Neurology International

332 KiB

Open AccessCase Report

Atypical Presentation of Lyme Neuroborreliosis Related Meningitis and Radiculitis

by Iman Dabiri, Nicholas Calvo, Feryal Nauman, Mahsa Pahlavanzadeh and Ahmet Z. Burakgazi

Neurol. Int. 2019, 11(4), 8318; https://doi.org/10.4081/ni.2019.8318 - 2 Dec 2019

Cited by 2 | Viewed by 664

Lyme disease related central and peripheral nervous system manifestations can occur in isolation or together. Radiculitis or inflammation of the nerve root can be seen 3-5% of the time in acute neuroborreliosis affecting the PNS with a typical presentation and meningitis affecting the CNS is usually seen 1% of the time. The appropriate diagnosis and management of neuroborelliosis can be challenging and require meticulous medical approaches. Herein we present a unique case of Lyme disease with neurologic manifestations including both radiculitis and meningitis due to its atypical and challenging clinical presentation and management with updated literature review. Full article

388 KiB

Open AccessArticle

Dynamics of Inflammatory Factors Expression in Ischemic Brain Tissue Injury

by Tonko Marinović, Silvio Bašić, Dominik Romić, Branimir Nevajda, Lovorka Đerek, Jurica Maraković and Marina Raguž

Neurol. Int. 2019, 11(4), 8282; https://doi.org/10.4081/ni.2019.8282 - 2 Dec 2019

Cited by 3 | Viewed by 624

Abstract

Ischemic stroke is one of the most common cause of mortality and disability in the modern world. Still, therapeutic options remains modest. Aim of the study was to present dynamics of inflammatory factors expression (C reactive protein, procalcitonin, interleukin 10) in patients after ischemic stroke. Our study included 101 patients divided in thrombolised and non-thrombolised groups. Inflammatory factors concentration in serum was determinate at admission, 24, 48 hours and seven days after the initial onset, while neurological assessment was measured at the admission, 24 hours, seven days and three months after the initial onset using National Institute of Health Stroke Scale and Rankin Scale. Certain pattern was observed in dynamics of inflammatory factors: intensive increase in first and second day after the stroke, followed by decrease till day seven in both groups. Additionally, thrombolised group showed significant neurological improvement. Although well investigated, the role of inflammatory factors in the ischemic stroke still stays controversial. High association of C reactive protein and interleukin 10 values suggest potential prognostic role in patients follow-up, while the role of procalcitonin values still remains unclear. Full article

492 KiB

Open AccessArticle

Investigation of Apomorphine during Sleep in Parkinson’s: Improvement in UPDRS Scores

by Miguel A. Pieroni

Neurol. Int. 2019, 11(4), 8207; https://doi.org/10.4081/ni.2019.8207 - 2 Dec 2019

Cited by 4 | Viewed by 1253

Abstract

Sleep is responsible for several functions required for homeostasis. REM sleep could be a rearrangement period where limits of certain functions can be moved to a new state of balance. This study proposes that dopaminergic deficit may be responsible for the circadian dysregulation that occur with neurodegeneration and therefore a restitution of REM sleep and an improvement in Parkinson disease’s symptoms can be achieved with the controlled use of dopamine agonists during the night. Twenty parkinsonian patients underwent to a onemonth study of subcutaneous nocturnal apomorphine treatment at the beginning of each REM stage. This therapeutic approach led to a significant benefit for patients in all of the 3 UPDRS scores. The mean change from baseline in the MDS-UPDRS Part I, II and III was significantly greater in the apomorphine vs. placebo group. In the UPDRS Part I total score was 0.8 (95% confidence interval [CI]: 1.612, -0.012) and 3.3 (95% CI: 4.732, 1.867) for the placebo and apomorphine groups, respectively (difference between groups: 2.5, 95% CI: 3.454, 1.545; P = 0.002). For UPDRS Part II total score, the mean change was 1.3 (95% CI: 2.692, - 0.09) and 4.6 (6.916, 2.28). Difference between groups: 3.3, 95% CI: 4.752, 1.847; P = 0.013. In UPDRS Part III was 1.1 (95% CI: 2.425, -0.225) and 5.5 (95% CI: 8.808, 2.191). Difference between groups: 4.4, (95% CI: 6.321, 2.478; P = 0.012). We can conclude that sleep alteration in PD can be improved by stimulation of D2 receptors. The symptomatic benefits obtained due to restoration of REM functions were significant. Full article

315 KiB

Open AccessArticle

Electrodiagnostic Findings in Myotonic Dystrophy: A Study on 12 Patients

by Ahmet Z. Burakgazi

Neurol. Int. 2019, 11(4), 8205; https://doi.org/10.4081/ni.2019.8205 - 2 Dec 2019

Cited by 1 | Viewed by 650

Abstract

Myotonic dystrophy (DM) is a complex multisystem disease with specific clinical and electrodiagnostic findings. Myotonia can be seen in the distal and proximal muscle groups in upper and lower limbs. There is no established guideline to demonstrate the sensitivity of muscles in the diagnosis of myotonic dystrophy. The aims of this study are to describe common electrodiagnostic findings in patients with DM; and to assess the electrodiagnostic sensitivity of muscles in the diagnosis of DM. In this retrospective study, patients’ age, sex, nerve conduction study findings including common upper and lower limbs nerve functions, and needle examination findings were collected and analyzed. A descriptive analysis (with percentage) was performed on the data obtained from the charts. NCS analysis showed more than half of patients had normal sensory and motor NCS findings. In 11 over 12 patients, sensory NCSs were within normal limits. Only one patient showed abnormal sensory responses. The most common abnormal NCS findings were decreased amplitude with normal latency and normal conduction velocity. The needle analysis showed distal muscles including first dorsal interosseous, abductor policies brevis, tibialis anterior, medial gastrocnemius and peroneal longus muscles are more sensitive in detecting myotonic discharges than proximal muscles including deltoid, triceps, vastus medialis and vastus lateralis. Our findings showed sensory nerve responses were usually within normal limits. The most common NCS abnormality showed decreased motor nerve amplitudes. The needle test showed myotonic discharges were more prominent in the distal muscles in upper and lower limbs. Full article

427 KiB

Open AccessArticle

Interferon β-1a Subcutaneously 3 Times/Week Clinical Outcome in Relapsing Multiple Sclerosis in Finland

by Elina Järvinen, Annukka Murtonen, Melina Tervomaa and Marja-Liisa Sumelahti

Neurol. Int. 2019, 11(4), 8177; https://doi.org/10.4081/ni.2019.8177 - 29 Nov 2019

Cited by 1 | Viewed by 608

Abstract

Prognostic factors and long-term treatment response of interferon β-1a s.c tiw has not been studied in a real-life clinical cohort in Finland. The aim of the paper was to evaluate long-term treatment response, prognostic clinical factors and adherence among interferon β-1a s.c tiw treated patients in Finland. A retrospective review of medical records was performed. Confirmed relapsing multiple sclerosis patients treated with interferon β-1a s.c tiw 22μg or 44μg as their first treatment, from 1996 to 2010 in Western Finland, were included. Longitudinal generalized linear regression models were applied to assess risk of disability progression, using Expanded Disability Status Scale (EDSS), during the treatment period. Odd’s ratios with 95% confidence intervals (95% CI) were calculated for risk factors: gender, age at diagnosis, treatment delay, dose, baseline EDSS and EDSS change in one year. Kaplan-Meier was applied to study median time to discontinuation. Mean duration of treatment in 293 cases was 2.9 years (min 0.04, max 13.5). EDSS increase vs. no increase in one-year carried a significant risk for long-term disability progression (1.20, 1.08-1.33). Older age, defined by a 10-year increase in age at diagnosis (1.43, 1.07 -1.91) and one-year delay to treatment start showed an increased risk for disability progression (1.05, 0.99-1.11), but gender (0.66, 0.38-1.15) or initial dose (1.00, 0.45-2.25) showed no risk. Treatment was stopped in 37% due to disease activation at median of 1.7 years, and in 25% due to side effects at 9.3 months. Our results show that young age, a short delay to treatment start and slower disability progression were identified as factors for better outcome among cases with interferon β-1a s.c tiw as their first disease modifying treatment. Full article

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Neurol. Int., Volume 11, Issue 4 (November 2019) – 5 articles

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