Analysis of feeding and eating disorders in 191 children according to psychiatric or gastroenterological recruitment: The PEDIAFED cohort study

OBJECTIVE

The DSM-5 classification introduced new Feeding and Eating Disorders (FED) diagnostic categories, notably Avoidant and Restrictive Food Intake Disorder (ARFID), which, like other FED, can present psychiatric and gastrointestinal symptoms. However, paediatric clinical research that focuses on children below the age of 12 years remains scarce. The aim of this study was first to investigate the clinical features of FED in a cohort of children, second to compare them according to their recruitment (gastroenterology or psychiatry unit).

METHOD

This non-interventional retrospective cohort study analysed 191 patients in a French paediatric tertiary care centre (gastroenterology n = 100, psychiatry n = 91). The main outcome variables were clinical data (type of FED, BMI, nutritional support, chronic diseases, psychiatric comorbidities, sensory, sleep, language disorders, gastrointestinal complaints, adverse life events, family history). The outcome was defined by a Clinical Global Impression of Change-score.

RESULTS

FED diagnoses were ARFID (n = 100), Unspecified FED (UFED, n = 57), anorexia nervosa (AN, n = 33) and one pica/rumination. Mean follow-up was 3.28 years (SD 1.91). ARFID was associated with selective and sensory disorders (p < 0.001); they had more anxiety disorders than patients with UFED (p < 0.001). Patients with UFED had more chewing difficulties, language disorder (p < 0.001), and more FED related to chronic disease (p < 0.05) than patients with ARFID and AN. Patients with AN were female, underweight, referred exclusively to the psychiatrist, and had more depression than patients with ARFID and UFED (p < 0.001). The gastroenterology cohort included more UFED, while the psychiatry cohort included more psychiatric comorbidities (p < 0.001). A worse clinical outcome was associated with ARFID, a younger age at onset (p < 0.001), selective/sensory disorders and nutritional support (p < 0.05).

CONCLUSION

ARFID and UFED children were diagnosed either by gastroenterologists or psychiatrists. Due to frequently associated somatic and psychiatric comorbidities, children with FED should benefit from a multidisciplinary assessment and care.

Developing an arabic questionnaire to assess sensory processing disorders among preschool Egyptian children

BACKGROUND

Sensory processing disorder (SPD) is a neurophysiologic disorder in which sensory input is poorly detected, modulated, interpreted and/or to which atypical responses occur. The objective of this study was to validate an Arabic questionnaire for identification of SPD among preschool Arabic-speaking children with Autism Spectrum Disorders (ASD) and Attention Deficit Hyperactivity Disorder (ADHD).

METHODS

A newly constructed Arabic questionnaire for assessment of SPD was completed by parents of 100 Egyptian Arabic-speaking children including 40 typically-developing children (control group), 30 children with ASD, and 30 children with ADHD in the age range 3-6 years RESULTS AND CONCLUSION: Sensory processing differences were detected between typically-developing children and children with ASD and ADHD. Significant differences were found in auditory processing, visual processing, oral sensory processing, olfactory processing, total scores and emotional/social response. The current study revealed non-significant differences between ASD and ADHD children as regards auditory, visual, touch, oral sensory, olfactory and total processing scores. On the other hand, ASD children showed higher scores in proprioceptive processing and lower scores in emotional/social response than children with ADHD. The designed Arabic questionnaire is a valid and reliable assessment tool for identification of SPD in preschool Arabic-speaking children.

Cancer survivors post-chemotherapy exhibit unique proprioceptive deficits in proximal limbs

BACKGROUND

Oxaliplatin (OX) chemotherapy for colorectal cancer is associated with adverse neurotoxic effects that can contribute to long-term sensorimotor impairments in cancer survivors. It is often thought that the sensorimotor impairments are dominated by OX-induced dying-back sensory neuropathy that primarily affects the distal regions of the limb. Recent preclinical studies have identified encoding dysfunction of muscle proprioceptors as an alternative mechanism. Unlike the dying-back sensory neuropathy affecting distal limbs, dysfunction of muscle proprioceptors could have more widespread effects. Most investigations of chemotherapy-induced sensorimotor impairments have considered only the effects of distal changes in sensory processing; none have evaluated proximal changes or their influence on function. Our study fills this gap by evaluating the functional use of proprioception in the shoulder and elbow joints of cancer survivors post OX chemotherapy. We implemented three multidirectional sensorimotor tasks: force matching, target reaching, and postural stability tasks to evaluate various aspects of proprioception and their use. Force and kinematic data of the sensorimotor tasks were collected in 13 cancer survivors treated with OX and 13 age-matched healthy controls.

RESULTS

Cancer survivors exhibited less accuracy and precision than an age-matched control group when they had to rely only on proprioceptive information to match force, even for forces that required only torques about the shoulder. There were also small differences in the ability to maintain arm posture but no significant differences in reaching. The force deficits in cancer survivors were significantly correlated with self-reported motor dysfunction.

CONCLUSIONS

These results suggest that cancer survivors post OX chemotherapy exhibit proximal proprioceptive deficits, and that the deficits in producing accurate and precise forces are larger than those for producing unloaded movements. Current clinical assessments of chemotherapy-related sensorimotor dysfunction are largely limited to distal symptoms. Our study suggests that we also need to consider changes in proximal function. Force matching tasks similar to those used here could provide a clinically meaningful approach to quantifying OX-related movement dysfunction during and after chemotherapy.

Oral Minocycline Therapy Improves Symptoms of Myalgic Encephalomyelitis, Especially in the Initial Disease Stage

Objective Central nervous system dysfunction associated with myalgic encephalomyelitis (ME) has been suggested to be the main cause of chronic fatigue syndrome. In animal models of chronic fatigue, minocycline was reported to act as a suppressor of neural inflammation. Minocycline may thus exert favorable therapeutic effects in patients with ME. Methods Oral minocycline (100 mg×2 on the first day, followed by 100 mg/day for 41 days) was administered to 100 patients with ME. The performance status score (0-9), orthostatic intolerance during the 10-min standing test, neurologic disequilibrium, and neuropathic pain were compared before and after treatment. Results After therapy completion, favorable effects were observed with a decrease in the performance status score of ≥2 points in 27 patients (27%). Before treatment, 6 of the 27 patients had orthostatic intolerance with an inability to complete the 10-min standing test; after treatment, this symptom resolved in 4 and improved in 2 patients. In addition, after treatment, postural orthostatic tachycardia resolved in five of eight patients, disequilibrium resolved in five of eight patients, and fibromyalgia or neuropathic pain was attenuated in four of five patients. The favorable effects appeared dependent on a shorter disease duration, primarily for a duration of less than three years and most frequently within six months of the disease onset. However, acute adverse effects with nausea and/or dizziness caused 38 patients (38%) to discontinue treatment in the first few days. Conclusion Oral minocycline therapy may be an effective treatment option for patients with ME, especially in the initial stage of the disease.

[Psychomotor disadaptation syndrome]

Psychomotor disadaptation syndrome (PDS) was first described by the Geriatrics School of Dijon (France), three decades ago, under the name «psychomotor regression syndrome». Over time, the original clinical features remained unchanged. However, progress has been made in its pathophysiology understanding and care, hence the new name, PDS, appeared in the 1990s. The PDS is also called sub-cortico-frontal dysfunction syndrome since the 2000s. It corresponds to a decompensation of posture, gait and psychomotor automatisms, related to an alteration of the postural and motor programming, which is a consequence of sub-cortico-frontal lesions. The clinical features of PDS associate backward disequilibrium, nonspecific gait disorders and neurological signs (akinesia, reactional hypertonia, impaired reactive postural responses and protective reactions, etc.). Psychological disorders of PDS are a fear of standing and walking in its acute form (the post-fall syndrome), or a bradyphrenia and anhedonia in its chronic form. The PDS occurrence results from the combination of three factors implicated in the reduction in functional reserves related to the alteration of the sub-cortico-frontal structures: ageing, chronic afflictions and acute situations, which induce a decrease in cerebral blood flow. The PDS management must be multidisciplinary, including the physician, the physiotherapist, the psychologist, nurses and care assistants.

[Chronic inflammatory demyelinating polyneuropathy]

In this review, we discuss chronic inflammatory demyelinating polyneuropathy (CIDP), which is a disease with proximal and distal weakness and sensory disturbances resulting in impaired daily activity. The diagnosis is based on the clinical presentation and electrophysiology demonstrating demyelination in the peripheral nerves. CIDP can be successfully treated with immunoglobulin, glucocorticoids or plasma exchange, and during the latest decade, immunoglobulin has been administered subcutaneously improving patients' flexibility and autonomy. By time, 30% of the patients will remit, and maintenance treatment will no longer be necessary.

Postural control deficits in people with Multiple Sclerosis: A systematic review and meta-analysis

BACKGROUND

Multiple sclerosis (MS) is a neurological condition that can affect the postural stability of the individual and predispose falls in this population.

METHODS

A systematic literature search identified case-control studies investigating differences in postural control across a diversity of task conditions, with the exception of gait, between people with MS and healthy controls. Meta-analysis was conducted where a variable was presented by four or more studies.

RESULTS

Forty-three studies of people with a mean Expanded Disability Status Scale (EDSS) of 1.0 to 6.0 were included. Seven conditions of assessment and 105 individual measurement variables relating to postural control were included. Quiet stance was the only condition (11 studies) possessing sufficient data to contribute to meta-analysis in terms of centre of pressure path length (SMD = 1.04, 95% CI {0.86-1.22}, p < 0.001), medio-lateral velocity (SMD = 1.35, 95% CI {0.77-1.92}, p < 0.001) and 95% confidence ellipse (SMD = 0.83 95% CI {0.59-1.08}, p < 0.001).

RESULTS

indicate that regardless of task complexity or sensory condition, people with MS display considerable deficits in postural control in comparison to healthy controls.

CONCLUSIONS

The large number of variables and lack of standardisation of reporting makes data synthesis challenging, however, people with MS display considerable deficits in postural control compared to healthy controls regardless of task condition or complexity.

Pali and Echo Phenomena: Symptoms of Persistence and Perseveration

Some neurological or psychiatric positive, productive symptoms are an abnormal persistence of a sensorial feeling or abnormal repetition of a motor, behavioral or cognitive process corresponding to a perseverative symptom. Palinopsia, palinacousis, and related sensorial symptoms have been described. Verbal and motor symptoms include echolalia, palilalia, echopraxia, and motor perseveration. Cognitive disorders induce perseverative behavior, perseverative thinking, including palipsychism, flashbulb memories, and reduplicative paramnesia (also known as "palimnesia") and many related perseverative symptoms. We propose a review of physiological phenomena and pathological symptoms involving these perseverative or repetitive characteristics and discuss the potential mechanisms and neural network involved in this productive semiology.

Personality and Depersonalization under Sensory Deprivation Conditions

Of 28 normal Ss undergoing brief sessions of S.D., 8 reported depersonalization experiences. They were found to be significantly more introverted than the rest of the group.

Postural Stability of Patients with Schizophrenia during Challenging Sensory Conditions: Implication of Sensory Integration for Postural Control

Postural dysfunctions are prevalent in patients with schizophrenia and affect their daily life and ability to work. In addition, sensory functions and sensory integration that are crucial for postural control are also compromised. This study intended to examine how patients with schizophrenia coordinate multiple sensory systems to maintain postural stability in dynamic sensory conditions. Twenty-nine patients with schizophrenia and 32 control subjects were recruited. Postural stability of the participants was examined in six sensory conditions of different level of congruency of multiple sensory information, which was based on combinations of correct, removed, or conflicting sensory inputs from visual, somatosensory, and vestibular systems. The excursion of the center of pressure was measured by posturography. Equilibrium scores were derived to indicate the range of anterior-posterior (AP) postural sway, and sensory ratios were calculated to explore ability to use sensory information to maintain balance. The overall AP postural sway was significantly larger for patients with schizophrenia compared to the controls [patients (69.62±8.99); controls (76.53±7.47); t_1,59 = -3.28, p<0.001]. The results of mixed-model ANOVAs showed a significant interaction between the group and sensory conditions [F_5,295 = 5.55, p<0.001]. Further analysis indicated that AP postural sway was significantly larger for patients compared to the controls in conditions containing unreliable somatosensory information either with visual deprivation or with conflicting visual information. Sensory ratios were not significantly different between groups, although small and non-significant difference in inefficiency to utilize vestibular information was also noted. No significant correlations were found between postural stability and clinical characteristics. To sum up, patients with schizophrenia showed increased postural sway and a higher rate of falls during challenging sensory conditions, which was independent of clinical characteristics. Patients further demonstrated similar pattern and level of utilizing sensory information to maintain balance compared to the controls.

Gait characteristics according to pyramidal, sensory and cerebellar EDSS subcategories in people with multiple sclerosis

Walking deterioration is a common problem in people with multiple sclerosis (PwMS). However, there are only scarce data examining the contribution of specific neurological functional systems on gait performance in multiple sclerosis (MS). Therefore, the objective of the current study was to examine the differences in spatio-temporal parameters of gait according to the pyramidal, cerebellar and sensory functional systems. The cross-sectional study included 289 PwMS with mean disease duration of 8.0 (SD = 8.2) years. Spatio-temporal parameters of gait were studied using an electronic walkway. The sample pool was divided into six groups according to the scores of the pyramidal, cerebellar and sensory functional systems, derived from the expanded disability status scale data. Findings indicated that asymmetry of the step time and asymmetry of the single support were significantly elevated in the pyramidal group compared to the sensory group; 9.4 (SD = 10.6) vs. 3.1 (SD = 6.7), P value = 0.004; 9.3 (SD = 10.4) vs. 2.7 (2.1), P value = 0.001, respectively. Additionally, patients in the pure sensory group walked significantly faster with longer strides and less asymmetry compared to the pyramidal-cerebellar-sensory group. Moreover, patients in the sensory group walked with longer steps/strides and symmetry compared to the patients in the pyramidal-cerebellar group. This study confirms that pyramidal disorders are main contributors of gait impairments in the MS population. Furthermore, patients with sensory impairments have a relatively preserved gait pattern compared to patients affected by the pyramidal system.

[Homogeneous spinal-shortening axial decompression procedure for tethered cord syndrome]

OBJECTIVE

Surgical detethering is a traditional treatment for symptomatic tethered cord syndrome. However, such complications as cerebrospinal fluid leakage and neurologic deterioration are common. Homogeneous spinal-shortening axial decompression (HSAD) is a modified procedure of monosegmental spinal-shortening osteotomy and it is a novel surgical alternative of reducing neural tension indirectly. The objective was to evaluate the surgical outcomes of HSAD for tethered cord syndrome.

METHODS

The surgical outcomes were examined for 15 consecutive patients with tethered cord syndrome undergoing HSAD from April 2010 to July 2014. Improvements of neurological symptoms including urinary dysfunction, lower-extremity motor and sensory disturbances and/or gait abnormalities, low-back and/or lower-extremity pain, bowel incontinence and sexual dysfunction were evaluated.

RESULTS

Their average follow-up period was 21.5 months. The length of spinal column shortening was 17.2 ± 2.9 mm. Urinary dysfunction (n = 9) was the most common residual deficit. All 9 patients with urological symptoms reported improvements, although deficits persisted at the last follow-up. All patients with lower-extremity motor dysfunction improved and 4 (50.0%) noted complete resolution of preoperative lower-extremity sensory symptoms. All patients reported immediate low-back or lower-extremity pain relief after HSAD. One patient reported improved sexual functioning and regained complete erectile capabilities. Two patients (11%) experienced less satisfactory symptomatic or functional benefit from HSAD. However, the main objective of surgery was to prevent further worsening of neurological status. Complete bone union at osteotomy site was noted in all cases at the last follow-up.

CONCLUSION

As a novel surgical option for tethered cord syndrome, HSAD may avoid such complications as cerebrospinal fluid leakage or neurologic deterioration commonly encountered during traditional detethering surgery. All patients gain satisfactory functional outcomes without complications compared to their preoperative symptoms.

Olfactory dysfunction and neurotransmitter disturbance in olfactory bulb of transgenic mice expressing human A53T mutant α-synuclein

Parkinson disease is a multi-system neurodegenerative disease characterized by both motor and non-motor symptoms. Hyposmia is one of the early non-motor symptoms occurring in more than 90% of Parkinson disease cases, which can precede motor symptoms even several years. Up to now, the relationship between hyposmia and Parkinson disease remains elusive. Lack of proper animal models of hyposmia restricts the investigation. In this study we assessed olfactory function in Prp-A53T-α-synuclein transgenic (αSynA53T) mice which had been reported to show age-dependent motor impairments and intracytoplasmic inclusions. We also examined cholinergic and dopaminergic systems in olfactory bulb of αSynA53T mice by immunofluorescent staining, enzyme linked immunosorbent assay and western blot. We found that compared to wild type littermates, αSynA53T mice at 6 months or older displayed a deficit of odor discrimination and odor detection. No significant changes were found in olfactory memory and odor habituation. Furthermore compared to wildtype littermates, in olfactory bulb of αSynA53T mice at 10 months old we detected a marked decrease of cholinergic neurons in mitral cell layer and a decrease of acetylcholinesterase activity, while dopaminergic neurons were found increased in glomerular layer, accompanied with an increase of tyrosine hydroxylase protein. Our studies indicate that αSynA53T mice have olfactory dysfunction before motor deficits occur, and the cholinergic and dopaminergic disturbance might be responsible for the Parkinson disease-related olfactory dysfunction.

Anti Ma2-associated myeloradiculopathy: expanding the phenotype of anti-Ma2 associated paraneoplastic syndromes

Anti-Ma2 associated paraneoplastic syndrome usually presents as limbic encephalitis in association with testicular tumours.^, Only four patients have been reported with involvement outside the CNS, two of whom also had limbic or brainstem encephalitis.^, We report a man with anti- Ma2 associated myeloradiculopathy and previous testicular cancer whose neurological syndrome stabilised and anti-Ma2 titres fell following orchidectomy of a microscopically normal testis.

Body integrity identity disorder: deranged body processing, right fronto-parietal dysfunction, and phenomenological experience of body incongruity

Body integrity identity disorder (BIID) is characterised by profound experience of incongruity between the biological and desired body structure. The condition manifests in "non-belonging" of body parts, and the subsequent desire to amputate, paralyse or disable a limb. Little is known about BIID; however, a neuropsychological model implicating right fronto-parietal and insular networks is emerging, with potential disruption to body representation. We argue that, as there is scant systematic research on BIID published to date and much of the research is methodologically weak, it is premature to assume that the only process underlying bodily experience that is compromised is body representation. The present review systematically investigates which aspects of neurological processing of the body, and sense of self, may be compromised in BIID. We argue that the disorder most likely reflects dysregulation in multiple levels of body processing. That is, the disunity between self and the body could arguably come about through congenital and/or developmental disruption of body representations, which, together with altered multisensory integration, may preclude the experience of self-attribution and embodiment of affected body parts. Ulimately, there is a need for official diagnostic criteria to facilitate epidemiological characterisation of BIID, and for further research to systematically investigate which aspects of body representation and processing are truly compromised in the disorder.

Relationship of airway sensory hyperreactivity to asthma and psychiatric morbidity

BACKGROUND

Patients with airway symptoms induced by chemicals and odors are common in allergy clinics, but the problems cannot be explained by allergic or asthmatic reactions. Previous studies have shown that these patients often have increased sensitivity to inhaled capsaicin, which is known to reflect sensory reactivity; a diagnosis of airway sensory hyperreactivity (SHR) has been suggested for this condition.

OBJECTIVES

To examine the relationship between asthma and SHR and to investigate whether patients with SHR show signs of increased psychiatric morbidity.

METHODS

This study included 724 patients who were attending an allergy center because of suspected allergy or asthma. All the patients completed a quantitative questionnaire on self-reported affective reactions and behavioral disruptions caused by odorous/pungent substances. A standardized capsaicin inhalation test was performed and a questionnaire to assess psychiatric morbidity was administered in patients with pronounced chemical sensitivity to identify those with SHR.

RESULTS

The prevalence of SHR was approximately 6% in asthmatic patients in the allergy center population, which is in accordance with the prevalence in a general population. There was no significant indication that SHR was related to either depression or anxiety.

CONCLUSION

There is no strong relationship between SHR and either asthma or psychiatric morbidity.

Relationships among rhinitis, fibromyalgia, and chronic fatigue

New information about the pathophysiology of idiopathic nonallergic rhinopathy indicates a high prevalence in chronic fatigue syndrome (CFS). This article shows the relevance of CFS and allied disorders to allergy practice. CFS has significant overlap with systemic hyperalgesia (fibromyalgia), autonomic dysfunction (irritable bowel syndrome and migraine headaches), sensory hypersensitivity (dyspnea; congestion; rhinorrhea; and appreciation of visceral nociception in the esophagus, gastrointestinal tract, bladder, and other organs), and central nervous system maladaptations (central sensitization) recorded by functional magnetic resonance imaging (fMRI). Neurological dysfunction may account for the overlap of CFS with idiopathic nonallergic rhinopathy. Scientific advances are in fMRI, nociceptive sensor expression, and, potentially, infection with xenotropic murine leukemia-related virus provide additional insights to novel pathophysiological mechanisms of the "functional" complaints of these patients that are mistakenly interpreted as allergic syndromes. As allergists, we must accept the clinical challenges posed by these complex patients and provide proper diagnoses, assurance, and optimum care even though current treatment algorithms are lacking.

Self-rated health and quality of life in adults attending regional disability services in Ireland

BACKGROUND

There is limited background information on self-rated health in people with disability in Ireland. This paper examines self-rated health scores and dimensions of functioning in people attending disability services and compares scores to the general population in Ireland, which has not been done before.

METHODS

Face-to-face interviews were carried out with 247 adults with intellectual disability and 180 with physical or sensory disability attending regional residential, day activity, or training disability centres in the East Coast Area of Ireland. EuroQol ED-5Q was used to assess five dimensions of functioning and quality of life, supplemented by questions taken from the national population study on general health, mental health, and quality of life.

RESULTS

Clients with intellectual disability scored their quality of life significantly higher than the adult general population. They scored their mental health significantly lower compared with clients with physical/sensory disability. Compared to clients with intellectual disability, and to the general population, clients with physical or sensory disability scored their quality of life significantly lower. They had more problems in all EuroQol ED-5Q dimensions (mobility; self-care; being able to carry out one's usual activities; pain; and anxiety) than both the general population and clients with intellectual disability.

CONCLUSION

These results give an insight into self-rated health and quality of life of regional disability services attendees. Findings provide an indicator of health needs and provide a baseline to measure the impact of interventions. Further elucidation of the relationship between functional impairment and quality of life in those with disability is needed. Factors affecting self-rating of health in people with intellectual disabilities need further exploration.

Sensory impairment, use of community support services, and quality of life in aged care clients

OBJECTIVE

To assess influences from visual or hearing impairment on use of community support services and health-related quality of life in aged care clients.

METHOD

The authors sampled 284 frail elderly individuals presenting for assessment in Sydney, Australia. Moderate to severe visual impairment was defined as visual acuity <20/80 (better eye), and moderate to severe hearing loss as hearing thresholds >40 decibels (better ear). Community support services included home-delivered meals, home help, and community nurse visits.

RESULTS

After adjusting for age, sex, and two or more comorbid conditions, moderate to severe visual impairment, but not moderate to severe hearing loss, was significantly associated with increased use of community services (adjusted odds ratio 2.8, 95% confidence interval = 1.0-7.8).

CONCLUSION

Moderate to severe visual impairment was associated with an increased likelihood of community service utilization in this aged care client sample.

[Impairment of social interaction, coordination disorder, and hypersensitivity in Asperger's syndrome]

Asperger's syndrome is not accompanied with intellectual disability, however it has social impairments as well as autism and demonstrates failure to develop peer relationships according to each life stage. Social reciprocal behavior deficits are revealed typically during childhood. On the other hand, after school age these deficits are modified by environmental factors that may induce secondary disorders consequently. Hypersensitivity and coordination disorder, which are not included in diagnostic criteria for Asperger's syndrome, are often in presence. These symptoms are diminished and rarely interfere daily living as growth. However they may keep Asperger's syndrome individuals from adapting to others, so we need to take it into consideration.

[Diagnosis of Asperger syndrome in infancy and childhood]

I discussed, in this chapter, the possibilities and limitations of clinical diagnosis for Asperger syndrome (AS) in infancy and early childhood. For early diagnosis or simply noticing the possibility of AS, clinicians should be sensitive to the auxiliary conditions of AS such as motor dysfunction and sensory/sleep disturbances during the early stage of life, as well as the incipient representations of the main AS symptoms in the diagnostic criteria, such as lack of reciprocal social interaction or joint attention. Future prospective study with large cohort, or creation of the new methods for cognitive evaluation which is applicable to infants and toddlers, would be profitable in order to establish the sensitive tool for AS diagnosis in early infancy, while the idea would be expected undoubtedly elusive.

The Psychophysical Relationship between Bitter Taste and Burning Sensation: Evidence of Qualitative Similarity

Although it has long been studied as a pure sensory irritant, the ability of capsaicin to evoke, mask, and desensitize bitter taste suggests that burning sensations and bitter taste might be closely related perceptually. The current study investigated the psychophysical relationship between bitterness and burning using 2 different approaches. In Experiment 1, spatial discrimination of 4 taste stimuli was measured in the presence or absence of capsaicin. The subjects' task was to report which of 3 swabs, spaced 1 cm apart and presented to the tongue tip, contained a taste stimulus when 1) water was presented on the other 2 swabs or 2) when 10 muM capsaicin was presented on all 3 swabs. The presence of capsaicin did not change performance on the 3 alternative forced-choice (3-AFC) task for sweet, sour, and salty stimuli, while the localization error for 1.8 mM quinine sulfate (QSO(4)) increased significantly. In Experiment 2, the perceptual similarity/dissimilarity of taste stimuli and capsaicin was measured directly using pairs of stimuli applied to opposite sides of the tongue tip on swabs separated by 2 cm. Multidimensional scaling analyses showed that capsaicin fell nearer to QSO(4) than to any other taste stimulus. Cluster analysis corroborated this finding: capsaicin was closely linked with QSO(4) and the capsaicin-QSO(4) group was separated from the other taste stimuli. The latter result indicated that bitterness was more similar to burning than to the other tastes. These findings imply that despite being mediated by different sensory modalities, bitterness and burn are qualitatively similar. We speculate that this similarity reflects a common function of these 2 sensations as sensory signals of potentially harmful stimuli.

Rituximab therapy in monoclonal IgM-related neuropathies

Monoclonal IgM-related neuropathies constitute a heterogeneous group of disorders, which are generally poorly responsive to treatment. Rituximab, a chimeric monoclonal antibody against the CD20 molecule, has been used with success in patients with neuropathy and monoclonal IgM with anti-MAG or anti-GM1 ganglioside activity. Based on this observation, four patients were treated with IgM-related neuropathy with rituximab. Between January 1999 - December 2000, four patients with IgM-related neuropathy (one with chronic inflammatory demyelinating polyneuropathy (CIDP) and three with sensorimotor demyelinating neuropathy) were treated with rituximab. Rituximab was administered at a standard dose of 375 mg m(-2) iv weekly for a consecutive 4 weeks; 3 months later, four additional weekly courses were administered to patients who did not experience deterioration of their neuropathy symptoms. Neurological evaluation was performed before each rituximab infusion and at 1 week and 2 months after last infusion and every 6 months the following years; including motor (MRC in six muscle groups, 9-hole peg test, 10 m walk, hand grip strength), sensory neuropathy (vibration threshold and sensory subjective score) assessment. Neurophysiological parameters were also assessed (MNCV, SNCV, CMAP, SNAP). Strength improved in three of four patients; including the patient with CIDP. This patient developed a significant worsening of her weakness 3 weeks after the initiation of rituximab. This phenomenon coincided with a serum monoclonal IgM flare and resolved spontaneously 1 week later. Her improvement is ongoing for more than 5 years. Considering neurophysiological parameters, two patients showed a slight improved regarding conduction velocities and CMAP (10%) and the patient with IgM flare had a transient worsening of conduction velocities followed by improvement. In conclusion, rituximab is a safe and well-tolerated treatment which may be effective in some patients with IgM-related neuropathy.

Pain and sensory dysfunction after breast cancer surgery: neurometer CPT evaluation

The purpose of our study was to evaluate the presence of anatomical and functional damage to the afferent and sensorial fibres using the Neurometer CPT test. A questionnaire regarding pain was sent to 300 women who had undergone surgery six months earlier. Out of 300 patients 67 did not respond; 105 experienced no pain; while 128 felt pain. One hundred and twenty-eight women were divided into two groups: mastectomy with reconstruction and simple mastectomy. The intensity of pain at T0 in women with reconstruction was significantly higher; at T4, on the other hand, was lesser and there was no significant difference between the two groups. In both groups at T4, the daily diary revealed that interference with sleep and normal daily activities were more evident in patients who had undergone reconstruction (p > 0.001). The final results at T4 demonstrated that among patients with reconstruction, 47% showed slight hypoesthesia-paraesthesia in the breast, armpit and arm zones, 39% slight hypoesthesia in the same locations and 18% severe hypoesthesia. Patients with reconstruction, instead, showed different percentages: 75% showed slight hypoesthesia-paraesthesia, 16% a slight hypoesthesia and 9% severe hypoesthesia. Our results support the utilization of the Neurometer CPT test as a device for monitoring post-mastectomy pain.

Pure neural leprosy presenting with multiple nerve abscesses

A 22-year-old male student presented to us with patchy sensory loss over the dorsum of right foot of 6 months' duration and swelling over the left index finger of 2 months' duration. Subsequently, a week later, he developed a painful swelling over the left forehead and right leg. On examination, tender soft, fluctuant subcutaneous saccular swellings were seen varying in size from 2x2 cm to 5x5 cm over the left supratrochlear, left radial cutaneous nerve, left digital nerve, right superficial peroneal nerve and left saphenous nerve. The nerves were tender and thickened above and below these cold swellings (cold nerve abscesses). Nerve biopsy of the left radial cutaneous nerve showed granulomatous infiltrate of epithelioid cells, lymphocytes and caseation necrosis of nerve. No bacilli were demonstrated with acid-fast stain. On the basis of the above findings, a diagnosis of pure neuritic leprosy (BT spectrum) in type 1 lepra reaction with multiple nerve abscesses was made. We present this case of pure neuritic leprosy exhibiting multiple nerve abscesses, for its rarity.

A Latent Growth Curve Analysis of Late-Life Sensory and Cognitive Function Over 8 Years: Evidence for Specific and Common Factors Underlying Change

Correlations among rates of change in sensory and cognitive functioning in adulthood were evaluated. Measures of Vision, Hearing, Memory, Speed and Verbal ability were obtained in 1992, 1994, and 2000 in the Australian Longitudinal Study of Aging (N = 2,087 at baseline). Data from 1,823 participants who undertook at least 1 clinical assessment were analyzed using latent growth curve models. A significant moderate-sized association between rates of change in Memory and Vision was found. This remained after statistically controlling for the effects of age, gender, education, self-rated health, medical conditions, and depressive symptoms. Rate of change in Hearing was weakly associated with rate of change in Memory. The results support a theory incorporating a major role for unique factors in addition to common factors underlying sensory and cognitive change in old age.

What good is EMG to the patient and practitioner?

Electromyography (EMG) and nerve conduction studies (NCS) are not only tests to be performed in isolation and reported without consideration of the clinical context, but rather form part of what has been referred to as the electrodiagnostic consultation. Using all of the pertinent information available to the electromyographer performing the test, the electrodiagnostic consultation strives toward the goal of helping the patient and the referring physician to establish a correct diagnosis. Although not without limitations, EMG as an extension of the clinical history and physical examination can be a powerful and sensitive diagnostic tool. Like any tool, however, the final result depends on the skill and expertise with which it is wielded.

Development of virtual reality stimuli for force platform posturography

People relying much on vision in the control of posture are known to have an elevated risk of falling. Dependence on visual control is an important parameter in the diagnosis of balance disorders. We have previously shown that virtual reality (VR) methods can be used to produce visual stimuli that affect balance, but suitable stimuli need to be found. In this study, the effect of six different VR stimuli on the balance of 22 healthy test subjects was evaluated using force platform posturography. We report in more detail and expand the results published earlier. According to the tests two of the stimuli have a significant destabilizing effect on balance. In addition a significant displacement effect on the subject's center of pressure (COP) was found. Thus it is shown that the design of VR stimuli to cause different effects on the control of balance is possible.

Cervical spine involvement in Larsen's syndrome: a case illustration

We present the progressive clinical course of a child with myelopathy attributable to cervical spine abnormalities associated with Larsen's syndrome. After anterior and posterior cervical fusion, his preoperative symptoms of weakness, gait dysfunction, and hyperreflexia have improved at 9-month follow-up. The progressive course and importance of early referral and intervention should be of interest to the general pediatric community.

Management of patients with trigeminal nerve injuries after mandibular implant placement

BACKGROUND

Placement of mandibular endosseous implants can result in damage to the lingual nerve, the inferior alveolar nerve or both nerves. All dentists who place mandibular implants should be aware of the appropriate early management of these injuries, as well as the appropriate time to refer patients with these injuries to a microneurosurgeon.

OVERVIEW

The lingual nerve is less likely to undergo spontaneous regeneration than is the inferior alveolar nerve, which is protected within the inferior alveolar canal. Since the inferior alveolar canal can be seen on most panoramic radiographs and on all high-quality computed tomographic scans, it is easier to avoid damage to the inferior nerve than to the lingual nerve, which is not visualized on radiographs and whose relationship to the posterior portion of the mandible varies from person to person.

RESULTS

The authors reviewed one study that showed that lingual nerve repair helped 90 percent of patients. A second study found that patients who underwent lingual nerve repair reported a mean score of 7 on a scale from 0 to 10 in regard to the postoperative return of nerve function. Several other studies reported favorable patient responses to inferior alveolar nerve repair.

CONCLUSIONS AND CLINICAL IMPLICATIONS

These results reinforce the need for early referral and intervention when inferior alveolar nerve injuries occur. Failure to refer patients with trigeminal nerve injury before distal nerve degeneration develops prevents minimization of the injury through microneurosurgical repair.

Adult-onset hereditary sensory and autonomic neuropathy accompanied by anosmia but without skin ulceration

We report a novel type of hereditary sensory and autonomic neuropathy (HSAN) with adult onset in a Japanese family. One male and 2 females of 6 siblings were affected. They developed anosmia initially at the ages of 20-50 years, followed by anhidrosis and sensory loss. Skin ulceration was absent. Both superficial and deep sensation were impaired in the most distal parts of all 4 limbs. Orthostatic hypotension was present in all patients. This is a unique subtype of HSAN distinct from the HSAN I-V described by Dyck.

Acute neurologic complications in children with systemic cancer

Neurologic complications are common in children with cancer, but the literature dealing with this subject is sparse. Using a symptoms and signs approach, the most common causes for requesting a neurologic evaluation for this population are reviewed. The spectrum of neurologic symptoms in children with cancer differs from adults and requires the consulting neurologist to have a thorough knowledge of childhood cancer and its effects on the nervous system.

[Behavior problems in patients with dementia. The impact on the career life]

Many studies have suggested that caring for patients with dementia may be associated with increased burden, particularly when subjects present with prominent behavioural problems. The present work aimed to review studies appearing on MedLine between 1990 and January 1998 that included the following keywords: 'burden or impact or cost' and 'dementia or Alzheimer's disease' and 'carer or caregiver or caregiving or family'. Only fourteen of the studies retrieved fulfilled the entry criteria for this review: crossectional or longitudinal studies looking at the association between behavioural problems in patients with dementia and burden of carers. All studies indicated that behavioural disturbances are an important cause of burden, although there was little consistency on the definition of 'behavioural disturbances'. As a consequence, it is still unclear which behavioural symptoms are more closely associated with increased burden of care. Future research in the area should aim to clarify these issues and develop management strategies to decrease burden on carers of patients with dementia.

Tooth-implant and implant supported fixed partial dentures: a 10-year report

PURPOSE

The use of implants for prosthetic rehabilitation of partially edentulous patients is increasing. However, the possibilities of placing implants in the posterior part of the mandible are often limited. The purpose of this longitudinal study with 10 years of follow-up was to evaluate the use of short implants supporting fixed partial dentures (FPD) in the posterior part of the mandible, and to compare implant supported FPDs to tooth-implant supported FPDs.

MATERIALS AND METHODS

The patient material comprised 23 patients with residual mandibular anterior teeth, and each patient received FPDs unilaterally. On one side the FPD was supported by two implants, and on the other side by one implant and one tooth, thus permitting intraindividual comparison. The distribution of the two types of FPDs in each jaw was randomized. Implant success rates, marginal bone changes, and mechanical complications were studied.

RESULTS

The tooth-implant connection did not demonstrate any negative influences on the overall success rates for the 10-year period, nor were the shorter implants found to be less favorable.

CONCLUSION

It is suggested that a prosthetic construction supported by both a tooth and an implant may be recommended as a predictable and reliable treatment alternative in the posterior mandible.

Dimensions of gut dysfunction in irritable bowel syndrome: altered sensory function

Growing evidence suggests that symptoms in patients with irritable bowel syndrome (IBS) may be due to a visceral sensory dysfunction. Specifically, it has been shown that patients with IBS have hypersensitive responses to distension of the rectum, whereas their tolerance to somatic stimuli is normal or even increased. Furthermore, patients with IBS have hypersensitivity of the small bowel, which selectively affects mechanosensitive afferents, with normal perception of electrical stimulation of the gut. Sensory dysfunctions may also be associated with altered reflex activity, which may contribute to the clinical symptoms. Normally, a series of mechanisms at different strata of the nervous system modulate visceral afferent input and determine conscious perception. Conceivably, a dysfunction of these regulatory mechanisms may alter sensitivity in clinical conditions. To date, neither the origin nor the clinical significance of visceral hyperalgesia has been elucidated. However, it seems likely that the sensory and reflex dysfunctions of the gut in IBS may combine to different degrees, and their interaction may explain the clinical pleomorphism of the syndrome.

[Serial MRI study on a case of anterior spinal artery syndrome]

A 63-year-old woman suddenly began to suffer from left chest pain. She gradually became unable to walk and was admitted to the emergency room at another hospital. When she became paraplegic in spite of steroid therapy, she was admitted to our hospital. Her affliction was diagnosed as anterior spinal artery syndrome because of flaccid paraplegia and dissociated sensory loss below the Th4 dermatome. Hematological study indicated a compensated DIC and hepatic enzyme abnormality, while the CSF examinations showed an elevation of protein and positive myelin basic protein (MBP) elevation. The initial MRI taken in the acute stage showed no abnormal signals on T1-weighted (T1) and Gd-enhanced images. The sagittal T2-weighted image (T2) revealed central high intensity (HI) with longitudinal extension from Th2 through the Th11 vertebral level. On axial T2, HI was located on the gray matter at the Th3 and Th4 vertebral level, the ventral two-thirds at the Th8 vertebral level, the central ventral side at the Th9 and Th10 vertebral level, and the entire cross section at the Th12 and L1. A follow-up MRI examination showed that the range of HI on the sagittal T2 had been reduced to 5 segments from Th6 through Th10 vertebral level. The T2 HI lesion on the axial aspect had become reduced so as to localize on the left ventral side at the Th8 vertebral level and on the central ventral side at Th9 and Th10.