Severity Of Neurological Impairment Research Articles

Urinary nerve growth factor level is correlated with the severity of neurological impairment in patients with cerebrovascular accident

To measure urinary nerve growth factor (uNGF, essential in nerve growth and regeneration) levels in patients with a cerebrovascular accident (CVA), to determine whether uNGF could be a biomarker for predicting the neurological deficits in CVA, as the level of uNGF increases in patients with idiopathic detrusor overactivity (DO) and incontinence. uNGF levels were measured using an enzyme-linked immunosorbent assay in normal subjects and patients with CVA and different severities of neurological impairment. Total uNGF levels were normalized to the concentration of urinary creatinine (uNGF/Cr). The median (interquartile range) uNGF/Cr levels were significantly higher in patients, at 0.13 (0-1.04), than in normal subjects (undetectable). The uNGF/Cr levels correlated well with the severity of neurological impairment. Patients with none/minimal neurological impairment had no detectable uNGF/Cr level, like the controls. Patients with mild/moderate impairment had levels of 0.27 (0.09-0.8) and with severe impairment level of 1.53 (0.5-3.0) (both P < 0.001), significantly greater than that of none/minimal impairment or controls. However, uNGF/Cr levels were not correlated with age, location of CVA, multiplicity of CVA, duration of CVA, urodynamic findings or the presence of urge urinary incontinence. The uNGF level is correlated with the severity of neurological impairment in patients with CVA but not with urge symptoms or urodynamic findings, suggesting elevated uNGF might be a result of the neurological lesion rather than lower urinary tract dysfunction in CVA.

Cerebrospinal Fluid Concentrations of Nitric Oxide Metabolites in Spinal Cord Injury

Multiple center study to evaluate cerebrospinal fluid (CSF) concentrations of nitric oxide metabolites [NOx] in relation to neurologic severity and prognosis in spinal cord injury (SCI). To examine whether CSF [NOx] correlates with neurologic severity and recovery in SCI. Inducible nitric oxide synthase is expressed in rat spinal cord immediately after SCI. Excessive nitric oxide production is cytotoxic, causing neuronal apoptosis with subsequent neurodysfunction in the spinal cord. We previously reported a significant correlation between initial [NOx] after incomplete cervical cord injury (CCI) and neurologic recovery at the final follow-up in 25 cases. Ninety-six cases (SCI group), including 76 patients with CCI and 20 patients with thoracic cord injury were examined. Mean follow-up period was 11 months. The control group comprised 40 cases (3 healthy volunteers and 37 patients with neither pain nor neurologic disorders). CSF [NOx] were measured using the Griess method. Severity of neurologic impairment was assessed using Frankel's classification and the American Spinal Injury Association motor score (ASIA MS). Degree of neurologic recovery was assessed using Frankel's classification and the ASIA motor recovery percentage. CSF [NOx] did not differ significantly among the control, CCI, and thoracic cord injury groups at the initial examination. In the CCI group, [NOx] in the Frankel A and B classes were significantly higher than [NOx] in the control group at 5 to 14 days, in the Frankel A and B classes at 0 to 4 days, and in the Frankel C and D classes at 5 to 14 days. Also, in the CCI group at 5 to 14 days, [NOx] correlated significantly with ASIA MS and motor recovery percentage. There was a significant correlation between CSF [NOx] at the pathologic early subacute stage (approximately 5-14 days) and neurologic severity and recovery in SCI.

Studies on the natural history of multiple sclerosis. 7. Correlates of clinical change in an early bout.

Factors of predictive value for the course of an early bout of multiple sclerosis were sought from a nationwide series of over 500 men who, before and during the bout under study, were on active duty in the U.S. Army. Most features of the neurologic involvement, as well as spinal fluid and season, were unrelated to change in hospital. Outcome was statistically associated with brain stem signs and age, but in an irregular fashion. Those for whom this was the onset bout (Group B) and those given “specific” treatment changed more for better and worse. The major correlates with improvement were short duration of the bout, sensory signs, and overall severity of neurologic impairment at admission; some inverse relationship was seen with total duration of illness for those with prior bouts (Group A). Bout duration and severity seemed additive in their effects: Of those with short and severe bouts, 95 per cent improved and none worsened; of those with long and mild or moderate bouts, 12 per cent improved and 17 per cent worsened. The relation with bout duration has been found in other series, but not that with severity.

The location of DCX mutations predicts malformation severity in X-linked lissencephaly

Lissencephaly spectrum (LIS) is one of the most severe neuronal migration disorders that ranges from agyria/pachygyria to subcortical band heterotopia. Approximately 80% of patients with the LIS spectrum carry mutations in either the LIS1 or DCX (doublecortin) genes which have an opposite gradient of severity. The aim of the study was to evaluate in detail the phenotype of DCX-associated lissencephaly and to look for genotype-phenotype correlations. Of the 180 male patients with DCX-related lissencephaly, 33 males (24 familial cases and nine cases with de novo mutations) were found with hemizygous DCX mutations and were clinically and genetically assessed here. DCX mutation analysis revealed that the majority of mutations were missense (79.2%), clustered in the two evolutionary conserved domains, N-DC and C-DC, of DCX. The most prominent radiological phenotype was an anteriorly predominant pachygyria or agyria (54.5%) although DCX-associated lissencephaly encompasses a complete range of LIS grades. The severity of neurological impairment was in accordance with the degree of agyria with severe cognitive impairment in all patients, inability to walk independently in over half and refractory epilepsy in more than a third. For genotype-phenotype correlations, patients were divided in two groups according to the location of DCX missense mutations. Patients with mutations in the C-DC domain tended to have a less severe lissencephaly (grade 4-5 in 58.3%) compared with those in the N-DC domain (grade 4-5 in 36.3%) although, in this dataset, this was not statistically significant (p = 0.12). Our evaluation suggests a putative correlation between phenotype and genotype. These data provide further clues to deepen our understanding of the function of the DCX protein and may give new insights into the molecular mechanisms that could influence the consequence of the mutation in the N-DC versus the C-DC domain of DCX.

Complications associated with anemia and blood transfusion in patients with aneurysmal subarachnoid hemorrhage

Patients with subarachnoid hemorrhage (SAH) frequently develop delayed cerebral ischemia and may be especially vulnerable to the effects of anemia. However, the potentially harmful effects of allogeneic red blood cells are increasingly being recognized. The optimal transfusion threshold is unknown, but current practice most often uses a liberal approach. We assessed the association between anemia or transfusion and subsequent adverse outcomes. Retrospective cohort study. Neuroscience intensive care unit of a university hospital. A total of 245 consecutive patients with aneurysmal SAH. None. Logistic regression models were used to adjust for baseline differences in age, severity of neurologic impairment, and amount of blood on computed tomography. Patients were dichotomized based on whether symptomatic vasospasm was diagnosed. Individually, anemia (nadir hemoglobin <10 g/dL) and the use of transfusions were both associated with the combined outcome of death, severe disability, or delayed infarction (odds ratio [OR] for anemia, 2.7; 95% confidence interval [CI] 1.5-5; p < .01; OR for transfusion, 4.8; 95% CI, 2.5-9.1; p < .01). When both variables were together introduced into a logistic regression model, only transfusion remained significantly predictive (OR, 4.3; 95% CI, 1.5-9.3; p < .01). The relationship between anemia and adverse outcomes was stronger among patients diagnosed with vasospasm, whereas for transfusion, it was stronger among patients without vasospasm. Transfusion also was associated with the development of nosocomial infections (OR, 3.2; 95% CI, 1.7-5.5; p < .01). There was no statistically significant difference in complications based on the duration of blood storage before transfusion. Although anemia is predictive of adverse outcomes in patients with SAH, this observation cannot be considered justification for a liberal transfusion strategy. Appropriate transfusion thresholds may vary depending on the presence or absence of clinical vasospasm. Randomized trials that compare liberal and restrictive transfusion strategies in patients with SAH are needed.

Quantification of the Probability of Reaching Mobility Independence at Discharge from a Rehabilitation Hospital in Nonwalking Early Ischemic Stroke Patients: A Multivariate Study

Background: This study was designed to quantify the probability of recovery of mobility in admission nonwalking stroke survivors. Methods: We evaluated 437 of 500 consecutive patients admitted for sequelae of first ischemic stroke within the first month. We performed several logistic regressions using mobility status at discharge (independence in stair climbing; walking outside and inside, without aid or supervision; walking with cane or other aid, or need for wheelchair) as dependent variable, and several independent variables, including stratification of patients according to their Barthel Index (BI) score into 6 classes (≤10; 11–20; 21–30; 31–40; 41–50; 51–60). Results: At discharge, 4.58% of patients were independent in stair climbing, 8.70% were able to walk outside, 14.41% to walk inside, and 27.46% to walk with cane or other aid, while 44.85% remained in wheelchair. Very low BI scores at admission were associated with a high risk of need for wheelchair, whereas patients with BI score 51–60 showed a high probability to reach independence in stair climbing (OR = 5.60). Age, severity of neurological impairment, global aphasia, unilateral spatial neglect, male gender and vocational status also played a prognostic role. Conclusions: The probability of potential mobility recovery can be quantified at admission with better accuracy for independence in stair climbing and walking outside without any aid (percentages correctly predicted 95.4 and 91.8%, respectively). Stratification of BI score may be useful to better quantify the risk for each patient.

Hospital Disposition After Stroke in a National Survey of Acute Cerebrovascular Diseases in Israel

Treger I, Ring H, Schwartz R, Tsabari R, Bornstein NM, Tanne D; for the National Acute Stroke Israeli Survey Group. Hospital disposition after stroke in a national survey of acute cerebrovascular diseases in Israel. Objective To investigate predictive factors for disposition after acute stroke. Design A nationwide survey (2004 National Acute Stroke Israeli Survey). Setting All 28 primary general medical centers operating in Israel. Participants Acute stroke patients (n=1583) admitted during February and March 2004 and discharged from the primary hospital. Interventions Data collected on baseline characteristics, stroke presentation, type and severity, in-hospital investigation and complications, discharge disability, acute hospital disposition, and mortality follow-up. Main Outcome Measure Hospital disposition to home, acute rehabilitation, or nursing facility. Results Among patients, 58.9% (n=932) were discharged home, 33.7% (n=534) to rehabilitation departments, and only 7.4% (n=117) to nursing facilities. Admission neurologic status was a good predictor of hospital disposition. Patients with severe strokes were mostly discharged to rehabilitation facilities. Patients with significant functional decline before the index stroke, resulting from a previous stroke or another cause, were sent to inpatient rehabilitation less frequently. Disability level at discharge from acute hospitalization had high predictive value in hospital disposition after stroke. In the northern region of Israel, a higher proportion of patients were sent home and a lower proportion to rehabilitation and nursing facilities, probably because of lower availability of rehabilitation care in this region of Israel. Conclusions This nationwide survey shows that most stroke survivors in Israel are discharged home from the acute primary hospital. Good functional status before the index stroke is an important predictor for being sent to acute inpatient rehabilitation. Severity of neurologic impairment and level of disability after the stroke at discharge from the primary hospital are strong predictors for disposition after stroke in Israel. Our data may be useful in discharge planning for stroke patients by policy-makers and health care providers in Israel.

Uric acid administration in patients with acute stroke: a novel approach to neuroprotection

Uric acid (UA) is the end product of purine catabolism in humans and is a powerful antioxidant whose generation is increased under ischemic conditions. However, both clinical and experimental studies reveal a gradual exhaustion of the antioxidant capacity after transient cerebral ischemia, and the magnitude of this consumption seems to be correlated with the extent of brain tissue injury, growth of the infarction, severity of neurological impairment in the acute phase, and long-term functional outcome. Growing evidence supports the neuroprotective effect of UA administration after brain ischemia. In experimental conditions, the administration of UA is neuroprotective both in mechanical models of brain ischemia (transient or permanent intraluminal occlusion of the middle cerebral artery) and in thromboembolic models of autologous clot injection. The administration of UA is feasible and safe in healthy volunteers. In acute stroke patients treated with recombinant tissue plasminogen activator (rt-PA), co-administration of UA has proven to reduce lipid peroxidation and to prevent the fall in UA blood levels that occur very early after stroke onset. Currently, a multicentric Phase III clinical trial is testing whether the administration of UA increases the clinical benefits of rt-PA, which represents the only approved therapy in patients with acute ischemic stroke. This review summarizes the available information justifying such a novel therapeutic approach in this devastating clinical condition.

The APOE polymorphism and 1-year outcome in ischemic stroke: genotype–gender interaction

In human genetic studies an effect of the apolipoprotein E gene (APOE) polymorphism on the risk, course and prognosis in chronic and acute nervous system disorders was established. We aimed to evaluate whether the APOE genotype is related to acute neurological impairments due to ischemic stroke (IS), and to outcomes (up to 1 year) indicated by severe functional disability, dependence in daily living or death. A total of 657 patients (326 men, 331 women), divided into the three groups: E2 (APOEepsilon2/epsilon3 subjects), E3 (APOEepsilon3/epsilon3 subjects), and E4 (APOEepsilon3/epsilon4 and epsilon4/epsilon4 subjects), were analyzed. There was no association between the APOE genotype and baseline clinical characteristics, severity of neurological impairments during acute stroke, and 1-year outcome, when analyzing whole patient population. APOE gene interacted with gender in predicting severity of acute neurological deficit and post-stroke mortality within the period up to 1 year after the IS. Gender-stratified analysis indicated the E4 genotype as a significant independent positive predictor of death within 1 year after stroke incidence in men patients. Ischemic stroke severity and outcome may be affected by complex interactions between gender and genetic factors that warrant further exploration.

Surface Structure of Amyloid-β Fibrils Contributes to Cytotoxicity

Amyloid beta (Abeta) toxicity has been hypothesized to initiate the pathogenesis of Alzheimer's disease (AD). The characteristic fibrillar morphology of Abeta-aggregates, that constitute the main components of senile plaque, has long been considered to account for the neurotoxicity. But recent reports argue against a primary role for mature fibrils in AD pathogenesis because of the lack of a robust correlation between the severity of neurological impairment and the extent of amyloid deposition. Toxicity from the soluble prefibrillar intermediate entity of aggregates often called oligomer has recently proposed a plausible explanation for this inconsistency. An alternative explanation is based on the observation that certain amyloid fibril morphologies are more toxic than others, indicating that not all amyloid fibrils are equally toxic. Here, we report that it is not only the beta-sheeted fibrillar structure but also the surface physicochemical composition that affects the toxicity of Abeta fibrils. For the first time, colloidal gold was used to visualize by electron microscopy positive-charge clusters on Abeta fibrils. Chemical modifications as well as point-mutated Abeta synthesis techniques were applied to change the surface structures of Abeta and to show how local structure affects surface properties that are responsible for electrostatic and hydrophobic interactions with cells. We also report that covering the surface of Abeta fibers with myelin basic protein, which has surface properties contrary to those of Abeta, suppresses Abeta toxicity. On the basis of these results, we propose that the surface structure of Abeta fibrils plays an important role in Abeta toxicity.

Commentary

There are few reports detailing an association between immediate and delayed changes in MR imaging findings and severity of neurologic impairment in patients with spinal cord DCS. We report on the cases of 3 patients diagnosed with spinal cord DCS presenting with severe neurologic symptoms after scuba diving.Of 175 patients with DCS referred to the Tokyo Metropolitan Ebara Hospital Department of Neurosurgery, 3 were determined by MR imaging and neurologic examination to have a spinal cord injury. Hyperbaric oxygen, methylprednisolone, and rehabilitation therapies were applied to these patients. We examined whether the severity of the patients' neurologic dysfunction, classified according to Fränkel's grade, was associated with the extent of abnormal signals depicted by spinal MR imaging in these patients at the acute phase and monthly follow-up points. T2-weighted MR imaging performed within 24 hours of the onset of the patients' neurologic symptoms revealed signals of increased intensity located predominantly in the dorsolateral regions, involving spinal segments 1 through 4, and a neurologic examination upon admission revealed severe sensory and motor dysfunction (Fränkel's grade A) in all 3 patients. The abnormal signals on MR images at 1 month postinjury were markedly decreased in size as compared with those at the acute phase. However, neurologic function showed minimal or no improvement (Fränkel's grade A or B).In patients with spinal cord DCS, the improvement in MR imaging findings was not associated with improved clinical status. This discrepancy suggests that intricate pathophysiologic changes, reversible and persistent damage subsequent to initial cord injuries (ie, edematous and neurotoxic lesions), underlie the disease and affect the clinical course.

Origin of DSS: to present the plan

The Disability Status Scale for multiple sclerosis was the direct result of World War II, in which 16.4 million persons served in the US military. Thereafter academic medicine enabled the modernization of the Veterans Administration in patient care, research, and training. Under the GI Bill, I attended Cornell University Medical College, where there was an intensive course in neurological diagnosis requiring detailed recording of positive and negative findings. This was used in junior and senior clinical clerkships and residency training, all of which I took at the Bronx VA Hospital. During my residency we assessed a possible treatment for MS, which required a comparison group and a means of measuring change. The former comprised the records of over 300 MS patients, whose neurological deficits were then consolidated into mutually exclusive Functional Systems, each with grades for severity. As rank-order scales they could not be summed or compared directly, but they were used as the basis for the DSS, which ranged from 0 (normal) to 10 (death due to MS). This scale was later expanded into the EDSS by halving each step 1 through 9. This bifid system is applicable to all patients with MS regardless of type or severity of neurological impairment.

Spinal cord decompression sickness associated with scuba diving: correlation of immediate and delayed magnetic resonance imaging findings with severity of neurologic impairment—a report on 3 cases

Background There are few reports detailing an association between immediate and delayed changes in MR imaging findings and severity of neurologic impairment in patients with spinal cord DCS. We report on the cases of 3 patients diagnosed with spinal cord DCS presenting with severe neurologic symptoms after scuba diving. Case Description Of 175 patients with DCS referred to the Tokyo Metropolitan Ebara Hospital Department of Neurosurgery, 3 were determined by MR imaging and neurologic examination to have a spinal cord injury. Hyperbaric oxygen, methylprednisolone, and rehabilitation therapies were applied to these patients. We examined whether the severity of the patients' neurologic dysfunction, classified according to Fränkel's grade, was associated with the extent of abnormal signals depicted by spinal MR imaging in these patients at the acute phase and monthly follow-up points. T2-weighted MR imaging performed within 24 hours of the onset of the patients' neurologic symptoms revealed signals of increased intensity located predominantly in the dorsolateral regions, involving spinal segments 1 through 4, and a neurologic examination upon admission revealed severe sensory and motor dysfunction (Fränkel's grade A) in all 3 patients. The abnormal signals on MR images at 1 month postinjury were markedly decreased in size as compared with those at the acute phase. However, neurologic function showed minimal or no improvement (Fränkel's grade A or B). Conclusion In patients with spinal cord DCS, the improvement in MR imaging findings was not associated with improved clinical status. This discrepancy suggests that intricate pathophysiologic changes, reversible and persistent damage subsequent to initial cord injuries (ie, edematous and neurotoxic lesions), underlie the disease and affect the clinical course.

Sequential Neurological Examinations in Infants with Neonatal Encephalopathy and Low Apgar Scores: Relationship with Brain MRI

The aims of this study were to (a) describe the evolution of neurological signs after the neonatal period in infants with neonatal encephalopathy and abnormal outcome and (b) to establish the relationship between the evolution of neurological signs and patterns of lesions on brain MRI. Fifteen children with low Apgar scores, abnormal neurological signs at the end of the neonatal period, and abnormal outcome were examined at 1 - 2 weeks, 5 - 7 weeks, and 6 months. All the infants had at least one MRI scan performed in the neonatal period. All infants had persistent abnormalities on all examinations performed but the severity of neurological impairment was variable and was related to the pattern of brain lesions. Infants with severe basal ganglia and white matter lesions showed abnormal axial and limb tone, movements, and visual function on all the examinations and none achieved independent sitting. In infants with moderate basal ganglia lesions and/or severe white matter changes, visual function and feeding improved by 5 - 7 weeks and were still normal at 6 months while limb tone, which was reduced in the first weeks, appeared to be normal at 5 - 6 weeks but was found to be increased at 6 months; all were able to sit unsupported at 2 years and most of them achieved the ability to walk with support. Our results suggest that the evolution of the neurological patterns after the neonatal period in infants with persisting neonatal abnormalities depends on their pattern of brain lesions.

The Relationship of Blood Alcohol Concentration to Impairment Severity in Spinal Cord Injury

Objective: To investigate the relationship between blood alcohol concentration (BAC) and severity of neurological impairment.Design: Retrospective cross-sectional study.Participants: Subjects with traumatic spinal cord injury (SCI; N = 119) with dates of injury between 1991 and 2000 who received their acute treatment at a midwestern Model SCI Care System and for whominformation regarding BAC was available.Analysis: Main outcome measure: severity of neurological impairment. Data were analyzed using x2 testsand analysis of variance (ANOVA).Results: A significant association was observed between impairment severity and BAC.Conclusions: The study suggests that alcohol consumption is associated with severity of SCI. A morerigorous study controlling for trauma attributes is necessary to confirm these results and appraise whetheralcohol has a potentiating effect on impairment. If borne out, the study's findings may lead to alterations inemergency room procedures and to changes in public health and education efforts resulting froma reframing of the issue of safe consumption of alcohol.

Uric acid administration for neuroprotection in patients with acute brain ischemia

Uric acid is the end product of purine metabolism and a powerful water-soluble antioxidant and radical scavenger in humans whose generation is increased in situations of oxidative stress, such as brain ischemia. Although hyperuricemia has been related to an increased risk of cardiovascular events, the association was not found significant in many studies after adjustment for the effect of confounders. In the ischemic rat brain, the administration of uric acid results in neuroprotection and improved behavioral outcome. The severity of neurological impairment and the volume of infarction in patients with stroke have been found inversely related to the concentration of uric acid. In healthy volunteers, uric acid has been administered without untoward effects to show a conspicuous reduction of oxidative stress. We hypothesize that the administration of uric acid could be beneficial and cost effective in patients sustaining acute oxidative stress, such as those with acute ischemic stroke. Uric acid could also extend to more than 3 h the therapeutic window of rt-PA after stroke and it could limit the appearance of neurobehavioral changes after cardiopulmonary bypass. Prospective double blind randomized controlled trials are needed to test the value of uric acid in these clinical settings in which oxyradical formation is prominent.

Is elevated plasma lactate a useful marker in the evaluation of pure carbon monoxide poisoning?

To examine whether CO poisoning induces a significant increase in plasma lactate concentration. Prospective observational clinical study in the emergency department and intensive care unit in a university-affiliated teaching hospital. 146 pure CO poisonings resulting from dysfunction of gas cookers or water heaters. Patients were classified into four neurological impairment groups: 37% were severely, 8% moderately, and 45% mildly intoxicated, while 1% were asymptomatic. We found only very mild increases in plasma lactate concentration (median 2.30 mmol/l) which, however, was significantly correlated with the severity of neurological impairment and blood CO concentration (1.41 mmol/l, Spearman's test r=0.3). Plasma lactate is mildly elevated in pure CO-exposed patients. This mild increase and the extensive overlap between the groups of neurological impairment severity do not suggest the usefulness of systematic plasma lactate measurement in pure CO poisoning.

Key neurological impairments influence function-related group outcomes after stroke.

The function-related group (FRG) classification is based on functional assessment and has been assumed to encompass the effects of different patterns and severity of neurological impairments. This assumption may not be correct. It has been proposed as a means of comparing rehabilitation outcome across institutions. If neurological impairments significantly affect FRG outcome, then higher FRG outcome scores may reflect selection bias favoring patients with fewer neurological impairments rather than better quality of rehabilitation care. The goal of this study was to assess the influence of motor, somatosensory, and hemianopic visual impairments on FRG outcomes after stroke. All 288 consecutive stroke patients discharged in 1999 from an acute rehabilitation hospital were assigned to 1 of 5 FRGs on the basis of their Functional Independence Measure (FIM) mobility subscore and age. Each FRG was also stratified into 1 of 4 cohorts on the basis of the presence or absence of key neurological impairments: motor impairment only (M), motor plus either somatosensory or hemianopic visual impairment (MS/MV), motor plus somatosensory plus hemianopic visual impairment (MSV), and other combinations of impairments. FIM scores were available every 10 days for all patients from admission to discharge. The effect of impairment group on outcome was assessed within each FRG category through repeated-measures analysis of variance to assess differences in serial FIM scores across the 4 impairment groups. The distribution of each of the 4 impairment groups across the 5 FRGs was assessed with chi2 analysis. The numbers of patients in each of the 5 FRGs from the lowest level, FRG-11, to the highest, FRG-15, were as follows: 78 (27%), 47 (16%), 75 (26%), 55 (19%), and 33 (11%). Different neurological impairments were associated with significantly different mean+/-SD discharge FIM scores as follows: for FRG-11, MSV=63+/-16, MS/MV=68+/-19, and M=81+/-13 (P=0.04); for FRG-12, MSV=47+/-14, MS/MV=61+/-12, and M=75+/-11 (P=0.01); and for FRG-13, MSV=79+/-20, MS/MV=85+/-19, and M=96+/-10 (P<0.02). For FRG-14 and FRG-15, those with M impairments had the highest and those with MSV impairments had the lowest discharge FIM scores, but the differences did not reach statistical significance. The chi2 analysis showed a highly significant difference in representation of MSV impairments across FRG-11 through FRG-15 as follows: 35 of 78 (45%), 20 of 47 (43%), 11 of 74 (15%), 4 of 55 (7%), and 2 of 33 (6%). For patients classified as having an M deficit only or other impairment, the results were as follows: 19 of 78 (24%), 15 of 47 (32%), 41 of 75 (55%), 41 of 55 (75%), and 27 of 33 (82%) (chi(2) analysis=78.7, P<0.0001). The presence of motor, somatosensory, and hemianopic visual impairment significantly affects FRG outcome and should be included in future outcome assessment tools. Comparisons of FIM change and efficiency scores across institutions are potentially biased by referral and selection criteria favoring equally dysfunctional but less neurologically impaired individuals.

Patterns of physical and neurologic development in preterm children.

To evaluate the influence of medical complications, gestational age, gender, ethnicity, and socioeconomic status on the changes in anthropometric measures and severity of neurologic impairment from 6 to 54 months of age in premature and term infants. This study was a prospective longitudinal study to determine predictors of patterns of growth and neurologic outcome in low-risk (n=137) and high-risk (n=96) preterm infants compared to full-term infants (n=136). Growth modeling analyses were used to evaluate factors that might influence patterns of physical growth and changes in neurologic status. Medical risk level was a predictor of height and head circumference at 30 months and neurologic outcome. Gender was a predictor of weight gain. Medical risk level and gender predicted 13.8% and 32% of the variance in head circumference and neurologic scores, respectively. Medical complications after birth and gender are stronger influences than gestational age on patterns of growth and neurologic outcome.

Interhemispheric transfer evaluation in multiple sclerosis 1The authors would like to thank Claude-Alain Hauert and Christoph Michel for their assistance in the evaluation of motor tapping and Michel Habib for his suggestions and comments. This work was supported by a grant from the Swiss Society of Multiple Sclerosis.

Patients suffering from Multiple Sclerosis (MS) have frequently been found to suffer from damage to callosal fibers. Investigations have shown that this damage is associated with signs of hemisphere disconnections. The aim of our study was to provide evidence for the first signs of interhemispheric dysfunction in a mildly disabled MS population. Therefore, we explored whether the Interhemispheric Transfer (IT) deficit is multi-modal and sought to differentiate two MS evolution forms, on the basis of an interhemispheric disconnection index. Twenty-two patients with relapsing-remitting form of MS (RRMS) and 14 chronic-progressive (CPMS) were compared with matched controls on four tasks: a tachistoscopic verbal and non-verbal decision task, a dichotic listening test, cross tactile finger localization and motor tapping. No overall impairment was seen. The dichotic listening and lexical decision tasks were the most sensitive to MS. In addition, CPMS patients' IT was more impaired and was related to the severity of neurological impairment. The different sizes of the callosal fibers, which determine their vulnerability, may explain the heterogeneity of transfer through the Corpus Callosum. Therefore, evaluation of IT may be of value as an index of evolution in MS.