偏瘫性肩痛患者腋囊的MRI观测及临床意义

目的通过MRI技术观察偏瘫患者肩疼痛腋囊形态变化,为影像诊断提供依据。方法对47例偏瘫性肩疼痛患者(疼痛组)和47例正常肩部(对照组),运用MRI技术对肩关节腋囊进行测量,观察腋囊下肱盂韧带信号。结果偏瘫性肩疼痛的腋囊厚度(4.1±1.45)mm,高于对照组。腋囊腔高度(8.70±1.80)mm,腋囊腔宽度(4.31±0.56)mm,小于对照组。偏瘫性肩痛下肱盂韧带呈高信号出现率达21%,腋囊厚度与VAS呈正相关,与肩关节外展外旋呈负相关。结论脑中风中后期肩周炎是引起偏瘫性肩疼痛患者的常见原因,腋囊厚度是限制肩关节活动度的重要因素。     

脑卒中后偏瘫肩痛患者生活质量的影响因素研究

目的 探讨脑卒中后偏瘫肩痛患者生活质量的直接和间接影响因素，以期为临床症状管理提供参考信息。 方法 采用一般资料调查表、脑卒中后偏瘫肩痛症状评估表、简易疲乏量表、医院焦虑抑郁量表、Fugl-Meyer上肢功能评分量表和脑卒中生活质量专用量表对205例脑卒中后偏瘫肩痛患者进行调查。结果 偏瘫肩痛患者的生活质量总分为（144.48±27.69），整体处于中等水平。生活质量的主要影响因素是肩痛困扰、肩痛频度、肩外旋、疲乏程度和抑郁，可以解释总变异的63.3%。路径分析结果显示，疲乏程度、肩痛频度和肩痛困扰可直接影响患者的生活质量（β_(疲乏程度-生活质量)=-0.252，P<0.001；β_(肩痛频度-生活质量)=-0.147，P<0.001；β_(肩痛困扰-生活质量)=-0.317，P<0.001）；疲乏程度和肩痛频度亦可通过肩痛困扰来间接影响患者的生活质量（ β_(疲乏程度-肩痛困扰-生活质量)=-0.066，P<0.001；β_(肩痛频度-肩痛困扰-生活质量)=-0.064，P<0.001）。结论 临床上应同时关注脑卒中患者疲乏和偏瘫肩痛症状，关注抑郁和疲乏对症状体验的协同作用，提高医护人员症状管理的效率，从而提高脑卒中偏瘫肩痛患者的生活质量。     

PRRT2 mutations and paroxysmal disorders

In the past year, mutations in the PRRT2 gene have been identified in patients with paroxysmal kinesigenic dyskinesia and other paroxysmal disorders. We conducted a review of the literature on PRRT2 mutation‐associated disorders. Our objectives were to describe the wide clinical spectrum associated with PRRT2 mutations, and to present the current hypotheses on the underlying pathophysiology. PRRT2 mutations are associated with a wide range of clinical syndromes: the various paroxysmal dyskinesias, infantile seizures, paroxysmal torticollis, migraine, hemiplegic migraine, episodic ataxia and even intellectual disability in the homozygous state. The PRRT2 protein, through its interaction with SNAP‐25, could play a role in synaptic regulation in the cortex and the basal ganglia. The pathogenesis may be caused by PRRT2 loss of function, which may induce synaptic deregulation and neuronal hyperexcitability. However, this does not explain the phenotypic variability, which is likely modulated by environmental factors, modifier genes or age‐dependent expression. The clinical spectrum of PRRT2 mutations has expanded among paroxysmal disorders and beyond. Unraveling the molecular pathways linking the genetic defect to its clinical expression will be crucial for the diagnosis and treatment of these disorders.     

早期康复训练联合行为学疗法治疗老年脑卒中偏瘫患者的效果分析

目的：探讨早期康复训练联合行为学疗法治疗老年脑卒中偏瘫患者的效果。方法依据随机数字表将75例老年脑卒中偏瘫患者随机分为对照组（38例）和观察组（37例）,两组均给予早期康复训练,仅观察组在此基础上加用行为学疗法;分析治疗前和治疗3、6个月后的步态能力（功能性运动量表 FAC）,下肢运动功能和平衡功能（简式 Fugl-Meyer 运动功能评定量表FMA）,步行相关指标（步速和跨步长度）,日常生活活动能力（Barthel 指数）及偏侧空间忽略情况（直线二等分、线段划消及画钟试验）。结果观察组治疗3 个月后的 FMA 评分中的运动功能、Barthel 指数均优于对照组（P ＜0．05）,且治疗 6个月后的FAC 评分、FMA 评分、步行相关指标、Barthel 指数及偏侧空间忽略情况均优于对照组（P ＜0．05）。结论早期康复训练联合行为学疗法治疗老年脑卒中偏瘫患者的效果较好,不仅可改善偏瘫步态和下肢功能,而且可改善偏侧空间忽略,可在脑卒中偏瘫患者患侧功能训练中实施。     

Efficiency of Neuromuscular Electrical Stimulation and Transcutaneous Nerve Stimulation on Hemiplegic Shoulder Pain: A Randomized Controlled Trial

Objective

To compare the efficacy of neuromuscular electrical stimulation (NMES) and transcutaneous nerve stimulation (TENS) on hemiplegic shoulder pain (HSP).

The effect of electrical stimulation on impairment of the painful post-stroke shoulder

Background: Transcutaneous electrical nerve stimulation (TENS) and transcutaneous neuromuscular electrical stimulation (t-NMES) are commonly used therapies in the treatment of chronic hemiplegic shoulder pain. These treatments are often utilized during physical or occupational therapy sessions, yet research into the acute analgesic effects of TENS and t-NMES on hemiplegic shoulder pain and use during therapy is limited.

Objective: To compare the acute effects of transcutaneous electrical nerve stimulation (TENS), transcutaneous neuromuscular electrical stimulation (t-NMES), and no stimulation on pain-free passive range of motion of the shoulder in subjects with hemiplegic shoulder pain.

Methods: Prospective cohort study of 10 subjects randomly treated with t-NMES, TENS, and one non-stimulation experimental condition. Pain-free passive external rotation and abduction range of motion of the affected shoulder were measured during stimulation.

Results: There was not a significant within-subject difference in pain-free range of motion for external rotation or abduction. Subject to subject differences explained the majority of the variability in pain-free range of motion.

Conclusion: This pilot study is the first to measure pain-free passive range of motion during electrical stimulation. Our findings demonstrate the lack of an acute effect of TENS and t-NMES on pain reduction.     

Familial hemiplegic migraine: permanent attack-related neurologic deficits

Hemiplegic migraine (HM) is characterized by motor weakness and at least one other aura symptom or sign that is fully reversible within 24 hours. While prolonged neurological impairment lasting weeks has been observed, persistent attack-related neurological deficits have not been described. This case illustrates the potential for permanent neurological deficits to occur as a sequelae of HM in the absence of infarction, and highlights potentially important pathophysiological and treatment implications.     

神经松动术联合经颅磁刺激治疗脑梗死后偏瘫肩痛的研究

目的 探讨神经松动术联合经颅磁刺激治疗脑梗死后偏瘫肩痛的效果及对神经营养因子、细胞因子水平的影响。方法 选取2019年2月—2021年3月徐州医科大学第二附属医院脑梗死后偏瘫肩痛患者114例,以随机数字表法分为观察组、对照组,各57例。对照组采取神经松动术,观察组采取神经松动术联合经颅磁刺激,均治疗2周。酶联免疫吸附法测定血清脑源性神经营养因子（BDNF）、促生长因子-1（IGF-1）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、一氧化氮（NO）水平。结果 观察组治疗2周后总有效率为94.74%,高于对照组的75.44%（P＜0.05）;观察组治疗1和2周后视觉模拟评分量表（VAS）评分均较对照组低,Fugl-Meyer运动功能评定量表（FMA）-上肢部分、日常生活活动能力量表（Barthel指数,BI）评分均较对照组高（P＜0.05）;观察组治疗1周、2周后肩关节外旋、内旋、外展、后伸、前屈活动度均较对照组高（P＜0.05）;观察组治疗1周、2周后血清BDNF、IGF-1水平均高于对照组,TNF-α、IL-6、NO水平均低于对照组（P＜0.05）。结论 应用神经松动术联合经颅磁刺激治疗脑梗死后偏瘫肩痛患者可降低疼痛程度,提升肩关节活动度、上肢功能、日常生活能力,调节血清神经营养因子、细胞因子表达,提升疗效。国际神经病学神经外科学杂志, 2022, 49(6): 54-58]     

平衡垫训练对偏瘫儿童步行能力的影响

目的:观察平衡垫训练对偏瘫儿童平衡及步行能力的影响。方法:选取北京博爱医院偏瘫儿童30例,随机分为对照组与观察组各15例。对照组每天进行常规康复训练60min,观察组每天进行常规康复训练40min及平衡垫训练20min,共4周。训练前后分别对2组儿童采用10m步行测试(10MWT)、“起立-行走”计时测定(TUGT)、患侧站立阶段百分比、患侧步长、步宽、动态及静态压力中心(COP)椭圆面积进行评定。结果:训练4周后,2组10MWT及动态COP椭圆面积均显著提高(均P<0.01),且观察组均高于对照组(均P<0.05);TUGT及静态COP椭圆面积均显著降低(均P<0.01),且观察组均低于对照组(均P<0.05)。训练后,2组步宽均显著减小(均P<0.01),但组间比较差异无统计学意义;2组患侧步长训练前后比较差异无统计学意义;训练后观察组患侧站立阶段百分比较治疗前及对照组明显提高(P<0.05),对照组治疗前后比较差异无统计学意义。结论:平衡垫训练结合常规康复训练能有效改善偏瘫儿童的平衡和步行能力。