The role of exaggerated patellar tendon reflex in knee joint position sense in patients with cerebral palsy

The aim of this pilot study was to determine if exaggerated patellar tendon jerk affects knee joint position sense (JPS) in cerebral palsy (CP) patients, by comparing JPS of the knee between participants with normal and exaggerated reflexes. The thresholds for reflex classification were based upon the data from able-bodied volunteers. JPS was measured as the ability of a subject (with eyes closed) to replicate a knee joint position demonstrated by an examiner. Tendon jerk was measured as the moment of force in response to patellar tendon taps. Data was collected from 27 limbs of CP patients (N = 14) and 36 limbs of able-bodied volunteers (N = 18). JPS was less accurate (p = 0.014) in limbs with non-exaggerated reflexes (50.28 ± 43.63%) than in control limbs (11.84 ± 10.85%). There was no significant difference (p = 0.08) in JPS accuracy between limbs with exaggerated reflexes (18.66 ± 15.50%) and control limbs.Our data suggests that one component of sensorimotor impairment, JPS, is not as commonly affected in CP patients as previously reported. JPS of the knee is reduced in limbs with non-exaggerated reflexes; however in limbs with exaggerated reflexes which is seen in the majority of CP patients, JPS is not affected.     

Finger tapping analysis in patients with Parkinson’s disease and atypical parkinsonism

The goal of this study was to investigate repetitive finger tapping patterns in patients with Parkinson’s disease (PD), progressive supranuclear palsy–Richardson syndrome (PSP-R), or multiple system atrophy of parkinsonian type (MSA-P). The finger tapping performance was objectively assessed in PD (n = 13), PSP-R (n = 15), and MSA-P (n = 14) patients and matched healthy controls (HC; n = 14), using miniature inertial sensors positioned on the thumb and index finger, providing spatio-temporal kinematic parameters. The main finding was the lack or only minimal progressive reduction in amplitude during the finger tapping in PSP-R patients, similar to HC, but significantly different from the sequence effect (progressive decrement) in both PD and MSA-P patients. The mean negative amplitude slope of −0.12°/cycle revealed less progression of amplitude decrement even in comparison to HC (−0.21°/cycle, p = 0.032), and particularly from PD (−0.56°/cycle, p = 0.001), and MSA-P patients (−1.48°/cycle, p = 0.003). No significant differences were found in the average finger separation amplitudes between PD, PSP-R and MSA-P patients (p_msa-pd = 0.726, p_msa-psp = 0.363, p_psp-pd = 0.726). The lack of clinically significant sequence effect during finger tapping differentiated PSP-R from both PD and MSA-P patients, and might be specific for PSP-R. The finger tapping kinematic parameter of amplitude slope may be a neurophysiological marker able to differentiate particular forms of parkinsonism.     

Differentiation of hand posture to object shape in children with unilateral spastic cerebral palsy

Quantifying hand-shaping in children with unilateral spastic cerebral palsy (USCP) is the first step in understanding hand posture differentiation. To quantify this ability and determine how hand posture evolves during reach toward various object shapes in children with unilateral spastic cerebral palsy (USCP), 2 groups of children (10 typically developing, and 10 USCP, ages 6–13) were studied in a single-session cross-sectional study. Subjects grasped rectangular, concave, and convex objects with each hand. Metacarpal and proximal interphalangeal joint finger flexion and finger abduction angles were calculated. The extent to which hand posture reflects object shape was calculated using a “visuomotor efficiency (VME) index” (a score of 100 reflects perfect discrimination between objects). A mixed design ANOVA with repeated measures on time was used to compare the VME between groups. Children with USCP demonstrated a lower VME than controls in the affected hand, indicating less effective hand-shaping; p < .01. There was also a difference between groups in the evolution of VME throughout reach; p < .01. No difference in hand-shaping in the less affected hand in USCP was observed. Analysis of joint angles at contact and VME throughout reach demonstrated that children with USCP differentiated their hand posture to objects of different shapes, but demonstrated deficits in the timing and magnitude of hand-shaping isolated to the affected side. The present study suggests it may be important to consider the quality of hand activity using quantitative approaches such as VME analyses. Rehabilitation approaches that target these deficits to improve joint mobility and motor control are worth testing.     

The effects of temporal lobe epilepsy on scene encoding

Forty-four patients with temporal lobe epilepsy (TLE) (25 left) and 40 healthy control participants performed a complex visual scene-encoding fMRI task in a 4-T Varian scanner. Healthy controls and left temporal lobe epilepsy (LTLE) patients demonstrated symmetric activation during scene encoding. In contrast, right temporal lobe (RTLE) patients demonstrated left lateralization of scene encoding which differed significantly from healthy controls and LTLE patients (all p ≤ .05). Lateralization of scene encoding to the right hemisphere among LTLE patients was associated with inferior verbal memory performance as measured by neuropsychological testing (WMS-III Logical Memory Immediate, p = 0.049; WMS-III Paired Associates Immediate, p = 0.036; WMS-III Paired Associates Delayed, p = 0.047). In RTLE patients, left lateralization of scene encoding was associated with lower visuospatial memory performance (BVRT, p = 0.043) but improved verbal memory performance (WMS-III Word List, p = 0.049). These findings indicate that, despite the negative effects of epilepsy, memory functioning is better supported by the affected hemisphere than the hemisphere contralateral to the seizure focus.     

Stigmatizing attitudes and social perception towards mental illness among Moroccan medical students

ObjectivesThis study aimed to explore medical students’ attitudes, social perception, and knowledge towards mental illness and identify the associated factors.MethodsA cross-sectional study was conducted in the Medical Faculty of Fez. A representative sample of 420 Moroccan students from the first to the seventh years was selected randomly during the academic year (2018/2019). They completed the Mental Illness Clinicians Attitudes scale (MICA) and a self-questionnaire exploring sociodemographic data, the university course, social perception and knowledge towards mental illness, and the potential consideration of psychiatry as a career.ResultsThe average age of participants was 21.73 years (SD ± 2.60), and 72.4% (n = 304) of respondents were female (M/F gender ratio = 0.39). The participants held stigmatizing attitudes and negative social perceptions towards mental illness, as indicated by the high score of the MICA scale (mean = 57.24; SD ± 9.95). Females (p = 0.02) and married students (p = 0.02) showed significantly more tolerant attitudes. The attitudes of students (p = 0.37) who completed the psychiatry clerkship were slightly more favorable (p = 0.15). There was no significant difference in attitudes according to the level of study (p = 0.06). Students with a lower socioeconomic level tended to be less stigmatizing (p = 0.08). The assessment of knowledge about mental illness among students objectified major gaps. A total of 17.9% (n = 75) considered psychiatry as a career.ConclusionThe attitudes of medical students in this study were stigmatizing, and this should without delay motivate Moroccan research, educational and health authorities to investigate further scientific research in this area to address these attitudes and remedies.     

Paralinguistic abilities of adults with intellectual disability

The aim of this research was to determine the ability level of paralinguistic production and comprehension in adults with intellectual disability (ID) with regard to the level of their intellectual functioning and presence of co-morbid psychiatric conditions or dual diagnosis (DD).The sample consisted of 120 participants of both genders, ranging in age between 20 and 56 years (M = 31.82, SD = 8.702). Approximately 50% of the sample comprised participants with a co-existing psychiatric condition. Each of these two sub-samples (those with ID only and those with DD) consisted of 25 participants with mild ID and 35 participants with moderate ID. The paralinguistic scale from The Assessment Battery for Communication (ABaCo; Sacco et al., 2008) was used to assess the abilities of comprehension and production of paralinguistic elements.The results showed that the participants with mild ID are more successful than the participants with moderate ID both in paralinguistic comprehension tasks (p = .000) and in paralinguistic production tasks (p = .001). Additionally, the results indicated the presence of separate influences of both ID levels on all of the paralinguistic abilities (F [1 1 6] = 42.549, p = .000) and the existence of DD (F [1 1 6] = 18.215, p = .000).     

At the boundary of the self: The insular cortex in patients with childhood-onset schizophrenia,their healthy siblings,and normal volunteers

The insular cortex (insula), whose normal function involves delineating the boundary between self and non-self stimuli, has been implicated in the pathophysiology of the positive symptoms of schizophrenia, including hallucinations and delusions. Childhood-onset schizophrenia (COS), that includes the onset of psychosis before age 13, is a severe and continuous form of the illness which shows profound and global progressive cortical brain abnormalities during adolescence which merge in the adult pattern with age. Using prospectively acquired anatomic brain magnetic resonance imaging (MRI) scans, a matched sample of COS patients, their nonpsychotic full siblings and healthy volunteers, we measured insular volume using the FreeSurfer automated software. COS patients (n = 98; 234 scans) had significantly lower right (p = 0.003), left (p < 0.001), and total (p < 0.001) insular volumes than healthy volunteers (n = 100; 248 scans). Right insular volume negatively correlated with positive symptoms as measured by the Scale for the Assessment of Positive Symptoms (SAPS) (p = 0.02), while both left (p = 0.01) and right (p = 0.006) insula volumes were positively correlated with overall functioning, as measured by the Children's Global Assessment Scale (CGAS) scores. COS siblings (n = 71; 153 scans), on the other hand, did not differ significantly from normal volunteers suggesting that the insular deficits are more related to the illness state than a familial endophenotype. These results also highlight the salience of the insula in positive symptoms of schizophrenia perhaps resulting from the inability to discriminate between self from the non-self in COS. Further work to connect insular deficits to other neurocircuitries is warranted.     

To evaluate the effects of a simplified hand washing improvement program in schoolchildren with mild intellectual disability: A pilot study

A quasi-experimental study using a pretest–posttest design with a control group was used to evaluate the effects of a simplified 5-step multimedia visualization hand hygiene improvement program by schoolchildren with mild intellectual disability (MID). A total of twenty schoolchildren aged 6–12 years old with MID (12 males) were recruited and they were assigned into intervention (n = 10) and control (n = 10) groups. To evaluate the quality of their hand washing, Glow gel, which contains plastic simulated germs that are visible under an ultra-violet lamp, was applied to participants’ hands to assess the quality of hand washing by comparing the amount of visible Glow gel before and after hand washing using a 4-point scale. Four raters used this 4-point scale to assess the quality of hand washing through digital photo images of the participants’ hands. A total of eight digital photos per participant were taken. A fifteen-minute hand washing training session was conducted every school day for 4 weeks for the intervention group. Those in the control group received no training. A multimedia visual package on steps of hand washing was presented together with a reward system, whereby a number of stars were earned each week depending on the quality of hand washing. Results showed encouraging findings, as the schoolchildren in the intervention group showed significant improvement in hand washing (p < 0.001) and the improvement was stronger than that of the control group (p = 0.02). To conclude, a systematic instruction emphasizing multimedia visualization in a hand washing improvement program can be successfully implemented in a special school, and the effect of integrating multimedia visuals in the hand hygiene program could improve hand hygiene among schoolchildren with MID.     

Using a motor imagery questionnaire to estimate the performance of a Brain–Computer Interface based on object oriented motor imagery

ObjectivesThe primary objective was to test whether motor imagery (MI) questionnaires can be used to detect BCI ‘illiterate’. The second objective was to test how different MI paradigms, with and without the physical presence of the goal of an action, influence a BCI classifier.MethodsKinaesthetic (KI) and visual (VI) motor imagery questionnaires were administered to 30 healthy volunteers. Their EEG was recorded during a cue-based, simple imagery (SI) and goal oriented imagery (GOI).ResultsThe strongest correlation (Pearson r² = 0.53, p = 1.6e-5) was found between KI and SI, followed by a moderate correlation between KI and GOI (r² = 0.33, p = 0.001) and a weak correlation between VI and SI (r² = 0.21, p = 0.022) and VI and GOI (r² = 0.17, p = 0.05). Classification accuracy was similar for SI (71.1 ± 7.8%) and GOI (70.5 ± 5.9%) though corresponding classification features differed in 70% participants. Compared to SI, GOI improved the classification accuracy in ‘poor’ imagers while reducing the classification accuracy in ‘very good’ imagers.ConclusionThe KI score could potentially be a useful tool to predict the performance of a MI based BCI. The physical presence of the object of an action facilitates motor imagination in ‘poor’ able-bodied imagers.SignificanceAlthough this study shows results on able-bodied people, its general conclusions should be transferable to BCI based on MI for assisted rehabilitation of the upper extremities in patients.     

Ocular vestibular evoked myogenic potentials to head tap and cervical vestibular evoked myogenic potentials to air-conducted sounds in isolated internuclear ophthalmoplegia

ObjectiveThe central pathways responsible for ocular vestibular evoked myogenic potentials (VEMPs) to forehead tapping remain to be determined. This study aimed to determine whether the medial longitudinal fasciculus (MLF) carries the signals for ocular VEMPs (oVEMPs) in response to this mode of stimulation.MethodsTwelve patients with isolated unilateral internuclear ophthalmoplegia (INO) due to brainstem infarction underwent evaluation of the ocular tilt reaction (ocular torsion and skew deviation), tilt of the subjective visual vertical (SVV), cervical VEMPs (cVEMPs) in response to tone burst sound, and oVEMPs induced by tapping the forehead.ResultsEight (67%) patients showed abnormal oVEMPs that included no wave formation (n = 4) and decreased amplitude (n = 3) in the lesion side, and bilaterally absent responses in the remaining patient. Furthermore, the patients showed diminished oVEMPs responses in the lesion side compared with normal side (6.0 ± 5.6 vs. 11.7 ± 5.5 μV, paired t-test, p = 0.001) and increased IAD_amp(%) of the oVEMPs compared with normal controls (43.6 ± 41.2 vs. 9.1 ± 6.2, t-test, p = 0.018). In contrast, cVEMPs were abnormal in only three (25%) patients, decreased (n = 2) or no response in the lesion side. Eleven (92%) patients showed contraversive ocular tilt reaction or SVV tilt.ConclusionPatients with INO frequently show impaired formation of ipsilesional oVEMPs in response to forehead tapping. The occasional abnormality and decreased amplitude of ipsilesional cVEMPs also suggest a modulatory pathway for the inhibitory sacculocollic reflex descending in the MLF.SignificanceThis study suggests that the MLF contains the fibers for the otolith-ocular reflex from the contralateral ear.     

Accelerometer-determined physical activity and walking capacity in persons with Down syndrome,Williams syndrome and Prader–Willi syndrome

In this study we describe by use of accelerometers the total physical activity (PA), intensity pattern and walking capacity in 87 persons age 16–45 years with Down syndrome (DS), Williams syndrome (WS) and Prader–Willi syndrome (PWS). Participants were recruited from all over Norway, and lived either with their parents or in community residences with support.On average the participants generated 294 counts per minute (cpm) or 6712 steps per day, with most of the day spent in sedentary activity, 522 min/day, followed by 212 min/day in light PA, 71 min/day in lifestyle activity and 27 min/day in moderate-to-vigorous physical activity (MVPA). Inactivity was prevalent, as only 12% meet the current Nordic recommendations for PA.When compared, no differences for total physical activity or time in MVPA were observed between the three groups. However, participant with DS spent a mean of 73 min/day less and 43 min/day less in sedentary activities compared to participants with PWS and WS, respectively, (p = 0.011, 95% CI: ?10.9; ?80.1). In addition the DS-group spent a mean of 66 min/day more in light PA than the PWS-group and 41 min/day more than the WS-group, (p < 0.001, 95% CI: 29.3; 79.7). Participants with PWS spent on average 30 min/day less in lifestyle activities compared to both participants with DS and WS, (p < 0.001, 95% CI: ?14.2; ?45.4). No association between total PA and BMI were observed. Males were more active than females across all diagnoses. Males accumulated on average 85 counts per minutes more than females, (p = 0.002, 95% CI: 33.3; 136.7), 2137 more steps per day, (p = 0.002, 95% CI: 778; 3496). The mean walking capacity during six-minutes was 507 m (SD 112 m) for males and 466 m (SD 88 m) for females. Distance walked during testing decreased with 33.6 m when comparing normal or underweight participants to overweight participants, and 78.1 m when comparing overweight to obese participants (p < 0.001 95% CI: ?40.4; ?85.8). When adjusted for BMI no differences in walking capacity between the three genetic conditions were observed.     

Impact of tactile function on upper limb motor function in children with Developmental Coordination Disorder

This study investigated the presence of, and relationship between tactile dysfunction and upper limb motor function in children with Developmental Coordination Disorder (DCD) compared to typical developing (TD) children. Participants were 36 children aged 6–12 years. Presence of DCD (n = 20) or TD (n = 16) was confirmed using the Movement Assessment Battery for Children, second edition. All children participated in a comprehensive assessment of tactile registration (Semmes Weinstein Monofilaments); tactile spatial perception (Single Point Localisation (SPL) and two-point discrimination (2PD)); haptic perception (Stereognosis); speed of simple everyday manual tasks (Jebsen–Taylor Test of Hand Function (JTTHF)); and handwriting speed and accuracy (Evaluation Tool of Children's Handwriting (ETCH)). Compared to TD children, children with DCD demonstrated poorer localisation of touch in the non-dominant hand (p = 0.04), slower speed of alphabet writing (p < 0.05) and less legible handwriting (p < 0.01), but no difference in speed of simple everyday manual tasks (JTTHF: p > 0.05). Regression analysis showed that spatial tactile perception (SPL) predicted handwriting legibility (ETCH: r = 0.11) and speed of functional tasks (JTTHF: r = 0.33). These results suggest that tactile function, specifically single point localisation, should be a primary tactile assessment employed to determine reasons for upper limb motor difficulties experienced by children with DCD.     

Effects of self-controlled feedback on learning of a throwing task in children with spastic hemiplegic cerebral palsy

The purpose of this study was to examine the effect of self-controlled feedback on learning a throwing task in children with spastic hemiplegic cerebral palsy (SHCP). In order to achieve the research objectives, using a semi-experimental method, 20 children with SHCP (7–12 years old) were selected from special schools in Tehran, Iran. After showing the participants how to do the throwing task, a pre-test with 10 trials was conducted to homogenize the participants. Then, they were randomly assigned to two groups (self-control group and yoked group) to be examined in acquisition, retention, and transfer phases. Children in self-control group requested feedback when necessary during the acquisition phase. In contrast, participants in yoked-group replicated the feedback schedules of their counterparts in self-control group without any choice. A multivariate analysis of variance (MANOVA) was performed to analyze the data. Based on the results, a significant difference was not found between the self-control and yoked-group in acquisition phase (F = .538, p < .473). However, there was a significant difference between the two groups in retention (F = 11.72, p < .003) and transfer (F = 6.74, p < .018) phases. Thus, based on the better results obtained in the self-control condition, this type of feedback can be used in physiotherapy programs related to children with CP to improve their motor skills and independence movements.     

The impact of negative treatment experiences on persistent refusal of antipsychotics

AimsWe investigate reasons for persistent medication refusal in schizophrenia spectrum disorders and test whether factors that speak for a rational decision, such as negative experiences with medication or low symptom distress predict medication refusal, even after taking differences in insight into account.MethodWe included 45 participants with schizophrenia spectrum disorders, of which 20 had refused antipsychotic medication for at least three months and assessed reasons for taking or not taking medication, labeling condition as mental disorder (“insight"), experiences with the previous treatments, symptoms and symptom distress, positive and negative consequences and experiences of psychosis, causal beliefs, therapeutic relationships with previous clinicians and attitudes towards medication.ResultsGroups did not differ in symptom severity but medication refusers reported significantly less insight, less satisfaction with their most-recent psychiatrist and with previous medication, and more negative beliefs about harmful effects of medication. They also felt less informed about medication. After controlling for insight, the perceived helpfulness of the previous treating psychiatrist (OR = 0.30, z = 5.58, p = 0.018) and of previous medication (OR = 0.27, z = 6.87, p = 0.009) and feeling insufficiently informed about medication (OR = 0.53, z = 3. 85, p = 0.050) significantly predicted medication discontinuation.ConclusionsBuilding rapport with patients with a different view of the nature of their condition and encouraging informed decisions on medication are likely to improve medication adherence. However, the findings also suggest that refusing medication after a phase of initial adherence is also the consequence of negative experiences with medication and could result from weighing the pros against the cons.     

Seat surface inclination may affect postural stability during Boccia ball throwing in children with cerebral palsy

The aim of the study was to examine how seat surface inclination affects Boccia ball throwing movement and postural stability among children with cerebral palsy (CP). Twelve children with bilateral spastic CP (3 with gross motor function classification system Level I, 5 with Level II, and 4 with Level III) participated in this study. All participants underwent pediatric reach tests and ball throwing performance analyses while seated on 15° anterior- or posterior-inclined, and horizontal surfaces. An electromagnetic motion analysis system was synchronized with a force plate to assess throwing motion and postural stability. The results of the pediatric reach test (p = 0.026), the amplitude of elbow movement (p = 0.036), peak vertical ground reaction force (PVGRF) (p < 0.001), and movement range of the center of pressure (COP) (p < 0.020) were significantly affected by seat inclination during throwing. Post hoc comparisons showed that anterior inclination allowed greater amplitude of elbow movement and PVGRF, and less COP movement range compared with the other inclines. Posterior inclination yielded less reaching distance and PVGRF, and greater COP movement range compared with the other inclines. The anterior-inclined seat yielded superior postural stability for throwing Boccia balls among children with bilateral spastic CP, whereas the posterior-inclined seat caused difficulty.     

Continuous positive airway pressure deepens sleep in patients with Alzheimer’s disease and obstructive sleep apnea

ObjectivePatients with Alzheimer’s disease (AD) and obstructive sleep apnea (OSA) experience disrupted sleep. This study examined the effect of continuous positive airway pressure (CPAP) on sleep parameters in AD patients with OSA.MethodsA randomized placebo-controlled trial of 3 weeks of therapeutic CPAP (tCPAP) vs. 3 weeks placebo CPAP (pCPAP) followed by 3 weeks tCPAP in patients with AD and OSA. Polysomnography data from screening after one night and after 3 weeks of treatment were analyzed. Records were scored for percent of each sleep stage, total sleep time (TST), sleep efficiency (SE), sleep period (SP), time in bed (TIB), sleep onset (SO), wake time after sleep onset (WASO), and arousals. A randomized design comparing one night of pCPAP to tCPAP and a paired analysis combining 3 weeks of tCPAP were performed.ResultsFifty-two participants (mean age = 77.8 years, SD = 7.3) with AD and OSA were included. After one treatment night, the tCPAP group had significantly less % Stage 1 (p = 0.04) and more % Stage 2 sleep (p = 0.02) when compared to the pCPAP group. In the paired analysis, 3 weeks of tCPAP resulted in significant decreases in WASO (p = 0.005), % Stage 1 (p = 0.001), arousals (p = 0.005), and an increase in % Stage 3 (p = 0.006).ConclusionIn mild to moderate AD patients with OSA, the use of tCPAP resulted in deeper sleep after just one night, with improvements maintained for 3 weeks.     

Percutaneous endoscopic lumbar discectomy for lumbar disc herniation

This study aims to compare the advantages and disadvantage of percutaneous endoscopic lumbar discectomy (PELD) and standard discectomy (SD) for the treatment of lumbar intervertebral disc herniation (LDH). We searched in MEDLINE, EMBASE, PubMed, Web of Science and Cochrane databases for relevant trials that compare PELD and SD for the treatment of LDH. The Cochrane Collaboration’s Revman 5.3 software was used for data analyses. This meta-analysis compiled 1301 cases from four random controlled trials and three retrospective studies. Compared with SD, PELD showed a shorter operative time (mean difference (MD) = −18.68, 95% confidence interval (CI): −24.92 to −12.43; p < 0.00001), less blood loss (MD = −64.88, 95% CI: −114.51 to −15.25, p < 0.0001), shorter hospital stay (MD = −3.51, 95% CI: −4.93 to −2.08, p < 0.00001), and shorter mean disability period (MD = −34.34, 95% CI: −53.90 to −14.77, p < 0.006). However, there were no significant differences in the visual analogue scale (VAS) scores at the final follow up (MD = −0.23, 95% CI: −0.53 to 0.07, p = 0.14), Macnab criteria at the final follow up (MD = 1.04, 95% CI: 0.72 to 1.50, p = 0.82), complications (RR = 0.76, 95% CI: 0.40 to 1.43, p = 0.39), recurrence rate (risk ratio (RR) = 1.00, 95% CI: 0.61 to 1.64, p = 1) and reoperation rate (RR = 1.40, 95% CI: 0.90 to 2.16, p = 0.13). In conclusion, despite PELD showing significant benefit in short term outcomes such as hospital course and mean disability period, similar clinical efficacy and long term outcomes were observed when compared to SD. Therefore, we suggest that PELD can be a feasible alternative to the conventional posterior approach for the LDH depending on surgeon preference and indication. High-quality randomized controlled trials with sufficient large sample sizes necessary further confirm these results.     

Reliability of lower limb motor evoked potentials in stroke and healthy populations: How many responses are needed?

ObjectiveTo determine the intra- and inter-session reliability of motor evoked potential (MEP) size parameters in the lower limb of patients with stroke, focussing on the number of MEPs collected and the method of measuring MEP size.MethodsTranscranial magnetic stimulation was used to elicit MEPs in the soleus muscle of patients with stroke (n = 13) and age-matched healthy participants (n = 13) during low level muscle activation. Two sets of 10 responses were collected in the first session and a further 10 responses collected in a second session held 7 days later. Four MEP size measurements were made using 4, 6, 8, or all 10 of the MEPs collected. Intra- and inter-session reliability was examined using intraclass correlation coefficients (ICC) and typical percentage error.ResultsIntrasession ICC statistics using 6 or more MEPs were >0.85 in the stroke group but intersession values were all <0.5. Reliability was best when measuring parameters from individual MEPs rather than averaged responses.ConclusionsReliability of intrasession MEP size is excellent in the lower limb of patients with stroke using as few as 6 MEPs but intersession reliability is poor.SignificanceComparing MEP size measures across two or more sessions is questionable in the lower limb of patients with stroke.     

Clinical and neuroradiological predictors of mortality in patients with primary pontine hemorrhage

Background and purposePrimary pontine hemorrhage (PPH) accounts aproximately for about 5–10% of intracranial hemorrhages, and PPHs are known to have a much less uniform prognosis. We aimed to evaluate the clinical and radiological predictors affecting the mortality in 32 patients with PPH.Material and methodsWe retrospectively evaluated the data of 32 patients with PPH admitted to our clinic between 1994 and 2004. We divided the patients into two groups: (1) patients who survived (14 patients), and (2) patients who died (18 patients). The two groups were compared for age, gender, diabetes mellitus, hypertension, initial clinical status, initial GCS, pupillary abnormalities, ophthalmoparesis, volume and localisation of hemorrhage, intraventricular and extrapontine extension, necessity of mechanical ventilation and hydrocephalus. The hematoma volumes were measured with the formulation described by Broderick.ResultsEighteen patients (56%) died and 14 patients (44%) survived. The patients who died (61.3 ± 8.8) were older than the survivors (56.4 ± 11.0), but the difference was not statistically significant. The mean GCS was 4.4 ± 0.2, the mean hematoma volume was 9.9 ± 3.3 ml for patients who died and the mean GCS was 10.1 ± 3.3, the mean hematoma volume was 3.3 ± 1.2 ml for survivors (p < 0.001). Coma on admission (p = 0.001), extrapontine extension (p = 0.001), intraventricular extension (p = 0.019), necessity of mechanical ventilation (p = 0.007), hydrocephalus (p = 0.024), massive and bilateral tegmental localisation (p = 0.006) were found statistically significant predictors for mortality with univariate comparison, and coma on admission (p = 0.038) was the only significant predictor with multivariate regression analysis.ConclusionIn patients with PPH, it is important to know the prognostic factors for mortality for planning the treatment protocol, and coma and bad clinical status on admission was found the only significant prognostic predictor for mortality with multivariate regression analysis.