Disorders Of Motor Function Research Articles

Clinical characteristics of motor functional neurological disorder manifesting as limb weakness after vaccination against coronavirus disease 2019: A case series

BackgroundThe characteristics of functional limb weakness (FLW) as one of the manifestations of functional neurological disorder after vaccination against coronavirus disease 2019 (COVID-19) remain controversial. MethodsIn this descriptive case series, we aimed to elucidate the characteristics of Japanese patients with FLW who claimed muscle weakness after COVID-19 vaccination among patients who visited our outpatient clinic between 1 June 2021 and 31 December 2022. ResultsNine patients were diagnosed with FLW (mean age: 30.8 years), including two men and seven women. Seven patients were vaccinated with the BioNTech/Pfizer vaccine and two with the mRNA-1273 Moderna vaccine. All patients demonstrated various positive signs for FLW. Magnetic resonance imaging or computed tomography indicated no abnormality that could explain their symptoms. At the time of the clinic visit, five patients were treated for psychiatric disorders, including depression, insomnia, attention-deficit hyperactivity disorder, and Asperger's syndrome. Muscle weakness spread to the limbs beyond the vaccinated arm in seven patients. ConclusionsWe describe the basic characteristics of FLW in Japanese patients after COVID-19 vaccination. Further recognition of these characteristics could aid the diagnosis of FLW by physicians allowing them to support these patients effectively.

Feasibility and safety study of wearable cyborg Hybrid Assistive Limb for pediatric patients with cerebral palsy and spinal cord disorders.

The wearable cyborg Hybrid Assistive Limb (HAL) is the world's first cyborg-type wearable robotic device, and it assists the user's voluntary movements and facilitates muscle activities. However, since the minimum height required for using the HAL is 150 cm, a smaller HAL (2S size) has been newly developed for pediatric use. This study aimed to (1) examine the feasibility and safety of a protocol for treatments with HAL (2S size) in pediatric patients and (2) explore the optimal method for assessing the efficacy of HAL. This clinical study included seven pediatric patients with postural and motor function disorders, who received 8-12 sessions of smaller HAL (2S size) treatment. The primary outcome was the Gross Motor Function Measure-88 (GMFM-88). The secondary outcomes were GMFM-66, 10-m walk test, 2- and 6-min walking distances, Canadian Occupational Performance Measure (COPM), a post-treatment questionnaire, adverse events, and device failures. Statistical analyses were performed using the paired samples t-test or Wilcoxon signed-rank test. All participants completed the study protocol with no serious adverse events. GMFM-88 improved from 65.51 ± 21.97 to 66.72 ± 22.28 (p = 0.07). The improvements in the secondary outcomes were as follows: GMFM-66, 53.63 ± 11.94 to 54.96 ± 12.31, p = 0.04; step length, 0.32 ± 0.16 to 0.34 ± 0.16, p = 0.25; 2-MWD, 59.1 ± 57.0 to 62.8 ± 63.3, p = 0.54; COPM performance score, 3.7 ± 2.0 to 5.3 ± 1.9, p = 0.06; COPM satisfaction score, 3.3 ± 2.1 to 5.1 ± 2.1, p = 0.04. In this exploratory study, we applied a new size of wearable cyborg HAL (2S size), to children with central nervous system disorders. We evaluated its safety, feasibility, and identified an optimal assessment method for multiple treatments. All participants completed the protocol with no serious adverse events. This study suggested that the GMFM would be an optimal assessment tool for validation trials of HAL (2S size) treatment in pediatric patients with posture and motor function disorders.

Pinostrobin mitigates neurodegeneration through an up-regulation of antioxidants and GDNF in a rat model of Parkinson's disease.

Background: One of the most common neurodegenerative diseases is Parkinson's disease (PD); PD is characterized by a reduction of neurons containing dopamine in the substantia nigra (SN), which leads to a lack of dopamine (DA) in nigrostriatal pathways, resulting in motor function disorders. Oxidative stress is considered as one of the etiologies involved in dopaminergic neuronal loss. Thus, we aimed to investigate the neuroprotective effects of pinostrobin (PB), a bioflavonoid extracted from Boesenbergia rotunda with antioxidative activity in PD. Methods: Rats were treated with 40 mg/kg of PB for seven consecutive days before and after 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced PD. After completing the experiment, the brains including SN and striatum were used for histological studies and biochemical assays. Results: PB treatment demonstrated a reduction of free radicals in the SN as indicated by significantly decreased MDA levels, whereas the antioxidative enzymes (SOD and GSH) were significantly increased. Furthermore, PB treatment significantly increased glial cell line-derived neurotrophic factor (GDNF) immunolabelling which has neurotrophic and neuroprotective effects on the survival of dopaminergic neurons. Furthermore, PB treatment was shown to protect CA1 and CA3 neurons in the hippocampus and dopaminergic neurons in the SN. DA levels in the SN were increased after PB treatment, leading to the improvement of motor function of PD rats. Conclusions: These results imply that PB prevents MPTP-induced neurotoxicity via its antioxidant activities and increases GDNF levels, which may contribute to the therapeutic strategy for PD.

Antidyskinetic activity of new derivatives of inydazol-4,5-dicarbonic acid in a parkinsonism experimental model due to administration of 6-hydroxydopapine

BACKGROUND: Levodopa therapy currently remains the clinical method of choice for patients with Parkinsons disease. However, in the late stages of the disease, approximately 80% of patients receiving treatment developed levodopa-induced dyskinesia. The studied substances are derivatives of imidazole-4,5-dicarboxylic acid. Their pharmacological effect is produced due to interaction with the recognition site of NMDA receptor, which, together with their high efficiency, implies that they are safer than previously available drugs in this pharmacological group.
 AIM: To study the antidyskinetic effect of IEM2295 and IEM2296 derivatives of imidazole-4,5-dicarboxylic acid.
 MATERIALS AND METHODS: The model is based on the toxic effect of 6-hydroxydopamine on rat brain tissue. The first (control) group of rats received injections of only Levodopa and Benserazide, the second group received injections of Levodopa, Benserazide, and the test substance IEM2295, and the third group received injections of Levodopa, Benserazide and the test substance IEM2296. Each group was evaluated based on three criteria: motor function violations, limb dyskinesia, and axial and chewing dyskinesia. The severity of motor functions was graded on a scale of 0 to 4 points at 35, 70, 105, and 140 minutes after injection of the above substances, where 0 and 4 represent the absence and most pronounced degree of pathological movements, respectively.
 RESULTS: The result analysis showed that the greatest effect on reducing the severity of limb dyskinesia, axial dyskinesia, and chewing dyskinesia in rats was observed at 105 and 140 minutes after injections of the studied substances. Statistically significant differences between the control group and rats receiving injections of the studied substances were revealed at all the time points for limb dyskinesia; i.e., at 35, 105, and 140 minutes for axial dyskinesia and at 105 and 140 minutes for chewing dyskinesia.
 CONCLUSIONS: In the experimental model of parkinsonism, IEM2295 and IEM2296 show antiparkinsonian and antidyskinetic activity because they reduce the severity of motor function disorders in rats with levodopa-induced dyskinesia. The results indicate the prospects for continued development of these substances and further research for effective and safe antiparkinsonian agents among compounds of this class.

Disrupted functional connectivity of the striatum in patients with diffuse axonal injury: a resting-state functional MRI study.

Diffuse axonal injury (DAI) disrupts the integrity of white matter microstructure and affects brain functional connectivity, resulting in persistent cognitive, behavioral and affective deficits. Mounting evidence suggests that altered cortical-subcortical connectivity is a major contributor to cognitive dysfunction. The functional integrity of the striatum is particularly vulnerable to DAI, but has received less attention. This study aimed to investigate the alteration patterns of striatal subdivision functional connectivity. Twenty-six patients with DAI and 27 healthy controls underwent resting-state fMRI scans on a 3.0 T scanner. We assessed striatal subdivision functional connectivity using a seed-based analysis in DAI. Furthermore, a partial correlation was used to measure its clinical association. Compared to controls, patients with DAI showed decreased functional connectivity between the right inferior ventral striatum and right inferior frontal gyrus, as well as the right inferior parietal lobule, between the left inferior ventral striatum and right inferior frontal gyrus, between the right superior ventral striatum and bilateral cerebellar posterior lobe, between the bilateral dorsal caudal putamen and right anterior cingulate gyrus, and between the right dorsal caudal putamen and right inferior parietal lobule. Moreover, decreased functional connectivity was observed between the left dorsal caudate and the right cerebellar posterior lobe, while increased functional connectivity was found between the left dorsal caudate and right inferior parietal lobule. Correlation analyses showed that regions with functional connectivity differences in the DAI group correlated with multiple clinical scoring scales, including cognition, motor function, agitated behavior, and anxiety disorders. These findings suggest that abnormalities in cortico-striatal and cerebellar-striatal functional connectivity are observed in patients with DAI, enriching our understanding of the neuropathological mechanisms of post-injury cognitive disorders and providing potential neuroimaging markers for the diagnosis and treatment of DAI.

Redefining cerebral palsies as a diverse group of neurodevelopmental disorders with genetic aetiology.

Cerebral palsy is a clinical descriptor covering a diverse group of permanent, non-degenerative disorders of motor function. Around one-third of cases have now been shown to have an underlying genetic aetiology, with the genetic landscape overlapping with those of neurodevelopmental disorders including intellectual disability, epilepsy, speech and language disorders and autism. Here we review the current state of genomic testing in cerebral palsy, highlighting the benefits for personalized medicine and the imperative to consider aetiology during clinical diagnosis. With earlier clinical diagnosis now possible, we emphasize the opportunity for comprehensive and early genomic testing as a crucial component of the routine diagnostic work-up in people with cerebral palsy.

Pinostrobin mitigates neurodegeneration through an up-regulation of antioxidants and GDNF in a rat model of Parkinson’s disease

Background: One of the most common neurodegenerative diseases is Parkinson’s disease (PD); PD is characterized by a reduction of neurons containing dopamine in the substantia nigra (SN), which leads to a lack of dopamine (DA) in nigrostriatal pathways, resulting in motor function disorders. Oxidative stress is considered as one of the etiologies involved in dopaminergic neuronal loss. Thus, we aimed to investigate the neuroprotective effects of pinostrobin (PB), a bioflavonoid extracted from Boesenbergia rotunda with antioxidative activity in PD. Methods: Rats were treated with 40 mg/kg of PB for seven consecutive days before and after 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced PD. After completing the experiment, the brains including SN and striatum were used for histological studies and biochemical assays. Results: PB treatment demonstrated a reduction of free radicals in the SN as indicated by significantly decreased MDA levels, whereas the antioxidative enzymes (SOD and GSH) were significantly increased. Furthermore, PB treatment significantly increased glial cell line-derived neurotrophic factor (GDNF) immunolabelling which has neurotrophic and neuroprotective effects on the survival of dopaminergic neurons. Furthermore, PB treatment was shown to protect CA1 and CA3 neurons in the hippocampus and dopaminergic neurons in the SN. DA levels in the SN were increased after PB treatment, leading to the improvement of motor function of PD rats. Conclusions: These results imply that PB prevents MPTP-induced neurotoxicity via its antioxidant activities and increases GDNF levels, which may contribute to the therapeutic strategy for PD.

Исследование психометрических свойств «Госпитальной шкалы тревоги и депрессии» (HADS), рекомендованной для врачей общесоматической практики, на выборке пациентов с нарушением двигательных функций

<p style="text-align: justify;">The aim of the study is to investigate the psychometric characteristics of the Hospital Anxiety and Depression Scale (HADS) on a sample of patients with impaired motor functions. HADS was used to examine the current psychoemotional state of 73 women and 27 men aged 62.1±13.7 years who were in the hospital for inpatient rehabilitation for motor function disorders arising from a stroke (n=50) or developing against the background of chronic musculoskeletal disorders (n=50). Independent of the psychologist, a psychiatrist examined the same patients, filling out Hamilton Anxiety and Depression scales. A comparison of the findings led to the conclusion of overdiagnosis with the HADS subscales. At the same time, it is shown that the questionnaire items have satisfactory indices of discriminativeness and internal reliability. The combination of low content and convergent validity of some items of the questionnaire allowed modifying subscales, reducing the number of items without prejudice to psychometric characteristics. By comparing the data obtained with an objective external criterion for the Anxiety (HADS-A) and Depression (HADS-D) subscales, new cutoffs (9 points) were determined for diagnosing the presence or absence of anxiety and depression, which allows to use this version of the test more effectively for screening the current psychoemotional state in patients with impaired motor functions who enter the second stage of medical rehabilitation.</p>

Overall comorbidities in functional neurological disorder: A narrative review

IntroductionThe importance to assess and include the frequent comorbidities in the personalised care management plan of patients with functional neurological disorders (FND) has arisen through the years. FND patients are not only complaining from motor and/or sensory symptoms. They also report some non-specific symptoms that participate to the burden of FND. In this narrative review, we aim to better describe these comorbidities in terms of prevalence, clinical characteristics and their variability depending on the subtype of FND. MethodsThe literature was searched for on Medline and PubMed. The search was narrowed to articles between 2000 and 2022. ResultsFatigue is the most common symptom reported in relation to FND (from 47 to 93%), followed by cognitive symptoms (from 80 to 85%). Psychiatric disorders are reported in 40 to 100% FND patients, depending on the FND subtype (functional motor disorder [FMD], functional dissociative seizures [FDS]…) but also on the type of psychiatric disorder (anxiety disorders being the most frequent, followed by mood disorders and neurodevelopmental disorders). Stress factors such as childhood trauma exposure (emotional neglect and physical abuse predominantly) have also been identified in up to 75% of FND patients, along with maladaptive coping strategies. Organic disorders are commonly reported in FND, such as neurological disorders (including epilepsy in FDS [20%] and FMD in Parkinson's Disease [7%]). Somatic symptom disorders including chronic pain syndromes are frequently associated to FND (about 50%). To be noted, recent data also suggest a high comorbidity between FND and hypermobile Ehlers Danlos Syndrome (about 55%). ConclusionPut together, this narrative review highlights the high burden of FND patients, not only due to somatosensory alterations but also by considering the frequent comorbidities reported. Thus, such comorbidities must be taken into consideration when defining the FND personalised care management strategy for the patients.

MODIFI: protocol for randomised feasibility study of eye-movement desensitisation and reprocessing therapy (EMDR) for functional neurological disorder (FND)

IntroductionFunctional neurological disorder (FND) refers to an involuntary loss of control over and/or aberrant perception of the body. Common presenting symptoms are functional (non-epileptic) seizures, and functional motor disorder, for...

METHODS OF PHYSICAL REHABILITATION OF PATIENTS WITH ISCHEMIC STROKE

The purpose of our research is to develop and justify the functional method of using physical rehabilitation tools in restoring the motor functions of patients with ischemic stroke in the area of the internal carotid artery, taking into account the psychological state of the patient, the ontogenetic features of the restoration of his/her postural and dynamic functions, and the biomechanical laws of the formation of compensatory changes in the motor system of the individual. Research methods. In the system of measures for physical rehabilitation of patients with ischemic stroke, one of the most important points it is control of the patient’s level of adaptation capabilities. Risk factors from the side of the cardiovascular system are: the degree of atherosclerosis, arterial hypertension, especially the increase in blood pressure over 200 mm Hg. art and diastolic is – more, than 110 mm Hg. art, increased blood viscosity, blood pressure fluctuations, for example, with heart rhythm disorders. Patients, having been included into the research, were selected by the method of randomization using a Table of random numbers (Paired Design Technology was used by us). Patients of the control group received a complex of rehabilitation measures using physical exercises (according to the classical method, proposed by us. To assess the psychological status of the patient, the eight-color test of M. Lüscher was used. The results of the research. According to all patients of the experimental and control groups, during the entire period of inpatient treatment, the following data were analyzed daily: well-being, frequency and nature of pain sensations, other complaints (shortness of breath, palpitations, sleep and mood disorders, tolerability of restorative treatment procedures). A clinical, functional and psychological examination was conducted for all patients before and after the complex rehabilitation course. Conclusions. The study of the initial state of voluntary motility of ischemic stroke patients at the beginning of the physical rehabilitation course showed the presence of disorders of static and dynamic motor function of the arm, leg, coordinated action of the arms and legs, head, trunk, but quite different in their explanation in the studied groups of patients. The state of motor functions of patients with ischemic stroke is characterized in such a way: on the affected side, the maximum values of the volume of active and passive movements of strength and muscle tone are diagnosed in the “hemiparesis” subgroup, the smallest one – is in the “hemiplesia” subgroup. On the side of the lesion lacuna, the most pronounced muscle strength and tone are diagnosed in the subgroup “hemiparesis”, the largest amount of active and passive movements, in turn, there are in the subgroup “plesia + paresis”, “hemiparesis”.

Characteristics of patients with primary ciliary dyskinesia

Primary ciliary dyskinesia (PCD) (Online Mendelian Inheritance in Man - OMIM - #242650) is a rare hereditary disease, which is based on a defect in the ultrastructure of the cilia epithelium of the respiratory tract which leads to the motor function disorder. Data about health characteristics of patients with PCD in the Russian Federation are incomplete.The aim of the study was to investigate the clinical, laboratory, and instrumental characteristics of patients with PCD.Methods. The data of 90 patients (22 adults (24.4%) and 68 children (75.6%)) from several medical centers were studied. The following methods were used: medical history, spirometry, microbiological examination of the respiratory tract, video microscopic analysis of the functional activity of the nasal mucosa ciliated epithelium, transmission electron microscopy of the ciliated epithelium, and DNA testing.Results. The median age at diagnosis was 17.0 years for adults and 5.0 years for children. Kartagener syndrome was detected in 23 (27%) people, including 6 (26.0%) adults. Hearing loss was noted in 5 (26.3%) adult patients and 15 (26.8%) children. Light microscopy of the ciliated epithelium was performed in 14 (82.3%) children and 3 (17.7%) adults. In 12 patients, cilia motor activity was not registered at each of the magnifications (x 100, x 400, x 1,000). Transmission electron microscopy showed that absence ofinternal and external dynein handles (51%) and absence of internal dynein handles (17.9%) were the most common disorders. DNA testing was performed in 55 (61.2%) patients: 16 (29.1%) adults and 38 (70.9%) children. The most common genetic variants were found in the DNAH5 and HYDIN genes. Lung function was reduced in both adults and children, but a significant decrease was noted in adult patients. P. aeruginosa predominated in the culture and accounted for 21.3% (intermittent detection in 13.2%, persistent detection in 9%). It has increased resistance to antibiotics.Conclusion. The results correlate with the European data. Infection caused by P. aeruginosa with the increased resistance to antibiotics was prevalent in patienths with PCD.

A282 RISK FACTORS ASSOCIATED WITH UNSUCCESSFUL HIGH-RESOLUTION MANOMETRY: FAILURE IS COMMON BUT WHAT CAN WE CHANGE

Abstract Background High-resolution manometry (HRM) is a diagnostic tool used to evaluate esophageal motor function and diagnose motility disorders. A standardized protocol is used to make an accurate diagnosis based on the Chicago Classification. Some existing literature suggests that incomplete or imperfect manometry tests are common, however; there remains a paucity of data to evaluate risk factors for failure to help clinicians determine when a study may be difficult to perform. Purpose Our goal was to quantify how often failed tests occurred and determine specific factors that may be associated with failed HRM. Method We retrospectively evaluated records for HRM tests performed over 1 year at our academic centre. Based on clinical experience, we identified several factors that may be associated with the success of HRM testing including the following: indications and symptoms leading to testing, patient’s age and biological sex, previous esophageal manometry history, previous esophageal/gastric surgery, previous septal repair/deviated septum, history of significant nausea/vomiting, history of anxiety/depression, history of irritable bowel syndrome, and medication use (opioids, proton pump inhibitors, calcium channel blockers, nitrates). We then compared patients with successful HRM vs. unsuccessful HRM with regard to our pre-specified risk factors. Result(s) 29 HRM tests were unsuccessful from a total of 152 that were performed (19% failure rate). Reasons for failure included the inability to pass the probe through LES (55%) and the inability to tolerate the manometry probe for a minimum of 10 saline swallows (45%). After separating the failed cases from successful tests, both groups had a similar distribution of age and sex. Specific symptoms and indications did not have a significant association with unsuccessful tests. A previous history of failed manometry was associated with unsuccessful HRM (OR: 15, 95% CI 1.88 to 183.8, p=0.0156). Conversely, PPI usage was associated with fewer failed HRM tests (OR: 0.37, 95% CI 0.16 to 0.90, p=0.0343). Other medical history or medication use was not found to be associated with testing failure in our study. Conclusion(s) HRM is useful for diagnosing esophageal motility disorders, but incomplete tests are common. Although this study did not identify any factors in a patient’s medical history that could be used to predict failure in patients who have never had testing, further investigations may identify if PPI therapy can make HRM testing more tolerable. Additionally, the association between previous failed HRM and repeat failures suggests that endoscopic probe placement techniques should be considered instead of retrying conventional probe placement. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Transcranial Stimulation for the Treatment of Stimulant Use Disorder

The increasing prevalence of stimulant use disorder (StUD) involving methamphetamine and cocaine has been a growing healthcare concern in the United States. Cocaine usage is associated with atherosclerosis, systolic and diastolic dysfunction, and arrhythmias. Furthermore, approximately one of every four MIs is cocaine-induced among patients aged 18 to 45. Methamphetamine use has been associated with nerve terminal damage in the dopaminergic system resulting in impaired motor function, cognitive decline, and co-morbid psychiatric disorders. Current treatment options for StUD are extremely limited, and there are currently no FDA-approved pharmacotherapies. Behavioral interventions are considered first-line treatment; however, in a recent meta-analysis comparing behavioral treatment options for cocaine, contingency management programs provided the only significant reduction in use. Current evidence points to the potential of various neuromodulation techniques as the next best modality in treating StUD. The most promising evidence thus far has been transcranial magnetic stimulation which several studies have shown to reduce risk factors associated with relapse. Another more invasive neuromodulation technique being studied is deep-brain stimulation, which has shown promising results in its ability to modulate reward circuits to treat addiction. Results showing the impact of transcranial magnetic stimulation (TMS) in the treatment of StUD are limited by the lack of studies conducted and the limited understanding of the neurological involvement driving addiction-based diseases such as StUD. Future studies should seek to provide data on consumption-reducing effects rather than craving evaluations.

Slow gastric emptying after pancreaticoduodenectomy: analysis of the impact factors

Objective. To investigate the efficacy of existing methods of formation of anastomoses and to determine the factors, influencing development of slow gastric emptying.
 Materials and methods. Retrospective investigation was conducted on 102 patients in Jan. 2019 – Nov. 2021 yrs period, in whom pyloro-preserving pancreaticoduodenectomy in accordance to Traverso was performed versus excision of pylorus in accordance to Whipple. The patients were distributed into two Groups: Group I - 26 patients, in whom the operation was complicated by slow gastric emptying, and Group II - 76 without such symptoms.
 Results. Postoperative complications were diagnosed in 43 (42.2%) patients, and slow gastric emptying - in 26 (25.5%). External pancreatic fistula was revealed in 14 (13.7%) patients, while clinically significant fistulas of grades B and C - in 9 (8.8%). Among 26 patients with slow gastric emptying in 16 there was grade of severity A, in 8 - B, and in 2 - C. Thus, the gastrojejunostomy type applied statistically significantly (p < 0.05) influenced a slow gastric emptying occurrence. The type of pancreatojejunostomy applied did not influenced (p = 0.85) a slow gastric emptying occurrence. The patients with complications have had more stationary stay – by 6 days at average. General surgical complications, pancreatic fistulas statistically significantly (p ≤ 0.001and p < 0.05, accordingly) were connected with clinically significant slow gastric emptying; while concerning biliary fistulas, hemorrhage such a correlation was not revealed (p = 0.75 and p = 0.44, accordingly).
 Conclusion. External pancreatic fistula and common surgical complications, the gut reconstruction pattern in pancreaticoduodenectomy (antecolic or retrocolic), connected with insufficient gastric evacuation, were determined as the main influencing factors in development of gastric motor function disorders. The patients with slow gastric emptying need complex conservative treatment and long period of time for their evacuation function restoration. For such patients it is necessary to guarantee a selective help and rapid ways of rehabilitation, as well as to prevent the complications occurrence. Thus, it is necessary to proceed with further investigations for surgical reconstructive procedures in pancreaticoduodenectomy.

Performance validity tests in nonlitigant patients with functional motor disorder.

Performance validity tests (PVTs) are used in neuropsychological assessments to detect patterns of performance suggesting that the broader evaluation may be an invalid reflection of an individual's abilities. Data on functional motor disorder (FMD) are currently poor and conflicting. We aimed to examine the rate of failure on three different PVTs of nonlitigant, non-compensation-seeking FMD patients, and we compared their performance to that of healthy controls and controls asked to simulate malingering (healthy simulators). We enrolled 29 nonlitigant, non-compensation-seeking patients with a clinical diagnosis of FMD, 29 healthy controls, and 29 healthy simulators. Three PVTs, the Coin in the Hand Test (CIH), the Rey 15-Item Test (REY), and the Finger Tapping Test (FTT), were employed. Functional motor disorder patients showed low rates of failure on the CIH and REY (7% and 10%, respectively) and slightly higher rates on the FTT (15%, n= 26), which implies a motor task. Their performance was statistically comparable to that of healthy controls but statistically different from that of healthy simulators (p< 0.001). Ninety-three percent of FMD patients, 7% of healthy simulators, and 100% of healthy controls passed at least two of the three tests. Performance validity test performance of nonlitigant, non-compensation-seeking patients with FMD ranged from 7% to 15%. Patients' performance was comparable to that of controls and significantly differed from that of simulators. This simple battery of three PVTs could be of practical utility and routinely used in clinical practice.

Development of a Bedside Tool to Predict the Diagnosis of Cerebral Palsy in Term-Born Neonates

Cerebral palsy (CP) is the most common abnormality of motor development and causes lifelong impairment. Early diagnosis and therapy can improve outcomes, but early identification of infants at risk remains challenging. To develop a CP prognostic tool that can be applied to all term neonates to identify those at increased risk of developing CP. This case-control study used data from the Canadian Cerebral Palsy Registry (data collected from January 2003 to December 2019) for children with CP and the Alberta Pregnancy Outcomes and Nutrition study (mothers enrolled from May 2009 to September 2012; data extracted in 2020) for controls. There were 2771 children with CP and 2131 controls evaluated; 941 and 144, respectively, were removed for gestational age less than 37 weeks at birth, 565 with CP removed for incomplete data, and 2 controls removed for a diagnosis of CP. Data were analyzed from April to August 2022. Potential risk factors were selected a priori based on the literature, including maternal, intrapartum, and infant characteristics. Diagnosis of CP, defined as a disorder of motor function due to a nonprogressive brain abnormality before age 1 year and classified by Gross Motor Function Classification System levels I to V. Of 3250 included individuals, 1752 (53.9%) were male, and the median (IQR) gestational age at birth was 39 (38-40) weeks. Encephalopathy was present in 335 of 1184 infants with CP (28%) and 0 controls. The final prediction model included 12 variables and correctly classified 75% of infants, with a sensitivity of 56% (95% CI, 52-60) and specificity of 82% (95% CI, 81-84). The C statistic was 0.74 (95% CI, 71-76). Risk factors were found to be additive. A proposed threshold for screening is probability greater than 0.3, with a sensitivity of 65% (95% CI, 61-68) and specificity of 71% (95% CI, 69-73). The prognostic tool identified 2.4-fold more children with CP than would have presented with encephalopathy (odds ratio, 13.8; 95% CI, 8.87-22.65; P < .001). In this case-control study, a prognostic model using 12 clinical variables improved the prediction of CP compared with clinical presentation with encephalopathy. This tool can be applied to all term newborns to help select infants for closer surveillance or further diagnostic tests, which could improve outcomes through early intervention.

Long-Term neurodevelopmental outcome after antenatal corticosteroid in late-preterm twin neonates: nationwide study

In singleton women who are at risk of late preterm delivery, consideration of antenatal corticosteroid is advocated by clinical guidelines to reduce respiratory complications. However, adoption of this practice has not been universal in twin pregnancies at risk for late preterm birth, because of lack of evidences regarding both effectiveness and long-term safety of corticosteroid in this population. In the current study, we evaluated the long-term neurodevelopmental outcome of late-preterm twin neonates after administration of antenatal corticosteroid. This nationwide population-based study included twin neonates who were delivered in late preterm (34∼36+6 weeks) between 2007 and 2010 and were checked for National Health Screening Program for Infants and Children. Group 1 included neonates from mothers who were injected antenatal corticosteroid and group 2 included neonates without antenatal corticosteroid injection. The risk of long-term neurodevelopmental outcome was compared between the two groups of cases. Adverse long-term neurodevelopmental outcome was defined as occurrence of at least one of the followings: autism, cerebral palsy, speech articulation disorder, developmental disorders of scholastic skills, developmental disorder of motor function, and developmental disorder. During the study period, a total of 10,078 neonates were delivered in late preterm and met the inclusion criteria: 2196 neonates in group 1 and 7882 neonates in group 2. In terms of long-term neurodevelopmental outcome, there were no statistically significant difference between the two groups (Figure). The risk of adverse long-term neurodevelopmental outcome was not increased after administration of antenatal corticosteroid at late preterm twin neonates.

Relationship between the degree of medulla spinalis retraction and motor function in experimental animals

Introduction: Spinal cord trauma can cause partial or total damage to the brain's and spinal cord's connection. The effects of spinal cord injury will affect motor function even if there is a severe injury, and in a longer duration, it will cause death. Medulla spinalis retraction can cause clinical abnormalities, especially in motor function. Methods: This study consisted of three groups of male Wistar rats (Rattus norvegicus). Each group was subjected to 15%, 25% and 37.5% retractions for 1 minute, 3 minutes and 5 minutes, respectively. After that, an assessment was carried out with the footprint test and forced swim test. Data were analyzed with Fisher's exact test. Results: This study had 27 samples of male Wistar rats which were divided into 3 groups. In the 15%, 25% and 37.5% retractions treatment with a duration of 3 minutes and 5 minutes, all samples died. Retraction of 15% of the diameter of the medulla spinalis in 1 minute does not cause motor function disorders. Statistically, there is no significant difference in the degree of medulla spinalis retraction and motor function on the footprint test and forced swim test (p = 0.102). Conclusion: The medulla spinalis retraction of less than 15% with a duration of less than 1 minute will not cause motor function impairment. If more than 15% retraction with more than 1 minute will cause motor function impairment and death, this relationship is not statistically significant.

A new approach in the treatment of chronic bilateral paralytic stenosis of the larynx: A review

The issues of surgical treatment of bilateral paralytic stenosis of the larynx do not lose their relevance today, since the proportion of patients suffering from this pathology is steadily increasing. Neurogenic disorders of laryngeal motor function most often occur due to previous surgical intervention on the thyroid gland and upper mediastinum. The predominant complaints of such patients are dyspnea, decreased tolerance to physical exertion and impaired lantern function. Thus, the main objectives in the treatment of chronic laryngeal stenosis are: restoration of the lumen of the vocal slit to ensure adequate respiratory function, prevention of respiratory failure and preservation of socially significant voice. The use of semiconductor lasers for laryngoplasty in bilateral paralytic stenoses of the larynx is a very common technique, however, there are no data in the literature on the use of semiconductor laser energy with a wave length of 445 nm for this surgical intervention. In their work the authors tried to show the advantages of the surgical treatment of bilateral paralytic laryngeal stenosis using 445 nm semiconductor laser, developed at the Saint Petersburg Research Institute of Ear, Throat, Nose and Speech, which allowed to reduce rehabilitation period of respiratory function and preserve socially significant voice, using a clinical example.