Electroneurographic Study Research Articles

OBJECTIVIZATION OF THE EFFECT OF A COMPLEX OF PHYSICAL FACTORS IN PATIENTS WITH CARPAL TUNNEL SYNDROME BY ELECTROMYOGRAM TEST

CTS is the most common compression neuropathy with an incidence of 125-515/100 000. It is a result of compression of the median nerve by the transverse carpal ligament. It is observed in 2 to 5% of the general population, more frequently in women.Electromyography is considered the most accurate diagnostic procedure, although it cannot be fully accepted as a gold standard due to the possibility of false positives (about 15%) and false negatives (about 18%) [1]However, because of its low cost, in comparison to other diagnostic methods, its high diagnostic reliability, and the few contraindications to its application, it remains a method of choice for diagnosis and follow-up of the reinnervation of the median nerve in CTS patients.Aim of study. To investigate the effect of a complex of physical factors on the reverse development of symptoms of moderate carpal tunnel syndrome using electromyography.Materials and methods. 57 patients with mild to moderate degree of carpal tunnel syndrome clinically proven by electroneurographic study were еexamined. 38.60% of the patients were with right hand affected, 9 patients (15.80%) with left hand affected and 26 patients (45.60%) with bilateral involvement (n=26). In the last group, we examined both hands, ie 57 patients and 82 hands were investigated.Based on the analysis of our own studies, we applied the following complex physiotherapeutic program to the patients involved in the study: ultrasound, electrophoresis with Nivalin (Galantamine), and traditional kinesitherapy program.In our study, we examined the sensory and motor fibres of the n. medianus. Changes in distal latency, amplitude, and conduction velocity were observed.Results and discussion. The electroneurographic examination we performed showed a statistically significant change (p <0.001) in the normalization of distal latency, conduction velocity and M amplitude in both the sensory and motor fibres of the affected nerve. These results were reported between the first and fourth months after physiotherapy. There is also a tendency for their retention within the next 4-8 months.Correlation analysis shows that there is a very strong, statistically significant (p <0.001) relationship between the ENG parameters for n. medianus sensory and motor fibres conductivity (distant latency, SNAP and conduction velocity) and the treatment performed, which is established even at the first check-up (1-4 months) after end of the treatment, and the results achieved are maintained over time.The statistically significant changes in the values of ENG parametric fibers of n. medianus, we refer to the complex physiotherapy treatment, aimed at improving the trophic and nerve conduction, accelerating the regenerative processes of the nerve structures, improving the trophic and vascularizing the structures located in the carpal tunnel.Last but not least, the fibrolytic action of ultrasound therapy leading to the spreading of fibrous seals, which is quite common in CTS, is also important. Although different in their mechanism of action, the physiotherapeutic procedures included in our program have a synergistic effect aimed at overcoming the functional deficiency and reversing the symptoms of CTS.Conclusions. Our study on the effectiveness of a complex of physical factors in the conservative treatment of the CTS showed that early diagnosis and timely initiation of physiotherapeutic treatment are a prerequisite for achieving very good results in terms of functional recovery of the affected hand and the reverse development of clinical symptoms in patients with proven mild to moderate CTS.The segmental demyelination of the sensory and motor fibers of n. medianus in the initial stages, as a result of its compression in the area of the carpal canal, is a reversible process. An integrated approach to the treatment of CTS, including early diagnosis, prevention and treatment, is the key for success in mild and moderate forms of the syndrome, and competent and timely medical advice is often crucial.

THE BOSTON CARPAL TUNNEL QUESTIONNAIRE /BCTQ/ − A RELIABLE METHOD FOR DIAGNOSIS AND ASSESSMENT OF THE TREATMENT OF CARPAL TUNNEL SYNDROME

CTS is the most common compression neuropathy with an incidence of 125-515/100 000. It is a result of compression of the median nerve by the transverse carpal ligament. It is observed in 2 to 5% of the general population, more frequently in women.In the last few years the scientific society has acknowledged the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and more and more frequently it is being used as a standard in CTS patients. The literature also contains numerous studies on the diagnostics and treatment of CTS using BCTQ.Aim of study. To investigate the effect of a complex of physical factors on the reverse development of symptoms of moderate carpal tunnel syndrome using BCTQ and to compare the results of the BCTQ subjective rating (SSS) (symptom severity scale) and function − FSS (functional status scale) with objective assessment measured by the ENG parameters of n. medianus Materials and methods. 57 patients with mild to moderate degree of carpal tunnel syndrome clinically proven by electroneurographic study were examined. 38.60% of the patients were with right hand affected, 9 patients (15.80%) with left hand affected and 26 patients (45.60%) with bilateral involvement (n=26), In the last group, we examined both hands, i.e. 57 patients and 82 hands were investigated.Based on the analysis of our own studies, we applied the following complex physiotherapeutic program to the patients involved in the study: ultrasound, electrophoresis with Nivalin (Galantamine), and traditional kinesitherapy program.Results and discussion. By analyzing the results of the symptom severity assessment of the first part of the questionnaire we find that subjective complaints of patients decreased statistically significantly at the end of physiotherapy course from an average of 2.67 before treatment to 2.21 at the end of FTP (p <0.01). This trend continues within 1 − 4 months after the end of physiotherapy − average 1.79 and maintains up to 4 − 8 months when the mean of the results is 1.69 (p <0.001). We found that with regard to the recovery of the function of the affected hand and the way it affects some of the activities of daily living, the results of the second part of the BCTQ - functional status scale - show a statistically significant improvement at the end of the physiotherapy course 1.91 to an average of 1.63 (p <0.001), with a tendency for long-term retention and a slight decrease in the average of the results obtained to 1.37 within the first control examination at 1-4 months (p <0.001) and resistance to this trend in the following months (4-8) − 1.31 (p <0.001).Based on the ANOVA analysis and the calculation of the η coefficient, we proved that there is no significant difference in the results obtained from the Boston questionnaire and those from the ENG examination. There is a high percentage of overlap - from 53.10% to 95.60%.Although the results of the questionnaire are based on the subjective assessment of the patient, there is a high percentage of overlap with those of the objective study (ENG), which is a prerequisite for assuming that the questionnaire is highly reliable and valid and can be used as a tool for evaluating and analyzing a number of CТ C studies, which is in line with Leite's findings that the Boston Questionnaire is highly reliable and can replace any other non-standard methods for assessing CTS severityConclusions. In the presented facts of the discussion impression makes the patient's influence both on the subjective complaints and the clinical symptoms as well as on the degree of restoration of the affected hand functions at the end of the physiotherapy course, the continuation of this trend up to 4 months after the end of the treatment and maintaining it for 4 to 8 months.Although the results of BCTQ are based on the subjective assessment of the patient, there is a high percentage of overlap with those of the objective study (ENG), which is a prerequisite for assuming that the questionnaire is highly reliable and valid and can be used as a tool for evaluating and analyzing a number of carpal tunnel studies, which is in line with Leite's findings that the Boston Questionnaire is highly reliable and can replace any other non-standard methods for assessing CTS severity

106. Combined Electroneurographic and Muscular ultrasound study in healthy neonatal and adult-juvenile populations: Maturational aspects

We used combined Electroneurography and Muscular-UltraSound study (c-ENG-MUS) to evaluate the morpho-functional neuromuscular aspects in healthy neonatal and adult-juvenile populations. The Tibial Anterior muscle was evaluated in 17 neonates, 10 Full-terms (38–40 ws)/ 7 preterms (32–36 ws) and in 11 young adults (19–45 ys) by c-ENG-MUS, measuring: (1) Onset-Peak (OP) and peak-to-peak (PP) amplitudes of maximum Motor-Compound-Action-Potential (mCMAP); (2) maximum Muscular Thickness (mMT); (3) MT at mCMAP’s detection point (mCMAP-MT). In preterms we performed serial studies until the term-age. (Study approved by the Local-Ethics-Committee). In newborns the OP- and PP-mCMAP amplitudes didn’t correlate linearly, unlike the adults; in the newborns’ and adults’ populations the mCMAP-MT and mMT values linearly relate. In newborns, the mCMAP’s amplitude and MT’s absolute value were about half of the adults’ ones. The detection points of mCMAP and mMT didn’t correspond. In preterms the values of mCMAP-amplitude and mMT proportionally increased to the postconceptional-age. The values of mCMAP-amplitude, mMT and mCMAP-MT significantly differed in neonates (full-terms and preterms) respect the adults because of the effect of age. There was no correlation between the mCMAP-amplitude and mMT (no significant site-effect). c-ENG-MUS is a quiclky and easy technique to evaluate the neuromuscular functional and morphological maturational processes.

Diabetes, peripheral neuropathy, and lower-extremity function

ObjectiveDiabetes among older adults causes many complications, including decreased lower-extremity function and physical disability. Diabetes can cause peripheral nerve dysfunction, which might be one pathway through which diabetes leads to decreased physical function. The study aims were to determine the following: (1) whether diabetes and impaired fasting glucose are associated with objective measures of physical function in older adults, (2) which peripheral nerve function (PNF) tests are associated with diabetes, and (3) whether PNF mediates the diabetes–physical function relationship. Research Design and MethodsThis study included 983 participants, age 65years and older from the InCHIANTI study. Diabetes was diagnosed by clinical guidelines. Physical performance was assessed using the Short Physical Performance Battery (SPPB), scored from 0 to 12 (higher values, better physical function) and usual walking speed (m/s). PNF was assessed via standard surface electroneurographic study of right peroneal nerve conduction velocity, vibration and touch sensitivity. Clinical cutpoints of PNF tests were used to create a neuropathy score from 0 to 5 (higher values, greater neuropathy). Multiple linear regression models were used to test associations. Results and ConclusionOne hundred twenty-six (12.8%) participants had diabetes. Adjusting for age, sex, education, and other confounders, diabetic participants had decreased SPPB (β=−0.99; p<0.01), decreased walking speed (β=−0.1m/s; p<0.01), decreased nerve conduction velocity (β=−1.7m/s; p<0.01), and increased neuropathy (β=0.25; p<0.01) compared to non-diabetic participants. Adjusting for nerve conduction velocity and neuropathy score decreased the effect of diabetes on SPPB by 20%, suggesting partial mediation through decreased PNF.

Electroneurographic pilot study with healthy volunteers to determine the efficacy, safety and duration of action of TrapoX, a potency-optimised botulinum toxin type A-based mutant

Electroneurographic pilot study with healthy volunteers to determine the efficacy, safety and duration of action of TrapoX, a potency-optimised botulinum toxin type A-based mutant

Pseudo-conduction block in nonsystemic vasculitic neuropathy

Introduction. Nonsystemic vasculitic neuropathy (NSVN) is an inflammatory disorder of the vasa nervorum which usually is expressed as a mononeuritis multiplex. We present a patient with NSVN with histological confirmination focused on the neurophysiological findings at the early stages. A 36 years-old woman presented with paresthesia and weakness in her right hand followed by left footdrop. The first neurophysiologic examination showed low amplitude of the right median nerve (RMN) CMAP with proximal stimulation. A second examination showed signs of axonal damage in several nerves, including the RMN. The acute ischemic damage of a nerve can give a pattern of conduction block in the electroneurographic study as in the RMN of the presented case. This phenomenon is referred as "pseudo-conduction block", since it is transient and evolves towards a definite pattern of axonal neuropathy. When a vasculitic neuropathy is suspected, repeated neurophysiologic studies are necessary in order to ensure a proper (appropriate) characterization of the lesional patterns.

Biological activity of two botulinum toxin type A complexes (Dysport® and Botox®) in volunteers

Despite extensive clinical experience and published data regarding botulinum toxin, questions remain about the clinical substitution of one botulinum toxin formulation for another. In the case of Dysport® and Botox®, doseequivalence ratios ranging from 1:1 to 6:1 (Dysport:Botox) have been advocated. This dose-ranging, electroneurographic study investigated the dose equivalence, diffusion characteristics (spread) and safety of these two type-A toxins in 79 volunteers. Dysport and Botox caused significant and similar reductions in compound muscle action potential (CMAP) amplitude in the target muscle (extensor digitorum brevis, EDB) 2 weeks after injection, with effects persisting to the 12-week timepoint. For both products, the reduction in amplitude was increased with increasing doses and with increasing concentration. The effects of toxin on neighbouring muscles were much smaller and of a shorter duration than those on the target muscle, implying a modest spread of toxin. Unlike the target muscle, the effects were greater with the higher volume, suggesting this volume led to greater diffusion from the EDB. No adverse events were reported. Statistical modelling with CMAP amplitude data from the target muscle gave a bioequivalence of 1.57 units of Dysport:1 unit of Botox (95 % CI: 0.77–3.20 units). The data indicate that a dose-equivalence ratio of 3:1 was within the statistical error limits, but ratios over 3:1 are too high.

Biological activity of two botulinum toxin type A complexes (Dysport® and Botox®) in volunteers

Despite extensive clinical experience and published data regarding botulinum toxin, questions remain about the clinical substitution of one botulinum toxin formulation for another. In the case of Dysport and Botox, dose-equivalence ratios ranging from 1:1 to 6:1 (Dysport:Botox) have been advocated. This dose-ranging, electroneurographic study investigated the dose equivalence, diffusion characteristics (spread) and safety of these two type-A toxins in 79 volunteers. Dysport and Botox caused significant and similar reductions in compound muscle action potential (CMAP) amplitude in the target muscle (extensor digitorum brevis, EDB) 2 weeks after injection, with effects persisting to the 12-week timepoint. For both products, the reduction in amplitude was increased with increasing doses and with increasing concentration. The effects of toxin on neighbouring muscles were much smaller and of a shorter duration than those on the target muscle, implying a modest spread of toxin. Unlike the target muscle, the effects were greater with the higher volume, suggesting this volume led to greater diffusion from the EDB. No adverse events were reported. Statistical modelling with CMAP amplitude data from the target muscle gave a bioequivalence of 1.57 units of Dysport:1 unit of Botox (95 % CI: 0.77-3.20 units). The data indicate that a dose-equivalence ratio of 3:1 was within the statistical error limits, but ratios over 3:1 are too high.

Biological activity of Dysport ® and Botox ® in the human EDB muscle: A double-blind, randomized, dose-ranging study

Although the potency of botulinum toxin type A preparations is expressed in mouse LD50 units, differences in the excipients used mean that the units from the assay used for Dysport are different from those from the assay used for Botox. Despite extensive clinical experience and published data, this remains controversial, with published dose-equivalence ratios ranging from 1:1 to 6:1 (Dysport: Botox). This dose-ranging, electroneurographic study investigated the dose equivalence, diffusion characteristics (spread) and safety of these two type-A toxins in 79 volunteers. Dysport and Botox caused significant and similar reductions in compound muscle action potential (CMAP) amplitude in the target muscle (extensor digitorum brevis, EDB) 2–12 weeks after injection. For both products, the reduction in amplitude increased with increasing doses and with increasing concentration. The effects of toxin on neighboring muscles were much smaller than those on the target muscle, implying some spread of toxin. These effects were greater with the higher volume, suggesting this volume led to greater diffusion from the EDB. No adverse events were reported. Statistical modelling with CMAP amplitude data from the target muscle gave a bioequivalence of 1.57 units of Dysport:1 unit of Botox (95% CI: 0.77–3.20 units). A dose-equivalence ratio of 3:1 was within the statistical error limits, but ratios over 3:1 are too high.

Peritonitis agudas y divertículos del intestino delgado en una paciente con encefalomiopatía neurogastrointestinal mitocondrial

Jejunal and ileal diverticula are acquired lesions that are often associated with intestinal motility disturbances like those occurring in myopathies and neuropathies with visceral affection. Mitochondrial neurogastrointestinal encephalomyopathy is characterized by gastrointestinal dysmotility, cachexia, ptosis with external ophthalmoparesis, neuropathy, leukoencephalopathy and laboratory evidence of mitochondrial alteration.A female patient that since 9 months age presented digestive symptoms: diarrhea, nauseous, vomits, slow digestions and abdominal pain. She had myopia. At the age of 20, in a seven months period, she precised urgent abdominal surgical intervention in three occasions for acute diffuse peritonitis related to jejunal and ileal diverticula. She presented cachexia, mild palpebral ptosis, external ophthalmoparesis, hypertrophic major auricular nerves, scoliosis, pes cavus, distal weakness and hypoesthesia in extremities, bilateral neurosensorial hypoacusia and lactic acidosis. The electroneurographic study was compatible with severe chronic demyelinating sensitive motor polyneuropathy. In the cerebral MR leukoencephalopathy was detected. In muscular tissue it was seen alteration in all fibers type I with numerous lipid vacuoles and an increase of mitochondrial number in the form of thick grains and subsarcolemmal mitochondrial bags. There was no ragged red fibers nor ultrastructural mitochondrial alterations. There was chain respiratory complex III deficiency.In patients with intestinal dysmotility manifestations and jejunal and ileal diverticula neuropathies and myopathies with visceral affection must be suspected, among them MNGIE syndrome.

Neuropatía hereditaria con susceptibilidad a la presión en la infancia

The diagnosis of hereditary neuropathy with liability to pressure palsies during childhood is uncommon, since the disorder is still asymptomatic and the clinical features are nonspecific. We present a case of hereditary neuropathy with liability to pressure palsies in a seven and a half year old girl with deteriorating clinical findings of 'pies cavos', scoliosis, difficulty in walking and torticollis, but without episodes of paralysis. On the electroneurographic (ENG) study numerous anomalies of sensory and motor nerve conduction were seen, especially at sites of nerve trapping, both in the patient and in her mother; genetic study showed deletions of chromosome 17p11.2 in both. Hereditary neuropathy with liability to pressure palsiesin childhood may follow a course which does not show typical pressure palsies. Therefore the ENG study is very important for detection of the disorder. Torticollis, as well as pies cavos and scoliosis, is frequently seen in neuropaediatric clinics, so the possibility, as in the case reported, that this is part of the clinical spectrum of hereditary neuropathy with liability to pressure palsies should be considered. With diagnostic confirmation on genetic studies, nerve biopsy is not necessary.

Estudio de polineuropatía en pacientes con movimientos periódicos de las piernas durante el sueño

Periodic legs movements of sleep (PLMS) are rhythmic, standard and repetitive contractions of muscles of the extremities during the sleep. It is known that the patients with restless legs syndrome (RLS) have disorders during the sleep: increase in the latency of the sleep, increased number of arousal, etc.; most of them have also periodic movements of the legs during the sleep. The relationship of the periodic movements of the legs during the sleep with polyneuropathy is not clear. Some authors have found evidence of electrophysiological and pathological of signs of axonal mild polyneuropathy in patients with restless legs syndrome. In this work, we evaluated nine patients that were diagnosed of PLMS, to determine the prevalence of neuropathy in such sample. Polysomnography of nocturnal sleep of 7-8 hours was performed, including electromyographic recording of both anterior tibialis muscles; and electroneurographic study of peroneal, sural, ulnar and median nerves. Just in none of the nine studied cases were obtained electrophysiological signs of neuropathy; though it has been able to demonstrate the existence of mild alteration of the peripheral nervous system, fundamentally of sensory character; nevertheless, C we think that it would have to be studied the existence of polyneuropathy in all the patients with PLMS in order to discard potentially tractable organic causes.

Facilitation and inhibition of synaptic transmission in the spinal cord: an electroneurographic study in humans

The neurographic activity evoked either by stimulation of the tibial nerve at the popliteal fossa or by percussion of the Achilles tendon has been recorded at lumbar and thigh levels, in order to find out whether conduction time, temporal dispersion and central delay of the neural volleys underlying the monosynaptic reflex (H or T) may change as a function of stimulus intensity; under facilitatory or inhibitory experimental conditions; "spontaneously", i.e. during the steady state. The reflexly evoked ventral root discharge (VRD) decreases in latency with increasing stimulus intensity up to the maximum reflex response in the absence of changes in afferent (thigh to spine) or efferent (spine to thigh) conduction times. Reduction of the central delay was greater with mechanical than electrical stimulation, probably due to the combined effect of spatial and temporal summation under the former experimental condition. The latency of the VRD related to the maximal H response was not further modified by supramaximal stimulus strengths. The Jendrassik manoeuvre caused a significant decrease in latency of the VRD, the opposite effect being observed during calf muscle vibration. A significant relationship between amplitude and latency of single VRDs could be demonstrated during the "steady state". Our data point to the existence of a positive correlation between the size of the motoneuronal pool activated by an afferent volley and speed of transmission in the reflex pathway, both during the "steady state" and under either facilitatory or inhibitory experimental conditions, provided that the test stimulus strength does not exceed the maximum reflex response (H or T). No detectable signs of peripheral dispersion of the VRD could be demonstrated, irrespective of the stimulus employed: this suggests that the axon diameters of the motoneurones contributing to the monosynaptic reflex fall within a fairly narrow distribution.

Electroneurographic evidence of polyneuropathy in chronic liver disease

An electroneurographic study performed on the peripheral nerves of 25 patients with severe cirrhosis following viral hepatitis showed slight slowing (P greater than 0.05) of motor conduction velocity (CV) and significant diminution (P less than 0.001) of sensory CV and mixed sensorimotor-evoked potentials, associated with a significant decrease in the amplitude of sensory evoked potentials. The slowing was about equal in the distal (digital) and in the proximal segments of the same nerve. A mixed axonal degeneration and segmental demyelination is presumed to explain these findings. The CV measurements proved helpful for an early diagnosis of hepatic polyneuropathy showing subjective symptoms in the subclinical stage.

Regional nerve block with the aid of a nerve stimulator.

AnaesthesiaVolume 27, Issue 2 p. 185-193 Free Access Regional nerve block with the aid of a nerve stimulator G. M. Chapman, G. M. Chapman G. M. Chapman, BSc, MB, BS, FFARCS, Registrar, Nuffield Department of Anaesthetics, Radcliffe Infirmary, Oxford, OX2 6HE.Search for more papers by this author G. M. Chapman, G. M. Chapman G. M. Chapman, BSc, MB, BS, FFARCS, Registrar, Nuffield Department of Anaesthetics, Radcliffe Infirmary, Oxford, OX2 6HE.Search for more papers by this author First published: April 1972 https://doi.org/10.1111/j.1365-2044.1972.tb08195.xCitations: 16AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL References 1 Löfström, B., Wennberg, A. & Widén, L. (1966). Late disturbances in nerve function after block with local anaesthetic agents. An electroneurographic study. Acta anaes-thesiologica Scandinavica, 10, 111. 2 Pearson, R.B. (1955). Nerve block in rehabilitation: a technique of needle localisation. Archives of Physical Medicine and Rehabilitation, 36, 631. 3 GreenbIatt, G.M. & Denson, J.S. (1962). Needle nerve stimulator-locator: Nerve blocks with a new instrument for locating nerves. Current Researches in Anesthesia and Analgesia, 41, 599. 4 Magora, F., Rozin, R. Ben-Menachem, Y., Magora, A. (1969). Obturator nerve block: an evaluation of technique. British Journal of Anaesthesia, 41, 695. 5 Wright, B.D. (1969). A new use for the Block-Aid Monitor. Anesthesiology, 30, 236. 6 Sarnoff, S.J. & Sarnoff, L.C. (1951). Prolonged peripheral nerve block by means of indwelling plastic catheter. Treatment of hiccup. Anesthesiology, 12, 270. 7 Koons, R.A. (1969). Use of the Block-Aid Monitor and plastic intravenous cannulae for nerve blocks. Anesthesiology, 31, 290. 8 Churchill-Davidson, H.C. (1965). A portable peripheral nerve-stimulator. Anesthesiology, 26, 224. 9 E. Erikson (ed.) (1969). Illustrated Handbook in Local Anaesthesia. 1st. edn. Chicago : Year Book Medical Publishers. 10 Gjessing, J. & Harley, N. (1969). Sciatic and femoral nerve block with mepivacaine for surgery on the lower limb. Anaesthesia, 24, 213. 11 Moore, D.C. (1953). Regional Block: A Handbook for Use in the Clinical Practice of Medicine and Surgery. 1st Edn. Springfield , Illinois : Charles C. Thomas. 12 Harley, N. & Gjessing, J. (1969). A critical assessment of supraclavicular brachial plexus block. Anaesthesia, 24, 564. Citing Literature Volume27, Issue2April 1972Pages 185-193 ReferencesRelatedInformation

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