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1.
PLoS Negl Trop Dis ; 15(8): e0009656, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34460829

RESUMO

BACKGROUND: Little is known about the diagnostic performance of rapid diagnostic tests (RDTs) for passive screening of human African trypanosomiasis (HAT) in Côte d'Ivoire. We determined HAT prevalence among clinical suspects, identified clinical symptoms and signs associated with HAT RDT positivity, and assessed the diagnostic tests' specificity, positive predictive value and agreement. METHODS: Clinical suspects were screened with SD Bioline HAT, HAT Sero-K-Set and rHAT Sero-Strip. Seropositives were parasitologically examined, and their dried blood spots tested in trypanolysis, ELISA/Tbg, m18S-qPCR and LAMP. The HAT prevalence in the study population was calculated based on RDT positivity followed by parasitological confirmation. The association between clinical symptoms and signs and RDT positivity was determined using multivariable logistic regression. The tests' Positive Predictive Value (PPV), specificity and agreement were determined. RESULTS: Over 29 months, 3433 clinical suspects were tested. The RDT positivity rate was 2.83%, HAT prevalence 0.06%. Individuals with sleep disturbances (p<0.001), motor disorders (p = 0.002), convulsions (p = 0.02), severe weight loss (p = 0.02) or psychiatric problems (p = 0.04) had an increased odds (odds ratios 1.7-4.6) of being HAT RDT seropositive. Specificities ranged between 97.8%-99.6% for individual RDTs, and 93.3-98.9% for subsequent tests on dried blood spots. The PPV of the individual RDTs was below 14.3% (CI 2-43), increased to 33.3% (CI 4-78) for serial RDT combinations, and reached 67% for LAMP and ELISA/Tbg on RDT positives. Agreement between diagnostic tests was poor to moderate (Kappa ≤ 0.60), except for LAMP and ELISA/Tbg (Kappa = 0.66). CONCLUSION: Identification of five key clinical symptoms and signs may simplify referral for HAT RDT screening. The results confirm the appropriateness of the diagnostic algorithm presently applied, with screening by SD Bioline HAT or HAT Sero-K-Set, supplemented with trypanolysis. ELISA/Tbg could replace trypanolysis and is simpler to perform. TRIAL REGISTRATION: ClinicalTrials.gov NCT03356665.


Assuntos
Testes Diagnósticos de Rotina/métodos , Trypanosoma brucei gambiense/imunologia , Tripanossomíase Africana/diagnóstico , Adulto , Animais , Antígenos de Protozoários/sangue , Antígenos de Protozoários/imunologia , Costa do Marfim/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Transtornos Motores/epidemiologia , Valor Preditivo dos Testes , Prevalência , Convulsões/epidemiologia , Sensibilidade e Especificidade , Transtornos do Sono-Vigília/epidemiologia , Tripanossomíase Africana/epidemiologia , Tripanossomíase Africana/fisiopatologia , Perda de Peso
2.
J Psychosom Res ; 148: 110565, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34252796

RESUMO

Functional motor disorders (FMD) are common and disabling. They are known to predominantly affect women and young to middle-aged patients, although they also occur during childhood or in the elderly. Demographic and clinical characteristics of patients with FMD are poorly known, since large series of consecutive patients are scarce. METHODS: In a chart review study, we retrospectively abstracted data from consecutive FMD patients who were referred to the Neurophysiology Department of the Salpêtrière University Hospital between 2008 and 2016 for treatment with repeated transcranial magnetic stimulation. RESULTS: 482 patients were included. Most patients were women (73.7%). Median age at symptoms onset was 35.5 years and symptoms were mostly characterized by acute (47.3%) or subacute (46%) onset. Only 23% of patients were active workers, while 58.3% were unemployed because of FMD. Half of the patients had functional motor weakness (n = 241) whereas the other half had movement disorders (n = 241), mainly with tremor (21.1%) or dystonia (20.5%). Among all patients, 66.4% had psychiatric comorbidity and 82.6% reported a history of trauma in the 6 months before symptoms onset. No difference was found in age or gender according to clinical phenotypes. CONCLUSION: This large series will contribute to better characterize FMDs.


Assuntos
Distonia , Transtornos Motores , Transtornos dos Movimentos , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Transtornos Motores/epidemiologia , Transtornos dos Movimentos/epidemiologia , Estudos Retrospectivos , Tremor
3.
Nutrients ; 13(6)2021 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-34073813

RESUMO

A study of the literature shows the lack of data on a comprehensive analysis of eating disorders in children with neurodysfunction, which constitute a clinical subgroup with an increased risk of abnormalities in this area. Therefore, the aim of this study was to determine the relationship between the coexistence of nutritional disorders and diseases or syndromes associated with neurodysfunction based on data collected during hospitalization at a rehabilitation center for children and adolescents. A retrospective analysis was carried out in a group of 327 children and adolescents aged 4-18 years. The study group covered various types of diseases or syndromes involving damage to the central nervous system. A retrospective analysis of baseline data (age, sex, main and additional diagnosis and Body Mass Index-BMI) was performed. Two assessment criteria of nutritional status were taken into account (z-score BMI and other previously published normative values). In the study group, malnutrition was found more frequently (18.0% of the respondents) than obesity (11.3% of the subjects). Hypothyroidism coexisting with malnutrition was identified in the study group (N% = 43.8%, p = 0.011) and malnutrition with tetraplegia in the subgroup of spastic cerebral palsy (N% = 34.2 %, p = 0.029).


Assuntos
Doenças do Sistema Nervoso Central/epidemiologia , Transtornos Nutricionais/epidemiologia , Adolescente , Índice de Massa Corporal , Paralisia Cerebral/epidemiologia , Criança , Pré-Escolar , Disfunção Cognitiva/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Feminino , Humanos , Hipotireoidismo/epidemiologia , Masculino , Desnutrição/epidemiologia , Transtornos Motores/epidemiologia , Estado Nutricional , Obesidade/epidemiologia , Quadriplegia/epidemiologia , Centros de Reabilitação , Estudos Retrospectivos , Síndrome
4.
Environ Health Prev Med ; 26(1): 36, 2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33752592

RESUMO

BACKGROUND: Among former Olympic-level athletes, engagement in different sport disciplines has been associated with mortality risk in subsequent years. However, limited evidence is available on whether engagement in different sport disciplines at a young age is associated with locomotive syndrome (LS) risk later in life. This study examined the relationship between engagement in different sport disciplines during university years and LS risk in older age among former university athletes. METHODS: Participants were 274 middle-aged and 294 older men alumni who graduated from a school of physical education in Japan. LS risk was defined as answering "yes" to any of the Loco-check questions. Data on university sports club membership were collected using questionnaires. University clubs were classified into three groups of cardiovascular intensity (low, moderate, high), following the classification system of sport disciplines by the American College of Cardiology. This classification considers the static and dynamic components of an activity, which correspond to the estimated percent of maximal voluntary contraction reached and maximal oxygen uptake achieved, respectively. University clubs were grouped based on the risk of bodily collision (no, yes) and extent of physical contact (low, moderate, high). Relationships between engagement in different sport disciplines and LS risk were analyzed using Cox proportional hazards models, and adjusted for age, height, weight, joint disease, habitual exercise, and smoking and drinking status. RESULTS: Adjusted hazard ratios and 95% confidence intervals associated with the low, moderate, and high cardiovascular intensity sports were 1.00 (reference), 0.48 (0.22-1.06, P = 0.070), and 0.44 (0.20-0.97, P = 0.042) in older men, respectively; however, there was no significant association between these parameters among middle-aged men. Engagement in sports associated with physical contact and collision did not affect LS risk in either group. CONCLUSIONS: Engagement in sports associated with high cardiovascular intensity during university years may reduce the risk of LS in later life. Encouraging young people to participate in such activities might help reduce LS prevalence among older populations.


Assuntos
Atletas/estatística & dados numéricos , Locomoção , Limitação da Mobilidade , Transtornos Motores/epidemiologia , Equilíbrio Postural , Adulto , Idoso , Idoso de 80 Anos ou mais , Exercício Físico , Avaliação Geriátrica , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Transtornos Motores/etiologia , Prevalência , Modelos de Riscos Proporcionais , Fatores de Risco , Esportes/fisiologia , Esportes/estatística & dados numéricos , Síndrome , Adulto Jovem
5.
Int Psychogeriatr ; 33(8): 827-834, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33375951

RESUMO

OBJECTIVES: Prior neuropsychiatric disturbances are risk factors for stroke. There is a knowledge gap on the predictors of prestroke psychopathology, as well as their association with stroke outcomes in survivors living in low- and middle-income countries (LMICs). We estimated prevalence, predictors, and association of prestroke neuropsychiatric symptoms with poststroke depression (PSD), disability, and mortality. DESIGN: Prospective observation. SETTING: Nigeria. PARTICIPANTS: Adult ischemic and hemorrhagic stroke survivors. MEASUREMENTS: Prestroke psychopathology were ascertained using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Outcomes were assessed using validated tools, including the Centre for Epidemiologic Studies - Depression Scale (CES-D 10) and modified Rankin scale (mRS). Independent associations were investigated using regression models with Bonferroni corrections, and presented as standardized mean differences (SMD) and odds ratios (OR) within 95% confidence intervals (CI). RESULTS: Among 150 participants, prestroke neuropsychiatric symptoms were found in 78 (52%). In multivariate logistic regression analyses, prestroke sleep disturbance was associated with systemic hypertension (OR = 5.39, 95% CI = 1.70-17.08). Prestroke neuropsychiatric symptoms independently predicted worse motor disability scores (SMD = 0.92, 95% CI = 0.21-1.62) and greater odds of poststroke mortality (OR = 2.7, 95% CI = 1.1-7.0) at 3 months. However, prestroke depression was not significantly associated with PSD. CONCLUSION: Prestroke sleep disturbances was associated with systemic hypertension, a key index of high cardiovascular risk profile and stroke. The findings should energize before-the-stroke identification and prioritization of limited treatment resources in LMICs to persons with sleep symptoms who have multiple, additional, risks of stroke.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Transtornos Motores/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Sobreviventes/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Humanos , Transtornos Mentais/complicações , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Nigéria/epidemiologia , Prevalência , Prognóstico , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/psicologia
6.
Autism Res ; 14(1): 202-219, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33300285

RESUMO

Eighty-seven percent of a large sample of children with autism spectrum disorder (ASD) are at risk for motor impairment (Bhat, Physical Therapy, 2020, 100, 633-644). In spite of the high prevalence for motor impairment in children with ASD, it is not considered among the diagnostic criteria or specifiers within DSM-V. In this article, we analyzed the SPARK study dataset (n = 13,887) to examine associations between risk for motor impairment using the Developmental Coordination Disorder-Questionnaire (DCD-Q), social communication impairment using the Social Communication Questionnaire (SCQ), repetitive behavior severity using the Repetitive Behaviors Scale - Revised (RBS-R), and parent-reported categories of cognitive, functional, and language impairments. Upon including children with ASD with cognitive impairments, 88.2% of the SPARK sample was at risk for motor impairment. The relative risk ratio for motor impairment in children with ASD was 22.2 times greater compared to the general population and that risk further increased up to 6.2 with increasing social communication (5.7), functional (6.2), cognitive (3.8), and language (1.6) impairments as well as repetitive behavior severity (5.0). Additionally, the magnitude of risk for motor impairment (fine- and gross-motor) increased with increasing severity of all impairment types with medium to large effects. These findings highlight the multisystem nature of ASD, the need to recognize motor impairments as one of the diagnostic criteria or specifiers for ASD, and the need for appropriate motor screening and assessment of children with ASD. Interventions must address not only the social communication and cognitive/behavioral challenges of children with ASD but also their motor function and participation. LAY ABSTRACT: Eighty-eight percent of the SPARK sample of children with ASD were at risk for motor impairment. The relative risk for motor impairment was 22.2 times greater in children with ASD compared to the general population and the risk increased with more social communication, repetitive behavior, cognitive, and functional impairment. It is important to recognize motor impairments as one of the diagnostic criteria or specifiers for ASD and there is a need to administer appropriate motor screening, assessment, and interventions in children with ASD.


Assuntos
Transtorno do Espectro Autista , Transtornos Motores , Nascimento Prematuro , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/epidemiologia , Criança , Cognição , Comunicação , Feminino , Humanos , Recém-Nascido , Transtornos Motores/epidemiologia , Gravidez
7.
Neurosurg Rev ; 44(1): 495-501, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31965363

RESUMO

To explore the relationship between postoperative motor deficits and the duration of reduced motor-evoked potentials (MEPs) in patients with middle cerebral artery (MCA) aneurysm. This study included 285 cases of MCA aneurysm treated with clipping surgery with MEP monitoring. The effects of MEP changes on postoperative motor function were assessed, and the key time point for minimizing the incidence of postoperative motor dysfunction was found through receiver operating characteristic (ROC) curve analysis. Motor dysfunction was significantly associated with the occurrence of MEP changes, and patients with irreversible changes were more likely to suffer motor dysfunction than were those with reversible changes. The critical duration of MEP changes that minimized the risk of postoperative motor dysfunction was 8.5 min. This study revealed that MEP monitoring is an effective method for preventing ischemic brain injury during surgical treatment of MCA aneurysm and proposes a critical cutoff for the duration of MEP deterioration of 8.5 min for predicting postoperative motor dysfunction.


Assuntos
Potencial Evocado Motor/fisiologia , Aneurisma Intracraniano/fisiopatologia , Aneurisma Intracraniano/cirurgia , Monitorização Neurofisiológica Intraoperatória , Transtornos Motores/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Fatores de Tempo , Adulto Jovem
8.
J Clin Neurosci ; 81: 6-11, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33222969

RESUMO

In a large cohort the clinical presentation, management and outcomes of spinal schwannoma and factors related to postoperative motor and sensory deficits were invesgtigated. In 244 patients (males: 126, females: 118, average age 51.8 y) at one center, significant factors related to postoperative motor and sensory deficits were identified. Tumors were in the cervical (n = 79, 32.4%), lumbar (n = 66), thoracolumbar (T11-L1) (n = 55), and thoracic (n = 39) regions, and 5 patients had sacrum tumors. The rates of postoperative motor and sensory deterioration were 13.1% and 20.5%, respectively. The risk factors for motor deterioration were preoperative motor weakness, preoperative gait disturbance, dumbbell Eden type II, subtotal resection, and operative time, and those for postoperative sensory deficit were preoperative gait disturbance and subtotal resection. Of 12 patients with significant TcMEP changes, 11 had a new motor deficit after surgery; and of 216 patients with stable TcMEP data, 196 were neurologically intact after surgery (true negative) and 20 (11.0%) had deficits in the immediate postoperative stage (false negative). These deficits resolved during hospitalization for most patients. Of 15 patients with TcMEP deterioration and recovery, 11 (93.3%) had no motor deficits after surgery (p < 0.01).


Assuntos
Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Neoplasias da Medula Espinal/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Motores/epidemiologia , Transtornos Motores/etiologia , Estudos Retrospectivos , Fatores de Risco , Transtornos das Sensações/epidemiologia , Transtornos das Sensações/etiologia , Resultado do Tratamento
9.
PLoS One ; 15(9): e0238936, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915893

RESUMO

PURPOSE: To study the effect of STN-DBS on balance performance of Parkinson's disease. METHOD: 16 idiopathic PD patients treated with bilateral STN-DBS (DBS Group) and 20 PD patients treated with Levodopa (Medicine group) were included in the study. Clinical material including Levodopa Equivalent Daily Dose (LEDD, mg/day), life quality (PDQ-39) were collected. For DBS group and Medicine group, The motor disability (Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale Ⅲ, MDS-UPDRSIII) and balance performance (MDS-UPDRS 3.12, Berg Balance Scale BBS) and the Limits of Stability (LoS) (target acquisition percentage, trunk swing angle standard deviation, time) in state of Med-Off/Med-On at preoperation, postoperation, 6 months postoperation and 12 months postoperation were evaluated. Repeated ANOVA was used to analyze the effect of STN-DBS on balance performance. RESULT: The Clinical material (age, gender, duration, LEDD preoperation, PDQ39), motor disability (Med-on/Med-Off), balance performance (Med-on/Med-Off) and LoS preoperation had no differences in DBS-group and Medical-group (P>0.05). During the follow up, LEDD, PDQ39, Motor disability (MDS-UPDRSIII), balance performance (MDS-UPDRS 3.12, BBS) in Medicine-group had no significant changes in both Med-Off and Med-On. For DBS-group, immediately improvement of motor disability (MDS-UPDRSIII), LoS (target acquisition percentage, trunk swing angle standard deviation, time) and LEDD were observed postoperation (P<0.05); PDQ39, balance performance (MDS-UPDRS 3.12, BBS) began to improve at 6 months and 12 months postoperation. Repeated ANOVA showed that DBS could significantly improve the motor disability, balance performance and LoS in PD. CONCLUSION: STN-DBS could improve the balance performance of PD patients in H&Y3.


Assuntos
Estimulação Encefálica Profunda/métodos , Transtornos Motores/terapia , Doença de Parkinson/fisiopatologia , Núcleo Subtalâmico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Motores/epidemiologia , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
10.
BMC Public Health ; 20(1): 1353, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32887600

RESUMO

BACKGROUND: The population prevalence of many diseases is known. However, little is known of the population prevalence of motor impairments. METHODS: The aim of this study was to determine the point prevalence of specific motor impairments (weakness, fatigue, contracture, impaired balance and impaired coordination) in the population aged 55 years and older resident in New South Wales, Australia in 2018. 55,210 members of the 45 and Up cohort were invited to participate in a follow-up survey that included questions on motor impairment. Responses were received from 20,141 people (36%). Calibrated estimates of prevalence of specific motor impairments, and of having at least one motor impairment, were obtained using survey weights based on the known multivariate distributions of age, gender and geographical location (28 regions) in the population. RESULTS: More than one-third of adults aged over 55 residing in New South Wales have difficulty using their hands, arms or legs. The prevalence of each motor impairment (muscle weakness, fatigue, contracture, impaired balance or impaired coordination) in this population is between 4 and 12%. The prevalence of at least one of these impairments is 21%. The prevalence of at least one impairment in people aged 85 and over is 42%. Women consistently had more difficulty using hands, arms and legs, and more motor impairment, than men. Difficulty using hands, arms and legs and the prevalence of all motor impairments, especially poor balance, greatly increased with age. CONCLUSION: The prevalence of specific motor impairments in older Australian adults is high - comparable to that of the most prevalent diseases. There may be merit in considering motor impairment as a significant public health problem in its own right.


Assuntos
Transtornos Motores/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Contratura/epidemiologia , Estudos Transversais , Fadiga/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/epidemiologia , New South Wales/epidemiologia , Prevalência
11.
Eur J Paediatr Neurol ; 28: 126-132, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32758415

RESUMO

OBJECTIVE: To test the association between exposure to perinatal inflammation - i.e. clinical chorioamnionitis or early-onset neonatal infection - in preterm children without severe neonatal brain injury and neurodevelopmental outcome at 30 months of corrected age (CA). DESIGN: Cross-sectional study from a French regional cohort of clinical follow-up (SEVE Network). PATIENTS: One hundred sixty-four surviving neonates without severe brain injury - namely, grade III and IV cerebral hemorrhage and cystic periventricular leukomalacia - and without late-onset neonatal inflammation exposure - namely, late-onset neonatal infection and necrotizing enterocolitis -, born at less than 33 weeks of gestational age from November 2011 to June 2015 and enrolled in the SEVE Network. MAIN OUTCOME MEASURE: Global developmental quotient (DQ) score of the revised Brunet-Lézine scale and its four indices measured by the same neuropsychologist at 30 months of CA. RESULTS: After multivariate analysis, exposure to perinatal inflammation was not found significantly associated with a modification of the global DQ score (coefficient -1.7, 95% CI -4.8 to 1.3; p = 0.26). Exposure to perinatal inflammation was associated with a decrease of the gross motor function DQ score (coefficient -6.0, 95% CI -9.9 to -2.1; p < 0.01) and a decrease of the sociability DQ score (coefficient -5.1, 95% CI -9.2 to -0.9; p = 0.02). Language and visuospatial coordination DQ scores were not affected by exposure to perinatal inflammation. CONCLUSION: Exposure to perinatal inflammation in preterm children without severe neonatal brain injury is independently associated with decreased motor and social abilities at 30 months of CA.


Assuntos
Corioamnionite , Infecções/complicações , Inflamação/complicações , Transtornos Motores/etiologia , Transtornos do Comportamento Social/etiologia , Criança , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/microbiologia , Recém-Nascido Prematuro , Masculino , Transtornos Motores/epidemiologia , Gravidez , Transtornos do Comportamento Social/epidemiologia
12.
Eur J Paediatr Neurol ; 28: 29-37, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807681

RESUMO

Rett syndrome (RTT) is neurodevelopmental disorder affecting approximately 1:10000-15000 live female births, commonly associated with MECP2 gene mutations. Hand stereotypies and gait disturbance, as well as spasticity and dystonia, were noted in RTT since first descriptions. This review aimed to explore the prevalence of reported movement disorders in RTT. DATA SOURCES AND EXTRACTION: Pubmed and Embase databases for papers describing features of movement disorders in RTT. Papers were selected if included description of case report, cohort or case-series of patients with RTT including descriptions of clinical features of their movement disorder. Papers were divided into 3 epochs - i) Pre-1999,ii) 2000-2009, and iii) 2010 onwards. RESULTS: 32 studies (13 in the first, 10 in the second and 9 in the third epochs) reported on movement disorders in RTT. Hand stereotypies were almost universal, diminishing but not disappearing over time. Gait disturbance and ataxia/tremor were also very common (>50% cases). Hypertonia was also often reported, increasing with age. In earlier descriptions spasticity was commonly described, with greater reference to dystonia/rigidity in more recent reports. Myoclonus and choreoathetosis were uncommonly reported. CONCLUSIONS: Movement disorders beyond hand stereotypies are common in RTT, most notably tremor. Hypertonia is frequently seen in RTT, increasing in prevalence with age, with apparent changes in nomenclature over time, (i.e early epoch spasticity, late epoch dystonia). Dystonia was specifically reported in 229/417 cases. Further work is required to explore the relative contribution of dystonia and rigidity to hypertonia in RTT, as well as the impact of these impairments when present.


Assuntos
Transtornos Motores/genética , Transtornos dos Movimentos/genética , Síndrome de Rett/complicações , Adulto , Feminino , Humanos , Masculino , Transtornos Motores/epidemiologia , Transtornos dos Movimentos/complicações , Transtornos dos Movimentos/epidemiologia , Prevalência
13.
Arch Osteoporos ; 15(1): 91, 2020 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-32556612

RESUMO

Bone health problems may be related to the nutritional deficit in pediatric patients with cerebral palsy. It is common to find asymptomatic vertebral fractures when they have low bone mineral density. Fat mass deficit could be related to a lower bone mineral density and a higher risk of vertebral fractures. OBJECTIVES: To study the bone health of patients with CP and its relationship with neurological and nutritional status. PURPOSE: Cerebral palsy (CP) is the most common cause of motor disability in pediatric age. METHODS: Cross-sectional, observational, descriptive, and analytical study in which patients with CP between 4 and 5 years with Gross Motor Function Classification System (GMFCS) grades III-IV-V were included. It was carried out: survey, anthropometric study, bioimpedanciometry (BIA), and bone densitometry. Patients with low bone mineral density (BMD Z score less than - 2.0) underwent lumbar radiography looking for vertebral fractures to be diagnosed with osteoporosis. RESULTS: Total sample: 51 patients (51.0% women). Mean age: 11.0 ± 0.5 years. BMD Z score average: - 2.1 (95% CI - 2.5, - 1.7). BMD Z score according to GMFCS: grade III - 1.6 (- 2.2; - 1.), grade IV - 1.6 (- 2.4; - 0.9), grade V - 3.1 (- 3.9, - 2.2) (p = 0.013). Bone health classification according to the International Society for Clinical Densitometry was: 47.1% normal, 52.9% low BMD. Relationship between low BMD and low fat mass (p = 0.030) and low cell mass (p = 0.040) was found. Prevalence of vertebral fractures in lumbar radiography: 25.9%, increasing as the degree of neurological involvement. Vertebral fractures were found in 5/13 GMFCS grade V, 2/6 GMFCS grade IV, and 0/10 GMFCS grade III. CONCLUSIONS: Bone health in the pediatric population with CP is compromised in relation to the degree of neurological involvement and nutritional status. Those patients with moderate-severe cerebral palsy and low BMD seem to present an increased risk of fracture.


Assuntos
Densidade Óssea/fisiologia , Paralisia Cerebral/complicações , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Paralisia Cerebral/epidemiologia , Criança , Estudos Transversais , Pessoas com Deficiência , Feminino , Fraturas Ósseas/diagnóstico , Humanos , Masculino , Transtornos Motores/epidemiologia , Transtornos Motores/etiologia , Osteoporose/epidemiologia
14.
J Diabetes Investig ; 11(6): 1602-1611, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32412166

RESUMO

AIMS/INTRODUCTION: To carry out a cross-sectional single-center study in a Japanese hospital to determine the diagnostic value of handgrip measurement to detect locomotive syndrome (LS). MATERIALS AND METHODS: Consecutive outpatients underwent an LS risk test, which comprised a stand-up test and a two-step test, and a handgrip measurement, along with general diabetes-related tests. We calculated the prevalence of LS, and evaluated the association between handgrip strength and LS. RESULTS: We enrolled 234 patients in this study. The prevalence of LS in the stand-up and two-step tests was 51.5 and 79.0%, respectively. The prevalence of LS in the stand-up or two-step tests increased with age both in men and women. Using the stand-up and two-step tests, 107 patients (46.7%) were diagnosed with LS. The area under the receiver operating characteristic curve, used to assess our identification of LS in terms of grip strength in men and women, showed 95% confidence intervals of 0.703 (0.563-0.813) and 0.698 (0.500-0.842), respectively. The odds ratios of grip strength for LS were 0.90 (95% confidence interval 0.83-0.97) and 0.87 (95% confidence interval 0.76-0.98) in men and women, respectively. CONCLUSIONS: Our findings showed that handgrip measurement was useful in detecting LS, and LS should be considered when evaluating patients with type 2 diabetes mellitus.


Assuntos
Biomarcadores/análise , Diabetes Mellitus Tipo 2/fisiopatologia , Força da Mão , Locomoção , Transtornos Motores/diagnóstico , Força Muscular , Adulto , Idoso , Idoso de 80 Anos ou mais , Benchmarking , Glicemia/análise , Estudos Transversais , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Transtornos Motores/epidemiologia , Transtornos Motores/metabolismo , Prognóstico , Adulto Jovem
15.
Early Hum Dev ; 146: 105056, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32470764

RESUMO

BACKGROUND: The Movement Assessment Battery for Children-Second Edition (Movement ABC-2) is widely used to assess children's motor function, yet there is a lack of normative data for many countries. AIMS: To assess the extent to which the application of different population reference norms for the Movement ABC-2 affects the classification and prevalence of motor impairment. DESIGN: Data were obtained from two Portuguese regions participating in the Screening to Improve Health in Very Preterm Infants in Europe (SHIPS) Study, which was a five year follow-up of a cohort of children born at <32 weeks' gestation in 2011-2012 in 19 regions in 11 European countries. Perinatal data were extracted from medical records and the Movement ABC-2 was administered at five years of age. SUBJECTS: Of 542 Portuguese children eligible for the five-year follow-up, 413 (76.2%) were evaluated. OUTCOME MEASURES: Movement ABC-2 raw scores were converted to standardized scores using norms from four countries with national standardisations (UK, Netherlands/Belgium, France and Italy). RESULTS: The prevalence of significant movement difficulties (total score ≤ 5th percentile) was 28.5% using Dutch/Flemish norms, 23.3% using French norms, 16.5% using UK norms and 11.4% using Italian norms; 10.8% and 68.3% of the children were consistently classified as having significant movement difficulties and as not having significant movement difficulties, respectively, according to any norms. However, for 20.9% of children there was a disagreement in motor function status using different norms. CONCLUSION: The use of different test norms has a large impact on the proportion of children classified with significant movement difficulties, with implications for clinical referrals, healthcare costs and research. Our results underscore the importance of using appropriately validated tests with sound psychometric properties, and raise questions about the large differences in norms for the Movement ABC-2 in European countries.


Assuntos
Lactente Extremamente Prematuro , Transtornos Motores/diagnóstico , Transtornos das Habilidades Motoras/diagnóstico , Adulto , Pré-Escolar , Feminino , Humanos , Recém-Nascido , Masculino , Idade Materna , Transtornos Motores/epidemiologia , Transtornos das Habilidades Motoras/epidemiologia , Portugal/epidemiologia , Gravidez , Fatores Socioeconômicos
16.
PLoS One ; 15(5): e0233349, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32469951

RESUMO

BACKGROUND: Numerous studies have noted the presence of a dysexecutive component of the ALS-FTD. The most widely replicated result refers to the significantly reduced verbal fluency of ALS patients when compared to healthy people. As ALS patients have motor alterations that interfere with production, qualitative studies have the advantage of being independent of the degree of motor disability and revealing patients' cognitive state. This study examined the production differences between 42 ALS patients who presented with different degrees of dementia and motor impairment and 42 healthy people. Production processes were studied by extending the administration time of a letter fluency task to 2 minutes for the phonemic verbal fluency (PVF) and semantic verbal fluency (SVF) categories. This ensured that the qualitative aspects of verbal fluency were addressed, paying special attention to the new perseverations and intrusions, as well as any clinical correlates that may exist. RESULTS: The ALS patients produced a significantly lower number of responses in PVF (p = .017) and SVF (p = .008). The rest of the indicators for frontal lobe alteration also suggested the existence of a dysfunction. The most remarkable results were the number of intrusions on the PVF task, which was much higher in the ALS group (p = .002). However, the number of perseverations did not differ significantly. CONCLUSIONS: This study highlights the value of intrusions in addressing cognitive deterioration in ALS patients. This deterioration seems to be independent of the degree of motor impairment and of behavioural alterations. Therefore, the value of the intromissions on the verbal fluency task was highlighted as an indicator of a new cognitive alteration, which can be easily evaluated, even retrospectively.


Assuntos
Esclerose Amiotrófica Lateral/fisiopatologia , Transtornos Cognitivos/epidemiologia , Transtornos da Linguagem/epidemiologia , Transtornos Motores/epidemiologia , Semântica , Comportamento Verbal , Estudos de Casos e Controles , Criança , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia
17.
Int J Speech Lang Pathol ; 22(5): 526-536, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32114835

RESUMO

Purpose: The aim was to investigate, describe and analyse speech characteristics, intelligibility, orofacial function and co-existing neurodevelopmental symptoms in children with SSD of unknown origin, persisting after six years of age.Method: The study included 61 children with SSD (6-17 years) of unknown origin, referred for a speech and oral motor examination. The severity of SSD was estimated using Percentage Consonants Correct (PCC) and Percentage Vowels Correct (PVC) and assessments of resonance based on Swedish Articulation and Nasality Test (SVANTE). Orofacial function was screened using the Nordic Orofacial Test-Screening (NOT-S). Parents completed the Intelligibility in Context Scale (ICS) and a questionnaire including questions about heredity, medical and neurodevelopmental conditions, and speech development.Result: SSD varied according to PCC (8-95%) and PVC (55-100%) measurements. Percentages of co-occurring disorders included: 51% resonance deviations, 90% intelligibility issues, and 87% orofacial difficulties. The most affected orofacial domains were "Chewing and swallowing" (41%), "Masticatory muscles and jaw function" (38%) and "Sensory function" (38%). The majority (64%) had co-existing dysfunctions relating to general motor and neurodevelopmental disorders.Conclusion: Children with persistent SSD are at risk for orofacial dysfunction, general motor difficulties and other neurodevelopmental disorders and therefore should be screened for co-occurring disorders.


Assuntos
Transtornos Motores/complicações , Transtornos Motores/epidemiologia , Transtorno Fonológico/fisiopatologia , Adolescente , Criança , Face/fisiopatologia , Feminino , Humanos , Masculino , Boca/fisiopatologia , Transtornos do Neurodesenvolvimento/epidemiologia , Transtornos do Neurodesenvolvimento/fisiopatologia , Inteligibilidade da Fala , Transtorno Fonológico/complicações
18.
Phys Ther ; 100(4): 633-644, 2020 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-32154876

RESUMO

BACKGROUND: Motor impairments are pervasive in Autism Spectrum Disorder (ASD); however, children with ASD rarely receive a dual diagnosis of Developmental Coordination Disorder (DCD). The Simons Foundation SPARK study engaged families affected by ASD through an online study. OBJECTIVES: The DCD parent questionnaire (DCDQ) was used to assess the prevalence of a risk for motor impairment or DCD in children with ASD between 5 and 15 years of age. DESIGN: This study utilizes parent reports from a large database of children with ASD. METHODS: A total of 16,705 parents of children with ASD completed the DCDQ. We obtained our final SPARK dataset (n = 11,814) after filtering out invalid data, using stronger cut-offs to confirm ASD traits, and excluding children with general neuromotor impairments/intellectual delays. We compared DCDQ total and subscale scores from the SPARK dataset with published norms for each age between 5 and 15 years. RESULTS: The proportion of children with ASD at risk for a motor impairment was very high at 86.9%. Children with ASD did not outgrow their motor impairments and continued to present with a risk for DCD even into adolescence. Yet, only 31.6% of children were receiving physical therapy services. LIMITATIONS: Our analysis of a large database of parent-reported outcomes using the DCDQ did not involve follow-up clinical assessments. CONCLUSIONS: Using a large sample of children with ASD, this study shows that a risk for motor impairment or DCD was present in most children with ASD and persists into adolescence; however, only a small proportion of children with ASD were receiving physical therapist interventions. A diagnosis of ASD must trigger motor screening, evaluations, and appropriate interventions by physical and occupational therapists to address the functional impairments of children with ASD while also positively impacting their social communication, cognition, and behavior. Using valid motor measures, future research must determine if motor impairment is a fundamental feature of ASD.


Assuntos
Transtorno do Espectro Autista/complicações , Transtornos Motores/etiologia , Transtornos das Habilidades Motoras/etiologia , Adolescente , Fatores Etários , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Criança , Pré-Escolar , Transtornos da Comunicação/epidemiologia , Bases de Dados Factuais , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Transtornos Motores/diagnóstico , Transtornos Motores/epidemiologia , Transtornos das Habilidades Motoras/diagnóstico , Transtornos das Habilidades Motoras/epidemiologia , Pais , Medição de Risco
19.
J Clin Neurosci ; 73: 150-154, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32001113

RESUMO

INTRODUCTION: STN-DBS has been claimed to change progressionsymptomsin animal models of PD, but information is lacking about the possible neuromodulatory role of STN-DBS in humans. The aim of this prospective controlled study was to evaluate the long-term impact of STN-DBS on motor disabilities and cognitive impairment in PD patients in comparison to Best-Medical-Therapy (BMT) and Long-term-Post-Operative (POP) groups. MATERIAL AND METHODS: Patients were divided into 3 groups: the BMT-group consisted of 20 patients treated only with pharmacotherapy, the DBS-group consisted of 20 PD patients who underwent bilateral STN-DBS (examined pre- and postoperatively) and the POP-group consisted of 14 long-term postoperative patients in median 30 month-time after DBS. UPDRS III scale was measured during 3 visits in 9 ± 2 months periods (V1, V2, V3) in total-OFF phase. Cognitive assessment was performed during each visit in total-ON phase. RESULTS: The comparable UPDRS III OFF gain was observed in both BMT-group and POP-group evaluations (p < 0.05). UPDRS III OFF results in DBS-group revealed significant UPDRS III OFF increase in ΔV2-V1 assessment (p < 0.05) with no significant UPDRS III OFF alteration in ΔV3-V2 DBS-group evaluation (p > 0.05). Cognitive assessment revealed significant alterations between DBS-group and BMT-group in working memory, executive functions and learning abilities (p < 0.05). CONCLUSIONS: The impact of STN-DBS on UPDRS III OFF score and cognitive alterations suggest its neuromodulatory role, mainly during the first 9-18 months after surgery.


Assuntos
Disfunção Cognitiva , Estimulação Encefálica Profunda/métodos , Transtornos Motores , Doença de Parkinson/complicações , Doença de Parkinson/terapia , Idoso , Antiparkinsonianos/uso terapêutico , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Motores/epidemiologia , Transtornos Motores/etiologia , Estudos Prospectivos , Núcleo Subtalâmico/fisiologia , Resultado do Tratamento
20.
Brain Dev ; 42(3): 256-263, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31982226

RESUMO

OBJECTIVES: We assessed the severity and pathology of osteoporosis in children and adults with severe motor and intellectual disabilities (SMID) by evaluating bone enzymes, by which we aimed to determine adequate treatment approaches for preventing fractures. METHODS: Ninety patients (44 men, 46 women; mean age, 34.5 years) underwent bone quality assessment. Quantitative ultrasonography (QUS) was used to measure the T-score and Z-score of the calcaneus, and blood tests were used to measure bone-specific alkaline phosphatase and tartrate-resistant acid phosphatase 5b levels as bone formation and resorption markers, as well as calcium, phosphorous, and parathyroid hormone levels as routine examination. RESULTS: Bone formation and resorption marker levels were within normal ranges in adults, although they were high during the growth period in children and adolescents and in elderly women. Patients receiving tube feeding showed a significantly lower Z-score than those without tube feeding. Tube feeding was a significant factor for the Z-score, whereas age, vitamin supplements, and anti-epileptic drugs were not. CONCLUSIONS: The severity of osteoporosis in SMID started during the growth period and seems to be caused by a lack of an effective increase in bone mineral density. Any treatment should be started during the growth period. More study about tube feeding is needed.


Assuntos
Densidade Óssea , Nutrição Enteral , Deficiência Intelectual , Limitação da Mobilidade , Transtornos Motores , Osteoporose/diagnóstico , Fosfatase Ácida Resistente a Tartarato/sangue , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Comorbidade , Nutrição Enteral/estatística & dados numéricos , Feminino , Humanos , Deficiência Intelectual/epidemiologia , Masculino , Pessoa de Meia-Idade , Transtornos Motores/epidemiologia , Osteoporose/sangue , Osteoporose/diagnóstico por imagem , Osteoporose/epidemiologia , Tóquio/epidemiologia , Ultrassonografia , Adulto Jovem
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