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Health Problem: Parkinson's disease is one of the major neurodegenerative disorders with prevalence rates between 0.1 and 0.2 % in the global population and 1.8 % in people aged 64 years and over. Future incidence rates are estimated to increase within aging societies. The progressive course of Parkinson's disease is clinically characterised by bradykinesia, rigidity and tremor. These limitations in motor functioning reduce the capacity to work, social participation and the clients' quality of life. Parkinson's disease causes incapacity to work and a large number of days off from work. The benefits clients expect from physiotherapy-led treatment include an improvement of gait, a better speed of motion and the decrease of fatigue and rigidity., Corpus of Evidence: A recent Cochrane review (Mehrholz et al., 2010) analysed seven randomised comparisons with 153 participants and found that treadmill training compared with no treatment improved gait speed (SMD 0.50; 95 % confidence interval [0.17 to 0.84]). A lack of evidence exists on how to reduce fatigue and rigidity. There is also need to evaluate long-term effects and cost-effectiveness. Furthermore, an updated meta-analysis should include eleven new randomised trials on treadmill training after 2009. Physiotherapy-led treadmill training can easily be transferred into the German healthcare context since the environmental and educational preconditions are met by German physiotherapeutic care., Implication for Research: Within the German context, there is need to prepare a randomised clinical trial evaluating the impact of physiotherapy-led treadmill training on motor functioning, quality of life, costs, adverse events und long-term effects. Prior to this, a feasibility study should explore the acceptance and intensity of treadmill training as well as the access of private physiotherapy practices to people suffering from early- to mid-stage Parkinson's disease., (Copyright © 2014. Published by Elsevier GmbH.)

Chronic subdural haematomas are mainly related to slight or moderate head trauma with consecutive lesion of bridge or cortical veins and bleeding in the subdural space. Further predisposing factors are known impairment of coagulation (coagulopathies, treatment with anticoagulants, alcohol abuse), risk factors for degenerative disease of the arteries (diabetes mellitus, arterial hypertension), and development of pressure gradients (hydrocephalus, epileptic seizures, lumbar puncture, CSF drainage and cerebral atrophy). Chronic subdural haematomas appear bilaterally in 20 to 25% of cases. We report on a 69-year-old male with a 4-day history of intermittent, proximal, painless paraparesis (BMA grade M2-5) without a trigger event. Sensibility was normal in all qualities and vigilance was not disturbed. Computed tomography of the neurocranium revealed a bitemporally located chronic subdural haematoma with extension to parietal on both sides. Trepanation was performed over the tuber parietale and temporoparietally on both sides, with release of 150 ml fluid. The neurologic deficits regressed totally within 12 hours postoperatively. To the best of our knowledge, we are the first to describe the clinical paradox of intermittent, painless paraparesis with preserved sensibility and without disturbances of vigilance, as manifestation of a chronic subdural haematoma possibly leading to impairment of cerebral blood flow in the area of the middle cerebral artery. Small changes in systemic blood pressure lead to changes in cerebral perfusion pressure due to vessel compression by the haematoma, thus explaining the intermittent character of the clinical presentation.

In a prospective study extending from November 1989 to December 1992 percutaneous discectomy was carried out in 50 patients (26 men, 24 women, mean age 41 [19-73] years). The aim of the study was to ascertain the efficacy of this new mode of treatment, and its indications. The patients selected for the procedure had chronic, therapy-resistant lumboradicular pain syndrome of at least six weeks' duration; imaging procedure had to show a "bulging disc" and neurological deficits had to be no more than minor. During the subsequent follow up period of 22 +/- 9.6 months 35 of the 50 patients did not require any further surgery; 24 of them (69%) resumed full work while seven (20%) regained partial (50%) working capacity. However, the operation proved ineffective in four of these 35 patients (11%). Fourteen of the 50 patients (28%) had persistent pain and required revision by open classical discectomy; seven of them resumed full work and one regained 50% working capacity. The most frequent findings at this revision were stenosis of the subarticular recess in combination with persistent forward bulging of the longitudinal ligament and anulus fibrosus (n = 7), calcification of the posterior longitudinal ligament (n = 1) and an intervertebral disc sequestrum which gave a false negative results on discography (n = 2). In another case there was a genuine recurrence 35 months after a successful percutaneous procedure; this was treated successfully by open operation. When performed at the level L5/S1, the procedure gave unsatisfactory results in five out of six cases.(ABSTRACT TRUNCATED AT 250 WORDS)