Neurological Disorders

Human consciousness has historically been an enigma tantalizingly engaged by philosophy. However, the topic of human consciousness was confronted by psychology in the later part of the 1800’s, most notably by William James [1]. In due course, a framework of consciousness based on the neural correlates of consciousness (NCC) was proposed by Francis Crick and Christof Koch in 2003 [2]. In this framework brain systems are active in tandem with the conscious experience.

This editorial has offered a commentary about the article, Limitations of Clinical Psychiatric Diagnostic Measurements by Aden Jacob, a research scientist working at the Gray Institute for Radiation Oncology and Radiobiology, Medical Physics Radiotherapy at the University of Oxford in the United Kingdom [1]. My first reaction to the article was, “Why would an oncologist write an article about the American Medical Association’s limitations in classification of psychiatric diagnoses? My curiosity led me to Google to search for answers. I found the author’s website. I did not seek this information to belittle or challenge the author’s credentials. I thought that other readers might be curious as well.

Although the hypothalamus is the master regulator, it is appropriate terming the pituitary gland as the conductor of endocrine orchestra of the human body. The existence of pituitary stem cells in the adult pituitary gland is supported by such findings as postnatal proliferation, differentiation based on environmental alterations, and development of hormoneproducing cells after specific lesions in the pituitary. Stem cell characteristics, including renewal, proliferation abilities, and the presence of stem cells markers, have been demonstrated in adult pituitary cells from mammals. Research into the capacity of “pituitary stem cells” to differentiate in vitro and in vivo will clarify the regulatory mechanisms of these cells. The characteristics of stem cells include self-renewal capacity, lack of specialization, and pluripotency with the ability to differentiate into different cell phenotypes. Adult pituitary cell lineages might have a pituitary stem cell role and the potential participation of these cells in pituitary tumorigenesis. Inevitably numerous questions remain to be resolved, and future challenges are enormous. Therefore, this review provides a comprehensive overview of the motivating recent developments in the pituitary stem cell exploration. The latest expansion in pituitary stem cell research may commence a stimulating period in the pituitary embryology and pathology

Objective: To test whether the Village incidence of new cases of Motor Neurone Disease (MND) over an 8-year period, is significantly different from those in the County to serve as a pilot study to identify possible interactive multienvironmental aetiology.

Design: Between September 2003-June 2011, Village MND cases were compared with the County’s in people aged >54 years. The incidence of MND was determined and Odds ratios calculated. The Village MND mortality rates were juxtaposed against England & Wales MND deaths over the period.

Setting: A rural Village flanked by Electro-Magnetic-Fields (EMF) close to an active airfield. The Village population has remained relatively stable, plane-take off from the airfield is at a low angle for 3-4 miles, with radar TACAN beams pulsed every 4 seconds.

Participants: General population (>54 yrs) in Village and County.

Main outcome measures: Cases and deaths of MND.

Results: Of the County’s 236 MND cases, 11came from the Village, equal to 1 MND case per 410 people, County rate was 1: 1,844, yielding an Odds ratio of 4.5:1. Village MND deaths compared to England & Wales gave an Odds ratio of 2.3: 1; England & Wales MND deaths were double the County’s.

Conclusion: The disproportionate incidence of Village MND, with its relatively intensive exposure to EMF and petrochemicals, leads us to a speculative hypothesis of possible multi-interactive environmental influences. Despite limitations inherent in cluster studies, these indicative results suggest that a more detailed national study of geographic, occupational, life-style and family background is merited and feasible.

Background: Chronic subdural hematoma (CSDH) is a common neurologic disease in elderly. It is not always a benign condition because high recurrence rate had been reported. Independent risk factors for CSDH recurrence, especially the surgical and post-operative factors, had not been sufficiently investigated.

Methods: We retrospectively collected and analyzed data for 125 CSDH patients treated by burr-hole craniostomy in a regional hospital in Taiwan.

Results: Of these CSDH patients, the mean age was 70.2 ± 13.2 years and 96 (76.8%) were males. The CSDH recurrence rate after burr-hole craniostomy was 8.8% in our hospital. The recurrence group had thicker hematoma (24 mm vs. 18.5mm, P=0.024) and more often had laminar type CSDH (27.3% vs. 6.1%, P=0.044) than the non-recurrence group. Multivariate analysis found that thicker hematoma (P=0.033; OR=1.121; 95% CI 1.01-1.25), laminar type CSDH (P=0.010; OR=13.461; 95% CI 1.87-97.14) and larger total post-operative drainage amount (P=0.021; OR=1.002; 95% CI 1.000−1.004) were independently associated with recurrence of CSDH after burr-hole craniostomy. We didn’t find an association between burr hole numbers and recurrence rate.

Conclusion: We found thicker hematoma,laminar type CSDH and larger post-operative drainage amounts independently predict recurrence of CSDH after burr-hole craniostomy. The patients with these risk factors may need closer surveillance post-operatively. Further studies are needed for surgical method modification to achieve lower recurrence rate.

Wegener’s granulomatosis (WG) is an immune-mediated systemic vasculitis of unknown etiology that can be seen in almost any system. It classically affects the upper and lower airways, lungs and kidneys. Despite its possibility of generalization, neurological involvement is hardly seen. When it occurs, WG tends to affect the peripheral nervous system, often as sensory-motor polyneuropathy or mononeuritis multiplex. Involvement of cranial nerves is much less frequent, and the most affected is the optic nerve. Involvement of the central nervous system is even rarer but there are reports including cerebrovascular events, seizures, cerebritis, diabetes insipidus and pachymeningitis. In 1990, four criteria have been identified for the clinical diagnosis of WG by the American College of Rheumatology, which are still in effect and include upper airways inflammation, pulmonary nodules and microhematuria. A patient who meets at least 2 of the criteria may be diagnosed as having classical WG with a sensitivity of 88% and a specificity of 92%. Usually there is positivity for antineutrophil cytoplasmatic antigene (ANCA) but its absence does not exclude this diagnosis, especially when the clinical picture is highly suggestive. We present a case of palsy of the lower cranial nerves as the initial presentation of a seronegative WG.

Lumbar drains (LD) for cerebrospinal fluid (CSF) diversion are commonly used in pituitary surgery. CSF perioperative diversion can be utilized as a prophylactic measure and/or as a first line treatment for CSF rhinorrhea following transsphenoidal pituitary surgery. In theory, lumbar drainage can prevent and/or treat CSF leaks and may preclude reexploration surgery. We performed a literature review to study the value of LDs in decreasing the postoperative CSF leak rates in transsphenoidal surgery and the reported perioperative complications in relation to perioperative LD insertion. We included studies with more than 100 patients, in the period from 2000 to 2012. The overall incidence of postoperative CSF rhinorrhea was 1.7%. Out of 6,401 patients, 385 patients (6%) received LD to prevent postoperative CSF leak or as a therapeutic intervention. Complications with the use of LDs are not common; however, LDs can increase the length of hospitalization. The most common reported complications are headaches and patient discomfort. Major potential morbidities include additional surgery, meningitis, and tension pneumocephalus. Postoperative meningitis rate increases from 0.3% to 3% in cases with LD perioperative usage. The current literature does not provide conclusive evidence that lumbar drainage during pituitary surgery decreases postoperative CSF leaks; however, its use during pituitary surgery is safe and can beneficial in selected cases.

Epilepsy in mitochondrial disorders (MIDs, mitochondrial epilepsy) is an increasingly recognised topic, due to the increasing prevalence of mitochondrial disorders also in adult patients. Aim of the study was to describe mitochondrial epilepsy as a dominant or collateral feature of the phenotype in syndromic and non-syndromic MIDs. Syndromic MIDs obligatory associated with epilepsy include MELAS-syndrome, MERRF-syndrome, Leigh-syndrome, myoclonic epilepsy, myopathy and sensory ataxia (MEMSA)-syndrome, also known as spino-cerebellar ataxia with epilepsy (SCAE), ANS, and Alpers-Huttenlocher-disease. Occasionally, mitochondrial epilepsy occurs in LHON, NARP, MILS, MIDD, CPEO, KSS, IOSCA, or LBSL. All types of seizures occur in mitochondrial epilepsy but in adult patients most frequently generalized tonic-clonic seizures, partial seizures, myoclonic seizures, or epilepsia partialis continua occur. Treatment of mitochondrial epilepsy is not at variance from epilepsy due to other causes but mitochondrion-toxic antiepileptic drugs, such as valproic acid, carbamazepine, phenytoin, phenobarbital, and oxcarbazepine should be avoided. Generally well tolerated antiepileptic drugs in mitochondrial epilepsy include lamotrigine, levetirazetam, and lacosamide.

Study objective: Sleep disturbances are one of the most common non-motor symptoms of Parkinson´s disease that influence on the quality of life. Our aim was to investigate the incidence of sleep disturbances in patients with idiopathic Parkinson Disease and to evaluate what type of sleep disturbance influence most on the quality of the sleep in these patients.

Methods: One hundred and four Parkinson Disease patients treated in the University Hospital Centre Osijek and General Hospital Nasice were analysed. The patients were assessed with regards to whether or not they were experiencing sleep disturbances and were divided accordingly into two groups: those that did not have sleep disturbances and those that experienced sleep disturbances. All of the patients completed Parkinson Disease Sleep Scale.

Results: Sleep disturbance was reported in 58% patients, while 42% did not report to have sleep disturbance. Sleep disturbances group recorded lower mean result in Parkinson Disease Sleep Scale as well as lower mean results for each sub-scale for all symptoms except incontinence due to immobility compared to group with no sleep disturbances. We found statistically significant difference between two groups of patients on these items: quality of sleep (t=-3.046; p<0.005), maintenance of sleep (t=-2.869; p<0.005), distressing dreams (t=-2.947; p<0.005) and fatigue (t=-2.494; p<0.01). Regresion logistic analysis predict sleep disturbances significantly (omnibus chi-square=41,387, df=17, p<.001) with quality of sleep, distressing dreams and painful posturing as most predictive variable for sleep disturbances in SD group.

Conclusion: Nocturnal awakening, distressing dreams and fatigue influence most on the quality of sleep in patients with Parkinson´s disease. Variables that proved to be most significant predictors for sleep disturbance of PDSS are quality of sleep, distressing dreams and painful posturing