Mild forms of Guillain-Barré syndrome in an epidemiologic survey in The Netherlands

OBJECTIVE: Assessment of incidence rates of Guillain-Barré syndrome (GBS) in the Netherlands over a 10-year period; investigation of a relationship between possible seasonality in GBS and the occurrence of preceding infections; and determination of distinctive characteristics in patients with GBS who are only mildly affected (able to walk unaided at nadir). METHOD: Records of patients with GBS admitted between 1987 and 1996 from all 45 hospitals in the southwest Netherlands were evaluated, covering a population of 4.2 million inhabitants. RESULTS: A total of 476 patients met National Institute for Neurological and Communicative Disorders and Stroke criteria for GBS. This resulted in a crude incidence rate (IR) of 1.18/100,000 inhabitants. This IR increased linearly with age (p < 0.001). Men were more frequently affected than women (p < 0.001). No seasonal preponderance for GBS, nor for any of the preceding infections, was found. Patients under 50 years of age (p < 0.001) and men (p = 0.01) were more frequently found in the mildly affected group. In both groups a preceding infection was reported in 70% of the cases. In the severely affected group, serologic evidence for infection with Campylobacter jejuni, cytomegalovirus, Epstein-Barr virus, or Mycoplasma pneumoniae was found more frequently than in the mildly affected group (41% versus 16%, p = 0.001). CONCLUSIONS: Overall IR in the Netherlands are similar to those found in other studies. The incidence increases linearly with age and men are more frequently affected than women. Distinctive characteristics for mildly and severely affected patients were found regarding age, sex, and preceding infections. This suggests that other infectious agents or host factors may be involved in mild forms of GBS.     

Jugular phlebectasia in adult—an overlooked cause of cervical pain

Neurological Sciences -     

Hyperphosphorylated Tau in an α-synuclein-overexpressing transgenic model of Parkinson's disease

Although clinically distinct diseases, tauopathies and synucleinopathies share a common genesis and mechanisms, leading to overlapping degenerative changes within neurons. In human postmortem striatum of Parkinson’s disease (PD) and PD with dementia, we have recently described elevated levels of tauopathy, indexed as increased hyperphosphorylated Tau (p‐Tau). Here we assessed tauopathy in striatum of a transgenic animal model of PD, overexpressing human α‐synuclein under the platelet‐derived growth factor promoter. At 11 months of age, large and progressive increases in p‐Tau in transgenic mice, hyperphosphorylated at sites reminiscent of Alzheimer’s disease, were noted, along with elevated levels of α‐synuclein and glycogen synthase kinase 3β phosphorylated at Tyr216 (p‐GSK‐3β), a major kinase involved in the hyperphosphorylation of Tau. Differential Triton X‐100 extraction of striata showed the presence of aggregated α‐synuclein in the transgenic mice, along with p‐Tau and p‐GSK‐3β, which was also confirmed through immunohistochemistry. After p‐Tau formation, both Tau and microtubule‐associated protein 1 (MAP1) dissociated from the cytoskeleton, consistent with the diminished ability of these cytoskeleton‐binding proteins to bind microtubules. Increases in free tubulin and actin were also noted, indicative of cytoskeleton remodeling and destabilization. In vivo magnetic resonance imaging of the transgenic animals showed a reduction in brain volume of transgenic mice, indicating substantial atrophy. From immunohistochemical studies, α‐synuclein, p‐Tau and p‐GSK‐3β were found to be overexpressed and co‐localized in large inclusion bodies, reminiscent of Lewy bodies. The elevated state of tauopathy seen in these platelet‐derived growth factor–α‐synuclein mice provides further confirmation that PD may be a tauopathic disease.     

The Analyst’s Participation in the Treatment of an Adolescent

Objective: The purpose of this study was twofold: (1) to estimate the prevalence of comorbid posttraumatic stress disorder (PTSD), major depressive episode (MDE), and substance use disorder (SUD); and (2) to identify risk factors for patterns of comorbidity among adolescents affected by disasters. Method: A population-based sample of 2,000 adolescents (51% female; 71% Caucasian, 26% African American) aged 12 to 17 years (M = 14.5, SD = 1.7) and their parents was recruited from communities affected by the spring 2011 tornadoes in Alabama and Joplin, Missouri. Participants completed structured telephone interviews assessing demographic characteristics, impact of disaster, prior trauma history, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), symptoms of posttraumatic stress disorder (PTSD) and major depressive episode (MDE), and substance use disorder (SUD) symptoms. Prevalence estimates were calculated for PTSD + MDE, PTSD + SUD, MDE + SUD, and PTSD + MDE + SUD. Hierarchical logistic regression was used to identify risk factors for each comorbidity profile. Results: Overall prevalence since the tornado was 3.7% for PTSD + MDE, 1.1% for PTSD + SUD, 1.0% for MDE + SUD, and 0.7% for PTSD + MDE + SUD. Girls were significantly more likely than boys to meet criteria for PTSD + MDE and MDE + SUD (ps < .05). Female gender, exposure to prior traumatic events, and persistent loss of services were significant risk factors for patterns of comorbidity. Parental injury was associated with elevated risk for PTSD + MDE. Adolescents should be evaluated for comorbid problems, including SUD, following disasters so that appropriate referrals to evidence-based treatments can be made. Conclusions: Results suggest that screening procedures to identify adolescents at risk for comorbid disorders should assess demographic characteristics (gender), impact of the disaster on the family, and adolescents’ prior history of stressful events.     

A Cost Analysis of the Innovation–Decision Process of an Evidence-Based Practice in Schools

School Mental Health - The translation of evidence-based practices (EBPs) to improve students’ social, emotional, behavioral, and academic outcomes into authentic school settings has posed...     

Evaluation of an Arabic version of the non-motor symptoms scale in Parkinson’s disease

Non-motor symptoms (NMS) of Parkinson Disease (PD) are common and can cause severe disability. They are often under-recognized and remain untreated. Tools to evaluate these symptoms in Arabic-speaking patients are still lacking. The objective of this study was to evaluate an Arabic version of the non-motor symptoms scale (NMSS) of PD as an instrument for measuring NMS in Arabic-speaking patients. Sixty-two PD patients clustered around Hoehn & Yahr Stages 2–3 were evaluated by the Arabic version of NMSS. They also underwent a battery of standard psychometric assessment measures that included the scales for outcomes of Parkinson’s disease-autonomic (SCOPA-AUT), the Pittsburgh sleep quality index (PSQI), the Beck depression inventory, the geriatric depression scale (GDS), the mini-mental state examination (MMSE), the visual analogical scale for pain(VAS) and the neuro-psychiatric inventory (NPI). The metric properties of the NMSS were studied as well as its correlation with other standard tests evaluating NMS. The mean NMSS score was 82 ± 56 (skewness 0.88). There were highly significant correlations between the NMSS and the SCOPA-AUT as well as the NMSS and PSQI scores. Significant positive correlations between NMSS and GDS, BECK and VAS were also observed. The sleep/fatigue domain significantly correlated with the PSQI, the cardiovascular/urinary/sexual function/gastrointestinal domains significantly correlated with the SCOPA-AUT, the mood/cognition domain significantly correlated with the GDS and BECK findings. The mean Cronbach’s alpha coefficient was 0.87, showing a satisfactory internal consistency. The Arabic version of NMSS can be considered a comprehensive and reliable measure for non-motor symptoms in Arabic-speaking PD patients.     

A matter of motion or an emotional matter? Management of depression in Parkinson's disease

Depression is one of the most frequent comorbidities occurring in Parkinson's disease, affecting up to 50% of patients. Depression is associated with severe negative symptoms and has been shown to contribute to an increased rate of decline of both cognitive and motor function, profoundly impacting on the patient's quality of life. The symptoms of depression overlap with the motor features of Parkinson's disease, making detection difficult. Moreover, the lack of specialized screening tools means that depression remains undiagnosed and untreated in a high percentage of patients. However, depression in Parkinson's disease, when identified early, can be effectively treated with a variety of antidepressant medications, improving quality of life and preserving daily function. The focus of this review is to provide an overview of current knowledge regarding depression in Parkinson's disease, followed by a practical discussion addressing the issues of the detection, diagnosis and treatment.     

Does auditory attention shift in the direction of an upcoming saccade?

In a series of experiments, we examined whether auditory attention shifts in the direction of an upcoming saccade, as recently reported for visual attention. Normal listeners made speeded discriminations for the elevation (up versus down) of abrupt sounds, regardless of their laterality. Each sound was presented around the time that a lateral saccade was made. Auditory elevation discriminations were reliably faster when the saccade was made towards the side of the auditory probe rather than away. Furthermore, an auditory probe on one side speeded up centrally-cued saccades made in that direction, although sounds did not influence saccades to peripheral visual events. The latter visual events were insufficient to affect hearing unless a saccade was made towards them. A further study showed that fixating towards or away from sounds, rather than saccading, could also affect elevation judgements, with poorer performance when fixating away. However, the influence of an upcoming saccade upon hearing could not be reduced to this fixation effect, since the saccade influence was found even for sounds which terminated before any shift in fixation began. Taken together, our results imply that the direction of an upcoming saccade can affect hearing, as can eye-position.     

Influence of heavy metals in Parkinson’s disease: an overview

Journal of Neurology - Parkinson’s disease (PD) is an ageing disorder with deterioration of dopamine neurons which leads to motor complications like tremor, stiffness, slow movement and...     

Preventive and curative effects of cyclophosphamide in an animal model of Guillain Barrè syndrome

The immunosuppressive agent cyclophosphamide (CY) was tested in rat experimental allergic neuritis (EAN), a preclinical model of Guillain Barrè syndrome (GBS). CY prophylaxis (day 0 and 14 post-immunization [p.i.]) effectively prevents clinical and histological signs of EAN and also reduces the cytokine and the NF-kappaB p65 expression in the nervous tissue. When administered therapeutically (day 14th p.i.) to rats with established disease CY only affects the clinical symptoms. Both the prophylactic and therapeutic treatment with CY reduced ex vivo antigen-specific T cell proliferative responses. These results warrant studies with CY in those cases of GBS resistant to conventional therapies.     

Effects of Cerebrolysin™ on neurogenesis in an APP transgenic model of Alzheimer’s disease

Cerebrolysin (CBL) is a peptide mixture with neurotrophic effects that might reduce the neurodegenerative alterations in Alzheimer’s disease (AD). We have previously shown that in the amyloid precursor protein (APP) transgenic (tg) mouse model of AD, CBL improves synaptic plasticity and behavioral performance. However, the mechanisms are not completely clear. The neuroprotective effects of CBL might be related to its ability to promote neurogenesis in the hippocampal subgranular zone (SGZ) of the dentate gyrus (DG). To study this possibility, tg mice expressing mutant APP under the Thy-1 promoter were injected with BrdU and treated with CBL for 1 and 3 months. Compared to non-tg controls, vehicle-treated APP tg mice showed decreased numbers of BrdU-positive (+) and doublecortin+ (DCX) neural progenitor cells (NPC) in the SGZ. In contrast, APP tg mice treated with CBL showed a significant increase in BrdU+ cells, DCX+ neuroblasts and a decrease in TUNEL+ and activated caspase-3 immunoreactive NPC. CBL did not change the number of proliferating cell nuclear antigen+ (PCNA) NPC or the ratio of BrdU+ cells converting to neurons and astroglia in the SGZ cells in the APP tg mice. Taken together, these studies suggest that CBL might rescue the alterations in neurogenesis in APP tg mice by protecting NPC and decreasing the rate of apoptosis. The improved neurogenesis in the hippocampus of CBL-treated APP tg mice might play an important role in enhancing synaptic formation and memory acquisition.     

Is there an order of loss of sounds in speakers with Parkinson’s disease?

Influential reports on speech changes in people with Parkinson’s disease (PD; Logemann et al., 1978, 1981) reported a posterior to anterior pattern of loss of speech sound accuracy. These claims have never been examined. In a partial replication of Logemann et al.’s work, we examined whether posterior lingual sounds are most affected in people with Parkinson’s disease, followed by anterior lingual sounds and then labial sounds. Ninety-nine people with PD (age: mean 70.7, SD 8.46; time since diagnosis: mean 6.97, SD 6.2) with mild to severe overall motor symptoms (Hoehn and Yahr stages 1–5, median 2.5) completed a diagnostic intelligibility test. This was scored by 60 listeners unfamiliar with PD and dysarthric speech. We calculated the proportion of posterior versus anterior lingual versus labial sounds misrecognized by the listeners. We compared profiles of misperceived sounds within and across Hoehn and Yahr stages of severity and in relation to Unified Parkinson’s Disease Rating Scale (UPDRS) and speech intelligibility scores. Speech accuracy declined significantly in relation to overall motor impairment for labial and anterior lingual sounds but not for velar sounds. Speech sound accuracy was strongly associated with intelligibility outcomes (p = < 0.01). Contrary to previous assertions, there was no evidence supporting the existence of a posterior to anterior order of ‘loss’ of oral speech sounds in people with PD, nor an interaction of anterior-posterior speech profile changes with Hoehn and Yahr stage. Findings support the notion that a common underlying impairment of movement downscaling affects all sounds similarly and simultaneously in PD from the start.