20 research outputs found
ΠΠΎΡΡΠ»ΠΈΠ½ΠΎΡΠ΅ΡΠ°ΠΏΠΈΡ Π² Π»Π΅ΡΠ΅Π½ΠΈΠΈ Π΄ΠΈΡΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠΊΠΎΠ»ΠΈΠΎΠ·Π° ΠΏΡΠΈ Π³Π΅Π½Π΅ΡΠ°Π»ΠΈΠ·ΠΎΠ²Π°Π½Π½ΠΎΠΉ Π΄ΠΈΡΡΠΎΠ½ΠΈΠΈ (ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠ΅)
Dystonic scoliosis as one of the forms of generalized dystonia is a highly disabling form of dystonia, which can lead to damage to internal organs (lungs, heart) and the peripheral nervous system, including the spinal cord. Almost always, those muscles that are involved in the formation of a dystonic posture in generalized dystonia have not been studied in terms of the effectiveness of treatment with botulinum toxin type A and are not reflected in the instructions. As a result, there is no understanding of the general motor interaction with differentiation into targeted and non-targeted muscles, administration doses and control methods.The aim of the work was to evaluate the efficacy and tolerability of high doses of botulinum toxin type A in dystonic scoliosis, as well as to present the introduction of botulinum toxin type A using ultrasound and electromyographic control. We have described a clinical case of a 19-year-old patient suffering from generalized dystonia with S-shaped dystonic scoliosis of the III degree. Deep brain stimulation was recommended as a treatment for the patient. During the waiting period for the timing of the operation, we attempted symptomatic therapy using the drug incobotulotoxin A. Over the next year and a half, 700 units of botulinum toxin type A were administered under ultrasound and electromyographic control every 3β4 months. As a result, treatment of trunk dystonia in the patient during the observation period led to a clinically significant decrease in the degree of curvature (from 37Β° to 27Β°, from III to II degree of scoliosis) in the absence of undesirable effects of the drug, including generalized muscle weakness. According to the repeated conclusion of the council of neurosurgeons, surgical intervention is not indicated for the patient due to the positive effect of the introduction of botulinum toxin type A.ΠΠΈΡΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠΊΠΎΠ»ΠΈΠΎΠ· ΠΊΠ°ΠΊ ΠΎΠ΄Π½Π° ΠΈΠ· ΡΠΎΡΠΌ Π³Π΅Π½Π΅ΡΠ°Π»ΠΈΠ·ΠΎΠ²Π°Π½Π½ΠΎΠΉ Π΄ΠΈΡΡΠΎΠ½ΠΈΠΈ ΡΠ²Π»ΡΠ΅ΡΡΡ Π²ΡΡΠΎΠΊΠΎΠΈΠ½Π²Π°Π»ΠΈΠ΄ΠΈΠ·ΠΈΡΡΡΡΠ΅ΠΉ ΡΠΎΡΠΌΠΎΠΉ Π΄ΠΈΡΡΠΎΠ½ΠΈΠΈ, ΠΊΠΎΡΠΎΡΠ°Ρ ΠΌΠΎΠΆΠ΅Ρ ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΡΡ ΠΊ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ Π²Π½ΡΡΡΠ΅Π½Π½ΠΈΡ
ΠΎΡΠ³Π°Π½ΠΎΠ² (Π»Π΅Π³ΠΊΠΈΡ
, ΡΠ΅ΡΠ΄ΡΠ°) ΠΈ ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ Π½Π΅ΡΠ²Π½ΠΎΠΉ ΡΠΈΡΡΠ΅ΠΌΡ, Π²ΠΊΠ»ΡΡΠ°Ρ ΡΠΏΠΈΠ½Π½ΠΎΠΉ ΠΌΠΎΠ·Π³. Π Π±ΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²Π΅ ΡΠ»ΡΡΠ°Π΅Π² ΠΌΡΡΡΡ, ΠΊΠΎΡΠΎΡΡΠ΅ ΡΡΠ°ΡΡΠ²ΡΡΡ Π² ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½ΠΈΠΈ Π΄ΠΈΡΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠΎΠ·Ρ ΠΏΡΠΈ Π³Π΅Π½Π΅ΡΠ°Π»ΠΈΠ·ΠΎΠ²Π°Π½Π½ΠΎΠΉ Π΄ΠΈΡΡΠΎΠ½ΠΈΠΈ, ΠΈΡΡΠ»Π΅Π΄ΡΡΡΡΡ ΠΌΠ°Π»ΠΎ Π² ΠΏΠ»Π°Π½Π΅ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ°ΠΌΠΈ Π±ΠΎΡΡΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠΎΠΊΡΠΈΠ½Π° ΡΠΈΠΏΠ° Π ΠΈ, ΠΊΠ°ΠΊ ΡΠ»Π΅Π΄ΡΡΠ²ΠΈΠ΅, Π½Π΅ ΠΎΡΡΠ°ΠΆΠ΅Π½Ρ Π² ΠΈΠ½ΡΡΡΡΠΊΡΠΈΡΡ
. Π ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ΅ ΠΎΡΡΡΡΡΡΠ²ΡΠ΅Ρ ΠΌΠ΅ΡΠΎΠ΄ΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΠΏΠΎΠ½ΠΈΠΌΠ°Π½ΠΈΠ΅ ΠΎΠ±ΡΠ΅Π³ΠΎ Π΄Π²ΠΈΠ³Π°ΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ Π²Π·Π°ΠΈΠΌΠΎΠ΄Π΅ΠΉΡΡΠ²ΠΈΡ Ρ Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²ΠΊΠΎΠΉ Π½Π° ΡΠ°ΡΠ³Π΅ΡΠ½ΡΠ΅ ΠΈ Π½Π΅ ΡΠ°ΡΠ³Π΅ΡΠ½ΡΠ΅ ΠΌΡΡΡΡ, Π΄ΠΎΠ·Ρ Π²Π²Π΅Π΄Π΅Π½ΠΈΡ ΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ.Π¦Π΅Π»Ρ Π½Π°ΡΡΠΎΡΡΠ΅ΠΉ ΡΠ°Π±ΠΎΡΡ β ΠΎΡΠ΅Π½ΠΈΡΡ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΠΈ ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠΈΠΌΠΎΡΡΡ Π²ΡΡΠΎΠΊΠΈΡ
Π΄ΠΎΠ· Π±ΠΎΡΡΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠΎΠΊΡΠΈΠ½Π° ΡΠΈΠΏΠ° Π ΠΏΡΠΈ Π΄ΠΈΡΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΌ ΡΠΊΠΎΠ»ΠΈΠΎΠ·Π΅, Π° ΡΠ°ΠΊΠΆΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°Π²ΠΈΡΡ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ Π²Π²Π΅Π΄Π΅Π½ΠΈΡ Π±ΠΎΡΡΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠΎΠΊΡΠΈΠ½Π° ΡΠΈΠΏΠ° Π Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠΎΠ²ΠΎΠ³ΠΎ ΠΈ ΡΠ»Π΅ΠΊΡΡΠΎΠΌΠΈΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ.ΠΠ°ΠΌΠΈ ΠΎΠΏΠΈΡΠ°Π½ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΏΡΠΈΠΌΠ΅Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° 19 Π»Π΅Ρ, ΡΡΡΠ°Π΄Π°ΡΡΠ΅Π³ΠΎ Π³Π΅Π½Π΅ΡΠ°Π»ΠΈΠ·ΠΎΠ²Π°Π½Π½ΠΎΠΉ Π΄ΠΈΡΡΠΎΠ½ΠΈΠ΅ΠΉ Ρ Π‘-ΠΎΠ±ΡΠ°Π·Π½ΡΠΌ Π΄ΠΈΡΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΡΠΊΠΎΠ»ΠΈΠΎΠ·ΠΎΠΌ III ΡΡΠ΅ΠΏΠ΅Π½ΠΈ. Π ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Π±ΡΠ»Π° ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΠΎΠ²Π°Π½Π° Π³Π»ΡΠ±ΠΎΠΊΠ°Ρ ΡΡΠΈΠΌΡΠ»ΡΡΠΈΡ Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π°. Π ΠΏΠ΅ΡΠΈΠΎΠ΄ ΠΎΠΆΠΈΠ΄Π°Π½ΠΈΡ ΡΡΠΎΠΊΠΎΠ² ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ Π½Π°ΠΌΠΈ Π±ΡΠ»Π° ΠΏΡΠ΅Π΄ΠΏΡΠΈΠ½ΡΡΠ° ΠΏΠΎΠΏΡΡΠΊΠ° ΡΠΈΠΌΠΏΡΠΎΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ° ΠΈΠ½ΠΊΠΎΠ±ΠΎΡΡΠ»ΠΎΡΠΎΠΊΡΠΈΠ½Π° Π. Π ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠΈΡ
ΠΏΠΎΠ»ΡΡΠΎΡΠ° Π»Π΅Ρ Π²Π²Π΅Π΄Π΅Π½ΠΈΠ΅ 700 ΠΠ Π±ΠΎΡΡΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠΎΠΊΡΠΈΠ½Π° Π ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈ ΠΏΠΎΠ΄ ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠΎΠ²ΡΠΌ ΠΈ ΡΠ»Π΅ΠΊΡΡΠΎΠΌΠΈΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΊΠΎΠ½ΡΡΠΎΠ»Π΅ΠΌ ΠΊΠ°ΠΆΠ΄ΡΠ΅ 3β4 ΠΌΠ΅Ρ. Π ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ΅ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Π·Π° ΠΏΠ΅ΡΠΈΠΎΠ΄ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Π΄ΠΈΡΡΠΎΠ½ΠΈΠΈ ΡΡΠ»ΠΎΠ²ΠΈΡΠ° ΠΏΡΠΈΠ²Π΅Π»ΠΎ ΠΊ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎΠΌΡ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΡ Π³ΡΠ°Π΄ΡΡΠ° ΠΈΡΠΊΡΠΈΠ²Π»Π΅Π½ΠΈΡ (Ρ 37 Π΄ΠΎ 27Β°, Ρ III Π΄ΠΎ II ΡΡΠ΅ΠΏΠ΅Π½ΠΈ ΡΠΊΠΎΠ»ΠΈΠΎΠ·Π°) ΠΏΡΠΈ ΠΎΡΡΡΡΡΡΠ²ΠΈΠΈ Π½Π΅ΠΆΠ΅Π»Π°ΡΠ΅Π»ΡΠ½ΡΡ
ΡΠ²Π»Π΅Π½ΠΈΠΉ Π΄Π΅ΠΉΡΡΠ²ΠΈΡ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ°, Π²ΠΊΠ»ΡΡΠ°Ρ Π³Π΅Π½Π΅ΡΠ°Π»ΠΈΠ·ΠΎΠ²Π°Π½Π½ΡΡ ΠΌΡΡΠ΅ΡΠ½ΡΡ ΡΠ»Π°Π±ΠΎΡΡΡ. Π‘ΠΎΠ³Π»Π°ΡΠ½ΠΎ ΠΏΠΎΠ²ΡΠΎΡΠ½ΠΎΠΌΡ Π·Π°ΠΊΠ»ΡΡΠ΅Π½ΠΈΡ ΠΊΠΎΠ½ΡΠΈΠ»ΠΈΡΠΌΠ° Π½Π΅ΠΉΡΠΎΡ
ΠΈΡΡΡΠ³ΠΎΠ², ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½ΠΎΠ΅ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²ΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Π½Π΅ ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΎ Π²Π²ΠΈΠ΄Ρ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΡΡΡΠ΅ΠΊΡΠ° ΠΎΡ Π²Π²Π΅Π΄Π΅Π½ΠΈΡ Π±ΠΎΡΡΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠΎΠΊΡΠΈΠ½Π° ΡΠΈΠΏΠ° Π
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Anti-drug Antibody Responses Impair Prophylaxis Mediated by AAV-Delivered HIV-1 Broadly Neutralizing Antibodies
Adeno-associated virus (AAV) delivery of potent and broadly neutralizing antibodies (bNAbs is a promising approach for the prevention of HIV-1 infection. The immunoglobulin G (IgG)1 subtype is usually selected for this application, because it efficiently mediates antibody effector functions and has a somewhat longer half-life. However, the use of IgG1-Fc has been associated with the generation of anti-drug antibodies (ADAs) that correlate with loss of antibody expression. In contrast, we have shown that expression of the antibody-like molecule eCD4-Ig bearing a rhesus IgG2-Fc domain showed reduced immunogenicity and completely protected rhesus macaques from simian-HIV (SHIV)-AD8 challenges. To directly compare the performance of the IgG1-Fc and the IgG2-Fc domains in a prophylactic setting, we compared AAV1 expression of rhesus IgG1 and IgG2 forms of four anti-HIV bNAbs: 3BNC117, NIH45-46, 10-1074, and PGT121. Interestingly, IgG2-isotyped bNAbs elicited significantly lower ADA than their IgG1 counterparts. We also observed significant protection from two SHIV-AD8 challenges in macaques expressing IgG2-isotyped bNAbs, but not from those expressing IgG1. Our data suggest that monoclonal antibodies isotyped with IgG2-Fc domains are less immunogenic than their IgG1 counterparts, and they highlight ADAs as a key barrier to the use of AAV1-expressed bNAbs
Electrical, Hemodynamic, and Motor Activity in BCI Post-stroke Rehabilitation: Clinical Case Study
The goal of the paper is to present an example of integrated analysis of electrical, hemodynamic, and motor activity accompanying the motor function recovery in a post-stroke patient having an extensive cortical lesion. The patient underwent a course of neurorehabilitation assisted with the hand exoskeleton controlled by brain-computer interface based on kinesthetic motor imagery. The BCI classifier was based on discriminating covariance matrices of EEG corresponding to motor imagery. The clinical data from three successive 2 weeks hospitalizations with 4 and 8 month intervals, respectively were under analysis. The rehabilitation outcome was measured by Fugl-Meyer scale and biomechanical analysis. Both measures indicate prominent improvement of the motor function of the paretic arm after each hospitalization. The analysis of brain activity resulted in three main findings. First, the sources of EEG activity in the intact brain areas, most specific to motor imagery, were similar to the patterns we observed earlier in both healthy subjects and post-stroke patients with mild subcortical lesions. Second, two sources of task-specific activity were localized in primary somatosensory areas near the lesion edge. The sources exhibit independent mu-rhythm activity with the peak frequency significantly lower than that of mu-rhythm in healthy subjects. The peculiarities of the detected source activity underlie changes in EEG covariance matrices during motor imagery, thus serving as the BCI biomarkers. Third, the fMRI data processing showed significant reduction in size of areas activated during the paretic hand movement imagery and increase for those activated during the intact hand movement imagery, shifting the activations to the same level. This might be regarded as the general index of the motor recovery. We conclude that the integrated analysis of EEG, fMRI, and motor activity allows to account for the reorganization of different levels of the motor system and to provide a comprehensive basis for adequate assessment of the BCI+ exoskeleton rehabilitation efficiency
EFFICACY OF COMPLEX NEUROREHABILITATION OF PATIENTS WITH A POST-STROKE ARM PARESIS WITH THE USE OF A BRAIN-COMPUTER INTERFACE+EXOSKELETON SYSTEM
Background: Rehabilitation of patients with poststroke motor disorders with the use of aΒ brain-computer interface (BCI)+exoskeleton may raise the rehabilitation to aΒ new high-tech level and allow for an effective correction of the post-stroke dysfunction. Aim: To assess the efficacy of BCI+exoskeleton procedures for neurorehabilitation of patients with post-stroke motor dysfunction. Materials and methods: The study included 40Β patients with aΒ history of cerebral stroke (mean age 59Β±10.4Β years, 26Β male and 14Β female). Thirty six of them had had an ischemic stroke and 4, aΒ hemorrhagic stroke from 2Β months to 4Β years before the study entry. All patients had aΒ various degree post-stroke hemiparesis predominantly of the arm. The main group patients (n=20), in addition to conventional therapy, had 10Β sessions (3Β times daily) of BCI+exoskeleton. The BCI recognized the hand ungripping imagined by the patient and, by aΒ feedback signal, the exoskeleton exerted the passive movement in the paretic arm. The control group patients (n=10) had 10Β BCI+exoskeleton sessions without imaginary movements, and the exoskeleton functioned in aΒ random mode. The comparison group included 10Β patients who received only standard treatment. Results: At the end of rehabilitation treatment (day 14), all study groups demonstrated an improvement in the function of the paretic extremity. There was an improvement of functioning and daily activities in the main group, compared to the control and the comparison groups: the change in the modified Rankin scale score was 0.4Β±0.1, 0.1Β±0.1Β and 0Β±0.2 (p<0.05), in the Bartel scale score, 5.6Β±0.8, 2.3Β±0.3 andΒ 1Β±0.2 (p<0.001), respectively. In the BCI+exoskeleton group the motor function of the paretic arm assessed by the ARAT scale, improved by 5.5Β±1.3Β points (2.4Β±0.6Β points in the control group and 1.9Β±0.7Β in the comparison group, Ρ<0.05), and as assessed by the Fugl-Meyer scale, by 10.8Β±1.5Β points (3.8Β±1.05Β points in the comparison group, p<0.001). Conclusion: Rehabilitation of patients with post-stroke paresis with the use of BCI+exoskeleton led not also to aΒ decrease in neurological deficit and an improvement of the paretic arm motor function, but also improved parameters of daily activities. Further studies of the effects of BCI+exoskeleton rehabilitation procedures on the course of motor function restoration are planned