Advances in Applied Neurological Sciences – serie

Over the last decades the developments and applications of electromyo- graphic and electroneurographic methods have been of great value in giv- ing us insights into the functions of various neuronal systems. More re- cently, considerable advances in new technologies, e.g. computerization and microtechniques, as well as a remarkable increase of interest in the functions of the central nervous system, especially in motor control, can be recognized. The tremendous advances in the development of electromyography, electroneurography and evoked potential recording as well as in record- ing of single motor units and of single nerve fibres raised the question from a clinical-physiological and physiological point of view as to which methods are relevant for clinical diagnosis and which technological devel- opments can provide us with better insight into the functions of the ner- vous system? This book which is based on a well balanced distribution of clinical neurophysiological and physiological contributions presents a great variety of important and interesting topics.We are grateful to the International Federation of Societies for Elec- troencephalography and Clinical Neurophysiology, in particular to the Chairman of the EMG Commission, Prof. J. Desmedt, Brussels, to the German EEG Society, and to the German Research Society (DFG) for their assistance. The secretarial assistance ofE. Amann, E. Buttner, D. Mitteregger, and the technical assistance ofR. Riescher are gratefully acknowledged.

The following papers were presented at an international symposium on the mechanisms and treatment of nausea and vomiting in man held in Oxford in 1984. I believe that this meeting was the first occasion on which representatives from such a wide variety of scientific and clinical specialities had come together to review and debate the spectrum of the vomiting phenomenon. An attempt was made to put before an invited international audience all the pertinent facts on the different facets of the topic and then to encourage extensive discussion of the contentious issues. The first day of the meeting was devoted to the basic science ap­ proach to the problem and the second day to the more clinical aspects. This format has been broadly retained in the layout of the book, with the addition of summary chapters reviewing each day's contributions and focusing upon areas of particular importance. Acknowledgement must here be made to the enormous input from the many participants who either spoke in the debate or rose and themselves gave small presenta­ tions in addition to those of the invited speakers. The meeting occurred at a time of increasing interest in the problem of nausea and vomiting, especially because of its importance in cancer chemotherapy and radiation therapy, and even in space travel.

Society is showing increasing concern for disorders related to aging that lead to a loss of brain function. In view of the enormous proportion of elderly people in our society today, brain aging is more than ever subject to challenge to us all, not only politicians and health authorities, but every individual who is confronted with the difficult situation of watching the mental powers of apparently healthy elderly friends, neighbours, or relatives fail, often with alarming rapidity. This challenge is directed especially toward us scientists. As one of our colleagues succinctly put it 2 years ago at the close of our First International Symposium on Brain Aging: "Do something. We are not dealing here with just another disease; we are concerned with human dignity. " More than any statistics, these words convinced me that Tropon's decision to leave the field of classic CNS pharmacology and move into the field of gerontopsychopharmacology was the right one, even though we knew that success would be uncertain and that, even if it finally comes it will be many years hence. At this point, let me add a personal comment: each one of us is judged by his or her own success. We live in a competitive society where success counts. This applies not only to the businessman, but also to the scientist, in particular, to those in industry.

The ability to use tools skillfully is generally regarded as one of the major achievements in the evolutionary development of the human nervous system. It is possible for controlled movements of muscles to be executed only if sensory information is integrated into complex neural circuits at various hierarchical levels. The chapters in this volume deal with basic and clinical aspects of integrative processing of sensory and motor activities. New findings emphasize the important influence of somatosensory activity such as tactile, proprioceptive, noxious cutaneous, and articular input on motor output. Furthermore, recordings of evoked potentials as well as unit recordings indicate that sensory and cortical activities are highly interrelated. Control of muscles by motoneurons is exerted both electrically and chemically. Disturbed muscle-motoneuron interaction is reflected in ultrastructural motoneuron morphology and may be of importance in the pathogenesis of motoneuron disease. Long loop reflex testing under various pathological conditions provides insight into disturbed sensory motor circuitry in humans. Electrophysiological recording as well as neurochemical and im­ munohistochemical studies elucidate the neural circuitry of basal ganglia and their neural connections, thus providing improved therapeutic concepts. The role of the thalamus and thalamocortical connections in sensory motor processing is of particular interest, because motor disturbances such as tremor or dystonia can be effectively relieved by stereotaxic interventions at the subthalamic or thalamic level.

M. WILKINSON Patients with frequent or daily headaches pose a very difficult problem for the physician who has to treat them, particularly as many patients think that there should be a medicine or medicines which give them instant relief. In the search for the compound which would meet this very natural desire, many drugs have been manufactured and the temptation for the physician is either to increase the dose of a drug which seems to be, at any rate, partially effective, or to add one or more drugs to those which the patient is already taking. Although there have been some references to the dangers of overdosage of drugs for migraine in the past, it was not until relatively recently that it was recognized that drugs given for the relief of headache, if taken injudiciously, may themselves cause headache. The first drugs to be implicated in this way were ergotamine and phenazone. In the case of ergotamine tartrate, the dangers of ergotism were well known as this was a disorder which had been known and written about for many years. In the treatment of headache, fully blown ergotism is rare and in recent years has usually been due to self-medication in doses much greater than those prescribed although there are a few recorded cases where toxic amounts have been given.