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Dziadkowiak E, Koszewicz M, Podgórski P, Wieczorek M, Budrewicz S, Zimny A. Central nervous system involvement in chronic inflammatory demyelinating polyradiculoneuropathy-MRS and DTI study. Front Neurol 2024; 15:1301405. [PMID: 38333607 PMCID: PMC10850251 DOI: 10.3389/fneur.2024.1301405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/04/2024] [Indexed: 02/10/2024] Open
Abstract
Objective The current research aimed to analyze the alterations within the motor cortex and pyramidal pathways and their association with the degree of damage within the peripheral nerve fibers in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). To achieve that goal, we investigated the microstructural changes within the pyramidal white matter tracts using diffusion tensor imaging (DTI) parameters, evaluated metabolic alterations in both precentral gyri using magnetic resonance spectroscopy (MRS) ratios, and correlated them with the neurographic findings in patients with CIDP. Methods The spectroscopic ratios of NAA/Cr, Cho/Cr, and mI/Cr from both precentral gyri and the values of fractional anisotropy (FA), axial diffusivity (AD), and mean diffusivity (MD) from both of the corticospinal tracts were correlated with the results of neurological and neurographic findings. The comparison of DTI parameters between the patients and controls was performed using Student's t-test or the Mann-Whitney U test. Due to the lack of normal distribution of most variables, Spearman's Rho rank coefficient was used to test all correlations. All analyses were performed at a significant level of alpha = 0.05 using STATISTICA 13.3. Results Compared to the control group (CG), the patient group showed significantly lower ratios of NAA/Cr (1.66 ± 0.11 vs. 1.61 ± 0.15; p = 0.022), higher ratios of ml/Cr in the right precentral gyrus (0.57 ± 0.15 vs. 0.61 ± 0.08; p = 0.005), and higher levels of Cho/Cr within the left precentral gyrus (0.83 ± 0.09 vs. 0.88 ± 0.14, p = 0.012). The DTI parameters of MD from the right CST and AD from the right and left CSTs showed a strong positive correlation (0.52-0.53) with the sural sensory nerve action potential (SNAP) latency of the right sural nerve. There were no other significant correlations between other DTI and MRS parameters and neurographic results. Significance In our study, significant metabolic alterations were found in the precentral gyri in patients with CIDP without clinical symptoms of central nervous system involvement. The revealed changes reflected neuronal loss or dysfunction, myelin degradation, and increased gliosis. Our results suggest coexisting CNS damage in these patients and may provide a new insight into the still unknown pathomechanism of CIDP.
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Affiliation(s)
- Edyta Dziadkowiak
- Department of Neurology, Wroclaw Medical University, Borowska, Wrocław, Poland
| | - Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, Borowska, Wrocław, Poland
| | - Przemysław Podgórski
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Borowska, Wrocław, Poland
| | - Małgorzata Wieczorek
- Faculty of Earth Sciences and Environmental Management, University of Wroclaw, Uniwersytecki, Wrocław, Poland
| | - Sławomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Borowska, Wrocław, Poland
| | - Anna Zimny
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Borowska, Wrocław, Poland
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Ubysz J, Koszewicz M, Bladowska J, Budrewicz S. Spinal adhesive arachnoiditis in an adult patient with spinal muscular atrophy type 3 treated with intrathecal therapy. BMC Neurol 2024; 24:43. [PMID: 38267835 PMCID: PMC10807066 DOI: 10.1186/s12883-024-03543-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Spinal adhesive arachnoiditis is a chronic inflammatory process of the leptomeninges and intrathecal neural elements. The possible causes of arachnoiditis are: infections, injuries of spinal cord, surgical procedures and intrathecal administration of therapeutic substances or contrast. CASE PRESENTATION We present a case of 56-old woman with spinal muscular atrophy type 3 who developed a severe back pain in the lumbosacral region after the fifth dose of nusinersen given intrathecally. Magnetic resonance of lumbosacral spine showed spinal adhesive arachnoiditis. She received high doses of methylprednisolone intravenously, and later non-steroidal anti-inflammatory drugs, alpha lipoic acid, vitamins and rehabilitation with slight improvement. CONCLUSIONS The authors summarize that scheduled resonance imaging of the lumbosacral spine may be an important element of the algorithm in the monitoring of novel, intrathecal therapy in patients with spinal muscular atrophy.
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Affiliation(s)
- Jakub Ubysz
- Department of Neurology, Wroclaw Medical University, Borowska 213, Wroclaw, 50-556, Poland
| | - Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, Wroclaw, 50-556, Poland.
| | - Joanna Bladowska
- Department of Preclinical Sciences, Pharmacology and Medical Diagnostics, Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw, Poland
- Department of Radiology, Wroclaw 4th Military Hospital, Wroclaw, Poland
| | - Slawomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, Wroclaw, 50-556, Poland
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Koszewicz M, Ubysz J, Dziadkowiak E, Wieczorek M, Budrewicz S. Motor fiber function in spinal muscular atrophy-analysis of conduction velocity distribution. Front Neurol 2023; 14:1305497. [PMID: 38192575 PMCID: PMC10773903 DOI: 10.3389/fneur.2023.1305497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/10/2023] [Indexed: 01/10/2024] Open
Abstract
Objectives The motor neuron survival protein, which is deficient in spinal muscular atrophy (SMA), performs numerous cellular functions. Currently, SMA is believed to be a multi-organ disease, including lesion of various structures of the central and peripheral nervous systems. Motor nerve damage, especially in milder SMA types, is controversial. This prompted the conduct of the electrophysiological studies in adults with SMA types 2 and 3 presented in this paper. Methods The study group consisted of 44 adult patients with SMA types 2 and 3. All patients underwent neurological examination with Hammersmith Functional Motor Scale-Expanded (HFMSE) assessment. Standard electrophysiological studies in the ulnar nerve and conduction velocity distribution (CVD) tests were performed in all patients and controls. Results A prolongation of the distal latency and lowering of the motor potential amplitude with no changes in CVD were found in the whole patient group. There were no dependencies on the number of gene copies. Patients with low HFSME value had slower standard conduction velocity, CVD in upper and median quartiles, and narrower CVD spread; in milder SMA, CVD spread was greater than in controls. Interpretation The significant reduction in motor response amplitude in SMA seems to be primarily related to motor neuron loss and directly proportional to its severity. The coexisting rearrangement in the peripheral nerve structure is present in SMA, and this could be partially caused by a coexisting demyelinating process. Nerve remodeling mainly affects large fibers and occurs in more severe SMA types with significant disability.
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Affiliation(s)
| | - Jakub Ubysz
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | - Edyta Dziadkowiak
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | - Malgorzata Wieczorek
- Faculty of Earth Sciences and Environmental Management, University of Wroclaw, Wroclaw, Poland
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Koszewicz M, Kaminska D, Martynkiewicz J, Domanasiewicz A, Gosk J. Selective demyelination of a sciatic nerve allograft after SARS-CoV-2 infection - Case report. Heliyon 2023; 9:e20624. [PMID: 37817996 PMCID: PMC10560830 DOI: 10.1016/j.heliyon.2023.e20624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 07/24/2023] [Accepted: 10/02/2023] [Indexed: 10/12/2023] Open
Abstract
Peripheral neurological complications are seen after SARS-CoV-2 infections. These are mostly immune-mediated such as Guillaine-Barré syndrome or chronic inflammatory demyelinating polyneuropathy. We present a 39-year-old man treated with a right sciatic nerve allotransplantation with subsequent clinical and electrophysiological improvement within 30 months of observation. After SARS-CoV-2 infection, he developed clinical deterioration with selective sciatic nerve demyelination in a nerve conduction study. Nerve conduction velocity returned to previous values within six months of treatment. Intravenous immunoglobulins were used at standard dosage. The inflammatory immune process seemed to be a cause of peripheral demyelination isolated to a nerve allograft with good reaction for intravenous immunoglobulin treatment.
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Affiliation(s)
- Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Dorota Kaminska
- Department of Trauma and Orthopedic Surgery, Regional Specialist Hospital, Kamienskiego 73a, 51-124, Wroclaw, Poland
| | - Jacek Martynkiewicz
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Adam Domanasiewicz
- Department of Trauma and Orthopedic Surgery, Regional Specialist Hospital, Kamienskiego 73a, 51-124, Wroclaw, Poland
| | - Jerzy Gosk
- Department of Biomedical Engineering, Faculty of Fundamental Problems of Technology, Wroclaw University of Science and Technology, Grunwaldzki Sq. 13 (D-1), 50-377, Wroclaw, Poland
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Budrewicz S, Koszewicz M, Konieczna P, Zimny A. Long-standing myoclonic hand tremor as an isolated symptom of hypertrophic olivary degeneration. Clin Neurol Neurosurg 2023; 232:107871. [PMID: 37413873 DOI: 10.1016/j.clineuro.2023.107871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/07/2023] [Accepted: 07/01/2023] [Indexed: 07/08/2023]
Abstract
Hypertrophic olivary degeneration (HOD) is a rare condition caused by lesions of the dentato-rubro-olivary pathway, usually bilateral. We presented a case of a 64-year old male with HOD caused by a unilateral, posterior pontine cavernoma. The patient has not developed the typical palate myoclonus until recently. Isolated hand myoclonus with coexisting asterixis was present for years. This case shows unique HOD symptomatology and emphasizes the important role of MRI in the differential diagnosis of monomelic myoclonus.
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Affiliation(s)
| | | | - Paulina Konieczna
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland.
| | - Anna Zimny
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical, University, Wroclaw, Poland.
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Andrusiów S, Pawlak Z, Stańczykiewicz B, Bogunia-Kubik K, Koszewicz M. Chronic inflammatory demyelinating polyradiculoneuropathy in patients with diabetes mellitus - treatment with intravenous immunoglobulins: A systematic review. Biomed Pharmacother 2023; 164:114974. [PMID: 37290187 DOI: 10.1016/j.biopha.2023.114974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare disease, but it is one of the most common inflammatory neuropathies in the population. It is particularly common among patients with diabetes mellitus. This raises many problems, both with the differential diagnosis of diabetic and inflammatory neuropathy, as well as the choice of treatment. Intravenous immunoglobulin (IVIG) is one of the therapeutic options. There is evidence for the effectiveness of IVIG in treating about two-thirds of patients. However, no review has been published to date systematising studies evaluating the response to IVIG treatment in patients with CIDP and coexisting diabetes. METHODS The present study is based on the PRISMA statement and is registered at PROSPERO (CRD42022356180). The study included searches of the databases of MEDLINE, ERIC, CINAHL Complete, Academic Search Ultimate and Health Source: Nursing/Academic Edition, finally including seven original papers evaluating a total of 534 patients in the review. The main inclusion criteria were the presence of a group of patients with CIDP and comorbid diabetes in the study. RESULTS The systematic review showed a lower efficacy of IVIG treatment among patients with coexisting diabetes compared with idiopathic CIDP (61 % vs 71 %). In addition, the presence of conduction blocks on neurography and shorter disease duration proved to be significant factors improving response to treatment. CONCLUSIONS Current scientific data do not allow for strong recommendations on the choice of treatment for CIDP. A randomised, multicentre study evaluating the efficacy of different therapeutic approaches to this disease entity needs to be planned.
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Affiliation(s)
- Szymon Andrusiów
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland.
| | - Zuzanna Pawlak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Bartłomiej Stańczykiewicz
- Division of Consultation Psychiatry and Neuroscience, Department of Psychiatry, Wroclaw Medical University, L. Pasteura 10, 50-367 Wroclaw, Poland
| | - Katarzyna Bogunia-Kubik
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
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Dziadkowiak E, Nowakowska-Kotas M, Rałowska-Gmoch W, Budrewicz S, Koszewicz M. Molecular, Electrophysiological, and Ultrasonographic Differences in Selected Immune-Mediated Neuropathies with Therapeutic Implications. Int J Mol Sci 2023; 24:ijms24119180. [PMID: 37298132 DOI: 10.3390/ijms24119180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
The spectrum of immune-mediated neuropathies is broad and the different subtypes are still being researched. With the numerous subtypes of immune-mediated neuropathies, establishing the appropriate diagnosis in normal clinical practice is challenging. The treatment of these disorders is also troublesome. The authors have undertaken a literature review of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), Guillain-Barre syndrome (GBS) and multifocal motor neuropathy (MMN). The molecular, electrophysiological and ultrasound features of these autoimmune polyneuropathies are analyzed, highlighting the differences in diagnosis and ultimately treatment. The immune dysfunction can lead to damage to the peripheral nervous system. In practice, it is suspected that these disorders are caused by autoimmunity to proteins located in the node of Ranvier or myelin components of peripheral nerves, although disease-associated autoantibodies have not been identified for all disorders. The electrophysiological presence of conduction blocks is another important factor characterizing separate subgroups of treatment-naive motor neuropathies, including multifocal CIDP (synonyms: multifocal demyelinating neuropathy with persistent conduction block), which differs from multifocal motor neuropathy with conduction block (MMN) in both responses to treatment modalities and electrophysiological features. Ultrasound is a reliable method for diagnosing immune-mediated neuropathies, particularly when alternative diagnostic examinations yield inconclusive results. In overall terms, the management of these disorders includes immunotherapy such as corticosteroids, intravenous immunoglobulin or plasma exchange. Improvements in clinical criteria and the development of more disease-specific immunotherapies should expand the therapeutic possibilities for these debilitating diseases.
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Affiliation(s)
- Edyta Dziadkowiak
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Marta Nowakowska-Kotas
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Wiktoria Rałowska-Gmoch
- Department of Neurology, The St. Jadwiga's Regional Specialist Neuropsychiatric Centre, Wodociągowa 4, 45-221 Opole, Poland
| | - Sławomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
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Szczygieł A, Logoń K, Poznański P, Koszewicz M, Krajewska M, Kamińska D. Guillain-Barré syndrome following severe COVID-19 directly after kidney transplantation. Pol Arch Intern Med 2023; 133:16472. [PMID: 36994916 DOI: 10.20452/pamw.16472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Affiliation(s)
- Aleksandra Szczygieł
- Student Scientific Club, Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Katarzyna Logoń
- Student Scientific Club, Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Paweł Poznański
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland.
| | | | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Dorota Kamińska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
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Sutkowska E, Marciniak D, Koszewicz M, Dziadkowiak E, Budrewicz S, Biernat K, Kuciel N, Mazurek J, Hap K. Validity and reliability of the Polish version of the Michigan Neuropathy Screening Instrument. World J Diabetes 2023; 14:435-446. [PMID: 37122429 PMCID: PMC10130898 DOI: 10.4239/wjd.v14.i4.435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/11/2022] [Accepted: 01/10/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Diabetic sensorimotor polyneuropathy is an important risk factor for foot ulceration and amputation. Thus, patients with diabetes should be screened for this disorder according to local guidelines. An obstacle to the diagnosis of this disease may be the lack of unified diagnostic criteria due to the lack of properly validated scales used for assessment.
AIM To validate both sections (A and B) of the Michigan Neuropathy Screening Instrument (MNSI) in Polish (PL) patients with diabetes.
METHODS A cross-sectional study using a test (A1, B1) and re-test (A2, B2) formula was performed in 80 patients with diabetes. The gold standard used for neuropathy detection was a nerve conduction study (NCS) which was performed in all participants. Reliability of the MNSI-PL was assessed using the Cronbach’s alpha, Kuder-Richardson formula 20 (KR-20), split-half reliability, the Gottman split-half tests, and correlation between first and second half was accessed. Stability was assessed using an intraclass correlation coefficient (ICC). For external validation, we used simple linear correlation, binomial regression, and agreement between two different tools using a Bland-Altman plot analysis.
RESULTS The scale was internally consistent (Cronbach’s alpha for the full scale: 0.81 for A and 0.87 for B). MNSI-PL scores in test/retest showed high stability (ICC = 0.73 for A and ICC = 0.97 for B). The statistically important correlations between MNSI-PL and NCS were found for B1, B2, and A1 (P < 0.005). The cut-off points of ≥ 3 for section A (sensitivity of 90%-100%; specificity of 33%-40%) and ≥ 2 for section B (sensitivity of 81%-84%; specificity of 60%-70%) were obtained during neuropathy detection.
CONCLUSION The MNSI-PL is a reliable and valid instrument in screening for diabetic neuropathy.
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Affiliation(s)
- Edyta Sutkowska
- University Rehabilitation Centre, Wroclaw Medical University, Wroclaw 50-556, Poland
| | - Dominik Marciniak
- Department of Drugs Form Technology, Wroclaw Medical University, Wroclaw 50-556, Poland
| | | | - Edyta Dziadkowiak
- Department of Neurology, Wroclaw Medical University, Wroclaw 50-556, Poland
| | - Slawomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Wroclaw 50-556, Poland
| | - Karolina Biernat
- University Rehabilitation Centre, Wroclaw Medical University, Wroclaw 50-556, Poland
| | - Natalia Kuciel
- University Rehabilitation Centre, Wroclaw Medical University, Wroclaw 50-556, Poland
| | - Justyna Mazurek
- University Rehabilitation Centre, Wroclaw Medical University, Wroclaw 50-556, Poland
| | - Katarzyna Hap
- University Rehabilitation Centre, Wroclaw Medical University, Wroclaw 50-556, Poland
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Dziadkowiak E, Baczyńska D, Wieczorek M, Olbromski M, Moreira H, Mrozowska M, Budrewicz S, Dzięgiel P, Barg E, Koszewicz M. miR-31-5p as a Potential Circulating Biomarker and Tracer of Clinical Improvement for Chronic Inflammatory Demyelinating Polyneuropathy. Oxid Med Cell Longev 2023; 2023:2305163. [PMID: 37077658 PMCID: PMC10110370 DOI: 10.1155/2023/2305163] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/02/2022] [Accepted: 10/06/2022] [Indexed: 04/21/2023]
Abstract
Background MicroRNAs are endogenous, small noncoding RNA molecules that play a pivotal role in the regulation of gene expression. MicroRNAs are involved in many biological processes such as proliferation, cell differentiation, neovascularization, and apoptosis. Studies on microRNA expression may contribute to a better understanding of the pathomechanism of chronic inflammatory demyelinating polyneuropathy (CIDP) and consequently enable the development of new therapeutic measures using antisense miRNAs (antagomirs). In this study, we evaluated the level of miR-31-5p in the serum of patients with CIDP and its correlation with the miR-31-5p level and clinical presentation and electrophysiological and biochemical parameters. Methods The study group consisted of 48 patients, mean age 61.60 ± 11.76, who fulfilled the diagnostic criteria of a typical variant of CIDP. The expression of miR-31-5p in patient serum probes was investigated by droplet digital PCR. The results were correlated with neurophysiological findings and the patient's clinical and biochemical parameters. Results The mean copy number of miRNA-31 in 100 μl serum was 1288.64 ± 2001.02 in the CIDP group of patients, while in the control group, it was 3743.09 ± 4026.90. There was a significant positive correlation (0.426) between IgIV treatment duration and miR-31-5p expression. Patients without IgIV treatment showed significantly lower levels of miR-31 compared to the treated group (259.44 ± 304.02 vs. 1559.48 ± 2168.45; p = 0.002). The group of patients with body weight > 80 kg showed statistically significantly lower levels of miRNA-31-5p than the patients with lower body weight (934.37 ± 1739.66 vs. 1784.62 ± 2271.62, respectively; p = 0.014). Similarly, the patients with elevated cerebrospinal fluid (CSF) protein levels had significantly higher miRNA-31-5p expression than those with normal protein levels (1393.93 ± 1932.27 vs. 987.38 ± 2364.10, respectively; p = 0.044). Conclusion The results may support the hypothesis that miR-31-5p is strongly involved in the autoimmune process in CIDP. The positive correlation between higher miR-31-5p levels and duration of IVIg treatment may be an additional factor explaining the efficacy of prolonged IVIg therapy in CIDP.
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Affiliation(s)
- Edyta Dziadkowiak
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Dagmara Baczyńska
- Department of Molecular and Cellular Biology, Wroclaw Medical University, Borowska 211A, Wroclaw, Poland
| | - Małgorzata Wieczorek
- Faculty of Earth Sciences and Environmental Management, University of Wroclaw, Uniwersytecki 1, 50-137 Wroclaw, Poland
| | - Mateusz Olbromski
- Department of Histology and Embryology, Wroclaw Medical University, ul. Chałubinskiego 6a, 50-368 Wroclaw, Poland
| | - Helena Moreira
- Department of Basic Medical Sciences, Wroclaw Medical University, Borowska 211, 50-556 Wroclaw, Poland
| | - Monika Mrozowska
- Department of Histology and Embryology, Wroclaw Medical University, ul. Chałubinskiego 6a, 50-368 Wroclaw, Poland
| | - Sławomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Piotr Dzięgiel
- Department of Histology and Embryology, Wroclaw Medical University, ul. Chałubinskiego 6a, 50-368 Wroclaw, Poland
| | - Ewa Barg
- Department of Basic Medical Sciences, Wroclaw Medical University, Borowska 211, 50-556 Wroclaw, Poland
| | - Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
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Dziadkowiak E, Nowakowska-Kotas M, Budrewicz S, Koszewicz M. Pathology of Initial Axon Segments in Chronic Inflammatory Demyelinating Polyradiculoneuropathy and Related Disorders. Int J Mol Sci 2022; 23:13621. [PMID: 36362407 PMCID: PMC9658771 DOI: 10.3390/ijms232113621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 07/30/2023] Open
Abstract
The diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is based on a combination of clinical, electrodiagnostic and laboratory features. The different entities of the disease include chronic immune sensory polyradiculopathy (CISP) and autoimmune nodopathies. It is debatable whether CIDP occurring in the course of other conditions, i.e., monoclonal IgG or IgA gammopathy, should be treated as a separate disease entity from idiopathic CIDP. This study aims to evaluate the molecular differences of the nodes of Ranvier and the initial axon segment (AIS) and juxtaparanode region (JXP) as the potential cause of phenotypic variation of CIDP while also seeking new pathomechanisms since JXP is sequestered behind the paranode and autoantibodies may not access the site easily. The authors initially present the structure of the different parts of the neuron and its functional significance, then discuss the problem of whether damage to the juxtaparanodal region, Schwann cells and axons could cause CIDP or if these damages should be separated as separate disease entities. In particular, AIS's importance for modulating neural excitability and carrying out transport along the axon is highlighted. The disclosure of specific pathomechanisms, including novel target antigens, in the heterogeneous CIDP syndrome is important for diagnosing and treating these patients.
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Koszewicz M, Szydlo M, Gosk J, Wieczorek M, Slotwinski K, Budrewicz S. The Relevance of Collision Tests and Quantitative Sensory Testing in Diagnostics and Postoperative Outcome Prediction in Carpal Tunnel Syndrome. Front Neurol 2022; 13:900562. [PMID: 35769372 PMCID: PMC9234301 DOI: 10.3389/fneur.2022.900562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background The gold standards for the diagnosis and treatment of carpal tunnel syndrome (CTS) and its outcome are undecided. Using clinical and electrophysiological methods, we tried to establish which fibers achieved full postoperative recovery, and the possibility of using non-standard electrophysiological tests as outcome predictors. Methods The study group consisted of 35 patients and controls. The Historical–Objective Scale, standard neurography, conduction velocity distribution tests (CVD), and quantitative sensory testing (QST) were performed before and after CTS surgery. Results Clinical improvement was observed on average in 54.3% of the patients, higher in less advanced CTS. All parameters improved significantly after surgery, except for CVD; most remained worse than in the controls. Only QST parameters fully returned to normal limits. Patient age and CTS severity were important in the estimation of the risk of no improvement. Conclusions The efficiency of minimally invasive CTS surgery is higher in younger patients with less advanced CTS. Complete recovery was present only in small fibers; larger fibers could most likely be responsible for residual signs. We did not notice any benefits in CTS diagnosis using methods of small fiber assessment. QST seemed to be useful in the diagnosis of residual signs, and in deciding upon possible reoperation.
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Affiliation(s)
- Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
- *Correspondence: Magdalena Koszewicz
| | - Mariusz Szydlo
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy Gosk
- Department of Trauma and Orthopedic Surgery, Regional Specialist Hospital, Wroclaw, Poland
| | - Malgorzata Wieczorek
- Faculty of Earth Sciences and Environmental Management, University of Wroclaw, Wroclaw, Poland
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13
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Koszewicz M, Mulak A, Dziadkowiak E, Budrewicz S. Is Fecal Calprotectin an Applicable Biomarker of Gut Immune System Activation in Chronic Inflammatory Demyelinating Polyneuropathy? - A Pilot Study. Front Hum Neurosci 2021; 15:733070. [PMID: 34867240 PMCID: PMC8636096 DOI: 10.3389/fnhum.2021.733070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/21/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction: Chronic inflammatory demyelinating polyneuropathy (CIDP) is a complex autoimmune disease caused by dysregulated response to not fully recognized antigens. Some association between CIDP and inflammatory bowel disease (IBD) has been reported, but the exact pathophysiological links of these disorders are not well understood. Aim of the Study: To evaluate fecal calprotectin as a biomarker of gut inflammation in CIDP patients without IBD. Methods: Fifteen patients with CIDP and 15 healthy controls were included in the study. The CIDP diagnosis was based on the EFNS/PNS criteria. The occurrence of bowel symptoms was assessed based on a questionnaire. The quantitative evaluation of fecal calprotectin level was performed by the ELISA test. Results: The fecal calprotectin level (μg/g) expressed as median along with the lower and upper quartiles [25Q–75Q] was significantly higher in CIDP patients compared to the controls: 26.6 [17.5–109.0] vs 15.6 [7.1–24.1], p = 0.0066. Abnormal fecal calprotectin level (>50 μg/g) was found in 33% of all CIDP patients and in none of the control subjects. The patients with abnormal fecal calprotectin level did not differ from the rest of the study group regarding the neurological status. The most common bowel symptoms reported by CIDP patients included constipation (33%), feeling of incomplete evacuation (33%), bloating (27%), and alternating bowel movement pattern (27%). Conclusion: In one-third of CIDP patients the signs of gut immune system activation have been observed. This finding may be associated with CIDP pathogenesis and induction of autoimmune response as well as concomitant dysautonomia with gastrointestinal symptoms.
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Affiliation(s)
| | - Agata Mulak
- Department of Gastroenterology and Hepatology, Wrocław Medical University, Wrocław, Poland
| | - Edyta Dziadkowiak
- Department of Neurology, Wrocław Medical University, Wrocław, Poland
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14
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Ejma M, Madetko N, Brzecka A, Alster P, Budrewicz S, Koszewicz M, Misiuk-Hojło M, Tomilova IK, Somasundaram SG, Kirkland CE, Aliev G. The Role of Stem Cells in the Therapy of Stroke. Curr Neuropharmacol 2021; 20:630-647. [PMID: 34365923 PMCID: PMC9608230 DOI: 10.2174/1570159x19666210806163352] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/19/2021] [Accepted: 06/03/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Stroke is a major challenge in neurology due to its multifactorial genesis and irreversible consequences. Processes of endogenous post-stroke neurogenesis, although insufficient, may indicate possible direction of future therapy. Multiple research considers stem-cell-based approaches in order to maximize neuroregeneration and minimize post-stroke deficits. Objective: Aim of this study is to review current literature considering post-stroke stem-cell-based therapy and possibilities of inducing neuroregeneration after brain vascular damage. Methods: Papers included in this article were obtained from PubMed and MEDLINE databases. The following medical subject headings (MeSH) were used: “stem cell therapy”, “post-stroke neurogenesis”, “stem-cells stroke”, “stroke neurogenesis”, “stroke stem cells”, “stroke”, “cell therapy”, “neuroregeneration”, “neurogenesis”, “stem-cell human”, “cell therapy in human”. Ultimate inclusion was made after manual review of the obtained reference list. Results: Attempts of stimulating neuroregeneration after stroke found in current literature include supporting endogenous neurogenesis, different routes of exogenous stem cells supplying and extracellular vesicles used as a method of particle transport. Conclusion: Although further research in this field is required, post stroke brain recovery supported by exogenous stem cells seems to be promising future therapy revolutionizing modern neurology.
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Affiliation(s)
- Maria Ejma
- Department of Neurology, Wroclaw Medical University, 50-556 Wrocław, Borowska 213. Poland
| | - Natalia Madetko
- Department of Neurology, Medical University of Warsaw, Kondratowicza 8, 03-242 Warszawa. Poland
| | - Anna Brzecka
- Department of Pulmonology and Lung Oncology, Wroclaw Medical University, Grabiszynska 105, 53-439 Wroclaw. Poland
| | - Piotr Alster
- Department of Neurology, Medical University of Warsaw, Kondratowicza 8, 03-242 Warszawa. Poland
| | - Sławomir Budrewicz
- Department of Neurology, Wroclaw Medical University, 50-556 Wrocław, Borowska 213. Poland
| | - Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, 50-556 Wrocław, Borowska 213. Poland
| | - Marta Misiuk-Hojło
- Department of Ophthalmology, Wroclaw Medical University, 50-556 Wroclaw, Borowska 213. Poland
| | - Irina K Tomilova
- Department of Biochemistry, Ivanovo State Medical Academy, Avenue Sheremetyevsky 8, Ivanovo, 153012. Russian Federation
| | - Siva G Somasundaram
- Department of Biological Sciences, Salem University, Salem, WV, 26426. United States
| | - Cecil E Kirkland
- Department of Biological Sciences, Salem University, Salem, WV, 26426. United States
| | - Gjumrakch Aliev
- Wroclaw Medical University, Department of Pulmonology and Lung Oncology, Wroclaw. Poland
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15
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Dziadkowiak E, Moreira H, Wieczorek M, Budrewicz S, Barg E, Koszewicz M. Correlations between Electrophysiological Parameters, Lymphocyte Distribution and Cytokine Levels in Patients with Chronic Demyelinating Inflammatory Polyneuropathy. J Pers Med 2021; 11:jpm11080766. [PMID: 34442410 PMCID: PMC8399760 DOI: 10.3390/jpm11080766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 11/23/2022] Open
Abstract
The goal of this study was to analyse, in relation to electrophysiological results, the distribution of lymphocyte subpopulations and the level of cytokines in patients with the typical form of chronic demyelinating inflammatory polyneuropathy (CIDP) before immunoglobulin treatment. The study group consisted of 60 patients (52 men, eight women), with a mean age 64.8 ± 11.2, who fulfilled the diagnostic criteria for the typical variant of CIDP, with (23 patients) and without (37 patients) diabetes mellitus. We analysed the results of the neurophysiological tests, and correlated them with the leukocyte subpopulations, and cytokine levels. In CIDP patients, IL-6, IL-2, IL-4 and TNF-α levels were significantly increased compared to the control group. Fifty patients had decreased levels of T CD8+ lymphocytes, and 51 patients had increased levels of CD4+ lymphocytes. An increased CD4+/CD8+ ratio was also found. Negative correlations were observed mainly between compound muscle action potential (CMAP) amplitudes and cytokine levels. The study enabled the conclusion that electrophysiological parameters in CIDP patients are closely related to the autoimmune process, but without any clear differences between patients with and without diabetes mellitus. Correlations found in the study indicated that axonal degeneration might be independent of the demyelinating process and might be caused by direct inflammatory infiltration.
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Affiliation(s)
- Edyta Dziadkowiak
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (E.D.); (S.B.)
| | - Helena Moreira
- Department of Basic Medical Sciences, Wroclaw Medical University, Borowska 211, 50-556 Wroclaw, Poland; (H.M.); (E.B.)
| | - Malgorzata Wieczorek
- Faculty of Earth Sciences and Environmental Management, University of Wroclaw, Uniwersytecki 1, 50-137 Wroclaw, Poland;
| | - Slawomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (E.D.); (S.B.)
| | - Ewa Barg
- Department of Basic Medical Sciences, Wroclaw Medical University, Borowska 211, 50-556 Wroclaw, Poland; (H.M.); (E.B.)
| | - Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (E.D.); (S.B.)
- Correspondence: ; Tel.: +48-71-734-31-00
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16
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Koszewicz M, Szydlo M, Gosk J, Wieczorek M, Slotwinski K, Budrewicz S. The Use of Quantitative Sensation Testing to Identify the Physiological Differences Between the Median and Ulnar Nerves. Front Hum Neurosci 2021; 15:601322. [PMID: 34025372 PMCID: PMC8134541 DOI: 10.3389/fnhum.2021.601322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Similarities in morphology, physiological function, and neurophysiological findings between median and ulnar nerves are not unequivocal. Our previous study confirmed differences in motor fiber parameters between these nerves in healthy persons. We made an attempt to assess and compare the physiological parameters of different sensation modalities (temperature, pain, and vibration) in median and ulnar nerves. Methods The study was performed in 31 healthy, right-handed volunteers: 17 women, 14 men, mean age 44.8 ± 15.5 years. Standard sensory conduction tests in the median and ulnar nerves were performed together with the estimation of vibratory, temperature, and warm- and cold-induced pain thresholds in the C7 and C8 dermatomes on the palm, using quantitative sensory testing. Results There were no statistically significant differences in the standard sensory conduction test in the median and ulnar nerves across the whole group: between right and left hands, and between women and men. We revealed differences in the temperature and pain thresholds between these nerves, mainly in low temperature perception. There were no differences in estimated thresholds between sides or in female and male groups. The vibratory limits did not differ significantly between nerves, and subgroups. Conclusion The study confirmed the differences in the physiological sensory perception between the median and ulnar nerves. The median nerve is more sensitive to temperature stimulation than the ulnar nerve, but simultaneously less sensitive to pain-inducing temperature stimuli. These findings should be considered during the examination of hand nerve pathology.
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Affiliation(s)
| | - Mariusz Szydlo
- Department of Neurology, Wrocław Medical University, Wrocław, Poland
| | - Jerzy Gosk
- Department of Trauma and Hand Surgery, Wrocław Medical University, Wrocław, Poland
| | - Malgorzata Wieczorek
- Faculty of Earth Sciences and Environmental Management, University of Wrocław, Wrocław, Poland
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17
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Siuda J, Boczarska-Jedynak M, Budrewicz S, Dulski J, Figura M, Fiszer U, Gajos A, Gorzkowska A, Koziorowska-Gawron E, Koziorowski D, Krygowska-Wajs A, Rudzińska-Bar M, Sławek J, Toś M, Wójcik-Pędziwiatr M, Lin J, Luo S, Martinez-Martin P, Stebbins GT, Goetz CG, Opala G, Koszewicz M, Leńska-Mieciek M, Michałowska M, Piaścik-Gromada M, Potasz-Kulikowska K, Śmiłowski M, Wasilewska A, Opala G. Validation of the Polish version of the Unified Dyskinesia Rating Scale (UDysRS). Neurol Neurochir Pol 2021; 55:186-194. [PMID: 33528833 DOI: 10.5603/pjnns.a2021.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/12/2020] [Accepted: 12/22/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND In 2008, the Movement Disorders Society published the Unified Dyskinesia Rating Scale (UDysRS). This has become the established tool for assessing the severity and disability associated with dyskinesia in patients with Parkinson's Disease (PD). We translated and validated the Polish version of the UDysRS, explored its dimensionality, and compared it to the Spanish version, which is the Reference Standard for UDysRS translations. MATERIAL AND METHODS The UDysRS was translated into Polish by a team led by JS and GO. The back-translation, completed by colleagues fluent in both Polish and English who were not involved in the original translation, was reviewed and approved by the Executive Committee of the MDS Rating Scales Programme. Then the translated version of the UDysRS underwent cognitive pretesting, and the translation was modified based on the results. The approved version was considered to be the Official Working Document of the Polish UDysRS and was tested on 250 Polish PD patients recruited at movement disorder centres. Data was compared to the Reference Standard used for validating UDysRS translations. RESULTS The overall factor structure of the Polish version was consistent with that of the Reference Standard version, as evidenced by the high Confirmatory Fit Index score (CFI = 0.98). The Polish UDysRS was thus confirmed to share a common factor structure with the Reference Standard. CONCLUSIONS The Official Polish UDysRS translation is recommended for use in clinical and research settings. Worldwide use of uniform rating measures offers a common ground to study similarities and differences in disease manifestations and progression across cultures.
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Affiliation(s)
- Joanna Siuda
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | | | | | - Jarosław Dulski
- Department of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland,Department of Neurology and Stroke, St. Adalbert Hospital, Gdansk, Poland
| | - Monika Figura
- Department of Neurology, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Urszula Fiszer
- Department of Neurology and Epileptology, Centre of Postgraduate Medical Education, Orłowski Hospital, Warsaw, Poland
| | - Agata Gajos
- Department of Extrapyramidal Diseases, Medical University of Łódź, Łódź, Poland
| | - Agnieszka Gorzkowska
- Department of Neurorehabilitation, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Dariusz Koziorowski
- Department of Neurology, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Anna Krygowska-Wajs
- Department of Neurology, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Monika Rudzińska-Bar
- Department of Neurology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Jarosław Sławek
- Department of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland,Department of Neurology and Stroke, St. Adalbert Hospital, Gdansk, Poland
| | - Mateusz Toś
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Magdalena Wójcik-Pędziwiatr
- Department of Neurology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Jeffrey Lin
- Department of Biostatistics, Gilead Sciences, Inc., Foster City, California, United States
| | - Sheng Luo
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States
| | - Pablo Martinez-Martin
- Centre for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Centre, Chicago, Illinois, United States
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Centre, Chicago, Illinois, United States
| | - Grzegorz Opala
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland,Department of Neurology, Wroclaw Medical University, Wroclaw, Poland,Department of Neurology, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland,Department of Neurology and Epileptology, Centre of Postgraduate Medical Education, Orłowski Hospital, Warsaw, Poland,Department of Extrapyramidal Diseases, Medical University of Łódź, Łódź, Poland,Department of Neurology, Jagiellonian University, Collegium Medicum, Krakow, Poland,Department of Neurology, John Paul II Specialised Hospital, Krakow, Poland
| | | | - Marta Leńska-Mieciek
- Department of Neurology and Epileptology, Centre of Postgraduate Medical Education, Orłowski Hospital, Warsaw, Poland
| | - Małgorzata Michałowska
- Department of Neurology and Epileptology, Centre of Postgraduate Medical Education, Orłowski Hospital, Warsaw, Poland
| | - Marta Piaścik-Gromada
- Department of Neurology and Epileptology, Centre of Postgraduate Medical Education, Orłowski Hospital, Warsaw, Poland
| | | | - Marek Śmiłowski
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Anna Wasilewska
- Department of Neurology, John Paul II Specialised Hospital, Krakow, Poland, Poland
| | - Grzegorz Opala
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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18
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Koszewicz M, Markowska K, Waliszewska-Prosol M, Poreba R, Gac P, Szymanska-Chabowska A, Mazur G, Wieczorek M, Ejma M, Slotwinski K, Budrewicz S. The impact of chronic co-exposure to different heavy metals on small fibers of peripheral nerves. A study of metal industry workers. J Occup Med Toxicol 2021; 16:12. [PMID: 33858451 PMCID: PMC8048227 DOI: 10.1186/s12995-021-00302-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 04/03/2021] [Indexed: 12/14/2022] Open
Abstract
Background Chronic exposure to heavy metals affects various organs, among them the brain and peripheral nerves. Polyneuropathy is mainly length-dependent with predominantly sensory symptoms. There have been few studies on small fiber neuropathy due to heavy metal intoxication. Methods We investigated 41 metal industry workers, mean age 51.3 ± 10.5 years, with at least 5 years’ professional exposure to heavy metals, and 36 age- and sex-matched healthy controls. We performed neurological examinations, and assessed blood levels of cadmium, lead, and zinc protoporphyrin, urine levels of arsenic, standard, sensory and motor electrophysiological tests in the ulnar and peroneal nerves, sympathetic skin responses from the palm and foot, and quantitative sensation testing from dermatomes C8 and S1. Discussion The results of standard conduction tests of all nerves significantly differed between groups. The latency of sympathetic skin responses achieved from the foot was also statistically significantly prolonged in the study group. Significant differences were seen in both C8 and S1 regions for temperature and pain thresholds, and for vibratory threshold only in the S1 region, while the dispersions of low and high temperatures were important exclusively in the C8 region. Conclusions We can conclude that co-exposure to many heavy metals results in explicit impairment of peripheral nerves. The lesion is more pronounced within small fibers and is predominantly connected with greater impairment of temperature-dependent pain thresholds. The evaluation of small fiber function should be considered in the early diagnosis of toxic polyneuropathy or in low-dose exposure to heavy metals.
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Affiliation(s)
- Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.
| | - Katarzyna Markowska
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | | | - Rafał Poreba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-550, Wroclaw, Poland
| | - Paweł Gac
- Department of Hygiene, Wroclaw Medical University, J. Mikulicza-Radeckiego 7, 50-345, Wroclaw, Poland
| | - Anna Szymanska-Chabowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-550, Wroclaw, Poland
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-550, Wroclaw, Poland
| | - Malgorzata Wieczorek
- Faculty of Earth Sciences and Environmental Management, University of Wroclaw, Plac Uniwersytecki 1, 50-137, Wroclaw, Poland
| | - Maria Ejma
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Krzysztof Slotwinski
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Slawomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
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19
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Koziorowska-Gawron E, Koszewicz M, Bladowska J, Ejma M, Budrewicz S. Opsoclonus-myoclonus syndrome with severe clinical course and beneficial outcome: A case report. Medicine (Baltimore) 2021; 100:e25261. [PMID: 33832088 PMCID: PMC8036019 DOI: 10.1097/md.0000000000025261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/04/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Opsoclonus-myoclonus syndrome (OMS) is a rare immune-mediated movement disorder, mostly of paraneoplastic or idiopathic origin. The disease usually has an acute onset, serious course and leads rapidly to disability in adult patients. To the best of our knowledge, this is the fourth presented case of OMS with a severe course and complete reversibility of neurological symptoms in a pregnant woman. This report includes videos and a literature review. PATIENT CONCERNS A 30-year-old woman in the 12th week of pregnancy developed severe nausea and vomiting, after several days balance and gait disorders appeared. On admission to hospital, neurological examination revealed opsoclonus, dysarthria, myoclonic jerks with ataxia of the trunk and limbs with inability to sit, stand or walk. DIAGNOSIS Well-known causes of OMS were excluded. Although in our patient the idiopathic origin of the disorder was taken under consideration, diagnosis of opsoclonus-myoclonus related to the pregnancy was highly likely. INTERVENTIONS After administration of steroids and benzodiazepines the patient improved. OUTCOMES In the 6th month of pregnancy, after termination of immunotherapy, she recovered completely and was able to sit, stand and walk independently. In the 39th week of pregnancy, she delivered a healthy child. LESSONS We confirm that understanding of clinical symptoms and rare causes of OMS contributes to early diagnosis and therapy, which ensures an optimal outcome. One probable cause of OMS could be a physiological change to immune system regulation during pregnancy. The relationship between OMS and pregnancy remains uncertain and needs further investigation.
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Affiliation(s)
| | | | - Joanna Bladowska
- Department of General, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
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20
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Markowska K, Koziorowska-Gawron E, Papier P, Koszewicz M, Budrewicz S, Bladowska J, Zimny A. Easily missed or misinterpreted: diabetic striatopathy in the course of ketotic hyperglycaemia. Postgrad Med J 2021; 97:539-540. [PMID: 33441478 DOI: 10.1136/postgradmedj-2020-139499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/17/2020] [Accepted: 12/19/2020] [Indexed: 11/04/2022]
Affiliation(s)
| | | | - Paulina Papier
- Neurology, Wroclaw Medical University, Wroclaw, Dolnoslaskie, Poland
| | | | | | - Joanna Bladowska
- General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Dolnoslaskie, Poland
| | - Anna Zimny
- General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Dolnoslaskie, Poland
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21
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Koszewicz M, Jaroch J, Brzecka A, Ejma M, Budrewicz S, Mikhaleva LM, Muresanu C, Schield P, Somasundaram SG, Kirkland CE, Avila-Rodriguez M, Aliev G. Dysbiosis is one of the risk factor for stroke and cognitive impairment and potential target for treatment. Pharmacol Res 2020; 164:105277. [PMID: 33166735 DOI: 10.1016/j.phrs.2020.105277] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023]
Abstract
More than 50 million people have various forms of cognitive impairment basically caused by neurodegenerative diseases, such as Alzheimer's, Parkinson's, and cerebrovascular diseases as well as stroke. Often these conditions coexist and exacerbate one another. The damaged area in post-stroke dementia may lead to neurodegenerative lesions. Gut microbiome functions like an endocrine organ by generating bioactive metabolites that can directly or indirectly impact human physiology. An alteration in the composition and function of intestinal flora, i.e. gut dysbiosis, is implicated in neurodegenerative and cerebrovascular diseases. Additionally, gut dysbiosis may accelerate the progression of cognitive impairment. Dysbiosis may result from obesity; metabolic disorders, cardiovascular disease, and sleep disorders, Lack of physical activity is associated with dysbiosis as well. These may coexist in various patterns in older people, enhancing the risk, incidence, and progression of cerebrovascular lesions, neurodegenerative disorders, and cognitive impairment, creating a vicious circle. Recently, it has been reported that several metabolites produced by gut microbiota (e.g., trimethylamine/trimethylamine N-oxide, short-chain fatty acids, secondary bile acids) may be linked to neurodegenerative and cerebrovascular diseases. New treatment modalities, including prebiotic and probiotics, may normalize the gut microbiota composition, change the brain-gut barrier, and decrease the risk of the pathology development. Fecal microbiota transplantation, sometimes in combination with other methods, is used for remodeling and replenishing the symbiotic gut microbiome. This promising field of research is associated with basic findings of bidirectional communication between body organs and gut microbiota that creates new possibilities of pharmacological treatments of many clinical conditions. The authors present the role of gut microbiota in physiology, and the novel therapeutic targets in modulation of intestinal microbiota Personalized therapies based on their personal genome make up could offer benefits by modulating microbiota cross-talk with brain and cardiovascular system. A healthy lifestyle, including pre and probiotic nutrition is generally recommended. Prevention may also be enhanced by correcting gut dysbiosis resulting a reduced risk of post-stroke cognitive impairment including dementia.
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Affiliation(s)
- Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, 50-556 Wrocław, Borowska 213, Poland
| | - Joanna Jaroch
- Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wrocław, Bartla 5, Poland; Department of Cardiology, Lower Silesian Specialist Hospital, Fieldorfa 2, 54-049 Wroclaw, Poland
| | - Anna Brzecka
- Department of Pulmonology and Lung Oncology, Wroclaw Medical University, 53-439, Wroclaw, Grabiszynska 105, Poland
| | - Maria Ejma
- Department of Neurology, Wroclaw Medical University, 50-556 Wrocław, Borowska 213, Poland
| | - Slawomir Budrewicz
- Department of Neurology, Wroclaw Medical University, 50-556 Wrocław, Borowska 213, Poland
| | - Liudmila M Mikhaleva
- Federal State Budgetary Institution «Research Institute of Human Morphology», 3, Tsyurupy Str., Moscow, 117418, Russian Federation
| | - Cristian Muresanu
- Research Center for Applied Biotechnology in Diagnosis and Molecular Therapies, Str. Trifoiului nr. 12 G, 400478, Cluj-Napoca, Romania
| | - Pamela Schield
- School of Education & Athletics, Salem University, Salem, WV 26426, United States
| | | | - Cecil E Kirkland
- Department of Biological Sciences, Salem University, Salem, WV, USA
| | - Marco Avila-Rodriguez
- Health Sciences Faculty, Clinic Sciences Department, University of Tolima, 730006 Ibague, Colombia
| | - Gjumrakch Aliev
- Federal State Budgetary Institution «Research Institute of Human Morphology», 3, Tsyurupy Str., Moscow, 117418, Russian Federation; I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya Str., Moscow, 119991, Russia; Institute of Physiologically Active Compounds, Russian Academy of Sciences, Chernogolovka, 142432, Russia; GALLY International Research Institute, 7733 Louis Pasteur Drive, #330, San Antonio, TX, 78229, USA.
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Siuda J, Boczarska-Jedynak M, Budrewicz S, Dulski J, Figura M, Fiszer U, Gajos A, Gorzkowska A, Koziorowska-Gawron E, Koziorowski D, Krygowska-Wajs A, Rudzińska-Bar M, Sławek J, Ren X, Luo S, Martinez-Martin P, Stebbins G, Goetz CG, Opala G, Janik P, Koszewicz M, Leńska-Mieciek M, Michałowska M, Piaścik-Gromada M, Potasz-Kulikowska K, Śmiłowski M, Wasielewska A, Wójcik-Pędziwiatr M. Validation of the Polish version of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Neurol Neurochir Pol 2020; 54:416-425. [PMID: 32639019 DOI: 10.5603/pjnns.a2020.0049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 2008, the Movement Disorders Society (MDS) published a new Unified Parkinson's Disease Rating Scale (MDS-UPDRS) as the official benchmark scale for Parkinson's Disease (PD). We have translated and validated the Polish version of the MDS-UPDRS, explored its dimensionality, and compared it to the original English one. METHODS The MDS-UPDRS was translated into Polish by a team of Polish investigators led by JS and GO. The back-translation was completed by colleagues fluent in both languages (Polish and English) who were not involved in the original translation, and was reviewed by members of the MDS Rating Scales Programme. Then the translated version of the MDS-UPDRS underwent cognitive pretesting, and the translation was modified based on the results. The final translation was approved as the Official Working Document of the MDS-UPDRS Polish version, and was tested on 355 Polish PD patients recruited at movement disorders centres all over Poland (at Katowice, Gdańsk, Łódź, Warsaw, Wrocław, and Kraków). Confirmatory and explanatory factor analyses were applied to determine whether the factor structure of the English version could be confirmed in the Polish version. RESULTS The Polish version of the MDS-UPDRS showed satisfactory clinimetric properties. The internal consistency of the Polish version was satisfactory. In the confirmatory factor analysis, all four parts had greater than 0.90 comparative fit index (CFI) compared to the original English MDS-UPDRS. Explanatory factor analysis suggested that the Polish version differed from the English version only within an acceptable range. CONCLUSIONS AND CLINICAL IMPLICATIONS The Polish version of the MDS-UPDRS meets the requirements to be designated as the Official Polish Version of the MDS-UPDRS, and is available on the MDS web page. We strongly recommend using the MDS-UPDRS instead of the UPDRS for research purposes and in everyday clinical practice.
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Affiliation(s)
- Joanna Siuda
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | | | | | - Jarosław Dulski
- Department of Neurological-Psychiatric Nursing, Medical University of Gdansk, Gdansk, Poland,Neurology and Stroke Department, St. Adalbert Hospital, Gdańsk, Poland
| | - Monika Figura
- Department of Neurology, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Urszula Fiszer
- Department of Neurology and Epileptology, Centre of Postgraduate Medical Education, Orłowski Hospital, Warsaw, Poland
| | - Agata Gajos
- Department of Extrapyramidal Diseases, Medical University of Łódź, Łódź, Poland
| | - Agnieszka Gorzkowska
- Department of Neurorehabilitation, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Dariusz Koziorowski
- Department of Neurology, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Anna Krygowska-Wajs
- Department of Neurology, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Monika Rudzińska-Bar
- Department of Neurology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Jarosław Sławek
- Department of Neurological-Psychiatric Nursing, Medical University of Gdansk, Gdansk, Poland,Neurology and Stroke Department, St. Adalbert Hospital, Gdańsk, Poland
| | - Xuehan Ren
- Department of Biostatistics, Gilead Sciences, Inc., Foster City, California, USA
| | - Sheng Luo
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Pablo Martinez-Martin
- National Centre of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - Glenn Stebbins
- Department of Neurological Sciences, Rush University Medical Centre, Chicago, Illinois, USA
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Centre, Chicago, Illinois, USA
| | - Grzegorz Opala
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland,Department of Neurology, Wroclaw Medical University, Wroclaw, Poland,Department of Neurology, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland,Department of Neurology and Epileptology, Centre of Postgraduate Medical Education, Orłowski Hospital, Warsaw, Poland,Department of Extrapyramidal Diseases, Medical University of Łódź, Łódź, Poland,Department of Neurology, Jagiellonian University, Collegium Medicum, Krakow, Poland,Department of Neurology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland,Department of Neurology, The John Paul II Specialist Hospital in Kraków, Poland
| | - Piotr Janik
- Department of Neurology, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | | | - Marta Leńska-Mieciek
- Department of Neurology and Epileptology, Centre of Postgraduate Medical Education, Orłowski Hospital, Warsaw, Warsaw, Poland
| | - Małgorzata Michałowska
- Department of Neurology and Epileptology, Centre of Postgraduate Medical Education, Orłowski Hospital, Warsaw, Warsaw, Poland
| | - Marta Piaścik-Gromada
- Department of Neurology and Epileptology, Centre of Postgraduate Medical Education, Orłowski Hospital, Warsaw, Warsaw, Poland
| | | | - Marek Śmiłowski
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia,, Medyków 14, 40-752 Katowice, Poland
| | - Anna Wasielewska
- Department of Neurology , The John Paul II Specialized Hospital in Kraków, Kraków, Poland
| | - Magdalena Wójcik-Pędziwiatr
- Department of Neurology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Cracow, Poland
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Abstract
INTRODUCTION Pure word deafness is a rare neurological disorder linked with an inability to comprehend speech. The precise localization of damage is still unclear. CASE PRESENTATION A 72-year-old woman presented with acute verbal contact disturbances, disorientation, and anxiety. In the neurological examination a slight right hemiparesis was found, together with a pure word deafness (PWD) in neuropsychological tests. Neuroimages confirmed bilateral ischemic lesions in the superior temporal gyrus (STG) acute in the left hemisphere. CONCLUSIONS Our case suggested that bilateral, symmetric lesions in the region of STG could cause pure world deafness. The diversity and severity of symptoms confirm the necessity of pure world deafness classification for subtypes.
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Affiliation(s)
| | - Maria Ejma
- Department of Neurology, Medical University , Wroclaw, Poland
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Dziadkowiak E, Ejma M, Wieczorek M, Pec P, Slotwinski K, Budrewicz S, Zimny A, Koszewicz M. The assessment of sensory pathway in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mulak A, Koszewicz M, Panek-Jeziorna M, Koziorowska-Gawron E, Budrewicz S. Fecal Calprotectin as a Marker of the Gut Immune System Activation Is Elevated in Parkinson's Disease. Front Neurosci 2019; 13:992. [PMID: 31611762 PMCID: PMC6776883 DOI: 10.3389/fnins.2019.00992] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/03/2019] [Indexed: 12/26/2022] Open
Abstract
Introduction Alpha-synucleinopathy constituting a characteristic feature of Parkinson’s disease (PD) occurs at all levels of the brain-gut axis including the enteric nervous system (ENS). Lesions in the ENS may be connected with gut inflammation, increased intestinal permeability and dysmotility contributing to the pathogenesis of PD and its gastrointestinal manifestations. Aims To evaluate fecal calprotectin and zonulin as biomarkers of gut inflammation and intestinal barrier dysfunction in PD patients. Methods Quantitative evaluation of fecal biomarkers was performed by ELISA tests in 35 PD patients and 20 healthy controls. Additionally, patients filled out a short questionnaire concerning gastrointestinal symptoms. Results Median fecal calprotectin level (μg/g) was significantly higher in PD patients compared to the controls: 54.5 (29.0–137.9) vs. 9.7 (5.2–23.3), p < 0.0001. Applying age-related reference ranges, the increased fecal calprotectin level was found in 43% of PD patients and in none of the control subjects (p < 0.001). No correlation between fecal calprotectin level and PD duration was observed. No statistically significant difference between the groups regarding zonulin level was found. The most frequent bowel symptoms reported by PD patients included constipation (69% of subjects), feeling of incomplete evacuation (51%), bloating (51%), abdominal pain (20%), and alternating bowel movement pattern (17%). Conclusion The evaluation of fecal calprotectin level may be a useful tool to detect the signs of gut immune system activation present in a remarkable number of PD patients, also in the early stage of the disease. Calprotectin may constitute a critical link between amyloid formation and neuroinflammatory cascades serving as a prospective diagnostic and therapeutic target.
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Affiliation(s)
- Agata Mulak
- Department of Gastroenterology and Hepatology, Wrocław Medical University, Wrocław, Poland
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Dziadkowiak E, Ejma M, Wieczorek M, Pec P, Slotwinski K, Budrewicz S, Zimny A, Koszewicz M. P39-S Multimodal evoked potentials in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2019.04.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Szczepańska A, Dziadkowiak E, Bladowska J, Kipiński L, Budrewicz S, Koszewicz M. The Usefulness of Quantitative EEG and Advanced MR Techniques in the Monitoring and Long-Term Prognosis of Lance-Adams Syndrome. Front Neurol 2019; 10:214. [PMID: 30915026 PMCID: PMC6422875 DOI: 10.3389/fneur.2019.00214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 02/19/2019] [Indexed: 11/13/2022] Open
Abstract
Objectives: Chronic post-hypoxic myoclonus, known as Lance-Adams syndrome (LAS), is a rare complication of successful cardiopulmonary resuscitation. It is characterized by intention myoclonus, cerebellar ataxia, and preserved intellect. The basis of the disease and its long-term prognosis remain unclear. Case report: The authors present a 53-year-old woman with a history of asthma bronchiale who suffered from myoclonus after hypoxic brain damage due to cardiac arrest. Advanced electrophysiological (quantitative EEG) and MR (MR spectroscopy) techniques were employed. Conclusions: Over long-term observation the results suggested permanent synaptic rearrangements of the neuronal networks due to brain plasticity in the patient after the brain hypoxia.
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Affiliation(s)
| | - Edyta Dziadkowiak
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | - Joanna Bladowska
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
| | - Lech Kipiński
- Department of Pathophysiology, Wroclaw Medical University, Wroclaw, Poland
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Marusiak J, Fisher BE, Jaskólska A, Słotwiński K, Budrewicz S, Koszewicz M, Kisiel-Sajewicz K, Kamiński B, Jaskólski A. Eight Weeks of Aerobic Interval Training Improves Psychomotor Function in Patients with Parkinson's Disease-Randomized Controlled Trial. Int J Environ Res Public Health 2019; 16:ijerph16050880. [PMID: 30861998 PMCID: PMC6427316 DOI: 10.3390/ijerph16050880] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 11/28/2022]
Abstract
Background: This study examined the generalized effects of cycle ergometer aerobic interval training (AIT) on psychomotor behaviors in individuals with Parkinson’s disease (PD), including bimanual motor control, cognitive function, and neurological motor and non-motor parkinsonian signs. Methods: Twenty mild to moderate PD patients were randomly allocated to the following groups: (1) trained group (PD-TR, n = 10), which besides receiving usual care, underwent an 8-week moderate intensity AIT program; or (2) control group (PD-CO, n = 10) which received usual care, including participation in conventional physical therapy. Both groups were tested before and after the 8-week AIT program period with the following assessments: (1) laboratory analyses of bimanual motor control, (2) psychological evaluation of cognitive function, and (3) an evaluation of neurological parkinsonian signs. Results: The PD-TR group exhibited improved (1) bimanual motor control, reflected by a decreased time (p = 0.013) and increased rate of grip force development (p = 0.013) in the manipulating hand and a decreased time delay between grip force initiation in the manipulating and stabilizing hand (p = 0.020); (2) executive function, reflected by decreased performance time in part II of the Stroop Test (p = 0.007); and (3) neurological parkinsonian signs, reflected by an amelioration of upper-extremity bradykinesia (p = 0.015) and improvement in daily life manual functions (p = 0.004), mood, and intellectual function (p = 0.005). Conclusions: Following an 8-week moderate intensity AIT program, patients with PD exhibited improved psychomotor behaviors, reflected by bimanual motor control, executive function, and neurological parkinsonian signs.
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Affiliation(s)
- Jarosław Marusiak
- Department of Kinesiology, Faculty of Physiotherapy, University School of Physical Education, Al. I.J. Paderewskiego 35, Building P4, 51-612 Wroclaw, Poland.
| | - Beth E Fisher
- Division of Biokinesiology and Physical Therapy and Department of Neurology, University of Southern California, Los Angeles, CA 90033, USA.
| | - Anna Jaskólska
- Department of Kinesiology, Faculty of Physiotherapy, University School of Physical Education, Al. I.J. Paderewskiego 35, Building P4, 51-612 Wroclaw, Poland.
| | | | - Sławomir Budrewicz
- Department of Neurology, Medical University of Wroclaw, 50-566 Wroclaw, Poland.
| | - Magdalena Koszewicz
- Department of Neurology, Medical University of Wroclaw, 50-566 Wroclaw, Poland.
| | - Katarzyna Kisiel-Sajewicz
- Department of Kinesiology, Faculty of Physiotherapy, University School of Physical Education, Al. I.J. Paderewskiego 35, Building P4, 51-612 Wroclaw, Poland.
| | - Bartosz Kamiński
- Department of Kinesiology, Faculty of Physiotherapy, University School of Physical Education, Al. I.J. Paderewskiego 35, Building P4, 51-612 Wroclaw, Poland.
| | - Artur Jaskólski
- Department of Kinesiology, Faculty of Physiotherapy, University School of Physical Education, Al. I.J. Paderewskiego 35, Building P4, 51-612 Wroclaw, Poland.
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Koszewicz M, Szydlo M, Gosk J, Wieczorek M, Budrewicz S. Use of collision tests to identify physiological differences between the median and ulnar nerves. Muscle Nerve 2019; 59:470-474. [PMID: 30681158 DOI: 10.1002/mus.26428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 01/11/2019] [Accepted: 01/20/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Median and ulnar nerves are used in comparative electrophysiological studies. We analyzed the conduction values in these hand nerves in healthy volunteers to find any physiological differences between them. METHODS We performed standard conduction studies and conduction velocity distribution (CVD) tests with estimation of 3 quartiles in 31 healthy right-handed volunteers (17 women, 14 men) with a mean age of 44.8 ± 15.5 years. RESULTS The conduction velocities in all quartiles of CVD tests were statistically faster in the ulnar nerve (P < 0.00001), with no differences in the spread of conduction values and no differences between sides. In the ulnar nerve, CVD velocities in all quartiles were faster in the female group (P < 0.05). DISCUSSION The ulnar nerve has more fibers conducting with high velocities than does the median nerve. Electrophysiological comparisons between hand nerves must be performed carefully. Muscle Nerve 59:470-474, 2019.
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Affiliation(s)
- Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Mariusz Szydlo
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Jerzy Gosk
- Department of Trauma and Hand Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Malgorzata Wieczorek
- Faculty of Earth Sciences and Environmental Management, University of Wrocław, Wroclaw, Poland
| | - Slawomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
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Budrewicz S, Zmarzły A, Rączka D, Szczepańska A, Koziorowska-Gawron E, Słotwiński K, Koszewicz M. Clinical and nutritional correlations in Parkinson's disease: Preliminary report. ADV CLIN EXP MED 2019; 28:193-198. [PMID: 29963785 DOI: 10.17219/acem/76375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is one of the most common neurodegenerative disorders. Malnutrition is an essential problem in the late stage of PD. Lowering of body mass is seen in 30% of patients, and malnutrition or the risk of malnutrition in 24% and 60%, respectively. OBJECTIVES The aim of the study was an analysis of the relationships between the parameters of the nutritional stage and the advancement of clinical symptoms in PD patients. MATERIAL AND METHODS A total of 40 patients (18 men, 22 women) with PD were analyzed, mean age: 70.7 years. In all patients, structured anamnesis, Nutrition Risk Screening (NRS 2002), body mass index (BMI), morphology, and basic biochemical tests were conducted. Skin fold thickness was also measured. The results were referred to the score of different scales. RESULTS The study showed a lot of correlations between the severity of PD, mostly motor symptoms in the Unified Parkinson's Disease Rating Scale (UPDRS), and parameters characterizing the patient's nutritional status. We revealed a correlation between malnutrition and PD duration, and l-DOPA frequency intake. The global score of parts I, II and III of UPDRS were correlated with the nutritional status. The results confirmed the existence of more severe smell change and taste impairment in the late stage of PD, with more pronounced malnutrition. CONCLUSIONS The duration of PD, motor and non-motor PD symptoms, and the frequency of l-DOPA intake closely correlate with the nutritional status. Understanding of the multifactorial interdependence might be useful in the estimation of the algorithm for monitoring the nutritional status of PD patients and taking early nutritional intervention.
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Affiliation(s)
| | - Anna Zmarzły
- Clinical Nutrition Unit, J. Gromkowski Regional Specialist Hospital, Wrocław, Poland
| | - Dominik Rączka
- Clinical Nutrition Unit, J. Gromkowski Regional Specialist Hospital, Wrocław, Poland
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Gosk-Bierska I, Misterska-Skóra M, Wasilewska M, Bilińska M, Gosk J, Adamiec R, Koszewicz M. Analysis of peripheral nerve and autonomic nervous system function and the stage of microangiopathy in patients with secondary Raynaud's phenomenon in the course of connective tissue diseases. ADV CLIN EXP MED 2018; 27:1587-1592. [PMID: 29558039 DOI: 10.17219/acem/75618] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The pathogenesis of secondary Raynaud's phenomenon (SRP) associated with connective tissue diseases (CTD) is not entirely understood. Nervous system dysfunction and microangiopathy are considered to be causes of this pathology. OBJECTIVES Peripheral and autonomic nervous system function, the stage of microangiopathy, and the relationships between these in patients with SRP were analyzed. MATERIAL AND METHODS In the study, 20 patients with CTD-related SRP and 30 healthy controls were subject to capillaroscopy, standard conduction velocity tests and conduction velocity distribution (CVD) tests in ulnar and peroneal nerves, heart rate variability (HRV), and sympathetic skin response (SSR) tests. RESULTS There were no significant differences in the standard motor and sensory conduction velocity tests, or in CVD tests in the ulnar and peroneal nerves in SRP patients compared with the controls. The patients with SRP had a significantly lower SSR amplitude and longer latency in hands and feet. The patients with CTD-related SRP had a significantly lower mean HRV with higher low frequency (LF) values in the spectral analysis and expiration/inspiration ratio (E/I) during deep breathing. There was no correlation between the stage of microangiopathy and neurophysiological test results. CONCLUSIONS Correct standard conduction velocity and CVD testing in patients with SPR suggest that vasomotor disturbances may occur in CTD regardless of peripheral neuropathy. The lack of relationship between SSR and microangiopathy could confirm that these 2 processes occur independently in patients with CTD-related SRP. Autonomic nervous system impairment together with normal peripheral nerve function suggest the central origin of CTD-related SRP.
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Affiliation(s)
- Izabela Gosk-Bierska
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Poland
| | - Maria Misterska-Skóra
- Department and Clinic of Rheumatology and Internal Medicine, Wroclaw Medical University, Poland
| | - Marta Wasilewska
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Poland
| | | | - Jerzy Gosk
- Clinical Department of Traumatology and Hand Surgery, Wroclaw Medical University, Poland
| | - Rajmund Adamiec
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Poland
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Koziorowska-Gawron E, Kaczorowski M, Bladowska J, Budrewicz S, Koszewicz M, Hałoń A. Diagnostic Difficulties in Primary Pauci-Melanotic Leptomeningeal Melanomatosis. Eur Neurol 2018; 80:68-70. [PMID: 30231251 DOI: 10.1159/000493197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 08/22/2018] [Indexed: 11/19/2022]
Abstract
We present a rare case of primary malignant melanoma of the central nervous system. We underline the difficulties we faced during diagnostic procedures. Finally, postmortem examination revealed the diagnosis of primary pauci--melanotic leptomeningeal melanomatosis.
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Affiliation(s)
| | - Maciej Kaczorowski
- Department of Pathomorphology and Oncologic Cytology, Wroclaw Medical University, Wroclaw, Poland
| | - Joanna Bladowska
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
| | | | | | - Agnieszka Hałoń
- Department of Pathomorphology and Oncologic Cytology, Wroclaw Medical University, Wroclaw, Poland
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Marusiak J, Jaskólska A, Budrewicz S, Koszewicz M, Andrzejewska R, Kisiel-Sajewicz K, Jaskólski A. Influence of dopaminergic treatment on resting elbow joint angle control mechanisms in patients with Parkinson's disease - a preliminary report. Acta Bioeng Biomech 2018; 20:75-82. [PMID: 30892280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE Heightened tonic stretch reflex contributes to increased muscle tone and a more-flexed resting elbow joint angle (EJA) in patients with Parkinson's disease (PD). Dopaminergic medication restores central nervous system (CNS) functioning and decreases resting muscle electrical and mechanical activities. This study aimed to evaluate the effects of dopaminergic medication on parkinsonian rigidity, resting EJA, resting electrical activity (electromyography, EMG) and mechanical properties (myotonometry, MYO) of elbow flexor muscles and the associations of EJA with these muscles resting electrical activity and mechanical properties in PD patients. We also evaluated a relationship between dopaminergic treatment dose and these outcome measures values. METHODS Ten PD patients (age 68 ± 10.1 years; body mass 70 ± 16.8 kg; height 162 ± 6.6 cm; illness duration 9 ± 4.5 years) were tested during medication on- and off-phases. Resting EJA, myotonometric muscle stiffness (S-MYO) and root mean square electromyogram amplitude (RMS-EMG) were recorded from relaxed biceps brachii and brachioradialis muscles. Based on the above parameters, we also calculated the EJA/S-MYO ratio and EJA/RMS-EMG ratio. Parkinsonian rigidity was assessed using the motor section of the Unified Parkinson's Disease Rating Scale. RESULTS EJA, EJA/S-MYO ratio, and EJA/RMS-EMG ratio were increased and S-MYO, RMS-EMG, and parkinsonian rigidity were decreased during the medication on-phase compared with the off-phase. In addition, the dopaminergic treatment dose was negatively correlated with S-MYO and RMS-EMG, and positively correlated with EJA/SMYO and EJA/RMS-EMG ratios. CONCLUSIONS We conclude that dopaminergic medication- induced improvements in resting elbow joint angle in tested patients with PD are related to changes in their muscle electrical and mechanical properties.
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Affiliation(s)
- Jarosław Marusiak
- Department of Kinesiology, Faculty of Physiotherapy, University School of Physical Education, Wrocław, Poland
| | - Anna Jaskólska
- Department of Kinesiology, Faculty of Physiotherapy, University School of Physical Education, Wrocław, Poland
| | | | | | - Renata Andrzejewska
- Department of Kinesiology, Faculty of Physiotherapy, University School of Physical Education, Wrocław, Poland
| | - Katarzyna Kisiel-Sajewicz
- Department of Kinesiology, Faculty of Physiotherapy, University School of Physical Education, Wrocław, Poland
| | - Artur Jaskólski
- Department of Kinesiology, Faculty of Physiotherapy, University School of Physical Education, Wrocław, Poland
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Budrewicz S, Koszewicz M, Zmarzly A, Raczka D, Koziorowska-Gawron E, Szczepańska A, Slotwinski K, Podemski R. The usefulness of skin fold thickness measurements in the estimation of the nutritional status in Parkinson disease. Parkinsonism Relat Disord 2018. [DOI: 10.1016/j.parkreldis.2017.11.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Koszewicz M, Budrewicz S, Zmarzly A, Raczka D, Koziorowska-Gawron E, Szczepańska A, Slotwinski K, Podemski R. The influence of smell and taste disturbances on the nutritional status in Parkinson disease. Parkinsonism Relat Disord 2018. [DOI: 10.1016/j.parkreldis.2017.11.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gajos A, Budrewicz S, Koszewicz M, Bieńkiewicz M, Dąbrowski J, Kuśmierek J, Sławek J, Bogucki A. Is nigrostriatal dopaminergic deficit necessary for Holmes tremor to develop? The DaTSCAN and IBZM SPECT study. J Neural Transm (Vienna) 2017; 124:1389-1393. [PMID: 28836067 PMCID: PMC5653710 DOI: 10.1007/s00702-017-1780-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/14/2017] [Indexed: 12/28/2022]
Abstract
Holmes’s tremor (HT) is assumed to be the result of coexistence of nigrostriatal dopaminergic system impairment and the lesion of cerebello-thalamic pathways. It was suggested that dopaminergic deficiency is responsible for rest tremor, and lack of compensatory cerebellar function leads to spill of tremor into voluntary movements. Cases of HT with and without abnormalities of the presynaptic part of dopaminergic nigrostriatal were published and these findings raised the question of possibility of the postsynaptic lesion. Three patients with HT diagnosed according to criteria of Consensus Statement on Tremor were studied. In all of them SPECT imaging with ligands of presynaptic (I 123-FP CIT—DaTSCAN) and postsynaptic (I 123-iodobenzamide—IBZM) nigrostriatal dopaminergic neurons was performed. Indices of uptake in caudate and putamen normalized to nonspecific uptake in occipital cortex and indices of asymmetry for each whole striatum as well as for putamen and caudate separately were calculated. SPECT studies did not reveal asymmetry of DaTSCAN and IBZM binding in striatum in all studied subjects. The current clinical diagnostic criteria of HT are presumably insufficiently specific and when using them we identify patients both with and without the involvement of dopaminergic system. These two groups may represent tremor disorders of similar phenomenology but of different pathomechanism.
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Affiliation(s)
- Agata Gajos
- Department of Extrapyramidal Diseases, Central University Hospital, Medical University of Łódź, Pomorska 251 Str, 92-213, Łódź, Poland
| | | | | | - Małgorzata Bieńkiewicz
- Department of Quality Control and Radiological Protection, Medical University of Łódź, Łódź, Poland
| | - Janusz Dąbrowski
- Department of Nuclear Medicine, Medical University of Łódź, Łódź, Poland
| | - Jacek Kuśmierek
- Department of Nuclear Medicine, Medical University of Łódź, Łódź, Poland
| | - Jarosław Sławek
- Department of Neurological and Psychiatric Nursing, Medical University of Gdańsk, Gdańsk, Poland
| | - Andrzej Bogucki
- Department of Extrapyramidal Diseases, Central University Hospital, Medical University of Łódź, Pomorska 251 Str, 92-213, Łódź, Poland.
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Koszewicz M, Michalak S, Bilinska M, Budrewicz S, Zaborowski M, Slotwinski K, Podemski R, Ejma M. Profile of autonomic dysfunctions in patients with primary brain tumor and possible autoimmunity. Clin Neurol Neurosurg 2016; 151:51-54. [PMID: 27788421 DOI: 10.1016/j.clineuro.2016.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/13/2016] [Accepted: 10/21/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Cerebral lesion due to different neurological conditions could be complicated by autonomic dysfunction, reported in the literature as a sympathetic hyperactivity. The mechanisms of dysautonomia still remains partial. The aim of the study was to assess the profile of autonomic dysfunction in patient with primary brain tumors, with attempt to estimate the additional factors in pathogenesis of dysautonomia. MATERIAL AND METHODS Neurological examinations, the Low's autonomic disorder questionnaire, electrophysiological autonomic tests (Heart Rate Variability test at rest and during deep breathing, spectral analysis of R-R intervals, sympathetic skin response test), studies of peripheral nerves, blood sampling collection for antibodies were done in 33 patients with recognized primary brain tumors. RESULTS The averaged Low's Questionnaire score in the patients group was significantly higher than in the controls, systolic blood pressure was increased, heart rate tended to be higher without significance, but heart rate variability was severe low, LF/HF ratio also tended to be higher in the patients group. In SSR test the amplitude of responses from hand and foot was significantly lower without changes in their latencies. We found changes in the electrophysiological tests of peripheral nerves, and positive anti-neural antibodies in 5 patients. CONCLUSIONS The results of the study indicated to the sympathetic nervous system hyperactivity in patients with primary brain tumors. Local brain lesion with high intracranial pressure, additional peripheral nerve damage probably in the course of autoimmunity, and direct influence of autoimmunity to the central part of autonomic nervous system are possible in the pathogenesis of dysautonomia.
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Affiliation(s)
- Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
| | - Slawomir Michalak
- Department of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznan, Poland; Neuroimmunological Unit, Miroslaw Mossakowski Medical Research Center of the Polish Academy of Sciences, Przybyszewskiego 49, 60-355 Poznan, Poland.
| | - Malgorzata Bilinska
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
| | - Slawomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
| | - Mikolaj Zaborowski
- Division of Gynecologic Oncology, Department of Gynecology, Obstetrics and Gynecologic Oncology, Poznan University of Medical Sciences, Polna 33, 60-535 Poznan, Poland.
| | - Krzysztof Slotwinski
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
| | - Ryszard Podemski
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
| | - Maria Ejma
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
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Koszewicz M, Michalak S, Bilinska M, Budrewicz S, Zaborowski M, Slotwinski K, Podemski R, Ejma M. Is peripheral paraneoplastic neurological syndrome possible in primary brain tumors? Brain Behav 2016; 6:e00465. [PMID: 27186442 PMCID: PMC4851647 DOI: 10.1002/brb3.465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/14/2016] [Accepted: 03/07/2016] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Systemic malignant diseases cause the induction of autoimmunity, for example, paraneoplastic syndromes. There are no proofs of paraneoplastic syndromes in primary brain tumors. The aim of the study was to evaluate the involvement of the peripheral nervous system, together with an assessment of onconeuronal and antineural antibodies as indicators of humoral immune response against nervous system in patients with primary brain tumors. MATERIALS AND METHODS Clinical examinations, electrophysiological studies of peripheral nerves (motor and sensory conduction velocity studies, conduction velocity distribution tests, thermal and vibratory quantitative sensory tests, and sympathetic skin response tests) and muscles, blood sampling collection (assessment of onconeuronal, and antineural antibodies) were performed on 33 patients with newly recognized primary brain tumors within 2-4 days after their admission to our department. RESULTS We revealed statistically significant changes of peripheral nerves, more pronounced in the peroneal nerve in standard and conduction velocity distribution tests, as well as in sympathetic skin responses. We revealed significantly higher vibratory thresholds, and pain thresholds for cold and warm in the upper and lower limbs in the study group than in the controls. In five patients, we have identified anti-neuroendothelium, anti-GFAP, anti-MAG, anti-PCNA, and anti-Ro52 antibodies. CONCLUSIONS In patients with primary brain tumors, electrophysiological changes in peripheral nerves, together with the presence of the antineural antibodies suggest an autoimmune humoral response, and make the diagnosis of paraneoplastic neurological syndrome possible.
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Affiliation(s)
- Magdalena Koszewicz
- Department of Neurology Wroclaw Medical University Borowska 213 51-669 Wroclaw Poland
| | - Slawomir Michalak
- Department of Neurochemistry and Neuropathology Poznan University of Medical Sciences Poznan Poland; Neuroimmunological Unit Miroslaw Mossakowski Medical Research Center of the Polish Academy of Sciences Wroclaw Poland
| | - Malgorzata Bilinska
- Department of Neurology Wroclaw Medical University Borowska 213 51-669 Wroclaw Poland
| | - Slawomir Budrewicz
- Department of Neurology Wroclaw Medical University Borowska 213 51-669 Wroclaw Poland
| | - Mikolaj Zaborowski
- Division of Gynecologic Oncology Department of Gynecology, Obstetrics and Gynecologic Oncology Poznan University of Medical Sciences Poznan Poland
| | - Krzysztof Slotwinski
- Department of Neurology Wroclaw Medical University Borowska 213 51-669 Wroclaw Poland
| | - Ryszard Podemski
- Department of Neurology Wroclaw Medical University Borowska 213 51-669 Wroclaw Poland
| | - Maria Ejma
- Department of Neurology Wroclaw Medical University Borowska 213 51-669 Wroclaw Poland
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Budrewicz S, Szewczyk P, Bladowska J, Podemski R, Koziorowska-Gawron E, Ejma M, Słotwiński K, Koszewicz M. The possible meaning of fractional anisotropy measurement of the cervical spinal cord in correct diagnosis of amyotrophic lateral sclerosis. Neurol Sci 2015; 37:417-21. [PMID: 26590991 PMCID: PMC4789300 DOI: 10.1007/s10072-015-2418-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/03/2015] [Indexed: 12/11/2022]
Abstract
Diagnosis of amyotrophic lateral sclerosis (ALS) is based on clinical criteria and electrophysiological tests (electromyography, and transcranial magnetic stimulation). In the search for ALS biomarkers, the role of imaging procedures is currently emphasized, especially modern MR techniques. MR procedures were performed on 15 ALS patients and a sex- and age-matched control group. The MR examinations were performed with a 1.5-T MR unit, and the protocol consisted of sagittal T1-weighed images, sagittal and axial T2-weighed images, and sagittal T2-weighed FAT SAT images followed by an axial diffusion tensor imaging (DTI) sequence of the cervical spinal cord. FA values in individual segments of the cervical spinal cord were decreased in the ALS group in comparison with the control group. After comparing FA values for anterior, posterior, and lateral corticospinal columns, the greatest difference was observed between the C2 and C5 segments. Spinal cord assessment with the use of FA measurements allows for confirmation of the motor pathways lesion in ALS patients. The method, together with clinical criteria, could be helpful in ALS diagnosis, assessment of clinical course, or even the effects of new drugs. The results also confirmed the theory of the generalized character of ALS.
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Affiliation(s)
- Slawomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Pawel Szewczyk
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
| | - Joanna Bladowska
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
| | - Ryszard Podemski
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Ewa Koziorowska-Gawron
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Maria Ejma
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Krzysztof Słotwiński
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.
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Waliszewska- Prosol M, Ejma M, Bladowska J, Koszewicz M, Budrewicz S, Slotwinski K, Podemski R. Electrophysiological visual pathway assessment in correlation with brain mr and mr-spectroscopy in patients with hashimoto’s disease. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Koszewicz M, Michalak S, Budrewicz S, Zaborowski M, Slotwinski K, Podemski R, Ejma M. Neuropathy in patients with confirmed antineural antibodies in the course of primary brain tumors — Case series. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Slotwinski K, Koszewicz M, Dziadkowiak E, Bladowska J, Budrewicz S, Podemski R. Cognitive impairment in patients with chronic inflammatory demyelinating polyneuropathy (Cidp) – preliminary report. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.1226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Budrewicz S, Szewczyk P, Slotwinski K, Koszewicz M. Symptoms of degeneration of the pyramidal tracts in conventional magnetic resonance imaging and diffusion tensor imaging in a young woman with primary lateral sclerosis. J Postgrad Med 2015; 61:206-8. [PMID: 26119443 PMCID: PMC4943406 DOI: 10.4103/0022-3859.150901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Primary lateral sclerosis (PLS) is one of the forms of motor neuron disease (MND), affecting only upper motor neurons. The diagnosis of PLS should be made on different diagnostic criteria, for example, Pringle or Gordon, but it is usually a diagnosis of exclusion. There are no characteristic findings in standard laboratory and electrophysiological assessment. We present details of a 31-year-old woman who had suffered from progressive paraparesis with right-side predominance. Conventional MRI of brain and spinal cord and diffusion tensor imaging (DTI) studies showed Hyperintense lesions in the upper part of the cervical spinal cord at the level C1 in lateral funicules, in the medulla oblongata at the pyramidal decussation and in the midbrain. Brain DTI revealed changes along the corticospinal tracts on fractional anisotropy (FA) maps. MRI of the thoracic spinal cord showed in T2-weighted images hyperintensive regions in the course of the lateral corticospinal tracts. This aided in PLS recognition.
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Affiliation(s)
| | | | | | - M Koszewicz
- Department of Neurology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
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Dolgan A, Budrewicz S, Koszewicz M, Bladowska J, Slotwinski K, Zagrajek M, Koziorowska-Gawron E, Podemski R. Acute Hyperkinetic Syndrome Due to Ephedrone Abuse. J Addict Med 2015; 9:244-5. [DOI: 10.1097/adm.0000000000000048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gosk J, Gutkowska O, Mazurek P, Koszewicz M, Ziółkowski P. Peripheral nerve tumours: 30-year experience in the surgical treatment. Neurosurg Rev 2015; 38:511-20; discussion 521. [DOI: 10.1007/s10143-015-0620-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 09/10/2014] [Accepted: 11/16/2014] [Indexed: 02/07/2023]
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Budrewicz S, Slotwinski K, Koszewicz M, Dolgan A, Podemski R. Impulse control disorder in psychogenic parkinsonism. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Budrewicz S, Koszewicz M, Slotwinski K, Podemski R. Self-assessment of dysarthria in Parkinson's/INS; disease verified by use of computer acoustic speech analysis. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kowalczyk E, Szewczyk P, Budrewicz S, Koszewicz M, Gruszka E, Slotwinski K, Podemski R. Dynamics of magnetic resonance image changes in a patient with Creutzfeldt-Jakob disease. Eur Neurol 2013; 70:139-40. [PMID: 23886950 DOI: 10.1159/000352038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 05/08/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Edyta Kowalczyk
- Department of Neurology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
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Strempska B, Bilinska M, Weyde W, Koszewicz M, Madziarska K, Golebiowski T, Klinger M. The effect of high-tone external muscle stimulation on symptoms and electrophysiological parameters of uremic peripheral neuropathy. Clin Nephrol 2013; 79 Suppl 1:S24-S27. [PMID: 23249529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE AND DESIGN Peripheral neuropathy is a devastating uremic complication that causes debilitating pain and movement limitation. The aim of the study was to assess the influence of high-tone external muscle stimulation (HTEMS) therapy on clinical and electrophysiologycal parameters in hemodialysis patients with uremic peripheral neuropathy. PATIENTS AND INTERVENTIONS The study group consisted of 28 chronic hemodialysis patients (mean age 71.6 ± 8.6 y, median 74 y) on maintenance dialysis for 3 - 187 months (median 31 months). Eight persons (28.9%) were diabetics. All of them exhibited overt peripheral neuropathy and had undergone pharmacological therapy without improvement. All subjects were treated with HTEMS for 1 h during a hemodialysis session, 3 times weekly for 12 weeks. The dialysis parameters (duration of the session, blood and dialysate flow) were constant during the treatment period. Electrophysiological evaluation before and after intervention included assessment of sensory nerves (ulnar nerve, sural nerve) and motor nerves (ulnar nerve, peroneal nerve). The examined nerve conduction parameters were conduction velocity, amplitude, distal latency and F-wave latency. RESULTS In the questionnaire 18 persons (64%) reported improvement of general well-being after HTEMS therapy, 17 persons (61%) felt an increase of physical capacity, and 16 persons (57%) experienced a decreased feeling of cold feet. The electrophysiological findings were obtained in 19 patients who completed the examination before and after the course of HTEMS. A significant improvement was noted in the motor conduction velocity of the ulnar nerve; respective values were 48.53 ± 6.14 vs. 51.50 ± 5.51 m/s, p = 0.03. CONCLUSION The study demonstrated for the first time that the subjective amelioration of uremic peripheral neuropathy by HTEMS treatment is associated with significant improvement in an objective electrophysiological parameter, motor conduction velocity of the ulnar nerve.
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Affiliation(s)
- Beata Strempska
- Department of Nephrology and Transplantation Medicine, and Department of Neurology, Medical University, Wrocław, Poland.
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