RESUMO
BACKGROUND: Electrophysiologic (EDX) study is the most valuable method in grading the severity of carpal tunnel syndrome (CTS), but it is invasive and painful. We evaluated the efficacy of ultrasound for this purpose. MATERIALS AND METHODS: Eighty-one wrists of 52 consecutive patients with clinical evidences of CTS, confirmed and graded by EDX as mild, moderate, and severe, were examined by ultrasonography. Cross-sectional area (CSA) of the median nerve was measured at the distal wrist (CSA-D), and proximal forearm (CSA-P), and wrist-to-forearm ratio (WFR) was calculated for each hand. RESULTS: The mean CSA-D was 0.12 cm(2) ± 0.03, 0.15 cm(2) ± 0.03 and 0.19 cm(2) ± 0.06 and the mean WFR was 2.77 ± 1.14, 3.07 ± 1.07 and 4.07 ± 1.61 in mild, moderate and severe groups respectively. WFR showed significant differences between the severe and none severe CTS groups (P < 0.001), but there was no significant difference between mild and moderate CTS groups (P < 0.381). CSA-D showed a significant difference between all groups (P < 0.0001). In the Receiver Operating Characteristic curve analysis, the optimal cut-off value of the CSA-D and WFR for detecting severe CTS were 0.15 (area under the curve 0.784, 95% confidence interval (CI): 0.662-0.898, P < 0.001, sensitivity of 68.2% and specificity of 70.9%) and 3 (area under the curve 0.714, 95% CI: 0.585-0.84, P = 0.001, sensitivity of 68.2% and specificity of 64.8%) respectively. All values were superior in CSA-D. CONCLUSION: Ultrasonography, can be complementary but not conclusive to the classification of CTS severities. CSA-D and WFR both increased in proportion to CTS severity, but neither parameter exhibited excellent performance in grading the severities.
RESUMO
BACKGROUND: We investigated the utility of epilepsy surgery and postoperative outcome in patients with lesional epilepsy in Iran, a relatively resource-poor setting. METHODS: This prospective longitudinal study was conducted during 2007-2017 in Kashani Comprehensive Epilepsy Center, Isfahan, Iran. Patients with a diagnosis of intractable focal epilepsy, with MRI lesions, who underwent epilepsy surgery and were followed up ≥ 24 months, were included and evaluated for postoperative outcome. RESULTS: A total of 214 patients, with a mean age of 26.90 ± 9.82 years (59.8% men) were studied. Complex partial seizure was the most common type of seizure (85.9%), and 54.2% of the cases had auras. Temporal lobe lesions (75.2%) and mesial temporal sclerosis (48.1%) were the most frequent etiologies. With a mean follow-up of 62.17 ± 19.33 months, 81.8% of patients became seizure-free postoperatively. Anticonvulsants were reduced in 86% of the cases and discontinued in 40.7%. In keeping with previous studies, we found that seizure freedom rates were lower among patients with longer follow-up periods. CONCLUSIONS: We found high rates of seizure freedom after surgery in lesional epilepsy patients despite limited facilities and infrastructure; antiepileptic medications were successfully tapered in almost half of the patients. Considering the favorable outcome of epilepsy surgery in our series, we believe that it is a major treatment option, even in less resource-intensive settings, and should be encouraged. Strategies to allow larger scale utility of epilepsy surgery in such settings in the developing world and dissemination of such knowledge may be considered an urgent clinical need, given the established mortality and morbidity in refractory epilepsy.