Journal of the neurological sciences
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Randomized Controlled Trial
Can botulinum toxin type A injection technique influence the clinical outcome of patients with post-stroke upper limb spasticity? A randomized controlled trial comparing manual needle placement and ultrasound-guided injection techniques.
Botulinum toxin type A is a first-line treatment for post-stroke focal spasticity, and the accuracy in delivering the toxin to the target muscles may influence the treatment outcome. Our aim was to compare the reduction of spasticity and the related finger position at rest improvement in post-stroke patients treated with botulinum toxin type A in upper limb muscles using ultrasound guidance and manual needle placement. ⋯ Ultrasound guidance for botulinum toxin type A injections could improve clinical outcome measures better than manual needle placement in post-stroke patients with spasticity.
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Ischemic lesions dynamically evolve during the acute phase of stroke. Although the ischemic lesion volume has been considered as a predictor of clinical outcome, it is still controversial whether early changes in ischemic lesion have prognostic information in addition to clinical variables. We hypothesized that early infarct growth on diffusion-weighted imaging (DWI) might be independently associated with long-term outcome in acute ischemic stroke patients. ⋯ Our present study findings show that infarct growth within a week of onset independently predicts 3-month clinical outcomes. This suggests that short-term changes in infarct volume may serve as a surrogate marker of long-term clinical outcomes after ischemic stroke.
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Botulinum toxin injections in the dystonic muscles are the preferred treatment for cervical dystonia (CD), but proper selection of the dystonic muscles remains a challenge. We investigated the use of EMG coherence and autospectral analysis as discriminative tools to identify dystonic muscles in CD patients. ⋯ Intermuscular EMG coherence analysis cannot reliably discriminate patients from controls. Autospectral changes in the SPL muscles are a more discriminative feature of CD. In patients, coherence analysis does not seem to be a reliable method to identify dystonic muscles. The clinical relevance and the origin of the autospectral changes need further study.
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The aim of this work is to study the relationship between information processing speed (IPS) impairment and motor testing that reflects cerebellar function in persons with multiple sclerosis (PwMS). ⋯ In this sample of PwMS, motor cerebellar impairment assessed by the NHPT was correlated with IPS impairment.
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We present the nerve ultrasound findings in sarcoid neuropathy and examine their correlation with electrophysiology and functional disability. ⋯ Sarcoid neuropathy seems to show predominantly CSA enlargement in peripheral nerves of the lower extremities, without any significant correlation to electrophysiological findings. The electroneurography documented signs of sensorimotor axonal loss in various peripheral nerves. Neither nerve sonography nor electrophysiology correlated with functional disability.