Neurovisualization features of brain anatomy in children with spastic cerebral palsy revealed by magnetic resonance tractography

Aim. To perform quantitative evaluation of the degree of white matter tract abnormalities in children with spastic cerebral palsy by magnetic resonance tractography to determine severity of the disease, as well as to carry out a dynamic assessment of treatment effectiveness.Materials and methods. The study included 46 children (32 males, 14 females; average age 5.4 ± 1.1 years). The participants were divided into two groups. The experimental group consisted of 23 children with spastic cerebral palsy. The control group included 23 children without any neurological disorder. Examination of the brain was performed on the Siemens Essenza 1,5 Т system (Siemens, Germany) and included magnetic resonance tractography to reconstruct the major white matter tracts. The number of fibers, average fractional anisotropy value, apparent diffusion coefficient, and coefficient of myelination of major white matter tracts in the brain were calculated and analyzed.Results. We found a significant difference in the above-stated parameters between the groups. The experimental group showed a decrease in the absolute number of fibers at the central and posterior segments of the corpus callosum, corticospinal tracts, and left inferior longitudinal fasciculus. Besides, we detected a decrease in fractional anisotropy at 2–5 segments of the corpus callosum and right lateral corticospinal tract, an increase in the apparent diffusion coefficient at 2, 4, and 5 segments of the corpus callosum and left lateral corticospinal tract, and a decrease in the myelination coefficient in all the examined tracts, except for superior longitudinal fasciculus. We revealed a positive correlation between the intensity of the motor disturbance and the coefficient of myelination at the anterior corpus callosum and inferior longitudinal fasciculus.Conclusion. Magnetic resonance tractography is an informative technique for unbiased evaluation of white matter tract anatomy, as well the level and degree of motor tract damage. The most useful characteristics of white matter tract anatomy are the absolute number of fibers in the tract, fractional anisotropy, and coefficient of myelination. Some of them correlated with the intensity of motor disturbance, so they can be regarded as potential predictors of rehabilitation potential.

Effect of training using the technology of teaching basic competitive swimming techniques to children with cerebral palsy

Purpose: According to many scholars, sport is essential for social adaptation and integration of people with disabilities. Therefore, it is important to research innovative technologies for teaching competitive swimming technique to 8-10-year- old children with cerebral palsy. The aim of this study is to develop the technology of teaching competitive swimming techniques to children with cerebral palsy and to evaluate its effectiveness for mastering the front crawl swimming technique. Materials and methods: analysis of scientific literature, questionnaires (e-correspondence), pedagogical experiment, expert survey, determination of the coefficient of technique efficiency, statistical methods. A total of 15 qualified swimming coaches participated in this study. The experiment involved 29 children who were diagnosed with cerebral palsy. Results: the main means of technology implementation is the web-based information system SwimCP (Swimming with Cerebral Palsy), which promotes effective swimming teaching for children with cerebral palsy at the initial stage of sports training by selecting and recommending an approximate complex of exercises that take into account the peculiarities of motor disturbance in accordance with the specific form of cerebral palsy and the stage of motor activity training. Conclusion: using expert assessment and the coefficient of swimming technique efficiency determination, it is confirmed that the proposed technology of teaching basic competitive swimming techniques to children with cerebral palsy is effective. Resumen: Objetivo: Según muchos estudiosos destacados, el deporte es fundamental para la adaptación social y la integración de las personas con discapacidad. Por lo tanto, es importante investigar modelos innovadores para enseñar brazadas de natación competitiva a niños con parálisis cerebral. El objetivo del estudio es diseñar el modelo pedagógico de enseñanza de los estilos básicos de natación competitiva a niños con parálisis cerebral y evaluar su efectividad para dominar el estilo de natación estilo crol. Material y métodos: Se utilizó una metodología de investigación selectiva. Implicó la recopilación directa de datos gracias a la encuesta a los participantes. Los resultados mostraron que el nivel de dominio de la brazada de natación utilizado por los niños que aplicaron este modelo diseñado fue objetivamente mayor en comparación con los mismos indicadores de entrenamiento relacionados con el método tradicional. Conclusiones: Basándonos en la evaluación de la eficiencia de la brazada de natación, creemos que el modelo pedagógico propuesto de enseñar las brazadas básicas de natación competitiva a niños con parálisis cerebral es eficaz.

#2950 Should the presence of neurodegenerative disease alter our management and understanding of psychiatric comorbidities?

As people are living longer, we are seeing more neurodegenerative diseases (NDs). NDs have both neurological and psychiatric manifestations. Depression and anxiety are common comorbidities in Alzheimers and Parkinsons disease. The diagnosis and intervention of depression and anxiety on the background of the aforementioned NDs is complicated by cognitive and motor disturbance. We aim to capture a general overview of the diagnostic and management challenges and compare these with the National Institute for Health and Care Excellence (NICE) guidance to identify any disparities that may exist.A general review of this topic was sought through the MEDLINE database. Papers matching search terms were selected based on size, novelty and relevance to diagnostics or treatment of the psychiatric complications, namely depression and anxiety, in Parkinsons (PD) and Alzheimers disease (AD). Large systematic reviews helped establish strong evidence, novelty allowed for emerging ideas to be identified and all articles were relevant to either PD or AD.The general approach to these psychiatric manifestations by non-specialists is as a one-size-fits-all approach. The efficacy of pharmacological treatments is questionable as often the side effects are much worse in this population and the action may vary on the degenerating anatomy. Many non-pharmacological treatments exist with some less traditional methods showing positive results including therapies focused on informal carers.Drawing on the expertise of neuropsychiatrists and non-conventional therapies could yield better management of these patients and inform NICE guidance which would improve practice nationally.

Inverted circadian variation of arterial pressure in a geriatric patient: an indicator of autonomic dysfunction

Background Orthostatic hypotension (OH) in geriatric patients frequently involves a component of autonomic failure (AF). The combination of OH with nocturnal hypertension (NHT) is indicative of AF, which is described as pure (PAF), when neurologic symptoms are absent, or as multisystem atrophy (MSA), when combined with motor disturbance (Parkinsonism or Parkinson disease). Case presentation An 87-year-old man presented with long-lasting OH. He frequently fell, causing several fractures, and he developed heart failure. Blood pressure (BP) registration revealed a reversal of the day-night rhythm with NHT. An 18-FDG PET brain CT scan showed cerebellar hypometabolism, indicating MSA. Conclusions This case demonstrates the use of continuous BP registration in geriatric patients with OH for diagnosing NHT. It illustrates the usefulness of 18-FDG PET brain CT scan to specify the nature of the AF. The case also illustrates the difficulty of managing the combination of OH and NHT.

Association of Golfing Career and Musculoskeletal Problems of the yips: A Large Scale Epidemiological Study in Japan

Background: The yips are a set of conditions associated with intermittent motor disturbance that affects precision movement, especially in sports. Specifically, skilled golfers suffer from the yips, although its clinical characteristics and pathophysiology have not been well studied. Methods: The purpose of this study was aimed to conduct an epidemiological investigation and explore potential confounding factors associated with the yips among skilled golfers in Japan. We surveyed highly-skilled golfers for characterizing the yips-related symptoms. The survey comprised golfers’ demographic information, golfing-career-related history, musculoskeletal status, and manifestations of the yips. The answers obtained were statistically analyzed to examine the association between golf and the yips.Results: Among the 1,576 questionnaires distributed, 1,457 (92%) responded, of which 39% experienced the yips. The median age and golfing careers were 48 and 28 years, respectively. Golfers with the yips experience were older, had longer golfing careers, and more frequent musculoskeletal problems than those without the yips experience. The multivariate logistic regression analysis revealed that a longer golfing career [odds ratio (OR), 1.07; 95% confidence interval (CI), 1.04–1.11] and musculoskeletal problems (OR, 1.08; 95% CI, 1.03–1.13) were independent factors associated with the yips experience. More severe musculoskeletal problems were associated with higher odds of experiencing the yips. Changing the training method and/or hitting style were effective for improving the yips.Conclusions: Our results revealed that the yips has similar characteristics to task-specific movement disorders, with a detrimental effect caused by excessive repetition of a routine task and a positive association between the yips and musculoskeletal problems. These findings supported the notion that the yips is a type of task-specific dystonia.

The Association between Hepatic Encephalopathy and Diabetic Encephalopathy: The Brain-Liver Axis

Hepatic encephalopathy (HE) is one of the main consequences of liver disease and is observed in severe liver failure and cirrhosis. Recent studies have provided significant evidence that HE shows several neurological symptoms including depressive mood, cognitive dysfunction, impaired circadian rhythm, and attention deficits as well as motor disturbance. Liver disease is also a risk factor for the development of diabetes mellitus. Diabetic encephalopathy (DE) is characterized by cognitive dysfunction and motor impairment. Recent research investigated the relationship between metabolic changes and the pathogenesis of neurological disease, indicating the importance between metabolic organs and the brain. Given that a diverse number of metabolites and changes in the brain contribute to neurologic dysfunction, HE and DE are emerging types of neurologic disease. Here, we review significant evidence of the association between HE and DE, and summarise the common risk factors. This review may provide promising therapeutic information and help to design a future metabolic organ-related study in relation to HE and DE.

Delirium

Delirium is an acute neuropsychiatric disturbance secondary to a pathophysiological insult, including illness, injury, or the effects or withdrawal of drugs. Features are variable, and fluctuate, with drowsiness or inattention, change in cognition, and often delusions, hallucinations, emotional, autonomic, and motor disturbance. It is commoner in those with prior dementia, and is seen in medical, surgical, intensive care, and palliative settings. Pathological mechanisms are uncertain. Nonpharmacological prevention strategies reduce incidence by up to 30%, including early mobilization, drug review, and sleep hygiene. Diagnosis is clinical, supported by various tools. Delirium is often underdiagnosed. Treatment comprises identifying and treating the (sometimes multiple) causes, avoiding complications, rehabilitation, and symptomatic relief of distress. Short-term, low-dose antipsychotic drugs may be used, but with limited supporting evidence. Prognosis is variable: some with delirium resolve within 24 hours, one-quarter persist for three months, and some never recover. Morality is up to 40% at six months.

Outcome following cervicothoracic junction fusion in T1 pathological fracture of breast cancer spinal metastases: a case report

The cervicothoracic junction (CTJ) is defined as the area extending from vertebral segment C7 to T2. Spinal metastases of CTJ are rare, range from 10% to less than 20%. A 47-year-old woman complained sensory and motor disturbance since 3 weeks prior to admission. History of lump on the left breast was confirmed. Neurological deficit was confirmed as ASIA C at the time of diagnosis. MRI finding suggest fracture of T1 vertebral body with kypothic angle 28° that causing anterior compression of spinal cord. The patient underwent decompression and posterior fusion from C4 to T4. A biopsy sample was also collected from the spine and left breast to confirm the diagnosis. Patient evaluation was done during discharge and at certain points of follow-up for improvement on its neurological, pain, and functional status. An MRI evaluation was performed to evaluate spinal stability and fusion. Significant improvements were observed in patient ambulatory and pain status. Cervicothoracic junction fusion procedure is a considerable choice for the management of pathological vertebral fractures with cervicothoracic junction involvement caused by spinal metastases of breast cancer.

Orthonasal, but not Retronasal Olfaction Is Specifically Impaired in Parkinson’s Disease

Olfactory dysfunction (OD) in Parkinson’s disease (PD) appears several years before the presence of motor disturbance. Olfactory testing has the potential to serve as a tool for early detection of PD, but OD is not specific to PD as it affects up to 20% of the general population. Olfaction includes an orthonasal and a retronasal components; in some forms of OD, retronasal olfactory function is preserved. We aimed to evaluate whether combined testing components allows for discriminating between PD-related OD and non-Parkinsonian OD (NPOD). The objective of this study is to orthonasal and retronasal olfactory function in PD patients and compare them to a NPOD group and to healthy controls. We hypothesized that this combined testing allows to distinguish PD patients from both other groups. We included 32 PD patients, 25 NPOD patients, and 15 healthy controls. Both olfactory components were impaired in PD and NPOD patients, compared with controls; however, NPOD patients had significantly better orthonasal scores than PD patients. Furthermore, the ratio of retronasal/orthonasal score was higher in PD than in both other groups. In the NPOD group, orthonasal and retronasal scores were significantly correlated; no such correlation could be observed in PD patients. In summary, PD patients seem to rely on compensatory mechanisms for flavor perception. Combined orthonasal and retronasal olfactory testing may contribute to differentiate PD patients from patients with NPOD.

Examining the Progressive Behavior and Neuropathological Outcomes Associated with Chronic Repetitive Mild Traumatic Brain Injury in Rats

While the physical and behavioral symptomologies associated with a single mild traumatic brain injury (mTBI) are typically transient, repetitive mTBIs (RmTBI) have been associated with persisting neurological deficits. Therefore, this study examined the progressive changes in behavior and the neuropathological outcomes associated with chronic RmTBI through adolescence and adulthood in male and female Sprague Dawley rats. Rats experienced 2 mTBIs/week for 15 weeks and were periodically tested for changes in motor behavior, cognitive function, emotional disturbances, and aggression. Brain tissue was examined for neuropathological changes in ventricle size and presentation of Iba1 and GFAP. We did not see progressively worse behavioral impairments with the accumulation of injuries or time, but did find evidence for neurological and functional change (motor disturbance, reduced exploration, reduced aggression, alteration in depressive-like behavior, deficits in short-term working memory). Neuropathological assessment of RmTBI animals identified an increase in ventricle size, prolonged changes in GFAP, and sex differences in Iba1, in the corpus callosum, thalamus, and medial prefrontal cortex. Telomere length reduced exponentially as the injury load increased. Overall, chronic RmTBI did not result in accumulating behavioral impairment, and there is a need to further investigate progressive behavioral changes associated with repeated injuries in adolescence and young adulthood.