Journal of neurology, neurosurgery, and psychiatry
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J. Neurol. Neurosurg. Psychiatr. · Aug 2010
EEG correlated functional MRI and postoperative outcome in focal epilepsy.
The main challenge in assessing patients with epilepsy for resective surgery is localising seizure onset. Frequently, identification of the irritative and seizure onset zones requires invasive EEG. EEG correlated functional MRI (EEG-fMRI) is a novel imaging technique which may provide localising information with regard to these regions. In patients with focal epilepsy, interictal epileptiform discharge (IED) correlated blood oxygen dependent level (BOLD) signal changes were observed in approximately 50% of patients in whom IEDs are recorded. In 70%, these are concordant with expected seizure onset defined by non-invasive electroclinical information. Assessment of clinical validity requires post-surgical outcome studies which have, to date, been limited to case reports of correlation with intracranial EEG. The value of EEG-fMRI was assessed in patients with focal epilepsy who subsequently underwent epilepsy surgery, and IED correlated fMRI signal changes were related to the resection area and clinical outcome. ⋯ These results show the potential value of EEG-fMRI in presurgical evaluation.
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J. Neurol. Neurosurg. Psychiatr. · Aug 2010
Case ReportsIsolated bulbar paralysis in a patient with medullar tau pathology: a case report.
Increased morbidity and mortality rates as well as some other manifestations in Alzheimer's disease can be explained by subcortical degeneration. Pathological evidence is scarce but confirmative. ⋯ The majority of symptoms and signs could be explained by the medullary tau pathology. Whether the medullary tau pathology in this case was a rare aberrant progression of Alzheimer's disease or a new presentation of tauopathy concomitant with subclinical Alzheimer's disease should be elucidated by additional studies.
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J. Neurol. Neurosurg. Psychiatr. · Aug 2010
Delayed onset of a second paraneoplastic neurological syndrome in eight patients.
The occurrence of a second delayed paraneoplastic neurological syndrome (PNS), different from the first, in the same patient, is not well known. However, recognition of this possibility is important in the management of the patient with PNS. ⋯ A second PNS can reveal a cancer relapse but can also arise in its absence. The long survival of patients with a second PNS suggests that the immune response might be more effective in controlling the cancer.
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J. Neurol. Neurosurg. Psychiatr. · Aug 2010
Neuroimaging of multimodal sensory stimulation in amyotrophic lateral sclerosis.
Structural and functional imaging techniques were combined to investigate sensory system function in amyotrophic lateral sclerosis (ALS). ⋯ Multiparametric MRI suggests a progressive functional deficit in secondary/higher order sensory processing areas in ALS, probably associated with reduction of re-afferent information flow due to progressive immobility. The changes described might also represent an expression of the disease process itself. Evidence for compensatory processes in multimodal associative cortices was found.
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J. Neurol. Neurosurg. Psychiatr. · Aug 2010
Tripod pinch strength and thumb opposition are the major determinants of manual dexterity in Charcot-Marie-Tooth disease type 1A.
Clinical features of Charcot-Marie-Tooth disease type 1A (CMT1A) include slowly progressive distal muscle weakness, atrophy and sensory loss. Upper-limb involvement results in reduced manual dexterity interfering with the execution of daily activities. ⋯ Tripod pinch strength and thumb opposition are major determinants of manual dexterity in CMT1A and should therefore be the focus of intervention strategies that aim to preserve or enhance manual dexterity in CMT1A.