Gunther Deuschl

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..A computationally simple and intuitively appealing technique based on this observation is presented...

..ENT and CBG reduced the patient's motor complications effectively and to a similar degree. The clinical benefit was more quickly apparent with ENT, which also showed a more favorable AE profile than CBG...

..Unlike the case of Parkinson's disease, functional neurosurgery of nonparkinsonian tremors is not yet based on a solid pathophysiological background...

..However, prospective studies for this procedure are lacking and some clinical problems may be more easily solved with targeting the internal pallidum or the thalamus. Despite major progress in this field, much work remains to be done...

..Further studies should specifically address the questions of efficacy and side effects as well as the impact on quality of life...

..The pathophysiology is unknown. Reciprocal inhibition and other inhibitory reflex pathways at various levels seem to be reduced at least in some cases with dystonic tremors...

..Better drugs are needed, and controlled trials are required to determine the safety and efficacy of DBS in the nucleus ventrointermedius and neighbouring subthalamic structures...

..Further promising interventions for invasive therapy of Parkinson's disease are transplantation of foetal cells and stem cells, gene therapy and the use of duo-dopa and apomorhine...

..Lacking such a standard, we propose a subclassification of ET into three categories: hereditary ET, sporadic ET, and senile ET, which we believe will help researchers resolve many of the controversies in this field...

..The report has been endorsed by the Scientific Issues Committee of the Movement Disorder Society and the American Society of Stereotactic and Functional Neurosurgery...

..Neurostimulation of the subthalamic nucleus reduces levodopa-related motor complications in advanced Parkinson's disease. We compared this treatment plus medication with medical management...

..Gabapentine has been assessed for efficacy in some tremors, and deep brain stimulation of the ventrolateral thalamus has been shown to be safer and more effective for severe essential and parkinsonian tremor than thalamotomy...

..Assuming the oscillator within the basal ganglia pathway, the mechanism of stereotactic surgery might be a desynchronization of the activity of the basal ganglia-thalamo-cortical or the cerebello-thalamo-cortical pathway...

..Modern neurology needs to develop and test such hypotheses, because this is the only way to develop rational medical and surgical therapies...

..ET(IT) patients have abnormalities of their upper limb function compatible with cerebellar disease. This suggests that patients with more advanced ET show abnormalities of cerebellar functions...

..Several differential diagnoses like rest tremor in ET, dystonic tremor, psychogenic tremor and Holmes' tremor may be misinterpreted as PD-tremor. Tests and clinical clues to separate them are presented...

..The present study was undertaken to collect data on the age dependent development of this index and on possible abnormalities in Parkinson's disease and dystonia...

..The patient needs to be well informed about his individual risk-benefit ratio and of alternative treatments, before undergoing stereotactic surgery...

..We conclude that cortical networks are involved in the generation of physiologic tremor...

..Improvement in QoL after STN-DBS is also correlated with changes in motor functions and changes in depression and anxiety...

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..These results demonstrate a single dissociation of depressive symptoms and anhedonia in response to an acute L-dopa and STN-stimulation challenge...

..Precise targeting of the lateral region of the STN is essential for achieving sufficient stimulation efficacy. Preoperative T2-weighted MRI might be a useful component of the targeting procedure to improve the outcome of PD patients...

..The improvement of PD motor symptoms by DBS of the STN depends on exact targeting...

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..To assess the neuropsychiatric consequences of DBS in patients with PD we did an ancillary protocol as part of a randomised study that compared DBS with the best medical treatment...

..We conclude that the cortical correlates of physiological tremor may be involved in linking different cortical motor centers and might therefore play a role in cortical motor planning...

..This bi-directional structural plasticity is functionally relevant as local grey matter changes are mirrored by changes in regional excitability...

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..These results provide evidence for a homeostatic response pattern in the human M1(HAND) that integrates acute plastic changes evoked through different "input channels."..

..The better efficacy of stimulation within the STA compared to thalamus proper favours the concept of a modulation of cerebello-thalamic projections underlying the improvement of these symptoms...

..7 +/- 2.6 (P < 0.001) whereas levodopa had no impact (R(2) reduction 3.7 +/- 1.6, P = 0.081). This demonstrates that STN-DBS, by reducing motor perseveration, influences higher order aspects of motor behavior of patients with PD...

..This finding questions the general role of the striatum in feedback-based learning and demonstrates that healthy aging particularly affects feedback-based learning...

..It has been hypothesized that the basic and first harmonic frequency of Parkinsonian tremor are somewhat independent oscillations the biological basis of which remains unclear...

..A similar cortical contribution may be important also for gait control in humans...

..Our study gives further evidence that LINGO1 acts as a susceptibility gene for ET...

..SNPs in the LINGO1 gene associated with ET could not be shown to be associated with PD in our study population, despite a postulated overlap between both diseases...

..We investigated whether essential tremor (ET) can be altered by suppressing the corticospinal excitability in the primary motor cortex (M1) with transcranial magnetic stimulation...

..Since less pharmacotherapy is needed after STN stimulation, reduced levodopa intake results in relative improvement of autonomic function in deep brain stimulated PD patients...

..Recent studies revealed a functional network consisting of occipital, parietal, and precentral areas that might be implicated in PPR. Herein, we investigate the microstructural changes associated with PPR...

..We conclude that re-training does not need to specifically focus on the task affected by dystonia to be clinically effective...

..This identifies poor leg coordination as a risk factor for causing freezing of gait...

..The time-locked responses and increased firing regularity may override abnormally patterned pallidal activity, and thereby significantly contribute to the clinical efficacy of STN-HFS in PD...

..The site of permanent stimulation is the subject of ongoing debate, as stimulation both within and adjacent to the subthalamic nucleus may be effective...

..One reason is the substantial fluctuation of tremor severity over time, which is difficult to capture and may render momentary clinical assessments unreliable...

..We therefore suggest that each assessment of Parkinsonian rest tremor should include a systematic provocation and this should be formally included in future versions of the UPDRS...

..To evaluate the usefulness of a new instrument for bedside testing of proximal arm and distal finger tapping performance in patients with Parkinson's disease (PD)...

..Despite high heritability, the genetic determinants of ET are largely unknown. We performed the second genome-wide association study (GWAS) for ET to elucidate genetic risk factors of ET...

..These findings, based on two case reports, highlight the pivotal role of the GPi in mediating dyskinesia-related neural activity within the basal ganglia loop...

..The cause of camptocormia in idiopathic PD is a focal myopathy. Our findings suggest that the myopathy has a progressive course, which finally leads to degeneration of the paravertebral muscles...

..In summary, the results of this study suggest that substantial adaptive changes within the central nervous system may contribute to motor symptoms in CRPS...

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..The TGA can be considered a model for a focal transient perturbation of memory circuits in the temporo-mesial region...

..We propose that the impairment of the odor threshold with DBS is related to effects on an olfacto-motor loop, while disturbed odor discrimination may be related to effects of DBS on short-term memory...

..Whereas PMBS seems to reset the supraspinal sensorimotor network, cortico-muscular coherence may represent the recalibration of cortico-motoneuronal and spinal systems...

..Here we describe the controlled measurements of tremor severity after alcohol ingestion and the practicability of using it as a home test...

..Clinical distinction between advanced essential tremor and tremulous Parkinson's disease can be difficult...

..And this may be the basis for the selective effect of deep brain stimulation on tremor...

..Furthermore, this is the first imaging study, which shows an effect of STN-DBS on sensory gating in PD patients and its neural basis...

..We present an easy to use and reliable screening instrument that is effective to identify patients with ET but not able to exclude patients with other tremor forms...

..01). STN-HFS restores the normal facilitatory drive of a transcranially evoked motor cortical response to the spinal motoneuron pool. In addition to subcortical routes, STN-DBS also alters spinal excitability via transcortical pathways...

..Quality of life in Parkinson patients with subthreshold depression could be improved if the prevalence and symptom profile were better understood...

..Thus the tremor rhythm is intermittently relayed only in different cortical motor areas. We hypothesize that tremor oscillations build up in different subcortical and subcortico-cortical circuits only temporarily entraining each other...

..These changes might be related to cerebellar disease but they are independent of the intention tremor component and saccade performance...

..This argues for different mechanisms that underlie the changes in task-switching behavior in healthy aging and PD...

..In addition, they emphasize abnormalities in the patterning and dynamics of neuronal discharges in the parkinsonian STN, which support current concepts of abnormal motor loop oscillations in Parkinson's disease...

..In two patients with freezing during the "on" period, subthalamic nucleus stimulation failed to reduce this symptom effectively...

..The goal of this study was to determine the relation and size of these artefacts to the electrodes by comparing the position of the electrodes in postoperative MR and CT imaging...

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..No correlation between rCBF and qT2' has been performed to date. In this study a correlation between rCBF and qT2' was performed in a temporary middle cerebral occlusion-reperfusion model of the rat...

..These results demonstrate a functional independence of implicit cognitive skill learning and certain aspects of executive functions...

..There are currently no established guidelines regarding their management...

..The clinical relevance of these differences remains unknown. We therefore compared the neuropsychological consequences of CAS and CEA and additionally measured the S100beta protein, a marker of cerebral damage...

..We did not find a significant association of the DRD3 variant with ET nor linkage to the DRD3 receptor in German, Danish and French ET patients and families, suggesting that it is unlikely to be a causal factor for ET...

..It does not show a clear levodopa response but affects dextrous movement coordination when associated with clinically severe overall akinesia...

..The second part reviews experiments with microglia cell cultures to elucidate underlying signalling pathways and summarizes recent advances of our knowledge in microglial molecular pathways that may ultimately lead to neurodegeneration...

..Future studies will prospectively compare the clinical effects of STN and pallidal DBS. Alternative targets for treatment of PD have to be considered including the pedunculopontine nucleus, thalamic CM/Pf complex and zona incerta...

..The ventro-lateral thalamus is the stereotactic target of choice for severe intention tremor. Nevertheless, the optimal target area has remained controversial, and targeting of the subthalamic area has been suggested to be superior...

..Recently, deep brain stimulation of the posterior hypothalamus has been shown to be effective in the treatment of drug-resistant chronic cluster headache...

..The patients presented initially with either parkinsonian or cerebellar signs, and developed severe autonomic failure and typical atrophy of the brain stem and cerebellum in the course of the disease...

..Future studies need to address which combination of clinical scores and kinematic measures are most appropriate to quantify impairment in writer's cramp...

..This prospective, 48 week, randomized, double-blind, multinational study failed to show a clinical effect of minocycline on symptom severity as assessed by clinical motor function...

..Even small infarcts of this strategic area can disrupt many of the projections from the motor cortices and could thereby limit recovery strategies between homolateral motor representations...

..This emphasizes a role of the sensorimotor part of the internal globus pallidus in regulating speech fluency...

..These results highlight the distinct and critical role of human hippocampal CA1 neurons in autobiographical memory retrieval and for re-experiencing detailed episodic memories...

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..Because of the close structural homology between Lp(a) and plasminogen, we also studied the role of plasminogen in different stroke subtypes and whether there is a dependency on Lp(a) plasma levels...

..Although hemispherectomy had been avoided due to slow progression of RE, she had not been seizure-free for more than 7 weeks since diagnosis...

..We hypothesize that in acute middle cerebral artery stroke, thrombus lengths measured in thin-slice nonenhanced CT images define a limit beyond which systemic thrombolysis will fail to recanalize occluded arteries...

..In this Review, we discuss clinical aspects, new imaging findings, and recent clinical-epidemiological data with regard to the phenotype, functional anatomy, and putative cellular mechanisms of TGA...

..In cases of suspected carcinomatous meningitis the clustering of increased CSF protein, lactate, decreased glucose, and a high opening pressure is suggestive of the diagnosis...

..The antagonization of microglial activation by a pharmacological intervention targeting microglial NF-kappaB or p38 MAPK could point to additional venues in the treatment of PD...

..The most effective site for subthalamic nucleus (STN) stimulation has remained unclear. The position of active contacts relative to the dorsal margin of the STN was determined...

..Compounds that inhibit the MAPK/NF-kappaB pathways might be a promising pharmacological strategy for the treatment of the inflammatory component of synucleinopathies including PD...

..Deep brain stimulation has a lower morbidity and is preferred for bilateral surgery. The subthalamic nucleus presently seems to be the most promising target in advanced stage Parkinson's disease...

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..The size of the lesions and the duration of the TGA correlated with the deficit in the performance...