Efficacy and tolerability of vagus nerve stimulation therapy (VNS) in Slovenian epilepsy patients: younger age and shorter duration of epilepsy might result in better outcome.

To review the outcome of vagus nerve stimulation (VNS) therapy in all implanted Slovenian patients with drug-resistant epilepsy, data on 48 patients implanted between 2001 and 2015 were obtained retrospectively from medical records. The outcome was assessed in 2016. Out of 48 patients, 39 responded at follow up. The seizure frequency was reduced in 18 (46.2%) patients; 13 (33.3%) of them reported ≥50% reduction after 12 months of therapy. The responder rate was higher among patients implanted before the age of six years. Ictal severity decreased in 22 (56.4%), seizure duration in 19 (48.7%) and post-ictal recovery time in 22 (56.4%) patients. Favorable effects on the quality of life (QOL) were improved alertness in 33.3%, concentration in 41.0%, energy and mood in 38.5%, and memory in 17.9% of patients. Reduced seizure burden and improved QOL were more often observed in patients implanted at a younger age. Shorter duration of epilepsy was significantly associated with QOL improvement. Adverse effects were transient. Overall positive effects showed VNS to be a safe, well-tolerated and effective adjunctive treatment in most severe drug-resistant epilepsy patients. Implantation at a younger age and shorter duration of epilepsy before implantation could be important predictors of better outcome.

Can neurologic examination predict pathophysiology of ulnar neuropathy at the elbow?

OBJECTIVE: To explore the utility of neurologic examination to predict the pathophysiology of ulnar nerve lesions in patients with ulnar neuropathies at the elbow (UNE). METHODS: We prospectively recruited consecutive patients with suspected UNE. Four blinded investigators took a history and performed neurologic, electrodiagnostic (EDx) and ultrasonographic (US) examinations. In patients with axonal UNE, conduction block and conduction slowing, the pathophysiologies of UNE and neurologic examination findings were compared. RESULTS: We found significant differences in muscle bulk and strength of the ulnar hand muscles between 96 arms with axonal UNE, 34 with conduction block, and 45 with isolated conduction slowing. Severe muscle atrophy and weakness (0-3/5 on MRC) predicted axonal UNE, and moderate weakness (-4/5 on MRC) with normal muscle bulk predicted UNE with conduction block. Using more restrictive criteria for axonal and conduction block UNE, muscle strength of 4-5/5 on MRC was predictive of isolated conduction slowing. CONCLUSION: Although we found significant differences in patterns of muscle bulk and strength between groups of UNE patients with different UNE pathophysiologies, in the majority of arms, neurologic examination could not reliably predict UNE pathophysiology. SIGNIFICANCE: Results confirm that nerve conduction studies are essential for determination of the pathophysiology of ulnar neuropathy at the elbow.

Diagnostic accuracy of ultrasonographic and nerve conduction studies in ulnar neuropathy at the elbow.

OBJECTIVE: To report diagnostic accuracy of ultrasonography (US) and compare it to standard 10-cm nerve conduction studies (NCSs), and short-segment NCSs (SSNCSs) across the elbow in the diagnosis of ulnar neuropathy at the elbow (UNE). METHODS: In a broad spectrum of consecutive patients with suspected UNE a prospective and blinded study was performed. This included a clinical examination, electrodiagnostic (EDx) and US studies. In clinically definite UNE patients we compared the sensitivity of SSNCSs, of 10-cm NCSs across the elbow, and of US. The specificity was calculated in asymptomatic controls. RESULTS: We studied 113 affected arms in 109 patients; definite UNE was diagnosed in 81, and alternative conditions in 12 arms. The sensitivity of SSNCSs was 89%, of 10-cm NCSs 83%, and of US 71%. We found the highest sensitivity of US in patients with axonal UNE (93%), followed by conduction slowing (82%) and conduction block (55%). Specificity of SSNCSs was 80%, of 10-cm NCSs 82%, and of US 82%. CONCLUSION: The present study found the highest diagnostic accuracy of SSNCSs (85%), followed by 10-cm NCSs (83%), and of US (77%). SIGNIFICANCE: US is particularly useful in patients with axonal UNE, while SSNCSs in UNE with conduction block.