Exercise with vibration dumb-bell enhances neuromuscular excitability measured using TMS.

AIM: The purpose of the study was to examine the effects of exercise without vibration and exercise with vibration (27 Hz) on the cortical silent period (CSP) and cortical motor threshold (CMT) measured using transcranial magnetic stimulation (TMS). METHODS: In 22 university athletes, a circular coil attached to a TMS stimulator was applied over the contralateral motor cortex of the target forearm. Resting cortical motor thresholds for dominant and non-dominant extremities were measured for each participant. Then, 15 biceps curls (15 flexion and 15 extension movements) were performed with the dominant arm using a single vibration dumbbell with the vibration turned off. On a different day, the same biceps curl protocol was performed with the dumbbell vibrating at 27 Hz (2 mm amplitude). A supra-threshold TMS stimulus (1.5x CMT) was delivered while participants were voluntarily contracting the flexor digitorum sublimus muscle (30% MVC grip strength) to determine cortical silent periods before and after each upper extremity exercise protocol. Cortical motor thresholds were measured at rest and after the vibration exercise protocol. RESULTS: All subjects completed the study protocol as designed. After TMS, the CSP in the dominant (exercised) extremities increased after exercise without vibration from a resting (pre-exercise) mean of 57.3 ms to 70.4 ms (P<0.05) and after exercise with vibration, the CSP decreased to a mean of 49.4 ms (P<0.02). The CSP in the non-dominant (unexercised) extremities decreased from resting values of 75.6 ms to 69.3 ms (P=0.935) after the exercise-only protocol and decreased to 49.4 ms (P<0.01) after the vibration exercise protocol. The cortical motor threshold in exercised extremities decreased from a resting mean of 41.4 µV to a postvibration exercise mean of 38.6 µV (P<0.01). In non-exercised extremities, the CMT also decreased, from mean of 43.5 µV to 39.9 µV after the vibration-exercise (P<0.01). CONCLUSION: Vibration exercise enhances bilateral corticospinal excitability, as demonstrated by a shortened cortical silent period and lower cortical motor threshold in both exercised and non-exercised extremities.

The use of botulinum toxin-a in the treatment of muscular temporomandibular joint disorders.

INTRODUCTION: Botulinum toxin has been used mainly in the treatment of muscular temporomandibular joint disorders (TMD) and hyperactivity of the masticatory muscles. It is used also as a therapeutic option to relieve pain and help in functional recovery from dental, oral and maxillofacial surgery. The aim of our study was to investigate the efficacy of botulinum toxin injection in the treatment of muscular TMD. MATERIALS AND METHODS: Of the 200 temporomandibular joint patients who applied for treatment, 25 patients with muscular dysfunction of the origin were included in the study. This patient group received drug, drug - physical therapy, occlusal splint therapy and botulinum toxin. These treatments were performed step by step. Botulinum toxin was applied, in accordance with reflex measurement in electromyography guidelines to nine patients whose results were not success from the other treatments had not been successful. Measurements were taken of bite force, pain and mouth openness. RESULTS: Sixteen patients were treated with drug-physical therapy-occlusal splint therapy, and botulinum toxin treatment was found to be successful in the case of nine patients. No side effects were observed at six months follow-up. CONCLUSION: Botulinum toxin injection for the treatment of muscular temporomandibular joint disorder is a viable treatment option in the case of patients who do not respond to conservative treatment methods.

Motor-evoked potentials from various levels of paravertebral muscles in normal subjects and in patients with focal lesions of the spinal cord.

STUDY DESIGN: This prospective study includes normal control subjects and patients with focal lesions of the spinal cord investigated by transcranial magnetic stimulation. OBJECTIVES: To establish a stable method to elicit motor evoked potentials from cervical to lumbar segmental levels and to apply the method that would allow the localization in patients with restricted cord lesion. Thirty-four healthy subjects (10 women, 24 men) and 17 patients with focal spinal lesions were admitted to this study. SUMMARY OF BACKGROUND DATA: The focal cord lesions and injuries were previously evaluated by the records of lower limb muscles after cortical stimulation, but this method did not demonstrate the vertebral levels at which the lesions were located. METHODS: The paravertebral myotomal-evoked potentials were recorded in different segmental levels (T1, T6, T12, and L3) from paravertebral muscles, using surface and needle electrodes by transcranial magnetic stimulation in normal control subjects and patients. RESULTS: In normal control subjects, paravertebral myotomal-evoked potentials were obtained from T1, T6, T12, and L3 paravertebral muscles with both recording techniques (surface and needle electrode). From T1 to L3 latencies of paravertebral myotomal-evoked potentials increased gradually (from 10 msec to 17 msec) in normal control subjects. The levels of spinal cord lesions were obtained reliably in 14 of 17 patients with thoracic-lumbar spinal cord lesions, by using both electrophysiologic methods. In 11 of 14 patients, the lesions produced total conduction block, at and below the lesion level. In the remaining 3 patients slowing of intersegmental conduction was observed along the focal cord lesion. CONCLUSIONS: The paravertebral myotomal-evoked potentials obtained by surface electrode from paravertebral muscles and by midline needle electrode in the intrinsic rotatory muscles of the spine were useful in localizing lesions in the spinal segments in most of the patients with thoracic-lumbar cord lesions.

Calcification of basal ganglia associated with pontine calcification in four cases: a radiologic and genetic study.

We describe 4 brothers with calcification of basal ganglia, pons and dentate nuclei. An abnormal iron metabolism was found in one case. The radiological, pathogenetic and genetic aspects of this disease are discussed.

Comparison of magnetic coil stimulation and needle electrical stimulation in the diagnosis of lumbosacral radiculopathy.

Electrical stimulation (ES) of lumbosacral nerve roots using a needle electrode inserted to the laminar level at the midline of Th12-L1 or L1-2 intervertebral interspace, was compared with magnetic stimulation using a 9-cm diameter coil (MCS) at the L3-4 or L4-5 spine levels, Compound muscle action potentials (CMAP) were superficially recorded from homologous muscles in both sides in 15 normal control subjects and in 20 patients with lumbosacral radiculopathy. Soleus muscles were used for S1, tibialis anterior (TA) for L5, and rectus femoris (RF) muscles for L4 roots. According to the clinical or radiological diagnosis (CAT, MRI and/or myelography) conventional needle EMG was capable to localise the root lesion in 16 of 20 patients (80%) and ES localised the root involvement in 18 of 20 patients (90%); the diagnostic value of MCS was lower, about 65% (13 of 20 patients). Although ES is uncomfortable and invasive, it is superior to needle EMG in localising unilateral or multiple lumbosacral root involvement. At present, MCS is not suitable for the diagnosis of lumbar radiculopathy.

Hand and genital sympathetic skin potentials in flaccid and erectile penile states in normal potent men and patients with premature ejaculation.

Sympathetic skin potentials were recorded from the hand and genital region in 14 normal potent men and 18 patients with premature ejaculations. With the penis flaccid the sympathetic skin potentials obtained did not differ significantly in both groups. However, when erection was induced by 50 mg. intracavernous papaverine injection, the genital sympathetic skin potentials were significantly suppressed in all but 3 normal men, while the hand potentials did not change. In subjects with premature ejaculation genital and hand sympathetic skin potentials were suppressed during erection as a generalized bodily reaction except in 1 patient. This phenomenon may indicate that the specific and regional suppression of genital sympathetic activity during erection could not be properly adjusted in patients with premature ejaculation.

The nature of spontaneous cavernosal activity.

OBJECTIVE: To determine the characteristics of spontaneous cavernosal activity (SCA) and to relate this to previous descriptions of spontaneous potentials from the cavernosum (single potential analysis of cavernosal activity, SPACE). SUBJECTS AND METHODS: The SCA was recorded in 31 normal men with no sexual problems; various manipulations were applied using concentric-needle (CN), bipolar needle (BN) and surface electrodes. The electrical activity was compared with the observed slow retractile movements of the flaccid penis and with other assessments of electrical activity from skin. RESULTS: SCA appeared synchronously from both sides of the cavernosal bodies in all normal subjects when detected by CN electrodes. The synchronous recordings both by CN and BN electrodes, or both by CN and surface electrodes registered similar oscillatory potentials. Slow retractile movements of the penis occurred synchronously with these potentials in all subjects and both were absent during erection. CONCLUSION: SCA is apparently related to biomechanical slow movement artefacts of the flaccid penis: it may be a consequence of the summed contractions of smooth muscle groups in the cavernosum. Observing the small retractile slow movements of the flaccid penis and recording the SCA may be a useful indirect method to characterize cavernosal neural innervation and smooth muscle activity.

[Routine sonography in suspected appendicitis. A trial of 24-hour screening at a general hospital]. / Routinesonographie bei Verdacht auf Appendizitis. Versuch eines 24-Stunden-Screenings im Allgemeinkrankenhaus.

A prospective study was conducted to determine the diagnostic value of sonography in suspected acute appendicitis. From September 1987 until May 1988, the end of the study, 152 patients suspected of having "acute appendicitis" were admitted to hospital. In contrast to other recently published studies conducted by a few highly qualified examiners, we dimed at determining whether this method is useful as a 24-hour-screening performed ba y number of more or less qualified examiners. In the beginning, the patients were examined with a 3.5 MHz scanner, later on exclusively with 5 MHz linear and sector scanners. 150 cases could be evaluated, 96 of which underwent surgery. We found 35 sonographically correct results, 89 correctly negative, 4 false positive and 13 false negative diagnoses. This means a sensitivity of 73% and a specificity of 96% for the sonographical diagnostic method. In 20 cases (13%) sonography led to other diagnoses. A large majority of these findings can be detected by less experienced examiners. The goal of a 24-hour-screening could not be reached because there a competent examiner was not always available at night. It became clear that clinically obvious cases do not require sonographic conformation. The value of sonography lies with doubtful cases of appendicitis: if the ultrasound examination is negative, appendectomy can be postponed; if sonography leads to other differential diagnoses, appropriate therapy can be started immediately.

Local heat effect on sympathetic skin responses after pain of electrical stimulus.

OBJECTIVE: To investigate the analgesic effort of local superficial heating by studying sympathetic skin responses. DESIGN: Randomized trial. SETTING: Electromyography laboratory in the department of physical therapy and rehabilitation of a university hospital. SUBJECTS: Twenty healthy volunteers participated with informed consent. INTERVENTIONS: Sympathetic skin response (SSR) amplitudes following electrical stimulation of the right peroneal nerve and skin temperatures in both hands were recorded simultaneously. All of the recordings were repeated at 5-minute intervals during local heat application over the right palm and within 15 minutes after heat application was stopped. RESULTS: SSR amplitudes in both hands decreased significantly during local heating (p < .05) and did not return to their initial levels within 15 minutes of the recovery period; the reductions remained statistically significant (p < .05). Amplitude reductions were statistically more significant on the heated hand compared with those on the contralateral hand (p < .05). CONCLUSION: Therapeutic local heat application reduces the sudomotor response to a painful stimulus. This analgesic effect may be due to suppression of cortical pain sensation resulting from increased levels of endorphins, and may also be a result of local inhibition of both afferent and efferent C fibres.

Continuous muscle fibre activity: a case treated with acetazolamide.

A case is reported of the continuous muscle fibre activity syndrome, which includes a group of disorders characterised by sustained motor unit activity due to hyperactivity of peripheral nerve motor axons. In this patient the muscle stiffness and myokymic movements were successfully treated with acetazolamide, which acts as a membrane stabiliser either by blockade of chloride and bicarbonate membrane transport or by producing kaliuresis and raising the transmembrane potential by decreasing extracellular potassium.

Electrodermal activity in patients with Parkinson's disease.

Peripheral sympathetic activity was investigated in 25 Parkinson's disease (PD) patients and 27 healthy subjects by measuring the skin resistance level (SRL) and skin resistance response (SRR) at the palm of the hand during rest, auditory stimulation and patellar tendon tapping. Blood flow to the hand was also monitored. Normal responses were obtained from all the 27 healthy subjects with both stimuli. All but one of the 25 PD patients responded to sound, six patients failed to respond to patellar tendon tapping and one patient failed to respond to both stimuli. The SRRs (when detectable) of PD patients were always smaller in amplitude than those of normal subjects. It was also observed that while an electrodermal response was present, no vasomotor response could be elicited by either stimulus in some patients. The opposite was true in some other patients. When response latencies were evaluated, it was found that although the mean latency of SRRs evoked by tendon taping was shorter than the mean latency of responses to auditory stimuli in normal subjects, this was not the case in PD patients. SRR mean latency to patellar tendon tapping was significantly longer in PD patients compared with that in normal subjects. Mean latencies of responses to auditory stimuli were the same for both normal subjects and patients. The ratio of the SRR amplitude to SRL (i.e. relative change in SRL) during both types of stimulation was significantly smaller in PD patients than in normal subjects. All the above findings were also true when blood flow to the tissue was interrupted briefly. These findings support the conjecture that the abnormal peripheral sympathetic neural responses associated with PD may arise from a functional disorder in the basal ganglia that influence the efferent autonomic pathway, from impairment of the intermediolateral column of the spinal cord, and possibly from cognitive deficits.

Autonomic nerve involvement and venous leakage in diabetic men with impotence.

OBJECTIVE: To determine the neurophysiological and vascular factors in diabetic impotence, particularly the role of autonomic neuropathy on venous leakage and erectile impotence. PATIENTS AND METHODS: Thirty-four diabetic men with impotence were investigated using various neurophysiological and radiological methods. The results were compared with those from patients with idiopathic penile venous leakage for autonomic neuropathy, especially for spontaneous cavernosal activity (SCA). RESULTS: Of the neurophysiological tests, the SCA was most frequently abnormal, with the loss of normal periodic oscillations. Penile venous leakage, either alone or with arterial insufficiency, was the most frequent vascular problem (67%) in patients with diabetic impotence, in whom the SCA was absent in most (83%). Conversely, the SCA was normal in all impotent patients with idiopathic venous leakage. CONCLUSION: Venous leakage in diabetic patients is probably produced by autonomic dysfunction of the penile vascular innervation or degeneration of penile smooth muscles, because the SCA was absent more often in these patients.

An electrophysiological investigation of deglutition in man.

This article describes a combined electrophysiological and mechanical method used to measure laryngeal movements and related submental EMG activity during swallowing. The mechanical upward and downward movements of the larynx were detected using a piezoelectric sensor while the submental integrated EMG (SM-EMG) was recorded. Measurements were performed in 29 human subjects. The interval between the onsets of the two sensor signal deflections was used as a measure of the time the larynx remained in its superior position during swallowing. In 10 subjects, the cricopharyngeus muscle (CP) of the upper esophageal spinchter showed a continuous tonic EMG activity except during swallowing. All the parameters measured were influenced by the type and volume of the bolus material. The method presented in this study proved its usefulness in the study of the physiology of deglutition as well as in its objective clinical evaluation in patients with dysphagia.

Diagnostic value of electrical stimulation of lumbosacral roots in radiculopathies.

Needle electrical stimulation of the lumbosacral roots at the laminar level of the Th12-L1 or L1-2 intervertebral spaces were performed in 24 normal subjects and 58 patients with various kinds of lumbar radiculopathy (unilateral L4, L5 and S1 herniated nucleus pulposus and lumber stenosis). The root stimulation method was compared with conventional needle EMG. Lumber electrical stimulation showed root abnormalities objectively in 80% of patients while the diagnostic value of needle EMG was 65%. Therefore, electrical root stimulation is superior to routine EMG for localizing lumbar root involvement. However, the only needle EMG demonstrated the root pathology in 7 cases (12%) and single electrophysiological abnormality was found by the root stimulation in 16 cases (27%). Thus, both electrophysiological methods should be complementary to each other in evaluation of the lumbar radioculopathy.

Four siblings with achalasia, alacrimia and neurological abnormalities in a consanguineous family.

Four siblings with achalasia, alacrimia and other problems involving the autonomic nervous system involvements are reported. Achalasia and alacrimia were present in all of them. Their parents are first cousins and have four other healthy children. Electrophysiological tests showed that autonomic dysfunction has progressed with age. Blood cortisol levels were normal in all four affected children. Depending on those findings of our case and previous reports, we conclude that triple-A syndrome and achalasia, alacrimia with or without neurological abnormalities could be variable manifestations of the same autosomal recessive gene defect.