Giuseppina Russo

Focal Muscle Vibration in the Treatment of Upper Limb Spasticity: A Pilot Randomized Controlled Trial in Patients With Chronic Stroke

OBJECTIVE To examine the clinical effect of repetitive focal muscle vibration (rMV) on the motor function of the upper extremity 1 month after treatment in patients with chronic stroke. DESIGN We performed a pilot randomized controlled trial using a double-blind, parallel-group study design. SETTING Medical center. PARTICIPANTS Patients with chronic stroke (N=49). INTERVENTIONS Patients randomly assigned to the study group (SG) received rMV, while patients in the control group (CG) received a placebo vibratory treatment. The patients and the clinical examiner were blind to the intervention. MAIN OUTCOME MEASURES The primary endpoint was an improvement of more than .37 points on the Functional Ability Scale of the Wolf Motor Function Test (WMFT FAS). The Modified Ashworth Scale and the visual analog scale were the secondary outcome measures. All measures were administered before the treatment (t0) and 1 week (t1) and 1 month (t2) after the treatment. RESULTS Twenty-eight patients were allocated to the SG and 21 to the CG. The analysis of variance for repeated measurements revealed a significant difference in the expression of the WMFT FAS score over time only in the SG (P=.006). The treatment was successful for 7 (33%) of 21 patients recruited in the SG and for 2 (13%) of 15 patients recruited in the CG. The relative risk was 2.5 (95% confidence interval, .60-10.39), and the number needed to treat was 5. The Wilcoxon test showed a statistically significant difference between t0 and t2 in the SG (P=.02). No adverse event was observed in the 2 groups. CONCLUSIONS Our results suggest that rMV treatment of the upper limb may improve the functional ability of chronic stroke patients, but a larger, multicenter, randomized controlled study is needed.

Prevalence of bifid median nerve at wrist assessed through ultrasound.

We performed a prospective study to evaluate the prevalence of bifid median nerve (BMN) and if it has a higher prevalence in carpal tunnel syndrome (CTS) patients than symptom-free subjects. We evaluated by ultrasound (US) 162 median nerves at wrist of 89 consecutive patients with symptoms suggestive of CTS and 104 of 52 consecutive symptom-free subjects. Neurophysiological evaluation confirmed CTS diagnosis. All patients underwent ultrasonographic evaluation of median nerve in the elbow–palm segment through high-frequency probe; BMN was arbitrarily classified as “complete” and “incomplete” on the basis of US results. BMN was observed in 16/104 wrists (15.4%) in control group and in 30/162 (18.5%) wrists in CTS group. Our study showed that BMN is frequent, not always bilateral, more often is “incomplete” and it has similar prevalence in CTS and control group. These findings suggest that BMN is not a risk factor of developing CTS.

Prefrontal cortex controls human balance during overground ataxic gait

PURPOSE 1) to verify if prefrontal cortex (PFC) is activated during over ground walking in ataxic patients, 2) to correlate the clinical parameters of gait with the PFC activation patterns. METHODS Fourteen patients and 20 healthy subjects were studied. Ataxia was assessed by the Scale for the Assessment and Rating of Ataxia (SARA). A 2-channel near-infrared system was used to investigate the changes in oxygenated ([O2Hb]t) and deoxygenated ([HHb]t) hemoglobin concentrations on the PFC during gait. [O2Hb] baseline-corrected activation values ([O2Hb]c) were calculated by the difference between [O2Hb]t and [O2Hb] during upright posture ([O2Hb]b). RESULTS [O2Hb]t was increased for both channels (respectively p < 0.01 and p = 0.01) only in the patients. No variation was observed in [HHB]t. The correlation coefficient between [O2Hb]c and the SARA gait score was respectively r: 0.878 (p < 0.01) and r: 0.839 (p < 0.01) for the right and left PFC, between [O2Hb]c and the SARA stance score respectively r: 0.893 (p < 0.01) and r: 0.832 (p < 0.01). CONCLUSIONS During over ground gait PFC is bilaterally activated in patients with severe chronic ataxia. These findings may be associated with compensatory mechanisms which are involved in severe conditions when other nervous centers controlling balance are functionally not efficient.

Effects of unilateral pedunculopontine stimulation on electromyographic activation patterns during gait in individual patients with Parkinson’s disease

In Parkinson’s disease (PD), the effects of deep brain stimulation of the pedunculopontine nucleus (PPTg-DBS) on gait has been object of international debate. Some evidence demonstrated that, in the late swing-early stance phase of gait cycle, a reduced surface electromyographic activation (sEMG) of tibialis anterior (TA) is linked to the striatal dopamine deficiency in PD patients. In the present study we report preliminary results on the effect of PPTg-DBS on electromyographic patterns during gait in individual PD patients. To evaluate the sEMG amplitude of TA, the root mean square (RMS) of the TA burst in late swing-early stance phase (RMS-A) was normalized as a percent of the RMS of the TA burst in late stance-early swing (RMS-B). We studied three male patients in the following conditions: on PPTg-DBS/on l-dopa, on PPTg-DBS/off l-dopa, off PPTg-DBS/on l-dopa, off PPTg-DBS/off l-dopa. For each assessment the UPDRS III was filled in. We observed no difference between on PPTg-DBS/off l-dopa and off PPTg-DBS/off l-dopa in UPDRS III scores. In off PPTg-DBS/off l-dopa, patient A (right implant) showed absence of the right and left RMSA, respectively, in 80% and 83% of gait cycles. Patient B (right implant) showed absence of the right RMS-A in 86% of cycles. RMS-A of the patient C (left implant) was bilaterally normal. In on PPTg- DBS/off l-dopa, no patient showed reduced RMS-A. Although the very low number of subjects we evaluated, our observations suggest that PPTg plays a role in modulating TA activation pattern during the steady state of gait.

fNIRS evaluation during a phonemic verbal task reveals prefrontal hypometabolism in patients affected by myotonic dystrophy type 1

OBJECTIVE Myotonic dystrophy type 1 (DM1), the most common muscular dystrophy in adults, is characterized by a multisystem involvement. Cognitive involvement predominantly affecting frono-temporal functions is an established clinical feature in this disorder. Brain imaging and metabolic studies showed a predominant involvement of fronto-temporal regions in DM1 patients, yet correlation studies among these findings and neuropsychological data gave contrasting results. In order to contribute to clarify the relationship between the metabolic changes documented in the frontal cortex of DM1 patients and a related cognitive task, we applied the functional near-infrared spectroscopy (fNIRS) during the execution of a phonemic verbal fluency task (pVFT). METHODS We enrolled 29 consecutive right-handed DM1 patients and 30 controls. A 2-channel fNIRS imaging system was used to investigate changes in oxygenated [O2Hb] and deoxygenated [HHb] hemoglobin concentrations in the prefrontal cortex (PFC) during a pVFT. [O2Hb] and [HHb] baseline-corrected activation values were calculated (respectively [O2Hb]c and [HHb]c). RESULTS In the control group [O2Hb] significantly increased and [HHb] significantly decreased during the pVFT, in the DM1 group no significant variation was found for both parameters revealing no activation of both PFCs during the task. On the other hand, in the DM1 sample, statistical analysis revealed a direct correlation between [O2Hb]c of the left PFC and the pVFT score, while no correlation was observed in the control group. CONCLUSIONS Our study reveals that DM1 patients show prefrontal hypometabolism during a specific frontal cognitive task compared to controls. Moreover the rapid temporal discrimination of fNIRS allows revealing the correlation between the PFC hypometabolism and the cognitive performance in DM1 patients. SIGNIFICANCE fNIRS can be helpful to understand the functional correlates of the frontal cognitive impairment in DM1.

P25.11 Influence of gender on upper limb motor-sensory function and pain in stroke patients

P25.8 Corticospinal reorganisation symmetry contributes to recovery after stroke S. Graziadio1, G. Assenza2, L. Tomasevic3, F. Tecchio3, J. Eyre1 1Developmental Neuroscience, Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom, 2Neurologia Clinica, Università Campus Biomedico, Rome, Italy, 3LET’S Laboratory of Electrophysiology for Translational neuroScience ISTC-Consiglio Nazionale delle Ricerche (CNR), Rome, Italy