Funct Neurol
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Non-invasive brain stimulation methods, such as repetitive transcranial magnetic stimulation (rTMS), are currently used to modulate the excitability of the cerebral cortex, providing important insights into mechanisms of cortical plasticity. Used to create long-lasting changes in the excitability of synapses, rTMS has been intensively investigated as a therapeutic tool in several neurological and psychiatric conditions and given some promising results. Recent studies have shown that rTMS of cerebellar structures is capable of inducing long-lasting changes in the excitability of cerebello-thalamo-cortical pathways. ⋯ Indeed, cerebellar rTMS has been shown to modulate motor control, cognitive functions, emotion and mood. Moreover, recent studies seem to indicate that long-lasting modifications of cerebellar pathways could be usefully exploited in the treatment of several pathological conditions characterized by altered cortical excitability, such as Parkinson's disease, stroke, depression and schizophrenia. The high potential of cerebellar rTMS as a therapeutic tool in neurology could depend on the possibility of modulating several interconnected remote areas, through the activation of different systems, such as the cerebello-thalamo-cortical and limbic-thalamo-cortical networks.
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Clinical Trial
Use of surface EMG for evaluation of upper limb spasticity during botulinum toxin therapy in stroke patients.
The clinical assessment of spasticity in stroke patients generally includes descriptive scales, such as the Modified Ashworth Scale (MAS) and the Global Pain Scale (GPS), however these may not be sufficiently sensitive to accurately detect improvements, especially at upper limb level; electromyography (EMG) may be the answer to this clinical requirement. The aim of this study was to quantify the effects of botulinum toxin type A (BTX) in treating upper extremity spasticity in stroke patients, using clinical evaluation (MAS and GPS) and EMG. Ten patients were assessed before, 30 days and 180 days after BTX injection using clinical evaluations and EMG. ⋯ Whereas MAS scores, after recording an improvement at the first evaluation session, were worse at the second assessment, GPS scores improved over time, both at the first and at the second evaluation session. A reduction of EMG activity was found 30 days after injections, in particular at baseline and during passive flexion movement. Our results demonstrated that measurement of EMG activity may be an effective means of detecting functional improvements and of monitoring the effects of treatment in post-stroke patients.
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In the indomethacin responsive headaches (IRHs), chronic paroxysmal hemicrania (CPH) and Hemicrania continua (HC), the indomethacin (INDO) response is swift, absolute, and permanent, with moderate doses. Traditionally, CPH has been linked to cluster headache (CH) due to clinical similarities: unilaterality, intensity, and some autonomic phenomena. However, other clinical features differ essentially between these two headaches: sex ratio, mean attack frequency (CPH: 13.6 versus CH: 1.7 attacks/day), and duration of attacks. ⋯ The chronic/non-chronic stage ratio is 3.9 in CPH, against 0.14 in CH, a >25 times difference. Conversely, CPH and HC are very similar, clinically speaking. Accordingly, we should probably sever the link between CH and CPH and favour, instead, a linking together of CPH and HC, the two principal IRHs.
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Review
Sexual differentiation of the human brain in relation to gender identity and sexual orientation.
During the intrauterine period the fetal brain develops in the male direction through a direct action of testosterone on the developing nerve cells, or in the female direction through the absence of this hormone surge. In this way, our gender identity (the conviction of belonging to the male or female gender) and sexual orientation are programmed into our brain structures when we are still in the womb. ⋯ This also means that in the event of ambiguous sex at birth, the degree of masculinization of the genitals may not reflect the degree of masculinization of the brain. There is no proof that social environment after birth has an effect on gender identity or sexual orientation.
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The assessment of residual brain function in the vegetative state is extremely difficult and depends frequently on subjective interpretations of observed spontaneous and volitional behaviours. For those patients who retain peripheral motor function, rigorous behavioural assessment supported by structural imaging and electrophysiology is usually sufficient to establish a patient's level of wakefulness and awareness. However, it is becoming increasingly apparent that, in some patients, damage to the peripheral motor system may prevent overt responses to commands, even though the cognitive ability to perceive and understand such commands may remain intact. Advances in functional neuroimaging suggest a novel solution to this problem; in several recent cases, so-called activation studies have been used to identify residual cognitive function and even conscious awareness in patients who are assumed to be vegetative, yet retain cognitive abilities that have evaded detection using standard clinical methods.