To examine whether the pattern of brain activation induced by a motor task and the motor responses to transcranial magnetic stimulation (TMS) have prognostic implications for motor recovery after stroke.
Ten patients with first-ever subcortical stroke (55.7±17.3 years, 5 ischemic and 5 hemorrhagic) underwent 2 FDG PET studies under different conditions (1: rest, 2: activation with a specific motor task) at 37.7±25.2 days after stroke. The regions showing more than a 10% increase in glucose metabolism on subtraction images during activation and rest were considered to be significantly activated. Cortical excitability of intracortical inhibition (ICI) and intracortical facilitation (ICF) were assessed using the TMS from both abductor pollicis brevis muscles within 7 days of PET scans. Recovery of motor function was assessed at the point of the neurological plateau.
The presence of a motor response at the plegic site to TMS and normal intracortical inhibition, and facilitation patterns in the unaffected hemisphere were found to be related to good recovery. An association between an ipsilesional activation on PET and good motor recovery was also observed, but this was significantly weaker than that between TMS measured cortical excitability and motor recovery.
Integrity of the ipsilesional corticospinal pathway, normalized contralesional intracortical excitability, and task-related activation in the ipsilesional hemisphere were found to predict post-stroke motor recovery significantly.
Citations
To identify the volumes of contrast material needed to reach the specific landmarks and contrast pattern during Kambin's triangle approach (KB-A) in lumbar spinal stenosis.
Sixty patients undergoing KB-A were investigated. Fifty-six patients were included in this study. KB-A were performed with the use of contrast-enhanced fluoroscopic visualization. After confirming the appropriate spinal needle position, a slow injection of up to 5.0 ml of nonionic contrast material was carried out. Under intermittent fluoroscopic guidance, contrast volumes were recorded as flow reached specific anatomic landmarks: ipsilateral inferior or superior neural foramen.
After 2.0 ml of contrast was injected, 93.2% of KB-A cases spread to the medial aspect of the inferior pedicle of the corresponding level of injection and 86.3% of KB-A spread to the medial aspect of the superior pedicle of the corresponding level of injection. After 3 ml of contrast was injected, 95.3% of KB-A spread to cover both the medial aspect of the inferior pedicle and the superior pedicle of the corresponding level of injection. A volume of 2 ml of injectate reaches the anterior epidural space 100% of the time.
This study demonstrates injectate volumes needed to reach the specific anatomic landmarks in KB-A. A volume of 3.0 ml of injectate reaches both the medial aspect of theinferior pedicle and the superior pedicle 94.6% of the time. Therefore, Interventionalists may consider a 1-level instead of a 2-level injection for patients with a bleeding risk or for 2 level central pathology.
Citations
Quantitative analysis of abnormal spontaneous activities, motor unit action potentials and interference patterns were recorded in 55 subjects with traumatic peripheral nerve injury to understand the changes of electromyographic signals.
We analyzed amplitudes of fibrillation potentials and positive sharp waves at rest, amplitude, duration, spike duration and polyphasicity of motor unit action potentials at minimal contraction, and the root mean square(RMS), and mean rectified voltage (MRV) at maximal contraction.
The amplitudes of fibrillation potentials and positive sharp waves had negative correlations with the duration of peripheral nerve injury but the amplitudes of motor unit action potentials, RMS, and MRV had positive correlations.
Therefore electromyographic evaluation could be used for the estimation of the duration of peripheral nerve injury.
Objective: Absolute or relative increase in the latency of the major surface positive component is almost invariably found in patients with demyelination optic neuropathy. Using the pattern- reversal method, our study illustrates the significant changes in the latency of the P100 component when refractive errors are introduced to defocus in normal person.
Method: Four women and ten men aged 20 to 27 years were selected after a thorough ophthalmological assessment. Visual acuity (VA) was 6/6 or better in all subject and none had dyschromatopsia or significant astigmatism. Refractive errors were created by the combined standard lenses.
Results: The mean value of P100 latency were as follows: 93.74⁑3.30 msec, naked eyes; 98.14⁑7.37 msec, the 2/⁓90 lens; 96.50⁑3.76 msec, the 1/1⁓90 lens; 94.55⁑4.20 msec, the 1/1⁓90; 96.29⁑2.88 msec, the 2/2⁓90 lens. The P100 latencies showed singnificant standard lens except with 1/1⁓90 lens. The P100 latency was prolonged according to the progression of refractive error.
Conclusion: Because a relative or absolute prolongation of P100 latency is often found in cases of suspected multiple sclerosis, and because of their similarity to the findings of our study, we would emphasize that refractive errors should be reduced or eliminated to minimize the false-positive results.
Objective: We observed the nature of ipsilateral weakness, not hemiplegic side after stroke. And we studied correlation between ipsilateral weakness and neurologic recovery of hemiplegia.
Method: This study was prospective, follow-up clinical trial. Ipsilateral motor power was checked serially in 20 subjects using Nicholas Manual Muscle Tester (NMMT) (shoulder abduction, wrist extension, hip flexion, ankle dorsiflexion). The subjects are first attacked hemiplegic stroke patients. Other outcome measures are Mini-mental Status Examination (MMSE) and National Institutes of Health Stroke Scale (NIHSS). We studied correlations between motor power recovery in ipsilateral limbs and recovery of neurologic impairment in hemiplegic limbs of stroke patients through SPSS 7.0 program.
Results: Ipsilateral motor power in early stage stroke patients is significantly low compared with that of normal subject except ankle dorsiflexion (p＜0.05). Comparing ipsilateral proximal with distal limbs power in pre and post multidisciplinary rehabilitation program, upper proximal part recovered faster than the distal part, but which was not statistically significant. Recovery of ipsilateral upper proximal and distal limb weakness is associated with neurologic recovery in hemiplegic side.
Conclusion: After the stroke, ipsilateral upper limb motor weakness does occur and which follows similar neurologic recovery pattern to the hemiplegic side. Ipsilateral cortical and subcortical tracts take effect on the neurologic recovery of contalateral side.
Objective: To evaluate the relationship of the respiration patterns and the abdominal muscle activities during various speech productions in the adults with athetoid cerebral palsy (CP).
Method: Subjects were 7 athetoid CPs and 7 healthy controls. Respirography and abdominal muscle activities were recorded by use of the pneumobelt and the surface EMG during their performances of six kinds of non-speech and speech tasks.
Results: The followings were observed in the athetoid CP.
1) Respiratory phase was irregular and variable in the intensity and period of revolution. The frequency of the respiratory phase was not different from the control in usual respiration, but higher in deep breathing. The time to persist one vowel phonation was shorter.
2) Inappropriate and frequent inspirations were occurred during speech task and the number of syllables was fewer and irregular for one speech breath.
3) The abdominal muscle activities were abrupt, irregular, inconsistent with the respiratory phase during all kinds of non-speech and speech tasks.
Conclusion: These findings suggest that the abnormal respiration patterns and abdominal muscle activities contribute to the abnormal speech production of athetoid CP and their incoordination is similar to athetoid movement of the extremities. We should consider the athetoid speech production as well as the dysarthria in the athetoid CP.
Postherpetic neuralgia(PHN) is a common complication of herpes zoster and one of most common intractable conditions in pain clinics. The PHN is defined solely by the persistence of pain after the herpes zoster. There has been no known pathophysiology for the PHN and the role of scars, local muscles, tendons and ligaments has not been addressed.
The characteristics, duration, and location of the referred pain were evaluated along with the electromyographic(EMG) examination of involved muscles. Then treatment was given under the concept of a myofascial pain syndrome till the pain was completely resolved. Most of the patients with acute or chronic pain were relieved from the pain.
This study revealed a practical and important new concept on herpes zoster related pains. In some cases of herpes zoster, acute herpes zoster seems to be an initiating factor to form an acute trigger point in the muscles of the related area. And uncomplicated trigger points neglected in an acute stage become chronic intractable problems, when they were neglected.
In conclusion, myofascial pain syndrome should be taken into account when a postherpetic neuralgia is diagnosed. The recognition of this possible relationship between PHN and myofascial pain syndrome and an early proper care can greatly reduce the suffering of patents from chronic pain.
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