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With the implementation of the Law for the Restoration of the Professional Civil Service (1933), including the Third Implementation Decree (1934), the Regulation for Obtaining a Teaching License (1934) and the Law for the Dismissal and Transfer of University Teachers (1935), the National Socialist (NS) government created legislative instruments to ban university staff (from lecturers to full professors) labelled as Jewish or considered politically unwanted from teaching and research. Whereas around 20% of the staff at the universities were affected by these measures after 1933, at various medical faculties the figures reached 30–40% and at neurological departments and institutes sometimes up to 90%. Student Nazi activists played a significant role in expelling faculty members from office. As beneficiaries of the expulsions, young doctors often improved their career prospects and established professors remained silent out of political conviction, opportunism or fear. A (self) coordination (Gleichschaltung) with immediate or gradual exclusion of "non-Aryan" members and boards is documented for numerous medical organizations and associations (e.g. Deutscher Ärztevereinsbund, Hartmannbund, German Medical Women's Association, Association of Statutory Health Insurance Physicians) as well as for scientific academies (e.g. Leopoldina) and research societies (Kaiser Wilhelm Institutes, German Research Foundation). The NS-loyal Society of German Neurologists and Psychiatrists, which had been founded in 1935, tolerated "Jewish" members until 1938. As a whole, the picture that emerged from everyday medical (and neurological) practice is one of drastic changes that massively affected not only the lives of many doctors but also the moral standards in terms of patient care, teaching, research and collegiality. [ABSTRACT FROM AUTHOR]

Max Nonne, an internationally renowned German neurologist, acted from 1918 to 1924 as president of the (first) Society of German Neurologists (GDN). Appointed honorary president in 1925, he held this position in the (second) German Neurological Society (DGN) until his death. Since 1961, this association has honored 16 neurologists with a commemorative medal named after Nonne. His outstanding findings in various fields of neurology are uncontested and some of them live on as eponyms (Nonne-Apelt syndrome, Nonne-Froin syndrome, Nonne-Milroy-Meige syndrome); however, recent archival studies and an analysis of individual publications deeply darkened the image of the "grey eminence" of German neurology. Records kept at the Hamburg State Archive prove that in a memorandum from 1941/1942 following the example of Binding and Hoche, Nonne firmly approved the killing of "life absolutely unworthy of living". In a report addressed to the District Court of Hamburg he attested in 1946 that many physicians charged with manslaughter acted in accordance with the regulations governing "child euthanasia", resulting in the withdrawal of the accusation. In a further statement from 1949 he confirmed that the killing of children and the "euthanasia program" during the NS era were consistent with the state of medical science. An earlier book chapter authored by Nonne immediately after World War I suggested that his social-Darwinistically colored concept of mankind was developed clearly before the Nazi era. Notwithstanding the arrangement to which he came with the new powers after 1933 and his acceptance of tributes to him by them, he repeatedly stood up for his Jewish colleagues. He was never a Nazi, nevertheless, he engaged in activities that fostered NS "euthanasia" going far beyond a "mentality of approval". [ABSTRACT FROM AUTHOR]

This article focuses on the institutional development of neurology in Germany up to the rise to power of the National Socialists and the radical sociopolitical changes after 1933. A wide range of scattered secondary literature was assessed and evaluated. Additionally, some original sources are literally quoted and interpreted according to the context. Since the end of the nineteenth century a complicated process of separation from internal medicine and psychiatry led to the formation of a self-conscious discipline of neurology. The first generation of German neurologists succeeded in founding the German Journal for Neurology ( 'Deutsche Zeitschrift für Nervenheilkunde') in 1890 and their own neurological association, the Society of German Neurologists ('Gesellschaft Deutscher Nervenärzte', GDN) in 1907. On an international scale, however, the institutional implementation of neurology with only a small number of chairs and few neurology departments remained more than modest. The ambitions for autonomy ended 2 years after the change of power in 1933. Regulatory interventions by the government and psychiatric interests led to the fusion of the GDN with the psychiatric specialist society, the new association being called the Society of German Neurologists and Psychiatrists ('Gesellschaft Deutscher Neurologen und Psychiater', GDNP) in 1935. In this group psychiatrists dominated the discourse. The expulsion, imprisonment and murder of physicians declared as non-Aryan or Jewish along with the forced consolidation ( 'Gleichschaltung') at the universities prompted profound changes in medical and academic life. It remains an ongoing challenge of neurological historical research to measure the impact of this upheaval on the few neurology departments in hospitals and private practices. [ABSTRACT FROM AUTHOR]

There are only a small number of studies dealing with the impact of eugenic theories and practices on the research of particular neurological diseases during the Third Reich. Thus, this contribution to the special issue on neurology in Germany between 1933 and 1945 focuses exemplarily on epilepsy research. By drawing on primary sources and secondary literature the article tries to reconstruct the scientific discourse of the time and consider the implications for patients. National socialistic ideology was based on eugenic thinking and the implementation of eugenic policies was a major political objective. An immediate effect of this policy was the passing of the Law for the Prevention of Genetically Diseased Offspring ( Gesetz zur Verhütung erbkranken Nachwuchses) in 1933. According to this law 'hereditary epilepsy' along with various other neurological and psychiatric disorders was regarded as a mandatory indication for forced sterilization. Subsequently, funding of epileptological research was generously increased and extended, e. g. at the German Research Institute (Deutsche Forschungsanstalt) in Munich and the Rheinische Provinzial-Institut in Bonn. The main focus was placed on idiopathic forms of the disease, which were a priori considered as hereditary. At the annual meetings of the Society of German Neurologists and Psychiatrists (Gesellschaft deutscher Neurologen und Psychiater), lectures and debates on epilepsy repeatedly constituted a key topic. Some participants opted for a broad interpretation of 'endogeneity' and thus favored an extension of the practice of sterilization but others advocated a more differentiated and restricted attitude. Several neurology researchers showed a penchant for self-mobilization in line with the doctrine of the new government. [ABSTRACT FROM AUTHOR]

The connection between systematic killing of the mentally ill and disabled, euphemistically called 'euthanasia' in the National Socialism ideology, and German brain research has been thoroughly investigated and in detail; however, the impact of this criminal nexus on the image and self-perception of German neurologists as well as the status of neurology as a medical discipline is still the subject of controversial debates. Between 1939 and 1945 the Kaiser Wilhelm Institute (KWI) in Berlin along with other research centres were insofar enmeshed in the 'euthanasia' program as brains of killed patients were dissected in the guise of 'concomitant research' in order to generate medical knowledge. Affected were mainly individuals suffering from oligophrenia, early childhood brain atrophy, cerebral palsy and epilepsy. According to current historical research, collegial networks were instrumental in receiving brains of killed patients. Furthermore, civil research units were supplemented by military ones at the KWI. These, too, were concerned with the collection of medical knowledge, for instance on injuries of the brain and spinal cord. The historical approach to consider the Nazi organizations and medicine as 'resources for each other' seems, therefore, at least in part applicable to neurology. [ABSTRACT FROM AUTHOR]

The article discusses the consequences for neurology as a discipline which resulted from neurologists' participation in the crimes committed under National Socialism (NS). Chronologically, the current literature distinguishes mainly four overlapping stages: (1) a first phase was characterized by legal persecution and 'denazification', which was also the time of the Nuremberg doctors' trial in which no neurologists were on trial. A detailed documentation of the trial for the German medical profession was published by Alexander Mitscherlich. (2) In the subsequent practice of wide amnestying and reintegration of former Nazi followers during the 1950s, neurologists were no exception as its elite continued in their positions. The year 1953 was the year of the Lisbon scandal, when chiefly Dutch representatives protested against the participation of Julius Hallervorden in the International Congress of Neurology. The newly founded societies, the German Society for Neurology (Deutsche Gesellschaft für Neurologie, DGN) and the German Society for Psychiatry and Neurology (Deutsche Gesellschaft für Psychiatrie und Neurologie, DGPN), unanimously supported their member. (3) The next period was characterized by a nascent criticism of the prevailing attitude of covering up the crimes committed by physicians during the Nazi period. The discovery of incriminating brain sections at various Max Planck Institutes brought neurology to the focus of the debate. (4) Since the 1980s and 1990s historians (of medicine) have been systematically examining medicine's Nazi past in a professional way, which resulted in a noticeable increase of knowledge. Additionally, a new generation of scholars provoked a change of mind insofar as they recognized medicine's responsibility for the crimes committed between 1933 and 1945. We expect that future historical research will further elucidate the history of neurology during the NS regime and have consequences for our current understanding of research ethics. [ABSTRACT FROM AUTHOR]

The care of elderly patients will continue to challenge the healthcare system over the next decades. As a rule geriatric patients suffer from multimorbidities with complex disease patterns, and the ability to cope with everyday life is severely reduced. Treatment is provided by a multiprofessional geriatric team, and the primary goal is improvement of functional status, quality of life in the social environment and autonomy by employing a holistic approach. In Germany geriatric care is provided by physicians from various medical specialties (e.g. general practitioners, internists, neurologists and psychiatrists). In the training for the subspecialty clinical geriatrics, these specialties enjoy equal rights. Recent efforts to establish a qualification as physician for internal medicine and geriatrics have initiated a discussion to make the suitability for qualification as a geriatrician dependent on the medical specialty. Geriatric patients benefit from multidisciplinary cooperation. Neurologists possess great expertise in the treatment of patients with dementia, depression, delirium, consequences of degenerative spinal cord diseases and vertebral bone fractures, stroke, Parkinson's syndrome, epileptic seizures, vertigo and dizziness, neuropathies, lesions of peripheral nerves and in the multimodal therapy of pain. To function in a position of responsibility in a geriatric department, neurologists need skills in general internal medicine. These are acquired either on a geriatric ward or during specialization as a neurologist by full time secondment to large neurological or interdisciplinary intensive care units. [ABSTRACT FROM AUTHOR]

Background: The number of sick leaves due to job strain is increasing. Objective: This study's scope is to examine working conditions of neurologists in hospitals in regard to job strain and job satisfaction. Methods: This study is part of the iCEPT-Study. The iCEPT-Study was conducted as a web based survey among physicians ( n = 7090) in German hospitals. The focus was on working conditions regarding job strain. Job strain was measured by a questionnaire consisting of items and scales from the short version of the Effort-Reward-Imbalance (ERI) questionnaire and the short questionnaire for working analysis (KFZA). By calculation ratios of distinct scales according to validated stress models a conclusion could be drawn as to whether or not job strain was present. Results: The total number of n = 354 neurologists were analyzed. The response rate was at 18.2 %. Job strain was encountered by 52.0 % (95 %-KI: 46.7|57.2) of all neurologists and no significant gender difference was present. However, resident neurologists were significantly more often exposed to job strain than attending neurologists (OR = 2.9; 95 %-KI: 1.6-4.7; p < 0.001). Regarding job satisfaction, 59.6 % (95 %-KI: 54.5-64.7) of all respondents stated to be satisfied with their job. Significantly more men were satisfied than women (OR = 1.5; 95 %-KI: 1.0-2.4; p < 0.05). Putting the focus on different occupational positions revealed that significantly more attendings were satisfied with their job than residents (OR = 2.9; 95 %-KI: 1.7-4.8; p < 0.001). Conclusion: The results of this study showed high prevalence of job strain among neurologists in German hospitals. Keeping the negative implications of mental and physical health in mind, the working conditions of neurologists must be improved. As shown in this study, a possible way to do so is to increase job control in order to decrease a major stressor at work. [ABSTRACT FROM AUTHOR]

Background: Germany is confronted with a lack of medical doctors and an increasing need for neurologists in particular. In order to recruit future doctors in neurology it is essential to attract young students when still at university. Objectives: This article presents the first German national survey of medical students' acceptance of teaching methods in neurology. The participants evaluated teaching methods and examination formats and were asked about their preferences. Material and methods: The survey was based on a questionnaire distributed to 22 German medical schools and 1245 participating students. Results: Interactive teaching methods, especially courses in practical examinations, clinical internships and bedside teaching were highly rated among the students. In contrast, multiple choice tests, as one of the most widespread examination methods, were poorly rated compared to practical and oral examinations. For most of the students it was not decisive, in which semester teaching of neurology took place, while the majority asked for additional and more intensive neurological education. Conclusion: The data give an overview of teaching of neurology in Germany and students' assessment of various approaches. The results should be utilized towards reorientation of future curricula that should aim at innovative and even more practically oriented teaching. [ABSTRACT FROM AUTHOR]

Mechanical devices for the recanalization of vessel occlusions in severe acute ischemic stroke have been developed for more than a decade. Several devices have been approved for clinical use on the basis of uncontrolled case series. Many neurologists have asked for randomized clinical trials comparing the new devices with standard treatment, e.g. thrombolytic therapy within a 4.5 h time window. The first 3 investigator initiated randomized trials published in 2013 failed to show superiority of mechanical thrombectomy over standard treatment. In the aftermath of these negative results several new trials with changes in design (e.g. shorter time window and only proximal vessel occlusions) and the use of modern devices with proven higher recanalization rates, so called stent retrievers, have been launched. In October 2014 the first of these new trials was presented and showed a clear superiority of thrombectomy. Based on this result interim analyses of five other studies were performed and most were prematurely terminated because of overwhelming efficacy. Only one trial testing another type of recanalization device failed to reach a statistically significant result. Currently five studies have already been published and two more studies have been presented at scientific conferences. This article provides an overview of the study protocols and the results of the individual studies, their common features and the characteristics of patients who benefit from this treatment. Finally, the consequences that these results may have for the treatment of patients with severe stroke caused by proximal vessel occlusion are discussed. [ABSTRACT FROM AUTHOR]

Summary: The still continuing accelerated development of neurology in Germany is described in this article by a contemporary witness who was active in this field from 1965 to 2005. The personal experiences of the author are obviously only reflected over these 40 years so that the glorious antecedents in the period up to 1933, the era in which our predecessors were the world leaders in neurology, is not sufficiently covered. This dominance was lost by the anti-Semitism during the era of National Socialism and the sequelae of World War II. As a result of the war, German neurologists became effectively isolated and their participation in international congresses was forbidden so that a gradual reestablishment of alignment only became possible after 1960. In this brief description no attempt at completeness has been made and only subjectivity and brevity have been considered. An attempt is made to retrospectively convey what essentially happened. An exact dating of advances over the period was sometimes difficult. The readership will have the opportunity to share the surprise of the author on how meagre the neurological knowledge and diagnostic methods were 50 years ago, how rapidly the subsequent development happened, how rapidly things became obvious which 20 years ago nobody was aware of and despite the progress how pleased we were to find ourselves at the most recent state of error and probably still find ourselves nowadays. In particular, how powerless and untested the therapeutic efforts were at that time. The progress can only be measured by a comparison between then, 50 years ago and the present. A projection of the future based on these experiences is not attempted but it seems to be certain that many conceptions, diagnostic advances and therapy options are still undiscovered and that further exciting times can be expected. [ABSTRACT FROM AUTHOR]

John Rittmeister was a German neurologist (1898-1943) who was executed in Berlin-Plötzensee because of his decision to support organized political resistance against National Socialism. He grew up in a socially and materially privileged environment and following his final school examinations (Abitur) in 1917 he volunteered for war duties despite limited physical capabilities and was posted as a private to the war front in the Italian Alps and the Champagne district. While he was there he made his first social experiences outside his original surroundings. After the war he studied medicine and following the final state examinations and graduation he progressed to specialist training as a neurologist in Munich. At this time he came into contact with C.G. Jung. During a study period in London in 1929 he worked for several weeks as a resident at Toynbee Hall, a university institution in Whitechapel and experienced the methods of community work used there which were known under the term settlement movement. He continued his specialist activities in the neurological clinic in Zürich founded by C. von Monakow. Following the experiences in London he broke up with C.G. Jung and turned to Sigmund Freud and therapeutic analysis under Gustav Bally. In 1937 he returned to Germany. In 1939 he became director of the Policlinic of the German Institute for Psychological Research and Psychotherapy. Probably also due to his own war experiences in 1941/1942 he participated in the drafting of a flyer for the Schulze-Boysen/Harnack group against the war and after 8 months in prison he was executed in Berlin on 13 May 1943. [ABSTRACT FROM AUTHOR]

The great physical resemblance between epileptic and dissociative seizures and a diagnosis of epilepsy that had been made years ago and usually had been treated unsuccessfully makes it difficult for both physician and patient to communicate the diagnosis of dissociative seizures. A direct referral to psychotherapy treatment is rarely accepted by patients. Intermediate steps, which are based on cooperation between neurologists and psychotherapists, are necessary. The approach that we use to communicate diagnosis and motivation for psychotherapeutic treatment includes eight steps: 1. Welcome and introduction; 2. Jointly watching a video of documented seizures; 3. The message that the seizures are not of epileptic origin, 4. Development of an alternative disease concept; 5. Motivation for a conversation with a representative from psychosomatics; 6. Responding to the fear of 'going crazy'; 7. If necessary, briefly touching on the subject of sexual violence; 8. More recommendations and conclusion of the conversation. The manual was discussed and practiced with the attending neurologist in two sessions and is now being regularly used by two neurologists with concomitant supervision. [ABSTRACT FROM AUTHOR]

Background: Neurological critical care lacks high-quality evidence to guide optimal treatment. Furthermore, it is presently rather unclear as to what extent German neurological intensivists adhere to guidelines, employ standard operating procedures or use scoring tools. Methods: An e-mail-based questionnaire was distributed to physicians directing German neurological, neurosurgical and neurological/neurosurgical interdisciplinary intensive care units (ICUs). Results: Of the 326 departments 78 answered the questionnaire and of these 53% were university units. The ICUs were either led by neurologists (37%), neurosurgeons (22%), anesthetists (28%) or a combination of these (13%). The mean number of ICU beds was 11.2 and the mean number of intensivists 7.7. Guideline adherence was stated to amount to 75 % by 41 % of the ICUs. Applications of standard procedures was achieved by more than 80 % for several ICU management aspects, while only 5 out of 19 of the respondents routinely used scoring tools in > 60% of the ICUs. The extent of protocol and score applications differed significantly according to hospital status or leading speciality. Conclusion: This survey suggests an obvious interest in but also an unfulfilled need of guidance in a standardized approach to neurological critical care in Germany. More activity in multicentre clinical research with a neurocritical focus to provide optimization of protocols, scores and guidelines appears to be warranted. [ABSTRACT FROM AUTHOR]

In diabetes mellitus, it is expected to see a common, mainly sensitive, distal symmetrical polyneuropathy (DPN) involving a large proportion of diabetic patients according to known risk factors. Several other diabetic peripheral neuropathies are recognized, such as dysautonomia and multifocal neuropathies including lumbosacral radiculoplexus and oculomotor palsies. In this review, general aspects of DPN and other diabetic neuropathies are examined, and it is discussed why and how the general practionner has to perform a yearly examination. At the present time, some consensuses emerge to ask help from neurologist when faced to other forms of peripheral neuropathies than distal symmetrical DPN. [ABSTRACT FROM AUTHOR]

Background: Decompressive hemicraniectomy reduces mortality in patients with space-occupying MCA infarction. Quality of life in surviving patients is discussed controversially. We assessed attitudes of neurologists and nurses providing care to this patient group towards decompressive hemicraniectomy. Methods: A postal questionnaire on attitudes and opinions on prognosis and quality of life after decompressive hemicraniectomy was returned by 280 neurologists and 166 nurses from tertiary care centers throughout Germany. Results: In both groups of professionals, estimates of the probability of survival after decompressive hemicraniectomy and the resulting degree of disability were consistent with results of clinical outcomes studies. Only 9% of the nurses and 33% of the physicians assumed that the majority of survivors achieve an acceptable quality of life; 58% of physicians and 32% of nurses would suggest decompressive hemicraniectomy to their nearest relative. Under the assumption of an uncertain outcome, 61% of physicians and 22% of nurses would agree to decompressive hemicraniectomy. In both professional groups, agreement for surgery increases when scenarios with a more favorable outcome were proposed [modified Rankin Scale (mRS) 2-5)]. If an outcome of 4 on the mRS is proposed, indicating moderately severe disability, only a minority favored decompressive hemicraniectomy (25% of doctors and 8% of nurses). Conclusions: Despite a realistic assessment of prognosis after decompressive hemicraniectomy, a majority of respondents estimated the quality of life of survivors as unsatisfactory. Nurses had a more pessimistic attitude towards decompressive hemicraniectomy. The majority of respondents consider an outcome of 4 on the mRS as unacceptable. [ABSTRACT FROM AUTHOR]

Reflex psychosis is a pathogenetic concept of the nineteenth century which has its roots in development of the concept of a reflex arc and its transfer to the understanding of psychiatric diseases. Reflex psychosis stands for different mental disorders caused by a peripheral affection, mostly of the skin, which alters brain function with subsequent psychosis. The concept of reflex psychosis also had an impact in questions of the problem of body and soul. Connections to Descartes' mechanistic theory and humoral pathology are discussed. In addition it influences modern psychiatric models, e.g. the vulnerability-stress concept. When the disease concept was first developed, pro and con arguments occupied neurologists, psychiatrists, pathologists and physicians from other specializations too. In Germany important exponents were Griesinger, Koeppe, Flemming and Schüle. This article deals with the phenomenology, development and fate of this concept. [ABSTRACT FROM AUTHOR]

My hands are numb is a common complaint in primary care. Generally, carpal tunnel syndrome can be suspected. This case report explains typical aspects of clinical reasoning used by neurologists to confirm the diagnosis, and also provides some details of "red flags" based on history and examination. Additionally, a short introduction to electrodiagnostic procederes is included and illustrated with diagrams. [ABSTRACT FROM AUTHOR]

Tonic neck reflexes described in 1921 by Magnus and deKlejn in animals and men were studied in hemiplegic patients who were mainly victims of WWI by Arthur Simons, a neurologist in Berlin and coworker of Hermann Oppenheim. The effect of the asymmetric neck reflexes after head rotation was restricted to the paralyzed side: tonus (spasms) of extension and adduction during mid-position of the head or head version to the paralyzed side; flexion tonus and abduction during head version to the non-paralyzed side; and flexion tonus (spasms) of the paralyzed limbs during flexion of the head and extension spasms by head extension. More than this, hemiplegic 'Mitbewegungen' or associated reactions (Walshe) were observed. They are elicited by conscious innervations of the unaffected side, e.g. by fist closure, and are increased or varied by head rotation, the tonic neck reflexes. They occurred in 25%. A film with Arthur Simons as examiner from the years 1916-1919 shows these nearly forgotten phenomena. Their everyday significance was already stressed in 1920, long before the rules of antispastic positions were defined by Bobath. [ABSTRACT FROM AUTHOR]

My hands are numb is a common complaint in primary care. Generally, carpal tunnel syndrome can be suspected. This case report explains typical aspects of clinical reasoning used by neurologists to confirm the diagnosis, and also provides some details of «red flags» based on history and examination. Additionally, a short introduction to electrodiagnostic procederes is included and illustrated with diagrams. [ABSTRACT FROM AUTHOR]

Sepsis is a frequent emergency and an acute disease which is still highly lethal. Due to an early involvement of the brain in terms of a sepsis-associated delirium the neurologist plays an important role in the early diagnosis of the interdisciplinary disease. The following review details the main diagnostic aspects of a sepsis-associated delirium. [ABSTRACT FROM AUTHOR]

The temporal lobes and other cortical regions are involved in the emotional, cognitive and sensorimotor aspects of central control of sexual behaviour, whereas the insula, anterior cingulate and hypothalamus coordinate the activation of the autonomic nervous system. Facilitatory and inhibitory descending pathways modify the activity of thoracolumbar sympathetic and sacral parasympathetic and somatic spinal centres which control the sexual response, i.e. arousal, orgasm and ejaculation. A normal hormonal milieu and vascular system, but also a healthy psychosocial context, are necessary for a fulfilled sexual life. Sexual dysfunction is not uncommon in the general population, particularly in the elderly; it is more common in neurological patients. It significantly lowers their quality of life. The neurologist should diagnose sexual dysfunction in his patients and provide basic management including explanation, suggestions and - if necessary - drugs. [ABSTRACT FROM AUTHOR]

Psychiatry can be seen as a natural and cultural science. According to this the postulate of freedom is its strong value judgment. Since the times of enlightenment it has been described metaphorically by the myth of the expulsion from Paradise. Following Max Weber and Wilhelm Dilthey, Karl Jaspers has introduced this perspective into psychiatry. His strict dichotomy between explaining and understanding has later been critically revised by Werner Janzarik and Hans Heimann. Their concepts of structure dynamic, of pathography and of anthropology are closer to Max Weber who connected natural and cultural sciences in a much stronger way. Especially the pathographic example of Nietzsche allows to demonstrate the differences between Jaspers and the later psychopathologists of the Heidelberg and Tübingen schools. [ABSTRACT FROM AUTHOR]

Salutotherapy encompasses therapeutic strategies and methods in the prevention, treatment and rehabilitation of physical and mental disorders that are primarily aimed at the preservation, recovery and strengthening of health. It is an ancient concept in medicine, but has temporarily been forgotten. However, both conceptual and economic considerations suggest the growing importance of salutotherapeutic approaches. Salutotherapeutic methods include various techniques from the areas of psychotherapy, psychoeducation and learning therapy. The main areas of life such as education, work, interpersonal relationships and sexuality are considered. This article reviews salutotherapeutic approaches. [ABSTRACT FROM AUTHOR]

Somatoform symptoms occur in the absence of clear organic pathology. Typically, such symptoms are long-lasting and disabling. Somatoform symptoms and disorders are highly prevalent in primary care. The course of somatoform disorders is mostly chronic, and remission rates are low. Multiple factors influence the development and perpetuation of somatoform disorders. Currently, there is strong debate about the classification of somatoform disorders, and it is very likely that there will be significant changes in the classification of somatoform disorders in the upcoming DSM-V. With regard to the psychotherapeutic treatment of somatoform disorders, there is empirical evidence for the efficacy of cognitive-behavioral as well as psychodynamic-interpersonal strategies. Pharmacotherapy plays a minor role, but it can be useful mainly in cases of comorbid depression or anxiety. [ABSTRACT FROM AUTHOR]

The National Health Care guidelines on unipolar depression play a leading role regarding the multitude of players providing general care services, regarding scientific research and, last but not least, regarding common etiologic and therapeutic concepts as perceived by affected people and their relatives. In terms of health care, depression as a universal disorder comprises qualitative and quantitative aspects. For practicing neurologists/psychiatrists the guidelines provides many suggestions for different forms of treatment of the many kinds of depressive patients. When using a comprehensive approach, the criteria of evidence-based medicine are particularly important for practicing psychiatrists regarding the knowledge based on medical experience and patients preferences. It is important to point out that the hitherto fervently debated treatment dichotomy of psychotherapy versus pharmacotherapy is beginning to diminish. This is also reflected by the holistic perception of diseases and treatment approaches prevailing among established psychiatrists and the apparent development of health care quality towards individualized medicine. [ABSTRACT FROM AUTHOR]

The relationship between headache and hypertension has been debated for many years. Although most studies have shown that chronic hypertension and headache are not associated, the myth of a hypertensive headache still exists. There are several reasons why the „hypertension headache“ misperception persists: Hypertension is an epiphenomenon of pain. Headache is a common side effect of some antihypertensive drugs. Headache is the most common presenting symptom of hypertensive encephalopathy, followed by seizures, focal neurological deficits and loss of consciousness. This review summarizes the existing literature and highlights the relationship between headache, hypertension and disease with a focus on hypertensive encephalopathy and posterior reversible encephalopathy syndrome with acute endothelial damage. [ABSTRACT FROM AUTHOR]

This article summarizes the new response criteria of the Response Assessment in Neuro-Oncology (RANO) working group and the clinical implications. The RANO criteria represent an important step forward in the accurate assessment of response to therapy in patients with malignant gliomas, not only in clinical trials but also in daily practice. The introduction of new substances to glioma therapy, such as antiangiogenic drugs, has complicated the assessment of efficacy by MRI due to profound effects on the vascular biology of these tumors. Moreover new treatment modalities have increased the incidence and awareness of imaging phenomena, such as pseudoprogression and pseudoresponse, not only within clinical trials but also outside. In addition to MRI the new RANO criteria also take clinical parameters, such as steroid medication and neurological symptoms, into account. Thus both neuroradiologists and neurologists/neurooncologists need to be aware of and experienced in applying these criteria when treating patients with malignant gliomas to be able to correctly assess the response to therapy. [ABSTRACT FROM AUTHOR]

Through a variety of technical enhancements modern radiotherapy offers the possibility to apply a high dose to an exactly defined target volume while the surrounding normal tissue is optimally spared. This article gives a short overview of new methods and techniques for radiotherapy of patients with brain tumors. Developments in the fields of biological imaging, radiation treatment planning, patient positioning and monitoring during radiotherapy will be especially discussed. [ABSTRACT FROM AUTHOR]

The major invasive procedure of the neurologist is the spinal tap. Its most frequent complication is post-lumbar puncture syndrome/headache. The syndrome's leading symptom is posture-dependent headache, which is caused by the prolonged escape of CSF from a dural leak. Its frequency lies between 1 and 30%, depending on the technique used for lumbar puncture. An important measure for reducing the risk of its occurrence is the use of a small (22-gauge), atraumatic Sprotte or Whitacre needle. The treatment of choice for the syndrome is caffeine, and if ineffective, then an epidural blood patch (at least 20 ml of the patient's own blood). Spontaneous low CSF pressure is due to a dural tear; it has the same symptoms as post-dural puncture headache, and on MRI there is a contrast enhancement of the meninges. In most cases the spontaneous low CSF pressure syndrome only is diagnosed after weeks to months. For this reason one should consider this syndrome in all cases of chronic headache. It is also treated with caffeine and an epidural blood patch. If it persists, the leak must be localized by means of radioisotope cisternography, thin-layer MRI, or CT myelography, and then the hole is closed either surgically or by CT-assisted application of fibrin glue. [ABSTRACT FROM AUTHOR]

Restitution after brain damage was the leading topic in 1930 at the 20th annual meeting of the Society of German Neurologists in Dresden, Germany. One of the 'nonanatomic' presentations was held by Viktor von Weizsäcker about modifications in neurological function. Finally the presentation by Kurt Goldstein about restitution after damage of the brain cortex, strongly supported by Weizsäcker, was the starting point for controversies on the significance of natural scientific methods in the field of neurology. Goldstein and Weizsäcker favored the idea that function can be understood only if we consider it in light of the whole organism. However, the president of the Society of German Neurologists, Otfrid Foerster, was mainly influenced by the overall concept of the structure of the peripheral nervous system and - as Weizsäcker indirectly blamed - came to inadequate conclusions by transferring these concepts to the entire nervous system. In contrast Weizsäcker and Goldstein suggested analyzing pathological phenomena not only according to classical physiology, i.e. isolated data acquired by the dissecting method of natural science. Weizsäcker stressed hermeneutic views concerning the mind: body relationship in a phenomenologically oriented medical anthropology. Some years later Foerster linked up with Weizsäcker's position. Goldstein established the new method, the so-called holistic, organismic approach, which he carried on after emigrating to the U.S.A. in 1935. The Heidelberg School around Weizsäcker tried during the following years to liberate neurology from the ideology of materialistic reductionism without however reducing it to simple psychology. The doctrine of neurons and principles of saltatory conduction as basic and descriptive instruments in neurology were not to be questioned. In 1941 Weizsäcker succeeded Foerster as Professor of Neurology at the University of Breslau and Director of the Neurological Research Institute. His literary work 'The Circle of Form. Theory of the Unity of Movement and Perception' and Goldstein's 'The Organism. A Holistic Approach to Biology derived from Pathological Data in Man' [new edn. by Oliver Sacks, Zone Books, New York, 1995] obtained paradigm values which had their beginnings in Dresden in 1930. 'The crisis in biology in the matter of theory of cognition and natural philosophy' was already then obvious and still can be found in present discussion about the relationship between neurosciences and humanities. Weizsäcker increased his focus on medical anthropology by taking a full professorship of general clinical medicine in 1946 in Heidelberg. It is not without reason that Weizsäcker is recognized as a founder of psychosomatic medicine. [ABSTRACT FROM AUTHOR]

Dissociative seizures, albeit a psychiatric symptom, are encountered only rarely in psychiatric settings and more often in a neurologic context. Due to the clinical similarity of these dissociative states with neurological symptoms, optimal treatment is often hampered and lies on the border between psychiatric and neurologic approaches. Diagnostic work-up as well as the therapy may prove to be complex and tedious, partly due to the underlying psychopathology of these patients. Management by neurologists, psychiatrists, and primary care physicians should take into account specific therapeutic and diagnostic guidelines aimed at improving outcome and minimizing the negative social and occupational effect which often burden these patients. [ABSTRACT FROM AUTHOR]