Locked-in Guillain-Barré syndrome: ‘my living nightmare’

A 48-year-old man with severe Guillain-Barré syndrome suffered complete paralysis, and for 31 days could not communicate with the outside world, while remaining fully conscious. After recovery, he provided feedback on aspects of his care, such as mechanical ventilation, physical therapy, and communication. Conventional low tidal volume normocapnic ventilation induced ongoing and profound dyspnoea, occasionally relieved by modest increases in minute ventilation. Routine and apparently benign physical therapy was extremely painful, which was not reflected in heart rate or blood pressure changes. When he eventually re-established communication after many weeks, via slight eye movements, his first message was to express a particular distressing symptom. His case is a valuable reminder of the sometimes large gap between clinical measurements and assumptions and the subjective patient experience. We propose several approaches to address such issues in other paralysed but conscious patients.

Preserved motor representations after paralysis

Neural plasticity allows us to learn skills and incorporate new experiences. What happens when our lived experiences fundamentally change, such as after a severe injury? To address this question, we analyzed intracortical population activity in a tetraplegic adult as she controlled a virtual hand through a brain-computer interface (BCI). By attempting to move her fingers, she could accurately drive the corresponding virtual fingers. Neural activity during finger movements exhibited robust representational structure and dynamics that matched the representational structure, previously identified in able-bodied individuals. The finger representational structure was consistent during extended use, even though the structure contributed to BCI decoding errors. Our results suggest that motor representations are remarkably stable, even after complete paralysis. BCIs re-engage these preserved representations to restore lost motor functions.

A few words about the arthrodesis operation

The operation of arthrodesis, or artificial ankylosis of the joint, first performed by Albert in 1878, is one of the most beneficial orthopedic methods of treatment in cases of complete paralysis of all muscles moving this joint and in cases of ankylosis in a functionally disadvantageous position of the joint, when a quick recovery of the patient's ability to work is required if it is impossible, for one reason or another, to use his orthopedic devices.

Role of Electromyography(EMG) for (Muscle Conductivity) management of Paralyzed Patients in Dhaka city

The purpose of this study is to assess the electromyography (EMG) signals of biceps muscle of paralyzed patients to know the condition of their affected muscle. For measuring the muscle signal, 5 voltages analog signal is sent to biceps muscle via EMG sensor with Arduino. As higher the voltage is, the condition of the muscle status is better. In this study, we have observed paralyzed patients in Dhaka city having different kinds of paralysis patients like Complete paralysis, Partial or incomplete paralysis and localized paralysis. The study also focused on monitoring different stage of paralysis like Flaccidity, dealing with appearance of spasticity, increased spasticity or decreased spasticity, complex movement combination, spasticity disappear and normal function return. This observational study was carried out in three largest and tertiary care hospitals located in Dhaka metropolitan area with the help of Myoware EMG based muscle sensor. Total 50 paralyzed cases were included in this study. Among the 50 cases of paralyzed patients, majority of the cases (55%) were of 40-55 years aged group where 75% were male and 25% were female. In this study, 85% were Localized paralyzed patients, 10% Partial paralyzed and 5% Complete paralyzed. This study also shows the condition of healthy biceps muscle as compared with paralyzed muscle. The findings of this study could play an important role to observe the condition of paralyzed muscle for better management of paralyzed patients and give a clear idea about which management is needed.

COVID-19 was found in A Patient's CSF Who Presented with A Severe form of Guillain Barre Syndrome; A Successful Sudanese Story: A Case Report

Background: Neurological manifestation and complications are common due to the coronavirus infectious disease COVID-19. It affects higher functions, cranial nerves and the motor system. It can lead to headaches, convulsions, mental and psychological changes like delirium and insomnia. Guillain Barre syndrome rarely occurs as a consequence of or in co-incidence with COVID-19. The authors report a case of Guillain Barre syndrome as an example of a success story in managing a complicated case of COVID-19 in an elderly male with signs of a poor prognosis. Case presentation: A previously healthy 70-year-old man presented (on the 25th of June, 2020) with a fever and cough followed by quadriplegia and facial weakness one week later. He tested positive for COVID-19, and a nerve conduction study revealed demyelinating neuropathy consistent with Guillain Barre syndrome. He received treatment in the form of intravenous immunoglobulin with marked improvement despite poor prognostic features. Conclusion: Patients with COVID-19 can present with any symptoms, including diseases of the nervous system and peripheral nerves such as Guillain Barre syndrome, which respond very well to IVIG treatment despite poor prognostic factors such as old age, gender, rapid onset of complete paralysis, lymphopenia and a ground-glass appearance on CT chest scans, which all existed in this case.

Spina Bifida: alternative approaches and treatment, based on evidence through gait analysis

Myelomeningocele results from failure of the neural tube to close in the developing fetus and is associated with neurological impairment (Incidence 1:1000 births). The level of the anatomic lesion generally correlates with the neurological deficit and ranges from complete paralysis to minimal or in some cases no motor involvement. Myelomeningocele or Spina bifida can lead to health problems, physical disabilities, and learning problems. Most commonly, associated with paralysis of the lower extremities and neurogenic bladder. Treatment requires multidisciplinary participation. The functional classification that concerns us in this review includes three types and were obtained through gait analysis. Keywords: Spina bifida; instrumental; gait analysis; kinematics and kinetics; orthotics

Functional outcome of traumatic paraplegia and paraparesis patients treated with pedicle screw stabilization with decompression

<p class="abstract"><strong>Background:</strong> In this study, unstable thoracolumbar spine fractures with neurological deficit fixed with Moss Miami pedicle screw and decompression were followed up for neurological improvement (sensory and motor functions). Patients were admitted in the department of Orthopaedics, Government medical college, Kottayam from November 2016 to October 2017.</p><p class="abstract"><strong>Methods:</strong> In this observational study, 96 patients (aged 17 to 60 years) are followed up. The preoperative neurological status and post-operative recovery are follow-up at 1, 3 and 6 months and graded by Frankel’s grading. Change from Frankel’s grade A OR B to Frankel grade C, D OR E was said to be improved neurologically.<strong></strong></p><p class="abstract"><strong>Results:</strong> 87.3% males and 12.7% females with 58.3% patients having fall from height sustained wedge compression fractures (49.1%), burst fractures (46.8%) and fracture dislocations (4.1%). vertebra fractured were L1-31.4%, T12-22.9% and L2-19.7%. Complete paralysis was 44.8% and 55.2% incomplete. At 6 months 75% patients showed improvement and 25% patients showed nil. 95.5% patients (18-30 years) showed improvement and only 50% (51-60 years). Incomplete neurological deficit showed significant improvement (100%) compared to patients with complete paralysis (44.2%). Preoperative Frankel score has significant relationship with final neurological (44% of patients with Frankel A and 100% with Frankel D.</p><p class="abstract"><strong>Conclusions:</strong> Moss Miami pedicle screw stabilization with decompression is an effective surgical technique in maintaining stability of spine in traumatic paraplegia and paraparesis patients and there is significant improvement in neurological status.</p>

Total en bloc spondylectomy is worth doing in complete paralysis spinal giant cell tumor, a minimum 1-year follow-up

Objective: To investigate the neurological recovery of Frankel A spinal giant cell tumor (GCT) patients after they had received a Total En Bloc Spondylectomy (TES). Materials and Methods: We retrospectively recorded data of three patients (two females) with mobile spine GCT (T6, T10, and L2) Enneking stage III with complete paralysis before surgery, who had undergone TES in our institute from January 2018 to September 2020. The duration of neurologic recovery to Frankel E was the primary outcome. The intra-operative blood loss, operative time, operative-related complications, and the local recurrence were the secondary outcomes. Results: The duration of suffering from Frankel A to TES surgery was 2 months for the T6 patient, 3 weeks for the T10 patient, and 1 month for the L2 patient. Three patients had achieved full neurological recovery to Frankel E within 6 months after TES (T6 for 5 months, T10 for 3 months, and L2 for 3 months). The average blood loss was 2833.33 ml and the mean operative time was 400 min. Up until the last follow-up (13–25 months), no evidence of local recurrences had been found in any of the three patients. Conclusion: Frankel A spinal GCT patients can achieve full neurological recovery after TES, if the procedure is performed within 3 months after complete paraplegia. TES can effectively control any local recurrences.

Effect of methanolic stem bark extract of Azadihiracta Indica on morbidity and mortality of chickens experimentally infected with velogenic Newcastle disease virus (kudu 113)

Newcastle Disease (ND) is a dangerous disease of poultry all over the world. Economically, ND is characterized by mortality which may reach up to 100% in affected poultry farms. This study was designed to evaluate the protective properties of crude methanolic extract of Azadihiracta indica in chickens experimentally infected with a velogenic strain of ND virus. A hundred- day old cockerel was brooded for three weeks before randomly divided into five equal groups (I, II, III, IV and V). They were not vaccinated with ND vaccine LaSota. At six weeks of age, each bird in groups I-IV was inoculated with 0.2mL of the live ND viral inoculum intramuscularly while group V was not inoculated with the virus. Thereafter, groups I, II and III were daily given in drinking water 200mg/kg, 400mg/kg and 600mg/kg of Azadihiracta indica extract, respectively whereas, groups IV and V were not treated with the extract. All the groups were monitored for the onset of clinical signs, morbidity and mortality rate. In all the groups inoculated with the ND virus, about 80% birds showed signs of depression, gasping, coughing, increased thirst, complete inappetence, huddling, diarrhoea, partial/complete paralysis on day 2 post inoculation (PI). A hundred percent (100%) mortality rate was recorded for groups I and IV by day 5 PI and in groups II and III on day 6 PI. Therefore, under the conditions of this study, oral administration of Azadihiracta indica extract does not protect birds from ND.

The impact of helicopter emergency medical services and craniocervical traction on the early reduction of cervical spine dislocation in a rural area of Japan

Background Several clinical and basic studies have shown that an association exists between achieving decompression of the spinal cord within a few hours and neurological recovery, even in patients with complete paralysis due to cervical spine dislocation. This study aimed to clarify the impact of helicopter emergency medical services(HEMS)and craniocervical traction using a halo ring on rapid reduction of lower cervical spine dislocation in rural Japan. Methods The success rate of and factors inhibiting closed reduction, time from injury to reduction and functional prognosis of lower cervical spine dislocations treated between July 2012 and January 2020 were retrospectively analysed. Results Fourteen patients were transported by HEMS (group H), seven were by ambulances (group A) and two were by themselves. Although the average travelled distance and injury severity score were significantly higher in group H (64.5 km, 28.0) than in group A (24.7 km, 18.6), there was no significant difference in the average time to admission or the time to start craniocervical traction after admission between group H (159.4 min, 52.2 min) and group A (163.6 min, 53.2 min). The urgent traction could be administered for 20 patients. The success rate of closed reduction was 95%, and neurological deterioration following traction was not observed in any cases. The average traction time and weight for reduction were 30.3 min and 16.3 kg, respectively. Patients’ body size and fracture-dislocation types did not significantly affect the traction time or weight. The rate of reduction within 4 h after injury was higher in group H (79%) than in group A (33%). Herniated discs were found at dislocation levels in five patients by magnetic resonance imaging scans performed after closed reduction, and all cases of inner fixation were treated via the posterior approach an average of 5.7 days after admission. After these treatment, three of nine AIS A patients recovered the ability to walk, and all the three patients underwent successful closed reduction within 4 h after injury. Conclusion HEMS and highly successful closed reduction considerably contributed to the early reduction of cervical spine dislocation and can potentially improve complete paralysis.