Distal Motor Latency Research Articles

Prevalence and the Influence of Trapeziometacarpal Osteoarthritis on Patients with Carpal Tunnel Syndrome.

Background: The coexistence of carpal tunnel syndrome (CTS) and trapeziometacarpal (TMC) osteoarthritis have been previously described. The influence of TMC osteoarthritis in the outcomes of CTS surgery is yet to be elucidated. The purpose of this study is to examine the prevalence of TMC osteoarthritis in patients who underwent open carpal tunnel release (OCTR) and to analyse the influence of osteoarthritis on the postoperative outcomes of CTS. Methods: We retrospectively reviewed 134 procedures on 113 patients who underwent OCTR between 2002 and 2017. The presence of TMC osteoarthritis was based upon preoperative plain radiograph. For the evaluation of CTS, pre- and postoperative muscle power of abductor pollicis brevis (APB) muscle by manual muscle testing (MMT) and distal motor latency (DML) detected on the APB muscle was examined. Results: The mean follow-up period was 11.4 months. The prevalence of radiographic TMC osteoarthritis was 40% in patients who underwent OCTR. In electrophysiological study, the mean pre- and postoperative DML showed no statistical difference regardless of the coexistence of TMC osteoarthritis. However, there was a significantly higher incidence of poorer muscle strength of the APB in patients with TMC osteoarthritis. No patients complained of TMC joint pain prior to OCTR, but four cases developed TMC joint pain during the postoperative follow-up period, all of whom had full recovery of APB muscle strength. Conclusions: The presence of asymptomatic TMC osteoarthritis may affect the postoperative outcomes of OCTR, so preoperative evaluation of TMC osteoarthritis should be considered in patients undergoing OCTR. In addition, the symptoms of TMC osteoarthritis may worsen in some patients after CTS surgery and should be taken into consideration during the postoperative follow-up. Level of Evidence: Level IV (Therapeutic).

Median to ulnar nerve comparison on diagnosis of carpal tunnel syndrome in patients with diabetic polyneuropathy - A neurophysiological study.

<p style="text-align: justify;"><strong>Background and purpose </strong>&ndash; To analyze the utility of median nerve (MN) to ulnar nerve (UN) comparative parameters on the diagnosis of carpal tunnel syndrome (CTS) in diabetic patients with distal symmetrical sensorimotor polyneuropathy (DSMPNP). <br><br><strong>Methods</strong> &ndash; Patients who were referred to our electroneuromyography laboratory within the last two years were included. We compared the diagnostic accuracy values of traditional MN conduction parameters, and the MN-to-UN comparative tests on electrodiagnosis of CTS between the patients with DSMPNP involving the nerves of upper and lower extremities (UEI-positive group), and the ones without the involvement of upper extremities (UEI-negative group). <br><br><strong>Results</strong> &ndash; There were 64 upper extremities in the UEI-positive group and 70 patients in the UEI-negative group. The most accurate traditional parameter was MN distal motor latency (DML) with a diagnostic accuracy of 70.2% whereas the most accurate comparative technique was the second lumbricalinterosseous DML difference (2L-INT DMLD) with an accuracy of 81.3%. (p=0.03). In addition, when compared diagnostic accuracy values of MN parameters with their corresponding comparative parameters in the UEI-positive group which carries the major diagnostic challenges for detecting co-morbid CTS, MN to UN minimum F wave latency (mFWL) difference, SNAP amplitude ratio on the ring finger (RF), and 2L-INT DMLD had higher accuracy values than MN mFWL, MN SNAP amplitude on RF, and MN DML on lumbrical muscle, respectively (p&lt;0.05 for all comparisons). <br><br><strong>Conclusion</strong> &ndash; MN to UN comparative studies have high accuracy values in electrodiagnosis of CTS in DSMPNP. In particular, 2L-INT DMLD could be helpful to overcome the diagnostic difficulty in the presence of UEI as an additional conduction technique.</p>.

Role of distal motor latency (M), F-wave latency (F), and M/F ratio in type-II diabetes mellitus

Background: Diabetic neuropathy is a common complication of diabetes mellitus and early diagnosis is crucial to prevent its progression. Aims and Objective: This study aimed to assess the distal motor latency (DML), F-wave latency, and M/F ratio in type-II diabetic patients. Materials and Methods: It was a cross-sectional study with comparison group conducted in the department of neurology in collaboration with the department of physiology in a tertiary care hospital. A total of 120 diagnosed patients were enrolled in this study. A thorough clinical evaluation, including neurological examinations, assessment of neuropathic symptoms, and relevant biochemical tests, were done in all participants. Nerve conduction studies were performed to measure DML and F-wave latency, whereas the M/F ratio was calculated for each participant. Results: Based on the findings, 66 patients had no signs or symptoms of neuropathy and were considered the control group whereas 54 patients having signs and symptoms of neuropathy were considered cases. The results were compared in both the groups (diabetic patients without neuropathy as control and diabetic patients with neuropathy as cases). The results of this study showed significantly prolonged DML and F-wave latency in diabetic patients with neuropathy (cases) as compared to the control group (P &lt; 0.05). In addition, the M/F ratio was significantly lower in diabetic patients with neuropathy compared to controls (P &lt; 0.05). Conclusion: These non-invasive nerve conduction parameters can aid in the early detection of neuropathic changes in diabetic patients, allowing for timely intervention and improved management of the condition.

Multisequence magnetic resonance neurography of brachial and lumbosacral plexus in chronic inflammatory demyelinating polyneuropathy: correlations with electrophysiological parameters and clinical features

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare and challenging demyelinating disorder. It is necessary to increase our understanding of potential connections between imaging, electromyography, and clinical characteristics. The aim of this study was to evaluate the relationships between multisequence magnetic resonance neurography (MRN) findings, electrophysiological parameters, and clinical characteristics in CIDP patients. A cross-sectional study. Overall, 51 CIDP patients underwent MRN of the brachial and lumbosacral plexus, and nerve conduction studies. The inflammatory Rasch-built overall disability scale (I-RODS) questionnaire, CIDP disease activity status (CADS) scale, and muscle strength scores were evaluated by two neurologists. Electrophysiological parameters, clinical information, and multiparameter-MRN were analyzed for correlations. Multiparameter-MRN includes diameter, nerve-to-muscle T2 signal intensity ratio (nT2), contrast-enhanced ratio (CR), fractional anisotropy (FA), and apparent diffusion coefficient (ADC) of bilateral plexus nerve roots. Electrophysiological parameters that were not elicited were significantly higher in the lower extremities than in the upper extremities, and those were higher in sensory nerve conduction than in motor. There were moderate correlations between motor nerve conduction velocity and distal motor latency in nerve diameter, nT2, FA, and ADC, respectively (|r|, 0.45-0.64, p < 0.05). The correlations between CR and sensory nerve conduction velocity and peak latency were moderate, and ADC had a positive correlation with compound motor action potential amplitude (|r|, 0.45-0.63). FA correlated negatively with the course (r = -0.62) and cerebrospinal fluid (CSF) protein (r = -0.41), whereas ADC had correlated positively with CSF protein (r = 0.34). Only CR had a moderately negative correlation with CADS (r's = -0.57). Muscle strength in all extremities was positively correlated with FA (r's range, 0.41-0.49). There was no significant correlation between I-RODS scores and multiparameter-MR. MRN-derived multiparameter [nerve size, nT2, and diffusion tensor imaging (DTI) parameters] could serve as quantitative biomarkers of myelin sheath integrity in CIDP. DTI parameters and CR correlated with clinical characteristics better than morphological parameters-MR for CIDP patients.

Electrophysiology of ataxia-telangiectasia-like disorder 1.

Ataxia-telangiectasia-like disorder-1 (ATLD1, OMIM # 604391) is a very rare clinical condition, characterized by slowly progressive ataxia with onset in childhood, associated with oculomotor apraxia and dysarthria. Laboratory findings reveal increased susceptibility to radiation, with a defect in DNA repair. Patients with ATLD1 show no telangiectasia, have no immunodeficiency, and also have preserved cognition. Reflexes might be initially brisk and later becomes reduced associated with axonal sensorimotor neuropathy. Brain magnetic resonance imaging (MRI) detects cerebellar atrophy. The condition is caused by mutations in the meiotic recombination 11 (MRE11A) gene. The present study reports on the neurophysiologic finding in eight Saudi patients, belonging to three Saudi families, who have genetically confirmed ATLD1. All investigated patients had cerebellar atrophy on brain MRI (5/5). Electrophysiologic studies showed normal motor conduction velocity (MCV) of the median (8/8) and tibial (2/2) nerves, while 5/6 (83%) had normal peroneal nerve MCV. The distal motor latency (DML) for median, tibial, and peroneal nerves was within the normal range in all examined patients. The amplitude of compound muscle action potential (CMAP) of median and tibial nerves was also normal, while that of the peroneal nerve was normal in 3/6 (50%). Two of seven (29%) patients had reduced amplitude of median nerve sensory nerve action potential (SNAP) while 3/8 (38%) had a reduction in the amplitude of sural nerve SNAP. These findings favour an axonal type of neuropathy predominately affecting the sensory fibres (axonal sensorimotor neuropathy). The present study constitutes the largest cohort of ATLD1 patients worldwide who had electrophysiologic tests.

The effect of aging on nerve conduction study of median nerve and ulnar nerves in healthy individuals

Background: Nerve conduction studies (NCS) are known to be influenced by various physiological and environmental factors. Region and population-specific normative reference values of NCS required for comparison and evaluation of results have been published in many research studies but the age-group-specific significant pattern of reference values is not available for the same. Researchers have agreed that results are variable by chronological age, the present study was carried out to determine the effect of aging on nerve conduction velocity (NCV) of two commonly tested median and ulnar nerves of upper limb in individuals of different age groups. Furthermore, the motive was to collect reference data that can be used during clinically significant diagnostic testing of nerves. Aims and Objectives: The study aimed to study the effect of aging on nerve conduction velocities of the median and ulnar nerve, as well as to observe the correlation of age and changes in NCS of the median and ulnar nerve. Materials and Methods: A cross-sectional (observational) study was conducted on 110 healthy individuals (count of males-60, females-50). The subjects for the study were taken up amongst the volunteers (medical students, teaching and nonteaching staff members in the Government Medical College and Rajindra Hospital, Patiala, and healthy volunteers who were willing to participate in the study). The subjects were grouped according to their age: Group I (18–30 years) (n = 38), Group II (31–45 years) (n = 38), and Group III (46–60 years) (n = 34). The motor and sensory distal latencies, amplitudes, and NCVs of median and ulnar nerves were recorded, and data were evaluated. Results: The mean and standard deviation of the median and ulnar nerve was studied for latencies, amplitude, and velocities for both sensory and motor components. Patients with older age had longer latencies (median: Motor and sensory P &lt; 0.001, ulnar: Motor = 0.013 and sensory = 0.006), smaller amplitudes (median: Motor P = 0.013 and sensory &lt;0.001, ulnar: Motor P = 0.014, and sensory = 0.008), and slower conduction velocities (median: Motor P &lt; 0.001 and sensory = 0.006, ulnar: Motor P = 0.003 and sensory = 0.069) compared with the younger age group, and the change was well observed in the age group of ≥46 years. The change with age was greater in sensory nerve conduction of the median and ulnar nerves. Conclusion: Our study results demonstrate that age is significantly correlated with all three nerve conduction parameters recorded from both nerves. An age-matched comparison of the results obtained during routine testing should be made to increase the diagnostic sensitivity of NCS.

Electrophysiologic Characteristics of Nitrous-Oxide-Associated Peripheral Neuropathy: A Retrospective Study of 76 Patients

The electrophysiologic characteristics of peripheral neuropathy secondary to nitrous oxide (N2O) abuse remain unclear. The paper therefore aimed to summarize the electrophysiologic characteristics of N2O-associated peripheral neuropathy and identify the risk factors of severe nerve injury. The electrophysiologic results and clinical data of patients with peripheral neuropathy secondary to N2O abuse at our hospital between 2018 and 2020 were analyzed retrospectively, and their electrophysiologic changes were summarized. Most patients exhibited decreased sensory and motor nerve conduction velocities (75% and 76%), decreased sensory nerve and compound motor action potentials (57% and 59%), and prolonged distal motor latency (59%), while a response was absent in 36%. These findings indicate that N2O abuse can result in generalized injury to sensory and motor nerves. Electrophysiologic results indicated axonal neuropathy in 37 cases (49%), demyelinating peripheral neuropathy in 4 (5%), and mixed neuropathy in 12 (16%). Peripheral nerve injury was more common in the lower limbs (72%) than in the upper limbs (42%, p<0.0001). The upper and lower limbs were primarily affected by sensory nerve demyelination (35%) and motor axonal injury (67%), respectively. Subgroup analysis indicated that longer N2O exposure and longer disease course were associated with more-severe motor axonal injury in the lower limbs. N2O-associated peripheral neuropathy can lead to sensory and motor nerve injury, with axonal injury being the most common. Injuries were more severe in the lower limbs. Prolonged N2O exposure and disease course increased the severity of motor axonal injury in the lower limbs.

Effectiveness of an Endoscopic Recurrent Branch Release Procedure Combined with Standard Endoscopic Carpal Tunnel Release Surgery Compared to Standard Endoscopic Carpal Tunnel Release Surgery Alone: A Propensity Score-Matched Study

Background: The purpose of this study is to compare the effectiveness of endoscopic release of the recurrent branch from surrounding soft tissue in combination with standard endoscopic carpal tunnel release (ECTR) surgery to standard ECTR surgery alone in patients with established abductor pollicis brevis (APB) muscle weakness. Methods: Using propensity score matching, we compared the recovery rates of postoperative clinical symptoms in patients with idiopathic carpal tunnel syndrome in whom the preoperative Medical Research Council (MRC) scale of the APB muscle (MRC-APB) was zero (no contraction) and with undetectable distal motor latency (DML) of APB, to those who underwent standard ECTR surgery alone and those who underwent recurrent branch release in addition to standard ECTR. Results: Forty-nine hands in the recurrent branch release group and 49 hands in the standard ECTR surgery group were extracted. There were statistically significant differences in postoperative recovery rate from MRC-APB 0 to '4 or 5' at 30 months (OR: 2.42; 95% CI: 1.03-5.67; p = 0.04) and at final follow-up (OR: 2.64; 95% CI: 1.11-6.26; p = 0.03). There were statistically significant differences in postoperative recovery of MRC-APB scales at 24 months (p = 0.03), 30 months (p = 0.02) and at final follow-up (p = 0.02). There were statistically significant differences in postoperative recovery of DML (p = 0.04). Conclusions: Endoscopic release of the recurrent branch in combination with standard ECTR surgery showed better recovery rates in MRC-APB and DML recovery compared to standard ECTR surgery alone. Level of Evidence: Level III (Therapeutic).

Scapular winging due to rhomboid muscle paralysis: clinical assessment of 4 cases and anatomic study of the dorsal scapular nerve.

A rare cause of scapular winging is rhomboid muscle paralysis secondary to dorsal scapular nerve (DSN) neuropathy. This paralysis causes winging of the medial border of the scapula with lateral rotation of its inferior angle. We report a series of 4 clinical cases of isolated DSN compression and the results of a specific rehabilitation protocol. A continuous clinical series of 4 patients with isolated rhomboid muscle deficiency was analyzed. Two patients were men and 2 were women, with a mean age of 40years (range, 33-51years). Three patients were right-handed and 1 was left-handed. Scapular winging always affected the dominant side. Two patients had occupations involving heavy physical work. The sports practiced involved exertion of the arms (dancing, boxing, gymnastics, muscle strengthening). A specific rehabilitation protocol was offered to the patients. In addition, 6 fresh cadaver dissections were performed to reveal possible DSN compression. Potential areas of compression were identified, in particular when the arm was raised. The 4 patients presented with isolated DSN neuropathy were confirmed by electroneuromyographic testing. Total correction of scapular winging was not obtained in any patient. Three patients experienced residual pain with a neuropathic pain by the questionnaire for a Diagnosis of Neuropathic Pain (DN4) score of 2. The mean Quick-Disabilities of the Arm, Shoulder and Hand (DASH) score after treatment was 31.8 of 100. The mean ASES score was 56.2. Only 1 patient agreed to rehabilitation in a specialized center and underwent follow-up electroneuromyography. Signs of rhomboid muscle denervation were no longer present and distal motor latencies had become normal. In all cadaver dissections, the DSN originated from the C5 nerve root and did not pass through the middle scalene muscle. We identified a site of dynamic compression of the DSN by the upper part of the medial border of the scapula when the arm was raised. DSN compression is conventionally attributed to the middle scalene muscle, but it is noteworthy that our study reveals the possibility of dynamic compression of the nerve by the proximal part of the medial border of the scapula, which occurs when the arm elevation is above 90°. Our study reveals the possibility of dynamic compression of the DSN by the proximal part of the medial border of the scapula, which occurs when the arm is raised above 90°. In the absence of a surgical solution, conservative treatment is fundamental and requires management in a rehabilitation center with intervention by a multidisciplinary team.

Characterization of the patients with antibodies against nodal-paranodal junction proteins in chronic inflammatory demyelinating polyneuropathy

ObjectiveAntibodies against nodal-paranodal junction proteins have been detected in some patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), which is a crucial step to define the most effective treatment strategies. In this paper, we tested the positive rates of these antibodies in CIDP and characterized the clinical and electrophysiological features of the antibodies-positive patients. MethodsWe prospectively recruited 47 patients with CIDP. We detected IgG antibodies against human neurofascin-155 (NF155), neurofascin-186 (NF186), contactin-1 (CNTN1), contactin-2 (CNTN2) and contactin-associated protein-1 (Caspr1), and identified the IgG isotype with cell-based assay (CBA). We collected the demographic, clinical, laboratory, and electrophysiological information of the patients that were seropositive. ResultsFive patients (10.6 %) had IgG against NF155, 3 (6.4 %) against Caspr1, 2 (4.3 %) against NF186 and 1 (2.1 %) against CNTN1. All the 11 antibody-positive patients (8 males and 3 females) presented with typical clinical features. Five of them needed assistance in walking, 5 had cranial nerve impairments and 3 had autonomic disturbances. The age at onset of the patients that were anti-NF155-positive was younger (19.60 ± 9.02 years vs. 55.33 ± 11.93 years, P = 0.003) than those that were anti-Caspr1-positive. No significant difference in the functional status was observed between these two groups. The action potentials of 11/79 (13.9 %) motor nerves and 62/93 (66.7 %) sensory nerves exhibited no response. Moreover, 16/68 (23.5 %) nerves presented conduction block and 13/68 (19.1 %) nerves presented temporal dispersion. Distal motor latency (DML) of ulnar nerve and tibial nerve tended to be longer (p = 0.008 and p = 0.006, respectively) in anti-NF155-positive patients than that in anti-Caspr1-positive patients. Of the 11 patients that were antibody-positive patients, corticosteroids were effective in 3/7 (42.9 %), intravenous immunoglobins (IVIG) were effective in 1/7 (14.3 %), and rituximab was effective in 6/8 (75.0 %). ConclusionsOur findings validate the previous observation on the clinico-serological correlation between CIDP and antibodies against nodal-paranodal proteins. Of note, the damage on nerves is more severe in anti-NF155-positive patients than that in anti-Caspr1-positive patients during electrophysiological diagnosis.

Carpal tunnel syndrome in rheumatoid arthritis patients: the role of combined ultrasonographic and electrophysiological assessment

BackgroundCarpal tunnel syndrome (CTS) is known as one of the most common neurological extra-articular manifestations in rheumatoid arthritis (RA) patients. Studies on CTS in RA depend mostly on electrophysiological assessment. Few studies have used ultrasonography for evaluation of the local causes with much focus on wrist arthritis and tenosynovitis as the main cause of entrapment neuropathy of the median nerve in RA. The aim of our study is to assess the local causes of carpal tunnel syndrome in rheumatoid arthritis patients by ultrasonography and whether inflammatory or anomalous variations could affect decision-making and patient management.ResultsCarpal tunnel syndrome was diagnosed in 71 out of 74 examined RA wrists by nerve conduction studies (NCSs) and was categorized from minimal to severe according to Padua et al.’s (Ital J Neurol Sci 18:145–50, 1997) grading criteria. Median nerve CSA at the level of the carpal tunnel inlet and flattening ratio showed statistically significant relation with CTS severity. Bifid MN was found in 20 wrists (10 mild CTS wrists and 10 moderate CTS wrists), a persistent median artery was found in 4 wrists with moderate CTS, and an accessory muscle bundle was present in 3 wrists (2 mild CTS and 1 moderate CTS). The majority of the examined hands (85.1%) showed flexor tendon tenosynovitis at the wrist level and radio-carpal joint synovitis. The US7-joint score using GSUS7 & PDUS7 for synovitis, tenosynovitis and erosions showed significant relation with patients’ disease activity by DAS28 score. Significant relations between CTS severity and the following nerve conduction studies’ parameters, median nerve distal motor latency (DML), motor/sensory NCV, peak sensory latency, amplitude of SNAP, and median-radial latency difference test, were observed.ConclusionSynovial inflammation and local causes of median nerve compression such as bifid median nerve, persistent median artery, and accessory muscle bundle are collectively contributing factors in the etiology of carpal tunnel syndrome in rheumatoid arthritis patients. Ultrasonographic visualization of these inflammatory and anomalous variations enables early detection of CTS and highlights the possibility of non-arthritic-related causes. Using the 7-joint ultrasound (US7) score for assessment of synovitis, tenosynovitis, and erosions in rheumatoid arthritis patients is of valuable role in reflecting inflammation and its relation to the development of CTS in RA patients.

Neurophysiological Hallmarks of Axonal Degeneration in CIDP Patients: A Pilot Analysis.

In this work, we aim to identify sensitive neurophysiological biomarkers of axonal degeneration in CIDP patients. A total of 16 CIDP patients, fulfilling the clinical and neurophysiological criteria for typical CIDP, treated with subcutaneous immunoglobulin (ScIg) (0.4 g/kg/week) were evaluated at baseline (before ScIg treatment) and after long-term treatment with ScIg (24 months) by clinical assessment scales, nerve conduction studies (NCS) and electromyography (EMG). Conventional and non-conventional neurophysiological parameters: motor unit potential (MUP) analysis, MUP thickness and size index (SI)] and interference pattern (IP) features were evaluated after long-term treatment (24 months) and compared with a population of 16 healthy controls (HC). An increase of distal motor latency (DML) and reduced compound motor action potential (CMAP) amplitude and area in CIDP patients suggest axonal damage of motor fibers, together with a significant increase of MUP amplitude, duration and area. Analysis of non-conventional MUP parameters shows no difference for MUP thickness; however, in CIDP patients, SI is increased and IP area and amplitude values are lower than HC. Despite clinical and neurophysiological improvement after ScIg treatment, neurophysiological analysis revealed axonal degeneration of motor fibers and motor unit remodeling. Correlation analysis shows that the axonal degeneration process is related to the diagnostic and therapeutic delay. MUP area and SI parameters can detect early signs of axonal degeneration, and their introduction in clinical practice may help to identify patients with the worst outcome.

A Novel Ultrasonographic Anthropometric-Independent Measurement of Median Nerve Swelling in Carpal Tunnel Syndrome: The "Nerve/Tendon Ratio" (NTR).

There is little consensus on ultrasound (US) normative values of cross-sectional area of median nerve (MN-CSA) in carpal tunnel syndrome (CTS) because of its dependency on anthropometric parameters. We aim to propose a novel anthropometric-independent US parameter: MN-CSA/flexor radialis carpi CSA (FCR-CSA) ratio ("Nerve Tendon Ratio", NTR), in the diagnosis of clinically and electrodiagnostic (EDS)-defined CTS. 74 wrists of 49 patients with clinically defined CTS underwent EDS (scored by the 1-5 Padua Scale of electrophysiological severity, PS) and US of carpal tunnel with measurement of MN-CSA (at the carpal tunnel inlet), FCR-CSA (over scaphoid tubercle) and its ratio (NTR, expressed as a percentage). US normality values and intra-operator agreement were assessed in 33 healthy volunteers. In controls, the mean MN-CSA was 5.81 mm2, NTR 64.2%. In 74 clinical CTS, the mean MN-CSA was 12.1 mm2, NTR 117%. In severe CTS (PS &gt; 3), the mean MN-CSA was 15.9 mm2, NTR 148%. In CTS, both MN-CSA and NTR correlated with sensitive conduction velocity (SCV) (p &lt; 0.001), distal motor latency (DML) (p &lt; 0.001) and PS (p &lt; 0.001), with a slight superiority of NTR vs. MN-CSA when controlled for height, wrist circumference and weight. In CTS filtered for anthropometric extremes, only NTR maintained a correlation with SCV (p = 0.023), DML (p = 0.016) and PS (p = 0.009). Diagnostic cut-offs were obtained with a binomial regression analysis. In those patients with a clinical diagnosis of CTS, the cut-off of MN-CSA (AUROC: 0.983) was 8 mm2 (9 mm2 with highest positive predictive value, PPV), while for NTR (AUROC: 0.987), the cut-off was 83% (100% with highest PPV). In patients with EDS findings of severe CTS (PS &gt; 3), the MN-CSA (AUROC: 0.876) cut-off was 12.3 mm2 (15.3 mm2 with highest PPV), while for NTR (AUROC: 0.858) it was 116.2% (146.0% with highest PPV). NTR can be simply and quickly calculated, and it can be used in anthropometric extremes.

Bridging potential of Taurine-loading PCL conduits transplanted with hEnSCs on resected sciatic nerves

Reconstruction of nerve conduits is a promising method for functional improvement in peripheral nerve repair. Besides choosing of a suitable polymer for conduit construction, adding factors such as Taurine improve a more advantageous microenvironment for defect nerve regeneration. Showing several major biological properties of Taurine, for example, regulation of the osmotic pressure, modulation of neurogenesis, and calcium hemostasis, makes it an appropriate option for repairing of defected nerves. To this, we examined repairing effects of Taurine-loading PCL conduits cultured with human endothelial stem cells (hEnSCs) on resected sciatic nerves. PCL/Taurine/Cell conduits transplanted to a 10-mm sciatic nerve gap. Forty-two wistar rats were randomly divided to seven groups: (1) Normal group, (2) Negative control (NC), (3) Positive control (nerve Autograft group), (4) PCL conduits group (PCL), (5) Taurine loaded PCL conduits group (PCL/Taurine), (6) hEnSCs cultured on the PCL conduits (PCL/Cell), (7) hEnSCs cultured on the PCL/Taurine conduits (PCL/Taurine/Cell). Functional recovery of motor and sensory nerves, the action potential of exciting muscle and motor distal latency has seen in PCL/Taurine/Cell conduits. Histological studies showed also remarkable nerve regeneration and obvious bridging has seen in this group. In conclusion, PCL/Taurine/Cell conduits showing suitable mechanical properties and biocompatibility may improve sciatic nerve regeneration.

From a dermatologist point of view, enthesopathy and peripheral neuropathy in psoriasis patients

Background: Investigating psoriasis patients’ enthesopathy and peripheral neuropathy, which dermatologists often neglect.Methods: Seventy-four psoriasis patients’ lower limb entheses were evaluated by ultrasonography using Glasgow Ultrasound Enthesitis Scoring Scale (GUESS). Sensory and motor nerve conduction studies in median and ulnar nerve, motor nerve conduction research of peroneal and tibial nerves and sensory conduction study on right sural nerve was performed in 25 patients.Results: 172 of 730 entheses had ultrasonographic enthesopathy symptoms (23.56%). Enthesopathy was substantially more common in cases involving the nail (p = 0.004). The frequency of enthesopathy did not change significantly between symptomatic and asymptomatic patients (p = 0.408). Seven of 25 patients (28%) had a pathology in nerve conduction studies. With increasing GUESS scores, bilateral ulnar and right tibial nerve distal motor latencies were shown to become longer (p = 0.001, p = 0.01, p =0.019), although left ulnar nerve sensory conduction velocity got slower (p = 0.033).Conclusions: Enthesopathy and peripheral nerve dysfunction were frequently observed in psoriasis patients. Dermatologists should be mindful of neuromusculoskeletal disorders in psoriasis patients.

Efficacy of rituximab in anti-myelin-associated glycoprotein demyelinating polyneuropathy: Clinical, hematological and neurophysiological correlations during 2 years of follow-up.

We evaluated the clinical and neurophysiological efficacy of rituximab (RTX) in a neurophysiologically homogeneous group of patients with monoclonal gammopathy and immunoglobulin M (IgM) anti-myelin-associated glycoprotein antibody (anti-MAG) demyelinating polyneuropathy. Twenty three anti-MAG-positive polyneuropathic patients were prospectively evaluated before and for 2 years after treatment with RTX 375 mg/m2 . The Inflammatory Neuropathy Cause and Treatment (INCAT) disability scale (INCAT-ds), modified INCAT sensory score (mISS), Medical Research Council sum score, Patients' Global Impression of Change scale were used, IgM levels were assessed and extensive electrophysiological examinations were performed before (T0) and 1 year (T1) and 2 years (T2) after RTX treatment. At T1 and T2 there was a significant reduction from T0 both in mISS and in INCAT-ds, with a pvalue < 0.001 in the inferential Friedman's test overall analysis. Ulnar nerve Terminal Latency Index and distal motor latency significantly changed from T0 to T1 and in the overall analysis (p=0.001 and p=0.002), and ulnar nerve sensory nerve action potential (SNAP) amplitude was significantly increased at T2 from T1, with a pvalue < 0.001 in the overall analysis. Analysis of the receiver-operating characteristic curves showed that a 41.8% increase in SNAP amplitude in the ulnar nerve at T2 from T0 was a fair predictor of a mISS reduction of ≥2 points (area under the curve 0.85; p=0.005; sensitivity: 90.9%, specificity: 83.3%). This study suggests that RTX is effective in patients with clinically active demyelinating anti-MAG neuropathy over 2 years of follow-up, and that some neurophysiological variables might be useful for monitoring this efficacy.

Application of the 2021 EAN/PNS criteria for chronic inflammatory demyelinating polyneuropathy

BackgroundThe diagnostic value of new criteria of the European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) for chronic inflammatory demyelinating polyneuropathy (CIDP) is unknown.MethodsWe performed a retrospective study of fulfilment of...

Amyotrofik lateral skleroz erken tanısında sinir iletim çalışmaları ve ayrık el bulgusunun önemi

Aim: The heterogeneity of the Amyotrophic Lateral Sclerosis (ALS) clinical phenotypes leads to difficulties in early diagnosis. The ‘split hand’ sign is defined as the thenar muscles that are more prominently affected by hypothenar. In this study, the results of the initial nerve conduction study of the patients were compared with those of the controls in order to increase the findings supporting early diagnosis.&#x0D; Material and Method: Seventy-five patients who were diagnosed with ALS in our clinic were included in the study. The initial ENMG findings of the patients were compared with those of 70 healthy controls: Distal motor latency (DML), the compound muscle action potential (CMAP) amplitude, velocity in the motor conduction of median, ulnar, peroneal and tibial nerves; distal latency, amplitude, velocity in sensorial conduction were evaluated. Ulnar/median DML and ulnar/median CMAP amplitude ratios were examined.&#x0D; Results: In ALS group, DMLs of the median, ulnar, peroneal, and tibial nerves were significantly longer, and CMAP amplitudes were significantly smaller than those of the controls. The sensory conductions of the median, ulnar, and sural nerves were not statistically different between the groups. The ulnar/median DML ratio of the patients was lower than the ratio of controls (0.73/0.80;p=0.003); while the ulnar/median CMAP amplitude ratio was greater (1.40/1.11; p=0.002).&#x0D; Conclusion: Prolonged DML and reduced amplitudes were observed in the motor nerve conduction of ALS patients in the early period. The results of the present study also support the presence of split-hand phenomenon even in early period of limb-onset ALS (both upper and lower). These findings suggest that nerve conduction studies and electrophysiologically detected split-hand sign are important clues for the early diagnosis of ALS in case of heterogeneous clinical phenotype.

Nerve Conduction Study in Healthy Elderly Subjects in Central India: A Cross-Sectional Study.

BackgroundThere are many physiological changes that accompany aging. Slowing of muscle contraction, alteration of muscle metabolism and neuromuscular junction, and reduction of nerve conduction velocity (NCV) are among these physiological changes. The present study was conducted to elucidate the effect of physiological factors like gender, height, and Body Mass Index (BMI) on motor and sensory nerve conduction study (NCS) of the upper limb and find out the normal data for healthy elderly subjects in central India.MethodsA cross-sectional study among 382 healthy adult participants of central India aged 60 years and above. The study was carried out in the department of Physiology, Acharya Vinoba Bhave Rural Hospital, Wardha, India, from July 2017 to June 2022. An NCS was performed using the Neuron Spectrum 5 machine (Neurosoft, Ivanovo, Russia). A Microsoft Excel spreadsheet (Microsoft Corporation, Redmond, Washington, United States) was used to tabulate the information gathered. For statistical analysis, IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp., Armonk, New York, United States) was used.ResultsAll NCS parameters were greater in males as compared to females. As age advances, longer distal motor latency (DML) and F-wave minimum latency, decreasing amplitude, and slowing of conduction velocity (CV) were observed. As height increases, increasing DML and F-wave minimum latency, decreasing amplitude, and slowing of CV were observed. Higher BMI was found to be associated with lower amplitudes and slowing of CVs.ConclusionAge and height have a negative influence on amplitude and CV is a positive influence on DML and F-min latency. Higher BMI has a negative influence on amplitude and CV.

Comparison of clinical findings and electromyography results in patients with preliminary diagnosis of carpal tunnel syndrome

ObjectiveTo evaluate the link between EMG findings and clinical status, the Boston questionnaire and the severity of pain in patients with pre-diagnosis of carpal tunnel syndrome. MethodsA total of 85 patients (133 hands) who presented to the Physical Therapy and Rehabilitation outpatient clinic consecutively with complaints of numbness, tingling, pain and weakness in their hands were evaluated for their demographic and clinical features. After the initial evaluation, the diagnosis of CTS was confirmed by EMG. Visual analog scale (VAS), the Boston Questionnaire (Symptom Severity Scale = SSS, Functional Status Scale = FSS) and nerve conduction study results (sensory conduction velocity = SCV, distal motor latency = DML, compound muscle action potential = CMAP) were enrolled. ResultsEighty-five patients (58 female and 27 male) participated in this study yielding 133 hands (73 right hands, 60 right hands) with CTS. The mean age was 48.3 ± 10.41 years. Of all patients, 68.2 % were female and 31.8 % were male. A statistically significant relationship was found between SSS and duration of symptoms, VAS, both right and left SCV, DML and CMAP. A statistically significant relationship was found between FSS and duration of symptoms, VAS and only right SCV, DML and CMAP. ConclusionThe diagnosis of CTS should be evaluated not only as an electrodiagnostic finding, but also the clinical picture of the patients. According to our results, both SSS and FSS had good correlations with VAS and the findings of EMG. Therefore, the Boston Questionnaire can provide a standardized measure of symptom severity and functional status in patients with CTS.