Background. It is currently impossible to diagnose Parkinson’s disease (PD) in the premotor phase even though at the time of motor symptom onset the number of already degenerated dopaminergic substantia nigra neurons is considerable. Degeneration of the dorsal nucleus of the vagus nerve (VN) has been reported early in the disease course, and it could lead to impaired function of the VN, resulting in certain nonmotor symptoms of PD. Therefore, we raised a hypothesis that the loss of VN neurons could result in a smaller diameter of the VN among PD patients. Methods. 20 PD patients and 20 age- and gender-matched individuals without any neurodegenerative disease were enrolled in a pilot study. The diameters of the right and left VNs were measured using ultrasonography, their average was calculated, and the narrower VN diameter was noted separately. Results. No difference was found between the PD and control groups neither in the average VN diameter (mean 1.17; 95% confidence interval (CI) 1.10–1.24 vs. 1.13; 1.07–1.18, mm; p = 0.353 ) nor in the narrower VN diameter (mean 1.11; 95% confidence interval (CI) 1.02–1.20 vs. 1.07; 1.02–1.13, mm; p = 0.421 ). The narrower VN diameter and the average VN diameter were not able to distinguish between PD patients and controls (area under curve (AUC) = 0.588, 95% CI = 0.408–0.767, and p = 0.344 ; and AUC = 0.578, 95% CI = 0.396–0.759, and p = 0.402 ). Conclusions. To conclude, no differences were found in VN diameter between the PD and control groups. Therefore, our data do not support the hypothesis that PD could be associated with a smaller diameter of the VN.

Background and objectives: tremor is an unintentional and rhythmic movement of any part of the body that is a typical symptom of Essential Tremor (ET). ET impairs the quality of life of patients and is treated with pharmacotherapy. We investigated the tremor reduction efficacy of an innovative vibrational medical device (IMD) in ET patients. Materials and Methods: we conducted a prospective, single-center, single-arm, pragmatic study in ET patients with an extended safety study to evaluate the efficacy and safety of the Vilim Ball—a local hand-arm vibration device that produces vibrations in the frequency range of 8–18 Hz and amplitude from 0 to 2 mm. The primary endpoint was the decrease in the power spectrum after device use. The secondary endpoints were safety outcomes. Results: In total, 17 patients with ET were included in the main study, and no patients withdrew from the main study. The tremor power spectrum (m²/s³ Hz) was lower after the device use, represented as the mean (standard deviation): 0.106 (0.221); median (Md) 0.009 with the interquartile range; IQR, 0.087 vs. 0.042 (0.078); Md = 0.009 with the IQR 0.012; Wilcoxon signed-rank test V = 123; and p = 0.027. Seven patients reported that vibrational therapy was not effective. Two patients reported an increase in tremor after using the device. In the extended safety study, we included 51 patients: 31 patients with ET and 20 with Parkinsonian tremor, where 48 patients reported an improvement in tremor symptoms and 49 in function. No serious adverse events were reported, while two patients in the Parkinsonian tremor group reported a lack of efficacy of the proposed medical device. Conclusions: the device reduces essential tremor in some patients and is safe to use in ET.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that affects both the upper and lower motor neurons in the nervous system, causing muscle weakness and severe disability. The progressive course of the disease reduces the functional capacity in the affected patients, limits daily activities and leads to complete dependence on caregivers, ultimately resulting in a fatal outcome. Respiratory dysfunction mostly occurs later in the disease and is associated with a worse prognosis. 46 participans were included in our study, with 23 patients in ALS group and 23 individuals in the control group. The ultrasound examination of the phrenic nerve (PN) was performed by two authors using a high-resolution "Philips EPIQ 7" ultrasound machine with a linear 4-18 MHz transducer. Our study revealed that the phrenic nerve is significantly smaller on both sides in ALS patients compared to the control group arba controls (p < 0.001). Only one significant study on PN ultrasound in ALS, conducted in Japan, also showed significant results (p < 0.00001). These small studies are particularly promising, as they suggest that ultrasound findings could serve as a additinioal diagnostic tool for ALS

Multifocal motor neuropathy is a rare motor neuron disease characterised by a progressive, gradual loss of muscle strength, although sensory functions are preserved. The worldwide frequency of this disease is estimated at 1 person per 100,000 people. MMN is diagnosed when there are characteristic clinical signs, electroneuromyography test results support the clinical findings, and other possible diagnoses are excluded. To prove the progressive course of the disease, the patient must be under long-term medical supervision, since the deteriorating state of the patient may imitate other diseases affecting the motor neuron, such as amyotrophic lateral sclerosis, chronic inflammatory demyelinating polyneuropathy, spinal muscular atrophy, and other.We present the clinical case of a 71-year-old patient who presented to the Neurology Department of the Hospital of Lithuanian University of Health Sciences Kauno Klinikos. She complained of pain in her right hip and progressing weakness of the right foot which had lasted for a year. After laboratory tests, long-term supervision, and exclusion of other diagnoses, the patient was diagnosed with an atypical type of multifocal motor neuropathy responsive to treatment with intravenous immunoglobulin.

Background. The study aims to evaluate the efficacy of gamma knife thalamotomy for the control of essential tremor and Parkinson’s-related tremor when other invasive treatment modalities are not recommended.Materials and methods. From June 2019 to January 2021, 27 patients with medically resistant essential tremor and 20 patients with Parkinson’s disease (PD) underwent unilateral gamma knife thalamotomy. The patients were treated with a mounted Leksell G frame with modified 4 mm shots aiming to deliver 130-140 Gy to the ventralis intermedius nucleus. Post-surgical evaluation was to be performed 6 and 12 months after surgery. However, due to state-imposed quarantine restrictions direct evaluation was challenging, hence post-surgical results were evaluated via phone call. Only 12 of 20 PD patients were reached via phone call, but 8 of them were evaluated less than 6 months after surgery. As a result, the group of PD patients was excluded from the study.Results. 23 patients from the essential tremor group were assessed via phone call. One patient died from COVID-19-related pneumonia during the follow-up period. During the phone call, 16 (72%) of 22 patients reported major improvement in hand tremor or full tremor arrest on the contralateral side of thalamotomy. Meanwhile, 6 (28%) patients did not feel any improvement after the treatment. Complications were observed in 4 (18%) patients – they reported transient ataxia and hand movement dyscoordination which resolved in few months.Conclusions. Gamma knife thalamotomy is safe and effective for essential hand tremor control. Main disadvantages include several months of latency period and transient ataxia.