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1445 Effect of alcohol on initiation and maintenance of sleep
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Poster Abstracts
Thursday, November 10, 2005
gradually increased as amplitudes of c o m p o u n d muscle action potential increased. Conclusions: Nodal persistent sodium currents commonly increase in patients with disorders affecting lower motor neurons, irrespective of causes. The increased axonal excitability could be responsible for positive motor symptoms such as muscle cramping frequently seen in these patients a n d normal elderly people. 1442 Relationship between biceps braclfii n m s d e IIIlt.SSanti size of the evoked compound UluSde action potential Wee, AS ~. 1University of Mississippi Medical Center, Yacicson,
IvIississippi, USA Background: C o m p o u n d muscle action potential (CMAP) is the s u m m a t i o n of the individual nmscle fiber action potentials produced during electrical nerve stimulation, and is a useful measure for assessing neuromuscular function. Objective: Determine if the size of the surface C M A P recorded from a large muscle such as the biceps brachii can be reliable in estimating the muscle mass. Methods: Supramaximal C M A P s were recorded from 32 normal biceps brachii muscles to stimulation of the musculocataneous nerve at the axilla. One-cm-diameter disc electrodes were used. Active electrode was at the middle of the muscle belly and reference at the tendon. Upper-arm circumference was measured with biceps muscle relm,~ed (elbow extended), and during contraction (full elbow flexion). Results: M e a n C M A P duration - 16.45 ms, amplitude _ 10.50 mV, and area -- 96.13 mVms. Body mass index and absolute upper-arm circumference (biceps muscle relaxed or contracted) did not correlate with C M A P duration, amplitude, a n d area; Pearson correlation coefficients (r) ranged f r o m - 0 . 2 4 to 0.16. However, the difference (increment) in upper-arm circumference due to biceps muscle contraction correlated with C M A P duration (r -- 0.47), amplitude (r -- 0.67), and area (r -- 0.75). Conclusions: C M A P size (amplitude and area) correlated well with biceps brachii muscle mass as estimated by the increase from baseline in upper-arm circumference during muscle contraction. The difference (increment) in upper-arm circumference due to muscle contraction reflects mainly the underlying biceps bractffi muscle bulk, and eliminates other variables such as thickness of subcutaneous tissues. 1443 Carpal Tunnel Syndrome: relationship between CMAPs recorded at the Thenar region from ulnar and median nerve stimulation Wee, AS ~. ZUniversity of Mississippi Medical Center, Yacicson,
Mississippi, USA Backgrouml: Thenar nmscles are primarily innervated by the median nerve. However, c o m p o u n d muscle action potentials (CMAPs) evoked by ulnar nerve stimulation can be recorded at the thenar region due to proximity o f some ulnar-innervated muscles, and from volume conduction events. Objective: Determine if loss of thenar muscle mass from carpal tunnel syndrome (CTS) could alter the size of ulnar C M A P s obtained at the thenar region, because o f changes in the physical surroundings and electrical conductivity. Methods: Supramaximal C M A P s were recorded from the thenar area to electrical stimulation of the ulnar nerve at the wrist and median nerve at the palm in 95 h a n d s with CTS. Needle E M G was done in the thenar muscles. Median/ulnar C M A P amplitude ratios were calculated. Results: Needle E M G severity was negatively correlated with medianC M A P amplitude (r - -0.72), but n o t with u l n a r - C M A P amplitude (r 0.15). There was no correlation between median and ulnar C M A P amplitudes ( 0.18). E M G severity had modest negative correlation (r -- 0.37) with median/ulnar C M A P amplitude ratios.
Mean median/ulnar C M A P amplitude ratios for normal E M G and mild, moderate, and severe E M G abnormalities were 3.72, 3.32, 1.71, and 0.45, respectively. Conclusions: The absolute amplitude of the ulnar C M A P recorded at the thenar region does not seem to be influenced by changes in the physical envirormlent due to thenar muscle loss (atrophy) from median nerve pathology. The median/ulnar C.MAP amplitude ratio is usually > 1.0; if it falls below 0.5, the study suggests severe loss of motor units in the thenar muscles. 1444 Peduncular Hallucinosis and dreams: a common source? Feve, A ~, Hart, G ~. 1Service de Neurologie, Hopital Leopold Bellan,
Paris, France Headings: to discuss the psychological and physiological nature of peduncular hallucinosis in relation relation with dreams. Background: Peduncular hallucinosis is a pathological form of onirism which occurs as a result of a cerebrovascular accident located in the cerebral peduncle. There is few literature about its significance and pathophysiology. Method: We will discuss the case of a patient who experienced tiffs hallucinosis characterised by a rich orfirism a n d the recurrence of the hallunation theme in her dream after the neurological episode. Result: The hallucination was: She saw herself transported alive in a coffin carried by a m a n in a boat. She also presented a diplopia, and the diagnosis was oriented to a neurological pathology rather than a psychiatric one. The cerebral M R I scan revealed a right cerebral peduncular infarction. Six m o n t h s later she had fully recovered neurologically but h a d a lot of nocturnal dreams and diurnal anxiety about them. She was then asked to report her dream a n d her impression. Thus, she reported multiple dreams with a content resembling her hallucinosis. The Contents of the dreams were about a sentiment to be abandoned and carried from one place to another, to be lost, to be in a room where u n k n o w n people come. The nature of her dreams progressively broadened to more familiar subject matter and, by contrast with the stroke episode, she was thus able to differentiate between what she h a d hallucinated and the reality. Discussion Peduncular hallucinosis is commonly associated with an altered state of consciousness, emotional disturbance a n d anxiety. Links between neurological pathology a n d dreams occurring after the stroke will be discussed. The involvement of brain stem centers of R E M sleep and their relation with the mechanisms of dream and ponrine pseudo-hallucinations could be discussed. 1445 Efl~ct of alcohol on initiation anti tnaintenance of sleep Ghanem, Q1. 1 University Of Ottawa, Canada The use of alcohol is universal. It is often not considered to be a drug by the patient, and its effect on sleep is generally underestimated. Patients often minimize their alcohol consmnption. These factors need to be considered by physicians when they assess insomrfia, obstructive sleep apnea and other sleep disorders. The effect of alcohol on initiation and maintenance of sleep and on sleep architecture will be discussed, and suggestion for m a n a g e m e n t offered. 1446 Dopaininergic therapy of dlfldhood-onset Restless Legs Nym[route Kotagal, S 1. ~Division of Child and Adoleseent Neurology and the Sleep
Disorders Center, Mayo Clinic, Rochester, Minnesota, USA Background: There is little available information about the treatment of childhood restless legs s~ldrome (RLS). The objective of tiffs study was to detet~dne the efficacy of pramipexole, a dopanffne agonist, in treating this disorder.
Poster Abstracts
Thursday, November 10, 2005
gradually increased as amplitudes of c o m p o u n d muscle action potential increased. Conclusions: Nodal persistent sodium currents commonly increase in patients with disorders affecting lower motor neurons, irrespective of causes. The increased axonal excitability could be responsible for positive motor symptoms such as muscle cramping frequently seen in these patients a n d normal elderly people. 1442 Relationship between biceps braclfii n m s d e IIIlt.SSanti size of the evoked compound UluSde action potential Wee, AS ~. 1University of Mississippi Medical Center, Yacicson,
IvIississippi, USA Background: C o m p o u n d muscle action potential (CMAP) is the s u m m a t i o n of the individual nmscle fiber action potentials produced during electrical nerve stimulation, and is a useful measure for assessing neuromuscular function. Objective: Determine if the size of the surface C M A P recorded from a large muscle such as the biceps brachii can be reliable in estimating the muscle mass. Methods: Supramaximal C M A P s were recorded from 32 normal biceps brachii muscles to stimulation of the musculocataneous nerve at the axilla. One-cm-diameter disc electrodes were used. Active electrode was at the middle of the muscle belly and reference at the tendon. Upper-arm circumference was measured with biceps muscle relm,~ed (elbow extended), and during contraction (full elbow flexion). Results: M e a n C M A P duration - 16.45 ms, amplitude _ 10.50 mV, and area -- 96.13 mVms. Body mass index and absolute upper-arm circumference (biceps muscle relaxed or contracted) did not correlate with C M A P duration, amplitude, a n d area; Pearson correlation coefficients (r) ranged f r o m - 0 . 2 4 to 0.16. However, the difference (increment) in upper-arm circumference due to biceps muscle contraction correlated with C M A P duration (r -- 0.47), amplitude (r -- 0.67), and area (r -- 0.75). Conclusions: C M A P size (amplitude and area) correlated well with biceps brachii muscle mass as estimated by the increase from baseline in upper-arm circumference during muscle contraction. The difference (increment) in upper-arm circumference due to muscle contraction reflects mainly the underlying biceps bractffi muscle bulk, and eliminates other variables such as thickness of subcutaneous tissues. 1443 Carpal Tunnel Syndrome: relationship between CMAPs recorded at the Thenar region from ulnar and median nerve stimulation Wee, AS ~. ZUniversity of Mississippi Medical Center, Yacicson,
Mississippi, USA Backgrouml: Thenar nmscles are primarily innervated by the median nerve. However, c o m p o u n d muscle action potentials (CMAPs) evoked by ulnar nerve stimulation can be recorded at the thenar region due to proximity o f some ulnar-innervated muscles, and from volume conduction events. Objective: Determine if loss of thenar muscle mass from carpal tunnel syndrome (CTS) could alter the size of ulnar C M A P s obtained at the thenar region, because o f changes in the physical surroundings and electrical conductivity. Methods: Supramaximal C M A P s were recorded from the thenar area to electrical stimulation of the ulnar nerve at the wrist and median nerve at the palm in 95 h a n d s with CTS. Needle E M G was done in the thenar muscles. Median/ulnar C M A P amplitude ratios were calculated. Results: Needle E M G severity was negatively correlated with medianC M A P amplitude (r - -0.72), but n o t with u l n a r - C M A P amplitude (r 0.15). There was no correlation between median and ulnar C M A P amplitudes ( 0.18). E M G severity had modest negative correlation (r -- 0.37) with median/ulnar C M A P amplitude ratios.
Mean median/ulnar C M A P amplitude ratios for normal E M G and mild, moderate, and severe E M G abnormalities were 3.72, 3.32, 1.71, and 0.45, respectively. Conclusions: The absolute amplitude of the ulnar C M A P recorded at the thenar region does not seem to be influenced by changes in the physical envirormlent due to thenar muscle loss (atrophy) from median nerve pathology. The median/ulnar C.MAP amplitude ratio is usually > 1.0; if it falls below 0.5, the study suggests severe loss of motor units in the thenar muscles. 1444 Peduncular Hallucinosis and dreams: a common source? Feve, A ~, Hart, G ~. 1Service de Neurologie, Hopital Leopold Bellan,
Paris, France Headings: to discuss the psychological and physiological nature of peduncular hallucinosis in relation relation with dreams. Background: Peduncular hallucinosis is a pathological form of onirism which occurs as a result of a cerebrovascular accident located in the cerebral peduncle. There is few literature about its significance and pathophysiology. Method: We will discuss the case of a patient who experienced tiffs hallucinosis characterised by a rich orfirism a n d the recurrence of the hallunation theme in her dream after the neurological episode. Result: The hallucination was: She saw herself transported alive in a coffin carried by a m a n in a boat. She also presented a diplopia, and the diagnosis was oriented to a neurological pathology rather than a psychiatric one. The cerebral M R I scan revealed a right cerebral peduncular infarction. Six m o n t h s later she had fully recovered neurologically but h a d a lot of nocturnal dreams and diurnal anxiety about them. She was then asked to report her dream a n d her impression. Thus, she reported multiple dreams with a content resembling her hallucinosis. The Contents of the dreams were about a sentiment to be abandoned and carried from one place to another, to be lost, to be in a room where u n k n o w n people come. The nature of her dreams progressively broadened to more familiar subject matter and, by contrast with the stroke episode, she was thus able to differentiate between what she h a d hallucinated and the reality. Discussion Peduncular hallucinosis is commonly associated with an altered state of consciousness, emotional disturbance a n d anxiety. Links between neurological pathology a n d dreams occurring after the stroke will be discussed. The involvement of brain stem centers of R E M sleep and their relation with the mechanisms of dream and ponrine pseudo-hallucinations could be discussed. 1445 Efl~ct of alcohol on initiation anti tnaintenance of sleep Ghanem, Q1. 1 University Of Ottawa, Canada The use of alcohol is universal. It is often not considered to be a drug by the patient, and its effect on sleep is generally underestimated. Patients often minimize their alcohol consmnption. These factors need to be considered by physicians when they assess insomrfia, obstructive sleep apnea and other sleep disorders. The effect of alcohol on initiation and maintenance of sleep and on sleep architecture will be discussed, and suggestion for m a n a g e m e n t offered. 1446 Dopaininergic therapy of dlfldhood-onset Restless Legs Nym[route Kotagal, S 1. ~Division of Child and Adoleseent Neurology and the Sleep
Disorders Center, Mayo Clinic, Rochester, Minnesota, USA Background: There is little available information about the treatment of childhood restless legs s~ldrome (RLS). The objective of tiffs study was to detet~dne the efficacy of pramipexole, a dopanffne agonist, in treating this disorder.