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Cerebellar Atrophy Following Long Term Phenytoin Overdose: A case report.

Brain & Neurorehabilitation.2011;4(1):69-71. doi:10.12786/bn.2011.4.1.69

Phenytoin is a commonly used antiepileptic drug, and its narrow therapeutic index causes various toxicities. Although acute toxicity commonly causes ataxia, few cases have been reported of permanent cerebellar atrophy. A 49-year-old female with epilepsy was prescribed oral phenytoin. After three years of medication, seizure was controlled, but she developed unsteady gait and dysarthria. On admission, the patient showed severe bilateral ataxia, gingival hypertrophy, nystagmus, and dysarthria. Phenytoin toxicity was the impression, and phenytoin was omitted. Serum phenytoin level was 46.9 mg/L (therapeutic range being 10~20 mg/L). Brain magnetic resonance imaging (MRI) was performed to rule out other brain lesions, and diffuse cerebellar atrophy was revealed. After rehabilitation, mild bilateral ataxia remained, standing balance was poor, and the patient was able to walk 70 meters with minimal assist using roller walker. We review a case of chronic phenytoin toxicity that manifested as cerebellar ataxia and later showed atrophy of cerebellum.
Ataxia ; Atrophy ; Brain ; Cerebellar Ataxia ; Cerebellum ; Dysarthria ; Epilepsy ; Female ; Gait Disorders, Neurologic ; Gingival Hypertrophy ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Phenytoin ; Seizures ; Walkers

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Treating Apraxia of Speech (AOS) using the Motor Learning Guided (MLG) Approach: A case report.

In Sop KIM ; In Hyo SEO

Brain & Neurorehabilitation.2011;4(1):64-68. doi:10.12786/bn.2011.4.1.64

The treatments of AOS have been debated since the late 1960s. Despite a considerable amount of study of intervention approaches to AOS, the effectiveness and efficacy of the treatment of AOS is still unclear. This study investigates the effect of motor learning guided (MLG) approach on individuals with AOS. Two individuals with AOS whose severity ranged from mild to moderate participated in this study. Two sets (each 20 utterance) of stimuli were created (based on high functionality) by the participants and their primary care-givers. Subjects were instructed to produce the target word three times with 4-second pause between each attempt. After 3 attempts, the experimenter provided knowledge of results (KR). Each target word was randomly selected from the written stimulus cards. The results showed that the mean scores of all the subjects increased during the sessions and this effect was transferred to the untrained target words.
Apraxias ; Knowledge of Results (Psychology) ; Learning ; Retention (Psychology)

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Delayed Onset Pneumo-hydrocephalus Caused by Traumatic Skull Base Fracture: A case report.

Hyoung Seop KIM ; Jong Moon KIM ; Gwang Bok PARK ; Myoung Sik BAE

Brain & Neurorehabilitation.2011;4(1):61-63. doi:10.12786/bn.2011.4.1.61

Pneumocephalus is defined as the presence of air or gas within the cranial cavity. It is usually associated with disruption of the continuity of the skull after head and facial trauma, neuro or otorhinolaryngologic surgery, and rarely, spontaneously. But a case of pneumo-hydrocephlus, a special subtype of pneumocephalus, has been rarely reported. This is a case of a 26-year-old quadriplegic patient who traumatic brain injury with left frontoparietal skull bone fracture and epidural hemorrhage with developed of pneumo-hydrocepahlus in the ventricle 6 months after injury. The mechanism of this case can be explained by the "inverted bottle" hypothesis. Clinical observation suggests that the leakage of cerebrospinal fluid through the ventricle-peritoneal shunt tube caused negative pressure gradient differences resulting in the inflow of outside air into the ventricle through fissures created by concealed fracture of the skull base.
Adult ; Brain Injuries ; Fractures, Bone ; Head ; Hemorrhage ; Humans ; Pneumocephalus ; Skull ; Skull Base ; Ventriculoperitoneal Shunt

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The Effect of Transcranial Direct Current Stimulation on Cortical Excitability and Motor Function in a Stroke Patient: A case report.

Lee suk KIM ; Dae Yul KIM

Brain & Neurorehabilitation.2011;4(1):57-60. doi:10.12786/bn.2011.4.1.57

In this case study, we investigated the change of cortical excitability and motor function recovery after transcranial direct current stimulation (tDCS). A patient with chronic right middle cerebal artery territory infarction received tDCS. We performed anodal tDCS on her ipsilesional primary motor cortex which was found by motor evoked potential and conventional occupational therapy for 2 weeks. We evaluated upper extremity function with Fugl-Meyer Assessment (FMA) before and after, one and three months after tDCS. In addition, functional magnetic resonance imaging (FMR) was carried out to evaluate the change of cortical excitability. FMA score was improved after tDCS and the improvement was prominent at one and three months later compared to pre-treatment score. And cortical excitability of ipsilesional primary motor cortex was increased after tDCS. As these results show tDCS seems to be useful tool in promoting motor recovery through increasing cortical excitability in stroke patients.
Arteries ; Evoked Potentials, Motor ; Humans ; Infarction ; Magnetic Resonance Imaging ; Motor Cortex ; Occupational Therapy ; Recovery of Function ; Stroke ; Upper Extremity

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The Effect of Treadmill Aerobic Exercise in Stroke Patients.

Hong Chae KIM ; Si Woon PARK ; Hyun Chul YOO ; Kyung In CHOI ; You Lim YIM ; Min Jung KIM

Brain & Neurorehabilitation.2011;4(1):50-56. doi:10.12786/bn.2011.4.1.50

OBJECTIVE: To investigate the effect of treadmill aerobic exercise for eight weeks on cardiopulmonary fitness and functional mobility in stroke patients METHOD: Twenty one stroke patients who could walk independently and had MMSE score of 24 or higher were included. We used maximal exercise test by means of modified Harbor protocol before and after eight weeks' treadmill aerobic exercise. We monitored patients' status with EKG, heart rate, blood pressure and Borg rating of perceived exertion, and measured maximal O2 consumption, maximal heart rate, blood pressure, minute ventilation, rate pressure product and respiratory exchange ratio during maximal exercise test. We also assessed functional mobility by Fugl-Meyer assessment of lower extremity, Berg balance scale, five times sit to stand test, timed up & go test, dynamic gait index scale, activities-specific balance confidence scale and Korean-modified Barthel index before and after 8 weeks' training. RESULTS: Twenty one patients completed treadmill aerobic exercise training. After eight weeks' treadmill aerobic exercise, the cardiopulmonary fitness, measured by maximal O2 consumption, maximal heart rate, minute ventilation, systolic blood pressure, functional mobility measured by Fugl-Meyer assessment of lower extremity, Berg balance scale, five times sit to stand test, timed up & go test, dynamic gait index scale, activities-specific balance confidence scale and Korean-modified Barthel index showed statistically significant improvement (p<0.05). CONCLUSION: Eight weeks' treadmill aerobic exercise improved the cardiopulmonary fitness and functional mobility in ambulatory stroke patients.
Blood Pressure ; Electrocardiography ; Exercise ; Exercise Test ; Gait ; Heart Rate ; Humans ; Lower Extremity ; Stroke ; Ventilation

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Ultrasonographic Finding of Painful Hemiplegic Shoulder Associated with Motor Recovery after Stroke.

Nack Hwan KIM ; Sung Bom PYUN ; Hwee Kyu KWON

Brain & Neurorehabilitation.2011;4(1):44-49. doi:10.12786/bn.2011.4.1.44

OBJECTIVE: To analyze the relationship between painful hemiplegic shoulder (PHS) and ultrasonographic (US) findings according to the motor recovery stage of the stroke. METHOD: The medical records were reviewed retrospectively in 82 stroke patients from January 2005 to November 2009 who undertook US examination on hemiplegic shoulder. The clinical data collected were age, gender, stroke type, affected side, duration from stroke onset, manual function test (MFT) and the Brunnstrom stage of arm. The presence of spasticity, glenohumeral subluxation and sensory impairment were also investigated. The patients were classified into three groups according to the Brunnstrom recovery stage: the first, second and third recovery stages (RS1, RS2 and RS3). Furthermore, the correlations between US findings and the clinical characteristics according to the Brunnstrom recovery stage were analyzed. RESULTS: The presence of spasticity, glenohumeral subluxation, sensory impairment (proprioception) and MFT scores had statistically significant differences in each group. Among the 82 stroke patients, 62 patients (75.6%) had abnormal findings in US examination. The common abnormal structures were supraspinatus tendon (SST), biceps long head tendon (BLH), subacromial-subdeltoid bursa (SA-SD bursa). The frequencies of total US abnormality in each group were not significantly different (p=0.07). However, the SST abnormality was more frequent in the RS1, and the BLH and SA-SD bursa abnormality were more frequent in the RS3 (p<0.05). CONCLUSION: In this study, abnormal findings in US examination are frequent in PHS. The abnormal SST is related to the flaccidity, and the abnormal BLH and SA-SD bursa are related to the overuse.
Arm ; Head ; Humans ; Hydrogen-Ion Concentration ; Medical Records ; Muscle Spasticity ; Retrospective Studies ; Shoulder ; Shoulder Dislocation ; Stroke ; Tendons

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Establishing Chronic Stroke Rat Models by MCA Occlusion Using Intraluminal Filament.

Jae Hyuk LEE ; Ja Young MOON ; Ki Chul PARK ; Min Young KIM

Brain & Neurorehabilitation.2011;4(1):35-43. doi:10.12786/bn.2011.4.1.35

OBJECTIVE: Focal brain ischemia induced in rats by occlusion of middle cerebral artery (MCA) is a widely used paradigm of human brain infarct. The purpose of this study is to establish chronic stroke model by MCA occlusion using intraluminal filament in rats. METHOD: A total 44 rats were operated by modified Longa's method. The surgical procedure consisted of introducing an intraluminal filament into the internal carotid artery and advancing it intracranially to block blood flow for 60 minutes into MCA. After this procedure motor and postural change were assessed using a 0~5 point grading scale consisted of forelimb, hindlimb and circling test. Behavioral tests such as rotarod, stepping and cylinder tests were examined in the survived rats after MCA occlusion up to 14 weeks post-ischemia. Autopsy was done to evaluate the cerebral infarct volume. RESULTS: Thirteen rats were survived up to 14 weeks post-ischemia and for the severely paralyzed subjects by acute neurological severity scoring were examined with behavioral tests once a week for 14 weeks. Although rotarod test have not shown any specific changes during 14 weeks, stepping and cylinder tests have shown stabilizing pattern since 4 weeks after the procedure. CONCLUSION: MCA occlusion using intraluminal filament could be reliable method to make stroke model in rats. We concluded that 4 weeks post-ischemia by this method in rats might be regarded as chronic model.
Animals ; Autopsy ; Brain ; Brain Ischemia ; Carotid Artery, Internal ; Forelimb ; Hindlimb ; Humans ; Middle Cerebral Artery ; Rats ; Rotarod Performance Test ; Stroke

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Animal Models of Neurodegenerative Diseases.

Sung Rae CHO

Brain & Neurorehabilitation.2011;4(1):30-34. doi:10.12786/bn.2011.4.1.30

Animal models of human diseases are essentially required to investigate the pathophysiological mechanisms of the diseases, and to test potential therapies for the clinics. However, neurodegenerative diseases including Parkinson's disease (PD) are particularly difficult to model or to recapitulate the features because most of them have multifactorial etiologies and chronically progressive symptoms, although Huntington's disease (HD) has an identified etiology such as an excessive expansion of CAG repeats. In this review, PD and HD which were typical neurodegenerative diseases were studied. The animals of PD were roughly classified into a neurotoxic model and a genetic model, and those of HD were divided into excitotoxic, transgenic, knock-in, and knock-out models. Insights obtained from these animal models of neurodegenerative diseases will guide us toward the understanding of the disease mechanisms, the design of new therapeutic strategies, and finally translation into the clinics.
Animals ; Humans ; Huntington Disease ; Models, Animal ; Models, Genetic ; Neurodegenerative Diseases ; Parkinson Disease

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Animal Models of Dementia.

Dong Hee CHOI ; Jongmin LEE

Brain & Neurorehabilitation.2011;4(1):21-29. doi:10.12786/bn.2011.4.1.21

The discovery of new therapies for neurological disorders is especially predicated on the use of animal models both to identify new therapeutic targets and to carry out preclinical drug trials. Of primary concern to a neuroscience researcher is the selection of the most relevant animal model to achieve his or her research goals. Dementia is defined as the loss of mental processing ability, including communication, abstract thinking, judgment, and ultimately physical abilities. Alzheimer's disease (AD) is the most common cause of progressive decline of cognitive function in aged humans, and is characterized by the presence of numerous senile plaques and neurofibrillary tangles accompanied by neuronal loss. Vascular cognitive impairment encompasses vascular dementia (VD) and is the second most common cause of dementing illness after AD. Some, but not all, of the neuropathological alterations and cognitive impairment in AD and VD can be reproduced genetically and pharmacologically in animals. We review the recent progress in the development of animal models of AD and VD. Experimental animal models of AD included cholinergic dysfunction-, Amyloid b-peptide-, neurofibrillary tangles-, and presenilin-related animal models. We focused on brief global ischaemic insults, chronic global hypoperfusion, and vasculopathies as experimental models of VD. Preclinical research based on animal models is pivotal to our knowledge of underlying molecular mechanisms and the drug discovery pipeline for dementia aiming at the development of therapeutic strategies alleviating or preventing this devastating disorder.
Aged ; Alzheimer Disease ; Amyloid ; Animals ; Dementia ; Dementia, Vascular ; Drug Discovery ; Humans ; Judgment ; Models, Animal ; Models, Theoretical ; Nervous System Diseases ; Neurofibrillary Tangles ; Neurons ; Neurosciences ; Plaque, Amyloid ; Thinking

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Animal Models of Traumatic Brain Injury.

Seong Eun KOH

Brain & Neurorehabilitation.2011;4(1):12-20. doi:10.12786/bn.2011.4.1.12

Traumatic brain injury could be used to describe all injuries to the brain caused by external mechanical forces. It shows a variety of clinical manifestations from mild to severe forms and can result to death. Moderate to severe injuries can produce disabilities on physical, cognitive, behavioral, and emotional aspects. Animal models of traumatic brain injury have been developed to reproduce characteristics of human brain injury, to understand molecular and cellular pathophysiology and neurobehavioral outcomes following trauma and to find out the promising pharmacological drugs or rehabilitative skills to treat. This article reviewed the current experimental traumatic brain injury models, including weight drop, fluid percussion, and controlled cortical impact, and also the neurobehavioral assessments that are most commonly used to measure loss of function.
Animals ; Brain ; Brain Injuries ; Humans ; Models, Animal ; Percussion

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