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Diabetes Mellitus, Obesity, Lipoprotein Disorders and other Metabolic Diseases
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Amyotrophy is characterized by unilateral (or bilateral) pain and weakness in the quadriceps muscles. Typically, it affects older men with type 2 DM. There is often quadriceps muscle wasting, weakness or difficulty in walking, reduced or absent knee jerks and sometimes extensor plantar reflexes. Poor glucose control is common and the condition usually responds to better glucose control. If extensor plantar responses are present, spinal cord compression should be excluded.
Diabetic Neuropathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Electrodiagnostic testing is used to diagnose diabetic amyotrophy. Nerve conduction studies and needle electromyography may also be required. If peripheral neuropathy is also present, leg sensations may be greatly reduced. Diagnosis is also based on blood tests for vitamin B deficiencies, assessment of blood glucose, lumbar puncture to check for inflammation in the cerebrospinal fluid, and MRI scans of the lower back to rule out nerve compression.
Dysfunctions of COVID-19
Published in Wenguang Xia, Xiaolin Huang, Rehabilitation from COVID-19, 2021
The inevitable long-term bed rest and inactivity of COVID-19 patients during the course of the disease is a major cause of physical dysfunction. Its symptoms are malaise, easy fatigue, muscle soreness, and palpitate and some patients have amyotrophy and decrease of muscle strength. At the same time, in addition to the psychological stress and trauma brought by the disease, there are also physical symptoms closely related to psychological factors, such as insomnia, fatigue, palpitation, chest tightness, dysphagia, urinary frequency, and so on. These physical symptoms may involve nervous, circulatory, digestive, respiratory, urogenital, endocrine, motor, and other systems. Therefore, in the assessment of patients’ physical dysfunction, the whole psychological and physiological analyses should be carried out, and careful observation should be made to identify whether physiological factors or psychological factors are dominant, which guides the formation of the rehabilitation treatment plan. The more common physical dysfunctions in COVID-19 patients during the convalescent period are discussed below.
Noninvasive ventilation use by patients enrolled in VITALITY-ALS
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2021
Stacy A. Rudnicki, Jinsy A. Andrews, Amy Bian, Bettina M. Cockroft, Merit E. Cudkowicz, Orla Hardiman, Fady I. Malik, Lisa Meng, Andrew A. Wolff, Jeremy M. Shefner
Amyotrophic lateral sclerosis (ALS) is a disease characterized by progressive motor neuron loss leading to weakness of skeletal muscles, including those involved with respiration. Neuromuscular respiratory failure is the leading contributor to mortality (1,2) with death occurring in most patients within 2–5 years (1,3–5). As respiratory muscle strength declines, dyspnea, orthopnoea, aspiration, reduced cough and poor sleep quality may result (6). Noninvasive ventilation (NIV) is used in the management of patients with ALS with the aim to extend survival and/or time to mechanical ventilation or death in addition to improving quality of life (7,8). Despite prior studies demonstrating NIV in ALS improved survival and slowed the decline in slow vital capacity (SVC) when used at least 4 h per 24 h (7,8), a third of patients with ALS may be noncompliant with its use, and noncompliance may be even higher in those with bulbar involvement and frontotemporal dysfunction (7–10). In a study of French patients with ALS, only 33% of them had been using NIV at the time of death despite having a mean forced vital capacity (FVC) of 44% predicted at the visit prior to death (11).
The feasibility of using robotic technology to quantify sensory, motor, and cognitive impairments associated with ALS
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2019
Leif Simmatis, Ghada Atallah, Stephen H. Scott, Sean Taylor
Amyotrophic lateral sclerosis (ALS) is primarily considered as a disease of motor neurons and, as such, clinical assessment of ALS is usually achieved with a combination of EMG as well as pen-and-paper tools to quantify motor dysfunction. One of the traditional pen-and-paper tools used to quantify motor functionality in ALS is the ALS Functional Rating Scale-Revised (ALSFRS-R) [1]. The ALSFRS-R captures the ability to perform daily life activities, scoring each of 15 items on a 0–4 point scale [1]. This scale captures several aspects of daily living (e.g. dressing oneself and writing), but each item is subjectively scored and the measurements are coarse. Subtle aspects of performance on each item, such the quantity of time required to complete them or the precision with which they are completed, cannot be appreciated using the ALSFRS-R. Thus, assessments of motor performance in ALS are needed that encompass multiple aspects of motor behavior and are quantitative.
Co-occurrence of MS and ALS: a clue in favor of common pathophysiological findings?
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2018
Anne-marie Guennoc, Maud Pallix-guyot, Emmanuelle Le Page, Damien Le Port, Mathieu Daryabin, Rudolph Hergesheimer, Stéphane Beltran, Ayman Tourbah, Gilles Edan, Philippe Corcia
A 60-year-old woman had a 30-year history of MS diagnosed after an episode of right optic neuritis, which improved after pulses of corticoids without sequela. Over the next 30 years, she complained of transient sensory defects in the lower limbs treated by pulses of Solumedrol. The current neurological history started nine months ago with the occurrence of gait disturbances due to left leg weakness. At the first visit, she was unable to walk without aid resulting from weakness and amyotrophy affected upper limbs during the three prior months. Neurological examination showed diffuse motor weakness in the four limbs. Amyotrophy was identified in the legs and arms in distality. DTRs were all brisk. Fasciculations were noted in the arms, legs, and tongue. There were no sensory, sphincter, cerebellar or cognitive abnormalities. Cerebral and spinal MRIs did not reveal active plaques or increases in the lesion burden. The disease continued to progress until death by respiratory failure after 22 months of progression (Figure 1).