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Objective: Parkinson's disease is a relatively common progressive neurodegenerative disorder, one of whose main features is difficulty with walking. This can be partially corrected by providing cues for the placement of each step. We piloted the potential benefit of simple custom-designed 'walking glasses' worn by the patient that provide visual and auditory cues to aid in step placement. Design: We used a repeated measures design to compare gait performance when unaided and when using the walking glasses with different patterns of visual and auditory stimulation by timing patients' walking over a 'real-life' predefined 30-m course. Setting: Hospital outpatient clinic. Subjects: Fifteen patients with idiopathic Parkinson's disease who had significant gait problems and no other condition affecting gait performance. Main measures: Timed walk. Results: Using the glasses, 8 of 15 patients achieved a significant and meaningful average improvement in walking time of at least 10% (mean (95% confidence interval) improvement in these patients was 21.5% (3.9%)), while a further 2 had subjective and modest objective benefit. Different patterns of visual and auditory cues suited different patients. Visual cueing alone with a fixed horizontal cue line present all the time statistically resulted in the greatest improvement in walking time. Conclusions: This pilot study shows promising improvement in the gait of a significant proportion of Parkinson's disease patients through the use of a simple, inexpensive and robust design of walking glasses, suggesting practical applicability in a therapy setting to large numbers of such patients. [ABSTRACT FROM AUTHOR]

Attempts to reconcile contradictory findings on the origin of essential tremor in the sensorimotor cortex. One study which reports that the origin was discovered by electroencephalogram (EEG), and another which found no correlation to the cortex with magnetoencephalography (MEG); Difficulties associated with interpreting coherence findings; Two other potential sites for the origin of essential tremor; Conclusion.

The placebo is an important tool to blind patients to treatment allocation and therefore minimise some sources of bias in clinical trials. However, placebos that are improperly designed or implemented may introduce bias into trials. The purpose of this systematic review was to evaluate the adequacy of placebo interventions used in low back pain trials. Electronic databases were searched systematically for randomised placebo-controlled trials of conservative interventions for low back pain. Trial selection and data extraction were performed by two reviewers independently. A total of 126 trials using over 25 different placebo interventions were included. The strategy most commonly used to enhance blinding was the provision of structurally equivalent placebos. Adequacy of blinding was assessed in only 13% of trials. In 20% of trials the placebo intervention was a potentially genuine treatment. Most trials that assessed patients’ expectations showed that the placebo generated lower expectations than the experimental intervention. Taken together, these results demonstrate that imperfect placebos are common in low back pain trials; a result suggesting that many trials provide potentially biased estimates of treatment efficacy. This finding has implications for the interpretation of published trials and the design of future trials. Implementation of strategies to facilitate blinding and balance expectations in randomised groups need a higher priority in low back pain research. [ABSTRACT FROM AUTHOR]

Clinical practice guidelines state that the tissue source of low back pain cannot be specified in the majority of patients. However, there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain. The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc, facet joint or sacroiliac joint (SIJ) as the source of low back pain. MEDLINE, EMBASE and CINAHL were searched up to February 2006 with citation tracking of eligible studies. Eligible studies compared index tests with an appropriate reference test (discography, facet joint or SIJ blocks or medial branch blocks) in patients with low back pain. Positive likelihood ratios (+LR) > 2 or negative likelihood ratios (-LR) < 0.5 were considered informative. Forty-one studies of moderate quality were included; 28 investigated the disc, 8 the facet joint and 7 the SIJ. Various features observed on MRI (high intensity zone, endplate changes and disc degeneration) produced informative +LR (> 2) in the majority of studies increasing the probability of the disc being the low back pain source. However, heterogeneity of the data prevented pooling. +LR ranged from 1.5 to 5.9, 1.6 to 4.0, and 0.6 to 5.9 for high intensity zone, disc degeneration and endplate changes, respectively. Centralisation was the only clinical feature found to increase the likelihood of the disc as the source of pain: +LR = 2.8 (95%CI 1.4–5.3). Absence of degeneration on MRI was the only test found to reduce the likelihood of the disc as the source of pain: −LR = 0.21 (95%CI 0.12–0.35). While single manual tests of the SIJ were uninformative, their use in combination was informative with +LR of 3.2 (95%CI 2.3–4.4) and −LR of 0.29 (95%CI 0.12–0.35). None of the tests for facet joint pain were found to be informative. The results of this review demonstrate that tests do exist that change the probability of the disc or SIJ (but not the facet joint) as the source of low back pain. However, the changes in probability are usually small and at best moderate. The usefulness of these tests in clinical practice, particularly for guiding treatment selection, remains unclear. [ABSTRACT FROM AUTHOR]

We describe three middle-aged and previously healthy patients in whom idiopathic spontaneous subdural hemorrhage occurred, giving rise to headache with minimal or no neurological signs and resolving with conservative management. Previous reports of this condition describe an associated severe neurological impairment, a poor prognosis, and a necessity for surgical evacuation. Our cases indicate that mild and self-limiting spontaneous subdural hemorrhage may occur and is perhaps underdiagnosed in our patients' age group because it presents non-specifically with headache. [ABSTRACT FROM AUTHOR]