F. Gerstenbrand – författare

Some 20 years ago the introduction of levodopa opened a new era in the treatment of Parkinson's disease. Although levodopa remains the single most effective drug for the treatment of this maladie, challeng- ing therapeutic problems arise in many patients after several years of sustained treatment. Among these, fluctuations in motor performance and drug-induced involuntary movements are the most troublesome. The search for improved antiparkinsonian medications therefore con- tinues and important new developments have already occurred, for example the introduction of the dopaminergic ergots and the selective MAO-B-inhibitor selegeline (deprenyl) into routine treatment. The International Workshop on Parkinson's Disease held in Inns- bruckjIgls primarily considered a new compound with antiparkinsonian properties unrelated to any of the conventional drugs - the diphenyl- ex- piperidine compound budipine. The present volume records the perimental and clinical data on budipine presented at the meeting.The editors felt especially encouraged by the authorative biochemical, physiological, clinical and therapeutic reviews that were given at this symposium by outstanding experts in the field of extrapyramidal dis- orders. Their inclusion should make this volume a valuable source of information on a variety of current research aspects into Parkinson's disease. InnsbruckjLondon, October 1984 The Editors v Contents James Parkinson and the Treatment of His Disease. G. Stern ...

The subject of the apallic syndrome is one which has long been familiar to me, although I have not personally studied it as deeply as I would have wished. I became acquainted with this syndrome long before the last war, when my neurosurgical colleague Hugh Cairns (1952), made his pioneer contribution under the term "akinetic mutism" . This was an ar­ resting title, but it was one which did not altogether satisfy some of his colleagues, includ­ ing myself. We found it difficult to suggest an alternative. That is one reason why I wel­ come the expression "apallic syndrome" . Forensic practice has forced me from time to time to consider rather more deeply this distressing syndrome, and to try and marshal my ideas in a form which would satisfy my colleagues in the legal profession. More than once I have been instructed to make a medico­ legal assessment of these unfortunate patients. The points which have concerned my lawyer friends have not been matters of diagnosis, or of morbid anatomy, or of etiology. The fac­ tual problem which has been put before me was to make some approximate assessment as to the expectation of life. Vague guess-work is unacceptable in such circumstances. What the lawyers require is a precise and dogmatic answer.

The subject of the apallic syndrome is one which has long been familiar to me, although I have not personally studied it as deeply as I would have wished. I became acquainted with this syndrome long before the last war, when my neurosurgical colleague Hugh Cairns (1952), made his pioneer contribution under the term "akinetic mutism" . This was an ar­ resting title, but it was one which did not altogether satisfy some of his colleagues, includ­ ing myself. We found it difficult to suggest an alternative. That is one reason why I wel­ come the expression "apallic syndrome" . Forensic practice has forced me from time to time to consider rather more deeply this distressing syndrome, and to try and marshal my ideas in a form which would satisfy my colleagues in the legal profession. More than once I have been instructed to make a medico­ legal assessment of these unfortunate patients. The points which have concerned my lawyer friends have not been matters of diagnosis, or of morbid anatomy, or of etiology. The fac­ tual problem which has been put before me was to make some approximate assessment as to the expectation of life. Vague guess-work is unacceptable in such circumstances. What the lawyers require is a precise and dogmatic answer.