Neuromuscular Medicine Research Articles

Ultrasound Measurements of the Median Nerve at the Distal Wrist Crease Correlate With Electrodiagnostic Studies.

Background: Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy and is commonly evaluated using electrodiagnostic studies (EDSs). Ultrasound (US) has emerged as a potentially easier and more comfortable alternative to EDSs. The purpose of this study is to evaluate whether measurements of the cross-sectional area (CSA) of the median nerve via US correlate with the severity rating of CTS based on EDSs. Methods: A retrospective review of patients aged 18 years or older who underwent US and EDSs of the median nerve for CTS was performed. Sensory nerve action potential, distal motor latency, and compound muscle action potential were measured, and severity was graded on American Association of Neuromuscular and Electrodiagnostic Medicine guidelines. Cross-sectional area of the median nerve was measured via US at the wrist crease. Results: There was a significant association between increasing CSA and increasing EDS severity (P < .0001). The mean CSA for normal, mild, moderate, and severe CTS was 7.48 ± 2.00, 10.36 ± 2.53, 12.01 ± 3.64, and 14.34 ± 4.77 mm2, respectively. The area under the curve demonstrated the ability of median nerve CSA to discriminate between normal and abnormal EDSs with an optimal cutoff CSA of ≥10 mm2, as well as, the ability to discriminate between mild CTS and moderate to severe CTS at a cutoff CSA of greater than or equal to 12 mm2. Conclusions: The results of this study show that US measurements of the median nerve at the distal wrist crease discriminate between normal and abnormal EDSs, and between mild CTS and moderate to severe CTS.

Investigating Late-Onset Pompe Prevalence in Neuromuscular Medicine Academic Practices: The IPaNeMA Study.

Background and ObjectivesWe investigated the prevalence of late-onset Pompe disease (LOPD) in patients presenting to 13 academic, tertiary neuromuscular practices in the United States and Canada.MethodsAll successive patients presenting with proximal muscle weakness or isolated hyperCKemia and/or neck muscle weakness to these 13 centers were invited to participate in the study. Whole blood was tested for acid alpha-glucosidase (GAA) assay through the fluorometric method, and all cases with enzyme levels of ≤10 pmoL/punch/h were reflexed to molecular testing for mutations in the GAA gene. Clinical and demographic information was abstracted from their clinical visit and, along with study data, entered into a purpose-built REDCap database, and analyzed at the University of California, Irvine.ResultsGAA enzyme assay results were available on 906 of the 921 participants who consented for the study. LOPD was confirmed in 9 participants (1% prevalence). Another 9 (1%) were determined to have pseudodeficiency of GAA, whereas 19 (1.9%) were found to be heterozygous for a pathogenic GAA mutation (carriers). Of the definite LOPD participants, 8 (89%) were Caucasian and were heterozygous for the common leaky (IVS1) splice site mutation in the GAA gene (c -32-13T>G), with a second mutation that was previously confirmed to be pathogenic.DiscussionThe prevalence of LOPD in undiagnosed patients meeting the criteria of proximal muscle weakness, high creatine kinase, and/or neck weakness in academic, tertiary neuromuscular practices in the United States and Canada is estimated to be 1%, with an equal prevalence rate of pseudodeficiency alleles.Trial Registration InformationClinical trial registration number: NCT02838368.

Physicians Preferences of Virtual Versus In-Person Visits in Neuromuscular Clinical Practice

Background: &#x0D; While the role of telemedicine is well established in certain fields of medicine, its role in disciplines like Neuromuscular medicine is not clear. COVID 19 pandemic compelled the medical community to utilize telemedicine and policies were rapidly changed to continue patient care during the pandemic. However, to guide the future of telemedicine in this field where a physical exam is an integral part of the visit, it is imperative to get a physician's opinion on this matter. We designed this study to assess the opinion of neuromuscular physicians about telemedicine, their preference, and factors influencing their decision.&#x0D; Methods:&#x0D; We used an online form composed of eleven questions to survey 94 neuromuscular specialists across the USA and Canada during September 2020.&#x0D; Results:&#x0D; 90.43% of participating neuromuscular specialists preferred physical visits with new patients versus 44.68% preferred physical visits with follow-up patients. The majority thought that telemedicine reduces revenue (58.51%), quality of service (57.45%), and quality time spent with patients (62.77%). Nevertheless, most surveyed physicians agreed that telemedicine is time-efficient (84.04%), improves patient compliance (70.21%), and will be a long-term solution in clinical practice (67.02%). Finally, 58.51% revealed that telemedicine does not affect workload.&#x0D; Conclusion:&#x0D; Neuromuscular specialists preferred seeing new patients and revealing a new diagnosis to the patient in physical visits, but they also considered telemedicine a long-term method that would continue to increase in the post-pandemic future, emphasizing the need to address their concerns to facilitate telemedicine. &#x0D;

New patient access via telehealth in neuromuscular medicine during COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has changed the face of health care delivery. Health care institutions rapidly transitioned to telehealth to provide care to patients. Prior to the pandemic, telehealth services extended mostly to patients with established diagnoses. Driven by a necessity to provide care to all patients during the pandemic, neurologists started evaluating new patients also via telehealth. To explore opportunities, challenges, and feasibility of telehealth for new patients with neuromuscular disorders. New patient visits performed in our neuromuscular clinic were analyzed from March 18, 2020 - July 31, 2020. Data collected included visit volume, demographics, geographic distance of patient's residence from our institution, and no-show and cancellation rates. Total number of patients seen was 1,471; 472 (32%) were new patients. No-show and cancellation rates for telehealth visits were lower than historical in-person visits. There was a wide range of ages (35-74 years) with representation of new patients from a large geographical territory. This study advances our understanding regarding the adoption and implementation of telehealth for new patients. Our clinic was able to provide timely access and care to a significant number of patients who could not travel to our institution during COVID-19.

WS7.9. Imaging as a natural complementary test in neuromuscular medicine

Advances in the understanding of peripheral nerve disorders occur when new techniques allow a better insight into the underlying pathophysiology. Functional tests have to date led the way in furthering our understanding of peripheral nerve disorders. EMG was rapidly followed by nerve conduction studies and further technical refinements enabled the use of evoked potentials, intraneural microneurography and threshold tracking. Similar to what happened in the exploration of the central nervous system, there was a gap in the field of Neuromuscular medicine until clinically useful imaging of the peripheral nerves emerged. Because of its ready availability, excellent resolution and relative low cost, peripheral nerve Ultrasound has rapidly become part of clinical routine. A particular domain of peripheral nerve MRI scanning is the depiction of neural structure lying deep and behind bone such as the lumbosacral plexus. In this review, we will be looking at how imaging techniques compliments functional tests and provides a comprehensive evaluation of the peripheral nervous system.

P-NE020. Nerve conduction studies in COVID-19: AN Indian hospital suggestion

Introduction. COVID-19 is no longer a scientific acronym to anyone. The whole world is aware of this pandemic which has affected every human being on the globe. Health facilities were at the centre stage of this global pandemic. The global shutdown had forced all the hospitals and diagnostic centres to limit their activity for COVID treatment only. When the entire world was forced to adopt virtual modes of communications, non COVID diagnostics could not be accomplished by virtual platform.Methods. With the initiation of unlock guidelines, the need for nerve conduction studies came back to normal. To fulfil the demand of nerve conduction testing for diagnosis and treatment of neuromuscular diseases, there must be adherence to covid guidelines and precautions. In Indian hospital scenario, during the time of economic instability due to COVID, it is recommended to adopt newer strategies to ensure the safety of patients and the technicians performing the test.Results. These provisions are cost effective and easily justifiable. Adherence to these new strategies is not a big problem but yes everyone needs to learn newer way of healthcare delivery to remain safe and keep safe.Conclusion. The cost of new set up or provisions is quite less than the weekly cost of PPE for lab staff and it does not need much expertise. These provisions and modifications are in accordance with American Association of Neuromuscular & Electrodiagnostic Medicine guidelines. Compliance from lab staff and patients will not be a problem as it does not have the complicated steps.

Optimizing the operation of an electrodiagnostic laboratory during the COVID-19 pandemic: A 6-month single-center experience.

Introduction/AimsThe initial surge of the coronavirus disease‐2019 (COVID‐19) pandemic in early 2020 led to widespread cancellation of elective medical procedures in the United States, including nonurgent outpatient and inpatient electrodiagnostic (EDx) studies. As certain regions later showed a downtrend in daily new cases, EDx laboratories have reopened under the guidance of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). In our reopening experience guided by the AANEM, we measured relevant outcomes to determine further workflow adaptations. We aimed to detail our experience and share the lessons learned.MethodsWe reviewed the clinical volumes, billing data, diagnosis distributions, and rates of COVID‐19 exposure and transmission among patients and staff in our EDx laboratory during the first 6 months of reopening, starting on June 1, 2020. For context, we detailed the recent AANEM guidelines we adopted at our laboratory, supplemented by other consensus statements.ResultsWe completed 816 outpatient studies from June 1 to December 1, 2020, reaching 97% of the total volume and 97% of total billing compared with the same time period in 2019. The average relative value units per study were similar. There were no major shifts in diagnosis distributions. We completed 10 of 12 requested inpatient studies during this period. There were no known COVID‐19 transmissions between patients and staff.DiscussionOur experience suggests that it is possible to safely operate an EDx laboratory under the guidance of the AANEM and other experts, with clinical volume and billing rates comparable to pre‐pandemic baselines.

In memoriam: Robert T. Leshner, MD

In memoriam: <scp>Robert T. Leshner</scp>, <scp>MD</scp>

Upcoming events of interest

Pediatric PulmonologyVolume 56, Issue 4 p. 796-796 UPCOMING EVENTS Upcoming events of interest First published: 15 March 2021 https://doi.org/10.1002/ppul.24830AboutPDF 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 onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume56, Issue4Special Issue: Neuromuscular Cardiopulmonary Medicine in the Age of Emerging TherapiesApril 2021Pages 796-796 RelatedInformation

Disinfection of Ultrasound Transducers Used for Percutaneous Procedures: Intersocietal Position Statement.

Disinfection of Ultrasound Transducers Used for Percutaneous Procedures: Intersocietal Position Statement.

Teaching and use of cervical high-velocity, low-amplitude manipulation at colleges of osteopathic medicine.

Despite the documented effectiveness of high-velocity, low-amplitude (HVLA) treatment of the cervical spine, concerns about patient safety potentially limit didactic instruction and use in clinical practice. Understanding how cervical HVLA is taught and employed is of interest to osteopathic educators and clinicians. To characterize the perspectives of osteopathic manipulative medicine/osteopathic principles and practices (OMM/OPP) departments within colleges of osteopathic medicine (COMs) in the US regarding patterns of teaching and practice of HVLA treatment of the cervical spine. A questionnaire was distributed on April 11, 2019 in paper format to OMM/OPP department chairs or designated faculty member attendees at the Educational Council on Osteopathic Principles biannual meeting. If the department chair was not available, the survey was provided to the faculty member designated to represent the Chair of the institution at ECOP. All respondents in this category returned the survey in paper before they left the meeting. The OMM/OPP department chairs who did not attend or send representatives to the ECOP meeting were sent the survey by email on April 11, 2019 and given three opportunities over 6weeksat 2-week intervals to reply to this voluntary online survey. The survey was given or sent to a total of 51 OMM/OPP department chairs or representatives. Six questions elicited demographic information pertaining to status, age, gender, ethnicity, board-certified specialty, and COM affiliation. Nine questions examined perspectives related to the instruction of cervical HVLA manipulation and treatment. Of the 51 OMM/OPP department chairs surveyed, 38 (74.5%) responded, 32 to the paper survey at the ECOP meeting and six to the digital survey. Respondents were primarily dual Board-certified in Family Medicine and Neuromuscular Medicine (55.3%). At over 90% (35) of the COMs for which department chairs responded to the survey, cervical HVLA instruction occurs in the curriculum primarily during program years 1 and 2. Instruction in cervical HVLA to the 2nd through 7th cervical vertebral levels occurred in 97% (37), while 11% (4) of the COMs excluded the occipital-atlanto (OA) and atlanto-axial (AA) joints. A high percentage (81.6%; 31) of the OMM/OPP department chairs or representatives reported employing cervical HVLA techniques within their practice. Among the respondents, 40.5% (15) reported that 0-25% of their school's medical school class could perform cervical HVLA competently upon graduation, whereas 27% (10) said that 51-75% of their class could perform cervical HVLA. A majority of COMs provide education in their curricula related to cervical HVLA primarily in the first 2 years of medical education. However, instruction often excludes cervical HVLA to the upper regions of the cervical spine. At COMs where HVLA to the cervical spine is not taught, that decision is because the techniques are thought to be too difficult and the attendant medicolegal risk perceived to be too high. OMM/OPP department chairs expressed confidence in only a small proportion of their graduates having the ability to competently apply HVLA to the cervical spine immediately after completing their predoctoral medical training.

Muscle Ultrasound Shear Wave Elastography as a Non-Invasive Biomarker in Myotonia.

Myotonia, i.e., delayed muscle relaxation in certain hereditary muscle disorders, can be assessed quantitatively using different techniques ranging from force measurements to electrodiagnostics. Ultrasound shear wave elastography (SWE) has been proposed as a novel tool in biomechanics and neuromuscular medicine for the non-invasive estimation of muscle elasticity and, indirectly, muscle force. The aim of this study is to provide ‘proof-of-principle’ that SWE allows a quantitative measurement of the duration of delayed muscle relaxation in myotonia in a simple clinical setting. In six myotonic muscle disorder patients and six healthy volunteers, shear wave velocities (SWV) parallel to the fiber orientation in the flexor digitorum superficialis muscle in the forearm were recorded with a temporal resolution of one per second during fist-clenching and subsequent relaxation; the relaxation time to 10% of normalized shear wave velocity (RT0.1) was calculated. Forty-six SWE imaging sequences were acquired, yielding a mean RT0.1 of 7.38 s in myotonic muscle disorder patients, significantly higher than in healthy volunteers (1.36 s), which is comparable to data obtained by mechanical dynamometry. SWV measurements during the baseline relaxation and voluntary contraction phases did not differ significantly between groups. We conclude that SWE is a promising, non-invasive, widely available tool for the quantitative assessment of myotonia to aid in diagnosis and therapeutic monitoring.

Neuromuscular amyloidosis: Unmasking the master of disguise.

Amyloidosis refers to an etiologically heterogeneous group of protein misfolding diseases, pathologically characterized by extracellular amyloid fibrils producing congophillic amorphous deposits in organs and tissues, which may lead to severe organ dysfunction and mortality. Clinical presentations vary and are often nonspecific, depending on what organs or tissues are affected. In systemic amyloidosis, the peripheral nervous system is commonly affected, whereas the skeletal muscles are only rarely involved. Immunoglobulin light chain (AL) amyloidosis and hereditary transthyretin (ATTRv) amyloidosis are the most frequent types of systemic amyloidosis involving the neuromuscular system. Localized amyloidosis can occur in skeletal muscle, so-called isolated amyloid myopathy. Amyloid neuropathy typically involves small myelinated and unmyelinated sensory and autonomic nerve fibers early in the course of the disease, followed by large myelinated fiber sensory and motor deficits. The relentlessly progressive nature with motor, painful sensory and severe autonomic dysfunction, profound weight loss, and systemic features are distinct characteristics of amyloid neuropathy. Amyloid myopathy presentation differs between systemic amyloidosis and isolated amyloid myopathy. Long-standing symptoms, distal predominant myopathy, markedly elevated creatine kinase level, and lack of peripheral neuropathy or systemic features are highly suggestive of isolated amyloid myopathy. In ATTR and AL amyloidosis, early treatment correlates with favorable outcomes. Therefore, awareness of these disorders and active screening for amyloidosis in patients with neuropathy or myopathy are crucial in detecting these patients in the everyday practice of neuromuscular medicine. Herein, we review the clinical manifestations of neuromuscular amyloidosis and provide a diagnostic approach to this disorder.

Ultrasound Assessment of Carpal Tunnel Syndrome in Comparison with Nerve Conduction Study: A Case-control Study

Introduction: Carpal Tunnel Syndrome (CTS) is the entrapment neuropathy which is diagnosed based on the clinical history, examinations and the electrophysiological findings. The Cross- sectional Area (CSA) measurement of the median nerve has emerged as an alternative to Nerve Conduction Studies (NCS) for diagnosis of CTS. This study was done to correlate NCS and Ultrasonography (USG) in clinically diagnosed CTS patients. Aim: To evaluate the diagnostic value of Cross-sectional Area (CSA) of median nerve at carpal tunnel inlet in patients with clinically and NCS confirmed Carpal Tunnel Syndrome (CTS) and to assess severity of the syndrome by NCS and its correlation with USG results. Materials and Methods: This was a hospital based, case-control study done on a total of 109 patients of CTS and analysed during the period from June 2017 to June 2019. Total 203 hands of the patients with abnormal NCS formed case group while 101 hands from healthy volunteers constituted the control group. All the patients underwent neurological evaluation by Boston Carpal Tunnel Questionnaire (BCTQ) and were divided into mild, moderate and severe according to the score. An electromyography machine was used to perform electrophysiological studies of both the limbs in all subjects. CTS was diagnosed electro-diagnostically based on the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) guidelines and were classified as mild (Grades 1 and 2), moderate (Grades 3 and 4), and severe (Grades 5 and 6) grades using Bland’s electrophysiological grading scale. USG was performed for all the subjects and all the data of various investigations was analysed using Statistical Package for Social Sciences (SPSS) version 22.0 software. Chi-square test and Mann Whitney U-test were used as test of significance for qualitative data. Results: The mean age of subjects was 44.38±9.561 years. Strongly significant association was observed in BCTQ symptom, functional and total scores with NCS severity grading (p-value &lt;0.001). Moderately significant association was found between BCTQ symptom and total scores with USG severity grading (p-value&lt;0.02). Tunnel grade and NCS grade were found significantly correlated (p-value &lt;0.001). The mean CSA cut-off value of 8.5 mm² at the inlet of carpal tunnel had a good sensitivity 86.21%, specificity 83.17%, Positive Predictive Value (PPV) 91.1% and Negative Predictive Value (NPV) 75%. Conclusion: The diagnostic accuracy of USG assessment and NCS was found to be correlated comparably and complement each other in all grades of CTS. USG, can be considered a preferable screening tool by the patients of CTS due to its painless nature and easy accessibility. It requires minimal time and many a times detects those structural abnormalities which have great therapeutic implications. In mild CTS cases, USG should always be combined with NCS for proper diagnosis as USG might give negative result.

Diagnosis of sleepiness, fatigue and depression in patients with myasthenia gravis

Introduction. Examination of excessive daytime sleepiness, fatigue and depression in patients with myasthenia gravis is important for differential diagnosis of other disorders, and adds to a comprehensive clinical assessment.Objective. The aim is a comprehensive assessment of sleepiness, fatigue and depression and evaluation of the impact of autoimmune comorbidity on these symptoms in myasthenia gravis patients, using newly validated Russian versions of international questionnaires. The present article aims at familiarizing a wider Russian-speaking audience of specialists in the field of neuromuscular disease and sleep medicine with the main findings of our previously published work.Materials and methods. The study included 73 patients with MG and 230 control subjects. For sleepiness, fatigue and depression evaluation were used: Fatigue Severity Scale (FSS), Fatigue Impact Scale (FIS) (cognitive / physical / psychosocial subscales), Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI) (cognitive-affective and somatic domains), Spielberger–Khanin State Trait Anxiety Inventory (STAI).Results. The Fatigue Severity Scale and Fatigue Impact Scale showed good psychometric properties and can be used to identify distinct aspects of fatigue in patients with myasthenia gravis. The studied patient cohort revealed clinically significant fatigue (69.9 %), excessive daytime sleepiness (15.1 %), moderate to severe depression (20.5 %), a high level of personal (64.4 %) and situational anxiety (27.4 %). Among 13 patients with myasthenia gravis and additional autoimmune comorbidity, there were no significant differences in the severity of sleepiness, fatigue and depression compared with the main group.Conclusion. The use of self-reported scale of sleepiness, fatigue and depression combined with careful clinical-neurological characterization adds to a more comprehensive view of the patient. The identification of sleepiness, fatigue and depression can guide therapeutic decisions and contributes to a better patient care. The presence of concomitant autoimmune pathology in patients with myasthenia gravis does not seem to increase the severity of sleepiness, fatigue and depression.

An Appraisal of Electrodiagnostic Studies in Stiff Person Syndrome.

A literature review was performed on the use of electrodiagnostic (EDX) tests including nerve conduction study, electromyography, exteroceptive reflex, blink reflex, and late response in the evaluation of patients with stiff person syndrome (SPS). A web survey was conducted to report the extent of EDX testing usage in the evaluation of SPS among laboratories accredited by the American Academy of Neuromuscular and Electrodiagnostic Medicine. Coactivation of selected agonist and antagonist muscles was performed in 5 healthy subjects to determine its specificity for SPS. Observation of continuous motor unit activity on electromyography and elicitation of exteroceptive reflexes by electric stimulation are informative in assisting a diagnosis of SPS, but further studies focusing on their sensitivities in diagnosing SPS and specificities in differentiating SPS from other movement disorders are needed. The value of EDX testing in SPS lies in ruling out other neuromuscular disorders.

Introduction to the special issue on neuromuscular cardiopulmonary medicine in the age of emerging therapies.

Introduction to the special issue on neuromuscular cardiopulmonary medicine in the age of emerging therapies.

Cardiopulmonary phenotypic variability and discordance in Duchenne muscular dystrophy: Implications for new therapies

Neuromuscular respiratory medicine has traditionally focused on assisted lung ventilation and mucus clearance. These therapies have prolonged survival for patients with Duchenne muscular dystrophy (DMD). However, the field is rapidly evolving in a new direction: it is being revolutionized by molecular and genetic therapies. A good correlation between a patient's dystrophin mutation and his cardiopulmonary phenotype would allow accurate prediction of patient prognosis and would facilitate the design of studies that assess new DMD therapies. Instead, patient prognosis and the design of valid therapeutic studies are complicated by cardiopulmonary phenotypic discordance and variability, by which a notable proportion of DMD patients have unexpectedly good or poor cardiopulmonary function. The likely cause of phenotypic variability and discordance is genetic modifiers. Once the modifiers that affect cardiopulmonary function are better understood, it should be possible to create a personalized genetic profile that accurately predicts the prognosis of each individual DMD patient. This would allow investigators to assess the effect of new therapies in the context of each patient's particular cardiopulmonary natural history. Amplification of beneficial cardiopulmonary genetic modifiers and blocking of detrimental modifiers is a promising strategy for creating new DMD therapies. When patients with chronic respiratory failure are treated with assisted ventilation, cardiac function determines their survival. Therefore, prioritizing new cardiac therapies is most likely to prolong patient survival. By focusing on these topics we aim to move neuromuscular respiratory medicine beyond assisted ventilation and coughing and into the age of translational medicine.

Editorial introductions

Current Opinion in Neurology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of neurology is divided into 14 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Claudia SommerClaudia SommerClaudia Sommer is a Professor of Neurology at the University of Würzburg, Germany. Her research interests are immune neuropathies and the pathophysiology of pain and of antibody-mediated diseases. She has written more than 250 original research papers and more than 100 reviews and book-chapters and edited several books. She is a longstanding member of the Peripheral Nerve Society (PNS) and a Board Member of the Inflammatory Neuropathy Consortium (INC), as well as Chair of the Teaching Course Subcommittee of the European Academy of Neurology (EAN). Dr Sommer is active in the development of national and international guidelines on immune neuropathies, diagnosis and treatment of peripheral neuropathies, on nerve and skin biopsies, and on neuropathic and primary pain syndromes. She is currently president of the German Pain Society and president elect of the International Association for the Study of Pain (IASP). John VissingJohn VissingJohn Vissing is professor of Neurology at the University of Copenhagen, Denmark, and the Director of the Copenhagen Neuromuscular Center at the National Hospital, Rigshospitalet, in Copenhagen, with 38 dedicated neuromuscular employees. He obtained his MD in 1986 and was then a research fellow at University of Copenhagen and UT, Southwestern Medical Center in Dallas, USA. His research focuses on hereditary muscle diseases. Main research interests are treatment and pathophysiology of metabolic myopathies myasthenia gravis and channelopathies, discovery of new neuromuscular diseases, rehabilitation of muscle disease including exercise training, MR imaging of muscle, defining outcome measures for natural history and trials and unraveling genotype-phenotype relations in muscle disease. He has authored more than 400 scientific papers on neuromuscular diseases. Jinsy A. AndrewsJinsy A. AndrewsJinsy A. Andrews, MD, MSc, FAAN is an Associate Professor of Neurology, in the Division of Neuromuscular Medicine and serves as the Director of Neuromuscular Clinical Trials at Columbia University Irving Medical Center, USA. She currently oversees neuromuscular clinical trials at the medical center and cares for patients with neuromuscular disease, primarily with Amyotrophic Lateral Sclerosis (ALS) at the Eleanor and Lou Gehrig ALS Center. Dr Andrews has extensive experience in all phases of human clinical trials and drug development in both the academic and industry settings. Dr Andrews is the elected co-chair of the Northeastern ALS (NEALS) Consortium, which is a network of over 100 ALS clinical research centers internationally. She is also elected to the National Board of Trustees of the ALS Association and is a Fellow of the American Academy of Neurology (FAAN) in the United States. She has also received the Diamond Award for ALS clinical research from Wings Over Wall Street and the Muscular Dystrophy Association. Dr Andrews received her B.S. from Union College, USA, M.Sc. in Biostatistics (Patient-Oriented Research) from Columbia University's Mailman School of Public Health, USA, and M.D. from Albany Medical College, USA. She completed her residency training in Neurology at the University of Connecticut, USA, and served as the Chief Neurology Resident in her final year. Dr Andrews completed fellowship training in Neuromuscular Disease/ALS and Clinical Neurophysiology at Columbia University. She is board certified in Neurology, Neuromuscular Disease, and Electrodiagnostic Medicine.

Age and Body Anthropometry as Predicting Factors for Carpal Tunnel Syndrome among Egyptian Obese Women

BACKGROUND: Carpal tunnel syndrome (CTS) is the most prevalent entrapment neuropathy in the upper limb. The most consistent risk factors are female gender, age, and obesity. The results of previous studies are conflicting, and moreover, data from studies regarding obesity and nerve conduction velocity are not available for our Egyptian population.&#x0D; AIM: This study was designed to investigate the contribution of age and body anthropometry as predictor factors to the CTS and to identify patients at high risk for CTS among Egyptian obese women.&#x0D; METHODS: The study included 120 obese women grouped according to the clinical and electrodiagnostic (EDX) findings into two groups: 60 with CTS and 60 without CTS (non-CTS). EDX study was used in the diagnosis of median nerve entrapment at the level of the wrist, according to the American Association of Neuromuscular and EDX Medicine. Body weight and height were measured and then body mass index (BMI) was calculated. Waist-to-hip ratio (WHR) was determined from the measured waist circumference (WC) and hip circumference (HC). Mid upper arm circumference (MUAC) was measured as well. The receiver operating characteristic (ROC) curve was used to assess the power of age and body anthropometry as predictor factors for CTS.&#x0D; RESULTS: CTS obese cases showed significantly lower values of both median motor nerve conduction velocity (MMNCV) and median sensory nerve conduction velocity compared to those without CTS. Significantly higher median sensory latency and median motor latency have been found in CTS cases compared to non-CTS group. Significant differences in the mean age have been found between the two groups and a tendency for higher body anthropometry measures in the CTS cases relative to those without CTS. Moreover, there were negative correlations between MMNCV and obesity indices. Age showed the highest area under the ROC curve, followed by BMI, WHR WC, HC, and MUAC.&#x0D; CONCLUSION: Age and obesity indices are important risk factors that can be used as predictors to CTS in obese women. Age is a more powerful diagnostic tool relative to the anthropometric measurements. Women of age above 40 years and suffering from a high degree of obesity are at risk of developing CTS.