Sensory Symptoms Research Articles

Sensory Phenomenon Assessment Scale: a new tool for assessment of tic-associated sensations.

Sensory symptoms linked to tic disorder (TD) are challenging to quantify via self- or parent-reported measures. The current study aimed to develop a novel observer-rated semi-structured interview, namely, the Sensory Phenomenon Assessment Scale (SPAS), to aid clinical evaluation on symptoms of TD among children. To test its psychometric properties, tic, premonitory urge (PU), and obsessive-compulsive symptoms (OCS) were also assessed in 223 children via the Yale Global Tic Severity Scale (YGTSS), the Premonitory Urge for Tic Scale (PUTS), and the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Factor analysis and internal consistency test were carried out using data from TD-diagnosed individuals. Good internal consistency and test-retest reliability were observed. Criterion validity was established by significant correlations between the PUTS, the YGTSS, the CY-BOCS, and scores of the SPAS. Factor analyses supported a single-factor model of the SPAS, in which the five items each showed a factor loading above 0.6. This study demonstrated that the SPAS is reliable and valid and, thus, can serve as a good and concise measure of clinical symptoms among children and adolescents with TD.

Cortical Venous Thrombosis Caused by Venous Compression by Arachnoid Cyst.

Identification, work-up and treatment approach of isolated cortical venous thrombosis (ICVT) in the absence of traditional risk factors. A 66-year-old previously well male presenting with two episodes of left-sided spreading sensory symptoms, found to be secondary to ICVT from extrinsic compression by an arachnoid cyst. Early identification of structural abnormalities causing extrinsic venous compression and ICVT or cerebral venous sinus thrombosis (CVST) is important for alternative treatment options and to avoid unnecessary testing.

Spinal arachnoid cysts

Objectives: Spinal arachnoid cysts (SAC) are rare lesions. There are many uncertainties regarding details about Intradural and Extradural SAC. We present a series of 12 cases of SAC along with a comprehensive review of the literature. In this review, we discussed the differences between Intradural and Extradural SAC pertaining to demography, pathogenesis, surgical procedures and outcomes. Methods: We retrospectively collected the data of 12 patients of SAC treated at our Institute from 2012 to 2023. The age, gender, clinical, radiological, surgical data and outcome were noted. An extensive review of the literature was done to analyse and note the differences between Intradural and extradural SAC and their surgical management. Results: In our series of 12 patients, 7 had Extradural SAC(58.3%), 3 had Intradural SAC(25%) and 2 had Intramedullary SAC(16.7%). . Of the 12 patients, 4 were males and 8 were females (1:2). Age range was 9 to 64 years and the mean age was 34.42 ± 17.71 years. There were four paediatric patients in the series. The most common symptoms reported at presentation are weakness of limbs(81.9%),back pain(36.4%), sensory symptoms(36.4%), radicular pain (18.2%), and bladder disturbances(9.1%). Out of the 12 patients, surgery was done in 11 patients and one patient was managed conservatively. Conclusions: From the review of the literature, intradural SAC was twice as common as extradural SAC. Ventrally located SACs are more common in Intradural locations as compared to Extradural. The intradural SACs were more commonly located in the thoracic and cervical regions when compared to extradural SACs which were located commonly in the thoracolumbar, thoracic and lumbar regions. Extradural SACs were mostly Primary and the mainstay of treatment is complete or partial excision of the cyst with identification and ligation of the communicating pedicle. Selective laminectomy, partial excision of the cyst and wide fenestration to sustain CSF flow is the recommended treatment in Intradural SAC.

The role of antibodies in small fiber neuropathy: a review of currently available evidence.

Small fiber neuropathy (SFN) is a peripheral nerve condition affecting thin myelinated Aδ and unmyelinated C-fibers, characterized by severe neuropathic pain and other sensory and autonomic symptoms. A variety of medical disorders can cause SFN; however, more than 50% of cases are idiopathic (iSFN). Some investigations suggest an autoimmune etiology, backed by evidence of the efficacy of IVIG and plasma exchange. Several studies suggest that autoantibodies directed against nervous system antigens may play a role in the development of neuropathic pain. For instance, patients with CASPR2 and LGI1 antibodies often complain of pain, and invitro and invivo studies support their pathogenicity. Other antibodies have been associated with SFN, including those against TS-HDS, FGFR3, and Plexin-D1, and new potential targets have been proposed. Finally, a few studies reported the onset of SFN after COVID-19 infection and vaccination, investigating the presence of potential antibody targets. Despite these overall findings, the pathogenic role has been demonstrated only for some autoantibodies, and the association with specific clinical phenotypes or response to immunotherapy remains to be clarified. The purpose of this review is to summarise known autoantibody targets involved in neuropathic pain, putative attractive autoantibody targets in iSFN patients, their potential as biomarkers of response to immunotherapy and their role in the development of iSFN.

Motor disorders related to oxaliplatin-induced peripheral neuropathy: long-term severity and impact on quality of life.

Sensory chemotherapy-induced peripheral neuropathy (CIPN) is well-recognized, but motor CIPN remains understudied. This secondary analysis focused on the long-term severity and impact of motor disorders, their relation to sensory CIPN, neuropathic pain, psychological distress, and health-related quality of life (HRQoL) after oxaliplatin-based chemotherapy in colorectal cancer (CRC) survivors. Data from a multicenter, cross-sectional study were re-analyzed to explore motor CIPN among CRC survivors up to 5years post-chemotherapy, with no longitudinal follow-up. Questionnaires assessed sensory and motor CIPN (QLQ-CIPN20), neuropathic pain (DN4), anxiety and depression (HADS), and HRQoL (QLQ-C30). Among 405 CRC survivors, 31.1% had sensory CIPN as previously described. When categorizing the 405 CRC survivors based on the years since their last oxaliplatin-based chemotherapy, the motor scores derived from the QLQ-CIPN20 showed no significant difference between years (p = 0.08). Motor CIPN scores correlated with female gender, higher oxaliplatin dose intensity, sensory CIPN, and neuropathic pain. Motor CIPN also linked to decreased HRQoL and increased psychological distress. The study underscores the detrimental impact of motor disorders on CRC survivors post-oxaliplatin-based chemotherapy. Oncologists should prioritize assessing and managing motor manifestations alongside sensory symptoms to enhance post-cancer quality of life. NCT02970526 (2016-11-22). https://classic. gov/ct2/show/NCT02970526?term=NCT02970526&draw=2&rank=1 .

The Long-Term Loss of Smell and Taste in COVID-19 Patients – A Systematic Review and Meta-Analysis

Introduction: Olfactory symptoms have been reported as particular in COVID-19 patients. Objective: To synthesize and analyze the existing evidence on the monitoring loss of sense of smell and taste in COVID-19 patients, and for how long symptoms persist after the virus is no longer active in the organism. Methods: A search was implemented in PubMed, Embase, Scopus, Science Direct, and Web of Science databases. This systematic review and meta-analysis were conducted according to PRISMA, and the risk of bias was assessed through the Newcastle-Ottawa Scale. The review protocol is registered in PROSPERO. Results: Our systematic review included data from 14 articles with a total of 2143 participants. The most reported sensory symptom of COVID-19 was anosmia, which was detected in 1499 patients, being the only symptom to appear in all studies. Ageusia was detected in 595 patients, dysgeusia in 514 patients, and hyposmia in 209 patients. The studies provided the number of 729 patients with sensory symptoms during the acute COVID-19 infection of 15 days, and 1020 patients with lasting sensory symptoms, presenting sensory dysfunctions after the average latent period of 15 days of the acute COVID-19 infection. Conclusion: Evidence points to the loss or dysfunction of taste and smell as one of the symptoms of COVID-19 persisting for an average time of 15 days, with 44% of COVID-19 patients with persistent symptoms for more than 15 days. Nevertheless, most studies do not perform a follow-up with those patients. Therefore, further research on sensory symptoms and their follow-up is required.

Shared behavioural impairments in visual perception and place avoidance across different autism models are driven by periaqueductal grey hypoexcitability in Setd5 haploinsufficient mice.

Despite the diverse genetic origins of autism spectrum disorders (ASDs), affected individuals share strikingly similar and correlated behavioural traits that include perceptual and sensory processing challenges. Notably, the severity of these sensory symptoms is often predictive of the expression of other autistic traits. However, the origin of these perceptual deficits remains largely elusive. Here, we show a recurrent impairment in visual threat perception that is similarly impaired in 3 independent mouse models of ASD with different molecular aetiologies. Interestingly, this deficit is associated with reduced avoidance of threatening environments-a nonperceptual trait. Focusing on a common cause of ASDs, the Setd5 gene mutation, we define the molecular mechanism. We show that the perceptual impairment is caused by a potassium channel (Kv1)-mediated hypoexcitability in a subcortical node essential for the initiation of escape responses, the dorsal periaqueductal grey (dPAG). Targeted pharmacological Kv1 blockade rescued both perceptual and place avoidance deficits, causally linking seemingly unrelated trait deficits to the dPAG. Furthermore, we show that different molecular mechanisms converge on similar behavioural phenotypes by demonstrating that the autism models Cul3 and Ptchd1, despite having similar behavioural phenotypes, differ in their functional and molecular alteration. Our findings reveal a link between rapid perception controlled by subcortical pathways and appropriate learned interactions with the environment and define a nondevelopmental source of such deficits in ASD.

Loss and Return of Ticklishness in Functional Neurological Disorder.

People with functional neurological disorder (FND) have abnormalities in sensory processing. Loss of ticklishness has been rarely reported. To describe associated clinical features in people with FND and loss of ticklishness and explore correlations with sensory changes. Retrospective audit of clinical letters of people diagnosed with FND in a tertiary clinic and further cases identified in a general neurology clinic. Thirty-eight patients with loss of ticklishness are described, of which most had other functional sensory symptoms and signs. It was more often localized to one limb, rather than generalized, in those with pain or weakness. Dissociation for the affected body part was often described. Loss of ticklishness in FND is frequently described and offers insights into mechanisms of agency, sensory processing and interoception, which are known to be altered in FND.

Sensory-Behavioral Deficits in Parkinson's Disease: Insights from a 6-OHDA Mouse Model.

Parkinson's disease (PD) is characterized by the degeneration of dopaminergic neurons in the striatum, predominantly associated with motor symptoms. However, non-motor deficits, particularly sensory symptoms, often precede motor manifestations, offering a potential early diagnostic window. The impact of non-motor deficits on sensation behavior and the underlying mechanisms remains poorly understood. In this study, we examined changes in tactile sensation within a Parkinsonian state by employing a mouse model of PD induced by 6-hydroxydopamine (6-OHDA) to deplete striatal dopamine (DA). Leveraging the conserved mouse whisker system as a model for tactile-sensory stimulation, we conducted psychophysical experiments to assess sensory-driven behavioral performance during a tactile detection task in both the healthy and Parkinson-like states. Our findings reveal that DA depletion induces pronounced alterations in tactile sensation behavior, extending beyond expected motor impairments. We observed diverse behavioral deficits, spanning detection performance, task engagement, and reward accumulation, among lesioned individuals. While subjects with extreme DA depletion consistently showed severe sensory behavioral deficits, others with substantial DA depletion displayed minimal changes in sensory behavior performance. Moreover, some exhibited moderate degradation of behavioral performance, likely stemming from sensory signaling loss rather than motor impairment. The implementation of a sensory detection task is a promising approach to quantify the extent of impairments associated with DA depletion in the animal model. This facilitates the exploration of early non-motor deficits in PD, emphasizing the importance of incorporating sensory assessments in understanding the diverse spectrum of PD symptoms.

Psychometric evaluation of the Japanese neck disability index by exploratory factor analysis in preoperative patients with cervical spondylotic myelopathy: impact of pain and numbness

BACKGROUND CONTEXTThe Neck Disability Index (NDI), a common Patient-Reported Outcome Measure (PROM) for neck pain, lacks sufficient study on its psychometric properties in preoperative patients with cervical spondylotic myelopathy (CSM). PURPOSEThis study aims to address these gaps by conducting an exploratory factor analysis of the Japanese NDI. The objectives are 2-fold: (1) to scrutinize the psychometric properties and internal consistency of the Japanese NDI, and (2) to explore the specific regions of pain and numbness influencing the NDI. STUDY DESIGN/SETTINGA single-center observational study. PATIENT SAMPLEA total of 100 preoperative patients with CSM. OUTCOME MEASURESThe NDI and Numerical Rating Scale (NRS) were employed to assess preoperative neck disability and pain and numbness in various body regions. METHODSDemographic and clinical characteristics were collected, encompassing age, sex, body mass index, American Society of Anesthesiologists classification, smoking status, comorbidities, pain and numbness at various sites using the NRS, and NDI. For evaluating the psychometric properties and internal consistency of the NDI, exploratory factor analysis (EFA) and Cronbach's α coefficient were utilized. Furthermore, the impact of pain and numbness on NDI factors was examined through multivariable regression analysis. RESULTSEFA identified 2 factors—Physical and Mental—highlighting the dual nature of neck-related disability. Physical factors (std.β=0.724, p<.001) exerted a stronger impact on NDI scores compared to Mental factors (std.β=0.409, p<.001). Cronbach's α coefficient was 0.831 for physical factors and 0.723 for mental factors, indicating a high level of internal consistency. Numbness in the hand (std.β=0.338, p<.001) and pain in the neck (std.β=0.202, p=.035) were significant variables influencing Physical factor, while numbness in the hand (std.β=0.485, p<.001) and pain in the head (std.β=0.374, p<.001) impacted Mental factor. CONCLUSIONThis study contributes valuable insights into the psychometric properties of the NDI in preoperative patients with CSM. The identified factors emphasize the importance of addressing both physical and sensory symptoms in preoperative care.

Latent class analysis of migraine associated vestibular-auditory symptoms.

This study aimed to identify the potential subgroups of migraines based on the patterns of migraine associated symptoms, vestibular and auditory symptoms using latent class analysis and to explore their characteristics. A total of 555 patients with migraine participated in the study. Symptoms such as nausea, vomiting, photophobia, phonophobia, osmophobia, visual symptoms, vestibular symptoms (dizziness, vertigo), and auditory symptoms (tinnitus, hearing loss, aural fullness) were assessed. Latent class analysis was performed to identify subgroups of migraines. Covariates such as gender, age of migraine onset, frequency of migraine attacks per month, and family history were also considered. The analysis revealed four latent classes: the Prominent Vestibular; Prominent Nausea; Presenting Symptoms but not prominent or dominant; and Sensory Hypersensitivity groups. Various covariates, such as gender, age of migraine onset, and frequency of migraine attacks, demonstrated significant differences among the four groups. The Sensory Hypersensitivity group showed the presence of multiple sensory symptoms, earlier age of migraine onset, and higher proportion of females. The Prominent Vestibular group had the highest probability of dizziness or vertigo but lacked the presence of auditory symptoms. The Prominent Nausea group exhibited prominent nausea. The Presenting Symptoms but not prominent or dominant group comprised individuals with the highest migraine attacks per month and proportion of chronic migraine. This study identifies four subgroups of migraines based on the patterns of symptoms. The findings suggest potential different but overlapped mechanisms behind the vestibular and auditory symptoms of migraine. Considering the different patterns of migraine-related symptoms may provide deeper insights for patients' prognosis and clinical decision-making.

Systemic low-grade C-reactive protein is associated with proximal symptom spread in carpal tunnel syndrome.

Neuropathic pain is a highly prevalent condition associated with persistent disability. Some patients with neuropathic pain experience symptom spread outside neuroanatomical boundaries; these patients report more severe sensory symptoms and greater disability. However, the mechanisms behind such symptom spread are not fully understood. We used pre-surgical carpal tunnel syndrome (CTS) as a human model system of neuropathic pain to identify differences in the concentration of serologic inflammatory mediators between patients with CTS with territorial symptoms and those with proximal symptom spread to either the elbow or shoulder/neck. We performed a post-hoc analysis, comparing levels of serologic inflammatory mediators in a discovery cohort among 3 symptoms spread profiles (n = 55; n = 25 no spread, n = 21 spread to elbow, n = 9 spread to shoulder/neck). We then de-novo analysed the significantly dysregulated mediators in an independent validation cohort (n = 72; n = 34 no spread, n = 16 spread to elbow, n = 22 spread to shoulder/neck). The discovery cohort revealed higher serum concentrations of C-reactive protein (CRP) and interleukin-6 in patients with any symptom spread proximal to the wrist; interferon-γ was higher in patients with symptom spread to the elbow compared with those without proximal spread. The validation study replicated the association of higher CRP concentrations in patients with proximal spread to the elbow (no spread: median [interquartile range] 2.5 [5.4]; spread to elbow 6.2 [4.6]; spread to shoulder/neck 2.6 [3.7], P = 0.006). No other markers replicated in the validation cohort. Our findings suggest that proximal symptom spread in the context of neuropathic symptoms is associated with low-grade inflammation.

Psychological Therapy for Functional Neurological Disorder: Examining Impact on Dissociation, Psychological Distress and General Functioning

ABSTRACT Functional neurological disorder (FND) represents a broad group of motor and sensory clinical symptoms which cannot be explained by other neurological diagnoses. Dissociation is considered a key mechanism in their development and maintenance. Despite psychological therapy being the recommended choice of treatment for FND, evidence for its effectiveness is in its infancy. This study explored the dissociative profile of forty-seven patients with FND and evaluated whether individual psychological therapy improved dissociative symptoms, psychological distress and general functioning among twenty-five adults with FND. Patients completed the Multiscale Dissociation Inventory, the EuroQol five-dimensional descriptive system, the General Anxiety Disorder-7 scale and the Patient Health Questionnaire-9. Our sample showed high levels of disengagement, depersonalization and memory disturbance at baseline. Treatment was associated with significant improvements in general functioning, and symptoms of dissociation and anxiety. Improvements in dissociative experiences were found to be possibly due to reduction in anxiety. Improvements in depression were the strongest predictor of improvements in general functioning. Limitations and areas for further research are discussed.

Intervensi Non Farmakologis untuk Memperbaiki Status Fungsional Pasien Kanker dengan Chemotherapy-Induced Peripheral Neuropathy (CIPN)

This study aims to identify non-pharmacological interventions that can improve the functional status of cancer patients with chemotherapy-induced peripheral neuropathy (CIPN). The research method uses a systematic review through literature searches from 4 databases: SAGE, PUBMED, SCIENCE DIRECT, and PROQUEST. The research results show that from 12 research articles, non-pharmacological interventions to improve functional status in CIPN can be grouped into physical and non-physical interventions. Physical interventions include physical exercise and stimulation, while non-physical interventions are through self-management. In conclusion, physical intervention effectively reduces the pain scale and sensory symptoms of CIPN, which improves the patient's functional status and quality of life. However, in some literature, it is stated that a combination with pharmacological therapy can reduce CIPN complaints. Keywords: CIPN, Non-Pharmacological Intervention, Functional Status

Functional Brain Mapping Using Depth Electrodes

ObjectiveThis study investigated the neurological symptoms and stimulus intensities in the stimulation of deep structures and subcortical fibers with the depth electrodes. MethodsSeventeen patients with drug-refractory epilepsy who underwent functional brain mapping with the depth electrodes were enrolled. The 50 Hz electrical stimulation was applied, and the diffusion tensor image was used to identify subcortical fibers. The responsible structures and stimulus intensities for the induced neurological symptoms were evaluated. ResultsNeurological symptoms were induced in 11 of 17 patients. The opercular stimulation elicited the neurological symptoms in six patients at the median threshold of 4.0 mA (visceral/face/hand sensory, hand/throat motor, negative motor and auditory symptoms). The insular stimulation induced the neurological symptoms in four patients at the median threshold of 4.0 mA (auditory, negative motor, and sensory symptoms). The stimulation of subcortical fibers induced in five of nine patients at the median threshold of 4.5 mA. The thresholds of depth electrodes were significantly lower than those of subdural electrodes in eight patients who used both subdural and depth electrodes and induced symptoms with both electrodes. ConclusionThe stimulation of depth electrodes can identify the function of deep structures and subcortical fibers with lower intensities than subdural electrodes.

Relationships between the global symptom score and electrophysiological findings after surgical release for carpal tunnel syndrome: Indications and outcomes.

Regarding surgical indications for carpal tunnel syndrome (CTS), the hypothesis that the recovery processes of subjective symptoms differ among pain, sensory, and motor symptoms and correlate with recovery in objective nerve conduction studies was examined in the present study. The global symptom score (GSS) is a method used to assess clinical outcomes and covers subjective symptoms, including pain (pain and nocturnal awakening), sensory (numbness and paresthesia), and motor (weakness/clumsiness) symptoms. The relationships between long-term changes in GSS and recovery in nerve conduction studies were investigated. Forty patients (40 hands) were included (mean age 65years; 80% female; 68% with moderate CTS: sensory nerve conduction velocity < 45m/s and motor nerve distal latency > 4.5ms). Pain and nocturnal awakening rapidly subsided within 1month after surgery and did not recur in the long term (median 5.6years). Paresthesia significantly decreased 3months after surgery and in the long term thereafter. Weakness/clumsiness significantly decreased at 1year. Sensory nerve distal latency, conduction velocity, and amplitude significantly improved 3months and 1year after surgery, and correlated with nocturnal awakening in the short term (3months) in moderate CTS cases. The patient satisfaction rate was 91%. Rapid recovery was observed in pain and nocturnal awakening, of which nocturnal awakening correlated with the recovery of sensory nerve conduction velocity. Patients with pain symptoms due to moderate CTS may benefit from surgical release.

Clinical, paraclinical and outcome features of 166 patients with acute anti-GQ1b antibody syndrome.

In this retrospective study, we aimed at defining the clinical, paraclinical and outcome features of acute neurological syndromes associated with anti-GQ1b antibodies. We identified 166 patients with neurological symptoms appearing in less than 1month and anti-GQ1b antibodies in serum between 2012 and 2022. Half were female (51%), mean age was 50years (4-90), and the most frequent clinical features were areflexia (80% of patients), distal upper and lower limbs sensory symptoms (78%), ophthalmoplegia (68%), sensory ataxia (67%), limb muscle weakness (45%) and bulbar weakness (45%). Fifty-three patients (32%) presented with complete (21%) and incomplete (11%) Miller Fisher syndrome (MFS), thirty-six (22%) with Guillain-Barre syndrome (GBS), one (0.6%) with Bickerstaff encephalitis (BE), and seventy-three (44%) with mixed MFS, GBS & BE clinical features. Nerve conduction studies were normal in 46% of cases, showed demyelination in 28%, and axonal loss in 23%. Anti-GT1a antibodies were found in 56% of cases, increased cerebrospinal fluid protein content in 24%, and Campylobacter jejuni infection in 7%. Most patients (83%) were treated with intravenous immunoglobulins, and neurological recovery was complete in 69% of cases at 1year follow-up. One patient died, and 15% of patients relapsed. Age > 70years, initial Intensive Care Unit (ICU) admission, and absent anti-GQ1b IgG antibodies were predictors of incomplete recovery at 12months. No predictors of relapse were identified. This study from Western Europe shows acute anti-GQ1b antibody syndrome presents with a large clinical phenotype, a good outcome in 2/3 of cases, and frequent relapses.

Exploring the psychometric properties of the premonitory urge for tics scale (PUTS) and its association with psychiatric symptoms in Chinese children with tic disorders

BackgroundThe Premonitory Urge for Tics Scale (PUTS) is a common self-report measure of premonitory urges for patients with tic disorders. This study aims to evaluate the Chinese version of the PUTS (PUTS-C) and to explore its association with psychiatric symptoms in Chinese children diagnosed with tic disorders.MethodsThe psychometric evaluation involved 204 outpatients with tic disorders, aged 7–16 years, who were divided into two age groups: (7–10 years, n = 103; 11–16 years, n = 95).ResultsThe PUTS-C demonstrated good internal consistency (McDonald’sω = 0.84) and two-week test-retest reliability (0.76). We observed a statistically significant correlation between the total PUTS-C score and various Yale Global Tic Severity Scale (YGTSS) subscales and total tic severity scores. The PUTS-C score also showed significant correlations with the Children Yale-Brown Obsessive Compulsive Scale (CY-BOCS), Screening Child Anxiety-Related Emotional Disorders (SCARED), and Children’s Depression Inventory (CDI). Notably, premonitory urges independently predicted tic severity, beyond the influence of comorbid symptoms. A two-factor structure of the PUTS-C was identified in the total sample through factor analysis.ConclusionsThe PUTS-C possesses acceptable validity and good reliability. It appears that premonitory urges in Chinese patients with tic disorders are associated with obsessive-compulsive symptoms, anxiety, and depression, but can independently predict tic severity. Specific PUTS-C factors possibly related to motor and vocal tics. Future research should continue to investigate age-related differences and the association with tics and other sensory symptoms.

Delayed initiation of disease modifying therapy increases relapse frequency and motor disability in pediatric onset multiple sclerosis

ObjectiveTo evaluate association between time to initiation of disease modifying treatment (DMT) and outcomes in pediatric-onset Multiple Sclerosis (POMS). MethodsA retrospective analysis of children with POMS from two tertiary referral pediatric Neuroimmunology clinics. Outcome measures comprised annualized relapse rate (ARR), MRI lesion burden (T1, T2-FLAIR, and post-GAD contrast sequences), EDSS, and 25-ft walk duration at the latest follow-up visit. Univariate and multivariate analysis using linear and logistic regression models were used to assess associations between patient characteristics and outcomes. ResultsIn total, 68 patients were reviewed. More than half of patients were female (62 %) and 32 (47 %) were Hispanic/LatinX. Median age at diagnosis was 14.2 years (IQR: 11.0–16.5), and median duration from diagnosis to the latest follow-up was 2.5 years (IQR: 1.6–4.6). Sensory (29.4 %), brainstem (23.5 %), and pyramidal (19.1 %) symptoms were most common. Interferon beta (32.4 %), dimethyl fumarate (27.9 %) and rituximab (26.5 %) were the most frequently used first-line DMT. Patients had a median ARR of 0.5 (IQR: 0.08–0.84), and EDSS score of 1.0 (IQR: 0.0–2.0) at the most recent follow-up. Delayed DMT initiation correlated with higher ARR (R = 0.38, p = 0.0016) and longer 25-ft walk duration (R = 0.34, p = 0.0077). In multivariate analysis, delayed DMT remained a significant predictor of higher ARR (p = 0.002) and longer 25-ft walk duration (p = 0.047). Delayed DMT initiation and use of low/moderate efficacy DMT predicted GAD enhancing lesions at the latest follow-up (p = 0.004 and 0.019 respectively). ConclusionDelayed DMT initiation in POMS is linked to unfavorable outcomes, including higher ARR and longer 25-ft walk duration.

Functional Neurological Disorder Presenting After Concussion: A Retrospective Case Series.

Although a majority of individuals recover from a concussion within weeks of the index injury, a substantial minority of patients report persistent postconcussion symptoms. Some of these symptoms may reflect a diagnosis of functional neurological disorder (FND). The authors evaluated the relationship between persistent postconcussion symptoms and FND symptoms. In this retrospective chart review, the authors characterized demographic and clinical information from 50 patients with a confirmed diagnosis of FND whose functional neurological symptoms started after a concussion. Patients who developed FND after a concussion had high rates of baseline risk factors for both persistent postconcussion symptoms and FND. After the concussive event, functional neurological symptoms presented abruptly or developed insidiously over time. Functional neurological symptoms ranged widely and included gait symptoms, seizures, speech and language symptoms, weakness, sensory symptoms, tremors, and vision and oculomotor symptoms. Functional neurological symptoms can arise after a concussion. FND should be considered in the differential diagnosis of individuals presenting with neurological symptoms beginning after a concussion. By failing to recognize functional symptoms, clinicians may inadvertently reinforce negative health-related beliefs regarding a patient's injured brain.