ABSTRACT
OBJECTIVE: Neuromyelitis optica spectrum disorders (NMOSD) are immune-mediated chronic inflammatory disorders of the central nervous system that are predominantly characterized by attacks of optic neuritis and/or transverse myelitis. The aim of this study was to investigate the clinical rehabilitation course of patients with NMOSD. METHODS: We carried out a retrospective evaluation of 20 cases of NMOSD in which the patients underwent multidisciplinary inpatient rehabilitation intervention starting within 2 months after acute exacerbation. Rehabilitation outcomes were assessed using the modified Rankin Scale, the Expanded Disability Status Scale (EDSS), and the Functional Independence Measure (FIM). RESULTS: A total of 19 cases were finally included in this study. The average EDSS scores ranged from 5.9 to 7.1 during hospitalization. Lower age significantly correlated with improved EDSS scores. Changes in the EDSS score during rehabilitation varied in patients experiencing their first attack; however, improvements in the EDSS score of ≥ 1.5 were observed only in patients who had experienced two or less attacks. During rehabilitation, the FIM significantly improved from 81.4 to 101.7, with a gain of 20.3 and efficacy of 0.2/day. CONCLUSION: Multidisciplinary rehabilitation may improve functional recovery after NMOSD attacks. Younger age and two or less attacks were associated with better outcomes in this study.
ABSTRACT
Diabetic hemichorea-hemiballism with non-ketotic hyperglycemia is usually a benign syndrome. Here, we report a 78-year-old woman with persistent hemichorea (HC) for longer than 1 year with a recurrence after rapid correction of hyperglycemia. Following the disappearance of the characteristic T1 hyperintensity at 3 months after onset, an MRI demonstrated T2* hypointensity and atrophic changes in the contralateral striatum, suggesting irreversible neuronal loss and some vascular proliferation. The electrophysiological examination using transcranial magnetic stimulation revealed significantly shorter cortical silent periods (CSPs) on the contralateral primary motor cortex (M1), possibly in relation to cortical hyperexcitability. We have applied 10 daily sessions of low-frequency repetitive transcranial magnetic stimulation (rTMS) over the contralateral M1 to reduce the hyperexcitability. The HC was suppressed during and for several minutes after rTMS with prolongation of CSPs. After rehabilitation therapy, the patient was able to walk independently with a walker. We suggest that the combination of low-frequency rTMS and rehabilitation therapy may be a possible choice in medically refractory involuntary movements.
ABSTRACT
We report 2 cases of Gasperini syndrome and consider them with the 11 previously reported cases to describe the clinical characteristics of this rare syndrome: Core neurological signs are peripheral facial nerve palsy and abducens nerve palsy of the affected side: Among all cases, imaging demonstrated a small lesion in the mediolateral tegmental pons (10/13 cases of microinfarction; 2/13 cases of microbleeding). We found that the responsible artery in ischemic Gasperini syndrome is mainly the long circumferential branch of the anterior inferior cerebellar artery; Case 1 is the first case thought to be caused by infarction of the basilar artery's paramedian branch.
