Neurophysiological visual assessment in patients with idiopathic intracranial hypertension: visual evoked potential and multifocal field electroretinography.

BACKGROUND: Determining the cause of visual deterioration in idiopathic intracranial hypertension (IIH) patients is of clinical necessity. This study aimed to study the effect of chronic increased ICP on the retina and optic nerve through objective electrophysiological measures in chronic IIH patients. METHODS: Thirty patients with chronic IIH and thirty age and sex-matched healthy controls were included in this study. Papilledema grade and CSF pressure were evaluated in the patients' group. Both groups were submitted to visual evoked potentials (VEP) and multifocal electroretinogram (mfERG). RESULT: The mean value of P100 latencies of the right and left on two check sizes, 1 deg and 15m in chronic IIH patients, was significantly delayed than controls (P-value < 0.001 for each). Chronic IIH patients showed a significantly lower amplitude of the right and left R1, R2, R3, R4 & R5 compared to controls (P-value < 0.001, < 0.001) (P-value < 0.001, < 0.001) (P-value < 0.001, < 0.001) (P-value < 0.001, = 0.001) (P-value = 0.002, < 0.001), respectively. Also, patients showed a significantly delayed peak time of the right and left R1 and R2 compared to controls (P-value < 0.001, < 0.001) (P-value = 0.001, = 0.009), respectively. There was a significant positive correlation between each of CSF pressure and papilledema grade with right and left PVEP latencies. In contrast, there was no statistically significant correlation between either CSF pressure or papilledema grade and PVEP amplitudes in both eyes. CONCLUSION: In chronic IIH patients, both optic nerve dysfunction and central retinal changes were identified, supported by VEP and the mfERG findings.

Transcranial direct current stimulation for spasticity in patients with multiple sclerosis: Exploring novel routes.

BACKGROUND: Patients with Multiple sclerosis (MS) usually suffer from severe neurological disabilities. Spasticity is one of the most bothering and disabling manifestations that MS patients suffer from. Owing to being a chronic inflammatory demyelinating disorder; finding new modalities to alleviate some of the disabilities related to MS became a desired objective. Transcranial direct current stimulation (tDCS), a relatively new tool for modulating cortical excitability has been recently considered as a tool to provide symptomatic treatment for many neurologic and psychiatric diseases. In our study, we used tDCS to assess its effect on spasticity in MS patients. METHODS: 5 consecutive daily sessions of 20 minutes duration of active anodal tDCS over the ipsilesional motor cortex were given to 10 relapsing remitting MS (RRMS) patients with at least 1 spastic lower limb (active group) who were compared with other matched10 RRMS patients who received sham stimulation (sham group). The outcome was to measure the effect on spasticity both clinically using the Modified Ashworth Scale (MAS) and through neurophysiological assessment (H reflex latency and H/M amplitude ratio). RESULTS: Patients who received active anodal tDCS showed significant improvement (p< 0.05) in the H/M amplitude ratio as compared to the sham group. However, there was no significant difference between the two groups in the MAS. H latency showed significant stability in active group when compared to the sham group. CONCLUSION: Anodal direct current stimulation of the ipsilesional motor cortex in patients with MS, resulted in reduced spasticity as per neurophysiological assessment.

The effect of cortical versus sacral repetitive magnetic stimulation on lower urinary tract dysfunction in patients with multiple sclerosis.

75% of multiple sclerosis (MS) patients have lower urinary tract symptoms. Moreover, up to 80% of asymptomatic patients show abnormalities on urodynamic examination. The objective of this study is to assess the effect of repetitive magnetic stimulation on the motor cortex versus sacral roots in MS patients with lower urinary tract dysfunction (LUTD). 40 MS patients with LUTD were divided according to urodynamic studies (UDS) into two groups (20 patients each): Group A (overactive bladder) and Group B (underactive bladder). Each group was further subdivided into Subgroup (A-I) and (B-I) which received cortical magnetic stimulation and Subgroup (A-II) and (B-II) which received sacral magnetic stimulation. UDS, pelvic ultrasound as well as Incontinence Quality of Life (I-QOL) questionnaire were compared before and after magnetic stimulation sessions in each group as well as between groups. UDS showed significant reduction in bladder capacity, improvement in bladder contractility in all groups and subgroups. Moreover, it showed improvement of urine flow rate only in Group B. Reduction of post-void residual urine was noted in all subgroups except in (Group A-II). I-QOL questionnaire showed improvement in patients with underactive bladder only. Intergroup comparison between A and B showed no difference. Cortical as well as sacral magnetic stimulation showed significant effect on lower urinary tract dysfunction that led to improvement in symptoms in MS patients with underactive bladder, rather than those with overactive bladder.

Squatting versus squatting with hip adduction in management of patellofemoral osteoarthritis: A randomized controlled trial.

BACKGROUND: Patellofemoral osteoarthritis is a common presentation in the outpatients' physical therapy clinics. The muscle imbalance between the vastus medialis oblique and vastus lateralis muscles is one of the main factors that lead to the development of this condition. OBJECTIVE: To compare the effect of a squatting versus squatting with hip adduction in management of patellofemoral osteoarthritis. METHODS: Patients in group A received a traditional physical therapy program in addition to squatting exercise and those in group B received a traditional physical therapy program in addition to squatting with hip adduction exercise for four weeks. The primary outcome measures were pain on the numerical rating scale (NRS) and performance of functional activities by Kujala scale, while the secondary outcomes were vastus medialis oblique (VMO) and vastus lateralis (VL) amplitudes as well as the VMO:VL ratio by surface electromyography were considered before and after intervention. RESULTS: Thirty patients (group A n= 15; group B n= 15) were randomized and analyzed. Comparing both groups post-program revealed that there was no significant difference between both groups regarding the vastus medialis oblique activity, VMO:VL ratio, pain intensity and performance of functional activities. CONCLUSION: Both a traditional physical therapy program in addition to squatting exercise and a traditional physical therapy program in addition to squatting exercise with hip adduction are effective in reduction of pain intensity increases performance of functional activities, and vastus medialis oblique amplitude. However, there is no superiority of one program over the other.

Carpal Tunnel Syndrome Grading Using High-Resolution Ultrasonography.

PURPOSE: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the wrist. The diagnosis of CTS has been a concern for physicians for a long time. The aim of this study is to evaluate the use of the median nerve (MN) cross-sectional area (CSA) in the wrist compared with the CSA in the forearm to grade the severity of CTS in Egyptian patients. METHODS: The CSAs of the MN in the wrist and forearm were measured in 72 wrists that were diagnosed with CTS via nerve conduction studies and 80 healthy wrists. The CTS group was subdivided into three subgroups (mild, moderate, and severe CTS). The ratio of the CSA of the MN in the wrist to that in the forearm was used to calculate cutoff values for CTS grading. RESULTS: There were positive correlations between the CSAs of the MN in the wrist and MN conduction latency. At a wrist-forearm ratio of 1.7, the high-resolution ultrasonography showed 96.1% accuracy in the detection of CTS. CONCLUSIONS: High-resolution ultrasonography can be used in CTS grading.