| 1. |
- Agerskov, Simon, et al.
(författare)
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The phenotype of idiopathic normal pressure hydrocephalus-a single center study of 429 patients
- 2018
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Ingår i: Journal of the Neurological Sciences. - : Elsevier BV. - 0022-510X. ; 391, s. 54-60
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Idiopathic Normal Pressure Hydrocephlaus (iNPH) is, despite a vastly improved knowledge of the disorder since its first description still underdiagnosed and undertreated. Because of this, there is a need for further large studies describing the typical symptomatology and reversibility of symptoms in iNPH, which was the aim of this study. Methods In all, 429 patients (mean age 71years) were included. Detailed pre- and postoperative examinations of symptoms and signs were analyzed. A composite outcome measure was constructed. Results Sixty-eight % improved after surgery. Preoperatively, 72% exhibited symptoms from three or four of the assessed domains (gait, balance, neuropsychology and continence) while 41% had symptoms from all four domains. Ninety % had gait disturbances, of which 75% had broad-based gait, 65% shuffling gait and 30% freezing of gait. These disturbances coexisted in most patients preoperatively, but were more likely to appear as isolated findings after surgery. Impaired balance was seen in 53% and retropulsion in 46%. MMSE <25 was seen in 53% and impaired continence in 86%. Improvements were seen in all symptom domains postoperatively. Conclusions The iNPH phenotype is characterized by a disturbance in at least 3/4 symptom domains in most patients, with improvements in all domains after shunt surgery. Most patients present with a broad-based and shuffling gait as well as paratonia. Present symptoms in all domains and a shuffling gait at the time of diagnosis seem to predict a favorable postoperative outcome, whereas symptom severity does not.
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| 2. |
- Andrén, Kerstin, 1980, et al.
(författare)
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Symptoms and signs did not predict outcome after surgery: a prospective study of 143 patients with idiopathic normal pressure hydrocephalus
- 2024
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Ingår i: JOURNAL OF NEUROLOGY. - : SPRINGER HEIDELBERG. - 0340-5354 .- 1432-1459.
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo determine the utility of symptoms, signs, comorbidities and background variables for the prediction of outcome of treatment in iNPH. MethodsA prospective observational study of consecutively included iNPH patients, who underwent neurological, physiotherapeutic and neuropsychological assessments before and after shunt surgery. The primary outcome measure was the total change on the iNPH scale, and patients were defined as improved postoperatively if they had improved by at least five points on that scale. Results143 iNPH patients were included, and 73% of those were improved after surgery. None of the examined symptoms or signs could predict which patients would improve after shunt surgery. A dominant subjective complaint of memory problems at baseline was predictive of non-improvement. The reported comorbidities, duration of symptoms and BMI were the same in improved and non-improved patients. Each of the symptom domains (gait, neuropsychology, balance, and continence) as well as the total iNPH scale score improved significantly (from median 53 to 69, p < 0.001). The proportions of patients with shuffling gait, broad-based gait, paratonic rigidity and retropulsion all decreased significantly. DiscussionThis study confirms that the recorded clinical signs, symptoms, and impairments in the adopted clinical tests are characteristic findings in iNPH, based on that most of them improved after shunt surgery. However, our clinical data did not enable predictions of whether patients would respond to shunt surgery, indicating that the phenotype is unrelated to the reversibility of the iNPH state and should mainly support diagnosis. Absence of specific signs should not be used to exclude patients from treatment.
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| 3. |
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| 4. |
- Bjerlemo, Berit, et al.
(författare)
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Recovery after early vestibular rehabilitation in patients with acute unilateral vestibular loss
- 2006
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Ingår i: Audiological Medicine. - : Informa UK Limited. - 1651-386X .- 1651-3835. ; 4:3, s. 117-123
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Tidskriftsartikel (refereegranskat)abstract
- The aims of this study were to follow the recovery process, and explore the disease impact on sick leave in patients with acute unilateral vestibular loss (AUVL). Another aim was to investigate whether initial signs of nystagmus, caloric response, and subjective symptoms of vertigo could predict the return to work. Recovery was followed through the reduction in spontaneous and head-shaking nystagmus, evaluated by Video-Frenzel examination, and by caloric response/asymmetry and spontaneous nystagmus, evaluated by bithermal binaural caloric testing. Information regarding employment, sick leave and subjective symptoms of vertigo was collected using a questionnaire. Twenty-seven patients with AUVL participated in a physiotherapy training programme, starting within 48 h of disease onset. Four assessments were performed: at disease onset, in the acute stage, and after one and six months. In most patients a very rapid cessation of spontaneous nystagmus could be observed (14/27 at a median time of two days after disease onset, a further 10 patients after one month and the remaining three patients after six months). A more prolonged persistence of head shaking nystagmus was observed (24/27, 14/27 and 5/21 of the patients showed head-shaking nystagmus at the three assessments). Caloric asymmetry was normalized after six months in 11/27 patients. A positive and significant correlation was observed between long-lasting sick leave and caloric asymmetry, sense of unsteadiness when standing and walking and older age. Unsteadiness when standing and walking, as well as existence of spontaneous nystagmus, were also positively and significantly correlated with the degree of caloric asymmetry. Spontaneous or head-shaking nystagmus, caloric asymmetry and subjective vertigo at disease onset did not, however, predict sick leave after one or six months. Recovery was excellent in most of the patients.
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| 5. |
- Hammarén, Elisabet, et al.
(författare)
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What Happened with Muscle Force, Dynamic Stability And Falls? A 10-Year Longitudinal Follow-Up in Adults with Myotonic Dystrophy Type 1
- 2021
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Ingår i: Journal of Neuromuscular Diseases. - : IOS Press. - 2214-3599 .- 2214-3602. ; 8:6, s. 1007-1016
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Tidskriftsartikel (refereegranskat)abstract
- Background: Individuals with myotonic dystrophy type 1 (DM1) are known to stumble and fall, but knowledge is scarce regarding dynamic stability in this disorder. Objective: To describe disease progress regarding muscle force, dynamic stability and patient reported unintentional falls during a ten-year period, in individuals with DM1. Methods: Quantification of isometric muscle force in four leg muscle groups and assessment of Timed 10-meter-walk in maximum speed (T10max), Timed Up&Go (TUG) and Step test (STEP) were performed at three occasions in a DM1 cohort, together with self-reported falls. Results: Thirty-four people (m/f:11/23, age: 50.2 + /-9.4) participated. The muscle force loss after ten years was large in the distal ankle muscles. A steeper force decrease was seen in most muscles between year five and ten compared to the former five-year period. Males reported more falls than females, 91% vs 35% had fallen last year. A positive correlation, rho = 0.633, p < 0.001, was shown between walking time (T10max) and number of falls. Frequent fallers were only seen among those with slower walk (T10max > 10seconds), and fewer steps in the STEP test (STEP <= 5 steps). Conclusions: A diminishing leg muscle strength and worse dynamic stability were seen in the group, with a steeper decrease in the latter five years. Weak ankle dorsiflexors, a slower walk and difficulties to lift the forefoot were related to frequent falls.
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| 6. |
- Kollén, Lena, 1960-, et al.
(författare)
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Benign Paroxysmal Positional Vertigo is a common cause of dizziness and unsteadiness in a large population of 75-year-olds
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background and aims: Dizziness is a common problem among the elderly. Studies have shown that 65% of people with dizziness may have a vestibular etiologic diagnosis, possibly Benign Paroxysmal Positional Vertigo (BPPV). The diagnosis of BPPV is made by history and findings in the Dix-Hallpike test. It can be difficult to perform the Dix-Hallpike test in elderly persons due to limited range of motion when extending the neck. In this study we used a side-lying test to stimulate the posterior semicircular canal while the head and neck were fully supported on the examination table. The aims were to investigate the prevalence of dizziness or impaired balance and BPPV in a 75-year old population. Methods: A representative population sample of 675 persons completed a questionnaire about dizziness and 571 persons performed side-lying, static balance and dynamic walking tests.Results: Subjective dizziness and/or impaired balance was found in 36% especially when walking outdoors. A significant gender difference was found with a higher prevalence in women (40%) compared to men (30%) (p<0.01). BPPV was found in 11%. This was significantly more common in women compared to men (p<0.01). Elderly persons with BPPV also showed significantly impaired balance ability in static and dynamic balance tests compared to age matched persons without BPPV(p<0.01). Persons with BPPV reported significantly more subjective problems with dizziness and balance compared to persons without BPPV (p<0.001).Conclusions: Subjective and objective unsteadiness, dizziness and BPPV are common in elderly. The side-lying test is a good screening test for BPPV.
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| 7. |
- Kollén, Lena, 1960-, et al.
(författare)
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Benign paroxysmal positional vertigo is a common cause of dizziness and unsteadiness in a large population of 75-year-olds
- 2012
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Ingår i: Aging Clinical and Experimental Research. - New York, USA : Springer. - 1594-0667 .- 1720-8319. ; 24:4, s. 317-323
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: Studies have shown that 65% of people with dizziness may have a vestibular etiologic diagnosis, possibly benign paroxysmal positional vertigo (BPPV). The diagnosis of BPPV is based on medical history and findings after the Dix-Hallpike test. It is sometimes difficult to perform the Dix-Hallpike test in elderly persons, due to the limited range of motion when extending the neck. In this study, we used a side-lying test to stimulate the posterior semicircular canal, while the head and neck were fully supported on the examination table. The aims of this study were to investigate the prevalence of dizziness and/or impaired balance and BPPV in a population of 75-year-olds by means of a questionnaire and clinical tests, and to compare elderly persons with and without BPPV.Methods: A representative population sample of 675 persons completed a questionnaire about dizziness and 571 persons underwent side-lying, static balance and dynamic walking tests.Results: Subjective dizziness and/or impaired balance were found in 36% of subjects, especially when walking outdoors. A significant gender difference was found, with a higher prevalence in women (40%) compared with men (30%) (p<0.01). BPPV was found in 11% and was significantly more common in women (p<0.01). Elderly individuals with BPPV also displayed significantly impaired balance in static and dynamic balance tests compared with persons without BPPV (p<0.01). Persons with BPPV reported significantly more subjective problems with dizziness and balance compared with persons without BPPV (p<0.001).Conclusions: Subjective and objective unsteadiness, dizziness and BPPV are common in the elderly.
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| 8. |
- Kollén, Lena, 1960-
(författare)
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Dizziness, balance and rehabilitation in vestibular disorders
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Dizziness and balance problems are common symptoms at all ages. The aims were; to evaluate rehabilitation, static, dynamic balance and recovery in acute unilateral vestibular loss (AUVL), to evaluate the treatment of benign paroxysmal positional vertigo (BPPV) with assessment of static and dynamic balance and to evaluate the prevalence of dizziness and BPPV in a population of 75-year-olds. Study 1: Twenty-seven patients (51years) with AUVL were included and the recovery was followed regarding vestibular function, dizziness, and sick-leave. The recovery was rapid, with disappearance of spontaneous nystagmus and rapid return to work. Study II: Forty two patents (51 years) with AUVL were included and compared with a reference group. Static and dynamic balance were assessed after six months. Significant instability was found both in static and dynamic balance compared to a reference group. Study III: Seventeen patients (52 years) with severe BPPV (> 3 months) were treated with Semonts´s manouver and/or Brandt-Daroff exercises. The recovery was evaluated by Dix-Hallpike test, subjective dizziness, unsteadiness and balance tests, after 1, 6 and 12 months. Semont´s maneouver resolved dizziness but the long term follow up showed impaired balance. Study IV: A large cohort (675) of elderly was assessed regarding dizziness and BPPV. Side lying test and balance tests were applied. A high prevalence of dizziness (36%) and BPPV (11%) was found. Conclusions: Patients with AUVL and BPPV have despite good symptomatic relief, still impaired static and dynamic balance at long term follow up. BPPV in elderly is common and should be examined since it can be treated.
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| 9. |
- Kollén, Lena, et al.
(författare)
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Evaluation of treatment in benign paroxysmal positional vertigo (BPPV)
- 2006
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Ingår i: Advances in Physiotherapy. - Oslo : Scandinavian University Press. - 1403-8196 .- 1651-1948. ; 8:3, s. 106-115
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Tidskriftsartikel (refereegranskat)abstract
- Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo. The prognosis is good, usually with spontaneous remission within three months, but symptoms may last. Patients were consecutively evaluated before and 1, 6 and 12 months after treatment, to evaluate the long-term effects of the Semont manoeuvre and Brandt & Daroff exercises. The subjects were 17 patients (13 women and four men, mean age 52 years) who had suffered from BPPV for more than three months. The Semont manoeuvre was performed. Patients with vertigo after two Semont manoeuvres were instructed to perform Brandt & Daroff exercises. Follow-up was done by the Dix–Hallpike test, measurement of static/dynamic balance and a health questionnaire; for the vertigo, a visual analogue scale (VAS) was used. Three of 17 patients still suffered from vertigo after 12 months but the nystagmus during the Dix–Hallpike test was significantly decreased. At the end of the study, nine of 17 patients still experienced unsteadiness during standing and walking. It is of importance to perform not only manoeuvres and Brandt & Daroff exercises but also to instruct the patient in vestibular rehabilitation including static/dynamic balance exercises in order to reduce unsteadiness.
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| 10. |
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