Sensory Disturbances Research Articles

Reconstruction of the Infraorbital Nerve Using Bilayered Artificial Nerve Conduits after Partial Maxillectomy.

Facial sensory nerves play vital roles in daily functions like self-protection, facial expressions, speaking, and eating. Severing the infraorbital nerve (ION) during partial maxillectomy via the Weber-Ferguson incision can lead to sensory disturbances. This study presents immediate ION reconstruction using artificial nerve conduits and its short-term outcomes. This retrospective study included three patients (mean age: 67.0 years) undergoing immediate ION reconstruction after partial maxillectomy via the Weber-Ferguson incision. Sensory recovery was evaluated using the Semmes-Weinstein and two-point discrimination (2PD) tests. A reference group of five patients who underwent total maxillectomy without ION reconstruction was also assessed. No postoperative complications were observed during the 15.3-month follow-up. Sensory recovery varied among patients, with one achieving normal perception at 24 months, another showing diminished light touch at 13 months, and the third experiencing diminished protective sensation at 7 months postoperatively. In comparison, the reference group showed lower sensory recovery. Two patients showed improvements in 2PD test results at 24 and 13 months, whereas one showed no recovery at 7 months. No patients in the reference group showed improvement. Immediate ION reconstruction using artificial nerve conduits after partial maxillectomy appears feasible, as evidenced by acceptable sensory recovery in the short term.

Cervical motion analysis using wearable inertial sensors to patients with cervical ossification of posterior longitudinal ligament.

This study aimed to clarify cervical kinematics during daily activities, including level walking and stair ascending, in patients with cervical ossification of the posterior longitudinal ligament (C-OPLL). Eighteen patients with myelopathy caused by C-OPLL and 18 healthy controls were recruited to participate in the study. The sagittal cervical kinematics during level walking and stair ascent were quantitatively assessed using a motion analysis system based on wearable inertial sensors. The Japanese Orthopaedic Association score, Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, Neck Disability Index, and deep sensation in the lower extremities were assessed in all participants. Nine of 18 patients with C-OPLL presented with deep sensory disturbances. Patients with C-OPLL with deep sensory disturbances exhibited different sagittal plane cervical motion patterns than healthy controls during level walking and stair ascent. During the first phase of stair ascent, both patients with C-OPLL and healthy controls flexed their necks to the same degree; however, during the middle and final phases of stair ascent and all phases of level walking, the mean cervical flexion angle of patients with C-OPLL with deep sensory disturbances was significantly higher than that of patients with C-OPLL without deep sensory disturbance and healthy controls. Our data suggest that patients with C-OPLL presenting with deep sensory disturbances are likely to walk with their necks flexed and gaze downward to observe their steps throughout their daily lives. This habitual neck posture may lead to a vicious cycle of cervical kyphosis and worsening of compressive myelopathy.

Cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS): a family with five affected sibs from Turkey

BackgroundCerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS), a relatively common cause of late-onset progressive ataxia, is a genetic disease characterised by biallelic pentanucleotide AAGGG repeat expansion in intron 2 of the replication factor complex subunit 1 gene. Herein, we describe the first molecularly confirmed CANVAS family with five affected siblings from Turkey.Case presentationThe family comprised seven siblings born from healthy non-consanguineous parents. CANVAS phenotype was present in five of them; two were healthy and asymptomatic. Chronic cough was the first symptom reported in all five siblings, followed by the development of sensory symptoms, oscillopsia and imbalance. Clinical head impulse test (HIT) was positive in all cases and video HIT performed on three patients revealed very low vestibulo-ocular reflex gains bilaterally. Magnetic resonance imaging and nerve conduction studies revealed cerebellar atrophy and sensory neuronopathy, respectively. RP-PCR confirmed the homozygous presence of the AAGGG repeat expansion in all five cases.ConclusionGenetic screening for CANVAS should be considered in all patients with late-onset ataxia, sensory disturbances and vestibular involvement, especially in the presence of chronic cough.

Risk factors of postoperative trigeminal neuropathy in surgical treatment of trigeminal schwannomas.

Trigeminal schwannomas are rare benign tumors originating from the Schwann cells of the trigeminal nerve. Despite the common occurrence of trigeminal neuropathy in trigeminal schwannomas, a detailed analysis has not yet been performed because of the rarity of this disease. This study aimed to analyze trigeminal neuropathy in trigeminal schwannoma resection and identify the risk factors for postoperative worsening of trigeminal neuropathy. A retrospective analysis of 86 surgical cases was performed at our institution between 1975 and 2018. Obtained parameters included age, sex, diagnosis, reoperation, tumor size, tumor location, presence or absence of cysts, surgical approach, degree of tumor removal, and pre/postoperative trigeminal neuropathy. Uni- and multivariate analyses were performed to identify the risk factors for worsening postoperative sensory disturbances. Of 83 patients, 58.1% had preoperative trigeminal neuropathy. Postoperative sensory disturbance occurred in 27.9%, with worsening in two cases and de novo symptoms in 22 cases. Regarding risk factors for worsening postoperative sensory disturbances, older age, smaller tumor size, middle and posterior (MP) type, gross total removal (GTR), and anterior transpetrosal approach were identified in the univariate analysis, while MP type and GTR were identified in the multivariate analysis. This study analyzed trigeminal neuropathy in trigeminal schwannomas in detail and identified tumor location and removal rate as risk factors for worsening postoperative sensory disturbances. Treatment strategies to reduce the risk of trigeminal neuropathy should be considered.

SLEEP DISORDERS AMONG INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES: A COMPREHENSIVE ANALYSIS

Sleep problems in individuals with developmental disabilities pose significant challenges for them and their families. This paper aims to examine the types of sleep problems in these individuals, the causes of these issues, and their impact on daily life. Through the analysis of available literature and research conducted on a sample of 67 individuals with special needs and their parents, data are obtained on the prevalence of sleep problems, influential factors, and methods for coping with them. The results show that sleep problems in individuals with developmental disabilities are significant and can seriously impact their quality of life. More than 70% of parents state that the lack of sleep negatively affects their daily life and professional activities. The main causes of sleep problems have been identified as sensory disturbances, melatonin deficiency, and other health issues related to the child's condition. Additionally, 73.4% of parents report that they cope with their children's sleep problems independently. These findings suggest a need for improved strategies and interventions for managing sleep in individuals with developmental disabilities, including enhanced support for parents. The significance of these findings lies in highlighting the need for the development of specialized programs and interventions that will help improve the quality of life for these individuals and their families.<p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/soc/0153/a.php" alt="Hit counter" /></p>

Dopaminergic neurodegeneration in Gerstmann-Sträussler-Scheinker (P102L) disease: insights from imaging and pathological examination.

Gerstmann-Sträussler-Scheinker (GSS) disease is an inherited prion disease characterized by dementia, cerebellar ataxia, and painful sensory disturbances. GSS is pathologically defined by the presence of amyloid plaques comprised of prion protein predominantly localized in the cerebral cortex, cerebellar cortex, and basal ganglia, resulting from mutations in the prion protein gene. This study investigated five cases of GSS P102L [GSS caused by a leucine (L) substitution of proline (P) at position 102 of the prion protein gene] with L-dopa-resistant extrapyramidal symptoms and reduced dopamine transporter single-photon emission computed tomography (DAT-SPECT) uptake. Clinical findings revealed diverse manifestations, with all cases exhibiting parkinsonism, and four patients had a vertical gaze palsy. Notably, all patients showed reduced striatal DAT-SPECT uptake, indicating neurodegeneration of the nigrostriatal system. Autopsy findings in one case confirmed prion protein plaques and dopaminergic neuron loss in the substantia nigra of a patient with GSS P102L. Additionally, reduced DAT immunostaining was observed in the putamen compared with a control. While previous studies have identified reduced DAT-SPECT and positron emission tomography uptake in Creutzfeldt-Jakob disease and fatal familial insomnia owing to nigrostriatal neurodegeneration induced by abnormal prion protein deposition, similar phenomena in GSS P102L have not been reported. This study provides support for a correlation between abnormal prion protein deposition and nigrostriatal system degeneration in GSS P102L. Our results reveal the importance of considering GSS P102L in cases of atypical Parkinsonism and abnormal DAT-SPECT results, which would serve as a valuable indicator for subsequent prion genetic testing.

Adverse Events and Efficacy of Acetazolamide in Meniere's Disease in a Vertigo Outpatient Clinic: A Retrospective Study.

Background Acetazolamide, a carbonic anhydrase inhibitor, is used in the treatment of several otolaryngological conditions, including Meniere's disease (MD). Despite its efficacy in reducing vertigo attacks, it is associated with a high rate of adverse events such as sensory disturbances, electrolyte imbalances, and liver dysfunction. The primary objective of this study is to evaluate the efficacy of acetazolamide in reducing vertigo attacks in MD patients. The secondary objective is to determine the incidence and severity of adverse drug events associated with acetazolamide treatment in this patient population. Methodology The study subjects were 70 patients who visited the vertigo outpatient clinic of our department from March 2019 to July 2024 and were diagnosed with definite or probable MD. Results A total of 15 cases had a history of acetazolamide prescription, with doses ranging from 125 to 750 mg/day. In total, 12 (80%) patients had symptoms of numbness in hands, feet, or other parts of the body, which caused discontinuation of medication after the initial prescription in five cases. Hypokalemia with liver dysfunction and hypokalemia with an open fracture of the distal end of the right radius due to staggering were observed in one patient each. In both cases of hypokalemia, Chinese herbal medicines containing licorice were prescribed in combination. Overall, 11 (73%) cases had a decrease in vertigo attacks. Hearing thresholds did not recover significantly after the prescription. Conclusions Although acetazolamide is effective in preventing vertigo attacks of MD, the rate of adverse events is high. Detailed instructions, careful dosage adjustment, periodic assessment of symptoms, and blood examinations for electrolyte and liver function are required.

Porphyria in pregnancy with exacerbation after delivery due to COVID-19

We present a case of acute intermittent porphyria (AIP) diagnosed in a pregnant woman with subsequent exacerbation after delivery due to COVID-19 infection. The patient’s symptoms manifested with acute neurovisceral attacks - abdominal pain followed by flaccid quadriparesis, sensory disturbances, hypertension and disturbance in electrolyte levels. The blood plasma test and a 24-hour urine collection revealed increased levels of urine porphobilinogen, 5-aminolevulinic acid and uroporphyrins, which led to the diagnosis of AIP. The patient received i.v. human hemin with positive outcome. After delivery she was again admitted to the hospital due to abdominal pain and trunk hyperesthesia that occurred after a mild course of COVID-19 infection. The second administration of human hemin led to the improvement of the patient's condition. The aim of this case report is to indicate that even with severe risk factors of AIP such as infection and pregnancy, proper diagnostics can increase the chance of quick recovery.

Evaluation of Risk Factors, Clinical Spectrum and Management of New Onset Seizure

A seizure is a brief deviation from the brain's regular electrical activity that alters awareness and behavior. Seizures are brief burst so fun controllable movement that can affect either a piece of the body (partial) or the full body (generalized) and are frequently followed by a loss of awareness and control over bowel or bladder function. Epilepsy is distinguished by recurring seizures. Epilepsy is a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, associated with abnormal electrical activity in the brain. The goal of the study is to find out risk factors and prescribing pattern of antiseizure drugs in different types of seizure disorder. An educational observational study was carried out among 42 samples in the In-patient Department of General Medicine, ESI MC- PGIMSR, and Rajajinagar. The data was collected using self-designed data collection form. All information’s were processed and analyzed by using Microsoft excel. It was observed that a majority of the subjects involved in the study was prescribed with Levetiracetam (69.81%). A high prevalence of New onset seizure with risk factor of CVS causes (36.92%) and Alcohol withdrawal (20%) was observed. In CVS cause, stroke was prominent. From this study, generalized tonic clonic seizure was most commonly observed type of seizure and Levetiracetam was most frequently prescribed drug to them. Majority of patients were given mono therapy to achieve seizure control.

YOGA CAN AMELIORATE QUALITY OF LIFE OF PATIENTS WITH MULTIPLE SCLEROSIS: A REVIEW

Multiple sclerosis (MS) is a condition in which the body's immune system mistakenly attacks the central nervous system (CNS). MS is characterised by the presence of inflammation, demyelination, and the formation of scar (sclerosis) in the white matter of the brain and spinal cord. This leads to a wide range of symptoms associated with multiple sclerosis, encompassing physical, emotional, and psychological manifestations such as fatigue, chronic pain, impaired mobility, imbalance, spasticity, cognitive impairment, depression, bladder and bowel dysfunction, visual and speech impairments and sensory disturbances. Currently, the aetiology and treatment for MS are still unidentified, and it impacts over 2.8 million individuals globally. Disease modifying therapy (DMT) for MS, which aids in reducing the development of lesions in the white matter of the central nervous system (CNS), is expensive and has notable side effects. Consequently, individuals diagnosed with MS are increasingly turning to complementary and alternative medicine (CAM) as a means to alleviate or conquer MS symptoms and improve their overall quality of life. Among the many kinds of CAM, yoga has emerged as a particularly popular choice. The present review aims to elucidate the possible influence of yoga on enhancing the quality of life in individuals diagnosed with MS. A comprehensive search was undertaken on Google Scholar, included fourteen publications published between 2004 and February 2024. Based on the available data of low to moderate quality, yoga seems to be useful in enhancing the quality of life for individuals with MS.

Sensory dysfunction in SMA type 2 and 3 - adaptive mechanism or concomitant target of damage?

BackgroundThe motor neuron survival protein performs numerous cellular functions; hence, spinal muscular atrophy (SMA) is considered to be a multi-organ disease with possible sensory system damage. The controversy surrounding the presence of sensory disturbances, prompted us to conduct standard electrophysiological studies and assess the sensory thresholds for different modalities in adults with SMA types 2 and 3. The study group consisted of 44 adult SMA patients (types 2 and 3). All patients underwent neurological examination using the Hammersmith Functional Motor Scale – Expanded (HFMSE). Standard sensory electrophysiological studies in the ulnar nerve and the estimation of vibratory, temperature, and warm- and cold-induced pain thresholds with temperature dispersion assessment were performed using quantitative sensory testing (QST).ResultsThe most repeatable result was the high amplitude of the sensory nerve action potentials (SNAP) in SMA patients compared to controls. This was higher in type 2 patients compared to type 3a and 3b patients and patients with low HFSME scores. Patients with SMA, especially type 3b presented a longer sensory latency and slower conduction velocity than did controls. Cold pain threshold was higher and warm dispersion larger in SMA. The vibratory limit was higher in patients with high HFSME scores.ConclusionsA high SNAP amplitude suggests sensory fibre hyperactivity, which may be based on overactivation of metabolic pathways as an adaptive mechanism in response to SMN protein deficiency with additionally coexisting small C- and A-delta fibre damage. SMA patients seem to have a concomitant, mild demyelinating process present at the early SMA stage.

Use of Ketamine in Patients with Multifactorial Neuropathic Pain: A Systematic Review and Meta-Analysis.

Neuropathic pain (NP) is a heterogeneous group of conditions characterized by the experience of a number of sensory disturbances including pain, burning sensations, paroxysms of stabbing pain, dysesthesias, allodynia, and hyperalgesia. The above-mentioned sensations may occur in a specific dermatome area or other delimited region of the body. The objective of this review was to analyze the evidence for ketamine in multifactorial neuropathic pain. The research group systematically searched the databases MEDLINE (via PubMed), EMBASE, SCOPUS, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health Literature (Cinahl), and the Web of Science. The findings of this review show that different forms of low doses of ketamine (LDK) do not present statistically significant changes for any of the scales included. In this study, the total symptom score [standardized mean difference (SMD) = -3.59, confidence interval (CI) = -4.16 to -3.02, and p < 0.00001], neuropathy impairment score (SMD = -1.42, CI = -3.68 to 0.84, and p = 0.22), and neuropathy symptom checklist (SMD = -0.09, CI = -0.15 to -0.02, and p = 0.01) were taken into account. For finality compared to the use of a placebo, the findings suggest that LDK does not exhibit significant differences in terms of pain reduction and functionality. Moreover, no specific dosages are identified to support the use of LDK in the reduction in NP.

Fibrin clot augmentation of high-risk meniscal repairs may result in clinical healing in up to 90% of cases

ObjectiveWhile meniscal repair is preferable to meniscectomy, some cases may be at higher risk of failure if repaired. Incorporating fibrin clot (FC) into the repair has been proposed to improve healing rates. The purpose of this study was to determine the failure rates, patient reported outcome measures (PROMs) and complications of FC augmented meniscal repair for cases considered to be at higher risk of failure. MethodsA retrospective case series of all patients undergoing FC augmented repair of isolated meniscus tears between January 2016 and September 2021 was undertaken. All cases were thought be at higher risk of failure; they included chronic, radial, complex, horizontal cleavage, and tears not in the red–red zone. Patients were excluded if they had a concomitant anterior cruciate ligament (ACL) reconstruction or if the repair was done through an open incision. The primary outcome was clinical failure defined as further repair or debridement. Secondary outcomes were PROMs and surgical complications. PROMs collected were Lysholm score, Knee injury and Osteoarthritis Outcome Score, Oxford Knee Score and the Tegner score. ResultsFifty one inside-out meniscal repairs using FC were performed in 50 patients (62% male). The mean age was 34 years (range 14–70). The median time from injury to repair was 122 days (range 4–1565). The medial meniscus was repaired in 63% of cases. Tear types included radial (31%) and complex (39%) and 71% of cases included repair of the white–white zone. 16% of cases were revision meniscal repairs. FC was used in 43% of isolated meniscal repairs during the study period. All patients were followed up to a median of 46 months (range 22–87 months). PROMs at a median of 30 months post-operatively showed statistically significant improvements. Five patients (10%) underwent further surgery for failure after median 21 months. Two patients (4%) reported sensory disturbance around their skin wounds, no other complications were reported. 13% of medial meniscal repairs failed, whereas only 5% of lateral meniscal repairs failed (p ​= ​0.4). ConclusionsFC augmented meniscal repair performed for tears considered to be at higher risk of failure may result in acceptably low rates of clinical failure. Level of evidenceLevel IV, case series.

Novel case of anastomosing hemangioma of the extradural space: illustrative case.

Anastomosing hemangiomas are benign vascular neoplasms occurring mainly in the genitourinary tract and paraspinal soft tissues. There have been no reported cases of anastomosing hemangiomas occurring in the spinal epidural space; therefore, their clinical and radiological presentations remain unclear. A 55-year-old man presented with progressive back pain and motor and sensory disturbances in both lower extremities. Magnetic resonance imaging (MRI) revealed an extradural lesion at the T4-6 level that extended into the extraspinal region through the left T5-6 intervertebral foramen. Axial MRI revealed that the tumor encircled the spinal cord, with sharp horn-like ends in the intraspinal canal. The patient underwent complete tumor resection with T4-6 laminectomy and left T5-6 foraminotomy. The histopathological diagnosis was an anastomo-sing hemangioma exhibiting anastomosing proliferation of capillary vessels with hobnailed endothelial cells. His symptoms improved, and tumor control was achieved 4 months after surgery without adjuvant therapy. Although rare, anastomosing hemangiomas can occur in the spinal epidural space. Radiologically, the tumors show horn-like projections encircling the spinal cord, which can be diagnostic cues. Anastomosing hemangiomas should be included in the differential diagnosis of spinal epidural tumors, especially when characteristic horn-like projections are present. https://thejns.org/doi/10.3171/CASE24265.

Treatment of Fourth Metatarsal Brachymetatarsia Using Distraction Osteogenesis with External Fixator: Surgical Techniques, Outcomes and Complications.

Surgical technique in distraction osteogenesis for the treatment of brachymetatarsia can influence the final prognosis. However, there are currently no standardized guidelines for surgical procedures and complication management. The aim of this study is to investigate the effect of bone lengthening with external fixation by minimally invasive osteotomy based on Ilizarov technique in the treatment of congenital brachymetatarsia. A retrospective study was conducted on patients with congenital brachymetatarsia treated by metatarsal lengthening, from June 2017 to December 2020. There were 11 patients with 17 shorted fourth metatarsals, including 10 females and 1 male, with age of 24.6 ± 4.5 years (16-31 years). Six patients were bilaterally involved. Orthofix external fixator mini track was installed through dorsal approach and the fourth MTP joints were temporarily fixed by Kirschner wire. Bone lengthening was performed after a minimally invasive osteotomy at the proximal metatarsals. American Orthopedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal (MTP-IP) scores, metatarsal length, complications were recorded. Statistical comparison was performed using the paired t-student test for pre- and postoperative AOFAS MTP-IP scores. Patients were followed up for 55 ± 10.8 months. The mean length of the fourth metatarsal bone was 49.9 ± 2.9 mm preoperatively. The mean metatarsal shortage was 18.8 ± 3.1 mm. The mean lengthening achieved was 19.8 ± 3.3 mm, with a lengthening ratio of 39.7% ± 6.6%. The lengthened callus ossified completely at 3-4 months after operation. All patients were satisfied with the results of lengthening. The AOFAS scores were improved significantly from 83.7 ± 4.2 preoperatively to 93.2 ± 2.7 postoperatively (t = -10.27, p < 0.001). One patient with traumatic metatarsophalangeal joint subluxation was treated by joint reduction and Kirschner wire fixation. One patient had metatarsophalangeal joint release and Kirschner wire fixation due to flexion contracture. Pin tract infections were controlled by wound care and antibiotics in 6 patients. All patients had no nonunion, necrosis of toes, and sensory disturbance of toes. Metatarsal lengthening by minimally invasive osteotomy with external fixator had satisfactory results in the treatment of congenital brachymetatarsia.

Case Report: New-onset relapsing-remitting multiple sclerosis with positive Uhthoff phenomenon after second BNT162b2 dose

Objectives new-onset relapsing-remitting multiple sclerosis (RRMS) has rarely been communicated as a side effect of SARS-CoV-2 vaccination (SC2V). Here we report a patient with new-onset RRMS shortly after the second BNT162b2 vaccine dose, which was diagnosed only after a relapse after the third vaccine dose. Case report the patient is a 31 year-old male who developed eye problems 48 days after the second dose of BNT162b2. The symptoms were attributed to eye strain and gradually disappeared without treatment. Further workup was negative. Three months after the third BNT162b2 dose, urinary urgency developed. Eleven months after the third BNT162b2 dose, he developed sensory and visual disturbances that were noticeable post-exercise and progressed and worsened with alcohol and heat. MRI showed typical lesions that met the Barkhof/Tintore criteria for RRMS. Cerebrospinal fluid (CSF) studies revealed elevated kappa free light chains and positive oligoclonal bands. Because the revised McDonalds criteria were met, RRMS was diagnosed and ocrelizumab was started. Conclusions this case shows that SARS-CoV-2 vaccination can trigger new-onset RRMS, the clinical presentation of SC2V-induced multiple sclerosis is similar to multiple sclerosis due to other triggers, and the severity of the relapses may increase with the number of boosters given. Although, rare, a neurologist should be aware of the presumably rare event in which SC2V triggers new-onset multiple sclerosis.

One- versus Two-Minute Intercostal Nerve Cryoanalgesia in Children Undergoing Surgery for Funnel Chest Deformity.

An inherent defect of the sternum and ribs results in the formation of a funnel-shaped anterior chest wall. The gold standard of surgical correction is the minimally invasive Nuss procedure, which might cause severe pain and carries the risk of sensory disturbances and chronic discomfort. Integrating cryoanalgesia with standard multimodal analgesia improves the outcomes of this procedure. Based on histological results, it was hypothesised that the time of cryo-application can be reduced from the current standard period of two minutes. The goal of this study was to evaluate the efficacy of a one-minute application compared with the routine two-minute method in the same patient, considering the subjective perception of pain and sensory disturbances. A total of 33 patients were included in this prospective study. The results show that the assessment of pain severity and sensory disturbances did not differ significantly in terms of the time of cryo-application during first 14 days after the surgical procedure. The one-minute cryo-application time for intraoperative intercostal nerve cryoablation prior to the Nuss procedure seems to be as safe and effective as the routinely used two-minute application time in regards to pain severity, sensory disturbances, and the risk of chronic pain development. Intercostal nerve cryoanalgesia is an essential element of multimodal analgesia.

Dipeptidyl Peptidase (DPP)-4 Inhibitors and Pituitary Adenylate Cyclase-Activating Polypeptide, a DPP-4 Substrate, Extend Neurite Outgrowth of Mouse Dorsal Root Ganglia Neurons: A Promising Approach in Diabetic Polyneuropathy Treatment.

Individuals suffering from diabetic polyneuropathy (DPN) experience debilitating symptoms such as pain, paranesthesia, and sensory disturbances, prompting a quest for effective treatments. Dipeptidyl-peptidase (DPP)-4 inhibitors, recognized for their potential in ameliorating DPN, have sparked interest, yet the precise mechanism underlying their neurotrophic impact on the peripheral nerve system (PNS) remains elusive. Our study delves into the neurotrophic effects of DPP-4 inhibitors, including Diprotin A, linagliptin, and sitagliptin, alongside pituitary adenylate cyclase-activating polypeptide (PACAP), Neuropeptide Y (NPY), and Stromal cell-derived factor (SDF)-1a-known DPP-4 substrates with neurotrophic properties. Utilizing primary culture dorsal root ganglia (DRG) neurons, we meticulously evaluated neurite outgrowth in response to these agents. Remarkably, all DPP-4 inhibitors and PACAP demonstrated a significant elongation of neurite length in DRG neurons (PACAP 0.1 μM: 2221 ± 466 μm, control: 1379 ± 420, p < 0.0001), underscoring their potential in nerve regeneration. Conversely, NPY and SDF-1a failed to induce neurite elongation, accentuating the unique neurotrophic properties of DPP-4 inhibition and PACAP. Our findings suggest that the upregulation of PACAP, facilitated by DPP-4 inhibition, plays a pivotal role in promoting neurite elongation within the PNS, presenting a promising avenue for the development of novel DPN therapies with enhanced neurodegenerative capabilities.

The pathogenesis and treatment of Parkinson's disease

Parkinson's disease (PD) is a neurodegenerative disease that primarily affects middle-aged and older adults. Its incidence is second only to that of Alzheimer's disease. The primary source of clinical symptoms is the degradation and death of dopaminergic neurons in the substantia nigra-striatum. Patients mainly show motor symptoms such as static tremor, rigidity, bradykinesia and postural instability, and non-motor symptoms such as sensory disturbance, autonomic nervous dysfunction and mental cognitive impairment. There is no proven way to cure the disease or to slow its progression through neuroprotection, therefore treatment focuses mostly on treating symptoms. This study examines the shared pathophysiology of PD, which includes inflammation, abnormalities in protein handling, oxidative stress, and mitochondrial dysfunction. Next it discusses the available PD treatment options, which include standard medication therapy, promising surgical procedures, gene therapy, and new approaches to individualized PD care. The safety and usefulness of many treatments are still unknown, though. Hope that as life science and technology advance, the etiology of Parkinson's disease will become clearer and more dependable treatment options will be created to enhance sufferers' quality of life.

Approach to gait disorders and orthotic management in adult onset neuromuscular diseases.

In order to understand abnormal gait, this article will first review normal gait, discuss how neuromuscular diseases disturb gait patterns and review orthotic interventions. In normal gait, concentric contractions accelerate and eccentric contractions decelerate the limb. Neuromuscular gait disorders can be grouped into (1) proximal weakness, (2) distal weakness, (3) nonlength-dependent or generalized weakness, (4) asymmetric weakness, and (5) sensory disorders. Identification of gait disturbance type in neuromuscular diseases leads to the appropriate orthotic prescription since orthotic strategies are grouped into (1) proximal weakness, (2) distal weakness, and (3) sensory disturbances. Orthotics is not indicated in all types of gait disturbance. Weakness in proximal hip musculature can be managed with gait aids such as walkers. In contrast, distal muscle weakness can be managed with orthotics. Preservation of gait assists in maintenance of daily function and integration in society.