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Controversies in a case of neuroboreliosis versus amyotrophic lateral sclerosis and methods of recovery.

Introduction

Early on, personality changes, psychiatric symptoms, or cognitive manifestations may be the first, and occasionally the only, symptoms that the patient or family is aware of.

Amyotrophic lateral sclerosis (ALS) is the most common degenerative disease of the motor neuron system.

The cause of ALS is unknown, although 5-10% of cases are familial.

The diagnosis of ALS is primarily clinical. Electro diagnostic testing contributes to the diagnostic accuracy.

Material and methods

We exam a 63 year patient hospitalized in Neurology Department of Clinical Hospital of Constanta, between 10-20.12.2012. We initiate a rehabilitation program for preventing the spasticity.

Results and discussion

Our patient has an history of exposure to B. Burgdorferi one year before the apparition of symptoms. Family describes personality changes and mild cognitive manifestations. We must say that in past history he has an ethanolic abuse. Next symptoms were muscle pain and trouble of gait. It was suspected to have borreliosis and lab results show a little increase of IGM antiborrelia. After one year of antibiotic treatment the gait is worse and appeared trouble of speech and patient was admitted in our department. On clinical examination we found sign of upper and lower motor neuron symptoms.

We perform a cervical and thoracal MRI with disk hernia C6-7, Angi-CT of carotid vessel shows carotidian bulbar calcification bilateral, cerebral MRI normal.

We perform serum immunology and LCR for borrelia was norm. Borrelia Ig G, Ig M in LCR and serum. Albumine in LCR 356 mg/dl, albumine in serum 40.4g/l, QAlb 8.8, Ig G in LCR 30MG/L, Ig G IN SERUM 8.22G/L, QIgG 3.6, IgM in LCR 0.19mg/l, IgM in serum 0.5 g/l, QIg M( all results show absence of intratecal sintesis of Ig G and Ig M).

Recutare pattern poor. PUM with duration and amplitude increased.

We begin a neuromotor and physiologic rehabilitation. Rehabilitation programme objectives: induce of voluntar motor activity; prevent wrong movement; prevent muscle retractures and joints diformities, decrease spasticity. Rehabilitation programme: we used physical programme for reduce pain, spasticity ALMEIDA (2012), ASHWORTH (2012), BALDINGER (2012) and also kinetic method for each objective. In each month we followed the evolution using specific scale assessment.

Conclusions

It is important if the symptoms are not clear and the results of immunology are not complete to not begin treatment for borreliosis and the interdisciplinary consult is necessary to complete the diagnosis. After antibiotic treatment we observe that clinical sign worst.

References

Almeida, JP., Silvestre, R., Pinto, AC., De Carvalho, M., 2012, Exercise And Amyotrophic Lateral Sclerosis.Neurol Sci. 2012 Feb;33(1):9-15

Ashworth, NL., Satkunam, LE., Deforge, D., 2012, Treatment For Spasticity In Amyotrophic Lateral Sclerosis/Motor Neuron Disease. Cochrane Database Syst Rev. 2012 Feb 15;2:CD004156

Baldinger, R., Katzberg, HD., Weber, M., 2012, Treatment For Cramps In Amyotrophic Lateral Sclerosis/Motor Neuron Disease. Cochrane Database Syst Rev. 2012 Apr 18;4:CD004157.

Blackhall, LJ. (2012), Amyotrophic Lateral Sclerosis And Palliative Care: Where We Are, And The Road Ahead. Muscle Nerve. 2012 Mar;45(3):311-8

Ludolph, AC., Brettschneider, J., Weishaupt, JH., 2012, Amyotrophic Lateral Sclerosis. Curr Opin Neurol. 2012 Oct;25(5):530-5.

Turner, MR., Barnwell, J., Al-Chalabi, A., Eisen, A., 2012, Young-Onset Amyotrophic Lateral Sclerosis: Historical And Other Observations.Brain, 2012 Sep;135(Pt 9):2883-91.

Mandell, H., Steere, AC., Reinhardt, BN., Yoshinari, N., Munsat, TL., Brod, SA., Clapshaw PA., 1989, Lack Of Antibodies To Borrelia Burgdorferi In Patients With Amyotrophic Lateral Sclerosis, N Engl J Med., 1989 Jan 26; 320(4):255-6.

Waisbren, BA., Cashman, N., Schell, RF., Johnson, R., 1987., Borrelia Burgdorferi Antibodies And Amyotrophic Lateral Sclerosis, Lancet, 1987 Aug 8;2(8554):332-3.

DOCU AXELERAD ANY (1), DANIEL DOCU AXELERAD (2)

(1) Ovidius University, Constanta, Romania, General Medicine Faculty, ROMANIA

(2) Ovidius University, Constanta, Romania, Physical Education And Sport Faculty, ROMANIA

Email: docuaxy@yahoo.com

Table 1. The nerves

EMG             Insertion             Spontaneous
                activity

                            Fibrill at.   PSW   Fascic   Other
                                                ul.      discharges

Tibialis                    -             ++    --       -
  anterior R
Vastus                      -             -     -        -
  lateralis R
Tibialis                    +             -     -        -
  anterior L
Gastroc caput               -             +++
med L
Vastus                      -             -     -        -
  lateralis L
Abd pollicis                -             -     -        -
  brev R
Abd dig min                 -             -     -        -
  (man) R
Biceps R                    +             +     -        -

EMG             Motor unit                Recruitment
                potential                 pattern

                Amp          Dur   Poly

Tibialis        +            +     -      sarac
  anterior R
Vastus          +            +     -      sarac
  lateralis R
Tibialis        +            +     -      sarac
  anterior L
Gastroc caput   +            +     -      sarac
med L
Vastus          +            +     +      sarac
  lateralis L
Abd pollicis    +            +     -      sarac
  brev R
Abd dig min     +            +     -      sarac
  (man) R
Biceps R        +            +     -      Sarac

MNCV         Site/Segment           Latency   Amplitude   Duration

                                        ms          mV         ms

Medianus R   Wrist-Abp                  6.6         1.7       13.2
             Elbow-Wrist               11.5         1.2       12.4
Ulnaris R    Wrist-ADM                  3.6         2.9        9.1
             Down Elbow-Wrist           7.6         2.4        9.2
Peroneus R   maleolla lat-EDB           4.4         2.1        7.2
             fibulla-maleolla lat      10.6         2.1        9.4
Peroneus L   maleolla lat-EDB           4.3         2.4        9.8
             fibulla-maleolla lat      10.5         2.2        9.7

SNCV         Site/Segment           Latency   Amplitude   Duration

                                        ms          uV         ms

Medianus R   Wrist-index finger        3.4         22.7        3.1
Ulnaris R    Wrist-V finger             2.2        13.9        1.7
Suralis R    Leg-Malleolus Lat          2.4        6.31        1.7
Suralis L    Leg-Malleolus Lat          2.9        3.39        1.9

MNCV         Site/Segment           Area        Distance   NCV

                                        mVms         mm    m/s

Medianus R   Wrist-Abp                    9.3
             Elbow-Wrist                  7.8       195    39.9
Ulnaris R    Wrist-ADM                    7.9
             Down Elbow-Wrist             8.5       205    51.5
Peroneus R   maleolla lat-EDB             8.4
             fibulla-maleolla lat         9.4       280    45.2
Peroneus L   maleolla lat-EDB             8.2
             fibulla-maleolla lat         8.4       270    44.0

SNCV         Site/Segment               Area    Distance    NCV

                                         uVms        mm     m/s

Medianus R   Wrist-index finger          24.2       150    43.9
Ulnaris R    Wrist-V finger              7.86       115    51.6
Suralis R    Leg-Malleolus Lat          104.4       100    41.5
Suralis L    Leg-Malleolus Lat             54       120    41.4

MUP             no.   Durate   Amplitude     Area

                         ms       uV        uVms

Tibialis        1      13.9      617.1     1600.0
  anterior R    2       11.1     454.2     1000.0
                3       14.5     953.4     1500.0
                4       11.4     410.7     1000.0
                5       15.4    1900.0     3900.0
Mean values             13.3     867.1     1800.0
Tibialis        1       10.5     477.3      921.3
  anterior L    2       13.3    1800.0     2800.0
                3       10.4     995.4     2000.0
Mean values             11.4    1090.9     1907.1
Gastroc         1       11.5    1200.0     2200.0
  caput med L   2        8.2     313.2      627.9
                3        9.8     523.9      967.3
Mean values             9.83     679.0     1265.1
Vastus          1       12.4    1000.0     2100.0
  lateralis L
Mean values             12.4    1000.0     2100.0
Vastus          1       13.1    1000.0     2100.0
  lateralis L   2       14.7    3800.0     4400.0
                3        9.3     630.0      940.7
Mean values             12.4    1810.0     2480.2

Abd dig min     1        9.5    2100.0     2600.0
  (man) R       2       19.1    3300.0     7700.0
Mean values             14.3    2700.0     5150.0
Biceps R        1       16.5    2200.0     5300.0
                2       18.2     206.6     738.7
Mean values             17.4    1203.3     3019.4

MUP                   Phases    Turns   Rise time

                                              us

Tibialis                    3      3      2100.0
  anterior R                2      2      3100.0
                            6      8      1000.0
                            2      2      2200.0
                            2      3      1300.0
Mean values        (0% poly.)
Tibialis                    1      3      4300.0
  anterior L                3      8      1400.0
                            4      6      1500.0
Mean values       (0% poly.)
Gastroc                     3      3      1500.0
  caput med L               2      2      2000.0
                            2      2      2000.0
Mean values        (0% poly.)
Vastus                      3      3      1300.0
  lateralis L
Mean values        (0% poly.)
Vastus                      3      3      1300.0
  lateralis L               8     15         568
                            2      2      1400.0
Mean values     (-1431655765%
                       poly.)
Abd dig min                 3      3      1600.0
  (man) R                   4      6      1500.0
Mean values         0% poly.)
Biceps R                    3      3      2300.0
                            2      2      3600.0
Mean values        (0% poly.)
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Article Details
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Title Annotation:KINETOTHERAPY
Author:Axelerad, Any; Axelerad, Daniel
Publication:Ovidius University Annals, Series Physical Education and Sport/Science, Movement and Health
Article Type:Report
Geographic Code:4EXRO
Date:Jun 1, 2013
Words:1314
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