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The brain tumours represent a complex tissue that has its own characteristic metabolic features and is interfaced with the whole organism. We investigated changes in basal blood plasma metabolites in the presence of primary brain tumour, their correlation with tumour grade, as well as the feasibility of statistical discrimination based on plasma metabolites. Together 60 plasma samples from patients with clinically defined glioblastoma, meningioma, oligodendrioglioma, astrocytoma, and non-specific glial tumour and plasma samples from 28 healthy volunteers without any cancer history were measured by NMR spectroscopy. In blood plasma of primary brain tumour patients, we found significantly increased levels of glycolytic metabolites glucose and pyruvate, and significantly decreased level of glutamine and also metabolites participating in tricarboxylic acid (TCA) cycle, citrate and succinate, when compared with controls. Further, plasma metabolites levels: tyrosine, phenylalanine, glucose, creatine and creatinine correlated significantly with tumour grade. In general, observed changes are parallel to the biochemistry expected for tumourous tissue and metabolic changes in plasma seem to follow the similar rules in all primary brain tumours, with very subtle variations among tumour types. Only two plasma metabolites tyrosine and phenylalanine were increased exclusively in blood plasma of patients with glioblastoma. Based on metabolite levels, an excellent discrimination between plasma from patient's tumours and controls was attainable. The metabolites creatine, pyruvate, glucose, formate, creatinine and citrate were of the highest discriminatory power.

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BACKGROUND AND OBJECTIVES: Recent evidence indicates that cerebral palsy is connected to specific autonomic dysregulation between sympathetic and parasympathetic efferent pathways, likely linked to hemispheric influences. These findings suggest a hypothesis that contralateral interhemispheric disinhibition, which may occur on various levels of brain processing including motor functions, could be linked to specific functional dysregulation and structural lesions, which may play a specific role in the modulation of autonomic functions and lead to autonomic dysregulation in cerebral palsy. METHOD: With the aim of comparing autonomic functions as they relate to interhemispheric modulatory influences during therapeutically indicated stereotactic cerebellar stimulation, we have performed bilateral electrodermal activity measurement and calculations of pointwise transinformation (PTI) in a patient with cerebral palsy. Measurement was performed during therapeutic deep cerebellar stimulation in two cerebellar areas in anterior cerebellar lobe-culmen (left electrode) and central lobule-superior cerebellar peduncle (right electrode). RESULTS: The results indicate that information transference (PTI) is able to distinguish the states related to specific cerebellar stimulations and that lowest levels of the PTI have been found during stimulation of the central lobule-superior cerebellar peduncle (electrode deepest contact 1), indicating a significantly increased level of inhibition between the left and right sides. CONCLUSION: The results may present potentially useful clinical findings indicating that increased PTI calculated from electrodermal activity could indirectly indicate disinhibitory activity as a possible indicator of a failure of interhemispheric communication that could explain some specific pathogenetic mechanisms in cerebral palsy. Nevertheless, these results need detailed confirmation in further research, as well as reliable clinical evaluation of their usefulness in the therapy of cerebral palsy.

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There is increasing evidence that the extent of tumor removal in low-grade glioma surgery is related to patient survival time. Thus, the goal of resecting the largest amount of tumor possible without leading to permanent neurological sequelae is a challenge for the neurosurgeon. Electrical stimulation of the brain to detect cortical and axonal areas involved in motor, language, and cognitive function and located within the tumor or along its boundaries has become an essential tool in combination with awake craniotomy. Based on a literature review, discussions within the European Low-Grade Glioma Group, and illustrative clinical experience, the authors of this paper provide an overview for neurosurgeons, neurophysiologists, linguists, and anesthesiologists as well as those new to the field about the stimulation techniques currently being used for mapping sensorimotor, language, and cognitive function in awake surgery for low-grade glioma. The paper is intended to help the understanding of these techniques and facilitate a comparison of results between users.

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BACKGROUND AND PURPOSE: The purpose of this study is to present the results of deep cerebellar stimulation in spasticity as a main symptom of cerebral palsy (CP). MATERIAL AND METHODS: Thirteen patients suffering from CP were surgically treated with deep cerebellar stimulation of the superior cerebellar peduncle region between April 2003 and April 2007. Outcome was evaluated in 11 out of 13 patients (two patients had their stimulators removed due to infections). The study group comprised 7 women and 4 men (age range: 16-27). Muscle tone was assessed with the 5-point Ashworth scale. Psychomotor status was evaluated with the questionnaire form prepared specially for this study. Each patient was evaluated four times: before surgery, as well as 6, 12, and 24 months after surgery. RESULTS: A great reduction of muscle tone was observed, mostly in the first six months. An improvement in psychomotor status during 2-year follow-up was also noted. One patient (9.1%) started walking, and speech improved in 7 cases (63.6%). Among patients with epileptic attacks, we found a decrease in frequency and intensity of attacks. Reduction of pain associated with muscle tone and improvement of mood were noted in all patients. Inflammatory complications occurred in 3 out of 13 cases (23.1%) and led to removal of the stimulating systems. In one case the stimulator was re-implanted successfully and the patient was evaluated in the active group. Two other patients (15.4%) were excluded from the active group due to inflammatory complications. CONCLUSIONS: Deep cerebellar stimulation in patients suffering from spasticity in CP is an effective way of treatment; it reduces signs of illness and permits effective rehabilitation, as well as significantly improving the quality of life of these patients. As a non-ablative and reversible procedure it seems to be a safe method of treatment. The most serious complication of the procedure is infection within the operation site.

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