Advances in the Diagnosis and Evaluation of Disabling Physical Health Conditions (2023) / Chapter Skim
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5 Techniques for Neurological Disorders
5 Techniques for Neurological Disorders
Pages 99-130
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From page 99... ...
, encompassing nerves extending from the spinal cord to all parts of the body. The autonomic nervous system (ANS)
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These improvements include advances in magnetic resonance imaging (MRI) technology, specifically functional MRI (fMRI)
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Magnetic Resonance Imaging As discussed in Chapter 3, magnetic resonance imaging, especially when combined with advanced techniques or other diagnostics, can show anatomical images of the brain or spinal cord, measure blood flow, or reveal deposits of minerals such as iron. According to the National Institute of Neurological Disorders and Stroke, "MRI is used to diagnose stroke, traumatic brain injury, brain and spinal cord tumors, inflammation, infection, vascular irregularities, brain damage associated with epilepsy, abnormally developed brain regions, and some neurodegenerative disorders.
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list of the ways that magnetic resonance imaging of various types is currently being used in diagnosing neurological disorders. MRI and Multiple Sclerosis MRI is a crucial tool in the diagnosis of multiple sclerosis (MS)
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, Parkinson's disease, Huntington's disease, Williams syndrome, fragile X syndrome Diffusion-weighted MRI Stroke caused by acute brain ischemia, brain tumors, white matter diseases, peripheral nerve imaging, spinal cord injury, multiple sclerosis Brain volumetric analysis Dementia, multiple sclerosis, epilepsy, traumatic brain injury MR spectroscopy Brain neoplasms, inherited metabolic disorders, demyelinating disorders, infective focal lesions Double inversion recovery Detection of demyelinating lesions observed in multiple sclerosis, malignancies, epileptogenic foci, and cortical anomalies MR venography Cerebral venous thrombosis NOTE: FLAIR = fluid-attenuated inversion recovery; MR = magnetic resonance; MRI = magnetic resonance imaging. SOURCES: Baggio and Junqué (2019)
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From page 104... ...
. Among the clinical applications of dwMRI are the early identification of ischemic stroke, the differentiation of acute stroke from chronic stroke and from other stroke mimics, the differentiation of herpes encephalitis from diffuse temporal gliomas, the assessment of the extent of diffuse axonal injury, the assessment of active demyelination, and the assessment of cortical lesions in Creutzfeldt-Jakob disease (Feeney, 2022)
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. The requested details related to the diagnosis of acute stroke with dwMRI are as follows: (a)
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. Genetic Testing for Hereditary Disorders Chapter 3 provides an overview molecular genetic testing for hereditary disorders.
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The accepted use of genetic testing in neurology is to diagnose a wide variety of neurological disorders, particularly in cases where clinical examination and other diagnostic techniques cannot iden tify a disorder with certainty. These disorders include Duchenne muscular dystrophy, Charcot-Marie-Tooth disease, Huntington's disease, spinocerebellar ataxias, Kennedy's disease, Alzheimer's dis ease, P arkinson's disease, amyotrophic lateral sclerosis, and dopa responsive dystonia, among many others (Fischbeck, 2014)
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From page 108... ...
It is used to examine brain metabolism, alterations in regional blood flow, and receptor binding of various neurotransmitters. It can be used to diagnose such neurological disorders as multiple sclerosis, Alzheimer's disease, Parkinson's disease, Huntington's disease, and various dementias.
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Another available technique looks for β-amyloid plaques in the cerebral spinal fluid, but that is more invasive. Preliminary indications are that this improved ability is seen with equally strong effect among different racial, ethnic, and gender sub-populations in the United States.
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. The detailed three-dimensional map of blood flow in the brain created from the procedure can also allow for detection of altered blood flow and clogged blood vessels, helping to diagnose or evaluate vascular brain disorders (Mayo Clinic, 2023)
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There are no data concerning whether this improved ability is seen with equally strong effect among dif ferent racial, ethnic, or gender subpopulations in the United States, but its mode of action indicates that the value should be equally strong among different populations.
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There is, however, one technology that may have the potential to revolutionize migraine diagnosis -- a new generation of computerized diagnostic tools based on various algorithms and machine learning approaches that offer an objective, accessible means of determining the presence or absence of migraine. According to a recent review of computerized migraine diagnostic tools (Woldeamanuel and Cowan, 2022)
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. The requested details related to the use of digitalized diagnostic tools for migraine are as follows: (a)
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(h) Digital migraine diagnostic tools are designed to be either self administered or administered by clinicians with no specialized training other than familiarity with headaches and migraine.
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. Among the current clinical applications of sEMG are the assessment of muscle coordination, particularly in clinical gait analysis; the functional diagnosis of and monitoring of therapeutic outcomes for neurological impairments such as cerebral palsy and stroke; and the study of orthopedic issues such as degenerative joint disease and back pain research (Campanini et al., 2020)
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From page 116... ...
Neuromuscular Ultrasound While ultrasonography using sound waves to create images has been around for decades, its use in the diagnosis of neuromuscular disorders is growing and becoming a standard element in the evaluation of peripheral nerve and muscle disease. Neuromuscular ultrasound is noninvasive, low risk, painless for the patient, easily available, and generally inexpensive, and can refine diagnosis and improve patient care.
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. This technique is more sensitive than MRI in detecting peripheral nerve pathologies, and can be used as a biomarker for conditions such as muscular dystrophy and spinal muscular dystrophy (Mah and Van Alfen, 2018)
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The requested details related to the use of prolonged EEG for diagnosis are as follows: (a) EEGs can be used to evaluate various brain disorders including epilepsy, brain tumors, stroke, narcolepsy, Alzheimer's disease, or certain psychoses (Johns Hopkins Medicine, 2023)
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From page 119... ...
. Especially when seizures do not respond to medications, video-EEG monitoring is the best available diagnostic tool and a key technique for epilepsy centers (Benbadis et al., 2004)
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The tables in the appendix are organized by stroke, spinal cord injury, multiple sclerosis, Parkinson's disease, traumatic brain injury, and vestibular dysfunction, and they identify the tests by name; the areas the test assesses and the specific conditions for which the test is used; the International Classification of Functioning, Disability, and Health (ICF) domain addressed (ICF is discussed in Chapter 2)
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. The Spinal Cord Injury Functional Ambulation Inventory The Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI)
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It is worth noting that the SCI-FAI is just one of multiple measures that have been developed to assess gait and ambulation in those with spinal cord injuries. Others include the Walking Index for Spinal Cord Injury II, the 50-Foot Walk Test, the 10-Meter Walk Test, Functional Independence Measure–Locomotor (Jackson et al., 2008)
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From page 123... ...
Specifically, EIM has been used in clinical trials involving a number of neuromuscular disorders, including amyotrophic lateral sclerosis (ALS) , Duchenne muscular dystrophy, spinal muscular a trophy, facioscapulohumeral muscular dystrophy, and sarcopenia (Sanchez and Rutkove, 2017; Spieker et al., 2013)
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2007. A multicenter international study on the Spinal Cord Independence Measure, version III: Rasch psychometric validation.
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2001. The Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI)
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2019. Neurological recovery following traumatic spinal cord injury: A systematic review and meta-analysis.
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2011. Spinal Cord Injury Functional Ambu lation Profile: A new measure of walking ability.
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2022. Spinal Cord Independence Measure (SCIM)
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2022. Spinal Cord Injury Functional Ambula tion Inventory (SCI-FAI)
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2022. Computerized migraine diagnostic tools: A systematic review.
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