Archive for November, 2015

[ARTICLE] The case for medical marijuana in epilepsy – Full Text HTML/PDF

Summary

EpilepsiaCharlotte, a little girl with SCN1A-confirmed Dravet syndrome, was recently featured in a special that aired on CNN. Through exhaustive personal research and assistance from a Colorado-based medical marijuana group (Realm of Caring), Charlotte’s mother started adjunctive therapy with a high concentration cannabidiol/Δ9-tetrahydrocannabinol (CBD:THC) strain of cannabis, now known as Charlotte’s Web. This extract, slowly titrated over weeks and given in conjunction with her existing antiepileptic drug regimen, reduced Charlotte’s seizure frequency from nearly 50 convulsive seizures per day to now 2–3 nocturnal convulsions per month. This effect has persisted for the last 20 months, and Charlotte has been successfully weaned from her other antiepileptic drugs. We briefly review some of the history, preclinical and clinical data, and controversies surrounding the use of medical marijuana for the treatment of epilepsy, and make a case that the desire to isolate and treat with pharmaceutical grade compounds from cannabis (specifically CBD) may be inferior to therapy with whole plant extracts. Much more needs to be learned about the mechanisms of antiepileptic activity of the phytocannabinoids and other constituents of Cannabis sativa.

Continue HTML —>  The case for medical marijuana in epilepsy – Maa – 2014 – Epilepsia – Wiley Online Library

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Apathy Secondary to Stroke: A Systematic Review and Meta-Analysis – Full Text HTML

Abstract

Background: Apathy is a disturbance of motivation, frequent in survivors of stroke. Several studies have evaluated the rate of apathy secondary to stroke and risk factors. Different conclusions and contradictory findings have been published. We aimed to perform a systematic review and meta-analysis of all studies evaluating apathy secondary to stroke to better estimate its rate and risk factors, and explore associations with poorer outcomes.

Methods: We searched PubMed, Cochrane Library, PsychINFO and PsycBITE databases and screened references of included studies and review articles for additional citations. Search results and data extraction was performed independently. We systematically reviewed available publications reporting investigations on ischemic and intracerebral hemorrhagic stroke and apathy. Quality assessment of the studies was performed independently. Subgroup analyses were performed according to stroke phase (acute and post-acute), stroke past history (first-ever and any-stroke) and patient age (younger and older patients). Pooled odds ratios (OR) and standardized mean difference, and 95% confidence intervals (CI), were derived by random-effects meta-analysis. Heterogeneity was assessed with I2 test.

Results: From the initial 1,399 publications, we included 19 studies (2,221 patients). The pooled rate of apathy was 36.3% (95% CI 30.3–42.8; I2 = 46.8), which was similar for acute [39.5% (95% CI 28.9–51.1)] and post-acute phase [34.3% (95% CI 27.8–41.4)], and about three times higher than the rate of depression [12.1% (95% CI 8.2–17.3)]. Apathetic patients were on average 2.74 years older (95% CI 1.25–4.23; I2 = 0%). No gender differences were found. Depression (OR 2.29; 95% CI 1.41–3.72; I2 = 44%) and cognitive impairment (OR 2.90; 95% CI 1.09–7.72; I2 = 14%) were more frequent and severe in apathetic patients. Apathy rate was similar for ischemic and hemorrhagic stroke type and for left- and right-sided hemispheric lesions. Clinical global outcome was similar between apathetic and nonapathetic patients.

Conclusion: Apathy secondary to stroke is a more frequent neuropsychiatric disturbance than depression. Apathetic patients are more frequently and severely depressed and cognitively impaired. A negative impact of apathy secondary to stroke on clinical global outcome cannot be ascribed. Future research should properly address its predictor factors and evaluate the impact of apathy treatment options in stroke patients.

Continue —> Apathy Secondary to Stroke: A Systematic Review and Meta-Analysis – FullText – Cerebrovascular Diseases 2013, Vol. 35, No. 1 – Karger Publishers

Literature search and results (systematic review flow chart).

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[WEB SITE] How To Get The Most Out Of Your Hand Strengthening Program Following A Stroke – Saebo

How to Get the Most Out of Your Hand Strengthening Program Following a Stroke

If you are setting out on a hand-strengthening program following a stroke or spinal cord injury, you are seeking to retrain your muscles, joints, mind and central nervous system. All were injured during your neurological event, and all need healing.

Retraining and strengthening a hand is complex and difficult work. It involves much more than going through the mechanical motions. The biggest challenge may be focusing your mind on the healing process, even as your brain, itself, continues to heal.

Listed below are four, simple but powerful, strategies to help stick to your hand strengthening program.

Continue —>  How To Get The Most Out Of Your Hand Strengthening Program Following A Stroke – SaeboSaebo

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Testing A New Drug For Traumatic Brain Injury

Traumatic Brain Injury: Centre for Neuro Skills

UT Southwestern, the National Institutes of Health and other partners announced that they’ll study a new drug that could help stop bleeding in the brain.

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[ARTICLE] Does stroke location predict walk speed response to gait rehabilitation? – Full Text PDF/HTML

Abstract

Objectives

Recovery of independent ambulation after stroke is a major goal. However, which rehabilitation regimen best benefits each individual is unknown and decisions are currently made on a subjective basis. Predictors of response to specific therapies would guide the type of therapy most appropriate for each patient. Although lesion topography is a strong predictor of upper limb response, walking involves more distributed functions. Earlier studies that assessed the cortico-spinal tract (CST) were negative, suggesting other structures may be important.

Experimental Design: The relationship between lesion topography and response of walking speed to standard rehabilitation was assessed in 50 adult-onset patients using both volumetric measurement of CST lesion load and voxel-based lesion–symptom mapping (VLSM) to assess non-CST structures. Two functional mobility scales, the functional ambulation category (FAC) and the modified rivermead mobility index (MRMI) were also administered. Performance measures were obtained both at entry into the study (3–42 days post-stroke) and at the end of a 6-week course of therapy. Baseline score, age, time since stroke onset and white matter hyperintensities score were included as nuisance covariates in regression models.

Principal Observations: CST damage independently predicted response to therapy for FAC and MRMI, but not for walk speed. However, using VLSM the latter was predicted by damage to the putamen, insula, external capsule and neighbouring white matter.

Conclusions

Walk speed response to rehabilitation was affected by damage involving the putamen and neighbouring structures but not the CST, while the latter had modest but significant impact on everyday functions of general mobility and gait.

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Continue HTML —> Does stroke location predict walk speed response to gait rehabilitation? – Simon Jones – 2015 – Human Brain Mapping – Wiley Online Library

Figure 1. Lesion overlap map from the 50 participants overlaid on a standard MNI space brain after the right-sided lesions had been flipped to the left side (see Methods section), and projected onto the whole set of axial slices from the canonical normal subject T1-weighted MRI in Montreal Neurological Institute (MNI) space. The number of participants in each pixel is shown on the pseudo-colour scale on the right. The maximum number of participants with a lesion for any voxel was 24 (red colour) and involved the striato-capsular area and corona radiata. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]

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[ARTICLE] May clinical neurophysiology help to predict the recovery of neurological early rehabilitation patients? – Full Text HTML

Abstract

Background: So far, the role of clinical neurophysiology in the prediction of outcome from neurological and neurosurgical early rehabilitation is unclear.

Methods: Clinical and neurophysiological data of a large sample of 803 early rehabilitation cases of the BDH-Clinic Hessisch Oldendorf in Northern Germany have been carefully reviewed. Most patients (43.5 %) were transferred to rehabilitation after stroke, mean age was 66.6 (15.5) years. Median somatosensory (SEP), auditory (AEP) and visual evoked potentials (VEP) along with EEG recordings took place within the first two weeks after admission. Length of stay (LOS) in early rehabilitation was 38.3 (37.2) days.

Results: Absence of SEP on one or both sides was associated with poor outcome, χ2 = 12.98 (p = 0.005); only 12.5 % had a good outcome (defined as Barthel index, BI ≥50) when SEP were missing on both sides. In AEP, significantly longer bilateral latencies III were observed in the poor outcome group (p < 0.05). Flash VEP showed that patients in the poor outcome group had a significantly longer latency III on both sides (p < 0.05). The longer latency III, the smaller BI changes (BI discharge minus admission) were observed (latency III right r = −0.145, p < 0.01; left r = −0.206, p < 0.001). While about half of the patients with alpha EEG activity belonged to the good outcome group (80/159, 50.3 %), only 39/125 (31.2 %) with theta and 5/41 (12.2 %) with delta rhythm had a favourable outcome, χ2 = 24.2, p < 0.001.

Conclusions: Results from this study suggest that loss of median SEP, prolongation of wave III in AEP and flash-VEP as well as theta or delta rhythms in EEG are associated with poor outcome from neurological early rehabilitation. Further studies on this topic are strongly encouraged.

When patients had alpha EEG-activity, BI on admission, at discharge and changes of BI (discharge minus admission) were significantly higher than patients with theta or delta activity (ANOVAs with LSD-tests, p < 0.001)

Continue —> May clinical neurophysiology help to predict the recovery of neurological early rehabilitation patients? – Springer

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[WEB SITE] New Tool Detects Epileptic Foci – Medscape

Researchers are using a powerful imaging tool to locate hard-to-find epileptic foci. Glutamate chemical exchange saturation transfer (GluCEST) is a high-resolution MRI technique that measures how much glutamate is in the hippocampus.

Glutamate is the most common excitatory neurotransmitter in the central nervous system. Studies show that it is increased ictally (during seizures), interictally (between seizures), and post-mortem in the epileptic focus.

“In epilepsy, the central underlying hypothesis is that when someone has a seizure, there is some mismatch between how much inhibition of glutamate there is and how much excitation there is,” explained Kathryn Adamiak Davis, MD, assistant professor, neurology, University of Pennsylvania, Philadelphia.
The study, published October 14 in Science Translational Medicine, was very small, including only four patients with epilepsy, but had “such striking results” that the researchers decided it was “important to get it out there,” said Dr Davis.

Dr Davis was first author of a new study suggesting that this new tool is more sensitive than currently available imaging methods to detect the area in the hippocampus that contains the epileptic network.

They also decided to publish the results because they’re now enrolling patients in a larger study using a more sophisticated multislice MRI technique rather than the single-slice approach used in the current study. Study coauthors Ravinder Reddy and Hari Hariharan, both at the Center for Magnetic Resonance & Optical Imaging, Department of Radiology, University of Pennsylvania, hold the patent on CEST MRI methods for imaging metabolites and the use of these as biomarkers.

Continue —> New Tool Detects Epileptic Foci

Axial sections from a patient with temporal lobe epilepsy, showing GluCEST signal. Courtesy of University of Pennsylvania

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[WEB SITE] Seizures in Children and Adolescents Aged 6-17 Years – Medscape

Introduction

A seizure is a brief change in normal electrical brain activity resulting in alterations in awareness, perception, behavior, or movement. Seizures affect persons of all ages, but are particularly common in childhood. There are many causes of seizures in children, including epilepsy; high fever (febrile seizures); head injuries; infections (e.g., malaria, meningitis, and gastrointestinal illness); metabolic, neurodevelopmental, and cardiovascular conditions; and complications associated with birth.[1–3] Outcomes associated with single or recurring seizures in children vary by seizure type (febrile compared with nonfebrile) and multiple risk factors (age, illness, family history, and family context). Outcomes range from no complications to increased risk for behavioral problems, epilepsy, or sudden unexpected death.[3–6] No nationally representative estimates have been reported for the number of U.S. children and adolescents with seizures, co-occurring conditions, or health service utilization. To address these information gaps, CDC analyzed combined data on children and adolescents aged 6–17 years from the National Health Interview Survey (NHIS) for the period 2010–2014. Overall, 0.7% of children and adolescents (weighted national estimate = 336,000) were reported to have had at least one seizure during the preceding year. Compared with children and adolescents without seizures, a higher percentage of those with seizures were socially and economically disadvantaged. Children and adolescents with seizures had higher prevalences of various mental, developmental, physical, and functional co-occurring conditions than those without seizures; however, only 65.6% of those with seizures had visited a medical specialist (defined as a medical doctor who specializes in a particular medical disease or problem, other than an obstetrician/gynecologist, psychiatrist, or ophthalmologist) during the preceding 12 months. Public health agencies can work with other health and human service agencies to raise awareness about childhood seizures, implement strategies to prevent known causes and risk factors for seizures, study the associations between sociodemographic characteristics and seizure incidence, and ensure linkages for children with seizures to appropriate clinical and community providers.

NHIS is an ongoing annual, nationally representative multistage household survey of the U.S. civilian noninstitutionalized population (http://www.cdc.gov/nchs/nhis/about_nhis.htm). CDC analyzed combined 2010–2014 NHIS data from the Sample Child component (questions asked about one randomly selected child from each family in the NHIS), with an average final response rate of 70%. Because these data do not distinguish the relatively large proportion of young children who experience usually benign febrile seizures* from those who have seizures of other etiologies,[7] only children and adolescents aged 6–17 years were selected for analysis. Those whose parents provided a “Yes” answer to the survey question, “During the past 12 months, has [your child] had any of the following conditions?” and indicated “seizures” were identified as respondents with seizures.

Multiple outcomes reported by parents of those with and without seizures were examined, including indicators of food insecurity; co-occurring conditions (e.g., neurodevelopmental disabilities, recent infectious illnesses), functional limitations, and taking prescription medications; barriers to care, represented by delaying getting care and being unable to afford care in the past 12 months; access to care or health service utilization in the past 12 months; and the number of missed school days associated with any illness or injury.

Multiple logistic regression was used to calculate the prevalences and 95% confidence intervals (CI) of co-occurring conditions and barriers and access to care, adjusted by sex, race/ethnicity, family poverty income ratio, and mother’s highest level of education, for children with and without seizures. Statistical software was used to account for the NHIS complex survey design and sample child weights. Prevalences were considered statistically significantly different if their CIs did not overlap.

During 2010–2014, parents of 0.7% of children and adolescents aged 6–17 years (weighted national estimate = 336,000) reported that their child had seizures during the past 12 months ( Table 1 ). Children and adolescents with seizures were significantly more likely than those without seizures to live in poverty and low-income families or households (41.6% compared with 28.6%), and were less likely to have mothers or fathers with a bachelor’s degree or higher (20.4% compared with 30.6% and 22.4% compared with 34.0%, respectively), or to live in nuclear families or households§ (30.3% compared with 41.9%). Parents of children with seizures also were more likely than parents of children without seizures to report worrying that food would run out (34.5% compared with 22.9%) or that food they bought would not last until they had money to get more (30.9% compared with 19.2%).

Co-occurring conditions were generally more frequently reported by parents of children and adolescents with seizures than by those without seizures ( Table 2 ). Children with seizures had higher reported prevalences of mental or developmental co-occurring conditions, including learning disabilities (43.7% compared with 8.2%); other types of developmental delay (32.3% compared with 4.3%); intellectual disability (22.9% compared with 1.0%); and attention deficit hyperactivity disorder/attention deficit disorder (19.3% compared with 10.3%) than did children without seizures. Parents of children with seizures more frequently reported that their children had headaches or migraines (23.7% compared with 7.0%), hay fever (19.0% compared with 11.2%), and stuttering or stammering (11.3% compared with 1.6%). In addition, children with seizures were more frequently reported to have an impairment or health problem that limited their abilities to crawl, walk, run, or play (23.7% compared with 1.9%); to require special equipment because of impairment or health problems (21.4% compared with 1.1%); and to have taken prescription medication for ≥3 months (68.7% compared with 15.6%) ( Table 2 ).

A significantly higher percentage of parents of children and adolescents with seizures reported delays in getting health care than did parents of children without seizures (14.4% compared with 8.8%) ( Table 3 ). Children and adolescents with seizures were significantly more likely to see different types of health care providers, but 34.4% had not seen a medical specialist during the past 12 months. During the same time period, 41.0% of children and adolescents with seizures visited an emergency department, compared with 15.4% of children and adolescents without seizures. Children and adolescents with seizures reportedly missed six or more school days associated with any illness or injury significantly more frequently than did children and adolescents without seizures (41.9% compared with 14.3%) ( Table 3 ).

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[BOOK] New Trends in Medical and Service Robots: Assistive, Surgical and Educational Robotics – Google Books

Front CoverMedical and Service Robotics integrate the most recent achievements in mechanics, mechatronics, computer science, haptic and teleoperation devices together with adaptive control algorithms.

The book includes topics such as surgery robotics, assist devices, rehabilitation technology, surgical instrumentation and Brain-Machine Interface (BMI) as examples for medical robotics.  Autonomous cleaning, tending, logistics, surveying and rescue robots, and elderly and healthcare robots are typical examples of topics from service robotics.

This is the Proceedings of the Third International Workshop on Medical and Service Robots, held in Lausanne, Switzerland in 2014. It presents an overview of current research directions and fields of interest. It is divided into three sections, namely

  1. assistive and rehabilitation devices;
  2. surgical robotics; and
  3. educational and service robotics.

Most contributions are strongly anchored on collaborations between technical and medical actors, engineers, surgeons and clinicians. Biomedical robotics and the rapidly growing service automation fields have clearly overtaken the “classical” industrial robotics and automatic control centered activity familiar to the older generation of roboticists.

Source: New Trends in Medical and Service Robots: Assistive, Surgical and … – Google Books

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[ARTICLE] Effectiveness of Mirror Therapy to Improve Hand Functions in Acute and Subacute Stroke Patients – Full Text PDF

Abstract

Background and aim: Trials have shown modest clinical improvement in disabilities after stroke with the use of different techniques; however most of the treatment protocols for the paretic hand are either expensive or labour intensive, which makes the provision of intensive treatment for many patients difficult. Mirror therapy (MT) is an alternative therapeutic intervention that uses the interaction of visuomotor-proprioception inputs to enhance movement performance of the impaired hand. It has been suggested that mirror therapy is a simple, inexpensive and, most importantly patient-directed treatment that may improve hand function. The aim of this pilot study was to assess the effectiveness of Mirror Therapy to improve hand functions in acute and sub-acute stroke patients.

Method: In a pre-test-post-test single-group design, a convenience sample of 11 of acute and sub-acute stroke patients at Department of Physiotherapy, in Pad. Dr. Vikhe Patil Hospital, Ahmednagar. Participants received a Mirror Therapy program, performing various movements by the less affected upper extremity and observing in the mirror box along with conventional management, 4 days per week for 4 weeks. Fugl-Meyer Assessment (FMA), which includes subsection hand (FMA-WH), Wolf Motor Function Test (WFMT-WH) were used as an outcome measure.

Results: Participants showed significant improvement for FMA-WH and WFMT-WH at post assessment. WFMTWH changed from 7.545 to 15.727. (p=<0.0001) whereas FMA-WH changed from 34.18 to 47.36. (p=0.0002).

Conclusion: The preliminary findings suggest that Mirror therapy can be a useful intervention supplement in rehabilitation of patients; it provides a simple and cost effective therapy for wrist and hand motor recovery in acute and sub-acute stroke patients. Further studies in the form of randomized trials are needed to validate its effectiveness.

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