Norman S. Namerow

Normative data stratified by age and education for the Neuropsychological Screening Battery for Hispanics (NeSBHIS): Initial report

Neuropsychological assessment of monolingual Spanish-speaking people in the United States is both a common practice and an ethical dilemma. Lack of appropriate tests, the absence of norms, use of interpreters, and the multiplicity of in-house translations of commonly used measures add to the problem of accurate assessment. This paper helps address the lack of appropriate measures for the neuropsychological assessment of Latinos in the United States by providing a standardization of the Neuropsychological Screening Battery for Hispanics (NeSBHIS). Normative data on a sample of 300 Hispanic subjects stratified by gender, age, and education are provided. Current results reveal that not one measure of cognitive functioning is free from education effects. Both nonverbal measures and psychomotor speed measures were highly related to education. Age effects were noted on measures of psychomotor speed, visuospatial reasoning, and visuoconstructive skills. Gender effects were found on measures of psychomotor speed and language, with males achieving higher scores than females. The limitations of the current findings are considered. Further research for the validation of the NeSBHIS with clinical populations, as well as further normative data collection at the national and international levels, is needed.

The orbicularis oculi reflex in multiple sclerosis.

FOR SOME PERIOD OF TIME, our laboratory has been interested in neurophysiological correlates of multiple sclerosis (MS) Although early work centered about evoked cortical response studies, more recently we have become interested in simple, centrally mediated reflex arcs that do not require averaging methods for detection of the evoked response. One such easily assessed pathway is that for the orbicularis oculi reflex, as generated by stimulation of the supraorbital nerve and detected by reflex contraction of the orbicularis oculi muscle. While several previous studies have demonstrated changes in this reflex with various pontine lesions, only one has dealt specifically with multiple sclerosis.3-7 It was anticipated that continued study of such a relatively simple pathway would further our understanding of the nature of neuronal conduction in human demyelinating disease.

Circadian temperature rhythm and vision in multiple sclerosis

THE TEMPOHAHY WORSENING of visual acuity by hyperthermia and exercise in multiple sclerosis (MS) patients with optic neuritis has been well described previously. Uhthoff was the first to describe the adverse effects of exercise, and the eponym “Uhthoffs symptom” has been ascribed to such aggravation of acuity.’ More recently, the effects of induced temperature changes in MS patients have been described.?--” Although raising body temperature will often lead to the temporary worsening of symptoms, particularly vision and strength, this phenomenon is not specific for MS. Patients with this disease react more commonly and more severely to this induced body change, but a similar aggravation of symptoms has been observed in patients with other neurological diseases.7 A mechanism for this action in MS patients has not been elucidated, although vasoconstriction has been rie’s experiments0 suggest humoral factor, but the nature, and site of action not yet been adequately mined. In each of these reports, were adversely influenced duced hyperthermia and considered.9 Gu&the presence of a site of production, of this factor have explored or deter-

Plaques, symptoms, and the remitting course of multiple sclerosis

MULTIPLE SCLEROSIS is a disease characterized by enigmas. Not only are we ignorant of the cause or causes of the disease, but we cannot as yet adequately explain many of the accumulated clinical and epidemiological facts pertaining to the illness. One major clinical feature, the frequent occurrence of an exacerbating and remitting course, has defied adequate explanation and is striking in this regard. Charcot’s concept of the cause of the episodic nature of multiple sclerosis has long been accepted and may account in many instances for the fluctuating clinical picture. Charcot held that, as a result of the demyelinatiiig process, there is swelling of the axis cylinder with swelling and other “reactive” changes in the surrounding tissue. As a result, axonal function may be temporarily affected. After resolution of the acute pathological process, function may be restored unless irreversible axonal damage has been produced. If this has occurred, symptoms persist. As a result of this “cause and effect” reasoning, there has been a tendency in the past to equate the clinical exacerbation with a new lesion or the extension of a previously existing lesion; that is, a new symptom must be associated with immediately antecedent fresh demyelination. In addition, the correlary to this view has also generally been accepted: along with demyelination of a critical pathway, one must have associated clinical symptoms and signs. Several clinicopathological features of niultiple sclerosis, however, indicate that these considerations need not necessarily follow. These features are: 11 The finding, at autopsy, of disseminated demyelinated lesions consistent with the diagnosis of multiple sclerosis in patients with 110 history or physical findings prior to death suggestive of this disease.13 21 The frequent finding, at postmortem examination, of a dissociation between the clinical findings and the number and extent of lesions. That is, although there is usually a good correlation between symptoms and appropriately placed lesions to produce these symptoms, many patients will demonstrate pathological findings far more extensive than anticipated on the basis of the clinical ~ o u r s e . ~ 31 The occurrence of cases of multiple sclerosis having an onset seemingly precipitated by immediately preceding trauma, fever, or other forms of stress. Many such cases can be explained by considering the patients to have had preexisting lesions that were clinically silent, but which were precipitated to producing functional deficits by the stress.”-7 41 The phenomenon of the temporary worsening of symptoms related to thermal, emotional, or physical stress. Because of the rapid onset, briefness of symptoms, and the usual return of the patient to his prestress functional status, it is unwarranted to incriminate new lesions or extensions of old plaques as the causative factor. Other factors yet to be elucidated must be considered operational in producing this temporary axonal nialfunction, although vasospasm has been incriminated more than any other potential factor.8.g It is not a

Somatosensory responses to stimulus trains: normative data

Abstract This paper investigates the human evoked response produced by peripherally stimulating the median nerve with a repetitive high frequency stimulus. The human somatosensory system can be driven and the resultant evoked response can be consistently recognized at frequencies as high as 200 Hz. This somatosensory evoked response to trains (SERT) has proven to be a very reliable and easily quantifiable measure. Seventeen normal subjects and a total of 28 hands were investigated. Each hand was stimulated with eight different frequency runs, each consisting of 64 trains of stimuli spaced 2 sec apart. The frequencies of stimulation were 12, 20,40,60,80,100,160 and 200 Hz. Each stimulus had a width of 0.25 msec and the train lenght was fixed at 250 msec. Three data processing steps were utilized. The initial procedure was the on-line computation of the contralateral SERT. Secondly, a filtered SERT was calculated by narrowband filtering of the EEG signal and averaging. Finally, a single cycle filtered SERT was calculated by narrowband filtering of the EEG signal and averaging across the interstimulus interval. The amplitude and time of occurence of the peak negative value obtained from this measure were used to quantify the suject response at each stimulating frequency. Signal variability due to activity at the bipolar reference electrode was investigated, as were differential phase shifts between signals recorded at anterior and posterior electrode locations. In addition, topographical mappings of the single cycle amplitudes and phase angles were obtained at the different stimulating frequencies. The distributions of the peak-to-peak amplitude values were consistent with topographical data previously reported for the somatosensory evoked response, while the phase angles tended to distribute in such a way as to divide the scalp into two discrete regions.

Visual evoked responses in patients with multiple sclerosis

The visual evoked response (VER) was evaluated in a series of multiple sclerosis patients and normal subjects. The data showed significant delays in wave peak latencies among the patient evoked responses. The prolonged latencies correlated closely with visual impairment; however, even patients with a previous history of visual impairment, but with no deficits noticeable on examination at the time of study, showed a delay in wave peak latencies. The results further suggest that the VER is primarily altered when there are central field defects.

Somatosensory recovery functions in multiple sclerosis patients

SUMMARYThe somatosensory evoked response amplitured and latency recovery functions have been determined in 11 normal subjects and 10 patients with MS. The results show [1] no difference in the amplitude recovery between the groups and [2] a significant shortening of the patient test stimulus latency at shorter interstimulus times. These results suggest that: Diseased or demyelinated axons cannot effectively respond to a test stimulus that follows a conditioning stimulus by short intervals (less than 60 msec). The more heavily myelinated and fastest conducting fibers are selectively more affected by the demyelination process. The application of this method holds promise for assessing neuronal conduction in MS patients in comparison to normal subjects.

Complex-pattern evoked somatosensory responses in the study of multiple sclerosis

Three approaches are described for investigation of human somatosensory evoked responses in normal subjects and in multiple sclerosis patients. To median-nerve stimulation, the cortical evoked response (SER) reveals components whose shapes and latencies may be altered as a consequence of the disease. The use of periodic trains of stimuli (SERT) demonstrates that the oscillatory response of the nervous system deteriorates with advancing disease. Finally, the use of functional power series to characterize the somatosensory modality shows that responses to temporally interactive stimuli are nonlinear, decrease with increasing rate, and degenerate in the advanced state of the disease.

An assessment of the reliability of three methods used in evaluating the status of multiple sclerosis patients

Abstract The reliability of three different evaluation methods used in a cooperative clinical trial of the efficacy of ACTH in multiple sclerosis patients was evaluated in a uniformity study that used an efficient statistical design requiring only 10 patients and 5 examiners. The methods were the standard neurologic examination, a scoring system for functional grades and disability status, and a 7-day symptom score. Each patient was examined only 3 times at the beginning of the study and 3 more times 6 days later. No significant differences among the 5 examiners were observed on 82 of the 87 items used to measure neurologic function. With the exception of 1 variable, there were no significant differences among the average values of the sequence of the 3 examinations, nor among the average increments of change in the numerical scores between the first and second trials. In an additional examination in which all 5 examiners simultaneously evaluated 3 patients 1 at a time, it was found that the 5 examiners observed uniformly in all of the neurologic tests. The results of this study indicate that, by and large, the three evaluation methods appear to be reliable in the evaluation of neurologic status when used in a cooperative clinical trial where several investigators contribute data. Furthermore, investigations of reliability in cooperative studies can be performed with the use of efficient statistical designs such as the incomplete Latin-square design.

Postpolio syndrome : response to deprenyl (selegiline)

Two patients with postpolio syndrome are presented. The first case developed mild Parkinsons syndrome, for which she was treated with a levodopa/carbidopa combination followed by the institution of deprenyl. An unexpected improvement in the symptoms of postpolio syndrome was noted. The second patient who was unaffected by Parkinsons syndrome was started on deprenyl alone and reported a similar improvement in symptomatology.