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European Journal of Physical and... Feb 2021Speech difficulties, such as dysarthria or aphasia, in addition to motor impairments are frequently seen in post-stroke patients. (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Speech difficulties, such as dysarthria or aphasia, in addition to motor impairments are frequently seen in post-stroke patients.
EVIDENCE ACQUISITION
Literature searches with the keywords: "stroke" and "dysarthria" and "diagnosis" and "stroke" and "dysarthria" and "assessment" were conducted using PubMed, EMBASE, Cochrane Library, and Web of Science databases to perform the systematic review about the methods used to measure the severity of dysarthria in subjects post-stroke. The search was performed by two authors from 15 January to 22 February 2020. The research identified a total of 402 articles for the search using the keywords "stroke" and "dysarthria," and "diagnosis" and 84 references for the search using the keywords "stroke" and "dysarthria" and "assessment." Sixty-nine selected articles were analyzed by the reviewers. Thirty-seven publications met the inclusion criteria and were included in the systematic review. Thirty-two articles were excluded for several reasons: 1) 12 involved individuals with aphasia or other speech problems different from dysarthria; 2) 12 examined different topics from our aim; and 3) eight did not include post-stroke cases.
EVIDENCE SYNTHESIS
The systematic review identified methods for measuring the severity of post-stroke dysarthria. The meta-analysis showed the acoustic parameters affected in dysarthria secondary to stroke and the differences in these parameters after speech therapy.
CONCLUSIONS
The alternating and sequential motion rate (AMR- Pə, AMR-Tə, AMR-Kə, and SMR-PəTəKə) and maximum phonation time were significantly improved after speech rehabilitation.
Topics: Dysarthria; Humans; Speech Therapy; Stroke Rehabilitation
PubMed: 32519528
DOI: 10.23736/S1973-9087.20.06242-5 -
JAMA Network Open Jan 2024Motor aphasia is common among patients with stroke. Acupuncture is recommended as an alternative therapy for poststroke aphasia, but its efficacy remains uncertain. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Motor aphasia is common among patients with stroke. Acupuncture is recommended as an alternative therapy for poststroke aphasia, but its efficacy remains uncertain.
OBJECTIVE
To investigate the effects of acupuncture on language function, neurological function, and quality of life in patients with poststroke motor aphasia.
DESIGN, SETTING, AND PARTICIPANTS
This multicenter, sham-controlled, randomized clinical trial was conducted in 3 tertiary hospitals in China from October 21, 2019, to November 13, 2021. Adult patients with poststroke motor aphasia were enrolled. Data analysis was performed from February to April 2023.
INTERVENTIONS
Eligible participants were randomly allocated (1:1) to manual acupuncture (MA) or sham acupuncture (SA) groups. Both groups underwent language training and conventional treatments.
MAIN OUTCOMES AND MEASURES
The primary outcomes were the aphasia quotient (AQ) of the Western Aphasia Battery (WAB) and scores on the Chinese Functional Communication Profile (CFCP) at 6 weeks. Secondary outcomes included WAB subitems, Boston Diagnostic Aphasia Examination, National Institutes of Health Stroke Scale, Stroke-Specific Quality of Life Scale, Stroke and Aphasia Quality of Life Scale-39, and Health Scale of Traditional Chinese Medicine scores at 6 weeks and 6 months after onset. All statistical analyses were performed according to the intention-to-treat principle.
RESULTS
Among 252 randomized patients (198 men [78.6%]; mean [SD] age, 60.7 [7.5] years), 231 were included in the modified intention-to-treat analysis (115 in the MA group and 116 in the SA group). Compared with the SA group, the MA group had significant increases in AQ (difference, 7.99 points; 95% CI, 3.42-12.55 points; P = .001) and CFCP (difference, 23.51 points; 95% CI, 11.10-35.93 points; P < .001) scores at week 6 and showed significant improvements in AQ (difference, 10.34; 95% CI, 5.75-14.93; P < .001) and CFCP (difference, 27.43; 95% CI, 14.75-40.10; P < .001) scores at the end of follow-up.
CONCLUSIONS AND RELEVANCE
In this randomized clinical trial, patients with poststroke motor aphasia who received 6 weeks of MA compared with those who received SA demonstrated statistically significant improvements in language function, quality of life, and neurological impairment from week 6 of treatment to the end of follow-up at 6 months after onset.
TRIAL REGISTRATION
Chinese Clinical Trial Registry: ChiCTR1900026740.
Topics: United States; Adult; Male; Humans; Middle Aged; Aphasia, Broca; Quality of Life; Acupuncture Therapy; Communication; Stroke
PubMed: 38252438
DOI: 10.1001/jamanetworkopen.2023.52580 -
HCA Healthcare Journal of Medicine 2020Acute Disseminated Encephalomyelitis (ADEM) is a rare autoimmune demyelinating disorder of the central nervous system. Clinical manifestations include encephalopathy,...
INTRODUCTION
Acute Disseminated Encephalomyelitis (ADEM) is a rare autoimmune demyelinating disorder of the central nervous system. Clinical manifestations include encephalopathy, motor deficits, ataxia, and meningeal signs. In most cases, ADEM is preceded by either vaccination or viral illness. Here, we present a case with neither of the two predisposing elements.
DISCUSSION
A 28-year-old Hispanic female presenting with substance use and suicidal ideation was placed on an involuntary psychiatric hold, started on olanzapine and scheduled for a psychiatric facility transfer. The following day, she was noted to have neurological deficits when ambulating. Computed tomography of the brain showed a right frontal lesion. Magnetic resonance imaging of the brain was notable for multiple peripherally enhancing white matter lesions. Multiple sclerosis and other etiologies were ruled out through supporting tests and lumbar puncture. ADEM was suspected, and the patient was treated with both a five-day course of intravenous methylprednisolone as well as immune globulins. She continued to have mild expressive aphasia after treatment; however, the majority of her symptoms improved.
CONCLUSIONS
Diagnosis of ADEM versus multiple sclerosis can be difficult given there are no current diagnostic criteria for it in the adult population. In this case, we explain how we reached a diagnosis of ADEM and provide further discussion regarding the disease course and treatment.
PubMed: 37425238
DOI: 10.36518/2689-0216.1038 -
Frontiers in Aging Neuroscience 2022This study aims at reviewing, within the framework of motor neuron disease-frontotemporal degeneration (MND-FTD)- disorders, evidence on the co-occurrence between... (Review)
Review
BACKGROUND
This study aims at reviewing, within the framework of motor neuron disease-frontotemporal degeneration (MND-FTD)- disorders, evidence on the co-occurrence between primary progressive aphasia (PPA) and MND in order to profile such a complex at pathological, genetic and clinical levels.
METHODS
This review was pre-registered (osf.io/ds8m4) and performed in accordance with the 2020 PRISMA guidelines. Case reports/series and group studies were included if addressing (1) progressive non-fluent aphasia (PNFA) or semantic dementia (SD) with MND or (2) MND patients with co-morbid PNFA/SD.
RESULTS
Out of 546 initial records, 56 studies were included. As to case reports/series ( = 35), which included 61 PPA-MND patients, the following findings yielded: (1) PNFA is more frequent than SD in PPA-MND; (2) in PPA-MND, the most prevalent motor phenotypes are amyotrophic lateral sclerosis and predominant-upper MND, with bulbar involvement being ubiquitous; (3) extrapyramidal features are moderately frequent in PPA-MND; (4) PPA-MND patients usually display frontotemporal, left-greater-than-right involvement; (5) TDP-43-B is the typical pathological substrate of PPA-MND; (6) mutations represent the most frequent genetic risk factors for PPA-MND.As to group studies, including 121 patients, proportional meta-analytic procedures revealed that: (1) the lifetime prevalence of MND in PPA is 6%; (2) PPA occurs in 19% of patients with co-morbid MND and FTD; (3) MND is more frequent in PNFA (10%) than in SD patients (3%).
DISCUSSION
Insights herewith delivered into the clinical, neuropathological and genetic features of PPA-MND patients prompt further investigations aimed at improving clinical practice within the MND-FTD .
PubMed: 36158556
DOI: 10.3389/fnagi.2022.1003792