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Background: Motor cortex stimulation (MCS) was introduced in the early 1990s by Tsubokawa and his group for patients diagnosed with drug-resistant, central neuropathic pain. Inconsistencies concerning the details of this therapy and its outcomes and poor methodology of most clinical essays divide the neuromodulation society worldwide into "believers" and "nonbelievers." A European expert meeting was organized in Brussels, Belgium by the Benelux Neuromodulation Society in order to develop uniform MCS protocols in the preoperative, intraoperative, and postoperative courses., Methods: An expert meeting was organized, and a questionnaire was sent out to all the invited participants before this expert meeting. An extensive literature research was conducted in order to enrich the results., Results: Topics that were addressed during the expert meeting were 1) inclusion and exclusion criteria, 2) targeting and methods of stimulation, 3) effects of MCS, and 4) results from the questionnaire., Conclusions: Substantial commonalities but also important methodologic divergencies emerged from the discussion of MCS experts from 7 European Centers. From this meeting and questionnaire, all participants concluded that there is a need for more homogenous standardized protocols for MCS regarding patient selection, implantation procedure, stimulation parameters, and follow-up-course., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: This study critically evaluates the long-term results of standalone anterior lumbar interbody fusion (ALIF), without use of rhBMP-2, as a therapeutic option for symptomatic patients with degenerative disc disease (DDD). Furthermore, this study intends to identify predictive parameters for anterior lumbar interbody fusion outcome., Methods: A retrospective cohort study with additional telephone interview to obtain missing data was performed. All patients who underwent an L4-L5 or L5-S1 ALIF-procedure, or both, in the period between 2006 and 2011 were identified. The medical files of 123 patients with 154 fusion levels were reviewed. All patients were contacted by telephone to gather supplementary and missing information. Pain and functionality scores (Visual Analogue Scale [VAS] and Oswestry Disability Index [ODI]), radiologic (intervertebral disc height, Modic and Pfirrmann classifications), and different clinical parameters were gathered., Results: The mean age of the population at surgery was 46.2 years. Overall, 59 female and 64 male patients were included in the study. The mean VAS score for back and leg pain improved significantly (P < 0.001) with 5 and 4.4 points respectively at 3-year follow-up. Modic-type I changes are associated with a better improvement in VAS score for back pain (P = 0.026), Pfirrmann-grades IV and V and an intervertebral disc height of less than 5 mm are associated with a better improvement in leg pain (respective P-values: 0.045 and 0.033). Overall, 89% of patients would reconsider the surgical intervention., Conclusions: The ALIF technique is a durable treatment option for patients with DDD. This study suggests different predictive parameters for treatment outcome., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Extraforaminal lumbar disc herniation (EFLDH) accounts for 7%-12% of all lumbar disc herniations. We report on a surgical technique for EFLDH, which requires only minimal resection of the facet joint and also allows access to the preforaminal space, if necessary., Methods: The medical records of 61 consecutive patients treated with disc fragment herniectomy through a facet joint quadrantectomy for EFLDH at the Universitair Ziekenhuis Brussel were critically evaluated with respect to preoperative clinical signs and symptoms, surgery-related complications and outcome at 6 weeks after intervention. Patient satisfaction after the surgery was evaluated using the MacNab classification., Results: The prevalence of leg pain decreased from 100% before the intervention to 19.7% at follow-up. Only 9 patients (14.8%) suffered from residual motor deficit at follow-up, compared with 37 patients (60.7%) in the preoperative situation. The postoperative improvement was highly significant for all parameters (P < 0.0001) and this evolution is also reflected in the MacNab classification showing 62.3% excellent, 23.0% good, 13.1% fair, and only 1.6% poor satisfaction. Using logistic regression analysis, only the presence of a preoperative sensory deficit was found to be an independent predictor for excellent patient satisfaction on the MacNab classification., Conclusions: Disc fragment herniectomy through a facet joint quadrantectomy for EFLDH is a safe and minimal invasive technique resulting in very satisfactory results. Preservation of facet joint stability and the possibility to convert to a classic approach to reach for preforaminal components, if necessary, are major advantages of this technique., (Copyright © 2016 Elsevier Inc. All rights reserved.)

A high-performance liquid chromatographic assay with electrochemical detection is described for the simultaneous determination of levodopa, 3-O-methyldopa, dopamine, dihydroxyphenylacetic acid, homovanillic acid, 3-methoxytyramine, noradrenaline, adrenaline, 3-methoxy-4-hydroxyphenylethylene glycol and 5-hydroxyindoleacetic acid in rat brain dialysates. Samples are obtained in vivo using the microdialysis technique. Microdialysis probes are placed in the brain area to be studied and neurochemicals are collected by perfusion of the probe with modified Ringer's solution. Direct injection of the dialysates allows rapid and reliable results to be obtained.

A 73-year-old women presented with a recurrent form of sporadic brachial plexus neuropathy, the so-called Parsonage and Turner syndrome. This diagnosis is based on clinical and electromyographic findings. Interestingly a biopsy of the temporal artery demonstrated a giant cell arteritis. The clinical picture started 2 weeks after an upper respiratory tract illness. The possible viral etiology of giant cell arteritis is considered. We think an immunological rather than ischemic disturbance may have caused the recurrent brachial plexus neuropathy. This case report suggests that giant cell arteritis be considered in the investigation of the Parsonage and Turner syndrome.

A combined procedure based on reversed-phase liquid chromatography with electrochemical detection has been developed for the determination in the picomole range of the monoamines dopamine, norepinephrine, epinephrine and serotonin, and their major metabolites 3,4-dihydroxyphenylacetic acid, homovanillic acid, 3-methoxy-4-hydroxyphenylethylene glycol, 5-hydroxyindoleacetic acid, normetanephrine, metanephrine and 3-methoxytyramine. Sample pretreatment consists of the extraction of the neutral and acidic metabolites with ethyl acetate, followed by the extraction into heptane of the catecholamines with tetraoctylammonium bromide as counter-ion in the presence of diphenylborate. The residual supernatant is directly injected in the chromatographic system for quantification of serotonin, normetanephrine, metanephrine and 3-methoxytyramine.

A combined extraction system for the selective and quantitative isolation of the monoamines norepinephrine, epinephrine, dopamine, serotonin (5-hydroxytryptamine) and their metabolites 3-methoxy-4-hydroxyphenylethylene glycol, 3,4-dihydroxyphenylacetic acid, 5-hydroxyindoleacetic acid, homovanillic acid and 3-methoxytyramine from one single brain tissue sample is described. The extraction system is a combination of an ethyl acetate extraction for 3-methoxy-4-hydroxyphenylethylene glycol, 3,4-dihydroxyphenylacetic acid, 5-hydroxyindoleacetic acid and homovanillic acid, and two successive ion-pair extractions. In a first step, the catecholamines are quantitatively isolated by extracting with heptane--octanol (99:1) containing 0.25% tetraoctylammonium bromide as an ion-pairing agent in the presence of 0.2% diphenylborate. In a second step, 3-methoxytyramine and 5-hydroxytryptamine are isolated from the aqueous phase with di(2-ethylhexyl)phosphoric acid as counter-ion in chloroform. Dihydroxybenzylamine, isohomovanillic acid and 5-hydroxy-N-methyltryptamine are used as the internal standards.

Norepinephrine, epinephrine, dopamine, serotonin and their major metabolites were measured in 20 regions of the left hemisphere in 4 presenile familial cases of Alzheimer-type dementia and 4 sporadic senile cases. Both groups were compared to values in normal brains obtained in our laboratory. Quantitative determination of the monoamines was performed by HPLC with electrochemical detection. The clinical diagnosis of Alzheimer-type dementia was confirmed by histological examination of the right hemisphere and brain stem. The serotonergic system was dramatically affected in the familial cases with very low or undetectable serotonin concentrations in most cortical and subcortical areas studied and an important cell loss in the nucleus raphe dorsalis, origin of the main ascending serotonergic system. In the senile demented patients the serotonergic deficit is less important but still clearly present. The noradrenergic, adrenergic and dopaminergic systems were less affected by the disease process in senile sporadic as well as in the presenile familial type of Alzheimer's disease.

Two patients presenting a relapsing form of sporadic brachial plexus neuropathy, the so-called Parsonage Turner syndrome, are reported. The diagnosis is based on clinical and electromyographic features. Recurrent attacks, although infrequently encountered, have been well described in the past. Sporadic cases of this syndrome must be differentiated from the familial varieties of neuralgic amyotrophy in which, two main subgroups of patients are distinguished: those showing facial dysmorphic features and those with findings of a tomaculous neuropathy predisposing them to pressure palsies. Apart from the obvious difference as regards familial occurrence, the familial and non-familial varieties of neuralgic amyotrophy differ in a number of respects: associated congenital defects, early age of onset and high rate of recurrence in the former. Finally some possible pathogenetic mechanisms of the syndrome are briefly reviewed.

Norepinephrine, epinephrine, dopamine, serotonin and their major catabolites were measured in 17 regions of the left hemisphere of two brains obtained from two brothers with Alzheimer's disease with very early onset. The clinical diagnosis was confirmed by histological examination of the right hemispheres and brain stems. The quantitative data were compared with our values in normal brains. In the patient suffering from the less severe dementia, there was a severe reduction of the serotonin concentration in all examined neocortical areas and its concentration was even below the detection limit in the nucleus amygdalis, hippocampus, caudate nucleus, putamen, globus pallidus and substantia nigra. In the other patient, who suffered from a more pronounced dementia with myoclonus, the serotonin concentration was below the detection limit in all examined structures. In contrast with these findings, the noradrenergic, adrenergic and dopaminergic systems appeared to be relatively unaffected by the disease process. Focusing our attention on the nuclei wherein the monoamine transmitter systems originate, it appeared that neuronal losses and neurofibrillary tangles clearly predominated in the substantia grisea subependymalis, the nucleus centralis superior and the nucleus raphe dorsalis, origin of the main serotonergic system. The serotonin deficiency sheds light on possible mechanisms of myoclonus in Alzheimer's disease.