Clinical Neurophysiology Laboratory Research Articles

Visual evoked potential abnormalities in patients with COVID-19.

It has been suggested that diseases that may cause visual evoked potential abnormality, such as optic neuritis, may be associated with the coronavirus disease 2019. This study aimed to find out whether there are visual evoked potential abnormalities in coronavirus disease 2019 patients using pattern reversal visual evoked potential and flash visual evoked potential. Patients with a history of coronavirus disease 2019 (coronavirus disease 2019 patients) and controls were included in this prospective case-control study. This study was conducted in the Clinical Neurophysiology Laboratory of Adana City Training and Research Hospital. Individuals without visual impairment were included. Coronavirus disease 2019 patients were required to have clinical features consistent with previous acute infection and a positive nose swab polymerase chain reaction test. Visual evoked potential was applied to coronavirus disease 2019 patients between July 2020 and July 2021. Controls consisted of patients without a history of chronic disease who underwent a visual evoked potential study between June 2017 and June 2018 due to headache or dizziness. Pattern reversal visual evoked potential and flash visual evoked potential were applied to all participants. N75, P100, and N135 waves obtained from pattern reversal visual evoked potential and P1, N1, P2, N2, P3, and N3 waves obtained from flash visual evoked potential were analyzed. A total of 44 coronavirus disease 2019 patients and 40 controls were included in the study. Age and gender were not different between the two groups. Pattern reversal visual evoked potential parameters were not different between the two groups. Right P2 latency was 114.4±21.1 and 105.5±14.7 ms in coronavirus disease 2019 patients and controls, respectively (p=0.031). Patients with P100 and P2 wave abnormalities were 6 (13.6%) and 13 (29.6%), respectively. This study showed that there may be visual evoked potential abnormalities in coronavirus disease 2019 patients.

Abdominal electromyograms mining: breathing patterns of asleep adults

The article’s subject matter is the processing of abdominal EMG recordings and finding breathing patterns. The goal is to automatically classify respiratory patterns into two classes, or clusters, by two breathing patterns, regular and irregular, using machine learning (ML) methods. The object of the study was to obtain a dataset of 40 randomly picked abdominal EMG recordings (sampling rate equal to 200 Hz) borrowed from the complete dataset published by the Computational Clinical Neurophysiology Laboratory and the Clinical Data Animation Laboratory of Massachusetts General Hospital. The tasks to be solved are as follows: finding ETS (errors-trend-seasonality) model for the EMG series using the exponential smoothing method; obtaining denoised and detrended signals; obtaining the Hurst exponents for EMGs using the power-law decaying of correlograms for the denoised and detrended signals; describing the variabilities, SNR, the outlier fractions, and Hurst exponents by robust statistics, performing correlation analysis, and Principal Components Analysis (PCA); analyzing the structure of the distant matrix by a graph-based technique; obtaining the periodograms in the frequency domain using the known Wiener-Khinchin theorem; and finding the best models and methods of classification and clusterization and evaluating them within modern Machine Learning methods. The methods used are exponential smoothing, the Wiener-Khinchin theorem, the graph theory method, principal component analysis, programing within MAPLE 2020, and data processing by Weka. The authors obtained the following results: 1) wide data variability has been rated with the median absolute deviations, which is the most robust statistic in this case; 2) most of the signals (38 of 40) showed frequent outliers: from a few percent up to 24.6 % of emissions; 3) these four variables: outliers' percentage, variability, SNR, and persistency factors – form the attributes of input vectors of the subjects for further Machine Learning with Weka software; 4) Manhattan distances matrix among subjects' vectors in 4D attributes space allows imaging the data set as a weighted graph, the vertices of which are subjects; 5) the weights of the graph's edges reflect distances between any pair of them. "Closeness centralities" of vertices allowed us to cluster the data set on two clusters with 11 and 29 subjects, and Weka clustering algorithms confirmed this result. 6) The learning curve shows that a sufficiently small data set (from 25 subjects) might be suitable for classification purposes. Conclusions. The scientific novelty of the results obtained is as follows: 1) the Error-Trend-Seasonality model was the same for all data sets. Abdominal EMG of sleeping patients had additive errors and undamped trends without any seasonality; 2) the correlograms' decaying according to power law had been set, and Hurst exponents were in the range (of 0.776–0.887). This testifies to "long memory" (high persistence) of abdominal EMGs; 3) the modified Z-scores and robust statistics with the highest breakdown values were used for the EMG parameters because of many outliers; 4) breathing patterns were set using the periodograms in the frequency domain using the Wiener-Khinchin theorem; 5) the new graph-based method was successfully exploited to cluster the dataset. Parallel clustering with Weka algorithms confirmed the graph-based clustering results.

ANXIETY AND DEPRESSION IN TYPE 2 DIABETES MELLITUS: A STUDY INCLUDING NERVE CONDUCTION STUDY AND NEUROPATHIC PAIN

Objective: It is known that neuropathy, neuropathic pain and psychiatric disorders are associated with diabetes mellitus (DM). It was aimed to find out whether there is a relationship between nerve conduction study findings, neuropathic pain, depression and anxiety.
 
 Material and Methods: Type 2 DM patients that applied to our clinical neurophysiology laboratory between September 2021 and January 2022 were included in this study. Median, ulnar, sural, peroneal and posterior tibial nerve conduction studies were performed on the patients. Douleur Neuropathique 4 Questions (DN4) was applied to the patients to evaluate neuropathic pain. Hospital Anxiety and Depression Scale (HADS) was applied to the patients. Anxiety (HADS-A) and depression (HADS-S) scores, which are the two subsections of HADS, were included in the analysis.
 
 Results: Forty DM patients (27 males, 13 females) were included in the study. The mean age of the patients was 57.9±12.7 (min-max 23-83) years. The number of patients with neuropathic pain, polyneuropathy according to neurophysiological findings, abnormal HADS-A and HADS-D scores were 32 (80%), 23 (58%), 17 (43%), and 24 (60%), respectively. Neuropathic pain was present in 22 (96%) and 10 (59%) of the patients with and without polyneuropathy, respectively. Neuropathic pain was found in 22 (92%) patients with depression and 16 (63%) patients without depression (p=0.046). Among patients with neuropathic pain, compound nerve action potential amplitudes of median, ulnar and sural nerves were lower than those without neuropathic pain (p=0.011, p=0.027, p

Needle electromyography abnormalities in the upper trapezius muscle in neuromuscular disorders.

: Needle electromyography (EMG) abnormalities in the trapezius muscle (TM) can be seen in neuromuscular disorders. The aim was to determine the characteristics of needle EMG abnormalities observed in the TM in neuromuscular disorders. The data of patients who applied to the Clinical Neurophysiology Laboratory of University of Health Sciences Adana City Training and Research Hospital between December 2018 and October 2021 were reviewed. Polio survivors, amyotrophic lateral sclerosis (ALS) patients, patients with sensorimotor polyneuropathy, patients with spinal cord lesions involving C2/C3/C4 segments, patients with spinal accessory nerve (SAN) lesions, neuralgic amyotrophy (NA) patients, and patients with myopathy were included. Needle EMG findings of the upper TM of the patients were analyzed. Positive sharp waves, fibrillation potentials, fasciculation potentials, myotonic discharges, and motor unit action potential (MUAP) changes were considered needle EMG abnormalities. Eighty-one polio survivors, 23 ALS patients, 39 patients with sensorimotor polyneuropathy, 10 patients with cervical spinal lesions, eight NA patients, seven patients with SAN lesions, and three patients with myopathy were included in the study. Fifteen (65.2%) ALS patients, 18 (22.2%) polio survivors, three (30%) patients with cervical spinal lesions, two (5.1%) patients with sensorimotor neuropathy, one (12.5%) NA patient, seven (100%) patients with SAN lesions, and two (66.7%) patients with myopathies had at least one needle EMG abnormality in the TM. Fasciculation potentials in the TM were seen in 10 (43.5%) ALS patients. In four patients with SAN lesions and one polio survivor, MUAP could not be obtained from the TM. There may be more frequent needle EMG abnormalities, particularly in ALS patients and patients with SAN lesions. Since the number of patients with myopathy included in this study was low, it is difficult to comment on the needle EMG features of the TM for these patients. In addition, this study indicated that fasciculation potentials in the TM are typical in ALS patients and that MUAP may not be obtained from the TM in patients with SAN lesions.

Brain and brain-heart Granger causality during wakefulness and sleep.

In this exploratory study we apply Granger Causality (GC) to investigate the brain-brain and brain-heart interactions during wakefulness and sleep. Our analysis includes electroencephalogram (EEG) and electrocardiogram (ECG) data during all-night polysomnographic recordings from volunteers with apnea, available from the Massachusetts General Hospital’s Computational Clinical Neurophysiology Laboratory and the Clinical Data Animation Laboratory. The data is manually annotated by clinical staff at the MGH in 30 second contiguous intervals (wakefulness and sleep stages 1, 2, 3, and rapid eye movement (REM). We applied GC to 4-s non-overlapping segments of available EEG and ECG across all-night recordings of 50 randomly chosen patients. To identify differences in GC between the different sleep stages, the GC for each sleep stage was subtracted from the GC during wakefulness. Positive (negative) differences indicated that GC was greater (lower) during wakefulness compared to the specific sleep stage. The application of GC to study brain-brain and brain-heart bidirectional connections during wakefulness and sleep confirmed the importance of fronto-posterior connectivity during these two states, but has also revealed differences in ipsilateral and contralateral mechanisms of these connections. It has also confirmed the existence of bidirectional brain-heart connections that are more prominent in the direction from brain to heart. Our exploratory study has shown that GC can be successfully applied to sleep data analysis and captures the varying physiological mechanisms that are related to wakefulness and different sleep stages.

Median amplitude and frequency analysis of sensory nerve responses to intraepidermal stimulation

BackgroundIn clinical practice, small myelinated sensory fibers conveying pain and other sensations, Aδ-fibers, cannot be examined with available nerve conduction study techniques. New methodEquipment available in clinical neurophysiology laboratories is used to record from human sensory nerves multiple averaged responses to non-painful stimulation of intraepidermal nerves. Ten averaged responses are analyzed in all possible pair combinations with an algorithm applied to a 0.45 ms period of amplitude and frequency (power spectrum). The median of the algorithms is compared to control data to identify potentials generated as response to intraepidermal stimulation. ResultsMedian analysis of the algorithm applied to amplitude and frequency of multiple record pairs identifies potentials with conduction velocities of Aδ-fibers. The analysis of frequency (power spectrum) adds data to the analysis of amplitude. Median analysis of multiple record pairs yields more data than analysis of one pair of alternate averages with the same algorithms. Comparison with existing method(s)At present, analysis of one pair of alternate average records with an algorithm is the only method to identify Aδ-fiber generated potentials. Median analysis of the same algorithm applied to the amplitude of multiple record pairs increases the number of Aδ-fiber generated potentials identified. Neither median analysis of amplitude nor frequency of multiple records pairs has ever been used for conduction studies of nerve fibers, including Aδ-fibers. ConclusionsStimulation, recording and data analysis methods used in this study can be applied in the clinical EMG laboratory to identify the conduction velocities of Aδ-fibers in human sensory nerves.

F-wave parameters and body mass index in carpal tunnel syndrome.

BackgroundSevere carpal tunnel syndrome (CTS) readily lends itself to both clinical and electrophysiological recognition. The uncertainty sometimes is in identifying and quantifying motor involvement in mild and, perhaps, in moderate CTS. Our study aimed to evaluate F responses in mild and moderate CTS and determine the contribution of BMI to the F‐wave parameters.MethodsA retrospective review of the clinical and electrophysiological data of patients with CTS seen at the clinical neurophysiology laboratory of Aga Khan Hospital, Dar es Salaam, between 1 August 2017 and 31 July 2019 was retrieved. Carpal tunnel syndrome was graded according to the electrophysiological criteria of Padua. The F‐wave parameters of patients with mild‐to‐moderate CTS were analyzed and compared with asymptomatic controls.ResultWe studied 91 hands. Twenty‐two hands were asymptomatic controls, 30 hands had mild CTS, and 39 hands had moderate CTS. Patients with moderate CTS were more obese (p =.011), had more females (p =.044), and were older (p= <0.001). F‐wave parameters were not convincingly different between mild and moderate CTS. F‐wave chronodispersion (p =.035) and F‐wave persistence (0.019) were significantly different between nonobese control and mild and moderate CTS. Median–ulnar F‐wave latency difference (FWLD) was significant between obese patients with mild CTS and moderate CTS scores (p =.017).ConclusionAlthough a clear difference exists between F‐wave parameters in asymptomatic controls and those with CTS, the F‐wave study is inadequate in distinguishing mild and moderate CTS even in the context of BMI. Median–ulnar F‐wave latency difference (FWLD) appeared to be a promising discriminant parameter between obese patients with mild CTS and those with moderate CTS.

Slowly conducting potentials in human sensory nerves

BackgroundIn clinical practice, small myelinated sensory fibers, Aδ-fibers, conveying mainly pain and temperature sensations, cannot be examined with available nerve conduction study techniques. Currently, these fibers can only be examined with experimental or very specialized and not commonly available nerve conduction techniques, or only indirectly with cerebral evoked potentials. New MethodThis study uses equipment and methods available in clinical neurophysiology laboratories to record from human sensory nerves ≥1000 averaged responses to focal, non-painful stimuli applied by a special electrode to epidermal nerves. The averaged responses to odd numbered stimuli are compared to the averaged responses to even numbered stimuli. An algorithm identifies potentials common in both averages. The 99th and 99.9th percentiles for this algorithm are obtained from control records without stimulation and applied to records with stimulation to identify potentials resulting from stimulation of intraepidermal nerves. ResultsThe algorithm identifies numerous negative and positive potentials as being different from controls at the 99th and 99.9th percentile levels. The conduction velocities of the potentials range from of 1.3–29.9 m/s and are compatible with conduction velocities of Aδ-fibers. Comparison with existing Method(s)No existing methods. ConclusionsThe stimulation, recording and data analysis methods used in this study can be applied in the clinical EMG laboratory to identify Aδ-fibers in human sensory nerves.

Relationship Between Obesity and Severity of Carpal Tunnel Syndrome in Tanzania.

Background: Carpal tunnel syndrome (CTS) is the most common focal mononeuropathy in the general population, and obesity is one of its established independent risk factors The prevalence of obesity in CTS patients and its association with CTS severity are yet to be fully studied among Tanzanians. In this study, we determined the frequency of obesity in patients with CTS and its relationship with the electrophysiological severity of CTS in a Tanzanian private tertiary level hospital. Methods: This is a retrospective observational and analytical study of patients referred for electrodiagnostic (EDX) evaluation of suspected CTS at the clinical neurophysiology laboratory of the Aga Khan Hospital, Dar es Salaam, Tanzania. All EDX studies done for CTS indications between August 1, 2017, and December 31, 2019, were reviewed. The frequency of CTS patients with obesity (body mass index >30 kg/m2) and overweight (25.0-29.9 kg/m2) was determined. Next, we explored the relationship between obesity and the electrophysiologic severity of CTS. Results: One-hundred nine hands were studied. The prevalence of obesity was 50.5% and overweight was 31.2%. Females were significantly more obese than males (P = 0.001). Many of the EDX parameters that defined CTS, including prolonged median nerve sensory and distal motor latencies as well as sensory conduction velocity, were significantly more abnormal in the obese when compared to the nonobese patients. On univariate analysis, severe CTS (stage 5) was commoner among nonobese patients (P = 0.031), while moderate CTS (stage3) was more prevalent among obese patients (P < 0.001). Multivariate regression analysis, however, revealed no effect of obesity on CTS severity (P = 0.490). Conclusion: Obesity and overweight are prevalent among this cohort with CTS, but did not predict severe CTS. The use of other indices of adiposity may show a trend.

Electric source imaging for presurgical epilepsy evaluation: current status and future prospects

ABSTRACTIntroduction: Electric source imaging (ESI) refers to the estimation of the cerebral sources of electric signals recorded at the head surface using electroencephalography (EEG). Thanks to the availability of EEG systems with high numbers of electrodes and to progress in software to analyze the signals they collect, ESI can be applied to epilepsy-related pathological EEG signals like interictal spikes and seizures.Areas covered: In this narrative review, we discuss selected original research articles on the use of ESI in epilepsy patients considered for surgery. Epilepsy-related activity can be localized accurately using ESI, as established by comparison to the gold standards of intracranial EEG and seizure control following epilepsy surgery. The information brought by ESI complements successfully that of other techniques like magnetic resonance imaging and positron-emission tomography, and is clinically relevant to patient management.Expert opinion: EEG is a readily available technique to measure brain activity in real time. Given its accuracy and usefulness, ESI should become part of the routine practice of clinical neurophysiology laboratories and epilepsy centers in the presurgical management of epilepsy patients.

Electrodiagnostic (EDX) Predictors of Sensory Neuropathy in Primary Hypothyroidism and its Association with Age and Body Mass Index (BMI): A Cross Sectional Study

Background: Sensory neuropathy occurs in hypothyroidism often early as compared to motor. Involvement of median and sural nerve is reported earliest in literature. There is controversial electrophysiological data with respect to predictors of neuropathy and its association with age and body mass index. Objectives: Present study was aimed to find out EDX predictors of sensory neuropathy and its association with age and BMI in primary hypothyroidism patients. Materials and Method: Total 28 out of 39 hypothyroid cases referred to clinical neurophysiology laboratory were selected for analysis. These cases satisfied the biochemical and EDX criteria. Percentages of abnormalities in different variables of nerve conduction study were calculated. Also coefficient of correlation between age, BMI and different variables evaluated for association between them if any. Results: Study population was having age range from 23-75 years, 15 female and 13 male. Female preponderance was observed. Correlation between Age, BMI and different variables of NCV were statistically not significant. Sensory conduction velocity was most common abnormality observed (49%), followed by SNAP amplitude (42%) and onset latency (25%). Conclusion: We concluded that age and BMI have no effect on occurrence of neuropathy in primary hypothyroidism. Sensory Conduction velocity was most common predictor of sensory neuropathy in these cases.

The Value of Inter Ictal EEG in the Diagnosis of Epilepsy at the Clinical Neurophysiology Laboratory of FANN Teaching Hospital of Dakar

Introduction: The diagnosis of epilepsy is mainly based on clinical features. Electroencephalography (EEG) is mainly essential on classifying epilepsy and epileptic syndromes. Our purpose is to demonstrate EEG has a role in setting the diagnosis of epilepsy. Method: We have studied the EEG of 775 patients of all age-groups registered in the EEGs laboratory of Fann Teaching hospital from July 1^st to November 15^th 2018. We included all patients not previously known with epilepsy. The EEGs conclusion were taken from the digital database. We have split them into two groups EEG abnormal versus EEG normal. The statistical analyzes were made by Epi Info 7.2.3.1. Results: The median age was 14 years old. The patient age range was from 38 days to 86 years. Patients with abnormal EEG were at 38% of the total. After univariate study were significantly associated with an abnormal EEG patients who came for focal onset crisis (74%) and those who came for spasm (84%). All with status epilepticus had abnormal EEG. Patients with generalized crises had an abnormal EEG in 60% but that was not significant. Diagnosis seek by pediatrician was significantly associated abnormal EEG. Conclusion: EEG is a very affordable test which plays a key role on the diagnosis of epilepsy. It sensitivity is closely linked with the experience of the ordering physician. Broad awareness of epilepsy among healthcare professionals and the community would be an important step in improving patient’s management.

Pediatric Montages in Clinical Practice.

The montages in clinical EEG recordings in neonates, infants, and children follow some basic principles of adolescent or adult EEG recordings; however, special considerations are needed to obtain optimal diagnostic yield in pediatric patients. The aim of this review is to summarize the pediatric montages recommended in clinical practice in the standard clinical neurophysiology laboratory and in special situations.

Vestibulo masseteric reflex and acoustic masseteric Reflex. Normative data and effects of age and gender

ObjectiveTo provide normative data for the Vestibulo-Masseteric Reflex (VMR) and Acoustic-Masseteric Reflex (AMR) in healthy subjects, stratified for age and gender. MethodsA total of 82 healthy subjects (M:F 43:39, mean age 39.3 ± 18.4 years, range 13–79 years) underwent recording of click-evoked VMR and AMR (0.1 ms duration, 5 Hz frequency) from active masseter muscles. Masseter responses to uni- and bilateral stimulation were recorded in a zygomatic and a mandibular configuration, according to the position of the reference electrode. Stimulation intensity curves were recorded for each reflex in ten subjects (mean age 20.7 ± 8.1 years). Gender effect was investigated in 62 subjects and age effect was analyzed in six 10-subject groups aged from <25 to >65 years. Onset and peak latencies, interpeak intervals, raw and corrected amplitudes, latency and amplitude asymmetries were analyzed. ResultsVMR had a higher elicitation rate than AMR. For both reflexes, rates of elicitation, and corrected amplitudes were higher in the zygomatic configuration, and bilateral stimulation elicited larger responses. Best acoustic ranges of elicitation were 98–113 dB for AMR and 128–138 dB for VMR. Reflex latencies were shorter in females than males. Frequency and amplitude of VMR and AMR decreased substantially over 55 year olds. ConclusionsVMR and AMR can be easily performed in any clinical neurophysiology laboratory. SignificanceThese reflexes can find application in the investigation of brainstem function in central neurological disorders.

Chapter 21 - Clinical neurophysiology of cranial nerve disorders

Electrophysiologic techniques are available to measure many of the cranial nerves. The procedures can be done using equipment available in standard clinical neurophysiology laboratories. These studies can aid in localization of cranial nerve lesions as well help identify the underlying pathology and possibly aid in prognosis. The trigeminal pathways can be measured using the blink and masseter responses. The facial nerve is measured by the blink response and by direct facial stimulation; techniques such as lateral spread can identify specific abnormalities. The spinal accessory nerve is measured using nerve conduction techniques. Needle examination can be routinely performed on muscles innervated by cranial nerves V, VII, X, XI and XII. These studies reliably measure the functional integrity of cranial nerves and their central pathways. Intraoperative monitoring of the cranial nerves is useful in certain surgeries. This chapter reviews current techniques used to evaluate cranial nerves, emphasizing the methods available in most clinical neurophysiology laboratories.

S02. The diagnostic and prognostic yield of long term EEG in a developing country

Continuous Electroencephalography Monitoring (c EEG) is routinely used in the intensive care units (ICU) to detect, evaluate and prognosticate. cEEG monitoring has only recently been adopted in Saudi Arabia and data with regards to its diagnostic and prognostic yields are still lacking. This study aims to report such data in a single tertiary care center in Saudi Arabia during the initial year after establishment of the cEEG program. The authors retrospectively identified all patients who underwent cEEG recording in adult surgical and medical ICUs at a tertiary care center in the 12-month time period from June 2016 to June 2017. These EEGs were retrieved from the records of the clinical neurophysiology laboratory. Continues EEG duration from 6 h to several days. Shorter EEGs were excluded. The medical records were reviewed to obtain data with regards to the diagnosis, duration of hospitalization, duration of ICU stay, neuroimaging findings and mortality. Descriptive and correlational statistics were then used to describe the yield of cEEGs. 101 cEEGs were performed during the study period. The most frequent diagnosis was ischemic stroke, followed by epilepsy, and sepsis. All cEEGs were abnormal. Forty-six percent showed epileptiform abnormalities. Electrographic seizures were seen in 10%. Periodic patterns were seen in 20% of cases. Rhythmic patterns were seen in 17%. There was a significant association between having an epileptifrom EEG and mortality at 3 and 6 months, as well as longer hospital stay (p < 0.05). In this first study of cEEG in Saudi Arabia using the ACNS nomenclature of EEG reporting, ICU EEG evidence of epileptiform abnormalities and seizures was helpful in guiding management and predicting mortality. Limitations and difficulties associated with this early phase of establishing cEEG in the ICU as well as patient selection may contribute to the relatively low incidence of seizures.

P349 Assessment of prevalence and risk factors for carpal tunnel syndrome in polio survivors

Objective Carpal tunnel syndrome (CTS) is a commonly reported nerve entrapment syndrome in patients with chronic physical disabilities. It causes disability independent of underlying disease. In this study, we aimed to identify prevalence and risk factors for CTS in polio survivors. Methods Based on clinical and electrophysiological findings, 46 patients with prior paralytic poliomyelitis were selected from patients referred to clinical neurophysiology laboratory. The CTS was classified according to the severity of nerve conduction (NC) changes. Demographic factors, medical history, crutch or cane use, post-polio syndrome,body mass index (BMI), wrist index and Barthel index were compared between the polio survivors with CTS (CTS group) and without CTS (non-CTS group). A logistic regression analysis was conducted to evaluate odds ratio of different risk factors. Results Prevalence of CTS confirmed by NC studies in polio survivors was 43.4% (20 patient). Eighteen (45%), 12 (30%) and 2 (%5) hands had mild, moderate and severe CTS, respectively. The age, BMI and wrist index were higher in the CTS group than in the non-CTS group (p Discussion Our study confirms a high occurrence of CTS in polio survivors. Conclusions Body mass index may be associated with prevalent CTS in polio survivors. Significance Prevention of weight gain in polio survivors may reduce the risk of CTS.

Neurocognitive rehabilitation for addiction medicine: From neurophysiological markers to cognitive rehabilitation and relapse prevention.

Currently, relapse prevention remains the main challenge in addiction medicine, indicating that the established treatment methods combining psychotherapy with neuropharmacological interventions are not entirely effective. Therefore, there is a push to develop alternatives to psychotherapy- and medication-based approaches to addiction treatment. Two major cognitive factors have been identified that trigger relapse in addicted patients: attentional biases directed toward drug-related cues, which increase the urge to consume, and impaired response inhibition toward these cues, which makes it more difficult for addicted people to resist temptation. Recent studies on newly detoxified alcoholic patients have shown that by using the appropriate tasks to index these cognitive functions with event-related potentials (ERPs), it is possible to discriminate between future relapsers and nonrelapsers. These preliminary data suggest that the ERP technique has great clinical potential for preventing relapse in alcohol-dependent patients, as well as for addictive states in general. Indeed, ERPs may help to identify patients highly vulnerable to relapse and allow the development of individually adapted cognitive rehabilitation programs. The implementation of this combined approach requires an intense collaboration between psychiatry departments, clinical neurophysiology laboratories, and neuropsychological rehabilitation centers. The potential pitfalls and limitations of this approach are also discussed.

Brainstem auditory evoked responses in an equine patient population: part I--adult horses.

BackgroundBrainstem auditory evoked response has been an underused diagnostic modality in horses as evidenced by few reports on the subject.Hypothesis/ObjectivesTo describe BAER findings, common clinical signs, and causes of hearing loss in adult horses.AnimalsStudy group, 76 horses; control group, 8 horses.MethodsRetrospective. BAER records from the Clinical Neurophysiology Laboratory were reviewed from the years of 1982 to 2013. Peak latencies, amplitudes, and interpeak intervals were measured when visible. Horses were grouped under disease categories. Descriptive statistics and a posthoc Bonferroni test were performed.ResultsFifty‐seven of 76 horses had BAER deficits. There was no breed or sex predisposition, with the exception of American Paint horses diagnosed with congenital sensorineural deafness. Eighty‐six percent (n = 49/57) of the horses were younger than 16 years of age. The most common causes of BAER abnormalities were temporohyoid osteoarthropathy (THO, n = 20/20; abnormalities/total), congenital sensorineural deafness in Paint horses (17/17), multifocal brain disease (13/16), and otitis media/interna (4/4). Auditory loss was bilateral and unilateral in 74% (n = 42/57) and 26% (n = 15/57) of the horses, respectively. The most common causes of bilateral auditory loss were sensorineural deafness, THO, and multifocal brain disease whereas THO and otitis were the most common causes of unilateral deficits.Conclusions and Clinical ImportanceAuditory deficits should be investigated in horses with altered behavior, THO, multifocal brain disease, otitis, and in horses with certain coat and eye color patterns. BAER testing is an objective and noninvasive diagnostic modality to assess auditory function in horses.

Brainstem auditory evoked responses in an equine patient population. Part II: foals.

BackgroundReports of the use of brainstem auditory evoked response (BAER) as a diagnostic modality in foals have been limited.Hypothesis/ObjectivesTo describe BAER findings and associated causes of hearing loss in foals.AnimalsStudy group 18 foals (15 neonatal, 3 nonneonatal), control group (5 neonatal foals).MethodsRetrospective. BAER records from the Clinical Neurophysiology Laboratory were reviewed from the years of 1982 to 2013. Peak latencies, amplitudes, and interpeak intervals were measured when visible. Clinical data were extracted from the medical records. Foals were grouped under disease categories. Descriptive statistics were performed.ResultsTen neonatal foals had complete absence of BAER bilaterally and 5 had findings within reference range. Abnormalities were associated with common neonatal disorders such as sepsis, neonatal encephalopathy, neonatal isoerythrolysis, and prematurity. BAER loss also was observed in foals with specific coat color patterns such as completely or mostly white with blue irides or lavender with pale yellow irides. An American Miniature foal with marked facial deformation also lacked BAER bilaterally. One nonneonatal foal with an intracranial abscess had no detectable BAER peaks bilaterally, and 2 older foals, 1 with presumed equine protozoal myeloencephalitis and the other with progressive scoliosis and ataxia, had BAER within normal limits.Conclusions and Clinical ImportanceIn neonatal foals, BAER deficits commonly are complete and bilateral, and associated with common neonatal disorders and certain coat and eye color patterns. Sepsis, hypoxia, bilirubin toxicity, and prematurity should be investigated as potential causes of auditory loss in neonatal foals.