Duration of Treatment Effect of Extracorporeal Shock Wave on Spasticity and Subgroup-Analysis According to Number of Shocks and Application Site: A Meta-Analysis

OBJECTIVE: To investigate duration of the treatment effect of extracorporeal shockwave therapy (ESWT) on spasticity levels measured with Modified Ashworth Scale (MAS) regardless of the patient group (stroke, multiple sclerosis, and cerebral palsy) and evaluate its spasticity-reducing effect depending on the number of shocks and site of application. METHODS: PubMed, EMBASE, the Cochrane Library, and Scopus were searched from database inception to February 2018. Randomized controlled trials and cross-over trials were included. All participants had spasticity regardless of cause. ESWT was the main intervention and MAS score was the primary outcome. Among 122 screened articles, 9 trials met the inclusion criteria.

Adrenomyeloneuropathy Presenting With Adrenal Insufficiency

Adrenomyeloneuropathy (AMN), one of the variants of X-linked adrenoleukodystrophy (ALD), is inherited peroxisomal disorder associated with the accumulation of very long chain fatty acids (VLCFA). AMN is characterized primarily by involvements of long ascending and descending tracts of the spinal cord and peripheral neuropathy, which leads to spastic paraparesis and urinary and erectile dysfunction. We experienced the AMN case of a 33-year-old man presenting bilateral progressive spastic paraparesis, impotence and urge incontinence with primary adrenal failures, as confirmed by increased serum of VLCFA concentrations. Considering that somatosensory evoked potentials in posterior tibial nerve was the only abnormal finding in electrophysiologic findings when compared with the severe spastic gait pattern shown, it is necessary to follow up with electrophysiologic studies.

Comparing the Effect of Botulinum Toxin Type B Injection at Different Dosages for Patient with Drooling due to Brain Lesion

OBJECTIVE: To investigate Botulinum toxin type B (BNT-B) injection's effect and duration depending on dose for patients with brain lesion. METHOD: Twenty one patients with brain lesion and severe drooling were included and divided into three groups. All patients received conventional dysphagia therapy. Group A patients (n=7) received an injection of 1,500 units and group B patients (n=7) received an injection of 2,500 units of BNT-B in submandibular gland under ultrasound guidance. Group C patients (n=7) received conventional dysphagia therapy. Saliva secretion was assessed quantitatively at baseline and at weeks 1, 2, 4, 8, and 12. The severity and frequency of drooling was assessed using the Drooling Quotient (DQ) by patients and/or caregivers. RESULTS: Group A and B reported a distinct improvement of the symptoms within 2 weeks after BNT-B injection. Compared to the baseline, the mean amount of saliva decreased significantly throughout the study. However, there was no meaningful difference between the two groups. The greatest reductions were achieved at 2 weeks and lasted up to 8 weeks after BNT-B injection. Group C did not show any differences. CONCLUSION: Local injection of 1,500 units of BNT-B into salivary glands under ultrasonic guidance proved to be a safe and effective dose for drooling in patient with brain lesion, as did 2,500 units.

Adverse Effects of Ketogenic Diet and its Recovery in Rats / 대한간질학회지

BACKGROUND & OBJECTIVES: We tried to investigate the impact of prolonged KD on liver, and their recovery in rats. METHOD: KD was administered to 25 male Sprague-Dawley rats, while 25 control rats were fed with standard rodent chow. Liver function and serum lipids were evaluated in 3, 5, 7, 9 and 11 weeks of KD group and RD group. To evaluate the recovery of liver function, regular diet (RD) was provided after the 3 weeks of KD and liver function and hyperlipidemia were evaluated in 1, 3, 5, 7, and 9 weeks (25rats). Plasma ALT (Alanine aminotransferase), AST (Aspartate aminotransferase), HDL-cholesterol, total cholesterol and triglycerides were measured in all rats. Liver was stained with Oil Red O and analysed with Visus image analysis system. RESULTS: Liver enzymes and serum lipids were markedly elevated in KD group and were partly correlated with the duration of KD. But these abnormal liver enzymes and lipids were rapidly normalized between 1 to 3 weeks after KD cessation. Liver weight/body weight ratio was smaller in KD rats in spite of visible fatty liver. Oil Red O stain showed that the longer period of KD causes more lipids in liver. During the recovery stage, liver lipids started to decreases 1 week after the RD and normalized 4 to 5 weeks afterwards. CONCLUSION: Although the KD has impact on liver in most rats, abnormal liver function, hyperlipidemia, and fatty liver induced by certain period of KD were reliably normalized within short duration of regular diet.

Nonlinear Dynamics of EEG in Pilocarpine-induced Status Epilepticus

BACKGROUND: Pilocarpine-induced status epilepticus (SE) model shows stereotypic EEG changes and behavioral characteristics. Although neuronal damages and therapeutic responses are also dependent on SE stages, the dynamical aspect of underlying neuronal interaction according to the SE stages has not been studied. We applied nonlinear analysis to the EEG recorded from pilocarpine-induced SE model to characterize nonlinear dynamics of different SE stage and to correlate therapeutic response with correlation dimension (D2). METHODS: Ten male Spraque-Dawley rats weighing 150-250g were used in this experiment. EEG was continuously recorded during SE and was classified into 6 stages as follows: baseline (BS), transitional (TR), discrete seizure (DS), continuous ictal discharges (CID), early periodic epileptiform discharges (EP), and late periodic epileptiform discharges (LP). High dose diazepam (20 mg/kg) was injected at the LP stage. SEs of 5 rats (control group) was controlled by diazepam and those of the rest (failed group) were failed to stop status epilepticus. RESULTS: Mean D2 value decreased progressively with fluctuation and was significantly different for SE stage (df=5, F=11.594, p=0.000). Independent t-test showed that the difference of D2 value between the controlled and failed group was significant at CID (df=40, t=2.591, p=0.013) and LP stage (df=49, t=-2.425, p=0.019). CONCLUSIONS: These results suggest that nonlinear dynamical change at the late half of SE stage is one of the contributing factors determining therapeutic responsiveness in pilocarpine-induced SE model.

Nonlinear Dynamics of EEG in Pilocarpine-induced Status Epilepticus

BACKGROUND: Pilocarpine-induced status epilepticus (SE) model shows stereotypic EEG changes and behavioral characteristics. Although neuronal damages and therapeutic responses are also dependent on SE stages, the dynamical aspect of underlying neuronal interaction according to the SE stages has not been studied. We applied nonlinear analysis to the EEG recorded from pilocarpine-induced SE model to characterize nonlinear dynamics of different SE stage and to correlate therapeutic response with correlation dimension (D2). METHODS: Ten male Spraque-Dawley rats weighing 150-250g were used in this experiment. EEG was continuously recorded during SE and was classified into 6 stages as follows: baseline (BS), transitional (TR), discrete seizure (DS), continuous ictal discharges (CID), early periodic epileptiform discharges (EP), and late periodic epileptiform discharges (LP). High dose diazepam (20 mg/kg) was injected at the LP stage. SEs of 5 rats (control group) was controlled by diazepam and those of the rest (failed group) were failed to stop status epilepticus. RESULTS: Mean D2 value decreased progressively with fluctuation and was significantly different for SE stage (df=5, F=11.594, p=0.000). Independent t-test showed that the difference of D2 value between the controlled and failed group was significant at CID (df=40, t=2.591, p=0.013) and LP stage (df=49, t=-2.425, p=0.019). CONCLUSIONS: These results suggest that nonlinear dynamical change at the late half of SE stage is one of the contributing factors determining therapeutic responsiveness in pilocarpine-induced SE model.

A Study on the Age-Dependent Ketosis Induced by the Ketogenic Diet / 대한간질학회지

PURPOSE: Ketogenic diet (KD) remains a therapy in search of explanation although it is an established treatment for patients with intractable epilepsy. It has been clinically proven more efficacious at younger ages, presumably because of the enhanced ability of the immature brain to extract and utilize ketone bodies. The study was designed to investigate whether ketosis induced by the KD is age-dependent. METHODS: A KD ([fat]:[protein+carbohydrate] ratio of 4.3:1) was administered to male Sprague-Dawley rats for 3 weeks, while control animals were fed a standard rodent chow. Dietary treatment was initiated at either postnatal 3 or 12 weeks. Blood beta-hydroxybutyrate (BHB) levels were assayed from blood obtained via the tail vein with the Keto-SiteTM reflectance meter and test cards on treatment day 21. RESULTS: Blood BHB levels in the KD-treated group were significantly higher than those in the control group in 3 week-old rats (4.18+/-0.62 [n=30] vs. 0.27+/-0.02 [n=30] mM, respectively; p0.05). CONCLUSIONS: The present study demonstrates that the KD induces more severe ketosis in younger rats. Age-dependent differences in the degree of ketosis induced by the KD may explain that the diet is clinically more efficacious at younger ages.