Botulinum Toxin Injections to the Obliquus Capitis Inferioris Muscle for Dynamic Cervical Dystonia Improves Subjective Patient Outcomes.

The obliquus capitis inferioris (OCI) muscle is a significant driver of cervical dystonia with torticaput movements and a no-no head tremor. Limited data are available on the efficacy of OCI injections on patient outcomes. Our study aims to determine whether the botulinum toxin injection into OCI improves subjective patient quality of life in those with dystonic head tremors. A retrospective chart review was performed for 25 patients receiving injections into the OCI for a dystonic head tremor at the London Movement Disorders Clinic between January 2020 and January 2022. Toronto Western Spasmodic Torticollis Scale-2 (TWSTRS-2) subscale scores for disability and pain, TWSTRS-PSYCH scores, and the global impression of severity were extracted. The average TWSTRS-2 disability subscale change was -2.8 points (p < 0.003). The average TWSTRS-2 pain subscale change was -4.6 points (p < 0.003). The average TWSTRS-PSYCH score prior to injection was 5.6. After injection, the average score was 3.7 (p < 0.004). The patient self-reported average global impression of severity before injection was 7.0; after this, it was 4.2 (p < 0.0003). The OCI injection showed significant improvement in retrospective patient self-reported outcomes; it should be considered early in the treatment plan for cervical dystonia with a no-no head tremor.

Clinical milestones as triggers for palliative care intervention in progressive Supranuclear palsy and multiple system atrophy.

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Graph index complexity as a novel surrogate marker of high frequency oscillations in delineating the seizure onset zone.

OBJECTIVE: To investigate the Graph Index Complexity (uGIC) as a marker of high frequency oscillatory (HFO) activity, the seizure onset zone (SOZ), and surgical outcome. METHODS: The SOZ, rates of HFOs at two thresholds (broad, strict), and uGIC were determined using EEG data from 41 patients. The correlation between HFOs and uGIC were calculated. HFOs and uGIC were compared within and outside the SOZ. Postsurgical outcome was compared to the colocalization of HFOs and resected SOZ. RESULTS: There was significant correlation between uGIC and both broad (r = 0.69, p < 0.0005) and strict HFOs (r = 0.48, p < 0.0005). All were significantly greater within the SOZ overall, but only in 17/41 (strict, uGIC) or 18/41 (broad) patients. HFO markers were significantly greater within the SOZ for 8/15 patients with positive postsurgical outcomes, but not for any patients with negative outcomes (0/5). CONCLUSION: The uGIC is a marker of HFO activity, while HFOs and uGIC are markers of the SOZ overall. Colocalization of HFOs and the SOZ has strong positive predictive value for postsurgical outcome, but poor negative predictive value. SIGNIFICANCE: The uGIC is an objective surrogate marker of HFO activity independent of identifying discrete HFO events.

Cardiorespiratory toxicity of environmentally relevant zinc oxide nanoparticles in the freshwater fish Catostomus commersonii.

The inhalation of zinc oxide engineered nanomaterials (ENMs) has been linked to cardiorespiratory dysfunction in mammalian models but the effects of aquatic ENM exposure on fish have not been fully investigated. Nano-zinc oxide (nZnO) is widely used in consumer products such as sunscreens and can make its way into aquatic ecosystems from domestic and commercial wastewater. This study examined the impact of an environmentally relevant nZnO formulation on cardiorespiratory function and energy metabolism in the white sucker (Catostomus commersonii), a freshwater teleost fish. Evidence of oxidative and cellular stress was present in gill tissue, including increases in malondialdehyde levels, heat shock protein (HSP) expression, and caspase 3/7 activity. Gill Na(+)/K(+)-ATPase activity was also higher by approximately three-fold in nZnO-treated fish, likely in response to increased epithelial permeability or structural remodeling. Despite evidence of toxicity in gill, plasma cortisol and lactate levels did not change in animals exposed to 1.0 mg L(-1) nZnO. White suckers also exhibited a 35% decrease in heart rate during nZnO exposure, with no significant changes in resting oxygen consumption or tissue energy stores. Our results suggest that tissue damage or cellular stress resulting from nZnO exposure activates gill neuroepithelial cells, triggering a whole-animal hypoxic response. An increase in parasympathetic nervous signaling will decrease heart rate and may reduce energy demand, even in the face of an environmental toxicant. We have shown that acute exposure to nZnO is toxic to white suckers and that ENMs have the potential to negatively impact cardiorespiratory function in adult fish.