A Patient with Coexisting Myasthenia Gravis and Lambert-Eaton Myasthenic Syndrome

BACKGROUND: The coexistence of myasthenia gravis (MG) and Lambert-Eaton myasthenic syndrome (LEMS) is very rare and remains controversial. CASE REPORT: A 48-year-old woman initially presented with noticeable right ptosis and intermittent diplopia. She then developed fluctuating proximal limb weakness and difficulty in swallowing. The serum titer of anti-acetylcholine-receptor antibody was elevated and the edrophonium (Tensilon) test was positive. However, repetitive nerve stimulation revealed abnormalities typical of LEMS. The patient exhibited a good response to treatment with anticholinesterase inhibitors and steroids, and long-term evaluation disclosed that she presented with the clinical, electrophysiological, and immunological characteristics of both diseases. CONCLUSIONS: The reported clinical and electrophysiological features suggest that this patient was a very rare case of combined MG and LEMS.

Development of Computer-assisted Memory Rehabilitation Programs for the Treatment of Memory Dysfunction in Patients with Brain Injury

OBJECTIVE: To develope the computer-assisted memory rehabilitation programs and to assess the effect of these programs in the patients with brain injury. METHOD: Ten memory training programs, which included verbal/non-verbal, sequential/ non-sequential, and visual/auditory memory properties were designed and converted to the computer program using C-language. The training program included various aspects of memory such as spatial memory, sequential verbal and nonverbal recall, associated recall, categorical memory, and integrated semantic memory. Each program used familiar pictures and sounds in our living situation to give the patients comfortable feelings and interests. Seven patients with brain injury were trained using the computer-assisted memory program 3 times per week for 4 weeks. All patients were assessed their cognitive function using Seoul Computerized Neuropsychological Test (Maxmedica) before and 1 month after the treatment. RESULTS: Ten computer-associated memory training programs using C-language were successfully developed. The patients who were trained with computer-assisted memory programs showed higher performances in forward digit span, backward digit span, backward visual span, verbal learning, visual controlled continuous performance, auditory controlled continuous performance, and finger tapping tests after than before the treatment. CONCLUSION: The computer-assisted memory training can be used as an additional tool for memory rehabilitation in patients with brain injury.

Effect of Computer-Assisted Cognitive Rehabilitation Program for Attention Training in Brain Injury

OBJECTIVE: To evaluate the effect of Korean Computer-Assisted Cognitive Rehabilitation Program (CogRehabK ) on cognitive function of the patients with brain injury. METHOD: Fifty subjects with brain injury were enrolled and classified into two groups, experimental (n=25) and control group (n=25). Control group received conventional rehabilitation therapy including physical and occupational therapy. Experimental group received additional computer-assisted cognitive training using CogRehabK software consisted of 10 level-completing programs, 3 times per week, 30 minutes per session, for 4 to 6 weeks. All patients were assessed their cognitive functions using Seoul Computerized Neuropsychological Test (SCNT , Maxmedica, 2001), minimental status examination (MMSE), digit span, and Wechslermemory scale before and after treatment. Functional independence measure and geriatric depression scale were also applied for evaluation of functional and mood status. RESULTS: Before the treatment, two groups showed no difference in their cognitive functions. After 4 to 6 weeks of treatment, the experimental group showed significantly higher performance in forward digit span, forward visual span, auditory continuous performance test, and visual continuous performance test in CNT and MMSE than control group (p<0.05). CONCLUSION: We conclude that the CogRehabK may be useful as an additional tool for the cognitive rehabilitation in patients with brain injury.