Functional neurology最新文献

Individuals with Parkinson's disease (PD) and freezing of gait (FOG) have impaired postural control. Recent studies using foot sensory stimulation delivered by means of automated mechanical peripheral stimulation (AMPS) have demonstrated improvements of gait in individuals with PD. This study aimed to investigate the effects of AMPS on postural control in individuals with PD and FOG. Thirty-three subjects participated in this randomized controlled trial. Participants were allocated to two groups: AMPS and AMPS SHAM. Subjects underwent eight sessions of real (AMPS) or placebo AMPS (AMPS SHAM) once every three/four days. Postural control was assessed by means of posturography before the first and after the eighth session of treatment. We did not find positive effects of AMPS on center of pressure parameters. Thus, it seems that AMPS has no positive effect in terms of improving static postural control in individuals with PD and FOG.

It is well established that non-motor symptoms are a core feature of Parkinson's disease (PD). A dysregulation of the autonomic nervous system seems to be present in PD, supporting the coexistence of urological and cardiovascular non-motor features. We evaluated whether bladder dysfunctions in patients with PD are linked to blood pressure dysregulation. Twenty-eight mild PD patients, previously submitted to a urodynamic evaluation, underwent 24-hour ambulatory blood pressure and heart rate monitoring to allow assessment of their circadian blood pressure profile; the occurrence of postprandial hypotension and orthostatic hypotension was also investigated. No significant differences in blood pressure control were detected between bladder hyperreflexic and normoreflexic subjects. Our findings support different origins of urological and cardiovascular impairments in PD.

By the 1860s, Paolo Mantegazza was a professor of general pathology at the University of Pavia, where he had graduated in medicine in 1854. There, he founded Italy's first laboratory of experimental pathology and did his first research on pain, the subject of various communications presented to the Istituto Lombardo in Milan. In 1880, Mantegazza published Physiology of Pain, one of the several "physiologies" (of pleasure, of love, of hatred, of woman) that he wrote during his career. In this book, a testament to his scientific versatility, experimental observations supplemented his insights into hygienism and anthropology. This research on pain also led to a dispute between Mantegazza and Cesare Lombroso, which was the start of the two scientists' estrangement.

Even after rehabilitation, post stroke patients remain disabled. The Post Stroke Checklist (PSC) was developed to highlight unmet needs of community-dwelling stroke patients. The present study set out to validate Post Soft Care-App, designed to administer the PSC using smartphones and tablets, in order to monitor unmet needs in chronic patients. Fifty-three patients and fifteen physiotherapists were enrolled. The therapists administered the PSC to patients using the app, and then completed a structured questionnaire on its usability and utility. The Post Soft Care-App highlighted the following unmet needs: increased spasticity (56.6%), reduced independence in activities of daily living (47.2%), reduced mobility (45.3%), absence of secondary prevention (45.3%). Therapists positively evaluated Post Soft Care-App as useful, practical, quick to complete (96.2%), and effective in helping improve communication with patients (75.5%). The Post Soft Care-App can be considered a valid assessment tool for helping therapists to monitor functional outcomes in chronic patients.

Some patients with multiple sclerosis (MS) complain of symptoms, such as myokymia, myotonia, spasms, and stiffness, which have been demonstrated to be due to a concurrent non-dystrophic myotonia, i.e. myotonia congenita or paramyotonia congenita. Beyond the known casual association between MS and non-dystrophic myotonia, a channelopathy representing a primary trait of MS rather than an epiphenomenon of demyelization (i.e., an acquired channelopathy) may exist. Indeed, the finding of MS patients with no genetic evidence of non-dystrophic myotonia but showing a clinical picture resembling this condition would support this hypothesis. Thirty patients with MS and no concurrent diagnosis of myotonia congenita or paramyotonia congenita were submitted to the Fournier protocol. Some of these MS patients presented abnormal muscle excitability with scarce myotonic discharges, but only a few of them had clinical features compatible with myotonia congenita or paramyotonia congenita syndromes. Even though the low number of recruited patients did not allow a robust statistical analysis, our data seemed to indicate the presence of an ion channel dysfunction that is independent of the acquired channelopathies and likely represents a common pathophysiological mechanism underlying a unique channelopathy simultaneously involving the peripheral and the central nervous system in individuals with MS. Confirming the presence of such a primary channelopathy in MS patients is of non-negligible importance, since dysfunction of ion channels may represent a suitable therapeutic target in MS.

The effects of exogenous melatonin on sleep diminish after its long-term use in haemodialysis patients. Our aim was to determine whether melatonin levels accumulate after chronic (at least three months) use of exogenous melatonin, 5 mg daily, and whether discontinuation of this treatment improves endogenous melatonin production and improves the circadian sleep-wake rhythm. In this case series, stable haemodialysis patients discontinued their chronic exogenous melatonin usage for seven days and melatonin concentrations in saliva were analysed. The primary endpoint was recovery of a normal circadian melatonin rhythm. Secondary endpoints were the effects on melatonin pharmacokinetics and sleep parameters. At day three after discontinuation the normal circadian melatonin rhythm recovered in the two patients who discontinued the treatment for the full week. They also had an effective maximum trough level of melatonin. Discontinuing melatonin seems to result in recovery of the circadian rhythm, based on achievement of effective melatonin thresholds. Further research is necessary to investigate whether sleep parameters improve after a drug holiday.most appropriate treatment.

The ABCD3-I criteria have proved to be effective for use in regular clinical practice to assist in transient ischemic attack (TIA) risk stratification and treatment. In this prospective study we aimed to explore the relationships between risk stratification and arterial stenosis location, carotid plaque morphology and vessel involvement in 90 TIA patients, stratifying risk by ABCD3-I scores. Clinical variables such as total cholesterol, triglyceride, low-density lipoprotein cholesterol, glycosylated hemoglobin, homocysteine and high-sensitive C-reactive protein levels were recorded. The endpoint was subsequent stroke at seven-day follow-up. Ninety patients were divided into three risk groups on the basis of their ABCD3-I scores. The results revealed that patients with higher ABCD3-I scores showed a higher occurrence of intracranial stenosis (P < 0.05), less organized carotid plaques (P < 0.05) and multiple-vessel involvement (P < 0.05).

Motor impairments of the upper extremities affect approximately 60% of stroke patients. Rehabilitation is extremely important and can make it possible to identify which manual function is causing difficulty for the patient and hindering daily activities. The Wolf Motor Function Test (WMFT) was recently highly recommended as one of several outcome measures that assess limitations of activities with a high level of psychometrics and clinical utility. The objective of this study was to translate and culturally adapt the WMFT for the Italian population (WMFT-IT) and examine its reliability and validity in Italian post-stroke adults with chronic hemiplegia or hemiparesis. The original scale was translated into Italian and culturally adapted in accordance with international guidelines. Its internal consistency and stability were examined using the Cronbach's alpha (α) coefficient and the intra-class correlation coefficient (ICC), respectively. Its concurrent validity was evaluated using the Pearson's correlation coefficient to compare the instrument with the Italian version of the Jebsen-Taylor Hand Function Test and the Disabilities of the Arm, Shoulder and Hand outcome measure. All WMFT-IT items were either identical or similar in meaning to the items in the original version. The WMFT-IT was administered to 24 subjects. Cronbach's α was 0.91 and 0.98 for the time and performance subscales respectively, and the ICC for test-retest reliability was 0.99. Pearson's correlation coefficients of the time subscale and the performance subscale both showed significant positive correlations (p <0.01). The WMFT-IT was found to be reliable and a valid outcome measure for assessing function and quality of movement of the upper extremities in post-stroke adults in the Italian population.

Hyperglycemia-associated chorea-ballism (HCB) is an infrequent neurological syndrome occurring predominantly in elderly females and in the setting of non-ketotic hyperglycemia (NKH). A systematic review was conducted in accordance with the PRISMA statement. Studies published between 1980 and 2018 that reported demographic, clinical, laboratory and imaging features from patients with HCB were screened. 136 studies describing 286 patients were included in the analysis. The patients included had a median age of 72 years; those with ketotic hyperglycemia (KH) were older (p<0.001). Women and NKH patients were the most frequently affected (63% and 92%, respectively). The median glucose level at admission was 420 mg/dL (IQR 328-535), and was significantly higher in KH (p=0.009). Moreover, the absence of a clear lesion on imaging studies and the finding of bilateral imaging evidence of lesions were each more frequent in the KH group (p=0.036 and p=0.008, respectively). 48 cases (19.4%) presented with bilateral CT/MRI lesions, having higher values of plasma osmolarity compared with the patients with unilateral lesions (p=0.011). Every patient received hypoglycemic treatment, but only 174 (60.84%) were prescribed neuroleptics. 213 patients (84.86%) showed a total recovery, after a median of 14 days (IQR 3-31). Bilateral chorea-ballism was supported by bilateral imaging evidence of involvement in only 60% of the cases (positive predictive value). Patients not prescribed neuroleptics, with negative lentiform nucleus involvement, and age within the third tertile (≥ 78 years) had an odds ratio of 6.6 (CI 95% 1.18-141.10) for a complete clinical recovery. Significant differences were identified between types of hyperglycemia and regarding the clinical and imaging laterality features. Furthermore, the predictor variables evaluated showed potential utility for assessing the prognosis of HCB patients.