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1. Neurophysiology of spinal cord and sacral root lesions
Clinical Neurophysiology 120 (2009) e127–e132
Contents lists available at ScienceDirect
Clinical Neurophysiology journal homepage: www.elsevier.com/locate/clinph
Society Proceedings
Symposium of Clinical Neurophysiology Society of Serbia and Montenegro with International Participation, Belgrade, Serbia, October 17, 2008 Zˇarko Martinovic´ * Department of Epilepsy and Clinical Neurophysiology, Institute of Mental Health, Palmoticeva 37, 11000 Belgrade, Serbia
1. Neurophysiology of spinal cord and sacral root lesions—Simon Podnar (Institute of Clinical Neurophysiology, Division of Neurology, University Medical Centre Ljubljana, Slovenia) For the diagnosis of spinal cord and sacral root lesions, in addition to clinical examination and imaging studies, neurophysiologic testing might be useful. Neurophysiologic tests are more useful in patients with sacral compared with suprasacral disorders. Anal sphincter electromyography (EMG) is the single most useful diagnostic test, particularly for focal sacral lesions, and atypical parkinsonism. Another clinically useful method that complements EMG is measurement of the penilo/clitoro-cavernosus reflex. Kinesiologic EMG is useful to demonstrate detrusor sphincter dyssynergia (i.e., increased external urethral sphincter activity during bladder contraction), which is particularly common in spinal cord disease. Somatosensory evoked potential (SEP) and motor evoked potential (MEP) studies (cortical and lumbar) may be useful to diagnose clinically silent spinal lesions. Sympathetic skin response (SSR) recorded from the saddle region might be also of help for testing the lumbosacral sympathetic system. doi:10.1016/j.clinph.2008.12.005
2. Stiff-person syndrome—S. Apostolski (Institute of Neurology, Clinical Centre, Belgrade, Serbia) The ‘‘Stiff person syndrome (SPS) is a chronic neurological disorder characterized by progressive stiffness, axial and often appendicular rigidity with lumbar hyperlordosis and painful spasms, mostly involving paraspinal and lower extremitiy muscles. It is an autoimmune disorder resulting from B-cell-mediated clonal production of glutamic acid decarboxylase (GAD) and the synaptic membrane protein amphiphysin. Diagnostic criteria include characteristic clinical features, a needle electromyography with continuous motor unit activity in at least one axial muscle, normal MRI finding, and serum and CSF oligoclonal GAD65 IgG bands, predominantly restricted to the IgG1 subclass. The most frequent cases (60–90%) with classic SPS characterized by trunk and lower limb involvement are associated with autoantibodies against GAD. The paraneoplastic SPS is characterized by the involvement of the upper-limb, cervical, and cranial nerves. Variants of SPS
include those with focal limb dysfunction (stiff-limb syndrome) and those with encephalomyelitis (‘‘SPS plus). The treatment consists of (1) drugs that increase cortical and spinal inhibition such as benzodiazepines and/or baclofen, (2) drugs that provide immune modulation such as intravenous immunoglobulin and plasmapheresis, and (3) removal of any associated neoplasia. According to the EFNS Task Force guidelines, in patients with SPS incompletely responding to diazepam and/or baclofen and with significant disability requiring a cane or a walker due to truncal stiffness and frequent falls, the recommendation is to use IVIG (2 g/kg in 2–5 days). doi:10.1016/j.clinph.2008.12.006
3. MR spectroscopy of brain tumors—T. Stošic´-Opinc´al 1, M. Dakovic´ 2 (1 Center for Magnetic Resonance, Clinical Center, Belgrade, Serbia, 2 Faculty of Physical Chemistry, University of Belgrade, Belgrade, Serbia) Purpose: MR spectroscopy is the tool for non-invasive tracking of chemical changes which acompany various pathologies of brain tissue. This technique has found the broad application in diagnostics of brain tumors, what is the scope of this work. Methods: MR spectroscopy can be performed in two basic regimes: by obtaining of spectra from volume element or simultaneous acquisition of spectra from two or three dimensional matrix of those elements. Volume of interest localization can be achieved by standard techniques for MR imaging, what is followed by acquiring of spectra in absence of magnetic field gradients. Quantification of the metabolites is usually peformed by comparing with creatine (Cr) signal which has virtually constant concentration in brain pathologies. Results: The main spectroscopic characteristic of brain tumors is decreased N-acetyl aspartate (NAA) to Cr and elevated of choline (Cho) to Cr ratio. This is more pronounced in high grade tumors in comparison with low grade tumors. Additional metabolites which can be observed in aggressive tumors are lipids and lactates, while low grade tumors usually have elevated mionisitol to creatine ratio. Conclusions: MR spectroscopy can be used for differentiation between various types of brain tissue tumors and help in tracking of therapy of these pathologies. doi:10.1016/j.clinph.2008.12.007
*
Tel.: +381 113307588; fax: +381 113231333. E-mail address: [email protected]
doi:10.1016/j.clinph.2008.12.002
Contents lists available at ScienceDirect
Clinical Neurophysiology journal homepage: www.elsevier.com/locate/clinph
Society Proceedings
Symposium of Clinical Neurophysiology Society of Serbia and Montenegro with International Participation, Belgrade, Serbia, October 17, 2008 Zˇarko Martinovic´ * Department of Epilepsy and Clinical Neurophysiology, Institute of Mental Health, Palmoticeva 37, 11000 Belgrade, Serbia
1. Neurophysiology of spinal cord and sacral root lesions—Simon Podnar (Institute of Clinical Neurophysiology, Division of Neurology, University Medical Centre Ljubljana, Slovenia) For the diagnosis of spinal cord and sacral root lesions, in addition to clinical examination and imaging studies, neurophysiologic testing might be useful. Neurophysiologic tests are more useful in patients with sacral compared with suprasacral disorders. Anal sphincter electromyography (EMG) is the single most useful diagnostic test, particularly for focal sacral lesions, and atypical parkinsonism. Another clinically useful method that complements EMG is measurement of the penilo/clitoro-cavernosus reflex. Kinesiologic EMG is useful to demonstrate detrusor sphincter dyssynergia (i.e., increased external urethral sphincter activity during bladder contraction), which is particularly common in spinal cord disease. Somatosensory evoked potential (SEP) and motor evoked potential (MEP) studies (cortical and lumbar) may be useful to diagnose clinically silent spinal lesions. Sympathetic skin response (SSR) recorded from the saddle region might be also of help for testing the lumbosacral sympathetic system. doi:10.1016/j.clinph.2008.12.005
2. Stiff-person syndrome—S. Apostolski (Institute of Neurology, Clinical Centre, Belgrade, Serbia) The ‘‘Stiff person syndrome (SPS) is a chronic neurological disorder characterized by progressive stiffness, axial and often appendicular rigidity with lumbar hyperlordosis and painful spasms, mostly involving paraspinal and lower extremitiy muscles. It is an autoimmune disorder resulting from B-cell-mediated clonal production of glutamic acid decarboxylase (GAD) and the synaptic membrane protein amphiphysin. Diagnostic criteria include characteristic clinical features, a needle electromyography with continuous motor unit activity in at least one axial muscle, normal MRI finding, and serum and CSF oligoclonal GAD65 IgG bands, predominantly restricted to the IgG1 subclass. The most frequent cases (60–90%) with classic SPS characterized by trunk and lower limb involvement are associated with autoantibodies against GAD. The paraneoplastic SPS is characterized by the involvement of the upper-limb, cervical, and cranial nerves. Variants of SPS
include those with focal limb dysfunction (stiff-limb syndrome) and those with encephalomyelitis (‘‘SPS plus). The treatment consists of (1) drugs that increase cortical and spinal inhibition such as benzodiazepines and/or baclofen, (2) drugs that provide immune modulation such as intravenous immunoglobulin and plasmapheresis, and (3) removal of any associated neoplasia. According to the EFNS Task Force guidelines, in patients with SPS incompletely responding to diazepam and/or baclofen and with significant disability requiring a cane or a walker due to truncal stiffness and frequent falls, the recommendation is to use IVIG (2 g/kg in 2–5 days). doi:10.1016/j.clinph.2008.12.006
3. MR spectroscopy of brain tumors—T. Stošic´-Opinc´al 1, M. Dakovic´ 2 (1 Center for Magnetic Resonance, Clinical Center, Belgrade, Serbia, 2 Faculty of Physical Chemistry, University of Belgrade, Belgrade, Serbia) Purpose: MR spectroscopy is the tool for non-invasive tracking of chemical changes which acompany various pathologies of brain tissue. This technique has found the broad application in diagnostics of brain tumors, what is the scope of this work. Methods: MR spectroscopy can be performed in two basic regimes: by obtaining of spectra from volume element or simultaneous acquisition of spectra from two or three dimensional matrix of those elements. Volume of interest localization can be achieved by standard techniques for MR imaging, what is followed by acquiring of spectra in absence of magnetic field gradients. Quantification of the metabolites is usually peformed by comparing with creatine (Cr) signal which has virtually constant concentration in brain pathologies. Results: The main spectroscopic characteristic of brain tumors is decreased N-acetyl aspartate (NAA) to Cr and elevated of choline (Cho) to Cr ratio. This is more pronounced in high grade tumors in comparison with low grade tumors. Additional metabolites which can be observed in aggressive tumors are lipids and lactates, while low grade tumors usually have elevated mionisitol to creatine ratio. Conclusions: MR spectroscopy can be used for differentiation between various types of brain tissue tumors and help in tracking of therapy of these pathologies. doi:10.1016/j.clinph.2008.12.007
*
Tel.: +381 113307588; fax: +381 113231333. E-mail address: [email protected]
doi:10.1016/j.clinph.2008.12.002