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Mar 2016 DOI 10.14302/issn.2470-5020.jnrt-15-910
B. Jensen MatthewCorresponding author
University of Wisconsin Department of Neurology
We review the promotion of electrical treatments by laypeople for neurological and other conditions in a largely rural period of United States history.
May 2015 DOI 10.14302/issn.2470-5020.jnrt-14-483
Raglio AlfredoCorresponding author
Department of Biomedical and Specialistic Surgical Sciences, Section of Neurological Clinic, University of Ferrara, Via Aldo Moro 8, 44100 Cona, Ferrara, Italy.
In the last years we could find many uses of music in different clinical settings, also in the field of neurology. In this field empirical results, but also scientific studies, showed the efficacy of music interventions on psychological, cognitive and motor aspects. This is consistent with strong effects of music on brain areas. Music can stimulate and modulate/regulate cognitive functions, behaviors, movements and emotions. Music plays an important role also from a psychological point of view, increasing motivation and promoting relationships and communication. Literature has showed how music interventions can improve behavioral, cognitive, motor, psychological, relational and emotional outcomes in different neurological pathologies. Significant results are present in particular in dementia, stroke and Parkinson's disease. We can find also minor results and qualitative research approaches in multiple sclerosis and in other brain injury such as vegetative and minimally conscious state. More rigorous methodologies and criteria of research are needed to support and strengthen the therapeutic value of music.
Jul 2023 DOI 10.14302/issn.2470-5020.jnrt-23-4576
HECHAM N.Corresponding author
Background The evolution of multiple sclerosis (MS) is highly variable. Predicting this evolution at the beginning of the disease will help in the therapeutic management. The objective of this study was to describe the clinical characteristics and to identify early predictors of long-term disability among MS patients in Algeria. Methods We performed a descriptive and retrospective study of 400 MS patients followed over a 4-years period from July 2012 to July 2016 in the neurology department of Mustapha Bacha hospital in Algiers. The following parameters were systematically assessed for each patient: Age at onset, gender, relapses, initial demyelinating event, interval between first and second attack, residual deficit after first attack, onset of the progressive course, time of assignment of the successive scores of irreversible disability and type of disease modifying therapies. Univariate and multivariate Cox models were used to determine factors influencing time to Expanded Disability Status Scale (EDSS) 4 and 6. Results During the follow-up of this cohort of MS patients, a total of 144 (36%) and 83 (20%) patients reached EDSS scores 4 and 6 respectively. The median times from the onset of MS to assignment of a score 4 and 6 was 10 years and 19 years, respectively. Using the MSSS severity score, and after univariate analysis we identified several risk factors predictive of disease severity. These included male sex (P= 0.002), age of onset ≥ 40 years (P= 0.001), pyramidal (P= 0.0001), cerebellar (P= 0.002), and poly-symptomatic (P=0.0001) onset of the disease, incomplete recovery after the first attack (P= 0.0001), a high number of attacks during the first 2 years (P= 0.04) and the progressive form (P=0.001), and all these factors were correlated with a high MSSS score. However, prognostic factors in the multivariate binomial logistic regression analysis were limited to pyramidal onset, incomplete recovery after the first attack, short interval between the first and second attack, and progressive onset. Conclusion On the whole, the early predictive factors of disability in MS among Algerian patients were age of onset over 40 years, pyramidal onset, incomplete recovery after the first attack, short interval between the first and second attack and progressive form at onset. To increase the generalizability of findings, a national MS registry is strongly recommended, as well as long-term follow-up epidemiological studies.
Feb 2022
K Al Miraj ACorresponding author
Research Assistant, Department of Vascular Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU)Dhaka, Bangladesh.
Introduction Calcium (Ca2+) plays an important role in the pathogenesis of ischemic cell damage. Intracellular Ca2+ accumulation leads to neuronal damage by triggering the cycle of cytotoxic events, however the relationship of serum Ca levels and the pathways involved in ischemic injury is unclear. Aim of Study To investigate the relationship of serum Ca2+ levels with severity of acute ischaemic stroke, serum calcium (Ca2+) levels were measured within the first 48 hours and were compared with the clinical severity of acute ischaemic stroke. Material and Methods A hospital based cross sectional study was performed among 100 patients of acute ischaemic stroke who fulfilled the inclusion criteria. The Study was done from July 2020 to August 2021 in SPRC & Neurology Hospital Dhaka, Bangladesh And BSMMU Hospital Dhaka, Bangladesh. After hospitalization presenting complaints, physical findings of the patients were recorded. Severity of stroke was measured by NIHSS scale. Serum calcium level of every patient was measured. Calcium level was divided into 3 groups by weighted average. Statistical analysis was carried out by a non-parametric Ruska Wallis test. Results Among the 100 patients 59% were male. Among all patients 57% of patients were found to be smokers (98% male, 2% female). Among all patients 63% patients were found hypertensive and 21% of all patients (24% male, 17% female) were diabetic. Mean cholesterol level was 257.98mg/dl with standard deviation 55.49 which is above the reference range suggesting hypercholesterolemia, Triglyceride was borderline and LDL cholesterol was slightly higher and HDL cholesterol was slightly lower. Calcium level was divided into 3 groups and NIHSS score was calculated for every patient in each group. The median NIHSS score for group1 (calcium level ≤8.8 mg/dl) was 9(2-20), for group 2 (calcium level 8.9-9.6 mg/dl) was 6 (1-17) and for group 3 (calcium level ≥9.7mg/dl) was 4 (1-16). Conclusion Commonest risk factor of ischaemic stroke is hypertension. Other risk factors are smoking, diabetes mellitus and hyperlipidemia, cardiac disease. Higher serum calcium level is associated with less severity of ischaemic stroke.
Dec 2017 DOI 10.14302/issn.2576-9383.jhhr-17-1788
Lesinskiene SigitaCorresponding author
Vilnius University, Faculty of Medicine, Clinic of Psychiatry, Email: [email protected]
Integration of music therapy into medical treatment facilities is very uneven in different countries. Scientific evidence of successful examples and sharing of good practices between countries is essential for the further development of music therapy and the improvement of the quality of complex medical services. The goal of this study was to analyse the situation of music therapy implementation into the health services in Lithuania. Analysis of historical background, legislation and overview on music therapy training has been made. Music therapy in Lithuania has gone through more than thirty years of development. Acqaintance and acceptance of music therapy as a relevant and fruitful component to the complexity of the existing medical services was long but successful process. Overview of current initiatives and achievements of the implementation of music therapy into clinical practice and research has shown promissing positive results in developmental pediatrics, psychiatry, special education, neurology, neonatology, oncology, somatic and preventive medicine, rehabilitation. The Music Therapy Master program in Lithuania is being implemented. Possibilities to use music therapy as an inovative service and resourse in various medical settings are in the process of the rapid growth. Collaboration involving music therapists in interdisciplinary teams would help to achieve a comprehensive, versatile patient-centered and health-centered complex service.
Jan 2017 DOI 10.14302/issn.2470-5020.jnrt-16-1415
W. Schrock JonCorresponding author
Associate Professor, Emergency Medicine Case Western Reserve University
Objectives: Computed tomography angiography (CTA) provides early assessment of cerebral vasculature in ED patients presenting with Acute Ischemic Stroke (AIS). Prior studies using 4 row detector CT scanners have suggested that results may be used to determine who receives thrombolytics (tPA). We sought to evaluate the rate of normal CTA and the use of tPA in AIS patients with and without blockages using modern CT technology. Patients and Methods: We conducted a retrospective cohort study of all code stroke patients presenting to our ED over a 3 year period. Inclusion criteria included an ED and neurology diagnosis of AIS with a CTA performed at presentation. All patients had a NIHSS score recorded at presentation and underwent imaging using a 64 row detector scanner with 50cc of non-ionic contrast. Demographic, imaging, and clinical data were collected. Modified Rankin Scores (mRS) were assigned at hospital discharge. Good clinical outcome was defined as a mRS of 0-2. Data are reported as frequencies and medians with interquartile ranges (IQR) as appropriate. Rates of tPA use were evaluated using χ2 testing. Rates of good outcomes were evaluated using odds ratios. Results: A total of 205 subjects met inclusion for analysis of which 103 (50%) were male and 109 (54%) had no blockage on CTA. The median NIHSS score and mortality rates were 14 (IQR 8-19), 14 (14%) with CTA blockage, and 4 (IQR 2-7), 2 (2%) for those without. Of those AIS with a blockage on CTA 46 (48%) were treated with tPA including 29 who were treated with intra-arterial therapy as well while only 13 (13%) of patients without a blockage were treated with tPA. Post tPA bleeding occurred in 12 (13%) patients with blockage on CTA and in 0 patients without blockage. Use of tPA was significantly more frequent in patients with a blockage on CTA, P <0.001. Conclusion: More than half of our AIS patients presenting through our ED have no blockage on CTA. Inter-rater reliability among neuroradiologists evaluating for large vessel occlusion appears to be very good. Patients with AIS and no blockage on CTA have less severe strokes and are less likely to receive tPA. Given the new guidelines recommending endovascular treatment for AIS we expect more emergency departments to begin performing CTA.
Jun 2014 DOI 10.14302/issn.2372-6601.jhor-14-378
Kulma-Kreft MonikaCorresponding author
Department of Radiotherapy and Medical Oncology, Gdynia Cancer Center, Gdynia
Progressive multifocal leukoencephalopathy (PML) is a rare complication associated, inter alia, with rituximab-based lymphoma treatment. PML diagnosis is made easier with the criteria recently published by the American Academy of Neurology. Unambiguous diagnosis of PML can be achieved by demonstration of the histopathological triad comprising:(1) demyelination, (2) bizarre astrocytes and (3) enlarged oligodendroglial nuclei together with detection of viral particles by electron microscopy. However, symptoms of PML may be similar to those observed during lymphoma progression into the central nervous system (CNS). Here we report the case of a patient with diffuse large B-cell lymphoma (DLBCL) treated with R-CHOP who developed clinical signs indicating PML. Intravital diagnostic methods failed to yield an unequivocal diagnosis of PML or lymphoma progression in the CNS. However, a post-mortem examination of brain biopsy specimens performed by electron microscopy demonstrated lesions typical for PML and the presence of viral particles. In addition, immunohistochemical assays identified a massive infiltration of lymphoma cells. The case thus suggests either the extremely rare coexistence of two complications: lymphoma CNS infiltration and PML or induction structural CNS lesions by lymphoma infiltration indistinguishable from PML. The presented findings thus highlight the need for a further review of the current diagnostic criteria for PML.