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Huang SC, Hsu CC, Fu TC, Chen CPC, Liao MF, Hsu CY, Wang JS. Stepper-Based Training Improves Monocyte-Platelet Aggregation and Thrombin Generation in Nonambulatory Hemiplegic Patients. Med Sci Sports Exerc 2022; 54:821-829. [PMID: 34935707 DOI: 10.1249/mss.0000000000002846] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Nonambulatory stroke patients are extremely sedentary, but most available data concerning exercise training in stroke patients are related to ambulatory patients. This study aimed to investigate the efficacy of stepper-based exercise training on cardiopulmonary fitness, monocyte subtypes, and associated monocyte-platelet aggregates (MPA) and thrombin generation (TrG) in nonambulatory hemiplegic patients with ischemic stroke. METHOD Thirty-eight patients were randomized into exercise training (ET, n = 20) and usual care (UC, n = 18) groups. The ET underwent supervised exercise training (60% peak work rate) using a recumbent stepper for two to four sessions per week and 36 sessions in total. In addition, 12 healthy participants were enrolled as healthy controls. Monocyte characteristics, MPA, and plasma TrG kinetics were determined before and after intervention by flow cytometry and calibrated automated thrombogram® (CAT). RESULTS Seventeen and 15 patients completed the protocol in the ET and UC groups. Peak V̇O2 improved in ET (15.7 ± 4.8 vs 18.9 ± 5.3 mL·min-1·kg-1, +20%), so did the phase angle of the hemiplegic limbs. The counts of total MPA and MPA associated with three monocyte subtypes, alongside CD42b expression all declined in ET with subtypes 2 and 1 being the most prominent. Macrophage inflammatory protein 1β (MIP-1 β) level also declined. The TrG kinetics was attenuated after ET by delaying initiation and reducing the rising slope and peak of thrombin production. In UC, no difference was revealed in the pre-post comparison. CONCLUSIONS Stepper-based ET is feasible in nonambulatory hemiplegic patients and is effective in improving aerobic fitness. Moreover, it decreases heteroaggregation of monocytes with platelets, especially in monocyte subtypes 2 and 1. Thrombin generation was also attenuated. Hence, stepper-based ET may be incorporated in the rehabilitation of nonambulatory hemiplegic patients.
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Affiliation(s)
| | | | | | | | - Ming-Feng Liao
- Department of Neurology, Chang Gung Memorial Hospital, Linkuo, TAIWAN
| | - Chien-Ya Hsu
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital, Linkou, TAIWAN
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Kimura A, Miyagi S. A pilot study of advice on physical activity in senior disabled individuals in rural Japan. Asia Pac J Public Health 2008; 20 Suppl:128-133. [PMID: 19533871] [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: 05/27/2023]
Abstract
This study evaluates the effect of active implementation of the amount of physical activity on the double product (DP) in senior disabled individuals. Our study included 20 hemiplegic patients comprising an intervention group (IG; n = 10) who performed prescribed exercises daily for 12 weeks and a control group (CG; n = 10) for whom physical activity (PA) was measured without intervention. In the IG, the energy consumption during PA with multiple positions and intensity increased significantly as compared to that of the CG. In the IG0 to the CG, the DP decreased significantly. We concluded that advice regarding active implementation increases the amount of PA and improves the DP after a 12-week period.
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Affiliation(s)
- Akira Kimura
- Division of Physical Therapy, School of Rehabilitation, Seirei Christopher University, Mikatahara 3453, Hamamatsu, Sizuoka 433-8558, Japan.
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Abstract
Recent studies indicate beneficial effects of acupuncture in the rehabilitation of vascular dementia (VaD). This study used 18-flourodeoxyglucose PET measures to compare cerebral effects of conventional acupuncture for hemiplegia with that of additional VaD-specific needling. As compared to baseline, conventional acupuncture increased glucose metabolism in the temporal lobe of unaffected and in the lentiform nucleus of the affected hemisphere. Additional needling in VaD-specific points rendered higher metabolism bilaterally in the frontal lobes and the thalamus, and in the temporal lobe and the lentiform nucleus of the unaffected hemisphere. The findings further underpin acupuncture's role in stroke and VaD rehabilitation.
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Affiliation(s)
- Yong Huang
- Department of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China.
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Keefer DJ, Wayland T, Caputo JL, Apperson K, McGreal S, Morgan DW. Within- and between-day stability of treadmill walking VO2 in children with hemiplegic cerebral palsy. Stability of walking VO2 in children with CP. Gait Posture 2005; 22:177-81. [PMID: 16278965 DOI: 10.1016/j.gaitpost.2004.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Within- and between-day stability in locomotor energy use was quantified in 13 children with hemiplegic CP. During testing, subjects were familiarized with the laboratory environment (Session 1), performed three 5-min level treadmill walks (Trials 1, 2, and 3) at 0.67 m x s-1 (Session 2), and completed a single 5-min walk (Trial 4) at 0.67 m x s-1 (Session 3). In Sessions 2 and 3, HR was assessed and expired air was collected and analyzed to determine VO2. Data analyses revealed no significant difference (P > 0.05) in either net VO2 (ml x kg-1 x min-1) or EEIHR (b x m-1) across the three trials performed in Session 2 and between average measures of net VO2 and EEIHR quantified in Session 2 and those obtained in Session 3. Mean within-day coefficient of variation (CV) values for net VO2 and EEIHR were 8.6% +/- 8.5% and 13.9% +/- 7.8%, respectively. Analysis of between-day variability and energy expenditure revealed a between-day CV value of 13.1% for net VO2 and 24.0% for EEIHR. In addition, significant inverse relationships between GMFM scores and within-day (r = -0.61) and between-day (r = -0.58) CV values for net VO2 were detected. Viewed in concert, these data suggest that fairly stable within- and between-day measures of locomotor energy expenditure during level treadmill walking can be achieved in subjects with hemiplegic CP if testing is preceded by a short period of treadmill accommodation. However, children with greater motor dysfunction may require an extended period of treadmill accommodation to reduce trial-to-trial variability in walking energy use.
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Affiliation(s)
- Daniel J Keefer
- Department of Wellness and Sport Sciences, Millersville University, Millersville, PA 17551-0302, USA.
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Abstract
BACKGROUND About 20% of patients with familial hemiplegic migraine (FHM) develop progressive cerebellar signs. Genetic studies have established an association with mutations in the CACNA1A gene. However, the mechanisms underlying cerebellar involvement are largely unknown. OBJECTIVE To use proton MR spectroscopy (1H-MRS) to investigate metabolic alterations in the cerebellum as well as cortical regions known to be involved in the propagation of migraine aura. METHODS Fifteen CACNA1A mutation carriers from three FHM families and 17 healthy control subjects were studied. Eleven patients had clinical signs of cerebellar involvement. LCModel fits were used to estimate absolute concentrations of N-acetyl aspartate (NAA), myo-inositol (mI), glutamate (Glu), choline-containing compounds, total creatine, and lactate in the superior cerebellar vermis (SCV), parietal cortex, and occipital cortex. To control for atrophy effects, automated image segmentation was performed using SPM99. The brain parenchyma fraction (BPF) was determined for all three regions. RESULTS Compared with controls, the brain parenchyma fraction (BPF), NAA, and Glu were significantly reduced and mI was significantly elevated in the SCV of patients with FHM. In contrast, no metabolite alterations were found in supratentorial regions. BPF and NAA in the SCV significantly correlated with cerebellar scores, in particular, gait ataxia. CONCLUSIONS The findings suggest that there is a regionally distinct neuronal impairment in the superior cerebellar vermis that exceeds macroscopic tissue loss. Correlations with clinical scores emphasize the functional relevance of localized atrophy (brain parenchyma fraction) and N-acetyl aspartate levels. These measures may be useful to monitor disease progression. The observed reduction in glutamate may in part reflect impaired glutamatergic neurotransmission.
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Affiliation(s)
- M Dichgans
- Department of Neurology, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany.
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Sato Y, Iwamoto J, Kanoko T, Satoh K. Negative Myoglobin Staining in Hemiplegic Muscle of Acute Stroke Patients Predicts Functional Recovery [Retracted]. Am J Phys Med Rehabil 2005; 84:692-8; quiz 699-700, 718. [PMID: 16141747 DOI: 10.1097/01.phm.0000176552.20059.e1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There is little information on skeletal muscle changes in patients with acute stroke, despite the repeated observation that levels of serum creatine kinase (CK) and myoglobin (Mb) increase in the initial phase of strokes. It is also not clearly known whether the CK and Mb are derived from skeletal muscle or myocardium. DESIGN Biceps muscle biopsies of the hemiplegic side were obtained from 157 ischemic stroke patients on the second day of stroke onset and were examined for immunoreactivity to Mb, and measurements of Mb, total CK, troponin T, epinephrine, and norepinephrine were made on the same day. The degree of disability of patients was assessed at 7 days and at 12 mos after stroke using the Barthel index and the Scandinavian Stroke Scale. The control group consisted of 159 healthy volunteers matched in age and sex. RESULTS Lack of Mb immunoreactivity was observed in 109 patients. The prevalence of negatively stained muscle fibers ranged from 0.0% to 22.0%, with a mean of 5.9% +/- 6.0%. The mean values of serum Mb, CK, troponin T, and norepinephrine were higher in patients than those in the control group (P < 0.0001 for all indices; percentage differences were 658% for Mb, 529% for CK, and 258% for norepinephrine). A positive correlation was observed between the prevalence of negative Mb immunostaining in fibers and the Mb (r2 = 0.968, P < 0.0001), CK (r 2= 0.910, P < 0.0001), and norepinephrine levels (r2 = 0.835, P < 0.0001). During the 12-mo study period, Barthel index and Scandinavian Stroke Scale values improved. The percentage change of the Barthel index and Scandinavian Stroke Scale correlated positively with the prevalence of negative Mb immunostaining in fibers. CONCLUSIONS It was speculated that ischemia, resulting from vasoconstriction induced by an increase in norepinephrine, may be responsible for the occurrence of fibers with negative immunoreactivity for Mb. Patients with higher negative immunostaining for Mb fibers had poor functional recovery of hemiplegia 12 mos after stroke onset. This implies that these muscular alterations may hamper functional recovery.
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Affiliation(s)
- Yoshihiro Sato
- Department of Neurology, Futase Social Insurance Hospital, Iizuka, Japan
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Segall L, Mezzetti A, Scanzano R, Gargus JJ, Purisima E, Blostein R. Alterations in the alpha2 isoform of Na,K-ATPase associated with familial hemiplegic migraine type 2. Proc Natl Acad Sci U S A 2005; 102:11106-11. [PMID: 16037212 PMCID: PMC1178013 DOI: 10.1073/pnas.0504323102] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A number of missense mutations in the Na,K-ATPase alpha2 catalytic subunit have been identified in familial hemiplegic migraine with aura. Two alleles (L764P and W887R) showed loss-of-function, whereas a third (T345A) is fully functional but with altered Na,K-ATPase kinetics. This study describes two additional mutants, R689Q and M731T, originally identified by Vanmolkot et al. [Vanmolkot, K. R., et al. (2003) Ann. Neurol. 54, 360-366], which we show here to also be functional and kinetically altered. Both mutants have reduced catalytic turnover and increased apparent affinity for extracellular K(+). For both R689Q and M731T, sensitivity to vanadate inhibition is decreased, suggesting that the steady-state E(1) <==> E(2) poise of the enzyme is shifted toward E(1). Whereas the K'(ATP) is not affected by the R689Q replacement, the M731T mutant has an increase in apparent affinity for ATP. Analysis of the structural changes effected by T345A, R689Q, and M731T mutations, based on homologous replacements in the known crystal structure of the sarcoplasmic reticulum Ca-ATPase, provides insights into the molecular bases for the kinetic alterations. It is suggested that the disease phenotype is the consequence of lowered molecular activity of the alpha2 pump isoform due to either decreased K(+) affinity (T345A) or catalytic turnover (R689Q and M731T), thus causing a delay in extracellular K(+) clearance and/or altered localized Ca(2+) handling/signaling secondary to reduced activity in colocalized Na(+)/Ca(2+) exchange.
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Affiliation(s)
- Laura Segall
- Departments of Biochemistry and Medicine, McGill University and Montreal General Hospital Research Institute, Montreal, Quebec, Canada H3G 1A4
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Abstract
BACKGROUND Transporters, ion pumps, and ion channels are membrane proteins that regulate selective permeability and maintain ionic gradients across cell membranes. Mutations in CACNA1A encoding a neuronal calcium channel and ATP1A2 encoding an ion pump cause episodic ataxia, hemiplegic migraine, and seizures. Mutant gene products of both CACNA1A and ATP1A2 may affect neurotransmission of glutamate, the most abundant excitatory amino acid neurotransmitter. METHODS We examined our patient population with episodic ataxia and hemiplegic migraine but with no mutation in either CACNA1A or ATP1A2. We looked for mutations in SLC1A3, which encodes the glutamate transporter excitatory amino acid transporter (EAAT) 1 that is important in removing glutamate from the synaptic cleft. RESULTS A patient with episodic ataxia, seizures, migraine, and alternating hemiplegia has a heterozygous mutation in SLC1A3 that is not present in his asymptomatic parents and controls. Expression studies of the mutant EAAT1 showed decreased expression of the protein with a markedly reduced capacity for glutamate uptake. When coexpressed, the mutant EAAT1 decreased the activity of wild-type EAAT1 but not of two other transporters EAAT2 or EAAT3, suggesting that mutant EAAT1 specifically multimerizes with wild-type EAAT1 to exert its dominant negative effect. CONCLUSION Our data show that a heterozygous mutation in EAAT1 can lead to decreased glutamate uptake, which can contribute to neuronal hyperexcitability to cause seizures, hemiplegia, and episodic ataxia.
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Affiliation(s)
- J C Jen
- Department of Neurology, School of Medicine, University of California, Los Angeles, CA 90095, USA
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Castellanos M, Leira R, Tejada J, Gil-Peralta A, Dávalos A, Castillo J. Predictors of good outcome in medium to large spontaneous supratentorial intracerebral haemorrhages. J Neurol Neurosurg Psychiatry 2005; 76:691-5. [PMID: 15834028 PMCID: PMC1739633 DOI: 10.1136/jnnp.2004.044347] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine potential predictors of good outcome in primary medium to large intracerebral haemorrhages (ICH) which could be useful for selecting patients for surgical procedures. METHODS Subjects were 138 patients with spontaneous hemispheric ICH >20 ml. They were non-surgically treated and were admitted consecutively to 15 hospitals within the first 12 hours of symptom onset (mean (SD), 5.8 (3.1) hours). Haematoma volume was measured on computed tomography (CT) at admission. Stroke severity was assessed by the Canadian stroke scale (CSS). Good outcome was defined as modified Rankin score < or =2 at three months. RESULTS At the end of the follow up period, 45 patients (32.6%) had good outcome. Baseline stroke severity, systolic and diastolic blood pressure, body temperature, and acute phase reaction biochemical markers (ESR, C-reactive protein, fibrinogen, neutrophil count) were significantly associated with good outcome in bivariate analyses. Of the initial CT scan variables, intraventricular contamination, deep location, mass effect, and greater ICH volume were related to poor outcome. On multiple logistic regression analysis, cortical location of bleeding (odds ratio 3.79 (95% confidence interval 1.2 to 12.01); p = 0.023), high CSS score (OR 2.3 (1.6 to 3.1); p<0.0001), and low fibrinogen concentrations (OR 0.92 (0.87 to 0.97); p = 0.001) were independent predictors of good outcome. These three factors correctly classified 85% of patients. CONCLUSIONS Good outcome in medium to large ICH can be predicted on admission by three readily assessable factors (CSS score, ICH location, and fibrinogen levels). These predictors may be helpful in selecting patients for surgical treatment.
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Affiliation(s)
- M Castellanos
- Department of Neurology, Hospital Clínico Universitario Santiago de Compostela, Travesa da Choupana s/n, Santiago de Compostela 15706, Spain
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Müllner C, Broos LAM, van den Maagdenberg AMJM, Striessnig J. Familial Hemiplegic Migraine Type 1 Mutations K1336E, W1684R, and V1696I Alter Cav2.1 Ca2+ Channel Gating. J Biol Chem 2004; 279:51844-50. [PMID: 15448138 DOI: 10.1074/jbc.m408756200] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Mutations in the Cav2.1 alpha1-subunit of P/Q-type Ca2+ channels cause human diseases, including familial hemiplegic migraine type-1 (FHM1). FHM1 mutations alter channel gating and enhanced channel activity at negative potentials appears to be a common pathogenetic mechanism. Different beta-subunit isoforms (primarily beta4 and beta3) participate in the formation of Cav2.1 channel complexes in mammalian brain. Here we investigated not only whether FHM1 mutations K1336E (KE), W1684R (WR), and V1696I (VI) can affect Cav2.1 channel function but focused on the important question whether mutation-induced changes on channel gating depend on the beta-subunit isoform. Mutants were co-expressed in Xenopus oocytes together with beta1, beta3, or beta4 and alpha2delta1 subunits, and channel function was analyzed using the two-electrode voltage-clamp technique. WR shifted the voltage dependence for steady-state inactivation of Ba2+ inward currents (IBa) to more negative voltages with all beta-subunits tested. In contrast, a similar shift was observed for KE only when expressed with beta3. All mutations promoted IBa decay during pulse trains only when expressed with beta1 or beta3 but not with beta4. Enhanced decay could be explained by delayed recovery from inactivation. KE accelerated IBa inactivation only when co-expressed with beta3, and VI slowed inactivation only with beta1 or beta3. KE and WR shifted channel activation of IBa to more negative voltages. As the beta-subunit composition of Cav2.1 channels varies in different brain regions, our data predict that the functional FHM1 phenotype also varies between different neurons or even within different neuronal compartments.
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Affiliation(s)
- Carmen Müllner
- Abteilung Pharmakologie und Toxikologie, Institut für Pharmazie, Universität Innsbruck, Peter-Mayrstrasse 1/I, A-6020 Innsbruck, Austria
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Sezer N, Ordu NK, Sutbeyaz ST, Koseoglu BF. Cardiopulmonary and metabolic responses to maximum exercise and aerobic capacity in hemiplegic patients. Funct Neurol 2004; 19:233-8. [PMID: 15776791] [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] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This study evaluated cardiopulmonary and metabolic responses to maximum exercise and aerobic capacity in hemiplegic patients and clarified the relationship between the resulting data and motor disability. Twenty patients with stroke and fifteen healthy controls were included in the study. Cardiopulmonary and metabolic responses to maximum exercise were investigated with an electronically braked arm crank ergometer. Vital capacity, forced expiratory volume in 1 second, peak expiratory flow rate, forced vital capacity, maximum voluntary ventilation, peak power output, respiratory exchange ratio, and exercise time were reduced in stroke patients when compared with the controls. No relationship was found between these data and motor disability. The hemiplegic patients showed a significant respiratory dysfunction and reduced exercise tolerance. These findings suggest that a program of ventilatory and aerobic training should be considered early after stroke to avoid cardiorespiratory problems and deconditioning.
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Affiliation(s)
- Nebahat Sezer
- 4th Physical Medicine and Rehabilitation Clinic, Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
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Ikeda R, Kurokawa MS, Chiba S, Yoshikawa H, Hashimoto T, Tadokoro M, Suzuki N. Transplantation of motoneurons derived from MASH1-transfected mouse ES cells reconstitutes neural networks and improves motor function in hemiplegic mice. Exp Neurol 2004; 189:280-92. [PMID: 15380479 DOI: 10.1016/j.expneurol.2004.05.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2004] [Revised: 05/27/2004] [Accepted: 05/28/2004] [Indexed: 11/30/2022]
Abstract
Mouse embryonic stem (ES) cells were transfected with a MASH1 expression vector and G418-resistant cells were selected. The MASH1-transfected cells became neuron-like appearance and expressed betaIIItubulin and panNCAM. Glial fibrillary acidic protein (GFAP) and galactocerebroside (GalC)-expressing cells were rarely detected. Half of the neural cells differentiated into the Islet1+ motoneuron lineage. Thus, we obtained motoneuron lineage-enriched neuronal cells by transfection of ES cells with MASH1. A hemiplegic model of mice was developed by cryogenic injury of the motor cortex, and motoneuron lineage-enriched neuronal cells were transplanted underneath the injured motor cortex neighboring the periventricular region. The motor function of the recipients was assessed by a beam walking and rotarod tests, whereby the results gradually improved, but little improvement was observed in vehicle injected control mice. We found that the grafted cells not only remained close to the implantation site, but also exhibited substantial migration, penetrating into the damaged lesion in a directed manner up to the cortical region. Grafted neuronal cells that had migrated into the cortex were elongated axon-positive for neurofilament middle chain (NFM). Synaptophysin immunostaining showed a positive staining pattern around the graft, suggesting that the transplanted neurons interacted with the recipient neurons to form a neural network. Our study suggests that the motoneuron lineage can be induced from ES cells, and grafted cells adapt to the host environment and can reconstitute a neural network to improve motor function of a paralyzed limb.
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Affiliation(s)
- Ritsuko Ikeda
- Department of Immunology and Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki, Kanagawa 216-8511, Japan
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Abstract
The disability of patients after stroke is generally attributed to upper motor neuron defects, but secondary changes in paretic muscle may enhance the disability. We analyzed the molecular phenotype and metabolic profile of the paretic and nonparetic vastus lateralis (VL) and we measured the severity of gait deficit in 13 patients at least 6 months after ischemic stroke. The results showed a significant increase in the proportion of fast myosin heavy chain (MHC, 68 +/- 14%) in the paretic compared to the nonparetic VL (50 +/- 13%). The specific activity of citrate synthase and glyceraldehyde phosphodehydrogenase was not significantly different between the two sides. The proportion of fast MHC was inversely associated with severity of gait deficit indexed by self-selected walking speed in the paretic leg, but not the nonparetic leg. Our findings demonstrate significant and potentially modifiable secondary biologic changes in hemiparetic muscle phenotype that may contribute to the disability of stroke.
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Affiliation(s)
- Patrick G De Deyne
- Departments of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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Auvin S, Joriot-Chekaf S, Cuvellier JC, Vallée L. 'Familial alternating hemiplegia of childhood or channelopathy? A report with valuable pathophysiological implications'. Dev Med Child Neurol 2004; 46:500; author reply 501. [PMID: 15230465 DOI: 10.1017/s0012162204210829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Boska MD, Welch KMA, Barker PB, Nelson JA, Schultz L. Contrasts in cortical magnesium, phospholipid and energy metabolism between migraine syndromes. Neurology 2002; 58:1227-33. [PMID: 11971091 DOI: 10.1212/wnl.58.8.1227] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Previous single voxel (31)P MRS pilot studies of migraine patients have suggested that disordered energy metabolism or Mg(2+) deficiencies may be responsible for hyperexcitability of neuronal tissue in migraine patients. These studies were extended to include multiple brain regions and larger numbers of patients by multislice (31)P MR spectroscopic imaging. METHODS Migraine with aura (MWA), migraine without aura (MwoA), and hemiplegic migraine patients were studied between attacks by (31)P MRS imaging using a 3-T scanner. RESULTS Results were compared with those in healthy control subjects without headache. In MwoA, consistent increases in phosphodiester concentration [PDE] were measured in most brain regions, with a trend toward increase in [Mg(2+)] in posterior brain. In MWA, phosphocreatine concentration ([PCr]) was decreased to a minor degree in anterior brain regions and a trend toward decreased [Mg(2+)] was observed in posterior slice 1, but no consistent changes were found in phosphomonoester concentration [PME], [PDE], inorganic phosphate concentration ([Pi]), or pH. In hemiplegic migraine patients, [PCr] had a tendency to be lower, and [Mg(2+)] was significantly lower than in the posterior brain regions of control subjects. Trend analysis showed a significant decrease of brain [Mg(2+)] and [PDE] in posterior brain regions with increasing severity of neurologic symptoms. CONCLUSIONS Overall, the results support no substantial or consistent abnormalities of energy metabolism, but it is hypothesized that disturbances in magnesium ion homeostasis may contribute to brain cortex hyperexcitability and the pathogenesis of migraine syndromes associated with neurologic symptoms. In contrast, migraine patients without a neurologic aura may exhibit compensatory changes in [Mg(2+)] and membrane phospholipids that counteract cortical excitability.
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Affiliation(s)
- M D Boska
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
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Pfund Z, Chugani DC, Muzik O, Juhász C, Behen ME, Lee J, Chakraborty P, Mangner T, Chugani HT. Alpha[11C] methyl-L-typtophan positron emission tomography in patients with alternating hemiplegia of childhood. J Child Neurol 2002; 17:253-60. [PMID: 12088079 DOI: 10.1177/088307380201700403] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Based on previous reports suggesting a role of the neurotransmitter serotonin in the pathomechanism of alternating hemiplegia of childhood and speculation that it may be a migraine variant, we measured brain serotonin synthesis in children with alternating hemiplegia of childhood. Clinical and neurodevelopmental data, as well as standard uptake values in 25 brain regions and whole-brain serotonin synthesis capacity (unidirectional uptake rate constant or K-complex), were assessed in six patients with alternating hemiplegia of childhood (three girls and three boys; mean age = 7 6/12 years) using alpha[11C]methyl-L-tryptophan positron emission tomography (PET). The PET studies were performed interictally in three patients, during the ictal state in two patients, and postictally in one patient. The PET data were compared to those obtained interictally from six age-matched patients with focal epilepsy (two girls and four boys; mean age = 7 8/12 years) and six non-age-matched apparently normal siblings of autistic children (two girls and four boys; mean age = 9 11/12 years). Patients with alternating hemiplegia of childhood studied in the ictal or postictal state showed increased serotonin synthesis capacity in the frontoparietal cortex, lateral and medial temporal structures, striatum, and thalamus when compared to controls, and subjects with alternating hemiplegia of childhood studied interictally. The involvement of these brain regions was consistent with the semiology of the hemiplegic attacks. In patients with interictal studies and in the controls, the PET scans revealed similar and bilaterally symmetric regional patterns of serotonin synthesis capacity. Increased whole-brain serotonin synthesis capacity (reported in migraine subjects without aura) was not found in the alternating hemiplegia of childhood group. There was no correlation between the neurodevelopmental scores and regional standard uptake values; however, patients with a larger estimated lifetime attack number showed greater delay in communication (P = .005) and daily living skills (P = .042). These studies suggest increased regional serotonergic activity associated with attacks in alternating hemiplegia of childhood. Furthermore, the attack number may have an effect on neurodevelopmental delay, thus supporting the notion that alternating hemiplegia of childhood may be a progressive disorder.
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Affiliation(s)
- Zoltán Pfund
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit 48201, USA
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17
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Abstract
Several inherited human neurological disorders can be caused by mutations in genes encoding Ca2+ channel subunits. This review deals with known human and mouse calcium channelopathies of the central nervous system (CNS). The human diseases comprise: 1) a recessive retinal disorder, X-linked congenital stationary night blindness, associated with mutations in the CACNA1F gene, encoding alpha(1)1.4 subunits of L-type channels; and 2) a group of rare allelic autosomal dominant human neurological disorders including familial hemiplegic migraine, episodic ataxia type 2, and spinocerebellar ataxia type 6, all associated with mutations in the CACNA1A gene, encoding alpha(1)2.1 subunits of P/Q-type calcium channels. Mutations at the mouse orthologue of the CACNA1A gene cause a group of recessive neurological disorders, including the tottering, leaner, and rocker phenotypes with ataxia and absence epilepsy, and the rolling Nagoya phenotype with ataxia without seizures. Two other spontaneous mouse mutants with ataxia and absence epilepsy, lethargic and stargazer, have mutations in genes encoding a calcium channel auxiliary beta subunit and a putative calcium channel auxiliary gamma subunit. For each channelopathy, the review describes disease phenotype, channel genotype, and known functional consequences of the pathological mutations; in some cases, it also describes working hypothesis and/or speculations addressing the challenging question of how the alterations in channel function lead to selective cellular dysfunction and disease.
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18
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Abstract
To determine the effect of flunarizine therapy on patients with alternating hemiplegia of childhood (AHC), we sent a questionnaire by mail to council members of the Japanese Society of Child Neurology. We collected 28 AHC patients, and studied their clinical courses and the effects of drug therapy. All of the patients had received flunarizine. In 18 of the 28 patients, flunarizine reduced the severity, duration, or frequency of the hemiplegic attacks. No other drug was more effective than flunarizine. Some flunarizine non-effective patients were severely deteriorated, for example, they had dementia or were ventilator-assisted. Flunarizine had not only a short-term effect, i.e. it reduced the hemiplegic attacks, but also a long-term effect on the motor and intellectual development in some patients with AHC. Flunarizine is still an essential drug for treating AHC.
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Affiliation(s)
- M Sasaki
- Department of Child Neurology, National Center Hospital for Mental, Nervous and Muscular Disorders, National Center of Neurology and Psychiatry (NCNP), 4-1-1 Oagawahigashi-cho, Kodaira, 187-8551, Tokyo, Japan.
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19
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Abstract
OBJECTIVE Stroke is an acute neurologic dysfunction of vascular origin, characterized by loss of voluntary movement, sensory disturbances, and neurologic findings in the contralateral half of the body. Acute and long-term complications because of immobilization are seen in all organ systems. The aim of this study was to determine any differences between the affected and unaffected sides' bone mineral densities of acute and chronic stroke patients. DESIGN In this study, we determined the bone mineral densities (BMD) of 30 male patients with acute (0-20 days) and 30 male patients with chronic (6 months or longer) stroke and compared the densities with the normal side. Upper and lower limb BMDs were measured by dual-energy x-ray absorptiometry. Additionally, patients were evaluated for the degree of spasticity, the phases of motor improvement, and the activities of daily living. RESULTS In acute-phase stroke patients, BMD of the affected side was not significantly different from BMD of the normal side. BMD of both upper limbs of acute stroke patients was not different from normal side upper limb BMD of chronic stroke patients. In both acute and chronic stroke patients, affected and unaffected side lower limb BMDs (femur total BMD scores) were not significantly different. However, in chronic stroke patients, affected side BMD of Ward's region was significantly higher compared with the normal side. There is no correlation between BMD and Brunnstrom phases, Ashworth scales, and the degree of activities of daily living. CONCLUSIONS Higher BMD of the affected side Ward's region in chronic cerebrovascular accident patients may be related to spasticity and changes in walking pattern, which increase the mechanical stress loading of the Ward's region.
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Affiliation(s)
- L Sahin
- Clinic of Physical Medicine and Rehabilitation, Ankara Numune Education and Research Hospital, Turkey
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20
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Abstract
The purpose of this study was to examine the effectiveness of the hinged ankle-foot orthosis (HAFO), posterior leaf spring (PLS), and solid ankle-foot orthosis (SAFO), in preventing contracture, improving efficiency of gait, and enhancing performance of functional motor skills in 30 children (21 male, 9 female; mean age 9 years 4 months; age range 4 to 18 years,) with spastic hemiplegia. Following a 3-month baseline period of no ankle-foot orthosis (AFO) use, each AFO was worn for 3 months after which ankle range of motion, gait analysis, energy consumption, and functional motor skills were assessed. The HAFO and PLS increased passive ankle dorsiflexion and normalization of ankle rocker function during gait. Normalization of knee motion in stance was dependent upon the knee abnormality present and AFO configuration. The HAFO was the most effective in controlling knee hyperextension in stance, while PLS was the most effective in promoting knee extension in children with >10 degree knee flexion in stance. Energy efficiency was improved in 21 of the children, with 13 of these children demonstrating the greatest improvement in HAFO and PLS. Improvements in functional mobility were greatest in the HAFO and PLS.
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Affiliation(s)
- C E Buckon
- Shriners Hospitals for Children, Portland, OR 97201, USA.
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21
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Abstract
Hip fractures on the paretic side are a serious post-stroke complication and may result from disuse hemiosteopenia, hypovitaminosis D, and an increasing risk of falls. To evaluate short-term immobilization effects, we assessed calcium metabolism in 89 patients 1 week after the hemiplegic stroke and in 36 controls. Patient activity was rated using the Barthel index (BI). Sera from stroke patients and control subjects were assayed for ionized calcium, parathyroid hormone (PTH), 25-hydroxyvitamin D (25-OHD), 1, 25-dihydroxyvitamin D (1,25-(OH)(2)D), bone Gla protein (BGP; a bone formation marker) and pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen (ICTP; a bone resorption marker). Patients' serum concentrations of ionized calcium and ICTP were higher than in controls and correlated negatively with BI; their BGP concentrations were low, correlating positively with BI. Concentrations of serum 25-OHD, 1,25-(OH)(2)D, and PTH also were low; serum 25-OHD was at a deficient level (<10 ng/ml) in nine patients (10%), an insufficient level (10-20 ng/ml) in 56 (63%), and a sufficient level (>20 ng/ml) in only 24 (27%). PTH correlated negatively with calcium and 1,25-(OH)(2)D. Hypovitaminosis D is common in acute stroke patients. Immobilization from acute hemiplegia can increase bone resorption and serum calcium, and inhibit PTH secretion and 1,25-(OH)(2)D production to add to the effects of hypovitaminosis D.
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Affiliation(s)
- Y Sato
- Department of Neurology, Kurume University Medical Center, Kokubu-machi, 839-0863, Kurume, Japan.
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22
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Abstract
OBJECTIVE To review how mineral stores and endocrine factors affect bone mass in poststroke patients immobilized by hemiparesis. DATA SOURCES Computer databases and published indexes. STUDY SELECTION Case-control studies of hemiparetic poststroke patients examined regarding bone metabolism. DATA EXTRACTION References were obtained from MEDLINE; all data concerning the objective were used. DATA SYNTHESIS Bone loss occurs in affected extremities after stroke. Immobilization from hemiplegia causes hypercalcemia. Insufficiency or deficiency of 25-hydroxyvitamin D (25-OHD) is very common in stroke patients and may be caused by poor dietary intake, decreased sunlight exposure, or both. Compensatory hyperparathyroidism may not occur because hypercalcemia inhibits the parathyroid glands even when 25-OHD is in the insufficient range. However, hyperparathyroidism does occur when 25-OHD is in the deficient range, in which case the parathyroid response to hypovitaminosis D overrides effects of hypercalcemia. Increased bone resorption was observed during the first year after stroke, declining to normal during the second year. During the first year, determinants of bone mineral density (BMD) in hands affected by hemiplegia were age, severity of hemiplegia, duration of paralysis, serum calcium concentration, and 25-OHD concentration. In the second year, BMD determinants on the hemiplegic side were severity of hemiplegia and 25-OHD concentration, whereas 25-OHD concentration was the only BMD determinant on the intact side. Administering 1alpha-hydroxyvitamin D3, vitamin K2, or ipriflavone ameliorated osteopenia on both sides and decreased the frequency of hip fracture on the hemiplegic side. CONCLUSIONS Bone remodeling and determinants of bone mass for the affected and unaffected sides after stroke differ between the first and subsequent years.
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Affiliation(s)
- Y Sato
- Department of Neurology, Kurume University Medical Center, Japan
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23
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Kawaguchi K, Onari K, Yamakido M. An indirect method of estimating VO2 from work load using arm-cranking in adult hemiplegic patients. Hiroshima J Med Sci 1999; 48:111-6. [PMID: 10804984] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The purpose of this study was to develop an oxygen consumption (VO2) measurement for adult hemiplegic patients during an incremental exercise arm-cranking test. Fifty-five adult hemiplegic patients performed a three-stage arm-cranking exercise test while VO2 was measured. The control group consisted of thirteen healthy elderly persons who performed a similar arm-cranking test until exhaustion. The results indicated that there was a significant difference in VO2 during rest periods between the adult hemiplegic and control groups. Based on data analysis, we developed an equation to estimate the VO2 for adult hemiplegic patients: VO2(ml/min) = (kgm/min x 4.2 ml/kgm) + ((4.2 ml/kg/min x kg body weight) + 105.6 ml/min) (r = 0.847), while the equation for the controls was VO2(ml/min) = (kgm/min x 4.3 ml/kgm) + ((2.9 ml/kg/min x kg body weight) + 105.5 ml/min) (r = 0.932). There was no significant difference between the estimated VO2 for the new equations (nVO2) and the measured VO2 (mVO2) in the two groups at any stage. In our data analysis, based on an estimated VO2 from the American College of Sports Medicine (ACSM) equation (aVO2), the nVO2 and mVO2 at each stage showed lower aVO2 than either nVO2 or mVO2 in each subject (p < 0.05). These findings suggest that the ACSM equation is unlikely to be applicable for estimating VO2 for one hand arm-cranking exercise. In conclusion, the new equations established in this study, when used with a specific prescribed exercise testing protocol, would allow us to estimate VO2 more accurately for both adult hemiplegic patients and healthy elderly persons.
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Affiliation(s)
- K Kawaguchi
- Institute of Health Sciences, Faculty of Medicine, Hiroshima University, Japan
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24
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Uebelhart D, Hartmann DJ, Barbezat S, Mermillod B, Chantraine A. Effect of calcitonin on bone and connective tissue metabolism in hemiplegic patients: a two-year prospective study. Clin Rehabil 1999; 13:384-91. [PMID: 10498345 DOI: 10.1191/026921599672302142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To test the effects of 200 IU/day of a nasal spray of salmon calcitonin in modulating the increased bone tissue metabolism observed in hemiplegic patients. DESIGN A two-year, prospective, randomized, double-blind, placebo-controlled study. PATIENTS Thirty-four patients with hemiplegia due to a cerebrovascular accident were included in the study during the first month after onset of hemiplegia after giving their informed consent. All patients followed a suitably planned course of active rehabilitation according to Bobath. They were randomly allocated to either the calcitonin or the placebo group but all of them received a daily oral calcium supplementation of 1000 mg. RESULTS Biochemical markers of bone formation, serum total alkaline phosphatase, osteocalcin and type I procollagen did not vary during the two years of follow-up. Cross-linked carboxy-terminal telopeptide of type I collagen, a biochemical marker of bone resorption, was elevated initially after stroke and then decreased significantly (p <0.001), stabilizing as of month 12. Urinary calcium/creatinine and total hydroxyproline/creatinine ratios presented with similar profiles. The serum levels of the type III procollagen, a marker of connective tissue metabolism, were also elevated upon entry and decreased thereafter. No significant difference could be found between the calcitonin-treated and the placebo group for any of the biochemical markers at any time point. CONCLUSION This prospective study demonstrated that biochemical markers of bone and connective tissue metabolism were elevated shortly after the occurrence of stroke and then gradually decreased during the first two years after injury. The daily administration of 200 IU of intranasal calcitonin did not influence the levels of these markers.
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Affiliation(s)
- D Uebelhart
- Department of Clinical Neurosciences and Dermatology, University Hospital, Geneva, Switzerland.
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25
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Sato Y, Fujimatsu Y, Kikuyama M, Kaji M, Oizumic K. Influence of immobilization on bone mass and bone metabolism in hemiplegic elderly patients with a long-standing stroke. J Neurol Sci 1998; 156:205-10. [PMID: 9588859 DOI: 10.1016/s0022-510x(98)00041-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Significant bone mass reduction occurs in stroke patients on the hemiplegic side compared with the intact side, correlating with the degree of paralysis and vitamin D deficiency. To evaluate the influence of long-standing immobilization on this osteopenia, we measured various serum markers of bone metabolism in 93 hemiplegic elderly patients with a long-standing stroke and in 37 controls. The bone mineral density (BMD) of the second metacarpal was determined bilaterally. The scoring of the stroke patients activity was based on the Barthel Index (BI). The serum ionized calcium was higher in the patients than in the controls, correlating negatively with the BI in the patients. The concentrations of parathyroid hormone (PTH), pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen and bone Gla protein were normal or low. The serum 25-hydroxyvitamin D level was low in the patients, correlating positively with the BMD on both sides. The serum 1,25-dihydroxyvitamin D (1,25-[OH]2D) level was markedly reduced in the patients. Hemiplegia from a stroke can result in immobilization hypercalcemia which inhibits PTH secretion and 1,25-[OH]2D production. Bone remodelling may have almost reached an equilibrium, resulting in a steady rate of bone loss. This and the hypovitaminosis D appear to be the dominant causes of immobilization-induced osteopenia in elderly, long-standing hemiplegic stroke patients.
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Affiliation(s)
- Y Sato
- Department of Neurology, Futase Social Insurance Hospital, Iizuka, Japan.
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26
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Terwindt GM, Ophoff RA, Haan J, Vergouwe MN, van Eijk R, Frants RR, Ferrari MD. Variable clinical expression of mutations in the P/Q-type calcium channel gene in familial hemiplegic migraine. Dutch Migraine Genetics Research Group. Neurology 1998; 50:1105-10. [PMID: 9566402 DOI: 10.1212/wnl.50.4.1105] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Familial hemiplegic migraine (FHM) is an autosomal dominant subtype of migraine with aura, with half of the families being assigned to chromosome 19p13. We identified missense mutations in a brain-specific calcium channel alpha1A-subunit (CACNA1A) gene on 19p13 segregating with FHM and truncating mutations in families with episodic ataxia type 2 (EA-2). Expansions of an intragenic CAG repeat have been shown in autosomal dominant cerebellar ataxia (SCA6). Hence, FHM, EA-2, and SCA6 are allelic ion channel disorders. We analyzed the phenotype-genotype relation in three unrelated FHM families with the calcium channel alpha1A-subunit gene mutations I1811L (two families) and V714A (one family). We found mutations in all but three patients with FHM (i.e., three phenocopies). In addition, the I1811L mutation occurred in two patients with "nonhemiplegic" migraine and in one subject without migraine. Cerebellar ataxia was found in both families with the I1811L mutation but not in the family with the V714A mutation. We failed to find expansions of the intragenic CAG repeat in FHM patients with cerebellar ataxia. We conclude that the I1811L mutation causes both FHM and cerebellar ataxia independent of the number of CAG repeats. The I1811L mutation may also occur in "normal" migraine patients, supporting the hypothesis that FHM is part of the migraine spectrum.
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Affiliation(s)
- G M Terwindt
- Department of Neurology, Leiden University Medical Center, The Netherlands
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27
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Popovtzer MM. Gravitational forces and bone metabolism. Am J Kidney Dis 1997; 30:xxxiv-xxxvi. [PMID: 9398114 DOI: 10.1016/s0272-6386(97)90075-5] [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: 02/05/2023]
Affiliation(s)
- M M Popovtzer
- Nephrology & Hypertension Services, The Jerusalem Osteoporosis Center, Hadassah Hebrew University Medical Center, Israel
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28
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Abstract
We studied motor unit (MU) firing rate and contractile properties and myosin isoform composition of single muscle fibers after upper motoneuron lesion. Single-MUs and surface electromyogram (EMG) were recorded during voluntary contractions and locomotion in the paretic (P) and nonparetic (NP) tibialis anterior (TA) of 15 hemiparetics. P TA low-threshold MUs fired within the lower end of their normal range. High-threshold MUs fired below their normal range or were not recruited. Surface EMG was abnormally low and high in the P TA and NP TA, respectively. On muscle cross sections stained with histochemical methods, type I fibers represented 99.4%, 74.3% and 66.6% of NP, P, and control TA, respectively. P TA fibers expressing type I myosin heavy chain (MyHC) were smaller, weaker, and slower. In conclusion, low MU firing rate and activity in the P TA was associated with slower type I MyHC fibers, while increased activity in NP TA resulted in homogenous expression of type I MyHC.
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Affiliation(s)
- W R Frontera
- Department of Clinical Neurophysiology, Karolinska Hospital, Stockholm, Sweden
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29
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Chabriat H, Pappata S, Traykov L, Kurtz A, Bousser MG. [Sturge-Weber angiomatosis responsible for hemiplegia without cerebral infarction in term pregnancy]. Rev Neurol (Paris) 1996; 152:536-41. [PMID: 8991175] [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: 02/03/2023]
Abstract
During the third quarter of her pregnancy, a young woman with Sturge-Weber angiomatosis had a severe right hemiplegia with hemianopia and aphasia, followed 48 hours later by focal seizures. Neuroimaging did not show any cerebral lesion but contrast magnetic resonance imaging revealed a left hemispheric pial angiomatosis. The patient recovered progressively from the third day after a ceasarean. The hemianopia disappeared within 15 days, the hemiplegia within one month and the aphasia greatly improved within 3 months. Ten weeks after the clinical onset, we performed a positron emission tomography study. A decrease from 15 to 40% of the cerebral radioactivity was observed after injection of water (H2(15)O) or fluorodesoxyglucose (18FDG) in the left temporooccipital area adjacent to the meningeal angiomatosis. A chronic and focal olighemia, already reported in Sturge-Weber angiomatosis, might participate in the occurrence of this cortical metabolic depression.
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Affiliation(s)
- H Chabriat
- Service de Neurologie, Hôpital Saint-Antoine, Paris
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30
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Abstract
OBJECTIVES To determine whether resting metabolic rate (RMR) is higher or lower in adults with cerebral palsy compared with the RMR of control subjects and to further examine physical characteristics of cerebral palsy that might affect RMR. DESIGN Twenty-one adults with cerebral palsy (9 women, 12 men) were compared with 50 control subjects (25 men, 25 women) within the same age range (18 through 50 years). The following measurements were made: RMR by indirect calorimetry, anthropometrics, body composition, and habitual physical activity patterns. The study was conducted at the University of Vermont General Clinical Research Center and the Ball State University Human Performance Laboratory. STATISTICAL ANALYSES Mean values +/- standard deviations, t tests, Pearson product-moment correlation coefficients, analysis of covariance, and stepwise multiple correlation regression analysis were used to examine the relationships among variables of interest. RESULTS No significant differences were found in body weight, body mass index, fat mass, percentage body fat, and measured RMR between the two groups. The subjects with cerebral palsy were significantly shorter, had less fat-free mass, and expended fewer kilocalories in leisure time activities than the control subjects. After statistical adjustment for differences in fat-free mass, the subjects with cerebral palsy had a 14% (P < .001) higher adjusted RMR (1,742 kcal/day) compared with that of the control subjects (1,534 kcal/day). According to stepwise regression analysis, RMR was best predicted in the entire sample by fat-free mass and the presence or absence of athetosis (multiple R = .83, P < .001). The presence of cerebral palsy alone was not significantly correlated with RMR. CONCLUSIONS The increased energy requirements of adults with cerebral palsy can be partially explained by athetotic movements. In this sample, the presence of athetosis increased RMR by an average of 524 kcal/day.
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Affiliation(s)
- R K Johnson
- Department of Nutritional Sciences, University of Vermont, Burlington 05405, USA
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31
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Abstract
Alternating hemiplegia of childhood is an uncommon disease characterized by repeated, transient attacks of hemiplegia. Its pathophysiology is uncertain, but attention recently has focused on possible mitochondrial abnormalities. Using 31P magnetic resonance spectroscopy, we studied gastrocnemius muscle in 5 patients with alternating hemiplegia, aged 8 to 30 (mean, 18) years, at rest and during incremental aerobic exercise and recovery. There were no significant differences in resting muscle between patients and a control group aged 7 to 42 (mean, 19) years. Exercise performance was grossly impaired in the patients, the mean duration being 30% of normal. The total change in pH during exercise was somewhat less than in control subjects, while the changes in phosphocreatine concentration and intracellular ADP were similar. Thus the average overall rate of fall of phosphocreatine concentration during exercise was three-fold greater than in control subjects. However, the initial rate of ATP turnover at the start of exercise (a measure of muscle mass and efficiency) was not abnormal. During recovery, both the initial rate of phosphocreatine resynthesis and the calculated mitochondrial capacity were reduced by about 35%. This mitochondrial defect probably explains most of the abnormalities seen during exercise.
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Affiliation(s)
- G J Kemp
- MRC Biochemical and Clinical Magnetic Resonance Unit, Oxford Radcliffe Hospital NHS Trust, United Kingdom
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32
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Uncini A, Lodi R, Di Muzio A, Silvestri G, Servidei S, Lugaresi A, Iotti S, Zaniol P, Barbiroli B. Abnormal brain and muscle energy metabolism shown by 31P-MRS in familial hemiplegic migraine. J Neurol Sci 1995; 129:214-22. [PMID: 7608738 DOI: 10.1016/0022-510x(94)00283-t] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Familial hemiplegic migraine (FHM) is a rare autosomal dominant disorder of unknown pathogenesis characterized by migraine and transitory hemiplegic attacks. We describe a kindred fulfilling the diagnostic criteria for FHM in which: (1) brain phosphorus magnetic resonance spectroscopy (31P-MRS) showed a reduced phosphocreatine content accompanied by high [ADP], high percentage of V/Vmax of ATP biosynthesis and decreased phosphorylation potential; (2) muscle 31P-MRS showed a reduced rate of phosphocreatine recovery after exercise; (3) blood lactate was increased after effort; (4) muscle biopsy showed, in one patient, rare ragged red fibers succinate-dehydrogenase positive and cytochrome c oxidase negative; (5) genetic analysis of muscle mitochondrial DNA did not show any of the two point mutations in the tRNA(Leu(UUR)) associated with the MELAS syndrome (Mitochondrial myopathy, Encephalopathy with Lactic Acidosis and Stroke-like episodes). The defective energy metabolism of brain and muscle found in this pedigree suggests a multisystemic disorder of mitochondrial function in this FHM pedigree.
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Affiliation(s)
- A Uncini
- Center for Neuromuscular Diseases, University of Chieti, Italy
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33
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Abstract
Phosphorus magnetic resonance spectra of resting muscle were obtained from 4 patients with alternating hemiplegia of childhood. All patients had abnormally high resonance intensities from inorganic phosphate and an abnormally low calculated cytosolic phosphorylation potential. Two of the 4 patients had abnormally low resonance intensities from phosphocreatine and an abnormally high calculated cytosolic free adenosine diphosphate concentration. These abnormalities are indicative of mitochondrial dysfunction. The combination of a central nervous system disorder and evidence of mitochondrial dysfunction in muscle suggests that alternating hemiplegia of childhood may represent a previously unrecognized phenotype of mitochondrial disease.
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Affiliation(s)
- D L Arnold
- Montreal Neurological Hospital and Institute, McGill University, Quebec, Canada
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34
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Abstract
Alternating hemiplegia of childhood is a rare syndrome characterized by onset before 18 months of age of frequent attacks of alternating paralysis, transient ocular palsies, nystagmus, choreoathetosis, and autonomic dysfunction. We describe features of 10 patients followed for up to 27 years. The mechanism of alternating hemiplegia remains unknown but an association to migraine is suspected because of the strong family history of migraine and aura symptoms in some patients. We treated nine patients with flunarizine, a calcium channel blocker, for up to 5 years; they showed a reduction in duration of the hemiplegic attacks, but the episodes ceased completely in only one patient. With long-term follow-up, the persistent motor, movement, and cognitive deficits are more apparent. It is not certain if the flunarizine alters this course.
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Affiliation(s)
- K Silver
- Department of Neurology and Neurosurgery, McGill University, Montréal, PQ, Canada
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35
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Abstract
Twenty-three children with 4 clinical subtypes of cerebral palsy were studied using 2-deoxy-2(18F)fluoro-D-glucose (FDG) and positron emission tomography (PET). Subtypes included spastic quadriparesis (N = 6), spastic diplegia (N = 4), infantile hemiplegia (N = 8), and choreoathetosis (N = 5). FDG-PET images were correlated with magnetic resonance imaging or computed tomography. Although the location of glucose metabolic abnormalities corresponded, in general, to abnormalities of brain structure demonstrated by structural imaging studies, the distribution of metabolic impairment almost invariably extended beyond the region of anatomic involvement. The following observations in specific subtypes of cerebral palsy were determined with FDG-PET: (1) In spastic diplegic patients, PET revealed focal areas of cortical hypometabolism in the absence of apparent structural abnormality; (2) A relatively normal pattern of cortical metabolism was observed in most patients with choreoathetoid cerebral palsy, despite marked hypometabolism in the thalamus and lenticular nuclei; and (3) In patients with infantile hemiplegia, FDG-PET disclosed symmetric cerebellar glucose metabolism with absence of crossed cerebellar hypometabolism (diaschisis). This finding is contrary to the typical persistence of crossed cerebellar diaschisis in adult patients with acquired cerebral lesions and suggests metabolic recovery due to developmental plasticity. The possibility that FDG-PET may be clinically useful in identifying the cerebral palsy patient with potential learning handicap and in the study of functional recovery or sparing following brain injury should be explored further.
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Affiliation(s)
- J F Kerrigan
- Department of Neurology, University of California, Los Angeles School of Medicine 90024
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36
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Abstract
The purpose of this descriptive study was to quantify the work that is accomplished by major muscle groups of the affected limb of 10 children with spastic hemiplegia secondary to cerebral palsy during walking. Cinematographic film and force-plate data were used in a biomechanical link-segment model to calculate the positive and negative work performed by the muscles around each joint. The results revealed that the ankle plantar flexors produced just over a third of the positive work for the affected limb instead of the normal two thirds. The greatest proportion of positive work was performed by the hip muscles. More research using work and power analyses will assist in prescribing and determining the effectiveness of treatments.
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Affiliation(s)
- S J Olney
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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37
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Abstract
A case of neuro-Behcet's syndrome is presented with sequential positron emission tomography (PET) studies. Regional cerebral blood flow (rCBF) and oxygen consumption (rCMRO2) were decreased in the brain lesion; however, on follow-up studies 3 months after steroid therapy rCBF and rCMRO2 had increased in the lesion, which demonstrated the reversibility of this disease. Such monitored improvement may accurately reflect the early stage of the disease and its response to steroid therapy.
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Affiliation(s)
- K Mineura
- Neurosurgical Service, Akita University Hospital, Japan
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38
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Abstract
The content of bone mineral (BMC), lean tissue, and fat tissue were measured by single and dual photon absorptiometry in both the paretic and the non-paretic limbs of 15 patients, hemiplegic due to cerebrovascular accident 23-38 weeks earlier. Compared with the non-paretic arm, the paretic arm had approximately 10% lower (P less than 0.01) BMC. This difference was largest at the measuring site with the highest ratio of trabecular to compact bone. The paretic leg had a 4% (P less than 0.001) lower BMC than the non-paretic leg. For both the arms and the legs, the lean content was lower (P less than 0.05) and the fat content higher (P less than 0.01) in the paretic than in the non-paretic. This was relatively more pronounced in the arms than in the legs. We conclude that partial immobilization, owing to paresis after a cerebrovascular accident, results in characteristic changes in the affected limbs, with a marked decrease in the content of bone and lean tissue and a pronounced increase in fatty tissue.
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Affiliation(s)
- E Iversen
- Department of Medicine, Glostrup Hospital, Copenhagen, Denmark
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39
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Abstract
Unilateral ablation of cerebral cortical areas 4 and 6 of Brodmann in the macaque monkey results in a contralateral hemiplegia that resolves partially with time. During the phase of dense hemiplegia, local cerebral metabolic rate for glucose (1CMRG1c) is decreased significantly in most of the thalamic nuclei ipsilateral to the ablation, and there are slight contralateral decreases. The lCMRGlc is reduced bilaterally in most of the brainstem nuclei and bilaterally in the deep cerebellar nuclei, but only in the contralateral cerebellar cortex. During the phase of partial motor recovery, lCMRGlc is incompletely restored in many of the thalamic nuclei ipsilateral to the ablation and completely restored in the contralateral nuclei. In the brainstem and deep cerebellar nuclei, poor to moderate recovery occurs bilaterally. Moderate recovery occurs in the contralateral cerebellar cortex. The findings demonstrate that a unilateral cerebral cortical lesion strongly affects lCMRGlc in the thalamus ipsilaterally and in the cerebellar cortex contralaterally, but in the brainstem bilaterally. Partial recovery of lCMRGlc accompanies the progressive motor recovery. The structures affected include those with direct, and also those with indirect, connections to the areas ablated.
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Affiliation(s)
- I Shimoyama
- Department of Neurology, University of Michigan Medical School, Ann Arbor 48109-0316
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40
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Abstract
The mechanical energy costs of walking were studied in 10 cerebral palsied children with hemiplegia to determine whether their values were substantially different from normal and, if so, to discover the movements that were responsible. A two-dimensional, sagittal-plane cinematographic analysis of the subjects' normal walking was undertaken. This technique provided continuous information about the mechanical energy costs of the whole body and each of its parts, the energy types involved, and the amounts of energy conserved. In most cases, the energy costs were above normal and were attributable to poor patterns of exchange between the potential and kinetic energy types of the head, arms, and trunk segment; to very low levels of kinetic energy that precluded exchange; or to both. We concluded that attention should be directed to restoring the sinusoidal pattern of motion and to the fluctuating speeds during each gait cycle when energy costs are a therapeutic consideration.
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41
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Abstract
Unilateral ablation of cerebral cortical areas 4 and 6 of Brodmann in the macaque monkey results in a dense contralateral hemiplegia that recovers partially with time. During the phase of dense hemiplegia, the local cerebral metabolic rate for glucose (lCMRGlc) is decreased significantly in the caudate nucleus, putamen, globus pallidus, subthalamic nucleus, substantia nigra, and red nucleus of the hemisphere ipsilateral to the lesion. In the present study, lCMRGlc in the basal ganglia was studied during the phase of partial recovery of motor activity. lCMRGlc was partially restored, and the greatest degree of restoration occurred in structures with direct connections to the cerebral cortex (caudate nucleus, putamen, subthalamic nucleus, substantia nigra, and red nucleus). Restoration was least in structures that do not receive direct connections from the cerebral cortex (the internal and external segments of the globus pallidus). The findings support the hypothesis that corticofugal activity accounts for a substantial degree of functional recovery.
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Affiliation(s)
- S Gilman
- Department of Neurology, University of Michigan Medical School, Ann Arbor 48109
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42
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Rougemont D, Baron JC, Lebrun-Grandié P, Bousser MG, Soisson T, Comar D. [A 15oxygen positron study of relative local perfusion and oxygen extraction of the brain in lacunar hemiparesis (author's transl)]. Pathol Biol (Paris) 1982; 30:295-302. [PMID: 7048222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The oxygen-15 non-invasive continuous inhalation technique coupled with positron emission tomography (PET) allows the local study of cerebral blood flow and oxygen metabolism. Recent PET studied have demonstrated the frequent occurrence of widespread metabolic depression remote from the site of middle cerebral artery territory infarct per se, especially over the cortical mantle and thalamus ipsilaterally, and over the cerebellar hemisphere contralaterally. These phenomena have been taken as indicative of a transneural depression (i.e. diaschisis). We thought interesting to study the possible occurrence of such abnormalities in patients with lacunar syndromes. We have applied the 15O technique to seven patients (2 with pure motor hemiplegia, 5 with ataxic hemiparesis) in whom no large causal ischemic lesion could be demonstrated on CT Scans; in only one patient was a lacunar lesion, presumably responsible for the clinical deficit, evidenced. Compared to a set of 19 patients without brain disease, the semi-quantitative results (analyzed in terms of asymmetry indices between homologous brain regions) in our patients did not disclose any pathophysiologically significant abnormality. More specifically, no evidence of physiological dysfunction similar to that reported in internal carotid artery territory infarcts, was detected over the cerebral or the cerebellar cortices. These original findings are commented upon in view of the presumably small size and the uncertain topography of the causal lesion.
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43
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Abstract
The two-compartment pharmacokinetics of theophylline in ten hospitalized elderly patients with apparently normal renal, hepatic and cardiopulmonary functions was investigated after intravenous administration of the drug. Nine patients suffered from slight hemiparesis and one from Parkinson's disease. Biological theophylline half-lives of 5.4--9.0 hours and plasma clearence values of 28--42 ml kg-1hr-1 were found. The apparent volumes of distribution during the beta-phase, Vdbeta, were 0.33--0.43 1 kg-1. It is concluded that a therapeutic concentration of about 10 microgram theophylline per ml serum could be established in the investigated group of elderly patients following an intravenous initial loading dose of 3.7 mg theophylline per kg followed by a continuous infusion of 0.35 mg per kg body weight per hour. In the therapeutic use of theophylline monitoring of the serum theophylline concentration is generally advised because of the elsewhere reported variability in the biological half-life of the compound.
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44
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Abstract
1. A group of eight male patients with moderate hemiparesis was studied at rest and during 40 min of exercise on four occasions. Both two-leg and one-leg exercise were performed and each leg was studied separately. Arterial concentrations and leg exchange of carbohydrate substrates and free fatty acids were examined. In addition, the concentrations of intramuscular metabolites for each leg were measured at rest and immediately after exercise.
2. In two-leg exercise, oxygen uptake for the paretic leg was significantly lower than for the non-paretic leg at rest (55%) as well as during exercise (40%). Glucose uptake by the paretic leg was smaller (25–50%) and there was no measurable net leg exchange for lactate. Recordings of pedal pressure indicated that the paretic leg did considerably less work than the non-paretic leg throughout the exercise period. The rate of uptake of oleic acid was lower for the paretic leg (50%) in the resting state but similar for the two legs during exercise. The recovery of 14CO2 from [14C]oleic acid during exercise was significantly reduced for the paretic leg.
3. During one-leg exercise, oxygen and glucose uptakes by the working leg were similar for the paretic and non-paretic leg but lactate release was significantly greater for the paretic leg during exercise (30–45%).
4. The concentrations of ATP and creatine phosphate in the basal state were similar for the two legs. ATP and creatine phosphate fell significantly in the two legs during both the two-leg and the one-leg exercise period. The most marked decrease in ATP was noted for the paretic leg during one-leg exercise. The pattern of glycogen depletion during one-leg exercise for the paretic leg indicated primarily activation of the type II fibres. In contrast, the depletion pattern for the non-paretic leg suggested mainly recruitment of type I fibres.
5. The results indicate that, during exercise, paretic muscle shows a reduced blood flow, an augmented lactate production and a diminished capacity to oxidize free fatty acids. These metabolic derangements may be referrable to an augmented number and increased activation of type II muscle fibres as well as to alterations in the structure of muscle mitochondria. In addition, the present study indicates that one-leg exercise should be preferred to two-leg exercise when studying leg muscle circulation and metabolism in hemiparetic patients.
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45
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Naftchi NE, Viau AT, Marshall CH, Davis WS, Lowman EW. Bone mineralization in the distal forearm of hemiplegic patients. Arch Phys Med Rehabil 1975; 56:487-92. [PMID: 1200819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Bone mineral content was measured by single photon absorptiometry using a modified bone densitometer (Packard) with 125I as the source. In 42 hemiplegic subjects, matched for sex and age, the bone density was compared bilaterally on the radius and ulna 2 cm and 4 cm above the wrist. The nonparalyzed side served as a control for the paralyzed side. The results indicate a consistent, general loss of bone mineral on the paralyzed side compared with the nonparalyzed side. The extent of demineralization in females was greater than in male subjects. Right-dominant left-paralyzed patients showed a greater loss of bone density than right-dominant right-paralyzed subjects. The absorption ratio of the paralyzed vs the nonparalyzed sides revealed that there was a 5.3% and 7.4% decrease in the average bone density at 4 and 2 cm above the wrist, respectively. There was a progressive loss of bone mineral content relative to time after the onset of paralysis, amounting to an average of 6.4% approximately three months after the onset of injury. It was estimated that before the onset of paralysis there was an excess of bone mineral on the dominant vs the nondominant side of +5.4% and +3.2% for males and females, respectively.
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46
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Saltin B, Landin S. Work capacity, muscle strength and SDH activity in both legs of hemiparetic patients and patients with Parkinson's disease. Scand J Clin Lab Invest 1975; 35:531-8. [PMID: 1198056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In recent muscle metabolic studies, patients with moderate upper motor neuron lesions showed marked difficulty in performing an equal submaximal work load (bilaterally) in two-legged exercise. For a better evaluation of these patients, studies were performed on each leg separately. Six patients with Parkinson's disease and six with moderate hemiparesis were studied. During one-legged submaximal and maximal exercise heart rate, oxygen uptake, and blood lactate were determined. Maximal voluntary contraction in knee and ankle flexion and extension for each leg was measured. Succinate dehydrogenase (SDH) activity in the thigh muscles was determined. During submaximal exercise, oxygen uptake, heart rate and blood lactate increased more in the paretic leg of hemiparetic patients and in the more affected leg of the Parkinson patients. In hemiparetic patients maximal voluntary contraction of flexors and extensors of the knee was significantly reduced in the paretic leg but was reduced even in the nonparetic knee flexors. SDH activity was very low in both legs in all patients and lowest in the paretic and more affected leg, respectively. It is concluded that (a) the general muscle inactivity per se, secondary to the neurological disorder, may lead to a reduced work capacity; (b) the increased heart rate and blood lactate level seem to be correlated to the relative exercise level of each leg; and (c) in patients with impaired muscle function of one or both legs, evaluation of each leg separately with regard to work capacity and muscle metabolism is of value.
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47
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D'Alessandro B, Bellastella A, Esposito V, Colucci CF, Montalbetti N. Letter: Circadian rhythm of cortisol secretion in elderly and blind subjects. Br Med J 1974; 2:274. [PMID: 4827085 PMCID: PMC1610517 DOI: 10.1136/bmj.2.5913.274-a] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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48
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49
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50
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Clendenon NR, Allen N, Komatsu T, Liss L, Gordon WA, Heimberger K. Biochemical alterations in the anoxic-ischemic lesion of rat brain. Arch Neurol 1971; 25:432-48. [PMID: 5110886 DOI: 10.1001/archneur.1971.00490050066006] [Citation(s) in RCA: 40] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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