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P28-20 ONTO-EDX: An ontology of electrodiagnostic medicine domain
29th International Congress of Clinical Neurophysiology P28-20 ONTO-EDX: An ontology of electrodiagnostic medicine domain J.E. Gutierrez1 , L. Pena2 Department of Physical Medicine and Rehabilitation, Universidad del Valle, Cali, Colombia, 2 Universidad Autonoma de Occidente, Cali, Colombia 1
Objective: To build an ontology capable to process and to code, using informatics and natural language processing tools, the specific terms and procedures of the Electrodiagnostic (EDX) Medicine field, in order to favor the interoperability among different equipment and providers and to help automatic decision making in this domain. Methods: After evaluating the published glossaries of terms, procedure codes, disease codes and thesauri specific to EDX Medicine we build a conceptual model of the domain. We use natural language processing tools to express the meaning of each concept using differential semantics principles and interpreting their properties, classes, and relations. The ontology was validated using electrodiagnostic studies reports from several laboratories and related textbooks and papers. The ontology was integrated with intelligent agents for automatic decision making. Results: Onto-EDX currently includes 1238 concepts in a hierarchical tree referenced by 8345 terms. The semantic web platform that we developed allows to navigate the ontology and to interact with expert systems for literature search and for use of decision making tools. In our test the ontology showed interoperability among 7 different EMG machine brands and among 5 different EMG labs. Conclusions: It is possible to model the specific information included in the electrodiagnostic medicine domain into a formal ontology using natural language. ONTO-EDX is fully operational and provides a better knowledge of the field. P28-21 Comparison of electrodiagnostic techniques in carpal tunnel syndrome and controls A. Ergun1 , A. Meznik2 , J. Rois2 , P. Stergar2 , W. Oder1 1 Rehabilitation Centre for Head Trauma Patients, AUVA, Vienna, Austria, 2 Trauma Centre Meidling, AUVA, Vienna, Austria Objective: The diagnosis of carpal tunnel syndrome (CTS) is based on clinical criteria. Electrodiagnostic (EDX) procedures should correlate the diagnosis. This prospectively performed study compares different recommended EDX procedures in CTS-hands and in controls. Methods: In 85 CTS-hands of different severity stages and 41 hands of healthy controls the following EDX studies were performed: comparison of median sensory with ulnar sensory nerve conduction across the wrist, comparison of median sensory nerve conduction through the carpal tunnel to distal segments of the median nerve and comparison of median motor with ulnar motor conduction across the wrist. Results: In CTS-hands, sensory nerve conduction in digit 2 and 3 was highly significantly slower than in digit 5, which, though of less degree, was also recorded in the control-hands. Similar results were found when comparing sensory median and sensory ulnar nerve conduction in digit 4. Segmental comparison of the median nerve across the wrist was unhelpful in the differential diagnosis of CTS. In CTS-hands, motor latency recorded from thenar was highly significantly longer than motor latency recorded from hypothenar. A significant slowing, though of less degree, was also recorded in the healthy control-hands. The comparison of the median motor nerve distal latency recorded from the second lumbrical to the ulnar motor nerve distal latency recorded from the second interossei showed a highly significant slowing in CTS-hands but not in the control group. Conclusion: Most of the EDX techniques comparing median and ulnar sensory and motor conduction, which are recommended for use in confirming the clinical diagnosis of CTS, reveal significant differences not only in CTS-hands but also in the healthy controls, though of lesser degree. The comparison of motor latency recorded from the median innervated second lumbrical and the ulnar innervated second interossei showed the most significant differentiation of CTS from controls.
S273 P28-22 One-year clinical and electrodiagnostic follow-up after open carpal tunnel release surgery W. Oder1 , A. Meznik2 , J. Rois2 , P. Stergar2 , A. Ergun1 Rehabilitation Centre for Head Trauma Patients, AUVA, Vienna, Austria, 2 Trauma Centre Meidling, AUVA, Vienna, Austria 1
Objective: Carpal tunnel syndrome (CTS) is a common mononeuropathy of the median nerve at the palm and wrist. Aside from clinical assessment, electrodiagnostic tests confirm the diagnosis of CTS. Very frequently an operation with decompression of the median nerve is performed. Long-term results of such operations have not been reported. This study presents long-term outcomes of such patients clinically and with electrondiagnostic techniques. Methods: In 39 CTS-hands of different severity stages (12 male, 27 female, mean age 60±15 years), open carpal tunnel release surgery was performed by specialized hand surgeons and the outcome followed over one year. Subjects were examined clinically and an extensive electrophysiological investigation was performed prior to the procedure and at 3, 6 and 12 months after operation. Results: All operated patients showed a highly significant reduction of clinical complaints (p < 0.05) as well as highly significant improvement of electrophysiological data (median motor and sensory conduction velocity across the carpal tunnel region (p < 0.05)) at 3 months post with further improvement in the following exams. The duration of recovery from CTS correlated with the severity of nerve damage expressed by a reduced amplitude due to axonal loss and a slowing of conduction velocity due to demyelination and was faster in less severe CTS. Conclusion:CTS-operation with decompression of the median nerve leads to a significant improvement of clinical complaints and of electrophysiological data in all, and even very severe, stages of CTS. Recovery is faster in less severe CTS, therefore a CTS-operation is recommended in early stages of CTS. P29. TMS (3) P29-1 Surround inhibition during motor imagery N. Liang1 , M. Takahashi2 , K. Yoshida1 , K. Matsukawa1 Department of Physiology, Graduate School of Health Sciences, Hiroshima University, Hiroshima, Japan, 2 Department of Health and Sports Medical Sciences, Graduate School of Health Sciences, Hiroshima University, Hiroshima, Japan
1
Objective: To examine whether surround inhibition is represented during motor imagery (MI) as well as during voluntary movement. Methods: Right-handed healthy volunteers (four males and six females, age range 21 26 yrs) were instructed to perform MI of phasic and tonic movement of the right little finger abduction. Transcranial magnetic stimulation (TMS) was applied over the left motor cortex for eliciting a motor evoked potential (MEP) from the agonist muscle (right abductor digiti minimi, ADM) and the surround muscles (right first dorsal interosseous and abductor pollicis brevis muscles, FDI and APB). The premotor reaction time was determined in advance during overt phasic little finger abduction, and then, during phasic MI, TMS was applied at the onset (0 ms) of ADM electromyography and 60 ms before and after the onset ( 60 and 60 ms). TMS was applied 2500 ms after the start cue during tonic MI. A paired-pulse TMS paradigm, with the inter-stimulus interval of 3 and 12 ms, was also adopted for exploring the changes in the short intracortical inhibition (SICI) and facilitation (ICF) within the motor cortex. Results: MEP in ADM was unchanged during phasic MI ( 60, 0 and 60 ms) in comparison with control, while that was significantly facilitated during tonic MI. MEPs in FDI and APB were significantly decreased during phasic MI at 0 and 60 ms, while there were no changes in those during tonic MI as compared with control. The paired TMS revealed that SICI in FDI was significantly increased during phasic MI (0 and 60 ms), while ICF showed no significant change. Conclusions: The present results provided definite evidence for the existence of surround inhibition during phasic but not tonic MI. The increase in SICI within the motor cortex may contribute to the neural mechanism of surround inhibition during phasic MI.
Objective: To build an ontology capable to process and to code, using informatics and natural language processing tools, the specific terms and procedures of the Electrodiagnostic (EDX) Medicine field, in order to favor the interoperability among different equipment and providers and to help automatic decision making in this domain. Methods: After evaluating the published glossaries of terms, procedure codes, disease codes and thesauri specific to EDX Medicine we build a conceptual model of the domain. We use natural language processing tools to express the meaning of each concept using differential semantics principles and interpreting their properties, classes, and relations. The ontology was validated using electrodiagnostic studies reports from several laboratories and related textbooks and papers. The ontology was integrated with intelligent agents for automatic decision making. Results: Onto-EDX currently includes 1238 concepts in a hierarchical tree referenced by 8345 terms. The semantic web platform that we developed allows to navigate the ontology and to interact with expert systems for literature search and for use of decision making tools. In our test the ontology showed interoperability among 7 different EMG machine brands and among 5 different EMG labs. Conclusions: It is possible to model the specific information included in the electrodiagnostic medicine domain into a formal ontology using natural language. ONTO-EDX is fully operational and provides a better knowledge of the field. P28-21 Comparison of electrodiagnostic techniques in carpal tunnel syndrome and controls A. Ergun1 , A. Meznik2 , J. Rois2 , P. Stergar2 , W. Oder1 1 Rehabilitation Centre for Head Trauma Patients, AUVA, Vienna, Austria, 2 Trauma Centre Meidling, AUVA, Vienna, Austria Objective: The diagnosis of carpal tunnel syndrome (CTS) is based on clinical criteria. Electrodiagnostic (EDX) procedures should correlate the diagnosis. This prospectively performed study compares different recommended EDX procedures in CTS-hands and in controls. Methods: In 85 CTS-hands of different severity stages and 41 hands of healthy controls the following EDX studies were performed: comparison of median sensory with ulnar sensory nerve conduction across the wrist, comparison of median sensory nerve conduction through the carpal tunnel to distal segments of the median nerve and comparison of median motor with ulnar motor conduction across the wrist. Results: In CTS-hands, sensory nerve conduction in digit 2 and 3 was highly significantly slower than in digit 5, which, though of less degree, was also recorded in the control-hands. Similar results were found when comparing sensory median and sensory ulnar nerve conduction in digit 4. Segmental comparison of the median nerve across the wrist was unhelpful in the differential diagnosis of CTS. In CTS-hands, motor latency recorded from thenar was highly significantly longer than motor latency recorded from hypothenar. A significant slowing, though of less degree, was also recorded in the healthy control-hands. The comparison of the median motor nerve distal latency recorded from the second lumbrical to the ulnar motor nerve distal latency recorded from the second interossei showed a highly significant slowing in CTS-hands but not in the control group. Conclusion: Most of the EDX techniques comparing median and ulnar sensory and motor conduction, which are recommended for use in confirming the clinical diagnosis of CTS, reveal significant differences not only in CTS-hands but also in the healthy controls, though of lesser degree. The comparison of motor latency recorded from the median innervated second lumbrical and the ulnar innervated second interossei showed the most significant differentiation of CTS from controls.
S273 P28-22 One-year clinical and electrodiagnostic follow-up after open carpal tunnel release surgery W. Oder1 , A. Meznik2 , J. Rois2 , P. Stergar2 , A. Ergun1 Rehabilitation Centre for Head Trauma Patients, AUVA, Vienna, Austria, 2 Trauma Centre Meidling, AUVA, Vienna, Austria 1
Objective: Carpal tunnel syndrome (CTS) is a common mononeuropathy of the median nerve at the palm and wrist. Aside from clinical assessment, electrodiagnostic tests confirm the diagnosis of CTS. Very frequently an operation with decompression of the median nerve is performed. Long-term results of such operations have not been reported. This study presents long-term outcomes of such patients clinically and with electrondiagnostic techniques. Methods: In 39 CTS-hands of different severity stages (12 male, 27 female, mean age 60±15 years), open carpal tunnel release surgery was performed by specialized hand surgeons and the outcome followed over one year. Subjects were examined clinically and an extensive electrophysiological investigation was performed prior to the procedure and at 3, 6 and 12 months after operation. Results: All operated patients showed a highly significant reduction of clinical complaints (p < 0.05) as well as highly significant improvement of electrophysiological data (median motor and sensory conduction velocity across the carpal tunnel region (p < 0.05)) at 3 months post with further improvement in the following exams. The duration of recovery from CTS correlated with the severity of nerve damage expressed by a reduced amplitude due to axonal loss and a slowing of conduction velocity due to demyelination and was faster in less severe CTS. Conclusion:CTS-operation with decompression of the median nerve leads to a significant improvement of clinical complaints and of electrophysiological data in all, and even very severe, stages of CTS. Recovery is faster in less severe CTS, therefore a CTS-operation is recommended in early stages of CTS. P29. TMS (3) P29-1 Surround inhibition during motor imagery N. Liang1 , M. Takahashi2 , K. Yoshida1 , K. Matsukawa1 Department of Physiology, Graduate School of Health Sciences, Hiroshima University, Hiroshima, Japan, 2 Department of Health and Sports Medical Sciences, Graduate School of Health Sciences, Hiroshima University, Hiroshima, Japan
1
Objective: To examine whether surround inhibition is represented during motor imagery (MI) as well as during voluntary movement. Methods: Right-handed healthy volunteers (four males and six females, age range 21 26 yrs) were instructed to perform MI of phasic and tonic movement of the right little finger abduction. Transcranial magnetic stimulation (TMS) was applied over the left motor cortex for eliciting a motor evoked potential (MEP) from the agonist muscle (right abductor digiti minimi, ADM) and the surround muscles (right first dorsal interosseous and abductor pollicis brevis muscles, FDI and APB). The premotor reaction time was determined in advance during overt phasic little finger abduction, and then, during phasic MI, TMS was applied at the onset (0 ms) of ADM electromyography and 60 ms before and after the onset ( 60 and 60 ms). TMS was applied 2500 ms after the start cue during tonic MI. A paired-pulse TMS paradigm, with the inter-stimulus interval of 3 and 12 ms, was also adopted for exploring the changes in the short intracortical inhibition (SICI) and facilitation (ICF) within the motor cortex. Results: MEP in ADM was unchanged during phasic MI ( 60, 0 and 60 ms) in comparison with control, while that was significantly facilitated during tonic MI. MEPs in FDI and APB were significantly decreased during phasic MI at 0 and 60 ms, while there were no changes in those during tonic MI as compared with control. The paired TMS revealed that SICI in FDI was significantly increased during phasic MI (0 and 60 ms), while ICF showed no significant change. Conclusions: The present results provided definite evidence for the existence of surround inhibition during phasic but not tonic MI. The increase in SICI within the motor cortex may contribute to the neural mechanism of surround inhibition during phasic MI.