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Hans Gerhard Creutzfeldt (1885-1964) is an internationally known Professor of Psychiatry and Neurology. During the time of National Socialism (1933-1945), he worked in the Charite University Hospital Berlin and moved to Kiel University as Head of the Department for Psychiatry and Neurology in 1938. Until the turn of the millennium, Creutzfeldt was considered to be of moral integrity and an opponent of the Nazi regime and its eugenics measures. Publications of the last years came to the conclusion that this depiction does not hold up. They questioned his relations to the ideas and structures of the National Socialist system, his role as a consultant in the National Socialist's forced sterilization program, a possible involvement in the Nazi euthanasia measures, and his position as a psychiatric consultant for the German navy. The article considers 2 aspects concerning the National Socialist racial hygiene in greater detail by using newly found source material. It is shown that Creutzfeldt, although he did not actively resist, was not acting in the interest of the Nazi regime, but rather was trying to save as much patients as possible by changing their diagnoses and prevent them from being killed in the euthanasia program., (© 2020 American Academy of Neurology.)

Deep brain stimulation of the subthalamic nucleus (STN-DBS) reduces akinesia in Parkinson's disease but its impact on fine motor functions was unknown. We assessed the effects of DBS and a levodopa (L-dopa) test on the timing of the precision grip in 18 patients. Improvement on UPDRS-items reflecting hand functions and the shortening of the first phases of the precision grip were more distinct in the L-dopa test than in the pure STN-DBS condition. Other akinesia items and the time for build-up of lifting force were equally improved in both conditions. This suggests that routine STN-DBS might not be equally effective on all aspects of fine motor functions., (Copyright 2003 Movement Disorder Society)

Various basic qualitative and quantitative methods for the evaluation of sensorimotor functions after Traumatic Brain Injury (TBI) are introduced and discussed. Methodological aspects are illustrated by a single case follow-up study of a child after severe TBI (age 11; 7–12;1 yrs; 6, 8 and 12 month post TBI) in comparison to an age-matched healthy control group (N=16). The evaluation consisted of neurological investigation, Barthel-Index, Terver Numeric Score for Functional Assessment, Rappaport Disability Rating Scale (modified version), a coordination-test for children (KTK), a pilot-tested Motor Function Score, quantitative evaluation of spatiotemporal gait parameters on a walkway and on a treadmill, and the kinematic assessment of hand motor functions. Quantitative movement analyses revealed two general types of motor disorder: Slowing of movements and compensatory motor strategies. Averaged z-scores showed deficits, which were pronounced in fine motor skills (hand movements: 1.86, gait: 1.3). During follow-up, a strong improvement rate during the first (-0.48 z-scores) and nearly no improvement rate (-0.03 z-scores) during the second time interval was seen. Clinical scores and developmental tests were not able to document the whole restitutional course, whereas motor tests with special emphasis on functional aspects and the quantitative movement assessment seemed to be suitable methods. We conclude that a sufficient evaluation of sensorimotor functions after TBI in childhood needs an increase in procedural uniformity on onehand and the combination of various qualitative and quantitative methods on the other hand. To connect both claims, further research is necessary.

The aim of this electromyographic study was to evaluate the functional result of tendon transfers for radial palsy. Eighteen patients were compared to 16 healthy volunteers. The intramuscular emg of four muscles was recorded in parallel during extension-flexion movements of the wrist and fingers. The data were stored on FM tape and evaluated off-line. Contrary to expectations, transferred flexor muscles revealed only part of their overall emg activity during extension. Therefore, an "extensor quota" (EQ) was calculated for each muscle. It reflects its emg activity during extension as part of its entire emg activity. In non-transferred flexors EQ was low (11-27%). High EQ values (69-91%) were seen in genuine extensors of healthy persons. In only 6 of 18 patients did transferred flexors show an EQ equivalent to genuine extensors (> or = 69%). Best functional results were seen in transferred flexor carpi ulnaris (median EQ 68%). The EQ of transferred pronator teres was low (median 18%) and minor to flexor carpi ulnaris in each patient (P < 0.05). It is concluded that in cases of radial palsy, pronator teres is not suitable for replacing extensor muscles. Superficial flexors of the fingers, however, work in synergy with extensors of the wrist. According to the la reflex connections involved, these muscles should be a good choice for regaining extension of the wrist.

The innervation of muscle spindles by skeletofusimotor (beta) axons in functionally different muscles of the cat forelimb has been correlated with the neural circuitry of the respective motor nuclei, morphological characteristics of their motoneurones and the innervated muscle fibres. In long digt extensor muscles a high degree of beta-innervation (more than 70%) and of fast contracting muscle fibres (more than 70% IIB fibres) correlates with specific projections of their Ia muscle spindle afferents, with the absence of a recurrent inhibitory system, with cell body diameters in the range of small alpha-motoneurones and with a short duration of their after-hyperpolarisations. In contrast, the investigated elbow muscles display a low degree of beta-innervation (41-47%) irrespective of their fibre type composition, their Ia afferent fibres show a divergent projection pattern and their motor nuclei a distinct recurrent inhibitory system. We suggest that for the distal muscles the specific combination of these different characteristics serves the control of manipulative movements, whereas for the proximal muscles the contrasting characteristics serve the control of posture and locomotion. This hypothesis is discussed in view of the phylogenetic development of motor control.

The projection pattern from large muscle spindle afferents (Ia) onto cat alpha-motoneurones innervating the elbow, wrist and digit muscles is correlated with new electromyographical and x-ray kinematic data on the motor behaviour of the forelimb. This correlation suggests that the Ia-synergistic groups may be one substrate to organize movement components mobilized in motor behaviour. This hypothesis is based on the data on the active stabilization of the radio-ulnar joints during the stance phase, on the data on the Ia-organization of a motor nucleus taking part in different motor behaviours and on the results showing how the Ia convergence onto the long digit extensor muscles fits the execution of finely tuned movements at ball joints.

The innervation of muscle spindles by skeletofusimotor (beta) axons has been compared in two long digit extensor muscles with three elbow extensor muscles of the cat forelimb. The proportion of muscle spindle poles with p1-endplates was analysed in silver impregnated teased material. The proximal and distal muscles displayed a significant difference in their proportion of muscle spindle poles with p1-endplates. The distal muscles had an estimated proportion of more than 70% beta innervation of their muscle spindles, the proximal muscles of 41-47%. This difference is discussed with respect to the different circuitry of the motoneurones. We suggest that the high proportion of beta-innervated spindles in distal muscles obtained with the absence of a recurrent inhibitory system in the innervating motoneurones [18] serves the execution of manipulative movements.

A computer program (EEG Analysis) was developed for the preclinical laboratory course in physiology held for medical and dental students. It offers an off-line analysis of a set of typical and frequently occurring physiological and pathological electroencephalogram (EEG) and evoked potential (EP) recordings, which are stored in an IBM-compatible personal computer (PC) system. The users are requested to measure and analyze the data sets and to work through a base of questions relevant in the frame of the particular topic. The program is structured in several exercises: calibration, pickup of non-EEG signals (eye movements, chewing), waveforms in EEG recordings from awake subjects (alpha-waves, beta-waves), desynchronization of cerebral activity (visual activation, acoustic activation, mental activation), habituation of cerebral activity upon acoustic stimuli, EEG recordings from asleep subjects (different sleep stages, sleep-specific EEG signals), epileptic seizures, and EPs (principle of averaging, visually evoked potentials in different cortical areas). The program runs under MS-DOS and is network capable. The software structure ensures maximal flexibility for rapid changes and adaptations of the program to specific needs of a particular EEG course. The program has been used for three years, and the response from > 800 students has been consistently positive.

Forelimb alpha-motoneurones were intracellularly recorded in anaesthetized cats and iontophoretically filled with horseradish peroxidase (HRP). All motoneurones to the elbow flexors, elbow extensor and to the extensor carpi radialis muscles displayed in parallel homonymous recurrent inhibitory postsynaptic potentials (RIPSPs) and axon collaterals. Homonymous RIPSPs and axon collaterals were missing in the nuclei to the long digit extensor muscles. Two populations of motoneurones, with and without recurrent axon collaterals, seem to be present in the extensor carpi ulnaris motor nucleus. These results are consistent with the hypothesis that the motoneurones to the extrinsic digit extensors lack a recurrent axonal system. This indicates that the contribution of the recurrent Renshaw systems to motor control may be more complex than hitherto assumed.

The position of the motornuclei projecting through the median (Mn) and ulnar (Ul) nerves to the cat distal forelimb has been investigated. Horseradish peroxidase (HRP) and fluorescent (Fl) compounds have been used as retrograde tracers. They were either injected into forelimb muscles or applied to the proximal end of transected forelimb nerves. Limb muscles that were not investigated were carefully denervated. The position and the architecture of the individual motornuclei were traced with HRP. The topographical relations between the nuclei were established with application of up to three different Fl compounds in the same animal. The Mn motoneurones had a bimodal distribution in the brachial spinal cord. The motoneurones to the pronator teres and flexor carpi radialis muscles were located in C7 and the other Mn motoneurones were located in C8 and Th1. In C7 the Mn motoneurones occupied a single representation area, which is located some distance medially of the lateral funiculus. In C8 and Th1 two Mn representation areas were found: A dorsal one that contacts the lateral funiculus and is located at the level of the central canal; a ventral one that is located ventrally in the ventral horn. The dorsal area is occupied by the motornuclei projecting to the intrinsic hand muscles and the ventral one by the nuclei projecting to the limb. The Ul motoneurones extend with an unimodal distribution from the caudal C7 to the caudal Th1 segments. They occupy a single, broad representation area. The dorsal part, which contacts the lateral funiculus, is located at the level of the central canal and harbours the nuclei to the intrinsic hand muscles. The other Ul nuclei are located ventromedially deep in the ventral horn. These results, together with those from the companion paper on the location of the deep radial motornuclei, provide important anatomical information for the investigation of the cat brachial enlargement.

This study aimed to establish the projection from the corticospinal tract (CST) to the motoneurones innervating the deep radial (DR) forelimb muscles. In the anaesthetized cat stimulation of the contralateral pyramid and intracellular recording from identified forelimb motoneurones was used. A train of pyramidal stimuli evoked disynaptic EPSPs in DR motoneurones. The effects were very similar in the different nuclei. Pyramidal IPSPs had a slightly longer latency and occurred in most cases together with disynaptic EPSPs. It is suggested that the inhibitory actions to the distal forelimb are predominantly relayed in a trisynaptic pathway, but that a disynaptic linkage seems possible as well. The disynaptic pyramidal EPSPs remained after CST transection in C5. They were abolished after CST transections in C2. It is concluded that disynaptic corticospinal excitation of distal DR motornuclei is relayed in a short midcervical propriospinal system. Transection experiments at different cervical levels suggest that the majority of the propriospinal neurones is located in C3-C4. The CST facilitated a variety of reflex pathways to motoneurones innervating distal forelimb muscles. Disynaptic excitatory and inhibitory effects from cutaneous and low threshold group I muscle afferents were common. They were present in all investigated nuclei and powerfully facilitated from the CST. It is suggested that this allows the brain to adapt the reflex mechanisms of the distal forelimb to the synergistic-antagonistic relations between the muscles, which are changing according to the performed movement.

Evidence is presented that in lumbar segments of the cat, two neighbouring rami communicantes albi (white rami, WR) may contain axons of one and the same preganglionic sympathetic neurone (PSN). This was shown with bisbenzimide (Bb) and propidium iodide (PI) applied in the same cat to the central cut ends of two WR (PI to WRL1, Bb to WRL2). PSN, double labelled from both these sites, were observed in the intermediolateral and intercalate nuclei of the L1 segment. It is postulated that axons of PSN branch intraspinally and project through different WR.

In the cat we have investigated the position of the motor nuclei projecting through the dorsal interosseus nerve to the distal forelimb muscles. Horseradish peroxidase was either injected into single muscles or applied to the central end of a cut nerve. The location of each nucleus is described in two ways: histograms giving the distribution of the labelled motoneurones along the rostro-caudal spinal cord axis; and regions in reconstructed cross-sections of the ventral horn which indicate the area occupied by the motoneurones of one nucleus. The relation between the nuclei was established by superposition of the reconstructed cross-sections. With this procedure we have obtained a map which shows the positions of the centres of the single radial nuclei.

The position of the motornuclei projecting through the dorsal interosseus (DR) nerve to the distal forelimb muscles has been investigated in the cat. Horseradish peroxidase (HRP) and fluorescent (Fl) compounds have been used as retrograde tracers. They were either injected into forelimb muscles or applied to the proximal end of transected forelimb nerves. Limb muscles that were not investigated have been carefully denervated. HRP was used to trace the position and the architecture of the individual motornuclei. The topographical relations between the nuclei were established with application of up to three F compounds in the same animal. The position of the labeled motornuclei was reconstructed with a computer-assisted approach which is described in the appendix. The DR representation area extends from the caudal C5 to the caudal Th1 segments. In C6 it forms a dorsoventrally oriented narrow region at the lateral border of the ventral horn; in C7 and rostral C8 it forms a broad column in the dorsolateral corner of the ventral horn. In caudal C8 and Th1 this column is shifted into a ventral direction. The motoneurones projecting to the individual DR muscles are not randomly distributed in this area, but arranged in long, slender columns. These motornuclei occupy specific positions with only minimal interindividual variations. Three nuclei (brachioradialis, extensor carpi radialis, and supinator) are located in the C6 and C7 segments. They compose about one-third of the DR cell population. The nuclei to the other radial muscles are all located in C8 and Th1. Thus most of the DR motoneurones are located in these two segments. These results, together with those from the companion paper on the location of the median and ulnar motornuclei, provide important anatomical knowledge for the investigation of the cat brachial enlargement.

This chapter reviews experiments on the distribution of recurrent pathways from motor axon collaterals to alpha motoneurones in the brachial enlargement of the cat. In anaesthetized cats intracellular recording from identified forelimb motoneurones was used to reveal the pattern of recurrent inhibition or excitation following stimulation of muscle nerves. The recurrent connections of the motor nuclei acting on the elbow follow the tight mechanical agonism of the muscles involved. Extensive bidirectional recurrent inhibitory connections were found between motor nuclei innervating elbow and wrist muscles. It is suggested that one group of these connections supports the organization of limb extension, the other group organization of limb flexion. The supinator and the pronator teres motornuclei have identical recurrent connections. Co-convergence from elbow flexor and extensor motornuclei in one and the same motoneurone is frequent. It is suggested that this pattern may serve the stabilization of the radio-ulnar plane. Neither homonymous nor heteronymous recurrent actions were observed in the radial motornuclei acting on the digits, which suggests a lack of recurrent axon collaterals in these nuclei. These results draw attention to the fact that recurrent inhibition is not evenly distributed between all limb motor nuclei.

The pattern of recurrent pathways from motor axon collaterals to motoneurones has been investigated in the spinal cord of anaesthetized cats with intracellular techniques. Only recurrent inhibitory postsynaptic potentials (RIPSPs) were observed so far. They were very pronounced between the mechanical synergists acting at the elbow. The triceps muscles received substantial effects also from the extensor carpi ulnaris (ECU) and from palmar-located medialis (M) and ulnaris (Ul) muscles. The effects were much smaller in the motor nuclei acting on the wrist (ECU, EC radialis (ECR]. The motor nuclei to the muscles acting on the phalanges (extensor digitorum communis and lateralis, extensor indicis proprius, and abductor pollicis longus (EDC, EDL, EIP, APL] neither received nor emitted any recurrent effects, which may indicate a lack of the recurrent system in these distal motor nuclei. A comparison of the recurrent pattern with the distribution of monosynaptic excitation from large muscles spindle afferents (Ia) shows that there is a partial overlap of both systems only at the elbow joint.

In patients suffering from paralysis of a major synergistic muscle group tendon transfers can be considered the therapy of choice in restoring the mobility of the affected joint(s). In order to study the mechanisms underlying the subsequent reversal of function in the transferred muscles, we have recorded the EMG of several forearm muscles in parallel and compared their activation periods with control data from healthy volunteers. Slow and fast extension-flexion movements of the wrist were evaluated. The findings demonstrated a 'new' phasic EMG activity within the transferred muscles, which correlated to their new mechanical function. However, the 'old' EMG pattern was not lost. In some muscles it was present in fast and slow wrist movements, in others only in fast ones. The results indicate that the reversal of function observed in the transferred muscles can be adjusted to meet the specific needs of the movement to be performed.

The location and dendritic projection of lumbar preganglionic sympathetic neurons (PSN) has been investigated in the cat. Horseradish peroxidase was either injected into lumbar paravertebral ganglia or directly applied to a lumbar ramus communicans albus. PSN were regularly found in the lateral funiculus and in the intermediate area of the ipsilateral spinal cord. They were concentrated in different nuclei: nuclei intermediolateralis pars principalis (IMLp) and pars funicularis (IMLf), nucleus intercalatus (IC) and medially near the central channel. Inconsistently, some PSN were observed in the ventral horn. Dendrites extending over a few soma were found in nearly all PSN, thus allowing description of the main dendritic projections of the preganglionic nuclei. Sometimes axons of IMLp and IC neurons could be traced into the ventral roots. In the IMLp the PSN were arranged in round clusters (up to 30 cells), which regularly followed each other in rostrocaudal direction. These clusters increased their mediolateral diameter from L1 to L4. Many cells distributed their dendrites longitudinally within the IMLp, but dendritic projections into the dorsal horn, the intermediate area and into the lateral funiculus were also frequently observed. The IMLf consisted of a few PSN only. These neurons were located in the tissue spaces between axon bundles and mediolaterally arranged, pointing towards the IMLp. The PSN of the IC were mediolaterally oriented and arranged in transverse bands extending from the lateral horn to the dorsal aspects of the central channel. All cells had mediolaterally oriented dendrites which sometimes crossed the spinal cord midline in case of the medially located neurons. The dendrites of the laterally located cells projected very often into the dorsal horn. In the medial region the PSN covered a narrow area extending from the dorsal aspects of the central channel in a ventrolateral direction up to the level of the ventral commissure. The neurons were localized in clusters and mediolaterally or longitudinally oriented. Dense clusters consisting of round cells were prevalent in the ventrolateral position. The dendrites had a rostrocaudal and mediolateral orientation and, in case of the dorsomedially located cells, sometimes crossed the spinal cord midline. The main dendritic projection areas of the different preganglionic nuclei have been compared with the location of the terminal fields of descending supraspinal and propriospinal systems and of primary afferents. It has been considered that this structural arrangement would allow for intricate interaction of the various systems with subpopulations of PSN. Thus each preganglionic nucleus might integrate specific neuronal information.

In the cat the distribution and projection of lumbar (L1-L4) preganglionic sympathetic neurones (PSNs) has been investigated with the horseradish peroxidase (HRP) technique. Following an HRP-injection into a lumbar sympathetic trunk ganglion, PSNs were found in the ipsilateral spinal cord in lamina VII, specially in its lateral and intermediate parts. In the medial region HRP positive cells were more frequently observed when the central, cut end of the ramus communicans albus was placed into HRP. HRP injection into the coeliac and lower mesenteric ganglia labelled lateral PSNs, but rarely medial ones. In the cranio-caudal direction, the PSNs projected over several segments via intraspinal and extraspinal pathways.