Open Access Short Communication

Thoracic Syringomyelia in a Patient with Amyotrophic Lateral Sclerosis

Daniele Lo Coco, Rossella Spataro, Alfonsa Claudia Taiello, Vincenzo La Bella

International Neuropsychiatric Disease Journal, Page 136-140
DOI: 10.9734/INDJ/2015/17176

We report a patient with bulbar-onset, clinically defined, sporadic amyotrophic lateral sclerosis bearing an isolated syringomyelia of the lower thoracic portion of the spinal cord. This is a very unusual association between two rare and progressive disorders, both affecting the spinal motoneurons. Syringomyelia might have acted as a phenotypic modifier in this ALS patient.

 

Open Access Original Research Article

Claustrophobia during Magnetic Resonance Imaging (MRI): Cohort of 8 Years

Fatima Mubarak, Kainat Baig, Shayan Sirat Maheen Anwar

International Neuropsychiatric Disease Journal, Page 106-111
DOI: 10.9734/INDJ/2015/13169

Objective: To calculate rate of claustrophobia in our population with further stratification.

Materials and Methods: This study was conducted in Aga Khan University Hospital (AKUH) Karachi. All patients undergoing Magnetic Resonance Imaging (MRI) for various indications, from 1st January 2006 to 31st December 2013 were enrolled. All cancelled MRI exams were retrieved from Radiology Information System (RIS) and rate of claustrophobia was calculated from total requested patients and separately from all cancelled exams. The MRI exams were performed on 1.5 and 3 Tesla machines. Claustrophobia rate was further analyzed in subgroups on the basis of age, gender, techniques, timings and body area covered and Odds ratios were calculated.

Results: In eight years, 76,254 patients underwent MRI exams. Out of total scans performed, 417 patients were found to be claustrophobic with rate of 0.53% making 14.32% of total cancelled exams due to various reasons.

Conclusion: Though claustrophobia rate is acceptable in our set up, it contributes to a significant proportion in all cancelled exams.

Open Access Original Research Article

A General Assessment of the Functional Impact of Acute Disseminated Encephalomyelitis

Iryna Lobanova, Olena Myalovitska

International Neuropsychiatric Disease Journal, Page 123-135
DOI: 10.9734/INDJ/2015/14217

Introduction: Long-term disability in patients with acute disseminated encephalomyelitis (ADEM) is caused not only by neurological deficiency, but also by the difficulties with social and psychological adaptation. Together with neurological condition, a very important role in clinical characteristics of the disease belongs to psychosocial disorders, as well as to patients’ subjective perception of the disease symptoms that has the impact on their quality of life.

Methods: We have examined 45 patients diagnosed with acute disseminated encephalomyelitis, 10 men and 35 women, aged 15- 53 (average age 32±0.4). All the patients were being treated at the Kiev city centre of multiple sclerosis (Kiev city hospital number 4, Alexandrovskaya City Clinical Hospital, Kiev city, Ukraine) during 3 years. The diagnosis of ADEM was based on neurological examination, MRI of the brain and CSF analysis. The neurological status was assessed by Kurtzke an Expanded Disability Status Scale (EDSS) and Functional Systems Points (FSS). In order to assess the impact of the disease on the daily life of patients to the most full extent a survey was conducted with the use of tests: “Functional Limitation Profile” and “Sickness Impact Profile – 68”.

Results: According to the "Functional Limitation Profile" test, patients diagnosed with acute disseminated encephalomyelitis demonstrated  functional condition impairment most often in 3 categories: "work" (86% of cases), "leisure and entertainments" (84% of cases), "social interaction" (82 % of cases), the least impaired were the categories "communication" (22% of cases), "emotions" (32% of cases), "food" (32% of cases). According to the "Sickness Impact Profile - 68" test, patients diagnosed with acute disseminated encephalomyelitis showed functional condition impairment most often in the category "social behavior" (84%), "somatic autonomy" (70% of cases), "mental autonomy and communication" (60% of cases). Categories "mobility control" (50%), "emotional stability" (44% of cases), "degree of mobility" (44% of cases) suffered the least. The highest percent in relation to the maximum possible point was noted in the category "social behavior", and the lowest – in the category “somatic autonomy”. Severity of neurologic deficit and increase in the number of demyelination foci on MRI have a negative impact on patients’ self-assessment of their quality of life. Gender of patients and the presence of disseminated encephalomyelitis relapses have the impact on the degree of functional limitation.

Conclusion: We can conclude from the assessments that the emergence of ADEM results in significant changes in the patient’s functional condition. Of the factors observed, the disease has the greatest impact on the patient’s social sphere and associated activities and the smallest impact on their emotional condition. The disease has a significant impact on the emotional state of women and patients with multiphasic course of disseminated encephalomyelitis. It is also reflected in the disorders of their sleep and rest. Social sphere of life is suffering more in men and patients with a first episode of disseminated encephalomyelitis.

 

Open Access Original Research Article

The Characteristics of Cognitive Functions in Patients with Acute Disseminated Encephalomyelitis

Iryna Lobanova

International Neuropsychiatric Disease Journal, Page 141-149
DOI: 10.9734/INDJ/2015/15286

Introduction: The clinical picture of acute disseminated encephalomyelitis is characterized not only by a variety of neurological signs, but also by disorders of higher cortical functions. Disorders of higher cognitive functions often remain undetected during routine examination of patients and the use of specialized neuropsychological tests enables timely diagnosis of cognitive disorders.

Methods: The assessment of cognitive impairment was carried out in 67 patients with ADEM (28 male and 39 female, aged 16 – 50, mean age - 31.6±2.3). All the patients were being treated at the Kiev city centre of multiple sclerosis (Ukraine). The diagnosis of ADEM was based on neurological examination, MRI of the brain and CSF analysis. The cognitive impairment in patients with ADEM was assessed during the first three days after the onset of the disease. The neurological status was assessed by Kurtzke an Expanded Disability Status Scale (EDSS) and Functional Systems Scores (FSS). Patients performed neuropsychological tests that enabled evaluation of short-term and long-term visual and auditory memory, various parameters of attention as well as ability to concentrate, orientation in time and space.

Results: The assessment of cognitive functions in patients with ADEM demonstrated impaired short-term and long-term memory indices according to “memorizing 10 words” test (34.6±1.5 words compared with control 42.7±1 words, P <0.001), verbal learning and delayed recall according to "California Verbal Learning Test "(12.3±1.9 words compared to control 14.6±1.1 words, P <0,01) and sustained attention and concentration according to "Symbol Digit Modalities Test "(54.5±10.2 compared to control 57.8±9.6, P> 0.05). In addition, assessment of memory, attention, orientation in time and space according to MMSE test (Mini - Mental State Examination) showed reduction of these functions in patients of the main group (27.2±0.24 points, compared with control 29.9±0.04 points, P <0.001). Demyelination foci in patients with cognitive disorders are most often localized to the periventricular regions in the frontal and parietal lobes, and in the cerebellum, where multiple demyelinating lesions are often observed.

Conclusion: We have detected cognitive disorders that require therapeutic correction in case of carrying out treatment-rehabilitation measures in patients with acute disseminated encephalomyelitis that will improve their quality of life.

 

Open Access Review Article

Substance Use Disorder: Biological Mechanisms, Clinical Effects and Neuroadaptations

Marc Fakhoury

International Neuropsychiatric Disease Journal, Page 112-122
DOI: 10.9734/INDJ/2015/16015

Substance use disorder is characterized by a psychological dependence on a substance or a drug that is beyond voluntary control and that can cause serious harm to the individual when used repetitively. The use of drugs, including alcohol, opiates and psychostimulants, is a wide spread behavior in human societies that pose massive public health costs. This paper aims at explaining the neurobiology of drug addiction and investigating the effects of substances such as psychostimulants, opioids, nicotine and alcohol on an individual’s health. Moreover, this paper gives an overview of the neurotransmitters and brains structures that are altered following the excessive use of drugs, and illustrates some of the neurobiological changes that occur during drug addiction. At the molecular level, drug abuse induces functional and morphological changes of specific brain structures, which generally lead to adverse consequences such as drug relapse. Although previous studies have significantly improved our understanding of the neurobiological mechanisms of substance use disorder in humans, more work need to be done to identify potential therapeutic targets and develop new treatment strategies.