The presence of depression and anxiety do not distinguish between functional jerks and cortical myoclonus

INTRODUCTION: Functional movement disorders are accompanied by a high occurrence of psychopathology and cause serious impairments in quality of life. However, little is known about this in patients with functional jerks and no comparison has been made between patients with functional jerks and organic myoclonus. This case control study compares the occurrence of depression, anxiety and quality of life (HR-QoL) in patients with functional jerks and cortical myoclonus. METHODS: Patients with functional jerks and cortical myoclonus, consecutively recruited, were compared on self-rated anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory), health-related quality of life (RAND-36), and myoclonus severity (UMRS and CGI-S rating scales). RESULTS: Sixteen patients with functional jerks and 23 with cortical myoclonus were evaluated. There was no significant difference in depression (44% vs. 43%) or anxiety (44% vs. 47%) scores between groups. The HR-QoL was similarly impaired except that functional jerks patients reported significantly more pain (p < 0.05). Only in the functional jerks group myoclonus severity correlated with depression and anxiety. CONCLUSION: Depression and anxiety scores are high and do not discriminate between functional jerks and cortical myoclonus. Quality of life was equally impaired in both sub-groups, but pain was significantly worse in patients with functional jerks

The Inter-rater Variability of Clinical Assessment in Post-anoxic Myoclonus.

Acute post-anoxic myoclonus (PAM) can be divided into an unfavorable (generalized/subcortical) and more favorable ((multi)focal/cortical) outcome group that could support prognostication in post-anoxic encephalopathy; however, the inter-rater variability of clinically assessing these PAM subtypes is unknown. We prospectively examined PAM patients using a standardized video protocol. Videos were rated by three neurologists who classified PAM phenotype (generalized/(multi)focal), stimulus sensitivity, localization (proximal/distal/both), and severity (Clinical Global Impression-Severity Scale (CGI-S) and Unified Myoclonus Rating Scale (UMRS)). Poor inter-rater agreement was found for phenotype and stimulus sensitivity (κ=-0.05), moderate agreement for localization (κ=0.46). Substantial agreement was obtained for the CGI-S (intraclass correlation coefficient (ICC)=0.64) and almost perfect agreement for the UMRS (ICC=0.82). Clinical assessment of PAM is not reproducible between physicians, and should therefore not be used for prognostication. PAM severity measured by the UMRS appears to be reliable; however, the relation between PAM severity and outcome is unknown

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Peesblessures door sport: pathomechanisme en nieuwe aangrijpingspunten voor therapie

Het doel van deze scriptie is het weergeven van nieuwe ontwikkelingen in de literatuur omtrent het pathomechanisme en therapie van tendinopathie. Chronische peesblessures zijn frequent voorkomende aandoeningen die voornamelijk een probleem vormen in de sportende populatie. Aanhoudende pijn, zwelling en verminderde functie zijn karakteristieken van de tendinopathische pees. Histologische analyse laat degeneratie zien van het peesweefsel, waarbij de normaal wit glinsterende kleur is vervangen door een dof bruinige kleur. Het pathomechanisme van tendinopathie wordt traditioneel omschreven als een pathologische onstekingsreactie, echter histologisch onderzoek ondersteund deze theorie niet. Hoewel het exacte pathomechanisme niet bekend is, spelen microtraumata, inflammatoire cytokinen, matrix metalloproteïnases, VEGF, vrije zuurstof radicalen en neurochemische factoren waarschijnlijk een rol. Pijn in tendinopathie kan worden omschreven als het topje van de ijsberg dat het gevolg is van pathologische degeneratie in de pees. Extrinsieke factoren als lichamelijke activiteitspatroon, slechte voeding en roken kunnen deze peesdegeneratie beïnvloeden. Ook intrinsieke factoren als genetica, overgewicht, leeftijd en psychosomatiek worden genoemd betrokken te zijn in het pathomechanisme. De behandeling van tendinopathie bestaat uit een breed scala aan conservatieve en chirurgische methodieken, allen beperkt effectief. Excentrische training, ESWT en chirurgie tonen de beste resultaten en zijn in +/- 60% van de patiënten effectief. Onderzoek naar het exacte pathomechanisme kan bijdragen aan de ontwikkeling van nieuwe effectieve behandelingsmethoden voor tendinopathie.