The effect of foot somatosensory loss in postural control during Functional reach test in patients with diabetic polyneuropathy: A controlled study.

BACKGROUND: In patients with diabetic polyneuropathy (DPN), differences in postural control due to losing the lower limb somatosensory information were reported. However, it is still unclear by which mechanisms the dynamic postural instability is caused. OBJECTIVES: This study aimed to investigate postural control differences and neuromuscular adaptations resulting from foot somatosensory loss due to DPN. METHODS: In this controlled cross-sectional study, fourteen DPN patients and fourteen healthy controls performed the Functional Reach Test (FRT) as a dynamic task. The postural control metrics were simultaneously measured using force plate, motion capture system, and surface electromyography (sEMG). The main metrics including reach length (FR), FR to height ratio (FR/H), displacement of CoM and CoP, moment arm (MA), and arch height ratio. Also, kinematic (range of motion of ankle, knee, and hip joints), and sEMG metrics (latencies and root mean square amplitudes of ankle and hallux muscles) were measured. To compare variables between groups, the independent sample T-test for (normally distributed) and the Mann-Whitney U test (non-normally distributed) were used. RESULTS: The subjects' reach length (FR), FR to height ratio, absolute MA, and displacement of CoM were significantly shorter than controls, while displacement of CoP was not significant. Arch height ratio was found significantly lower in DPN patients. We observed that CoM was lagging CoP in patients (MA = + 0.89) while leading in controls (MA = -1.60). Although, the muscles of patients showed significantly earlier activation, root mean square sEMG amplitudes were found similar. Also, DPN patients showed significantly less hip flexion, knee extension, and ankle plantar flexion. CONCLUSIONS: This study presented that decreasing range of motion at lower limbs' joints and deterioration in foot function caused poor performance at motor execution during FRT in DPN patients.

The Diagnostic Role of Adding the Hoffman Reflex for L5 Radiculopathy in the Electrodiagnostic Laboratory: A Cross-sectional Study.

OBJECTIVES: To investigate changes in the H-reflex in patients with monoradiculopathies involving L5 or S1 levels by stimulating the sciatic nerve and recording simultaneously from the tibialis anterior (TA), peroneus longus (PL), and soleus (S) muscles. METHODS: Patients with unilateral radicular back pain with L5 or S1 root compression on MRI, participated in this cross-sectional study. The H-reflex over the TA, PL, and S muscles was simultaneously recorded by sciatic nerve stimulation. The H-reflex latency was compared with that of the contralateral extremity. RESULTS: Fifty-eight patients (29 patients L5; 29 patients S1 radiculopathy) were included in the study. There were significant delays in the latency of the H-reflex over TA (30.95±2.31-29.21±1.4) and PL (31.05±2.85-29.02±1.99) muscles on the affected side in patients with L5 radiculopathy. However, the latency of the S H-reflex was similar on both sides. In contrast, in patients with S1 radiculopathy, there was a significant delay in the latency of soleus H reflex (32.76±3.45-29.9±3.19), while the significant delay was not detected in the TA and PL muscles. However, the cutoff values for the H-reflex latency of all muscles were not found to have clinical significance. CONCLUSIONS: The study presents that the H-reflex study, recorded from the TA, PL, and S muscles by sciatic nerve stimulation, is of interest but has minimal contribution to radiculopathy diagnosis in conventional electrodiagnostic tests.

Evaluation of handgrip strength in children with pulmonary hypertension.

BACKGROUND: Handgrip strength is a crucial indicator of upper extremity muscular strength and is vital for monitoring disorders like cardiac diseases that restrict a patient's physical activity and result in muscle atrophy. The aim of our study was to evaluate whether muscle strength loss is present in patients with pulmonary hypertension and whether this test can be an alternative to 6-minute walk test. MATERIALS AND METHODS: The study included 39 healthy children who were admitted to the outpatient clinic and 16 children with a diagnosis of pulmonary hypertension who were being followed in our centre. We assessed the differences in upper extremity handgrip strength using the Jamar Hydraulic Hand Dynamometer device among both healthy children and those diagnosed with pulmonary hypertension. Moreover, we compared the handgrip strength of pulmonary hypertension patients with significant prognostic indicators such as NYHA class, 6-minute walk test, and pro-brain natriuretic peptide. RESULTS: The mean dominant handgrip strength was 20.8 ± 12 kg in the patient group and 21.6 ± 12.4 kg in the control group (p = 0.970). Handgrip strength was shown to be negatively connected with pro-brain natriuretic peptide (r = -0.565, p = 0.023) and positively correlated with 6-minute walk test (r = 0.586, p = 0.022) during the patient group evaluation. CONCLUSION: Six-minute walk test needs a customised physical area (30 m of a straight hallway) and trained personnel for applying the test. The handgrip strength test, a different muscle strength indicator, can be used to more clearly and simply indicate the decline in patients' ability for effort. Additionally, it was found in our study that handgrip strength decreased as pro-brain natriuretic peptide levels rose, a crucial measure in the monitoring of pulmonary hypertension.

How did intraoperative neuromonitorization prevent tetraplegia?

PURPOSE: Patients with mucopolysaccharidosis type IVA (MPS IVA) have many risk factors for myelopathy and paresis. These are spinal cord compression, bone stenosis, and soft tissue thickening with ligament laxity, deformity, odontoid hypoplasia, and atlantoaxial instability. Although most patients with MPS IVA appear generally healthy at birth, patients often show skeletal deformities within a few years. Surgical indications are difficult to determine. Historically, many physicians have used prophylactic decompression and fusion in young, asymptomatic MPS IVA patients to prevent cord compression. Although spinal cord decompression is usually required at the craniocervical junction in patients with MPS IVA, decompression may be required at other spinal cord levels as well. There is a risk of developing neurological damage during surgery. The most common causes are ischemia secondary to cardiac output deteriorated in the prone position or due to artery damage, and local trauma due to neck movements or traction while bringing the patient to the prone position. Neurophysiological monitoring is very important during surgery to reduce the risk of neurological damage in spinal cord surgery. In this case report, a case with loss of lower extremity neuromonitorization motor evoked potential (MEP) responses in the early period of surgery without any intervention to the craniocervical junction after prone positioning will be presented.

3D Printed Biodegradable Polyurethaneurea Elastomer Recapitulates Skeletal Muscle Structure and Function.

Effective skeletal muscle tissue engineering relies on control over the scaffold architecture for providing muscle cells with the required directionality, together with a mechanical property match with the surrounding tissue. Although recent advances in 3D printing fulfill the first requirement, the available synthetic polymers either are too rigid or show unfavorable surface and degradation profiles for the latter. In addition, natural polymers that are generally used as hydrogels lack the required mechanical stability to withstand the forces exerted during muscle contraction. Therefore, one of the most important challenges in the 3D printing of soft and elastic tissues such as skeletal muscle is the limitation of the availability of elastic, durable, and biodegradable biomaterials. Herein, we have synthesized novel, biocompatible and biodegradable, elastomeric, segmented polyurethane and polyurethaneurea (TPU) copolymers which are amenable for 3D printing and show high elasticity, low modulus, controlled biodegradability, and improved wettability, compared to conventional polycaprolactone (PCL) and PCL-based TPUs. The degradation profile of the 3D printed TPU scaffold was in line with the potential tissue integration and scaffold replacement process. Even though TPU attracts macrophages in 2D configuration, its 3D printed form showed limited activated macrophage adhesion and induced muscle-like structure formation by C2C12 mouse myoblasts in vitro, while resulting in a significant increase in muscle regeneration in vivo in a tibialis anterior defect in a rat model. Effective muscle regeneration was confirmed with immunohistochemical assessment as well as evaluation of electrical activity produced by regenerated muscle by EMG analysis and its force generation via a custom-made force transducer. Micro-CT evaluation also revealed production of more muscle-like structures in the case of implantation of cell-laden 3D printed scaffolds. These results demonstrate that matching the tissue properties for a given application via use of tailor-made polymers can substantially contribute to the regenerative outcomes of 3D printed tissue engineering scaffolds.

Consensus recommendations for botulinum toxin injections in the spasticity management of children with cerebral palsy during COVID-19 outbreak

Spasticity is the most common motor disturbance in cerebral palsy (CP). Lockdown in the COVID-19 outbreak has profoundly changed daily routines, and similarly caused the suspension of spasticity treatment plans. Besides, the delay in botulinum toxin (BoNT) injection, which is important in the management of focal spasticity, led to some problems in children. This consensus report includes BoNT injection recommendations in the management of spasticity during the COVID-19 pandemic in children with CP. In order to develop the consensus report, physical medicine and rehabilitation (PMR) specialists experienced in the field of pediatric rehabilitation and BoNT injections were invited by Pediatric Rehabilitation Association. Items were prepared and adapted to the Delphi technique by PMR specialists. Then they were asked to the physicians experienced in BoNT injections (PMR specialist, pediatric orthopedists, and pediatric neurologists) or COVID-19 (pediatric infectious disease, adult infectious disease). In conclusion, the experts agree that conservative management approaches for spasticity may be the initial steps before BoNT injections. BoNT injections can be administered to children with CP with appropriate indications and with necessary precautions during the pandemic.

Peripheral axonal excitability in hemiplegia related to subacute stroke

Background/aim: This study aims to investigate peripheral nerve excitability in patients with subacute stroke. Materials and methods: Thestudy was performed in 29 stroke patients within the subacute period and 29 healthy controls using QTRAC software and TRONDNF protocol. The threshold electrotonus, recovery cycle, stimulus-response, strength-duration, and current-threshold relationships were recorded. Results: The membrane was more hyperpolarized, and excitability was decreased in the hemiplegic side. The impairment of inward rectifying channel function, degree of hyperpolarization, and decrease of excitability were directly related to the Brunnstrom stages, which were more pronounced in lower stages. Conclusion: The lower motor neurons were affected at the level of axonal channels as a result of upper motor neuron lesions. It can be due to dying back neuropathy, homeostasis, and neurovascular regulation changes in the axonal environment, activity-dependent plastic changes, loss of drive coming from the central nervous system, or a combination of these factors.

The utility of shear wave elastography in the evaluation of muscle stiffness in patients with cerebral palsy after botulinum toxin A injection.

PURPOSE: The first aim of this study was to evaluate changes in the stiffness of the medial gastrocnemius muscle (GM) after a botulinum toxin A (BoNT-A) injection in children with cerebral palsy (CP) using shear wave elastography (SWE). We also wanted to investigate the usability of SWE for evaluating spasticity in a clinical setting. The second aim of this study was to show how treatment of the gastrocnemius muscle spasticity caused a change in the elasticity of the anterior tibial (TA) muscle. METHODS: Twenty-four pediatric patients diagnosed with a spastic type of CP, who were scheduled to receive a BoNT-A injection in the gastrocnemius muscle, were included in the study. There was a total of 43 lower extremities to evaluate, and muscle stiffness was measured before the injection and a month post injection using SWE. The physiatrist evaluated muscle spasticity using the Modified Ashworth Scale (MAS) and the Modified Tardieu Scale at about the same time. RESULTS: SWE values of the GM (pre-BoNT-A: 45.9 ± 6.5 kPa, post-BoNT-A: 25.0 ± 5.7 kPa) decreased significantly post BoNT-A injection (P < 0.01). SWE measurements of the GM had positive correlations with MAS, V1X, V3X, and R2-R1 (P < 0.01); and negative correlations with R2 and R1 (P < 0.05). SWE values of the TA muscle (pre: 36.9 ± 7.9 kPa, post: 28.4 ± 5.2 kPa) decreased significantly (P < 0.01). CONCLUSION: Quantitative measurement of muscle stiffness using SWE may provide important information for the evaluation of spasticity and treatment efficiency in pediatric CP patients.

A novel approach to the diagnostic assessment of carpal tunnel syndrome based on the frequency domain of the compound muscle action potential.

Conventional electrophysiological (EP) tests may yield ambiguous or false-negative results in some patients with signs and symptoms of carpal tunnel syndrome (CTS). Therefore, researchers tend to investigate new parameters to improve the sensitivity and specificity of EP tests. We aimed to investigate the mean and maximum power of the compound muscle action potential (CMAP) as a novel diagnostic parameter, by evaluating diagnosis and classification performance using the supervised Kohonen self-organizing map (SOM) network models. The CMAPs were analyzed using the fast Fourier transform (FFT). The mean and maximum power parameters were calculated from the power spectrum. A counter-propagation artificial neural network (CPANN), supervised Kohonen network (SKN) and XY-fused network (XYF) were compared to evaluate the classification and diagnostic performance of the parameters using the confusion matrix. The mean and maximum power of the CMAP were significantly lower in patients with CTS than in the normal group (p < 0.05), and the XYF network had the best total performance of classification with 91.4%. This study suggests that the mean and maximum power of the CMAP can be considered as less time-consuming parameters for the diagnosis of CTS without using additional EP tests which can be uncomfortable for the patient due to poor tolerance to electrical stimulation.

Anticipatory effect of execution on observation: an approach using ExoPinch finger robot

Background/aim: This study aims to explore the mirror neuron system (MNS) involvement using mu (8­12 Hz)/beta (15­25 Hz) band suppression in an action observation-execution paradigm. Materials and methods: Electrophysiological (EEG) data from 16 electrodes were recorded while 8 participants observed video clips of a hand squeezing a spring. Specifically, the effect of anticipated execution on observation was studied. For this purpose, a fully actuated finger exoskeleton robot was utilized to synchronize observation and execution and to control the execution condition for the partici-pants. Anticipatory effect was created with a randomized robot accompany session. Results: The results showed that the observational condition (with or without anticipation) interacted with hemisphere at central chan-nels near somatosensory cortex. Additionally, we explored the response of MNS on the kinetics features of visual stimuli (hard or soft spring). Conclusion: he results showed an interaction effect of kinetics features and hemisphere at frontal channels corresponding nearly to the ventral premotor cortex area of the brain. The activation of mirror neurons in this area plays a crucial role in observational learning. Based on our results, we propose that specific type of visual stimuli can be combined with the functional abilities of the MNS in the ac-tion observation based treatment of hand motor dysfunction of stroke patients to have a positive additional impact.

Bilateral pan-plexus lesion after substance use: A case report.

Peripheral nervous system complications such as acute demyelinating polyradiculopathy and mononeuropathy may rarely develop after substance use. A 27-year-old man used illegal drugs the day before his admission to the emergency service. Initially, he was suspected for rhabdomyolysis, due to elevated blood urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase, myoglobin, and creatine kinase levels. On Day 4, generalized edema and flask paralysis were noted in both upper limbs. The patient was diagnosed with bilateral brachial pan-plexopathy based on electrophysiological study results. He underwent a rehabilitation program. After eight months, repeated electrophysiological study revealed a significant improvement in all bilateral upper limb muscles, except for the right abductor pollicis brevis and abductor digiti minimi muscles. The underlying cause of bilateral brachial pan-plexopathy was rhabdomyolysis secondary to substance use. In conclusion, substance use in patients with non-traumatic plexopathy should always be questioned.

Comparison of Interpolation Methods in the Diagnosis of Carpal Tunnel Syndrome

Background: Diagnosis of carpal tunnel syndrome is based on clinical symptoms, examination findings, and electrodiagnostic studies. For carpal tunnel syndrome, the most useful of these are nerve conduction studies. However, nerve conduction studie can result in ambiguous or false-negative results, particularly for mild carpal tunnel syndrome. Increasing the number of nerve conduction studie tests improves accuracy but also increases time, cost, and discomfort. To improve accuracy without additional testing, the terminal latency index and residual latency are additional calculations that can be performed using the minimum number of tests. Recently, the median sensory-ulnar motor latency difference was devised as another way to improve diagnostic accuracy for mild carpal tunnel syndrome. Aims: The median sensory-ulnar motor latency difference, terminal latency index, and residual latency were compared for diagnostic accuracy according to severity of carpal tunnel syndrome. Study Design: Diagnostic accuracy study. Methods: A total of 657 subjects were retrospectively enrolled. The carpal tunnel syndrome group consisted of 546 subjects with carpal tunnel syndrome according to nerve conduction studie (all severities). The control group consisted of 121 subjects with no hand symptoms and normal nerve conduction studie. All statistical analyses were performed using SAS v9.4. Means were compared using one-way ANOVA with the Bonferroni adjustment. Sensitivity, specificity, positive predictive value, and negative predictive value were compared, including receiver operating characteristic curve analysis. Results: For mild carpal tunnel syndrome, the median sensory-ulnar motor latency difference showed higher specificity and positive predictive value rates (0.967 and 0.957, respectively) than terminal latency index (0.603 and 0.769, respectively) and residual latency (0.818 and 0.858, respectively). The area under the receiver operating characteristic was highest for the median sensory-ulnar motor latency difference (0.889), followed by the residual latency (0.829), and lastly the terminal latency index (0.762). Differences were statistically significant (median sensory-ulnar motor latency difference being the most accurate). For moderate carpal tunnel syndrome, sensitivity and specificity rates of residual latency (0.989 and 1.000) and terminal latency index (0.983 and 0.975) were higher than those for median sensory-ulnar motor latency difference (0.866 and 0.958). Differences in area under the receiver operating characteristic curve were not significantly significant, but median sensory-ulnar motor latency difference sensitivity was lower. For severe carpal tunnel syndrome, residual latency yielded 1.000 sensitivity, specificity, positive predictive value, negative predictive value and area beneath the receiver operating characteristic curve. Differences in area under the receiver operating characteristic curve were not significantly different. Conclusion: The median sensory-ulnar motor latency difference is the best calculated parameter for diagnosing mild carpal tunnel syndrome. It requires only a simple calculation and no additional testing. Residual latency and the terminal latency index are also useful in diagnosing mild to moderate carpal tunnel syndrome.

Analysis of mirror neuron system activation during action observation alone and action observation with motor imagery tasks.

This study aimed to explore the relationship between action observation (AO)-related corticomotor excitability changes and phases of observed action and to explore the effects of pure AO and concurrent AO and motor imagery (MI) state on corticomotor excitability using TMS. It was also investigated whether the mirror neuron system activity is muscle-specific. Fourteen healthy volunteers were enrolled in the study. EMG recordings were taken from the right first dorsal interosseous and the abductor digiti minimi muscles. There was a significant main effect of TMS timing (after the beginning of the movement, at the beginning of motor output state, and during black screen) on the mean motor evoked potential (MEP) amplitude. Mean MEP amplitudes for AO combined with MI were significantly higher than pure AO session. There was a significant interaction between session and TMS timing. There was no significant main effect of muscle on MEP amplitude. The results indicate that corticomotor excitability is modulated by different phases of the observed motor movement and this modulation is not muscle-specific. Simultaneous MI and AO enhance corticomotor excitability significantly compared to pure AO.

Using fuzzy logic for diagnosis and classification of spasticity.

BACKGROUND/AIM: Spasticity is generally defined as a sensory-motor control disorder. However, there is no pathophysiological mechanism or appropriate measurement and evaluation standards that can explain all aspects of a possible spasticity occurrence. The objective of this study is to develop a fuzzy logic classifier (FLC) diagnosis system, in which a quantitative evaluation is performed by surface electromyography (EMG), and investigate underlying pathophysiological mechanisms of spasticity. MATERIALS AND METHODS: Surface EMG signals recorded from the tibialis anterior and medial gastrocnemius muscles of hemiplegic patients with spasticity and a healthy control group were analyzed in standing, resting, dorsal flexion, and plantar flexion positions. The signals were processed with different methods: by using their amplitudes in the time domain, by applying short-time Fourier transform, and by applying wavelet transform. A Mamdani-type multiple-input, single-output FLC with 64 rules was developed to analyze EMG signals. RESULTS: The wavelet transform provided better positive findings among all three methods used in this study. The FLC test results showed that the test was 100% sensitive to identify spasticity with 95.8% accuracy and 93.8% specificity. CONCLUSION: A FLC was successfully designed to detect and identify spasticity in spite of existing measurement difficulties in its nature.

The Effect of Albumin and Platelet-Poor Plasma Supplemented Botulinum A Toxin on Bioavaliability: An Experimental Rabbit Model.

Today, botulinum toxin is commonly used for cosmetic purposes throughout the world. Despite various agents reducing the efficiency of toxin are well defined, the studies related to increasing the bioavailability are limited. The purpose of our study is to assess the effect of the preparation of toxin by diluting with platelet-poor plasma (PPP) and/or albumin instead of standard dilution (saline) on bioavailability in cosmetic-purpose botulinum toxin applications.In the study, 24 New Zealand rabbits were used. Right anterior auricular muscle was preferred for toxin injections. Subjects were divided in 4 groups and in every group; botulinum A toxin (BTxA) that was prepared by different dilution methods was injected. 2.5 U saline-diluted BTxA was injected to the subjects in group 1, 2.5 U ready-to-use rabbit albumin-diluted BTxA was injected to group 2 and 2.5 U autologous PPP-diluted BTxA was injected to group 3 and pure saline was injected to group 4.Before the injection (0th week) and in the second, sixth, and 12th weeks after the injection, visual and electroneuromyographic evaluations of the ears of the subjects were performed.In the second week, median amplitude levels in group 2 were significantly found lower than other groups.In the sixth week, median amplitude levels in group 1 were significantly found lower than other groups.In 12th week, no significant difference was found among all the groups in terms of median amplitude levels.Visual findings were also correlated with electroneuromyographic findings.It was observed that the dilution of BTxA with albumin had caused a stronger paralysis when compared to dilution with saline or PPP at the beginning (second week); however, in the following weeks (sixth week), it was seen that dilution with saline had maintained paralysis better when compared with other dilution methods.In cosmetic BTxA applications, dilution of the toxin with albumin or PPP instead of standard dilution has no positive effect on bioavailability and such modifications regarding this kind of dilution are found unsuitable. Further studies are needed to directly relate the results with clinical applications.

Effect of Kinesio taping on elbow muscle strength in healthy individuals: A randomized trial1.

INTRODUCTION: The effect of the application of kinesiotape on muscle strength is still uncertain. This trial represents the first randomized-controlled trial to investigate the immediate and delayed effects of kinesiotape application on triceps muscle strength in healthy subjects. METHOD: The trial was randomized and placebo-controlled. Young adult (18-35 years of age), healthy men were randomly assigned in a 1:1 ratio to either a kinesiotape group or a sham tape for the control group. ``Y''-shaped kinesiotape was applied to the triceps muscle in the sitting position. ``I''-shaped tape was used for the control group, and the sham tape was placed horizontally on the triceps muscle. A hand-held digital dynamometer was used to evaluate the peak force of elbow extension and flexion. Assessments were carried out before taping, an hour after taping, and after the first week. RESULTS: The mean ages of the participants in the kinesiotape and control groups were 26.2 ± 4.8 and 26.7 ± 4.8, respectively. The mean values of the peak force before taping, after the first hour, and after first week were statistically analyzed using one-way repeated measures. No statistical significance was found for in-group analysis of either the kinesiotape group or the control group (p> 0.05). In addition, there was no statistical significance in the between-group assessments (p> 0.05). CONCLUSION: The triceps muscle is appropriate for studying the effects of kinesiotape on muscle strength because elbow extension is provided by only one fusiform-shaped muscle. The results of this study did not show any significant changes in immediate or delayed muscle strength according to the initial measurements and between-group assessments.

Comparison of multimodal intraoperative neurophysiological monitoring efficacy in early childhood and school aged children undergoing spinal surgery.

OBJECTIVE: The aim of this study was to compare the performance of multimodal intraoperative neurophysiological monitoring (MIONM) in children below and over 6 years of age. METHODS: 43 children, diagnosed with spinal pathologies were divided into two cohorts according to their age and enrolled in the study. Those under the age of 6 consisted group A, whereas those between the age of 6 and 11 consisted group B. All patients underwent spinal surgical procedures according to their diagnosis. A standard anesthesia protocol was given to both groups. Baseline somatosensory evoked potentials (SSEPs) and transcranial electrical motor evoked potentials (tcMEPs) were recorded and evaluated at specific time points for each patient. RESULTS: Except for the SSEPs in three cases, tcMEPs and SSEPs were recorded for all patients. There was no false-negative whereas 9 false positive recordings due to physiological conditions that all recovered intraoperatively. In 10 patients, MIOMN recorded more than %50 decrement, in which 8 had the kyphosis component. The tcMEPs fully recovered by the end of the operation except for the patient with post-tuberculosis kyphosis. There was no statistically significant difference in the mean threshold values with regard to transcranial stimulus intensity for the tcMEPs between the two groups. CONCLUSION: Compared to school aged children, both SSEPs, tcMEPs recordings are feasible and MIONM is effective for early childhood patients undergoing spinal surgery. LEVEL OF EVIDENCE: Level III, Diagnostic Study.

Overactive bladder symptoms in patients with multiple sclerosis: Frequency, severity, diagnosis and treatment.

OBJECTIVE: To determine the frequency and severity as well as the diagnosis and treatment of overactive bladder problems in patients with multiple sclerosis (MS) followed up at five centers in Turkey. DESIGN: Survey study. SETTING: Outpatient tertiary clinics of physical medicine and rehabilitation and neurology. PARTICIPANTS: Consecutive MS patients scheduled for outpatient follow-up (n = 309). INTERVENTION: MS patients were asked to complete a questionnaire regarding the frequency and severity, as well as the diagnosis and treatment of their overactive bladder problems. RESULTS: The mean age ± SD was 39.3 ± 10.6 years. Urinary urgency was the most common urinary symptom (62%), followed by frequency (50.4%), urge incontinence (44.7%) and nocturia (33%). Residual urine volume was measured using a portable ultrasound instrument in 13.3% of the patients and by catheterization in 16.2% of them. Urodynamic investigations and urinary tract ultrasound were performed on 26.5% and 35.3% of the patients, respectively. Anticholinergic medications were prescribed for 27.5% of the patients. Intermittent catheterization and indwelling catheterization were used on 8.1% and 1.9% of the patients, respectively. The overactive bladder symptom score (OABSS) was significantly higher in patients who had had residual urine measurement (P < 0.001), upper urinary tract assessment by ultrasound (P < 0.001), urodynamic assessment (P < 0.001), admitted to a doctor for urinary symptoms (P < 0.001), and current or past catheter use (P = 0.002). CONCLUSION: Urgency was the most common urinary symptom followed by frequency, urge incontinence and nocturia in MS patients. The patients with lower OABSS had detailed urological assessments less frequently than the patients with higher OABSS.

The Inhibitory Effect of Platelet-Rich Plasma on Botulinum Toxin Type-A: An Experimental Study in Rabbits.

BACKGROUND: Combination treatments of botulinum toxin type-A and other rejuvenation agents or instruments are gradually becoming more popular. After observing a high incidence of therapy failure following simultaneous applications of botulinum toxin type-A and platelet-rich plasma mesotherapy, we aimed to investigate whether PRP has an inhibitory effect on botulinum toxin type-A. METHODS: Twenty-four New Zealand white rabbits were divided into 4 groups, and the anterior auricular muscle and overlying skin were used for injections. Groups I and II both received onabotulinumtoxinA intramuscular injections. In addition, autologous platelet-rich plasma mesotherapy was performed in Group I while Group II received saline mesotherapy. Group III was designed as the in vitro mixture group in which onabotulinumtoxinA and platelet-rich plasma were mixed and then administered intramuscularly. Group IV received saline within the mixture instead of platelet-rich plasma. The contralateral ears of all the rabbits served as control and were only treated with onabotulinumtoxinA. Visual evaluation of ear positions and electroneuromyographic studies were done prior to all procedures and at day 14. Anterior auricular muscles were harvested at day 14 and were evaluated with quantitative real-time PCR. RESULTS: Visual and electroneuromyographic studies revealed less onabotulinumtoxinA activity in Groups I and III. When platelet-rich plasma was administered through skin mesotherapy, onabotulinumtoxinA activity failure was more severe in comparison with direct contact. No significant difference in SNAP-25 mRNA expression through quantitative real-time PCR was observed between groups. CONCLUSION: Although we could not explain the exact mechanism underlying this interaction, platelet-rich plasma applications result in less onabotulinumtoxinA muscle paralysis activity.

Femoral nerve injury following a lumbar plexus blockade.

BACKGROUND: Lumbar plexus blockade (LPB) combined with sciatic nerve block (SNB) is frequently used for lower extremity surgery. Perioperative nerve injury is a rarely encountered complication of peripheral nerve blocks (PNB). CASE REPORT: Here we report a 44-year-old male patient who developed a partial femoral nerve injury (FNI) following a LPB which was performed before the surgery of a patellar fracture. The clinical and electroneuromyographic findings of the patient were recovered almost completely within the following six months. CONCLUSION: The presented case demonstrated a FNI despite the absence of any pain or paresthesia sensation, with the disappearance of motor response under 0.3 mA of neurostimulation in the experienced hands.