171 research outputs found
Op de trap van Erasmus: de vrijheid van neuronen
Afscheidsrede als Hoogleraar Neurologie, uitgesproken op 8 januari 201
Locomotion in the cat : a behavioural and neurophysiological study of interlimb coordination
The alternating periods of flexion and extension movements at
the different joints farm the elements of the locomotor cycle, which
may be adapted in force and timing to satisfy the requirements for
support of the body, balance and direction of progression.
These basic elements of movement are produced by the activities
of interneurones and moteneurones lying in the respective spinal
segments innervating each limb. In his study of narcosis progression
in the cat Brown (20) suggested that the flexion and extension
movernents were generated by groups of rieurones driving the
respective motoneurons. These groups were organized into functional
half eentres producing the signals necessary for the flexion and
extension phases of stepping by virtue of mutual inhibition. The
existence of half eentres received some confirmatien by Lundberg and
hi.s collaborators in studies on the effects of L-DOPA on spinal cord
reflexes (82). Thè actual mechanisms by which the groups of interneurones
produce phases of flexor and extensor activity have not yet
been defined, although Grillner (62) and Pearson (I 15) have suggested
some possible models
Chronic motor neuropathies: response to interferon-beta1a after failure of conventional therapies
OBJECTIVES: The effect of interferon-beta1a (INF-beta1a; Rebif) was
studied in patients with chronic motor neuropathies not improving after
conventional treatments such as immunoglobulins, steroids,
cyclophosphamide or plasma exchange. METHODS: A prospective open study was
performed with a duration of 6-12 months. Three patients with a multifocal
motor neuropathy and one patient with a pure motor form of chronic
inflammatory demyelinating polyneuropathy were enrolled. Three patients
had anti-GM1 antibodies. Treatment consisted of subcutaneous injections of
IBF-beta1a (6 MIU), three times a week. Primary outcome was assessed at
the level of disability using the nine hole peg test, the 10 metres
walking test, and the modified Rankin scale. Secondary outcome was
measured at the impairment level using a slightly modified MRC sumscore.
RESULTS: All patients showed a significant improvement on the modified MRC
sumscore. The time required to walk 10 metres and to fulfil the nine hole
peg test was also significantly reduced in the first 3 months in most
patients. However, the translation of these results to functional
improvement on the modified Rankin was only seen in two patients. There
were no severe adverse events. Motor conduction blocks were partially
restored in one patient only. Anti-GM1 antibody titres did not change.
CONCLUSION: These findings indicate that severely affected patients with
chronic motor neuropathies not responding to conventional therapies may
improve when treated with INF-beta1a. From this study it is suggested that
INF-beta1a should be administered in patients with chronic motor
neuropathies for a period of up to 3 months before deciding to cease
treatment. A controlled trial is necessary to confirm these findings
Holter monitoring in patients with transient and focal ischemic attacks of the brain
The results of Holter monitoring in 100 patients with transient and focal cerebral ischemia were studied retrospectively. Atrial fibrillation (AF) was found in five patients compared with two from a group of 100 age and sex-matched control patients. Four of these had a previous history of AF or showed AF on the standard electrocardiogram. Episodic forms of sick sinus syndrome, which have also been related to cerebral embolism, were found in 32 of the TIA patients against 13 of the controls (p less than 0.0025). Sick sinus syndrome was of the bradyarrhythmia-tachyarrhythmia type in 14 of the TIA patients and in three of the controls (p less than 0.01). The relationship between TIAs and transient sinus node dysfunction could not be explained by concomitant heart disease. It is not yet clear whether the relationship is causal or indirect
Self reported stressful life events and exacerbations in multiple sclerosis: prospective study
OBJECTIVE: To study the relation between self reported stressful life
events not related to multiple sclerosis and the occurrence of
exacerbations in relapsing-remitting multiple sclerosis. DESIGN:
Longitudinal, prospective cohort study. SETTING: Outpatient clinic of
department of neurology in the Netherlands. PARTICIPANTS: Patients aged
18-55 with relapsing-remitting multiple sclerosis, who could walk with a
cane or better (score of 0-6.0 on the expanded disability status scale),
and had had at least two exacerbations in 24 months before inclusion in
the study. Patients with other serious conditions were excluded. MAIN
OUTCOME MEASURE: The risk of increased disease activity as measured by the
occurrence of exacerbations after weeks with stressful events. RESULTS:
Seventy out of 73 included patients (96%) reported at least one stressful
event. In total, 457 stressful life events were reported that were not
related to multiple sclerosis. Average follow up time was 1.4 years.
Throughout the study, 134 exacerbations occurred in 56 patients and 136
infections occurred in 57 patients. Cox regression analysis with time
dependent variables showed that stress was associated with a doubling of
the exacerbation rate (relative risk 2.2, 95% confidence interval 1.2 to
4.0, P = 0.014) during the subsequent four weeks. Infections were
associated with a threefold increase in the risk of exacerbation, but this
effect was found to be independent of experienced stress. CONCLUSION:
Stressful events were associated with increased exacerbations in
relapsing-remitting multiple sclerosis. This association was independent
of the triggering effect of infections on exacerbations of multiple
sclerosis
Indices from flow-volume curves in relation to cephalometric, ENT- and sleep-O2 saturation variables in snorers with and without obstructive sleep-apnoea
In a group of 37 heavy snorers with obstructive sleep apnoea (OSA, Group
1) and a group of 23 heavy snorers without OSA (Group 2) cephalometric
indices, ENT indices related to upper airway collapsibility, and nocturnal
O2 desaturation indices were related to variables from maximal expiratory
and inspiratory flow-volume (MEFV and MIFV) curves. The cephalometric
indices used were the length and diameter of the soft palate (spl and
spd), the shortest distance between the mandibular plane and the hyoid
bone (mph) and the posterior airway space (pas). Collapsibility of the
upper airways was observed at the level of the tongue base and soft palate
by fibroscopy during a Muller manoeuvre (mtb and msp) and ranked on a five
point scale. Sleep indices measured were the mean number of oxygen
desaturations of more than 3% per hour preceded by an apnoea or hypopnoea
of more than 10 s (desaturation index), maximal sleep oxygen desaturation,
baseline arterial oxygen saturation (Sa,O2) and, in the OSA group,
percentage of sleep time with Sa,O2 < 90%. The variables obtained from the
flow-volume curves were the forced vital capacity (FVC), forced expiratory
and inspiratory volume in 1 s (FEV1 and FIV1), peak expiratory and peak
inspiratory flows (PEF and PIF), and maximal flow after expiring 50% of
the FVC (MEF50). The mean of the flow-volume variables, influenced by
upper airway aperture (PEF, FIV1) was significantly greater than
predicted.(ABSTRACT TRUNCATED AT 250 WORDS
IVIG Treatment and Prognosis in Guillain–Barré Syndrome
Introduction Guillain-Barré syndrome (GBS) is an acute, immune-mediated polyneuropathy that often leads to severe weakness. Intravenous immunoglobulin (IVIG) is a proven effective treatment for GBS (class 1 evidence). However, about 25% of patients need artificial ventilation and 20% are still unable to walk unaided after 6 months. Important clinical factors associated with poor outcome are age, presence of preceding diarrhea and the severity of disability in the early course of disease. These clinical factors were combined in a clinical prognostic scoring scale, the Erasmus GBS Outcome Scale (EGOS). Materials and Methods GBS patients being unable to walk unaided are currently treated with a standard single IVIg dose (0.4 g/kg bodyweight for 5 days). A recent retrospective study in 174 GBS patients enrolled in one of our randomized controlled clinical trials showed that patients with a minor increase of serum IgG level after standard single IVIg dose recovered significantly slower. Additionally, fewer patients reached the ability to walk unaided at six months after correction for the known clinical prognostic factors (multivariate analysis; P<0.022). Discussion It is yet unknown why some GBS patients only have a minor increase after standard IVIg treatment. By using the EGOS it is possible to select GBS patients with a poor prognosis. These patients potentially may benefit from a second IVIg dose. Conclusion A standard dose of IVIG is not sufficiently effective in many GBS patients. Whether these patients might benefit from a second IVIg dose needs further investigation
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