Usefulness of blink reflex in hypothyroid patients with or without polyneuropathy: a case control study.

Central nervous system (CNS) dysfunction is an important consequence of thyroid deficiency. Cranial nerves are frequently affected in hypothyroid process. On routine nerve conduction studies, symptomatic peripheral and cranial neuropathy can be detected, however, diagnosing subclinical cranial neuropathy pose the major problem. Blink reflex (BR), has been shown to be an effective method for revealing subclinical involvement of cranial nerves in generalized neuropathies. The present study was undertaken to evaluate the efficacy of BR as a method for early diagnosis of subclinical cranial neuropathy in hypothyroid patients with or without overt peripheral polyneuropathy. A case control study was conducted on 150 subjects aged 18 years and above (100 controls, 50 cases). A routine nerve conduction study and BR evaluation was done in all the subjects. We found abnormal BR response in 50% of hypothyroid patients studied. In hypothyroid patient without polyneuropathy R1 latency was significantly prolonged (P < 0.05 Vs control). Ipsilateral and contralateral R2 latencies were significantly prolonged in hypothyroid cases with or without polyneuropathy on bilateral stimulation. Magnitude of prolongation was greater in with polyneuropathy group. In conclusion, study suggests that BR is a useful non-invasive method for the detection of clinically silent cranial nerve compromise in hypothyroid patients.

A Study of Sensory Nerve Conduction in Pre- and Post-immunoglobulin Treatment of Guillain-Barré Syndrome.

BACKGROUND: Guillain-Barré syndrome (GBS) is a condition characterized by acute and progressive weakness that impacts the limbs, facial muscles, and bulbar muscles due to acute polyneuro-radiculopathy. Typically, an infection that results in immune-mediated nerve dysfunction is what starts the disease. Patients often encounter paresthesia or discomfort before progressing to muscle weakness, initially in the lower extremities (which may include some proximal components) and subsequently in the upper extremities. The features of polyneuropathy identified during electrophysiology tests, bolstered by evidence of acquired demyelination in the nerve conduction study (NCS), support the clinical diagnosis of GBS. In peripheral neuropathies, NCS often reveals abnormalities in nerve conduction parameters. A specific pattern observed in the sensory nerve conduction study (SNCS), referred to as "sural sparing," signifies that the sural nerve, located near the calf muscles, remains relatively unaffected compared to other sensory nerves. Very few studies have been conducted to investigate improvements in sensory nerve conduction (SNC) parameters before and after intravenous immunoglobulin (IVIG), offering limited clinical correlation for the recovery and prognosis of the disease. The study aimed to observe the NCS parameters of the sensory nerves in both the upper and lower limbs, before and after the infusion of IVIG. METHODOLOGY: This study was an observational investigation conducted in the neurophysiology laboratory of the Physiology Department at a rural medical college in central India. Fifty clinically diagnosed cases of GBS aged between 18 and 60 years were referred from the Department of Medicine to the Physiology Department for conducting the NCS. Basic sociodemographic information, along with clinical history, was collected. Subsequently, the RMS EMG EP Mark-II machine was employed to examine the sensory nerve action potentials (SNAPs), such as amplitude (in mV) and conduction velocity (in ms), of the sensory nerves in both the upper and lower limbs before and after IVIG infusion. The IVIG infusion occurs within one week of clinically diagnosing GBS. Following an initial NCS, a second NCS follow-up study was conducted one week after the IVIG infusion to analyze the changing trend in sensory nerves. RESULTS: Upon analysis, no significant correlation was observed between the pre- and post-IVIG SNAPs of the median and ulnar nerves. However, the sural nerve conduction velocity's p-value of 0.033 demonstrated statistical significance, suggesting that the sural nerve is comparatively spared, confirming sural sparing. However, the SNAP of the sensory nerves in GBS patients showed a significant improvement overall, and only NCS quantified the percentage of improvement. CONCLUSION: According to the study, the NCS of sensory nerves showed a positive change in the parameters examined before and after the infusion of IVIG. This underscores the timely intervention of GBS with IVIG, and conducting the sensory conduction study diligently will enhance knowledge about the recovery period. Additionally, it supports the treating physician in making informed interventions based on the results post-IVIG infusion. This enhancement in the sensory nerves can only be quantified through NCS.

The study of diagnostic efficacy of nerve conduction study parameters in cervical radiculopathy.

BACKGROUND: Cervical Radiculopathy (CR) is a neurologic condition characterised by dysfunction of a cervical spinal nerve, the roots of the nerve, or both. Diagnostic criteria for CR are not well defined, and no universally accepted criteria for its diagnosis have been established. Clinical examination, radiological imaging and electrophysiologic evaluation are the different modalities to diagnose CR. The incidence of Cervical Spondylosis and related conditions is increasing in the present scenario and the use of radiologic examination is time consuming and uneconomical for the common Indian setup. Thus, there is a definite need to establish a cost effective, reliable, and accurate means for establishing the diagnosis of cervical radiculopathy. Electrodiagnostic tests are the closest to fulfill these criteria. AIM: To evaluate diagnostic utility of various motor and sensory nerve conduction study parameters in cervical radiculopathy. SETTING AND DESIGN: It was a cross-sectional study conducted on 100 subjects of age > 40 years. MATERIAL AND METHODS: The consecutive patients clinically diagnosed to have cervical radiculopathy, referred from department of Orthopaedics were prospectively recruited for the motor and sensory nerve conduction study using RMS EMG EP Mark-II. Parameters studied were Compound Muscle Action Potential (CMAP), Distal Motor Latency (DML) and Conduction Velocity (CV) for motor nerves and Sensory Nerve Action Potential (SNAP) and CV for sensory nerves. STATISTICAL ANALYSIS: Study observations and results were analysed to find the Specificity, Sensitivity, Positive Predictive Value and Negative Predictive Value using SPSS 16.0. RESULTS: Among various motor nerve conduction parameters CMAP was found to be more sensitive with high positive predicative value. CV was found to have greater specificity and DML had least negative predictive value. Sensory nerve conduction parameters were found to have less sensitivity but higher specificity as compared to motor parameters. CONCLUSION: Nerve conduction studies are useful supportive diagnostic tool for suspected cervical radiculopathy as they are found to have reliable sensitivity and specificity.

Effect of Various Eye Exercise Techniques along with Pranayama on Visual Reaction Time: A Case Control Study.

INTRODUCTION: We depend on eyesight more than any other of our senses to maneuver through the space around us. In a fraction of a second, our eyes work with our brain to tell us the size, shape, colour, and texture of an object. Our eyes are body's most highly developed sensory organs. The use of computers and television in the era of information technology has given new heights to the professional success rate and it saves time but on the other hand, it has led to an increase in the number of patients with ocular complaints. AIMS: The objective of the study was to study the effect of eye exercise techniques along with kapalbhati pranayama on Visual Reaction Time (VRT). MATERIAL & METHODS: Total 60 subjects in an age group of 18-30 were recruited in the study. All the subjects were divided into two equal groups (study group and control group) containing 30 subjects (18 male & 12 female) each. Both the male and female subjects were selected on the basis of their voluntary involvement. Visual reaction time for red and green light was recorded from all 60 subjects before the start of the study. Study group subjects were trained to practice various eye exercise techniques and kapalbhati pranayama for 8 weeks regularly whereas control group were busy with their routine activities. After 8 weeks, visual reaction time was measured for red and green light from all 60 subjects. STATISTICAL ANALYSIS: Data expressed as Mean ± S.D, Student t -test was applied for analysis of data, p value <0.05 is taken as statistically significant. RESULTS: Statistical analysis of data shows that there is a significant decrease in the visual reaction time for red and green light after intervention in study group (p value <0.05). Whereas there is no significant decrease in VRT in control group (p value >0.05). CONCLUSION: The results of our study suggest that simple eye exercises along with pranayama helps in improvement of visual reaction time.