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Hypertonia

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https://www.readbyqxmd.com/read/28634003/spasticity-video-challenge-a-look-at-methods-for-addressing-difficult-cases
#1
Katharine E Alter, Mark Gormley, Atul T Patel
As seen in this CME online activity (available at http://courses.elseviercme.com/spasticity/662e), treatment of patients with spasticity due to upper motor neuron syndromes, including traumatic brain injury, stroke, and cerebral palsy, is multifaceted, involving chemodenervation, systemic medications, surgical therapy, rehabilitation efforts, and home care. Optimal care begins with the recognition that each patient's impairments are unique and must be assessed carefully to determine the impact of muscle overactivity, loss of dexterity, and weakness on passive and active function in the context of the patients' goals...
June 17, 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/28601565/gait-analysis-of-young-male-patients-diagnosed-with-primary-bladder-neck-obstruction
#2
Matteo Zago, Tommaso Ciro Camerota, Stefano Pisu, Daniela Ciprandi, Chiarella Sforza
Primary bladder neck obstruction (PBNO) represents an inappropriate or inadequate relaxation of the bladder neck during micturition. Based on the observation of an increased rate of postural imbalances in male patients with PBNO, we hypothesized a possible role of an unbalanced biomechanics of the pelvis on urethral sphincters activity. Our aim was to identify kinematic imbalances, usually disregarded in PBNO patients, and which could eventually be involved in the etiopathogenesis of the disease. Seven male adult patients (39...
June 2, 2017: Journal of Electromyography and Kinesiology
https://www.readbyqxmd.com/read/28566161/long-term-safety-of-repeated-high-doses-of-incobotulinumtoxina-injections-for-the-treatment-of-upper-and-lower-limb-spasticity-after-stroke
#3
Andrea Santamato, Francesco Panza, Domenico Intiso, Alessio Baricich, Alessandro Picelli, Nicola Smania, Francesca Fortunato, Davide Seripa, Pietro Fiore, Maurizio Ranieri
Current guidelines suggested a dosage up to 600units (U) of botulinum toxin type A (BoNT-A) (onabotulinumtoxinA or incobotulinumtoxinA) in reducing spastic hypertonia with low prevalence of complications, although a growing body of evidence showed efficacy with the use of high doses (>800U). The available evidence mainly referred to a single set of injections evaluating the efficacy and safety of the neurotoxin 30days after the treatment. In a prospective, non-randomized, open-label study, we studied the safety of repeated higher doses of incobotulinumtoxinA in post-stroke upper and lower limb spasticity...
July 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28558966/advanced-glycation-end-products-are-associated-with-the-presence-and-severity-of-paratonia-in-early-stage-alzheimer-disease
#4
Hans Drenth, Sytse U Zuidema, Wim P Krijnen, Ivan Bautmans, Cees van der Schans, Hans Hobbelen
OBJECTIVE: Paratonia, a distinctive form of hypertonia in patients with dementia, causes loss of functional mobility in early stage dementia to severe contractures and pain in the late stages. The pathogenesis of paratonia is not well understood. Patients in early stage dementia with diabetes mellitus showed a significantly higher risk for the development of paratonia. Both Alzheimer disease and diabetes mellitus are related to higher concentrations of advanced glycation end-products (AGEs)...
May 27, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28557247/european-consensus-on-the-concepts-and-measurement-of-the-pathophysiological-neuromuscular-responses-to-passive-muscle-stretch
#5
J C van den Noort, L Bar-On, E Aertbeliën, M Bonikowski, S M Braendvik, E W Broström, A I Buizer, J H Burridge, A van Campenhout, B Dan, J F Fleuren, S Grunt, F Heinen, H L Horemans, C Jansen, A Kranzl, B K Krautwurst, M van der Krogt, S Lerma Lara, C M Lidbeck, J-P Lin, I Martinez, C Meskers, D Metaxiotis, G Molenaers, D A Patikas, O Rémy-Néris, K Roeleveld, A P Shortland, J Sikkens, L Sloot, R J Vermeulen, C Wimmer, A S Schröder, S Schless, J G Becher, K Desloovere, J Harlaar
BACKGROUND AND PURPOSE: To support clinical decision-making in central neurological disorders, a physical examination is used to assess responses to passive muscle stretch. However, what exactly is being assessed is expressed and interpreted in different ways. A clear diagnostic framework is lacking. Therefore, the aim was to arrive at unambiguous terminology about the concepts and measurement around pathophysiological neuromuscular response to passive muscle stretch. METHODS: During two consensus meetings, 37 experts from 12 European countries filled online questionnaires based on a Delphi approach, followed by plenary discussion after rounds...
May 29, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/28553200/phase-ii-clinical-validation-of-a-powered-exoskeleton-for-the-treatment-of-elbow-spasticity
#6
Simona Crea, Marco Cempini, Stefano Mazzoleni, Maria Chiara Carrozza, Federico Posteraro, Nicola Vitiello
Introduction: Spasticity is a typical motor disorder in patients affected by stroke. Typically post-stroke rehabilitation consists of repetition of mobilization exercises on impaired limbs, aimed to reduce muscle hypertonia and mitigate spastic reflexes. It is currently strongly debated if the treatment's effectiveness improves with the timeliness of its adoption; in particular, starting intensive rehabilitation as close as possible to the stroke event may counteract the growth and postpone the onset of spasticity...
2017: Frontiers in Neuroscience
https://www.readbyqxmd.com/read/28545899/multiple-brain-abscesses-due-to-enterobacter-cloacae-in-an-immune-competent-child
#7
Arushi Gahlot Saini, Vinay Rathore, Chirag Kumar Ahuja, Rajesh Chhabra, Pankaj C Vaidya, Pratibha Singhi
Brain abscesses due to Enterobacteriaceae in immune-competent children are rare, and those due to Enterobacter cloacae are even rarer. We report an interesting case of community-acquired E. cloacae neuroinfection resulting in multiple brain abscesses in a young child with no underlying risk-factors. A 10 year-old-boy presented with low-grade fever, headache, neck pain and progressive deterioration of sensorium. On examination, he was conscious but drowsy with photophobia, normal fundii, meningeal signs, mild hypertonia, brisk muscle stretch reflexes and extensor plantar responses...
May 22, 2017: Journal of Infection and Public Health
https://www.readbyqxmd.com/read/28532916/spinal-intramedullary-tuberculosis-with-concurrent-supra-and-infratentorial-intracranial-disease-in-a-9-month-old-boy-case-report-and-review-of-the-literature
#8
REVIEW
Michael George Zaki Ghali, Visish M Srinivasan, C J Kim, Archana Malik
Tuberculous involvement of the spinal cord parenchyma is an exceedingly rare clinical entity; even more so is concurrent intracranial tuberculosis (TB). Spinal intramedullary TB presents with a characteristic subacute myelopathy, with slowly progressive paraplegia, sensory deficits, and/or bowel and bladder dysfunction. Diagnosis is strongly suspected with a clinical history of known TB in conjunction with characteristic findings on magnetic resonance imaging. Management involves multi-agent antitubercular chemotherapy without or with operative intervention...
May 19, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28515516/changes-in-cardiac-index-during-labour-analgesia-a-double-blind-randomised-controlled-trial-of-epidural-versus-combined-spinal-epidural-analgesia-a-preliminary-study
#9
Stephanie Yacoubian, Corrina M Oxford, Bhavani Shankar Kodali
BACKGROUND AND AIMS: Combined spinal-epidural (CSE) analgesia for labour and delivery is occasionally associated with foetal bradycardia. Decreases in cardiac index (CI) and/or uterine hypertonia are implicated as possible aetiological factors. No study has evaluated CI changes following combined spinal analgesia for labour and delivery. This prospective, double-blind, randomised controlled trial evaluates haemodynamic trends during CSE and epidural analgesia for labour. METHODS: Twenty-six parturients at term requesting labour analgesia were randomised to receive either epidural (E) or CSE analgesia...
April 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28514307/exome-sequencing-identifies-a-de-novo-mutation-of-ctnnb1-gene-in-a-patient-mainly-presented-with-retinal-detachment-lens-and-vitreous-opacities-microcephaly-and-developmental-delay-case-report-and-literature-review
#10
REVIEW
Niu Li, Yufei Xu, Guoqiang Li, Tingting Yu, Ru-En Yao, Xiumin Wang, Jian Wang
RATIONALE: The CTNNB1 (β-catenin) gene is well known for its crucial role in cell adhesion and the Wnt-signaling pathway. Previous studies have shown that gain-of-function mutations in the CTNNB1 gene contribute to the occurrence and development of a variety of carcinomas in humans. Recently, de novo, heterozygous, loss-of-function mutations of the CTNNB1 gene were found that partially explain intellectual disability in some patients. Other major clinical symptoms in these patients included microcephaly, abnormal facial features, motor delays, speech impairments, and deformities of the hands and feet...
May 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28511417/effectiveness-of-a-four-week-diet-regimen-exercise-and-psychological-intervention-for-weight-loss
#11
Tobias Weinreich, Hans-Peter Filz, Ursula Gresser, Barbara M Richartz
INTRODUCTION: Obesity is accompanied by restriction in the quality of life and an increased risk of morbidity and mortality. Cardiovascular, orthopedic, and metabolic disorders are among the possible consequences. In the management of obesity, a combination therapy that includes dietary, exercise, and behaviour modules has proven its worth. AIM: To evaluate the effect of weight-associated parameters, circulation associated parameters, glucose metabolism, body composition and life quality changes within a four-week inpatient rehabilitation program...
March 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28503163/different-effects-of-cold-stimulation-on-reflex-and-non-reflex-components-of-poststroke-spastic-hypertonia
#12
Sheng Li, Henry Shin, Ping Zhou, Xiaoyan Li
OBJECTIVE: To use an established biomechanical approach to quantify reflex and non-reflex responses from spastic-paretic elbow flexors in response to controlled cold and heat stimulation. METHODS: Thirteen spastic-hemiplegic stroke subjects were tested in the experiment. The spastic elbow joint was stretched into extension for 50° at two speeds (5°/s and 100°/s) in a customized apparatus. Thermal stimulation (HEAT at heat pain threshold, COLD at 0°C, or BASELINE at room temperature) was applied to the thenar eminence of the contralateral hand immediately prior to stretching for at least 30 s...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28495146/neonatal-vein-of-labb%C3%A3-infarction-size-is-associated-with-long-term-language-outcomes
#13
Kristen L Benninger, Lynne Ruess, Laurel A Slaughter, Nathalie L Maitre, Jerome A Rusin
BACKGROUND: The vein of Labbé is a superficial cortical vein, which drains the lateral surface of the temporal lobe. Thrombosis of the vein of Labbé can occur in the neonatal period. The developmental outcomes of infants who had vein of Labbé thrombosis are unknown as few studies of outcomes exist. METHODS: We completed a retrospective review of infants born ≥34 weeks of gestation, diagnosed with vein of Labbé thrombosis, and/or infarction on neuroimaging during the first 30 days of life...
July 2017: Pediatric Neurology
https://www.readbyqxmd.com/read/28433979/lethal-high-acute-disseminated-encephalomyelitis-adem-triggered-by-toxic-effect-of-synthetic-cannabinoid-black-mamba
#14
Kiran Samra, Ian S Boon, Gregory Packer, Saiju Jacob
A previously well 25-year-old man presented with agitation, double incontinence and left-sided incoordination. His symptoms started after smoking a synthetic cannabinoid (black mamba) 5 days earlier. Over 48 hours, he developed aphasia, generalised hypertonia, hyper-reflexia and dense left hemiparesis. This progressed to profuse diaphoresis, fever, tachycardia, hypertension and a possible seizure necessitating admission to the intensive care unit. CT head and cerebrospinal fluid analysis were unremarkable...
April 22, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28417072/atypical-juvenile-presentation-of-gm2-gangliosidosis-ab-in-a-patient-compound-heterozygote-for-c-259g%C3%A2-%C3%A2-t-and-c-164c%C3%A2-%C3%A2-t-mutations-in-the-gm2a-gene
#15
Carla Martins, Catherine Brunel-Guitton, Anne Lortie, France Gauvin, Carlos R Morales, Grant A Mitchell, Alexey V Pshezhetsky
GM2-gangliosidosis, AB variant is an extremely rare autosomal recessive inherited disorder caused by mutations in the GM2A gene that encodes GM2 ganglioside activator protein (GM2AP). GM2AP is necessary for solubilisation of GM2 ganglioside in endolysosomes and its presentation to β-hexosaminidase A. Conversely GM2AP deficiency impairs lysosomal catabolism of GM2 ganglioside, leading to its storage in cells and tissues. We describe a 9-year-old child with an unusual juvenile clinical onset of GM2-gangliosidosis AB...
June 2017: Molecular Genetics and Metabolism Reports
https://www.readbyqxmd.com/read/28378817/severe-neurodegeneration-progressive-cerebral-volume-loss-and-diffuse-hypomyelination-associated-with-a-homozygous-frameshift-mutation-in-cstb
#16
Alan O'Brien, Christian R Marshall, Susan Blaser, Peter N Ray, Grace Yoon
Mutations of the cystatin B gene (CSTB; OMIM 601145) are known to cause Unverricht-Lundborg disease or progressive myoclonic epilepsy-1A (EPM1A, MIM #254800). Most patients are homozygous for an expanded (>30) dodecamer repeat in the promoter region of CSTB, or are compound heterozygotes for the dodecamer repeat and a point mutation. We report two adolescent sisters born to consanguineous parents of Sri Lankan descent who presented with profound global developmental delay, microcephaly, cortical blindness and axial hypotonia with appendicular hypertonia...
June 2017: European Journal of Human Genetics: EJHG
https://www.readbyqxmd.com/read/28377349/-factors-affecting-recovery-of-consciousness-in-patients-with-disorders-of-consciousness-following-brain-trauma-a-logistic-regression-analysis
#17
Qing Lin, Qiu-You Xie, Yan-Bin He, Yan Chen, Xiao-Xiao Ni, Ye-Qun Guo, Yan Shen, Rong-Hao Yu
OBJECTIVE: To explore the factors that affect the recovery of consciousness in patients with disorders of consciousness following brain trauma. METHODS: We analyzed the data of 114 patients with disorders of consciousness following brain trauma admitted for rehabilitation. Bilateral logistic regression analysis was used to explore the factors that affected the recovery of the patients' consciousness. A logistic regression model was established and the ROC curve was drawn to obtain the optimal threshold of the prognostic model...
March 20, 2017: Nan Fang Yi Ke da Xue Xue Bao, Journal of Southern Medical University
https://www.readbyqxmd.com/read/28347765/spinal-cord-injury-in-hypertonic-newborns-after-antenatal-hypoxia-ischemia-in-a-rabbit-model-of-cerebral-palsy
#18
Alexander Drobyshevsky, Katharina A Quinlan
While antenatal hypoxia-ischemia (H-I) is a well-established cause of brain injury, the effects of H-I on the spinal cord remain undefined. This study examined whether hypertonia in rabbits was accompanied by changes in spinal architecture. Rabbit dams underwent global fetal H-I at embryonic day 25 for 40min. High resolution diffusion tensor imaging was performed on fixed neonatal CNS. Fractional anisotropy (FA) and regional volumetric measurements were compared between kits with and without hypertonia after H-I and sham controls using Tract Based Spatial Statistics...
March 24, 2017: Experimental Neurology
https://www.readbyqxmd.com/read/28347207/evaluation-of-the-effectiveness-of-transcranial-direct-current-stimulation-tdcs-and-psychosensory-stimulation-through-docs-scale-in-a-minimally-conscious-subject
#19
Danilo Dimitri, Daniela De Filippis, Valentina Galetto, Marina Zettin
The aim of our study was to assess the effectiveness of transcranial direct current stimulation (tDCS) on alertness improvement in a patient in a minimally conscious state (MCS) by means of disorders of consciousness scale combined with psycho-sensory stimulation. The effects of tDCS on muscle hypertonia through the Ashworth scale were also examined. tDCS was performed through a two-channel intra-cephalic stimulator. After stimulation, the patient followed a psychosensory stimulation training. Results pointed out an increase in DOCunit score, as well as an increase in alertness maintenance and an improvement in muscle hypertonia, although a MCS state persisted...
March 27, 2017: Neurocase
https://www.readbyqxmd.com/read/28319872/intrathecal-baclofen-bolus-reduces-exaggerated-extensor-coactivation-during-pre-swing-and-early-swing-of-gait-after-acquired-brain-injury
#20
John W Chow, Stuart A Yablon, Dobrivoje S Stokic
OBJECTIVE: To characterize the concurrent activation of rectus femoris (RF) and medial gastrocnemius (MG) muscles (extensor coactivation) during gait in subjects with pronounced resting hypertonia after acquired brain injury (ABI) and examine changes after intrathecal baclofen (ITB) bolus injection. METHODS: Magnitude and duration of extensor coactivation during different phases of gait were assessed by recording gait kinematics and activity in bilateral RF and MG muscles in 18 controls and 18 ABI subjects before and at 2, 4, and 6h after a 50-μg ITB injection...
May 2017: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
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