Neurological Disorders

A number of disorders cause ataxia which are the determinants of the choice of treatment for the patients affected by it. Correct diagnosis of the underlying disorder depends, not only on the qualification of the attending doctor but also on the accurate communication of the patient with the doctor. History thus plays a vital role in the diagnosis. Proper management might follow counselling sessions at times just to highlight the importance of history to a patient who is unaware about it. Here we present the case of a 32-year-old male who was experiencing progressive motor impairment. This report highlights the value of proper history in the diagnosis of the disease our patient is affected with.

Objective: To determine the effectiveness of multi-professional palliative care in patients with amyotrophic lateral sclerosis in Brazilian public health system.

Methods: Historic-control study before and after the Reference Center, with records and mortality data of 302 patients treated with riluzole between 2005 and 2015, were retrospectively evaluated and survival curves were analyzed.

Results: There were 181 men (59.9%) and 121 women (40.1%) with a diagnostic delay time of 28.1 months for spinal-onset and 20.1 months for bulbar-onset (p=0.003) and a mean survival of 61.7 ± 5.4 months for spinal-onset and 38 ± 3.5 months for bulbar-onset (p=0.01). Electromyography did not confirm the diagnosis in 55.6% of the suspected spinal-onset cases and 36.1% of the bulbar-onset. From 2005 to 2011, mean survival was 33.6 ± 2.4 months, and after multidisciplinary care, 72.2 ± 7.2 months (log-rank: 0.0001).

Conclusion: Multidisciplinary care improves the survival of amyotrophic lateral sclerosis patients in the Unique Health System.

Sarcoidosis is an inflammatory multisystem disorder, usually involving the lung, the skin, the lymph nodes, and the eyes. The prevalence of clinical involvement of the nervous system is estimated to be about 5% to 15% [1]. Both central and peripheral nervous system can be affected. Sarcoid polyneuropathy is a rare and clinically heterogeneous disorder that may be the initial presentation of sarcoidosis [2]. Only a few cases have been reported of chronic demyelinating inflammatory polyradiculoneuropathy (CIDP) associated with sarcoidosis. We report a clinical course of a patient presented with a sensorimotor demyelinating polyneuropathy with secondary axonal loss few years after being diagnosed with lung sarcoidosis.

Repetitive Transcranial magnetic stimulation (rTMS) is emerging as a new investigation as well as treatment tool for various neurological and psychiatric diseases. Recent studies showed its application as treatment tool in movement disorders, where rTMS stimulation on primary motor cortex alters physiological patterns of motor threshold; motor evoked potential and cortical plasticity which induces motor activity. Recent studies on rTMS combined with rehabilitation therapy demonstrated functional improvement in motor activities of spastic cerebral palsy (sCP) children. Thus, this study was designed to evaluate the effect of rTMS on hand function of sCP patients.

Forty-five children diagnosed as sCP participated in this study after written consent from their parents or guardians. They were divided into three groups- control (CG) and interventional group (IG-A and IG-B). Participants in CG were provided only physical therapy (PT) of 30 minutes duration daily for 20 days and those in IG were administered rTMS frequency of 5Hz (IG-A) and 10Hz (IG-B) for 15 minutes consisting of 1500 pulses daily for 20 days; followed by PT as given to CG. Quality of upper extremity skill test (QUEST) scoring was used for evaluating the improvement in hand function of sCP patients. The pre (before starting any therapy) versus post (after completion of 20 sessions) mean QUEST score between different groups were statistically significant (p<0.01) and the mean change was 0.61, 2.46 and 2.87 in CG, IG-A and IG-B respectively.

However, encouraging functional improvement in hand function was observed in diplegic patients in the age group of 2-6 years employing 5Hz frequency and higher frequency (10Hz) induced better activity in hemiplegic and quadriplegic patient of older age groups (7-16 years).

Vertical diplopia and nystagmus typically occur in lesions of the brainstem or cerebellum. The ocular findings are exceedingly rare in thalamic infarction. The vertical gaze paresis is usually involved. Here, we describe a patient presenting with vertical diplopia and nystagmus without gaze paresis secondary to isolated medial thalamic infarct.