Clinical Neuroscience

Congenital myasthenic syndromes (CMS) represent a heterogeneous group of disorders in which the safety margin of neuromuscular transmission is compromised by one or more specific mechanisms. Clinical, electrophysio-logic, and morphologic studies have paved the way for detecting CMS-related mutations in proteins residing in the nerve terminal, the synaptic basal lamina, or in the postsynaptic region of the motor endplate. The disease proteins identified to date include the acetylcholine receptor, acetylcholinesterase, choline acetyltransferase, rapsyn, and Na v 1.4, muscle-specific kinase, agrin, β2-laminin, downstream of tyrosine kinase 7, and glutamine-fructose-6-phosphate transaminase 1. Analysis of electrophysiologic and biochemical properties of mutant proteins expressed in heterologous systems have contributed crucially to defining the molecular consequences of the observed mutations and have resulted in improved therapy of most CMS.

Lesioning or chronic deep brain stimulation (DBS) of the nucleus ventralis intermedius results in abolition of tremor in the contralateral limbs in Parkinson's disease (PD) and also in essential tremor. Recently, chronic DBS of the subthalamic nucleus has also proved to be very effective in reducing contralateral limb tremor in PD. These targets have been less effective in controlling the complex limb tremor often seen in multiple sclerosis (MS). Consequently, other targets have been sought in cases of MS with tremor. We describe a patient with MS with disabling proximal and distal involuntary arm movements in whom we were able to obtain sustained control of contralateral arm tremor and achieve functional improvement of the affected arm by chronic DBS of the region of the zona incerta. We also highlight the important role played by local field potentials recorded from the brain, with simultaneous recording of corresponding EMGs, in target localisation.

Frontal intracerebral haemorrhage (ICH) is a common result of cranial trauma. Outcome differences between bilateral and unilateral frontal ICH are not well studied but would be valuable to predict prognosis in clinical practice. Two aims are proposed in this study: first to compare the risk of developing delayed ICH after bilateral or unilateral frontal ICH, and second to determine the variables helpful to predict outcome according to the Glasgow Outcome Scale (GOS). Between January 1993 and December 1997, 694 consecutive patients with traumatic ICH were admitted to the Chang Gung Medical Center within 24 h of the trauma. Patients with ICH in sites other than the frontal lobes were excluded. A total of 161 cases (mean age 46.3 ± 20.3 years), including 57 bilateral (mean age 52.5 ± 18.7 years) and 104 unilateral (mean age 42.9 ± 20.5 years) traumatic frontal ICH were studied. Twenty-eight of 57 patients (49%) with bifrontal ICH versus 17 of 104 patients (16%) with unilateral frontal ICH had a further, delayed ICH. In 42 of 45 patients (93%) with delayed ICH, this occurred within 5 days of the initial trauma. Multivariate logistic regression was used to select significant predictors of outcome. We found that delayed ICH (p < 0.001), age (p = 0.004) and mechanism of injury (p = 0.001) explained the worse outcome in patients with bifrontal ICH. The best-fitting logistic regression model included three variables: delayed ICH (p = 0.011), initial GCS (p = 0.023), and a sum score of clinical and radiological variables (p = 0.003). Bifrontal ICH tended to occur in older patients after a fall and was associated with a higher risk of developing delayed ICH or brain stem compression compared to unilateral ICH damage. Using these three variables-delayed ICH, initial GCS, and the sum score-in a logistical regression model is useful to predict outcome in patients with traumatic frontal ICH and may aid patient management.

Photodynamic therapy (PDT) is a binary treatment modality that has been used to treat malignant brain tumours for 25 years. The treatment involves the selective uptake of a photosensitizer (PS) by the tumour cells followed by irradiation of the tumour with light of the appropriate wavelength to excite and activate the PS resulting in selective tumour destruction and is a potentially valuable adjunct to surgical excision and other conventional therapies. PDT has undergone extensive laboratory studies and clinical trials with a variety of PS and tumour models. These are discussed with reference mainly to clinical studies involving the PDT of brain tumours.

A 72-year-old man with a past medical history of hypertension, diabetes, peripheral vascular disease, tobacco use, history of ischemic stroke in 2003 with residual right hemiparesis, on aspirin and clopidogrel, presented with sudden worsening right-sided weakness and dysarthria. The day before admission, his wife noticed that the patient could not get up from a chair because of worsening right lower extremity weakness. He was also noted to have slurred speech with word finding difficulties. The patient was brought to the emergency department the next day due to persistent symptoms. Upon arrival, the patient was alert and able to follow commands. Head CT and an MRA was performed (Fig. 1A and B). Also, an initial MRI was performed (Fig. 1C). Forty-eight hours after admission, he developed left-sided weakness. Three days later, patient was unable to verbally communicate or follow commands and became apathetic. He was able to follow the examiner with his eyes but unable to move upper or lower extremities, findings consistent with akinetic mutism. An emergent MRI was performed (Fig. 1D). 2. The most likely diagnosis is A. Multiple sclerosis B. Bilateral infarction of the anterior cingulate gyri C. Chronic microvascular changes D. Acute intracranial hemorrhage E. Glioblastoma multiforme Answer on page 248.

Wilson's disease (WD), a familial neurological disorder involving the brain and liver secondary to altered copper metabolism, is common in South India. In view of the paucity of studies on this condition, the pathomorphological features of eight cases of WD were studied in detail at autopsy (brain alone, 1; brain and liver biopsy, 1; brain and visceral organs, 6), and are described with a discussion of the differential features of the neurological and hepatic forms. Of the six patients presenting with neurological manifestations, five had central pontine myelinolysis, five had subcortical white matter cavitations, four had putaminal softening, and six had variable ventricular dilatation, unlike the hepatic form. The presence of Opalski cells and pontine myelinolysis appear to be specific to the neurological form of WD. Liver abnormalities were observed in all cases (cirrhosis, 6; steatosis, 4; chronic active hepatitis, 2). Contrary to the rubric 'hepatolenticular degeneration', involvement of the lenticular nucleus was not universal, and nor was the pathology restricted to these anatomical areas.

Migraine and multiple sclerosis (MS) can both cause white matter lesions that appear similar on conventional MRI. This study aimed to compare these abnormalities, and to find anatomical biomarkers specific for migraine. Supratentorial white matter hyperintensities (WMH) of 17 migraineurs and 15 patients with MS were counted, volumetrically analyzed, and their lobar distribution assessed on fluid-attenuated inversion recovery MRI. We found that migraine WMH affected mainly the deep white matter and subcortical U-fibers, belonged to the anterior circulation, appeared more frequently in the frontal and parietal lobes, showed no difference in average size between lobes, and were smaller and fewer than in MS. Most of the MS WMH were in the frontal lobe and were the smallest average size, while the fewest WMH with the largest size were in the occipital lobe. The pattern of supratentorial WMH appearance differs between the two groups; however, accurate differential diagnosis of WMH by conventional MRI is probably not possible in individual patients.

Vestibular schwannoma (VS) is a benign tumour arising from the vestibular component of the vestibulocochlear nerve. Treatment protocols range from observation to microsurgical resection (MS) or radiation therapy using focused delivery techniques: either stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT). Most reported outcome measures explore medically orientated results such as extent of resection or facial nerve function and do not give any insight into how the initial disease, the treatment or operative complications impinge upon the patient's quality of life (QoL). The primary aim of this review was to appraise the quality of research concerning the measurement of QoL in patients with VS. A systematic review was performed including trials of patients with newly diagnosed VS undergoing MS, SRT/SRS, or observation with a measure of QoL. Only trials of prospective design were included. Excluded trials included participants with recurrent disease or comorbidities, and studies reporting patients with VS in association with neurofibromatosis type 2. Each trial for inclusion was assessed for bias and underwent formal data extraction. Between 1973 and 2010, 47 unique trials were identified with eight trials of prospective design. All included studies were prospective non-randomised, observational convenience sampled trials. No randomised control trials or systematic reviews were identified. The most common QoL measure used was the Short Form Questionnaire (SF-36), although it has not been validated in VS. The included trials suggest that the treatment protocols of MS and SRS/SRT are of equal efficacy with regard to impact on QoL; however, the trials were hetereogenous and suffered from a variety of methodological deficiencies. Given this heterogeneity, no meta-analysis was able to be performed. The available literature on QoL in the treatment of VS suffers from significant methodological weaknesses making it difficult to make any assessment as to the efficacy on QoL of available treatment options for VS. Further well-designed, randomised prospective research is necessary to understand this condition, its effect on QoL and how QoL outcomes may be used alongside clinical indicators in making treatment decisions.

Spontaneous ventriculostomy (SV) is a rare condition where there is a spontaneous communication between the ventricle and the subarachnoid space as a result of hydrocephalus. Only four cases of SV through the floor of the third ventricle have been previously reported. Two further cases are presented and the literature reviewed.

amyotrophic lateral sclerosis motor neurons superoxide dismutase 1 a b s t r a c t Amyotrophic lateral sclerosis (ALS) is a rare and lethal neurodegenerative disease for which there is no effective medical treatment. Although riluzole, an N-methyl-D-aspartate receptor antagonist, has been shown to be reasonably safe for patients with ALS, the drug has been demonstrated to prolong median survival by only 2e5 months. There is mounting evidence that stem cell-based gene therapy is a promising treatment modality for patients with ALS. In this review, we focus on the types, sources, and doses of stem cells that have been shown to be effective for ALS patients, the differences in cytokines or chemokines secreted from these various stem cells, and the immune-modulation activity of stem cells as treatment for ALS.

A cranioplasty has long been thought to be therapeutic. This patient confirms this by illustrating a serious complication that may occur following cerebellar herniation through an occipital defect. It should alert readers to the fact that although there may be no immediate complications associated with not closing the dura or replacing the bone flap, the uncommon problem described in this paper is serious and potentially life-threatening. Thus, we recommend adequate dural and bony closure for all intracranial surgery, particularly in the posterior fossa. We are not aware of a similar report following posterior fossa surgery.

Functional MRI studies on patients with multiple sclerosis (MS) have demonstrated widespread cortical reorganization of the motor network. However, few functional studies have addressed cortical plasticity in patients with clinically isolated syndrome (CIS). The activity of the lower limb motor system, despite its highlighted involvement in patients with CIS and MS, has been little studied. Thus, brain activation was compared in CIS patients with clinically intact motor systems with that in healthy control participants while they were performing motor tasks with four limbs. A total of 26 right-handed patients with CIS with clinically intact motor systems and 28 right-handed age and sex-matched controls participated in the functional MRI (fMRI) motor task. Patients with CIS showed greater activation in the ipsilateral secondary somatosensory cortex, cingulate gyrus and precuneus cortex while performing the ankle movement task compared to healthy controls. In the finger-tapping task, patients with CIS showed greater activity in the contralateral thalamus, ipsilateral premotor and superior temporal gyrus. In addition, the left inferior frontal gyrus was activated more in patients with CIS, regardless of the hand used. Therefore, despite having clinically intact motor systems, patients with CIS had different motor networks. All novel recruited regions were adjacent to the somatotopy of the primary motor areas of the limbs. Our finding confirm that brain reorganization precedes clinical manifestation, as no patient had any clinical manifestation that suggested involvement of the motor system.

Idiopathic normal pressure hydrocephalus (INPH) is a potentially treatable form of dementia but its diagnosis is difficult and the effectiveness of shunting remains controversial. This study investigates the clinical outcomes of ventriculo-peritoneal shunting in a controlled trial of 33 consecutive patients with INPH. Mean age was 77.2 years (range 58-92 years) and the duration of symptoms was 4.6 years (3 months-14 years). Nineteen patients underwent shunt surgery. At 3-4 months follow-up, patients who had undergone shunt surgery, compared to those who had not (controls), had significantly better global change ratings (median Clinician's Interview Based Impression of Change with Carer Input rating of 2 [moderately improved] versus 6 [moderately worsened], respectively, p < 0.001), had increased Mini Mental State Examination scores by 5 points (p < 0.001) and were 6.3 s faster on the Timed ''up and go" test (p = 0.008). We conclude that ventriculo-peritoneal shunting is associated with improved clinical outcomes for patients with INPH.

Brain abscesses are rare but potentially deadly complications of odontogenic infections. This phenomenon has been described mainly in the form of case reports, as large-scale studies are difficult to perform. We compiled a total of 60 previously published cases of such a complication to investigate the predisposing factors, microbiology, and clinical outcomes of intracranial abscesses of odontogenic origin. A systematic review of the literature using the PubMed database was performed. Men accounted for 82.1% of cases, and the mean age was 42.1years. Caries with periapical involvement and periodontitis were the two most common intra-oral sources, and wisdom tooth extraction was the most common preceding dental procedure. In 56.4% of cases, there were obvious signs of dental disease prior to development of intracranial infection. Commonly implicated microorganisms included Streptococcus viridans (especially the anginosus group), Actinomyces, Peptostreptococcus, Prevotella, Fusobacteri...

A full investigation into the features extracted from voice signals of people with and without Parkinson's disease was performed. A total of 31 people with and without the disease participated in the data collection phase. In this study subjects' voice signals were used to let computer decide whether the person is suffering from the disease or they are not. Methods: Their voice signals were recorded and processed. The relevant features were then extracted. Features were fed to different classifiers so as to be let them decide whether the subjects have the disease or not. Three different classifiers were used in order to rule out any doubt about the validity of classification performance on the given data. Results: The use of a variety of feature selection methods resulted in a good performance for the diagnosis of Parkinson. The classifiers' performances were compared with one another and showed that the best performance was obtained with a correct rate of 0.9382 when using the KNN classifier. Discussion: Results reveal that the use of proposed feature selection method results in a desirable precision for the diagnosis of Parkinson's disease (PD). The performances were assessed from different points of view, providing different aspects of the diagnosis, from which the physicians are able to choose one with higher accuracy in the diagnosis.

Intracranial hemangioblastomas are benign vascular tumors. The peak age of incidence is between 20 to 50 years. Hemangioblastomas rarely occur in patients over the age of 65. To our knowledge there is no review of the prevalence and clinical features in an elderly population. We reviewed our 12 year experience with intracranial hemangioblastomas, and characterized the clinical features of hemangioblastomas in patients over the age of 65. We present a 72-year-old man with a cerebellar mass initially thought to be a metastasis as an illustrative case. We reviewed our pathology database and identified all patients with a histopathologically confirmed diagnosis of hemangioblastoma over the last 12 years in a large tertiary adult hospital; all patients were over the age of 18. Of all cases of hemangioblastoma in the last 12 years, six of 77 (7.7%) occurred in patients over the age of 65. All were cerebellar in location, and none were associated with von-Hippel Lindau disease. Hemangioblastomas are uncommon, but not rare, in patients over the age of 65, and should be included in the differential diagnosis of patients presenting with gait ataxia and a cerebellar lesion in this age group.

Most contemporary text books of neurology and of psychology pay little attention to the function of the cerebellum beyond noting it to be an organ of motor control. A historical overview of research on cerebellar function is presented, from pre-Sherrinton suggestions of sensory and motor function, through the post-Sherrinton and dominant 20 th . Century view of "motor" function, to the 21 st . century perspective of "sensorimotor" function. The intrinsic capability of the cerebellum is briefly considered in terms of: its size/complexity/capacity; its information representation/processing characteristics (with "a particular computational function"); its sensory information processing capability; and, its role in sensorimotor regulatory control. It is suggested that the cerebellum can process sensorimotor stimulus information in a statistical (connectionist type) manner and respond to in on the basis of its own learning based sensorimotor representations, albeit at a "level" that does not necessarily involve cerebral "awareness".

Recent functional imaging studies suggest deficits in connectivity between disparate and distant regions in the brains of autistic individuals. One possible explanation to these findings is the presence of modular abnormalities in the neocortex of autistic patients: a change in neuronal specialization within minicolumns that emphasizes short connecting fibers. In this study, we expand on previous findings by exploring the topography of minicolumnar abnormalities in autism. Our postmortem study included six patients with autism (DSM-IV-TR and ADI-R diagnosed) and six age-matched controls. Entire brain hemispheres were celloidin embedded, serially sectioned, and stained with gallocyanin. Digital photomicrographs of n = 9 cortical areas (including paralimbic, heteromodal association, unimodal association, and primary areas) obtained at high magnification were assembled into montages covering the entire cortical thickness. Stained cell somata were segmented from neuropil by thresholding. Computer image analysis clustered neurons into minicolumnar fragments. The full width of the image region nearest each fragment and the width of the cell-dense core of the fragment were estimated. The difference between these two quantities can be used as a measure of the peripheral neuropil space of minicolumns. We found an interaction of diagnosis and region for peripheral neuropil space (p = 0.041). Post hoc analysis revealed significant differences (p < 0.05) for the frontopolar region (area 10) and the anterior cingulate gyrus (area 24). The frontopolar cortex is involved in executive functions by implementing control over internally generated thoughts and relational integration (combination of multiple cognitive rules). The anterior cingulate gyrus is involved in the analysis of socially salient information, including the processing of familiar faces. Pathological findings in these areas may provide a correlate to some of the more salient manifestations of autism.

Cerebellar ptosis and dural prolapse are known complications after posterior craniocervical decompression of Chiari 1 malformation (CM1), and are associated with larger craniectomies, epidural scarring and intradural adhesions. Although management of these complications has been well documented, little has been reported in regards to their prevention. We describe our variation of the posterior fossa decompression technique for CM1 using a titanium mesh-assisted dural tenting expansile cranioplasty to prevent both cerebellar ptosis and dural prolapse. A watertight dural augmentation patch is performed after posterior craniocervical decompression. A titanium mesh cranioplasty is performed to cover the superior aspect of the craniectomy. The duraplasty is then tented to the titanium mesh plate with several interrupted sutures. The titanium mesh plate was intended to prevent postoperative cerebellar ptosis or sag, while the dural tenting was performed to prevent delayed collapse and res...

BCNU has an established role in the treatment of high-grade gliomas and has previously been used as first line therapy for recurrent disease. More recently, Temozolomide has taken its place as first line therapy for recurrent high-grade glioma. Thus, BCNU has become our standard second line therapy following disease progression after Temozolomide therapy. This study retrospectively analysed the activity and toxicity associated with BCNU as second line therapy. Twenty four patients with recurrent high-grade gliomas were treated with BCNU having previously received Temozolomide. Patients received BCNU intravenously at 130-200 mg/m 2 every 6 weeks. The median number of treatment cycles was two (range 1-8). Of the 24 patients, one patient (4%) achieved a partial response and six (25%) achieved a minor response or stable disease. BCNU was generally well tolerated. In conclusion, BCNU has limited activity as second line chemotherapy following the use of Temozolomide. Novel strategies are required in this patient group. ª

A subjective study of a hemianopic field defect was reported to the London Royal Society in 1824. The German ophthalmologist Albrecht von Graefe devised a means of mapping field defects, which evolved into quantitative perimetry as an exact method of localizing lesions in the visual pathways. Knowledge of these pathways increased during the nineteenth century; final identification of the visual cortex in the occipital lobe was achieved by Japanese and British ophthalmologists and neurologists on the basis of wartime studies of field defects due to cerebral missile wounds.

Artigo Resumo O artigo apresenta parte de uma pesquisa de mestrado que utilizou como referencial epistemológico a teoria da criatividade de Winnicott. A investigação aconteceu a partir de entrevistas com professores da 2a Fase do Ensino Fundamental de escolas da rede pública e particular de Brasília-DF, a fim de compreendermos a interpretação dos educadores sobre o processo de constituição do sujeito-aluno no entretecer de comportamentos transgressores e criativos no trabalho-educar. Concluiu-se que a transgressão pode ser considerada parte do processo criativo para o aluno, tanto em relação a ações e produções no mundo social quanto à criação da própria identidade do indivíduo. Descritores: transgressão; criatividade; constituição do sujeito.

Temporal lobe epilepsy (TLE), the most common form of partial epilepsy in adults is often refractory to medical treatment and in these patients epilepsy surgery is considered. Successful surgery is dependent on accurate localisation and lateralisation of the epileptogenic zone. The preoperative evaluation involves a series of assessments and investigations including detailed clinical history, interictal EEG, video-EEG monitoring, MRI, PET,

Low pressure headache typically occurs as a complication of dural puncture. ''Spontaneous'' low pressure headache is a relatively rare but under-recognised cause of intractable headache. Clinical suspicion of this condition warrants imaging of the brain to confirm the diagnosis; spinal imaging may be needed to identify the site of the leak. Epidural blood patching may be necessary to seal the leak-CT fluoroscopy may be helpful in delivering the patch directly to the site of the leak. Surgical intervention may be required in intractable cases. We describe a patient with spontaneous intracranial hypotension and review the clinical and radiological features of this syndrome.

The effectiveness of botulinum toxin injections in 11 patients with hemifacial spasm was investigated in a prospective placebo-controlled blinded study. The patients were treated with four sets of injections to various facial muscles, selected by clinical evaluation. Three injections were with graded doses of toxin and one was with placebo. The order of injections was random and unknown to the patients. Results were scored both subjectively by patient assessment of symptoms and objectively by blinded review of videotapes made one month after each injection. Subjective improvement occurred after 79% of injections with botulinum toxin, regardless of dose of toxin. Only 1 patient improved after placebo. Objective improvement was seen after 84% of injections with botulinum toxin. No patient showed objective improvement after placebo injection. The most frequent side effect was facial weakness, seen after 97% of injections of botulinum toxin. Facial bruising (20%), diplopia (13O/0), ptosis (7%), and various other mild side effects were seen less frequently. Botulinum toxin appears to be an effective and safe method of therapy for hemifacial spasm. 0 1992 John Wiley & Sons, Inc.

Anterior cervical discectomy and fusion (ACDF) is a widely accepted surgical treatment for symptomatic cervical spondylosis. Some patients develop symptomatic adjacent segment degeneration, occasionally requiring further treatment. The cause and prevalence of adjacent segment degeneration and disease is unclear at present. Proponents for motion preserving surgery such as disc arthroplasty argue that this technique may decrease the ''strain'' on adjacent discs and thus decrease the incidence of symptomatic adjacent segment degeneration. The purpose of this study was to assess the pre-operative prevalence of adjacent segment degeneration in patients undergoing ACDF. A database review of three surgeons' practice was carried out to identify patients who had undergone a one-or two-level ACDF for degenerative disc disease. Patients were excluded if they were operated on for recent trauma, had an inflammatory arthropathy (for example, rheumatoid arthritis), or had previous spine surgery. The pre-operative MRI of each patient was reviewed and graded using a standardised methodology. One hundred and six patient MRI studies were reviewed. All patients showed some evidence of intervertebral disc degeneration adjacent to the planned operative segment(s). Increased severity of disc degeneration was associated with increased age and operative level, but was not associated with sagittal alignment. Disc degeneration was more common at levels adjacent to the surgical level than at non-adjacent segments, and was more severe at the superior adjacent level compared with the inferior adjacent level. These findings support the theory that adjacent segment degeneration following ACDF is due in part to the natural history of cervical spondylosis.

In this study, we reported the reliability and validity of Bedside version of Persian WAB (P-WAB-1) adapted from Western Aphasia Battery (WAB-R) (1,2). P-WAB-1 is a clinical linguistic measuring tool to determine severity and type of aphasia in brain damaged patients based on Aphasia Quotient (AQ) as a functional measure. For the purposes of a quick clinical screening of aphasia in Persian, we adapted the bedside version of WAB-R to assess the performance of Persian aphasic patients. The data we reported on adaptation, validity and reliability of P-WAB-1 are based on faithful translation and criterion validity ratio (CVR) taken from the expert panel and the performance of 60 consecutive brain damaged patients referred to different university clinics for rehabilitation and 30 healthy subjects as norms and 40 age-matched epileptic patients as the control group. Based on the results of this study, P-WAB-1 has internal consistency (a=0.71) and test-retest reliability (r=.65 P&lt;0.001) ...

The aim of this case series is to describe the surgical technique and postoperative outcomes for endoport-assisted microsurgical resection (EAMR) of cerebral cavernous malformations (CCM). Significant manipulation of subcortical white matter tracts may be necessary for the successful resection of CCM located in deep brain regions. Minimally invasive neurosurgical devices such as endoport systems can decrease disruption of the cortex and white matter tracts overlying deep-seated CCM through small cranial and dural openings. The role of endoport technology in modern CCM surgery is incompletely understood. Three patients with symptomatic CCM underwent EAMR at our institution using the BrainPath endoport system (NICO Corporation, Indianapolis, IN, USA). Complete resection was achieved in two patients. One patient with a large 4.5cm callosal CCM was left with a small residual lesion. There were no postoperative complications and all patients were functionally independent (modified Rankin...

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"It is a common experience that a problem difficult at night is resolved in the morning after the committee of sleep has worked on it." --John Steinbeck Scientific research confirms what people have always known: answers, ideas, and inspiration do come to us in dreams. Harvard psychologist and world-renowned dream specialist Deirdre Barrett, Ph.D., offers this rich collection of examples of how the world's most creative practitioners in art, music, film, science, literature and other fields have used the revelations of their dream life to inform their work. Dr. Barrett offers insights showing us how to encourage lucid, meaningful dreaming, and how to apply the meanings of our dreams to solving problems--from the everyday to the extraordinary. This is the stuff dreams are made of. In the visual arts, Jasper Johns couldn't find his unique artistic vision until he dreamed it in the form of a large American flag. Salvador Dali and his colleagues built the startling new genre of surrealism out of dreams. Kubla Kahn dreamed the design for his stately pleasure dome; thousands of years later, Lucy Davis, chief architect at a major firm, continues the tradition of dreaming designs into life in her extraordinary buildings. Film is a fertile avenue for dreams: "Twice I have transferred dreams to film exactly as I had dreamed them," confides director Ingmar Bergman, as have Federico Fellini, Orson Welles, Akira Kurosawa, Robert Altman, and John Sayles. From Mary Shelley's terrible nightmare, which became Frankenstein, to Stephen King's haunting dream as a little boy, which led to his first bestseller, countless writers have consulted the Committee. Musicians from Beethoven to Billy Joel and Paul McCartney have whistled the Committee's tunes. In science, physiologist Otto Loewi dreamed the medical experiment that earned him the Nobel Prize. In sports, Marion Jones dreamed she'd broken a world record, then brought the dream to life. Gandhi translated his dream of resistance into a movement that changed the world. Since Freud, we take it for granted that our dreams reflect our past. In The Committee of Sleep, Barrett reveals how dreams can also tell us about our future potential--and how to reach it.

The horizontal head impulse test (HIT) is a valuable clinical tool that can help identify peripheral vestibular hypofunction by the refixation (compensatory) saccade that returns the eyes to the target of interest after the head has stopped. We asked if there were differences in the compensatory saccade responses during the HIT when the head was rotated away or toward straight ahead (outward versus inward). We also investigated the influence of a fixation target. Using scleral search-coils, we tested five patients with chronic unilateral vestibular hypofunction (UVH) and three healthy control subjects. In UVH patients, the latencies of both overt and covert saccades were longer when the head was rotated inward from an initially eccentric position, regardless of a visual target. The proportion of HIT with covert saccades was independent of a visual target. In control subjects no compensatory saccades were observed and there were no differences in either angular vestibulo-ocular refle...

We studied the efficacy of two surgical methods used for the treatment of intracranial subdural empyema (ISDE) at our centre. A cross-sectional study (1999)(2000)(2001)(2002)(2003)(2004)(2005) of 90 patients with non-traumatic supratentorial ISDE revealed that the two surgical methods used for empyema removal were burr hole/s and drainage (50 patients, 55.6%) and a cranial bone opening procedure (CBOP) (40 patients, 44.4%). Patients in the CBOP group had a better result in terms of clinical improvement (chi-squared analysis, p = 0.006) and clearance of empyema on brain CT scan (chi-squared analysis, p < 0.001). Reoperation was more frequent among patients who had undergone burr hole surgery (multiple logistic regression, p < 0.001). The outcome and morbidity of ISDE survivors were not related to the surgical method used (p > 0.05). The only factor that significantly affected the morbidity of ISDE was level of consciousness at the time of surgery (multiple logistic regression, p < 0.001). We conclude that CBOP and evacuation of the empyema is a better surgical method for ISDE than burr hole/s and drainage. Wide cranial opening and empyema evacuation improves neurological status, gives better clearance of the empyema and reduces the need for reoperation. Level of consciousness at the time of presentation is a predictor of the morbidity of ISDE. Thus, aggressive surgical treatment should occur as early as possible, before the patient deteriorates.

BACKGROUND:
In spite of its indusrial usefulness and varied daily uses, lead (Pb) pollution is a widespread ecological problem that faces the humans in the 21th century. Pb was found to produces a wide range of toxic effects including neurotoxicity especially to the developing and young offspring. Recently, the utilization of herbal plants has received a significant attention where there has been rising awareness in their therapeutic use; among these is the garlic.
AIM OF THE WORK:
In light of the above, the current study is designed experimentally in female pregnant rats in order to investigate the beneficial role of garlic extract in the protection from the maternal and fetal cerebellar damage that produced by administration of different doses of Pb during pregnancy.
MATERIALS AND METHODS:
Positively pregnant female rats were divided into five groups; one control group, two Pb-treated groups (exposed to 160 and 320 mg/kg b.wt. of Pb, respectively) and two groups treated with both Pb and garlic (exposed to Pb as previous groups together with 250 mg/ kg b.wt. /day of garlic extract). Treatments started from day 1 till day 20 of pregnancy, where the mother rats of different experimental groups were sacrified to obtain the fetuses. Pb level in the maternal nd fetal blood and cerebellum was estimated by spectrophotometry. Specimens of the cerebellum of different mother and fetal groups were processed to histological and immunohistochemical staining for microscopic examination.
RESULTS:
The results showed that administration of Pb to pregnant rats resulted in a dose-dependent toxicity for both mothers and fetuses in the form of decrease of maternal weight gain, placental and fetal weights, brain weight and diminished fetal growth parameters, which were prominent in rat's group treated with larger dose of Pb. In Pb-treated rats, Pb level in blood and cerebellum was high when compared to the control. The histopathological examination of the cerebellum of treated dams and fetuses showed marked alterations mainly in the form of Purkinje cell degeneration and lack of deveopmet of fetal cerebellum. Co-treatment of garlic extract along with Pb resulted in a significant decrease in Pb levels as compared with those treated with Pb alone with improvement of the histopathological changes.
CONCLUSIONS:
This study was useful in evaluating the hazardous effects of uncontrolled use of Pb in general and in assessing the developmental and neurotoxicity of fetuses due to exposure during pregnancy in particular. Co-administration of garlic has beneficial effects in amelioration of Pb-induced neurotoxicity and reversing the histopathological changes of the cerebellum of mother rats and fetuses.
KEYWORDS:
garlic; glial fibrillary acidic protein; lead; purkinje cells

Background
The peripheral neuropathic pain syndromes greatly impair patient’s quality of life. A clear differentiation between etiology, mechanisms, clinical signs, symptoms and syndrome is crucial to treat such patients (Woolf and Mannion, Lancet:1999).

Aim
The present prospective study aimed at investigating the efficacy of somatosensory rehabilitation to relieve chronic neuropathic pain of the upper extremity.

Patients & Methods
81 chronic neuropathic pain patients treated by somatosensory rehabilitation were included in the study. 6 patients were excluded of the study (another important painful pathology, Portuguese McGill Pain not valid or untestable). The day of the initial testing, the pain was during since 56.0 months ± SD=22.6 months (range: 7-523 months). The neuropathic pain assessed before treatment by the McGill Pain Questionnaire was at 43.8 points ± SD=26.9 (range: 11-88).
The Diagnostic Testing of Axonal Lesions was administrated by two therapists. The diagnosis of damaged nerves is described in details. The rehabilitation of the hyposensibility and its neurophysiologic mechanisms is briefly described .

Results
The Number Needed to Treat (NNT) of somatosensory treatment (to obtain one patient with more than 50% pain relief) = 2.5. If we only consider the patients who finished their somatosensory rehabilitation: NNT = 1.2. Their neuropathic pain assessed after treatment was at 8.4 points at the McGill Pain Questionnaire ± SD=6.4 (range: 0-27). The duration of the treatment, with a session per week, was 94.5 days ± SD=65.6 days (range: 9-405 days)

Discussion/Conclusion
The somatosensory testing and rehabilitation is effective to relieve chronic neuropathic pain of the upper extremity. Somatosensory testing and rehabilitation compares favorably with other treatments: gabapentin 3.8; pregabalin 3.6; oxycodone 2.6).

Degenerative disks and cervical spine ligaments diseases caused by the collapse of the anatomical position of vertebral structures and attempt to adapt. The Degenerative disorder of the neck disks has a prevalence of 20% to 25% in the population under the age of 59 and 70%-95% in the population 65 years and older. This study performed as a retrospective by reviewing the clinical files of patients with anterior neck discectomy in Shohada Tajrish hospital between 2014-2017. The severity of pain in the type of radiculopathy and neck pain measured from 1 to 10 based on the visual analog scale (VAS). The most common clinical manifestations of degenerative and cervical disks are neck pain, radiculopathy, and cervical myelopathy, alone or in combination. Generally, the disc hernia suddenly associated with acute symptoms.

Special issue of "Culture Unbound". Through an introduction and six original articles, the issue investigates a variety of cultural and scientific discourses and practices that in different ways are related to neuroscience and the brain.

The special issue was edited by guest editors Peter Bengtsen and Kristofer Hansson.

This handbook about somatosensory rehabilitation of neuropathic pain discusses the dysfunctions of the skin sensitivity and its painful complications. If a slight loss of vibrotactile sensitivity only hampers the flow of re-education, a more important loss disables the affected body part, such as rendering it impossible for the hand to perform everyday movements or for the foot to walk. Most traumas affecting body parts alter the nerves in the skin which control our sense of touch. These micro-lesions can generate painful complications causing certain areas of the skin to be sensitive to the point of sometimes depriving their victim of sleep.
This work presents clinical tools developed from the 19th century until now. Four of these tools allow to establish a diagnostic of axonal lesions, which in turn might bring into light undetectable lesions in the nervous cells called the axones.
These various clinical tools enable the evaluation and the re-education of the dysfunctions in the skin's sensitivity and their afflicting complications. The early detection of these dysfunctions and their origin can prevent the appearance of neuropathic pain?
This work, dedicated to all patients whose pain is unspoken of, places itself at the crossroad of medicine, fundamental research and re-education. It is intended for re-education therapists, physicians as well as the patients placed into their care.

Surgeons in abdominal and gynecological fields have pioneered the use of Seprafilm (a chemically modified sodium hyaluronate/carboxymethylcellulose absorbable adhesion barrier, Genzyme Biosurgery, Cambridge, MA, USA) to prevent adhesion but its use outside these specialties is not well documented. The authors have used Seprafilm for craniectomy closure in several patients as a dural substitute and anti-adhesion barrier. During emergent craniectomy, the dura mater is reapproximated and a layer of Seprafilm is placed over the dura as an onlay and anti-adhesion barrier. During subsequent surgery for bone flap replacement, dissection between the dural plane and overlying tissues has been completed easily. There has been minimal adhesion to the underlying Seprafilm/dural layer. The Seprafilm has been incorporated into the surrounding dural plane. No postoperative complications have been noted. Seprafilm's anti-adhesive properties and biodegradable characteristics make it useful as a dural onlay for craniectomy in which a second surgery is planned.