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Cerebellum (London, England) Dec 2023Current understanding of anti-Yo/PCA1 antibody-associated cerebellar ataxia is based on case reports and small case series. Our goal was to summarize clinical features,... (Review)
Review
Current understanding of anti-Yo/PCA1 antibody-associated cerebellar ataxia is based on case reports and small case series. Our goal was to summarize clinical features, highlighting atypical presentations and gaps of knowledge. Following the PRISMA guidelines, we systematically screened Pubmed/MEDLINE, Embase, Scopus, and Web of Science from inception to April 2022 for all case reports and series concerning anti-Yo antibody-associated cerebellar ataxia. We collected data on clinical presentation, investigation findings, and treatment outcomes. Of 379 included patients, 96% were female with gynecologic cancer (82%). Among men, 87% had an associated tumor, mainly of gastrointestinal origin. The median age was 60 years old. Pancerebellar ataxia was the main clinical feature, but extracerebellar findings were frequent during the disease course. Vertigo and imbalance can be present early in the disease course in about two thirds of patients, as a prodromal phase. Although neuroimaging usually is normal or shows cerebellar atrophy, inflammatory changes may also be present. More than half of the patients reported some improvement after immunotherapy. However, despite treatment, 84% of survivors were unable to walk unassisted on follow-up. Our study provides objective data and advances in current knowledge of anti-Yo antibody-associated cerebellar ataxia such as the description of prodromal symptoms, extracerebellar findings, and its presentations in males.
Topics: Male; Middle Aged; Humans; Female; Cerebellar Ataxia; Paraneoplastic Cerebellar Degeneration; Purkinje Cells; Cerebellar Diseases; Neoplasms; Autoantibodies; Disease Progression
PubMed: 36334195
DOI: 10.1007/s12311-022-01492-3 -
Acta Neurologica Scandinavica Nov 2022Restless Legs Syndrome (RLS) is a sleep-related movement disorder, which can also result from brainstem pathology. A systematic review of articles published in the... (Review)
Review
Restless Legs Syndrome (RLS) is a sleep-related movement disorder, which can also result from brainstem pathology. A systematic review of articles published in the electronic databases PubMed and Web of Science was conducted to summarize the existent literature on RLS associated with a brainstem stroke. We identified eight articles including 19 subjects with RLS due to brainstem ischemic lesion. The symptoms occurred simultaneously with the infarction (66.7%) or few days after (33.3%). The most common location of infarction was pons and less commonly medulla. In most cases (68.4%), symptoms were unilateral. In the majority of those cases (92.3%), the contralateral limb was affected due to a lateral pons infarction. RLS symptoms after infarction improved or resolved in almost 90% of cases within a few days up to 3 months. In almost all patients who received dopaminergic treatment (11 out of 13, 91.7%), the symptoms improved significantly or resolved completely. Screening for RLS has to be considered in patients suffering a brainstem stroke, particularly anteromedial pontine infarction. The appearance of acute unilateral RLS symptoms, usually in association with other sensorimotor deficits, should prompt the clinician to consider a vascular event in the brainstem. RLS in these cases seem to have a favorable outcome and respond well to dopaminergic treatment.
Topics: Brain Stem Infarctions; Dopamine; Humans; Pons; Restless Legs Syndrome; Stroke
PubMed: 36063288
DOI: 10.1111/ane.13702 -
Neurology Feb 2019To study hematoma location and morphology of intracerebral hemorrhage (ICH) associated with oral anticoagulants (OAC) and delineate causes and mechanism.
OBJECTIVE
To study hematoma location and morphology of intracerebral hemorrhage (ICH) associated with oral anticoagulants (OAC) and delineate causes and mechanism.
METHODS
We performed a systematic literature research and meta-analysis of studies comparing neuroimaging findings in patients with OAC-ICH compared to those with ICH not associated with OAC (non-OAC ICH). We calculated pooled risk ratios (RRs) for ICH location using the Mantel-Haenszel random-effects method and corresponding 95% confidence intervals (95% CI).
RESULTS
We identified 8 studies including 6,259 patients (OAC-ICH n = 1,107, pooled OAC-ICH population 17.7%). There was some evidence for deep ICH location (defined as ICH in the thalamus, basal ganglia, internal capsule, or brainstem) being less frequent in patients with OAC-ICH (OAC-ICH: 450 of 1,102/40.8% vs non-OAC ICH: 2,656 of 4,819/55.1%; RR 0.94, 95% CI 0.88-1.00, = 0.05, = 0%) while cerebellar ICH location was significantly more common in OAC-ICH (OAC-ICH: 111 of 1,069/10.4% vs non-OAC ICH: 326 of 4,787/6.8%; RR 1.45, 95% CI 1.12-1.89, = 0.005, = 21%) compared to non-OAC ICH. There was no statistically significant relationship to OAC use for lobar (OAC-ICH: 423 of 1,107/38.2% vs non-OAC ICH: 1,884 of 5,152/36.6%; RR 1.02, 95% CI 0.89-1.17, = 0.75, = 53%, for heterogeneity = 0.04) or brainstem ICH (OAC-ICH: 36 of 546/6.6% vs non-OAC ICH: 172 of 2,626/6.5%; RR 1.04, 95% CI 0.58-1.87, = 0.89, = 59%, for heterogeneity = 0.04). The risk for intraventricular extension (OAC-ICH: 436 of 840/51.9% vs non-OAC ICH: 1,429 of 3,508/40.7%; RR 1.26, 95% CI 1.16-1.36, < 0.001, = 0%) was significantly increased in patients with OAC-ICH. We found few data on ICH morphology in OAC-ICH vs non-OAC ICH.
CONCLUSION
The overrepresentation of cerebellar ICH location and intraventricular extension in OAC-ICH might have mechanistic relevance for the underlying arteriopathy, pathophysiology, or bleeding pattern of OAC-ICH, and should be investigated further.
Topics: Administration, Oral; Anticoagulants; Basal Ganglia Hemorrhage; Brain; Brain Stem; Case-Control Studies; Cerebellum; Cerebral Hemorrhage; Hematoma; Humans; Internal Capsule; Thalamus
PubMed: 30674603
DOI: 10.1212/WNL.0000000000006958 -
Neurosurgical Review Feb 2021The cerebellum is historically implicated in motor coordination, but accumulating modern evidence indicates involvement in non-motor domains, including cognition,...
The cerebellum is historically implicated in motor coordination, but accumulating modern evidence indicates involvement in non-motor domains, including cognition, emotion, and language. This correlates with the symptoms observed in postoperative cerebellar mutism syndrome (CMS). Profound knowledge of cerebellar functional topography and tractography is important when approaching cerebellar tumors, as surgical trauma to relevant structures of cerebellar pathways plays a role in the pathogenesis of CMS. The aim of this systematic review is to provide a concise overview of relevant modern neuroimaging data and cerebellar functional tracts with regard to neurosurgical procedures.
Topics: Cerebellum; Humans; Neural Pathways; Neuroimaging; Neurosurgeons; Neurosurgical Procedures
PubMed: 32056026
DOI: 10.1007/s10143-020-01242-1 -
Stereotactic and Functional Neurosurgery 2021Surgical interventions for spasticity aim to improve motor function and pain in cases that are refractory to medical treatment. Ablation of the cerebellar dentate...
BACKGROUND
Surgical interventions for spasticity aim to improve motor function and pain in cases that are refractory to medical treatment. Ablation of the cerebellar dentate nucleus (dentatotomy) may be a useful alternative.
CASE REPORT
A 55-year-old male patient with spasticity, secondary to a traumatic cervical spinal cord injury with quadriparesis, had bilateral lumbar DREZotomy with an improvement that lasted for 6 years. Ten years after the DREZotomy, a progressive increased spasticity manifested as spastic diplegia (Ashworth 4) and spontaneous muscle painful spasms (Penn 4), as well as spasticity in the upper extremities, predominantly on the right side (Ashworth 3). A right radio frequency dentatotomy was performed with intraoperative electrophysiological monitoring. Spasticity scales were applied at the following times: preoperative and at 1 and 8 months after surgery. During the first month, the patient presented a clear decrease in spasticity ipsilateral to the side of lesioning (Ashworth 1) and of painful spasms in the lower extremities (Penn 1). After 8 months, spasticity ipsilateral to the injury decreased even more to Ashworth (0), but a progressive increase in muscle spasms of lower extremities was observed (Penn 2).
CONCLUSION
Stereotactic dentatotomy may be an effective surgical alternative for management of spasticity associated with painful spasms in selected patients.
Topics: Cerebellar Nuclei; Humans; Male; Middle Aged; Muscle Spasticity; Pain
PubMed: 34107470
DOI: 10.1159/000516423 -
Neuroscience Apr 2023Walking is an important function which requires coordinated activity of sensory-motor neural networks. Noninvasive brain stimulation (NIBS) is a safe neuromodulatory... (Review)
Review
BACKGROUND AND OBJECTIVES
Walking is an important function which requires coordinated activity of sensory-motor neural networks. Noninvasive brain stimulation (NIBS) is a safe neuromodulatory technique with motor function-improving effects. This study aimed to determine the effect of different types of NIBS interventions explored in randomized controlled trials on gait in healthy young and older adults.
METHODS
Based on the PRISMA approach, we conducted an electronic search in PubMed, Web of Science, Scopus, and PEDro for randomized clinical trials assessing the effect of NIBS on gait in healthy young and older adults and performed a narrative review.
RESULTS
Fourteen studies were included in this systematic review. According to the outcomes, transcranial direct current stimulation (tDCS) over the motor cortex and transcranial alternating current stimulation (tACS) over the cerebellum seem to be promising for improving gait characteristics such as speed, synchronization, and variability. Furthermore, tDCS over the dorsolateral prefrontal cortex (DLPFC) improved gait speed and reduced gait parameter variability under dual-task conditions. Only one repetitive transcranial magnetic stimulation was available, which showed no effects. No studies were available for transcranial random noise stimulation, and transcranial pulsed current stimulation. Moreover, the intervention parameters of the included studies were heterogeneous, and studies comparing directly specific intervention protocols were missing.
CONCLUSION
NIBS is a promising approach to improve gait in healthy young and older adults. Anodal tDCS over the motor areas and DLPFC, and tACS over the cerebellum have shown positive effects on gait.
Topics: Transcranial Direct Current Stimulation; Transcranial Magnetic Stimulation; Gait; Walking; Cerebellum; Randomized Controlled Trials as Topic
PubMed: 36720301
DOI: 10.1016/j.neuroscience.2023.01.026 -
Cerebellum (London, England) Feb 2024The cerebellum is involved in many motor, autonomic and cognitive functions, and new tasks that have a cerebellar contribution are discovered on a regular basis.... (Review)
Review
The cerebellum is involved in many motor, autonomic and cognitive functions, and new tasks that have a cerebellar contribution are discovered on a regular basis. Simultaneously, our insight into the functional compartmentalization of the cerebellum has markedly improved. Additionally, studies on cerebellar output pathways have seen a renaissance due to the development of viral tracing techniques. To create an overview of the current state of our understanding of cerebellar efferents, we undertook a systematic review of all studies on monosynaptic projections from the cerebellum to the brainstem and the diencephalon in mammals. This revealed that important projections from the cerebellum, to the motor nuclei, cerebral cortex, and basal ganglia, are predominantly di- or polysynaptic, rather than monosynaptic. Strikingly, most target areas receive cerebellar input from all three cerebellar nuclei, showing a convergence of cerebellar information at the output level. Overall, there appeared to be a large level of agreement between studies on different species as well as on the use of different types of neural tracers, making the emerging picture of the cerebellar output areas a solid one. Finally, we discuss how this cerebellar output network is affected by a range of diseases and syndromes, with also non-cerebellar diseases having impact on cerebellar output areas.
Topics: Animals; Cerebellum; Cerebellar Nuclei; Diencephalon; Brain Stem; Mammals; Neural Pathways
PubMed: 36575348
DOI: 10.1007/s12311-022-01499-w -
Neuroscience and Biobehavioral Reviews Oct 2015Functional magnetic resonance imaging (fMRI) studies suggest that stroke-induced motor deficits are associated with an interhemispheric imbalance of motor activation.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Functional magnetic resonance imaging (fMRI) studies suggest that stroke-induced motor deficits are associated with an interhemispheric imbalance of motor activation. This meta-analysis aims to determine the changes of interhemispheric activation balance (IHAB) in motor-related cortices along with post-stroke motor recovery.
METHODS
We searched PubMed for fMRI studies that investigated IHAB in stroke patients with motor recovery. Laterality indexes (LIs, (ipsilesional activation-contralesional activation)/(ipsilesional activation+contralesional activation)) before and after motor improvement were extracted as the outcome measures of IHAB. Data were synthesized by calculating standardized mean difference (SMD, Hedges' adjusted g) with 95% confidence intervals (CI).
RESULTS
After the rejection of 459 studies, 22 trials fulfilled the inclusion criteria and were included in the systematic review and meta-analysis. The LIs of sensorimotor cortex (SMC, 22 trials, 195 subjects), premotor cortex (PMC, 12 trials, 93 subjects), supplementary motor area (SMA, 12 trials, 92 subjects), and cerebellum (CB, 4 trials, 31 subjects) were assessed. Studies sampling from stroke patients with motor improvement showed positive changes of LI in SMC (SMD, 0.71; 95% CI, 0.41-1.01; P<0.00001) and PMC (SMD, 0.68; 95% CI, 0.36-1.00; P<0.0001), but not in SMA (SMD, 0.07; 95% CI, -0.62 to 0.75; P=0.85) and CB (SMD, -0.17; 95% CI, -1.52 to 1.19, P=0.81). Studies involving stroke patients with poor motor recovery showed non-significant changes in all of the four motor-related cortices (P>0.05).
CONCLUSIONS
This meta-analysis suggests that along with good motor recovery of stroke patients, the IHAB is up-regulated in SMC and PMC, but not significantly changed in SMA and CB. Because of the limited data, further studies are needed to verify the findings.
Topics: Cerebellar Cortex; Cerebral Cortex; Humans; Magnetic Resonance Imaging; Movement Disorders; Recovery of Function; Stroke; Stroke Rehabilitation
PubMed: 26344667
DOI: 10.1016/j.neubiorev.2015.09.003 -
Cerebellum (London, England) Feb 2024Cerebellar ataxia(CA) is defined as a degenerative disease of the nervous system. Repetitive transcranial magnetic stimulation (rTMS) has been a promising treatment for... (Meta-Analysis)
Meta-Analysis Review
Cerebellar ataxia(CA) is defined as a degenerative disease of the nervous system. Repetitive transcranial magnetic stimulation (rTMS) has been a promising treatment for neurological and psychiatric diseases. Hence, to find out whether cerebellar rTMS impacts CA as a potential therapy, we performed a systematic review and meta-analysis. Qualified studies through a systematic search were retrieved for randomized controlled trials (RCTs) using acknowledged databases. Review Manager 5.4 software was employed to synthesize the data. A total of seven studies were identified as eligible and included in the quantitative review. Comparing real and sham-rTMS interventions, the utilization of rTMS on cerebellum improved the scale for the assessment and rating of ataxia (SARA) (SMD - 0.87, 95% CI - 1.41 to - 0.34; P = 0.001; I = 62%), the International Cooperative Ataxia Rating Scale (ICARS) (SMD - 1.06, 95% CI - 1.47 to - 0.64; P < 0.00001; I = 0%) and Berg balance Scale (BBS) (SMD 0.76, 95% CI 0.33 to 1.19; P = 0.0005; I = 39%). The subgroup analysis demonstrated high-frequency of rTMS had a positive effect (SMD - 1.28, 95% CI - 1.82 to - 0.74; P < 0.00001; I = 0%). For the safety, the incidence of adverse events between the two groups was not significantly different (OR 1.73, 95% CI 0.55 to 5.46; P = 0.35; I = 0%). In conclusion, this meta-analysis provided limited evidence, suggesting a possible strategy that rTMS over the cerebellum could be a viable therapy for symptoms associated with CA. Besides, rTMS intervention was well-attended and did not result in unanticipated negative effects.
Topics: Humans; Transcranial Magnetic Stimulation; Cerebellar Ataxia; Cerebellum; Ataxia; Mental Disorders
PubMed: 36604400
DOI: 10.1007/s12311-022-01508-y -
Cerebellum (London, England) Oct 2023The cerebellum is involved in regulating motor, affective, and cognitive processes. It is a promising target for transcranial direct current stimulation (tDCS)... (Review)
Review
BACKGROUND
The cerebellum is involved in regulating motor, affective, and cognitive processes. It is a promising target for transcranial direct current stimulation (tDCS) intervention in stroke.
OBJECTIVES
To review the current evidence for cerebellar tDCS (ctDCS) in stroke, its problems, and its future directions.
METHODS
We searched the Web of Science, MEDLINE, CINAHL, EMBASE, Cochrane Library, and PubMed databases. Eligible studies were identified after a systematic literature review of the effects of ctDCS in stroke patients. The changes in assessment scale scores and objective indicators after stimulation were reviewed.
RESULTS
Eleven studies were included in the systematic review, comprising 169 stroke patients. Current evidence suggests that anode tDCS on the right cerebellar hemisphere does not appear to enhance language processing in stroke patients. Compared with the sham group, stroke patients showed a significant improvement in the verb generation task after cathodal ctDCS stimulation. However, with regard to naming, two studies came to the opposite conclusion. The contralesional anodal ctDCS is expected to improve standing balance but not motor learning in stroke patients. The bipolar bilateral ctDCS protocol to target dentate nuclei (PO10h and PO9h) had a positive effect on standing balance, goal-directed weight shifting, and postural control in stroke patients.
CONCLUSIONS
ctDCS appears to improve poststroke language and motor dysfunction (particularly gait). However, the evidence for these results was insufficient, and the quality of the relevant studies was low. ctDCS stimulation parameters and individual factors of participants may affect the therapeutic effect of ctDCS. Researchers need to take a more regulated approach in the future to conduct studies with large sample sizes. Overall, ctDCS remains a promising stroke intervention technique that could be used in the future.
Topics: Humans; Transcranial Direct Current Stimulation; Cerebellum; Stroke; Language; Postural Balance
PubMed: 36028789
DOI: 10.1007/s12311-022-01464-7