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To evaluate the beneficial effect of botulinum toxin A (Botox) injection into the subscapularis muscle on intractable hemiplegic shoulder pain.
Six stroke patients with intractable hemiplegic shoulder pain were included. Botulinum toxin A was injected into the subscapularis muscle. Intractable hemiplegic shoulder pain was evaluated using an 11-point numerical rating scale. Pain-free range of motion was assessed for shoulder abduction and external rotation. The spasticity of the shoulder internal rotator was measured using the modified Ashworth scale. Assessments were carried out at baseline and at 1, 2, 4, and, if possible, 8 weeks.
Intractable hemiplegic shoulder pain was improved (p=0.004) after botulinum toxin injection into the subscapularis muscle. Restricted shoulder abduction (p=0.003), external rotation (p=0.005), and spasticity of the shoulder internal rotator (p=0.005) were also improved. Improved hemiplegic shoulder pain was correlated with improved shoulder abduction (r=–1.0, p<0.001), external rotation (r=–1.0, p<0.001), and spasticity of the internal rotator (r=1.0, p<0.001).
Botulinum toxin A injection into the subscapularis muscle appears to be valuable in the management of intractable hemiplegic shoulder pain.
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To evaluate the therapeutic effect of botulinum toxin A (BTX-A) injection on spastic gastrocnemius (GCM) and tibialis posterior muscles (TPo) by using the foot pressure measurement system (FPMS).
Eighteen ambulatory CP patients were recruited in this study. BTX-A was injected into the GCM at a dose of 6-12 units/kg and TPo at a dose of 4-9 units/kg according to the severity of equinus and varus deformity. Foot contact pattern, pressure time integral (PTI), coronal index using the FPMS and Modified Ashworth Scale (MAS), and visual inspection of gait pattern were used for evaluation of the therapeutic effect of BTX-A injection. Clinical and FPMS data were statistically analyzed according to the muscle group.
A significant decrease in the MAS score of the GCM and TPo was observed, and spastic equinovarus pattern during gait showed improvement after injection. The GCM+TPo injection group showed a significant decrease in forefoot, lateral forefoot pad, and lateral column PTI, and a significant increase in hindfoot PTI and coronal index. In the GCM only injection group, forefoot PTI and lateral column PTI were significantly decreased and hindfoot PTI was significantly increased. The TPo only injection group showed a significant decrease in lateral column PTI and a significant increase in the coronal index. Change in PTI in the hindfoot showed a significant correlation with the change in MAS score of the GCM. Change in PTI of the lateral column and coronal index showed a significant correlation with the change in MAS score of the TPo.
The FPMS demonstrated the quantitative therapeutic effect of BTX-A on abnormal pressure distribution in equinovarus foot in detail. The FPMS can be a useful additional tool for evaluation of the effect of BTX-A injection.
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Ullrich congenital muscular dystrophy (UCMD) is characterized by congenital weakness, proximal joint contractures, and hyperlaxity of distal joints. UCMD is basically due to a defect in extra cellular matrix protein, collagen type VI. A 37-year-old woman who cannot walk independently visited our outpatient clinic. She had orthopedic deformities (scoliosis, joint contractures, and distal joint hyperlaxity), difficulty of respiration, and many skin keloids. Her hip computed tomography showed diffuse fatty infiltration and the 'central shadow' sign in thigh muscles. From the clinical information suggesting collagen type VI related muscle disorder, UCMD was highly considered.
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To evaluate whether age influences a change in the spasticity of the ankle plantar flexor after botulinum toxin type A (BTA) injection in children with spastic cerebral palsy (CP).
Sixteen children with spastic CP were enrolled in the study. Seven children (group 1) were under 5 years of age, and nine (group 2) were over 5 years of age. They all received BTA injection in the gastrocnemius muscle (GCM) under ultrasound guidance. Passive range of motion (PROM) of ankle dorsiflexion, Modified Ashworth Scale (MAS) of the ankle plantar flexor, Gross Motor Function Measure (GMFM) and median red pixel intensity (RPI) of the medial GCM on real-time sonoelastography were measured at baseline (pre-injection) and 1-, 3-, and 6-month post-injection.
In both groups, the mean PROM, MAS, and RPI were significantly improved after injection until 6-month post-injection. The change of PROM of ankle dorsiflexion in group 1 was significantly greater than that in group 2, until 6-month post-injection. The change in the MAS and GMFM between baseline and 6-month post-injection in group 1 was greater than that in group 2. The changes in the median RPI between baseline and 3- and 6-month post-injections were greater in group 1 than in group 2.
Our pilot study demonstrated the different changes in spasticity of the ankle plantar flexor after BTA injection based on age. Therefore, age may be considered when establishing a treatment plan using BTA injection for children with spastic CP.
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Birth brachial plexus palsy (BBPP) is usually caused by plexus traction during difficult delivery. Although the possibility of complete recovery is relatively high, 5% to 25% of BBPP cases result in prolonged and persistent disability. In particular, muscle imbalance and co-contraction around the shoulder and elbow cause abnormal motor performance, osseous deformities, and joint contracture. Physical and occupational therapies have most commonly been used, but these conventional therapeutic strategies have often been inadequate, in managing the residual muscle imbalance and muscle co-contraction. Therefore, we attempted to improve the functional movements, by using botulinum toxin type A, to reduce the abnormal co-contraction of the antagonist muscles.
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Several cases of acute necrotizing encephalopathy (ANE) with influenza A (H1N1) have been reported to date. The prognosis of ANE associated with H1N1 is variable; some cases resulted in severe neurologic complication, whereas other cases were fatal. Reports mostly focused on the diagnosis of ANE with H1N1 infection, rather than functional recovery. We report a case of ANE with H1N1 infection in a 4-year-old Korean girl who rapidly developed fever, seizure, and altered mentality, as well as had neurologic sequelae of ataxia, intentional tremor, strabismus, and dysarthria. Brain magnetic resonance imaging showed lesions in the bilateral thalami, pons, and left basal ganglia. To our knowledge, this is the first report of ANE caused by H1N1 infection and its long-term functional recovery in Korea.
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To evaluate the short-term clinical effects of the intra-articular injection of botulinum toxin type A (BoNT-A) for the treatment of adhesive capsulitis.
A prospective, controlled trial compared the effects of intra-articular BoNT-A (Dysport; 200 IU, n=15) with the steroid triamcinolone acetate (TA; 20 mg, n=13) in patients suffering from adhesive capsulitis of the shoulder. All patients were evaluated using a Numeric Rating Scale (NRS) of the pain intensity and a measurement of the range of motion (ROM) at baseline (before treatment) and at 2, 4, and 8 weeks post-treatment.
The NRS at 2 weeks (BoNT-A vs. TA; 5.0 vs. 5.2), 4 weeks (4.1 vs. 4.9) and 8 weeks (3.8 vs. 4.6) of both treatment groups were significantly lower than that measured at baseline (7.4 vs. 7.6). The ROM of patients' shoulders increased significantly from baseline in both treatment groups. There was no significant difference in the NRS of pain intensity or the ROM between the two groups. Reduction in the pain intensity score was maintained for 8 weeks post-injection in both groups. There were no significant adverse events in either treatment group.
The results suggest that there are no significant short-term differences between the intra-articular injections of BoNT-A and TA. Although BoNT-A has a high cost, it may be used as a safe alternative of TA to avoid the steroid-induced side effects or as a second-line agent, for patients who have failed to respond to the current treatments.
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To investigate the effect of botulinum toxin type A (BTXA) on drooling and the morphologic change of the salivary gland in patients with cerebral palsy.
Eight cerebral palsy patients suffering from severe drooling participated in this study. BTXA was injected into both submandibular and parotid glands under intravenous sedation and with ultrasound guidance (1 unit/gland/kg: maximum 100 units) in an outpatient or inpatient procedure. The severity of drooling was measured before injection and 3 weeks after injection using the Teacher Drooling Scale, the Drooling Score-severity, frequency and the Visual Analog Scale. To investigate the morphologic change of the salivary glands, the size of salivary glands were measured before injection and 3 weeks after injection using computed tomography of the neck. The measurement values were analyzed by Wilcoxon signed rank test.
Statistically significant improvements were shown in all three parameters for assessing the severity of drooling after BTXA injections (p<0.05). Size of the salivary glands were significantly decreased at 3 weeks after BTXA injection (p<0.05).
Salivary gland injection with BTXA could be a useful treatment method to reduce drooling in patients with cerebral palsy and decreased size of salivary glands may partially explain the mechanism.
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To investigate changes in (1) the colonic response to acetylcholine (Ach), (2) the muscarinic (M) receptors in the colon, and (3) the levels of colonic contraction-related proteins after a spinal cord injury (SCI).
We divided 16 Sprague-Dawley rats into 2 groups: the control group and the SCI group. A spinal cord transection was performed surgically at the T10 vertebral level. After 1 week, the entire colon was divided into 2 segments, the proximal and distal colon. Each segment was mounted in a longitudinal or circular muscle direction in a 10-ml organ bath. We determined the intergroup differences as percentage changes in contractility after Ach treatment alone, Ach treatment with M2 receptor antagonist (AQ-RA741) pretreatment, and Ach treatment with M3 receptor antagonist (4-DAMP) pretreatment. Western blot analyses were performed to determine the expression level of RhoA, and heat shock protein 27 (HSP27).
Compared to the control rats, the SCI rats showed an increased response to Ach along both the directions in the proximal colon (p<0.05). Compared to the control group, in the SCI group, the Ach response was significantly different in the proximal segment under AQ-RA741 pretreatment (p<0.05) and in the distal segment under 4-DAMP pretreatment (p<0.05). Findings of the western blot analyses showed a significant decrease in the level of protein gene product 9.5 in the proximal and distal colon and a significant increase in the level of RhoA and HSP27 in the proximal colon of the SCI rats.
Our results suggest that changes in colonic contractility after SCI are partly attributable to changes in the M receptor subtypes.
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To identify the effect of serial casting combined with Botulinum toxin type A (BTX-A) injection on spastic equinus foot.
Twenty-nine children with cerebral palsy who had equinus foot were recruited from the outpatient clinic of Rehabilitation Medicine. The children were divided into 2 groups, one of which received serial casting after BTX-A injection, and the other which only received BTX-A injection. Serial casting started 3 weeks after the BTX-A injection, and was changed weekly for 3 times. Spasticity of the ankle joint was evaluated using the modified Ashworth scale (MAS), and the modified Tardieu scale (MTS). Gait pattern was measured using the physician's rating scale (PRS).
The degree of ankle dorsiflexion and the MAS improved significantly until 12 weeks following the BTX-A injection in the serial casting group (p<0.001), while the BTX-A injection-only group improved until 6 weeks following injection (p<0.05). The combined group showed a significantly greater increase in the degree of dorsiflexion compared to the BTX-A injection-only group at post-injection weeks 6 and 12 (p<0.05). Three children (11.5%) suffered from foot ulcers as a complication caused by the serial casting.
Our study demonstrated that the effect of BTX-A injection with serial casting was superior and lasted longer than the effect of BTX-A injection only in patients with spastic equinus foot. We therefore recommend BTX-A injection with serial casting for the treatment of equinus foot. However, physicians must also consider the possible complications associated with serial casting.
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There have been a many reports of observational analysis on hip disarticulation prosthetic ambulation, but not a scientific analysis by a computerized motion analyzer. We present to share with our professional colleague our invaluable experience gained from the study on the gait analysis of a left hip disarticulation prosthetic gait.
Using a Vicon 370 three dimensional gait analysis system, the gait analysis was performed in a left hip disarticulation patient fitted with a left Canadian type hip disarticulation prosthesis.
In linear parameters, the cadence showed 79 steps/min, the gait speed was 0.68 m/sec, and the double support phase was 25.27% of a total gait cycle. In kinematics, the maximal pelvic tilt angle showed 29.92o at pre-swing phase, and significantly increased as compared with normal person. Hip motion change remained flexed, and maximal knee flexion angle disclosed 22.07o at the terminal stage of initial swing phase. In kinetics, the hip extension moment on initial contact stage was 0.089 NM/kg, which was impaired being compared with normal person.
In conclusion, the increased pelvic tilt which implies that initiation of a prosthetic gait for hip disarticulation comes from a forward swing of the pelvis on the affected side, and an overall decrease of gait parameters accounts for the degree of disability of hip disarticulation amputee.
Method Fifty patients were assigned at random to receive intra-articular shoulder injection. The treatment groups were divided into two groups: BoNT-A group, 200 IU of BoNT-A and 2 ml of normal saline; triamcinolone acetonide (TA) group, 20 mg of triamcinolone and 2 ml of 2% lidocaine. Uptake ratio of quantitative three phase bone scintigraphy (QTPBS) was calculated by dividing the radioactivity count on the affected side by that on the unaffected side. Shoulder pain was assessed by visual analogue scale (VAS) and neuropathic pain scale (NPS). Range of motion (ROM) of shoulder joint and functional independence measurement (FIM) of upper limb were evaluated. All of them were measured before injection, and 4 weeks after injection.
Results After 4 weeks, the uptake ratio of blood pool phase was significantly decreased in hands of BoNT-A group than TA group. VAS, ROM and upper extremity FIM was similarly improved in both groups. Pain intensity and cold pain of NPS were similarly decreased in both groups. Hot pain and dull pain of NPS decreased more significantly in BoNT-A group than TA group.
Conclusion In the short-term, intra-articular BoNT-A shoulder injection maybe has the therapeutic effect on acute CRPS I related stroke. And the uptake ratio of blood pool phase of the hand of QTPBS may be useful to assess the therapeutic effect of CRPS after acute stroke.
Congenital fiber type disproportion (CFTD) has been described as a form of congenital myopathy characterized by the smallness and marked predominance of type I fibers in a muscle biopsy. Only major morphological characters in CFTD are the abnormality of the size of muscle fibers and the disproportion of the type of muscle fibers. Clinical feature of CFTD is characterized by congenital hypotonia, nonprogressive muscle weakness and delayed motor milestones. The disease is sometimes associated with a myopathic pattern in the electromyography (EMG) and a slightly increased creatine kinase (CK). In this report, we describe a case of the child presented the subtle clinical symptoms of mild proximal weakness of lower extremities, who was diagnosed as CFTD not by the laboratory findings such as EMG and muscle enzyme study of CK initially but with a muscle biopsy finally. (J Korean Acad Rehab Med 2002; 26: 485-488)
Objective: Botulinum toxin works at the neuromuscular junction by inhibiting the release of acetylcholine from the presynaptic membrane. It has been indicated for limb spasticity in patients with upper motor neuron lesions. The paralytic effect of this toxin usually lasts for 3 to 4 months, and repeated injections are needed to maintain the effect. This study was performed to investigate whether electrical stimulation can prolong the paralytic effect induced by botulinum toxin type A.
Method: Ninety male Sprague-Dawley rats, 30 for control and 60 for experimental, were studied. Botulinum toxin type A (DysportⰒ) was injected into the gastrocnemius muscle in the experimental groups (10 units for group 1 and 5 units for group 2), and normal saline 0.05 ml was injected into the same muscle in the control group. Thirty minutes of electrical stimulation was applied to the injected muscle with surface-stimulating electrodes. The stimulation was given once a day for 3 times in subgroup E1 and once every other day for 6 times in subgroup E2. No electrical stimulation was applied to subgroup N. Amplitudes of action potentials were measured serially on the injected muscles. At the third week, hematoxylin-eosin stained sections and synaptophysin immunohistochemical stained sections were examined.
Results: 1) At the second week after the toxin injection, amplitudes of action potentials maximally declined to 2.1∼3.7% in group 1 and to 4.0∼5.3% in group 2, compared to the initial amplitude. The amplitudes were beginning to recover from the third week. 2) Electrically stimulated groups demonstrated significantly more depressed amplitudes than non-stimulated group N. These effects lasted till week 2∼4. 3) Hematoxylin-eosin staining for muscle sections showed degenerative changes of muscle fibers. Synaptophysin immunoreactivity in the muscle demonstrated multiple synaptophysin-positive areas in a muscle fiber of the toxin injected muscle.
Conclusion: Transient electrical stimulation to the botulinum toxin injected muscles seems to enhance the paralytic effects of the toxin.
Glycogen Storage Disease Type II is caused by the deficiency of acid maltase resulting in lysosomal accumulation of glycogen. There are two major clinical syndromes, a severe generalized and invariable fatal disease of infancy, and a myopathy starting in juvenile or adult life.
The clinical and laboratory findings of a patient with Glycogen Storage Disease Type II are presented. The patient, a 17-year-old male, experienced slowly progressive weakness of muscle of the pelvis shoulder girdles and trunk. Muscle biopsy showed vacuolar myopathy and electromyograph showed features of myopathy with fibrillation potentials, positive sharp waves, myotonic discharges, without clinical myotonia at rest, and polyphasic potentials on volition.
Clinical features, histopathologic and electrophysiologic findings of this disease and differential diagnosis were reviewed.
Objective: This study was to investigate the relationship between genotype of Apolipoprotein E (Apo E) and severity of disability after brain injury as well as serum lipid profile.
Method: One hundred thirty-five brain injured patients (mean age 54.6⁑16.7 years, 90 male and 45 female) were enrolled. There were 34 patients with ischemic Stroke, 61 hemorrhagic stroke, and 40 traumatic brain injury. Apo E genotype was determined by polymerase chain reaction and polyacrylamide gel electrophoresis. The serum concentrations of total cholesterol, triglyceride, and HDL-cholesterol were measured. The outcome of brain injury was assessed by functional independence measure (FIM) scores.
Results: Most frequent Apo E genotype was E 3/3 (72%). In hemorrhagic stroke patients with ε4 allele, FIM score at admission was significantly lower than that of the patients without ε4 allele (p＜0.05). In traumatic brain injury patients with ε4 allele, FIM score change was significantly smaller than that of patients without ε4 allele (p＜0.05). The level of total serum cholesterol was lower in the ischemic stroke patients who have ε2 allele in comparison with the patients without that allele.
Conclusion: The presence of ε4 allele is considered to have relationship with the severity of disability and functional outcome in the patients with brain injury. (J Korean Acad Rehab Med 2002; 26: 243-248)
Cerebral palsy is a non-progressive cerebral sensori-motor defect, acquired either prenatally or in an early life and evolves over the first few years. Until recently many people believed that asphyxia at birth was a major cause of cerebral palsy and that the prevention of asphyxia at birth by improving perinatal care would reduce the number of cerebral palsy children. However the incidence of cerebral palsy in children has remained steady or ever risen slightly. The real cause of cerebral palsy is still unbaron to us.
This analysis was undertaken to determine the clinical features of cerebral palsy in Korea by the retrospective study of 98 children. Over a half of infants with cerebral palsy (64.2%) was recognized by parents before 1 year of corrected age, and their chief complaints were delayed developments or equinus foot deformities.
The most common type of cerebral palsy was spastic type (64.2%) which was followed by athetoid (10.5%), ataxia and hypotonia types (4.2% each). The mixed type was 19.4% Among 98 cerebral palsies, the preterm infants were 42.9% and the infants with low birth weight were 41.4%. The cerebral palsies with low birth weight and preterm infants were more likely to have spastic diplegia.
The most frequent abnormal primitive reflex was absent protective extension(78.3%). No significant associations of the type of cerebral palsy with primitive reflexes were found. An increased risk of cerebral palsy with increased maternal age was not observed in this study.
Of 55 MRI findings, no abnormalities were seen in 27.2%, periventricular leukomalacias in 34.5%, brain atrophies in 21.8%, cerebral infarcts in 10.9%, intracerebral hemorrhage in 3.6%, and delayed myelinations in 1.8%. The periventricular leukomalacias were associated with the preterm infants in 63.2%.
Method: The subjects comprised 83 patients with CP. We analyzed the brain MRI findings such as periventricular leukomalacia (PVL), brain atrophy, infarction or hemorrhage, basal ganglia lesion, migration anomaly and delayed myelination with consideration of clinical subtypes of CP.
Results: Of the 83 MRI findings, 69 abnormalities (83.1%) were the followings; PVL in 47 cases{17 spastic diplegics (SD), 17 spastic quadriplegics (SQ), 5 spastic hemiplegics (SH), 4 atonic or hypotonic quadriplegics, 2 ataxic quadriplegics and 2 mixed quadriplegics (MQ)}, brain atrophy in 6 cases (3 SQ, 1 SD, 1 SH and 1 MQ), infarction or hemorrhage in 7 cases (5 SH and 2 SQ), migration anomaly in 2 cases (1 SQ and 1 SH), delayed myelination in 3 cases (2 SQ and 1 SH) and basal ganglia lesion in 4 cases (3 MQ and 1 atonic quadriplegic). 33 cases of 47 PVL and 2 cases of 6 brain atrophy were preterm CPs. There was no difference in severity of CP between preterm and fullterm CPs.
Conclusion: The results of this study would be helpful in estimating the brain lesions in various clinical subtypes of CP. (J Korean Acad Rehab Med 2003; 27: 862-867)
Objective: To determine allele frequencies of apolipoprotein (Apo) E according to the type of stroke in Korean and to investigate the relationship between the Apo E genotype and serum lipid profile as well as outcome after stroke.
Method: Fifty-eight stroke patients admitted between January and December 1999 were enrolled. The serum concentrations of total cholesterol, triglyceride, and HDL-cholesterol were measured. The LDL-cholesterol concentration were calculated by Friedwald formula. Apo E genotypes were determined by polymerase chain reaction (PCR) and polyacrylamide gel electrophoresis (PAGE). The outcome of stroke was measured by functional independence measure (FIM) scores.
Results: Most frequent Apo E genotype was E 3/3 (72%), followed by E 3/4 (17%), E 2/3 (9%) and E 2/2 (2%). The level of total serum cholesterol and LDL-cholesterol were lower in the stroke patients who have ε2 allele in comparison with the patients without that allele. ε4 allele does not influence on the outcome of stroke patients measured by FIM.
Conclusion: Most frequent Apo E genotype was E3/3. ε2 allele influenced on the serum cholesterol level in stroke patients. However, ε4 allele does not correlate with worse prognosis in stroke patients in this study.
Method: A cross sectional study in 155 type II diabetic patients was done. The presence of LJM and shoulder adhesive capsulitis was sought. The diseases closely related to diabetes were recorded. The patients were assessed for retinopathy, nephropathy, and neuropathy.
Results: The prevalence of LJM and shoulder adhesive capsulitis in type II diabetic patients was 32.3% and 29.7%, respectively. Development of LJM and shoulder adhesive capsulitis was correlated with age and duration of diabetes. Higher blood HbA1c level was noticed in mild and moderate degree of LJM. The prevalence of shoulder adhesive capsulitis was shown association with LJM. The prevalence of LJM was associated with a history of myocardial infarction and chronic diabetic compli cations. The prevalence of shoulder adhesive capsulitis was associated with retinopathy, carpal tunnel syndrome, and autonomic neuropathy.
Conclusion: According to the results, around 30% of type II DM patients could have hand LJM and should adhesive capsulitis, which suggested more attention and effort to prevent the LJM and shoulder adhesive capsulitis were needed.
The peripheral nerves can restore their impaired function after injuries from trauma or surgery. The known factors affecting the recovery of damaged peripheral nerves include the severity of damage, nerve growth factor(NGF) from the damaged area and the concentrations of fibrinogen and thrombin. One of polypeptides, transforming growth factors beta(TGF-β) has been known to be related to inflammation and healing process of various wound. The TGF-β has to three subtypes, TGF-β1, TGF-β2 and TGF-β3. This study was performed to explore the effects of TGF-β subtypes on the recovery phase of damaged nerve. Sciatic nerves of rat were compressed 200 dyne/mm2. The latencies were measured by stimulation of proximal and distal portion of compression injury site and expression of TGF-β isoforms was studied in proximal and distal nerve of compression site and spinal cord by using avidin-biotin complex immunoperoxidase technique.
The latencies were increased at one week after nerve injury and then recovered progressively following 4 weeks. The latencies were restored to almost normal values at 4 weeks after nerve injury. TGF-β1 and TGF-β3 were expressed weakly at the cytoplasm of Schwann cell in the distal portion after 12 hours of injury. The values of TGF-β1 and TGF-β3 were increased at 3rd day after injury and lasted till the 4th week which was the end point of nerve regeneration. The changes of proximal portion were different from those of distal portion. TGF-β1 and TGF-β3 of proximal portion showed stronger positive reaction than that of distal portion and the reaction was peaked at 3rd day after injury. TGF-β subtypes were rarely present at neuronal cells and astrocytes in spinal cord from 12th hour to 3rd day after injury. The TGF-β subtypes were weakly appeared at the 1st week after injury and successively increased to 4th week at which the latencies were restored to almost normal value. The patterns of revelation of TGF-β subtypes showed that TGF-β1 was predominant at neuronal cell and TGF-β2 was at glial cells.
We suggest that TGF-β subtypes might be related to the regeneration process of nerve injuery.
The association between pediatric Chiari malformation and the development of syringomyelia has been well documented. Scoliosis in the patient with syringomyelia is thought to be secondary to anterior horn cell damage, which innervate the muscles of trunk, by an asymmetrically expanded syrinx. In pediatric patients, the neurologic signs and symptoms due to Chiari malformation and syringomyelia show much lower frequency but the incidence of scoliosis is very high. Thus, the MRI study for the diagnosis of the underlying syringomyelia and Chiari malfornation is essential in pediatric scoliosis patients, which may otherwise be misdiagnosed for idiopathic scoliosis.
We present a case of Chiari type I malformation associated with syringomyelia and scoliosis.
Objective: To assess the significance of anti-type I collagen antibody titer in estimating cumulative trauma and predicting the presence of occupational low back pain.
Method: Under the hypothesis that cumulative trauma on the spine will expose collagen and stimulate the formation of auto-antibody, we measured the serum anti-type I collagen antibody titers (IgM and IgG) in 408 male workers of a metal welding and manufacturing company. The antibody titers were measured in duplicates by ELISA. Statistical analysis was done to compare the titers according to occupational profiles (type of occupation and duration of employment) and clinical profiles (occurrence of low back pain, duration of low back pain and clinical impression).
Results: The anti-type I collagen IgG antibody titers were significantly increased in labor workers (n=357) in comparison with office workers (n=51)(p＜0.05). Among the labor workers both IgM and IgG antibody titers were increased in the low back pain group (n=50) though it did not reach statistical significance (p-value of IgM antibody titers=0.07). IgM and IgG antibody titers were increased in the chronic low back pain group (≥3 months)(n=8).
Conclusion: These data suggest that anti-type I collagen IgM and IgG antibody may be useful in predicting the presence of occupational low back pain and estimating cumulative trauma, respectively.
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