The reader is referred to the updated review 2 for a detailed discussion of the literature and the EDX techniques for the assessment of CTS which are summarized here. Both reviews addressed the following key clinical questions:

Four patients with primary writing tremor had a focal, task-specific tremor that responded to anticholinergic drugs. Physiologic features included EMG activity alternating in antagonist muscles, 5- to 20-microV cerebral potentials evoked by stretch of pronator teres, and no C-reflexes. Another patient had myoclonic jerks of the forearm on attempts to write ("myoclonic writer's cramp") that also responded to anticholinergic drugs; EMG activity appeared synchronously or alternating in antagonist muscles. These disorders have features of dystonia and enlarge the spectrum of writer's cramp.

A patient with histiocytic lymphoma developed bilateral oculomotor nerve palsies, sparing the pupils. At postmortem examination, there was lymphomatous infiltration in the oculomotor nerves. To our knowledge, this is the first patient with lymphoma to manifest these isolated findings.

In this report, a unique and bizarre case of complicated suicide is presented. The decedent was found dead in the basin of a porta-potty, wearing women's pantyhose, jewelry, and makeup. The initial investigation was suspect for homicide. Although an autoerotic accidental death cannot be excluded, the patient's medical history and autopsy results provided evidence for suicide, including several substances positive in his serum. Tramadol was quantified to be 140 mg/L, approximately 470 times the therapeutic range. Moreover, formaldehyde was also present, presumably absorbed from the contents of the chemical toilet. An exhaustive search could not reveal similar circumstances of suicide in a porta-potty or with the levels of tramadol found in the decedent.

A July 1997 assessment of the American Academy of Neurology (AAN) Therapeutics and Technology Subcommittee reviewed vagus nerve stimulation (VNS) for epilepsy, and concluded that it was promising, but not yet established. 1 Subsequent to that review, a second multicenter, randomized, controlled clinical trial has shown safety and efficacy of VNS for treatment of intractable partial seizures. Given the importance of this novel therapy for epilepsy, and the new information provided by a second major study, the Therapeutics and Technology Subcommittee requested an update on VNS. Use of VNS in epilepsy has recently been reviewed. 2-4 VNS uses intermittent stimulation of the left vagus nerve in the neck to reduce the frequency and intensity of seizures. Mechanism of action of VNS remains uncertain, but stimulation does not induce grossly visible alterations in the human EEG. 5 Recent studies suggest that metabolic activation of certain thalamic, brainstem, and limbic structures may be important in mediating the effect of VNS. 6,7 Depletion of norepinephrine in the locus coeruleus attenuates the antiseizure affect of VNS. 8 After open-label studies, 9,10 sponsors of VNS engaged in a multicenter randomized study, named E03, 11 details of which were reviewed in the previous assessment. 1 Results of the trial were positive, and the technology was considered promising, but the number of patients receiving VNS was insufficient to achieve Food and Drug Administration approval. Therefore, a second randomized, controlled, multicenter clinical trial, called E05, was undertaken. 12 Update on controlled studies. The E05 study 12 of VNS evaluated 254 patients, ages 13 to 60 years, with intractable partial seizures. To be eligible, subjects had to have at least six complex partial, visible partial motor, or secondarily generalized seizures in the month before entry, and to be free from other complicating neurologic, psychiatric, or medical conditions. Individuals with prior VNS were excluded. After a 12-to 16-week baseline, the vagus nerve stimulator electrode was implanted around the left vagus nerve and connected subcutaneously to the subclavicular stimulator device. Two weeks after implantation, patients were randomly assigned to high-or low-stimulation groups. Current was increased over 2 weeks, and maintained for 3 months of treatment. The high-stimulation group received stimulation with 500-µsec pulses at 30 pulses per second, on for 30 seconds and off for 5 minutes. Current was increased as tolerated over the next 16 weeks to a maximum of 3.5 mA. Patients receiving low stimulation as an active control received 130-µsec pulses at one per second, on for 30 seconds and off for 3 hours, with mA set to the point of patient perception. All patients were told that they could activate the stimulator with a hand-held magnet to produce a 30-second stimulation train at the start of a perceived seizure; however, only patients in the high-stimulation group actually received magnet-induced stimulation. The 94 patients receiving high stim...