Non-paretic quadriceps activity influences paretic quadriceps activity post-stroke

Objective

Inappropriate muscle activity is common following stroke. Paretic muscle activation may be influenced by non-paretic volitional activation. We examined the influence of non-paretic quadriceps activation on paretic quadriceps excitability.

Methods

Individuals with chronic stroke performed bilateral and unilateral (paretic and non-paretic) maximum voluntary isometric contractions. Peak torque and muscle activity were compared between conditions. An instrumented tendon tapper elicited a patellar tendon reflex of the relaxed paretic leg while the non-paretic leg was relaxed and pre-activated. The threshold to elicit a paretic quadriceps response was compared between conditions.

Results

During the bilateral MVIC, the paretic quadriceps generated less absolute torque, but greater relative torque than the non-paretic side when normalized to the respective unilateral condition (p < 0.05). During reflex testing, the tendon tapping threshold to elicit paretic muscle and torque responses decreased with non-paretic activity (p < 0.05).

Conclusions

Concurrent non-paretic activation resulted in a relative disinhibition of the paretic quadriceps. The paretic limb’s inability to remain inactive during isolated non-paretic contractions implies increased excitation or decreased inhibition of paretic motor pools, although the source remains unknown.

Significance

Unwanted muscle activity during reciprocal tasks (gait training) may be due to contralateral effects of non-paretic muscle activity.     

Influence of sports climbing and yoga on spasticity,cognitive function,mood and fatigue in patients with multiple sclerosis

Objectives

Spasticity, cognitive impairment, depression and fatigue significantly reduce the quality of life in multiple sclerosis (MS) patients. To find out whether nonpharmalogical treatment approaches can reduce these symptoms we investigated effects of sports climbing (SC) and yoga on spasticity, cognitive impairment, mood change and fatigue in MS patients. Sports climbing (SC) and yoga are aerobic physical activities comprised a series of stretching techniques, implementation of which demands body control and planning of complex movements.

Materials and methods

20 subjects with relapsing–remitting or progressive MS, 26–50 years of age, with EDSS ≤ 6 and EDSS pyramidal functions score (EDSSpyr) > 2 were enrolled in a randomized prospective study. The participants were randomly divided into SC and yoga group. We evaluated spasticity, cognitive function, mood and fatigue before and after both programs, that lasted 10 weeks, with standardized assessment methods.

Results

There were no significant improvements in spasticity after SC and yoga. In the SC group we found a 25% reduction (p = 0.046) in EDSSpyr. There were no differences in executive function after the completion of both programs. There was a 17% increase in selective attention performance after yoga (p = 0.005). SC reduced fatigue for 32.5% (p = 0.015), while yoga had no effect. We found no significant impact of SC and yoga on mood.

Conclusions

Yoga and SC might improve some of the MS symptoms and should be considered in the future as possible complementary treatments.     

Effect of gender,age, fatigue and contraction level on electromechanical delay

Objective

The aim of this study was to determine electromechanical delay (EMD) using supramaximal stimuli and to investigate its variation with gender, age, contraction level and fatigue.

Methods

Fifteen male and 15 female healthy subjects (aged between 18 and 60) participated in our study. Electromyogram (EMG) recordings were taken from triceps surae muscle. While subjects contracted their muscles voluntarily at specified percentages of maximum voluntary contraction, 10 supramaximal stimuli were applied to the tibial nerve. The time lag between the onset of the EMG response (M-wave) and the onset of force generation was calculated as EMD.

Results

EMD was found to be 8.5 ± 1.3 ms (at rest condition), which is much shorter than those reported in previous studies. Although EMD did not significantly vary with gender (P > 0.05), it decreased significantly with escalating muscle contraction level (P < 0.05) and increased significantly with advancing age and with fatigue (P < 0.05).

Conclusions

EMD was found to be considerably shorter than those reported in previous studies, and hence we discuss the possible reasons underlying this difference. We suggest that supramaximal nerve stimulation and high resolution EMG and force recording may have generated this difference.

Significance

Current findings suggest that EMD is very sensitive to the method used to determine it. We discuss the reasons for the short EMD value that we have found in the present study.     

Which nerve conduction parameters can predict spontaneous electromyographic activity in carpal tunnel syndrome?

Objective

We investigate electrodiagnostic markers to determine which parameters are the best predictors of spontaneous electromyographic (EMG) activity in carpal tunnel syndrome (CTS).

Methods

We enrolled 229 patients with clinically proven and nerve conduction study (NCS)-proven CTS, as well as 100 normal control subjects. All subjects were evaluated using electrodiagnostic techniques, including median distal sensory latencies (DSLs), sensory nerve action potentials (SNAPs), distal motor latencies (DMLs), compound muscle action potentials (CMAPs), forearm median nerve conduction velocities (FMCVs) and wrist–palm motor conduction velocities (W–P MCVs). All CTS patients underwent EMG examination of the abductor pollicis brevis (APB) muscle, and the presence or absence of spontaneous EMG activities was recorded. Normal limits were determined by calculating the means ± 2 standard deviations from the control data. Associations between parameters from the NCS and EMG findings were investigated.

Results

In patients with clinically diagnosed CTS, abnormal median CMAP amplitudes were the best predictors of spontaneous activity during EMG examination (p < 0.001; OR 36.58; 95% CI 15.85–84.43). If the median CMAP amplitude was ?2.1 mV, the rate of occurrence of spontaneous EMG activity was >95% (positive predictive rate >95%). If the median CMAP amplitude was higher than the normal limit (>4.9 mV), the rate of no spontaneous EMG activity was >94% (negative predictive rate >94%). An abnormal SNAP amplitude was the second best predictor of spontaneous EMG activity (p < 0.001; OR 4.13; 95% CI 2.16–7.90), and an abnormal FMCV was the third best predictor (p = 0.01; OR 2.10; 95% CI 1.20–3.67). No other nerve conduction parameters had significant power to predict spontaneous activity upon EMG examination.

Conclusions

The CMAP amplitudes of the APB are the most powerful predictors of the occurrence of spontaneous EMG activity. Low CMAP amplitudes are strongly associated with spontaneous activity, whereas high CMAP amplitude are less associated with spontaneous activity, implying that needle EMG examination should be recommended for the detection of spontaneous activity in those CTS patients whose NCS reveals CMAP amplitudes between 2.1 mV and the lower normal limit (4.9 mV in the present study).

Significance

Using NCS, electromyographers can predict the presence of spontaneous EMG activity in CTS patients.     

Vestibular evoked myogenic potentials and habituation to seasickness

Objective

Seasickness may impose severe limitations on the performance of ships’ crew. Cervical vestibular evoked myogenic potentials (cVEMP) assess the function of the saccule, the organ responsible for monitoring vertical linear acceleration, which has been found to be the most provocative motion stimulus in the evolution of motion sickness. We used the cVEMP test in a prospective evaluation of susceptibility and habituation to seasickness.

Methods

Forty-six naval recruits underwent the cVEMP test before exposure to sea conditions. After 6 months’ sailing experience, participants completed a questionnaire evaluating their initial and current seasickness severity. Based on their most recent experience, subjects were divided into three groups: non-vomiting non-habituating (NV-NH), vomiting (V), and non-vomiting habituating (NV-H).

Results

Statistically significant lower thresholds for cVEMP were found in subjects who habituated to sea conditions (NV-H), compared with those remaining severely susceptible (V) (77.0 dB HL vs. 84.9 dB HL; p < 0.01).

Conclusions

The ability to produce the cVEMP at lower thresholds represents a broader dynamic range, in which the reflex can respond to a wider array of stimuli amplitudes.

Significance

The present study demonstrates the potential of the cVEMP test for predicting future habituation to seasickness.     

The metabolic costs of hostility in healthy adult men and women: Cross-sectional and prospective analyses

Background

Hostility is associated with altered metabolic activity but little research has examined sex and/or age differences using a global index of metabolic dysfunction or examined different aspects of hostility.

Methods

The moderating effect of sex and age on the associations between three aspects of hostility (cynical attitude, angry affect, quarrelsome behavior in daily living) and metabolic burden (number of metabolic parameters in the higher quartile) were evaluated in 188 healthy men and women (M_age = 41; SD = 11.34). Three years later, metabolic burden was measured again in 133 participants.

Results

At study onset, quarrelsome behavior was associated with greater metabolic burden in men and women (Beta = .144; p < .05). After 3 yrs, cynical hostility predicted increased metabolic burden among mid-age and older individuals (b = .013 and .046 respectively; p < .001).

Conclusion

The aspect of hostility that is most closely associated with metabolic burden depends on the age of the participants and whether measures are concurrent or prospective.     

Management and outcome of primary spinal ependymomas: A single center experience from Taiwan

Background

Surgical treatment of spinal ependymomas requires careful consideration of the relative risks of neurological worsening from surgery. Our aim was to determine the risk factors of neurological deterioration after surgery for spinal ependymomas.

Material and methods

This 20-year study included 17 patients (seven men and 10 women; 44.65 ± 13.62 years) with histologically confirmed spinal ependymomas. The basic features were reviewed and the functional status was assessed by using the modified McCormick classification. We subdivided the patient population into two groups according to whether neurological deterioration occurred after primary tumor resection (N = 5) or not (N = 12), and compared their clinical characteristics.

Results

The average duration of presenting symptoms in the 17 patients was 23.53 ± 21.45 months. Three (17.6%) patients underwent subtotal or partial resection and 14 (82.4%) patients underwent gross total resection. The incidence of neurological deterioration after primary resection of spinal ependymomas was 29.4%. There were five (100%) and two (16.7%) male patients in the neurological-deterioration and no-deterioration groups, respectively (p = 0.003). The duration of presenting symptoms was 24 months or over in all the patients with neurological deterioration and five of the 12 patients with improved or stabilized function (p = 0.044).

Conclusion

The risk associated with surgical resection of spinal ependymomas should not be overlooked because of the significant incidence of neurological deterioration. The male gender and long-standing symptom (≥24 months) are risk factors of postoperative neurological worsening. Early diagnosis and surgery are therefore critical for successful treatment of spinal ependymomas.     

Changes in movement-related β-band EEG signals in human spinal cord injury

Objective

The purpose of this study was to characterize differences in movement-related β-band signals of the brain between people with chronic spinal cord injury (SCI) and neurologically intact volunteers.

Methods

A 64 channel EEG system was used to record EEG while subjects attempted brisk toe plantar flexion in response to auditory cues. Change in amplitude in β-band frequencies during times of event-related desynchronization and synchronization (ERD and ERS) and topography of ERD and ERS were compared across groups and correlated to ASIA motor and sensory impairment scores for SCI subjects.

Results

ERS amplitude immediately following the movement attempt was significantly smaller (t-test; p < 0.001) in SCI subjects as compared to controls. The ERD change tended to be greater and the topography was more widespread in SCI subjects. Incomplete SCI subjects with more severe neurological injury (lesser ASIA motor score) had lower peak ERS amplitude and a significant correlation was observed between sensorimotor impairments and ERS amplitude (r² = 0.79; p = 0.02).

Conclusions

Our results suggest that motor processing in the brain is altered after SCI, and that it occurs in proportion to the severity of neurological injury.

Significance

These results are important for brain computer interface applications that rely on ERD and ERS pattern recognition.     

The relationship between actigraphically defined sleep disturbance and REM sleep behaviour disorder in Parkinson's Disease

Aim

In this study, we sought to evaluate the utility of actigraphy for examining symptoms of rapid eye movement sleep behaviour disorder (RSBD).

Methods

Twenty-two patients with idiopathic Parkinson's Disease (mean age = 63.4 years, SD = 7.5) underwent neurological assessment and completed sleep diaries, self-report sleep questionnaires and 2-weeks of actigraphy. They also completed the rapid eye movement sleep behavior disorder questionnaire and were classified as screening negative (RSBD−, n = 9) or positive (RSBD+, n = 13) for RSBD according to published criteria. Key outcome data were the number of wake bouts and duration of arousals during the sleep interval as determined by actigraphy.

Results

Patients classified as RSBD+ demonstrated a higher number of wake bouts than those who were RSBD− (p = 0.011).

Conclusions

These results suggest that actigraphy may be a viable tool to assist in the early identification of RSBD. In turn, this could guide early intervention approaches.     

Single- and multi-level anterior decompression and fusion for cervical spondylotic myelopathy – A long term follow-up with a minimum of 5 years

Objective

Cervical spondylotic myelopathy (CSM) is a common disease leading to significant neurological disability. We compared patients suffering from a single- and a multi-level pathology to analyze the influence of the natural course of the disease on the long-term outcome after surgery.

Methods

We analyzed the records of 52 patients with CSM after surgery. The neurological status of the patients was assessed by the modified Japanese Orthopaedic Association Scale (mJOAS). X-rays were conducted before and after surgery.

Results

52 patients were treated by a single-level (n = 27) or a multi-level approach (n = 25) more than 5 years ago. A significant improvement of the neurological status could be seen even 5 years or more after surgery in both groups without differences. After one year no further improvement could be observed. In the single-level group a trend to a subsequent loss of lordotic correction could be seen. Anterior plates were only used in the multi-level group.

Conclusion

The anterior approach is an effective procedure to improve the symptoms of a CSM for many years. The risk of a multi-level pathology does not appear to exceed the risks of a single-level pathology concerning clinical long-term outcome after surgery. The clinical success is not hindered by a loss of correction in this specific setting.     

Corticospinal excitability during walking in humans with absent and partial body weight support

Objective

To establish changes in corticospinal excitability with absent and partial body weight support (BWS), and determine test–retest reliability of motor evoked potentials (MEPs) recordings during stepping in healthy humans.

Methods

The tibialis anterior (TA) and soleus MEPs during stepping at 0 and at 25 BWS were recorded in two experimental sessions in the same subjects. Transcranial magnetic stimulation was delivered randomly across the step cycle at 1.2 × TA MEP resting threshold. The non-stimulated associated electromyogram (EMG) was subtracted from the TA and soleus MEPs at identical time windows and bins of the step cycle, and the resultant values were normalized to the maximal homologous EMG activity during stepping. The relationship between MEPs and background EMG activity was determined for each BWS level and session tested.

Results

The TA MEPs were facilitated at heel contact, progressively decreased during the stance phase, and facilitated throughout the swing phase of the step cycle. In contrast, the soleus MEPs were progressively increased at early-stance, depressed at the stance-to-swing transition, and remained depressed throughout the swing phase. The TA and soleus MEPs were modulated in a similar pattern across sessions at 0 and at 25 BWS, and were linearly related to the associated background EMG activity.

Conclusions

These results provide evidence that reduced body weight loading does not alter the strength of corticospinal excitability, and that MEPs can be reliably recorded at different sessions during stepping in healthy humans.

Significance

A rehabilitation strategy to restore gait in neurological disorders utilizes BWS during stepping on a motorized treadmill. Based on our findings, the strength of corticospinal drive will not be affected negatively during stepping under conditions of partial body loading.     

Rearrangement of motor centers and its relationship to the neurological status of low-grade glioma examined on pre- and postoperative fMRI

Objective

Well-developed compensatory mechanisms, based on the phenomenon of brain plasticity, exist in patients with neuroepithelial tumors, especially with highly differentiated gliomas (WHO grade II). We studied phenomenon of rearrangement of sensorimotor cortex using functional magnetic resonance imaging (fMRI), and verified relationship between observed changes and results of neurological and neuropsychological assessment.

Methods

Study group included 20 patients with WHO grade II gliomas located within motor or sensory cortex. fMRI examination, as well as clinical, neurological (Karnofsky performance score [KPS] and Lovett's scale [Lo]), and neuropsychological assessment (Digit Coding Symbol Test and Digit Span Test) were performed pre-operatively and 3 months post-surgery.

Results

There were no significant differences in pre- and postoperative performance status of patients. Although statistically insignificant, an increase in frequency of activation of primary and secondary cortical motor centers was observed postoperatively (p > 0.05). Prior to surgery, motor centers were characterized by lower values of t-statistics than in postoperative period (p > 0.05). In contrast, values of parameters describing the size of examined centers, i.e. mean number of clusters, were lower, but not statistically significant on postoperative examination (p > 0.05). Compared to individuals without motor deficit, patients with preoperative Lo3/Lo4 paralysis showed significantly higher mean values of t-statistics in the accessory motor area on postoperative examination (p < 0.05).

Conclusions

The processes of motor cortex rearrangement seemed to be associated with the pre- and postoperative neurological and neuropsychological status of patients. After contralateral primary motor cortex, accessory motor area was the second most frequently activated center, both pre- and postoperatively.     

The galvanic whole-body sway response in health and disease

Objective

To explore the galvanic-evoked vestibulospinal reflex in health and disease.

Methods

Vestibular-evoked whole-body movement was measured in 60 controls and eight patients with bilateral vestibular impairment, using 1 mA × 2 s Galvanic Vestibular Stimulation (GVS). The displacement (s) and velocity (v) of 7 markers placed on the head, neck, shoulders, mid-thorax and hips and ground reaction forces (F) were recorded.

Results

Monaural GVS evoked anterolateral whole-body movement away from the cathode. For controls, peak response magnitudes were 22.3 ± 12.4 mm, 25.9 ± 14.3 mm s⁻¹ and 3.2 ± 1.3 N for s, v and F. Left right asymmetry measured using the Jongkee’s formula was 12.59 ± 8.64%, 11.94 ± 11.09% and 11.68 ± 8.99% for s, v and F. All three measures were symmetrical for left and right mastoid stimulation and showed good to excellent test retest reliability. Patients with bilateral vestibular failure had absent or attenuated responses. For this patient group, the (“R/B”) ratios between the “response period” and baseline body-sway for s, v and F were 2.1 ± 0.8, 1.7 ± 1.1 and 1.3 ± 0.6, which were significantly lower than 5.4 ± 4.2, 4.1 ± 2.5 and 2.3 ± 0.8 for controls, with s and v providing better separation between controls and patients. There were no significant correlations between the amplitudes of galvanic body sway responses and vestibular-evoked myogenic potentials (VEMPs).

Conclusion

GVS enables non-invasive assessment of the vestibulospinal reflex.

Significance

This method offers a clinically applicable, test of vestibular contributions to standing balance.     

Less favorable neurological recovery after acute stroke in patients with hypercholesterolemia

Objectives

We aimed to investigate the effect of hypercholesterolemia on recovery after acute ischemic stroke.

Methods

Data of 3048 patients admitted for acute ischemic stroke from January to December 2009 were collected from the Stroke Registry in the Chang Gung Healthcare System. Baseline characteristics of patients with and without hypercholesterolemia were compared. The association of hypercholesterolemia with neurological severity and recovery was analyzed using multivariate logistic regression. The patients were then divided on the basis of age for subgroup analysis.

Results

The number of patients with and without a history of hypercholesterolemia was 474 (15.6%) and 2574 (84.4%), respectively. Univariate analysis showed that patients with hypercholesterolemia had a lower National Institutes of Health Stroke Scale (NIHSS) score on admission (p = 0.004). However, during hospitalization, these patients displayed less improvement in their NIHSS score (p = 0.002). These results remained significant in multivariate logistic regression analysis (p < 0.001 and p = 0.002, respectively). Subgroup analysis showed a similar association for hypercholesterolemia in both younger (age < 70) and older (age ≥ 70) age groups.

Conclusions

Acute ischemic stroke in patients with hypercholesterolemia was correlated with reduced severity on admission and less favorable recovery during hospitalization, regardless of age.     

Additional value of quantitative EEG in acute anterior circulation syndrome of presumed ischemic origin

Objective

The clinical course of acute stroke can be highly variable and for effective management outcome prediction needs to be refined. We investigated whether EEG parameters are of additional diagnostic and prognostic value in the early phase of acute ischemic anterior circulation stroke.

Methods

Ninety-four patients presenting with acute anterior circulation syndrome (ACS) of presumed ischemic origin were incrementally included. Clinical characteristics were correlated with volume of ischemia and EEG parameters. Predictive values for definite stroke, early neurological deterioration, spontaneous early neurological improvement and death within 1 week after ACS were calculated using ROC curves and logistic regression modelling.

Results

In patients with normal or near normal NIHSS score of 0 or 1, the pairwise derived brain symmetry index (pdBSI) was an independent predictor for definite stroke displaying an overall accuracy of 80%. Early neurological deterioration was independently predicted by pdBSI with a correct classification rate of 95%. In ROC analysis, death was predicted by pdBSI with overall accuracy of 97%. Spontaneous neurological improvement was independently predicted by the delta + theta/alpha + beta – ratio with overall accuracy of 75%. Small-vessel stroke was independently predicted by pdBSI with a correct classification rate of 92%.

Conclusions

EEG may be of prognostic value for spontaneous neurological improvement, early neurological deterioration and death in the acute setting of acute anterior circulation syndrome of presumed ischemic origin.

Significance

These findings may have an impact on stroke care.     

Association analysis of genes in serotonin pathway with attention and executive function in patients with bipolar affective disorder

Background

The reason why it is difficult to identify susceptibility genes attributed to bipolar disorder (BPD) is the phenotypic heterogeneity. The use of endophenotypes has been advocated as one possible strategy to discovery cause variants of BPD.

Methods

A total of 164 patients with BPD and 164 matched controls were employed in the present research. Fifty-two single nucleotide polymorphisms (SNPs) within the genes in serotonin pathway were selected for genotyping using the GoldenGate genotyping assay. All participants completed three neurocognitive tests including the tower of Hanoi (TOH), the Wisconsin card sorting test (WCST) and Trail making tests (TMTA and TMTB-M).

Results

Patients with BPD demonstrated a wide range of deficits in mental activities of attention and speed of information processing, and executive function. Significant interactions between rs2760347 in 5HTR2A gene and diagnosis were found for the executive time of TOH, with β = 11.82 and P = 0.002 (adjusted P = 0.03 after Bonferroni correction).

Conclusions

Cognitive impairments existing in BPD may be particularly notable in certain domains of attention and executive function, and 5HTR2A gene may be involved in modulating executive function of BP-I patients.     

Comparison of quantitative EEG between patients with Alzheimer’s disease and those with Parkinson’s disease dementia

Objective

Dementia frequently occurs in Parkinson’s disease (PD) but its pathophysiological basis is little known. Comparative EEG studies of Alzheimer’s disease (AD) and Parkinson’s disease dementia (PDD) are still rare, but could provide knowledge on the different pathophysiological mechanisms involved. The objective of the present study was to comparatively evaluate the absolute power and coherence on the EEG for patients with AD and PDD.

Methods

This study assessed 38 adults with AD, 12 with PDD, 31 with Parkinson’s disease without dementia, and 37 controls (CG) by a neurological evaluation, CERAD neuropsychological battery, executive functions tests and qEEG, calculating global absolute powers for the delta, theta, alpha and beta bands and inter- and intra-hemispheric coherences.

Results

The delta and theta powers were highest in PDD and lowest in CG (p < 0.05). The beta frontal-occipital inter-hemispheric coherence was highest in PDD (p < 0.05). Whereas, alpha and beta frontal inter-hemispheric coherence was highest in PDD and lowest in AD (p < 0.05).

Conclusion

These results suggest that qEEG power and coherence measures are different in AD and PDD.

Significance

These qEEG differences must be related to the distinct mechanisms of cortical neural connections in AD and PDD.     

Higher heart rate increments on head-up tilt in control subjects are not associated with autonomic dysfunction

Objective

To determine whether there is altered autonomic function associated with elevated heart rate increments on head-up tilt (HUT) in younger individuals.

Methods

A total of 149 subjects were enrolled in this study. Subjects underwent the autonomic reflex screen including HUT and completed the Autonomic Symptom Profile.

Results

Heart rate increment on HUT did not show a correlation with Composite Autonomic Severity Score (CASS) and the individual CASS scores were low (score 0/10, n = 103; score 1/10, n = 27; score 2/10, n = 1; score 3/10, n = 2). There was no correlation with multiple autonomic domains assessed by the Autonomic Symptom Profile. However, there were significant inverse correlations between heart rate increment and total COMPASS score including male sexual dysfunction (r = −0.318; p = 0.011; n = 64), bladder (r = −0.209; p = 0.014; n = 138), pupillomotor (r = −0.235; p = 0.006; n = 138) and male sexual dysfunction (r = −0.554; p < 0.0001; n = 64). These domains showed a positive correlation with age and a significant effect of age but not heart rate increment with regression analysis (except pupillomotor domain).

Conclusions

These results argue against a reduction in autonomic function underlying the higher heart rate increments seen on HUT in younger individuals.

Significance

These findings argue that the development of Postural Tachycardia Syndrome involves mechanisms that potentially occur independently of heart rate increment.     

Relationships that compulsive buying has with addiction,obsessive-compulsiveness,hoarding, and depression

Background and objectives

Compulsive buying has been associated with addiction, depression, and obsessive-compulsive disorder, as well as hoarding. The present study investigated the relationship that compulsive buying (CB) has with ‘addictive’ (i.e., sensitivity to reward), obsessive-compulsive, and depressive phenomena, after controlling for hoarding, substance dependence, manic, and Borderline Personality Disorder symptoms.

Methods

87 participants from a community population completed the online questionnaires for the study, however 70 participants (M = 29.19, SD = 10.45; 70% were female) were used in the analyses because of exclusion criteria.

Results

As expected, CB measures correlated with hoarding, depression, sensitivity to reward, and, but less so, obsessive-compulsive measures. Sensitivity to reward was the most important predictor of CB severity, compared to obsessive-compulsive and depression symptoms. Hoarding was also an important predictor of CB severity.

Limitations

Small sample size meant gender comparisons could not be made, and the use of a novel, communicated questionnaire meant that interpretation should be considered conservatively.

Conclusions

Overall, findings suggest that CB may be most closely related to the phenomena associated with addiction (an increased sensitivity to reward), rather than obsessive-compulsive or depression symptoms. Hoarding and reward sensitivity perhaps might separate compulsive buying from ordinary and recreational shopping.     

Therapeutic sedation for functional (psychogenic) neurological symptoms

Background

Patients with severe functional (psychogenic) neurological symptoms such as paralysis and fixed dystonia present a therapeutic challenge, particularly if no movement is possible during physiotherapy. Sedation has been discussed as a treatment for functional neurological symptoms for 100 years but technique, use of video and outcome has not been systematically described.

Methods

Therapeutic sedation of patients with severe functional neurological symptoms with propofol and follow up at a neuroscience centre.

Results

Of eleven patients (median duration 14 months), five were cured or had major improvement with sedation. At follow up (median 30 months) four were asymptomatic, two were significantly improved and one had minor improvements. We describe a standardized anesthetic and physician technique, refined over consecutive treatments.

Conclusion

In carefully chosen patients, therapeutic sedation with propofol can be a useful adjunctive treatment for patients with severe functional neurological symptoms. The treatment deserves randomized evaluation.