Adjunct therapies after botulinum toxin injections in spastic adults: Systematic review and SOFMER recommendations.

Background: Adjunct therapies (ATs) may further improve outcomes after botulinum toxin injections in spastic patients, but evidence was unclear in previous systematic reviews.

Objective: To assess the efficacy of non-pharmacological ATs in spastic adults according to the International Classification of Functioning, Disability and Health and build an expert consensus-based on a Delphi process.

Methods: Four electronic databases were searched up to May 2020 for reports of comparative trials of non-pharmacologic ATs after botulinum toxin injections in spastic adults.

Evaluation of an integrated multidisciplinary approach in multiple sclerosis care: A prospective, randomized, controlled study.

Background: Disabled multiple sclerosis (MS) patients often need intervention of multiple specialists, resulting in a complex organization of care. How this multidisciplinary care should be organized and structured has not been studied.

Objective: The objective of this article is to address the effectiveness of an integrated multidisciplinary approach versus usual care in MS patients.

Both L-DOPA and HFS-STN restore the enhanced group II spinal reflex excitation to a normal level in patients with Parkinson's disease.

Objective: To investigate the contribution of group II spinal pathways in Parkinsonian upper limb rigidity and the modulation of spinal excitability of group I and group II pathways by L-DOPA and subthalamic nucleus-high-frequency stimulation (STN-HFS).

Methods: The effect of ulnar nerve electrical stimulation on Flexor Carpi Radialis Electromyogram (FCR EMG) was investigated in two groups of patients: patients receiving medication (MED group) and chronically surgically implanted patients (DBS group). Results were compared in patients ON and OFF treatment, and between patients and control subjects.

TENS is harmful in primary writing tremor.

Objective: It is unclear whether primary writing tremor (PWT) is a tremulous form of dystonia or a tremor per se. Transcutaneous electrical nerve stimulation (TENS) at 50 Hz applied for 2 weeks was reported to improve the writing capabilities of patients with writer's cramp (WC). We explored whether such a beneficial effect can be obtained in patients with a PWT.

Distinguishing active from passive components of ankle plantar flexor stiffness in stroke, spinal cord injury and multiple sclerosis.

Objective: Spasticity is a common manifestation of lesion of central motor pathways. It is essential for correct anti-spastic treatment that passive and active contributions to increased muscle stiffness are distinguished. Here, we combined biomechanical and electrophysiological evaluation to distinguish the contribution of active reflex mechanisms from passive muscle properties to ankle joint stiffness in 31 healthy, 10 stroke, 30 multiple sclerosis and 16 spinal cord injured participants.

Enhanced spinal excitation from ankle flexors to knee extensors during walking in stroke patients.

Objectives: It is still unclear to what an extent altered reflex activity contributes to gait deficit following stroke. Spinal group I and group II excitations from ankle dorsiflexors to knee extensors were investigated during post-stroke walking.

Methods: Electrical stimulation was applied to the common peroneal nerve (CPN) in the early stance, and the short-latency biphasic excitation in Quadriceps motoneurones was evaluated from the Vastus Lateralis (VL) rectified and averaged (N=50) EMG activity in 14 stroke patients walking at 0.

Impaired efficacy of spinal presynaptic mechanisms in spastic stroke patients.

Pathophysiological mechanisms underlying spasticity have been the subject of many studies. These studies performed in various kinds of spastic patients have revealed abnormalities in many spinal pathways controlling motoneurone discharge. Unfortunately, the pathophysiological mechanisms responsible for the development of spasticity remains nevertheless largely unknown since most of the previous studies failed to reveal a link between the characteristics of spasticity (severity, time course) and that of the dysfunction of a given perturbed spinal pathway.

Reduction of common motoneuronal drive on the affected side during walking in hemiplegic stroke patients.

Objective: The objective of this study was to use motor unit coupling in the time and frequency domains to obtain evidence of changes in motoneuronal drive during walking in subjects with stroke.

Methods: Paired tibialis anterior (TA) EMG activity was sampled during the swing phase of treadmill walking in eight subjects with unilateral stroke.

Results: On the unaffected side, short-term synchronization was evident from the presence of a narrow central peak in cumulant densities and from the presence of significant coherence between these signals in the 10-25 Hz band.

Semantic processing of neglected numbers.

While neglected stimuli can still be processed, few studies have directly addressed the issue of the unconscious access to semantics. In order to clarify this issue, we engaged four patients with unilateral left spatial neglect in a number comparison task. Each target number was preceded by a lateralized number prime, either in the intact or neglected hemifield (HF).

[Neuropathy with non-alcoholic thiamine deficiency: two cases of bladder disorders].

Introduction: Neuropathy with non-alcoholic thiamine deficiency is reported in the literature, but bladder disorders are rarely detailed.

Case Reports: We report two cases of bladder disorders in neuropathy with thiamine deficiency. One patient presented with a flaccid bladder and impaired sensation; the postvoid residual volume was raised.

[Spontaneous muscular haematomas in hemiplegic patients receiving anticoagulation therapy].

Introduction: Muscular hematomas are frequently reported as a complication of anticoagulation therapy.

Methods: We report six cases of spontaneous muscular hematomas occurring in hemiplegic patients receiving anticoagulation therapy using heparin, low-molecular-weight heparin or fluindione. Anticoagulation therapy was given in prophylactic doses to two patients to prevent deep vein thrombosis and in therapeutic doses to four patients with deep vein thrombosis, pulmonary embolism or cardiac arrhythmia.

Changes in propriospinally mediated excitation of upper limb motoneurons in stroke patients.

It has been argued that, in humans, a part of the descending command to upper limb motoneurons is transmitted through cervical propriospinal pre-motoneurons. We explored whether excitation of these putative propriospinal neurons projecting onto extensor carpi radialis (ECR) motoneurons was modified in patients recovering from stroke. Suppression of the voluntary on-going ECR EMG activity by stimulation of cutaneous afferents in the superficial radial nerve was used to estimate the component of the descending command passing through the propriospinal relay.

[Conduction aphasia and phonemic disorder].

Conduction aphasia is usually described as a repetition impairment. Semiology or pathophysiology cannot be explained with this definition. We report a single case particularly demonstrative.

Interruption of a relay of corticospinal excitation by a spinal lesion at C6-C7.

In a patient with a limited lesion of the spinal cord at the C6-C7 junction, ulnar and superficial radial-induced modulations of the motor evoked potentials (MEP) and of ongoing electromyographic (EMG) activity were observed in the biceps (above the lesion) but not in the triceps (below the lesion). This suggests an interruption of the axons of cervical propriospinal neurons. This relay transmits an indirect (disynaptic) component of corticospinal excitation to human upper limb motoneurons.

Neurologic sequelae after severe falciparum malaria in adult travelers.

Severe falciparum malaria usually occurs in nonimmune patients, namely children in endemic areas or travelers returning from tropical areas. It generally has one of two outcomes: rapid death or cure without sequelae. Neurologic sequelae have been reported in children but have not been described in detail in adults.

Distribution of non-monosynaptic excitation to early and late recruited units in human forearm muscles.

The distribution of monosynaptic and nonmonosynaptic excitation was investigated within flexor carpi radialis (FCR) and extensor carpi radialis (ECR) motoneurone (MN) pools. FCR H reflexes of different size were conditioned by various conditioning stimuli eliciting different effects: (1) musculocutaneous-induced non-monosynaptic excitation of FCR MNs at the onset of biceps contraction, (2) heteronymous monosynaptic Ia facilitation, (3) reciprocal Ia inhibition, and (4) presynaptic inhibition of Ia terminals. Musculocutaneous-induced non-monosynaptic excitation increased continuously with the size of the unconditioned reflex.

The monosynaptic reflex: a tool to investigate motor control in humans. Interest and limits.

The principle of the monosynaptic reflex used as a tool to explore the excitability of the motoneurones (MNs) is explained and the general methodology of the H reflex is described. The different drawbacks inherent in the technique are then considered: mechanisms other than the monosynaptic la excitation of MNs contributing to the H reflex size (limitation of the H reflex size by disynaptic IPSPs, presynaptic inhibition of la terminals, post-activation depression); non-linearity and changes in the 'recruitment gain' in the MN pool; and poor time resolution of the method. Despite these drawbacks, it is emphasized that the H reflex is the only available technique enabling one to investigate changes in transmission in spinal pathways during motor tasks.

Handedness-related asymmetry in transmission in a system of human cervical premotoneurones.

The possibility was investigated that human handedness is associated with an asymmetrical cortical and/or peripheral control of the cervical premotoneurones (PreMNs) that have been shown to mediate part of the descending command to motoneurones of forearm muscles. Heteronymous facilitation evoked in the ongoing voluntary extensor carpi radialis (ECR) electromyographic activity (EMG) by weak (0.8 times motor threshold) stimulation of the musculo-cutaneous (MC) nerve was assessed during tonic co-contraction of biceps and ECR.

Overactivity of cervical premotor neurons in Parkinson's disease.

Objectives: Cortical command to upper limb motor neurons is transmitted, in humans, not only through the monosynaptic corticomotor neuronal pathway, but also through cervical premotor neurons. Whether activity in this non-monosynaptic corticospinal pathway is modified in Parkinson's disease was explored.

Methods: Ongoing EMG activity recorded in wrist extensors during tonic extension of the wrist is suppressed by a volley evoked by stimulating the superficial radial nerve.

A propriospinal-like contribution to electromyographic responses evoked in wrist extensor muscles by transcranial stimulation of the motor cortex in man.

We tested the hypothesis that some of the electromyographic (EMG) responses elicited in preactivated forearm muscles by transcranial stimulation of the human motor cortex are produced by activity in a disynaptic corticospinal linkage involving propriospinal-like interneurones with cell bodies in the spinal C3-4 segments. The experimental design incorporated a previous observation that stimulation of afferents in the superficial radial nerve inhibits propriospinal-like neurones projecting to the extensor carpi radialis (ECR) muscle. Surface EMG responses were recorded from the active ECR muscle after transcranial electrical or magnetic stimulation over the motor cortex.

A quantitative assessment of presynaptic inhibition of Ia afferents in spastics. Differences in hemiplegics and paraplegics.

Soleus H-reflex facilitation evoked by a supramaximal conditioning stimulation to the femoral nerve was investigated in 28 healthy control subjects and 35 spastic patients of whom 17 were paraplegics with bilateral spinal cord lesion and 18 were hemiplegics with unilateral cerebral lesion. Heteronymous facilitation from quadriceps to soleus was measured 0.4 ms after onset, while the monosynaptic Ia excitation is still uncontaminated by any non-monosynaptic effect and can be used to assess ongoing presynaptic inhibition on Ia terminals to soleus motor neurons.