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As dystonia may represent a severe disease with possible fatal outcome or physical or social incapacity, and considering the limited efficacy of drug treatments (excepted doparesponsive dystonia), efforts have been made since the 1950s to propose alternative treatment. In this paper, an overview of the works done by neurosurgeons over fifty years to treat severe dystonia is presented. In this area of therapeutical research, the pioneering contribution of Irving Cooper is presented and discussed, and the way his publications were evaluated emphasized. Undoubtedly, Cooper observed striking improvement after performing basal ganglia lesions in patients with generalized dystonia, even in the long term. It should be noted that he early made almost the same statements as today's preliminary observations regarding the clinical criteria for the selection of good responders to brain functional surgery. However, the message was lost, given the amount of critics Cooper received, and probably, the way he required to present them. This point emphasize the need we are today to carry out carefully designed, controlled, double-blind studies in this area.

The functional role of the cerebellum is traditionally defined as a mere coordinator of automatic and somatic motor functions. This view determined most of the clinical and experimental investigations of the functions of the cerebellum and overshadowed many attempts to expand its role to non-motor functions. However, during the past decades the collaboration across contemporary neuroscience disciplines has brought about a substantial modification of traditional thinking about the cerebellum. Converging evidence from different neuroscientific angles established the view that the human cerebellum participates in a much wider range of functions than conventionally accepted. Studies have brought to the fore that the cerebellum also modulates neurocognitive functions of at least these parts of the brain to which it is reciprocally connected. In less than two decades, the concept of 'cerebellar neurocognition' evolved from a mere afterthought to an exciting new multifaced area of contemporary neuroscientific investigations. Within this area, one of the major avenues of current research is the role of the cerebellum in non-motor language processing. This paper reviews the recently acknowledged role of the cerebellum in neurocognition and linguistic processes.

Since decades, the dental profession has been challenged by pain and dysfunction of the masticatory system. In recent years, a better understanding of the pathophysiological mechanisms of masticatory pain paralleled the increase of basic and clinical research focusing on pain in general. Consequently, so-called diagnostic techniques and treatment procedures, based upon hypothetical, sometimes dogmatic, etiological mechanisms, are increasingly questioned, and the ill-supported thoughts are gradually replaced by research-based insights. In addition, a better communication between basic scientists, researchers, and medical or dental practitioners focusing on musculoskeletal pain, has led to an improved quality of research on pain and dysfunction of the masticatory muscles and the temporomandibular joint (TMJ). This paper will try to review this progress, comment on the clinical implications, and give some suggestions for future research.

Vagus nerve stimulation (VNS) is an established treatment for patients with medically refractory epilepsy who are unsuitable candidates for conventional epilepsy surgery. VNS requires an initial financial investment but apart from our own previous study there are no reports on cost-benefit published to date. The purpose of this paper is to assess prospectively the cost-benefit ratio of VNS in a series of patients with long term follow-up.Our experience with VNS comprises 25 patients of whom 20 with sufficient follow-up will be further discussed. These 20 patients have a mean post-implantation follow-up of 26 months (range: 6-50 months). Mean age was 30 years (range: 12-45 years); mean duration of epilepsy 17 years (range: 5-35 years). We prospectively assessed seizure frequency, prescribed AEDs, number of hospital admission days and side effects and calculated the epilepsy related direct medical cost and compared this with pre-implantation data.Mean seizure frequency decreased from 14 seizures/month (range: 2-40) to 9 seizures/month (range: 0-30) (p = 0.0003). The mean yearly epilepsy related direct medical costs per patient dropped from 6,682 USD (range: 829-21,888 USD) to 3,635 USD (range: 684-12,486 USD) (p = 0.0046). The mean number of hospital admission days was reduced from 16 days/year (range: 0-60) to 4 days/year (range: 0-30) (p = 0.0029).VNS is an efficacious and cost-beneficial treatment for refractory partial seizures.

The purpose of this paper is to demonstrate the diagnostic efficacy and therapeutic relevance of video-EEG monitoring in an large patient population with long-term follow-up.Between October 1990 and May 1997, 400 patients were monitored at the Epilepsy Monitoring Unit (EMU) of the University Hospital in Gent. In all patients, the following parameters were retrospectively examined: reason for referral, tentative diagnosis, prescribed antiepileptic drugs (AEDs), seizure frequency, number of admission days, number of recorded seizures, ictal and interictal EEG, clinical and electroencephalographic diagnosis following the monitoring session. During follow-up visits at the Epilepsy Clinic, we prospectively collected data on different types of treatment and post-monitoring seizure control.255/400 (64%) patients were referred for refractory epilepsy. 145/400 (36%) patients were evaluated for attacks of uncertain origin. Mean follow-up, available in 225 patients, was 28 months (range: 6-80 months). Mean duration of a single monitoring session was 4 days (range: 2-7 days). Prolonged interictal EEG was recorded in all patients and ictal EEG in 258 (65%) patients. Following the monitoring session, the diagnosis of epilepsy was confirmed in 217 patients. Pseudoseizures were diagnosed in 31 patients (8%). AEDs were started in 19 patients, stopped in 6 and left unchanged in 110. The type and/or number of AEDs was changed in 111 patients. Sixty patients underwent epilepsy surgery. In 48 surgery patients, follow-up data were available, 29 of whom became seizure-free, and 16 of whom experienced a greater than 90% seizure reduction. Vagus nerve stimulation was performed in 11 patients, 2 became seizure-free, and 7 improved markedly. Of the non-invasively treated patients in whom follow-up was available (n = 135), 70 became seizure-free or experienced a greater than 50% reduction in seizure frequency; 51 patients experienced no change in seizure frequency. Outcome was unrelated to the availability of ictal video-EEG recording. In patients with complex partial seizures, seizure control was significantly improved when a well-defined ictal onset zone could be defined during video-EEG monitoring.Prolonged interictal EEG monitoring is mandatory in the successful management of patients with refractory epilepsy. Ictal video-EEG monitoring is very helpful but not indispensable, except in patients enrolled for presurgical evaluation or suspected of having pseudoseizures.

This paper evaluates the laboratory and environmental factors that induce seizures in photosensitive epileptic patients. The aims are (i) to identify those factors that trigger seizures so that the patients could take preventive measures, (ii) to advise the patients on appropriate preventive measures that could be taken to avoid spontaneous seizures. Thirty-six photosensitive epileptic patients were studied. The electroencephalographic laboratory seizure-inducing factors identified were intermittent photic stimulation (IPS), flickering lights from both the TV and the visual display unit (VDU) at various flashes per second, grid patterns (vertical, horizontal lines, squares, black and white lines) of various cycles per degree, and blank screens. In the environmental factor investigation, 10 out of 36 patients had series of seizures induced by narrow stripes of black and white, or white and red striped coloured dresses especially, when stepping outdoors on sunny days. Other environmental factors identified include moving escalators; 'moving' trees, bushes, and houses when travelling in a vehicle, including trains; faceted patterns in the bathroom windows with light passing through; swirling light patterns especially on displayed objects of black and white colours; telegraphic post, gantry post, and luminance variance when stepping outdoors from the dark in bright sunlight. The effective preventive measures were: (i) patients should occlude one eye when travelling in a vehicle or using computers or when stepping outdoors on a sunny day, or when there are various patterns before them, (ii) patients should sit at least 3 metres away from the TV when watching a programme, (iii) they should avoid any object that transmits luminance variance; if this is not possible, they should occlude one eye.

It is well established that head injury often causes brain damage leading to long term physical, cognitive and behavioural changes in the injured patients. Whereas the physical effects ranging from sensori-motor disturbances to posttraumatic epilepsy are often reported as well as cognitive sequelae, deteriorations of emotional and behavioural aspects are often neglected. Recent advances in imaging technology and clinical neuropsychology research have greatly contributed to increase our understanding of the effect of traumatic brain injury on diverse behavioural functions. After a brief review of the current status of problems facing the brain injured patients, this paper discusses the neuropsychological aspects of 3 long term brain injured patients. All 3 patients showed important behavioural and emotional distress several years after the accident. Whereas case report of patient A and C discuss the emotional and personality disturbance characterised by anxiety, depression and irritability, case report of patient C which is a case of classic frontal syndrome showed important memory impairment with emotional disturbance characterised by apathy, lack of motivation and complete indifference to his surrounding environment. Whatever the mechanisms involved, psychoaffective disturbances in the brain injured patients appear as important problems in the long term. These emotional difficulties must be considered in the treatment and rehabilitation procedures of these victims in order to help them to improve their social adjustment and quality of life aspects. Neuropsychological test data can be used to develop treatment strategies tailored for an individual's specific cognitive strengths and deficits.

In this paper I review the recently introduced syndrome of focal retrograde amnesia-a disproportionate impairment of remote memory in the presence of normal or near normal anterograde memory. It is concluded that the modal form of the syndrome has been reliably demonstrated and that the underlying pathology involves damage to the temporal lobes and relative sparing of the hippocampal formation. A variant of the syndrome associated with parietal and occipital lobe damage is also presented. Finally, a third type of focal retrograde amnesia associated with minor brain trauma is considered to be or primarily psychogenic origin.

The purpose of this paper is to evaluate, in the light of all available evidence, the place of aspirin alone and of aspirin combined with dipyridamole in the secondary prevention of cerebrovascular accidents.We performed a meta-analysis of all identified double blind, controlled, studies in secondary prevention of cerebrovascular accidents for the following categories: studies comparing aspirin with placebo; studies comparing aspirin plus dipyridamole with placebo; studies comparing aspirin plus dipyridamole with aspirin alone. An indirect comparison was carried out to compare the results obtained with aspirin alone and those obtained with aspirin combined with dipyridamole.The meta-analysis of trials involving aspirin alone against placebo showed a risk reduction on strokes (17% reduction, p = 0.02), "important vascular events", i.e. a combination of vascular deaths, non-fatal strokes and non-fatal myocardial infarction (18% reduction, p = 0.003). Fatal vascular events (vascular deaths and fatal strokes) did not seem to be reduced at all. The overall mortality was reduced by 10%, but this reduction failed to reach statistical significance (p = 0.23). The meta-analysis of trials involving aspirin combined with dipyridamole showed more important risk reductions on every outcome whether fatal or not. Strokes were reduced by 42% (p0.001), fatal strokes by 43% (p = 0.02) and vascular deaths by 24% (p = 0.07, not significant). The overall mortality was reduced by 30% (p = 0.004). Direct comparisons of aspirin with aspirin plus dipyridamole did not indicate differences between the two treatment regimens. However the sample sizes involved in these comparisons were far too small to be informative. Indirect comparisons yielded statistically significant results in favour of the combination in terms of "important vascular events" (p = 0.007), all strokes (p = 0.007) and fatal strokes (p = 0.03). The results were also in favour of the combination but not statistically significant in terms of all deaths (p = 0.10) and vascular deaths (p = 0.08).Aspirin used alone reduces secondary occurrence of vascular events in cerebrovascular patients. There is no evidence, however, of a reduction of fatal events (vascular deaths and fatal strokes). In contrast, aspirin in combination with dipyridamole reduces non-fatal as well as fatal events. These results as well as the indirect comparisons of the risk reductions suggest that the combination of aspirin with dipyridamole may be superior to aspirin alone; this hypothesis is presently tested in a large randomized trial.

This paper deals with the level of succinic dehydrogenase (SDH) in various locations of the central nervous system (CNS) of rat, treated with methylmercury chloride (MMC) and later with antagonists. None of the CNS areas reveals any effect after 2 days of MMC application, but further treatment causes a linear inhibition of the enzyme with increasing duration of MMC exposure. Maximal inhibition in all regions is exhibited after 15 days of treatment. In absolute terms, the maximal inhibition is observed in the olfactory bulbs and the minimal effect is seen in the spinal cord after 15 days with low and high doses of MMC respectively.

The paper deals with comparative account of the distribution of acid phosphatase 5-nucleotidase and non-specific esterase in the olfactory bulbs of rabbit and hedgehog. The acid phosphatase is observed in all the neurons of both the animals. However, the concentration of the enzyme is higher in hedgehog as compared to rabbit. The intensity of 5-nucleotidase in all the layers of olfactory bulb of hedgehog is stronger than in the rabbit. Intensity of non-specific esterase is quite higher in the olfactory bulb of rabbit than of hedgehog. Along with comparison the distribution of these enzymes have been correlated with their role in the olfactory senses.