ResearchPad - Neurology https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[MRI evaluation of the relationship between carotid artery endothelial shear stress and brain white matter lesions in migraine]]> https://www.researchpad.co/product?articleinfo=N33e3509c-592a-4277-a3ee-c1a653188a41

Although white matter lesions are frequently detected in migraine patients, underlying mechanisms remain unclear. Low carotid artery endothelial shear stress has been associated with white matter lesions. We aimed to investigate the association between carotid artery endothelial shear stress and white matter lesions in migraine. In 40 elderly migraine patients (n = 29 females, 75 years [SD 3]) and 219 controls (n = 80 females, 74 years [SD 3]) from the PROSPER-MRI study, carotid artery endothelial shear stress was estimated on 1.5 T gradient-echo phase contrast MRI. White matter lesion volumes were calculated from structural MRI scans. Analyses were adjusted for age, sex, cardiovascular risk factors and cardiovascular disease. Migraine patients had lower mean endothelial shear stress compared to controls (0.90 [SD 0.15] vs. 0.98 [SD 0.16] Pa; P = 0.03). The association between mean endothelial shear stress and white matter lesion volume was greater for the migraine group than control group (P for interaction = 0.05). Within the migraine group, white matter lesion volume increased with decreasing endothelial shear stress (β-0.421; P = 0.01). In conclusion, migraine patients had lower endothelial shear stress which was associated with higher white matter lesion volume.

]]>
<![CDATA[Commentary: Outer Retinal Dysfunction on Multifocal Electroretinography May Help Differentiating Multiple Sclerosis From Neuromyelitis Optica Spectrum Disorder]]> https://www.researchpad.co/product?articleinfo=N42d632ba-a152-4844-ae7d-a5a1246cbb91 ]]> <![CDATA[Severe Acute Flaccid Myelitis Associated With Enterovirus in Children: Two Phenotypes for Two Evolution Profiles?]]> https://www.researchpad.co/product?articleinfo=N28b7bb19-f400-48f3-8794-e9c0f846d91e

Acute flaccid myelitis (AFM) is an acute paralysis syndrome defined by a specific inflammation of the anterior horn cells of the spinal cord. From 2014, worrying waves of life-threatening AFM consecutive to enterovirus infection (EV-D68 and EV-A71) have been reported. We describe 10 children displaying an AFM with an EV infection, the treatments performed and the 1 to 3-years follow-up. Two groups of patients were distinguished: 6 children (“polio-like group”) had severe motor disability whereas 4 other children (“brainstem group”) displayed severe brainstem weakness requiring ventilation support. Electrodiagnostic studies (n = 8) support the presence of a motor neuronopathy associated to myelitis. The best prognosis factor seems to be the motor recovery after the first 4 weeks of the disease.

]]>
<![CDATA[Editorial: Patient Empowerment and Person-Centered Care in Movement Disorders]]> https://www.researchpad.co/product?articleinfo=N6325566a-d15e-4b1e-9c8d-1cc2914fb91d ]]> <![CDATA[Principles of Epilepsy Management for Women in Their Reproductive Years]]> https://www.researchpad.co/product?articleinfo=N50c065b2-7e9d-4ee3-b304-1c87295250ed

In the United States, there are over one million women with epilepsy (WWE) in their childbearing years. Pregnancy can be challenging for this population. A number of international registries have documented that children born to these women are at increased risk for major congenital malformations (MCM), lower intelligence quotient scores and neurodevelopmental disorders, when the mother is managed on antiseizure medications (ASMs). To prevent poor neonatal outcomes for this population, safe and thoughtful management strategies are necessary. We propose to divide these management strategies into five principles. These include (I) choosing suitable ASMs for the patient's seizure type, (II) choosing an ASM with the least teratogenic and cognitive side effects, (III) dosing at the lowest possible effective dosage, (IV) selecting the best ASM regimen as promptly as possible, even before a woman has her first menses, and (V) supplementing these patients with folic acid in order to try to enhance cognition and reduce neural tube defects.

]]>
<![CDATA[Orbital Magnetic Resonance Imaging May Contribute to the Diagnosis of Optic Nerve Lymphoma]]> https://www.researchpad.co/product?articleinfo=Ndff2744d-6348-406f-9a00-f6b22d3ee349

Background: Optic nerve lymphoma can present a diagnostic challenge because of its confusing clinical features and the difficulty of obtaining lesion tissue for biopsy. The objective of this study was to find some flags of lymphomatous infiltration of optic nerves.

Methods: We report two cases of optic nerve lymphoma and conduct a literature review to determine whether a common diagnostic characteristic can be identified.

Results: We examined 22 optic nerve lymphoma cases. Thirteen cases were systemic lymphoma infiltration of the optic nerve, five were primary central nervous system lymphoma (PCNSL), and four were primary isolated optic nerve lymphoma. Twenty patients manifested significant enlargement of the lesions in orbital/brain MRI. Seventeen contrast-enhanced MRIs showed abnormal enhancement of the optic nerve. All PCNSL and isolated optic nerve lymphoma patients in the series showed marked enhancement. Moderate and subtle enhancement was found in systemic lymphoma patients only. At the enhancement site, six isolated optic nerve lymphoma and PCNSL patients presented intrinsic enhancement, ten systemic patients showed both optic nerve and sheath enhancement, and one demonstrated sheath enhancement. Cerebrospinal fluid (CSF) tests showed elevated protein levels in six patients, and a neoplasm in one patient. We found abnormality of CSF immunity in both of our patients.

Conclusion: Combined characteristics of orbital MRI and CSF tests may facilitate expeditious suspicion establishment of optic nerve lymphoma.

]]>
<![CDATA[G-CSF (filgrastim) treatment for amyotrophic lateral sclerosis: protocol for a phase II randomised, double-blind, placebo-controlled, parallel group, multicentre clinical study (STEMALS-II trial)]]> https://www.researchpad.co/product?articleinfo=N6a71a841-f5f7-4bfd-8b02-fef4c48d094f

Introduction

Amyotrophic lateral sclerosis (ALS) is a fatal progressive neurological disorder characterised by a selective degeneration of motor neurons (MNs). Stem cell transplantation is considered as a promising strategy in neurological disorders therapy and the possibility of inducing bone marrow cells (BMCs) to circulate in the peripheral blood is suggested to investigate stem cells migration in degenerated ALS nerve tissues where potentially repair MN damage. Granulocyte-colony stimulating factor (G-CSF) is a growth factor which stimulates haematopoietic progenitor cells, mobilises BMCs into injured brain and it is itself a neurotrophic factor for MN. G-CSF safety in humans has been demonstrated and many observations suggest that it may affect neural cells. Therefore, we decided to use G-CSF to mobilise BMCs into the peripheral circulation in patients with ALS, planning a clinical trial to evaluate the effect of G-CSF administration in ALS patients compared with placebo.

Methods and analysis

STEMALS-II is a phase II multicentre, randomised double-blind, placebo-controlled, parallel group clinical trial on G-CSF (filgrastim) and mannitol in ALS patients. Specifically, we investigate safety, tolerability and efficacy of four repeated courses of intravenous G-CSF and mannitol administered in 76 ALS patients in comparison with placebo (indistinguishable glucose solution 5%). We determine increase of G-CSF levels in serum and cerebrospinal fluid as CD34+ cells and leucocyte count after treatment; reduction in ALS Functional Rating Scale-Revised Score, forced vital capacity, Scale for Testing Muscle Strength Score and quality of life; the adverse events/reactions during the treatment; changes in neuroinflammation biomarkers before and after treatment.

Ethics and dissemination

The study protocol was approved by the Ethics Committee of Azienda Ospedaliera Universitaria ‘Città della Salute e della Scienza’, Torino, Italy. Results will be presented during scientific symposia or published in scientific journals.

Trial registration number

Eudract 2014-002228-28.

]]>
<![CDATA[Comparison of mobile and clinical EEG sensors through resting state simultaneous data collection]]> https://www.researchpad.co/product?articleinfo=Na9ad671e-9020-41e5-9873-c25142c66f31

Development of mobile sensors brings new opportunities to medical research. In particular, mobile electroencephalography (EEG) devices can be potentially used in low cost screening for epilepsy and other neurological and psychiatric disorders. The necessary condition for such applications is thoughtful validation in the specific medical context. As part of validation and quality assurance, we developed a computer-based analysis pipeline, which aims to compare the EEG signal acquired by a mobile EEG device to the one collected by a medically approved clinical-grade EEG device. Both signals are recorded simultaneously during 30 min long sessions in resting state. The data are collected from 22 patients with epileptiform abnormalities in EEG. In order to compare two multichannel EEG signals with differently placed references and electrodes, a novel data processing pipeline is proposed. It allows deriving matching pairs of time series which are suitable for similarity assessment through Pearson correlation. The average correlation of 0.64 is achieved on a test dataset, which can be considered a promising result, taking the positions shift due to the simultaneous electrode placement into account.

]]>
<![CDATA[Human T-cell Lymphotropic Virus Type I Associated with Amyotrophic Lateral Sclerosis Syndrome: Immunopathological Aspects and Treatment Options]]> https://www.researchpad.co/product?articleinfo=Nfc197654-122a-4fc5-b9ac-75f1e2de608e

Human T-cell lymphotropic virus type I (HTLV-I) is a retrovirus related to infectious myelopathies, neoplasms, lymphomas, leukemias, and amyotrophic lateral sclerosis (ALS). It is acquired through sexual transmission, transfusion of blood products, and breastfeeding. The increased expression of human endogenous retrovirus K (HERV-K) in the brain tissue of patients with ALS has been demonstrated, a finding that supports the relationship between the virus and this disease. Therapeutic options include supportive measures and symptomatic treatment with anti-inflammatory medications including steroids, cyclosporines, pentoxifylline, danazol, interferons, and vitamin C. New management proposals are being implemented with valproic acid that acts to facilitate the recognition of the virus by the immune system and with zidovudine antivirals focused on reducing viral load. The purpose of this paper is to describe a clinical case that exhibits clinical signs and evidence of motor neuron compromise as described in electrophysiology studies along with positive laboratory tests for the HTLV-I virus.

]]>
<![CDATA[Usual care and a self-management support programme versus usual care and a relaxation programme for people living with chronic headache disorders: a randomised controlled trial protocol (CHESS)]]> https://www.researchpad.co/product?articleinfo=N66380eea-f76b-460e-8d51-efd77e352582

Introduction

Chronic headaches are poorly diagnosed and managed and can be exacerbated by medication overuse. There is insufficient evidence on the non-pharmacological approaches to helping people living with chronic headaches.

Methods and analysis

Chronic Headache Education and Self-management Study is a pragmatic randomised controlled trial to test the effectiveness and cost-effectiveness of a self-management education support programme on top of usual care for patients with chronic headaches against a control of usual care and relaxation. The intervention is a 2-day group course based on education, personal reflection and a cognitive behavioural approach, plus a nurse-led one-to-one consultation and follow-up over 8 weeks. We aim to recruit 689 participants (356 to the intervention arm and 333 to the control) from primary care and self-referral in London and the Midlands. The trial is powered to show a difference of 2.0 points on the Headache Impact Test, a patient-reported outcome measure at 12 months post randomisation. Secondary outcomes include health related quality of life, self-efficacy, social activation and engagement, anxiety and depression and healthcare utilisation. Outcomes are being measured at 4, 8 and 12 months. Cost-effectiveness will be expressed in terms of incremental cost per quality-adjusted life year gained.

Ethics and dissemination

This trial will provide data on effectiveness and cost-effectiveness of a self-management support programme for chronic headaches. The results will inform commissioning of services and clinical practice. North West – Greater Manchester East Research Ethics Committee have approved the trial. The current protocol version is 3.6 date 7 March 2019.

Trial registration number

ISRCTN79708100.

]]>
<![CDATA[Health Utility Weighting of the Modified Rankin Scale]]> https://www.researchpad.co/product?articleinfo=N8953b731-21ce-41f6-b565-ded738c95d9c

This systematic review and meta-analysis characterizes the between-study variability in health utility weighting of the modified Rankin Scale in a population of patients with stroke and its implications when applied to the results of a clinical trial.

]]>
<![CDATA[Long-Term Neurological Threats of COVID-19: A Call to Update the Thinking About the Outcomes of the Coronavirus Pandemic]]> https://www.researchpad.co/product?articleinfo=Nfb1fc66a-2ed1-41d1-99bc-18e0ca63f494 ]]> <![CDATA[Absent Arm Swing and Dual Tasking Decreases Trunk Postural Control and Dynamic Balance in People With Parkinson's Disease]]> https://www.researchpad.co/product?articleinfo=Ne66cf0c2-3401-439c-8edc-93e7cf20a83e

Introduction: Falling during walking is a common occurrence in people with Parkinson's disease and is closely associated with severe social and medical consequences. Recent evidence demonstrates that arm swing affects dynamic balance in healthy young adults; however, it remains unexamined what its effect is in people with Parkinson's disease, particularly when combined with a secondary dual task.

Methods: Twenty people with Parkinson's disease (63.78 ± 8.97) walked with two arm swing conditions (absent and normal) with and without a secondary dual task. Data were collected on a split-belt treadmill CAREN Extended-System (Motek Medical, Amsterdam, NL). Average and standard deviations for trunk linear and angular velocity were calculated along with their instantaneous values (during foot strikes) in all three axes. Averages and coefficient of variations for step length, time, and width; margin of stability; and harmonic ratios were also calculated.

Results: Compared with normal arm swing, absent arm swing reduced the least affected leg's average step length and increased its step length coefficient of variation while increasing step time coefficient of variation in the most affected leg. Further, absent arm swing reduced trunk anteroposterior instantaneous angular velocity (least affected leg) and reduced anteroposterior instantaneous linear velocity (bilaterally). For the vertical axis, absent arm swing increased the trunk's average angular velocity but reduced its instantaneous linear velocity and angular velocity standard deviation (least affected leg). Additionally, the margin of stability increased when the arms were absent (least affected leg). Alternatively, dual tasking reduced average step time (most affected leg) and increased the step width coefficient of variation (bilaterally). Additionally, dual tasking increased the mediolateral average angular velocity, instantaneous linear velocity standard deviation (bilaterally), and instantaneous angular velocity standard deviation (least affected leg). For the vertical axis, dual tasking increased average linear and angular velocity standard deviation as well as instantaneous angular velocity standard deviation (bilaterally).

Conclusion: Findings suggest that participants attempted to control extraneous trunk movement (due to absent arm swing) through compensatory responses in both lower and upper extremities. However, participants appeared to predominately compensate on their least affected side. Contrastingly, modifying mediolateral foot placement appeared to be the main means of maintaining walking stability while dual tasking.

]]>
<![CDATA[Diffusion Kurtosis Imaging of Microstructural Changes in Gray Matter Nucleus in Parkinson Disease]]> https://www.researchpad.co/product?articleinfo=Nd7b1bd05-105f-430d-b1a5-819fdd342e47

Objective: To explore the microstructural damage of extrapyramidal system gray matter nuclei in Parkinson disease (PD) using diffusion kurtosis imaging (DKI).

Materials and Methods: We enrolled 35 clinically confirmed PD patients and 23 healthy volunteers. All patients underwent MR examination with conventional MRI scan sequences and an additional DKI sequence. We subsequently reconstructed the DKI raw images and analyzed the data. A radiologist in our hospital collected the Mini-Mental State Examination (MMSE) score of all subjects.

Results: In the PD group, the mean kurtosis and axial kurtosis level decreased in the red nucleus (RN) and thalamus; the radial kurtosis increased in the substantia nigra (SN) and globus pallidus (GP). Fractional anisotropy decreased in the putamen. The largest area under the ROC curve of mean diffusion in GP was 0.811. Most kurtosis parameters demonstrated a positive correlation with the MMSE score, while several diffusion parameters showed a negative correlation with the same.

Conclusion: DKI can qualitatively distinguish PD from healthy controls; furthermore, DKI-derived parameters can quantitatively evaluate the modifications of microstructures in extrapyramidal system gray matter nucleus in PD.

]]>
<![CDATA[Clinico-Immunological Status and Neurocognitive Function of Perinatally Acquired HIV-Positive Children on cART: A Cross-Sectional Correlational Study in South Africa]]> https://www.researchpad.co/product?articleinfo=Nee71f0b4-0d36-4cf5-8507-79b3a1103a02

Despite the undisputed benefits of combination antiretroviral therapy (cART), perinatally acquired human immunodeficiency virus (PHIV) children on treatment often present with a spectrum of neurological deficits known as HIV-associated neurocognitive impairment. Even higher CD4 cell count does not seem to prevent the development of neurocognitive impairment in children with PHIV. While CD4 cell count has shown to have the greatest prognostic value, its association with neurocognitive abilities remains to be clarified. This study aimed at determining the correlation between plasma CD4+ lymphocyte and neurocognitive function in children with PHIV on cART. In total, 152 purposively recruited hospital-based sample of children with PHIV on cART, aged 3 years to 7 years 6 months (mean age, 63.13 months), underwent neurocognitive assessment using the Wechsler Preschool and Primary Scale of Intelligence, Third Edition. Immunological status of each child was based on the plasma CD4+ lymphocyte levels. The mean CD4+ lymphocyte cell count at the time of neurocognitive assessment was 1,259.85 cells/mm3 (mean range, 139–2,717 cells/mm3), with significant age difference on CD4+ lymphocyte count levels [F(2, 149) = 13.58, p = 0.000]. CD4+ lymphocyte counts was significantly correlated with subdomains of neurocognitive function scores of task that measures working memory, processing speed, and perceptual reasoning. Global cognitive ability (Full Scale Intellectual Quotient) had no significant association with immunological status of the children. The findings support an association between immunological status of PHIV infection and executive function task. These neurocognitive faculties are critical for learning, school readiness and success in early childhood, and ultimately treatment adherence in adolescence. The need for early identification of neurodevelopment deficits in children, even when on cART, is crucial because early psychosocial and neurorehabilitative interventions can lead to better outcome for children with PHIV.

]]>
<![CDATA[KCNQ2-Neonatal Epileptic Encephalopathy Complicated by Ventricular Tachycardia: A Case Report]]> https://www.researchpad.co/product?articleinfo=N2cd64702-c033-4d6c-8a50-204b103af3bd

Introduction: Mutations in KCNQ2 are related to a spectrum of neonatal epileptic phenotypes. Here we report a case of KCNQ2-related neonatal epileptic encephalopathy (KCNQ2-NEE) that is complicated by an incidentally found ventricular tachycardia.

Case Presentation: An infant boy presented with very early onset refractory focal tonic seizures and developmental delay, and was diagnosed with epilepsy. Trio-whole exome sequencing identified a previously reported de novo mutation in KCNQ2 [c.794C>T; p. (Ala265Val)], a known pathogenic variant for KCNQ2-NEE. Interestingly, ventricular tachycardia was incidentally found on electrocardiography.

Conclusions: We here suggest the possibility of a potential electrophysiologic link between the two phenotypes and that they may be attributable to the same de novo mutation.

]]>
<![CDATA[Surface Electromyography Normalization Affects the Interpretation of Muscle Activity and Coactivation in Children With Cerebral Palsy During Walking]]> https://www.researchpad.co/product?articleinfo=Nefdd1110-903b-431c-bf54-3c7cff0645a7

Investigating muscle activity and coactivation with surface electromyography (sEMG) gives insight into pathological muscle function during activities like walking in people with neuromuscular impairments, such as children with cerebral palsy (CP). There is large variation in the amount of coactivation reported during walking in children with CP, possibly due to the inconsistent handling of sEMG and in calculating the coactivation index. The aim of this study was to evaluate how different approaches of handling sEMG may affect the interpretation of muscle activity and coactivation, by looking at both absolute and normalized sEMG. Twenty-three ambulatory children with CP and 11 typically developing (TD) children participated. We conducted a three-dimensional gait analysis (3DGA) with concurrent sEMG measurements of tibialis anterior, soleus, gastrocnemius medialis, rectus femoris, and hamstring medialis. They walked barefoot at a self-selected, comfortable speed back and forth a 7-m walkway. The gait cycle extracted from the 3DGA was divided into six phases, and for each phase, root mean square sEMG amplitude was calculated (sEMG-RMS-abs), and also normalized to peak amplitude of the linear envelope (50-ms running RMS window) during the gait cycle (sEMG-RMS-norm). The coactivation index was calculated using sEMG-RMS-abs and sEMG-RMS-norm values and by using two different indices. Differences between TD children's legs and the affected legs of children with CP were tested with a mixed model. The between-subject muscle activity variability was more evenly distributed using sEMG-RMS-norm; however, potential physiological variability was eliminated as a result of normalization. Differences between groups in one gait phase using sEMG-RMS-abs showed opposite differences in another phase using sEMG-RMS-norm for three of the five muscles investigated. The CP group showed an increased coactivation index in two out of three muscle pairs using sEMG-RMS-abs and in all three muscle pairs using sEMG-RMS-norm. These results were independent of index calculation method. Moreover, the increased coactivation indices could be explained by either reduced agonist activity or increased antagonist activity. Thus, differences in muscle activity and coactivation index between the groups change after normalization. However, because we do not know the truth, we cannot conclude whether to normalize and recommend incorporating both.

]]>
<![CDATA[The Regulation of microRNAs in Alzheimer's Disease]]> https://www.researchpad.co/product?articleinfo=N0faf9908-7fe0-4c74-aca8-506b9ec8dbaa

MicroRNAs are small non-coding nucleic acids that are responsible for regulating the gene expression by binding to the coding region and 3' and 5' un-translated region of target messenger RNA. Approximately 70% of known microRNAs are expressed in the brain and increasing evidences demonstrate the possible involvement of microRNAs in Alzheimer's disease (AD) according to the statistics. The characteristic symptoms of AD are the progressive loss of memory and cognitive functions due to the deposition of amyloid β (Aβ) peptide, intracellular aggregation of hyperphosphorylated Tau protein, the loss of synapses, and neuroinflammation, as well as dysfunctional autophagy. Therefore, microRNA-mediated regulation for above-mentioned changes may be the potential therapeutic strategies for AD. In this review, the role of specific microRNAs involved in AD and corresponding applications are systematically discussed, including positive effects associated with the reduction of Aβ or Tau protein, the protection of synapses, the inhibition of neuroinflammation, the mitigation of aging, and the induction of autophagy in AD. It will be beneficial to develop effective targets for establishing a cross link between pharmacological intervention and AD in the near future.

]]>
<![CDATA[Ross Syndrome: A Patient with a 23-Year History]]> https://www.researchpad.co/product?articleinfo=N989354a7-c6db-49ce-9b89-5b58dae5d136

We present a 60-year-old female with a 23-year history of anhidrosis with concomitant heat intolerance. At examination, we found a right-sided tonic pupil, absent tendon reflexes, and a segmental patch of compensatory hyperhidrosis in the left lower quadrant of her trunk. To further confirm this finding, a minor test (a starch-iodine test, which is used to evaluate the sudomotor function, sweating) was performed. Nerve conduction studies revealed evidence of a mild distal sensory polyneuropathy of the axonal type. Tilt-table testing showed signs of orthostatic hypotension with evidence of reduced sympathetic function. Skin biopsy excluded pathology in the sweat glands. Our patient met the criteria for a diagnosis of Ross syndrome. This case describes the long-term outcome of this rare entity and highlights how careful examination and bedside autonomic testing can confirm the diagnosis of autonomic neurological disorders.

]]>
<![CDATA[Eufemiusz J. Herman (1892–1985)]]> https://www.researchpad.co/product?articleinfo=Necaf5d78-3a67-4102-bd48-7a68267ab49e ]]>