Brain lesions caused by cerebral ischemia lead to network disturbances in both hemispheres, causing a subsequent reorganization of functional connectivity both locally and remotely with respect to the injury. Quantitative electroencephalography (qEEG) methods have long been used for exploring brain electrical activity and functional connectivity modifications after stroke. However, results obtained so far are not univocal. Here, we used basic and advanced EEG methods to characterize how brain activity and functional connectivity change after stroke. Thirty-three unilateral post stroke patients in the sub-acute phase and ten neurologically intact age-matched right-handed subjects were enrolled. Patients were subdivided into two groups based on lesion location: cortico-subcortical (CS, n = 18) and subcortical (S, n = 15), respectively. Stroke patients were evaluated in the period ranging from 45 days since the acute event (T0) up to 3 months after stroke (T1) with both neurophysiological (resting state EEG) and clinical assessment (Barthel Index, BI) measures, while healthy subjects were evaluated once. Brain power at T0 was similar between the two groups of patients in all frequency bands considered (δ, θ, α, and β). However, evolution of θ-band power over time was different, with a normalization only in the CS group. Instead, average connectivity and specific network measures (Integration, Segregation, and Small-worldness) in the β-band at T0 were significantly different between the two groups. The connectivity and network measures at T0 also appear to have a predictive role in functional recovery (BI T1-T0), again group-dependent. The results obtained in this study showed that connectivity measures and correlations between EEG features and recovery depend on lesion location. These data, if confirmed in further studies, on the one hand could explain the heterogeneity of results so far observed in previous studies, on the other hand they could be used by researchers as biomarkers predicting spontaneous recovery, to select homogenous groups of patients for the inclusion in clinical trials.
Carbon monoxide (CO) poisoning is a leading cause of intentional and unintentional poisoning worldwide, associated with mortality and severe morbidity. Some survivors of CO poisoning develop, after a lucid interval, a potentially permanent encephalopathy in the form of cognitive impairment and movement disorders, such as Parkinsonism. One of the most frequent neuroimaging findings is a cerebral white matter damage, but so far its precise cause and specific therapy are still debated. We here report the case of a 33-year-old woman with severe carbon monoxide poisoning who, after a period of lucid interval, presented symptoms of declining motor and cognitive functions. She was treated with 40 sessions of Hyperbaric Oxygen Therapy (HBOT). The therapeutic use of oxygen at supraphysiological pressures might either increase systemic oxidative stress or cause an overproduction of oxygen free radicals as drawbacks. Concurrent use of antioxidants and anti-inflammatory drugs may prevent the side effects of oxygen therapy at supraphysiological pressure due to oxidative stress. For this reason, the patient was also treated with high-dose N-Acetylcysteine and glucocorticoids. Here, we describe the longitudinal monitoring of patient’s cognitive abilities and leukoencephalopathy associated with her positive clinical outcome.
Background: The loss of arm function is a common and disabling outcome after stroke. Robot-assisted upper limb (UL) training may improve outcomes. The aim of this study was to explore the effect of robot-assisted training using end-effector and exoskeleton robots on UL function following a stroke in real-life clinical practice. Methods: A total of 105 patients affected by a first-ever supratentorial stroke were enrolled in 18 neurorehabilitation centers and treated with electromechanically assisted arm training as an add-on to conventional therapy. Both interventions provided either an exoskeleton or an end-effector device (as per clinical practice) and consisted of 20 sessions (3/5 times per week; 6–8 weeks). Patients were assessed by validated UL scales at baseline (T0), post-treatment (T1), and at three-month follow-up (T2). The primary outcome was the Fugl-Meyer Assessment for the upper extremity (FMA-UE). Results: FMA-UE improved at T1 by 6 points on average in the end-effector group and 11 points on average in the exoskeleton group (p < 0.0001). Exoskeletons were more effective in the subacute phase, whereas the end-effectors were more effective in the chronic phase (p < 0.0001). Conclusions: robot-assisted training might help improve UL function in stroke patients as an add-on treatment in both subacute and chronic stages. Pragmatic and highmethodological studies are needed to confirm the showed effectiveness of the exoskeleton and end-effector devices.
Case reportA woman aged 32 years, whose first pregnancy had been terminated, contacted us for routine ultrasound at 29 weeks of gestation. She was well and the pregnancy seemed normal. Our ultrasound scan, including a detailed echocardiographic evaluation, showed severe fetal ascites ( Fig. 1) without any other detected anomaly. The fetal heart rate was regular (1 30 bpm) and the amount of amniotic fluid was normal. Previous scans at 10 and 22 weeks of gestation had found normal growth and morphology of the fetus. Maternal serum tests for anti-toxoplasma, anti-rubella virus, anticytomegalovirus, anti-herpes virus (TORCH) and antiparvovirus B19 immunoglobulin (Ig) G and IgM were negative. Her blood group was 0 Rhesus positive, Coombs negative. By paracentesis of the fetus, 280 cc of yellowish fluid were obtained and analysed: the TORCH and parvovirus B 19 titers were confirmed negative, the cultures were also negative, and the biochemical tests were normal. However, lymphocytes were predominant (> 80%) in the analysed fluid. Thus, a chylous ascites was suspected. Amniocentesis was also performed: the karyotype was 46, XY. At 31 weeks of gestation further sonography, including M-mode evaluation of cardiac activity, revealed paroxysmal supraventricular tachycardia (SVT) with a heart rate of 300 bpm ( Fig. 2), in addition to the reaccumulation of ascites. Maternal therapy with digoxin was started at a dose of 0.5 mg/day; maternal serum digoxin levels ranged between 1.6 and 1.8 ng/mL. After two weeks of therapy (now 33 weeks of gestation) conversion of the arrhythmia was achieved (heart rate = 127 bpm), as assessed by echocardiography and confirmed by cardiotocographic monitoring. However, ultrasonography showed that ascites was still present; nevertheless, fetal growth was regular and the Doppler waveforms of the umbilical artery and the internal carotid artery were normal. At 35 weeks of gestation, due to the onset of preterm labour with initial fetal distress, a caesarean section was perCorrespondence: Dr V. Spina, Largo Messico, 7-00] 98 Rome, Italy.formed and a male infant was delivered, weighing 3100 g and with Apgar scores 3 and 7 at 1 and 5 minutes, respectively. He was fed milk formula, and a further paracentesis showed a milky fluid rich in triglycerides and characterised by a raised white blood cell count (predominantly lymphocytes), confirming the chylous nature of the ascites. Episodes of paroxysmal SVT (heart rate = 240 to 270 bpm) recurred after birth and a diagnosis of Wolff-Parkinson white syndrome was made at surface ECG. Several pharmacological treatments, including propafenone, flecainide, flecainide + propranolol, amiodarone, amiodarone + flecainide + propranolol, propafenone + propranolol, were given but were not completely successful. Episodes of SVT, although ceasing promptly after therapy, continued to occur until two months after birth, when a combination of amiodarone (6 mg/kg/day) with propranolol (1 8 mg/kg/day) controlled the arrhythmia. On this therapy only short episodes, either self-t...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.