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Miyamoto H, Ikeda T, Akagi M. Conservative treatment for dropped head syndrome. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3505-3510. [PMID: 37597042 DOI: 10.1007/s00586-023-07890-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/13/2023] [Accepted: 08/06/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE Previous reports on the outcome of conservative treatment for dropped head syndrome (DHS) are scarce. The purpose of this study was to elucidate the efficacy of conservative treatment for DHS and to identify possible predictive factors relating to the outcome. METHODS Among 76 DHS patients, conservative treatment (2-3 months collar application, active neck range of motion exercise, and occasional prescription of analgesics) succeeded in 17 patients (22.4%, group S, 4 male, 13 female, mean age 75.9 years). The treatment failed in the remaining 59 patients (group F). Clinical and radiological parameters were compared between the groups. Radiological findings of group S were compared between before treatment and at follow-up. RESULTS Duration of disease was 6.6 ± 9.3 months in group S and 20.0 ± 27.6 months in group F. C2-7 angle (degree), the incidence of anterior slippage of the vertebra (%), reducibility (%), and upper thoracic kyphosis angle (degree) in group S/F were - 19.2 ± 17.5/- 34.6 ± 26.6, 23.5/62.7, 100/52, and 6.7 ± 8.6/17.9 ± 13.7, respectively. C2-7 angles were - 19.2 ± 17.5 degrees at pre-treatment and 10.2 ± 20.7 degrees at follow-up. These differences were statistically significant. CONCLUSIONS The present study indicated that conservative treatment was successful in 22% of DHS patients, with improvement in their cervical kyphotic alignment. Shorter duration of disease, relatively smaller cervical kyphosis without anterior slippage of the vertebra, reducibility, and abundant compensation at the upper thoracic region were good indications for the success of conservative treatment.
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Affiliation(s)
- Hiroshi Miyamoto
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-851, Japan.
| | - Terumasa Ikeda
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-851, Japan
| | - Masao Akagi
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-851, Japan
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Miyamoto H, Ikeda T, Aoyama S, Toriumi K, Akagi M. Dropped head syndrome: a treatment strategy and surgical intervention. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1275-1281. [PMID: 36781488 DOI: 10.1007/s00586-023-07563-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/12/2023] [Accepted: 01/24/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE The pathology of dropped head syndrome (DHS) is diverse, and reports of surgery for DHS are scarce. We aimed to describe surgery for DHS and to investigate the surgical outcomes thereof. METHODS We enrolled 40 consecutive patients (six males and 34 females; average age at surgery, 72.0 years) with DHS who underwent correction surgeries at a single institute. Short fusion (SF), with the extent of fixation mainly at the cervical region, was performed for 27 patients; long fusion (LF), involving the cervical and thoracic spine, for 13. Clinical and radiological outcomes were investigated, and factors analyzed using the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). RESULTS All patients were able to gaze horizontally at the follow-up. Instances of five transient C5 palsy results, and five distal junctional kyphosis results were found, but no revisions were reported due to recurrence. Patients whose T1 slope-20° was smaller than the C2-7 angle postoperatively exhibited better clinical outcomes in the three domains of the JOACMEQ, regardless of the extent of fixation. CONCLUSION For cases where the T1 slope is relatively small, and approximately 10° of cervical lordosis is predicted to be obtained postoperatively, SF is appropriate. Alternatively, for cases with higher T1 slope, obtaining a cervical lordosis over 20° has a risk of postoperative complications. For such cases, it is an option to perform an LF involving the cervical and thoracic spine.
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Affiliation(s)
- Hiroshi Miyamoto
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-851, Japan.
| | - Terumasa Ikeda
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-851, Japan
| | - Shingo Aoyama
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-851, Japan
| | - Kensuke Toriumi
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-851, Japan
| | - Masao Akagi
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-851, Japan
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Yu M, Zhao X, Wu W, Wang Q, Liu J, Zhang W, Yuan Y, Hong D, Wang Z, Deng J. Widespread Mislocalization of FUS Is Associated With Mitochondrial Abnormalities in Skeletal Muscle in Amyotrophic Lateral Sclerosis With FUS Mutations. J Neuropathol Exp Neurol 2022; 81:172-181. [PMID: 35139534 DOI: 10.1093/jnen/nlac004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Mutations in the fused in sarcoma (FUS) gene have been reported to be the most common genetic cause of early-onset amyotrophic lateral sclerosis (ALS); cytoplasmic inclusions containing FUS protein are the predominant pathological feature. Recent studies indicated that mutant FUS impaired neuromuscular junctions and induced muscle intrinsic toxicity in cell and animal models. However, the role of FUS in muscle degeneration remains unclear. In this study, we investigated FUS protein distribution in skeletal muscle fibers in ALS-FUS. Our data show that cytoplasmic mislocalized FUS in the unaggregated form represented a remarkable pathological feature in affected muscle fibers in ALS-FUS. Additional studies found that cytoplasmic FUS colocalized with some mitochondria and was associated with mitochondrial swelling and disorganized cristae. RNA sequencing and quantitative real-time polymerase chain reaction analyses indicated downregulation of the key subunits of mitochondrial oxidative phosphorylation complexes in the affected skeletal muscle in ALS-FUS patients. Further immunoblot analysis showed increased levels of FUS, but decreased levels of Cox I (subunit of complex IV) in ALS-FUS patients compared with age-matched controls. This is the first demonstration of the close association of cytoplasmic mislocalized FUS with mitochondrial dysfunction in skeletal muscle, implicating the presence of a cell-autonomous mechanism in muscle degeneration in ALS.
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Affiliation(s)
- Meng Yu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Xutong Zhao
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Wu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Qingqing Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Jing Liu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Daojun Hong
- Department of Medical Genetics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhaoxia Wang
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Jianwen Deng
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
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Pikatza-Menoio O, Elicegui A, Bengoetxea X, Naldaiz-Gastesi N, López de Munain A, Gerenu G, Gil-Bea FJ, Alonso-Martín S. The Skeletal Muscle Emerges as a New Disease Target in Amyotrophic Lateral Sclerosis. J Pers Med 2021; 11:671. [PMID: 34357138 PMCID: PMC8307751 DOI: 10.3390/jpm11070671] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/09/2021] [Accepted: 07/14/2021] [Indexed: 01/02/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder that leads to progressive degeneration of motor neurons (MNs) and severe muscle atrophy without effective treatment. Most research on ALS has been focused on the study of MNs and supporting cells of the central nervous system. Strikingly, the recent observations of pathological changes in muscle occurring before disease onset and independent from MN degeneration have bolstered the interest for the study of muscle tissue as a potential target for delivery of therapies for ALS. Skeletal muscle has just been described as a tissue with an important secretory function that is toxic to MNs in the context of ALS. Moreover, a fine-tuning balance between biosynthetic and atrophic pathways is necessary to induce myogenesis for muscle tissue repair. Compromising this response due to primary metabolic abnormalities in the muscle could trigger defective muscle regeneration and neuromuscular junction restoration, with deleterious consequences for MNs and thereby hastening the development of ALS. However, it remains puzzling how backward signaling from the muscle could impinge on MN death. This review provides a comprehensive analysis on the current state-of-the-art of the role of the skeletal muscle in ALS, highlighting its contribution to the neurodegeneration in ALS through backward-signaling processes as a newly uncovered mechanism for a peripheral etiopathogenesis of the disease.
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Affiliation(s)
- Oihane Pikatza-Menoio
- Neuromuscular Diseases Group, Neurosciences Area, Biodonostia Health Research Institute, 20014 Donostia/San Sebastián, Spain; (O.P.-M.); (A.E.); (X.B.); (N.N.-G.); (A.L.d.M.); (G.G.); (F.J.G.-B.)
- CIBERNED, Carlos III Institute, Spanish Ministry of Economy & Competitiveness, 28031 Madrid, Spain
| | - Amaia Elicegui
- Neuromuscular Diseases Group, Neurosciences Area, Biodonostia Health Research Institute, 20014 Donostia/San Sebastián, Spain; (O.P.-M.); (A.E.); (X.B.); (N.N.-G.); (A.L.d.M.); (G.G.); (F.J.G.-B.)
- CIBERNED, Carlos III Institute, Spanish Ministry of Economy & Competitiveness, 28031 Madrid, Spain
| | - Xabier Bengoetxea
- Neuromuscular Diseases Group, Neurosciences Area, Biodonostia Health Research Institute, 20014 Donostia/San Sebastián, Spain; (O.P.-M.); (A.E.); (X.B.); (N.N.-G.); (A.L.d.M.); (G.G.); (F.J.G.-B.)
| | - Neia Naldaiz-Gastesi
- Neuromuscular Diseases Group, Neurosciences Area, Biodonostia Health Research Institute, 20014 Donostia/San Sebastián, Spain; (O.P.-M.); (A.E.); (X.B.); (N.N.-G.); (A.L.d.M.); (G.G.); (F.J.G.-B.)
- CIBERNED, Carlos III Institute, Spanish Ministry of Economy & Competitiveness, 28031 Madrid, Spain
| | - Adolfo López de Munain
- Neuromuscular Diseases Group, Neurosciences Area, Biodonostia Health Research Institute, 20014 Donostia/San Sebastián, Spain; (O.P.-M.); (A.E.); (X.B.); (N.N.-G.); (A.L.d.M.); (G.G.); (F.J.G.-B.)
- CIBERNED, Carlos III Institute, Spanish Ministry of Economy & Competitiveness, 28031 Madrid, Spain
- Department of Neurology, Donostialdea Integrated Health Organization, Osakidetza Basque Health Service, 20014 Donostia/San Sebastián, Spain
- Department of Neurosciences, Faculty of Medicine and Nursery, University of the Basque Country UPV-EHU, 20014 Donostia/San Sebastián, Spain
| | - Gorka Gerenu
- Neuromuscular Diseases Group, Neurosciences Area, Biodonostia Health Research Institute, 20014 Donostia/San Sebastián, Spain; (O.P.-M.); (A.E.); (X.B.); (N.N.-G.); (A.L.d.M.); (G.G.); (F.J.G.-B.)
- CIBERNED, Carlos III Institute, Spanish Ministry of Economy & Competitiveness, 28031 Madrid, Spain
- Department of Physiology, University of the Basque Country UPV-EHU, 48940 Leioa, Spain
| | - Francisco Javier Gil-Bea
- Neuromuscular Diseases Group, Neurosciences Area, Biodonostia Health Research Institute, 20014 Donostia/San Sebastián, Spain; (O.P.-M.); (A.E.); (X.B.); (N.N.-G.); (A.L.d.M.); (G.G.); (F.J.G.-B.)
- CIBERNED, Carlos III Institute, Spanish Ministry of Economy & Competitiveness, 28031 Madrid, Spain
| | - Sonia Alonso-Martín
- Neuromuscular Diseases Group, Neurosciences Area, Biodonostia Health Research Institute, 20014 Donostia/San Sebastián, Spain; (O.P.-M.); (A.E.); (X.B.); (N.N.-G.); (A.L.d.M.); (G.G.); (F.J.G.-B.)
- CIBERNED, Carlos III Institute, Spanish Ministry of Economy & Competitiveness, 28031 Madrid, Spain
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Verla T, Vedantam A, North RY, Xu DS, Raber MR, Fuentes A, Liou NE, Ropper AE. Surgical Management of Post-Radiation, Dropped Head Spinal Deformity in Head and Neck Cancer Patients. World Neurosurg 2021; 156:e1-e8. [PMID: 34245881 DOI: 10.1016/j.wneu.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dropped head syndrome is a morbid condition, which affects daily functionality, causing pain and dysphagia and respiratory compromise. Reported causes of dropped head syndrome include neuromuscular disorders, iatrogenic from cervical spine surgery, idiopathic and post-radiation for head and neck cancers. Management of this spinal disorder remains challenging, as the complication rates are high. We present our series of 7 patients who underwent surgical correction of dropped head syndrome, all resulting from radiation for head and neck cancers. METHODS Retrospective review of 7 patients who underwent surgery between 2016 and 2019 for dropped head syndrome secondary to post-radiation cervical spine deformity. Clinical variables were obtained from medical records. Radiographic parameters pre- and post-surgery including T1 slope, sagittal vertical axis, and C2-7 cervical lordosis were examined. RESULTS Seven patients were included in the study, with an average age 69 years. Two patients underwent traction pre-operatively. Five patients had posterior fixation and fusion only and two patients had a combined anterior and posterior fixation and fusion. Overall, there was improvement in average pre/post-op SVA (6.96cm to 3.04cm), T1 slope (33.61o to 24.34o) and C2-7 lordosis (-21.65o to -0.03o). CONCLUSION Surgical correction of post-radiation dropped head spinal deformity involving anterior and posterior fixation with osteotomies provides improvement in functional and radiographic outcomes as shown in our series. These cases are technically challenging and have a high rate of peri-operative complications. Approaches must be tailored to the patient with attention to their specific surgical and radiation history.
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Affiliation(s)
- Terence Verla
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge St, Suite 9A, Houston, TX 77030 USA.
| | - Aditya Vedantam
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge St, Suite 9A, Houston, TX 77030 USA
| | - Robert Y North
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge St, Suite 9A, Houston, TX 77030 USA
| | - David S Xu
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge St, Suite 9A, Houston, TX 77030 USA
| | - Michael R Raber
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge St, Suite 9A, Houston, TX 77030 USA
| | - Alfonso Fuentes
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge St, Suite 9A, Houston, TX 77030 USA
| | - Nelson Eddie Liou
- Bobby R. Alford Department of Otolaryngology, Baylor College of Medicine, 1977 Butler Blvd. Suite E5.200. Houston, TX 77030
| | - Alexander E Ropper
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge St, Suite 9A, Houston, TX 77030 USA
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Kusakabe T, Endo K, Sawaji Y, Suzuki H, Nishimura H, Matsuoka Y, Murata K, Takamatsu T, Maekawa A, Aihara T, Yamamoto K. Mode of onset of dropped head syndrome and efficacy of conservative treatment. J Orthop Surg (Hong Kong) 2021; 28:2309499020938882. [PMID: 32638646 DOI: 10.1177/2309499020938882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The initial treatment of dropped head syndrome (DHS) is basically nonsurgical, but the mode of onset of DHS and efficacy of conservative treatment have not been fully clarified. METHODS The subjects were 38 DHS patients without neuromuscular disease (11 men and 27 women, average age 74.5 years). Cervical collar, physical therapy, and temporary medication for cervical pain were provided for all DHS patients. The following parameters were measured on lateral global spine standing radiographs: sagittal vertical axis (SVA), cervical sagittal vertical axis, C2-C7 angle, first thoracic slope, thoracic kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence. According to the mode of onset of DHS, the subjects were classified into acute-onset group (<3 months) and chronic-onset group (≥3 months). RESULTS Acute- and chronic-onset DHS were observed in 20 and 18 patients, respectively. A history of cervical trauma was involved in nine and two cases of acute- and chronic-onset DHS, respectively. Acute-onset DHS included more balanced-SVA (B-SVA: -30 mm <SVA ≤40 mm) than chronic-onset DHS. In conservative cases, the recovery rate was better in acute-onset DHS with B-SVA. In acute-onset DHS treated conservatively, the recovery rate was significantly poor in cervical trauma cases. CONCLUSIONS Acute-onset DHS includes more balanced SVA and a history of cervical trauma, while acute-onset DHS without a history of cervical trauma has better prognosis by conservative treatment. Surgical indications for DHS should be carefully determined, and sufficient conservative treatment is essential.
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Affiliation(s)
- Takuya Kusakabe
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kenji Endo
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yasunobu Sawaji
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hirosuke Nishimura
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yuji Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kazuma Murata
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Taichiro Takamatsu
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Asato Maekawa
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takato Aihara
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
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Dillingham TR, Annaswamy TM, Plastaras CT. Evaluation of persons with suspected lumbosacral and cervical radiculopathy: Electrodiagnostic assessment and implications for treatment and outcomes (Part II). Muscle Nerve 2020; 62:474-484. [PMID: 32564381 DOI: 10.1002/mus.27008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 11/06/2022]
Abstract
The electrodiagnostic (EDX) examination with needle electromyography (EMG) is the most important means of testing for radiculopathy. This test has modest sensitivity but high specificity and complements imaging of the spine. In this second of a two-part review, the implications of electrodiagnostic findings for diagnosis and clinical management of persons with radiculopathy are reviewed. An EMG confirmed lumbosacral radiculopathy is associated with better clinical outcomes for persons undergoing aggressive conservative management. A positive EMG test portends a better clinical response to epidural corticosteroid injections. If a person undergoes spine surgery, a positive pre-operative EMG for radiculopathy is also associated with better outcomes.
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Affiliation(s)
- Timothy R Dillingham
- Department of Physical Medicine and Rehabilitation, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thiru M Annaswamy
- Electrodiagnostic and Spine Sections, VA North Texas Health Care System, Dallas VA Medical Center, Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christopher T Plastaras
- Musculoskeletal Spine & Sports Rehabilitation Medicine, MossRehab, Einstein Spine Institute, Co-Chair, Albert Einstein Healthcare Network, Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Kudo Y, Toyone T, Endo K, Matsuoka Y, Okano I, Ishikawa K, Matsuoka A, Maruyama H, Yamamura R, Emori H, Tani S, Shirahata T, Hayakawa C, Hoshino Y, Ozawa T, Suzuki H, Aihara T, Murata K, Takamatsu T, Inagaki K. Impact of Spinopelvic sagittal alignment on the surgical outcomes of dropped head syndrome: a multi-center study. BMC Musculoskelet Disord 2020; 21:382. [PMID: 32539767 PMCID: PMC7296732 DOI: 10.1186/s12891-020-03416-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 06/12/2020] [Indexed: 11/18/2022] Open
Abstract
Background Most of the previous studies about the surgical treatment of dropped head syndrome (DHS) are small case series, and their primary outcome measures were cervical alignment parameters. Therefore, little is known about the associations between pre- and postoperative global sagittal alignment in the whole spine and the clinical outcomes of the surgical treatment of DHS. In this study, we investigated the surgical outcomes of DHS, including correction of cervical and global spinal sagittal alignment. Methods This study was a retrospective observational study. Fifteen patients with DHS who had undergone correction surgery were enrolled. Surgical outcomes, including complications and implant failures, were investigated. We assessed cervical alignment parameters as well as spinopelvic global alignment parameters, including pelvic incidence (PI), lumbar lordosis (LL), and C7-sacral sagittal vertical axis (SVA). We examined the changes in these parameters using pre- and posoperative whole spine lateral radiographs. The parameters were compared between the failure and nonfailure groups. Results Recurrence of sagittal imbalance and horizontal gaze difficulty was observed in 6 cases (40%). In all, 3 cases (20%) exhibited a distal junctional failure and required multiple surgeries with extension of fusion. Of all the radiographic parameters compared between the failure and nonfailure groups, significant differences were only observed in pre and postoperative SVA and PI-LL. Conclusions Our results suggest that the global sagittal alignment parameters, including PI-LL and SVA, were different between the patients with failure and non failure, and these parameters might have notable impacts on surgical outcomes. Surgeons should consider PI-LL and SVA while determining the surgical course for patients with DHS.
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Affiliation(s)
- Yoshifumi Kudo
- Department of Orthopaedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8666, Japan.
| | - Tomoaki Toyone
- Department of Orthopaedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Kenji Endo
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yuji Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Ichiro Okano
- Department of Orthopaedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Koji Ishikawa
- Department of Orthopaedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Akira Matsuoka
- Department of Orthopaedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Hiroshi Maruyama
- Department of Orthopaedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Ryo Yamamura
- Department of Orthopaedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Haruka Emori
- Department of Orthopaedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Soji Tani
- Department of Orthopaedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Toshiyuki Shirahata
- Department of Orthopaedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Chikara Hayakawa
- Department of Orthopaedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Yushi Hoshino
- Department of Orthopaedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Tomoyuki Ozawa
- Department of Orthopaedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Hidekazu Suzuki
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Takato Aihara
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kazuma Murata
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Taichiro Takamatsu
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Katsunori Inagaki
- Department of Orthopaedic Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8666, Japan
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Endo K, Kudo Y, Suzuki H, Aihara T, Matsuoka Y, Murata K, Takamatsu T, Sawaji Y, Nishimura H, Matsuoka A, Ishikawa K, Maruyama H, Fukutake K, Wada A, Takahashi H, Toyone T, Yamamoto K. Overview of dropped head syndrome (Combined survey report of three facilities). J Orthop Sci 2019; 24:1033-1036. [PMID: 31444010 DOI: 10.1016/j.jos.2019.07.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/17/2019] [Accepted: 07/24/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dropped head syndrome (DHS) is a low prevalence and the clinical features remain unclear. The purpose of the present study was to clarify the general overview of DHS. METHODS The subjects were 67 consecutive DHS patients (17 men and 50 women; average age 72.9 ± 10.2 years) presenting difficulty of horizontal gaze in up-right position. The patients' background, global spinal alignment, clinical findings and treatment were analyzed. RESULTS The peak population of DHS was 75-79-year-old females. The comorbidities included Parkinson's disease in 9 cases, minor trauma in 9 cases, post-cervical operation in 3 cases, mental depression in 3 cases, malignant tumor in 3 cases, diabetes mellitus in 2 cases and rheumatoid arthritis in 2 cases. The C2-C7 cervical coronal vertical axis was distributed more to the right side (2.6 ± 12.8 mm). Regarding sagittal alignment, 24 cases (35.8%) showed negative balanced DHS (N-DHS) and 43 cases (64.2%) showed positive balanced DHS (P-DHS). There were significant differences in C2-C7 angle, T1S, LL and PI-LL between the two groups. Cervical or back pain was present in 62 cases (92.5%), and average numerical rating scale was 3.0 ± 2.6. Fourteen cases (20.9%) recovered (average 11.3 months), but 29 cases (43.3%) did not recover without surgery. Twenty-four cases (35.8%) underwent surgery, 20 for cervical spine and 4 for thoraco-lumbar spine, and horizontal gaze difficulty was improved in all patients post-surgery. CONCLUSION DHS was mainly observed in elderly women. About 20% of DHS patients recovered without surgical treatment. DHS was accompanied by scoliosis in 37.3% of the cases.
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Affiliation(s)
- Kenji Endo
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Yoshifumi Kudo
- Department of Orthopaedic Surgery, Showa University School of Medicine, Japan
| | - Hidekazu Suzuki
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Takato Aihara
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yuji Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kazuma Murata
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Taichiro Takamatsu
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yasunobu Sawaji
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Hirosuke Nishimura
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Akira Matsuoka
- Department of Orthopaedic Surgery, Showa University School of Medicine, Japan
| | - Koji Ishikawa
- Department of Orthopaedic Surgery, Showa University School of Medicine, Japan
| | - Hiroshi Maruyama
- Department of Orthopaedic Surgery, Showa University School of Medicine, Japan
| | | | - Akihito Wada
- Department of Orthopaedic Surgery, Toho University, Japan
| | | | - Tomoaki Toyone
- Department of Orthopaedic Surgery, Showa University School of Medicine, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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Cervical spondylotic amyotrophy: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2293-2301. [PMID: 31037421 DOI: 10.1007/s00586-019-05990-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/22/2019] [Accepted: 04/22/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Cervical spondylotic amyotrophy (CSA) is characterized by upper limb muscle weakness and atrophy, without sensory deficits. The pathophysiology of CSA has been attributed to selective injury to the ventral nerve root and/or anterior horn of the spinal cord. This review aimed to delineate the history of CSA and to describe the epidemiology, etiology, pathophysiology, classification, clinical features, radiological and electrophysiological assessment, diagnosis, differential diagnosis, natural history and treatment of CSA. METHODS A comprehensive search of PubMed, EMBASE, Cochrane library and Web of Science databases was conducted, from their inception to April 3, 2018. RESULTS Clinically, CSA is classified into three types: a proximal-type (involving the scapular muscles, deltoid and biceps), a distal-type (involving the triceps and muscles of the forearm and hand) and a diffuse-type (involving features of both the distal- and proximal-type). Diagnosis requires documentation of muscle atrophy, without significant sensory deficits, supported by careful neurological, radiological and neurophysiological assessments, with amyotrophic lateral sclerosis, Parsonage-Turner syndrome, rotator cuff tear and Hirayama disease being the principle differential diagnoses. Conservative management of CSA includes cervical traction, neck immobilization and physical therapy, with vitamin B12 or E administration being useful in some patients. Surgical treatment, including anterior decompression and fusion or laminoplasty, with or without foraminotomy, is indicated after conservative treatment failure. Factors associated with a poor outcome include the distal-type CSA, long symptom duration, older age and greater preoperative muscle weakness. CONCLUSION Although the disease process of CSA is self-limited, treatment remains challenging, leaving scope for future studies. These slides can be retrieved under Electronic Supplementary Material.
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Amin Lari A, Ghavanini AA, Bokaee HR. A review of electrophysiological studies of lower motor neuron involvement in amyotrophic lateral sclerosis. Neurol Sci 2019; 40:1125-1136. [PMID: 30877611 DOI: 10.1007/s10072-019-03832-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/07/2019] [Indexed: 02/08/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease involving both the upper and lower motor neuron diseases. In this review, we studied and compared different articles regarding the electrodiagnostic criteria for diagnosis of lower motor neuron pathology in ALS. We reviewed the most recent articles and metaanalysis regarding various lower motor neuron electrodiagnostic methods for ALS and their sensitivities. We concluded that Awaji Shima criteria is by far the most sensitive criteria for diagnosis of ALS.
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Affiliation(s)
- Ali Amin Lari
- Canadian Neurologic Center, Mississauga, ON, Canada.
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Andrews JA, Shefner JM. Clinical neurophysiology of anterior horn cell disorders. HANDBOOK OF CLINICAL NEUROLOGY 2019; 161:317-326. [PMID: 31307610 DOI: 10.1016/b978-0-444-64142-7.00057-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The development of neurophysiological techniques for clinical assessment in the 20th century is closely related to the study of anterior horn cell diseases. The effects of motor axon loss on nerve conduction velocity and compound motor amplitude were elucidated first in amyotrophic lateral sclerosis (ALS), as was the characterization of reinnervation as detected by needle electromyography. The same changes noted in early studies still play a major role in the diagnosis of anterior horn cell diseases. In addition, much of modern neurophysiological assessment of motor axon quantitation, ion channel changes in neurogenic disease, and cortical physiology studies to assess both network and excitability abnormalities have all been applied to ALS. In this chapter, we summarize the clinical attributes of ALS and Spinal Muscular Atrophy, and review how clinical neurophysiology is employed in the clinical and the research setting.
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Affiliation(s)
- Jinsy A Andrews
- The Neurological Institute, Columbia University, New York, NY, United States
| | - Jeremy M Shefner
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, United States.
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Electromyographic Study of Thoracic Paraspinal and Rectus Abdominis Muscles in Amyotrophic Lateral Sclerosis. J Clin Neurophysiol 2018. [DOI: 10.1097/wnp.0000000000000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cykowski MD, Powell SZ, Appel JW, Arumanayagam AS, Rivera AL, Appel SH. Phosphorylated TDP-43 (pTDP-43) aggregates in the axial skeletal muscle of patients with sporadic and familial amyotrophic lateral sclerosis. Acta Neuropathol Commun 2018; 6:28. [PMID: 29653597 PMCID: PMC5899326 DOI: 10.1186/s40478-018-0528-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 03/19/2018] [Indexed: 01/08/2023] Open
Abstract
Muscle atrophy with weakness is a core feature of amyotrophic lateral sclerosis (ALS) that has long been attributed to motor neuron loss alone. However, several studies in ALS patients, and more so in animal models, have challenged this assumption with the latter providing direct evidence that muscle can play an active role in the disease. Here, we examined the possible role of cell autonomous pathology in 148 skeletal muscle samples from 57 ALS patients, identifying phosphorylated TAR DNA-binding protein (pTDP-43) inclusions in the muscle fibers of 19 patients (33.3%) and 24 tissue samples (16.2% of specimens). A muscle group-specific difference was identified with pTDP-43 pathology being significantly more common in axial (paraspinous, diaphragm) than appendicular muscles (P = 0.0087). This pathology was not significantly associated with pertinent clinical, genetic (c9ALS) or nervous system pathologic data, suggesting it is not limited to any particular subgroup of ALS patients. Among 25 non-ALS muscle samples, pTDP-43 inclusions were seen only in the autophagy-related disorder inclusion body myositis (IBM) (n = 4), where they were more diffuse than in positive ALS samples (P = 0.007). As in IBM samples, pTDP-43 aggregates in ALS were p62/ sequestosome-1-positive, potentially indicating induction of autophagy. Phospho-TDP-43-positive ALS and IBM samples also showed significant up-regulation of TARDBP and SQSTM1 expression. These findings implicate axial skeletal muscle as an additional site of pTDP-43 pathology in some ALS patients, including sporadic and familial cases, which is deserving of further investigation.
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Affiliation(s)
- Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA.
- Institute of Academic Medicine (IAM) in the Houston Methodist Research Institute (HMRI), Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA.
| | - Suzanne Z Powell
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
- Institute of Academic Medicine (IAM) in the Houston Methodist Research Institute (HMRI), Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
- Houston Methodist Neurological Institute, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
| | - Joan W Appel
- Houston Methodist Neurological Institute, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
- Department of Neurology, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
| | - Anithachristy S Arumanayagam
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
| | - Andreana L Rivera
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
- Institute of Academic Medicine (IAM) in the Houston Methodist Research Institute (HMRI), Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
- Houston Methodist Neurological Institute, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
| | - Stanley H Appel
- Institute of Academic Medicine (IAM) in the Houston Methodist Research Institute (HMRI), Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
- Houston Methodist Neurological Institute, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
- Department of Neurology, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX, 77030, USA
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Radiologic features of dropped head syndrome in the overall sagittal alignment of the spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:467-474. [PMID: 28601994 DOI: 10.1007/s00586-017-5186-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 05/02/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Dropped head syndrome (DHS) is a rare clinical entity which is defined as a chin-on-chest deformity in the standing or sitting position, resulting from sagittal imbalance of the cervical region. The purpose of the present study was to clarify the radiologic features of DHS in the overall sagittal alignment of the spine. We also investigated the changes in sagittal alignment after correction surgery for DHS. METHODS Twenty DHS patients [1 male and 19 female, with an average age of 78.9 years (range 59-88)] with a main complaint of horizontal gaze disorder were enrolled in this study. Spino-pelvic lateral radiographs in the free-standing clavicle position were taken of all patients. Parameters such as sagittal vertical axis (SVA), C2-7 angle, clivo-axial angle (CAA), C2-7 SVA, T1 slope, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were measured, and the radiologic features of DHS in the overall sagittal alignment of the spino-pelvis were investigated. Eight patients underwent correction surgery, and the parameter changes between pre- and post-operative radiographs were also examined. RESULTS DHS appeared to have two distinct types: SVA+ and SVA-. Seven of 20 cases were SVA+, and 13 were SVA-. The radiologic parameters in which we found statistically significant differences between the groups were: 80.2 ± 68 and -44.5 ± 40 (SVA), 42.1 ± 16.8 and 18.4 ± 11.4 (T1 slope), and 21.1 ± 19.2 and 44.2 ± 19.8 (LL) in SVA+ and SVA-, respectively. After surgical intervention, T1 slope and LL appeared to approach normal in the SVA- group, because compensation at downward spine was no longer necessary. In SVA+ group, although the patients gained horizontal gaze after surgery, abnormality of the sagittal alignment in the whole spine remained, because compensation in the thoracic and lumbar spine was still insufficient. CONCLUSIONS The present study has indicated that radiologic feature of DHS in the sagittal alignment of the overall spino-pelvis can be categorized into two types: SVA+ and SVA-.
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Babu S, Pioro EP, Li J, Li Y. Optimizing muscle selection for electromyography in amyotrophic lateral sclerosis. Muscle Nerve 2017; 56:36-44. [DOI: 10.1002/mus.25444] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 10/12/2016] [Accepted: 10/18/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Suma Babu
- Neuromuscular Center Desk S90, Department of Neurology; Cleveland Clinic; 9500 Euclid Avenue Cleveland Ohio 44195 USA
| | - Erik P Pioro
- Neuromuscular Center Desk S90, Department of Neurology; Cleveland Clinic; 9500 Euclid Avenue Cleveland Ohio 44195 USA
| | - Jianbo Li
- Department of Quantitative Health Sciences; Learner Research Institute, Cleveland Clinic Foundation; Cleveland Ohio USA
| | - Yuebing Li
- Neuromuscular Center Desk S90, Department of Neurology; Cleveland Clinic; 9500 Euclid Avenue Cleveland Ohio 44195 USA
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New insights into the clinical neurophysiological assessment of ALS. Neurophysiol Clin 2016; 46:157-63. [PMID: 27364772 DOI: 10.1016/j.neucli.2016.05.070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 12/11/2022] Open
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Margraf N, Wrede A, Deuschl G, Schulz-Schaeffer W. Pathophysiological Concepts and Treatment of Camptocormia. JOURNAL OF PARKINSON'S DISEASE 2016; 6:485-501. [PMID: 27314757 PMCID: PMC5008234 DOI: 10.3233/jpd-160836] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 12/12/2022]
Abstract
Camptocormia is a disabling pathological, non-fixed, forward bending of the trunk. The clinical definition using only the bending angle is insufficient; it should include the subjectively perceived inability to stand upright, occurrence of back pain, typical individual complaints, and need for walking aids and compensatory signs (e.g. back-swept wing sign). Due to the heterogeneous etiologies of camptocormia a broad diagnostic approach is necessary. Camptocormia is most frequently encountered in movement disorders (PD and dystonia) and muscles diseases (myositis and myopathy, mainly facio-scapulo-humeral muscular dystrophy (FSHD)). The main diagnostic aim is to discover the etiology by looking for signs of the underlying disease in the neurological examination, EMG, muscle MRI and possibly biopsy. PD and probably myositic camptocormia can be divided into an acute and a chronic stage according to the duration of camptocormia and the findings in the short time inversion recovery (STIR) and T1 sequences of paravertebral muscle MRI. There is no established treatment of camptocormia resulting from any etiology. Case series suggest that deep brain stimulation (DBS) of the subthalamic nucleus (STN-DBS) is effective in the acute but not the chronic stage of PD camptocormia. In chronic stages with degenerated muscles, treatment options are limited to orthoses, walking aids, physiotherapy and pain therapy. In acute myositic camptocormia an escalation strategy with different immunosuppressive drugs is recommended. In dystonic camptocormia, as in dystonia in general, case reports have shown botulinum toxin and DBS of the globus pallidus internus (GPi-DBS) to be effective. Camptocormia in connection with primary myopathies should be treated according to the underlying illness.
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Affiliation(s)
- N.G. Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - A. Wrede
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | - G. Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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Jenkins TM, Alix JJ, Kandler RH, Shaw PJ, McDermott CJ. The role of cranial and thoracic electromyography within diagnostic criteria for amyotrophic lateral sclerosis. Muscle Nerve 2016; 54:378-85. [DOI: 10.1002/mus.25062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 01/05/2016] [Accepted: 01/25/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Thomas M. Jenkins
- Sheffield Institute for Translational Neuroscience; University of Sheffield; 385A Glossop Road Sheffield S10 2HQ UK
| | - James J.P. Alix
- Sheffield Institute for Translational Neuroscience; University of Sheffield; 385A Glossop Road Sheffield S10 2HQ UK
| | - Rosalind H. Kandler
- Department of Clinical Neurophysiology; Royal Hallamshire Hospital; Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield UK
| | - Pamela J. Shaw
- Sheffield Institute for Translational Neuroscience; University of Sheffield; 385A Glossop Road Sheffield S10 2HQ UK
| | - Christopher J. McDermott
- Sheffield Institute for Translational Neuroscience; University of Sheffield; 385A Glossop Road Sheffield S10 2HQ UK
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Bent spine syndrome as an initial manifestation of late-onset multiple acyl-CoA dehydrogenase deficiency: a case report and literature review. BMC Neurol 2015. [PMID: 26205240 PMCID: PMC4513616 DOI: 10.1186/s12883-015-0380-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Late-onset multiple acyl-CoA dehydrogenase deficiency (MADD) is an autosomal recessive inherited disease of metabolic dysfunction clinically characterized by fluctuating proximal muscle weakness, excise intolerance, and dramatic riboflavin responsiveness. Dropped head syndrome can occasionally be observed in some severe patients with late-onset MADD; however, bent spine syndrome as an initial symptom had not been reported in patients with late-onset MADD. Case presentation A 46-year-old man lost the ability to hold his trunk upright, and had difficulty in raising his head, but he had no obvious symptoms of limb weakness. Meanwhile, he developed persistent numbness of limbs and lips around. Myopathological features and combined elevation of multiple acylcarnitines indicated that the axial myopathy might be caused by lipid storage myopathy. Cervical and lumbosacral MRI revealed a lot of abnormal signals diffusing along paravertebral muscles, while the abnormal signals almost disappeared after riboflavin treatment. Nerve conduction study indicated the patient suffering from predominantly sensory neuropathy and mildly motor neuropathy. Muscle pathology also demonstrated no typical neurogenic change, which was consistent with the electrophysiological findings. Causative mutations were found in the ETFDH gene. Conclusion We report the first case of late-onset MADD with sensory neuropathy initially manifesting as bent spine syndrome and dropped head syndrome.
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Sekiguchi T, Kanouchi T, Shibuya K, Noto YI, Yagi Y, Inaba A, Abe K, Misawa S, Orimo S, Kobayashi T, Kamata T, Nakagawa M, Kuwabara S, Mizusawa H, Yokota T. Spreading of amyotrophic lateral sclerosis lesions--multifocal hits and local propagation? J Neurol Neurosurg Psychiatry 2014; 85:85-91. [PMID: 24027298 DOI: 10.1136/jnnp-2013-305617] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate whether or not the lesions in sporadic amyotrophic lateral sclerosis (ALS) originate from a single focal onset site and spread contiguously by prion-like cell-to-cell propagation in the rostrocaudal direction along the spinal cord, as has been hypothesised (the 'single seed and simple propagation' hypothesis). METHODS Subjects included 36 patients with sporadic ALS and initial symptoms in the bulbar, respiratory or upper limb regions. Abnormal spontaneous activities in needle electromyography (nEMG)-that is, fibrillation potentials, positive sharp waves (Fib/PSWs) or fasciculation potentials (FPs)-were compared among the unilateral muscles innervated by different spinal segments, especially between the T10 and L5 paraspinal muscles, and between the vastus medialis and biceps femoris. Axon length and the proportion of muscle fibre types, which are both related to motoneuronal vulnerability in ALS, are similar in the paired muscles. RESULTS Fourteen of 36 patients showed a non-contiguous distribution of nEMG abnormalities from the onset site, with skipping of intermediate segments. In eight of them, the non-contiguous pattern was evident between paired muscles with the same motoneuronal vulnerability. The non-contiguously affected lumbosacral lesions involved motoneuron columns horizontally or radially proximate to one another, appearing to form a cluster in four of the eight patients. FPs, known to precede Fib/PSWs, were shown more frequently than Fib/PSWs in all the lumbosacral segments but L5, suggesting that 2nd hits occur at L5 and then spread to other lumbosacral segments. CONCLUSIONS In sporadic ALS, the distribution of lower motoneuron involvement cannot be explained by the 'single seed and simple propagation' hypothesis alone. We propose a 'multifocal hits and local propagation' hypothesis instead.
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Affiliation(s)
- Teruhiko Sekiguchi
- Department of Neurology and Neurological Science, Graduate School, Tokyo Medical and Dental University, , Tokyo, Japan
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Differential pattern of neuroprotection in lumbar, cervical and thoracic spinal cord segments in an organotypic rat model of glutamate-induced excitotoxicity. J Chem Neuroanat 2013; 53:11-7. [DOI: 10.1016/j.jchemneu.2013.09.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 07/13/2013] [Accepted: 09/20/2013] [Indexed: 11/18/2022]
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Dillingham TR. Evaluating the patient with suspected radiculopathy. PM R 2013; 5:S41-9. [PMID: 23524070 DOI: 10.1016/j.pmrj.2013.03.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 03/15/2013] [Indexed: 10/27/2022]
Abstract
Persons with back, neck, and limb symptoms are commonly seen by health care providers. They constitute a major referral population to specialists in electrodiagnostic medicine. The evaluation of these patients involves consideration of both the common and less common disorders. The electrodiagnostic examination with needle electromyography is the most important means of testing for radiculopathy. This test has modest sensitivity but high specificity. It complements imaging of the spine. Electromyography in combination with nerve conduction testing is valuable in excluding entrapment neuropathies and polyneuropathy, conditions that frequently mimic radicular symptoms. A streamlined examination with 6 muscles, 1 of which is the paraspinal, has a high diagnostic yield, yet minimizes patient discomfort and examiner time. This article presents an overview of the electrodiagnostic evaluation for patients with suspected radiculopathy.
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Affiliation(s)
- Timothy R Dillingham
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, 1800 Lombard Street, 1st floor, Philadelphia, PA 19146, USA.
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Thani NB, Bala A, Kimber TE, Lind CRP. High-frequency pallidal stimulation for camptocormia in Parkinson disease: case report. Neurosurgery 2012; 68:E1501-5. [PMID: 21307785 DOI: 10.1227/neu.0b013e318210c859] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Camptocormia is characterized by abnormal flexion of the thoracolumbar spine that increases during upright posture and abates in the recumbent position and has been reported to occur in patients with Parkinson disease. Camptocormia causes significant spinal and abdominal pain, impairment of balance, and social stigma. CLINICAL PRESENTATION A 57-year-old woman with Parkinson disease developed severe camptocormia, which did not improve with trials of antiparkinsonian and muscle relaxant medications. The patient was successfully treated with bilateral globus pallidus interna deep brain stimulation surgery under general anesthesia. High-frequency neuromodulation afforded relief of camptocormia and improvement in Parkinson disease symptoms. CONCLUSION Camptocormia in Parkinson disease may represent a form of dystonia and can be treated effectively with chronic pallidal neuromodulation.
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Affiliation(s)
- Nova B Thani
- West Australian Neurosurgical Service, Sir Charles Gairdner Hospital, Perth, Australia
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Kalmar B, Edet-Amana E, Greensmith L. Treatment with a coinducer of the heat shock response delays muscle denervation in the SOD1-G93A mouse model of amyotrophic lateral sclerosis. ACTA ACUST UNITED AC 2012; 13:378-92. [DOI: 10.3109/17482968.2012.660953] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Jordan B, Eger K, Koesling S, Zierz S. Camptocormia phenotype of FSHD: a clinical and MRI study on six patients. J Neurol 2010; 258:866-73. [PMID: 21165637 DOI: 10.1007/s00415-010-5858-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Revised: 11/27/2010] [Accepted: 11/30/2010] [Indexed: 01/05/2023]
Abstract
Recently it has been postulated that there is an atypical facioscapulohumeral muscular dystrophy (FSHD) phenotype with isolated axial myopathy. Involvement of paraspinal and limb muscles was evaluated in six patients with molecularly proven FSHD and a predominant bent spine phenotype. Consistent with the camptocormia phenotype, the most severely affected muscles in all six patients were the thoracic and lumbar spinal tract together with hamstrings. MRI disclosed severe axial muscle degeneration but mostly subclinical involvement of limb muscles. The involvement of hip extensor muscles in FSHD might considerably contribute to the clinical phenotype of camptocormia due to axial muscle involvement.
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Affiliation(s)
- Berit Jordan
- Department of Neurology, Martin-Luther University Halle-Wittenberg, Halle/Saale, Germany.
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Abstract
Paraspinal EMG needle examination is commonly performed in amyotrophic lateral sclerosis (ALS) for diagnosis. Because lower motor neurons for axial muscles and diaphragm are located medially in the anterior horn, we tested if involvement of axial muscles is associated with diaphragm weakness in ALS. Forty-four ALS patients were included with ALSFRS greater than 20/40. We used needle EMG to search for signs of denervation in biceps, tibialis anterior, C6 and T5 paraspinal muscles, and intercostal and diaphragm muscles. We also evaluated phrenic nerve motor responses and forced vital capacity (FVC). We tested specificity, sensitivity, and discriminative strength (ROC analysis). Fibs-sw in C6 and T5 paraspinal muscles, as well as fibs-sw in diaphragm and intercostal muscles showed high specificity and positive predictive value for FVC<80%. Discriminative strength was good for all the above tests, as well as for phrenic nerve amplitude and ALSFRS regarding FVC<80%. Axial muscles denervation is related to diaphragm denervation and therefore to poor respiratory function in ALS. We suggest that medially located lower motor neurons are affected concurrently in ALS.
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de Carvalho M, Pinto S, Swash M. Motor unit changes in thoracic paraspinal muscles in amyotrophic lateral sclerosis. Muscle Nerve 2009; 39:83-6. [DOI: 10.1002/mus.21202] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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30
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de Carvalho MA, Pinto S, Swash M. Paraspinal and limb motor neuron involvement within homologous spinal segments in ALS. Clin Neurophysiol 2008; 119:1607-13. [DOI: 10.1016/j.clinph.2008.03.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 02/18/2008] [Accepted: 03/01/2008] [Indexed: 11/25/2022]
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31
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Visser J, de Visser M, Van den Berg-Vos RM, Van den Berg LH, Wokke JHJ, de Jong JMBV, Franssen H. Interpretation of electrodiagnostic findings in sporadic progressive muscular atrophy. J Neurol 2008; 255:903-9. [DOI: 10.1007/s00415-008-0813-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2007] [Revised: 10/18/2007] [Accepted: 11/09/2007] [Indexed: 10/22/2022]
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32
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Kiernan MC. Paraspinal muscles and amyotrophic lateral sclerosis - getting to the core? Clin Neurophysiol 2008; 119:1457-8. [PMID: 18468484 DOI: 10.1016/j.clinph.2008.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 03/19/2008] [Indexed: 12/11/2022]
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33
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de Carvalho M, Dengler R, Eisen A, England JD, Kaji R, Kimura J, Mills K, Mitsumoto H, Nodera H, Shefner J, Swash M. Electrodiagnostic criteria for diagnosis of ALS. Clin Neurophysiol 2007; 119:497-503. [PMID: 18164242 DOI: 10.1016/j.clinph.2007.09.143] [Citation(s) in RCA: 804] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2007] [Revised: 09/19/2007] [Accepted: 09/22/2007] [Indexed: 12/13/2022]
Abstract
A consensus meeting was held to determine the best use and interpretation of electrophysiological data in the diagnosis of ALS. The utility of needle EMG and nerve conduction studies was affirmed. It is recommended that electrophysiological evidence for chronic neurogenic change should be taken as equivalent to clinical information in the recognition of involvement of individual muscles in a limb. In addition, in the context of a suspected clinical diagnosis of ALS, fasciculation potentials should be taken as equivalent to fibrillation potentials and positive sharp waves in recognising denervation. The importance of searching for instability in fasciculation potentials and in motor unit potentials in ALS is stressed. These changes in the interpretation of electrophysiological data render obsolete the category Probable Laboratory-Supported ALS in the modified El Escorial diagnostic criteria for ALS. Methods for detection of upper motor neuron abnormality appear sensitive but require further study, particularly regarding their value when clinical signs of upper motor neuron lesion are uncertain.
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Affiliation(s)
- Mamede de Carvalho
- Department of Neurology, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Reinhard Dengler
- Department of Neurology, Medizinische Hochschule Hannover, Germany
| | - Andrew Eisen
- Department of Neurology, University of British Columbia, Vancouver, Canada
| | - John D England
- Department of Neurology, Billings Clinic, Billings, MT, USA
| | - Ryuji Kaji
- Department of Neurology, Tokushima University Graduate School of Medicine, Tokushima-city, Japan
| | - Jun Kimura
- Department of Neurology, University of Iowa, Iowa City, USA
| | - Kerry Mills
- Department of Neurology, Kings College Hospital, Guys Kings and St. Thomas's School of Medicine, London, UK
| | - Hiroshi Mitsumoto
- Eleanor and Lou Gehrig ALS Center, Neurological Institute, Columbia University, NY, USA
| | - Hiroyuki Nodera
- Department of Neurology, Tokushima University, Tokushima-city, Japan
| | - Jeremy Shefner
- Department of Neurology, Upstate Medical University, Syracuse, NY, USA
| | - Michael Swash
- Department of Neurology, Royal London Hospital, Queen Mary University of London, London, UK.
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34
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Makki AA, Benatar M. Diagnostic Accuracy of Thoracic Paraspinal Electromyography in Amyotrophic Lateral Sclerosis. J Clin Neurophysiol 2007; 24:298-300. [PMID: 17545836 DOI: 10.1097/wnp.0b013e31803bb993] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The goal of this study was to estimate the accuracy of thoracic paraspinal (T-PSP) electromyography (EMG), performed at the time of initial evaluation, for the subsequent clinical diagnosis of amyotrophic lateral sclerosis (ALS). Medical records from a consecutive series of patients referred for suspected ALS were abstracted. Those in whom T-PSP EMG was not performed or for whom follow-up was not available were excluded. The study population included 64 patients. T-PSP EMG was abnormal in 28 (44%) study patients, 26 (93%) of whom were subsequently diagnosed with ALS. T-PSP EMG showed neither fibrillation potentials nor positive sharp waves in 36 (56%) patients, 9 (25%) of whom later developed ALS. The sensitivity of T-PSP for the diagnosis of ALS was 0.74 and the specificity was 0.93. The likelihood ratio positive was 10.5 and the likelihood ratio negative was 0.28. These results suggest that T-PSP EMG is very useful for "ruling in" the diagnosis of ALS, but less useful as a screening test for "ruling out" the diagnosis. Because T-PSP EMG is used clinically in an effort to confirm the diagnosis (and not as a screening test), these results suggest that T-PSP EMG is an extremely useful adjunct for the diagnosis of ALS.
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Affiliation(s)
- Achraf A Makki
- Department of Neurology, Emory University, Atlanta, GA 30322, USA
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35
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Nakanishi K, Taneda M, Sumii T, Yabuuchi T, Iwakura N. Cervical myelopathy caused by dropped head syndrome. J Neurosurg Spine 2007; 6:165-8. [PMID: 17330586 DOI: 10.3171/spi.2007.6.2.165] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓The authors present a rare case of cervical myelopathy caused by dropped head syndrome. This 68-year-old woman presented with her head hanging forward. After 1 month, she was admitted to the medical service because of head drop progression. Examination of biopsy specimens from her cervical paraspinal muscles showed nonspecific myopathic features without inflammation, and isolated neck extensor myopathy was diagnosed. The patient’s condition did not respond to the administration of corticosteroids. During follow up as an outpatient, the patient’s head drop continued to gradually progress. At 1 year after onset, she developed bilateral weakness of the upper and lower extremities, clumsiness of the hands, and gait disturbance. A radiograph of the cervical spine obtained in a standing position showed a pronounced kyphotic deformity and instability at the level of C4–5. Magnetic resonance imaging demonstrated spinal cord compression at C-3 and C-4. The patient underwent a C3–4 laminectomy and occipitocervicothoracic fixation. Gait and hand coordination gradually improved, and she was able to walk with no support 1 month postoperatively. Surgical fixation was beneficial in this patient with dropped head syndrome, myelopathy, and cervical instability.
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Affiliation(s)
- Kinya Nakanishi
- Department of Neurosurgery, Kinki University School of Medicine, Osaka, Japan.
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36
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Makki AA, Benatar M. The electromyographic diagnosis of amyotrophic lateral sclerosis: Does the evidence support the El Escorial criteria? Muscle Nerve 2007; 35:614-9. [PMID: 17294439 DOI: 10.1002/mus.20748] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this retrospective cohort study was to examine the accuracy of the El Escorial electromyographic criteria for the diagnosis of amyotrophic lateral sclerosis (ALS). Based on a consecutive series of 73 patients with suspected ALS, the sensitivity of electromyography (EMG) ranged from 0.2 in the cranial segment to 0.74 in the thoracic segment. Specificity was highest (0.92-1.0) in the cranial and thoracic segments. Using receiver operating characteristic (ROC) curve analysis to examine the effect of varying the number of abnormal segments required for the diagnosis, we found an overall accuracy of 0.90 and 0.87 if one or two abnormal segments, respectively, were required. The best combination of sensitivity and specificity was achieved by requiring EMG changes in two segments with abnormalities in a single muscle in the cranial and thoracic segments, but abnormalities in two muscles in the cervical and lumbosacral regions. These findings lend support to the EMG criteria proposed at El Escorial.
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Affiliation(s)
- Achraf A Makki
- Department of Neurology, Emory University School of Medicine, Woodruff Memorial Building, 101 Woodruff Circle, Suite 6000, Atlanta, Georgia 30322, USA
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37
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Wakata N, Konno S, Nomoto N, Sugimoto H, Nemoto H, Kurihara T, Kishi M. Myasthenia gravis with concomitant severe paraspinal muscle degeneration and mitochondrial DNA4977 deletion. Intern Med 2007; 46:747-50. [PMID: 17541228 DOI: 10.2169/internalmedicine.46.6400] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Recent reports have discussed the many causes of dropped head syndrome and bent spine syndrome. We described a case of myasthenia gravis with concomitant severe degeneration of spinal muscle, mitochondrial DNA4977 deletion and sensorineural deafness. These associations were thought to be independent, however this is an important case to consider the etiology of bent spine syndrome.
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Affiliation(s)
- Nobuo Wakata
- Department of Neurology, Toho University, Oohashi Hospital, Tokyo.
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38
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Xu Y, Zheng J, Zhang S, Kang D, Zhang J, Fan D. Needle electromyography of the rectus abdominis in patients with amyotrophic lateral sclerosis. Muscle Nerve 2007; 35:383-5. [PMID: 17034039 DOI: 10.1002/mus.20659] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We examined the role of needle electromyography (EMG) of the rectus abdominis (RA) in assessing thoracic involvement in amyotrophic lateral sclerosis (ALS). Needle EMG of the RA was performed in 67 patients with sporadic ALS and 110 healthy controls. The presence of abnormal spontaneous activity, configuration of motor unit action potentials (MUAPs), and recruitment pattern of motor unit potentials were examined. In ALS patients, MUAPs in the RA were of prolonged duration, large amplitude, and showed increased prevalence of polyphasic waveforms compared to controls. Significant differences in MUAP parameters, presence of abnormal spontaneous potentials, and interference patterns were noted between ALS patients and controls. Additionally, we found that active denervation was more frequent in the RA of ALS patients with dyspnea than those without dyspnea. Thus, conventional needle EMG of the RA is a valuable electrophysiological method to assess clinical and subclinical involvement of thoracic lower motor neurons in patients with suspected ALS.
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Affiliation(s)
- Yingsheng Xu
- Department of Neurology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100083, China
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39
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Critères électro-neuro-myographiques de la sclérose latérale amyotrophique. Rev Neurol (Paris) 2006. [DOI: 10.1016/s0035-3787(06)75163-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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40
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Kawaguchi A, Miyamoto K, Sakaguchi Y, Nishimoto H, Kodama H, Ohara A, Hosoe H, Shimizu K. Dropped Head Syndrome Associated with Cervical Spondylotic Myelopathy. ACTA ACUST UNITED AC 2004; 17:531-4. [PMID: 15570127 DOI: 10.1097/01.bsd.0000123423.12852.bb] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case of an 80-year-old woman with dropped head syndrome associated with cervical spondylotic myelopathy. She could not keep her cervical spine in a neutral position for >1 minute. She had a disturbed gait and severe kyphotic deformity in her thoracic spine. Magnetic resonance imaging revealed severe compression of the spinal cord due to cervical spondylotic change. Laminoplasty from C2 through C6 levels was performed. One year after operation, she could keep her cervical spine in a neutral position easily. Her gait was also improved. The symptoms did not recur during 4 years of follow-up. We surmise that to maintain daily activities, she had to extend her cervical spine owing to the thoracic kyphotic deformity, resulting in compression of the spinal cord. The compression led to weakening of the cervical extensor muscles. Cervical laminoplasty was effective.
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Affiliation(s)
- Atsushi Kawaguchi
- Department of Orthopaedic Surgery, Gifu University School of Medicine, Yanagido 1-1, Gifu City, Gifu, Japan
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41
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Fischer D, Grothe C, Schmidt S, Schröder R. On the early diagnosis of IVIg-responsive chronic multifocal acquired motor axonopathy. J Neurol 2004; 251:1204-7. [PMID: 15503098 DOI: 10.1007/s00415-004-0507-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2003] [Revised: 03/29/2004] [Accepted: 04/01/2004] [Indexed: 10/26/2022]
Abstract
Multifocal acquired motor axonopathy (MAMA) is a treatable, immune mediated motor neuropathy with purely axonal electrophysiological features. Distinction from degenerative neuronopathies such as progressive muscular atrophy (PMA) or early motor neuron disease (MND) can be difficult because of the similar clinical and electrophysiological findings. Here, we report the clinical, electrophysiological and laboratory findings in 6 patients with MAMA. Electrophysiological testing showed purely axonal findings with evidence of pathological spontaneous activity and chronic neurogenic changes. Of particular note, pathological spontaneous activity in paraspinal myotoms was not detectable in any of the patients even though it had been documented in peripheral muscles of the corresponding myotome(s). Elevated serum ganglioside antibody levels,most frequently anti-GD1a antibodies, were present in all 6 patients. IV Ig treatment led to clinical improvement in all but one patient, who showed an allergic response when exposed to IVIg. Our findings indicate that paraspinal EMG and anti-GD1a antibodies can facilitate the early identification of treatable, IVIg responsive, patients with MAMA.
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Affiliation(s)
- Dirk Fischer
- Department of Neurology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
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42
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Bromberg MB. Motor unit action potential analysis of the paraspinal muscles : Paraspinal muap analysis is useful. Muscle Nerve 2004; 29:451-3. [PMID: 14981748 DOI: 10.1002/mus.10562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Mark B Bromberg
- Department of Neurology, University of Utah, 50 North Medical Drive, Salt Lake City, Utah 84132, USA
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43
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Electrodiagnostic assessment of respiratory dysfunction in motor neuron disease. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/s1567-4231(04)04029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Shindo K, Watanabe H, Tanaka H, Nagasaka T, Tsunoda SI, Shiozawa Z. A comparison of sympathetic outflow to muscles between cervical spondylotic amyotrophy and ALS. AMYOTROPHIC LATERAL SCLEROSIS AND OTHER MOTOR NEURON DISORDERS : OFFICIAL PUBLICATION OF THE WORLD FEDERATION OF NEUROLOGY, RESEARCH GROUP ON MOTOR NEURON DISEASES 2002; 3:233-8. [PMID: 12710514 DOI: 10.1080/146608202760839010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
To confirm the diagnostic usefulness of muscle sympathetic nerve activity (MSNA) in differentiation between cervical spondylotic amyotrophy (CSA) and amyotrophic lateral sclerosis (ALS) with cervical spondylosis (CS), MSNA, heart rate (HR) and blood pressure (BP) were recorded in 10 patients with CSA and ALS with CS, and age-matched healthy volunteers at rest and during head-up tilting. There were no differences in age, disability scores, pulmonary function, and HR or BP at rest between ALS and CSA groups. Resting MSNA was significantly greater in patients with ALS with CS than in comparison groups (P<0.001) with virtually no overlap between ALS and the CSA groups. During head-up tilting, changes in BP and MSNA were significantly less in patients with ALS than in patients with other subjects. MSNA at rest clearly differentiated CSA from ALS with CS, suggesting diagnostic utility.
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Affiliation(s)
- Kazumasa Shindo
- Department of Neurology, Yamanashi Medical University, Yamanashi, Japan
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45
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Abstract
This article reviews the electrodiagnostic testing for persons suspected of having radiculopathies and the expected sensitivities that different testing modalities provide. One cannot minimize the importance of the clinical evaluation and differential diagnosis formulation by the electrodiagnostician to guide testing. The needle EMG examination is the most useful electrodiagnostic test but is limited in sensitivity. Electromyographic screening examinations using six muscles are possible that optimize identification yet minimize patient discomfort. Electrodiagnostic findings must be interpreted relative to the patient's clinical presentation, and the consultant should tailor the electrodiagnostic study to the clinical situation.
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Affiliation(s)
- Timothy R Dillingham
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins University, Baltimore, MD 21239, USA [corrected].
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46
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Abstract
The diagnosis of amyotrophic lateral sclerosis (ALS) per se may be challenging since there is no single diagnostic test for ALS (with the exception of finding a mutation in the SOD1 gene). Additionally, the disease may begin focally and resemble a variety of other neurologic disorders that share clinical features with ALS. This latter point emphasizes an important imperative for the clinician--the need to consider a broad range of peripheral and central nervous system disorders in the process of differential diagnosis of ALS, especially when the disease is in its early stages. The authors review the diagnostic criteria for ALS and discuss which features to consider in determining the degree of certainty or level of confidence in the diagnosis. The authors then enumerate the important differential diagnostic possibilities that emerge from a careful consideration of the clinical features and comment on neuroimaging studies and laboratory tests employed in the diagnostic process. Next, the authors turn their attention to the important role played by electrophysiologic studies in the diagnostic evaluation of the patient with suspected ALS. The authors then return to a focused consideration of selected disorders in the differential diagnosis of ALS and conclude with a summary of their diagnostic approach for this disease.
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Affiliation(s)
- David A Chad
- University of Massachusetts Medical School, UMass Memorial Health Care, Department of Neurology, University of Massachusetts Medical Center, 55 Lake Ave., North Worcester, MA 01605, USA.
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47
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Desiato MT, Bernardi G, Hagi H A, Boffa L, Caramia MD. Transcranial magnetic stimulation of motor pathways directed to muscles supplied by cranial nerves in amyotrophic lateral sclerosis. Clin Neurophysiol 2002; 113:132-40. [PMID: 11801435 DOI: 10.1016/s1388-2457(01)00724-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES In amyotrophic lateral sclerosis (ALS), transcranial magnetic stimulation (TMS) detects remarkable abnormalities of central motor circuits: cortical excitability threshold, silent period (SP) duration and intra-cortical inhibition. TMS directed to cranio-facial musculature was performed in ALS patients in order: (1) to document the neurophysiological involvement of motor central and peripheral cranial pathways by evaluating changes of threshold and SP; (2) to discover a possible correlation between the clinical picture and abnormal excitability properties. METHODS Motor evoked potentials (MEPs) were recorded from masseter, genioglossus and orbicularis oris muscles of both sides in 25 ALS patients and 25 controls, in response to TMS delivered over the face M1 area and the vertex. RESULTS TMS gave rise to two orders of responses: bilateral MEPs during contraction represented the central responses, and motor action potentials (MAPs) during rest represented the peripheral responses. MEPs were followed by SPs, which increased linearly with increasing TMS intensity (r=0.8). At least one of the analyzed parameters was abnormal in all patients: central abnormalities (increased active threshold, delayed MEPs, reduced SP) were found in 96% of patients, alone or combined with abnormalities of the MAPs (reduced area and/or prolonged latency). The reduction of SP was linearly related to the Norris score (r=0.95). CONCLUSIONS Our study shows that TMS is able to detect the involvement of multiple cranial muscles in ALS. This finding offers often pre-clinical information about the disease picture. Therefore, it can be employed as a valuable means for early diagnosis.
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Affiliation(s)
- Maria Teresa Desiato
- Clinica Neurologica, Dipartimento di Neuroscienze, Università Tor Vergata, Ospedale S. Eugenio, Piazzale Umanesimo, 10, 00144 Rome, Italy
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48
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Takekawa H, Kubo J, Miyamoto T, Miyamoto M, Hirata K. Amyotrophic lateral sclerosis associated with insomnia and the aggravation of sleep-disordered breathing. Psychiatry Clin Neurosci 2001; 55:263-4. [PMID: 11422868 DOI: 10.1046/j.1440-1819.2001.00852.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A case of amyotrophic lateral sclerosis (ALS) diagnosed by sleep-disordered breathing is described. The patient's chief complaints were insomnia and nocturnal dyspnea after taking a hypnotic drug. On examination, he showed restrictive ventilatory impairment, alveolar hypoventilation and hypoxia. Polysomnographic examination revealed marked hypoxia during REM sleep periods, decreased duration of REM sleep periods, and increased sleep disruption. Amyotrophic lateral sclerosis was diagnosed by the neurological finding of paraspinal muscle weakness and neurogenic changes revealed by needle electromyography and muscle biopsy. The daytime and nocturnal respiratory insufficiency improved after nasal bilevel positive airway pressure therapy. Amyotrophic lateral sclerosis should be suspected as a cause of insomnia and nocturnal dyspnea.
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Affiliation(s)
- H Takekawa
- Department of Neurology, Dokkyo University School of Medicine, Tochigi, Japan
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49
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Electrodiagnostic Approach to Patients with Suspected Generalized Neuromuscular Disorders. Phys Med Rehabil Clin N Am 2001. [DOI: 10.1016/s1047-9651(18)30068-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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50
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Affiliation(s)
- J A Van Gerpen
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
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