Clinical correlates of anhedonia in patients with Parkinson's disease

Objective

To investigate the prevalence and clinical correlates of anhedonia in patients with Parkinson's disease (PD) and to also examine the relationship between anhedonia and the QOL.

Methods

One hundred and seventeen patients with PD completed the Snaith–Hamilton Pleasure Scale (SHAPS), the State–Trait Anxiety Inventory (STAI), the Beck Depression Inventory Second Edition (BDI-II), Starkstein's Apathy Scale (AS) and a quality of life (QOL) battery. Hoehn and Yahr (HY) staging, the Unified Parkinson's Disease Rating Scale (UPDRS) and the Mini-Mental State Examination (MMSE) were administered on the same day.

Results

Anhedonia (SHAPS score ≥ 3) was diagnosed in 15% of the patients. The SHAPS score was found to be significantly correlated with the HY stage and the UPDRS (I, IV_B, IV_C, total), BDI-II, AS and STAI (State, Trait) scores. A multivariate analysis revealed that the BDI-II and STAI (Trait) scores significantly influenced the SHAPS scores. The SHAPS scores were found to be negatively correlated with the QOL.

Conclusions

These findings indicate that anhedonia is associated with depression and anxiety. In addition, recognizing anhedonia in patients with PD is important since it may have a negative effect on the QOL.     

Application of depression criteria (DSM-IV) in patients with Parkinson's disease

Introduction

The aim of this study is to analyze the clinical differences between Parkinson's disease patients with major (MD) and minor depression (md) and to see how both affect the quality of life.

Material and methods

118 patients diagnosed with Parkinson's disease. The mean age of onset was 60.4 ± 11.2 years with a mean duration of 8.5 ± 6.2 years. Depression was diagnosed according to DSM-IV-TR criteria. Scores on the Hamilton depression inventory, MMSE, PDQ-39, NPI-10, UPDRS III, and UPDRS IV were recorded.

Results

Twenty-one patients (17.8%) met the criteria of major depression (MD) and 33 (28.0%) those of minor depression (md). The scores on the PDQ-39 and NPI-10 of patients with MD were higher than in patients with md, and control group. The MMSE scores were lower in patients with MD. In 52.2% of the patients with MD, the diagnosis of depression was made prior to that of PD, this occurred only in 24.2% of the patients with md (p < 0.001). The presence of anhedonia was related to cognitive impairment and the presence of neuropsychiatric symptoms.

Discussion

MD is probably a part of the disease process of PD; it is associated with cognitive impairment and may precede motor symptoms.     

Female gender but not cigarette smoking delays the onset of Parkinson's disease

Objective

Cigarette smoking has been proposed as a protective factor against Parkinson's disease (PD); however it is not known whether smoking also delays its onset.

Methods

We conducted a long-term study of 247 patients with idiopathic PD to determine whether smoking and other factors influence its onset and development.

Results

The mean age at disease onset was 57 ± 9 years. In smokers, the intensity and age at which exposure occurred did not modify the beginning of symptoms. Only female gender (p = 0.005) and low educational level (p = 0.03) showed a statistical association in the multivariate analysis with a delayed onset of symptoms.

Conclusion

Our results suggest that females have a delayed onset of symptoms, possibly related to the gonadotropin profile of our population upon the nigrostriatal dopaminergic system. The effect of low educational level may be related to a delayed diagnosis, rather than a true delay of disease onset. This report suggests an influence of gender on the onset of Parkinson's disease.     

Decreased resting energy expenditure in patients with Duchenne muscular dystrophy

Background

Skeletal muscle metabolism is a major determinant of resting energy expenditure (REE). Although the severe muscle loss that characterizes Duchenne muscular dystrophy (DMD) may alter REE, this has not been extensively investigated.

Methods

We studied REE in 77 patients with DMD ranging in age from 10 to 37 years using a portable indirect calorimeter, together with several clinical parameters (age, height, body weight (BW), body mass index (BMI), vital capacity (VC), creatine kinase, creatinine, albumin, cholinesterase, prealbumin), and assessed their influence on REE. In addition, in 12 patients maintaining a stable body weight, the ratio of energy intake to REE was calculated and defined as an alternative index for the physical activity level (aPAL).

Results

REE (kcal/day, mean ± SD) in DMD patients was 1123 (10–11 years), 1186 ± 188 (12–14 years), 1146 ± 214 (15–17 years), 1006 ± 136 (18–29 years) and 1023 ± 97 (?30 years), each of these values being significantly lower than the corresponding control (p < 0.0001). VC (p < 0.001) was the parameter most strongly associated with REE, followed by BMI (p < 0.01) and BW (p < 0.05). The calculated aPAL values were 1.61 (10–11 years), 1.19 (12–14 years), 1.16 (15–17 years), and 1.57 (18–29 years).

Conclusion

The REE in DMD patients was significantly lower than the normal value in every age group, and strongly associated with VC. Both the low REE and PAL values during the early teens, resulting in a low energy requirement, might be related to the obesity that frequently occurs in this age group. In contrast, the high PAL value in the late stage of the disease, possibly due to the presence of respiratory failure, may lead to a high energy requirement, and thus become one of the risk factors for development of malnutrition.     

Switching to aripiprazole in subjects with Pervasive Developmental Disorders showing tolerability issues with risperidone

Background

Subjects with Pervasive Developmental Disorders (PDD) often exhibit behavioral symptoms such as aggressiveness and irritability, which are targets of psychopharmacologic intervention. This retrospective study was designed to examine children and adolescents with PDD experiencing tolerability issues with risperidone treatment, and thereby assess the efficacy and tolerability of switching to aripiprazole.

Methods

This naturalistic study included 23 subjects with PDD (16 males, 7 females, age range 9–24 years, mean age 15.1 ± 3.9 years) diagnosed according to DSM-IV criteria and followed up for 14.9 ± 8.4 weeks after switching to aripiprazole from risperidone. Outcome measures were the Clinical Global Impression-Severity (CGI-S) and CGI Improvement (CGI-I) scales.

Results

The mean CGI-S scores of pre-aripiprazole treatment and post-aripiprazole treatment were, respectively 4.7 ± 1.4 and 4.6 ± 1.3. Mean maintenance dosages of risperidone and aripiprazole were, respectively, 0.7 ± 0.5 mg/day and 2.8 ± 1.3 mg/day. The mean CGI-I score, which shows the difference induced by switching from risperidone to aripiprazole, was 3.4 ± 0.8 for the whole sample, suggesting that the efficacy of risperidone for treating behavioral problems of PDD was maintained by aripiprazole. Some improvement of safety/tolerability issues such as increased appetite, somnolence, hyperprolactinemia, and amenorrhea occurred after switching to aripiprazole.

Conclusion

Results show that switching to aripiprazole might be generally well tolerated and might constitute an alternative treatment for subjects with PDD who experience tolerability issues with risperidone treatment. Additional long-term controlled studies of PDD subjects should be undertaken to evaluate the efficacy and safety of switching to aripiprazole from other antipsychotics.     

A multicentre retrospective study of the clinical use of ropinirole in the treatment of Parkinson's disease: The ROPI-PARK Study

Objectives

To evaluate the use of the non-ergot dopamine agonist ropinirole (RPN) in patients with Parkinson's disease in Spain, and to examine its effectiveness and tolerability in both monotherapy and combination therapy.

Methods

Fifty-two investigators participated in this study. Patients receiving RPN under usual clinical care conditions in Spanish Neurology outpatient clinic settings were identified (n = 643) out of these, a random sample of 423 clinical records of patients treated with RPN in the previous 18 months was selected. The endpoints analyzed were: percentage of patients remaining on treatment during the period of study (maintenance), reported adverse reactions and treatment withdrawal (tolerability), changes in symptoms’ severity as assessed by the Clinical Global Impression-Improvement (CGI-I) scale (effectiveness), and start-to-end mean RPN dose.

Results

Patients were 68.6 ± 9.7 years old (mean ± SD) and 57.6% were male. RPN was administered as monotherapy (24%) or add-on treatment (76%). The mean maintenance dose was 9.54 ± 5.34 mg/day. Adverse reactions were reported by 28.6% patients, the most frequent being somnolence and sedation (9.2%), gastrointestinal symptoms (6.9%), increase in dyskinesia (5.9%), and orthostatic symptoms (3.8%). Treatment was withdrawn in 14.4% of patients, because of adverse reactions (5.9%), lack of efficacy (2.1%), change in treatment or clinical trial inclusion (1.9%) or other reasons (4.5%). Neurologists considered that improvement was achieved in 81.5% of patients, according to CGI-I scale.

Conclusions

The low incidence of adverse reactions and low rate of treatment withdrawal observed in this study support the effectiveness and tolerability of RPN in the treatment of Parkinson's disease.     

Surgical treatment of unruptured intracranial aneurysms in a low-volume hospital--outcome and review of literature

Background

The aim of this study was to evaluate surgical outcome of unruptured intracranial aneurysms (UIAs) in a low-volume hospital and compare the results with the recent literature.

Methods

A retrospective review of all consecutive craniotomies for UIA from July 1999 through June 2009 was performed. Morbidity was defined as modified Rankin Scale (mRS) ≥ 3 and evaluated six weeks after surgery. Cognitive function was evaluated at rehabilitation-to-home discharge. A PubMed database search (2001–2011) seeking retrospective, single-center studies reporting on surgical outcome of UIAs was performed.

Results

There were 47 procedures performed in 42 patients to treat 50 UIAs (mean of 5 annual craniotomies). The mean age was 54.7 ± 12.1 years and mean aneurysm size was 7.6 ± 4.0 mm. Favorable outcome (mRS 0–2) at six weeks after surgery was achieved in 45 of 47 procedures (95.7%). Aneurysm size ≥ 12 mm was statistically significant related to adverse outcome defined as mRS change ≥ 1 (71% vs. 29%; p = 0.018). Five patients (10.6%) with favorable neurological outcome (mRS 2) presented with cognitive impairment at rehabilitation-to-home discharge. There was no significant difference in overall morbidity and mortality comparing low- and high-volume hospitals (4.0% vs. 4.8%; p = 0.85).

Conclusions

Low-volume hospitals may achieve good results for surgical treatment of UIAs. The results indicate that defining numeric operative volume thresholds is not feasible to guide centralization of aneurysm treatment.     

Comparing efficacy and side effects of a weekly intramuscular biogeneric/biosimilar interferon beta-1a with Avonex in relapsing remitting multiple sclerosis: a double blind randomized clinical trial

Objective

We compared the efficacy and safety of two biosimilar forms of interferon beta-1a in the treatment of multiple sclerosis: Avonex (Biogen Idec, USA) and CinnoVex (CinnaGen, Iran).

Methods

In a double blind randomized clinical trial study 84 patients with relapsing remitting multiple sclerosis (RRMS) with Expanded Disability Status Scale (EDSS) score of 0–5.5 were randomly allocated to two groups of 42 subjects.

Results

Twenty-four patients lost to follow-up. Finally, 31 patients (mean ± SD of age = 33.7 ± 7.0; 7 males and 24 females) in the Avonex and 29 patients (mean ± SD of age = 32.2 ± 9.2; 8 males and 21 females) in the CinnoVex group completed full 24 months of study period. Decrease in EDSS was 1.05 ± 0.24, p = 0.62 in the Avonex and 0.16 ± 0.88, p = 1.0 in the CinnoVex group after 12 months and 0.27 ± 1.05, p = 0.46 in the Avonex and 0.16 ± 1.06, p = 1.0 in the CinnoVex group after 24 months. There was no statistically significant difference in attack number between two groups (1.0 ± 1.2 in Avonex and 1.2 ± 1.3 in CinnoVex; p = 0.46). Volume of T2-weighted lesions on MRI showed a progressive significant increase in the 12th month (28056 ± 23693) in Avonex treated patients compared with first image (16353 ± 11172) (p = 0.01). But number of gadolinium-enhancing lesions in CinnoVex showed statistically significant decrease after 12 months (0.08 ± 0.28 vs. 1.00 ± 1.22; p = 0.03). However, there were no significant differences between groups after 24 months. There were no significant differences between 2 groups regarding frequency and duration of most considerable side effects, as well. Neutralizing antibodies were not positive in any patients.

Conclusion

CinnoVex can be used as a safe and effective alternative to Avonex in treatment of RRMS.     

Estimation of cranial capacity and brain weight in 18-22-year-old Iranian adults

Objective

Cranial capacity, brain weight and cerebral index are important measurements in the study of racial differences. Clinically, an analysis of cranial capacity and weight exposes another aspect of growth and development and permits critical evaluation of unusually large, small, or misshapen crania.

Subjects and methods

Brain weight and cerebral index were estimated in 772 normal 18–22-year-old (320 males, 452 females) Iranian people of different socioeconomic groups, using linear dimensions of the head (using Lee–Pearson's formula) measured with spreading caliper and auricular head spanner.

Results

Cranial capacity, brain weight and cerebral index in males were 1343.45 ± 102.37 cm³ (mean ± S.D.), 1390.47 ± 105.95 g, and 2.17 ± 0.27% respectively. Cranial capacity, brain weight and cerebral index in females were 1163.02 ± 115.76 cm³, 1203.73 ± 119.81 g, and 2.25 ± 0.31% respectively.

Conclusion

It was shown that neurocranial volume and weight of male is higher than female. Also, the results are different from previous studies in Western countries which may be a result of racial, topodemic, and socioeconomic variations. Finally, we propose the new “cerebral quotient” for anthropometric measurements.     

Minocycline as adjunctive therapy for patients with unipolar psychotic depression: an open-label study

Background

Approximately 25% of patients admitted to a hospital as a result of depression are actually suffering from psychotic depression. Psychotic symptoms can be present in patients with either unipolar depression or bipolar depression and can be difficult to treat. It was reported the second-generation tetracycline may exert potential antidepressant effects through its robust neuroprotective activities, which include neurogenesis, antioxidation, and anti-glutamate excitotoxicity, and may direct regulation of pro-inflammatory agents.

Methods

This was a 6-week, open-label study to evaluate the efficacy and safety of minocycline in combination with antidepressants in adult inpatients (n = 25) diagnosed with major depression with psychotic features (psychotic depression) according to DSM-IV-TR. The primary endpoint was the change from baseline in the Hamilton Depression Rating Scale (HAM-D-21) score from baseline to week 6. Secondary endpoints were changes in the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impression (CGI) Scale scores from baseline to week 6. Spontaneously reported adverse events were recorded.

Results

The patients' average age was 46.9 ± 10.2 years. Minocyline (150 mg/day) in combination with antidepressants (fulvoxamine, paroxetine, and sertraline) provided significant improvement in depression. Mean (± SD) HAM-D-21 was reduced to 6.7 ± 1.9 at week 6 from a baseline value of 40.4 ± 2.5. Significant improvement of psychotic symptoms (mean ± SD) was indicated by the decrease in BPRS scores from baseline (63.3 ± 8.7) to week 6 (4.6 ± 2.4). No serious adverse events occurred.

Conclusions

These preliminary data suggest that minocycline in combination with antidepressants is effective and well tolerated in the treatment of unipolar psychotic depression. Further studies using larger, double-blind, parallel-group design are warranted to confirm these findings.     

Altered antioxidant defense system in clinically stable patients with schizophrenia and their unaffected siblings

Objective

To determine Red Blood Cell (RBC) antioxidant enzyme activities and plasma Thiobarbituric Acid Reactive Substances (TBARS) in clinically stable patients with schizophrenia and their unaffected siblings.

Methods

A case-control study carried out on three groups: 60 schizophrenic patients treated with neuroleptics, 33 of their unaffected siblings and 30 healthy controls with no family psychiatric history. Biological markers were measured on fasting patients after a period of tobacco abstinence: RBC antioxidant enzyme activities – superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), catalase (CAT) – by spectrophotometry and plasma levels of TBARS by spectrofluorimetry.

Results

RBC SOD and CAT activities were significantly lower in schizophrenic patients and their unaffected siblings compared to the control group (P < 0.001). Schizophrenic patients also had significantly lower RBC GSH-Px activity than controls (P = 0.03), whereas their unaffected siblings had significantly higher RBC GSH-Px activity than controls (P = 0.04). Plasma TBARS were higher in schizophrenic patients than their unaffected siblings: 2.1 ± 0.8 μmol/l vs. 1.7 ± 0.6 μmol/l (P = 0.06).

Conclusions

Our results showed a decrease in antioxidant enzyme activities and an increase in lipid peroxidation confirming the existence of oxidative stress in schizophrenic patients treated with neuroleptics. Additionally, this suggests that the increase in GSH-Px activity in unaffected siblings would be a protective mechanism against oxidative stress and damage. Other studies are necessary to confirm these findings.     

Prediction of coma and anisocoria based on computerized tomography findings in patients with supratentorial intracerebral hemorrhage

Objectives

Coma and anisocoria are the two common signs of a crucial state of neurological dysfunction. The ability to forecast the occurrence of these conditions would help clinicians make clinical risk assessments and decisions.

Patients and methods

From October 2006 to September 2008, 118 patients with supratentorial intracerebral hemorrhage (SICH) were enrolled in this retrospective investigation. Patients were distributed into 3 groups according to occurrence of the signs of coma and/or anisocoria in the observation unit during a 30-day period. Group 1 included 52 patients who had normal or impaired consciousness, group 2 included 27 patients who had coma with no anisocoria and group 3 consisted of 39 patients who had coma with anisocoria. The clinical characteristics and parameters on computerized tomography (CT) findings were compared using univariate analysis to determine the factors that were related to the level of consciousness. Logistic regression models established the predictive equations for coma and anisocoria.

Results

Univariate analysis revealed that hematoma volume, the score of intraventricular hemorrhage (IVH score) and the amplitude of midline shift were the factors related to coma and anisocoria. Mean hematoma volume was 24.0 ± 13.0 ml, 53.6 ± 12.6 ml and 80.5 ± 24.6 ml, the mean amplitudes of midline shift were 1.3 ± 2.0 mm, 5.9 ± 4.9 mm and 10.1 ± 5.5 mm, and the mean IVH score was 0.8 ± 1.3, 3.3 ± 3.3 and 5.9 ± 3.4 in groups 1, 2 and 3, respectively. Multivariate analysis showed that hematoma volume and IVH score were independent prognostic factors for coma and anisocoria. The predictive equations for coma and anisocoria were Logit P = 0.279X_HV + 0.521X_IVH − 18.164 and Logit P = 0.125X_HV + 0.326X_IVH − 6.864, respectively.

Conclusions

Hematoma volume and IVH score were the independent prognostic factors for coma and anisocoria. Logistic regression models established the fitted predictive equations, which could help clinicians make clinical risk assessments and decisions.     

Clinical safety and primary efficacy of bone marrow mesenchymal cell transplantation in subacute spinal cord injured patients

Background

In recent years, some studies were conducted to evaluate the effects of stem cells from different sources on patients with spinal cord injury (SCI). This study was carried out to evaluate the feasibility and therapeutic potential of autologous bone marrow cell (BMC) transplantation in 11 complete spinal cord injured patients at thoracic level.

Methods and materials

This nonrandomized clinical trial compared the results of autologous BMC transplantation into cerebrospinal fluid (CSF) via lumbar puncture (LP) in 11 patients having complete SCI, with 20 patients as control group who received conventional treatment without BMC transplantation. The patients underwent preoperative and follow-up neurological assessments using the American Spinal Injury Association (ASIA) impairment scale. Then, the participants were followed for 12–33 months.

Results

Eleven patients with the mean age of 33.2 ± 8.9 years and 20 patients with the mean age of 33.5 ± 7.2 years were enrolled in the study and in the control group, respectively. None of the patients in the study and control group experienced any adverse reaction and complications, neither after routine treatment nor after cell transplantation. Five patients out of 11 (45.5%) in the study group and three patients in the control group (15%) showed marked recovery, but the result was statistically borderline (P = 0.095).

Conclusion

We conclude that transplantation of autologous BMC via LP is a feasible and safe technique, but at the moment, no clear answer can be given regarding the clinical potential, despite a potential tendency to treat SCI patients, observed through statistics.     

Preliminary findings of the effects of autonomic dysfunction on functional outcome after acute ischemic stroke

Background and purpose

Impaired autonomic function is common in the acute poststroke phase but little is known about its effects on functional outcome after acute ischemic stroke. This study sought to investigate the impact of autonomic dysfunction by Ewing's classification on functional outcome 2 months after acute ischemic stroke.

Methods

34 consecutive acute ischemic stroke patients within 7 days after onset were enrolled. On admission, autonomic function was assessed by Ewing's battery tests. Stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS), autonomy in activities of daily living by the Barthel Index (BI), and global disability by the modified Rankin Scale (mRS). BI and mRS were also evaluated 2 months after ischemic stroke onset.

Results

On admission, eight patients were diagnosed as minor autonomic dysfunction and 26 patients as relatively severe autonomic dysfunction. The prevalence of relatively severe autonomic dysfunction in ischemic stroke patients was 76.5%. There were no significant differences in baseline characteristics between the minor and severe autonomic dysfunction groups. 2 months after stroke onset, the mean BI score of patients with minor autonomic dysfunction and severe autonomic dysfunction increased from 76.3 ± 15.3 on admission to 95.0 ± 7.1, 66.5 ± 15.2 on admission to 74.8 ± 15.9 respectively. The mean BI score after 2-month stroke onset and the change in BI from admission to 2-month outcome (delta BI) in patients with severe autonomic dysfunction were lower than those in patients with minor autonomic dysfunction (all P < 0.05).

Conclusions

Autonomic dysfunction occurs in acute stroke patients. Relatively severe autonomic dysfunction is related to an unfavorable functional outcome in patients with acute ischemic stroke.     

A cytokine study in children and adolescents with Tourette's disorder

Background

While immune system dysregulation has been postulated to play a role in Tourette's disorder (TD), most research has focused on the hypothesis of an autoimmune process similar to rheumatic fever. This study examined the potential role of cytokines, modulators of the immune system. We hypothesized that children with TD would have increased levels of tumor necrosis factor (TNF)-α, interleukin (IL)-12, IL-1β and IL-6, and decreased IL-2. We also explored whether comorbid obsessive compulsive disorder (OCD) had an effect on the cytokine profile of TD patients.

Method

Thirty-two children and adolescents with TD (27 males, ages 7–18 years), 17 with comorbid OCD (14 males), and 16 healthy comparison subjects (7 males, ages 9–19), were enrolled. Plasma cytokines were examined using an enzyme-linked immunosorbent assay. The Mann–Whitney and binary logistic regression tests were used to compare the groups.

Results

Only patients with comorbid OCD (TD+OCD; n = 17) had significantly elevated IL-12 plasma levels compared to controls (2.73 ± 5.12 pg/ml vs. 0.55 ± 0.88 pg/ml, rank statistic = 222.5; p < 0.04). IL-2 was significantly higher in the TD+OCD subgroup compared to the non-OCD TD subgroup (0.74 ± 0.29 pg/ml vs. 0.49 ± 0.24 pg/ml, rank statistics = 108.5; p < 0.03). There were no other significant cytokine differences between groups.

Conclusions

Findings suggest a role for IL-12 and IL-2 in TD, and that the TD+OCD subgroup may involve different neuroimmunological functions than the TD−OCD subgroup. Larger studies with medication-free patients should follow.     

Evaluation of the GABAergic nervous system in autistic brain: (123)I-iomazenil SPECT study

Purpose

To evaluate the GABA_A receptor in the autistic brain, we performed ¹²³I-IMZ SPECT in patients with ASD. We compared ¹²³I-IMZ SPECT abnormalities in patients who showed intellectual disturbance or focal epileptic discharge on EEG to those in patients without such findings.

Subjects and methods

The subjects consisted of 24 patients with ASD (mean age, 7.3 ± 3.5 years), including 9 with autistic disorder (mean age, 7.0 ± 3.7 years) and 15 with Asperger’s disorder (mean age, 7.5 ± 3.2 years). We used 10 non-symptomatic partial epilepsy patients (mean age, 7.8 ± 3.6 years) without intellectual delay as a control group.For an objective evaluation of the ¹²³I-IMZ SPECT results, we performed an SEE (Stereotactic Extraction Estimation) analysis to describe the decrease in accumulation in each brain lobule numerically.

Results

In the comparison of the ASD group and the control group, there was a dramatic decrease in the accumulation of ¹²³I-IMZ in the superior and medial frontal cortex. In the group with intellectual impairment and focal epileptic discharge on EEG, the decrease in accumulation in the superior and medial frontal cortex was greater than that in the group without these findings.

Conclusion

The present results suggest that disturbance of the GABAergic nervous system may contribute to the pathophysiology and aggravation of ASD, since the accumulation of ¹²³I-IMZ was decreased in the superior and medial frontal cortex, which is considered to be associated with inference of the thoughts, feelings, and intentions of others (Theory of Mind).     

Correlational study of the serum levels of the glial fibrillary acidic protein and neurofilament proteins in Parkinson's disease patients

Objective

To investigate changes in the serum levels of the glial fibrillary acidic protein (GFAP) and neurofilament proteins (NFs) in patients with Parkinson's disease (PD) and to determine their clinical significance.

Methods

In this study, 82 subjects were divided into 3 groups: the PD group, the acute cerebral infarction (ACI) group, and a normal control group. The serum levels of GFAP and NFs were measured using a sandwich ELISA assay.

Results

The serum levels of GFAP and NFs were significantly higher in the PD and the ACI groups than in the normal control group (P < 0.05). There was no significant difference between the PD group and the ACI group (P > 0.05). The serum level of GFAP in the PD group had no significant correlation with duration of the disease or age (P > 0.05). The serum level of NFs in the PD group was significantly correlated with duration of the disease and age (P < 0.05).

Conclusions

The serum levels of GFAP and NFs were significantly higher in the PD group than in the normal group, indicating that astrocytic activity may remain elevated during the axonal degeneration that occurs over duration of the disease, although this activity is not specific to the disease.     

Effectiveness of home rehabilitation program for ischemic stroke upon disability and quality of life: a randomized controlled trial

Background

To develop and examine the effectiveness of individual 6-month home rehabilitation program in ischemic stroke patients upon disability and quality of life at 2 years.

Methods

This is a prospective randomized controlled trial (RCT) in 60 patients with recent ischemic stroke. They were randomly assigned to receive either home rehabilitation program once a month for 6 months with audiovisual materials (intervention group) or usual care (control group). We collected outcome data after discharge from the hospital until 2 years. The Barthel index (BI), the modified Rankin Scale (mRS) and utility index (EQ-5D) were measured for function, disability and quality of life respectively.

Results

At 2 years, the BI was significantly improved in the intervention group more than the control group: 97.2 ± 2.8 vs. 76.4 ± 9.4, p < 0.001. The good outcome, defined as BI 95–100, or mRS 0 or 1. For BI, there were 29 patients (96.7%) in intervention group vs 12 patients (42.9%) in usual care group (95% CI, 42.0, 85.0, p = 0.03). For mRS, there were 28 patients (93.3%) in intervention group vs 9 patients (32.1%) in usual care group (95% CI, 38.2, 87.0, p = 0.02). Number needed to treat for good outcome in mRS was 2.0 (95% CI: 1.0, 1.3). The mean (SD) of utility index in intervention group and control group were 0.9 ± 0.02 and 0.7 ± 0.04 respectively (p = 0.03). There was no significant interaction in baseline characteristics and treatment outcome.

Conclusions

Early home rehabilitation program in the first 6 months period after ischemic stroke leads to more rapid improvement in function, reducing disability and increase quality of life than usual care.     

Evaluation of ability for basic movement scale for children type T (ABMS-CT) for disabled children

Background

The objective of this pilot study was to test the validity and reliability of a new scale, the Ability for Basic Movement Scale for Children Type T (ABMS-CT).

Methods

Forty-nine pediatric patients with disabilities (aged 1.00–15.17 years; 29 males and 20 females) participated in this prospective study. To prove the validity and reliability of the ABMS-CT, subjects were administered the ABMS-CT by two physicians. In addition to the ABMS-CT score, data on age, diagnosis, and results of the Functional Independence Measure for Children (WeeFIM) were recorded.

Results

Spearman’s rank correlation coefficient analysis showed that the ability to perform basic movements according to the individual scores for each item on the ABMS-CT and the total scores of the ABMS-CT correlated significantly with the total scores of the motor and cognitive WeeFIM, respectively (r = 0.753–0.892, p = 0.0001). The five items on the ABMS-CT had appropriate internal consistency (Cronbach’s α = 0.966). Inter-rater reliability analysis indicated that the “oral and facial area”, “hands and fingers”, “one leg”, “both legs”, and “stairs” items on the ABMS-CT had almost perfect reliability (κ = 0.854–0.925).

Conclusion

This study provides evidence for the validity and reliability of the ABMS-CT with regard to assessment of the functional ability for complex movements in disabled pediatric patients even if they can walk independently.     

Topography of maturational changes in EEG burst spectral power of the preterm infant with a normal follow-up at 2years of age

Objective

To quantify the electroencephalography (EEG) burst frequency spectrum of preterm infants by automated analysis and to describe the topography of maturational change in spectral parameters.

Methods

Eighteen preterm infants <32 weeks gestation and normal neurological follow-up at 2 years underwent weekly 4-h EEG recordings (10–20 system). The recordings (n = 77) represent a large variability in postmenstrual age (PMA, 28–36 weeks). We applied an automated burst detection algorithm and performed spectral analysis. The frequency spectrum was divided into δ1 (0.5–1 Hz), δ2 (1–4 Hz), θ (4–8 Hz), α (8–13 Hz) and β (13–30 Hz) bands. Spectral parameters were evaluated as a function of PMA by regression analysis. Results were interpolated and topographically visualised.

Results

The majority of spectral parameters show significant change with PMA. Highest correlation is found for δ and θ band. Absolute band powers decrease with increasing PMA, while relative α and β powers increase. Maturational change is largest in frontal and temporal region.

Conclusions

Topographic distribution of maturational changes in spectral parameters corresponds with studies showing ongoing gyration and postnatal white matter maturation in frontal and temporal lobes.

Significance

Computer analysis of EEG may allow objective and reproducible analysis for long-term prognosis and/or stratification of clinical treatment.