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Sporadic Parkinson's disease (sPD) is one of the most common neurodegenerative diseases. Degeneration of dopaminergic neurons in the substantia nigra and the stratium, are the hallmarks of the disease. Numerous studies have shown that dysfunctions of mitochondrial respiratory chain complex I and oxidative stress are associated with sPD development. Mitochondria are dynamic organelles, constantly undergoing processes of fusion and fission. Shape of mitochondrial network is modified in accordance to cellular needs and external stimuli. Growing number of evidence show the presence of disturbances of mitochondrial dynamics in sPD. The aim of this article is to summarize recent data concerning role of mitochondrial dynamics in sPD pathogenesis.

Apomorphine is the most potent dopamine receptor agonist and its symptomatic effectiveness is comparable to levodopa. Subcutaneous apomorphine is rapidly and completely absorbed. Plasma peak concentrations are achieved after 5-15 minutes and onset of clinical effect is within 20 minutes. Apomorphine intermittent subcutaneous injections are effective as rescue therapy for unpredictable off periods in advanced Parkinson disease (PD). More often apomorphine is administered as a subcutaneous infusion which secures the continuous dopaminergic stimulation. The benefit on 'off' periods is consistent across all studies, but dyskinesia improvement is not so obvious. Two infusion therapies (apomorphine and intraduodenal levodopa) and deep brain stimulation (DBS) are effective in advanced PD patients with untreatable motor complications. Apomorphine infusions should be considered in patients unable to undergo DBS because of cognitive impairment and neurosurgical contraindications.

Neurotrophic factors regulate survival, development, and function of nervous tissue. They act via two different classes of receptors and activation of various signaling pathways in the target cells. Illumination of their physiological role in the maintenance of central nervous system homeostasis as well as regeneration of damaged tissue have ignited expectations to heal neurodegenerative diseases, including amyotrophic late-ral sclerosis and Parkinson disease. Advances in pharmaco-therapy, gene therapy, and stem cell biology have enabled development of novel therapies with application of regenerating cell transplantation. In the foreseeable future, it may lead to the establishment of safe and effective ways of treatment of these severe and currently incurable diseases.

Instrumental methods of tremor investigation can be used in differential diagnosis between essential and parkinsonian tremor in uncertain cases. This paper describes the method of tremor quantification using long-term surface electro- myography registration of antagonistic forearm muscles. Examples of clinical application of the method are also given.

Fatigue without coincident depression may accompany many neurological disorders, including multiple sclerosis, Parkinson's disease, motor neuron disease, stroke and post-polio syndrome, and is frequently reported by patients as a predominant complaint. The pathophysiology of fatigue is unknown. The role of various mechanisms has been suggested, including the effect of proinflammatory cytokines (TNF-alpha, IL-1beta and IL-6) on glutaminergic transmission, hypothalamo-pituitary-adrenal (HPA) axis dysfunction, disturbances of astroglia metabolism and decreased levels of the neurotransmitters noradrenaline and serotonin. The diagnosis of fatigue syndrome is based on exclusion of depression and additional organic conditions (anaemia, cardiovascular disorders, kidney diseases or hypothyroidism). The treatment of fatigue syndrome is complex. Physical activity, rehabilitation, psychotherapy and avoidance of factors which may increase fatigue, such as fever, anxiety, depression, pain, sleep disturbances, as well as some drugs like opioids and benzodiazepines, are important. Pharmacological treatment leads to slight improvement. Amantadine, modafinil and pemoline are administered to such patients.

Background and Purpose: The aim of the study was to assess the prevalence of vascular risk factors and white matter hyperintensities (WMH) in patients with Parkinson's disease (PD) and its impact on clinical features such as motor impairment., Material and Methods: 60 patients with PD [25 women and 35 men; mean age 68.4 (51-81) years, mean duration of disease 8.4 (1-27) years] with good response to L-Dopa were studied. Besides neurological examination, the degree of motor impairment was evaluated in all patients using UPDRS, Hoehn-Yahr, and Schwab-England scales. All patients underwent MRI to assess the degree of WMH using Age Related White Matter Changes (ARWMC) Wahlund scale. Moreover, the prevalence of classic vascular risk factors included arterial hypertension, diabetes mellitus t. 1 and 2; plasma cholesterol, cardiovascular diseases, alcohol abuse and smoking was assessed., Results: Presence of at least one vascular risk factor was noted in 19 patients (31.7%). No significant differences were found between the groups of patients with and without vascular risk factors with regard to all clinical parameters and total ARWMC score. These factors did not differ between the groups of patients with more than 3 vascular risk factors and other patients. WMH (ARWMC > or =1) occurred in 33 patients (55%). No significant differences in all analysed clinical factors and the total number of vascular risk factors between the groups with (ARWMC > or =1) and without (ARWMC=0) WMH were found. The group of patients with at least one focus with score of 2 in the Wahlund scale did not differ significantly in all analysed clinical parameters from the rest of the patients., Conclusions: Our data suggest that the severity of WMH and incidence of vascular risk factors are not significantly related with the degree of motor disability in PD.

Background and Purpose: In advanced stages of Parkinson's disease (PD) beside resting tremor, rigidity, and bradykinesia, most patients reveal severe balance instability. The goal of this study is to determine objectively postural control changes using static posturography after neurosurgical treatment (unilateral posteroventrolateral pallidotomy)., Material and Methods: 15 patients with advanced idiopathic PD underwent unilateral posteroventrolateral pallidotomy. The study group was composed of 8 men and 7 women. The mean disease duration until operation was 12.5+/-3.5 years, and the mean age of the patients at the time of surgery was 65.8+/-4.1 years. Postural control changes were assessed objectively by static computerized posturography and subjectively according to items of posture, gait and postural stability derived from Part III (motor examination) UPDRS. All evaluations of the balance system were performed preoperatively in the off and on condition, and also two weeks postoperatively in the same conditions., Results: It was found that the majority of posturographic parameters in the off condition were improved after neurosurgical treatment. The improvement in the on condition was less pronounced. For example, the mean path length in the off condition during eyes opened was 318+/-159 mm before pallidotomy, and after surgery it was 240.9+/-119.2 mm in off. The difference was statistically significant (p < 0.005, t=3.11)., Conclusions: Pallidotomy improves postural control changes in the early postoperative period, which can be proved by static computerized posturography.

In the study oculomotor abnormalities were investigated in 35 patients with idiopathic Parkinson's disease. Vestibular-oculomotor reflexes, pursuit eye movement, saccades and optokinetic nystagmus were evaluated using videonystagmographic registration. Saccadis, smooth pursuit and optokinetic reflexes were significantly disturbed in the majority of cases. Pathological results of caloric and rotatory tests were observed rarely. In the patients after stereotactic thalamotomy--14 cases, there were no changes in visual-oculomotor reflexes pathology. The results show that visual reflexes are often disturbed in Parkinson's disease and suggest the possibility that subcortical neurons, not thalamus are engaged in reflex eye movements.

The aim of the study was review of literature and description of surgical treatment of Parkinson's disease, based on neuroanatomical and neurophysiological aspects ofnigrostriatal system. Parkinson's disease is the neurodegenerative disorder characterized by dopaminergic cell loss in the compact part of substantia nigra. It is treated pharmacologically or surgically. The surgical treatment is the supplement to the pharmacological one in severe and drug resistant cases. In this study the common methods of surgical treatment of Parkinson's disease: ablative lesions and deep brain stimulation procedures in globus pallidus internus, thalamus and subthalamic nucleus and also the intrastriatal transplantation ofdopaminergic cells (into the striatum) were described.

Fatigue or piercing feeling of weakness, lack of strength and energy or total exhaustion is a common complaint of patients with neurological disorders. From 40 to over 90 per cent of individuals with multiple sclerosis, Parkinson disease, amyotrophic lateral sclerosis, neuroboreliosis, post polio syndrome or stroke confirm its experience. It is not infrequently numbered among most disabling complaints. A separate entity, with fatigue as a cardinal sign, is a chronic fatigue syndrome, a disorder, though controversial, more and more frequently diagnosed. Fatigue ought to be discriminated from fatigability, paresis, somnolence and, first of all depression which commonly coexists in chronic disorders. The assessment is almost entirely based on self-estimate scales filled in by a patient. Attainable results of neuroimaging, electrophysiological, polisomnographic, vegetative, psychological and biochemical surveys have not allowed yet to define the pathogenesis of fatigue. The treatment basis consists of behavioral therapy, psychotherapy and a proper treatment of the basic disease.

Unlabelled: Degenerative process in Parkinson's disease affects substantia nigra and other central structures of an extrapyramidal system but it can also affect central and peripheral autonomic centres. One of the most frequent late complications in levodopa therapy is a wearing off phenomenon. We present a patient treated for Parkinson's disease in whom during the period of levodopa wearing off we observed a paroxysmal abdominalgia apart from other features of a typical movement disorders like: increasing rigidity, gait disturbances and tremor. Abdominalgia consisted of stomach cramps, with variable localization in epi-, meso- and hypogastrium. Rectal tenesmus was also present. The patient was treated with analgesics, spasmolytics and carminative drugs with no effect. Abdominal pains regressed after an intake of the next levodopa dose. The patient presented with other features of a gastrointestinal tract autonomic system dysfunction like: chronic constipation, preterm satiety resulting in food intake reduction and a decrease in body weight. There was no organic lesions of the gastrointestinal system that could explain such disturbances. Pharmacologic treatment modification (more frequent levodopa dosage, additional dopamine agonist) resulted in some improvement., Conclusion: It is possible that the abdominal pains could be a clinical manifestation of a digestive tract dyskinesias, occurring during

Among all the extrapiramidal movement disorders Parkinson's disease (PD) is the one most often submitted to neurosurgical treatment. Technical advances in neurosurgery, neuroimaging and neurophysiology, as well as shortcomings of chronic Levodopa medication (i.e. on/off fluctuations, violent dyskinesia and painful dystonia) have greatly contributed to the renewed interest in the surgical treatment of PD. The attainment of a better understanding of the basal ganglia function and of PD pathophysiology has also encouraged centers to treat Parkinson's disease in recent years. This article presents the current model of PD and the rationale for using GPi, thalamus and STN as target sites in stereotactic surgery.

The aim of the study was to check whether VEP in Parkinson disease are pathological and if there is a relationship between VEP studies and severity, duration of the disease. The authors recruited 54 patient with idiopathic Parkinson disease with significant differences in laterality of bradykinesia, rigidity and tremor. The examined group consisted of 25 males and 29 females, aged from 34 to 82 years; mean age 70.47; the disease duration--from 3 month to 20 years; mean duration 7.76. The asymmetry of extra-pyramidal symptoms, severity of disease with UPDRS and activities of daily living with Schwabach and England were evaluated. Age, disease duration, treatment duration, current dose and side effects of levodopa were taken into account. Neurological examination and VEP were performed before the morning dose of levodopa U-test and Spearman correlation were used for statistical analysis. The VEP latencies were found in 11 patients (15.94%). Mean VEP latency for the right eye in this group was 116.83 (range: 122.3-111.0) and 120.45 (range: 161.5-111.0) for the left. In the group of patients with normal VEP the results were respectively 99.91 and 100.39. There were no significant correlations between the VEP and the asymmetry of neurological symptoms, disease severity and duration, treatment duration, the dose and side effects of Levodopa. There was a significant relationship between VEP latency and patients age and activities of daily living.

Introduction: Dementia is more frequent in patients suffering from Parkinson's disease (PD) then in general population. The mechanism for mental deterioration in PD remains controversial. The aim of our study was comparison of the regional cerebral perfusion quantified by single photon emission computed tomography in patients suffering from idiopathic Parkinson's disease with and without dementia., Material and Methods: We examined 49 PD patients: 22 PD patients with dementia and 27 PD patients without dementia. Dementia was recognized according to ICD-10 and DSM-IV criteria. Cognitive functions were executed by means of the Mini Mental State Examination (MMSE) and neuropsychological assessment. The Unified Parkinson's Disease Rating Scale (UPDRS) and Modified Hoehn & Yahr Scale was used to quantify the severity of PD. SPECT was performed with Siemens Diacam single--head rotating gamma camera after intravenous application of technetium 99m hexamethylpropylene amine oxime (99mTc-HMPAO). The perfusion values were expressed as cortical or basal ganglia regions of interest (ROIs)/cerebellum activity ratios., Results: In both examined group of patients the lowest uptake was in basal ganglia region, while the highest uptake was in occipital region. In the subgroup of PD patients with dementia significant hypoperfusion affecting the inferior frontal cortices was observed., Conclusions: In Parkinson's disease with dementia hypoperfusion in inferior frontal region can be found.

Planning and verification of progress of efficacious physiotherapeutic effect on Parkinson's disease depends notably on the right identification of areas and scope of dysfunction of motoric systems. Biomechanical evaluation of motoric organ disability made by means of three-dimensional motion analysis using the "Vicon" system can make it considerably easier. A sample of three patients (two women and one man of average age of sixty-four) with idiopathic parkinsonism has been examined for the purpose of this evaluation. Based upon results of the three-dimensional motion analysis of these patients, dominant individual movement disorders were determined and individual therapeutic rehabilitation using the PNF method was planned. Within therapy, using the PNF method, they applied special techniques using motor patterns for the pelvis, upper and lower limbs in order to improve movement through an approach of assessed parameters to the biomechanical standard. After three weeks of therapy, specific characteristics of gait were examined again. On the basis of research results before therapy, it was found that these patients had none or limited scope of plantar flexion of feet, excessive dorsal flexion of feet, lengthened duration of stance phase, considerable excessive external rotation of shanks and excessive anteversion of the pelvis during gait cycle. Also big differences in values for spatiotemporal parameters (such as walking speed and frequency, stride length and time of single limb support) between the patients and healthy people were observed. After therapy, there has not been a marked variability in the scope of angular changes to the above-mentioned dysfunction. Only proportions between the duration of stance phase and swing phase have improved noticeably, so that they have directly resulted in better rhythm of gait. They have considerably approached the standards of frequency and speed (p = 0.05). However, stride length and duration of single limb support has not changed significantly.

The renewal of interest in the neurosurgical treatment of Parkinson's disease (PD) also in Poland results from of our improved understanding of functional anatomy of basal ganglia, developments in neurophysiological and neuroimaging techniques, as well as from advances in stereotactic surgery techniques. In view of the growing number of PD patients referred to surgical treatment and the wide variety of interventions offered, the development of clear of PD patient's selection to surgery seems necessary. Various surgical options and possible targets provide different functional benefits, but the almost 10 year's experience makes us aware also of the limitations and possible complications involved. Algorithms worked out by researchers from the most experienced centers include the following selection criteria as a minimal standard of the PD patient's evaluation before surgery: a reliable diagnosis of Parkinson's disease, at least 5 years of PD duration since the onset of symptoms, good responsiveness to L-dopa or apomorphine, exclusion of severe depression and dementia, neuroimaging (MRI) performed before the surgery, and optimal (but ineffective) attempts at available pharmacological therapy prior to the surgery.

Unlabelled: Rehabilitation plays an important role in treatment of Parkinson's disease (PD). The influence of rehabilitation on balance and gait in PD hasn't been widely investigated. There is general agreement about positive influence of rehabilitation on postural instability and prevention of falls, but therapeutic program prevention of falls hasn't been worked out. Ambiguous results of studies indicate necessity of further investigations., Material and Methods: 61 patient were included (H&Y 1, 5-3) and randomly assigned to two groups with and without rehabilitation. The balance test battery included: Functional Reach Test, Balance Performance-Oriented Mobility Assessment (Tinetti), assessment on force platform of quiet standing and active standing with Rhythmic Weight Shifts Test and dynamic task (reaction time, number of hitted targets). Gait was assessed with: timed Up&Go test, 10 m walk, locomotion test and 360 degrees turn. Patients were assessed 3 times, at month intervals. Between 1 and 2 assessment, exercising group took part in 1 month complex rehabilitation, consist of the 28 therapeutic sessions., Results: The group, which took part in rehabilitation significantly improved in quiet standing with closed eyes after rehabilitation in comparison with initial status. All of the rest variables significantly improved in exercising group after rehabilitation both in comparison between evaluations and in comparison with the nonexercising group., Conclusions: Rehabilitation significantly influences balance and gait of patients with PD.

The evidence supports from clinical and epidemiological studies demonstrates that the prevalence of various neurological diseases changes with gender. The reason for the gender difference in these diseases is still unclear, but accumulating evidence suggests a link between gonadal hormone, such as estrogens, levels and the incidence of these diseases. Numerous reports support the idea that immunological processes contribute to the etiopathogenesis of the neurodegenerative disease, such as, Parkinson's or Alzheimer's disease; psychiatric disorders, such as schizophrenia or depression; multiple sclerosis or stroke. The neuroinflammation is regulated by numerous signal molecules, including cytokines. Estrogens have been shown to play a major role in inflammatory processes. One mechanisms by which estrogens could modulated the immune reaction is regulation of the cytokines expression. This article briefly describes different biological mechanisms underlying estrogen anti-inflammatory activity.

Frontotemporal dementia and Parkinsonism linked to chromosome 17 (FTDP-17) is a congenital degenerative disease of the central nervous system. Molecular genetics studies have indicated the presence of 26 various mutations of the tau protein gene. At present 61 families with this syndrome are known. The clinical criteria proposed in this paper were developed on the grounds of the author's own research as well as detailed review of the literature. The criteria include;--clinical symptoms: personality and behavior disorders, Parkinsonism rather resistant to treatment with Levodopa less frequently also speech disorders and epilepsy,--an early onset and rapid progression of the disease,--positive family history,--heterogeneity of clinical symptoms both among patients within the same family and among families with the same mutation,--heterogeneity of the clinical picture depending on the type of mutation. Although FTDP-17 is and extremely rare clinical syndrome, it is noted all over the world. In Poland nobody has been diagnosed with this condition yet. The aim of this paper is to acquaint the readers of Neurologia i Neurochirurgia Polska with the FTDP-17. The syndrome has considerably contributed to our understanding of pathogenesis of many sporadic degenerative diseases of the brain, including such frequent conditions as Alzheimer's disease, Pick's disease the the Steel-Richardson-Olszewski syndrome, corticobasal degeneration, and other ones. Undoubtedly further research into the FTDP-17 will contribute to the development of a successful treatment for these devastating degenerative diseases of the c.n.s.

Impairment of swallowing is a common symptom in advanced stage of Parkinson's disease and severe defect of this function may cause aspiration pneumonia, problems with food intake and cachexy. The aim of this study was to assess the reflex and oral, pharyngeal, oesophageal phase of swallowing. Eleven patients with Parkinson's disease and 9 healthy subjects were investigated by electromyography (EMG) and oesophageal scintigraphy. The study demonstrates delayed triggering of swallowing reflex (543 +/- 84 ms in patients with PD vs. 230 +/- 66 ms in controls, p < 0.05) and prolongation of laryngeal movement (1880 +/- 140 ms vs. 1349 +/- 154 ms, p < 0.05). The prolongation of the oesophageal phase of swallowing with predilection to retention of water in lower one/third part of esophagus (12.45 +/- 2.45 s vs. 6.45 +/- 1.18 s, p < 0.001) was observed. The dysphagia limit, that is the maximum amount of water swallowed at once, was also evaluated (all normal subjects are able to swallow 20 ml water or more at once). In the studied patients with Parkinson's disease it was 4.5 +/- 0.86 ml. These results evidently and objectively indicate the presence of swallowing disorders in Parkinson's disease. Dysphagia was observed in all studied patients, although only 8 of them complained about it. In other 3 cases the impairment of swallowing was subclinical and it was connected with prolongation of oesophageal phase.

To document changes in SEPs in PD we have chosen a patient with the idiopathic form of the disease. Because of drug intolerance and progressively deteriorating clinical course she was selected for thalamotomy. Before the operation we recorded oscillations in the range of 150-300 Hz superimposed on SEP over the area of the right hand cortical representation, an a low amplitude of the N20-P25-N34 components. Eight weeks after left thalamotomy the amplitude of oscillations recorded over the left hemisphere diminished. A new wave, P65, appeared and similar SEPs were seen in the right hemisphere ipsilateral to the stimulated median nerve. Following stimulation of the left median nerve unchanged SEPs were observed only in the right hemisphere. Sixteen weeks after the operation, SEPs from the left hemisphere had a similar sequence as before the procedure. There was a clear increase in amplitude of long latency waves recorded from the left scalp. Changes in SEP polarity and amplitude following operation are attributed to plastic reorganization of cortical connections.

The qualitative changes in substantia nigra were analysed in the material of 25 cases of Parkinson's disease. A morphometric quantitative study of depletion of pigmented dopaminergic cells of substantia nigra was performed in six long-term cases of the disease. In addition, the number of melanin nodules was assessed as a marker of cell disintegration. The results obtained were compared with the morphometric evaluation of neuronal depletion in the mesocorticolimbic system (ventral tegmental area-VTA). The qualitative study indicated that melanin depletion in dopaminergic cells of substantia nigra in Parkinson's disease is diffuse and it is located mainly in the lateral alfa layer. Neuronal depletion with concomitant numerous extracellular neuromelanin nodules and granules was observed. A slight astrocytic gliosis free of macrophages accompanied cellular changes. The qualitative changes in substantia nigra are similar to those observed in VTA. The morphometric evaluation revealed that depletion of dopaminergic neurons in substantia nigra in Parkinson's disease is 73%, on average, while in VTA it remains under 5%. Hence, depletion in substantia nigra is much more intense. The analysis of the relationship between the number of neurons in substantia nigra and the age of subjects in the control group indicated that the number of neurons decreased proportionally to the age. In the group under study no significant relationship between neurons depletion and duration of disease or patients age was found. In the studied group of patients with Parkinson's disease, the number of melanin nodules in substantia nigra was significantly higher than in controls.

We introduce a case of diffuse Lewy body disease (DLBD) diagnosed post mortem. Clinically patient was assessed as severe Alzheimer's disease. Typical picture of DLBD was disclosed immunohistochemically; anti-ubiquitin staining revealed numerous temporal, neocortical Lewy bodies, CA2/3 alterations and scanty senile plaques.

In the metabolism of one of the main CNS neurotransmitters dopamine very important roles are played by four enzymes: two synthetizing dopamine: TH and DDC, and two enzymes breaking down dopamine: MAO-B and COMT. In a short review the author discusses disturbances of these enzymatic systems in parkinsonism and therapeutic possibilities of using drugs stimulating or inhibiting the activity of these systems.

This article, basing on experimental analysis and clinical observations, focuses on the role of subcortical structures in memory processes. It explained terminological problems and defined terms of memory: immediate, delayed, recent, remote, declarative and procedural. The present article pointed out functional hemispheric specialization as a predicator of material-specific forms of memory. Neuroanatomical basis was revealed, especially limbic system with its connections to prefrontal, cortical and brain stem regions. Amnesic Korsakoff and Wernicke syndromes, transient global amnesia, memory loss after bilateral damage of temporal lobes and after anterior communicating artery aneurysm rupture, were also discussed. Next part exhibited current knowledge about definition of dementia which may be caused by many multi-focal brain diseases like multiinfarct (vascular) dementia, Parkinson disease, Huntington disease, and sclerosis multiplex, and compared to Alzheimer disease. Term of dementia was defined, according to Cummings and Benson, as syndrome of acquired intellectual dysfunction when three of the following mental functions are impaired: language, memory, visuospatial skills, emotion, and cognition (abstraction, calculation, judgement). There is little doubt that various subcortical diseases are characterised by similar, no specific dysfunctions of cognitive processes including: disturbed attention and concentration, slowness of mental processing, forgetfulness, personality alterations and mood disturbances as well as motivational impairment, visuospatial disturbances, absence of symptoms of cortical dysfunction such as aphasia, agnosia and apraxia and associated motor disorder. Review of the literature suggests that rapid forgetting and retrieval deficits are most often symptoms of memory deficits observed after subcortical brain injuries.

Iron is one of few metal ions whose role in the central nervous system has received little attention, even though it is important in many enzymatic, metabolic and structural processes. The brain is rich in iron, and iron is the most likely initiator of free oxygen radicals generation. Recent investigations have reported that iron-generated free radicals play an important role in the pathogenesis of many neurological disorders. Experimental studies have shown that iron chelators and free-radical scavengers may have an important therapeutic potential in the future trends of treatment. This paper reviewed the current state of knowledge in this highly complicated field.

The article presents diagnostic criteria for dementia associated with diffuse Lewy body disease (DLBD) elaborated by the group of investigators from Nottingham (Byrne et al. 1991). These criteria allow to make the diagnosis of "probable" or "possible" dementia associated with DLBD. With certainty this form of dementia can only be diagnosed by neuropathological examination which reveals diffuse cortical Lewy bodies. At present there is no agreement whether DLBD is a variant of Alzheimer's disease or a separate nosological entity--the second commonest cause of dementia. The main clinical feature of DLBD is coexistence of dementia and symptoms of parkinsonian syndrome. The other important feature which differentiates between DLBD and other forms of dementia is a very considerable early fluctuation of cognitive state. Psychotic symptoms in the course of DLBD--visual and auditory hallucinations, delusions and depression--are common. At present treatment of DLBD is unknown. Treatment of psychotic symptoms is difficult because of the presence of parkinsonism.

Eye movement disorders detected by oculography indicate abnormal function of specific brain areas involved in the motor control. Registration of conjugate eye movement can be very useful diagnostic tool to study neurodegenerative disorders of the brain. In some conditions oculographic registration may reveal eye movement abnormalities in subclinical stages of the disease.

Mössbauer spectroscopy was used to study iron content, its redox state and binding sites in substantia nigra from parkinsonian and control brains. Measurements performed on fresh frozen samples demonstrated the presence of ferric iron only, both in disease and control. We found no difference in the total amount of iron in substantia nigra between the disease and control. Mössbauer spectra observed at 4.1 K in fresh frozen samples were different from those obtained in formalin fixed samples. In the fresh frozen samples only ferritin like iron was observed, whereas in the formalin fixed samples also non-ferritin iron was detected. It seems that in formalin fixed brains, during years, iron is released from ferritin and bound to an iron chelator or formalin.

Before the intracerebral transplantations of adrenal medulla and fetal substantia nigra in parkinsonian patients were introduced to restore the dopamine deficit, many intensive experimental studies were performed during the last decades. The history of these experiments was presented including the animal models of Parkinson's disease, different implantation techniques and the effects of neurotransplantations of adrenal medulla and fetal substantia nigra obtained in experimental animals. Different mechanisms underlying the transplant-induced functional effects as well as the methods of its stimulation to extend the graft survival and function were described. The ability of intracerebral transplantations to ameliorate the symptoms in animal models of disorders other than Parkinson's disease is also discussed.

Brain mapping of the cerebral bioelectric activity was done by the BEAM method in 20 patients with Parkinson's disease treated by cryothalamotomy. Conventional egg examinations demonstrating relatively small changes of the type of local asymmetry of frequencies and/or amplitudes, sporadic focal changes, and sporadic generalized and disseminated generalized changes were analysed in a computer system in the domain of frequency and time. Brain mapping demonstrated very distinctly the asymmetry in the frequency bands alpha and beta. On the operated side a regular alpha rhythm of lower frequency but higher amplitude dominated in the brain hemisphere. On the intact side a quick beta rhythm prevailed and an irregular alpha rhythm was noticeable. This phenomenon described by analysis in the domain of frequency confirms the unilateral synchronizing influence of thalamotomy on the bioelectric activity of the operated brain hemisphere and may correlate with the functional motor improvement noted in the operated subjects. In three cases with a longer course of the disease analysis in the frequency domain demonstrated the presence of generalized diffused slow waves in both frontal regions. These changes correlated with mental insufficiency of the examined patients.

In 20 patients with parkinsonism somatosensory evoked potentials were studied. The posterior tibial nerves were stimulated successively at the medial ankle. The averaged responses were recorded at the level of the L2 vertebra, C2 vertebra and in the central parietal area (Cz/Pz). The obtained data were compared with similar values in a control group. The conduction velocity in the sensory fibres of the tibial nerves was normal in both groups. No significant differences were found also between the patients and the controls in the latency of the spinal lumbar and cervical potentials, and the spinal conduction time (L2-C2) was normal. In the patients with parkinsonism the cortical evoked response N35 was significantly prolonged. Differences were noted also in the time of central conduction (C2-cortex) between the patients and the controls, but they were not significant statistically. The effects of disturbed dopamine metabolism on the electro-physiological processes in the peripheral and the central nervous system are discussed.

In 21 patients with parkinsonism and 20 healthy controls visual potentials evoked with checker pattern used as an alternating stimulus were studied. The left and right eye were examined separately recording visual cortical responses in the central occipital area. The analysed elements included the latency of the first highest positive wave P100 and the amplitude of the P100/N120 complex. Prolongation of the mean latency of P100 was found in patients with parkinsonism, but it was not significant statistically. No differences were found of the P100/N120 amplitude in the group with parkinsonism in relation to healthy controls. In the patients with parkinsonian syndrome (mainly of atherosclerotic origin) the mean latency of the visual potentials was longer and the amplitude was lower than in cases of Parkinson's disease. Attention is called to the high variability of the visual evoked potentials related to the clinical state and origin of the disease (parkinsonian syndrome and Parkinson's disease).

Verbal memory and learning ability were determined before the operation and immediately 3-4 weeks after stereotactic surgery in 11 patients with extrapyramidal motor disturbances treated by ventrolateral (VL and Vim) thalamotomy. Preoperative examinations demonstrated disturbances of short-term verbal memory with narrowing of its extent and increased susceptibility of the trace to interference. Long-term memory was disturbed also, with presence of difficulties in recall and difficulties in memorization of verbal materials. Directly after the operation, in relation to the preoperative testing, increased disturbances were demonstrated in all stages of verbal memory, after damage to the border area of VL and Vim nuclei in the left as well as in the right thalamus. It was possible to detect some functional differentiation between thalamic lesions, with a tendency for increased disturbances of short-term verbal visual memory after right-sided thalamotomy and verbal auditory memory after left-sided thalamotomy.

For a trial of explaining of the occurrence of sensory symptoms in Parkinson's disease evoked somatosensory potentials were studied in 10 patients with hemiparkinsonism and paraesthesiae on the side of the parkinsonian signs. Somatosensory evoked potentials were compared after stimulation of the median nerve on the side of parkinsonian signs with those obtained after stimulation of this nerve on the asymptomatic side. No statistically significant differences were found in the latency of various components of the evoked potentials between both sides of the body. Only slight differences were observed in the morphology of the evoked potentials which were difficult for statistical interpretation.

The authors studied the dynamics of EEG changes in 27 patients treated with L-dopa. The records obtained before treatment were compared with those made during treatment and with the clinical manifestations. In 8 cases the EEG pattern was normal before treatment and 6 of them improved (three-fourths of this subgroup). In 19 cases the EEG pattern was abnormal and 10 of them improved (about 50%). Some intensification of temporal episodic complexes in EEG records was observed during treatment without concomitant changes of clinical manifestations. In 2 cases with slowed down background activity in initial records psychic disturbances of hallucinatory obnubilation type developed requiring withdrawal of treatment. This psychotic reaction was characterized in EEG with increased intensity of generalized slowing down of EEG activity.

For evaluation of the state of excitability of motoneurons in the dorsal flexor of the foot in patients with drug-induced muscle rigidity curves of excitability of motoneurons in the anterior tibial muscle were plotted in 10 patients not receiving psychotropic agents (controls) and 10 patients treated with chlorpromazine. Two variants of experiment wase used: in the 1st variant stimulation of the peroneal nerve behind the fibular capitulum served as the conditioning and testing stimulus, in the 2nd variant stimulation of the tibial nerve in the popliteal fossa was the conditioning stimulus and stimulation of the peroneal nerve in the above way was the testing stimulus. The investigations were carried out before and 30-50 min after intramuscular injection of ethylbenzatropine 5 mg. In the 1st variant the curve of excitability of the motoneurons of the anterior tibial muscle showed the same configuration as the curve of excitability of motoneurons of the soleus muscle in the control group as well as in the treated group. Similarly as in the excitability curve of the soleus muscle five phases could be differentiated in it. Phase III of depression was, however, deeper and phase IV of returning excitability was more evident. In variant II in phase III depression was observed lasting only 40 msec., then in place of return of excitability its decrease was observed. These results were similar to these obtained in the case of conditioning stimulation of afferent fibres of the anterior tibialis muscle, and testing stimulation of the afferent fibres of the soleus muscle. After ethylbenzatropine injection no changes were found in variant I, on the other hand, in variant II a rise of excitability was present in phase III in the control group and in phases III and IV in treated patients. Ethylbenzatropine seemed, thus, to have no effect on the excitability of motoneurons in the dorsal flexor of the foot in the case of conditioning afferent stimulation of the dorsae flexor of the foot.

In patients with drug-induced parkinsonism and in healthy subjects the effect of stimulation of low-threshold skin fibres of sural nerve producing the polysynaptic flexion reflex of the short head of the biceps femoris muscle on the monosynaptic H reflex of calf muscles was studied before and after administration of ethylbenzatropine. In healthy subjects stimulation of low-threshold skin nerve was followed by facilitation of H reflex in the time of 70 to 200 msec. from the conditioning stimulation to the test stimulation. After one single intramuscular dose of ethylbenzatropine this late facilitating effect disappeared. In patients with drug-induced parkinsonism stimulation of afferent fibres of flexion reflex failed to cause late facilitation of H reflex and one dose of ethylbenzatropine brought no changes. During systematic administration of the drug an evident tendency for facilitation of H reflex was observed, similarly as in healthy subjects. The results obtained in healthy subjects and in patients with drug-induced parkinsonism are explained as evidence of inhibitory action of noradrenaline in certain chains of spinal interneurons, since noradrenaline release in the spinal cord is determined by the striatal equilibrium between the cholinergic and dopaminergic systems. The corrective action of ethylbenzatropine would depend on its central action on certain spinal chains of interneurons determining transmission of impulses from dermal afferent nerves to alpha motoneurons.

The authors tested verbal memory and learning in 15 patients with motor disturbances treated by ventrolateral thalamotomy before operation and late after it, after a mean time of 5.8 years. Disturbances of verbal memory in the form of retrieval of information from the memory stores and disturbances of learning of verbal material were found already before the operation. In comparative investigations late after the operation greater disturbances of verbal memory were observed with disturbances of verbal retrieval from memory stores after damage to the VL nucleus in the left as well as right thalamus. On the other hand, no decrease of the mental efficiency of these patients was demonstrated.

The authors describe the application of Akt -30 Aktograf apparatus designed by the branch of the Centre of Medical Technique in Bia ł ystok for recording extrapyramidal involuntary movements, cerebellar dyssynergia and clonic movements.

Somatosensory evoked potentials were recorded in two groups of patients with extrapyramidal syndromes including: 1) parkinsonian syndromes, 2) spasmodic torticollis. In the first group stereotactic lesions were produced at the borderline between VOp and Vim nuclei, and in the second group they were situated in VOa and VOi thalamic nuclei. Short-latency components of the potentials were analysed assuming that they were the specific parts of the somatosensory potential and their value was doubtless, in contrast to the late latency components. It was found that stereotaxic lesions the VOa and VOp thalamic nuclei caused no disappearance of the short-latency potentials but reduced their amplitude. In cases with oscillation potentials recorded before the operation, they disappeared after the operation and this disappearance was correlated with clinical improvement.

The authors report the results of electronystagmographic investigations of the eyes in patients with damage to the motor nerves of the eyes, their neuromuscular junctions in cases of internuclear ophthalmoplegia, and lesions of the cerebellar and extrapyramidal systems. In all these cases pathological records of these movements were found which were fairly characteristic of a given type of damage.

The authors describe 5 patients with Parkinson's disease with coexistent sensory symptoms, mainly pains. In the light of the pertinent literature the authors regard pain as one of the symptoms in the parkinsonian syndrome. Diagnostic and therapeutic difficulties in this form of parkinsonism are stressed.

For assessment of the effect of trihexiphenidil on the excitability state of the alpha-motoneurons of the plantar flexor of the foot in patients with drug-induced parkinsonian rigidity curves of the excitability of motoneurons of the soleus muscle were plotted in two variants of experiments: I. with afferent stimulation of the Ia fibres of the soleus muscle as the conditioning and testing stimulus (tibial nerve in the popliteal fossa), II. with afferent stimulation of Ia fibres of the anterior tibial muscle (peroneal nerve behind the fibular capitulum) used as the conditioning stimulus and stimulation of the tibial nerve as the testing stimulus. These investigations were carried out on 12 psychiatric patients who received no drugs at the time of these investigations (control group), 13 similar patients treated with chlorpromazine, 12 treated with phenothiazine compounds with piperazine ring in the side chain. The investigations were repeated 30-50 min. after oral administration of trihexiphenidil 5 mg. In variant I typical excitability curves were obtained and 5 phases could be discerned in them. In patients treated with piperazine-containing phenothiazine derivatives inducting more significant parkinsonian effects phase III - depression - was significantly shortened, and the excitability was raised in phase IV. In variant II phases III and IV were reversed and in phase IV a rise in excitability was observed in place of depression. In variant II in the group of drug-induced parkinsonism as compared with controls the rise in exictability was greater in phase III and depression in phase IV was smaller. The effect of trihexiphenidil in variant I depended on the initial state. In controls and in patients treated with chlorpromazine trihexiphenidil reduced the duration of phase III of depression and decreased its intensity. In atients treated with phenothiazines containing the piperazine ring depression in phase III was weak but increased after trihexiphenidil administration and increased excitability in phase IV was decreased. The curves became similar to those obtained in controls. In variant II in the control group excitability in phase III increased after trihexiphenidil administration.