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BACKGROUND: Incidental observations led to the question whether ESWT could alleviate the still difficult-to-improve symptoms of DSPNP. METHODS: In a pilot study, out of an original 24 patients with DSPNP, 10 patients with diabetes mellitus were excluded because of their inhomogeneous performances. Of the 14 patients remaining, 6 received one sham treatment at the beginning. All 14 patients were then treated with ESWT to the soles of the feet using the Duolith® shock wave generator (Storz Medical) 3 times weekly for 2 weeks. The assessments were carried out before and after the sham treatment, the first ESWT (question: before and after the first ESWT or only after?) and after 2, 4 and 8 weeks. RESULTS: The placebo treatment did not influence pain or paraesthesia. After the 2 weeks of ESWT, intensity decreased from 100% to 23.6%, rising again after 8 weeks to 45.7% of the original state (p < 0.01). The placebo treatment did however have a great effect on walking abilities. The results of ESWT did not become significant until the 8th week. Step length improved by 14.6% (p < 0.001), walking speed by 24.8% (p < 0.001) and time of dual support during the stance phase of the gait declined by 12.2% (p < 0.009). CONCLUSIONS: Despite the small number of cases, it appears that ESWT can alleviate some of the symptoms of DSPNP.

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OBJECTIVE: Can stimulation of nerve growth factors by focused transcranial extracorporeal shock wave therapy (TESWT) be made effective for persons within unresponsive wakefulness syndrome (apallic syndrome)? DESIGN: Between eight and 18 years after the brain lesion, five patients with unresponsive wakefulness syndrome of differing severity received TESWT with the device Duolith (Storz Medical) during four-week physicomedical complex therapies. In the previous years they had been treated with the same complex therapies without TESWT. The vigilance did not change. RESULTS: After two-four years and an average of 5.2 treatment series, the patients' abilities improved by 135.9% on the German Coma Remission Scale (KRS) and by 43.6% on the Glasgow Coma Scale. In the motor area of the KRS, the patients improved by 64.3%. Three PEG feeding tubes could be removed, nonverbal communication initiated four times. CONCLUSION: In this longitudinal observation study, focused TESWT stimulated vigilance in patients with unresponsive wakefulness syndrome. The precise neurophysiological effects remain to be verified by a study of the clinical results.

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In two previous fMRI studies, it was reported that eyes-open and eyes-closed conditions in darkness had differential effects on brain activity, and typical patterns of cortical activity were identified. Without external stimulation, ocular motor and attentional systems were activated when the eyes were open. On the contrary, the visual, somatosensory, vestibular, and auditory systems were activated when the eyes were closed. In this study, we investigated whether cortical areas related to the olfactory and gustatory system are also animated by eye closure without any other external stimulation. In a first fMRI experiment (n = 22), we identified cortical areas including the piriform cortex activated by olfactory stimulation. In a second experiment (n = 12) subjects lying in darkness in the MRI scanner alternately opened and closed their eyes. In accordance to previous studies, we found activation clusters bilaterally in visual, somatosensory, vestibular and auditory cortical areas for the contrast eyes-closed vs. eyes-open. In addition, we were able to show that cortical areas related to the olfactory and gustatory system were also animated by eye closure. These results support the hypothesis that there are two different states of mental activity: with the eyes closed, an "interoceptive" state characterized by imagination and multisensory activity and with the eyes open, an "exteroceptive" state characterized by attention and ocular motor activity. Our study also suggests that the chosen baseline condition may have a considerable impact on activation patterns and on the interpretation of brain activation studies. This needs to be considered for studies of the olfactory and gustatory system.

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INTRODUCTION: Extracorporeal shock waves (ESW) are being used increasingly frequently for the treatment of narrowly localized pain in the musculoskeletal system. Pain is normally associated with muscular dysfunction. Beginning with the observation that not only is the pain soothed by treatment with ESW, but that the muscular dysfunction itself is relieved, an attempt has been made to treat the impaired function in cases of infantile cerebral palsy with ESW. METHOD: In 35 children and young people with mainly spastic disturbances of movement, the bellies of those muscles producing the flexion contracture of the lower limb were each treated with 500 non-focused pulses of low-energy ESW. The focus (focal pressure 10 MPA=0.06 mJ/mm) of the shock waves itself was placed either within the coupling cushion of the therapy source (Minilith, Storz Medical, CH-Kreuzlingen) or obliquely outside the patient's body. In this way ESW could be dispersed throughout the muscles and the risk of undesirable effects was minimized. The energy used amounted to about 30% of the threshold value at which cellular damage from focused treatment with ESW had been observed in the endothelium of the human umbilical cord. RESULTS: The degree of movement at the hip joint increased after one treatment by an average of 17 degrees, at the knee joint by 12.3 degrees and at the ankle joint by 7.1 degrees, each increase being statistically significant. Muscular stiffness, spastic co-contractions, and myofascial viscoelasticity, as well as dyskinetic and ataxic symptoms, decreased. It appeared as if a systemic action had entered into the motor control. Together with an increase in general proprioception, there was an improvement in body image, in economy of movement and also in the limbs that had not been treated. A few patients showed euphoric reactions for about 2 days after treatment. No undesirable effects were observed during a follow-up of 12 months. The treatment was painless and is therefore suitable for children. The biomechanical improvement remained for several weeks and this time could be used for initiating an improved pattern of movement. CONCLUSION: ESW is suitable for use as an additional instrument for physiotherapeutic treatment of infantile cerebral palsy. The effective action of ESW on disturbed peripheral muscles has been discussed in terms of positive pressure and tensile wave forces and/or forces acting by cavitation. The results obtained in this pilot investigation showed particular a decrease in muscle stiffness. A controlled investigation with gait analysis and psychological control is to be undertaken.