Functional neurology最新文献

Chronic deep brain stimulation (CDBS) is a surgical treatment that reduces the cardinal signs of Parkinson's disease (PD). Although CDBS has been in use for a long time, very little has been reported on its supposed effects on cognition, particularly in relation to implants in the subthalamic nucleus. The results of the rare studies that do exist are controversial, and in many cases the studies have several design flaws. The present study compared cortical activation during three tasks (action execution, action observation and motor imagery) in PD patients with and without subthalamic implants. The study sample consisted of 36 volunteers, divided into three groups: healthy controls, PD patients with CDBS of the subthalamic nucleus, and PD patients without CDBS. Through a quantitative electroencephalogram assessment, absolute beta power was examined to observe the interaction between group and cognitive motor tasks. The electrodes at sites Fp1, Fp2, F7, F8, F3, Fz and F4, located in the prefrontal and frontal regions, were analyzed and a Group x Task interaction (p < 0.05) was observed for all of them. These findings suggest that CDBS of the subthalamic nucleus is efficient in reducing some of the effects of PD in these study tasks. At the same time, the dysfunctions found in several cortical areas, characteristic of PD, limited the effects of the CDBS. The results of this study suggest that CDBS of the subthalamic nucleus can modulate cognitive-motor aspects of PD.

In recent years, cognitive theories have increasingly influenced the approach to motor rehabilitation. The connection between different aspects of cognitive and motor function is increasingly documented, underlining the importance of developing rehabilitation projects that take cognitive aspects into account. The aim of this non-systematic review is to highlight the relationship between cognition and motion and, in the light of new rehabilitation technologies, to better define how aspects of cognition can affect motor rehabilitation.

Our aim was to evaluate the impact of a single bout of exercise, consisting of a gait training session with body weight support (BWS), on histone acetylation status (global histone H4 and H3 acetylation levels), brain-derived neurotrophic factor (BDNF) levels, and oxidative stress markers in peripheral blood of individuals with chronic spinal cord injury (SCI). We also set out to compare these responses with those recorded after gait training performed using a walker and with no BWS. The subjects (nearly all with an incomplete spinal cord lesion) were each submitted to two 60-minute experimental sessions on separate days with a 1- week wash-out period between the interventions. The order of the sessions was randomized. Blood samples were collected before and after each experimental trial for measurement of biomarkers. The histone acetylation status and BDNF levels remained unchanged after both interventions. After the treadmill training, the participants showed a strong increase in levels of oxidative stress markers [plasma advanced oxidation protein products (AOPPs), nitrite and thiobarbituric acid-reactive substances] without changes in antioxidant mediators. Instead, elevations in AOPP and nitrite concentrations, in addition to increased levels of glutathione and catalase activity, were found after the walker training. A single bout of gait training, be it conducted on a treadmill with BWS or using a walker without BWS, is not able to alter BDNF levels and histone acetylation status in SCI patients. However, these trials can modulate oxidative stress parameters, seemingly in a protocol-dependent manner.

The aim of this study was to assess admissions, for headache, to the emergency department (ED) of the Di Cristina Children's Hospital in Palermo over a decade. The total number of ED admissions for headache was retrospectively analysed considering two 24- month periods: 2009-2010 and 2017-2018. Total admissions to the ED decreased from 55,613 to 50,096 (-10%) between the two periods considered, while the number of admissions for headache increased by 63.56% (p < 0.0001). There was also a significant increase in the number of multiple ED admissions by single children (9.5% versus 17.98% of the patients accessing the ED for headache). This significant increase in admissions for paediatric headache is probably due to limited efficacy of the Italian and international guidelines and of the educational strategies implemented in this setting, and also to communication difficulties, both with patients and between primary care networks and hospitals.

Although rabies, or hydrophobia, is one of the so-called forgotten tropical diseases, it still kills thousands of people each year, especially children living in rural areas of Asia and Africa. This terrible disease was once a much-feared threat throughout Europe, whose terrifying symptoms were described in a vast body of literature that was based on both science and popular beliefs. One notable individual whose name is linked to the fight against this disease is Adelchi Negri, a brilliant but unfortunate pupil of Camillo Golgi. At the beginning of the 20th century, Negri observed peculiar formations in the brains of infected animals: known as Negri's bodies, these formations became an important diagnostic tool used in anti-rabies institutes all over the world.

Management of acute stroke varies greatly within and between different countries. This study assesses the current practices of physicians in Lebanon routinely involved in ischemic stroke (IS) management. We conducted a prospective observational study of patients hospitalized at 8 different Lebanese hospitals in the period August 1, 2015 to July 31, 2016, with a diagnosis of acute stroke. Baseline characteristics and data on diagnostic studies, as well as treatments received during hospitalization and at discharge, were collected and analyzed. Two hundred and three strokes/transient ischemic attacks (TIAs) were recorded but only 173 patients (85%) with ischemic events were included in the study. The patients' mean age was 69.8±12.7 years. All underwent brain imaging (CT scan and/or MRI) on admission. All ISs were managed by a neurologist, and patient management included consultation of a cardiologist. Hypertension was the most prevalent risk factor (78.6%), followed by a current cigarette smoking habit (50.3%), diabetes mellitus (42.8%), hypercholesterolemia (39.9%), previous stroke or TIA (17.3%), and atrial fibrillation (14.7%). Only four patients (accounting for 2.5% of the ISs) received thrombolytic therapy. More than 89% of the patients were discharged on at least one anti-hypertensive drug, 89.2% on statins and 37.6% on antidiabetic medications. More than 55% of patients were dependent at discharge, as shown by a modified Rankin Scale (mRS) score of 0-2, whereas 33% were independent (mRS score of 3-5). There are many challenges facing stroke care in Lebanon, and there is potential for improvement in this setting. Reperfusion therapy is still largely underused and remains a major challenge in achieving guideline-based reperfusion goals.

The Barthel Index (BI) is used in Italy to measure the severity of disability and to identify patients suitable for admission to rehabilitation units. The objective of this psychometric study was to validate the Italian version of the BI in a population of patients with Parkinson's disease (PD). The study was conducted at three neurological and rehabilitation centres in Rome, Italy. The BI was administered to outpatients with PD. The reliability of the scale was assessed using Cronbach's alpha for internal consistency; the intra-class correlation coefficient (ICC) was used to measure its intra- and inter-rater reliability. Pearson's correlation coefficient was calculated to evaluate its validity, comparing it with the Parkinson's disease Questionnaire (PDQ-39), the Italian version of the Geriatric Depression Scale (GDS), the Hospital Anxiety and Depression Scale (HADS), and the Short Form 36-Health Survey Questionnaire (SF-36). The BI was administered to 94 patients with PD. The psychometric properties measured were significant: Cronbach's alpha was 0.866 and the ICC for intra- and inter-rater reliability was 0.998 and 0.993, respectively. Pearson's correlation coefficient showed good correlation with the PDQ-39, GDS, HADS and SF-36 (p < 0.01). The BI is a valid and reliable tool for measuring disability in a PD population.

Multiple sclerosis (MS) is a chronic disease of the central nervous system, characterized by demyelinization and axonal loss resulting, in 66% of cases, in upper limb motor impairment. The effects of constraint-induced movement therapy (CIMT) have recently been investigated in MS patients. The aim of this randomized single-blind pilot study was to assess the effects of CIMT on upper limb activity, specifically smoothness of movement, in patients affected by progressive MS. Patients affected by MS, and reporting reduced use primarily of one upper limb, were enrolled and randomly allocated to two different groups: a CIMT group, where treatment was performed with the less affected limb immobilized by a splint, and a control group, submitted to intensive bi-manual treatment. All evaluations were performed at baseline (T0) and after two weeks of treatment (T1) by an operator unaware of the patients' allocation. The primary outcome was the difference in movement smoothness, measured by means of a bidimensional kinematic evaluation. Secondary outcomes were: endpoint error and arm trajectory mean speed. Furthermore, patients performed the Hand Grip Strength Test (HGS) and 9-Hole Peg Test (9HPT), for both arms, at both time points. Ten patients with MS (4 males, 6 females; mean age 51.0±7.7 years) were randomly allocated to the CIMT group (n=5) and control group (n=5). There were no significant differences between groups in any of the data assessed at baseline. In the CIMT group subjects, the treatment effect, in terms of movement smoothness, was significant at the more affected limb (p=0.0376). The CIMT group displayed statistically significant improvements, versus the baseline values, in muscle strength (HGS:22.4±8.3 vs 26.0±6.0; p<0.05) and dexterity (9HPT: 31.8±6.1 vs 27.4±4.9; p<0.05) of the more affected limb. A positive, although not significant, trend in terms of muscle strength and upper limb dexterity was observed, for both limbs, in the control group after the two-week treatment. Bi-dimensional kinematic evaluation demonstrated that the CIMT group showed a significant reduction of endpoint error and higher mean speed for the more affected arm; these data are in line with the significant improvements recorded on the HGS and 9HPT. Moreover, in the CIMT group, a non-significant worsening of muscle strength was recorded for the less affected upper limb.