الملخص
Objective:To explore the clinical and electrophysiological characteristics of peripheral neuropathy in prediabetic patients.Methods:Subjects aged 20-65 years with high-risk factors of impaired glycemia enrolled in Beijing Tiantan Hospital, Capital Medical University from 2019 to 2022 were recruited to conduct oral glucose tolerance test, after excluding other causes of neuropathy or radiculopathy. Patients with impaired fasting glucose or impaired glucose tolerance were defined by American Diabetes Association criteria. These patients were divided into clinical polyneuropathy (PN) and clinical non-PN groups, according to the 2010 Toronto consensus criteria and the presence of PN symptoms and signs or not. Nerve conduction studies (NCS), F wave, sympathetic skin response (SSR), R-R interval variation (RRIV) and current perception thresholds (CPT) were performed and the abnormal rate was compared between different electrodiagnostic methods and between clinical subgroups.Results:Among the 73 prediabetic patients ultimately enrolled, only 20 (27.4%) can be diagnosed as clinical PN according to the Toronto consensus criteria. The abnormal rate of CPT (68.5%, 50/73) was significantly higher than those of F wave (2.7%, 2/73), lower limb NCS (0, 0/73), upper limb NCS changes of carpal tunnel syndrome (26.0%, 19/73), SSR (6.8%, 5/73) and RRIV (5.5%, 4/73; McNemar test, all P<0.001). With sinusoid-waveform current stimuli at frequencies of 2 000 Hz, 250 Hz and 5 Hz, the CPT device was used to measure cutaneous sensory thresholds of large myelinated, small myelinated and small unmyelinated sensory fibers respectively. CPT revealed a 21.9% (16/73) abnormal rate of unmyelinated C fiber in the hands of prediabetic patients, significantly higher than that of large myelinated Aβ fibers [8.2% (6/73), χ2=5.352, P=0.021]. Both abnormal rates of small myelinated Aδ [42.5% (31/73)] and unmyelinated C fibers [39.7% (29/73)] in the feet of prediabetic patients were significantly higher than that of large myelinated Aβ fibers [11.0% (8/73), χ2=18.508, 15.965, both P<0.001]. Compared with the clinical non-PN group, the abnormal rates of CPT [90.0% (18/20) vs 60.4% (32/53), χ2=5.904, P=0.015] and SSR [20.0% (4/20) vs 1.9% (1/53), P=0.016) were significantly higher in the clinical PN group. Conclusions:Peripheral neuropathies in prediabetic patients are usually asymptomatic or subclinical, and predispose to affect unmyelinated and small myelinated sensory fibers. Selective electrodiagnostic measurements of small fibers help to detect prediabetic neuropathies in the earliest stages of the disease.
الملخص
Objective:To analyze the clinical, electromyographic and tremor characteristics in tremor patients with neuronal intranuclear inclusion disease (NIID).Methods:From May 2018 to April 2023, 34 patients with NIID diagnosed in the Department of Neurology, Beijing Tiantan Hospital of Capital Medical University were retrospectively included. Sixteen patients with tremor of at least one limb and (or) head were in tremor group, and 18 patients without tremor were in control group. The clinical, electromyogram and tremor data of all participants were summarized, the clinical features and electromyogram differences of the 2 groups were compared, and the tremor characteristics of patients with NIID were analyzed.Results:The proportion of female patients in the tremor group was higher than that in the non tremor group (12/16 vs 7/18, P=0.045). The proportion of upper and lower limb peripheral nerve damage in the tremor group was lower than that in the non tremor group (2/16 vs 9/18, P=0.030), with statistical significance. There was no significant difference between the 2 groups in higher cortex and autonomic nervous dysfunction. The amplitude of composite muscle action potential and sensory nerve action potential in all patients was normal or slightly decreased; some patients experienced a decrease in motor and sensory fiber conduction velocity. The proportion of motor and sensory nerve conduction velocity slowing in the non tremor group was higher than that in the tremor group [motor nerve:41.7%(30/72) vs 17.2%(11/64), χ 2=9.64, P=0.002;sensory nerve:38.9% (35/90) vs 20.0%(16/80), χ 2=7.19, P=0.007]. The number of cases of postural tremors in different parts among the 16 patients was as follows: 13 in the upper limbs, 7 in the lower limbs, and 6 in the head; static tremor: 8 cases in the upper limbs, 3 cases in the lower limbs, and 5 cases in the head. At rest, the frequency of tremors in different parts of the body was as follows: upper limb (5.3±1.1) Hz, lower limb (4.2±0.4) Hz, and head (3.9±0.6) Hz. The difference in tremor frequency among the 3 parts was statistically significant ( F=3.92, P=0.047); Pairwise comparison showed that the frequency of head tremor was lower than that of upper limb tremor, with a statistically significant difference ( P=0.020). In a postural state, tremor frequency in different parts was as follows: upper limb (5.4±0.9) Hz, lower limb (5.0±0.7) Hz, head (3.9±0.7) Hz. There was a statistically significant difference in tremor frequency among the 3 parts ( F=6.65, P=0.005). Further pairwise comparison revealed statistically significant differences in tremor frequency between the patient′s head, upper and lower limbs ( P=0.001, P=0.022). Synchronous tremor rhythm was predominant, with occasional alternations or synchronous+alternations. There was no harmonic tremor spectrum was observed. Conclusions:NIID patients with tremors were more common in female patients.The degree of peripheral nerve damage was milder than those without tremors. The site and form of tremor were diverse, with a dominant frequency of 4-6 Hz, mainly synchronous rhythm, and no harmonic spectrum. Postural tremors were common in the limbs.
الملخص
Objective To investigate the diagnostic value of spontaneous activities in genioglossus of amyotrophic lateral sclerosis (ALS).Methods A retrospective analysis of 79 patients diagnosed with ALS from January 2014 to December 2015 in Beijing Tiantan Hospital Affiliated to Capital Medical University was made.The patients were divided into two groups according to the clinical examination:with (44 patients) or without bulbar symptoms (35 patients).The course of disease,spontaneous potentials and ALS-Functional Rating Scale (ALS-FRS) scores were discussed,together with the association between semi-quantitative evaluation of spontaneous potential of the genioglossus and ALS-FRS score.Results In ALS patients,the overall positive rate of glossal spontaneous potentials was 69.6％ (55/79),among which the positive rate was 82.9％ (29/35) in patients with bulbar symptoms and 59.1％ (26/44) in patients without bulbar symptoms,with statistically significant differences between the two groups (x2=5.206,P＜0.05).While the positive rate in sternocleidomastoid was only 13.9％ (11/79),and there was no statistically significant difference between patients with or without bulbar symptoms.Semi-quantitative evaluation of fibrillation potentials in genioglossus muscle was correlated with ALS-FRS score (r=-0.258,P＜0.05).Conclusion Compared with sternocleidomastoid muscle,genioglossus muscle has a higher positive rate of spontaneous potentials and a higher diagnostic value in patients with subclinical bulbar symptoms.
الملخص
Objective To optimize the method to elicit the facial nerve F wave and to establish its reference values and its related parameters, in order to provide an electrophysiological basis for facial nerve assessment in patients with hemifacial spasm (HFS). Methods Thirty-six healthy volunteers and 22 patients with HFS underwent this project. Compound muscle action potentials (CAMP, or M waves) and F waves were elicited by stimulating the marginal mandibular branch of the facial nerve and recorded with needle electrodes placed in the mentalis muscle. The association between F parameters and Cohen Grading of the HFS patients were analyzed. Results There were no significant differences in F parameters between men and women or between the two sides in control subjects. Minimal latency of F wave (Fmin) and mean latency of F wave (Fmean) had positive correlations with head circumference (Fmin r=0.449, P=0.013; Fmean r=0.391, P=0.033), but had no correlations with age nor height. Patients with HFS had prolonged duration of F wave (Fdura) in spasm side, compared with normal side (13.1 ms vs. 9.5 ms, P<0.01) and healthy subjects (13.1 ms vs. 9.7 ms, P<0.001), and increased ratio of F-wave amplitude and M-wave amplitude (F/M) in spasm side, compared with normal side (6.9% vs. 3.8%, P<0.001) and healthy subjects (6.9% vs. 3.7%, P<0.001). F/M exhibited a positive correlation with Cohen Grading (r=0.538, P=0.001). Conclusion A clear facial nerve F wave can be achieved by stimulating the marginal mandibular branch of the facial nerve, which provides an objective basis for evaluation of the facial nerve function in HFS patients with increased F/M and prolonged Fdura.