- Email: [email protected]
Application of neuromuscular taping on occipital neuralgia: Case study
46
Abstracts / Journal of the Neurological Sciences 405S (2019) 116543
Background The FOCUS phase 3b study demonstrated the effectiveness of fremanezumab for the preventive treatment of episodic and chronic migraine (EM and CM) and documented inadequate response to 2-4 classes of migraine preventive medications. This post-hoc analysis evaluated response rates in patients reverting from CM to EM during the FOCUS study. Methods After IRB approval, CM patients were randomised (1:1:1) to quarterly fremanezumab (month1: 675 mg; months2/3: placebo), monthly fremanezumab (month1: 675 mg; months2/3: 225 mg), or matched monthly placebo for 12 weeks of double-blind treatment. Reversion rates from CM to EM were defined as: A) ≥15 headache days (HDs) at baseline but b15 HDs at all 3 months or B) ≥15 HDs at baseline but b15 HDs on average over 12 weeks. Proportions of responders (≥50% reduction in migraine days) were calculated using both reversion definitions. Results Of the CM patients, 18/167(11%) with placebo, 59/167(35%) with quarterly fremanezumab, and 59/172(34%) with monthly fremanezumab reverted to EM using definition A, and 50/167(30%), 81/167(49%), and 91/172(53%), respectively, reverted using definition B. Higher proportions of patients achieved ≥50% reductions in migraine days within 1 and 4 weeks and sustained ≥50% reductions through 12 weeks with fremanezumab versus placebo (Table).
Methods We assessed 107 requests of studies of patients who were referred with the clinical suspicion of CTS, uni or bilateral to the Instituto Nacional de Nutrición at Mexico City, from 2016 to 2019. We obtained informed consent and classified the reports into five groups according to the specialty from which the request came. We performed a standard NCV/EMG and the rate of clinical misdiagnosis was determined individually for five groups specialties; we used SPSS® version 25 software to analyze data and evaluate with the Chi square if there were any difference clinical diagnostic accuracy between the specialties. Results Five reports were excluded for insufficient information. NCV were normal in 38.8% of patients with clinically suspect CTS. By electrodiagnostic methods the diagnosis was confirmed in 88.8% of cases referred from plastic surgery, 83.3% from endocrinology and 72.2% from internal medicine. For rheumatology and neurology this ratios were 63.6% and 51.8%, respectively. There was no statistically significant difference for clinical presumption of CTS between specialties. Conclusion Electrodiagnosis studies might confirm the diagnosis, but we know that these studies may show up to 10-20% of false positive, some misdiagnosis could be explained by this fact. We suggest the implementation of standardized clinical questionnaire for diagnosis of CTS to improved clinical accuracy. doi:10.1016/j.jns.2019.10.1638
Conclusions Reversion was common (~35%) at all 3 months of double-blind treatment with both fremanezumab dosing regimens in patients with documented inadequate response to 2–4 classes of migraine preventive medications. Clinically meaningful response rates within 1 and 4 weeks and sustained ≥50% response rates over 12 weeks were greater with fremanezumab versus placebo.
WCN19-1394 Journal of the Neurological Sciences 405S (2019) 105300 Poster Session 4
doi:10.1016/j.jns.2019.10.1637
WCN19-1388 Journal of the Neurological Sciences 405S (2019) 105299
Application of neuromuscular taping on occipital neuralgia: Case study W.S. Andiab, R. Wahidac, B. Davidd a University of Muhammadiyah Makassar, Neurology, Makassar, Indonesia b Pelamonia Hospital, Neurology, Makassar, Indonesia c Tenriawaru Hospital, Neurology, Bone, Indonesia d Neuromuscular Taping Institute, Neuro rehabilitation, Rome, Italy
Poster Session 4 Background Correlation between clinical suspicion of carpal tunnel syndrome and neurophysiology studies C.E. Mendoza Tejedaa, J.A. Ortiz Quezadaa, J.C. Espinoza Retuertoa, S.L. Perez Castañedaa, E. Matias Beniteza, B. Estañol Vidalb a Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Clinical Neurophysiology, Mexico City, Mexico b Universidad Nacional Autónoma de México, Clinical Neurophysiology, Mexico City, Mexico Background Carpal tunnel syndrome (CTS) it's one of the most frequent diagnosis referred to the electrodiagnostic laboratory. Nerve conduction velocities (NCV) and electromyography (EMG) usually confirm the diagnosis. Objective To assess the clinical accuracy between referred hospital services and electrodiagnostic studies.
Occipital Neuralgia (ON) as a headache disorder characterized by unilateral or bilateral paroxysmal, shooting or stabbing pain in the posterior part of the scalp. It is a headache syndrome that can be either primary or secondary. Irritation or pressure to the occipital nerve possibly due to an injury, tight muscles that entrap the nerves, or inflammation can cause this syndrome. The pain usually originates at the base of the skull and radiates near the back or along the side of the scalp. Neck movements may trigger pain in some patients. Conservative treatments always not fully satisfied. Neuromuscular Taping (NMT) is an innovative treatment method which is a biomechanical therapy using decompressive stimuli to obtain positive effects in the musculoskeletal, vascular, lymphatic, and neurological system. The effect of decompression is to produce skin lifting, improve blood circulation and reduce pain. Objective To investigate changes in pain and range of motion (ROM) in patients with Occipital Neuralgia
Abstracts / Journal of the Neurological Sciences 405S (2019) 116543
Method Four cases present with occipital neuralgia, Numerical Pain Rating Scale and ROM were evaluate before and after NMT application. Ishaped posterior neck were applied. Results There were improvement of NPRS and ROM after I-shaped posterior neck decompression of NMT application twice. These are more quicker than serial treatments planned. Keywords: Occipital Neuralgia, Decompression Neuromuscular Taping, I-shaped posterior neck taping
47
WCN19-1420 Journal of the Neurological Sciences 405S (2019) 105302 Poster Session 4 Phrenic nerve palsy: A rare cause of respiratory distress in newborn: A literature review V. Kumar, A. Jha Texila American University, College of Medicine, East Bank Demerara, Guyana
doi:10.1016/j.jns.2019.10.1639
WCN19-1395 Journal of the Neurological Sciences 405S (2019) 105301 Poster Session 4 Paraneoplastic antibody-anti amphiphysin presenting as sensory ataxia, cerebellar signs and anterior horn cell involvement-a rare case report A. Awasthy, H. Kathuria, N. Tandyala, N. Prabhat, S. Turlapati Padmavathi, K. Mahesh Vinay, S. Mehta, V. Lal Post Graduate Institute of Medical Education and Research, Neurology, Chandigarh, India
Phrenic nerve palsy could result from multiple etiologies including birth injuries. It could often be associated with brachial plexus palsy. The phrenic nerve plays a major role in innervating the diaphragm. It is the only motor supply to the diaphragm and also acts a sensory nerve. In this palsy, the patient may present with diaphragmatic dysfunction, unilateral diaphragmatic paralysis, or bilateral diaphragmatic paralysis. This diaphragmatic paralysis caused by phrenic nerve injury could lead to respiratory distress in the newborn. Thus, a newborn with respiratory distress and an elevated hemidiaphragm should be suspected for phrenic nerve palsy in the imaging studies and also in the differential diagnosis of respiratory distress in a newborn presenting with a history of traumatic delivery or brachial plexus palsy. We also herein report a case of phrenic nerve palsy in a newborn presenting with respiratory distress. doi:10.1016/j.jns.2019.10.1641
Background Antiamphiphysin antibodies react with a 128-kd protein found in synaptic vesicles. First described in patients with paraneoplastic stiffman syndrome, may be associated with sensory neuronopathy, encephalomyelitis,limbic encephalitis,lambert eaton myasthenic syndrome with tumors like breast cancer, small cell lung cancer.
WCN19-1426
Case report A 56 years old male presented with 6 months history of gradually progressive sensory disturbances in lower limbs, weakness of all four limbs progressing from proximally to distally, tremulousness of all four limbs. On examination had sensory ataxia, asymmetrical cerebellar signs in the form of nystagmus, abnormal finger nose finger, dysdiadochokinesia and fasciculations in all four limbs and tongue suggestive of anterior horn cell involvement.
Recurrent stroke and aseptic meningitis in patient with Fabry disease: A case report
Investigations Hematological investigations normal, CEMRI brain-normal, CECTchest, abdomen, PET-CT whole body- normal, serum and protein electrophoresis-no M band seen, CSF –no cells, biochemistry normal, paraneoplastic panel-anti amphyphysin antibody positive, nerve conduction studies suggestive of demyelinating sensorimotor polyneuropathy. EMG revealed fasciculations, late and incomplete recruitment and interference pattern respectively in left deltoid, first dorsal interossei, vastus lateralis, gastrocnemius, tibialis anterior, genioglossus. Patient showed marked improvement with immunosuppression in form of intravenous steroids. Constellation of clinical features suggesting multiaxial involvement presenting simultaneously with sensory ataxia, cerebellar signs and fasciculations associated with anti amphiphysin antibody has never been shown in literature to the best of our knowledge, which makes it a unique and rare case and response to immunosuppression further favors the fact that his symptoms were immune mediated. doi:10.1016/j.jns.2019.10.1640
Journal of the Neurological Sciences 405S (2019) 105303 Poster Session 4
E. Kimelfelda, V. Gudkovaa, E. Koltsovaa, L. Stahovskayaa, N. Abramenkovab a Pirogov Russian National Research Medical University, Department of Neurology- neurosurgery and medical genetic, Moscow, Russia b Hospital for War Veterans №3, Department of Neurology, Moscow, Russia Background Fabry Disease (FD) is a rare, potentially curable, hereditary disease. Despite of enzyme replacement therapy (ERT) recurrent stroke and aseptic meningitidis are developed. Method The 26 year-old male was diagnosed FD after the first ischemic stroke. In a 6 months of receiving ERT the second ischemic stroke in the vertebrobasilar system was developed. In a month severe headache with nausea, vomiting and paresis of the right oculomotor nerve developed, without lesions on MRI. The cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis of 24/μL. Aseptic meningitis was diagnosed. Prednisolone 50 mg a day was prescribed. After treatment with glucocorticoids, oculomotor disturbances and cerebral symptoms regressed over a 3 day. In a month the third ischemic stroke developed in the patient in the vertebrobasilar system with headache and dysarthria. He had stopped to take prednisolone by this time. After this stroke headache increased, and the patient started taking nonsteroid anti-inflammatory drugs without permanent effect. The cognitive impairment progressed.
Abstracts / Journal of the Neurological Sciences 405S (2019) 116543
Background The FOCUS phase 3b study demonstrated the effectiveness of fremanezumab for the preventive treatment of episodic and chronic migraine (EM and CM) and documented inadequate response to 2-4 classes of migraine preventive medications. This post-hoc analysis evaluated response rates in patients reverting from CM to EM during the FOCUS study. Methods After IRB approval, CM patients were randomised (1:1:1) to quarterly fremanezumab (month1: 675 mg; months2/3: placebo), monthly fremanezumab (month1: 675 mg; months2/3: 225 mg), or matched monthly placebo for 12 weeks of double-blind treatment. Reversion rates from CM to EM were defined as: A) ≥15 headache days (HDs) at baseline but b15 HDs at all 3 months or B) ≥15 HDs at baseline but b15 HDs on average over 12 weeks. Proportions of responders (≥50% reduction in migraine days) were calculated using both reversion definitions. Results Of the CM patients, 18/167(11%) with placebo, 59/167(35%) with quarterly fremanezumab, and 59/172(34%) with monthly fremanezumab reverted to EM using definition A, and 50/167(30%), 81/167(49%), and 91/172(53%), respectively, reverted using definition B. Higher proportions of patients achieved ≥50% reductions in migraine days within 1 and 4 weeks and sustained ≥50% reductions through 12 weeks with fremanezumab versus placebo (Table).
Methods We assessed 107 requests of studies of patients who were referred with the clinical suspicion of CTS, uni or bilateral to the Instituto Nacional de Nutrición at Mexico City, from 2016 to 2019. We obtained informed consent and classified the reports into five groups according to the specialty from which the request came. We performed a standard NCV/EMG and the rate of clinical misdiagnosis was determined individually for five groups specialties; we used SPSS® version 25 software to analyze data and evaluate with the Chi square if there were any difference clinical diagnostic accuracy between the specialties. Results Five reports were excluded for insufficient information. NCV were normal in 38.8% of patients with clinically suspect CTS. By electrodiagnostic methods the diagnosis was confirmed in 88.8% of cases referred from plastic surgery, 83.3% from endocrinology and 72.2% from internal medicine. For rheumatology and neurology this ratios were 63.6% and 51.8%, respectively. There was no statistically significant difference for clinical presumption of CTS between specialties. Conclusion Electrodiagnosis studies might confirm the diagnosis, but we know that these studies may show up to 10-20% of false positive, some misdiagnosis could be explained by this fact. We suggest the implementation of standardized clinical questionnaire for diagnosis of CTS to improved clinical accuracy. doi:10.1016/j.jns.2019.10.1638
Conclusions Reversion was common (~35%) at all 3 months of double-blind treatment with both fremanezumab dosing regimens in patients with documented inadequate response to 2–4 classes of migraine preventive medications. Clinically meaningful response rates within 1 and 4 weeks and sustained ≥50% response rates over 12 weeks were greater with fremanezumab versus placebo.
WCN19-1394 Journal of the Neurological Sciences 405S (2019) 105300 Poster Session 4
doi:10.1016/j.jns.2019.10.1637
WCN19-1388 Journal of the Neurological Sciences 405S (2019) 105299
Application of neuromuscular taping on occipital neuralgia: Case study W.S. Andiab, R. Wahidac, B. Davidd a University of Muhammadiyah Makassar, Neurology, Makassar, Indonesia b Pelamonia Hospital, Neurology, Makassar, Indonesia c Tenriawaru Hospital, Neurology, Bone, Indonesia d Neuromuscular Taping Institute, Neuro rehabilitation, Rome, Italy
Poster Session 4 Background Correlation between clinical suspicion of carpal tunnel syndrome and neurophysiology studies C.E. Mendoza Tejedaa, J.A. Ortiz Quezadaa, J.C. Espinoza Retuertoa, S.L. Perez Castañedaa, E. Matias Beniteza, B. Estañol Vidalb a Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Clinical Neurophysiology, Mexico City, Mexico b Universidad Nacional Autónoma de México, Clinical Neurophysiology, Mexico City, Mexico Background Carpal tunnel syndrome (CTS) it's one of the most frequent diagnosis referred to the electrodiagnostic laboratory. Nerve conduction velocities (NCV) and electromyography (EMG) usually confirm the diagnosis. Objective To assess the clinical accuracy between referred hospital services and electrodiagnostic studies.
Occipital Neuralgia (ON) as a headache disorder characterized by unilateral or bilateral paroxysmal, shooting or stabbing pain in the posterior part of the scalp. It is a headache syndrome that can be either primary or secondary. Irritation or pressure to the occipital nerve possibly due to an injury, tight muscles that entrap the nerves, or inflammation can cause this syndrome. The pain usually originates at the base of the skull and radiates near the back or along the side of the scalp. Neck movements may trigger pain in some patients. Conservative treatments always not fully satisfied. Neuromuscular Taping (NMT) is an innovative treatment method which is a biomechanical therapy using decompressive stimuli to obtain positive effects in the musculoskeletal, vascular, lymphatic, and neurological system. The effect of decompression is to produce skin lifting, improve blood circulation and reduce pain. Objective To investigate changes in pain and range of motion (ROM) in patients with Occipital Neuralgia
Abstracts / Journal of the Neurological Sciences 405S (2019) 116543
Method Four cases present with occipital neuralgia, Numerical Pain Rating Scale and ROM were evaluate before and after NMT application. Ishaped posterior neck were applied. Results There were improvement of NPRS and ROM after I-shaped posterior neck decompression of NMT application twice. These are more quicker than serial treatments planned. Keywords: Occipital Neuralgia, Decompression Neuromuscular Taping, I-shaped posterior neck taping
47
WCN19-1420 Journal of the Neurological Sciences 405S (2019) 105302 Poster Session 4 Phrenic nerve palsy: A rare cause of respiratory distress in newborn: A literature review V. Kumar, A. Jha Texila American University, College of Medicine, East Bank Demerara, Guyana
doi:10.1016/j.jns.2019.10.1639
WCN19-1395 Journal of the Neurological Sciences 405S (2019) 105301 Poster Session 4 Paraneoplastic antibody-anti amphiphysin presenting as sensory ataxia, cerebellar signs and anterior horn cell involvement-a rare case report A. Awasthy, H. Kathuria, N. Tandyala, N. Prabhat, S. Turlapati Padmavathi, K. Mahesh Vinay, S. Mehta, V. Lal Post Graduate Institute of Medical Education and Research, Neurology, Chandigarh, India
Phrenic nerve palsy could result from multiple etiologies including birth injuries. It could often be associated with brachial plexus palsy. The phrenic nerve plays a major role in innervating the diaphragm. It is the only motor supply to the diaphragm and also acts a sensory nerve. In this palsy, the patient may present with diaphragmatic dysfunction, unilateral diaphragmatic paralysis, or bilateral diaphragmatic paralysis. This diaphragmatic paralysis caused by phrenic nerve injury could lead to respiratory distress in the newborn. Thus, a newborn with respiratory distress and an elevated hemidiaphragm should be suspected for phrenic nerve palsy in the imaging studies and also in the differential diagnosis of respiratory distress in a newborn presenting with a history of traumatic delivery or brachial plexus palsy. We also herein report a case of phrenic nerve palsy in a newborn presenting with respiratory distress. doi:10.1016/j.jns.2019.10.1641
Background Antiamphiphysin antibodies react with a 128-kd protein found in synaptic vesicles. First described in patients with paraneoplastic stiffman syndrome, may be associated with sensory neuronopathy, encephalomyelitis,limbic encephalitis,lambert eaton myasthenic syndrome with tumors like breast cancer, small cell lung cancer.
WCN19-1426
Case report A 56 years old male presented with 6 months history of gradually progressive sensory disturbances in lower limbs, weakness of all four limbs progressing from proximally to distally, tremulousness of all four limbs. On examination had sensory ataxia, asymmetrical cerebellar signs in the form of nystagmus, abnormal finger nose finger, dysdiadochokinesia and fasciculations in all four limbs and tongue suggestive of anterior horn cell involvement.
Recurrent stroke and aseptic meningitis in patient with Fabry disease: A case report
Investigations Hematological investigations normal, CEMRI brain-normal, CECTchest, abdomen, PET-CT whole body- normal, serum and protein electrophoresis-no M band seen, CSF –no cells, biochemistry normal, paraneoplastic panel-anti amphyphysin antibody positive, nerve conduction studies suggestive of demyelinating sensorimotor polyneuropathy. EMG revealed fasciculations, late and incomplete recruitment and interference pattern respectively in left deltoid, first dorsal interossei, vastus lateralis, gastrocnemius, tibialis anterior, genioglossus. Patient showed marked improvement with immunosuppression in form of intravenous steroids. Constellation of clinical features suggesting multiaxial involvement presenting simultaneously with sensory ataxia, cerebellar signs and fasciculations associated with anti amphiphysin antibody has never been shown in literature to the best of our knowledge, which makes it a unique and rare case and response to immunosuppression further favors the fact that his symptoms were immune mediated. doi:10.1016/j.jns.2019.10.1640
Journal of the Neurological Sciences 405S (2019) 105303 Poster Session 4
E. Kimelfelda, V. Gudkovaa, E. Koltsovaa, L. Stahovskayaa, N. Abramenkovab a Pirogov Russian National Research Medical University, Department of Neurology- neurosurgery and medical genetic, Moscow, Russia b Hospital for War Veterans №3, Department of Neurology, Moscow, Russia Background Fabry Disease (FD) is a rare, potentially curable, hereditary disease. Despite of enzyme replacement therapy (ERT) recurrent stroke and aseptic meningitidis are developed. Method The 26 year-old male was diagnosed FD after the first ischemic stroke. In a 6 months of receiving ERT the second ischemic stroke in the vertebrobasilar system was developed. In a month severe headache with nausea, vomiting and paresis of the right oculomotor nerve developed, without lesions on MRI. The cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis of 24/μL. Aseptic meningitis was diagnosed. Prednisolone 50 mg a day was prescribed. After treatment with glucocorticoids, oculomotor disturbances and cerebral symptoms regressed over a 3 day. In a month the third ischemic stroke developed in the patient in the vertebrobasilar system with headache and dysarthria. He had stopped to take prednisolone by this time. After this stroke headache increased, and the patient started taking nonsteroid anti-inflammatory drugs without permanent effect. The cognitive impairment progressed.