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Purpose: Promising new rehabilitative approaches to improve the substantial motor disability associated with chronic stroke include pharmacotherapy to enhance motor recovery. We conducted a single-blind placebo-controlled crossover pilot study to investigate the effects of prolonged treatment with L-DOPA in stroke patients. Methods: Ten chronic (10–48 months) stroke patients received placebo or L-DOPA 100 mg daily for 5 weeks. During drug's treatment patients suspended physiotherapy. Patients underwent clinical evaluation (Rivermead Motor Assessment, Nine Hole Peg Test, and 10 meter walking test) and transcranial magnetic stimulation recordings from the affected and unaffected hemisphere (resting motor threshold, motor evoked potential amplitude and cortical silent period) before and after 5 weeks of treatment. Results: After L-DOPA treatment patients improved their walking speed (p< 0.01) and manual dexterity (p< 0.01) with the affected hand, the cortical silent period over the affected hemisphere lengthened (p< 0.01), while no changes were found in placebo-group. Conclusion: A 5-week course of oral L-DOPA in a single daily dose substantially improves motor performance in patients with chronic stroke and could do so by modulating motor cortical excitability (cortical silent period lengthening) suggesting that cortical inhibitory mechanisms have a role in motor recovery after stroke. Pharmacotherapy could be a useful therapeutic approach for chronic stroke patients. [ABSTRACT FROM AUTHOR]

Seric IgM autoreactivity in 100 multiple sclerosis (MS) and 106 control (70 of whom had other neurological diseases) patients was assessed either by immunohistochemistry on normal human CNS tissue or to GD2, GD1a, GD3 by ELISA and thin layer chromatography (TLC) techniques. By double immunohistochemistry, we found that 44% of the total MS population showed seric IgM reactivity to oligodendrocytes and myelin, this finding being particularly frequent in patients with secondary progressive MS. In the non-MS cohort, positive signals were seen only in one patient. In all cases, extraction of lipids from CNS sections abolished the immunoreactivity. Among the gangliosides investigated by ELISA, anti-GD2-like IgM autoantibodies were detected in the serum of 30% of MS patients, a subgroup of whom (below 10%) reacted also with GD1a and/or GD3. More than 85% of MS cases with anti-GD2-like IgM immunoreactivity by ELISA showed also IgM antioligodendrocyte/myelin staining by immunohistochemistry. However, no immunostaining in MS sera was observed when gangliosides were resolved by TLC. A positive correlation with neurological disability was observed, as the Expanded Disability Status Scale of MS patients with anti-GD2-like IgM autoreactivity by ELISA was significantly worse than seronegative MS cases. The results of the present study enforce the role of glycolipids as potential autoantigens and of IgM autoantibodies in MS pathogenesis. [ABSTRACT FROM AUTHOR]

Background: Post-polio syndrome (PPS) develops about 20–40years after acute paralytic poliomyelitis, and manifests with progressively deteriorating muscle strength and endurance. Objective: Here, we assessed whether frontal transcranial direct current stimulation (tDCS) improves central fatigue symptoms in patients with PPS. Materials and methods: We enrolled 32 patients with a definitive diagnosis of PPS; 16 patients received anodal tDCS and the remainder sham tDCS. We evaluated changes induced by tDCS (1.5mA, 15min, daily for five days a week) on clinical scales (Short Form Health Survey, SF-36, Piper Fatigue Scale, PFS, Fatigue Severity Scale, FSS, 101-Point Numerical Rating, PNR-101), Hamilton Rating Scale for Depression, HRSD, Pittsburgh Sleep Quality Index, PSQI) and motor performance (six-min walk test and the endurance test) at baseline (T0) and three weeks later (T1). Results: Scores for the SF-36 sub-items physical functioning, role physical, vitality and social functioning improved significantly more in patients who received tDCS (p). Discussion: Anodal tDCS delivered for 15min at 1.5mA over the frontal areas improves fatigue symptoms in patients with PPS. tDCS could be a non-invasive and valuable new tool for managing central fatigue in patients with PPS. [Copyright &y& Elsevier]

Abstract: Objective: To investigate blood oxygenation level-dependent (BOLD) activation during somatosensory electrical stimulation of the median nerve in acute stroke patients and to determine its correlation with ischemic damage and clinical recovery over time. Methods: Fourteen acute stroke patients underwent functional magnetic resonance imaging (fMRI) during contralesional median-nerve electrical stimulation 12–48h after stroke. Findings were then validated by diffusion tensor imaging (DTI) and motor evoked potential by transcranial magnetic stimulation (TMS). Results: Poor clinical recovery at three months was noted in four patients with no activation in the early days after stroke, whereas good clinical recovery was observed in eight patients with a normal activation pattern in the primary sensory motor area in the acute phase. In two patients BOLD activation correlated weakly with clinical recovery. Findings from TMS and DTI partially correlated with clinical recovery and functional scores. Conclusions: Clinically relevant insights into the “functional reserve” of stroke patients gained with peripheral nerve stimulation during fMRI may carry prognostic value already in the acute period of a cerebrovascular accident. Significance: BOLD activation maps could provide insights into the functional organization of the residual systems and could contribute to medical decision making in neurological and rehabilitative treatment. [Copyright &y& Elsevier]