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Gross PW, Chipman DE, Nagra K, Tracey OC, Jones RH, Blanco JS, Sink EL, Scher DM, Dodwell ER, Doyle SM. Incidence of Nerve Palsies During Pavlik Harness Treatment for Developmental Dysplasia of the Hip: A Retrospective Cohort Study. J Bone Joint Surg Am 2024; 106:525-530. [PMID: 38506721 DOI: 10.2106/jbjs.23.00948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND The Pavlik harness has been used for approximately a century to treat developmental dysplasia of the hip (DDH). Femoral nerve palsy is a documented complication of Pavlik harness use, with an incidence ranging from 2.5% to 11.2%. Rare reports of brachial plexus palsy have also been documented. The primary purpose of the current study was to evaluate the incidence of various nerve palsies in patients undergoing Pavlik harness treatment for DDH. Secondary aims were to identify patient demographic or hip characteristics associated with nerve palsy. METHODS We performed a retrospective review of patients diagnosed with DDH and treated with a Pavlik harness from February 1, 2016, to April 1, 2023, at a single tertiary care orthopaedic hospital. Hip laterality, use of a subsequent rigid abduction orthosis, birth order, breech positioning, weight, and family history were collected. The median (and interquartile range [IQR]) or mean (and standard deviation [SD]) were reported for all continuous variables. Independent 2-sample t tests and Mann-Whitney U tests were conducted to identify associations between the variables collected at the initiation of Pavlik harness treatment and the occurrence of nerve palsy. RESULTS Three hundred and fifty-one patients (547 hips) were included. Twenty-two cases of femoral nerve palsy (4% of all treated hips), 1 case of inferior gluteal nerve palsy (0.18%), and 2 cases of brachial plexus palsy (0.37%) were diagnosed. Patients with nerve palsy had more severe DDH as measured by the Graf classification (p < 0.001) and more severe DDH as measured on physical examination via the Barlow and Ortolani maneuvers (p = 0.003). CONCLUSIONS Nerve palsies were associated with more severe DDH at the initiation of Pavlik harness use. Upper and lower-extremity neurological status should be scrutinized at initiation and throughout treatment to assess for nerve palsies. The potential for femoral, gluteal, and brachial plexus palsies should be included in the discussion of risks at the beginning of treatment. Families may be reassured that nerve palsies associated with Pavlik harness can be expected to resolve with a short break from treatment. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Baharvahdat H, Qoorchi Moheb Seraj F, Al-Raaisi A, Blanc R, Najafi S, Mirbolouk MH, Redjem H, Ebrahimnia F, Escalard S, Zabihyan S, Desilles JP, Mowla A, Boisseau W, Mazighi M, Smajda S, Piotin M. Long-term outcome of endovascular treatment for indirect carotid-cavernous fistulas. Neurosurg Focus 2024; 56:E5. [PMID: 38427986 DOI: 10.3171/2023.12.focus23795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/27/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Endovascular treatment (EVT) is the primary approach used to treat indirect carotid-cavernous fistulas (CCFs). In this study, the authors evaluated the immediate and long-term efficacy and safety of different endovascular techniques for indirect CCFs. METHODS The databases of two endovascular centers were retrospectively reviewed to collect the patients with indirect CCFs treated using endovascular techniques between 2013 and 2023. Demographics, clinical presentation, CCF features, EVT characteristics, and clinical and radiological outcomes were evaluated and analyzed. The analysis was performed to compare the clinical and radiological data between different endovascular approaches and different embolic materials. RESULTS Ninety-eight patients were included in the study. EVT was successful in 95 patients (96.9%). Immediate complete obliteration of the CCF was achieved in 93.9% of patients, with 98% undergoing embolization with liquid embolic agents (LEAs) and 95.6% undergoing coiling alone. Complete CCF obliteration was higher in the transvenous than in the transarterial approach (94.3% vs 75%, p = 0.010). At ≥ 6 months follow-up, complete CCF obliteration was achieved in all patients (100%). The rate of procedure-related complications was higher following LEAs than with coiling alone (32.0% vs 15.6%). New cranial nerve (CN) palsy was diagnosed in 26.0% and 2.2% after embolization with LEAs and coiling alone, respectively (p = 0.001), with complete CN palsy recovery in 78.6%. Procedure-related intracranial hemorrhage occurred in 3 patients (3.1%). Two patients experienced an ischemic stroke following Onyx migration into the internal carotid artery. Ocular symptoms improved in 93% (83/89) of the patients who were followed. CONCLUSIONS In this study, complete obliteration of an indirect CCF was achieved in more than 90% of patients. Despite the occurrence of some new postprocedural ocular CN palsy, ocular symptoms improved in most patients in long-term follow-up. The transvenous approach was the most effective method for treating the indirect CCF. Coiling was safer than LEAs for the embolization of the indirect CCF.
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Affiliation(s)
- Humain Baharvahdat
- 1Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
- 2Department of Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Amira Al-Raaisi
- 1Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Raphael Blanc
- 1Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Sajjad Najafi
- 3Department of Neurosurgery, Mazandaran University of Medical Sciences, School of Medicine, Sari, Iran
| | | | - Hocine Redjem
- 1Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Feizollah Ebrahimnia
- 2Department of Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Simon Escalard
- 1Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Samira Zabihyan
- 2Department of Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Jean-Philipe Desilles
- 1Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Ashkan Mowla
- 5Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Willian Boisseau
- 1Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Mikael Mazighi
- 1Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Stanislas Smajda
- 1Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Michel Piotin
- 1Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
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Tutak S, Bartosz P, Burda B, Sztwiertnia P, Białecki J. Femoral nerve palsy as a complication due to COVID-19 coagulopathy and iliopsoas muscle hematoma - case report. BMC Musculoskelet Disord 2023; 24:949. [PMID: 38057812 PMCID: PMC10701933 DOI: 10.1186/s12891-023-07062-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/25/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND COVID-19 (Coronavirus disease 2019) pandemic is the main medical problem around the world from the end of 2019. We found until now many symptoms of this disease, but one of the most problematic was thrombosis. Wide recommendation on COVID-19 treatment was pharmacological thromboprophylaxis. In some papers we found that clinicians face the problem of bleeding in those patients. Is still unknown that coronavirus could led to the coagulopathy. CASE PRESENTATION We described case report of patient who with COVID-19 disease present femoral nerve palsy caused by the iliopsoas hematoma. There were no deviations in coaguology parameters, patient got standard thromboprophylaxis, besides above probably COVID-19 was risk factor of hematoma formation. Non-operative treatment was applied, thrombophylaxis was discontinued. In the follow up in the radiological exam we saw reduction of the haematoma and patient report decrease of symptoms. CONCLUSIONS We should assess individually patient with COVID-19 according to thrombosis risk factors. Probably we should be more careful in ordering thrombophylaxis medications in COVID-19 patients.
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Affiliation(s)
- Sławomir Tutak
- Centre of Postgraduate Medical Education, Orthopedic Department in Otwock, Konarskiego 13, Otwock, 05-400, Poland
| | - Paweł Bartosz
- Centre of Postgraduate Medical Education, Orthopedic Department in Otwock, Konarskiego 13, Otwock, 05-400, Poland.
| | - Bartosz Burda
- Centre of Postgraduate Medical Education, Orthopedic Department in Otwock, Konarskiego 13, Otwock, 05-400, Poland
| | - Paweł Sztwiertnia
- Radiological Department in Otwock, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock, Poland
| | - Jerzy Białecki
- Centre of Postgraduate Medical Education, Orthopedic Department in Otwock, Konarskiego 13, Otwock, 05-400, Poland
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Qin J, Li S, Zheng J. Therapeutic effect of acupuncture combined with hyperbaric oxygen therapy on improving the cerebral blood flow and neurological function of children with severe non-speaking limb paralysis. Minerva Pediatr (Torino) 2023; 75:937-939. [PMID: 37255400 DOI: 10.23736/s2724-5276.23.07325-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Jiao Qin
- Department of Pediatrics, Sichuan Bayi Rehabilitation Center, Sichuan Rehabilitation Hospital, Chengdu, China
| | - Suting Li
- Department of Internal Medicine, Binzhou Polytechnic, Binzhou, China
| | - Jie Zheng
- Department of Nursing, The Third People's Hospital of Gansu Province, Lanzhou, China -
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Silva Campos JJ, Abels E, Rinder HM, Tormey CA, Jacobs JW. Botulism mimicking Guillain-Barre syndrome: The question of plasma exchange in an unusual case of acute paralysis. J Clin Apher 2023; 38:760-763. [PMID: 37519071 DOI: 10.1002/jca.22081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/17/2023] [Accepted: 07/22/2023] [Indexed: 08/01/2023]
Abstract
Guillain-Barré syndrome (GBS) is an immune-mediated polyradiculoneuropathy and the most common cause of acute flaccid paralysis worldwide. GBS classically presents with acute, progressive, ascending weakness, reduced to absent reflexes, and albuminocytological dissociation on cerebrospinal fluid (CSF) analysis. Botulism is a neurotoxin-mediated acute descending flaccid paralysis with cranial nerve palsies and dysautonomia. Botulism in adults is caused by ingestion/inhalation of botulinum toxin or wound infection with Clostridium botulinum. Both GBS and botulism can rapidly precipitate respiratory failure; thus, prompt diagnosis and treatment are crucial to mitigate poor outcomes. Herein, we describe a case of botulism initially diagnosed as GBS given classic laboratory features, and describe the importance of careful consideration of the most appropriate therapeutic modalities in cases of acute flaccid paralysis, particularly regarding empiric administration of botulinum antitoxin and use of intravenous immune globulin in lieu of plasma exchange for potential GBS to prevent removal of antitoxin.
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Affiliation(s)
- Juan J Silva Campos
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Elizabeth Abels
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Henry M Rinder
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine (Hematology), Yale School of Medicine, New Haven, Connecticut, USA
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Despang A. Gene therapy for walking recovery after paralysis. Nat Biotechnol 2023; 41:1521. [PMID: 37950011 DOI: 10.1038/s41587-023-02037-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
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Wang L, Gao W, Tang Q, Zhu L, Wu M. Immediate effects of electroacupuncture in oculomotor nerve palsy following brainstem infarction: A case report. Explore (NY) 2023; 19:861-864. [PMID: 37142473 DOI: 10.1016/j.explore.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/28/2023] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Research has demonstrated that electroacupuncture (EA) stimulation of paralyzed muscles significantly improves nerve regeneration and functional recovery. DESCRIPTION An 81-year-old man with no history of diabetes mellitus or hypertension presented with a history of brainstem infarction. Initially, the patient had medial rectus palsy in the left eye and diplopia to the right in both eyes, which almost returned to normal after six sessions of EA. METHODS The CARE guidelines informed the case study report. The patient was diagnosed with oculomotor nerve palsy (ONP) and photographed to document ONP recovery after treatment. The selected acupuncture points and surgical methods are listed in the table. DISCUSSION Pharmacological treatment of oculomotor palsy is not ideal, and its long-term use has side effects. Although acupuncture is a promising treatment for ONP, existing treatments involve many acupuncture points and long cycles, resulting in poor patient compliance. We chose an innovative modality, electrical stimulation of paralyzed muscles, which may be an effective and safe complementary alternative therapy for ONP.
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Affiliation(s)
- Linjing Wang
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150000, China
| | - Weibin Gao
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150000, China
| | - Qiang Tang
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150000, China
| | - Luwen Zhu
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150000, China
| | - Minmin Wu
- Department of Rehabilitation Medicine, Heilongjiang University of Chinese Medicine, Harbin 150000, China.
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Abstract
Treating cardiovascular paralysis with epidural electrical neuromodulation.
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Affiliation(s)
- Aaron Phillips
- Hotchkiss Brain Institute and Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
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10
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Abstract
OBJECTIVE To describe a case of persistent facial nerve palsy after middle meningeal artery (MMA) embolization for chronic subdural hematoma (cSDH). METHODS A literature search was conducted for publications within the last 10 years of facial nerve palsy following cerebral circulation embolization procedures. RESULTS With inconsistencies between previously believed pathophysiology and clinical features, other mechanisms causing cSDH such as angiogenesis and capillary formation have been proposed. MMA embolization has evolved as a therapeutic approach to reduce recurrence of subdural hematoma; however, postoperative neural complications such as cranial nerve palsies are poorly described in the literature. CONCLUSIONS cSDH is increasingly more common and is on trajectory to become the most prevalent cranial neurosurgical condition. MMA embolization is described as a safe and minimally invasive procedure; however, as a relatively new procedure further research is needed to elucidate associated complications.
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Affiliation(s)
- Ally Ferber
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, New Jersey, USA
| | - Yi Zhou
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
| | - Brian Greenwald
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
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Wong DG, Monda S, Vetter J, Lai H, Olsen MA, Keller M, Desai A. Time Course and Risk Factors for Repeat Procedures After Ureteroscopy or Shockwave Lithotripsy. Urology 2023; 174:42-47. [PMID: 36574909 PMCID: PMC10494519 DOI: 10.1016/j.urology.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/14/2022] [Accepted: 12/14/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine risk factors and time course for repeat procedures after ureteroscopy (URS) or shockwave lithotripsy (SWL) procedure using a large employer-based claims database. METHODS We identified all patients who underwent treatment for ureteral or renal stone with URS or SWL from January 1, 2007 to December 31, 2014 using the IBM MarketScan Commercial Database. Repeat stone procedure was evaluated after a 90-day grace period from the index procedure. Patients were followed until December 31, 2017. We performed multivariate analyses using Cox proportional hazards to determine independent risk factors for repeat procedure after the initial stone removal. RESULTS A total of 189,739 patients underwent a SWL or URS and were included in the study. The incidence of repeat procedure per 100 person years was 6.8, and 4.4 after SWL and URS, respectively. The median time to reoperation was 12.5 months for SWL and 14.6 months for URS. On multivariable analysis, SWL was associated with an increased risk of repeat procedure compared to URS. (HR = 1.63). Paralysis, neurogenic bladder and inflammatory bowel disease were also associated with an increased risk of repeat procedure (HR = 1.66, 1.40, and 1.36 respectively) CONCLUSION: In a large national cohort, patients with paralysis and neurogenic bladder had a significantly higher risk of repeat stone procedure. SWL was associated with higher risk of repeat procedure than URS. Urologists can use these data to identify and counsel patients at high risk for need for recurrent procedure.
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Affiliation(s)
- Daniel G Wong
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO.
| | - Steve Monda
- Department of Urologic Surgery, University of California Davis School of Medicine, Sacramento, CA
| | - Joel Vetter
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Henry Lai
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Margaret A Olsen
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Matthew Keller
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Alana Desai
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
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Nguyen NB, Nguyen Thi HH, Thi HL, Nguyen ST, Nguyen TV. Results of acute cerebral infarction treatment with hyperbaric oxygen therapy, 2020-2022. Int Marit Health 2023; 74:265-271. [PMID: 38111247 DOI: 10.5603/imh.97720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Cerebral stroke is the third leading cause of death after cardiovascular disease, cancer and the leading cause of disability for patients. Hyperbaric oxygen is a non-drug treatment that has the potential to improve brain function for patients with ischaemic stroke. The objective of this study was to evaluate the results of treatment of acute cerebral infarction with hyperbaric oxygen therapy (HBOT). MATERIALS AND METHODS This was a case-control study. One hundred ninety-five patients diagnosed with cerebral infarction, with signs of onset within 24 hours, were treated at the Centre for Underwater Medicine and Hyperbaric Oxygen of Vietnam National Institute of Maritime Medicine during the period from January 2020 to December 2022. Study group included 100 patients with acute cerebral infarction treated with a combination of HBOT and medication and reference group included 95 patients treated by medication only (antiplatelets drugs, statins, control of associated risks factors) RESULTS: After 7 days of treatment with hyperbaric oxygen (HBO), symptoms such as headache, dizziness, nausea, sensory disturbances, and Glasgow score of the study group improved better than that of the reference group (p < 0.01). Movement recovery in the study group was better than the reference group: the percentage of patients with mild and moderate paralysis in the study group increased higher than that of the reference group (86.0% and 68.4%), the degree of complete paralysis of the study group decreased more than that of the reference group (14.0% and 31.6%). The degree of independence in daily activities in the study group was better than the reference group. In the study group, the percentage of patients with complete independence in daily life increased from 27.0% to 84.0%. In the reference group, the rate of patients who were independent in their daily activities increased from 37.9% to 51.6%. The average number of treatment days of the study group was 10.32 ± 2.41 days and it the reference group 14.51 ± 3.24 days. CONCLUSIONS Hyperbaric oxygen therapy is a non-drug treatment with many good effects in the treatment of cerebral infarction, especially acute cerebral infarction. HBOT reduces and improves functional symptoms, improves mobility, and reduces treatment time for patients.
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Affiliation(s)
- Nam Bao Nguyen
- Vietnam National Institute of Maritime Medicine (VINIMAM), Haiphong, Vietnam.
| | | | | | - Son Truong Nguyen
- Vietnam National Institute of Maritime Medicine (VINIMAM), Haiphong, Vietnam
| | - Tam Van Nguyen
- Faculty of Marine Medicine-Hai Phong University of Medicine and Pharmacy, Haiphong, Vietnam
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Berényi M, Szeredai M, Cseh Á. Neonatal brachial plexus palsy - early diagnosis and treatment. Ideggyogy Sz 2022; 75:247-252. [PMID: 35916611 DOI: 10.18071/isz.75.0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND PURPOSE The incidence of brachial plexus palsy (BPP) has decreased recently, but the indivi-d-ual's quality of life is endangered. To provide better chan-ces to BPP neonates and infants, the Department of Developmental Neurology worked out, introduced, and applied a complex early therapy, including nerve point stimulation. METHODS After diagnosing the severity of BPP, early intensive and complex therapy should be started. Appro-x-imately after a week or ten days following birth, the slightest form (neurapraxia) normalizes without any intervention, and signs of recovery can be detected around this period. The therapy includes the unipolar nerve point electro-stimulation and the regular application of those elemen-tary sensorimotor patterns, which activate both extremities simultaneously. RESULTS With the guideline worked out and applied in the Department of Developmental Neurology, full recovery can be achieved in 50% of the patients, and even in the most severe cases (nerve root lesion), functional upper limb usage can be detected with typically developing body-scheme. CONCLUSION Immediately starting complex treatment based on early diagnosis alters the outcome of BPP, providing recovery in the majority of cases and enhancing the everyday arm function of those who only partially benefit from the early treatment.
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Affiliation(s)
- Marianne Berényi
- Department of Developmental Neurology, St. Margaret Hospital, Budapest
| | - Márta Szeredai
- Department of Developmental Neurology, St. Margaret Hospital, Budapest
| | - Ágnes Cseh
- Department of Developmental Neurology, St. Margaret Hospital, Budapest
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Hirayama K, Fuchigami T, Morioka S. Transcranial direct electrical stimulation for hand function in a stroke patient with severe upper limb paralysis due to lenticulostriate artery occlusion: a case report. J Med Case Rep 2021; 15:582. [PMID: 34903298 PMCID: PMC8667432 DOI: 10.1186/s13256-021-03137-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/30/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Transcranial direct current stimulation, a therapeutic modality to modulate the excitability of injured and uninjured brain hemispheres in stroke patients, is expected to be effective in treating upper limb paralysis. We describe the use of transcranial direct current stimulation to improve the function and frequency of use of the paralyzed hand of a patient with lenticulostriate artery occlusion. CASE PRESENTATION A Japanese man in his fifties developed a left internal hindfoot perforator branch infarction owing to lenticulostriate artery occlusion, and presented with severe right upper and lower limb paralysis. Multiple interventions for the paralyzed hand, primarily robot therapy, did not noticeably change his hand function or frequency of use in daily life. Therefore, transcranial direct current stimulation was used in combination with upper limb functional exercises for 20 minutes a day, five times a week, for 6 weeks. Consequently, scores for the hand items of the Fugl-Meyer Assessment of the upper extremities improved, and pain and subluxation around the shoulder joint were reduced. Furthermore, the frequency of use and the quality of movement of the paralyzed hand were improved. CONCLUSIONS Upper limb functional training and transcranial direct current stimulation improved the function and frequency of use of the paralyzed hand in a stroke patient with severe upper limb paralysis, suggesting that this combined intervention could effectively improve hand function in patients with severe upper limb paralysis.
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Affiliation(s)
- Koichiro Hirayama
- Department of Rehabilitation, Eishinkai Kishiwada Rehabilitation Hospital, 8-10, Kanmatsucho, Kishiwada, Osaka, 596-0827, Japan.
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka, Japan.
- Stroke Rehabilitation Research Laboratory, Eishinkai Kishiwada Rehabilitation Hospital, Osaka, Japan.
| | - Takeshi Fuchigami
- Department of Rehabilitation, Eishinkai Kishiwada Rehabilitation Hospital, 8-10, Kanmatsucho, Kishiwada, Osaka, 596-0827, Japan
- Stroke Rehabilitation Research Laboratory, Eishinkai Kishiwada Rehabilitation Hospital, Osaka, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Shu Morioka
- Stroke Rehabilitation Research Laboratory, Eishinkai Kishiwada Rehabilitation Hospital, Osaka, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
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Engström K, Saber A. [Patient treated for severe Covid-19 with paralysis of cranial nerves]. Lakartidningen 2021; 118:21079. [PMID: 34228809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Patients with Covid-19 can experience neurological complications, for example cranial nerve palsy. We present a case with a patient treated for severe Covid-19 infection. She was intubated for 16 days and was ventilated in the prone-position for several hours a day during her care in the intensive care unit (ICU). She developed paralysis of the left facial nerve, observed while intubated. After extubation the patient was hoarse and had dysphagia and examination showed paralysis of the left hypoglossal nerve with the tongue deviating to the left and of the left vagus nerve causing a paralysis of the left vocal cord. It is impossible to know whether the paralysis of the three cranial nerves was due to direct damage by the Covid-19 virus or due to compression of the nerves during the ICU care. As facial nerve palsy has been shown to be more common in patients with Covid-19, we believe that the paralysis in our patient was due to a combination of both.
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Affiliation(s)
- Kristina Engström
- överläkare, öron-, näs- och halskliniken, Universitetssjukhuset Örebro; öron-, näs- och halsmottagningen, Karlskoga lasarett
| | - Amanj Saber
- med dr, överläkare, öron-, näs- och halskliniken, Universitetssjukhuset Örebro; öron-, näs- och halsmottagningen, Karlskoga lasarett; institutionen för me-dicinska vetenskaper, Örebro universitet
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Ueda R, Yamada N, Abo M, Senoo A. White matter changes follow low-frequency repetitive transcranial magnetic stimulation plus intensive occupational therapy for motor paralysis after stroke: a DTI study using TBSS. Acta Neurol Belg 2021; 121:387-396. [PMID: 31115787 DOI: 10.1007/s13760-019-01150-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 05/02/2019] [Indexed: 01/01/2023]
Abstract
Intervention that combines low-frequency repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy (OT) may improve brain function in post-stroke patients with motor paralysis. We aimed to clarify the brain region involved in motor function improvement following chronic stroke. We recruited 25 patients hospitalized for 15 days with post-stroke upper extremity paralysis to receive 12 sessions of low-frequency rTMS over the non-lesioned hemisphere and occupational therapy. In this study, 72% of the patients had suffered from intracranial haemorrhage. Imaging analysis was performed using diffusion tensor imaging (DTI) to assess changes in white matter after intervention. We investigated white matter change before and after intervention and the relationship between white matter structure and motor function recovery using tract-based spatial statistics. The intra-voxel directional coherence was significantly increased in the anterior limb of the internal capsule and anterior thalamic radiation on the lesional side following intervention. Mean diffusivity and radial diffusivity values of clusters in the superior corona radiata on the lesional side were negatively correlated with motor function recovery. White matter nerve fibre structures are involved in motor function improvement following rTMS and OT interventions. Our results show novel findings regarding the relationship between stroke neurorehabilitation and cerebral nerve structure.
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Affiliation(s)
- Ryo Ueda
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-Ogu, Arakawa-ku, Tokyo, 116-8551, Japan
- Office of Radiation Technology, Keio University Hospital, Tokyo, Japan
| | - Naoki Yamada
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
- Department of Rehabilitation, Shimizu Hospital, Tottori, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Atsushi Senoo
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-Ogu, Arakawa-ku, Tokyo, 116-8551, Japan.
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Oxley TJ, Yoo PE, Rind GS, Ronayne SM, Lee CMS, Bird C, Hampshire V, Sharma RP, Morokoff A, Williams DL, MacIsaac C, Howard ME, Irving L, Vrljic I, Williams C, John SE, Weissenborn F, Dazenko M, Balabanski AH, Friedenberg D, Burkitt AN, Wong YT, Drummond KJ, Desmond P, Weber D, Denison T, Hochberg LR, Mathers S, O'Brien TJ, May CN, Mocco J, Grayden DB, Campbell BCV, Mitchell P, Opie NL. Motor neuroprosthesis implanted with neurointerventional surgery improves capacity for activities of daily living tasks in severe paralysis: first in-human experience. J Neurointerv Surg 2021; 13:102-108. [PMID: 33115813 PMCID: PMC7848062 DOI: 10.1136/neurintsurg-2020-016862] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Implantable brain-computer interfaces (BCIs), functioning as motor neuroprostheses, have the potential to restore voluntary motor impulses to control digital devices and improve functional independence in patients with severe paralysis due to brain, spinal cord, peripheral nerve or muscle dysfunction. However, reports to date have had limited clinical translation. METHODS Two participants with amyotrophic lateral sclerosis (ALS) underwent implant in a single-arm, open-label, prospective, early feasibility study. Using a minimally invasive neurointervention procedure, a novel endovascular Stentrode BCI was implanted in the superior sagittal sinus adjacent to primary motor cortex. The participants undertook machine-learning-assisted training to use wirelessly transmitted electrocorticography signal associated with attempted movements to control multiple mouse-click actions, including zoom and left-click. Used in combination with an eye-tracker for cursor navigation, participants achieved Windows 10 operating system control to conduct instrumental activities of daily living (IADL) tasks. RESULTS Unsupervised home use commenced from day 86 onwards for participant 1, and day 71 for participant 2. Participant 1 achieved a typing task average click selection accuracy of 92.63% (100.00%, 87.50%-100.00%) (trial mean (median, Q1-Q3)) at a rate of 13.81 (13.44, 10.96-16.09) correct characters per minute (CCPM) with predictive text disabled. Participant 2 achieved an average click selection accuracy of 93.18% (100.00%, 88.19%-100.00%) at 20.10 (17.73, 12.27-26.50) CCPM. Completion of IADL tasks including text messaging, online shopping and managing finances independently was demonstrated in both participants. CONCLUSION We describe the first-in-human experience of a minimally invasive, fully implanted, wireless, ambulatory motor neuroprosthesis using an endovascular stent-electrode array to transmit electrocorticography signals from the motor cortex for multiple command control of digital devices in two participants with flaccid upper limb paralysis.
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Affiliation(s)
- Thomas J Oxley
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Synchron, Inc, Campbell, California, USA
| | - Peter E Yoo
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Synchron, Inc, Campbell, California, USA
| | - Gil S Rind
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Synchron, Inc, Campbell, California, USA
| | - Stephen M Ronayne
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Synchron, Inc, Campbell, California, USA
| | - C M Sarah Lee
- Neurology, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - Christin Bird
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Rahul P Sharma
- Interventional Cardiology, Cardiovascular Medicine Faculty, Stanford University, Stanford, California, USA
| | - Andrew Morokoff
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Neurosurgery, Melbourne Health, Parkville, Victoria, Australia
| | | | | | - Mark E Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Lou Irving
- Respiratory Medicine, Melbourne Health, Parkville, Victoria, Australia
| | - Ivan Vrljic
- Radiology, Melbourne Health, Parkville, Victoria, Australia
| | | | - Sam E John
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Frank Weissenborn
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Madeleine Dazenko
- Neurology, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | | | | | - Anthony N Burkitt
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Yan T Wong
- Department of Electrical and Computer Systems Engineering, Monash University, Clayton, Victoria, Australia
| | - Katharine J Drummond
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Neurosurgery, Melbourne Health, Parkville, Victoria, Australia
| | - Patricia Desmond
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Radiology, Melbourne Health, Parkville, Victoria, Australia
| | - Douglas Weber
- Department of Mechanical Engineering and Neuroscience Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Timothy Denison
- Synchron, Inc, Campbell, California, USA
- Institute of Biomedical Engineering, Oxford University, Oxford, Oxfordshire, UK
| | - Leigh R Hochberg
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Harvard University, Cambridge, Massachusetts, USA
| | - Susan Mathers
- Neurology, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - Terence J O'Brien
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Neurology, Melbourne Health, Parkville, Victoria, Australia
| | - Clive N May
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - J Mocco
- Neurosurgery, The Mount Sinai Health System, New York, New York, USA
| | - David B Grayden
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Bruce C V Campbell
- Medicine, University of Melbourne, Parkville, Victoria, Australia
- Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Peter Mitchell
- Radiology, Melbourne Health, Parkville, Victoria, Australia
| | - Nicholas L Opie
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Synchron, Inc, Campbell, California, USA
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Stazi M, D’Este G, Mattarei A, Negro S, Lista F, Rigoni M, Megighian A, Montecucco C. An agonist of the CXCR4 receptor accelerates the recovery from the peripheral neuroparalysis induced by Taipan snake envenomation. PLoS Negl Trop Dis 2020; 14:e0008547. [PMID: 32898186 PMCID: PMC7537909 DOI: 10.1371/journal.pntd.0008547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/06/2020] [Accepted: 06/19/2020] [Indexed: 01/15/2023] Open
Abstract
Envenomation by snakes is a major neglected human disease. Hospitalization and use of animal-derived antivenom are the primary therapeutic supports currently available. There is consensus that additional, not expensive, treatments that can be delivered even long after the snake bite are needed. We recently showed that the drug dubbed NUCC-390 shortens the time of recovery from the neuroparalysis caused by traumatic or toxic degeneration of peripheral motor neurons. These syndromes are characterized by the activation of a pro-regenerative molecular axis, consisting of the CXCR4 receptor expressed at the damaged site in neuronal axons and by the release of its ligand CXCL12α, produced by surrounding Schwann cells. This intercellular signaling axis promotes axonal growth and functional recovery from paralysis. NUCC-390 is an agonist of CXCR4 acting similarly to CXCL12α. Here, we have tested its efficacy in a murine model of neuroparalytic envenoming by a Papuan Taipan (Oxyuranus scutellatus) where a degeneration of the motor axon terminals caused by the presynaptic PLA2 toxin Taipoxin, contained in the venom, occurs. Using imaging of the neuromuscular junction and electrophysiological analysis, we found that NUCC-390 administration after injection of either the purified neuroparalytic Taipoxin or the whole Taipan venom, significantly accelerates the recovery from paralysis. These results indicate that NUCC-390, which is non-toxic in mice, should be considered for trials in humans to test its efficacy in accelerating the recovery from the peripheral neuroparalysis induced by Taipans. NUCC-390 should be tested as well in the envenomation by other snakes that cause neuroparalytic syndromes in humans. NUCC-390 could become an additional treatment, common to many snake envenomings, that can be delivered after the bite to reduce death by respiratory deficits and to shorten and improve functional recovery.
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Affiliation(s)
- Marco Stazi
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Giorgia D’Este
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Andrea Mattarei
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - Samuele Negro
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Florigio Lista
- Department of Medical and Veterinary Research, the Ministry of Defense, Rome, Italy
| | - Michela Rigoni
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Aram Megighian
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Cesare Montecucco
- Department of Biomedical Sciences, University of Padova, Padova, Italy
- CNR Institute of Neuroscience, Department of Biomedical Sciences, Padua, Italy
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20
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Wang R, Xie R, Hu J, Wu Q, Rao W, Huang C. Different acupuncture therapies for spastic paralysis after stroke: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2020; 99:e20974. [PMID: 32629711 PMCID: PMC7337531 DOI: 10.1097/md.0000000000020974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Stroke is emerging as a significant health issue that threatens human health worldwide and as a common sequela of stroke spastic paralysis after stroke (SPAS) has received wide attention. Currently, several systematic reviews have suggested that the commonly used acupuncture therapy (electroacupuncture, fire acupuncture, warm acupuncture, and filiform needle acupuncture) has achieved significant efficacy in the treatment of SPAS. In this study, network meta-analysis will be used to analyze the results of different clinical trials and evaluate the differences in the efficacy of different acupuncture treatments for SPAS. METHODS Only randomized controlled trials will be included and all patients were diagnosed as spastic paralysis after stroke. A computer-based retrieval will be conducted at CNKI, WanFang databases, VIP, Sinoed, Pubmed, Embase, Web of Science, and the Cochrane library. The search period limit is from the time the date of database establishment to April 17, 2020. To avoid omissions, we will manually retrieve relevant references and conference papers. The risk of bias in the final included studies will be evaluated based on the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. All data analysis will be conducted by Revman5.3, WinBUGS 1.4.3, and Stata14.2. RESULTS This study quantified the effectiveness of each intervention for different outcome indicators. The primary outcomes include the Fugl-Meyer Assessment score, the modified Ashworth scale for the assessment of spasticity, and Barthel Index. The secondary outcomes include clinical effectiveness and adverse reactions. CONCLUSION It will provide evidence-based medical evidence for clinicians to choose more effective acupuncture therapy for SPAS.
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Affiliation(s)
- Ruiqi Wang
- Jiangxi University of Traditional Chinese Medicine
| | - Rongfang Xie
- Jiangxi University of Traditional Chinese Medicine
| | - Jinwen Hu
- Jiangxi University of Traditional Chinese Medicine
| | - Qingzhong Wu
- Jiangxi University of Traditional Chinese Medicine
| | - Wangfu Rao
- Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province, China
| | - Chunhua Huang
- Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province, China
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Wang D, Bo Z, Lan T, Pan J, Cui D. Application of Magnetic Resonance Imaging Molecular Probe in the Study of Pluripotent Stem Cell-Derived Neural Stem Cells for the Treatment of Posttraumatic Paralysis of Cerebral Infarction. World Neurosurg 2020; 138:637-644. [PMID: 32001413 DOI: 10.1016/j.wneu.2020.01.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/16/2020] [Accepted: 01/18/2020] [Indexed: 11/20/2022]
Abstract
The feasibility and efficacy of magnetic resonance imaging molecular probe application and pluripotent stem cell-derived neural stem cell (NSC) transplantation for the treatment of hind limb paralysis in mice with cerebral infarction were studied. A model of middle cerebral artery infarction using adult mice was established to stimulate hind limb reactions. After the model was successfully established, the mice were first divided into an experimental group and a control group, with 25 mice in each group. Cultured neural cells were obtained from the cerebral cortex and hippocampus of a mouse 15 days pregnant to prepare pluripotent stem cells. Pluripotent stem cell-derived NSCs were identified by positive expression of Nestin. The experimental group was injected with 1 μL of NSC suspension through the tail vein, and the control group was injected with 1 μL of saline through the tail vein. The neurologic function of mice in each group was scored 1 day, 3 days, 7 days, 14 days, and 28 days after transplantation according to the Garcia 18 subscale. Finally, the differentiation, migration, and integration of pluripotent stem cell-derived NSCs after transplantation were observed using a magnetic resonance imaging molecular probe method. The results showed that the neurologic function scores of the ischemic transplantation group were significantly higher than those of the control group, and the results were significantly different (P < 0.05). Through research, it was found that after transplantation of pluripotent stem cell-derived NSCs, the transplanted cells migrated and differentiated around the body at 28 days and participated in angiogenesis, and the blood vessels in the infarcted area were obviously proliferated. The NSCs cultured in vitro were transplanted to the small infarction after cerebral infarction. In rats, it plays a positive role in the repair of nerve function in mice with cerebral infarction. NSCs cultured in vitro can survive, migrate, and differentiate in the brain tissue of mouse ischemic models and play a positive role in the repair of neurologic function in mice with cerebral infarction. Magnetic resonance imaging molecular probes have a good adjuvant effect on the use of pluripotent stem cell-derived NSCs to treat hind limb paralysis in mice with cerebral infarction.
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Affiliation(s)
- Dayan Wang
- Department of Neurology, Qianwei Hospital of Jilin Province, Changchun City, China
| | - Zhang Bo
- Department of Neurosurgery, First Hospital of Jilin University, Changchun City, China
| | - Tianye Lan
- Department of Encephalopathy, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Jianyu Pan
- Department of Encephalopathy, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Dayong Cui
- Department of Neurosurgery, Qianwei Hospital of Jilin Province, Changchun City, China.
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22
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Abstract
Individuals with paralyzed limbs due to spinal cord injuries lack the ability to perform the reaching motions necessary to every day life. Functional electrical stimulation (FES) is a promising technology for restoring reaching movements to these individuals by reanimating their paralyzed muscles. We have proposed using a quasi-static model-based control strategy to achieve reaching controlled by FES. This method uses a series of static positions to connect the starting wrist position to the goal. As a first step to implementing this controller, we have completed a simulated study using a MATLAB based dynamic model of the arm in order to determine the suitable parameters for the quasi-static controller. The selected distance between static positions in the path was 6 cm, and the amount of time between switching target positions was 1.3 s. The final controller can complete reaches of over 30 cm with a median accuracy of 6.8 cm.
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Abstract
Bioelectronic medicine is a rapidly growing field that explores targeted neuromodulation in new treatment options addressing both disease and injury. New bioelectronic methods are being developed to monitor and modulate neural activity directly. The therapeutic benefit of these approaches has been validated in recent clinical studies in various conditions, including paralysis. By using decoding and modulation strategies together, it is possible to restore lost function to those living with paralysis and other debilitating conditions by interpreting and rerouting signals around the affected portion of the nervous system. This, in effect, creates a bioelectronic "neural bypass" to serve the function of the damaged/degenerated network. By learning the language of neurons and using neural interface technology to tap into critical networks, new approaches to repairing or restoring function in areas impacted by disease or injury may become a reality.
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Affiliation(s)
- Chad E Bouton
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York 11030
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Pappal RD, Roberts BW, Mohr NM, Ablordeppey E, Wessman BT, Drewry AM, Yan Y, Kollef MH, Avidan MS, Fuller BM. Protocol for a prospective, observational cohort study of awareness in mechanically ventilated patients admitted from the emergency department: the ED-AWARENESS study. BMJ Open 2019; 9:e033379. [PMID: 31594905 PMCID: PMC6797343 DOI: 10.1136/bmjopen-2019-033379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Awareness with paralysis is a complication with potentially devastating psychological consequences for mechanically ventilated patients. While rigorous investigation into awareness has occurred for operating room patients, little attention has been paid outside of this domain. Mechanically ventilated patients in the emergency department (ED) have been historically managed in a way that predisposes them to awareness events: high incidence of neuromuscular blockade use, underdosing of analgesia and sedation, delayed administration of analgesia and sedation after intubation, and a lack of monitoring of sedation targets and depth. These practice patterns are discordant to recommendations for reducing the incidence of awareness, suggesting there is significant rationale to examine awareness in the ED population. METHODS AND ANALYSIS This is a single centre, prospective cohort study examining the incidence of awareness in mechanically ventilated ED patients. A cohort of 383 mechanically ventilated ED patients will be included. The primary outcome is awareness with paralysis. Qualitative reports of all awareness events will be provided. Recognising the potential problem with conventional multivariable analysis arising from a small number of events (expected less than 10-phenomenon of separation), Firth penalised method, exact logistic regression model or penalised maximum likelihood estimation shrinkage (Ridge, LASSO) will be used to assess for predictors of awareness. ETHICS AND DISSEMINATION Approval of the study by the Human Research Protection Office has been obtained. This work will be disseminated by publication of peer-reviewed manuscripts, presentation in abstract form at scientific meetings and data sharing with other investigators through academically established means.
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Affiliation(s)
- Ryan D Pappal
- Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Brian W Roberts
- Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Nicholas M Mohr
- Emergency Medicine and Anesthesiology, Roy J. and Lucille A. Carver College of Medicine University of Iowa, Iowa City, Iowa, USA
| | - Enyo Ablordeppey
- Anesthesiology and Emergency Medicine, Washington University, Saint Louis, Missouri, USA
| | - Brian T Wessman
- Anesthesiology and Emergency Medicine, Washington University, Saint Louis, Missouri, USA
| | - Anne M Drewry
- Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Yan Yan
- Clinical Epidemiology Center, VA Saint Louis Health Care System, Saint Louis, Missouri, USA
- Public Health Sciences, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Marin H Kollef
- Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Michael Simon Avidan
- Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Brian M Fuller
- Anesthesiology and Emergency Medicine, Washington University, Saint Louis, Missouri, USA
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Abstract
BACKGROUND Data to guide neurointensivists seeing patients with West Nile Neuroinvasive disease (WNND) are lacking. We present a comparatively large series of patients with WNND admitted to the intensive care unit (ICU) and provide data on their early diagnosis, triage to the ICU and predictors of short-term outcomes. METHODS We retrospectively identified patients aged ≥ 18 years old with WNND from January 1999 to November 2016. Demographic and clinical data, the modified Rankin Scale at discharge and disposition were collected. Univariate analysis was performed to find predictors of ICU admission and to assess the impact of ICU admission on the short-term outcomes. P values < 0.05 were considered significant. RESULTS Among 26 patients, 16 were admitted to the ICU. Age < 60 years and the presentation with encephalitis and acute flaccid paralysis predicted ICU admission (P = 0.044 and 0.0007). Among patients requiring ICU admission, four died and no one was discharged home. ICU admission predicted longer hospital stay (P = 0.021), inhospital death (P = 0.034), survival with inability to walk independently (P = 0.0094), and discharge disposition other than home (P = 0.007). In the ICU group, older age was associated with longer hospital stay (P = 0.0001) and inhospital death (P = 0.035). CONCLUSION WNND requiring ICU care has a high morbidity and mortality, especially among older patients. Survivors are highly disabled at discharge, but many improve over time. Therefore, more data on the long-term prognosis of survivors are needed to guide the goals of care in the acute setting.
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Affiliation(s)
- Maximiliano A Hawkes
- Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA.
| | - Ivan D Carabenciov
- Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Eelco F M Wijdicks
- Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Alejandro A Rabinstein
- Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
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Silver JR, Weiner MF. Urtication (flogging with stinging nettles) and flagellation (beating with rods) in the treatment of paralysis. Spinal Cord Ser Cases 2019; 5:79. [PMID: 31632737 PMCID: PMC6786426 DOI: 10.1038/s41394-019-0222-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/12/2019] [Accepted: 08/23/2019] [Indexed: 11/16/2022] Open
Abstract
Urtication and flagellation were used as a last resort in the treatment of paralysis when all other means were exhausted, and very few cases are reported in the literature. Two cases were identified and reviewed, one of urtication (flogging with nettles) and one of flagellation (beating with rods). In both cases the symptoms were alleviated, but there was insufficient detail to evaluate the therapeutic value of each treatment.
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Affiliation(s)
- J. R. Silver
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
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Power R, Muhit M, Heanoy E, Karim T, Badawi N, Akhter R, Khandaker G. Health-related quality of life and mental health of adolescents with cerebral palsy in rural Bangladesh. PLoS One 2019; 14:e0217675. [PMID: 31185015 PMCID: PMC6561392 DOI: 10.1371/journal.pone.0217675] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/16/2019] [Indexed: 11/19/2022] Open
Abstract
AIM To assess the health-related quality of life (HRQoL) and mental health of adolescents with cerebral palsy (CP) in rural Bangladesh. METHODS Case-control study of adolescents with CP (10 to ≤18-years) and age and sex matched controls without disability. Primary caregivers were included for proxy report. HRQoL was measured with Bengali versions CP Quality of Life-Teens (CPQoL-Teens) and KIDSCREEN-27. Mental health was measured with Strengths and Difficulties Questionnaire (SDQ). RESULTS 154 cases and 173 controls matched on age and sex participated (mean age 15.1 (1.6) and 14.9 (1.6) respectively; female n = 48, n = 55 respectively, p>0.05). CPQoL-Teens was administered to adolescents with CP only; mean outcomes ranged from 38.5 (27.4) to 71.5 (16.1) and 'feelings about functioning' was poorest domain for both self- and proxy-report groups. KIDSCREEN-27 was administered to adolescents with CP and controls; adolescents with CP mean outcomes ranged from 25.9 (12.2) to 48.7 (10.56) and were significantly poorer than controls, mean difference 4.3 (95% CI 0.7 to 7.8) to 16.7 (95% CI 14.5 to 18.5), p<0.05. 'Peers and social support' was poorest domain for all groups. In regards to mental health, adolescents with CP reported significantly poorer mean SDQ than peers without disability, mean difference 0.7 (95% CI 0.3 to 1.1) to 7.8 (95% CI 6.7 to 8.9), p<0.05; and were for self-report 7.8 (95% CI 2.6 to 23.0) and proxy-report 12.0 (95% CI 6.9 to 20.9) times more likely to report 'probable' range 'total difficulties' score. Individual item analysis of CPQoL-Teens and KIDSCREEN-27 identified unique areas of concern for adolescents with CP related to pain, friendships, physical activity and energy, what may happen later in life, and feelings about having CP. Financial resources were of concern for both cases and controls. INTERPRETATION Adolescents with CP in rural Bangladesh are at high risk of poor HRQoL and mental health problems. Effort to reduce the disparity between adolescents with CP and those without disability should consider wellbeing holistically and target dimensions including physical, psychological and social wellbeing. Specific interventions to alleviate modifiable aspects of HRQoL including pain, social isolation, and physical in-activity are recommended.
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Affiliation(s)
- Rosalie Power
- Discipline of Child and Adolescent Health, Sydney Medical School,
University of Sydney, Sydney, New South Wales, Australia
- Asian Institute of Disability and Development (AIDD), University of South
Asia, Dhaka, Bangladesh
| | - Mohammad Muhit
- Asian Institute of Disability and Development (AIDD), University of South
Asia, Dhaka, Bangladesh
- CSF Global, Dhaka, Bangladesh
| | - Eamin Heanoy
- Asian Institute of Disability and Development (AIDD), University of South
Asia, Dhaka, Bangladesh
- CSF Global, Dhaka, Bangladesh
| | - Tasneem Karim
- Asian Institute of Disability and Development (AIDD), University of South
Asia, Dhaka, Bangladesh
- CSF Global, Dhaka, Bangladesh
| | - Nadia Badawi
- Discipline of Child and Adolescent Health, Sydney Medical School,
University of Sydney, Sydney, New South Wales, Australia
- Cerebral Palsy Alliance Research Institute, University of Sydney, Sydney,
New South Wales, Australia
| | - Rahena Akhter
- Faculty of Dentistry, University of Sydney, Sydney, New South Wales,
Australia
| | - Gulam Khandaker
- Discipline of Child and Adolescent Health, Sydney Medical School,
University of Sydney, Sydney, New South Wales, Australia
- Asian Institute of Disability and Development (AIDD), University of South
Asia, Dhaka, Bangladesh
- CSF Global, Dhaka, Bangladesh
- Public Health Unit, Central Queensland Hospital and Health Service,
Rockhampton, Queensland, Australia
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28
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Abstract
Upper extremity entrapment neuropathies are common and can cause pain, sensory loss, and muscle weakness that lead to functional disability. In this article, the authors review common entrapment neuropathies of the upper extremities, including median neuropathy at the wrist (carpal tunnel syndrome), ulnar neuropathy at the elbow, and radial neuropathy. The authors discuss the pathophysiology of nerve compression and typical etiologies, as well as strategies for differentiating between common mimics such as cervical radiculopathy and for selecting between various treatment modalities.
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Affiliation(s)
- Christopher T Doughty
- Department of Neurology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Michael P Bowley
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, WACC 739B, Boston, MA 02114, USA.
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29
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Song GF, Li X, Feng Y, Yu CH, Lian XY. Acupuncture combined Bobath approach for limbs paralysis after hypertensive intracerebral hemorrhage: A protocol for a systematic review. Medicine (Baltimore) 2019; 98:e14750. [PMID: 30855470 PMCID: PMC6417558 DOI: 10.1097/md.0000000000014750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Previous studies have reported that acupuncture combined Bobath approach (BA) can be used to treat limbs paralysis (LP) after hypertensive intracerebral hemorrhage (HICH) effectively. However, no systematic review has explored its effectiveness and safety for LP following HICH. In this systematic review, we aim to assess the effectiveness and safety of acupuncture plus BA for the treatment of LP following HICH. METHODS The following 7 databases will be searched from their inception to the February 1, 2019: Cochrane Central Register of Controlled Trials, EMBASE, PUBMED, the Cumulative Index to Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure without any language restrictions. The randomized controlled trials (RCTs) of acupuncture plus BA that evaluate the effectiveness and safety for LP after HICH will be included. The methodological quality of all included studies will be assessed by using Cochrane risk of bias tool. Two authors will independently perform study selection, data extraction, and methodological quality evaluation. Any disagreements occurred between 2 authors will be resolved by a third author involved through discussion. Data will be pooled and analyzed by using RevMan 5.3 Software. RESULTS This review will evaluate the effectiveness and safety of acupuncture combined BA for LP following HICH. The primary outcome is limbs function. The secondary outcomes are muscle strength, muscle tone, and quality of life, as well as the adverse events. CONCLUSION The results of this study will summarize the latest evidence of acupuncture combined BA for LP following HICH.
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Affiliation(s)
| | | | | | - Chang-hong Yu
- Department of Gastroenterology, First Affiliated Hospital of Jiamusi University, Jiamusi, China
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30
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Lloret L, Hayhoe S. A Tale of Two Foxes - Case Reports: 1. Radial Nerve Paralysis Treated with Acupuncture in a Wild Fox 2. Acupuncture in a Fox with Aggressive and Obsessive Behaviour. Acupunct Med 2018; 23:190-5. [PMID: 16430128 DOI: 10.1136/aim.23.4.190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Case 1 This is believed to be the first report of acupuncture treatment for traumatic radial nerve paralysis in a wild fox. From the first treatment, improvement in the range of mobility and sensation of the limb was evident. Additionally, the attitude of this wild animal changed from fear and aggression to complete cooperation: he lay peacefully during every treatment in a calm, drowsy state. Case 2 This reports the calming effects of acupuncture on a fox which had been showing aggressive behaviour and obsessive circling following toxoplasma infection.
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31
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Watanabe S, Nakahara I, Ohta T, Matsumoto S, Ishibashi R, Nagata I. Vagal Nerve Palsy After Transarterial Embolization of Transverse-Sigmoid Dural Arteriovenous Fistula Using Onyx. J Stroke Cerebrovasc Dis 2018; 28:464-469. [PMID: 30425023 DOI: 10.1016/j.jstrokecerebrovasdis.2018.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/25/2018] [Accepted: 10/16/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We report a case of a 70-year-old man who developed a transverse-sigmoid dural arteriovenous fistula (TS-DAVF) that was successfully treated by transarterial embolization (TAE) with Onyx. CASE PRESENTATION The patient presented with sudden and progressive disturbance of consciousness and left hemiparesis. Magnetic resonance imaging (MRI) revealed venous infarction and hemorrhagic changes with brain swelling in the right parietal lobe. Angiography revealed a right TS-DAVF and multiple occlusions with retrograde leptomeningeal venous drainage into the cortical veins. The TS-DAVF was graded as Borden type III and Cognard type IIa+b. Because of its progressive clinical nature and wide distribution of DAVF in the occluded sinus wall, he underwent emergent TAE with liquid embolic materials including n-butyl cyanoacrylate and Onyx under informed consent by his family. Complete obliteration of the TS-DAVF was achieved, leading to a marked amelioration of symptoms, and MRI after treatment confirmed a decrease in the brain swelling. However, he suffered transient dysphagia due to right vagal nerve palsy caused by occlusion of vasa nervorum of ascending pharyngeal artery. He returned home 5 months later with a modified Rankin Scale of 1. CONCLUSIONS TAE with Onyx appears to be effective for aggressive TS-DAVF with a widely distributed shunt. However, the blood supply to the cranial nerves and potentially dangerous anastomoses between the external-internal carotid artery and vertebral artery should be taken into account to avoid serious complications.
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Affiliation(s)
- Sadayoshi Watanabe
- Department of Comprehensive Strokology, Fujita Health University School of Medicine.
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University School of Medicine.
| | - Tsuyoshi Ohta
- Department of Neurosurgery, Kochi Health Science Center.
| | - Shoji Matsumoto
- Department of Comprehensive Strokology, Fujita Health University School of Medicine.
| | | | - Izumi Nagata
- Department of Neurosuragery, Stroke Center, Kokura Memorial Hospital, Japan.
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32
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Abstract
RATIONALE We present the first case of enterovirus (EV) D68, lineage B3 infection, associated with acute flaccid myelitis (AFM) in Taiwan. AFM caused by EV D68 is relatively rare. This report highlights the importance of clinical recognition of the disease and discusses treatments that can benefit such patients. PATIENT CONCERNS A 5-year-old boy experienced sudden onset of acute flaccid paralysis (AFP) involving left arm after fever and respiratory symptoms for 3 days. DIAGNOSES Magnetic resonance imaging (MRI) of the spinal cord revealed signal changes over segments C1 to T5 on a T2-weighted image (T2WI), compatible with the diagnosis of AFM. The EV D68 strain, cultured from the throat of the patient was identified. INTERVENTIONS We administered intravenous immunoglobulin (IVIG, 1g/kg, twice), pulse steroid therapy (methylprednisolone, 30 mg/kg, twice) and oral prednisolone (1mg/kg/day). Rehabilitation was also arranged. OUTCOMES The patient still had mild muscle atrophy over left arm after following-up for 1 year. LESSONS Early diagnosis and prompt management are essential for managing this kind of patient. IVIG, pulse therapy, and oral prednisolone may play crucial roles in controlling its clinical course.
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Affiliation(s)
- I-.Ju Chen
- Department of Pediatrics, Cathay General Hospital
| | - Su-Ching Hu
- Department of Pediatrics, Cathay General Hospital
| | - Kun-Long Hung
- Department of Pediatrics, Cathay General Hospital
- School of Medicine
- Department of Pediatrics, Fu-Jen Catholic University Hospital, New Taipei, Taiwan
| | - Chiao-Wei Lo
- Department of Pediatrics, Cathay General Hospital
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33
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Schmidt T, Philipsen BB, Manhoobi Y, Bruun Christiansen EL. [Vagus and hypoglossus palsy after nasotracheal intubation and throat packing]. Ugeskr Laeger 2018; 180:V11170844. [PMID: 29984697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Ipsilateral extracranial palsy of the hypoglossus and vagus nerve is a rare complication of intubation. This is a case report of a 50-year-old male with unilateral palsy of the hypoglossus and vagus nerve after reoperation for a mandibular fracture. The patient underwent logopaedic treatment, and ten months after the operation there was significant but not complete remission of symptoms. Videostroboscopy revealed near-normalisation of vocal cord movement.
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34
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Wakao N, Takeuchi M, Riew DK, Hirasawa A, Imagama S, Kawanami K, Matsuo T, Murotani K, Deie M. Effect of an intensive conservative therapy with daily teriparatide administration and rehabilitation for osteoporotic delayed vertebral collapse and paralysis. Medicine (Baltimore) 2018; 97:e10906. [PMID: 29879028 PMCID: PMC5999469 DOI: 10.1097/md.0000000000010906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Although patients with osteoporotic delayed vertebral collapse (ODVC) have frequently been treated surgically, the efficacy and limitation of conservative treatment for it have not yet been reported. The purpose of this study was to investigate the effectiveness and limitation of further intensive conservative treatment for patients with ODVC.Patients treated for ODVC from 2011 to 2014 with a follow-up period of more than 1 year were eligible. The fundamental treatment strategy consisted of surgical treatment following intensive conservative treatment with daily teriparatide and rehabilitation for 3 months. We conducted a surgical treatment for patients who could not keep standing position by themselves because of prolonged leg paralysis or intolerable back pain. We performed a logistic regression model in which surgical treatment was set as an objective variable, and other related factors including sex, age, the level of affected vertebrae, the quality of paralysis, changing rate (δ) of spinal canal encroachment, local kyphotic angle, mobility of collapsed vertebrae, EuroQol questionnaires (EQ5D), numerical rating scale (NRS), and Frankel grade as explanatory variables. We also plotted receiver operating curves (ROCs) to investigate the cutoff values of parameters at the baseline.Thirty patients (6 males and 24 females, mean age 76.7 years) were enrolled. Eventually 12 out of 30 patients avoided surgical treatment because their symptoms were improved. Logistic regression showed that δ of local kyphotic angle (odds ratio: 1.072), P = .01), mobility of collapsed vertebrae (1.063, 0.01), EQ5D (0.98, 0.04), and NRS (1.113, 0.01) were significantly correlated with the need for surgical treatments. Among the factors at baseline, only the mobility of collapsed vertebrae showed a significant value of area under a curve (AUC = 0.727, P = .008).The results that 40% of patients with ODVC did not need further surgical treatment after the intensive conservative treatment was of great significance. Patients with greater mobility of collapsed vertebrae might be treated surgically as quickly as possible.
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Affiliation(s)
- Norimitsu Wakao
- Department of Spine Center
- Department of Orthopedic Surgery, Clinical Research Center, Aichi Medical University, Yazako,Nagakute-city, Aichi-pref, Japan
| | | | - Daniel K. Riew
- Department of Orthopedic Surgery, Columbia University, New York, NY
| | | | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University, Nagoya
| | - Katsuhisa Kawanami
- Department of Orthopedic Surgery, Clinical Research Center, Aichi Medical University, Yazako,Nagakute-city, Aichi-pref, Japan
| | - Toshihiro Matsuo
- Department of Orthopedic Surgery, Clinical Research Center, Aichi Medical University, Yazako,Nagakute-city, Aichi-pref, Japan
| | - Kenta Murotani
- Division of Biostatistics, Clinical Research Center, Aichi Medical University, Yazako,Nagakute-city, Aichi-pref, Japan
| | - Masataka Deie
- Department of Orthopedic Surgery, Clinical Research Center, Aichi Medical University, Yazako,Nagakute-city, Aichi-pref, Japan
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35
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Vermeulen M. [Advice and treatment from the clairvoyant Croiset]. Ned Tijdschr Geneeskd 2018; 162:D2777. [PMID: 30040325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Around 1960, the Dutch clairvoyant Gerard Croiset (1909-1980) was consulted by 'people with symptoms - considered to be unexplained - such as paralysis or neurological disorders'. I searched the archive of the Johan Borgman Fund Foundation for the effect of Croiset's advice and treatment in patients with these symptoms who might have had the diagnosis of conversion disorder. Contrary to my expectations, Croiset treated no patients with conversion disorder. His advice and treatment were successful in patients with poliomyelitis, epilepsy, lumbar disc prolapse and infantile encephalopathy. Four of his patients had been insufficiently stimulated by the first person who treated them to improve their remaining muscular strength through exercise; symptoms of anxiety had not been investigated sufficiently in two patients; and in one patient the treating professional had adhered too rigidly to the set treatment. Alternative healers are apparently not only successful with patients with unexplained symptoms, and their success is not always the result of a placebo effect.
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Affiliation(s)
- M Vermeulen
- Academisch Medisch Centrum, afd. Neurologie, Amsterdam
- Contact: M. Vermeulen
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36
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Degenhart AD, Hiremath SV, Yang Y, Foldes S, Collinger JL, Boninger M, Tyler-Kabara EC, Wang W. Remapping cortical modulation for electrocorticographic brain-computer interfaces: a somatotopy-based approach in individuals with upper-limb paralysis. J Neural Eng 2018; 15:026021. [PMID: 29160240 PMCID: PMC5841472 DOI: 10.1088/1741-2552/aa9bfb] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Brain-computer interface (BCI) technology aims to provide individuals with paralysis a means to restore function. Electrocorticography (ECoG) uses disc electrodes placed on either the surface of the dura or the cortex to record field potential activity. ECoG has been proposed as a viable neural recording modality for BCI systems, potentially providing stable, long-term recordings of cortical activity with high spatial and temporal resolution. Previously we have demonstrated that a subject with spinal cord injury (SCI) could control an ECoG-based BCI system with up to three degrees of freedom (Wang et al 2013 PLoS One). Here, we expand upon these findings by including brain-control results from two additional subjects with upper-limb paralysis due to amyotrophic lateral sclerosis and brachial plexus injury, and investigate the potential of motor and somatosensory cortical areas to enable BCI control. APPROACH Individuals were implanted with high-density ECoG electrode grids over sensorimotor cortical areas for less than 30 d. Subjects were trained to control a BCI by employing a somatotopic control strategy where high-gamma activity from attempted arm and hand movements drove the velocity of a cursor. MAIN RESULTS Participants were capable of generating robust cortical modulation that was differentiable across attempted arm and hand movements of their paralyzed limb. Furthermore, all subjects were capable of voluntarily modulating this activity to control movement of a computer cursor with up to three degrees of freedom using the somatotopic control strategy. Additionally, for those subjects with electrode coverage of somatosensory cortex, we found that somatosensory cortex was capable of supporting ECoG-based BCI control. SIGNIFICANCE These results demonstrate the feasibility of ECoG-based BCI systems for individuals with paralysis as well as highlight some of the key challenges that must be overcome before such systems are translated to the clinical realm. ClinicalTrials.gov Identifier: NCT01393444.
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Affiliation(s)
- Alan D. Degenhart
- Systems Neuroscience Institute, University of Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Shivayogi V. Hiremath
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Therapy, Temple University, Philadelphia, PA, USA
| | - Ying Yang
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephen Foldes
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Veterans Affairs Medical Center, Pittsburgh, PA, USA
| | - Jennifer L. Collinger
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Veterans Affairs Medical Center, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Veterans Affairs Medical Center, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- McGowan Institute for Regenerative Medicine, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, Pittsburgh, PA, USA
| | - Elizabeth C. Tyler-Kabara
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wei Wang
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, Pittsburgh, PA, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Barnes-Jewish Hospital, St. Louis, MO, USA
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Bjerin O, Martín Muñoz D, Gerald C, Brytting M, Eriksson M. [Acute flaccid myelitis amongst Swedish children with a possible link to an outbreak of enterovirus D68]. Lakartidningen 2017; 114:ETDZ. [PMID: 29292957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Acute flaccid myelitis amongst Swedish children with a possible link to an outbreak of enterovirus D68 In september 2016 we had several cases of acute flaccid myelitis in our clinic. This coincided with an outbreak of enterovirus D68 (EV-D68) in Sweden during the same period. We describe three cases, of which one tested positive for EV-D68. Acute flaccid paralysis of one or more limbs preceded by an upper respiratory tract infection is highly suspicious of myelitis, and a viral cause must be included in the clinical work-up. In order to detect infection with EV-D68 in suspected acute flaccid myelitis, nasopharyngeal aspirate should be performed as early as possible. EV-D68 is normally not found in stool or cerebrospinal fluid tests but should be included in the clinical work-up. Treatment of acute flaccid myelitis is supportive only. There is no effective antiviral treatment and immunomodulating therapies show little effect. Persisting neurological deficits are common but lethal cases are rare.
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Affiliation(s)
- Olof Bjerin
- Karolinska sjukhuset - Solna, Sweden - pediatric neurology Solna, Sweden
| | - Daniel Martín Muñoz
- Karolinska Universitetssjukhuset - Div. Pediatric Neuroradiology, Dpt of Neuroradiology Stockholm, Sweden Karolinska Universitetssjukhuset - Div. Pediatric Neuroradiology, Dpt of Neuroradiology Stockholm, Sweden
| | - Cooray Gerald
- Karolinska Universitetssjukhuset Neurofysiologiska kliniken - Stockholm, Sweden Karolinska Universitetssjukhuset Neurofysiologiska kliniken - Stockholm, Sweden
| | - Mia Brytting
- The Public Health Agency of Sweden - Microbiology Solna, Sweden The Public Health Agency of Sweden - Microbiology Solna, Sweden
| | - Mats Eriksson
- Karolinska Institutet - Institutionen för kvinnors och barns hälsa Stockholm, Sweden Karolinska Institutet - Institutionen för kvinnors och barns hälsa Stockholm, Sweden
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38
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Weber C. On the Verge of Neuro-Motion: Chad Bouton and His Team are Developing Breakthrough Neural Decoding Methods That Help People with Paralysis Move Again. IEEE Pulse 2017; 8:8-12. [PMID: 28961089 DOI: 10.1109/mpul.2017.2734220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Chad Bouton, director of the Center for Bioelectronic Medicine and vice president of advanced engineering at the Feinstein Institute for Medical Research, which serves as the research arm of one of the largest health systems in the United States, has spent nearly two decades developing innovative medical technology and products that help diagnose and treat conditions including cancer, stroke, diabetes, and paralysis. Last year, in a groundbreaking effort, Bouton and his colleagues published their findings in Nature on neural-decoding methods that helped Ian Burkhart become the first paralyzed person with a brain implant to move again with his own thoughts.
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39
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Abstract
Paralysis, whether caused by spinal cord injury, neurodegenerative disease, or other factors, poses a host of issues for patients. These include not just the inability to move parts of their bodies but potential problems with communication and bladder control as well. Fortunately, the last decade has seen promising technology advances to address these concerns. Although most are still in the research stage, these technologies-including brain-computer interfaces (BCIs), exoskeletons, and robotics-may one day improve the lives of people with paralysis.
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Pandey PC, Bajaj S, Srivastava A. A Clinico-Epidemiological Profile of Neuroparalytic Snake Bite: Using Low Dose ASV in a Tertiary Care Centre from North India. J Assoc Physicians India 2016; 64:16-20. [PMID: 27762104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Snake bite in India is a common medical emergency and an occupational hazard for majority of Indian population especially farmers. Epidemiological data on snake bite from the North India is sparse. Hence we conducted this study to find clinico-epidemiological profile of neuroparalytic snake bite. METHODS This is a record-based, descriptive study carried out at the Department of Medicine, M.L.N. Medical College and associated Swaroop Rani Nehru Hospital, Allahabad, U.P. (India) which is a tertiary care hospital of north India.. This study describes the epidemiology, arrival delays and the outcome of neuroparalytic snakebites with low dose ASV along with ventilatory support. RESULTS Among the total 113 cases of neuroparalytic snake bite victims (56.63%) were males aged 21-40 years. Majorities of the victims were bitten outdoor (63.71%) and most of the bites occurred on the lower limbs (83%). The highest number of cases occurred during the monsoon season of July-September. Most of the victims were farmers (53.44%) and labourers (30.55%), which suggested that snake bite was an occupational hazard. Mean dose of ASV administered was 16.99 vials. The percentage of patients requiring intensive care and ventilatory support were (40.70%) and the total percentage of patients showing recovery was (84.07%). The most important positive prognostic factor was reaching hospital within 7 hours. CONCLUSIONS Snake bite can be viewed as an occupational hazard among farmers and labourers. Delay in reaching hospital in time where definite treatment and care can be done was identified as the most important cause of mortality. Low dose ASV administration and ventilatory support can provide sufficient cure if patients reach on time. Public health programs regarding the prevention and the importance of the early arrival to the hospital should be emphasized.
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Affiliation(s)
| | | | - Anubha Srivastava
- Assistant Professor, Department of Medicine, MLN Medical College Allahabad, Uttar Pradesh
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41
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Abstract
We report a case of femoral nerve palsy occurring as a result of spontaneous bilateral iliopsoas haematomas in an elderly patient on treatment dose dalteparin for a suspected pulmonary embolus. There are limited case reports in the literature relating to this rare problem, and their management is controversial. We advocate non-operative treatment in the instance of a delayed presentation in a frail elderly patient with a subsequent good functional outcome.
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Affiliation(s)
- Hannah Podger
- Poole Hospital NHS Foundation Trust, Poole, Dorset BH15 2JB, UK
| | - Michael Kent
- Poole Hospital NHS Foundation Trust, Poole, Dorset BH15 2JB, UK
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Jennette J, Tauferner D. Paralysis as a Presenting Symptom of Hyperthyroidism in an Active Duty Soldier. US Army Med Dep J 2015:48-50. [PMID: 26606408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Thyrotoxic periodic paralysis (TPP) is an endocrine disorder presenting with proximal motor weakness, typically greatest in the lower extremities, hypokalemia, and signs or laboratory findings consistent with hyperthyroidism. The incidence of TPP is highest in Asian males. This is a case report of a 30-year-old male active duty Soldier who presented to the emergency department complaining of several recent episodes of lower extremity paralysis. The patient underwent a workup which included serum and cerebrospinal fluid studies, and was found to be hypokalemic and hyperthyroid. Following consultation with neurology, the patient was admitted to the medicine service and treated for thyrotoxic periodic paralysis with potassium replacement and treatment of his hyperthyroidism. Since achieving a euthyroid state, he has had no recurrences of TPP. This disease should be considered in patients presenting with symmetric motor weakness and hypokalemia, whether or not symptoms of hyperthyroidism are elicited during the review of systems.
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Affiliation(s)
- John Jennette
- Carl R. Darnall Army Medical Center, Fort Hood, Texas
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Sun Y, Sun Y. [Acupuncture for 8 cases of hysterical paralysis]. Zhongguo Zhen Jiu 2015; 35:922. [PMID: 26721149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Ju S, Zong L. [Discussion on acupuncture for flaccid paralysis from "treating flaccid paralysis by yangming alone"]. Zhongguo Zhen Jiu 2015; 35:956-959. [PMID: 26721160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Theories regarding"treating flaccid paralysis by yangming alone" are summarized, and the treatment effects of "yangming is the sea of five viscera and six organs", "yangming is in charge of smoothing the tendon and muscle, while tendon and muscle is in charge of connecting bones and movement" and "tendon and muscle is the crossing point of yin meridians and yang meridians, which is converged in yangming" are explained. With medical cases from later generations, it is summarized that besides "using yangming alone", "mainly using yang-ming" and "multiple meridians and acupoints" can also be recommend, indicating that focus should be paid not only on yangming, but also on,syndrome differentiation and treatment, and accompanying symptoms should be emphasized to regulate the body. The commonly used acupoints for flaccid paralysis are summarized to guide the clinical treatment and manipulation.
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Wesołowski A, Płusa T. [Saxitoxins and tetrodotokxins as a new biological weapon]. Pol Merkur Lekarski 2015; 39:173-175. [PMID: 26449582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Saxitoxins (STX) and tetrodotoxins (TTX) are a group of chemical compounds produced by certain species of marine algae and fish. Lethal dose for a human is about 0.5-2.0 mg when the toxin enters the body via food, and 0.05 mg of poisoning at the time of injection. In the case of aerosol the lethal dose for human being is 5 mg/min/m(3). STX and TTX poisoning cause mostly symptoms from the nervous system in the form of: paresthesia around the lips, tongue, gums, distal segments of the limbs, headache, dysphonia, astigmatism, floating feeling, muscle weakness, paralysis of cranial and peripheral nerves. There is no specific antidote for STX and TTX. It is recommended supportive treatment.
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Affiliation(s)
- Adam Wesołowski
- Military Medical Institute in Warsaw, Department of Internal Medicine, Pulmonology and Allergology, Central Clinical Hospital of the Ministry of National Defense
| | - Tadeusz Płusa
- Military Medical Institute in Warsaw, Department of Internal Medicine, Pulmonology and Allergology, Central Clinical Hospital of the Ministry of National Defense
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Abstract
Sensory and motor complete spinal cord injury (SCI) has been considered functionally complete resulting in permanent paralysis with no recovery of voluntary movement, standing or walking. Previous findings demonstrated that lumbosacral spinal cord epidural stimulation can activate the spinal neural networks in one individual with motor complete, but sensory incomplete SCI, who achieved full body weight-bearing standing with independent knee extension, minimal self-assistance for balance and minimal external assistance for facilitating hip extension. In this study, we showed that two clinically sensory and motor complete participants were able to stand over-ground bearing full body-weight without any external assistance, using their hands to assist balance. The two clinically motor complete, but sensory incomplete participants also used minimal external assistance for hip extension. Standing with the least amount of assistance was achieved with individual-specific stimulation parameters, which promoted overall continuous EMG patterns in the lower limbs’ muscles. Stimulation parameters optimized for one individual resulted in poor standing and additional need of external assistance for hip and knee extension in the other participants. During sitting, little or negligible EMG activity of lower limb muscles was induced by epidural stimulation, showing that the weight-bearing related sensory information was needed to generate sufficient EMG patterns to effectively support full weight-bearing standing. In general, electrode configurations with cathodes selected in the caudal region of the array at relatively higher frequencies (25–60 Hz) resulted in the more effective EMG patterns for standing. These results show that human spinal circuitry can generate motor patterns effective for standing in the absence of functional supraspinal connections; however the appropriate selection of stimulation parameters is critical.
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Affiliation(s)
- Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States of America
| | - Claudia Angeli
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States of America
- Frazier Rehab Institute, Kentucky One Health, Louisville, Kentucky, United States of America
| | - Susan Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States of America
- Frazier Rehab Institute, Kentucky One Health, Louisville, Kentucky, United States of America
- * E-mail:
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Gad P, Roy RR, Choe J, Zhong H, Nandra MS, Tai YC, Gerasimenko Y, Edgerton VR. Electrophysiological mapping of rat sensorimotor lumbosacral spinal networks after complete paralysis. Prog Brain Res 2015; 218:199-212. [PMID: 25890138 DOI: 10.1016/bs.pbr.2015.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Stimulation of the spinal cord has been shown to have great potential for improving function after motor deficits caused by injury or pathological conditions. Using a wide range of animal models, many studies have shown that stimulation applied to the neural networks intrinsic to the spinal cord can result in a dramatic improvement of motor ability, even allowing an animal to step and stand after a complete spinal cord transection. Clinical use of this technology, however, has been slow to develop due to the invasive nature of the implantation procedures and the difficulty of ascertaining specific sites of stimulation that would provide optimal amelioration of the motor deficits. Moreover, the development of tools available to control precise stimulation chronically via biocompatible electrodes has been limited. In this chapter, we outline the use of a multisite electrode array in the spinal rat model to identify and stimulate specific sites of the spinal cord to produce discrete motor behaviors in spinal rats. The results demonstrate that spinal rats can stand and step when the spinal cord is stimulated tonically via electrodes located at specific sites on the spinal cord. The quality of stepping and standing was dependent on the location of the electrodes on the spinal cord, the specific stimulation parameters, and the orientation of the cathode and anode. The spinal motor evoked potentials in selected muscles during standing and stepping are shown to be critical tools to study selective activation of interneuronal circuits via responses of varying latencies. The present results provide further evidence that the assessment of functional networks in the background of behaviorally relevant functional states is likely to be a physiological tool of considerable importance in developing strategies to facilitate recovery of motor function after a number of neuromotor disorders.
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Affiliation(s)
- Parag Gad
- Departments of Integrative Biology and Physiology, University of California, Los Angeles, CA, USA
| | - Roland R Roy
- Departments of Integrative Biology and Physiology, University of California, Los Angeles, CA, USA; Brain Research Institute, University of California, Los Angeles, CA, USA
| | - Jaehoon Choe
- Departments of Integrative Biology and Physiology, University of California, Los Angeles, CA, USA; Department of Neuroscience, University of California, Los Angeles, CA, USA
| | - Hui Zhong
- Departments of Integrative Biology and Physiology, University of California, Los Angeles, CA, USA
| | | | - Yu-Chong Tai
- Department of Electrical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Yury Gerasimenko
- Departments of Integrative Biology and Physiology, University of California, Los Angeles, CA, USA; Pavlov Institute of Physiology, St. Petersburg, Russia; Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - V Reggie Edgerton
- Departments of Integrative Biology and Physiology, University of California, Los Angeles, CA, USA; Department of Neurobiology, University of California, Los Angeles, CA, USA; Department of Neurosurgery, University of California, Los Angeles, CA, USA; Brain Research Institute, University of California, Los Angeles, CA, USA.
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Shi G, Zheng X, Song N. [Acupuncture at tendons node combined with movement for 30 cases of post-stroke spastic paralysis in lower limbs]. Zhongguo Zhen Jiu 2015; 35:212. [PMID: 26062181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Becerra-Fajardo L, Ivorra A. Towards addressable wireless microstimulators based on electronic rectification of epidermically applied currents. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:3973-6. [PMID: 25570862 DOI: 10.1109/embc.2014.6944494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Electrical stimulation has been explored to restore the capabilities of the nervous system in paralysis patients. This area of research and of clinical practice, known as Functional Electrical Stimulation, would greatly benefit from further miniaturization of implantable stimulators. To that end, we recently proposed and demonstrated an innovative electrical stimulation method in which implanted microstimulators operate as rectifiers of bursts of innocuous high frequency current supplied by skin electrodes, thus generating low frequency currents capable of stimulating excitable tissues. A diode could suffice in some applications but, in order to broaden the method's clinical applicability, we envision rectifiers with advanced capabilities such as current control and addressability. We plan flexible thread-like implants (diameters < 300 μm) containing ASICs. As an intermediate stage, we are developing macroscopic implants (diameters ~ 2 mm) made of off-the-shelf components. Here we present a circuit which responds to commands modulated within the high frequency bursts and which is able to deliver charge-balanced currents. We show that a number of these circuits can perform independent stimulation of segments of an anesthetized earthworm following commands from a computer.
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Juarez Becerril O, Salgado Ceballos H, Anguiano Solis C, Alvarado Sanchez B, Lopez Hernandez ME, Diaz Ruiz A, Torres Castillo S. Electro-Acupuncture at GV.4 Improves Functional Recovery in paralyzed rats after a Traumatic Spinal Cord Injury. ACUPUNCTURE ELECTRO 2015; 40:355-369. [PMID: 26934797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In the present study, the effect of electro-acupuncture (EA) on the oxidative stress, the spinal cord tissue preservation and the recovery of motor function was evaluated after a traumatic spinal cord injury (TSCI). Long Evans rats were randomized into five groups: 1. Sham; 2. TSCI without treatment; 3. TSCI + EA (acupoint GV.4); 4. TSCI + EA (acupoint GV.26) and 5.TSCI + EA (GV.4 + GV.26). The EA was performed with an Electro-Acupunctoscope, AWQ-104L Digital, wave dense-dispersed, current intensity 2.5mA and frequency 2-100Hz for 30 minutes. The biochemical results showed a significant increase in the hydroxyl radical concentration in group 2 (3.1 ± 1.4 nmol) compared with groups 1 (1.8 ± 0.5 nmol) and 4 (2.4 ± 1.1 nmol) (p< 0.05), whereas in group 4 (4.8 ± 1.8 nmol), there was a significant increase in lipid peroxidation when compared with group 1 (1.7 ± 0.5 nmol) (p < 0.05). The BBB motor function score in the paralyzed hind limbs (normal BBB = 21points) was greater in groups 3 (15.2 points) and 5 (13.5 points) in comparison with groups 2 (11.4 points) and 4 (9.3 points) (p < 0.05). The quantity of preserved spinal cord tissue was greater in group 3 (6582.7± 20 μm2) than in groups 2 (5262.4 20 μm2), 4 (3995.6 ± 26μm2) and 5 (4266.7± 22 μm2). Although EA in GV.26 decreases hydroxyl radical concentration (50%), it significantly increases lipid peroxidation (45%), while stimulation of GV.4 decreases oxidative stress (15%), preserves spinal cord tissue (25%) and improves recovery of motor function in the hind limbs of rats with paralysis (18.1%) compared with untreated group. These findings suggest that EA in GV.4 may be a therapeutic alternative on TSCI.
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