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PO1.2 Compression on the Spinal Nerve Root, Magnetic Resonance, Electroneurography and Microcirculation of the Upper Limb
Clinical Neurophysiology 120(2009) Suppl. 1, S33–S99
Posters PO1. Nerve Conduction Studies PO1.1 The Utility of Inching Technique in Diagnosis of Motor Nerve Conduction Block Mingsheng Liu *, Liying Cui, Xiaofu Tang, Xiaoguang Li Dept. of Neurology, Peking Union Medical College Hospital, China E-mail address: [email protected] Background: Motor nerve conduction block (CB) is of great importance in differentiating amyotrophic lateral sclerosis (ALS) from acquired demyelinating neuropathy. The objective of this study is to assess the utility of inching technique in diagnosis of motor nerve CB. Methods: 3 groups of subjects including 30 healthy controls, 44 patients with ALS, 38 patients with acquired demyelinating neuropathy were recruited in 4 years. Routine motor nerve conduction studies (long segment) and inching technique (stimulating along the course of the nerve in 2-cm increments from the wrist to axilla) were performed in median nerves and ulnar nerves simultaneously. Results: In patients with acquired demyelinating neuropathy, 24 long segments of 18 nerves had a reduction in amplitude of 20% to 40%, no CB or probable CB could be diagnosed according to the criteria of AAEM, when studied with inching technique, 21 CBs and 18 probable CBs over short segment were detected in 14 nerves, CBs over short segments were detected with inching technique in 5 long segments with abnormal temporal dispersion which had increase in duration more than 60%. In patients with ALS, No CB over short segment was confirmed in 19 nerves which had a reduction in amplitude of 20% to 40%. According to the criteria recommended by AAEM, 4 standard segments of 4 patients with ALS met the criteria of CB or probable CB but not confirmed by inching technique. Conclusions: Inching technique can give more subtle information of the nerve and have additional diagnostic value in motor neuropathy. Inching technique is more sensitive in detecting CB, useful to extract CB from abnormal TD, and helpful to identify the pseudo-CB in ALS. PO1.2 Compression on the Spinal Nerve Root, Magnetic Resonance, Electroneurography and Microcirculation of the Upper Limb aly Gervain2 , P´ eter Mayer3 , M´ arta G´ alfi4 B´ ela Heged˝ us1 *, Mih´ County Hospital, Rehabilitation Institute, Hungary, 2 County Hospital, Laboratory for Thermography, Hungary, 3 County Hospital, Neurology asz Gyula Institute, Hungary, 4 Institute of Applied Natural Science, Juh´ Teacher Training Faculty, University of Szeged, Hungary E-mail address: [email protected] 1
Background: The role of magnetic resonance (MR) in diagnosing cervical disc hernia is well known. Electroneurography (ENG) represents an important method in detecting disturbances in peripheral nerve conduction. Thermography is an established means of indicating conditions tied to advanced perfusion (tumour of the kidney, testicles etc.). We wished to examine the applicability of thermography in the diagnosis of cervical disc hernia and were searching for a link between morphological deviations demonstrated by MR and microcirculatory changes detected by thermographic test. Methods: We conducted MR scans on patients (15) with possible cervical disc hernia based on their case history and neurological symptoms.
We took an ENG in cases of clear and express root compression, and measured upper limb circulation by Doppler. We then took thermograms of the torso, head and upper limbs. As a control, we examined patients who, in addition to degenerative changes in the spine, showed no root compression. Results: In accordance with morphological alterations demonstrated by MR and disturbances in nerve conduction indicated by ENG (FCV < 50 m/s), thermography showed a (significant) rise in temperature of at least 0.5ºC. or more; i.e. an improvement in circulation was demonstrated in the dermatome of the affected root. These changes were not present on the control side. Conclusions: Thermography appears to be a suitable method for diagnosing cervical disc hernia. In addition to the three known deficiency symptoms (muscle strength, reflexes and sensation), it has succeeded in demonstrating a fourth, one linked to microcirculation. The option arises of using thermography to diagnose cervical disc hernia separately and/or prior to MR. PO1.3 The Utility of Statistical Motor Unit Number Estimation in Motor Neuropathy Mingsheng Liu *, Liying Cui, Xiaofu Tang, Xiaoguang Li Dept. of Neurology, Peking Union Medical College Hospital, China E-mail address: [email protected] Background: Motor unit number estimation (MUNE) techniques have been applied to the study of muscle denervating disorders to evaluate motor neuron loss. The objective of this study is to determine the utility of Statistical MUNE in the differentiating of axonal loss and demyelination. Methods: 3 groups of subjects including 48 healthy controls, 41 patients with ALS, 25 patients with demyelinating neuropathy were recruited in 2 years. Statistical MUNE were performed on the median nerve/ thenar muscle. The features of MUNE, the mean amplitude of surface recorded motor unit potential (SMUP), the maximal amplitude of SMUP were compared. Results: The number weighted-MUNE in ALS, demyelinating neuropathy and healthy controls were 49±20, 109±38, 118±12 respectively, the mean amplitude of SMUP were 121±51 mV, 58±33 mV, 110±25 mV respectively, the maximal amplitude of SMUP were 263±150 mV, 107±74 mV, 139±36 mV respectively, the amplitude of compound muscle action potential were 5.8±2.8 mV, 6.5±4.6 mV, 13.1±2.8 mV respectively. There is significant difference between ALS and healthy controls in MUNE, mean amplitude of SMUP and maximal amplitude of SMUP (P < 0.01). Mean amplitude of SMUP in demyelinating neuropathy was significantly decreased compared to those in healthy controls and ALS, and there is no difference between demyelinating neuropathy and healthy controls in MUNE and maximal amplitude of SMUP. Conclusions: In patients with ALS, there is significantly decrease in MUNE and increase in maximal amplitude of SMUP; while there is a significantly decrease in mean amplitude of SMUP in patients with demyelinating neuropathy, which suggest that Statistical MUNE may be a useful noninvasive technique to help differentiate axonal loss and demyelination in distal part of the nerve.
1388-2457/ $34.00 © 2009 International Federation of Clinical Neurophysiology. Published by Elsevier Ltd. All rights reserved.
Posters PO1. Nerve Conduction Studies PO1.1 The Utility of Inching Technique in Diagnosis of Motor Nerve Conduction Block Mingsheng Liu *, Liying Cui, Xiaofu Tang, Xiaoguang Li Dept. of Neurology, Peking Union Medical College Hospital, China E-mail address: [email protected] Background: Motor nerve conduction block (CB) is of great importance in differentiating amyotrophic lateral sclerosis (ALS) from acquired demyelinating neuropathy. The objective of this study is to assess the utility of inching technique in diagnosis of motor nerve CB. Methods: 3 groups of subjects including 30 healthy controls, 44 patients with ALS, 38 patients with acquired demyelinating neuropathy were recruited in 4 years. Routine motor nerve conduction studies (long segment) and inching technique (stimulating along the course of the nerve in 2-cm increments from the wrist to axilla) were performed in median nerves and ulnar nerves simultaneously. Results: In patients with acquired demyelinating neuropathy, 24 long segments of 18 nerves had a reduction in amplitude of 20% to 40%, no CB or probable CB could be diagnosed according to the criteria of AAEM, when studied with inching technique, 21 CBs and 18 probable CBs over short segment were detected in 14 nerves, CBs over short segments were detected with inching technique in 5 long segments with abnormal temporal dispersion which had increase in duration more than 60%. In patients with ALS, No CB over short segment was confirmed in 19 nerves which had a reduction in amplitude of 20% to 40%. According to the criteria recommended by AAEM, 4 standard segments of 4 patients with ALS met the criteria of CB or probable CB but not confirmed by inching technique. Conclusions: Inching technique can give more subtle information of the nerve and have additional diagnostic value in motor neuropathy. Inching technique is more sensitive in detecting CB, useful to extract CB from abnormal TD, and helpful to identify the pseudo-CB in ALS. PO1.2 Compression on the Spinal Nerve Root, Magnetic Resonance, Electroneurography and Microcirculation of the Upper Limb aly Gervain2 , P´ eter Mayer3 , M´ arta G´ alfi4 B´ ela Heged˝ us1 *, Mih´ County Hospital, Rehabilitation Institute, Hungary, 2 County Hospital, Laboratory for Thermography, Hungary, 3 County Hospital, Neurology asz Gyula Institute, Hungary, 4 Institute of Applied Natural Science, Juh´ Teacher Training Faculty, University of Szeged, Hungary E-mail address: [email protected] 1
Background: The role of magnetic resonance (MR) in diagnosing cervical disc hernia is well known. Electroneurography (ENG) represents an important method in detecting disturbances in peripheral nerve conduction. Thermography is an established means of indicating conditions tied to advanced perfusion (tumour of the kidney, testicles etc.). We wished to examine the applicability of thermography in the diagnosis of cervical disc hernia and were searching for a link between morphological deviations demonstrated by MR and microcirculatory changes detected by thermographic test. Methods: We conducted MR scans on patients (15) with possible cervical disc hernia based on their case history and neurological symptoms.
We took an ENG in cases of clear and express root compression, and measured upper limb circulation by Doppler. We then took thermograms of the torso, head and upper limbs. As a control, we examined patients who, in addition to degenerative changes in the spine, showed no root compression. Results: In accordance with morphological alterations demonstrated by MR and disturbances in nerve conduction indicated by ENG (FCV < 50 m/s), thermography showed a (significant) rise in temperature of at least 0.5ºC. or more; i.e. an improvement in circulation was demonstrated in the dermatome of the affected root. These changes were not present on the control side. Conclusions: Thermography appears to be a suitable method for diagnosing cervical disc hernia. In addition to the three known deficiency symptoms (muscle strength, reflexes and sensation), it has succeeded in demonstrating a fourth, one linked to microcirculation. The option arises of using thermography to diagnose cervical disc hernia separately and/or prior to MR. PO1.3 The Utility of Statistical Motor Unit Number Estimation in Motor Neuropathy Mingsheng Liu *, Liying Cui, Xiaofu Tang, Xiaoguang Li Dept. of Neurology, Peking Union Medical College Hospital, China E-mail address: [email protected] Background: Motor unit number estimation (MUNE) techniques have been applied to the study of muscle denervating disorders to evaluate motor neuron loss. The objective of this study is to determine the utility of Statistical MUNE in the differentiating of axonal loss and demyelination. Methods: 3 groups of subjects including 48 healthy controls, 41 patients with ALS, 25 patients with demyelinating neuropathy were recruited in 2 years. Statistical MUNE were performed on the median nerve/ thenar muscle. The features of MUNE, the mean amplitude of surface recorded motor unit potential (SMUP), the maximal amplitude of SMUP were compared. Results: The number weighted-MUNE in ALS, demyelinating neuropathy and healthy controls were 49±20, 109±38, 118±12 respectively, the mean amplitude of SMUP were 121±51 mV, 58±33 mV, 110±25 mV respectively, the maximal amplitude of SMUP were 263±150 mV, 107±74 mV, 139±36 mV respectively, the amplitude of compound muscle action potential were 5.8±2.8 mV, 6.5±4.6 mV, 13.1±2.8 mV respectively. There is significant difference between ALS and healthy controls in MUNE, mean amplitude of SMUP and maximal amplitude of SMUP (P < 0.01). Mean amplitude of SMUP in demyelinating neuropathy was significantly decreased compared to those in healthy controls and ALS, and there is no difference between demyelinating neuropathy and healthy controls in MUNE and maximal amplitude of SMUP. Conclusions: In patients with ALS, there is significantly decrease in MUNE and increase in maximal amplitude of SMUP; while there is a significantly decrease in mean amplitude of SMUP in patients with demyelinating neuropathy, which suggest that Statistical MUNE may be a useful noninvasive technique to help differentiate axonal loss and demyelination in distal part of the nerve.
1388-2457/ $34.00 © 2009 International Federation of Clinical Neurophysiology. Published by Elsevier Ltd. All rights reserved.