Converging data on focal dystonias suggest a widespread disorder of somatosensory processing. The aims of our study were, first, to assess somatosensory activation patterns in cervical dystonia (CD) beyond the representation of the affected body parts and, second, to search for task-related activation changes induced by botulinum toxin type-A (BoNT-A) therapy. Functional magnetic resonance imaging (MRI) during electrical median nerve stimulation was employed in seven CD patients and nine controls; the examination was repeated 4 weeks after BoNT-A application to dystonic neck muscles. The pretreatment activation map of patients showed activation in the contralateral primary somatosensory cortex, but missing activation in the secondary somatosensory cortex and insula, in contrast to controls and patients after treatment. Clinically significant effect of BoNT-A therapy was associated with a significant increase of BOLD response in the contralateral secondary somatosensory, insular, and inferior parietal cortices. The posttreatment somatosensory maps of patients did not significantly differ from controls. This study has brought evidence of widespread disruption of somatosensory processing in CD and its modification with BoNT-A therapy.
- MeSH
- Botulinum Toxins, Type A pharmacology therapeutic use MeSH
- Adult MeSH
- Injections, Intramuscular methods MeSH
- Neck Muscles drug effects innervation physiopathology MeSH
- Middle Aged MeSH
- Humans MeSH
- Neuromuscular Agents pharmacology therapeutic use MeSH
- Somatosensory Cortex physiopathology MeSH
- Somatosensory Disorders drug therapy physiopathology MeSH
- Torticollis drug therapy physiopathology MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
In cervical dystonia, functional MRI (fMRI) evidence indicates changes in several resting state networks, which revert in part following the botulinum neurotoxin A (BoNT) therapy. Recently, the involvement of the cerebellum in dystonia has gained attention. The aim of our study was to compare connectivity between cerebellar subdivisions and the rest of the brain before and after BoNT treatment. Seventeen patients with cervical dystonia indicated for treatment with BoNT were enrolled (14 female, aged 50.2 ± 8.5 years, range 38-63 years). Clinical and fMRI examinations were carried out before and 4 weeks after BoNT injection. Clinical severity was evaluated using TWSTRS. Functional MRI data were acquired on a 1.5 T scanner during 8 min rest. Seed-based functional connectivity analysis was performed using data extracted from atlas-defined cerebellar areas in both datasets. Clinical scores demonstrated satisfactory BoNT effect. After treatment, connectivity decreased between the vermis lobule VIIIa and the left dorsal mesial frontal cortex. Positive correlations between the connectivity differences and the clinical improvement were detected for the right lobule VI, right crus II, vermis VIIIb and the right lobule IX. Our data provide evidence for modulation of cerebello-cortical connectivity resulting from successful treatment by botulinum neurotoxin.
- MeSH
- Botulinum Toxins, Type A administration & dosage MeSH
- Adult MeSH
- Injections, Intralesional MeSH
- Cognition physiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Cerebellum physiopathology MeSH
- Cerebral Cortex physiopathology MeSH
- Rest physiology MeSH
- Severity of Illness Index MeSH
- Torticollis diagnostic imaging drug therapy physiopathology psychology MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Keywords
- atletická pubalgie, Guna MD-Tissue, MD přípravky,
- MeSH
- Pain MeSH
- Adult MeSH
- Injections MeSH
- Collagen * pharmacology therapeutic use MeSH
- Humans MeSH
- Magnetic Resonance Imaging utilization MeSH
- Pain Management methods MeSH
- Athletes MeSH
- Athletic Injuries * diagnosis therapy MeSH
- Pubic Symphysis physiopathology MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
Cíl: Cílem práce bylo zjistit, u kterých osob se symptomatologií onemocnění vnitřního ucha (náhle vzniklá nedoslýchavost, periferní typ závrati, tinnitus) lze prokázat hydrops endolymfatického prostoru na základě vyšetření MR po intratympanické aplikaci kontrastní látky. Současně tak lze ověřit metodický postup zobrazování vnitřního ucha s cílem odlišit endolymfatický a perilymfatický prostor. Metodika: Vyšetřeno bylo 34 pacientů (18 žen a 16 mužů průměrného věku 56 let). Náhle vzniklá percepční nedoslýchavost byla audiometricky potvrzena u 33 pacientů, jedna pacientka byla bez poruchy sluchu. Šesti pacientům byla diagnostikována definitivní Méni?rova choroba dle kritérií AAO-HNS Commitee of Hearing and Equilibrium (1995). Dvacetišesti pacientům byla do bubínkové dutiny ambulantně aplikována kontrastní látka (gadobutrol 1,0 mmol/ml, ředěn fyziologickým roztokem 1:7), u 8 pacientů byla aplikace zajištěna systémem MicroWick. Vyšetření MR (1,5 Tesla) proběhlo za 24 hodin (+/-7 hod) po aplikaci kontrastní látky, k vyhodnocení byly použity T1 sekvence. Přítomnost a velikost hydropsu byla hodnocena na základě velikosti poměru endolymfatického prostoru k celému vestibulu. Pokud byl tento poměr 33 % a více, bylo toto rozšíření endolymfatického prostoru vestibula hodnoceno jako hydrops. Následně byli pacienti sledováni, včetně kontrolních audiometrických vyšetření. Průměrná doba sledování byla 48 dnů. Výsledky: Podíl velikosti endolymfatického prostoru k velikosti celého vestibula bylo možné z výsledků MR vyšetření posoudit u 31 pacientů. Výsledek u 3 pacientů byl nediagnostický. Rozšíření endolymfatického prostoru bylo prokázáno u 14 pacientů. Pěti pacientům s definitivní Méni?rovou chorobou byl prokázán endolymfatický hydrops. U osob pouze s percepční nedoslýchavostí nebyl hydrops v oblasti vestibula přítomen. U žádného z pacientů nebylo dle MR zjištěno retrokochleární postižení (např. ve smyslu schwannomu vestibulárního nervu). Závěr: Vyšetření vnitřního ucha MR s intratympanicky podávanou kontrastní látkou se jeví jako vhodná metoda volby k zobrazení hydropsu vnitřního ucha (nejčastěji u osob s Méni?rovou chorobou). Tento nález může sloužit k cílené léčbě těchto pacientů.
Objective: The aim of this study was to identify persons with endolymphatic hydrops (using Magnetic Resonance Imaging - MRI and local application of gadobutrol) to subjects with clinical symptoms of inner ear disease (sudden hearing loss, peripheral type of vertigo, tinnitus). The goal was to confirm the method of inner ear imaging suitable for distinguishing endolymphatic and perilymphatic space. Methods: We included 34 patients of average age 56 years, 18 women and 16 men. Thirty three patients experienced acute sensorineural hearing loss, in 6 patients definite Méni?re’s disease was diagnosed. Contrast agent (gadobutrol) diluted with saline solution (1:7) was administered in the tympanic cavity of 26 patients in outpatient setting, in 8 cases the transport was provided by a system Silverstein MicroWick. MRI examination (1.5 Tesla) was performed 24 hours (+/-7 hours) after administration of contrast medium (T1 sequence). The presence and size of hydrops was evaluated by the ratio of endolymphatic space compared to the whole vestibule. The ratio of 33 % and more was classified as endolymphatic hydrops. Subsequently, patients were observed including tone audiometry examination. The average follow-up time was 49 days. Results: The assessment of the size of the endolymphatic space in relation to the whole vestibule was relevant in 31 out of 34 patients. Result of 3 patients was not diagnostic. Extension of the endolymphatic space was present in 14 patients. In 5 patients with definite Méni?re’s disease was detected endolymphatic hydrops. The hydrops was found in none of the patients with sensorineural hearing loss as a single symptom. In any patient wasn´t found retrocochlear disease, especially schwannoma of vestibular nerve. Conclusion: MRI examination of the inner ear with the intratympanic injection of the contrast agent appears to be a suitable method of choice to depict hydrops of the inner ear (most often in people with Méni?re’s disease). This finding can be used for targeted treatment of these patients.
- MeSH
- Adult MeSH
- Endolymphatic Hydrops diagnosis MeSH
- Injections MeSH
- Injection, Intratympanic MeSH
- Contrast Media diagnostic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging * MeSH
- Meniere Disease * diagnosis MeSH
- Organometallic Compounds * diagnostic use MeSH
- Hearing Loss, Sensorineural etiology MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Tinnitus etiology MeSH
- Vertigo etiology MeSH
- Vestibule, Labyrinth pathology MeSH
- Ear, Inner pathology MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
Magnetická rezonance je důležitou vyšetřovací metodou pro stanovení diagnózy roztroušené sklerózy i pro následné sledování úspěšnosti nastavené imunomodulační terapie u již diagnostikovaných pacientů. Klinickými příznaky se projeví jen část zánětlivého postižení mozku a míchy, klinicky němou fázi onemocnění pak pomáhá kontrolovat právě magnetická rezonance. Časné zahájení léčby je důležité pro prognózu choroby, jelikož k nevratné neurodegeneraci dochází již od počátku onemocnění. Významnou účinnost v redukci MR aktivity prokázal subkutánní interferon ß-1a i u pacientů s vyšší aktivitou onemocnění při zahájení léčby ve studii IMPROVE. Vyšší efektivitu pak potvrdil v redukci sledovaných MR parametrů při přímém srovnání s interferonem ß-1a aplikovaným 1x týdně intramuskulárně v klinickém hodnocení EVIDENCE.
Magnetic resonance imaging is an important tool in establishing the diagnosis of multiple sclerosis as well as in subsequentlymonitoring the success of immunomodulatory therapy in patients already diagnosed with the disease. Clinical signs are presentonly in a proportion of inflammatory lesions of the brain and spinal cord, and it is magnetic resonance imaging that helps to monitorthe clinically silent phase of the disease. Early treatment initiation is important for prognosis of the disease since irreversibleneurodegeneration occurs already at the onset of the disease. Subcutaneous interferon ß-1a was shown to have significant efficacyin reducing MRI activity also in patients with a higher disease activity at treatment initiation in the IMPROVE trial. Moreover, inthe EVIDENCE trial, it was confirmed to have a higher efficacy in reducing the observed MRI parameters when directly comparedwith interferon ß-1a administered intramuscularly once a week.
- Keywords
- studie IMPROVE, studie EVIDENCE,
- MeSH
- Injections, Subcutaneous MeSH
- Interferon beta-1a * administration & dosage therapeutic use MeSH
- Humans MeSH
- Magnetic Resonance Imaging * MeSH
- Brain pathology MeSH
- Neuroimaging MeSH
- Randomized Controlled Trials as Topic MeSH
- Multiple Sclerosis, Relapsing-Remitting * drug therapy pathology MeSH
- Check Tag
- Humans MeSH
Diagnostika onemocnění čelistního kloubu se v zobrazovacích metodách opírá o rentgenový snímek a pak především o magnetickou rezonanci, která má ale řadu nevýhod: vysoká nákladnost, množství kontraindikací (gravidita, přítomnost feromagnetického materiálu v těle, přítomnost kardiostimulátoru nebo kochleárního implantátu) i fakt, že vyšetření může být pro mnoho pacientů nepříjemné (pro hluk a omezený prostor vyvolávající klaustrofobii). Autoři prezentují alternativní zobrazovací metodu magnetické rezonance - ultrasonografické vyšetření a jeho využití v terapii poruch čelistního kloubu.
Diagnostics of temporomandibular disorders is based on x-ray and especially magnetic resonance imaging (MRI). MRI has a number of inconviences: high cost and contraindications (gravidity, presence of ferromagnetic material in the body, presence of cardiostimulator or cochlear implant). MRI examination may be discomfortable for patients due to noise and limited space causing claustrophobia. Authors present paging method alternative to MRI – ultrasound examination and its use in therapy of temporomandibular joint disorders.
- MeSH
- Injections, Intra-Articular methods MeSH
- Ultrasonography, Interventional methods utilization MeSH
- Humans MeSH
- Magnetic Resonance Imaging contraindications methods MeSH
- Temporomandibular Joint Disorders ultrasonography MeSH
- Ultrasonography methods MeSH
- Drug Administration Routes MeSH
- Check Tag
- Humans MeSH
McDonaldova kritéria revidovaná v roce 2010 reflektují klinický požadavek stanovit diagnózu roztroušené sklerózy (RS) již po první atace neurologických příznaků, v časném stadiu – klinicky izolovaného syndromu (CIS). CIS indikuje diagnostickou triádu paraklinických vyšetření, která mohou podpořit hypotézu první demyelinizační ataky RS a predikovat pravděpodobnost konverze do definitivní RS – CDMS. Časná diagnostika determinuje splnění požadavku časné léčby RS. Léčba glatiramer acetátem (GA) nebo dalšími léčivými přípravky první linie léčby RS (interferon-beta nebo teriflunomid) má zásadní význam pro redukci rizika konverze do CDMS a pro léčebnou strategii ovlivnění prognózy RS. Kazuistika prezentuje léčbu RS glatiramer acetátem po první demyelinizační atace RS.
The 2010 revised McDonald criteria reflect the clinical requirement to establish the diagnosis of multiple sclerosis (MS) as early as the initial attack of neurological symptoms, in an early stage – that of clinically isolated syndrome (CIS). CIS is the indication for a diagnostic triad of paraclinical investigations that can support the hypothesis of the initial demyelinating attack of MS and predict the likelihood of conversion to clinically definite MS – CDMS. Early diagnosis is required to meet the need for early MS treatment. Treatment with glatiramer acetate (GA) or other medicinal products for the first-line treatment of MS (interferon-beta or teriflunomide) is of essential importance in reducing the risk of conversion to CDMS and in the therapeutic strategy for influencing MS prognosis. The case report presents treatment of MS with glatiramer acetate following the initial demyelinating attack of MS.
- Keywords
- klinicky izolovaný syndrom, McDonaldova kritéra,
- MeSH
- Early Diagnosis MeSH
- Immunosuppressive Agents * administration & dosage MeSH
- Injections, Subcutaneous MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Methylprednisolone administration & dosage MeSH
- Adolescent MeSH
- Brain pathology MeSH
- Peptides * administration & dosage MeSH
- Disease Progression MeSH
- Multiple Sclerosis * diagnosis drug therapy pathology MeSH
- Syndrome MeSH
- Check Tag
- Humans MeSH
- Adolescent MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
McDonaldova kritéria revidovaná v roce 2010 reflektují klinický požadavek stanovit diagnózu roztroušené sklerózy (RS) již po první atace neurologických příznaků, v časném stadiu – klinicky izolovaného syndromu (CIS). CIS indikuje diagnostickou triádu paraklinických vyšetření, která mohou podpořit hypotézu první demyelinizační ataky RS a predikovat pravděpodobnost konverze do definitivní RS – CDMS. Časná diagnostika determinuje splnění požadavku časné léčby RS. Léčba glatiramer acetátem (GA) nebo dalšími léčivými přípravky první linie léčby RS (interferon-beta nebo teriflunomid) má zásadní význam pro redukci rizika konverze do CDMS a pro léčebnou strategii ovlivnění prognózy RS. Kazuistika prezentuje léčbu RS glatiramer acetátem po první demyelinizační atace RS.
The 2010 revised McDonald criteria reflect the clinical requirement to establish the diagnosis of multiple sclerosis (MS) as early as the initial attack of neurological symptoms, in an early stage – that of clinically isolated syndrome (CIS). CIS is the indication for a diagnostic triad of paraclinical investigations that can support the hypothesis of the initial demyelinating attack of MS and predict the likelihood of conversion to clinically definite MS – CDMS. Early diagnosis is required to meet the need for early MS treatment. Treatment with glatiramer acetate (GA) or other medicinal products for the first-line treatment of MS (interferon-beta or teriflunomide) is of essential importance in reducing the risk of conversion to CDMS and in the therapeutic strategy for influencing MS prognosis. The case report presents treatment of MS with glatiramer acetate following the initial demyelinating attack of MS.
- Keywords
- klinicky izolovaný syndrom, McDonaldova kritéra,
- MeSH
- Early Diagnosis MeSH
- Immunosuppressive Agents * administration & dosage MeSH
- Injections, Subcutaneous MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Methylprednisolone administration & dosage MeSH
- Adolescent MeSH
- Brain pathology MeSH
- Peptides * administration & dosage MeSH
- Disease Progression MeSH
- Multiple Sclerosis * diagnosis drug therapy pathology MeSH
- Syndrome MeSH
- Check Tag
- Humans MeSH
- Adolescent MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Afferent Pathways drug effects MeSH
- Botulinum Toxins, Type A administration & dosage pharmacology MeSH
- Lower Extremity MeSH
- Injections, Intramuscular MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods instrumentation MeSH
- Neurologic Manifestations MeSH
- Multiple Sclerosis * diagnostic imaging complications physiopathology MeSH
- Muscle Spasticity drug therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Observational Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- MeSH
- Pain diagnosis MeSH
- Failed Back Surgery Syndrome pathology prevention & control therapy MeSH
- Fibrosis prevention & control therapy MeSH
- Financing, Organized MeSH
- Hyaluronoglucosaminidase therapeutic use MeSH
- Injections, Epidural methods MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods utilization MeSH
- Pain Management MeSH
- Spinal Diseases surgery pathology MeSH
- Neurosurgical Procedures methods adverse effects MeSH
- Postoperative Complications diagnosis epidemiology therapy MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
