[25 years after CO poisoning].
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Atrophy↗
Biomedical subjects
J Kesselring
Publications and source records attributed to J Kesselring.
Multiple sclerosis and infectious childhood diseases.
To examine a possible relationship between infectious diseases and multiple sclerosis (MS) an enquiry was carried out among 606 MS patients in Switzerland. The data concerning their infectious childhood diseases were compared with epidemiological data for the normal Swiss population obtained from the Swiss Federal Health Office and from the Institute of Medical Statistics. The mean age of the MS patients was 50.7 years and the mean age at onset of multiple sclerosis was 33.8 years, significantly earlier in women (33.2 years) than in men (35.4 years, p < 0.05). In 18.8% multiple members of the family were affected. In comparison with persons of the control population, MS patients had measles infection at a later age (6.4 vs. 7.5 years). The curve of the age at which several infectious childhood diseases occurred was shifted to higher ages for MS patients (p < 0.005) compared to normal controls for mumps (80.2% for MS vs. 64.1% for controls in the age group 5-14 years), rubella (64.3% for MS vs. 48.4% for controls in the age group 5-14 years) and varicella (81.9% for MS vs. 39.0% for controls in the age group 5-19 years). For pertussis, however, there were more cases among those who later developed MS in the age group 1-9 years, which was earlier than in controls (86.0 vs. 56.7%). These results are compatible with the hypothesis that the risk of developing multiple sclerosis may be associated with acquiring certain infectious childhood diseases at a later stage in comparison to normal controls.
Adolescent↗
[Leg pain--the contribution of the neurologist].
Pain syndromes in the lower limbs are a particular challenge for the clinical neurologist. Pain may be due to various disorders of the central and peripheral nervous system or muscles of different etiologies. There is a continuum from slightly unpleasant sensory disturbances to nociception. Differential diagnosis must be sought according to topological and pathophysiological interpretation of the clinical findings. This will determine the necessary diagnostic requirements and therapeutic procedures. Within the central nervous system lesions of the nociceptive projections of the spinal cord or brain may lead to pain in the lower limbs. Furthermore, different pathologies of the peripheral nervous system (root, plexus, peripheral nerve) or muscles can cause pain. Finally, pain syndromes are known in clinical syndromes with disturbances of the muscle tone (extrapyramidal syndromes, spasticity) and secondary to postural problems in patients with muscular dysbalance due to paralysis.
Diagnosis, Differential↗
[Neurology 1997: a therapeutic specialty?].
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Forecasting↗
[Prognosis in multiple sclerosis].
Prognosis of the natural course of multiple sclerosis is most often measured on Kurtzke's "expanded disability status scale" (EDSS), a non-linear scale over 20 steps, heavily weighted on mobility. Optic neuritis and sensory disturbances as initial symptoms, lower age at onset of the disease, female sex and a longer interval between relapses are indicators of a more favorable prognosis. As a rule, disability as measured on this scale 5 years after onset corresponds to 3/4 of the disability status after 15 years. The number of relapses diminishes naturally over the course of the disease. Presence and extent of lesions on the initial MRI of the brain in clinically isolated syndromes are valuable predictors of dissemination of the disease process over the following 5-10 years. New therapies (e.g. interferon beta 1b and 1a, copolymer 1) reduce relapse frequency by 1/3 and diminish the extent of pathological lesions in brain MRI, but fail to show (as yet) significant influence on disability.
Adult↗
Spasticity, ataxia and fatigue in multiple sclerosis.
Multiple sclerosis frequently results in a wide range of symptoms which often coexist, creating a complex pattern of disability. Chief among these symptoms, both in relation to their frequency and their impact on the patient, are spasticity, ataxia and fatigue. This chapter discusses the pathological basis and current treatment of these symptoms and stresses the importance of a multidisciplinary approach to their management, producing a comprehensive care plan which incorporates these and any other coexisting problems.
Ataxia↗
Antidopaminergic antibodies in a patient with a complex autoimmune disorder and rapidly progressing Parkinson's disease.
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Adult↗
[Developments in neurology from the 19th to the 20th century with special reference to various contributions from Switzerland].
Several modern concepts of the nervous system have developed since the last century: Their influence on modern neurology is traced by notes from biographies and the work of leading Swiss neurologists and neurobiologists. 1. Psychiatrists working in neuroanatomy: Auguste Forel, Constantin von Monakow, Bernhard Aloys von Gudden and Eduard Hitzig. 2. Anatomists who influenced the development of the "neurone-theory": Rudolf Albert von Kölliker and Wilhelm His Senior. 3. A practising physician developing "interactionism" as a basis for neurorehabilitation: Heinrich Simon Frenkel. 4. Behavioural aspects considered within a general framework of neurobiology: Walter R. Hess. 5. Neurosurgery: Hugo Krayenbühl.
Europe↗
High prevalence of multiple sclerosis in Switzerland.
Prevalence of multiple sclerosis (MS) was determined in the Canton of Berne, Switzerland. This canton is a geographically diverse region at 47 degrees northern latitude with 920,000 inhabitants. Epidemiological data were obtained from the case records of the University Department of Neurology, from the Swiss MS Society, from practising neurologists and from regional hospitals. Diagnostic accuracy was ascertained in retrospect, and only those cases fulfilling the criteria proposed by the Poser Committee were included. Of the patients provided by the Swiss MS Society, only those who had been diagnosed by a neurologist were accepted as definite cases. Changes of population due to migration or death were traced at governmental registry offices, and the place of residence was determined. Using the 1,016 cases of definite and probable MS identified, the minimal prevalence rate was 110 MS cases/100,000 inhabitants in the Canton of Berne on January 1, 1986. The increase in MS in this region since the 1950s was due mainly to the increase in life duration of MS patients rather than an increase in incidence rates over the last 20 years.
Adolescent↗
Rotation-induced change of muscle tone.
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Hemiplegia↗
[Neurological side effects following vaccination of early-summer meningoencephalitis. Case report and experiences of the Swiss Center for Adverse Drug Effects].
Two weeks after vaccination against tick-born encephalitis (TBE) a 69-year-old patient developed subacute myelo-polyradiculitis. The neurological symptoms subsided after a few weeks. Alerted by this observation, we scanned the database of the Swiss Drug Monitoring Center (SANZ) for similar case reports. Of twenty spontaneous reports 11 concerned neurological side effects closely related to TBE vaccination. We conclude that TBE vaccination is associated with substantial neurological side effects and should, therefore, remain restricted to individuals at high risk for TBE.
Adolescent↗
[Multiple sclerosis--what should be done?].
Major progress in MS-research has been achieved in recent years concerning diagnosis and differential diagnosis, pathogenetic mechanisms and prognostic indicators. Symptomatic treatment and prevention of complications help to improve quality of life and to prolong expected duration of life. Treatment trials intended to influence the course of the disease must still be considered experimental. Comprehensive rehabilitation remains the cornerstone of long-term management in MS. First results of carefully designed placebo-controlled double-blind studies, however, justify the expectation, that more efficient measures to influence the course of the disease will be available in the near future.
Combined Modality Therapy↗
[Gait analysis--a prerequisite for general movement analysis].
Our system for analysis of gait is a combined visualisation of angular velocities in any joint with dynamic measurements of pressure at the sole while walking in a natural surrounding. Infrared reflectors are attached to chosen parts of the body. Their position in space is sampled over time and transferred to an easily manageable personal computer that visualizes motion in progression as angular velocities. Pressure at the sole is measured by pressure sensors. The magnitude of force is expressed as calibrated circular areas following the dynamic course of gait. The system is accurate and easily operated. The time necessary for measurements and evaluation of data as well as the costs render an application in daily clinical work acceptable.
Foot↗
[Neurology of behavior as basis in neuro-rehabilitation].
Based on phylogenetic and ontogenetic aspects of sensorimotor development, human behaviour may be differentiated on three levels: (1) visceration as movements within the organism itself; (2) expression of inner states in posture, language and gesture by which only other living organisms can be influenced (socioverse activity); and (3) effectuation, which leads to changes of the living and material environment by direct contact (materioverse activity). These levels of behaviour are organized in different, cooperating structures of the central nervous system. Knowledge of them, and their practical applicability, form the basis of neurorehabilitation.
Behavior↗
[Value of neuro-rehabilitation. Attempt at quantification as exemplified in 312 stroke patients in the Valens Hospital].
Functional recovery was assessed in 312 patients with hemiplegia (153 right, 159 left) due to stroke (210 men, 102 women), who were treated at the Rehabilitation Centre, Valens, Switzerland. A scoring system was developed using a number of items in hierarchic order for gross function (13 items), leg and trunk (10 items) and arm (15 items). The test was applied at entry and at monthly intervals during treatment. The difference in scores before and after the rehabilitation program was statistically highly significant, irrespective of age and time interval between stroke and onset of treatment. Two thirds to three fourths of patients who were wheelchair-bound at entry no longer used a wheelchair at the end of the treatment period. Lower scores at entry necessitated longer rehabilitation.
Activities of Daily Living↗
[Rehabilitation in multiple sclerosis].
Rehabilitation is the only effective treatment in multiple sclerosis (MS), as long as the cause of this commonest neurological disease of younger adults is not known. No medical treatment constantly influences the course of the disease. Methods for restitution of functional impairments, for improvement of abilities and for adaptation of daily life according to constraints caused by disability and handicap are applied with the goal of enlarging personal free space. Inadequate prevention of complications is often the cause for apparent progressive deterioration of the disease. Efficient symptomatic therapies have helped to increase life expectancy and to improve quality of life of MS patients in recent years.
Humans↗
[Steroid therapy in multiple sclerosis].
Since the 1950s steroids have been known to have a beneficial effect on recovery from acute exacerbations of multiple sclerosis. The main effect is a more rapid improvement after acute relapses due to resolution of edema in the central nervous system. Long-term steroid therapy showed no benefit in patients with a progressive course and involves dangerous side effects (Cushing's habitus, hyperglycemia, increased susceptibility to infections, peptic ulcers, osteoporosis, cataract). Intrathecal steroid administration offered no advantage over the conventional i.v. route. On the basis of a multicentre trial, ACTH therapy became the standard regime in the treatment of acute exacerbations. Recent reports have demonstrated a beneficial effect of therapy with high-dose methylprednisolone. Taking into account the restrictions and possible side effects, this therapy is a safe and efficient alternative to the standard ACTH regimen in the treatment of acute exacerbations in multiple sclerosis.
Adrenocorticotropic Hormone↗
[Sequelae of severe craniocerebral injuries. An epidemiological study in the Canton of St. Gallen].
Severe head injuries often lead to serious medical and socioeconomic sequelae. The incidence rate indicated in other studies shows a wide variation due to differences in selection criteria. Based upon an unselected population, the incidence of severe head injury was calculated and the surviving patients were interviewed and clinically examined 3 years after the accident in order to describe the course, rehabilitation and psychosocial sequelae after severe head injury. Retrospectively we collected 80 patients living in the canton of St. Gallen who had a severe head injury requiring hospitalization in 1987, indicating an incidence of 20 per 100,000 inhabitants. 22 (28%) of these patients died as a consequence of the head trauma. The best predictor was the Glasgow coma score at admission, which showed a highly significant direct correlation with survival rate. Regarding the degree of impairment of survivors the duration of posttraumatic amnesia was the best predictive parameter. Of the 45 patients controlled 3 years after the head trauma only 11% were severely impaired in daily activities. 79% of the patients who were gainfully employed before the accident were working full- or at least part-time. However, only 3 patients (7%) were absolutely free of symptoms. Most patients suffered from cognitive and emotional deficits. Based on an estimated incidence for minor head trauma of 174 per 100,000 inhabitants, a total annual incidence for all head traumas of 194 per 100,000 inhabitants is calculated, with severe head injury representing about 1/9 of all head injuries.
Adolescent↗