Cutaneous silent period changes in Type 2 diabetes mellitus patients with small fiber neuropathy

ObjectiveSmall myelinated (A-δ) and unmyelinated (C) somatic sensory fibers are initially affected and may be the earliest exhibited sign of neuropathy in glucose dysmetabolism. Cutaneous silent period (CSP) is an inhibitory spinal reflex and its afferents consist of A-δ nerve fibers. The aim of this study was to evaluate CSP changes in Type 2 diabetic patients with small fiber neuropathy.MethodsForty-three patients and 41 healthy volunteers were included. CSP latency and duration, as well as CSP latency difference of the upper and lower extremities, were examined.ResultsNerve conduction studies were within normal limits in both groups. Lower extremity CSP latency was longer (122.1 ± 15.5 vs. 96.4 ± 6.4 ms; p < 0.001), CSP duration was shorter (29.5 ± 8.9 vs. 43.1 ± 5.0 ms; p < 0.001), and latency difference was longer (48.1 ± 12.6 vs. 22.7 ± 3.7; p < 0.001) in patients than controls. The difference was more significant in patients with neuropathic pain. No significant difference existed in upper extremity on CSP evaluation.ConclusionThe CSP evaluation together with nerve conduction study, has been demonstrated to be beneficial and performance of latency difference in addition to CSP latency and duration may be a valuable parameter in electrophysiological assessment of diabetic patients with small fiber neuropathy.SignificanceAn additional CSP evaluation may be considered in cases which nerve conduction studies do not provide sufficient information.     

Characteristics of muscle cramps in patients with polyneuropathy

Muscle cramps are common in the general population and can be disabling for patients, but there is little evidence comprehensively evaluating cramp characteristics in patients with polyneuropathy. This study describes the prevalence and characteristics of muscle cramps in this patient group. Patients over 18 diagnosed with polyneuropathy were invited to join the study. Patients completed nerve conduction studies, the Toronto Clinical Neuropathy score, neuropathy-specific Vickrey’s Quality of Life Assessment and a self-administered questionnaire examining demographics, neuropathy symptoms and cramp characteristics. Two hundred and twenty-five participants were enrolled (28.0% female). Sixty-three percent of patients experienced cramps, occurring on average 6 times per week, lasting 10.5 min and scoring 6 out of 10 on a pain scale and described as disabling by 43.6% of patients. No significant difference was found in cramp prevalence according to underlying pathophysiology (p = 0.52) or fiber type (p = 0.41). Patients with disabling cramps rated their physical (p < 0.0001) and mental (p = 0.04) quality of life lower than patients without disabling cramps. This study confirms that muscle cramps are common, disabling and associated with reduced quality of life in patients with polyneuropathy. Similar prevalence of cramps across predominant nerve fiber type suggests a role of sensory afferents in cramp generation, although this needs to be confirmed in larger cohorts.     

Electrophysiological features of lower motor neuron involvement in progressive supranuclear palsy

BackgroundAbnormalities of the spinal cord were considered uncommon in progressive supranuclear palsy (PSP), and therefore spinal symptoms were not included among PSP characteristic features. However there have been some neuropathological reports of spinal cord lesions in patients with PSP. The aim of our study was to find out if the possible lower motor neuron involvement in PSP is reflected by electromyographic (EMG) and/or electroneurographic (ENG) abnormalities.Material24 patients with clinically probable PSP (mean age 67.5 yrs; 66% males) were included in the study. The control group for ENG studies consisted 25 age matched healthy volunteers.MethodsNerve conduction studies in the ulnar, peroneal and sural nerves and EMG of the first interosseus dorsal and tibial anterior muscles were performed.ResultsThe only ENG abnormality observed was decreased compound muscle action potential (CMAP) and sensory nerve action potential (SNAP) amplitudes in the ulnar nerve. Such decrease was registered in 8.3% and 20% of PSP patients respectively. There was no significant difference between the values of ENG parameters between PSP patients and the control group. In EMG abnormalities suggesting chronic reinnervation were recorded in the first interosseous dorsal (FID) muscle in 45.8%, and in the tibialis anterior (TA) muscle in 37.5% of PSP patients. A significant correlation was found between the age of PSP patients and their mean motor unit potential (MUP) amplitude in TA muscle (p = 0.04) and also between the age of onset and MUP amplitude in both, the TA and FID muscles (p = 0.026 and p = 0.03 respectively).ConclusionsIn PSP, neurogenic EMG abnormalities in skeletal muscles are present in nearly half the patients suggesting a loss of motor neurons in the anterior horns of the spinal cord which is in line with our histopathological findings. In contrast, electrophysiological signs of neuropathy in peripheral nerves in PSP are very rare. Concluding, although PSP is characterized by the pathological process in specific basal ganglia and brainstem areas, our electromyographic study suggests the need for broadening the spectrum of PSP for lower motor neurons degeneration.     

Perioperative complications in open versus percutaneous treatment of spinal fractures in patients with an ankylosed spine

We compared open stabilization of vertebral fractures to percutaneous spinal fixation techniques in patients with a diagnosis of either ankylosing spondylitis (AS) or diffuse idiopathic skeletal hyperostosis (DISH). A retrospective review of patients known to have AS or DISH treated for spinal column fracture at a single institution between 1995 and 2011 was performed. Patients were analyzed by the type of fixation, divided into either a percutaneous group (PG) or an open group (OG). There were 41 patients identified with a spinal column fracture and history of AS or DISH who received surgical intervention. There were 17 (42%) patients with AS and 24 (58%) with DISH. Patients in the PG and OG cohorts presented with similar mechanisms of injury, Injury Severity Scale, number of vertebral fractures, number of additional injuries, and Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification scores. Mean operative time (254.76 minutes versus 334.67 minutes, p = 0.040), estimated blood loss (166.8 versus 1240.36 mL, p < 0.001), blood transfusion volume (178.32 versus 848.69 mL, p < 0.001), and time to discharge (9.58 days versus 16.73 days, p = 0.008) were significantly less in the PG cohort. The rate of blood transfusion (36% versus 87.5%, p = 0.001) and complications (56% versus 87%, p = 0.045) were significantly less in the PG cohort. Percutaneous stabilization of fractures in patients with AS or DISH was associated with lower blood loss, shorter operative times and decreased need for transfusion, shorter hospitalization time and a lower perioperative complication rate.     

Efficacy and safety of prostaglandin E1 plus lipoic acid combination therapy versus monotherapy for patients with diabetic peripheral neuropathy

The aim of this report was to evaluate the efficacy and safety of prostaglandin E1 (PGE1) plus lipoic acid (LA) for the treatment of diabetic peripheral neuropathy (DPN) compared with that of PGE1 or LA monotherapy. Randomized controlled trials (RCT) published up to 3 August 2014 were reviewed. A random or fixed effect model was used to analyze outcomes expressed as risk ratios (RR) or mean difference (MD) with a 95% confidence interval (CI). I² statistic was used to assess heterogeneity. Subgroup and sensitivity analyses were performed. The outcomes measured were as follows: clinical efficacy, median motor nerve conduction velocity (MNCV), median sensory nerve conduction velocity (SNCV), peroneal MNCV, peroneal SNCV and adverse effects. Thirty-one RCT with 2676 participants were included. Clinical efficacy of PGE1 + LA combination therapy was significantly better than monotherapy (p < 0.00001, RR = 1.32, 95% CI 1.26 to 1.38). Compared with monotherapy, PGE1 + LA combination therapy led to significant improvements in median MNCV (p < 0.00001, MD = 4.69, 95% CI 3.16 to 6.23), median SNCV (p < 0.00001, MD = 5.46, 95% CI 4.04 to 6.88), peroneal MNCV (p < 0.00001, MD = 5.19, 95% CI 3.71 to 6.67) and peroneal SNCV (p < 0.00001, MD = 5.50, 95% CI 3.30 to 7.70). There were no serious adverse events associated with drug intervention. PGE1 + LA combination therapy is superior to PGE1 or LA monotherapy for improvement of neuropathic symptoms and nerve conduction velocities in patients with DPN. These findings should be further validated by larger well-designed and high-quality RCT.     

Assessment of cardiorespiratory and neuromotor fitness in children with developmental coordination disorder

The decreased participation in physical activity by children with probable developmental coordination disorder (pDCD) has raised concerns about their aerobic fitness and lung function levels. The purpose of the present study was to examine assessment of cardiorespiratory and neuromotor fitness, using laboratory-based tests during an incremental treadmill protocol in healthy children with and without pDCD. Twenty sex children ages 6–9 years took part in this study. Motor coordination was assessed using the Movement Assessment Battery for Children (MABC). All participants performed a cardiopulmonary exercise test (CPET) on a cycle ergometer. Pulmonary function was assessed by spirometric measurements (forced vital capacity: FVC, forced expiratory volume in 1 s: FEV₁) and walking distance (6MWD) was assessed using the 6-min walking test. The children with pDCD had lower VO_2 max than children without pDCD (p < 0.01). Moreover, FVC and FEV₁ were significantly higher in children without pDCD than in children with the disorder (p < 0.05, p < 0.01 respectively). Likewise, children with pDCD had poorer performance on the 6MWD than children without pDCD (p < 0.01). A significant correlation between the absolute value for FEV₁ and 6MWD (r = 0.637, p < 0.05) in pDCD group was observed. We found a significant correlation between VO_2 max and MABC score (r = −0.612, p < .001) and between VO_2 max and 6MWD (r = 0.502, p < .001) for all children. Moreover, a significant correlation between VO_2 max and FEV₁ (r = 0.668, p < .05) was found in children with pDCD. Overall, the reduced aerobic capacity of DCD was associated with decreased of lung function, as well as an alteration of peripheral muscle responses.     

Neurological soft signs and brain structural abnormalities in patients with first episode psychosis and healthy controls

ObjectivesTo assess and compare neurological soft signs (NSSs) and brain magnetic resonance imaging (MRI) findings between the patients with first episode psychosis and a group of healthy participants.MethodsThirty patients with first episode psychosis and thirty healthy participants were evaluated for psychiatric disorders using Structured Clinical Interview for DSM-IV, Axis I disorders (SCID-I). The assessment of NSSs and handedness was done using Neurological Evaluation Scale (NES) and Edinburgh Handedness Inventory (EHI), respectively. Moreover, a brain structural evaluation was done by using MRI.ResultsIn the patients with first episode psychosis, the total score of NES was significantly higher than in the healthy participants. The scores for the subgroups sequencing of motor acts (p < 0.01), motor coordination (p < 0.001) and sensory integration (p < 0.01) were higher for the patients in comparison with the healthy group. Several abnormal findings of MRI were significantly higher in the patients’ group as compared with the healthy group consisted of cortical atrophy, decrease in upper temporal cortex, and increase in the width of left Sylvian fissure volume.ConclusionNSSs were higher in the patients with first episode psychosis than in the healthy participants. NSSs and structural abnormalities in MRI are part of neurological deficit, leading to psychosis, and are not caused by the process of neurological deterioration due to psychosis itself. The current study is cross-sectional, so longitudinal data is required for elucidating if NSSs change during the course of illness.     

Mexiletine suppresses nodal persistent sodium currents in sensory axons of patients with neuropathic pain

ObjectiveTo investigate changes in axonal persistent Na⁺ currents in patients with neuropathic pain and the effects of mexiletine, an analogue of lidocaine, on axonal excitability properties.MethodsThe technique of latent addition was used to estimate nodal persistent Na⁺ currents in superficial radial sensory axons of 17 patients with neuropathic pain/paresthesias before and after mexiletine treatment. Brief hyperpolarizing conditioning currents were delivered, and threshold change at the conditioning-test interval of 0.2 ms was measured as an indicator of the magnitude of persistent Na⁺ currents.ResultsThreshold changes at 0.2 ms in latent addition were greater in the neuropathic patients than in the normal controls (p < 0.001). After mexiletine treatment, there was a reduction in clinical pain scores (p < 0.001), associated with decreased threshold changes at 0.2 ms (p < 0.001).ConclusionsIn patients with neuropathy, nodal persistent Na⁺ currents in large sensory fibers increase, and the abnormal currents can be suppressed by mexiletine. Pain reduction after mexiletine treatment raises the possibility that excessive Na⁺ currents are also suppressed in small fibers mediating neuropathic pain.SignificanceLatent addition can be used for indirect in vivo monitoring of nodal Na⁺ currents in large sensory fibers, and future studies using this approach in small fibers would provide new insights into the peripheral mechanism of neuropathic pain.     

Afferent control of walking: Are there distinct deficits associated to loss of fibres of different diameter?

ObjectivesTo compare the gait pattern in patients affected by different types of neuropathy.MethodsWe recruited healthy subjects (HS, n = 38), patients with Charcot–Marie–Tooth disease type 1A (CMT1A) (n = 10) and patients with diabetic neuropathy (DNP) (n = 12). Neuropathy impairment score and neuropathy score were assessed. Body sway during quiet stance, and spatio-temporal gait parameters were recorded.ResultsMost patients had reduced or absent tendon-tap reflexes. Strength of foot dorsiflexor muscles (p < 0.05) and conduction velocity (CV) of leg nerves (p < 0.0001) were more impaired in CMT1A than DNP, whereas joint-position sense was more affected (p < 0.05) in DNP. Body sway while standing was larger in DNP compared to CMT1A and HS (p < 0.01 and p < 0.0001 respectively). During gait, the distribution of foot sole contact pressure was abnormal in CMT1A (p < 0.05) but not in DNP. Velocity and step length were decreased, and foot yaw angle at foot flat increased, in DNP with respect to CMT1A and HS (both variables, p < 0.001). Gait velocity and step length were decreased (p < 0.005) also in CMT1A, but to a smaller extent than in DNP, so that the difference between patient groups was significant (p < 0.0005). Duration of the double support was protracted in DNP compared to CMT1A and HS (p < 0.0005). For DNP only, velocity of gait and duration of single support were correlated (p < 0.05) both to sway path and lower limb muscle strength.ConclusionsChanges in both body sway and stance phase of gait were larger in DNP than CMT1A, indicating more impaired static and dynamic control of balance when neuropathy affects the small in addition to the large afferent fibres. Diminished somatosensory input from the smaller fibres rather than muscle weakness or foot deformity plays a critical role in the modulation of the support phase of gait.SignificanceThe analysis of balance and gait in patients with neuropathy can offer a tool for understanding the nature and functional impact of the neuropathy and should be included in their functional evaluation.     

Changes of the phrenic nerve motor response in amyotrophic lateral sclerosis: Longitudinal study

ObjectivePhrenic nerve motor amplitude (Diaphr Ampl) is predictive of hypoventilation in amyotrophic lateral sclerosis (ALS). We aimed to evaluate its change over disease course and to correlate it to other measurements.MethodsForty-nine unselected patients (35 men, 13 bulbar-onset, 56.5 ± 8.9 years) with definitive or probable ALS were included. They were evaluated at entry (time 0) and 4–6 months (5.2 ± 1.0) later (time 1) with: functional ALS rating scale (ALS-FRS) and respiratory subscore (ALS-FRSr); forced vital capacity (FVC); maximal inspiratory pressure (MIP); mean O₂ saturation overnight (SpO₂mean); sniff maximal inspiratory pressure (SNIP); Diaphr Ampl and mean amplitude of the ulnar nerve response (ADM Ampl).ResultsALS-FRS, ALS-FRSr, Diaphr Ampl, FVC, SNIP, ADM Ampl (p < 0.01) and SpO₂mean (p < 0.05) declined significantly. MIP did not change significantly (p = 0.203). Coefficient of variation was similar for FVC, Diaphr Ampl, ADM Ampl and ALS-FRS but higher for SNIP. The percentage of change for Diaphr Ampl was significantly correlated to FVC and SNIP, but not to ADM Ampl or ALS-FRS.ConclusionsDiaphr Ampl decreased significantly in a short period of time and its change is correlated to other respiratory tests. This test can be useful in patients with marked facial weakness or uncooperative.SignificanceDiaphr Ampl is useful to monitor respiratory function in ALS patients and can be applied in clinical trials.     

Effects of overweight and obese body mass on motor planning and motor skills during obstacle crossing in children

Little is known about how obesity relates to motor planning and skills during functional tasks. We collected 3-D kinematics and kinetics as normal weight (n = 10) and overweight/obese (n = 12) children walked on flat ground and as they crossed low, medium, and high obstacles. We investigated if motor planning and motor skill impairments were evident during obstacle crossing. Baseline conditions showed no group differences (all ps > .05). Increased toe clearance was found on low obstacles (p = .01) for the overweight/obese group and on high obstacles (p = .01) for the normal weight group. With the crossing leg, the overweight/obese group had larger hip abduction angles (p = .01) and medial ground reaction forces (p = .006) on high obstacles and high anterior ground reaction forces on low obstacles (p = .001). With the trailing leg, overweight/obese children had higher vertical ground reaction forces on high obstacles (p = .005) and higher knee angles (p = .01) and anterior acceleration in the center of mass (p = .01) on low obstacles. These findings suggest that differences in motor planning and skills in overweight/obese children may be more apparent during functional activities.     

The threshold of cortical electrical stimulation for mapping sensory and motor functional areas

This study aimed to investigate the threshold of cortical electrical stimulation (CES) for functional brain mapping during surgery for the treatment of rolandic epilepsy. A total of 21 patients with rolandic epilepsy who underwent surgical treatment at the Beijing Institute of Functional Neurosurgery between October 2006 and March 2008 were included in this study. Their clinical data were retrospectively collected and analyzed. The thresholds of CES for motor response, sensory response, and after discharge production along with other threshold-related factors were investigated. The thresholds (mean ± standard deviation) for motor response, sensory response, and after discharge production were 3.48 ± 0.87, 3.86 ± 1.31, and 4.84 ± 1.38 mA, respectively. The threshold for after discharge production was significantly higher than those of both the motor and sensory response (both p < 0.05). A negative linear correlation was found between the threshold of after discharge production and disease duration. Using the CES parameters at a stimulation frequency of 50 Hz and a pulse width of 0.2 ms, the threshold of sensory and motor responses were similar, and the threshold of after discharge production was higher than that of sensory and motor response.     

A comparison of respiratory and peripheral muscle strength,functional exercise capacity,activities of daily living and physical fitness in patients with cystic fibrosis and healthy subjects

There are limited reports that compare muscle strength, functional exercise capacity, activities of daily living (ADL) and parameters of physical fitness of cystic fibrosis (CF) patients with healthy peers in the literature. The purpose of this study was to assess and compare respiratory and peripheral muscle strength, functional exercise capacity, ADL and physical fitness in patients with CF and healthy subjects. Nineteen patients with CF (mean forced expiratory volume in one second-FEV₁: 86.56 ± 18.36%) and 20 healthy subjects were included in this study. Respiratory (maximal inspiratory pressure-MIP and maximal expiratory pressure-MEP) and peripheral muscle strength (quadriceps, shoulder abductors and hand grip strength) were evaluated. Functional exercise capacity was determined with 6 min walk test (6MWT). ADL was assessed with Glittre ADL test and physical fitness was assessed with Munich fitness test (MFT). There were not any statistically significant difference in MIP, %MIP, MEP and %MEP values between two groups (p > 0.05). %Peripheral muscle strength (% quadriceps and shoulder abductors strength), 6MWT distance and %6MWT distance were significantly lower in patients with CF than those of healthy subjects (p < 0.05). Glittre ADL-test time was significantly longer in patients with CF than healthy subjects (p < 0.05). According to Munich fitness test, the number of bouncing a ball, hanging score, distance of standing vertical jumping and standing vertical jumping score were significantly lower in patients with CF than those of healthy subjects (p < 0.05). Peripheral muscle strength, functional exercise capacity, ADL performance and speed, coordination, endurance and power components of physical fitness are adversely affected in mild-severe patients with CF compared to healthy peers. Evaluations must be done in comprehensive manner in patients with CF with all stages.     

Polyneuropathy induced by HIV disease and antiretroviral therapy

ObjectiveTo investigate the underlying mechanisms of polyneuropathy induced by HIV infection or antiretroviral drugs.MethodsWe tested 100 HIV patients (59 with AIDS). Ninety-three patients received antiretroviral drugs. Forty-four were treated with neurotoxic compounds (ddI, ddC, d4T). Nerve conduction velocities and the sympathetic skin response (SSR) in palms and soles were measured in all patients. In skin biopsies (ankle and thigh), the intraepidermal nerve fiber density (IENFD) and the number of epidermal fibers without contact to the basal membrane (fragments) were quantified using PGP9.5 staining.ResultsSeverity of the disease (CD4 + count) correlated to conduction velocities of peroneal (p < 0.01, Spearmans rank correlation), sural (p < 0.01) and median nerves (p < 0.05/p < 0.001, sensory/motor). In contrast, the duration of neurotoxic treatment did not impair conduction velocities (p > 0.3) but correlated to reduced IENFD in the ankle (r = ?0.24, p < 0.05). Despite their reduced IENFD, patients with long neurotoxic treatment had a high number of fragments irrespective of their CD4 + count.ConclusionsNeurotoxic treatment appears to primarily impair thin fiber conduction, whereas HIV neuropathy is linked to large fiber impairment and reduction of fragments of nerve fibers.SignificanceThese findings emphasize the differential pattern of polyneuropathy in HIV patients caused by the infection or induced by antiretroviral treatment.     

Prevalence and predictors of carotid stenosis in Thai patients with ocular disorders

There are limited data on prevalence and predictors of carotid stenosis (CS) in Thai and Asian patients with ocular disorders. A total of 135 of 2849 patients enrolled in the Neurosonology Registry had an ocular indication (OI). Demographics, the nature of the OI, risk factors (RF), presence of CS >50% and non-stenotic carotid plaque (NSCP) were analyzed. The mean age of patients was 60.40 ± 14.02 years. The RF included hypertension (47.4%), hypercholesterolemia (34.07%), diabetes mellitus (DM) (31.11%) and current smoking (41.48%). NSCP was found in 20% of Thai patients with OD. CS was found in 11.11% (ipsilateral 10.37%). Predictors of CS were ocular ischemic syndrome (odds ratio [OR] 19.63, p = 0.000), retinal artery occlusion (OR 14.13, p = 0.000), anterior ischemic optic neuropathy (OR 9.75, p = 0.002), neovascularized glaucoma (OR 8.15, p = 0.018), and DM (OR 2.53, p = 0.037). The presence of CS (11.11%), and CS or NSCP (31%) are markers of atherosclerotic risk. The nature of the OI predicted carotid findings. Carotid ultrasound helps to identify the risk for cardiovascular events and should be considered in patients with OI.     

Blink reflex in patients with postparalytic facial syndrome and blepharospasm: Trigeminal and auditory stimulation

ObjectiveThe enhancement of blink reflex (BR) excitability was shown in patients with postparalytic facial syndrome (PFS) and essential blepharospasm (EB). We prospectively investigated patients with PFS and EB whether BR alterations demonstrated by trigeminal stimulation will similarly be observed upon auditory stimulation.MethodsFifteen patients with PFS, 15 patients with EB, and 30 healthy volunteers were involved. Electrically stimulated trigeminal BR and auditory BR were studied bilaterally.ResultsThe mean R2 amplitude and duration values were highest in EB patients, being significantly higher than PFS patients (p < 0.05) and control group (p < 0.01). The mean R2 duration in PFS patients were also significantly longer in compared to control group (p = 0.025). EB patients showed a higher mean R (auditory) amplitude and duration than PFS patients (p < 0.05) and controls (p < 0.04). The mean R (auditory) duration was longer on symptomatic side of PFS patients in compared to controls (p = 0.05).ConclusionsWe observed that there is an enhanced excitability of BR circuit in postparalytic facial syndrome and essential blepharospasm, which could be evoked by auditory stimulation in addition to trigeminal stimulation.SignificanceThe enhanced excitability in patients with EB and PFS probably originates from the final common pathway of BR circuit, namely facial motor or premotor neurons.     

Ictal and postictal semiology in patients with bilateral temporal lobe epilepsy

Bilateral temporal lobe epilepsy is characterized by evidence of seizure onset independently in both temporal lobes. The main aim of the present study was to determine whether patients with evidence of independent bilateral temporal lobe epilepsy (biTLE) can be identified noninvasively on the basis of seizure semiology analysis. Thirteen patients with biTLE, as defined by invasive EEG, were matched with 13 patients with unilateral temporal lobe epilepsy (uniTLE). In all 26 patients, the frequency of predefined clusters of ictal and periictal signs were evaluated: ictal motor signs (IMSs), periictal motor signs (PIMSs), periictal vegetative signs (PIVSs), the frequency of early oroalimentary automatisms (EOAs), and the duration of postictal unresponsiveness (PU). Some other noninvasive and clinical data were also evaluated. A lower frequency of IMSs was noted in the group with biTLE (patients = 46.2%, seizures = 20.7%) than in the group with uniTLE (patients = 92.3%, seizures = 61.0%) (p = 0.030; p < 0.001, respectively). The individual IMS average per seizure was significantly lower in the group with biTLE (0.14; range = 0–1.0) than in the group with uniTLE (0.80; range = 0–2.6) (p = 0.003). Postictal unresponsiveness was longer than 5 min in more patients (75.0%) and seizures (42.9%) in the group with biTLE than in the group with uniTLE (patients = 30.8%, seizures = 18.6%) (p = 0.047; p = 0.002). The frequency of EOAs, PIMSs, PIVSs, and other clinical data did not differ significantly. There is a lower frequency of ictal motor signs and longer duration of postictal unresponsiveness in patients with biTLE.     

Implicit and explicit motor learning: Application to children with Autism Spectrum Disorder (ASD)

Aims and objectivesThis study aims to determine whether children with Autism Spectrum Disorder (ASD) are capable of learning a motor skill both implicitly and explicitly.MethodsIn the present study, 30 boys with ASD, aged 7–11 with IQ average of 81.2, were compared with 32 typical IQ- and age-matched boys on their performance on a serial reaction time task (SRTT). Children were grouped by ASD and typical children and by implicit and explicit learning groups for the SRTT.ResultsImplicit motor learning occurred in both children with ASD (p = .02) and typical children (p = .01). There were no significant differences between groups (p = .39). However, explicit motor learning was only observed in typical children (p = .01) not children with ASD (p = .40). There was a significant difference between groups for explicit learning (p = .01).DiscussionThe results of our study showed that implicit motor learning is not affected in children with ASD. Implications for implicit and explicit learning are applied to the CO-OP approach of motor learning with children with ASD.     

Minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis in patients with significant obesity

Comparative studies evaluating efficacy and safety of minimally invasive spinal fusion between patients with significant obesity (body mass index [BMI] ? 35 kg/m²) and those of normal weight are scarce. We examined complication rates and outcomes for minimally invasive transforaminal lumbar interbody fusion (MITLIF) in patients with significant obesity and those of normal weight undergoing treatment for symptomatic spondylolisthesis. Patients with a BMI ? 35 kg/m² or <25 kg/m² undergoing elective MITLIF for symptomatic spondylolisthesis for the period 2006–09 were identified. Of the 16 patients identified, nine patients with a mean BMI of 37.4 kg/m² were included in the obese group, while seven patients with a mean BMI of 23.4 kg/m² comprised the normal weight group. Estimated blood loss (EBL), operative time, complication rate, length of hospital stay, and clinical outcomes were assessed. Outcome measures included patient-reported visual analog scale (VAS) score for pain and the Oswestry Disability Index (ODI) questionnaire completed by the patient. No significant differences were found in blood loss (p = 0.436), hospital stay (p = 0.606), or number of surgical complications (p = 0.920) between the two groups. Mean follow-up intervals were 15.0 months for patients with obesity, and 18.6 months for those of normal weight. Both groups had significant improvements in VAS (obese, p = 0.003; normal, p = 0.016) and ODI (obese, p = 0.020; normal, p = 0.034) scores. There were no statistically significant differences between normal weight and obese groups in postoperative VAS (p = 0.728) and ODI (p = 0.886) scores. Patients with significant obesity experienced clinical improvement similar to that of patients with normal weight, suggesting that obesity does not impact MITLIF outcomes. In addition, both groups experienced similar complication rates, operative times, EBL, and length of hospital stay.     

Primary lesion location influences postoperative survival in patients with metastatic colorectal spinal lesions

Spinal metastasis from colorectal cancer occurs rarely. However, with increasing incidence of colorectal cancer in the setting of improved therapies, physicians are more likely to encounter such patients. We performed a retrospective review of patients who underwent spine surgery for metastatic colorectal cancer from 2005–2011. Preoperative, operative and postoperative factors; functional outcome as determined by Karnofsky Performance Status (KPS) and modified Rankin scale (mRS); and survival were recorded. Univariate analysis was performed, with patients stratified into two groups based on the position of the primary cancer, either proximal (colon) or distal (rectum) to the rectosigmoid junction. Fourteen patients, with a median age of 52 (interquartile range [IQR] 48–66) years, underwent 21 spine surgeries for metastatic colorectal cancer. Pain was the common presenting symptom (n = 11, 79%), followed by motor weakness (n = 8, 57%). Twenty-seven postoperative complications occurred in 11 (52%) patients. Baseline KPS and mRS remained stable in four (29%), improved in two (14%), worsened in six (43%), and was unknown in two (14%) at last follow-up. Patients with spinal metastasis from a rectal primary (n = 6) had a significantly longer survival compared to those with a colon primary (n = 8), with a median survival of 84 (IQR 56–103) versus 26 (IQR 19–44) months after primary diagnosis (p = 0.002), 19 (IQR 13–27) versus five (IQR 3–9) months after spine metastasis diagnosis (p = 0.010), and six (IQR 4–14) versus three (IQR 2–4) months after surgery (p = 0.030). Patients with spinal metastasis arising from rectal primary lesions display longer survival compared to colon lesions. Consideration of these factors is essential to appropriately assess surgical candidacy.