Perceptual Disturbances Research Articles

Nursing Care: A Combination of Occupational Therapy and Psycho-Religious Therapy for Changes in Hallucination Symptoms in Schizophrenia Patients at Nur Ilahi Rehabilitation Clinic

Aims: Schizophrenia is a mental disorder that causes hallucinations, delusions, and highly disorganized thinking and behavior that impairs daily functioning, and can be disabling. 90% of people with schizophrenia have hallucinations. This study aimed to determine the effectiveness of occupational therapy and psychoreligious therapy in reducing hallucinations. Objective: This study was to determine the effectiveness of occupational therapy and psychoreligious therapy in reducing hallucinations. Methode : This study used a case study with a nursing care approach that includes assessment to evaluation. Patients with auditory hallucinations were given occupational therapy to shift focus and psycho-religious therapy to provide relaxation for hallucinatory patients. This therapy was given for 10 days with a total of 5 meetings. Results: Problems with sensory perceptual disturbances: reduced auditory hallucinations. Patient get a combination of occupational therapy and psycho-religious therapy which shows changes in behavior such as clients being able to control hallucinations and taking part in activities held by the clinic. This can be seen from the client being able to control his hallucinations, the frequency of hallucinations is reduced, and the client regularly participates in activities held by the clinic. Conclusion: Occupational therapy and psycho-religious therapy can be used for patients with hallucinatory disorders. Therapy is only carried out for 10 days to the patient. so the recommendation for further research is the need to analyze the effectiveness of occupational therapy and psycho-religious therapy to reduce the symptoms of auditory hallucinations. Nursing Implications: This research was conducted to become a basis for nurses in carrying out nursing interventions in patients with sensory perception disorders: auditory hallucinations and can be a guideline for health facilities to make policies regarding interventions for clients with auditory hallucinations.

Autoimmune Encephalitis a Differential Diagnosis of Auditory Hallucination: A Case Report

Anti-N-Methyl-D-Aspartate Receptor (anti-NMDAR) has been the first specific-antibody type to be associated with Autoimmune Encephalitis [1]. Autoimmune encephalitis is associated with the neuropsychiatric symptoms including abrupt personality changes, cognitive decline, memory loss, perceptual disturbances among many others. Initial presentation might range from agitation, psychosis, and changes in speech, hallucinations, involuntary motor movements and autonomic dysfunction [2]. In general adult population are found to have higher association with paraneoplastic conditions and specific antibodies, but the pediatric age group do not show the strong association making the diagnosis a difficulty [3]. Also unlike adults association with cancer is also found to be less likely [4]. Due to these complications cases of autoimmune encephalitis are usually missed in pediatric population when focusing more on the psychiatric symptoms. Here we present a case of 14 year old boy who had a similar presentation.

Loose ends in the differential diagnosis of IBS-like symptoms.

Two thirds of the patients we believed to have IBS in the 1970's have since been possible to diagnose with treatable conditions like bile acid diarrhea, inflammatory bowel disease, microscopic colitis, celiac disease, disaccharide malabsorption, exocrine pancreatic insufficiency, or rare genetic variants. Despite advances in diagnostic techniques a substantial proportion of patients continue suffering from IBS-like symptoms that cannot be explained by current knowledge. Although it is likely that further research will reveal small but important subgroups of patients with treatable mechanisms for IBS-like symptoms, we propose that only two large groups remain for being addressed in the clinic: those with connective tissue disorders such as Ehlers-Danlos syndrome or hypermobility spectrum disorders and those with autism spectrum disorders. Patients with connective tissue disorders exhibit identifiable disturbances of gut motor function and possibly increased gut permeability as underlying mechanisms for IBS-like symptoms. Autism spectrum disorders pose a much more difficult problem in the clinic. Disturbances of perception combined with anxiety and excessive worry about signals from the gut can lead to an endless but futile search for something being wrong. The search can involve large numbers of care givers, no one understanding the patient's suffering. Others may try to change their diet to lessen symptoms, only to find that almost all foods may cause worrying perceptions from the gut. Early recognition of autism spectrum disorders is essential for finding better ways to help patients with gastrointestinal and, as is often the case, extraintestinal symptoms.

Virtual embodiment in fibromyalgia

Chronic pain alters the experience of owning a body and leads to disturbances in bodily perception. We tested whether women with fibromyalgia (FM) are receptive to bodily illusions of owning a visible and progressively invisible body in immersive virtual reality (VR), and what modulates this experience. Twenty patients participated in two experimental sessions; each session included two conditions in a counterbalanced order. We found that patients with FM could indeed experience virtual embodiment. Sentiment analysis revealed significantly more positive reactions to the progressively invisible body, yet twice as many patients declared they preferred the illusion of a visible virtual body. A linear mixed model revealed that the strength of embodiment was positively associated with body perception disturbances and negatively associated with FM symptoms intensity. No effect of pain during the VR experience nor interoception awareness on embodiment was found. The results indicated that patients with FM are receptive to virtual bodily illusions and that the impact of the embodiment depends on affective reactions, the level of cognitive body distortions, and the intensity of symptoms. Importantly, there is a large variation among patients which should be considered in future VR-based interventions.

Data-driven categorization of postoperative delirium symptoms using unsupervised machine learning.

Phenotyping analysis that includes time course is useful for understanding the mechanisms and clinical management of postoperative delirium. However, postoperative delirium has not been fully phenotyped. Hypothesis-free categorization of heterogeneous symptoms may be useful for understanding the mechanisms underlying delirium, although evidence is currently lacking. Therefore, we aimed to explore the phenotypes of postoperative delirium following invasive cancer surgery using a data-driven approach with minimal prior knowledge. We recruited patients who underwent elective invasive cancer resection. After surgery, participants completed 5 consecutive days of delirium assessments using the Delirium Rating Scale-Revised-98 (DRS-R-98) severity scale. We categorized 65 (13 questionnaire items/day × 5 days) dimensional DRS-R-98 scores using unsupervised machine learning (K-means clustering) to derive a small set of grouped features representing distinct symptoms across all participants. We then reapplied K-means clustering to this set of grouped features to delineate multiple clusters of delirium symptoms. Participants were 286 patients, of whom 91 developed delirium defined according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria. Following the first K-means clustering, we derived four grouped symptom features: (1) mixed motor, (2) cognitive and higher-order thinking domain with perceptual disturbance and thought content abnormalities, (3) acute and temporal response, and (4) sleep-wake cycle disturbance. Subsequent K-means clustering permitted classification of participants into seven subgroups: (i) cognitive and higher-order thinking domain dominant delirium, (ii) prolonged delirium, (iii) acute and brief delirium, (iv) subsyndromal delirium-enriched, (v) subsyndromal delirium-enriched with insomnia, (vi) insomnia, and (vii) fit. We found that patients who have undergone invasive cancer resection can be delineated using unsupervised machine learning into three delirium clusters, two subsyndromal delirium clusters, and an insomnia cluster. Validation of clusters and research into the pathophysiology underlying each cluster will help to elucidate the mechanisms of postoperative delirium after invasive cancer surgery.

Effects of Hallucination Proneness and Sensory Resolution on Prior Biases in Human Perceptual Inference of Time Intervals.

Bayesian models of perception posit that percepts result from the optimal integration of new sensory information and prior expectations. In turn, prominent models of perceptual disturbances in psychosis frame hallucination-like phenomena as percepts excessively biased toward perceptual prior expectations. Despite mounting support for this notion, whether this hallucination-related prior bias results secondarily from imprecise sensory representations at early processing stages or directly from alterations in perceptual priors-both suggested candidates potentially consistent with Bayesian models-remains to be tested. Using modified interval timing paradigms designed to arbitrate between these alternative hypotheses, we show in human participants (16 females and 24 males) from a nonclinical population that hallucination proneness correlates with a circumscribed form of prior bias that reflects selective differences in weighting of contextual prior variance, a prior bias that is unrelated to the effect of sensory noise and to a separate index of sensory resolution. Our results thus suggest distinct mechanisms underlying prior biases in perceptual inference and favor the notion that hallucination proneness could reflect direct alterations in the representation or use of perceptual priors independent of sensory noise.SIGNIFICANCE STATEMENT Current theories of psychosis posit that hallucination proneness results from excessive influence of prior expectations on perception. It is not clear whether this prior bias represents a primary top-down process related to the representation or use of prior beliefs or instead a secondary bottom-up process stemming from imprecise sensory representations at early processing stages. To address this question, we examined interval timing behaviors captured by Bayesian perceptual-inference models. Our data support the notion that excessive influence of prior expectations associated with hallucination propensity is not directly secondary to sensory imprecision and is instead more consistent with a primary top-down process. These results help refine computational theories of psychosis and may contribute to the development of improved intervention targets.

Deficient Audiovisual Speech Perception in Schizophrenia: An ERP Study.

In everyday verbal communication, auditory speech perception is often disturbed by background noise. Especially in disadvantageous hearing conditions, additional visual articulatory information (e.g., lip movement) can positively contribute to speech comprehension. Patients with schizophrenia (SZs) demonstrate an aberrant ability to integrate visual and auditory sensory input during speech perception. Current findings about underlying neural mechanisms of this deficit are inconsistent. Particularly and despite the importance of early sensory processing in speech perception, very few studies have addressed these processes in SZs. Thus, in the present study, we examined 20 adult subjects with SZ and 21 healthy controls (HCs) while presenting audiovisual spoken words (disyllabic nouns) either superimposed by white noise (-12 dB signal-to-noise ratio) or not. In addition to behavioral data, event-related brain potentials (ERPs) were recorded. Our results demonstrate reduced speech comprehension for SZs compared to HCs under noisy conditions. Moreover, we found altered N1 amplitudes in SZ during speech perception, while P2 amplitudes and the N1-P2 complex were similar to HCs, indicating that there may be disturbances in multimodal speech perception at an early stage of processing, which may be due to deficits in auditory speech perception. Moreover, a positive relationship between fronto-central N1 amplitudes and the positive subscale of the Positive and Negative Syndrome Scale (PANSS) has been observed.

Slowed alpha oscillations and percept formation in psychotic psychopathology.

Psychosis is in part defined by disturbances in perception. Recent investigations have implicated the speed of alpha oscillations observed in brain electrical activity as reflective of a sampling rate of the visual environment and perception. Although both slowed alpha oscillations and aberrant percept formation are evident in disorders of psychotic psychopathology such as schizophrenia it is unclear whether slow alpha accounts for abnormal visual perception in these disorders. To examine the role of the speed of alpha oscillations in perception in psychotic psychopathology we gathered resting-state magneto-encephalography data from probands with psychotic psychopathology (i.e., schizophrenia, schizoaffective disorder, and bipolar disorder with a history of psychosis), their biological siblings, and healthy controls. We appraised visual perceptual function without the confound of cognitive ability and effort through the use of a simple binocular rivalry task. We found a slowed pace of alpha oscillations in psychotic psychopathology that was associated with longer percept durations during binocular rivalry, consistent with the assertion that occipital alpha oscillations govern the rate of accumulation of visual information used to generate percepts. Alpha speed varied widely across individuals with psychotic psychopathology and was highly stable across several months indicating that it is likely a trait characteristic of neural function that is relevant to visual perception. Finally, a lower speed of alpha oscillation was associated with a lower IQ and greater disorder symptomatology implying that the effects of the endogenous neural oscillation on visual perception may have wider consequences for everyday functioning. Slowed alpha oscillations in individuals with psychotic psychopathology appear to reflect altered neural functions related to percept formation.

IMPAIRED VERTICALITY PERCEPTION AND POSTURAL BALANCE AT 1 MONTH AFTER HEMISPHERIC STROKE

Introduction. In some patients with hemispheric strokes the internal model of verticality is shifted to the opposite side, so patients actively tilt the body axis in the opposite direction from the affected hemisphere. Disturbances of verticality perception are associated with worse functional conditions and slower dynamics of their recovery, with the need for longer rehabilitation treatment, etc. Objective: to investigate the relationships between impaired perception of verticality and indicators of postural balance during the 1st month after hemispheric strokes. Material and methods. There were examined 205 patients with hemispheric strokes that occurred during the last month. The Scale for Contraversive Pushing was used to assess the orientation of the body axis in relation to the force of gravity in the frontal plane. For evaluating of static and dynamic balance we used Berg Balance Scale, Postural Assessment Scale for Stroke, Trunk Impairment Scale, Test Timed Up and Go. Results. Depending on the presence (absence) of verticality perception disorders it had been revealed significant differences in postural balance scales and tests. Severity of verticality perception impairment was associated with significant changes in postural balance: patients with pushing syndrome had reliably worse indicators of postural balance compared to patients with lateropulsion. Moreover, even minimal lateropulsion was associated with significant deterioration of postural balance indicators, compared to normal perception of verticality. In addition, increasing severity of lateropulsion was associated with significant deterioration of postural balance indicators, regardless of spatial hemineglect and hemiparesis severity. Conclusions. 1. Impaired verticality perception in the recovery period of hemispheric strokes was associated with reliable negative changes in postural balance status. 2. Increasing severity of verticality perception disorders corresponded to a reliable deterioration of postural balance indicators.

Cathepsin S Upregulation Measured in the Peripheral Blood Mononuclear Cells Prior to Surgery Points to Postoperative Pain Development in Patients with Hip Osteoarthritis.

Disability caused by hip osteoarthritis has increased due to population aging, obesity, and lifestyle behaviors. Joint failure after conservative therapies results in total hip replacement, which is considered to be one of the most successful interventions. However, some patients experience long-term postoperative pain. Presently, there are no reliable clinical biomarkers for the prognosis of postoperative pain prior to surgery. Molecular biomarkers can be considered as intrinsic indicators of pathological processes and as links between clinical status and disease pathology, while recent innovative and sensitive approaches such as RT-PCR have extended the prognostic value of clinical traits. In light of this, we examined the importance of cathepsin S and proinflammatory cytokine gene expression in peripheral blood in addition to the clinical traits of patients with end-stage hip osteoarthritis (HOA) to predict postoperative pain development prior to surgery. This study included 31 patients with radiographic Kellgren and Lawrence grade III-IV HOA who underwent total hip arthroplasty (THA) and 26 healthy volunteers. Before surgery, a visual analog scale (VAS), DN4, PainDETECT, and the Western Ontario and McMaster Universities osteoarthritis index scores were used for pain and function assessment. Three and six months post-surgery, VAS pain scores of 30 mm and higher were reported. The intracellular protein levels of cathepsin S were measured using ELISA. The expression of the cathepsin S, tumor necrosis factor α, interleukin-1β, and cyclooxygenase-2 genes in peripheral blood mononuclear cells (PBMCs) was assessed using quantitative real-time RT-PCR. Pain persisted in 12 (38.7%) patients after THA. Patients who developed postoperative pain demonstrated significantly higher cathepsin S gene expression in the PBMCs and higher rates of neuropathic pain based on the DN4 testing compared to the other HOA subjects that were examined. No significant differences in proinflammatory cytokine gene expression were noted in either patient cohort prior to THA. The development of postoperative pain in patients with hip osteoarthritis might be associated with disturbances in pain perception, while increased expression of cathepsin S in the peripheral blood prior to surgery may serve as its prognostic biomarker and could be used in clinical settings to improve medical service for patients with end-stage hip OA.

A pre experimental study to evaluate the effectiveness of structured teaching programme regarding management of dementia among geriatric care givers

Dementia is a chronic progressive debilitating disease that is largely a disorder of old age. It is characterized by widespread impairment of mental functioning, progressive memory loss, language difficulties, confusion and disorientation. These impairments are often accompanied by behavioral and psychological disturbance. The behavioral disturbances associated with dementia are defined as symptoms of disturbed perception, altered thought content, mood and Behavior. A pre-experimental research design with one group pre-test and post-test design was adopted. Sixty samples of geriatric care givers were selected from Chhatauna and Mandir Hausad, Arrang, Raipur, (C.G.). Samples were using by convenient sampling technique. A self structured knowledge questionnaire was prepared as a tool to assess socio demographic variables, and knowledge of geriatric care givers regarding management of dementia. Collected data was analyzed using paired „ z‟- test and chi-square test. : In the pretest 38 (63.33%) are having poor knowledge,22 (36.66%) are having Average knowledge and no one had good Knowledge. After administration of structured teaching programmein the post test level of knowledge has improved in 34 (56.66%) are having average Knowledge and26 (43.33%) are having good knowledge and no one had poor knowledge. Hence it can be interpreted that in the pretest majority of the geriatric care giver were in the poor category and after structured teaching programme the geriatric care giver gained adequate knowledge regarding management of dementia of the subject were in the good category. In the pre test the calculated mean is 9 the mean score 30% the standard deviation is 3.86 and in the post test the calculated mean is 20.5, the mean score 66.83% and the standard deviation is 5.27, hence it can be interpreted that there is a striking difference between the mean pretest and post test knowledge score of geriatric care giver which explains that the structured teaching programme was effective in enhancing the knowledge score regarding management of dementia among geriatric care givers in selected area of Raipur, Chhattisgarh. Hence, it can conclude that the structured teaching programme was highly effective. And they gain knowledge i.e 36.83% using„ z‟ test it was found that at 0.05 level of significance the table value is 2.00 and the calculated value is 7.81(p>0.05) which shows that the calculated value is higher than the table value, so the test was highly Significant at 0.05 level. Research hypothesis (H) was accepted. Findings of the study indicates significant difference in the knowledge level after administration of Structured teaching Prgramme regarding Management of Dementia among Geriatric care Givers in Selected Area of Raipur, Chhattisgarh.

Adaptation of the Game Transfer Phenomena Scale into Spanish: Sensory-Perceptual Changes, Intrusive Thoughts, and Involuntary Behaviors in Mexican Video Game Players

Introduction: research on game transfer phenomena (GTP) is focused on understanding the impact of video game features and experiences on sensory perception, thoughts, and behaviors rather than on excessive/uncontrollable playing regardless of negative consequences. However, studies have shown a relationship between GTP and gaming disorder, and there is a resemblance between some forms of GTP and the perceptual disturbances that result as side effects of hallucinogens. Video game players have reported experiencing sensory perception changes (e.g., perceptual distortions of objects or environments and visual, auditory, or tactile hallucinations from games), intrusive thoughts, involuntary actions, and behaviors (e.g., the movement of fingers when interacting with game elements or a keyboard) . Objective: first, to adapt and validate the Game Transfer Phenomena Scale (GTPS) in Spanish with a Mexican sample. Second, to examine the adequacy of the frequency rating scale used in the GTPS. Method: cross-sectional survey with 607 players; most were males between 18 and 27 years old. Results: the higher-order factor model showed acceptable results. The prevalence of GTP was 96%. The number of game genres played and session length was correlated with all GTPS subscales, confirming the criterion validity. The examination of the frequency rating scale via the item response theory showed that selecting the second level of the scale “once” should be treated with caution. Discussion and conclusions: confirmatory factor analysis showed that the GTPS adapted into Spanish and tested in the Mexican sample was valid and reliable. Experiencing GTP more than once may be more meaningful for establishing the prevalence of GTP.

Role of Ayurvedic Herbs and Panchakarma Procedures in the Management of Cerebral Palsy

Cerebral palsy is a common chronic motor disability prevalent among pediatric population. It describes a group of permanent disorders of movement and posture causing activity limitation that attributed to non-progressive disturbances of sensation, perception, cognition, communication, and behavior as well as by epilepsy and secondary musculoskeletal problems. Cerebral palsy is not a contagious disease. At present treatment modalities are either very costly or employ very complicated procedures like baclofen pump implantation, botulinum toxin injection, selective posterior rhizotomy which have their own limitations. Recent studies prove that Ayurvedic treatment modality through its principals can repair damaged neurons and stimulation for forming new synapses for better functional recovery in Cerebral palsy affected children. This paper review number of research on certain herbs and Panchkarma procedures that found very effective in the management of cerebral palsy

Role of Ayurvedic Herbs and Panchakarma Procedures in the Management of Cerebral Palsy

Cerebral palsy is a common chronic motor disability prevalent among pediatric population. It describes a group of permanent disorders of movement and posture causing activity limitation that attributed to non-progressive disturbances of sensation, perception, cognition, communication, and behavior as well as by epilepsy and secondary musculoskeletal problems. Cerebral palsy is not a contagious disease. At present treatment modalities are either very costly or employ very complicated procedures like baclofen pump implantation, botulinum toxin injection, selective posterior rhizotomy which have their own limitations. Recent studies prove that Ayurvedic treatment modality through its principals can repair damaged neurons and stimulation for forming new synapses for better functional recovery in Cerebral palsy affected children. This paper review number of research on certain herbs and Panchkarma procedures that found very effective in the management of cerebral palsy.

Vertiginous dizziness: A primary care approach

Dizziness is an extremely common, yet complex neurological symptom that reflects a disturbance of normal balance perception and spatial orientation. Dizziness is a non-specific, catch-all term commonly used by patients to describe a wide array of symptoms, including a sensation of motion, weakness, light-headedness, unsteadiness, emotional upset and depression. The national 1-year prevalence of dizziness is around 50%, accounting for 4% of emergency department presentations and 1% of primary care consultations in South Africa. This article will focus on a diagnostic approach to the most common cause of dizziness (vertigo).

Attenuated psychotic symptoms, substance use and self-reported PTSD in adolescence

ABSTRACT Background: The occurrence of attenuated psychotic symptoms (APS) is a major concern in populations with substance use disorders (SUDs). However, APS also frequently develop in the course of Post-Traumatic Stress Disorder (PTSD). This study explores how the prevalence of APS differs between adolescent patients with only SUD, SUD with a history of traumatic experiences (TEs), and with SUD and self-reported PTSD. Methods: We recruited n = 120 treatment-seeking adolescents at a German outpatient clinic for adolescents with SUD. All participants filled out questionnaires assessing APS (PQ-16, YSR schizoid scale), trauma history, PTSD symptoms (both UCLA PTSD Index), and SUD severity (DUDIT) next to an extensive substance use interview. We performed a multivariate analysis of co-variance with the four PQ-16 scales and the YSR scale as outcomes and PTSD status as predictor. Additionally, we performed five linear regressions predicting each PQ-16 score and YSR score based on tobacco, alcohol, cannabis, ecstasy, amphetamine, and methamphetamine use. Results: Participants with co-occurring SUD and self-reported PTSD showed significantly higher APS prevalence rates (PQ-16 score, p = .00002), more disturbed thought content (p = .000004), more perceptual disturbances (p = .002), more negative symptoms (p = .004) and more thought problems (p = .001) compared to adolescents with SUD and a history of trauma and adolescents with only SUD. Past-year substance use was not predictive for APS prevalence (F(75) = 0.42; p = .86; R 2 = .04). Conclusion: Our data suggests that the occurrence of APS in adolescents with SUD is better explained by co-occurring self-reported PTSD than by substance use frequency or substance class. This finding might indicate that APS might be reduced through treating PTSD or focusing on TEs in SUD therapy.

To treat or not to treat? High-potency benzodiazepine use in a case of comorbid hallucinogen persisting perception disorder and alcohol use disorder.

Hallucinogen persisting perception disorder (HPPD) is characterized by visual disturbances that resemble psychedelic intoxication and linger after use has ceased. The most common substances precipitating HPPD, lysergic acid diethylamide (LSD) and psilocybin, are posited to do so via damage to serotonergic neurons involved in vision. Mr. N is a 37-year-old with a history of alcohol, cannabis, LSD, cocaine, and nicotine use disorders who described visual distortions that resolved when he drank heavily or received benzodiazepines for withdrawal. He did not appear psychotic. Over 20 years after his last LSD use, he continued to experience illusions of halos around objects, moving walls, and figures appearing cartoonish. He understood that his perceptual disturbances were not reality based. During hospitalization for suicidal ideation, laboratory tests, head computed tomography (CT), and electroencephalogram (EEG) studies offered no explanation for his visual disturbances other than HPPD. The visual distortions remitted with scheduled clonazepam treatment, although chemical dependency treatment programs were hesitant to accept him while on a benzodiazepine. This case emphasizes the importance of diagnostic clarification when patients present with perceptual disturbances that do not fit typical psychotic presentations. Our discussion will distinguish misperceptions from hallucinations and review the pathophysiology of HPPD. Last, we will discuss management strategies for patients with co-occurring HPPD and substance use disorders. It is necessary to discern the correct cause of visual disturbances in order to provide proper treatment. The risks and benefits of long-term benzodiazepine use must be weighed when deciding whether to prescribe them for patients with comorbid HPPD and alcohol use disorder. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Oculomotor Impairments in Children After Posterior Fossa Tumors Treatment.

Posterior fossa tumors (PFT) are the most common pediatric brain tumors, and the study of the somatic and cognitive status of PFT survivors still remains a critical problem. Since cerebellar damage can affect eye movement centers located in the vermis and hemispheres, such patients suffer from disturbances in visual perception, visual-spatial functions, reading, etc. Our investigation aimed at describing oculomotor impairments in PFT survivors linked to core oculomotor functions assessed through eye tracking method: gaze holding, reflexive saccades, and organization of voluntary saccades and their dependency on age at tumor diagnosis. Also, we investigated the relationship between oculomotor functions and ataxia measured with International Cooperative Ataxia Rating Scale (ICARS). A total of 110 children (patients and age-matched healthy controls, aged 9-17 years old) participated in the study. We found that the earlier the child had a tumor, the more impaired gaze holding (p = 0.0031) and fewer isometric saccades (p = 0.035) were observed at the time of examination. The above-mentioned functions in healthy controls improved with age. Visual scanning was also impaired compared to controls but was not related to age at diagnosis. A positive correlation between ICARS scores and number of hypermetric saccades (r = 0.309, p = 0.039), but no correlation with the number of hypometric saccades (r = - 0.008, p = 0.956). Furthermore, number of hypometric saccades did not differ between patients and controls (p = 0.238). Thus, primarily hypermetric saccades can be considered a prominent oculomotor symptom of cerebellar tumors. Our study provides basis for new methods of PFT diagnosis and rehabilitation procedure evaluation, both playing essential roles in modern pediatric neurooncology.

Central sensitization in CRPS patients with widespread pain: a cross-sectional study.

Widespread pain hypersensitivity and enhanced temporal summation of pain (TSP) are commonly reported in patients with complex regional pain syndrome (CRPS) and discussed as proxies for central sensitization. This study aimed to directly relate such signs of neuronal hyperexcitability to the pain phenotype of CRPS patients. Twenty-one CRPS patients and 20 healthy controls (HC) were recruited. The pain phenotype including spatial pain extent (assessed in % body surface) and intensity were assessed and related to widespread pain hypersensitivity, TSP, and psychological factors. Quantitative sensory testing (QST) was performed in the affected, the contralateral and a remote (control) area. CRPS patients showed decreased pressure pain thresholds in all tested areas (affected: t(34) = 4.98, P < .001, contralateral: t(35) = 3.19, P = .005, control: t(31) = 2.65, P = .012). Additionally, patients showed increased TSP in the affected area (F(3,111) = 4.57, P = .009) compared to HC. TSP was even more enhanced in patients with a high compared to a low spatial pain extent (F(3,51) = 5.67, P = .008), suggesting pronounced spinal sensitization in patients with extended pain patterns. Furthermore, the spatial pain extent positively correlated with the Bath Body Perception Disturbance Scale (ρ = 0.491; P = .048). Overall, we provide evidence that the pain phenotype in CRPS, that is, spatial pain extent, might be related to sensitization mechanism within the central nociceptive system. This study points towards central neuronal excitability as a potential therapeutic target in patients with more widespread CRPS.

Thalamocortical disconnection involved in pusher syndrome.

The presence of both isolated thalamic and isolated cortical lesions have been reported in the context of pusher syndrome-a disorder characterized by a disturbed perception of one's own upright body posture, following unilateral left- or right-sided stroke. In recent times, indirect quantification of functional and structural disconnection increases the knowledge derived from focal brain lesions by inferring subsequent brain network damage from the respective lesion. We applied both measures to a sample of 124 stroke patients to investigate brain disconnection in pusher syndrome. Our results suggest a hub-like function of the posterior and lateral portions of the thalamus in the perception of one's own postural upright. Lesion network symptom mapping investigating functional disconnection indicated cortical diaschisis in cerebellar, frontal, parietal and temporal areas in patients with thalamic lesions suffering from pusher syndrome, but there was no evidence for functional diaschisis in pusher patients with cortical stroke and no evidence for the convergence of thalamic and cortical lesions onto a common functional network. Structural disconnection mapping identified posterior thalamic disconnection to temporal, pre-, post- and paracentral regions. Fibre tracking between the thalamic and cortical pusher lesion hotspots indicated that in cortical lesions of patients with pusher syndrome, it is disconnectivity to the posterior thalamus caused by accompanying white matter damage, rather than the direct cortical lesions themselves, that lead to the emergence of pusher syndrome. Our analyses thus offer the first evidence for a direct thalamo-cortical (or cortico-thalamic) interconnection and, more importantly, shed light on the location of the respective thalamo-cortical disconnections. Pusher syndrome seems to be a consequence of direct damage or of disconnection of the posterior thalamus.