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Neuropsychological assessment should be an integral component of clinical psychiatric diagnostics. Yet, the commonly used tests have not been investigated adequately for this population so far. The current study evaluated a clinically approved neuropsychological test battery by analyzing data on 226 mentally ill patients using factor and regression analyses. The extraction of three factors (Speed, Memory, and Executive Functions) proved to be adequate as the tests could be allocated properly. Regression analysis revealed an economical basis assessment consisting of three tests (TAP Alertness, VLMT, and Matrices Test). Based on acceptance, economy, and factorial structure aspects, we recommend the investigated test battery for neuropsychological assessment of psychiatric and psychosomatic patients.Neuropsychologische Untersuchungen sollten ein integraler Bestandteil der klinisch-psychiatrischen Diagnostik sein. Die gängigen Testverfahren wurden bisher jedoch nicht ausreichend an dieser Klientel untersucht. In der vorliegenden Untersuchung wurde eine im klinischen Alltag bewährte neuropsychologische Testbatterie evaluiert. Hierzu wurden Daten von 226 psychisch kranken Patienten anhand von Faktoren- und Regressionsanalysen ausgewertet. Es erwies sich als sinnvoll, drei Faktoren zu extrahieren (Speed, Gedächtnis, Exekutivfunktionen), zu denen sich die Einzeltests plausibel zuordnen ließen. Anhand regressionsanalytischer Berechnungen konnte zudem ein zeitökonomisches Basisassessment aus drei Einzeltests (TAP Alertness, VLMT und Matrizentest) ermittelt werden. Zusammenfassend kann vor dem Hintergrund der Akzeptanz, Ökonomie und faktoriellen Struktur die evaluierte Testbatterie für den Einsatz bei psychiatrischen und psychosomatischen Patienten empfohlen werden.

Ziel dieser Arbeit ist die Beantwortung der Frage, ob das Tragen unterschiedlich stark immobilisierender Orthesen für Hüftgelenk und Wirbelsäule bei gesunden Personen die Führungseignung für ein Kraftfahrzeug einschränkt. Hierfür wurden bei 30 freiwilligen Probanden in einem speziell dafür entworfenen Fahrsimulator Gefahrenbremsungen simuliert und die Messwerte von Mentaler Verarbeitungszeit, Transferzeit, Brems-Reaktionszeit, sowie maximaler Bremskraft erhoben und mit den Kontrollwerten, die ohne das Tragen von Orthesen ermittelt wurden, verglichen. Für die Mentale Verarbeitungszeit zeigten sich bei den Wirbelsäulenorthesen VERTEBRADYN®-STRONG (p = 0,002) und SofTec Dorso® (p = 0,013) gegenüber der Kontrollmessung signifikant höhere Mittelwerte. Dieser Effekt konnte bei den Hüftorthesen nicht beobachtet werden; im Gegensatz dazu zeigte sich hier die Transferzeit beim Tragen der Hohmann-Bandage (p < 0,001) und der DynaCox® (p < 0,001) signifikant verlängert. Als Summe von Mentaler Verarbeitungszeit und Transferzeit ergaben sich für die Brems-Reaktionszeit bei der Wirbelsäulenorthese VERTEBRADYN®-STRONG (p = 0,016), sowie den Hüftorthesen Hohmann-Bandage (p = 0,003) und DynaCox® (p < 0,001) signifikant längere Zeiten. Bei unter Ortheseneinfluss tendenziell reduzierter maximaler Bremskraft konnte hierbei kein statistisch signifikanter Unterschied festgestellt werden. Die Studie zeigt, dass beim Tragen von Hüft- und Wirbelsäulenorthesen mit bis zu 19 (7; 30) ms längeren Brems-Reaktionszeiten (436 (± 46) ms; Hohmann-Bandage) gegenüber dem Tragen keiner Orthese (418 (± 40) ms) zu rechnen ist. Als praktische Konsequenz ergäben sich bei Gefahrenbremsungen um bis zu etwa 0,5 m verlängerte Anhaltewege bei Annahme einer Ausgangsgeschwindigkeit eines Fahrzeuges von 100 km/h. Schließlich verbleibt die Entscheidung über die Fahreignung unter Ortheseneinfluss bei minimaler Verlängerung der Brems-Reaktionszeit und Einhaltung der von Straßenverkehrsbehörden vorgeschlagenen Obergrenzen beim zuständigen Gesetzgeber.

In 2006 the psychosomatic day care hospital for the treatment of acute mental illness of elderly people opened as the first clinic of its kind in Germany. The aim of the study was to determine treatment effectiveness regarding quality of life and cognition.Designed as a naturalistic study of a population sample of 116 patients, the cognitive capacity (memory performance and cognitive speed) and the subjective quality of life were measured by the Nuremberg aging inventory (NAI) and the World Health Organization quality of life for elderly persons (WHOQOL-OLD). The patients were surveyed at four points in time including at 8‑month follow-up. A 5-week waiting time before admission to the 5‑week therapy was implemented as a control condition.In comparison with the waiting time, after treatment significant improvement (0.05) was found in cognitive capacity and quality of life. Effect sizes were partly small and mostly moderate (ES 0.2-1.0) with larger effect sizes in the quality of life than in the cognitive domain. Improvements of cognition and quality of life remained stable at follow-up (admission to follow-up ES 0.1-1.0). No correlation was found between cognitive improvement and reduction of depressive symptoms.The results indicate that the psychosomatic day care hospital treatment of the elderly improves subjective quality of life and cognitive capacity.

Investigate whether treatment response in people at clinical high risk of psychosis (CHR) is predicted by their cognitive performance.128 CHR outpatients were randomized into two treatment groups, one receiving integrated psychological intervention (IPI), including psychoeducation, the other receiving supportive counselling (SC) for 12 months. Multiple regression analysis was used to identify neurocognitive predictors of treatment response in a subgroup of n = 105, measured by symptomatic and functional improvement at 1-year follow-up.In the IPI, treatment response was associated with performance of executive control and processing speed (R² = 0.27, p = 0.002). In both treatment groups, performance of working memory/attention was a significant predictor (IPI: R² = 0.15, p = 0.039, SC: R² = 0.19, p = 0.012).Cognitive performance is associated with treatment response in CHR people. The enhancement of cognitive performance is a useful target of early intervention.

Visual perceptual abilities are increasingly being neglected in research concerning reading disabilities. This study measures the visual perceptual abilities of children with disabilities in reading.The visual perceptual abilities of 35 children with specific reading disorder and 30 controls were compared using the German version of the Developmental Test of Visual Perception – Adolescent and Adult (DTVP-A).11 % of the children with specific reading disorder show clinically relevant performance on the DTVP-A. The perceptual abilities of both groups differ significantly. No significant group differences exist after controlling for general IQ or Perceptional Reasoning Index, but they do remain after controlling for Verbal Comprehension, Working Memory, and Processing Speed Index.The number of children with reading difficulties suffering from visual perceptual disorders has been underestimated. For this reason, visual perceptual abilities should always be tested when making a reading disorder diagnosis. Profiles of IQ-test results of children suffering from reading and visual perceptual disorders should be interpreted carefully.

30-50% of late talkers catch-up their language delay during the third year of life. So far it is unclear whether this is a permanent or an illusionary recovery. The aim of the study was to examine the further language development of late bloomers.Language skills of 83 three-year-old children (16 late bloomers [LB], 29 late talkers [LT] with persistent language problems, 38 Non-LT) were assessed with a standardized language test. Before school entry formal language skills, expressive and receptive vocabulary and precursors of written language (verbal memory, phonological awareness, verbal information-processing speed) were assessed.At follow-up before school entry LB scored below Non-LT on phonological memory test. 31% of the LB in contrast to 3% of the Non-LT had slight language problems. 38% had received speech-language therapy. Nevertheless, no LB met the criteria of developmental language disorder. The language skills of LT with persistent language problems remained significantly below the level of LB and Non-LT. Every fourth of these children was language impaired.LB as a group are not at risk for later clinically relevant language disorders. However, their language abilities are often within the lower range of normal variation. Therefore, it is recommended to facilitate their language acquisition either by kindergarten training programs or by parent-directed intervention programs to provide a more stimulating environment.

It is not unusual for a neurological expert to have problems defining the precise anatomical location and the required objective proof of damage, especially if the medical history and the neurological report released by the clinic prove inadequate in terms of providing a reliable assessment. This may well result from somatoform disorders, dissociation, aggravation and simulation, as well as dissimulation and complex organic diagnostic findings. A range of standardised neurophysiologic procedures is available for the objective measuring of motor, vegetative and sensory systems; a brief summary of the most frequent occurrences is given here, along with their significance for appraising damage resulting from an accident. Target groups primarily include surgeons, orthopaedists, lawyers and insurance specialists. Structural improvements and measures to integrate immigrant doctors is essential.

Providing expert opinion in the context of smell disorders is often challenging, not only with regard to general aspects of providing an expert opinion but particularly with regard to chemosensory testing. Currently there is no consensus which chemosensory test should be selected and how they should be executed. This positions paper from Committee on Olfaction and Gustation of the German Society of Otorhinolaryngology, Head and Neck Surgery aims to give concrete recommendations for chemosensory testing for providing expert opinion for smell disorders with regard to the selection and execution of these test.

Emotion regulation dysfunctions marked by negative affectivity are a core feature of borderline personality disorder (BPD). In addition, patients with BPD show disturbed attentional processes which become particularly apparent in the domain of selective attention when emotional stimuli are presented (negative attentional bias). Assuming that emotion regulation is linked to attentional deployment processes, this study aimed (1) to determine whether a negative attentional bias is established by using film clips of fearful faces and (2) to investigate the association between dysfunctional emotion regulation strategies (emotional suppression) and negative attention bias in BPD.We investigated 18 inpatients with BPD and 18 healthy control participants using the modified version of the fearful face-paradigm to assess the inhibition of emotional stimuli. We also administered self-report emotion regulation questionnaires.Compared to the healthy controls, patients with BPD showed significant longer reaction times during the emotional versus the neutral film stimuli in the modified fearful face-paradigm. With regard to the second hypothesis, we failed to find an association between the negative attentional bias and the habitual use of emotional suppression in BPD.In this study, we could confirm an attentional bias for negative stimuli, using complex, dynamic material. Future studies need to address the impact of confounding variables (e. g. comorbid disorders) on the relationship between maladaptive emotion regulation and selective attentional bias.

Several studies have revealed impairments in cognitive functions among patients with affective disorders (AD). However, to date there are few neuropsychological studies on cognitive flexibility among adolescent patients with AD, especially on gender differences in AD. Here, we investigate cognitive functions, especially cognitive flexibility, in adolescent patients with unipolar AD (UAD) compared to a healthy control group (CG).The study population consists of 17 male patients (Minfage/inf= 15.4 ± 1.3) and 22 female patients with UAD (Minfage/inf= 15.6 ± 1.4) as well as 20 male (Minfage/inf= 16.0 ± 1.0) and 30 female (Minfage/inf= 15.7 ± 0.9) healthy adolescents. A neuropsychological test battery was conducted, and depressive symptoms, psychological stress, and intelligence were also assessed.The analyses revealed no significant group differences regarding cognitive flexibility or visual processing speed, albeit slight better performance in motor processing speed for the CG. Furthermore, no gender differences were observed regarding cognitive flexibility, though female subjects general displayed better performance in processing speed.Overall, there are no indications for serious deficits and specific gender differences in cognitive flexibility or processing speed in adolescent patients with UAD. Independent of psychological distress, female subjects seem to have some advantages in processing speed.Fragestellung: Verschiedene Studien verweisen auf Einschränkungen in der kognitiven Flexibilität bei Patienten mit Affektiven Störungen (AS). Derzeit herrscht jedoch ein Forschungsmangel hinsichtlich neuropsychologischer Untersuchungen bei jugendlichen Patienten mit AS sowie der Erforschung geschlechtsbezogener Unterschiede. Ziel der vorliegenden Studie ist daher die Erfassung kognitiver Funktionen, insbesondere kognitiver Flexibilität, bei jugendlichen Patienten mit unipolaren Affektiven Störungen (UAS) im Vergleich zu einer gesunden Kontrollgruppe (KG). Methodik: In die Stichprobe wurden 17 männliche (MinfAlter/inf= 15.4 ± 1.3) und 22 weibliche (MinfAlter/inf= 15.6 ± 1.4) Patienten mit UAS sowie 20 männliche (MinfAlter/inf= 16.0 ± 1.0) und 30 weibliche (MinfAlter/inf= 15.7 ± 0.9) gesunde Kontrollprobanden einbezogen. Neben dem Einsatz einer neuropsychologische Testbatterie erfolgte die Erfassung depressiver Symptome, psychischer Belastung sowie Intelligenz. Ergebnisse: Die Ergebnisse zeigen keine signifikanten Gruppenunterschiede bezüglich kognitiver Flexibilität oder visueller Verarbeitungsgeschwindigkeit und lediglich tendenzielle Unterschiede hinsichtlich der motorischen Verarbeitungsgeschwindigkeit mit einer besseren Leistung bei der KG. Zudem ergeben sich keine geschlechtsbezogenen Unterschiede in der kognitiven Flexibilität, jedoch bessere Leistungen in der Verarbeitungsgeschwindigkeit bei weiblichen Probanden. Schlussfolgerung: Insgesamt betrachtet offenbaren sich keine Hinweise für gravierende Einschränkungen in der kognitiven Flexibilität und Verarbeitungsgeschwindigkeit oder diesbezügliche spezifische geschlechtsbezogene Unterschiede bei jugendlichen Patienten mit UAS. Mädchen scheinen, unabhängig von einer psychischen Beeinträchtigung, Vorteile in Bezug auf die Verarbeitungsgeschwindigkeit aufzuweisen.

The peroneal reaction time (PRT) is used in the assessment of neuromuscular deficits in chronic functional ankle instability. Powered by the Editorial Manager and Preprint Manager from Aries Systems Corporation the present study was conducted to determine the PRT in a large collective of patients with chronic ankle instability because it is unclear if this parameter of neuromuscular deficit is prolonged. In this study 186 patients underwent a diagnostic algorithm consisting of anamnesis, clinical examination, X-ray and determination of the PRT on a tilting platform. A prolonged PRT as a manifestation of a neuromuscular deficit could be detected in the majority of the patients (n = 143, 77%). Comparing the affected and healthy legs 77 patients (41%) showed a significant difference in talar shift (p = 0.002) and talar tilt (p = 0.04) in the radiological stress views. Of these 77 patients only 15 (8%) showed radiological evidence of a mechanical problem. As a consequence of recurring ankle sprains a post-traumatic deficit in proprioception has to be expected in most cases. In general a conservative therapy approach should be followed including specific training to improve neuromuscular and proprioceptive deficits.

Previous studies could show a complex relationship between alcohol consumption and cognition but also with processes of ageing both social and biological. Acute effects of alcohol during intoxication include clinical signs such as excitation and reduced inhibition, slurred speech, and increased reaction time but also cognitive dysfunction, especially deficits in memory functions. However, these cognitive deficits during alcohol intoxication are reversible while patients with alcohol addiction and chronic alcohol intake show severe impairments of cognitive functions especially deficits in executive functions. Frontal executive impairments in these patients include deficits in problem solving, abstraction, planning, organizing, and working memory.Additionally, gender specific deficits are relevant for the course of the disease and its concomitant health problems with female alcoholics showing a higher vulnerability for cognitive dysfunction and brain atrophy at earlier stages of alcoholism history.

The focus of the present study were performances of N = 433 children and adolescents with AD(H)D on the German version of the Wechsler Intelligence Scale for children (HAWIK-IV). Furthermore, we investigated whether test results depend on comorbid disorders based on subgroups (n = 212, n = 262, n = 217) composed by excluding individuals based on comorbidities on either (a) the first, (b) the second, and (c) the first and the second axis of the multiaxial classification scheme for mental disorders in childhood and adolescents. The specificity of the AD(H)D profile was investigated by comparing it against a clinical control group of children with anxiety or other emotional disorders (N = 41). As expected, a significant deficit in the Speed Index was shown not only in the total sample of all AD(H)D children, but also in the subsample cleared of comorbidities. There was also a deficit in Working Memory, although this result was no longer found in the subsample of AD(H)D children without comorbidities. The profile of the AD(H)D-only group was not significantly different from the profile of the clinical control group. The results support the assumption that AD(H)D is associated with deficits in Processing Speed. Working Memory deficits seem to occur only if comorbid disorders are present.

Pain-related evoked potentials (PREPs) represent a novel method for the evaluation of peripheral and central nociceptive pathways, e.g. in the diagnosis of small fiber neuropathy (SFN) or after therapeutic interventions for headache. Compared to contact heat-evoked and laser-evoked potentials, recording of PREPs is less stressful for the subjects and technically less demanding. The clinical usefulness of PREPs has been described for SFN associated with diabetes, HIV and hepatitis C infections as well as in headache and facial pain disorders. They have also been evaluated after interventional methods, such as direct current stimulation (tDCS). The article reviews and discusses the advantages and pitfalls of this technique in the context of recent clinical studies as compared to other paradigms of peripheral electrical stimulation and delineates perspectives and possible indications.

Social reinforcement can improve inhibitory control in boys with attention deficit/hyperactivity disorder (ADHD), suggesting that hyperkinetic conduct disorder (ADHD + CD/ODD), a combination of ADHD and conduct disorder (CD)/oppositional defiant disorder (ODD), might show similar improvements. This study investigated the effects of social and monetary reward on response inhibition in boys with ADHD + CD/ODD compared to healthy controls.An incentive go/no-go task was applied. We hypothesized that the control group (n = 17) would show greater improvements in inhibitory control in response to social reward than the ADHD + CD/ODD group (n = 17), but that both groups would respond equally to monetary reward.Both groups showed improved inhibition accuracy in the social condition and even greater improvement in the monetary condition. Interestingly, the control group altered their response strategy when money was at stake, i.e., they slowed down more dramatically in favour of stronger inhibitory control and, thus, a potentially greater financial gain.Our findings do not provide evidence for hyporesponsivity to social rewards in boys with ADHD + CD/ODD. Rather, our data suggest that both social and nonsocial reward procedures can be effective in behavioral interventions, but that monetary reinforcers may be more effective.

In patients with complex regional pain syndrome (CRPS) a disruption of the body schema has been shown in an altered cortical representation of the hand and in delayed reaction times (RT) in the hand laterality recognition task. However, the role of attentional processes or the effect of isolated limb laterality training has not yet been clarified. The performance of healthy subjects (n = 38), CRPS patients (n = 12) and phantom limb pain (PLP) patients (n = 12) in a test battery of attentional performance (TAP) and in a limb laterality recognition task was compared and the effect of limb laterality training in CRPS patients and healthy subjects evaluated. The RTs of both CRPS and PLP patients were significantly slower than those of healthy subjects despite normal TAP values. The CRPS and PLP patients showed bilaterally delayed RTs. Through training RTs improved significantly but the RTs of CRPS patients remained slower than those of healthy subjects. In this study an equal disruption of the body schema was found in both CRPS and PLP patients which cannot be accounted for by attentional processes. For CRPS patients this disorder cannot be fully reversed by isolated limb laterality recognition training.

Vestibular-evoked myogenic potentials (VEMP) are widely used to assess vestibular function. Air conducted (AC) cervical VEMP (cVEMP) reflect sacculus and inferior vestibular nerve function. Ocular VEMP (oVEMP) however has been hardly examined up to now. In recent studies it has been assumed that AC oVEMP probably reflects superior vestibular nerve function. The aim of this pilot study was to evaluate clinical application of the AC oVEMP.AC oVEMP were recorded in patients with peripheral vestibular disorders (n=21). In addition thermal irritation and head impulse test were performed and AC cVEMP were recorded. For intense AC-sound stimulation tone bursts (500 Hz) with 100 dB nHL were used.In peripheral vestibular disorders AC oVEMP and AC cVEMP could be classified into: • type 1 (inferior vestibular neuritis) with loss of AC oVEMP but normal AC cVEMP, • type 2, probable type of superior vestibular neuritis, showing present AC cVEMP but loss of AC oVEMP, • type 3, probable complete vestibular neuritis, without AC oVEMP and AC cVEMP.AC oVEMP may be used as an appropriate test for clinical investigation in patients with vestibular disorders. AC oVEMP is an additional, essential test for assessing otolith function beside AC cVEMP. Further vestibular test are necessary for precise clinical interpretation.

Air conducted (AC) cervical vestibular evoked myogenic potentials (AC cVEMP) and air conducted ocular VEMP (AC oVEMP) may be used for measurement of otolith function. However AC oVEMP are few examined till now. The aim of this pilot study was to apply a method for use of AC oVEMP in clinical practice.AC oVEMP were recorded in healthy voluntary people (n=20) using intense AC-sound stimulation (500 Hz tone bursts, 100 dB nHL). Thermal irrigation and AC cVEMP were normal as including criteria. Values were evaluated statistically.AC oVEMP were recorded in all healthy patients. Mean and standard deviation for the first negative peak was 11.35±1.00 ms and for the first negative peak 16.30±1.10 ms. The mean amplitudes were 7.70±4.50 μV. The stability of n10 and p15 component was the same.AC oVEMP can be easy and fast obtained. N10 and p15 latencies may used as parameter for clinical interpretation. Amplitude fluctuations are relatively large. Results can be used in further clinical investigation of AC oVEMP.

Die Experimente aus dem Jahr 2002 schließen an die Arbeiten von Bha­rucha und Stoeckig (1986, 1987) an. In ihren Experimenten wurden Dur und Moll-Akkorde beurteilt, nachdem ein Ankerreiz (prime) eine Tonalität wachgerufen hatte. Die Ergebnisse von Bharucha und Stoeckig konnten präzisiert werden. (1) Die Zeiten der 10 männlichen und 10 weiblichen Ex­perten waren deutlich kürzer als in allen anderen Studien, in denen Akkord­beurteilungen vorgenommen wurden. (2) Ein tonaler Ankerreiz verlängert die Beurteilungszeit geringfügig, aber signifikant. (3) Bei den Verbindun­gen zwischen einem Dur-Ankerreiz und einem Dur-Zielakkord verlängerte sich die Beurteilungszeit mit jeder zusätzlichen Quinte Abstand um 5 bis 10 ms, aber nur wenn man die Reaktionen betrachtet, die länger als 450 ms dauerten. (4) Sobald Zielakkord und/oder Ankerreiz in Moll gespielt wur­den, zeigte die Verteilung der Antwortzeiten Besonderheiten, die darauf schließen lassen, dass mit Mollankerreizen eine verwandte Durtonart aktiviert wird. (5) Die besonders schnellen richtigen Reaktionen (266 bis 440 ms) zeigen keine Beziehung zum tonalen Gefüge des Ankerreizes., The experiments from 2002 follow the work of Bharucha and Stoeckig (1986, 1987). They play major and minor chords which had to be distin­guished as fast as possible. The present experiment was able to report results more precisely. (1) Decisions were much faster than in any other up to now reported harmony experiment. (2) A tonal prime prolonges response times significantly. (3) Response times longer than 450 ms provide evidence for the fact that the distance between chords is represented mentally by fifths. (4) Minor chords cause particularly differing tonal structures: lt seems as if minor chords activate related major tonalities. (5) Response times less than 440 ms are not affected by the tonality of a prime.

Psychophysiological research focusing on child development and on child and adolescent psychiatric disorders has provided many important insights. The use of cognitive neuroscience methods along with the assessment of peripheral psychophysiological measures - particularly functional magnetic resonance imaging and electroencephalography reflecting brain activity - have advanced our understanding of the physiological basis of many cognitive processes such as attention, memory, learning, and language in the context of child development and psychiatric disorders. These insights are proving increasingly helpful when evaluating and advancing treatment. The following review introduces the reader to psychophysiological and particularly electrophysiological methods widely used in child and adolescent psychiatry research.

A useful tool for the investigation of the human olfactory system is functional magnetic resonance tomography (fMRI). Since the length of the fMRI examination is a limiting factor for its usefulness in clinical routine in this study a fast, reliable paradigm should be found in order to reduce the overall examination time and the olfactory habituation.A MRI-compatible constant flow olfactometer was developed. 9 healthy normosmic subjects were stimulated 16 times with the odorant phenyl-ethyl-alcohol (PEA) using an event-related design. The statistical evaluation of the data was performed by the MATLAB based SPM5 software package.The group analysis showed cerebral activations within the insula, the adjacent operculum and orbitofrontal cortex bilaterally. Furthermore, bilateral activations were measured in the cingulum, piriform cortex and the cerebellum. All mentioned areas could be already identified after 8 repetitions of odorant condition. Bilateral insular activations and activations in the left piriform cortex were even shown after 4 repetitions. In the single subject analysis, all 9 subjects exhibited insular activity and in 3 subjects showed activation of the piriform cortex after 4 repetitions.In olfactory fMRI, stimulus repetition more than 8 did not improve the quality and reliability of the results. Therefore, 4-8 stimuli are expected to be sufficient.

Newly developed vagal stimulation probes permit continuous intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroid resection. A complete signal loss indicates an interrupted nerve conductance. There are no other criteria so far which may serve as warning criteria for imminent nerve function impairment.The vagal stimulation probe V3 was used in 50 patients with thyroid resection (96 nerves at risk) and recorded during the complete operation (V3, adhesive tube electrode, bipolar needle electrode; Fa. Inomed, Teningen, Germany). The signal parameters amplitude, latency and thresholds of nerve conductance were compared before start-ing thyroid resection and after finishing thyroid preparation. The changes of these parameters were analysed.Complete signal loss was documented in 2 cases and vocal cord palsy confirmed laryngoscopically. Changes of the signal amplitude were seen in range from - 51% to + 243% after resection. The latencies (right vagal nerve 4.39 +/- 0.51 ms; left vagal nerve 6.78 +/- 0.75 ms) remained unchanged during the complete resection time. Lower threshold of nerve conduction varied from 0.5 to 2.5 mA, the upper threshold from 1.5 to 5.0 mA. All recorded changes of these parameters were not associated with laryngoscopic vocal cord disorders.Continuous intraoperative neuromonitoring permits an immediate problem solving reaction of the surgeon in the case of complete signal loss. The parameters signal amplitude, latency and conduction threshold cannot be applied as additional warning criteria for nerve function impairment during thyroid resection.

Opioids are important in pain management of patients suffering from chronic pain. However, opioid use is associated with several concerns, such as opioid induced impairment of cognitive and psychomotor performance. Several studies could demonstrate that opioid treatment in stable doses does not necessarily impair complex activities such as driving ability. But due to intraindividual variability to opioid response and other confounding factors (e.g. pain intensity, co-morbidity) judgements have to be made on an individual basis only.

Respiratory orienting reactions after olfactory stimulation can be seen as an indicator of an intact olfactory processing. Olfactory stimuli have to be recognized and they have to be important for a subject in order to generate a respiratory orienting reaction.Hyposmic patients were stimulated pre-nasally with one sub-threshold and two supra-threshold concentrations of hydrogen sulfide (H(2)S) using a flow olfactometer. Nasal respiration was measured unilaterally using a differential pressure transducer. The data were processed after digitalization with the LabView software package. Duration of inspiration (DIN) and duration of expiration (DEX) were used as test variables for the evaluation of a regular resting respiration or a poststimulation respiration complex (PRC), respectively.The rate of poststimulatory respiration alterations (47%) in hyposmic subjects was significantly higher than the rate of spontaneous changes after resting respiration (31%). The reaction rate was not stimulus concentration-dependent. In spite of the stimulus recognition poststimulatory respiration alterations were less often in hyposmic subjects compared to normosmic subjects.Maybe this is due to the reduced significance of perceptible odors for hyposmic persons.

Intraoperative neuromonitoring allows the evaluation of the recurrent laryngeal nerve function only at the moment of stimulation. Continuous vagal stimulation checks the complete extra- and intrathoracic course of the recurrent laryngeal nerve during all phases of preparation. The continuously running neuromonitoring is not implemented in the practice of thyroid surgery so far. A newly developed vagal probe for continuous stimulation is introduced and tested in a series of 20 thyroid resections. This advancement in probe technique for intraoperative neuromonitoring allows safe and continuous verification of the recurrent laryngeal nerve function during surgical preparation and may be beneficial in anatomically difficult situations.

In about 20% of patients with Chiari II malformation brainstem signs and symptoms occur. Ventilatory dysfunction is the main cause of death in these patients. The indication for craniocervical decompression is based on clinical examination because supporting electrophysiological or radiological methods were lacking.In a prospective study the clinical courses of 106 patients were documented during a 3-year period. In addition brainstem diagnostic procedures using the masseter reflex (MR), blink reflex (BR) and early auditory evoked potentials (EAEP) were done. Based on the model of binary logistic regression the odds ratio (OR) of progression over time was calculated.The combination of MR and late BR components showed the highest correlation with clinical findings (OR: 23). The highest predictive value regarding clinical progression over a 3-year period was shown by the combined evaluation of MR, late BR components and EAEP interpeak latency I-V (OR: 17.6). Signs and symptoms had no predictive value.Combined brainstem reflex recordings (MR and late BR components) support the clinical examination. To evaluate the long-term prognosis brainstem reflexes and EAEP recordings should be used.

Deficits in auditory short-term memory are thought to underlie developmental language disorders and dyslexia. There is, however, a lack of systematic studies of short-term memory in children at a young age. The aim of this study was to probe the duration of auditory sensory memory using objective methods in young children.37 two-year-old and 52 six-year-old normally developing children were included in the study. Event-related potentials (ERPs) were elicited in a passive auditory oddball paradigm with variable interstimulus intervals (ISIs of 0.5-5 s, depending on the subgroup).For shorter ISIs, a prominent mismatch negativity (MMN) and late discriminative negativity (LDN) were found, while a distinct P3a occurred particularly for longer ISIs. Statistical significance was proven for the dependence of MMN and LDN amplitudes on the ISI. The change in the structure of the ERP components occurred at a longer ISI for the six-year-olds than for the 2-year-olds.The points where MMN and LDN disappear with increasing ISI suggest that the duration of auditory sensory memory lies between 1 and 2 s in two-year-old children and between 3 and 5 s in six-year-olds. The occurrence of a P3a beyond the point where MMN and LDN can no longer be elicited, however, provides evidence that several different mechanisms with different durations of memory representations are involved in short-term storage of auditory information.

Wilson's disease is a rare autosomal recessive disorder of hepatic copper transport leading to hepatic but also to highly variable neurological symptoms with basal ganglia and cerebellar manifestation. Symptoms, signs and results of investigations can overlap with those of other central nervous system disorders such as multiple sclerosis and sometimes delay diagnosis.We report on a 38-year-old male patient who was diagnosed with a hepatic form of Wilson's disease at age 12 and with multiple sclerosis at age 38. Intravenous radio copper test confirmed the diagnosis of Wilson's disease. Multiple sclerosis was diagnosed after occurrence of transient sensory disturbances in both legs, based on typical changes on MRI over the course of 2 years, in the cerebrospinal fluid and in multimodal evoked potentials.Although Wilson's disease and multiple sclerosis are known as distinct diseases with a completely different pathophysiology, symptoms and results of evoked potentials overlap, and they share a common historic background. Similarities and differences of both disorders are discussed.