Journal of Central Nervous System Disease最新文献

{"title":"Implementing Virtual Care in Neurology - Challenges and Pitfalls.","authors":"Filzah Faheem,&nbsp;Zaitoon Zafar,&nbsp;Aisha Razzak,&nbsp;Junaid Siddiq Kalia","doi":"10.1177/11795735221109745","DOIUrl":"https://doi.org/10.1177/11795735221109745","url":null,"abstract":"<p><p>Virtual care is here to stay. The explosive expansion of telehealth caused by the SARS-CoV-2 pandemic is more than a necessary measure of protection. The key drivers of this transition in healthcare delivery to a virtual setting are changes in patient behavior and expectations and societal attitudes, and prevailing technologies that are impossible to ignore. The younger population - Generation Z - is increasingly connected and mobile-first. We are heading to a world where we expect to see healthcare in general and neurology, in particular, delivered virtually. The medical community should prepare for this overhaul; proper implementation of virtual care from the ground up is the need of the hour. In an era of virtualization, it is up to the medical community to ensure a well-informed patient population, overcome cultural differences and build digital infrastructure with enhanced access and equity in care delivery, especially for the aging neurological patient population, which is not technologically savvy. Virtual care is a continuum of care that needs deeper integration at systematic levels. The design principles of a patient's journey need to be incorporated while simultaneously placing physician satisfaction with a better user experience at the center of implementation. In this paper, we discuss common challenges and pitfalls of virtual care implementation in neurology - logistical, technical, medicolegal, and those faced in incorporating health and medical education into virtual care - intending to provide solutions and strategies.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":" ","pages":"11795735221109745"},"PeriodicalIF":4.8,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/46/6c/10.1177_11795735221109745.PMC9252001.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40566135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experimental Models of SARS-COV-2 Infection in the Central Nervous System.","authors":"Anna Maria Paoletti,&nbsp;Maria Grazia Melilli,&nbsp;Immacolata Vecchio","doi":"10.1177/11795735221102231","DOIUrl":"https://doi.org/10.1177/11795735221102231","url":null,"abstract":"<p><p>Coronavirus disease 2019 (COVID-19) has raised serious concerns worldwide due to its great impact on human health and forced scientists racing to find effective therapies to control the infection and a vaccine for the virus. To this end, intense research efforts have focused on understanding the viral biology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for COVID-19. The ever-expanding list of cases, reporting clinical neurological complications in COVID-19 patients, strongly suggests the possibility of the virus invading the nervous system. The pathophysiological processes responsible for the neurological impact of COVID-19 are not fully understood. Some neurodegenerative disorders sometimes take more than a decade to manifest, so the long-term pathophysiological outcomes of SARS-CoV-2 neurotropism should be regarded as a challenge for researchers in this field. There is no documentation on the long-term impact of SARS-CoV-2 on the human central nervous system (CNS). Most of the data relating to neurological damage during SARS-CoV-2 infection have yet to be established experimentally. The purpose of this review is to describe the knowledge gained, from experimental models, to date, on the mechanisms of neuronal invasion and the effects produced by infection. The hope is that, once the processes are understood, therapies can be implemented to limit the damage produced. Long-term monitoring and the use of appropriate and effective therapies could reduce the severity of symptoms and improve quality of life of the most severely affected patients, with a special focus on those have required hospital care and assisted respiration.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":" ","pages":"11795735221102231"},"PeriodicalIF":4.8,"publicationDate":"2022-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d4/85/10.1177_11795735221102231.PMC9247991.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40467885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alopecia in Multiple Sclerosis Patients Treated with Disease Modifying Therapies.","authors":"Mokshal H Porwal,&nbsp;Amber Salter,&nbsp;Dhruvkumar Patel,&nbsp;Ahmed Z Obeidat","doi":"10.1177/11795735221109674","DOIUrl":"https://doi.org/10.1177/11795735221109674","url":null,"abstract":"<p><strong>Background: </strong>There is currently limited literature addressing the reporting of alopecia in multiple sclerosis (MS) patients treated with disease-modifying therapies (DMTs). Anecdotal reports of hair thinning from patients on various DMTs prompted further investigation of a large database.</p><p><strong>Objective: </strong>To analyze total reports, source of reporting, age distribution, and sex distribution of alopecia associated with DMTs.</p><p><strong>Methods: </strong>FDA Adverse Event Reporting System (FAERS) public dashboard and OpenFDA database were analyzed for alopecia reports between January 1, 2009, and June 30, 2020, attributed to usage in MS of FDA approved DMTs. The main outcomes included total reports for each drug, age, sex distribution, and reporting source. OpenFDA data was used for statistical analyses including reporting odds ratios (ROR) and information components.</p><p><strong>Results: </strong>8759 alopecia reports were identified among 44 114 adverse events in skin and subcutaneous tissue disorders (19.9%). 3701 (42.3%) with teriflunomide, 1675 (19.1%) with dimethyl fumarate, 985 (11.2%) with natalizumab, 926 (10.6%) with fingolimod, 659 (7.5%) with interferon beta-1a, 257 (2.9%) with glatiramer acetate, 243 (2.8%) with ocrelizumab, 124 (1.4%) with interferon beta-1b, 117 (1.3%) with alemtuzumab, 36 (.4%) with siponimod, 24 (.3%) with cladribine, and 12 (.1%) with rituximab. Reports were mostly made by patients (78.3%) and highest in fifth and sixth decades of life. OpenFDA analyses showed increased ROR (ROR 95% confidence interval) of alopecia in females with teriflunomide (18.00, 17.12-18.93), alemtuzumab (1.43, 1.16-1.76), dimethyl fumarate (1.26, 1.18-1.34), and ocrelizumab (1.28, 1.11-1.49). Increased ROR in males was associated with teriflunomide (24.65, 20.72-29.31).</p><p><strong>Conclusion: </strong>We identified many reports of alopecia for DMTs in addition to teriflunomide. Within the limitations of the database, increased RORs of alopecia were observed for females treated with alemtuzumab, dimethyl fumarate, and ocrelizumab. The source of reporting was largely driven by female patients. Possible alopecia, even if transient, should be considered during patient education when starting DMTs.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":" ","pages":"11795735221109674"},"PeriodicalIF":4.8,"publicationDate":"2022-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/db/fb/10.1177_11795735221109674.PMC9234852.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40410583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Transcranial Direct Current Stimulation on Memory of Elderly People with Mild Cognitive Impairment or Alzheimer's Disease: A Systematic Review.","authors":"Eliclebysson Rodrigo da Silva,&nbsp;Italo Ramon Rodrigues Menezes,&nbsp;Ivani Brys","doi":"10.1177/11795735221106887","DOIUrl":"https://doi.org/10.1177/11795735221106887","url":null,"abstract":"<p><strong>Background: </strong>Transcranial direct current stimulation (tDCS) is one of the most studied non-invasive neuromodulation techniques, presenting itself as a promising technique for several pathologies, such as cognitive decline.</p><p><strong>Objectives: </strong>The aim of this study was to conduct a systematic review of the effects of tDCS on the memory of elderly people with mild cognitive impairment or Alzheimer's disease, in order to describe the main protocols used, and to investigate the therapeutic effectiveness of this technique.</p><p><strong>Data sources and methods: </strong>869 studies reporting controlled clinical trials were found in the databases PubMed, Web of Science, Lilacs, PsycArticles and Scielo, from which 13 met the expected requirements and were included in the final analysis.</p><p><strong>Results: </strong>There was a great variability in the stimulation protocols used in the studies; and methodological weaknesses were observed, such as absence of sample size calculation, and of information on effect sizes. Positive effects of tDCS were observed only in five studies, and the combination of stimulation and cognitive training did not seem to potentiate the effects of tDCS.</p><p><strong>Conclusion: </strong>Although tDCS can be considered a technique with important therapeutic potential, more studies are needed to understand the acute effects of tDCS on memory of elderly people and the durability of these effects over time.</p><p><strong>Registration: </strong>PROSPERO (CRD-42020200573).</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":" ","pages":"11795735221106887"},"PeriodicalIF":4.8,"publicationDate":"2022-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/29/17/10.1177_11795735221106887.PMC9234827.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40410582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Viloxazine for Attention-Deficit Hyperactivity Disorder: A Systematic Review and Meta-analysis of Randomized Clinical Trials.","authors":"Alok Singh, Mahesh Kumar Balasundaram, Abhishek Singh","doi":"10.1177/11795735221092522","DOIUrl":"10.1177/11795735221092522","url":null,"abstract":"<p><strong>Background: </strong>Recently, the United States Food and Drug Administration (USFDA) approved viloxazine extended-release (ER) to manage attention-deficit hyperactivity disorder (ADHD) in pediatric patients of 6-17 years of age.</p><p><strong>Objective: </strong>To perform a meta-analysis to determine the safety and efficacy of viloxazine ER in the management of ADHD.</p><p><strong>Data source and methods: </strong>A literature search was performed through the databases Cochrane Library, PubMed, and clinicaltrials.gov, for a period from inception to August 2021, with the keywords: viloxazine, SPN-812, ADHD, and randomized clinical trials. The randomized controlled trials published in English language that analyzed the efficacy and safety were included. The risk of bias (RoB) was assessed by RoB tool. The outcomes included in this study were the proportion of patients with a 50% reduction in ADHD-Rating Scale-5 (ADHD-RS-5 responders) and improvement in CGI-I scale and the proportion of patients with at least one adverse event, the incidence of somnolence and Serious Adverse Events (SAEs).</p><p><strong>Results: </strong>This meta-analysis includes 1605 patients from five randomized clinical trials; all of the trials were at low risk of bias. Viloxazine group had more ADHD-RS-5 responders as compared to placebo; RR = 1.62; 95% CI = 1.36-1.93; <i>P</i> = <.00001. Significantly higher number of patients showed improved CGI-I score; RR = 1.53; 95% CI = 1.32-1.78; <i>P</i> = <.00001. A higher proportion of patients was observed with at least one adverse event (RR = 1.52; 95% CI = 1.24-1.85; <i>P</i> = <.0001), and somnolence (RR = 3.93; 95% CI = 2.11-7.31; <i>P</i> = <.0001) in viloxazine group. The incidence of SAEs was more in viloxazine group (RR = 2.98; 95% CI = .67-13.3; <i>P</i> = .15).</p><p><strong>Conclusions: </strong>Viloxazine was found to be significantly superior to placebo in both efficacy outcomes. Adverse events and somnolence were significantly more than the placebo. The incidence was SAEs was more in the viloxazine group but was not statistically significant.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":"14 ","pages":"11795735221092522"},"PeriodicalIF":2.6,"publicationDate":"2022-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/35/ee/10.1177_11795735221092522.PMC9125110.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10250403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatigue in Post-COVID-19 Syndrome: Clinical Phenomenology, Comorbidities and Association With Initial Course of COVID-19","authors":"L. Diem, Livia Fregolente-Gomes, J. Warncke, H. Hammer, C. Friedli, N. Kamber, Simon Jung, S. Bigi, M. Funke-Chambour, A. Chan, C. Bassetti, A. Salmen, R. Hoepner","doi":"10.1177/11795735221102727","DOIUrl":"https://doi.org/10.1177/11795735221102727","url":null,"abstract":"Introduction Post-COVID-19 syndrome affects approximately 10-25% of people suffering from COVID-19 infection, irrespective of initial COVID-19 severity. Fatigue is one of the major symptoms, occurring in 30-90% of people with post-COVID-19 syndrome. This study aims at describing factors associated with fatigue in people with Post-COVID-19 seen in our newly established Post-Covid clinic. Methods This retrospective single center study included 42 consecutive patients suffering from Post-COVID-19 syndrome treated at the Department of Neurology, University Hospital Bern, between 11/2020 and05/2021. Clinical phenomenology of Post-COVID-19 syndrome with a special focus on fatigue and risk factor identification was performed using Mann-Whitney U Test, Pearson Correlation, and Chi-Quadrat-Test. Results Fatigue (90.5%) was the most prevalent Post-COVID-19 symptom followed by depressive mood (52.4%) and sleep disturbance (47.6%). Fatigue was in mean severe (Fatigue severity scale (FSS) mean 5.5 points (95% Confidence interval (95CI) 5.1 - 5.9, range .9 - 6.9, n = 40), and it was unrelated to age, COVID-19 severity or sex. The only related factors with fatigue severity were daytime sleepiness and depressed mood. Conclusion Fatigue is the main symptom of the Post-COVID-19 syndrome in our cohort. Further studies describing this syndrome are needed to prepare the healthcare systems for the challenge of treating patients with Post-COVID-19 syndrome.","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47691164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stronger Microstructural Damage Revealed in Multiple Sclerosis Lesions With Central Vein Sign by Quantitative Gradient Echo MRI.","authors":"Victoria A Levasseur, Biao Xiang, Amber Salter, Dmitriy A Yablonskiy, Anne H Cross","doi":"10.1177/11795735221084842","DOIUrl":"10.1177/11795735221084842","url":null,"abstract":"<p><strong>Background: </strong>Multiple sclerosis (MS) lesions typically form around a central vein that can be visualized with FLAIR* MRI, creating the central vein sign (CVS) which may reflect lesion pathophysiology. Herein we used gradient echo plural contrast imaging (GEPCI) MRI to simultaneously visualize CVS and measure tissue damage in MS lesions. We examined CVS in relation to tissue integrity in white matter (WM) lesions and among MS subtypes.</p><p><strong>Objective: </strong>We aimed to determine if CVS positive lesions were specific to MS subtype, if CVS can be detected consistently among readers using the GEPCI method, and if there were differences in tissue damage in lesions with vs without CVS.</p><p><strong>Subjects and methods: </strong>Thirty relapsing-remitting MS (RRMS) subjects and 38 primary and secondary progressive MS (PMS) subjects were scanned with GEPCI protocol at 3T. GEPCI T2*-SWI images were generated to visualize CVS. Two investigators independently evaluated WM lesions for CVS and measured lesion volumes. To estimate tissue damage severity, total lesion volume, and mean lesion volume, R2t*-based tissue damage score (TDS) of individual lesions and tissue damage load (TDL) were measured for CVS+, CVS-, and confluent lesions. Spearman correlations were made between MRI and clinical data. One-way ANCOVA with age and sex as covariates was used to compare measurements of CVS+ vs CVS- lesions in each individual.</p><p><strong>Results: </strong>398 of 548 lesions meeting inclusion criteria showed CVS. Most patients had ≥40% CVS+ lesions. CVS+ lesions were present in similar proportion among MS subtypes. Interobserver agreement was high for CVS detection. CVS+ and confluent lesions had higher average and total volumes vs CVS- lesions. CVS+ and confluent lesions had more tissue damage than CVS- lesions based on TDL and mean TDS.</p><p><strong>Conclusion: </strong>CVS occurred in RRMS and PMS in similar proportions. CVS+ lesions had greater tissue damage and larger size than CVS- lesions.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":"14 ","pages":"11795735221084842"},"PeriodicalIF":2.6,"publicationDate":"2022-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9e/9f/10.1177_11795735221084842.PMC8973074.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10361599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glaucomatous Type Cupping Caused by Internal Carotid Artery Compression: a Case Report.","authors":"Francesco Pellegrini,&nbsp;Alessandra Cuna,&nbsp;Giovanni Prosdocimo","doi":"10.1177/11795735221081588","DOIUrl":"https://doi.org/10.1177/11795735221081588","url":null,"abstract":"<p><p>A 71-year-old woman with a diagnosis of normal tension glaucoma (NTG) presented with complains of progressive visual loss in the right eye. Examination revealed features consistent with compressive optic neuropathy. Although brain magnetic resonance imaging (MRI) was initially interpreted as normal, re-evaluation disclosed a compression on the right optic nerve from the right internal carotid artery. We highlight the clinical differential diagnosis between NTG and compressive optic neuropathy. This case is a reminder that a compressive optic neuropathy may be caused by anatomical variation of normal intracranial structures.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":" ","pages":"11795735221081588"},"PeriodicalIF":4.8,"publicationDate":"2022-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d2/92/10.1177_11795735221081588.PMC8854233.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39938477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep-related hypermotor epilepsy with genetic diagnosis: description of a case series in a tertiary referral hospital.","authors":"Carmen Arenas-Cabrera,&nbsp;Pablo Baena-Palomino,&nbsp;Javier Sánchez-García,&nbsp;María Oliver-Romero,&nbsp;Yamin Chocrón-González,&nbsp;Manuel Caballero-Martínez","doi":"10.1177/11795735211060114","DOIUrl":"https://doi.org/10.1177/11795735211060114","url":null,"abstract":"<p><strong>Introduction: </strong>Sleep-related hypermotor epilepsy (SHE) is characterized by asymmetric tonic/dystonic posturing and/or complex hyperkinetic seizures occurring mostly during sleep. Experts agree that SHE should be considered a unique syndrome.</p><p><strong>Purpose: </strong>We present 8 cases of SHE for which a genetic diagnosis was carried out using a multigene epilepsy panel.</p><p><strong>Methods: </strong>We retrospectively screened familial and isolated cases of SHE in current follow-ups in our center.</p><p><strong>Results: </strong>We included 8 (5F/3M) patients, 5 of whom had a positive familial history of epilepsy. We identified a pathogenic mutation in <i>CHRNA4</i>, <i>CHRNB2</i>, and 3 different pathogenic changes in <i>DEPDC5</i>.</p><p><strong>Conclusions: </strong>Awareness of SHE needs to be raised, given its implications for finding an appropriate treatment, its relationship to cognitive and psychiatric comorbidities, and the opportunity to prevent the disorder in the descendants. We present our series with their clinical, radiological, electroencephalographic, and genetic characteristics, in which we found 3 pathogenic mutations in the <i>DEPDC5</i> gene but not previously reported in the literature. Identifying new pathogenic mutations or new genes responsible for SHE will facilitate a better understanding of the disease and a correct genetic counseling.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":" ","pages":"11795735211060114"},"PeriodicalIF":4.8,"publicationDate":"2022-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6e/5a/10.1177_11795735211060114.PMC8844731.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39934108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the effect and treatment sequence between a 2-week parallel repetitive transcranial magnetic stimulation and rehabilitation and a 2-week rehabilitation-only intervention during a 4-week hospitalization for upper limb paralysis after stroke: An open-label, crossover observational study.","authors":"Naoki Yamada,&nbsp;Kazumi Kashiwabara,&nbsp;Toru Takekawa,&nbsp;Midori Hama,&nbsp;Masachika Niimi,&nbsp;Takatoshi Hara,&nbsp;Satoshi Furumizo,&nbsp;Marika Tsuboi","doi":"10.1177/11795735211072731","DOIUrl":"https://doi.org/10.1177/11795735211072731","url":null,"abstract":"<p><strong>Background: </strong>NEURO^® is a 2-week program that combines low-frequency repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy (OT) to treat patients with chronic hemiparesis following stroke. The degree to which each element contributes to the improvement of upper limb function remains unclear. It has been suggested that low-frequency rTMS applied to a healthy cerebrum activates neural activity in the contralateral hemispheric area surrounding the lesion. Intensive OT performed in parallel to rTMS promotes the functional remodeling of the cerebrum to help with rehabilitation.</p><p><strong>Objectives: </strong>However, this has not been demonstrated using NEURO^®. Therefore, we aimed to compare the effects of the NEURO^® and OT-only protocols in patients with hemiparesis following stroke.</p><p><strong>Methods: </strong>Thirty-seven patients with upper limb paralysis following stroke were recruited and hospitalized for treatments and randomly divided into two groups. Group A consisted of 16 patients who underwent NEURO^® for the first 2 weeks, and Group B consisted of 21 patients who underwent OT-only for the first 2 weeks. After 2 weeks of hospitalization, the treatments of Groups A and B were reversed for the subsequent 2 weeks of treatment. Improvement in upper limb motor function in Groups A and B at 2 and 4 weeks after the start of treatment was evaluated using the Fugl-Meyer Motor Assessment (FMA) and the Wolf Motor Function Test (WMFT).</p><p><strong>Results: </strong>Group A, who underwent NEURO^® first during their initial 2-week hospitalization, showed significantly greater improvement than that in Group B, who underwent OT-only first (<i>P</i> = .041 for FMA and <i>P</i> < .01 for WMFT). At 4 weeks following the reversal of treatments, Group A who underwent NEURO^® and then OT-only showed significantly greater improvement than that in Group B, who underwent OT-only followed by NEURO^® (<i>P</i> = .011 for FMA and <i>P</i> = .001 for WMFT).</p><p><strong>Conclusion: </strong>Our findings indicate that rTMS facilitates neuromodulation when combined with OT, which leads to more effective rehabilitation than with OT alone (Trial registration: JMACCT (http://www.jmacct.med.or.jp/); trial ID JMA-IIA00215).</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":" ","pages":"11795735211072731"},"PeriodicalIF":4.8,"publicationDate":"2022-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/16/48/10.1177_11795735211072731.PMC8785323.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39963885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}