ABSTRACT
Cerebrospinal fluid (CSF) biomarkers are useful in the diagnosis and the prediction of progression of several neurodegenerative diseases. Among them, CSF neurofilament light (NfL) protein has particular interest, as its levels reflect neuroaxonal degeneration, a common feature in various neurodegenerative diseases. In the present study, we analyzed NfL levels in the CSF of 535 participants of the SPIN (Sant Pau Initiative on Neurodegeneration) cohort including cognitively normal participants, patients with Alzheimer disease (AD), Down syndrome (DS), frontotemporal dementia (FTD), amyotrophic lateral sclerosis (ALS), dementia with Lewy bodies (DLB), progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). We evaluated the differences in CSF NfL accross groups and its association with other CSF biomarkers and with cognitive scales. All neurogenerative diseases showed increased levels of CSF NfL, with the highest levels in patients with ALS, FTD, CBS and PSP. Furthermore, we found an association of CSF NfL levels with cognitive impairment in patients within the AD and FTD spectrum and with AD pathology in DLB and DS patients. These results have implications for the use of NfL as a marker in neurodegenerative diseases.
Subject(s)
Neurodegenerative Diseases/diagnosis , Neurofilament Proteins/cerebrospinal fluid , Aged , Biomarkers/cerebrospinal fluid , Cohort Studies , Disease Progression , Early Diagnosis , Female , Follow-Up Studies , Humans , Male , Neuroaxonal Dystrophies/diagnosis , Neuroaxonal Dystrophies/pathology , Neurodegenerative Diseases/pathologyABSTRACT
We present the case of a 36 year-old woman, with history of transient consciousness disorders with vegetative state, interpreted as epileptic crises and treated with valproate for two years. After nine asymptomatic years, they reappeared associated with migraine, vomiting and some generalized convulsions. Electroencephalogram and cerebral magnetic resonance turned out normal, and treatment with zonisamide was started, without beneficial results. Later cardiological studies objectified a blockage of the left branch that coincided with dizziness. The study was completed with Video-EGG monitoring, where there was an episode that showed temporary right epileptiform activity, with a diagnosis established of focal epilepsy of unknown cause. At present, she remains asymptomatic with oxycarbazepine.
Subject(s)
Consciousness Disorders/diagnosis , Electrocardiography , Electroencephalography , Adult , Consciousness Disorders/etiology , Diagnosis, Differential , Female , Humans , Video RecordingABSTRACT
Introducción: El hombro doloroso hemipléjico es frecuente después de un ictus. Su aparición conlleva además del dolor, una limitación para las actividades de la vida diaria, así como para la participación en programas específicos de neurorrehabilitación. Todo este conjunto determina un peor resultado funcional. El buen manejo de los pacientes puede reducir tanto la frecuencia de aparición de hombro doloroso, como la intensidad del mismo, mejorando así el pronóstico funcional.Desarrollo: Entre los años 1980 y 2008 se llevó a cabo una búsqueda de la literatura en diferentes bases de datos. La evaluación de los artículos se realizó con el sistema de puntuación PEDro. Se establecieron 5 niveles de evidencia para obtener las conclusiones.Conclusiones: La subluxación del hombro, ocurre de manera precoz tras el ictus y se asocia con subluxación de la articulación del hombro y con espasticidad (subescapular y pectoral mayor principalmente). Los cabestrillos previenen la subluxación del hombro. Es preferible realizar movimientos con un menor rango de movimiento y sin agresividad, para evitar la aparición del hombro doloroso. La inyección de corticoides no mejora el dolor ni el rango de movimiento de los pacientes hemipléjicos, mientras que la toxina botulínica combinada con fisioterapia parece reducir el dolor del hombro hemipléjico (AU)
Introduction: The hemiplegic shoulder pain is common after a stroke. Its appearance brings pain and limits daily living activities as well as participation in specific Neuro-rehabilitation programs. All this leads to a worse functional outcome. Good management of patients can reduce both the frequency and intensity of shoulder pain, improving functional outcome.Development: We conducted a literature search of various databases between 1980 and 2008. The articles were evaluated using the PEDro scoring system. Five evidence levels were established for the conclusions.Conclusions: Shoulder subluxation, occurs at an early stage after stroke and is associated with subluxation of the shoulder joint and spasticity (mainly subscapularis and pectoralis). Slings prevent subluxation of the shoulder. It is preferable to move within a lower range of motion and without aggression to prevent the occurrence of shoulder pain. The injection of corticosteroids does not improve pain and range of motion in hemiplegic patients, while botulinum toxin combined with physical therapy appears to reduce hemiplegic shoulder pain (AU)
Subject(s)
Humans , Shoulder Pain/etiology , Stroke/complications , Hemiplegia/complications , Shoulder Pain/rehabilitationABSTRACT
Se presenta el caso de una mujer de 36 años, con antecedentes de trastornos de conciencia transitorios con cortejo vegetativo en la adolescencia, interpretados como crisis epilépticas y tratados con ácido valproico durante dos años. Tras permanecer nueve años asintomática, reaparecieron asociados a migraña, vómitos y alguna convulsión generalizada. El electroencefalograma y la resonancia magnética cerebral resultaron normales e inició tratamiento con zonisamida, sin beneficio. Estudios cardiológicos posteriores objetivaron bloqueo de rama izquierda, que coincidía con mareo. Se completó el estudio mediante monitorización con vídeo-EEG, donde tuvo un episodio que evidenció actividad epileptiforme temporal derecha, estableciéndose el diagnóstico de epilepsia focal de causa desconocida. Actualmente, permanece asintomática con oxcarbacepina. La anamnesis es fundamental para diferenciar trastornos de conciencia transitorios, especialmente síncopes y crisis epilépticas, pero no siempre es suficiente. La monitorización con vídeo-EEG y registro simultáneo de electrocardiograma resulta muy útil para distinguirlos(AU)
We present the case of a 36 year-old woman, with history of transient consciousness disorders with vegetative state, interpreted as epileptic seizures and treated with valproic acid for two years. After nine asymptomatic years, they reappeared associated with migraine, vomiting and some generalized convulsions. Electroencephalogram and cerebral magnetic resonance turned out normal, and treatment with zonisamide was started, without beneficial results. Later cardiological studies objectified a blockage of the left branch that coincided with dizziness. The study was completed with Video-EEG monitoring, where there was an episode that showed right temporal epileptiform activity, with a diagnosis established of focal epilepsy of unknown etiology. At present, she remains asymptomatic with oxycarbazepine(AU)
Subject(s)
Humans , Female , Adult , Consciousness Disorders/diagnosis , Epilepsy/complications , Monitoring, Physiologic/methods , Electrocardiography , Electroencephalography , Syncope/diagnosisABSTRACT
INTRODUCTION: The hemiplegic shoulder pain is common after a stroke. Its appearance brings pain and limits daily living activities as well as participation in specific Neuro-rehabilitation programs. All this leads to a worse functional outcome. Good management of patients can reduce both the frequency and intensity of shoulder pain, improving functional outcome. DEVELOPMENT: We conducted a literature search of various databases between 1980 and 2008. The articles were evaluated using the PEDro scoring system. Five evidence levels were established for the conclusions. CONCLUSIONS: Shoulder subluxation, occurs at an early stage after stroke and is associated with subluxation of the shoulder joint and spasticity (mainly subscapularis and pectoralis). Slings prevent subluxation of the shoulder. It is preferable to move within a lower range of motion and without aggression to prevent the occurrence of shoulder pain. The injection of corticosteroids does not improve pain and range of motion in hemiplegic patients, while botulinum toxin combined with physical therapy appears to reduce hemiplegic shoulder pain.
