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Revista de NeurologiaAcute flaccid paralysis, a common paediatric disorder, is fundamentally caused by disorders involving neuromuscular diseases of acute onset. It generally presents as an...
Acute flaccid paralysis, a common paediatric disorder, is fundamentally caused by disorders involving neuromuscular diseases of acute onset. It generally presents as an acute or extremely acute motor disorder which is progressive or extremely progressive. Successful management depends on a rapid, accurate differential diagnosis, based on the patient s history of muscular weakness.
Topics: Acute Disease; Child; Diagnosis, Differential; Hemiplegia; Humans; Paraplegia; Quadriplegia
PubMed: 11988907
DOI: No ID Found -
Annals of Physical and Rehabilitation... Feb 2015Brain-machine interfaces (BMIs) use brain activity to control external devices, facilitating paralyzed patients to interact with the environment. In this review, we...
INTRODUCTION
Brain-machine interfaces (BMIs) use brain activity to control external devices, facilitating paralyzed patients to interact with the environment. In this review, we focus on the current advances of non-invasive BMIs for communication in patients with amyotrophic lateral sclerosis (ALS) and for restoration of motor impairment after severe stroke.
BMI FOR ALS PATIENTS
BMI represents a promising strategy to establish communication with paralyzed ALS patients as it does not need muscle engagement for its use. Distinct techniques have been explored to assess brain neurophysiology to control BMI for patients' communication, especially electroencephalography (EEG) and more recently near-infrared spectroscopy (NIRS). Previous studies demonstrated successful communication with ALS patients using EEG-BMI when patients still showed residual eye control, but patients with complete paralysis were unable to communicate with this system. We recently introduced functional NIRS (fNIRS)-BMI for communication in ALS patients in the complete locked-in syndrome (i.e., when ALS patients are unable to engage any muscle), opening new doors for communication in ALS patients after complete paralysis.
BMI FOR STROKE MOTOR RECOVERY
In addition to assisted communication, BMI is also being extensively studied for motor recovery after stroke. BMI for stroke motor recovery includes intensive BMI training linking brain activity related to patient's intention to move the paretic limb with the contingent sensory feedback of the paretic limb movement guided by assistive devices. BMI studies in this area are mainly focused on EEG- or magnetoencephalography (MEG)-BMI systems due to their high temporal resolution, which facilitates online contingency between intention to move and sensory feedback of the intended movement. EEG-BMI training was recently demonstrated in a controlled study to significantly improve motor performance in stroke patients with severe paresis. Neural basis for BMI-induced restoration of motor function and perspectives for future BMI research for stroke motor recovery are discussed.
Topics: Amyotrophic Lateral Sclerosis; Brain-Computer Interfaces; Humans; Neurological Rehabilitation; Paralysis; Recovery of Function; Stroke Rehabilitation
PubMed: 25623294
DOI: 10.1016/j.rehab.2014.11.002 -
Canadian Medical Association Journal Mar 1966
Topics: Alberta; Child, Preschool; Humans; Insect Bites and Stings; Male; Paralysis; Ticks
PubMed: 5904928
DOI: No ID Found -
Journal of Neurointerventional Surgery Feb 2021Implantable brain-computer interfaces (BCIs), functioning as motor neuroprostheses, have the potential to restore voluntary motor impulses to control digital devices and...
BACKGROUND
Implantable brain-computer interfaces (BCIs), functioning as motor neuroprostheses, have the potential to restore voluntary motor impulses to control digital devices and improve functional independence in patients with severe paralysis due to brain, spinal cord, peripheral nerve or muscle dysfunction. However, reports to date have had limited clinical translation.
METHODS
Two participants with amyotrophic lateral sclerosis (ALS) underwent implant in a single-arm, open-label, prospective, early feasibility study. Using a minimally invasive neurointervention procedure, a novel endovascular Stentrode BCI was implanted in the superior sagittal sinus adjacent to primary motor cortex. The participants undertook machine-learning-assisted training to use wirelessly transmitted electrocorticography signal associated with attempted movements to control multiple mouse-click actions, including zoom and left-click. Used in combination with an eye-tracker for cursor navigation, participants achieved Windows 10 operating system control to conduct instrumental activities of daily living (IADL) tasks.
RESULTS
Unsupervised home use commenced from day 86 onwards for participant 1, and day 71 for participant 2. Participant 1 achieved a typing task average click selection accuracy of 92.63% (100.00%, 87.50%-100.00%) (trial mean (median, Q1-Q3)) at a rate of 13.81 (13.44, 10.96-16.09) correct characters per minute (CCPM) with predictive text disabled. Participant 2 achieved an average click selection accuracy of 93.18% (100.00%, 88.19%-100.00%) at 20.10 (17.73, 12.27-26.50) CCPM. Completion of IADL tasks including text messaging, online shopping and managing finances independently was demonstrated in both participants.
CONCLUSION
We describe the first-in-human experience of a minimally invasive, fully implanted, wireless, ambulatory motor neuroprosthesis using an endovascular stent-electrode array to transmit electrocorticography signals from the motor cortex for multiple command control of digital devices in two participants with flaccid upper limb paralysis.
Topics: Activities of Daily Living; Aged; Brain-Computer Interfaces; Feasibility Studies; Female; Humans; Imaging, Three-Dimensional; Implantable Neurostimulators; Male; Middle Aged; Motor Cortex; Paralysis; Prospective Studies; Severity of Illness Index
PubMed: 33115813
DOI: 10.1136/neurintsurg-2020-016862 -
Tropical Medicine & International... Nov 2013
Topics: Africa; Asia, Western; Child; Diphtheria; Global Health; Health Services Needs and Demand; Humans; Nervous System Diseases; Paralysis; Poliomyelitis; Population Surveillance; Rabies
PubMed: 24033476
DOI: 10.1111/tmi.12181 -
Brain : a Journal of Neurology Jan 2010Baclofen, a gamma-aminobutyric acid receptor(B) agonist, is used to reduce symptoms of spasticity (hyperreflexia, increases in muscle tone, involuntary muscle activity),... (Comparative Study)
Comparative Study
Baclofen, a gamma-aminobutyric acid receptor(B) agonist, is used to reduce symptoms of spasticity (hyperreflexia, increases in muscle tone, involuntary muscle activity), but the long-term effects of sustained baclofen use on skeletal muscle properties are unclear. The aim of our study was to evaluate whether baclofen use and paralysis due to cervical spinal cord injury change the contractile properties of human thenar motor units more than paralysis alone. Evoked electromyographic activity and force were recorded in response to intraneural stimulation of single motor axons to thenar motor units. Data from three groups of motor units were compared: 23 paralysed units from spinal cord injured subjects who take baclofen and have done so for a median of 7 years, 25 paralysed units from spinal cord injured subjects who do not take baclofen (median: 10 years) and 45 units from uninjured control subjects. Paralysed motor unit properties were independent of injury duration and level. With paralysis and baclofen, the median motor unit tetanic forces were significantly weaker, twitch half-relaxation times longer and half maximal forces reached at lower frequencies than for units from uninjured subjects. The median values for these same parameters after paralysis alone were comparable to control data. Axon conduction velocities differed across groups and were slowest for paralysed units from subjects who were not taking baclofen and fastest for units from the uninjured. Greater motor unit weakness with long-term baclofen use and paralysis will make the whole muscle weaker and more fatigable. Significantly more paralysed motor units need to be excited during patterned electrical stimulation to produce any given force over time. The short-term benefits of baclofen on spasticity (e.g. management of muscle spasms that may otherwise hinder movement or social interactions) therefore have to be considered in relation to its possible long-term effects on muscle rehabilitation. Restoring the strength and speed of paralysed muscles to pre-injury levels may require more extensive therapy when baclofen is used chronically.
Topics: Adult; Baclofen; Cervical Vertebrae; Chronic Disease; Electric Stimulation; Female; Humans; Male; Middle Aged; Motor Neurons; Muscle Fibers, Skeletal; Paralysis; Spinal Cord Injuries; Young Adult
PubMed: 19903733
DOI: 10.1093/brain/awp285 -
The American Journal of Tropical... Mar 2021Lathyrism is an incurable neurological disorder, resulting from excessive consumption of grass pea (Lathyrus sativus), which clinically manifests as paralysis of lower...
Lathyrism is an incurable neurological disorder, resulting from excessive consumption of grass pea (Lathyrus sativus), which clinically manifests as paralysis of lower limbs. Because of the high production of grass peas, a large number of people are expected to be affected by the disease in Northeast Ethiopia. However, there is no comprehensive study that quantified the magnitude of the problem. Therefore, in this study, we determined the prevalence of lathyrism and socioeconomic disparities in Northeast Ethiopia. A community-based cross-sectional study was used which used a quantitative method of data collection from January to February 2019. Data were collected from a total of 2,307 inhabitants in the study area using structured questionnaires. Lathyrism cases were identified using a case definition of symmetrical spastic leg weakness, and subacute or insidious onset, with no sensory deficit, and with a history of grass pea consumption before and at the onset of paralysis. The majority (56.8%) of participants were male, and 34.7% were aged 45 years or older. Overall, the prevalence of lathyrism was 5.5%, and it was higher in males (7.9%) than in females (2.5%). Moreover, the prevalence was higher among farmers (7.0%) than merchants (0.3%), very poor economic status (7.2%) than very rich (1.1%), who produced (9.6%) grass pea than not produced (0.9%), and those who used clay pottery (6.2%) than metal (4.8%) for cooking. The prevalence of lathyrism in Northeast Ethiopia is remarkably high. Therefore, we recommend lathyrism to be among the list of reportable health problems and incorporated in the national routine surveillance system.
Topics: Cooking; Cross-Sectional Studies; Ethiopia; Female; Foodborne Diseases; Humans; Lathyrism; Lathyrus; Lower Extremity; Male; Middle Aged; Paralysis; Prevalence; Public Health; Socioeconomic Factors; Surveys and Questionnaires
PubMed: 33684061
DOI: 10.4269/ajtmh.20-1480 -
American Family Physician Feb 2013
Topics: Attitude of Health Personnel; Guillain-Barre Syndrome; Humans; Immunoglobulins, Intravenous; Paralysis; Physicians; Travel
PubMed: 23418759
DOI: No ID Found -
Orthopaedic Surgery Feb 2013To report three cases of transient paralysis shortly after (within 4 hours) anterior cervical corpectomy and fusion (ACCF), and investigate the possible causes.
OBJECTIVE
To report three cases of transient paralysis shortly after (within 4 hours) anterior cervical corpectomy and fusion (ACCF), and investigate the possible causes.
METHODS
Clinical and radiological data of three cases (two men and one woman, aged 41-61 years) were analyzed retrospectively. All three patients underwent ACCF for cervical spondylotic myelopathy. The decompressed segments were located in C(5) , C(6) and C(5) + C(6-7) discs, respectively. Paralysis occurred from 30 minutes to 4 hours after surgery. In two cases the paralysis was complete; it was incomplete in the third. All patients received immediate dehydration, neurotrophic drugs and high-dose methylprednisolone therapy upon recognition of their paralysis. Meanwhile, cervical MRIs were performed and showed no significant hematomas compressing the cervical spinal cord; spinal cord edema was clearly evident in all cases.
RESULTS
In two cases the paralysis resolved within 2 hours of diagnosis and immediate medication. In the third case, because the neurological symptoms were incompletely resolved 24 hours after beginning medication, a second laminoplasty was performed. During decompression, tremendous pressure was released from the cervical spinal cord. The neurological symptoms had resolved completely by 1 week after decompression.
CONCLUSION
The precise cause for transient paralysis after these anterior cervical surgeries is not yet clear. Spinal cord ischemia-reperfusion injury is generally regarded as the most likely cause. Therefore, a combination of cervical spinal cord edema and limited anterior decompression space may have been the main contributing factors to the paralysis reported here. Early diagnosis and early intervention to relieve the paralysis can restore spinal cord function and result in a satisfactory prognosis.
Topics: Adult; Cervical Vertebrae; Decompression, Surgical; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Paralysis; Retrospective Studies; Spinal Cord Diseases; Spinal Fusion; Spondylosis; Treatment Outcome
PubMed: 23420743
DOI: 10.1111/os.12021 -
IEEE Transactions on Bio-medical... Mar 2013Neurotechnology has made major advances in development of interfaces to the nervous system that restore function in paralytic disorders. These advances enable both...
Neurotechnology has made major advances in development of interfaces to the nervous system that restore function in paralytic disorders. These advances enable both restoration of voluntary function and activation of paralyzed muscles to reanimate movement. The technologies used in each case are different, with external surface stimulation or percutaneous stimulation generally used for restoration of voluntary function, and implanted stimulators generally used for neuroprosthetic restoration. The opportunity to restore function through neuroplasticity has demonstrated significant advances in cases where there are retained neural circuits after the injury, such as spinal cord injury and stroke. In cases where there is a complete loss of voluntary neural control, neural prostheses have demonstrated the capacity to restore movement, control of the bladder and bowel, and respiration and cough. The focus of most clinical studies has been primarily toward activation of paralyzed nerves, but advances in inhibition of neural activity provide additional means of addressing the paralytic complications of pain and spasticity, and these techniques are now reaching the clinic. Future clinical advances necessitate having a better understanding of the underlying mechanisms, and having more precise neural interfaces that will ultimately allow individual nerve fibers or groups of nerve fibers to be controlled with specificity and reliability. While electrical currents have been the primary means of interfacing to the nervous system to date, optical and magnetic techniques under development are beginning to reach the clinic, and provide great opportunity. Ultimately, techniques that combine approaches are likely to be the most effective means for restoring function, for example combining regeneration and neural plasticity to maximize voluntary activity, combined with neural prostheses to augment the voluntary activity to functional levels of performance. It is a substantial challenge to bring any of these techniques through clinical trials, but as each of the individual techniques is sufficiently developed to reach the clinic, these present great opportunities for enabling patients with paralytic disorders to achieve substantial independence and restore their quality of life.
Topics: Biomedical Engineering; Equipment Design; Humans; Neural Prostheses; Paralysis
PubMed: 23481680
DOI: 10.1109/TBME.2013.2245128