Multi-center observational study on occurrence and related clinical factors of neurogenic heterotopic ossification in patients with disorders of consciousness.

Aims: to assess occurrence and clinical correlates of neurogenic heterotopic ossifications (NHO) in patients with prolonged disorder of consciousness (DoC).Design: multi-center cross-sectional observational study.Setting: 23 intensive neurorehabilitation units.Subjects: 287 patients with prolonged disorder of consciousness (DoC; 150 in vegetative state, VS, and 128 in minimally conscious state, MCS) of different etiology (vascular = 125, traumatic = 83, anoxic = 56, others = 14).Main Measures: clinical evidence of NHO confirmed by standard radiological and/or sonographic evaluation; Coma Recovery Scale-Revised; Disability Rating Scale (DRS); Early Rehabilitation Barthel Index; presence of ventilator support, spasticity, bone fractures and paroxysmal sympathetic hyperactivity.Results: 31 patients (11.2%) presented NHO. Univariate analyses showed that NHO was associated with VS diagnosis, traumatic etiology, high DRS category and total score, and high occurrence of limb spasticity and bone fractures. A cluster-corrected binary logistic regression model (excluding spasticity available in a subset of patients) showed that only lower DRS total score and presence of bone fractures were independently associated with NHO.Conclusions: NHO are relatively frequent in patients with DoC, and are independently associated with functional disability, bone fractures and spasticity. These findings contribute to identifying patients with DoC prone to develop NHO and requiring special interventions to improve functional recovery.

Multi-center study on overall clinical complexity of patients with prolonged disorders of consciousness of different etiologies.

Aim: to assess overall clinical complexity of patients with acquired disorders of consciousness (DoC) in vegetative state/unresponsive wakefulness syndrome (VS/UWS) vs. minimally conscious state- MCS) and in different etiologies..Design: Multi-center cross-sectional observational study.Setting: 23 intensive neurorehabilitation units.Subjects: 264 patients with DoC in the post-acute phase: VS/UWS = 141, and MCS = 123 due to vascular (n = 125), traumatic (n = 83) or anoxic (n = 56) brain injury.Main Measures: Coma Recovery Scale-Revised, and Disability Rating Scale (DRS); presence of medical devices (e.g., for eating or breathing); occurrence and severity of medical complications.Results: patients in DoC, and particularly those in VS/UWS, showed severe overall clinical complexity. Anoxic patients had higher overall clinical complexity, lower level of responsiveness/consciousness, higher functional disability, and higher needs of medical devices. Vascular patients had worse premorbid clinical comorbidities. The two etiologies showed a comparable rate of MC, higher than that observed in traumatic etiology.Conclusion: overall clinical complexity is significantly higher in VS/UWS than in MCS, and in non-traumatic vs. traumatic etiology. These findings could explain the worse clinical evolution reported in anoxic and vascular etiologies and in VS/UWS patients and contribute to plan patient-tailored care and rehabilitation programmes.

Neutral wrist splinting in carpal tunnel syndrome: a 3- and 6-months clinical and neurophysiologic follow-up evaluation of night-only splint therapy.

AIM: The aim of the study was to evaluate the long-term efficacy of night-only splint wear therapy for carpal tunnel syndrome (CTS). METHODS: We conducted a randomized case-control trial with evaluation after three and six months of follow-up of outpatients with mild, recent onset symptoms of CTS recruited from the department clinic. Fifty patients (50 hands) were enrolled, of which 36 completed the study at 6 months. The case group utilized a thermoplastic neutral wrist splint for night-only wear. Outcome measures were instrumental parameters (sensory and motor nerve conduction velocity), symptom and function alterations (as measured by Levine's self-administered questionnaire), clinical parameters (pressure-provocative and Phalen tests). RESULTS: Improvements were observed in Levine's symptom status score at the three-month (P=0.001) and the six-month (P=0.001) follow-up visits, in functional score (P=0.0001) and (P=0.0004), in median distal sensory latency (P=0.01) and (P=0.02), in pressure-provocative test outcome (P=0.01) and (P=0.003), in Phalen test outcome (P=0.04) and (P=0.05) respectively. CONCLUSION: Symptom relief and neurophysiological improvement after night-only splint wear therapy lasted up to the six-month follow-up visit.

Sacral reflexes normal values with monopolar short needle electrodes recording.

To reduce patients discomfort and improve reliability in pelvic floor neurophysiological studies we examined 28 normal subjects employing short monopolar electrodes. The technique proved to be reliable and less discomfort to the patient than the traditional concentric needle method. Data were tested for Gaussian distribution and tolerance limits for normality were assessed. Our data suggest that use of monopolar instead of concentric needle electrodes may be suitable for pelvic floor examination.

Comparison between median and ulnar sensitive action potential (SAP) obtained with two different stimulation methods.

We studied the sensory action potentials (SAP) of median and ulnar nerves in four groups of 20-30, 30-40, 40-50 and 50-60 years old healthy subjects. In each group ten sensitive ulnar and median nerves were examined stimulating respectively V and III hand digital nerves, with two compared methods. In the former stimulus intensity was 20 mA, with a duration 0.1 msec, and SAP was recorded with averaging technique after 20 stimuli; in the latter the stimulus intensity was supra maximal (100 mA), with a duration 0.1 msec and a single SAP was recorded. The SAP's recording was performed by bipolar surface electrodes at the wrist, following conventional techniques. There was not statistically significant difference between SAP's latencies obtained with the two methods in each group, even if there was a decrease of the latency value obtained with supra maximal stimulus. Otherwise there was a statistically significant increase of SAP's amplitude obtained with supra maximal stimulus, above all in elderly people for median (p < 0.001) and ulnar (p < 0.0005) nerve.

Peripheral neuropathy in monoclonal gammopathy of undetermined significance: prevalence and immunopathogenetic studies.

In an unselected series of patients with monoclonal gammopathy of undetermined significance (MGUS) we found neuropathy in 2 of 34 patients with IgG (6%), 2 of 14 with IgA (14%), and 8 of 26 with IgM MGUS (31%). The neuropathy was subclinical in 6 patients (1 IgG, 1 IgA, and 4 IgM). Patients with IgG or IgA MGUS had a prominent motor impairment with electrophysiologic and morphologic findings suggestive of predominant axonal degeneration. No deposit of the M-protein in sural nerve and no reactivity of the M-protein with nerve was detected in these patients. Patients with IgM MGUS had a prominent sensory impairment with evidence of predominant demyelination. In 6 of these patients the M-protein reacted with the myelin-associated glycoprotein (MAG). The higher prevalence of neuropathy in patients with IgM MGUS may be related to the frequent reactivity of IgM M-proteins with MAG.

Myasthenia gravis treatment: twelve years experience on 110 patients.

The clinical conditions of 110 patients affected by myasthenia gravis (MG) were followed from two to twelve years. Patients with thymectomy showed a statistically higher percentage of clinical remissions than patients without thymectomy. In patients without clinical remission immunosuppressive drugs were prescribed in different schedule; the greater percentage of pharmacological remissions with less adverse effects was obtained with administration of prednisone 50-75 mg/die initially, than gradually reduced to smaller dosage in alternate day, associated to azathioprine. Plasmapheresis, performed in six cases not responders to immunosuppressive drugs, always showed a positive and even prolonged effect.