A longitudinal, multimodal approach to characterizing chemotherapy-induced peripheral neuropathy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21595-e21595 ◽  
Author(s):  
Sabrina Ramnarine ◽  
Patrick M. Dougherty ◽  
Linda J Williams ◽  
Charlie Gourley ◽  
Marie T Fallon
Keyword(s):  
Peripheral Neuropathy ◽  
Upper Limb ◽  
Lower Limb ◽  
Detection Threshold ◽  
Post Treatment ◽  
Dominant Hand ◽  
Motor Score ◽  
Mechanical Detection ◽  
Grooved Pegboard Test ◽  
Over Time

e21595 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a complex, dose-limiting toxicity impacting prognosis and quality of life. The optimal approach to identification and assessment remains unclear. This study aims to prospectively characterize the development and trajectory of CIPN using a combination of patient-reported outcomes (PROs) and objective Quantitative Sensory Testing (QST) measures in gynaecological, colorectal and lung cancer patients receiving neurotoxic platinum and/or taxane-based chemotherapy. Methods: Patients (n = 33, mean age 60.8) were evaluated at baseline prior to chemotherapy, during (every 3 weeks) and post-treatment every 3 months up to 1 year. Assessments at each time point included: PRO (EORTC QLQ-CIPN20 questionnaire) and QST measures (thermal and mechanical detection and grooved pegboard test). Statistical modelling using repeated measures analysis by patient was conducted. Results: Significant and parallel changes were observed in PROs and QST measures over time. Total EORTC score (sensory, motor and autonomic) increased in severity from baseline at all time points, peaking at 3 months post-treatment (34.8% increase; p < 0.0001) and persisting at 1 year (17.9% increase; p = 0.01). Every increase by one point in EORTC sensory score over time corresponded with an elevation in QST parameters: warm detection threshold (upper limb; p = 0.02 and lower limb; p = 0.03) and mechanical detection threshold, MDT (upper limb; p = 0.04 and lower limb; p = 0.02). Equally, rising total EORTC and motor score were related to increasing MDT in the upper limb p = 0.02 and p = 0.003 respectively. A delay of one second taken to complete the grooved pegboard test (dominant hand) was linked to a proportional increase in EORTC motor score (p = 0.01). Conclusions: Associations are shown here amongst PROs and QST parameters providing an opportunity to quantify and synthesize objective with subjective measures of neuropathy in CIPN patients. This may have potentially informative implications to underlying mechanisms of CIPN symptom burden, contributing to a more comprehensive clinical picture and allow stratification of patients by phenotype severity. Additional studies are warranted.

Is in vivo reflectance confocal microscopy a useful assessment tool in chemotherapy-induced peripheral neuropathy (CIPN)?

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23088-e23088
Author(s):  
Sabrina Ramnarine ◽  
Roman Rolke ◽  
Patrick M. Dougherty ◽  
Linda J Williams ◽  
Christi Alessi Fox ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Confocal Microscopy ◽  
Cancer Patients ◽  
Sensorimotor Function ◽  
Dominant Hand ◽  
Healthy Controls ◽  
Detection Thresholds ◽  
Mechanical Detection ◽  
Grooved Pegboard Test

e23088 Background: The lack of standardized diagnostic or assessment tools in CIPN pose an unmet need for objective and reliable measures. Advances in non-invasive, in vivo reflectance confocal microscopy (RCM) offer a painless method to identify markers of peripheral neuropathy such as loss of Meissner’s corpuscles (MC). This study aims to investigate the feasibility of RCM in CIPN by assessing MC density in healthy controls compared to cancer patients. Methods: RCM imaging (Vivascope 1500) was performed on the fingertip (digit V) to evaluate MC density in 45 healthy controls and 9 cancer patients prior to starting chemotherapy. Quantification was completed by two reviewers, one being blinded to achieve unbiased identification as the maximum MC count/6x6 mm image. Quantitative Sensory Testing (thermal and mechanical detection thresholds) along with the grooved pegboard test (sensorimotor function) were conducted for comparison with MC density. Spearman’s correlation coefficients were used to determine associations. Results: In healthy controls (25 females, 20 males; mean age 58.9, range 24-81 years), females exhibited a greater mean MC density compared with males (49.9 ± 7.1 MC vs 30.9 ± 4.2 MC; p = 0.03). Variances were observed across age range by decade (p < 0.0001). MC density was inversely correlated with mechanical detection (ρ = -0.51) and warm detection thresholds (ρ = -0.47) in contrast to cold pain threshold (ρ = 0.49). All correlations were significant (p < 0.01). Time to complete the grooved pegboard test correlated with MC density in the dominant hand (p = 0.02) and non-dominant hand (p < 0.01). Compared with age and gender matched controls, cancer patients had reduced MC density (22.0 ± 9.3 vs 35.4 ± 14.1; p = 0.03), mirroring deficits in cold detection threshold and the grooved pegboard test. Inter-rater reliability of MC density count showed an intraclass correlation of 0.96 (p < 0.0001). Conclusions: The findings from this study support the clinical utility of RCM in CIPN. Assessment of MC density using RCM may provide meaningful markers of sensory loss, sensorimotor function and an ability to detect possible subclinical deficits in patients at risk of CIPN prior to initiating chemotherapy.

scholarly journals Relationship between upper limb motor function and activities of daily living after removing the influence of lower limb motor function in subacute patients with stroke: A cross-sectional study

2020 ◽  
pp. 156918612092660
Author(s):  
Haruka Yamamoto ◽  
Kazuya Takeda ◽  
Soichiro Koyama ◽  
Keisuke Morishima ◽  
Yuichi Hirakawa ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Motor Function ◽  
Upper Limb ◽  
Lower Limb ◽  
Daily Living ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Motor Score ◽  
Cross Sectional ◽  
The Relationship

Background Previous studies have reported a relationship between upper limb motor function and activities of daily living. However, their relationship after removing the influence of lower limb motor function has not been clarified. Objective This study aimed to investigate the relationship between Fugl-Meyer assessment upper limb and total Functional Independence Measure motor score and between Fugl-Meyer assessment upper limb and each item contained in Functional Independence Measure motor score after eliminating the influence of the motor function of the affected lower limb. Methods This retrospective cross-sectional study included 58 subacute stroke patients. To investigate the relationship between the Fugl-Meyer assessment upper limb and total Functional Independence Measure motor score before and after removing the influence of Fugl-Meyer assessment lower limb, Spearman’s rank correlation coefficient and partial correlation analysis were used. Additionally, the relationship between Fugl-Meyer assessment upper limb and each item of Functional Independence Measure motor score after removing the influence was assessed. Results Before removing the influence of Fugl-Meyer assessment lower limb, Fugl-Meyer assessment upper limb was strongly correlated with total Functional Independence Measure motor score (r = 0.74, p < 0.001). However, it became weak after removing the influence (r = 0.27, p = 0.04). Regarding each item of Functional Independence Measure motor score, Fugl-Meyer assessment upper limb was correlated with grooming (r = 0.27, p = 0.04), bathing (r = 0.28, p = 0.03), dressing upper body (r = 0.33, p = 0.01), dressing lower body (r = 0.31, p = 0.02), and stair-climbing (r = 0.31, p = 0.02) after removing the influence. Conclusion These findings suggest that the relationship between the upper limb motor function and activities of daily living is strongly influenced by lower limb motor function.

scholarly journals Subclinical Peripheral Neuropathy in Patients with Head and Neck Cancer: A Quantitative Sensory Testing (QST) Study

2018 ◽  
Vol 1 (21;1) ◽  
pp. E419-E427 ◽  
Author(s):  
Carlos J. Roldan
Keyword(s):  
Head And Neck Cancer ◽  
Peripheral Neuropathy ◽  
Head And Neck ◽  
Patient Group ◽  
Neck Cancer ◽  
Quantitative Sensory Testing ◽  
Detection Threshold ◽  
Sensory Function ◽  
Dominant Hand ◽  
Sensory Testing

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and chronic complication associated with cancer treatment. Prior investigations have demonstrated the presence of subclinical peripheral neuropathy in patients with colorectal cancer even before the patients had received chemotherapy. Objective: To investigate subclinical peripheral neuropathy of the upper limbs in patients with squamous cell carcinoma (SCC) of the head and neck which developed before their exposure to neurotoxic anticancer agents. Study Design: Retrospective analysis. Methods: With the use of our quantitative sensory testing (QST) data bank, we retrospectively assessed the afferent fiber function of 25 patients with SCC of the head and neck before they had received chemotherapy (the patient group) and compared our findings with those from 23 healthy control patients. Skin temperature, sensorimotor function, sharpness detection, thermal detection, and touch detection (using both von Frey monofilaments and the Bumps detection test) were measured. Results: Touch thresholds were statistically higher in the patient group than in the healthy volunteer group at the palm (mean [± SD], 0.54 g [± 0.07 g] and 0.27 g [± 0.05 g], respectively [P < 0.01]) and at the forearm (0.74 g [± 0.12 g] and 0.41 g [± 0.08 g] [P < 0.05]). There was also a clear deficit in touch sensation as indicated by a Bumps detection threshold in patients of 6.5 µm ± 0.8 µm and in controls of 3.7 µm ± 0.5 µm. This yields an elevation in threshold to 165% in the patients relative to that of the control volunteers. The grooved pegboard test showed delayed completion times for patients compared with controls, with differences of 18.65 seconds in the dominant hand and of 23.36 seconds in the nondominant hand. The sharpness detection thresholds did not differ between patients and volunteers. Limitations: Inadequacies in the original data acquisition and documentation of the QST and the medical records could not be addressed due to the retrospective nature of the study. In addition, based on available information, we did not find an objective parameter able to correlate the QST findings with pre-pain levels. Conclusion: Patients with SCC were found to have deficits in sensory function before undergoing treatment, suggesting that cancer itself alters peripheral nerve function and may contribute to the development of CIPN. These results confirm the sensitivity of the Bumps detection test and highlight its potential role in early detection of peripheral neuropathy, especially in cancer patients for whom chemotherapies associated with CIPN have been prescribed. Key words: Peripheral neuropathy, head and neck cancer, quantitative sensory testing

Cardiac troponin I in patients with acute upper and lower limb ischemia

VASA ◽  
2008 ◽  
Vol 37 (4) ◽  
pp. 327-332 ◽  
Author(s):  
Koutouzis ◽  
Sfyroeras ◽  
Moulakakis ◽  
Kontaras ◽  
Nikolaou ◽  
...  
Keyword(s):  
Upper Limb ◽  
Lower Limb ◽  
Cardiac Troponin ◽  
Cardiac Involvement ◽  
Troponin I ◽  
Limb Ischemia ◽  
Elevated Troponin ◽  
Troponin Elevation ◽  
Lower Limb Ischemia ◽  
Ischemia Group

Background: The aim of this study was to investigate the presence, etiology and clinical significance of elevated troponin I in patients with acute upper or lower limb ischemia. The high sensitivity and specificity of cardiac troponin for the diagnosis of myocardial cell damage suggested a significant role for troponin in the patients investigated for this condition. The initial enthusiasm for the diagnostic potential of troponin was limited by the discovery that elevated cardiac troponin levels are also observed in conditions other than acute myocardial infarction, even conditions without obvious cardiac involvement. Patients and Methods: 71 consecutive patients participated in this study. 31 (44%) of them were men and mean age was 75.4 ± 10.3 years (range 44–92 years). 60 (85%) patients had acute lower limb ischemia and the remaining (11; 15%) had acute upper limb ischemia. Serial creatine kinase (CK), isoenzyme MB (CK-MB) and troponin I measurements were performed in all patients. Results: 33 (46%) patients had elevated peak troponin I (> 0.2 ng/ml) levels, all from the lower limb ischemia group (33/60 vs. 0/11 from the acute upper limb ischemia group; p = 0.04). Patients with lower limb ischemia had higher peak troponin I values than patients with upper limb ischemia (0.97 ± 2.3 [range 0.01–12.1] ng/ml vs. 0.04 ± 0.04 [0.01–0.14] ng/ml respectively; p = 0.003), higher peak CK values (2504 ± 7409 [range 42–45 940] U/ml vs. 340 ± 775 [range 34–2403] U/ml, p = 0.002, respectively, in the two groups) and peak CK-MB values (59.4 ± 84.5 [range 12–480] U/ml vs. 21.2 ± 9.1 [range 12–39] U/ml, respectively, in the two groups; p = 0.04). Peak cardiac troponin I levels were correlated with peak CK and CK-MB values. Conclusions: Patients with lower limb ischemia often have elevated troponin I without a primary cardiac source; this was not observed in patients presenting with acute upper limb ischemia. It is very important for these critically ill patients to focus on the main problem of acute limb ischemia and to attempt to treat the patient rather than the troponin elevation per se. Cardiac troponin elevation should not prevent physicians from providing immediate treatment for limb ischaemia to these patients, espescially when signs, symptoms and electrocardiographic findings preclude acute cardiac involvement.

Study on Pramana Shareera in relation to Prakriti

2016 ◽  
Vol 2 (3) ◽  
Author(s):  
Rajendra Pai N. ◽  
U. Govindaraju
Keyword(s):  
Observational Study ◽  
Upper Limb ◽  
Lower Limb ◽  
Characteristic Property ◽  
The Body ◽  
Artificial Limbs ◽  
Body Parts ◽  
Unit Of Measurement ◽  
The Individual ◽  
Different Parts

Ayurveda in its principle has given importance to individualistic approach rather than generalize. Application of this examination can be clearly seem like even though two patients suffering from same disease, the treatment modality may change depending upon the results of Dashvidha Pariksha. Prakruti and Pramana both used in Dashvidha Pariksha. Both determine the health of the individual and Bala (strength) of Rogi (Patient). Ayurveda followed Swa-angula Pramana as the unit of measurement for measuring the different parts of the body which is prime step assessing patient before treatment. Sushruta and Charaka had stated different Angula Pramana of each Pratyanga (body parts). Specificity is the characteristic property of Swa-angula Pramana. This can be applicable in present era for example artificial limbs. A scientific research includes collection, compilation, analysis and lastly scrutiny of entire findings to arrive at a conclusion. Study of Pramana and its relation with Prakruti was conducted in 1000 volunteers using Prakruti Parkishan proforma with an objective of evaluation of Anguli Pramana in various Prakriti. It was observed co-relating Pramana in each Prakruti and Granthokta Pramana that there is no vast difference in measurement of head, upper limb and lower limb. The observational study shows closer relation of features with classical texts.

scholarly journals Sympathetic and sensory nerve fiber function in multiple system atrophy and idiopathic Parkinson’s disease

2021 ◽  
Author(s):  
Heidrun H. Krämer ◽  
Cora Rebhorn ◽  
Christian Geber ◽  
Frank Birklein
Keyword(s):  
Detection Threshold ◽  
Sensory Nerve ◽  
Research Network ◽  
Sensory Testing ◽  
Sympathetic Function ◽  
Autonomic Testing ◽  
German Research ◽  
Pain Sensitization ◽  
Mechanical Detection ◽  
Mechanical Pain Thresholds

Abstract Objective To explore small fiber somatosensory and sympathetic function in PD and MSA. Methods We recruited 20 PD patients (7 women, median age 65.5 years; IQR 54.75–70.0), 10 MSA patients (4 women; median age 68 years; IQR 66.25–74.0), and 10 healthy subjects (HC; 4 women, median age 68; IQR 59.0–71.0 years). Autonomic testing included forehead cooling, intradermal microdialysis of norepinephrine (NE; 10–5; 10–6; 10–7; and 10–8), and orthostatic hypotension (OH); somatosensory testing included quantitative sensory testing (QST) according to the protocol of the German Research Network on Neuropathic Pain (DFNS). Results OH occurred more frequently in PD (p = 0.018) and MSA (p = 0.002) compared to HC. Vasoconstriction responses were stronger in PD compared to MSA during forehead cooling (p = 0.044) and microdialysis of physiologically concentrated NE solutions (10–7; 10–8; p = 0.017). PD and MSA had impaired cold (PD: p < 0.01; MSA: p < 0.05) and warm detection thresholds (PD and MSA, both p < 0.05). The mechanical detection threshold was higher in PD (p < 0.01). Conversely, mechanical pain thresholds were decreased in PD and MSA (both p < 0.001), indicating mechanical hyperalgesia. Conclusion In contrast to MSA, we found evidence of peripheral adrenoreceptor hypersensitivity in PD, probably caused by peripheral sympathetic denervation. Sensory testing revealed peripheral neuropathy and central pain sensitization in PD and MSA. Jointly, our data demonstrate autonomic and somatosensory dysfunction in PD and MSA.

Computed tomography angiography and microsurgical flaps for traumatic wounds: What is the added value?

2021 ◽  
pp. 1-9
Author(s):  
Lucas Sousa Macedo ◽  
Renato Polese Rusig ◽  
Gustavo Bersani Silva ◽  
Alvaro Baik Cho ◽  
Teng Hsiang Wei ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Upper Limb ◽  
Computed Tomography Angiography ◽  
Lower Limb ◽  
High Energy ◽  
Lower Limbs ◽  
Added Value ◽  
Vascular Lesions ◽  
Limb Injuries ◽  
Significant Difference

BACKGROUND: Microsurgical flaps are widely used to treat complex traumatic wounds of upper and lower limbs. Few studies have evaluated whether the vascular changes in preoperative computed tomography angiography (CTA) influence the selection of recipient vessel and type of anastomosis and the microsurgical flaps outcomes including complications. OBJECTIVE: The aim of this study was to evaluate if preoperative CTA reduces the occurrence of major complications (revision of the anastomosis, partial or total flap failure, and amputation) of the flaps in upper and lower limb trauma, and to describe and analyze the vascular lesions of the group with CTA and its relationship with complications. METHODS: A retrospective cohort study was undertaken with all 121 consecutive patients submitted to microsurgical flaps for traumatic lower and upper limb, from 2014 to 2020. Patients were divided into two groups: patients with preoperative CTA (CTA+) and patients not submitted to CTA (CTA–). The presence of postoperative complications was assessed and, within CTA+, we also analyzed the number of patent arteries on CTA and described the arterial lesions. RESULTS: Of the 121 flaps evaluated (84 in the lower limb and 37 in the upper limb), 64 patients underwent preoperative CTA. In the CTA+ group, 56% of patients with free flaps for lower limb had complete occlusion of one artery. CTA+ patients had a higher rate of complications (p = 0.031), which may represent a selection bias as the most complex limb injuries and may have CTA indicated more frequently. The highest rate of complications was observed in chronic cases (p = 0.034). There was no statistically significant difference in complications in patients with preoperative vascular injury or the number of patent arteries. CONCLUSIONS: CTA should not be performed routinely, however, CTA may help in surgical planning, especially in complex cases of high-energy and chronic cases, since it provides information on the best recipient artery and the adequate level to perform the microanastomosis, outside the lesion area.

scholarly journals Audio-visual stimulation in conjunction with functional electrical stimulation to address upper limb and lower limb movement disorder

2016 ◽  
Vol 26 (2) ◽  
Author(s):  
Deepesh Kumar ◽  
Sunny Verma ◽  
Sutapa Bhattacharya ◽  
Uttama Lahiri
Keyword(s):  
Electrical Stimulation ◽  
Movement Disorder ◽  
Upper Limb ◽  
Functional Electrical Stimulation ◽  
Lower Limb ◽  
Neurological Disorders ◽  
Visual Stimulation ◽  
Lower Limbs ◽  
Lower Limb Movement ◽  
Rehabilitation Exercises

Neurological disorders often manifest themselves in the form of movement deficit on the part of the patient. Conventional rehabilitation often used to address these deficits, though powerful are often monotonous in nature. Adequate audio-visual stimulation can prove to be motivational. In the research presented here we indicate the applicability of audio-visual stimulation to rehabilitation exercises to address at least some of the movement deficits for upper and lower limbs. Added to the audio-visual stimulation, we also use Functional Electrical Stimulation (FES). In our presented research we also show the applicability of FES in conjunction with audio-visual stimulation delivered through VR-based platform for grasping skills of patients with movement disorder.

A variant of the gene HARS detected in the clinical exome: etiology of a peripheral neuropathy undiagnosed for 20 years

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Raquel Lahoz Alonso ◽  
Paula Sienes Bailo ◽  
Jose Luis Capablo Liesa ◽  
Sara Álvarez de Andrés ◽  
Jose Luis Bancalero Flores ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Neurological Disease ◽  
Motor Impairment ◽  
Lower Limbs ◽  
Case Presentation ◽  
Genetic Sequencing ◽  
Charcot Marie Tooth ◽  
Sensory Motor ◽  
Exacerbation Of Symptoms ◽  
Over Time

AbstractObjectivesDescribe a case with axonal Charcot-Marie-Tooth (CMT) type 2W, a neurological disease characterized by peripheral neuropathy typically involving the lower limbs and causing gait alterations and distal sensory-motor impairment.Case presentationWe report this case, where the application of massive genetic sequencing (NGS) with clinical exome in a molecular genetics laboratory enabled to detect the presence of candidate variants of the clinic of the patient.ConclusionsThe variant detected in HARS gene suggests that this variant could be causative of the symptoms of the patient, who went undiagnosed for 20 years and experienced an exacerbation of symptoms over time.

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