‘Severe’ Traumatic Brain Injury (TBI) survivors are likely to be hospitalised and experience Post Traumatic Amnesia (PTA): a transient state of confusion, disorientation and memory loss, until the return of continuous memory. Survivors often experience distressing ‘islands’ of memory during PTA, and this can exacerbate psychological deterioration and lead to additional poor outcomes if left untreated. The literature for neuropsychological rehabilitation is well established in the multidisciplinary delivery of services for severe TBI, but the alleviation of post-traumatic distress caused during PTA has received little attention to date. This case report demonstrates how Eye Movement Desensitisation Reprocessing (EMDR) therapy might provide psychological improvement in clients who sustain severe TBI with distressing ‘islands’ of memory during PTA and provides a 4 year follow up to measure sustained benefits.
{"title":"Treating distressing islands of memory: severe TBI and EMDR treatment for distressing experiences during post traumatic amnesia","authors":"Phil S. Moore","doi":"10.47795/uttr3399","DOIUrl":"https://doi.org/10.47795/uttr3399","url":null,"abstract":"‘Severe’ Traumatic Brain Injury (TBI) survivors are likely to be hospitalised and experience Post Traumatic Amnesia (PTA): a transient state of confusion, disorientation and memory loss, until the return of continuous memory. Survivors often experience distressing ‘islands’ of memory during PTA, and this can exacerbate psychological deterioration and lead to additional poor outcomes if left untreated. The literature for neuropsychological rehabilitation is well established in the multidisciplinary delivery of services for severe TBI, but the alleviation of post-traumatic distress caused during PTA has received little attention to date. This case report demonstrates how Eye Movement Desensitisation Reprocessing (EMDR) therapy might provide psychological improvement in clients who sustain severe TBI with distressing ‘islands’ of memory during PTA and provides a 4 year follow up to measure sustained benefits.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"314 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72985214","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}
The National Hospital for Neurology and Neurosurgery (NHNN) hosts a specialist centre for people living with Progressive Ataxias. Patients attend from across the UK for differential diagnosis, specialist opinion, expert assessment and exploration of treatment options. This article discusses the treatment and management considerations of the multi-disciplinary team in the context of a condition with a huge variety of symptoms and limited evidence base for clinically effective treatment. It highlights the importance of tailored treatment focused on symptom management and optimising participation. It also discusses service initiatives that enabled patients continued access to treatment during the COVID-19 pandemic. These initiatives were proven to be very successful and therefore continue to run today.
{"title":"Multidisciplinary Management of Progressive Ataxia","authors":"R. Kimber, Genny Hart, E. Ladyman, J. Richmond","doi":"10.47795/vgop7444","DOIUrl":"https://doi.org/10.47795/vgop7444","url":null,"abstract":"The National Hospital for Neurology and Neurosurgery (NHNN) hosts a specialist centre for people living with Progressive Ataxias. Patients attend from across the UK for differential diagnosis, specialist opinion, expert assessment and exploration of treatment options. This article discusses the treatment and management considerations of the multi-disciplinary team in the context of a condition with a huge variety of symptoms and limited evidence base for clinically effective treatment. It highlights the importance of tailored treatment focused on symptom management and optimising participation. It also discusses service initiatives that enabled patients continued access to treatment during the COVID-19 pandemic. These initiatives were proven to be very successful and therefore continue to run today.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86042115","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}
Professor C. David Marsden (1938-1998) made major advances in the understanding of movement disorders during his illustrious career prior to his untimely death 25 years ago. In addition to this body of work, he also made contributions to the understanding of cognitive functions in these disorders, necessarily so in view of the neuropsychological overlap of cognition and movement. This article briefly summarises Professor Marsden’s clinical contributions to cognitive neurology, some of which still inform clinical practice today.
C. David Marsden教授(1938-1998)在25年前英年早逝之前，在他杰出的职业生涯中对运动障碍的理解取得了重大进展。除了这些工作之外，他还对这些疾病的认知功能的理解做出了贡献，鉴于认知和运动的神经心理学重叠，这是必要的。本文简要总结了马斯登教授对认知神经学的临床贡献，其中一些至今仍为临床实践提供信息。
{"title":"David Marsden (1938-1998): contributions to cognitive neurology","authors":"A. Larner","doi":"10.47795/mebn5761","DOIUrl":"https://doi.org/10.47795/mebn5761","url":null,"abstract":"Professor C. David Marsden (1938-1998) made major advances in the understanding of movement disorders during his illustrious career prior to his untimely death 25 years ago. In addition to this body of work, he also made contributions to the understanding of cognitive functions in these disorders, necessarily so in view of the neuropsychological overlap of cognition and movement. This article briefly summarises Professor Marsden’s clinical contributions to cognitive neurology, some of which still inform clinical practice today.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"87 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83430176","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}
The blood–brain barrier (BBB) regulates the transport of molecules between the central nervous system (CNS) and blood. It consists of two components: the vascular endothelial cells forming so–called tight junctions, and the blood–cerebrospinal fluid barrier. It plays an important role in the pathogenesis and in recovery from many cerebrospinal disorders. Paul Ehrlich was the first to observe in mice that intravenously injected acidic dyes stained the tissues of the body but not the brain. He deduced there was a barrier between systemic blood and nervous tissues. His pupil Lewandowsky visualised a capillary wall that blocked the entrance of certain molecules. And, Edwin Goldman injected trypan blue into the CSF and observed that the brain but no peripheral organs was stained — indicating the dye could not cross from CSF to the systemic bloodstream, but could leave the blood vessels of the choroid plexuses within the ventricles to enter the brain tissues. Experiments of the heroic Russian Lina Solomonova Stern (Shtern), persecuted by Stalin, formulated the rule that every substance contained in the blood must penetrate the cerebrospinal fluid before it can exercise its effects on the nerve elements; she named the blood–brain barrier: barrière hémato–encéphalique.
{"title":"The blood brain barrier and Lina Solomonovna Stern (Shtern)","authors":"J. Pearce","doi":"10.47795/evrj6805","DOIUrl":"https://doi.org/10.47795/evrj6805","url":null,"abstract":"The blood–brain barrier (BBB) regulates the transport of molecules between the central nervous system (CNS) and blood. It consists of two components: the vascular endothelial cells forming so–called tight junctions, and the blood–cerebrospinal fluid barrier. It plays an important role in the pathogenesis and in recovery from many cerebrospinal disorders. Paul Ehrlich was the first to observe in mice that intravenously injected acidic dyes stained the tissues of the body but not the brain. He deduced there was a barrier between systemic blood and nervous tissues. His pupil Lewandowsky visualised a capillary wall that blocked the entrance of certain molecules. And, Edwin Goldman injected trypan blue into the CSF and observed that the brain but no peripheral organs was stained — indicating the dye could not cross from CSF to the systemic bloodstream, but could leave the blood vessels of the choroid plexuses within the ventricles to enter the brain tissues. Experiments of the heroic Russian Lina Solomonova Stern (Shtern), persecuted by Stalin, formulated the rule that every substance contained in the blood must penetrate the cerebrospinal fluid before it can exercise its effects on the nerve elements; she named the blood–brain barrier: barrière hémato–encéphalique.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78428520","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}
Functional tics form a part, albeit a small proportion, of the wider spectrum of functional neurological disorders (FND). In this review, we focus on the recent increase in presentations of functional tics since the COVID-19 pandemic. A functional tic disorder is often characterised by rapid onset of complex motor and vocal tics predominantly in adolescent females, distinct from Tourette’s syndrome which typically begins in younger boys. Rapid onset of severe tics merging into other types of functional neurological disorders, marked coprolalia, self-injury from tics and school absenteeism, are additional features of functional tics, however, the disorders can co-exist. There has been a lot of focus on social media as an explanation for the rise in cases, although the data suggest that this is just one of many potential factors, with the pandemic itself and its effect on teenage lives being the most likely culprit.
{"title":"Functional tics, the pandemic and social media","authors":"N. Ramsay, Vicky Marshall, J. Stone","doi":"10.47795/vhrl6262","DOIUrl":"https://doi.org/10.47795/vhrl6262","url":null,"abstract":"Functional tics form a part, albeit a small proportion, of the wider spectrum of functional neurological disorders (FND). In this review, we focus on the recent increase in presentations of functional tics since the COVID-19 pandemic. A functional tic disorder is often characterised by rapid onset of complex motor and vocal tics predominantly in adolescent females, distinct from Tourette’s syndrome which typically begins in younger boys. Rapid onset of severe tics merging into other types of functional neurological disorders, marked coprolalia, self-injury from tics and school absenteeism, are additional features of functional tics, however, the disorders can co-exist. There has been a lot of focus on social media as an explanation for the rise in cases, although the data suggest that this is just one of many potential factors, with the pandemic itself and its effect on teenage lives being the most likely culprit.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"215 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86334208","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}
We describe an unusual case of stroke manifesting as alien hand syndrome (AHS) causing sudden onset of abnormal hand movements. The patient reported his left arm would move outside his control and grab things in his surroundings without his conscious will. He felt his arm did not belong to him. Examination showed left arm brisk reflexes, astereognosis, and agraphesthesia in the left hand. Imaging revealed an established right parietal lobe ischaemic stroke. Lesions of the parietal cortex can cause AHS by disrupting the interpretation of somatosensory feedback when a movement is made and decreasing the ability to consciously monitor motor intentions. A low threshold should be adopted for arranging brain imaging and a thorough neurological examination is needed in any sudden onset movement disorder.
{"title":"Dominant Parietal Lobe Ischaemic Stroke Presenting as Alien Hand Syndrome","authors":"Tamara Al Bahri, S. Bell, A. Majid, J. Janbieh","doi":"10.47795/dcyq4219","DOIUrl":"https://doi.org/10.47795/dcyq4219","url":null,"abstract":"We describe an unusual case of stroke manifesting as alien hand syndrome (AHS) causing sudden onset of abnormal hand movements. The patient reported his left arm would move outside his control and grab things in his surroundings without his conscious will. He felt his arm did not belong to him. Examination showed left arm brisk reflexes, astereognosis, and agraphesthesia in the left hand. Imaging revealed an established right parietal lobe ischaemic stroke. Lesions of the parietal cortex can cause AHS by disrupting the interpretation of somatosensory feedback when a movement is made and decreasing the ability to consciously monitor motor intentions. A low threshold should be adopted for arranging brain imaging and a thorough neurological examination is needed in any sudden onset movement disorder.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73831766","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}
Dystonia is a hyperkinetic movement disorder (HMD), characterised by sustained or intermittent involuntary muscle contractions resulting in abnormal postures and/or movements [1]. Although primary dystonia has an estimated prevalence of 16 per 100,000 [2], the diagnosis may be delayed, due to its clinical heterogeneity, the lack of objective biomarkers and the potential for pseudodystonic conditions to mimic it [1,3]. We provide an overview of the classification and common subtypes of focal dystonia, focusing on the clinical phenomenology and diagnosis.
{"title":"A Clinical Approach to Focal Dystonias","authors":"Sacha E Gandhi, David G. Anderson, E. Newman","doi":"10.47795/ufdf2068","DOIUrl":"https://doi.org/10.47795/ufdf2068","url":null,"abstract":"Dystonia is a hyperkinetic movement disorder (HMD), characterised by sustained or intermittent involuntary muscle contractions resulting in abnormal postures and/or movements [1]. Although primary dystonia has an estimated prevalence of 16 per 100,000 [2], the diagnosis may be delayed, due to its clinical heterogeneity, the lack of objective biomarkers and the potential for pseudodystonic conditions to mimic it [1,3]. We provide an overview of the classification and common subtypes of focal dystonia, focusing on the clinical phenomenology and diagnosis.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"52 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72407101","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}
Pub Date : 2022-08-15DOI: 10.20944/preprints202206.0325.v2
M. Sivan, Joanna Corrado, C. Mathias
Autonomic dysfunction is an increasingly recognised complication in chronic neurological conditions such as Parkinson’s disease, and other medical conditions, including diabetes mellitus, chronic fatigue syndrome, postural tachycardia syndrome (PoTS) with and without Ehlers-Danlos syndrome, fibromyalgia and recently Long COVID. Despite laboratory-based tests to evaluate normal and abnormal autonomic function, there are no home-based tests to record neuro-cardiovascular autonomic responses to common stimuli in daily life that are dependent on normal functioning of the autonomic nervous system. We have developed an adapted blood pressure/heart rate Autonomic Profile (aAP) that can be used by an individual independently and repeatedly in a domiciliary setting to determine the physiological and symptomatic response to standing, food, and physical or mental (cognitive, emotional) activities. The aAP aids separating autonomic failure (often irreversible) from autonomic dysfunction. This helps the individual and attending healthcare professional understand the relationship between symptoms and common triggers in daily life and informs on self-management in debilitating conditions such as the postural tachycardia syndrome (PoTS) and Long Covid.
{"title":"The adapted Autonomic Profile (aAP) home-based test for the evaluation of neuro-cardiovascular autonomic dysfunction","authors":"M. Sivan, Joanna Corrado, C. Mathias","doi":"10.20944/preprints202206.0325.v2","DOIUrl":"https://doi.org/10.20944/preprints202206.0325.v2","url":null,"abstract":"Autonomic dysfunction is an increasingly recognised complication in chronic neurological conditions such as Parkinson’s disease, and other medical conditions, including diabetes mellitus, chronic fatigue syndrome, postural tachycardia syndrome (PoTS) with and without Ehlers-Danlos syndrome, fibromyalgia and recently Long COVID. Despite laboratory-based tests to evaluate normal and abnormal autonomic function, there are no home-based tests to record neuro-cardiovascular autonomic responses to common stimuli in daily life that are dependent on normal functioning of the autonomic nervous system. We have developed an adapted blood pressure/heart rate Autonomic Profile (aAP) that can be used by an individual independently and repeatedly in a domiciliary setting to determine the physiological and symptomatic response to standing, food, and physical or mental (cognitive, emotional) activities. The aAP aids separating autonomic failure (often irreversible) from autonomic dysfunction. This helps the individual and attending healthcare professional understand the relationship between symptoms and common triggers in daily life and informs on self-management in debilitating conditions such as the postural tachycardia syndrome (PoTS) and Long Covid.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"104 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79223557","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}
The active vitamin D hormone, 1,25-dihydroxyvitamin D3, is well established to inhibit cellular proliferation and induce differentiation in several cell types of the central nervous system. Indeed, a myriad of studies demonstrate the important role 1,25-dihydroxyvitamin D3 plays in maintaining a healthy brain and nervous system. This mini review will briefly summarise in vitro, in vivo, and epidemiological evidence related to the anti-proliferative and anti-cancer activities of vitamin D in hyperproliferative disorders like brain cancer. Here, we focus on the clinical application of 1,25-dihydroxyvitamin D3 and vitamin D analogues (synthetic vitamin D-like compounds) in glioblastoma treatment and discuss their potential as efficacious and tolerable adjunct therapeutic agents for patients diagnosed with this aggressive form of brain tumour.
{"title":"Vitamin D: A Complementary Nutritional Therapy for Treatment of Glioblastoma?","authors":"Síle M. Griffin, Fiona Griffen","doi":"10.47795/kymf8006","DOIUrl":"https://doi.org/10.47795/kymf8006","url":null,"abstract":"The active vitamin D hormone, 1,25-dihydroxyvitamin D3, is well established to inhibit cellular proliferation and induce differentiation in several cell types of the central nervous system. Indeed, a myriad of studies demonstrate the important role 1,25-dihydroxyvitamin D3 plays in maintaining a healthy brain and nervous system. This mini review will briefly summarise in vitro, in vivo, and epidemiological evidence related to the anti-proliferative and anti-cancer activities of vitamin D in hyperproliferative disorders like brain cancer. Here, we focus on the clinical application of 1,25-dihydroxyvitamin D3 and vitamin D analogues (synthetic vitamin D-like compounds) in glioblastoma treatment and discuss their potential as efficacious and tolerable adjunct therapeutic agents for patients diagnosed with this aggressive form of brain tumour.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85099619","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}
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