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Evidence-based Complementary and... 2020This study aimed to evaluate the effect of acupuncture intervention and manipulation types on poststroke dysarthria. Electronic database, including PubMed, CENTRAL,... (Review)
Review
This study aimed to evaluate the effect of acupuncture intervention and manipulation types on poststroke dysarthria. Electronic database, including PubMed, CENTRAL, Scopus, RISS, and CNKI, were searched for randomized controlled trials (RCT), treating dysarthria using acupuncture, speech-language therapy (SLT), and general management (GM), published before April 2019. The number, distribution, intensity, depth, and repetition of acupuncture and bleeding therapy on the sublingual veins were considered as manipulation types. Risk of bias of the included trials was evaluated, and their efficacy was assessed using risk ratio (RR) and the standard mean differences in the Frenchay Dysarthria Assessment and Speech Function Grading, with 95% confidence intervals (CIs).Fifteen RCT trials involving 1453 patients were isolated. Electroacupuncture plus SLT and manual acupuncture plus SLT were more effective than SLT only, respectively (RR = 1.520, 95% CI [1.183-1.952], RR = 1.380, 95% CI [1.281-1.488]). The clinical efficacy of acupuncture plus GM was higher than that of GM alone (RR = 1.165, 95% CI [1.050-1.293]). Meta-ANOVA showed that none of the manipulation types increased the clinical efficacy of acupuncture on dysarthria. The methodological quality was low. In conclusion, our study suggests that the effect of acupuncture on poststroke dysarthria may be maximized when manual acupuncture or electroacupuncture is combined with SLT, irrespective of manipulation types.
PubMed: 33005199
DOI: 10.1155/2020/4981945 -
Neurological Sciences : Official... Feb 2022Amyotrophic lateral sclerosis (ALS) is a fatal and incurable neurodegenerative disease. There is still no established cost-effective treatment that can improve... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Amyotrophic lateral sclerosis (ALS) is a fatal and incurable neurodegenerative disease. There is still no established cost-effective treatment that can improve functional status and survival of ALS patients. Perampanel, by inhibiting neuronal calcium ion influx and preventing dyslocalization of nuclear proteins, has the potential to ameliorate ALS neurodegeneration.
OBJECTIVES
This study aims to determine the efficacy and safety of perampanel among ALS patients in terms of improvement in functional status using a review of relevant studies.
METHODS
MedLine, Cochrane Central Register for Controlled Trials, Scopus, Embase, Literatura Latino-Americana e do Caribe em Ciências da Saúde, ClinicalTrials.gov website, and HERDIN databases were searched from inception to August 2021 for relevant studies.
RESULTS
The search yielded 132 articles; 3 studies were included in the analysis. Pooled evidence shows that perampanel compared to placebo significantly improves cortical motor hyperexcitability but not the ALS functional rating scale-revised score. Perampanel is associated with adverse events such as aggression, somnolence, anger, and dysarthria.
CONCLUSION
There is no sufficient evidence to support the role of perampanel in improving functional status of ALS patients. Although it can ameliorate motor cortical hyperexcitability, its clinical benefit has not yet been elucidated. Perampanel is not well tolerated among ALS patients as it is associated with adverse events such as aggression, somnolence, anger, and dysarthria. Further studies investigating the role of perampanel early in the ALS disease course, excluding ALS patients with frontotemporal lobe degeneration features and C9ORF72 repeat expansion, and using gradual drug titration schedule are needed to evaluate the potential benefit of perampanel in ALS.
Topics: Amyotrophic Lateral Sclerosis; Humans; Neurodegenerative Diseases; Nitriles; Pyridones
PubMed: 34994876
DOI: 10.1007/s10072-022-05867-6 -
Neurology Nov 2021To perform literature review of clinical, radiographic, and anatomical features of posterior circulation ischemia (PCI) and systematic review of the literature on the...
BACKGROUND AND OBJECTIVES
To perform literature review of clinical, radiographic, and anatomical features of posterior circulation ischemia (PCI) and systematic review of the literature on the management of basilar artery occlusion (BAO) and associated outcomes.
METHODS
Review of literature was conducted to identify publications describing the risk factors, etiology, clinical presentation, and imaging for PCI. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. PubMed and Ovid MEDLINE were searched from 2009 to 2020 for articles relating to management of BAO. A synthesis was compiled summarizing current evidence on management of BAO.
RESULTS
PCI accounts for 15%-20% of strokes. Risk factors are similar to anterior circulation strokes. Dizziness (47%), unilateral limb weakness (41%), and dysarthria (31%) are the most common presenting symptoms. A noncontrast head CT will identify PCI in 21% of cases; diffusion-weighted MRI or CT perfusion increase sensitivity to 85%. Recent trials have shown endovascular therapy can achieve >80% recanalization of BAO. In select patients, 30%-60% who receive endovascular treatment can achieve favorable outcome vs without. A total of 13% achieve good outcome and there is an 86% mortality rate.
DISCUSSION
PCI can present with waxing and waning symptoms or clinical findings that overlap with stroke mimics and anterior circulation ischemia, making diagnosis more heavily dependent on imaging. Recanalization is an important predictor of improved functional outcome and survival. In this endovascular era, trials of BAO are fraught with deterrents to enrollment. Despite limitations, endovascular treatment has shown improved outcome in select patients.
Topics: Endovascular Procedures; Humans; Ischemia
PubMed: 34785614
DOI: 10.1212/WNL.0000000000012808 -
Annals of Physical and Rehabilitation... Sep 2022Although non-invasive central and peripheral stimulations are accruing support as promising treatments in different neurological conditions, their effects on dysarthria... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Although non-invasive central and peripheral stimulations are accruing support as promising treatments in different neurological conditions, their effects on dysarthria have not been systematically investigated.
OBJECTIVE
The purpose of this review was to examine the evidence base of non-invasive stimulation for treating dysarthria, identify which stimulation parameters have the most potential for treatment and determine safety risks.
METHODS
A systematic review with meta-analysis, when possible, involving publications indexed in MEDLINE, PsychINFO, EMBASE CINHAL the Linguistics and Language Behavioral Abstracts, Web of Science, Cochrane Register of Control Trials and 2 trial registries was completed. Articles were searched in December 2018 and updated in June 2021 using keywords related to brain and electrical stimulation, dysarthria and research design. We included trials with randomised, cross-over or quasi-experimental designs; involving a control group; and investigating treatment of neurogenic dysarthria with non-invasive stimulation. Methodological quality was determined with the Cochrane's Risk of Bias-2 tool.
RESULTS
In total, 6186 studies were identified; 10 studies (6 randomised controlled trials and 4 cross-over studies) fulfilled the inclusion criteria. All 10 trials (268 adults with Parkinson's disease, stroke and neurodegenerative cerebellar ataxia) focused on brain stimulation (6 repetitive transcranial magnetic stimulation; 3 transcranial direct current stimulation; and 1 repetitive transorbital alternating current stimulation). Adjunct speech-language therapy was delivered in 2 trials. Most trials reported one or more positive effects of stimulation on dysarthria-related features; however, given the overall high risk of bias and heterogeneity in participant, trial and outcome measurement characteristics, no conclusions can be drawn. Post-treatment size effects for 2 stroke trials demonstrated no statistically significant differences between active and sham stimulation across 3 dysarthria outcomes.
CONCLUSIONS
Evidence for use of non-invasive brain stimulation in treating dysarthria remains inconclusive. Research trials that provide reliable and replicable findings are required.
Topics: Adult; Brain; Dysarthria; Humans; Speech Therapy; Stroke; Transcranial Direct Current Stimulation
PubMed: 34626861
DOI: 10.1016/j.rehab.2021.101580 -
Neurology. Clinical Practice Dec 2023The objective of this study was to explore the clinical spectrum of movement disorders and associated neurologic findings in hypomagnesemia and challenges in diagnosis... (Review)
Review
PURPOSE OF REVIEW
The objective of this study was to explore the clinical spectrum of movement disorders and associated neurologic findings in hypomagnesemia and challenges in diagnosis and treatment.
RECENT FINDINGS
Sixty patients were identified in the literature for analysis. Movement disorders observed were postural tremor (23.3%, n = 14), resting tremor (8.3%, n = 5), intention tremor (10%, n = 6), ataxia involving the trunk (48.3%, n = 29) or limbs (25%, n = 15) and dysarthria (21.7%, n = 13), athetosis (8.3%, n = 5), myoclonus (6.7%, n = 4), and chorea (1.8%, n = 1). Symptoms may be accompanied by downbeat nystagmus, tetany, drowsiness, vertigo, and proximal muscle weakness. Residual deficits were noted in 16 (26.67%) patients. Serum magnesium was 1.3 mg/dL or lower in 53 patients (88.3%). Imaging findings include bilateral cerebellar (20%, n = 11) and vermis hyperintensities (9.09%, n = 5) and normal imaging. Proton pump inhibitors are the commonest etiology.
SUMMARY
The movement disorders linked with hypomagnesemia can be associated with varied neurologic symptoms. A high degree of suspicion will enable early diagnosis to prevent residual deficits.
PubMed: 37795503
DOI: 10.1212/CPJ.0000000000200202 -
Cancer Treatment and Research... 2023Radiation-induced oral mucositis (RIOM) is one of the common toxic reactions from ionizing radiation and normal tissue injuries as a complication of radiation therapy... (Review)
Review
Radiation-induced oral mucositis (RIOM) is one of the common toxic reactions from ionizing radiation and normal tissue injuries as a complication of radiation therapy and chemotherapy. Radiation therapy is an option for the treatment of head and neck cancer (HNC). The use of natural products is an alternative therapy for RIOM. This review aimed to describe the effectiveness of natural-based products (NBPs) in reducing the severity, pain score, incidence, oral lesion size, and other symptoms such as dysphagia, dysarthria, and odynophagia. This systematic review follows the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Pubmed, ScienceDirect, and Ebscohost-CINAHL Plus databases were used for article searches. The inclusion criteria were studies published from 2012 to 2022 with full text available, in English, a study in humans, and a Randomized Clinical Trial (RCT) that evaluate the effect of NBPs therapy in RIOM patients diagnosed with HNC. This study's population was HNC patients who had oral mucositis after receiving radiation or chemical therapy. The NBPs were manuka honey, thyme honey, aloe vera, calendula, zataria multiflora, Plantago major L., and turmeric. Eight of the twelve included articles showed significant effectiveness against RIOM in various parameters, such as a decrease in severity, incidence rate, pain score, oral lesion size, and the other symptoms of oral mucositis such as dysphagia and burning mouth syndrome. This review concludes that NBPs therapy is effective for RIOM in HNC patients.
Topics: Humans; Deglutition Disorders; Head and Neck Neoplasms; Radiation Injuries; Randomized Controlled Trials as Topic; Stomatitis
PubMed: 37209466
DOI: 10.1016/j.ctarc.2023.100720 -
PM & R : the Journal of Injury,... Mar 2021To define methods to measure dysarthria due to stroke and guide physicians in delineating a diagnostic protocol using the best current strategies.
OBJECTIVE
To define methods to measure dysarthria due to stroke and guide physicians in delineating a diagnostic protocol using the best current strategies.
DESIGN
Systematic review.
LITERATURE SURVEY
A search was conducted on PubMed, EMBASE, the Cochrane Library, and Web of Science to identify measurement methods for dysarthria severity in adults after stroke.
METHODS
Two reviewers independently reviewed articles and came to a consensus about which ones to include. The authors excluded all duplicates, articles involving individuals with aphasia or other speech problems other than dysarthria, and articles unrelated to stroke. Articles were included if diagnostic measures were used to examine the effectiveness of speech rehabilitation in stroke patients.
SYNTHESIS
The search identified 1154 articles with the keywords "stroke" OR "ictus" OR "cerebral vascular accident" AND "dysarthria" OR "Speech and Language Disorders" AND "diagnosis" OR "assessment." The reviewers analyzed 86 full texts. There were 37 publications that met the criteria and were included in the systematic review. These articles were used to describe the main methods used for measuring the severity of stroke-related dysarthria before and after speech rehabilitation.
CONCLUSION
Despite the range of diagnostic tools available, robust trials are lacking, and the diagnostic approaches are always different. More research is needed to find the best diagnostic methodologies and delineate a definitive diagnostic protocol.
Topics: Adult; Aphasia; Dysarthria; Humans; Speech Disorders; Speech Therapy; Stroke
PubMed: 32818305
DOI: 10.1002/pmrj.12469 -
Disability and Rehabilitation Jun 2022This review aimed to evaluate the evidence for group therapy in improving speech production in adults with acquired dysarthria. Secondary outcomes included communication...
PURPOSE
This review aimed to evaluate the evidence for group therapy in improving speech production in adults with acquired dysarthria. Secondary outcomes included communication effectiveness and/or wellbeing.
MATERIALS AND METHODS
A review protocol was prospectively published on PROSPERO. Fourteen electronic databases were searched to identify experimental studies investigating adults with acquired dysarthria participating in group intervention with outcomes related to communication and/or wellbeing. The quality of included studies was assessed using the Mixed Methods Appraisal Tool (MMAT) or the McMaster University's Critical Review Form, and the TIDieR template for intervention description and replication.
RESULTS
21 studies were identified involving 330 individuals with dysarthria, from mostly Parkinson's disease (PD) (97%; 321). Treatment approaches included singing therapy ( = 10), loudness therapy ( = 5) and multi-components therapy (including a combination of impairment and/or compensatory approaches) ( = 4). Studies varied in intensity and outcome measures used. Statistically significant improvements to speech production and/or wellbeing were reported following most approaches.
CONCLUSION
There is some preliminary moderate-quality evidence to suggest that group therapy may improve speech production and in some cases communication effectiveness or wellbeing in people with dysarthria following PD, with more consistent improvements being found for loudness approaches. Singing approaches were frequently studied in PD with some improvements to intelligibility evident. Further well-designed controlled studies including individuals with non-progressive aetiologies is warranted to establish the effectiveness of group treatment.IMPLICATIONS FOR REHABILITATIONGroup therapy may be an effective means of improving speech production and/or wellbeing in individuals with dysarthria following Parkinson's disease.Studies' employing loudness-based group therapy for PD demonstrated more consistent improvements to intensity measures.Some controlled studies utilising singing group therapy resulted in improved intelligibility in PD. CRD42015029374.
Topics: Adult; Dysarthria; Humans; Language Therapy; Parkinson Disease; Singing; Speech Therapy
PubMed: 33356634
DOI: 10.1080/09638288.2020.1859629 -
Clinical Microbiology and Infection :... May 2022Lyme neuroborreliosis (LNB) presenting with encephalitis is rare and scarcely described. (Review)
Review
BACKGROUND
Lyme neuroborreliosis (LNB) presenting with encephalitis is rare and scarcely described.
OBJECTIVES
To describe the available literature on LNB encephalitis and to characterize this patient group through a Scandinavian retrospective cohort study.
DATA SOURCES
Medline, Embase, Scopus, Cochrane library.
STUDY ELIGIBILITY CRITERIA
There was no discrimination on study type, time of publication or language.
PARTICIPANTS
Review: All articles with definite LNB and confirmed/possible encephalitis.
COHORT
LNB cohorts from Denmark, Sweden and Norway 1990-2019 were screened for patients with encephalitis.
METHODS
Review: Adhering to PRISMA guidelines; two authors extracted reviews and assessed quality of studies.
COHORT
Data on demography, symptoms, cerebrospinal fluid findings, differential diagnostic examinations, treatment, residual symptoms, 1-year mortality were registered.
RESULTS
Review: 2330 articles screened on title/abstract, 281 full texts, yielding 42 articles (case reports/series or cohort studies), including 45 patients from 18 countries spanning 35 years. Altered mental status ranged from personality changes and confusion to unconsciousness. Common focal symptoms were hemiparesis, ataxia and dysarthria; seven patients had seizures. Median time from symptom onset to hospital was 2 weeks (IQR 2-90 days). Of 38 patients with available follow-up after median 12 months (IQR 5-13), 32 had fully or partially recovered, two had died.
COHORT
Thirty-five patients (median age 67 years, IQR 48-76) were included. The encephalitis prevalence was 3.3% (95% CI 2.2-4.4%) among 1019 screened LNB patients. Frequent encephalitis symptoms were confusion, personality changes, aphasia, ataxia. EEGs and neuroimaging showed encephalitis in 93.8% and 20.6%, respectively. Median delay from symptom onset to hospital was 14 days (IQR 7-34), with further 7 days (IQR 3-34) delay until targeted therapy. At follow-up (median 298 days post-treatment; IQR 113-389), 65.6% had residual symptoms. None had died.
CONCLUSIONS
This study shows that encephalitis is an uncommon, but likely overlooked clinical manifestation of LNB. As the high frequency of residual symptoms may be related to prolonged treatment delay, prompt LNB testing of patients with encephalitis in Borrelia burgdorferi-endemic areas should be considered.
Topics: Aged; Ataxia; Cohort Studies; Encephalitis; Humans; Lyme Neuroborreliosis; Retrospective Studies
PubMed: 34768019
DOI: 10.1016/j.cmi.2021.11.001 -
Chinese Medicine Jan 2021Hereditary ataxia (HA) represents a group of genetically heterogeneous neurodegenerative diseases caused by dysfunction of the cerebellum or disruption of the connection... (Review)
Review
BACKGROUND
Hereditary ataxia (HA) represents a group of genetically heterogeneous neurodegenerative diseases caused by dysfunction of the cerebellum or disruption of the connection between the cerebellum and other areas of the central nervous system. Phenotypic manifestation of HA includes unsteadiness of stance and gait, dysarthria, nystagmus, dysmetria and complaints of clumsiness. There are no specific treatments for HA. Management strategies provide supportive treatment to reduce symptoms.
OBJECTIVES
This systematic review aimed to identify, evaluate and summarise the published literature on the therapeutic roles of natural remedies in the treatment of HA to provide evidence for clinical practice.
METHODS
A systematic literature search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Web of Science, PubMed and Science Direct Scopus were thoroughly searched for relevant published articles from June 2007 to July 2020.
RESULTS
Ten pre-clinical and two clinical studies were eligible for inclusion in this systematic review. We identified the therapeutic roles of medicinal plants Brassica napus, Gardenia jasminoides, Gastrodia elata, Ginkgo biloba, Glycyrrhiza inflata, Paeonia lactiflora, Pueraria lobata and Rehmannia glutinosa; herbal formulations Shaoyao Gancao Tang and Zhengan Xifeng Tang; and medicinal mushroom Hericium erinaceus in the treatment of HA. In this review, we evaluated the mode of actions contributing to their therapeutic effects, including activation of the ubiquitin-proteasome system, activation of antioxidant pathways, maintenance of intracellular calcium homeostasis and regulation of chaperones. We also briefly highlighted the integral cellular signalling pathways responsible for orchestrating the mode of actions.
CONCLUSION
We reviewed the therapeutic roles of natural remedies in improving or halting the progression of HA, which warrant further study for applications into clinical practice.
PubMed: 33509239
DOI: 10.1186/s13020-020-00414-x