Electrophysiologic Testing In Patients Research Articles

N°301 – Autonomic and electrophysiological tests in patients with moderate covid 19 and their relationship with fatigue symptoms

N°301 – Autonomic and electrophysiological tests in patients with moderate covid 19 and their relationship with fatigue symptoms

Assessment of changes in penile sensation by electrophysiological study after radical prostatectomy: A pilot study.

Background:To evaluate the changes in penile sensation by electrophysiological tests in patients who underwent radical prostatectomy (RP) and to demonstrate the role of dorsal penile nerve injury in postoperative erectile dysfunction.Materials and methods:Twenty-six volunteer patients who were eligible for RP were included in the study. Preoperative penile sensory electromyography and the International Index of Erectile Function-5 (IIEF-5) questionnaire were done for each patient. Erectile function assessment and electrophysiological evaluation of penile sensation were repeated at postoperative 3rd and 6th months.Results:Postoperative IIEF-5 scores and electromyography values were significantly lower than preoperative findings (p < 0.05). The IIEF-5 scores in the nerve sparing-RP (NS-RP) group were significantly higher than the non-nerve sparing-RP (NNS-RP) group in the postoperative period. Nerve conduction velocity values in the NS-RP group were also higher than the NNS-RP group at the postoperative 3rd and 6th months. However, these changes were not statistically significant (p > 0.05).Conclusions:Patients who underwent RP have decreased penile sensation due to cavernous nerve damage and a possible dorsal penile nerve injury. The decrease of penile sensation may be associated with postoperative erectile dysfunction.

Etripamil Nasal Spray for Rapid Conversion of Supraventricular Tachycardia to Sinus Rhythm

BackgroundThere is no nonparenteral medication for the rapid termination of paroxysmal supraventricular tachycardia. ObjectivesThe purpose of this study was to assess the efficacy and safety of etripamil nasal spray, a short-acting calcium-channel blocker, for the rapid termination of paroxysmal supraventricular tachycardia (SVT). MethodsThis phase 2 study was performed during electrophysiological testing in patients with previously documented SVT who were induced into SVT prior to undergoing a catheter ablation. Patients in sustained SVT for 5 min received either placebo or 1 of 4 doses of active compound. The primary endpoint was the SVT conversion rate within 15 min of study drug administration. Secondary endpoints included time to conversion and adverse events. ResultsOne hundred four patients were dosed. Conversion rates from SVT to sinus rhythm were between 65% and 95% in the etripamil nasal spray groups and 35% in the placebo group; the differences were statistically significant (Pearson chi-square test) in the 3 highest active compound dose groups versus placebo. In patients who converted, the median time to conversion with etripamil was <3 min. Adverse events were mostly related to the intranasal route of administration or local irritation. Reductions in blood pressure occurred predominantly in the highest etripamil dose. ConclusionsEtripamil nasal spray rapidly terminated induced SVT with a high conversion rate. The safety and efficacy results of this study provide guidance for etripamil dose selection for future studies involving self-administration of this new intranasal calcium-channel blocker in a real-world setting for the termination of SVT. (Efficacy and Safety of Intranasal MSP-2017 [Etripamil] for the Conversion of PSVT to Sinus Rhythm [NODE-1]; NCT02296190)

F43. Electrophysiological tests in patients with anti-MuSK myasthenia gravis: A retrospective study

Introduction Myasthenia gravis (MG) with autoantibodies to muscle-specific tyrosine kinase (MuSK) represents a distinct type of disease, as compared MG with antibodies against acetylcholine receptor (AchR-Abs). MuSK-MG patients have peculiar clinical features characterized by predominant oculo-bulbar symptoms and a lack of response to conventional MG treatments. Since the role of electrophysiological tests in MuSK patients is still argued, our aim was to investigate their electrophysiological profile in order to arise a light over this darkness. Methods We retrospectively evaluated repetitive nerve stimulation (RNS) and single-fibre electromyography (SF-EMG) reports of 63 MuSK patients, at the time of MG diagnosis, and we compared them with 35 non-timomatous AChR-Abs positive patients matched with MuSK group according to gender, age at onset of MG, age at MG diagnosis and severity of the disease. Disease severity was graded according to Myasthenia Gravis Foundation of America (MGFA) classification. Seronegative patients and thymoma-associated MG patients were excluded from the study. Results Sixty-three MuSK patients (11 males; 52 females; mean age at MG onset: 37 ± 2.0; mean age at diagnosis: 38.7 ± 2.0) and 35 AChR-Abs positive patients (9 males; 26 females; mean age at MG onset: 31.2 ± 2.7: mean age at diagnosis: 33.1 ± 2.5) were enrolled in the study. Fifty-nine MuSK patients (93.6%) and 31 AChR-Abs positive patients (88.5%) underwent RNS, whereas SF-EMG was tested in 17 MuSK patients and in 7 AChR-Abs patients. RNS showed a significant decrement in a higher percentage of AChR-Abs positive patients than the MuSK group (p Conclusion While SR-EMG positivity was significantly higher in AChR-Abs group, there was no difference regarding SF-EMG. In MusK group, the decrement of RNS was more evident in proximal muscles while RNS in distal muscles can be negative. Although neurophysiological evaluation is still important for MG diagnosis, it plays a secondary role after anti-MuSK titration.

Electrophysiological Testing in Patients with Chronic Inflammatory Demyelinating Polyneuropathy Treated with Subcutaneous Immunoglobulin: The PATH Study (P1.433)

Electrophysiological Testing in Patients with Chronic Inflammatory Demyelinating Polyneuropathy Treated with Subcutaneous Immunoglobulin: The PATH Study (P1.433)

Electrophysiological Testing for the Investigation of Bradycardias.

In this article we review the role of electrophysiological testing in patients presenting with bradycardia due to sinus node or atrioventricular node disease. In sinus bradycardia the role of electrophysiology studies is not established. In AV conduction disturbances, an electrophysiology study may be necessary both for the establishment of atrioventricular block as the main cause of symptoms, and for identification of the anatomic site of block that may dictate the potential need of permanent pacing.

The autonomic dysfunction in patients with lupus disease: An electrophysiological study.

Background:The aim of this study was to investigate autonomic nervous system (ANS) function by using electrophysiological tests in patients with systemic lupus erythematosus (SLE).Materials and Methods:This descriptive analytical study was done on 28 individuals with a history of lupus and ten age- and sex-matched healthy objects were being selected randomly. The autonomy questionnaire has been used to determine clinical symptom of ANS involvement. The electrophysiological assessments of ANS function were performed by sympathetic skin response (SSR). The mean values of sympathetic (SSR latency and amplitude) parameters were compared to determine any correlations between SSR parameters and clinical characteristics of ANS.Results:28 SLE patients (3 males, 25 females) with a mean age of 34.6 ± 9.74 years and 10 control subjects (4 males, 6 females) with a mean age of 36.8 ± 6.43 years were included in the study. Among patients 17 (60.7%) exhibited autonomic symptoms. Headache was the most common issue with the highest percentage rate (41.17%). The mean latency and amplitude of SSR were increased (1.52 ± 0.16 vs. 1.39 ± 0.16 and 107 ± 15.6 vs. 110 ± 15.6, respectively), compared to control. A significant difference was observed between the SSR test results of patients with lupus compared to normal healthy objects (P < 0.05). R = 0.43 correlation was found between autonomy questionnaire scores and SSR (P < 0.05).Conclusion:It could be concluded that latency measures in SSR test can be used as a valuable and accurate evaluation guideline for autonomic system assessment.

The subclinic autonomic dysfunction in patients with Behçet disease: an electrophysiological study

Studies that have evaluated autonomic nervous system (ANS) function in Behçet disease (BD) are rare and have indicated conflicting results with different degrees of involvement. The aim of this study was to investigate ANS function by using electrophysiological tests in patients with BD and to determine the relationship between the disease activity parameters and the indicators of autonomic activity. We included 70 BD patients and 50 healthy controls. Demographic characteristics including age, sex, and disease duration were recorded. A detailed neurological examination was performed, and clinical autonomic symptoms were recorded. The Behçet Disease Current Activity Form (BDCAF) was used to determine the disease activity. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were determined for laboratory activity. The electrophysiological assessments of ANS function were performed by sympathetic skin response (SSR) and R-R interval variation (RRIV) tests. The mean values of sympathetic (SSR latency and amplitude) and parasympathetic (RRIV at rest [R%] and deep breathing [D%], D% - R%, and D%/R%) parameters were compared, and any correlations between ANS parameters and clinical disease characteristics were determined. Seventy BD patients (23 males, 47 females) with a mean age of 41.2 ± 10.01years and 50 control subjects (18 males, 32 females) with a mean age of 39.5 ± 8.94years were included in the study. All the subjects were totally symptom free with respect to ANS involvement, and the subjects in both groups had normal neurological examination findings. The demographic characteristics were similar between the groups. The mean latency of SSR was increased (1.4 ± 0.4 vs 0.7 ± 0.8), and R% (0.3 ± 0.3 vs 0.5 ± 0.4) and D% (0.3 ± 0.3 vs 0.6 ± 0.5) values were decreased in BD patients compared to control subjects. No correlation was found between BDCAF scores and ANS variables. However, there was a significant correlation between SSR latency and ESR and CRP values (p < 0.01, r = -0.25, r = -0.31, respectively) in the patient group, indicating a more sympathetic dysautonomia in patients with active laboratory parameters. In conclusion, our study indicates a subclinical sympathetic and parasympathetic autonomic dysfunction in patients with BD, which may be related with disease activity. As the early recognition of abnormalities in ANS may be very important in order to prevent excessive morbidity, simple electrophysiological methods are suggested to identify Behçet patients at high risk for symptomatic dysautonomia.

Accuracy of diagnoses delivered by an automated hand-held nerve conduction device in comparison to standard electrophysiological testing in patients with unilateral leg symptoms

Automated hand-held nerve conduction study (NCS) devices are being marketed for use in the diagnosis of lumbosacral radiculopathy (LSR). In this study we compared the specificity and sensitivity of a hand-held NCS device for the detection of LSR with standard electrodiagnostic study (EDX). Fifty patients referred to a tertiary referral electromyography (EMG) laboratory for testing of predominantly unilateral leg symptoms (weakness, sensory complaints, and/or pain) were included in the investigation. Twenty-five normal "control" subjects were later recruited to calculate the specificity of the automated protocol. All patients underwent standard EDX and automated testing. Raw NCS data were comparable for both techniques; however, computer-generated interpretations delivered by the automated device showed high sensitivity with low specificity (i.e., many false positives) in both symptomatic patients and normal controls. The automated device accurately recorded raw data, but the interpretations provided were overly sensitive and lacked the specificity necessary for a screening or diagnostic examination.

Poster 70: Accuracy of Diagnoses Delivered by an Automated Hand Held Nerve Conduction Study Device in Comparison to Standard Electrophysiologic Testing in Patients with Unilateral Leg Symptoms

Poster 70: Accuracy of Diagnoses Delivered by an Automated Hand Held Nerve Conduction Study Device in Comparison to Standard Electrophysiologic Testing in Patients with Unilateral Leg Symptoms

Stratifying disease stages with different progression rates determined by electrophysiological tests in patients with amyotrophic lateral sclerosis

Muscle & NerveVolume 40, Issue 2 p. 318-318 Letter to the Editor Stratifying disease stages with different progression rates determined by electrophysiological tests in patients with amyotrophic lateral sclerosis Mamede de Carvalho MD, Mamede de Carvalho MD Neuroscience Department and Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Lisbon, PortugalSearch for more papers by this authorMichael Swash MD, Michael Swash MD Department of Clinical Neuroscience, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UKSearch for more papers by this author Mamede de Carvalho MD, Mamede de Carvalho MD Neuroscience Department and Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Lisbon, PortugalSearch for more papers by this authorMichael Swash MD, Michael Swash MD Department of Clinical Neuroscience, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UKSearch for more papers by this author First published: 16 July 2009 https://doi.org/10.1002/mus.21408Citations: 1Read the full textAboutPDF 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 Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume40, Issue2August 2009Pages 318-318 RelatedInformation

Stratifying disease stages with different progression rates determined by electrophysiological tests in patients with amyotrophic lateral sclerosis (reply)

Stratifying disease stages with different progression rates determined by electrophysiological tests in patients with amyotrophic lateral sclerosis (reply)

Stratifying disease stages with different progression rates determined by electrophysiological tests in patients with amyotrophic lateral sclerosis

By determining the usefulness of motor unit number estimate (MUNE) and compound muscle action potential (CMAP) amplitude in patients with amyotrophic lateral sclerosis (ALS), we tried to find an effective way to stratify the disease stages. In all, 112 consecutive ALS patients were enrolled, among whom 73 were elicited in a longitudinal study. MUNE by the standard incremental technique, the average CMAP amplitude, total Medical Research Council (MRC) score, ALS-functional rating score (ALS-FRS), Appel ALS rating scale (AARS), and forced vital capacity (FVC) were performed at baseline and months 3, 6, and 12 after study entry. We found MUNE correlated with CMAP amplitude (P < 0.01) as well as MRC score (P < 0.01) in regionally concordant distal muscles. Both MUNE and CMAP amplitude correlated significantly with ALS-FRS (P < 0.05) and AARS (P < 0.01). A MUNE decrease was observed at months 3, 6, and 12 compared with baseline, and the rate of change at month 3 was 50.47%. The decrease in MUNE over the first 3 months was significantly greater than other measurements. We arbitrarily divided the patients into three stages: (1) rapid progression: the rate of change of MUNE and CMAP amplitude during the first 3 months exceeded 50%; (2) moderate progression: the rate of change of MUNE was greater than 50% but CMAP amplitude was less than 50%; (3) slow progression: the rate of change of both MUNE and CMAP amplitude were less than 50%. Comparing the rate of ALS-FRS descent per year using one-way ANOVA showed a significant difference among the three groups (P < 0.01).

Upper limb pain in chronic demyelinating polyneuropathy: electrophysiological correlates.

Pain is not usually considered a symptom of chronic relapsing demyelinating polyneuropathy. We report two patients with chronic demyelinating polyneuropathies in whom clinical and electrophysiological worsening was associated with the development of deep and distressing upper limb aching discomfort. One patient had a MGUS-associated hypertrophic demyelinating and prednisone-dependent polyneuropathy, followed over a course of two and a half years. His discomfort regularly predicted electrophysiological relapse of neuropathy, before more obvious clinical signs had emerged. Resolution of the discomfort also predicted subsequent clinical and electrophysiological improvement. Upper limb pain may be an important feature of early relapse in some patients with demyelinating polyneuropathies. Standardized serial electrophysiological testing in patients with chronic demyelinating polyneuropathy can be an important management tool in conjunction with clinical signs and symptoms.

The autonomic dysfunction in patients with ankylosing spondylitis: a clinical and electrophysiological study

The aim of this study was to determine autonomic nervous system (ANS) functions by using clinical and electrophysiological tests in patients with ankylosing spondylitis (AS). Twenty AS and 20 healthy control subjects were recruited. Demographic data, symptoms related with ANS, and neurological findings were recorded. Clinical measurements including the heart rate variation with deep breathing (HRV), heart rate response to standing (HRS), systolic blood pressure response to standing, and diastolic blood pressure response to isometric exercise were obtained to assess parasympathetic and sympathetic functions of the subjects. The electrophysiological assessments of ANS were performed by sympathetic skin response (SSR) and R-R interval variation (RRIV) measurements for the sympathetic and parasympathetic functions, respectively. Patients with AS were subdivided into two groups depending on the activity of disease. The difference between the groups and relationship between ANS variables and clinical entities were determined. Fifteen male and five female AS patients with a mean age of 38+/-8.05 years and 14 male and six female healthy control subjects with a mean age of 40+/-9.8 years were included in the study. All the subjects were totally symptom free for ANS involvement and had normal neurological examination findings. The levels of HRV, HRS, and the mean RRIV values were significantly lower in AS patients than in control subjects. The clinical ANS parameters of the patients having more active disease were lower than in subjects with mild disease in regard to HRV values and SSR amplitudes and higher in regard to SSR latencies. The HRV values were found to be correlated with the mean scores of Bath ankylosing spondylitis disease activity index (BASDAI) and C-reactive protein (CRP) levels, and the mean latencies of SSR were correlated with BASDAI scores and CRP levels. In conclusion, our study indicates a subclinical mainly parasympathetic dysfunction of ANS in patients with AS which can be related with disease activity.

Effect of bundle branch block on microvolt T-wave alternans and electrophysiologic testing in patients with ischemic cardiomyopathy

T-wave alternans (TWA) and electrophysiology study (EPS) are used for risk stratification for sudden death. The purpose of the study was to determine the effect of bundle branch block or intraventricular conduction delay on TWA and EPS. 386 patients with coronary artery disease, nonsustained ventricular tachycardia, and left ventricular ejection fraction < or =40% underwent TWA and EPS, and were followed for 40 +/- 19 months. Patients with wide QRS were more likely than narrow QRS patients to have nonnegative TWA (77% vs 63%, P <.01) or positive EPS (60% vs 48%, P = .03). Nonnegative TWA predicted the combined endpoint of ventricular tachyarrhythmia or death in narrow QRS (HR = 1.64, P = .04) but not wide QRS patients (HR = 1.04, P = .91). Similarly, positive EPS predicted the combined endpoint in narrow QRS (HR = 2.28, P <.001) but not wide QRS patients (HR = 0.94, P = .84). In multivariate analysis, QRS width and TWA, as well as QRS width and EPS, were independent predictors of events. There was no TWA- or EPS-based difference in arrhythmia-free survival within any specific wide QRS morphology. TWA and EPS are more often abnormal in patients with a wide QRS than in those with a narrow QRS. In patients with narrow QRS, both TWA and EPS stratify patients according to their risk of ventricular tachyarrhythmia or death. However, among patients with a wide QRS, regardless of specific QRS morphology, the risk is high and comparable regardless of TWA or EPS results. Therefore, the only truly low-risk group consists of those patients with negative test results and a narrow QRS.

AHA/ACCF Scientific Statement on the Evaluation of Syncope

AHA/ACCF Scientific Statement on the Evaluation of Syncope

Simulated Microgravity Induces Microvolt T Wave Alternans

There are numerous anecdotal reports of ventricular arrhythmias during spaceflight; however, it is not known whether spaceflight or microgravity systematically increases the risk of cardiac dysrhythmias. Microvolt T wave alternans (MTWA) testing compares favorably with other noninvasive risk stratifiers and invasive electrophysiological testing in patients as a predictor of sudden cardiac death, ventricular tachycardia, and ventricular fibrillation. We hypothesized that simulated microgravity leads to an increase in MTWA. Twenty-four healthy male subjects underwent 9 to 16 days of head-down tilt bed rest (HDTB). MTWA was measured before and after the bed rest period during bicycle exercise stress. For the purposes of this study, we defined MTWA outcome to be positive if sustained MTWA was present with an onset heart rate<or=125 bpm. During various phases of HDTB, the following were also performed: daily 24-hour urine collections, serum electrolytes and catecholamines, and cardiovascular system identification (measure of autonomic function). Before HDTB, 17% of the subjects were MTWA positive [95%CI: (0.6%, 37%)]; after HDTB, 42% of the subjects were MTWA positive [95%CI: (23%, 63%)] (P=0.03). The subjects who were MTWA positive after HDTB compared with MTWA negative subjects had an increased versus decreased sympathetic responsiveness (P=0.03) and serum norepinephrine levels (P=0.05), and a trend toward higher potassium excretion (P=0.06) after bed rest compared to baseline. HDTB leads to an increase in MTWA, providing the first evidence that simulated microgravity has a measurable effect on electrical repolarization processes. Possible contributing factors include loss in potassium and changes in sympathetic function.

Primary Prevention of Sudden Cardiac Death

The trouble with sudden cardiac death (SCD) is just that—it is sudden and individually unpredictable. Recent data from the Centers for Disease Control showed that SCD accounted for >460 000 deaths, or about 63% of deaths due to cardiac disease, in 1999.1 Typically, a cardiac arrest results from sustained ventricular tachycardia (VT) or ventricular fibrillation that progresses to death if effective resuscitative efforts are not started within several minutes of the arrest.2 It is not surprising that the overall survival rate of patients with out-of-hospital cardiac arrest in the United States is low, estimated to be <5%.3 Although more widespread use of automated external defibrillators could lead to a reduction in SCD,3 it is unrealistic to expect too much from this technology, especially because most cardiac arrests either are unwitnessed or occur in a location without ready access to an automated external defibrillator. The epidemic proportions of SCD have led to decades of research and randomized clinical trials designed to predict which individuals are at risk of SCD and to determine what methods prevent it. See p 1082 Coronary artery disease (CAD) causes ≈70% of SCD,1 and most clinical trials have evaluated this patient population. The emphasis of this Focused Perspective is on antiarrhythmic drug and device trials, but the reader should remember that selective use of β-adrenergic–blockers and angiotensin-converting enzyme inhibitors has reduced SCD.2,4,5 It has been known for decades that patients at highest risk for SCD after myocardial infarction (MI) have substantial left ventricular dysfunction, frequent premature ventricular complexes (PVCs) or nonsustained VT, or both conditions.2 Early efforts to prevent SCD employed the PVC suppression method. The Cardiac Arrhythmia Suppression Trial (CAST) was a randomized, placebo-controlled study that tested the hypothesis that PVC suppression after MI would reduce arrhythmic death.6 …

9.8 Prognostic value of electrophysiological testing in patients with cronic chagas disease and ventricular arrhythmias detected by holter monitoring

9.8 Prognostic value of electrophysiological testing in patients with cronic chagas disease and ventricular arrhythmias detected by holter monitoring