Clinical Neurology and Neurosurgery RSS feed: Current Issue. Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide. Professor Peter Paul De Deyn, Scientific Director of the Institute Born-Bunge at the University of Antwerp, Belgium, is the Editor-in-Chief. The journal has a broad international perspective. Types of Papers: • Reviews • Neurological progress, concerning new developments in the field of clinical neurology and neurosurgery • Special articles, written by invited authors • Original articles, full-length papers devoted to the scope and purpose of the journal • Case histories, reporting unusual clinical syndromes or diseases. These papers should be no less than 3 pages print, not including illustrations and tables • Letters to the Editor, comments on articles in Clinical Neurology and Neurosurgery • Book reviews • Announcements are carried at the Editor's and Publisher's discretion. http://www.clineu-journal.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Clinical Neurology and Neurosurgery0303-84671145June 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.clineu-journal.com/article/PIIS0303846712002211/abstract?rss=yesEditorial Board10.1016/S0303-8467(12)00221-1Clinical Neurology and Neurosurgery 114, 5 (2012)2012-06-01Clinical Neurology and Neurosurgery2012-06-011145S0303-8467(12)X0005-2iihttp://www.clineu-journal.com/article/PIIS0303846712000674/abstract?rss=yes30 years have transpired since the 1982 Symposium on Restorative Neurology held at Baylor College of Medicine in Houston. At that time the field was being defined, its principles established, and methods of assessment and intervention introduced . The interval from that time to now has provided further elucidation of a theory of motor control. This has presented us with even more practical methods for characterizing residual motor control in those who have suffered nervous system injury, and well as modalities for functional activation of that residual control to provide greater recovery of movement and enhanced quality of life .PrefaceJustin M. Brown10.1016/j.clineuro.2012.01.035Clinical Neurology and Neurosurgery 114, 5 (2012)2012-04-13Clinical Neurology and Neurosurgery2012-04-131145S0303-8467(12)X0005-2Editorial427427http://www.clineu-journal.com/article/PIIS0303846712000285/abstract?rss=yesAbstract: Rather than focusing on the deficits and lost function caused by upper motor neuron lesions or disorders, it is more advantageous to elucidate, in each individual, the specific neural functions that remain available, and then, to build upon them by designing a treatment protocol to optimize their effectiveness and thus improve recovery. The practice of Restorative Neurology is based on detailed assessment of the individual patient, the use of neurophysiological methods to elucidate and characterize subclinical function and the application of interventions that modify neural activity to improve clinical function.Outline of restorative neurology: Definition, clinical practice, assessment, interventionMilan R. Dimitrijevic10.1016/j.clineuro.2012.01.014Clinical Neurology and Neurosurgery 114, 5 (2012)2012-03-02Clinical Neurology and Neurosurgery2012-03-021145S0303-8467(12)X0005-2Background – setting the stage428431http://www.clineu-journal.com/article/PIIS0303846712000157/abstract?rss=yesAbstract: The motoneuronal outputs from cortex and spinal cord have quite different patterns of organisation. The cortex consists of a highly intermixed mosaic of small output zones whereas the motoneurones in the cord are located in clearly defined columns of cells, that all project to the same muscle. I describe the pattern of innervation between cortex and cord, indicate the importance of cortical plasticity in allowing flexible control of spinal circuits, and show how these inputs interact. Finally I discuss some of the new methods of stimulating descending motor pathways in humans.Overview of neurophysiology of movement controlJ.C. Rothwell10.1016/j.clineuro.2011.12.053Clinical Neurology and Neurosurgery 114, 5 (2012)2012-01-27Clinical Neurology and Neurosurgery2012-01-271145S0303-8467(12)X0005-2Background – setting the stage432435http://www.clineu-journal.com/article/PIIS0303846712000224/abstract?rss=yesAbstract: The adult human nervous system is an incredibly complex set of thousands to tens of thousands of connections between a hundred billion neurons that develops via an intricate spatial-temporal process and is shaped by experience. In addition, any one anatomical arrangement of neural circuits is usually capable of multiple physiological states. Following neurological injury, a new anatomy, and consequently a new spectrum of physiology, emerges within this nervous system with its mix of both injured and uninjured parts. It is this new combination of neural components that determines the extent to which natural functional recovery can occur and the extent to which clinical interventions can further that recovery. Detecting the new anatomy and physiology of the injured human nervous system is difficult but not impossible and some methods can track over time changes in neural structure or, more often, functions that correlate with neurological improvement. The goal of restorative neurology is to make best use of this new anatomy and physiology to facilitate neurological recovery. While we are still learning about how neurorehabilitation interventions generate functional recovery, we can begin to test hypothesis regarding the underlying mechanisms of neural plasticity and attempt to augment those processes.Restorative neurology: Consideration of the new anatomy and physiology of the injured nervous systemKeith E. Tansey, William Barry McKay, Byron A. Kakulas10.1016/j.clineuro.2012.01.010Clinical Neurology and Neurosurgery 114, 5 (2012)2012-02-03Clinical Neurology and Neurosurgery2012-02-031145S0303-8467(12)X0005-2Background – setting the stage436440http://www.clineu-journal.com/article/PIIS0303846712001321/abstract?rss=yesDisruption of neurons, their axons, or simply loss of conduction through these axons, when involving CNS motor pathways, results in the upper motor neuron (UMN) syndrome. The causes may be traumatic, vascular, inflammatory, metabolic, neoplastic, inherited or developmental and degenerative. Regardless of the site or cause of the UMN dysfunction, the result is a spectrum of motor control impairment . Common clinical examinations of this population include grading volitional and passive movements and tendon and cutaneo-muscular reflexes. While this may capture enough information to note the difference between subtle, moderate and severe upper motor neuron dysfunction impairments, it often lacks the resolution necessary to document the residual capacity of the nervous system to respond to a particular intervention and to detect more subtle changes that may result from an intervention.Clinical features of brain motor control and influence in upper motor neuron dysfunctionJustin M. Brown, Keith E. Tansey10.1016/j.clineuro.2012.02.038Clinical Neurology and Neurosurgery 114, 5 (2012)2012-04-13Clinical Neurology and Neurosurgery2012-04-131145S0303-8467(12)X0005-2New anatomy and methods of assessment441446http://www.clineu-journal.com/article/PIIS0303846712000273/abstract?rss=yesAbstract: Following injury or disease, the central nervous system (CNS), to varying degrees, loses neurons, synaptic connections and conduction-promoting myelin insulation altering the neural circuitry assembled during development. This “New Anatomy” changes neural processing, bringing spasticity, paresis and paralysis to motor function and altered sensation, numbness and pain to sensory function. Focusing on the effects of CNS damage on the motor subsystems, this review offers a neurophysiological assessment perspective developed within the study of human spinal cord injury and extends it to other CNS disorders. It puts forward the concept that there are essential domains of CNS processing, altered by most neurological disorders, that are temporal, the speed of activation and deactivation, and spatial, the distribution across multiple muscles of motor units selected and activated. Measured through multiple-muscle recordings of selected motor-task performance, these domains can be useful in quantifying the severity of CNS damage and changes achieved through recovery or treatment.Neurophysiological characterization of the New Anatomy and motor control that results from neurological injury or diseaseWilliam Barry McKay10.1016/j.clineuro.2012.01.013Clinical Neurology and Neurosurgery 114, 5 (2012)2012-02-10Clinical Neurology and Neurosurgery2012-02-101145S0303-8467(12)X0005-2New anatomy and methods of assessment447454http://www.clineu-journal.com/article/PIIS030384671200145X/abstract?rss=yesAbstract: Objective: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized by degeneration of the upper and lower motor neurons. Each voluntary movement, including inspiration, is preceded by movement-related cortical potential (MRCP) that can be recorded from the scalp. MRCPs of ALS patients with severe upper motor neuron involvement are smaller. Our aim was to explore whether the inspiratory-(sniffing)-related cortical potentials (SRCPs) and index-finger-flexion MRCPs (FFRCPs) can be used as markers of cortical involvement in ALS.Methods: Thirteen ALS patients and 15 healthy volunteers were assessed for their hand dexterity and strength, respiratory function, speech capacity, spasticity, electromyographic parameters and functional rating scales. EEG was recorded during self-paced sniffing and the right index finger flexion. The MRCP amplitudes were assessed at the relevant electrode positions.Results: No statistically significant difference was found between the MRCP amplitudes of the ALS patients and the control subjects. However, patients with more severely affected upper limb functions generated smaller FFRCPs and those with more affected respiratory functions generated smaller SRCPs. Excessively high FFRCPs were associated with better while excessively low FFRCPs with worse scores on some of the clinical measures of the upper limb function.Conclusion: Our preliminary results demonstrate that it is feasible to record SRCP in ALS patients, which combined with FFRCP, may be useful to determine the spectrum of motor control changes in this population.Inspiratory- and finger-flexion-related cortical potentials in patients with amyotrophic lateral sclerosis – An exploratory studyNataša Bizovičar, Ignac Zidar, Blaž Koritnik, Janez Zidar10.1016/j.clineuro.2012.02.049Clinical Neurology and Neurosurgery 114, 5 (2012)2012-03-19Clinical Neurology and Neurosurgery2012-03-191145S0303-8467(12)X0005-2New anatomy and methods of assessment455459http://www.clineu-journal.com/article/PIIS0303846712000145/abstract?rss=yesAbstract: Advances in technology in recent decades have contributed to rapid developments in non-invasive methods for imaging human anatomy, and advanced imaging methods are now one of the primary tools for clinical diagnosis after neurological trauma or disease. Here we review the current and upcoming capabilities of one of the most rapidly developing methods, magnetic resonance imaging (MRI). The underlying theory is introduced so that the reasons for the strengths, weaknesses, and future expectations of this method, can be explained. Current techniques for imaging anatomical changes, inflammation, and changes in white matter, axonal integrity, blood flow and function, are reviewed. Applications for specific purposes of assessing traumatic injury in the brain or spinal cord, and for multiple-sclerosis are also presented, and are used as examples of how the advanced techniques are being used in practice.Advanced MR imaging techniques and characterization of residual anatomyP.W. Stroman, R.L. Bosma, J. Kornelsen, J. Lawrence-Dewar, C. Wheeler-Kingshott, D. Cadotte, M.G. Fehlings10.1016/j.clineuro.2012.01.003Clinical Neurology and Neurosurgery 114, 5 (2012)2012-02-13Clinical Neurology and Neurosurgery2012-02-131145S0303-8467(12)X0005-2New anatomy and methods of assessment460470http://www.clineu-journal.com/article/PIIS0303846712002363/abstract?rss=yesAbstract: Recent years have witnessed significant advances in the treatment of neurological injuries such as stroke, traumatic brain injuries (TBI), and spinal cord injuries (SCI). The current approach includes acute intervention to curb the primary insult, prevention of secondary complications and early rehabilitation to optimize residual function to ultimately enhance quality of life and independence. While this is effective in providing a degree of independence to many patients, we believe that further functional gains are possible for many patients who have plateaued followed a contemporary rehabilitation program. Complementary methods are available today that are not widely used, but have demonstrated great promise in augmenting function and quality of life in patients who cannot benefit further from currently available treatment options.From contemporary rehabilitation to restorative neurologyJustin M. Brown, David M. Deriso, Keith E. Tansey10.1016/j.clineuro.2012.04.009Clinical Neurology and Neurosurgery 114, 5 (2012)2012-06-01Clinical Neurology and Neurosurgery2012-06-011145S0303-8467(12)X0005-2Modalities of intervention471474http://www.clineu-journal.com/article/PIIS0303846712000133/abstract?rss=yesAbstract: Babies and young children with early spinal cord injury (SCI) have evidence of an improved level of recovery over an extended time period. Enhanced neuroplasticity is well recognized in neonatal animal models. In the young human, developmental apraxia and learned early habitual movements mask expression of residual or recovered motor function. Techniques providing sensorimotor stimulation with threshold electrical stimulation (TES) and EMG triggered stimulation (ETS) act to increase awareness and useful function. Small cohort size and prolonged developmental maturation argue for the use of single subject research designs in this population.Developmental and maladaptive plasticity in neonatal SCIKaren E. Pape10.1016/j.clineuro.2012.01.002Clinical Neurology and Neurosurgery 114, 5 (2012)2012-02-06Clinical Neurology and Neurosurgery2012-02-061145S0303-8467(12)X0005-2Modalities of intervention475482http://www.clineu-journal.com/article/PIIS0303846712000212/abstract?rss=yesAbstract: Objective: This chapter presents modalities of physical therapy used in optimizing sensorimotor recovery from nervous system injury.Methods: A brief historical perspective, rationale, indications for application, and evidence of effectiveness of various physical treatment modalities is provided.Results: Many of the facilitatory and inhibitory techniques used in the past are no longer used, as they were based on an understanding of recovery after nervous system injury that is now outdated. There has been a paradigm shift in the management of people with neurological dysfunction. In particular there has been a reduction in focus on the positive features or the upper motor neuron syndrome, such as spasticity, and an increasing emphasis on active, task-related practice of functional tasks.Conclusion: Physical therapy for people with neurological disorders has undergone a paradigm shift as a result of new knowledge about motor control, skill acquisition, and recovery of function after injury. Future research should address new applications of electrical stimulation and whole body vibration as well as the optimal dosage and timing of interventions.Physical modalities in the treatment of neurological dysfunctionMary P. Galea10.1016/j.clineuro.2012.01.009Clinical Neurology and Neurosurgery 114, 5 (2012)2012-02-02Clinical Neurology and Neurosurgery2012-02-021145S0303-8467(12)X0005-2Modalities of intervention483488http://www.clineu-journal.com/article/PIIS0303846712001655/abstract?rss=yesAbstract: One consequence of central nervous system injury or disease is the impairment of neural control of movement, resulting in spasticity and paralysis. To enhance recovery, restorative neurology procedures modify altered, yet preserved nervous system function. This review focuses on functional electrical stimulation (FES) and spinal cord stimulation (SCS) that utilize remaining capabilities of the distal apparatus of spinal cord, peripheral nerves and muscles in upper motor neuron dysfunctions. FES for the immediate generation of lower limb movement along with current rehabilitative techniques is reviewed. The potential of SCS for controlling spinal spasticity and enhancing lower limb function in multiple sclerosis and spinal cord injury is discussed. The necessity for precise electrode placement and appropriate stimulation parameter settings to achieve therapeutic specificity is elaborated. This will lead to our human work of epidural and transcutaneous stimulation targeting the lumbar spinal cord for enhancing motor functions in spinal cord injured people, supplemented by pertinent human research of other investigators. We conclude that the concept of restorative neurology recently received new appreciation by accumulated evidence for locomotor circuits residing in the human spinal cord. Technological and clinical advancements need to follow for a major impact on the functional recovery in individuals with severe damage to their motor system.Neuromodulation of lower limb motor control in restorative neurologyKaren Minassian, Ursula Hofstoetter, Keith Tansey, Winfried Mayr10.1016/j.clineuro.2012.03.013Clinical Neurology and Neurosurgery 114, 5 (2012)2012-03-30Clinical Neurology and Neurosurgery2012-03-301145S0303-8467(12)X0005-2Modalities of intervention489497http://www.clineu-journal.com/article/PIIS0303846712001667/abstract?rss=yesAbstract: Study design: Blinded, placebo-controlled, prospective clinical trial.Purpose: To examine the effects of botulinum toxin type A (BTX-A) injections into plantar flexor muscles in stroke patients with equinovarus gait.Subjects: 15 post-stroke and 10 matched neurologically intact subjects.Methods: Modified Ashworth Scale (MAS) and Fugl–Meyer assessment of physical function scale scores along with surface EMG collected before and up to 12weeks after BTX-A injections to plantar flexor muscle motor points in stroke subjects. Saline placebo injections were performed in a subset of stroke subject group.Results: MAS scores were decreased at 4, 8 and 12weeks but F–M scores did not improve until 12weeks post injection. Multi-muscle EMG patterns showed the return of volitional dorsiflexor activity in 11 and a decrease of antagonistic and distant coactivation in all but one of the 15.Conclusions: BTX-A is effective in reducing antagonistic and distant muscle activation that impedes volitional dorsiflexion.Modification of altered ankle motor control after stroke using focal application of Botulinum toxin type ASimon F. Tang, Jia-Pei Hong, William Barry McKay, Chu-Wen Tang, Pei-Hsuan Wu, Ngok-Kiu Chu10.1016/j.clineuro.2012.03.014Clinical Neurology and Neurosurgery 114, 5 (2012)2012-04-05Clinical Neurology and Neurosurgery2012-04-051145S0303-8467(12)X0005-2Modalities of intervention498501http://www.clineu-journal.com/article/PIIS0303846712000807/abstract?rss=yesAbstract: Background: The etiology of diaphragm paralysis is often elusive unless an iatrogenic or traumatic injury to the phrenic nerve can be clearly implicated. Until recently, there has been little interest in the pathophysiology of diaphragm paralysis since few treatment options existed.Methods: We present three cases of symptomatic diaphragm paralysis in which a clear clinico-pathologic diagnosis could be identified, specifically a vascular compression of the phrenic nerve in the neck caused by a tortuous or adherent transverse cervical artery.Results: In two patients the vascular compression followed a preceding traction injury, whereas in one patient an inter-scalene nerve block had been performed. Following vascular decompression, all three patients regained diaphragmatic motion on fluoroscopic chest radiographs, and experienced a resolution of respiratory symptoms.Conclusion: We suggest that vascular compression of the phrenic nerve in the neck may occur following traumatic or iatrogenic injuries, and result in symptomatic diaphragm paralysis.Diaphragm paralysis caused by transverse cervical artery compression of the phrenic nerve: The Red Cross syndromeMatthew R. Kaufman, Lourens J. Willekes, Andrew I. Elkwood, Michael I. Rose, Tushar R. Patel, Russell L. Ashinoff, Alan R. Colicchio10.1016/j.clineuro.2012.01.048Clinical Neurology and Neurosurgery 114, 5 (2012)2012-02-27Clinical Neurology and Neurosurgery2012-02-271145S0303-8467(12)X0005-2Modalities of intervention502505http://www.clineu-journal.com/article/PIIS0303846712000686/abstract?rss=yesAbstract: Surgical interventions to improve function following nervous system injury have been in development since the early 1900s. Only recently these have been assimilated into a coherent approach which can be applied to injuries of the brain, spinal cord and peripheral nerves. In addition to pharmacological and stimulation based interventions, surgical manipulation of the peripheral nerves and muscles of the extremity can offer functional enhancement for a variety of limb impairments. In order to plan an effective surgical intervention, neurophysiological assessment of the injury and residual motor control is essential. Effective implementation of these surgical interventions can enhance function and quality of life for many individuals whose activity has been limited as a result of nervous system injury.The clinical practice of reconstructive neurosurgeryJustin M. Brown, Nicholas Vivio, Geoffrey L. Sheean10.1016/j.clineuro.2012.01.036Clinical Neurology and Neurosurgery 114, 5 (2012)2012-03-15Clinical Neurology and Neurosurgery2012-03-151145S0303-8467(12)X0005-2Modalities of intervention506514http://www.clineu-journal.com/article/PIIS0303846712000236/abstract?rss=yesAbstract: Restoring movement control after central nervous system injury requires reconnecting the brain and spinal motoneurons, and doing so with sufficient precision and strength to enable robust voluntary muscle recruitment. Whereas the connection between the upper motoneuron in motor cortex and alpha-motoneurons was thought to be the only important connection for normal motor function in humans, we know that a multiplicity of motor circuits are recruited during normal motor control. Multiplicity of functionally important motor circuits points to the myriad possibilities of intervention that restorative neurology can turn to for repairing motor systems connections to recover movement control after injury. New motor systems repair strategies in animal models and humans are tapping into distributed motor control functions of the spinal cord; neural activity-based approaches, especially for corticospinal tract repair; and circuit-selective activation approaches. I focus on studies harnessing activity-based therapeutic approaches to promote sprouting of spared corticospinal tract axons after injury and redirecting potentially maladaptive plasticity. I discuss that we can see on the near horizon, many different strategies for repairing motor systems connections after injury.Systems neurobiology of restorative neurology and future directions for repair of the damaged motor systemsJohn H. Martin10.1016/j.clineuro.2012.01.011Clinical Neurology and Neurosurgery 114, 5 (2012)2012-02-10Clinical Neurology and Neurosurgery2012-02-101145S0303-8467(12)X0005-2Future directions515523http://www.clineu-journal.com/article/PIIS0303846712001515/abstract?rss=yesTo fully appreciate the spectacular progress in individualized neurophysiologically based functional enhancement represented by Restorative Neurology (RN) there is nothing more compelling than to view the new discipline in historical perspective. In contrast to the in depth knowledge and sophisticated techniques underpinning RN as shown in the preceding articles, remarkably, it is only in comparatively recent times that neurophysiologists were absorbed with learning how an action potential was transmitted in the giant axon of the squid.Restorative neurology: Past, present, and futureJustin M. Brown, Byron A. Kakulas10.1016/j.clineuro.2012.02.055Clinical Neurology and Neurosurgery 114, 5 (2012)2012-03-26Clinical Neurology and Neurosurgery2012-03-261145S0303-8467(12)X0005-2Future directions524527