Investigation of Post-Transplant Mental Well-Being in Liver Transplant Recipients with Hepatic Encephalopathy.

Objective: In this study, we aimed to examine the healing trend of hepatic encephalopathy after transplantation surgery in patients with liver failure. Method: We conducted this descriptive and cross-sectional study with the participation of liver transplant recipients. A personal information form, the West Haven Criteria (WHC), the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS), and the Richmond Agitation Sedation Scale (RASS) were used for data collection. The data were analyzed using Chi-squared tests, ANOVA, and paired-samples t-tests. Results: As time progressed after liver transplantation, hepatic encephalopathy stages regressed (p < 0.01). We found that liver transplant recipients with end-stage hepatic encephalopathy were mostly within the first 6 months after transplantation, while patients with first-stage hepatic encephalopathy had received liver transplants more than 2 years ago (p < 0.01). Conclusions: The results of our study revealed that hepatic encephalopathy stages regressed after transplantation, but there was no complete recovery. This highlights the need to develop new treatment strategies other than liver transplantation for the treatment of hepatic encephalopathy.

Do women with vaginismus have a lower threshold of pain?

OBJECTIVE: Vaginismus and dyspareunia are together categorized as a genito-pelvic pain and penetration disorder. We aimed to evaluate the threshold of pain and the pain sensitivity in women with vaginismus. STUDY DESIGN: In this prospective case-control study; 32 women with vaginismus and 29 healthy women were enrolled. Sociodemographic Information Form, Female Sexual Function Index (FSFI), Pain Beliefs Questionnaire (PBQ), Revised Fibromyalgia Impact Questionnaire (FIQR), The Lamont Scale of Vaginismus were applied. Threshold of pain was measured with algometer in terms of Newton (N). RESULTS: The pain thresholds vaginismus and control group were as follows; left posterior superior iliac crest (40.3 N, 84.9 N respectively;p < 0.001), right posterior superior iliac crest (42.9 N, 76.1 N respectively;p = 0.007), left lateral trochanter (42.0 N, 69.8 N respectively; p = 0.015), right lateral trochanter (43.8 N, 75.3 N respectively; p = 0.003), left anterior superior iliac spine (29.2 N, 51.2 N respectively; p = 0.003), left insertion of gracilis muscle (27.3 N, 45.2 N respectively; p = 0.038), left medial vastus muscle (37.0 N, 52.4 N respectively; p = 0.025) and the pain thresholds were significantly lower in the vaginismus patients. CONCLUSION: Women with vaginismus have a lower threshold of pain, and the pain threshold decreases in higher grades of vaginismus. The pain may aggravate the avoiding behavior of women from sexual intercourse.

Neurophysiological measurements of affected and unaffected motor cortex from a cross-sectional, multi-center individual stroke patient data analysis study.

OBJECTIVES: Transcranial magnetic stimulation (TMS) has been used to measure cortical excitability as a functional measurement of corticomotor pathways. Given its potential application as an assessment tool in stroke, we aimed to analyze the correlation of TMS parameters with clinical features in stroke using data from 10 different centers. METHODS: Data of 341 patients with a clinical diagnosis of stroke were collected from studies assessing cortical excitability using TMS. We used a multivariate regression model in which the baseline cortical excitability parameter "resting Motor Threshold (rMT)" was the main outcome and the demographic, anatomic and clinical characteristics were included as independent variables. RESULTS: The variable "severity of motor deficit" consistently remained significant in predicting rMT in the affected hemisphere, with a positive ß coefficient, in the multivariate models after sensitive analyses and adjusting for important confounders such as site center. Additionally, we found that the correlations between "age" or "time since stroke" and the rMT in the affected hemisphere were significant, as well as the interaction between "time since stroke" and "severity of motor deficit". CONCLUSIONS: We have shown that severity of motor deficit is an important predictor for rMT in the affected hemisphere. Additionally, time since stroke seems to be an effect modifier for the correlation between motor deficit and rMT. In the unaffected motor cortex, these correlations were not significant. We discuss these findings in the context of stroke rehabilitation.

Quantum neurophysics: From non-living matter to quantum neurobiology and psychopathology.

The concepts of quantum brain, quantum mind and quantum consciousness have been increasingly gaining currency in recent years, both in scientific papers and in the popular press. In fact, the concept of the quantum brain is a general framework. Included in it are basically four main sub-headings. These are often incorrectly used interchangeably. The first of these and the one which started the quantum mind/consciousness debate was the place of consciousness in the problem of measurement in quantum mechanics. Debate on the problem of quantum measurement and about the place of the conscious observer has lasted almost a century. One solution to this problem is that the participation of a conscious observer in the experiment will radically change our understanding of the universe and our relationship with the outside world. The second topic is that of quantum biology. This topic has become a popular field of research, especially in the last decade. It concerns whether or not the rules of quantum physics operate in biological structures. It has been shown in the latest research on photosynthesis, the sense of smell and magnetic direction finding in animals that the laws of quantum physics may operate in warm-wet-noisy biological structures. The third sub-heading is quantum neurobiology. This topic has not yet gained wide acceptance and is still in its early stages. Its primary purpose is directed to understand whether the laws of quantum physics are effective in the biology of the nervous system or not. A further step in brain neurobiology, toward the understanding of consciousness formation, is the research of quantum laws effects upon neural network functions. The fourth and final topic is quantum psychopathology. This topic takes its basis and its support from quantum neurobiology. It comes from the idea that if quantum physics is involved in the normal working of the brain, diseased conditions of the brain such as depression, anxiety, dementia, schizophrenia and hallucinations can be explained by quantum physical pathology. In this article, these topics will be reviewed in a general framework, and for the first time a general classification will be made for the quantum brain theory.

Diagnostic value of "dysphagia limit" for neurogenic dysphagia: 17 years of experience in 1278 adults.

OBJECTIVE: Neurogenic dysphagia (ND) is a prevalent condition that accounts for significant mortality and morbidity worldwide. Screening and follow-up are critical for early diagnosis and management which can mitigate its complications and be cost-saving. The aims of this study are to provide a comprehensive investigation of the dysphagia limit (DL) in a large diverse cohort and to provide a longitudinal assessment of dysphagia in a subset of subjects. METHODS: We developed a quantitative and noninvasive method for objective assessment of dysphagia by using laryngeal sensor and submental electromyography. DL is the volume at which second or more swallows become necessary to swallow the whole amount of bolus. This study represents 17 years experience with the DL approach in assessing ND in a cohort of 1278 adult subjects consisting of 292 healthy controls, 784 patients with dysphagia, and 202 patients without dysphagia. A total of 192 of all patients were also reevaluated longitudinally over a period of 1-19 months. RESULTS: DL has 92% sensitivity, 91% specificity, 94% positive predictive value, and 88% negative predictive value with an accuracy of 0.92. Patients with ALS, stroke, and movement disorders have the highest sensitivity (85-97%) and positive predictive value (90-99%). The clinical severity of dysphagia has significant negative correlation with DL (r=-0.67, p<0.0001). CONCLUSIONS: We propose the DL as a reliable, quick, noninvasive, quantitative test to detect and follow both clinical and subclinical dysphagia and it can be performed in an EMG laboratory. SIGNIFICANCE: Our study provides specific quantitative features of DL test that can be readily utilized by the neurologic community and nominates DL as an objective and robust method to evaluate dysphagia in a wide range of neurologic conditions.

Differential effects of peripheral vibration on motor-evoked potentials in acute stages of stroke.

OBJECTIVE: The excitability of sensorimotor cortex and spinal motoneurones can be modulated by afferent signals arising from the periphery. Low- and high-frequency vibrations activate separate classes of afferent units in the periphery. Low-frequency vibrations (2-100 Hz) activate the type I fast adapting afferent units (FA-I), whereas high-frequency vibrations (60-1000 Hz) preferentially activate the type II units (FA-II). Muscle spindles are also sensitive to high-frequency mechanical vibrations. Motor-evoked potentials (MEP) generated in response to transcranial magnetic stimulation (TMS) can be modulated by afferent signals. However, it is not clear whether these interactions take place at cortical or spinal cord levels. METHODS: Cerebrovascular attacks resulting in stroke generally affect both sensory and motor systems. In eight stroke patients with partial motor deficit in the first two weeks of the incident we studies the effects of low- (30 Hz) and high- (130 Hz) frequency mechanical vibrations on the MEPs obtained in response to TMS. Recordings from the abductor digiti minimi muscle were carried out by TMS of both lesioned and intact hemispheres. Six patients were tested again four to eight weeks after the initial assessment. The results also were compared with data obtained from eight control subjects. MEPs were evoked by 50% above threshold intensities and for each testing condition initially five control MEPs were recorded. This was followed by consecutive MEPs obtained during vibration (N= 5) and between vibrations (N= 5), and the traces were averaged and analyzed. RESULTS: In normal subjects both low- (30 Hz) and high- (130 Hz) frequency vibration resulted in shortening of MEP latencies. In patients, there was a similar effect on the affected side with 30 Hz, but not with 130 Hz. Stimulation of the intact hemisphere during high-frequency vibration in the second test revealed a latency shortening, which could be due to central reorganization. The amplitude of MEPs showed a stronger facilitation in the presence of low-frequency vibration in the early stage of stroke compared with normal subjects. However, in the second test the level of facilitation was reduced, indicating an effect at the cortical level. CONCLUSIONS: The results suggest that a cerebrovascular accident influences the modulatory effects of afferent inputs at both spinal and cortical levels, and in time, as reorganization takes place, these altered influences settle towards normal levels.

Escitalopram and venlafaxine for the prophylaxis of migraine headache without mood disorders.

There is evidence that some antidepressant drugs are beneficial in the prophylaxis of migraine. Previous reports have shown that migraine patients may respond to various antidepressant agents used for prophylactic therapy. The main purpose of this study was to compare the efficacy of antidepressants from 2 different groups (venlafaxine vs escitalopram) on people who had migraine headache without depression or anxiety. In this prospective study, we evaluated the headache diaries of 93 patients who were being treated with venlafaxine (n = 35) and escitalopram (n = 58). At the end of the 3-month period, patients were reassessed, and those with marked differences in attack frequency, duration, intensity (with visual analog scales), lost work-day equivalent index, and migraine disability assessment questionnaire were compared. There was a clear reduction in headache frequency (P < 0.0001), duration (P < 0.0001), and severity (P < 0.0001) in the venlafaxine group. In addition, there was a significant improvement in daily work performance during headaches (P < 0.0001). In the escitalopram group, monthly headache frequency (P < 0.026), duration (P < 0.002), and intensity (P < 0.027) all decreased significantly, although not to the same extent as with venlafaxine. After the third month of venlafaxine and escitalopram treatment, most of the patients (82.8% vs 96.5%) were seen to have moved to the minimal or infrequent migraine disability assessment group. According to our findings, venlafaxine and escitalopram are both effective in the prophylaxis of migraine headache without depression and anxiety. This effect was independent of mood disorder. Escitalopram should be the first choice because of its fewer side effects, but venlafaxine may be used if escitalopram is found to be insufficient.

Vincristine-induced fatal neuropathy in non-Hodgkin's lymphoma.

The vinca alkaloids are neurotoxic, usually causing a peripheral neuropathy, but cranial neuropathies are rare as side effects. We describe a case of vincristine-induced multiple cranial and autonomic neuropathy, and sensory-motor axonal peripheral neuropathy (pan-neuropathy), which is an extremely rare fatal complication of this drug. The patient developed fulminant cranial, peripheral and significant autonomic neuropathy.

Citalopram-induced jaw tremor.

A variety of medications can induce or enhance a tremor. Tremors most commonly affect the limbs, especially the arms. We report a patient who presented with a 5-6 Hz jaw tremor with a temporal association with the administration of citalopram. To our knowledge, this is the first report in literature, of a transient jaw tremor associated with citalopram. According to the current data, citalopram-induced jaw tremor can be explained by an indirect inhibitory effect on central dopaminergic activity.

Electrophysiological evaluation of pharyngeal phase of swallowing in patients with Parkinson's disease.

We studied the various physiological aspects of oropharyngeal swallowing in Parkinson's disease (PD). Fifty-eight patients with PD were investigated by clinical and electrophysiological methods that measured the oropharyngeal phase of swallowing. All patients except 1 had mild to moderate degree of disability score. Dysphagia was demonstrated in 53% of all patients in whom the test of dysphagia limit was abnormal. All PD patients with or without dysphagia displayed the following abnormalities: (1) the triggering of the swallowing reflex was prolonged probably due to inadequate bolus control in the mouth and tongue and/or a specific delay in the execution of the swallowing reflex; (2) the duration of the pharyngeal reflex time was extremely prolonged due to slowness of the sequential muscle movements, especially those of the suprahyoid-submental muscles; (3) cricopharyngeal muscle of the upper oesophageal sphincter was found to be electrophysiologically normal; and (4) the electrophysiological phenomena in PD patients could not be strongly correlated with the degree of the disability and clinical score of the PD. It was concluded that various motor disorders of PD have considerable influence on oropharyngeal swallowing: hypokinesia, reduced rate of spontaneous swallowing, and the slowness of segmented but coordinated sequential movements rather than any abnormalities in the central pattern generator of the bulbar center. Some compensatory mechanisms in the course of PD may explain the benign nature of swallowing disorder until the terminal stage of the disease. Similarly, the swallowing problems of PD are not only related with the dopamine deficiency; some other nondopaminergic mechanisms may also be involved.