Palsy Patients Research Articles

Isolated Third Cranial Nerve Palsy: Aetiology - Clinical Profile and Recovery at a Tertiary Neuro-ophthalmology Centre on the East Coast Peninsular of Malaysia

Objective: This study aimed to study the aetiologies, clinical profile and recovery of isolated third cranial nerve palsy (ITCNP) patients, at a tertiary neuro-ophthalmology center on the East Coast Peninsular of Malaysia. Material and Methods: This was a retrospective study, involving 33 patients with newly diagnosed ITCNP, who were treated at the Hospital of the Universiti Sains, Malaysia; from January 2018 to December 2019, with a follow up period ranging from 18 to 24 months. The demographic data, clinical features and aetiologies of the patients were analysed. Results: Patients’ ages ranged from 14 to 79 years (mean: 48, 50 years of age). The main aetiology was microvascular ischemia (39.4%), followed by trauma (30.3%), aneurysm (15.2%), tumour (9.1%) and undetermined cause (6.1%). Neuroimaging was performed for those indicated cases; with either computed tomography (CT), CT angiography, digital subtraction angiography, magnetic resonance imaging (MRI) with contrast or MRI angiography. Two-thirds of the patients (66.7%) had periorbital pain, which included 30.8% of patients with microvascular ischemia and 60.6% had pupil involvement; which was also found in 23.1% of patients with microvascular ischemia. Complete external third nerve palsy occurred in 18.2% of patients, and aberrant regeneration was observed in 36.4% of patients. Complete recovery occurred in 48.5%, of all patients, having microvascular ischemia and undetermined causes. Conclusion: The aetiologies, clinical profile and recovery of ITCNP patients in our institution are comparable to those reported in other previous studies. Patients with microvascular ischemia may also demonstrate periorbital pain and anisocoria. Neuroimaging remains the gold standard and the best tool via which to exclude other sinister and lifethreatening aetiologies.

PC008 / #808 EFFECT OF ANODAL TCDS COMBINED WITH COGNITIVE TRAINING FOR IMPROVING COGNITION AND LANGUAGE AMONG CHILDREN WITH CEREBRAL PALSY WITH COGNITIVE IMPAIRMENT: E-POSTER VIEWING

About 30–45% of cerebral palsy (CP) patients have cognitive impairment. Previous studies showed the evidence that transcranial direct current stimulation (tDCS) may have some benefits in attention-deficit/hyperactivity disorder, autism spectrum disorder, and motor development in CP. The aim of this study is to evaluate the effect of tDCS on cognition, language, and activities of daily living (ADL) among children with CP with cognitive impairment.

VP.90 Is an early diagnosis of congenital and childhood forms of myotonic dystrophy type 1 possible? Clinical and electromyographic description of case series

Myotonic dystrophy Type 1 (DM1) is the most common among muscular dystrophies in patients of any age and among all hereditary neuromuscular diseases in adults. Myotonia is the leading symptom in DM1 and may appear at any stage of the disease. Clinical myotonia (CM) and reports on electrical myotonia (EM) are delayed after the onset in patients with congenital (CDM1) and childhood-onset (ChDM1) forms of DM1 making it difficult to diagnose and prevent fatal complications in patients with early onset.The description of 9 patients with CDM1 and 4 patients with ChDM1 aged from 2 months to 34 years is demonstrated. 11 patients (14.8±10.0 years) underwent electromyography in 16 muscles with the analysis of spontaneous activity and motor unit action potentials pattern on needle electromyography (needle EMG) in skeletal muscle. The diagnosis was confirmed on the basis of clinical, paraclinical manifestations of the disease and increase CTG-repeats >50 in <i>DMPK</i>. The onset with respiratory failure (66.7% - CDM1) and/or dysphagia, diffuse hypotonia, high-arched palate, club feet (100% - CDM1), facial diplegia (100% - CDM1 and ChDM1), speech delay (100% - ChDM1), mental retardation and/or psychiatric disorders (100% - ChDM1) were noted as the first symptoms of CDM1 and ChDM1. All patients with CDM1 were observed for a long time as cerebral palsy patients. CM was absent in 5 patients aged from 2 months to 9 years; in 8 patients the onset of CM was revealed at the age of 11.0±4.1 years. EM was revealed in all patients with CM, while the rest of the patients showed an increased insertional activity on needle EMG and single myotonic discharges in distal muscles. A myopathic pattern in needle EMG was detected in 9 out of 10 patients. All mothers had the classic form of DM1 with the onset of the disease in 4 (30.8%) of them within 10.3±3.3 years after DM1 onset in their children. In the absence of CM, the clinical picture and clinical improvement after birth causes DM1 patients to be misdiagnosed with cerebral palsy. Therefore, testing for CDM1 should be carried out if dysphagia, facial diplegia, high-arched palate and club feet are present. ChDM1 should be carried out at the onset of the disease with facial diplegia, speech delay, mental retardation and/or psychiatric disorders. The combination of the described symptoms with a myopathic pattern in needle EMG and/or a family history of DM1 makes it possible to diagnose CDM1 and ChDM1 at the onset of the disease.

S1881 A Case of Non-Insulinoma Pancreatogenous Hypoglycemia Syndrome in a Cerebral Palsy Patient Where Diagnosis and Treatment Was Delayed Due to Continuous PEG-Tube Feeding

Introduction: Non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS), a rare cause of post-prandial hypoglycemia, presents with neuroglycopenia and negative localization studies for insulinoma. We present a case of NIPHS in a female whose cerebral palsy and continuous tube feeds created difficulty in establishing her diagnosis. Case Description/Methods: A 22-year-old female with cerebral palsy (baseline nonverbal status and quadriplegia) presented to the hospital with 5 days of lethargy. She had no fevers or seizures at home and had been on continuous enteral nutrition via PEG tube for two years. Vitals were normal. Physical exam showed decreased responsiveness and absent spontaneous eye opening on top of baseline posturing and muscle spasticity. Infectious workup was negative. Labs found a decreased blood glucose of 72mg/dl. As patient’s mentation improved overnight, hospital tube feeds were restarted at a reduced rate. Patient’s morning blood glucose was 66mg/dl so tube feeding rate was increased. Blood glucose further declined to 42mg/dl a few hours later. Continuous dextrose infusions, high carbohydrate tube feeds, and continuous glucagon drip were administered with minimal benefit. Insulin, proinsulin, and c-peptide were found to be within normal range. Insulin antibody test was also negative. Abdominal ultrasound and CT found no lesions in the pancreas or other acute pathology. Patient was deemed to have NIPHS. Acarbose was initiated with resolution of hypoglycemia and improvement in mentation and patient was discharged home with no further complications. Discussion: The postprandial hypoglycemia differential in non-nondiabetic patients includes insulinoma, post bariatric surgery hypoglycemia, dumping syndrome, insulin autoimmunity, postprandial syndrome, and NIPHS. Our patient’s cerebral palsy and nonverbal status masked the neuroglycopenic symptoms typical in NIPHS. Continuous home tube feeds via PEG initially prevented us from determining the postprandial timing of her lethargy. These clues could have pointed us in the direction of NIPHS sooner which would have allowed for more prompt utilization of acarbose, earlier discharge and avoidance of the use of dextrose infusions, glucagon, and high carbohydrate tube feeds. The high carbohydrate diet likely worsened our patient’s condition as reports indicate free carbohydrate reduction improves the clinical status of NIPHS patients. Fortunately, we were able to administer acarbose to resolve our patient’s condition without incident.

Translation and Validation Scale for Assessment and Rating of Ataxia in Urdu Language for Cerebral Palsy Patients

Aim: To translate the Scale for assessment and rating of Ataxia from English to Urdu language Methods: The study employed a linguistic validation study design with a non-random sample approach and was done at different clinical setups of Lahore. Parents of children with ataxic cerebral palsy with children aged 2 to 15 years old who speak Urdu should contact us. Sara's English version was translated into Urdu by two translators, one with a medical background and the other with a technical background in Urdu, both proficient in Urdu and English. Two individuals with medical and technology backgrounds who are competent in Urdu to English translation reverse translated the translated versions of SARA-Urdu I and SARA-Urdu II into English. The re-translated versions of SARA-Urdu I and SARA-Urdu II were translated back into English (SARA English III and SARA English IV). The translated versions were compared and generated a new Urdu version SARA Urdu-V. The data was entered into the SPSS version 23 application, which was also used to analyze it. Results: The translated version of the SARA scale has a Cronbach's alpha of 0.883. The inter-item correlation between the total SARA score and the eight domains of gait, stance, sitting, speech disturbance, finger chase, nose finger test, fast alternating hand movements, and heel shin slide was 0.131, 0.046, 0.159, 0.188, 0.136, 0.400, 0.698, and 0.450, respectively, after the translation of the Urdu version of SARA. For test retest reliability, the Pearson correlation value varied from 0.400 to 0.842. Conclusion: The Urdu version of SARA has appropriate internal consistency and fair inter-item correlation, and hence may be utilized by Urdu speakers. Keywords: Cerebral palsy, Cerebellar ataxia, Scale for assessment and rating of Ataxia

A Rare Disorder: Hypokalemia Induced Paralysis

Hypokalemic (Induced) Periodic Paralysis is a rare group of disorders that can cause sudden onset of flaccid paralysis. Here we present a case of 41 year old female who presented to the ED complaining of severe flaccid paralysis in both lower &amp; upper limbs since morning. Initially, she was treated as a stroke alert patient and had head scans which showed no acute pathologic changes. Laboratory evaluation revealed a markedly low potassium level. The patient's paralysis resolved after potassium correction and she was discharged with no neurologic deficits. Although rare, Periodic Paralysis must be differentiated from other causes of weakness and paralysis so that the proper treatment can be initiated quickly.

Metabolic assessment of cerebral palsy with normal clinical MRI using 18F-FDG PET imaging: A preliminary report.

To explore the cerebral metabolic patterns of cerebral palsy (CP) patients without structural abnormalities by brain magnetic resonance imaging (MRI) scans, we evaluated 18F-fluoro-deoxyglucose positron emission tomography (18F-FDG PET) imaging features in patients. Thirty-one children with CP [Gross Motor Function Classification System (GMFCS) levels II-V] showing no structural abnormalities by MRI were enrolled in this study. Regional glucose metabolic activity values were calculated using Scenium software and compared between the right and left cerebral hemispheres. These comparisons revealed asymmetric metabolic reductions in the central region, cerebellum, frontal lobe, and parietal lobe (p < 0.01). We next determined whether averaged brain metabolic activity values in different brain regions correlated with GMFCS levels. The metabolic activity values of basal ganglia, left temporal lobe, and cerebellum correlated negatively with GMFCS scores (all p < 0.05). This method was applied to the left cerebellum, which showed higher metabolic activity values than those in the right cerebellum in most patients (83.8%), and these values also correlated negatively with GMFCS scores (Spearman's r = −0.36, p = 0.01). Differential cortical glucose metabolism by 18F-FDG PET, may help to distinguish between different CP diagnoses that are not detected by MRI.

Study on clinical characteristics and evaluating treatment results of bell’s palsy patients at Can Tho Central General Hospital and Can Tho University of Medicine and Pharmacy Hospital in 2020 – 2022

Background: The primary and most common cause of peripheral VII nerve palsy is Bell’s palsy, which may be related to a viral attack of facial neuritis. Despite evidence of a role in viral infection, the therapeutic efficacy of antiviral agents for Bell’s palsy is unclear. However, it has been reported that the combination of antiviral- Withdrawal and steroids is more effective than steroids alone. Objectives: To describe the clinical characteristics and to evaluate treatment results of patients with Bell’s palsy. Materials and methods: A cross-sectional descriptive study was conducted on 70 patients diagnosed with Bell’s palsy at Can Tho Central General Hospital and Can Tho University of Medicine and Pharmacy Hospital met the sampling criteria and had no exclusion criteria. Participants were evaluated on clinical characteristics and treatment results at admission, after one week, and after four weeks. Results: The main reason for hospital admission was a distorted mouth (71.4%). The main clinical characteristic was the disappearance of the nasolabial fold (100%), frontal wrinkles absent (98.6%), and Charles Bell’s sign (88.6%).Treatment results after one week: the recovery rate in patients using corticosteroids combined with acyclovir was 62.9%, compared to the group using corticosteroids alone was 54.3% (p=0.467).Treatment results after four weeks: the recovery rate in patients using corticosteroids combined with acyclovir was 91.4% compared to the group using corticosteroids alone was 80.0% (p=0.172).Conclusion: The prominent clinical symptoms of patients with Bell’s palsy were the disappearance of nasolabial folds, loss of frontal wrinkles, and Charles Bell’s sign. After one week and four weeks of treatment, the group of patients who used the combination treatment of corticosteroids and acyclovir had a higher recovery rate than the group of patients using corticosteroids alone.

Early Intervention and Parent Counseling Give Positive Impact in Cerebral Palsy Child: A Case Report

Cerebral palsy is a neuro-development disorder, management of which requires awareness of risk factors and regular developmental assessments. Committed routine follow up is necessary for cerebral palsy patient along with parental adequate knowledge.Effective timely intervention with professional guidance along with medication could significantly improve the overall condition of cerebral palsy patient and therefore would make their living relatively meaningful.Early intervention starts withinfirst 6 months after term age. Intervention should be performed daily in home consideringthe importance of parent child relationship, training and counseling by professionalguidance. In fact, Parental knowledge of their child’s cerebral palsy is inadequate. If professionals give early intervention to the child and improve parental knowledge about cerebral palsy will empower them to help their children to overcome this chronic lifelong disorder. Bangladesh Journal of Medical Science Vol. 21 No. 04 October’22 Page : 926-930

Numerical Approach to Facial Palsy Using a Novel Registration Method with 3D Facial Landmark.

Treatment of facial palsy is essential because neglecting this disorder can lead to serious sequelae and further damage. For an objective evaluation and consistent rehabilitation training program of facial palsy patients, a clinician’s evaluation must be simultaneously performed alongside quantitative evaluation. Recent research has evaluated facial palsy using 68 facial landmarks as features. However, facial palsy has numerous features, whereas existing studies use relatively few landmarks; moreover, they do not confirm the degree of improvement in the patient. In addition, as the face of a normal person is not perfectly symmetrical, it must be compared with previous images taken at a different time. Therefore, we introduce three methods to numerically approach measuring the degree of facial palsy after extracting 478 3D facial landmarks from 2D RGB images taken at different times. The proposed numerical approach performs registration to compare the same facial palsy patients at different times. We scale landmarks by performing scale matching before global registration. After scale matching, coarse registration is performed with global registration. Point-to-plane ICP is performed using the transformation matrix obtained from global registration as the initial matrix. After registration, the distance symmetry, angular symmetry, and amount of landmark movement are calculated for the left and right sides of the face. The degree of facial palsy at a certain point in time can be approached numerically and can be compared with the degree of palsy at other times. For the same facial expressions, the degree of facial palsy at different times can be measured through distance and angle symmetry. For different facial expressions, the simultaneous degree of facial palsy in the left and right sides can be compared through the amount of landmark movement. Through experiments, the proposed method was tested using the facial palsy patient database at different times. The experiments involved clinicians and confirmed that using the proposed numerical approach can help assess the progression of facial palsy.

Comparative Study of Multimodal Therapy in Facial Palsy Patients.

Introduction In chronic facial palsy, synkinetic muscle overactivity and shortening causes muscle stiffness resulting in reduced movement and functional activity. This article studies the role of multimodal therapy in improving outcomes. Methods Seventy-five facial palsy patients completed facial rehabilitation before being successfully discharged by the facial therapy team. The cohort was divided into four subgroups depending on the time of initial attendance post-onset. The requirement for facial therapy, chemodenervation, or surgery was assessed with East Grinstead Grade of Stiffness (EGGS). Outcomes were measured using the Facial Grading Scale (FGS), Facial Disability Index, House-Brackmann scores, and the Facial Clinimetric Evaluation scale. Results FGS composite scores significantly improved posttherapy (mean-standard deviation, 60.13 ± 23.24 vs. 79.9 ± 13.01; confidence interval, –24.51 to –14.66, p < 0.0001). Analysis of FGS subsets showed that synkinesis also reduced significantly ( p < 0.0001). Increasingly, late clinical presentations were associated with patients requiring longer durations of chemodenervation treatment ( p < 0.01), more chemodenervation episodes ( p < 0.01), increased doses of botulinum toxin ( p < 0.001), and having higher EGGS score ( p < 0.001). Conclusions This study shows that multimodal facial rehabilitation in the management of facial palsy is effective, even in patients with chronically neglected synkinesis. In terms of the latency periods between facial palsy onset and treatment initiation, patients presenting later than 2 years were still responsive to multimodal treatment albeit to a lesser extent, which we postulate is due to increasing muscle contracture within their facial muscles.

Long-term efficacy of diaphragm plication on the pulmonary function of adult patients with diaphragm paralysis: a retrospective cohort study.

BackgroundDiaphragm plication is an effective and safe procedure for patients with symptomatic, acquired diaphragm paralysis. Improvements in dyspnea scores, ventilation perfusions and exercise capacity has been reported. Unfortunately, no continuous measurements of lung functions at 3 to 5 years’ follow-up have been recorded. This study was designed to assess the long-term effects and potential mechanism of diaphragm plication for non-malignant diaphragmatic paralysis patients, especially in relation to patients’ subjective and objective improvement.MethodsThis study retrospectively reviewed the medical records of 36 adult patients with diaphragmatic paralysis treated with diaphragm plication by thoracotomy at the Tianjin Chest Hospital from 1992 to 2016. The adult patients were carefully selected based on etiology and a combination of clinical manifestation, pulmonary function testing, and chest imaging characteristics. Patients’ preoperative pulmonary functions, forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) in the supine and sitting positions were recorded. Survival information was obtained at follow-ups continuously conducted with 8 patients for 4 years after surgery.ResultsThe main symptoms were lifestyle-limiting dyspnea and orthopnea, and a few patients also had digestive symptoms. The mean body mass index of patients was 26.02±2.19. The etiology was trauma in 3 patients, and surgery in 5 patients. The operated diaphragm was found to be lower than the contralateral diaphragm in the first 3 months after surgery; however, from the 4th month, both sides of the diaphragm were basically at the same level. Additionally, 31 patients (86.11%) showed an improvement in subjective symptoms, especially digestive symptoms preoperatively. The averages of FVC and FEV1 increased by 26.8% and 24.3%, respectively, in patients 6 months after diaphragmatic plication, and from the 18th month, lung function declined gradually, returning to preoperative levels in the 4th year.ConclusionsDiaphragmatic plication can obviously improve the lung function and subjective symptoms of patients in the short term, but from the 18th month, lung function declined gradually to preoperative levels in the 4th year indicated that its long-term effect on lung function is poor. The major purpose of diaphragmatic plication is to balance the position of the heart and abdominal organs, and thus to improve patients’ symptoms to a certain extent.

Prognostic and Clinical Role of Contrast Enhancement on Magnetic Resonance Imaging in Patients with Bell's Palsy.

Objective:To investigate the prognostic value of the magnetic resonance imaging in Bell’s palsy patients.Methods:Patients who were diagnosed and treated with Bell’s palsy between October 2013 and March 2016 retrospectively selected. House–Brackmann grades, pre- and post-treatment pure tone audiograms, stapedial reflexes were analyzed and magnetic resonance imaging (MRI) scans with gadolinium-based contrast agents were evaluated. Contrast-enhanced segments of the facial nerve were determined. MRI findings were compared statistically with pre- and post-treatment grade, recurrence rate of Bell’s palsy, MRI scanning timing, presence of stapes reflexes and posttreatment recovery data.Results:No significant correlation was observed between pretreatment House–Brackmann grades and enhancement (p>0.05). Similarly, there was no significant correlation between clinical recovery and enhancement (p>0.05). Also, no significant correlation was observed between MRI scanning time, the recurrence rate of Bell’s palsy and MRI findings (p>0.05). None of the MRIs showed neoplastic contrast enhancement.Conclusion:The routine use of the contrast-enhanced temporal MRI is not recommended in the diagnosis and monitoring of Bell’s palsy patients, because the contrast enhancement pattern of the facial nerve has no effect on the prognosis of Bell’s palsy. MRI should be used in cases that do not heal despite treatment, for the differential diagnosis of facial nerve tumors and in patients who are candidates for surgical decompression.

Towards a Reliable and Rapid Automated Grading System in Facial Palsy Patients: Facial Palsy Surgery Meets Computer Science.

Background: Reliable, time- and cost-effective, and clinician-friendly diagnostic tools are cornerstones in facial palsy (FP) patient management. Different automated FP grading systems have been developed but revealed persisting downsides such as insufficient accuracy and cost-intensive hardware. We aimed to overcome these barriers and programmed an automated grading system for FP patients utilizing the House and Brackmann scale (HBS). Methods: Image datasets of 86 patients seen at the Department of Plastic, Hand, and Reconstructive Surgery at the University Hospital Regensburg, Germany, between June 2017 and May 2021, were used to train the neural network and evaluate its accuracy. Nine facial poses per patient were analyzed by the algorithm. Results: The algorithm showed an accuracy of 100%. Oversampling did not result in altered outcomes, while the direct form displayed superior accuracy levels when compared to the modular classification form (n = 86; 100% vs. 99%). The Early Fusion technique was linked to improved accuracy outcomes in comparison to the Late Fusion and sequential method (n = 86; 100% vs. 96% vs. 97%). Conclusions: Our automated FP grading system combines high-level accuracy with cost- and time-effectiveness. Our algorithm may accelerate the grading process in FP patients and facilitate the FP surgeon’s workflow.

Clinical and psychosocial outcomes following correction of supination deformity in obstetrical brachial plexus palsy patients: A retrospective study

BackgroundForearm supination contracture is the mostAQ common deformity of the forearm following obstetric brachial plexus palsy (OBPP). Supination deformities in OBPP may be corrected by performing forearm osteotomy; however, the high recurrence rate limits patient satisfaction. Apart from the cosmetic impairment of this deformity, there are no previous reports on the clinical and psychosocial outcomes of forearm osteotomy in patients with supination deformities secondary to OBPP. Therefore, our study aimed to assess the clinical, functional, and psychosocial outcomes following forearm pronation osteotomy in OBPP patients with supination deformity.MethodsThis retrospective study was conducted after a chart review of all OBPP sequelae with supination forearm deformity in patients who underwent forearm pronating osteotomy from 2006 to 2018. Data relating to OBPP were gathered, and functional and psychosocial outcomes were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire through interviewsResultsThis study included 60 patients with a mean age of 8.7 years at the time of surgery. A total of 46 patients had lesions involving C5-T1 (76.7%). The mean preoperative supination deformity position was 68.5°, the mean amount of correction was 98.9°, and the mean forearm position was 30.5°, postoperatively. In the DASH assessment scale used postoperatively, 24 patients (42.9%) reported no restrictions on their daily activities, 25 patients (44.6%) believed that their social activities were unaffected, and 20 patients (35.7%) strongly disagreed with feeling less capable or less confident due to arm, shoulder, or hand problems. The factors significantly affecting position at the final follow-up were the amount of correction (p = 0.011), postoperative position (p = 0.005), and degree of pronation achieved (p = 0.02). The amount of correction significantly affected both self-confidence (p = 0.049) and activities of daily living (p = 0.033).ConclusionIn conclusion, our study showed that the position at the final follow-up, the degree of pronation achieved intraoperatively, and the postoperative position significantly affected the position at follow-up and the outcome assessment. The amount of intraoperative correction was significantly associated with higher self-confidence and normal activities of daily living.

An Analysis of the Implantable Doppler Probe for Postoperative Free-Flap Monitoring and Risk Factor Analysis for Revision Surgery in Facial Reanimation Surgery.

Background: Postoperative monitoring after free functional gracilis transfer for smile reconstruction in long-standing facial paralysis is challenging as clinical assessments are limited. Objective: In patients receiving free gracilis transfer for smile reconstruction, we compared the implantable Doppler probe with a handheld Doppler/intraoperative blood flow regarding the reliability in detecting perfusion compromised free flaps. Methods: In a retrospective cohort study we analyzed facial paralysis patients who, after free functional smile reconstruction, were postoperatively monitored using the implantable Doppler probe. Furthermore, we conducted a multiple logistic regression analysis on risk factors for vascular complications. Results: We included 119 patients who received 125 free functional gracilis transfers. The sensitivity of the implanted Doppler probe was 1.0 and the specificity 0.88. There were no false-negative results (negative predictive value = 1.0). The calculated positive predictive value was 0.41. We used a handheld Doppler device to verify signal changes. The combined positive predictive value of both tests was 0.91. Previous surgery in the surgical field was a risk factor for impaired blood flow. Conclusions: The implantable Doppler probe proved to be a reliable tool for postoperative monitoring of free functional gracilis transfer in facial reanimation surgery. Special care should be taken in preoperated patients.

Modified blink dynamic index predicts activity and severity in patient with facial nerve palsy.

We analyzed the dynamics of blink and defined the blink index in facial nerve palsy (FNP) patients using an ocular surface interferometer associated with clinical characteristics and clinical progress. In total, 49 patients were enrolled this study. All patients were tested using an ocular surface interferometer which is used to measure blink patterns (total blink (TB), partial blink rate (PBR)) and blink dynamics (blink time (BT), lid closing time (LCT), closure time (CT), lid opening time (LOT), interblink time (IBT), closing speed (CS), and opening speed (OS)) using 600 frames recorded over 20 s. The distance of lagophthalmos and modified interpalpebral fissure (IPF), which was defined as the actual moving distance of the upper eyelid, subtracting the distance of lagophthalmos from IPF, was measured using the ImageJ program. The types of FNP were "idiopathic" (Bell's palsy) and "surgical" (following the neurosurgery). Patients were classified into "acute" and "chronic" based on the duration of 6 months from the onset time of FNP. The clinical characteristics were classified into mild or severe according to the severe degree of exposure keratopathy-as "severe" if treatment such as tarsorrhaphy and gold plate insertion was required. Reduced MRD1, brow height, and modified IPF and increased lagophthalmos were noted in the palsy side. LCT was longer and CS, modified CS, and modified OS were shorter in the palsy side. The LCT was longer and the modified CS was shorter in idiopathic patients with acute onset and with clinically severe. IBT was increased in idiopathic patients with clinically severe. Analyzing the blink patterns and blink dynamics, this study suggests meaningful indicators among blink profiles and dynamics, LCT, and modified CS based on modified IPF. It was more associated in the idiopathic type than in the surgical type of FNP patients. The modified CS can be a useful tool for evaluating the activity and severity indicator of FNP.

Nomogram model for predicting oculomotor nerve palsy in patients with intracranial aneurysm.

To explore the risk factors of oculomotor nerve palsy (ONP) in patients with intracranial aneurysm (IA) and develop a nomogram model for predicting ONP of IA patients. A total of 329 IA patients were included. Logistic regression analysis was applied to identify independent factors, which were then integrated into the nomogram model. The performance of the nomogram model was evaluated by calibration curve, receiver operating curve (ROC), and decision curve analysis. Univariate and multivariate logistic regression analysis indicated posterior communicating artery (PCoA) aneurysm [hazard ratio (HR)=17.13, P<0.001] and aneurysm diameter (HR=1.31, P<0.001) were independent risk factors of ONP in IA patients. Based on the results of logistic regression analysis, a nomogram model for predicting the ONP in IA patients was constructed. The calibration curve indicated the nomogram had a good agreement between the predictions and observations. The nomogram showed a high predictive accuracy and discriminative ability with an area under the curve (AUC) of 0.863. The decision curve analysis showed that the nomogram was powerful in the clinical decision. PCoA aneurysm (HR=3.38, P=0.015) was identified to be the only independent risk factor for ONP severity. PCoA aneurysm and aneurysm diameter are independent risk factors of ONP in IA patients. The nomogram established is performed reliably and accurately for predicting ONP. PCoA aneurysm is the only independent risk factor for ONP severity.

Prevalence and associated factors of frailty and sarcopenia in multiple system atrophy and progressive supranuclear palsy: a cross-sectional study.

To investigate the prevalence of, and clinicodemographic factors associated with, frailty and sarcopenia in patients with multiple system atrophy or progressive supranuclear palsy. A total of 264 participants were recruited in this study. Demographic and clinical data were collected through structured interviews. Frailty was assessed with the clinical frailty scale (CFS), and sarcopenia was assessed with the simple five-item scoring questionnaire (SARC-F). The prevalence of frailty and sarcopenia was 48.57% and 35.71% in multiple system atrophy, and 51.09% and 39.13% in progressive supranuclear palsy. Multiple system atrophy patients with frailty or sarcopenia were more likely to be female and have longer disease duration, greater motor impairment, greater non-motor burden, and lower life quality. In multiple system atrophy, frailty was associated with reduced motor function and sarcopenia was associated with female sex, reduced motor function, and orthostatic hypotension. Progressive supranuclear palsy patients with frailty or sarcopenia had more severe motor impairment and non-motor burden, longer disease duration, and lower life quality. In progressive supranuclear palsy, frailty was associated with mentation and gait/midline symptoms, while sarcopenia was associated with reduced daily activity and severe gait/midline symptoms. Frailty and sarcopenia may be more common among patients with multiple system atrophy or progressive supranuclear palsy than among the general population, and they are associated with more severe forms of the two diseases. Prospective studies are necessary to clarify causal relationships between frailty/sarcopenia and clinical manifestations of multiple system atrophy and progressive supranuclear palsy.

Measuring the knowledge level of cerebral palsy patients' parents about the complications of the disease

Measuring the knowledge level of cerebral palsy patients' parents about the complications of the disease