Chronic cerebellar stimulation and developmental reflexes

1977 ◽  
Vol 46 (4) ◽  
pp. 506-511 ◽  
Author(s):  
Richard D. Penn ◽  
Mary Liz Etzel
Keyword(s):  
Cerebral Palsy ◽  
Anterior Lobe ◽  
Chronic Stimulation ◽  
Content Type ◽  
Motor Disabilities ◽  
Primitive Reflexes ◽  
Developmental Scale ◽  
Motor Retardation ◽  
Fine Print ◽  
Cerebellar Stimulation

✓ The changes in motor function in cerebral palsy patients produced by chronic anterior lobe cerebellar stimulation were documented with the Milani-Comparetti developmental scale, which allows comparison between functional gains and reflex patterns. Two patients with marked motor retardation and primitive reflexes were followed serially over several months of stimulation. Using these measures, the efficiency of chronic stimulation can be assessed, although many years will be needed to evaluate its role in treating motor disabilities.

Cerebellar stimulation in man

1978 ◽  
Vol 48 (5) ◽  
pp. 779-786 ◽  
Author(s):  
Richard D. Penn ◽  
Gerald L. Gottlieb ◽  
Gyan C. Agarwal
Keyword(s):  
Cerebral Palsy ◽  
Anterior Lobe ◽  
New Method ◽  
Muscle Rigidity ◽  
Electromyographic Activity ◽  
Stretch Reflexes ◽  
Content Type ◽  
Flexor Muscles ◽  
Fine Print ◽  
Cerebellar Stimulation

✓ The effects of chronic anterior lobe cerebellar stimulation on patients with cerebral palsy have been investigated using a new method of quantifying muscle rigidity and stretch reflexes. The ankle is oscillated sinusoidally, compliance is measured at several frequencies, and electromyographic activity of the extensor and flexor muscles is recorded. In some patients stimulation can reduce rigidity and coactivation of muscles immediately or slowly over days or months. In others no change is found.

Effects on speech of chronic cerebellar stimulation in cerebral palsy

1978 ◽  
Vol 48 (6) ◽  
pp. 876-882 ◽  
Author(s):  
David L. Ratusnik ◽  
Virginia I. Wolfe ◽  
Richard D. Penn ◽  
Sheila Schewitz
Keyword(s):  
Cerebral Palsy ◽  
Speech Intelligibility ◽  
Group Analysis ◽  
Anterior Lobe ◽  
Motor Dysfunction ◽  
Content Type ◽  
Speech Characteristics ◽  
Trained Panel ◽  
Vocal Quality ◽  
Cerebellar Stimulation

✓ Chronic cerebellar stimulation of the anterior lobe is undertaken for relief of motor dysfunction in cerebral palsy, but the effect on speech and vocal ability has been uncertain. The present study evaluated speech before cerebellar stimulation and during the immediate postoperative period in seven severely spastic/athetoid patients with congenital cerebral palsy and one patient with traumatic brain damage. Structured listening tasks were completed in blind fashion by a trained panel of speech pathologists. Group analysis revealed no significant improvement in speech intelligibility or articulatory accuracy after stimulation. With the exception of strain/strangle vocal quality, which improved considerably, vocal characteristics were not affected by cerebellar stimulation. In three of eight patients, however, improvement in certain speech characteristics was noted.

Cerebellar stimulation for cerebral palsy

1980 ◽  
Vol 52 (5) ◽  
pp. 648-653 ◽  
Author(s):  
C. Keith Whittaker
Keyword(s):  
Cerebral Palsy ◽  
Double Blind ◽  
Content Type ◽  
Sham Stimulation ◽  
Children With Cerebral Palsy ◽  
Fine Print ◽  
Cerebellar Stimulation

✓ Eight children with cerebral palsy, who had implanted cerebellar stimulators, were evaluated by a panel of six experienced physicians in a double-blind cross-over experiment with 3-week periods of real and sham stimulation. Neither the panel of physicians nor the patients could tell whether the stimulators were operating or not.

On the origin and nature of the pituitary gland capsule

1977 ◽  
Vol 46 (5) ◽  
pp. 596-600 ◽  
Author(s):  
Ivan Ciric
Keyword(s):  
Pituitary Gland ◽  
Anterior Lobe ◽  
Pituitary Stalk ◽  
Operating Microscope ◽  
Pia Mater ◽  
Content Type ◽  
Fine Print

✓ Observations under the operating microscope confirming the presence of a pituitary capsule are reported. This capsule envelops the anterior lobe of the pituitary, the neurohypophysis, and the pituitary stalk. It merges along the stalk with the intracranial pia mater. The origin and nature of this capsule are discussed in light of the known facts of development of the pituitary gland and surrounding structures. It is concluded that the pituitary gland capsule is a derivative of the primitive pia mater.

Infusion of intrathecal baclofen for generalized dystonia in cerebral palsy

1998 ◽  
Vol 88 (1) ◽  
pp. 73-76 ◽  
Author(s):  
A. Leland Albright ◽  
Margaret J. Barry ◽  
Michael J. Painter ◽  
Barbara Shultz
Keyword(s):  
Cerebral Palsy ◽  
Intrathecal Baclofen ◽  
Term Therapy ◽  
Short Term ◽  
Intrathecal Catheter ◽  
Content Type ◽  
Body Regions ◽  
Before And After ◽  
Generalized Dystonia ◽  
Fine Print

Generalized dystonia occurs in 15 to 25% of persons with cerebral palsy (CP) and responds poorly to medical and surgical treatments. Object. After the authors observed a woman whose dystonic CP was dramatically improved by continuous infusion of intrathecal baclofen, they designed this pilot study to evaluate the effect of this treatment on a group of patients with dystonic CP. Methods. The authors assessed the short-term response to intrathecal baclofen infusion in 12 patients with dystonic CP. An intrathecal catheter was inserted percutaneously and connected to an external microinfusion pump. The infusion began at a rate of 100 µg/day and was increased by 50 µg every 12 hours until the dystonia abated, adverse effects occurred, or the dose reached 900 mg/day with no improvement. Two observers, one blinded and one not blinded to the patient's treatment status, viewed videotapes made before and after the infusions and graded the dystonia in eight body regions, using a 5-point scale. Overall and regional scores were compared by using Wilcoxon signed-rank tests. Conclusions. Dystonia diminished in 10 of 12 patients whose average daily dose of intrathecal baclofen was 575 µg. Overall dystonia scores and scores for the extremities, trunk, and cervical regions were significantly better after infusion (p = 0.003). The two observers' scores were not significantly different. Programmable infusion pumps were subsequently implanted in eight patients for long-term therapy and improvement was sustained in six (p < 0.05). Intrathecal baclofen infusion is a promising treatment option for generalized dystonia associated with CP. The effects of intrathecal baclofen infusion on dystonia can be evaluated by using short-term continuous infusions.

Changes in ankle spasticity and strength following selective dorsal rhizotomy and physical therapy for spastic cerebral palsy

1999 ◽  
Vol 91 (5) ◽  
pp. 727-732 ◽  
Author(s):  
Jack R. Engsberg ◽  
Sandy A. Ross ◽  
Tae Sung Park
Keyword(s):  
Cerebral Palsy ◽  
Physical Therapy ◽  
Spastic Cerebral Palsy ◽  
Control Group ◽  
Selective Dorsal Rhizotomy ◽  
Content Type ◽  
Dorsal Rhizotomy ◽  
Angle Data ◽  
Work Done ◽  
Fine Print

Object. In this investigation the authors quantified changes in ankle plantarflexor spasticity and strength following selective dorsal rhizotomy (SDR) and intensive physical therapy in patients with cerebral palsy (CP).Methods. Twenty-five patients with cerebral palsy (CP group) and 12 able-bodied volunteers (AB controls) were tested with a dynamometer. For the spasticity measure, the dynamometer was used to measure the resistive torque of the plantarflexors during passive ankle dorsiflexion at five different speeds. Data were processed to yield a single value that simultaneously encompassed the three key elements associated with spasticity: velocity, resistance, and stretch. For the strength test, the dynamometer rotated the ankle from full dorsiflexion to full plantarflexion while a maximum concentric contraction of the plantarflexors was performed. Torque angle data were processed to include the work done by the patient or volunteer on the machine. Plantarflexor spasticity values for the CP group were significantly greater than similar values for the AB control group prior to surgery but not significantly different after surgery. Plantarflexor strength values of the CP group were significantly less than those of the AB control group pre- and postsurgery. Postsurgery strength values did not change relative to presurgery values.Conclusions. The spasticity results of the present investigation agreed with those of previous studies indicating a reduction in spasticity for the CP group. The strength results did not agree with the findings of most previous related literature, which indicated that a decrease in strength should have occurred. The strength results agreed with a previous investigation in which knee flexor strength was objectively examined, indicating that strength did not decrease as a consequence of an SDR. The methods of this investigation could be used to improve SDR patient selection.

Evoked potentials from direct cerebellar stimulation for monitoring of the rodent spinal cord

1992 ◽  
Vol 76 (2) ◽  
pp. 280-291 ◽  
Author(s):  
R. John Hurlbert ◽  
Charles H. Tator ◽  
Michael G. Fehlings ◽  
Greg Niznik ◽  
R. Dean Linden
Keyword(s):  
Spinal Cord ◽  
Evoked Potentials ◽  
Posterior Fossa ◽  
Evoked Potential ◽  
Thoracic Spinal Cord ◽  
Content Type ◽  
Thoracic Spinal ◽  
Ventral Funiculus ◽  
Fine Print ◽  
Cerebellar Stimulation

✓ Although the assessment of spinal cord function by electrophysiological techniques has become important in both clinical and research environments, current monitoring methods do not completely evaluate all tracts in the spinal cord. Somatosensory and motor evoked potentials primarily reflect dorsal column and pyramidal tract integrity, respectively, but do not directly assess the status of the ventral funiculus. The present study was undertaken to evaluate the use of evoked potentials, elicited by direct cerebellar stimulation, in monitoring the ventral component of the rodent spinal cord. Twenty-nine rats underwent epidural anodal stimulation directly over the cerebellar cortex, with recording of evoked responses from the lower thoracic spinal cord, both sciatic nerves, and/or both gastrocnemius muscles. Stimulation parameters were varied to establish normative characteristics. The pathways conducting these “posterior fossa evoked potentials” were determined after creation of various lesions of the cervical spinal cord. The evoked potential recorded from the thoracic spinal cord consisted of five positive (P1 to P5) and five negative (N1 to N5) peaks. The average conduction velocity (± standard deviation) of the earliest wave (P1) was 53 ± 4 m/sec, with a latency of 1.24 ± 0.10 msec. The other components followed within 4 msec from stimulus onset. Unilateral cerebellar stimulation resulted in bilateral sciatic nerve and gastrocnemius muscle responses; there were no significant differences (p > 0.05) in the thresholds, amplitudes, or latencies of these responses elicited by right- versus left-sided stimulation. Recordings performed following creation of selective lesions of the cervical cord indicated that the thoracic response was carried primarily in the ventral funiculus while the sciatic and gastrocnemius responses were mediated through the dorsal half of the spinal cord. It is concluded that the posterior fossa evoked potential has research value as a method of monitoring pathways within the ventral spinal cord of the rat, and should be useful in the study of spinal cord injury.

Cerebellar stimulation for chronic extensor-flexor rigidity and opisthotonus secondary to hypoxia

1980 ◽  
Vol 53 (3) ◽  
pp. 391-396 ◽  
Author(s):  
Michael H. Sukoff ◽  
Robert E. Ragatz
Keyword(s):  
Content Type ◽  
Decerebrate State ◽  
Fine Print ◽  
Cerebellar Stimulation

✓ Two patients with chronic hypertonus (in a decerebrate state) as a result of hypoxia are described. Long-term cerebellar stimulation markedly modified their extraordinarily severe extensor-flexor rigidity phenomena that had resulted in chronic opisthotonus.

Cerebrospinal fluid GABA reductions in seizure patients evoked by cerebellar surface stimulation

1977 ◽  
Vol 47 (4) ◽  
pp. 582-589 ◽  
Author(s):  
James H. Wood ◽  
Bruce S. Glaeser ◽  
Theodore A. Hare ◽  
Jonas Sode ◽  
Benjamin R. Brooks ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cyclic Guanosine Monophosphate ◽  
Guanosine Monophosphate ◽  
Gamma Aminobutyric Acid ◽  
Content Type ◽  
Percentage Decrease ◽  
Radio Immunoassay ◽  
Lumbar Cerebrospinal Fluid ◽  
Fine Print ◽  
Cerebellar Stimulation

✓ Lumbar cerebrospinal fluid (CSF) gamma-aminobutyric acid (GABA) levels determined by fluorometric assay in four seizure patients were found to be significantly lower during bilateral, continuous cerebellar stimulation than those determined after a 7-day period without stimulation. The CSF GABA concentrations during chronic unilateral, alternating cerebellar stimulation were reduced in three seizure patients but unchanged in a fourth patient. The percentage decrease in CSF GABA appeared to be independent of cerebellar stimulation frequency. These findings suggest that GABA-mediated neuronal transmission is depressed during cerebellar surface stimulation and this evoked reduction in GABA activity may compromise the efficacy of cerebellar stimulation in the treatment of epilepsy. Lumbar CSF cyclic guanosine monophosphate levels determined by radio-immunoassay were not significantly altered by either mode or frequency of cerebellar stimulation.

Selective excision of adenomas originating in or extending into the pituitary stalk with preservation of pituitary function

1997 ◽  
Vol 87 (3) ◽  
pp. 343-351 ◽  
Author(s):  
R. Bryan Mason ◽  
Lynnette K. Nieman ◽  
John L. Doppman ◽  
Edward H. Oldfield
Keyword(s):  
Cushing’S Disease ◽  
Pituitary Tumors ◽  
Optic Chiasm ◽  
Anterior Lobe ◽  
Pituitary Function ◽  
Pituitary Stalk ◽  
Cushing's Disease ◽  
Content Type ◽  
Suprasellar Cistern ◽  
Fine Print

✓ When the surgeon identifies an adenoma within the gland and selectively excises it, endocrine-active pituitary tumors are usually cured and pituitary function is preserved. Occasionally ectopic adenomas arise primarily in the pituitary stalk or arise superiorly in the midportion of the anterior lobe and extend upward within the stalk. To determine if these tumors can be selectively excised with preservation of pituitary function, the authors examined the outcome of selective adenomectomy in 10 patients with Cushing's disease with an ectopic adenoma originating in, and confined to, the stalk (four microadenomas) or an adenoma extending superiorly through the diaphragma sella and into the stalk (five microadenomas and one macroadenoma) from an operative series of 516 patients with Cushing's disease. To reach the adenoma transsphenoidally in these patients, the diaphragma sella was incised anteroposteriorly in the midline to the anterior edge of the stalk, the suprasellar cistern was entered, and the adenoma was selectively excised using care to limit injury to the infundibulum. After selective adenomectomy, Cushing's disease remitted in all patients. All patients were hypocortisolemic immediately after surgery and required hydrocortisone for up to 21 months. Apart from the adrenal axis, pituitary function was normal in five patients in the immediate postoperative period, including two patients with tumors confined to the stalk and three patients with preoperative hypothyroidism (one patient) and/or hypogonadism (three patients). Three others with transient postoperative hypothyroidism (one patient) or diabetes insipidus (two patients) had normal pituitary function within 7 months of surgery. One patient with hypothyroidism and one with hypogonadism before surgery had panhypopituitarism postoperatively. A patient with a microadenoma located high in the stalk next to the optic chiasm had bitemporal hemianopsia postoperatively. These results demonstrate the feasibility of achieving curative transsphenoidal resection and preservation of pituitary function in cases of pituitary adenomas that are confined to the pituitary stalk or tumors that extend superiorly within the stalk from an intrasellar origin.

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