The influence of botulinum toxin on auditory disturbances in hemifacial spasm.

BACKGROUND AND PURPOSE: Hemifacial spasm (HFS) is frequently accompanied by other symptoms, such as visual and auditory disturbances or pain. The aim of the study was to assess the occurrence of auditory symptoms accompanying HFS using subjective and objective methods, their relation with other HFS symptoms, and their resolution after botulinum toxin (BTX-A) treatment. MATERIAL AND METHODS: The occurrence of hypoacusis, ear clicks and tinnitus was assessed by questionnaire in 126 HFS patients from an electronic database which included medical data such as severity of HFS rated by clinical scale and magnetic resonance imaging focused on the presence of vascular nerve VII and VIII conflict. Forty consecutive patients treated with BTX-A and 24 controls matched by sex and age underwent laryngological examination including audiometry, tympanometry and acoustic middle ear reflex before injection and two weeks later. RESULTS: About 45.2% of patients complained of auditory disturbances (31.7% hypoacusis, 30.2% ear clicks and 7.1% tinnitus) on the side of HFS. Auditory disturbances correlated with severity of HFS symptoms but not with age, disease duration, or neurovascular conflict with nerves VII and VIII. We did not find abnormalities in audiometric and tympanometric assessment in patients in comparison with controls. No abnormalities were detected in brainstem evoked potentials comparing the sides with and without HFS symptoms. Tinnitus and absence of ipsilateral acoustic middle ear reflex occurred more often in patients with auditory symptoms than those without them. BTX-A treatment caused resolution of subjective acoustic symptoms without any improvement in audiometric assessment. CONCLUSIONS: Auditory disturbances accompanying HFS are probably caused by dysfunction of the Eustachian tube, which improves after BTX-A treatment.

Cardiac responses to orthostatic stress deteriorate in Parkinson disease patients who begin to fall.

BACKGROUND AND PURPOSE: It is not clear how cardiovascular autonomic nervous system dysfunction can affect falls in Parkinson disease (PD) patients. The aim of the study was to evaluate cardiovascular autonomic responses to orthostatic stress and occurrence of falls in PD patients over a period of 1-2 years. MATERIAL AND METHODS: In 53 patients, who either experienced at least one fall during 12 months preceding the study onset (fallers) or did not fall (non-fallers), we monitored RR intervals (RRI), heart rate (HR) and systolic (SBP) and diastolic (DBP) blood pressure, and calculated the coefficient of variation of RRI (RRI-CoV) and the ratio of low to high frequency spectral powers of RRI oscillations (LF/HF) at rest and upon tilting at study entry and after at least 12 months. Based on the number of falls at study closure, we identified three subgroups: non-fallers, chronic fallers, and new fallers. RESULTS: At study entry, RR-CoV, SBP, or DBP did not differ between fallers and non-fallers, while LF/HF ratios were lower in fallers than non-fallers at rest and upon tilting. After the follow-up period, HR and RRI-CoV responses to head-up tilt were reduced in new fallers as compared to study entry, whereas these variables remained unchanged during the study in non-fallers and chronic fallers. Prevalence of orthostatic hypotension did not differ between subgroups of patients. CONCLUSIONS: Cardiac responses to orthostatic stress deteriorate in PD patients who begin to fall. Orthostatic blood pressure responses remain unchanged over time and are not associated with falls in PD.

[The usefulness of posturography and caloric tests in selected neurological diseases]. / Uzytecznosc posturografii i prób kalorycznych w wybranych schorzeniach neurologicznych.

BACKGROUND: Many functions are disturbed after stroke. THE AIM: Of the research was to evaluate the usefulness of static posturography and caloric tests in the rehabilitation of postural stability disorders. MATERIAL AND METHODS: It was examined in 40 patients with cerebral stroke as compared with 40 healthy subjects. Based on selected stabilographic parameters it was investigated whether there is a difference in body deflection between patients and healthy individuals. The effect of visual control on stability was analyzed. The research was carried out with the use of static posturography and the standard set of tests. RESULTS: It has been shown that the postural stability of patients with stroke is characterized by a larger surface area of the stabilogram and a greater total length of deflection than of healthy individuals. It was observed that patients with stroke suffer the most significant deterioration of posture stability both with conscious visual control and without it. After examination of the patients before and after rehabilitation and having analyzed the coordination index, it has been proved that rehabilitation has a positive influence on the stability of posture in healthy controls. It has been proved that caloric tests performed in patients with damage to the central nervous system did not have an influence on the evaluation of the progress of rehabilitation. CONCLUSIONS: Post stroke postural stability disturbances are worsening without visual control and increased after rehabilitation.

Causes and risk factors of falls in patients with Parkinson's disease.

BACKGROUND AND PURPOSE: Falls are a common and serious problem among Parkinson's disease (PD) patients. However, knowledge about the causes and risk factors of falls is limited. There have been a few attempts to classify the causes of falls. The classification suggested by Olanow seems to be the most comprehensive one. The aim of this study was to analyze retrospectively the causes of falls and risk factors of falls in PD patients. MATERIAL AND METHODS: One hundred and four patients with moderately advanced PD were included in the study. The patients were asked to describe the circumstances and consequences of falls which occurred during 12 months preceding the examination. The falls were classified according to the Olanow classification of causes of falls. RESULTS: Fifty-two patients (50%) reported at least one fall during the previous year with a mean number of 1.5 falls per year. The most common causes of falls were environmental factors, sudden falls and postural instability. There were no falls caused by severe dyskinesia, drugs or cardiovascular disorders. The only independent risk factors of the recurrent falls identified in this study were UPDRS part II score (OR 1.17, 95% CI: 1.02-1.37) and Mini Mental State Examination score (OR 0.85, 95% CI: 0.72-0.99). CONCLUSIONS: Considering these results we may be able to prevent most falls by means of the education of patients about environmental factors and using adequate rehabilitation techniques concentrating on postural stability and gait.

Eye movement abnormalities in essential tremor.

Essential tremor (ET) is the most prevalent movement disorder, characterized mainly by an action tremor of the arms. Only a few studies published as yet have assessed oculomotor abnormalities in ET and their results are unequivocal. The aim of this study was to assess the oculomotor abnormalities in ET patients compared with the control group and to find the relationship between oculomotor abnormalities and clinical features of ET patients. We studied 50 ET patients and 42 matched by age and gender healthy controls. Saccadometer Advanced (Ober Consulting, Poland) was used to investigate reflexive, pace-induced and cued saccades and conventional electrooculography for evaluation of smooth pursuit and fixation. The severity of the tremor was assessed by the Clinical Rating Scale for Tremor. Significant differences between ET patients and controls were found for the incidence of reflexive saccades dysmetria and deficit of smooth pursuit. Reflexive saccades dysmetria was more frequent in patients in the second and third phase of ET compared to the first phase. The reflexive saccades latency increase was correlated with severity of the tremor. In conclusion, oculomotor abnormalities were significantly more common in ET patients than in healthy subjects. The most common oculomotor disturbances in ET were reflexive saccades dysmetria and slowing of smooth pursuit. The frequency of reflexive saccades dysmetria increased with progression of ET. The reflexive saccades latency increase was related to the severity of tremor.

Coagulation profile in patients with H1N1 influenza A infection undergoing treatment for haematological malignancies.

Patients with haematological malignancies receiving concurrent treatment or after allogeneic stem cell transplantation (HSCT) are considered to be at increased risk for acquiring influenza A (H1N1) infection (pH1N1) and influenza-associated complications leading to increased mortality. We report of a series of haematological patients with severe course of laboratory-confirmed pH1N1, including two patients after HSCT. Coagulation assays were conducted and the association between coagulation activation and poor outcome pH1N1 infection was found in the analyzed group.