Amyotrophic lateral sclerosis is a rare neurodegenerative disease characterized by the involvement of both upper and lower motor neurons.Early bilateral limb involvement significantly affects patients'daily lives ...Amyotrophic lateral sclerosis is a rare neurodegenerative disease characterized by the involvement of both upper and lower motor neurons.Early bilateral limb involvement significantly affects patients'daily lives and may lead them to be confined to bed.However,the effect of upper and lower motor neuron impairment and other risk factors on bilateral limb involvement is unclear.To address this issue,we retrospectively collected data from 586 amyotrophic lateral sclerosis patients with limb onset diagnosed at Peking University Third Hospital between January 2020 and May 2022.A univariate analysis revealed no significant differences in the time intervals of spread in different directions between individuals with upper motor neuron-dominant amyotrophic lateral sclerosis and those with classic amyotrophic lateral sclerosis.We used causal directed acyclic graphs for risk factor determination and Cox proportional hazards models to investigate the association between the duration of bilateral limb involvement and clinical baseline characteristics in amyotrophic lateral sclerosis patients.Multiple factor analyses revealed that higher upper motor neuron scores(hazard ratio[HR]=1.05,95%confidence interval[CI]=1.01–1.09,P=0.018),onset in the left limb(HR=0.72,95%CI=0.58–0.89,P=0.002),and a horizontal pattern of progression(HR=0.46,95%CI=0.37–0.58,P<0.001)were risk factors for a shorter interval until bilateral limb involvement.The results demonstrated that a greater degree of upper motor neuron involvement might cause contralateral limb involvement to progress more quickly in limb-onset amyotrophic lateral sclerosis patients.These findings may improve the management of amyotrophic lateral sclerosis patients with limb onset and the prediction of patient prognosis.展开更多
The hulbar paralysis of upper rnotor neurons is a common seniIe disease. ln recentycars. we select Lianquan (CV 23 ) as a chief point in comhination with Jinjin (EX-HN l2 ). Yuye(FX-HN 13 ) and Zhaohai (KI 6 ) and emp...The hulbar paralysis of upper rnotor neurons is a common seniIe disease. ln recentycars. we select Lianquan (CV 23 ) as a chief point in comhination with Jinjin (EX-HN l2 ). Yuye(FX-HN 13 ) and Zhaohai (KI 6 ) and employ uniform reinforcing-reducing manipuIation to treat 280patients. The results show that a total effectivc rate is 55. 71％. The possible mechanisms are dis-cussed preliminarily in thc present paper.展开更多
We report a 50-year-old woman who developed localized proximal muscle weakness, in addition to transient elevation of antibodies to GM-1 ganglioside, without multifocal conduction block. She was treated with intraveno...We report a 50-year-old woman who developed localized proximal muscle weakness, in addition to transient elevation of antibodies to GM-1 ganglioside, without multifocal conduction block. She was treated with intravenous immunoglobulin (IVIg) and steroid pulse therapy, which were effective for over 10 years. Her clinical course and laboratory tests were consistent with lower motor neuron syndrome (LMNS) with localized proximal muscle weakness. We suggest that some patients diagnosed as LMNS may remain responsive to IVIg or steroid pulse therapy for a long time.展开更多
目的:研究镜像神经元康复策略(Mirror Neuron System,MNS)联合经颅磁刺激(Transcranial Magnetic Stimulation,TMS)对卒中后神经与功能康复的作用。方法:选取2019年1月至2023年6月某部队康复中心收治的198例卒中后遗留有运动功能障碍患...目的:研究镜像神经元康复策略(Mirror Neuron System,MNS)联合经颅磁刺激(Transcranial Magnetic Stimulation,TMS)对卒中后神经与功能康复的作用。方法:选取2019年1月至2023年6月某部队康复中心收治的198例卒中后遗留有运动功能障碍患者,采用随机数字表法分为三组,各66例。三组均给予常规康复指导,磁刺激组给予TMS治疗,镜像组给予MNS治疗,联合组给予TMS+MNS治疗。比较三组干预前、干预2周后、干预4周后神经功能(NIHSS)、上下肢运动功能(FMA)、日常生活能力(ADL)、平衡能力(BBS)、上肢与下肢肌张力(MAS)、健患侧步长差、患侧负重时间百分比及语言功能。结果:联合组干预2周、4周后NIHSS评分低于磁刺激组、镜像组,差异具有统计学意义(P<0.05),磁刺激组、镜像组组间比较,差异无统计学意义(P>0.05);联合组干预2周、4周后FMA-上肢、FMA-下肢评分高于磁刺激组、镜像组,且镜像组高于磁刺激组,差异具有统计学意义(P<0.05);联合组干预2周、4周后ADL评分、BBS评分高于磁刺激组、镜像组,且镜像组高于磁刺激组,差异具有统计学意义(P<0.05);联合组干预4周后上肢和下肢MAS分级0~1级患者占比高于磁刺激组、镜像组,且磁刺激组高于镜像组,差异具有统计学意义(P<0.05);联合组干预2周、4周后健患侧步长差低于磁刺激组、镜像组,患侧负重时间百分比高于磁刺激组、镜像组,且镜像组变化幅度大于磁刺激组,差异具有统计学意义(P<0.05);联合组干预2周、4周后语言功能中阅读理解、复述、流畅度、命名评分高于磁刺激组、镜像组,且磁刺激组高于镜像组,差异具有统计学意义(P<0.05)。结论:MNS联合TMS能促进卒中后神经与功能康复,有利于改善患者日常生活能力,且二者各有优势,互相补充,联合治疗效果显著,值得临床推广。展开更多
Activation and reconstruction of the spinal cord circuitry is important for improving motor function following spinal cord injury.We conducted a case series study to investigate motor function improvement in 14 patien...Activation and reconstruction of the spinal cord circuitry is important for improving motor function following spinal cord injury.We conducted a case series study to investigate motor function improvement in 14 patients with chronic spinal cord injury treated with 4 weeks of unilateral(right only)cortical intermittent theta burst stimulation combined with bilateral magnetic stimulation of L3-L4 nerve roots,five times a week.Bilateral resting motor evoked potential amplitude was increased,central motor conduction time on the side receiving cortical stimulation was significantly decreased,and lower extremity motor score,Berg balance score,spinal cord independence measure-III score,and 10 m-walking speed were all increased after treatment.Right resting motor evoked potential amplitude was positively correlated with lower extremity motor score after 4 weeks of treatment.These findings suggest that cortical intermittent theta burst stimulation combined with precise root stimulation can improve nerve conduction of the corticospinal tract and lower limb motor function recovery in patients with chronic spinal cord injury.展开更多
基金supported by the National Natural Science Foundation of China,Nos.82071426,81873784Clinical Cohort Construction Program of Peking University Third Hospital,No.BYSYDL2019002(all to DF)。
文摘Amyotrophic lateral sclerosis is a rare neurodegenerative disease characterized by the involvement of both upper and lower motor neurons.Early bilateral limb involvement significantly affects patients'daily lives and may lead them to be confined to bed.However,the effect of upper and lower motor neuron impairment and other risk factors on bilateral limb involvement is unclear.To address this issue,we retrospectively collected data from 586 amyotrophic lateral sclerosis patients with limb onset diagnosed at Peking University Third Hospital between January 2020 and May 2022.A univariate analysis revealed no significant differences in the time intervals of spread in different directions between individuals with upper motor neuron-dominant amyotrophic lateral sclerosis and those with classic amyotrophic lateral sclerosis.We used causal directed acyclic graphs for risk factor determination and Cox proportional hazards models to investigate the association between the duration of bilateral limb involvement and clinical baseline characteristics in amyotrophic lateral sclerosis patients.Multiple factor analyses revealed that higher upper motor neuron scores(hazard ratio[HR]=1.05,95%confidence interval[CI]=1.01–1.09,P=0.018),onset in the left limb(HR=0.72,95%CI=0.58–0.89,P=0.002),and a horizontal pattern of progression(HR=0.46,95%CI=0.37–0.58,P<0.001)were risk factors for a shorter interval until bilateral limb involvement.The results demonstrated that a greater degree of upper motor neuron involvement might cause contralateral limb involvement to progress more quickly in limb-onset amyotrophic lateral sclerosis patients.These findings may improve the management of amyotrophic lateral sclerosis patients with limb onset and the prediction of patient prognosis.
文摘The hulbar paralysis of upper rnotor neurons is a common seniIe disease. ln recentycars. we select Lianquan (CV 23 ) as a chief point in comhination with Jinjin (EX-HN l2 ). Yuye(FX-HN 13 ) and Zhaohai (KI 6 ) and employ uniform reinforcing-reducing manipuIation to treat 280patients. The results show that a total effectivc rate is 55. 71％. The possible mechanisms are dis-cussed preliminarily in thc present paper.
文摘We report a 50-year-old woman who developed localized proximal muscle weakness, in addition to transient elevation of antibodies to GM-1 ganglioside, without multifocal conduction block. She was treated with intravenous immunoglobulin (IVIg) and steroid pulse therapy, which were effective for over 10 years. Her clinical course and laboratory tests were consistent with lower motor neuron syndrome (LMNS) with localized proximal muscle weakness. We suggest that some patients diagnosed as LMNS may remain responsive to IVIg or steroid pulse therapy for a long time.
文摘目的:研究镜像神经元康复策略(Mirror Neuron System,MNS)联合经颅磁刺激(Transcranial Magnetic Stimulation,TMS)对卒中后神经与功能康复的作用。方法:选取2019年1月至2023年6月某部队康复中心收治的198例卒中后遗留有运动功能障碍患者,采用随机数字表法分为三组,各66例。三组均给予常规康复指导,磁刺激组给予TMS治疗,镜像组给予MNS治疗,联合组给予TMS+MNS治疗。比较三组干预前、干预2周后、干预4周后神经功能(NIHSS)、上下肢运动功能(FMA)、日常生活能力(ADL)、平衡能力(BBS)、上肢与下肢肌张力(MAS)、健患侧步长差、患侧负重时间百分比及语言功能。结果:联合组干预2周、4周后NIHSS评分低于磁刺激组、镜像组,差异具有统计学意义(P<0.05),磁刺激组、镜像组组间比较,差异无统计学意义(P>0.05);联合组干预2周、4周后FMA-上肢、FMA-下肢评分高于磁刺激组、镜像组,且镜像组高于磁刺激组,差异具有统计学意义(P<0.05);联合组干预2周、4周后ADL评分、BBS评分高于磁刺激组、镜像组,且镜像组高于磁刺激组,差异具有统计学意义(P<0.05);联合组干预4周后上肢和下肢MAS分级0~1级患者占比高于磁刺激组、镜像组,且磁刺激组高于镜像组,差异具有统计学意义(P<0.05);联合组干预2周、4周后健患侧步长差低于磁刺激组、镜像组,患侧负重时间百分比高于磁刺激组、镜像组,且镜像组变化幅度大于磁刺激组,差异具有统计学意义(P<0.05);联合组干预2周、4周后语言功能中阅读理解、复述、流畅度、命名评分高于磁刺激组、镜像组,且磁刺激组高于镜像组,差异具有统计学意义(P<0.05)。结论:MNS联合TMS能促进卒中后神经与功能康复,有利于改善患者日常生活能力,且二者各有优势,互相补充,联合治疗效果显著,值得临床推广。
基金supported by National Key R&D Program of China,No.2020YFC2004202the National Natural Science Foundation of China,Nos.81974358 and 81772453(all to DSX).
文摘Activation and reconstruction of the spinal cord circuitry is important for improving motor function following spinal cord injury.We conducted a case series study to investigate motor function improvement in 14 patients with chronic spinal cord injury treated with 4 weeks of unilateral(right only)cortical intermittent theta burst stimulation combined with bilateral magnetic stimulation of L3-L4 nerve roots,five times a week.Bilateral resting motor evoked potential amplitude was increased,central motor conduction time on the side receiving cortical stimulation was significantly decreased,and lower extremity motor score,Berg balance score,spinal cord independence measure-III score,and 10 m-walking speed were all increased after treatment.Right resting motor evoked potential amplitude was positively correlated with lower extremity motor score after 4 weeks of treatment.These findings suggest that cortical intermittent theta burst stimulation combined with precise root stimulation can improve nerve conduction of the corticospinal tract and lower limb motor function recovery in patients with chronic spinal cord injury.
