Central nervous system regeneration does not occur.

Study Design: Review.

Objectives: To examine the state of research in central nervous system (CNS) regeneration and to suggest an alternative to the sterile research at the lesion site.

Setting: Worldwide.

The case for specialist units.

There is considerable evidence that management in a specialist unit is beneficial both for the individual patient and for the economy. A specialised unit provides a focus for a campaign for prevention, for the improvement in care in areas such as orthopaedic, bladder, bowel, skin, etc and for the promotion of interdisciplinary work, combining the needs of public health, low-cost technology, and high quality. Strategy and training is dictated by the specific problems that occur in patients with spinal injuries, particularly the multisystem impairment, which is a feature of such injuries and can only be comprehensively dealt with in a specialised unit.

Herpes simplex encephalitis: long term magnetic resonance imaging and neuropsychological profile.

The first comprehensive in vivo documentation of the long term profile of pathological and spared tissue is described in a group of 10 patients with a diagnosis of herpes simplex encephalitis, who were left with memory difficulties as a major residual sequel of their condition. With a dedicated MRI protocol, which included high resolution images of temporal lobe and limbic system areas, data are provided on structures that have recently gained importance as anatomical substrates for amnesia. The major features of the lesion profile were: (1) unilateral or bilateral hippocampal damage never occurred in isolation, and was often accompanied by damage to the parahippocampus, the amygdala, specific temporal lobe gyri, and the temporal poles; (2) the insula was always abnormal; (3) neocortical temporal lobe damage was usually unilateral or asymmetric.

Reversible motor and sensory neurophysiological abnormalities in cauda equina claudication.

A case of cauda equina claudication with canal stenosis is presented. Neurophysiological studies show reversible changes during symptomatic and asymptomatic phases. The somatosensory evoked potential from the tibial nerve was reduced in amplitude.

Monoclonal IgM cold agglutinins with anti-Pr1d specificity in a patient with peripheral neuropathy.

A patient with a demyelinating sensory motor polyneuropathy secondary to IgM paraproteinaemia is reported. The paraprotein binds to the gangliosides GD1b, GT1b, GQ1b and GD3, all of which contain disialosyl groups with the sequence NeuAc alpha 2-8NeuAc alpha 2-3Gal. The paraprotein also acts as a cold agglutinin recognising the sialic-acid-dependent Pr1d antigenic determinant of the red cell membrane glycophorins.

Spinal shock: possible role of receptor plasticity and non synaptic transmission.

Spinal shock remains an enigma. To date there has been no convincing explanation of the recovery of reflexes following their complete abolition. Volume transmission includes both the activation of extrasynaptic receptors, and activity induced by substances diffusing into synaptic clefts via the extracellular fluid.

On the late failure of spinal cord stimulation for deafferentation pain.

Two cases are described in which spinal cord stimulation was effective in abolishing previously intractable deafferentation pain for a number of years, but in which late failure occurred for non-technical reasons. A possible explanation for this is advanced; namely that the dorsal column fibres have altered electrical properties due to a form of transganglionic degeneration.

Spinal cord stimulation for the control of spasticity in patients with chronic spinal cord injury: II. Neurophysiologic observations.

We sought neurophysiologic evidence that spinal cord stimulation could modify the behavior of spinal reflexes in 15 chronic SCI patients who showed the beneficial effect of SCS on spasticity. We studied the behavior of passive stretch, clonus, cutaneous touch, plantar reflex irradiation, and the response to the neck flexion reinforcement maneuver during spinal cord stimulation by use of surface PEMG recordings. Fifty-five percent of the responses were changed during spinal cord stimulation, but with widely varying patterns of response in individual patients.

Spinal cord stimulation for the control of spasticity in patients with chronic spinal cord injury: I. Clinical observations.

The effectiveness of spinal cord stimulation for control of spasticity was studied in 59 spinal cord injury patients. SCS was markedly or moderately effective in reducing spasticity in 63% of the patients. We found that control of spasticity by SCS was not correlated with the severity of spasticity, the type of spasticity (flexor or extensor), or the ability to ambulate.

Spinal cord stimulation in peripheral vascular disease.

The results of ten patients with severe, intractable symptoms of arterial disease receiving spinal cord stimulation are reported. Six out of ten patients showed clinical improvement. Three of five patients with severe rest pain obtained complete or very marked relief and one of two patients with moderate rest pain in the legs obtained complete relief.

Spinal cord stimulation in the United Kingdom.

All the medical, surgical and engineering personnel in the UK who have used spinal cord stimulation (SCS) in patients, attended a workshop to discuss their results. The major use of SCS has been for multiple sclerosis and intractable pain. It was concluded that the technique benefited up to two thirds of patients with bladder dysfunction, and that pain and possibly spasticity also responded to SCS, but other manifestations of multiple sclerosis did not.

The effect of spinal cord stimulation upon peripheral blood flow in patients with chronic neurological disease.

The impact of spinal cord stimulation (SCS) upon patients with chronic neurological disease appears to be primarily upon autonomic functions. There is clinical evidence of increased blood flow in the lower limbs. In the present study, cutaneous blood flow was measured by means of xenon clearance in the legs and feet of patients receiving SCS for chronic neurological disease.

The quantitative assessment of the influence of spinal cord stimulation on motor function in patients with multiple sclerosis.

This paper gives the results of quantitative measurements of motor function made in a group of 23 patients receiving spinal cord stimulation (SCS) for multiple sclerosis. Although 14 out of the 23 patients reported subjective improvement in motor function and many felt these improvements were significant to them, only 4 patients showed an improvement in pyramidal function, only 1 in cerebellar function. There was no statistically significant improvement in walking speed.