Preservation Of Motor Function Research Articles

Micro‐Doses of DNP Preserve Motor and Muscle Function with a Period of Functional Recovery in Amyotrophic Lateral Sclerosis Mice

ObjectiveMitochondrial dysfunction is one of the earliest pathological events observed in amyotrophic lateral sclerosis (ALS). The aim of this study is to evaluate the therapeutic efficacy of 2,4‐dinitrophenol (DNP), a mild mitochondrial uncoupler, in an ALS mouse model to provide preclinical proof‐of‐concept evidence of using DNP as a potential therapeutic drug for ALS.MethodshSOD1G93A mice were treated with 0.5–1.0 mg/kg DNP through daily oral gavage from presymptomatic stage or disease onset until 18 weeks old. Longitudinal behavioral studies were performed weekly or biweekly from 6 to 18 weeks old. In situ muscle contraction measurements in extensor digitorum longus muscles were conducted to evaluate the preservation of contractile force and motor unit numbers in hSOD1G93A mice following DNP treatment. Muscle innervation and inflammatory markers were assessed using immunostaining. Extent of protein oxidation and activation of Akt pathway were also examined.ResultsDNP delayed disease onset; improved motor coordination and muscle performance in vivo; preserved muscle contractile function, neuromuscular junction morphology, and muscle innervation; and reduced inflammation and protein oxidation at 18 weeks old in hSOD1G93A mice. Strikingly, symptomatic hSOD1G93A mice exhibited a period of recovery in running ability at 20 cm/s several weeks after 2,4‐dinitrophenol treatment started at disease onset, offering the first observation in disease phenotype reversal using a small molecule.InterpretationOur results strongly support that micro‐dose DNP may be used as a potential novel treatment for ALS patients, with a possibility for recovery, when used at optimal doses and time of intervention. ANN NEUROL 2024

Ketone ester-enriched diet ameliorates motor and dopamine release deficits in MitoPark mice.

Parkinson's disease (PD) is a progressive, neurodegenerative disease characterized by motor dysfunction and dopamine deficits. The MitoPark (MP) mouse model of PD recapitulates several facets of Parkinson's disease, including gradual development of motor deficits, which enables the study of potential therapeutic interventions. One therapeutic strategy involves decreasing the mitochondrial metabolic load by inducing ketosis and providing an alternative energy source for neurons, leading to decreased neuronal oxidative stress. Thus, we hypothesized that administration of a ketone ester-enriched diet (KEED) would improve motor and dopamine release deficits in MP mice. Motor function (rotarod and open field tests), dopamine release (fast-scan cyclic voltammetry), tissue dopamine levels (gas chromatography-mass spectrometry) and dopamine neurons and axons (immunofluorescence) were assessed in MP, and control mice fed either the standard or a KEED. When started on the ketone diet before motor dysfunction onset, MP mice had improved motor function relative to standard diet (SD) MP mice. While the KEED did not preserve dopamine neurons or striatal dopamine axons, dopamine release in ketone diet MP mice was greater than SD MP mice but less than control mice. In a follow-up experiment, we began the ketone diet after motor dysfunction onset and observed a modest preservation of motor function in ketone diet MP mice relative to SD MP mice. The improvement in motor dysfunction indicates that a KEED or ketone supplement may have a beneficial effect on delaying motor deficit progression in Parkinson's disease.

Frontal lobe disconnection: How I do it.

The objective of frontal lobe disconnection (FD) is to isolate the frontal lobe without removing brain parenchyma, to achieve epilepsy outcomes comparable to those for frontal lobectomy but with fewer complications, since a large post-operative cavity is not created. Main surgical steps include "Identification of the central sulcus" to ensure the preservation of motor function, and "Frontal lobe disconnection" comprising: 1) fronto-parietal disconnection; 2) fronto-basal disconnection; 3) anterior corpus callosotomy; and 4) insula and basal ganglia disconnection. In performing FD, consideration of the disconnection boundary based on an anatomical understanding of white matter tracts is essential.

The burden of executive dysfunction after ischemic stroke (Bulgaria, 2019-2021)

Abstract Background Executive dysfunctions have great impact on behavior and quality of life in elderly. They also play important role for post-stroke functional outcome. The aim of our study was to examine the frequency, severity and types of executive dysfunctions at the third month after the ischemic stroke. Methods We examined 108 patients 3 months after ischemic stroke (66.67±9.03 years old, 66 males and 42 females) via 128-Wisconsin Card Sorting Test (WCST). WCST is a standardized instrument for detecting various executive dysfunctions. It is applicable for patients after stroke, because the test doesn’t require preserved arm motor functions. It measures global executive functioning (GEF), inhibitory control system (ICS), executive attention (EA), cognitive flexibility (CF) and working memory (WM). Our patients’ results were compared to the normal population test results. SPSS 24 was used for statistical analysis. Results Impaired GEF were found in 46% of our patients, most of them had mild or moderate impairment. One fourth of them showed impaired ICS, although the impairment in most of the cases was mild. EA deficits were found in 43% of our cases (17% had mild, 15% mild to moderate, 7% moderate and 4% severe impairment). WM dysfunction was found in 1/3 of them (the average result was about 27 percentiles; 29% had mild and 5% had mild to moderate deficits) and about ¼ of our patients had borderline results. CF was impaired in 68% of our patients (11% had mild, 28% mild to moderate, 16% moderate and 13% severe impairment). Conclusions GEF impairment is frequent after stroke. Patients had problems in ICS, EA, CF and WM. However, in most of the cases the dysfunction is mild or moderate and can be found only if it is actively searched and accessed. The most impaired functions were CF and EA. Patients with executive dysfunction require cognitive rehabilitation and specific social support. Key messages • Executive dysfunctions are frequent after ischemic stroke. The impairment is mild or moderate, but however it impacts the quality of life, behavior, prognosis and outcome of post-stroke survivors. • Patients with executive dysfunctions require specific cognitive rehabilitation and social support.

P11.09.B STRUCTURAL REORGANIZATION IN MOTOR-ELOQUENT GLIOMA PATIENTS EXHIBITING MOTOR DEFICITS

Abstract BACKGROUND Recent advancements in navigated transcranial magnetic stimulation (nTMS) have significantly improved the localization of motor functions in human subjects. Although previous studies have demonstrated the occurrence of tumor-induced motor plasticity, the detailed mechanisms of motor function plasticity and reorganization in patients with tumors affecting motor-eloquent regions are not fully elucidated. Our study aims to investigate the functional plasticity of motor functions in patients with gliomas located within motor-eloquent regions, providing deeper insights into the mechanisms of functional plasticity. MATERIAL AND METHODS In this research, we studied 60 glioma patients with tumors located in the motor-eloquent region. These patients were categorized into two groups depending on whether they experienced motor impairments in the upper extremities. We utilized nTMS, including Motor Evoked Potentials (MEP), to outline the control regions of motor function in terms of area, localization, and Center of Gravity (CoG). These identified regions also acted as seeds for tracing the Corticospinal Tract (CST). RESULTS The study unveiled significant variations in cortical and subcortical motor function localizations between the groups. Patients with motor impairments exhibited a broader cortical distribution connected to motor functions and increased volumes of CST, reflecting compensatory adaptations with different fractional anisotropy (FA) values (FA 0.15, p=0.02; FA 0.10, p=0.04). The analysis of the CST also showed overlapping regions, particularly within the hand-knob areas, which is indicative of these areas acting as critical motor output pathways. Despite varying degrees of functional impairment, all patients maintained some degree of motor output capability. CONCLUSION These findings suggest that motor-eloquent gliomas induce significant cortical and subcortical reorganization of motor functions. A persistent network of CST fibers, crucial for preserving motor function, highlights a complex interplay between cortical adaptation and subcortical reorganization. This study underscores the resilience of motor pathways and their pivotal role in functional recovery and plasticity, emphasizing the clinical relevance of nTMS in the therapeutic planning and monitoring of patients with motor-eloquent gliomas.

Advanced tractography-guided laser ablation of a perirolandic long-term epilepsy-associated tumor: illustrative case.

Microsurgical resection of drug-resistant epilepsy-associated perirolandic lesions can lead to postoperative motor impairment. Magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (MRgLITT) has emerged as a less invasive alternative, offering reduced surgical risks and improved neurological outcomes. Electrophysiological tools routinely used for motor mapping in resective microsurgery are incompatible with intraoperative MRI. The utilization of advanced neuroimaging adjuncts for eloquent brain mapping during MRgLITT is imperative. The authors present the case of a 17-year-old athlete who underwent MRgLITT for a perirolandic long-term epilepsy-associated tumor (LEAT). They performed probabilistic multi-tissue constrained spherical deconvolution (MT-CSD) tractography to delineate the corticospinal tract (CST) for presurgical planning and intraoperative image guidance. The CST tractography was integrated into neuronavigation and MRgLITT workstation software to guide the ablation while monitoring the CST throughout the procedure. The integration of CST tractography into neuronavigation workstation planning and laser ablation workstation thermoablation is feasible and practical, facilitating complete ablation of a deep-seated perirolandic LEAT while preserving motor function. Probabilistic MT-CSD tractography enhanced MRgLITT planning as well as intraprocedural CST visualization and preservation, leading to a favorable functional outcome. The limitations of tractography and the predictability of thermal output distribution compared to the gold standard of microsurgical resection merit further discussion. https://thejns.org/doi/10.3171/CASE24139.

Somatosensory Mapping Using a Novel Sensory Discrimination Task: Technical Note.

Although diffuse gliomas in the primary somatosensory cortex (S1) are often considered resectable, gliomas in the primary motor cortex require motor mapping to preserve motor function. Recent evidence indicates that some somatosensory cortex neurons may trigger motor responses, necessitating refined somatosensory mapping techniques. Using piezoelectric tactile stimulators on patients' faces and hands, we delivered 25 Hz vibrations and prompted patients to discriminate between dermatomes. Testing included areas contralateral to tumor-infiltrated and to non-tumor-infiltrated cortical regions. Sensory thresholds were determined by reducing stimulus intensity based on performance. Intraoperatively, electrocorticography electrode arrays were used to map sensory responses, and postoperative assessments evaluated sensory outcomes. The high-grade glioma case involved a 61-year-old man with right-sided weakness and numbness with a left parietal mass on MRI. Preoperative testing showed that the average vibratory detection threshold of the hand contralateral to the suspected tumor site was significantly higher than that of the hand contralateral to healthy cortex (P < .001). Intraoperative mapping confirmed the absence of functional involvement in cortical structures overlying the tumor. Postoperative imaging confirmed gross total resection, and sensory vibratory thresholds were normalized (P = .51). The low-grade glioma case included a 54-year-old man with a left parietal nonenhancing mass on MRI. No baseline sensory impairments were found on preoperative testing. Intraoperative mapping identified motor and sensory cortices, guiding tumor resection while preserving motor function. Postoperative MRI confirmed near-total resection, but new sensory impairments were noted in the hand and face contralateral to the resection site (P < .001). These deficits resolved by postoperative day 11, with no evidence of tumor progression on follow-up imaging. The sensory discrimination task provides a quantifiable method for assessing sensory changes and functional outcomes related to glioma. This technique enhances our understanding of how glioma infiltration remodels sensory systems and affects clinical outcomes in patients.

Postsurgical motor function and processing speed as predictors of quality of life in patients with chronic-phase glioblastoma

PurposePatients with glioblastomas (GBMs) have poor prognosis despite various treatments; therefore, attention should be paid to maintaining the quality of survival. Neurocognitive deficits can affect the quality of life (QOL) in patients with GBM. Most studies concerning QOL and neurocognitive functions have demonstrated a relationship between QOL and self-reported neurocognitive decline, although this method does not accurately reflect damaged functional domains. Therefore, this study aimed to clarify the neurocognitive functions that influence the QOL in patients with GBMs using an objective assessment of neurocognitive functions.MethodsData from 40 patients newly diagnosed with GBMs were analyzed. All patients completed the assessment of QOL and various neurological and neurocognitive functions including general cognitive function, processing speed, attention, memory, emotion recognition, social cognition, visuospatial cognition, verbal fluency, language, motor function, sensation, and visual field at 6 months postoperatively. QOL was assessed using the 36-Item Short Form Survey (SF-36). In the SF-36, the physical, mental, and role and social component summary (PCS, MCS, and RCS, respectively) scores were calculated. Multiple logistic regression analyses and chi-square tests were used to evaluate the association between SF-36 scores and neurocognitive functions.ResultsThe MCS was maintained, while the PCS and RCS scores were significantly lower in patients with GBMs than in healthy controls (p = 0.0040 and p < 0.0001, respectively). Among several neurocognitive functions, motor function and processing speed were significantly correlated with PCS and RCS scores, respectively (p = 0.0048 and p = 0.030, respectively). Patients who maintained their RCS or PCS scores had a higher probability of preserving motor function or processing speed than those with low RCS or PCS scores (p = 0.0026).ConclusionsMotor function and processing speed may be predictors of QOL in patients with GBMs.

Comparative analysis of neurofilaments and biomarkers of muscular damage in amyotrophic lateral sclerosis.

Diagnosis of the fatal neurodegenerative disease amyotrophic lateral sclerosis is challenging. Neurofilaments, indicative of neuronal damage, along with creatine kinase, creatinine, myoglobin, and troponin T, representing muscular damage, have been identified as promising fluid biomarkers. This study aims to comprehensively assess and compare their diagnostic and prognostic potential in a 'real-world' cohort of patients with amyotrophic lateral sclerosis. About 77 patients with amyotrophic lateral sclerosis and its clinical variants, and 26 age- and sex-matched controls with various neuromuscular and neurodegenerative diseases, were retrospectively included in this monocentric, cross-sectional study. Neurofilaments in cerebrospinal fluid and biomarkers of muscular damage in serum were measured and correlated with demographic features, motor function, survival time, clinical phenotypes, and the extent of upper and lower motor neuron involvement. Neurofilament, myoglobin, and troponin T concentrations were higher in patients with amyotrophic lateral sclerosis compared to disease controls. Higher neurofilament levels correlated with lower motor function and faster disease progression rate, while higher creatine kinase and creatinine concentrations were linked to preserved motor function. In contrast, troponin T elevation indicated poorer fine and gross motor functions. Increased neurofilament levels were associated with shorter survival, whereas biomarkers of muscular damage lacked survival correlation. Neurofilament concentrations were higher in classical amyotrophic lateral sclerosis than in progressive muscular atrophy, while myoglobin and troponin T levels were elevated in progressive muscular atrophy compared to primary lateral sclerosis. Neurofilaments were predominantly linked to upper motor neuron involvement. Our findings confirmed the robust diagnostic and prognostic value of neurofilaments in amyotrophic lateral sclerosis. Elevated neurofilament concentrations were associated with higher disease severity, faster disease progression, shorter survival, and predominant upper motor neuron degeneration. Biomarkers of muscular damage were inferior in distinguishing amyotrophic lateral sclerosis from other neuromuscular and neurodegenerative diseases. However, they may serve as complementary biomarkers and support in discriminating clinical variants of amyotrophic lateral sclerosis.

Prenatal surgery in fetal myelomeningocele with severe ventriculomegaly.

Prenatal myelomeningocele (MMC) repair is performed to decrease risk for treatment of hydrocephalus after birth and to preserve motor function. Some centers may not consider patients candidates for surgery if severe ventriculomegaly is present and there is no expected benefit in decreased risk for hydrocephalus treatment. This study sought to compare postnatal outcomes of fetuses with MMC and severe ventriculomegaly (>15mm) who underwent prenatal repair, with fetuses with severe ventriculomegaly who underwent postnatal repair and fetuses with ventriculomegaly (<15mm) who underwent prenatal repair. This was a retrospective study of fetuses with MMC that underwent prenatal or postnatal repair between 2012 and 2021 at a single institution. The cohort was divided based on preoperative fetal ventricular size into two groups, those with severe ventriculomegaly (≥15 mm) and those without severe ventriculomegaly (<15 mm). Fetal ventricular size was measured by MRI prior to surgery using the standardized approach and the mean of the left and right ventricle was used for analysis. Motor function of lower extremities was assessed at the time of referral by ultrasound and if flexion-extension movements of the ankle were seen, it was considered as preserved S1 motor function. Postnatal outcomes including motor function of lower extremities assessed at birth and need for diversion procedure for hydrocephalus treatment during the first year of life were collected and compared between groups. Data was presented as median and range or number and percentages as appropriate. P value >0.05 was considered statistically significant. Multivariate regression analysis was used to adjust for potential confounders. 154 patients were included in this study: 145 patients underwent fetal surgery (101 fetoscopic and 44 open hysterotomy) and 9 patients with severe ventriculomegaly underwent postnatal repair. Among the 145 patients who underwent fetal surgery, 22 presented with severe ventriculomegaly. Prenatally repaired fetuses with severe ventriculomegaly at referral were at a significantly higher need for hydrocephalus treatment by 12 months than those without severe ventriculomegaly (62% vs. 29%, p<0.01). However, motor function assessment at birth was similar between both prenatally repaired groups (OR=0.92, 95% CI [0.33-2.59], p=0.88) adjusted for the anatomical level of the lesion. The prenatally repaired group with severe ventriculomegaly had better preserved motor function levels at birth compared to the postnatal repair group with severe ventriculomegaly (L3 with 11.1% S1 motor function; p=<0.01 and p=<0.01). Prenatally repaired patients with severe ventriculomegaly had an 18.9 times chance of having an intact motor function at birth [95% CI (1.2 - 290.1)] adjusted for ethnicity, presence of clubfeet at referral, and gestational age at delivery compared to postnatal repair. There was not a significant difference in the need for hydrocephalus treatment in the first year of life between prenatal and postnatal repair of patients with severe ventriculomegaly (61.9% vs 87.5%, p=0.18). Although fetuses with MMC and severe ventriculomegaly do not seem to benefit from fetal surgery in terms of postnatal hydrocephalus treatment, they benefit from increased chance of preserved motor function at birth. Results from this study highlight the benefits of having prenatal MMC repair for cases with severe ventriculomegaly at referral to preserve motor function. This article is protected by copyright. All rights reserved.

The protective effects of repetitive transcranial magnetic stimulation with different high frequencies on motor functions in MPTP/probenecid induced Parkinsonism mouse models.

High-frequency repeated transcranial magnetic stimulation (rTMS) stimulating the primary motor cortex (M1) is an alternative, adjunctive therapy for improving the motor symptoms of Parkinson's disease (PD). However, whether the high frequency of rTMS positively correlates to the improvement of motor symptoms of PD is still undecided. By controlling for other parameters, a disease animal model may be useful to compare the neuroprotective effects of different high frequencies of rTMS. The current exploratory study was designed to compare the protective effects of four common high frequencies of rTMS (5, 10, 15, and 20Hz) and iTBS (a special form of high-frequency rTMS) and explore the optimal high-frequency rTMS on an animal PD model. Following high frequencies of rTMS application (twice a week for 5weeks) in a MPTP/probenecid-induced chronic PD model, the effects of the five protocols on motor behavior as well as dopaminergic neuron degeneration levels were identified. The underlying molecular mechanisms were further explored. We found that all the high frequencies of rTMS had protective effects on the motor functions of PD models to varying degrees. Among them, the 10, 15, and 20Hz rTMS interventions induced comparable preservation of motor function through the protection of nigrostriatal dopamine neurons. The enhancement of brain-derived neurotrophic factor (BDNF), dopamine transporter (DAT), and vesicular monoamine transporter 2 (VMAT-2)and the suppression of TNF-α and IL-1β in the nigrostriatum were involved in the process. The efficacy of iTBS was inferior to that of the above three protocols. The effect of 5Hz rTMS protocol was weakest. Combined with the results of the present study and the possible side effects induced by rTMS, we concluded that 10Hz might be the optimal stimulation frequency for preserving the motor functions of PD models using rTMS treatment.

The relationship between the structural changes in the cervical spinal cord and sensorimotor function of children with thoracolumbar spinal cord injury (TLSCI)

Study designCross-sectional study.ObjectivesTo study the relationship between the structural changes in the cervical spinal cord (C2/3 level) and the sensorimotor function of children with traumatic thoracolumbar spinal cord injury (TLSCI) and to discover objective imaging biomarkers to evaluate its functional status.SettingXuanwu Hospital, Capital Medical University, China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, China.Methods30 children (age range 5–13 years) with TLSCI and 11 typically developing (TD) children (age range 6–12 years) were recruited in this study. Based on whether there is preserved motor function below the neurological level of injury (NLI), the children with TLSCI are divided into the AIS A/B group (motor complete) and the AIS C/D group (motor incomplete). A Siemens Verio 3.0 T MR scanner was used to acquire 3D high-resolution anatomic scans covering the head and upper cervical spinal cord. Morphologic parameters of the spinal cord at the C2/3 level, including cross-sectional area (CSA), anterior-posterior width (APW), and left-right width (LRW) were obtained using the spinal cord toolbox (SCT; https://www.nitrc.org/projects/sct). Correlation analyses were performed to compare the morphologic spinal cord parameters and clinical scores determined by the International Standard for Neurological Classification of Spinal Cord Injuries (ISNCSCI) examination.ResultsCSA and LRW in the AIS A/B group were significantly lower than those in the TD group and the AIS C/D group. LRW was the most sensitive imaging biomarker to differentiate the AIS A/B group from the AIS C/D group. Both CSA and APW were positively correlated with ISNCSCI sensory scores.ConclusionsQuantitative measurement of the morphologic spinal cord parameters of the cervical spinal cord can be used as an objective imaging biomarker to evaluate the neurological function of children with TLSCI. Cervical spinal cord atrophy in children after TLSCI was correlated with clinical grading; CSA and APW can reflect sensory function. Meanwhile, LRW has the potential to be an objective imaging biomarker for evaluating motor function preservation.

Outcomes of complete neurotomy and immediate repair of the musculocutaneous nerve for treatment of elbow spasticity.

Neurotomy interrupts the stretch reflex and can be used for the treatment of spasticity. We hypothesized that neurotomy with nerve repair reduces spasticity while preserving motor function due to the preferential recovery of efferent over afferent fibres. This study reports the 1-year outcomes of neurotomy and immediate repair of the musculocutaneous nerve in the proximal arm for treatment of elbow flexor spasticity, comparing these to outcomes in the literature for neurectomy without nerve repair. A total of 10 adult patients with spasticity of the elbow flexors from stroke or traumatic brain injury who had undergone neurotomy and immediate repair of the musculocutaneous nerve were prospectively studied. The results suggest that this procedure effectively reduces elbow flexor spasticity, improves elbow resting position, active elbow extension and is useful for achieving patient goals with effects lasting at least 12 months.Level of evidence: IV (therapeutic).

Maximal Resection of Gliomas Adjacent to the Corticospinal Tract Using 3-T Intraoperative Magnetic Resonance Imaging

BackgroundGliomas adjacent to the corticospinal tract (CST) should be carefully resected to preserve motor function while achieving maximal surgical resection. Modern high-field intraoperative magnetic resonance imaging (iMRI) enables precise visualization of the residual tumor and intraoperative tractography. We prospectively evaluated the extent of resection and distance between the tumor resection cavity and CST using 3-T iMRI combined with motor evoked potentials (MEP) in glioma surgery. MethodParticipants comprised patients who underwent surgery for solitary supratentorial glioma located within 10 mm of the CST. All cases underwent surgery using neuronavigation with overlaid CST under MEP monitoring. The correlation between distance from CST and transcortical MEP amplitude was calculated using Spearman rank correlation. ResultsAmong the 63 patients who underwent surgery, 27 patients were enrolled in the study. Gross total resections were achieved in 26 of the 27 cases. Volumetric analysis showed the extent of resection was 98.6%. Motor function was stable or improved in 24 patients (Stable/Improved group) and deteriorated in 3 patients (Deteriorated group). All patients in the Deteriorated group showed motor deficit before surgery. Mean intraoperative minimal distance was significantly longer in the Stable/Improved group (7.3 mm) than in the Deteriorated group (1.1 mm; p < 0.05). MEP amplitude correlated with minimal distance between the resection cavity and CST (R=0.64). ConclusionsResection of gliomas adjacent to CST with a navigation system using 3-T iMRI could result in an ultimate EOR >98%. The combination of intraoperative tractography and MEP contributes to maximal removal of motor-eloquent gliomas.

The Potential Role of Wearable Inertial Sensors in Laboring Women with Walking Epidural Analgesia.

There is a growing interest in wearable inertial sensors to monitor and analyze the movements of pregnant women. The noninvasive and discrete nature of these sensors, integrated into devices accumulating large datasets, offers a unique opportunity to study the dynamic changes in movement patterns during the rapid physical transformations induced by pregnancy. However, the final cut of the third trimester of pregnancy, particularly the first stage of labor up to delivery, remains underexplored. The growing popularity of "walking epidural", a neuraxial analgesia method allowing motor function preservation, ambulation, and free movement throughout labor and during delivery, opens new opportunities to study the biomechanics of labor using inertial sensors. Critical research gaps exist in parturient fall prediction and detection during walking epidural and understanding pain dynamics during labor, particularly in the presence of pelvic girdle pain. The analysis of fetal descent, upright positions, and their relationship with dynamic pelvic movements facilitated by walking during labor is another area where inertial sensors can play an interesting role. Moreover, as contemporary obstetrics advocate for less restricted or non-restricted movements during labor, the role of inertial sensors in objectively measuring the quantity and quality of women's movements becomes increasingly important. This includes studying the impact of epidural analgesia on maternal mobility, walking patterns, and associated obstetrical outcomes. In this paper, the potential use of wearable inertial sensors for gait analysis in the first stage of labor is discussed.

Effects of Different Volumes of Ropivacaine for Pericapsular Nerve Group Block on Incidence of Quadriceps Weakness and Analgesic Efficacy Following Hip Arthroplasty: A Randomized Controlled Trial.

The pericapsular nerve group (PENG) block has been shown to be an effective approach to alleviating pain and reducing the need for opioids among older adults following hip surgery, with possible motor-sparing effects. No reports to date, however, have described appropriate ropivacaine volumes for use in the context of PENG block. The present prospective randomized controlled study was thus developed to assess the quadriceps muscle strength and analgesic efficacy associated with PENG block performed using three different volumes of 0.33% ropivacaine following general anesthesia in older adults undergoing hip arthroplasty. In this prospective randomized double-blind controlled clinical study, 60 patients were assigned at random to undergo ultrasound-guided PENG block for hip arthroplasty using different volumes of ropivacaine. Specifically, these patients were administered 10ml (Group A, n = 20), 20ml (Group B, n = 20), or 30ml (Group C, n = 20) of 0.33% ropivacaine. Quadriceps muscle strength was evaluated at 6h post-surgery. Visual analog scale (VAS) scores at rest and with movement were assessed at 4, 6, 12, and 24h post-surgery. Block duration, adverse event incidence, and patient satisfaction were evaluated at 24h post-surgery. Quadriceps motor block incidence rates at 6h post-surgery in the 10ml, 20ml, and 30ml groups were 5%, 20%, and 75%, respectively. Quadriceps muscle weakness at 6h post-surgery was significantly more common in the 30ml group relative to the others (p < 0.001). Patients administered 10ml 0.33% ropivacaine exhibited significantly higher VAS pain scores at rest and with movement relative to those patients in the 20ml and 30ml treatment groups at all time points (p < 0.05). No apparent differences in analgesic efficacy were observed when comparing the 20ml and 30ml groups at 4, 6, 12, and 24h post-surgery. No significant differences in block duration, satisfaction, or adverse event incidence were observed among groups. The preservation of motor function in the 20ml 0.33% ropivacaine group was superior to that in the 30ml 0.33% ropivacaine group. Relative to the group that received 10ml 0.33% ropivacaine during PENG block, those elderly patients administered 20ml and 30ml volumes of 0.33% ropivacaine experienced superior postoperative pain relief following hip arthroplasty.

Combination of neuroendoscopic hematoma evacuation and endovascular coil embolization for a ruptured anterior choroidal artery aneurysm in patients with moyamoya disease: illustrative cases.

The treatment strategy for hemorrhagic moyamoya disease (MMD) due to a ruptured aneurysm at the distal portion of the anterior choroidal artery remains controversial. The authors successfully treated the ruptured aneurysm with neuroendoscopic hematoma evacuation, followed by endovascular coil embolization. The authors encountered two patients with massive hemorrhagic MMD whose MMD had already been diagnosed and who had a periventricular anastomosis due to a ruptured aneurysm of the distal portion of the anterior choroidal artery involving the periventricular anastomosis. In both cases, neuroendoscopic hematoma evacuation was performed for hemorrhagic MMD in the acute phase, followed by endovascular coil embolization of the ruptured aneurysm in the chronic phase. In both endovascular treatments, the patient's condition was stabilized by hematoma evacuation, allowing a detailed preoperative evaluation of the anatomical findings of the vessel and functional findings of intraoperative neurophysiological monitoring using continuous monitoring of motor evoked potentials to preserve motor function. Combination therapy can be useful for hemorrhagic MMD in patients with diagnosed MMD with a periventricular anastomosis. Additionally, a preoperative understanding of the vascular construction and intraoperative neurophysiological monitoring will aid in the successful coil embolization of aneurysms at the distal portion of the anterior choroidal artery with hemorrhagic MMD.

Can Robotic Gait Training with End Effectors Improve Lower-Limb Functions in Patients Affected by Multiple Sclerosis? Results from a Retrospective Case-Control Study.

Background: Multiple sclerosis (MS) is characterized as a neurodegenerative condition possibly triggered by autoimmune mechanisms, impacting the entire central nervous system. In this context, neurorehabilitation plays a crucial role in every phase of the disease, aiming to restore and preserve motor functions in MS patients. In particular, robotic gait training (RGT) allows intensive, repetitive, and task-oriented training, which is pivotal in boosting neuroplastic processes. Thus, the primary aim of our study is to evaluate the effectiveness of innovative robotic gait training, using the G-EO system, on gait, functional abilities, and quality of life (QoL) in patients affected by MS. Secondly, we evaluated the effect of the robotic rehabilitation on lower-limb motor functioning, balance, sensation, and joint functioning. Methods: The study involved twenty MS patients, divided into two groups with comparable medical characteristics and rehabilitation training duration. The experimental group (EG) underwent robotic gait training with the G-EO system (n. 10), while the control group (CG) received traditional rehabilitation training (n. 10). Results: Both groups exhibited improvements in disability level (Functional Independence Measure), 10 m walking distance (10MWT), gait, and balance performance (Functional Ambulation Classification, Tinetti Scale). However, the EG demonstrated a more significant improvement. The G-EO system notably reduced spasticity in the lower limbs (Modified Ashworth Scale) exclusively in the EG. Discussion: This study suggests that the G-EO system could be a valuable tool for enhancing gait functions, including lower-limb movements, functional abilities, and QoL in individuals with MS.

Significance of navigated transcranial magnetic stimulation and tractography to preserve motor function in patients undergoing surgery for motor eloquent gliomas

Resection of gliomas in or close to motor areas is at high risk for morbidity and development of surgery-related deficits. Navigated transcranial magnetic stimulation (nTMS) including nTMS-based tractography is suitable for presurgical planning and risk assessment. The aim of this study was to investigate the association of postoperative motor status and the spatial relation to motor eloquent brain tissue in order to increase the understanding of postoperative motor deficits.Patient data, nTMS examinations and imaging studies were retrospectively reviewed, corticospinal tracts (CST) were reconstructed with two different approaches of nTMS-based seeding. Postoperative imaging and nTMS-augmented preoperative imaging were merged to identify the relation between motor positive cortical and subcortical areas and the resection cavity.38 tumor surgeries were performed in 36 glioma patients (28.9% female) aged 55.1 ± 13.8 years. Mean distance between the CST and the lesion was 6.9 ± 5.1 mm at 75% of the patient-individual fractional anisotropy threshold and median tumor volume reduction was 97.7 ± 11.6%. The positive predictive value for permanent deficits after resection of nTMS positive areas was 66.7% and the corresponding negative predictive value was 90.6%. Distances between the resection cavity and the CST were higher in patients with postoperative stable motor function. Extent of resection and distance between resection cavity and CST correlated well.The present study strongly supports preoperative nTMS as an important surgical tool for preserving motor function in glioma patients at risk.

Outcome and complications of operatively treated subaxial cervical spine injuries: A population-based retrospective cohort study

ObjectiveThe aim was to study the outcome and complications of operative treatment for subaxial cervical spine injuries with respect to injury morphology and surgical strategy. MethodsA population-based cohort of 271 consecutive patients treated at Kuopio University Hospital from 2003 to 2018 was retrospectively reviewed. ResultsThe mean age was 52.4 (range 12–90) years and 78.6% were male. The AOSpine morphological classification was C in 56.5%, B in 24.7% and A in 17.0% of cases. The surgical approach was anterior in 70.8%, posterior in 20.3% and combined in 8.9% of patients. Fixation alignment was maintained in 96.9% of patients. Instrumentation failures were observed only in patients operated anteriorly but no statistical difference was found between the surgical approaches. The American Spinal Injury Association Impairment Scale (AIS) grade improved in 22.1% of patients. Patients with preoperative AIS grade C had significant potential for neurological improvement (OR 10.44; 95% CI 1.77–61.56; p = 0.010). Postoperative, mostly mild, complications manifested in 22.5% of patients. The posterior approach was associated with fewer postoperative complications (OR 0.18; 95% CI 0.06–0.51; p = 0.001). Preoperative AIS grade A was a significant predisposing factor for complications (OR = 4.90; 95% CI = 1.49–16.10; p = 0.009). The perioperative (90-day) mortality rate was 3.3%. The mean follow-up period was 64.7 ± 25.9 (radiological)/136.7 ± 174.8 (clinical) days. ConclusionsOperative treatment is safe and effective but the surgical approach should be patient- and injury-specific. The prognosis for neurological recovery from spinal cord injury is superior in patients with partially preserved motor function.