Comparison of the Effects of Botulinum Toxin Doses on Nerve Regeneration in Rats with Experimentally Induced Sciatic Nerve Injury.

This study was designed to compare the effects of various doses of botulinum neurotoxin A (BoNT/A) on nerve regeneration. Sixty-five six-week-old rats with sciatic nerve injury were randomly allocated to three experimental groups, a control group, and a sham group. The experimental groups received a single session of intraneural BoNT/A (3.5, 7.0, or 14 U/kg) injection immediately after nerve-crushing injury. The control group received normal intraneural saline injections after sciatic nerve injury. At three, six, and nine weeks after nerve damage, immunofluorescence staining, an ELISA, and toluidine blue staining was used to evaluate the regenerated nerves. Serial sciatic functional index analyses and electrophysiological tests were performed every week for nine weeks. A higher expression of GFAP, S100ß, GAP43, NF200, BDNF, and NGF was seen in the 3.5 U/kg and 7.0 U/kg BoNT/A groups. The average area and myelin thickness were significantly greater in the 3.5 U/kg and 7.0 U/kg BoNT/A groups. The sciatic functional index and compound muscle action potential amplitudes exhibited similar trends. These findings indicate that the 3.5 U/kg and 7.0 U/kg BoNT/A groups exhibited better nerve regeneration than the 14 U/kg BoNT/A and control group. As the 3.5 U/kg and the 7.0 U/kg BoNT/A groups exhibited no statistical difference, we recommend using 3.5 U/kg BoNT/A for its cost-effectiveness.

Effectiveness of Extracorporeal Shockwave Therapy on Controlling Spasticity in Cerebral Palsy Patients: A Meta-Analysis of Timing of Outcome Measurement.

Extracorporeal shockwave therapy (ESWT) has been suggested as an alternative treatment for reducing spasticity in patients with cerebral palsy (CP). However, the duration of its effect was rarely known. A meta-analysis was performed to investigate the effectiveness of ESWT at controlling spasticity in patients with CP according to the follow-up period. We included studies in which ESWT was used to manage spasticity in patients with CP, and the effect was compared with that in a control group. Finally, three studies were included. In the meta-analysis, spasticity, measured using the modified Ashworth scale (MAS), was significantly reduced after ESWT compared with that in the control group; however, it was sustained for only 1 month. After ESWT, significant increases in passive ankle range of motion (ROM) and plantar surface area in the standing position were observed compared with those in the control group and sustained for up to 3 months. Although spasticity measured using MAS was significantly reduced for only 1 month, improvement in spasticity-associated symptoms, such as ankle ROM and plantar surface area contacting the ground, persisted for over 3 months. ESWT appears to be a useful and effective therapeutic option for managing spasticity in patients with CP.

Bilateral Atypical Femoral Fractures after Bisphosphonate Treatment for Osteoporosis: A Literature Review.

INTRODUCTION: This literature review aimed to investigate the incidence, anatomical concerns, etiology, symptoms, diagnostic tools, management, and prognosis of bisphosphonate (BP)-associated bilateral atypical femoral fractures (AFFs). METHODS: The PubMed, Cochrane Library, Web of Sciences, and CINAHL databases were searched up to 20 March 2022. All cases of bilateral AFFs were included, excluding those without any bisphosphonate treatment information and those in which the femoral fracture did not precisely fit into the diagnostic criteria for AFF. RESULTS: We identified 43 patients with bilateral AFFs associated with BP use and conducted a comprehensive analysis. Among 43 patients, 29 (67%) had prodromal symptoms. Regarding the simultaneity of fracture, 21 cases (49%) occurred simultaneously, and 22 cases (51%) occurred sequentially. Alendronate was the most commonly used BP treatment (59%). Regardless of the medication type, BP intake duration was more than 5 years in 77%. The initial diagnosis was performed using X-rays in all cases. A total of 53% of patients had complete fractures, and all patients underwent surgical treatment. Among the remaining patients with incomplete fractures, 18% and 29% received surgical and medical treatments, respectively. After BP discontinuation, teriparatide was most commonly used (63%). CONCLUSIONS: The careful evaluation of relevant imaging findings in patients with thigh/groin pain allows the identification of early incomplete fractures and timely management. Since the rate of contralateral side fractures is also high, imaging studies should be performed on the asymptomatic contralateral side.

Effect of Botulinum Toxin Injection and Extracorporeal Shock Wave Therapy on Nerve Regeneration in Rats with Experimentally Induced Sciatic Nerve Injury.

This study was designed to compare the roles of botulinum neurotoxin A (BoNT/A) and extracorporeal shock wave therapy (ESWT) in promoting the functional recovery and regeneration of injured peripheral nerves. A total of 45 six-week-old rats with sciatic nerve injury were randomly divided into two experimental groups and one control group. The experimental groups received a single session of intranerve BoNT/A or ESWT immediately after a nerve-crushing injury. The control group was not exposed to any treatment. Differentiation of Schwann cells and axonal sprouting were observed through immunofluorescence staining, ELISA, real-time PCR, and Western blot at 3, 6, and 10 weeks post-nerve injury. For clinical assessment, serial sciatic functional index analysis and electrophysiological studies were performed. A higher expression of GFAP and S100ß was detected in injured nerves treated with BoNT/A or ESWT. The levels of GAP43, ATF3, and NF200 associated with axonal regeneration in the experimental groups were also significantly higher than in the control group. The motor functional improvement occurred after 7 weeks of clinical observation following BoNT/A and ESWT. Compared with the control group, the amplitude of the compound muscle action potential in the experimental groups was significantly higher from 6 to 10 weeks. Collectively, these findings indicate that BoNT/A and ESWT similarly induced the activation of Schwann cells with the axonal regeneration of and functional improvement in the injured nerve.

Association Between Latency of Dermatomal Sensory-Evoked Potentials and Quantitative Radiologic Findings of Narrowing in Lumbar Spinal Stenosis.

OBJECTIVE: To identify the difference of quantitative radiologic stenosis between a normal latency group and an abnormal latency group, and to investigate the association of dermatomal somatosensory-evoked potential (DSEP) with magnetic resonance imaging (MRI) findings of narrowing in patients with lumbar spinal stenosis (LSS). METHODS: We retrospectively reviewed the clinical records and P40 latencies of L5 DSEP of 40 patients with unilateral symptoms of LSS at the L4-5 disc level. Quantitative assessments of stenosis in lumbar spine MRI were performed with measurements of the anteroposterior diameter (APD), cross-sectional area (CSA) of the dural sac, ligamentous interfacet distance (LID), CSA of the neural foramen (CSA-NF), and subarticular zone width. Analyses were conducted through comparisons of radiologic severity between the normal and abnormal latency groups and correlation between radiologic severity of stenosis and latency of DSEP in absolute (APD <10 mm) and relative (APD <13 mm) stenosis. RESULTS: The radiologic severities of lumbar stenosis were not significantly different between the normal and abnormal latency groups. In absolute and relative stenosis, latency showed a significant negative correlation with APD (r=-0.539, r=-0.426) and LID (r=-0.459, r=-0.494). In patients with relative stenosis, a weak significant positive correlation was found between latency and CSA-NF (r=0.371, p=0.048). LID was the only significant factor for latency (ß=-0.930, p=0.011). CONCLUSION: The normal and abnormal DSEP groups showed no significant differences inradiologic severity. The latency of DSEP had a negative correlation with the severity of central stenosis, and LID was an influencing factor.

Isolated Oculomotor Nerve Palsy in Mild Traumatic Brain Injury.

BACKGROUND: Isolated oculomotor nerve palsy is rarely encountered after mild traumatic brain injury. It is difficult to offer patients accurate management strategies or prognostic assessments because only a few reports have described the management of oculomotor nerve palsy. METHODS: We performed a search for all clinical studies of isolated oculomotor nerve palsy after mild traumatic brain injury published up to July 9, 2019. We placed no restrictions on language or year of publication in our search, and we searched the following key words: traumatic brain injury, isolated oculomotor nerve palsy, mild head trauma, management, and prognosis. RESULTS: We identified 14 cases of isolated oculomotor nerve palsy after mild traumatic brain injury. In three cases, steroids were used to manage the oculomotor nerve palsy. Five patients who had underlying brain lesions underwent surgery, and seven patients were observed and followed up. The time to partial or complete resolution was 6.0 ± 5.3 mos with a range of 0.5-18 mos. CONCLUSIONS: This review includes a survey of surgical treatment for the management of traumatic brain injury that underlies oculomotor nerve palsies, steroid therapy to reduce related brain edema, and oculomotor rehabilitation with training eye movement behavior.

Tarlov Cysts Misdiagnosed as Adnexal Masses in Pelvic Sonography: A Literature Review.

Introduction: A Tarlov cyst (TC) is a perineural cyst filled with cerebrospinal fluid that originates from the dorsal ganglion or the spinal posterior nerve root. TCs are usually asymptomatic and incidentally found in the sacral region. Endopelvic extension of TCs is uncommon and can be misdiagnosed as an adnexal mass on gynecological ultrasound imaging. Methods: We performed a search for all clinical studies of TCs that mimicked adnexal masses that had been published through October 12, 2020. We placed no restrictions on language or year of publication in our search, and we performed searches with the following keywords: perineural cyst, Tarlov cyst, sclerotherapy, management, and prognosis. We included all misdiagnosed cases or cases considered as adnexal masses on pelvic sonography. Results: We identified 21 cases of TCs mimicking adnexal masses and conducted a comprehensive analysis of these 21 cases to assess the epidemiology, symptoms, initial diagnoses, provisional ultrasound diagnoses, confirmative modalities, sizes, locations, treatments, and outcomes. The 21 cases included 16 symptomatic cases (76%) and 5 cases with incidental findings (24%), and the average patient age was 41.3 years. The initial diagnosis was performed with ultrasonography in all cases. The most frequent misdiagnosis was unspecified adnexal mass. Confirmative diagnostic modalities were MRI only (67%), CT only (5%), and both MRI and CT (28%). Treatments were surgery (33%), conservative treatment (19%), percutaneous intervention (5%), and alcohol sclerotherapy (5%). In two symptomatic cases misdiagnosed as pelvic masses, cystectomy was performed and leakage of cerebrospinal fluid occurred, necessitating repair of the leak. In one of the asymptomatic patients, cauda equina syndrome occurred after alcohol sclerotherapy for misdiagnosed TC. However, the patient improved with no neurologic deficit after 18 months of conservative treatment. Conclusion: The possibility of large TCs should be considered when assessing adnexal masses in sonography. Since TCs can masquerade as pelvic masses, they should be considered if the mass appears tubular/cystic or multilocular/multiseptate, does not move with respiration, and originates from the sacrum in sonography with or without neurologic symptoms. Accurate diagnosis can prevent medical mismanagement and reduce patient discomfort.

Effect of extracorporeal shockwave therapy on muscle spasticity in patients with cerebral palsy: meta-analysis and systematic review.

INTRODUCTION: Recently, clinical trials have been performed to evaluate the efficacy of extracorporeal shockwave therapy (ESWT) in patients with cerebral palsy (CP). However, various studies adopted different clinical scales, making it insufficient to draw a definite conclusion about the efficacy of ESWT in reducing spasticity after cerebral palsy. The purpose of this meta-analysis was to assess the effects of ESWT on reducing spasticity after applying ESWT in patients with CP. EVIDENCE ACQUISITION: In accordance with the PRISMA statement, authors searched MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials and Scopus from their inception dates through December 11th 2018. We included randomised controlled trials in any language that using ESWT for the purpose of ameliorating spasticity in patients with CP. We assessed spasticity measured by modified Ashworth Scale (MAS), range of motion (ROM) and baropodometric values as outcomes. EVIDENCE SYNTHESIS: Two authors independently extracted and verified data. Meta-analysis was completed where possible, otherwise data were synthesised narratively. From a total of 206 articles, 16 manuscripts were selected and 5 of them were ultimately included in this meta-analysis. MAS grade as primary outcome was significantly improved after ESWT compared to that in the control group (mean difference [MD]: -0.62; 95% CI: -1.52 to -0.18). ROM after ESWT was also significantly improved compared to that in the control groups (MD: 18.01; 95% CI: 6.11 to 29.91). Baropodometric measures showed significantly increases in foot contact area during gait (SMD: 29.00; 95% CI: 11.08 to 46.92), but not significantly in peak pressure under the heel (MD: 15.12; 95% CI: -1.85 to 32.10) immediately after ESWT. CONCLUSIONS: No serious side effects were observed in any patient after ESWT. ESWT may be a valid alternative to existing treatment options targeting spasticity diminishment and ROM improvement in CP patients to maintain healthy lifestyles and normalize spastic gait pattern. Further standardization of treatment protocols including treatment intervals and intensities needs to be established and long-term follow-up studies are needed to verify our results.

The relationship between foot posture index and resting calcaneal stance position in elementary school students.

BACKGROUND: Static foot assessment is commonly performed in clinical practice to classify foot type for prescribing therapeutic interventions. Foot posture index is known to be a reliable indicator for foot position. Resting calcaneal stance position angle is used widely to determine foot posture and manufacture orthoses for pediatric flat foot patients. However, the relationship between foot posture index and resting calcaneal stance position angle in elementary school students is currently unclear. RESEARCH QUESTION: To investigate the relationship between foot posture index and resting calcaneal stance position angle in elementary school students. METHODS: Between January 2016 and December 2017, 208 elementary school students (average age, 10.3 years; range, 8-13 years) were enrolled for this study. All students were examined physically by one practitioner to measure foot posture index and resting calcaneal stance position angle. Age, gender, and body mass index were analyzed for factors associated with flat foot prevalence. This study was conducted as a retrospective comparative study. Associations between foot posture index and resting calcaneal stance position angle were determined by Pearson's correlation analysis. RESULTS AND SIGNIFICANCE: When measured by foot posture index and resting calcaneal stance position angle, the overall prevalence of flatfoot was 29% and 24% in the right foot and 26% and 23% in the left foot, respectively. Resting calcaneal stance position angle and foot posture index score showed moderate correlation in Pearson's correlation analysis (left side foot: kappa value = 0.710; right side foot: kappa value = 0.704). CONCLUSION: There is a moderate correlation between foot posture index and resting calcaneal stance position angle in elementary school students. Thus, both foot posture index with proven validity and reliability and resting calcaneal stance position widely used in the manufacture of insoles can be used as important biomechanical evaluation tools for feet in clinical settings.

Perineural cyst with intracystic hemorrhage following aneurysmal subarachnoid hemorrhage: A case report.

RATIONALE: Most perineural cysts are asymptomatic and discovered incidentally at the time of imaging. Although enlargement of the perineural cyst (PC) through a ball-valve mechanism and resultant compression of the adjacent neural or bony structures are known to be a source of pain in PCs, the reason why asymptomatic PCs become symptomatic is unclear. The authors report a case of PC, which was presumed to become symptomatic after subarachnoid hemorrhage without enlargement of the pre-existing PC. PATIENT CONCERNS: A 47-year-old woman complained of lumbosacral pain after neck clipping for a ruptured cerebral aneurysm. DIAGNOSES: Magnetic resonance imaging (MRI) revealed a PC with intracystic hemorrhage at the S2 level. In comparison with the size of the PC on computed tomography performed 3 years ago, there was no change in the size. Electrodiagnostic studies performed 6 weeks after the onset of the pain showed subacute right S2 radiculopathy. INTERVENTIONS: With conservative treatment, her pain gradually diminished. OUTCOMES: When the lumbosacral pain improved, follow-up MRI showed that a fluid-fluid level within the PC disappeared. LESSONS: Hemorrhage from the subarachnoid space, such as spontaneous aneurysmal SAH, into the pre-existing PC can cause an asymptomatic PC to become symptomatic without getting enlarged. Stretching of the nerve root due to hemorrhage or irritation of the nerve root due to an inflammatory reaction to blood products can make asymptomatic PCs symptomatic without enlargement of PCs.

Efficacy and Safety of Topical 3% Diquafosol Ophthalmic Solution for the Treatment of Multifactorial Dry Eye Disease: Meta-Analysis of Randomized Clinical Trials.

PURPOSE: A meta-analysis was performed to evaluate the safety and efficacy of topical 3% diquafosol in treating patients with dry eye disease (DED). METHODS: Nine qualified randomized controlled trials incorporating 1,467 patients were included. Two of the reviewers selected the studies and independently assessed the risk of bias. The outcome measures were Schirmer score, tear film break-up time (TFBUT), rose bengal staining score, and corneal fluorescein staining score. To confirm the effect of diquafosol on dryness after cataract surgery, we performed a subgroup analysis according to the presence or absence of surgery. RESULTS: We observed statistically significant improvements in scores on the Schirmer test (weighted mean difference 0.74 mm at 4 weeks; 95% CI: 0.24-1.24; I2 = 0%), fluorescein stain, rose bengal stain, and TFBUT after treatment with diquafosol compared with the group using other eye drops. As a result of the subgroup analysis of DED after cataract surgery, diquafosol was found to be more effective than the other eye drops with regard to TFBUT and rose bengal staining. CONCLUSIONS: Topical diquafosol could be an effective treatment for DED, and also for DED after cataract surgery. Further randomized controlled trials with larger sample sizes for the different clinical types of DED are warranted to determine the efficacy and limitations of diquafosol for these different clinical types of DED.

Isolated hook of hamate fracture in sports that require a strong grip comprehensive literature review.

BACKGROUND: The aim of the study was to report characteristics of isolated hook of hamate fractures related to sports that require a strong grip and to identify factors affecting early diagnosis and recovery period. METHODS: A comprehensive literature search was conducted using MEDLINE, EMBASE, SCOPUS, Web of Science, the Cochrane Central Register of Controlled Trials, the World Health Organization International Clinical Trials Registry Platform, and the clinical trials registry and database of the US National Institutes of Health (ClinicalTrials.gov). There were no limits on the language or year of publication.This article included case reports and literature reviews for patients with isolated hook of hamate fractures related to sports that require a strong grip from 1977 to 2016.Two experienced reviewers extracted data from each study. The following data were extracted: sample size, patient's characteristics, cause of injury, injury side, time to diagnosis and symptoms, physical examination results, diagnostic work-up, treatment, complications, and recovery period. RESULTS: A total of 21 case reports and literature reviews with 120 patients satisfied our inclusion criteria. There was no significant difference in the time to diagnosis between the group before computed tomography (CT) was widely used and the group after CT was widely used. Recovery period showed a positive relationship with age (coefficient = 0.418, P < .01), time from injury to diagnosis or surgery (coefficient = 0.206, P < .05), and type of athlete (coefficient = 0.270, P < .01). On multiple stepwise regression analysis, recovery period was significantly associated with age (ß = 0.418, P = .00), but not with time from injury to diagnosis or surgery. CONCLUSIONS: Advance in diagnostic techniques does not guarantee early diagnosis of hook of hamate fractures. Strong suspicion of the disease with physical examination and carefully hearing patient's history are important for early diagnosis and management for patients with hook of hamate fractures.

Posterior Epidural Migration of a Lumbar Intervertebral Disc Fragment Resembling a Spinal Tumor: A Case Report.

Posterior epidural migration of a lumbar intervertebral disc fragment (PEMLIF) is uncommon because of anatomical barriers. It is difficult to diagnose PEMLIF definitively because of its relatively rare incidence and the ambiguity of radiological findings resembling spinal tumors. This case report describes a 76-year-old man with sudden-onset weakness and pain in both legs. Electromyography revealed bilateral lumbosacral polyradiculopathy with a mass-like lesion in L2-3 dorsal epidural space on lumbosacral magnetic resonance imaging (MRI). The lesion showed peripheral rim enhancement on T1-weighted MRI with gadolinium administration. The patient underwent decompressive L2-3 central laminectomy, to remove the mass-like lesion. The excised lesion was confirmed as an intervertebral disc. The possibility of PEMLIF should be considered when rim enhancement is observed in the epidural space on MRI scans and electrodiagnostic features of polyradiculopathy with sudden symptoms of cauda equina syndrome.

Posterior epidural disc fragment masquerading as spinal tumor: Review of the literature.

BACKGROUND: Posterior epidural lumbar disc fragment is infrequent because of anatomical barriers, and it is difficult to diagnose posterior epidural lumbar disc fragment because of its rare incidence and the ambiguity of radiologic evaluations. And it is difficult to differentiate it from other diseases such as spinal tumors. OBJECTIVE: Differential diagnosis of posterior epidural lumbar disc fragment is clinically important because its diagnosis can affect treatment and prognosis. To investigate the incidence, anatomical concern, etiology, symptom, diagnostic tool, management and prognosis of posterior epidural lumbar disc fragment, we reviewed articles including case report. METHODS: We performed a search of all clinical studies of posterior epidural lumbar disc fragment published to date. The following keywords were searched: Posterior epidural lumbar disc fragment, disc migration, posterior epidural disc, extradural migration, dorsal epidural migration, sequestrated disc, and disc fragment. RESULTS: We identified 40 patients of posterior epidural lumbar disc fragment from 28 studies. The most common presentation of posterior epidural lumbar disc fragment was sudden onset radiculopathy (70.0%), followed by cauda equina syndrome (27.5%). The most frequently used diagnostic modality was magnetic resonance imaging (MRI), conducted in 36 cases (90.0%), and followed by computed tomography in 14 cases (35.0%). After the imaging studies, the preoperative diagnoses were 45.0% masses, 20.0% lesions, and 12.5% tumors. Characteristic MRI findings in posterior epidural lumbar disc fragment are helpful for diagnosis; it typically displays low signals on T1-weighted images and high signals on T2-weighted images with respect to the parent disc. In addition, most of the disc fragments show peripheral rim enhancement on MRI with gadolinium administration. Electrodiagnostic testing is useful for verifying nerve damage. Surgical treatment was performed in all cases, and neurologic complications were observed in 12.5%. CONCLUSIONS: As posterior epidural lumbar disc fragment could be masqueraded as spinal tumor, if rim enhancement is observed in MRI scans with sudden symptoms of radiculopathy or cauda equina syndrome, it should be taken into consideration. Early diagnosis can lead to early surgery, which can reduce complications.

Effect of Whole Body Horizontal Vibration Exercise in Chronic Low Back Pain Patients: Vertical Versus Horizontal Vibration Exercise.

OBJECTIVE: To elucidate the effect of a 12-week horizontal vibration exercise (HVE) in chronic low back pain (CLBP) patients as compared to vertical vibration exercise (VVE). METHODS: Twenty-eight CLBP patients were randomly assigned to either the HVE or VVE group. All participants performed the exercise for 30 minutes each day, three times a week, for a total of 12 weeks. Altered pain and functional ability were evaluated using the visual analog scale (VAS) and Oswestry Disability Index (ODI), respectively. Changes in lumbar muscle strength, transverse abdominis (TrA) and multifidus muscle thicknesses, and standing balance were measured using an isokinetic dynamometer, ultrasonography, and balance parameters, respectively. These assessments were evaluated prior to treatment, 6 weeks and 12 weeks after the first treatment, and 4 weeks after the end of treatment (that is, 16 weeks after the first treatment). RESULTS: According to the repeated-measures analysis of variance, there were significant improvements with time on VAS, ODI, standing balance score, lumbar flexor, and extensor muscle strength (all p<0.001 in both groups) without any significant changes in TrA (p=0.153 in HVE, p=0.561 in VVE group) or multifidus (p=0.737 in HVE, p=0.380 in VVE group) muscle thickness. Further, there were no significant differences between groups according to time in any of the assessments. No adverse events were noticed during treatment in either group. CONCLUSION: HVE is as effective as VVE in reducing pain, strengthening the lumbar muscle, and improving the balance and functional abilities of CLBP patients. Vibrational exercise increases muscle strength without inducing muscle hypertrophy.

Radiculopathy in neuromyelitis optica. How does anti-AQP4 Ab involve PNS?

BACKGROUND: Until recently, the peripheral nervous system (PNS) had been known to be spared in multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). However, some studies of late have reported PNS damage in demyelination diseases of the central nervous system (CNS) such as MS and NMOSD. Although multiple studies have reported characteristics reminiscent of peripheral neuropathy in MS, there have been limited reports in NMOSD. To investigate the incidence and pathology of peripheral neuropathy in NMOSD, we reviewed articles describing such cases including our own case. METHODS: We performed a search of all clinical studies of peripheral neuropathy in NMOSD published up to December 17, 2016. We put no restrictions on language or year of publication in our search. The following keywords were searched: radiculopathy, peripheral nervous system diseases, neuromyelitis optica, neuromyelitis optica septrum disorder, aquaporin 4, electrodiagnosis, neural conduction and electromyography. RESULT: We review ten cases (nine published reports and our own case study) of peripheral neuropathy in NMOSD. Each case could be confirmed as radiculopathy by electrodiagnostic (EDX) testing. Presently, there are two disparate viewpoints on peripheral neuropathy in NMOSD. In the first, aquaporin 4, which exists in the transitional zone of the CNS-PNS at the root level, may be the target of radiculitis in NMOSD. In the second, there may be some other unknown antibody to an axoglial antigen or something else that may play an active role in PNS damage. In our survey of ten case studies, the EDX results confirmed mixed axonal loss as well as demyelination type radiculopathy, which lends support to the first viewpoint. CONCLUSION: Pathophysiology of PNS damage in NMOSD might be due to radiculopathy. Although it seems to be rare, radiculopathy may actually be underestimated, and correspondingly underreported, due to its overlap with symptoms of myelitis. Therefore, further evaluation is needed to establish the incidence and pathophysiology of radiculopathy in NMOSD.

Predictive factors for photic phenomena after refractive, rotationally asymmetric, multifocal intraocular lens implantation.

AIM: To investigate the independent factors associated with photic phenomena in patients implanted with refractive, rotationally asymmetric, multifocal intraocular lenses (MIOLs). METHODS: Thirty-four eyes of 34 patients who underwent unilateral cataract surgery, followed by implantation of rotationally asymmetric MIOLs were included. Distance and near visual acuity outcomes, intraocular aberrations, preferred reading distances, preoperative and postoperative refractive errors, mesopic and photopic pupil diameters, and the mesopic and photopic kappa angles were assessed. Patients were also administered a satisfaction survey. Photic phenomena were graded by questionnaire. Independent-related factors were identified by correlation and bivariate logistic regression analyses. RESULTS: The distance from the photopic to the mesopic pupil center (pupil center shift) was significantly associated with glare/halo symptoms [odds ratio (OR)=2.065, 95% confidence interval (CI)=0.916-4.679, P=0.006] and night vision problems (OR=1.832, 95% CI=0.721-2.158, P=0.007). The preoperative photopic angle kappa was significantly associated with glare/halo symptoms (OR=2.155, 95% CI=1.065-4.362, P=0.041). The photopic angle kappa was also significantly associated with glare/halo symptoms (OR=2.155, 95% CI=1.065-4.362, P=0.041) and with night vision problems (OR=1.832, 95% CI=0.721-2.158, P=0.007) in patients implanted with rotationally asymmetric MIOLs. CONCLUSION: A large pupil center shift and misalignment between the visual and pupillary axis (angle kappa) may play a role in the occurrence of photic phenomena after implantation of rotationally asymmetric MIOLs.

Neuromyelitis Optica Masquerading as Lumbosacral Radiculopathy: A Case Report.

Neuromyelitis optica spectrum disorders (NMOSD) is a demyelinating syndrome of the central nervous system. This case report describes a 31-year-old woman whose electromyography revealed radiculopathy in the left L5-S1 spinal segment without anatomical abnormalities on lumbosacral magnetic resonance imaging (MRI). She was diagnosed with NMOSD based on gadolinium contrast whole spine and brain MRI and anti-aquaporin-4 antibody findings. Her peripheral nervous system might have been damaged during the early course of NMOSD. Therefore, it is necessary to consider NMOSD for patients who have radiculopathy in electromyography if lumbosacral MRI shows no abnormalities.