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Nature Nov 2022A spinal cord injury interrupts pathways from the brain and brainstem that project to the lumbar spinal cord, leading to paralysis. Here we show that spatiotemporal...
A spinal cord injury interrupts pathways from the brain and brainstem that project to the lumbar spinal cord, leading to paralysis. Here we show that spatiotemporal epidural electrical stimulation (EES) of the lumbar spinal cord applied during neurorehabilitation (EES) restored walking in nine individuals with chronic spinal cord injury. This recovery involved a reduction in neuronal activity in the lumbar spinal cord of humans during walking. We hypothesized that this unexpected reduction reflects activity-dependent selection of specific neuronal subpopulations that become essential for a patient to walk after spinal cord injury. To identify these putative neurons, we modelled the technological and therapeutic features underlying EES in mice. We applied single-nucleus RNA sequencing and spatial transcriptomics to the spinal cords of these mice to chart a spatially resolved molecular atlas of recovery from paralysis. We then employed cell type and spatial prioritization to identify the neurons involved in the recovery of walking. A single population of excitatory interneurons nested within intermediate laminae emerged. Although these neurons are not required for walking before spinal cord injury, we demonstrate that they are essential for the recovery of walking with EES following spinal cord injury. Augmenting the activity of these neurons phenocopied the recovery of walking enabled by EES, whereas ablating them prevented the recovery of walking that occurs spontaneously after moderate spinal cord injury. We thus identified a recovery-organizing neuronal subpopulation that is necessary and sufficient to regain walking after paralysis. Moreover, our methodology establishes a framework for using molecular cartography to identify the neurons that produce complex behaviours.
Topics: Animals; Humans; Mice; Neurons; Paralysis; Spinal Cord; Spinal Cord Injuries; Walking; Electric Stimulation; Lumbosacral Region; Neurological Rehabilitation; Sequence Analysis, RNA; Gene Expression Profiling
PubMed: 36352232
DOI: 10.1038/s41586-022-05385-7 -
The Medical Clinics of North America Mar 2019Upper extremity entrapment neuropathies are common and can cause pain, sensory loss, and muscle weakness that lead to functional disability. In this article, the authors... (Review)
Review
Upper extremity entrapment neuropathies are common and can cause pain, sensory loss, and muscle weakness that lead to functional disability. In this article, the authors review common entrapment neuropathies of the upper extremities, including median neuropathy at the wrist (carpal tunnel syndrome), ulnar neuropathy at the elbow, and radial neuropathy. The authors discuss the pathophysiology of nerve compression and typical etiologies, as well as strategies for differentiating between common mimics such as cervical radiculopathy and for selecting between various treatment modalities.
Topics: Carpal Tunnel Syndrome; Diagnosis, Differential; Electrodiagnosis; Humans; Nerve Compression Syndromes; Neurologic Examination; Paralysis; Upper Extremity
PubMed: 30704687
DOI: 10.1016/j.mcna.2018.10.012 -
Seminars in Neurology Oct 2015An isolated ocular motor nerve palsy is defined as dysfunction of a single ocular motor nerve (oculomotor, trochlear, or abducens) with no associated or localizing... (Review)
Review
An isolated ocular motor nerve palsy is defined as dysfunction of a single ocular motor nerve (oculomotor, trochlear, or abducens) with no associated or localizing neurologic signs or symptoms. When occurring in patients aged 50 or older, the most common cause is microvascular ischemia, but serious etiologies such as aneurysm, malignancy, and giant cell arteritis should always be considered. In this article, the authors review the clinical approach, anatomy, and differential diagnosis of each isolated ocular motor nerve palsy and discuss the clinical characteristics, pathophysiology, and treatment of microvascular ischemia.
Topics: Abducens Nerve Diseases; Humans; Oculomotor Nerve Diseases; Paralysis; Trochlear Nerve Diseases
PubMed: 26444399
DOI: 10.1055/s-0035-1563568 -
Ideggyogyaszati Szemle Jul 2022The incidence of brachial plexus palsy (BPP) has decreased recently, but the indivi-d-ual's quality of life is endangered. To provide better chan-ces to BPP neonates and... (Review)
Review
BACKGROUND AND PURPOSE
The incidence of brachial plexus palsy (BPP) has decreased recently, but the indivi-d-ual's quality of life is endangered. To provide better chan-ces to BPP neonates and infants, the Department of Developmental Neurology worked out, introduced, and applied a complex early therapy, including nerve point stimulation.
METHODS
After diagnosing the severity of BPP, early intensive and complex therapy should be started. Appro-x-imately after a week or ten days following birth, the slightest form (neurapraxia) normalizes without any intervention, and signs of recovery can be detected around this period. The therapy includes the unipolar nerve point electro-stimulation and the regular application of those elemen-tary sensorimotor patterns, which activate both extremities simultaneously.
RESULTS
With the guideline worked out and applied in the Department of Developmental Neurology, full recovery can be achieved in 50% of the patients, and even in the most severe cases (nerve root lesion), functional upper limb usage can be detected with typically developing body-scheme.
CONCLUSION
Immediately starting complex treatment based on early diagnosis alters the outcome of BPP, providing recovery in the majority of cases and enhancing the everyday arm function of those who only partially benefit from the early treatment.
Topics: Brachial Plexus; Brachial Plexus Neuropathies; Early Diagnosis; Humans; Infant; Infant, Newborn; Neonatal Brachial Plexus Palsy; Paralysis; Quality of Life
PubMed: 35916611
DOI: 10.18071/isz.75.0247 -
Nature Nov 2018Spinal cord injury leads to severe locomotor deficits or even complete leg paralysis. Here we introduce targeted spinal cord stimulation neurotechnologies that enabled...
Spinal cord injury leads to severe locomotor deficits or even complete leg paralysis. Here we introduce targeted spinal cord stimulation neurotechnologies that enabled voluntary control of walking in individuals who had sustained a spinal cord injury more than four years ago and presented with permanent motor deficits or complete paralysis despite extensive rehabilitation. Using an implanted pulse generator with real-time triggering capabilities, we delivered trains of spatially selective stimulation to the lumbosacral spinal cord with timing that coincided with the intended movement. Within one week, this spatiotemporal stimulation had re-established adaptive control of paralysed muscles during overground walking. Locomotor performance improved during rehabilitation. After a few months, participants regained voluntary control over previously paralysed muscles without stimulation and could walk or cycle in ecological settings during spatiotemporal stimulation. These results establish a technological framework for improving neurological recovery and supporting the activities of daily living after spinal cord injury.
Topics: Activities of Daily Living; Biomedical Technology; Computer Simulation; Electric Stimulation Therapy; Electromyography; Epidural Space; Humans; Leg; Locomotion; Male; Motor Neurons; Muscle, Skeletal; Paralysis; Spinal Cord; Spinal Cord Injuries; Walking
PubMed: 30382197
DOI: 10.1038/s41586-018-0649-2 -
Ugeskrift For Laeger Apr 2021Todd's paralysis is a clinical entity consisting of acute focal neurological deficits following an epileptic seizure. It occurs after 6-13% of seizures, and the symptoms... (Review)
Review
Todd's paralysis is a clinical entity consisting of acute focal neurological deficits following an epileptic seizure. It occurs after 6-13% of seizures, and the symptoms may last from minutes to 36 hours. Stroke with seizure at symptom onset is difficult to differentiate clinically from Todd's paralysis. The use of advanced imaging such as cerebral CT and MRI with angiography is recommended. This is a review of the current knowledge on pathogenesis, clinical presentation and differential diagnoses, and we propose an investigation plan for patients presenting with symptoms of Todd's paralysis.
Topics: Epilepsy; Humans; Magnetic Resonance Imaging; Paralysis; Seizures; Stroke
PubMed: 33913429
DOI: No ID Found -
Thoracic Surgery Clinics Feb 2023Diaphragmatic paralysis is an elevation of the diaphragm caused by a lesion along the neuromuscular axis and may be either bilateral or unilateral. Most commonly,... (Review)
Review
Diaphragmatic paralysis is an elevation of the diaphragm caused by a lesion along the neuromuscular axis and may be either bilateral or unilateral. Most commonly, paralysis is unilateral and iatrogenic in nature. Symptoms of this disease may be life-limiting, and when conservative measures fail, surgical therapy may be of significant benefit to patients. With the advent of robotic minimally invasive techniques, diaphragm plication can be a useful therapy for patients with resolution of symptoms, reduced length of hospitalization, and quickened recovery. This article provides an overview of the disease, diagnosis, and current therapies including robotic techniques.
Topics: Humans; Diaphragm; Respiratory Paralysis
PubMed: 36372538
DOI: 10.1016/j.thorsurg.2022.08.004 -
Expert Review of Molecular Diagnostics 2023Skeletal muscle channelopathies (SMCs) are a heterogenous group of disorders, caused by mutations in skeletal ion channels leading to abnormal muscle excitability,... (Review)
Review
INTRODUCTION
Skeletal muscle channelopathies (SMCs) are a heterogenous group of disorders, caused by mutations in skeletal ion channels leading to abnormal muscle excitability, resulting in either delayed muscle relaxation (myotonia) which characterizes non-dystrophic myotonias (NDMs), or membrane transient inactivation, causing episodic weakness, typical of periodic paralyses (PPs).
AREAS COVERED
SMCs include myotonia congenita, paramyotonia congenita, and sodium-channel myotonia among NDMs, and hyper-normokalemic, hypokalemic, or late-onset periodic paralyses among PPs. When suspecting an SMC, a structured diagnostic approach is required. Detailed personal and family history and clinical examination are essential, while neurophysiological tests should confirm myotonia and rule out alternative diagnosis. Moreover, specific electrodiagnostic studies are important to further define the phenotype of de novo cases and drive molecular analyses together with clinical data. Definite diagnosis is achieved through genetic testing, either with Sanger sequencing or multigene next-generation sequencing panel. In still unsolved patients, more advanced techniques, as exome-variant sequencing or whole-genome sequencing, may be considered in expert centers.
EXPERT OPINION
The diagnostic approach to SMC is still mainly based on clinical data; moreover, definite diagnosis is sometimes complicated by the difficulty to establish a proper genotype-phenotype correlation. Lastly, further studies are needed to allow the genetic characterization of unsolved patients.
Topics: Humans; Myotonia; Channelopathies; Muscle, Skeletal; Myotonic Disorders; Paralyses, Familial Periodic; Mutation; Paralysis
PubMed: 38009256
DOI: 10.1080/14737159.2023.2288258 -
Acta Oto-laryngologica Oct 2019Because the incidence of bilateral facial palsy is extremely low, clinical diagnosis and treatment may be delayed and the possibility of misdiagnosis is high. This...
Because the incidence of bilateral facial palsy is extremely low, clinical diagnosis and treatment may be delayed and the possibility of misdiagnosis is high. This systematic review, therefore, evaluated the clinical manifestations of bilateral facial palsy. The SCOPUS and PubMed databases were searched through 31 August 2018, using the search term 'bilateral facial palsy'. Reference lists of identified studies were also reviewed. A search of titles and abstracts identified 390 studies; after eliminating duplicates and inappropriate studies, 10 studies, involving 75 patients from four countries, were analyzed. The percentage of patients with facial nerve palsy who experienced simultaneous bilateral facial palsy ranged from 0.3% to 2.0%. There were no differences between men and women in all age groups. The causes of bilateral facial palsy differed, and 51% were associated with other cranial nerves. Complete recovery was achieved in 80% of patients and incomplete recovery in 20%. Bilateral facial palsy has various causes. Prognosis for recovery is good.
Topics: Adolescent; Adult; Aged; Child; Facial Paralysis; Female; Humans; Male; Middle Aged; Young Adult
PubMed: 31430217
DOI: 10.1080/00016489.2019.1651134 -
Spinal Cord May 2019
Topics: Clinical Trials as Topic; Humans; Internationality; Paralysis; Spinal Cord Injuries
PubMed: 30962517
DOI: 10.1038/s41393-019-0277-1