Years Of Paralysis Research Articles

Laminar fMRI in the locked-in stage of amyotrophic lateral sclerosis shows preserved activity in layer Vb of primary motor cortex

Amyotrophic lateral sclerosis (ALS) affects the cerebral cortex layer-dependently, most notably by the foremost targeting of upper motor neurons (UMNs) sited in layer Vb. Previous studies have shown a retained ability of paralysed patients to activate cortical motor networks, even in late-stage ALS. However, it is currently unknown whether such activation reflects a retained capacity to process sensorimotor inputs or if it is a result of actual motor output. Given the distinct function of individual cortical layers, layer-specific functional measurements may provide insight to this question. In this study, using submillimetre resolution laminar fMRI, we assessed the layer-dependent activation associated with attempted (motor) and passive (somatosensory) movements in a locked-in stage ALS patient. We found robust activation in both superficial and deep layers of primary motor cortex (M1). The peak activation in deep layers was localised to layer Vb. These findings demonstrate preserved activity in deep output layers of M1, possibly reflecting a retained ability to engage surviving UMNs despite years of paralysis. Our study underscores the capacity of laminar fMRI to discern subtle cortical activity and elucidates a promising pathway for probing in vivo human ALS pathology with unprecedented resolution.

Urinary Bladder Cancer as a Long-term Sequela of Spinal Cord Injury - Relevance to Practice

Urinary bladder cancer is the second most common tumour disease after lung cancer leading to death in people with a spinal cord injury. This paper provides a comprehensive overview of the differences relevant to urologists between urinary bladder tumours in this population compared with urinary bladder tumours in the general population.People with a spinal cord injury are 1 to 2 decades younger on average at the time of tumour diagnosis than patients without a spinal cord injury. Histopathologic findings at the initial diagnosis of urinary bladder cancer in people with a spinal cord injury are much less favourable than for urinary bladder cancers in the general population. Muscle-invasive tumours and tumours with poor differentiation are much more common, and the proportion of squamous cell carcinomas is significantly higher. The incidence rises after more than 10 years of paralysis. Urinary bladder cancer mortality is significantly elevated and increases with the duration of paralysis. In diagnostic procedures and, in particular, in radical cystectomy, clinically important features have to be considered. For example, urodynamic examinations or cystoscopy may trigger autonomic dysreflexia with hypertensive crises and the risk of life-threatening bradycardia.In the case of radical cystectomy, frequent adhesions and callosities of the urinary bladder, among other things, must be taken into account intraoperatively. Severe paralysis, prolonged intestinal atony and other conditions are frequently observed after the surgical procedure due to neurogenic bowel dysfunction. Correct positioning of the patient immediately after surgery to avoid decubitus and to support breathing, as well as bowel management specific to spinal cord injury, must be strictly observed.Other special features of paraplegic patients with urinary bladder cancer that should also be considered in clinical practice, as well as considerations for screening for urinary bladder tumors, are presented in the article.

The strong spirit: history, politics, and aesthetics in the writings of James Joyce, 1898-1912

Introduction 1. Resurgence: Early Writings from the Local Government Act to the Land Act, 1898-1903 2. Where We Stand: Dubliners and the Anatomy of Irish Culture 1904-6 3. One of His Explosives: Stephen Hero and the Years of Paralysis, 1904-6 4. Desolating Certainties: The 'Triestine Writings' and the Return of the Liberals 1906-12 5. Inside the Labyrinth: A Portrait of the Artist as a Young Man 1907-14 6. The Impossibility of Union: Exiles, 1912-15 Endpiece

Anemia and hypoalbuminemia of chronic spinal cord injury: prevalence and prognostic significance

The study was a retrospective analysis. The objective of the study was to survey a chronic spinal cord injury (SCI) population for the prevalence and prognostic significance of anemia (AN) and hypoalbuminemia (HA). The study was conducted at VA Boston Healthcare System, USA. A review of records of 322 SCI subjects (318 males) scheduled for annual examination was carried out for the period from 1998 to 2007. The number of follow-up years with AN (hematocrit <40%) or severe anemia (SAN) (hematocrit <30%) or HA (serum albumin <3 g%) was recorded for all subjects, divided between survivor and deceased subjects. A total of 239 subjects survived to an average age of 60 and 30 years of paralysis and 83 subjects died at an average age of 70 and 27 years of paralysis (P<0.01 and P<0.06, respectively). The level and grade of paralysis were similar in these groups. The average prevalence rates of AN, SAN and HA were 34, 6 and 6% of survey years in the survivor group and 83, 18 and 22% in the deceased group; the respective ratios were 2.4, 3.0 and 3.7 (P<0.001). The fractions of survey years that were positive for SAN and/or HA among causes of death were sepsis, 42%; cancer, 33%; pulmonary failure 30%; cardiovascular disease, 25%; and undetermined causes, 9%. The mortality rate for the 95 subjects with a recurrence of SAN or HA was 40% within 3 years. The prevalence of AN, SAN and HA among chronic SCI subjects is high; repeated SAN and HA often precede death, particularly due to sepsis.

Stable muscle atrophy in long-term paraplegics with complete upper motor neuron lesion from 3- to 20-year SCI

Unrandomized trial. To investigate the structural and functional relationships and the progression of muscle atrophy up to 20 years of spastic paraplegia. Clinical follow-up in Vienna, Austria; muscle biopsies analyzed by light microscopy in Padova and by electron microscopy (EM) in Chieti, Italy. Force was measured as knee extension torque; trophism by computer tomography scan; tissue composition and fiber morphology by histopathology and EM. In the long-term group of patients (17.0+/-2.6 years), force and size of thigh muscles were only slightly different from those of mid-term subjects (2.2+/-0.5 years). Histology and ultrastructure confirm that the difference in average size of muscle fibers between long-term and mid-term paralyzed leg muscles is actually very small. In addition, muscle fibers maintain the striated appearance characteristic of normal skeletal fibers even after 14-20 years of paralysis. Ultrastructural alterations of the activating and metabolic machineries, and the presence of fibers with lower motor neuron denervation features, may explain the low-force output and the reduced endurance of paretic muscles. The stable muscle atrophy that characterizes long-lasting spastic paraplegia suggests that there are no upper-time limits to begin a training program based on functional electrical stimulation.

Surgical Strategies for Brachial Plexus Polio-Like Paralysis

Brachial plexus polio-like paralysis is an acute flaccid paralysis of the upper limb following viral infection. Surgical approaches to the paralytic limb have not previously been discussed in the literature. This study is the first to describe the clinical course and propose a surgical strategy for disabilities related to poliomyelitis-like paralysis. Between 1982 and 2004, 17 patients (11 boys and six girls) presented with acute flaccid paralysis of the upper limb. Their clinical course was reviewed retrospectively. Average age at onset of disease was 2 years (range, 4 months to 13 years). All patients had disability in shoulder abduction and/or elbow flexion. Ten patients underwent reconstructive surgery. Stage V shoulder abduction (>160 degrees) according to Gilbert's classification was regained in five patients who underwent nerve transfer within 1 year of paralysis. One patient treated by nerve transfer after 3 years of paralysis obtained only stage I abduction (<45 degrees). In two patients, multiple local muscle transfers were performed for the shoulder abduction disability, resulting in mild improvement from stage I to stage II abduction (<90 degrees). In four patients, functioning free muscle transplantation for elbow flexion was carried out, and all regained functional M4 muscle strength. Of seven patients in the nonsurgical group, two had complete spontaneous recovery within 1 year, but five had permanent residual limb paralysis at a mean follow-up of 10 years. Surgical strategies, including nerve transfer for shoulder abduction deficit within 1 year after attack and functioning free muscle transplantation for the elbow flexion deficit in the late period, should be considered for this disease. Late reconstruction, either by nerve transfer or by using local multiple muscle transfer for shoulder abduction, is ineffective.

Nerve fibres in urothelium and submucosa of neuropathic urinary bladder: an immunohistochemical study with S-100 and neurofilament.

Intravesical administration of drugs has been used commonly in spinal cord injury patients to suppress detrusor hyperreflexia (eg oxybutynin, verapamil, terodiline) or, to initiate a micturition reflex (eg 15S 15-methyl prostaglandin F2 alpha, protaglandin E2); however, the response has been variable and sometimes, unpredictable. This prompted us to study the presence of nerve fibres in the vesical urothelium and submucosa in mucosal biopsies taken from the dome and trigone (obtained prior to performing a therapeutic procedure eg, vesical lithotripsy, or a diagnostic cystoscopy) in 47 consecutive, unselected paraplegic/tetraplegic patients with a neuropathic urinary bladder. Nerve fibres were demonstrated by routine immunohistochemical technique using commercially available monoclonal and polyvalent antibodies against S-100 (DAKO A/S, Glostrup, Denmark) and Neurofilament (MILAB, Malmo, Sweden). Biopsy specimens were graded for the presence of nerve fibres on a 0-3 scale for urothelium, and superficial/deep submucosa separately in a blind and randomised manner. Virtually no fibre presence was found in one paraplegic patient and no superficial or single fibres were noted in a tetraplegic patient. Absence of C-fibre hyperplasia (Grade 0) was found in nine cases (paraplegic: 4; tetraplegic: 5); Grade 1 hyperplasia was observed in 17 cases (paraplegic: 4; tetraplegic: 13); Grade 2 hyperplasia was seen in 11 cases (paraplegic: 7; tetraplegic 4); and Grade 3 hyperplasia was noticed in eight cases (paraplegic 3: tetraplegic: 5). The magnitude of C-fibre hyperplasia was not significantly different between paraplegic and tetraplegic patients (chi(2) = 4.64; P = 0.3262). The relationship, if any, between the degree of C-fibre hyperplasia and duration of paralysis was studied by categorising patients as < 5 years, and > 5 years of paralysis. No evidence of single fibre or fibre bundle hyperplasia (Grade 0) was seen in five and six cases, grade 1 hyperplasia in six and 11 cases, grade 2 hyperplasia in two and nine cases, and grade 3 hyperplasia in three and five cases respectively in these two categories of patients. (chi(2) = 1.92; P = 0.58). The possible relationship between C-fibre hyperplasia in the vesical mucosa/submucosa and (i) the vesical response to intravesical drug administration; (ii) the vesical urothelial proliferation arrest; (iii) the electrical stimulation of urinary bladder by implanted electrodes (sacral anterior root stimulator); and (iv) long-term indwelling urethral Foley catheter drainage, are discussed with illustrative case reports. In conclusion, mucosal biopsy and study of nerve fibres in urothelium and submucosa of neuropathic bladder has helped to generate hypotheses on the association between C-fibre hyperplasia and response to intravesical pharmacotherapy and the predictive value of such a study in identifying those patients who are likely to respond to intravesical pharmacotherapy.