International Journal of Neurorehabilitation

Background: Medication therapy is commonly accepted as the initial treatment of trigeminal neuralgia (TN). Microvascular decompression (MVD) is the surgical treatment with the highest efficacy, but is considered as last tier therapy for patients with medication refractory pain or for those with unbearable side effects. The aim of this study was to investigate the association of symptom duration on outcome.
Methods: A retrospective study was conducted from 2001 through 2012. Patients were categorized according to Burchiel’s “Classification scheme for facial pains commonly encountered in neurosurgical practice”. Demographical, disease and treatment data as well as surgical data including complications and outcome were recorded and analyzed.
Results: In total, 65 patients were included. Distribution of diagnoses was as follows: TN type 1 (>50% episodic pain) n=54, TN type 2 (>50% constant pain) n=4, neuropathic TN n=1, symptomatic TN due to multiple sclerosis n=3, post herpetic n=2. Onset of disease to surgery was on average 7 years (<1-21 years). Shorter time from disease onset to surgery had a statistically significant association with a pain-free outcome in only TN type 1 patients (6 vs. 13 years, p=0.01). Overall success rate in TN1 was 88.9%. Overall mortality and morbidity rate were 3%. Overall complication rate was 13.5%.
Conclusion: Earlier MVD was significantly associated with better outcome. Patients should be informed about the option of MVD at an early stage of disease.

We previously reported evidence about the positive effects of continuous aerobic training (CAT) in hypertensive obese people. We showed that 90 min/week of aerobic exercise on a treadmill (70%-80% of the Maximal Heart Rate [MHR]) was able to improve the systemic blood metabolism of obese subjects. Therefore, we believe that reducing the recommended amount of aerobic exercise (150 min/week) by American College of Sports Medicine (ACSM) is a valuable strategy to for sedentary individuals with pathological conditions, since the suggested protocol is easyto- perform, fast and enjoyable for the subjects. In this comment, we tempt to summarize the literature evidences regarding physical aerobic exercise on cardiac metabolism in hypertensive obese individuals. These findings may influence the consenting information over the prescription of physical activity for individuals with cardiac-associated pathologies.

Autism spectrum disorders (ASD) are composed by a variety of developmental deficits, such as problems in verbal communication and repetitive behaviours. Together with these social deficits, the recent literature has reported difficulties in motor coordination during the everyday life of children and adolescents with ASD. These motor deficits could be linked to a possible alteration of motor simulation processes in ASD but just a few studies attempted to directly compare motor imagery tasks and actual motor coordination within these disorders and specifically using the same task. In a recent study, the relationship between explicit motor imagery and motor execution has been investigated within the same experimental paradigm. The authors employed a spatial bimanual task called “circles-lines” task where participants are asked to draw with one hand (i.e., baseline), either hands (i.e., bimanual task) or try to imagine the movements with one hand while simultaneously draw with the other (i.e., imagery task). This task is a prototype of a complex bimanual skill and shows how these two processes can be studied together within the same paradigm. In particular, results of the study highlighted how motor imagery and motor coordination only partially follow the same path of development in ASD. Indeed, ASD participants showed much lower results in the motor imagery task in comparison to the performance in actual bimanual task, which was similar to the typically developed controls. In conclusion, the data show that motor imagery and actual coordination, even though interrelated processes which share similar brain areas, can be dissociated in ASD where development of spatial coordination consolidates earlier than motor imagery

We previously reported the recurrence factors and the effect of Gorei-san on chronic subdural hematoma (CSDH) using percutaneous subdural tapping. Herein, we comment on less invasive surgical option and postsurgical administration for CSDH. Many factors for CSDH recurrence have been identified and categorized into four groups, namely: patient background, hematoma character, postsurgical administration, and surgical option. Patient background and hematoma character cannot be intervened for patients’ specific problem. Gorei-san has been reported to prevent CSDH recurrence without adverse events even if administered for elder patients. Gorei-san inhibits aquaporin-4, which is expressed on the outer membrane of chronic subdural hematoma. We have good impression of prevention effect of CSDH recurrence especially for those who started Gorei-san before surgery. Several surgical options for CSDH are reported as follows: burr hole surgery, percutaneous subdural tapping, endovascular embolization of middle meningeal artery, and craniotomy. Although burr hole surgery has been performed worldwide as a standard procedure for CSDH, percutaneous subdural tapping has been developed to realize less invasive surgical option, which allows noninvasive measurement of initial hematoma pressure and eases the perioperative management due to rapid discharge.

Disorders of movement and posture development in children with cerebral palsy can limit the participation in everyday activities, such as learning and play. In the modern concept of motor learning, the interaction among an individual, the task, and the individual’s environment are crucial in improving the individual’s motor ability, and taskorientation training is the representative approach for motor learning. This short commentary reviews task-orientation training as an intervention in the functional mobility and postural control of children with cerebral palsy

Background: Increased levels of asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) are associated with endothelial dysfunction. Here, we analyzed the relationship between L-arginine pathway metabolites and functional outcome of ischemic stroke at discharge and 6 months follow-up.
Methods: Plasma concentration of L-arginine, ADMA, SDMA were investigated in 46 patients at post-stroke 24 h. Outcome measures were assessed by modified Rankin scale (mRS) at hospital discharge and 6 months follow-up. According to change in mRS score during the 6 months period, patients were divided into subgroups of improved, unchanged and worsened function. Predictive role of L-arginine pathway metabolites were explored in these outcome groups.
Results: Significant inverse correlations were found between initial NIHSS and the L-arginine/ADMA, the L-arginine/SDMA ratios and L-arginine plasma concentration (all p<0.05, respectively). Patients with worsened mRS by 6 months had significantly higher L-arginine plasma concentrations at 24 post-stroke hours compared to patients with improved mRS (p<0.001) and unchanged mRS (p<0.005). The L-arginine/ADMA (p<0.004) and the L-arginin/ SDMA (p<0.002) ratios at 24 h were significantly higher among patients with worsened compared to improved mRS. Besides, clinical factors, such as BMI showed negative correlation with L-arginine/ADMA; creatinine showed positive correlation with L-arginine and L-arginine/ADMA; LDL showed positive correlation with L-arginine/SDMA ratio. Plasma concentration of ADMA was significantly higher among smokers compared to non-smokers. The L-arginine/ADMA, the L-arginine/SDMA ratios and L-arginine plasma concentration negatively correlated with change of mRS between hospital discharge and at 6 months.
Conclusion: Our data indicate that lower L-arginine/SDMA ratio is associated with worse outcome on the shortterm, but these patients improve on the long-term resulting in association of lower ratios with improving mRS. In contrast, patients with high L-arginine and low mRS improve fast, but will not improve or may even worsen by 6 months indicating a time-dependent biological effect.