Neurology Commons^™

Accommodating Hyperaroused Information Processing In Persons At Risk For Alcoholism, Kellianne Clark, Jaclyn Cutler

Student Scholar Symposium Abstracts and Posters

In the search for the factors related to the heightened alcoholism risk in adult children of alcoholics (ACOA), it has been reported that these persons possess a high incidence of attention deficit disorders (ADD) as determined by clinical assessment instruments. However, investigations of alcoholism risk and ADD indicate that, in contrast to the hypoarousal model of ADD, the ACOA’s attention problems represent hyperarousal of attention mechanisms resulting in reduced ability to select and encode relevant information. If true, then unlike persons with ADD, clinical and cognitive assessments of ACOAs would benefit if the ACOA was provided with more time to …

A Randomized Noninferiority Trial Of Condensed Protocols For Genetic Risk Disclosure Of Alzheimer's Disease, Peter J. Whitehouse, Melissa Barber Butson

Faculty Scholarship

Introduction Conventional multisession genetic counseling is currently recommended when disclosing apolipoprotein E (APOE) genotype for the risk of Alzheimer's disease (AD) in cognitively normal individuals. The objective of this study was to evaluate the safety of brief disclosure protocols for disclosing APOE genotype for the risk of AD. Methods A randomized, multicenter noninferiority trial was conducted at four sites. Participants were asymptomatic adults having a first-degree relative with AD. A standard disclosure protocol by genetic counselors (SP-GC) was compared with condensed protocols, with disclosures by genetic counselors (CP-GC) and by physicians (CP-MD). Preplanned co-primary outcomes were anxiety and depression scales …

The Impact Of Prenatal Stress On The Development Of Limbic System Structures, Alyssa Murray

Honors Theses

Stress in early life is well documented as detrimental for the brain’s developmental trajectory, while prenatal stress is minimally explored. In the prenatal period, the placenta prevents much of the mother’s cortisol from reaching the fetus, but the fetus is still exposed to some maternal cortisol, and exposure increases with increasing stress. One neural structure particularly susceptible to stress is the hippocampus. The goal of this review is to address the role prenatal stress may play in damaging the hippocampus, a structure integral to learning and memory functions. Correlations between prenatal stress and a reduction in volume and function of …

Adults With Intellectual Disability Or Autism Spectrum Disorder. Executive Summary, Kimberly I. Snow Mhsa, Ba, Stuart Bratesman Mpp, Taryn Bowe, Julie T. Fralich Mba

Disability & Aging

This chartbook describes Maine’s historical trends in meeting the needs of adults with ID/ASD through institutional and community based services in comparison to other states; a detailed analysis of the population’s utilization of different types of services and their costs in SFY 2010; the implementation of the Supports Intensity Scale (SIS) as a means of identifying the supports needs of the adults with ID/ASD; and the complement of providers serving this population in Maine.

A Case Report Of Joubert Syndrome In Adult Presenting With Seizures, Ramla Nayaib Hashmi, Umm Ul Kiram

Pakistan Journal of Neurological Sciences (PJNS)

Joubert syndrome (JS) is rare autosomal recessive condition characterized by hypotonia, ataxia, psychomotor delay, and variable occurrence of oculomotor apraxia and neonatal breathing abnormalitie,intellectual disability, and specific mid-hindbrain malformation (“molar tooth sign”, MTS) We reportthe case of Joubert syndrome in a 32 years old female patient presenting with intellectual impairment, breathing abnormal breathing patterns like tachypnea followed by apnea ataxia, and seizures. She was diagnosed on the basis of Magnetic Resonance Imaging (MRI) and clinical features. JoubertSyndrome should be considered in all patients presenting with hypotonia, ataxia, nystagmus, breathing abnormalities and developmental delay. Its neuroimaging hallmarks include molar tooth sign …

Effectiveness Of Stretching Of The Flexor Retinaculum With Ultrasonic Therapy In The Management Of Carpal Tunnel Syndrome, Waqar Ahmed Awan, Muhammad Naveed Babur, Misha Ansari, Maria Liaqat

Pakistan Journal of Neurological Sciences (PJNS)

Aims & Objective: The objective of study was to compare the effectiveness of manual stretching of the flexor retinaculum with or without ultrasonic therapy. Methods: The study was started by selecting the 50 patients from the out patients department of Al-nafees Hospital AlipurFarash and National institute of Rehabilitation Medicine Islamabad with history of carpal tunnel syndrome. The 25 patients in experimental group were treated with manual stretching of flexor retinaculum and ultrasound and 25 patients of control group were treated with manual stretching of flexor retinaculum. Every session was started by assessment of improvement of the symptoms in each patient. …

The Burden Of Dysphagia And Chest Infection In Acute Ischemic Stroke In A Tertiary Care Hospital Of Islamabad Capital Territory, Rao Suhail, Shahzad Ahmed, Sumaira Nabi, Mansoor Iqbal

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is the foremost cause of severe neurologic disability in adults and is associated with a variety of complications. Dysphagia complicates acute ischemic strokes (AIS) in 42% cases and is more evident during the first week after ischemic stroke. Chest infection complicates AIS in 32% of the cases and 89% of these cases are due to dysphagia. Videofluoroscopy is the gold standard for swallowing assessment but due to non availability, bedside swallowing assessment is a more handytool. Methods: From August 2013 to February 2014151 patients were enrolled according to the set criteria.Each patient was assessed for dysphagia according to the …

Diagnostic Issues And Clinical Spectrum Of Childhood Degenerative Brain Diseases, Tipu Sultan, Ashfa Ameer Khan, Muhammad Arshad Khawaja, Zia Ur Rahman, Ahsan Waheed Rathore

Pakistan Journal of Neurological Sciences (PJNS)

To find out the spectrum of clinical presentation and typesof neurodegenerative disorders of childhoodin tertiary care child neurology centre of Pakistan. To find out the role of brain imaging in the diagnosis of degenerative brain disorders in children. Methods: It will bea retrospective, descriptive study conducted at department of paediatric neurology,The Children’s Hospital, Institute of child health, Lahore, Pakistanfrom January 1st,2004 to December 31,2013 (10 years). A total of 22,737 patients were admitted in the Paediatric Neurology department in the above said period. Out of them 366 children fulfilled the inclusion criteria. History, clinical examination and relevant investigations were evaluated …

Stiff Person Syndrome: A Diagnostic And Management Challenge, Zoya Sajjad, Anam Abrar, Zafar Ullah, Aasim Rehman, Wasim Tariq, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

Stiff person syndrome (SPS) is a rare neurological disorder characterized by progressive muscle stiffness and rigidity, mostly involving axial muscles, resulting in functional disability. It is associated with elevated anti- Glutamic acid decarboxylase (GAD) antibody levels. Electromyography findings are often diagnostic. We present a case of a 48 years old male, who presented with progressive stiffness and rigidity of axial muscles and limbs. His EMG was consistent with SPS. Anti GAD antibodies were markedly elevated. He was treated with rituximab and has improved significantly. SPS is a difficult diagnosis, usually under diagnosed due to lack of awareness among medical community. …

Gender Based Differences In Diabetic Peripheral Neuropathy, Athar Javed, Ahmad Furqan, Mohsin Zaheer, Naeem Kasuri

Pakistan Journal of Neurological Sciences (PJNS)

Diabetic peripheral neuropathy (DPN) is one of the common complications of diabetes mellitus. Aim: To find out gender based differences in frequency of DM, age at diagnosis of DM and subsequent onset of DPN, duration of DM and DPN and electrophysiological patterns. Methodology: On the basis of non-probability purposive sampling, a cross sectional study was conducted at Neurology department, Mayo Hospital, Lahore. Patients fulfilling the ADA criteria for DM, and DPN were included in the study. Data was analyzed using SPSS 16 version. Results: A total of 125 patients were included in the study with 57/125 (45.6%) males and 68/125 …

Factor Structure Of The Cpt-Ii, Mary Vertinski

UNLV Theses, Dissertations, Professional Papers, and Capstones

The current study investigates the factor structure of the Conners' Continuous Performance Test-II (CPT-II) in four pediatric samples of participants: (a) patients with traumatic brain injury, (b) healthy controls, (c) patients with various clinical diagnoses, and (d) all of the previously mentioned subjects combined. Confirmatory factor analyses (CFA) were used to investigate a one-, three- and four-factor model fit of the data. None of the models examined were an adequate fit for the data; however, it appears that the four-factor model seemed to be the best fitting of the models examined. Failure to find reasonably adequate fit precluded further analyses.

Meeting The Needs Of Students With Traumatic Brain Lnjury, Heather K. Koole

Dissertations

School reintegration following pediatric traumatic brain injury (TBI) presents a number of challenges. This dissertation comprises three studies exploring common themes of best practice, training, and supporting success for students with TBI in school settings.

Study 1 reports the results of a survey of 70 speech-language pathologists (SLPs) who responded to questions about their use of clinical activities that described more or less contextualized services. Current literature supports contextualized service delivery as best practice. Findings indicated that 98% of participants reported using at least one contextualized practice. Higher use of contextualized practices was associated with working in schools (compared to …

Stroke Rehabilitation In Pakistan: What We Know And What We Need To Do?, Farooq Azam Rathore, Akhtar Waheed

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is one of the leading causes of adult neurological disability all around the globe. There have been some remarkable improvements in the acute management of stroke. These include the use of thrombolysis, development of radiological investigations including computerized tomographic scan and magnetic resonance imaging and establishment of acute stroke units. There have been some promising advances the field of stroke rehabilitation as well in the last three decades.

Prof. Akhtar Ahmed – A Memoir Of Love, Respect, Admiration, And..., Ismail A. Khatri

Pakistan Journal of Neurological Sciences (PJNS)

Prof. Akhtar Ahmed – a majzoob, how can it be. What an unusual analogy! I was kind of surprised when I heard this from one of my revered teachers Prof. Iftekhar Ahmed who happen to be one of the students of Prof. Akhtar Ahmed like me. However, when he explained this analogy it made complete sense. He explained that a majzoob throws stones on the salik and treats the salik harshly until he is confident that the salik can go through and endure the hardships on the path. Once satisfied, the majzoob opens up for the salik and the knowledge …

Pattern And Outcome Of Epilepsy At Department Of Neurology At Cmc Teaching Hospital Larkana, Alam Ibrahim Siddiqui, Badaruddin Junejo, Lal Chander Dhingra, Anila Mumtaz

Pakistan Journal of Neurological Sciences (PJNS)

Epilepsy is third most common chronic neurological disease. Mortality is 2-3% more common in epilepsy patients than in general population. World wide survey have shown that epilepsy responds to treatment in about 70 % of epileptic patients and three fourth of the affected people do not get the treatment they need. So objective of our study was to know the outcome and pattern of epilepsy at Department of Neurology CMC teaching hospital Larkana ,so that in next step we could know which factors could reduce the morbitity and mortality due to epilepsy hence could prevent complications due to epilepsy. Total …

Radiological Findings In Peri-Partum Neurological Emergencies: Experience From A Tertiary Care Hospital, Pari Gul, Bushra Rehan, Saleha Anwar, Muhammad Usman Aziz

Pakistan Journal of Neurological Sciences (PJNS)

Acute neurological diseases requiring hospitalization are unusual in young women. Some of these diseases are unique to pregnancy and the post-partum period including pre-ecclampsia. Others such as cerebral venous thrombosis, ischemic stroke, intracranial hemorrhage, etc. are indirectly related to pregnancy and seen less frequently. To explore the causes of neurological emergencies in this specific patient population, we performed a radiological audit of young women in pregnancy and postpartum period presenting with neurological emergencies. Material and methods: This was a retrospective study carried in the Department of Radiology, Liaquat National Hospital over one year from January 2013 till January 2014, after …

Frequency Of Peripheral Neuropathy In Newly Diagnosed Patients Of Diabetes Mellitus Iion Clinical And Electrophysiological Basis, Muslim Ali Lakhiar, Naila Naeem Shahbaz, Abdul Hafeez Bughio, Jai Prakash

Pakistan Journal of Neurological Sciences (PJNS)

To determine the frequency of peripheral neuropathy in newly diagnosed patients of Diabetes Mellitus type II on clinical and electrophysiological basis. Methods: This is Hospital based descriptive cross sectional study conducted at department of Neurology Civil Hospital Karachi/ Dow University of Health Sciences from 20th December 2011 to 20th June 2012. Data was collected from Neurology OPD, Medicine OPD and Diabetic Clinic Civil Hospital Karachi. Results: Total no of patients were 107 who were already diagnosed as type 2 Diabetes Mellitus. Out of these, there were 57 (53.3%) male patients and 50 (46.7%) female patients, with ratio of males to …

Endovascular Treatment Of Spontaneous Indirect High Flow Carotid Cavernous Fistula With A Covered Stent., Qasim Bashir, Hina Nabi Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

The treatment of symptomatic carotid-cavernous fistulas [CCF] has been historically treated in the developed world through the endovascular route. We report our first case of using a covered stent in a patient with spontaneous CCF. Method: Single patient with spontaneous indirect high flow CCF treated with a covered stent. We present retrospective analysis of technical success, initial and 6-month follow-up angiography and clinical outcome. Result: The stent was successfully navigated and deployed covering the CCF orifice. Immediate post stent deployment angiography showed marked reduction in flow and complete occlusion at 6-months. Clinically, patient showed near-complete recovery at 6 months. Conclusion: …

A Clinical Approach To Disorders Of Speech, Apoorva Pauranik

Pakistan Journal of Neurological Sciences (PJNS)

Disorders of speech and communication, including Aphasia (mainly post stroke) are a major community health burden in terms of DALY (Disability Adjusted Life Years). Unfortunately they are relatively neglected with huge treatment gap. Traditionally aphasia related lesion sites have been grouped with reference to Rolandic & Sylvian fissures. However the theoretical models of language and speech organization in brain have undergone major conceptual shifts due to advances in cognitive neuropsychology, linguistics and functional neuro-imaging. Much more widely distributed overlapping neural networks are understood to be actively involved in various communication activities. The notion of speech centers or areas is somewhat …

First International Neuro Rehabilitation & 3rd National Rehabilitation Conference (31st October To 2nd November, 2014), Naveed Babur

Pakistan Journal of Neurological Sciences (PJNS)

The First International Neuro Rehabilitation & 3rd National Rehabilitation Conference was held at Isra Institute of Rehabilitation Sciences, Islamabad Campus Capital City of Pakistan from 31stOct to 2nd Nov, 2014.

Brief Report On 14th International Neurology Update & 7th National Stroke Conference, Muhammad Malik

Pakistan Journal of Neurological Sciences (PJNS)

Learning is an enduring burden for neurologists aiming to maintain a high standard of clinical practice and education. Keeping up to date with new developments in medicine is a real challenge. But it's a challenge all neurologists must take if they are to do justice to their patients and aim for superior clinical expertise. The colossal burden of neurological disorders in Pakistan often overwhelms neurologists and trainees leaving them little time for professional self development.

A Combined Therapeutic Regimen Of Buspirone And Environmental Enrichment Is More Efficacrious Than Either Alone In Enhancing Spatial Learning In Brain-Injured Rats, Christina M. Monaco, Kory M. Gebhardt, Sarah M. Chlebowski, Kaitlyn E. Shaw, Jeffrey P. Cheng

PCOM Scholarly Works

Abstract Buspirone, a 5-HT1A receptor agonist, and environmental enrichment (EE) enhance cognition and reduce histopathology after traumatic brain injury (TBI) in adult rats, but have not been fully evaluated after pediatric TBI, which is the leading cause of death in children. Hence, the aims of this study were to assess the efficacy of buspirone alone (Experiment 1) and in combination with EE (Experiment 2) in TBI postnatal day-17 male rats. The hypothesis was that both therapies would confer cognitive and histological benefits when provided singly, but their combination would be more efficacious. Anesthetized rats received a cortical impact or sham …

Plumbing And Wiring: Atherosclerosis In Epilepsy., Scott Mintzer, Md

Department of Neurology Faculty Papers

Over the long term, epilepsy is clearly associated with cognitive impairment. This has been demonstrated functionally, using neuropsychological testing, and reinforced by structural studies showing progressive atrophy in patients with chronic epilepsy ^1-3. The prevailing explanation for this, of course, has been the direct and cumulative effects of seizures on the brain. The basic science literature is chock full of studies showing impairment of neuronal function after seizures, both acutely and chronically. And for those of us who see patients, the progressive memory complaints and clear-cut decline in function seen in those with drug-resistant epilepsy — particularly temporal lobe …

Wordless Intervention For Epilepsy In Learning Disabilities (Wield): Study Protocol For A Randomized Controlled Feasibility Trial, Marie-Anne Durand, Bob Gates, Georgina Parkes, Asif Zia

Dartmouth Scholarship

Epilepsy is the most common neurological problem that affects people with learning disabilities. The high seizure frequency, resistance to treatments, associated skills deficit and co-morbidities make the management of epilepsy particularly challenging for people with learning disabilities. The Books Beyond Words booklet for epilepsy uses images to help people with learning disabilities manage their condition and improve quality of life. Our aim is to conduct a randomized controlled feasibility trial exploring key methodological, design and acceptability issues, in order to subsequently undertake a large-scale randomized controlled trial of the Books Beyond Words booklet for epilepsy.

Olfactory Acuity In Chronic Migraine: A Cross-Sectional Study., Alexander C Whiting, Michael J. Marmura, Sarah E Hegarty, Scott W. Keith

Department of Neurology Faculty Papers

OBJECTIVE/BACKGROUND: This study aims to measure olfactory acuity in chronic migraine subjects, at baseline and on migraine days, and compare to age- and sex-matched controls. Olfactory impairment is common in neurological disorders. While smell hypersensitivity has been established with chronic migraine, olfactory acuity has not been well studied.

METHODS: We recruited 50 subjects with chronic migraine from the Jefferson Headache Center and 50 age- and sex-matched controls. Using the University of Pennsylvania Smell Identification Test (UPSIT), a validated test of olfaction, olfactory acuity was measured at baseline and during a migraine for subjects, and compared to controls at baseline and …

On Reporting The Onset Of The Intention To Move, Uri Maoz, Liad Mudrik, Ram Rivlin, Ian Ross, Adam Mamelak, Gideon Yaffe

Psychology Faculty Books and Book Chapters

"In 1965, Hans Kornhuber and Luder Deecke made a discovery that greatly influenced the study of voluntary action. Using electroencephalography (EEG), they showed that when aligning some tens of trials to movement onset and averaging, a slowly decreasing electrical potential emerges over central regions of the brain. It starts 1 second ( s) or so before the onset of the voluntary action1 and continues until shortly after the action begins. They termed this the Bereitschaftspotential, or readiness potential (RP; Kornhuber & Deecke, 1965).2 This became the first well-established neural marker of voluntary action. In that, the RP allowed for more …

Self-Propagative Replication Of Aβ Oligomers Suggests Potential Transmissibility In Alzheimer Disease, Amit Kumar, Kayla M. Pate, Melissa A. Moss, Dexter N. Dean, Vijayaraghavan Rangachari

Faculty Publications

The aggregation of amyloid-β (Aβ) peptide and its deposition in parts of the brain form the central processes in the etiology of Alzheimer disease (AD). The low-molecular weight oligomers of Aβ aggregates (2 to 30 mers) are known to be the primary neurotoxic agents whose mechanisms of cellular toxicity and synaptic dysfunction have received substantial attention in the recent years. However, how these toxic agents proliferate and induce widespread amyloid deposition throughout the brain, and what mechanism is involved in the amplification and propagation of toxic oligomer species, are far from clear. Emerging evidence based on transgenic mice models indicates …

The Impact Of Polio Eradication On Routine Immunization And Primary Health Care: A Mixed-Methods Study, Svea Closser, Kelly Cox, Thomas M. Parris, R Matthew Landis, Judith Justice, Ranjani Gopinath, Kenneth Maes, Hailom Banteyerga Amaha, Ismaila Zango Mohammed, Rashid Jooma

Section of Neurosurgery

Background: After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC).
Methods: Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review.
Results: Our quantitative analysis did not find compelling evidence of widespread and …

Adult Neurogenesis In The Four-Striped Mice (Rhabdomys Pumilio), Olatunbosun O. Olaleye, Amadi O. Ihunwo

Brain and Mind Institute

In this study, we investigated non-captive four-striped mice (Rhabdomys pumilio) for evidence that adult neurogenesis occurs in the adult brain of animal models in natural environment. Ki-67 (a marker for cell proliferation) and doublecortin (a marker for immature neurons) immunostaining confirmed that adult neurogenesis occurs in the active sites of subventricular zone of the lateral ventricle with the migratory stream to the olfactory bulb, and the subgranular zone of the dentate gyrus of the hippocampus. No Ki-67 proliferating cells were observed in the striatum substantia nigra, amygdala, cerebral cortex or dorsal vagal complex. Doublecortin-immunoreactive cells were observed in …

Non Communicable Diseases In Pakistan: Burden, Challenges And Way Forward For Health Care Authorities, Mohammad Wasay, Shehla Zaidi, Maria Khan, Rashid Jooma

Section of Neurology

No abstract provided.