Quantitative muscle ultrasound and quadriceps strength in patients with post‐polio syndrome

Introduction: We investigated whether muscle ultrasound can distinguish muscles affected by post‐polio syndrome (PPS) from healthy muscles and whether severity of ultrasound abnormalities is associated with muscle strength. Methods: Echo intensity, muscle thickness, and isometric strength of the quadriceps muscles were measured in 48 patients with PPS and 12 healthy controls. Results: Patients with PPS had significantly higher echo intensity and lower muscle thickness than healthy controls. In patients, both echo intensity and muscle thickness were associated independently with muscle strength. A combined measure of echo intensity and muscle thickness was more strongly related to muscle strength than either parameter alone. Conclusions: Quantitative ultrasound distinguishes healthy muscles from those affected by PPS, and measures of muscle quality and quantity are associated with muscle strength. Hence, ultrasound could be a useful tool for assessing disease severity and monitoring changes resulting from disease progression or clinical intervention in patients with PPS. Muscle Nerve 51 : 24–29, 2015     

Postural control in persons with late effects of polio

BACKGROUND: Persons who have suffered from acute poliomyelitis may decades later experience reduction of balance and gait capacity due to muscle weakness, fatigue and/or pain. This may affect the activity level in daily life of these persons. AIMS OF THE STUDY: The aim of this study was to describe observer assessed and subjectively perceived postural control in persons with late effects of polio and to evaluate the correlation between postural control and gait velocity for this population. METHOD: 50 persons (mean age 59.8 yrs) with diagnosed polio disease and without other causes of mobility disorders were included. Balance was tested with the Timed Up and Go test (TUG), the Functional Reach test (FR) and the Falls Efficacy Scale (FES) (Swedish Version). Gait velocity over 30 m was measured for convenient and maximal velocity. RESULTS: The subjects had reduced balance (TUG mean 9.0 sec, FR mean 23.5 cm) and perceived balance problems in ADL items (FES(S) median 119.5, normal value 130). They also showed reduced gait velocity compared to healthy persons of the same age (mean 1.01 m/s compared to 1.30 m/s, convenient speed). Correlations were demonstrated between the reduced balance and decreased convenient and maximal gait velocity (TUG/gait velocity: r = -0.7 (convenient), r = -0.8 (maximal), p 相似文献   

A fatal neuromuscular disease in an adult patient after poliomyelitis in early childhood: Consideration of the pathology of post‐polio syndrome

Post‐polio syndrome (PPS) characterized by new neuromuscular problems can appear many years after acute poliomyelitis in polio survivors. We report a 77‐year‐old man with antecedent poliomyelitis who newly developed neuromuscular disease with a clinical course of 27 years, the final 10 years of which were characterized by apparent progression, thus raising doubt as to the clinical diagnosis of amyotrophic lateral sclerosis (ALS) following PPS. Pathologically, plaque‐like, old poliomyelitis lesions were found almost exclusively in the lumbosacral cord, showing complete neuronal loss and glial scars in the anterior horns. Although less severe, neuronal loss and gliosis were also evident outside the old lesions, including the intermediate zone. Moreover, symmetrical degeneration of the corticospinal tracts, as evidenced by CD68 immunostaining, was a feature of the white matter of the lower spinal cord. In the motor cortex, loss of Betz cells was also confirmed. Synaptophysin immunostaining of the lumbosacral cord also revealed decreased expression outside the old lesions, excluding the posterior horn. Interestingly, decreased expression of synaptophysin was also evident in the cervical anterior horns, where no old lesions were observed. No Bunina bodies, TDP‐43 inclusions, or Golgi fragmentation were found. Neurogenic atrophy was evident in the iliopsoas and scalenus muscles, and inclusion body myositis‐like changes were also observed in these muscles and the tongue. Was it possible to have diagnosed this patient as having ALS? We consider that the features in this case may have represented the pathology of long‐standing and/or fatal PPS itself, and not ALS.     

Relationship between post‐traumatic stress disorder‐like behavior and reduction of hippocampal 5‐bromo‐2′‐deoxyuridine‐positive cells after inescapable shock in rats

Aim: Inescapable shocks (IS) have been reported to reduce the number of 5‐bromo‐2′‐deoxyuridine (BrdU)‐positive cells in hippocampus. Antidepressants prevent this reduction, and the role of neurogenesis in depression is now suggested. It has been reported, however, that the number of BrdU‐positive cells was not different between the rats that developed learned helplessness and those that did not. This suggests that reduction of neurogenesis does not constitute a primary etiology of depression. It has been previously shown that IS can cause various post‐traumatic stress disorder (PTSD)‐like behavioral changes in rats. The aim of the present was therefore to examined whether the reduction of BrdU‐positive cells relates to any PTSD‐like behavioral changes in this paradigm. Methods: Rats were given either inescapable foot‐shocks (IS) or not shocked (non‐S) treatment in a shuttle box on day 1 and received BrdU injections once daily during the first week after IS/non‐S treatment. On day 14, rats treated with IS and non‐S were given an avoidance/escape test in the shuttle box and dorsal hippocampal SGZ were analyzed by BrdU immunohistochemistry. Results: In accordance with previously reported results, IS loading resulted in fewer BrdU‐positive cells in the hippocampal subgranular zone (SGZ). Furthermore, in the IS‐treated group, the number of BrdU‐positive cells in the hippocampal SGZ was negatively correlated at a significant level with several hyperactive behavioral parameters but not with hypoactive behavioral parameters. Earlier findings had indicated that chronic selective serotonin re‐uptake inhibitor administration, which is known to increase hippocampal neurogenesis, restored the increase in hypervigilant/hyperarousal behavior but did not attenuate the increase in numbing/avoidance behavior. Conclusion: The regulatory mechanism responsible for the decreased proliferation and survival of cells in the hippocampus may be related to the pathogenic processes of hypervigilance/hyperarousal behaviors.     

How to diagnose and treat post‐stroke seizures and epilepsy

Stroke is one of the commonest causes of seizures and epilepsy, mainly among the elderly and adults. This seminar paper aims to provide an updated overview of post‐stroke seizures and post‐stroke epilepsy (PSE) and offers clinical guidance to anyone involved in the treatment of patients with seizures and stroke. The distinction between acute symptomatic seizures occurring within seven days from stroke (early seizures) and unprovoked seizures occurring afterwards (late seizures) is crucial regarding their different risks of recurrence. A single late post‐stroke seizure carries a risk of recurrence as high as 71.5% (95% confidence interval: 59.7–81.9) at ten years and is diagnostic of PSE. Several clinical and stroke characteristics are associated with increased risk of post‐stroke seizures and PSE. So far, there is no evidence supporting the administration of antiepileptic drugs as primary prevention, and evidence regarding their use in PSE is scarce.     

Post‐traumatic stress symptoms in Guillain–Barré syndrome patients after prolonged mechanical ventilation in ICU: a preliminary report

Thirty percent of Guillain–Barré syndrome (GBS) patients require mechanical ventilation (MV) in intensive care unit (ICU). Post‐traumatic stress disorder (PTSD) is found in ICU survivors, and the traumatic aspects of intubation and MV have been previously reported as risk factors for PTSD after ICU. Our objective was to determine long‐term PTSD or post‐traumatic stress symptoms (PTSS) in GBS patients after prolonged MV in ICU. We assessed GBS patients who had MV for more than 2 months. PTSD was assessed using Horowitz Impact of Event Scale (IES), IES‐Revisited (IES‐R), and the Post‐traumatic CheckList Scale; functional outcome using Rankin and Barthel scales; quality of life (QoL) using Nottingham Health Profile (NHP) and 36‐Item Short Form Health Survey (SF‐36) and depression using Hospital Anxiety and Depression Scale (HAD) and Beck questionnaire. Thirteen patients could be identified and analyzed. They had only mild disability. They were neither anxious nor depressed with an anxiety HAD at 5 (4–11.5), a depression HAD at 1 (0–3.5) and a Beck at 1 (0–5). QoL was mildly decreased in our population with a NHP at 78.5 (12.8–178.8) and mild decreased SF‐36. Compared with the French population, the SF‐36 sub‐categories were, however, not statistically different. Twenty‐two percentage of our 13 patients had PTSD and PTSS with a Horowitz IES at 12 (2–29), and an IES‐R at 16 (2–34.5). Although severe GBS patients requiring prolonged MV had good functional recovery and no difference in QoL, they had a high incidence of PTSS.