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FUNCTIONAL NEUROLOGY, REHABILITATION, AND ERGONOMICS Volume 3, Issue 4

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Infants have a sophisticated behavioral and cognitive repertoire suggestive of a capacity for conscious reflection. Demonstrating consciousness in infants is challenging and prenatally even more so, mainly because infants cannot report their thoughts and behavioral measurements in the fetus is difficult. Such evaluations of consciousness are even more difficult in the prenatal and antenatal infant. The importance of being able to evaluate conscious reflection in prenatal, infancy and early childhood is important as numerous treatment decisions are based on its adequate assessment. Consciousness requires a sophisticated network of highly interconnected components. Its physical substrate, the thalamo-cortical complex, with its highly elaborate content, begins to be in place between the 24th and 28th week of gestation. Roughly two months later synchrony of the electro-encephalographic (EEG) rhythm across both cortical hemispheres signals the onset of global neuronal integration. Thus, many of the circuit elements necessary for consciousness are in place by the third trimester. By this time, preterm infants can survive outside the womb under proper medical care. As it is easier to observe and interact with a preterm baby than with a fetus of the same gestational age in the womb, the fetus is often considered to be like a preterm baby. This notion disregards the unique uterine environment: suspended in a warm and dark cave, connected to the placenta that pumps blood, nutrients and hormones into its growing body and brain. Invasive experiments in rat and lamb pups and observational studies using ultrasound and electrical recordings in humans show that the third-trimester fetus is almost always in one of two sleep states. Called active and quiet sleep, these states can be distinguished using electroencephalography. Their different EEG signatures go hand in hand with distinct behaviors: breathing, swallowing, licking, and moving the eyes but no large-scale body movements in active sleep; no breathing, no eye movements and tonic muscle activity in quiet sleep. These stages correspond to rapid-eye-movement (REM) and slow-wave sleep common to all mammals. In late gestation the fetus is in one of these two sleep states 95 percent of the time, separated by brief transitions. Fascinating is the discovery that the fetus is actively sedated by the low oxygen pressure (equivalent to that at the top of Mount Everest), the warm and cushioned uterine environment and a range of neuro-inhibitory and sleep-inducing substances produced by the placenta and the fetus itself: adenosine; two steroidal anesthetics, allopregnanolone and pregnanolone; one potent hormone, prostaglandin D2; and others. The role of the placenta in maintaining sedation is revealed when the umbilical cord is closed off while keeping the fetus adequately supplied with oxygen. We can conclude that the fetus is asleep while its brain matures. We will examine the parallelism of brain and cognitive development until both the physiological and cognitive aspects of awake and aware behavior, (i.e. consciousness) is understood. The importance of understanding these issues provides us with a context for treatment decisions and for understanding the nature of functional connectivities.
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Background: Persistent vegetative states (PVS) and locked-in syndrome (LIS) are well differentiated disorders of consciousness that can be reached after a localized brain injury in the brainstem. The relations of the lesion topography with the impairment in the whole-brain architecture and functional disconnections are poorly understood. Methods: Two patients (PVS and LIS) and 20 age-matched healthy volunteers were evaluated using diffusion tensor imaging (DTI). Anatomical network was modeled as a graph whose nodes are represented by 71 brain regions. Inter-region connections were quantified through Anatomical Connection Strength (ACS) and Density (ACD). Complex networks properties such as local and global efficiency and vulnerability were studied. Mass univariate testing was performed at every connection using network based statistic approach. Results: LIS patients’ network showed significant differences from controls in the brainstem-thalamus-frontal cortex circuitry, while PVS patients showed a widespread disruption of anatomical connectivity in both hemispheres. Both patients showed a reorganization of network attributes, with decreased global and local efficiency, significantly more pronounced in PVS. Conclusions: Our results suggest that DTI-based network connectivity combined with graph theory is useful to study the long-range effect of confined injuries and the relationship to the degree of consciousness impairment, underlying PVS and LIS.
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Little of the 150 years of research in Cognitive Neurosciences, Human Factors, and the mathematics of Production Management have found their way into educational policy and certainly not into the classroom or in the production of educational materials in any meaningful or practical fashion. While more mundane concepts of timing, sequencing, spatial organization, and Gestalt principles of perception are well known and applied, as well as the maintenance of simplistic notions of developmental brain organization and hemisphericity for language rather than the neurophysiology of embodied language, these concepts still inform pre-K-3 curriculum and clinical neurological practice in both the diagnostic and therapeutic modalities. The paper overviews the science of human physiologic efficiencies to develop a fundamental understanding that the concept of localization of function in the brain is a just reflection of plasticity and required for optimized function, but understanding brain function by that alone would obscure the understanding of the education and rehabilitation process from early childhood through the older years. Diagnostic and therapeutic systems need to address pathways in the brain and their changes as a result of intervention rather than examine more static notions of localized function.
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We model the brainstem as two layers of purely excitatory and inhibitory cells, with a time delay in transmission of information between the layers. The response to a localized afferent impulse is a strong function of this inhibitory delay; at first showing increased amplification as the delay increases, but at larger delays showing increased convection away from the impulse location. These features are consistent with the function of the brainstem in regulating attentional levels, and have possible implications for the understanding of higher brain mechanisms
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Exposure to musical training in childhood has been studied extensively as models of neuroplasticity. The long-term training and continued practice of complex bi-manual motor sequences are highly associated with changes in brain structure and cortical motor maps compared with individuals without such training. We know that the anterior corpus callosum, with fibers connecting frontal motor regions and pre-frontal areas coordinating bimanual activity is larger in musicians who started training prior to age seven than in either controls. Additionally, auditory experiences during early postnatal development shape the functional neurology of auditory cortical representation resulting in increased functional areas of the auditory cortex. The developing brain is far more plastic than the adult brain explaining the results that we see in recovery of function after brain damage in childhood, neuronal connections are being continuously remodeled by experience, enrichment, and by performance on specific and complex movements during motor and cognitive learning. New skill acquisition, present to a much greater degree in childhood is highly associated with structural changes in the intracortical and subcortical networks in motor skill training. The relationship between music, visual, and spatial training on brain organization and plasticity are discussed with applications for solutions to the rehabilitation of the brain impaired.
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An application is discussed that uniquely integrates auditory and visual stimulation with force modulation. It was developed to answer unmet needs of Occupational Therapists, Art Therapists and Music Therapists, who treat developmental disorders, as well as therapists specializing in neurological aftercare and hand rehabilitation. Squeezing the special pressure sensitive grip sensors causes the application to generate sounds, voices and music, along with captivating imagery, based on the level of force applied and according to the therapy objective. The described system’s development was guided by the assumption that the human brain intuitively associates sound pitch with tension. The system uses the association of pitch with muscle tension to simplify the creation of music by transforming grip-induced muscle tension to musical phrases which provides a new therapy option based on sensory integration. The grip force sensors’ sensitivity and responsiveness can be adjusted to the patient’s motor skills, thus making the transformation more “natural.”. Even patients suffering severe disabilities find the grip squeezing force and the produced sounds highly correlated in a direct and natural manner. The musicality and continuity of the musical creation highly depends on the patient’s skills, Farah Jubran and Gerry Leisman 214 pace and the system’s speed of response. The system’s “on-the-fly tuning” helps matching the system tempo with the patient’s pace, accelerating or decelerating speed, to determine the desired level of challenge and gratification during the treatment. The system helps in reducing passivity and increasing motivation and awareness through the sense of control granted to the patient playing the tool, as well as in reducing involuntary movement. In addition, the system allows the creation of personalized treatment programs that make use of meaningful images or photos from the patient and his/her world and surroundings.
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Background: The neuroimaging findings of acute central transtentorial herniation are well documented; however survival in this condition is unusual. Case report: A 20-year-old woman developed central transtentorial herniation secondary to acute hydrocephalus after the obstruction of a ventriculo-peritoneal shunt inserted for the treatment of chronic hydrocephalus. The surgical ventricular drainage was delayed, and after being in coma for several days, the patient was finally diagnosed as being in a persistent vegetative state (PVS). The neuroimaging studies revealed a severe bilateral infarction of thalamus, subthalamus, mesocephalus and left superior cerebellum, a distribution suggestive of ischemia affecting perforating arteries arising from the top of the basilar artery and proximal segment of the posterior cerebral artery, as well as from the superior cerebellar artery. Conclusion: Survivors of central transtentorial herniation can sustain severe damage to the thalamus and mesencephalon, despite a relative preservation of the neocortex, leading to a PVS syndrome.
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Exploratory field measurements in the Mexico City Metropolitan Area (MCMA) in February 2002 set the stage for a major air quality field measurement campaign in the spring of 2003 (MCMA-2003). Involving over 100 scientists from more than 30 institutions in Mexico, the United States and Europe, MCMA-2003 revealed important new insights into the meteorology, primary pollutant emissions, ambient secondary pollutant precursor concentrations, photochemical oxidant production and secondary aerosol particle formation in North America's most populated and polluted megacity. A description of meteorological and atmospheric chemistry and aerosol microphysics measurements performed during MCMA-2003 is presented. More than three dozen published or submitted MCMA-2003 research papers are reviewed and key discoveries pertinent to understanding and improving air quality in Mexico City and similar megacities in the developing world are summarized.
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Recent spectacular advances in neurosciences have stimulated the hope that the application of our understanding that it is no longer about cerebral asymmetries and simplistic left-right differences but more complex applications of networks, and communication system principles that have led to newly developed concepts and findings that have not, as yet, found there way into the classroom. We are at the cusp of developing breakthrough concepts in the understanding of how children learn in the formal setting of the classroom in the context of brain function and how that function can be modified. We believe that the techniques and knowledge of neuroscience as well as Human Factors and Industrial Engineering notions of efficiency and production management can provide a service to education at all stages throughout life. Although the human brain - the most crucial part of the anatomy - is the most complex mechanism known to man, it is now being analyzed in ways that are clearly significant for education. Recent research on the human brain has provided data relevant to understanding the processes of human learning and therefore to improving methods of teaching. Most currently prevailing patterns of education are heavily biased to wards left cerebral functioning and are antithetical to right cerebral functioning. Reading, writing and arithmetic are all logical linear processes, and for most of us are fed into the brain through our right hand. Most educational policies have tended to aggravate and prolong this one-sidedness. There is a kind of damping down of fantasy, imagination, clever guessing, and visualization in the interests of rote-learning, reading, writing, and arithmetic. Great emphasis is placed upon being able to say what one has on one's mind clearly and precisely the first time. The atmosphere emphasizes intra-verbal skills, ”Using words to talk about words that refer to still other words" What emerges as the central proposition of this paper is that (A) the examination and study of regional cerebral differences in brain function as a way of explaining and evaluating the learning process within the educational system is a non-starter. (B) The evaluation of students by standardized aptitude and achievement tests is not sufficient although probably still necessary and (C) the educational systems would be better to examine student performance and teach towards “cognitive efficiency” rather than simply mastery v. non-mastery with methods that employ both psychophysics that examine person-environment interaction and mathematical means of examining optimization and the strategy used to get there as well as how far or close a student is functioning from a mathematically derived optimization regression line or, in fact, how quickly the learner is progressing in that direction. Educators, although perhaps not palatable to conceive of early childhood education as such, are producing a product and production management techniques should be useful for evaluating not just the product but the process or “manufacture” of that product as well.
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We studied autistics by quantitative EEG spectral and coherence analysis during three experimental conditions: basal, watching a cartoon with audio (V–A), and with muted audio band (VwA). Significant reductions were found for the absolute power spectral density (PSD) in the central region for delta and theta, and in the posterior region for sigma and beta bands, lateralized to the right hemisphere. When comparing VwA versus the V–A in the midline regions, we found significant decrements of absolute PSD for delta, theta and alpha, and increments for the beta and gamma bands. In autistics, VwA versus V–A tended to show lower coherence values in the right hemisphere. An impairment of visual and auditory sensory integration in autistics might explain our results.
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Abstract The EEG has not been comprehensively used to study the brain function in Autistic Spectrum Disorder (ASD) patients. Therefore, the researchers recently developed a specifically designed software (EEGConn) to explore brain function based on advanced algorithms to explore EEG activity. They studied a group of 14 righthanded autistic patients with age 70.3±29.32 and 14 healthy subjects with IQs over 85. All recordings were performed with the subjects lying in a recumbent position, in eye opened condition; EEG ...
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Neural circuits linking activity in anatomically segregated populations of neurons in subcortical structures regulate complex behaviors such as walking, talking, language comprehension, and other cognitive functions associated with frontal lobes. The basal ganglia are also crucial elements in the circuits that confer human reasoning and adaptive function and are key elements in the control of reward-based learning, sequencing, discrete elements that constitute complete motor acts, and cognitive function. Imaging studies of intact humans and electrophysiologic studies of the brains and behavior of other species confirm these findings. We know that the relation between the basal ganglia and the cerebral cortical region allows for connections organized into discrete circuits. Rather than serving as a means for widespread cortical areas to gain access to the motor system, these loops reciprocally interconnect a large and diverse set of cerebral cortical areas with the basal ganglia. Neuronal activity within the basal ganglia associated with motor areas of the cerebral cortex is highly correlated with parameters of movement. Neuronal activity within the basal ganglia and cerebellar loops associated with the prefrontal cortex is related to the aspects of cognitive function. Thus, individual loops appear to be involved in distinct behavioral functions. Damage to the basal ganglia of circuits with motor areas of the cortex leads to motor symptoms, whereas damage to the subcortical components of circuits with non-motor areas of the cortex causes higher-order deficits. In this report, we review some of the anatomic, physiologic, and behavioral findings that have contributed to a reappraisal of function concerning the basal ganglia and cerebellar loops with the cerebral cortex and apply it in clinical applications to ADHD with biomechanics and a discussion of retention of primitive reflexes being highly associated with the condition.
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Mexico City Metropolitan Area children chronically exposed to high concentrations of air pollutants exhibit an early brain imbalance in genes involved in oxidative stress, inflammation, innate and adaptive immune responses along with accumulation of misfolded proteins observed in the early stages of Alzheimer and Parkinson's diseases. A complex modulation of serum cytokines and chemokines influences children's brain structural and gray/white matter volumetric responses to air pollution. The search for biomarkers associating systemic and CNS inflammation to brain growth and cognitive deficits in the short term and neurodegeneration in the long-term is our principal aim. We explored and compared a profile of cytokines, chemokines (Multiplexing LASER Bead Technology) and Cellular prion protein (PrPC) in normal cerebro-spinal-fluid (CSF) of urban children with high vs. low air pollution exposures. PrPC and macrophage inhibitory factor (MIF) were also measured in serum. Samples from 139 children ages 11.91 ± 4.2 years were measured. Highly exposed children exhibited significant increases in CSF MIF (p = 0.002), IL6 (p = 0.006), IL1ra (p = 0.014), IL-2 (p = 0.04), and PrPC (p = 0.039) vs. controls. MIF serum concentrations were higher in exposed children (p = 0.009). Our results suggest CSF as a MIF, IL6, IL1Ra, IL-2, and PrPC compartment that can possibly differentiate air pollution exposures in children. MIF, a key neuro-immune mediator, is a potential biomarker bridge to identify children with CNS inflammation. Fine tuning of immune-to-brain communication is crucial to neural networks appropriate functioning, thus the short and long term effects of systemic inflammation and dysregulated neural immune responses are of deep concern for millions of exposed children. Defining the linkage and the health consequences of the brain / immune system interactions in the developing brain chronically exposed to air pollutants ought to be of pressing importance for public health.
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Objective: To study the Zolpidem arousing effect in persistent vegetative state (PVS) patients combining clinical evaluation, autonomic assessment by heart rate variability (HRV), and EEG records. Methods: We studied a group of 8 PVS patients and other 8 healthy control subjects, matched by age and gender. The patients and controls received drug or placebo in two experimental sessions, separated by 10-14 days. The first 30 minutes of the session were considered the basal record, and then Zolpidem was administered. All participants were evaluated clinically, by EEG, and by HRV during the basal record, and for 90 minutes after drug intake. Results: We found in all patients, time-related arousing signs after Zolpidem intake: behavioral (yawns and hiccups), activation of EEG cortical activity, and a vagolytic chronotropic effect without a significant increment of the vasomotor sympathetic tone. Conclusions: We demonstrated time-related arousing signs after Zolpidem intake. We discussed possible mechanisms to explain these patho-physiological findings regarding EEG cortical activation and an autonomic vagolytic drug effect. As this autonomic imbalance might induce cardiocirculatory complications, which we didn't find in any of our patients, we suggest developing future trials under control of physiological indices by bedside monitoring. However, considering that this arousing Zolpidem effect might be certainly related to brain function improvement, it should be particularly considered for the development of new neuro-rehabilitation programs in PVS cases. According to the literature review, we claim that this is the first report about the vagolitic effect of Zolpidem in PVS cases.
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Introduction: Zolpidem is a non-benzodiazepine drug used for the therapy of insomnia, which has selectivity for stimulating the effect of GABA-A receptors. Recently, a paradoxical arousing effect of zolpidem in patients with severe brain damage has been repeatedly reported. Methods: A placebo-controlled magnetic resonance study was conducted to evaluate its effect on BOLD and metabolites spectral signals in a patient with severe brain injuries and an age-matched healthy volunteer. A multi-modal analysis was used to assess aspects in the pharmacologically-induced changes in the resting-state brain metabolism. Results: A significantly increased BOLD signal was transiently localized in the left frontal cortices, bilateral anterior cingulated areas, left thalamus and right head of the caudate nucleus. The healthy subject showed a deactivation of the frontal, parietal and temporal cortices. BOLD signal changes were found to significantly correlate with concentrations of extravascular metabolites in the left frontal cortex. It is discussed that, when zolpidem attaches to modified GABA receptors of neurodormant brain cells, brain activation is induced. This might explain the significant correlations of BOLD signal changes and proton-MRS metabolites in this patient after zolpidem. Conclusion: It was concluded that proton-MRS and BOLD signal assessment could be used to study zolpidem-induced metabolic modulation in a resting state.
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Chronic exposure to particulate matter air pollution is known to cause inflammation leading to respiratory- and cardiovascular-related sickness and death. Mexico City Metropolitan Area children exhibit an early brain imbalance in genes involved in oxidative stress, inflammation, and innate and adaptive immune responses. Early dysregulated neuroinflammation, brain microvascular damage, production of potent vasoconstrictors, and perturbations in the integrity of the neurovascular unit likely contribute to progressive neurodegenerative processes. The accumulation of misfolded proteins coincides with the anatomical distribution observed in the early stages of both Alzheimer's and Parkinson's diseases. We contend misfolding of hyperphosphorylated tau (HP π ), alpha-synuclein, and beta-amyloid could represent a compensatory early protective response to the sustained systemic and brain inflammation. However, we favor the view that the chronic systemic and brain dysregulated inflammation and the diffuse vascular damage contribute to the establishment of neurodegenerative processes with childhood clinical manifestations. Friend turns Foe early; therefore, implementation of neuroprotective measures to ameliorate or stop the inflammatory and neurodegenerative processes is warranted in exposed children. Epidemiological, cognitive, structural, and functional neuroimaging and mechanistic studies into the association between air pollution exposures and the development of neuroinflammation and neurodegeneration in children are of pressing importance for public health.
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Autism is a heterogeneous disorder with genetic and environmental factors likely contributing to its origins. Examination of hazardous pollutants has suggested the importance of air toxics in the etiology of autism, yet little research has examined its association with local levels of air pollution using residence-specific exposure assignments. To examine the relationship between traffic-related air pollution, air quality, and autism. This population-based case-control study includes data obtained from children with autism and control children with typical development who were enrolled in the Childhood Autism Risks from Genetics and the Environment study in California. The mother's address from the birth certificate and addresses reported from a residential history questionnaire were used to estimate exposure for each trimester of pregnancy and first year of life. Traffic-related air pollution was assigned to each location using a line-source air-quality dispersion model. Regional air pollutant measures were based on the Environmental Protection Agency's Air Quality System data. Logistic regression models compared estimated and measured pollutant levels for children with autism and for control children with typical development. Case-control study from California. A total of 279 children with autism and a total of 245 control children with typical development. Crude and multivariable adjusted odds ratios (AORs) for autism. Children with autism were more likely to live at residences that had the highest quartile of exposure to traffic-related air pollution, during gestation (AOR, 1.98 [95% CI, 1.20-3.31]) and during the first year of life (AOR, 3.10 [95% CI, 1.76-5.57]), compared with control children. Regional exposure measures of nitrogen dioxide and particulate matter less than 2.5 and 10 μm in diameter (PM2.5 and PM10) were also associated with autism during gestation (exposure to nitrogen dioxide: AOR, 1.81 [95% CI, 1.37-3.09]; exposure to PM2.5: AOR, 2.08 [95% CI, 1.93-2.25]; exposure to PM10: AOR, 2.17 [95% CI, 1.49-3.16) and during the first year of life (exposure to nitrogen dioxide: AOR, 2.06 [95% CI, 1.37-3.09]; exposure to PM2.5: AOR, 2.12 [95% CI, 1.45-3.10]; exposure to PM10: AOR, 2.14 [95% CI, 1.46-3.12]). All regional pollutant estimates were scaled to twice the standard deviation of the distribution for all pregnancy estimates. Exposure to traffic-related air pollution, nitrogen dioxide, PM2.5, and PM10 during pregnancy and during the first year of life was associated with autism. Further epidemiological and toxicological examinations of likely biological pathways will help determine whether these associations are causal.
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We report a 30-year-old man with atlanto-occipital dislocation after a traffic accident. Diagnosis was based on radiography, computed tomography, and magnetic resonance imaging. Owing to the critical conditions that did not fulfil advanced trauma and life support protocols, surgical treatment was deferred, and the patient died 10 hours later.
Article
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Abstract New information about the basal ganglia and cerebellar connections with the cerebral cortex has prompted a reevaluation of the role of the basal ganglia in cognition. We know that the relation between the basal ganglia and the cerebral cortical region allows for connections organized into discrete circuits. Rather than serving as a means for widespread cortical areas to gain access to the motor system, these loops reciprocally interconnect a large and diverse set of cerebral cortical areas with the basal ganglia. The properties of neurons within the basal ganglia or cerebellar components of these circuits resemble the properties of neurons within the cortical areas subserved by these loops. For example, neuronal activity within the basal ganglia and cerebellar loops with motor areas of the cerebral cortex is highly correlated with parameters of movement, whereas neuronal activity within the basal ganglia and cerebellar loops with areas of the prefrontal cortex is more related to the aspects of cognitive function. Thus, individual loops appear to be involved in distinct behavioral functions. Studies of the basal ganglia and cerebellar pathology support this conclusion. Damage to the basal ganglia or cerebellar components of circuits with motor areas of the cortex leads to motor symptoms, whereas damage to the subcortical components of circuits with nonmotor areas of the cortex causes higher-order deficits. In this report, we review some of the new anatomic, physiologic, and behavioral findings that have contributed to a reappraisal of function concerning the basal ganglia and cerebellar loops with the cerebral cortex and apply it in clinical applications to obsessive-compulsive disorder, Tourette's syndrome, and attention-deficit/hyperactivity disorder as examples of how compromise at different points in the system may yield similar but different clinical results.
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The term persistent vegetative state (PVS) refers to the only circumstance in which an apparent dissociation of both components of consciousness is found, characterized by preservation of wakefulness with an apparent loss of awareness. Several authors have recently demonstrated by functional neuroimaging studies that a small subset of unresponsive "vegetative" patients may show unambiguous signs of consciousness and command following that is inaccessible to clinical examination at the bedside. The term "estado vegetativo" used in Spanish to describe the PVS syndrome by physicians came from the English-Spanish translation. The Spanish term "vegetativo" is related to unconscious vital functions, and "vegetal" is relative to plants. According to our experience, when a physician informs to patients' relatives that his/her family member's diagnosis is a "estado vegetativo", they understand the he/she is no more a human being, that there is no hope of recovery. The European Task Force on Disorders of Consciousness has recently proposed a new term, unresponsive wakefulness syndrome (UWS), to assist society in avoiding the depreciatory term vegetative state. Our group has embraced the use of the new term UWS and might suggest that we change our concept and use of the term MCS to minimally responsive wakefulness state (MRWS), or minimally aware wakefulness state (MAWS). Medical terms must be current and avoid any pejorative description of patients, which will promote our abilities to serve humankind and challenge neuroscientists to offer society new and realistic hopes for neurorehabilitation.
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Objective: To assess the autonomic nervous system (ANS) in coma by heart rate variability (HRV). Methods: Sixteen comatose patients and 22 normal subjects with comparable ages and genders were studied. Patients were classified in two subgroups according to the Glasgow Coma Scale (GCS). Time, frequency, and informational HRV domain indices were calculated. Results: A notable reduction of HRV was found in patients. Regarding the time domain indices, the triangular index, and the Delta_RRs, were significantly reduced in the subgroup with GCS=3. Absolute power for the whole frequency spectrum decreased whenever GCS scores were lower. A significant decrement was found for absolute power of the VLF and LF bands in the subgroup of GCS=3, and although it was lower for the HF band in these patients, those changes were not statistically significantly different. The LF/HF ratio and the Shannon´s entropy indices were significantly reduced in the subgroup with GCS=3. Our results are discussed regarding the progressive dysfunction the ANS networks when coma deepens. Conclusions: The HRV procedure is a powerful tool to assess the ANS in comatose patients. Significance: HRV is a minimally invasive, low-cost methodology, suitable for assessing the ANS in coma.
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Little of 150 years of research in Cognitive Neurosciences, Human Factors, and the mathematics of Production Management have found their way into educational policy and certainly not into the classroom or in the production of educational materials in any meaningful or practical fashion. Whilst more mundane concepts of timing, sequencing, spatial organisation, and Gestalt principles of perception are well known and applied, the nature of Receiver Operating Characteristics (ROC) and the responsibility of the sender in that regard, as well as the maintenance of simplistic notions of developmental brain organization and hemisphericity for language rather than the neurophysiology of embodied language as an example, still inform pre-K-3 curriculum. The paper intends to overview the science of human physiologic efficiencies in engineering terms in an attempt to develop novel approaches and thinking to classroom-based practice and subsequently leadership and policy informed by current neuroscientific realities and by production management and optimization principles now applied to schools, and their consumers.
Article
Consciousness requires a sophisticated network of highly interconnected components. Its physical substrate, the thalamo-cortical complex, allows for its basis to be in place between the 24-28th gestational week. Roughly two months later, bi-hemispheric EEG synchrony signals the onset of global neuronal integration. Thus, many of the circuits necessary for consciousness are in place by the 3rd trimester. Now, pre-term infants can survive outside the womb. It is also easier to interact with a preterm infant than with a fetus of the same gestational age in the womb. The notion that the fetus is like a preterm baby disregards the unique uterine environment. Invasive experiments in rat and lamb pups, ultrasound observational studies, and electrical recordings in humans show that 3rd- trimester fetuses are almost always in one of two sleep states, active or quiet, distinguished by different eeg signatures. Fascinating is that the fetus is actively sedated by the low oxygen pressure, the warm and cushioned uterine environment, and a range of neuroinhibitory and sleep-inducing substances produced by the placenta and the fetus itself: adenosine; two steroidal anesthetics, allopregnanolone and pregnanolone; one potent hormone, prostaglandin d2 and others. Objectives: to outline the nature of functional disconnectivities in neonates and how rapid frontal lobe growth and functional connection development is associated with consciousness in early life and its deficits implicit in developmental disorders such as autism.
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Over the last two decades, electrical neuromodulation has become a dominant approach in surgical treatment of medically refractory neuropathic pain, essentially eclipsing multiple available neuroablative procedures. Among different types of neuromodulation, peripheral nerve stimulation (PNS) holds the unique position of being the least invasive - and at the same time the least established in terms of scientific evidence and regulatory approvals. However, it is now gaining tremendous momentum in terms of accumulation of clinical experience and development of new indications. As a matter of fact, recent European approval of PNS for treatment of chronic lower back pain and intractable migraine headaches is expected to add legitimacy and marketing support to the entire field of PNS. This article provides an overview of PNS history, reviews current thoughts regarding its mechanism of action, summarises common indications, clinical outcomes, technical procedural details and complications, and suggests future directions for PNS development. It appears that PNS today is the most rapidly growing field of neuromodulation - and that does not come as a surprise, considering its potential for treatment of very prevalent and hard-to-treat conditions, such as back pain and headaches. From the point of view of a practising neurologist, PNS presents an attractive pain management option that combines a high level of efficacy and reproducibility of results with low invasiveness and minimal morbidity. As the worldwide experience with PNS continues to grow, one may expect to see it becoming a widely accepted treatment approach in a variety of clinical conditions.
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Trigeminal neuralgia is a rare form of neuropathic pain that results in sudden, usually unilateral, severe, brief stabbing, recurrent pains in the distribution of one or more branches of the fifth cranial nerve. Diagnosis of all orofacial pain is principally on careful historic assessment because there are few investigations with high specificity and sensitivity. Management of trigeminal neuralgia is initially medical with the “gold standard” drug being carbamazepine. More drugs are now available, but relatively few have been evaluated in high-quality, randomized, controlled trials. Surgical treatments have yielded favorable outcomes, especially microvascular decompression, but evidence has come only from case reports. Other forms of facial pain respond to tricyclic antidepressants, but invasive occlusal rehabilitation for temporomandibular disorders must be avoided. Patients require high-quality information. National support groups are available.
Article
Neurovascular compression at the root entry zone accounts for more than 80% of trigeminal neuralgia (TN) cases, but not all patients with TN have neurovascular compression. Many non-TN subjects have neurovascular contract at the root entry zone. TN is reported to occur in 0.9% to 4.5% of patients with multiple sclerosis (MS). In patients with TN, 1.7% to 15% of patients suffer from MS. The reported range for patients with TN due to tumors is from 0.8% to 11.6%. Because carbamazepine may relieve pain temporarily, relief of pain with carbamazepine does not exclude the diagnosis of a tumor or cyst. There are the peripheral cause theory, central cause theory, peripheral origin central pathogenesis theory, and multiple factors theory in the pathology of TN. Dental pain and/or treatment may trigger TM. Alveolar cavitational osteonecrosis may also cause TN.
Article
Trigeminal neuralgia (TN) causes sudden, usually unilateral, severe, brief stabbing recurrent pains in the distribution of one or more branches of the trigeminal nerve. Radiological examination is not required, however, patient interview and physical examination are necessary for diagnosis alone. When a patient is diagnosed with TN, an MRI is recommended to exclude tumor, cyst or multiple sclerosis, irrespective of the patient's age. From the etiological viewpoint, TN is classified into primary or idiopathic TN and secondary or symptomatic TN. From the symptomatic viewpoint, TN is classified into typical TN and atypical TN. Atypical TN, trigeminal neuropathy, pretrigeminal neuralgia, and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) are also described.
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The authors review the existing literature on the mental health impact of the September 11th attacks and the implications for disaster mental health clinicians and policy makers. The authors discuss the demographic characteristics of those affected and the state of mental health needs and existing mental health delivery services; the nature of the disaster and primary impacts on lives, infrastructure, and socioeconomic factors; the acute aftermath in the days and weeks after the attacks; the persistent mental health impact and evolution of services of the postacute aftermath; and the implications for future disaster mental health practitioners and policy makers.
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Because this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published by the American Psychiatric Association (APA) in May 2013. The new edition introduced major revisions to the diagnostic criteria for autism spectrum disorder (ASD). These changes could have a significant impact on patients and families affected by ASD, as well as mental health providers and researchers working in the field of autism.
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In recent years there has been a plethora of articles claiming that various neurological syndromes are associated with or are caused by gluten sensitivity. However, the busy clinical neurologist needs to know the answers to just two main questions – does gluten sensitivity predispose patients to the development of various neurological complications, and should a patient with a cryptogenic neurological illness be investigated for occult gluten sensitivity (and if so how)?WHAT IS GLUTEN SENSITIVITY?Coeliac disease is a classic gluten sensitive enteropathy, typically presenting in childhood. It is common with a prevalence of between 1 : 80 and 1 : 300. There is characteristic small bowel villous atrophy (Fig. 1a) associated with abdominal pain, malabsorption and weight loss. A gluten-free diet rapidly reverses this atrophy (within weeks) (Fig. 1b), corrects malabsorption and leads to symptomatic improvement. In addition, patients may sometimes present with non-specific or trivial complaints and the diagnosis
Peripheral nerve stimulation is the gold standard method of nerve identification in Argentina. In this article we focus on the basic principles needed to understand and perform regional blocks with the aid of a peripheral nerve stimulator, avoiding complications. Based on our experimental investigation in animals, we recommend permanently checking the equipment to always perform the blocks in an awake or slightly sedated patient and to inject the AL solution when a motor response GII is obtained with an intensity of ≤0.5 mA, a pulse duration of 100 μsec and a frequency of 2 Hz. MR at that point must disappear if intensity is decreased to 0.2 mA. Disparition of MR after local anesthetic injection is due to electrophysiologic changes of injectates and not to the physical displacement of the nerve. Paresthesia are the only protection that patients have against needle nerve contact or penetration.
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EDITORIAL COMMENTNottingham and Sheffield are less than 50 miles apart, but clearly patients are managed very differently in the two cities when it comes to searching for the neurological complications of coeliac disease or gluten sensitivity. Whilst the observational epidemiological arguments rage backwards and forwards, the proof that patients are benefited – or not – by a gluten free diet will only come from randomised trials. After all, observational epidemiology can get the wrong answer, for example with hormone replacement therapy and the risk of stroke. However, these trials will probably have to be done by neurologists who are much less certain of their position than those in Sheffield and Nottingham who have already made up their minds to treat or not to treat.The proliferation of publications on the neurological manifestations of gluten sensitivity reflects a surge of interest in this fascinating group of immune-mediated diseases. Thorough knowledge of the
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Although still considered experimental by some, computerized posturography is becoming more and more the standard assessment of balance and neuromuscular control mechanisms while standing. However, there is no consensus as to the data acquisition parameters to be used. Depending on which posturography school one belongs to, acquisition frequencies vary from a few Hz all the way to 1 kHz, and little attention is usually given to the post-sampling filter cut-off frequency (implemented either in the hardware or in the software used to acquire the data), often without realizing the consequences such choices will have on the results. But the sampling and the filter cut-off frequencies are particularly important when dealing with spectral analysis or when secondary measurements such as the center of pressure coordinates, sway path length, velocity or acceleration are calculated from the measured forces and moments. In this paper, frequency content of vertical ground reaction force and center of pressure path coordinates excursion were determined for 946 subjects of both genders, with various age, height, body type, health status and nationality. The results of this spectral analysis made it possible to draw some general conclusions as to what should be a proper acquisition frequency for posturographic data.
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The concept of the CNS as an immune-privileged organ has led to a common misunderstanding that it is not an active immunological organ, guarded from its surroundings by the blood-brain barrier (BBB). Recent advances in this field clearly demonstrate that the CNS is a highly immunologically active organ, with complex immune responses mostly based on innate immune processes. Such responses implicate a continuum of heterogeneous cell types both inside the CNS, in the periphery, and at their interface, the BBB. This Review aims to discuss the importance of the BBB as the first line of defense against brain infections and injuries of the CNS and the main molecular mechanisms involved in the control of the innate immune system of the CNS. We also review the central role of the neurovascular unit in diseases of the CNS and how it can be targeted for novel therapeutic strategies.
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Trigeminal neuralgia (TN) is one of the most excruciating pain syndromes afflicting the orofacial region. Trigeminal neuralgia may be primary i.e. idiopathic or secondary, resulting from trauma or a CNS lesion. Considering the agonizing nature of the disease and TN being the commonest of the neural maladies affecting the orofacial region it is important for the oral physician to be aware of all available treatment options. This article makes an attempt to present a brief insight into the current treatment modalities that are on hand to treat this condition. From the perspective of the oral physician the pharmacotherapy constitutes the cornerstone in the management of TN. At the same time, it is also important to be aware and updated of the role of the oral surgeon and radiologist in the application of the array of interventional procedures available for treating TN.
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This study examined the differential contribution of pre- and perinatal risks in narrowly versus broadly defined autism spectrum disorder (ASD) and across core symptom domains, IQ and co-morbid problems. Children with a DSM-IV diagnosis of autistic disorder (AD) (n = 121) or pervasive developmental disorder not otherwise specified (PDD-NOS) (n = 75) were compared to a typical control sample (n = 311). Diagnoses were based on extensive assessments between 12 and 49 months of age (M = 33.3, SD = 6.4) and re-evaluated at 43-98 months (M = 68.1, SD = 10.7) in 70 % of the cases. Compared with controls, cases with ASD were more likely to be firstborn and show a suboptimal condition after birth. Case mothers reported more infections and more stress during pregnancy. Although the ASD subgroups showed mostly overlapping risks, cases with PDD-NOS differed from those with AD by higher exposure to smoking during pregnancy (SDP) and by a negative association of smoking with IQ, regardless of confounders. SDP appears to contribute more to broadly defined (PDD-NOS) than to narrowly defined ASD (AD). Findings suggest differences in etiological contributors between ASD phenotypes.
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Objective The aim of this study was to investigate the diagnostic criteria and clinical presentations and compare the different treatment modalities in relation to prognosis in a sample of patients with the neuropathic disorder trigeminal neuralgia (TN). MethodsA retrospective review study of clinical records was conducted of 92 patients diagnosed with TN. ResultsThe mean age[standard deviation (SD)] of the patients was 67.3 +/- 12.7years with an average TN duration of 7.1 +/- 6years and a female predominance (M:F=1:2.5). The maxillary branch was the most involved nerve (in 45% of patients). Twelve patients underwent CT scans, while thirty-six patients had MRIs. Carbamazepine used by 92.4% of patients was the most commonly used drug in the management of the disorder. Twenty-two patients had microvascular decompression (MVD). TN symptoms were completely relieved following surgery in 73% of patients who underwent neurosurgery. ConclusionsMRI is highly sensitive in the exclusion of central intracranial lesions and recommended as a routine consideration during the assessment of TN patients. Despite the side effects, carbamazepine is the drug therapy of choice. MVD produces satisfactory relief of TN symptoms in the majority of cases and should be offered to young healthy patients.
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We report a patient with late-onset celiac disease and neurological manifestations including myopathy, polyneuropathy, and ataxia. Laboratory investigations showed anti-gliadin antibodies and severe vitamin E deficiency. Muscle biopsy revealed inflammatory infiltrates and rimmed vacuoles, similar to those found in inclusion-body myositis. A gluten-free diet and vitamin E supplementation reversed both the clinical neurological manifestations and the abnormalities in the muscle biopsy. Anti-gliadin antibodies were no longer present. This case illustrates the spectrum of neurological complications of celiac disease and documents the occurrence of reversible pathology resembling inclusion-body myopathy in the muscle. Muscle Nerve 2004
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This double-blind, placebo-controlled study assessed the efficacy of 4 weeks of impulse magnetic-field therapy (16 Hz, 5 μTs), delivered through a small device, for different types of headache and migraine. Eighty-two patients were randomly assigned to receive either active treatment or placebo (n = 41 each) and were characterized according to one of seven diagnoses (migraine, migraine combined with tension, tension, cluster, weather-related, posttraumatic, or other). Efficacy was assessed in terms of duration, severity, and frequency of migraine and headache attacks, as well as ability to concentrate. Data for77 patients were analyzed. In the active-treatment group, all assessed criteria were significantly improved at the end of the study (P<.0001 vs baseline and placebo). Seventy-six percent of active-treatment patients experienced clear or very clear relief of their complaints. Only 1 placebo-patient (2.5%) felt some relief; 8% noted slight and 2% reported significant worsening of symptoms. No side effects were noted.