Acupoint selection rules of acupuncture for pseudobulbar palsy dysphagia / 中国针灸

OBJECTIVE@#To analyze the acupoint selection rules of acupuncture for pseudobulbar palsy dysphagia using data mining technology.@*METHODS@#The literature of acupuncture for pseudobulbar palsy dysphagia published from January 1, 1990 to May 1, 2021 was retrieved from CNKI, SinoMed, Wanfang, VIP, and PubMed databases. Acupuncture prescription database was established. The frequency of acupoint selection was analyzed by Microsoft Excel 2016; Apriori algorithm was used to analyze the association rules and draw the high-frequency acupoint co-occurrence network diagram; SPSS21.0 was used to perform clustering analysis.@*RESULTS@#A total of 87 literature was included, involving 89 acupuncture prescriptions and 71 acupoints. Fengchi (GB 20) was the most frequently-used acupoint; the commonly-selected meridians were gallbladder meridian, conception vessel, governor vessel and stomach meridian; the acupoints located at the neck were the most frequently-used acupoints; the crossing points were commonly selected among the special acupoints. The most commonly-used acupoint combination was Jinjin (EX-HN 12) plus Yuye (EX-HN 13).@*CONCLUSION@#The modern acupuncture for pseudobulbar palsy dysphagia usually selects local acupoints, especially the neck acupoints such as Fengchi (GB 20) and Lianquan (CV 23). The acupoints in the front and back are concurrently selected with needles towards the disease location.

Management of the pseudobulbar affect (PBA) in Kabuki syndrome combined dextromethorphan-fluoxetine treatment as an alternative to dextromethorphan/quinidine

A case report of a patient with pseudo bulbar affect previous treatments included haloperidol (10mg), Inosina pranobex (600mg), clozapine (600mg), olanzapine (20mg), carbamazepine (200mg), paroxetine (20mg), phenobarbital (100mg) and topiramate (50mg), all suspended at August 2016, with current use of quetiapine (700mg) Chlorpromazine (600mg) (+ 200mg on demand of aggression), clonazepam (4 mg), valproate 2500 mg, propranolol (40mg). that was successful treated with off label treatment (dextromethorphan plus quinidine). Previous Brief Psychiatric Rating Scale and Clinical Global Impression-Improvement was applied after and before treatment with dextromethorphan (20mg) plus fluoxetine (20 mg, further increased to 40 mg). Previous Brief Psychiatric Rating Scale BPRS score 56 points and Clinical Global Impression-Severity (CGI-S) Score was 6 (severely ill). The addition of dextromethorphan (20mg) and fluoxetine (20 mg, further increased to 40 mg), allowed clear improvement of pathological crying and outbursts, with BPRS decrease of 8 points and Clinical Global Impression-Improvement (CGI-I) 2 (much improved) ­ especially pertaining to PBA related symptoms and aggressive behavior. There were no noticeable side-effects. This case report shown an interesting clinical response. It's could be a great alternative in treatment of pseudobulbar affect symptoms. Even though an only case and a great clinical study be necessary. (AU)

Fire needling on dysphagia due to pseudobulbar palsy after stroke: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the clinical effect of fire needling on dysphagia due to pseudobulbar paralysis after stroke and to compare the difference in clinical effect between fire needling and swallowing function rehabilitation training.@*METHODS@#A total of 76 patients with dysphagia due to pseudobulbar paralysis after stroke were randomly divided into an observation group and a control group, 38 cases in each group (1 case dropped out in the control group). The both groups were based on conventional western medication treatment. Fire needle pricking was exerted at Lianquan (CV 23), Fengchi (GB 20), Wangu (GB 12), Shuigou (GV 26), Neiguan (PC 6) and Zusanli (ST 36) without needle retaining every other day in the observation group. The control group was treated with the swallowing function rehabilitation training. In both groups, treatment for 2 weeks was as one course and 2 courses of treatment with 2-day interval were required. After treatment, swallowing scores of Fujishima Ichiro and swallow quality of life questionnaire (SWAL-QOL) scores were observed in both groups, and the clinical effect was compared. Follow-up of swallowing scores of Fujishima Ichiro in 4 weeks after treatment was completed to evaluate the clinical effect.@*RESULTS@#The clinical effective rates after treatment and follow-up were 92.1% (35/38) and 94.7% (36/38) in the observation group, higher than 75.7% (28/37) and 83.8% (31/37) in the control group (<0.05). After treatment, the swallowing scores of Fujishima Ichiro and SWAL-QOL scores were increased in the two groups (<0.05), and those in the observation group were higher than the control group (<0.05). The swallowing scores of Fujishima Ichiro were increased during follow-up in the two groups (<0.05).@*CONCLUSION@#Fire needling has a better effect than conventional rehabilitation training in the treatment of dysphagia due to pseudobulbar paralysis after stroke, which can obviously improve the swallowing function and quality of life in patients with dysphagia.

Therapeutic effects of acupuncture combined with rehabilitation training on dysphagia in post-stroke pseudobulbar palsy / 中国针灸

<p><b>OBJECTIVE</b>To compare the therapeutic effects on dysphagia in post-stroke pseudobulbar palsy between the combined treatment with acupuncture and rehabilitation training and the combined treatment with low-frequency electrical therapy and rehabilitation training and to explore its more effective therapy, using the ultrasonographic examination.</p><p><b>METHODS</b>A total of 60 patients of dysphagia in post-stroke pseudobulbar palsy were randomly assigned into an observation group and a control group, 30 cases in each one. The rehabilitation treatment was provided in the two groups. Additionally, in the observation group, acupuncture was used at the three-tongue points [Shanglianquan (Extra), located in the depression between the lingual bone and the border of lower jaw, 1 inferior to the midline of the jaw; and the other two points, located at 0.8 bilateral to Shanglianquan (Extra)], bilateral Fengchi (GB 20) and Fengfu (GV 16). After arrival of , the last two tongue-points were stimulated with electricity, with disperse-dense wave, periodically at 2 Hz, 10 Hz and 100 Hz, at the interval of 3 s, lasting for 30 min. Bilateral Fengchi (GB 20) was stimulated with electricity, with disperse-dense wave and the same frequency as above, lasting for 30 min. In the control group, the low-frequency electrical stimulation was adopted. The electrodes were placed on the bilateral sides of the midline of the throat, 30 min each time. The treatment was for 1 month in the two groups, once a day. The scores of the standardized swallowing assessment (SSA) and the videofluoroscopy swallowing study (VFSS) were observed and the reducing rate of the hyoid-thyroid cartilage distance was determined with ultrasound quantitative measure.</p><p><b>RESULTS</b>After treatment, SSA scores of the two groups were all lower than those before treatment and VFSS scores were higher than those before treatment (all <0.05). The above scores in the observation group were better than those in the control group (both <0.05). The reducing rates of the hyoid-thyroid cartilage distance were higher than those before treatment in the two groups (both <0.05). The result in the observation group was higher than that in the control group (<0.05).</p><p><b>CONCLUSION</b>The treatments with acupuncture and rehabilitation training or with the low-frequency electrical therapy and rehabilitation obtain the effects on dysphagia in post-stroke pseudobulbar palsy in the patients. The effects of the combined treatment with acupuncture and rehabilitation training are better. The ultrasonographic technology effectively and quantitatively analyzes the changes in the glossopharyngeal complex in the patients of dysphagia.</p>

Acute Pseudobulbar Palsy After Bilateral Paramedian Thalamic Infarction: A Case Report

Bilateral paramedian thalamic infarction is a rare subtype of stroke caused by occlusion of the artery of Percheron, an uncommon variant originating from one of the posterior cerebral arteries. This type of stroke has several major clinical presentations: altered mental status, behavioral amnestic impairment, aphasia or dysarthria, ocular movement disorders, motor deficits, cerebellar signs, and others. Few cases of bilateral paramedian thalamic infarction-related pseudobulbar palsy characterized by dysarthria, dysphagia, and facial and tongue weakness have been reported. We report here a rare case of acute severe pseudobulbar palsy as a manifestation of bilateral paramedian thalamic infarction.

Síndrome biopercular producido por lesión unilateral / Biopercular syndrome caused by unilateral ischemia: report of one case

Biopercular syndrome is a labio-facio-pharyngeal-laryngeal-gloso-masticatory diplegia, with automatic dissociation of movements. Ischemia is the most common etiology when it occurs bilaterally in the opercular area, but it has been also described in patients with bilateral subcortical lesions. There arefew cases described with unilateral lesions. We report a 76-year-old woman who developed a biopercular syndrome caused by unilateral ischemic lesion ofthe right middle cerebral artery confirmed by magnetic resonance imaging and cerebral SPECT.

Regulating the governor Vessel and Conception Vessel for treatment of pseudobulbar palsy after stroke / 中国针灸

<p><b>OBJECTIVE</b>To compare the therapeutic effect of method for regulating the Governor Vessel and Conception Vessel as well as routine needling method.</p><p><b>METHODS</b>Sixty-four cases of pseudobulbar palsy after stroke were randomly divided into an observation group and a control group, 32 cases in each group. The observation group was treated with regulating the Governor Vessel and Conception Vessel, Tiantu (CV 22) through to Danzhong (CV 17), Shanglianquan (Extra), Baihui (GV 20) through to Naohu (GV 17), Fengfu (GV 16) were selected; the control group was treated with routine needling method with acupoints Yamen (GV 15), Lianquan (CV 23), Tongli (HT 5), Guanchong (TE 1). Scores of Watian drinking water test were observed before and after treatment, and therapeutic effects of two groups were compared.</p><p><b>RESULTS</b>The effective rate of 87.5% (28/32) in the observation group was superior to that of 65.6% (21/32) in the control group (P < 0.05). Scores of Watian drinking water test in both groups were significantly decreased after treatment (both P < 0.01), and the degree of the decrease in the observation group was superior to that of control group (P < 0.01).</p><p><b>CONCLUSION</b>Regulating the Governor Vessel and Conception Vessel has a significant therapeutic effect for treatment of pseudobulbar palsy after stroke, and superior to that of routine needling.</p>

Síndrome biopercular: presentación de dos casos y revisión de la literatura / Biopercular syndrome: report of two cases and literature review

El síndrome biopercular es una parálisis pseudobulbar cortical causada por lesiones bilaterales que comprometen el opérculo cerebral anterior. Se caracteriza por preservación de la función refleja y de la actividad automática, sin deterioro mental. Se presentan dos casos clínicos y se hace una revisión de la literatura. Caso 1. Se trata de una mujer de 73 años de edad con antecedentes de enfermedad cerebrovascular hace siete años sin secuelas. Presentó pérdida súbita del conocimiento y en el examen neurológico se le encontró paresia facial central derecha y anartria, con actos reflejos como sonreír, parpadear y bostezar –los cuales no se producían al mandato–, hemiparesia derecha e imposibilidad para la marcha. En la tomografía cerebral se encontraron signos de lesión isquémica antigua en el territorio de la arteria cerebral media derecha. Por el compromiso motor derecho, que no se correlacionaba con los hallazgos de la imagen inicial, se solicitó nueva tomografía, en la que se evidenció infarto agudo en territorio de la arteria cerebral media izquierda. Caso 2. Se trata de una niña de ocho años con retardo mental y trastorno en el desarrollo del lenguaje verbal por paquigiria biopercular. Las pacientes presentan diplejía facio-faringo-gloso-masticatoria y parálisis volitiva selectiva de músculos oro-faciales. La evaluación neuropsicológica evidenció compromiso cognitivo, emocional y de la interacción social como parte de un síndrome de la convexidad frontal en el primer caso y, de retardo mental, en el segundo caso. La fonoaudiología demostró que las dos pacientes tenían dificultades en el proceso de masticación y deglución, y dificultades graves en el lenguaje verbal. El pronóstico de recuperación del lenguaje verbal es pobre, pero muchos pacientes pueden recuperar la deglución.

Anartria o apraxia del habla progresiva / Progressive anarthria or speech apraxia

Two cases of progressive anarthria are reported; we remark their close but distinct relation with speech apraxia. Both of them were older female, with a progressive loss of speech, bilateral paresis of lower face, tongue and palatal muscles. They also had mild pyramidal signs and a fronto-subcortical cognitive deterioration. Brain TC and MRI were within normal limits. One of them had a possible progressive supranuclear palsy, the other one a possible corticobasal degeneration. The analysis of similar cases reports let us to conclude than there are several pathologies that can cause a progressive pseudobulbar palsy. The final diagnosis must be by postmortem examination of the brain.

Se presentan dos casos de anartria progresiva, discutiendo la relación o el diagnóstico diferencial con la apraxia del habla progresiva. En ambos casos se trataba de mujeres mayores de 65 años con un cuadro de pérdida progresiva del lenguaje oral, con diparesia facial, lingual y velar, deterioro cognitivo de tipo frontal y discretos signos piramidales. Las imágenes cerebrales estructurales fueron normales. Uno de ellos pudo corresponder a una parálisis supranuclear progresiva, la otra a una degeneración corticobasal. Se analiza la literatura, llegando a la conclusión de que existen una serie de cuadros que pueden presentarse con un síndrome pseudobulbar progresivo. El diagnóstico definitivo debiera ser patológico.

Conhecendo a síndrome pseudobulbar: considerações anatomofisiológicas, fonoaudiológicas e clínicas / Pseudobulbar syndrome: anatomophysiological, speech-language pathological and clinical considerations

A síndrome pseudobulbar caracteriza-se por disartria, disfagia e disfonia, deficiência dos movimentos voluntários da língua e músculos faciais e por labilidade emocional. E causada pelo comprometimento bilateral das aferências bulbares supranucleares determinada por diferentes fato¬res etiológicos, entre os quais transtornos cerebrovasculares, traumatismo cranioencefálico, doenças do neurônio motor superior e esclerose múltipla. Considerando as dificuldades encontradas pelos fonoaudiológos em compreender os mecanismos de controle neural da deglutição e da fala, que são essenciais para o diagnostico e terapia dos distúrbios destes sistemas, este estudo foi realizado com o objetivo de revisar a literatura especializada sobre a síndrome pseudobulbar, enfocando seus aspectos anatomofisiológicos, fisiopatológicos, clínicos e fonoaudiológicos.

The pseudobulbar syndrome is characterized by dysarthria, dysphagia and disphonia, deficiency of the voluntary movements of the tongue and facial muscles and emotional lability. It is caused by bilateral injury of the supranuclear bulbar afferences determined by different etiological factors like cerebrovascular disorders, traumatic brain injury, diseases of the upper motor neuron and multiple sclerosis. The difficulties found by the speech-language pathologists in understanding the mechanisms of the neural control of deglutition and speech, which are essential for the diagnosis and therapy of these systems disturbances, is the reason of this review of the specialized literature about the pseudobulbar syndrome, focusing its anatomophysiological, physiopathological, clinical and speech-language pathological features.

Observation on therapeutic effect of acupuncture at Fengchi (GB 20) at different stages on pseudobulbar palsy / 中国针灸

<p><b>OBJECTIVE</b>To observe the therapeutic effect of acupuncture at different stages on pseudobulbar palsy. Methods Two hundred and forty cases of pseudobulbar palsy were divided into 4 groups according to different courses of disease, i.e. group I, the course within 10 days; group II, between 10-30 days; group III, between 1-3 months; group IV, between 3-6 months. They were treated with acupuncture at Fengchi (GB 20) for 2 courses, and then their therapeutic effects were ohserved.</p><p><b>RESULTS</b>The effective rate was 100.0% in the group I, 96.7% in the group II, 83.3% in the group III and 76.7% in the group IV, with a significant difference among the 4 groups (P < 0.01).</p><p><b>CONCLUSION</b>Acupuncture at Fengchi (GB 20) at any stage has therapeutic effect on pseudohulbar paisy, hut the earlier treatments, the better the therapeutic effects.</p>

A Case of Central Pontine Myelinolysis Presenting as Continuous Nausea in the 16th week of Pregnancy

Central pontine myelinolysis (CPM) is a demyelinating disease of the pons often associated as well with the demyelination of extrapontine areas of the central nervous system. Although the etiology and pathogenesis are unclear, CPM is usually associated with states such as too rapid correction of hyponatremia, alcohol intoxication, malnutrition, liver disease, burn, cancer, addison's disease, dehydrated disease, and electrolyte imbalance. Clinical presentations are nonspecific but are typically characterized by confused mentation, bulbar or pseudobulbar palsy (dysarthria, dysphagia, tetraplegia), rock-in syndrome, and common symptoms such as lethargy and dysarthria. Brain magnetic resonance imaging(MRI) in CPM results in diffuse high signal intensity in the pons on T2-weighted images, and shows slightly decreased signal intensity and no enhancement in the central pons on T1-weighted images. We described a case of a 30-year-old woman presenting with continuous nausea and vomiting in the 16th week of pregnancy. In order to achieve early diagnosis of CPM, We recommend that emergency physicians should consider CPM during differential diagnosis. Prompt diagnosis and management of associated complications are essential for favorable clinical outcomes in CPM.

Central Pontine and Extrapontine Myelinolysis without Hyponatremia after Alcohol Withdrawal: One Case Report

Central pontine myelinolysis (CPM) is a demyelinating disorder that was first described by Adams et al. in 1959 in patients with a history of alcoholism and malnutrition. It is characterized by delirium, quadriparesis, pseudobulbar palsy, and dysarthria. A subgroup of patients at risk for CPM are chronic alcoholics, malnutrition, diabetes, liver transplantation, hepatic disease, advanced age. Although the cause and pathogenesis remains unclear, but many studies have implicated that the rapid correction of hyponatremia is the major factor associated with CPM. But CPM without hyponatremia has been rarely reported. Diagnosis is confirmed by MR image. Here we present one case of CPM without electrolyte disturbance after alcohol withdrawal in a chronic alcoholic with literature reviews.

A Case of Central Pontine and Extrapontine Myelinolysis in a Patient with Maintenance Hemodialysis / 대한신장학회잡지

Central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) is a rare syndrome that is clinically characterized by quadriparesis, pseudobulbar palsy, and disturbance of consciousness. It commonly occurs in patients with rapid correction of hyponatremia and chronic alcoholism. We report a case of CPM and EPM in a 55-year-old male patient with maintenance hemodialysis. He had type 2 diabetes mellitus for more than 20 years and underwent hemodialysis for the past 7 months. He was admitted for left periorbital cellulitis and uremic symptoms. On the 34th hospital day, he had nausea, vomiting, decreased consciousness, dysarthria and quadriparesis. Laboratory data were revealed as follows:glucose, 117 mg/dL; sodium, 137.1 mEq/L; and serum osmolality, 277 mosm/L. Magnetic resonance imaging (MRI) of the brain revealed increased signal intensity in the pons, upper medulla, cerebellar peduncle and cerebral peduncle in T2 weighted images. This case was considered as primary CPM and EPM occurring in a patient with maintenance hemodialysis. With general supportive care, the patient has been recovered gradually and is being followed up on an outpatient basis.

Observation on clinical therapeutic effect of acupuncture on apoplectic pseudobulbar palsy / 中国针灸

<p><b>OBJECTIVE</b>To find a clinically effective therapy for apoplectic pseudobulbar palsy.</p><p><b>METHODS</b>Seventy-five cases of apoplectic pseudobulbar palsy were randomly divided into 3 groups, acupuncture group, western medicine group and acupuncture plus medicine group. They were treated for one month.</p><p><b>RESULTS</b>The scores for clinical symptoms and signs, and the clinical scores for water provocative test in the acupuncture plus medicine group and the acupuncture group were superior to that in the western medicine group with significant difference (P < 0.01), and the therapeutic effects of the 3 groups were related with age, course of disease and condition of illness.</p><p><b>CONCLUSION</b>Acupuncture has some predominances in treatment of apoplectic pseudobulbar palsy.</p>

Treatment of 120 cases of pseudobulbar palsy of wind-phlegm type with needling method for dispelling wind and expelling phlegm / 中国针灸

<p><b>OBJECTIVE</b>To observe clinical therapeutic effects of needling method for dispelling wind and expelling phlegm on pseudobulbar palsy of wind-phlegm type.</p><p><b>METHODS</b>Two hundred and forty cases of pseudobulbar palsy of wind-phlegm type were randomly divided into an observation group and a control group, 120 cases in each group, and they were treated by needling method for dispelling wind and expelling phlegm, and intravenous dripping of cytidine diphosphate choline injection plus blank needling method, respectively. One month later, main symptoms and signs were systematically compared and assessed.</p><p><b>RESULTS</b>The cured rate and the total effective rate were 40.7% and 89.0% in the observation group respectively, which were superior to 7.6% and 37.0% in the control group (P < 0.01).</p><p><b>CONCLUSION</b>The needling method for dispelling wind and expelling phlegm has obvious therapeutic effect on pseudobulbar palsy of wind-phlegm type.</p>

A Study of Ulegyria as Pathognomonic Aspects of Congenital Bilateral Perisylvian Syndrome

OBJECTIVE: Congenital bilateral perisylvian syndrome (CBPS) has been defined as a characteristic malformative perisylvian polymicrogyria (PMG) in patients with clinical symptoms of pseudobulbar palsy and epileptic seizures. For the present study, we investigate clinicopathologic features of CBPS associated with timing of lesion formation. METHODS: Clinicopathologic features of CBPS from 6 patients with surgical resection of the cerebral lesions due to medically intractable seizures were studied. RESULTS: Seizure onset ranged from 1 to 10years (average 6.7years) of age, and average duration of seizure was 23years. All had complex partial seizures, and two patients had additional tonic clonic seizures. Magnetic resonance (MR) images showed polymicrogyria, atropic gyri with gliosis. In the histopathologic examination, the cortical lesions revealed features of ulegyria ; atrophic and sclerotic gyri, laminar loss of neurons, extensive lobular gliosis throughout the gray and white matter, neuronoglial nodule formation, and many amyloid bodies. Unlayered or four-layered PMG was not identified. CONCLUSION: Above data suggest that CBPS might be caused by ulegyria resulting from developmental cortical defect during early fetal stage or acquired hypoxic/ischemic injury in prenatal or postnatal life.

Asymptomatic Extrapontine Myelinolysis in Diabetic Woman

Osmotic myelinolysis syndrome in central nervous system is classified into central pontine myelinolysis(CPM) and extrapontine myelinolysis(EPM). The former can cause a spastic quadriplegia, pseudobulbar palsy, and varying degree of mental disorder, but the latter a movement disorder(tremor, dystonia, parkinsonism, and chorea, etc), behavior change(mood instability, personality change, agitated delirium, and disinhibition, etc), and cognitive dysfunction. Although a few cases of asymptomatic CPM have been reported, asymptomatic EPM were rare. A 67-year-old woman with diabetes mellitus and old cerebral infarction has suffered from the common bile duct stone. She had hyponatremia(Na=126mEq/L) on admission and was corrected rapidly. Incidental findings of her brain MRI showed EPM. We experienced a case of bilateral middle cerebellar peduncle myelinolysis incidentally without neurological presentations and report a rare case of asymptomatic EPM recoverd in diabetic woman after rapid correction of hyponatremia.

Pseudobulbar paralysis--a sequelae of cerebral malaria.

Demyelination may be a pathogenic mechanism of post-malarial neurological sequelae. It can cause pseudobulbar palsy, which has not been documented earlier. In the present communication we report two cases of pseudobulbar palsy after cerebral malaria with evidence of demyelination.

Transplante hepático en una paciente con daño neurológico ¿un recurso terapéutico excepcional?: algunas reflexiones bioéticas / Liver transplantation in a patient with neurological damage: a one-off treatment?: some bioethical considerations

Se presenta el dilema ético-clínico planteado por el caso de una paciente de 8 años 6 meses de edad, portadora de enfermedad hepática con daño neurológico irreversible y severo en la cual los padres solicitan la posibilidad de realizar un transplante hepático. Se trata de la única hija de padres sanos, preocupados y responsables del manejo de su hija, con un riesgo de recurrencia de esta enfermedad de 25 porciento para otro hijo. Se discuten las posibilidades de hacer todo lo terapéuticamente posible o si se debe tomar la decisión de limitar los tratamientos. Con el objetivo de mostrar un proceso de deliberación bioética y de permitir al lector confrontar sus apreciaciones personales, se presenta el caso clínico, seguido de dos comentarios independientes