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Dank der Fortschritte der modernen Medizin ist die unmittelbare Mortalitatsrate nach einem Schlaganfall in den vergangenen Jahrzehnten kontinuierlich gesunken. Kehrseite dieser Entwicklung ist, dass die den Schlaganfall uberlebenden Patienten fur die verbliebene Lebensspanne teilweise erhebliche funktionelle motorische und/oder sprachliche Einschrankungen aufweisen. Im vorliegenden Beitrag werden evidenzbasierte Methoden der Neurorehabilitation zur Forderung motorischer und sprachlicher Funktionen in der akuten sowie chronischen Phase nach einem Schlaganfall vorgestellt. Neben intensiv durchgefuhrten Trainingsansatzen zahlen dazu neuropharmakologische Ansatze und nichtinvasive Hirnstimulationstechniken, wie die transkranielle Magnet- oder Gleichstromstimulation (TMS, tDCS). Zusatzlich erfolgt ein Ausblick auf vielversprechende, derzeit noch als experimentell anzusehende Interventionen.

Ionic liquid monomers substituted with a polymerizable group were polymerized using free radical polymerization and group transfer polymerization mechanisms. Homopolymers containing a polycation or a polyanion structure were made as well as various copolymers. The latter include statistical copolymers, alternating copolymers, and block copolymers. The new polymers obtained may become of interest for application as binders for coatings. Furthermore, glass transition temperature of the polymers obtained was discussed as an important parameter for the application temperature needed for film formation. It was shown that a variation of the ionic liquid monomer structure affects the glass transition temperature of the polymer obtained. Moreover, antimicrobial properties of selected polymers were investigated using Escherichia coli and Micrococcus luteus. The results show significant differences in the antimicrobial properties of the polymers investigated. This is highly interesting for applications in which these polymers function as binders in coatings.

Die Funktionsrestitution nach einem Schlaganfall wird von vielen Faktoren beeinflusst. Insbesondere das Alter des Patienten, die initiale Auspragung der Symptomatik, das Vorhandensein kognitiver oder neuropsychologischer Defizite zahlen dazu. In dieser Studie wurde untersucht, ob ein Polymorphismus im fur den „brain derived neurotrophic factor“ (BDNF) kodierenden Gen Einfluss auf die Verbesserung von motorischen Funktionen und Alltagsaktivitaten nimmt. Patienten mit subakutem ischamischem Hirninfarkt (n = 67) wurden zu Beginn einer stationaren neurologischen Rehabilitation, nach 4-wochiger Behandlung und 6 Monate spater mittels Barthel-Index (BI) und Rivermead Motor Assessment (RMA) untersucht. Je nach BDNF-Polymorphismus im Codon 66 erfolgte die Einteilung in Gruppen (Valin [Val]/Valin, Val/Methionin[Met] oder Met/Met). Die 3 Gruppen (Val/Val, n = 34 Patienten; Val/Met, n = 26; Met/Met, n = 7) wiesen im BI und im RMA sowohl nach 4 Wochen als auch nach 6 Monaten eine signifikante Verbesserung zum jeweils vorhergehenden Untersuchungsergebnis auf. BI und RMA waren hoch miteinander korreliert. Es gab keinen Unterschied in Bezug auf den BDNF-Polymorphismus. Nach Hirninfarkt kommt es uber mindestens 6 Monate zu kontinuierlichen Verbesserungen der motorischen Funktionen und der Alltagsfunktionen. Der BDNF-Polymorphismus beeinflusste diese Entwicklung nicht.

Advancements in medical care over the last decades have contributed to a continuous decline in immediate post-stroke mortality. The flipside of this development is that patients surviving the initial stroke are forced to live with sometimes extreme functional motor and/or language limitations for the remaining life span. The following overview presents evidence-based neurorehabilitative interventions to promote motor and language recovery in the acute and chronic post-stroke stages. Therapeutic approaches comprise intensive training, neuropharmacological drugs and non-invasive brain stimulation techniques, such as transcranial magnetic stimulation (TMS) or direct current stimulation (tDCS). Additionally, an outlook on promising future interventions for stroke neurorehabilitation is provided.

Randomized controlled trials with a variety of drugs have been performed for approximately 20 years in order to support functional restitution of motor deficits after a stroke. Nowadays, serotonin reuptake inhibitors show the highest level of evidence due to the largest number of positive studies and L‑dopa also seems to be effective; however, much fewer studies have been conducted. In the majority of trials amphetamines provided no additional benefits and D‑cycloserine cannot be recommended either. Future therapeutic approaches, e.g. anti-nogo antibodies and cell therapy are presented.

Mental training, including motor observation and motor imagery, has awakened much academic interest. The presumed functional equivalence of motor imagery and motor execution has given hope that mental training could be used for motor rehabilitation after a stroke. Results obtained from randomized controlled trials have shown mixed results. Approximately half of the studies demonstrate positive effects of motor imagery training but the rest do not show an additional benefit. Possible reasons why motor imagery training has so far not become established as a robust therapeutic approach are discussed in detail. Moreover, more recent approaches, such as neurofeedback-based motor imagery or closed-loop systems are presented and the potential importance for motor learning and rehabilitation after a stroke is discussed.

In this review, treatments for motor rehabilitation after stroke will be presented. In particular, randomised, controlled trials, meta-analyses and systematic reviews, mainly from the years 2009 - 2011, were taken into consideration. In summary, evidence is best for constraint-induced movement therapy and Botulinum toxin type A in patients with focal spasticity. Superiority has been demonstrated for the administration of drugs (serotonin re-uptake inhibitors and L-dopa), mirror therapy, the use of virtual reality, electromechanical devices to restore independent walking, and fitness and circuit training. Other therapies (bilateral arm training, treadmill therapy, robot-assisted arm therapy) did not show superiority. For sensory training and repetitive transcranial magnetic stimulation large clinical studies still need to be done.

To investigate whether the increased urge to move the legs in restless legs syndrome (RLS) corresponds to an electrophysiological phenomenon and whether motor excitability or behavior is influenced by the treatment with a dopamine agonist. We examined 10 patients who had RLS with transcranial magnetic stimulation (TMS) before and during treatment with the dopamine agonist cabergoline. Results were compared with data obtained from healthy subjects. Inhibitory mechanisms were explored by measurement of the cortical silent period (cSP). Recordings were obtained from the right anterior tibial muscle. Clinical severity of RLS was rated using the International Restless Legs Syndrome Study Group Rating Scale (IRLSSGRS). During therapy with cabergoline, all patients reported a significant improvement of RLS symptoms. Before medication, patients showed a significant shortening of cSP compared with healthy subjects. After 14 days of treatment with cabergoline, cSP normalized in RLS patients; 90 days after the start of daily cabergoline, cSP tended to shorten again, whereas RLS symptoms further improved. There was no correlation between cSP duration and IRLSSGRS results. There were no differences in patient and control motor thresholds. These thresholds remained unchanged during treatment with cabergoline. RLS patients have a disturbance of inhibitory neurons that can temporarily be reversed with a dopamine agonist. However, the cSP does not correlate with the clinical symptoms.

After ischemic stroke, many factors influence the restitution of functions. In particular they include the patient age, the initial stroke severity and the presence of cognitive and neuropsychological deficits. In this study we investigated whether a polymorphism in the gene encoding for brain derived neurotrophic factor (BDNF) influences improvements of motor functions and everyday activities.Patients with subacute ischemic stroke (n = 67) were examined at the beginning of an inpatient neurological rehabilitation, after 4 weeks of treatment and after 6 months. The Barthel index (BI) and the Rivermead motor assessment (RMA) were used to measure motor functions and everyday activities. Patients were allocated to three groups (valine [Val]/valine, val/methionine [Met] and Met/Met) depending on the BDNF polymorphism at codon 66.The 3 groups (Val/Val, n = 34 patients, Val/Met, n = 26 and Met/Met, n = 7) showed significant improvements in BI and RMA after 4 weeks and after 6 months as compared to the preceding measurements. The BI and RMA were positively correlated. The three groups did not differ with respect to the extent of improvement.After ischemic stroke, motor functions and everyday activities improved continuously over a period of at least 6 months. The BDNF polymorphism did not influence this development.

ZusammenfassungMechanismen der Erholung im motorischen System lassen sich unter anderem tierexperimentell untersuchen. Funktionelle Bildgebungsstudien beim Menschen ergänzen diese Befunde und legen nahe, dass das periläsionelle Hirngewebe, das vorübergehend durch eine Ischämie beeinträchtigt worden ist, wieder funktionstragend werden kann. Eine Erhöhung der zerebralen Erregbarkeit tritt aber nicht nur periläsionell, sondern auch in der nicht-betroffenen Hemisphäre auf. Sie ist wahrscheinlich eine weitere Grundlage der postläsionellen Plastizität. Die veränderte zerebrale Erregbarkeit wird auch vom Ort der Schädigung mitbestimmt. Denn umschriebene Hirninfarkte führen zu lokalisationsspezifischen Erregbarkeitsänderungen in räumlich entfernten, aber funktionell verbundenen Hirnarealen. Damit gehen auch unterschiedliche Effekte eines motorischen Trainings auf die zerebrale Erregbarkeit einher. Das verbesserte Verständnis über die Mechanismen der Erholung trägt dazu bei, die rehabilitative Therapie neurowissenschaftlich zu fundieren. Die Entwicklung und Evaluation klinischer motorischer Skalen unterstützt dabei die alltagsnahe Dokumentation von Lähmungsauswirkungen und fördert die Messung von Therapieeffekten. Ein neues Therapiekonzept, dass spezifisch die verschiedenen motorischen Kontrolldefizite bei Lähmungen behandelt (impairment-oriented training – IOT) erwies sich in klinischen Studien als wirksam. Auch pharmakologische Effekte auf Erholung und Trainingseffekte werden geprüft.

To compare the laryngeal mask airways (LMA), LMA-Classic(TM) (LMA-C) and LMA-ProSeal(TM) (PLMA) with the endotracheal tube (ETT) with respect to pulmonary ventilation and gastric distension during gynecologic laparoscopy.We stratified 209 women, agedor = 18 yr, ASA physical status I-III, by body mass index as non-obese (or = 30 kg x m(-2)) or obese (30 kg x m(-2)) and randomized them to LMA-C/PLMA or ETT groups for airway management. Anesthesia was induced with propofol, fentanyl and succinylcholine or rocuronium. In the LMA-C/PLMA group we used a size 4 LMA-C in non-obese patients and size 4 or 5 PLMA in obese patients. In the ETT group we used a cuffed 7.0 mm ETT in all patients. Anesthesia was maintained with isoflurane in nitrous oxide and 30-50% oxygen, fentanyl and neuromuscular blockade with mechanical ventilation (tidal volume 10 mL x kg(-1)). The staff surgeon, blinded to the type of airway, scored stomach size on an ordinal scale 0-10 at initial insertion of the laparoscope and immediately before the conclusion of the surgical procedure.There were no crossovers and no statistically significant differences between LMA-C/PLMA and ETT groups for SpO(2,) P(ET)CO(2) or airway pressure before or during peritoneal insufflation in short (or = 15 min) or long (15 min) periods of peritoneal inflation. Differences between groups with respect to stomach size changes during surgery were not statistically significant.A correctly placed LMA-C or PLMA is as effective as an ETT for positive pressure ventilation without clinically important gastric distension in non-obese and obese patients.

Purpose: To compare LMA-ProSeal™ (LMA-PS) with endotracheal tube (ETT) with respect to pulmonary ventilation and gastric distension during laparoscopic cholecystectomy. Methods: We randomized 109 ASA I–III adults to LMA-PS or ETT after stratifying them as non-obese or obese (body mass index > 30 kg·m –2 ). After preoxygenation, anesthesia was induced with propofol, fentanyl and rocuronium. An LMA-PS (women #4, men #5) or ETT (women 7 mm, men 8 mm) was inserted and the cuff inflated. A #14 gastric tube was passed into the stomach in every patient and connected to continuous suction. Anesthesia was maintained with nitrous oxide, oxygen and isoflurane. Ventilation was set at 10 mL·kg –1 and 10 breaths·min –1 . The surgeon, blinded to the airway device, scored stomach size on an ordinal scale of 0–10 at insertion of the laparoscope and upon decompression of the pneumoperitoneum. Results: There were no statistically significant differences in SpO 2 or P ET CO 2 between the two groups before or during peritoneal insufflation in either non-obese or obese patients. Median (range) airway pressure at which oropharyngeal leak occurred during a leak test with LMA-PS was 34 (18–45) cm water. Change in gastric distension during surgery was similar in both groups. Four of 16 obese LMA-PS patients crossed over to ETT because of respiratory obstruction or airway leak. Conclusions: A correctly seated LMA-PS or ETT provided equally effective pulmonary ventilation without clinically significant gastric distension in all non-obese patients. Further studies are required to determine the acceptability of the LMA-PS for laparoscopic cholecystectomy in obese patients.

Berichtet wird uber eine Patientin mit schwerer, therapieresistenter depressiver Episode bei rezidivierender depressiver Storung (ICD-10: F33,3), die sich innerhalb der vergangenen 7 Jahre insgesamt 60 Monate in stationarer Behandlung befand. Funf Elektrokrampftherapie (EKT)-Serien (insgesamt 61 Behandlungen) fuhrten zu kurzzeitigen Stimmungsaufhellungen, blieben jedoch langerfristig ohne Erfolg. Auserdem wurden zunehmende kognitive Defizite und prolongierte postnarkotische Aufwachphasen beobachtet, sodass weitere Behandlungen kontraindiziert waren. Als alternativer Behandlungsansatz erfolgte die repetitive transkranielle Magnetstimulation (rTMS) uber dem Gyrus frontalis superior links unter Verwendung eines Neuronavigationsverfahrens. Im Verlauf wurde der psychische Befund anhand standardisierter Ratings (HAMD [1], BDI [2]) kontrolliert. Die kognitive Leistungsfahigkeit wurde im Langzeitverlauf erfasst. Bereits nach wenigen rTMS-Behandlungen zeigte sich eine Befundverbesserung mit Stimmungsaufhellung, Distanzierung von depressiven Wahninhalten und Zunahme von Ausenaktivitaten, sodass nach 4 Wochen taglicher Behandlung die Entlassung erfolgte. Durch ambulante Erhaltungsbehandlungen und verhaltenstherapeutische Interventionen wurde eine kontinuierliche, familiare und soziale Reintegration moglich.

Objectives : To test whether a disinhibition occurs in the human motor cortex after stroke. Methods : Patients with a mild to moderate hemiparesis after an acute unilateral ischemic stroke were compared with age-matched healthy controls. We used paired transcranial magnetic stimuli (TMS) to investigate intracortical inhibition and facilitation. Single TMS were applied to obtain a cortical silent period. Results : Intracortical inhibition was significantly reduced in the affected hemisphere at interstimulus intervals of 2, 3 and 4 ms. The cortical silent period was significantly prolonged when compared to the unaffected hemisphere of the patients and to the control group. Motor cortex disinhibition observed in stroke patients was associated either with minimal impairment at the onset of symptoms or with rapidly improving motor functions. Conclusions : Motor cortex disinhibition occurs in humans after stroke. We suggest that this disinhibition is indicative of compensatory mechanisms, which are involved in recovery-related reorganization.

We used focal transcranial magnetic stimulation to examine the effects of 120 synchronized thumb and foot movements on the motor output map of the right abductor pollicis brevis muscle (APB) (experiment 1). To evaluate the performance, the latencies between the onset of the electromyographic activity (EMG) of the two muscles were measured. As control, 120 asynchronous thumb and foot movements were performed (experiment 2). Exclusively in experiment 1, the center of gravity (CoG) of the output map moved medially in the direction of the foot representation area (mean 7 mm, P

Summary The purpose of this report was to review basic hemodynamic physiology and to develop an improved understanding of the principles necessary to both diagnose and treat the various causes of hypoperfusion. In addition, a comparative physiologic approach is presented to provide a broader clinical understanding of pathophysiologic mechanisms. This understanding of the underlying mechanisms of shock can lead to a rational approach to the use of fluid, inotropes, vasoactive agents, and mechanical aids to perfusion to provide for effective hemodynamic resuscitation. Continued investigation into the etiologies and therapy of the cellular dysfunction is essential to improve outcome. The clinician must remain attentive to these ongoing investigational efforts to positively impact survival of patients with shock. Critical evaluation will be necessary to avoid, as with steroids, becoming enthralled with therapies that, having undergone minimal investigative scrutiny, are only later found to be ineffective or deleterious.

In this review, treatments for motor rehabilitation after stroke will be presented. In particular, randomised, controlled trials, meta-analyses and systematic reviews, mainly from the years 2009 - 2011, were taken into consideration. In summary, evidence is best for constraint-induced movement therapy and Botulinum toxin type A in patients with focal spasticity. Superiority has been demonstrated for the administration of drugs (serotonin re-uptake inhibitors and L-dopa), mirror therapy, the use of virtual reality, electromechanical devices to restore independent walking, and fitness and circuit training. Other therapies (bilateral arm training, treadmill therapy, robot-assisted arm therapy) did not show superiority. For sensory training and repetitive transcranial magnetic stimulation large clinical studies still need to be done.

Introduction ALPHA-GAL is a glycoconjugate present on cell membranes of mammals and bacteria but not humans who display anti-Gal antibodies (AB) in high titers provoked by the commensal gut flora. In the present study, we sought to determine the longitudinal course of alpha-Gal specific AB titers of all isotypes over 8 weeks among healthy adult subjects. Furthermore, we hypothesized that inflammatory bowel disease (IBD) patients display increased anti-Gal titers. Materials and methods We drew serum from healthy probands (n = 20) weekly for 8 weeks and obtained plasma samples of from patients suffering from Crohn's disease (n = 20) and ulcerative colitis (n = 20). We measured anti-Gal ABs of all isotypes and total immunoglobulin (Ig) content using an enzyme-linked immunosorbent assay technique. For statistical evaluation of the longitudinal titers, we calculated confidence intervals for the slopes of a random intercept model, comparing variances between and within the probands. For group comparisons, we performed paired student t-tests and Pearson correlations. Results Alpha-Gal specific IgG, IgM, IgD, and IgA titers remained unvaried within a narrow range upon longitudinal observation. Most probands did not display alpha-Gal specific IgE ABs. Crohn's disease patients showed highly increased alpha-Gal-specific IgA titers compared with control subjects (P Conclusion Apart from IgE, alpha-Gal-specific ABs of all isotypes remained constant over longer time periods in healthy subjects. Thus, significant titer changes actually represent increased antigen exposure and a specific anti-alpha-Gal response. Crohn's disease patients display increased anti-Gal IgA titers compared with healthy controls, which reflects a chronically impaired mucosal gut barrier in this patient cohort.

Das Bobath-Konzept ist eine losungsorientierte Vorgehensweise bei der Befundaufnahme und Behandlung von Individuen mit funktionellen Storungen, Bewegungsstorungen und Storungen der posturalen Kontrolle aufgrund einer Lasion des zentralen Nervensystems (IBITA 1996; Panturin 2001; Brock et al. 2002; Raine 2006). Dieser Ansatz zur Rehabilitation Erwachsener mit Storungen des zentralen Nervensystems entstand ursprunglich aus der Arbeit von Berta und Karel Bobath und wird nun bereits seit uber 50 Jahren weiterentwickelt. Als Grundlage fur die praktische Anwendung heute dient der aktuelle Wissensstand uber motorische Kontrolle, motorisches Lernen, neurale und muskulare Plastizitat sowie uber Biomechanik Daruber hinaus fliesen sowohl die Ergebnisse spezialisierter Behandlungserfahrung als auch die Bedurfnisse und Erwartungen der zu Behandelnden in diesen therapeutischen Denkansatz mit ein (Sackett 2000).

Lidocaine can be prepared in a variety of ways which may affect the characteristics of neural blockade achieved. Experimental evidence is equivocal as to the clinical impact of the use of different lidocaine preparations. A randomized, double-blind study was performed to investigate the differences in epidural anaesthesia for Caesarean section using three different lidocaine solutions: lidocaine CO2, two per cent lidocaine and two per cent lidocaine with its pH adjusted by the addition of bicarbonate. No differences were found among the groups in time of onset of neural blockade, quality or duration of neural blockade, time to delivery of the infant or volume of anaesthetic solution injected into the epidural space. A significant difference was found between the pH's of the solutions used. It is concluded that all three solutions are equally efficacious in epidural anaesthesia for Caesarean section.

Drugs that modulate neuronal transmission can influence motor recovery after stroke. Here, we tested if a single dose of levodopa could improve motor functions and change motor excitability in a group of chronic stroke patients.Ten patients6 months after their stroke participated in a placebo-controlled double-blind trial. On two different occasions, they received either 100 mg levodopa or placebo in a randomized order. After drug intake, they participated in one hour of physiotherapy aimed at an improvement of dexterity. Motor functions were tested by application of the Nine-Hole-Peg Test, a dynamometer measuring grip strength and the Action Research Arm Test. In addition, transcranial magnetic stimulation (TMS) was applied to study intracortical excitability, stimulus response curves and silent periods. TMS studies and motor function measurements were performed before drug intake, 45 minutes after drug ingestion and after the physiotherapy.Compared to placebo, levodopa neither improved motor functions nor changed motor excitability as tested by TMS.These findings suggests that a single levodopa dose is not sufficient to improve motor function in chronic stroke. However, it cannot be excluded that the lack of a beneficial effect is related to the small study sample.

The etiology of peripheral neuropathy (PN) often remains elusive resulting in a lack of objective therapeutic strategies. We conducted a pilot study to evaluate the therapeutic effect of acupuncture on PN as measured by changes in nerve conduction and assessment of subjective symptoms. One hundred and ninety-two consecutive patients with PN as diagnosed by nerve conduction studies (NCS) were evaluated over a period of 1 year. Of 47 patients who met the criteria for PN of undefined etiology, 21 patients received acupuncture therapy according to classical Chinese Medicine as defined by the Heidelberg Model, while 26 patients received the best medical care but no specific treatment for PN. Sixteen patients (76%) in the acupuncture group improved symptomatically and objectively as measured by NCS, while only four patients in the control group (15%) did so. Three patients in the acupuncture group (14%) showed no change and two patients an aggravation (10%), whereas in the control group seven showed no change (27%) and 15 an aggravation (58%). Importantly, subjective improvement was fully correlated with improvement in NCS in both groups. The data suggest that there is a positive effect of acupuncture on PN of undefined etiology as measured by objective parameters.

Fragestellung: Durch Vibration wird die intrakortikale Erregbarkeit fur den vibrierten Handmuskel im Sinne einer Disinhibition gesteigert, wahrend nicht-vibrierte Muskeln eine Zunahme der Intrakortikalen Inhibition aufweisen [1]. Wir untersuchten, ob die Silent Period (SP) als ein anderes Mas fur inhibitorische Neuronenkreise durch Vibration moduliert wird. Methodik: Transkranielle Magnetstimulation (TMS) mit einer fokalen Spule wurde bei 12 gesunden Probanden (mittl. Alter: 41J.) uber dem linken motorischen Kortex eingesetzt. Die Ableitung erfolgte entweder vom M. flexor carpi radialis (FCR) rechts (Exp. 1) oder vom M. extensor carpi radialis (ECR) rechts (Exp. 2). In Exp. 3 wurden TM-Einzelreize unter Muskelentspannung appliziert und vom FCR abgeleitet. In Exp. 4 wurde der N. medianus rechts zur Auslosung einer peripheren SP (pSP) supramaximal elektrisch stimuliert, die Ableitung erfolgte vom FCR. An der besten Spulenposition an der Kopfoberflache erfolgte die Bestimmung der motorischen Ruheschwelle (MRS) und der Schwelle fur die Auslosung der SP (SP-S). Zur Messung der SP aktivierten die Probanden den Zielmuskel mit ca. 20% ihrer Maximalkraft. Die Antworten in Exp. 1,2 und 4 wurden jeweils gleichgerichtet und gemittelt, in Exp. 3 wurden peak-to-peak Amplituden bestimmt. Die Vibration erfolgte durch 60Hz Stimulation am muskulotendinosen Ubergang des ECR. Ergebnisse: Die Schwellen und die Einzelreiz-MEP-Amplituden des FCR (Exp. 3) wurden durch Vibration nicht verandert. Die Dauer der durch TMS evozierten SP verlangerte sich im FCR signifikant (von 105±23 msec auf 126±28 msec). Die pSP (Exp. 4) veranderte sich nicht (vorher: 115±18 msec; unter Vibration: 116±18 msec). Die im ECR TMS-evozierte SP war unter Vibration nicht-signifikant verkurzt (von 140±26 msec auf 132±31 msec). Schlussfolgerung: Vibration eines Unterarm-Extensors fuhrt zu einer Verlangerung der SP im antagonistisch wirkenden Unterarm-Flexor ohne Veranderung der kortikospinalen Exzitabilitat.Da nur die TMS-evozierte SP, nicht aber die pSP verlangert wurde, spricht dieses fur einen Mechanismus oberhalb spinaler Neuronenkreise. Zukunftige Untersuchungen mussen zeigen, ob die in spastischen Muskeln typischerweise verkurzte SP [2] durch Vibration der Extensoren verlangert und somit ein antispastischer Effekt erzielt werden kann. [1] Rosenkranz K et al. J Physiol 2003; 551: 649–660 [2] Liepert J et al. Neurol, Psych and Brain Res 1995; 4: 1–6

In neurorehabilitation, transcranial magnetic stimulation (TMS) offers information regarding prognosis and pathophysiology and could also be useful for therapeutic purposes. Numerous studies have indicated that, after stroke, the absence of motor evoked potentials is associated with a poor motor recovery. In contrast, MEPs obtained in the paretic muscle with low stimulus intensities suggest a good restitution of motor function. TMS studies have shown that the location of a brain lesion determines motor cortex excitability changes: Patients with central somatosensory lesions show a disinhibition in the ipsilesional motor cortex. Lesions in the territory of the superior cerebellar artery are associated with a loss of motor cortex excitability. Stroke patients participating in a Constraint-induced movement therapy show an enlargement of the motor output area in the affected hemisphere after therapy. This enhancement of motor excitability is associated with an improvement of motor function. Some evidence is emerging that the application of low frequency repetitive TMS over the non-lesioned hemisphere improves neglect phenomena by down-regulation of the excitability of the non-lesioned hemisphere.

In neurorehabilitation, transcranial magnetic stimulation (TMS) offers information regarding prognosis and pathophysiology and could also be useful for therapeutic purposes. Numerous studies have indicated that, after stroke, the absence of motor evoked potentials is associated with a poor motor recovery. In contrast, MEPs obtained in the paretic muscle with low stimulus intensities suggest a good restitution of motor function. TMS studies have shown that the location of a brain lesion determines motor cortex excitability changes: Patients with central somatosensory lesions show a disinhibition in the ipsilesional motor cortex. Lesions in the territory of the superior cerebellar artery are associated with a loss of motor cortex excitability. Stroke patients participating in a Constraint-induced movement therapy show an enlargement of the motor output area in the affected hemisphere after therapy. This enhancement of motor excitability is associated with an improvement of motor function. Some evidence is emerging that the application of low frequency repetitive TMS over the non-lesioned hemisphere improves neglect phenomena by down-regulation of the excitability of the non-lesioned hemisphere.

A stroke may modulate motor cortex excitability. We examined if distinct ischemic brain lesions are associated with a specific pattern of excitability changes. We also investigated the effects of a rehabilitative therapy on motor excitability.In stroke patients, the consequences of a) a lesion in the central somatosensory system, b) a cerebellar lesion and c) a two week period of Constraint-induced movement therapy (CIMT), on motor cortex excitability were studied. Transcranial magnetic stimulation techniques and functional magnetic resonance imaging (fMRI) were employed.Patients with a lesion in the primary somatosensory cortex or in the ventroposterolateral nucleus of the thalamus had a decreased intracortical inhibition on the affected side. Patients with lesions in the territory of the superior cerebellar artery had a loss of intracortical facilitation and an increase of intracortical inhibition. Patients with cortical lesions undergoing CIMT had a loss of intracortical inhibition prior to therapy. After CIMT, changes of ICI were stronger in the lesioned than in the non-lesioned hemisphere but could result either in an increase of ICI or a reduction of ICI. In three patients fMRI results showed that cortical activation was less post CIMT as compared to pre-treatment activation. In parallel, ICI was reduced after treatment.Our results suggest that, physiologically, central somatosensory influence on the motor cortex is inhibitory. In contrast, the cerebellum normally exerts a facilitatory influence on the motor cortex. CIMT induces changes of intracortical excitability mainly in the affected hemisphere.

Background: Hereditary spastic paraparesis (HSP) denotes a group of inherited neurological disorders with progressive lower limb spasticity as their clinical hallmark; a large proportion of autosomal dominant HSP belongs to HSP type 4, which has been linked to the SPG4 locus on chromosome 2. A variety of mutations have been identified within the SPG4 gene product, spastin. Objective: Correlation of genotype and electrophysiological phenotype. Material: Two large families with HSP linked to the SPG4 locus with a very similar disease with respect to age of onset, progression, and severity of symptoms. Methods: Mutation analysis was performed by PCR from genomic DNA and cDNA, and direct sequencing. The motor system was evaluated using transcranial magnetic stimulation. Results: Patients differ in several categories depending on the type of mutation present. Conclusions: For the first time in hereditary spastic paraparesis, a phenotypic correlate of a given genetic change in the spastin gene has been shown.

Bei 7 Patientinnen mit chronischen Spannungskopfschmerzen fanden sich vor Beginn eines 6-wochigen Muskelrelaxationstrainings nach Jacobson signifikant werkurzte Phasen der spaten exterozeptiven Suppression der Temporalismuskelaktivitat (ES 2). Die ES 2 normalisierte sich im Verlauf, hatte sich 16 Wochen nach Abschlus des Trainings jedoch wieder verkurzt. Sie stellt bei Spannungskopfschmerzen einen state marker dar, ist durch ein Muskelrelaxationsverfahren modifizierbar und tragt zur Diagnostik und Therapieverlaufskontrolle bei Spannungskopfschmerzen bei.

The aim of our study was to measure the effects of the glutamate antagonist riluzole on different parameters of motor excitability, using transcranial magnetic stimulation (TMS) during 7 days of riluzole administration, and to correlate these effects with riluzole plasma levels. Nine healthy volunteers received a dose of 100 mg riluzole from day 1 to 7 of the study period. Electrophysiological examinations were performed on day 1 before and 2 h, 5 h and 8 h after riluzole administration, on day 2, day 3 and day 5 before riluzole administration, and on day 8. Plasma samples were taken simultaneously. The excitability of the motor cortex, supraspinal and spinal motor pathways was tested by studying intracortical facilitation and inhibition, the cortical silent period and motor threshold after TMS, as well as the peripheral silent period and F-wave amplitudes after electrical peripheral nerve stimulation. We found a significant reduction of intracortical facilitation, which correlated significantly with riluzole plasma levels. To a lesser extent, intracortical inhibition was enhanced on day 1, motor threshold was increased on day 8 and F-wave amplitudes were reduced. These changes did not correlate with riluzole plasma levels. We conclude that the main effect of riluzole in vivo is a reduction of intracortical facilitation, which is closely related to the drug's level in the plasma. The most probable mechanism involves an effect on glutamatergic synaptic transmission.

To study changes in motor cortex representations after a single session of physiotherapy in stroke patients.TMS mapping was used to evaluate the motor output map of the abductor pollicis brevis (APB) in both hemispheres. Stroke patients (4-8 weeks after the infarction) were studied prior to a training session aimed at improving dexterity and 1 h and 1 day after the training.Prior to the training, the APB representation area in the affected hemisphere was significantly smaller than on the non-affected side. After therapy, the cortical motor output to the paretic APB was significantly enlarged, and motor function was improved. One day later, these effects were partially reversed. Motor thresholds remained significantly increased in the affected hemisphere before and after the therapy.A single session of physiotherapy produces a use-dependent enlargement of motor cortex representations paralleled by an improvement of motor function in stroke patients.

Background and Purpose —Injury-induced cortical reorganization is a widely recognized phenomenon. In contrast, there is almost no information on treatment-induced plastic changes in the human brain. The aim of the present study was to evaluate reorganization in the motor cortex of stroke patients that was induced with an efficacious rehabilitation treatment. Methods —We used focal transcranial magnetic stimulation to map the cortical motor output area of a hand muscle on both sides in 13 stroke patients in the chronic stage of their illness before and after a 12-day-period of constraint-induced movement therapy. Results —Before treatment, the cortical representation area of the affected hand muscle was significantly smaller than the contralateral side. After treatment, the muscle output area size in the affected hemisphere was significantly enlarged, corresponding to a greatly improved motor performance of the paretic limb. Shifts of the center of the output map in the affected hemisphere suggested the recruitment of adjacent brain areas. In follow-up examinations up to 6 months after treatment, motor performance remained at a high level, whereas the cortical area sizes in the 2 hemispheres became almost identical, representing a return of the balance of excitability between the 2 hemispheres toward a normal condition. Conclusions —This is the first demonstration in humans of a long-term alteration in brain function associated with a therapy-induced improvement in the rehabilitation of movement after neurological injury.

In animals simple passive co-activation causes a fusion and expansion of the involved cortical representations. We used passive tactile finger co-activation for 40 min to investigate cortical representational changes in the human somatosensory cortex. Magnetic source imaging revealed that the euclidean distance between median and ulnar nerve somatosensory evoked fields (SEF) was significantly reduced after application of 600 synchronous airpuff stimuli to the fingertips of four fingers. In the control experiment without co-activation no significant change in distance was observed. Perception threshold and spatial two-point discrimination were not affected by the synchronous stimulation. This is in contrast to blind three-finger Braille readers who frequently mislocalize stimuli applied to the reading fingers. This points to a lack of behavioural relevance or the short duration of co-activation.