Korean Database of Cerebral Palsy: A Report on Characteristics of Cerebral Palsy in South Korea

OBJECTIVE: To introduce the Korean Database of Cerebral Palsy (KDCP) and to provide the first report on characteristics of subjects with cerebral palsy (CP). METHODS: The KDCP is a nationwide database of subjects with CP, which includes a total of 773 subjects. Characteristics such as demography, birth history, onset and type of CP, brain magnetic resonance imaging (MRI) findings, functional ability and accompanying impairments, were extracted and analyzed. RESULTS: Preterm delivery and low birth weight were found in 59.51% and 60.28% of subjects, respectively. Postnatally acquired CP was 15.3%. The distribution of CP was 87.32%, 5.17%, and 1.81% for spastic, dyskinetic, and ataxic types, respectively. Functional ability was the worst in dyskinetic CP, as compared to other types of CP. Speech-language disorder (43.9%), ophthalmologic impairment (32.9%), and intellectual disability (30.3%) were the three most common accompanying impairments. The number of accompanying impairments was elevated in subjects with preterm birth and low birth weight. Brain MRI showed normal findings, malformations, and non-malformations in 10.62%, 9.56%, and 77.35% of subjects, respectively. Subjects with normal MRI findings had better functional ability than subjects with other MRI findings. MRI findings of a non-malformation origin, such as periventricular leukomalacia, were more common in subjects with preterm birth and low birth weight. CONCLUSION: The KDCP and its first report are introduced in this report, wherein the KDCP established agreement on terminologies of CP. This study added information on the characteristics of subjects with CP in South Korea, which can now be compared to those of other countries and ethnicities.

The Effect of Continuous Epidural Electrical Stimulation on Neuronal Proliferation in Cerebral Ischemic Rats

OBJECTIVE: To investigate the effect of electrical stimulation (ES) on the recovery of motor skill and neuronal cell proliferation. METHODS: The male Sprague-Dawley rats were implanted with an epidural electrode over the peri-ischemic area after photothrombotic stroke in the dominant sensorimotor cortex. All rats were randomly assigned into the ES group and control group. The behavioral test of a single pellet reaching task (SPRT) and neurological examinations including the Schabitz's photothrombotic neurological score and the Menzies test were conducted for 2 weeks. After 14 days, coronal sections were obtained and immunostained for neuronal cell differentiation markers including bromodeoxyuridine (BrdU), neuron-specific nuclear protein (NeuN), and doublecortin (DCX). RESULTS: On the SPRT, the motor function in paralytic forelimbs of the ES group was significantly improved. There were no significant differences in neurological examinations and neuronal cell differentiation markers except for the significantly increased number of DCX+ cells in the corpus callosum of the ES group (p<0.05). But in the ES group, the number of NeuN+ cells in the ischemic cortex and the number of NeuN+ cells and DCX+ cells in the ischemic striatum tended to increase. In the ES group, NeuN+ cells in the ischemic hemisphere and DCX+ cells and BrdU+ cells in the opposite hemisphere tended to increase compared to those in the contralateral. CONCLUSION: The continuous epidural ES of the ischemic sensorimotor cortex induced a significant improvement in the motor function and tended to increase neural cell proliferation in the ischemic hemisphere and the neural regeneration in the opposite hemisphere.

Recommendations for Establishing Cardiac Rehabilitation Programs; Facility, Equipment and Staff: The Korean Society of Cardiac Rehabilitation (KSCR) Position Statement

The Korean Society of Cardiac Rehabilitation (KSCR) have recommended standards for establishing cardiac rehabilitation programs in terms of facility, equipment and staff. This is the first time a statement concerning these types of standards has been issued in Korea, and presents the minimal requirements for establishing cardiac rehabilitation programs. Cardiac rehabilitation facilities should contain individual spaces for patient examination, exercise stress testing, monitoring exercise training, patient education, patient preparation, storing medical records, showers and lockers, toilets, and walking tracks. Essential equipment must include at least four sets of aerobic exercise equipment such as treadmills, bicycles, arm ergometers, step machines, and floor mats, and medical equipment such as exercise stress test for ECG with gas analysis, telemetry ECG monitoring systems, sphygmomanometers, stethoscopes, pulse oximeters, glucometers, portable oxygenators, and emergency carts with defibrillators. Hospital staff should include a medical director (a physician with a subspecialty in cardiac rehabilitation), exercise physiologist, nurse specializing in cardiac rehabilitation, exercise specialist, physical therapist, and clinical nutritionist. All should have an expertise in exercise science and be trained in basic life support or advanced cardiac life support. This statement is a recommendation by KSCR and cardiac rehabilitation council of regional cardiocerebrovascular center, and set forth the standards for facilities, equipment, and staff to set up or upgrade cardiac rehabilitation programs in Korea. These recommendations should be developed as a national standard for the establishment of cardiac rehabilitation programs, and adjusted for the current situation of the Korean medical industry through nationwide and long-term research.

The Effect of Functional Electrical Stimulation on the Motor Function of Lower Limb in Hemiplegic Patients

OBJECTIVE: To investigate the effect of functional electrical stimulation (FES) on the motor function of lower limb in hemiplegic patients with stroke or brain injury. METHOD: Fifty subjects (age, 56.66+/-9.85 years old; prevalence duration, 113.49+/-79.94 days after stroke or brain injury) were assigned randomly to 1 of 2 groups; the experimental group (n=25) received conventional rehabilitation with FES and the control group (n=25) received conventional rehabilitation without FES. FES was applied 20 minutes concomitant with rehabilitation, 5 days per week for 4 weeks. Outcome measurements included muscle strength, modified Ashworth scale, Brunnstrom stage, motricity index, 10 meter walking test (10 MWT), and circumference ratios of lower extremity (including thigh and calf). Subjects were evaluated before treatment and at 4 weeks after treatment. RESULTS: No significant differences were found in the baseline measurements. After 4 weeks of treatment, there was significant improvement in thigh circumference ratio and 10 MWT in the FES group, when compared with the control group (p<0.05). CONCLUSION: Twenty sessions of FES, applied to postacute stroke or brain injured patients plus conventional rehabilitation, improved their motor and walking ability.

Sequential Change of Hypometabolic Metastasis from Non-small-cell Lung Cancer on Brain FDG-PET/CT / 핵의학분자영상

A 60-year-old woman, who had non-small-cell lung cancer (NSCLC) in left lower lobe underwent brain F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for evaluation of cerebral metastasis. On follow-up FDG-PET/CT, only hypometaolic lesion was detected and progressed in right frontal lobe at 6 months and 10 months, later. Hypermetabolic metastasis was not detected even at last scan time of FDG-PET/CT. Brain MRI showed brain metastasis in right frontal lobe. As might be expected, the physician should take cerebral metastasis into consideration even though there is only hypometabolic change on subsequent FDG-PET/CT in patients with NSCLC.

A Neurofibroma Confused with Sarcomatous Transformation on F-18 FDG PET/CT in Neurofibromatosis-1 / 핵의학분자영상

We present a patient with high 18F-fluorodeoxyglucose (FDG) uptake detected in a neurofibroma that was confused with sarcomatous transformation on a positron emission tomography/computed tomography (PET/CT) scan. A 39-year-old male patient with a 20-year history of neurofibromatosis-1 (NF-1) performed FDG PET/CT scan for the evaluation of lesions with sarcomatous transformation. The FDG PET/CT images demonstrated varying degrees of increased FDG uptake in the multiple nodules throughout whole body. The left pelvic mass with the highest FDG uptake had a maximum standardized uptake values (maxSUV) 5.0 and surgical resection was performed. Histological analysis confirmed the presence of a benign neurofibroma infiltrated with inflammatory cells.

The Effect of Functional Electrical Stimulation on Gait Function in Children with Cerebral Palsy

OBJECTIVE: To evaluate the effect of functional electrical stimulation (FES) on the motor function and gait in children with cerebral palsy. METHOD: Sixteen ambulant children (8 females, 8 males) with diplegic (n=12) or hemiplegic (n=4) cerebral palsy participated in this study. All were randomly assigned to either the FES (n=8) or control (n=8) group. Both groups received physical therapy based on neurodevelopmental technique for 20 minutes a day, 5 days a week for a period of 6 weeks. The FES group was treated with additional neuromuscular electrical therapy over quadriceps, hamstring, and ankle dorsiflexor on affected legs. Modified Ashworth scale, active range of motion of affected ankle and knee joints, motricity index for strength, gross motor function measure (GMFM), and gait analysis were performed before and after treatments. RESULTS: The strength of lower limbs, section of D (standing), E (walking-running-jumping) and total of GMFM, and maximal range of motion of knee from sagittal kinematic data improved significantly in FES group (p<0.05). In FES group, change values of before and after treatments to the strength of lower limbs, and section of D and total of GMFM were significantly improved compared to control group (p<0.05). There was no serious side effect. CONCLUSION: This study suggests that FES in children with cerebral palsy may be a safe and beneficial therapeutic technique in improving the leg strength and gross motor function. However, we could not find any superior changes then control in gait kinematics of FES group.

The Effect of Continuous Epidural Electrical Stimulation on Synapse and Neuronal Cell in Rat with Focal Ischemia

OBJECTIVE: To evaluate the effects of continuous epidural electrical stimulation (ES) on the behavioral recovery, and the molecular proliferation of synapse and neural cell in rats with photothrombotic stroke. METHOD: The male Sprague-Dawley rats were pre-trained on a single pellet reaching task (SPRT), and then received the photothrombotic infarction on dominant sensorimotor cortex (SMC) and implantation of electrode over the peri-lesion SMC surface. All rats were randomly assigned to one of two groups: anodal ES on infarcted SMC (ES group) and no ES on infarcted SMC (control group). Rats received daily SPRT and neurological examinations for 14 days. After the rats had been sacrificed, brain sections were immunostained for quantification of infarct volumes and evaluation of the structural remodeling markers (MAP2, synaptophysin and GFAP). RESULTS: The functional improvement of SPRT was significantly increased in the ES group compared to control group. There were no significant group differences in the infarct volumes, neurological examinations, structural remodeling markers. But, in the ES group, MAP2 and synaptophysin in affected peri-infarct area tended to increase compared with unaffected hemisphere. In affected hemisphere of ES group, many structural remodeling markers tended to increase compared with unaffected hemisphere. Especially, the staining of synaptophysin and GFAP in peri-infarct area showed more increased uptake than unaffected hemisphere in ES group and control group, respectively (p<0.05). CONCLUSION: The ES improved greatly the behavioral motor function after SMC infarction and induced the significant synaptogenesis with the widespread neuronal proliferation in peri-infarct area. Postischemic astrogliosis was not remarkable in ES group.

Ultrasonographic Findings of Carpal Tunnel Syndrome in Patients with Paraplegia

OBJECTIVE: To assess the diagnostic value of ultrasonography for the median nerve, the state of life style activities and the pain degree of upper extremities in paraplegics with carpal tunnel syndrome (CTS). METHOD: Eighteen wheelchair ambulators with spinal cord injury who had neurological level below T2 were studied. Patients with peripheral or central neuropathies were excluded. Patients were assigned to either the electrodiagnostic CTS (group CTS, 7) or electrodiagnostically negative (group non- CTS, 11), and healthy volunteers (15) were classified as control group. The cross sectional area of the median nerve (MN-CSA) at carpal pisiform level was ultrasonographically measured. The degree of painful restriction to execute ADL by hands (TR-ADL), the pain grade (visual analog scale, VAS) of upper extremities and revised version of Korean spinal cord independence measure (KSCIM-R) for functional level were measured and analyzed. RESULTS: Nine hands (14.3%) of 7 patients out of 34 hands had CTS in electrodiagnostic study. There were significant difference among groups in TR-ADL hours (CTS group; 5.0 vs non-CTS group; 10.2, p0.05), MN-CSA (12.3 mm2 vs 7.9 mm2 vs control group; 8.0 mm2, p<0.05). Using the ROC curve, the cut-off value of MN-CSA produced 8.5 mm2 providing a diagnostic sensitivity of 77.8% and specificity of 59.6%. CONCLUSION: The ultrasonographic measurement of the median nerve may be a useful non-invasive screening test for the diagnosis of CTS in paraplegic patients with wrist pain.

Multiorgan Thrombotic Occlusions after Acitretin Treatment in a Patient with Chronic Psoriasis: A case report

Psoriasis, whose symptom is shown in around 1~3% American people, is a chronic and inflammatory skin disease. There are many treatments for pustular and erythrodermic psoriasis and oral retinoid which is a synthetic derivative of vitamin A is the most popular drug of them. Acitretin called as the second generation retinoid is a kind of active retinoid metabolite, which shows some drug toxicities in hepatic, skeletal and cardiovascular systems including atherosclerosis after a long term use. Even though that, we have just one case which has ever reported on acitretin-associated thrombotic stroke so far. We report a case on a patient who has multiorgan thrombotic occlusions resulted from longstanding psoriatic treatments by using acitretin for five years. This patient suffers from lots of complications such as superior mesenteric artery thrombosis, small cerebellar infarctions, cerebral infarction, acute renal failure concomitant with both small renal infarctions and atherosclerosis obliterans in his two legs.

The Effects of Heme Oxygenase-1 on Collagen Induced Arthritis Model / 대한해부학회지

Heme oxygenase-1 (HO-1), an inducible heme-degrading enzyme, is expressed by macrophages and endothelial cells in response to inflammatory stresses. It has been known to show strong immunosuppressive properties although its mechanisms are not completely understood. This study was designed to determine the effects of HO-1 modulation on collagen induced arthritis (CIA) model. CIA model was induced by subcutaneous injection of collagen on tail of DBA/1J mice. For evaluation of HO-1 effects, an inducer of HO-1, cobalt protoporphyrin IX (CoPPIX), or an inhibitor of HO-1, tin protoporphyrin IX (SnPPIX), were administered every other days into peritoneal cavity from day 1 to day 42 after CIA induction. The macrocopic clinical findings of CIA were evaluated and histo-pathologic findings and radiographic analysis were carried out. The expressions of TNF-alpha, IL-6, and VEGF which have important roles in pathogenesis of rheumatoid arthritis were observed by immuno-histochemical staining. Collagen on DBA/1J mice induced arthritis at knee joint and ankle joint. Administration of CoPPIX significantly aggravated the severity of arthritis while SnPPIX protected collagen induced arthritis. SnPPIX strongly suppressed inflammatory cell infiltration, swelling of synovial membrane, and erosion and destruction of bone on CIA mice. Furthermore subcutaneous injection of collagen also increased expression of TNF-alpha, IL-6, and VEGF which are important pro-inflammatory mediators in rheumatoid arthritis. SnPPIX suppressed expression of the pro-inflammatory mediators on CIA mice. Finally, we suggest that HO-1 mediates the expression of pro-inflammatory mediators and bone destruction during pathogenesis of CIA, which indicates modulation of HO-1 can be a new therapeutic target of rheumatoid arthritis.

Electromyographically Triggered Electrical Stimulation on Shoulder Subluxation in Hemiplegic Stroke Patients

BACKGROUND: The aim of this study is to evaluate the effect of electromyographically triggered electrical stimulation (ETES) on shoulder subluxation in stroke patients. METHOD: Twenty-three patients, who had hemiplegic shoulder subluxation within 3 months after stroke attack, were included. They were assigned randomly to either a control group (11 subjects) or a study group (12 subjects), and divided clinically to mild and severe subgroups by the degree in subluxation. Patients in both groups were received physical therapy and used an arm-sling. Subjects in the study group were taken ETES using biofeedback training on posterior deltoid and the supraspinatus muscle of hemiplegic subluxation side, daily 30 minutes a session, five days a week for 6 weeks. Electromyographic signals, which are derived from patient's voluntary muscle contraction, that exceeded a preset threshold trigger an immediate stimulation to force movement completion. The effect of ETES was assessed by the degree of subluxation using radiologic measurements at pre-treatment and 6 weeks post-treatment. RESULTS: In the control group, the degree of subluxation was increased after 6 weeks (p>0.05). In the study group, the subluxation was significantly reduced (p<0.05). The significant difference after treatment 6 weeks in mild and severe subgroups implied similar improvement between subgroups. CONCLUSION: The ETES may be the one of effective treatment methods for reducing the severity of hemiplegic shoulder subluxation in stroke patients.

Melkersson-Rosenthal Syndrome: Two cases report

Melkersson-Rosenthal (M-R) syndrome consists of a triad of (1) recurrent peripheral facial nerve paralysis which develops alternatively on both sides of face, (2) non-inflammatory facial edema, and (3) furrowed tongue. Since the cause of M-R syndrome is unknown, various forms of therapy have been tried, but there were no conclusive evidence that they altered the course of the disease. A 27-year-old female and a 44-year-old male patient with recurrent facial nerve paralysis were diagnosed with M-R syndrome. We report the two cases of M-R syndrome with the brief review of literatures.

Localization of Nerves Innervating Sublingual Gland in the Rat Brain Stem Using Cholera Toxin B Subunit / 체질인류학회지

In the rat brain stem, the nerves innervating sublingual gland was studied with submandibular gland together. Cholera Toxin B subunit (CTB), neural tracer, is not yet used to study the sublingual gland. The purpose of this study is to investigate the origin of neurons and afferent fibers projecting to sublingual gland by means of retrograde transport of CTB. CTB was injected into the sublingual gland. In the rat brain stem, neurons were labeled with CTB in superior salivatory nucleus (SSN), inferior salivatory nucleus (ISN), facial nucleus and their afferent fibers in nucleus tractus solitarius. At the rostal level of SSN, the labeled cells were found in lateral aspect of pontine reticular formation. At the level of facial nerve that transverse the dorsal part of the spinal trigeminal tract, the labeled cells of SSN extended in the area of facial nerve fibers. Labeled cells were also seen at the level of internal genu of facial nerve. In ISN at the level of facial nerve that traverse the dorsal part of the spinal trigeminal tract, the labeled cells were seen in the anterolateral direction of lateral aspect of reticular formation. In the facial nucleus, the labeled cells were confined in central part of facial nucleus. The labeled nerve fibers in nucleus tractus solitarius were seen in the level at which the medial border of the nucleus tractus solitarius meets the 4th ventricle.

Comparison of MBI, FIM, and ESCROW in the Evaluation of Rehabilitation Status

OBJECTIVE: The main purposes of this study were to understand the correlations among Modified Barthel Index (MBI), Functional Independence Measure (FIM), and ESCROW (Environment, Social support, Cluster of family members, Resources, Outlook, Work or School status) Profile, and to establish the more appropriate assessment standards to check patient's conditions in the hospital and in their homes and society. METHOD: Thirty-four patients, who received the rehabilitation treatment and home visiting at the Presbyterian Medical Center, were evaluated for their functions by MBI, FIM, and ESCROW Profile. RESULTS: The mean scores of assessment measures by home visiting were all higher than in the hospital showing an improvement of the patients' functions after discharge from the hospital. The results of MBI and FIM in the hospital and home visiting showed a significant correlation, while the results of MBI and Cognitive FIM measure indicated a relatively low correlation coefficient. Although each result of MBI, FIM, and ESCROW provided a low correlation when the patients were in the hospital, the result for home visiting revealed very significant correlations. Especially, the items of environment, social support, outlook, and work status of ESCROW showed very significant correlations with MBI and FIM. CONCLUSION: The results showed that MBI and FIM measurements were very useful in observing and following up the functional conditions of the patients, while ESCROW profile was more appropriate to evaluate the familial and social rehabilitation status.

The Trends of Urinary Tract Infection in Patients with Neurogenic Bladder

The urinary tract infection(UTI) is a very common complication of rehabilitation patients with neurogenic bladder. Proper diagnosis and early treatment are very important for the long term rehabilitation outcomes. Many reports are available in the literature on the characteristics of UTI in spinal cord injury(SCI) patients, however only few reports appear on non-SCI patients. We have done comprehensive chart reviews of 1,251 patients with neurogenic bladder who were admitted to the rehabilitation medicine department, PMC from January 1982 to August 1996. Patients were divided into 4 groups: patients with stroke, spinal cord injury, traumatic brain injury and other neurologic diseases, and we have studied: incidence of UTI, commonly cultured organisms, antibiotic sensitivities, urinary pH, voiding methods, and residual urine volumes. The incidences of UTI are 50.9% for all patients, 48.1% in Stroke, 72.3% in Spinal cord injury, 38.9% in Traumatic brain injury, and 34.1% in other neurologic diseases. There has been increase of Gram(+) cocci and decrease of Gram(-) rod during study period. Commonly cultured organisms are Escherichia coli(E. coli), Pseudomonas, Klebsiella. The decreased antibiotic sensitivities are noted in almost all organisms. Positive correlations are found between the incidence of UTI, high urine pH, high residual urine volumes, and use of catheters. In conclusion, despite of many variable factors, the trends of UTI in each groups show no significant difference.