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Biomedical subjects

J D Rollnik

Publications and source records attributed to J D Rollnik.

At least 19 recordsLinked to original sources
PubMed2004

[Dystonias: what the practitioner needs to know].

Dystonia is characterized by involuntary muscular contractions resulting in repetitive movements and/or postures, with co-contraction of antagonist muscle groups. the present overview describes the fundamentals of dystonic movement disorders, and provides information on their diagnosis and therapy, including in particular the not infrequent focal dystonias spasmodic torticollis, blepharospasm, and writer's cramp, and the generalized forms. For the practitioner it is of primary importance to be able to recognize these sometimes bizarre movement disorders as dystonias. In many cases, the correct diagnosis makes possible effective treatment that frequently results in an appreciable improvement in the patient's symptoms.

Blepharospasm↗
PubMed2003

[A case of symptomatic paroxysmal kinesigenic dsykinesia with primary central nervous system lymphoma].

Paroxysmal dyskinesias are rare movement disorders. In one fourth of cases, a symptomatic cause can be found, e.g., brain ischemia or inflammatory diseases. We report a unique case of secondary paroxysmal kinesigenic dyskinesia (PKD). The 37-year-old patient suffered from a primary CNS lymphoma invading the right thalamus. Consecutively, he showed dystonic-athetoid movements in the left half of the body. The involuntary movements had a duration of approximately 20 s and occurred more than 100 times per day. Carbamazepine treatment showed excellent results. This is the first reported case of a symptomatic paroxysmal dyskinesia induced by a primary CNS lymphoma.

Adult↗
PubMed2002

Effects of subthalamic nucleus (STN) stimulation on motor cortex excitability.

BACKGROUND: Deep brain stimulation of the internal global pallidus (GPi) and the subthalamic nucleus (STN) has become a treatment alternative in advanced PD. Although the effects of GPi stimulation have been examined recently, little is known about STN stimulation effects on motor cortex excitability. METHODS: The effects of STN stimulation were studied in eight patients with advanced PD using paired-pulse transcranial magnetic stimulation (TMS) in comparison with healthy control subjects. Motor evoked potentials following paired-pulse TMS (interstimulus interval 3 ms to test for corticocortical inhibition vs 13 ms for facilitation) have been recorded from the extensor carpi radialis and its functional antagonist, the flexor carpi radialis muscle. Silent period (SP) was also determined. Patients were examined under four conditions: medication "off"/stimulator "off" vs medication "on"/stimulator "off" vs medication "off"/stimulator "on" vs medication "on"/stimulator "on." RESULTS: Although the mean values for intracortical inhibition (ICI) were not significantly different, data variation was smaller and levels of significance higher with the STN stimulator switched "on," suggesting that ICI was more consistent. SP during stimulator "on"/medication "on" was longer than during stimulator "off"/medication "off." Motor performance as indicated by a finger-tapping test and Unified PD Rating Scale III was significantly better with dopaminergic medication and further improved with stimulator "on." CONCLUSIONS: Results suggest an effect of subthalamic nucleus stimulation on intracortical inhibitory mechanisms. This hypothesis could at least partially explain a more consistent depression of motor evoked potentials following inhibiting paired-pulse transcranial magnetic stimulation, a longer silent period (under stimulator "on"/medication "on"), and a reduction of akinesia and rigidity leading to a better motor performance in subthalamic nucleus-stimulated patients.

Aged↗
PubMed2002

Reduced binocular depth inversion in schizophrenic patients.

Binocular depth inversion represents an illusion of visual perception, serving to invert the perception of implausible hollow objects, e.g. a hollow face into a normal face. Such inversion occurs frequently, especially when objects with a high degree of familiarity (e.g. photographs of faces) are displayed. Under normal conditions, cognitive factors apparently override the binocular disparity cues of stereopsis. This internal mechanism--a kind of "censorship" of perception balancing "top-down" and "bottom-up" processes of perception--appears to be disturbed in psychotic states. The clinical and neuropsychological performance of schizophrenic patients was assessed using the Brief Psychiatric Rating Scale (BPRS), the Positive And Negative Symptoms Scale (PANSS), the Clinical Global Impression Scale (CGI), the Mehrfach-Wahlwortschatz Intelligence Test (MWT-B) and the binocular depth inversion test (BDIT) using pictures with a high degree of familiarity. In schizophrenic patients, the performance in the BDIT differed significantly from healthy controls and from patients with major depression. The schizophrenic patients were more veridical in their judgements in the BDIT. During antipsychotic treatment, BPRS and PANSS scores improved and the inversed faces were seen as more illusionary, driven by an increase in top-down processing. At the end of treatment, there was no significant difference between the patient group and the healthy controls in the score of binocular depth inversion. These findings suggest that testing of binocular depth inversion can detect specific dysfunctions in visual perception and might be useful as a state-marker for psychotic states.

Adult↗
PubMed2002

Electrical stimulation of the sural nerve partially compensates effects of central fatigue.

OBJECTIVES: Depression of motor evoked potentials (MEPs) following transcranial magnetic stimulation (TMS) may be a sign of central motor fatigue. Abnormal fatigue can be observed in MS patients. We have examined whether post-exercise MEP depression can be compensated by application of sensory stimuli prior to TMS. METHODS: We studied 15 healthy volunteers (aged 21 to 28 years) who were required to perform an exercise protocol of ankle dorsiflexion until force fell below 66% of maximum force. MEPs were recorded from the right tibialis anterior muscle. Prior to TMS, electrical stimuli were applied to the ipsilateral sural nerve with an individual interstimulus interval between 50 to 80 ms. RESULTS: MEP areas decreased after exercise. When a sensory stimulus was administered MEPs did not change. DISCUSSION: We conclude that the effects of central fatigue may be--at least partially compensated--by application of sensory stimuli. Sensory stimulation (e.g. by implantation of a neurostimulator) might be a useful therapy for abnormal central fatigue.

Adult↗
PubMed2002

Botulinum toxin (DYSPORT) in tension-type headaches.

OBJECTIVES: Botulinum toxin type A is effective in the reduction of muscle tenderness and pain in many diseases associated with myofascial pain. Since increased muscle tension may contribute to tension-type headaches, injections of botulinum toxin could be of therapeutic value. METHODS/PATIENTS: Results of own investigations are presented, in particular a double-blind, placebo-controlled study with 21 patients fulfilling the International Headache Society criteria for tension-type hedaches. Participants were randomly assigned to verum (pericranial injection of 10 x 20 MU DYSPORT) or placebo condition (injection of isotonic saline in the same manner). RESULTS: After 4, 8, and 12 weeks no significant differences between placebo and verum could be observed. Nevertheless, both groups significantly improved. DISCUSSION: The findings strongly suggest that higher doses or other injection sites might be necessary to achieve therapeutic effects of botulinum toxin in tension-type headaches. Actually, we are participating in a multi-center study using 500 MU of DYSPORT. Besides dose-finding problems, another explanation could be that peripheral mechanisms--such as increased pericranial muscle tension--only play a minor role in the pathogenesis of tension-type headaches.

Adult↗
PubMed2002

Vibratory proprioceptive stimulation affects Parkinsonian tremor.

Previous research on tremor pathophysiology showed that tremor can be affected, e.g. by electrical stimulation of the peripheral nerve, mechanical perturbation of the limb and by transcranial magnetic stimulation of the motor cortex. This report is focused on possible effects of muscle vibration (MV) on resting tremor in Parkinson's Disease (PD). Vibratory stimulation was applied to the tendons of M. extensor carpi radialis longus and M. flexor ulnaris in 27 subjects with moderate PD resting tremor. The following effects were observed: (1) tremor stopped or started time-locked to MV onset and offset, (2) tremor persisted during MV but its frequency pattern changed. These results are discussed with specific emphasis to effects of MV on spinal and supraspinal levels.

Aged↗
PubMed2002

Two cases of abortion and premature birth after removal of a levonorgestrel-releasing intrauterine system.

Levonorgestrel-releasing intrauterine systems (IUSs) are frequently used for contraception, increasingly also in young women before and/or between planned pregnancy. We report on two cases of abortion (double abortion and abortion followed by premature birth) after removal of a levonorgestrel-releasing IUS. Both women (25 and 26 years old) with no previous gynecological problems had a normal pregnancy and had previously delivered healthy babies. The significance of the two cases remains unclear, unless further cases are reported. However, the authors believe that there is a need for further investigation of this issue.

Abortion, Spontaneous↗
PubMed2001

Muscle vibration and prefrontal repetitive transcranial magnetic stimulation.

We previously demonstrated that prefrontal subthreshold repetitive transcranial magnetic stimulation (rTMS) may reduce motor cortex excitability. We have now examined whether muscle vibration (MV) can compensate for this depression. We enrolled 25 healthy volunteers (aged 22 to 37 years) who received 5 HZ, 10% subthreshold prefrontal rTMS for 12 s. The extensor carpi radialis muscle was vibrated with an electromagnetic mechanical stimulator with a stimulation frequency of 120 HZ and 0.5 mm amplitude. Motor evoked potentials (MEPs) from the flexor carpi radialis muscle (FCR) following single-pulse transcranial magnetic stimulation (TMS) were recorded at baseline, and after 4, 8, and 12 s. During prefrontal rTMS, MEPs of the FCR exhibited a serial depression (P = 0.001). This effect did not occur during MV. We conclude that rTMS of the prefrontal cortex may inhibit the corticospinal system. This depression may be compensated by MV, suggesting that vibration changes motor cortex excitability. The underlying mechanism might be an input from Ia sensory afferents to the motor and prefrontal cortex.

Adult↗
PubMed2001

[Primary angiitis of CNS (PACNS)].

Primary angiitis of the CNS (PACNS) is a rare inflammatory disease affecting middle-aged patients. The angiitis is focal and segmental in distribution, involving small and medium-sized leptomeningeal and intracranial vessels. The most frequent presenting symptoms are headaches, focal neurologic deficits, and confusion. In addition, aphasia, neuropsychological deficits, and seizures may occur. The paper presents a review of the literature. In addition, a typical case of PACNS is presented. This case demonstrates that diagnosis of PACNS is difficult and brain biopsy is essential to confirm it.

Adult↗
PubMed2001

Cardiovascular reactions induced by unpredictable, predictable, and controllable painful stimuli during sphygmomanometry.

Sphygmomanometry is the most common technique of blood pressure (BP) determination. In order to study effects of predictability and controllability in sphygmomanometric BP measurements, 72 normotensive healthy subjects were examined. BP was determined continuously and non-invasively using a Finapres device (Penaz-technique) and by sphygmomanometry. Five sphygmomanometric measurements took place, during the fourth the arm cuff was inflated to 300 mmHg, the others were done with a pressure of 175 mmHg. Subjects were randomly assigned to one of three groups: In one group the recordings were unpredictable to the subject, in the second group measurements were announced 1 min before cuff inflation took place, and in the third group, subjects could decide when the sphygmomanometric recordings should occur. With unpredictable measurements systolic and diastolic BP decreased (approx. 5 mmHg). When sphygmomanometric recordings were controllable or predictable to the subject BP remained relatively stable. We would suggest that automatic BP devices (e.g. in ambulatory BP monitoring) should generally work with acoustic signals, making cuff inflation predictable for the subject.

Acoustic Stimulation↗
PubMed2001

Crossed effects of muscle vibration on motor-evoked potentials.

OBJECTIVES: Muscle vibration (MV) to a forearm muscle augments motor-evoked potentials (MEPs) following transcranial magnetic stimulation (TMS) and the underlying mechanism involves cortical structures. Although MV-induced cortical activation is bilateral, the effects of MV on MEPs in contralateral muscles have not been investigated. METHODS: Low-amplitude MV (80 Hz, amplitude 0.5 mm, duration 4 s), subthreshold for the tonic vibration reflex, was applied to the right extensor carpi radialis muscle (ECR). MEPs were elicited (0.5, 3 and 5 s after MV onset) in the left and right ECR and flexor carpi radialis muscle (FCR) by TMS (120% of threshold at rest) to the left and right hemisphere, respectively. RESULTS: During MV of right ECR the left ECR revealed a slight non-significant augmentation of MEPs. In contrast, the left FCR showed a gradual depression of MEPs with ongoing MV and at 3 s the reduction of MEPs was significant. The time course of MEP changes in left FCR correlated with the facilitation of the vibrated right ECR. Post-vibration MEPs at 1 s after the offset of MV were still significantly decreased. CONCLUSIONS: The study demonstrates crossed effects of MV on motor cortex excitability, suggesting transcallosal MEP modulation.

Adult↗
PubMed2001

Coping strategies in episodic and chronic tension-type headache.

OBJECTIVE: To study the importance of coping with illness strategies in tension-type headache (TTH). BACKGROUND: The pathophysiology of TTH is complex, and coping with illness strategies might contribute to the transformation to a chronic form. METHODS: We examined 89 subjects (mean age, 45.6 +/- 14.8 years; range, 18 to 72 years) with episodic (n = 37) and chronic (n = 52) TTH. Patients were required to fill in a Freiburg Questionnaire of Coping with Illness (FQCI), a von Zerssen Depression Scale, quality-of-life questionnaires, and a headache home diary (over 4 weeks). In addition, pressure pain thresholds (temporal muscles) and total tenderness scores were obtained. RESULTS: Patients with chronic TTH exhibited poorer quality-of-life measures, slightly more depressive symptoms, and significantly stronger avoidance behavior and endurance strategies on FQCI scales F4 and F5 (P< .05). There was no difference between episodic and chronic TTH with respect to measures of muscle tenderness or pain thresholds. CONCLUSIONS: We conclude that disadvantageous coping with illness strategies might contribute to a transformation to chronic TTH.

Adaptation, Psychological↗
PubMed2001

Rescue lifting system (RLS) might help to prevent death after rescue from immersion in cold water.

OBJECTIVE: In order to prevent sudden death after rescue from immersion in cold water, victims should be handled carefully avoiding additional cardiovascular stress. In this study we investigated if a new double-sling rescue system ("Rescue Lifting System-RLS) was superior to conventional single-sling techniques. METHODS: We studied 14 healthy male subjects in good physical condition aged 21 to 40 years. They were lifted up from the ground with the new RLS and two conventional techniques ("Lifesling" and a navy rescue system used in SAR helicopters). Heart rate was determined by QRS detection (Polar Precision Performance device; Polar Electro Oy, Kempele, Finland) and blood pressure by sphygmomanometry. RLS and "Lifesling" were tested under conditions of dry land and immersion in 18 degrees C water. RESULTS: Rescue with RLS induced only moderate heart rate changes which were significantly lower (about 30 bpm) than with conventional techniques. These findings could be reproduced under "wet" condition. DISCUSSION: RLS enables rescue in a supine position avoiding extensive orthostatic stress. It might therefore be favourable in preventing sudden death after rescue from immersion in cold water.

Adult↗
PubMed2001

Neutralizing botulinum toxin type a antibodies: clinical observations in patients with cervical dystonia.

Neutralization of antibodies poses a problem for a substantial number of cervical dystonia (CD) patients treated with botulinum toxin type A (BoNT/A). Presence of these antibodies may lead to a secondary nonresponse to BoNT/A treatment. In this study, we compared 6 antibody-positive (Ab+) with 12 antibody- negative (Ab-) CD patients treated with BoNT/A (Dysport) and matched for du- ration of treatment, number of BoNT/A injections, and severity of clinical symptoms. The two groups differed in cumulative BoNT/A dose (Ab+, 5984 mouse units [MU ], SD = 3151 MU; Ab-, 3143 MU, SD =1294 MU; P <.05), in addition, ab+ patients were significantly younger (ab+ mean age = 41.3 y, sd =5.9 y; ab - mean age = 56.8 y, sd = 15.3 y; p <.05), in or- der to avoid formation of neutralizing antibodies, doses of bont/a should be kept as low as possible, the risk of antibody formation seems to be higher in younger patients.

Adult↗