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Research on neurobiological effects of psychotherapy in depression facilitates the improvement of treatment strategies. The cortico-limbic dysregulation model serves as a framework for numerous studies on neurobiological changes in depression. In this model, depression is described as hypoactivation of dorsal cortical brain regions in conjunction with hyperactivation of ventral paralimbic regions. This assumption has been supported by various studies of structural and functional brain abnormalities in depression. However, also regions not included in the original cortico-limbic dysregulation model, such as the dorsomedial prefrontal cortex, seem to play an important role in depression. Functional connectivity studies of depression have revealed an enhanced connectivity within the so-called default mode network which is involved in self-referential thinking. Studies also point to a normalization of limbic and cortical brain activity, especially in the anterior cingulate cortex, during psychotherapy. Some neurobiological markers like the activity of the anterior cingulate cortex, striatum and insula as well as hippocampal volume have been proposed to predict treatment response on a group-level. The activity of the anterior insula appears to be a candidate bio-marker for differential indication for psychotherapy or pharmacotherapy. The cortico-limbic dysregulation model and following research have inspired new forms of treatment for depression like deep brain stimulation of the subgenual anterior cingulate cortex, repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex, neurofeedback and attention training.Die Depression – eine der häufigsten psychischen Erkrankungen in Deutschland. Dieser Beitrag vermittelt Grundwissen über die Bildgebung in der Psychotherapieforschung und beschreibt Erklärungsmodelle für neurobiologische Prozesse mit der Möglichkeit der Vorhersage des Therapieerfolgs mittels bildgebender Verfahren.

Tremor is clinically defined as a rhythmic, oscillating movement of parts of the body, which functionally leads to impairment of the coordination and execution of targeted movements. It can be a symptom of a primary disease, such as resting tremor in Parkinson's disease or occur as an independent disease, such as essential or orthostatic tremor. For the development of tremor, cerebral components as well as mechanisms at the spinal and muscular level play an important role. This review presents the results of new imaging and electrophysiological studies that have led to important advances in our understanding of the pathophysiology of tremor. We discuss pathophysiological models for the development of resting tremor in Parkinson's disease, essential and orthostatic tremor. We describe recent developments starting from the classical generator model, with an onset of pathological oscillations in distinct cerebral regions, to a network perspective in which tremor arises and spreads through existing anatomical or newly emerged pathological brain networks. In particular translational approaches are presented and discussed. These could serve in the future as a basis for the development of new therapeutic strategies.

Purpose: In radiotherapy (RT) of brain tumors, the primary motor cortex is not regularly considered in target volume delineation, although decline in motor function is possible due to radiation. Noninvasive identification of motor-eloquent brain areas is currently mostly restricted to functional magnetic resonance imaging (fMRI), which has shown to lack precision for this purpose. Navigated transcranial magnetic stimulation (nTMS) is a novel tool to identify motor-eloquent brain areas. This study aims to integrate nTMS motor maps in RT planning and evaluates the influence on dosage modulations in patients harboring brain metastases. Materials and Methods: Preoperative nTMS motor maps of 30 patients diagnosed with motor-eloquent brain metastases were fused with conventional planning imaging and transferred to the RT planning software. RT plans of eleven patients were optimized by contouring nTMS motor maps as organs at risk (OARs). Dose modulation analyses were performed using dose-volume histogram (DVH) parameters. Results: By constraining the dose applied to the nTMS motor maps outside the planning target volume (PTV) to 15 Gy, the mean dose (Dmean) to the nTMS motor maps was significantly reduced by 18.1% from 23.0 Gy (16.9-30.4 Gy) to 18.9 Gy (13.5-28.8 Gy, p < 0.05). The Dmean of the PTV increased by 0.6 ± 0.3 Gy (1.7%). Conclusion: Implementing nTMS motor maps in standard RT planning is feasible in patients suffering from intracranial metastases. A significant reduction of the dose applied to the nTMS motor maps can be achieved without impairing treatment doses to the PTV. Thus, nTMS might provide a valuable tool for safer application of RT in patients harboring motor-eloquent brain metastases.

After just a clinical examination, the experienced neurologist can assign specific symptoms quite precisely to distinct lesions within the brain and other parts of the nervous system, on the basis of his neuroanatomical knowledge. This also holds true for lesions affecting the oculomotor system. The aim of this article is to give a comprehensive overview of the neuroanatomical basis of the oculomotor system, in order to facilitate the precise spatial assignment of potential lesions affecting the control of eye movements. After a brief introduction, the components of the system are discussed, including the extraocular muscles and their innervating nerves. The following section will then cover the control of eye movements and will specifically address distinct patterns of eye movements and areas within the central nervous system controlling these. This article also gives a brief overview of the intraocular muscles and their control.Neuroanatomische Kenntnisse erlauben dem erfahrenen Untersucher von Patienten mit Erkrankungen des Nervensystems bereits nach einer klinischen Untersuchung eine gute Topodiagnostik. Dies trifft auch auf die Elemente des Nervensystems zu, die an der Steuerung der Augen beteiligt sind. In diesem Beitrag sind neuroanatomische Grundlagen zusammengetragen, welche die Okulomotorik betreffen. Der Beitrag soll dazu dienen, den Aufbau und die Funktion dieses Systems zu verstehen und pathologische Veränderungen bestimmten Läsionsorten zuordnen zu können. Nach einer kurzen Einführung werden zunächst die einzelnen Elemente, wie die extraokulären Muskeln und die sie versorgenden Nerven, vorgestellt. Der folgende Teil dieses Beitrags beschäftigt sich schließlich mit der Kontrolle der Augenbewegung, mit unterschiedlichen Bereichen des zentralen Nervensystems (ZNS), die hierbei beteiligt sind, und mit spezifischen Bewegungsmustern. Darüber hinaus soll dieser Beitrag aber auch einen kurzen Überblick über die Steuerung der inneren Augenmuskeln liefern.

Every year in Europe 1.5 million patients suffer a new stroke. Despite the further developments in acute therapy with nationwide stroke units, thrombolysis, thrombectomy and post-acute neurorehabilitation, only a small proportion of patients recover to a satisfactory degree allowing them to return to their normal social and professional life. This makes stroke the main cause of long-term disability with a corresponding impact on patient lives, socioeconomics and the healthcare system. Thus, the concepts of neurorehabilitation have to be extended to enhance the effects of rehabilitative treatment strategies. To achieve this, an understanding of the prediction of the course of recovery, the mechanisms underlying functional recovery and factors influencing recovery have to be enhanced for the development towards patient-tailored precision medicine approaches. A central point towards this is the understanding of stroke as a disease, which not only influences the damaged area but also the associated network. This is crucial for the understanding of the stroke-induced deficits, for prediction of recovery and options for interventional treatment strategies, which can target different areas in this network (e.g. primary motor cortex and secondary motor regions) based on individual factors of the patient. The present article discusses the importance of network alterations for motor neurorehabilitation after a stroke and which novel options, concepts and consequences could arise from this for neurorehabilitation.

Language processing requires the coordinated interaction of local and distant neural populations within distributed networks of the temporal, frontal and parietal brain regions. Poststroke aphasia is the consequence of both local as well as remote dysfunction within language-specific and domain-general networks. Language recovery, in turn, rests on reorganization processes within these networks. These comprise the resolution of an acute network failure (i. e. diaschisis), the subacute activation of right hemisphere homologous regions and the gradual reintegration of left hemisphere remote and perilesional areas. The application of unifocal noninvasive brain stimulation over these regions provides a means of modulating neural plasticity in order to enhance the reorganization processes underlying language recovery. The lack of knowledge as to the optimal stimulation site, the appropriate stimulation protocol and the proper timing of interventions might explain the only marginal effects of brain stimulation adjunct to speech and language therapy. In addition, individually different contributions of left and right hemisphere regions to recovery due to heterogeneous lesion sites among patients limit the possibility to identify general principles for brain stimulation. The assumption that aphasia is not only the consequence of the focal effect of a brain lesion but arises from remote dysfunctions within associated functional networks ignites the concept for individualized, potentially multifocal therapeutic network modulation.

Current developments in functional magnetic resonance imaging (fMRI) of the human visual system have generated a set of powerful approaches that are of great promise for modern ophthalmology. These make it possible to perform an objective spatially resolved test of visual function in patients with strong visual impairment and even to investigate the functional organisation of the visual cortex in the blind. As a consequence, they open a broad field of applications for functional assessment in ophthalmology and provide fundamental insights into the interplay of pathology and plasticity in the human visual system. This is highlighted by current studies investigating patients with acquired or congenital defects of the macula, or with visual pathway abnormalities, extended retinal damage, and complete blindness. Therapeutic approaches targeting the restoration of visual input are expected to benefit from these fMRI applications, either for the estimation of the success rate of a planned retinal therapy or as an objective high-level biomarker for the readout of therapy success.

Electrophysiological methods in clinical ophthalmology include the full-field electroretinogram (ERG) for assessment of outer and middle retinal layers, pattern ERG (PERG) for assessment of ganglion cell function, the electrooculogram (EOG) for assessment of retinal pigment epithelium function, as well as visual evoked potentials (VEP) for assessment of the visual pathway, including the optic nerve and visual cortex. Multifocal recording techniques for ERG and VEP are used for tests within selected areas of the visual field. Technical progress in ocular imaging, especially optical coherence tomography (OCT) and fundus autofluorescence (FAF), allows high-resolution imaging of subtle morphological changes of the retina and posterior fundus. Typical retinal diseases may then be diagnosed at an early stage, without conventional electrophysiological investigations (e.g. x-linked retinoschisis, Stargardt disease, vitelliform macular dystrophy). OCT outclasses electrophysiological methods in the quantification of optic atrophies. With newly developed optic techniques, peripheral retinal structures (wide angle optics) and subtle structures up to the photoreceptor level (adaptive optics) can be imaged with increasing quality. However, differentiation of central retinal disorders (e.g. macular dystrophy) from generalised retinal diseases requires electrophysiological diagnostic testing. The same applies to discrimination between different functional disorders in generalised retinal diseases (e.g. enhanced S-cone syndrome, congenital stationary night blindness, achromatopsia).

Emotions and emotion regulation are of special importance in the perception and modulation of pain but the mechanisms underlying this reciprocal relationship remain unclear. The transdiagnostic model provides an approach to explain the link between pain and emotion regarding cognitive and neuronal mechanisms and aims to identify mutual processes, which are relevant for both. Structural and functional imaging studies of pain indicate the involvement of specific cortical and subcortical structures, which also play an important role in emotion regulation. While numerous studies have investigated emotion regulation and their correlates in the central nervous system in pathological states, the research on emotion regulation in pain is still young. The purpose of this review is to provide an overview of experimental and clinical studies of neuronal and behavioral correlates of pain-related emotion regulation. The current transdiagnostic approach may be able to enhance pain relief in the future.

The primary diagnostic aim prior to cochlear implantation is establishment of a comprehensive and multidisciplinary diagnosis, in order to subsequently begin therapy as early as possible. Audiological evaluation prior to implantation employs a test battery-approach, including subjective and objective procedures. Objective measures show high reliability and therefore play a major role in the diagnosis of difficult-to-test subjects such as infants and young children. During postoperative follow-up, objective measures offer a valid method for analyzing the effects of different stimuli on the auditory system. Particularly in infants, children, and uncooperative patients, the results of these tests enable the speech processor settings to be optimized, the hearing benefit to be assessed, and treatment to be adapted accordingly. Auditory brainstem responses (ABR) offer an excellent test/retest and inter-/intrarater reliability and validity, and are the most commonly used method for objective hearing threshold estimation and evaluation of the functional integrity of the lower auditory pathway. The use of narrow-band stimuli allows frequency-specific threshold estimation; analysis of stationary auditory steady state potentials (ASSR) adds the advantages of automated objective detection. Electrocochleography and electrically evoked ABR give valuable information in special cases. The use of cortical potentials (CAEP) in response to speech stimuli is quite promising, although the high response variability currently limits this method's clinical application. An audiological test-battery approach combining the results of subjective and objective measures leads to significantly increased reliability of preoperative diagnosis and postoperative follow-up in cochlear implantees.

EMDR is an effective treatment for people diagnosed with posttraumatic stress disorder. The traditional technique of EMDR combines the activation of distressing reminders with guided rhythmic eye movements. The present article reviews the current state of research on the neurobiological correlates of the eye movements occurring during EMDR. The distinction between saccades and smooth pursuit eye movements allows for detailed analyses of ocular motor connections with cerebral networks of attention, memory and emotion. Possible consequences for research and clinical practice with EMDR are discussed.

Within the context of treatment with cochlear implants (CIs), different electrical and electrophysiological diagnostic procedures are applied both intra- and postoperatively. These assess electrical measures from the CI and electrophysiological measures from CI patients, respectively. The electrophysiological diagnostic procedures comprise measurement of electrically evoked compound action potentials of the auditory nerve, the registration of electrically evoked auditory brainstem potentials and the assessment of electrically evoked auditory cortical potentials. These potentials reflect auditory nerve excitation and stimulus processing in different parts of the ascending auditory pathway for intracochlear electrical stimulation via a CI. For current CIs, assessment of electrode position and examination of the implant's coupling to the auditory nerve are important domains of application for electrophysiological diagnostic procedures. Another substantial application area is the examination of stimulus processing in the auditory pathway. However, the main field of application of these procedures is supporting the fitting of CI speech processors in infants and toddlers on the basis of electrophysiological thresholds.

Principally, in the fourth update of the rules for the procedure to finally determine the irreversible cessation of function of the cerebrum, the cerebellum and the brainstem, the importance of an electroencephalogram (EEG), somatosensory evoked potentials (SEP) and brainstem auditory evoked potentials (BAEP) are confirmed. This paper presents the reliability and validity of the electrophysiological diagnosis, discusses the amendments in the fourth version of the guidelines and introduces the practical application, problems and sources of error.An EEG is the best established supplementary diagnostic method for determining the irreversibility of clinical brain death syndrome. It should be noted that residual brain activity can often persist for many hours after the onset of brain death syndrome, particularly in patients with primary brainstem lesions. The derivation and analysis of an EEG requires a high level of expertise to be able to safely distinguish artefacts from primary brain activity. The registration of EEGs to demonstrate the irreversibility of clinical brain death syndrome is extremely time consuming.The BAEPs can only be used to confirm the irreversibility of brain death syndrome in serial examinations or in the rare cases of a sustained wave I or sustained waves I and II. Very often, an investigation cannot be reliably performed because of existing sound conduction disturbances or failure of all potentials even before the onset of clinical brain death syndrome. This explains why BAEPs are only used in exceptional cases.The SEPs of the median nerve can be very reliably derived, are technically simple and with few sources of error. A serial investigation is not required and the time needed for examination is short. For these reasons SEPs are given preference over EEGs and BAEPs for establishing the irreversibility of clinical brain death syndrome.

Functional magnetic resonance imaging (fMRI) is a non-invasive method that has become one of the major tools for understanding human brain function and in recent years has also been developed for clinical applications.Changes in hemodynamic signals correspond to changes in neuronal activity with good spatial and temporal resolution in fMRI. Using high-field MR systems and increasingly dedicated statistics and postprocessing, activated brain areas can be detected and superimposed on anatomical images. Currently, fMRI data are often combined in multimodal imaging, e. g. with diffusion tensor imaging (DTI) sequences. This method is helping to further understand the physiology of cognitive brain processes and is also being used in a number of clinical applications. In addition to the blood oxygenation level-dependent (BOLD) signals, this article deals with the construction of fMRI investigations, selection of paradigms and evaluation in the clinical routine. Clinically, this method is mainly used in the planning of brain surgery, analyzing the location of brain tumors in relation to eloquent brain areas and the lateralization of language processing.As the BOLD signal is dependent on the strength of the magnetic field as well as other limitations, an overview of recent developments is given. Increases of magnetic field strength (7 T), available head coils and advances in MRI analytical methods have led to constant improvement in fMRI signals and experimental design. Especially the depiction of eloquent brain regions can be done easily and quickly and has become an essential part of presurgical planning.

The manifestation of chronic pain and psychological impairments are related to alterations of neurotransmitter metabolism in cerebral pain processing regions, e.g., anterior cingular cortex (ACC), insula. Magnetic resonance spectroscopy ((1)H-MRS) enables in vivo quantification of neurotransmitters in the brain and was applied in this study to examine the hypothesized chronic pain-related imbalance between excitatory (glutamatergic) and inhibitory (GABA-ergic) neurotransmitter turnovers in the brain of patients with nonspecific chronic pain.A total of 19 patients with nonspecific chronic ( 3 months) back pain and 19 age- and gender-matched healthy subjects participated in this study. Glutamate and GABA as well as glutamate/GABA ratios were determined in the ACC and insula using (1)H-MRS. Sociodemographic, psychological, and pain-related features were measured with standardized questionnaires.There was a strong variance of glutamate/GABA ratios for both patients and healthy subjects with no significant difference between the two groups. Regression analysis revealed certain significant predictors, such as anxiety as causal variable for reduced glutamate and depression and age as predictors for reduced GABA in ACC. In the patient group, intensity of pain was a significant predictor for glutamate and GABA levels in the insula.Despite the uniform diagnosis of nonspecific chronic back pain, we observed a strong variance of neurotransmitters in cerebral pain processing regions. It is necessary to include psychological as well as clinical parameters (e.g., intensity of pain or depression) for a proper interpretation of neurotransmitter turnovers.

Chronic pain results in structural and functional changes of the brain. However, most of the neurophysiologic and imaging studies have been conducted with small sample sizes, some have been reproduced, but studies on larger populations are lacking. Larger epidemiologic studies are currently being performed to show specific structural changes due to chronic pain. Longitudinal studies using neurophysiologic or imaging methods are very rare and often not feasible. Most methods are very complex, which hampers their application in daily practice. But it is not only the complexity of methods, but also a lack of interaction between researchers and practitioners to formulate joint research topics and targets. This article tries to fill the gap between the practicing pain therapist and the researcher in summarizing neurophysiological and imaging results on neuropathic and chronic pain in a clear and simple manner.

Brain tumor surgery in functionally relevant areas is particularly challenging. Preoperative functional mapping with navigated transcranial magnetic stimulation (TMS) was introduced into the clinical routine in 2009 and since then has seen widespread adoption.Accuracy and consistency of TMS motor and language mapping and its clinical relevance.Analysis of published scientific papers and discussion of the findings.Positive (i.e. motor responses are elicited) and negative cortical points for TMS motor mapping can be used for treatment planning and intraoperative decision making. Language mapping points (disruption of language function) positive in TMS can support treatment planning but should be confirmed intraoperatively with direct electrical stimulation. Negative TMS language mapping (language functions are not disrupted) correlates well with the gold standard of intraoperative testing. Recent studies reported improved treatment outcome after preoperative TMS mapping.Patients suffering from brain tumors in eloquent locations should be counseled based on individual functional mapping data before surgery and TMS is a valid non-invasive methodology which can provide such functional mapping.

Over the last 15 years, functional brain imaging techniques have provided critical insights into cortical, subcortical and even spinal mechanisms involved in pain perception and pain modulation in humans. The pivotal contribution of brain imaging studies conducted in Germany have thereby been internationally acknowledged. One of the key challenges for the next decade is to shift the focus from studies in healthy volunteers to different clinical populations suffering from chronic pain to characterize CNS mechanisms, as well as neurobiological predictors and resilience factors of pain chronification. Ultimately, the knowledge gained by this work may help identify individual or syndrome-specific CNS changes as biomarkers to make therapeutic decisions.

The neuronal correlate of the current cultural performance arose from developmental processes that can be observed by functional and anatomical magnetic resonance imaging. The velocity of these maturation processes occurs differently between adolescents, causing implications for both school career and academic performance. Regarding spatial-numerical cognition the myelinization of the superior longitudinal bundle appears to be crucial because this fiber connection intermediates between the linguistic nature of number words and conception of their spatial-numerical magnitude. The neuroscientific observation of anatomical brain maturation and its influence on school-relevant number processing may be helpful for educational purposes as well as for school psychology.

Electrophysiology is an objective functional test of the visual pathway and allows the location of visual dysfunctions to be detected. The flash electroretinogram (ERG) allows recognition of large area damage to the retina and can distinguish between rod and cone diseases by recording under both dark and light-adapted conditions. Specific stimulation techniques are used for the multifocal ERG (mfERG) which reveals localized retinal dysfunction, e. g. in maculopathies. The pattern ERG (PERG) is an indicator of ganglion cell function and can be used for early detection of glaucoma. The visual evoked potential (VEP) is a cortical response and serves as a functional test of the entire visual pathway from the eye to the visual system of the brain. After presenting each of these methods individually, the article gives assistance in situations where the appropriate electrophysiological method for a given clinical hypothesis is to be selected and explains how the methods can be combined in a reasonable way.

1.1 EINLEITUNG Die Resektion eines Hirntumors, der sich innerhalb oder in der Nähe von funktionell wichtigen Strukturen befindet, ist eine hochsensible Prozedur. Bei der Operationsplanung muss eine Balance zwischen dem Erhalt funktioneller Strukturen und möglichst kompletter Tumorresektion gefunden werden. Die präoperative Kenntnis der exakten funktionellen Topographie ist Voraussetzung für die Beratung des Patienten über Nutzen und Risiken der Operation. Ziel der vorliegenden Arbeiten ist es, die navigierte transkranielle Magnetstimulation hinsichtlich ihrer Zuverlässigkeit, ihres Einflusses auf die Behandlungsstrategie bei Patienten mit Tumoren im Bereich motorischer Areale und der Korrelation neurophysiologischer Messwerte zum prä- und postoperativen Status der Patienten zu untersuchen. 1.2 METHODEN Bei der nTMS werden über eine elektromagnetische Spule räumlich sehr präzise fokussierte Stimulationsimpulse transkraniell auf den Kortex übertragen. Seit Oktober 2007 führten wir das nTMS Mapping jeweils auf der Tumor tragenden und der gesunden Hemisphäre durch. Die Patientendaten, klinische Daten, nTMS Messergebnisse sowie der Einfluss der nTMS Daten auf die Behandlungsstrategie wurden unmittelbar nach jeder Messung in die laboreigene Datenbank eingegeben. Wir führten eine Konsistenzstudie, eine Analyse der neurophysiologischen Messwerte sowie Studien zum Einfluss der nTMS auf Operationsplanung und Behandlungsergebnis durch. 1.3 ERGEBNISSE Wir konnten zeigen, dass nTMS in über 25% der Fälle einen signifikanten Einfluss auf die Behandlungsstrategie bei Hirntumoroperationen hat. Zudem beschrieben die Operateure in weiteren 50% der Fälle einen subjektiven Nutzen für die Operationsplanung. Es wurde erstmalig dokumentiert, dass sich die Resting Motor Threshold (RMT) Werte und die Motorisch evozierten Potentiale (MEP) bei Tumorpatienten im Gegensatz zu gesunden Probanden signifikant zwischen beiden Hemisphären unterscheiden. Die durchschnittliche Distanz der Center of Gravity (CoG) bei der nTMS Messung zu verschiedenen Zeitpunkten und bei unterschiedlichen Untersuchern war sehr gering. Bei den hirneigenen Tumoren führte die exakte Abgrenzung von motorischer Funktion tragendem Gewebe zu Tumor durch nTMS in 6 von 11 Fällen zu einer früheren und vollständigeren Tumorresektionen. 1.4 SCHLUSSFOLGERUNGEN Die vorliegende Arbeit zeigt, dass das nTMS Motormapping für diagnostische Zwecke eine hohe Reliabilität aufweist. Weiterhin erscheint Aufgrund der beobachteten Korrelationen zwischen den neurophysiologischen Messwerten und klinischen Parametern die Etablierung eines auf diesen Messwerten basierenden prognostischen Modells in der Zukunft möglich. Im klinischen Alltag führen die nTMS Ergebnisse in über der Hälfte der Fälle zu einer Modifikation des allein auf den anatomischen MRTs basierend festgelegten Behandlungsplans. Dieser deutliche Einfluss der nTMS auf die Therapie bestätigte sich insbesondere bei Patienten mit langsam-invasiv wachsenden Tumoren – hier zeigen unsere Ergebnisse, dass die präoperative nTMS Untersuchung das Behandlungsergebnis signifikant verbessert., 1.1 INTRODUCTION The resection of a brain tumor, located near or within functional structures is a very delicate procedure. It is necessary to find a balance between the preservation of functional tissue and complete tumor resection. The exact knowledge of the functional cortical topography preoperatively is a prerequisite to give the patient good counsel about the risks and chances of the surgery. It is the aim of this dissertation to evaluate the reliability, influence on the treatment strategy and correlation of neurophysiological parameters with pre- and postsurgical motor status of the patients, of navigated transcranial Brain stimulation (NBS). 1.2 METHODS With NBS spatially very precise stimulation impulses are transmitted transcranially by an electromagnetic coil onto the cortex. Since October 2007 the tumor hemisphere and healthy hemisphere were mapped of all patients with brain tumors in or near the motor cortex. Patient characteristics, clinical data, NBS results and the influence of NBS on the treatment strategy were collected prospectively in a database. A consistency study, an analysis of neurophysiological data and studies about the influence of NBS on surgical planning and treatment outcome were based on this data. 1.3 RESULTS The study showed in over 25% of the cases a significant influence of NBS on the treatment strategy of brain tumor operations. Additionally, surgeons described in 50% of the cases a subjective benefit for the surgical planning. For the first time a significant difference of RMT and MEP data between both hemispheres of tumor patients in contrast to healthy subjects could be documented. There was no significant distance of CoGs of the NBS examination at different times or by different examiners. The exact distinction between functional brain tissue and tumor by NBS facilitated in the treatment of lowgrade gliomas in 6 of 11 cases the early and complete tumor resection. 1.4 CONCLUSIONS This dissertation shows that the NBS Motormapping is highly reliable for preoperative diagnostics. The correlations between neuropysiological data and clinical outcome which were found make a prognostic Model based on this Data feasible. In clinical practice in half of the cases NBS results lead to a change of the treatment plan which was solely based on MRTs before. The influence of NBS on the therapy was especially confirmed for patients with lowgrade gliomas – here the results showed a significantly better treatment outcome if NBS was used preoperatively.

Motor system excitability can be tested by transcranial magnetic stimulation CFMS). In this article, an overview of recent methodological developments and research findings related to attention deficit/hyperactivity disorder (ADHD) is provided. Different TMS parameters that reflect the function of interneurons in the motor cortex may represent neurophysiological markers of inhibition in ADHD, particularly the so-called intracortical inhibition. In children with a high level of hyperactivity and impulsivity, intracortical inhibition was comparably low at rest as shortly before the execution of a movement. TMS-evoked potentials can also be measured in the EEG so that investigating processes of excitability is not restricted to motor areas in future studies. The effects of methylphenidate on motor system excitability may be interpreted in the sense of a 'fine-tuning' with these mainly dopaminergic effects also depending on genetic parameters (DAT1 transporter). A differentiated view on the organization of motor control can be achieved by a combined analysis of TMS parameters and event-related potentials. Applying this bimodal approach, strong evidence for a deviant implementation of motor control in children with ADHD and probably compensatory mechanisms (with involvement of the prefrontal cortex) was obtained. These findings, which contribute to a better understanding of hyperactivity/impulsivity, inhibitory processes and motor control in ADHD as well as the mechanisms of medication, underline the relevance of TMS as a neurophysiological method in ADHD research.Die Exzitabilität des motorischen Systems kann mittels der transkraniellen Magnetstimulation (TMS) untersucht werden. In dieser Arbeit wird ein Überblick über methodische Weiterentwicklungen und Forschungsergebnisse im Bereich der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) der vergangenen Jahre gegeben. Es werden verschiedene TMS-Parameter vorgestellt, die unter anderem die Funktion von Interneuronen im Motorkortex abbilden und neurophysiologische Inhibitionsmarker für ADHS darstellen könnten. Dies gilt insbesondere für die sogenannte intrakortikale Inhibition, die bei Kindern mit stark ausgeprägter hyperaktiver/impulsiver Symptomatik in Ruhe ähnlich gering wie kurz vor der Durchführung einer Bewegung ausfällt. Durch die Ableitung von TMS-evozierten Potentialen im EEG können Exzitabilitätsprozesse prinzipiell auch in nicht-motorischen Arealen untersucht werden. Die Effekte von Methylphenidat auf die Exzitabilität des motorischen Systems lassen sich im Sinne eines «Fine-Tunings» interpretieren, wobei diese überwiegend dopaminergen Effekte auch von genetischen Parametern (DAT1 Transporter) abhängen. Ein detaillierter Blick auf die Organisation motorischer Kontrolle ist durch eine kombinierte Messung von TMS-Parametern und ereignisbezogenen Potentialen möglich. Mit diesem Ansatz konnten bei Kindern mit ADHS eine unterschiedliche Implementierung bzw. mögliche kompensatorische Mechanismen (unter Beteiligung des präfrontalen Kortex) aufgezeigt werden. Diese Befunde, die zu einem besseren Verständnis von Hyperaktivität/Impulsivität, Inhibitionsmechanismen und motorischer Kontrolle bei ADHS sowie den Wirkmechanismen medikamentöser Therapie beitragen, unterstreichen die Bedeutung der TMS als neurophysiologische Methode zur Erforschung von ADHS.

Pediatric intracranial tumors account for approximately 24% of childhood malignancies. Pathological entities and their frequencies differ significantly from adult intracranial tumors and have age-specific differences in the pediatric population itself. In Germany treatment and diagnosis must be carried out according to ongoing multicenter trials for therapy optimization and registers of the Gesellschaft für pädiatrische Onkologie und Hämatologie (GPOH, Society of Pediatric Oncology and Hematology) in specialized centers for pediatric oncology. In addition to the articles in this issue which focus on the radiological aspects of the different entities, this article provides an overview of the principles of diagnostics and treatment of pediatric intracranial tumors.

Psychiatric disorders in childhood and adolescence, in particular attention deficit disorder or specific learning disorders like developmental dyslexia and developmental dyscalculia, affect academic performance and learning at school. Recent advances in neuroscientific research have incited an intensive debate both in the general public and in the field of educational and instructional science as well as to whether and to what extent these new findings in the field of neuroscience might be of importance for school-related learning and instruction. In this review, we first summarize neuroscientific findings related to the development of attention, working memory and executive functions in typically developing children and then evaluate their relevance for school-related learning. We present an overview of neuroimaging studies of specific learning disabilities such as developmental dyslexia and developmental dyscalculia, and critically discuss their practical implications for educational and teaching practice, teacher training, early diagnosis as well as prevention and disorder-specific therapy. We conclude that the new interdisciplinary field of neuroeducation cannot be expected to provide direct innovative educational applications (e.g., teaching methods). Rather, the future potential of neuroscience lies in creating a deeper understanding of the underlying cognitive mechanisms and pathomechanisms of learning processes and learning disorders.Psychische Störungen im Kindes- und Jugendalter, vor allem Störungen der Aufmerksamkeit, Lese-Rechtschreibstörungen (LRS) und Rechenstörungen, betreffen in ihrem Auftreten und ihren Auswirkungen ganz besonders die Schule und das schulische Lernen. In jüngster Zeit entfachten neurowissenschaftliche Befunde sowohl in der Öffentlichkeit als auch in der Lehr- und Lernforschung eine rege Diskussion, ob und inwieweit neue Erkenntnisse zur Funktionsweise des Gehirns auch relevant für das Lernen und Lehren in der Schule sein können. Der vorliegende Übersichtsartikel fasst neurowissenschaftliche Befunde zur regelhaften kindlichen Entwicklung von Aufmerksamkeits-, Arbeitsgedächtnis- und Exekutivfunktionen zusammen und diskutiert kritisch deren Relevanz für schulisches Lernen. Des Weiteren werden Bildgebungsbefunde zu spezifischen Teilleistungsstörungen wie LRS und Dyskalkulie dargestellt und mögliche praktische Implikationen für Unterrichtspraxis, Lehrerausbildung, Frühdiagnostik und Prävention sowie störungsspezifische Therapie zusammengefasst. Insgesamt sind es wohl weniger neue Anwendungen (wie z. B. Lehrmethoden), die von einer Neurodidaktik als interdisziplinärem Forschungsfeld zu erwarten sind; vielmehr können die Neurowissenschaften Argumentationsgrundlagen für bestimmte Theorien und Modelle liefern, welche ein tieferes Verständnis zugrundeliegender kognitiver Mechanismen und Pathomechanismen von Lernprozessen und –störungen ermöglichen.

The psychophysiology of visceral pain is--different from cardiac psychophysiology--much less well investigated due to the invasiveness of its methods and problems associated with reliably and reproducibly stimulating as well as recording of the gastrointestinal tract. Despite these problems, the last 30 years have documented a number of psychophysiological phenomena such as the perception (interoception) of visceral stimuli, the effect of emotions and stress on visceral sensations, and the effect of visceral processes on cortical processing. This was mainly due to the application of neurophysiological techniques (cortical imaging and stimulation) in these investigations.

Modern neuroimaging techniques, such as structural and functional magnetic resonance imaging (MRI) and non-invasive brain stimulation techniques, such as transcranial magnetic stimulation (TMS) are increasingly used in the neuroscientific research of neurological disorders, such as stroke, tinnitus and movement disorders. These methods offer a non-invasive approach and especially in combination, not only the opportunity to add to the pathophysiological understanding of these disorders but also to provide information about the functional recovery and the natural course of the disease in a predictive way. Based on such knowledge therapeutic approaches can be adapted in a patient-tailored fashion to achieve the best therapeutic effects. Furthermore, these methods might provide additional non-invasive information for neurosurgical interventions reducing perioperative interventional risks.In the present article these aspects will be discussed with a focus on the combination of MRI and TMS especially addressed for the topic of recovery from stroke.

Numerous neurological patients suffer from speech and language disorders but the underlying pathomechanisms are not well understood. Imaging studies on speech production disorders lag behind aphasiological research on speech perception, probably due to worries concerning movement artifacts. Meanwhile, modern neuroimaging techniques allow investigation of these processes. This article summarizes the insights from neuroimaging on physiological speech production and also on the pathomechanisms underlying Parkinson's disease and developmental stuttering.

The following article presents an introduction to simultaneous electroencephalography and functional magnetic resonance imaging (EEG-fMRI) measurements which have undergone a huge development during the last few years.The idea behind combining both non-invasive methods is to join the excellent temporal resolution of EEG (ms) together with the superior spatial resolution of fMRI (mm). In this article the status quo of the method and perspectives regarding multimodal imaging are discussed.Simultaneous EEG-fMRI measurements are affected by scanner and cardioballistic artifacts. We present common artifact subtraction methods in order to achieve a feasible data quality and outline what to consider when planning and recording EEG and fMRI simultaneously. Moreover, we discuss different analysis strategies.Combined EEG-fMRI measurements have already increased our knowledge about the underlying relationships between the blood oxygenation level-dependent (BOLD) response and the EEG signal and are applied to answer widespread research questions. Simultaneous measurements are an essential part of multimodal imaging in investigating the underlying processing mechanisms of the brain as well as in advancing our understanding of neuropsychiatric diseases.Current developments in multimodal imaging focus on the combination of electrophysiological and MRI parameters within ultra-high field MRI as well as on positron emission tomography (PET) in a trimodal approach.

The investigation of emotional processes has been neglected for a long time. But with the appearance of new imaging methods, a growing interest in the neural representation of emotional processes emerged. According to recent findings, emotional information were proceed by overlapping neural networks, especially the interaction between the limbic system and heteromodal association cortices.Nachdem in den Neurowissenschaften die Untersuchung der neuronalen Grundlagen emotionaler Prozesse lange Zeit vernachlässigt wurde, setzte mit dem Aufkommen neuer Methoden der funktionellen Bildgebung ein zunehmendes Interesse an der neuronalen Repräsentation emotionaler Prozesse ein. Gemäss neueren Forschungsergebnissen werden emotionale Prozesse durch überlappende neuronale Netzwerke prozessiert, wobei der Interaktion des limbisches Systems mit heteromodalen Assoziationskortices eine hohe Relevanz für die Verarbeitung emotionaler Informationen zukommt.L'investigation des processus émotionnels a été négligée pendant longtemps. Avec la disponibilité des nouvelles méthodes d'imagerie, cependant, la représentation neuronale des processus émotionnels a émergé. Selon les données récentes, ces processus impliquent l'interaction de réseaux, le système limbique jouant le rôle d'unité centrale. Les malades souffrant de troubles psychiatriques ont souvent des symptômes affectifs qui sont corrélés avec des anomalies de l'interaction entre les aires limbiques et hétéromodales.

Recent advances achieved in the field of clinical neuro(bio-)psychology have been varied and impressive. Together with the related social and psychosocial aspects, they contribute to and enrich the development of new options in diagnosis and psychotherapy. Important research results are discussed here based on the examples of depression, Alzheimer's disease and self-injury, which profit greatly from neuropsychological research, especially through early detection of symptoms and prevention.

Motor-independent communication is a novel diagnostic and therapeutic method that is currently in development in order to enable communication with severely physically challenged patients. Some patients with locked-in syndromes or with chronic disorders of consciousness are capable of modulating their brain activities to such a degree that the latter can be analyzed regarding communicative intentions with neuroscientific technologies, such as functional magnetic resonance imaging. Further scientific development and an increasing clinical use of motor-independent communication will aid in meeting essential quality standards for this method. In particular, the requirements need to be clarified under which the method may be utilized to support the patients' autonomy by enabling them to make their own decisions about therapeutic interventions. Communication mediated by technology promises to significantly improve the quality of life for severely physically challenged patients.

Speech is a multifactorial term. In relationship with our central organ, speech is a communication medium which in a complex manner includes the production and perception of verbal information. Even within this limitation, imaging exploration of the neuronal basis of verbal communication offers an extensive investigative field which can only be presented in this article as highlights. The main focus is on the technical hurdles of investigations into speech production using functional magnetic resonance imaging (fMRI) and solution options will be presented. The difficulties contained in this aspect are that spoken words can only be poorly assessed in the noise level of the measurements and that the movements of the mouth necessary for speech motoric can lead to technical imaging artefacts. Investigation techniques and designs will be discussed which allow a representation of speech-relevant brain centers despite these problems.

Examination of the sense of hearing is a technically difficult undertaking especially with functional magnetic resonance imaging because the machine causes a high noise level during the measurement. This article describes the technical conditions which, nevertheless, allow the auditory capabilities to be tested. Furthermore, every switch point of the auditory pathway and the cortical areas involved, which are technically accessible in an investigation of the sense of hearing are pictorially described.