Clinical Neurological Testing Research Articles

Evaluation of neurologic testing in guinea pigs (Cavia porcellus)

BackgroundUp-to-date, specialized literature provides very little information on performing and interpreting clinical neurological tests on small mammals, particularly guinea pigs. MethodsTwo clinical neurologists performed separate neurological examinations of 25 guinea pigs. The structure of the examination was similar to those performed in other companion animals and included hands-off examination, postural reaction tests, cranial nerve tests, and spinal reflex tests. Each test was evaluated for feasibility, reproducibility, and associated stress level for the animals. ResultsThe following tests revealed an excellent ability to elicit the expected response: hopping reaction in the thoracic limbs, wheelbarrowing and hemiwalking, medial and lateral palpebral reflex, auricular sensitivity, maxillary sensitivity, horizontal oculocephalic reflex, tone of the jaw, voluntary movement of the tongue, and direct pupillary light reflex. On the other hand, a poor ability to elicit the expected response was observed in the following tests: visual paw replacement of the thoracic limbs, tactile paw replacement in both thoracic and pelvic limbs, paper test for thoracic and pelvic limbs, mandibular sensitivity, vertical oculocephalic reflex, menace response, patellar reflex, cutaneous trunci reflex, and perineal reflex. The most reliable spinal reflex test with a good ability to elicit the expected response was the withdrawal reflex for both thoracic and pelvic limbs. The guinea pigs experienced the most stress during the spinal reflex tests. ConclusionIt is possible to apply several clinical neurological tests on guinea pigs and produce meaningful results. However, certain tests elicited high stress responses in the animals and should therefore only be used if necessary. Based on the results, we propose a possible protocol for neurological examination in guinea pigs. Clinical relevanceThis is the first study to evaluate a full range of clinical neurological tests performed on guinea pigs. The results of this study could lead to a better understanding of lesion localization and serve as a basis for further diagnostic and therapies in guinea pigs with neurological diseases.

Implementation of a 3‐Dimensional Embodied Conversational Agent to Support Neurologists in Conducting Cognitive Assessment in Alzheimer Patients

AbstractBackgroundAlzheimer’s disease is a universal medical and public health challenge. A timely identification of this ailment can enhance both the standard of care and the patient’s quality of life. Alzheimer’s diagnosis includes a critical component called cognitive assessment. These examinations have been carried out by neurologists, manually and digitally since the development of clinical neurological tests. But it’s obvious that integrating AI technologies into such assessments has many advantages. This research paper describes the implementation of a 3‐Dimensional Embodied Conversational Agent to support Neurologists in conducting cognitive assessments in Alzheimer patients.MethodTwenty‐two questions are included in the assessment. The assessment checks different mental abilities of patients such as time orientation, place orientation, ability to recall things, concentration skills, language skills, ability to follow written and oral instructions, visual interpretation skills, etc. A score is given for each correct answer. A normal score must be higher than 24. A score of 24 or less is typically seen as abnormal and indicative of possible cognitive impairment further subject to detailed analysis of a neurologist as the result may occasionally be impacted by certain physical impairments, language or speech barriers, education level, or cultural differences.The 3D agent was created using software such as Blender, iclone7, Adobe Photoshop, JavaScript, and MIT App Inventor. Text‐to‐speech synthesis algorithms were used to convert the questions to speech. The answers given by the user will be recognized using Natural Language Processing (NLP) algorithms. Correspondingly, a score will be awarded. TinyDB is used for local storage and CloudDB for web storage.ResultThe 3D agent receives the speech input, analyzes the input, and provides a vocal response. As per the total score, it will suggest suitable recommendations vocally. Also, an assessment report with the AI impression is generated.ConclusionThe implementation of a 3‐D Embodied Conversational Agent to support Neurologists in conducting cognitive assessment is portrayed in this research. Instead of trying to replace clinicians, Artificial Intelligence aims to help them and make their tasks simpler.

Cerebral microangiopathy according to magnetic resonance imaging of the brain in patients undergoing longterm programmed hemodialysis

Introduction. Cerebral microangiopathy (CMA), being the leading cause of vascular cognitive impairment and strokes, has a number of causes, among which chronic kidney disease (CKD) and programmed hemodialysis (HD) are the least studied.Purpose of the study: to determine the frequency of CMA neuroimaging markers and risk factors for its development in patients receiving renal replacement therapy for a long time using the programmed HD.Material and methods: the study involved 70 patients who had been on programmed HD for 10 months or more. Clinical neurological examination, laboratory tests and brain MRI were performed. The analysis of CMA neuroimaging markers was carried out in accordance with the STRIVE recommendations. Cerebral Small Vessel Disease Score (CSVDS) was used to quantify the overall severity of MR imaging markers of CMA.Results. Among 70 examined (29 men and 41 women) aged 53.0 ± 14.2 years, average HD experience – 70.0 ± 39.5 months, the main clinical manifestations of CMA were cognitive impairment (82.9%, n = 58), emotional disorders (61.4%, n = 43), sleep disorders (38.6%, n = 27), pseudobulbar syndrome (17.1%, n = 12), walking disorders (8.6%, n = 6), acute lacunar syndromes (7.1%, n = 5) and pelvic dysfunction (4.3%, n = 3). CMA neuroimaging markers of varying severity were found in 100% of cases. Expansion of perivascular spaces (100%, n = 70) and white matter hyperintensities (81.4%, n = 57) prevailed in the structure of CMA imaging markers. Cortical atrophy (67%, n = 47), cerebral microbleeds (47%, n = 33), asymptomatic lacunae (35.7%, n = 25) and minor subcortical infarctions (2.9%, n = 3) were less common. Mild CMA (1–2 points on the CSVDS scale) was determined in 38 patients (54.3%), severe CMA (3–4 points on the CSVDS scale) – in 32 patients (45.7%). The presence of uncontrolled arterial hypertension (OR 1.85, p < 0.05), intradialysis hypertension (OR 2.8, p < 0.05), dialysis vegetative polyneuropathies (OR 2.75, p < 0.05), type 2 diabetes mellitus (OR 5.7, p < 0.05) and the experience of programmed HD (more than 50 months) (OR 3.1, p < 0.05) were prognostic signifi cance for the development of severe CMA in dialysis patients.Conclusion. All patients with end-stage CKD who have been on programmed HD for a long time are shown to undergo the brain MRI in order to timely diagnose CMA imaging markers and possible correction of therapy.

Dynamics of clinical and neurological changes in patients with acute ischemic stroke in an open clinical study.

Background: Studies of treatment methods for patients with acute ischaemic stroke should include aetiological causes, concomitant pathology, and localisation of the lesion, and the extent of the lesion in the brain. The purpose of the study was to determine changes in clinical and neurological parameters in patients with ischaemic stroke in the acute period. Methods: This is an open clinical study for which 240 patients were selected with an acute condition after an ischaemic stroke. All patients were divided into 4 groups (depending on the treatment). Clinical neurological examination and testing was performed upon admission to the hospital and upon discharge– after treatment. Electroencephalographic biofeedback (EEG-BFB) therapy was performed using a EEG-BSE device (Bio-Link). Data was processed according to the statistical method of experimental data assessment. Results: To study the effectiveness of treatment upon acute ischaemic stroke, a comprehensive treatment system was developed, involving acupuncture, Qigong breathing exercises, and electroencephalographic biological feedback (EEG-BIOFEEDBACK), based mainly on the mechanisms of action. The study investigated the features of the acupuncture treatment in patients with ischaemic stroke during recovery. The authors noted the degree of effectiveness of EEG-BFB therapy, Qigong therapy, acupuncture, and standard treatment. Studies revealed that the development of ischaemic stroke begins gradually and at an early age. Conclusion: It was concluded that the most effective method for treating the clinical and neurological manifestations of acute ischaemic stroke is EEG-BFB therapy, followed by acupuncture, Qigong therapy, and standard treatment.

Neck-specific exercise for radiating pain and neurological deficits in chronic whiplash, a 1-year follow-up of a randomised clinical trial

Up to 90% of people with neurological deficits following whiplash injury report chronic symptoms. A recent unique study of neck-specific exercise showed positive results (post-intervention at 12 weeks), regarding arm pain and neurological deficits in people with chronic whiplash associated disorders (WAD). This 1-year follow-up of that randomised controlled study with assessor blinding aimed to examine whether neck-specific exercise with (NSEB) or without (NSE) a behavioural approach has long-term benefits over physical activity prescription (PPA) regarding arm pain and neurological deficits (n = 171). Interventions were: NSE, NSEB, or PPA. Follow-up of arm pain, paraesthesia bothersomeness (questionnaires) and clinical neurological tests were performed after 3, 6 and 12 months and analysed with Linear Mixed Models and General Estimating Equations. The NSE and/or NSEB groups reported significantly less pain and paraesthesia bothersomeness as well as higher odds of normal key muscle arm strength and of normal upper limb neural tension over the year (all p < 0.03), compared with PPA. In conclusion, results suggest that neck-specific exercise with or without a behavioural approach may have persisting long term benefits over PPA regarding arm pain and clinical signs associated with neurological deficits in chronic WAD.

Brain Magnetic Resonance Imaging and Angiography Findings in Ugandan Children with Sickle Cell Anemia; A Cross Sectional Study

Sickle Cell Anemia (SCA) is a leading cause of childhood stroke in sub-Saharan Africa and sickle cell brain vasculopathy manifests either as overt stroke or clinically “silent infarcts”. This study aimed to describe brain abnormalities seen on magnetic resonance imaging in Ugandan SCA children. Our hypothesis was that multi-model abnormalities would be associated with cerebrovasculopathy found on MRI/MRA.MethodsAs part of a larger study to determine the burden and spectrum of neurological and cognitive impairments in SCA children in Uganda, we selected 81 children ages 1-12 years with HbSS, a sample enriched for possible brain pathology from Mulago hospital SCA clinic out of a random sample of 265 stable children. None was receiving hydroxyurea. All had detailed clinical history, and physical, neurological and cognitive testing, trans-cranial Doppler (TCD) cerebral blood flow velocity determination and non-contrasted brain MRI/MRA using a 1.5 Tesla scanner. Cognitive testing was performed using age-specific tools validated for Ugandan children.ResultsOf the 81 participants imaged, 61 had one or more of history of stroke, an abnormal neurological exam, cognitive impairment or abnormal TCD, while 20 had normal test results. MR abnormalities were seen in 35/61 (63.9%) participants with probable brain pathology and in 4/20 (20.0%) without any probable brain pathology. They included different structural abnormalities seen in all brain regions ranging from only T2 weighted hyper-intensities, white matter lacuna infarction to bilateral ischemic and multi-focal cerebral infarcts with associated compensatory hydrocephalus. MRA abnormalities ranged from cerebral microangiopathy to multiple stenosis and occlusions of major arteries, including moya-moya in 4 subjects. Severe vessel obstructions were also seen in multiple young children <36 months.ConclusionsBrain injury in Uganda children with SCA begins early in childhood and becomes a common finding during later childhood. Early screening for stroke and intervention therapy is warranted to prevent sickle brain vasculopathy initiated early after diagnosis. The risk factors for such early brain injury should be investigated. DisclosuresNo relevant conflicts of interest to declare.

Neck-specific exercise may reduce radiating pain and signs of neurological deficits in chronic whiplash - Analyses of a randomized clinical trial

Up to 90% of people with neurological deficits following a whiplash injury do not recover and cervical muscle dysfunction is common. The aim of this multicentre, randomized controlled trial was to examine whether two versions of neck-specific exercise or prescription of physical activity (PPA) can improve radiating arm pain and clinical signs that can be associated with neurological deficits in people with chronic whiplash associated disorders (WAD). Participants with chronic WAD, arm symptoms and signs associated with neurological deficits (n = 171) were randomized to: 12 weeks of neck-specific exercise without (NSE) or with a behavioural approach (NSEB), or PPA. Pain/bothersomeness frequency, six measures of arm pain/paraesthesia (VAS scales), and four clinical neurological tests were evaluated after 3 months. The NSE group reported the lowest frequency and lowest levels of arm pain, the highest proportion of participants with at least 50% pain reduction and the highest proportion of normal arm muscle force. The NSEB group reported increased normal tendon reflexes. No improvements were recorded for the PPA group. Neck-specific exercise may improve arm pain and decrease signs of neurological deficits, but the addition of a behavioural approach does not seem to be of additional benefit.

Preliminary experience with a transcranial magnetic resonance-guided focused ultrasound surgery system integrated with a 1.5-T MRI unit in a series of patients with essential tremor and Parkinson's disease.

OBJECTIVE Transcranial magnetic resonance-guided focused ultrasound surgery (tcMRgFUS) is one of the emerging noninvasive technologies for the treatment of neurological disorders such as essential tremor (ET), idiopathic asymmetrical tremor-dominant Parkinson's disease (PD), and neuropathic pain. In this clinical series the authors present the preliminary results achieved with the world's first tcMRgFUS system integrated with a 1.5-T MRI unit. METHODS The authors describe the results of tcMRgFUS in a sample of patients with ET and with PD who underwent the procedure during the period from January 2015 to September 2017. A monolateral ventralis intermedius nucleus (VIM) thalamic ablation was performed in both ET and PD patients. In all the tcMRgFUS treatments, a 1.5-T MRI scanner was used for both planning and monitoring the procedure. RESULTS During the study period, a total of 26 patients underwent tcMRgFUS thalamic ablation for different movement disorders. Among these patients, 18 were diagnosed with ET and 4 were affected by PD. All patients with PD were treated using tcMRgFUS thalamic ablation and all completed the procedure. Among the 18 patients with ET, 13 successfully underwent tcMRgFUS, 4 aborted the procedure during ultrasound delivery, and 1 did not undergo the tcMRgFUS procedure after stereotactic frame placement. Two patients with ET were not included in the results because of the short follow-up duration at the time of this study. A monolateral VIM thalamic ablation in both ET and PD patients was performed. All the enrolled patients were evaluated before the treatment and 2 days after, with a clinical control of the treatment effectiveness using the graphic items of the Fahn-Tolosa-Marin tremor rating scale. A global reevaluation was performed 3 months (17/22 patients) and 6 months (11/22 patients) after the treatment; the reevaluation consisted of clinical questionnaires, neurological tests, and video recordings of the tests. All the ET and PD treated patients who completed the procedure showed an immediate amelioration of tremor severity, with no intra- or posttreatment severe permanent side effects. CONCLUSIONS Although this study reports on a small number of patients with a short follow-up duration, the tcMRgFUS procedure using a 1.5-T MRI unit resulted in a safe and effective treatment option for motor symptoms in patients with ET and PD. To the best of the authors' knowledge, this is the first clinical series in which thalamotomy was performed using tcMRgFUS integrated with a 1.5-T magnet.

Accuracy of clinical neurological examination in diagnosing lumbo-sacral radiculopathy: a systematic literature review

BackgroundLumbar radiculopathy remains a clinical challenge among primary care clinicians in both assessment and diagnosis. This often leads to misdiagnosis and inappropriate treatment of patients resulting in poor health outcomes, exacerbating this already debilitating condition. This review evaluated 12 primary diagnostic accuracy studies that specifically assessed the performance of various individual and grouped clinical neurological tests in detecting nerve root impingement, as established in the current literature.MethodsEight electronic data bases were searched for relevant articles from inception until July 2016. All primary diagnostic studies which investigated the accuracy of clinical neurological test (s) in diagnosing lumbar radiculopathy among patients with low back and referred leg symptoms were screened for inclusion. Qualifying studies were retrieved and independently assessed for methodological quality using the ‘Quality Assessment of Diagnostic tests Accuracy Studies’ criteria.ResultsA total of 12 studies which investigated standard components of clinical neurological examination of (sensory, motor, tendon reflex and neuro-dynamics) of the lumbo-sacral spine were included. The mean inter-observer agreement on quality assessment by two independent reviewers was fair (k = 0.3 – 0.7).The diagnostic performance of sensory testing using MR imaging as a reference standard demonstrated a sensitivity (confidence interval 95%) 0.61 (0.47-0.73) and a specificity of 0.63 (0.38-0.84). Motor tests sensitivity was poor to moderate, ranging from 0.13 (0.04-0.31) to 0.61 (0.36-0.83). Generally, the diagnostic performance of reflex testing was notably good with specificity ranging from (confidence interval 95%) 0.60 (0.51-0.69) to 0.93 (0.87-0.97) and sensitivity ranging from 0.14 (0.09-0.21) to 0.67 (0.21-0.94). Femoral nerve stretch test had a high sensitivity of (confidence interval 95%) 1.00 (0.40-1.00) and specificity of 0.83 (0.52-0.98) while SLR test recorded a mean sensitivity of 0.84 (0.72-0.92) and specificity of 0.78 (0.67-0.87).ConclusionsThere is a scarcity of studies on the diagnostic accuracy of clinical neurological examination testing. Furthermore there seem to be a disconnect among researchers regarding the diagnostic utility of lower limb neuro-dynamic tests which include the Straight Leg Raise and Femoral Nerve tests for sciatic and femoral nerve respectively. Whether these tests are able to detect the presence of disc herniation and subsequent nerve root compression or hyper-sensitivity of the sacral and femoral plexus due to mechanical irritation still remains debatable.

Proinflammatory Cytokines, Enolase and S-100 as Early Biochemical Indicators of Hypoxic-Ischemic Encephalopathy Following Perinatal Asphyxia in Newborns

Estimation of the neurological prognosis of infants suffering from perinatal asphyxia and signs of hypoxic-ischemic encephalopathy is of great clinical importance; however, it remains difficult to satisfactorily assess these signs with current standard medical practices. Prognoses are typically based on data obtained from clinical examinations and neurological tests, such as electroencephalography (EEG) and neuroimaging, but their sensitivities and specificities are far from optimal, and they do not always reliably predict future neurological sequelae. In an attempt to improve prognostic estimates, neurological research envisaged various biochemical markers detectable in the umbilical cord blood of newborns (NB). Few studies examining these biochemical factors in the whole blood of newborns exist. Thus, the aim of this study was to determine the expression and concentrations of proinflammatory cytokines (TNF-α, IL-1β and IL-6) and specific CNS enzymes (S-100 and enolase) in infants with perinatal asphyxia. These data were compared between the affected infants and controls and were related to the degree of HIE to determine their utilities as biochemical markers for early diagnosis and prognosis. The levels of the proinflammatory cytokines and enzymes were measured by enzyme-linked immunosorbent assay (ELISA) and Reverse Transcription polymerase chain reaction (RT-PCR). The expression and serum levels of the proinflammatory cytokines, enolase and S-100 were significantly increased in the children with asphyxia compared with the controls. The role of cytokines after hypoxic-ischemic insult has been determined in studies of transgenic mice that support the use of these molecules as candidate biomarkers. Similarly, S-100 and enolase are considered promising candidates because these markers have been correlated with tissue damage in different experimental models.

Validity of a Neurological Scoring System for Canine X-Linked Myotubular Myopathy.

A simple clinical neurological test was developed to evaluate response to gene therapy in a preclinical canine model of X-linked myotubular myopathy (XLMTM). This devastating congenital myopathy is caused by mutation in the myotubularin (MTM1) gene. Clinical signs include muscle weakness, early respiratory failure, and ventilator dependence. A spontaneously occurring canine model has a similar clinical picture and histological abnormalities on muscle biopsy compared with patients. We developed a neuromuscular assessment score, graded on a scale from 10 (normal) to 1 (unable to maintain sternal recumbency). We hypothesize that this neurological assessment score correlates with genotype and established measures of disease severity and is reliable when performed by an independent observer. At 17 weeks of age, there was strong correlation between neurological assessment scores and established methods of severity testing. The neurological severity score correctly differentiated between XLMTM and wild-type dogs with good interobserver reliability, on the basis of strong agreement between neurological scores assigned by independent observers. Together, these data indicate that the neurological scoring system developed for this canine congenital neuromuscular disorder is reliable and valid. This scoring system may be helpful in evaluating response to therapy in preclinical testing in this disease model, such as response to gene therapy.

Validity of a neurological scoring system for canine X-linked myotubular myopathy

A simple clinical neurological test was developed to evaluate response to gene therapy in a preclinical canine model of X-linked Myotubular Myopathy (XLMTM). This devastating congenital myopathy is caused by mutation in the myotubularin (MTM1) gene. Clinical signs include muscle weakness, early respiratory failure and ventilator dependence. A spontaneously occurring canine model has a similar clinical picture and histological abnormalities on muscle biopsy compared to patients. We developed a neuromuscular assessment score, graded on a scale from 10 (normal) to 1 (unable to maintain sternal recumbency). We hypothesize that this neurological assessment score correlates with genotype and established measures of disease severity and is reliable when performed by an independent observer. At 17 weeks of age, there was strong correlation between neurological assessment scores and established methods of severity testing. The neurological severity score correctly differentiated between XLMTM and wild type dogs with good interobserver reliability, on the basis of strong agreement between neurological scores assigned by independent observers. Together, these data indicate that the neurological scoring system developed for this canine congenital neuromuscular disorder is reliable and valid. This scoring system may be helpful in evaluating response to therapy in preclinical testing in this disease model, such as response to gene therapy.

Monomelic amyotrophy: a rare variant of lower motor neuron disorder (2 clinical cases)

Monomelic amyotrophy (MMA) is a rare variant of lower motor neuron disease with benign progression. The disease is characterized by muscular weakness and atrophy in the hand and forearm on one side or asymmetrical lesion of both upper limbs with the presence of cold paresis, fasciculations, and fine tremor of the fingers. Sensory disorders, pyramidal symptoms, and involvement of the leg muscles are not typical of it. The final diagnosis of MMA can be made only on the basis of clinical neurological and electrophysiological tests as well as long-term follow-up of the patient. Timely recommendations for correction of the movement pattern and prevention of flexion compression may slow down the disease progression in some cases and, thereby, improve the quality of life of patients. The article describes two clinical cases with a probable diagnosis of MMA.

Long-Term Neuropsychological and Cardiac Follow-Up of Children and Adults Who Were Antenatal Exposed to Radiotherapy

ABSTRACT Aim: The use of radiation in medical diagnostics and treatment is standard of care. Apart from deductions from atom bomb and nuclear plant disaster survivors, there are scarce data on the long-term outcome after antenatal exposure to medical radiation. We aimed to assess the general health, cardiac and neuropsychological outcome of children in utero exposed to radiotherapy. Methods: Women treated with radiotherapy during pregnancy were retro- and prospectively registered by the International Network on Cancer, Infertility and Pregnancy (INCIP). Children were assessed at 1.5, 3.0, 6.0 or 9.0 years of age, by echocardiography, a clinical neurological examination, cognitive tests and questionnaires regarding health and behavior. Adults were examined by echocardiography and questionnaires regarding health and behavior. Echocardiographic data were compared to an age- and gender-matched control group and neurocognitive data to test specific age-appropriate norms. Results: Sixteen children (median age: 6.0 years, range 1.5–9.6) and ten adults (median age: 33.0 years, range 22.0–49.0) antenatal exposed to radiotherapy from Belgium, The Netherlands and Italy were enrolled. Median maternal and estimated fetal irradiation were 48 Gy (range, 12–70) and 91 mGy (range, 0–1690), respectively. Conventional and advanced cardiac function measurements were normal. Overall neuropsychological, behavioral and general health outcomes were within normal ranges. No linear relationship was found between fetal dose of radiation and cognitive outcome. One child revealed a severe cognitive delay, however this child was exposed to a relatively low dose of radiotherapy (34 mGy) in addition to other confounding pregnancy complications. The mother suffered from an aggressive non-hodgkin tumor of the brain with impact on her general state (maternal somnolence, hemiplegia and intravenous nutrition) followed by preterm delivery. Conclusions: The overall long-term cardiac, neuropsychological, behavioral and general health outcomes after prenatal exposure to radiotherapy appear to be within normal ranges. Larger series are needed to strengthen these findings. Disclosure: All authors have declared no conflicts of interest.

Galvanic vestibular stimulation impairs cell proliferation and neurogenesis in the rat hippocampus but not spatial memory

Galvanic vestibular stimulation (GVS) is a method of activating the peripheral vestibular system using direct current that is widely employed in clinical neurological testing. Since movement is recognized to stimulate hippocampal neurogenesis and movement is impossible without activation of the vestibular system, we speculated that activating the vestibular system in rats while minimizing movement, by delivering GVS under anesthesia, would affect hippocampal cell proliferation and neurogenesis, and spatial memory. Compared with the sham control group, the number of cells incorporating the DNA replication marker, bromodeoxyuridine (BrdU), was significantly reduced in the bilateral hippocampi in both the cathode left-anode right and cathode right-anode left stimulation groups (P ≤ 0.0001). The majority of the BrdU(+ve) cells co-expressed Ki-67, a marker for the S phase of the cell cycle, suggesting that these BrdU(+ve) cells were still in the cell cycle; however, there was no significant difference in the degree of co-labeling between the two stimulation groups. Single labeling for doublecortin (DCX), a marker of immature neurons, showed that while there was no significant difference between the different groups in the number of DCX(+ve) cells in the right dentate gryus, in the left dentate gyrus there was a significant decrease in the cathode left-anode right group compared with the sham controls (P ≤ 0.03). Nonetheless, when animals were tested in place recognition, object exploration and Morris water maze tasks, there were no significant differences between the GVS groups and the sham controls. These results suggest that GVS can have striking effects on cell proliferation and possibly neurogenesis in the hippocampus, without affecting spatial memory.

Критерії обмеження життєдіяльності при віддалених наслідках закритої черепно-мозкової травми

On the basis of international classification of functioning, limitations of vital functions and health (MKF) were conducted inspections patients with the remote consequences of the closed craniocerebral trauma. All of patients passed a standard clinical neurological inspection and testing with a help MKF. It is well-proven that adaptation MKF allows to apply it at expert diagnostics, and also to estimate rehabilitation potential and efficiency of leadthrough of rehabilitation measures at patients with the remote consequences of the closed craniocerebral trauma.

A23 “(Organs) Wanted! But dead or alive?”

Background: The Academy of Royal Medical Colleges(ARMC) code for the diagnosis and confirmation of death1 includes criteria for determining irreversible cessation of brain-stem function diagnosed by clinical neurological testing. We report on the results of an audit conducted to assess what supplementary information clinicians provided when performing brain stem tests using the draft document provided in appendix 1 of the ARMC code of practice1. Methods: Retrospective study of 30 sets of patient case notes in our tertiary referral Neurosurgical Intensive Care unit was performed for the year 2010 - 2011. Any documentation made supplementary to the ARMC document to support the diagnosis of brain stem death was recorded. Results: 80% of records provided supplementary information to that on the form,. This was either as written text or printed arterial blood gas results. Discussion: The decision to proceed to organ donation is made on the basis of the neurological tests. This explains why clinicians feel it is incumbent on them to perform and document the tests rigorously. On the basis of this audit, a new proforma has been introduced for the confirmation of brain stem death in our hospital. This includes documentation of: mean arterial pressure; body temperature; electrolytes; and arterial blood gas results during the apnoea testing. This audit has therefore supported the introduction of a more comprehensive, ‘fit for purpose’ document for the determination of brain stem death in our institution. This is currently the subject of a repeat audit. References A Code of Practice for the Diagnosis and Confirmation of Death, Academy of Medical Royal Colleges, 2008 http://aomrc.org.uk/publications/reports-guidance.html (Accessed October 2011).

Importance of pain evaluation for more accurate diagnosis of painful diabetic polyneuropathy

Pain is a common problem in diabetic neuropathy, but relatively little has been published regarding the extent to which it needs to be addressed in clinical practice. To assess neuropathic pain profile and its association with quantitative sensory testing in painful diabetic polyneuropathy. Altogether, 61 consecutive diabetic inpatients with symmetric neuropathic complaints were enrolled. Clinical neurological examination and quantitative sensory testing (QST) were performed. Patients were interviewed using the Neuropathic Pain Scale (NPS) and filled in the McGill Pain Questionnaire (MPQ). Of all patients, 49 (80.3%) had clinical diabetic polyneuropathy. Only 17 of these patients complained of lower extremity pain on an initial interview, while 27 marked it in the MPQ. The intensity of deep and superficial pain did not differ, but patients rated deep pain as more unpleasant than superficial (6.27±2.37 vs. 4.30±1.42 on the NPS, P=0.034). Superficial pain NPS items tended to correlate with QST results, while deep pain items did not. Only female gender (OR=7.87) and lower glycosylated hemoglobin level (OR=0.65) were predictive of pain in case of diabetic neuropathy. Standard pain questionnaires were useful in identifying pain sufferers. At the same intensity, deep neuropathic pain was more unpleasant than superficial. Pain manifestation was associated with female gender and lower level of glycosylated hemoglobin.

Deutschsprachige Validierung des Vertigo Handicap Questionnaire (VHQ) anhand einer Patientenstichprobe mit vestibulärem und somatoformem Schwindel

The Vertigo Handicap Questionnaire (VHQ) by Yardley (1992) assesses physical and psychosocial impairments of vertigo or dizziness. Our study examines the structure, reliability, and aspects of validity of the German version of the VHQ. 98 vestibular vertigo syndromes vs. 90 patients with somatoform vertigo and dizziness were evaluated with the VHQ, symptom severity (VSS), distress (GSI), anxiety and depression (HADS), catastrophizing beliefs (ACQ), fear of body sensations (BSQ), and quality of life (SF-36). For diagnostic classification detailed clinical neurological, neuro-otological and psychosomatic testing were conducted. Principal components analysis identified two factors, which could be confirmed by confirmatory factor analyses: 'handicapped activity'(VHQ-ACT) and 'anxiety' (VHQ-ANX). The VHQ had good internal consistency (Cronbach's alpha: 0.92). Test-retest reliability was r = 0.80. We noted close relations between the VHQ, the VSS and measures of emotional distress as aspects of good construct validity. Together with the VSS, the VHQ completes a comprehensive diagnostic screening tool for vertigo or dizziness.

Outcomes Remain Ambivalent for Deep Brain Stimulation and Epilepsy

Deep Brain Stimulation in Patients with Refractory Temporal Lobe Epilepsy. Boon P, Vonck K, De Herdt V, Van Dycke A, Goethals M, Goossens L, Van Zandijcke M, De Smedt T, Dewaele I, Achten R, Wadman W, Dewaele F, Caemaert J, Van Roost D. Epilepsia 2007;48(8):1551–1560. PURPOSE: This pilot study prospectively evaluated the efficacy of long-term deep brain stimulation (DBS) in medial temporal lobe (MTL) structures in patients with MTL epilepsy. METHODS: Twelve consecutive patients with refractory MTL epilepsy were included in this study. The protocol included invasive video-EEG monitoring for ictal-onset localization and evaluation for subsequent stimulation of the ictal-onset zone. Side effects and changes in seizure frequency were carefully monitored. RESULTS: Ten of 12 patients underwent long-term MTL DBS. Two of 12 patients underwent selective amygdalohippocampectomy. After mean follow-up of 31 months (range, 12–52 months), one of 10 stimulated patients are seizure-free (&gt;1 year), one of 10 patients had a &gt;90% reduction in seizure frequency; five of 10 patients had a seizure-frequency reduction of ≥50%; two of 10 patients had a seizure-frequency reduction of 30–49%; and one of 10 patients was a nonresponder. None of the patients reported side effects. In one patient, MRI showed asymptomatic intracranial hemorrhages along the trajectory of the DBS electrodes. None of the patients showed changes in clinical neurological testing. Patients who underwent selective amygdalohippocampectomy are seizure-free (&gt;1 year), AEDs are unchanged, and no side effects have occurred. CONCLUSIONS: This open pilot study demonstrates the potential efficacy of long-term DBS in MTL structures that should now be further confirmed by multicenter randomized controlled trials.