Pub Date : 2020-05-11eCollection Date: 2020-01-01DOI: 10.1155/2020/1473981
Martin Matharan, Stéphane Mathis, Sarah Bonabaud, Louis Carla, Antoine Soulages, Gwendal Le Masson
Introduction: Amyotrophic lateral sclerosis (ALS), usually fatal in a few years, is a neurodegenerative disorder where the diagnostic delay, although variable according to the studies, remains too long. The main objective of this study was to determine the average time to diagnose ALS and the role of each physician, general practitioner (GP), or specialist (neurologist or not) involved in the management of these patients. The secondary objective was to propose some simple schemes to quickly identify an ALS suspicion with the aim to reduce this delay. Patients and Methods. This retrospective study evaluated the diagnostic delay (and other intermediate delays) of 90 ALS patients registered in the ALS Center of Bordeaux (France) in 2013. The main clinical signs encountered (and their order of appearance) were studied.
Results: The average diagnostic delay was 17 months, with a median diagnostic delay of 12 months. The average diagnostic delay was 2.7 months between the first symptoms and the first complaint to GP, followed by an additional 6.5 month delay before the patient's first visit to a neurologist. This period could be shortened, especially if GP performed additional tests quickly (p=0.01), as the time spent consulting various specialists often extends this crucial step. Overall, diagnostic delay accounted for 40% of the total duration of the disease progression.
Conclusion: In relation to total survival time, the diagnostic delay of ALS appears to be proportionately very long, sometimes longer than that observed in previous studies (because it also included the total delay to diagnostic or treatment initiation). The rapid execution of useful additional tests by the first medical doctor, often GP (with the help of a neurologist), considerably reduces the diagnostic delay. The central role of GP seems to be crucial in the management of patients with ALS. The main objective is, of course, to initiate appropriate treatment and care as soon as possible. Finally, based on our results, we also provide a short practical diagram to help nonneurologist practitioners to quickly discuss the diagnosis of ALS in case of some specific symptoms ("red flags").
{"title":"Minimizing the Diagnostic Delay in Amyotrophic Lateral Sclerosis: The Role of Nonneurologist Practitioners.","authors":"Martin Matharan, Stéphane Mathis, Sarah Bonabaud, Louis Carla, Antoine Soulages, Gwendal Le Masson","doi":"10.1155/2020/1473981","DOIUrl":"https://doi.org/10.1155/2020/1473981","url":null,"abstract":"<p><strong>Introduction: </strong>Amyotrophic lateral sclerosis (ALS), usually fatal in a few years, is a neurodegenerative disorder where the diagnostic delay, although variable according to the studies, remains too long. The main objective of this study was to determine the average time to diagnose ALS and the role of each physician, general practitioner (GP), or specialist (neurologist or not) involved in the management of these patients. The secondary objective was to propose some simple schemes to quickly identify an ALS suspicion with the aim to reduce this delay. <i>Patients and Methods</i>. This retrospective study evaluated the diagnostic delay (and other intermediate delays) of 90 ALS patients registered in the ALS Center of Bordeaux (France) in 2013. The main clinical signs encountered (and their order of appearance) were studied.</p><p><strong>Results: </strong>The average diagnostic delay was 17 months, with a median diagnostic delay of 12 months. The average diagnostic delay was 2.7 months between the first symptoms and the first complaint to GP, followed by an additional 6.5 month delay before the patient's first visit to a neurologist. This period could be shortened, especially if GP performed additional tests quickly (<i>p</i>=0.01), as the time spent consulting various specialists often extends this crucial step. Overall, diagnostic delay accounted for 40% of the total duration of the disease progression.</p><p><strong>Conclusion: </strong>In relation to total survival time, the diagnostic delay of ALS appears to be proportionately very long, sometimes longer than that observed in previous studies (because it also included the total delay to diagnostic or treatment initiation). The rapid execution of useful additional tests by the first medical doctor, often GP (with the help of a neurologist), considerably reduces the diagnostic delay. The central role of GP seems to be crucial in the management of patients with ALS. The main objective is, of course, to initiate appropriate treatment and care as soon as possible. Finally, based on our results, we also provide a short practical diagram to help nonneurologist practitioners to quickly discuss the diagnosis of ALS in case of some specific symptoms (\"red flags\").</p>","PeriodicalId":19124,"journal":{"name":"Neurology Research International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2020-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/1473981","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37977168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-13eCollection Date: 2020-01-01DOI: 10.1155/2020/5260820
Vijay Renga
Electricity and neurology evolved synchronously over the past few centuries. This article looks at their origins and their journey into noninvasive brain stimulation technique of transcranial direct current stimulation (tDCS), which is now popular in neuroscience research.
{"title":"Electricity, Neurology, and Noninvasive Brain Stimulation: Looking Back, Looking Ahead.","authors":"Vijay Renga","doi":"10.1155/2020/5260820","DOIUrl":"https://doi.org/10.1155/2020/5260820","url":null,"abstract":"<p><p>Electricity and neurology evolved synchronously over the past few centuries. This article looks at their origins and their journey into noninvasive brain stimulation technique of transcranial direct current stimulation (tDCS), which is now popular in neuroscience research.</p>","PeriodicalId":19124,"journal":{"name":"Neurology Research International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2020-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/5260820","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37867189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-08eCollection Date: 2020-01-01DOI: 10.1155/2020/8109858
Ameha Zewudie, Yitagesu Mamo, Desalegn Feyissa, Mohammed Yimam, Gosaye Mekonen, Ahmed Abdela
Background: Epilepsy is among the most common neurological disorders which is highly treatable with currently available antiepileptic drugs at a reasonable price. In Ethiopia, despite a number of studies revealed high prevalence of epilepsy, little is known on predictors of poorly controlled seizures. Thus, the aim of this study was to assess epilepsy treatment outcome and its predictors among patients with epilepsy on follow-up at the ambulatory care unit of Mizan-Tepi University Teaching Hospital, Southwest Ethiopia.
Methods: A hospital-based cross-sectional study involving patient interview and chart review was conducted from March 10 to April 10, 2018. Drug use patterns and sociodemographic data of the study participants were accustomed to descriptive statistics. Backward logistic regression analysis was done to identify predictors of poor seizure control. Statistical significance was considered at p value <0.05.
Results: From a total of 143 studied patients with epilepsy, 60.8% had uncontrolled seizures. Monotherapy (79%) was commonly used for the treatment of seizures, of which phenobarbital was the most commonly utilized single anticonvulsant drug (62.9%). The majority (72.7%) of the patients had developed one or more antiepileptic-related adverse effects. Medium medication adherence (adjusted odds ratio (AOR) = 5.4; 95% CI = 1.52-19.23; p=0.009), poor medication adherence (AOR = 8.16; 95% CI = 3.04-21.90; p=0.001), head injury before seizure occurrence (AOR = 4.9; 95% CI = 1.25-19.27; p=0.02), and seizure attacks ≥4 episodes/week before AEDs initiation (AOR = 8.52; % CI = 2.41-13.45; p=0.001) were the predictors of uncontrolled seizure.
Conclusions: Based on our findings, more than half of the patients with epilepsy had poorly controlled seizures. Nonadherence to antiepileptic drugs, high frequency of seizure attack before AEDs initiation, and history of a head injury before the occurrence of seizure were predictors of uncontrolled seizure. Patient medication adherence should be increased by the free access of antiepileptic drugs and attention should be given for the patients with a history of head injury and high frequency of seizure attacks before AEDs initiation.
背景:癫痫是最常见的神经系统疾病之一,目前可用的抗癫痫药物价格合理,可高度治疗。在埃塞俄比亚,尽管一些研究表明癫痫发病率很高,但对癫痫发作控制不佳的预测因素知之甚少。因此,本研究的目的是评估埃塞俄比亚西南部Mizan-Tepi大学教学医院门诊随访癫痫患者的癫痫治疗结果及其预测因素。方法:于2018年3月10日至4月10日进行以医院为基础的横断面研究,包括患者访谈和图表复习。研究参与者的药物使用模式和社会人口学数据采用描述性统计。进行逆向逻辑回归分析以确定癫痫控制不良的预测因素。结果:143例癫痫患者中,60.8%的癫痫发作不受控制。癫痫发作常用单药治疗(79%),其中苯巴比妥是最常用的单药抗惊厥药物(62.9%)。大多数(72.7%)患者出现一种或多种抗癫痫相关不良反应。中等药物依从性(调整优势比(AOR) = 5.4;95% ci = 1.52-19.23;p=0.009),药物依从性差(AOR = 8.16;95% ci = 3.04-21.90;p=0.001),癫痫发作前头部损伤(AOR = 4.9;95% ci = 1.25-19.27;p=0.02),起用aed前癫痫发作≥4次/周(AOR = 8.52;% ci = 2.41-13.45;P =0.001)是不受控制的癫痫发作的预测因子。结论:根据我们的研究结果,超过一半的癫痫患者癫痫发作控制不佳。抗癫痫药物的不依从性、使用aed前癫痫发作的高频率以及癫痫发作前的头部损伤史是癫痫发作失控的预测因素。应通过免费获得抗癫痫药物来提高患者的药物依从性,并应注意在使用aed之前有头部损伤史和癫痫发作频率高的患者。
{"title":"Epilepsy Treatment Outcome and Its Predictors among Ambulatory Patients with Epilepsy at Mizan-Tepi University Teaching Hospital, Southwest Ethiopia.","authors":"Ameha Zewudie, Yitagesu Mamo, Desalegn Feyissa, Mohammed Yimam, Gosaye Mekonen, Ahmed Abdela","doi":"10.1155/2020/8109858","DOIUrl":"https://doi.org/10.1155/2020/8109858","url":null,"abstract":"<p><strong>Background: </strong>Epilepsy is among the most common neurological disorders which is highly treatable with currently available antiepileptic drugs at a reasonable price. In Ethiopia, despite a number of studies revealed high prevalence of epilepsy, little is known on predictors of poorly controlled seizures. Thus, the aim of this study was to assess epilepsy treatment outcome and its predictors among patients with epilepsy on follow-up at the ambulatory care unit of Mizan-Tepi University Teaching Hospital, Southwest Ethiopia.</p><p><strong>Methods: </strong>A hospital-based cross-sectional study involving patient interview and chart review was conducted from March 10 to April 10, 2018. Drug use patterns and sociodemographic data of the study participants were accustomed to descriptive statistics. Backward logistic regression analysis was done to identify predictors of poor seizure control. Statistical significance was considered at <i>p</i> value <0.05.</p><p><strong>Results: </strong>From a total of 143 studied patients with epilepsy, 60.8% had uncontrolled seizures. Monotherapy (79%) was commonly used for the treatment of seizures, of which phenobarbital was the most commonly utilized single anticonvulsant drug (62.9%). The majority (72.7%) of the patients had developed one or more antiepileptic-related adverse effects. Medium medication adherence (adjusted odds ratio (AOR) = 5.4; 95% CI = 1.52-19.23; <i>p</i>=0.009), poor medication adherence (AOR = 8.16; 95% CI = 3.04-21.90; <i>p</i>=0.001), head injury before seizure occurrence (AOR = 4.9; 95% CI = 1.25-19.27; <i>p</i>=0.02), and seizure attacks ≥4 episodes/week before AEDs initiation (AOR = 8.52; % CI = 2.41-13.45; <i>p</i>=0.001) were the predictors of uncontrolled seizure.</p><p><strong>Conclusions: </strong>Based on our findings, more than half of the patients with epilepsy had poorly controlled seizures. Nonadherence to antiepileptic drugs, high frequency of seizure attack before AEDs initiation, and history of a head injury before the occurrence of seizure were predictors of uncontrolled seizure. Patient medication adherence should be increased by the free access of antiepileptic drugs and attention should be given for the patients with a history of head injury and high frequency of seizure attacks before AEDs initiation.</p>","PeriodicalId":19124,"journal":{"name":"Neurology Research International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2020-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/8109858","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37867190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-30eCollection Date: 2020-01-01DOI: 10.1155/2020/6916135
Ayse Kuspinar, Kedar K V Mate, Anne-Louise Lafontaine, Nancy Mayo
Methods: Patients with PD completed the PGI and various standard patient-reported outcome (PRO) measures. The PGI and standard PRO measures were compared at the total score, domain, and item levels. Pearson's correlations and independent t-tests were used, as well as positive and negative predictive values.
Results: The sample (n = 76) had a mean age of 69 (standard deviation 9) and were predominantly men (59%). The PGI was moderately correlated (r = -0.35) with the standardized disease-specific QOL measure Parkinson's Disease Questionnaire (PDQ-8). Within one severity rating, agreement between the PGI and different standard outcome measures ranged from 85 to 100% for walking, 69 to 100% for fatigue, 38 to 75% for depression, and 20 to 80% for memory/concentration.
Conclusion: This study demonstrates that nominated areas of QOL on the PGI provide comparable results to standard PRO measures, and provides evidence in support of the validity of this individualized measure in PD.
{"title":"Validation of an Individualized Measure of Quality of Life, Patient Generated Index, for Use with People with Parkinson's Disease.","authors":"Ayse Kuspinar, Kedar K V Mate, Anne-Louise Lafontaine, Nancy Mayo","doi":"10.1155/2020/6916135","DOIUrl":"https://doi.org/10.1155/2020/6916135","url":null,"abstract":"<p><strong>Methods: </strong>Patients with PD completed the PGI and various standard patient-reported outcome (PRO) measures. The PGI and standard PRO measures were compared at the total score, domain, and item levels. Pearson's correlations and independent <i>t</i>-tests were used, as well as positive and negative predictive values.</p><p><strong>Results: </strong>The sample (<i>n</i> = 76) had a mean age of 69 (standard deviation 9) and were predominantly men (59%). The PGI was moderately correlated (<i>r</i> = -0.35) with the standardized disease-specific QOL measure Parkinson's Disease Questionnaire (PDQ-8). Within one severity rating, agreement between the PGI and different standard outcome measures ranged from 85 to 100% for walking, 69 to 100% for fatigue, 38 to 75% for depression, and 20 to 80% for memory/concentration.</p><p><strong>Conclusion: </strong>This study demonstrates that nominated areas of QOL on the PGI provide comparable results to standard PRO measures, and provides evidence in support of the validity of this individualized measure in PD.</p>","PeriodicalId":19124,"journal":{"name":"Neurology Research International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2020-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/6916135","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37837526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-20eCollection Date: 2020-01-01DOI: 10.1155/2020/3929438
Bolanle M Famakin, Orest Tsymbalyuk, Natalia Tsymbalyuk, Svetlana Ivanova, Seung Kyoon Woo, Min Seong Kwon, Volodymyr Gerzanich, J Marc Simard
Limited, and underutilized, therapeutic options for acute stroke require new approaches to treatment. One such potential approach involves better understanding of innate immune response to brain injury such as acute focal cerebral ischemia. This includes understanding the temporal profile, and specificity, of Toll-like receptor 4 (TLR4) signaling in brain cell types, such as astrocytes, following focal cerebral ischemia. This study evaluated TLR4 signaling, and downstream mediators, in astrocytes, during acute and chronic phases post transient middle cerebral artery occlusion (MCAO). We also determined whether high mobility group box 1 (HMGB1), an endogenous TLR4 ligand, was sufficient to induce TLR4 signaling activation in astrocytes in vivo and in vitro. We injected HMGB1 into normal cortex, in vivo, and stimulated cultured astrocytes with HMGB1, in vitro, and determined TLR4, and downstream mediator, expression by immunohistochemistry. We found that expression of TLR4, and downstream mediators, such as inducible nitric oxide synthase (iNOS), occurs in penumbral astrocytes in acute and chronic phases after focal cerebral ischemia, but was undetectable in cortical astrocytes in the contralateral hemisphere. In addition, cortical injection of recombinant HMGB1 led to a trend towards an almost 2-fold increase in TLR4 expression in astrocytes surrounding the injection site. Consistent with these results, in vitro stimulation of the DI TNC1 astrocyte cell line, with recombinant HMGB1, led to increased TLR4 and iNOS message levels. These findings suggest that HMGB1, an endogenous TLR4 ligand, is an important physiological ligand for TLR4 signaling activation, in penumbral astrocytes, following acute and chronic ischemia and HMGB1 amplifies TLR4 signaling in astrocytes.
有限的和未充分利用的急性中风治疗方案需要新的治疗方法。其中一种潜在的方法是更好地理解对脑损伤(如急性局灶性脑缺血)的先天免疫反应。这包括了解局灶性脑缺血后脑细胞类型(如星形胶质细胞)中toll样受体4 (TLR4)信号的时间分布和特异性。本研究评估了短暂性大脑中动脉闭塞(MCAO)后急性期和慢性期星形胶质细胞中的TLR4信号及其下游介质。我们还确定了内源性TLR4配体HMGB1 (high mobility group box 1)是否足以在体内和体外诱导星形胶质细胞中TLR4信号激活。我们在体内将HMGB1注射到正常皮层,并在体外用HMGB1刺激培养的星形胶质细胞,并通过免疫组织化学检测TLR4及其下游介质的表达。我们发现TLR4及其下游介质,如诱导型一氧化氮合酶(iNOS),在局灶性脑缺血后的急性和慢性期在半暗区星形胶质细胞中表达,但在对侧半球皮质星形胶质细胞中未检测到。此外,皮质注射重组HMGB1导致注射部位周围星形胶质细胞中TLR4表达增加近2倍。与这些结果一致的是,用重组HMGB1体外刺激DI TNC1星形胶质细胞细胞系,导致TLR4和iNOS信息水平升高。上述结果提示,内源性TLR4配体HMGB1是半暗部星形胶质细胞急性和慢性缺血后TLR4信号激活的重要生理配体,HMGB1可放大星形胶质细胞中的TLR4信号。
{"title":"HMGB1 is a Potential Mediator of Astrocytic TLR4 Signaling Activation following Acute and Chronic Focal Cerebral Ischemia.","authors":"Bolanle M Famakin, Orest Tsymbalyuk, Natalia Tsymbalyuk, Svetlana Ivanova, Seung Kyoon Woo, Min Seong Kwon, Volodymyr Gerzanich, J Marc Simard","doi":"10.1155/2020/3929438","DOIUrl":"https://doi.org/10.1155/2020/3929438","url":null,"abstract":"<p><p>Limited, and underutilized, therapeutic options for acute stroke require new approaches to treatment. One such potential approach involves better understanding of innate immune response to brain injury such as acute focal cerebral ischemia. This includes understanding the temporal profile, and specificity, of Toll-like receptor 4 (TLR4) signaling in brain cell types, such as astrocytes, following focal cerebral ischemia. This study evaluated TLR4 signaling, and downstream mediators, in astrocytes, during acute and chronic phases post transient middle cerebral artery occlusion (MCAO). We also determined whether high mobility group box 1 (HMGB1), an endogenous TLR4 ligand, was sufficient to induce TLR4 signaling activation in astrocytes <i>in vivo and in vitro.</i> We injected HMGB1 into normal cortex, <i>in vivo,</i> and stimulated cultured astrocytes with HMGB1, <i>in vitro,</i> and determined TLR4, and downstream mediator, expression by immunohistochemistry. We found that expression of TLR4, and downstream mediators, such as inducible nitric oxide synthase (iNOS), occurs in penumbral astrocytes in acute and chronic phases after focal cerebral ischemia, but was undetectable in cortical astrocytes in the contralateral hemisphere. In addition, cortical injection of recombinant HMGB1 led to a trend towards an almost 2-fold increase in TLR4 expression in astrocytes surrounding the injection site. Consistent with these results, <i>in vitro</i> stimulation of the DI TNC1 astrocyte cell line, with recombinant HMGB1, led to increased TLR4 and iNOS message levels. These findings suggest that HMGB1, an endogenous TLR4 ligand, is an important physiological ligand for TLR4 signaling activation, in penumbral astrocytes, following acute and chronic ischemia and HMGB1 amplifies TLR4 signaling in astrocytes.</p>","PeriodicalId":19124,"journal":{"name":"Neurology Research International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2020-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/3929438","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37717978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-14eCollection Date: 2020-01-01DOI: 10.1155/2020/7906547
Carmen M Tyler, Richard S Henry, Paul B Perrin, Jack Watson, Teresita Villaseñor, Sarah K Lageman, Erin R Smith, Genoveva Rizo Curiel, Judith Avila, Miriam E Jimenez Maldonado, Jose A Soto-Escageda
Only scant literature has focused on social support in Parkinson's disease (PD) caregivers, and no studies to date have examined resilience in this population, despite both variables having been shown to be important in other caregiving populations. As a result, the purpose of the current study was to construct and validate a theoretical structural equation model whereby social support is associated with higher levels of resilience in PD caregivers and increased resilience is related to decreased mental health symptoms. Two hundred fifty three PD caregivers from two clinics in the United States and Mexico completed self-report measures of these constructs. Results suggested that the hypothesized pattern was robustly supported with the structural equation model showing generally good fit indices. Higher levels of social support were associated with increased resilience, which in turn was associated with reduced mental health symptoms. Resilience partially mediated social support's effect on mitigating mental health symptoms. The model explained 11% of the variance in resilience and 35% in mental health symptoms. These findings have implications for future research on the development and tailoring of interventions to improve social support, resilience, and mental health in PD caregivers.
{"title":"Structural Equation Modeling of Parkinson's Caregiver Social Support, Resilience, and Mental Health: A Strength-Based Perspective.","authors":"Carmen M Tyler, Richard S Henry, Paul B Perrin, Jack Watson, Teresita Villaseñor, Sarah K Lageman, Erin R Smith, Genoveva Rizo Curiel, Judith Avila, Miriam E Jimenez Maldonado, Jose A Soto-Escageda","doi":"10.1155/2020/7906547","DOIUrl":"10.1155/2020/7906547","url":null,"abstract":"<p><p>Only scant literature has focused on social support in Parkinson's disease (PD) caregivers, and no studies to date have examined resilience in this population, despite both variables having been shown to be important in other caregiving populations. As a result, the purpose of the current study was to construct and validate a theoretical structural equation model whereby social support is associated with higher levels of resilience in PD caregivers and increased resilience is related to decreased mental health symptoms. Two hundred fifty three PD caregivers from two clinics in the United States and Mexico completed self-report measures of these constructs. Results suggested that the hypothesized pattern was robustly supported with the structural equation model showing generally good fit indices. Higher levels of social support were associated with increased resilience, which in turn was associated with reduced mental health symptoms. Resilience partially mediated social support's effect on mitigating mental health symptoms. The model explained 11% of the variance in resilience and 35% in mental health symptoms. These findings have implications for future research on the development and tailoring of interventions to improve social support, resilience, and mental health in PD caregivers.</p>","PeriodicalId":19124,"journal":{"name":"Neurology Research International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2020-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7042552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37687708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-29eCollection Date: 2020-01-01DOI: 10.1155/2020/5621461
Olivier Mukuku, Pascal Nawej, Marcellin Bugeme, Frank Nduu, Paul Makan Mawaw, Oscar Numbi Luboya
Background: Epilepsy is one of the most common neurological conditions, but the majority of epilepsy patients in sub-Saharan countries do not receive appropriate treatment. In the Democratic Republic of Congo (DRC), particularly in Lubumbashi, very few epidemiological studies on epilepsy have emerged. This study aims to analyze demographic characteristics, semiology of epileptic seizures, and their etiologies in patients followed in hospital.
Methods: This is a prospective descriptive study that enrolled 177 epileptic patients who performed a neurological consultation at the Centre Médical du Centre Ville (CMDC) in Lubumbashi (DRC) from January 1, 2016, to December 31, 2017.
Results: The mean age of the patients was 20.0 years (range: 5 months and 86 years). The male sex was predominant (57.1%). The mean age at the seizure onset was 13.1 years, and the mean duration between onset of seizures and consultation was 83.5 months. The family history of epilepsy was present in 27.7%. Generalized tonic-clonic seizures were the most frequent (58.2%), followed by atonic generalized seizures (9.6%) and focal clonic seizures (8.5%). The etiology was found in 68 (38.4%) patients and was dominated by neurocysticercosis (26.5%), meningitis (25%), perinatal pathologies (20.6%), and head injury (20.6%).
Conclusion: This study is a useful starting point from which health programs and health professionals can work to improve the diagnosis and quality of epilepsy management in our community.
{"title":"Epidemiology of Epilepsy in Lubumbashi, Democratic Republic of Congo.","authors":"Olivier Mukuku, Pascal Nawej, Marcellin Bugeme, Frank Nduu, Paul Makan Mawaw, Oscar Numbi Luboya","doi":"10.1155/2020/5621461","DOIUrl":"https://doi.org/10.1155/2020/5621461","url":null,"abstract":"<p><strong>Background: </strong>Epilepsy is one of the most common neurological conditions, but the majority of epilepsy patients in sub-Saharan countries do not receive appropriate treatment. In the Democratic Republic of Congo (DRC), particularly in Lubumbashi, very few epidemiological studies on epilepsy have emerged. This study aims to analyze demographic characteristics, semiology of epileptic seizures, and their etiologies in patients followed in hospital.</p><p><strong>Methods: </strong>This is a prospective descriptive study that enrolled 177 epileptic patients who performed a neurological consultation at the Centre Médical du Centre Ville (CMDC) in Lubumbashi (DRC) from January 1, 2016, to December 31, 2017.</p><p><strong>Results: </strong>The mean age of the patients was 20.0 years (range: 5 months and 86 years). The male sex was predominant (57.1%). The mean age at the seizure onset was 13.1 years, and the mean duration between onset of seizures and consultation was 83.5 months. The family history of epilepsy was present in 27.7%. Generalized tonic-clonic seizures were the most frequent (58.2%), followed by atonic generalized seizures (9.6%) and focal clonic seizures (8.5%). The etiology was found in 68 (38.4%) patients and was dominated by neurocysticercosis (26.5%), meningitis (25%), perinatal pathologies (20.6%), and head injury (20.6%).</p><p><strong>Conclusion: </strong>This study is a useful starting point from which health programs and health professionals can work to improve the diagnosis and quality of epilepsy management in our community.</p>","PeriodicalId":19124,"journal":{"name":"Neurology Research International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2020-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/5621461","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37939679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-07eCollection Date: 2019-01-01DOI: 10.1155/2019/7397491
David Czell, Christoph Neuwirth, Markus Weber, Sabine Sartoretti-Schefer, Andreas Gutzeit, Carolin Reischauer
Objective: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with involvement of the upper and lower motor neurons. Since the loss of fine motor skills is one of the earliest signs of ALS, the hypothesis was tested if the nine hole PEG test (NHPT) and transcranial magnet stimulation (TMS) with resting-motor threshold (RMT) could be useful in monitoring disease progression.
Methods: We examined 28 ALS patients and 27 age-matched healthy controls. ALS patients and healthy controls underwent the nine hole peg test (NHPT) and TMS with RMT. Measurements in patients were repeated after three and six months.
Results: At baseline, the median NHPT durations were 1,4-fold longer (p < 0.001), and TMS scores showed a significant 0.8-fold smaller score in ALS patients compared with healthy controls (p < 0.001). The comparison of three and six months versus baseline revealed significant differences for NHPT durations and ALSFRS-R in patients, whereas TMS scores did not significantly differ in the patients.
Conclusion: NHPT seems to be a good tool to evaluate dexterity of the hand and the progression of the disease in ALS patients. TMS RMT to the hand muscles seems to be poorly qualified to evaluate the dexterity of the hand function and the course of the disease.
{"title":"Nine Hole Peg Test and Transcranial Magnetic Stimulation: Useful to Evaluate Dexterity of the Hand and Disease Progression in Amyotrophic Lateral Sclerosis.","authors":"David Czell, Christoph Neuwirth, Markus Weber, Sabine Sartoretti-Schefer, Andreas Gutzeit, Carolin Reischauer","doi":"10.1155/2019/7397491","DOIUrl":"https://doi.org/10.1155/2019/7397491","url":null,"abstract":"<p><strong>Objective: </strong>Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with involvement of the upper and lower motor neurons. Since the loss of fine motor skills is one of the earliest signs of ALS, the hypothesis was tested if the nine hole PEG test (NHPT) and transcranial magnet stimulation (TMS) with resting-motor threshold (RMT) could be useful in monitoring disease progression.</p><p><strong>Methods: </strong>We examined 28 ALS patients and 27 age-matched healthy controls. ALS patients and healthy controls underwent the nine hole peg test (NHPT) and TMS with RMT. Measurements in patients were repeated after three and six months.</p><p><strong>Results: </strong>At baseline, the median NHPT durations were 1,4-fold longer (<i>p</i> < 0.001), and TMS scores showed a significant 0.8-fold smaller score in ALS patients compared with healthy controls (<i>p</i> < 0.001). The comparison of three and six months versus baseline revealed significant differences for NHPT durations and ALSFRS-R in patients, whereas TMS scores did not significantly differ in the patients.</p><p><strong>Conclusion: </strong>NHPT seems to be a good tool to evaluate dexterity of the hand and the progression of the disease in ALS patients. TMS RMT to the hand muscles seems to be poorly qualified to evaluate the dexterity of the hand function and the course of the disease.</p>","PeriodicalId":19124,"journal":{"name":"Neurology Research International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2019-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/7397491","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37449394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. G. Mugendi, M. Kubo, D. Nyamu, L. Mwaniki, S. Wahome, J. Haberer
Background HIV-associated neurocognitive disorders (HAND) represent a spectrum of cognitive abnormalities affecting attention, concentration, learning, memory, executive function, psychomotor speed, and/or dexterity. Our objectives in this analysis are to determine the prevalence of HAND and the covariates in a Kenyan population. Methods We conducted a cross-sectional study in a convenient sample of people living with HIV on antiretroviral therapy (ART) attending routine care visits at the Kenyatta National Hospital HIV clinic between July and August 2015. Baseline demographics were obtained using interviewer-administered questionnaires; clinical data were abstracted from patient records. Trained research clinicians determined the neurocognitive status by administration of the International HIV Dementia Scale (IHDS), the Montreal Cognitive Assessment (MOCA) scale, and the Lawton Instrumental Activities of Daily Living (IADL) scale. Cognitive impairment was defined as a score of ≤26 on the MOCA and ≤10 on the IHDS. Descriptive analysis and logistic regression to determine predictors of screening positive for HAND were done with the significance value set at <0.05. Results We enrolled 345 participants (202 men; 143 women). The mean age of the study population was 42 years (±standard deviation (SD) 9.5). Mean duration since HIV diagnosis and mean duration on ART were 6.3 (±SD 3.7) and 5.6 years (±SD 3.4), respectively. Median CD4 count at interview was 446 cells/mm3 (interquartile range (IQR) 278–596). Eighty-eight percent of participants screened positive for HAND, of whom 87% had asymptomatic neurocognitive impairment (ANI) and minor neurocognitive disorders (MND) grouped together while 1% had HIV-associated dementia (HAD). Patients on AZT/3TC/EFV were 3.7 times more likely to have HAND (OR = 3.7, p=0.03) compared to other HAART regimens. In the adjusted analysis, women were more likely to suffer any form of HAND than men (aOR = 2.17, 95% CI: 1.02, 4.71; p=0.045), whereas more years in school and a higher CD4 count (aOR = 0.58, 95% CI: 0.38, 0.88; p=0.012), (aOR = 0.998, 95% CI 0.997, 0.999; p=0.013) conferred a lowered risk. Conclusion Asymptomatic and mild neurocognitive impairment is prevalent among people living with HIV on treatment. Clinical care for HIV-positive patients should involve regular screening for neurocognitive disorders while prioritizing women and those with low education and/or low CD4 counts.
{"title":"Prevalence and Correlates of Neurocognitive Disorders among HIV Patients on Antiretroviral Therapy at a Kenyan Hospital","authors":"A. G. Mugendi, M. Kubo, D. Nyamu, L. Mwaniki, S. Wahome, J. Haberer","doi":"10.1155/2019/5173289","DOIUrl":"https://doi.org/10.1155/2019/5173289","url":null,"abstract":"Background HIV-associated neurocognitive disorders (HAND) represent a spectrum of cognitive abnormalities affecting attention, concentration, learning, memory, executive function, psychomotor speed, and/or dexterity. Our objectives in this analysis are to determine the prevalence of HAND and the covariates in a Kenyan population. Methods We conducted a cross-sectional study in a convenient sample of people living with HIV on antiretroviral therapy (ART) attending routine care visits at the Kenyatta National Hospital HIV clinic between July and August 2015. Baseline demographics were obtained using interviewer-administered questionnaires; clinical data were abstracted from patient records. Trained research clinicians determined the neurocognitive status by administration of the International HIV Dementia Scale (IHDS), the Montreal Cognitive Assessment (MOCA) scale, and the Lawton Instrumental Activities of Daily Living (IADL) scale. Cognitive impairment was defined as a score of ≤26 on the MOCA and ≤10 on the IHDS. Descriptive analysis and logistic regression to determine predictors of screening positive for HAND were done with the significance value set at <0.05. Results We enrolled 345 participants (202 men; 143 women). The mean age of the study population was 42 years (±standard deviation (SD) 9.5). Mean duration since HIV diagnosis and mean duration on ART were 6.3 (±SD 3.7) and 5.6 years (±SD 3.4), respectively. Median CD4 count at interview was 446 cells/mm3 (interquartile range (IQR) 278–596). Eighty-eight percent of participants screened positive for HAND, of whom 87% had asymptomatic neurocognitive impairment (ANI) and minor neurocognitive disorders (MND) grouped together while 1% had HIV-associated dementia (HAD). Patients on AZT/3TC/EFV were 3.7 times more likely to have HAND (OR = 3.7, p=0.03) compared to other HAART regimens. In the adjusted analysis, women were more likely to suffer any form of HAND than men (aOR = 2.17, 95% CI: 1.02, 4.71; p=0.045), whereas more years in school and a higher CD4 count (aOR = 0.58, 95% CI: 0.38, 0.88; p=0.012), (aOR = 0.998, 95% CI 0.997, 0.999; p=0.013) conferred a lowered risk. Conclusion Asymptomatic and mild neurocognitive impairment is prevalent among people living with HIV on treatment. Clinical care for HIV-positive patients should involve regular screening for neurocognitive disorders while prioritizing women and those with low education and/or low CD4 counts.","PeriodicalId":19124,"journal":{"name":"Neurology Research International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2019-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84884080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective While administration of intravenous tissue plasminogen activator (IV-tPA) is the standard of care in acute ischemic stroke and has been shown to have statistically significant benefit, there can also be potentially life-threatening complications; however, there is no standard informed consent approach. The purpose of this study was to present a parental, technical, and general model of informed consent for IV-TPA and to determine which approach was preferred. Methods Survey respondents were asked to hypothetically decide whether or not to provide consent for their family member to receive IV-tPA. Respondents were presented with 3 informed consent models: one emphasizing parental qualities, one emphasizing statistical data, and one representing a general consent statement. After being presented each model, the respondents had to select their preferred consent model, as well as rate their level of agreeability toward their family member receiving the medication following each approach. Results The results of 184 surveys showed respondents were equally as likely to give consent for their family member to receive IV-TPA following all three approaches; however, respondents were significantly more likely to prefer the parental approach compared to a technical or general approach. Conclusion Our results indicate that while paternalism is generally discouraged in the medical community, some degree of parental language may be preferred by patients in tough decision-making situations toward consent to receive medical interventions.
{"title":"Utilization of a Parental Approach to Informed Consent in Intravenous Tissue Plasminogen Activator Administration Decision-Making: Patient Preference and Ethical Considerations","authors":"Ann M Murray, A. Petrone, Amelia K. Adcock","doi":"10.1155/2019/9240603","DOIUrl":"https://doi.org/10.1155/2019/9240603","url":null,"abstract":"Objective While administration of intravenous tissue plasminogen activator (IV-tPA) is the standard of care in acute ischemic stroke and has been shown to have statistically significant benefit, there can also be potentially life-threatening complications; however, there is no standard informed consent approach. The purpose of this study was to present a parental, technical, and general model of informed consent for IV-TPA and to determine which approach was preferred. Methods Survey respondents were asked to hypothetically decide whether or not to provide consent for their family member to receive IV-tPA. Respondents were presented with 3 informed consent models: one emphasizing parental qualities, one emphasizing statistical data, and one representing a general consent statement. After being presented each model, the respondents had to select their preferred consent model, as well as rate their level of agreeability toward their family member receiving the medication following each approach. Results The results of 184 surveys showed respondents were equally as likely to give consent for their family member to receive IV-TPA following all three approaches; however, respondents were significantly more likely to prefer the parental approach compared to a technical or general approach. Conclusion Our results indicate that while paternalism is generally discouraged in the medical community, some degree of parental language may be preferred by patients in tough decision-making situations toward consent to receive medical interventions.","PeriodicalId":19124,"journal":{"name":"Neurology Research International","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2019-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83119832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}