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   2019| January-March  | Volume 4 | Issue 1  
    Online since February 25, 2019

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Systemic lupus erythematosus is easily misdiagnosed as subacute combined degeneration
Hui Zhang, Yitao He, Yi Guo
January-March 2019, 4(1):14-16
Background and objective: Systemic lupus erythematosus is likely the cause of neurological dysfunction manifested as subacute combined degeneration. The objective of this article is to report the clinical manifestation of systemic lupus erythematosus manifested as subacute combined degeneration. Methods: We retrospectively analyzed the clinical data of a 37-year-old female patient with systemic lupus erythematosus accompanied by subacute combined degeneration who received treatment at Shenzhen People's Hospital, China. This study met the requirements of the Declaration of Helsinki and the patient gave informed consent. Results: The patient initially presented the symptoms of numbness and weakness of both upper and lower limbs and urinary retention. The patient's physical signs involved peripheral nerve, and posterior and lateral columns of the spinal cord. Blood test revealed anemia and low folate level. Her clinical manifestation was consistent with subacute combined degeneration. But serum antinuclear antibodies (ANA), anti-double-stranded DNA (anti-dsDNA) antibodies, anti-Ro/Sjögren's antibodies (anti-Ro/SSA) and anti-La/Sjögren's antibodies (anti-La/SSB) were found to be positive. Finally, the diagnosis of systemic lupus erythematosus was considered. Conclusion: Systemic lupus erythematosus can cause a variety of neurological defect symptoms, especially in female patients. Tests for autoantibodies should be performed to reduce misdiagnosis rate.
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Effects of galvanic vestibular stimulation versus cervical proprioception training on pain, pressure pain sensitivity, and joint position sense in patients with chronic neck pain: study protocol for a randomized controlled trial
Sayyed Hamed Fazeli, Mohammad Akbari, Ismail Ebrahimi Takamjani, Holakoo Mohsenifar, Amir Salar Jafarpisheh
January-March 2019, 4(1):17-23
Background and objectives: Neck pain is a disabling condition associated with pain and proprioceptive disturbances. There is limited evidence on the efficacy of treatments for chronic neck pain (CNP). The aim of this study is to conduct a randomized, controlled trial to compare the effect of galvanic vestibular stimulation (GVS) with that of cervical proprioception training (CPT) on pain and proprioception acuity in patients with chronic neck pain. Subjects and methods: Forty-eight patients with CNP enrolled in this prospective, single-blind, randomized, controlled study will be randomly allocated to one of four groups: GVS, CPT, GVS + CPT, and control. The GVS group will receive galvanic stimulation, three sessions per week, for 6 weeks. The CPT group will perform proprioceptive exercises daily for 6 weeks. The GVS + CPT group will receive both interventions. The control group will have no intervention for 6 weeks, but 6 weeks later, they will receive physical therapy. In addition, 12 healthy subjects will be recruited. This study protocol has been approved by the Ethics Review Board of Iran University of Medical Sciences, with permission number IR.IUMS.REC 1395.9211342210 on August 8, 2016. Patient recruitment began in October 2016 and ended in October 2018. Data analysis will be performed in March 2019 and the study will be completed in May 2019. Outcome measures: The primary outcome measures will be intensity of pain, pressure pain threshold, and joint position error. The secondary outcome measures will be disability and health-related quality of life. Outcomes will be assessed at baseline and at the end of sessions 1 and 18. Discussion: Findings from the trial are expected to help assess the effectiveness of GVS, compared with CPT in patients with CNP. If this protocol is proven to be effective, it can be implemented in a clinical setting to manage chronic pain in patients with CNP. We expect this study to offer information about the positive effects of GVS and CPT. Findings from this study will be helpful in progressing GVS from science to practice and in managing disturbances in CNP. Trial registration: The study was registered at the Iranian Registry of Clinical Trials on September 26, 2016 (IRCT2016060121459N2).
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A reminder incentive system promotes the functional recovery of stroke patients with hemiplegia: A large-sample, single-blind, randomized controlled trial
Da-Hong Gao, Yuan-Feng Peng, Bin Dong
January-March 2019, 4(1):3-13
Background and objectives: Acupuncture and physical rehabilitation training have been shown to promote recovery in stroke patients with hemiplegia. Many patients are unable to consistently complete rehabilitation training because of a variety of factors. The aim of this study was to investigate the effects of wearing a wrist watch with versus without a rehabilitation training-reminder incentive system on locomotor function in stroke patients with hemiplegia. Participants and methods: This large-sample, single-blind, randomized controlled trial will be performed at the Second Affiliated Hospital of Anhui University of Chinese Medicine, Oxford International Rehabilitation Foundation Limited, and Oxford Brookes University. A total of 200 stroke patients with hemiplegia will be randomly divided into a test group and a control group. The two groups of patients will receive routine medication, acupuncture, and rehabilitation training. Patients in the test group will wear a smart watch with a reminder incentive system that encourages them to complete a set amount of personalized physical exercise tasks, and patients in the control group will wear a watch without a reminder incentive system. This study was approved by the Medical Ethics Committee of the Chinese Clinical Trial Registry on June 16, 2015 (approval No. ChiECRCT-20150034). Study protocol: 1.0. Participants will provide written informed consent. Results: The primary outcome measure of this study is the differences in the Barthel index measured 3 weeks after discharge (i.e., after 6 weeks of treatment). The secondary outcome measures include neurological deficit scores, National Institutes of Health stroke scale score, Rivermead mobility index, Montreal Cognitive Assessment score, blood pressure, body weight, grip strength, Timed Up and Go Test score, exercise level, EuroQol five dimensions questionnaire score, and adverse events before treatment, after 3 weeks of treatment, and 3 weeks after discharge (after 6 weeks of treatment). In a pilot study, 60 stroke patients with hemiplegia received acupuncture and incentive rehabilitation training. The results showed that in stroke patients with hemiplegia who received elongated needle acupuncture at antagonistic muscles combined with muscle balance exercises, Barthel index and Fugl-Meyer Assessment scale scores increased and Modified Ashworth Scale scores decreased compared with those who received elongated needle acupuncture at antagonistic muscles alone. Conclusion: We will perform a study involving 200 stroke patients to evaluate whether stroke patients with hemiplegia who receive acupuncture combined with rehabilitation training while wearing a smart watch with a reminder incentive system exhibit better recovery of locomotor function compared with those who receive similar interventions but are not exposed to a reminder incentive system. These experimental data will support the implementation of functional smart device-assisted rehabilitation medical programs. Trial registration: This study was registered with Chinese Clinical Trial Registry on August 8, 2015 (registration number: ChiCTR-IOR- 15007179).
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A central pattern generator in the spinal cord for the central control of micturition: An opportunity for first-in-class drug treatments
Pierre A Guertin
January-March 2019, 4(1):1-2
For non-neuroscientists, the spinal cord is often considered simply as a relay between the brain and peripheral organs such as the skin, smooth muscles, and skeletal muscles. However, its gray matter has also been shown to play a pivotal role in the control of stereotyped motor behaviors. Neuroscientists have indeed clearly shown recently that the spinal cord contains command centers also known as central pattern generators. Those spinal centers have been found to elicit, inhibit or modulate locomotion, ejaculation, defecation and micturition. This short communication briefly outlines the main characteristics of the central pattern generator for micturition and how it could become a therapeutic target for innovative drugs against micturition-related problems.
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Information for Authors–Asia Pacific Journal of Clinical Trials: Nervous System Diseases

January-March 2019, 4(1):24-28
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