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119. Electrophysiological findings in ulnar neuropathy at wrist
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Society Proceedings / Clinical Neurophysiology 120 (2009) e147–e180
118. A case with abnormal nocturnal behavior during EEGwakefulness—Yuka Kimura, Fusae Kawana, Takatoshi Kasai, Koji Narui, Taneyoshi Nozawa, Sugao Ishiwata (Toranomon Hospital, Tokyo, Japan) We present a 35-year-old man with abnormal nocturnal behavior during EEG-wakefulness. He has been diagnosed as depression and panic disorder which were treated with several tranquilizers. His wife complained about his abnormal behaviors during sleep period, such as screaming, walking and going outside with opening locked door. However, he was always completely amnestic for such behaviors. Though he was young, he was initially suspected to have REM sleep behavior disorder. However, in the polysomnography, such abnormal behaviors occurred during EEG-wakefulness just after short-term REM sleep. Next morning, he was totally amnestic about such behaviors. Therefore, he was diagnosed as sleep related dissociative disorder. This case reminds us to perform polysomnography for all cases with psychiatric disorders in order to diagnose such nocturnal behavior disorder, appropriately. doi:10.1016/j.clinph.2009.02.124
119. Electrophysiological findings in ulnar neuropathy at wrist— Ayumu Ohnuma, Shingo Nobuta (Kohnan Hospital, Tohoku Rosai Hospital, Sendai, Japan) Five months previously, a 46-year-old man developed finger weakness in the right hand. Patient denied pain and numbness. Weakness and muscle atrophy were present in right first dorsal interosseous, and extension of right IVth and Vth finger was difficult. However, there was no hypothener weakness, and sensory function was intact. CMAP of first interossei palmares had extremely low amplitudes with mild increase in distal latency. CMAP and distal latency of right abductor digit quinti were normal, and conduction velocity across the elbow was normal as well. SNAP of right Vth finger was normal. Needle EMG examination of the right abductor digit quinti had normal findings, although that of right first dorsal interosseous revealed inactive neurogenic patterns. The operation revealed benign bone tumor of the right hamate, which compressed the deep motor branch of ulnar nerve. There are several pattern of ulnar lesion on the precise location. In addition, there are some variation of the nerve distribution within the canal of Guyon. The clinical and electrophysiological findings suggestive of variation that ulnar motor branch to thenar muscles divide from the sensory branch of ulnar nerve. doi:10.1016/j.clinph.2009.02.125
120. Limitations of auditory brainstem response (ABR) monitoring in surgery for acoustic neurinoma: A report on two cases— Yojiro Seki, Hidemi Miyazaki, Shigeru Murakami, Yasuyuki Shirai (Tokyo Kyosai Hospital, Tokyo, Japan) Although preservation of waves I and V in intraoperative ABR monitoring highly guarantees good postoperative hearing in surgery for acoustic neurinoma, we report on one case with a small tumor where the intraoperative delay of wave V was 1.7 msec but which showed a remarkable reduction of hearing from 30 to 88.8 dB in pure tone average (PTA) on the 6th postoperative day. Intraoperative ABR cannot indicate such rare postoperative changes in hearing that were presumably due to injury to the vasa nervorum. Another case is of a large acoustic tumor without useful hearing or ABR. Preceding
gamma knife treatment, sufficient volume reduction (75%) and unroofing of the internal auditory meatus (IMA) was performed. As a result, hearing recovered from 96.3 to 43.8 dB in PTA three months after surgery. Postoperative MRI revealed entry of cerebrospinal fluid along the anterior wall of the IAM, indicating that there was enough decompression to the cochlear nerve. In cases showing poor or no ABR, intraoperative recording of cochlear nerve action potentials, at least in the final stage of surgery, may be effective for knowing the possibility of hearing preservation. doi:10.1016/j.clinph.2009.02.126
121. Memory function after hippocampal transection for temporal lobe epilepsy—Kensuke Kawai, Mayumi Kubota, Takahiro Ohta, Kyosuke Kamada, Toshimitsu Momose, Shigeki Aoki, Akiko Kawashima, Nobuhito Saito (Graduate School of Medicine, University of Tokyo, and Ogawa Brain Institute, Tokyo, Japan) The aim of this study is to evaluate the postoperative change of memory function after multiple hippocampal transection (MHT) that was developed as a hippocampal counterpart to multiple subpial transection for neocortical focus. Series of 21 patients with temporal lobe epilepsy were evaluated. Treatment side was language-dominant in 12 patients and nondominant in 9. WAIS-R, WMS-R, and Miyake Paired Word Recall were tested preoperatively, 1 month and 6–12 months postoperatively. FDG-PET, ECD-SPECT and IMZSPECT images were acquired preoperatively and 6–12 months postoperatively.The numbers of patients of Engel’s class I/II/III were 17/ 4/0, 6/4/0, 4/2/1 at 1, 2, 3 years, respectively. Nine of 12 patients who underwent dominant-sided MTH experienced transient deterioration in verbal memory scores at 1 month but later recovery to the preoperative level at 6–12 months. Glucose uptake, blood flow and benzodiazepine binding in the treated medial temporal area at the last time point remained much lower than preoperative and contralateral ones. This study showed memory preserving effect of MHT while functional recovery did not accompany recovery of glucose uptake and blood flow. Further study is required to elucidate the underlying mechanisms of functional recovery. doi:10.1016/j.clinph.2009.02.127
122. Excitation–contraction coupling in the masseter—Tomihiro Imai (Sapporo Medical University, Sapporo, Japan) In the masseter muscle, we can examine single fiber electromyography (SFEMG) and repetitive nerve stimulation test (RNS), as well as a new method to assess the excitation–contraction (E–C) coupling. Furthermore, the bite force can be evaluated using the pressure-sensitive sheet. These advantages lead us to investigate a correlation between masticatory muscle strength and the neuromuscular transmission followed by E–C coupling process in myasthenia gravis (MG). Subjects were MG patients with various chewing disabilities. The severity of MG and masticatory muscle weakness were graded according to the clinical classification of MGFA and MG-ADL. The E–C coupling time (ECCT) was defined as the difference in onset latencies between masseteric compound muscle action potentials and movement-related potentials recorded by an accelerometer placed at the chin. The SFEMG/RNS examinations were also performed in the same masseter right before the ECCT recordings. The mean ECCT was significantly shorter in MG patients in remission than in those with relapse. Successive measurements of ECCT showed a significant correlation with the bite force even in MG
Society Proceedings / Clinical Neurophysiology 120 (2009) e147–e180
118. A case with abnormal nocturnal behavior during EEGwakefulness—Yuka Kimura, Fusae Kawana, Takatoshi Kasai, Koji Narui, Taneyoshi Nozawa, Sugao Ishiwata (Toranomon Hospital, Tokyo, Japan) We present a 35-year-old man with abnormal nocturnal behavior during EEG-wakefulness. He has been diagnosed as depression and panic disorder which were treated with several tranquilizers. His wife complained about his abnormal behaviors during sleep period, such as screaming, walking and going outside with opening locked door. However, he was always completely amnestic for such behaviors. Though he was young, he was initially suspected to have REM sleep behavior disorder. However, in the polysomnography, such abnormal behaviors occurred during EEG-wakefulness just after short-term REM sleep. Next morning, he was totally amnestic about such behaviors. Therefore, he was diagnosed as sleep related dissociative disorder. This case reminds us to perform polysomnography for all cases with psychiatric disorders in order to diagnose such nocturnal behavior disorder, appropriately. doi:10.1016/j.clinph.2009.02.124
119. Electrophysiological findings in ulnar neuropathy at wrist— Ayumu Ohnuma, Shingo Nobuta (Kohnan Hospital, Tohoku Rosai Hospital, Sendai, Japan) Five months previously, a 46-year-old man developed finger weakness in the right hand. Patient denied pain and numbness. Weakness and muscle atrophy were present in right first dorsal interosseous, and extension of right IVth and Vth finger was difficult. However, there was no hypothener weakness, and sensory function was intact. CMAP of first interossei palmares had extremely low amplitudes with mild increase in distal latency. CMAP and distal latency of right abductor digit quinti were normal, and conduction velocity across the elbow was normal as well. SNAP of right Vth finger was normal. Needle EMG examination of the right abductor digit quinti had normal findings, although that of right first dorsal interosseous revealed inactive neurogenic patterns. The operation revealed benign bone tumor of the right hamate, which compressed the deep motor branch of ulnar nerve. There are several pattern of ulnar lesion on the precise location. In addition, there are some variation of the nerve distribution within the canal of Guyon. The clinical and electrophysiological findings suggestive of variation that ulnar motor branch to thenar muscles divide from the sensory branch of ulnar nerve. doi:10.1016/j.clinph.2009.02.125
120. Limitations of auditory brainstem response (ABR) monitoring in surgery for acoustic neurinoma: A report on two cases— Yojiro Seki, Hidemi Miyazaki, Shigeru Murakami, Yasuyuki Shirai (Tokyo Kyosai Hospital, Tokyo, Japan) Although preservation of waves I and V in intraoperative ABR monitoring highly guarantees good postoperative hearing in surgery for acoustic neurinoma, we report on one case with a small tumor where the intraoperative delay of wave V was 1.7 msec but which showed a remarkable reduction of hearing from 30 to 88.8 dB in pure tone average (PTA) on the 6th postoperative day. Intraoperative ABR cannot indicate such rare postoperative changes in hearing that were presumably due to injury to the vasa nervorum. Another case is of a large acoustic tumor without useful hearing or ABR. Preceding
gamma knife treatment, sufficient volume reduction (75%) and unroofing of the internal auditory meatus (IMA) was performed. As a result, hearing recovered from 96.3 to 43.8 dB in PTA three months after surgery. Postoperative MRI revealed entry of cerebrospinal fluid along the anterior wall of the IAM, indicating that there was enough decompression to the cochlear nerve. In cases showing poor or no ABR, intraoperative recording of cochlear nerve action potentials, at least in the final stage of surgery, may be effective for knowing the possibility of hearing preservation. doi:10.1016/j.clinph.2009.02.126
121. Memory function after hippocampal transection for temporal lobe epilepsy—Kensuke Kawai, Mayumi Kubota, Takahiro Ohta, Kyosuke Kamada, Toshimitsu Momose, Shigeki Aoki, Akiko Kawashima, Nobuhito Saito (Graduate School of Medicine, University of Tokyo, and Ogawa Brain Institute, Tokyo, Japan) The aim of this study is to evaluate the postoperative change of memory function after multiple hippocampal transection (MHT) that was developed as a hippocampal counterpart to multiple subpial transection for neocortical focus. Series of 21 patients with temporal lobe epilepsy were evaluated. Treatment side was language-dominant in 12 patients and nondominant in 9. WAIS-R, WMS-R, and Miyake Paired Word Recall were tested preoperatively, 1 month and 6–12 months postoperatively. FDG-PET, ECD-SPECT and IMZSPECT images were acquired preoperatively and 6–12 months postoperatively.The numbers of patients of Engel’s class I/II/III were 17/ 4/0, 6/4/0, 4/2/1 at 1, 2, 3 years, respectively. Nine of 12 patients who underwent dominant-sided MTH experienced transient deterioration in verbal memory scores at 1 month but later recovery to the preoperative level at 6–12 months. Glucose uptake, blood flow and benzodiazepine binding in the treated medial temporal area at the last time point remained much lower than preoperative and contralateral ones. This study showed memory preserving effect of MHT while functional recovery did not accompany recovery of glucose uptake and blood flow. Further study is required to elucidate the underlying mechanisms of functional recovery. doi:10.1016/j.clinph.2009.02.127
122. Excitation–contraction coupling in the masseter—Tomihiro Imai (Sapporo Medical University, Sapporo, Japan) In the masseter muscle, we can examine single fiber electromyography (SFEMG) and repetitive nerve stimulation test (RNS), as well as a new method to assess the excitation–contraction (E–C) coupling. Furthermore, the bite force can be evaluated using the pressure-sensitive sheet. These advantages lead us to investigate a correlation between masticatory muscle strength and the neuromuscular transmission followed by E–C coupling process in myasthenia gravis (MG). Subjects were MG patients with various chewing disabilities. The severity of MG and masticatory muscle weakness were graded according to the clinical classification of MGFA and MG-ADL. The E–C coupling time (ECCT) was defined as the difference in onset latencies between masseteric compound muscle action potentials and movement-related potentials recorded by an accelerometer placed at the chin. The SFEMG/RNS examinations were also performed in the same masseter right before the ECCT recordings. The mean ECCT was significantly shorter in MG patients in remission than in those with relapse. Successive measurements of ECCT showed a significant correlation with the bite force even in MG