Electrophysiological Features Of Patients Research Articles

Persistent Atrial Fibrillation Phenotypes and Ablation Outcomes: Persistent From Outset vs Progression From Paroxysmal AF

BackgroundMany patients with persistent atrial fibrillation (PsAF) have progressed from an initial paroxysmal phenotype; however, there are patients in whom atrial fibrillation (AF) is persistent at diagnosis. Relatively little is known about this subgroup, but prior observational studies have suggested these patients have worse outcomes with ablation. ObjectivesThis study sought to: 1) assess demographic and electrophysiologic characteristics of patients with PsAF at first diagnosis compared with those with who have progressed from paroxysmal atrial fibrillation (PAF); and 2) assess the impact of pattern of AF at diagnosis on recurrence post ablation. MethodsCAPLA (Catheter Ablation for persistent atrial fibrillation: A Multicentre randomised trial of Pulmonary vein isolation [PVI] vs PVI with posterior Left Atrial wall isolation [PWI]) was a multicenter trial that randomized patients with PsAF to PVI plus PWI or PVI alone. Follow-up was 12 months. Outcomes were assessed after a 3-month blanking period. ResultsA total of 334 patients were included (median age 65.6 years, 23.1% female), 194 (58.1%) had PsAF at first AF diagnosis and 140 (41.9%) had PAF. Patients with PsAF at diagnosis were younger (age 64.0 vs 67.7 years, P = 0.005), had higher rates of heart failure (P < 0.001), and lower left ventricular ejection fraction (54.5% IQR: 40-60 vs 60% IQR: 50-61, P = 0.007). AF recurrence occurred in 85 (43.8%) with PsAF at diagnosis and 70 (50%) with PAF at diagnosis. PsAF at diagnosis was not associated with risk of recurrence on univariable (HR: 0.802; 95% CI: 0.585-1.101; P = 0.173) or multivariable analysis (HR: 0.922; 95% CI: 0.647-1.312; P = 0.650). Median AF burden was 0% in both groups (P = 0.125). There was no difference in left atrial size (P = 0.337) or bipolar voltage (P = 0.579) between the groups. ConclusionsIn the CAPLA cohort of patients, pattern of AF at first diagnosis did not influence post-ablation rate of AF recurrence or AF burden. (Catheter Ablation for persistent atrial fibrillation: A Multicentre randomised trial of Pulmonary vein isolation [PVI] vs PVI with posterior Left Atrial wall isolation [PWI]; ACTRN12616001436460)

Clinical, etiological, and electrophysiological characteristics of patients with peripheral nerve damage caused by the February 6 earthquake in Türkiye

Objectives: This study aimed to analyze the clinical, etiological, and electrophysiological characteristics of the February 6 earthquake victims referred to our center due to nerve damage. Patients and methods: In this retrospective study, the demographic characteristics and findings of clinical examinations of 36 earthquake victims (25 females, 11 males; mean age: 31.6±15.5 years; range, 5 to 61 years) referred to our electrophysiology laboratory during the four-month period following the February 6 earthquake were investigated. The patients’ time spent under rubble, affected extremities, and electrophysiological findings were evaluated, and the locations of their lesions were determined using electromyography. Results: The mean time spent under rubble was 14.94±18.62 h, and 31 (86.1%) patients experienced partial nerve damage. Nerves were affected peripherally in 23 (74.2%) patients, at the lumbosacral plexus level in four (12.9%) patients, and at the brachial plexus level in another four (12.9%). Patients who were under rubble for more than 6.5 h had an increased risk of developing crush syndrome (p=0.014), and those under rubble for more than 8.5 h had an increased risk of developing compartment syndrome (p=0.008). Conclusion: The duration of exposure to rubble has been identified as a significant factor in the severity of nerve injury, as well as the development of compartment syndrome and crush syndrome. Therefore, the potential for peripheral nerve injury, which is a significant cause of morbidity, should be considered in the follow-up of patients who have survived earthquakes.

Analysis of the characteristics of patients with amyotrophic lateral sclerosis with neuromuscular junction dysfunction prior to motor neuron degeneration

Objective: To investigate the clinical and electrophysiological characteristics of patients with amyotrophic lateral sclerosis (ALS) with positive repetitive nerve stimulation (RNS) test results on the accessory nerve and negative needle electromyography (EMG) test results on the sternocleidomastoid with the goal to enrich the knowledge of disease progression in patients with ALS. Methods: The clinical data of 612 patients diagnosed with ALS at the Neurology Department of the First Medical Center, Chinese PLA General Hospital from June 2016 to August 2022 were collected. In total, 267 cases had undergone EMG tests on the sternocleidomastoid following a positive 3 Hz RNS test result on the accessory nerve, who were selected as the study subjects. The differences in clinical indicators were compared between RNS (+)/EMG (-) group and RNS (+)/EMG (+) group. A binomial distribution model with multiple variables was built to quantitatively analyze the major factors and their effects. Results: At the initial visit, 15.8% of patients with ALS were 3 Hz RNS (+) on the accessory nerve and EMG (-) on the ipsilateral sternocleidomastoid, accounting for 36.3% of RNS (+) patients. The decremental range of the 3 Hz RNS test delivered to the accessory nerve in these patients [-14% (-19%, -12%)] was lower than that in patients with RNS (+)/EMG (+) [-17% (-23%, -13%)] (P<0.05), while the ratio of upper limb onset (64.9%) and non-definite diagnosis (28.9%) were higher [54.7% and 13.5% for patients with RNS (+)/EMG (+), P<0.05]. Furthermore, the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) score [40 (37, 42)], body mass index (BMI) [23.8 (22.0, 25.4) kg/m2] and forced vital capacity (FVC) [92.8% (76.6%, 103.8%)] were higher in patients with RNS(+)/EMG(+) (P<0.05). The multivariate model suggested that, in patients with RNS (+)/EMG (-), the ratio of upper limb onset to lower limb onset was 1.04, while that of upper limb onset to bulbar onset was 2.02, and that of lower limb onset to bulbar onset was 1.94. The ratio of non-definite ALS to definite ALS was 1.13. The ALSFRS-R score, BMI, and FVC had a protective contribution to the electrophysiological function of the motor neurons. The ratio of the effect size of the ALSFRS-R or BMI to that of FVC was 3.37 and 1.14, respectively. Conclusions: Patients with ALS that were 3 Hz RNS (+) on the accessory nerve and EMG (-) on the ipsilateral sternocleidomastoid had a smaller decremental range of the compound muscle action potential amplitude, and a higher proportion of upper limb onset and non-definite ALS. A higher ALSFRS-R score, BMI, and FVC have a protective effect to the electrophysiological function of motor neurons. The effect size of the ALSFRS-R score is the largest, followed by BMI and FVC.

Study of P wave dispersion in patients with paroxysmal atrial fibrillation and its role in prediction of atrial fibrillation recurrence

BackgroundIt has been known that increased P wave duration and P wave dispersion reflect prolongation of intra-atrial and interatrial conduction time and the inhomogeneous propagation of sinus impulses, which are well-known electrophysiologic characteristics in patients with atrial arrhythmias and especially paroxysmal atrial fibrillation. The objective of this study was assessment of P wave dispersion value in cases with paroxysmal atrial fibrillation and its role in predicting recurrence.ResultsForty-eight patients with documented paroxysmal AF were subjected to clinical evaluation, electrocardiogram and routine Doppler echocardiogram. We found that a statistically significant association was detected between P wave dispersion and older age, diabetic and hypertensive cases with positive correlation also detected with left atrial dimension (LAD), left ventricle size and diastolic dysfunction grade. Mean corrected P wave dispersion and corrected QT interval were higher among cases using sotalol, ca channel blockers, among cases using nitrates and among cases with Morris index > 0.04. Higher mean value of corrected QT was associated with biphasic P v1 shape. Old age, female sex, P wave dispersion and QT wave dispersion are statistically significant predictors of PAF recurrence.ConclusionP wave dispersion in patients with paroxysmal atrial fibrillation was strongly correlated to older age, diabetic and hypertensive patients and also with left atrial dimension (LAD), left ventricle size and diastolic dysfunction grade. Also, mean corrected P wave dispersion can predict atrial fibrillation recurrence in patients with Morris index > 0.04, old age, female sex, and QT wave dispersion.

Clinical/electrophysiologic characteristics of infranodal Wenckebach in patients with indication for permanent ventricular pacing: A prospective study

BackgroundInfranodal Wenckebach is rare and not well characterized. ObjectiveWe prospectively studied clinical and electrophysiologic characteristics of patients with atrioventricular (AV) Wenckebach with an indication for permanent ventricular pacing. MethodsDuring a 2-year period, all patients with an indication for permanent ventricular pacing underwent targeted preimplantation electrophysiologic study. Clinical and electrophysiologic characteristics at presentation and ventricular pacing percentage at 6-month follow-up were evaluated. ResultsA total of 163 patients (median age, 68 [interquartile range, 60–74] years; male, 59%; median QRS duration, 110 [90–130] ms; complete AV block in 123 [75.5%]) were included. AV Wenckebach was noted in 22 (13.4%) patients (median age, 70 [63–76.5] years; male, 54%; median QRS duration, 120 [110–140] ms) and classified as infranodal (12/163 [7.3%]) vs AV nodal (10/163 [6.1%]). Patients with infranodal Wenckebach (infrahisian in all), compared with AV nodal Wenckebach, demonstrated higher frequency with left ventricular ejection fraction ≤40% (41.7% vs 0%; P = .04), longer median HV interval (90 vs 49 ms; P = .005), lower frequency of isolated first-degree AV block (8.3% vs 60%; P = .02), higher frequency of right bundle branch block with left anterior fascicular block (75% vs 10%; P = .003), lesser PR increment at onset of AV Wenckebach (20.5 vs 80 ms; P = .002), and onset of 2:1 AV block at longer cycle lengths (91.7% vs 20%; P = .002). ConclusionOf patients referred for pacemaker implantation, infranodal Wenckebach was present in 27.5% (11/40) without complete AV block. It was as frequent as AV nodal Wenckebach and associated with characteristic electrophysiologic findings.

Evaluation of cardiac electrophysiological features in patients with premature adrenarche.

This study aimed to analyze the cardiac effects of hyperandrogenism in premature adrenarche (PA) and evaluate the risk of arrhythmia development. Fifty patients with PA and 50 healthy children from a pediatric endocrinology outpatient clinic were included in the study. The patients underwent echocardiography and electrocardiographic evaluations. Conventional echocardiography, tissue Doppler echocardiography, repolarization time, and repolarization dispersion time were evaluated. The median age in the PA and control groups was 7.91 years (5.83-9.25), 8.08 years (5.75-9.33), respectively. Thirty percent of patients in the PA group were male. While mitral early diastolic velocity deceleration time (DT), isovolumetric relaxation time (IRT), and E/e' ratio were significantly higher in the PA group than in the control group, mitral lateral annulus tissue Doppler early diastolic velocity was significantly lower (p=0.0001, 0.0001, 0.003, 0.0001). While P wave dispersion (PWD), Tpe, and QT-dispersion (QT-d) values were significantly higher in the PA group than in the control group, the P minimum value was significantly lower in the PA group (p=0.0001, 0.02, 0.004, and 0.0001, respectively). Early subclinical diastolic dysfunction was observed in the PA group. There was an increased risk of atrial arrhythmia with PWD and an increased risk of ventricular arrhythmia with increased Tpe and QT-d. There was a correlation between testosterone levels and diastolic function parameters. The increased risk of atrial arrhythmia is closely related to diastolic function.

Study on the clinical and electrophysiological characteristics of nerve function in myasthenia gravis patients in Vietnam.

In Vietnam, there is limited research on the role of nerve conduction in myasthenia gravis and its association with clinical features. This study aims to describe the electrophysiological features in patients with myasthenia gravis. This descriptive study was conducted from September 2019 to December 2021. The study included 33 myasthenia gravis patients who sought medical consultation or received inpatient treatment during this period. The Myasthenia Gravis Foundation of America classifies myasthenia gravis into five groups: I, IIa, IIb, IIIa, IIIb, IVa, IVb, and V. Notably, Group I involves pure ocular weakness, whereas Group a primarily impacts limb and axial muscles, and Group b mainly affects bulbar and respiratory muscles. The study revealed that motor and sensory nerve conduction in the upper and lower limbs were within normal limits for the patient group under evaluation. Repetitive nerve stimulation testing at a frequency of 3 Hz showed positive results in 66.7% of myasthenia gravis patients. Myasthenia gravis patients displayed distinct clinical symptoms, with ptosis being the most common (87.9%). Myasthenia Gravis Foundation of America classification indicated the highest proportion in subgroup IIa (24.2%), with myasthenia gravis predominating in limb and axial muscles (Group a) observed in 51.5% of cases. Needle electromyography showed no abnormalities in myasthenia gravis patients. There was an association between acetylcholine receptor antibody titers and the results of the 3 Hz repetitive nerve stimulation test in myasthenia gravis patients, with a significance of p = 0.002. Nerve conduction studies should be performed in patients with suspected neuromuscular disorders to aid in differential diagnosis and definitive diagnosis of myasthenia gravis.

Clinical characteristics and electrophysiological features in patients with persistent atrial fibrillation undergoing radiofrequency energy ablation

Objective: To investigate the clinical and paraclinical characteristics and electrophysiological features after cardioversion in patients with persistent atrial fibrillation (AF). Subejct and method: This was a prospective study of 40 patients with persistent AF who underwent catheter ablation of AF using a three-dimensional (3D) system at the Vietnam Heart Institute, Bach Mai Hospital. Result: The mean age of the patients was 54.25 ± 12.54 years, and 80% of patients were male, the symptoms (according to EHRA) of patients ranged from grade IIb (67.5%) to grade III (32.5%). Hypertension (42.5%) and alcohol abuse (37.5%) were the most common risk factors. After cardioversion, patients with persistent AF exhibited longer sinus node recovery time (SNRT) (1445.11 ± 547.33ms) and corrected SNRT (667.03 ± 517.21ms) than healthy controls. Conclusion: Persistent AF is common in the elderly, especially men, with prevalent risk factors, such as hypertension and alcohol abuse. After cardioversion, patients with persistent AF have an SNRT longer than normal.

Clinical and Electrophysiological Characteristics of Patients with Juvenile Absence Epilepsy in a Turkish Cohort

Juvenile absence epilepsy is an epileptic syndrome that usually begins between the ages of 9-13 and is classified in the group of genetic generalized epilepsies, in which absence seizures are seen mainly but may also be accompanied by motor seizures in the follow-up. In our study, 33 patients who were followed up in our clinic with the diagnosis of juvenile absence epilepsy between 2010-2022 were evaluated retrospectively. Thirteen of them were excluded from the study due to insufficient clinical or electrophysiological knowledge, being diagnosed with another epileptic syndrome during follow-up. The mean age of the 20 patients included in the evaluation was 16.8 years; The mean age of seizure onset was 10.6 years. All patients had absence seizures, which were not seen more often than once a day, 40% had additional generalized tonic-clonic seizures, and 20% had focal electroencephalographic abnormalities in addition to generalized discharges on electroencephalography. Seizures recurred in 3 of 5 patients whose treatment was terminated. It was found that currently 85% of the patients continued treatment with valproic acid and monotherapy was sufficient. While there are generalized discharges at the time of diagnosis electrophysiologically, focal findings tend to occur in the follow-up; This was also found to be important in the evaluation of seizure recurrence and treatment options in patients with long-term follow-up.

Electrophysiological Characteristics of Cervical Spinal Stenosis.

Objective To investigate electrophysiological characteristics of patients with cervical spinal stenosis (CSS) due to cervical disc herniation. Methods A total of 51 patients with CSS diagnosed in our hospital from January 2018 to March 2020 were selected. According to magnetic resonance imaging (MRI), the degree of spinal cord compression was divided into 1-3 grades, namely, group A (MRI grade 1), group B (MRI grade 2), and group C (MRI grade 3), with 17 cases in each group. Subsequently, we analyzed the correlation of the degree of spinal cord compression with the general information, clinical data, and electromyography (EMG) of patients. Results Compared with group A and group B, group C had the longest disease course [(48.06 ± 17.71) months], the lowest JOA score (4.59 ± 2.15), and the highest number of positive results of EMG (EMG: A/B/C, 25/51/77); there were significant differences among the 3 groups. And group C had the higher number of positive cases of both upper and lower limbs in SEP test compared with the other two groups (SEP: A/B/C: 12/18/29: χ2 = 7.559, P = 0.023). According to correlation analysis, MRI grading had no association with gender, age, and spinal canal diameter/volume but was positively correlated with disease course and negatively correlated with JOA score. Conclusion This study primarily verifies that higher MRI grade of CSS is associated with longer disease duration and lower JOA score and EMG. The obtained results secondarily demonstrate the correlation between abnormal neurological status and the MRI grade.

Diagnostic possibilities of cognitive EEG in patients with dyscirculatory encephalopathy with mild cognitive impairment

Object: identification of electrophysiological features in patients with dyscirculatory encephalopathy at the stage of moderate cognitive disorders according to the developed scenario of registration of EEG with cognitive load. Materials and methods: the study was conducted in the conditions of MBUZ GB No. 1 «Polyclinic for adults», Department of Medical and Biological Physics of the Rostov State Medical University during 2016-2019. A total of 80 patients with dyscirculatory encephalopathy and vascular risk factors were examined, who made up 3 observation groups: «A», «B» and «C». Group «A» is represented by patients with grade I and II DEP and concomitant moderate cognitive disorders, group «B» — patients diagnosed with grade I DEP, cognitively healthy according to the results of neuropsychoological testing (40 and 25 people, respectively), control group «C» —15 people, without manifestations of DEP and cognitive disorders. All patients underwent electroencephalogram registration using the Encephalan-131-03 device. Results: the detected neuropsychiatric disorders in patients with DEP are a reflection of violations of the bioelectric activity of the brain. A tendency to shift bioelectric activity towards slow waves has been revealed according to statistical analysis. The aggravation of the degree of cognitive disorders correlates with a decrease in the activity of the a-rhythm by 12% and an increase in the activity of the δ-rhythm by 16%. According to the spectral analysis, the reflection of cognitive impairments on the parameters of the α- and δ-rhythm was also revealed. As the power of the α-rhythm decreases and above the δ-rhythm, the pathological processes associated with cognitive impairment in the brain in patients with DEP are aggravated. Also among the pathognomonic changes detected by spectral analysis is a significant asymmetry in all leads, and it was especially pronounced in the frontal (Fp1, Fp2) and temporal (T3, T4, T5, T6) areas of the brain. Conclusions: Thus, a new method for studying the EEG in patients with DEP makes it possible to detect characteristic differences, the most significant changes were found in the α- and δ-bands. Changes in cognitive activity reflected in the EEG can serve as additional diagnostic criteria, provided that the experiment is extended.

A diagnostic score for anti-myelin-associated-glycoprotein neuropathy or chronic inflammatory demyelinating polyradiculoneuropathy in patients with anti-myelin-associated-glycoprotein antibody.

A diagnostic score was developed to discriminate anti-myelin-associated-glycoprotein (MAG) neuropathy from chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and applied it to patients with atypical anti-MAG neuropathy. The clinical and electrophysiological features of patients with a diagnosis of typical anti-MAG neuropathy were compared to those of patients with a diagnosis of CIDP. The association of each feature with the diagnosis was assessed in the two groups. Features showing a significant association with the diagnosis were included in a multivariable logistic regression model and adjusted odds ratios were estimated for each feature. A score ranging from 1 to 3 was applied to each feature based on the magnitude of the estimated odds ratios. The score was then applied to patients with a clinical diagnosis of CIDP who also had high anti-MAG antibody titers (CIDP-MAG). Thirty-one anti-MAG neuropathy patients, 45 typical CIDP patients and 16 CIDP-MAG patients were included. Scores in anti-MAG antibody patients ranged from 1 to 5 and in CIDP patients from -7 to -1. Using the score, 4/16 CIDP-MAG patients were diagnosed to have anti-MAG neuropathy and 12/16 patients to have CIDP. Response to intravenous immunoglobulin in the CIDP-MAG patients classified as CIDP was similar to that of definite CIDP patients and higher than that of anti-MAG neuropathy patients. Our score allowed an accurate discrimination to be made, amongst patients with anti-MAG antibodies, of those affected by CIDP and the patients with anti-MAG neuropathy. This score may help proper treatment to be chosen for patients with anti-MAG antibodies with a CIDP-like presentation.

Stepwise mapping and ablation algorithm in patients undergoing ablation of unstable, unmappable scar-based atrial tachycardias.

Scar based atrial tachycardia (AT)'s usually presents with a complex electrophysiological substrate. It is not uncommon that multiple instable ATs are present in a single patient. The aim of this study was to analyze clinical and electrophysiological characteristics of patients who had undergone ablation for instable ATs, and report outcomes of the stepwise substrate ablation procedure during the follow-up. Patients scheduled to undergo AT ablation were screened for enrollment to the study. When instable ATs were diagnosed a stepwise mapping and ablation algorithm was applied to all patients. After the procedure, patients were clinically and electrocardiographically followed. Twenty-six patients were enrolled in the study. The mean number of ATs observed during the procedures is 3.1±0.7. At the end of the procedure, 18 (69.2%) patients had isolated posterior wall. Anterior mitral line ablation was successfully performed in 13 (50%), mitral isthmus line in 4 (15.4%), roof line in 4 (15.4%) patients. The mean follow-up was 13.5±5.4 months. During the follow-up period 6(23.1%) patients developed arrhythmia recurrence. A reasonable mid-term success can be expected in patients with instable ATs undergoing ablation according to the stepwise substrate modification algorithm, however due to extensive ablation it should be reserved for patients where conventional activation mapping cannot be performed.

Association between Guillain-Barré syndrome and COVID-19 infection: Experience of a Turkish neurophysiology laboratory

Coronavirus disease 2019 (COVID-19) has affected the practice of neurology and other medical fields. The neurological complications associated with SARS-CoV-2 infection are remarkable. In this study, we investigated the clinical and electrophysiological characteristics of patients with Guillain-Barré syndrome (GBS) caused by COVID-19 diagnosed between 1 September 2020 and 30 November 2020. This study included patients diagnosed with GBS clinically and electrophysiologically between September-November 2020 (pandemic period) and September-November 2019 (prepandemic period). Patients with GBS during the pandemic period, who were diagnosed with COVID-19 within 6 weeks before neuropathic symptoms developed, were included in the study. Pandemic period GBS patients were grouped as GBS associated with COVID-19 (n=13), and prepandemic period patients were grouped as GBS non-associated with COVID-19 (n=7). Demographic, clinical, electrophysiological and laboratory data of these two patient groups were compared. The most common symptoms were fever and cough (46.2%) in GBS associated with COVID-19 group and diarrhoea (71.4%) in GBS non-associated with COVID-19 group during active infection period. In the GBS associated with COVID-19 patients, lung involvement was apparent in 12 (92.3%) during active viral infection. A positive and significant correlation was observed in GBS associated with COVID-19 patients between comorbid factors and a need for ventilation support. GBS cases associated with COVID-19 may have a more severe course, especially if they have comorbidities. It is important to define the unique clinical, electrophysiological, and laboratory findings of such patients to optimise follow-up, treatment and management.

Autoimmune retinopathy: clinical, electrophysiological, and immunological features in nine patients with long-term follow-up.

We aim to report on the clinical, imaging, immunological, and electrophysiological features of patients with autoimmune retinopathy (AIR) with long-term follow-up. Single-center, retrospective study of a consecutive group of AIR patients treated in a tertiary academic medical center. Included were nine patients with a mean ± SD age at presentation of 65 ± 13years and a median follow-up of 63months (range 18-120). Five patients were known to have cancer. Median interval between onset of ocular symptoms and diagnosis of AIR was 36months. Mean baseline and final LogMAR visual acuity were 0.72 ± 0.9 and 1.1 ± 1.2, respectively (p = 0.17). The most common funduscopic findings included optic atrophy and bone-spicule-like pigmentation. Thinning of the nerve fiber layer was the most frequent optical coherence tomographic abnormality. Electroretinographic (ERG) recordings demonstrated variably reduced cone- and rod-derived amplitudes in the majority of eyes at presentation. The most commonly detected anti-retinal antibody was anti-α-enolase. Treatment included immunomodulatory therapy and plasmapheresis. ERG tests showed stability in 64% of eyes throughout the treatment period. This study highlights the importance of maintaining a high index of suspicion of AIR, particularly in late middle-aged and elderly patients with "unexplained" visual loss, in light of the non-specific posterior segment signs and the inconsistency of the routinely used ancillary tests.

Myastenia Gravis Hastalarının Klinik Özellikleri: 138 Hastanın Değerlendirilmesi

Aim: The aim of this study was to evaluate the demographic characteristics, clinical presentation, antibody, and electrophysiological characteristics of patients with the diagnosis of Myasthenia Gravis (MG).&#x0D; Materials and Methods: The demographic characteristics, clinical presentation, antibody, electrophysiological and radiological (thoracic tomography) characteristics of the patients who were followed in the Neuromuscular and Muscular Diseases Polyclinic of the hospital between 2014-2019 were analyzed.&#x0D; Results: The mean age of the patients was 53.8±16.67 years. The mean disease duration was 4.8±5.05 years. Ptosis was the most common complaint in 79% (n=109) of our patients. The number of patients followed as pure ocular MG was 61.6% (n=85). There were 26 patients who presented with ptosis or diplopia at the first presentation and follow-up generalized MG with bulbar findings and weakness. Acetylcholine receptor antibody (AntiAChRAb) positivity was found in 78.3% (n=108) of the patients and thymus pathology was detected in thorax tomography in 37.7% (n=52).&#x0D; Conclusions: The initial complaint provides little insight into the course of the disease. The important factor is clinical follow-up. Although MG treatment is known, the pathophysiology of MG remains to be elucidated, and other autoimmune conditions cause changes in treatment choice. Clarifying the pathophysiology of MG will enable the development of more effective diagnostic and treatment methods.

Electrophysiological characteristics of patients with nitrous oxide abuse

ABSTRACT Objective : In the young generations with nitrous oxide abuse (N2O), featured electrophysiological response of the peripheral neuropathy caused by nitrous oxide remains to be defined. Methods : Patients with nitrous oxide abuse (20 cases), two variants of Guillain-Barré syndrome (GBS), that is, acute inflammatory demyelinating polyradiculoneuropathy (GBS-AIDP, 19 cases) and acute motor axonal neuropathy (GBS-AMAN, 18 cases), as well as diabetic peripheral neuropathy (DPN, 20 cases) were enrolled into this study. Electrophysiological parameters including distal motor latency (DML), motor nerve conduction velocity (MNCV), sensory nerve conduction velocity (SNCV), amplitudes of compound muscle action potential (CMAP), and sensory nerve action potential (SNAP) were measured and analyzed by comparing the parameters between the aforementioned patients groups as well as normal control group (20 subjects). Results : Compared to normal control subjects, patients with nitrous oxide abuse showed prolonged DML, slower MNCV and SNCV in the limbs, lower amplitudes of CMAP in the median, tibial and peroneal nerves, and lower SNAP in median and ulnar nerves. Abnormalities of MNCV and amplitudes of CMAP in the lower limbs were significantly higher than that in the upper limbs . Abnormal electrophysiological features of patients with nitrous oxide abuse were dramatically different from those in GBS-AIDP or DPN patients, but similar to those in GBS-AMAN patients. Conclusions : Nitrous oxide abuse could cause abnormal electrophysiological response in the limbs. Some of the parameters (DML, MNCV, SNCV, CMAP and SNAP) appeared significantly different between the patients with nitrous oxide abuse, GBS with AIDP or AMAN, and DPN patients. Significance: Electrophysiological examination could be considered as an important supporting factor in differential diagnosis for nitrous oxide abuse, GBS with AIDP or AMAN, and DPN.

The Video-Urodynamic and Electrophysiological Characteristics in Patients With Traumatic Spinal Cord Injury.

PurposeTo investigate the video-urodynamic and pelvic floor electrophysiological characteristics in patients with traumatic spinal cord injury (SCI).MethodsThis retrospective reviewed the clinical records, urodynamic and pelvic floor electrophysiological data of 647 patients with traumatic SCI and out of spinal shock. Patients were classified based on American Spinal Injury Association (ASIA) Impairment Scale and urodynamic findings.ResultsOf the 647 patients, detrusor overactivity (DO) with or without detrusor sphincter dyssynergia (DSD) was found in 79.5%, 61%, 35.2%, 35%, and 19.2% of patients with cervical, thoracic (T1–9), thoracic (T10–12), lumbar, and conical cauda injury, respectively. Other patients manifested detrusor areflexia (DA). Patients with DO and/or DSD had a longer duration of SCI at each injury level than patients with DA. In suprasacral injury patients with DA, 63.0% (58 of 92) had a normal bulbocavernosus reflex (BCR) response. Compared with patients without bladder sensation (BS), bladder capacity during urine leakage was far higher in those with BS. The manifestation of BCR and somatosensory-evoked potential (SEP) was associated with the level of injury.ConclusionsThis study showed a significant correlation between the level of SCI and video-urodynamic findings, but clinical examination cannot by predict bladder function; urodynamic testing is also necessary. In addition, the role of BCR and SEP for guiding bladder management is limited. Moreover, BS is important for urinary control in patients with traumatic SCI.

Clinical and electrophysiological characteristics of patients diagnosed with bypass-tract associated arrhythmias from a tertiary care centre in South India

Clinical and electrophysiological characteristics of patients diagnosed with bypass-tract associated arrhythmias from a tertiary care centre in South India

Comparison of clinical and electrophysiological features of patients with hereditary neuropathy with liability to pressure palsies with or without pain

BackgroundHereditary neuropathy with liability to pressure palsies (HNPP) is a rare neuropathy with a heterogeneous clinical profile. Painless recurrent palsies are the usual presentation, but neuropathic pain could be predominant or inaugural. Browsing the medical literature, we only found two articles reffering to this important clinical feature. Whether there are differences between patients with or without pain is unclear. The main objective of this study was to compare the clinical and electrophysiological features of these patients and to evaluate the impact on their disability. MethodsAll patients diagnosed with HNPP at the Limoges University Hospital Centre were included and separated into two groups according to the presence or absence of neuropathic pain. In each case, the clinical, genetic, electrodiagnostic, therapeutic features and the modified Rankin Scale (mRS) were evaluated. ResultsOut of 23 patients, 52% presented with neuropathic pain. There was no difference between groups regarding to clinical and electrophysiological features, except for the amplitude of the ulnar sensory nerve (p < 0,003). The amplitudes of sensory nerve action potentials (SNAPs) seemed to be higher in patients with pain, but were below the lower limit of normal. Patients with pain had a higher mRS than patients without pain (p < 0,007). ConclusionThis study supports previous published results and highlights a trend for higher sensory amplitudes in HNPP patients with pain. We found a prevalence of neuropathic pain of 52% in patients with HNPP, underlining the need to systematically assess pain in such patients in order to improve their management.