Gliedmaßenapraxie bei Patienten mit Multipler Sklerose

Abstract

Zusammenfassung. Gliedmaßenapraxie ist eine Störung der motorischen Kognition, die besonders häufig nach linkshemisphärischem Schlaganfall auftritt. Diese Störung ist bei Patienten mit Multipler Sklerose (MS) noch wenig untersucht. Bisherige MS-Studien indizieren, dass die Leistung in den klassischen Pantomime- und Imitationstests beeinträchtigt sein kann. Die vorliegende Studie untersuchte die Gliedmaßenapraxie bei 26 MS-Patienten und 24 Gesunden mit dem Diagnostic Instrument for Limb Apraxia – Short Version (DILA-S), das zusätzlich zu den klassischen Imitations- und Pantomimetests auch den tatsächlichen Werkzeuggebrauch untersucht. Bei 27 % der MS-Patienten wurden apraktische Symptome in jeweils einzelnen Untertests diagnostiziert. Die Symptomausprägung war jedoch gering, sodass Gruppenvergleiche keine signifikanten Unterschiede zeigten. Insgesamt legen die Studienergebnisse nahe, dass Gliedmaßenapraxie bei MS-Patienten auftreten kann, aber vermutlich selten zu einem klinisch relevanten Symptom wird.

Limb apraxia profiles in different clinical samples

“…This could be due to the method of merely testing the stronger hand (which controlled for motor deficits), which has been applied here, compared to testing both hands in studies of other research groups (Kamm et al, 2012;Rapaic et al, 2014). Further, in the current MS sample, limb apraxia symptoms did not reach clinical relevance, which was shown by absent complaints by the patients as well as absent notes on apraxia in the discharge report of the rehabilitation clinic (Harscher et al, 2017).…”

“…Participants were recruited from the neurorehabilitation clinic "Kliniken Schmieder" in Konstanz, Germany. The patient population was first described in Harscher et al (2017). All patients (N ¼ 26) suffered from MS, diagnosed with the revised McDonald criteria (Polman et al, 2011) as ICD-10 code G35 (MS).…”

“…Limb apraxia symptoms seem to occur in about 13-27% of MS patients, but mostly only mild deficits were reported (Harscher, Hirth-Walther, Buchmann, Dettmers & Randerath, 2017;Kamm et al, 2012;Rapaic, Medenica, Kozomara & Ivanovic, 2014;Staff et al, 2009). Low severity levels could be explained by the relatively small amount of 20% brain atrophy in the gray matter compared to 80% brain atrophy in the white matter (Gil Moreno et al, 2013).…”

Syndromes of limb apraxia: Developmental and acquired disorders of skilled movements.

“…For example, the following apraxias have been identified: limb apraxia (performing meaningless or meaningful skillful movements with the limbs), callosal apraxia (performing skilled movements with the left upper limb in patients with corpus callosum injury), buccofacial apraxia or orofacial apraxia (performing or imitation of facial or lip gestures such as whistling, winking, or licking the lips), apraxia of speech or verbal apraxia (planning and coordination of mouth and speech movements), and constructional apraxia (constructing or copying of simple drawings including simple diagrams, figures, or objects). The current chapter focuses on limb apraxia as a motor cognitive disorder that can occur with varying reported incidence rates and severity in developmental disorders as well as acquired neurological or psychiatric diseases, including stroke, traumatic brain injury, dementia, Parkinson' s disease, corticobasal syndrome, Huntington' s disease, multiple sclerosis, and schizophrenia (Dewey, 1995;Dutschke et al, 2018;Harscher et al, 2017;Holl et al, 2011;Kübel et al, 2017;Stamenova et al, 2009;Stegmayer et al, 2016;. Limb apraxia can affect activities of daily living, ranging from communicative gesturing to the actual use of novel and familiar tools and objects.…”