Innovations In Clinical Neuroscience

JAN-FEB 2018

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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O R I G I N A L R E S E A R C H 32 ICNS Innovations in Clinical Neuroscience • January–February 2018 • Volume 15 • Number 1–2 are the widespread availability of IVIG, which can be prescribed in an "off-label" fashion; the low incidence of new HIVM cases; and a reluctance of this patient population to undergo randomization. While this trial did not meet its recruitment goals, other useful information can be gleaned from our experience with this study. Muscle dynamometry had not previously been used as an outcome measure for HIVM. Our data demonstrate that it is feasible based on its tolerability to most participants, reliable based on test-retest correlations, and valid based on its internal consistency between muscle groups and its correlation with other measures, namely the HDMS and the two-minute timed walk test. Although HIVM is a rare disorder, functional gait limitation due to frailty and sarcopenia is common in HIV, particularly in aging populations. 19 Hand-grip dynamometry has been employed to study these conditions, but it is not a direct measure of lower-limb strength, so is only weakly correlated with function. 20,21 It is possible that lower-limb dynamometry would provide a more accurate representation of the functional consequences of frailty and sarcopenia on gait and could be used more widely as an outcome measure in HIV-infected populations. Lower-limb dynamometry might also prove useful in commoner forms of myelopathy, and indeed other studies have begun to examine its utility in this setting. 16 Of the three muscle groups tested (hip flexion, knee flexion, and ankle dorsiflexion), we found that hip flexor dynamometry was most strongly correlated with other measures, in keeping with our original supposition that hip flexion would be the most functionally important measure. Thus, if it were necessary to use one lower-limb dynamometry measure in isolation, hip flexion would likely be the best choice. CONCLUSION In summary, while the data produced by this study cannot be used to support or refute the efficacy of IVIG for HIVM due to low power related to small sample size, the treatment was generally well tolerated without significant adverse events in this population, and there was a suggestion of improvement in some patients. Thus, we recommend that clinical use of IVIG for the treatment of HIVM be based on an informed discussion and open communication between patient and provider. REFERENCES 1. Simpson DM, Tagliati M. Neurologic manifestations of HIV infection. Ann Intern Med. 1994;121(10):769–875. 2. Artigas J, Grosse G, Niedobitek F. Vacuolar myelopathy in AIDS. A morphological analysis. Pathol Res Pract. 1990;186(2): 228–237. 3. Henin D, Smith TW, De Girolami U, et al. Neuropathology of the spinal cord in the acquired immunodeficiency syndrome. Hum Pathol. 1992;23(10):1106–1114. 4. Dal Pan GJ, Glass JD, McArthur JC. Clinicopathologic correlations of HIV- 1-associated vacuolar myelopathy: an autopsy-based case-control study. Neurology. 1994;44(11):2159–2164. 5. Geraci A, Di Rocco A, Liu M, et al. AIDS myelopathy is not associated with elevated HIV viral load in cerebrospinal fluid. Neurology. 2000;55(3):440–2. 6. Petito CK, Vecchio D, Chen YT. HIV antigen and DNA in AIDS spinal cords correlate with macrophage infiltration but not with vacuolar myelopathy. J Neuropathol Exp Neurol. 1994;53(1):86–94. 7. Di Rocco A, Tagliati M, Danisi F, et al. A pilot study of L-methionine for the treatment of AIDS-associated myelopathy. Neurology. 1998;51(1):266–268. 8. Di Rocco A, Werner P, Bottiglieri T, et al. Treatment of AIDS-associated myelopathy with L-methionine: a placebo-controlled study. Neurology. 2004;63(7):1270–1275. 9. Tyor WR, Glass JD, Baumrind N, et al. Cytokine expression of macrophages in HIV-1- associated vacuolar myelopathy. Neurology. 1993;43(5):1002–1009. 10. Kuroda Y, Takashima H, Ikeda A, et al. Treatment of HTLV-I-associated myelopathy with high-dose intravenous gammaglobulin. J Neurol. 1991;238(6):309–314. 11. Cikurel K, Schiff L, Simpson DM. Pilot study of intravenous immunoglobulin in HIV- associated myelopathy. AIDS Patient Care STDS. 2009;23(2):75–78. 12. Shefner JM. Strength testing in motor neuron diseases. Neurotherapeutics. 2017;14(1):154–160. 13. Mulder-Brouwer AN, Rameckers EA, Bastiaenen CH. Lower extremity handheld dynamometry strength measurement in children with cerebral palsy. Pediatr Phys Ther. 2016;28(2):136–153. 14. Kristensen OH, Stenager E, Dalgas U. Muscle strength and poststroke hemiplegia: a systematic review of muscle strength assessment and muscle strength impairment. Arch Phys Med Rehabil. 2017;98(2):368–380. 15. Ford-Smith CD, Wyman JF, Elswick RK Jr, Fernandez T. Reliability of stationary dynamometer muscle strength testing in community-dwelling older adults. Arch Phys Med Rehabil. 2001;82(8):1128–1132. 16. DiPiro ND, Holthaus KD, Morgan PJ, et al. Lower extremity strength is correlated with walking function after incomplete SCI. Top Spinal Cord Inj Rehabil. 2015;21(2):133–139. 17. Robinson-Papp J, Byrd D, Mindt MR, et al. Motor function and human immunodeficiency virus-associated cognitive impairment in a highly active antiretroviral therapy-era cohort. Arch Neurol. 2008;65(8):1096–1101. 18. Rossier P, Wade DT. Validity and reliability comparison of four mobility measures in patients presenting with neurologic impairment. Arch Phys Med Rehabil. 2001;82(1):9–13. 19. Greene M, Justice AC, Covinsky KE. Assessment of geriatric syndromes and physical function in people living with HIV. Virulence. 2016;07:1–13. 20. Richert L, Brault M, Mercie P, et al. Handgrip strength is only weakly correlated with physical function in well-controlled HIV infection: ANRS CO3 Aquitaine Cohort. J Acquir Immune Defic Syndr. 2014;65(1): e25–e27. 21. Raso V, Shephard RJ, do Rosario Casseb JS, et al. Handgrip force offers a measure of physical function in individuals living with HIV/AIDS. J Acquir Immune Defic Syndr. 2013;63(1):e30–e32. ICNS

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