EMG Results Research Articles

Electrophysiological Effect of Acupuncture in the Carpal Tunnel Syndrome Case

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and occurs as a result of compression of the median nerve in the carpal tunnel at the wrist. The classic symptom in patients with CTS is paresthesia (numbness, burning, tingling) and pain in the median nerve distribution area of the hand, especially at night. A 24-year-old female patient presented to GETAT polk with the diagnosis of mild carpal tunnel syndrome after examination and EMG after the complaint of numb tingling in the hand in the neurology outpatient clinic. The patient was using Parkyn (pramipexole dihydrochloride monohydrate) 25mg. Acupuncture was applied to the patient for 10 sessions. Disposable sterile acupuncture needles were applied to the PC-6, H-7, LU-9, H-7, SI-3 points (0.22x13mm, 0.22x1.5mm Hua Long). The sessions lasted 20 minutes. The sessions were done first twice a week, then once a week. The patient was prescribed Vitamin B1 + B6 supplements. After 10 sessions of acupuncture, the EMG was repeated. The EMG result of the patient was normal. Parkyn was cut by neurology, Lyrica (pregabalin) was switched to 150mg. The patient's need for medication was also reduced.

AFECTACIÓN NEUROVASCULAR TRAS LUXACIÓN GLENO-HUMERAL: A PROPÓSITO DE UN CASO

We present a case of a 58 years old woman who presents a low-anterior dislocation with vascular and total nerve injury secondary to a fall with the shoulder extended and abducted (90º). In this situation, it was fixed with closed reduction. After 6 weeks, the ENG and the EMG showed brachial plexopathy. Disruptions were not detected in NMR. She gradually improved with rehabilitation, not having new vascular symptoms. Age, obesity, the delay until the reduction and associated fractures are risk factors to completed brachial plexus palsy, being more common in low energy traumas. Axilar nerve is the most affected element, followed by radial, ulnar and median, in this order. EMG/ENG is the gold standard technique for the diagnosis after one month. MNR will be essential to check the state of the nerve. Rehabilitation is key in the treatment, and the surgery can be postponed. Neurolysis showed encouraging results in the first semester. Functional recovery is slow (six months - one year), being faster in the EMG results. Acute vascular affection is a traumatology emergency. The third section of the axillar nerve is the most common affected. Suspected diagnosis is important, even when the radial pulse is detected. After closed reduction, ECO-Doppler and CT Angiography are the diagnosis test indicated. Suspecting neurovascular injury is mandatory. Systematic exploration and urgent treatment decrease complications and they can improve the patient prognosis.

Evaluation of Duruöz Hand Index in diagnosis and staging of Carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the upper limb. In this cross-sectional study our aim is to investigate the value of Duruöz Hand Index (DHI) in diagnosis and staging of CTS patients and comparing it with Boston Carpal Tunnel Questionnaire (BQ) and provocative tests. Among 423 patients who were referred to the EMG laboratory at the physical medicine and rehabilitation unit with the symptoms of CTS, 294 patients were included in the study. Patients’ demographic data, weight, height, body mass index (BMI) measurements, physical examinations, Tinel and Phalen provocative test results, visual analog scale for pain, DHI and BQ scores were recorded. Electrophysiological examinations were also performed. The mean age was 45.1 ± 11.6 years and 254 (86.4%) patients were women. Based on the results of EMG, 120 (40.8%) patients were found negative for CTS, 57 (19.4%) patients had mild CTS, 89 (30.3%) patients had moderate CTS and 28 (9.5%) patients had severe CTS. Among the parameters evaluated, DHI scores were found to be significantly higher in the severe CTS group. DHI (r: 0.306, p < 0.001) and Boston functional status scale (FSS) (r: 0.257p = 0.001) were found to be correlated with CTS severity. Tinel positivity (OR: 2.36, p: 0.01), Phalen positivity (OR: 2.22, p: 0.02), Boston symptom severity scale (SSS) scores (OR: 1.76, p: 0.024), increasing age (OR: 1.06, p < 0.001) and increased BMI (OR: 1.07, p: 0.03) were found to be associated with increased likelihood of CTS diagnosis. In conclusion, DHI was found to be correlated with CTS severity similar to Boston FSS.

Paradoxical Vocal Fold Movement: A Retrospective Analysis

Paradoxical vocal fold motion (PVFM) is a disorder in which the vocal folds adduct inappropriately during inspiration resulting in episodic dyspnea and sometimes respiratory distress. Diagnosis is obtained through careful history, physical examination, flexible laryngoscopic examination with provocative maneuvers, and laryngeal electromyography. The pathogenesis and clinical findings of this disorder are not known. To determine characteristics of patients with confirmed PVFM and to evaluate efficacy of current treatments. A retrospective chart review of the patients with PVFM who presented at a quaternary care laryngology office between January 1, 2007 and August 31, 2019 was performed. Comorbidities, laboratories tests, imaging, 24-hours pH impedance testing, and laryngeal EMG results were analyzed. Dyspnea Index questionnaire before and after treatment was used to evaluate the efficiency of treatments for PVFM. The average age of the 40 patients was 30.25 years. Forty-five percent of patients were under the age of 18, and 80% were female. Twenty-five percent of patients were serious athletes, and 40% of patients were students. Sixty-five percent had a previous diagnosis of asthma. One third of patients had concurrent psychiatric diagnosis. There was no family history of PVFM in the cohort. There were no other common findings. Treatment for laryngopharyngeal reflux (LPR) was used only when there was evidence of LPR; and 93% of our 40 patients received LPR treatment. Ninety percent of patients who received botulinum toxin, voice therapy (VT), and LPR treatment had subjective improvement. Patients with just VT and LPR treatment had a 43% subjective improvement rate; and the difference was statistically significant at P of 0.021. There was no statistical difference between VT and LPR treatment versus VT or LPR treatment alone. Botulinum toxin, VT, and LPR treatment regimen is currently the most effective management for patients with paradoxical vocal fold movement disorder. More research is needed to determine the etiology of this disorder.

Human cremaster muscle and cremasteric reflex: A comprehensive review

ObjectiveHuman research on the cremaster muscle (CM), cremasteric reflex (CMR) and genitofemoral nerve (GFN) and reports on their clinical applications using electrophysiological and histological techniques are rare. We aimed to present a detailed review of the human CM and CMR based on our earlier publications and relevant literature. MethodsElectromyography (EMG) of the CM was recorded using disposable needle electrodes. CMR was obtained with tactile and/or electrical stimulation of the inner thigh. Transcranial magnetic stimulation (TMS) and magnetic stimulation of the upper lumbar roots were applied; GFN was stimulated using a surface electrode at the anterior superior iliac spine. ResultsCM striated fibers comprised multiple motor end plates. CM needle EMG results were similar to those of the limb muscles in chronic neurogenic disorders. TMS produced clear-cut evoked motor responses from CM. GFN motor conduction time to CM was absent or delayed in patients with inguinal hernia. EMG of CM was abnormal in 40% of patients with premature ejaculation. ConclusionCM is different from other skeletal muscles both morphologically and physiologically. Intersegmental sacrolumbar reflexes are useful for evaluating ejaculatory dysfunction. SignificanceCM is an important muscle for testis thermoregulation and sexual reflexes. Neurophysiological techniques are available for physiological and clinical studies.

Melatonin Ameliorates Radiation-induced Sciatic Nerve Injury

Background: Radiotherapy is a treatment method for cancer mostly utilized for about 60% of cancer patients. Peripheral neuropathy is one of the severe complications of radiotherapy. Two stages of neuropathy will occur following irradiation; electrophysiological and biochemical variations as the first stage, while the second stage involves fibrosis of soft tissues surrounding the exposed nerve. This novel study aimed to investigate the radioprotective effects of melatonin against ionizing radiation-induced sciatic nerve damage. Methods: 60 rats were randomly assigned to four groups; C (Control), M (Melatonin), R (Radiation), MR (Radiation + Melatonin). Their right legs were exposed to 30 Gy single dose gamma rays. Melatonin (100 mg/kg) was administered 30 min before irradiation and once daily (5 mg/kg) till the day of rats’ sacrifice. Their exposed nerve tissues were evaluated for biochemical changes in addition to Electromyography (EMG) and Nerve Conduction Study (NCS). Results: 4, 12 and 20 weeks post-irradiation, EMG and NCS examinations in R group showed reduced Compound Muscle Action Potential (CMAP) representing axonal degeneration when compared with C and M groups. Prolonged latency and a decrease in Conduction Velocity (CV) gave an indication of demyelinating neuropathy at 12 and 20 weeks. EMG and NCS results of R group showed partial nerve lesion. Biochemical assessments showed that irradiation of sciatic nerve led to increased MDA level, as well as decreased CAT and SOD activities. However, in all cases, treatment with melatonin can reverse these effects. Conclusion: We conclude that melatonin can improve electrophysiological, oxidative stress and antioxidant defense features of irradiated rats’ sciatic nerves. We would also recommend the use of melatonin in an optimal and safe dose. It should be administered over a long period of time for effective protection of the peripheral nerve tissues, as well as improving the therapeutic ratio of radiotherapy.

The Carpal Tunnel Syndrome and the Double Crush Syndrome Hypothesis: Revisited

AbstractBackground: The commonest application of the double crush hypothesis is its association to median nerve entrapment at the wrist. The double crush concept has gained popularity because it provides a reason to evaluate the cervical spine and roots when treating carpal tunnel syndrome (CTS). It is more likely for CTS to occur as DCS rather than occurring by itself. Up to 90% of CTS patients are misdiagnosed, whereas only 10% have the problem at their wrists.Aim of Study: To examine the validity of DCS hypothesis in CTS patients, to support or disregard the theory.Patients and Methods: This study was conducted on 80 patients; 40 patients claiming failed carpal tunnel release operation (Group I) and 40 cases presenting with brachialgia (Group II). Diagnostic work up included neurological exam-ination, Phalen test, Tinel sign, electromyographic examination (EMG) and nerve conduction studies (NCS) and cervical MRI. Group I patients had undergone the EMG and NCS at our laboratory pre and post operatively.Results: EMG and NCS showed 10 cases with CTS (25%), 20 (50%) with DCS and 10 (25%) with cervical radiculopathy in group I, while group II patients showed 10 cases (25%) with CTS and 30 (75%) with DCS. In all patients, 50 cases (62.5%) showed DCS. On comparing the EMG and NCS preoperative results of Group (I), with their postoperative follow-up results, there was a high statistically significant difference (p-value <0.001) with 34 cases (85%) who showed improvement of the NCS results, while 6 cases (15%) deteri-orated postoperatively. There was a high statistically significant difference between both; CTS and DCS (p-value <0.001), denoting a positive correlation between the two syndromes.Conclusion: The DCS hypothesis was supported, while the concept of frequent failure of CTS release surgery was not supported for the benefit of DC hypothesis.

Stiff limb syndrome with lower limb myoclonus

Rationale:stiff limb syndrome (SLS) is a variant of stiff-man syndrome, primarily affecting a specific limb. Its diagnosis has always been challenging due to the lack of a specific confirmation test. We present a rare case of a patient with lower limb myoclonus and rigidity.Patient concerns:A 53-year-old male presented with a sudden onset of progressive left lower extremity myoclonus and muscle rigidity for 3 days. He rapidly showed signs of right lower limb involvement with severe joint stiffness and inability to walk.Diagnosis:The symptoms nature, physical examination, careful elimination of differential diagnosis suggested a diagnosis of stiff limb syndrome.Interventions:Intravenous infusion of gamma globulin 0.4 mg/kg coupled with baclofen and clonazepam were given after admission. He also received an injection of botulinum toxin A to relieve his muscle stiffness.Outcomes:The patients’ condition improved after the initial treatment with complete disappearance of muscle twitching. Further improvements were seen later on after the local administration of botulinum toxin A.Lessons:Stiff limb syndrome shares the same complex symptoms with many other conditions. Its diagnosis relies heavily on clinical presentations and on ruling out other conditions. However, unusual symptoms such as myoclonus can occur in few cases and together with the rarity of the condition, the prevalence of misdiagnosis is high. Therefore, being aware and recognizing the signs and symptoms is crucial for proper management. Additionally, EMG is a very important test if the present condition is suspected. However, a negative EMG result or a negative anti-glutamic acid decarboxylase antibody test should not exclude SLS diagnosis.

Latissimus Dorsi Tendon Transfer for Irreparable Rotator Cuff Tears: Clinical, EMG and Kinematic Results of Arthroscopically Assisted Approach vs Fully Open Approach

Latissimus Dorsi Tendon Transfer for Irreparable Rotator Cuff Tears: Clinical, EMG and Kinematic Results of Arthroscopically Assisted Approach vs Fully Open Approach

MIOPATI KONGENITAL PADA BAYI: SEBUAH LAPORAN KASUS

Background: The congenital myopathies are group of genetic muscle disorders with a prevalence estimated between 1:22,480 in Sweden and 1:135,000 in Northern England. The most severe forms of congenital myopathy present In infant is the floppy infant with hypotonia and generalized musle weakness, and a frog leg posture, with facial, bulbar and respiratory weakness. We will provide an approach to the diagnosis of congenital myopathies with clinical examination, muscle imaging (MRI), muscle biopsy and identifying the genetic basis. Management of congenital myopathy are treatment of symptoms and complication caused by myopathies.&#x0D; Aim: To report a case of congenital myopathy in infant&#x0D; Case Description: A boy, a month, consulted from pediatric department to neurology department with chief complains the mouth is held in a open position, difficulty in feeding and generalized muscle weakness. From physical examintaion shows hypotonus in the masseter muscle, bulbar, respiration and all of extremities. In the chest cavity show pectus excavatum. Reflexes decrease in all of extremities with phatological reflexes in both lower extremities. We found pneumonia bilateral from thorax X-ray. ENMG shows moderate to severe axonal neuropathy and demyelination on all of extremities with normal EMG results. He received paracetamol 30 mg iv, ampicilin 150 mg iv, gentamicin 12 mg iv. He received exercise and chest fisiotherapy. After 22 days of treatment, he was discharge with clinical improvement. &#x0D; Conclusion: Patient has pneumonia bilateral caused by respiratory weakness congenital myopathy. Follow up and histological features is essential in guiding management for prediction of prognosis.

Distal Nerve Transfers to the Triceps Brachii Muscle: Surgical Technique and Clinical Outcomes

To report the clinical outcomes and describe the surgical technique of triceps muscle reinnervation using 2 different distal nerve transfers: the flexor carpi ulnaris (FCU) fascicle of the ulnar nerve and the posterior branch of the axillary nerve (PBAN) to the triceps nerve branch. A retrospective review of patients undergoing FCU fascicle of ulnar nerve or PBAN to triceps nerve branch transfer was performed. Outcome measures included preoperative and postoperative modified British Medical Research Council (MRC) score, EMG results, and complications. Between September 2003 and April 2017, 6 patients were identified. Four patients with a traumatic upper trunk and posterior cord palsy underwent ulnar nerve fascicle to triceps nerve transfer. Two patients with a recovering upper trunk following a pan-brachial plexus palsy underwent PBAN to triceps nerve branch transfer. The median age was 30.0 years (range, 18-68 years). Surgery was performed at a median of 6.9 months (range, 5.0-8.9 months) postinjury, with a median follow-up of 18.4 months (range, 7.6-176.3) months. Before surgery, 4 patients exhibited grade M0 and 2 patients exhibited grade M1 triceps strength. Four patients had M5 donor muscle strength and 2 had grade M4. Postoperatively, 4 patients regained MRC grade M4 triceps muscle strength, 1 regained M3, and 1 regained M2. There was no noticeable donor muscle weakness. Nerve fascicles to the FCU and PBAN are viable options for obtaining meaningful triceps muscle recovery in a select group of patients. Therapeutic V.

P93-T EMG and clinical results of Leechavengvongs transfer, our experiences

Background The long head triceps radialis branch to axillary nerve transfer (“Leechavenvongs’ transfer”) is an option of restoring the motor function of the deltoid muscle in case of complete axillary nerve or C5,6 root injury. The most advantages are anatomic proximity, appropriate diameter, intraplexal donor, no grafting, useful functional recovery achieved in other sources. Material and methods Group of 11 patients, who underwent Leechavengvongs’s transfer in last 4 years was analysed. The main inclusion criterium was irreparable axillary nerve injury (simple or as a part of brachial plexus injury) with complete denervation signs in deltoid musle preoperatively. We assessed motor recovery according to MRC scoring system and EMG reinnervation signs every 3 months after surgery. We set the preliminary follow - up period for 18 month, complete for 24 months. Results and conclusions 1 patient was exclude from the results (death from other reasons). The rest of 10 patients had an evidence of partial reinnervation signs 6 months after surgery. We observed good functional recovery by 5 patients, if surgery was performed early after injury (to 6 months at latest). We conclude the Leechavengvongs transfer is reliable and effective procedure. All patients had an evidence of partial muscle reinnervation. In agreement with other sources there was no impairment of the triceps brachii function. We consider the injury-to-surgery time is an important factor of good results. This group of patients is too small to consider general.

Effectiveness of home exercise in pregnant women with carpal tunnel syndrome

To evaluate the effectiveness of a home exercise programme in pregnant patients with carpal tunnel syndrome. The randomised, single-blind, controlled clinical study was conducted at Vakif University School of Medicine, Istanbul, Turkey, From December 2017 to June 2018 and comprised pregnant women with carpal tunnel syndrome (CTS) . Clinical evaluation of each patient was performed by a blind researcher and (EMG) Electromyography measurements were performed by another blind researcher. Patients were divided into two groups with normal and (mild or moderate) CTS based on EMG results and clinical examination. Patients with symptoms, clinical signs and CTS in EMG were included in group 1, while patients whose symptoms and clinical evaluation (such as Tinel, Phalen, Reverse Phalen and Durkan's test) were positive but not CTS in EMG were included in group 2. Exercise forms were given to both groups and they were asked to perform the exercises stated in the form in 3 sets each day and 10 repetitions in each set. The Sick Boston Carpal Tunnel Syndrome Questionnaire was administered face-to-face to collect data which was analysed using SPSS 22. Of the 33 subjects, 19(57.6%) were in patient group 1 and 14(42.4%) in control group 2. The overall mean age of the sample was 28.84±3.62 years. There were no significant differences between the groups in terms of symptoms and clinical tests (p>0.05). The symptom severity scale between the groups was significantly high in group 1 (p<0.05). Patients receiving treatment showed a decrease in symptom severity and functional capacity, but only the former showed a significant decrease in group 2 (p>0.05). Nerve and tendon slip exercises for patients with mild to moderate carpal tunnel syndrome symptoms were found to be simple and reliable methods that could be applied to patients to increase their functionality and to reduce the severity of the disease.

The influence of job rotation and task order on muscle responses in females

Job rotation aims to reduce muscle fatigue by switching between functionally different tasks to theoretically lessen the risk of site-specific fatigue and work-related musculoskeletal disorders (WMSDs). The effectiveness of job rotation in mitigating the onset of muscle fatigue is partially known, but there is limited ergonomic data on female populations despite comparatively lower upper body strength and increased risk of WMSDs. Rotating between two functionally different tasks, continuing a single task, and varying task order were assessed in the present study for influence on muscle fatigue indicators in a female population. Participants performed a randomized set of four task combinations involving two unilateral, repetitive shoulder tasks (forward flexion and internal rotation). During these combinations, maximal voluntary force, mean power frequency, average EMG (aEMG) and ratings of perceived exertion (RPE) were recorded. Differences between task combinations and time were tested using a two-way repeated measures ANOVA. Indications of fatigue were limited in the results. Forward flexion (p = 0.004) and internal rotation (p = 0.002) maximum voluntary force declined in all task combinations while RPE increased (p < 0.0001); non-rotating task combinations had the greatest declines in force and increases in RPE. Results from EMG amplitude were less clear, and were muscle and task specific. While non-rotating task combinations had the greatest decrements in aEMG submaximal force, rotating task combinations often had similar decrements, creating limited statistical differences. Changes in aEMG were too small to distinguish an order effect. The EMG results suggest muscular demand overlap between the two tasks, despite being functionally different. The effectiveness of job rotation is partially dependent on selecting tasks that engage distinct muscle groups.

Evidence of peripheral large nerve involvement in fibromyalgia: a retrospective review of EMG and nerve conduction findings in 55 FM subjects

Whereas small fiber neuropathy (SFN) is now a recognized part of fibromyalgia (FM), surprisingly little attention has been paid to any findings of large fiber neuropathy (LFN) in this disorder. Since 90% to 95% of FM subjects seen in our outpatient facility routinely undergo EMG and nerve conduction studies (NCS) we elected to retrospectively review the EMG/NCS results garnered from a large cohort of unselected subjects in order to describe the electrodiagnostic features of LFN in FM. Records from 100 consecutive, unselected clinic patients meeting the 1990 ACR criteria for FM, who had undergone EMG/NCS, were reviewed. The same electromyographer tested all subjects. After exclusion of FM patients with any other clinically relevant condition that might influence EMG results (e.g., familial neural degenerative conditions, diabetes mellitus, Vitamin B-12 deficiency, etc.) fifty-five FM subjects remained: 29 subjects with "FM Only," and 26 subjects with FM+Rheumatoid Arthritis ("FM+RA"). All subjects had also undergone ankle area skin biopsy for determination of epidermal nerve fiber density (ENFD). Fourteen other subjects, without FM or RA, examined by the same electromyographer, were used as an EMG/NCS comparison group. Ninety percent of the "FM Only" subjects demonstrated a demyelinating and/or axonal, sensorimotor polyneuropathy, and 63% had findings of SFN (ENFD ≤7 fibers/mm), suggesting a mixed fiber neuropathy in most. Furthermore, 61% of the "FM Only" subjects showed EMG findings suggestive of non-myotomal lower extremity axonal motor denervation, most likely due to a polyneuropathy, and 41% satisfied published criteria for "possible" chronic inflammatory demyelinating polyneuropathy (CIDP). There was surprisingly little difference in the EMG/NCS findings between the "FM Only" and the "FM+RA" groups. With the exception of carpal tunnel syndrome, our EMG/NCS comparison group showed few to none of these findings. Our review of the EMG/NCS results, gleaned from the largest FM cohort yet studied with these modalities, shows that electrodiagnostic features of polyneuropathy, muscle denervation, and CIDP are common in FM. Furthermore these electrodiagnostic findings are often seen coincident with SFN, and are not significantly influenced by the presence of RA. These results, particularly when taken as a whole, suggest that EMG/NCS may be clinically useful in detecting LFN in FM and help in better understanding the etiopathogenesis of this painful disorder.

Long-term evaluation of osteoarthritis sheep knee, treated with TGF-β3 and BMP-6 induced multipotent stem cells

BackgroundHyaline articular cartilage, which protects the bones of diarthrodial joints from forces associated with load bearing, frictions, and impacts has very limited capacities for self-repair. Over the years, the trend of treatments has shifted to regenerations and researchers have been on the quest for a lasting regeneration. We evaluated the treatment of osteoarthritis by chondrogenically induced ADSCs and BMSCs for a long time functional recovery. MethodsOsteoarthritis was induced at the right knee of sheep by complete resection of ACL and medial meniscus. Stem cells from sheep were induced to chondrogenic lineage. Test sheep received 5 mls single doses of 2 × 107 autologous PKH26-labelled ADSCs or BMSCs, while controls received basal medium. Functional recovery of the knees was evaluated via electromyography. ResultsInduced ADSCs had 625, 255, 393, 908, 409, 157 and 1062 folds increases of collagen I, collagen II, aggrecan, SOX9, cartilage oligomeric protein, chondroadherin and fibromodullin compare to uninduced cells, while BMSCs had 702, 657, 321, 276, 337, 233 and 1163 respectively; p = .001. Immunocytochemistry was positive for these chondrogenic markers. 12 months post-treatment, controls scored 4 in most regions using ICRS, while the treated had 8; P = .001. Regenerated cartilages were positive to PKH26 and demonstrated the presence of condensing cartilages on haematoxylin and eosin; and Safranin O. OA degenerations caused significant amplitude shift from right to left hind limb. After treatments, controls persisted with significant decreases; while treated samples regained balance. ConclusionsBoth ADSCs and BMSCs had increased chondrogenic gene expressions using TGF-β3 and BMP-6. The treated knees had improved cartilage scores; PKH26 can provide elongated tracking, while EMG results revealed improved joint recoveries. These could be suitable therapies for osteoarthritis.

A case of myasthenia gravis accompanied with hasimato thyroiditis and familial mediterranean fever

Familial mediterranean fever (FMF), HasimatoA‚’s thyroiditis (HT) ve Myastenia gravis (MG) are chronical diseases that show autoimmunity. Literature reviews indicate several cases of coexisting MG and HT and only one case coexistence of MG and FMF. We present a clinical table of a 21-year-old male patient with all three diseases. The patient admitted to the hospital with limited eye movements, difficulty in swallowing which became evident towards the end of a meal. The patient had a history of FMF. The anti-TPO and anti-TG levels of the patient had increased. The ACh Receptor antibody was in the normal range (0.01), and the anti-MuSK value was high (>12). Single fiber EMG results of the patient were compatible with myasthenia gravis. The methylprednisolone and pyridostigmine treatment led to an almost complete improvement of the symptoms. As the patient had three different autoimmune disorders at once, it was thought to be a notable case worth presenting.

Development of a foot-wheel driving exoskeleton for moving assistance of paraplegic patients

Paraplegic patients need assistant devices to manage daily lives due to moving disability of lower limbs, standing and moving always being their most pressing needs. A foot-wheel driving exoskeleton for moving assistance in a standing posture is introduced in this study, which uses a motor-belt-wheel driving mechanism at each foot to propel the whole system and a wireless handle to control the moving status. The overall design concept and detailed specifications of each module are presented in this paper. This study has completed the using experiments on two healthy subjects and a T10 paraplegic patient. The motion analysis was performed in a 3D gait analysis system to evaluate the fluctuation of the joint angle and corresponding response of major muscles in a process from start to a 4-s operation. The kinematics and EMG results showed that this exoskeleton could assist the upper body-abled user to complete the upright move without the help from others and the musculus triceps brachii and brachioradialis play an important role in maintaining the balance and counteract the motion fluctuation.

P334 Value of electrophysiological studies in detecting lumbo-sacral radiculopathy in patients with questionable MRI findings

Objective To test value of electrophysiologic studies in confirming lumbo-sacral radiculopathies in patients with questionable MRI findings for nerve root compression. Methods The study was conducted on 80 adult patients with sciatica, weakness of myotomal distribution in one limb, hypoesthesia in dermatomal distribution, all with MRI findings of focal disc protrusion/bulge with questionable nerve root compromise not correlating with the clinical symptoms. Results 25% of cases were acute, 60% subacute, and 15% were chronic. Clinical picture was sciatica with +ve SLRT in 35% of cases, L5 myotomal weakness in 30% of cases, S1 myotomal weakness 15% of cases, L5/S1 myotomal weakness in 15% of cases, sensory deficit in 4% of cases, back pain in 1.25% of cases. Positive EMG findings were found in 96.3% of cases, 96.3% had +ve lower limb findings, 57.5% had +ve paraspinal muscles findings, 70% had small CMAP amplitude, and 7.5% had active denervating potentials. 44% of cases were treated conservatively, while 56% of cases underwent surgery. There was a statistically significant association between the EMG results and clinical picture of radiculopathy, while there was no statistical significance between the MRI findings and the clinical picture of radiculopathy. Conclusion Electrophysiological studies are efficacious in diagnosing and predicting prognosis of lumbo-sacral radiculopathies. Significance The proper management decision should be based on the triad of imaging, electrophysiological tests and clinical context. Discussion MRI accuracy in detecting nerve root compromise is questionable by conflicting reports including this study.

The feasibility of sugammadex for general anesthesia and facial nerve monitoring in patients undergoing parotid surgery

The use of neuromuscular blocking agent (NMBA) during anesthesia may interfere with facial nerve monitoring (FNM) during parotid surgery. Sugammadex has been reported to be an effective and safe reversal of rocuronium-induced neuromuscular block (NMB) during surgery. This study investigated the feasibility and clinical effectiveness of sugammadex for NMB reversal during FNM in Parotid surgery.Fifty patients undergoing parotid surgery were randomized allocated into conventional anesthesia group (Group C, n = 25) and sugammadex group (Group S, n = 25). Group C did not receive any NMBA. Group S received rocuronium 0.6 mg/kg at anesthesia induction and sugammadex 2 mg/kg at skin incision. The intubating condition and influence on FNM evoked EMG results were compared between groups. The intubation condition showed significantly better in group S patients than C group patients (excellent in 96% v.s. 24%). In group S, rapid reverse of NMB was found and the twitch (%) recovered from 0 to >90% within 10 min. Positive and high EMG signals were obtained in all patients at the time point of initial facial nerve stimulation in both groups. There was no significant difference as comparing the EMG amplitudes detected at the time point of initial and final facial nerve stimulation in both groups. Implementation of sugammadex in anesthesia protocol is feasible and reliable for successful FNM during parotid surgery.