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P92-T Acute motor and sensory axonal neuropathy followed bariatric surgery: Report of two cases
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Abstracts / Clinical Neurophysiology 130 (2019) e21–e116
Results: CTS patients revealed abnormal conduction of median nerve. The only significant anthropometric measure that correlated to electrophysiological aspect of CTS was short palm length. Cutaneus silent period (CSP) was induced in similar rate between the groups likewise the onset latency and duration of CSP. Patients with CTS revealed higher sensory threshold and needed more powerful stimulus on 2nd digit to induce CSP. Anthropometric measures of CTS patients with metabolic syndrome were similar to ones who don’t have it. CTS patient with MS revealed slightly lower median motor amplitude and prolonged latency difference between median and ulnar nerves on palmar mixed afferent conduction. Conclusions: CSP can inducible in CTS patients who had preserved sensory and motor responses. Short palm length predicts the presence of CTS. MS slightly affects median nerve conduction in patients with CTS. doi:10.1016/j.clinph.2019.04.451
P91-T Neurophysiological assessment of asymptomatic TTRVal50Met carriers (transthyretin amyloid polyneuropathy) from the endemic foci of Mallorca—Cristina Descals a,b,*, Mercedes Uson a,b, Carles Montalà a,b, Antonio Figuerola a,b, Ines Losada b, Juan González b, Asunción Ferrer b, Eugenia Cisneros b (a Department of Neurology and Clinical Neurophysiology, H.U. Son Llàtzer, Palma de Mallorca, Spain, b Transthyretin Amyloidosis Multidisciplinary Unit, H.U. Son Llàtzer, Palma de Mallorca, Spain) ⇑
Corresponding author.
Hereditary transthyretin amyloidosis (hATTR) is a rare, multisystem disease caused by amyloid deposition, characterized by heterogeneous presentation and symptomatology. Therefore, early diagnosis remains a challenge.For carriers of the most common mutation (Val50Met-TTR variant), axonal sensorimotor polyneuropathy (AxSMP) and small fiber and autonomic neuropathy (SFN) are the main clinical features. Very few studies have used neurophysiological tests for the assessment of SFN and AxSMP in the monitoring of carriers of the Val50Met mutation. However, few alterations that can serve as an alert to identify the possible onset of neuropathy have been identified in asymptomatic carriers. The aim of this project is to evaluate SFN and AxSMP in undiagnosed individuals carrying the TTR Val50Met variant by the assessment of Nerve Conduction Studies, Sympathetic Skin Response, RR variability, QST (thermotest) and Sudoscan. 46 carriers have been included in the study. Baseline evaluation unraveled a low amplitude of the plantar SSR as a frequent finding (14/46) using the cut-off point of 0,2 mV for plantar response. This amplitude is significantly lower than the detected for the control group (n = 20). Prevalence of carpal tunnel syndrome was similar to general population. Study of asymptomatic carriers allowed the diagnosis of two subjects after the first examination. Also, 3 subjects are under suspicion of SFN. Early detection of neuropathy, specially the small fiber and autonomic neuropathy, is essential to improve diagnosis and prognosis of hATTR-PN. A complete neurophysiological test battery is the best approach to detect changes from the basal examination. doi:10.1016/j.clinph.2019.04.452
P92-T Acute motor and sensory axonal neuropathy followed bariatric surgery: Report of two cases—Sevki Sahin *, Sibel Karsidag, Nilgun Cinar, Miruna Florentina Ates (Maltepe University, Medical Faculty, Department of Neurology, Istanbul, Turkey) ⇑
Corresponding author.
Background: Bariatric surgery is an effective treatment for obesity. However, the number of neurological complications including polyneuropathies after bariatric surgery is increasingly reported. Case reports: Case1. A 27-year-old female underwent a sleeve gastrectomy (SG) and was discharged on a special diet including parenteral B vitamins. Three months later she developed a weakness in both lower limbs progressively increased. The electroneuromyography (ENMG) showed a severe amplitude reduction in both motor and sensory nerves. It was thought to be a case of AMSAN. Vitamin B1, B6, B12 levels and metabolic tests were normal. Intravenous immune globulin (IVIG) was started 0.4 g/kg/day for 5 days and 2 g/kg/month for 6 consecutive months. Her condition improved in 6 months. Case2. A 19-year-old male was submitted to a SG, 4 months before. He had numbness and pain in his legs and hands for 2 weeks. Weakness in the lower extremities started gradually ascended over the following days. Biochemical analyses were normal. His ENMG verified the diagnosis of AMSAN. IVIG was started at same dose for 5 days. However, his muscle strength reduced to distal part of the extremities. Plasma exchange (PE) started 5 times on alternate days. Physiotherapy was started after PE for 6 weeks. At his last examination his condition was nearly normal. Discussion: Micronutational deficiencies which cannot be monitored can trigger processes of inflammatory neuropathy in SE cases. Our cases showed that IVIG and PE should be kept in mind as a reliable treatment option for subacute polyneuropathies caused by bariatric surgery. doi:10.1016/j.clinph.2019.04.453
P93-T EMG and clinical results of Leechavengvongs transfer, our experiences—Jiri Cee a,b, Stepanka Brusakova c, Ivan Humhej a (a Dpt. of Neurosurgery, Masaryk Hospital, Usti nad Labem, Czech Republic, b Litnea, Litomerice, Czech Republic, c Dpt. of Neurology, Masaryk Hospital, Usti nad Labem, Czech Republic)
Background: The long head triceps radialis branch to axillary nerve transfer (‘‘Leechavenvongs’ transfer”) is an option of restoring the motor function of the deltoid muscle in case of complete axillary nerve or C5,6 root injury. The most advantages are anatomic proximity, appropriate diameter, intraplexal donor, no grafting, useful functional recovery achieved in other sources. Material and methods: Group of 11 patients, who underwent Leechavengvongs’s transfer in last 4 years was analysed. The main inclusion criterium was irreparable axillary nerve injury (simple or as a part of brachial plexus injury) with complete denervation signs in deltoid musle preoperatively. We assessed motor recovery according to MRC scoring systém and EMG reinnervation signs every 3 months after surgery. We set the preliminary follow - up period for 18 month, complete for 24 months. Results and conclusions: 1 patient was exclude from the results (death from other reasons). The rest of 10 patients had an evidence of partial reinnervation signs 6 months after surgery. We observed
Abstracts / Clinical Neurophysiology 130 (2019) e21–e116
Results: CTS patients revealed abnormal conduction of median nerve. The only significant anthropometric measure that correlated to electrophysiological aspect of CTS was short palm length. Cutaneus silent period (CSP) was induced in similar rate between the groups likewise the onset latency and duration of CSP. Patients with CTS revealed higher sensory threshold and needed more powerful stimulus on 2nd digit to induce CSP. Anthropometric measures of CTS patients with metabolic syndrome were similar to ones who don’t have it. CTS patient with MS revealed slightly lower median motor amplitude and prolonged latency difference between median and ulnar nerves on palmar mixed afferent conduction. Conclusions: CSP can inducible in CTS patients who had preserved sensory and motor responses. Short palm length predicts the presence of CTS. MS slightly affects median nerve conduction in patients with CTS. doi:10.1016/j.clinph.2019.04.451
P91-T Neurophysiological assessment of asymptomatic TTRVal50Met carriers (transthyretin amyloid polyneuropathy) from the endemic foci of Mallorca—Cristina Descals a,b,*, Mercedes Uson a,b, Carles Montalà a,b, Antonio Figuerola a,b, Ines Losada b, Juan González b, Asunción Ferrer b, Eugenia Cisneros b (a Department of Neurology and Clinical Neurophysiology, H.U. Son Llàtzer, Palma de Mallorca, Spain, b Transthyretin Amyloidosis Multidisciplinary Unit, H.U. Son Llàtzer, Palma de Mallorca, Spain) ⇑
Corresponding author.
Hereditary transthyretin amyloidosis (hATTR) is a rare, multisystem disease caused by amyloid deposition, characterized by heterogeneous presentation and symptomatology. Therefore, early diagnosis remains a challenge.For carriers of the most common mutation (Val50Met-TTR variant), axonal sensorimotor polyneuropathy (AxSMP) and small fiber and autonomic neuropathy (SFN) are the main clinical features. Very few studies have used neurophysiological tests for the assessment of SFN and AxSMP in the monitoring of carriers of the Val50Met mutation. However, few alterations that can serve as an alert to identify the possible onset of neuropathy have been identified in asymptomatic carriers. The aim of this project is to evaluate SFN and AxSMP in undiagnosed individuals carrying the TTR Val50Met variant by the assessment of Nerve Conduction Studies, Sympathetic Skin Response, RR variability, QST (thermotest) and Sudoscan. 46 carriers have been included in the study. Baseline evaluation unraveled a low amplitude of the plantar SSR as a frequent finding (14/46) using the cut-off point of 0,2 mV for plantar response. This amplitude is significantly lower than the detected for the control group (n = 20). Prevalence of carpal tunnel syndrome was similar to general population. Study of asymptomatic carriers allowed the diagnosis of two subjects after the first examination. Also, 3 subjects are under suspicion of SFN. Early detection of neuropathy, specially the small fiber and autonomic neuropathy, is essential to improve diagnosis and prognosis of hATTR-PN. A complete neurophysiological test battery is the best approach to detect changes from the basal examination. doi:10.1016/j.clinph.2019.04.452
P92-T Acute motor and sensory axonal neuropathy followed bariatric surgery: Report of two cases—Sevki Sahin *, Sibel Karsidag, Nilgun Cinar, Miruna Florentina Ates (Maltepe University, Medical Faculty, Department of Neurology, Istanbul, Turkey) ⇑
Corresponding author.
Background: Bariatric surgery is an effective treatment for obesity. However, the number of neurological complications including polyneuropathies after bariatric surgery is increasingly reported. Case reports: Case1. A 27-year-old female underwent a sleeve gastrectomy (SG) and was discharged on a special diet including parenteral B vitamins. Three months later she developed a weakness in both lower limbs progressively increased. The electroneuromyography (ENMG) showed a severe amplitude reduction in both motor and sensory nerves. It was thought to be a case of AMSAN. Vitamin B1, B6, B12 levels and metabolic tests were normal. Intravenous immune globulin (IVIG) was started 0.4 g/kg/day for 5 days and 2 g/kg/month for 6 consecutive months. Her condition improved in 6 months. Case2. A 19-year-old male was submitted to a SG, 4 months before. He had numbness and pain in his legs and hands for 2 weeks. Weakness in the lower extremities started gradually ascended over the following days. Biochemical analyses were normal. His ENMG verified the diagnosis of AMSAN. IVIG was started at same dose for 5 days. However, his muscle strength reduced to distal part of the extremities. Plasma exchange (PE) started 5 times on alternate days. Physiotherapy was started after PE for 6 weeks. At his last examination his condition was nearly normal. Discussion: Micronutational deficiencies which cannot be monitored can trigger processes of inflammatory neuropathy in SE cases. Our cases showed that IVIG and PE should be kept in mind as a reliable treatment option for subacute polyneuropathies caused by bariatric surgery. doi:10.1016/j.clinph.2019.04.453
P93-T EMG and clinical results of Leechavengvongs transfer, our experiences—Jiri Cee a,b, Stepanka Brusakova c, Ivan Humhej a (a Dpt. of Neurosurgery, Masaryk Hospital, Usti nad Labem, Czech Republic, b Litnea, Litomerice, Czech Republic, c Dpt. of Neurology, Masaryk Hospital, Usti nad Labem, Czech Republic)
Background: The long head triceps radialis branch to axillary nerve transfer (‘‘Leechavenvongs’ transfer”) is an option of restoring the motor function of the deltoid muscle in case of complete axillary nerve or C5,6 root injury. The most advantages are anatomic proximity, appropriate diameter, intraplexal donor, no grafting, useful functional recovery achieved in other sources. Material and methods: Group of 11 patients, who underwent Leechavengvongs’s transfer in last 4 years was analysed. The main inclusion criterium was irreparable axillary nerve injury (simple or as a part of brachial plexus injury) with complete denervation signs in deltoid musle preoperatively. We assessed motor recovery according to MRC scoring systém and EMG reinnervation signs every 3 months after surgery. We set the preliminary follow - up period for 18 month, complete for 24 months. Results and conclusions: 1 patient was exclude from the results (death from other reasons). The rest of 10 patients had an evidence of partial reinnervation signs 6 months after surgery. We observed