Autoantibodies to glutamic acid decarboxylase in patients with therapy-resistant epilepsy.

BACKGROUND: Autoantibodies to glutamic acid decarboxylase (GAD-A) are present in type 1 diabetes and stiff man syndrome (SMS), and have also been reported in cerebellar ataxia. Epilepsy was present in 4 of 19 patients with SMS and GAD-A, implying that epilepsy sometimes is associated with anti-GAD autoimmunity. METHODS: The authors investigated the prevalence of GAD-A in patients with therapy-resistant localization-related epilepsy (n = 51) and generalized epilepsy (n = 49) by a radiobinding assay. The positive samples were confirmed by immunohistochemistry and immunoblotting of recombinant human GAD65. RESULTS: GAD-A were found in eight patients with localization-related epilepsy, whereas none of the patients with generalized epilepsy, other neurologic disorders (n = 38), or the control subjects (n = 48) had GAD-A. Two patients had high levels of GAD-A, similar to SMS, whereas six patients had significantly lower titers, characteristic of type 1 diabetes. The two patients with high levels of GAD-A had GAD-A both in serum and CSF by immunohistochemistry and immunoblotting. Both of them had longstanding therapy-resistant temporal lobe epilepsy but did not have diabetes. One had a history of autoimmune disease, whereas the other had serologic evidence of multiple autoantibodies without any clinical signs of autoimmune disease. CONCLUSIONS: GAD autoimmunity may be associated with refractory localization-related epilepsy.

Antiphospholipid and antinuclear antibodies in patients with epilepsy or new-onset seizure disorders.

PURPOSE: The increased prevalence of autoantibodies in patients with epilepsy has been traditionally regarded to be a consequence of antiepileptic drugs. The purpose of this study was to measure autoantibodies in well-defined groups of patients with seizures to determine the effects of epilepsy and antiepileptic medications on the presence of autoantibodies. PATIENTS AND METHODS: We studied the frequency of antinuclear antibodies, anti-beta2-glycoprotein I antibodies, and anticardiolipin antibodies in 50 patients with therapy-resistant localization-related epilepsy, 50 patients with generalized epilepsy syndromes, 52 patients with a newly diagnosed seizure disorder but no antiepileptic medication, and 83 healthy controls. RESULTS: Compared with controls, newly diagnosed patients had a significantly greater prevalence of immunoglobulin (Ig) G class anticardiolipin antibodies (21% versus 7%); the prevalence was 14% in patients with localization-related epilepsy and 8% in patients with generalized epilepsy. The prevalence of IgM class anticardiolipin antibodies was significantly greater in all seizure groups (60% in localization-related epilepsy, 42% in generalized epilepsies, and 33% in newly diagnosed patients) compared with controls (7%). Antinuclear antibodies were significantly more common in newly diagnosed patients (21%) and localization-related epilepsy (24%) compared with controls (12%). When patients with generalized epilepsy (8%) were used as the reference group, antinuclear antibodies were also significantly more frequent in localization-related epilepsy (relative risk [RR] = 2.9, 95% confidence interval [CI]: 1.1 to 8.2) and newly diagnosed seizures (RR = 3.4, 95% CI: 1.2 to 9.3). There were no consistent associations between autoantibodies and specific antiepileptic medications. CONCLUSIONS: The prevalence of autoantibodies is greater in patients with epilepsy, including newly diagnosed seizure disorder. The increased prevalence of autoantibodies is more strongly associated with epilepsy than with antiepileptic drugs, perhaps indicating that immune dysregulation may be commonly associated with epilepsy.

Torque acceleration energy, power and peak torque in thigh muscles after a previous knee sprain.

This investigation assessed the relationship between the isometric and isokinetic peak torque (PT) (speed of movement 0, 60, and 180 degrees(s) and (I) the peak torque acceleration energy (PTAE), and (2) average power (AP) of multiple contractions (180 degrees/s) of the quadriceps and hamstrings in subjects with a past history of a grade I knee injury. At every test speed the Pearson product moment (r) and the Spearman rank (rs) correlation coefficients between the PT and PTAE were significant (p less than .001) for both muscle groups in the uninjured (r = .83-.97, rs = .84-.97) as well as in the injured (r = .86-.95, rs = .86-.95) Knees. The results were similar in comparison of PT and AP (uninjured: r = .81-.97, rs = .81 -.97; injured: r = .82-.98, rs = .83-.98). The PTAE and AP analyses offer little additional information about thigh muscle function to that obtained through more simple measurements, the PT analysis.

Simple measurements in assessing muscle performance after an ACL reconstruction.

The purpose of this study was to evaluate the validity of the simple measurements of the muscle performance of the lower extremity, one legged hop testing for distance and the measurement of the circumference of the thigh 15 cm proximal to the joint line, by comparing them to the isokinetic strength testing 5 to 9 years after an ACL reconstruction with a bone-patellar tendon-bone (BTB) autograft. The measurements were performed on 86 patients on average 7 years after the surgery. The clinical evaluation was performed using the standard knee ligament evaluation form of the International Knee Documentation Committee (IKDC) and the Lysholm and the Marshall knee scores. At seven years, the isokinetic mean strength deficit of knee extension at the 60 degrees per second was 10 % in the operated limb as compared to the contralateral limb (NS). In the knee flexion, the differences were even smaller and statistically not significant either. The strength deficit of the knee extension at all knee angle velocities (p < 0.005), and flexion at 60 degrees per second (p < 0.05), correlated to the one legged hop testing, so that the patients with the greatest strength deficit also had the worst outcome in the one legged hop test. Also, the correlation between thigh atrophy and the deficit in the isokinetic strength test was significant in knee extension at all knee angle velocities (p < 0.001), and in knee flexion at 180 degrees per second (p < 0.005). In the final evaluation of the IKDC, 21 patients were rated as "normal", 51 as "nearly normal", 13 as "abnormal", and one as "severely abnormal". The mean of the Lysholm score was 83, classified as good, and that of Marshall score 43, classified as good. In conclusion, the one legged hop testing, as a functional muscle strength testing after an anterior cruciate ligament reconstruction, seems to correlate well with the isokinetic strength testing of the knee, especially in the knee extension. Because the hop testing can be easily performed and without extra equipment, we recommend its use for the evaluation of the functional muscle performance after an anterior cruciate ligament reconstruction. The measurement of the thigh atrophy is also easy to perform, and should be used beside the one legged hop testing, especially if the isokinetic strength testing is not available.

Isokinetic thigh muscle performance after long-term recovery from patellar dislocation.

Eighty-two patients (50 women, 32 men) underwent isokinetic muscle testing on average 13 years after a conservatively treated unilateral primary patellar dislocation. Three study groups were formed according to the natural history of recovery: group A (n = 32), patients with only primary conservative treatment; group B (n = 34) patients with conservative (group B1; n = 24) or surgical (group B2; n = 10) treatment of redislocations; group C (n = 16) patients with other residual complaints (anterior knee, pain subluxations) requiring surgery. The Cybex 6000 dynamometer system was used as the testing machine for quadriceps and hamstrings muscles, with proportional deficits of peak torque as the test parameter. Isokinetic testing revealed both quadriceps and hamstring muscle atrophy even after long-term recovery from injury. There were statistically significant differences between the three study groups at both tested speeds of quadriceps muscles (60 rad/s, P < 0.002; 180 rad/s, P < 0.009). Groups B1 and B2 presented similar results. The muscle performance findings are probably due to more than one factor: primary immobilization, poor outcome, patellofemoral degeneration, redislocations, and residual knee complaints followed by surgery and deficiency in motor control of thigh muscle had--together or separately--an effect on muscle performance.

Isokinetic muscle performance after anterior cruciate ligament surgery. Long-term results and outcome predicting factors after primary surgery and late-phase reconstruction.

The purpose of this study was to evaluate the long-term isokinetic muscle performance after ACL surgery and to analyze by a multiple stepwise regression which factors (if any) predict the overall outcome. The study subjects were 119 patients who had a complete rupture of the ACL and had been treated surgically at the Tampere University Hospital between 1981 and 1990. They were divided into the acute group (N = 62) and into the chronic group (N = 57) according to the time delay between the injury and the ACL surgery. The isokinetic strength measurements of the quadriceps and hamstring muscles were performed on average 4 years after the operation using Cybex II and Cybex 6000 dynamometers (Lumex Inc., Ronkokoma, NY, USA). The peak torques were determined at speeds of 60 and 180 degrees/s and the peak work at speed of 180 degrees/s. The measurements revealed that after the ACL surgery there was still a considerable thigh muscle strength deficit especially in extension of the injured extremity, the average extension strength deficit ranging from 9 to 20%. The extension strength deficit was significantly more prominent in the chronic (18-20%) than in the acute group (9-15%). The extension strength deficit was significantly greater ar the slower (15-20%) than higher (9-18%) speed of the isokinetic movement. In both the acute and chronic groups, a multiple stepwise regression analysis indicated that patellofemoral pain and flexion deficit of the knee were the factors that most frequently and significantly associated with the strength deficits. At the higher speed of the isokinetic movement, these two factors accounted 20% and 21% for the variation seen in the quadriceps strength deficit of the acute group and the chronic group. No correlation could be found between age, sex, height, weight, body mass index, length of the follow-up time, injury type, athletic activity level, immobilization method, knee stability, and the isokinetic muscular performance.

Isokinetic performance of the thigh muscles after tibial plateau fractures.

The isokinetic performance of thigh muscles was evaluated in 37 patients at an average of 7 years after sustaining a fracture of the tibial plateau. The mean torque deficit in the quadriceps of the injured limb was an average of 15% at a speed of 60 degrees/s and 16% at 180 degrees/s, while the corresponding deficits in the hamstrings were 3% and 8%. The radiological appearance of the injured knee correlated significantly to the quadriceps deficit at both speeds. Limited knee movement and thigh atrophy also correlated with the deficit at the lower speed. The strength deficit tended to decrease during follow-up. A multiple step-wise regression analysis showed that the radiological result, length of follow-up and thigh atrophy accounted for 47% of the variation in loss of quadriceps strength. At the higher speed, the functional result was associated with the deficit in quadriceps strength, and older patients had greater deficits than younger. Regression analysis indicated that the radiological and functional result accounted for 31% of the variation in quadriceps strength. Anatomical restoration of the tibial plateau and good muscle rehabilitation are important in obtaining good long term results after this fracture.

Isokinetic muscle performance after surgery of the lateral ligaments of the ankle.

In this study, we assessed the isokinetic strength and power profile of 138 patients with a surgically treated lateral ligament injury of an ankle. In addition, the outcome predicting factors were analyzed. The measurements were done 6.2+/-0.8 years after the surgery using the Cybex II isokinetic dynamometer. The general strength status of the patients was good, the isokinetic testing showing no or only moderate (always < or = 18%) average strength deficits in the peak torque values of dorsiflexor and plantar flexor muscles of the injured ankle. Of the outcome predicting variables, only the age of the patient in the group with surgery for chronic ankle instability correlated significantly with the isokinetic peak torque deficits: the older the subject, the greater the peak torque deficit in the injured ankle (r(s) = -0.388 with p = 0.015) in ankle dorsiflexion at the speed of 60 degrees/s. In conclusion, patients having surgery for ankle ligament insufficiency, either in acute or chronic phase of the injury, seem to recover well showing no remarkable deficiencies in the isokinetic ankle muscle strengths several years after the repair.