RESUMEN
OBJECTIVE: To determine the functional recovery in patients with severe transient peripheral facial motor paralysis (Bell palsy). STUDY DESIGN: Prospective controlled trial. SETTING: Academic medical center. SUBJECTS AND METHODS: Blink recovery was studied in 2 groups of severely affected Bell palsy patients during a follow-up period of 84 weeks. The patients in one group received prednisolone within the first week after the onset of symptoms. No medication was given to the other group. A control group of healthy subjects was also included. Simultaneous orbicularis oculi muscle activity and eyelid kinematics were recorded by surface electromyographic (EMG) recording and eyelid search coils, respectively. RESULTS: At the beginning of the paralysis, very little integrated orbicularis oculi muscle activity and eyelid movement was measured at the palsied side of the face. Thirteen weeks later, the integrated orbicularis oculi EMG and functional blink recovery gradually improved until 39 weeks. Beyond, only the integrated orbicularis oculi EMG slightly increased. At 84 weeks, the integrated orbicularis oculi EMG was significantly larger in the prednisolone group compared with the control group. The integrated EMG of the nonmedicated group recovered to normal values. Curiously enough, the functional blink recovery at the palsied side remained reduced to 64% compared with the healthy controls in the prednisolone-treated group and to 36% in the nonmedicated group. CONCLUSION: The authors demonstrate that prednisolone significantly increased the orbicularis oculi muscle activity and significantly improved functional blink recovery in severely affected Bell palsy patients. However, the increase of muscle activity was insufficient to restore functional blinking to normal values.
Asunto(s)
Parálisis de Bell/diagnóstico , Parálisis de Bell/tratamiento farmacológico , Parpadeo/efectos de los fármacos , Prednisolona/administración & dosificación , Centros Médicos Académicos , Administración Oral , Adulto , Anciano , Parpadeo/fisiología , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Electromiografía/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recuperación de la Función , Valores de Referencia , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Cognitive performance often is impaired permanently in long-term brain tumor survivors after neurosurgery and radiotherapy. Hyperbaric oxygen treatment (HBOT) stimulates neovascularization of hypoperfused tissue and may result in improved functionality of damaged tissue. In this pilot study, clinical neurophysiologic tests were used to assess the effect of HBOT on brain performance. METHODS: Ten long-term brain tumor survivors received HBOT for severe cognitive deficits after neurosurgery and radiosurgery. Patients were tested before HBOT and at 6 weeks and 4 months after HBOT. The tests comprised a quantitative electroencephalographic (EEG) examination, the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) for memory performance, and 2 cognitive tests, the number connection test (NCT) and the continuous reaction time test (CRTT). Late event-related components (LERCs) of averaged evoked EEG responses to a visual odd-ball stimulus were analyzed from whole-head activity maps. For comparison, a control group of healthy individuals (no HBOT) also were investigated. RESULTS: After HBOT, the amplitude of the LERC with the longest latency, P3b (involved in object interpretation) was improved significantly (P = .02). The amplitudes of the N200 (occipital, negative) and the intermediate P3a (centroparietal, positive), LERCs with shorter latencies, and of a small, positive, occipital visual component did not change. Neither latencies nor reaction times changed after HBOT. However, P3a and P3b (parietal, positive) latencies were longer in survivors than in healthy individuals. The NCT produced inconclusive results, but the IQCODE revealed an improvement. When outcomes of the NCT, CRTT, IQCODE, and P3b amplitudes were evaluated in common tests, HBOT appeared to provide substantial improvement (P<.006). CONCLUSIONS: On the basis of the current results, the authors concluded tentatively that HBOT improves neurophysiologic performance in long-term brain tumor survivors.
Asunto(s)
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/cirugía , Oxigenoterapia Hiperbárica , Adulto , Anciano , Neoplasias Encefálicas/fisiopatología , Cognición , Electroencefalografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
OBJECTIVE: With MEG and EEG the effect of perinatal dioxin load of 38 healthy 7- to 12-year-old children was studied to assess possible disturbances of visual development. METHODS: Latencies and amplitudes of the motion (N2 with subcomponents) and oddball responses (N200 and P3b) were analysed after age correction. RESULTS: With increasing load, latencies increased and the amplitudes of the oddball components tended to be reduced. The latency increase between the high- and low-loaded children was about 13 ms (P<0.004) and the oddball response showed an amplitude decrease of 12% (P=0.009). CONCLUSIONS: It may be concluded that, during the end-80s/early-90s, exposure to background levels in industrialized regions seems to have resulted in small underdevelopment or damage to visual motion processing and visual cognition. SIGNIFICANCE: Since dioxin pollution by incinerators still exists in many regions in developing countries and also still, although at a smaller scale, in the industrialized world, perinatal loads of similar magnitude and possibly more as measured in this study may occur and as a consequence might affect the developing brain.
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Discapacidades del Desarrollo/inducido químicamente , Discapacidades del Desarrollo/prevención & control , Dioxinas/toxicidad , Electroencefalografía/efectos de los fármacos , Contaminantes Ambientales/toxicidad , Magnetoencefalografía/efectos de los fármacos , Percepción de Movimiento/efectos de los fármacos , Efectos Tardíos de la Exposición Prenatal/psicología , Desempeño Psicomotor/efectos de los fármacos , Percepción Visual/efectos de los fármacos , Tejido Adiposo/química , Envejecimiento/psicología , Niño , Depresión Química , Dioxinas/análisis , Relación Dosis-Respuesta a Droga , Contaminantes Ambientales/análisis , Potenciales Evocados Visuales/efectos de los fármacos , Femenino , Humanos , Recién Nacido , Modelos Lineales , Masculino , Países Bajos , Estimulación Luminosa , Embarazo , Valores de Referencia , Visión Binocular/efectos de los fármacosRESUMEN
PURPOSE: To examine the recovery process of blinking in a longitudinal study of nine patients severely affected by Bell's palsy. METHODS: Kinematics of bilateral eyelid and eye movements and concomitant orbicularis oculi activity during voluntary blinking and air-puff- and acoustic-click-induced reflex blinking were determined by using the magnetic search coil technique and electromyographic recording of the orbicularis oculi muscle (OO-EMG). RESULTS: In the first 3 months of absence of OO-EMG activity, reduced eyelid and eye movement of the palsied eyelid were observed during all types of blinking. First OO-EMG activity was determined 3 months after onset of the affliction. After 1 year, OO-EMG activity was normalized and showed values similar to those on the nonpalsied side. Clinically, eyelid movements were normal after 1 year, although corresponding maximum amplitudes and corresponding velocities were two times smaller, expressed in reduced eyelid motility. Directions of eye movement during reflex blinking were normal after 1 year, although maximum amplitudes were smaller on the palsied side. Eye movements during voluntary blinking remained impaired. A simultaneous horizontal upward shift of both eyes in the same direction was recorded throughout the study. CONCLUSIONS: Although OO-EMG activity on the palsied side was normalized 1 year after onset of the affliction, the accompanying eyelid movements and their maximum amplitudes and velocities remained smaller throughout the study. The consistent impairment of eye movements in voluntary blinking during the study and reduced motility of eyelid movements indicates that higher brain structures, which modify eyelid and eye movement control during blinking, may be altered by the affliction.
Asunto(s)
Parálisis de Bell/fisiopatología , Parpadeo/fisiología , Párpados/fisiopatología , Recuperación de la Función/fisiología , Adulto , Anciano , Fenómenos Biomecánicos , Electromiografía , Movimientos Oculares/fisiología , Músculos Faciales/fisiopatología , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Músculos Oculomotores/fisiopatologíaRESUMEN
We examined eyelid movements during spontaneous, voluntary, and trigeminal reflex blinks in 16 patients with mild to moderate Parkinson's disease (PD) off medication and 14 controls. Voluntary and reflex blink amplitudes tended to be smaller than normal for PD patients, whereas eyelid kinematics (amplitude-maximum velocity relationship) for all three blink types were normal. Spontaneous blink rate was less than normal for 10 patients and abnormally high for 6 patients. A significant positive correlation between spontaneous blink amplitude and blink rate was found. These observations suggest that PD modifies the gain of a premotor blink circuit shared by spontaneous, voluntary, and reflex blinks.
Asunto(s)
Parpadeo/fisiología , Párpados/fisiología , Enfermedad de Parkinson/fisiopatología , Adulto , Edad de Inicio , Anciano , Antiparkinsonianos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Movimiento , Enfermedad de Parkinson/tratamiento farmacológicoRESUMEN
The kinematics and neurophysiological aspects of eyelid movements were examined during spontaneous, voluntary, air puff, and electrically induced blinking in healthy human subjects, using the direct magnetic search coil technique simultaneously with electromyographic recording of the orbicularis oculi muscles (OO-EMG). For OO-EMG recordings, surface electrodes were attached to the lower eyelids. To measure the vertical lid displacement, a search coil with a diameter of 3 mm was placed 1 mm from the rim on the upper eyelid on a marked position. Blink registrations were performed from the zero position and from 28 randomly chosen positions. Blinks elicited by electrical stimulation of the supraorbital nerve had shortest duration and were least variable. In contrast, spontaneous blinks had longer duration and greater variability. Blinks induced by air puff had a slightly longer duration and similar variability as electrically induced blinks. There was a correlation between the maximal down phase amplitude and the integrated OO-EMG. Blink duration and maximal down phase amplitude were affected by eye position. Eyes positioned 30 degrees above horizontal displayed the shortest down phase duration and the largest maximal down phase amplitude and velocity. At 30 degrees below horizontal, blinks had the longest total duration, the longest down phase duration, and the lowest maximal down phase amplitude and velocity. The simultaneously recorded integrated OO-EMG was largest in the 30 degrees downward position. In four subjects, the average blinking data showed a linear relation between eye position and OO-EMG, maximal down phase amplitude, and maximal downward velocity.