How Much Evidence do we have on the Central Effects of Botulinum Toxin in Spasticity and Dystonia?

The brain is continually reorganizing (plasticity). Plastic changes within the sensorimotor system are not only beneficial (adaptive plasticity) but may even worsen function (maladaptive plasticity). Conditions such as dystonia and poststroke spasticity (PSS) that interfere with motor performance could be attributed to maladaptive plasticity. Botulinum toxin (BoNT) has been proven to be safe and effective in treating various hyperfunctional cholinergic states. Beside the well-known neuromuscular junction site of action, BoNT also exerts effects through supraspinal mechanisms and can even affect cortical reorganization. The hypothesis of central reorganization following BoNT treatment has been supported by studies using neurophysiological and imaging methods in patients with focal dystonia and PSS. The growing evidence of BoNT-related central (remote) effects make BoNT injections a promising tool to favorably affect maladaptive changes even at the cortical level

HARDI-ZOOMit protocol improves specificity to microstructural changes in presymptomatic myelopathy

ABSTRACT: Diffusion magnetic resonance imaging (dMRI) proved promising in patients with non-myelopathic degenerative cervical cord compression (NMDCCC), i.e., without clinically manifested myelopathy. Aim of the study is to present a fast multi-shell HARDI-ZOOMit dMRI protocol and validate its usability to detect microstructural myelopathy in NMDCCC patients. In 7 young healthy volunteers, 13 age-comparable healthy controls, 18 patients with mild NMDCCC and 15 patients with severe NMDCCC, the protocol provided higher signal-to-noise ratio, enhanced visualization of white/gray matter structures in microstructural maps, improved dMRI metric reproducibility, preserved sensitivity (SE = 87.88%) and increased specificity (SP = 92.31%) of control-patient group differences when compared to DTI-RESOLVE protocol (SE = 87.88%, SP = 76.92%). Of the 56 tested microstructural parameters, HARDI-ZOOMit yielded significant patient-control differences in 19 parameters, whereas in DTI-RESOLVE data, differences were observed in 10 parameters, with mostly lower robustness. Novel marker the white-gray matter diffusivity gradient demonstrated the highest separation. HARDI-ZOOMit protocol detected larger number of crossing fibers (5–15% of voxels) with physiologically plausible orientations than DTI-RESOLVE protocol (0–8% of voxels). Crossings were detected in areas of dorsal horns and anterior white commissure. HARDI-ZOOMit protocol proved to be a sensitive and practical tool for clinical quantitative spinal cord imaging

Effect of Gait Imagery Tasks on Lower Limb Muscle Activity With Respect to Body Posture

The objective of this study was to evaluate the effect of gait imagery tasks on lowerlimb muscle activity with respect to body posture. The sitting and standing position and lower limb muscle activity were evaluated in 27 healthy female students (24.4±1.3 years, 167.2±5.2 cm, 60.10±6.4 kg). Surface electromyography was assessed during rest and in three different experimental conditions using mental imagery. These included a rhythmic gait, rhythmic gait simultaneously with observation of a model, and rhythmic gait after performing rhythmic gait. The normalized root mean square EMG values with respect to corresponding rest position were compared using non-parametric statistics. Standing gait imagery tasks had facilitatory effect on proximal lower limb muscle activity. However, electromyography activity of distal leg muscles decreased for all gait imagery tasks in the sitting position, when the proprioceptive feedback was less appropriate. For subsequent gait motor imagery tasks, the muscle activity decreased, probably as result of habituation. In conclusion, the effect of motor imagery on muscle activity appears to depend on relative strength of facilitatory and inhibitory inputs

Diffusion magnetic resonance imaging reveals tract‐specific microstructural correlates of electrophysiological impairments in non‐myelopathic and myelopathic spinal cord compression

ABSTRACT: Background and purpose: Non- myelopathic degenerative cervical spinal cord compres-sion (NMDC) frequently occurs throughout aging and may progress to potentially irre-versible degenerative cervical myelopathy (DCM). Whereas standard clinical magnetic resonance imaging (MRI) and electrophysiological measures assess compression sever-ity and neurological dysfunction, respectively, underlying microstructural deficits still have to be established in NMDC and DCM patients. The study aims to establish tract- specific diffusion MRI markers of electrophysiological deficits to predict the progression of asymptomatic NMDC to symptomatic DCM. Methods: High-resolution 3 T diffusion MRI was acquired for 103 NMDC and 21 DCM patients compared to 60 healthy controls to reveal diffusion alterations and relation-ships between tract-specific diffusion metrics and corresponding electrophysiological measures and compression severity. Relationship between the degree of DCM disability, assessed by the modified Japanese Orthopaedic Association scale, and tract-specific mi-crostructural changes in DCM patients was also explored. Results: The study identified diffusion-derived abnormalities in the gray matter, dor-sal and lateral tracts congruent with trans-synaptic degeneration and demyelination in chronic degenerative spinal cord compression with more profound alterations in DCM than NMDC. Diffusion metrics were affected in the C3-6 area as well as above the com-pression level at C3 with more profound rostral deficits in DCM than NMDC. Alterations in lateral motor and dorsal sensory tracts correlated with motor and sensory evoked po-tentials, respectively, whereas electromyography outcomes corresponded with gray mat-ter microstructure. DCM disability corresponded with microstructure alteration in lateral columns. Conclusions: Outcomes imply the necessity of high- resolution tract-specific diffusion MRI for monitoring degenerative spinal pathology in longitudinal studies