The Effect of Biofeedback on the Motor– Muscular Situation in Rehabilitation of Stroke Patients

Introduction: Stroke is the most common debilitating neurological disease in adults. Therefore, rehabilitation is a major consideration to reduce costs and relief disabilities. Biofeedback, a newly recommended method is claimed to be able to improve the consequences following stroke by enhancing the understanding of the psychological functions of the body. The purpose of this study was to investigate the effects of biofeedback on the motor– muscular situation in balance and ability to walk, muscle stiffness (spasticity), hand muscles strength of stroke patients. Methods: The present study was a randomized clinical trial done in 2016. The participants were randomly divided into 2 groups (case and control group). In the intervention group, biofeedback was performed. The check list of main variables, including balance and ability to walk, muscle stiffness (spasticity) and hand muscles strength was completed by a physician before the intervention and at the end of the intervention (16th session). The statistical analysis was conducted, using SPSS version 13. Results: The mean score of balance in intervention group versus control group showed significant differences. The results showed that by eliminating the effects of muscular strength before the intervention, this variable had made improvements and significant differences in both intervention and control groups after the intervention. Comparison of the average spasticity showed that spasticity evaluation score before and after the intervention revealed no significant difference between the two groups. Conclusion: Biofeedback therapy is a promising treatment modality for improving the motor–muscular situation of patients after stroke

Periodic Limb Movements of Sleep: A Survey on Polysomnographic Characteristics of Patients with Obstructive Sleep Apnea

Background and Objective: Periodic limb movements of sleep (PLMS) and obstructive sleep apnea (OSA) are two common sleep disorders that frequently co-occur in one subject. In this study, we evaluated the polysomnographic (PSG) features of patients with OSA with and without PLMS. Materials and Methods: Patients with OSA diagnosed by PSG who referred to our sleep clinic over 2 years were studied for PLMS during a standard diagnostic sleep study. PSG features including apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and sleep quality were evaluated and compared between patients with OSA with and without PLMS. Results: We evaluated 122 patients with OSA, of whom 17 had comorbid PLMS. Mean sleep quality was significantly lower in patients with PLMS compared to those without PLMS (P < 0.05). There was no significant difference in terms of mean age, gender, arousal index (AI), ODI, and apnea/hypopnea between the two groups. Conclusion: Patients with OSA with PLMS comorbidity have remarkably lower sleep quality and this finding is independent of the severity of arousals or respiratory events. Proper evaluation, diagnosis, and treatment of PLMS comorbidity in patients with OSA might improve treatment response.  

Restless legs syndrome in lung chemical warfare patients

BACKGROUND: Restless legs syndrome (RLS) has been associated with a variety of diseases, including chronic obstructive pulmonary disease (COPD), which can worsen the symptoms of underlying disease and correlates with co-morbidities. We aimed to investigate RLS in patients with chemical warfare-induced lung diseases. METHODS: This cross-sectional study recruited patients with sulfur mustard (SM) lung injury, their healthy family members, and patients with COPD from August 2018 to August 2019. COPD was confirmed by medical history, physical examination, and spirometry according to GOLD COPD guidelines. RLS diagnosis was recognized by the International Restless Legs Syndrome Study Group (IRLSSG) and severity was assessed using the International Restless Legs Scale (IRLS) rating scale. Other research measures were COPD Assessment Test (CAT), modified Medical Research Council (mMRC) scale for dyspnoea severity, and Epworth Sleepiness Scale (ESS) for daytime somnolence. Laboratory values included hemoglobin, ferritin, creatinine, and fibrinogen. RESULTS: This study was conducted on 143 men in three groups: 40 (30.0%) SM-exposed veterans, 73 (55.3%) patients with COPD, and 30 (20.9%) healthy cases. Due to the high prevalence of COPD and better comparison with the control group, more patients with COPD were selected. 20 cases (50%) of the veterans group had RLS, while 25 (32.9%) cases of COPD were affected by this disorder. One normal case (3.33%) suffered from RLS. The chemical veterans who suffered from cough, sputum production, chest pain, and hemoptysis had a higher incidence in proportion to patients with COPD (P < 0.001). The CAT score was significantly higher in SM-exposed veterans with RLS (P = 0.004). CONCLUSION: RLS is more common in SM lung injuries with higher CAT scores; therefore, evaluation and treatment of RLS are recommended in mustard lung victims

Neuroacanthocytosis in Two Brothers: An Ultra-rare Cause of Movement Disorder

We report a rare genetic disorder case of neuroacanthocytosis with clinical profile (oro-lingual-facial abnormal involuntary movements, neuropathy) and typical magnetic resonance findings (cerebral atrophy, bilateral caudate nuclei atrophy with dilated anterior horns of the lateral ventricles), positive family history in his brother and acanthocytosis in peripheral blood smear

Accurate method for home-based diagnosis of obstructive sleep apnea: a review

Overnight polysomnography is the gold standard for the detection of obstructive sleep apnea-hypopnea syndrome (OSAS). However, it is expensive and needs attending personnel. The study of simplified sleep apnea monitoring is one of the recent trends for sleep medicine research. The proposed clinical prediction rules employ the vital and social statistics, symptoms, craniofacial traits, and obesity-related measures for initial screening of OSAS in an ambulatory setting. However, most of them are partially or completely clinical and not home-based. One disadvantage of this sort of screening methods is their inability to asses OSAS severity. Another approach of initial OSAS screening is a usage of just one or two physiological signals such as electrocardiography (ECG), pulse oximetry, snoring, nasal airflow, or even speech sound. In this study, we aimed to review the different strategies and to compare their performances, reported by means of their sensitivity–specificity and accuracy for OSAS incidence and severity. OSAS severity is determined by apnea-hypopnea index (AHI) value. Based on the data obtained from the related articles, the most accurate methods of AHI estimation exploit ECG and pulse oximetry signals

Reflex epilepsy: a review

Interesting phenomena of reflex epileptic syndromes are characterized by epileptic seizures each one induced by specific stimulus with a variety of types. Simple triggers, which lead to seizures within seconds, are of sensory type (most commonly visual, most rarely tactile or proprioceptive stimuli). Complex triggers, which are mostly of cognitive type such as praxis, reading, talking, and music, usually induce the epileptic event within minutes. It should differ from what most epileptic patients report as provocative precipitants for seizures (such as emotional stress, fatigue, fever, sleep deprivation, alcohol, and menstrual cycle). The identification of a specific trigger is not only important for patients or their parents to avoid seizures, but also it might help neurologists to choose the most effective antiepileptic drug for each case. In addition, research in this area may possibly reveal some underlying pathophysiology of epileptic phenomena in the brain.In this review, we briefly introduce reported reflex epileptic seizures, their clinical features and management

Sleep apnea headaches

Obstructive sleep apnea syndrome (OSAS) is a common disorder characterized by recurrent apnea during sleep. Nocturnal laboratory-based polysomnography (PSG) is the gold standard test for diagnosis of OSA. The sufferers may complain from daytime sleepiness, snoring or occasional headaches. Serious consequences such as cardiovascular complications, stroke or symptoms of depression may complicate the syndrome. Headache prevalence due to sleep apnea is estimated 1%-2% in general population and affects 2%-8% of middle age population. Morning headache is more common in the OSAS patients. OSAS patients present with various characteristics of morning headache. Treatment with continuous positive airway pressure usually reduces headache. The pathophysiologic background for a relation between obstructive sleep apnea and morning headache is multifactorial. Some theories have been proposed for OSAS-related headaches such as changing oxygen saturation during sleep, cerebral vasodilation and increased intracranial pressure due to cerebral vasodilation, sleep disruption and depression but the definite cause of headaches in OSAS patients is not yet clear

Headache: A Presentation of Pompe Disease; A Case Report

Pompe disease, also termed glycogen storage disease type II or acid maltase deficiency, caused by deficient activity of acid alpha-glucosidase (GAA), the glycogen degrading lysosomal enzyme. As a result, massive lysosomal glycogen deposits in the numerous organs including the muscles. In Pompe disease weakness of truncal muscles is a prominent presentation which results in respiratory failure as a main clinical presentation in the early stages of the disease. Even sleep may be affected by nocturnal respiratory disturbances. Specific treatment with enzyme replacement (human recombinant GAA) is available. Here we present a case of progressive muscular weakness which had been misdiagnosed with limb girdle muscular dystrophy. A history of severe morning headaches led authors to think about sleep apnea, which was confirmed by polysomnography and therefore provided a clue for appropriate diagnosis of Pompe disease. As a conclusion, Morning headaches and sleep insufficiency in any stage of a progressive muscular disorder can lead us to think about respiratory muscle involvement, which is more prominent in Pompe disease