Supplementary Motor Area Syndrome and Flexor Synergy of the Lower Extremities

Clinical presentation of supplementary motor area (SMA) syndrome includes complete akinesia of the contralateral side of the body and mutism, with secondary recovery of neurologic deficit. Multi-joint coordination is frequently impaired following the development of a brain lesion and is generally restricted by abnormal patterns of muscle activation within the hemiparetic limb, clinically termed muscle synergies. However, no work to date has confirmed this observation with the aid of objective methods, such as gait analysis, and the development of reflex pattern has not been suggested as a possible cause. We describe two unusual cases of flexor synergy after tumor resection of SMA lesions.

The Effectiveness of Oro-Esophageal Tube Feeding with Dysphagia after Brainstem Stroke

OBJECTIVE: To investigate whether intermittent oro-esophageal (OE) tube feeding could improve swallowing function in brainstem stroke patients. METHOD: 23 patients suffering from dysphagia after acute brainstem stroke were enrolled in this study. All patients used nasogastric tubes for feeding. In a prospective, single blinded, randomized case control study conducted between January 2007 and April 2009, 11 patients were randomized to the study group who were fed with OE tube and received traditional swallowing treatment, and 12 patients were randomized to the control group who were fed with nasogastric tube and received traditional swallowing treatment. The effects of each treatment were assessed using functional dysphagia scale (FDS), penetration-aspiration scale (PAS), and American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS). RESULTS: The pretreatment evaluation showed no significant difference between the two groups for all parameters. After treatment, FDS, ASHA NOMS improved in both groups (p<0.05). But, PAS score improved only in the study group (p<0.05). In comparison between two groups, FDS, PAS and ASHA NOMS scores showed significant improvement in study groups (p<0.05) than control groups. CONCLUSION: OE tube can be a possible substitute for nasogastric tube in patients suffering from dysphagia after brainstem stroke. And it suggests that OE tube feeding may be used to facilitate recovery of swallowing function.

The Effects of Transcranial Direct Current Stimulation on Dysarthria in Stroke Patients

OBJECTIVE: To investigate whether transcranial direct current stimulation (tDCS) can improve dysarthria in stroke patients. METHOD: Twelve patients who developed dysarthria after acute middle cerebral artery (MCA) infarction were included in this study. In a prospective, double blinded, randomized case control study performed between January 2007 and December 2008, six patients were randomized to anodal tDCS application and conventional speech therapy, and six patients were randomized to the sham group which received only conventional speech therapy. tDCS was delivered for 30 minutes at 2 mA with 25cm2, five times/week, for a total two weeks. The effects were assessed in maximal phonation time (MPT), alternative motion rates (AMR)-Pa, AMR-Ta, AMR-Ka, and sequential motion rates (SMR)-PaTaKa using the Multi-Media Dimension Voice Program. RESULTS: Pre-treatment patient evaluation showed no significant difference between the two groups for all parameters. The MPT, AMR-Pa, AMR-Ta, AMR-Ka, and SMR-PaTaKa were improved pre- and post-treatment in the stimulation group, while MPT, SMR-PaTaKa were improved in the sham group (p<0.05). The AMR-Pa significantly improved in the stimulation group compared to the sham group (p<0.05). CONCLUSION: As these results demonstrated the beneficial effects of anodal tDCS on dysarthria, tDCS can successfully be used as a treatment modality for patients suffering from dysarthria after stroke.

Atypical Form of Motor Neuron Disease: Brachial Amyotrophic Diplegia

Brachial amyotrophic diplegia is a rare disease presenting with severe weakness that is completely confined to the upper limbs over time without upper motor neuron sign. It might be a stable and relatively benign variant of motor neuron disease and should be differentiated from other motor neuropathies. A 60-year-old man presented with a two year history of symmetrical muscle wasting and weakness in his arm and shoulder girdle. Bulbar and leg muscle were not affected and he was independent in ambulation. Nerve conduction studies revealed normal except the low amplitude of median and ulnar compound muscle action potential with no evidence of conduction block. Needle electromyography showed denervation potential and neuropathic motor unit action potential throughout the upper limb. We report this case with a brief review of related literatures.