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Jeong T, Alessandri-Bonetti M, Pandya S, Liu H, Stofman GM, Egro FM. The Development and Management of Neck Burn Scar Contracture Recurrence: A Single-Center Retrospective Cohort Study. Ann Plast Surg 2024; 92:S142-S145. [PMID: 38556663 DOI: 10.1097/sap.0000000000003854] [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] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Burn neck contractures pose a great challenge for reconstructive surgeons. A paucity of literature exist regarding long-term outcomes based on different surgical management strategies. The aim of this study was to evaluate the long-term outcomes of the treatment of neck burn scar contractures and evaluate surgical strategies according to their long-term effectiveness and associated complications. METHODS A retrospective cohort study was conducted to review outcomes of neck contractures release after burn injury. All patients operated on between January 2009 and February 2023 at a single institution were included. RESULTS A total of 20 patients developed neck burn scar contracture and were included in this study. The mean age was 32.9 ± 20.3 years. The burn injuries were most commonly thermal (n = 19, 95%). All burn injuries were full-thickness burns, with an average neck defect size of 130.5 ± 106.0 cm2. Overall, 45 surgical scar release procedures were performed on the 20 patients who developed a neck contracture. Patients underwent 1.65 ± 1.04 surgeries on average to address neck contracture. Although 25% of patients only received 1 surgery to treat neck contracture, some patients underwent as many as 8 surgeries. Contracture recurrence (CR) was the most common complication and occurred in 28.9% of the cases. The mean percentage total body surface area did not significantly differ in CR patients (26.7% ± 14.9%) and no-CR patients (44.5% ± 30.2%). However, there was a significant difference (P = 0.01) in the average neck defect size between CR patients (198.5 ± 108.3 cm2) and no-CR patients (81.1 ± 75.1 cm2). CONCLUSIONS This study showed that risk factors for initial burn scar contractures may differ from those associated with CR, highlighting the importance of neck defect size as a predictor. The study also examines various surgical approaches, with Z-plasty showing promise for managing CR. However, the absence of data on neck range of motion is a limitation. This research underscores the complexity of managing CR and emphasizes the need for ongoing postoperative monitoring.
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Affiliation(s)
- Tiffany Jeong
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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O'Connor S, Hevey D, Burke T, Rafee S, Pender N, O'Keeffe F. A Systematic Review of Cognition in Cervical Dystonia. Neuropsychol Rev 2024; 34:134-154. [PMID: 36696021 PMCID: PMC10920436 DOI: 10.1007/s11065-022-09558-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 05/12/2021] [Revised: 04/17/2022] [Accepted: 06/10/2022] [Indexed: 01/26/2023]
Abstract
Growing evidence points to a spectrum of non-motor symptoms, including cognitive difficulties that have a greater impact on functional outcomes and quality of life than motor symptoms in cervical dystonia (CD). Some cognitive impairments have been reported; however, findings are inconsistent, and described across mixed groups of dystonia. The current review aimed to examine the evidence for cognitive impairments in CD. MEDLINE, EMBASE, PsychINFO and Web of Science databases were searched. Studies were included if they met the following criteria (i) cross-sectional or longitudinal studies of adults with CD, (ii) where the results of standardised measures of cognitive or neuropsychological function in any form were assessed and reported, (iii) results compared to a control group or normative data, and (iv) were published in English. Results are presented in a narrative synthesis. Twenty studies were included. Subtle difficulties with general intellectual functioning, processing speed, verbal memory, visual memory, visuospatial function, executive function, and social cognition were identified while language, and attention and working memory appear to be relatively spared. Several methodological limitations were identified that should be considered when interpreting the evidence to describe a specific profile of cognitive impairment in CD. Clinical and research implications are discussed.
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Affiliation(s)
- Sarah O'Connor
- Department of Clinical Psychology, School of Psychology, Aras an Phiarsaigh, Trinity College Dublin, Dublin 2, Dublin, Ireland.
| | - David Hevey
- Department of Clinical Psychology, School of Psychology, Aras an Phiarsaigh, Trinity College Dublin, Dublin 2, Dublin, Ireland
| | - Tom Burke
- Department of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Shameer Rafee
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine & Health Science, University College Dublin, Dublin, Ireland
| | - Niall Pender
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiadhnait O'Keeffe
- Department of Clinical Psychology, School of Psychology, Aras an Phiarsaigh, Trinity College Dublin, Dublin 2, Dublin, Ireland
- Department of Psychology, St Vincent's University Hospital, Dublin, Ireland
- School of Psychology, University College Dublin, Dublin, Ireland
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Colucci F, Pugliatti M, Casetta I, Capone JG, Diozzi E, Sensi M, Tugnoli V. Idiopathic cervical dystonia and non-motor symptoms: a pilot case-control study on autonomic nervous system. Neurol Sci 2024; 45:629-638. [PMID: 37648939 PMCID: PMC10791952 DOI: 10.1007/s10072-023-07033-y] [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: 03/15/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE Non-motor symptoms, such as sleep disturbances, fatigue, neuropsychiatric manifestations, cognitive impairment, and sensory abnormalities, have been widely reported in patients with idiopathic cervical dystonia (ICD). This study aimed to clarify the autonomic nervous system (ANS) involvement in ICD patients, which is still unclear in the literature. METHODS We conducted a pilot case-control study to investigate ANS in twenty ICD patients and twenty age-sex-matched controls. The Composite Autonomic System Scale 31 was used for ANS clinical assessment. The laser Doppler flowmetry quantitative spectral analysis, applied to the skin and recorded from indices, was used to measure at rest, after a parasympathetic activation (six deep breathing) and two sympathetic stimuli (isometric handgrip and mental calculation), the power of high-frequency and low-frequency oscillations, and the low-frequency/high-frequency ratio. RESULTS ICD patients manifested higher clinical dysautonomic symptoms than controls (p < 0.05). At rest, a lower high-frequency power band was detected among ICD patients than controls, reaching a statistically significant difference in the age group of ≥ 57-year-olds (p < 0.05). In the latter age group, ICD patients showed a lower low-frequency/high-frequency ratio than controls at rest (p < 0.05) and after mental calculation (p < 0.05). Regardless of age, during handgrip, ICD patients showed (i) lower low-frequency/high-frequency ratio (p < 0.05), (ii) similar increase of the low-frequency oscillatory component compared to controls, and (iii) stable high-frequency oscillatory component, which conversely decreased in controls. No differences between the two groups were detected during deep breathing. CONCLUSION ICD patients showed ANS dysfunction at clinical and neurophysiological levels, reflecting an abnormal parasympathetic-sympathetic interaction likely related to abnormal neck posture and neurotransmitter alterations.
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Affiliation(s)
- Fabiana Colucci
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Aldo Moro, 8, 44100, Ferrara, Italy.
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Maura Pugliatti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Aldo Moro, 8, 44100, Ferrara, Italy
| | - Ilaria Casetta
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Aldo Moro, 8, 44100, Ferrara, Italy
| | - Jay Guido Capone
- Department of Neuroscience and Rehabilitation, Azienda Ospedaliero-Universitaria S, Anna, Ferrara, Italy
| | - Enrica Diozzi
- Department of Neuroscience and Rehabilitation, Azienda Ospedaliero-Universitaria S, Anna, Ferrara, Italy
| | - Mariachiara Sensi
- Department of Neuroscience and Rehabilitation, Azienda Ospedaliero-Universitaria S, Anna, Ferrara, Italy
| | - Valeria Tugnoli
- Department of Neuroscience and Rehabilitation, Azienda Ospedaliero-Universitaria S, Anna, Ferrara, Italy
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Parau D, Todoran AB, Balasa R. Factors Influencing the Duration of Rehabilitation in Infants with Torticollis-A Pilot Study. Medicina (Kaunas) 2024; 60:165. [PMID: 38256426 PMCID: PMC10820052 DOI: 10.3390/medicina60010165] [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] [Received: 11/27/2023] [Revised: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Torticollis is a common pediatric condition, with an incidence of 0.3-2.0%. Studies show that an adequate, tailored, and early treatment helps 90% to 95% of children recover before the first year of life and 97% of patients recover if treatment starts before the first six months. To identify the relationships between variables considered essential in the recovery process of infants with torticollis, we included factors such as the type of torticollis, age at onset of treatment, gender, birth weight, mode of delivery, fetal position in the uterus, the presence of craniofacial deformities, regions affected by postural asymmetries, and duration of the rehabilitation program. The hypothesis of the study is that early initiation of therapy can contribute to achieving favorable outcomes in the recovery process. Material and Methods: This retrospective cohort pilot study was conducted within a rehabilitation facility, spanning a duration of 1 year. The study involved a population of 41 children aged between 0 and 6 months. The rehabilitation program consisted of the application of Vojta therapy. Each session lasted 20 min, with a frequency of three times per week. Results: A total of 41% of those who started therapy in the first 3 months of life were fully recovered after 4-6 weeks of therapy. Of infants who started therapy at 5 and 6 months of age, 15% showed no improvement in measurements from 14 to 16 weeks of age, at which point the use of a cranial orthosis was recommended, and 23% experienced a plateau in measurements from 10 to 14 weeks, requiring the use of a cervical collar in conjunction with therapy. Conclusions: The findings from the study suggest that there may be a correlation between early initiation of therapy and favorable outcomes in the recovery process. The primary factors influencing the duration of recovery were identified as the presence of body asymmetries and the age at which therapy was initiated.
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Affiliation(s)
- Daniela Parau
- Doctoral School, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Anamaria Butila Todoran
- Department of Genetics, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Rodica Balasa
- Department of Neurology, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540136 Targu Mures, Romania;
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Dressler D, Kopp B, Pan L, Adib Saberi F. Excessive psychological stress preceding the onset of idiopathic cervical dystonia. J Neural Transm (Vienna) 2024; 131:53-57. [PMID: 37773224 PMCID: PMC10770183 DOI: 10.1007/s00702-023-02694-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/21/2023] [Accepted: 09/04/2023] [Indexed: 10/01/2023]
Abstract
Idiopathic cervical dystonia (ICD) is the largest subgroup of dystonia. Psychological stress as a triggering factor has long been discussed, but detailed descriptions are lacking. We report on a group of 13 patients with ICD and preceding excessive psychological stress (age at ICD onset 39.0 ± 13.9 years, 7 females, 6 males). The observation period was 7.8 ± 5.0 years. Excessive psychological stress included partner conflicts (divorce and separation, domestic violence), special familial burdens, legal disputes and migration. It started 8.3 ± 3.9 months before ICD onset. In 85% of our patients (typical cases), ICD developed within 5.8 ± 4.4 weeks, then lasted 18.5 ± 8.3 months, before it started to remit 2.7 ± 0.8 years after its onset to 54.5 ± 35.3% of its maximal severity. Idiopathic dystonia is thought to be based upon a genetic predisposition triggered by epigenetic factors. Our study suggests that excessive psychological stress could be one of them. Pathophysiologic elements are only vaguely identified, but could include the endoplasmic reticulum stress response, cerebellar 5HT-2A receptors and the metabolism of heat shock proteins. Whilst the clinical presentation of ICD preceded by excessive psychological stress is typical, its course is atypical with rapid onset and fast and substantial remission.
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Affiliation(s)
- Dirk Dressler
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Bruno Kopp
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Lizhen Pan
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Department of Neurology, Neurotoxin Research Center, Tongji University School of Medicine, Shanghai, China
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Elendu C, Adenikinju J, Ogala F, Ologunde T, Adebambo S, Egbunu E. Metoclopramide-induced acute dystonic reaction: A pediatric case report. Medicine (Baltimore) 2023; 102:e36140. [PMID: 38050314 PMCID: PMC10695606 DOI: 10.1097/md.0000000000036140] [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: 08/22/2023] [Accepted: 10/25/2023] [Indexed: 12/06/2023] Open
Abstract
INTRODUCTION This case report presents a unique acute dystonic reaction (ADR) induced by metoclopramide in a 6-year-old male patient with pertussis-associated vomiting. The rarity of such a reaction in pediatric patients underscores the significance of this case in contributing to the scientific literature. This report highlights the need for heightened awareness of the potential adverse effects of medications commonly used in pediatrics and emphasizes the importance of tailored interventions for this population. MAIN SYMPTOMS AND IMPORTANT CLINICAL FINDINGS Following the administration of metoclopramide for vomiting associated with pertussis cough, the patient exhibited distressing symptoms, including torticollis, facial grimacing, and tongue protrusion. These involuntary movements were promptly recognized, leading to the suspicion of an ADR. The clinical findings underscore the importance of vigilant monitoring for extrapyramidal symptoms following medication administration, especially in children. THE MAIN DIAGNOSES, THERAPEUTIC INTERVENTIONS, AND OUTCOMES The primary diagnosis of ADR induced by metoclopramide was confirmed, prompting the cessation of the medication and the initiation of anticholinergic therapy with benztropine. This intervention rapidly resolved the patient's symptoms, highlighting the importance of tailored and swift therapeutic strategies. The outcome demonstrated the efficacy of timely intervention in managing ADR in pediatric patients. CONCLUSION The main takeaway lesson from this case lies in the critical need for healthcare practitioners to remain vigilant for potential adverse reactions in pediatric patients, even when prescribing commonly used medications. The successful management of this case underscores the importance of prompt recognition, appropriate interventions, and continuous monitoring. Ultimately, this case contributes to the scientific literature by highlighting the unique manifestation of ADR in a pediatric patient, reinforcing the significance of individualized patient care and medication safety.
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Affiliation(s)
| | | | - Faith Ogala
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Tunde Ologunde
- King’s College Hospital NHS Foundation Trust, London, UK
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Agharazi H, Wang A, Guha A, Gupta P, Shaikh AG. Unraveling the Twist: Spatial Navigational Challenges in Cervical Dystonia. Mov Disord 2023; 38:2116-2121. [PMID: 37914913 DOI: 10.1002/mds.29612] [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: 05/24/2023] [Accepted: 09/05/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Cervical dystonia (CD) is an intricate neurological condition with motor and nonmotor symptoms. These include disruptions in visual perception, self-orientation, visual working memory, and vestibular functions. However, the specific impact of CD on perceiving self-motion direction, especially with isolated visual or vestibular stimuli, remains largely unexplored. OBJECTIVE This study aimed to examine the effects of CD on linear motion perception, hypothesizing impaired heading discrimination in both vestibular and visual tasks, and that such deficits correlate with the disease severity. METHODS We employed a cutting-edge motion platform to precisely control whole-body linear motion. Through repeated two-alternative forced-choice tasks, we assessed vestibular heading direction discrimination. Participants observed dynamic star clouds in immersive virtual reality and indicated their perceived self-motion direction, evaluating visual heading direction discrimination. Sensitivity to direction variations and response accuracy errors were analyzed using robust Gaussian cumulative distribution psychometric functions. RESULTS Heading perception is impaired in individuals with CD, particularly evident in vestibular heading discrimination. CD severity correlated with elevated thresholds for both vestibular and visual heading discrimination. Surprisingly, lateralized CD did not introduce bias in either system, suggesting widespread disruption over localized effects. CONCLUSIONS Contrary to previous beliefs, our findings challenge the idea that CD-related heading discrimination issues mainly arise from peripheral vestibular effects. Instead, abnormal proprioceptive input from dystonic neck muscles introduces noise into the central mechanism integrating visual, vestibular, and proprioceptive signals. These insights into spatial navigation deficits have implications for future CD research. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.
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Affiliation(s)
- Hanieh Agharazi
- National VA Parkinson Consortium Center, Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Alexander Wang
- Department of Neurology, Case Western Reserve University, Cleveland, Ohio, USA
- Movement Disorders Center, Neurological Institute, University Hospitals, Cleveland, Ohio, USA
| | - Aratrik Guha
- National VA Parkinson Consortium Center, Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Palak Gupta
- National VA Parkinson Consortium Center, Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Aasef G Shaikh
- National VA Parkinson Consortium Center, Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- Department of Neurology, Case Western Reserve University, Cleveland, Ohio, USA
- Movement Disorders Center, Neurological Institute, University Hospitals, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
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Furuhata-Yoshimura M, Yamaguchi T, Izu Y, Kosho T. Homozygous splice site variant affecting the first von Willebrand factor A domain of COL12A1 in a patient with myopathic Ehlers-Danlos syndrome. Am J Med Genet A 2023; 191:2631-2639. [PMID: 37353357 DOI: 10.1002/ajmg.a.63328] [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: 12/29/2022] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/25/2023]
Abstract
Myopathic Ehlers-Danlos syndrome (mEDS) is a subtype of EDS that is caused by abnormalities in COL12A1. Up-to-date, 24 patients from 15 families with mEDS have been reported, with 14 families showing inheritance in an autosomal dominant manner and one family in an autosomal recessive manner. We encountered an additional patient with autosomal recessive mEDS. The patient is a 47-year-old Japanese man, born to consanguineous parents with no related features of mEDS. After birth, he presented with hypotonia, weak spontaneous movements, scoliosis, and torticollis. He had soft palms but no skin hyperextensibility or fragility. Progressive scoliosis, undescended testes, and muscular torticollis required surgery. During adulthood, he worked normally and had no physical concerns. Clinical exome analysis revealed a novel homozygous variant in COL12A1 (NM_004370.6:c.395-1G > A) at the splice acceptor site of exon 6, leading to in-frame skipping of exon 6. The patient was diagnosed with mEDS. The milder manifestations in the current patient compared with previously reported patients with mEDS might be related to the site of the variant. The variant is located in the genomic region encoding the first von Willebrand factor A domain, which affects only the long isoform of collagen XII, in contrast to the variants in previously reported mEDS patients that affected both the long and short isoforms. Further studies are needed to delineate comprehensive genotype-phenotype correlation of the disorder.
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Affiliation(s)
- Megumi Furuhata-Yoshimura
- Department of Medical Genetics, Shinshu University School of Medicine, Matsumoto, Japan
- Department of Pediatrics, Saku Medical Center, Saku, Japan
| | - Tomomi Yamaguchi
- Department of Medical Genetics, Shinshu University School of Medicine, Matsumoto, Japan
- Center for Medical Genetics, Shinshu University Hospital, Matsumoto, Japan
- Division of Clinical Sequencing, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yayoi Izu
- Department of Laboratory Animal Science, Faculty of Veterinary Medicine, Okayama University of Science, Imabari, Japan
| | - Tomoki Kosho
- Department of Medical Genetics, Shinshu University School of Medicine, Matsumoto, Japan
- Center for Medical Genetics, Shinshu University Hospital, Matsumoto, Japan
- Division of Clinical Sequencing, Shinshu University School of Medicine, Matsumoto, Japan
- Research Center for Supports to Advanced Science, Shinshu University, Matsumoto, Japan
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Høiness PR, Medbøe A. Surgical Treatment of Congenital Muscular Torticollis: Significant Improvement in Health-related Quality of Life Among a 2-year Follow-up Cohort of Children, Adolescents, and Young Adults. J Pediatr Orthop 2023; 43:e769-e774. [PMID: 37493035 PMCID: PMC10481919 DOI: 10.1097/bpo.0000000000002480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 07/27/2023]
Abstract
OBJECTIVE Surgical treatment of congenital muscular torticollis (CMT) has been proven clinically effective in cases that fail to normalize after conservative treatment, but reports on self-reported outcome and quality of life have been scarce. This study aimed to assess health-related quality of life (HRQoL) in children, adolescents, and young adults undergoing surgical treatment for CMT, comparing HRQoL with clinical outcomes. METHODS We conducted a level 2 prospective observational study on a surgically treated CMT cohort at a single tertiary center. The surgeries focused on releasing all tightness, and the medial head was routinely elongated to preserve cosmetic function. Patients underwent rigorous pre/postoperative assessments and follow-up. A strict postoperative protocol entailing stretching, physiotherapy, and positional exercises was adhered to for a minimum of 6 months. The Cheng and Tang torticollis scoring system and PedsQLTM 4.0 generic core scales were used to evaluate clinical outcome and HRQoL, respectively. RESULTS The study included 31 patients, averaging 11.4 years. Significant improvements in range of motion, deformities, and overall subjective satisfaction were observed 2 years postoperatively. The Cheng and Tang score improved overall significantly from fair (9.9 points) to excellent (17.9 points) after 2 years ( P <0.001). The oldest patients showed less improvement than the youngest ones, especially regarding craniofacial asymmetry ( P =0.004). Patient PedsQL scores significantly improved 2 years post-surgery ( P =0.040), with no discernable age differences. CONCLUSION Our findings demonstrated significant improvements in both HRQoL and clinical outcomes after surgical treatment of CMT. The PedsQL score seemed sensitive to the clinical changes.
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Affiliation(s)
- Per Reidar Høiness
- Department of Orthopedic, Drammen Hospital and Oslo University Hospital, Drammen
| | - Anja Medbøe
- Department of Orthopedic, Oslo University Hospital, Oslo, Norway
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Bhattacharjee S, Silverdale MA, Bonello M, Evans J, Kobylecki C. Generalized Dystonia Due to a Pathogenic THAP1 Variant Showing Sustained Response to Globus Pallidus Deep Brain Stimulation. Tremor Other Hyperkinet Mov (N Y) 2023; 13:23. [PMID: 37637848 PMCID: PMC10453957 DOI: 10.5334/tohm.774] [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: 04/19/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023] Open
Abstract
A 21-year-old woman of south Asian origin presented with cervical dystonia which had progressed over the previous three years. Her symptoms started as writer's cramp since the age of seven years. She did not respond to medications and needed botulinum toxin injection for generalised dystonia. Subsequent whole genome sequencing revealed a likely pathogenic c.98G>A p.(Cys33Tyr) heterozygous variant in the THAP1 gene. She underwent bilateral posteroventral globus pallidus interna (GPi) deep brain stimulation (Medtronic Activa PC) implantation at the age of thirty-one years. She responded well to the deep brain stimulation even after more than 8 years post-surgery though she needs botulinum toxin injection for her cervical dystonia.
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Affiliation(s)
- Shakya Bhattacharjee
- Department of Neurology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Monty A. Silverdale
- Department of Neurology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Division of Neuroscience and Experimental Psychology, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Michael Bonello
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Julian Evans
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Christopher Kobylecki
- Department of Neurology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Division of Neuroscience and Experimental Psychology, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Hallundbæk L, Hagstrøm S, Mathiasen R, Herlin T, Hasle H, Weile KS, Amstrup J, Brix N. Musculoskeletal misdiagnoses in children with brain tumors: A nationwide, multicenter case-control study. PLoS One 2023; 18:e0279549. [PMID: 37352313 PMCID: PMC10289381 DOI: 10.1371/journal.pone.0279549] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/08/2023] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVE Childhood brain tumors belong to the cancer type with the longest diagnostic delay, the highest health care utilization prior to diagnosis, and the highest burden of long-term sequelae. We aimed to clarify whether prior musculoskeletal diagnoses in childhood brain cancer were misdiagnoses and whether it affected the diagnostic delay. STUDY DESIGN In this retrospective, chart-reviewed case-control study we compared 28 children with brain tumors and a prior musculoskeletal diagnosis to a sex and age-matched control group of 56 children with brain tumors and no prior musculoskeletal diagnosis. Using the Danish registries, the cases were identified from consecutive cases of childhood brain cancers in Denmark over 23 years (1996-2018). RESULTS Of 931 children with brain tumors, 3% (28/931) had a prior musculoskeletal diagnosis, of which 39% (11/28) were misdiagnoses. The misdiagnoses primarily included torticollis-related diagnoses which tended to a longer time interval from first hospital contact until a specialist was involved: 35 days (IQR 6-166 days) compared to 3 days (IQR 1-48 days), p = 0.07. When comparing the 28 children with a prior musculoskeletal diagnosis with a matched control group without a prior musculoskeletal diagnosis, we found no difference in the non-musculoskeletal clinical presentation, the diagnostic time interval, or survival. Infratentorial tumor location was associated with a seven-fold risk of musculoskeletal misdiagnosis compared to supratentorial tumor location. CONCLUSION Musculoskeletal misdiagnoses were rare in children with brain tumors and had no significant association to the diagnostic time interval or survival. The misdiagnoses consisted primarily of torticollis- or otherwise neck-related diagnoses.
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Affiliation(s)
- Laura Hallundbæk
- Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Hagstrøm
- Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Rene Mathiasen
- Department of Pediatric and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Troels Herlin
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Hasle
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kathrine Synne Weile
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Amstrup
- Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Ninna Brix
- Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
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12
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Sondergaard RE, Strzalkowski NDJ, Gan LS, Jasaui Y, Furtado S, Pringsheim TM, Sarna JR, Avanzino L, Kiss ZHT, Martino D. Cerebellar Brain Inhibition Is Associated With the Severity of Cervical Dystonia. J Clin Neurophysiol 2023; 40:293-300. [PMID: 34334683 DOI: 10.1097/wnp.0000000000000884] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Cerebellar connectivity is thought to be abnormal in cervical dystonia (CD) and other dystonia subtypes, based on evidence from imaging studies and animal work. The authors investigated whether transcranial magnetic stimulation-induced cerebellar brain inhibition (CBI), a measure of cerebellar efficiency at inhibiting motor outflow, is abnormal in patients with CD and/or is associated with clinical features of CD. Because of methodological heterogeneity in CBI reporting, the authors deployed additional controls to reduce potential sources of variability in this study. METHODS Cerebellar brain inhibition was applied in 20 CD patients and 14 healthy control subjects. Cerebellar brain inhibition consisted of a cerebellar conditioning stimulus delivered at four different interstimulus intervals (ISIs) before a test stimulus delivered to hand muscle representation in the motor cortex. The average ratio of conditioned to unconditioned motor evoked potential was computed for each ISI. Cervical dystonia clinical severity was measured using the Toronto Western Spasmodic Torticollis Rating Scale. Control experiments involved neuronavigated transcranial magnetic stimulation, neck postural control in patients, and careful screening for noncerebellar pathway inhibition via cervicomedullary evoked potentials. RESULTS There was no difference between CBI measured in healthy control subjects and CD patients at any of the four ISIs; however, CBI efficiency was significantly correlated with worsening CD clinical severity at the 5 ms ISI. CONCLUSIONS Cerebellar brain inhibition is a variable measure in both healthy control subjects and CD patients; much of this variability may be attributed to experimental methodology. Yet, CD severity is significantly associated with reduced CBI at the 5 ms ISI, suggestive of cerebello-thalamo-cortical tract dysfunction in this disorder.
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Affiliation(s)
- Rachel E Sondergaard
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Nicholas D J Strzalkowski
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, AB, Canada
| | - Liu Shi Gan
- Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Yamile Jasaui
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Sarah Furtado
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Tamara M Pringsheim
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada
- Department of Psychiatry, Pediatrics and Community Healthy Sciences, University of Calgary, Calgary, AB, Canada
| | - Justyna R Sarna
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Laura Avanzino
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy; and
- IRCCS Policlinico, San Martino, Genova
| | - Zelma H T Kiss
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada
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13
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Kang BH, Park SH, Kang S, Yoon JS. Identifying safety zone of invasive procedures in the sternocleidomastoid muscle using ultrasonography. Medicine (Baltimore) 2023; 102:e33021. [PMID: 36827066 DOI: 10.1097/md.0000000000033021] [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: 02/25/2023] Open
Abstract
Dysfunctions of the sternocleidomastoid (SCM) muscle, such as myofascial syndrome, torticollis, and cervical dystonia, have been treated using several invasive procedures. In such situations, it is possible to injure the adjacent nerves. This study aimed to demonstrate the course of these nerves in healthy volunteers using ultrasound. The great auricular nerve (GAN), spinal accessory nerve (SAN), transverse cervical nerve (TCN), and supraclavicular nerve (SCN) were scanned by ultrasonography in 26 healthy volunteers. The neck was scanned in the supine position with the head turned 45° to the contralateral side. The cervical plexus was detected in half of the SCM muscle. Each nerve was then traced to the level of contact with the anterior border of the SCM muscle. The following features of the nerves were recorded bilaterally: vertical and horizontal positions of each nerve at the posterior border of the SCM and the cross-sectional area and depth of each nerve at the reference line and anterior border of the SCM. The mean proportions of GAN, SAN, TCN, and SCN were 26%, 26%, 48%, and 80%, respectively near the posterior border, whereas they were 18%, 23%, and 51% for GAN, SAN, and TCN, respectively, at the level of the reference line. Notably, SCN was not visible at the level of the reference line. The mean TCN proportion was 47% at the anterior border of the SCM. The precise location of the nerves and their relationship with the SCM muscle should be considered during invasive procedures. It is recommended that the procedure be performed in the lower half of the SCM muscle, which refers to 50 to 80% of the proportions in our study.
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Affiliation(s)
- Byung Heon Kang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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14
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Manzo N, Leodori G, Ruocco G, Belvisi D, Merchant SHI, Fabbrini G, Berardelli A, Conte A. Cortical mechanisms of sensory trick in cervical dystonia. Neuroimage Clin 2023; 37:103348. [PMID: 36791488 PMCID: PMC9950946 DOI: 10.1016/j.nicl.2023.103348] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/11/2023] [Accepted: 02/10/2023] [Indexed: 02/13/2023]
Abstract
Patients with cervical dystonia (CD) often show an improvement in dystonic posture after sensory trick (ST), though the mechanisms underlying ST remain unclear. In this study, we aimed to investigate the effects of ST on cortical activity in patients with CD and to explore the contribution of motor and sensory components to ST mechanisms. To this purpose, we studied 15 CD patients with clinically effective ST, 17 without ST, and 14 healthy controls (HCs) who mimicked the ST. We used electroencephalographic (EEG) recordings and electromyography (EMG) data from bilateral sternocleidomastoid (SCM) muscles. We compared ST-related EEG spectral changes from sensorimotor and posterior parietal areas and EMG power changes between groups. To better understand the contribution of motor and sensory components to ST, we tested EEG and EMG correlates of three different conditions mimicking ST, the first without skin touch ("no touch" condition), the second without voluntary movements ("passive" condition), and finally without arm movements ("examiner touch" condition). Results showed ST-related alpha desynchronization in the sensorimotor cortex and theta desynchronization in the sensorimotor and posterior parietal cortex. Both spectral changes were more significant during maneuver execution in CD patients with ST than in CD patients without ST and HCs who mimicked the ST. Differently, the "no touch", "passive", or "examiner touch" conditions did not show significant differences in EEG or EMG changes determined by ST execution/mimicking between CD patients with or without ST. A higher desynchronization within alpha and theta bands in the sensorimotor and posterior parietal areas correlated with a more significant activity decrease in the contralateral SCM muscle, Findings from this study suggest that ST-related changes in the activity of sensorimotor and posterior parietal areas may restore dystonic posture and that both motor and sensory components contribute to the ST effect.
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Affiliation(s)
- Nicoletta Manzo
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy; IRCCS San Camillo Hospital, Via Alberoni 70, Venice 30126, Italy
| | - Giorgio Leodori
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy; IRCCS Neuromed, Via Atinense 18, Pozzilli, IS 86077, Italy
| | - Giulia Ruocco
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy
| | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy; IRCCS Neuromed, Via Atinense 18, Pozzilli, IS 86077, Italy
| | | | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy; IRCCS Neuromed, Via Atinense 18, Pozzilli, IS 86077, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy; IRCCS Neuromed, Via Atinense 18, Pozzilli, IS 86077, Italy.
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy; IRCCS Neuromed, Via Atinense 18, Pozzilli, IS 86077, Italy
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15
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Cai Z, Meng Y, Li X, Wu J, Gao R, Zhou X. Hemi-atlas resection by combined approach: case report, literature review, and technical note. Childs Nerv Syst 2022; 38:2239-2244. [PMID: 35687170 DOI: 10.1007/s00381-022-05583-8] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/06/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Hemivertebra within the craniovertebral junction is a rare but complex spinal deformity. Torticollis caused by hemi-atlas is extremely rare. There is no consensus on the treatment of these patients. We present our experience with one case of hemi-atlas excision and torticollis correction via a combined anterior-posterior surgical approach and short-segment fixation. METHODS An 11-year-old girl with progressive torticollis due to hemi-atlas underwent surgery consisting of combined anterior-posterior hemivertebra resection and instrumentation and had a follow up of 20 months. Pre- and postoperative radiographic features, as well as clinical outcomes, were evaluated. RESULTS The patient had complete recovery of torticollis at a 20-month follow-up. Radiographs showed favorable deformity correction, well-balanced coronal and sagittal alignment, and solid bony fusion. CONCLUSION For patients with congenital cervical hemivertebra within the craniovertebral junction, combined anterior-posterior hemivertebra resection with instrumentation allows for satisfactory deformity correction and good cosmetic improvement.
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Affiliation(s)
- Zhuyun Cai
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Yichen Meng
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Xiang Li
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Jinhui Wu
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Rui Gao
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Xuhui Zhou
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China.
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16
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Merino P, Chapinal A, Gómez de Liaño P, Yáñez-Merino J, Zavarse Fadul F. Transposition of the inferior oblique muscle belly without disinsertion for overshoot in adduction treatment. Arch Soc Esp Oftalmol (Engl Ed) 2022; 97:565-571. [PMID: 35879173 DOI: 10.1016/j.oftale.2022.03.013] [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] [Received: 12/15/2021] [Accepted: 03/04/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To evaluate the efficacy and safety of inferior oblique muscle transposition and myopexy in patients with mild/moderate inferior oblique muscle overaction, with or without diplopia. METHOD We retrospectively analysed data for the 12 patients who underwent the technique. Data were collected from October 2018 to September 2021. Surgery was performed by suturing the inferior oblique belly to the sclera at 5 mm posterior to the temporal end of the inferior rectus. All 12 patients had mild hypertropia (≤6 prism diopters [pd]) in primary position and mild/moderate inferior oblique overaction. Mean preoperative hypertropia was 4.42 pd ± 1.62. Diplopia was recorded in 10 cases. The diagnoses were fourth nerve paresis (9), unilateral primary inferior oblique overaction (2) and dissociated vertical deviation (1). Torticollis was observed in 7 cases, 2 had subjective torsion and 2 objective torsion. RESULTS Mean age was 46.86 ± 25.1 years (50%: men). Diplopia resolved in 9 of the 10 cases. The mean final vertical deviation was 1.5 ± 2.93 (p = 0.001) pd in straight gaze. Of 7 mild overshoot in adduction, it disappeared in 3 and 4 remained the same. Of 5 moderate overshoot in adduction, 2 improved to mild and 3 disappeared. Torticollis was eliminated in 5 patients and improved in another 2. Mean time from surgery was 14.08 ± 8.05 months. There were no overcorrections. CONCLUSIONS Inferior oblique muscle transposition with myopexy is a safe and effective procedure in patients with mild-to-moderate inferior oblique muscle overaction and small-angle hypertropia, with or without diplopia.
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Affiliation(s)
- P Merino
- Sección de Motilidad Ocular, Servicio de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - A Chapinal
- Sección de Motilidad Ocular, Servicio de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - P Gómez de Liaño
- Sección de Motilidad Ocular, Servicio de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Yáñez-Merino
- Sección de Motilidad Ocular, Servicio de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - F Zavarse Fadul
- Sección de Motilidad Ocular, Servicio de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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17
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Lagrand TJ, Almuwais A, Lehn AC. ‘Tricked’ sensory trick: a geste antagoniste in functional dystonia. BMJ Case Rep 2022; 15:15/7/e248779. [PMID: 35793856 PMCID: PMC9260767 DOI: 10.1136/bcr-2022-248779] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
A sensory trick, or geste antagoniste, is a manoeuvre used by patients with dystonia to ameliorate their dystonic movements or posturing. Typically, a sensory trick is a confirmatory clue indicating an organic nature of the dystonia. In this report, we present an extremely rare case of a sensory trick in a patient with functional dystonia.
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Affiliation(s)
- Tjerk J Lagrand
- Department of Neurology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ahmed Almuwais
- Department of Neurology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Alexander C Lehn
- Department of Neurology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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18
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Zang Z, Shao D, Zhang H, Sun D, Diao T, Zhang K, Fu Q. Extraperitoneal Laparoscopic Modified Y-V Plasty for the Treatment of Refractory Bladder Neck Contracture. J Vis Exp 2022. [PMID: 35848822 DOI: 10.3791/64011] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Bladder neck contracture (BNC) is a rare, late complication of transurethral resection of the prostate (TURP). Although the endoscopic procedure is the primary treatment for BNC, the recurrence rate remains high. Y-V plasty offers excellent surgical results for those individuals with refractory and recurrent BNC. Traditional open operations usually fail to provide satisfactory exposure to the operating field and lead to greater invasiveness. Interrupted sutures lead to prolonged operative time and increased anastomotic leakage. Laparoscopic modified Y-V plasty is performed through extraperitoneal access to the pelvis, which provides adequate exposure to the surgical view and avoids intra-abdominal injury. After incising the anterior bladder wall neck in a Y-shaped fashion, anastomosis is performed using two absorbable barbed sutures. The mucosa and submucosa layer of the bladder is closed to both sides with consecutive sutures in a V-shape before suturing serosa, and tunica muscularis are sutured to reinforce. The aforementioned procedures reduce leakage from the anastomosis and decrease operative time and patient trauma. Extraperitoneal laparoscopic modified Y-V plasty offers significant advantages over the open approach in terms of post-surgical recovery and invasiveness, making it a feasible and safe surgical option for patients with refractory BNC.
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Affiliation(s)
- Zhenjie Zang
- Department of Urology, Shandong Provincial Hospital, Shandong University
| | - Dingchang Shao
- Department of Urology, Shandong Provincial Hospital, Shandong University
| | - Hui Zhang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University
| | - Dingqi Sun
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University
| | - Tongxiang Diao
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University
| | - Keqin Zhang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University;
| | - Qiang Fu
- Department of Urology, Shandong Provincial Hospital, Shandong University; Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University;
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19
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Zachou A, Palaiologou D, Kanavakis E, Anagnostou E. Retrocollis as the cardinal feature in a de novo ITRP1 variant. Brain Dev 2022; 44:347-352. [PMID: 35148930 DOI: 10.1016/j.braindev.2022.01.005] [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: 10/21/2021] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND ITPR1 gene encodes inositol 1,4,5-trisphosphate-receptor-type 1, a Ca2+ channel highly expressed in cerebellar Purkinje cells. ITPR1 gene variants, through a loss-of-function mechanism, have been found to be related with the manifestation of spinocerebellar ataxia (SCA) 15, an adult-onset slow progressive cerebellar ataxia, SCA 29, a rare non-progressive congenital cerebellar ataxia and Gillepsie syndrome (SCA 29 phenotype plus aniridia). They share an heterogeneity of additional phenotypic features while no genotype-phenotype correlation has ever been found. CASE REPORT Here we report the case of a boy with cerebellar ataxia who came to our clinic due to his cervical dystonia in the form of retrocollis. He presented an early-onset, non-progressive cerebellar ataxia, with cognitive impairment and delayed motor milestones. Whole exome sequencing (WES) revealed an heterozygous nucleotide variation, c.829A > C (p.Ser277Arg) in ITPR1 gene (NM_001168272.1), a de novo ITPR1 variant, as his parents came up with negative genetic testing. Due to his clinical presentation and genetic result, we came up with the diagnosis of SCA 29. CONCLUSION We described cervical dystonia as a phenotypic feature of ITPR1 related SCA 29, found in a new de novo ITPR1-variant.
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Affiliation(s)
- Athena Zachou
- Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Greece.
| | - Danai Palaiologou
- Genesis Genoma Lab, Genetic Diagnosis, Clinical Genetics & Research, Athens, Greece
| | - Emmanouil Kanavakis
- Genesis Genoma Lab, Genetic Diagnosis, Clinical Genetics & Research, Athens, Greece
| | - Evangelos Anagnostou
- Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Greece
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Malhotra A, Shah UA, Chakraborty SS, Baraiya D, Shetty SP, Babu SR, Dandekar PB. Reconstruction of Postburn Mild Anterior Neck Contracture With a Free Thin Anterolateral Thigh Flap. Plast Aesthet Nurs (Phila) 2022; 42:39-42. [PMID: 36450074 DOI: 10.1097/psn.0000000000000420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
In this article, we describe reconstruction of a McCauley's Grade I postburn anterior neck contracture with extensive scarring in a 34-year-old woman using a free thin anterolateral thigh (ALT) flap. To our knowledge, this is the first case of reconstruction of Grade I neck contracture using a thin ALT flap that has been reported. By selecting the correct patient, adhering to recommended standards of microvascular technique, and implementing appropriate postoperative nursing care, we achieved a near-normal neck contour in this patient in a single-staged procedure.
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Affiliation(s)
- Anjana Malhotra
- Anjana Malhotra, MS, MCh, DNB (Plastic), is Chief Specialist & HOD, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Urvi Ashok Shah, MS, DNB (Plastic), is Contractual Medical Practitioner, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Sourabh Shankar Chakraborty, DNB (ENT), MCh (Plastic), is Senior Resident (Non-acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, West Bengal, Kolkata, India
- Dhaval Baraiya, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shrikrishna Prasad Shetty, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shylesh Ramesh Babu, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Puja Bhaurao Dandekar, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
| | - Urvi Ashok Shah
- Anjana Malhotra, MS, MCh, DNB (Plastic), is Chief Specialist & HOD, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Urvi Ashok Shah, MS, DNB (Plastic), is Contractual Medical Practitioner, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Sourabh Shankar Chakraborty, DNB (ENT), MCh (Plastic), is Senior Resident (Non-acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, West Bengal, Kolkata, India
- Dhaval Baraiya, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shrikrishna Prasad Shetty, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shylesh Ramesh Babu, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Puja Bhaurao Dandekar, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
| | - Sourabh Shankar Chakraborty
- Anjana Malhotra, MS, MCh, DNB (Plastic), is Chief Specialist & HOD, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Urvi Ashok Shah, MS, DNB (Plastic), is Contractual Medical Practitioner, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Sourabh Shankar Chakraborty, DNB (ENT), MCh (Plastic), is Senior Resident (Non-acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, West Bengal, Kolkata, India
- Dhaval Baraiya, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shrikrishna Prasad Shetty, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shylesh Ramesh Babu, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Puja Bhaurao Dandekar, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
| | - Dhaval Baraiya
- Anjana Malhotra, MS, MCh, DNB (Plastic), is Chief Specialist & HOD, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Urvi Ashok Shah, MS, DNB (Plastic), is Contractual Medical Practitioner, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Sourabh Shankar Chakraborty, DNB (ENT), MCh (Plastic), is Senior Resident (Non-acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, West Bengal, Kolkata, India
- Dhaval Baraiya, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shrikrishna Prasad Shetty, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shylesh Ramesh Babu, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Puja Bhaurao Dandekar, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
| | - Shrikrishna Prasad Shetty
- Anjana Malhotra, MS, MCh, DNB (Plastic), is Chief Specialist & HOD, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Urvi Ashok Shah, MS, DNB (Plastic), is Contractual Medical Practitioner, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Sourabh Shankar Chakraborty, DNB (ENT), MCh (Plastic), is Senior Resident (Non-acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, West Bengal, Kolkata, India
- Dhaval Baraiya, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shrikrishna Prasad Shetty, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shylesh Ramesh Babu, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Puja Bhaurao Dandekar, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
| | - Shylesh Ramesh Babu
- Anjana Malhotra, MS, MCh, DNB (Plastic), is Chief Specialist & HOD, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Urvi Ashok Shah, MS, DNB (Plastic), is Contractual Medical Practitioner, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Sourabh Shankar Chakraborty, DNB (ENT), MCh (Plastic), is Senior Resident (Non-acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, West Bengal, Kolkata, India
- Dhaval Baraiya, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shrikrishna Prasad Shetty, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shylesh Ramesh Babu, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Puja Bhaurao Dandekar, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
| | - Puja Bhaurao Dandekar
- Anjana Malhotra, MS, MCh, DNB (Plastic), is Chief Specialist & HOD, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Urvi Ashok Shah, MS, DNB (Plastic), is Contractual Medical Practitioner, Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Sourabh Shankar Chakraborty, DNB (ENT), MCh (Plastic), is Senior Resident (Non-acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, West Bengal, Kolkata, India
- Dhaval Baraiya, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shrikrishna Prasad Shetty, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Shylesh Ramesh Babu, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
- Puja Bhaurao Dandekar, MS (Surg), is Senior Resident (Acad), Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
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Holla VV, Neeraja K, Prasad S, Surisetti BK, Sharma D, Kamble N, Kulanthaivelu K, Dwarakanth S, Pruthi N, Pal PK, Yadav R. In Reply to the Letter to the Editor Regarding "Cervical Myeloradiculopathy and Atlantoaxial Instability in Cervical Dystonia". World Neurosurg 2021; 157:263. [PMID: 34929783 DOI: 10.1016/j.wneu.2021.10.093] [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] [Received: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Vikram Venkappayya Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Koti Neeraja
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Shweta Prasad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India; Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Bharath Kumar Surisetti
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Dinesh Sharma
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Karthik Kulanthaivelu
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Srinivas Dwarakanth
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Nupur Pruthi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India.
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Marion MH. Henry Meige: The man and his understanding of dystonia, at the turn of the 19th to 20th century. Rev Neurol (Paris) 2021; 178:532-538. [PMID: 34799079 DOI: 10.1016/j.neurol.2021.07.024] [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: 05/17/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Henry Meige (1866-1940), a French neurologist, the pupil of Charcot, is remembered for the eponym, the Meige syndrome, describing the clinical picture of craniocervical dystonia. This historical review highlights the controversies from his essay on "Le Juif Errant" (the Wandering Jew), and the evolution of his understanding of the movement disorders of the face and neck at the time of the encephalitis lethargica. RESULTS His thesis reported 5 patients from Eastern Europe, presenting with functional neurological disorders following traumatic life experiences. He wrote with Feindel the first book on movement disorders "Les tics et leur traitement". He pioneered the concept of focal dystonia and distinguished the facial median spasm as a dystonic movement disorder of the face. He highlighted the co-existence of psychopathology and the influence of the mental on tics and dystonia. He coined with Brissaud and Feindel the term "geste antagoniste" in cervical dystonia. He emphasized the importance of self-management and psycho-motor retraining for focal dystonia. CONCLUSION Meige made an invaluable contribution to our understanding of movement disorders, during his long medical career. The eponym Meige syndrome should be retained to describe an individual clinical entity.
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Affiliation(s)
- M-H Marion
- London BTX Centre, 280 King's road, SW3 5AW London, UK.
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Crisafulli O, Trompetto C, Puce L, Marinelli L, Costi S, Abbruzzese G, Avanzino L, Pelosin E. Dual task gait deteriorates gait performance in cervical dystonia patients: a pilot study. J Neural Transm (Vienna) 2021; 128:1677-1685. [PMID: 34324056 PMCID: PMC8536592 DOI: 10.1007/s00702-021-02393-1] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/26/2021] [Indexed: 01/22/2023]
Abstract
Day-to-day walking-related activities frequently involve the simultaneous performance of two or more tasks (i.e., dual task). Dual task ability is influenced by higher order cognitive and cortical control mechanisms. Recently, it has been shown that the concomitant execution of an attention-demanding task affected postural control in subject with cervical dystonia (CD). However, no study has investigated whether dual tasking might deteriorate gait performance in CD patients. To investigate whether adding a concomitant motor and cognitive tasks could affect walking performance in CD subjects.17 CD patients and 19 healthy subjects (HS) participated in this pilot case–control study. Gait performance was evaluated during four walking tasks: usual, fast, cognitive dual task and obstacle negotiation. Spatiotemporal parameters, dual-task cost and coefficients of variability (CV%) were measured by GaitRite® and were used to detect differences between groups. Balance performance was also assessed with Mini-BEST and Four Step Square tests. In CD participants, correlation analysis was computed between gait parameters and clinical data. Significant differences in complex gait and balance performance were found between groups. CD patients showed lower speed, longer stance time and higher CV% and dual-task cost compared to HS. In CD, altered gait parameters correlated with balance performance and were not associated with clinical features of CD. Our findings suggest that complex walking performance is impaired in patients with CD and that balance and gait deficits might be related
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Affiliation(s)
- Oscar Crisafulli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Stefania Costi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Abbruzzese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Laura Avanzino
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy.
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy.
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
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Carbone F, Ellmerer P, Ritter M, Spielberger S, Mahlknecht P, Hametner E, Hussl A, Hotter A, Granata R, Seppi K, Boesch S, Poewe W, Djamshidian A. Impaired Inhibitory Control of Saccadic Eye Movements in Cervical Dystonia: An Eye-Tracking Study. Mov Disord 2021; 36:1246-1250. [PMID: 33416199 PMCID: PMC8247854 DOI: 10.1002/mds.28486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/24/2020] [Revised: 11/24/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The pathophysiology of cervical dystonia is still unclear. Recent evidence points toward a network disorder affecting several brain areas. The objective of this study was to assess the saccadic inhibition as a marker of corticostriatal function in cervical dystonia. METHODS We recruited 31 cervical dystonia patients and 17 matched healthy controls. Subjects performed an overlap prosaccade, an antisaccade, and a countermanding task on an eye tracker to assess automatic visual response and response inhibition. RESULTS Cervical dystonia patients made more premature saccades (P = 0.041) in the overlap prosaccade task and more directional errors in the antisaccade task (P = 0.011) and had a higher rate of failed inhibition in the countermanding task (P = 0.001). CONCLUSIONS The results suggest altered saccadic inhibition in cervical dystonia, possibly as a consequence of dysfunctional corticostriatal networks. Further studies are warranted to confirm whether these abnormalities are affected by the available therapies and whether this type of impairment is found in other focal dystonias. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Federico Carbone
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Philipp Ellmerer
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Marcel Ritter
- Interactive Graphics and Simulation GroupUniversity of InnsbruckInnsbruckAustria
| | | | | | - Eva Hametner
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Anna Hussl
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Anna Hotter
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Roberta Granata
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Klaus Seppi
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Sylvia Boesch
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Werner Poewe
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
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Yang C, Huang W, Cui Y, Zhang G, Wang D, Xie W, Wiederhold M, Wiederhold B, Chu H, Yan L, Zeng J. Binocular integration and stereopsis in children with television torticollis. BMC Ophthalmol 2021; 21:102. [PMID: 33627106 PMCID: PMC7905628 DOI: 10.1186/s12886-021-01850-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/31/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To observe the characteristics of binocular integration and stereopsis in children with television torticollis. METHODS A retrospective study was carried out, where data were collected from 25 children with television torticollis as the disease group after refractive error correction and 25 normal children as the control group. A virtual reality system was used to assess and analyze the characteristics of binocular integration by a contrast balance test and binocular stereopsis. RESULTS The 25 children in the disease group included 17 males and 8 females with an average age of 7.5 ± 1.9 years old and an average binocular spherical equivalent of - 0.35 ± 1.46D. The 25 children in the control group were also 17 males and 8 females with an average age of 7.3 ± 2.2 years old and the average binocular spherical equivalent of - 0.48 ± 0.93D. No significant differences were found in the horizontal bar contrast balance test between the 2 groups at near and far distances. Near-distance vertical bar contrast balance test was normal in 23 subjects and suppressed in 2 subjects in the control group, while it was normal in 13 subjects and suppressed in 12 subjects in the disease group, which showed a statistically significant difference (P = 0.002). Far distance vertical bar contrast balance test was normal in 24 subjects and suppressed in 1 subject in the control group, normal in 7 subjects and suppressed in 18 subjects in the disease group, showing a statistically significant difference (P = 0.000). All subjects in the 2 groups showed 100〞 as near distance stereoacuity. At far distance, the mean stereoacuity was 176.00〞 ± 92.56〞 in the control group, and 352.00〞 ± 270.99〞 in the disease group, with a statistically significant difference (P = 0.011). CONCLUSION By using virtual reality technology, defects in binocular visual function were found in children whose television torticollis persisted after regular refractive error correction. Television torticollis may be associated with the deficit of binocular integration for vertical bars and far distance stereopsis.
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Affiliation(s)
- Cheng Yang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Wanshu Huang
- LiKaShing Faculty of Medicine, The University of Hong Kong, 6 William MW, Mong Block 21 Sassoon Road, Pokfulam, HongKong SAR, China
| | - Ying Cui
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Guanrong Zhang
- Information and Statistics Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Dongmei Wang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Wenjuan Xie
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Mark Wiederhold
- Virtual Reality Medical Center, Scripps Memorial Hospital, 9834 Genesee Suite#427, La Jolla, California, USA
| | - Brenda Wiederhold
- Virtual Reality Medical Center, Scripps Memorial Hospital, 9834 Genesee Suite#427, La Jolla, California, USA
| | - Hang Chu
- National Engineering Research Center for Healthcare Devices, 1307 Guangzhou Avenue Middle, Guangzhou, Guangdong, China
| | - Li Yan
- National Engineering Research Center for Healthcare Devices, 1307 Guangzhou Avenue Middle, Guangzhou, Guangdong, China
| | - Jin Zeng
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
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Erro R, Antelmi E, Bhatia KP, Latorre A, Tinazzi M, Berardelli A, Rothwell JC, Rocchi L. Reversal of Temporal Discrimination in Cervical Dystonia after Low-Frequency Sensory Stimulation. Mov Disord 2020; 36:761-766. [PMID: 33159823 DOI: 10.1002/mds.28369] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/26/2020] [Accepted: 10/12/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Somatosensory temporal discrimination is abnormal in dystonia and reflects reduced somatosensory inhibition. In healthy individuals, both the latter are enhanced by high-frequency repetitive somatosensory stimulation, whereas opposite effects are observed in patients with cervical dystonia. OBJECTIVES We tested whether low-frequency repetitive sensory stimulation, which in healthy individuals worsens discrimination, might have the opposite effect in patients with cervical dystonia at the physiological level and, in turn, improve their perceptual performance. METHODS Somatosensory temporal discrimination and several electrophysiological measures of sensorimotor inhibition were collected before and after 45 minutes of low-frequency repetitive sensory stimulation. RESULTS As predicted, and opposite to what happened in controls, low-frequency repetitive sensory stimulation in patients enhanced sensorimotor inhibition and normalized somatosensory temporal discrimination. CONCLUSIONS Patients with cervical dystonia have an abnormal response to repetitive sensory stimulation, which we hypothesize is attributed to abnormally sensitive homeostatic mechanisms of inhibitory circuitry in both sensory and motor systems. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi (SA), Italy
| | - Elena Antelmi
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | - Anna Latorre
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
- Department of Human Neurosciences, University of Rome "Sapienza", Rome, Italy
| | - Michele Tinazzi
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, University of Rome "Sapienza", Rome, Italy
- IRCCS Neuromed Institute, Pozzilli, Italy
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
- Department of Human Neurosciences, University of Rome "Sapienza", Rome, Italy
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Affiliation(s)
- Martin Schwarze
- *Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg,
| | - Stefan Hemmer
- *Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg,
| | - Michael Akbar
- **Clinic für Wirbelsäulenerkrankungen und -Therapien, MEOCLINIC GmbH
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Alonso Cadenas JA, Pérez Suárez E, Moral Larraz A, Niño Taravilla C, Martínez González C, de la Torre Espí M. Nontraumatic atlantoaxial subluxation: Grisel syndrome. Emergencias 2020; 32:215-216. [PMID: 32395937] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | - Esther Pérez Suárez
- Servicio de Urgencias, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Ana Moral Larraz
- Servicio de Cuidados Intensivos Pediátricos, Hospital Infantil Doctor Roberto del Río, Chile
| | - Carmen Niño Taravilla
- Servicio de Cuidados Intensivos Pediátricos, Hospital Infantil Doctor Roberto del Río, Chile
| | - Carmen Martínez González
- Servicio de Traumatología y Ortopedia Infantil, Hospital Infantil Universitario Niño Jesús, Madrid, España
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Narasimham S, Sundarajan V, McGovern E, Quinlivan B, Killian O, O'Riordan S, Hutchinson M, Reilly RB. Characterizing Brain Network Topology in Cervical Dystonia Patients and Unaffected Relatives via Graph Theory. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:1694-1697. [PMID: 31946223 DOI: 10.1109/embc.2019.8856624] [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] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Cervical Dystonia (CD) is a neurological movement disorder characterized by intermittent muscle contractions in the head and neck. The pathophysiology and neural networks underpinning this condition are incompletely understood. There is increasing evidence that isolated focal dystonias are due to network-wide functional alterations. An abnormal temporal discrimination threshold (TDT) is believed to be a mediational endophenotype due to its prevalence in unaffected first-degree relatives as well as patients. However the neural correlates linking abnormal TDT and CD remain poorly understood. Probing changes in large-scale network topology via graph theory with resting state fMRI data from relatives and patients may provide further insight into the pathophysiology of CD. In this study, resting state fMRI data were acquired and analyzed from 16 CD patients with abnormal TDT, 32 unaffected first degree relatives (16 with normal TDT and 16 with abnormal TDT) and 16 healthy controls. Graph theory metrics demonstrating network topology were extracted. The results indicate large-scale functional reorganization of networks in relatives (with abnormal TDT) along with a manifestation of topological aberrations similar to patients.
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Gao Y, Zan T, Li H, Li Q. [A COMPARATIVE STUDY ON TREATMENT OF SCAR CONTRACTURE ON FACE, NECK, AND JOINTS WITH PRE-EXPANDED FLAPS AND SKIN GRAFTS]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2015; 29:1124-1128. [PMID: 26750013] [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
OBJECTIVE To study the treatment results of the pre-expanded flaps for scar contracture on face, neck, and joints by comparing with the skin grafts. METHODS A total of 240 cases of scar contracture between July 2004 and June 2014 were included in the study by random sampling; skin grafts were used in 120 cases (skin graft group), and pre-expanded flaps in 120 cases (pre-expanded flap group). There was no significant difference in age, sex, injury sites, and disease duration between 2 groups (P>0.05). Re-operation rate and A&F 0-6 quantization score were used to evaluate the treatment results. RESULTS The patients were followed up 12 to 75 months (mean, 23.47 months) in the skin graft group, and 12 to 61 months (mean, 19.62 months) in the pre-expanded flap group. The re-operation rate of the skin graft group was 72.5% (87/120), and was significantly higher than that of the pre-expanded flap group (19.2%, 23/120) (P=0.000). The re-operation rate of the neck contracture in teenagers was the highest. It was 93.9% in the skin graft group and 35.0% in the pre-expanded flap group. In the patients who did not undergo re-operations, A&F 0-6 quantization score of the skin graft group was 2.85±1.12, and was significantly lower than that of the pre-expanded flap group (5.22±0.74) (t=13.830, P=0.000). CONCLUSION Pre-expanded flap for scar contracture on face, neck, and joints has lower re-operation rate and better aesthetic and functional restoration than skin graft. It should be regarded as the preferred method for teenagers.
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HIRSCHMANN J, MAYER K. Zur Beeinflussung der Akinese und anderer extrapyramidal-motorischer Störungen mit L-Dopa (L-Dihydroxyphenylalanin). Dtsch Med Wochenschr 2009; 89:1877-80. [PMID: 14211843 DOI: 10.1055/s-0028-1113210] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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HANDA H, ARAKI C, MORI K, MIZAWA I, ITO M. Spasmodic Torticollis Treated by Chemothalamotomy and Chemopallidotomy. Stereotact Funct Neurosurg 2007; 22:393-6. [PMID: 13952487 DOI: 10.1159/000104391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Shafi M, Hui JHP. Common paediatric orthopaedic problems in the upper limb. Singapore Med J 2006; 47:654-59; quiz 660. [PMID: 16865203] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- M Shafi
- Department of Orthopaedic Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074
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Abstract
We hypothesised that, since anomalous neck proprioceptive input can produce perturbing effects on posture, neck muscle fatigue could alter body balance control through a mechanism connected to fatigue-induced afferent inflow. Eighteen normal subjects underwent fatiguing contractions of head extensor muscles. Sway during quiet stance was recorded by a dynamometric platform, both prior to and after fatigue and recovery, with eyes open and eyes closed. After each trial, subjects were asked to rate their postural control. Fatigue was induced by having subjects stand upright and exert a force corresponding to about 35% of maximal voluntary effort against a device exerting a head-flexor torque. The first fatiguing period lasted 5 min (F1). After a 5-min recovery period (R1), a second period of fatiguing contraction (F2) and a second period of recovery (R2) followed. Surface EMG activity from dorsal neck muscles was recorded during the contractions and quiet stance trials. EMG median frequency progressively decreased and EMG amplitude progressively increased during fatiguing contractions, demonstrating that muscle fatigue occurred. After F1, subjects swayed to a larger extent compared with control conditions, recovering after R1. Similar findings were obtained after F2 and after R2. Although such behaviour was detectable under both visual conditions, the effects of fatigue reached significance only without vision. Subjective scores of postural control diminished when sway increased, but diminished more, for equal body sway, after fatigue and recovery. Contractions of the same duration, but not inducing EMG signs of fatigue, had much less influence on body sway or subjective scoring. We argue that neck muscle fatigue affects mechanisms of postural control by producing abnormal sensory input to the CNS and a lasting sense of instability. Vision is able to overcome the disturbing effects connected with neck muscle fatigue.
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Affiliation(s)
- M Schieppati
- Department of Experimental Medicine, Section of Human Physiology, University of Pavia, Pavia, Italy.
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41
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Abstract
We report a patient showing unilateral split foot together with unusual malformations.
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Chalmers AJ, Gillham CM, Plowman PN. Nuchal aggressive fibromatosis in childhood: two instructive case reports. Clin Oncol (R Coll Radiol) 2002; 13:378-83. [PMID: 11716234 DOI: 10.1053/clon.2001.9294] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aggressive fibromatosis is a rare, benign tumour with a capacity for infiltration of surrounding structures and a propensity for local recurrence. The cornerstone of therapy is surgery, with various other treatment modalities having ill-defined roles. Assessment of the efficacy of these interventions is difficult. The natural history of the condition is variable and different treatment modalities are often used concurrently. Childhood cases pose particular management problems because of their tendency to occur in the head and neck region and the potential for treatment-related morbidity. Two children presented after surgery with recurrent disease threatening the airway. One remitted spontaneously and remains disease free at 20 years. The other achieved a complete remission with radiotherapy and toremifene. The role of non-surgical treatment, particularly radiotherapy, is reviewed.
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Imaiso Y, Taniwaki T, Yamada T, Yoshimura T, Hirano M, Ueno S, Kaneda N, Kira J. A novel mutation of the GTP-cyclohydrolase I gene in a patient with hereditary progressive dystonia/dopa-responsive dystonia. Neurology 1998; 50:517-9. [PMID: 9484387 DOI: 10.1212/wnl.50.2.517] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 02/06/2023] Open
Abstract
We report a 37-year-old Japanese woman with hereditary progressive dystonia with marked diurnal fluctuation and dopa-responsive dystonia. She developed dystonia in the lower limbs at the age of 11 years, followed by spasmodic torticollis and resting tremor of the feet, which responded remarkably to low doses of levodopa (100 mg/day). Concentrations of biopterin and neopterin in CSF were decreased. Polymerase chain reaction analysis of the guanosine 5'-triphosphate cyclohydrolase I gene revealed a novel mutation (Thr186-->Lys).
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Affiliation(s)
- Y Imaiso
- Department of Neurology, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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47
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Abstract
Two siblings with a congenital muscular dystrophy and severe mental retardation which was not due to dystrophin, merosin, or adhalin deficiency are described. These cases overlap with congenital muscular dystrophy of the Fukuyama-type but are less severe. Atypical features include limited facial involvement, retained ambulation, and severe retrocollis.
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Affiliation(s)
- L Nashef
- Kent and Canterbury Hospital, Department of Neurology, London, UK
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