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Sessenta e dois casos de neurossífilis sintomática foram tratados com penicilina G, na dose diária de 20 ou 24 milhões de UI,por via intravenosa, durante 15 a 30 dias. O tempo médio de acompanhamento após o tratamento foi de 30 meses. Aparecimento de novos sinais neurológicos depois do tratamento foi constatado em 13 pacientes. As formas clínicas apresentadas por esses pacientes eram: paralisia geral progressiva (9), taboparalisia (2), tabes dorsal (1) e neurossífilis meningovascular (1). Trinta e seis pacientes (58,1%) apresentaram melhora do quadro clinico, 22 (35,5%) não sofreram alteração e 4 pacientes (6,4%) pioraram clinicamente depois do tratamento. Em dois pacientes houve progressão para outras formas de neurossífilis. Os resultados clínicos da penicilinoterapia intravenosa constatados neste estudo não diferiram daqueles obtidos com penicilinoterapia intramuscular clássica registrados na literatura. Sixty-two patients with symptomatic neurosyphilis were treated with 20 or 24 megaunits of intravenous penicillin G daily for 15 to 30 days. The mean follow-up time after the treatment was 30 months. Thirteen patients developed new neurological signs after the treatment. Their diagnosis were: general paresis (9), taboparesis (2), tabes dorsalis (1) and meningovascular neurosyphilis (1). After the treatment, thirty-six patients (58.1%) improved, 22 patients (35.5%) were unchanged and 4 patients (6.4%) deteriorated on clinical grounds. In two patients there was a progression to other forms of neurosyphilis. The results of the treatment of these patients with high doses of intravenous penicillin G were not different from the results verified with classical intramuscular penicillin that were reported in the literature, from the clinical standpoint.

Summary At the age of 50 years, a known diabetic presented with clinical features of diabetic neuropathy which on investigations proved to be taboparesis. The case is described as a reminder that tabes dorsalis, although rare in the United Kingdom at present, must be included in the differential diagnosis of diabetic neuropathy. In addition, the tabo paresis developed over a 5-year period, in contrast to the slow development classically described in this condition.

The question of tabes from a diagnostic standpoint offers very few difficulties. Where clinical manifestations are few and indefinite, laboratory aids as elaborated by the latest serologic methods give ready and at times conclusive evidence of the presence of this disease. It is not my purpose to travel over well-beaten paths of diagnosis, be it clinical or serologic, but to offer to the neurologist a guide to therapy and to assist in the rendition of a prognostic opinion in this disease. To the serologist it may also be of interest to know that some forms of tabes behave differently from a serologic attitude than others. As there are different types of tabes clinically, so there are also various serologic manifestations of this disease. The clinician is thoroughly familiar with the form of disease which will ultimately present the full picture of taboparesis and is also acquainted with the type that

In June of 1924, we 1 presented a preliminary report on the use of tryparsamide in cases of neurosyphilis. Our earlier report embodied a study of fifty cases of various types of cerebrospinal syphilis. We have extended our studies now to include eighty-five carefully selected patients, whose treatment has been followed for about a year and a half, and who have received a total of more than 800 injections as well as mercury, in the form either of inunctions or of injections, when this was possible, in the interval period between courses of tryparsamide. Of the eighty-five cases, thirty-two were clear cut cases of general paresis, twelve of taboparesis, seven of tabes dorsalis, thirty-three of diffuse cerebrospinal syphilis, and one of acute syphilitic basilar meningitis (Table 1). EFFECT OF TREATMENT In the present study, we attempt to show the effect of the treatment on the clinical progress of the disease.

During the past two decades the widespread therapeutic use of malaria gave rise to the consideration of other pyrexial methods for the treatment of paresis. The present study has been designed to compare the therapeutic results obtained by use of artificial fever produced by physical methods with those obtained by the use of inoculated malaria in the treatment of paresis. These two methods of fever therapy were employed independently or in association with some form of chemotherapy and have been evaluated in terms of the clinical and serologic response observed in the patients. The effects of chemotherapy alone have not been evaluated. THE DATA A total of 1,420 patient records were pooled for this study. Of these, 1,100 patients were treated with malaria and 320 with artificial fever. Prior to the administration of fever therapy, the diagnosis of paresis or of taboparesis was established for each patient. In evaluating the