Restorative Neurology and Neuroscience - Volume 35, issue 3

Authors: Safari, Anahid | Fazeli, Mehdi | Namavar, Mohammad Reza | Tanideh, Nader | Jafari, Peyman | Borhani-Haghighi, Afshin

Article Type: Research Article

Abstract: Background: Dimethyl fumarate (DMF) has immune-modulatory and neuro-protective characteristics that can be used for treatment of acute ischemic stroke. Objective: To investigate the therapeutic effects of DMF on histological and functional recovery of rats after transient middle cerebral artery (MCA) occlusion. Methods: 22 Sprague-Dawley male rats weighing 275–300 g were randomized into three groups by block randomization. In the sham group (n  = 7), the neck was opened, but neither MCA was occluded, nor any drug was administered. The control group (n  = 7) was treated with vehicle (methocel) by gavage for 14 days after MCA occlusion. …In the DMF-treated group (n  = 8), treatment was performed with 15 mg/kg body weight dimethyl fumarate twice a day for 14 days after MCA occlusion. Transient occlusion of the right MCA was performed by intraluminal thread method in the DMF-treated and the control group. Neurological deficit score (NDS), pole test, and adhesive removal test were performed before the surgery, and on post-operative Days 0, 3, 5, 7, 10, and 14. After the final behaviour test, the animals’ brains were perfused and removed. Brains were frozen and sectioned serially and coronally using a cryostat. Infract volume and brain volume were estimated by stereology. Results: The percentage of infarct volume was significantly lower in DMF-treated animals (5.76%) than in the control group (22.39%) (P  < 0.0001). Regarding behavioural tests, the DMF-treated group showed better function in NDS on Days 7 (P  = 0.041) and 10 (P  = 0.046), but not in pole and adhesive removal tests. There was no significant correlation between behavioural tests and histological results. Conclusion: Dimethyl fumarate could be beneficial as a potential neuroprotective agent in the treatment of stroke. Show more

Keywords: Stroke, Cerebrovascular accident, dimethyl fumarate, middle cerebral artery occlusion, neuroprotection

DOI: 10.3233/RNN-160670

Citation: Restorative Neurology and Neuroscience, vol. 35, no. 3, pp. 265-274, 2017

Authors: Chen, Hui | Zhang, Qian | Tan, Song | Fu, Huazhu | Farris, Bradley K. | Yang, Zhenglin

Article Type: Research Article

Abstract: Background: With the ongoing development of surgical procedures and instruments, the safety of optic nerve sheath fenestration (ONSF) has been improved. Objective: Through the past three decades, progress has been made in preventing visual loss from chronic optic nerve swelling in idiopathic intracranial hypertension (IIH), secondary intracranial hypertension and local optic nerve diseases. We now review the updated application of ONSF in those diseases. Methods: The application of ONSF in papilledema due to IIH, secondary intracranial hypertension to cerebral venous sinus occlusion, Cryptococcal meningitis, and intracranial mass or tumors is reviewed. Additionally, the potential benefits of ONSF in …local optic neuropathy from optic nerve sheath meningioma, optic nerve drusen, traumatic optic neuropathy and optic nerve/sheath biopsy are also described. Results: Although ONSF has little or no effect on intracranial pressure, it is a safe, relative easy and effective surgical procedure to prevent or reverse visual loss in IIH. When other treatment modalities fail to timely protect vision, ONSF can be useful in protecting visual function or delay visual loss in secondary intracranial hypertension. Conclusion: We recommend that ONSF should be considered as a meaningful alternative or an adjunct therapy to reduce or delay the visual morbidity of these diseases, although the use of ONSF for some of them remains controversial. Show more

Keywords: Optic nerve sheath fenestration (ONSF), idiopathic intracranial hypertension (IIH), secondary intracranial hypertension, optic neuropathy

DOI: 10.3233/RNN-160693

Citation: Restorative Neurology and Neuroscience, vol. 35, no. 3, pp. 275-286, 2017

Authors: Nardone, Raffaele | Langthaler, Patrick B. | Orioli, Andrea | Höller, Peter | Höller, Yvonne | Frey, Vanessa N. | Brigo, Francesco | Trinka, Eugen

Article Type: Research Article

Abstract: Purpose: Spasticity is a common disorder in patients with spinal cord injury (SCI). The aim of this study was to investigate whether intermittent theta burst stimulation (iTBS), a safe, non-invasive and well-tolerated protocol of excitatory repetitive transcranial magnetic stimulation (rTMS), is effective in modulating spasticity in SCI patients. Methods: In this randomized, double-blind, crossover, sham-controlled study, ten subjects with incomplete cervical or thoracic SCI received 10 days of daily sessions of real or sham iTBS. The H/M amplitude ratio of the Soleus H reflex, the amplitude of the motor evoked potentials (MEPs) at rest and during …background contraction, as well as Modified Ashworth Scale (MAS) and the Spinal Cord Injury Assessment Tool for Spasticity (SCAT) were compared before and after the stimulation protocols. Results: Patients receiving real iTBS showed significant increased resting and active MEPs amplitude and a significant reduction of the H/M amplitude ratio. In these patients also the MAS and SCAT scores were significantly reduced after treatment. These changes persisted up to 1 week after the end of the iTBS treatment, and were not observed under the sham-TBS condition. Conclusion: These findings suggest that iTBS may be a promising therapeutic tool for the spasticity in SCI patients. Show more

Keywords: Intermittent theta burst stimulation, spinal cord injury, spasticity, motor evoked potential, H/M amplitude ratio, Modified Ashworth Scale, Spinal Cord Injury Assessment Tool for Spasticity

DOI: 10.3233/RNN-160701

Citation: Restorative Neurology and Neuroscience, vol. 35, no. 3, pp. 287-294, 2017

Authors: Schönfeld, Lisa-Maria | Jahanshahi, Ali | Lemmens, Evi | Bauwens, Matthias | Hescham, Sarah-Anna | Schipper, Sandra | Lagiere, Melanie | Hendrix, Sven | Temel, Yasin

Article Type: Research Article

Abstract: Background: Motor impairments are among the major complications that develop after cortical damage caused by either stroke or traumatic brain injury. Motor cortex stimulation (MCS) can improve motor functions in animal models of stroke by inducing neuroplasticity. Objective: In the current study, the therapeutic effect of chronic MCS was assessed in a rat model of severe cortical damage. Methods: A controlled cortical impact (CCI) was applied to the forelimb area of the motor cortex followed by implantation of a flat electrode covering the lesioned area. Forelimb function was assessed using the Montoya staircase test and …the cylinder test before and after a period of chronic MCS. Furthermore, the effect of MCS on tissue metabolism and lesion size was measured using [18 F]-fluorodesoxyglucose (FDG) μPET scanning. Results: CCI caused a considerable lesion at the level of the motor cortex and dorsal striatum together with a long-lasting behavioral phenotype of forelimb impairment. However, MCS applied to the CCI lesion did not lead to any improvement in limb functioning when compared to non-stimulated control rats. Also, MCS neither changed lesion size nor distribution of FDG. Conclusion: The use of MCS as a standalone treatment did not improve motor impairments in a rat model of severe cortical damage using our specific treatment modalities. Show more

Keywords: Motor cortex stimulation, motor impairment, rehabilitation, behavioral tests, PET

DOI: 10.3233/RNN-160703

Citation: Restorative Neurology and Neuroscience, vol. 35, no. 3, pp. 295-305, 2017

Authors: Pavlova, Elena L. | Lindberg, Påvel | Khan, Amirah | Ruschkowski, Sigurd | Nitsche, Michael A. | Borg, Jörgen

Article Type: Research Article

Abstract: Background: Recent studies exploring the combined effect of motor learning and transcranial direct current stimulation (tDCS) for stroke rehabilitation have shown partially conflicting results. Objective: To test the efficacy of an optimized hand training approach combined with tDCS in stroke patients. Methods: In the present pilot study we investigated motor effects of four-week training with a visuomotor grip force tracking task combined with tDCS in 11 chronic stroke patients. Anodal (0.5 mA) or sham tDCS was applied over the primary motor cortex of the lesioned side for 20 minutes, twice a day, during training. Results: …No difference between the Active and Sham groups in the total upper extremity (UE) Fugl-Meyer Assessment (FMA) score was found. The most prominent recovery occurred in the shoulder-elbow FMA sub-score; in this segment a significantly greater improvement in the Active compared to the Sham group was observed up to two months after the intervention. Mean hold force during the first treatment session predicted the change in the total UE FMA score after treatment. Conclusion: Four-week visuo-motor training combined with tDCS showed no difference between the Active and Sham groups in the total UE FMA score, which may be explained by heterogeneity of the degree of recovery in the Active group. However, the shoulder-elbow FMA sub-score improved significantly more in the Active compared to the Sham group, which deserves further study. Show more

Keywords: Transcranial direct current stimulation, visuo-motor training, chronic stroke, hand motor function, Fugl-Meyer assessment

DOI: 10.3233/RNN-160706

Citation: Restorative Neurology and Neuroscience, vol. 35, no. 3, pp. 307-317, 2017

Authors: Schick, Thomas | Schlake, Hans-Peter | Kallusky, Juliane | Hohlfeld, Günter | Steinmetz, Maria | Tripp, Florian | Krakow, Karsten | Pinter, Michaela | Dohle, Christian

Article Type: Research Article

Abstract: Background: Neurorehabilitation requires the development of severity-dependent and successful therapies for arm/hand rehabilitation in stroke patients. Objective: To evaluate the effectiveness of adding mirror therapy to bilateral EMG-triggered multi-channel electrostimulation for the treatment of severe arm/hand paresis in stroke patients. Methods: The subjects of this randomized, controlled, multicentre study were stroke patients who had suffered their first insult between 1 and 6 months before study start and had severe or very severe arm/hand paresis, as classified by Fugl-Meyer-Assessment. Subjects were randomly allocated to an intervention group (n  = 16) or control group (n  = 17). Both groups …were treated for 3 weeks (5x week, 30 minutes) with bilateral EMG-triggered multi-channel electrostimulation. The intervention group additionally received mirror feedback of the unaffected limb. The primary outcome measure was motor recovery of the upper extremities, as measured by the Fugl-Meyer Assessment. Results: The Intervention Group with very severe paresis had significantly better motor recovery in total Fugl-Meyer Assessment (p  = 0.017) at a medium effect size (Cohen) of d = 0.7, due to a significant recovery of shoulder and elbow function (p  = 0.003) in the Fugl-Meyer Assessment Part A subtest. For subjects with severe paresis, additional mirror therapy did not significantly influence outcome. Conclusion: Additional mirror therapy in combination with EMG-triggered multi-channel electrostimulation is therapeutically beneficial for post-acute stroke patients with very severe arm/hand paresis. Show more

Keywords: Stroke, motor recovery, mirror therapy, EMG-triggered multi-channel electrical stimulation, functional electrical stimulation

DOI: 10.3233/RNN-160710

Citation: Restorative Neurology and Neuroscience, vol. 35, no. 3, pp. 319-332, 2017

Authors: To, Wing Ting | De Ridder, Dirk | Menovsky, Tomas | Hart, John | Vanneste, Sven

Article Type: Research Article

Abstract: Background: The anterior cingulate cortex (ACC) has been implicated in both cognitive and emotional processing, with cognitive information proposed to be processed through the dorsal/caudal ACC and emotional information through the rostral/ventral ACC. Objective: The objective of this study is to investigate the role of the dorsal anterior cingulate cortex (dACC) in cognitive and emotional processing using a cognitive and emotional counting Stroop task in two patients in whom abnormalities in the dACC were identified and treated. Methods: Two patients performed the cognitive and emotional counting Stroop task before and after treatment to examine whether …the dACC has a specific or more general processing function. Results: We observed an overall improvement in the emotional, cognitive, and neutral trials of the counting Stroop task after the intervention, indicating that the dACC is not a subregion of the ACC that only contributes to a specific domain. Conclusion: This study reveals that the dACC is not just a subregion of the ACC that contributes to a specific cognitive function, but is rather part of a salience network that influences general brain functioning, influencing cognitive as well as emotional processing. Show more

Keywords: Anterior cingulate cortex, Stroop task, brain calcification, invasive brain stimulation, non-invasive brain stimulation

DOI: 10.3233/RNN-170730

Citation: Restorative Neurology and Neuroscience, vol. 35, no. 3, pp. 333-345, 2017