Acta Neurologica Taiwanica[JOURNAL]
Sun
200 papers
Clinical characteristics and risk factors for seizures to recur in calcified neurocysticercosis : Prospective cohort Study.
Verma A, Kumar A, Sachan D
Acta Neurol Taiwan · 2024 Dec · PMID 38030224
AIM: Calcification of degenerating neurocysticercosis (NCC) is common and likely to occur late in the degenerative process and is important for seizure foci. The present study was aimed at identifying the clinical and ra...
AIM: Calcification of degenerating neurocysticercosis (NCC) is common and likely to occur late in the degenerative process and is important for seizure foci. The present study was aimed at identifying the clinical and radiological variables associated with seizure recurrence in people with single or multiple calcified NCC lesions. MATERIAL AND METHODS: We evaluated 85 adult patients with calcified NCC lesions for recurrence of seizures during the follow-up period of one year. RESULTS: The mean age of the study population was 24.49 ± 9.17 years. Nocturnal seizures were present in 43.5% and serial seizures in 42.4%. A single calcified lesion was present in 61 (71.8%), and perifocal oedema surrounding the calcified lesions was present in 38 (44.7%). Recurrence of seizures was noted in 37 (43.5%) of the cases. On multivariate analysis, the factors that were significantly associated with the recurrence of seizures were: nocturnal seizures [OR: 0.054 (0.015-0.199)], serial seizures [OR: 0.141 (0.041-0.485)], and perifocal oedema [OR: 0.031 (0.008-0.129)]. CONCLUSION: In our study, serial seizures, nocturnal seizures, and perifocal oedema were linked with the recurrence of seizures in calcified NCC lesions. Perilesional oedema should be treated aggressively with anti-inflammatory/immunosuppressive therapy as well as with anti-seizure medication.
Treatment of Intracranial Hemorrhage Induced Hemichorea- Hemiballism by Low-Frequency Repetitive Transcranial Magnetic Stimulation.
Nakaya Y, Hayashi K, Suzuki A … +6 more , Asano R, Hayashi K, Fujita K, Kawabata K, Kobayashi Y, Sato M
Acta Neurol Taiwan · 2024 Jun · PMID 38030220
An 80-year-old woman with a history of rheumatoid arthritis, hypertension, and hyperlipidemia, and no family history of hyperkinesis developed suddenly involuntary movement and visited our hospital two-day after onset. N...
An 80-year-old woman with a history of rheumatoid arthritis, hypertension, and hyperlipidemia, and no family history of hyperkinesis developed suddenly involuntary movement and visited our hospital two-day after onset. Neuro-examination revealed hemichorea-hemiballismus in the right side of the body, including the face (Suppl. video). Blood tests revealed neither hyperglycemia nor acanthocyte. Brain MRI showed acute microbleeding in the left subthalamic nucleus (Figure 1A-C). Although she was treated with haloperidol (max. 4.5 mg/day), hemichorea-hemiballismus did not subside. Repetitive transcranial magnetic stimulation (rTMS) with a low-frequency protocol (LFP) (1 Hz, 1200 pulses, with a stimulus intensity of 90% of the resting motor threshold, 3 days/week for 2-week) was applied to the left precentral knob (Figure 1D). Its effect was drastic, as the symptoms disappeared for half-hour after rTMS. Hemichorea-hemiballism then reappeared but was attenuated by repeated rTMS. The symptoms disappeared after one-month. Subthalamic nucleus lesions can develop hemichorea-hemiballism (1). According to a study on Huntington's disease and diabetic hemichorea-hemiballism, increased thalamocortical drive may increase the excitability of excitatory and inhibitory circuits of the frontal cortex as the etiologies of hyperkinesia (2-3). However, the target points of rTMS in treating hemichorea-hemiballism have not been consistent in literature. Moreover, rTMS with a LFP on the bilateral supplementary motor areas is effective in treating chorea in Huntington's disease (2). Additionally, rTMS on the ipsilateral precentral knob (primary motor cortex) with continuous θ burst stimulation (cTBS), which decreases the excitability and inhibitory cortical circuits, was effective in treating contralateral hemichorea caused by midbrain hemorrhage (3). Similar to cTBS, LFP can suppress cortical excitation (4); therefore, we applied rTMS with LFP on the primary motor cortex to treat hemichorea-hemiballism. Our results were drastic for both short- and long-term efficiency. This is the first report of the efficacy of rTMS with LFP in treating hemichorea-hemiballism caused by encephalorrhagia.
Advancing Our Knowledge of Cognition in Disorders of Consciousness: A Critical Revisit.
Lin PT, Yu HY
Acta Neurol Taiwan · 2024 Mar · PMID 37994104
This narrative review aims to elucidate an emerging state of consciousness termed "cognitivemotor dissociation", characterized by brain activity patterns closely resembling those observed in healthy individuals. This dis...
This narrative review aims to elucidate an emerging state of consciousness termed "cognitivemotor dissociation", characterized by brain activity patterns closely resembling those observed in healthy individuals. This distinctive phenomenon is notably evident in patients diagnosed with comatose states, unresponsive wakefulness states, or minimally conscious states. Employing functional magnetic resonance imaging or electroencephalography holds promise for identifying cognitive-motor dissociation. The emergence of cognitive-motor dissociation not only introduces a fresh conceptual framework but also provides valuable predictive insights into outcomes and prognoses for individuals with disorders of consciousness. However, the recognition of cognitive-motor dissociation raises ethical considerations, particularly in evaluating the decision-making capacity regarding life-or-death choices for individuals in this state. Therefore, it is crucial to advocate for further scientific and comprehensive research to enhance our understanding of cognitive-motor dissociation and navigate its nuanced complexities. Keywords: cognitive-motor dissociation, coma, unresponsive wakefulness syndrome, minimally conscious state, functional MRI, EEG.
The effect of 5A self-management program on medication adherence of epileptic patients during the COVID - 19 pandemic: A randomized controlled trial.
Moosavimoghadam SF, Dehghani A, Akbar RE
Acta Neurol Taiwan · 2024 Dec · PMID 37994005
BACKGROUND: Adherence to medication adherence plays a vital role in controlling the problems and complications of epilepsy. During the COVID - 19 pandemic and limitations of face-to-face education, the use of distance ed...
BACKGROUND: Adherence to medication adherence plays a vital role in controlling the problems and complications of epilepsy. During the COVID - 19 pandemic and limitations of face-to-face education, the use of distance education can play an important role in providing education to patients. The aim of this study is the effect of model 5A self-management training on medication adherence in epileptic patients. METHODS: In this single-blind randomized controlled trial, 56 epileptic patients referred to Shiraz Namazi Hospital were divided into intervention and control groups using random allocation. Thereafter, 5A self - management training sessions were virtually held in 5 sessions in WhatsApp application for intervention group. The data collection tool was MMAS-8 at two stages of before and two months after intervention. Data analysis was performed using SPSS 21 software. RESULTS: The results of Wilcoxon test showed that in intervention group, the mean drug adherence in patients after intervention significantly increased compared to before intervention (p = 0.005). But in control group, this was not significant (p = 0.909). According to results of Mann-Whitney test, there was no significant difference between intervention and control groups before intervention (p = 0.632). However, by passing two months from intervention, a significant difference was found between intervention and control groups (p = 0.041). CONCLUSIONS: Based on results, the implementation of model 5A can be effective on medication adherence in epileptic patients. This program can be considered as a suitable method in epileptic patients during COVID - 19 pandemic.
Association between health literacy with stress, anxiety and depression in multiple sclerosis patients: A cross sectional analytical study.
Dehghani A
Acta Neurol Taiwan · 2024 Dec · PMID 37994003
OBJECTIVE: Multiple sclerosis is one of the diseases of the central nervous system, which causes numerous physical and mental problems. Since stress, anxiety and depression are effective in various dimensions of chronic...
OBJECTIVE: Multiple sclerosis is one of the diseases of the central nervous system, which causes numerous physical and mental problems. Since stress, anxiety and depression are effective in various dimensions of chronic diseases management and considering that health literacy plays a decisive role in the quality of life of these patients. Therefore, this study was conducted with the aim of determining the association between health literacy and stress, anxiety and depression. MATERIALS AND METHODS: The current research is a cross-sectional analytical study that was conducted with the participation of 164 patient's from the MS society of Jahrom city with convenience sampling. The data collection tool was the health literacy questionnaire of multiple sclerosis patients and a 21-question stress, anxiety and depression questionnaire. SPSS - 21 software, descriptive statistics and spearman and chi-square tests were used to analyze the data. RESULTS: The findings showed that the majority of patients had a borderline health literacy (53.7%). 43.3% of patients had adequate level of health literacy. Also, the findings showed that the stress, anxiety and depression levels of the majority of patients were moderate. Spearman's test showed that there is a negative and significant correlation between health literacy and stress in multiple sclerosis patients (p=0.03) (r=-0.37). While there was no significant correlation between health literacy and anxiety and depression of patients. CONCLUSION: The findings showed that with the increase in the health literacy, the rate of stress in patient's decreases.
Perception of Neurologists on Intraoperative Neurophysiological Monitoring in Saudi Arabia.
Algahtani HA, Shirah BH, Albeladi YK … +1 more , Albeladi RK
Acta Neurol Taiwan · 2024 Dec · PMID 37994002
OBJECTIVE: Intraoperative neurophysiological monitoring (IONM) has the advantage of minimizing intraoperative neurological injury and limiting serious postoperative complications. No previous studies have evaluated the i...
OBJECTIVE: Intraoperative neurophysiological monitoring (IONM) has the advantage of minimizing intraoperative neurological injury and limiting serious postoperative complications. No previous studies have evaluated the importance of IONM, especially in Gulf and Arab countries. We aimed to investigate the importance of IONM, as evaluated from a neurologist perspective in Saudi Arabia. METHODS: This cross-sectional study was conducted in Saudi Arabia through face-to-face interviews. The inclusion criterion was adult neurology consultants in Saudi Arabia. The instrument used was a self-administered questionnaire consisting of 20 items to evaluate the perceptions on IONM. Data collection was from January 2022 to June 2022. RESULTS: A total of 72 neurology consultants from Saudi Arabia participated in this study. The years of experience of the participants were 10-20 years (43.1%), most of whom worked in a tertiary healthcare center (72.2%), 31.9% had a certified neurologist trained in IONM, and approximately two-thirds of the institutions did not have an IONM setup (59.7%). Most neurologists believed that IONM should be part of neurology training programs (59.7%). Approximately, half of the respondents believed that IONM was mandatory (52.8%). CONCLUSION: IONM is considered the standard of care in many complex intracranial, spinal, and vascular surgeries. In our study, the perception of neurologists regarding IONM was promising, and the readiness of secondary and tertiary care centers to implement IONM was encouraging. Education, training, implementation, and regulations regarding IONM should be mandatory to prevent operative complications.
Neurofibroma: Case Series with Clinical Features and Recommendations.
Khatri N, Raza ML, Aijaz A … +3 more , Ramesh R, Gianchand N, Khan FAA
Acta Neurol Taiwan · 2024 Sep · PMID 37968860
Neurofibroma is an autosomal benign disorder. It can be localized, diffuse or invasive like plexiform neurofibroma that involves the nerves, muscle, tissues, skeleton. It represents itself as a destructive variant of neu...
Neurofibroma is an autosomal benign disorder. It can be localized, diffuse or invasive like plexiform neurofibroma that involves the nerves, muscle, tissues, skeleton. It represents itself as a destructive variant of neurofibroma, mostly present as orbital or periorbital neurofibroma or may be associated with autosomal dominant disease. Clinical diagnosis of neurofibromatosis (NF) according to National Institutes of Health (NIH) criteria should have more than two of the seven features including lisch nodules, cafe'- au-lait spots, plexiform neurofibroma, optic glioma, freckling, first degree relative with NF or dysplasia of cortical bones. However, proper early diagnosis is still crucial due to its various presentation such as cheek mass, painless swelling on skin, chalazion, intratracheal tumor, genital swelling or ptosis. It is reported that neurofibroma often represents as ocular or facial swelling. Here we are presenting features of neurofibroma of eight cases of patients from Civil Hospital, Karachi. These cases had main complain of overhanging skin mass mainly on orbital or periorbital region that damage the area and with poor daily activities. Multiple nodules on face and body along with them Cafe'-au-lait spots and lisch nodules were main signs. While, other signs i.e. ptosis, pterygium, telecanthus and muddy discoloration of conjunctiva need further evaluation for correlation with neurofibromatosis. Debulking surgery was planned for most of the cases but the huge disfigurement caused by overhanging skin mass and nodules made it a challenge for plastic surgeons to provide good outcomes with minimum damage. Keywords: neurofibroma; lisch nodules; ptosis; Cafe'-au-lait spot; periorbital; overhanging skin.
Development and Validation of the Self-efficacy Questionnaire in multiple sclerosis patients.
Dehghani A
Acta Neurol Taiwan · 2024 Sep · PMID 37968855
OBJECTIVE: Self-efficacy is one of the factors affecting on the quality of life and adjustment to the chronic diseases such as multiple sclerosis. Self-efficacy is the individual's belief that they have the ability to ov...
OBJECTIVE: Self-efficacy is one of the factors affecting on the quality of life and adjustment to the chronic diseases such as multiple sclerosis. Self-efficacy is the individual's belief that they have the ability to overcome challenges presented to them. The current study aimed to develop and validate of selfefficacy questionnaire in Iranian MS patients. MATERIALS AND METHODS: This is a methodological study that was performed in three phases. In the first phase, the concept of self-efficacy was defined through qualitative content analysis approach. In the second phase, early items of questionnaire was generated according to findings of the first phase. In the final phase, validation of the developed questionnaire were evaluated using face, content and construct validity as well as reliability. RESULTS: In exploratory factor analysis, four subscales including: adherence to medication regimens (5 items), social performance control (4 items), symptom management (4 items) and maintain independence and activity (5 items) were extracted by Eigen value above one and factor load above 0.3. Internal consistency and stability of the developed questionnaire confirmed with 0.91 and 0.88 respectively that indicated acceptable reliability. CONCLUSIONS: The 18-item developed questionnaire is valid and reliable for measurement of self-efficacy of Iranian MS patients.
Isolated Hypoglossal Nerve Palsy: A Rare Complication of Organophosphate Poisoning.
Jati M, Kaur A
Acta Neurol Taiwan · 2024 Sep · PMID 37968853
PURPOSE: This case report aims to describe a rare manifestation of isolated hypoglossal nerve palsy (HNP) resulting from organophosphate poisoning (OP), specifically organophosphate- induced delayed neuropathy (OPIDN). T...
PURPOSE: This case report aims to describe a rare manifestation of isolated hypoglossal nerve palsy (HNP) resulting from organophosphate poisoning (OP), specifically organophosphate- induced delayed neuropathy (OPIDN). The primary objective of this case report is to highlight this unusual manifestation and discuss its potential underlying mechanisms, emphasizing the importance of timely diagnosis and appropriate management. CASE REPORT: A 31-year-old male with a history of consuming a commercial chlorpyrifos formulation presented with acute organophosphate poisoning symptoms that improved with appropriate treatment. However, two weeks later, the patient developed neurological deficits (numbness and weakness spreading from the plantar region to the upper limbs) involving the hypoglossal nerve, manifesting as left-sided tongue deviation, fasciculation, and atrophy, resulting in speech and swallowing difficulties. A comprehensive workup ruled out other potential causes of HNP, supporting the link between OPIDN and isolated HNP. Despite regaining limb strength, the patient's speech and swallowing issues persisted, prompting a follow-up visit to our hospital for further management and rehabilitation. CONCLUSION: This case report highlights a unique manifestation of OPIDN, resulting in isolated HNP, a rare phenomenon. The correlation between exposure to chlorpyrifos, acute organophosphate poisoning, and delayed onset of HNP suggests a causative relationship. Prompt diagnosis, appropriate treatment, and timely speech and swallowing rehabilitation are vital for optimizing outcomes in such cases. Further research is needed to understand the mechanisms underlying this selective vulnerability of OPIDN and to develop targeted interventions.
Stroke in Tuberculous Meningitis.
Becerra-Aguiar NN, Jiménez-Ruiz A, Gutierrez-Baeza DM … +2 more , Aguilar-Fuentes V, Ruiz-Sandoval JL
Acta Neurol Taiwan · 2024 Sep · PMID 37968851
A 17-year-old male presented with a 20-day history of vomiting, abdominal pain, weight loss, headache and fever progressing to dysarthria, somnolence, urinary incontinence, slurred speech, weakness, and inability to walk...
A 17-year-old male presented with a 20-day history of vomiting, abdominal pain, weight loss, headache and fever progressing to dysarthria, somnolence, urinary incontinence, slurred speech, weakness, and inability to walk. Neurological examination revealed diminished visual acuity and diplopia. A head computed tomography (CT) showed acute hydrocephalus (Figure 1). Cerebrospinal fluid (CSF) analysis revealed pleocytosis (lymphocyte predominant), hypoglycorrhachia (8 mg/dL), and hyperproteinorrachia (156 mg/dL). The brain magnetic resonance imaging (MRI) revealed leptomeningitis, basal ganglia infarcts and basal meningeal enhancement highly suggestive of tuberculous meningitis (TBM) (Figure 2). We calculated a positive Thwaites score (-5) for TBM. The patient responded well to antituberculous treatment and dexamethasone. At 2 year follow-up the patient remains symptom-free. Stroke is a frequent complication of TBM and might contribute to long-term disability. Brain imaging findings, such as basal meningeal enhancement and basal exudates, hydrocephalus, and infarctions (TBM triad) are useful tools to rapidly identify probable TBM(3,4). Brain infarcts in TBM are located mostly in the arterial territory of distal branching arterires(5). Other less frequent imaging findings are tuberculomas and vasospasm. Key message: Hydrocephalus, basal meningeal enhancement, and basal ganglia infarcts should raise suspicion of tuberculosis, especially in endemic regions.
Reversible Cerebral Vasoconstriction Syndrome And Fibromuscular Dysplasia: An Epiphenomenon Or A Causal Relationship?
Santos Neto EPD, Sousa ÍA, Ricarte IF … +1 more , Pontes-Neto OM
Acta Neurol Taiwan · 2024 Sep · PMID 37968850
Fibromuscular dysplasia (FMD) is a rare non-atherosclerotic arterial disease that primarily affects middle-aged Caucasian women. Carotid web (CW) is a variant of FMD characterized by a nonatheromatous, membrane-like tiss...
Fibromuscular dysplasia (FMD) is a rare non-atherosclerotic arterial disease that primarily affects middle-aged Caucasian women. Carotid web (CW) is a variant of FMD characterized by a nonatheromatous, membrane-like tissue protrusion into the carotid bulb. Reversible cerebral vasoconstriction syndrome (RCVS) is defined by severe headaches and reversible narrowing of cerebral arteries, which typically resolves within three months. While most RCVS cases have identifiable triggers, a significant portion occurs without known causes. Recent studies have reported a high prevalence of neurovascular abnormalities in RCVS patients. We present a case of a thirty-year-old woman with a sudden-onset severe headache, diagnosed with RCVS associated with carotid web. The patient had no ischemic involvement and responded well to flunarizine treatment. Follow-up imaging showed no stenosis. This case highlights a potential association between carotid web and RCVS, suggesting that FMD may contribute to vascular hyperreactivity and presents as a risk factor for RCVS. Further investigations are needed to understand the underlying mechanisms connecting these two vascular disorders. Keywords: reversible vasoconstriction syndrome; fibromuscular dysplasia; carotid web; structural abnormalities; vascular hyperreactivity.
Hyperintensity in Bilateral Posterior Limbs of Internal Capsule Due to Hypernatremia.
Wu MY, Sun YT
Acta Neurol Taiwan · 2024 Sep · PMID 37968847
PURPOSE: Osmotic demyelination syndrome is usually caused by rapid correction of hyponatremia but sometimes develops from acute severe hypernatremia. Studies suggested that serum sodium increasing at the rate of less tha...
PURPOSE: Osmotic demyelination syndrome is usually caused by rapid correction of hyponatremia but sometimes develops from acute severe hypernatremia. Studies suggested that serum sodium increasing at the rate of less than 6~8 mmol/L in 24 hours has a low risk of osmotic demyelination syndrome, but sometimes exceptions present. Aside from the classical sites of involvement, such as pons and basal ganglia, internal capsules are rarely affected. We report a case with acute paraparesis caused by acute hypernatremia-induced extrapontine myelinolysis involving the posterior limbs of bilateral internal capsules. CASE: A 54-year-old man was admitted for aseptic encephalitis and moved to the intensive care unit due to poor consciousness and respiratory failure. Although cerebrospinal fluid pleocytosis was improved later, acute hypernatremia due to partial diabetes insipidus developed. He presented acute paraplegia two days later with a negative result on the whole spine MRI. Although the increasing rate of serum sodium did not exceed the recommended safety range, the extrapontine myelinolysis involving posterior limbs of the bilateral internal capsule, as long as the corpus callosum, still developed. The patient regained partial walking ability after one year. CONCLUSION: This case report extends the spectrum of classical osmotic demyelination in clinical manifestations, image findings, and the causal range of electrolyte derangements.
Novel Case of Streptococcus Mitis-infected Chronic Subdural Hematoma.
Asserson DB, Kassicieh AJ, Ghatalia DV … +6 more , Kassicieh CS, Shah SP, Kazim SF, Cole KL, Schmidt MH, Bowers CA
Acta Neurol Taiwan · 2024 Sep · PMID 37968845
PURPOSE: Subdural hematoma (SDH) is a common pathology found in neurosurgery. Infected SDH, however, is less common, and reports have typically identified Escherichia coli as the causative organism. CASE REPORT: We prese...
PURPOSE: Subdural hematoma (SDH) is a common pathology found in neurosurgery. Infected SDH, however, is less common, and reports have typically identified Escherichia coli as the causative organism. CASE REPORT: We present here a case of an infected chronic SDH caused by Streptococcus mitis, likely for the first time, following a burn injury in a 40-year-old male patient. CONCLUSION: The workup for infected SDH should now include S. mitis as a possible culprit.
Secondary Trigeminal Neuralgia Caused by Cerebellopontine Angle Arachnoid Cyst in A 27-Year-Old Female: A Case Report.
Niryana IW, Tombeng MA, Lauren C … +4 more , Maliawan S, Golden N, Mahadewa TGB, Maliawan MGD
Acta Neurol Taiwan · 2024 Jun · PMID 37968093
PURPOSE: Secondary (TN) caused by an arachnoid cyst in the (CPA) region is a rare finding. Based on the reported literature, there are only 5 cases of secondary trigeminal neuralgia caused by an arachnoid cyst in the cer...
PURPOSE: Secondary (TN) caused by an arachnoid cyst in the (CPA) region is a rare finding. Based on the reported literature, there are only 5 cases of secondary trigeminal neuralgia caused by an arachnoid cyst in the cerebellopontine angle region. CASE REPORT: A 27-year-old female presented to our neurosurgery clinic with a 2-year history of brief episodes of paroxysm pain in the left cheek. The pain was described as an electric shock-like pain triggered by simple stimuli. The magnetic resonance imaging (MRI) showed a well-confined cystic lesion in the left CPA, which compresses the left pons and the cisternal segment of the left trigeminal nerve. The patient was managed operatively to fenestrate the cyst and decompress the trigeminal nerve. The histopathological result of the cyst wall was consistent with an arachnoid cyst. Six months after surgery, the patient is in good health condition and symptom-free without medication. CONCLUSION: Arachnoid cyst in the CPA region is one of the rare causes of secondary TN. Preoperative imaging with MRI is important to provide better results to differentiate the pathology. Surgical treatment to fenestrate the arachnoid cyst and decompress the trigeminal nerve have a good result and can improve the patient's quality of life.
Treatment of Intracranial Hemorrhage Induced Hemichorea- Hemiballism by Low-Frequency Repetitive Transcranial Magnetic Stimulation.
Nakaya Y, Hayashi K, Suzuki A … +6 more , Asano R, Hayashi K, Fujita K, Kawabata K, Kobayashi Y, Sato M
Acta Neurol Taiwan · 2024 Jun · PMID 37968091
An 80-year-old woman with a history of rheumatoid arthritis, hypertension, and hyperlipidemia, and no family history of hyperkinesis developed suddenly involuntary movement and visited our hospital two-day after onset. N...
An 80-year-old woman with a history of rheumatoid arthritis, hypertension, and hyperlipidemia, and no family history of hyperkinesis developed suddenly involuntary movement and visited our hospital two-day after onset. Neuro-examination revealed hemichorea-hemiballismus in the right side of the body, including the face (Suppl. video). Blood tests revealed neither hyperglycemia nor acanthocyte. Brain MRI showed acute microbleeding in the left subthalamic nucleus (Figure 1A-C). Although she was treated with haloperidol (max. 4.5 mg/day), hemichorea-hemiballismus did not subside. Repetitive transcranial magnetic stimulation (rTMS) with a low-frequency protocol (LFP) (1 Hz, 1200 pulses, with a stimulus intensity of 90% of the resting motor threshold, 3 days/week for 2-week) was applied to the left precentral knob (Figure 1D). Its effect was drastic, as the symptoms disappeared for half-hour after rTMS. Hemichorea-hemiballism then reappeared but was attenuated by repeated rTMS. The symptoms disappeared after one-month. Subthalamic nucleus lesions can develop hemichorea-hemiballism (1). According to a study on Huntington's disease and diabetic hemichorea-hemiballism, increased thalamocortical drive may increase the excitability of excitatory and inhibitory circuits of the frontal cortex as the etiologies of hyperkinesia (2-3). However, the target points of rTMS in treating hemichorea-hemiballism have not been consistent in literature. Moreover, rTMS with a LFP on the bilateral supplementary motor areas is effective in treating chorea in Huntington's disease (2). Additionally, rTMS on the ipsilateral precentral knob (primary motor cortex) with continuous θ burst stimulation (cTBS), which decreases the excitability and inhibitory cortical circuits, was effective in treating contralateral hemichorea caused by midbrain hemorrhage (3). Similar to cTBS, LFP can suppress cortical excitation (4); therefore, we applied rTMS with LFP on the primary motor cortex to treat hemichorea-hemiballism. Our results were drastic for both short- and long-term efficiency. This is the first report of the efficacy of rTMS with LFP in treating hemichorea-hemiballism caused by encephalorrhagia.
Myalgia! Where does it come from?
Lee HH, Chen CC
Acta Neurol Taiwan · 2023 Dec · PMID 37967833
Myalgia (also called muscle pain or muscle ache) is a symptom associated with many diseases, including fibromyalgia, neurodegenerative diseases, degenerative spine diseases, etc. Myalgia is a major medical problem affect...
Myalgia (also called muscle pain or muscle ache) is a symptom associated with many diseases, including fibromyalgia, neurodegenerative diseases, degenerative spine diseases, etc. Myalgia is a major medical problem affecting 60~85% of the population (lifetime prevalence). However, our understanding of chronic myalgia is still limited and effective treatment for intractable myalgia like fibromyalgia is still lacking. Although multifactorial, one known source of muscle pain is tissue acidosis. Experimental muscle pain can be induced by the intramuscular infusion of a buffered acidic solution in humans. As well, animal studies have revealed that acidic infusion activates chemosensitive nociceptors via the proton-sensing ion channels and receptors. Intriguingly, acid signaling in muscle afferents is promiscuous and could be either pro-nociceptive or antinociceptive, so we have coined the term sngception to describe the somatosensory function of acid sensation. Recent single-cell RNAseq studies have shown proton-sensing ion channels and receptors are expressed in all subpopulations of the somatosensory neurons, including nociceptors and non-nociceptive mechanoreceptors. Here, we address how the acid signaling is integrated in muscle afferents and why muscle pain can be chronic and intractable in mouse models of fibromyalgia. Besides acidosis, we have recently found oxidative stress can be another factor to activate proton-sensing ion channels and thus trigger fibromyalgia-like pain in mice. Together, understanding how the acid signaling works in muscle afferents will provide novel therapeutic strategies for myalgia.
Diabetes ketoacidosis and Recurrent Childhood Stroke-like Episodes.
Liu RC, Sheu JN, Liu CS … +1 more , Tsai JD
Acta Neurol Taiwan · 2024 Mar · PMID 37853548
A 13-year and 4-month-old girl was brought to the emergency department due to fever, dizziness,vomiting, and blurred vision. Laboratory data revealed hyperglycemia with an HbA1C of 7.3 percent, ketonuria, and lactic acid...
A 13-year and 4-month-old girl was brought to the emergency department due to fever, dizziness,vomiting, and blurred vision. Laboratory data revealed hyperglycemia with an HbA1C of 7.3 percent, ketonuria, and lactic acidosis. The initial impression was diabetic ketoacidosis. During admission, recurrent focal impaired awareness seizures were noted, and magnetic resonance imaging of the brain revealed multiple brain infarctions in the bilateral cerebrum. Mitochondrial gene report showed A3243 G with 64 percent heteroplasmy, and mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes was diagnosed. At 16 years and 7 months old, recurrence of vomiting and onset of right hemianopia and mild right limb weakness were observed and follow-up T2 images showed massive edema in her left parieto-occipital region. At 16 years and 10 months old, she developed clonus in her left hand associated with an unsteady gait and blurred vision. MRI of the brain revealed recurrent brain infarction, and T2 images showed massive edema of the right parieto-occipital region. MELAS is a rare disease entity and occasionally comorbid with mitochondrial diabetes in childhood. Characteristic radiological features of MELAS include infarction-like lesions over the parieto-occipital or parieto-temporal areas, which help distinguish MELAS from childhood ischemic stroke.
A case of Listeria monocytogenes brain abscess with a clinical presentation mimicking stroke.
Chu YC, Chen NC, Chen CL
Acta Neurol Taiwan · 2024 Mar · PMID 37849344
PURPOSE: Kidney transplant recipients are at a high risk of both stroke and infection. We report this case to inform readers of the possibility of the occurrence of Listeria monocytogenes brain abscess despite treatment...
PURPOSE: Kidney transplant recipients are at a high risk of both stroke and infection. We report this case to inform readers of the possibility of the occurrence of Listeria monocytogenes brain abscess despite treatment with low dose trimethoprim-sulfamethoxazole. CONCLUSION: Physicians should monitor unusual stroke symptoms and consider Listeria brain abscess as a differential diagnosis. This case suggests that listeria brain abscesses can potentially cause temporary neurological deficits akin to a stroke, despite trimethoprim-sulfamethoxazole prophylaxis, but these symptoms resolve without necessitating surgical intervention.
Diabetic striatopathy in pediatric patient- a case report on a reversible and acquired movement disorder.
Palisoc MP, Navarro AJS, Jamora RDG
Acta Neurol Taiwan · 2024 Mar · PMID 37849343
PURPOSE: To present a rare case of diabetic striatopathy in a child with type 1 diabetes mellitus with reversible unilateral hemichorea hemiballismus. CONCLUSION: A high index of suspicion is required to make a diagnosis...
PURPOSE: To present a rare case of diabetic striatopathy in a child with type 1 diabetes mellitus with reversible unilateral hemichorea hemiballismus. CONCLUSION: A high index of suspicion is required to make a diagnosis of DS in children presenting with abnormal movement disorder and characteristic neuroimaging findings in a background of uncontrolled DM.
Association of Toll-like receptor 4 gene polymorphism with multiple sclerosis in Iranian patients.
Jahromi AS, Erfanian S, Safavi S … +1 more , Roustazadeh A
Acta Neurol Taiwan · 2024 Mar · PMID 37849336
Multiple sclerosis is a chronic debilitating disease with unknown pathogenesis. Recent studies indicated that pathogen recognition receptors such as Toll-like receptor 4 may have a role in pathogenesis of MS. The aim of...
Multiple sclerosis is a chronic debilitating disease with unknown pathogenesis. Recent studies indicated that pathogen recognition receptors such as Toll-like receptor 4 may have a role in pathogenesis of MS. The aim of the study was to evaluate the association of rs1927911 polymorphism in TLR4 gene with MS.
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