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Solid state electronic (UV–Vis) and vibrational (IR) spectra of the fullerene–zinc porphyrin dyad ( 1 ) as well as 5,10,15,20-tetrakis(3,5-di- tert -butylphenyl)porphyrinatozinc(II) ( 2 ) and modified fullerene ( 3 ) were investigated in the frequency range between 400 and 50,000 cm −1 . Variable temperature IR studies were also performed. Molecular geometry of the compounds and their IR theoretical absorption spectra were calculated using AM1 method. It was stated, that redistribution of the charges occurs in both fullerene and porphyrin moieties upon covalent linkage. This effect is mainly observed as shifts of both electronic and vibrational bands in comparison with the respective free porphyrin and fullerene features.

Solid-state electronic (UV–Vis) and vibrational (IR) spectra of several fullerene–porphyrin conjugates were recorded in KBr in the spectral range between 400 and 50,000 cm −1 . It was observed that significant redistribution of the charges occurs in both fullerene and porphyrin moieties upon covalent linkage. This effect is mainly observed as shifts of both electronic and vibrational bands in comparison with the respective free porphyrin and fullerene features. Variable temperature IR measurements were also performed.

Spectral properties of selected charge-transfer complexes of the fullerene C 60 with planar electron donor molecules as well as polyadducts of tetrathiafulvalenes (TTFs) linked to C 60 by a rigid bridge have been investigated. It was shown that charge distribution on the C 60 sphere and on the TTF-derived donor substituents is distinctly disturbed after the adduct formation. The most interesting feature of selected polyadducts is an appearance of very strong bands in the IR spectra. A resonance coupling between vibrations of appropriate parts of substituents is suggested as a reason of this effect.

The supraspinatus tendon was detached from the greater tubercle in 30 rabbits. After 6 weeks (group A), 3 months (group B) and 6 months (group C) in vivo evaluation of the twitch-tension and fatigue index were done. Next the scapulas with muscles were examined by CT. During the first 6 weeks a marked reduction in power and fatigue index by about 20% and 10-15%, respectively, in comparison with the control side was noted. These findings remained unchanged at 3 and 6 months. The CT examination showed fatty muscle degeneration, mainly in the 1/3 distal part of supraspinatus, but not in the infraspinatus muscle.

POEMS syndrome is a rare multisystem disorder, characterized by the presence of polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes. The variety of clinical pictures and asynchronous manifestation of dominant features make diagnosis difficult. We report a case of a 42-year-old man with polyneuropathy who was initially negative for monoclonal protein and so Guillain-Barré syndrome was diagnosed. Other signs and symptoms, including monoclonal gammopathy, developed later in the course of the disease and finally POEMS syndrome was diagnosed.

Medical treatment of advanced Parkinson disease complicated with fluctuations and dyskinesias remains difficult or in some patients totally ineffective. Recently, new methods were introduced to manage those problems: deep brain stimulation, subcutaneous apomorphine infusion and the Duodopa system for intrajejunal continuous delivery of gel containing levo-dopa/carbidopa (through percutaneous gastrostomy). This last method was proven to be very effective in reducing the fluctuations of levodopa plasma levels and furthermore in reducing the off periods and dyskinesias. The Duodopa system is used in patients with contraindications to deep brain stimulation or apomorphine infusions. According to recently published studies, it may also be more effective in reducing motor complications than other methods. The authors present the current knowledge on the Duodopa system, its effectiveness (also in relationship to other methods, specially deep brain stimulation and apomorphine) and possible complications (mostly due to gastric tube failures) along with the indications and contraindications.

Both disease progression and pulsatile stimulation of dopaminergic receptors are responsible for development of fluctuations and dyskinesia in about 50% of patients with Parkinson disease (PD) after 4-6 years of therapy with levodopa. In order to prevent motor complications, the ideal therapy should secure continuous dopaminergic stimulation (CDS). The concept of CDS is supported by the results of both experimental and clinical studies. Several treatment options are available to achieve CDS. Dopamine agonists have a longer half-life than levodopa and the development of dyskinesia is delayed when they are used as monotherapy in early PD. Continuous delivery of agonists can be improved with prolonged-release oral preparations, a transdermal delivery system or continuous subcutaneous infusion. Continuous enteral infusion of levodopa is another way to achieve CDS and it is very effective in reducing motor complications in advanced PD.

Recently, the list of clinical applications of botulinum toxin type A (BTX-A) enlarged. This medication is used not only by neurologists, but also by medical rehabilitation specialists, urologists, proctologists, and migraine and aesthetic medicine specialists. Currently, there are three commercially available BTX-A preparations available: Botox, Dysport and Xeomin. They have similar mechanisms of action but their chemical formulation, clinical potency, migration and diffusion as well as safety profile seem to be different. This may result in problems of bioequivalence, not only clinical but also economic ones. The authors reviewed the available clinical and laboratory studies on neurological indications labelled in Poland. Each BTX-A formulation should be treated as a different medication and used cautiously according to the individual range of dosages established in clinical trials.

Gajos A, Bogucki A, Schinwelski M, Soltan W, Rudzinska M, Budrewicz S, Koszewicz M, Majos A, Gorska-Chrząstek M, Bienkiewicz M, Kuśmierek J, Slawek J. The clinical and neuroimaging studies in Holmes tremor. Acta Neurol Scand: 2010: 122: 360–366. © 2010 The Authors Journal compilation © 2010 Blackwell Munksgaard. Aim – Holmes tremor (HT) is a combination of rest, postural and action tremor. A parallel dysfunction of cerebello-thalamic and nigrostriatal pathways seems necessary to produce this kind of tremor. We present the clinical and neuroimaging study verifying that hypothesis. Material and methods – A total of 10 patients: five male, five female, fulfilling consensus criteria were included. Demographic, clinical and neuroimaging data (MRI = 9; CT = 1, SPECT with the use of 123-I-FP CIT: DaTSCAN in six patients to assess the presynaptic dopaminergic nigrostriatal system involvement, indices of asymmetry for ligand uptake for each striatum were calculated) were analyzed. Results – Hemorrhage was the most frequent etiology and thalamus – the most commonly involved structure. Contrary to the previous reports, the visual assessment did not reveal remarkable interhemispheric differences of DaTSCAN uptake. Quantitative measurements showed only minimal differences. Conclusions – It is open to debate whether nigrostriatal pathway damage is crucial for the phenomenology of HT. Alternative hypothesis is presented that HT represents the heterogeneous spectrum of tremors with similar phenomenology, but different pathophysiology.

W ostatnim czasie lista klinicznych zastosowań toksyny botulinowej typu A (BTX-A) znacznie się wydłużyła. Substancja ta stała się narzędziem w rękach neurologów, lekarzy rehabilitacji, urologów, proktologów, migrenologów czy kosmetologów. Zwiększyła się także liczba produkowanych preparatów BTX-A. Obecnie na rynku dostępne są preparaty: Botox, Dysport i Xeomin. Mają one podobny mechanizm działania, aczkolwiek różnią się istotnie budową chemiczną, siłą działania, migracją poza miejsce podania, skutecznością i profilem działań niepożądanych. Te odrębności mogą sprawiać trudności w ich zamiennym stosowaniu przez niedoświadczonego lekarza. Rodzą także pytania o ich równowartość ekonomiczną. Autorzy dokonali przeglądu prac i porównali dostępne preparaty w zarejestrowanych w Polsce wskazaniach neurologicznych. Preparaty te powinny być traktowane jako odrębne leki, a ich zastosowanie kliniczne oparte o dane z badań klinicznych dotyczących poszczególnych preparatów. Recently, the list of clinical applications of botulinum toxin type A (BTX-A) enlarged. This medication is used not only by neurologists, but also by medical rehabilitation specialists, urologists, proctologists, and migraine and aesthetic medicine specialists. Currently, there are three commercially available BTX-A preparations available: Botox, Dysport and Xeomin. They have similar mechanisms of action but their chemical formulation, clinical potency, migration and diffusion as well as safety profile seem to be different. This may result in pro­blems of bioequivalence, not only clinical but also economic ones. The authors reviewed the available clinical and labora­tory studies on neurological indications labelled in Poland. Each BTX-A formulation should be treated as a different medication and used cautiously according to the individual range of dosages established in clinical trials.

The aim of the paper is to review the influence of the spatial structure of the cations on selected physical properties of TCNQ complex salts. Some effects such as multidimensionality of HB networks of the salts, melting of organic composites based on TCNQ and photoinduced melting of spin‐Peierls phase are discussed.

Laser evoked potentials (LEPs) are one of the few neurophysiological methods available whose purpose is to evaluate the functions of small fibres' sensory pathways Ad and C. This non-invasive technique is applied at the present time in diagnosing small fibre neuropathy. In order to record distinctive and repetitive evoked potentials from the surface of the skull, the skin of the dorsal surface of the hands and feet is stimulated with laser thermal, nociceptive stimuli. The main cortical laser-evoked potential is a complex of components N2-P2. Evaluation of the registered potentials in- cludes their morphology with shape, latency and amplitude. Up to now, laser evoked potentials have not been performed in Poland.

The quality of visually and semi-quantitatively assessed DaTSCAN images is crucial for differential diagnostics of extrapyramidal diseases. Neuroimaging with the use of presynaptic tracers of the dopaminergic system provides evidence of nigrostriatal degeneration and may support the clinical diagnosis of Parkinsonism. During the last two years (2007-2008) we tried to elaborate the optimal methodology of SPECT/CT examination with the use of DaTSCAN ((123)I-Ioflupane), and we sought to evaluate the effect of the reconstruction and attenuation correction method on semi-quantitative measures of relative uptake in the striatum. In a present study, we retrospectively studied DaTSCAN scans of 44 consecutive patients with clinical indications of Parkinson's disease or uncertain Parkinsonian syndromes. The quality of DaTSCAN images reconstructed with the use of ordered-subset expectation maximization reconstruction technique (OSEM) with attenuation correction based on CT maps was found to be superior to that provided by the commonly applied filtered backprojection method (FBP) with Chang attenuation correction. OSEM reconstructed transverse slices were more legible for clinical interpretation because of increased contrast and improved delineation between striatum structures. Semi-quantitative assessments of relative striatum uptake for OSEM reconstructed slices secured better intra-operator reproducibility than that obtained by FBP method.

Central nervous system involvement in systemic lupus erythematosus contributes to more serious course and poor prognosis. Whereas neuropsychiatric lupus is the scantiest recognized aspect of SLE.Assessment of neurological syndromes prevalence and its clinical features in patients diagnosed with systemic lupus erythematosus.The study comprised a group of 44 in- and outpatients of the Department of Dermatology and Venerology of Medical University of Lodz diagnosed with systemic lupus erythematosus and treated in 2006-2007. Each patient was assessed by a neurologist, who took history, performed clinical, neurological examination and, if required, laboratory studies. Systemic lupus activity measure (SLAM) was employed for the assessment of the disease activity. Cumulative dose of administered corticosteroids was calculated retrospectively for each patient, according to medical history.High prevalence of neurological syndromes was observed in the examined group (77,27%). The most frequent was headache (38,64%). Cerebrovascular disease, prevalent among systemic lupus erythematosus patients (31,82%) was related to more active lupus course. Moreover in the examined group seizures (13,64%), mononeurpathy (13,64%), cognitive impairment (6,82%), polineuropathy (4,55%), cranial neuropathy (2,77%) and acute confusional state (2,27%) were diagnosed. Neurological syndromes were often the first manifestation of systemic lupus erythematosus. There was no relationship observed between the cumulative dose of glucocorticosteroids and the nervous system involvement.High prevalence of nervous system manifestation in SLE indicates the need for neurological care in SLE patients. Headache is frequent but low specific sign of neuropsychiatric lupus. Neurological disease should incline toward more intense immunosuppressive therapy which may delay the nervous system destruction.

Sixteen patients with a clinical diagnosis of subcortical arteriosclerotic encephalopathy (Binswanger's disease) were studied. Mild or moderate dementia was found in 14 cases, with characteristic disturbances of concentration, and psychic retardation with apathy. Neuropsychological studies revealed that signs of diffuse lesions in the frontal lobes dominated. Impairment of memory was significant in all cases. Although intellectual impairment in subcortical arteriosclerotic encephalopathy resembled subcortical dementia, some significant differences were found.

Cerebral vascular amyloid deposits, senile plaques and neurofibrillary tangles have been found in subcortical arteriosclerotic encephalopathy (Binswanger disease). A mouse antiserum, prepared against a 43-amino acid synthetic peptide homologous to the amyloid β-protein of Alzheimer disease (anti-SP43), revealed immunoreactive amyloid deposits in meningeal and intracortical blood vessels, senile plaques, intraneuronal amyloid and preamyloid in a neuropathologically confirmed case of Binswanger disease previously reported to have cerebral vascular amyloid deposits. These lesions contained sulfated glycosaminoglycans as determined by the Alcian blue/critical electrolyte concentration method. Similar findings were not observed in a case of Binswanger encephalopathy without cerebral amyloid deposits. Our study indicates that amyloidotic lesions in Binswanger encephalopathy with cerebral amyloid deposits contain amyloid β-protein and sulfated glycosaminoglycans.

Multifocal motor neuropathy with conduction block (MMNcb) is a relatively rare disease characterized clinically by asymmetric limb weakness with spared sensation and electrophysiologically by persistent focal motor conduction block. We present the case of a 40-year-old male patient with six-year history of progressive, asymmetric weakness of upper and lower extremities without sensory symptoms. Electroneurography revealed definite or probable motor conduction block in several nerves. However, features of axonal lesion of sensory fibres were also found. Laboratory studies were unremarkable apart from an abnormal glucose tolerance test, and type 2 diabetes was diagnosed. In the presented case the differential diagnosis should take into consideration MMNcb with coexisting diabetic sensory polyneuropathy and multifocal acquired demyelinating sensory and motor neuropathy (MADSAM).

DYT1 dystonia is the most common form of inherited primary dystonia. The aim of the study was: 1) to evaluate the prevalence of the DYT1 mutation in a population of Polish patients with early-onset generalized dystonia and with other forms of familial dystonia, 2) to evaluate the frequency of the DYT1 mutation in patients with writer's cramp, 3) to characterize the phenotype of the DYT1 mutation in the Polish population, and 4) to define the group of patients in whom genetic testing is recommended.The following groups of patients were included in the study: 1) patients with early-onset (30 years) generalized dystonia and those patients with onset after age 30 years who have relatives with early-onset dystonia, 2) patients with writer's cramp (focal or as part of segmental dystonia) independently of age of onset, 3) asymptomatic (adult only) relatives of the diagnosed DYT1 carriers. Genetic tests were performed in 63 subjects---28 sporadic cases of dystonia, 20 patients with familial dystonia, and 15 asymptomatic relatives of patients with confirmed DYT1 mutation.The DYT1 mutation was found in 17 subjects--10 patients with dystonia and 7 asymptomatic relatives (from 6 families). In all mutation carriers dystonia occurred in one limb before age 26 years. In 8 patients, generalization of dystonia was observed and in 2 cases it remained in a focal form.1. The prevalence of DYT1 mutation among patients with early-onset (or= 24 years) dystonia was 20.8% and it was similar to that found in other European populations. 2. No DYT1 mutation was found among sporadic cases of writer's cramp. 3. In the studied group the most common was the phenotype with early onset (or= 24 years) and the first symptoms localized in one of the limbs. 4. The obtained results confirm that the recommendations available in the literature concerning DYT1 genetic testing can be applied to the Polish population.

Attacks of cluster headache provoked by the administration of nitroglycerin (1 mg sublingually) or histamine (0.01 mg/kg subcutaneously) were studied. The constant latency time in individual patients during nitroglycerin and histamine provocation suggested that the same mechanism is involved in both methods of headache induction. Repeated nitroglycerin provocation revealed its tendency to lengthen duration of the refractory period at the end of the bout, when the attacks were less frequent. The “cross studies” on spontaneous and nitroglycerin provoked attacks indicated that the underlying mechanism of both is at least partially the same.

Monoclonal gammopathy is responsible for about 10% of acquired peripheral neuropathies of unknown origin. Monoclonal gammopathy is the result of uncontrolled proliferation of a single clone of plasma cells producing the first class of immunoglobulin (M-protein). The routine diagnostic process of peripheral neuropathy requires electrophysiological studies and several laboratory tests, including the immunoelectrophoresis or immunofixation of serum proteins. Monoclonal gammopathies develop in malignancy, immunological disorders, chronic infections and as so-called "benign form" or monoclonal gammopathy of undetermined significance (MGUS). Lymphoproliferative malignancy may develop in MGUS after many years of disease. Patients with MGUS-associated neuropathy should be carefully evaluated, and if malignancy is not found the progress of the disease should be monitored. We present four patients with peripheral neuropathy associated with monoclonal gammopathy. These cases represent different forms of this type of neuropathy and well illustrate the necessity of looking for monoclonal gammopathies in peripheral neuropathy.

Solid-state electronic (UV-Vis) and vibrational (IR) spectra of the tetrathiafulvalene-perylenediimide (PDI-TTF) 1 and perylenediimide-fullerene (PDI-C60) 2 dyads as well as PDI 3 , TTF 8 and fullerene 9 derivatives used as references molecules were investigated in the frequency range between 400 and 45,500 cm−1. Electronic and vibrational features of the dyads were compared and analysed. Molecular geometry of the compounds and their IR and Raman theoretical spectra were calculated. It was stated, that small redistribution of the charges occurs in both moieties of these dyads. This effect is observed as shifts of both electronic and vibrational bands of the dyads in comparison with the respective bands of free components.

Systemic lupus erythematosus is an autoimmune, multiorgan disease, in the course of which central nervous system (CNS) disturbances are usually observed. Pathomechanism of CNS changes is complex and not fully investigated. Neuropathological alterations are often not characteristic, usually caused by vasculopathy, infarction, hemorrhages or infection. Vascular changes are generally disseminated and develop in different time period, sometimes they precede clinical symptoms. Currently applied diagnostic methods and their usefulness in diagnosis of CNS involvement in lupus patients, especially single photon emission computed tomography (SPECT), are presented.

The pathomechanism of the migraine aura remains unclear. The most probable cause of the aura is cortical spreading depression with associated hypoperfusion. Both the cortical spreading depression and hypoperfusion begin in the occipital lobes and spread forward slowly (2-3 mm/min) in a wave-like mode along the brain convolutions and cross territories of brain arteries. We present a 24-year-old female patient with a combination of aura symptoms. Each migraine attack began with a bright scintillating zig-zag, which crossed the visual field. It was followed by left sided hemiparesthesiae marching from the face to the hand. The last symptom of aura was motor aphasia. Later a unilateral, pulsating headache developed with associated photo- and phonophobia. The stable pattern and duration of aura symptoms in the presented case suggest that the cortical spreading depression plays an important role in the pathomechanism of migraine with aura.

Physiological sweating from cutaneous eccrine glands maintains normothermia and skin hydratation. Hyperhidrosis, a pathological condition caused by excessive secretion of the eccrine sweat glands, is divided into physiologic, symptomatic and idiopathic type. Contemporary methods of hyperhidrosis treatment, in particular botulinum toxin injections are discussed.

Results of the first extended spectral investigation of the bis-linked tetrathiafulvalene donors (TTFs) to [60]fullerene are reported. From UV-VIS-NIR-IR spectra it is stated that charge distribution on C60 moiety and on TTFs attachments is disturbed after the adduct formation.This redistribution depends not only on the nature of an attached molecular group but also on the number of bounded donors. In the infrared spectra of the bis-adducts, a particularly strong resonant effect was observed.

Thirty rabbits were anesthetized, and the supraspinatus tendon was detached from the greater tuberosity and the infraspinatus and subscapularis tendons. After 6 weeks (group A), 3 months (group B), and 6 months (group C), in vivo evaluation of twitch tension and fatigue index was done. Next, scapulas with muscles were examined with computed tomography. The most prominent decrease of twitch tension and fatigue index was noted during the first 6 weeks. The twitch tension and fatigue index after 2 and 4 minutes of the muscle operated on expressed as a percentage of the values developed by healthy contralateral nonoperated muscle were 58.2%, 34.5%, and 32.7% at the beginning of stimulation, 45.4%, 35.3%, and 26.7% after 2 minutes, and 42.5%, 32.6%, and 18.5% after 4 minutes of stimulation, respectively, in groups A, B, and C. Computed tomography examination showed fatty degeneration of the supraspinatus averaging 1.85 (group A), 2.28 (group B), and 2.43 (group C). Moderate infraspinatus fatty degeneration was noted in all groups. There was no significant fatty degeneration of subscapularis muscle. (J Shoulder Elbow Surg 2000;9:211-6.)

Subcortical arteriosclerotic encephalopathy (SAE), or Binswanger's disease, is one of the forms of vascular dementia. In SAE arteriosclerotic changes affect subcortical arteries and arteroles. Atherosclerosis of large cerebral arteries is common among SAE patients. As dyslipoproteinemias are risk factors for atherosclerosis we studied blood lipids and lipoproteins in patients with clinical diagnosis of SAE. In 11 patients diagnosis of the disease was established on the basis of CT scans and clinical course consistent with SAE. In the studied group a tendency to increased total cholesterol and apolipoprotein B and to decreased HDL cholesterol (HDL-CH) were found. The levels of LDL cholesterol (LDL-CH) and the CH/HDL-CH and HDL phospholipides/HDL-CH ratios were significantly higher in SAE patients when compared to controls.

Serial single fiber electromyography (SFEMG) examinations of orbicularis oculi muscle in patients with blepharospasm or hemifacial spasm treated with botulinum toxin injections were performed. The aim of the study was to evaluate the impairment of neuromuscular transmission, to follow reinnervation after botulinum toxin administration and to find out whether there was a relationship between SFEMG parameters and clinical symptoms. Examinations were performed before injection, during early and late remission of symptoms, and after recurrence of the involuntary movement. Severe impairment of neuromuscular transmission, as revealed by increased jitter and increased presence of abnormal potential pairs and pairs with blocking, was found in early remission, but fiber density remained unchanged when compared with pretreatment values. In late remission, increased fiber density was registered for the first time. The recurrence of involuntary movements was related to the further increase of fiber density and tendency to normalization of jitter parameters. The study therefore suggests that formation of new neuromuscular junctions and their functional maturation is responsible for muscle recovery after botulinum toxin administration.

Extended spectral investigations of the bis-linked tetrathiafulvalene-derived donors (TTFs) to [60]fullerene were performed. From UV-VIS-NIR-IR spectra it is stated that charge distribution on C 60 moiety and TTFs substituents is disturbed after the adduct formation. In the IR spectra of double-substituted C 60 molecules, a particularly strong resonant effect was observed. The temperature dependence of the spectra has been analyzed.

An interesting interplay between two different modifiers and the surface of titanium dioxide leads to a significant change in photoelectrochemical properties of the designed hybrid materials. The semiconductor is photosensitized by one of the counterparts and exhibits the photoelectrochemical photocurrent switching effect thanks to interactions with graphene oxide - the second modifier mediates charge transfer processes in the system, allowing us to design the materials response at the molecular level. Based on the selection of molecular counterpart we may affect the behaviour of hybrids upon light irradiation in a different manner, which may be useful for the applications in photovoltaics, optoelectronics and photocatalysis. Here we focus particularly on the nanocomposites made of titanium dioxide with graphene oxide combined with either 2,3,5,6-tetrachlorobenzoquinone or 2,3-dichloro-5,6-dihydroxybenzoquinone - for these two materials we observed a major change in the charge transfer processes occurring in the system.

Subcortical arteriosclerotic encephalopathy was diagnosed in a 56-year-old female normotensive patient with gradually progressing dementia, pseudobulbar palsy and motor deficits. CT scan showed white matter low attenuation in the frontal and parietal lobes. Neuropathological examination revealed degeneration of the white matter. Amyloid was found in walls of small cortical vessels. The walls of small vessels in the white matter showed severe thickening, fibrosis and hyalinization but not amyloid. Cerebral amyloid angiopathy may be responsible for subcortical arteriosclerotic encephalopathy.

Two cases of chronic paroxysmal hemicrania are presented, both with atypical late onset of illness and lack of pre-CPH stage. In one patient the pain attacks were unusually short, and no associated symptoms during the pain attack were observed. However, the positive reaction to indomethacin substantiates the diagnosis of CPH.

SYNOPSIS A case of chronic cluster headache with unusually frequent attacks (up to 30 per day) is discussed. Such numerous attacks are usually observed in chronic paroxysmal hemicrania only. The patient did not respond to indomethacin therapy, but rapid improvement during lithium treatment was observed.

Paroxysms clinically similar or even identical to spontaneous cluster headache (CH), attacks, may be provoked by exogenous histamine [1,2] or by administration of nitroglycerin (NTG) [3].

Thirty-two cluster headache patients and healthy controls (n = 16-20 for the various tests) were examined by means of a Whitaker pupillometer during pain-free intervals. Eye drops of the sympathomimetic agents tyramine, hydroxyamphetamine, and phenylephrine were instilled into the conjuctival sacs on separate occasions, and pupillary diameters recorded at standard time intervals. The mydriatic responses of the two pupils were compared. A moderate, but statistically significant, basal relative miosis was found on the pain side in cluster headache. The symptomatic-side pupils were less responsive than their counterparts when stimulated with tyramine and hydroxyamphetamine, the difference being statistically significant for the OH-amphetamine test. With the phenylephrine test, however, the mydriasis on the symptomatic side significantly exceeded that of the contralateral pupil. This pattern of reactions does not quite correspond to those of “ordinary” Horner‘s syndrome (1st, 2nd, and 3rd neuron lesion). There are, however, gross similarities with the recently reported pattern in central sympathetic neuron dysfunction. In cluster headache there is probably a “Homer-like picture” rather than a proper Horner's syndrome.

Eight patients with Horner's syndrome (five with a 1st neuron lesion and three with a 2nd neuron lesion) were examined for their pupillary responses to pharmacologic stimulation with tyramine (2%) and with phenylephrine (1%) eye drops. The same patients were also evaluated for their forehead sweating pattern on stimulation with body heating and pilocarpine injection, using the Evaporimeter. Five patients had a brain stem (1st sympathetic neuron) lesion, while three patients had had a traumatic C8-Th1 root avulsion and hence had a preganglionic neuron lesion. The average response with the phenylephrine eye test and the pilocarpine sweat test differed markedly between the two groups; only the central neuron lesion group had a supersensitivity reaction to both drugs. These procedures may be of diagnostic value in localizing the lesion in patients with a Horner's syndrome of unknown etiology. Patients with 3rd neuron lesion have not been examined with this combination of techniques.

Eleven female patients with cervicogenic headache (mean age, 43 years; range, 25–59 years) have been examined with the pupillometer. The pupillary diameter was examined in the basal state (that is, the status before pharmacologic stimulation) and after topically administered tyramine (2%), phenylephrine (1%), and hydroxyamphetamine (1%). A total of 51 tests were performed, 35 in the asymptomatic period and 16 during pain attacks. In a control group consisting of 26 age-matched women a total of 39 tests were carried out. Before pharmacologic stimulation (that is, in the “basal state”) the pupils were smaller in the asymptomatic (pain-free) period than during pain attacks in the patients and also as compared with that of control individuals. The anisocoria (the difference in pupillary size in the same individual) observed was not significantly different between the patient group and control individuals either in the basal state (before pharmacologic stimulation) or after pharmacologic stimulation. The mydriasis resulting from the instillation of the three sympathicomimetic drugs was symmetrical in both controls and patients both during and between the pain attacks. This finding is in clear contrast to what is found in cluster headache, in which there is a “Horner-like” syndrome on the symptomatic side. These two headaches thus seem to differ essentially with regard to this variable.

Histamine skin tests were performed in the painful area and on the opposite side in ten cluster headache patients. The studies were carried out with and without local anaesthesia. No differences between histamine skin response in the painful region compared with the contralateral side were revealed. This study concerns the part of the triple response which is the result of a direct action of histamine on the skin vasculature (mediated by both H1 and H2) histaminergic receptors, i.e. wheal and redness, and the flare, which is the result of neuro-humoral mechanisms.

ObjectiveThis pivotal phase III study, SIAXI, investigated the efficacy and safety of incobotulinumtoxinA for the treatment of chronic sialorrhea due to Parkinson disease (PD), atypical parkinsonism, stroke, or traumatic brain injury (TBI).MethodsAdult patients with PD (70.7%), atypical parkinsonism (8.7%), stroke (19.0%), or TBI (2.7%) were randomized (2:2:1) to double-blind treatment with placebo (n = 36), or total doses of incobotulinumtoxinA 75 U (n = 74) or 100 U (n = 74), in a single treatment cycle. The coprimary endpoints were change in unstimulated salivary flow rate from baseline to week 4, and patients' Global Impression of Change Scale score at week 4. Adverse events were recorded throughout.ResultsA total of 184 patients were randomized. Both incobotulinumtoxinA dose groups showed reductions in mean unstimulated salivary flow rate at week 4, with a significant difference vs placebo in the incobotulinumtoxinA 100 U group (p = 0.004). Patients' Global Impression of Change Scale scores also improved at week 4, with a significant difference vs placebo in the incobotulinumtoxinA 100 U group (p = 0.002). A lasting effect was observed at week 16 post injection. The most frequent treatment-related adverse events in the incobotulinumtoxinA 75 U and 100 U groups were dry mouth (5.4% and 2.7% of patients) and dysphagia (2.7% and 0.0% of patients).ConclusionsIncobotulinumtoxinA 100 U is an effective and well-tolerated treatment of chronic sialorrhea in adults.ClinicalTrials.gov identifierNCT02091739.Classification of evidenceThis study provides Class I evidence that incobotulinumtoxinA reduces salivary flow rates in patients with chronic sialorrhea due to PD, atypical parkinsonism, stroke, or TBI.

O dimer,where M = Fe, Mn and X = phenyl or naphthyl, are presented. Discus-sion of the main electronic and vibrational bands observed in the UV-Vis-IRand Raman spectra of both classes of fullerene{porphyrin systems is given.Experimental data are completed with the quantum chemical calculations ofMnTNP