scholarly journals Functional motor phenotypes: to lump or to split?

2021 ◽  
Author(s):  
Michele Tinazzi ◽  
Christian Geroin ◽  
Enrico Marcuzzo ◽  
Sofia Cuoco ◽  
Roberto Ceravolo ◽  
...  
Keyword(s):  
Neurological Disorders ◽  
Time Lag ◽  
Acute Onset ◽  
Demographic Variables ◽  
Gait Disorders ◽  
Motor Disorders ◽  
Definite Diagnosis ◽  
Precipitating Factors ◽  
Functional Neurological Symptoms ◽  
Pathophysiologic Mechanisms

Abstract Introduction Functional motor disorders (FMDs) are usually categorized according to the predominant phenomenology; however, it is unclear whether this phenotypic classification mirrors the underlying pathophysiologic mechanisms. Objective To compare the characteristics of patients with different FMDs phenotypes and without co-morbid neurological disorders, aiming to answer the question of whether they represent different expressions of the same disorder or reflect distinct entities. Methods Consecutive outpatients with a clinically definite diagnosis of FMDs were included in the Italian registry of functional motor disorders (IRFMD), a multicenter data collection platform gathering several clinical and demographic variables. To the aim of the current work, data of patients with isolated FMDs were extracted. Results A total of 176 patients were included: 58 with weakness, 40 with tremor, 38 with dystonia, 23 with jerks/facial FMDs, and 17 with gait disorders. Patients with tremor and gait disorders were older than the others. Patients with functional weakness had more commonly an acute onset (87.9%) than patients with tremor and gait disorders, a shorter time lag from symptoms onset and FMDs diagnosis (2.9 ± 3.5 years) than patients with dystonia, and had more frequently associated functional sensory symptoms (51.7%) than patients with tremor, dystonia and gait disorders. Patients with dystonia complained more often of associated pain (47.4%) than patients with tremor. No other differences were noted between groups in terms of other variables including associated functional neurological symptoms, psychiatric comorbidities, and predisposing or precipitating factors. Conclusions Our data support the evidence of a large overlap between FMD phenotypes.

Chyloptysis

2010 ◽  
pp. 826-843
Author(s):  
Edward C. Rosenow
Keyword(s):  
Acute Onset ◽  
Low Grade ◽  
Productive Cough ◽  
Precipitating Factors

• 73-year-old woman • Nonsmoker • 5 episodes in 2 years of acute-onset dyspnea on exertion, orthopnea, productive cough of peculiar-tasting sputum • Knew of no precipitating factors • Low-grade fever • Bibasilar crackles • CXR ∘ Migratory with different events that lasted 2 to 6 days...

scholarly journals Incidence and Outcomes of Hypernatremia in Adult Neurological Non–Brain-Dead Patients Admitted to Tertiary Care Neurologic Institute: A Retrospective Study

2019 ◽  
Vol 06 (01) ◽  
pp. 024-029
Author(s):  
Sritam S. Jena ◽  
Ramesh J. Venkatapura ◽  
Rita Christopher ◽  
Dhaval Shukla ◽  
Dhritiman Chakrabarti
Keyword(s):  
High Mortality ◽  
Neurological Disorders ◽  
Tertiary Care ◽  
Demographic Variables ◽  
Mortality And Morbidity ◽  
Neurological Patients ◽  
Case Files ◽  
Brain Dead ◽  
The Brain ◽  
Very High

Abstract Background Hypernatremia is known to have high mortality and morbidity in patients with neurological disorders. However, in most studies, it is not clear whether hypernatremia associated with brain death has been excluded. Including brain-dead patients will spuriously give a very high mortality rate. Therefore, in this study, we have evaluated the mortality of hypernatremic patients after excluding the brain-dead patients on the first day of hypernatremia. Methods All neurological patients admitted to the hospital who developed hypernatremia (serum Na > 150 mEq/L) were included in the study. Brain-dead patients and patients with Glasgow coma score (GCS) 3 on the first day of detection of hypernatremia were excluded. Demographic variables, clinical variables, and outcome variables were collected from the case files retrospectively. Results In total, 100 patients developed hypernatremia during the study period. Among them, 14 patients were excluded because of GCS 3 or unavailability of GCS data on the day of detection of hypernatremia. There were 37 mild, 28 moderate, and 21 severe hypernatremic patients. The mortality was 32%, 39%, and 52% in the mild, moderate, and severe hypernatremic patients, respectively. Patients with traumatic brain injury had higher mortality in comparison to all other disease conditions (56% vs. 29.6%, p < 0.02). Conclusion The mortality is high even in mild cases of hypernatremia. Very high mortality (52%) is seen in severe hypernatremic patients. Therefore, it is important to monitor, identify, and treat these patients aggressively.

scholarly journals The Potential Therapeutic Effects of Artesunate on Stroke and Other Central Nervous System Diseases

2016 ◽  
Vol 2016 ◽  
pp. 1-16 ◽  
Author(s):  
Shilun Zuo ◽  
Qiang Li ◽  
Xin Liu ◽  
Hua Feng ◽  
Yujie Chen
Keyword(s):  
Neurological Disorders ◽  
Therapeutic Effects ◽  
Nervous System Diseases ◽  
Foreseeable Future ◽  
Central Nervous System Diseases ◽  
Pharmacological Activities ◽  
Pharmacological Mechanism ◽  
Single Mechanism ◽  
Anti Inflammation ◽  
Pathophysiologic Mechanisms

Artesunate is an important agent for cerebral malaria and all kinds of other severe malaria because it is highly efficient, lowly toxic, and well-tolerated. Loads of research pointed out that it had widespread pharmacological activities such as antiparasites, antitumor, anti-inflammation, antimicrobes activities. As we know, the occurrence and development of neurological disorders usually refer to intricate pathophysiologic mechanisms and multiple etiopathogenesis. Recent progress has also demonstrated that drugs with single mechanism and serious side-effects are not likely the candidates for treatment of the neurological disorders. Therefore, the pluripotent action of artesunate may result in it playing an important role in the prevention and treatment of these neurological disorders. This review provides an overview of primary pharmacological mechanism of artesunate and its potential therapeutic effects on neurological disorders. Meanwhile, we also briefly summarize the primary mechanisms of artemisinin and its derivatives. We hope that, with the evidence presented in this review, the effect of artesunate in prevention and curing for neurological disorders can be further explored and studied in the foreseeable future.

scholarly journals Functional (Psychogenic) Neurological Disorders: Assessment and Acute Management in the Emergency Department

2019 ◽  
Vol 39 (01) ◽  
pp. 102-114 ◽  
Author(s):  
Vihang Nakhate ◽  
Christopher Stephen ◽  
David Perez ◽  
Jordan Anderson
Keyword(s):  
Emergency Department ◽  
Neurological Disorders ◽  
Interdisciplinary Approach ◽  
Acute Onset ◽  
Initial Assessment ◽  
Acute Setting ◽  
Initial Task ◽  
Neuropsychiatric Conditions ◽  
Functional Neurological Disorders ◽  
Rule Out

AbstractFunctional neurological disorders (FND) are complex and prevalent neuropsychiatric conditions. Importantly, some patients with FND develop acute onset symptoms requiring emergency department (ED) evaluations. Historically, FND was a “rule-out” diagnosis, making assessment and management in the ED difficult. While the rapid triage of potential neurological emergencies remains the initial task, advancements have altered the approach to FND. FND is now a “rule-in” diagnosis based on validated neurological examination signs and semiological features. In this perspective article, we review signs and semiological features that can help guide the initial assessment of FND in the acute setting. Thereafter, we outline potential approaches to introduce a suspected diagnosis of FND to patients in the ED, while emphasizing the need for a comprehensive neurological evaluation. Physical and occupational therapy may be useful adjunct assessments in some individuals. Notably, clinicians in the ED setting are important members of the interdisciplinary approach to FND.

scholarly journals Problems seeded in the past: lagged effects of historical land-use changes can cause an extinction debt in long-lived species due to movement limitation

2022 ◽  
Author(s):  
María V. Jiménez-Franco ◽  
Eva Graciá ◽  
Roberto C. Rodríguez-Caro ◽  
José D. Anadón ◽  
Thorsten Wiegand ◽  
...  
Keyword(s):  
Land Use ◽  
Population Dynamics ◽  
Land Use Change ◽  
Animal Movement ◽  
Land Use Changes ◽  
Time Lag ◽  
Demographic Variables ◽  
Extinction Debt ◽  
Agricultural Abandonment ◽  
Historical Land Use

Abstract Context Land-use change is one of the main threats to biodiversity on the global scale. Legacy effects of historical land-use changes may affect population dynamics of long-lived species, but they are difficult to evaluate through observational studies alone. We present here an interdisciplinary modelling approach as an alternative to address this problem in landscape ecology. Objectives Assess effects of agricultural abandonment and anthropisation on the population dynamics of long-lived species. Specifically, we evaluated: (a) how changes in movement patterns caused by land-use change might impact population dynamics; (b) time-lag responses of demographic variables in relation to land-use changes. Methods We applied an individual-based and spatial-explicit simulation model of the spur-tighed tortoise (Testudo graeca), an endangered species, to sequences of real-world landscape changes representing agricultural abandonment and anthropisation at the local scale. We analysed different demographic variables and compared an “impact scenario” (i.e., historical land-use changes) with a “control scenario” (no land-use changes). Results While agricultural abandonment did not lead to relevant changes in demographic variables, anthropisation negatively affected the reproductive rate, population density and the extinction probability with time-lag responses of 20, 30 and 130 years, respectively, and caused an extinction debt of 22%. Conclusions We provide an understanding of how changes in animal movement driven by land-use changes can translate into lagged impacts on demography and, ultimately, on population viability. Implementation of proactive mitigation management are needed to promote landscape connectivity, especially for long-lived species for which first signatures of an extinction debt may arise only after decades.

scholarly journals Raised visual contrast thresholds with intact attention and metacognition in functional motor disorder

2018 ◽  
Author(s):  
Julian Matthews ◽  
Kanae Jennifer Nagao ◽  
Catherine Ding ◽  
Rachel Newby ◽  
Peter Kempster ◽  
...  
Keyword(s):  
Target Detection ◽  
Sensory Processing ◽  
Neurological Disorders ◽  
Predictive Coding ◽  
Detection Sensitivity ◽  
Motor Disorders ◽  
Healthy Controls ◽  
Organic Group ◽  
Visual Contrast ◽  
Functional Neurological Disorders

Functional motor disorders (FMDs) are distinguished by signs that lack congruence with recognised patterns of organic disease and show inconsistency over time. Their pathophysiology is poorly understood, but there is evidence that irregularities in perceptual and cognitive processing lie at the heart of these conditions.Here, we draw on a predictive coding account of functional neurological disorders to study perceptual decision-making in three groups: 20 patients with FMDs (14 with functional movements and 6 with functional weakness), 20 with phenotypically-matched organic motor disorders, and 20 age-matched healthy controls. We examine four cognitive domains with putative roles in FMD pathogenesis: attention, expectations, sensory processing (perceptual sensitivity), and metacognition (introspective evaluation of performance). We augmented a dual-task paradigm, manipulating the visual contrast required for target detection to examine these domains in one design. With sensory input (stimulus contrast) psychometrically adjusted to staircase target detection at a fixed level for all groups, the FMD group exhibited statistically equivalent attentional, expectational and metacognitive processing to healthy controls. However, we demonstrate Bayesian evidence and a frequentist trend that FMD patients require higher visual contrast than controls to maintain the same detection sensitivity (BF10=8.1, pholm=.066). This was statistically equivalent to the visual contrast required by the organic group, and unlikely to be accounted for by medication use or comorbid psychopathology. The organic group showed differences in processing of attention and expectations for target detection that were not observed in either healthy controls or the functional group.The distinctive behavioural profile of FMDs may arise from abnormalities in basic sensory processing, while higher attentional, expectational and metacognitive mechanisms remain intact. Conceptualising functional neurological disorders under a predictive coding account may consolidate and refine existing pathophysiological theories about them.

scholarly journals Functional neurological disorders in patients with brain tumours

2021 ◽  
Vol 23 (Supplement_4) ◽  
pp. iv12-iv12
Author(s):  
Charmaine Toh ◽  
Dorothy Joe ◽  
Katia Cikurel ◽  
Julia Johnson ◽  
Francesco Vergani ◽  
...  
Keyword(s):  
Brain Tumour ◽  
Neurological Disorders ◽  
Neurological Disorder ◽  
Brain Tumours ◽  
Neurological Symptoms ◽  
Adult Brain ◽  
Case Review ◽  
Functional Neurological Symptoms ◽  
Functional Neurological Disorders ◽  
Functional Neurological Disorder

Abstract Aims Signs and symptoms that develop in people with brain tumours are often attributed to their tumour. The prevalence and management of functional neurological symptoms in brain tumour patients have received little attention. This is surprising because functional neurological symptoms complicate management greatly and misdiagnosis can lead to inappropriate treatment and iatrogenic side-effects. Therefore, we investigated the presentation, diagnosis and management of functional neurological disorders (FND) in patients who had a brain or meningeal tumour. Method A retrospective case review was performed from 2017 - 2021 to identify adult brain tumour patients who developed a functional neurological disorder that caused significant disability necessitating expedited investigations. All patients attended a regional neuro-oncology centre. We recorded type of brain tumour and diagnostic investigations. The onset of functional symptoms was divided into three time windows: before tumour diagnosis, after diagnosis and before treatment or after tumour treatment. A neuropsychological review looked for evidence of previous adverse life events. Therapeutic interventions for functional neurological disorder and their outcomes were documented. The case review was combined with a systematic review of the literature to identify the published presentations of functional neurological disorder in the adult brain tumour population. MEDLINE, EMBASE and PsycINFO databases were searched for studies published between January 1980 and February 2021. Results Six patients (5 female, 1 male) were identified from the case review with a median age of 41 (range 29 - 56) years old. Four patients had non-epileptic attack disorder, which was diagnosed with videotelemetry of habitual attacks. One patient had a functional hemiparesis with normal central motor conduction time. One patient had a functional speech disorder with normal EEG. Half of these patients had functional neurological symptoms prior to surgery/oncological treatment. Five patients (83%) were referred for further neuropsychiatric or psychological evaluation. A history of significant psychological trauma prior to the brain tumour diagnosis was elicited in four (66%) patients. Conclusion Patients with either a brain or meningeal tumour may develop functional neurological symptoms. Our findings suggest the possibility that diagnosis of a brain tumour may precipitate a debilitating functional neurological disorder. The neurobiological basis for functional neurological disorders is being actively investigated. There are suggestions in the literature that some brain diseases increase the risk of developing a functional neurological disorder. Further work is needed to determine whether this is true for patients with brain tumours. Increased awareness of functional neurological disorders will improve management. Withdrawal of unnecessary treatment, such as anticonvulsant drugs, reduces the risk of iatrogenic side effects. Initiation of multi-disciplinary care pathways, e.g. physiotherapy, speech and language therapy and psychological treatments, promotes recovery. Collectively, these interventions improve our patients’ quality of life.

Difficulties in diagnosing tuberculous spondylitis against the background of liver echinococcosis

MedAlliance ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 88-92
Keyword(s):  
Neurological Disorders ◽  
Soft Tissues ◽  
Correct Diagnosis ◽  
Molecular Genetic ◽  
Treatment Algorithm ◽  
Definite Diagnosis ◽  
Tuberculous Spondylitis ◽  
Treat Ment ◽  
Appropriate Treatment ◽  
Logical Study

Difficulties in diagnosing tuberculous spondylitis are caused by the rarity of the pathology, and blurred clinical and laboratory presentation. The correct diagnosis can take several months, since pain is often interpreted as a degenerative process. Spondylitis should be assumed in patients with back pain resistant to conservative treat-ment methods, it may be accompanied by neurological disorders, fever, and increased laboratory indicators of inflammation. Radiodiagnostic methods can reveal the presence of destruction, its localization, distribution, and the degree of involvement of the surrounding soft tissues. To confirm the etiology of the process, morpho-logical study of the biopsy or surgical samples is needed, as well as pathogen verification by bacteriological and/or molecular genetic methods. Only after making a definite diagnosis, it is possible to choose the most appropriate treatment algorithm for the patient

Neuromuscular disorders

2011 ◽  
Author(s):  
Tim Theologis
Keyword(s):  
Botulinum Toxin ◽  
Neurological Disorders ◽  
Neuromuscular Disorders ◽  
Sensory Nerve ◽  
Motor Disorders ◽  
Sensory Motor ◽  
Charcot Joints

♦ Neurological disorders can be sensory, motor, or a combination of the two♦ Motor disorders may be flaccid or spastic, static or progressive♦ Splints may improve function but are not proven to prevent contractures♦ Botulinum toxin and tenotomy can be used to manage spasticity♦ Osteotomies may be needed to manage rotatory abnormalities♦ Sensory nerve abnormalities may cause Charcot joints.

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