Advances in neurology (1)

Nuclear imaging. 67Gallium, 201thallium, 18F-labeled fluoro-2-deoxy-D-glucose positron emission tomography

67Gallium scan has been used for years in sarcoidosis as a marker of activity, a determiner of the extent and distribution of the disease, a diagnostic support, and an aid in therapeutic management. Because of its limited sensitivity and specificity for sarcoidosis, however, it is currently used mainly to assist in diagnosis in difficult cases, particularly in those with isolated extrathoracic sarcoidosis. The finding of the typical lambda or panda patterns supports the diagnosis and reinforces the indication to perform an appropriate biopsy or Kveim-Siltzbach test. In addition, the detection of clinically silent extrathoracic uptake may provide sites for biopsy. 67Gallium scans' routine use in the follow-up of pulmonary sarcoidosis under treatment has decreased because that is best accomplished by means of serial chest radiographs and PFT. 201Thallium scintigraphy studies the myocardial perfusion and is complementary to echocardiography and 24-hour electrocardiographic monitoring in the assessment of sarcoid cardiac involvement. It typically shows segmental areas of decreased uptake in the ventricular myocardium that disappear or decrease in size during stress or after intravenous administration of dipyridamole. That reverse distribution is not specific for cardiac sarcoidosis, however, because it may also occur in other cardiomyopathies. PET is based on the increase of glucose metabolism in inflamed tissues. It may have great potential to assess sarcoidosis activity, but it is still largely experimental and is not routinely employed.

Epilepsy is not a disease. Proposal for a new approach in the International Classification of Diseases (ICD)

What is epilepsy? a disease? a symptom? a syndrome? is it important to define it? Basing his study on an extensive bibliography, the author shows that epilepsy is not a disease. He emphasizes the significance of that definition and suggest a new approach in the International Classification of Diseases (ICD).

The relations between neuroscience and human behavioral science

Neuroscience seeks to understand how the human brain, perhaps the most complex electrochemical machine in the universe, works, in terms of molecules, membranes, cells and cell assemblies, development, plasticity, learning, memory, cognition, and behavior. The human behavioral sciences, in particular psychiatry and clinical psychology, deal with disorders of human behavior and mentation. The gap between neuroscience and the human behavioral sciences is still large. However, some major advances in neuroscience over the last two decades have diminished the span. This article reviews the major advances of neuroscience in six areas with relevance to the behavioral sciences: (a) evolution of the nervous system; (b) visualizing activity in the human brain; (c) plasticity of the cerebral cortex; (d) receptors, ion channels, and second/third messengers; (e) molecular genetic approaches; and (f) understanding integrative systems with networks and circadian clocks as examples.

Parkinson's Disease

Parkinson's disease is a progressive neurological disorder with a usual age of onset between 40 and 70 years. It is characterized by a tetrad of symptoms: resting tremor, bradykinesia, rigidity, and postural abnormalities. In addition, patients may display varying degrees of autonomic dysfunction. The clinical course of the disease is unpredictable, with patients who exhibit minimal symptoms to those with rapid deterioration. Pharmacological therapy provides symptomatic relief in most patients, although adverse effects of medications are often intolerable. Recent advances have focused on the ability to eliminate or lessen fluctuations in symptom control, decrease the severity of adverse effects, and seek surgical interventions aimed at reversing the disease.