QoL changes most effectively. Establishing the most appropriate definition to assess treatment-related changes in OAB will require further investigation, but it is clear from this analysis that composite clinical endpoints, based on the ICS definition of OAB, are a valid approach for assessing the effect of treatments for OAB.     

Utility of magnetic resonance imaging in diagnosing ulnar neuropathy at the elbow.

OBJECTIVE: Magnetic resonance imaging (MRI) of the ulnar nerve is being increasingly employed in the diagnosis of ulnar neuropathy at the elbow (UNE). Our aims were to: (i) assess the sensitivity of MRI in diagnosing UNE, especially in cases where neurophysiologic studies were non-localizing, (ii) determine the spectrum of MRI abnormalities in patients presenting with symptoms and signs of ulnar neuropathy, (iii) assess whether MRI findings differ between grades of UNE severity, and (iv) to see if MRI findings give an input into the pathological mechanisms of UNE. METHODS: Clinical, neurophysiologic, and radiologic (MRI) records were reviewed in 52 patients with symptoms and signs of ulnar neuropathy. Ulnar nerve MRI studies were assessed by an unblinded observer. RESULTS: The sensitivity of MRI at diagnosing UNE was higher than conventional nerve conduction studies, 90 versus 65%, respectively. In patients with non-localizing neurophysiologic studies (n=19), MRI disclosed changes consistent with UNE in 16 (84%) cases. The most frequent MRI findings included a combination of high signal intensity and nerve enlargement (63%), followed by nerve compression (27%) and isolated high signal intensity (23%), and isolated nerve enlargement (2%). There was no significant difference between patients with localizing and non-localizing neurophysiologic testing. Lastly, there were no differences between different grades of UNE, suggesting that UNE may be a neurophysiologically heterogeneous disorder. CONCLUSIONS: MRI studies proved to be more sensitive than conventional nerve conduction studies at diagnosing UNE. In addition, the MRI studies were highly sensitive in patients with non-localizing UNE. SIGNIFICANCE: Our study shows that MRI of the ulnar nerve should be used in patients with clinical features of UNE especially in those with non-localizing neurophysiologic testing.     

Langerhans' cell histiocytosis of the frontal bone

Two cases of Langerhans' cell histiocytosis of the frontal bone are presented. This condition was previously known as eosinophilic granuloma and rarely involves the orbit but may be associated with widespread and life-threatening disease. Clinical, radiological and histopathological features are presented. A discussion of the light and electron microscopic appearances, investigation and management follows.     

Multimodality evoked potentials in motor neuron disease

We performed median and tibial nerve somatosensory evoked potentials (SEPs), pattern-shift visual evoked potentials (PSVEPs), and brain-stem auditory evoked potentials (BAEPs) on 27 patients with motor neuron disease (MND). Median and tibial nerve SEPs were abnormal in 8 (30%) of 27 and 3 (14%) of 21 patients tested, respectively. Central and peripheral abnormalities were recorded in the absence of spondylosis. As a group, patients with MND and no evidence of cervical spondylosis had normal conduction to Erb's point following median nerve stimulation, but conduction times beyond this point were prolonged. The PSVEPs and BAEPs were within normal limits in all patients, excluding abnormalities attributable to other disease, but the group P100 latency was significantly prolonged in the group with MND. The BAEPs were normal in the group with MND. This study provides neurophysiological evidence of sensory system involvement in MND.     

Intraventricular CNS lesions: A pictorial essay

Intraventricular lesions of the central nervous system (CNS) can present a diagnostic challenge due to a range of differential diagnoses and radiological appearances. Both CT and MRI imaging findings, in combination with location and patient's age, can help limit the differentials. This pictorial essay presents the salient radiological features, location and demographics of the more common intraventricular lesions of the brain.