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12. Stance with head extension – Posturographic test
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Society Proceedings / Clinical Neurophysiology 123 (2012) e9–e15
Results: After 10 steroid pulses, the visual acuity was significantly better and the pattern-reversal VEP amplitudes (element size 20’ only) had a similar trend of improvement. However, this effect disappeared after seven weeks when only apheresis treatment was performed. No significant changes in latencies of any of the tested VEP variants were found in relationship to the treatment. Conclusion: This pilot study cannot give a definite view on usefulness of the extended set of VEPs in objective monitoring of GO, it seems that steroid pulse therapy effect is detectable in contrary to no apheresis influence onto the tested electrophysiological parameters. Acknowledgements: Supported by Czech Ministry of Education (VZ0021620816) and by Grant Agency of the Czech Republic 309/ 09/0869. doi:10.1016/j.clinph.2011.10.023
12. Stance with head extension – Posturographic test— M. Kucharík a, M. Šaling a, J. Púcˇik b (a 2nd Department of Neurology, Comenius University Hospital, Limbova 5, Bratislava, Slovak Republic, b FEI STU, Ilkovicova 3, Bratislava, Slovak Republic) Stance with head extension represents significant stress on postural system. Posturographic studies on healthy young subjects indicate a reduction of stability during stance with head extension when compared to direct head position (Jaskson and Epstein, 1991). However, some patients with peripheral vestibular deficit improve postural stability during stance with head extension when comparing to stance with direct head position (Norris, 1995). Based on these data, we included stance with head extension to our posturographic examination. We compared measurements in stance with head extended (Ex) with parameters measured during the stance with direct head position (Pr). Both situations measured with eyes closed to eliminate the influence of visual information. For comparison of individual parameters of centre of pressure displacement, we used the formula (Ex Pr/Ex + Pr) 100 (thus we get the differences between the measurements in percentages). During 3 years 542 patients underwent our posturographic tests. We found that in healthy subjects head extension always led to deterioration of stability. Deterioration within 20% we considered as physiological variance. Higher values (20–25%) we observed in patients with cervical vertebral disabilities. Even higher values we observed in cerebellar patients or patients with atrophic brain process. Improvement of stability during stance with head extension was observed only in patients with peripheral vestibular impairment. According to our investigation we consider stance with head extension an appropriate test included in posturographic examination. doi:10.1016/j.clinph.2011.10.024
13. Cutaneous silent periods in multiple system atrophy— I. Šteˇtkárˇová a,b, M. Kofler c (a Dept. of Neurology, 3rd Medical Faculty Charles University, Prague, Czech Republic, b Dept. of Neurology, Na Homolce Hospital, Prague, Czech Republic, c Dept. of Neurology, Hospital Hochzirl, Zirl, Austria) Objective: The cutaneous silent period (CSP) is a spinal inhibitory reflex mediated by A-delta fibers. Prolonged CSPs have previously been reported in patients with restless legs syndrome (RLS) and idiopathic Parkinson’s disease (IPD). Dopaminergic medication normalized the CSP alteration, concurring with dopaminergic influence on
CSPs. To date, CSPs have not been extensively studied in patients with multiple system atrophy (MSA). Methods: We investigated 15 patients (11 females) who fulfilled diagnostic criteria for possible MSA (Gilman 2008). Thirteen patients had predominant parkinsonian symptoms (MSA-P), two had predominant cerebellar signs (MSA-C). We recorded CSPs in thenar muscles following noxious digit II stimulation. Sixteen healthy volunteers (10 females) served as the control subjects for CSP recordings. Results: Group average CSP onset (p < 0.01) and end latency (p < 0.001) were delayed, and CSP duration was prolonged (p < 0.001), in MSA patients in comparison to healthy controls. One patient had no recordable CSPs unilaterally. Conclusion: The observed CSP prolongation corresponds with findings in IPD and RLS. The lack of significant influence of L-dopa on CSP abnormalities is in agreement with the poor clinical response to dopaminergic medication in MSA. The CSP delay on the other hand concurs with corticomotoneuronal involvement in MSA. Acknowledgement: Supported by IGA MZ Czech Republic NT/ 12282-5. doi:10.1016/j.clinph.2011.10.025
14. Electrophysiological intraoperative monitoring in vestibular schwannoma surgery—J. Ceé a,b, T. Radovnicky´ a, R. Bartoš a, P. Vachata a, E. Provazníková a, M. Sameš a (a Department of Neurosurgery, Masaryk hospital, Ústí nad Labem, Czech Republic, b Outpatient Department of Neurology, Dvorˇákova 4, Litomeˇrˇice, Czech Republic) We present the results of 48 patients, who underwent surgery of vestibular schwannomas (VS) from 2001 to 2011, with electrophysiological monitoring. Material and methods: Fifty operations (two re-resection). Monitoring used: EMG in identification and monitoring of CN VII, auditory evoked potentials (BAEP, ABR), motor evoked potentials (MEP). House–Brackmann scale (HB) was used in evaluation of postoperative deficit of CN VII. To determine the hearing disability we used audiometry or AAO-HNS score. We detected preoperative anacusis (respectively D score in the AAO-HNS classification) by 82% of patients. Results: Mortality was 2% (n = 1) – brainstem ischemia immediately after surgery. Partial resection of the tumor in 42%, radical resection or near-total resection in 50%. CN VII was monitored during surgery in 96% of cases, in 20% of cases was monitored simultaneously BAER (preserved hearing preoperatively) and in 28% of cases were monitored MEPs. Postoperative morbidity CN VII: The average disability score before surgery was 1.20 (median 1) in HB scale. The average disability score after surgery was 2.31 HB (median 2). In 2 cases (in 2001) CN VII was not monitored. In these patients HB score worsened from 1 to 3, respectively remained unchanged (HB 2) before and after surgery. Conclusion: Electrophysiological monitoring has become standard in vestibular schwannoma surgery. We cannot compare the results of monitored and non-monitored patients – in most of surgeries was monitored at least CN VII. The possibility of monitoring CN VII or BAEP and MEP leads to greater certainty of the surgeon during critical parts of resection and may increase radicality of surgery. doi:10.1016/j.clinph.2011.10.026
Society Proceedings / Clinical Neurophysiology 123 (2012) e9–e15
Results: After 10 steroid pulses, the visual acuity was significantly better and the pattern-reversal VEP amplitudes (element size 20’ only) had a similar trend of improvement. However, this effect disappeared after seven weeks when only apheresis treatment was performed. No significant changes in latencies of any of the tested VEP variants were found in relationship to the treatment. Conclusion: This pilot study cannot give a definite view on usefulness of the extended set of VEPs in objective monitoring of GO, it seems that steroid pulse therapy effect is detectable in contrary to no apheresis influence onto the tested electrophysiological parameters. Acknowledgements: Supported by Czech Ministry of Education (VZ0021620816) and by Grant Agency of the Czech Republic 309/ 09/0869. doi:10.1016/j.clinph.2011.10.023
12. Stance with head extension – Posturographic test— M. Kucharík a, M. Šaling a, J. Púcˇik b (a 2nd Department of Neurology, Comenius University Hospital, Limbova 5, Bratislava, Slovak Republic, b FEI STU, Ilkovicova 3, Bratislava, Slovak Republic) Stance with head extension represents significant stress on postural system. Posturographic studies on healthy young subjects indicate a reduction of stability during stance with head extension when compared to direct head position (Jaskson and Epstein, 1991). However, some patients with peripheral vestibular deficit improve postural stability during stance with head extension when comparing to stance with direct head position (Norris, 1995). Based on these data, we included stance with head extension to our posturographic examination. We compared measurements in stance with head extended (Ex) with parameters measured during the stance with direct head position (Pr). Both situations measured with eyes closed to eliminate the influence of visual information. For comparison of individual parameters of centre of pressure displacement, we used the formula (Ex Pr/Ex + Pr) 100 (thus we get the differences between the measurements in percentages). During 3 years 542 patients underwent our posturographic tests. We found that in healthy subjects head extension always led to deterioration of stability. Deterioration within 20% we considered as physiological variance. Higher values (20–25%) we observed in patients with cervical vertebral disabilities. Even higher values we observed in cerebellar patients or patients with atrophic brain process. Improvement of stability during stance with head extension was observed only in patients with peripheral vestibular impairment. According to our investigation we consider stance with head extension an appropriate test included in posturographic examination. doi:10.1016/j.clinph.2011.10.024
13. Cutaneous silent periods in multiple system atrophy— I. Šteˇtkárˇová a,b, M. Kofler c (a Dept. of Neurology, 3rd Medical Faculty Charles University, Prague, Czech Republic, b Dept. of Neurology, Na Homolce Hospital, Prague, Czech Republic, c Dept. of Neurology, Hospital Hochzirl, Zirl, Austria) Objective: The cutaneous silent period (CSP) is a spinal inhibitory reflex mediated by A-delta fibers. Prolonged CSPs have previously been reported in patients with restless legs syndrome (RLS) and idiopathic Parkinson’s disease (IPD). Dopaminergic medication normalized the CSP alteration, concurring with dopaminergic influence on
CSPs. To date, CSPs have not been extensively studied in patients with multiple system atrophy (MSA). Methods: We investigated 15 patients (11 females) who fulfilled diagnostic criteria for possible MSA (Gilman 2008). Thirteen patients had predominant parkinsonian symptoms (MSA-P), two had predominant cerebellar signs (MSA-C). We recorded CSPs in thenar muscles following noxious digit II stimulation. Sixteen healthy volunteers (10 females) served as the control subjects for CSP recordings. Results: Group average CSP onset (p < 0.01) and end latency (p < 0.001) were delayed, and CSP duration was prolonged (p < 0.001), in MSA patients in comparison to healthy controls. One patient had no recordable CSPs unilaterally. Conclusion: The observed CSP prolongation corresponds with findings in IPD and RLS. The lack of significant influence of L-dopa on CSP abnormalities is in agreement with the poor clinical response to dopaminergic medication in MSA. The CSP delay on the other hand concurs with corticomotoneuronal involvement in MSA. Acknowledgement: Supported by IGA MZ Czech Republic NT/ 12282-5. doi:10.1016/j.clinph.2011.10.025
14. Electrophysiological intraoperative monitoring in vestibular schwannoma surgery—J. Ceé a,b, T. Radovnicky´ a, R. Bartoš a, P. Vachata a, E. Provazníková a, M. Sameš a (a Department of Neurosurgery, Masaryk hospital, Ústí nad Labem, Czech Republic, b Outpatient Department of Neurology, Dvorˇákova 4, Litomeˇrˇice, Czech Republic) We present the results of 48 patients, who underwent surgery of vestibular schwannomas (VS) from 2001 to 2011, with electrophysiological monitoring. Material and methods: Fifty operations (two re-resection). Monitoring used: EMG in identification and monitoring of CN VII, auditory evoked potentials (BAEP, ABR), motor evoked potentials (MEP). House–Brackmann scale (HB) was used in evaluation of postoperative deficit of CN VII. To determine the hearing disability we used audiometry or AAO-HNS score. We detected preoperative anacusis (respectively D score in the AAO-HNS classification) by 82% of patients. Results: Mortality was 2% (n = 1) – brainstem ischemia immediately after surgery. Partial resection of the tumor in 42%, radical resection or near-total resection in 50%. CN VII was monitored during surgery in 96% of cases, in 20% of cases was monitored simultaneously BAER (preserved hearing preoperatively) and in 28% of cases were monitored MEPs. Postoperative morbidity CN VII: The average disability score before surgery was 1.20 (median 1) in HB scale. The average disability score after surgery was 2.31 HB (median 2). In 2 cases (in 2001) CN VII was not monitored. In these patients HB score worsened from 1 to 3, respectively remained unchanged (HB 2) before and after surgery. Conclusion: Electrophysiological monitoring has become standard in vestibular schwannoma surgery. We cannot compare the results of monitored and non-monitored patients – in most of surgeries was monitored at least CN VII. The possibility of monitoring CN VII or BAEP and MEP leads to greater certainty of the surgeon during critical parts of resection and may increase radicality of surgery. doi:10.1016/j.clinph.2011.10.026