Neurophysiological Tests Research Articles

Assessment of Mental Imagery of Movement in Schizophrenia

Schizophrenia patients often present with neurological signs such as left/right confusion, impaired coordination of movements, and motor abnormalities may occur secondary to antipsychotic medications. Neuropsychological tests identify various dysfunctions, such as difficulty in focusing attention, difficulty in abstract thinking or difficulty in changing the response frame, while Neurophysiological tests show slowing down of reaction time, problems with eye tracking, etc. There are no studies in the international literature dealing with the investigation of mental imagery of movement in Greek patients with schizophrenia. Also, the position that patients with schizophrenia – regardless of their symptom profile, age, sex, and chronicity of the disease – have a permanent difficulty in creating and manipulating an internal model of their movement prediction, has not been substantiated enough to date. Aim: In the present study we examine the function of visual-motor coordination and the time to achieve the goal-directed movement of the dominant hand of patients with schizophrenia Method: The sample we used in our research consisted of patients with diagnosed schizophrenia and healthy individuals. Schizophrenia patients belonged to the experimental group and healthy subjects to the control group. The number of examined patients was 39 and the healthy 51. the assessment of the movement and its mental representation was carried out with the real and mental movement of the dominant hand between two square targets located at a distance of 20 cm, on white paper of A4 size. Conclusions: Visuomotor coordination of a specific hand movement differs between patients with schizophrenia and the normal population. In particular, the means of the goal-directed hand movement achievement time in the actual execution condition and in the mental execution condition of the patients were significantly higher than the corresponding times of the standard population.

The Role of Transcranial Magnetic Stimulation, Peripheral Electrotherapy, and Neurophysiology Tests for Managing Incomplete Spinal Cord Injury

Efforts to find therapeutic methods that support spinal cord functional regeneration continue to be desirable. Natural recovery is limited, so high hopes are being placed on neuromodulation methods which promote neuroplasticity, such as repetitive transcranial magnetic stimulation (rTMS) and electrical stimulation used as treatment options for managing incomplete spinal cord injury (iSCI) apart from kinesiotherapy. However, there is still no agreement on the methodology and algorithms for treatment with these methods. The search for effective therapy is also hampered by the use of different, often subjective in nature, evaluation methods and difficulties in assessing the actual results of the therapy versus the phenomenon of spontaneous spinal cord regeneration. In this study, an analysis was performed on the database of five trials, and the cumulative data are presented. Participants (iSCI patients) were divided into five groups on the basis of the treatment they had received: rTMS and kinesiotherapy (N = 36), peripheral electrotherapy and kinesiotherapy (N = 65), kinesiotherapy alone (N = 55), rTMS only (N = 34), and peripheral electrotherapy mainly (N = 53). We present changes in amplitudes and frequencies of the motor units' action potentials recorded by surface electromyography (sEMG) from the tibialis anterior-the index muscle for the lower extremity and the percentage of improvement in sEMG results before and after the applied therapies. The increase in values in sEMG parameters represents the better ability of motor units to recruit and, thus, improvement of neural efferent transmission. Our results indicate that peripheral electrotherapy provides a higher percentage of neurophysiological improvement than rTMS; however, the use of any of these additional stimulation methods (rTMS or peripheral electrotherapy) provided better results than the use of kinesiotherapy alone. The best improvement of tibialis anterior motor units' activity in iSCI patients provided the application of electrotherapy conjoined with kinesiotherapy and rTMS conjoined with kinesiotherapy. We also undertook a review of the current literature to identify and summarise available works which address the use of rTMS or peripheral electrotherapy as neuromodulation treatment options in patients after iSCI. Our goal is to encourage other clinicians to implement both types of stimulation into the neurorehabilitation program for subjects after iSCI and evaluate their effectiveness with neurophysiological tests such as sEMG so further results and algorithms can be compared across studies. Facilitating the motor rehabilitation process by combining two rehabilitation procedures together was confirmed.

Improving Effects of Peripheral Nerve Decompression Microsurgery of Lower Limbs in Patients with Diabetic Peripheral Neuropathy

Peripheral nerve decompression microsurgery can relieve nerve entrapment and improve the symptoms of DPN. However, postoperative tissue adhesion will produce new pressure on the nerves, affecting the surgical efficacy. In this study, a nerve conduit was used in the peripheral nerve decompression microsurgery to prevent postoperative adhesions, and the role of the nerve conduit in surgical nerve decompression was explored. A total of 69 patients with DPN were recruited and randomly divided into three groups: the nerve conduit group, conventional surgery group, and control group. Two weeks before surgery and 6 months after surgery, patients in each group were clinically tested using the visual analog scale (VAS) score, neurophysiological test, Toronto clinical scoring system (TCSS) score, and two-point discrimination (2-PD) test. The patients' symptoms in the nerve conduit group were relieved to varying degrees, and the relief rate reached 90.9%; the treatment efficacy was higher than that in the other groups. The postoperative nerve conduction velocity (NCV) in the two surgical groups was significantly higher than that before the surgery, and the difference between the nerve conduit group and the conventional surgery group was statistically significant (p < 0.05). For the 2-PD test, there was a statistically significant difference between the two surgical groups (p < 0.05). The TCSS score in the two surgical groups was significantly higher than that in the control group (p < 0.01). There was a significant difference in the TCSS scores between the nerve conduit group and the conventional surgery group (p < 0.05). The nerve conduit could further improve the efficacy of peripheral nerve decompression microsurgery in the treatment of DPN.

Neurodevelopmental Effects of a Mindfulness and Kindness Curriculum on Executive Functions in Preschool Children—A Randomized, Active‐Controlled Study

ABSTRACTThis study aimed to explore the effect of a mindfulness‐based curriculum designed especially for preschoolers on facets of executive functions. Fifty‐one preschoolers were randomly assigned to either a mindfulness and kindness curriculum (MC) or an active control dialogic reading program (DR). A battery of behavioral and neurophysiological tests was used to tap into facets of executive control (inhibition, shifting). Electroencephalography data were acquired during the attentional network task (ANT). Relative to DR, children in the MC group exhibited a reduced difference in the N200 Event related potentials (ERP) amplitudes for the congruent versus incongruent conditions during the ANT paradigm representing inhibition and shifting abilities. On the behavioral tasks, both groups improved on executive functions (EF) but on different facets; MC group showed increased inhibition and the DR group demonstrated significantly greater shifting abilities. The results highlight the sensitivity of electrophysiological data to detect subtle cognitive changes. The understanding of how mindfulness‐based interventions in preschoolers affect facets of executive functions can enable further refinement and maximization of the benefits of these interventions for this age group.

Cognitive Dysfunction, an Increasingly Valued Long-Term Impairment in Acromegaly.

Acromegaly is a chronic disease caused by the overproduction of growth hormone (GH) and accompanying insulin-like growth factor-1 (IGF-1), which is often caused by GH-secreting pituitary adenomas. In addition to its somatic burden, a growing number of studies have found that patients suffering from acromegaly exhibit psychosocial and personality changes. Over the past 70 years, there has been increasing interest in the cognitive impairment and neuropsychological issues of patients with acromegaly, and a variety of neuropsychological and neurophysiological tests have been used to measure cognitive changes in patients. The impact of disease progression status, treatment modalities, and various comorbidities on cognitive function and the mechanisms of cognitive impairment in patients with acromegaly are therefore outlined in this review. Multidisciplinary assessment has important implications for the management of acromegaly, particularly in relation to cognitive function. Here, we summarize the relevant literature concerning cognitive-behavioral research on acromegaly to demonstrate the impact of long-term impairment caused by GH and IGF-1 on the cognitive behavior of patients.

Assessment of muscle fatigue in multiple sclerosis patients in electromyographic examinations.

Although surface electromyography (sEMG) is the method used to assess muscle fatigue in patients with multiple sclerosis (PwMS), no pattern of signal change has been established. The differences shown in the parameters of other neurophysiological tests between PwMS and control groups (CG) suggest the differentiation of the sEMG signal. The purpose of the study was to verify potential differences in the fatigue sEMG signal in PwMS compared to CG. Cross-sectional study. Chair and Department of Functional Diagnostics and Physical Medicine. A randomised group of patients diagnosed with MS (30, 20-41 years). A random sample of young, healthy adults (median 28, 20-39 years). Measurement of sEMG was performed from extensor carpi radialis (ECR) and FCR (flexor carpi radialis) during 60-80% of maximum voluntary contraction (MVC) of extension and then flexion for 60sec, accordance with the fatigue protocol in Research XP Master Edition software (v. 1.08.27). Root mean square amplitude (A<inf>RMS</inf>) were lower for muscle in the PwMS compared to the CG (ECR P=0.0001, FCU P<0.0001). In the CG, the A<inf>RMS</inf> value increases during fatigue contraction (ECR P=0.0003, FCU P<0.0001), while in the PwMS) the A<inf>RMS</inf> value decreases (ECR: P<0.0001, FCU P<0.0001. The PwMS show an opposite pattern of preservation of the absolute value of A<inf>RMS</inf> during prolonged contraction to fatigue, compared with healthy subjects. The results are important for clinical trials using sEMG to assess fatigue in PwMS. Knowledge of the differences in the time domain changes in sEMG signal between healthy subjects and PwMS is crucial for correctly interpreting the results.

Isolated Dystonia as an Initial Presentation of GDAP2-Related Disorder.

Isolated Dystonia as an Initial Presentation of GDAP2-Related Disorder.

3D EEG and Clinical Evidence of Brain Dying. Preliminary Report

Determination of brain dying means reversible or irreversible injury to the brain, including the brainstem. Current guidelines rely on clinical examination including the proof of coma, absent brain stem reflexes, and apnoea test. Neurophysiological testing using electroencephalography and evoked potentials — somatosensory evoked potentials and brainstem auditory evoked potential could have been helpful in the final diagnostic brain death conclusion, but the diagnostic accuracy of these methods in the last years has revealed controversies. Here, we present data on quantitative EEG signal evaluation (qEEG) by a 3-dimensional brain mapping (3D BM) as developing tool to clarify whether the transverse and anterior posterior coherences such as connectivity indices may demonstrate connection in transversal or anterior posterior dimensions with «wavelet transformation» and if the 3D BM visualization of the of representative EEG signals may improve informative value of EEG signals quantification when evaluating the brain dying.The purpose of our work is to provide an update on the evidence and controversies on the use of EEG for determining brain dying and raise discussion on EEG applications to improve the transplantation program.Results. We analyzed the EEG records of 10 patients admitted for cardiopulmonary resuscitation (CPR) during September, 2017 — August, 2018. Data from one patient, ŽM, 33 years old, after haemorrhagic shock (August 2018) were analyzed in details. Quantitative EEG dynamics by images and clinical course of brain dying were monitored prior and after the amantadine sulfate intravenous administration for brain revival. Data demonstrated the ability of brain to survive; the cause of final brain death was heart failure.Conclusion. Data confirm the hope for survival of the brain in a coma and demonstrate brain capability to keep functionally optimal state as a potential for a good social adaptation.

The Role of Magnetic Transcranial Stimulation in the Diagnosis and Post-Surgical Follow-Up of Cervical Spondylotic Myelopathy.

Degenerative cervical myelopathy (DCM) consists of spinal cord damage due to its compression through the cervical spine. The leading cause is degenerative. The diagnosis is clinical, and the therapeutic approach is usually surgical. Confirmation of the diagnostic suspicion is done by magnetic resonance imaging (MRI); however, this test lacks functional information of the spinal cord, the abnormality of which may precede involvement in neuroimaging. Neurophysiological examination using somatosensory evoked potentials (SSEPs) and transcranial magnetic stimulation (TMS) allows for an evaluation of spinal cord function, and provides information in the diagnostic process. Its role in the post-surgical follow-up of patients undergoing decompressive surgery is being studied. We present a retrospective study of 24 patients with DCM and surgical decompression who underwent neurophysiological tests (TMS and SSEP) before, 6, and 12 months after surgery. The result of the TMS and the SSEP in the post-operative follow-up did not correlate with the clinical outcome, either subjective or measured by clinical scales at six months. We only found post-surgical improvement of central conduction times (CMCTs) in patients with severe pre-surgical motor impairment on TMS. In patients with normal pre-surgical CMCT, we found a transient worsening with return to baseline at the one-year follow-up. Most patients presented pre-surgical increased P40 latency at diagnosis. CMCT and SSEP were more related to clinical outcomes one year after the surgical procedure and were very useful in diagnosing.

Mismatch negativity as a marker of music perception in individual cochlear implant users: A spike density component analysis study

ObjectiveNinety percent of cochlear implant (CI) users are interested in improving their music perception. However, only few objective behavioral and neurophysiological tests have been developed for tracing the development of music discrimination skills in CI users. In this study, we aimed to obtain an accurate individual mismatch negativity (MMN) marker that could predict behavioral auditory discrimination thresholds. MethodsWe measured the individual MMN response to four magnitudes of deviations in four different musical features (intensity, pitch, timbre, and rhythm) in a rare sample of experienced CI users and a control sample of normally hearing participants. We applied a recently developed spike density component analysis (SCA), which can suppress confounding alpha waves, and contrasted it with previously proposed methods. ResultsStatistically detected individual MMN predicted attentive sound discrimination ability with high accuracy: for CI users 89.2% (278/312 cases) and for controls 90.5% (384/424 cases). As expected, MMN was detected for fewer CI users when the sound deviants were of smaller magnitude. ConclusionsThe findings support the use of MMN responses in individual CI users as a diagnostic tool for testing music perception. SignificanceFor CI users, the new SCA method provided more accurate and replicable diagnostic detections than preceding state-of-the-art.

Protocolo diagnóstico y terapéutico ante una primera crisis epiléptica

When attending to epileptic seizures in the emergency department, it is important to take a detailed medical history, paying special attention to the patient's history and the semiological description of the episodes in addition to performing the appropriate systemic, neurophysiological, and neuroimaging diagnostic tests. One of the first tasks is determining if it really is an epileptic seizure and, if so, evaluate whether it was a provoked or unprovoked seizure, carrying out a study and targeted treatment based on each case. It is important to adequately define the epilepsy syndrome, as it will condition not only the treatment choice but the type of treatment, which must also be suited to the patient's clinical profile. It will also condition the drugs to avoid, considering the risk of worsening of some types of seizures in certain cases as well as other more specific or precise treatments for each.

Effect of Wrist Dorsiflexion/Palmar Flexion on Median Nerve Deviation and Cross-Sectional Area in Patients with Carpal Tunnel Syndrome.

To evaluate the effect of wrist dorsiflexion/palmar flexion on median nerve excursion and cross-sectional area in patients with carpal tunnel syndrome. From November 2019 to December 2021, 85 patients (110 affected wrists) who presented to our department and were diagnosed with carpal tunnel syndrome were collected and classified by severity as mild to moderate. Twenty-five healthy controls were selected during the same period, with a total of 50 healthy wrists. All patients and healthy volunteers underwent high-frequency ultrasonography to measure the vertical deviation between the median nerve and the transverse carpal ligament during wrist dorsiflexion/palmar flexion and the changes in the cross-sectional area of the median nerve in the pisiform plane. All patients with carpal tunnel syndrome underwent neurophysiological testing to measure median nerve sensory conduction velocity, sensory latency time, and sensorimotor point fluctuation amplitude. The mean age of the patients was 50 ± 8 years, the proportion of males was 18%, and the disease course was 2.3 ± 1.2 years. In terms of severity grading, 38 patients (34.5%) had mild carpal tunnel syndrome, 30 patients (27.3%) had moderate carpal tunnel syndrome, and 42 patients (38.2%) had severe carpal tunnel syndrome. Compared with the control group, the distance between the proximal median nerve and the transverse carpal ligament, the distance between the distal median nerve and the transverse carpal ligament, and the cross-sectional area were decreased in the carpal tunnel syndrome group compared with those during wrist dorsiflexion, and the differences were statistically significant (P < 0.05). Compared with the control group, there were significant differences in the vertical distance and cross-sectional area between the median nerve and the transverse carpal ligament at the proximal and distal ends in the mild, moderate, and severe groups (P < 0.05). The proximal vertical distance of the median nerve was positively correlated with sensory latency (P < 0.05) and negatively correlated with sensory conduction velocity (P < 0.05). The vertical distance of the distal end of the median nerve was also significantly positively correlated with sensory latency (P < 0.05) and significantly negatively correlated with sensory conduction velocity (P < 0.05). Wrist dorsiflexion/palmar flexion can affect median nerve deviation and cross-sectional area in patients with carpal tunnel syndrome. High-frequency ultrasound is helpful to detect such an effect and can also help determine the severity of carpal tunnel syndrome, which is worthy of clinical promotion.

Tilt perception is different in the pitch and roll planes in human.

Neurophysiological tests probing the vestibulo-ocular, colic and spinal pathways are the gold standard to evaluate the vestibular system in clinics. In contrast, vestibular perception is rarely tested despite its potential usefulness in professional training and for the longitudinal follow-up of professionals dealing with complex man-machine interfaces, such as aircraft pilots. This is explored here using a helicopter flight simulator to probe the vestibular perception of pilots. The vestibular perception of nine professional helicopter pilots was tested using a full flight helicopter simulator. The cabin was tilted six times in roll and six times in pitch (-15°, -10°, -5°, 5°, 10° and 15°) while the pilots had no visual cue. The velocities of the outbound displacement of the cabin were kept below the threshold of the semicircular canal perception. After the completion of each movement, the pilots were asked to put the cabin back in the horizontal plane (still without visual cues). The order of the 12 trials was randomized with two additional control trials where the cabin stayed in the horizontal plane but rotated in yaw (-10° and +10°). Pilots were significantly more precise in roll (average error in roll: 1.15 ± 0.67°) than in pitch (average error in pitch: 2.89 ± 1.06°) (Wilcoxon signed-rank test: p< 0.01). However, we did not find a significant difference either between left and right roll tilts (p= 0.51) or between forward and backward pitch tilts (p= 0.59). Furthermore, we found that the accuracies were significantly biased with respect to the initial tilt. The greater the initial tilt was, the less precise the pilots were, although maintaining the direction of the tilt, meaning that the error can be expressed as a vestibular error gain in the ability to perceive the modification in the orientation. This significant result was found in both roll (Friedman test: p< 0.01) and pitch (p< 0.001). However, the pitch trend error was more prominent (gain=0.77 vs gain=0.93) than roll. This study is a first step in the determination of the perceptive-motor profile of pilots, which could be of major use for their training and their longitudinal follow-up. A similar protocol may also be useful in clinics to monitor the aging process of the otolith system with a simplified testing device.

A COMPREHENSIVE REVIEW ON NEUROTOXICITY OF PYRETHROIDS

Pyrethroids are synthetic derivations of natural pyrethrins from the factory Chrysanthemum cinerariaefolium. They comprise esters of chrysanthemum acid (ethyl, 2-dimethyl-3-(1-isobutenyl) cyclopropane-1-carboxylate) and halogenated derivations of their acids and alcohols. Pyrethroids are generally used in menage diseases and companion beast ectoparasite control products, and their limited use in the home terrain raises the trouble of exposure and adverse goods in the general population for humans and advanced creatures. Exploration with a wide range of pyrethroids has indicated that the choreothetosis-expectoration (CS) pattern frequently occurs as substances like deltamethrin, cypermethrin, and fenvalerate, which have the mode T- cyano-3-phenoxybenzylalcohol. General, extensively used bracket of Pyrethroid composites are determined grounded upon the symptomology of nonentity goods noted in neurophysiological tests. Numerous lines of substantiation indicate that the voltage sensitive sodium channel for both insects is the one main molecular destination for all pyrethroids and DDT analogues. In biophysical and biochemical examinations, the changes in sodium channel functioning are nearly connected to the impact of these substances on complete neurons. The pyrethroid sodium channel discovery point demonstrates the strict stereo particularity anticipated by in vivo nonentity neurotoxicity estimates. Composites of type I and type II have qualitative goods on currents of the sodium channel tail, divergent impact on complete neurons and differing goods on muscle excitability of the invertebrate shell. Knowledge of the molecular events bolstering pyrethroid neurotoxicity is directly applicable to determining whether this large and important class of diseases constitutes a single “common medium” group or multiple groups for the purposes of cumulative trouble assessment.

Vestibular Evoked Myogenic Potential Abnormalities in Early and Late Stage Parkinson Patients

ABSTRACT&#x0D; Aim: Loss of balance can be seen in idiopathic Parkinson's disease (IPD) There are only a few studies in the literature in which brainstem involvement in IPD has been researched with neurophysiological tests such as vestibular evoked myogenic potential (VEMP). In this study, it was investigated whether there is a difference in the results of VEMP testing in early or late stage of IPD.&#x0D; Material and method: The IPD cases were classified as early stage and late stage according to the Hoehn-Yahr scale. The presence of a positive wave with a latency of P13 and a negative wave with a latency of N23 was investigated as the first reflex response The latencies of these potentials and the absolute amplitude of the P13-N23 component were measured. The VEMP results of the patients with early and late stage IPD were compared with those of the control group.&#x0D; Results: The right P13 latency mean value in the late stage patient group was significantly prolonged than in the early stage patient group and the control group. The right P13-N23 amplitude mean value of the late and early stage patient groups was significantly smaller than that of the control group (p &lt; 0.002 and p &lt; 0.001, respectively). Among the patients with IPD, the P13 latency was statistically increased in those with a fall history than in those without a fall history.&#x0D; In conclusion, this study indicates that the VEMP pathway is affected over time especially in patients with late stage Parkinson’s disease.

Review on Diagnosis and Management of Cauda Equina

Disorders of the cauda equina are etiologically and physically connected to the neuromuscular system in the spinal cord. A thorough history and neurological examination are necessary for clinical recognition of a cauda equina-affecting condition, and to make a rapid diagnosis, the selection and interpretation of relevant neuroimaging investigations, neurophysiologic testing, and laboratory tests are necessary. The diagnosis and treatment of Cauda Equina Syndrome (CES) are difficult. It could app

Repetitive Transcranial Magnetic Stimulation and Rehabilitation Therapy for Upper Limb Hemiparesis in Stroke Patients: A Narrative Review.

Recent technological advances in non-invasive brain stimulation (NIBS) have led to the development of therapies for post-stroke upper extremity paralysis. Repetitive transcranial magnetic stimulation (rTMS), a NIBS technique, controls regional activity by non-invasively stimulating selected areas of the cerebral cortex. The therapeutic principle by which rTMS is thought to work is the correction of interhemispheric inhibition imbalances. The guidelines for rTMS for post-stroke upper limb paralysis have graded it as a highly effective treatment, and, based on functional brain imaging and neurophysiological testing, it has been shown to result in progress toward normalization. Our research group has published many reports showing improvement in upper limb function after administration of the NovEl Intervention Using Repetitive TMS and intensive one-to-one therapy (NEURO), demonstrating its safety and efficacy. Based on the findings to date, rTMS should be considered as a treatment strategy based on a functional assessment of the severity of upper extremity paralysis (Fugl-Meyer Assessment), and NEURO should be combined with pharmacotherapy, botulinum treatment, and extracorporeal shockwave therapy to maximize therapeutic effects. In the future, it will be important to establish tailormade treatments in which stimulation frequency and sites are adjusted according to the pathological conditions of interhemispheric imbalance, as revealed by functional brain imaging.

Evaluation of Cognitive Function Using P300 Latency and Amplitude in Children with Profound Sensorineural Hearing Loss Using Hearing Aids: A Comparative Cross-sectional Study

Introduction: As hearing function is directly linked to language and communication abilities, hearing loss may negatively affect children’s cognitive development. Therefore, it is important that hearing-impaired children undergo cognitive function assessments to better understand how to alleviate this comorbidity. The P300 event-related potential measurement is a neurophysiological test increasingly used to objectively measure cognitive function. Aim: The aim of the study was to compare the latency and amplitude of P300 waves in children with profound sensorineural hearing loss (SNHL) with hearing aids and normal-hearing children aged 7–15 years old. Methods: A comparative cross-sectional study involving 15 children with profound SNHL and 15 children with normal hearing was conducted. The latency and amplitude of P300 waves in these children in response to auditory and visual stimuli were recorded and analyzed. Results: The mean P300 wave latency in children with SNHL was slightly longer than that in children with normal hearing, albeit insignificant (P = 0.578). Similarly, the amplitude of the P300 waves was not significantly smaller in children with SNHL (P = 0.885). Conclusions: SNHL children with hearing aid habilitation have comparable P300 amplitude and latency compare to normal-hearing children.

Effects of the Treatment of Carpal Tunnel Syndrome with Surgery and Injections on the Hospital Anxiety and Depression Scale (HADS)

Background: The prevalence of carpal tunnel syndrome (CTS) and of anxiety and depression in primary care practice are high. Different studies had shown an increased prevalence of anxiety and depression in CTS patients. Nevertheless, few papers had been published studying the anxiety and depression scales in the treatment of CTS, either with corticosteroid injections (I) or with surgical decompression (S). Objective: To assess whether clinical improvement observed after the treatment of CTS either with I or with S correlates with an improvement in the punctuations of the Hospital Anxiety and Depression scales (HADS), at 3, 6 and 12-month follow-up. Methods: Randomized and open-label clinical trial, comparing I and S. Patients with symptoms suggestive of CTS (nocturnal paraesthesias) of at least 3 months duration and neurophysiological confirmation were included. Patients with clinically apparent motor impairment were excluded. The subjective evaluation of symptoms was carried out using the visual-analogue scale of pain (VAS-p). Clinical reviews were performed 3, 6 and 12 months after treatment. Each patient completed the HADS questionnaire and a VAS-p at 0, 3, 6, and 12 months. Statistical significance was established using the Student’s t test and the Mann-Whitney U test when necessary. A linear regression analysis was used to know the effect of the treatment adjusted for the initial score of both scales. Results: 65 patients were included (30 in group I and 35 in group S). There was no statistical difference between both groups in terms of age, gender distribution, disease duration, VAS-p, neurophysiological testing severity of CTS or the 8 subscales of HADS. Both groups improved significantly in relation to the baseline VAS-p values, in the reviews at 3, 6 and 12 months, with no significant differences between I and S. At 6 months, the reduction in the anxiety scale was around 3 points for both treatments (S = 3.6 and I = 3.2), without reaching significant differences. At 12 months, it was somewhat higher for those treated with I, but always around 3 points and without significant differences. The Depression scale score was slightly reduced at 6 months, and in a similar way for both groups (I = 1 and S = 1.19; p = 0.8). After 12 months, group I doubled the previous reduction, with group S experiencing a very slight change (I = 1.96 and S = 1.03; p = 0.3). When analysing the effect of group S on group I, the result was a reduction of 0.25 points for Anxiety (p = 0.7) and of 0.02 points for Depression (p = 0.9). Conclusions: Treatment of CTS with I or S results in a similar and discrete improvement in Anxiety scores on the HADS scale at 6 and 12 months. For both types of treatment, the Depression scores barely changed at 6 months, being somewhat higher in group I after 12-month follow-up. The independent effect of the S on both scales is small and not significant.

Overactive bladder, lack of habituation, and central sensitisation: The sympathetic skin response as a possible diagnostic marker and neuromodulation as a treatment

Objectives1) to characterise clinically, neurophysiologically and manometrically the overactive bladder (OAB); 2) to objectify the lack of habituation in OAB; 3) to quantify the comorbidities associated with CS (central sensitisation); and 4) to evaluate the effect of neuromodulation (NM) of the tibialis posterior nerve in OAB. Material and methodsForty-seven patients, retrospective observational pre-post study.Intervention: manometric biofeedback and posterior tibial transcutaneous NM (PTNM), 8 sessions.Outcome variables: a) clinical (daytime urinary frequency [DUF] and nocturnal urinary frequency [NUF]), b) neurophysiological (latency, amplitude and percentage of habituation); c) comorbidities associated with CS; d) manometric (maximum and average pressure); at the beginning/end of treatment. ResultsAge, 58.91 ± 13.27 years. Comorbidities associated with CS, 1.98 ± 0.32 (range 1–5 pathologies). Percentage of habituation, 88.6%. PTNM decreased DUF (10.4 ± 4.86 to 6.21 ± 1.87 episodes; P = .0001), and NUF (3.02 ± 1.66 to 1.17 ± 1 episodes; P = .0001). PTNM increased maximum (38.46 ± 23.06 to 42.61 ± 19.46 mmHg; P = .0964), and mean (7.63 ± 3.56 to 8.66 ± 4.76 mmHg; P = .1639) pressure. NMTP modified latency (1.32 ± 0.32 to 1.38 ± 0.32 s; P = .3397), and reduced amplitude (1.98 ± 1.28 to 1.67 ± 1.44 mV; P = .0004) and habituation (88.6 ± 23.5% at 70 ± 30.2%; P = .0001) of sympathetic skin response (SSR). ConclusionThe lack of habituation is a neurophysiological phenomenon present in OAB. PTNM improved clinical and neurophysiological variables. SSR is a neurophysiological test capable of objectifying lack of habituation and could characterize other response patterns (alteration of the ascending, central, descending or postganglionic pathway).