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where 1 : the exact value of the integral, I (h) : the approximationfrom an n-segment applicationof the trapezoidal rule with stepsizeh : (b - a) I n, andE (h) : the truncation error. If we make two separate estimates using stepsizesof h1 andh2 andhave exact values for the error: I (hr)-t E(ht) : I (h) -f E(hz) (1 8 . 1 )

FIGURE 8-1.

spasm is spontaneous ectopic excitation arising in injured bers Nielsen and Jannetta have shown that ephaptic transmission disappears after the nerve is decompressed Treatment Surgical decompression of a vascular loop, which involves exploration of the posterior fossa, carries some small risk The facial muscles may be weakened, sometimes permanently Another complication has been deafness due to injury of the adjacent eighth nerve Also, there is a modest risk of recurrence of the spasms, usually within 2 years of the operation (Piatt and Wilkins) Operative success depends on tight dural closure to prevent CSF leakage from the posterior fossa The authors suggest that patients with idiopathic hemifacial spasm should rst be treated medically Alexander and Moses noted that carbamazepine (Tegretol) in a dosage of 600 to 1200 mg/day controlled the spasm in two thirds of the patients Baclofen or gabapentin can be tried if carbamazepine fails.

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Some patients cannot tolerate these drugs, have only brief remissions, or fail to respond; they may be treated with botulinum toxin injected into the orbicularis oculi and other facial muscles The hemifacial spasms are relieved for 4 to 5 months and injections can be repeated without danger Some patients have been injected repeatedly for more than 5 years without apparent adverse effects Failing these conservative measures, surgery is quite appropriate Other Disorders of the Facial Nerve Facial myokymia is a ne rippling activity of all the muscles of one side of the face mentioned above It develops most often in the course of multiple sclerosis or a brainstem glioma It has also occurred after other diseases of the facial nerve, eg, in GBS, in which case it is usually bilateral We have seen it more often in the recovery stage than in the early phase of GBS.

The brillary nature of the involuntary movements and their arrhythmicity tend to distinguish them from the coarser intermittent facial spasms and contracture, tics, tardive dyskinesia, and clonus The EMG pattern is one of spontaneous asynchronous discharge of adjacent motor units, appearing singly or in doublets or triplets at a rate varying from 30 to 70 cycles per second Demyelination of the intrapontine part of the facial nerve and possibly supranuclear disinhibition of the facial nucleus have been the postulated mechanisms But the observation of facial myokymia in GBS informs us that the abnormal movement may have its origin in a lesion at any point along the nerve (see pages 1194 and 1278 for further discussion of myokymia) A clonic or tonic contraction of one side of the face may be the sole manifestation of a cerebral cortical seizure.

These slender worms have a complete digestive tube, which extends from the mouth all the way to the anus. Their muscles run lengthwise through their entire bodies, which are nonsegmented (not divided into small segments). But there is no true coelom (cavity with an actual lining of mesoderm) between the muscles and the digestive tube. There is, instead, a pseudocoelom cavity that is lled with uid, but is not lined with mesoderm. Finally, we turn to the coelomates. The coelomates are commonly represented by the annelids (AN-eh-lids) the worms with many little rings of muscles encircling their bodies. The most familiar annelid is the common earthworm (Figure 10.4, C). The earthworm is considered a segmented worm, due to the division of its body into numerous ring-like segments. The uid- lled space surrounding its digestive tract is a true coelom, because

5. Create a tell block for TextEdit, as shown in boldface here:

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