Prevalence and evolution of spasticity in patients suffering from first-ever stroke with carotid origin: a prospective, longitudinal study.

BACKGROUND AND PURPOSE: The main aim of the study was to document the occurrence and evolution of post-stroke spasticity (PSS). The secondary goal was to identify predictors for increases and decreases in PSS rates during 12 months of subsequent follow-up. METHODS: In a longitudinal, multicenter, prospective cohort study, assessments were done at 7 days (V1), 6 months (V2), and 12 months (V3) after stroke onset. A total of 307 consecutive patients from four comprehensive stroke centers with the first-ever stroke of carotid origin and the presence of motor deficit at day 7 were included. The demographic data, baseline characteristics, Barthel index, degree and pattern of paresis and muscle tone were evaluated and recorded. Spasticity was assessed using the modified Ashworth scale. RESULTS: Spasticity was present in 45.0% of patients at V1, in 49.5% at V2, and in 43.2% at V3. A significant number of patients experienced changes in spasticity between visits: increased/new occurrence of spasticity in 32.5% (V1 and V2) and in 13.6% (V2 and V3) of patients; decreased occurrence/disappearance of spasticity in 18.5% (V1 and V2) and in 18.3% (V2 and V3) of patients. The number of patients with severe spasticity increased throughout the year, from 2.6% to 13.0% (V2) and 12.5% (V3). CONCLUSIONS: Spasticity developed in almost half of the included patients. The degree of spasticity often changed over time, in both directions. The rate of severe spasticity increased during the first year, with the maximum at 6 months following stroke onset.

Cerebrospinal fluid levels of chromogranin A and phosphorylated neurofilament heavy chain are elevated in amyotrophic lateral sclerosis.

BACKGROUND: Various cerebrospinal fluid (CSF) biomarkers are being studied to improve the sensitivity and specificity of the diagnostic methods for amyotrophic lateral sclerosis (ALS). AIMS OF THE STUDY: The aim of our study was to establish the CSF levels of chromogranin A (CgA) and phosphorylated neurofilament heavy chain (pNF-H) in patients with ALS in order to assess these proteins as possible biomarkers of ALS. METHODS: Cerebrospinal fluid levels of CgA and pNF-H were examined and mutually compared in 15 patients with sporadic ALS and 16 gender- and age-matched controls. RESULTS: Lumbar CSF CgA levels were increased in the patients with ALS compared to the controls (median 235 vs 138, P=.031). Lumbar CSF pNF-H levels were significantly increased in the patients with ALS compared to the control group (median 3091 vs 213, P<.0001). CONCLUSIONS: Identifying CSF biomarkers in ALS is important in order to establish the diagnosis in the early stages of the disease. pNF-H seems to be a good biomarker for the diagnosis of ALS. If confirmed on a larger group of patients, CgA may also become useful in the diagnosis of sporadic ALS.

[Influence of Cervical Spondylotic Spinal Cord Compression on Cerebral Cortical Adaptation. Radiological Study]. / Vliv cervikální spondylogenní mísní komprese na korové funkce mozku. Radiologická studie.

PURPOSE OF THE STUDY: The aim of the study was to measure the sensorimotor brain adaptation activity, shown on functional magnetic resonance images (fMRI), in relation to the degree and extent of spinal cord compression or cervical spondylotic myelopathy (CSM) detected by cervical spine MRI. MATERIAL AND METHODS: Twenty-one patients (average age, 57 years; 9 men and 12 women) with anterior cervical cord compression detected on cervical MRI scans were included. On the images, the degree of spinal canal stenosis, the spinal cord compression based on the antero-posterior diameter of the spinal canal and on transverse areas of the cervical spinal cord and cervical spinal canal, and changes in spinal cord signal intensity were identified. Clinical examination included neurological status, Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) and pain intensity assessment using the Visual Analogue Scale (VAS). Electrophysiological tests involving motor evoked and sensory evoked potential (MEP and SEP) recording were conducted and, using fMRI, brain activity during movement of both arms was measured. Based on the transverse spinal cord area of above or below 70 mm2, the patients were placed into two subgroups. According to changes in spinal cord signal intensity, the patients were included into three subgroups with normal findings, incipient myelopathy and advanced myelopathy, respectively. Surgery was carried out from the anterior approach and involved cervical disc replacement. All examinations were performed again at 6 months after surgery. Pre- and post-operative results were compared within each set of subgroups and statistically evaluated. RESULTS: The average pre-operative values were found to increase post-operatively as follows: from 6.4 mm to 8.9 mm (by 39%) for the antero-posterior diameter of the spinal canal; from 129.3 mm2 to 162.8 mm2 (by 26%) for the transverse area of the spinal canal; from 72.6 mm2 to 87.4 mm2 (by 20%) for the transverse spinal cord area; and from 16.3 to 17.4 for the JOA score. The average NDI decreased from 37.9 to 23.7 and the average VAS fell from 6.4 to 1.5. All patients with the change of spinal cord signal that indicated advanced myelopathy also had relevant pathological findings on MEP/SEP examination and this was statistically significant. There was no significant difference in fMRI scans between the two subgroups established on the basis of transverse spinal cord area measurements. In the patients grouped by a change in spinal cord signals, the pre-operative fMRI showed a significantly higher brain activation volume in the subgroup with advanced myelopathy, as compared with the two other subgroups. Surgery resulted in a moderate reduction of the volume of active brain tissue in all three groups. In the patients with advanced myelopathy evaluated in relation to local changes in brain activation, surgery led to a significant decrease in activation volumes in the ipsilateral primary motor cortex and cerebellar hemisphere. There was also a significant increase in activation of the contralateral supplementary motor cortex. DISCUSSION: It is evident that the brain responds to spinal cord damage by increased activity, but with a certain delay. A slightly altered spinal cord signal intensity, such as in incipient myelopathy, apparently does not result in brain activation. On the other hand, significant changes in signal intensity in advanced myelopathy are related to deterioration of spinal cord function, as shown by MEP and SEP examination results, and an increase in both the volume and intensity of cortical motor activation as a compensation mechanism for myelopathy. CONCLUSIONS Hyperintense spinal cord signals on T2-weighted images correlated with the pathological spinal cord function detected by electrophysiological test in all patients. The transverse spinal cord area (around 70 mm2) showed no significant correlation with either sensory and motor brain adaptations or the results of SEP and MEP testing; therefore, as a criterion for indication to surgery it is of no value. The patients with advanced myelopathy, as detected by spinal cord MRI, had a significantly higher pre-operative cortical motor activation on fMRI than patients with normal findings or those with incipient myelopathy. In addition, the patterns of cortical motor activation altered significantly at 6 months after spinal cord decompression, which was shown by an increase or decrease in activation of the relevant motor cortex areas.

[Effects of spinal cord decompression in patients with cervical spondylotic myelopathy oncortical brain activations]. / Efekt dekomprese krcní míchy pri spondylogenní myelopatii na korové funkce mozku.

INTRODUCTION: The aim of this project was to compare and evaluate cortical sensorimotor adaptations as measured by brain fMRI (functional magnetic resonance imaging) in patients before and after surgery for cervical spondylotic myelopathy (CSM), i.e., after spinal cord decompression. MATERIAL AND METHODS: Study inclusion required evidence of CSM on MRI of the cervical spine, anterior compression of the spinal cord by osteophytes, or disc herniation. We measured the antero-posterior diameter of the spinal canal stenosis before and 3 months after surgery. Surgery was performed at one or two levels from the anterior approach with implantation of radiolucent spacers, without plate fixation. Each participant underwent two fMRI brain examinations, the first one preoperatively and the second one 6 months following surgery. Subjects performed acoustically paced repetitive wrist flexion and extension of each upper extremity according to block design. MRI data were acquired using 1.5 Tesla scanners. Statistical analysis was carried out using the general linear model implemented in FEAT 6.00 (FMRI Expert Analysis Tool), part of the FSL 5.0 package (FMRIB Software Library). The group differences were evaluated using paired t-test and the resulting statistical maps evaluated as Z-score (standardised value of the t-test) were thresholded at a corrected significance level of p <0.05. The study group consisted of 7 patients including 5 female and 2 male patients, with the average age of 55.7 years. Patients with cervical spondylogenous radiculopathy were evaluated as a control group. RESULTS: The analysis of mean group effects in brain fMRI during flexion and extension of both wrists revealed significant activation in dorsal primary motor cortex contralaterally to the active extremity and in adjacent secondary motor and sensory areas, bilaterally in supplementary motor areas, the anterior cingulum, primary auditory cortex, in the region of the basal ganglia, thalamus and cerebellum. After surgery, the cortical activations and maximum Z-scores decreased in most areas. Analysis of differences between sessions before and after surgery showed a statistically significant activation decrease during movement of both extremities in the right parietal operculum and the posterior temporal lobe. During left wrist movement, there was additional activation decrease in the right superior parietal lobe, the supramarginal gyrus, insular cortex, and the central operculum. In contrast, an activation decrease was detected in the left middle temporal gyrus during right wrist movement. CONCLUSION: An average difference of anteroposterior cervical spinal canal distance before and after surgery of CSM was 2.67 millimetres, representing a 40% increase; the cross-sectional area of the spinal canal increased by 37% and that of the spinal cord by 36%. Functional MRI of the brain revealed significant activation especially in primary and secondary motor cortex and sensory areas in patients with CSM. After surgical decompression of the spinal cord, cortical activations and maximum Z-score decreased in the majority of areas. We proved decreased cortical activation on functional MRI of the brain after surgery in patients with CSM (evaluated according to MRI of cervical spine), even at an initial stage of the disease.

[Peripheral nerve injury and the degree of motor involvement in Parkinson's disease: a correlation study]. / Postizení periferního nervového systému a míra motorického postizení u Parkinsonovy nemocí: korelacní studie.

BACKGROUND: The aim of the study was to validate a hypothesis about the presence of a concomitant peripheral nerves injury in patients suffering from neurodegenerative disorders. The study was focused on the correlation between motor involvement in Parkinson's disease and peripheral nerves injury. METHODS AND RESULTS: 23 patients suffering from Parkinson's disease, which was diagnosed in terms of strict UK-PDBB criteria, were examined. There were 14 men (mean age: 57 years, mean age at the disease onset: 51 years, mean disease duration: 7 years, mean duration of dopaminergic treatment: 4 years) and 9 women (mean age: 67 years, mean age at the disease onset: 63 years, mean duration of disease: 4 years, mean duration of dopaminergic treatment: 1 year). Polyneuropathy was clinically present and confirmed using EMG examination in 10 patients (43.5 %), 5 men and 5 women. CONCLUSIONS: Our observation indicates that the neurodegenerative process can be involved not only in the degeneration of central nervous system, but also in the peripheral disorders in this population.