Search

Objective A high proportion of patients experience fatigue and impairment of cognitive functions after coronavirus disease 2019 (COVID-19). Here we applied transcranial magnetic stimulation (TMS) to explore the activity of the main inhibitory intracortical circuits within the primary motor cortex (M1) in a sample of patients complaining of fatigue and presenting executive dysfunction after resolution of COVID-19 with neurological manifestations. Methods Twelve patients who recovered from typical COVID-19 pneumonia with neurological complications and complained of profound physical and mental fatigue underwent, 9 to 13 weeks from disease onset, a psychometric evaluation including a self-reported fatigue numeric-rating scale (FRS, Fatigue Rating Scale) and the Frontal Assessment Battery (FAB). Intracortical activity was evaluated by means of well-established TMS protocols including short-interval intracortical inhibition (SICI), reflecting GABAA-mediated inhibition, long-interval intracortical inhibition (LICI), a marker of GABAB receptor activity, and short-latency afferent inhibition (SAI) that indexes central cholinergic transmission. TMS data were compared to those obtained in a control group of ten healthy subjects (HS) matched by age, sex and education level. Results Post-COVID-19 patients reported marked fatigue according to FRS score (8.1 ± 1.7) and presented pathological scores at the FAB based on Italian normative data (12.2 ± 0.7). TMS revealed marked reduction of SICI, and disruption of LICI as compared to HS. SAI was also slightly diminished. Conclusions The present study documents for the first time reduced GABAergic inhibition in the M1 in patients who recovered from COVID-19 with neurological complications and manifested fatigue and dysexecutive syndrome. Significance TMS may serve as diagnostic tool in cognitive disturbances and fatigue in post-COVID-19 patients.

Parkinson's disease (PD) is characterized by motor and cognitive dysfunctions, affecting the motor behaviour. We summarize evidence that the interplay between motor and cognitive approaches is crucial in PD rehabilitation. Rehabilitation is complementary to pharmacological therapy and effective in reducing the PD disturbances, probably acting by inducing neuroplastic effects. The motor behaviour results from a complex integration between cortical and subcortical areas, underlying the motor, cognitive and motivational aspects of movement. The close interplay amongst these areas makes possible to learn, control and express habitual-automatic actions, which are dysfunctional in PD. The physiopathology of PD could be considered the base for the development of effective rehabilitation treatments. As the volitional action control is spared in early-medium stages of disease, rehabilitative approaches engaging cognition permit to achieve motor benefits and appear to be the most effective for PD. We will point out data supporting the relevance of targeting both motor and cognitive aspects in PD rehabilitation. Finally, we will discuss the role of cognitive engagement in motor rehabilitation for PD.

Objectives To assess whether a specific land-based physical intervention with the inclusion of aquatic therapy is more effective than land-based rehabilitation alone for the treatment of balance dysfunction in patients with Parkinson disease (PD), immediately after therapy and at 6 months' follow-up. Design Randomized controlled study with 6-month follow-up. Setting A PD and brain injury rehabilitation department in a general hospital. Participants Patients (N=34) with moderate-stage PD. Intervention Seventeen patients underwent a land-based rehabilitation protocol called multidisciplinary intensive rehabilitation treatment (MIRT), and 17 underwent MIRT plus aquatic therapy (MIRT-AT). Main Outcome Measures The primary outcome measure was the Berg Balance Scale (BBS); secondary outcome measures were the Unified Parkinson Disease Rating Scale parts II and III (UPDRS II/III) and the Timed Up and Go (TUG) test. These measures were assessed in both groups at admission, at discharge, and after 6 months. Results BBS improved after treatment in both groups. Even though no statistically significant difference between groups was observed at each observation time, BBS scores at follow-up were significantly higher than at baseline in MIRT-AT patients. Both groups also showed an improvement in UPDRS II/III and TUG at the end of treatment compared with baseline, but these findings were lost at the 6-month follow-up. Conclusions Aquatic therapy added to land-based rehabilitation could provide a contribution to the treatment of balance dysfunction in patients with moderate-stage PD.

1. IntroductionThe involuntaryco-contractionofipsilateralmusclesofthefaceis a common consequence of facial nerve lesion. A chin-eyelidsynkinesis is a common consequence of facial nerve pathologiesgenerally due to a peripheral facial paresis, although otherpathological processes might be involved [1]. The most frequentlyobserved phenomenon is a contraction of perioral musclessynchronous with the rhythmic eyelid closures. It is generallyaccepted that a pathologic rearrangement of facial nerve fibersleads to an ectopic diffusion of the contraction signals [2,3]. To ourknowledge, there are no reports of patients showing chin-eyelidsynkinesis in absence of a facial nerve injury. Here we report theclinical case of a young male who developed an orbicularis oculimentalis muscle synkinesis after a brain trauma. Interestingly,neither clinical nor instrumental evidences of facial nerve lesionwere demonstrated. We therefore, hypothesize that the abnormalco-activation was due to central nervous plasticity.2. Clinical caseA 20 years old male had a traumatic brain injury during a caraccident inSeptember2011,determiningatwomonthsprolongedloss of consciousness. He was admitted to an intensive care unit,mechanically ventilated and underwent an endovascular proce-dure in order to treat a right cavernous sinus-carotid fistula. Aftersix months of rehabilitation, he was admitted to a long term carefacility, in a stable condition of minimally conscious state andbilateral hemiparesis, more severe to the left side. Eighteenmonths after the trauma, he was admitted to our neuro-rehabilitation unit, with three main purposes: titration ofintrathecal baclofen and treatment of postural deformities,evaluation/treatment of a post-hemorrhagic hydrocephalus topossibly ameliorate the level of consciousness. At the hospitali-zation, he showed a left chin and perioral contraction for everyspontaneous closure of the eyelids (video).Furthermore, when the left palmomental reflex was elicited,theipsilateraleyelidclosurewas consistentlyinduced.Thesmilingwas completely symmetric, and all the facial muscles of the leftside had a normal strength, including the orbicularis oculi. Thepatient had not a previous history of facial palsy and no signs offacialhemiatrophyweredetectedatthephysicalexamination.MRIscan showed sequelae of diffuse axonal injury, and contusivelesions in both frontal lobes and temporal poles (Fig. 2).3. Electrophysiologic evaluation3.1. ENG–EMG–Blink reflexENG–EMG data were collected using a data acquisition system(Micromed Myoquick Device, Mogliano Veneto, Italy). The signalswere