No abstract

THE NEED for a method affording relief through surgical measures to patients suffering from severe parkinsonism can scarcely be questioned by anyone who has had to do with this unhappy group. The use of drugs of the belladonna series should, of course, always be tried, and if it is satisfactory surgical intervention need scarcely be considered; but failures are numerous, and, all in all, the medical profession has little reason to be complacent over the results so far obtained. It has been clearly shown by several surgeons that relief of tremor is possible following various procedures which destroy the pyramidal tract to a greater or less degree (Bucy,1 Putnam,2 Klemme,3 Myers4), but it remains to be seen which of the operative methods yields the most satisfactory results in the long run.

as a practical test in the evaluation of injuries of peripheral nerves. This method, in contrast to the sensory examination, does not depend on the cooperation of the patient. It can therefore be used with uncooperative, or even unconscious, patients and may give objective results in cases of hysteria or suspected malingering. Richter and Katz examined 10 patients with injury of the ulnar nerve and found a correlation of skin resistance with sensory changes in most of them. Of the 27 patients with various peripheral nerve lesions studied by Jasper and Robb, all but 2 showed a correlation of the areas of increased skin resistance with the areas of sensory loss. This method is now being used on a large scale in the evaluation of

THE OCCURRENCE of involuntary motor activity of the muscles of the neck was described in 1727 by Wepfer1 as "convulsio particularis"; but Wepfer, as well as most observers up to recent times, did not make a strict differentiation of clinical types. Classifications have been attempted, particularly by French authors, the most respected one being that of Cruchet.2 Preconceived ideas of the etiology of "tics" and "spasm," based on definitions of Brissaud,3 referred almost exclusively to the psychogenic nature of these conditions. As Patterson and Little4 have stressed recently, the classification of Wilson,5 given thirty years later, is similar to that of Cruchet; by classifying torticollis under the heading of "neuroses," Wilson showed that he still considered that psychogenic factors were the most important ones in the pathogenesis of this condition.It was not only the lack of success of psychotherapy in the majority of cases but, rather, the universal recognition of the organic nature of the abnormal involuntary movements in nervous diseases which led to the recognition, at least in some cases, of torticollis as the symptom of an organic process of the brain, although, owing to the benign nature of the condition, only a few autopsy observations with lesions in the basal ganglia have been made in verification. Foerster," in his extensive report on torticollis spasticus (1929), called attention to the fact that From the

EXTENSI VEXTENSIVE reports are available concerning the action potentials occurring in normal and denervated muscles.1 A few investigators have reported the electromyographic changes during the process of reinnervation following section and suture of peripheral nerves. However, these reports have been confined to a relatively short period following the suture. Weddell, Feinstein and Pattle 2 described the changes during this period: (a) Fibrillation action potentials decrease in number; (b) motor unit action potentials, small in amplitude and highly polyphasic, are the earliest to make their appearance, first close to the motor point and then spreading rapidly throughout the muscle; (c) with what the authors term "functional recovery," a few polyphasic units and fibrillation potentials are still present, and the range of amplitude and duration of motor unit responses are greater than in normal muscle.In the cases which they reported in detail, nerve sections were not all complete; the patients were followed for periods too short to assure complete reco\rery, and, though the authors reported functional recovery, Read in part at a meeting of the Eastern Association of Electroencephalography, Dec. 4, 1949, in New York.