Characterizing the Intraoperative Microelectrode Recording-Induced Microlesion Effect on Motor Symptoms in Patients with Parkinson's Disease Undergoing Deep Brain Stimulation of the Subthalamic Nucleus.

AIM: To investigate microelectrode recording (MER)-induced microlesion effect (MLE) on the motor symptoms of 30 patients with Parkinson’s disease (PD) who underwent deep brain stimulation of the subthalamic nucleus. MATERIAL AND METHODS: MER-induced MLE was evaluated based on the difference between tremor, rigidity, and bradykinesia scores in the preoperative off-state and intraoperative state following MER and before test stimulation. RESULTS: MLE scores improved by 21.7% [left (L) side] and by 13.6% [right (R) side] from baseline (p < 0.05). Tremor scores improved by 31.5% (L) and by 14.2% (R) (p < 0.05), rigidity scores improved by 17.3% (L) and by 14.2% (R) (p < 0.05) and bradykinesia scores improved by 20.6% (L) and by 11.5% (R) (p < 0.05) from baseline. There was no significant difference between MLE and the number of microelectrodes used (p > 0.05). CONCLUSION: MER-induced MLE improved motor symptoms and was not correlated with the number of microelectrodes used during the procedure.

Intravenous transplants of human adipose-derived stem cell protect the brain from traumatic brain injury-induced neurodegeneration and motor and cognitive impairments: cell graft biodistribution and soluble factors in young and aged rats.

Traumatic brain injury (TBI) survivors exhibit motor and cognitive symptoms from the primary injury that can become aggravated over time because of secondary cell death. In the present in vivo study, we examined the beneficial effects of human adipose-derived stem cells (hADSCs) in a controlled cortical impact model of mild TBI using young (6 months) and aged (20 months) F344 rats. Animals were transplanted intravenously with 4 × 10(6) hADSCs (Tx), conditioned media (CM), or vehicle (unconditioned media) at 3 h after TBI. Significant amelioration of motor and cognitive functions was revealed in young, but not aged, Tx and CM groups. Fluorescent imaging in vivo and ex vivo revealed 1,1' dioactadecyl-3-3-3',3'-tetramethylindotricarbocyanine iodide-labeled hADSCs in peripheral organs and brain after TBI. Spatiotemporal deposition of hADSCs differed between young and aged rats, most notably reduced migration to the aged spleen. Significant reduction in cortical damage and hippocampal cell loss was observed in both Tx and CM groups in young rats, whereas less neuroprotection was detected in the aged rats and mainly in the Tx group but not the CM group. CM harvested from hADSCs with silencing of either NEAT1 (nuclear enriched abundant transcript 1) or MALAT1 (metastasis associated lung adenocarcinoma transcript 1), long noncoding RNAs (lncRNAs) known to play a role in gene expression, lost the efficacy in our model. Altogether, hADSCs are promising therapeutic cells for TBI, and lncRNAs in the secretome is an important mechanism of cell therapy. Furthermore, hADSCs showed reduced efficacy in aged rats, which may in part result from decreased homing of the cells to the spleen.

Skilled motor control for the preclinical assessment of functional deficits and recovery following nigral and striatal cell transplantation.

Neural transplantation holds the promise for restoring behavioral function following brain injury. Substantial evidence indicates that fetal neurons transplanted to the adult brain survive and incorporate into remaining neural tissue and produce positive behavioral effects. A yet-unanswered question is whether the integration of new tissue can restore complex neural circuits that connect the neocortex, basal ganglia, and brainstem, and restore functions that are mediated by these circuits. This chapter describes the skilled reaching task, a task that requires transport of the arm and hand to grasp a food item and withdrawal to place the food item in the mouth for eating. It is a movement that is readily expressed in rodents and is fundamental to both nonhuman primates and humans. Methods for analyzing skilled reaching have been developed for preclinical rodent and mouse models of Parkinson's disease and Huntington's disease that are generalizable to humans with those clinical disorders. It is suggested that the task provides a motor benchmark for assessing the restoration of function produced by neural transplantation.

Case reports: the influence of selective voluntary motor control on gait after hamstring lengthening surgery.

BACKGROUND: Preliminary evidence suggests selective voluntary motor control (SVMC), defined as performance of isolated voluntary joint movement on request, may be an important factor affecting functional movement tasks. Individuals with poor SVMC are unable to dissociate hip and knee synergistic movement during the swing phase of gait and have difficulty extending their knee while the hip is flexing during terminal swing regardless of hamstring length. This pattern may limit their ability to take advantage of hamstring-lengthening surgery (HLS) and may explain a lack of improved stride length postoperatively. QUESTIONS/PURPOSES: Provide a preliminary clinical and conceptual framework for using SVMC to predict swing phase parameters of gait after HLS. PATIENTS AND METHODS: We contrasted two patients with spastic diplegia of similar age, gross motor function, and spasticity but with different SVMC scores using the Selective Control Assessment of the Lower Extremity (SCALE). The patients underwent bilateral HLS. Popliteal angles, joint kinematics, step length, stride length, and walking velocity were assessed pre- and postoperatively. RESULT: Popliteal angles, terminal knee extension, and knee range of motion improved for both patients. However, only the patient with higher SCALE scores improved stride length postoperatively. CONCLUSION: Although preliminary, the data suggest that SVMC, as measured by SCALE, may be a prognostic factor for improved stride length after HLS in patients with spastic diplegia. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

[Ulnar nerve compression in Guyon's canal by an accessory abductor digiti minimi brevis muscle]. / Kompression des N. ulnaris in der Loge de Guyon durch eine Variation des M. abductor digiti minimi brevis.

Compression syndromes of the ulnar nerve are more often located proximally in the cubital tunnel than distally in Guyon's canal. In many cases anatomic structures can be found that induce compression. These may be ganglia, tumours, vascular abnormalities, crossing fibrous bands or accessory muscles. The ulnar nerve has therefore to be revised all along its passage through Guyon's canal. When other causes are excluded, it might be necessary to excise an accessory muscle to decompress the ulnar nerve sufficiently.

Systemic transplantation of mesenchymal stem cells can reduce cognitive and motor deficits in rats with unilateral lesions of the neostriatum.

Huntington's disease (HD) is an inherited neurodegenerative disorder that usually occurs in the third or fourth decades of life. Stem cell therapy is one of the approaches for HD treatment. Since mesenchymal stem cells (MSCs) have the ability to migrate into the lesioned site, we transplanted rat bone marrow-derived MSCs intravenously, following unilateral intrastriatal lesion made by quinolinic acid (QA) in Wistar rats. QA administration caused widespread neuropathological deficits similar to those found in HD, including impairments in motor and cognitive functions. Animals receiving MSCs exhibited significant improvement in motor and cognitive performance compared with sham group animals that did not receive cells. Animals were tested by apomorphine-induced rotations, beam walk, cylinder and hang wire tests at different times after cell transplantation. Results indicate that systemic transplantation of MSCs can significantly reduce the behavioral abnormalities of these animals. This method of systemic injection has a great advantage over invasive surgical techniques for transplantation of cells at the lesioned site.

Comprehensive short-term outcome assessment of selective dorsal rhizotomy.

This study retrospectively evaluated the safety and efficacy of selective dorsal rhizotomy (SDR) in participants who underwent a rigorous selection process, uniform surgical procedure, and a standardized postoperative rehabilitation process. Outcome measures assessed were the Ashworth scale for spasticity, the Gillette Gait Index (GGI) for overall gait pathology, oxygen cost for gait efficiency, and the Gillette Functional Assessment Questionnaire (functional walking ability scale; [FAQ]) for functional mobility. Outcomes were evaluated for 136 children (81 males, 55 females; mean age 7y 3mo [SD 2y 1mo], range 3y 5mo-18y 9mo) for an average of 18.3 months (SD 4.4mo) postoperatively. All participants had a diagnosis of cerebral palsy (CP): 10 quadriplegia, 19 triplegia, and 107 diplegia. Preoperative Gross Motor Function Classification System levels were: Level I n=6; Level II n=64; Level III n=59, and Level IV n=7. All outcome measures improved for the group as a whole. Spasticity improved with 66 to 92% of possible gain in Ashworth scores; GGI was 7.5 times more likely to have a good as opposed to a poor outcome; energy efficiency improved in over half of the participants, and the FAQ demonstrated a statistically significant improvement of 0.9 levels (p<0.001). The rate of complications was low, with peri- and postoperative complications resolved by time of discharge.

Tratamiento quirúrgico de la enfermedad de Parkinson: ¿es hora de cambiar el momento de la indicación? / No disponible

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CSF drainage ameliorates the motor deficit in normal pressure hydrocephalus: evidence from the analysis of grasping movements.

Apart from the classic triad of hypokinetic gait disorder, cognitive dysfunction and urinary incontinence, the clinical spectrum of normal pressure hydrocephalus has been found to affect the upper limbs. It is unclear if the motor deficit of hand and arm movements improves with CSF evacuation. The present study was designed to quantitatively assess the effect of CSF evacuation on the hypokinesia of grasping movements in normal pressure hydrocephalus. Eight subjects with normal pressure hydrocephalus grasped to lift an instrumented object prior to and following evacuation of 40 ml CSF. The build-up of fingertip forces and the kinematics of the lifting movement were slower for patients compared with healthy controls. Patients also generated excessive grasping forces when lifting and holding the object stationary prior to and following CSF evacuation. CSF evacuation significantly improved the gait disorder, the cognitive impairment and the urinary incontinence in normal pressure hydrocephalus. CSF evacuation accelerated the lifting movement and reduced the grip force overshoot. These data suggest that the measurement of grasping forces may provide an additional test to quantify the clinical response to CSF tapping in normal pressure hydrocephalus.

[From Marey to modern gait analysis. Advances in orthopedic surgery of motor disability]. / De marey à l'analyse de la marche aujourd'hui. Progrès de la chirurgie orthopédique du handicap moteur.

Marey broke movement down into a series of stills. We still use this approach but technical advances, especially in computing, allow us to record cinematics, kinetics and electrical muscular activity simultaneously. We now have a better understanding of gait disorders in children with motor disabilities, challenging previous surgical indications and leading to the concept of single-procedure "multisite" surgery with spectacular improvements in outcome.

Temporal sequence of response to unilateral GPi pallidotomy of motor symptoms in Parkinson's disease.

The present study was performed to determine the temporal sequence of the response to unilateral MRI/microelectrode-guided pallidotomy of each cardinal symptom in Parkinson's disease (PD). For this purpose, we performed a quantitative assessment of motor functions in 19 patients with PD at several time points up to 6 months following surgery. We here report that although all the motor signs were significantly improved 6 months after pallidotomy, the temporal sequence of tremor response was different from those of other symptoms.