Neurological Disorders

POEMS syndrome is a multisystem disorder associated with polyneuropathy, organomegaly, endocrinopathy, a monoclonal protein (M-protein), and skin changes. Polyneuropathy is the most common initial symptom and it can hide other features of this disorder. We describe a patient with chronic inflammatory demyelinating polyneuropathy (CIDP) associated with extra-neurologic signs fulfilling the diagnosis criteria of POEMS syndrome to emphasize the importance of meticulous physical examination leading to challenging diagnosis.

The diagnosis of Myasthenia gravis (MG) is chiefly based on clinical symptoms and neurological examination coupled with serological testing for the presence of auto-antibodies, electrodiagnostic studies consisting of repetitive nerve stimulation test (RNST) and single fiber electromyography (SFEMG) and pharmacologic tests such as the edrophonium test. The ice pack test, based on the scientific principle that cooling improves neuromuscular transmission in Myasthenia gravis (MG), is a low cost, sensitive and specific test used for differentiating myasthenic ptosis from other causes of ptosis.

Based on the same principle, we propose the iced drink test as a quick, bedside test for differentiating bulbar weakness caused by myasthenia gravis from other causes of lower motor neuron type of bulbar weakness. The iced drink test, if validated, can prove to be useful in quick diagnosis of bulbar myasthenia.

Background: Many studies show the beneficial effects of overground gait training in stroke patients. However, it is not know whether it is able to induce changes in brain-derived neurotrophic factor (BDNF) levels, which could positively influence neurophysiological mechanisms. Objective: To evaluate the effect of a single session of light-to-moderate intensity walk on BDNF serum levels and its precursors (proBDNF) in chronic ischemic stroke patients. Methods: Patients were asked to walk for 30 minutes in the target heart rate training zone (30-60% of maximal heart rate). Blood samples were collected immediately before and after a single session. Results: Fifteen individuals with 60.8 (7.7) years old participated of this study. There was no significant difference in proBDNF (p=0.573) and BDNF (p=0.563) serum levels between pre- and post-session. Conclusion: This study used light-to-moderate intensity because the goal is to approach the gait training in clinical setting. The lack of increase in BDNF levels can be explained by two reasons: the intensity zone of the heart rate selected during the session and not having a gradual increase in this intensity.

It is not pleasant to reflect on the truth that science can be wrong. Even more so, when such wrong scientific conclusions have found expression in Courts of Law, and fashioned the destinies of men and women. Yet, facts are facts and truth is truth, whether we face it squarely or turn our heads to avert its gaze.

The misdirection in the aetiology of Cerebral Palsy generated in the USA in the 1960’s has the onus of responsibility of misdirecting not only medicine, but, also jurisprudence, as far as the scientific advisory goes. This article has the unhappy responsibility of recalling those facts, in order for history not to repeat its sad past. It is neither uncommon nor unusual for science to correct its original statements. However when medical science has erred and its mistaken conclusions wrought mistaken clinical conclusions, it is serious business. It is doubly serious when those conclusions have been applied in a Court of Law, which needs medical advice in the form of an expert.

This article commences from the original two pillars of misconception and retraces the subsequent mistaken steps after the 1960’s. One cannot point fingers at individuals, but one is certainly obliged to lance the collective buboes, and once the pus is freed, encourage regeneration of growth. And since, the essential core of the scope of the reasoning is medico-legal, it is essential that at no point does the article oppose legal retribution of sub-standard obstetric practice leading to the disastrous condition of Cerebral palsy of a new-born child. Such legal redress is right and just. However the mechanism of assessing the parameters in use in bringing forward such a claim must be fairly based on correct science. Only then, can justice prevail, both for the plaintiff as well as the defendant.

Introduction: In developing countries, stroke rehabilitation is conducted by family caregivers. Long-term stroke rehabilitation had impact on certain life domains of caregivers. The aim of the study was to examine predictors of quality of life and impact of quality of life on adopted coping styles.

Methods: A cross-sectional community based survey was conducted. 100 stroke family caregivers were purposively selected. WHOQOL –BREF scale and Coping Checklist (CCL) was used to measures quality of life and coping styles in caregivers. Appropriate descriptive and inferential statistics was applied to compute the results.

Results: Study findings revealed that there is statistical significant relationship between coping and physical quality of life (r=0.273, p<0.05). However, emotional and problem focused coping styles shows a significant positive relationship with overall quality of life (r=0.233, p<0.05) and satisfaction to health (r=0.208, p<0.05) respectively. Use of denial as a coping style found significant and negative relationship with social (r=-0.318, p<0.01) and environment (r=0.397, p<0.01) quality of life. Simple liner regression shows that availability of sub caregiver at home (p<0.05), family types (p<0.05) and caregiver as primary earning member (p<0.05) had direct relationship with satisfaction of health in caregivers.

Conclusion: Caregiving task is challenging to perform and had negative impacts on different sphere of life in family caregivers. Use of appropriate coping strategies helps to improve caregiver’s welfare.

Background: A growing body of evidence would consider the cryptogenic cirrhosis as the immediate offspring of Type 2 diabetes mellitus (T2DM). But, what we routinely observe here in Iran seems totally different. We would suggest that, the majority of reported cases of cryptogenic cirrhosis are actually the result of surreptitious or under-estimated alcohol consumption in a subject suffering from metabolic syndrome, not the direct consequence or as a blooming belief, a chronic complication of T2DM. In order to clarify the issue, a population of T2DM subjects living in a closed, religious society in which alcohol production, distribution, and consumption were legally and also ritually controlled, were investigated for manifestations of end-stage liver disease.

Materials and methods: In a prospective observational study, one hundred and thirty-two T2DM subjects (43 males and 89 females) were consecutively included. They were interviewed and carefully examined for any stigmata of chronic liver failure and cirrhosis. Then, a comprehensive set of liver function tests not to mention viral and immunological markers and also abdominal sonography were carried out. Liver biopsy was considered once academically indicated.

Results: The average age of patients was 58 ± 10.9 years (range, 31-83 years), and the duration of diabetes was 7.4 ± 6 years (range, 1-25 years). BMI came out as 34.9 ± 5.3 with mean waist circumference of 71.2 ± 11.5 cm. To our surprise, from 132 T2DM patients only eight cases (6%) displayed mild to moderate abnormal liver enzymes level, of which only 2 cases had liver enzymes more than twice normal. With regard to our main concern, only two subjects (1.5%) manifested overt liver failure and cirrhosis, of whom, one person tested positive for HCVAb and the other disclosed eventually to have been drinking alcohol at younger ages for years while living abroad.

Conclusion: We would suggest, if alcoholic liver disease -as a major confounding variable- becomes efficiently eliminated from the relevant studies, T2DM, per se, would seldom persist as a direct causative risk for cryptogenic cirrhosis. We, as a matter of quite conceivable fact, believe that T2DM, NAFLD and cryptogenic cirrhosis are all the results of a superior pathogenic process, the metabolic syndrome or better to say insulin resistance syndrome.

The etiology of Parkinson Disease (PD) remains elusive, but may include environmental and genetic factors leading to neuronal degeneration [1]. The difference in incidence of PD among different racial groups may provide additional insight into the etiology. In 2004, McInerney-Leo et al. reviewed twenty studies analyzing the prevalence and incidence of PD among Caucasians, African-Americans in the United States and African populations [2]. The differences in prevalence of Parkinson’s disease and Parkinsonism could not be demonstrated because of poor designs and numerous biases, such as referral bias and differences in access to healthcare. Therefore, they were unable to determine the effect of race in PD. Yet, studies continue to suggest that there is a significantly higher prevalence of PD among Caucasians compared to other racial groups [3]

In cerebral palsy (CP) cognitive development is one of the major problems seen which hamper the mental development and deprive the child to achieve normal development to survive the normal quality of life. In cognitive impairment for CP children now a day, there are lots of conventional treatments available such as mental exercise, special education and schooling are available but rTMS is new treatment approaches to change the scenario in cognitive domain in various neurological disorders. The aim of this study was to observe the changes in Vinland social maturity scale (VSMS) by using rTMS therapy on CP children. VSMS is a one of the psychological tool used to assess the cognition, social and communication skills in many domains was used as assessment tool. After the completion of treatment we concluded that rTMS have promising result in various cognitive domains. The result shows that in control group(CG) and experimental group(EG) both have significant result that is p<0.03 and p<0.001 respectively, but EG have more significant result as compare to CG. Similarly, in mean change value scores of both the groups shows that 0.8% in CG and 1.03% in EG it means EG have 0.23% more result than CG with rTMS therapy.