Sensory Conduction Velocity Research Articles

Blocking CTGF/CCN2 reverses neural fibrosis and sensorimotor declines in a rat model of overuse-induced median mononeuropathy.

Encapsulation of median nerves is a hallmark of overuse‐induced median mononeuropathy and contributes to functional declines. We tested if an antibody against CTGF/CCN2 (termed FG‐3019 or Pamrevlumab) reduces established neural fibrosis and sensorimotor declines in a clinically relevant rodent model of overuse in which median mononeuropathy develops. Young adult female rats performed a high repetition high force (HRHF) lever‐pulling task for 18 weeks. Rats were then euthanised at 18 weeks (HRHF untreated), or rested and systemically treated for 6 weeks with either an anti‐CCN2 monoclonal antibody (HRHF‐Rest/FG‐3019) or IgG (HRHF‐Rest/IgG), with results compared with nontask control rats. Neuropathology was evident in HRHF‐untreated and HRHF‐Rest/IgG rats as increased perineural collagen deposition and degraded myelin basic protein (dMBP) in median nerves, and increased substance P in lower cervical dorsal root ganglia (DRG), compared with controls. Both groups showed functional declines, specifically, decreased sensory conduction velocity in median nerves, noxious cold temperature hypersensitivity, and grip strength declines, compared with controls. There were also increases of ATF3‐immunopositive nuclei in ventral horn neurons in HRHF‐untreated rats, compared with controls (which showed none). FG‐3019‐treated rats showed no increase above control levels of perineural collagen or dMBP in median nerves, Substance P in lower cervical DRGs, or ATF3‐immunopositive nuclei in ventral horns, and similar median nerve conduction velocities and thermal sensitivity, compared with controls. We hypothesize that neural fibrotic processes underpin the sensorimotor declines by compressing or impeding median nerves during movement, and that inhibiting fibrosis using an anti‐CCN2 treatment reverses these effects.

Electrophysiological evaluation of carpal tunnel syndrome female patients after vitamin D replacement.

The effects of vitamin D on the central and peripheral nervous system continue to be investigated today. In the present study, we aimed to evaluate pain and electrophysiologic response in patients with carpal tunnel syndrome (CTS) who have undergone replacement therapy due to vitamin D deficiency. Fifty female patients diagnosed with mild and moderate CTS and accompanied by vitamin D deficiency were included in this study. Nerve conduction study (NCS) was performed before and after vitamin D replacement, and the patient's pain was evaluated with Visual Analogue Scale (VAS). When NCS were compared before and after treatment, there was a statistically significant improvement in the median distal sensory onset latency (DSOL) and sensory conduction velocity (CV) and motor distal latencies (DML) values (p=0.001; p<0.001; p=0.001, respectively). At the same time, there was a decrease in the VAS values in patients (p<0.001). When the two groups were compared there was an improvement in DSOL and sensory CV in both groups, but in DML only in moderate CTS group. In this study, it was shown that mild and moderate CTS patients had an improvement in pain and electrophysiological parameters after vitamin D replacement. Replacing vitamin D in early stages of CTS may be beneficial.

Abnormality of multimodal evoked potentials in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)

IntroductionChronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an autoimmune disease of the peripheral nervous system, sometimes including the central nervous system. The aim of the study was the assessment of the prevalence of central sensory impairment and its reliance on peripheral nerve damage in patients with CIDP.Material and methodsMultimodal (visual—VEP, brainstem auditory—BAEP, somatosensory—SEP) evoked potentials (EPs) were studied in 24 patients diagnosed with CIDP. The results were compared with neurographic parameters of sensory responses. The control group consisted of 35 healthy volunteers selected with respect to age and sex.ResultsMean latency of most components of EP were considerably prolonged in patients compared with the control group. There were no correlations between the P100 VEP latency and the peripheral sensory parameters. Statistically significant negative correlations were obtained between BAEP and SEP responses and the amplitude and sensory conduction velocity of peripheral nerves. The inter-latencies were also longer.ConclusionsThe authors indicated to the possibility of central sensory involvement in patients with CIDP, especially based on the prolonged inter-latency of BAEPs with simultaneously confirmed root affection. The severity of central damage correlates with the degree of peripheral nerve impairment.

Does diabetes mellitus change the carpal tunnel release outcomes? Evidence from a systematic review and meta-analysis

Study DesignA systematic review and meta-analysis. IntroductionCarpal tunnel syndrome (CTS) is one of the most common upper extremity conditions which mostly affect women. Management of patients suffering from both CTS and diabetes mellitus (DM) is challenging, and it was suggested that DM might affect the diagnosis as well as the outcome of surgical treatment. Purpose of the StudyThis meta-analysis was aimed to compare the response with CTS surgical treatment in diabetic and nondiabetic patients. MethodsElectronic databases were searched to identify eligible studies comparing the symptomatic, functional, and neurophysiological outcomes between diabetic and nondiabetic patients with CTS. Pooled MDs with 95% CIs were applied to assess the level of outcome improvements. ResultsTen articles with 2869 subjects were included. The sensory conduction velocities in the wrist-palm and wrist–middle finger segments showed a significantly better improvement in nondiabetic compared with diabetic patients (MD = −4.31, 95% CI = −5.89 to −2.74, P < .001 and MD = −2.74, 95% CI = −5.32 to −0.16, P = .037, respectively). However, no significant differences were found for the improvement of symptoms severity and functional status based on the Boston Carpal Tunnel Questionnaire and Quick Disabilities of the Arm, Shoulder, and Hand questionnaire as well as motor conduction velocities and distal motor latencies. ConclusionMetaresults revealed no significant difference in improvements of all various outcomes except sensory conduction velocities after CTS surgery between diabetic and nondiabetic patients. A better diabetic neuropathy care is recommended to achieve better sensory recovery after CTS surgery in diabetic patients.

The optimum hand temperature to study nerve conduction in patients with carpal tunnel syndrome

To define the skin temperature at which diseased nerves are better differentiated from the healthy. Motor and sensory conduction of median and ulnar nerve were evaluated in 52 patients with carpal tunnel syndrome (CTS) and 52 matched healthy controls at environmental skin temperature (mean 32–33 °C), after warming by an average of 2 °C and cooling to approximately 6 °C below baseline. In the hot condition, group comparisons for the median nerve showed a similar rate of distal motor latency (DML) reduction and sensory conduction velocity (SCV) increase in CTS and controls. With cold, the rate of change was smaller for the patients: DML mean increase was 5% /°C (7% for controls) and SCV mean decrease was 2.5%/°C (3.2% for controls). Individual patients’ analysis revealed fewer abnormal median DML and SCV values at hot or at cold, compared to environmental temperature. It is concluded that conduction adjustments for low hand temperatures based on healthy measurements resulted in overcorrection and therefore underdiagnosis of CTS. Alternatively, at excessive hand warming the convergence of patient and healthy measurements also lead to underdiagnosis. Maintenance of skin temperature at 32–33 °C, corresponding to normal body temperature, is the optimum approach and should always be employed in clinical practice.

Analysis of Surgical Cases of Tarsal Tunnel Syndrome in Our Department: Case Series and Literature Review.

Background:Tarsal tunnel syndrome (TTS) is an entrapment neuropathy in which the tibial nerve is compressed within the tarsal tunnel and causes sensory disturbance in the sole of the foot. In this manuscript, we summarized our early surgical cases of TTS.Materials and Methods:Six feet in five patients with TTS were treated surgically. The patients were aged 31–70 years (mean 53.1 years), and all of them complained of pain or dysesthesia of the sole of the foot sparing the heel. Magnetic resonance imaging (MRI) and nerve conduction test were performed preoperatively. In surgery, flexor retinaculum was dissected (tarsal tunnel opening [TTO]), the posterior tibial nerve was freed from the arteriovenous complex (neurovascular decompression [NVD]), and fascia of the abductor hallucis muscle was excised to decompress the medial and lateral plantar nerve (releasing fascial of abductor hallucis muscle [RFAH]).Results:Preoperative MRI confirmed that all seven cases were idiopathic TTS. Moreover, NCD demonstrated delayed sensory conduction velocity but not delayed distal motor latency. Surgical decompression was beneficial in 5 feet. The recurrence of symptoms was found in one case within 1 postoperative month.Conclusion:Surgical treatment for idiopathic TTS with TTO, NVD, and RFAH was generally good. However, symptoms recurred in one instance. Some methods to prevent adhesion and granulation in the reconstructed tarsal tunnel should be considered.

Integrated Chinese and Western Medicine for Acute Guillain-barré Syndrome Treatment.

IntroductionGuillain-Barré syndrome (GBS) is a worldwide demyelinating polyradiculopathy and polyneuropathy. Currently, there is no specific drug for GBS, and established treatment is generally based on immune-modulating treatment with plasma exchange or intravenous immunoglobulin in combination with supportive care. This study aimed to investigate the efficiency of integrated Chinese and Western medicine for acute GBS treatment.MethodsWe enrolled 73 subjects, and randomly divided them into two groups: 35 cases in the traditional Chinese medicine (TCM) group, and 28 in the Control group. The Control group was treated with the common Western medicine for one month; and the TCM group was administrated with one month of common treatment combined with TCM medication.ResultsCompared to the controls, TCM significantly enhanced the treatment efficiency in symptom expression, including the TCM syndrome score, the activity of daily living score, Hughes functional score and sensory dysfunction assessment. The total effective rate of the TCM group was 94.29%, significantly better than controls (78.59%). Moreover, TCM provide better improvement in motor nerve conduction functions (distal motor latency and motor conduction velocity) and sensory nerve conduction functions (sensory conduction velocity and sensory nerve action potential) in median nerve, ulnar nerve, and common fibular nerve.ConclusionWhen combined with TCM administration, the GBS treatment could acquire better outcomes.

Electrodiagnostic (EDX) Predictors of Sensory Neuropathy in Primary Hypothyroidism and its Association with Age and Body Mass Index (BMI): A Cross Sectional Study

Background: Sensory neuropathy occurs in hypothyroidism often early as compared to motor. Involvement of median and sural nerve is reported earliest in literature. There is controversial electrophysiological data with respect to predictors of neuropathy and its association with age and body mass index. Objectives: Present study was aimed to find out EDX predictors of sensory neuropathy and its association with age and BMI in primary hypothyroidism patients. Materials and Method: Total 28 out of 39 hypothyroid cases referred to clinical neurophysiology laboratory were selected for analysis. These cases satisfied the biochemical and EDX criteria. Percentages of abnormalities in different variables of nerve conduction study were calculated. Also coefficient of correlation between age, BMI and different variables evaluated for association between them if any. Results: Study population was having age range from 23-75 years, 15 female and 13 male. Female preponderance was observed. Correlation between Age, BMI and different variables of NCV were statistically not significant. Sensory conduction velocity was most common abnormality observed (49%), followed by SNAP amplitude (42%) and onset latency (25%). Conclusion: We concluded that age and BMI have no effect on occurrence of neuropathy in primary hypothyroidism. Sensory Conduction velocity was most common predictor of sensory neuropathy in these cases.

Study of motor and sensory nerve conduction of wrist palm and palm-finger segments of median nerve and studying their contribution in diagnosis of carpal tunnel syndrome

Objectives Our objective is to report a modified and simplified technique of sensory and motor segmental conduction studies to improve diagnostic sensitivity, especially in cases with mild carpal tunnel syndrome (CTS). Patients and methods Patients with suspected CTS referred to our electrophysiology laboratory and a control group were included. The data were collected prospectively. The following measurements made: median sensory conduction velocity wrist digit 1(W-1), median sensory conduction velocity wrist digit 3 (W-3), median wrist palm sensory conduction velocity (W-Ps), distoproximal ratio of velocity (D/P), median distal motor latency wrist (MDML) -APB (Abductor pollicis brevis), and median wrist -palm segment motor conduction velocity (W-Pm). Results The highest sensitivity test for an electrodiagnostic CTS diagnosis was D/P (63.7%), W-Pm (43.1%), W-Ps (39.2%), median distal motor latency (33.3%), median sensory conduction velocity wrist digit 1 (31.4%), and median sensory conduction velocity wrist digit 3 (29.4%), correspondingly. A total of 52 patients were diagnosed as having CTS electrophysiologically after containment of W-Ps, 58 patients were defined as having CTS after containment of W-Pm, and 55 patients were diagnosed as having CTS electrophysiologically after containment of D/P. Of 102 hands with CTS, 70 were defined as an electrophysiologically proven CTS using routine electrophysiologic tests together with D/P, W-Pm, and W-Ps segmental studies, increasing the sensitivity of diagnoses by nearly 55.5%. Conclusion The results of this study suggested that motor or sensory segmental studies have an important inputs in the diagnosis, particularly for mild cases of CTS.

Evaluation of peak or onset latency in the median-versus-ulnar digit four sensory comparison study for diagnosing carpal tunnel syndrome

Aim: Peak or onset latency difference of the median and ulnar nerves can be used in the median-versus-ulnar digit 4 sensory comparison study (MUD4CS) for electrodiagnosis of carpal tunnel syndrome (CTS). This study aimed to investigate the differences in results while using peak or onset latency difference.Material and Methods: The hands of patients with clinical CTS diagnosis but normal median nerve conduction study (NCS) results were included retrospectively in this study. NCSs of the median and ulnar nerves with onset and peak latencies in MUD4CS were recorded. Onset and peak latency differences of the two nerves and also peak-onset latency difference of the median nerve in MUD4CS were calculated. The hands were divided into two groups according to MUD4CS findings: abnormal and normal. The hands in the abnormal group were also divided into peak and onset subgroups.Results: A total of 277 hands were included in this study. Abnormal MUD4CS results were observed in 103 hands; 77 hands based on onset latency difference, and in 76 hands based on peak latency difference. Median sensory conduction velocity was slower and amplitude was smaller in the abnormal group than in the normal group (p=0.003, p=0.027 respectively). Median peak-onset latency difference was significantly greater in the peak subgroup than in the onset subgroup (p=0.0001).Conclusion: It may be more useful to measure both peak and onset latency differences when diagnosing CTS because some cases may be overlooked by using a single latency difference.

Minimally invasive techniques for sensory and motor nerve conduction in Wistar albino rats

Decrease in motor and/or sensory conduction velocities, or a decrease in the amplitude of muscle or nerve potential indicates certain peripheral nerve system disorders. Techniques for the measurement of motor and sensory conduction velocities are well established in humans as well as in numerous animal models such as the rat and the monkey. Scientists widely use rats as experimental animals for scientific research for their viability, fast reproduction and simplicity, which makes them indispensable in experimental researches. Particularly, rats are used for investigation of models of peripheral axonal and demyelinating neuropathies, neural tissue injury and regeneration.[1-3] In rats, motor nerve conduction velocity (NCV) is measured at the level of the sciatic nerve[4] or less frequently at the tail.[5-6] The sensory nerve conduction velocity (SNCV) has been measured on the external saphenous nerve and sural nerve.[7]

Topiramate prevents oxaliplatin-related axonal hyperexcitability and oxaliplatin induced peripheral neurotoxicity.

Oxaliplatin (OHP) Induced Peripheral Neurotoxicity (OIPN) is one of the dose-limiting toxicities of the drug and these adverse effects limit cancer therapy with L-OHP, used for colorectal cancer treatment. Acute neurotoxicity consists of symptoms that are the hallmarks of a transient axonal hyperexcitability; chronic neurotoxicity has a clinical picture compatible with a length-dependent sensory neuropathy. Acute OIPN pathogenesis has been linked to sodium voltage-operated channels (Na + VOC) dysfunction and it has been advocated as a possible predisposing factor to chronic neurotoxicity.We tested if topiramate (TPM), a well-known Na + VOC modulator, was able to modify acute as well as chronic OIPN. The project was divided into two parts. In Experiment 1 we tested by means of Nerve Excitability Testing (NET) a cohort of female Wistar rats to assess TPM effects after a single OHP administration (5 mg/kg, iv). In Experiment 2 we assessed TPM effects after chronic OHP treatment (5 mg/kg, 2qw4ws, iv) using NET, nerve conduction studies (NCS), behavioral tests and neuropathology (caudal nerve morphometry and morphology and Intraepidermal Nerve Fiber [IENF] density). In Experiment 1 TPM was able to prevent OHP effects on Na + VOC: OHP treatment induced a highly significant reduction of the sensory nerve's threshold, during the superexcitability period (p-value = 0.008), whereas TPM co-administration prevented this effect. In Experiment 2 we verified that TPM was able to prevent not only acute phenomena, but also to completely prevent chronic OIPN. This latter observation was supported by a multimodal approach: in fact, only OHP group showed altered findings compared to CTRL group at a neurophysiological (proximal caudal nerve sensory nerve action potential [SNAP] amplitude, p-value = 0.001; distal caudal nerve SNAP amplitude, p-value<0.001, distal caudal nerve sensory conduction velocity, p-value = 0.04), behavioral (mechanical threshold, p-value 0.003) and neuropathological levels (caudal nerve fibers density, p-value 0.001; IENF density, p-value <0.001).Our data show that TPM is a promising drug to prevent both acute and chronic OIPN. These findings have a high translational potential, since they were obtained using outcome measures that match clinical practice and TPM is already approved for clinical use being free from detrimental interaction with OHP anticancer properties.

Association of serum adropin with risk and severity of diabetic peripheral neuropathy in patients with type 2 diabetes mellitus

BackgroundDiabetic peripheral neuropathy (DPN) is the major microvascular complication of type 2 diabetes mellitus (T2DM). Adropin is a peptide hormone that has essential roles in metabolic homeostasis and the pathogenesis of T2DM and its complications. This study was designed to estimate serum adropin levels in patients with T2DM in correlation with risk factors of DPN. The authors also aimed to investigate the association between serum adropin level and clinical and electrophysiological tests of DPN.Patients and methodsThis case–control study enrolled 100 patients with T2DM (40 diabetic cases without DPN and 60 diabetic cases with DPN) and 50 controls. All participants were subjected to a complete neurological examination. The motor and sensory conduction velocities of the median nerve, ulnar nerve, and common peroneal nerve were measured. The severity of DPN was assessed by Toronto clinical scoring system (TCSS). Serum adropin levels were assessed using an enzyme-linked immunosorbent assay.ResultsOur results revealed decreased circulating serum adropin levels in patients with T2DM (3.5±1.2), especially diabetic patients with DPN (3.1±1.07), compared with controls (6.1±0.89). There is a negative correlation between serum adropin level and TCSS as well as electrophysiological tests: motor nerve conduction velocity of median and ulnar nerve, sensory nerve conduction velocity of median and ulnar nerve, compound muscle action potential amplitude (median and ulnar nerve), and sensory nerve action potential amplitude (median, ulnar, and perception threshold nerve) (P<0.001*).ConclusionDiabetic patients with DPN had lower values of serum adropin than diabetic patients without DPN, and serum adropin levels were negatively correlated with metabolic risk factors, TCSS, as well as electrophysiological tests of DPN.

Long-term patient observation after conservative treatment of carpal tunnel syndrome: a summary of two randomised controlled trials.

BackgroundPhysiotherapy of carpal tunnel syndrome (CTS) involves manual therapy based on neurodynamic techniques. Until now, two randomized controlled trials have shown that immediately after therapy, CTS patients who received neurodynamic techniques had significant improvement in nerve conduction, pain, symptom severity (SSS), functional state (FSS), muscle strength (MS) and two-point discrimination (2PD). However, long-term effects seem to be more important, as they are the only ones that can significantly improve the patient’s health and influence economic and social costs. Thus, the objective of this study was to evaluate the long-term (six months) effects of neurodynamic techniques in the conservative treatment of CTS patients.MethodsCarpal tunnel syndrome patients (107) from two previously published randomised clinical trials were observed for six months after the treatment based on neurodynamic techniques.ResultsThe sensory conduction velocity, motor conduction velocity, and motor latency were not subject to statistically significant changes within six months after therapy (p > 0.05). In both groups, there was further pain reduction (p < 0.05). In Group B, the symptom severity improved significantly (p < 0.05), while the functional status in both groups remained unchanged (p > 0.05). In both groups, there was muscle strength improvement (p < 0.05). Two-point discrimination remained unchanged six months after the therapy.ConclusionThe use of manual therapy based on neurodynamic techniques maintains the beneficial effects 6 months after therapy in CTS patients.

Sensory and Motor Conduction Velocity in Spontaneously Hypertensive Rats: Sex and Aging Investigation.

The literature is extensive on how hypertension affects the morphology and function of the central nervous system (CNS) and is being focused on multiple organ damage involving the kidneys, heart, endothelium and retina. Hypertension damage to the peripheral nervous system is less explored in the literature. We have previously shown morphometric alterations in large and small caliber myelinated fibers of nerves in the adult spontaneously hypertensive rat (SHR). However, the functional correlation of these findings has not been explored. We performed an electrophysiological investigation of hind limb nerves in SHR of both genders in different ages. Normotensive Wistar-Kyoto (WKY) rats were used as controls. Electrophysiological recordings and determination of motor (MCV) and sensory (SCV) nerve conduction velocity were performed in the same animals at four different ages: 5, 8, 20 and 40 weeks after birth. Comparisons were made between ages, genders and animal strain. We showed a continuous body weight increase in adult life in all animals studied. MCV got stable at 20-week old hypertensive animals and continued to increase in normotensive ones. The SCV was constant between the ages of 20 and 40 weeks old in female SHR and decreased in male SHR while it continued to increase in WKY animals. The electrophysiological investigation of the nerves in WKY and SHR from both genders and different ages, associated with morphological and morphometric data from the literature suggest that hypertension affects the nerve function and might corroborate the development of a peripheral neuropathy.

A physiological dose of oral vitamin B-12 improves hematological, biochemical-metabolic indices and peripheral nerve function in B-12 deficient Indian adolescent women.

BackgroundVitamin B-12 deficiency is often considered synonymous with pernicious anemia, a rare condition in which severe malabsorption of the vitamin requires high-dose parenteral treatment. In developing countries such as India, inadequate dietary intake of B-12 due to socio-cultural factors leads to widely prevalent asymptomatic low B-12 status. In this scenario, lower doses of oral B-12 may be effective, safer and more affordable.ObjectiveTo examine the effects of oral B-12 treatment at physiological doses on hematological and biochemical indices and peripheral nerve function in B-12 deficient rural Indian adolescent women.MethodsThirty-nine women with B-12 deficiency who were excluded from a community based B-12 supplementation trial (Pune Rural Intervention in Young Adolescents (PRIYA)) received oral B-12 2μg/day, either alone (n = 19) or with multiple micronutrients (UNIMAPP formula + 20gm milk powder, n = 20) for 11 months. Hematological indices, nutrients (B-12, folate), metabolites (homocysteine) and peripheral nerve function (SUDOSCAN, Impetomedical, Paris and sensory nerve conduction velocity (NCV) of median and sural nerves) were assessed at baseline and after 11 months of B-12 treatment.ResultsResults were similar in the two treatment allocation groups, which were therefore combined. At baseline, all women had B-12 concentration <100pmol/L, 79% were anemic and 33% had macrocytosis, but none had neuropathy. After 11 months of treatment, B-12 levels increased, while folate did not change. The prevalence of anemia fell to 59% and mean corpuscular volume (MCV) and plasma homocysteine concentrations decreased. Sudomotor nerve function in the feet improved by an average of 14.7%, and sensory conduction velocity in median and sural nerves increased by 16.2% and 29.4% respectively.ConclusionWe document clinically beneficial effects of supplementation with a physiological dose of oral B-12 in asymptomatic rural Indian adolescent women with very low B-12 status. These findings support a public health approach to tackle the widely prevalent low B-12 status in young Indians.

A systematic review of randomized controlled trials of the Wenyang Huoxue method in treating diabetic peripheral neuropathy.

Objective:To assess the efficacy and safety of the Wenyang Huoxue method for patients with diabetic peripheral neuropathy.Methods:A systematic literature search was performed using 7 databases: PUBMED, EMBASE, the Chinese National Knowledge Infrastructure, Wanfang, Chinese BioMedical, and the VIP Chinese Science and Technique Journals. The publication time was from the start of each database up to November 2018. Review Manager 5.3 software was used for assessing potential bias, data synthesis, and the subgroup analysis. Begg and Egger tests were used to assess funnel plot symmetries using Stata 14.0 software. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence.Results:A total of 22 trials involving 1835 participants were eligible. There were significant differences in a total effective rate between the Wenyang Huoxue method combined with Western medicine and Western medicine alone (RR = 1.33, 95% CI 1.26–1.41; P < .00001). As for the sensory conduction velocity (SCV) of the peroneal nerve, the Wenyang Huoxue method combined with Western medicine compared with Western medicine alone had a significant increase (weighted mean difference [WMD] = 5.00, 95% CI 3.42–6.57; P < .00001). Also, the Wenyang Huoxue method combined with Western medicine had significant increases in motor conduction velocity (MCV) of the peroneal nerve (WMD = 4.48, 95% CI 3.78–5.19; P < .00001), tibial nerve SCV (WMD = 3.47, 95% CI 2.66–4.28; P < .00001), tibial nerve MCV (4.87, 95% CI 3.21–6.53; P < .00001), median nerve SCV (WMD = 3.78, 95% CI 3.07–4.50; P < .00001), and median nerve MCV (WMD = 4.50, 95% CI 3.40–5.59; P < .00001). However, the effect of the Wenyang Huoxue method on fasting blood glucose, 2-h postprandial blood glucose, and glycosylated hemoglobin was not statistically significant. Egger's test results showed that there was no publication bias (P = .0008), but the trim and filling method showed steady results. An influence analysis showed that no single study affected the overall result. The GRADE quality of the evidence was low to moderate across the different outcomes.Conclusion:Despite of the apparently positive findings, the quality of GRADE is not high, suggesting that the Wenyang Huoxue method can improve nerve conduction velocity to a certain extent, but more rigorous literature is needed to support this evidence.

The assessment of sensory pathway in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an autoimmune polyneuropathy, predominately affecting motor, less sensory fibers, sometimes with the central nervous system involvement. The aim of the study was the assessment of the prevalence of peripheral and central sensory impairment, and their reciprocal reliance in patients with CIDP. 24 patients (mean 60.7 years old) diagnosed with CIDP, and 35 healthy controls, age and sex-matched. Multimodal (visual- VEP, brainstem auditory - BAEP, somatosensory SEP) evoked potentials (EPs) were studied. The results were compared to neurographic parameters of sensory responses in peripheral nerves. Neurological examination, cerebro-spinal fluid analysis, and brain CT/MRI were done in all participants. Statistically significant negative correlations were obtained between BAEP and SEP responses (amplitude, latencies, interlatencies) and the amplitude and sensory conduction velocity of peripheral nerves. There were no correlations between the P100 VEP latency and the peripheral sensory parameters. There were no structural changes of the central nervous system in neuroimages, and central symptoms in the neurological examination. The authors confirmed the presence of peripheral and central sensory involvement in patients with CIDP. The severity of central damage correlates with the degree of peripheral nerve impairment. Subclinical lesion of the central sensory pathways is possible.

Electrophysiological responsiveness and clinical outcomes of local corticosteroid injection in the treatment of carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is the most common mononeuropathy caused by entrapment of the median nerve at the wrist. Common treatment options for CTS include oral analgesics, splinting, hand therapy, local injections with steroids or surgery. OBJECTIVE The aim of the present study was to assess the short-term clinical and electrophysiological outcomes of local corticosteroid injection (LCI) in patients with symptomatic CTS. METHODS Electrophysiological parameters were evaluated before and three months after LCI. Moreover, the Numeric Rating Scale (NRS), the Boston Symptom Severity Scale (SSS) and the Functional Status Scale (FSS) were administered before and after the injection. A mixture of 1 mL (40 mg) of methylprednisolone and 1 mL of 0.5% bupivacaine were injected blindly on the volar side of the forearm between the tendons of the radial carpal flexor muscle and long palmar muscle. RESULTS A total of 25 patients (45 hands) were enrolled in the study. Twenty women and five men with a mean age of 49.28 ± 11.37 years were included. A statistically significant difference was noted for improvement of sensory conduction velocities, sensory peak latency, and motor distal latency (p = 0.001) after LCI. A significant difference was recorded between pre- and post-injection for NRS, SSS and FSS scores (p = 0.000). CONCLUSION Local corticosteroid injection for CTS provides a short-term improvement in neurophysiological and clinical outcomes such as pain intensity, symptom severity and functional ability.

Simulating perinodal changes observed in immune-mediated neuropathies: impact on conduction in a model of myelinated motor and sensory axons.

Immune-mediated neuropathies affect myelinated axons, resulting in conduction slowing or block that may affect motor and sensory axons differently. The underlying mechanisms of these neuropathies are not well understood. Using a myelinated axon model, we studied the impact of perinodal changes on conduction. We extended a longitudinal axon model (41 nodes of Ranvier) with biophysical properties unique to human myelinated motor and sensory axons. We simulated effects of temperature and axonal diameter on conduction and strength-duration properties. We then studied effects of impaired nodal sodium channel conductance and paranodal myelin detachment by reducing periaxonal resistance, as well as their interaction, on conduction in the 9 middle nodes and enclosed paranodes. Finally, we assessed the impact of reducing the affected region (5 nodes) and adding nodal widening. Physiological motor and sensory conduction velocities and changes to axonal diameter and temperature were observed. The sensory axon had a longer strength-duration time constant. Reducing sodium channel conductance and paranodal periaxonal resistance induced progressive conduction slowing. In motor axons, conduction block occurred with a 4-fold drop in sodium channel conductance or a 7.7-fold drop in periaxonal resistance. In sensory axons, block arose with a 4.8-fold drop in sodium channel conductance or a 9-fold drop in periaxonal resistance. This indicated that motor axons are more vulnerable to developing block. A boundary of block emerged when the two mechanisms interacted. This boundary shifted in opposite directions for a smaller affected region and nodal widening. These differences may contribute to the predominance of motor deficits observed in some immune-mediated neuropathies.NEW & NOTEWORTHY Immune-mediated neuropathies may affect myelinated motor and sensory axons differently. By the development of a computational model, we quantitatively studied the impact of perinodal changes on conduction in motor and sensory axons. Simulations of increasing nodal sodium channel dysfunction and paranodal myelin detachment induced progressive conduction slowing. Sensory axons were more resistant to block than motor axons. This could explain the greater predisposition of motor axons to functional deficits observed in some immune-mediated neuropathies.