RESUMEN
PURPOSE: Repetitive transcranial magnetic stimulation (rTMS) can enhance brain plasticity after stroke. At low frequencies, rTMS has an inhibitory effect, whereas at high frequencies, it has an excitatory effect. Combining both frequencies in bilateral stimulation is a new rTMS protocol under investigation, especially in the subacute stage. METHODS: Fifty-five patients with subacute stroke were divided into four groups according to the rTMS protocol delivered: bilateral, inhibitory, excitatory, and control groups. All groups received concomitant task-oriented physiotherapy. Pretreatment to posttreatment assessment was performed twice, immediately after sessions and 1 month later. Volitional motor control was evaluated by Fugl-Meyer and Wolf motor function tests, and for spasticity, the Ashworth scale was used. RESULTS: All groups showed significant improvement. Bilateral, inhibitory, and excitatory groups showed same efficacy, but the bilateral protocol was superior in spasticity. No correlations were found between improvement and stroke duration and site except for spasticity. CONCLUSIONS: Bilateral rTMS shows a comparable effect to inhibitory and excitatory rTMS in improving motor disability in subacute stroke. However, it is superior for spasticity.
Asunto(s)
Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Estimulación Magnética Transcraneal , Humanos , Masculino , Femenino , Estimulación Magnética Transcraneal/métodos , Persona de Mediana Edad , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/terapia , Anciano , Rehabilitación de Accidente Cerebrovascular/métodos , Resultado del Tratamiento , Recuperación de la Función/fisiología , Adulto , Espasticidad Muscular/fisiopatología , Espasticidad Muscular/terapiaRESUMEN
BACKGROUND: Conventional motor nerve conduction studies are usually normal in early and mild carpal tunnel syndrome (CTS). Single-fiber electromyography (SFEMG) measures the mean consecutive difference (MCD) as an expression of the variability in impulse transmission over the motor endplates and along the nerve fibers distally to the last branching point and along the muscle fibers.Application of concentric needle SFEMG in a group of CTS patients who showed pure sensory abnormalities in nerve conduction studies to examine for subclinical motor involvement. METHODS: Thirty CTS patients having only sensory involvement proved clinically and by conventional electrophysiological studies were included in addition to 30 control subjects. Concentric needle SFEMG was performed to the abductor pollicis brevis (APB), abductor digiti minimi (ADM), and extensor digitorum communis (EDC) muscles. RESULTS: There was a statistically significant difference in the MCD between the patient and control groups in the APB only (p = 0.038). CONCLUSIONS: The results suggest the presence of a subclinical motor median neuropathy at the wrist in patients with early and mild carpal tunnel syndrome and highlight the validity of the concentric needle SFEMG in early neuropathies. TRIAL REGISTRATION: PACTR201802002971380 registered 12 February 2018, retrospectively registered.
RESUMEN
PURPOSE: The extent and clinical relevance of the association between epilepsy and sleep apnea are not previously studied in Egypt. What we wanted to know was the frequency of sleep apnea in Egyptian children with epilepsy and its influence on seizure frequency, other seizure characteristics, sleep complaint, and architecture. METHODS: All patients with epilepsy, aged up to 18 years, who underwent polysomnography were studied. Patients with any neurological disease apart from epilepsy, with psychiatric illness, had hypnotics, or sedatives or those with liver or kidney failure were excluded from the study. The patients were divided into two subgroups according to apnea/hypopnea index: group (1) patients without obstructive sleep apnea (OSA) and group (2) patients with OSA. For control group, we choose 12 healthy individuals, with age and sex matched to that of our patients. We studied the clinical characteristics of epilepsy, sleep history, and polysomnographic recording of the patients with epilepsy and the control. EEG digital and video monitoring was done for all patients. RESULTS: Eleven patients (42.3%) were found to have obstructive sleep apnea. Seizure frequency was significantly higher in the patients with OSA. Apart from apnea and hypopnea indices, all other sleep parameters did not differ between patients' subgroups. Hypopnea index in REM positively correlates with number of awaking. Apnea index in REM positively correlates with latency to deep sleep and to periodic leg movement. CONCLUSIONS AND RECOMMENDATIONS: Sleep apnea is frequent in patients with epilepsy. OSA may contribute to increase seizure frequency. We recommend investigating sleep apnea in all patients with epilepsy.