Botulinum toxin A modifies nociceptive withdrawal reflex in subacute stroke patients

Objectives: The aims of this study were to evaluate the pattern of the nociceptive withdrawal reflex (NWR) of the upper limb at rest and after injection of Botulinum toxin type A (BoNT-A) in poststroke subacute hemiparetic patients. Methods: Fourteen patients with poststroke subacute hemiparesis underwent clinical and instrumental evaluation and BoNT-A injection. Painful electrical stimulation was applied to induce the NWR. Baseline EMG activity and NWR recordings (EMG and kinematic response) were performed at T0, one month (T1), and three months (T2) after the BoNT-A injection, as were Modified Ashworth Scale (MAS) and Functional Independence Measure (FIM) scores. Results: Comparison of results at T0, T1, and T2 revealed significant changes in the MAS score for the elbow (p < 0.001) and wrist joints (p < 0.001) and in the FIM score at T0 and T2. BoNT-A injection had a significant effect on both NWR amplitude and baseline EMG activity in the posterior deltoid (PD) and flexor carpi radialis (FCR) muscles as well as in all averaged muscles. Analysis of elbow kinematics before and after treatment revealed that the reflex probability rates were significantly higher at T1 and T2 than at T0. Conclusion: Injection of BoNT-A in the subacute phase of stroke can modify both the baseline EMG activity and the NWR-related EMG responses in the upper limb muscles irrespective of the site of injection; furthermore, the reflex-mediated defensive mechanical responses, that is, shoulder extension and abduction and elbow flexion, increased after treatment. BoNT-A injection may be a useful treatment in poststroke spasticity with a potential indirect effect on spinal neurons

Visual Search in good and poor readers:effect with single and combined features targets

This study examined differences between normal and poor readers in the visual-search strategy used to detect a target shape in a background of similar shapes. No differences between the two groups occur in search for simple features (Exps. 1 and 3) and conjunction of features (Exp. 2). However, the performance of the two groups differ on search tasks with multifeatured shapes, in which targets and nontargets differ in both the identity of features and their spatial relationship or in the spatial relationship of features alone. Results suggest that, rather than a problem in searching complex stimuli, poor searchers have difficulty within stimuli like letters and geometrical shapes which require integration of features within a module of the visual system

New and forthcoming anti-epileptic drugs.

PURPOSE OF REVIEW: There is a need for newer anti-epileptic drugs (AEDs) with improved efficacy and tolerability. This article reviews AEDs introduced since 2007 and investigational compounds in clinical development. RECENT FINDINGS: Two recently introduced AEDs, stiripentol and rufinamide, have been licensed exclusively for orphan indications, that is severe myoclonic epilepsy of infancy (stiripentol, Europe) and Lennox-Gastaut syndrome (rufinamide, Europe and the USA). This signals a welcome new trend to explore novel treatments in specific pediatric syndromes for which there are high therapeutic needs. Two additional AEDs, lacosamide and eslicarbazepine acetate, have been licensed recently for a more traditional indication, refractory partial-onset seizures. Although newly introduced agents given as adjunctive therapy have been found to be superior to placebo in reducing seizure frequency, the ultimate goal of sustained seizure freedom is rarely achieved. Therefore, the search for better agents should continue. Several investigational compounds are currently in various stages of clinical development. SUMMARY: The recent introduction of newer AEDs has enlarged the armamentarium against epilepsy. However, newer agents had only a modest impact on the probability of achieving long-term remission. Novel strategies for the discovery and development of truly innovative AEDs are sorely needed

Improving Content Validity Evaluation of Assessment Instruments Through Formal Content Validity Analysis

Content validity is defined as the degree to which elements of an assessment instrument are relevant to and representative of the target construct. The available methods for content validity evaluation typically focus on the extent to which a set of items are relevant to the target construct, but do not afford precise evaluation of items’ behavior, nor their exhaustiveness with respect to the elements of the target construct. Formal content validity analysis (FCVA) is a new procedure combining methods and techniques from various areas of psychological assessment, such as (a) constructing Boolean classification matrices to formalize relationships among an assessment instrument’s items and target construct elements, and (b) computing interrater agreement indices. We discuss how FCVA can be extended through the implementation of a Bayesian procedure to improve the interrater agreement indices’ accuracy (Bayesian formal content validity analysis [B-FCVA]). With respect to extant methods, FCVA and B-FCVA can provide a great amount of information about content validity while not demanding much more work for authors and experts

Time perspective and the subjective passage of time in patients with borderline personality disorders

Patients with borderline personality disorders (BPD) show heightened negative affect and maladaptive emotion-regulation strategies. An individual's time perspective towards the past, present, and future as well as the feeling of time passage are strongly related to affect and emotion regulation. We therefore assessed the time perspective (Zimbardo Time Perspective Inventory, ZTPI) and the subjective passage of time for present and past time intervals (Subjective Time Questionnaire, STQ) in 17 patients with BPD between the ages of 18 and 52 and 17 control subjects matched for gender, age and education. Patients with BPD show deviations in nearly all time orientations in the ZTPI: lower scores in the future and the past-positive dimension and higher scores in the present-fatalistic and past-negative dimensions. Patients deviate significantly more than controls from a balanced time perspective (BTP). Regarding the STQ, patients with BPD feel a general expansion of time at present but not for past intervals. Taken together, we show how BPD can be understood as a strong imbalance in individual time orientations and a most likely negatively felt expansion of subjective time in daily life

Diagnostic and Prognostic Value of External Anal Sphincter EMG Patterns in Multiple System Atrophy

Background: It is debated whether external anal sphincter (EAS) electromyography can distinguish between multiple system atrophy (MSA) and Parkinson's disease (PD), whereas its usefulness for MSA prognosis is unknown. Objectives: We explored the diagnostic and prognostic value and clinical correlations of EAS electromyography patterns in MSA. Methods: We collected clinical data and EAS electromyography findings in 72 patients with MSA and 21 with PD. Results: We identified four EAS patterns. The normal pattern was frequently observed in PD and associated with prolonged survival when identified in MSA. Abnormal patterns were predominant in MSA. The most severe pattern was associated with the highest likelihood of MSA diagnosis and with the worst prognosis in the MSA cohort. MSA patients with EAS abnormalities often showed urogenital symptoms and fecal incontinence. Conclusions: The increasing severity of EAS electromyography patterns paralleled diagnostic accuracy and survival in MSA, and correlated with prevalence of bladder and bowel symptoms. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society

Attachment disorganisation and borderline patients’ metacognitive responses to therapists’ expressed understanding of their states of mind: A pilot study

This study explores the relationship between psychotherapists’ validation interventions and patients’ metacognitive responses at the beginning of treatment of borderline personality disorder (BPD). A model of BPD based on disorganized attachment provides the hypothesis that, before patients’ internal working model of attachment has been corrected within the therapeutic relationship, therapist interventions that are likely to activate patients’ attachment system are also likely to induce temporary disorganization of patients’ metacognitive functions. Any validation intervention implies that therapists openly display an understanding and accepting attitude when they comment on patients’ reported experiences and is, therefore, likely to activate the patients’ attachment system. Linehan’s (1993) manual of dialecticbehavioral therapy (DBT) was used as a guideline to assess validation interventions adopted by therapists. The transcripts of the second individual session in the psychotherapy of 19 consecutive patients were analyzed. Checklists based on the DBT manual were used to identify therapists’ validating, supportive, and neutral interventions. The Metacognitive Assessment Scale was used to assess changes in specific aspects of patients’ metacognitive processes during therapeutic dialogues. Following validation interventions, patients’ responses revealed significantly higher rates of temporary metacognitive failure in comparison to the responses solicited by neutral intervention