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Ein 54-jahriger Patient leidet seit vielen Jahren unter Mouches ­volantes, also kleinen schwarzen Flecken im Gesichtsfeld. Dadurch bedingt macht er sich grose Sorgen um seine Gesundheit, verfallt in Grubeleien und hat eine depressive Symptomatik entwickelt.

In 22 healthy subjects, painless repetitive transcranial magnetic stimulation (rTMS) was used to investigate the role of the cortex in the regulation of pupil size and the influence of TMS on the central autonomic nervous system. RTMS was performed over three brain regions of each hemisphere (frontal, central, parieto-occipital), over cervical nerve roots and in front of the ear (sham stimulation) while the size of the pupil was measured by infrared oculography. rTMS always elicited a dilatation of both pupils, with its maximum after approximately 1.5 s and without significant R–L difference in latency or amplitude of pupillary response. No differential effects were observed for stimulation over different cortex regions of one hemisphere, but stimulation over the right central region evoked a larger dilatation of the pupil than stimulation over the left. Pupillary dilatation was larger for cervical nerve root stimulation (+13.2±8.3% (S.D.) of baseline) than for suprathreshold cortex stimulation (+8.4±4.5%, five 10-Hz stimuli). Pupillary dilatation in response to magnetic cortex stimulation appears to reflect a mainly unspecific activation of the sympathetic system rather than an activation of a cortical pupillomotor centre. Sympathetic activation following rTMS of the cortex does not limit its experimental and therapeutic application.

Depressive disorders often lead to work incapacity and to the granting of social security benefits due to the patients decreased ability to work. Rehabilitative options offered in connection with statutory pension schemes are in many instances made use of either too late or not at all. These disorders as they develop and progress have a high potential of becoming chronic illnesses. Possible solutions may lie in improved networking of the various benefit and service providers and in rehabilitation case management.

The pathophysiological and neuroanatomical bases of reading epilepsy (RE) are unclear. We performed video-EEG, high quality MRI and [11C]diprenorphine PET in a patient with RE to detect structural and functional abnormalities. EEG showed multifocal seizure onset bilaterally in temporal and fronto-central regions. MRI was normal, whereas [11C]diprenorphine PET revealed peri-ictal opioid binding decrease in both temporal lobes and the left frontal lobe. These findings confirm that RE is due to abnormal activity in the network subserving reading.