Modulation of the withdrawal reflex during hemiplegic gait: effect of stimulation site and gait phase.

OBJECTIVE: The objective of the study was to investigate the sensitivity of the nociceptive withdrawal reflex to stimulation of different locations on the sole of the foot during hemiplegic gait. METHODS: Reflexes were evoked by cutaneous electrical stimulation of 4 locations on the sole of the foot of 7 hemiplegic and 6 age-matched healthy persons. The stimuli were delivered at heel-contact, during foot-flat, at heel-off, and during mid-swing. Reflexes were recorded from muscles of the stimulated and the contralateral leg. Ankle, knee, and hip joints angles were recorded using goniometers. RESULTS: In the hemiplegic persons, the size of tibialis anterior reflexes, and the latency of soleus reflexes were site- and phase-modulated. In both groups, the tibialis anterior reflexes were significantly smaller with stimulation to the fifth metatarsophalangeal joint and the heel compared with the first metatarsophalangeal joint and the arch of the foot. The tibialis anterior reflexes evoked at heel-off and mid-swing were larger in hemiplegic persons than in healthy persons. Reflexes in the proximal and contralateral limb muscles were not site-modulated during hemiplegic gait. The kinematic response at the ankle joint was also different in the two groups during mid-swing. CONCLUSIONS: Hemiplegic and healthy middle-aged people presented different phase-modulation of the kinematic and muscle nociceptive reflex responses evoked by stimulation delivered on the sole of the foot. SIGNIFICANCE: The results have potential application in programs to rehabilitate hemiplegic gait.

A clinical trial of dextromethorphan in amyotrophic lateral sclerosis.

INTRODUCTION: Although the cause of amyotrophic lateral sclerosis (ALS) is unknown, excitotoxicity mediated by glutamate has been implicated. Dextromethorphan is a NMDA-glutamate receptor antagonist with neuroprotective properties. MATERIAL AND METHODS: The effect of treatment with dextromethorphan (150 mg daily) in ALS patients was evaluated in a randomized, double-blind, placebo-controlled study. Forty-five patients were included in the analysis. RESULTS: At the end of the treatment period, 12 months after randomization, 15 patients (65%) in the placebo group and 12 patients (55 %) in the dextromethorphan group were still alive (log rank test, P=0.49). Rates of disease progression, as expressed by rates of decline in pulmonary function and in functional disability, were similar in both groups except for a significantly less pronounced rate of decline in the ability scores for the lower extremities in the dextromethorphan group. CONCLUSION: Treatment with a relatively low dose of dextromethorphan did not result in an improvement in 12-month survival in ALS.

Clinical course and long-term prognosis of acute transverse myelopathy.

The clinical characteristics and course of acute transverse myelopathy (ATM) was studied. One patient developed multiple sclerosis. In 1 patient ATM was caused by tumour-cell embolization of the intramedullar vessels; 30 aged 12-74 years (median 36 years) had ATM of unknown course, of these, 13 had symptoms of a preceding viral-like infection, 18 had back-pain and 10 signs of spinal shock. The time from onset of ATM to maximum deficit varied from less than 1 h to 20 days. The thoracic region was the most common level of cord damage. Follow-up was possible in 29 cases; 2 died (2 and 8 months after onset), of the surviving 27 (follow-up 1-13 years, median 6 years) one third had a good outcome, one third a fair, while one third remained paraplegic, incontinent with severe sensory deficits. Back-pain and signs of spinal shock indicated a poor outcome.

[Duchenne muscular dystrophy. Therapeutic principles and status after 14 years]. / Duchenne's muskeldystrofi. Behandlingsprincipper og status efter 14 år.

Eighty-one patients with Duchenne muscular dystrophy (DMD) were included in a retrospective investigation involving the period 1975-1989 with the object of describing a therapeutic programme to prevent the sequelae of the disease and to illustrate the course of the disease in the treated DMD-patients. The therapeutic programme was carried out at home under the supervision of a physiotherapist with current control examinations by specialists in neurology, orthopaedic surgery, physiurgy, pulmonary medicine and anaesthesia. Employing the Kaplan-Meier principle of calculation, it was found that the median age for cessation of ambulatory function was ten years and the age of survival 22 years. The results suggest that a daily training programme which includes prevention of contractures postpones cessation of ambulation and prolongs survival.

Double-blind study of naproxen vs placebo in the treatment of acute migraine attacks.

Naproxen was compared with placebo in a double-blind, crossover trial in classic and common migraine. The trial was terminated at a fixed date; 37 patients had entered, 5 of whom were excluded. Naproxen was given as 750 mg at the first symptom of the attack, a total of 1250 mg per 24 h was allowed. Patients were followed for six attacks or three months in each phase, whichever came first. The severity of the headache was significantly less with naproxen in the first 2 h of the attack (p = 0.047), whereas there was no difference when the whole attack was considered. Significantly more patients preferred naproxen (p = 0.042). Side effects occurred in five patients, causing withdrawal of one patient while on naproxen.

X-linked Duchenne muscular dystrophy. Motor functions and prognosis.

69 patients with x-linked Duchenne Muscular Dystrophy (DMD) were included in a retrospective investigation from 1975-1986. A mean profile of the decline of the motor functions was made by using the median age at which the patients were unable to perform specific motor functions by request. It was found that 81.2% of the personal profiles followed the pattern shown in the mean profile of the disease and that DMD is progressing in a uniform way, but with a different progression rate in every DMD patient. Good correlation between two motor functions made it possible to predict a personal prognosis of the decline of the motor functions in the DMD patient. No correlation between late walkers (later than 18 months) and rapid progression was found.

The prognosis of transient global amnesia. Results of a multicenter study.

In a Danish multicenter study, 74 patients 20 to 75 years of age (mean age, 58.8 years) with transient global amnesia (TGA) without accompanying major neurological signs were studied. Over a follow-up period ranging from seven to 210 months (mean, 66.6 months) the observed rates of death and cerebrovascular morbidity were similar to those expected in the Danish population, matched for age and sex. Sixteen patients (22%) had further TGAs occurring one month to nine years after the original episode; the mean annual recurrence rate was 4.7%. We concluded that TGA without associated major neurological deficits is a benign clinical phenomenon, probably caused by a functional cerebral disturbance unrelated to cerebrovascular disease in general. Furthermore, the observed temporal pattern of recurrence suggests that, although TGA is in principle a recurrent disorder, the annual risk of recurrence is so low that most of the elderly patients are likely to experience only one attack.