Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 29.329
J Bodyw Mov Ther ; 39: 489-495, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38876673


INTRODUCTION: Imaginary exercises seem to be useful therapeutic approaches to modulate neuromuscular functions due to two main reasons: first, this training would not greatly increase body temperature, and secondly, it can positively affect brain-muscle pathways-which are both primary factors should be considered in rehabilitation programs for patients with multiple sclerosis (MS). METHOD: 32 pre-elderly adult females with relapsing-remitting MS (n = 16 - age M (SD): 56.75 (5.07)) and without MS (n = 16 - age M (SD): 56.56 (4.35)) voluntarily recruited. First, they were assigned into two groups: MS patients and healthy controls, to investigate baseline between-group comparison. Then, MS patients were randomly divided into two groups of eight each, designated as experimental and control groups. Recording the nerve conduction velocity (NCV) of tibial nerve and integrated electromyographic muscle activation (IEMG) of gastrocnemius muscle was conducted twice, before and after a six-week mind-body exercise therapy to evaluate its effectiveness on improving neuromuscular function. RESULTS: The results showed significant difference in both tibial NCV (P < 0.001) and IEMG (P = 0.001) variables between non-MS group and MS group. Furthermore, there was a significant main effect of intervention (P = 0.05) and time (P < 0.001) on IEMG in the MS group, while there was no significant effect of intervention (P = 0.18) and time (P = 0.23) on NCV (p = 0.89). CONCLUSION: Neuromuscular dysfunction were apparent in MS patients, and a mind-body therapy of imagery isometric training was found to be useful on improving the neurological deficit in women with MS. TRIAL REGISTRATION NUMBER: UMIN000046935.

Eletromiografia , Terapias Mente-Corpo , Esclerose Múltipla Recidivante-Remitente , Músculo Esquelético , Humanos , Feminino , Pessoa de Meia-Idade , Músculo Esquelético/fisiologia , Músculo Esquelético/fisiopatologia , Esclerose Múltipla Recidivante-Remitente/reabilitação , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Terapias Mente-Corpo/métodos , Condução Nervosa/fisiologia , Nervo Tibial/fisiologia , Pandemias , Adulto
Zhonghua Yi Xue Za Zhi ; 104(21): 1987-1993, 2024 Jun 04.
Artigo em Chinês | MEDLINE | ID: mdl-38825942


Objective: To test the new method of iMAX (the minimum stimulus current that elicits the maximum compound muscle action potential amplitude) electrodiagnosis, verify the feasibility of this method in evaluating the excitability of peripheral motor axons, and preliminarily explore the clinical application value. Methods: This study was a cross-sectional study. A total of 50 healthy subjects were recruited from the outpatient department of Peking University Third Hospital from June 2022 to March 2023, including 25 males and 25 females, aged 25-68 (48±8) years. Eleven patients with Charcot-Marie-Pain-1A (CMT1A), 7 males and 4 females, aged 19-55 (41±13) years and 21 patients with diabetic peripheral neuropathy (DPN), 10 males and 11 females, aged 28-79 (53±16) years were enrolled in this study. iMAX of bilateral median nerves, ulnar nerves and peroneal nerves were detected in all patients. Repeatable motor responses with minimum motor threshold and amplitude of at least 0.1 mV and the minimum stimulus current intensity, at which the maximum compound muscle action potential amplitude is elicited, were measured respectively [1 mA increment is called (iUP) and, 0.1 mA adjustment is called (iMAX)].Comparison of the parameters: the parameters of threshold, iUP and iMAX were compared among different age groups, genders and sides, body mass index(BMI) values and detection time , as well as between CMT1A patients, DPN patients and healthy subjects. Results: In healthy subjects, the threshold, iUP value and iMAX value were (1.8±0.7) mA, (4.4±1.2) mA, and (4.2±1.3) mA respectively; ulnar nerve (3.1±1.6) mA, (6.8±3.2) mA, (6.4±3.2) mA; peroneal nerve (3.7±2.0) mA, (7.8±2.8) mA, (7.4±2.9) mA. There were statistically significant differences in threshold, iUP value and iMAX value among different age groups (all P<0.001).With the increase of age, there was a trend of increasing threshold, iUP, and iMAX values in different nerves, and the differences are statistically significant (all P<0.001). There were no significant differences in gender, side and detection time threshold, iUP value and iMAX value (all P>0.05). The parameters of healthy subjects with high BMI value were higher than those of healthy subjects with low BMI value(all P<0.05). Compared with the healthy subjects, the parameters of 11 CMT1A patients were significantly increased (all P<0.05), and the parameters of 21 DPN patients were slightly increased (P<0.05). Conclusion: The new iMAX method reflects the excitability of motor axons and early axonal dysfunction, which is an important supplement to the traditional nerve conduction, and can be used to monitor motor axon excitability disorders.

Potenciais de Ação , Eletrodiagnóstico , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Estudos Transversais , Idoso , Eletrodiagnóstico/métodos , Neurônios Motores/fisiologia , Nervo Mediano/fisiopatologia , Condução Nervosa , Nervo Ulnar , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/fisiopatologia , Nervos Periféricos/fisiopatologia , Estimulação Elétrica , Eletromiografia
BMC Musculoskelet Disord ; 25(1): 463, 2024 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-38872094


BACKGROUND: Double crush syndrome refers to a nerve in the proximal region being compressed, affecting its proximal segment. Instances of this syndrome involving ulnar and cubital canals during ulnar neuropathy are rare. Diagnosis solely through clinical examination is challenging. Although electromyography (EMG) and nerve conduction studies (NCS) can confirm neuropathy, they do not incorporate inching tests at the wrist, hindering diagnosis confirmation. We recently encountered eight cases of suspected double compression of ulnar nerve, reporting these cases along with a literature review. METHODS: The study included 5 males and 2 females, averaging 45.6 years old. Among them, 4 had trauma history, and preoperative McGowan stages varied. Ulnar neuropathy was confirmed in 7 cases at both cubital and ulnar canal locations. Surgery was performed for 4 cases, while conservative treatment continued for 3 cases. RESULTS: In 4 cases with wrist involvement, 2 showed ulnar nerve compression by a fibrous band, and 1 had nodular hyperplasia. Another case displayed ulnar nerve swelling with muscle covering. Among the 4 surgery cases, 2 improved from preoperative McGowan stage IIB to postoperative stage 0, with significant improvement in subjective satisfaction. The remaining 2 cases improved from stage IIB to IIA, respectively, with moderate improvement in subjective satisfaction. In the 3 cases receiving conservative treatment, satisfaction was significant in 1 case and moderate in 2 cases. Overall, there was improvement in hand function across all 7 cases. CONCLUSION: Typical outpatient examinations make it difficult to clearly differentiate the two sites, and EMG tests may not confirm diagnosis. Therefore, if a surgeon lacks suspicion of this condition, diagnosis becomes even more challenging. In cases with less than expected postoperative improvement in clinical symptoms of cubital tunnel syndrome, consideration of double crush syndrome is warranted. Additional tests and detailed EMG tests, including inching tests at the wrist, may be necessary. We aim to raise awareness double crush syndrome with ulnar nerve, reporting a total of 7 cases to support this concept.

Eletromiografia , Síndromes de Compressão do Nervo Ulnar , Nervo Ulnar , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Síndromes de Compressão do Nervo Ulnar/cirurgia , Síndromes de Compressão do Nervo Ulnar/diagnóstico , Síndromes de Compressão do Nervo Ulnar/etiologia , Síndromes de Compressão do Nervo Ulnar/fisiopatologia , Nervo Ulnar/cirurgia , Nervo Ulnar/fisiopatologia , Síndrome de Esmagamento/cirurgia , Síndrome de Esmagamento/diagnóstico , Síndrome de Esmagamento/complicações , Síndrome de Esmagamento/fisiopatologia , Punho/inervação , Condução Nervosa/fisiologia , Cotovelo/inervação , Cotovelo/cirurgia , Resultado do Tratamento , Idoso
Clinics (Sao Paulo) ; 79: 100392, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38908048


BACKGROUND: This study explored the correlation between pancreatic islet α cell function, as reflected by the plasma glucagon levels, and Diabetic Peripheral Neuropathy (DPN) in patients with Type 2 Diabetes Mellitus (T2DM). METHODS: A total of 358 patients with T2DM were retrospectively enrolled in this study and divided into the Non-DPN (NDPN) group (n = 220) and the DPN group (n = 138). All patients underwent an oral glucose tolerance test to detect levels of blood glucose, insulin and glucagon, and the Area Under the Curve (AUC) for Glucagon (AUCglu) was used to estimate the overall glucagon level. The Peripheral Nerve Conduction Velocity (PNCV), Amplitude (PNCA) and Latency (PNCL) were obtained with electromyography, and their Z scores were calculated. RESULTS: There were significant differences regarding the age, disease duration, serum levels of alanine aminotransferase, aspartate aminotransferase, urea nitrogen, high-density lipoprotein, and 2h-C peptide between these two groups (p < 0.05). The NDPN group had higher glucagon levels at 30, 60 and 120 min and AUCglu (p < 0.05). The Z-scores of PNCV and PNCA showed an increasing trend (p < 0.05), while the Z-score of PNCL showed a decreasing trend (p < 0.05). The glucagon levels were positively correlated with PNCV and PNCA, but negatively correlated with PNCL, with Gluca30min having the strongest correlation (p < 0.05). Gluca30min was independently related to PNCV, PNCL, PNCA and DPN, respectively (p < 0.05). The function of pancreatic α islet cells, as reflected by the plasma glucagon level, is closely related to the occurrence of DPN in T2DM patients. CONCLUSION: Gluca30min may be a potentially valuable independent predictor for the occurrence of DPN.

Glicemia , Diabetes Mellitus Tipo 2 , Neuropatias Diabéticas , Glucagon , Teste de Tolerância a Glucose , Condução Nervosa , Humanos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/fisiopatologia , Masculino , Pessoa de Meia-Idade , Feminino , Neuropatias Diabéticas/sangue , Neuropatias Diabéticas/fisiopatologia , Neuropatias Diabéticas/etiologia , Glucagon/sangue , Estudos Retrospectivos , Glicemia/análise , Condução Nervosa/fisiologia , Idoso , Adulto , Eletromiografia , Células Secretoras de Glucagon , Insulina/sangue , Área Sob a Curva , Fatores de Tempo , Valores de Referência
J Clin Neurophysiol ; 41(5): 473-477, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38922289


PURPOSE: The corpus callosum is crucial for interhemispheric interactions in the motor control of limb functions. Human and animal studies suggested spinal cord pathologies may induce cortical reorganization in sensorimotor areas. We investigate participation of the corpus callosum in executions of a simple motor task in patients with cervical spondylotic myelopathy (CSM) using transcranial magnetic stimulation. METHODS: Twenty patients with CSM with various MRI grades of severity of cord compression were compared with 19 normal controls. Ipsilateral silent period, contralateral silent period, central motor conduction time, and transcallosal conduction time (TCT) were determined. RESULTS: In both upper and lower limbs, TCTs were significantly increased for patients with CSM than normal controls ( p < 0.001 for all), without side-to-side differences. Ipsilateral silent period and contralateral silent period durations were significantly increased bilaterally for upper limbs in comparison to controls ( p < 0.01 for all), without side-to-side differences. There were no significant correlations of TCT with central motor conduction time nor severity of CSM for both upper and lower limbs ( p > 0.05 for all) bilaterally. CONCLUSIONS: Previous transcranial magnetic stimulation studies show increased motor cortex excitability in CSM; hence, increased TCTs observed bilaterally may be a compensatory mechanism for effective unidirectional and uniplanar execution of muscle activation in the distal limb muscles. Lack of correlation of TCTs with severity of CSM or central motor conduction time may be in keeping with a preexistent role of the corpus callosum as a predominantly inhibitory pathway for counteracting redundant movements resulting from increased motor cortex excitability occurring after spinal cord lesions.

Corpo Caloso , Potencial Evocado Motor , Espondilose , Estimulação Magnética Transcraniana , Humanos , Corpo Caloso/fisiopatologia , Corpo Caloso/diagnóstico por imagem , Masculino , Feminino , Pessoa de Meia-Idade , Espondilose/fisiopatologia , Potencial Evocado Motor/fisiologia , Adulto , Idoso , Vértebras Cervicais/fisiopatologia , Condução Nervosa/fisiologia , Doenças da Medula Espinal/fisiopatologia , Doenças da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/fisiopatologia
Ideggyogy Sz ; 77(5-6): 161-166, 2024 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-38829252


Background and purpose:

The aim of this study is to comprehensively determine the types of affected fibers in Parkinson’s disease (PD) patients by employing nerve conduction studies (NCS), sympathetic skin response (SSR) examinations, and current perception threshold (CPT) testing and to analyze the correlation between levodopa use and nerve involvement.

. Methods:

This retrospective study included 36 clinically diagnosed PD patients who were recruited between January 2018 and April 2019. All patients underwent NCS, SSR testing, and CPT sensory examinations. Additionally, the PD patients were assessed for disease staging using the Hoehn and Yahr (H-Y) scale. 

. Results:

Fifteen patients were included in the tremor-dominant subtype, ten patients in the rigid-dominant subtype, and eleven patients in the mixed subtype. Eleven patients were using levodopa, while twenty-five patients had never used any anti-Parkinson’s medication. Ten patients (28%) showed abnormal sympathetic skin responses (SSR). The CPT examination revealed sensory abnormalities in twenty-four patients (67%), with eighteen patients (75%) experiencing sensory hypersensitivity and six patients (25%) experiencing sensory hypoesthesia. Twelve patients (33%) had normal CPT results. Among the patients with abnormal CPT findings, seven cases (29%) involved large myelinated fiber damage, twenty-two cases (92%) involved small myelinated fiber damage, and nineteen cases (79%) involved unmyelinated fiber damage. The rate of sensory abnormalities was 64% (7/11) in the levodopa group and 68% (17/25) in the non-levodopa group, with no statistically significant difference between the two groups. 

. Conclusion:

The incidence of abnormal CPT findings in PD patients was higher than that of abnormal SSR responses, suggesting that nerve fiber damage primarily affects small fiber nerves (SFN).


Levodopa , Condução Nervosa , Doença de Parkinson , Humanos , Levodopa/administração & dosagem , Levodopa/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/fisiopatologia , Doença de Parkinson/complicações , Pessoa de Meia-Idade , Feminino , Idoso , Estudos Retrospectivos , Masculino , Condução Nervosa/efeitos dos fármacos , Fibras Nervosas/patologia , Fibras Nervosas/efeitos dos fármacos , Antiparkinsonianos/uso terapêutico , Antiparkinsonianos/efeitos adversos , Nervos Periféricos/patologia
Sci Rep ; 14(1): 13816, 2024 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-38879579


Creatine kinase (CK) has been associated with neuropathy, but the mechanisms are uncertain. We hypothesized that peripheral nerve function is impaired in subjects with persistent CK elevation (hyperCKemia) compared to age- and sex matched controls in a general population. The participants were recruited from the population based Tromsø study in Norway. Neuropathy impairment score (NIS), nerve conduction studies (NCS) and electromyography (EMG) in subjects with persistent hyperCKemia (n = 113; 51 men, 62 women) and controls (n = 128; 61 men, 67 women) were performed. The hyperCKemia group had higher NIS score than the controls (p = 0.050). NCS of the tibial nerve showed decreased compound motor action potential amplitude (p < 0.001), decreased motor conduction velocity (p < 0.001) and increased F-wave latency (p = 0.044). Also, reduced sensory amplitudes of the median, ulnar, and sural nerves were found. EMG showed significantly increased average motor unit potential amplitude in all examined muscles. CK correlated positively with glycated hemoglobin and non-fasting glucose in the hyperCKemia group, although not when controlled for covariates. The length dependent polyneuropathy demonstrated in the hyperCKemia group is unexplained, but CK leakage and involvement of glucose metabolism are speculated on.

Creatina Quinase , Eletromiografia , Condução Nervosa , Polineuropatias , Humanos , Masculino , Feminino , Creatina Quinase/sangue , Polineuropatias/sangue , Estudos de Casos e Controles , Idoso , Pessoa de Meia-Idade , Noruega
J Clin Neurosci ; 125: 76-82, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38759351


BACKGROUND: Intravenous immunoglobulin (IVIg) and plasmapheresis (PLEX) are recommended in moderate to severe Guillain-Barré Syndrome (GBS), but there is paucity of studies evaluating its effect on nerve conduction studies (NCS). We report the effect of IVIg and PLEX on the NCS parameters and clinical outcomes compared to natural course (NC) of GBS patients. METHOD: Moderate to severe GBS patients were included based on clinical, cerebrospinal fluid, and NCS finding. Six motor and sensory nerves were evaluated at admission, one month and 3 months, and NCS subtyping was done. Axonal and demyelination burden in motor nerves and early reversible conduction block (ERCB) were noted. Patients receiving IVIg, PLEX or on NC were noted. Outcome was defined at 3 months into complete, partial and poor using a 0-6 GBS Disability Scale (GBSDS). RESULT: Seventy-two patients were included, whose median age was 36 years and 22(30.6 %) were females. 44 patients received IVIg, 9 PLEX and 19 were in NC, and they had comparable peak disability. AIDP was the dominant subtype at admission (58.3 %), which remained so at 3 months (50 %). The shift of subtypes was the highest from the equivocal group followed by AMAN and the least from AIDP. IVIg and PLEX group had more reduction in axonal burden and had ERCB compared to NC. 33(44 %) patients had complete recovery, and 40(55.5 %) patients had concordance in clinical and neurophysiological outcome. CONCLUSION: Transition of GBS subtype may occur at follow-up from all the subtypes, the highest from the equivocal and the lowest from the AIDP group. IVIg/PLEX treatment may help in reducing conduction block and axonal burden.

Síndrome de Guillain-Barré , Imunoglobulinas Intravenosas , Condução Nervosa , Plasmaferese , Humanos , Síndrome de Guillain-Barré/terapia , Síndrome de Guillain-Barré/fisiopatologia , Imunoglobulinas Intravenosas/uso terapêutico , Imunoglobulinas Intravenosas/administração & dosagem , Feminino , Masculino , Adulto , Plasmaferese/métodos , Condução Nervosa/fisiologia , Condução Nervosa/efeitos dos fármacos , Pessoa de Meia-Idade , Adulto Jovem , Resultado do Tratamento , Fatores Imunológicos/uso terapêutico , Fatores Imunológicos/administração & dosagem , Adolescente
J Occup Health ; 66(1)2024 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-38710168


OBJECTIVES: To compare the effects of 1-hour computer use on ulnar and median nerve conduction velocity and muscle activity in office workers with symptomatic neck pain and asymptomatic office workers. METHODS: A total of 40 participants, both male and female office workers, with symptomatic neck pain (n = 20) and asymptomatic (n = 20), were recruited. Pain intensity, ulnar nerve conduction velocity, median nerve conduction velocity, and muscle activity were determined before and after 1 hour of computer use. RESULTS: There was a significant increase in pain intensity in the neck area in both groups (P < .001). The symptomatic neck pain group revealed a significant decrease in the sensory nerve conduction velocity of the ulnar nerve (P = .008), whereas there was no difference in the median nerve conduction velocity (P > .05). Comparing before and after computer use, the symptomatic neck pain group had less activity of the semispinalis muscles and higher activity of the anterior scalene muscle than the asymptomatic group (P < .05). The trapezius and wrist extensor muscles showed no significant differences in either group (P > .05). CONCLUSIONS: This study found signs of neuromuscular deficit of the ulnar nerve, semispinalis muscle, and anterior scalene muscle after 1 hour of computer use among office workers with symptomatic neck pain, which may indicate the risk of neuromuscular impairment of the upper extremities. The recommendation of resting, and encouraging function and flexibility of the neuromuscular system after 1 hour of computer use should be considered.

Nervo Mediano , Cervicalgia , Condução Nervosa , Doenças Profissionais , Nervo Ulnar , Humanos , Masculino , Feminino , Adulto , Condução Nervosa/fisiologia , Cervicalgia/fisiopatologia , Doenças Profissionais/fisiopatologia , Eletromiografia , Computadores , Pessoa de Meia-Idade , Músculo Esquelético , Fatores de Tempo
Handb Clin Neurol ; 201: 43-59, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38697746


Electrodiagnostic (EDX) testing plays an important role in confirming a mononeuropathy, localizing the site of nerve injury, defining the pathophysiology, and assessing the severity and prognosis. The combination of nerve conduction studies (NCS) and needle electromyography findings provides the necessary information to fully assess a nerve. The pattern of NCS abnormalities reflects the underlying pathophysiology, with focal slowing or conduction block in neuropraxic injuries and reduced amplitudes in axonotmetic injuries. Needle electromyography findings, including spontaneous activity and voluntary motor unit potential changes, complement the NCS findings and further characterize chronicity and degree of axon loss and reinnervation. EDX is used as an objective marker to follow the progression of a mononeuropathy over time.

Eletrodiagnóstico , Condução Nervosa , Humanos , Eletrodiagnóstico/métodos , Condução Nervosa/fisiologia , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/fisiopatologia , Eletromiografia/métodos
J Basic Clin Physiol Pharmacol ; 35(3): 189-198, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38804046


OBJECTIVES: The main objective of the current study was to find the association between oxidative stress, inflammatory markers, and electrophysiological profile with symptom severity in patients of carpal tunnel syndrome (CTS). METHODS: Thirty-two carpal tunnel syndrome patients and 32 controls were included in the study. Boston CTS questionnaire along with plasma oxidative stress markers including superoxide dismutase, malondialdehyde, and nitric oxide and inflammatory markers including IL-6 and TNF-α were compared with the electrophysiological parameters derived from nerve conduction studies. Statistical significance of the levels between groups was calculated using unpaired-t test after checking for normality with D'Agostino & Pearson omnibus normality test. RESULTS: We found that the median nerve conduction velocity was prolonged, amplitude was decreased, while the levels of oxidative stress markers like malondialdehyde (MDA), superoxidase dismutase (SOD), and nitric oxide (NO) were increased in CTS patients compared to controls. Inflammatory markers like interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were also increased in CTS patients. We found that plasma SOD and TNF-α correlated well with the median motor amplitude. There was no other significant correlation between oxidative stress markers and inflammatory markers with nerve conduction studies or disease severity. Patients with mild disease also showed lesser levels of SOD, NO, IL-6, and TNF-α markers than patients with severe disease. CONCLUSIONS: CTS is probably a disease of sterile inflammation and disbalance of oxidative stress, with higher inflammatory and oxidative stress markers pointing to a more severe disease.

Síndrome do Túnel Carpal , Inflamação , Interleucina-6 , Condução Nervosa , Óxido Nítrico , Estresse Oxidativo , Superóxido Dismutase , Fator de Necrose Tumoral alfa , Humanos , Síndrome do Túnel Carpal/sangue , Síndrome do Túnel Carpal/fisiopatologia , Síndrome do Túnel Carpal/metabolismo , Estresse Oxidativo/fisiologia , Feminino , Masculino , Inflamação/metabolismo , Inflamação/sangue , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Adulto , Óxido Nítrico/sangue , Óxido Nítrico/metabolismo , Superóxido Dismutase/sangue , Fator de Necrose Tumoral alfa/sangue , Interleucina-6/sangue , Biomarcadores/sangue , Malondialdeído/sangue , Nervo Mediano/fisiopatologia , Estudos de Casos e Controles
J Neuroimaging ; 34(4): 486-492, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38764165


BACKGROUND AND PURPOSE: Uremic neuropathy (UN) is a disabling neuropathy in end-stage kidney disease (ESKD) affecting the majority of patients receiving long-term hemodialysis (HD). One previous nerve ultrasound study reported an increased cross-sectional area (CSA) of the median nerve in moderate UN, while another study found enlarged sural nerves in small-fiber polyneuropathy associated with ESKD. The present cohort study aims to analyze bilateral CSA of multiple nerves in UN. METHODS: Ten nondiabetic ESKD patients with UN on HD for at least 2 years and 10 healthy age-matched controls underwent bilateral ultrasound examinations with CSA measurements in 13 arm and leg nerve sites. Nerve conduction studies (NCS) and the total neuropathy score (TNS) were recorded. Pearson's coefficient and the Mann-Whitney U-test were used to analyze correlations and compare groups. RESULTS: ESKD patients presented advanced neuropathic symptoms (mean TNS 15.9). NCS showed significantly reduced motor and sensory amplitudes in the UN group compared to the control group, and a slightly reduced nerve CSA was observed in 5 of 13 nerve sites (p < .05); the other nerve sites were not enlarged. Sural nerve CSA (p < .05) and sensory amplitude (p < .01) were negatively correlated with the TNS. CONCLUSIONS: Nerve enlargement was not observed in the present study in advanced UN. A reduced nerve CSA observed in the sural nerve suggests an axonal loss associated with long-term HD in ESKD. During clinical workup of an acute disease of the peripheral nervous system in ESKD patients, nerve enlargement might be attributable to other causes than chronic UN.

Falência Renal Crônica , Ultrassonografia , Uremia , Humanos , Masculino , Feminino , Projetos Piloto , Pessoa de Meia-Idade , Uremia/complicações , Uremia/diagnóstico por imagem , Falência Renal Crônica/complicações , Falência Renal Crônica/diagnóstico por imagem , Falência Renal Crônica/terapia , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Idoso , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Nervo Sural/diagnóstico por imagem , Condução Nervosa
J Peripher Nerv Syst ; 29(2): 252-261, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38772556


BACKGROUND AND AIM: Recreational use of nitrous oxide (N2O) has been associated with the development of severe nitrous oxide-induced neuropathy (N2On). Follow-up of these patients poses challenges, and their clinical progression remains largely unknown. The identification of prognostic factors is made difficult by the lack of standardized longitudinal assessments in most studies. The objective was to document the course of neuropathy through systematic follow-up assessments in N2On patients to identify prognostic factors for persistent disability after 6 months. METHODS: We gathered demographic, clinical, biological, and electrophysiological data from N2On patients hospitalized in the Referral center in Marseille, both at baseline and during a standardized follow-up assessment at 6 months. RESULTS: We retrospectively included 26 N2On patients (mean age 22.6 ± 4.4). Significant improvements were observed in all main clinical scores including Rankin, ONLS, and MRC testing (p < .01). Electrophysiological studies (EDX) revealed a predominantly motor neuropathy with marked reduction in CMAP in the lower limbs at baseline, and no significant improvement in motor parameters (p = .543). Rankin score at 6 months correlated with the initial weekly N2O consumption (r = .43, p = .03) and the CMAP sum score in the lower limbs at the first EDX (r = -.47, p = .02). Patients with and without myelitis showed similar Rankin and ONLS score after 6 months. INTERPRETATION: The clinical course generally improved favorably at 6 months with notable amelioration in the primary disability scores, sensory deficits, and ataxia. However, distal motor impairment associated with peripheral neuropathy persisted, with distal axonal loss emerging as the main prognostic factor for long-term disability in these young patients.

Óxido Nitroso , Doenças do Sistema Nervoso Periférico , Humanos , Óxido Nitroso/efeitos adversos , Óxido Nitroso/administração & dosagem , Masculino , Feminino , Adulto , Adulto Jovem , Estudos Retrospectivos , Prognóstico , Estudos Longitudinais , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doenças do Sistema Nervoso Periférico/fisiopatologia , Doenças do Sistema Nervoso Periférico/diagnóstico , Seguimentos , Adolescente , Condução Nervosa/fisiologia , Condução Nervosa/efeitos dos fármacos
Orphanet J Rare Dis ; 19(1): 217, 2024 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-38790028


BACKGROUND: To investigate the peripheral nervous system involvement in S sialidosis with typical features of myoclonus, seizure, and giant waves in somatosensory evoked potentials suggesting hyperexcitability in the central nervous system. METHODS: The clinical presentation of patients with genetically confirmed sialidosis was recorded. Neurophysiological studies, including nerve conduction studies (NCSs), F-wave studies, and needle electromyography (EMG), were performed on these patients. RESULTS: Six patients (M/F: 2:4) were recruited. In addition to the classical presentation, intermittent painful paresthesia was noted in four patients, and three of whom reported it as the earliest symptom. In the NCSs, one patient had reduced compound muscle action potential amplitudes in the right ulnar nerve, while another patient had prolonged distal motor latency in the bilateral tibial and peroneal nerves. Prolonged F-wave latency (83.3%), repeater F-waves (50%), and neurogenic polyphasic waves in EMG (in 2 out of 3 examined patients) were also noted. Interestingly, a very late response was noted in the F-wave study of all patients, probably indicating lesions involving the proximal peripheral nerve or spinal cord. CONCLUSION: In addition to the central nervous system, the peripheral nervous system is also involved in sialidosis, with corresponding clinical symptoms. Further study on these phenomena is indicated.

Eletromiografia , Mucolipidoses , Humanos , Masculino , Feminino , Adulto , Mucolipidoses/fisiopatologia , Condução Nervosa/fisiologia , Adulto Jovem , Nervos Periféricos/fisiopatologia , Nervos Periféricos/patologia , Adolescente , Sistema Nervoso Periférico/fisiopatologia , Potenciais Somatossensoriais Evocados/fisiologia , Pessoa de Meia-Idade , Criança
Muscle Nerve ; 70(1): 101-110, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38698725


INTRODUCTION/AIMS: Whole-body magnetic resonance neurography (MRN) is an imaging modality that shows peripheral nerve signal change in patients with chronic inflammatory demyelinating polyneuropathy (CIDP). We aimed to explore the diagnostic potential of whole-body MRN and its potential as a monitoring tool after immunotherapy in treatment-naïve CIDP patients. METHODS: Whole-body MRN using coronal 3-dimensional short tau inversion recovery (STIR) sampling perfection with application-optimized contrasts by using different flip angle evolution (SPACE) techniques was performed in patients being investigated for CIDP and in healthy controls. Baseline clinical neuropathy scales and electrophysiologic parameters were collected, and MRN findings were compared before and after CIDP treatment. RESULTS: We found highly concordant symmetrical thickening and increased T2 signal intensities in the brachial/lumbosacral plexus, femoral, or sciatic nerves in five of the eight patients with a final diagnosis of CIDP and none of the healthy controls. There were no treatment-related imaging changes in five patients with CIDP who completed a follow-up study. Diffuse, symmetrical thickening, and increased T2 signal in root, plexus, and peripheral nerves were found in two patients ultimately excluded due to a diagnosis of polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes (POEMS) syndrome in addition to signal changes in the muscles, bony lesions, organomegaly, and lymphadenopathy. DISCUSSION: Whole-body MRN imaging shows promise in detecting abnormalities in proximal nerve segments in patients with CIDP. Future studies evaluating the role of MRN in assessing treatment response should consider follow-up scans after treatment durations of more than 4 months.

Imageamento por Ressonância Magnética , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica , Imagem Corporal Total , Humanos , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico por imagem , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/fisiopatologia , Masculino , Feminino , Pessoa de Meia-Idade , Imageamento por Ressonância Magnética/métodos , Idoso , Imagem Corporal Total/métodos , Adulto , Nervos Periféricos/diagnóstico por imagem , Condução Nervosa/fisiologia
Muscle Nerve ; 70(1): 111-119, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38717235


INTRODUCTION/AIMS: Electrodiagnostic examinations, such as nerve conduction studies (NCS) and needle electromyography (EMG), are perceived as painful by children and their parents/guardians. Methods to reduce peri-procedural pain improve compliance and have neurocognitive and neuropsychiatric benefits. This study aimed to assess the efficacy of combined oral and topical analgesics (COTA), oral analgesics (OA), and placebo in reducing pain during NCS/EMG in children. METHODS: We performed a double-blind, randomized, placebo-controlled trial on children presenting to our neurophysiology lab. Patients were stratified into two age groups (6M-6Y and 7Y-18Y) and randomized into three arms: COTA, OA, and placebo. Pain scores post-NCS/EMG were assessed using the Modified Behavioral Pain Scale (MBPS) and Faces Pain Scale-Revised (FPS-R). RESULTS: One hundred thirteen participants were enrolled. A comparison of participants from both age groups combined revealed no significant differences in guardian FPS-R scores across all arms for NCS and EMG. A significant difference in the distribution of post-NCS FPS-R score severities in children aged 7Y-18Y was noted between OA and placebo (p = .007). EMG was more painful than NCS across all arms (p < .05). In children aged 6M-6Y undergoing at least 10 muscle samplings during EMG, those receiving COTA had significantly lower pain scores (p = .014). DISCUSSION: This study reveals the complexity of pediatric pain perception during NCS/EMG and highlights that other methods to reduce experienced pain are required. Our findings suggest that procedural characteristics, such as number of muscles sampled, may influence the effectiveness of analgesia and serve as a foundation for future research aimed at optimizing pain management strategies.

Administração Tópica , Eletromiografia , Medição da Dor , Humanos , Criança , Masculino , Feminino , Adolescente , Método Duplo-Cego , Administração Oral , Pré-Escolar , Medição da Dor/métodos , Analgésicos/administração & dosagem , Analgesia/métodos , Eletrodiagnóstico/métodos , Condução Nervosa/efeitos dos fármacos , Condução Nervosa/fisiologia , Dor/tratamento farmacológico , Dor/diagnóstico
J Clin Neuromuscul Dis ; 25(4): 171-177, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38771226


OBJECTIVES: Small fiber neuropathy presents a significant diagnostic and therapeutic challenge. To solve this challenge, efforts have been made to identify autoantibodies associated with this condition. Previous literature has often considered tri-sulfated heparin disaccharide (TS-HDS) and fibroblast growth factor receptor 3 (FGFR3) as a singular seropositive group and/or focused primarily on symptomatic associations. METHODS: One hundred seventy-two small fiber neuropathy patients with a Washington University Sensory Neuropathy panel were selected for TS-HDS seropositivity, FGFR-3 seropositivity, and seronegative controls. Data were collected to on the demographic, symptomatic, and laboratory profiles of each subgroup. RESULTS: Percent female (P = 0.0043), frequency of neuropathic pain symptoms (P = 0.0074), and erythrocyte sedimentation rate (P = 0.0293), vitamin D (P < 0.0001), and vitamin B12 (P = 0.0033) differed between the groups. Skin biopsy was more frequently normal within both the FGFR-3 and the TS-HDS cohort (P = 0.0253). CONCLUSIONS: TS-HDS and FGFR-3 display a distinct phenotype from both controls and one another. Immunoglobulin M (IgM) against FGFR-3 and IgM against TS-HDS may be individually valuable markers for the development of distinct clinical phenotypes.

Autoanticorpos , Condução Nervosa , Receptor Tipo 3 de Fator de Crescimento de Fibroblastos , Neuropatia de Pequenas Fibras , Humanos , Feminino , Neuropatia de Pequenas Fibras/diagnóstico , Pessoa de Meia-Idade , Masculino , Condução Nervosa/fisiologia , Idoso , Adulto , Autoanticorpos/sangue , Heparina/análogos & derivados , Imunoglobulina M/sangue , Heparitina Sulfato/sangue , Estudos de Condução Nervosa , Dissacarídeos
BMC Vet Res ; 20(1): 201, 2024 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-38750534


BACKGROUND: To determine whether sensory nerve conduction stimulus threshold measurements of the infraorbital nerve are able to differentiate horses with idiopathic trigeminal-mediated headshaking (i-TMHS) from healthy horses and from horses with secondary trigeminal-mediated headshaking (s-TMHS). In a prospective trial, headshaking horses were examined using a standardized diagnostic protocol, including advanced diagnostics such as computed tomography and 3-Tesla-magnetic resonance imaging (MRI), to differentiate s-TMHS from i-TMHS. Clinically healthy horses served as controls. Within this process, patients underwent general anesthesia, and the minimal sensory nerve conduction stimulus threshold (SNCT) of the infraorbital nerve was measured using a bipolar concentric needle electrode. Sensory nerve action potentials (SNAP) were assessed in 2.5-5 mA intervals. Minimal SNCT as well as additional measurements were calculated. RESULTS: In 60 horses, SNAP could be recorded, of which 43 horses had i-TMHS, six had suspected s-TMHS, three horses had non-facial headshaking, and eight healthy horses served as controls. Controls had a minimal SNCT ≥ 15 mA, whereas 14/43 horses with i-TMHS and 2/6 horses with s-TMHS showed a minimal SNCT ≤ 10 mA. Minimal SNCT ≤ 10 mA showed 100% specificity to distinguish TMHS from controls, but the sensitivity was only 41%. CONCLUSION: A minimal SNCT of the infraorbital nerve ≤ 10 mA was able to differentiate healthy horses from horses with TMHS. Nevertheless, a higher minimal SNCT did not exclude i-TMHS or s-TMHS and minimal SNCT does not distinguish s-TMHS from i-TMHS.

Doenças dos Cavalos , Condução Nervosa , Animais , Cavalos , Doenças dos Cavalos/diagnóstico , Feminino , Masculino , Condução Nervosa/fisiologia , Cabeça , Estudos Prospectivos , Nervo Trigêmeo/fisiologia
Brain Nerve ; 76(5): 449-462, 2024 May.
Artigo em Japonês | MEDLINE | ID: mdl-38741483


Electrophysiologic testing plays an important role in evaluating peripheral nerve, muscle, and neuromuscular junction diseases, aiding in diagnosis and treatment strategies by offering real-time assessment. Demyelination of peripheral nerves results in increased conduction delay, temporal dispersion, conduction block, and stimulation threshold. The localization or diffusion of these changes is crucial in understanding disease pathogenesis, necessitating stimulation at multiple points along nerve pathways. When axonal degeneration occurs, the amplitude is reduced, with mild conduction delay. Acute axonal degeneration may require 1 week to develop into Wallerian degeneration. During this time, conductivity was preserved in the nerve peripheral to the lesion. When MG or LEMS is suspected, repetitive nerve stimulation tests and single-fiber EMG are valuable for the diagnosis and pathophysiological evaluation. Notably, the latter is highly sensitive but not specific. Needle electromyography (EMG) assists in differentiating between myopathies and neurogenic diseases, and in determining whether the patient is in an acute or chronic stage. Integration of these tests contribute to an accurate diagnosis when considering the presenting symptoms.

Eletromiografia , Doenças Neuromusculares , Humanos , Doenças Neuromusculares/diagnóstico , Doenças Neuromusculares/fisiopatologia , Condução Nervosa/fisiologia