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BACKGROUND AND AIMS: This study aimed to identify the clinical characteristics and electrodiagnostic subtypes of Guillain-Barré syndrome (GBS) in Istanbul. METHODS: Patients with GBS were prospectively recruited between April 2019 and March 2022 and two electrodiagnostic examinations were performed on each patient. The criteria of Ho et al., Hadden et al., Rajabally et al., and Uncini et al. were compared for the differentiation of demyelinating and axonal subtypes, and their relations with anti-ganglioside antibodies were analyzed. RESULTS: One hundred seventy-seven patients were included, 69 before the coronavirus disease 2019 pandemic (April 2019-February 2020) and 108 during the pandemic (March 2020-March 2022), without substantial changes in monthly frequencies. As compared with the criteria of Uncini et al., demyelinating GBS subtype diagnosis was more frequent according to the Ho et al. and Hadden et al. criteria (95/162, 58.6% vs. 110/174, 63.2% and 121/174, 69.5%, respectively), and less frequent according to Rajabally et al.'s criteria (76/174, 43.7%). Fourteen patients' diagnoses made using Rajabally et al.'s criteria were shifted to the other subtype with the second electrodiagnostic examination. Of the 106 analyzed patients, 22 had immunoglobulin G anti-ganglioside antibodies (14 with the axonal subtype). They had less frequent sensory symptoms (54.5% vs. 83.1%, p = 0.009), a more frequent history of previous gastroenteritis (54.5% vs. 22.9%, p = 0.007), and a more severe disease as compared with those without antibodies. INTERPRETATION: Serial electrodiagnostic examinations are more helpful for accurate subtype diagnosis of GBS because of the dynamic pathophysiology of the disease. We observed no significant increase in GBS frequency during the pandemic in this metropolis.
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Síndrome de Guillain-Barré , Humanos , Estudos Prospectivos , Condução Nervosa/fisiologia , Eletrodiagnóstico/métodos , Gangliosídeos , AnticorposRESUMO
Purpose To evaluate the value of shear-wave elastography (SWE) in the detection of diabetic peripheral neuropathy (DPN) of the tibial nerve. Materials and Methods This study was approved by the institutional review board, and written informed consent was obtained from all study participants. The study included 20 diabetic patients with DPN (10 men, 10 women), 20 diabetic patients without DPN (eight men, 12 women), and 20 healthy control subjects (nine men, 11 women). The tibial nerve was examined at 4 cm proximal to the medial malleolus with gray-scale ultrasonography and SWE. The nerve cross-sectional area (in square centimeters) and the mean nerve stiffness (in kilopascals) within the range of the image were recorded. Inter- and intrareader variability, differences among groups, and correlation of clinical and electrophysiologic evaluation were assessed with intraclass correlation coefficients, the Mann Whitney U test, and the Wilcoxon signed rank test. Results Between diabetic patients with and diabetic patients without DPN, mean age (60 years [range, 38-79 years] vs 61 years [range, 46-75 years], respectively), mean duration of diabetes (10 years [range, 1-25 years] vs 10 years [range, 2-26 years]), and mean body mass index (31.4 kg/m2 [range, 24.7-48.1 kg/m2] vs 29.8 kg/m2 [range, 22.9-44.0 kg/m2]) were not significantly different. Diabetic patients without DPN had significantly higher stiffness values on the right side compared with control subjects (P < .001). Patients with DPN had much higher stiffness values on both sides compared with both diabetic patients without DPN (P < .001) and healthy control subjects (P < .001). A cutoff value of 51.0 kPa at 4 cm proximal to the medial malleolus revealed a sensitivity of 90% (95% confidence interval [CI]: 75.4%, 96.7%) and a specificity of 85.0% (95% CI: 74.9%, 91.7%). Conclusion Tibial nerve stiffness measurements appear to be highly specific in the diagnosis of established DPN. The increased stiffness in subjects without DPN might indicate that the nerve is affected by diabetes. © RSNA, 2016 Online supplemental material is available for this article.
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Neuropatias Diabéticas/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Nervo Tibial/diagnóstico por imagem , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos TestesRESUMO
Electroneurography (ENoG) is one of the most objective tests in grading the damage and prediction of prognosis in peripheral facial palsy (PFP). We aimed to determine temporal changes of ENoG recorded over occipitalis muscle in acute idiopathic PFP. Consecutive 21 patients with unilateral acute idiopathic PFP and age- and sex-matched 15 healthy volunteers were included in the study. Nasal and occipital ENoG values were recorded once in the control group and the same procedure was repeated daily between the second and eight days of the disorder in the PFP group. Occipital ENoG value began to increase on the third day while nasal ENoG value was still within the normal range (27.04 vs 7.69 %, p = 0.0001). In the fourth, fifth and sixth days, occipital ENoG value was significantly high compared to nasal ENoG value (p = 0.0001 for each day) whereas nasal and occipital ENoG values were very similar in the seventh and eighth days (p = 0.181 and p = 0.584, respectively). Our study presents further support for technical possibility of occipital ENoG which may reflect the degree of fiber degeneration earlier than the nasalis muscle in PFP.
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Paralisia de Bell , Eletrodiagnóstico/métodos , Músculos Faciais , Adulto , Paralisia de Bell/diagnóstico , Paralisia de Bell/fisiopatologia , Fenômenos Eletrofisiológicos , Músculos Faciais/inervação , Músculos Faciais/patologia , Músculos Faciais/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
Juvenile myoclonic epilepsy (JME) is hypothesized to originate from the dysfunction of thalamo-cortical circuit. We aimed to analyze any changes in auditory startle response in JME patients to determine the role of brainstem in JME. The responses of 18 JME patients to auditory simulation were recorded over the unilateral orbicularis oculi, masseter, sternocleidomastoid, and extremity muscles. Results were compared with those of 18 age and gender matched healthy volunteers. Total auditory startle response frequencies were similar between the two groups (31.1 ± 11.1 % vs. 33.7 ± 8.7 %, p = 0.400). Other parameters over each muscle were also similar. There were no impacts of antiepileptic drug use or disease duration. We may conclude that our findings may provide sufficient evidence for the lack of functional changes of the auditory startle response circuit even in longstanding cases of JME.
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Epilepsia Mioclônica Juvenil/fisiopatologia , Reflexo de Sobressalto/fisiologia , Estimulação Acústica , Adolescente , Adulto , Anticonvulsivantes/uso terapêutico , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Criança , Eletroencefalografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estatísticas não Paramétricas , Ácido Valproico/uso terapêutico , Adulto JovemRESUMO
OBJECTIVE: This study was designed to investigate the effects of open technique rhinoplasty on facial nerve terminal branches more concerned with mimicry via electroneurography (ENoG). METHODS: Twenty patients ages between 24 and 36 years were included in the study. Five nasal mimicry muscles were used to evaluate axonal loss of the facial nerve: bilateral transverse nasal, levator labii superioris alaeque nasi (LLSAN), and procerus muscles of all patients were evaluated preoperatively and postoperative third month by ENoG. The patients that have abnormalities regarding the amplitude and latency at third month were reevaluated at sixth month postoperatively. RESULTS: Mean latencies of the facial nerve were calculated to be increased for all muscles at third postoperative month, but this increase was significant only for left LLSAN (P = 0.002). Amplitudes of the facial nerve decreased in all of the groups, but this decrease was not significant (P > 0.05). Two patients with exceptionally long latency facial nerve response of transverse nasal muscle and 11 muscle recordings with abnormal low amplitudes of the facial nerve at the third month was reevaluated at sixth postoperative month and the values were improved. CONCLUSIONS: This study demonstrated that facial nerve integrity is minimally affected after rhinoplasty, yet all affected muscles were recovered on the long term.
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Eletromiografia/métodos , Expressão Facial , Músculos Faciais/inervação , Nervo Facial/fisiopatologia , Rinoplastia/métodos , Adulto , Músculos Faciais/fisiopatologia , Feminino , Humanos , Masculino , Período Pós-Operatório , Adulto JovemRESUMO
OBJECTIVES: To measure the median nerve (MN) stiffness by quantitative shear wave elastography (SWE) at the carpal tunnel inlet and to determine whether SWE can be used in the diagnosis of carpal tunnel syndrome (CTS). METHODS: The study included 37 consecutive patients (60 wrists) with a definitive diagnosis of CTS and 18 healthy volunteers (36 wrists). The MN cross-sectional area (CSA) by ultrasound and stiffness by SWE were studied. The difference between CTS patients and controls, and the difference among subgroups based on electrodiagnostic tests were studied by the Student's t test. Interobserver variability and ROC analysis were performed. RESULTS: The MN stiffness was significantly higher in the CTS group (66.7 kPa) when compared to controls (32.0 kPa) (P < 0.001), and higher in the severe or extreme severity group (101.4 kPa) than the mild or moderate severity group (55.1 kPa) (P < 0.001). A 40.4-kPa cut-off value on SWE revealed sensitivity, specificity, PPV, NPV and accuracy of 93.3%, 88.9%, 93.3%, 88.9% and 91.7%, respectively. Interobserver agreement was excellent for SWE measurements. CONCLUSIONS: Median nerve stiffness at the carpal tunnel inlet is significantly higher in patients with carpal tunnel syndrome, for whom shear wave elastography appears to be a highly reproducible diagnostic technique. KEY POINTS: ⢠Clinical examination is important for diagnosis of carpal tunnel syndrome ⢠Shear wave elastography (SWE) offers new clinical opportunities within diagnostic ultrasound ⢠SWE is highly reproducible in evaluation of median nerve stiffness ⢠Median nerve stiffness is significantly increased in carpal tunnel syndrome ⢠Elastography could become useful in diagnosis of carpal tunnel syndrome.
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Síndrome do Túnel Carpal/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Nervo Mediano/fisiopatologia , Adulto , Idoso , Síndrome do Túnel Carpal/fisiopatologia , Elasticidade , Feminino , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Pessoa de Meia-Idade , Curva ROC , Reprodutibilidade dos TestesRESUMO
BACKGROUND: Information regarding involuntary movements in chronic inflammatory polyneuropathy (CIDP) is gradually increasing. Our goal is to identify the types of involuntary movements in CIDP. METHODS: All patients who were followed with the diagnosis of CIDP were invited for clinical and electrophysiological evaluations. Demographic and clinical findings (age, gender, duration of illness, diagnosis, treatments) were noted. Clinical examination and multichannel surface electromyography were done. We also performed routine upper and lower extremity peripheral nerve conduction studies, F-waves, long latency reflexes, blink reflex, mixed nerve silent period and cutaneous silent period in all patients. RESULTS: Twenty-two patients accepted the invitation. Eleven patients with CIDP had involuntary movements. Ten (45.5%) patients with CIDP had tremor and seven (31.8%) had short-duration and high-amplitude myoclonus. Regarding demographic, clinical and electrophysiological features, there was no significant difference between patients with and without tremor. The latencies of R1, R2 and R2c components of BR were longer among CIDP patients without tremor compared to CIDP patients with tremor. Presence of myoclonus (p = 0.007) and delayed F-waves (p = 0.008) were associated with the presence of tremor. CONCLUSION: Tremor and myoclonus were frequent in CIDP. The fact that myoclonus was detected in the majority of patients only by multichannel surface EMG who were clinically evaluated as pure tremor suggests that a more detailed electrophysiological evaluation is required. There was no difference in the medications used or other clinical features between patients with and without tremor.
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Mioclonia , Polineuropatias , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica , Eletromiografia , Humanos , Mioclonia/diagnóstico , Mioclonia/etiologia , Condução Nervosa/fisiologia , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/complicações , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico , Tremor/diagnósticoAssuntos
Carcinoma Neuroendócrino/complicações , Síndrome Miastênica de Lambert-Eaton/etiologia , Timoma/complicações , Neoplasias do Timo/complicações , Carcinoma Neuroendócrino/diagnóstico por imagem , Carcinoma Neuroendócrino/cirurgia , Fluordesoxiglucose F18 , Humanos , Síndrome Miastênica de Lambert-Eaton/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Timectomia/métodos , Timoma/diagnóstico por imagem , Timoma/cirurgia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/cirurgiaRESUMO
Repetitive nerve stimulation (RNS) is a highly sensitive electrophysiological test used for diagnosing myasthenia gravis (MG). Here, we evaluated electrodiagnostic value of RNS using facial nerve and occipitalis muscle. Patients with generalized MG were included. Clinical findings were assessed. RNS test was performed on occipitalis, nasalis, trapezius, abductor policis brevis (APB) and abductor digiti minimi (ADM) muscles. Twenty-five (78%) patients had relevant decrement during RNS test of at least one muscle. Nasalis muscle had the highest diagnostic potential (68.8%), followed by trapezius (53.3%), occipitalis (50%), APB (30%) and ADM (16.7%) muscles. There was not a significant relationship between clinical symptoms and facial RNS recorded on occipitalis muscle. In conclusion, we suggest that facial RNS recording over occipitalis muscle can be added in electrodiagnosis of MG because of cranial nerve innervation and proximal location. Facial RNS recording over occipitalis muscle provides a good choice under the conditions such as atrophy, cosmetic surgery, or botulinum toxin application in which nasalis muscle is unavailable for use.
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Estimulação Elétrica/métodos , Eletrodiagnóstico/métodos , Músculos Faciais/inervação , Nervo Facial/fisiopatologia , Miastenia Gravis/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/fisiopatologia , Adulto JovemRESUMO
PURPOSE: In diabetes mellitus (DM), upper extremity entrapment neuropathies are suggested to be a component of polyneuropathy (PNP). Our aim is to examine the presence of ulnar neuropathy at the elbow (UNE) and its relation to other findings including PNP in symptomatic and asymptomatic type-2 DM patients who were admitted for routine examinations. METHODS: The study included all cases referred for electromyography because of type-2 DM between November 2017 and May 2018. Demographic and clinical characteristics were recorded. Routine electromyography examinations in all cases included the following: bilateral motor conduction of the median, ulnar, peroneal, and tibial nerves and sensory conduction of the median, ulnar, and sural nerves. For ulnar nerve examination, stimuli were given at the wrist, below the elbow, and above the elbow. Electrophysiological findings were evaluated according to the American Association of Neuromuscular and Electrodiagnostic Medicine criteria. RESULTS: Eighty-two patients with type-2 DM and 144 upper extremities were included in the study. Of the 82 patients who participated in the study, 3 had findings suggesting ulnar neuropathy, and electrophysiology confirmed UNE in only one. Electrophysiological studies showed UNE in 36 patients. Other diagnoses identified by electrophysiology were carpal tunnel syndrome and PNP. Ulnar neuropathy at the elbow was more commonly associated with PNP compared with carpal tunnel syndrome. Gender and PNP were independent risk factors for the development of UNE. CONCLUSIONS: Although the majority of diabetic patients were asymptomatic for the UNE, approximately one third of all patients with DM were found to have UNE. Ulnar neuropathy at the elbow is closely related with PNP.
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Diabetes Mellitus Tipo 2/complicações , Neuropatias Diabéticas/epidemiologia , Neuropatias Diabéticas/etiologia , Neuropatias Ulnares/epidemiologia , Neuropatias Ulnares/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cotovelo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de RiscoRESUMO
OBJECTIVE: The aim of this study was to examine cutaneous silent periods (CSPs) in spinal muscular atrophy (SMA) type 2 and type 3 patients. METHODS: Fourteen patients with SMA and 14 healthy subjects were included. CSPs were recorded from thenar muscles after painful stimulation of the index finger during slight thumb abduction. CSP parameters (including onset latency, duration, index of suppression, long-loop reflex, and post-inhibitory rebound activity) were measured. All parameters were compared between SMA patients and healthy subjects using the Mann-Whitney U test. We then correlated CSP parameters to Hammersmith Functional Motor Scale Expanded (HFMSE) scores in SMA patients by Spearman-rho testing. RESULTS: No CSP parameter except E3% (i.e., the post-inhibitory rebound activity relative to pre-stimulus baseline) differed significantly between SMA patients and healthy subjects. E3% was significantly smaller in patients than healthy individuals. HFMSE scores of SMA patients correlated negatively with CSP duration and positively with E3%. DISCUSSION: Smaller E3%, correlating with longer CSP duration, in SMA patients with more severe clinical findings and therefore more marked motoneuron loss suggests that the E3 component following the CSP is directly affected by motoneuron loss.
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Atrofias Musculares Espinais da Infância , Eletromiografia , Mãos , Humanos , Músculo Esquelético , ReflexoRESUMO
OBJECTIVES: To investigate the effects of topical and systemic administrations of melatonin and dexamethasone on facial nerve regeneration. MATERIALS AND METHODS: In total, 50 male albino Wistar rats underwent facial nerve axotomy and neurorrhaphy. The animals were divided into 5 groups: control, topical melatonin, systemic melatonin, topical dexamethasone, and systemic dexamethasone. Nerve conduction studies were performed preoperatively and at 3, 6, 9, and 12 weeks after drug administrations. Amplitude and latency of the compound muscle action potentials were recorded. Coapted facial nerves were investigated under light and electron microscopy. Nerve diameter, axon diameter, and myelin thickness were recorded quantitatively. RESULTS: Amplitudes decreased and latencies increased in both the melatonin and dexamethasone groups. At the final examination, the electrophysiological evidence of facial nerve degeneration was not significantly different between the groups. Histopathological examinations revealed the largest nerve diameter in the melatonin groups, followed by the dexamethasone and control groups (p<0.05). Axon diameter of the control group was smaller than those of the melatonin (topical and systemic) and topical dexamethasone groups (p<0.05). The melatonin groups had almost normal myelin ultrastructure. CONCLUSION: Electrophysiological evaluation did not reveal any potential benefit of dexamethasone and melatonin in contrast to histopathological examination, which revealed beneficial effects of melatonin in particular. These agents may increase the regeneration of facial nerves, but electrophysiological evidence of regeneration may appear later.
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Dexametasona/farmacologia , Nervo Facial/efeitos dos fármacos , Nervo Facial/transplante , Melatonina/farmacologia , Administração Tópica , Animais , Axotomia/métodos , Depressores do Sistema Nervoso Central/administração & dosagem , Dexametasona/administração & dosagem , Modelos Animais de Doenças , Fenômenos Eletrofisiológicos/efeitos dos fármacos , Nervo Facial/fisiopatologia , Nervo Facial/ultraestrutura , Glucocorticoides/administração & dosagem , Masculino , Melatonina/administração & dosagem , Bainha de Mielina/ultraestrutura , Regeneração Nervosa/efeitos dos fármacos , Condução Nervosa/efeitos dos fármacos , Procedimentos Neurocirúrgicos/métodos , Ratos , Ratos Wistar , Procedimentos de Cirurgia Plástica/métodos , Recuperação de Função FisiológicaRESUMO
INTRODUCTION: We aimed to analyze the frequency, clinical characteristics, medical treatment options and final functional status of Guillain-Barré syndrome (GBS) and its variants in a population from a tertiary hospital setting. METHODS: All medical records of patients with acute inflammatory polyneuropathy between the years of 1998-2013 were retrospectively screened. Demographic, clinical and laboratory information, treatment options and the rate of recovery of the patients were gathered. RESULTS: A total of 183 patients met the study criteria. Subtypes were typical demyelinating form (n=102, 79.1%), acute motor sensory axonal variant (n=11, 8.5%), acute motor axonal variant (n=10, 7.8%), Miller-Fisher syndrome (n=5, 3.9%), and pure sensory subtype (n=1, 0.8%). Remaining patients had the diagnosis of acute-onset chronic inflammatory demyelinating polynuropathy. The data of treatment option were available for 70 patients. Most of the patients received intravenous immunoglobulin (IVIg) treatment or the combination of IVIg and methylprednisolone. One patient died, there was no improvement in eight patients and rest showed improvement with varying degrees. CONCLUSIONS: We did not observe major change of recovery between different treatment options, however, most of the patients using methylprednisolone required IVIg because of inadequate response.
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Background and objective We aimed to analyze the alterations in sensorimotor gating at brainstem after peripheral facial palsy (PFP). To examine sensorimotor gating, we used prepulse modulation (PPM) of blink reflex (BR). We also recorded BR recovery to identify excitability changes in the facial nucleus. Patients and method We included 33 patients and 39 recordings. Control group was composed of 16 healthy subjects. Simultaneous bilateral baseline BR, BR recovery at ISI of 300-ms and BR-PPM at ISI of 100-ms recordings were performed after stimulation of trigeminal nerve on right sides of healthy subjects and on both sides of patients. Severity of PFP and time lapse from the onset was noted. Results Mean R1 amplitude was increased, whereas mean R2 and R2c magnitude were reduced in all groups after prepulse stimulation. However, multivariate ANOVA showed significance at group level (patients and healthy subjects), at prepulse level (no prepulse and 100-ms prepulse) and group and prepulse level. Suppression of R2 or R2c was lower on both sides of patients compared to healthy subjects and the deficit first started on the symptomatic side. Conclusion Suppression of R2 and R2c after prepulse stimulation is reduced in PFP suggesting decreased filtering of facial sensory input at brainstem level. Trigeminal sensitization at brainstem develops early after PFP.
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Piscadela/fisiologia , Tronco Encefálico/fisiopatologia , Paralisia Facial/complicações , Paralisia Facial/patologia , Filtro Sensorial/fisiologia , Adulto , Análise de Variância , Área Sob a Curva , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Spinal cord injury (SCI) may cause functional changes at various levels in central and peripheral nervous systems. One of these changes is increased excitability above the lesion such as enhanced auditory startle responses (ASR). Startle response may also be obtained after somatosensory stimulus (startle reflex to somatosensory stimuli, SSS). In this study, we investigated changes of both ASR and SSS in SCI. METHOD: We examined ASR and SSS in 14 patients with SCI and 18 age-matched healthy volunteers. SSS responses were recorded from orbicularis oculi (O.oc), sternocleidomastoid (SCM) and biceps brachii (BB) muscles by electrical stimulation of median nerve at the wrist. ASR was evoked by binaural auditory stimuli and recorded from O.oc, masseter, SCM and BB muscles. Probability, latency, amplitude and duration of responses were compared between two groups for each muscle. RESULTS: Presence of response over O.oc after somatosensory stimuli was decreased in patients compared to controls (P = 0.004). There were no differences in SSS responses of other muscles. ASR latency was shorter in masseter, SCM and BB in patients with SCI, but only BB had significantly reduced latency (P = 0.033). The duration of O.oc response was longer and the amplitude of SCM was larger in patients with SCI (P = 0.037 and P = 0.015, respectively). CONCLUSION: ASR is enhanced after SCI whereas SSS of eye muscles is hypoactive and pattern of SSS after median stimulation changes in SCI.
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Estimulação Acústica , Reflexo de Sobressalto , Traumatismos da Medula Espinal/fisiopatologia , Adulto , Potencial Evocado Motor , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologiaRESUMO
The aim of this study is to investigate the role of diabetes mellitus on the clinical and electrophysiological findings of peripheral facial palsy (PFP), the effect of the diabetes duration and polyneuropathy on the electrophysiological parameters. A total of 32 diabetic and 40 non-diabetic patients with peripheral facial palsy were included. All patients were divided into two subgroups based on the time of electrophysiological examinations: within the first 15 days versus within 16-30 days. Neuropathy symptoms and the results of neurological examinations and electrophysiological findings were recorded. The findings of electroneurography (EnoG), blink reflex (BR) evaluation, and needle electromyography (EMG) indicated statistically significant blink reflex abnormalities in diabetic patients compared to non-diabetics. Delay in the latency was more remarkable in the R2 component than in the R1 (p<0.001). The delay in the R1 latency was also observed in the non-affected side for diabetic patients. The longer duration of the diabetes caused significant delay on the blink reflex latency on both the affected and non-affected sides for R1 component (p=0.019, p=0.041, respectively). In contrary, neither the diabetes duration nor the age of the patients correlated with the clinical severity of facial palsy, fiber loss, fibular nerve compound muscle action potential amplitudes, and the nerve conduction velocities.
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Neuropatias Diabéticas/complicações , Eletrofisiologia , Paralisia Facial/etiologia , Potenciais de Ação/fisiologia , Potenciais de Ação/efeitos da radiação , Adulto , Idoso , Piscadela/fisiologia , Piscadela/efeitos da radiação , Estimulação Elétrica/métodos , Eletromiografia/métodos , Paralisia Facial/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora/fisiologia , Tempo de Reação/fisiologia , Tempo de Reação/efeitos da radiação , Estudos Retrospectivos , Fatores de TempoRESUMO
OBJECTIVES: Diabetic foot lesions develop predominantly in male patients and sensory neuropathy is the most frequent type of neuropathy associated with these lesions. The aim of this study was to analyze the clinical and electrophysiological features in a cohort of patients with diabetic foot. RESEARCH DESIGN AND METHODS: The recordings of 318 consecutive diabetic patients (127 women and 191 men) with an ongoing or healed foot ulcer who had been referred for electrophysiological consultation were evaluated retrospectively. RESULTS: 60.1% of our cohort were male. Loss of deep sensation and deep tendon reflex abnormalities were the most common neurological findings. Negative sensory symptoms (63.7% vs 40.8%, p<0.01) and neuropathic pain (38.5% vs 18.3%, p<0.01) were more frequent in females, whereas atrophy was more frequent in male patients (22.8% vs 46%, p<0.01). Motor nerve conduction abnormalities and ulnar nerve involvement was more frequent and severe in males. Abnormal electrophysiological findings were mild in 70 patients (female 42, 60%). In this group, hemiplegia, peripheral arterial disease, multiple bone fractures, end stage renal failure, recent pulmonary tuberculosis and dementia accompanied mild polyneuropathy. Thirty patients had shown prominent decrease in nerve conduction velocity which indicated severe demyelination. Among these 30 patients, 6 male subjects had clinical features similar to that of chronic inflammatory demyelinating polyneuropathy. CONCLUSIONS: Our results indicate that male gender, motor neuropathy and mononeuropathies, especially ulnar neuropathy is associated with the development of DF among our patients with DF. Patients with diabetes mellitus have a predisposition to develop chronic inflammatory demyelinating polyneuropathy and this may also facilitate formation of diabetic foot. History of hemiplegia, dementia and trauma are permissive risk factors for diabetic foot in the presence of mild polyneuropathy.
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Neuropatias Diabéticas/complicações , Neuropatias Diabéticas/epidemiologia , Úlcera do Pé/epidemiologia , Úlcera do Pé/etiologia , Condução Nervosa/fisiologia , Potenciais de Ação/fisiologia , Idoso , Distribuição de Qui-Quadrado , Estudos de Coortes , Estimulação Elétrica/métodos , Eletromiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Condução Nervosa/efeitos da radiação , Fatores SexuaisRESUMO
PURPOSE: We aimed to evaluate the reliability and reproducibility of repetitive nerve stimulation recorded on occipitalis muscle by comparing recordings on nasalis muscle in healthy subjects. METHODS: A total of 23 healthy subjects (mean age: 44.7 ± 13.8 years) underwent detailed neurological examination and repetitive nerve stimulation using nasalis and occipitalis muscles. Amplitude and area percentage changes of compound muscle action potentials (CMAPs) after repetitive nerve stimulation with different frequency were compared between right and left sides and between recordings on nasalis and occipitalis muscles. RESULTS: Comparisons of percentage amplitude changes of nasalis and occipitalis CMAPs showed no differences (+0.1% ± 3.8% vs. +1.4% ± 3.9%, P = 0.129). Average area percentage change of nasalis CMAPs was 0.3% ± 19.0%, whereas the value of occipitalis CMAP was +2.8% ± 15.2% (P = 0.851). Comparisons of nasalis and occipitalis CMAPs values showed no differences. CONCLUSIONS: The repetitive nerve stimulation recorded on occipitalis muscle is simple, easy to apply, noninvasive, consistent, and reproducible.
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Potenciais de Ação/fisiologia , Eletromiografia/normas , Músculos Faciais/fisiologia , Nervo Facial/fisiologia , Couro Cabeludo/fisiologia , Estimulação Elétrica Nervosa Transcutânea/normas , Adulto , Eletromiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estimulação Elétrica Nervosa Transcutânea/métodosRESUMO
OBJECTIVE: Prepulse inhibition (PPI) of the blink reflex (BR) is a reduction in BR excitability due to a conditioning stimulus, reflecting sensory gating by brainstem structures. We aimed to analyze PPI changes during a painful episode in chronic or episodic migraine and its relation to allodynia, since abnormal brainstem filtering has been hypothesized in migraine pathophysiology. METHODS: We included 20 patients with migraine during headache episode, and age- and gender-matched 22 healthy subjects. We recorded BR after unconditioned and conditioned supraorbital stimuli. For conditioned stimuli, we applied preceding subthreshold stimulus to the median nerve at wrist. The presence of PPI was compared between the two groups, as well as the specific BR parameters (latency, amplitude or area of R1 and R2 components) in unconditioned (test) and conditioned (PPI) paradigms. RESULTS: In the patient group, seven (35%) patients did not have R2-PPI whereas all healthy subjects had R2-PPI (P=0.003). Healthy subjects displayed significantly increased R1 amplitude and reduced R2 amplitude and area after conditioned stimuli. In migraine patients, we observed significant reduction only in R2 amplitude. Logistic regression demonstrated that allodynia was independently related with the presence of PPI (beta: -0.535, P=0.021). CONCLUSIONS: Our study provides evidence for sensory gating impairment at brainstem level in migraine headache, related to the presence of allodynia.
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Piscadela , Hiperalgesia/fisiopatologia , Transtornos de Enxaqueca/fisiopatologia , Inibição Pré-Pulso , Adulto , Tronco Encefálico/fisiopatologia , Feminino , Humanos , Hiperalgesia/complicações , Masculino , Transtornos de Enxaqueca/complicaçõesRESUMO
INTRODUCTION: Restless legs syndrome (RLS) is associated with dysfunction of the dopaminergic systems in the pathways that specifically link the sensory input and motor output. Keeping in mind that clinical symptomatology in RLS and cerebrospinal fluid dopamine concentrations in healthy individuals show changes throughout the day, we hypothesized that excitability of the related pathways increases during the night in RLS, and in the present study, we aimed to analyze our hypothesis by the assessment of blink reflex (BR) recovery. METHODS: Eleven patients with primary RLS and eight age- and gender-matched healthy subjects were included in the study. All participants underwent detailed interviews and neurological examinations. BR responses were recorded after single and paired supraorbital stimulation during the early afternoon and late at night. For double stimulation, interstimulus intervals (ISI) of 100, 300, and 500 ms were used. Daytime and nighttime investigations were separately compared between the patient and control groups (between-group analyses). In-group analyses were conducted between daytime and nighttime investigations of the patient and control groups. RESULTS: BR responses to single stimuli were normal in all participants at all sessions. R2 recovery was the highest in the patient group during nighttime investigations. In-group analysis showed a reduction of R2 recovery during the night in healthy subjects. R2 recoveries at ISIs of 300 and 500 ms at nighttime were higher in RLS patients but did not reach statistical significance. CONCLUSION: The BR circuit is less excitable during the night in healthy individuals, whereas the reduction of excitability is lost in RLS. Despite the limited number of included subjects, we suggest that the normal circadian modulation of the BR circuit is lost in RLS.