Muscle & nerve
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Amyotrophic lateral sclerosis (ALS) remains a rapidly progressive fatal degenerative disease of motor neurons for which there are few interventions to slow disease progression or improve quality of life. A diaphragm pacing system was approved by the U. S. ⋯ We review the currently available data on the diaphragm pacing system and its use in ALS. Diaphragm pacing appears to be reasonably safe in carefully selected patients, but flaws in the reporting on it thus far preclude conclusions regarding efficacy. Further study is needed.
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The aims of this study were to clarify the intramuscular branching patterns and arborizing area of hip adductor muscles with reference to surface landmarks on the thigh and to thus suggest effective and safe injection points for botulinum neurotoxin (BoNT). ⋯ The most effective and safest point for BoNT injection into adductor muscles appears to be between 35% and 50% from ASIS, where neuromuscular junctions are most densely distributed.
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Case Reports
Adult-onset lower extremity weakness caused by venous malformation detected by magnetic resonance imaging.
Symptomatic venous malformation (VM) of muscle in adults is rare and usually presents in childhood or adolescence as the individual is growing. We describe an atypical presentation of a malformation affecting the gastrocnemius muscle asymmetrically with onset in adulthood, which created a diagnostic challenge. Electromyography (EMG) and muscle biopsy did not fit clinically and MRI of the gastrocnemius led to the diagnosis. ⋯ This case represents a rare cause of atrophic weakness in adults, but muscle MRI should be considered when other tests are equivocal.