Medical Specialties Commons^™

Inhibitory Or Excitatory? Optogenetic Interrogation Of The Functional Roles Of Gabaergic Interneurons In Epileptogenesis, Hui Ye

Biology: Faculty Publications and Other Works

Alteration in the excitatory/inhibitory neuronal balance is believed to be the underlying mechanism of epileptogenesis. Based on this theory, GABAergic interneurons are regarded as the primary inhibitory neurons, whose failure of action permits hyperactivity in the epileptic circuitry. As a consequence, optogenetic excitation of GABAergic interneurons is widely used for seizure suppression. However, recent evidence argues for the context-dependent, possibly “excitatory” roles that GABAergic cells play in epileptic circuitry. We reviewed current optogenetic approaches that target the “inhibitory” roles of GABAergic interneurons for seizure control. We also reviewed interesting evidence that supports the “excitatory” roles of GABAergic interneurons in epileptogenesis. …

Reorganization Of Thalamic Intrinsic Connectivity Following Anterior Temporal Lobectomy, Xiaosong He, Chaitanya Ganne, Michael R. Sperling, Ashwini Sharan, Joseph I. Tracy

Department of Neurosurgery Posters

The thalamus has played a crucial role in determining surgical outcome following anterior temporal lobectomy (ATL) in temporal lobe epilepsy (TLE) (He, et al., 2017). Before successfully quantifying the impact of the thalamus on ATL outcomes, this structure’s own intrinsic connectivity must be understood. Accordingly, we characterize thalamic intrinsic connectivity through resting-state fMRI (rsfMRI) longitudinally, exploring its change pre- to post-surgery.

Intermediate-Term Risk Of Stroke Following Cardiac Procedures In A Nationally Representative Data Set., Laura Stein, Alison Thaler, John W. Liang, Stanley Tuhrim, Amit S. Dhamoon, Mandip S. Dhamoon

Department of Neurology Faculty Papers

BACKGROUND: Studies on stroke risk following cardiac procedures addressed only perioperative and long-term risk following limited higher-risk procedures, were poorly generalizable, and often failed to stratify by stroke type. We calculated stroke risk in the intermediate risk period following cardiac procedures compared with common noncardiac surgeries and medical admissions.

METHODS AND RESULTS: The Nationwide Readmissions Database contains readmission data for 49% of US admissions in 2013. We compared age-adjusted stroke readmission rates up to 90 days postdischarge. We used Cox regression to calculate hazard ratios, up to 1 year, of stroke risk comparing transcatheter aortic valve replacement versus surgical aortic …

X-Linked Hypomyelination With Spondylometaphyseal Dysplasia (H-Smd) Associated With Mutations In Aifm1., Noriko Miyake, Nicole I Wolf, Ferdy K Cayami, Joanna Crawford, Annette Bley, Dorothy Bulas, Ryan J Taft, Adeline Vanderver, +Several Additional Authors

Neurology Faculty Publications

An X-linked condition characterized by the combination of hypomyelinating leukodystrophy and spondylometaphyseal dysplasia (H-SMD) has been observed in only four families, with linkage to Xq25-27, and recent genetic characterization in two families with a common AIFM1 mutation. In our study, 12 patients (6 families) with H-SMD were identified and underwent comprehensive assessment accompanied by whole-exome sequencing (WES). Pedigree analysis in all families was consistent with X-linked recessive inheritance. Presentation typically occurred between 12 and 36 months. In addition to the two disease-defining features of spondylometaphyseal dysplasia and hypomyelination on MRI, common clinical signs and symptoms included motor deterioration, spasticity, tremor, …

Survival Benefit Of Surgery In Recurrent Glioblastoma Multiforme, Usama Khalid Choudry, Saad Akhtar Khan, Muhammad Shahzad Shamim

Section of Neurosurgery

There is an ongoing debate regarding role of surgery for recurrent glioblastoma multiforme (GBM). Older literature hinted at only modest survival benefits with surgery and a high rate of morbidity. However, more recent literature suggests better survival that may be attributed to better surgical techniques and better options in adjuvant treatment. Herein the authors review recent literature with regards to the possible role of surgery in recurrent GBM and also look into the key factors impacting second surgery.

Incidence Of Cognitively Defined Late-Onset Alzheimer's Dementia Subgroups From A Prospective Cohort Study., Paul K Crane, Emily Trittschuh, Shubhabrata Mukherjee, Andrew J Saykin, R Elizabeth Sanders, Eric B Larson, Susan M Mccurry, Wayne Mccormick, J D Bowen, Thomas Grabowski, Mackenzie Moore, Julianna Bauman, Alden L Gross, C Dirk Keene, Thomas D Bird, Laura E Gibbons, Jesse Mez

Articles, Abstracts, and Reports

INTRODUCTION: There may be biologically relevant heterogeneity within typical late-onset Alzheimer's dementia.

METHODS: We analyzed cognitive data from people with incident late-onset Alzheimer's dementia from a prospective cohort study. We determined individual averages across memory, visuospatial functioning, language, and executive functioning. We identified domains with substantial impairments relative to that average. We compared demographic, neuropathology, and genetic findings across groups defined by relative impairments.

RESULTS: During 32,286 person-years of follow-up, 869 people developed Alzheimer's dementia. There were 393 (48%) with no domain with substantial relative impairments. Some participants had isolated relative impairments in memory (148, 18%), visuospatial functioning (117, 14%), …

Neurological Burden In Baluchistan Province, Pakistan, Mohammad Saleem Barech

Pakistan Journal of Neurological Sciences (PJNS)

Total population of Balochistan is about13.16 million, while there are only nine qualified Neurologists in the whole province who look after not only neurological disorders of the province, but also patients from nearby countries like Afghanistan and Iran. The common neurological disorders are Stroke, Neuropathies, Myopathies, Epilepsy, Migraine, SSPE, Multiple Sclerosis, Meningitis, Myasthenia Gravis, Parkinson's disease and infectious diseases especially Tuberculosis, which is very common.

Correlation Of Duration Of Diabetes With Upper Limb Musculoskeletal Problems, Hazim Brohi, Rajesh Kumar, Aqiba Surfaraz, Tahira Parveen, M Usman, Syed Ijlal Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Long standing uncontrolled diabetes is associated with many clinical problems and it frequently involves hands and shoulder causing stenosing tenosynovitis (trigger finger), Dupuytren's contracture, carpal tunnel syndrome, limited joint mobility and shoulder capsulitis. The prevalence of hand symptoms has been variable in different studies. Data from our part of world is scares. Our study aimed at looking at frequency of these hand symptoms with duration of the diabetes.

Depression In Stroke Patients; A Cross Sectional Study Highlighting The Association Of Stroke On Age And Gender Basis., Saira Abbas, Naila Naeem Shahbaz, Muhammad Amir Umer, Sumera Rafat Umer, Asfia Irfan, Adnan Anwar

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is the second leading cause of death. Depressive disorder is characterized by period of sad mood and anhedonia occurring for two consecutive weeks. Among stroke survivors, the consequence of physical and psychological changes can be devastating. One of those psychological changes is post-stroke depression (PSD). Stroke itself has debilitating morbidity and superimposed PSD further decreases the quality of life of patients and impairs recovery. This study leads us to know the magnitude of post stroke depression.

Dopamine Responsive Dystonia(Drd) In A 25 Year Old Lady, Samar Iltaf Pechuho, Abdul Rahman Soomro, Alam Ibrahim Siddiqui, Tufail Ahmed Pechuho, Imran Ali Gopang

Pakistan Journal of Neurological Sciences (PJNS)

Dopamine responsive dystonia (DRD) is a dystonic syndrome of childhood, usually affecting gait. It presents with walking difficulties, spasticity or dystonia with a characteristic diurnal variation and MRI brain scan is normal in it. It may however develop into Parkinsonism later, which shows dramatic therapeutic response to levodopa. A 25 year old lady presented with difficulty in walking along with weakness and stiffness of both legs at Neurology OPD of Chandka Medical College Hospital,Larkana. After reaching at proper diagnosis of DRD, treatment was started. As a result of which, she showed dramatic improvement and was able to return back to …

A Rare Case Of Becker Disease In A 7 Year Old Boy, Prem Chand, Rozmeen Badruddin Husein, Fazal M. Arain

Pakistan Journal of Neurological Sciences (PJNS)

Becker Disease is an autosomal recessive version of the rare congenital disorder called Myotonia Congenita. Due to the rarity of Becker Disease, the genetic and pathological basis of this disease have not been studied well and possible diagnostic methods and techniques are yet to be explored. The existing method of diagnosis of such a case is predominantly dependent on the clinical examination. More work and studies need to be done on the diagnostic aspect of this disease to discover newer diagnostic methods for this disease, which are more reliable and specific. In order to develop better diagnostic methods for the …

Epidemiological Data Of Neurological Disorders In Pakistan And Neighboring Countries: A Review, Ghulam Hussain, Azhar Rasul, Haseeb Anwar, Muhammad Umar Sohail, Syed Kashif Shahid Kamran, Shahid Mahmood Baig, Asghar Shabbir, Javed Iqbal

Pakistan Journal of Neurological Sciences (PJNS)

Neurological disorders are the impairments of nervous system and are an important and growing cause of morbidity, mortality, and disability. In addition to health costs, those suffering from these conditions are also frequently victimized of stigmatization and discrimination. Stigmatization further minimizes the patients' access to treatment and social activities. These disorders, therefore, require special attention particularly in developing countries where unfortunately, the burden of these disorders remains largely unrecognized. Moreover, the burden imposed by such chronic neurological conditions in general can be expected to be particularly devastating in poor populations. These conditions are emerging as severe public health concerns in …

5th National Headache Update, Abdul Malik

Pakistan Journal of Neurological Sciences (PJNS)

Headache is one of the most common disorders worldwide. On the World Health Organization's ranking of causes of disability, this would bring headache disorders into the 10 most disabling conditions for both genders, and into the five most disabling for women. The prevalence of headache disorders in Pakistan is high, and would be at least on par with that reported in other parts of the world, although a recent epidemiological survey suggests that the prevalence of migraines could be as high as 22%, almost twice that noted in the international literature. Over the years, the Pakistan Headache Society (PHS) has …

Trends In Spinal Surgery For Pott's Disease (2000-2016): An Overview And Bibliometric Study., Christian Fisahn, Fernando Alonso, Ghazwan A Hasan, R Shane Tubbs, Joseph R Dettori, Thomas A Schildhauer, Tarush Rustagi

Articles, Abstracts, and Reports

Study Design: Systematic review.

Objectives: (1) What are the surgical indications? Have they changed over time since the year 2000? (2) What is the current surgical approaches of choice? Have they changed over time since the year 2000? Do they vary by geographical region? (3) What are the most common outcome measures following surgery?

Methods: Electronic databases and reference lists of key articles were searched from database inception from January 1, 2000 to December 31, 2016 to identify studies specifically evaluating surgical indications, current surgical approaches, and outcome measures for spinal tuberculosis.

Results: Six randomized controlled trials were identified from …

Editorial Perspective., Jens R Chapman

Articles, Abstracts, and Reports

No abstract provided.

Editorial., Jeffrey C Wang, Jens R Chapman, Karsten Wiechert

Articles, Abstracts, and Reports

No abstract provided.

Influence Of Dietary Salt Knowledge, Perceptions, And Beliefs On Consumption Choices After Stroke In Uganda, Martin N. Kaddumukasa, Elly Katabira, Martha Sajatovic, Svetlana Pundik, Mark Kaddumukasa, Larry B. Goldstein

Neurology Faculty Publications

Background

Previous research on Uganda's poststroke population revealed that their level of dietary salt knowledge did not lead to healthier consumption choices.

Purpose

Identify barriers and motivators for healthy dietary behaviors and evaluate the understanding of widely accepted salt regulation mechanisms among poststroke patients in Uganda.

Methods

Convergent parallel mixed methods triangulation design comprised a cross-sectional survey (n = 81) and 8 focus group discussions with 7-10 poststroke participants in each group. We assessed participant characteristics and obtained insights into their salt consumption attitudes, perceptions, and knowledge. Qualitative responses were analyzed using an inductive approach with thematic analytic procedures. Relationships …

Plekhg5-Regulated Autophagy Of Synaptic Vesicles Reveals A Pathogenic Mechanism In Motoneuron Disease., Patrick Lüningschrör, Beyenech Binotti, Benjamin Dombert, Peter Heimann, Angel Perez-Lara, Carsten Slotta, Nadine Thau-Habermann, Cora R. Von Collenberg, Franziska Karl, Markus Damme, Arie Horowitz, Isabelle Maystadt, Annette Füchtbauer, Ernst-Martin Füchtbauer, Sibylle Jablonka, Robert Blum, Nurcan Üçeyler, Susanne Petri, Barbara Kaltschmidt, Reinhard Jahn, Christian Kaltschmidt, Michael Sendtner

Department of Medicine Faculty Papers

Autophagy-mediated degradation of synaptic components maintains synaptic homeostasis but also constitutes a mechanism of neurodegeneration. It is unclear how autophagy of synaptic vesicles and components of presynaptic active zones is regulated. Here, we show that Pleckstrin homology containing family member 5 (Plekhg5) modulates autophagy of synaptic vesicles in axon terminals of motoneurons via its function as a guanine exchange factor for Rab26, a small GTPase that specifically directs synaptic vesicles to preautophagosomal structures. Plekhg5 gene inactivation in mice results in a late-onset motoneuron disease, characterized by degeneration of axon terminals. Plekhg5-depleted cultured motoneurons show defective axon growth and impaired autophagy …

Cognitive Trajectory Changes Over 20 Years Before Dementia Diagnosis: A Large Cohort Study., Ge Li, Eric B Larson, Jane B Shofer, Paul K Crane, Laura E Gibbons, Wayne Mccormick, J D Bowen, Mary Lou Thompson

Articles, Abstracts, and Reports

BACKGROUND/OBJECTIVES: Longitudinal studies have shown an increase in cognitive decline many years before clinical diagnosis of dementia. We sought to estimate changes, relative to "normal" aging, in the trajectory of scores on a global cognitive function test-the Cognitive Abilities Screening Instrument (CASI).

DESIGN: A prospective cohort study.

SETTING: Community-dwelling members of a U.S. health maintenance organization.

PARTICIPANTS: Individuals aged 65 and older who had no dementia diagnosis at baseline and had at least two visits with valid CASI test score (N = 4,315).

MEASUREMENTS: Average longitudinal trajectories, including changes in trajectory before clinical diagnosis in those who would be diagnosed …

Lefort 1 Access For Juvenile Nasopharyngeal Angiofibroma Treated Without Angiographic Embolization., Shaheen Ahmed, Muhammad Imran, Atiq Ahmed Khan, Anwar Ali, Syed Ijlal Ahmed, Asim Rehmani, Muhammad Faaiq Ali

Pakistan Journal of Neurological Sciences (PJNS)

To assess and analyze the clinical presentation of Juvenile nasopharyngeal angiofibroma and analyze the complications associated with JNA resection without pre surgical embolization using LeFort 1.

Pharygeal Cervicobrachial Variant Of Guillian -Barre Syndrome, Hazim Brohi, Marium Mustaqeem, Sundus Khan

Pakistan Journal of Neurological Sciences (PJNS)

Guilain-Barre Syndrome (GBS) is a common cause of Neuro-muscular paralysis with a spectrum of clinical and electrophysiology variants. We present a case of thePharyneo-cervico-brachial type. A 25 yr old male came to the Medical OPD with the complains of one day history of upper limb weakness and decreased flexion of the neck , which was progressively worsening, along-with associated shortness of breath. His systemic inquiry and past medical/surgical histories were insignificant. Physical exam correlated withthe diagnostic criteria of PCB variant of GBS. Diagnosis was confirmed on EMG/NCS,which showed axonal neuropathy involving axillay and musculocutaneousnerve, along with absent F –waves latencies …

New Oral Anticoagulants (Noacs) For Cerebral Venous Thrombosis, Maria Khan, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Cerebral venous thrombosis (CVT) is a relatively rare condition that results from thrombosis of the superficial or deep venous sinuses of the brain. The first ever reported case of the condition was back in 1825 and this was diagnosed at autopsy. It took more than 150 years before imaging modalities were developed that could diagnose cases earlier. With the advent of CT and MR venogram, the diagnosis has become much easier and is contributing to a larger number of cases being picked up. Despite that the incidence in Western literature stays low at 1.3-1.6 cases per 100,000 people. Middle Eastern …

Early Electrophysiological Findings In Guillain Barre Syndrome, Hazim Brohi, Rajesh Kumar, Sadia Mubarak, Muhammmad Anees Mumtaz

Pakistan Journal of Neurological Sciences (PJNS)

Early electrophysiological testing is more important as early abnormalities can be obtained even in the first week. However the electrical abnormalities may not be that prominently evident for definitive diagnosis in the first 2 weeks. However at times the decision of treatment has to be taken early. Research is required to look at different electrophysiological parameter which could give clue for an earlier diagnosis. The aim of our study is to determine early electrophysiological parameters with in first week to identify GBS at earliest.

Burden And Pattern Of Neurological Diseases Seen In Neurology Department Of A Tertiary Care Hospital In Baluchistan, Wazir Akbar, Noor Ahmed Khosa, Abdul Bari Nasar

Pakistan Journal of Neurological Sciences (PJNS)

Neurologic disorders represent a major burden of disease globally. These are common and represent a major public health problem. The spectrum of diseases ranges from non communicable disorders like stroke and neurodegenerative disorders to central nervous system infections. The burden of neurological diseases may be on the increase especially in developing countries. Improved outcome in these settings may require appreciation of the spectrum of neurological diseases and the impediments to their management.The pattern of neurological admissions in hospital varies amongst different regions of the world and this depends on many factors including the regional burden of neurological disorders.

Dementia Survey Among Attendees Of A Dementia Awareness Event In Karachi, Pakistan, Qurat Ul Ain Khan, Yusra Hanif Khan, Mohammad Zaman Khan, Shireen Najam

Pakistan Journal of Neurological Sciences (PJNS)

There is little information available about peoples'knowledgeregarding symptoms of dementia, dementia diagnosis, and care arrangementsfor dementia patients in Pakistan. Aims: We aimed to find out if patients with dementia and their caregivers were aware of diagnosis, the most common and most distressing symptoms, and care arrangement for these patients.

Does Music Therapy Intervention Have An Effect On The Emotional Behavior Of Alzheimer Patients?, Alexandra P. Lahurd

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not music therapy intervention have an effect on emotional behavior of Alzheimer patients. Behavior variables measuring are agitation and anxiety.

STUDY DESIGN: Systematic review of two randomized, controlled trials published in 2009 and 2014, respectively, and one randomized control case study published in 2006.

DATA SOURCE: Three published studies comparing music therapy intervention on behavioral modifications with Alzheimer patients were found using PubMed and Medline

OUTCOMES MEASURES: All three studies measure behavior in Alzheimer patients based on a variety of well validated …

Pitx3null Mutant (Striatal Dopamine-Deficient) Mice Have Exaggerated Spiny Projection Neuron Responses To L-Dopa And D1 Agonism And Lack Baseline Striatonigral Spiking, Ben Sagot

Theses and Dissertations (ETD)

L-3,4 dihidroxyphenylalanine (l-DOPA) strongly stimulates motor activity in parkinsonian patients and animal models of Parkinson's disease. Severe striatal dopamine (DA) loss characterizes Parkinson's disease and its animal models. Given the canonical rate model of Parkinson's Disease pathophysiology based on differences in DA pharmacology manifesting as electrophysiological differences in striatal projection neuron (SPN) spike rates, SPNs should increase spiking during the motor response to l-DOPA. In fact, stimulating specific subsets of these neurons to spike in freely-moving wild type and parkinsonian animals causes or inhibits motor activity as predicted. However, pharmacological effects of DA deficiency, let alone those of DA replacement, …

Silent Sentence Completion Shows Superiority Localizing Wernicke's Area And Activation Patterns Of Distinct Language Paradigms Correlate With Genomics: Prospective Study., Kamel El Salek, Islam S. Hassan, Aikaterini Kotrotsou, Srishti Abrol, Scott H. Faro, Feroze B. Mohamed, Pascal O. Zinn, Wei Wei, Nan Li, Ashok J. Kumar, Jeffrey S. Weinberg, Jeffrey S. Wefel, Shelli R. Kesler, Ho-Ling Anthony Liu, Ping Hou, R. Jason Stafford, Sujit Prabhu, Raymond Sawaya, Rivka R. Colen

Department of Radiology Faculty Papers

Preoperative mapping of language areas using fMRI greatly depends on the paradigms used, as different tasks harness distinct capabilities to activate speech processing areas. In this study, we compared the ability of 3 covert speech paradigms: Silent Sentence Completion (SSC), category naming (CAT) and verbal fluency (FAS), in localizing the Wernicke's area and studied the association between genomic markers and functional activation. Fifteen right-handed healthy volunteers and 35 mixed-handed patients were included. We focused on the anatomical areas of posterosuperior, middle temporal and angular gyri corresponding to Wernicke's area. Activity was deemed significant in a region of interest if P < 0.05. Association between fMRI activation and genomic mutation status was obtained. Results demonstrated SSC's superiority at localizing Wernicke's area. SSC demonstrated functional activity in 100% of cancer patients and healthy volunteers; which was significantly higher than those for FAS and CAT. Patients with 1p/19q non-co-deleted had higher extent of activation on SSC (P < 0.02). Those with IDH-1 wild-type were more likely to show no activity on CAT (P < 0.05). SSC is a robust paradigm for localizing Wernicke's area, making it an important clinical tool for function-preserving surgeries. We also found a correlation between tumor genomics and functional activation, which deserves more comprehensive study.

The Technique Of S2-Alar-Iliac Screw Fixation: A Literature Review, Ai-Min Wu, Dong Chen, Chun-Hui Chen, Yu-Zhe Li, Li Tan Li Tang, Kevin Phan, Kern Singh, Brittany E. Haws, Daniele Vanni, Yusef I. Mosley, Srinivas K. Prasad, James Harrop, Zhong-Ke Lin, Yan Lin, Wen-Fei Ni, Xiang-Yang Wang

Department of Neurosurgery Faculty Papers

The distal fixation in thoracolumbar deformity surgery can be challenging for spine surgeons. When isolated S1-pedicle screws are utilized as the sole distal fixation in long thoracolumbar posterior constructs, there is a high rate of failure, due to loosening, breakage, and pseudarthrosis. Unfortunately, with iliac screw fixation the entry point at the posterior superior iliac spine requires considerable soft tissue dissection and may potentially increase the likelihood of wound complications. S2-alar-iliac (S2AI) screw fixation technique was developed recently to provide increased fixation with a lower profile screw and rod construct. These screws can be inserted with percutaneous or free hand …

Anaesthetic Management Of Supratentorial Tumor Craniotomy Using Awake-Throughout Approach, Faraz Shafiq, Fahad Salim, Ather Enam, Jai Parkash, Mohammad Faheem

Department of Anaesthesia

The authors are reporting an anaesthetic management of patient presenting with left parietal lobe space occupying lesion and scheduled for Awake-craniotomy. Awake-throughout approach using scalp block was planned. Among techniques reported for keeping patient awake during the surgery, this one is really underutilized. The successful conduct requires thorough preoperative assessment and psychological preparation. We used powerpoint presentation as a preoperative teaching tool. The anatomical landmark technique was used to institute scalp block, where individual nerves were targeted bilaterally. Patient remained stable throughout and participated actively in intraoperative neurological monitoring. Postoperative period showed remarkable recovery, better pain control, and shorter length …