12,346 results on '"paralysis"'
Search Results
2. Electrophysiological Guidance of Epidural Electrode Array Implantation over the Human Lumbosacral Spinal Cord to Enable Motor Function after Chronic Paralysis
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Calvert, Jonathan S, Grahn, Peter J, Strommen, Jeffrey A, Lavrov, Igor A, Beck, Lisa A, Gill, Megan L, Linde, Margaux B, Brown, Desmond A, Van Straaten, Meegan G, Veith, Daniel D, Lopez, Cesar, Sayenko, Dimitry G, Gerasimenko, Yury P, Edgerton, V Reggie, Zhao, Kristin D, and Lee, Kendall H
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Biomedical and Clinical Sciences ,Neurosciences ,Clinical Sciences ,Spinal Cord Injury ,Traumatic Head and Spine Injury ,Bioengineering ,Rehabilitation ,Neurodegenerative ,Clinical Research ,Physical Injury - Accidents and Adverse Effects ,Assistive Technology ,Neurological ,Adult ,Electrodes ,Implanted ,Electromyography ,Epidural Space ,Evoked Potentials ,Motor ,Humans ,Intraoperative Neurophysiological Monitoring ,Locomotion ,Lumbosacral Region ,Male ,Neurosurgical Procedures ,Paralysis ,Spinal Cord Injuries ,Spinal Cord Stimulation ,electrically evoked spinal motor potentials ,epidural electrical stimulation ,spinal cord injury ,neuromodulation ,spinal cord intraoperative electrophysiology ,Neurology & Neurosurgery ,Clinical sciences ,Biological psychology - Abstract
Epidural electrical stimulation (EES) of the spinal cord has been shown to restore function after spinal cord injury (SCI). Characterization of EES-evoked motor responses has provided a basic understanding of spinal sensorimotor network activity related to EES-enabled motor activity of the lower extremities. However, the use of EES-evoked motor responses to guide EES system implantation over the spinal cord and their relation to post-operative EES-enabled function in humans with chronic paralysis attributed to SCI has yet to be described. Herein, we describe the surgical and intraoperative electrophysiological approach used, followed by initial EES-enabled results observed in 2 human subjects with motor complete paralysis who were enrolled in a clinical trial investigating the use of EES to enable motor functions after SCI. The 16-contact electrode array was initially positioned under fluoroscopic guidance. Then, EES-evoked motor responses were recorded from select leg muscles and displayed in real time to determine electrode array proximity to spinal cord regions associated with motor activity of the lower extremities. Acceptable array positioning was determined based on achievement of selective proximal or distal leg muscle activity, as well as bilateral muscle activation. Motor response latencies were not significantly different between intraoperative recordings and post-operative recordings, indicating that array positioning remained stable. Additionally, EES enabled intentional control of step-like activity in both subjects within the first 5 days of testing. These results suggest that the use of EES-evoked motor responses may guide intraoperative positioning of epidural electrodes to target spinal cord circuitry to enable motor functions after SCI.
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- 2019
3. Self-Assisted Standing Enabled by Non-Invasive Spinal Stimulation after Spinal Cord Injury
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Sayenko, Dimitry G, Rath, Mrinal, Ferguson, Adam R, Burdick, Joel W, Havton, Leif A, Edgerton, V Reggie, and Gerasimenko, Yury P
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Biomedical and Clinical Sciences ,Biological Psychology ,Clinical Sciences ,Neurosciences ,Psychology ,Neurodegenerative ,Clinical Research ,Rehabilitation ,Physical Injury - Accidents and Adverse Effects ,Assistive Technology ,Traumatic Head and Spine Injury ,Bioengineering ,Spinal Cord Injury ,Neurological ,Musculoskeletal ,Adult ,Double-Blind Method ,Electromyography ,Female ,Humans ,Male ,Middle Aged ,Muscle ,Skeletal ,Spinal Cord Injuries ,Spinal Cord Stimulation ,Standing Position ,balance control ,neuromodulation ,neuroplasticity ,paralysis ,transcutaneous electrical spinal cord stimulation ,Neurology & Neurosurgery ,Clinical sciences ,Biological psychology - Abstract
Neuromodulation of spinal networks can improve motor control after spinal cord injury (SCI). The objectives of this study were to (1) determine whether individuals with chronic paralysis can stand with the aid of non-invasive electrical spinal stimulation with their knees and hips extended without trainer assistance, and (2) investigate whether postural control can be further improved following repeated sessions of stand training. Using a double-blind, balanced, within-subject cross-over, and sham-controlled study design, 15 individuals with SCI of various severity received transcutaneous electrical spinal stimulation to regain self-assisted standing. The primary outcomes included qualitative comparison of need of external assistance for knee and hip extension provided by trainers during standing without and in the presence of stimulation in the same participants, as well as quantitative measures, such as the level of knee assistance and amount of time spent standing without trainer assistance. None of the participants could stand unassisted without stimulation or in the presence of sham stimulation. With stimulation all participants could maintain upright standing with minimum and some (n = 7) without external assistance applied to the knees or hips, using their hands for upper body balance as needed. Quality of balance control was practice-dependent, and improved with subsequent training. During self-initiated body-weight displacements in standing enabled by spinal stimulation, high levels of leg muscle activity emerged, and depended on the amount of muscle loading. Our findings indicate that the lumbosacral spinal networks can be modulated transcutaneously using electrical spinal stimulation to facilitate self-assisted standing after chronic motor and sensory complete paralysis.
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- 2019
4. Burden of gluteal fibrosis and post-injection paralysis in the children of Kumi District in Uganda
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Alves, Kristin, Penny, Norgrove, Ekure, John, Olupot, Robert, Kobusingye, Olive, Katz, Jeffrey N, and Sabatini, Coleen S
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Biomedical and Clinical Sciences ,Clinical Sciences ,Health Sciences ,Clinical Research ,Pediatric ,Prevention ,Buttocks ,Child ,Child ,Preschool ,Female ,Fibrosis ,Humans ,Injections ,Intramuscular ,Male ,Paralysis ,Prevalence ,Retrospective Studies ,Rural Health ,Uganda ,Gluteal fibrosis ,Post-injection paralysis ,Orthopedics ,Clinical sciences ,Allied health and rehabilitation science ,Sports science and exercise - Abstract
BackgroundThe purpose of this study was to estimate the prevalence of postinjection paralysis (PIP) and gluteal fibrosis (GF) among children treated in a rural Ugandan Hospital.MethodsWe conducted a retrospective cohort study by reviewing the musculoskeletal clinic and community outreach logs for children (age
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- 2018
5. Gluteal fibrosis, post-injection paralysis, and related injection practices in Uganda: a qualitative analysis
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Alves, Kristin, Godwin, Christine L, Chen, Angela, Akellot, Daniella, Katz, Jeffrey N, and Sabatini, Coleen S
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Health Services and Systems ,Health Sciences ,Clinical Research ,Prevention ,Health Services ,8.1 Organisation and delivery of services ,Health and social care services research ,Good Health and Well Being ,Adult ,Attitude of Health Personnel ,Buttocks ,Child ,Delivery of Health Care ,Female ,Fibrosis ,Health Personnel ,Humans ,Iatrogenic Disease ,Injections ,Intramuscular ,Interviews as Topic ,Male ,Middle Aged ,Motivation ,Paralysis ,Qualitative Research ,Uganda ,Gluteal fibrosis ,Post-injection paralysis ,Injection practices ,Safe injection ,Pediatric musculoskeletal health ,Pediatric orthopaedics ,Intramuscular injection ,Library and Information Studies ,Nursing ,Public Health and Health Services ,Health Policy & Services ,Health services and systems ,Public health - Abstract
BackgroundIatrogenic injection injury is a major cause of disability in Ugandan children. Two injuries thought to result from injection of medications into the gluteal region include post-injection paralysis (PIP) and gluteal fibrosis (GF). This study aimed to describe perceptions of local health care workers regarding risk factors, particularly injections, for development of GF and PIP. Specifically, we examine the role of injection practices in the development of these injuries by interviewing a diverse cohort of individuals working in the health sector.MethodsWe conducted a qualitative study in the Kumi and Wakiso Districts of Uganda in November 2017, utilizing 68 key informant interviews with individuals working in healthcare related fields. Interviews were structured utilizing a moderator guide focusing on injection practices, gluteal fibrosis and post-injection paralysis.ResultsWe identified six themes regarding perceptions of the cause of GF and PIP and organized these themes into a theoretical framework. There was a consensus among the individuals working in healthcare that inadequacies of the health care delivery system may lead to inappropriate intramuscular injection practices, which are presumed to contribute to the development of GF and PIP. Poor access to medications and qualified personnel has led to the proliferation of private clinics, which are often staffed by under-trained practitioners. Misaligned economic incentives and a lack of training may also motivate practitioners to administer frequent intramuscular injections, which cost more than oral medications. A lack of regulatory enforcement enables these practices to persist. However, due to limited community awareness, patients often perceive these practitioners as appropriately trained, and the patients frequently prefer injections over alternative treatment modalities.ConclusionThis qualitative study suggests that inappropriate intramuscular injections, may arise from problems in the health care delivery system. To prevent the disability of GF and PIP, it is important to not only address the intramuscular injections practices in Uganda, but also to examine upstream deficits in access, education, and policy enforcement.
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- 2018
6. Trunk Stability Enabled by Noninvasive Spinal Electrical Stimulation after Spinal Cord Injury
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Rath, Mrinal, Vette, Albert H, Ramasubramaniam, Shyamsundar, Li, Kun, Burdick, Joel, Edgerton, Victor R, Gerasimenko, Yury P, and Sayenko, Dimitry G
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Biomedical and Clinical Sciences ,Biological Psychology ,Clinical Sciences ,Neurosciences ,Psychology ,Neurodegenerative ,Spinal Cord Injury ,Traumatic Head and Spine Injury ,Rehabilitation ,Physical Injury - Accidents and Adverse Effects ,Clinical Research ,Adult ,Electric Stimulation Therapy ,Female ,Humans ,Male ,Middle Aged ,Paralysis ,Postural Balance ,Posture ,Sitting Position ,Spinal Cord Injuries ,Torso ,Young Adult ,neuromodulation ,paralysis ,seated posture ,transcutaneous electrical spinal cord stimulation ,trunk stability and control ,Neurology & Neurosurgery ,Clinical sciences ,Biological psychology - Abstract
Electrical neuromodulation of spinal networks improves the control of movement of the paralyzed limbs after spinal cord injury (SCI). However, the potential of noninvasive spinal stimulation to facilitate postural trunk control during sitting in humans with SCI has not been investigated. We hypothesized that transcutaneous electrical stimulation of the lumbosacral enlargement can improve trunk posture. Eight participants with non-progressive SCI at C3-T9, American Spinal Injury Association Impairment Scale (AIS) A or C, performed different motor tasks during sitting. Electromyography of the trunk muscles, three-dimensional kinematics, and force plate data were acquired. Spinal stimulation improved trunk control during sitting in all tested individuals. Stimulation resulted in elevated activity of the erector spinae, rectus abdominis, and external obliques, contributing to improved trunk control, more natural anterior pelvic tilt and lordotic curve, and greater multi-directional seated stability. During spinal stimulation, the center of pressure (COP) displacements decreased to 1.36 ± 0.98 mm compared with 4.74 ± 5.41 mm without stimulation (p = 0.0156) in quiet sitting, and the limits of stable displacement increased by 46.92 ± 35.66% (p = 0.0156), 36.92 ± 30.48% (p = 0.0156), 54.67 ± 77.99% (p = 0.0234), and 22.70 ± 26.09% (p = 0.0391) in the forward, backward, right, and left directions, respectively. During self-initiated perturbations, the correlation between anteroposterior arm velocity and the COP displacement decreased from r = 0.5821 (p = 0.0007) without to r = 0.5115 (p = 0.0039) with stimulation, indicating improved trunk stability. These data demonstrate that the spinal networks can be modulated transcutaneously with tonic electrical spinal stimulation to physiological states sufficient to generate a more stable, erect sitting posture after chronic paralysis.
- Published
- 2018
7. Non-Invasive Activation of Cervical Spinal Networks after Severe Paralysis
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Gad, Parag, Lee, Sujin, Terrafranca, Nicholas, Zhong, Hui, Turner, Amanda, Gerasimenko, Yury, and Edgerton, V Reggie
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Biomedical and Clinical Sciences ,Clinical Sciences ,Rehabilitation ,Physical Rehabilitation ,Clinical Research ,Neurodegenerative ,Traumatic Head and Spine Injury ,Neurosciences ,Spinal Cord Injury ,Physical Injury - Accidents and Adverse Effects ,Neurological ,Injuries and accidents ,Adult ,Female ,Hand Strength ,Humans ,Male ,Middle Aged ,Paralysis ,Recovery of Function ,Spinal Cord Injuries ,Spinal Cord Stimulation ,cervical spinal cord injury ,non-invasive spinal cord stimulation ,tetraplegia ,upper extremity rehabilitation ,Neurology & Neurosurgery ,Clinical sciences ,Biological psychology - Abstract
Paralysis of the upper extremities following cervical spinal cord injury (SCI) significantly impairs one's ability to live independently. While regaining hand function or grasping ability is considered one of the most desired functions in tetraplegics, limited therapeutic development in this direction has been demonstrated to date in humans with a high severe cervical injury. The underlying hypothesis is that after severe cervical SCI, nonfunctional sensory-motor networks within the cervical spinal cord can be transcutaneously neuromodulated to physiological states that enable and amplify voluntary control of the hand. Improved voluntary hand function occurred within a single session in every subject tested. After eight sessions of non-invasive transcutaneous stimulation, combined with training over 4 weeks, maximum voluntary hand grip forces increased by ∼325% (in the presence of stimulation) and ∼225% (when grip strength was tested without simultaneous stimulation) in chronic cervical SCI subjects (American Spinal Injury Association Impairment Scale [AIS] B, n = 3; AIS C, n = 5) 1-21 years post-injury). Maximum grip strength improved in both the left and right hands and the magnitude of increase was independent of hand dominance. We refer to the neuromodulatory method used as transcutaneous enabling motor control to emphasize that the stimulation parameters used are designed to avoid directly inducing muscular contractions, but to enable task performance according to the subject's voluntary intent. In some subjects, there were improvements in autonomic function, lower extremity motor function, and sensation below the level of the lesion. Although a neuromodulation-training effect was observed in every subject tested, further controlled and blinded studies are needed to determine the responsiveness of a larger and broader population of subjects varying in the type, severity, and years post-injury. It appears rather convincing, however, that a "central pattern generation" phenomenon as generally perceived in the lumbosacral networks in controlling stepping neuromodulator is not a critical element of spinal neuromodulation to regain function among spinal networks.
- Published
- 2018
8. Brain-machine interface cursor position only weakly affects monkey and human motor cortical activity in the absence of arm movements
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Stavisky, Sergey D, Kao, Jonathan C, Nuyujukian, Paul, Pandarinath, Chethan, Blabe, Christine, Ryu, Stephen I, Hochberg, Leigh R, Henderson, Jaimie M, and Shenoy, Krishna V
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Biological Psychology ,Information and Computing Sciences ,Machine Learning ,Psychology ,Rehabilitation ,Clinical Research ,Assistive Technology ,Bioengineering ,Neurosciences ,Neurological ,Animals ,Arm ,Brain-Computer Interfaces ,Humans ,Macaca mulatta ,Male ,Motor Cortex ,Movement ,Paralysis ,Time Factors - Abstract
Brain-machine interfaces (BMIs) that decode movement intentions should ignore neural modulation sources distinct from the intended command. However, neurophysiology and control theory suggest that motor cortex reflects the motor effector's position, which could be a nuisance variable. We investigated motor cortical correlates of BMI cursor position with or without concurrent arm movement. We show in two monkeys that subtracting away estimated neural correlates of position improves online BMI performance only if the animals were allowed to move their arm. To understand why, we compared the neural variance attributable to cursor position when the same task was performed using arm reaching, versus arms-restrained BMI use. Firing rates correlated with both BMI cursor and hand positions, but hand positional effects were greater. To examine whether BMI position influences decoding in people with paralysis, we analyzed data from two intracortical BMI clinical trial participants and performed an online decoder comparison in one participant. We found only small motor cortical correlates, which did not affect performance. These results suggest that arm movement and proprioception are the major contributors to position-related motor cortical correlates. Cursor position visual feedback is therefore unlikely to affect the performance of BMI-driven prosthetic systems being developed for people with paralysis.
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- 2018
9. Ultrasound Screening for Posterior Shoulder Dislocation in Infants with Persistent Brachial Plexus Birth Palsy
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Bauer, Andrea S, Lucas, Justin F, Heyrani, Nasser, Anderson, Ryan L, Kalish, Leslie A, and James, Michelle A
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HIV/AIDS ,Biomedical Imaging ,Prevention ,Clinical Research ,Pediatric ,Brachial Plexus Neuropathies ,Female ,Humans ,Infant ,Infant ,Newborn ,Male ,Paralysis ,Obstetric ,Physical Examination ,Prevalence ,Retrospective Studies ,Sensitivity and Specificity ,Shoulder Dislocation ,Ultrasonography ,Biomedical Engineering ,Clinical Sciences ,Orthopedics - Abstract
BackgroundEarly detection of posterior shoulder dislocation in infants with brachial plexus birth palsy (BPBP) is essential, but it may be difficult to accomplish with physical examination alone. The aim of this study was to determine the prevalence of shoulder dislocation in patients with BPBP using ultrasound and to identify which physical examination measurements correlated most with dislocation in these patients.MethodsThis study was a retrospective review of data obtained in an ultrasound screening program of infants with BPBP born from January 2011 to April 2014. Physical examination included the use of the Active Movement Scale (AMS) and measurement of passive external rotation of the shoulder. Ultrasound measurements included PHHD (percentage of the humeral head displaced posterior to the axis of the scapula) and the alpha angle (intersection of the posterior scapular margin with a line tangential to the humeral head through the glenoid). Shoulder dislocation was defined as both a PHHD of >0.5 and an alpha angle of >30°.ResultsOf sixty-six infants who had undergone a total of 118 ultrasound examinations (mean, 1.8; range, 1 to 5), 19 (29%) demonstrated shoulder dislocation with the shoulder positioned in internal rotation; the dislocation was first detected between 2.1 and 10.5 months of age. Infants with a dislocated shoulder demonstrated significantly less mean passive external rotation in adduction (mean, 45.8° versus 71.4°, p < 0.001) and a greater difference between internal rotation and external rotation AMS scores (mean, 5.5-point versus 3.3-point difference, p < 0.001) than those without shoulder dislocation. Passive external rotation in adduction was a better measure for discriminating between dislocation and no dislocation (area under receiver operating characteristic curve [AUC] = 0.89) than was the difference between internal and external rotation AMS scores (AUC = 0.73). A cutoff of 60° of passive external rotation in adduction (≤60° versus° >60) yielded a sensitivity of 94% and a specificity of 69%.ConclusionsShoulder dislocation is common in infants with BPBP; 29% of the infants presenting to our tertiary care center had a dislocation during their first year of life. Ultrasound shoulder screening is appropriate for infants with BPBP. If passive external rotation in adduction is used to determine which infants should undergo ultrasound, ≤60° should be utilized as the criterion to achieve appropriate sensitivity.Level of evidenceTherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
- Published
- 2017
10. Non‐Sedated Rapid Volumetric Proton Density MRI Predicts Neonatal Brachial Plexus Birth Palsy Functional Outcome
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Shen, Peter Y, Nidecker, Anna E, Neufeld, Ethan A, Lee, Paul S, James, Michelle A, and Bauer, Andrea S
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Biomedical and Clinical Sciences ,Clinical Sciences ,Biomedical Imaging ,Perinatal Period - Conditions Originating in Perinatal Period ,Clinical Research ,Infant Mortality ,Prevention ,Pediatric ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Brachial Plexus Neuropathies ,Female ,Humans ,Infant ,Infant ,Newborn ,Magnetic Resonance Imaging ,Male ,Paralysis ,Obstetric ,Prognosis ,Treatment Outcome ,Brachial plexus ,birth palsy ,magnetic resonance imaging ,Neurosciences ,Neurology & Neurosurgery ,Clinical sciences ,Biological psychology - Abstract
Background and purposeThe current prognostic biomarker of functional outcome in brachial plexus birth palsy is serial clinical examination throughout the first 6 months of age. This can delay surgical treatment and prolong parental anxiety in neonates who will recover spontaneously. A potentially superior biomarker is a volumetric proton density MRI performed at clinical presentation and within the first 12 weeks of life, providing a high spatial and contrast resolution examination in 4 minutes.MethodsNine neonates ranging in age from 4 to 9 weeks who presented with brachial plexus birth palsy were enrolled. All subjects underwent non-sedated 3 Tesla MRI with Cube Proton Density MRI sequence at the same time as their initial clinical visit. Serial clinical examinations were conducted at routine 4 week intervals and the functional performance scores were recorded. MRI findings were divided into pre-ganglionic and post-ganglionic injuries and a radiological scoring system (Shriners Radiological Score) was developed for this study.ResultsProton Density MRI was able to differentiate between pre-ganglionic and post-ganglionic injuries. Radiological scores (Shriners Radiological Score) correlated better with functional performance at 6 months of age (P = .022) than the initial clinical examinations (Active Movement Scale P = .213 and Toronto P = .320).ConclusionsRapid non-sedated volumetric Cube Proton Density MRI protocol performed at initial clinical presentation can accurately grade severity of brachial plexus birth palsy injury and predict functional performance at 6 months of age.
- Published
- 2017
11. Thyrotoxic periodic paralysis (TPP): assessment in the emergency department
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Freyia Mahon-Daly, Claire Liegeois, and John-Paul Carter
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Male ,Thyrotoxicosis ,Hypokalemic Periodic Paralysis ,Potassium ,Humans ,Paralysis ,General Medicine ,Emergency Service, Hospital ,Aged - Abstract
A male patient aged in his early twenties presented to the emergency department (ED) with quadriparesis. He was ordinarily fit and well and had exercised and eaten a carbohydrate rich meal the evening before. His point-of-care venous blood sample on arrival to the ED showed hypokalaemia of 1.6 mmol/L. (normal range=3.5–5.0 mmol/L). He was put on a cardiac monitor and started on an intravenous infusion of potassium chloride. With the benefit of hindsight, his male sex, particular features in his history and his initial ECG all pointed to a differential diagnosis of thyrotoxic periodic paralysis (TPP), although a differential diagnosis of a first attack of familial hypokalaemic paralysis was considered. As urgent thyroid function tests were sent promptly, there was minimal delay in reaching a diagnosis of TPP and promptly starting propranolol as a safe and more effective means of reversing TPP, followed by definitive treatment with carbimazole.
- Published
- 2024
12. Noninvasive Reactivation of Motor Descending Control after Paralysis
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Gerasimenko, Yury P, Lu, Daniel C, Modaber, Morteza, Zdunowski, Sharon, Gad, Parag, Sayenko, Dimitry G, Morikawa, Erika, Haakana, Piia, Ferguson, Adam R, Roy, Roland R, and Edgerton, V Reggie
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Biomedical and Clinical Sciences ,Neurosciences ,Physical Rehabilitation ,Physical Injury - Accidents and Adverse Effects ,Traumatic Head and Spine Injury ,Spinal Cord Injury ,Neurodegenerative ,Clinical Research ,Rehabilitation ,Neurological ,Adult ,Cervical Vertebrae ,Electric Stimulation Therapy ,Evoked Potentials ,Motor ,Humans ,Male ,Middle Aged ,Paralysis ,Psychomotor Performance ,Pyramidal Tracts ,Spinal Cord ,Spinal Cord Injuries ,Thoracic Vertebrae ,Young Adult ,motor complete paralysis ,neuronal network ,transcutaneous spinal cord stimulation ,voluntary movements ,Clinical Sciences ,Neurology & Neurosurgery ,Clinical sciences ,Biological psychology - Abstract
The present prognosis for the recovery of voluntary control of movement in patients diagnosed as motor complete is generally poor. Herein we introduce a novel and noninvasive stimulation strategy of painless transcutaneous electrical enabling motor control and a pharmacological enabling motor control strategy to neuromodulate the physiological state of the spinal cord. This neuromodulation enabled the spinal locomotor networks of individuals with motor complete paralysis for 2-6 years American Spinal Cord Injury Association Impairment Scale (AIS) to be re-engaged and trained. We showed that locomotor-like stepping could be induced without voluntary effort within a single test session using electrical stimulation and training. We also observed significant facilitation of voluntary influence on the stepping movements in the presence of stimulation over a 4-week period in each subject. Using these strategies we transformed brain-spinal neuronal networks from a dormant to a functional state sufficiently to enable recovery of voluntary movement in five out of five subjects. Pharmacological intervention combined with stimulation and training resulted in further improvement in voluntary motor control of stepping-like movements in all subjects. We also observed on-command selective activation of the gastrocnemius and soleus muscles when attempting to plantarflex. At the end of 18 weeks of weekly interventions the mean changes in the amplitude of voluntarily controlled movement without stimulation was as high as occurred when combined with electrical stimulation. Additionally, spinally evoked motor potentials were readily modulated in the presence of voluntary effort, providing electrophysiological evidence of the re-establishment of functional connectivity among neural networks between the brain and the spinal cord.
- Published
- 2015
13. Assessment of brain–machine interfaces from the perspective of people with paralysis
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Blabe, Christine H, Gilja, Vikash, Chestek, Cindy A, Shenoy, Krishna V, Anderson, Kim D, and Henderson, Jaimie M
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Bioengineering ,Rehabilitation ,Neurodegenerative ,Spinal Cord Injury ,Physical Injury - Accidents and Adverse Effects ,Assistive Technology ,Neurosciences ,Traumatic Head and Spine Injury ,Clinical Research ,Adolescent ,Adult ,Aged ,Aged ,80 and over ,Brain-Computer Interfaces ,Communication Aids for Disabled ,Electroencephalography ,Female ,Health Care Surveys ,Humans ,Male ,Middle Aged ,Needs Assessment ,Patient Preference ,Quadriplegia ,Robotics ,Technology ,United States ,Young Adult ,spinal cord injury ,brain-computer interface ,brain-machine interface ,paralysis ,BCI ,BMI ,Biomedical Engineering ,Clinical Sciences - Abstract
ObjectiveOne of the main goals of brain-machine interface (BMI) research is to restore function to people with paralysis. Currently, multiple BMI design features are being investigated, based on various input modalities (externally applied and surgically implantable sensors) and output modalities (e.g. control of computer systems, prosthetic arms, and functional electrical stimulation systems). While these technologies may eventually provide some level of benefit, they each carry associated burdens for end-users. We sought to assess the attitudes of people with paralysis toward using various technologies to achieve particular benefits, given the burdens currently associated with the use of each system.ApproachWe designed and distributed a technology survey to determine the level of benefit necessary for people with tetraplegia due to spinal cord injury to consider using different technologies, given the burdens currently associated with them. The survey queried user preferences for 8 BMI technologies including electroencephalography, electrocorticography, and intracortical microelectrode arrays, as well as a commercially available eye tracking system for comparison. Participants used a 5-point scale to rate their likelihood to adopt these technologies for 13 potential control capabilities.Main resultsSurvey respondents were most likely to adopt BMI technology to restore some of their natural upper extremity function, including restoration of hand grasp and/or some degree of natural arm movement. High speed typing and control of a fast robot arm were also of interest to this population. Surgically implanted wireless technologies were twice as 'likely' to be adopted as their wired equivalents.SignificanceAssessing end-user preferences is an essential prerequisite to the design and implementation of any assistive technology. The results of this survey suggest that people with tetraplegia would adopt an unobtrusive, autonomous BMI system for both restoration of upper extremity function and control of external devices such as communication interfaces.
- Published
- 2015
14. Acute flaccid paralysis with anterior myelitis - California, June 2012-June 2014.
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Ayscue, Patrick, Van Haren, Keith, Sheriff, Heather, Waubant, Emmanuelle, Waldron, Paul, Yagi, Shigeo, Yen, Cynthia, Clayton, Anna, Padilla, Tasha, Pan, Chao, Reichel, John, Harriman, Kathleen, Watt, James, Sejvar, James, Nix, William Allan, Feikin, Daniel, and Glaser, Carol
- Subjects
Prevention ,Rare Diseases ,Vaccine Related ,Neurosciences ,Infectious Diseases ,Biodefense ,Emerging Infectious Diseases ,Infection ,Good Health and Well Being ,Acute Disease ,Adolescent ,Adult ,Aged ,Anterior Horn Cells ,California ,Child ,Child ,Preschool ,Diagnosis ,Differential ,Female ,Humans ,Infant ,Male ,Middle Aged ,Muscle Hypotonia ,Myelitis ,Paralysis ,Young Adult ,Centers for Disease Control and Prevention ,General & Internal Medicine - Abstract
In August 2012, the California Department of Public Health (CDPH) was contacted by a San Francisco Bay area clinician who requested poliovirus testing for an unvaccinated man aged 29 years with acute flaccid paralysis (AFP) associated with anterior myelitis (i.e., evidence of inflammation of the spinal cord involving the grey matter including anterior horn cell bodies) and no history of international travel during the month before symptom onset. Within 2 weeks, CDPH had received reports of two additional cases of AFP with anterior myelitis of unknown etiology. Testing at CDPH's Viral and Rickettsial Disease Laboratory for stool, nasopharyngeal swab, and cerebrospinal fluid (CSF) did not detect the presence of an enterovirus (EV), the genus of the family Picornaviridae that includes poliovirus. Additional laboratory testing for infectious diseases conducted at the CDPH Viral and Rickettsial Disease Laboratory did not identify a causative agent to explain the observed clinical syndrome reported among the patients. To identify other cases of AFP with anterior myelitis and elucidate possible common etiologies, CDPH posted alerts in official communications for California local health departments during December 2012, July 2013, and February 2014. Reports of cases of neurologic illness received by CDPH were investigated throughout this period, and clinicians were encouraged to submit clinical samples for testing. A total of 23 cases of AFP with anterior myelitis of unknown etiology were identified. Epidemiologic and laboratory investigation did not identify poliovirus infection as a possible cause for the observed cases. No common etiology was identified to explain the reported cases, although EV-D68 was identified in upper respiratory tract specimens of two patients. EV infection, including poliovirus infection, should be considered in the differential diagnosis in cases of AFP with anterior myelitis and testing performed per CDC guidelines.
- Published
- 2014
15. Altering spinal cord excitability enables voluntary movements after chronic complete paralysis in humans
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Angeli, Claudia A, Edgerton, V Reggie, Gerasimenko, Yury P, and Harkema, Susan J
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Spinal Cord Injury ,Neurosciences ,Rehabilitation ,Physical Injury - Accidents and Adverse Effects ,Neurodegenerative ,Traumatic Head and Spine Injury ,Physical Rehabilitation ,Clinical Research ,Neurological ,Adult ,Chronic Disease ,Electric Stimulation Therapy ,Electromyography ,Evoked Potentials ,Motor ,Exercise Test ,Humans ,Locomotion ,Male ,Movement ,Muscle ,Skeletal ,Paralysis ,Physical Therapy Modalities ,Spinal Cord ,Treatment Outcome ,Young Adult ,human spinal cord injury ,epidural stimulation ,voluntary movement ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Neurology & Neurosurgery - Abstract
Previously, we reported that one individual who had a motor complete, but sensory incomplete spinal cord injury regained voluntary movement after 7 months of epidural stimulation and stand training. We presumed that the residual sensory pathways were critical in this recovery. However, we now report in three more individuals voluntary movement occurred with epidural stimulation immediately after implant even in two who were diagnosed with a motor and sensory complete lesion. We demonstrate that neuromodulating the spinal circuitry with epidural stimulation, enables completely paralysed individuals to process conceptual, auditory and visual input to regain relatively fine voluntary control of paralysed muscles. We show that neuromodulation of the sub-threshold motor state of excitability of the lumbosacral spinal networks was the key to recovery of intentional movement in four of four individuals diagnosed as having complete paralysis of the legs. We have uncovered a fundamentally new intervention strategy that can dramatically affect recovery of voluntary movement in individuals with complete paralysis even years after injury.
- Published
- 2014
16. Neuromuscular blockade administration is associated with altered energy expenditure in critically ill intubated patients with COVID-19
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Edison Jahaj, Anastasia Kotanidou, Aikaterini Sarri, Christina N. Katsagoni, Z. Mastora, T. Mikropoulos, Ageliki Kanavou, A. Maragkouti, and D. Karayiannis
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Adult ,Male ,0301 basic medicine ,Coronavirus disease 2019 (COVID-19) ,Fi02, fraction of inspired oxygen ,Critical Illness ,medicine.medical_treatment ,REE, Resting Energy Expenditure ,030209 endocrinology & metabolism ,Critical Care and Intensive Care Medicine ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,AcBW, actual body weight ,Paralysis ,medicine ,Humans ,Resting energy expenditure ,Obesity ,Respiratory system ,Mechanical ventilation ,Neuromuscular Blockade ,030109 nutrition & dietetics ,Nutrition and Dietetics ,business.industry ,Body Weight ,COVID-19 ,Calorimetry, Indirect ,Neuromuscular Diseases ,medicine.disease ,ICU, intensive care unit ,Intensive care unit ,APACHE, Acute Physiology and Chronic Health Evaluation ,NUTRIC SCORE, Nutrition Risk in the Critically Il ,Anesthesia ,AjBW, Adjusted Body Weight ,Female ,BMI, Body Mass Index ,NMBAs, Neuromuscular blocking agents ,medicine.symptom ,Energy Metabolism ,business ,COVID 19 - Abstract
Summary Background & aims ESPEN guidelines advocate that energy needs of critically ill patients with COVID 19 should be assessed using indirect calorimetry, if safely available. This study described energy needs of intubated patients with COVID-19 and explores whether neuromuscular blockade administration (NMBAs) is associated with altered energy expenditure. Methods Resting energy expenditure (REE) and respiratory exchange rate (RER) evaluated among critically ill intubated COVID-19 patients until 28th day of intensive care unit stay (ICU–S) by indirect calorimetry. Paralysed patients were defined as those with drug induced paralysis using cicatracurium, for at least 3 days during their ICU-S. Results 34 adult COVID 19 patients (59.8% male, 35.2% obese) requiring mechanical ventilation were assessed prospectively. REE measurements suggest a gradual increase of energy needs post 3rd day of ICU-S in both patients without obesity (non ob) ((from 17.8 kcal/kgr up to 29.3 kcal/kgr actual body weight (AcBW) during 28th day of ICU-S, p = 0.011)) and patients with obesity (ob) ((from 18.1 kcal/kgr up to 30.1 kcal/kgr adjusted body weight (AjBW) during 28th day of ICU-S, p = 0.021)). NMBAs use was accompanied by a significant drop in REE, especially during first 7 days of hospitalization, both in non ob (22.9 vs 17.9 kcal/kgr AcBW, p = 0.014) and ob patients (22.5 vs 19.5 kcal/kgr ABW, p = 0.027). Conclusion We identified the energy needs of COVID-19 intubated patients and highlighted a significant increase beyond the 1st week in the ICU. Administration of NMBAs should be considered, as it may impact resting energy expenditure.
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- 2022
17. Scapular winging due to rhomboid muscle paralysis: clinical assessment of 4 cases and anatomic study of the dorsal scapular nerve
- Author
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Alexandre Morante de Los Reyes, Guillaume Bacle, Camilo Chaves, Manon Tranier, Anaïs Jacquot, Philippe Corcia, Jacky Laulan, and Steven Roulet
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Male ,Adult ,Scapula ,Back Muscles ,Cadaver ,Humans ,Paralysis ,Neuralgia ,Female ,Orthopedics and Sports Medicine ,Surgery ,General Medicine - Abstract
A rare cause of scapular winging is rhomboid muscle paralysis secondary to dorsal scapular nerve (DSN) neuropathy. This paralysis causes winging of the medial border of the scapula with lateral rotation of its inferior angle. We report a series of 4 clinical cases of isolated DSN compression and the results of a specific rehabilitation protocol.A continuous clinical series of 4 patients with isolated rhomboid muscle deficiency was analyzed. Two patients were men and 2 were women, with a mean age of 40 years (range, 33-51 years). Three patients were right-handed and 1 was left-handed. Scapular winging always affected the dominant side. Two patients had occupations involving heavy physical work. The sports practiced involved exertion of the arms (dancing, boxing, gymnastics, muscle strengthening). A specific rehabilitation protocol was offered to the patients. In addition, 6 fresh cadaver dissections were performed to reveal possible DSN compression. Potential areas of compression were identified, in particular when the arm was raised.The 4 patients presented with isolated DSN neuropathy were confirmed by electroneuromyographic testing. Total correction of scapular winging was not obtained in any patient. Three patients experienced residual pain with a neuropathic pain by the questionnaire for a Diagnosis of Neuropathic Pain (DN4) score of 2. The mean Quick-Disabilities of the Arm, Shoulder and Hand (DASH) score after treatment was 31.8 of 100. The mean ASES score was 56.2. Only 1 patient agreed to rehabilitation in a specialized center and underwent follow-up electroneuromyography. Signs of rhomboid muscle denervation were no longer present and distal motor latencies had become normal. In all cadaver dissections, the DSN originated from the C5 nerve root and did not pass through the middle scalene muscle. We identified a site of dynamic compression of the DSN by the upper part of the medial border of the scapula when the arm was raised.DSN compression is conventionally attributed to the middle scalene muscle, but it is noteworthy that our study reveals the possibility of dynamic compression of the nerve by the proximal part of the medial border of the scapula, which occurs when the arm elevation is above 90°.Our study reveals the possibility of dynamic compression of the DSN by the proximal part of the medial border of the scapula, which occurs when the arm is raised above 90°. In the absence of a surgical solution, conservative treatment is fundamental and requires management in a rehabilitation center with intervention by a multidisciplinary team.
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- 2022
18. Development of a mathematical model for predicting electrically elicited quadriceps femoris muscle forces during isovelocity knee joint motion.
- Author
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Perumal, Ramu, Wexler, Anthony S, and Binder-Macleod, Stuart A
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Knee Joint ,Humans ,Paralysis ,Gait ,Range of Motion ,Articular ,Electric Stimulation Therapy ,Electric Stimulation ,Electrodes ,Implanted ,Movement ,Muscle Contraction ,Algorithms ,Models ,Neurological ,Computer Simulation ,Adolescent ,Adult ,Female ,Male ,Quadriceps Muscle ,Muscle Strength ,Young Adult ,Biomechanical Phenomena ,Range of Motion ,Articular ,Electrodes ,Implanted ,Models ,Neurological ,Rehabilitation ,Biomedical Engineering ,Neurosciences - Abstract
BackgroundDirect electrical activation of skeletal muscles of patients with upper motor neuron lesions can restore functional movements, such as standing or walking. Because responses to electrical stimulation are highly nonlinear and time varying, accurate control of muscles to produce functional movements is very difficult. Accurate and predictive mathematical models can facilitate the design of stimulation patterns and control strategies that will produce the desired force and motion. In the present study, we build upon our previous isometric model to capture the effects of constant angular velocity on the forces produced during electrically elicited concentric contractions of healthy human quadriceps femoris muscle. Modelling the isovelocity condition is important because it will enable us to understand how our model behaves under the relatively simple condition of constant velocity and will enable us to better understand the interactions of muscle length, limb velocity, and stimulation pattern on the force produced by the muscle.MethodsAn additional term was introduced into our previous isometric model to predict the force responses during constant velocity limb motion. Ten healthy subjects were recruited for the study. Using a KinCom dynamometer, isometric and isovelocity force data were collected from the human quadriceps femoris muscle in response to a wide range of stimulation frequencies and patterns. % error, linear regression trend lines, and paired t-tests were used to test how well the model predicted the experimental forces. In addition, sensitivity analysis was performed using Fourier Amplitude Sensitivity Test to obtain a measure of the sensitivity of our model's output to changes in model parameters.ResultsPercentage RMS errors between modelled and experimental forces determined for each subject at each stimulation pattern and velocity showed that the errors were in general less than 20%. The coefficients of determination between the measured and predicted forces show that the model accounted for approximately 86% and approximately 85% of the variances in the measured force-time integrals and peak forces, respectively.ConclusionThe range of predictive abilities of the isovelocity model in response to changes in muscle length, velocity, and stimulation frequency for each individual make it ideal for dynamic applications like FES cycling.
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- 2008
19. Percivall Pott (1713-1788) on the curvature of the spine and the French contribution
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O. Walusinski and J. Poirier
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Male ,medicine.medical_specialty ,Eponyms ,History ,General surgery ,Pott's fracture ,Neurosurgery ,Eponym ,medicine.disease ,Spine ,Cranial trauma ,Scrotum cancer ,Neurology ,Child, Preschool ,medicine ,Paralysis ,Humans ,First law ,Tuberculosis, Spinal ,Neurology (clinical) ,medicine.symptom ,Pott's Paraplegia ,Child ,Paraplegia - Abstract
Physicians remember the name of the surgeon Percivall Pott (1713-1788) because of the eponym "Pott's disease", described as "paralysis in the lower limbs, which is often accompanied by curvature of the spine". Pott's writings on surgical subjects are far vaster. For example, he described the fracture-dislocation of the ankle, or Pott's fracture, and determined the cause of scrotum cancer in chimney sweeps. He attributed this disease to contact with tar that contaminated the clothing of workers, often very young children because they were small enough to fit into chimney conduits. His work led to the first law addressing the employment of children. After a brief account of Pott's life, this article presents the description of Pott's paraplegia, for which both Jean-Martin Charcot and Yvonne Sorrel-Dejerine paid him homage. The contribution of some of his predecessors and of French contemporaries is highlighted. Pott was also a pioneer in neurosurgery, describing the non-symptomatic interval between cranial trauma and coma and the indication for trepanation to remove a haematoma.
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- 2022
20. Relationship Between Peroneal Nerve and Anterior Cruciate Ligament Involvement in Multiligamentous Knee Injury: A Multicenter Study
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Danielle H, Markus, Edward S, Mojica, Andrew, Bi, Joseph B, Kahan, Jay, Moran, Brian J, Mannino, Erin F, Alaia, Laith M, Jazrawi, Michael J, Medvecky, and Michael J, Alaia
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Male ,Adult ,Peripheral Nerve Injuries ,Anterior Cruciate Ligament Injuries ,Humans ,Peroneal Nerve ,Paralysis ,Orthopedics and Sports Medicine ,Surgery ,Knee Injuries ,Anterior Cruciate Ligament ,Peroneal Neuropathies ,Retrospective Studies - Abstract
Peroneal nerve injuries are rare injuries and usually associated with multiligamentous knee injuries (MLKIs) involving one or both cruciate ligaments. The purpose of our study was to perform a multicenter retrospective cohort analysis to examine the rates of peroneal nerve injuries and to see whether a peroneal nerve injury was suggestive of a particular injury pattern.A retrospective chart review was conducted in patients who were diagnosed with MLKI at two level I trauma centers from January 2001 to March 2021. MLKIs were defined as complete injuries to two or more knee ligaments that required surgical reconstruction or repair. Peroneal nerve injury was clinically diagnosed in these patients by the attending orthopaedic surgeon. Radiographs, advanced imaging, and surgical characteristics were obtained through a chart review.Overall, 221 patients were included in this study. The mean age was 35.9 years, and 72.9% of the population was male. Overall, the incidence of clinical peroneal nerve injury was 19.5% (43 patients). One hundred percent of the patients with peroneal nerve injury had a posterolateral corner injury. Among patients with peroneal nerve injury, 95.3% had a complete anterior cruciate ligament (ACL) rupture as compared with 4.7% of the patients who presented with an intact ACL. There was 4.4 times of greater relative risk of peroneal nerve injury in the MLKI with ACL tear group compared with the MLKI without an ACL tear group. No statistical difference was observed in age, sex, or body mass index between patients experiencing peroneal nerve injuries and those who did not.The rate of ACL involvement in patients presenting with a traumatic peroneal nerve palsy is exceptionally high, whereas the chance of having a spared ACL is exceptionally low. More than 90% of the patients presenting with a nerve palsy will have sustained, at the least, an ACL and posterolateral corner injury.IV, Case Series.
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- 2022
21. Orbital Fractures With Concomitant Ocular Nerve Palsy: An Insidious and Potentially Misleading Association in Surgical Decision-Making
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Paolo, Scolozzi, Edward, Gigon, Petra, Schampel, and Heimo, Steffen
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Adult ,Male ,Middle Aged ,Young Adult ,Otorhinolaryngology ,Oculomotor Muscles ,Diplopia ,Humans ,Paralysis ,Female ,Surgery ,Oral Surgery ,Orbital Fractures ,Retrospective Studies - Abstract
Orbital fractures (OFs) are common, but their association with concomitant traumatic ocular nerve palsy (TONP) is exceptional and may potentially cause confusing clinical pictures of oculomotor involvement. The purpose of the present study is to describe a series of patients with OFs and concomitant TONP following facial trauma and to evaluate clinical features, diagnostic pitfalls, and final functional outcome.The investigators designed and implemented a retrospective case series and enrolled a sample of patients with OFs and concomitant TONP who had been managed at the University Hospitals of Geneva between 2013 and 2020. The primary outcomes were clinical pitfalls (diagnosis of neurogenic vs restrictive ocular motility pattern at baseline) and final functional outcome (persistent symptomatic diplopia). Other study variables included demographic and injury related parameters.The sample was composed of 10 patients with a mean age of 40.7 ± 12.3 years (range 21 to 53 years) and 80% were men. In all patients, the diagnosis of the neurogenic component accounted for the main diagnostic pitfalls associated to the baseline post-traumatic limitation of ocular motility and diplopia. Six patients (60%) had a full spontaneous recovery of their diplopia. Four patients (40%) had a partial recovery with residual diplopia. Of these 4 patients, 1 patient underwent corrective strabismus surgery, 2 had temporary occlusion of 1 eye, and 1 had Fresnel prisms. At the final follow-up visit none of the patients had persistent symptomatic diplopia.The present study has shown that OFs with concomitant TONP entail complex ocular motility patterns of neurogenic and/or restrictive origin; the diagnosis of the neurogenic component represents the main clinical pitfall that warrants a careful orthoptic evaluation to ensure the appropriate management; the final outcome was favorable with no persistent symptomatic diplopia in any of the patients.
- Published
- 2022
22. Learning Curve for Endoscopic Thyroidectomy Using Video-Assisted Neck Surgery: Retrospective Analysis of a Surgeon's Experience with 100 Patients
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Mami Matsui, Iwao Sugitani, Kazuo Shimizu, Takehito Igarashi, Ritsuko Okamura, Hiroko Kazusaka, Tomoo Jikuzono, Masaomi Sen, Ryuta Nagaoka, and Marie Saitou
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Adult ,Male ,medicine.medical_specialty ,endocrine system diseases ,Video-Assisted Surgery ,Thyroid carcinoma ,Paralysis ,medicine ,Recurrent laryngeal nerve ,Retrospective analysis ,Humans ,Thyroid Neoplasms ,Retrospective Studies ,Surgeons ,business.industry ,Thyroid ,General Medicine ,Single surgeon ,Surgery ,Dissection ,medicine.anatomical_structure ,Endoscopic thyroidectomy ,Thyroidectomy ,Neck Dissection ,Female ,medicine.symptom ,business ,Vocal Cord Paralysis ,Learning Curve - Abstract
Background Endoscopic thyroidectomy offers excellent cosmetic outcomes, but requires a period of time for surgeons to become proficient. We examined the learning curve for the first 100 cases experienced by a single surgeon using a video-assisted neck surgery (VANS) subclavian approach. Methods We retrospectively studied 100 patients (99 women, 1 man; mean age, 36.2 years) with both benign and malignant thyroid diseases treated between 2016 and 2020. Results Preoperative diagnosis was papillary thyroid carcinoma (PTC) in 36 cases and other (non-PTC) in 64 cases. All patients underwent lobectomy, with unilateral central node dissection added for patients with PTC. Mean operative time was 125 min for non-PTC cases and 129 min for PTC cases (p = 0.43), with blood loss of 33.8 ml and 7.6 ml, respectively (p = 0.01). Recurrent laryngeal nerve paralysis (RNP) was observed in 12 patients (12%) and hemorrhage in 2 patients (2%). Comparing the first 30 cases with the last 70 cases, no significant differences in operative time or blood loss were evident, although tumor size of non-PTC cases was significantly greater among later cases (32.4 mm vs. 39.5 mm, p = 0.039). RNP was significantly decreased in later cases (26.7% vs. 5.7%, p = 0.003). Multivariate analysis revealed tumor size as a significant risk factor for increased blood loss, and increased experience correlated significantly with the decrease in RNP. Conclusions In VANS, a certain surgical level was reached after experiencing 30 cases.
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- 2022
23. Anamnestic, clinical and laboratory features of the acute period of ischemic stroke in young patients
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Gusev, V. V., Kovtun, O. P., Lvova, O. A., Partylova, E. A., Sergeev, A. P., Sergeeva, M. V., Yanchuk, I. T., Dobrazova, D. A., Suvorkov, P. A., and Shamalov, N. A.
- Subjects
FIBRINOGEN BETA ,GENETIC VARIABILITY ,PARALYSIS ,SINGLE NUCLEOTIDE SUBSTITUTIONS ,MAJOR CLINICAL STUDY ,UNCLASSIFIED DRUG ,CLINICAL FEATURE ,BETA3 INTEGRIN ,ATRIAL FIBRILLATION ,COMPUTER ASSISTED TOMOGRAPHY ,HYPERLIPIDEMIA ,CEREBROVASCULAR MALFORMATION ,PARESIS ,HUMAN ,RISK FACTOR ,BRACHIOCEPHALIC ARTERY STENOSIS ,FEMALE ,Psychiatry and Mental health ,Clinical Psychology ,METABOLIC DISORDER ,BRAIN VASCULITIS ,MIGRAINE ,HOSPITALIZATION ,RISK FACTORS ,ISCHEMIC STROKE ,ATHEROSCLEROTIC PLAQUE ,BLOOD CLOTTING FACTOR 7 ,NUCLEIC ACID BASE SUBSTITUTION ,HEART LEFT VENTRICLE HYPERTROPHY ,BLOOD CLOTTING FACTOR 5 ,PLASMINOGEN ACTIVATOR INHIBITOR 1 ,COHORT ANALYSIS ,GENETIC PREDISPOSITION ,BRAIN INFARCTION ,HETEROZYGOTE ,NUCLEAR MAGNETIC RESONANCE IMAGING ,ADULT ,DNA POLYMORPHISM ,MITRAL VALVE PROLAPSE ,DYSLIPOPROTEINEMIA ,ALPHA2 INTEGRIN ,ARTICLE ,FIBRINOGEN ,ERYTHROCYTE SEDIMENTATION RATE ,HOSPITAL ADMISSION ,MALE ,OCCLUSIVE CEREBROVASCULAR DISEASE ,SPEECH DISORDER ,YOUNG AGE ,CONTROLLED STUDY ,ANAMNESIS ,INTENSIVE CARE ,THROMBOPHILIA ,Neurology (clinical) ,RANKIN SCALE ,SELF CARE - Abstract
Objective: to study the anamnestic, clinical and laboratory features of the acute period of ischemic stroke (IS) and to determine the risk factors for its development in young patients.Patients and methods. Clinical and statistical processing of data of 256 patients aged 18 to 44 years included, who had IS, confirmed by computed and/or magnetic resonance imaging of the brain in the acute period, was carried out. Furthermore, in 154 patients and in 117 healthy participants, who made up the control group, eight polymorphisms of the thrombophilic spectrum genes were determined – FGB: -455G>A, F2: 20210G>A, F5: 1691G>A, F7: 10976G>A, F13: 103 G>T, ITGA2: 807C>T, ITGB3: 1565 T>C, PAI-1: -675 5G>4G.Results and discussion. 154 (60.15%) patients demonstrated good recovery (achievement of a level of ≤2 points on the Rankin scale by the patient). None of the patients died during their hospitalization. In the evaluated group of patients, we identified allelic variants of the thrombophilic spectrum genes and gene-gene combinations, the carriage of which increased the likelihood of IS development at the young age by 1.74 and 2.19 times, respectively. Taking into consideration additional examination methods, the pathogenetic variant of IS according to the TOAST classification was verified in 226 (88%) patients.Conclusion. In IS at a young age a detailed assessment of risk factors is required, including an analysis of carrier variants and combinations of procoagulant and prothrombotic spectrum gene polymorphisms.
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- 2022
24. Common peroneal nerve palsy after primary total hip arthroplasty
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Vlad Alexandru Georgeanu, Octav Marius Russu, Bogdan Obada, Madalina-Gabriela Iliescu, Marius Nicolae Popescu, Dan Marcel Iliescu, and Vlad Predescu
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Male ,Arthroplasty, Replacement, Hip ,Humans ,Paralysis ,Peroneal Nerve ,Female ,Orthopedics and Sports Medicine ,Surgery ,Prospective Studies ,Middle Aged ,Peroneal Neuropathies ,Aged - Abstract
The study wants to evaluate the incidence, the clinical evolution, and treatment of common peroneal nerve (CPN) palsy after primary total hip arthroplasty.Our clinical prospective study was made between January 2016 and December 2020. The study group comprised 1240 total hip replacements over a period of five years. Six cases were diagnosed with CPN palsy (0.48%). Five were women and one man, aged from 52 to 71 years old. The common peroneal nerve lesion was diagnosed clinically and by electromyography.The follow-up period was at least 24 months post-operatively. In all six cases, there was a complete common peroneal nerve palsy, documented by electromyography. The poorest results were obtained in the older patients and those who had the highest body mass index, which at two years post-operatively achieved only a partial sensory rehabilitation, with complete motor deficit. All patients can walk unassisted, without support, with one case having complete rehabilitation achieved 18 months postoperatively and three with partial rehabilitation.CPN palsy after primary THA is a very serious complication with poor functional outcome. There is no consensus regarding the treatment. The age and the intensity of the rehabilitation program are the only significant factors for the medical rehabilitation after this debilitating post-operative complication.
- Published
- 2022
25. Outcome of arthroscopic pectoralis minor release and scapulopexy for the management of scapulothoracic abnormal motion
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Bassem T, Elhassan, Khang H, Dang, Tiffany M, Huynh, Chelsea, Harstad, and Matthew J, Best
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Joint Instability ,Male ,Shoulder Joint ,Pain ,General Medicine ,Pectoralis Muscles ,Arthroscopy ,Treatment Outcome ,Humans ,Paralysis ,Female ,Orthopedics and Sports Medicine ,Surgery ,Range of Motion, Articular ,Retrospective Studies - Abstract
Management of persistent symptomatic scapulothoracic abnormal motion (STAM) in the absence of periscapular muscle paralysis may be challenging. This study reports the outcomes of arthroscopic pectoralis minor release and scapulopexy for the management of symptomatic STAM secondary to pectoralis minor hyperactivity and serratus anterior hypoactivity in the absence of periscapular paralysis.This was a retrospective cohort study with prospectively collected data of patients with symptomatic STAM secondary to pectoralis minor hyperactivity and serratus anterior hypoactivity. Surgery was indicated if patients failed 6 months of conservative management. Patient outcomes were assessed with shoulder range of motion (ROM) measurements, numerical pain scale, shoulder subjective value (SSV), and Constant score. Data were analyzed with Fischer's exact test for categorical variables and Student's t-test of unequal variance for continuous and categorical variables.Thirty-one consecutive patients were included in the study period between 2017 and 2020. Average age at the time of surgery was 24 years (range, 14-44 years), 80% of patients were female, and average follow-up after surgery was 23 months (range, 15-39 months). Thirteen patients also had a diagnosis of recurrent posterior instability. At final follow-up, 81% reported significant improvements in their STAM, as demonstrated by improved mean pain scale, ROM, SSV, and Constant scores. Pain improved from 6 (range, 4-10) to 2 (range, 1-4), SSV from 30% (range, 10%-40%) to 75% (range, 60%-100%), and Constant score from 49 (range, 43-61) preoperatively to 79 (range, 51-100) postoperatively (P.01). All 13 patients with recurrent associated posterior instability had resolution of their instability. Flexion ROM improved from average 100° (range, 60°-150°) to 140° (range, 120°-160°). One patient had traumatic rupture of her scapulopexy 7 weeks postoperatively and underwent revision scapulopexy. Thirteen percent had minimal improvement after surgery and experienced recurrence 3 months postoperatively.In patients with symptomatic STAM secondary to pectoralis minor hyperactivity and serratus anterior hypoactivity, arthroscopic pectoralis minor release and scapulopexy is an effective surgical option.
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- 2022
26. Diaphragmatic paralysis resulting in respiratory failure as a feature of hepatitis E virus-associated neuralgic amyotrophy
- Author
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Shakya Bhattacharjee, Muhammed Ameen Noushad, Demetra Limnatitou, and Azlisham Mohd Nor
- Subjects
Male ,viruses ,Case Report ,Diaphragmatic paralysis ,medicine.disease_cause ,03 medical and health sciences ,0302 clinical medicine ,Hepatitis E virus ,Medicine ,Brachial Plexus Neuritis ,Humans ,Paralysis ,Respiratory function ,Phrenic nerve ,business.industry ,virus diseases ,General Medicine ,Respiratory Paralysis ,Hepatitis E ,Phrenic Nerve ,Lumbosacral plexus ,Respiratory failure ,Anesthesia ,Breathing ,030211 gastroenterology & hepatology ,business ,Brachial plexus ,030217 neurology & neurosurgery - Abstract
Hepatitis E virus (HEV)-associated neuralgic amyotrophy (NA) is often bilateral and severe, involving structures outside the brachial plexus, such as the phrenic nerves or the lumbosacral plexus. We report a case of an HEV-positive man who had presented with brachial neuritis, with significant phrenic nerve involvement, resulting in diaphragmatic paralysis requiring non-invasive ventilation. Prognosis of HEV-associated NA is often unfavourable and recovery is usually incomplete. Identifying HEV-associated NA early could potentially aid in prognostication and management planning, as clinicians and patients would be expectant of its potential features and severity. Respiratory function should be monitored in patients with HEV who suffer from NA, as diaphragmatic paralysis could potentially lead to severe respiration difficulties requiring ventilatory support.
- Published
- 2023
27. Louis Duménil (1823–1890), surgeon and pioneer in neurology
- Author
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O. Walusinski
- Subjects
Male ,medicine.medical_specialty ,Neurology ,Guillain-Barre Syndrome ,Atrophy ,Neurosyphilis ,medicine ,Humans ,Paralysis ,Amyotrophic lateral sclerosis ,Locomotor ataxia ,Surgeons ,Soft palate ,business.industry ,General surgery ,Amyotrophic Lateral Sclerosis ,History, 19th Century ,Progressive muscular atrophy ,medicine.disease ,Spinal cord ,medicine.anatomical_structure ,Syringobulbia ,France ,Neurology (clinical) ,business - Abstract
Louis-Stanislas Dumenil (1823–1890) was a surgeon from Normandy who was a contemporary of Jean-Martin Charcot (1825–1893). Throughout his career, Dumenil published annotated observations of neurological pathologies . One year before Guillaume Duchenne de Boulogne (1806–1875), he reported a case of “progressive muscular paralysis of the tongue, soft palate , and lips”. He added five other cases of progressive muscular atrophy in 1867, together with histological examinations which showed atrophy in the anterior horns of the spinal cord. Charcot, who described amyotrophic lateral sclerosis , did not fail to pay homage to Dumenil for his contribution. In 1862, Dumenil added clinical observations of progressive locomotor ataxia , one of the first to do so. This included anatomopathological examinations, thus significantly completing the clinical picture presented by Duchenne in 1858. He confirmed the damage to the roots and posterior tracts of the spinal cord. Finally, by providing multiple observations of the syndrome described by Octave Landry (1826–1865) in 1859, he contributed to the clinical picture of “acute ascending paralysis” which has come down to us as Guillain-Barre syndrome, with no mention of the perspicacious physicians of the previous century who had already perfectly recognised this disease. Finally, Augusta Dejerine-Klumpke (1859–1927) paid a warm tribute to Dumenil in her 1889 thesis, calling him one of the pioneers in understanding “the individuality and autonomy of the peripheral nervous system .” He was indeed a pioneer, although he has been often overlooked.
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- 2022
28. The Action of Botulinum Toxin A on the Sternocleidomastoid Muscle: An Experimental Study on Rats
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Themistoklis Vampertzis, Christina Barmpagianni, Chrysa Mpekiari, Rania Baka, Ioannis Zervos, Eleftherios Tsiridis, and Nikiforos Galanis
- Subjects
Male ,Dose-Response Relationship, Drug ,Article Subject ,Electromyography ,General Medicine ,Injections, Intramuscular ,General Biochemistry, Genetics and Molecular Biology ,Rats ,Neck Muscles ,Animals ,Paralysis ,Botulinum Toxins, Type A ,Rats, Wistar ,General Environmental Science - Abstract
In this study, we aim to investigate the effective dose of botulinum neurotoxin A that results in paralysis of the sternocleidomastoid muscle for a minimum duration of 28 days in Wistar rats. This research is the first in a series of studies to investigate the value of botulinum toxin A in the healing of clavicle fractures through the temporary paralysis of the sternocleidomastoid. A surgical incision was made under general anaesthesia, and botulinum neurotoxin A in respective doses of 4 and 6 international units (IU) or normal saline in equivalent volumes were injected directly into the exposed muscle. Electromyography was conducted on days 0, 7, and 28 following substance administration to determine the extent of muscle paralysis. Electromyography on day 0 showed no paralysis in either group. Animals injected with neurotoxin all exhibited paralysis on days 7 and 28 that was weaker in the group injected with the smaller dose of 4 IU. One death occurred in the group injected with the higher dose (6 IU), whereas in the control group, no paralysis was seen. Botulinum neurotoxin A in a dose of 6 IU resulted in complete paralysis of the sternocleidomastoid in rats for a minimum of 28 days. A dose of 4 IU resulted in less potent paralysis but was safer in our research. Botulinum neurotoxin is a substance utilised in cosmetics and therapeutics for many years, yet research shows that its use can be expanded to target a wider range of pathologies. In this series of studies, we aim to explore the neurotoxin’s applications on the treatment of clavicle fractures. To investigate this, we need to first establish the duration of its action on the sternocleidomastoid muscle.
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- 2022
29. Psychometric Validation of the FACE-Q Craniofacial Module for Facial Nerve Paralysis
- Author
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Jonathan H Norris, Marinka L. F. Hol, Lucas Gallo, Teresa O, Heather L. Baltzer, Andrea L. Pusic, David W. Johnson, Karen W. Y. Wong Riff, Dylan J. Murray, Charlene Rae, Nancy Van Laeken, Anne F. Klassen, Stefan J. Cano, Kathleen R. Bogart, Graduate School, and Oral and Maxillofacial Surgery
- Subjects
Adult ,Male ,Adolescent ,Psychometrics ,Facial Paralysis ,Young Adult ,Cronbach's alpha ,Paralysis ,medicine ,Humans ,Patient Reported Outcome Measures ,Craniofacial ,Child ,Qualitative Research ,Reliability (statistics) ,Aged ,Aged, 80 and over ,Rasch model ,Qualitative interviews ,Reproducibility of Results ,Middle Aged ,Facial nerve ,Systematic review ,Female ,Surgery ,Facial Nerve Diseases ,medicine.symptom ,Psychology ,Clinical psychology - Abstract
Background: Systematic reviews have identified the need for a patient-reported outcome measure for facial nerve paralysis (FNP). The aim of this study was to determine the psychometric properties of FACE-Q Craniofacial module scales when used in a combined sample of children and older adults with FNP. Methods: Data were collected between December 2016 and December 2019. We conducted qualitative interviews with children and adults with FNP. FACE-Q data were collected from patients aged 8 years and older with FNP. Rasch measurement theory analysis was used to examine the reliability and validity of the relevant scales in the FNP sample. Results: Twenty-five patients provided 2052 qualitative codes related to appearance, physical, psychological, and social function. Many patient concerns were common across age. The field-test sample included 235 patients aged 8-81 years. Of the 13 scales examined, all 122 items had ordered thresholds and good item fit to the Rasch model. For 12 scales, person separation index values were ≥0.79 and Cronbach's alpha values were ≥0.82. The 13th scale's reliability values were ≥0.71. Conclusion: The FACE-Q Craniofacial module scales described in this study can be used to collect and compare evidence-based outcome data from children and adults with FNP.
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- 2022
30. Involuntary movements as a prognostic factor for acute encephalopathy with biphasic seizures and late reduced diffusion
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Tohru Okanishi, Yosuke Miyamoto, Sotaro Kanai, Yoshiaki Saito, Masanori Maeda, Yoshihiro Maegaki, and Tatsuya Kawaguchi
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Multivariate analysis ,Epilepsy ,Developmental Neuroscience ,Seizures ,Outcome Assessment, Health Care ,Intellectual disability ,Paralysis ,Humans ,Medicine ,Glasgow Coma Scale ,Retrospective Studies ,Involuntary movement ,Brain Diseases ,Univariate analysis ,Dyskinesias ,business.industry ,Infant ,General Medicine ,Prognosis ,medicine.disease ,Hyperintensity ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,Neurology (clinical) ,medicine.symptom ,business - Abstract
Background Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is characterized by biphasic seizures and white matter lesions with reduced diffusion, which are often accompanied by involuntary movements. The neurological outcomes of AESD vary from normal to mild or severe sequelae, including intellectual disability, paralysis, and epilepsy. The present study aimed to clarify the prognostic factors of AESD, including involuntary movements. Methods We enrolled 29 patients with AESD admitted to Tottori University Hospital from 1991 to 2020 and retrospectively analyzed their clinical data. Neurological outcomes were assessed by the Pediatric Cerebral Performance Category score and cerebral paralysis as neurological sequelae. Results Of the 29 patients, 12 had favorable outcomes and 17 had unfavorable outcomes. Univariate analysis revealed that the presence of underlying diseases, a decline in Glasgow Coma Scale (GCS) score 12–24 h after early seizures, and involuntary movements were associated with unfavorable outcomes. In multivariate analysis, a decline in GCS score and involuntary movements were associated with unfavorable outcomes. The sensitivities and specificities of underlying diseases, a decline of ≥ 3 points in GCS score 12–24 h after early seizures, and involuntary movements for unfavorable outcomes were 53% and 92%, 92% and 65%, and 59% and 92%, respectively. Conclusions The appearance of involuntary movements may be associated with unfavorable outcomes of AESD. The prognostic factors identified herein are comparable with previously known prognostic factors of consciousness disturbances after early seizures.
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- 2022
31. Magnetic stimulation of muscle evokes cerebral potentials by direct activation of nerve afferents: A study during muscle paralysis
- Author
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Zhu, Yu, Starr, Arnold, Haldeman, Scott, Fu, Hongxiang, Liu, Jinshen, and Wu, Pingjia
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Neurosciences ,Adult ,Brain ,Electric Stimulation ,Electrophysiology ,Female ,Humans ,Magnetics ,Male ,Middle Aged ,Muscles ,Neuromuscular Depolarizing Agents ,Neurons ,Afferent ,Paralysis ,Succinylcholine ,somatosensory evoked potentials ,magnetic stimulation ,muscle afferents ,succinylcholine paralysis ,Medical and Health Sciences ,Neurology & Neurosurgery ,Biological sciences ,Biomedical and clinical sciences - Abstract
We tested the hypothesis that magnetic stimulation of muscle evokes cerebral potentials by causing a muscle contraction that then activates muscle receptors. We measured cerebral evoked potentials accompanying magnetic stimulation of muscle in 3 patients during surgery both before and after muscle paralysis with succinylcholine, a depolarizing agent. The magnetic stimulation was at low intensity (30%) and at a 2/s rate. The administration of succinylcholine sufficient to produce muscle paralysis did not alter cerebral potentials evoked by either low-intensity magnetic stimulation of muscle (gastrocnemius/soleus) or electrical stimulation of peripheral nerve (tibial nerve). In 1 normal subject, the S1 nerve root action potentials conducting at rapid velocity (> 60 m/s) were detected at the S1 foramen with a needle electrode using electrical stimulation of the tibial nerve. However, no S1 nerve root potentials could be identified to magnetic stimulation of muscle that evoked a cerebral potential. We conclude that magnetic stimulation of muscle activates terminal afferents in the muscle to provide the afferent drive for the cerebral potentials independent of muscle contraction. The failure to detect the afferent volley in S1 nerve root to magnetic stimulation suggests that only a few afferents are activated or that the activation of afferents is temporally dispersed.
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- 1996
32. A case of cardioembloic stroke with wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome
- Author
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Sho, Wako, Sono, Toi, Takafumi, Mizuno, Ayako, Nishimura, Kentaro, Ishizuka, and Kazuo, Kitagawa
- Subjects
Aged, 80 and over ,Male ,Stroke ,Embolic Stroke ,Ocular Motility Disorders ,Ophthalmoplegia ,Exotropia ,Humans ,Paralysis ,Syndrome ,Neurology (clinical) - Abstract
Here, we report a case of an 85-year-old man who presented sudden onset of diplopia, dysarthria, and gait disturbance. On admission, he exhibited bilateral adduction palsy, convergence palsy, and binocular exotropia in the forward gaze showing wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome. He had a history of chronic nonvalvular atrial fibrillation. DWI-MRI revealed acute ischemic lesions in the paramedian pontine tegmentum, lower midbrain, both cerebellar hemispheres, and left frontal cortex. He was thus diagnosed with an acute phase of cardioembolic stroke. Subsequently, the right eye adduction palsy in the forward gaze was slightly improved, but other eye movement disorders persisted during discharge from the hospital. The pathology was suspected to involve bilateral damages to both medial longitudinal fasciculus and the paramedian pontine reticular formation. WEBINO syndrome was not only ascribed to lacunar infarction and large artery atherosclerosis but also cardioembolic stroke. The presence of other non-eye symptoms and multiple ischemic lesions could be the characteristics of WEBINO syndrome following cardioembolic stroke.
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- 2022
33. Functional gland-preserving surgery via periauricular incision for pleomorphic adenoma of the parotid gland
- Author
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Jong-Lyel Roh
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Facial Paralysis ,Adenoma, Pleomorphic ,Pleomorphic adenoma ,Young Adult ,Postoperative Complications ,stomatognathic system ,medicine ,Paralysis ,Humans ,Parotid Gland ,Longitudinal Studies ,Radionuclide Imaging ,Aged ,Facial Nerve Injuries ,Salivary gland ,business.industry ,Recovery of Function ,General Medicine ,Middle Aged ,medicine.disease ,Facial nerve ,Parotid Neoplasms ,Parotid gland ,Surgery ,medicine.anatomical_structure ,Parotid Pleomorphic Adenoma ,Oncology ,Superficial Parotidectomy ,Patient Satisfaction ,Female ,Neoplasm Recurrence, Local ,Ultrasonography ,medicine.symptom ,Salivation ,business ,Organ Sparing Treatments - Abstract
Introduction Gland-preserving surgery is often used for benign tumours in the parotid gland. Partial superficial parotidectomy via a periauricular incision may bring satisfactory cosmetic outcomes but the disease control outcome remains unrevealed. This study evaluated functional and disease control outcomes after gland-preserving surgery via periauricular incision for pleomorphic adenoma of the parotid gland. Methods This longitudinal study included 248 consecutive patients with parotid pleomorphic adenoma who underwent the preservation of most normal parotid tissues and the facial nerve combined with the en-bloc resection of tumours via periauricular incision. Postoperative complications, subjective satisfaction, salivary function, and tumour recurrence were assessed in each patient. The secretory function of the salivary gland was measured using salivary scintigraphy at 6 months after surgery, and ultrasonography was regularly followed. Results Median tumour size was 2.5 cm (range, 0.8–5.2 cm) and median operation time was 55 min (range, 39–88 min). All tumours were safely removed by gland-preserving surgery via periauricular incision without extension to Blair or hairline incision and tumour spillage. Temporary and permanent paralysis of the facial nerve was 14 (5.6%) and none of the study patients, respectively. Postoperative complications were minor and Frey's syndrome was found in 6 (2.4%) patients. The Secretary function of the affected gland was equal to that of the unaffected gland. No patients had a recurrence for a median follow-up of 78 months (range, 24–126 months). Conclusions Functional gland-preserving surgery via periauricular incision can treat pleomorphic adenoma in the parotid gland with satisfactory functional, cosmetic, and disease control outcomes.
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- 2022
34. Targeted chemodenervation of the posterior belly of the digastric muscle for the management of jaw discomfort in facial synkinesis
- Author
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Aude Perusseau-Lambert, Daniel Butler, Ruben Kannan, Charles Nduka, and Elena Pescarini
- Subjects
Adult ,Male ,medicine.medical_specialty ,Synkinesis ,Visual analogue scale ,Facial Muscles ,Injections, Intramuscular ,Chemodenervation ,Disability Evaluation ,03 medical and health sciences ,0302 clinical medicine ,Swallowing ,Surveys and Questionnaires ,Paralysis ,medicine ,Humans ,Botulinum Toxins, Type A ,Ultrasonography, Interventional ,Aged ,Pain Measurement ,Digastric muscle ,business.industry ,Mandible ,Middle Aged ,medicine.disease ,Botulinum toxin ,Surgery ,Neuromuscular Agents ,030220 oncology & carcinogenesis ,Female ,medicine.symptom ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Summary Background Botulinum toxin (BT-A) chemodenervation has been proved to significantly improve the physical and psychological well-being of patients suffering from facial synkinesis. Despite this, a cohort of patients has persistent tightness and discomfort around the angle of the jaw, which may be caused by synkinesis within the posterior belly of digastric (PBD) muscle. This study was designed to evaluate the benefits of ultrasound-guided BT-A injections into the PBD. Methods Thirty-three patients with recalcitrant tightness and discomfort around the angle of the jaw, despite maximal facial therapy and platysmal chemodenervation were selected for inclusion. Patients underwent ultrasound-guided BT-A injection into the ipsilateral PBD muscle (skin puncture site 1 cm inferior and posterior to the angle of mandible). Outcomes consisted of the Facial Disability Index (FDI), Synkinesis Assessment Questionnaire (SAQ), and a visual analogue scale (VAS) designed to assess tightness and pain around the PBD when moving the jaw, swallowing, and masticating. Questionnaires were completed two weeks before and postinjection. Statistical analysis was performed using a paired t-test. Results Nineteen patients completed the post-treatment outcome questionnaire. A statistically significant improvement was noted in the physical and social function aspects of the FDI and all aspects of the patient-reported VAS scores apart from tightness and pain on jaw retrusion and swallowing. There was no significant difference in the SAQ. Conclusion This study has demonstrated the patient-perceived benefit of ultrasound-targeted BT-A chemodenervation of PBD. This represents a low-risk treatment option that can be easily added to the repertoire of treatments offered to patients with post paralysis facial synkinesis.
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- 2021
35. Clinical characteristics and surgical outcomes of isolated inferior rectus palsy
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Licheng, Fu, Binbin, Zhu, and Jianhua, Yan
- Subjects
Adult ,Male ,Dysplasia ,Adolescent ,Extraocular muscle ,Research ,Paralytic strabismus ,Strabismus surgery ,Ophthalmologic Surgical Procedures ,General Medicine ,Middle Aged ,RE1-994 ,Inferior rectus muscle ,Strabismus ,Young Adult ,Ophthalmology ,Treatment Outcome ,Oculomotor Muscles ,Child, Preschool ,Humans ,Paralysis ,Female ,Child ,Aged ,Retrospective Studies - Abstract
Aim As isolated inferior rectus muscle (IRM) palsy represents a rare clinical entity, very limited information is available on this condition. The aim of this report was to elucidate the etiology, clinical characteristics and surgical outcomes of isolated IRM palsy. Methods Isolated IRM palsy cases who underwent surgical treatments at the Zhongshan Ophthalmic Center, Sun Yat-sen University, China over the period from January 2008 to June 2019 were reviewed retrospectively. Data evaluated from these cases included their etiology, ocular alignment, ocular motility, surgical procedures and surgical outcomes. Results A total of 61 patients (40 males, 21 females) were included in this review. Their mean ± SD age was 27.21 ± 16.03 years (range: 2 to 73 years). In these cases, 32 (52.5%) involved traumatic injury, 28 (45.9%) congenital hypoplasia or absence of inferior rectus and 1 (1.6%) with thyroid ophthalmopathy. The right eye was affected in 33 patients (54.1%), the left in 24 patients (39.3%), and both eyes in 4 patients (6.6%). The main clinical presentations consisted of hypertropia of the affected eye, motility limitation in abduction and depression and incyclotropia. After treatment consisting of various surgical approaches, including muscle repair or resection of the affected inferior rectus, recession of ipsilateral superior rectus, elongation of contralateral superior oblique and partial transposition of the horizontal rectus, the isolated IRM palsy was rectified in 49 patients (80.4%) with one surgery, while 11 cases (18.0%) required two surgeries and 1 case (1.6%) needed three surgeries. Finally, 52 patients (85.2%) showed a complete recovery, 6 (9.9%) improved and 3 (4.9%) experienced a surgical failure. Conclusion The main etiologies of isolated IRM palsy involved traumatic injury and developmental events. Overall, surgical outcomes of the various approaches employed were quite effective.
- Published
- 2021
36. Incidence and risk factors for near-fatal and fatal outcomes after perioperative and periprocedural anaphylaxis in the USA, 2005–2014
- Author
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Alexei Gonzalez-Estrada, Ismael Carrillo-Martin, J. Ross Renew, Matthew A. Rank, Gerald W. Volcheck, and Ronna L. Campbell
- Subjects
Adult ,Male ,medicine.medical_specialty ,Databases, Factual ,Adrenergic beta-Antagonists ,Postoperative Complications ,Sex Factors ,Risk Factors ,Internal medicine ,Epidemiology ,medicine ,Paralysis ,Coagulopathy ,Humans ,Obesity ,Intraoperative Complications ,Anaphylaxis ,Aged ,Inpatients ,business.industry ,Incidence ,Incidence (epidemiology) ,Perioperative ,Length of Stay ,Middle Aged ,medicine.disease ,United States ,Confidence interval ,Anesthesiology and Pain Medicine ,Heart failure ,Female ,Neuromuscular Blocking Agents ,medicine.symptom ,business - Abstract
Background The incidence of fatal and near-fatal outcomes after perioperative anaphylaxis is unknown in the USA. Previously identified risk factors of neuromuscular-blocker-induced fatal perioperative anaphylaxis include male sex, obesity, and use of beta blockers. We examined the incidence of fatal and near-fatal outcomes after perioperative anaphylaxis in the USA and the underlying risk factors using a large national database. Methods Using the Nationwide Inpatient Sample from 2005 to 2014, we identified cases of fatal and near-fatal perioperative anaphylaxis, defined as perioperative anaphylaxis cases complicated by respiratory or cardiac arrest, using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Results Amongst 5223 perioperative anaphylaxis cases, the proportion of near-fatal or fatal cases attributable to perioperative anaphylaxis was 7.0% (95% confidence interval [CI]: 6.2–7.7), with near-fatal perioperative anaphylaxis cases accounting for 5.0% (95% CI: 4.4–5.6%) and fatal cases accounting for 2.0% (95% CI: 1.5–2.5%) of cases overall. Thus, the incidence of fatal or near-fatal perioperative anaphylaxis is 1.26 in 100 000 procedures. Risk factors for fatal or near-fatal perioperative anaphylaxis include age (≥65 yr); undergoing a cardiac procedure; and comorbid conditions of weight loss, non-metastatic solid tumours, metastatic cancer, paralysis, coagulopathy, renal failure, congestive heart failure, fluid and electrolyte disorder, and neurological disorders. Individuals with near-fatal or fatal perioperative anaphylaxis reactions had increased lengths of stay and hospital costs compared with controls. Conclusions The incidence of fatal or near-fatal perioperative anaphylaxis in the USA was 1.26 in 100 000 procedures. Risk factors for fatal or near-fatal outcomes include older age, cardiac procedures, and specific comorbidities.
- Published
- 2021
37. mRNA vaccines against COVID‐19: a showcase for the importance of microbial biotechnology
- Author
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Harald Brüssow
- Subjects
Male ,Special Issue Articles ,COVID-19 Vaccines ,Myocarditis ,Population ,Vaccine Efficacy ,Alpha (ethology) ,Bioengineering ,Disease ,Microbiology ,Applied Microbiology and Biotechnology ,Biochemistry ,Neutralization ,Paralysis ,medicine ,Humans ,BNT162B2 VACCINE ,education ,Aged ,Vaccines, Synthetic ,education.field_of_study ,Science & Technology ,SARS-CoV-2 ,business.industry ,COVID-19 ,Special Issue Article ,medicine.disease ,Vaccine efficacy ,SCOTLAND ,Biotechnology & Applied Microbiology ,Spike Glycoprotein, Coronavirus ,Immunology ,Chills ,mRNA Vaccines ,medicine.symptom ,business ,Life Sciences & Biomedicine ,TP248.13-248.65 ,Biotechnology - Abstract
Pfizer-BioNTech and Moderna developed in record time mRNA vaccines against COVID-19 of high efficacy. The modest protection achieved with a similarly designed mRNA from CureVac underlines the importance of biotechnological details in formulation such as replacement of uridine by pseudouridine in the mRNA encoding the SARS-CoV-2 spike protein or the lipid composition of the nanoparticle coating the mRNA. Phase 3 vaccine trials and vaccine studies in special subject groups as well observational studies in whole populations confirmed the real-world vaccine efficacy against symptomatic disease, particularly against severe COVID-19 cases and to a lesser extent against mild SARS-CoV-2 infections. mRNA vaccine protection extended also to the alpha and beta variant viruses. The surge of delta variants led to an increase of infections and cases even in populations which achieved high vaccine coverage. This efficacy decline resulted to a lesser extent from a weaker neutralization of the delta variant but mostly from a waning vaccine protection over time. Data from Israel documented the efficacy of a third 'booster' injection 5 months after the second injection in older segments of the population. Adverse reactions consisted of transient injection site pain, headache, muscle pain, fatigue, fever and chills. Extensive surveillance studies documented a good safety profile revealing only a non-significant increase in transient facial nerve paralysis and a significant, but modest increase in myocarditis in vaccinated young males that was lower than the myocarditis risk induced by SARS-CoV-2 infection. ispartof: MICROBIAL BIOTECHNOLOGY vol:15 issue:1 pages:135-148 ispartof: location:United States status: published
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- 2021
38. National Surveillance for Acute Flaccid Myelitis — United States, 2018–2020
- Author
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Brian Emery, Randall English, Halle Getachew, Eileen Yee, Adriana S. Lopez, Shannon Rogers, Sarah E. Kidd, and Janell Routh
- Subjects
Male ,medicine.medical_specialty ,Weakness ,Pediatrics ,Health (social science) ,Adolescent ,Epidemiology ,Health, Toxicology and Mutagenesis ,Upper limb involvement ,Health Information Management ,medicine ,Paralysis ,Humans ,Full Report ,Pleocytosis ,Child ,business.industry ,technology, industry, and agriculture ,General Medicine ,Neuromuscular Diseases ,Myelitis ,Acute flaccid myelitis ,United States ,Child, Preschool ,Population Surveillance ,Etiology ,Central Nervous System Viral Diseases ,Female ,medicine.symptom ,Complication ,business - Abstract
Acute flaccid myelitis (AFM), a recognized complication of certain viral infections, is a serious neurologic condition that predominantly affects previously healthy children and can progress rapidly, leading to respiratory insufficiency and permanent paralysis. After national AFM surveillance began in 2014, peaks in AFM cases were observed in the United States in 2014, 2016, and 2018 (1). On the basis of this biennial pattern, an increase in AFM was anticipated in 2020. To describe the epidemiology of confirmed AFM cases since 2018, demographic, clinical, and laboratory information collected as part of national AFM surveillance was reviewed. In 2018, a total of 238 confirmed AFM cases were reported to CDC, compared with 47 cases in 2019 and 32 in 2020. Enterovirus D68 (EV-D68) was detected in specimens from 37 cases reported in 2018, one case in 2019 and none in 2020. Compared with 2018, cases reported during 2019-2020 occurred in older children and were less frequently associated with upper limb involvement, febrile or respiratory prodromal illness, or cerebrospinal fluid (CSF) pleocytosis. These findings suggest that the etiologies of AFM in 2019 and 2020 differed from those in 2018. The absence of an increase in cases in 2020 reflects a deviation from the previously observed biennial pattern, and it is unclear when the next increase in AFM should be expected. Clinicians should continue to maintain vigilance and suspect AFM in any child with acute flaccid limb weakness, particularly in the setting of recent febrile or respiratory illness.
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- 2021
39. Outcome of free gracilis muscle transfer for the restoration of elbow flexion in traumatic brachial plexus palsy
- Author
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Sırrı Sinan Bilgin, Uğur Bezirgan, Tugrul Yildirim, Mehmet Armangil, Sinan Adiyaman, Seyyid Şerif Ünsal, and Anar Keremov
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Elbow ,Brachial plexus paralysis ,Young Adult ,Quality of life ,Dash ,Elbow Joint ,medicine ,Paralysis ,Humans ,Orthopedics and Sports Medicine ,Gracilis muscle ,Brachial Plexus ,Range of Motion, Articular ,Retrospective Studies ,elbow flexion ,Palsy ,business.industry ,Rehabilitation ,Recovery of Function ,neurotization ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Gracilis Muscle ,free muscle transfer ,Quality of Life ,Original Article ,Female ,medicine.symptom ,Range of motion ,business ,Brachial plexus - Abstract
Objectives The aim of this study was to evaluate the functional outcomes of patients with free gracilis muscle transfer (FGMT) for the restoration of elbow flexion. Patients and methods Between January 2012 and January 2019, a total of 16 patients (13 males, 3 females; mean age: 27.3±11.7 years; range: 18 to 53 years) who underwent FGMF to achieve elbow flexion after traumatic brachial plexus palsy (TBPP) were retrospectively analyzed. Data including demographic and clinical characteristics of the patients, etiology, affected side, injury level, accompanying injuries, time between injury and surgery, follow-up time, complications, whether nerve reconstruction and artery repair were performed previously, and details of the procedure were recorded. The outcome measures were elbow range of motion in degrees, muscle strength, and Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form-36 (SF-36) scores. Results The mean follow-up was 30±11.5 (range, 24 to 42) months. Two patients had C5-C8 injuries, two patients had C6-T1 injuries, and all other patients had injuries to the C5-T1 roots. Muscle strength was M3/M4 in 11 (68.8%) patients, M2 in two (12.5%) patients, and M0 in one (6.2%) patient. The median active range of motion of the elbow joint in patients with successful results (M3 and above) was measured as 75 (range, 30 to 100) degrees. A statistically significant improvement was observed in the pre- and postoperative DASH scores and in some SF-36 subscale scores of patients with successful results. Conclusion Free gracilis muscle flap is a reliable option in the restoration of elbow flexion in patients with TBPP. Although there is an improvement in functional results, disability, and quality of life, there may be no change in patients' mental status and pain.
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- 2021
40. Association between duration of peripheral facial palsy, severity, and age of the patient, and psychological distress
- Author
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Frank W. de Jongh, Carien H. G. Beurskens, Koen J. A. O. Ingels, Henri A. M. Marres, Stan Monstrey, Ietske Siemann, Dharmanand Ramnarain, Robin E. Luijmes, Scott R. Chaiet, Elijah E. Sanches, and Sjaak Pouwels
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Facial Paralysis ,Psychological Distress ,Hospital Anxiety and Depression Scale ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Internal medicine ,medicine ,Paralysis ,Humans ,030223 otorhinolaryngology ,Association (psychology) ,Depression (differential diagnoses) ,Depressive Disorder ,Palsy ,business.industry ,Age Factors ,Middle Aged ,Surgery ,Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10] ,Duration (music) ,Quality of Life ,030221 ophthalmology & optometry ,Anxiety ,Female ,medicine.symptom ,business ,Rare cancers Radboud Institute for Health Sciences [Radboudumc 9] - Abstract
Contains fulltext : 244202.pdf (Publisher’s version ) (Closed access) BACKGROUND: Peripheral facial palsy (PFP) (paralysis) can be a devastating condition that has been shown to have associations with increased depression and worse quality of life. The aim of the present study is to better understand the complex association of psychological distress with the duration, severity, and age of patients with PFP. We hypothesize that a shorter duration of PFP is associated with higher levels of psychological distress. METHODS: Fifty-nine patients with PFP that existed longer than 3 months were included in this study. The Hospital Anxiety and Depression Scale (HADS) was used to assess the presence and severity of anxiety and depressions. Spearman's correlation analysis was used to determine correlation between psychological distress, duration, severity of the PFP, and age. RESULTS: Fifty-nine patients were included in this study, of whom 22 were male and 37 were female. The mean age was 55.6 ± 14.6 years and mean duration of PFP from onset ranged from 3 months to 35 years (with a mean duration of 5.39 ± 6.06 years). Twenty-eight patients had left-sided PFP, 30 patients had right-sided PFP, and one patient had bilateral PFP. The majority were caused by Bell's palsy (50.8%). In the group with a duration less than 5 years, there were five (12.8%) patients having a score between 11 and 15 (on HADS) compared to two (10%) patients in the group with a duration of 5 years or more(p = 0.04). CONCLUSION: There seems to be an association between moderate depression and duration of the PFP. Further studies need to substantiate our findings.
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- 2021
41. Primary facial nerve paraganglioma: report and review of the literature
- Author
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Cherie-Ann O. Nathan, Gauri Mankekar, Jonathan Austin Berry, and Ashley B Flowers
- Subjects
Male ,medicine.medical_specialty ,Decompression ,Hearing Loss, Sensorineural ,Facial Paralysis ,Case Report ,Paraganglioma ,03 medical and health sciences ,0302 clinical medicine ,Biopsy ,medicine ,Paralysis ,Humans ,Cranial Nerve Neoplasms ,030223 otorhinolaryngology ,medicine.diagnostic_test ,business.industry ,Cranial nerves ,Interventional radiology ,General Medicine ,Middle Aged ,medicine.disease ,Facial nerve ,Magnetic Resonance Imaging ,Facial paralysis ,Radiology ,medicine.symptom ,Facial Nerve Diseases ,business ,Tomography, X-Ray Computed ,030217 neurology & neurosurgery - Abstract
This report describes the diagnosis and treatment of a patient with a rare primary facial nerve paraganglioma as well as a review of the current literature. A 60-year-old male patient presented to our clinic with a 4-month history of left-sided progressive facial paralysis House-Brackmann V. Biopsy taken during facial nerve (FN) decompression confirmed the diagnosis of paraganglioma. The left FN was sacrificed during resection of the mass and a 12-7 jump graft, using the left greater auricular nerve, was performed with acceptable outcomes. The rarity of these tumours does not discount their clinical importance or the necessity to include them in the differential when presented with unilateral FN paralysis. Investigation should begin with CT and MRI imaging to identify and localise the potential mass. Histologic confirmation requires tissue. While surveillance imaging is occasionally an option, often complete surgical resection of the mass and sacrifice of the nerve is necessary.
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- 2022
42. IgG4-Related Hypertrophic Pachymeningitis with Skull Base Involvement Presenting with Isolated Glossopharyngeal and Vagus Nerve Palsy
- Author
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Shuya Hirano, Reiji Koide, Ryota Tanaka, Tadashi Ozawa, Risa Suzuki, Shigeru Fujimoto, Saeko Uemura, Kosuke Matsuzono, Takafumi Mashiko, Harushi Mori, and Kumiko Miura
- Subjects
Male ,medicine.medical_specialty ,Clivus ,Internal Medicine ,Humans ,Paralysis ,Medicine ,Meningitis ,In patient ,Aged ,Skull Base ,Palsy ,medicine.diagnostic_test ,business.industry ,Vagus Nerve ,Magnetic resonance imaging ,Hypertrophy ,General Medicine ,Cranial neuropathy ,medicine.disease ,Magnetic Resonance Imaging ,Vagus nerve ,Skull ,medicine.anatomical_structure ,Immunoglobulin G ,IgG4-related disease ,Radiology ,business - Abstract
We herein report a 70-year-old man diagnosed with IgG4-related hypertrophic pachymeningitis with skull base involvement, who presented with isolated glossopharyngeal and vagus nerve palsy. Contrast-enhanced magnetic resonance imaging (MRI) showed enhanced dural thickening of the posterior clivus and skull base involvement. When a patient with hypertrophic pachymeningitis presents with isolated cranial neuropathy without systemic manifestations or definite MRI abnormalities, it is difficult to make a diagnosis, and the patient may be misdiagnosed. This case suggests that a detailed radiological evaluation including contrast enhancement of the skull base is very important in patients with isolated glossopharyngeal and vagus nerve palsy.
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- 2022
43. Clinical Characteristics for Predicting Recovery of Acquired Fourth Cranial Nerve Palsy
- Author
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Hee Young Choi, Hyeshin Jeon, and Jae Hyun Kim
- Subjects
Adult ,Male ,medicine.medical_specialty ,Ischemia ,Fundus (eye) ,Risk Factors ,Diplopia ,Oculomotor Nerve Diseases ,medicine ,Humans ,Paralysis ,In patient ,Aged ,Retrospective Studies ,Palsy ,business.industry ,Medical record ,Middle Aged ,medicine.disease ,Trochlear Nerve Diseases ,Surgery ,Ophthalmology ,Etiology ,Neurology (clinical) ,medicine.symptom ,Fourth cranial nerve palsy ,business - Abstract
BACKGROUND Fourth cranial nerve palsy is the most common disease diagnosed in patients with vertical diplopia. Although it is reported to present a good prognosis, there are currently no agreed on prognostic factors that anticipate the recovery of the palsy other than the etiology. The purpose of this study was to investigate the prognostic factors of acquired fourth cranial nerve palsy. METHODS The medical records of consecutive patients diagnosed with acquired unilateral fourth cranial nerve palsy from 2010 to 2020 and followed up for ≥6 months were retrospectively reviewed. The cause and degree of palsy, ocular deviation (horizontal, vertical, and cyclo), and fundus torsion were reviewed. The cause of palsy was classified as ischemic, traumatic, intracranial mass, others, or idiopathic. Patients were divided into 2 groups according to palsy recovery: complete recovery (group CR) or not CR (group NCR). The clinical characteristics of the 2 groups were compared, and the risk factors for incomplete recovery were investigated. RESULTS Thirty-five patients (25 men) were included in the study. The average age was 55.94 ± 16.11 years. CR was achieved in 23 patients (65.7%), and the time to recovery was 3.91 ± 4.03 months. The most common cause was traumatic (40.0%), followed by ischemia (37.1%), intracranial mass (11.4%), others (8.6%), and idiopathic (2.9%). The degree of palsy and fundus torsion was significantly higher in group NCR (P = 0.010 and P = 0.001). Severe oculomotor limitation, large fundus torsion, and intracranial mass cause rather than ischemic cause indicated a higher risk of incomplete or no recovery (P = 0.016, P = 0.009, and P = 0.043). CONCLUSION Identifying whether a patient has an intracranial mass, severe oculomotor limitation, or large fundus excyclotorsion may be useful for predicting the recovery of acquired unilateral fourth cranial nerve palsy.
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- 2021
44. Application of Triggered EMG in the Intraoperative Neurophysiological Monitoring of Posterior Percutaneous Endoscopic Cervical Discectomy
- Author
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Yaobin Wang, Chen Cao, Xiao-Yun Sheng, Shulian Chen, Kai Zhang, Xiao-Bing Zhao, Bin Geng, and Yayi Xia
- Subjects
Adult ,Male ,medicine.medical_specialty ,Percutaneous ,Nerve root ,Intraoperative Neurophysiological Monitoring ,Visual analogue scale ,Triggered EMG ,medicine ,Paralysis ,Cervical endoscopy ,Humans ,Orthopedics and Sports Medicine ,Diskectomy, Percutaneous ,Radiculopathy ,Intraoperative monitoring ,Pain Measurement ,Retrospective Studies ,Orthopedic surgery ,Cervical discectomy ,Clinical Article ,business.industry ,Electromyography ,Retrospective cohort study ,Endoscopy ,Middle Aged ,Surgery ,Percutaneous endoscopic cervical discectomy ,Clinical Articles ,Cervical spondylotic radiculopathy ,Female ,Spondylosis ,medicine.symptom ,Complication ,business ,RD701-811 ,Intraoperative neurophysiological monitoring - Abstract
Objective To describe the rationale and application of triggered EMG (T‐EMG) in intraoperative neurophysiological monitoring, and to explore the efficacy and safety of posterior percutaneous endoscopic cervical discectomy (PPECD) in the treatment of cervical spondylotic radiculopathy (CSR) under multimodal intraoperative neurophysiological monitoring (IOM). Methods This study was a retrospective cohort control study. The clinical data of 74 patients with single‐segment CSR from June 2015 to August 2018 were analyzed retrospectively, of whom 35 underwent IOM‐assisted PPECD with triggered EMG (T‐EMG group), while 39 were subjected to IOM‐assisted PPECD alone (IOM group). Operation time, hospital stay, and complications were recorded for both groups. The curative effect was evaluated according to the Visual Analog Scale (VAS) of neck and arm pain, Japanese Orthopaedic Association (JOA) score, and modified MacNab scale. Results Operations were successful and all patients were followed up for at least 24 (average 31.77 ± 9.51) months with no patient lost to follow‐up. No significant difference was found in preoperative baseline data between the T‐EMG and the IOM group (P > 0.05). Also, no significant difference was found in the operation time between the T‐EMG (108.29 ± 11.44 min) and the IOM (110.13 ± 12.70 min) (P > 0.05) group, but the difference in hospital stay (T‐EMG: 5.66 ± 0.99 days; IOM: 7.10 ± 1.43 days) was statistically significant (P 0.05). The 1‐month postoperative JOA scores for the two groups (12.69 ± 0.76; 12.59 ± 0.82) and those at the last follow‐up (14.60 ± 0.77; 14.36 ± 0.78) were significantly different from the preoperative scores (11.09 ± 0.98; 11.05 ± 0.89) (P 0.05). One patient in the T‐EMG group developed a transient aggravation of symptoms on the first day after surgery. In the IOM group, three patients had intraoperative cerebrospinal fluid leakage, and symptoms of C5 nerve root paralysis were presented in four patients following surgery. Compared with the IOM group, the T‐EMG group had fewer complications (1/35; 7/39, P
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- 2021
45. Scapular winging secondary to serratus anterior dysfunction: analysis of clinical presentations and etiology in a consecutive series of 96 patients
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Chye Yew Ng and Feiran Wu
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Adult ,Male ,Parsonage–Turner syndrome ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Scapular winging ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Paralysis ,Orthopedics and Sports Medicine ,Muscle, Skeletal ,Myopathy ,Aged ,Retrospective Studies ,Genetic testing ,030222 orthopedics ,Palsy ,medicine.diagnostic_test ,Electromyography ,business.industry ,030229 sport sciences ,General Medicine ,Middle Aged ,medicine.disease ,Scapula ,Radiological weapon ,Etiology ,Female ,Surgery ,Abnormality ,medicine.symptom ,business - Abstract
Background This study aimed to establish the relative incidence of etiologies causing serratus anterior (SA) dysfunction in patients with proven abnormality on needle electromyography. Methods This was a retrospective review of patients with scapular winging secondary to SA dysfunction. Each patient underwent a detailed clinical, radiological, and neurophysiological assessment to arrive at the precise etiological diagnosis. Patients with atypical clinical features were referred for a neurologist’s assessment. Hematological and genetic testing were requested at the discretion of the neurologist. A scapular winging severity score based on clinical signs was devised to aid clinical grading. Results Between 2014 and 2020, a consecutive series of 108 patients with suspected SA dysfunction were assessed, of whom 96 met the inclusion criteria. There were 34 females and 62 males, with a mean age of 38 years (range, 15-77 years). Winging affected the right scapulae in 69 patients, the left scapulae in 17 patients, and was bilateral in 10 patients. This was caused by a myopathic disorder in 12 (12%) patients. Eighty-four (88%) patients had a long thoracic nerve lesion, caused by cervical pathology (2), iatrogenic injury (2), trauma (33), and neuralgic amyotrophy (NA) (47). Among those with NA, winging resolved spontaneously within 3 years of onset in 22 patients (mean duration, 16 months; range, 3-36 months). No patients recovered fully if their duration of winging lasted longer than 3 years. Patients with palsy secondary to NA tended to have a worse severity of winging than those due to a traumatic cause (P = .04). Conclusion NA accounted for approximately half of the patients with SA dysfunction; therefore, it is essential to also consider the differentials of myopathy, trauma, iatrogenic injury, and spinal pathology. We recommend the judicious employment of ancillary tests and a low threshold of referral to a neurologist, in order to arrive at the exact diagnosis to accurately guide patient treatment.
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- 2021
46. Timing of referral to peripheral nerve specialists in patients with postoperative C5 palsy
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Nikita Lakomkin, Daniel Lubelski, Zach Pennington, Daniel M. Sciubba, Sheng Fu L. Lo, Benjamin D. Elder, and Timothy F. Witham
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Male ,Occupational therapy ,Weakness ,medicine.medical_specialty ,Referral ,Electromyography ,Postoperative Complications ,Peripheral nerve ,Physiology (medical) ,medicine ,Humans ,Paralysis ,Peripheral Nerves ,Referral and Consultation ,medicine.diagnostic_test ,business.industry ,Postoperative complication ,General Medicine ,Decompression, Surgical ,Neurology ,Nerve Transfer ,Anesthesia ,Cohort ,Cervical Vertebrae ,Female ,Surgery ,Neurology (clinical) ,medicine.symptom ,business - Abstract
The objective of this study was to examine the association between electrophysiology data post-C5-palsy and referral to peripheral nerve surgeons (PNS) using a 15-year cohort of patients who underwent posterior cervical decompression. Endpoints included the associations of postoperative treatments employed with functional recovery and abnormal electrophysiology data. Of 77 included patients (median 64 yr; 68% male), 48% completely recovered. The most common treatments were physical therapy (90%), occupational therapy (34%), oral corticosteroids (18%), and PNS referral (17%). Baseline weakness did not associate with PNS referral or postoperative treatment strategy. None of the treatments predicted recovery, though patients with no [versus complete] recovery were more likely to be recommended for nerve transfers (22.2 vs 0%; p = 0.03). Abnormal electromyography data associated with PNS referral (p 0.01), nerve transfer recommendation (p 0.01), occupational therapy referral, and oral corticosteroid therapy. Abnormal findings on EMG obtained between 6-weeks and 6-months post-injury were the most strongly associated with peripheral nerve surgeon referral (p = 0.02) and nerve transfer recommendation (p 0.01). These data suggest strategies for postoperative C5 palsy management are highly heterogeneous. None of the treatments employed significantly predicted the extent of functional recovery. However, patients with abnormal electrophysiology results were most likely to receive multimodal treatment, suggesting these results may significantly alter medical management of patients with postoperative C5 palsy. Early (6-week to 6-month) electrophysiology data may help to ensure that patients likely to benefit from nerve transfer procedures are referred to a PNS within the 9-12-month time frame associated with the best recovery of function.
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- 2021
47. Spinal cord infarction caused by extensive aortic intramural hematoma
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Rodica Diaconu, Dumitru Sandu Râmboiu, Ionuţ Donoiu, Oana Mirea, Alexandru Claudiu Munteanu, Adelina Oana Neagoe, and Octavian Istrătoaie
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Male ,Embryology ,medicine.medical_specialty ,Infarction ,Case Report ,Pathology and Forensic Medicine ,medicine.artery ,medicine ,Paralysis ,Back pain ,Thoracic aorta ,Humans ,aortic dissection ,Aorta ,Paraplegia ,spinal cord infarction ,Hematoma ,business.industry ,Abdominal aorta ,anterior spinal artery syndrome ,Cell Biology ,General Medicine ,Middle Aged ,medicine.disease ,spinal arteries ,Surgery ,medicine.anatomical_structure ,Dermatome ,Spinal Cord ,aortic hematoma ,medicine.symptom ,business ,Developmental Biology - Abstract
We report the case of a 62-year-old Caucasian man, an ex-smoker, who presented to the emergency room complaining of intense lower back pain followed by immediate bilateral loss of inferior limbs motor function. Clinical examination showed complete paralysis and paranesthesia in both legs, while pain and temperature sensory examination revealed a sensory level at dermatome T6, with normal touch, vibration, and position senses. His blood pressure was 190∕100 mmHg. Computed tomography demonstrated dilated thoracic aorta (maximum diameter 44 mm) and abdominal aorta (maximum 58 mm), with extended intramural hematoma (IMH), thus establishing the diagnosis of type A aortic IMH complicated with paraplegia through spinal perfusion deficit. Due to the extension of the lesions, surgical intervention for aortic repair was considered at high risk while cerebrospinal fluid drainage was not recommended by the neurologist. The patient remained stable while hospitalized and was released from the hospital with mild improvement of neurological deficiencies.
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- 2021
48. Short-term Outcomes of Robot-assisted Minimally Invasive Esophagectomy Compared With Thoracoscopic or Transthoracic Esophagectomy
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Tomohiro Matsumoto, Hiroya Takeuchi, Sanshiro Kawata, Wataru Soneda, Eisuke Booka, Yoshihiro Hiramatsu, Hirotoshi Kikuchi, Ryoma Haneda, and Tomohiro Murakami
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Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Pleural effusion ,medicine.medical_treatment ,Atelectasis ,Laryngeal Nerve Injuries ,Ramie ,Postoperative Complications ,Robotic Surgical Procedures ,Paralysis ,Recurrent laryngeal nerve ,Humans ,Medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,Thoracic Surgery, Video-Assisted ,business.industry ,Thoracoscopy ,nutritional and metabolic diseases ,General Medicine ,Middle Aged ,medicine.disease ,Dysphagia ,Surgery ,Esophagectomy ,Treatment Outcome ,Oncology ,Cardiothoracic surgery ,Female ,medicine.symptom ,business ,human activities - Abstract
Background/aim There is no study comparing open esophagectomy (OE), video-assisted thoracic surgery (VATS), and robot-assisted minimally invasive esophagectomy (RAMIE) in a single institution. Patients and methods This study included 272 patients who underwent subtotal esophagectomy divided into three groups: OE (n=110), VATS (n=127), and RAMIE (n=35) groups. Moreover, short-term outcomes were compared. Results Overall complications (CD≥II) were significantly less in the RAMIE than the OE and VATS groups. Recurrent laryngeal nerve paralysis (CD≥II) was significantly lower in the RAMIE than the OE group (p=0.026) and tended to be lower than that in the VATS group (p=0.059). The RAMIE group had significantly less atelectasis (CD≥I and II), pleural effusion (CD≥I and II), arrhythmia (CD≥II), and dysphagia (CD≥II), than both the OE and VATS groups. Conclusion RAMIE reduced overall postoperative complications after esophagectomy compared with both OE and VATS.
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- 2021
49. Spinal schwannoma causes acute subarachnoid haemorrhage: A case report and literature review
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Guo Yao, Huang Rui, Chen Peng, Zujue Cheng, and Juexian Xiao
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Male ,Ependymoma ,medicine.medical_specialty ,Subarachnoid hemorrhage ,Schwannoma ,Subarachnoid Space ,03 medical and health sciences ,0302 clinical medicine ,Spinal cord compression ,medicine ,Paralysis ,Humans ,Spinal Cord Neoplasms ,business.industry ,Middle Aged ,Subarachnoid Hemorrhage ,medicine.disease ,Spinal cord ,Magnetic Resonance Imaging ,Surgery ,Conus medullaris ,medicine.anatomical_structure ,Arachnoid mater ,030220 oncology & carcinogenesis ,Neurology (clinical) ,medicine.symptom ,business ,Spinal Cord Compression ,Neurilemmoma ,030217 neurology & neurosurgery - Abstract
Background Spinal schwannomas that arise from spinal nerve root sheaths are the most common intradural extramedullary spinal tumours and are often accompanied by nerve roots or spinal cord irritation symptoms. The phenomenon of spinal schwannoma causing subarachnoid haemorrhage (SAH) is rare, with ependymoma of the conus medullaris accounting for most cases. Case report A 45-year-old man was admitted to our hospital due to progressive lower limb weakness and sudden back pain after hard physical work. The patient had not been able to walk for 2 hours upon admission. An emergency magnetic resonance imaging (MRI) scan showed that the spinal cord at the C6-T4 level was severely compressed by a subdural mass. During the emergency operation, exploration of the dura and arachnoid mater revealed a fresh blood clot covering a tumour located on the ventral side of the spinal cord. The size of the tumour was approximately 3 × 2 × 1 cm without adhesion to the surrounding tissue, but the drainage vein was ruptured. Postoperative pathology showed that the tumour was a schwannoma with areas of fresh haemorrhage and focal necrosis. Conclusions Spinal schwannomas presenting with SAH are rare events. In our opinion, spinal pathology with rapid progression of neurological symptoms requires early diagnosis and emergency management. Complete excision of haemorrhagic tumours is the goal of treatment to prevent recurrence, which can effectively avoid irreversible damage to the spinal cord resulting from spinal cord compression.
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- 2021
50. Clinical and genetic spectrum of a Chinese cohort with SCN4A gene mutations
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J. Sun, S. Luo, K.J. Suetterlin, J. Song, J. Huang, W. Zhu, J. Xi, L. Zhou, J. Lu, C. Zhao, M.G. Hanna, R. Männikkö, E. Matthews, and K. Qiao
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Adult ,Male ,0301 basic medicine ,China ,medicine.medical_specialty ,Genotype ,Gene mutation ,Asymptomatic ,Myotonia ,Paralyses, Familial Periodic ,Cohort Studies ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Asian People ,Hypokalemic periodic paralysis ,Surveys and Questionnaires ,Internal medicine ,medicine ,Paralysis ,Humans ,Hyperkalemic periodic paralysis ,NAV1.4 Voltage-Gated Sodium Channel ,Genetics (clinical) ,Retrospective Studies ,Electromyography ,business.industry ,Periodic paralysis ,medicine.disease ,Pedigree ,Phenotype ,030104 developmental biology ,Neurology ,Paramyotonia congenita ,Mutation ,Pediatrics, Perinatology and Child Health ,Channelopathies ,Female ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Myotonic Disorders - Abstract
Skeletal muscle sodium channelopathies due to SCN4A gene mutations have a broad clinical spectrum. However, each phenotype has been reported in few cases of Chinese origin. We present detailed phenotype and genotype data from a cohort of 40 cases with SCN4A gene mutations seen in neuromuscular diagnostic service in Huashan hospital, Fudan University. Cases were referred from 6 independent provinces from 2010 to 2018. A questionnaire covering demographics, precipitating factors, episodes of paralysis and myotonia was designed to collect the clinical information. Electrodiagnostic studies and muscle MRI were retrospectively analyzed. The clinical spectrum of patients included: 6 Hyperkalemic periodic paralysis (15%), 18 Hypokalemic periodic paralysis (45%), 7 sodium channel myotonia (17.5%), 4 paramyotonia congenita (10%) and 5 heterozygous asymptomatic mutation carriers (12.5%). Review of clinical information highlights a significant delay to diagnosis (median 15 years), reports of pain and myalgia in the majority of patients, male predominance, circadian rhythm and common precipitating factors. Electrodiagnostic studies revealed subclinical myotonic discharges and a positive long exercise test in asymptomatic carriers. Muscle MRI identified edema and fatty infiltration in gastrocnemius and soleus. A total of 13 reported and 2 novel SCN4A mutations were identified with most variants distributed in the transmembrane helix S4 to S6, with a hotspot mutation p.Arg675Gln accounting for 32.5% (13/40) of the cohort. Our study revealed a higher proportion of periodic paralysis in SCN4A-mutated patients compared with cohorts from England and the Netherlands. It also highlights the importance of electrodiagnostic studies in diagnosis and segregation studies.
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- 2021
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