ISRN Neurology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Small Fiber Neuropathy Associated with Hyperlipidemia: Utility of Cutaneous Silent Periods and Autonomic Tests Wed, 19 Mar 2014 06:30:51 +0000 Background. Established electrophysiological methods have limited clinical utility in the diagnosis of small fiber neuropathy. The cutaneous silent period (CSP) may be useful as a method for the evaluation of smaller and unmyelinated fiber dysfunctions. Hyperlipidemia is a very rare cause of small fiber neuropathy. In this study, hyperlipidemia and small fiber neuropathy in symptomatic patients with normal nerve conduction studies were evaluated with autonomic tests and cutaneous silent periods. Methods. Twenty-five patients with clinically suspected small fiber neuropathy and 23 healthy volunteers were included. CSP latency and duration, as well as CSP latency difference of the upper and lower extremities, were examined. Two tests were used to assess the autonomic nervous system, namely, the R-R interval variation test in basal and profound breath conditions and the sympathetic skin response. Results. Twenty-five patients with clinically suspected small fiber neuropathy and normal nerve conduction studies were compared with 23 controls. In the upper extremities, patients had prolonged CSP latencies () and shortened CSP durations (), whereas in the lower extremities, patients had shortened CSP durations (). The expiration-to-inspiration ratios were also reduced in patients groups. There was no significant difference between sympathetic skin response latencies and amplitude of the case and control groups. Conclusion. Our findings indicate that CSP may become a useful technique for the assessment of small fiber neuropathy in hyperlipidemic patients. G. Morkavuk and A. Leventoglu Copyright © 2014 G. Morkavuk and A. Leventoglu. All rights reserved. Cognitive Impairment in Relapsing Remitting and Secondary Progressive Multiple Sclerosis Patients: Efficacy of a Computerized Cognitive Screening Battery Thu, 13 Mar 2014 13:22:34 +0000 Objective. To investigate the pattern of cognitive impairment in relapsing remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS) patients using a computerized battery. Methods. RRMS patients , SPMS patients , and controls were assessed by Central Nervous System Vital Signs (CNS VS) computerized battery, Trail Making Tests (TMT) A and B, and semantic and phonological verbal fluency tasks. Results. The overall prevalence of cognitive dysfunction was 53.75% (RRMS 38%, SPMS 80%). RRMS patients differed from controls with large effect size on reaction time, medium effect size on TMT A and small on TMT B, phonological verbal fluency, composite memory, psychomotor speed, and cognitive flexibility. SPMS patients differed from controls in all neuropsychological measures (except complex attention) with large effect sizes on TMT A and B, phonological verbal fluency, composite memory, psychomotor speed, reaction time, and cognitive flexibility. Between patient groups, medium effect sizes were present on TMT B and psychomotor speed, while small effect sizes were present on composite memory and processing speed. Conclusion. CNS VS is sensitive in detecting cognitive impairment in RRMS and SPMS patients. Significant impairment in episodic memory, executive function, and processing speed were identified, with gradual increment of the frequency as disease progresses. Athanasios Papathanasiou, Lambros Messinis, Vasileios L. Georgiou, and Panagiotis Papathanasopoulos Copyright © 2014 Athanasios Papathanasiou et al. All rights reserved. Minimizing Technical Failure of Percutaneous Balloon Compression for Trigeminal Neuralgia Using Neuronavigation Sun, 09 Mar 2014 11:30:36 +0000 Objective. Percutaneous balloon compression (PBC) is an effective and safe management for medically refractory trigeminal neuralgia; however, technical failure to cannulate the foramen ovale (FO) using only fluoroscopy is a significant problem in some cases. In this paper, we suggest the use of intraoperative navigation, in cases of reoperation due to prior technical failure to cannulate the FO under fluoroscopy. Methods. A total of 174 patients underwent PBC for TN since 2003. In 9 cases the penetration of the FO was not accomplished. Five of those patients were reoperated on for PBC using navigation from March 2012 to September 2012. Surgical technique: preoperatively, a head Computed Tomography (CT) scan is performed and the acquired images are imported into the navigation system. Intraoperatively, a small reference frame is strapped firmly to the patient’s forehead, the CT images are registered, and cannulation is performed under the guidance of the navigation system. Results. In all patients, the operation overall was completed successfully. Moreover, all patients reported complete pain relief immediately postoperatively and no complications were recorded overall. Conclusions. We suggest the use of neuronavigation in cases of technical failure of PBC. That technique involves technology with significant advantages helping the successful cannulation of the FO and seems more efficient and safer. Miltiadis Georgiopoulos, John Ellul, Elisabeth Chroni, and Constantine Constantoyannis Copyright © 2014 Miltiadis Georgiopoulos et al. All rights reserved. Nonmotor Symptoms in Early- and Advanced-Stage Parkinson’s Disease Patients on Dopaminergic Therapy: How Do They Correlate with Quality of Life? Thu, 06 Mar 2014 11:17:45 +0000 To determine the impact of nonmotor symptoms (NMS) on health-related quality of life (HRQoL) we examined 100 Parkinson’s disease (PD) patients on dopaminergic medications. An “early-stage” (ES) and an “advanced-stage” (AS) groups were formed. HRQoL was established by the questionnaire PDQ-8, number of NMS by NMSQuest, and severity and frequency of NMS by the assessment scale NMSS. The total NMS averaged 11.3 , . The NMSS domain correlation profiles for ES and AS did not fundamentally differ; however, the domains attention/memory and mood/apathy correlated moderately to strongly with HRQoL in ES, while the sleep/fatigue domain correlated moderately with HRQoL in AS. Weakly correlating domains were sleep/fatigue in ES and cardiovascular, attention/memory, and mood/apathy domains in AS. In view of these findings we strongly recommend systematic, active screening and therapy for neuropsychiatric disorders (mood, cognitive and sleep disorders, and fatigue) at the initial diagnosis and throughout the entire course of PD. Peter Valkovic, Jan Harsany, Marta Hanakova, Jana Martinkova, and Jan Benetin Copyright © 2014 Peter Valkovic et al. All rights reserved. Evaluating Different Aspects of Prospective Memory in Amnestic and Nonamnestic Mild Cognitive Impairment Wed, 05 Mar 2014 13:26:42 +0000 Prospective memory, the inability to remember an intended action, is a common complaint, but not formally assessed in most clinical and research studies of mild cognitive impairment (MCI). In this study, patients with amnestic mild cognitive impairment (aMCI), non-amnestic cognitive impairment (naMCI), and cognitively normal (CN) elders were assessed using the Miami Prospective Memory Test (MPMT). A unique aspect of the paradigm was that participants were scored for intention to perform, accuracy in recollection for specific elements of the task, and the need for reminder cues. Excellent test-retest stability was obtained for MPMT Event-Related (ER), combined Time-Related (TR) subscales, and total MPMT score for aMCI subjects. MPMT impairments were observed in 48.6% of aMCI, 29.4% of naMCI, and 10.0% of normal elderly participants. Prospective memory deficits were common in participants with aMCI, and occurred in almost a third of naMCI participants. Intention to perform and need for reminder cues were significantly more impaired than retrospective memory for specific details of the task. It is concluded that assessment of different elements of prospective memory is important in MCI research and that inability to remember intended actions is a significant feature in those as risk for Alzheimer’s disease. Rene Hernandez Cardenache, Lizmar Burguera, Amarilis Acevedo, Rosie Curiel, and David A. Loewenstein Copyright © 2014 Rene Hernandez Cardenache et al. All rights reserved. Urinary Catheterization May Not Adversely Impact Quality of Life in Multiple Sclerosis Patients Thu, 20 Feb 2014 15:43:58 +0000 Background. Multiple sclerosis (MS) healthcare providers (HCP) have undergone considerable educational efforts regarding the importance of evaluating and treating pelvic floor disorders, specifically, urinary dysfunction. However, limited data are available to determine the impact of catheterization on patient quality of life (QoL). Objectives. To describe the use of urinary catheterization among MS patients and determine the differences between those who report positive versus negative impact of this treatment on QoL. Methods. Patients were queried as part of the 2010 North American Research Committee On Multiple Sclerosis survey; topics included 1) urinary/bladder, bowel, or sexual problems; 2) current urine leakage; 3) current catheter use; 4) catheterizing and QoL. Results. Respondents with current urine leakage were 5143 (54.7%), of which 1201 reported current catheter use (12.8%). The types of catheters (intermittent self-catheterization and Foley catheter (indwelling and suprapubic)) did not differ significantly. Of the current catheter users, 304 (25.35%) respondents reported catheterization negatively impacting QoL, 629 (52.4%) reported a positive impact on QoL, and 223 (18.6%) reported neutral QoL. Conclusions. A large proportion of catheterized MS patients report negative or positive changes in QoL associated with urinary catheterization. Urinary catheterization does not appear to have a universally negative impact on patient QoL. Rebecca James, Heidi E. Frasure, and Sangeeta T. Mahajan Copyright © 2014 Rebecca James et al. All rights reserved. Minicraniotomy for Standard Temporal Lobectomy: A Minimally Invasive Surgical Approach Thu, 06 Feb 2014 00:00:00 +0000 Introduction. The common surgical approach for standard temporal lobectomy is a question-mark skin incision and a frontotemporal craniotomy. Herein, we describe minicraniotomy approach through a linear skin incision for standard temporal lobectomy. Methods. A retrospective observational cohort study was conducted for a group of consecutive 21 adult patients (group I) who underwent minicraniotomy for standard temporal lobectomy utilizing a linear skin incision. This group was compared to a consecutive 17 adult patients (group II) who previously underwent a reverse question-mark skin incision and standard frontotemporal craniotomy. Results. The mean age was 29 and 23 for groups I and II, respectively. The mean estimated blood loss was 190 mL and 280 mL in groups I and II, respectively (). Three patients in group II developed chronic postcraniotomy headache compared to none in group I. Cosmetic outcome was excellent in group I while 4 patients in group II developed disfiguring depression at lateral sphenoid wing and anterior temple. In group I 17 out of 21 became seizure-free at one-year followup. Conclusion. Minicraniotomy through a linear skin incision is a sufficient surgical approach for effective standard temporal lobectomy and it has an excellent cosmetic outcome. Faisal Al-Otaibi, Monirah Albloushi, and Saleh Baeesa Copyright © 2014 Faisal Al-Otaibi et al. All rights reserved. Serotonin Transporter Availability in Early Stage Parkinson’s Disease and Multiple System Atrophy Mon, 03 Feb 2014 08:53:59 +0000 Background. Differentiating Parkinson’s disease (PD) from multiple system atrophy (MSA) can be challenging especially early in the course of the disease. Previous studies have shown that midbrain serotonin transporter (SERT) availability in patients with established MSA was significantly lower compared to PD. It is unknown if this is also true for early-stage patients. Methods. 77 early-stage, untreated PD patients were recruited between 1995 and 1998, underwent [123I]β-CIT SPECT imaging, and were followed for at least five years. 16 patients were lost to followup, and in 4 the diagnosis was changed to another atypical parkinsonian syndrome, but not in MSA. In 50 patients, the PD diagnosis was unchanged at followup. In seven patients, the diagnosis was changed to MSA at followup. We retrospectively assessed baseline midbrain SERT availability as well as midbrain SERT-to-striatal dopamine transporter (DAT) ratios. Results. No difference in baseline [123I]β-CIT SERT availability was found. The midbrain SERT-to-striatal DAT ratio for whole striatum was significantly lower in patients with PD compared to MSA (). However, when adjusting for the disease duration at imaging this difference is not significant (). Conclusion. Midbrain SERT availability is not different between early-stage PD and MSA. Therefore, SERT imaging is not useful to differentiate between early PD and MSA. S. R. Suwijn, H. W. Berendse, C. V. M. Verschuur, R. M. A. de Bie, and J. Booij Copyright © 2014 S. R. Suwijn et al. All rights reserved. Continuous Spike-Wave during Slow Wave Sleep and Related Conditions Thu, 30 Jan 2014 00:00:00 +0000 Continuous spike and wave during slow wave sleep (CSWS) is an epileptic encephalopathy that presents with neurocognitive regression and clinical seizures, and that demonstrates an electroencephalogram (EEG) pattern of electrical status epilepticus during sleep, as defined by the Commission on Classification and Terminology of the International League Against Epilepsy 1989. CSWS is an age-related condition, typically presenting in children around 5 years of age, with clinical seizures which progress within 2 years to a severe epileptic encephalopathy. The pathophysiology of CSWS is not completely understood, but the corticothalamic neuronal network involved in sleep patterns is thought to be involved. Genetic predisposition and injury in early development are thought to play etiological roles. Treatment strategies have involved traditional anticonvulsants, hormonal therapies, and other newer techniques. Outcomes are fair, and the thought is that earlier diagnosis and intervention preserve neurocognitive development, as in the case of other epileptic encephalopathies. Further understanding of the mechanisms of CSWS may lead to improved therapeutic options and thus outcomes of children with CSWS. Nilika Shah Singhal and Joseph E. Sullivan Copyright © 2014 Nilika Shah Singhal and Joseph E. Sullivan. All rights reserved. Working Memory and the Enactment Effect in Early Alzheimer’s Disease Tue, 28 Jan 2014 10:55:38 +0000 This study examines the enactment effect in early Alzheimer’s disease using a novel working memory task. Free recall of action-object instruction sequences was measured in individuals with Alzheimer’s disease and older adult controls . Instruction sequences were read out loud by the experimenter (verbal-only task) or read by the experimenter and performed by the participants (subject-performed task). In both groups and for all sequence lengths, recall was superior in the subject-performed condition than the verbal-only condition. Individuals with Alzheimer’s disease showed a deficit in free recall of recently learned instruction sequences relative to older adult controls, yet both groups show a significant benefit from performing actions themselves at encoding. The subject-performed task shows promise as a tool to improve working memory in early Alzheimer’s disease. Lara A. Charlesworth, Richard J. Allen, Suzannah Morson, Wendy K. Burn, and Celine Souchay Copyright © 2014 Lara A. Charlesworth et al. All rights reserved. Inflammatory Cytokines and Physical Activity in Multiple Sclerosis Mon, 27 Jan 2014 07:53:11 +0000 Background. Besides the functional benefits, physical activity triggers a hormonal pattern of immunologic responses with an anti-inflammatory effect in individuals who suffer from multiple sclerosis. Purpose. To analyze the influence of physical activity on multiple sclerosis and identify the intensity threshold which triggers the anti-inflammatory physiological mechanism. Methodology. A systematic review was made on the databases Medline, PubMed, ScienceDirect, PloS, PEDro, and Web of Science. Studies from references of retrieved articles were also collected. The criteria included studies published in English and random studies referred to the inflammatory process, connected with physical activity in individuals with multiple sclerosis. The studies were methodologically analyzed by two reviewers according to PEDro scale. Results and Discussion. Five random control trial studies were identified. The results revealed that with physical activity there seems to have a modulation on anti-inflammatory cytokines which improve physical and cardiorespiratory performance. More investigation is required. Conclusions. Physical activity influences the quality of life and it seems to stimulate the presence of anti-inflammatory cytokines. With light physical activity the cellular activity is lower, while with moderate activity there seems to have more capacity to help in the resolution of an inflammatory situation. Margarida Florindo Copyright © 2014 Margarida Florindo. All rights reserved. Dopamine D2R Agonist-Induced Cardiovascular Effects in Healthy Male Subjects: Potential Implications in Clinical Settings Wed, 22 Jan 2014 13:15:30 +0000 Dopamine D2 receptor agonists represent a first line treatment option in young patients with signs and symptoms of idiopathic Parkinson’s disease. An association between the use of D2 receptor agonists in Parkinson’s disease patients and heart failure has been reported. The identification of the underlying mechanism is needed to minimize the resultant cardiovascular morbidity. In a phase I clinical trial, a D2 receptor agonist (pramipexole) was administered to 52 healthy male subjects following a dose escalation scheme. Serial measurements of resting blood pressure, heart rate, and derived parameters including pulse pressure, pulsatile stress, and rate pressure product were analysed. Statistically significant and clinically relevant increases in most of the assessed parameters were found. Ten subjects were removed prematurely from the trial because of clinically significant increases in blood pressure and/or heart rate requiring immediate intervention with IV rescue medications including a selective β-1 blocker. The observed drug-related changes in vital signs were of clinical relevance and might explain some of the cardiovascular morbidity reported in patients receiving D2 receptor agonist in clinical settings. We suggest that the additional use of a β-1 blocking agent might mitigate the risk of cardiovascular morbidity among patients receiving long-term D2 receptor agonists. Khalid Abou Farha, Corine Baljé-Volkers, Wim Tamminga, Izaak den Daas, and Sandra van Os Copyright © 2014 Khalid Abou Farha et al. All rights reserved. Prevalence of Anti-JC Virus Antibody in Multiple Sclerosis Patients in Kuwait Wed, 22 Jan 2014 08:10:41 +0000 Background. Multiple sclerosis (MS) therapeutics entered a new era after the development of anti-JC virus (anti-JCV) antibody assay that assesses the risk of development of progressive multifocal leukoencephalopathy (PML) in patients treated with natalizumab. Objective. To determine the prevalence of anti-JCV antibody among MS patients in Kuwait. Methods. Using the national MS registry, demographics and disease characteristics of MS patients who were screened for anti-JC virus antibody were collected. The prevalence of anti-JCV antibody seropositivity and its association with demographic and disease characteristics were evaluated. Results. Out of 110 screened MS patients for anti-JCV antibodies, 65.5% were females. Mean age and disease duration were 29.23 ± 8.55 and 5.39 ± 5.04 years, respectively. 47.3% of patients were already on natalizumab and 52.7% of patients were screened for stratification to either natalizumab or a different Disease Modifying Therapy (DMT). The overall prevalence of anti-JC virus antibody was 40%. Gender (), disease duration (), and number of natalizumab infusions () were not associated with seropositivity. Patients aged ≥30 years were more likely to be seropositive (). Conclusion. The prevalence of anti-JCV antibody is slightly lower than what is reported in published studies. Seropositivity was associated with an increasing age of MS patients. S. Lamdhade, A. Ashkanani, and R. Alroughani Copyright © 2014 S. Lamdhade et al. All rights reserved. Neuroprotection in Stroke: Past, Present, and Future Tue, 21 Jan 2014 13:58:17 +0000 Stroke is a devastating medical condition, killing millions of people each year and causing serious injury to many more. Despite advances in treatment, there is still little that can be done to prevent stroke-related brain damage. The concept of neuroprotection is a source of considerable interest in the search for novel therapies that have the potential to preserve brain tissue and improve overall outcome. Key points of intervention have been identified in many of the processes that are the source of damage to the brain after stroke, and numerous treatment strategies designed to exploit them have been developed. In this review, potential targets of neuroprotection in stroke are discussed, as well as the various treatments that have been targeted against them. In addition, a summary of recent progress in clinical trials of neuroprotective agents in stroke is provided. Arshad Majid Copyright © 2014 Arshad Majid. All rights reserved. Histological Quantification of Angiogenesis after Focal Cerebral Infarction: A Systematic Review Mon, 30 Dec 2013 10:49:59 +0000 Ischemic stroke is a leading cause of disability, and current treatments to improve recovery are limited. Part of the natural recovery process after brain injury is angiogenesis. The formation of new blood vessels around the infarct appears to be important for restoration of adequate perfusion to allow for healing of brain tissue. Many potential restorative treatments may affect, and be affected by, angiogenesis, so accurate quantification of this outcome is needed. We performed a systematic review of histological methods to quantify angiogenesis after cerebral infarction. We found reports of the use of a variety of histological and general and immunostaining techniques in conjunction with a variety of analysis methods. We found no direct comparison studies and concluded that more research is needed to optimize the assessment of this important stroke outcome. Wai Yin Leung and Matthew B. Jensen Copyright © 2013 Wai Yin Leung and Matthew B. Jensen. All rights reserved. A Retrospective Comparison of Conventional versus Transverse Mini-Incision Technique for Carpal Tunnel Release Thu, 12 Dec 2013 11:31:24 +0000 Background. In this retrospective study, we aimed to compare the results of two surgical techniques, conventional and transverse mini-incision. Materials and Methods. 95 patients were operated between 2011 and 2012 in Bitlis State Hospital. 50 patients were operated with conventional technique and 45 of them were operated with minimal transverse incision. Postoperative complications, incision site problems, and the time of starting to use their hands in daily activities were noted. Results. 95 patients were included in the study. The mean age was 48. 87 of them were female and 8 were male. There was no problem of incision site in both of the two surgical techniques. Only in one patient, anesthesia developed in minimal incision technique. The time of starting to use their hands in daily activities was 22,2 days and 17 days in conventional and minimal incision technique, respectively. Conclusion. Two surgical techniques did not show superiority to each other in terms of postoperative complications and incision site problems except the time of starting to use their hands in daily activities. İsmail Gülşen, Hakan Ak, Gökhan Evcılı, Özlem Balbaloglu, and Enver Sösüncü Copyright © 2013 İsmail Gülşen et al. All rights reserved. VGLUTs in Peripheral Neurons and the Spinal Cord: Time for a Review Wed, 20 Nov 2013 19:15:53 +0000 Vesicular glutamate transporters (VGLUTs) are key molecules for the incorporation of glutamate in synaptic vesicles across the nervous system, and since their discovery in the early 1990s, research on these transporters has been intense and productive. This review will focus on several aspects of VGLUTs research on neurons in the periphery and the spinal cord. Firstly, it will begin with a historical account on the evolution of the morphological analysis of glutamatergic systems and the pivotal role played by the discovery of VGLUTs. Secondly, and in order to provide an appropriate framework, there will be a synthetic description of the neuroanatomy and neurochemistry of peripheral neurons and the spinal cord. This will be followed by a succinct description of the current knowledge on the expression of VGLUTs in peripheral sensory and autonomic neurons and neurons in the spinal cord. Finally, this review will address the modulation of VGLUTs expression after nerve and tissue insult, their physiological relevance in relation to sensation, pain, and neuroprotection, and their potential pharmacological usefulness. Pablo R. Brumovsky Copyright © 2013 Pablo R. Brumovsky. All rights reserved. Therapeutic Effects of Tai Chi in Patients with Parkinson’s Disease Thu, 31 Oct 2013 15:29:38 +0000 Objective. The purpose of the study was to investigate the effects of a 12-week program of therapeutic Tai Chi on the motor function and physical function of idiopathic Parkinson’s disease patients (PDs). Methods. The participants were 22 clinically stable PDs in Hoehn-Yahr stages 1-2 randomly assigned to a therapeutic Tai Chi group (TTC, ) or a control group (CON, ). Two subjects in control group did not complete the study for personal reasons. TTC was performed three days a week (60 min/session). Motor symptoms by the UPDRS were assessed, and tests of physical function were administered before and after the 12-week trial. Results. The TTC group, as compared to the CON group, showed changes in the mentation, behavior, mood, and motor scales of the UPDRS (, , resp.), with no significant main effects on the activities of daily living scale (ADL). However, there was a significant interaction between the time and intervention group on ADL (). There were no significant main effects for any of the physical function variables. There were significant interaction effects in balance and agility (, resp.). Conclusions. This study showed that TTC training had modest positive effects on the functional status of Parkinson’s disease patients. Hye-Jung Choi, Carol Ewing Garber, Tae-Won Jun, Young-Soo Jin, Sun-Ju Chung, and Hyun-Joo Kang Copyright © 2013 Hye-Jung Choi et al. All rights reserved. Profile of Cognitive Complaints in Vascular Mild Cognitive Impairment and Mild Cognitive Impairment Mon, 28 Oct 2013 12:01:17 +0000 Objective. Vascular mild cognitive impairment (VaMCI) is differentiated from mild cognitive impairment (MCI) by the presence of vascular events such as stroke or small vessel disease. Typically, MCI and VaMCI patients present with subjective complaints regarding cognition; however, little is known about the specific nature of these complaints. We aimed to create a profile of subjective cognitive complaints in MCI and VaMCI patients with similar levels of objective cognitive performance. Methods. Twenty MCI and twenty VaMCI patients were recruited from a Memory Disorders Clinic in Toronto. Subjective cognitive complaints were assessed and categorized using the Neuropsychological Impairment Scale. Results. MCI and VaMCI patients achieved similar scores on measures of objective cognitive function (). However, the VaMCI group had more subjective complaints than the MCI group (), particularly in the critical items, cognitive efficiency, memory, and verbal learning domains of the Neuropsychological Impairment Scale. Conclusions. Our findings support the idea that VaMCI and MCI differ in their clinical profiles, independent of neuroimaging. VaMCI patients have significantly more subjective cognitive complaints and may be exhibiting particular deficits in memory, verbal learning, and cognitive efficiency. Our findings promote the need for further research into VaMCI-specific cognitive deficits. Jenny Gu, Corinne E. Fischer, Gustavo Saposnik, and Tom A. Schweizer Copyright © 2013 Jenny Gu et al. All rights reserved. Effect of Socks on the Assessment of Vibration Sensation Thu, 24 Oct 2013 16:59:02 +0000 Objective. To investigate the difference between the measurement of vibration sensation without and with socks. Material and Methods. Fifty healthy volunteers (H group) and 19 patients with diabetic polyneuropathy (PNP group) were included. The sites of measurement were the great toe (GT) and medial malleolus (MM). A standard 128 Hz tuning fork was used in the measurements. Results. Mean duration of vibration sensations without and with socks was as follows: in the H group, 19.4 ± 4.2 and 19.5 ± 4.2 s at GT and 15.1 ± 3.3 and 14.6 ± 3.3 s at MM; in the PNP group, 13.4 ± 3.8 and 12.7 ± 4.1 s at GT and 11.9 ± 3.8 and 11.7 ± 3.4 s at MM. No significant difference was found between the measurements without and with socks, except those found at the MM in group H (). This significant difference was further analyzed in terms of effect size which was concluded to be practically insignificant (Cohen’s ). Shorter mean vibration duration was measured at MM as compared to GT that could be explained by the damping effect. Conclusions. Wearing socks of moderate thickness does not have any important effect on the duration of vibration sensation. This might be considered as a reflection of the remarkable properties of vibration sensation. R. C. Meral, Z. Matur, B. Dertsiz, and A. E. Öge Copyright © 2013 R. C. Meral et al. All rights reserved. The Afferent Visual Pathway: Designing a Structural-Functional Paradigm of Multiple Sclerosis Wed, 23 Oct 2013 14:46:24 +0000 Multiple sclerosis (MS) is a disease of the central nervous system (CNS) believed to arise from a dysfunctional immune-mediated response in a genetically susceptible host. The actual cause of MS is not known, and there is ongoing debate about whether this CNS disorder is predominantly an inflammatory versus a degenerative condition. The afferent visual pathway (AVP) is frequently involved in MS, such that one in every five individuals affected presents with acute optic neuritis (ON). As a functionally eloquent system, the AVP is amenable to interrogation with highly reliable and reproducible tests that can be used to define a structural-functional paradigm of CNS injury. The AVP has numerous unique advantages as a clinical model of MS. In this review, the parameters and merits of the AVP model are highlighted. Moreover, the roles the AVP model may play in elucidating mechanisms of brain injury and repair in MS are described. Fiona Costello Copyright © 2013 Fiona Costello. All rights reserved. Production, Control, and Visual Guidance of Saccadic Eye Movements Wed, 23 Oct 2013 11:36:09 +0000 Primate vision is served by rapid shifts of gaze called saccades. This review will survey current knowledge and particular problems concerning the neural control and guidance of gaze shifts. Jeffrey D. Schall Copyright © 2013 Jeffrey D. Schall. All rights reserved. Intrathecal Administration of Autologous CD34 Positive Cells in Patients with Past Cerebral Infarction: A Safety Study Wed, 25 Sep 2013 14:54:53 +0000 Regenerative strategies in treatment of stroke have great potential. The goal of the current study was to investigate safety of intrathecal administration of autologous CD34 positive cells in treatment of patients with poststroke. A total of eight male patients with a history of stroke were enrolled. The patients were treated subcutaneously with 5 μg/kg body weight rhG-CSF for 5 consecutive days, and then leukapheresis was performed to concentrate cells for CD34 positive immunoselection. All patients underwent intrathecal administration of CD34 positive cells via lumbar puncture. The primary outcome was safety evaluation for 12-month followup. In addition, behavioral function was evaluated with NIH stroke scale and Barthel index 1, 6, and 12 months after the last treatment, respectively. There were no major adverse events, and abnormal changes of blood tests during the whole treatment process included intrathecal administration and 12-month followup. The main message from the current study was that administration of G-CSF-mobilized autologous CD34 positive cells in patients with poststroke was safe. Future studies with larger population and control group are needed to confirm the safety and investigate the efficacy. Liming Wang, Haijie Ji, Ming Li, Jianjun Zhou, Wen Bai, Zhanqiang Zhong, Na Li, Delin Zhu, Zijia Zhang, Yongjun Liu, and Mingyuan Wu Copyright © 2013 Liming Wang et al. All rights reserved. Alzheimer’s Disease: Screening Biomarkers Using Frequency Doubling Technology Visual Field Wed, 25 Sep 2013 13:15:11 +0000 This study was to investigate the feasibility of frequency doubling technology (FDT) visual field testing in Alzheimer’s disease (AD) in order to identify early biomarkers of AD in patients already diagnosed with AD and compare the findings to participants not having Alzheimer’s disease. This biomarker would be useful in a battery of tests for the early identification of those with AD. It was not the intent to correlate the visual system biomarker with severity of disease, but to determine if the biomarker was present in pass or fail screening criteria. The study showed with very strong significance that the FDT can identify biomarkers of those with AD compared to an age-matched population that does not have AD. FDT is a simple test to take and administer and has been used to screen for eye and retinal diseases such as glaucoma, retinal macular degeneration, and diabetic retinopathy. The results obtained in the FDT readout are analyzed and compared to the age normative database within the system. The FDT ability to screen for AD biomarker in the visual system was significant in those with AD compared to the controls, and the deficits were not related to any ocular pathology. Denise A. Valenti Copyright © 2013 Denise A. Valenti. All rights reserved. Body Mass Index in Multiple Sclerosis: Associations with CSF Neurotransmitter Metabolite Levels Tue, 24 Sep 2013 16:07:02 +0000 Body weight and height of patients with relapsing-remitting multiple sclerosis (RRMS) or clinically isolated syndrome suggesting MS (CIS) in the age range 18 to 60 years (154 males and 315 females) were compared with those of subjects (146 males and 212 females) free of any major neurological disease. In drug-free patients, CSF levels of the metabolites of noradrenaline (MHPG), serotonin (5-HIAA), and dopamine (HVA), neurotransmitters involved in eating behavior, were estimated in searching for associations with body mass index (BMI). Statistical evaluations were done separately for males and females. Lower BMI was found in female MS patients compared to female controls, more pronounced in RRMS. BMI was not associated with duration of illness, smoking, present or previous drug treatment, or disability score. Body height showed a shift towards greater values in MS patients compared to controls. Patients in the lower BMI quartile (limits defined from control subjects) had lower 5-HIAA and HVA compared to patients in the upper quartile. The results provide evidence for weight reduction during disease process in MS, possibly related to deficits in serotoninergic and dopaminergic activities that develop during disease course, resulting in impairments in food reward capacity and in motivation to eat. Manolis Markianos, Maria-Eleftheria Evangelopoulos, Georgios Koutsis, Panagiota Davaki, and Constantinos Sfagos Copyright © 2013 Manolis Markianos et al. All rights reserved. Study on the Dynamic Changes in Synaptic Vesicle-Associated Protein and Axonal Transport Protein Combined with LPS Neuroinflammation Model Tue, 24 Sep 2013 11:29:49 +0000 Microglia activation is the major component of inflammation that constitutes the characteristic of neurodegenerative disease. A large amount of researches have demonstrated that inflammation involved in the pathogenesis of PD process activated microglia acting on the neurons through the release of a variety of inflammatory factors. However, the molecular mechanism underlying how it does work on neurons is still unclear. Here, we show that intracerebral injections of LPS induced Parkinson’s disease pathology in C57BL/6J mice. Furthermore, study on the dynamic changes in Synaptic vesicle-associated protein and axonal transport Protein in this process. The results indicated that after administration of LPS in the brain, the inflammatory levels of TNF-α and IL-1β both are elevated, and have a time-dependent. Rui Zhang, Ming Zhao, Hai-jie Ji, Yu-he Yuan, and Nai-hong Chen Copyright © 2013 Rui Zhang et al. All rights reserved. Age Predicts Functional Outcome in Acute Stroke Patients with rt-PA Treatment Thu, 19 Sep 2013 14:14:35 +0000 The standard treatment for acute ischemic stroke is thrombolytic therapy. There is limited data on prognostic factors of acute stroke with thrombolytic therapy particularly in Asian population. Acute ischemic stroke patients who were treated with thrombolytic therapy at Srinagarind Hospital between May 2008 and July 2010 were included. Factors associated with Barthel index more than 80 were studied by multiple logistic regression analysis. There were 75 patients included in the study. The mean NIHSS scores before treatment and at 3 months were 9.16 ± 4.82 and 3.83 ± 4.00, respectively, and median Barthel index at 3 months was 86. Only significant predictor for having Barthel index more than 80 points at 3 months was age (adjusted odds ratio 0.929, 95% confidence interval 0.874, 0.988). Four patients developed intracranial hemorrhage after the treatment (5%), and two died (2.6%). In conclusion, age predicts Barthel index in acute stroke patients with rt-PA treatment. Jarin Chindaprasirt, Kittisak Sawanyawisuth, Paiboon Chattakul, Panita Limpawattana, Somsak Tiamkao, Patcharin Aountri, and Verajit Chotmongkol Copyright © 2013 Jarin Chindaprasirt et al. All rights reserved. Zonisamide Induces Crystalluria without Urinary pH Changes in Children and Young Adults Thu, 19 Sep 2013 10:48:01 +0000 Purpose. Adjunctive zonisamide therapy was demonstrated to be beneficial for multiple-disabled patients with refractory childhood-onset epilepsy. Zonisamide is well tolerated, but urolithiasis and calcium sludge in the bladder were sometimes described in patients treated with antiepileptic drug polytherapy including zonisamide. In previous studies, alkaline urine and crystalluria were shown to be risk factors for urolithiasis. Therefore, the effects of zonisamide addition and withdrawal on the urinary pH and crystalluria were investigated in patients treated with antiepileptic drug polytherapy to clarify the cause of urolithiasis induced by zonisamide. Methods. The urinary pH and the degree of crystalluria were retrospectively studied in epilepsy patients one month after the addition or withdrawal of zonisamide as part of their antiepileptic drug treatment regimen over the previous three years. Results. A total of 27 zonisamide-on patients and 16 zonisamide-off patients were enrolled in the study. The urinary pH did not change after the addition or withdrawal of zonisamide. However, the degree of crystalluria significantly increased after the addition () of zonisamide and decreased after its withdrawal (). Conclusions. Zonisamide induces crystalluria without alkalinization of the urine. Crystalluria should be carefully monitored in patients treated with zonisamide to prevent urolithiasis. Tohshin Go Copyright © 2013 Tohshin Go. All rights reserved. Cognitive Dysfunction and Dementia in Primary Sjögren’s Syndrome Thu, 19 Sep 2013 08:51:08 +0000 Background. Primary Sjögren’s syndrome (PSS) is a frequent systemic autoimmune disease. In this study, we aimed to explore the cognitive impairment and the correlations with brain MRI. Methods. Twenty-five patients (mean age 55 ± 11.8 years, 21 females) with PSS were prospectively selected and tested with a French translation of the Brief Repeatable Battery for Neuropsychological Examination. The results were compared with the scores for 25 matched patients with multiple sclerosis (MS) and 25 controls. Brain lesions were assessed by brain MRI using the Wahlund classification. Results. Fifteen of the 25 PSS patients (60%) presented with cognitive disorders versus 19/25 MS patients (76%). Five patients had dementia in the PSS group. Speed of information processing, attention, immediate and long-term memory, and executive functions were frequently impaired. The mean duration of cognitive complaints was 5.6 ± 6.1 years, and the mean duration of PSS was 15.8 ± 14.0 years. A trend towards a correlation was found between the severity of cognitive impairment and the degree of white matter lesions (WML) (, rho = 0.43). Conclusion. Cognitive impairment—mild or dementia—exists in patients with PSS. Further MRI studies are needed to better understand the precise neural basis of cognitive impairment in PSS patients. Frederic Blanc, Nadine Longato, Barbara Jung, Catherine Kleitz, Laure Di Bitonto, Benjamin Cretin, Nicolas Collongues, Christelle Sordet, Marie Fleury, Vincent Poindron, Jacques-Eric Gottenberg, Olivier Anne, Dan Lipsker, Thierry Martin, Jean Sibilia, and Jérôme de Seze Copyright © 2013 Frederic Blanc et al. All rights reserved. Common Carotid Artery Occlusion: A Case Series Mon, 16 Sep 2013 14:19:14 +0000 Subjects and Methods. We analysed 5000 cerebrovascular ultrasound records. A total of 0.4% of the patients had common carotid artery occlusion (CCAO). Results. The mean age was years, and the male/female ratio was 2.33. The most frequent risk factors were hypertension, ischaemic heart disease, dyslipidemia, diabetes mellitus, and smoking. Right-sided and left-sided CCAO occurred in 65% and 30% of the cases, respectively, and bilateral occlusion was detected in one case (5%). Patent bifurcation was observed in 10 cases of CCAO in which the anterograde flow in the ICA was maintained from the external carotid artery with reversed flow. In two of the cases, the occluded CCA was hypoplastic. The aetiology of CCAO in the majority of cases was the atherosclerosis (15 cases). The male/female ratio was higher in the patients with occluded distal vessels, and the short-term outcome was poorer. Only two cases from this series underwent revascularisation surgery. Spontaneous recanalisation was observed in one case. Conclusions. The most frequent cause of CCAO was atherosclerosis. The outcome is improved in the cases with patent distal vessels, and spontaneous recanalisation is possible. Treatment methods have not been standardised. Surgical revascularisation is possible in cases of patent distal vessels, but the indications are debatable. Zoltán Bajkó, Rodica Bălaşa, Anca Moţăţăianu, Smaranda Maier, Octavia Claudia Chebuţ, and Szabolcs Szatmári Copyright © 2013 Zoltán Bajkó et al. All rights reserved.