Effects of botulinum neurotoxin on spatio-temporal gait parameters of patients with chronic stroke: a prospective open-label study.

BACKGROUND: Nowadays, administration of botulinum neurotoxin type A is considered a safe, well tolerated and effective treatment for muscles tone reduction in focal spasticity care. Lack of evidence regards instead its functional role on gait parameters, as well patterns. AIM: To assess the botulinum neurotoxin treatment efficacy on chronic poststroke subjects, in order to investigate its functional effects on spatio-temporal gait parameters, in addition to the evaluation of spasticity grade based on clinical scales. DESIGN: A prospective open-label study along 16-weeks trials. SETTING: Outpatient neurophysiology rehabilitation structure and laboratory of movement and gait analysis. POPULATION: Twenty chronic poststroke patients, suffering from equinovarus foot deformity, with a stabilized hemiparesis were recruited according to inclusion criteria of the protocol. METHODS: Single neurotoxin-based local intramuscular injections were given according to a specific protocol concerning both the considered muscles and the relative toxin doses, with a maximum total dose ranged between 200 U and 400 U. Patients were observed both at baseline (t0) and for 4 following monthly visits (t1, t2, t3, t4) after injections at baseline. Gait analysis sessions were performed at each visit, by means of a video-cameras based system and body reflective markers attached to the body, based on a protocol. Authors focus on both global and local gait temporospatial parameters, such as walking speed, stride-length, cadence, stride-time, step-width, single limb support, double support and limp index to point out the functional changes due to the treatment. For comparison prior to and after the treatment, clinical scales like Modified Ashworth Scale, Berg Balance Scale and Rivermead Mobility Index have been also considered. RESULTS: Subsequent to the neurotoxin intramuscular injections, patients reported statistical significant gait improvements after 90 days (t3) regarding temporospatial parameters: (P<0.05) for walking speed, single limb support and double support and (P<0.10) for stride-length, stride-time, cadence and step-width. CONCLUSION: The botulinum neurotoxin treatment has demonstrated its efficacy for a functional recovery of gait, as pointed out by a statistically significant improvement of some spatio-temporal parameters. Thus, the analyzed changes reveal an improved balance and self-confidence in gait. Studies involving a wider population data are nevertheless needed to better confirm this efficacy. CLINICAL REHABILITATION IMPACT: The poststroke botulinum neurotoxin-based treatment is a safe and potentially useful neurorehabilitative approach for the analyzed data.

[Correlated study of visual evoked potentials-polyneuropathy in diabetic patients without retinopathy]. / Studio correlato potenziali evocati visivi-polineuropatia in pazienti diabetici non retinopatici.

The functional study of visual pathways by means of pattern reversals VEPs (visual evoked potentials) was used as a noninvasive method in the study of diabetic patients, but the correlations between alterations in VEPs and the involvement of peripheral nervous system were not explored. Among 35 diabetic patients not suffering from retinopathy, we tested early deteriorations in visual pathways by means of pattern reversals VEPs and we considered similarities between these alterations, clinical metabolic parameters of the disease and clinical and paraclinical aspects of polyneuropathy (PNP). Four of these patients were insulin-dependent and 31 non-insulin-dependent, all with normal electroretinography and fluorangiography. Monitoring control of diabetes was performed by measuring hemoglobin HbA1. The control group was composed of 35 healthy subjects with normal neurologic and ophthalmologic examinations and normal visual acuity. In all subjects we tested four peripheral nerve conduction velocities (PNCV) (sensory and motor conduction of median nerve, motor conduction of peroneal nerve, anthidromic sensory conduction of sural nerve) diabetic patients were distributed in two groups according to the presence (group A, 15 patients) or absence (group B, 20 patients) of polyneuropathy. Pattern reversals PEVs were recorded after mono and binocular stimulation; screen was 25 x 18 cm with black and white check board pattern, check size 1.1 cm. Subject-to-stimulus distance was 1 m, corresponded to a visual angle of 38 degrees. Active electrode were located in Oz, O1 and O2, reference electrode in Fz.(ABSTRACT TRUNCATED AT 250 WORDS)

Stretch reflex of quadriceps femoris in normal man: methodological considerations and normative data.

Short- and long-latency responses to stretching have been evoked in various muscles in the healthy subject. The quadriceps femoris, however, has never been investigated in this connection, despite its functional importance. We studied its stretch reflex in 17 healthy subjects with a torque motor to determine its morphological features in relation to the level of background EMG activity, the stretching velocity and duration and the instructions given to the subject. Two bursts of EMG activity were constantly evoked when the muscle was voluntarily activated. Response magnitude was proportional to the background activity and displacement velocity. Short stretching evoked only one EMG burst. These findings are similar to those from other muscles. Intra-individual variability was evaluated repeating the experiment in the same session without changing position of the electrodes, and then after two months. The long-latency response showed a good intra-individual reproducibility.

A simple and disposable visual measuring device to assay antiepileptic drugs from whole blood samples.

This study evaluated a new, simple, disposable visual measuring device (AccuLevel), which uses enzyme immunochromatography to indicate visually, without any instrument, the concentrations of three major antiepileptic drugs (AEDs) in small blood samples. Drug levels (30 values for diphenylhydantoin, 41 for phenobarbital, and 40 for carbamazepine) obtained by AccuLevel were compared with those obtained with the enzyme-multiplied immunoassay technique (EMIT). Results showed an excellent correlation between EMIT and AccuLevel data for the three major AEDs. The method appears to be particularly suitable in outpatients and in case of emergency.

Rhinocerebral mucormycosis and internal carotid artery thrombosis in a previously healthy patient.

Mucormycosis is a very serious fungal infection caused by habitual saprophytes of the human organism, in many cases concomitant with various pathological conditions marked by immunodepression. The rhinocerebral variant habitually accompanies ketoacidotic diabetes. We report a case of rhinocerebral mucormycosis in a subject free from immunodepression and non-diabetic, in apparently normal health. Following treatment with amphotericin B combined with 5-fluorocytosine and surgery, remission of the disease was finally secured and about one year after the last operation there are no sign of resumption.

Free drug levels monitoring as a detector of false metabolic refractory epilepsy.

Unbound and total plasma levels of carbamazepine (CBZ) and phenobarbital (PB) were evaluated in a group of 12 refractory patients out of 397 subjects, with normal values of total drug concentration and unbound levels below the expected ones. We established a minimal acceptable 'subtherapeutic' free drug level, i.e. less than 9.62 micrograms/ml for PB and 1.36 micrograms/ml for CBZ. PB and CBZ dosages were increased during a 3-month period. We observed a normalization of free levels, unaccompanied by a significant decrease in seizure frequency. Free drug level monitoring may prove to be an unchallenged detector of false metabolic refractory epilepsy.