Electroneuromyography Research Articles

Transverse Myelitis and Guillain-Barré Syndrome Overlap Secondary to Bartonella henselae: Case Report

The GBS/ATM overlap is characterized by the simultaneous occurrence of Guillain-Barré syndrome (GBS) and acute transverse myelitis (ATM), which are two neurological autoimmune disorders. In this context, cat scratch disease (CSD) was rarely reported combined with this overlap. An adult female presenting fever, back pain, inferior limb weakness, and anuria was admitted to our hospital. On the physical exam, a distended bladder and bilateral lymphadenopathy were observed. The neurological assessment revealed muscle weakness, plantar flexion, and hyporeflexia in right with absence in left. Also, she reported hyperalgesia in inferior limbs. Her blood pressure was fluctuating being in the majority of the time hypertensive. A spinal cord MRI (magnetic resonance imaging) was suggestive of transverse myelitis. Methylprednisolone was started. The cerebrospinal fluid showed 37.0 cells/mm3 of white blood cell count, 49 mg/dl of glucose, and 50.7 mg/dl of protein. Ceftriaxone and vancomycin were started. On further questioning, the subject stated that her finger was bitten by a cat about two weeks before the beginning of the symptoms. Serological tests were positive for Bartonella henselae. Doxycycline and rifampin were started. After one-month, her symptoms improve but she continued with a radicular pain and weakness. An EMG (electroneuromyography) was suggestive of demyelination. IVIG (intravenous immunoglobulin) was started. After IVIG 4-day, the patient had recovery of her strength. To the authors' knowledge, there are two case reports of pediatric individuals linking CSD and GBS/ATM. Still, this association in an adult patient has not been reported until the present moment.

Peripheral polyneuropathy in patients receiving long-term statin therapy.

Peripheral neuropathy is an important potential side effect of statin use. This study was an investigation of the incidence of peripheral neuropathy in patients taking atorvastatin or rosuvastatin for hypercholesterolemia and the relationship to the dose and duration of the treatment. In all, 50 patients using a statin treatment and 50 healthy controls matched for age and gender who had never taken a statin were included in the study. Polyneuropathy was assessed with a neurological examination and electroneuromyography (ENMG). While no polyneuropathy was detected in the control group, polyneuropathy was seen in 33 (66%) of the patients in the statin group (p<0.01). There was no significant difference between the 2 statin groups in the results of the neurological examination or the ENMG findings regarding the incidence of polyneuropathy (p=0.288 and p=0.720, respectively). Neuropathy was observed in a neurological examination performed within the first year in 50% of the rosuvastatin users and 18% of those taking atorvastatin. The severity of the polyneuropathy increased with the duration of the treatment in the atorvastatin group (p=0.030). This study revealed an increased risk of peripheral neuropathy with long-term statin use (>1 year). Electrodiagnostic changes have been detected in motor and sensory nerves in nerve conduction studies of patients on long-term statin treatment. The assessment of neurological symptoms, like tingling, numbness, pain and tremor in the hands and feet, and unsteadiness during walking associated with peripheral neuropathy may be useful in the follow-up of the patients on long-term statin treatment. Early detection of peripheral neuropathy and changing hypercholesterolemia treatment may prevent permanent nerve damage.

Neuromarketing as an Innovative Instrument in Marketing

The article presents the study of the essence of such an innovative type of marketing as neuromarketing, which creates new opportunities for the promotion of goods and services, taking into account the psychological and physiological characteristics of consumers. The research is based on practical examples of application of mechanisms of neuromarketing by leading companies, in particular in the direction of overcoming consumer resistance to innovative products.The main methods of neuromarketing studies that are considered in the article are instrumental and socio-psychological, where instrumental methods such as: EEG (electroencephalography), MEG (magnetocencephalography), EMG (electroneuromyography), and TMS (magnetic stimulation) are used to measure changes in the nervous and metabolic activity of the brain of consumers. The most common socio-psychological methods are the concept of ZMET (the study of unconscious emotional reactions to a set of images that later becomes the basis for the creation of advertising), as well as the concept of engineering cannibal (transformation of emotions and human experiences in the product design and its properties).The article states that the correct use of instruments of influence on the consumer through visual, auditory, and aromatic channels can increase sales, create and maintain customer loyalty, a positive image of the company and its product, which will increase profits.To overcome consumer resistance, the following marketing strategies are proposed in the article: functional (improvement of product positioning, provision of appropriate level of service, introduction of certificates and quality certificates, etc.) and psychological: increase of brand recognition, effective use of the policy of a trademark.Thus, even considering the high cost of neyromarketing researches, companies are ready to study the organs of human senses, scan the brain, do physiological and psychological research, increasingly competing for the quality of the product and its presentation to the consumer.Article received 03.05.2018

Absence of H-Reflex as an Additional Neurophysiological Sign of the Development of Acute Inflammatory Demyelinating Polyneuropathy in Children

Introduction. Early diagnosis of acute inflammatory demyelinating polyneuropathy (AIDP) is of fundamental importance for the timely administration of therapy. At early stages of this condition, conventionally used electrophysiological diagnostic techniques are not sensitive enough. The objective of this work was to study H-reflex as a potential tool for early diagnosis of AIDP in children. Materials and methods. A total of 57 children were examined: 20 healthy children (7–14 years; mean age 12 years) and 37 patients diagnosed with AIDP (8−13 years; mean age 11 years). Electroneuromyography (ENMG) was performed on the 3d–7th day after the first symptoms onset. Nerve conduction velocity for motor fibers, amplitude of M-response during stimulation of n. tibialis, n. ulnaris and n. medianus, as well as latency and threshold of M-response and H-reflex during stimulation of m. soleus, were evaluated. Results. No significant intergroup differences in amplitudes of motor responses and the nerve conduction velocity were recorded, while the residual latency of M-response was significantly higher in the AIDP group. In individuals of the control group, the H-reflex was recorded in 100% of cases, while being recorded only in 2 (5.4%) patients in the AIDP group. In the latter two patients, the study was performed at the earliest stage (3d day) after the onset of the first symptoms. Conclusions. In pediatric patients with AIDP, on the 3d–7th day after the first symptoms onset, H-reflex was absent in 94.6% of cases. Evaluation of the H-reflex at the early stage of AIDP in children can be used as an additional diagnostic criterion.

Is there a correlation between sensory and motor axonal damage of the median nerve during carpal tunnel syndrome?

Objectives Carpal tunnel syndrome (CTS) is the most common nerve compression. The Electroneuromyography (ENMG) is the most objective test to document neurophysiological abnormalities [1] . Sensory impairment often precedes motor impairment, and demyelination precedes axonal loss. To our knowledge, no study has investigated the relationship between sensory and motor impairment. The aim of this work is to look for a correlation between sensory axonal loss and motor loss of the median nerve. Methods This is a retrospective study that regrouped 60 patients (120 hands) and for whom the diagnosis of CTS was retained following the ENMG. The statistical study was carried out with SPSS 20 software. The correlation was studied by the Pearson test. Results The mean age of the patients was 53.16 ± 11.8 years. The female sex was predominant with a sex ratio of 0.11. Diabetes was present in 40% of patients and hypothyroidism in one patient. The clinical lesion was bilateral in 75% of cases. Tinel sign was positive in 59.2% of the hands and phalen sign in 53.3% of the hands. The ENMG objectified CTS in 89.2% of hands with sensory-motor involvement in 50.8% of hands. Axonal loss was found in 36.7% of the hands. Mean sensory and motor amplitude was 63.4 ± 46.7 uV and 12.54 ± 4.9 mV respectively. The Pearson test showed a significant correlation between the amplitude of the sensory potential and that of the motor potential of the median nerve (P = 0.005). Conclusion This study shows a correlation between sensory and motor axonal loss. A multicenter study is needed to better retain this correlation relationship.

F42. EMG findings in patients with limb-girdle muscular dystrophy due to heterozygous CAPN3 mutations

Introduction Limb-girdle muscular dystrophy type 2A (LGMD2A) is the most common autosomal recessive (AR) LGMD subtype worldwide. The disease is caused by homozygous pathogenic mutations in the calpain 3 gene (CAPN3). Although strict AR inheritance is assumed for CAPN3-related myopathies, recent reports described symptomatic patients carrying a single CAPN3 mutation. The LGMDs share common clinical and laboratory findings such as weakness and atrophy of proximal muscles, often affecting lower extremities first; elevated creatine kinase (CK) levels; and dystrophic findings on muscle biopsy. Some clinical and imaging findings help to differentiate LGMD2A, such as asymmetric weakness and atrophy and early scapular winging. On muscle MRI, calpain deficiency characteristically reveals preferential involvement of posterior thigh muscles and the adductor magnus muscle with relative sparing of the anterior thigh muscles. There are few reports on EMG findings in patients with single CAPN3 mutations. Methods Two unrelated patients with LGMD and harboring single CAPN3 mutations were identified. They underwent detailed neurological evaluation, muscle biopsy, muscle MRI and electroneuromyography (ENMG). Results Patient one: man, 28 years old, born from nonconsanguineous parents, presenting progressive calves atrophy since 24 years old. Genetic analysis showed the variant c.258dupT;p. (Leu87Serfs*4) at CAPN3 in heterozygosity. ENMG showed myopathic motor unit action potential (MUAP) on left gastrocnemius and pectoralis major, and on right biceps brachii, without fibs or positive sharp waves. Right gastrocnemius muscle biopsy showed moderate myopathic changes. Patient two: woman, 77 years old, born from nonconsanguineous parents, presenting progressive proximal lower limb weakness in the last 2 years. Genetic analysis revealed the heterozygous frameshift variant c.550delA; p. (Thr184Argfs*36) in the CAPN3 gene. ENMG showed moderate diffuse myopathy, with preferential involvement of posterior tigh muscles and gastrocnemius with fibs and positive sharp waves. MRI showed severe atrophy of posterior tight muscles. Right quadriceps femoris biopsy revealed minimal myopathic changes. Conclusion The typical clinical, imaging and electrophysiological findings from LGMD2A can be found in patients presenting heterozygous pathogenic mutations in CAPN3 gene, indicating that a dominantly inherited form of calpainopathy exists, but with a milder fenotype. EMG reveals a predominantly posterior leg pattern of involvement.

DIAGNOSTIC POSSIBILITIES OF RESEARCHING THE STATE OF NEUROMUSCULAR TRANSMISSION IN PATIENTS WITH MYASTHENIA AND MYASTHENIC SINDROMES

Aim. To study and analyse diagnostic meaningfulness of the different electromyographic methods applied for the exposure of violations of neuromuscular transmission transmission. Materials and methods. There are many methods of the researching of the condition of neuro muscular transfer, each of them carries the certain diagnostic importance allowing to define character of a lesion of a neuro muscular synapse, to tap mechanisms of its development not only in clinically affected muscles, but also intact ones, and also at an early stage of a disease, at local forms of a myasthenia. The research of the condition of neuromuscular transmission was carried out with the use of the following electromyographic techniques: stimulation electroneuromyography (ENMG), the decrement test, the jitter-phenomenon, research of density of a single muscle fiber. Results. The result of the analysis of electromiographic diagnostic opportunities of researching the condition of neuro muscle fiber development is the developing of the clinic-instrumental algorithm of inspection of patients with a myasthenia. Conclusion. The different neurophysiological methods of study of the state of neuromuscular transmission carry certain diagnostic meaningfulness. Advantages of separate electromyographic methods are shown: research of initial amplitude of M-answer, decrement-test, джиттер-phenomenon. The indexes of ENMG-tests are analysed in detail-tests, and also their change at violation of neuromuscular transmission for patients with myasthenia gravis and myasthenic syndromes.

Dysphagia in myasthenia gravis: the tip of the Iceberg.

We evaluated swallowing function in patients with myasthenia gravis (MG) with or without dysphagia symptoms using different evaluation parameters and compared the results with those of healthy subjects. A total of 36 patients with MG and 25 healthy volunteers were included in the study. The subjects were classified into three groups; patients without dysphagia (group 1), patients with dysphagia (group 2), and healthy participants (group 3). The presence and severity of dysphagia, the oropharyngeal, pharyngeal, pharyngoesophageal, and esophageal phases were assessed using a screening test, manometric test, electrophysiologic studies [electroneuromyography (EMG)], fiberoptic endoscopic evaluation of swallowing (FEES), and barium swallow pharyngeal esophagography (BSPE), respectively. There was a significant difference between group 1 and group 3 in terms of BSPE (p=0.001) and manometry tests (p=0.001). A significant difference was found in all methods between group 2 and group 3 (p=0.001, for all). In the comparison of the patient groups, although the number of patients with dysphagia in group 2 was significantly higher in the clinical tests (p=0.007), FEES (p=0.001), and EMG (p=0.043) than in group 1, no difference was detected for BSPE (p=0.119) and manometry (p=0.644). Swallowing functions in patients with MG may be affected even without symptoms. This condition should be considered in their follow-up.

Application of applications of medical mud in Tambukan lake for restoration of elite sportsmen

The aims of this work was to study the use of mud in the Tambukansky lake in the complex rehabilitation of elite athletes. Materials and methods. The study involved 30 elite athletes (rugby, judo, boxing, athle-tics). For the rehabilitation of the musculoskeletal apparatus of the lower extremities of elite athletes during the intensive physical exertion, a mud applicator Tambukansky, was used. During the procedure, the athletes lay on the couch in a relaxed state for 15 minutes. At the course of the procedure, the procedures were performed daily, in total 7 procedures. To substantiate the effectiveness of mud application, methods were used: electroneuromyography (ENMG) and testing of the dynamometric characteristics of the musculoskeletal system in the robotic complex CON-TREX. The results of the research show that after 1 session of Tambukan mud applications, elite athletes had a tendency to improve ENMG indices during stimulation at the «tarsus» point. There was a tendency to increase the amplitude of the Mresponse. The area of the M-response on the left leg increased significantly (p<0.05). With stimulation at the «caput fibulae» point, the motor speed on both legs significantly increased (p<0.05). With stimulation at the point “fossa popliteav”, the amplitude and area of the M-response on the left leg and the speed of motor conduction on the right leg increased significantly (p <0.05). The study of the effect of the application of the course of procedures showed significant improvements in the parameters of the M-response at all points of stimulation. At the point of stimulation “tarsus” the parameters of terminal and residual latency improved, the duration of the M-response. At the point of stimulation, the “caput fibulae” improved the indicator of terminal latency. At the point of stimulation, the popliteal fossa improved the parameters of terminal latency and duration. Comparison of the performance of the muscles surrounding the right knee joint in highly qualified female athletes before and after applying the course of 7 sessions of Tambukan mud revealed a significant decrease in the fatigue factor of flexor and extensor muscles.

PENGGUNAAN PEMERIKSAAN AMPLITUDO SENSORY NEURON ACTION POTENTIAL SEBAGAI PENEGAK DIAGNOSIS POLINEUROPATI

Background. Polyneuropathy is the pathologic changes and functional disturbances in the peripheral nervous system. These changes manifest as sign and symptoms such as numbness, burning, allodynia, atrophy, and lose of stimulation responses. Diagnosing polyneuropathy can use electrodiagnostic method like electroneuromyography (ENMG). One of the most sensitive ENMG parameters for polyneuropathy is SNAP amplitude which can be measured at Sural Nerve. Objective. The goal of this study is to know whether SNAP amplitude can be used to diagnose polyneuropathy. Methods. The study design is diagnostic test in cross-sectional method. Results. Samples were taken from 108 ENMG medical records of Neurology Department Saiful Anwar General Hospital during the whole 2014. Two variables which are compared are polyneuropathy diagnosis and SNAP amplitude. Fisher test shows significant differences between the two with p = 0.04. Diagnostic test shows sensitivity 68.3%, spesifisity 80%, positive predictive value 97.1%, and negative predictive value 20.5%. Conclusion. There is a significant relationship between SNAP amplitude reduction with the diagnosis of polyneuropathy.

Effectiveness of Pelotherapy in carpal tunnel síndrome

Carpal tunnel syndrome (CTS) is the most common neuromuscular cause of upper extremity disability. We aimed to investigate the effectiveness of peloid therapy in patients with CTS. This randomized, controlled, single-blind study enrolled 70 patients between the ages of 30 to 65 who had a diagnosis of either mild, mild-tomoderate, or moderate CTS. The patients were randomized into two groups using random number table. In the first group, (Group 1) (n = 35), patients were given splint (every night for 6 weeks) + peloid treatment(five consecutive days a week for 2 weeks) and in the second group, (Group 2) (n = 28), patients received splint treatment (every night for 6 weeks) alone. The patients were assessed by using visual analog scale (VAS) for pain, electroneuromyography (ENMG), the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ), hand grip strength (HGS), finger grip strength (FGS), and Short Form-12 (SF-12). The data were obtained before treatment (W0), immediately after treatment (W2), and one month after treatment (W6). Both in Group 1 and 2, there was a statistically significant improvement in all the evaluation parameters at W2 and W6 when compared to W0 (p < 0.05). Comparison of the groups with each other revealed significantly better results for VAS, BCTSQ, mSNCV, SF-12 in Group 1 than in Group 2 at W2 (p < 0.05). There was also a statistically significant difference in favor of Group 1 for VAS, BCTSQ, FGS and MCS at W6 when compared to W0 (p < 0.05). The results of our study demonstrated that in patients with CTS; peloid + splint treatment was more effective than splint treatment alone in pain, functionality and life quality both at after treatment (W2) and one month after treatment (W6). We may suggest peloid as a supplementary therapeutic agent in CTS.

Dynamics of neurologic disturbances on the background of combined therapy in patients with type 2 diabetes

The aim of the research was to study the dynamics of neurologic disorders in the context of combined therapy in patients with type 2 diabetes mellitus. We examined 50 patients with diabetic polyneuropathy aged 50-70 years, with more than 12 months disease duration. The main group (n=30) included the patients who received 18 injections of Cocarnit against the background of hypoglycemic therapy. The control group patients (n=20) received only hypoglycemic therapy. The intensity and character of the pain on the background of the therapy was assessed on the TSS and NSS scales. An objective evaluation of the neurological status was performed using NDS. The state of the neuromotor apparatus was studied using stimulation electroneuromyography (ENMG) on motor fibers. As a result of the study, patients in the main group experienced a significant improvement in the NSS, TSS, NDS scales, as well as a decrease in the latent period, an increase in the M-response amplitude and n. peroneus impulse conduction rate. The obtained data confirm the efficacy and high safety profile of Cocarnit in the treatment of diabetic polyneuropathy in patients with type 2 diabetes.

Prevalence of carpal tunnel syndrome and its correlation with pain amongst female hairdressers.

Carpal tunnel syndrome (CTS) may develop with repetitive and forced movements of the hands and wrists. In this study, we have aimed to evaluate whether the frequency of CTS is increased amongst female hairdressers as compared with unemployed women or not. Besides, we have also analyzed whether the functionality and pain intensity levels amongst female hairdressers with CTS are different from the ones of unemployed women with CTS or not. The consecutive female hairdressers and unemployed women who had referred to our electroneuromyography (ENMG) laboratory for the upper extremity nerve conduction studies were included. They were evaluated in terms of clinical and ENMG findings, socio-demographic characteristics, functionality and pain intensity levels determined with the Boston CTS Questionnaire and visual analog scale (VAS). In this study, 110 women (70 female hairdressers and 40 unemployed women) were included. The frequency of CTS among hairdressers (74.3%) was higher than the one of the unemployed control group (55%) (p = 0.032). We detected that as the time period of occupation in hairdressing increased, the risk of developing CTS also increased among hairdressers (p < 0.001). Additionally, pain intensity and functional loss levels were higher for hairdressers with CTS than those for the control group with CTS (p = 0.005, p < 0.001, p = 0.028, respectively). The frequency of CTS is elevated for female hairdressers with respect to the unemployed women as in many other occupations requiring forced or repetitive hand movements. Besides, the occupational exposure in hairdressing also results in more elevated pain intensity and functional loss levels related with CTS as compared with the unemployed subjects. Int J Occup Med Environ Health 2018;31(3):333-339.

Injury of the external branch of the superior laryngeal nerve in thyroid surgery.

The external branch of the superior laryngeal nerve (EBSLN) innervates the cricothyroid muscle (CTM) to promote lengthening and thinning of the vocal fold, thus increasing voice pitch. The close relation with the superior thyroid vessels (STV) puts the EBSLN in risk every time the superior pole of the thyroid is dissected. It travels downward to innervate the CTM, lateral to the thyroid cartilage and to the inferior pharyngeal constrictor muscle (IPCM), being eventually covered by this muscle fibers as it approaches its entry point. During its descending course, the EBSLN curves and crosses the STV posteriorly. The lower this crossing occurs in the neck, the higher the risk of surgical damage to the nerve by transection, traction, entrapment, thermal damage or disrupted blood supply. The chances of surgical trauma are also increased by size and weight of the specimen, shorter neck length and non-white ethnicity. Voice changes following thyroid surgery are common and multifactorial. The actual rate of vocal impairment due to EBSLN injury is unclear, since changes to the everyday speaking voice can be minimal and laryngeal findings are usually subtle and controversial. CTM electroneuromyography (EMG) is the most accurate tool to diagnose abnormal EBSLN conductivity, but it is technically difficult and barely applicable in routine practice. Recommended approaches to prevent injury include: (I) individual distal ligature of the STV by the thyroid capsule; (II) visual identification of the nerve and its trajectory and (III) electrostimulation with either observation of CTM twitch or intraoperative nerve monitoring (IONM) via dedicated endotracheal tube electrodes. There is accumulating evidence that a combination of visual and standardized electrophysiological EBSLN identification with meticulous division of the STV improves preservation rates. IONM bears the additional benefits of prognostication, quantification and documentation of neural function once it allows intraoperative laryngeal EMG.

Efficacy of paraffin wax bath for carpal tunnel syndrome: a randomized comparative study

Carpal tunnel syndrome (CTS) is the most frequently diagnosed neuropathy of upper extremity entrapment neuropathies. We aimed to investigate the effectiveness of paraffin therapy in patients with CTS. Seventy patients diagnosed with mild or moderate CTS were randomly divided into two groups as splint treatment (during the night and day time as much as possible for 3weeks) alone and splint (during the night and day time as much as possible for 3weeks)+paraffin treatment (five consecutive days a week for 3weeks). Clinical and electrophysiological assessments were performed before and 3weeks after treatment. The patients were assessed by using visual analog scale (VAS) for pain, electroneuromyography (ENMG), and Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ). The significant improvement was found in VAS scores in both groups when compared with pretreatment values (p<0.05). There was no significant improvement in functional capacity score (p>0.05), whereas a significant improvement was noted in the BCTQ symptom severity scale score in the splint group (p<0.05). Significant improvements were demonstrated in both scorers in the combined treatment group. Similarly, significant improvements were found in the combined treatment group in terms of motor and sensory distal latency, sensory amplitude, and median sensory nerve velocity (p<0.05). There was no significant change in electrophysiologic parameters in the splint group (p>0.05), and the difference in these parameters between the groups was statistically significant (p<0.05). In conclusion, using splinting alone in patients with CTS is an effective treatment for reducing symptoms in the early stages. Paraffin treatment with splint increases the recovery in functional and electrophysiological parameters.

The lack of H-reflex as an additional neurophysiological sign of development of acute inflammatory demyelinating polyneuropathy in children

bstract Early diagnosis of acute inflammatory demyelinating polyneuropathy (AIDP) is of fundamental importance for the timely prescription of therapy. The conventionally used techniques of electrophysiological diagnosis are not sensitive enough at early stages of development of the condition. The objective of this work was to assess the applicability of studying H-reflex as a tool for early diagnosis of AIDP in children. Materials and Methods. A total of 57 children were examined: 20 healthy children (range: 7–14 years; mean age 12 years) and 37 patients diagnosed with AIDP (range: 8-13 years; mean age 11 years). Electroneuromyography (ENMG) was performed on day 3–7 after the first symptoms had emerged. The velocity of impulse conduction along motor fibers, the amplitude of M responses during stimulation of nn. tibialis, ulnaris and medianus , as well as latency and threshold of M response and H-reflex during stimulation of m. soleus , was evaluated. Results. No significant intergroup differences in amplitudes of motor responses and the velocity of impulse conduction were recorded, while the residual latency of M-response was significantly higher in the AIDP group. In individuals in the control group, the H-reflex was recorded in 100% of cases, while being recorded only in 2 (5.4%) patients in the AIDP group. In both patients, examination was performed as early as possible (day 3) after the onset of the first symptoms among the entire group examined. Conclusions. In pediatric patients with AIDP, which develops on day 3–7 after the onset of the first symptoms, no H-reflex was recorded in 94.6% of cases. Investigation of the H-reflex at the early stage of AIDP in children can be used as an additional criterion for diagnosing the disease.

Effects of Canine and Murine Mesenchymal Stromal Cell Transplantation on Peripheral Nerve Regeneration.

Background and ObjectivesMaintaining a permissive microenvironment is essential for adequate nerve regeneration. Cell-based therapy has the potential based cell replacement and promotion of axonal growth. The adipose tissue derived mesenchymal stromal cells (Ad-MSC) attract interest because neuroregenerative and anti-inflammatory properties. The aim of this study was to evaluate the effects of canine and murine Ad-MSC transplantation on the sciatic nerve regeneration.MethodsForty Wistar rats were divided randomly into: control group - CG (n=8); denervated group - DG (n=8); decellularized vein group - VG (n=8); decellularized vein+canine MSC–cMSC (n=8); descellularized vein+murine MSC–mMSC (n=8). After 10-mm nerve gap, the tubulation technique was performed with decellularized vein filled with 106 MSC labeled with quantum dots (Qtracker 665®). The sciatic nerve functional index (SFI) and electroneuromyography (ENMG) measurements were carried and morphometric and immunohistochemistry analysis of the tissue.ResultsThe SFI values were higher in the cMSC and mMSC groups at day 27 (p<0.020) and day 35 (p<0.011). The ENMG analysis also revealed better results in the mMSC group. Density, number, and total area of the fibers were increased in the mMSC and cMSC groups. Brain-derived neurotrophic factor BDNF and S-100 protein positive immunoreactivity showed a higher expression for both in the nerve of the mMSC and cMSC groups. The MSC labeled with quantum dots were detected at day 35, indicating neuronal survival long after the nerve damage.ConclusionsMurine and canine Ad-MSC associated with decellularized vein scaffold had positive effects on sciatic nerve regeneration in rats.

Effectiveness of PELOID therapy in carpal tunnel syndrome: A randomized controlled single blind study.

Carpal tunnel syndrome(CTS) is the most common neuromuscular cause of upper extremity disability. We aimed to investigate the effectiveness of peloid therapy in patients with CTS. This randomized, controlled, single-blind study enrolled 70 patients between the ages of 30 to 65 who had a diagnosis of either mild, mild-to-moderate, or moderate CTS. The patients were randomized into two groups using random number table. In the first group, (Group 1)(n=35), patients were given splint (every night for 6weeks)+peloid treatment(five consecutive days a week for 2weeks) and in the second group, (Group 2)(n=28), patients received splint treatment(every night for 6weeks) alone. The patients were assessed by using visual analog scale(VAS) for pain, electroneuromyography(ENMG), the Boston Carpal Tunnel Syndrome Questionnaire(BCTSQ), hand grip strength(HGS), finger grip strength(FGS), and Short Form-12(SF-12). The data were obtained before treatment(W0), immediately after treatment(W2), and one month after treatment(W6). Both in Group 1 and 2, there was a statistically significant improvement in all the evaluation parameters at W2 and W6 when compared to W0(p<0.05). Comparison of the groups with each other revealed significantly better results for VAS, BCTSQ, mSNCV, SF-12 in Group 1 than in Group 2 at W2(p<0.05). There was also a statistically significant difference in favor of Group 1 for VAS, BCTSQ, FGS and MCS at W6 when compared to W0 (p<0.05). The results of our study demonstrated that in patients with CTS; peloid+splint treatment was more effective than splint treatment alone in pain, functionality and life quality both at after treatment(W2) and one month after treatment (W6). We may suggest peloid as a supplementary therapeutic agent in CTS.

Demonstration of autonomic dysfunction in traumatic brachial plexus injury using quantitative sudomotor axon reflex test: Preliminary results.

To objectively document autonomic dysfunction in the affected arm with traumatic brachial plexus injury (TBPI) using quantitative sudomotor axon reflex test (QSART). Patients with TBPI presenting to the neurosurgical outpatient department from August 2013 to November 2014 were included in the study. The QSART was administered to each patient with prior informed consent detailing the procedure. A total of 20 patients with TBPI were included in the study. The age, sex, mode of injury, date of injury, side of injury, and type of injury (pan brachial plexus vs preserved distal function) were recorded. The presence of any pain was also recorded. The injuries were also grouped as preganglionic and postganglionic injuries based on clinical, electroneuromyography (ENMG) and magnetic resonance imaging (MRI) findings. The results of the test for the affected and normal limb were recorded and analyzed with appropriate statistical tests to determine any significant differences. The study included 20 patients, with their age ranging from 15 to 50 years. Out of the 20 patients, one was female and the rest 19 were males. Seven (35%) of the injuries were complete (pan brachial plexus) and 13 (65%) were incomplete (preserved distal function). All patients had preganglionic TBPI. There was no evidence of any statistically significant difference between the affected and normal arm for total sweat volume (P = 0.20) and latency period (P = 0.42). However, the average mean values for the same were lower in the affected arm as compared to the normal. The baseline sweat output (P = 0.010), however, was significantly lower in the affected arm as compared to the normal arm. QSART has demonstrated reduced baseline sweat output in the affected arm in patients with TBPI. This indicates the presence of autonomic dysfunction in the injured arm.

ФУНКЦИОНАЛЬНАЯ ДИАГНОСТИКА И ИГЛОРЕФЛЕКСОТЕРАПИЯ У ПАЦИЕНТОВ С ОСТЕОХОНДРОЗОМ ШЕЙНОГО ОТДЕЛА ПОЗВОНОЧНИКА

We developed an algorithm for spinal diagnostics to optimize the diagnosis and treatment of patients with cervical osteochondrosis. This algorithm includes physical and neurological examination of a patient, radiological methods, multi-layer spiral CT (MRI) of cervical spine, densitometry and electroneuromyography (ENMG) and is used in practical work of neurosurgical unit of Irkutsk Scientific Center of Surgery and Traumatology. We managed 40patients with cervical osteochondrosis in period I–III localized in CIII–CIV, CIV–CV, CV–CVI, CVI–CVII segments and with severe muscular tonic syndrome (cervicalgia, cervical cranialgia, cervicobrachialgia). Patients with osteochondrosis in period I–II had medium decreased conduction of peripheral nerve motor fibers on both sides of spine, which indicates the lesion of some motor fibers. In patients with osteochondrosis in period III in case of protrusion and herniation of intervertebral discs the ENMG values corresponded to the increase in neurility and conduction velocity of motor nerve and muscle fibers in diseased segment.Conservative treatment was conducted up to the Standard approved by the Ministry of Health of the Russian Federation and was supplemented with acupuncture (9–10 sessions) based on the changes in ENMG values. Performed treatment caused significant decrease in pain syndrome, reduction of neurological manifestations and, as a consequence, positive dynamics of ENMG values. Proposed algorithm for management of patients with osteochondrosis allowed to diagnose the localization of diseased functional spinal unit, to reveal problem peripheral nerves and, as a result, to choose adequate treatment tactics and to estimate its effectiveness.