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- 609409 (1)
To investigate the usefulness of pain-related evoked potentials (PREP) elicited by electrical stimulation for the identification of small fiber involvement in patients with mixed fiber neuropathy (MFN). Eleven MFN patients with clinical signs of large fiber impairment and neuropathic pain and ten healthy controls underwent clinical and electrophysiological evaluation. Small fiber function, electrical conductivity and morphology were examined by quantitative sensory testing (QST), PREP, and skin punch biopsy. MFN was diagnosed following clinical and electrophysiological examination (chronic inflammatory demyelinating neuropathy: n = 6; vasculitic neuropathy: n = 3; chronic axonal neuropathy: n = 2). The majority of patients with MFN characterized their pain by descriptors that mainly represent C-fiber-mediated pain. In QST, patients displayed elevated cold, warm, mechanical, and vibration detection thresholds and cold pain thresholds indicative of MFN. PREP amplitudes in patients correlated with cold (p < 0.05) and warm detection thresholds (p < 0.05). Burning pain and the presence of par-/dysesthesias correlated negatively with PREP amplitudes (p < 0.05). PREP amplitudes correlating with cold and warm detection thresholds, burning pain, and par-/dysesthesias support employing PREP amplitudes as an additional tool in conjunction with QST for detecting small fiber impairment in patients with MFN.
Background
Fabry disease is an inborn lysosomal storage disorder which is associated with small fiber neuropathy. We set out to investigate small fiber conduction in Fabry patients using pain-related evoked potentials (PREP).
Methods
In this case–control study we prospectively studied 76 consecutive Fabry patients for electrical small fiber conduction in correlation with small fiber function and morphology. Data were compared with healthy controls using non-parametric statistical tests. All patients underwent neurological examination and were investigated with pain and depression questionnaires. Small fiber function (quantitative sensory testing, QST), morphology (skin punch biopsy), and electrical conduction (PREP) were assessed and correlated. Patients were stratified for gender and disease severity as reflected by renal function.
Results
All Fabry patients (31 men, 45 women) had small fiber neuropathy. Men with Fabry disease showed impaired cold (p < 0.01) and warm perception (p < 0.05), while women did not differ from controls. Intraepidermal nerve fiber density (IENFD) was reduced at the lower leg (p < 0.001) and the back (p < 0.05) mainly of men with impaired renal function. When investigating A-delta fiber conduction with PREP, men but not women with Fabry disease had lower amplitudes upon stimulation at face (p < 0.01), hands (p < 0.05), and feet (p < 0.01) compared to controls. PREP amplitudes further decreased with advance in disease severity. PREP amplitudes and warm (p < 0.05) and cold detection thresholds (p < 0.01) at the feet correlated positively in male patients.
Conclusion
Small fiber conduction is impaired in men with Fabry disease and worsens with advanced disease severity. PREP are well-suited to measure A-delta fiber conduction.
Background: Compensation of brain injury in multiple sclerosis (MS) may in part work through mechanisms involving neuronal plasticity on local and interregional scales. Mechanisms limiting excessive neuronal activity may have special significance for retention and (re-)acquisition of lost motor skills in brain injury. However, previous neurophysiological studies of plasticity in MS have investigated only excitability enhancing plasticity and results from neuroimaging are ambiguous. Thus, the aim of this study was to probe long-term depression-like central motor plasticity utilizing continuous theta-burst stimulation (cTBS), a non-invasive brain stimulation protocol. Because cTBS also may trigger behavioral effects through local interference with neuronal circuits, this approach also permitted investigating the functional role of the primary motor cortex (M1) in force control in patients with MS. Methods: We used cTBS and force recordings to examine long-term depression-like central motor plasticity and behavioral consequences of a M1 lesion in 14 patients with stable mild-to-moderate MS (median EDSS 1.5, range 0 to 3.5) and 14 age-matched healthy controls. cTBS consisted of bursts (50 Hz) of three subthreshold biphasic magnetic stimuli repeated at 5 Hz for 40 s over the hand area of the left M1. Corticospinal excitability was probed via motor-evoked potentials (MEP) in the abductor pollicis brevis muscle over M1 before and after cTBS. Force production performance was assessed in an isometric right thumb abduction task by recording the number of hits into a predefined force window. Results: cTBS reduced MEP amplitudes in the contralateral abductor pollicis brevis muscle to a comparable extent in control subjects (69 ± 22% of baseline amplitude, p < 0.001) and in MS patients (69 ± 18%, p < 0.001). In contrast, postcTBS force production performance was only impaired in controls (2.2 ± 2.8, p = 0.011), but not in MS patients (2.0 ± 4.4, p = 0.108). The decline in force production performance following cTBS correlated with corticomuscular latencies (CML) in MS patients, but did not correlate with MEP amplitude reduction in patients or controls. Conclusions: Long-term depression-like plasticity remains largely intact in mild-to-moderate MS. Increasing brain injury may render the neuronal networks less responsive toward lesion-induction by cTBS.
The objective of this study was to examine the therapeutic potential of multiple sessions of training on a split-belt treadmill (SBT) combined with cerebellar anodal transcranial direct current stimulation (tDCS) on gait and balance in People with Multiple Sclerosis (PwMS). Twenty-two PwMS received six sessions of anodal (PwMS\(_{real}\), n = 12) or sham (PwMS\(_{sham}\), n = 10) tDCS to the cerebellum prior to performing the locomotor adaptation task on the SBT. To evaluate the effect of the intervention, functional gait assessment (FGA) scores and distance walked in 2 min (2MWT) were measured at the baseline (T0), day 6 (T5), and at the 4-week follow up (T6). Locomotor performance and changes of motor outcomes were similar in PwMS\(_{real}\) and PwMS\(_{sham}\) independently from tDCS mode applied to the cerebellum (anodal vs. sham, on FGA, p = 0.23; and 2MWT, p = 0.49). When the data were pooled across the groups to investigate the effects of multiple sessions of SBT training alone, significant improvement of gait and balance was found on T5 and T6, respectively, relative to baseline (FGA, p < 0.001 for both time points). The FGA change at T6 was significantly higher than at T5 (p = 0.01) underlining a long-lasting improvement. An improvement of the distance walked during the 2MWT was also observed on T5 and T6 relative to T0 (p = 0.002). Multiple sessions of SBT training resulted in a lasting improvement of gait stability and endurance, thus potentially reducing the risk of fall as measured by FGA and 2MWT. Application of cerebellar tDCS during SBT walking had no additional effect on locomotor outcomes.
Candida albicans ist ein opportunistischer Hefepilz, den die meisten gesunden Menschen als harmlosen Kommensalen des Verdauungstraktes beherbergen. Bei einer Schwächung des Immunsystemes kann es jedoch zu schweren Candida-Infektionen bis hin zur lebensbedrohlichen Pilzsepsis kommen. Neben anderen Virulenzfaktoren spielt offenbar der Polymorphismus, also die Fähigkeit, sowohl in einer sprossenden Hefeform als auch in einer filamentösen Hyphenform zu wachsen, eine bedeutende Rolle in der Pathogenität von C._albicans. Welche Wachstumsform überwiegt, hängt entscheidend von den Wachstumsbedingungen, insbesondere auch vom pH-Wert, ab. Im Zentrum des pH-abhängigen Transduktionsweges steht der alkalisch-exprimierte Transkriptionsfaktor RIM101, dessen inaktive Vorläuferform unter neutralen bzw. alkalischen Wachstumsbedingungen vermutlich durch eine zweistufige proteolytische Prozessierung des C-Terminus in (mindestens) eine aktive Form übergeführt wird. Diese wiederum hat mindestens zwei Funktionen: Erstens induziert sie im Rahmen der pH-abhängigen Genexpression unter anderem PHR1 und reprimiert PHR2, die beide für den Zellwandaufbau erforderliche, funktionell homologe Proteine kodieren. Zweitens steuert sie bei gleichzeitig vorliegender Temperaturerhöhung auf ca. 37°C auf noch unbekannte Weise den Übergang der Zelle in die filamentöse Wachstumsform. Ziel dieser Arbeit ist es, die Folgen C-terminaler Verkürzungen von Rim101 auf das Wachstum, die PHR1-Induktion und die Filamentierung, jeweils in Abhängigkeit vom extrazellulären pH-Wert, zu untersuchen. Daraus können neue Einsichten über die Bedeutung von RIM101, den Mechanismus seiner Aktivierung und seine Funktion im Geflecht der Transduktionskaskaden gewonnen werden. Hierzu wurden zunächst 14 phr2∆-Suppressormutanten isoliert, die trotz der phr2∆-Nullmutation in der Lage waren, bei saurem pH-Wert zu wachsen. Es zeigte sich, dass diese Stämme im sauren Milieu nicht nur eine starke PHR1-Induktion aufwiesen, sondern darüber hinaus unabhängig vom pH-Wert des Mediums in hohen Raten zur Filamentierung fähig waren. Die molekulargenetische Analyse beider RIM101-Allele in diesen Revertanten ergaben, dass in jedem der Stämme ein RIM101-Allel eine Nonsense-Mutation enthielt, die offensichtlich zur Synthese eines trunkierten und damit konstitutiv aktiven Rim101p führte. Die spontan aufgetretenen RIM101-Suppressormutationen fanden sich bei den 14 verschiedenen analysierten Revertanten in einem umschriebenen Bereich, der auf dem das C-terminale Drittel codierenden Teil des RIM101-ORF liegt. Um die Folgen von stärkeren, also weiter upstream lokalisierten, Rim101p-Trunkierungen zu untersuchen, wurden daraufhin C.-albicans-Stämme konstruiert, die nach Transformation eines linearisierten Plasmides jeweils ein RIM101-Allel mit einer gezielt eingeführten Nonsense-Mutation enthielten. Wir erhielten 19 solcher Stämme (phr2∆) mit in 5’-Richtung progessiven RIM101-Trunkierungen in einem weiten Bereich des RIM101-ORF. Interessanterweise konnten wir bei der darauf folgenden Untersuchung der gewonnenen Stämme drei Gruppen von RIM101-Trunkierungen unterscheiden, die verschiedene Konsequenzen für Wachstum und Filamentierung mit sich brachten: a) Der Austausch der Codons 281, 305 und 333, die näher am 5’-Ende im Bereich oder der Nähe der Zinkfingerregion lokalisiert sind, ermöglicht kein Wachstum bei pH 4. b) Die Einführung von Nonsense-Codons an die Stellen 385 und 411 führt dazu, dass die entsprechenden Stämme bei pH 4 wachsen und PHR1 induzieren, aber nicht in der Lage sind, bei diesem pH-Wert zu filamentieren. c) Dagegen erlaubt der Ersatz von einem der Codons 463 bis 475 durch ein Stop-Codon Wachstum, PHR1-Induktion und filamentöses Wachstum bei pH 4. Die Region zwischen den Aminosäuren 411 und 463 muss also für die Initiation der Keimschlauchbildung essentiell, für die Induktion pH-regulierter Gene wie PHR1 aber nicht notwendig sein. Dieses Ergebnis scheint darauf hinzuweisen, dass der Funktion des Transkriptionsfaktors Rim101p in den Bereichen Zellwandaufbau/Wachstum und pH-abhängiger Morphogenese zwei verschiedenartige Steuermechanismen zugrunde liegen. Denkbare Modelle für solche Mechanismen werden in der vorliegenden Arbeit auf dem Hintergrund früherer Studien diskutiert. Der letzte Teil dieser Arbeit befasst sich mit der potentiellen Bedeutung von Rim101p bei der Regulation der Expression von sog. sekretorischen Aspartylproteinasen (SAPs). Mit Hilfe eines Reportersystemes sollen die Auswirkungen von RIM101-Mutationen auf drei „hyphenspezifische“ Mitglieder der SAP-Genfamilie, nämlich SAP4, SAP5 und SAP6, untersucht werden. Daraus gewonnene Informationen könnten die bisher vorwiegend isolierte Betrachtung des Dimorphismus und der Proteinasen im Pathogenitätsprozess ausweiten auf ein sich ergänzendes Zusammenspiel dieser Faktoren.
Spinal muscular atrophy (SMA) is a disabling disease that affects not only the patient’s health-related quality of life (HRQoL), but also causes a high caregiver burden (CGB). The aim of this study was to evaluate HRQoL, CGB, and their predictors in SMA. In two prospective, cross-sectional, and multi-center studies, SMA patients (n = 39) and SMA patient/caregiver couples (n = 49) filled in the EuroQoL Five Dimension Five Level Scale (EQ-5D-5L) and the Short Form Health Survey 36 (SF-36). Caregivers (CGs) additionally answered the Zarit Burden Interview (ZBI) and the Hospital Anxiety and Depression Scale (HADS). Patients were clustered into two groups with either low or high HRQoL (EQ-5D-5L index value <0.259 or >0.679). The latter group was mostly composed of ambulatory type III patients with higher motor/functional scores. More severely affected patients reported low physical functioning but good mental health and vitality. The CGB (mean ZBI = 22/88) correlated negatively with patients’ motor/functional scores and age. Higher CGB was associated with a lower HRQoL, higher depression and anxiety, and more health impairments of the CGs. We conclude that patient and CG well-being levels interact closely, which highlights the need to consider the health of both parties while evaluating novel treatments.
Background
Eye movement abnormalities are commonplace in neurological disorders. However, unaided eye movement assessments lack granularity. Although videooculography (VOG) improves diagnostic accuracy, resource intensiveness precludes its broad use. To bridge this care gap, we here validate a framework for smartphone video-based nystagmography capitalizing on recent computer vision advances.
Methods
A convolutional neural network was fine-tuned for pupil tracking using > 550 annotated frames: ConVNG. In a cross-sectional approach, slow-phase velocity of optokinetic nystagmus was calculated in 10 subjects using ConVNG and VOG. Equivalence of accuracy and precision was assessed using the “two one-sample t-test” (TOST) and Bayesian interval-null approaches. ConVNG was systematically compared to OpenFace and MediaPipe as computer vision (CV) benchmarks for gaze estimation.
Results
ConVNG tracking accuracy reached 9–15% of an average pupil diameter. In a fully independent clinical video dataset, ConVNG robustly detected pupil keypoints (median prediction confidence 0.85). SPV measurement accuracy was equivalent to VOG (TOST p < 0.017; Bayes factors (BF) > 24). ConVNG, but not MediaPipe, achieved equivalence to VOG in all SPV calculations. Median precision was 0.30°/s for ConVNG, 0.7°/s for MediaPipe and 0.12°/s for VOG. ConVNG precision was significantly higher than MediaPipe in vertical planes, but both algorithms’ precision was inferior to VOG.
Conclusions
ConVNG enables offline smartphone video nystagmography with an accuracy comparable to VOG and significantly higher precision than MediaPipe, a benchmark computer vision application for gaze estimation. This serves as a blueprint for highly accessible tools with potential to accelerate progress toward precise and personalized Medicine.
Background:
Clinical reasoning in Neurology is based on general associations which help to deduce the site of the lesion. However, even “golden principles” may occasionally be deceptive. Here, we describe the case of subacute flaccid tetraparesis due to motor cortical lesions. To our knowledge, this is the first report to include an impressive illustration of nearly symmetric motor cortical involvement of encephalitis on brain MRI.
Case presentation:
A 51 year old immunocompromized man developed a high-grade pure motor flaccid tetraparesis over few days. Based on clinical presentation, critical illness polyneuromyopathy was suspected. However, brain MRI revealed symmetrical hyperintensities strictly limited to the subcortical precentral gyrus. An encephalitis, possibly due to CMV infection, turned out to be the most likely cause.
Conclusion:
While recognition of basic clinical patterns is indispensable in neurological reasoning, awareness of central conditions mimicking peripheral nervous disease may be crucial to detect unsuspected, potentially treatable conditions.
Topological differences and confounders of mental rotation in cervical dystonia and blepharospasm
(2023)
Mental rotation (mR) bases on imagination of actual movements. It remains unclear whether there is a specific pattern of mR impairment in focal dystonia. We aimed to investigate mR in patients with cervical dystonia (CD) and blepharospasm (BS) and to assess potential confounders. 23 CD patients and 23 healthy controls (HC) as well as 21 BS and 19 hemifacial spasm (HS) patients were matched for sex, age, and education level. Handedness, finger dexterity, general reaction time, and cognitive status were assessed. Disease severity was evaluated by clinical scales. During mR, photographs of body parts (head, hand, or foot) and a non-corporal object (car) were displayed at different angles rotated within their plane. Subjects were asked to judge laterality of the presented image by keystroke. Both speed and correctness were evaluated. Compared to HC, CD and HS patients performed worse in mR of hands, whereas BS group showed comparable performance. There was a significant association of prolonged mR reaction time (RT) with reduced MoCA scores and with increased RT in an unspecific reaction speed task. After exclusion of cognitively impaired patients, increased RT in the mR of hands was confined to CD group, but not HS. While the question of whether specific patterns of mR impairment reliably define a dystonic endophenotype remains elusive, our findings point to mR as a useful tool, when used carefully with control measures and tasks, which may be capable of identifying specific deficits that distinguish between subtypes of dystonia.
Background: Recently, attention has grown toward cerebellar neuromodulation in motor learning using transcranial direct current stimulation (tDCS). An important point of discussion regarding this modulation is the optimal timing of tDCS, as this parameter could significantly influence the outcome. Hence, this study aimed to investigate the effects of the timing of cerebellar anodal tDCS (ca-tDCS) on motor learning using a sequential finger-tapping task (FTT).
Methods: One hundred and twenty two healthy young, right-handed subjects (96 females) were randomized into four groups (During\(_{sham}\), Before, During\(_{real}\), After). They performed 2 days of FTT with their non-dominant hand on a custom keyboard. The task consisted of 40 s of typing followed by 20 s rest. Each participant received ca-tDCS (2 mA, sponge electrodes of 25 cm\(^{2}\), 20 min) at the appropriate timing and performed 20 trials on the first day (T1, 20 min). On the following day, only 10 trials of FTT were performed without tDCS (T2, 10 min). Motor skill performance and retention were assessed.
Results: All participants showed a time-dependent increase in learning. Motor performance was not different between groups at the end of T1 (p = 0.59). ca-tDCS did not facilitate the retention of the motor skill in the FTT at T2 (p = 0.27). Thus, our findings indicate an absence of the effect of ca-tDCS on motor performance or retention of the FTT independently from the timing of stimulation.
Conclusion: The present results suggest that the outcome of ca-tDCS is highly dependent on the task and stimulation parameters. Future studies need to establish a clear basis for the successful and reproducible clinical application of ca-tDCS.