Restorative Neurology and Neuroscience - Volume 14, issue 2-3

Authors: Neugebauer, Edmund | Lefering, Rolf | Noth, Johannes

Article Type: Other

Abstract: Traumatic brain and spinal cord injuries are severe burdens for the patients, their relatives, the health care providers and society as a whole. Recent data demonstrate the magnitude of the problem: It is mostly a disease of the young gen-eration (age 2045years) with mortality rates for severe traumatic brain injury (TBI) between 4050%. In approximately 60% of cases, multiple trauma is accompanied by head injury. The outcome of TBI is determined not only by the extent …and severity of the primary insult, but also by the degree of secondary brain damage. In the subgroup of severe TBI (GCS≤8) only 25%t of patients showed a complete recovery or had minor neurological deficits; 15% resulted in a lifelong disability or even in a permanent vegetative state. Economically, the impact of TBI is enormous estimates of the costs of TBI in the U.S. range from 415 billion dollars per year. Valid data for Germany are not yet available. Show more

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 83-84, 1999

Authors: Bouillon, Bertil | Raum, Markus | Fach, Hagen | Buchheister, Bettina | Lefering, Rolf | Menzel, Jürgen | Klug, Norfried

Article Type: Research Article

Abstract: Epidemiological data on the incidence, the prehospital and hospital care and the outcome of traumatic brain injury in Germany are scarce. It is therefore difficult to estimate the importance of this injury with respect to magnitude as well as effectiveness and efficiency of therapeutic concepts. We therefore planned a study that was supposed to provide population based epidemiological data in the field of severe brain trauma from the site of the accident until discharge from hospital. …All 90.000 prehospital emergencies that were cared for by emergency physicians in Cologne from January 1990 until December 1996 were screened for identification of severe brain trauma. Their clinical course was reviewed using standard records and patients were included if they had their accident within the city of Cologne and fullfilled the final inclusion criteria of GCS ≤ 8 or AISHead ≥3. 650 eligible patients were identified of whom 530 had complete datasets (follow-up 80 %). Univariate statistical analysis was performed for all relevant variables. The main study endpoints were incidence and outcome of severe brain trauma. The annual incidence of severe brain trauma in Cologne (1 mio. inhabitants) was 93. The average age was 39 years and 71 % of the patients were male. The average prehospital GCS was 6.8, the average prehospital Trauma Score was 8.3 points. 49 % of the study population suffered from multiple injuries. The overall mortality rate was 46,6 %. 60 % of deaths occurred within the prehospital setting. The incidence of severe brain trauma in Cologne in this study was significantly lower compared to what could be expected from the litera-ture. The overall mortality was high, especially the high prehospital death rate is striking. Show more

Keywords: brain trauma, head injury, incidence, epidemiology, outcome

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 85-92, 1999

Authors: Berger, Eva | Leven, Friederike | Pirente, Nicola | Bouillon, Bertil | Neugebauer, Edmund

Article Type: Research Article

Abstract: In modern industrial countries traumatic brain injury (TBI) is a common sequel after different kinds of accidents especially amongst young male adults. Apart from medical and economic consequences Quality of Life (QoL) after TBI becomes increasingly important in outcome assessment. Besides the classical domains of QoL (physical, psychological, social) cognitive impairments are playing an important role especially for TBI patients. In 1991 the Meran conference set important standards and formulated basic guidelines …for defining and measuring QoL in surgery, but a special index for TBI patients has not yet been developed. Instead, QoL research concentrates on physical, medical, psychological and social problems only. Based on the existing QoL concept extended by the cognitive aspect it was the aim of this review to give an overview about the recent QoL research in TBI patients since 1991. Sixteen studies in TBI patients mentioning at least 2 domains of QoL (physical, psychological, social, cognitive) were published since 1991. Five of them considered all 4 domains of QoL. All studies except of one dealt with psychological and social problems. Only half of the studies considered cognitive impairments. Four studies tried to define QoL, but none of them included the cognitive component. There was no consensus regarding the definition and the choice of measurement instrument for QoL after TBI. This review of 16 studies considering outcome and QoL after TBI confirms that a homogenous and clinically relevant QoL concept for this group of patients is still missing. Further research in TBI patients should include all 4 domains of QoL. Show more

Keywords: Brain injuries, quality of life, head injury

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 93-102, 1999

Authors: Hermann, Dirk Matthias | Mies, Günter | Hossmann, Konstantin-Alexander

Article Type: Research Article

Abstract: The effects of spreading depression-like DC depolarizations on biochemical changes and gene expression were examined following trau-matic neocortical lesions, as induced by transcranial cold injury. The surrounding of traumatic cold lesions was characterized by increased glu-cose and lactate contents, without major disturbances of protein synthesis or energy state. A transient pH decrease by 0.4 units was noticed 1 h post-injury, which shifted towards alkaline values by 3 h. These changes were similar in animals with …spontaneous spreading depression-like DC shifts (n = 14) and those without spreading depressions (n = 7), but there was a marked difference in the gene response. In injured animals without SD, only a short-lasting response of c-fos, junB, c-jun and MKP-1 mRNAs as well as c-Fos protein was bilaterally found in the piri-form cortex, and - with ipsilateral dominance - the dentate gyrus and hippocampal CA3/4 fields at 1 h after lesioning. In injure d animals with spreading depressions, on the contrary, a strong elevation was seen in layers II-IV and VI of the injury-remote ipsilateral cerebral cortex, which persisted over as long as 6 h. The expression of c-fos, junB and MKP-1 mRNAs was closely related to the time interval between the last spreading depression and the end of the experiments. Levels were highest shortly after transient DC shifts, and decreased thereafter mono-exponentially with half-lives of 48, 75 and 58 min for c-fos, junB and MKP-1 mRNAs, respectively. Thus, spreading depression is a prominent factor influencing the trauma-related gene response, but - in contrast to focal ischemia - it does not aggravate the metabolic dysfunction. Show more

Keywords: Neocortical trauma, Cerebral metabolism, Tissue acidosis, Immediate-early gene, Transient DC depolarization

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 103-108, 1999

Authors: Herrmann, Manfred | Curio, Noreen | Jost, Stefan | Wunderlich, Michael T. | Synowitz, Hans | Wallesch, Claus-W.

Article Type: Research Article

Abstract: The present study aimed at the predictive value of early release patterns of protein S-100B and neuron specific enolase (NSE) in patients with traumatic brain injury. We investigated 69 patients who were admitted to the Department of Neurosurgery following traumatic brain injury. Both NSE and S-100B serum concentrations during the first three days after admission were highly and significantly correlated with Glasgow Coma and Coma Remission Scale scores at the respective blood sampling times as well …as 2 weeks later. Signs of intracranial pathology as evaluated by CCT or MRI scans showed no association with NSE or S-100B release patterns. Our data support the hypothesis that NSE and protein S-100B are useful and sensitive neurobiochemical markers for the early clinical outcome of traumatic brain injury. Show more

Keywords: NSE, protein S-100B, traumatic brain injury, outcome

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 109-114, 1999

Authors: Callsen-Cencic, Peter | Mense, Siegfried

Article Type: Research Article

Abstract: The urine storage ability of the urinary bladder is markedly impaired following inflammation of the urinary bladder and spinal cord injury because of a hyperexcitability of micturition reflexes. Using two rat models of inflammation-induced bladder overactivity and detrusor hyper-reflexia following spinal cord injury we investigated changes in the neuronal pathways to the urinary bladder which may underlie the development of this instability. Our results suggest that among the factors involved in inflammation-induced bladder …instability are significant changes in the expression of the neuropeptides substance P, calcitonin gene-related peptide and galanin at the primary afferent level, as well as of the enzyme neuronal nitric oxide synthase (nNOS) at the afferent and postganglionic efferent level. In the lumbar and sacral spinal cord nNOS-immunoreactivity was depleted from dorsal horn neurones in both cystitis and spinal cord injured rats and from preganglionic parasympathetic neurones after spinal cord injury. Distension of the bladder in chronically spinalized rats elicited c-Fos expression in a significantly greater number of neurones throughout the lumbar and sacral segments than in rats with an intact neuraxis. Thus, under pathological conditions rather complicated changes in the synthesis of neuropeptides and nNOS occur at the primary afferent, spinal cord and postganglionic efferent level that together control the activity of the urinary bladder. Further mechanisms like unmasking of silent synapses and axonal sprouting in the spinal cord might further contribute to an increase in activity in micturition reflex pathways. Local cooling of the dorsal spinal cord at the level L6/S1 with temperatures between 14 and 20 °C proved a simple technique to control the unstable bladder and restore continence in both inflammation-induced detrusor overactivity and detrusor hyperreflexia following spinal cord injury. The effects of cooling are probably the result of a blockade of synaptic transmission within the dorsal cord which eliminates neuronal overactivity. Thus, local spinal cord cooling could offer a new method to treat bladder instability and reflex incontinence. Show more

Keywords: Urinary bladder, detrusor overactivity, incontinence, neuropeptides, nitric oxide, spinal cord cooling

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 115-126, 1999

Authors: Kreutz, Michael R. | Seidenbecher, Constanze I. | Sabel, Bernhard A.

Article Type: Research Article

Abstract: In the past few years we established the partial crush of the optic nerve as an in vivo model system for the study of signaling pathways involved in molecular plasticity after axonal injury. The simplicity of this model at the cellular level allows decisive questions to be anwsered whilst functional aspects of visual information processing can be studied in parallel. A major advantage of a partial optic nerve crush model is the opportunity to directly compare …different cell populations: (i) the rapidly degenerating retinal ganglion cells (RGC), (ii) the axotomized RGC population that eventually dies over the period of the next few weeks, (iii) the axotomized RGC population surviving for a long time in the retina without an axon and (iv) the surviving RGC population that maintains axonal connections to their brain targets. Thus, differential aspects of post-lesion plasticity can be analyzed. Using this axonal injury model we investigated the expression of immediate early genes, glutamate receptors, and other differentially expressed genes that we identified with a combined subtractive hybridization and suppression polymerase chain reaction (PCR) screen. Moreover, we characterized time course of cell death, the astroglia response of the retina and optic nerve as well as the topography of anterograde and retrograde axonal transport. Show more

Keywords: axonal lesions, cell death, glutamate receptors, signaling pathways, gene transcription, c-jun, adhesion kinases

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 127-134, 1999

Authors: Benz, Barbara | Ritz, Annegret | Kiesow, Susanne

Article Type: Research Article

Abstract: Cerebral plasticity of the immature brain is often inferred to lead to less serious consequences of early traumatic brain injury (TBI) in the pediatric age group. This notion is seriously challenged by recent research findings. Data from prospective studies point to some children's dif-ficulties in ongoing skill-acquisition and the possibility of late-emerging deficits. Accordingly, preliminary group data of an own ongoing study support the notion of an increased risk for pervasive neuropsychological impairment in …subjects with severe TBI and early age at trauma. The pattern of neuropsychological deficits may depend on the developmental level at the time of injury, although effects of hemispheric site of lesion were also found to persist in individual cases. Theoretical considerations and empirical findings stress the importance of a longitudinal developmental perspective for the evaluation of long-term outcome after pediatric TBI. ("Verbund Neurotrauma Kiel / Project 4: Evaluation of neurological rehabilitation and course of cognitive development in children and adoles-cents with secondarily acquired brain damage", funded through the Research Program "Gesundheit 2000" of the German government, FKZ 01 KO 9512.) Show more

Keywords: pediatric TBI, age at injury, follow-up, post-traumatic development, long-term outcome

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 135-141, 1999

Authors: Jöhnk, Kerstin | Kuhtz-Buschbeck, Johann P. | Stolze, Henning | Serocki, Götz | Kalwa, Sabine | Ritz, Annegret | Benz, Barbara | Illert, Michael

Article Type: Research Article

Abstract: 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; 712;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. Show more

Keywords: traumatic brain injury, sensorimotor functions, functional restitution, children

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 143-152, 1999

Authors: Melchers, Peter | Maluck, Andreas | Suhr, Lydia | Scholten, Stefan | Lehmkuhl, Gerd

Article Type: Research Article

Abstract: Survived traumatic brain injuries (TBI) are one of the most serious challenges to the patient's future life. Recent literature increasingly questions the long believed protective effects of functional cerebral plasticity in children. Although TBI in children and adolescents is frequent, they are less frequently admitted to rehabilitation centers as in-patients than adults. This emphasizes the role of out-patient treatment. The progressing study described here aims to achieve a contribution to a comprehensive approach …in TBI-rehabilitation for youngsters. A two-stage multimethodal program, starting with stimulation in coma while the patient is on the intensive care unit, and neuropsychological therapy after regaining consciousness is to be evaluated in a controlled, prospective and randomized study. After including nearly 50 % of the planned sample (100 persons), some preliminary results can be mentioned with all applicable caution. The effectiveness of the applied therapy can be stated here with respect to the posttraumatic development of intellectual abilities in the 6- and 12 months follow ups. Moreover, in the control group development of psychopathological alterations was found to a considerable degree and also lower ratings in a quality of life questionnaire, compared to the experimental group. It is expected to prove these differences statistically, after the total sample has been included, and thus equal distributions have been achieved in all predictive variables. Show more

Keywords: Traumatic brain injury, neurotrauma-children, rehabilitation, neuropsychology, neurotrauma-psychotherapy

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 153-160, 1999

Authors: Platz, Thomas | Hesse, S. | Mauritz, K.-H.

Article Type: Research Article

Abstract: A long-term goal in motor rehabilitation is that treatment is not selected on the basis of 'schools of thought', but rather, based on knowledge about efficacy and effectiveness of specific interventions for specific situations (e.g. functional syndromes). Motor dysfunction after stroke or TBI can be caused by many different functional syndromes such as paresis, ataxia, deafferentaion, visuo-perceptual deficits, or apraxia. Examples are provided showing that theory-based analysis of motor behavior makes it possible …to describe 'syndrome-specific motor deficits'. Its potential implications for motor rehabilitation are that our understanding of altered motor behavior as well as specific therapeutic approaches might be promoted. A methodological prerequisite for clinical trials in rehabilitation is knowledge about test properties of assessment tools in follow-up situations such as test-retest reliability and responsiveness to change. Test-retest reliability assesses whether a test can produce stable measures with test repetition, while sensitivity to change reflects whether a test detects changes that occur over time. Exemplifying these considerations, a reliability and validity study of a kinematic arm movement analysis is summarized. In terms of new therapeutic developments, two examples of clinical therapeutic studies are provided assessing the efficacy of specific inter-ventions for specific situations in arm and gait rehabilitation: the Arm Ability Training for high functioning hemiparetic stroke and TBI patients, and the treadmill training for non-ambulatory hemiparetic patients. In addition, a new technical development, a machine-controlled gait trainer ist introduced. Show more

Keywords: TBJ, stroke, movement, arm, gait, therapy, assessment

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 161-166, 1999

Authors: von Steinbüchel, Nicole | Wittmann, Marc | Szelag, Elzbieta

Article Type: Research Article

Abstract: Neuropsychological research on temporal constraints of perception and motor performance can add important information to research on human behavior. Without considering temporal mechanisms of perceiving, generating, and updating information, brain mechanisms can never be fully understood. In this study temporal aspects of performance in psychophysical experiments on three different temporal levels (around 30 ms, 300 ms, and 3000 ms) were investigated in patients with acquired brain lesions and a control group without …neurological deficits. The patients had acquired focal brain lesions in: anterior (pre-central) regions of the left hemisphere (with non-fluent aphasia), posterior (post-central) regions of the left hemisphere (with fluent aphasia), the left hemipshere in predominantly subcortical regions (without aphasia), or anterior (pre-central) or posterior (post-central) regions of the right hemipshere. Perception of temporal order (20 to 60 ms) was impaired in patients with left-hemispheric post-central lesions; repetitive voluntary action (300 to 500 ms) was affected mostly in patients with left hemi-spheric lesions, both pre-central and post-central; and a deficit in integrating (2000 ms to 3000 ms) information was most pronounced in patients with left and right pre-central lesions. These findings provide insight into the associations between different levels of temporal organisation and circumscribed regions of the neocortex. Show more

Keywords: Temporal processing, temporal-order threshold, personal-tapping tempo, maximum-tapping tempo, ambiguous Figures, metronome, brain lesion, cortex,

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 167-182, 1999

Authors: Lotze, Martin | Laubis-Herrmann, U. | Topka, Helge | Erb, M. | Grodd, Wolfgang

Article Type: Research Article

Abstract: Activation maps in the primary motor cortex (M1) were investigated in three patients with complete spinal cord injury (SCI) at level TH3, TH7 and TH9 and in one patient with an incomplete spinal cord injury at level L1 during right elbow (4 patients), right thumb (4 patients), bilateral lip (2 patients) and right foot (3 patients during imagined, 1 patient during executed) movements using functional Magnetic Resonance Imaging (fMRI). Compared to controls fMRI activation maps of …patients with complete paraplegia showed a cranial displacement of the activation maxima in the contralateral primary motor cortex during elbow movement of 13.3mm, whereas the maxima of thumb and lip movements were not altered. The patient with an incomplete spinal cord injury revealed no displacement of elbow activation maxima. The reorganization is likely to occur on the cortical and not on the spinal level. Show more

Keywords: Spinal cord injury, cortical plasticity, reorganization, functional Magnetic Resonance Imaging (fMRI), primary motor cortex

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 183-187, 1999

Authors: Grünewald, Volker | Höfner, Klaus | Thon, Walter F. | Kuczyk, Markus A. | Jonas, Udo

Article Type: Research Article

Abstract: Temporary electrical stimulation using anal or vaginal electrodes and an external pulse generator has been a treatment modality for urinary urge incontinence for nearly three decades. In 1981 Tanagho and Schmidt introduced chronic electrical stimulation of the sacral spinal nerves using a permanently implanted sacral foramen electrode and a battery powered pulse generator for treatment of different kinds of lower urinary tract dysfunction, refractory to conservative treatment. At our department chronic unilateral electrical …stimulation of the S3 sacral spinal nerve has been used for treatment of vesi-courethral dysfunction in 43 patients with a mean postoperative follow up of 43,6 months. Lasting symptomatic improvement by more than 50 % could be achieved in 13 of 18 patients with motor urge incontinence (72,2 %) and in 18 of the 21 patients with urinary retention (85,7 %). Implants offer a sustained therapeutic effect to treatment responders, which is not achieved by temporary neuromodulation. Chronic neuromodulation should be predominantly considered in patients with urinary retention. Furthermore in patients with motor urge incontinence, refusing temporary techniques or in those requiring too much effort to achieve a sustained clinical effect. Despite high initial costs chronic sacral neuromodulation is an economically reasonable treatment option in the long run, when comparing it to the more invasive remaining therapeutic alternatives. Show more

Keywords: neuromodulation, electrical stimulation, sacral nerves, incontinence, detrusor instability, voiding dysfunction

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 189-193, 1999

Authors: Schumacher, Stefan | Bross, Stephan | Scheepe, Jeroen R. | Alken, Peter | Jünemann, Klaus-Peter

Article Type: Research Article

Abstract: The combination of sacral anterior root stimulation (SARS) and posterior rhizotomy is a successful procedure for the restoration of bladder function after supraconal spinal cord injury. Today, complete posterior rhizotomy has become part of the standard therapy. Conventional SARS leads to simultaneous activation of both the detrusor muscle and the external urethral sphincter. We evaluated the possibilities of different neurostimulation techniques to overcome stimulation-induced detrusor-sphincter-dyssynergia and to achieve physiological voiding. Selective detrusor …activation improves current sacral neurostimulation of the bladder, including the poststimulus voiding principle. Selec-tive neurostimulation is possible in the following techniques: anodal block, high-frequency block, depolarizing prepulses, sinusoidal pulses and cryoblock. The anodal block technique and cryotechnique are excellent methods for selective bladder activation to avoid detrusor-sphinc-ter-dyssynergia and thus improve stimulation-induced voiding. Our experience has shown that future modern selective bladder neurostimulation systems will be based on either the anodal block technique or the cryotechnique. Show more

Keywords: sacral nerve roots, selective neurostimulation, posterior rhizotomy, spinal cord injury, bladder control

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 195-199, 1999

Authors: Wang, Xu | Kadner, Alexander | Scheich, Henning

Article Type: Research Article

Abstract: Speech coding strategies for cochlear implants commonly use amplitude modulations of constant high rate pulses to differentially stimulate separate frequency channels in the cochlea. Thereby, time domain information in the fine structure of speech sounds, especially on transients, is largely lost. In gerbils with a single electrode cochlear implant was explored, whether upward and downward interval modulation of pulse trains can carry discriminable information. This question was pursued with unit recordings in primary auditory …cortex (AI) and with behavioral discrimination training in a shuttle box. Units in AI showed multiple differences in the dynamic responses to the two directions of interval modulation and notably ON-response dominated patterns with increasing intervals and OFF-response dominated patterns with decreasing intervals of stimulation. In accordance with these neuronal correlates gerbils learned to distinguish the directions of interval modulation within 3 days, but only with certain specifications. Show more

Keywords: Auditory cortex, learning, temporal analysis, speech coding, rehabilitation

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 201-208, 1999

Authors: Sabel, Bernhard A.

Article Type: Research Article

Abstract: A conference was held in Magdeburg, Germany on March 46 where experts discussed current research in neurotraumatology and neurop-sychological rehabilitation. A total of about 60 research projects of a nationwide program project funded by the German Ministry of Education and Research (BMBF) were presented in conjunction with projects from the BMBF-initiative program Neuropathology of the Otto-v.-Guericke University of Magdeburg and the Graduate Program in Neuroscience which were funded by the German Research …Society (DFG) and the State of Sachsen-Anhalt. The scientific program ranges from molecular, cell biological, anatomical, physiological and behavioral analyses of secondary cell death, regeneration and plasticity to clinical outcome studies and epidemiological evaluations. As such, the conference provides a broad overview of German neuroscience in the areas of neurotrauma, rehabilitation and brain plasticity. The abstracts are part of a special issue of Restorative Neurology and Neuroscience on Neurotrauma and Neuropsychological Rehabilitation which was published on the occasion of the conference. Show more

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 209-236, 1999