The treatment dilemma in post-traumatic syringomyelia

Purpose: The aim of the present study was to compare the functional effect of conservative and surgical treatment in post-traumatic syringomyelia. Method: The files of 10 male patients treated for post-traumatic syringomyelia were retrospectively reviewed from 1986 to 1996. Results: The spinal lesion was complete in five patients and incomplete in five. All patients underwent rehabilitation, five of them following surgery. The operative procedures included drainage by syringosubarachnoid shunting (four patients) and decompressive laminectomy (one patient). Rehabilitation alone improved the functional status in all five patients so treated. After surgery, function deteriorated in four of the five operated patients, and rehabilitation failed to restore the preoperative functional status in any of them. Conclusion: In view of the results it is suggested that patients with post-traumatic syringomyelia undergo rehabilitation with very close clinical and magnetic resonance imaging follow-up.     

Early head movements elicited by visual stimuli or collicular electrical stimulation in the cat.

During the course of previous recordings of visually-triggered gaze shifts in the head-unrestrained cat, we occasionally observed small head movements which preceded the initiation of the saccadic eye/head gaze shift toward a visual target. These early head movements (EHMs) were directed toward the target and occurred with a probability varying between animals from 0.4% to 16.4% (mean=5.2%, n=11 animals). The amplitude of EHM ranged from 0.4 degrees to 8.3 degrees (mean=1.9 degrees ), their latency from 66 to 270 ms (median=133 ms) and the delay from EHM onset to gaze shift onset averaged 183+/-108 ms (n=240). Their occurrence did not depend on visual target eccentricity in the studied range (7-35 degrees ), but influenced the metrics and dynamics of the ensuing gaze shifts (gain and velocity reduced). We also found in the two tested cats that low intensity microstimulation of the superior colliculus deeper layers elicited a head movement preceding the gaze shift. Altogether, these results suggest that the presentation of a visual target can elicit a head movement without triggering a saccadic eye/head gaze shift. The visuomotor pathways triggering these early head movements can involve the deep superior colliculus.     

Effect of methylprednisolone on CSF IgG parameters, myelin basic protein and anti-myelin basic protein in multiple sclerosis exacerbations

Clinical exacerbations of multiple sclerosis (MS) are characterized by elevated levels of cerebrospinal fluid (CSF) myelin basic protein (MBP). The purposes of this study were to determine whether anti-MBP antibodies are present in increased titer in CSF of MS patients with exacerbations, and whether they can be suppressed by the administration of immunosuppressive dosages of methylprednisolone (MP). A solid phase radio-immunoassay (RIA) was used to detect free and total anti-MBP antibodies before and after acid hydrolysis of CSF. In MS exacerbations, the majority of elevated anti-MBP is in the free form. With the exception of subacute sclerosing panencephalitis (SSPE) and some cases of post infectious encephalomyelitis, anti-MBP antibodies are not present in either MS patients in remission or in non-MS controls. Anti-MBP levels remained elevated over a 10 day period when patients are managed by bed rest only or when treated with intravenous (IV) ACTH. IV administration of MP in "high" (160 mg/day) or "mega" (2 g/day) dosages produces a highly significant reduction of both MBP (p less than 0.01) and anti-MBP (p less than 0.001) levels. Total intrathecal IgG synthesis is also significantly suppressed by IV-MP but not by ACTH.     

Detecting bone marrow metastases at the time of examining the liver with radiocolloid

In a prospective study of 200 different consecutive patients with cancer, the bone marrow of the lumbar spine and pelvis has been examined at the time of obtaining a radiocolloid examination of liver and spleen. The images were examined "blind" by three observers who all agreed about the findings in 177 (89%) of the patients. Agreement by any two was considered to be definitive. The radiocolloid marrow examinations in this selected population had an accuracy of 0.97, sensitivity of 0.80, and specificity of 0.98 in diagnosing metastatic disease when validated by all other available evidence, or follow-up. Of the patients thus examined, 16 (8%) had abnormal marrow scan findings reflecting metastatic disease, eight (4%) at the time radiographs were normal, and two at the time bone scintigraphy was normal. Excluding patients with bowel cancer, in whom the detection rate was zero, 16 (12.4%) marrow examinations were abnormal. As a result we now obtain "saturated" images of the marrow incidental to radiocolloid examinations of the liver and spleen in patients with cancer other than that of the bowel.     

Electromyographic signal-activated functional electrical stimulation of abdominal muscles: the effect on pulmonary function in patients with tetraplegia

BACKGROUND: Paralysis of abdominal muscles is the main cause of respiratory dysfunctions in patients with lower cervical spinal cord lesion. Activation of the abdominal muscles using functional electrical stimulation (FES) improved respiratory function in these patients. But application of FES frequently requires a caregiver, and it may not be well synchronized with the patient's respiratory activity. OBJECTIVE: To perform preliminary examination of electromyographic (EMG)-activated FES for caregiver-independent and synchronized cough and expiration induction in tetraplegia. DESIGN: Self-controlled study. SETTING: Loewenstein Rehabilitation Center, Raanana, Israel. SUBJECTS: A total of 10 male patients with complete or almost complete tetraplegia. MAIN OUTCOME MEASURES: Peak expiratory flow (PEF), forced vital capacity (FVC), and maximal voluntary ventilation (MVV). METHODS: The outcome measures were examined with the abdominal muscles unassisted or assisted by various methods. These included manual assistance or application of FES, activated by a caregiver, by the patient, or by EMG signals elicited from the patient's muscle. RESULTS: Manual assistance improved the mean PEF value by 36.7% (P<0.01) and the mean FVC value by 15.4% (P=0.01). FES did not significantly change most measurements, and patient-activated FES even reduced PEF (P<0.05). But following EMG-activated FES PEF and FVC values were higher than those following patient-activated FES (P<0.05 for PEF; P<0.01 for FVC), and their mean values were higher by 15.8 and 18.9%, respectively. CONCLUSIONS: Abdominal FES failed to improve respiratory function in this study, but applying FES to abdominal muscles by EMG from the patient's muscle may promote caregiver-free respiration and coughing in persons with cervical SCL.     

Mood, Side-effects and Smoking Outcomes Among Persons With and Without Probable Lifetime Depression Taking Varenicline

BACKGROUND  Varenicline may be associated with greater mood disturbance and side-effects among smokers with psychiatric history, but empirical evidence is limited. Differential treatment effectiveness by psychiatric history may also exist. OBJECTIVE  To compare mood, prevalence and intensity of treatment side-effects, and abstinence among people with a probable history of major depression (DH+) or not (DH−) who took varenicline and received behavioral smoking cessation treatment. DESIGN  Smokers participated in a randomized behavioral intervention effectiveness trial. Treatment side-effects and outcomes were compared between DH+ and DH− participants (n = 1,117) at 2 days and 3 months after the target quit date. PARTICIPANTS  Smokers recruited from a large regional health plan. MEASUREMENTS  Change in stress and depression scores, prevalence and intensity of treatment side-effects, and abstinence rates. RESULTS  All side-effects averaged moderate intensity or less and were similar across DH groups, except DH+’s endorsed slightly worse confusion, nausea (adjusted P = 0.04) and trouble sleeping (adjusted P = 0.008) at 21 days. Depression and stress scores declined in both DH groups and an equal proportion of each evidenced new/worsening depressive symptoms. Despite few differences in symptom intensity, more DH+ participants reported recent tension/agitation, irritability/anger, confusion, and depression at 21 days (adjusted P < 0.05), and depression and anxiety (adjusted P < 0.01) at three months. Nonsmoking rates did not differ by DH group at follow-up. CONCLUSION  While some group differences were noted, DH+ smokers did not report qualitatively worse neuropsychiatric symptoms, more new/worsening mood disturbance, or differential abstinence rates compared to DH- smokers. An erratum to this article can be found at