Neurology Commons^™

Botulinum Toxin Type-A In The Management Of Cerebral Palsy: Low Or High Dose?, Alper I. Dai, Mohammad Wasay

Department of Medicine

Cerebral palsy is the most common cause of severe physical disability in childhood. Spasticity is a common and disabling symptom for many patients with cerebral palsy. Therapy for spasticity is symptomatic with the aim of increasing functional capacity and relieving discomfort. Spasticity treatment by orally administered drugs and intramuscular chemodenervation agents has become more frequent. Most oral medications to treat spasticity have been inadequately studied in children, especially those with cerebral palsy. Since its first use in pediatric patients, reported in 1993, botulinum toxin (BTX-A), a relatively recent addition to the available medical interventions for children with cerebral palsy, has …

Stroke-Related Complications Due To Delay In Seeking Medical Care: A Review Of 100 Cases, Asad Ali

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Operating On The Master Gland: 100consecutive Hypophysectomies At Aga Khan University Hospital, Karachi, Muhammad Shahzad Shamim, Faraz Khursheed, Muhammad Ehsan Bari

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Neurology, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Central Nervous System Involvement Indengue Viral Infection, Romasa Channa, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Mult-Slice Ct Scanning, Zafar Sajjad

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Sporadic Hemiplegic Migraine: A Challenging Diagnosis, Azra Zafar, Shahid Mustafa, Kaneez Aelia

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Clinical Applications Of Polysomnography, Imran I. Ali

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Neurosurgery, S. Ather Enam

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Psychiatry, Syed Ahmer

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Preventive Treatment Of Migraine, Stephen Silberstein

Department of Neurology Faculty Papers

Migraine is a common episodic pain disorder, the treatment of which can be acute to stop an attack or preventive to reduce the frequency, duration or severity of attacks. Preventive treatment is used when attacks are frequent or disabling. Many different medication groups are used for preventive treatment, including β-blockers, antidepressants and antiepileptic drugs. Their mechanisms of action include raising the threshold to migraine activation, enhancing antinociception, inhibiting cortical spreading depression, inhibiting peripheral and central sensitization, blocking neurogenic inflammation and modulating sympathetic, parasympathetic or 5-HT tone. In this article, I review evidence of the effectiveness of migraine preventive drugs. I …

Brain Tumor Stem Cells: Role In Neuro-Oncogenesis And Therapeutic Implications, Muhammad Zeeshan Ozair, Adil Hameed Khan, Ather Enam

Department of Biological & Biomedical Sciences

Malignant brain tumors are notorious for high morbidity and mortality. Our deficient understanding of brain tumor pathogenesis is reflected in our inability to cure this disease. Treatment remains palliative at best. The cancer stem cell hypothesis of brain tumors promises to consolidate many observations which have previously eluded neuroscientists and may reveal why aberrations in developmental programs are among the commonest findings in brain tumors. It is ironic that brain ontogeny and cancer - two processes with very different outcomes - exploit similar mechanisms to multiply, migrate,and survive. Implications of this hypothesis extend beyond mere academic interest. It may explain …

Comparison Of Dynamic (Brush) And Static (Pressure) Mechanical Allodynia In Migraine, C. Lopinto, W. B. Young, Avi Ashkenazi

Department of Neurology Faculty Papers

Allodynia has been described in migraine but has not been fully investigated for the different sensory modalities. The aim of this study was to compare the prevalence of dynamic (brush) and static (pressure) mechanical allodynia in migraine patients and to suggest a practical method of testing them in a clinical setting. Patients with International Headache Society-defined episodic migraine (EM) or with transformed migraine (TM) as defined by Silberstein and Lipton were prospectively recruited from the Jefferson Headache Center out-patient clinic. A questionnaire of migraine features and symptoms of allodynia was administered. Brush allodynia (BA) was tested by cutaneous stimulation with …

Botulinum Toxin Type A In The Prophylactic Treatment Of Chronic Tension-Type Headache: A Multicentre, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study, Stephen D. Silberstein, H. Göbel, R. Jensen, A. H. Elkind, R. Degryse, J. M.C.M. Walcott, C. Turkel

Department of Neurology Faculty Papers

We studied the safety and efficacy of 0 U, 50 U, 100 U, 150 U (five sites), 86 Usub and 100 Usub (three sites) botulinum toxin type A (BoNTA; BOTOX); Allergan, Inc., Irvine, CA, USA) for the prophylaxis of chronic tension-type headache (CTTH). Three hundred patients (62.3% female; mean age 42.6 years) enrolled. For the primary endpoint, the mean change from baseline in the number of TTH-free days per month, there was no statistically significant difference between placebo and four BoNTA groups, but a significant difference favouring placebo vs. BoNTA 150 was observed (4.5 vs. 2.8 tension headache-free days/month; P …

Central Nervous System Involvement In Dengue Viral Infection, Romasa Channa, Mohammad Wasay

Department of Medicine

Neurological manifestations of dengue infection are rare. This review includes data regarding the epidemiology of the disease, neurological manifestations,pathogenesis, diagnosis and prognosis. It is based on 9 original articles and 10 case reports, adding up to 200 cases of dengue fever with neurological manifestations. Relevant cases have been reported from Asia, the Pacific rim, the Americas, the Mediterranean region, and Africa. A wide range of neurological manifestations has been reported. Altered consciousness and seizure are among the more common manifestations. The exact pathogenesis of this disease has not yet been established. However, recent studies hypothesize that the virus is neurotropic. …

Dissociation Of Automatic And Strategic Lexical-Semantics: Functional Magnetic Resonance Imaging Evidence For Differing Roles Of Multiple Frontotemporal Regions, Brian T. Gold, David A. Balota, Sara J. Jones, David K. Powell, Charles D. Smith, Anders H. Andersen

Neuroscience Faculty Publications

Behavioral research has demonstrated three major components of the lexical-semantic processing system: automatic activation of semantic representations, strategic retrieval of semantic representations, and inhibition of competitors. However, these component processes are inherently conflated in explicit lexical-semantic decision tasks typically used in functional magnetic resonance imaging (fMRI) research. Here, we combine the logic of behavioral priming studies and the neurophysiological phenomenon of fMRI priming to dissociate the neural bases of automatic and strategic lexical-semantic processes across a series of three studies. A single lexical decision task was used in all studies, with stimulus onset asynchrony or linguistic relationship between prime and …

Wernekink Comissure Syndrome: A Rare Midbrain Syndrome Secondary To Stroke, Alper I. Dai, Mohammad Wasay

Department of Medicine

Wernekink commissure involves the decussation of superior cerebellar peduncle (SCP) in midbrain. We report an elderly hypertensive, diabetic man who developed slurred speech, ataxia, and internuclear ophthalmoplegia. MRI examination revealed an unusual ischemic stroke involving Wernekink commissure. This rare stroke pattern involving decussation of SCP occurs in the setting of small arterial disease. The association between the anatomic location of the stroke and clinical findings is noteworthy.

Light During Darkness And Cancer: Relationships In Circadian Photoreception And Tumor Biology, Samar A. Jasser, David E. Blask, George C. Brainard

Department of Neurology Faculty Papers

The relationship between circadian phototransduction and circadian-regulated processes is poorly understood. Melatonin, commonly a circadian phase marker, may play a direct role in a myriad of physiologic processes. The circadian rhythm for pineal melatonin secretion is regulated by the hypothalamic suprachiasmatic nucleus (SCN). Its neural source of light input is a unique subset of intrinsically photosensitive retinal ganglion cells expressing melanopsin, the primary circadian photopigment in rodents and primates. Action spectra of melatonin suppression by light have shown that light in the 446–477 nm range, distinct from the visual system’s peak sensitivity, is optimal for stimulating the human circadian system. …

Ms In Asian Countries, M Wasay, I A. Khatri, B Khealani, M Sheerani

Section of Neurology

This paper reviews all available English language literature on MS from Asian countries published between 1970 and 2005. Although limited data are available, the review reveals that western Asia--including the Middle East--has the highest prevalence of MS across the continent, and that MS in Asia largely resembles conventional MS in western countries. Opticospinal MS (a distinct clinical entity from conventional MS) is more common in eastern Asian regions. Larger epidemiological and genetic studies, with more complete ascertainment in various Asian populations, are needed so that we can understand the diversity of Asian MS.

Art Therapy And Sensory Stimulation To Decrease Agitation: A Pilot Study, Leslie Cristen Lavergne

EVMS School of Health Professions Theses & Dissertations

Dementia affects 1% of older adults in America between the ages of 65 and 74 years, and increases to 10% in those 85 years and older. The cognitive and behavioral symptoms of dementia may restrict an individuals ability to perform activities of daily living, such as self-care, memory, and language. The literature supports the premise that individuals who have dementia can benefit from a treatment approach that focuses on medication regulation, as well as mental stimulation. This study was an art therapy and sensory stimulation intervention designed to reduce agitation, a common non-cognitive symptom of dementia. This study included five …

Spontaneous Intracranial Arterial Dissection In The Young: Diagnosis By Ct Angiography, William C. Robertson, Curtis A. Given

Neurology Faculty Publications

BACKGROUND: Spontaneous carotid artery dissections have been rarely reported in children. Diagnosis has traditionally been confirmed by catheter arteriography. More recently diagnosis has been made by magnetic resonance imaging and magnetic resonance angiography; however the sensitivity of these techniques has yet to be determined. The authors are unaware of reports of carotid dissection confirmed by dynamic computed tomography (computerized tomographic arteriography) in the young.

CASE PRESENTATION: We recently evaluated a fourteen year-old male following the development of transient neurologic symptoms. There was no antecedent illness or trauma. Dynamic computed tomography revealed an intracranial dissection involving the supraclinoid segment of the …

Surgery For Prolactinomas, Ashfaq A. Razzaq, Rashid Jooma

Section of Neurosurgery

A large proportion of prolactin secreting tumours of the pituitary gland are treatable by dopamine agonist drugs. however certain subgroups of these patients are better managed by surgical excision. the indications for surgery in prolactinomas remain controversial and this paper attempts to clarify these with illustrative cases. the factors favouring a surgical approach include poor tolerance of long term medical therapy, progression of visual deficits or recurrence while on medical treatment, cystic change in the tumour with pressure effects, csf fistula secondary to tumour shrinkage and prophylactic surgery in tumours anticipated to cause csf leak following medical therapy. the size …

Trans-Mastoid Approach To Otogenic Brain Abscess, Ashfaq A. Razzaq, Rashid Jooma, Shahid Ahmed

Section of Neurosurgery

The treatment of otogenic brain abscess initially involves excision or aspiration of the abscess through a temporal or sub-occipital route depending on its location. This is followed by a mastoidectomy by the ENT surgeon to eradicate the primary source of infection. During the last three years, we have approached such lesions through a mastoidectomy followed by excision of the abscess through the same approach. This trans-mastoid approach is technically feasible in following the tract of suppuration, and clearing the cause and effect of pathology, at the same sitting. This paper describes our initial experience with the trans-mastoid approach to otogenic …

Zonisamide For Migraine Prophylaxis In Refractory Patients, Avi Ashkenazi, Adam Benlifer, Jason Korenblit, Stephen D. Silberstein

Department of Neurology Faculty Papers

Zonisamide, a new antiepileptic drug, has been approved in the US as adjunctive therapy for the treatment of partial seizures in adults.^1,2 Chemically a sulfonamide analogue, zonisamide is thought to have several mechanisms of action, including a rate-dependent blockade of voltage-gated sodium channels and reduction of ion flow through T-type calcium channels.^3-5 It is also a weak carbonic anhydrase inhibitor. Zonisamide has a favorable pharmacokinetic profile that includes high oral bioavailability and a long half life (63 hours), permitting a once- or twice-daily dosing regimen.⁶

There are only a limited number of current migraine preventive medications that …

Long Scarf Injuries, Arshad A. Siddiqui, Muhammad Shahzad Shamim, Rashid Jooma, Ather Enam

Section of Neurosurgery

Long scarf (Dopatta) traditionally worn by females in South-East Asia have been described to make the females prone to sustain specific injuries when they ride pillion on the cycle powered rickshaw or motor bike. Two cases of females have been described.

Measuring Sustained Attention After Traumatic Brain Injury: Differences In Key Findings From The Sustained Attention To Response Task (Sart), John Whyte, Patricia Grieb-Neff, Christopher Gantz, Marcia Polansky

Department of Rehabilitation Medicine Faculty Papers

Clinical reports after traumatic brain injury (TBI) suggest frequent difficulties with sustained attention, but their objective measurement has proved difficult. In 1997, Robertson and colleagues reported on a new sustained attention assessment tool, the sustained attention to response task (SART). Individuals with TBI were reported to produce more errors of commission on the SART than control participants, and both groups showed a relationship between SART errors and everyday lapses of attention as measured by the cognitive failures questionnaire (CFQ). Although few direct replications of these findings have been reported, the SART has been used widely as a measure of sustained …

Differences In Mnemonic Processing By Neurons In The Human Hippocampus And Parahippocampal Regions, Indre Viskontas, B. J. Knowlton, P. N. Steinmetz, I. Fried

Psychology

Different structures within the medial-temporal lobe likely make distinct contributions to declarative memory. In particular, several current psychological and computational models of memory predict that the hippocampus and parahippocampal regions play different roles in the formation and retrieval of declarative memories [e.g., Norman, K. A., & O'Reilly, R. C. Modeling hippocampal and neocortical contributions to recognition memory: A complementary-learning systems approach. Psychological Review, 110, 611-646, 2003]. Here, we examined the neuronal firing patterns in these two regions during recognition memory. Recording directly from neurons in humans, we find that cells in both regions respond to novel stimuli with an increase …

Production Of Il-16 Correlates With Cd4+ Th1 Inflammation And Phosphorylation Of Axonal Cytoskeleton In Multiple Sclerosis Lesions, Dusanka S. Skundric, Juan Cai, William W. Cruikshank, Djordje Gveric

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Multiple sclerosis (MS) is a central nervous system-specific autoimmune, demyelinating and neurodegenerative disease. Infiltration of lesions by autoaggressive, myelin-specific CD4+Th1 cells correlates with clinical manifestations of disease. The cytokine IL-16 is a CD4+ T cell-specific chemoattractant that is biased towards CD4+ Th1 cells. IL-16 precursor is constitutively expressed in lymphocytes and during CD4+ T cell activation; active caspase-3 cleaves and releases C-terminal bioactive IL-16. Previously, we used an animal model of MS to demonstrate an important role for IL-16 in regulation of autoimmune inflammation and subsequent axonal damage. This role of IL-16 in MS is largely unexplored. Here …

Neprilysin: An Enzyme Candidate To Prevent Alzheimer's Disease, Salim Sabri El-Amouri

MUSC Theses and Dissertations

Alzheimer's disease is named after Alois Alzheimer, the German psychiatrist and neuropathologist who identified it in 1907. Alzheimer's disease (AD) is the most common form of dementia and accounts for at least half of all dementias (Owen et al., 1994). The disease moved from eighth to seventh place among the leading causes of death in 2004, with 65,829 deaths in the United States (Minifio et al., 2006). In an attempt to solve the mystery of this disease, scientists have discovered brain changes in people with AD that lead to dementia. Nerve cells die in areas of the brain that are …

Dual-Hit Hypothesis For Dopamine Neurodegeneration And Motor Dysfunction, Heather Anne Boger

MUSC Theses and Dissertations

Glial cell line-derived neurotrophic factor (GDNF) is a trophic factor for peripheral organs, spinal cord, and midbrain dopamine (DA) neurons. Studies have shown that GDNF levels decrease in the substantia nigra (SN) and striatum during normal aging and in patients with Parkinson's disease. Furthermore, exogenous GDNF infusion protects DA neurons against injury induced by 6-hydroxydopamine, MPTP, and methamphetamine (METH). A heterozygous mouse model was created to assess whether a chronic reduction in this neurotrophic factor impacts motor function and the nigrostriatal DA system during the aging process. In this dissertation, two models of dopaminergic loss and motor dysfunction were characterized. …