Comparison of Effects of Repetitive Transcranial Magnetic Stimulation with High- or Low-frequency on Visuospatial Neglect in Stroke Patients

OBJECTIVE: To compare the effect of repetitive transcranial magnetic stimulation (rTMS) applied over the right or left parietal cortex with high- or low-frequency on visuospatial neglect in stroke patients. METHOD: Nineteen stroke subjects (10 males, 9 females) were enrolled. All subjects received 1,200 real rTMS over left parietal cortex at an intensity of 90% of motor thresholds with 1 Hz, sham rTMS over right parietal cortex with 20 Hz and real rTMS over right parietal cortex at same intensity with 20 Hz under randomized cross over design. To compare the effects of different rTMS protocols, letter cancellation test, line bisection test (near, far) and Ota's task were administered before and after rTMS. RESULTS: Low frequency rTMS over left parietal cortex, compared with sham stimulation, significantly improve visuospatial neglect in Ota's task (p<0.05). CONCLUSION: As low frequency rTMS over left parietal cortex showed beneficial effects on visuospatial neglect, low frequency rTMS can be used as a treatment modality for patients suffering from visuospatial neglect after stroke.

Effect of Botulinum Toxin A on Trismus after Traumatic Brain Injury: A case report

We report a case of severe trismus following traumatic brain injury (TBI), which was treated successfully with botulinum toxin A. Its effect evidenced long-term resolution, for over one year. A 36 year-old man with a multifocal intracranial hemorrhage was admitted for quadriplegia with dysphagia and trismus. During ten months, a nasogastric tube was placed for feeding after TBI, and at that time his upper- to-lower interincisal distance was only 1.2 cm upon voluntary mouth opening. Botulinum toxin A 450 U (Dysport(R)) was injected into both masseter, medial pterygoid and left temporalis muscles under electromyographic guidance. The interincisal distance began to improve one week after injection. He successfully underwent percutaneous endoscopic gastrostomy, dysphagia rehabilitation therapy, and dental prosthesis. More than one month after injection, oral feeding proved possible. After 1 year his interincisal distance was maintained at 2.9 cm.

A Case of Developmental Delay with Canavan's Disease: A case report

Canavan's disease is a hereditary disease that causes development delay by demyelinization of white matter in brain. The cardinal symptoms of Canavan's disease are head-lag, macrocephaly, developmental delay, blindness, epilepsy and hypotonia. Seven-month old baby delivered by Caesarean section at gestational age 40 weeks was complaining of an inability to keep head up. In past history, he was treated for congenital nystagmus. Chromosomal study was normal. Brain MRI showed delay of myelination of 5 months old. During neurodevelopment treatment in our hospital about development delay, macrocephaly was observed with head circumference 46 cm (90~97 percentile). He couldn't control his head yet. Brain MRI was done when he was 12-month old. There was no myelination in whole brain compared with that of same age group. The peak elevation of N-acetylaspartic acid (NAA) was showed in magnetic resonance spectroscopy (MRS). NAA was detected as high as 29.7 mmol/molCr, we diagnosed him as Canavan's disease. So we reported this case with a brief review of related literatures.

Usefulness of Digital Infrared Thermal Imaging in Evaluating the Efficacy of Epidural Block among the Patients with Lumbar Radiculopathy

OBJECTIVE: To assess the clinical value of digital infrared thermal imaging (DITI) as an indicator for successful lumbar epidural block in patients with lumbar radiculopathy. METHOD: Ten patients having lumbar radiculopathy with low back pain and unilateral radicular leg pain participated in this study. The DITI was taken before and 20 minutes after lumbar epidural block. Visual analog scale (VAS) and straight leg raising (SLR) test were done before taking DITI. Temperatures were measured over 39 sectors of both lower extremities. Temperature differences of the affected and the sound side were compared between before and after lumbar epidural block. Correlation between the temperature differences and two variables, the VAS and SLR were assessed. RESULTS: There were the relative increase of temperature in DITI after lumbar epidural block, especially in posterior part of sector 7, posterior upper lateral thigh, sector 8, posterior upper middle thigh, sector 14, medial popliteal area, sector 15, posterior upper lateral calf, and sector 18, posterior middle medial calf. In posterior 15(th) sectors, the relative increase of temperature had a positive correlation with improvement of VAS score, and in 18(th) sector, it is positively correlated with improvement of SLR. CONCLUSION: It seems that the relative increase of temperature differences after lumbar epidural block is positively correlated with improvement of VAS and SLR in specific sectors, posterior 15(th) and 18(th) each. DITI may be useful as an objective indicator of successful lumbar epidural block.

The Effects of a Computer-assisted Cognition Training Program (RehaCom®) in Stroke Patients

OBJECTIVE: To evaluate the effect of computer-assisted cognitive training program (RehaCom®) on cognitive function of the patients with stroke. METHOD: Fifty seven subjects with stroke (34 males, 23 females) were enrolled and classified into two groups, experimental and control group. There was no significant difference between two groups in age, sex and lesion type distribution. Control group received conventional rehabilitation therapy including physical and occupational therapy. Experimental group received additional computer-assisted cognitive training using RehaCom software (Germany, 1996), 5 times per a week, 30 minutes per session, for 4 weeks. The RehaCom software consisted of reaction behavior, memory of words, topological memory programs. All patients were assessed their cognitive function using Computerized Neuropsychological Test (CNT), Lowenstein Occupational Therapy Cognitive Assessment (LOTCA) and Korean Version of Mini-Mental Status Examination (MMSE-K) before and after treatment. Functional independence measurement (FIM) was also applied for evaluation of functional status. RESULTS: There was no difference between two groups in the LOTCA, CNT and FIM scores at baseline. Four weeks later, scores of the MMSE and FIM were significantly improved in the experimental group compared to the control group (p<0.05). Especially, the improvement was significant in moderate cognitive impairment group (MMSE = 11~21) (p<0.05). In learned patients of experimental group, the score of the MMSE and LOTCA were significantly more improved than control group (p<0.05). CONCLUSION: Computer-assisted cognitive training would be useful as a additional tool of cognitive rehabilitation in patients with stroke. Especially, the effect of computer-assisted cognitive training program was far better in patients with moderate cognitive impairment and in patients who show learning in cognitive training program.