0000000000406722
AUTHOR
Th. Vogt
Optimierte Therapie des spastischen Syndroms durch Kombination von intrathekalem Baclofen mit Botulinumtoxin
Die intrathekale Dauerapplikation von Baclofen stellt nicht selten bei ausgepragten spastischen Syndromen die einzig wirksame Therapieform dar. Ein Benefit ist besonders bei Patienten mit spinalem Lasionsort und vordergrundiger Beugespastik der Beine zu erwarten, der Effekt ist haufig enttauschend bei dominierender Streckspastik und bei zerebral bedingten Spastikformen. Daruber hinaus kann der Einsatz durch relevante Nebenwirkungen limitiert sein. Als weitere Therapiealternative ist in den letzten Jahren der Einsatz von Botulinumtoxin propagiert worden, allerdings ergibt sich bei kritischer Wertung eine sinnvolle Indikation, mit Ausnahme der infantilen spastischen Zerebralparese, uberwiegen…
Electrophysiological and MRI findings in 2 patients with Listeria rhombencephalitis.
Intravenöse Immunglobulin- und Prednisolon-Behandlung bei kryoglobulinämischer Polyneuropathie
A 71-year-old man with cryoglobulinemia associated with severe symmetrical sensorimotor polyneuropathy was successfully treated with intravenous immunoglobulin (IVIG) and a corticosteroid. Within 2-3 months, he developed distal motor and sensory deficits and burning feet deteriorating after cold exposure. On examination, symmetric hypesthesia and hypalgesia were found along with bilateral loss of vibration and position sense, loss of ankle jerks, and paralysis of the pretibial muscles with step-page gait. The laboratory exam revealed elevated cryoglobulin levels and reduced complement C4. Nerve conduction studies were consistent with a severe axonal sensorimotor polyneuropathy. Sural nerve …
Functional properties of motor units in motor neuron diseases and neuropathies.
The relationship between the size of single motor unit (MU) action potentials and their twitch properties was estimated in patients with spinal muscular atrophy (SMA, n = 5) and amyotrophic lateral sclerosis (ALS, n = 10), as well as in patients with peripheral nerve lesions (PNL, n = 9). The data obtained from these groups were compared to normal controls (n = 8). In controls, the single MU twitch force was highly correlated to the corresponding EMG potential size in terms of macro EMG area. An enlargement of MUs, due to collateral sprouting and reflected by increased potential size and twitch force, was found in regenerating PNL and in slowly progressing SMA. Both parameters were highly c…
Differential effect of Incobotulinumtoxin A on pain, neurogenic flare and hyperalgesia in human surrogate models of neurogenic pain
Background: The effectiveness of Botulinum-neurotoxin A (BoNT/A) to treat pain in human pain models is very divergent. This study was conducted to clarify if the pain models or the route of BoNT/A application might be responsible for these divergent findings. Methods: Sixteen healthy subjects (8 males, mean age 27 ± 5 years) were included in a first set of experiments consisting of three visits: (1) Visit: Quantitative sensory testing (QST) was performed before and after intradermal capsaicin injection (CAPS, 15 μg) on one thigh and electrical current stimulation (ES, 1 Hz) on the contralateral thigh. During stimulation pain and the neurogenic flare response (laser-Doppler imaging) were ass…