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Multiple Sclerosis in Mongolia; the First Study Exploring Predictors of Disability and Depression in Mongolian MS Patients. PATHOPHYSIOLOGY 2023; 30:15-26. [PMID: 36810422 PMCID: PMC9944952 DOI: 10.3390/pathophysiology30010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
Mongolia is located at 45° north latitude in the center of the Asian continent, and about 80% of the territory is at 1000 m above sea level. Epidemiologically, multiple sclerosis (MS) has not been investigated in Mongolia, although there have been a few MS case reports. We investigated the characteristics of MS in Mongolia for the first time, focusing on the association between MS-related parameters and depression levels. We initiated cross-sectional analyses, using data from 27 MS patients aged 20 to 60 years in Ulaanbaatar, Mongolia. The patients completed a questionnaire on their lifestyles and clinical information. We classified the MS patients on the basis of disability levels using the expanded disability status scale (EDSS) scores: 11.1% mild disability and 88.9% moderate to severe disability (median EDSS score, 5.5). We also classified the patients on the basis of depression levels using the 9-item patient health questionnaire (PHQ-9) scores: 44.4% mild depression, 40.7% moderate depression, and 14.8% severe depression (mean PHQ-9's score, 9.96 ± 5.05). We used multivariate logistical regression analyses to identify predictors of EDSS or PHQ-9 scores. Disability levels were associated with vision and balance problems. Depression levels were associated with corticosteroid treatment; no patients were treated with disease-modifying drugs (DMDs). The odds ratios for disease onset age and treatment duration were associated with EDSS scores. In conclusion, MS onset age and treatment duration were independent predicting factors influencing the level of disability. Appropriate DMD treatment would lower the disability and depression levels.
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Shirota Y, Otsuka J, Toda T, Hamada M. Neurophysiological differentiation of upper motor neuron damage in neurodegenerative disorders. Clin Neurophysiol Pract 2022; 7:273-278. [PMID: 36263296 PMCID: PMC9574772 DOI: 10.1016/j.cnp.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/31/2022] [Accepted: 09/11/2022] [Indexed: 12/04/2022] Open
Abstract
ALS and MSA presented with similar profiles of upper motor neuron signs. Central motor conduction time was more abnormal in ALS than in MSA. Different structures may be involved in ALS and MSA along the corticospinal tract.
Objective Using transcranial magnetic stimulation (TMS) to delineate upper motor neuron (UMN) signs of two neurodegenerative disorders: amyotrophic lateral sclerosis (ALS) and multiple system atrophy (MSA). Methods Medical records including clinical signs for UMN damage and TMS results were reviewed retrospectively. The UMN signs were classified into none, mild, and severe based on neurological examination of various reflexes. Then TMS-elicited motor evoked potentials (MEPs) were recorded from a hand and a leg muscle to calculate the central motor conduction time (CMCT), which represents fast, mono-synaptic conduction along the corticospinal tract. Relations between the UMN signs and CMCT were analysed for the two diseases. Results Prevalence and severity of the UMN signs for ALS and MSA were comparable for both upper and lower limbs. However, abnormality in CMCT was found more frequently in ALS: CMCT abnormalities were found in upper limbs for 44% in ALS patients but only for 7% in MSA patients; CMCT abnormalities in lower limbs were 55% in ALS and 20% in MSA. Some ALS patients showed abnormal CMCT in limbs without UMN signs, which was not true for most MSA patients. Conclusions The abnormalities of CMCT were different in ALS and MSA, even for those who clinically had similar UMN signs. Sometimes, CMCT can reveal UMN damage in the absence of clinical UMN signs. Differences presumably derive from selective degeneration of different fibres in the motor descending pathways. Longitudinal studies must be conducted to accumulate neuroimaging and pathological findings. Significance CMCT can be useful to differentiate ALS and MSA.
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Teive HAG, Camargo CHF, Sommaruga N, Amorin-Costábile HI, Walusinski O. Would Francisco Soca have been the first to relate toe phenomenon as pyramidal disorders? J Clin Neurosci 2021; 91:172-175. [PMID: 34373023 DOI: 10.1016/j.jocn.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/06/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The Uruguayan physician Francisco Soca, who specialized in neurology in Jean-Martin Charcot's clinic, defended a thesis at the Paris Faculty of Medicine in 1888 on Friedreich's ataxia in eleven patients. In this work he described the presence of toe phenomenon. OBJECTIVE This historical note presents a toe sign described by the Soca eight years before Babiński's classic description. DISCUSSION In the late 1800s Soca completed a specialization in neurology at the service run by Charcot in Paris. He defended an important thesis in 1888 assessing data from 11 Friedreich's ataxia. In his thesis, Soca also described the toe phenomenon and the presence of structural changes in the feet of these patients that were not described in the Friedreich study published in 1863. CONCLUSION The Soca's thesis contained the description of toe extension associated with pyramidal tract lesions, eight years later described and further immortalized as Babiński's sign. Therefore, Soca had already publicized this sign as being representative of a pyramidal dysfunction before Babiński or any other neurologist.
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Affiliation(s)
- Hélio A G Teive
- Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil; Neurological Diseases Group, Internal Medicine Postgraduate Program, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil.
| | - Carlos Henrique F Camargo
- Neurological Diseases Group, Internal Medicine Postgraduate Program, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil.
| | - Nicolás Sommaruga
- Neurology Service, Neurology Institute, Hospital de Clínicas, School of Medicine, University of the Republic, Montevideo, Uruguay.
| | - Héctor Ignacio Amorin-Costábile
- Neurology Service, Neurology Institute, Hospital de Clínicas, School of Medicine, University of the Republic, Montevideo, Uruguay.
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Tu J, Vargas Castillo J, Das A, Diwan AD. Degenerative Cervical Myelopathy: Insights into Its Pathobiology and Molecular Mechanisms. J Clin Med 2021; 10:jcm10061214. [PMID: 33804008 PMCID: PMC8001572 DOI: 10.3390/jcm10061214] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 12/12/2022] Open
Abstract
Degenerative cervical myelopathy (DCM), earlier referred to as cervical spondylotic myelopathy (CSM), is the most common and serious neurological disorder in the elderly population caused by chronic progressive compression or irritation of the spinal cord in the neck. The clinical features of DCM include localised neck pain and functional impairment of motor function in the arms, fingers and hands. If left untreated, this can lead to significant and permanent nerve damage including paralysis and death. Despite recent advancements in understanding the DCM pathology, prognosis remains poor and little is known about the molecular mechanisms underlying its pathogenesis. Moreover, there is scant evidence for the best treatment suitable for DCM patients. Decompressive surgery remains the most effective long-term treatment for this pathology, although the decision of when to perform such a procedure remains challenging. Given the fact that the aged population in the world is continuously increasing, DCM is posing a formidable challenge that needs urgent attention. Here, in this comprehensive review, we discuss the current knowledge of DCM pathology, including epidemiology, diagnosis, natural history, pathophysiology, risk factors, molecular features and treatment options. In addition to describing different scoring and classification systems used by clinicians in diagnosing DCM, we also highlight how advanced imaging techniques are being used to study the disease process. Last but not the least, we discuss several molecular underpinnings of DCM aetiology, including the cells involved and the pathways and molecules that are hallmarks of this disease.
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Affiliation(s)
- Ji Tu
- Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW 2217, Australia; (J.T.); (A.D.D.)
| | | | - Abhirup Das
- Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW 2217, Australia; (J.T.); (A.D.D.)
- Spine Service, St. George Hospital, Kogarah, NSW 2217, Australia;
- Correspondence:
| | - Ashish D. Diwan
- Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW 2217, Australia; (J.T.); (A.D.D.)
- Spine Service, St. George Hospital, Kogarah, NSW 2217, Australia;
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Qu JF, Chen YK, Luo GP, Qiu DH, Liu YL, Zhong HH, Wu ZQ. Does the Babinski sign predict functional outcome in acute ischemic stroke? Brain Behav 2020; 10:e01575. [PMID: 32105418 PMCID: PMC7177556 DOI: 10.1002/brb3.1575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 02/01/2020] [Accepted: 02/05/2020] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The aim of this prospective cohort study was to determine the incidence and neuroimaging risk factors associated with Babinski sign following acute ischemic stroke, as well as its relationship with the functional outcome of patients. METHODS A total of 351 patients were enrolled in the study within 7 days of acute ischemic stroke. The Babinski sign along with other upper motor neuron signs were examined upon admission and between days 1 and 3 and days 5 and 7 after admission. Neuroimaging parameters included site and volume of infarction and white matter lesions. All patients were followed up at 3 months. Functional outcome was assessed with the Lawton Activities of Daily Living scale and modified Rankin Scale. RESULTS Babinski sign was observed in 115 of 351 (32.8%) patients in the acute ischemic stroke. These patients had higher National Institutes of Health Stroke Scale (NIHSS) scores at admission and higher rates of atrial fibrillation and cardioembolism; higher frequencies of frontal, temporal, and limbic lobes and basal ganglia infarcts; and larger infarct volume. Higher NIHSS score and basal ganglia infarct were significant predictors of the presence of Babinski sign. After adjusting for confounds, the presence of Babinski sign did not predict poor functional outcome. CONCLUSION The incidence of Babinski sign was 32.8% in the acute ischemic stroke. Severe infarction and basal ganglia infarct were independent predictors of Babinski sign. Although Babinski sign is common in acute ischemic stroke patients, it does not predict poor functional outcome 3 months later.
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Affiliation(s)
- Jian-Feng Qu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Yang-Kun Chen
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Gen-Pei Luo
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Dong-Hai Qiu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Yong-Lin Liu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Huo-Hua Zhong
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China.,Faculty of Neurology, Guangdong Medical University, Dongguan, China
| | - Zhi-Qiang Wu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
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Kiernan MC, Goadsby PJ, Burke D. Marco Polo of Australian neurology. J Neurol Neurosurg Psychiatry 2019; 90:627-628. [PMID: 31048340 DOI: 10.1136/jnnp-2019-320989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/11/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Matthew C Kiernan
- Department of Neurology, Royal Prince Alfred Hospital, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - David Burke
- Department of Neurology, Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia
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Maranhão-Filho P, Correa RB. Babinski's hand sign: many have tried…. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:716-719. [PMID: 30427513 DOI: 10.1590/0004-282x20180107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 07/11/2018] [Indexed: 11/21/2022]
Abstract
Recognizing the semiologic importance of the second, and most famous, sign described by Joseph Babinski - the extension of the hallux after stimulation of the plantar region in order to differentiate organic from pithiatic paralysis- several authors have tried to find a comparable signal in the hand. After 122 years, no one has succeeded.
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Affiliation(s)
- Péricles Maranhão-Filho
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Departamento de Clínica Médica, Serviço de Neurologia, Rio de Janeiro RJ, Brasil
| | - Rosalie Branco Correa
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Departamento de Clínica Médica, Serviço de Neurologia, Rio de Janeiro RJ, Brasil
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Affiliation(s)
- Matthew C Kiernan
- Bushell Professor of Neurology, Sydney Medical School, Sydney, New South Wales, Australia Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
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Broussolle E, Poirier J, Clarac F, Barbara JG. Figures and institutions of the neurological sciences in Paris from 1800 to 1950. Part III: Neurology. Rev Neurol (Paris) 2012; 168:301-20. [DOI: 10.1016/j.neurol.2011.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 09/26/2011] [Accepted: 10/02/2011] [Indexed: 10/28/2022]
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Maximum voluntary ventilation as a sensitive measure to monitor the ventilatory function in cervical spondylotic myelopathy. Spinal Cord 2012; 50:328-32. [PMID: 22231545 DOI: 10.1038/sc.2011.144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A prospective clinical cohort study. OBJECTIVES To test if maximum voluntary ventilation (MVV), which is currently underutilized in diseases, serves for assessing subclinical ventilatory impairment in cervical spondylotic myelopathy (CSM). SETTING Kochi Medical School, Japan. METHODS We studied ventilatory function in 49 CSM patients and 20 age- and sex-matched control patients with either lumbar stenosis or lower limb osteoarthritis. All patients underwent ventilatory function studies consisting of flow volume curves, vital capacity (VC) and the MVV in 12 s before and after surgery. Tetraparesis was assessed by the functional scale of the Japanese Orthopaedic Association (JOA). RESULTS The CSM group had significantly smaller %forced VC , %peak expiratory flow rate (%PEFR) and %MVV than the control group preoperatively. In contrast to the control group, the CSM group showed a significant increase in %MVV from 74.9±18.7% preoperatively to 80.3±19.0% postoperatively (P<0.005), but not in any other ventilatory measures. This postoperative increase in %MVV significantly correlated with the JOA score (r=0.493; P<0.001). As a possible effect of diaphragmatic recovery, the %PEFR significantly increased postoperatively only in patients with the primary site of involvement at or rostral to C3-4. CONCLUSION Of the various ventilatory measurements, MVV was most sensitive to changes in tetraparesis in CSM, presumably because MVV, unlike the other ventilatory measures, reflects the coordination in addition to the strength of respiratory muscles.
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Fractional anisotropy values detect pyramidal tract involvement in multiple system atrophy. J Neurol Sci 2008; 271:40-6. [DOI: 10.1016/j.jns.2008.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2007] [Revised: 03/08/2008] [Accepted: 03/14/2008] [Indexed: 11/21/2022]
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Deutsch KM, Hornby TG, Schmit BD. The intralimb coordination of the flexor reflex response is altered in chronic human spinal cord injury. Neurosci Lett 2005; 380:305-10. [PMID: 15862907 DOI: 10.1016/j.neulet.2005.01.060] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2004] [Revised: 12/28/2004] [Accepted: 01/20/2005] [Indexed: 11/21/2022]
Abstract
The current study compared the intralimb coordination of flexor reflex responses in spinal intact and complete chronic spinal cord injured (SCI) individuals. Noxious electrocutaneous stimulation was applied at the apex of the medial arch of the foot (50 mA, 500 Hz, 1 ms pulse width, 20 ms) in 21 complete chronic SCI and 19 spinal intact volunteers and the flexor reflex response was quantified by measuring the isometric joint torques at the ankle, knee and hip. The results showed that SCI individuals had significantly smaller peak knee and hip joint flexion torques, often exhibited a net knee extension torque, and produced a much smaller hip joint flexion torque during the flexor reflex response in contrast to the spinal intact individuals. The latency of the reflex response, measured from the tibialis anterior electromyogram, was comparable in both test populations. These findings indicate that the intralimb coordination of the flexor reflex response of chronic complete SCI individuals is altered, possibly reflecting a functional reorganization of the flexion pathways of the spinal cord.
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Affiliation(s)
- Katherine M Deutsch
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL 60611, USA
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Layne CS, Forth KE, Abercromby AFJ. Spatial factors and muscle spindle input influence the generation of neuromuscular responses to stimulation of the human foot. ACTA ASTRONAUTICA 2005; 56:809-819. [PMID: 15835006 DOI: 10.1016/j.actaastro.2005.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Removal of the mechanical pressure gradient on the soles leads to physiological adaptations that ultimately result in neuromotor degradation during spaceflight. We propose that mechanical stimulation of the soles serves to partially restore the afference associated with bipedal loading and assists in attenuating the negative neuromotor consequences of spaceflight. A dynamic foot stimulus device was used to stimulate the soles in a variety of conditions with different stimulation locations, stimulation patterns and muscle spindle input. Surface electromyography revealed the lateral side of the sole elicited the greatest neuromuscular response in ankle musculature, followed by the medial side, then the heel. These responses were modified by preceding stimulation. Neuromuscular responses were also influenced by the level of muscle spindle input. These results provide important information that can be used to guide the development of a "passive" countermeasure that relies on sole stimulation and can supplement existing exercise protocols during spaceflight.
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Affiliation(s)
- Charles S Layne
- Laboratory of Integrated Physiology, Department of Health and Human Performance, University of Houston, TX 77024-6015, USA.
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