Talk:Hirayama disease

Unsourced or dubious
The following is unsourced and was moved here per WP:PRESERVE. Per WP:BURDEN please do not restore without finding independent, reliable sources, checking the content against them, and citing them, and ensuring that this content has appropriate WP:WEIGHT in the article overall.

EMG tests reveal loss of the nerve supply, or denervation, in the affected limb without conduction block (nerve blockage restricted to a small segment of the nerve). Increased sweating, coldness and cyanosis have been reported for a few patients, indicating involvement of the sympathetic nervous system.While MMA will cause weakness and/or wasting in only one limb, EMG and NCV tests often show signs of reinnervation in the unaffected limbs.

Patient feels contracture of middle and ring finger. Slight thinning of the subdigital Palm of the affected fingers. Initial pain and weakness subside with preliminary treatment with antiinflammatories, and B-complex vitamins. Initial loss of function improves almost fully.
 * Symptoms==

The disability originates with impaired functioning of the anterior horn cells of the lower cervical cord (lower neck), but the cause of the decline is still considered unknown. Researchers, including Hirayama, believe that in many cases damage in the cervical cord is due to compression of cervical disks. Some research has tried to establish a link between DTP (diphtheria-tetnus-pertussis) vaccines and MMA but has not found a strongly credible relationship. A familial link has been found in a minor percentage of cases, including parent-child and sibling-sibling (including once with identical twins).
 * Cause==

The symptoms of MMA usually progress slowly for one to two years before reaching a plateau, and then remain stable for many years. Disability is generally slight. Rarely, the weakness progresses to the opposite limb. There is also a slowly progressive variant of MMA known as O'Sullivan-McLeod syndrome, which only affects the small muscles of the hand and forearm and has a slowly progressive course.
 * Prognosis==

MMA mostly occurs in males between the ages of 15 and 25. Onset and progression are slow. MMA is seen most frequently in Asia, particularly in Japan and India; it is much less common in North America.
 * Epidemiology==

{[reflist-talk}}

-- Jytdog (talk) 22:09, 7 May 2018 (UTC)
 * Thanks for the changes. I have references for several of the sections that I will add in the next day or three as time allows, see if we can move this back from being a stub.  GeeBee60 (talk) 15:35, 8 May 2018 (UTC)


 * The above is now mostly a relic and archivable. GeeBee60 (talk) 14:51, 27 May 2018 (UTC)

Focal
Someone deleted this word with edit summary: "deleted unclear term "focal")" . Ignorance is not the reason for deletion of terms in topics you have no idea . In fact, the term "focal" has pretty much clear meaning in medicine, although, as a non-expert I had some troubles with figuring it out. Therefore I wikilinked it in this weird way.  Staszek Lem (talk) 20:34, 16 May 2018 (UTC)


 * (moved out of my talk page)

Thank you User:Staszek Lem for your concern -

In a review of literature on MMA, only a limited number of researchers describe the disease as a "focal" neuron disease. My deletion of the term was an expedient because I have yet to see the term well-defined as I plow through dozens of useful and not so useful documents, in anticipation of a thorough revision. I'd propose that ultimately the lede language be simple and brief and the more technical descriptions go into the body of the text. At this point I am not attached to minor points of wording, given the many other deficits of the article. I agree that ultimately it should be defined /explained somewhere in the text.

"Focal" probably means that the disease / disorder is focused in a small part of the nervous system, rather than expressed diffusely. It is confined (in MMA) to the nerve chord in vertebrae C7 through T1 and does not extend beyond this. Only one upper limb is typically involved (and the right limb far more often than left!). It may be adolescent mis-alignment in the growth of the neck, as the dura seems to bulge and compress the chord. If caught early the diseases progress can frequently be slowed -- though not reversed -- through use of a cervical collar.

If you want to see my present in-process MMA project (w/o some key refs and some stuff still wrong, etc.), you can visit my sandbox: User:GeeBee60/sandbox

Gratitude, GeeBee60 (talk) 22:03, 16 May 2018 (UTC)
 * OK. Sorry for confusion: your edit summary was a bit unclear.
 * Still, the readers must be able to find this term in wikipedia. Yes, "focal" describes conditions localized in a part of nervous system, e.g., in one lobe. Staszek Lem (talk) 22:11, 16 May 2018 (UTC)


 * Thanks for the move. Yes focal (neurology) deserves a med definition, but it is not on my to-do list.  I'm trying to figure out how best to otherwise rewrite this article.  I have generated MMA related queries and comments in a few places -- beyond this comment are two other discussions that might be better off if they were all incorporated on this MMA Talk page.  In lieu of that happening -- at least by me now -- here are links to a couple more comments / queries I have been part of as I work on a rewrite (in my sandbox):
 * User talk:GeeBee60
 * Wikipedia talk:No original research
 * Turns out focal has a link in WP -- Focal neurologic signs. Red links in an article drive me nuts, even more if due to my own tired sloppy editing.  Fixed.  GeeBee60 (talk) 11:57, 19 May 2018 (UTC)
 * This is the correct way to handle this: (1) create it: focal (neurology) (2) list it in focal (3) wikilink as  focal . In this way, next time a layman wikipedian like me will find the way around. (What drives me nuts even more is when professional articles in math, biology, etc. assume everybody understands the professional slang.) Staszek Lem (talk) 20:04, 21 May 2018 (UTC)
 * Is "focal" professional slang? I thought it was universally meant as focusing on a single area or point. Natureium (talk) 20:06, 21 May 2018 (UTC)
 * As long as it has a special meaning, it is professional terminology. This "area" or "point" means different things in different contexts. Staszek Lem (talk) 00:04, 22 May 2018 (UTC)
 * BTW, your explanation is kinda circular. Because the word "focusing" is just as unclear as "focal". Even etymology suggests two groups of meanings: something that orifinates from focus and something that converges into a focus, not forgetting about the possibility of etymological fallacy. Staszek Lem (talk) 00:15, 22 May 2018 (UTC)

In the queue -- Monomelic amyotrophy -- complete revision
I have been working on a total revision of MMA in my sandbox and have submitted it for review. The message is that this review could take two months, which may not be needed if folk want to look at it here: [The submission was immediately rejected because it was not new, but a revision. Instead I need to request history merge and (separately, optional) a peer review.]

The revision waiting review is here: revised Monomelic amyotrophy.

[A link for the review comments is now here:Peer_review/Monomelic_amyotrophy/archive1 ]

The article is about 24,000 bytes [20,000 bytes], almost 3 times [2½ times] longer than the current article of 8500 bytes. References have been increased from 6 to 22 [21] (and yes I have read them ... and more). I am sure there are some errors but my head is maxed out right now. Note that I have used a few case studies because of the quality of their discussion and the research they contain. I can share papers that on-line are only abstracts but am not publishing any that I had to obtain from a library etc.

GeeBee60 (talk) 02:57, 25 May 2018 (UTC)


 * [Revisions after folk responded to request for review from Wikipedia talk:WikiProject Medicine ] Thanks GeeBee60 (talk) 01:45, 27 May 2018 (UTC)

Citations needed
Several "Citations needed" have added, with mixed justification. This is a challenging disease description filled with "usually" "commonly" "79% of individuals" "three to five years after onset" etc. in the literature. Diagnostically folk are getting pretty good at sorting out MMA from more other MND, though one diagnostic tool -- long term survival -- is not particularly helpful. And there is barely a whisper as to why this is so disproportionately found in Asia. Far more discussed is whether or not the name "Monomelic amyotrophy" is the correct name, as there are a high percentage of cases where "monomelic" is misleading or inaccurate.

My rant (whine) is that the WP directive of "no original research" is in truth a bunch of pasture chips. While I didn't interview, tweak, or needle any patients, I have attempted to comprehensively interpret dozens of documents, and that borders on original research -- and a task presently a bit beyond my reach. I am confident of my interpretation of the literature, but not my ability to simultaneously keep track of what I read where. I wish I had the resources -- and space and time -- to have hard copies of each of these twenty plus citations -- along with a collegial setting like the dozens of variant CSI television dramas with giant bulletin boards and eager smart interns.

OK, enough of this. Please dive in here with suggestions.


 * The truth is out there ... subject to interpretation.

GeeBee60 (talk) 15:31, 27 May 2018 (UTC)