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Jankelowitz SK, Tastula K, Mitchell N, Tang P, Ang T, Brunacci D, Parker G, Winters S, Wong J, Allen R, Worthington J. 087 Endovascular clot retrieval (ECR) in the elderly. For better or worse in the real world? J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-anzan.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
IntroductionAcross multicentre trials ECR is safe and effective in octogenarians. Despite RCT evidence elderly patients may be denied ECR due to perceived poor risk-benefit. We examine impact of age on ECR outcomes and outcomes in transcatheter aortic valve implantation (TAVI) cases (where stroke risk is high), in a real world setting.MethodsWe analysed 311 consecutive ECR cases between 2016 and 2019 in 10 year age bands for ECR outcomes including 90 day mRS and mortality. Impact of premorbid function (mRS), NIHSS, recorded co-morbidities, and aetiology was assessed. TAVI case outcomes were examined.ResultsThirty one percent of ECR outcome cases were over 79 years of age; 90 day mortality was 34%; 25% had a 90 day mRS 0–2. Early NIHSS improvement was 5. Ninety-day mortality and mRS 0–2 for 10–19 (n=3), 20–29 (n=2), 30–39 (n=4), 40–49 (n=23), 50–59 (n=27), 60–69 (n=69), 70–79 (n=84),80–89 (n=62) and 90–99 (n=11) years were 0 and 100%, 0 and 100%, 33 and 67%, 4 and 78%, 15 and 52%, 13 and 49%, 17 and 33%, 24 and 2% and 55 and 18%, respectively. There was 9% lost to follow-up.Six TAVI cases had a NIHSS of 8–20 and pre-morbid mRS<3, four with mRS 0. Mean 24 hour NIHSS improvement was 8.ConclusionWithout age exclusions older patients had worse unadjusted outcomes. However, patients over 79 years had clinically important early improvement in NIHSS score and ninety day outcomes were comparable to favourable RCT data and TAVI patients also had early improvement.
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Taylor RL, Jankelowitz SK, Young AS, Sullivan D, Halmagyi GM, Welgampola MS. Reversible vestibular neuropathy in adult Refsum disease. Neurology 2018; 90:890-892. [PMID: 29626179 DOI: 10.1212/wnl.0000000000005472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 02/08/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Rachael L Taylor
- From the Institute of Clinical Neurosciences (R.L.T., S.K.J., A.S.Y., G.M.H., M.S.W.) and Department of Clinical Biochemistry (D.S.), Royal Prince Alfred Hospital, and Faculty of Medicine (D.S.), Central Clinical School, University of Sydney; and The Balance Clinic and Laboratory (A.S.Y., M.S.W.), Sydney, Australia
| | - Stacey K Jankelowitz
- From the Institute of Clinical Neurosciences (R.L.T., S.K.J., A.S.Y., G.M.H., M.S.W.) and Department of Clinical Biochemistry (D.S.), Royal Prince Alfred Hospital, and Faculty of Medicine (D.S.), Central Clinical School, University of Sydney; and The Balance Clinic and Laboratory (A.S.Y., M.S.W.), Sydney, Australia
| | - Allison S Young
- From the Institute of Clinical Neurosciences (R.L.T., S.K.J., A.S.Y., G.M.H., M.S.W.) and Department of Clinical Biochemistry (D.S.), Royal Prince Alfred Hospital, and Faculty of Medicine (D.S.), Central Clinical School, University of Sydney; and The Balance Clinic and Laboratory (A.S.Y., M.S.W.), Sydney, Australia
| | - David Sullivan
- From the Institute of Clinical Neurosciences (R.L.T., S.K.J., A.S.Y., G.M.H., M.S.W.) and Department of Clinical Biochemistry (D.S.), Royal Prince Alfred Hospital, and Faculty of Medicine (D.S.), Central Clinical School, University of Sydney; and The Balance Clinic and Laboratory (A.S.Y., M.S.W.), Sydney, Australia
| | - G Michael Halmagyi
- From the Institute of Clinical Neurosciences (R.L.T., S.K.J., A.S.Y., G.M.H., M.S.W.) and Department of Clinical Biochemistry (D.S.), Royal Prince Alfred Hospital, and Faculty of Medicine (D.S.), Central Clinical School, University of Sydney; and The Balance Clinic and Laboratory (A.S.Y., M.S.W.), Sydney, Australia
| | - Miriam S Welgampola
- From the Institute of Clinical Neurosciences (R.L.T., S.K.J., A.S.Y., G.M.H., M.S.W.) and Department of Clinical Biochemistry (D.S.), Royal Prince Alfred Hospital, and Faculty of Medicine (D.S.), Central Clinical School, University of Sydney; and The Balance Clinic and Laboratory (A.S.Y., M.S.W.), Sydney, Australia.
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Jankelowitz SK, Anderson C. Implementation of Clinical Guidelines for Secondary Prevention of Stroke. Int J Stroke 2015; 10:E37. [DOI: 10.1111/ijs.12447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Stacey K Jankelowitz
- Central Clinical School, Sydney Medical School, University of Sydney, Australia
- Institute of Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
| | - Craig Anderson
- Central Clinical School, Sydney Medical School, University of Sydney, Australia
- Institute of Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
- George Institute for Global Health, Institute of Neurosciences, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Phillips CJ, Marshall AP, Chaves NJ, Jankelowitz SK, Lin IB, Loy CT, Rees G, Sakzewski L, Thomas S, To TP, Wilkinson SA, Michie S. Experiences of using the Theoretical Domains Framework across diverse clinical environments: a qualitative study. J Multidiscip Healthc 2015; 8:139-46. [PMID: 25834455 PMCID: PMC4370908 DOI: 10.2147/jmdh.s78458] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The Theoretical Domains Framework (TDF) is an integrative framework developed from a synthesis of psychological theories as a vehicle to help apply theoretical approaches to interventions aimed at behavior change. Purpose This study explores experiences of TDF use by professionals from multiple disciplines across diverse clinical settings. Methods Mixed methods were used to examine experiences, attitudes, and perspectives of health professionals in using the TDF in health care implementation projects. Individual interviews were conducted with ten health care professionals from six disciplines who used the TDF in implementation projects. Deductive content and thematic analysis were used. Results Three main themes and associated subthemes were identified including: 1) reasons for use of the TDF (increased confidence, broader perspective, and theoretical underpinnings); 2) challenges using the TDF (time and resources, operationalization of the TDF) and; 3) future use of the TDF. Conclusion The TDF provided a useful, flexible framework for a diverse group of health professionals working across different clinical settings for the assessment of barriers and targeting resources to influence behavior change for implementation projects. The development of practical tools and training or support is likely to aid the utility of TDF.
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Affiliation(s)
- Cameron J Phillips
- Division of Pharmacy, Flinders Medical Centre, Bedford Park, SA, Australia ; School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Andrea P Marshall
- Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Southport, QLD, Australia ; Gold Coast University Hospital, Southport, QLD, Australia
| | - Nadia J Chaves
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Stacey K Jankelowitz
- Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia ; Institute of Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ivan B Lin
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA, Australia
| | - Clement T Loy
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia ; Huntington Diseases Centre, Westmead Hospital, Westmead, NSW, Australia
| | - Gwyneth Rees
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Susie Thomas
- Physiotherapy Department, Flinders Medical Centre, Bedford Park, SA, Australia ; International Centre for Allied Health Evidence (iCAHE), School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - The-Phung To
- Pharmacy Department, Austin Health, Heidelberg, VIC, Australia
| | - Shelley A Wilkinson
- Mater Research Institute, The University of Queensland, South Brisbane, QLD, Australia ; Department of Nutrition and Dietetics, Mater Health Services, South Brisbane, QLD, Australia
| | - Susan Michie
- University College London Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College, London, UK
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Abstract
OBJECTIVE Hereditary liability to pressure palsies (HNPP) is an autosomal dominant disorder of myelination resulting in susceptibility to pressure palsies from compression or stretching of peripheral nerves. PATIENTS AND METHODS This study examined axonal excitability at two sites (one distal and one proximal) in five patients with biopsy and genetically proven HNPP to understand the pathophysiology of the disease. Comparisons were made with age-matched control subjects as well as five Charcot-Marie-Tooth type 1A patients to contrast the findings and explain the different phenotypes of diseases affecting the same gene. RESULTS Changes in axonal excitability were found in HNPP subjects, but these were not uniform along the nerve: at the wrist there were prominent alterations in threshold electrotonus, whereas at the elbow there were only subtle alterations in the recovery cycle and the response to strong long-lasting hyperpolarisation. Threshold was raised at both sites, but the nerves were probably not hyperpolarised. Not unexpectedly, changes in CMT1A subjects were more marked than those in HNPP subjects and were uniform along the nerve. CONCLUSIONS Structural abnormalities at the node of Ranvier are sufficient to explain the changes in axonal excitability in HNPP, and these abnormalities would predispose the nerves to conduction block when subjected to pressure or stretch.
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Affiliation(s)
- Stacey K Jankelowitz
- Department of Neurology, Institute of Clinical Neuroscience, Royal Prince Alfred Hospital, and University of Sydney, Level 2, Medical Foundation Building, 92 Parramatta Road, Camperdown, Sydney, NSW 2050, Australia.
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Abstract
Tardive dyskinesia (TDK) includes orobuccolingual movements and "piano-playing" movements of the limbs. It is a movement disorder of delayed onset that can occur in the setting of neuroleptic treatment as well as in other diseases and following treatment with other drugs. The specific pathophysiology resulting in TDK is still not completely understood but possible mechanisms include postsynaptic dopamine receptor hypersensitivity, abnormalities of striatal gamma-aminobutyric acid (GABA) neurons, and degeneration of striatal cholinergic interneurons. More recently, the theory of synaptic plasticity has been proposed. Considering these proposed mechanisms of disease, therapeutic interventions have attempted to manipulate dopamine, GABA, acetylcholine, norepinephrine and serotonin pathways and receptors. The data for the effectiveness of each class of drugs and the side effects were considered in turn.
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Jankelowitz SK, Spies JM, Burke D. Late-onset neurological symptoms in thalidomide-exposed subjects: a study of an Australasian cohort. Eur J Neurol 2012; 20:509-514. [PMID: 23078293 DOI: 10.1111/ene.12005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 09/10/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Thalidomide was marketed for the treatment of morning sickness and resulted in foetal death and physical deformities. The exact mechanism of action of thalidomide in its teratogenicity is still actively debated in the literature. METHODS This study reviewed 16 of the confirmed Australasian victims of in utero exposure to thalidomide who now presented with new-onset neurological symptoms in the fourth and fifth decades. RESULTS Clinical neurological examination and neurophysiological investigations revealed that new symptoms were due in part to compressive neuropathies, often exacerbated by the adaptations made to accommodate the disability and poor mobility arising from the limb deformities. Other subjects were found to have musculoskeletal symptoms due to compensatory postures employed to perform tasks of daily living. CONCLUSIONS The study provides no evidence of ongoing loss of neurons or late reactivated neural degeneration and no evidence of a generalized peripheral neuropathy. Rather, the development of new symptoms in subjects can be explained by compressive neuropathies and compensatory postures employed to perform tasks of daily living.
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Affiliation(s)
- S K Jankelowitz
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney.,Central Clinical School, University of Sydney, Sydney, Australia
| | - J M Spies
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney.,Central Clinical School, University of Sydney, Sydney, Australia
| | - D Burke
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney.,Central Clinical School, University of Sydney, Sydney, Australia
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Abstract
BACKGROUND Axonal excitability is altered in common medical conditions such as stroke, multiple sclerosis, and spinal cord injury. Given the motor neuron changes in the presence of rigidity and tremor in Parkinson disease, we examine whether there are also changes in motor axon excitability. METHODS Axonal excitability studies were performed in 15 Parkinson subjects and 12 age-matched control subjects. RESULTS There was no significant difference in excitability indices between Parkinson subjects and control subjects. CONCLUSIONS It is unlikely that the lack of change in the excitability indices reflects a balance between the effects of bradykinesia ("underactivity") and the effects of rigidity and tremor ("overactivity") on the motoneuron and its axon. It is more likely that plastic changes in motoneuron properties do not occur symmetrically with decreases and increases in activity, being more profound when activity levels are interrupted and less obvious when they are enhanced.
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Jankelowitz SK, Spies JM, Burke DJ. 17. Is there ongoing loss of nerve cells in subjects exposed to thalidomide in utero? J Clin Neurosci 2010. [DOI: 10.1016/j.jocn.2010.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Burke D, Howells J, Trevillion L, McNulty PA, Jankelowitz SK, Kiernan MC. Threshold behaviour of human axons explored using subthreshold perturbations to membrane potential. J Physiol 2008; 587:491-504. [PMID: 19047204 DOI: 10.1113/jphysiol.2008.163170] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The present study explores the threshold behaviour of human axons and the mechanisms contributing to this behaviour. The changes in excitability of cutaneous afferents in the median nerve at the wrist were recorded to a long-lasting subthreshold conditioning stimulus, with a waveform designed to maximize the contribution of currents active in the just-subthreshold region. The conditioning stimulus produced a decrease in threshold that developed over 3-5 ms following the end of the depolarization and then decayed slowly, in a pattern similar to the recovery of axonal excitability following a discharge. To ensure that the conditioning stimulus did not activate low-threshold axons, similar recordings were then made from single motor axons in the ulnar nerve at the elbow. The findings were comparable, and behaviour with the same pattern and time course could be reproduced by subthreshold stimuli in a model of the human axon. In motor axons, subthreshold depolarizing stimuli, 1 ms long, produced a similar increase in excitability, but the late hyperpolarizing deflection was less prominent. This behaviour was again reproduced by the model axon and could be explained by the passive properties of the nodal membrane and conventional Na+ and K+ currents. The modelling studies emphasized the importance of leak current through the Barrett-Barrett resistance, even in the subthreshold region, and suggested a significant contribution of K+ currents to the threshold behaviour of axons. While the gating of slow K+ channels is slow, the resultant current may not be slow if there are substantial changes in membrane potential. By extrapolation, we suggest that, when human axons discharge, nodal slow K+ currents will be activated sufficiently early to contribute to the early changes in excitability following the action potential.
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Affiliation(s)
- David Burke
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia.
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McNulty PA, Jankelowitz SK, Wiendels TM, Burke D. Postactivation Depression of the Soleus H Reflex Measured Using Threshold Tracking. J Neurophysiol 2008; 100:3275-84. [PMID: 18922951 DOI: 10.1152/jn.90435.2008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The interpretation of changes in the soleus H reflex is problematic in the face of reflex gain changes, a nonlinear input/output relationship for the motoneuron pool, and a nonhomogeneous response of different motoneurons to afferent inputs. By altering the stimulus intensity to maintain a constant reflex output, threshold tracking allows a relatively constant population of α-motoneurons to be studied. This approach was used to examine postactivation (“homosynaptic”) depression of the H reflex (HD) in 23 neurologically healthy subjects. The H reflex was elicited by tibial nerve stimulation at 0.05, 0.1, 0.3, 1, and 2 Hz at rest and during voluntary plantar flexion at 2.5, 5, and 10% of maximum. A computerized threshold tracking procedure was used to set the current needed to generate a target H reflex 10% of Mmax. The current needed to produce the target reflex increased with stimulus rate but not significantly beyond 1 Hz. In three subjects, the current needed to produce H reflexes of 5, 10, 15, and 20% Mmax at 0.3, 1, and 2 Hz increased with rate and with the size of the test H reflex. HD was significantly reduced during voluntary contractions. Using threshold tracking, HD was maximal at lower frequencies than previously emphasized, probably because HD is greater the larger the test H reflex. This would reinforce the greater sensitivity of small motoneurons to reflex inputs.
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Jankelowitz SK, McNulty PA, Burke D. Changes in measures of motor axon excitability with age. Clin Neurophysiol 2007; 118:1397-404. [PMID: 17452010 DOI: 10.1016/j.clinph.2007.02.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Revised: 02/19/2007] [Accepted: 02/21/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Threshold tracking is a novel technique that permits examination of the excitability of human axons in vivo. Protocols have been validated for sensory and motor axons, but there are limited data on the changes in the excitability of motor axons with age. This study aimed to determine such changes from the third to the eighth decades. METHODS Sixty healthy subjects aged 22-79, 10 per decade, were studied using the TRONDXM4 protocol of the QTRAC threshold-tracking program to assess motor axon function. The median nerve was stimulated at the wrist and the compound muscle action potential was recorded from the thenar muscles. RESULTS There was an increase in threshold in elderly subjects, associated with a decrease in slope of the stimulus-response curves. Strength-duration time constant and threshold electrotonus to depolarising and hyperpolarising currents of up to 40% did not change significantly with aging. The current-threshold relationship was similar across all decades for subthreshold depolarising currents, but the slope of the current-threshold relationship was significantly steeper the older the subjects for hyperpolarising currents, particularly those greater than 40% of threshold. There was also a significant decrease in supernormality in the recovery cycle with increasing age. CONCLUSIONS The threshold of axons increases with age and the extent of supernormality decreases. There may also be greater inward rectification in motor axons, perhaps due to greater activity of I(H), the hyperpolarisation-activated conductance, though this is only significant with hyperpolarising currents greater than 40% of the threshold current. SIGNIFICANCE Many indices of axonal excitability, such as strength-duration time constant, the relative refractory period, late subnormality, threshold electrotonus and the depolarising side of the current-threshold relationship, do not change significantly with age. For other indices, age-related changes may be due to a combination of non-neural factors that alter current access to the node of Ranvier, changes in the axon and its myelination and, possibly, changes in channel activity and/or changes in extracellular [K(+)](o).
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Affiliation(s)
- S K Jankelowitz
- Institute of Clinical Neurosciences, University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia.
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Abstract
This study investigated whether there are changes in the excitability of motor axons in peripheral nerves of patients with corticospinal lesions, reflecting plasticity of the motoneuron due to altered descending drives and/or changes in afferent feedback. The excitability of motor and sensory axons in peripheral nerves of the affected limb of 11 patients with unilateral hemiparesis due to stroke was compared with that for the unaffected limbs and with data for 12 age-matched controls. There was significantly less accommodation to hyperpolarizing currents in motor axons on the affected side. There were small differences between the data for the unaffected side and that of the control subjects but these were not statistically significant. Other findings indicate that there was no change in resting membrane potential. There was no comparable alteration in the excitability of sensory axons. The changes in response of motor axons to hyperpolarizing currents could be reproduced in a computer model of the human motor axon by reducing the hyperpolarization-activated conductance, IH, by 30% and the quantitatively small leak conductance by 77%. The data for the uninvolved side matched the data for control subjects best when IH was increased. These findings are consistent with modulation of IH by activity. They demonstrate a change in the biophysical properties of motor axons not directly affected by the pathology and synaptically remote from the lesion, and have implications for 'trans-synaptic' changes in central nervous system pathways. In human subjects studies of motor axon properties may allow insight into processes affecting the motoneuron.
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Affiliation(s)
- Stacey K Jankelowitz
- Medical Foundation Building - K25, The University of Sydney, NSW 2006, Australia.
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Abstract
Weakness is a common symptom of neurological illness, and recovery may occur via restorative or compensatory mechanisms. Functional imaging studies have shown varied patterns of activity in motor areas following recovery from stroke. Movement related potentials (MRP) reflect the activity in primary and non-primary motor areas. We recorded MRPs in association with index finger abduction in six normal volunteers before and after induced weakness of a hand muscle and in six stroke patients with subcortical lesions and weakness affecting the arm. In both groups of subjects the greatest change was observed in the motor potential component of the MRP. On average, the motor potential had its greatest amplitude and duration at the time of the greatest weakness and became smaller with recovery. In artificially-induced weakness, the MRP had an earlier onset latency (P=0.042) and a greater early BP component (P=0.05) for the weakened finger. For the stroke subjects overall, the peak and NS' amplitudes were largest for the initial study and declined thereafter. Similar but smaller changes were present for movements of the clinically unaffected side. The increased motor potential is therefore consistent with increased activity in the motor cortex, and this may occur as compensation for weakness in both normals and after stroke.
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Affiliation(s)
- S K Jankelowitz
- Institute of Neurological Sciences and UNSW Clinical School, Prince of Wales Hospital, High Street, Sydney, NSW 2031, Australia
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Abstract
OBJECTIVE Following stroke, the startle reflex, mediated via the reticulospinal tract, is often facilitated. Vestibulospinal reflexes are another bulbospinal reflex, abnormalities of which may contribute to impaired body posture and stance following stroke. We recorded galvanic evoked vestibulospinal and vestibulocollic reflexes to assess whether these showed similar changes to those for startle following stroke affecting the pons and above. METHODS Twenty-four stroke subjects (aged 40-82) were studied in the vestibulospinal part of the study, 21 stroke subjects (aged 40-81 years) were studied in the vestibulocollic part, including 18 studied in both. Transmastoid galvanic (DC) current was used to stimulate the vestibular nerve. Vestibulocollic responses were recorded from the sternocleidomastoid muscles and vestibulospinal responses from over soleus in standing subjects. RESULTS Vestibulocollic reflex amplitudes and latencies showed no significant differences between the two sides. Similarly short latency (SL) and medium latency (ML) vestibulospinal reflexes did not differ significantly in frequency, latency or amplitude between the affected and unaffected legs. CONCLUSIONS Vestibular reflexes are not facilitated by stroke at or above the pontine level. The exaggeration of startle by stroke may be specific to this reflex.
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Affiliation(s)
- S K Jankelowitz
- Department of Neurology, Institute of Neurological Sciences, Prince of Wales Hospital, Sydney 2031, Australia
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Abstract
The authors recorded the acoustic startle response in 32 patients with stroke, 6 patients with incomplete cervical cord lesions, and 26 controls. Increased startle occurred in about one quarter of both stroke and spinal cord injury patients. The response in biceps demonstrated the greatest deviation from normal, with less marked changes in tibialis anterior. Increased startle in spinal cord injury suggests that changes at the segmental level may contribute. Symptomatic increased startle occurred only in pontine lesions.
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Affiliation(s)
- S K Jankelowitz
- Department of Neurology, Institute of Neurological Sciences, Prince of Wales Hospital, Sydney, Australia
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Jankelowitz SK, Colebatch JG. Movement-related potentials associated with self-paced, cued and imagined arm movements. Exp Brain Res 2002; 147:98-107. [PMID: 12373374 DOI: 10.1007/s00221-002-1220-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2002] [Accepted: 06/28/2002] [Indexed: 10/27/2022]
Abstract
Self-paced movements, movement to a cue and imagined movement have all been reported to be preceded by a prolonged negativity on averaged electroencephalograph (EEG) recordings. Considerable evidence supports an important contribution from the supplementary motor area (SMA) to this potential and all three types of movement have been shown to be associated with SMA activation. This study was designed to compare the premovement component of these movement-related potentials (MRPs) in a group of subjects who performed each of these three types of movement. In addition, in view of the greater SMA activation in association with proximal arm movements, we studied movements at multiple joints in the right arm. All the potentials were largest at Cz. Self-paced movements were preceded by a negativity (mean onset 1.2 s prior to electromyographic activity) with two distinct phases - an early slow increase (early BP, Bereitschaftspotential) and a later, steeper phase (NS', negative slope). Proximal movements were associated with a larger peak amplitude (mean peak amplitude for shoulder 11.6 micro V, finger movement 9.0 micro V at Cz, n=14) due to a bigger NS' phase. Movements to a regular cue, but not to a randomly timed cue, were also preceded by a long duration negativity, but the NS' phase began earlier and was less distinct than for self-paced movements (mean peak amplitude for shoulder movement 9.1 micro V, finger 8.2 micro V at Cz, n=12). Imagining the movements to a regular cue was associated with a slow negativity, with no clear NS' phase (mean peak amplitude for shoulder movement 6.5 micro V, finger 6.2 micro V at Cz). Our results indicate that the MRPs prior to the three types of movement have distinct characteristics, most notably for the NS' phase. The MRP associated with movement to a regular cue may be analogous to the S2-related negativity of the contingent negative variation (CNV). We discuss the findings in the light of current evidence from functional imaging as to the cortical areas activated in similar movements.
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Affiliation(s)
- S K Jankelowitz
- Institute of Neurological Sciences and UNSW Clinical School, The Prince of Wales Hospital, Randwick, Sydney 2031, NSW, Australia
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Abstract
We describe 8 patients who presented with continuous, irregular movements occurring independently in individual fingers and, in some cases, toes, in the setting of mild dystonia present since early childhood and not associated with major disability. The finger movements varied from low-amplitude quivering or wriggling to larger amplitude movements in the plane of abduction-adduction as well as flexion-extension; they were asymmetrical but not unilateral. Quivering or working of the facial muscles was seen in 5 patients. Most patients reported worsening of the movements over the years, but there was no other evidence of a progressive neurological disease. We classify the movement disorder as athetosis as described by Hammond and Shaw and the syndrome as mild athetoid cerebral palsy.
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Affiliation(s)
- John G L Morris
- Department of Neurology, Westmead Hospital, Sydney, Australia.
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Affiliation(s)
- John G L Morris
- Department of Neurology, Westmead Hospital, Sydney, Australia.
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Affiliation(s)
- S K Jankelowitz
- Department of Neurology, Westmead Hospital, Sydney, Australia
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Friedland RH, Jankelowitz SK, de Beer M, de Klerk C, Khoury V, Csizmadia T, Padayachee GN, Levy S. Perceptions and knowledge about the acquired immunodeficiency syndrome among students in university residences. S Afr Med J 1991; 79:149-54. [PMID: 1994485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Using an anonymous questionnaire to obtain baseline data on sexual behaviour and knowledge of the acquired immunodeficiency syndrome (AIDS) among students in university residences, the following information was obtained: Knowledge of AIDS was found to be high, although misconceptions regarding transmission of the virus were prevalent. Mosquito bites (15%) and the donating of blood (31%) were incorrectly identified as methods of transmission of the virus. Deep kissing was recognised by only 27% of the students as a possible method of transmission while 22% and 13% of the students, respectively, failed to identify the sharing of razor blades and blood transfusions as possible means of contracting HIV infection. The students' knowledge had not greatly affected sexual behaviour. Two-thirds of the respondents had previously had sexual contact; 38% were sexually active at the time of the study, and of these 74% had engaged in unprotected intercourse with casual partners in the previous 6 months. There was a negative attitude towards condom use and over 80% of sexually active students did not perceive themselves to be at risk of contracting AIDS. Campus Health (82%), State health services (51%), and public advertisements (60%) were preferred sources of AIDS information. Newspapers/magazines (80%) and leaflets (69%) were identified as the preferred media. In reality, significantly fewer students obtained their information from Campus Health (15%; P less than 0.05), State health services (19%, P less than 0.05) and leaflets (44%; P less than 0.05). It can be concluded that education programmes should be developed by credible organisations to ensure that an awareness of AIDS results in appropriate sexual behaviour.
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Affiliation(s)
- R H Friedland
- Department of Community Health, University of the Witwatersrand, Johannesburg
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