Abnormal Nerve Conduction Studies Research Articles

The impacts of poor glycemic control and disease duration on peripheral nerves in children and adolescents with type 1 diabetes mellitus

Objective: To evaluate the risk factors of subclinical neuropathy, and the nerve conduction study (NCS) results in children, and adolescents with type 1 diabetes mellitus (T1DM). Methods: A total of 81 patients without neuropathy symptoms were studied. Demographical features, pubertal stage, disease duration, NCS results, lipid profile results in the last 2 years, HbA1c results in the last 5 years, and the types of treatments (multiple-dose and insulin pump therapy) were recorded. Results: The median age was 14 (5) years, 49.3 % (n=40) of the study group was female and 81.5 % (n=66) of the patients were pubertal. Of the patients, 16.04% had abnormal NCS results. There were no significant differences between patients with normal and abnormal NCS results in terms of demographical features, pubertal stage, disease duration, lipid profiles, and dysglycemia. No significant differences were found between the types of treatment in terms of NCS results. The proximal and distal compound muscle action potential (CMAP) amplitudes of the median nerve were significantly lower in patients with poor glycemic control than in those with well-glycemic control. Sensory nerve action potential (SNAP) amplitudes of sural nerve were significantly lower in patients whose disease durations were ≥60 months than in those <60 months. Conclusions: About a sixth of the T1DM has subclinical neuropathy. CMAP amplitudes of the median nerve are the most affected measurement from poor-glycemic control. Additionally, SNAP amplitudes of the sural nerve are the values most affected by longer disease duration.

Neuronal Intranuclear Inclusion Disease with Abnormal Peripheral Nerve Conduction

A 70-year-old female presented with progressive gait disturbance. Neurologic examination revealed sensory impairment, hyporeflexia, and sensory ataxia. Nerve conduction study demonstrated mildly decreased velocity in motor nerves. Brain magnetic resonance imaging showed high signal intensities in the corticomedullary junction on diffusion weighted imaging. Neurocognitive function test implied mild cognitive impairment. Based on eosinophilic intranuclear inclusions in pathology, neuronal intranuclear inclusion disease was confirmed. Neuronal intranuclear inclusion needs to be considered when abnormal nerve conduction studies are consistent with abnormal brain imaging findings.

Diagnostic value of clinical examination for identifying patients with large- and small-fibre neuropathy.

The diagnosis of polyneuropathy usually requires neurophysiological investigation, necessitating specialised testing and interpretation thereby increasing the time to final diagnosis. To investigate the predictive value of the clinical examination in patients with potential neuropathies. Patients were recruited based on their referral requesting neurophysiological testing. Two examiners tested ankle jerk reflexes and gradient to temperature sensation prior to the patient undergoing neurophysiology investigations, blinded to subsequent testing results. The neurophysiology investigations were either standard nerve conduction study (NCS) or thermal threshold testing (TTT) or both. These data were then analysed to determine the Kappa between examiners as well as sensitivity, specificity, and positive and negative likelihood ratios. There was a modest level of agreement between examiners for ankle jerk testing (Kappa=0.6) but poor agreement for gradient temperature testing (Kappa=0.3). Bilateral absence of ankle jerk reflexes was moderately associated with abnormal NCS, with the following characteristics: sensitivity 72%, specificity 91%, positive likelihood ratio 7.6 and negative likelihood ratio 0.3. The presence of a temperature gradient was poorly diagnostic for abnormal TTT: sensitivity 87%, specificity 14%, with positive and negative likelihood ratios close to 1. The absence of ankle jerks performed moderately well in identifying patients likely to have large-fibre neuropathy and could potentially be used to help decide who should be sent for NCS. Gradient temperature testing was much more subjective and did not change the likelihood of abnormal TTT.

Facial Diplegia as the Sole Manifestation of Post-Vaccination Guillain-Barre Syndrome: A Case Report and Literature Review.

Recently, a large study concluded that certain brands of vaccines may increase the risk of Bell's palsy and Guillain Barre Syndrome (GBS). As to whether vaccination after COVID-19 modify the risk of Bell's palsy or GBS has not yet been studied. Here we report a 35years old COVID-19 survivor whom in less than 2weeks after his second dose of inactivated SARS-CoV2 vaccine, developed bilateral facial nerve paralysis. In addition, he had hyperacusis, dysgeusia and decreased lacrimation without any signs of sensory and motor deficits in the limbs. His limb nerve conduction study (NCS) was unremarkable in contrast to bilaterally abnormal facial NCS and blink reflexes. Although he had negative anti-GM1 IgG and IgM antibodies, he has marked albuminocytologic dissociation, classic of acute inflammatory demyelinating polyneuropathy. To date, there were no similar case reports which published the occurrence of facial diplegia as sole manifestation of GBS in a post COVID-19 patient who recently completed vaccination. We believe that molecular mimicry, induced by magnified immune response from both COVID-19 and vaccination may have caused the symptom.

Disease-specific quality of life in patients with diabetic neuropathy

To compare health-related quality of life (HRQoL) among patients with diabetes mellitus (DM) and diabetic neuropathy (DN) (D+N) with patients with DM without DN (D-DN) and healthy participants. To evaluate factors associated with poor HRQoL in patients with DN. This study included 306 participants residing in Bisha, Saudi Arabia. Patients with DM were screened for DN using the Michigan Neuropathy Screening Instrument. Neuropathy severity, disability and HRQoL were determined using the Neuropathy Severity Scale (NSS), the Neuropathy Disability Score (NDS), and the Norfolk Quality of Life-Diabetic Neuropathy (QOL-DN) tool, respectively. Nerve conduction studies (NCSs) were also performed. The D+DN group had poorer overall and domain HRQoL scores compared to the D-DN group (p<0.001). There was a strong correlation between overall HRQoL score and both NDS and NSS scores in the D+DN group (ρ= -0.71 and p<0.0001; ρ= -0.81 and p<0.0001, respectively). There was also a significant difference in all mean HRQoL domain scores between D+DN participants with normal and abnormal NCS. Physical inactivity (p=0.043), duration of DM (p<0.0001), abnormal NCS, NSS (p<0.0001), and NDS (p<0.0001) predicted HRQoL in the D+DN group. D+DN participants had a worse HRQoL compared with D-DN and healthy counterparts. NDS, NNS, physical inactivity, abnormal NCS, and duration of DM independently predicted poor HRQoL in D+DN participants.

IDF21-0671 Identification of neurophysiological abnormalities in nerve in patients with type 1 diabetes

Background: The progression of neuropathy is a continuum from subclinical neuropathy detectable with electrophysiological tests to clinically evident one recognizable on neurological examination. Although there has been considerable research of peripheral neuropathy in type 1 diabetes, still there is controversy regarding the pattern of nerve involvement in diabetic neuropathy. Detection of the pattern of nerve involvement can help to establish a protocol for screening of diabetic peripheral neuropathy (DPN) in its subclinical stage. Aim: The aim of this study was to describe the pattern of nerve involvement in type 1 diabetic patients with subclinical neuropathy using nerve conduction studies. Method: 65 patients with type 1 diabetes, ages from 18 to 55 years, and 34 controls without diabetes matched to the patient group were included into the study. All patients and controls underwent a standard neurological examination (NSS and NDS (the variant used in Belarus) score) and bilateral nerve conduction study (NCS) of the sensory and motor lower limb nerves using NeuroSoft machine. Interpretation of the results was based on the following normal reference ranges: n. Peroneus superficialis A> 10μV, v> 45 m/s; n Suralis A> 5 μV, v> 45 m / s; n Peroneus profundus A> 3mV, v> 40 m/s; n Tibialis A> 3.5mV, v> 40m/s. Data was analysed using IBM SPSS statistics v 20.0. Results: Clinically evident DPN was detected in 14 patients with type 1 diabetes from 65 examined. The use of NCS allowed to identify the subclinical stage of polyneuropathy (abnormalities in at least two of the electrophysiological parameters) additionally in 35 patients who had no symptoms and clinical signs of DPN. In all the patients of the control group, the NCS parameters were in the reference range. Regarding abnormal NCS parameters in patients with subclinical diabetic neuropathy (conduction velocity vs. amplitude of the compound action potential), amplitudes reduction for the n. Peroneus superficialis and n. Peroneus profundus predominated. Median of the amplitude for n. Peroneus superficialis in patients with subclinical diabetic polyneuropathy was 7.22 [5.25; 8.54] μV vs. 12.4 [10.57; 16.2] μV in the control group, p <0.001; for n. Peroneus profundus 2.21 [1.68; 2.68]mV vs. 3.15 [3.04; 3.42]mV in the control group, p <0.001. Significant differences in the amplitudes for n.Suralis and n.Tibialis has not been identified. Nerve conduction velocity (NCV) in both groups – in patients with the subclinical diabetic polyneuropathy and the control group – was within the reference range. However, the medians of NCV for n. Suralis and n. Tibialis were significantly lower in the group of patients with neuropathy compared with the controls – 47.08 [44.35; 50.13]m/s vs. 51.3 [47.6; 59.05]m/s, p = 0.025 and 44.8 [42.15; 48.2]m/s vs. 49.35 [48.30; 53.45]m/s, p = 0.004, respectively. Conclusion: In patients with type 1 diabetes with a subclinical stage of diabetic polyneuropathy the most frequent neurophysiological abnormalities were reduced amplitudes (the axonal damage) for sensory and motor fibers of n. Peroneus.

Lower motor neuron involvement in patients with neuromyelitis optica spectrum disorders

BackgroundInvolvement of the central gray matter of spinal cord is a characteristic magnetic resonance imaging (MRI) feature of aquaporin-4-immunoglobulin G antibodies (AQP4-IgG) positive neuromyelitis optica spectrum disorders (NMOSD). However, there has been no systemic electrophysiological study investigating the frequency of lower motor neuron involvement in NMOSD patients. MethodsWe retrospectively reviewed a cohort of 59 NMOSD patients with results of concentric needle electromyography (EMG) and nerve conduction studies (NCS) that were admitted to the Department of Neurology of Chinese PLA General Hospital between January 2016 and December 2019. ResultsAcute and/or chronic denervation was found in 22.0% (13/59) of the NMOSD patients by EMG. Peripheral or cranial neuropathy indicated by abnormal NCS changes was found in 11.9% (7/59) of the NMOSD patients. Denervation indicated by EMG that can be accounted for by abnormal NCS was found in 6.8% (4/59) of the NMOSD patients, while 3.4% (2/59) of the NMOSD patients had NCS abnormality without denervation indicated by EMG. Accordingly, 9 of the 59 NMOSD patients (15.3%) had lower motor neuron involvement, and moreover, 6.8% (4/59) of the NMOSD patients had corresponding spinal cord or brainstem lesions on MRI. ConclusionNot uncommon lower motor neuron involvement exists in NMOSD patients, so needle EMG and NCS studies should be performed in NMOSD patients with suspected lower motor neuron involvement.

Homozygosity of the Z-2 polymorphic variant in the aldose reductase gene promoter confers increased risk for neuropathy in children and adolescents with Type 1 diabetes.

Diabetic neuropathy (DN) is the least recognized complication of diabetes mellitus and may start early in the course of the disease. Aldose reductase (AKR1B1) gene promoter Z-2/Z-2 polymorphism increases the expression of AKR1B1 enzyme and may contribute to DN. We evaluated 108 Type 1 diabetes (T1D) children and adolescents (mean ± SD age: 13.5 ± 3.46 years, disease duration: 5.3 ± 3.4 years) and 150 healthy controls (age: 11.9 ± 2.7 years). In both groups, pupillary dilation (PD) in darkness, postural blood pressure test (PBPT), and vibration sensation thresholds (VST) in upper and lower limbs were estimated as indices of autonomic and peripheral neuropathy, respectively. Nerve conduction studies (NCS) were performed in patients as peripheral neuropathy index. The polymorphisms of AKR1B1 gene were evaluated using microsatellite (AC)n sequence Z. PBPT, PD, and VST impairments were more frequent in patient group compared with controls, while 38.6% of patients exhibited NCS abnormality. Gender, age, pubertal status, height, body mass index, diabetes duration, HbA1c, and anti-GAD titers were associated with neuropathy indices in patients. There was a strong correlation between PD and NCS in patients, while homozygous patients for Z-2 AKR1B1 gene polymorphism had higher prevalence of abnormal NCS (83.3% vs. 34.6%), PD (62.5% vs. 31.5%), and PBPT values compared with heterozygous or negative patients. Homozygous AKR1B1 status predicted PD, NCS, and PBPT variance, while PD, VST, NCS, and PBPT parameters accurately discriminated homozygous AKR1B1 patients. Impaired indices of peripheral and autonomic DN were present in a significant proportion of young T1D patients. PD, VST, NCS, and PBPT parameters were simultaneously associated with homozygous state of AKR1B1 Z-2 gene polymorphism, implicating polyol metabolism with both autonomic and peripheral neuropathies.

Differences in peripheral neuropathy in xeroderma pigmentosum complementation groups A and D as evaluated by nerve conduction studies

BackgroundXeroderma pigmentosum (XP) is a rare autosomal recessive genetic disorder with defective DNA nucleotide excision repair and associated with a high frequency of skin cancer. Approximately 25% of patients develop progressive neurological degeneration. Complementation groups XP-A and XP-D are most frequently associated with neurological disorders.Design/methodsThis is a retrospective review of patients with XP who were evaluated at NIH from 1986 to 2015 and had nerve conduction studies (NCS). In the complementation groups with peripheral neuropathy, further comparisons of the NCS were made with audiological, brain imaging, neuropsychological assessments that were also performed on most of the patients. Limited neuropathology of XP-A and XP-D patients were examined..ResultsThe 33 patients had NCS: XP-A (9 patients), XP-C (7 patients), XP-D (10 patients), XP-E (1 patient), XP-V (4 patients), and XP-unknown (2 patients). Peripheral neuropathy based on nerve conduction studies was documented only in two complementation groups: 78% (7/9) of XP-A patients had a sensorimotor neuropathy while 50% (5/10) of XP-D patients had a sensory neuropathy only. Analysis of sural sensory nerve amplitude in both complementation groups XP-A and XP-D correlated with sensorineural hearing loss (SNHL), MRI/CT severity, and Full-scale Intelligence Quotient (IQ). Analysis of fibular motor nerve amplitude in complementation XP-A correlated with SNHL and MRI/CT severity. Limited follow-up studies showed gradual loss of NCS responses compared to an earlier and more rapid progression of the hearing loss.ConclusionsDespite similar brain imaging and audiological findings patients, XP-A and XP-D complementation groups differ in the type of neuropathy, sensorimotor versus sensory alone. A few cases suggest that sensorineural hearing loss may precede abnormal NCS in XP and therefore serve as valuable clinical indicators of XP patients that will later develop peripheral neuropathy.

Relapsing inflammatory neuropathy with normal peripheral nerve conduction studies – a paradoxical phenomenon in two patients

The diagnosis of Guillain Barre Syndrome and Chronic Inflammatory Demyelinating Polyneuropathy depends on an appropriate history, examination, CSF cyto-protein dissociation and abnormal peripheral nerve conduction studies (PNCS). We present two cases suggestive of GBS but with repeatedly normal PNCS, a paradoxical phenomenon.

Relation between the severity of liver cirrhosis and neurological symptoms, nerve conduction study results, and motor unit number estimation.

Liver cirrhosis is a global health problem that can be associated with several neurological manifestations. We aimed to assessment of the relation between the severity of the liver cirrhosis and the neurological symptoms, nerve conduction studies (NCS), as well as detecting subclinical neuropathic affection using motor unit number estimation (MUNE) technique. This cross-sectional study was conducted on 56 cirrhotic patients and 61 age- and sex-matched healthy controls. Neurological manifestations, Child-Pugh classification, Model for End-Stage Liver Disease score, NCS and MUNE using a modified spike-triggered averaging technique were studied. Forty-five (80.3%) of the cirrhotic patients had neurological manifestations. Muscle cramps were the most frequently reported manifestation, followed by fatigue and then numbness. NCS abnormality was significantly related to the presence of neurological symptoms (p<0.001) and not only to peripheral numbness. Only fatigue was significantly related to the lower MUNE values (p<0.017). Child-Pugh classification progression was significantly related to the presence of fatigue and abnormal NCS results (p<0.001); no similar relation was detected between the Child-Pugh classification and the MUNE value (p=0.103). Higher MELD scores were significantly related to NCS abnormalities (p=0.014) and negatively correlated, although not significantly, with the MUNE values (r=-0.246 and p=0.067). The progression of liver cirrhosis was related to the presence of neurological manifestations and nerve conduction abnormalities. Nerve conduction abnormalities may be present even in the absence of clinical numbness. A decline in motor unit number could explain the pathophysiology of fatigue in cirrhotic patients.

Neurological involvement in Ile68Leu (p.Ile88Leu) ATTR amyloidosis: not only a cardiogenic mutation

Background Ile68Leu transthyretin-related amyloidosis (ATTR) is known as a mainly or exclusively cardiogenic variant. We hypothesized that an accurate specialized neurological evaluation could reveal a consistent frequency of mixed phenotypes. Methods Forty-six consecutive subjects with transthyretin (TTR) Ile68Leu (p.Ile88Leu) mutation (29 patients and 17 unaffected carriers) underwent an in-depth cardiac and neurologic evaluation at a single center. Results All 29 patients showed cardiac involvement. In 20 (69%) cases, it was associated with neurological abnormalities (i.e. a mixed phenotype): 10 (35% of the total) had signs and symptoms of neuropathy, 5 (17%) had abnormalities at the neurologic specialist examination but without symptoms, and 5 (17%) had abnormal nerve conduction study only. None of the asymptomatic carriers showed neurological abnormalities or cardiac involvement. The Neuropathy Impairment Score was > 5 in seven patients at baseline, and became >5 in six more patients during follow-up. The probability of experiencing a major adverse cardiac event (MACE) during follow-up was higher in the mixed than cardiologic phenotype (p = 0.026). Age and phenotype were independent prognostic predictors of MACE. Conclusion At least two-thirds of patients with Ile68Leu ATTR and amyloidotic cardiomyopathy show an associated – definite or probable – neurologic impairment of variable degree if accurately evaluated in a neurologic setting. This proportion can rise during follow-up. The mixed phenotype carries a worse prognosis compared to the exclusively cardiologic one. These observations show that more patients could be eligible for treatment with gene silencers than currently indicated and highlight the need for an in-depth and continuous multidisciplinary evaluation of Ile68Leu ATTR patients.

Sensory and motor axonal excitability testing in early diabetic neuropathy

ObjectiveThe aim of the present study was to gain insight into the pathophysiology of diabetic polyneuropathy (DPN) and examine the diagnostic value of sensory and motor axonal excitability testing. MethodsOne hundred and eleven type 2 diabetics with and without DPN (disease duration: 6.36 ± 0.25 years) and 60 controls were included. All participants received a thorough clinical examination including Michigan Neuropathy Screening Instrument (MNSI) score, nerve conduction studies (NCS), and sensory and motor excitability tests. Patients were compared by the likelihood of neuropathy presence, ranging from no DPN (17), possible/probable DPN (46) to NCS-confirmed DPN (48). ResultsMotor excitability tests showed differences in rheobase and depolarizing threshold electrotonus measures between NCS-confirmed DPN group and controls but no changes in hyperpolarising threshold electrotonus or recovery cycle parameters. Sensory excitability showed even less changes despite pronounced sensory NCS abnormalities. There were only weak correlations between the above motor excitability parameters and clinical scores. ConclusionsChanges in excitability in the examined patient group were subtle, perhaps because of the relatively short disease duration. SignificanceLess pronounced excitability changes than NCS suggest that axonal excitability testing is not of diagnostic value for early DPN and does not provide information on the mechanisms.

A timed Phalen’s test predicts abnormal electrophysiology in carpal tunnel syndrome

ObjectivePrevious studies reported variable sensitivity and specificity of the Phalen test. We investigated whether a timed Phalen’s test (TPT) could predict abnormal nerve conduction studies (NCS) results in carpal tunnel syndrome (CTS).MethodsPatients with CTS were consecutively recruited. A neurologist confirmed the clinical diagnosis of CTS and recorded the TPT before NCS were performed. Another neurologist, blinded to the TPT, graded the severity of NCS. The TPT sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.ResultsIn total, 403 patients with 706 hands were recruited and diagnosed with CTS; 465 hands had positive TPT, and 611 hands showed abnormal NCS results. A positive TPT at ≤ 10 s had a specificity of 96.8% and a PPV of 96.6% in predicting abnormal NCS. The sensitivity and NPV of TPT were insignificant.DiscussionA positive TPT at ≤ 10 s can be useful in predicting NCS abnormalities in patients with CTS.

Large fiber peripheral neuropathy in systemic sclerosis: A prospective study using clinical and electrophysiological definition.

The reported prevalence of peripheral neuropathy in systemic sclerosis (SSc) is variable between 0.01% to 28%, probably due to differences in sample size, study design and population. Our aim is to determine the prevalence of large fiber peripheral neuropathy in SSc and to identify any contributing factors. A prospective cross-sectional study of 60 SSc patients were evaluated for large fiber neuropathy using the modified clinical Total Neuropathy Score (cTNS) and nerve conduction study (NCS) of the upper and lower limbs. A combination of clinical (cTNS score≥2) and NCS criteria (≥2 abnormal nerves including 1 sural [symmetrical polyneuropathy] and NCS abnormalities consistent with individual nerves/nerve roots [focal neuropathy]) was used to diagnose peripheral neuropathy. The majority had limited cutaneous subset (75%). Mean age was 55.73 (SD±13.04) years and mean disease duration was 8.61 (SD±8.09) years. Twenty-two (36.7%) had combined clinical and NCS criteria for peripheral neuropathy, 14 (23.3%) with symmetrical polyneuropathy and 8 (13.3%) with focal neuropathy. Symmetrical polyneuropathy patients had significantly lower hemoglobin levels (11.2 vs. 12.35g/L; P=.047). Serum vitamin B12 levels were normal, therefore excluding vitamin B12 deficiency. No other associations were found for both polyneuropathy and focal neuropathy with demography, co-morbid diseases and SSc disease factors such as Raynaud's phenomenon and modified Rodnan skin score. Large fiber neuropathy is common in SSc patients, which could contribute to non-lethal burden in SSc with sensory loss and muscle weakness. Apart from lower hemoglobin in polyneuropathy, there were no associations with disease-specific features or co-morbid diseases.

Study on electrophysiological changes of peripheral nerves in type 2 diabetes mellitus

Background: Peripheral neuropathy is a common and disabling complication due to diabetes mellitus. In such neuropathy, the function of sensory neurons, motor neurons, and autonomic functions are affected. The involvement of sensory function predominates in majority of cases. The neuropathy when develops is not reversible and also can not be stopped with any modality of treatment. Aim and Objectives: The objective is to evaluate diabetic neuropathy using the electrodiagnostic studies which are considered as a valuable tool. These studies are sensitive, specific, reproducible, and easily standardized. Material and Methods: Forty patients were subjected to electrodiagnostic study to evaluate the status of peripheral nerves in type- 2 diabetic patients. The different conduction velocities (motor nerve conduction velocity [MNCV], sensory nerve conduction velocity [SNCV]), distal latency (DL), nerve action potential (sensory nerve action potential [SNAP], and combined muscle action potential [CMAP]) are studied. All the cases were divided into two groups based on normal and abnormal diabetic neuropathy score. Sex, body mass index matched thirty numbers of healthy adults of both sexes were included in the control group. Nerve conduction study (NCS) of all the three groups were compared. Result: Neuropathy mostly peripheral was observed in 15 (37.5%) cases. The age of majority of cases was from 50–60 (45%) with mean age of 52.42 ± 7.39, having predominance of male (66.67%) in cases with symptoms of neuropathy. Fourteen (93.33%) cases out of the above cases had abnormal NCS. Abnormal NCS was also found in cases without clinical neuropathy, i.e. 14 (56%). The mean values of CMAP, SNAP, MNCV, and SNCV with prolonged DL are observed which was statistically significant. The conduction defect was observed more in lower limbs than in upper limbs. In the category of the motor nerve (common peroneal) is the most affected whereas the most affected sensory nerve was Sural nerve. Conclusion: Affection of nerves with neuropathies due to diabetes was in Sensory nerve than motor nerve. Early screening for neuropathy in clinical practice with NCSs can help in early diagnosis and their management.

The pattern of Electrophysiological Abnormality in Long-Standing Type-2 Diabetes Mellitus Patients: Experience at Referral Neurology Hospital in Bangladesh

Background: Nerve conduction studies (NCS) are the most objective measure of nerve function, and their use is recommended in the clinical and epidemiological evaluation of diabetic polyneuropathy.&#x0D; Objective: This study was conducted to describe the pattern of electrophysiological abnormality in long-standing type-2 Diabetes Mellitus patients.&#x0D; Methodology: This cross-sectional study was conducted in the Department of Neurophysiology at the National Institute of Neurosciences &amp; Hospital, Dhaka, Bangladesh from July 2017 to June 2019. Among the one hundred and eight consecutive patients of type 2 diabetes with a duration of more than 10 years attending the Neurophysiology laboratory, patients were selected for the study based on the inclusion and exclusion criteria. NCS study of the right upper limb (median and ulnar nerves) and left lower limbs (tibial, peroneal, and sural nerves) were done. NCS of other nerves were also done when indicated.&#x0D; Result: A total number of 92 patients were recruited for this study. NCS was abnormal in 56 (60.9%) patients. 43.5% (n=40) patients were male and 56.5% (n=52) patient were female. Among the 56 (60.9%) patients with abnormal NCS, most [35 (38%)] had mixed types (both sensory and motor) of neuropathy. In 28 (30.4%) patients, both demyelination and axonal involvement were present. The median nerve (46.7%) was the commonest nerve to be involved followed by the Sural nerve. In patients with elevated HbA1C, the axonal loss was more pronounced in the lower limbs’ nerves. Polyneuropathy (28.26%) was more than mononeuropathy (21.74%).&#x0D; Conclusion: Most of the patients of type 2 long-standing DM developed a mixed type of polyneuropathy and elevated HbA1C was significantly associated with the axonal involvement predominantly in lower limbs’ nerves.&#x0D; Journal of National Institute of Neurosciences Bangladesh, January 2021, Vol. 7, No. 1, pp. 10-13

Nerve conduction study findings and their predictors in clinically diagnosed patients with carpal tunnel syndrome in a Saudi population.

Despite the reports of carpal tunnel syndrome (CTS) being commonplace in Saudi Arabia, there is scarcity of cross-sectional or prospective studies detailing the profile of nerve conduction study (NCS) findings in patients with CTS. The study aimed to evaluate the neurophysiologic profile of CTS with the view to finding the determinant of abnormal findings in clinically diagnosed cases of CTS in a population of Saudis. Nerve conduction study was performed on consecutive patients with clinically diagnosed CTS. Median sensory, ulnar sensory, radial sensory median motor and ulnar motor nerves were assessed. The nerve conduction parameters measured were median and ulnar sensory peak latency, amplitude and velocity. Median conduction velocity, distal latency, and amplitude were also measured. Comparative median-ulnar and median-ulnar-digit 4 studies were done and the severity of CTS was determined. Data was analyzed using STATA software version 12. A total of 152 patients, comprising 59 males and 93 females (mean age of 42.7 years) with clinically diagnosed CTS were seen during the study period. About 72.4% patients had numbness and paresthesia in the affected fingers, 66.5% had pain in the hands, and 10.5% had weakness in the affected hands. Majority of the patients (62%) had bilateral clinical features. Carpal tunnel syndrome was confirmed with NCS in 84 (55.26%) patients. Presence of weakness in the affected hand, positive Phalen' sign, and positive Tinel's sign in patients appear to predict [6.1 (1.2-30.7), 3.9 (1.2-30.2), and 4.9 (1.4-17.0) respectively] abnormal NCS findings after adjustment for age, gender and the presence of DM. The study revealed that over half of the patients with CTS had NCS/ Electromyography (EMG) abnormalities. Presence of hand muscles weakness, positive Phalen and Tinel's signs predict abnormal findings on NCS/EMG in patients with CTS.

Ultrasound Assessment of Carpal Tunnel Syndrome in Comparison with Nerve Conduction Study: A Case-control Study

Introduction: Carpal Tunnel Syndrome (CTS) is the entrapment neuropathy which is diagnosed based on the clinical history, examinations and the electrophysiological findings. The Cross- sectional Area (CSA) measurement of the median nerve has emerged as an alternative to Nerve Conduction Studies (NCS) for diagnosis of CTS. This study was done to correlate NCS and Ultrasonography (USG) in clinically diagnosed CTS patients. Aim: To evaluate the diagnostic value of Cross-sectional Area (CSA) of median nerve at carpal tunnel inlet in patients with clinically and NCS confirmed Carpal Tunnel Syndrome (CTS) and to assess severity of the syndrome by NCS and its correlation with USG results. Materials and Methods: This was a hospital based, case-control study done on a total of 109 patients of CTS and analysed during the period from June 2017 to June 2019. Total 203 hands of the patients with abnormal NCS formed case group while 101 hands from healthy volunteers constituted the control group. All the patients underwent neurological evaluation by Boston Carpal Tunnel Questionnaire (BCTQ) and were divided into mild, moderate and severe according to the score. An electromyography machine was used to perform electrophysiological studies of both the limbs in all subjects. CTS was diagnosed electro-diagnostically based on the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) guidelines and were classified as mild (Grades 1 and 2), moderate (Grades 3 and 4), and severe (Grades 5 and 6) grades using Bland’s electrophysiological grading scale. USG was performed for all the subjects and all the data of various investigations was analysed using Statistical Package for Social Sciences (SPSS) version 22.0 software. Chi-square test and Mann Whitney U-test were used as test of significance for qualitative data. Results: The mean age of subjects was 44.38±9.561 years. Strongly significant association was observed in BCTQ symptom, functional and total scores with NCS severity grading (p-value &lt;0.001). Moderately significant association was found between BCTQ symptom and total scores with USG severity grading (p-value&lt;0.02). Tunnel grade and NCS grade were found significantly correlated (p-value &lt;0.001). The mean CSA cut-off value of 8.5 mm² at the inlet of carpal tunnel had a good sensitivity 86.21%, specificity 83.17%, Positive Predictive Value (PPV) 91.1% and Negative Predictive Value (NPV) 75%. Conclusion: The diagnostic accuracy of USG assessment and NCS was found to be correlated comparably and complement each other in all grades of CTS. USG, can be considered a preferable screening tool by the patients of CTS due to its painless nature and easy accessibility. It requires minimal time and many a times detects those structural abnormalities which have great therapeutic implications. In mild CTS cases, USG should always be combined with NCS for proper diagnosis as USG might give negative result.

A Comparison of Neuropathy Quality of Life Tools: Norfolk QOL-DN, PN-QOL-97, and NeuroQOL-28

Aims To explore the effectiveness of the Norfolk QOL-DN (QOL-DN), PN-QOL-97, and NeuroQOL-28 as tools for early detection of diabetic peripheral neuropathy in overweight, obese, and inactive (OOI), prediabetes (PD), and type 2 diabetes (T2D) individuals. Methods Thirty-four adults were divided by A1C [(10 OOI, 13 PD, and 11 T2D] and the sural nerves were tested bilaterally via NC-Stat DPN Check, conducting a sural nerve conduction study (NCS). Participants were individually timed, filling out questionnaires (QOL-DN, NeuroQOL-28, and PN-QOL-97) at a self-selected pace. Data were analyzed and compared to NCS findings to determine the best instrument for early neuropathy detection, usability in screening settings, and application for individuals with OOI, PD, and T2D. Results Abnormal NCS results were obtained from 27 individuals, of which 25 were bilateral and symmetrical. Confirmed DSPN criteria were met for 24, and 1 case met criteria for subclinical neuropathy. Normal NCS findings, reported symptoms, and reduced bilateral sensation were found in 7 cases. The QOL-DN and NeuroQOL-28 significantly predict neuropathy criteria in OOI, PD, and T2D subjects. Analyses revealed the QOL-DN as the quickest for completion (M=5.17; SD=1.83), followed by the NeuroQOL-28 (M=5.58; SD=3.56), and the PN-QOL-97 (M=13.23; SD=3.606). Conclusions The QOL-DN and NeuroQOL-28 are valid early screening measures for DPN detection. Time completion studies revealed that the QOL-DN and NeuroQOL-28 may be used as excellent short screening measures, completed in approximately 6 minutes or less, with reasonable scoring for both. The NeuroQOL-28 is a better fit for immediate feedback, time constraints, or limited staff. Future investigations should evaluate these tools for detection in DPN-prone individuals and in subclinical populations screenings.