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Carpal tunnel syndrome in patients with Parkinson's Disease: An electrodiagnostic and ultrasonographic study
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Abstracts / Journal of the Neurological Sciences 333 (2013) e109–e151
Scores could be helpful to predict dementia. Non-tremor motor deficits could be predictive factors for frontal cognitive decline and dementia.
doi:10.1016/j.jns.2013.07.458
Abstract—WCN 2013 No: 796 Topic: 2—Movement Disorders Structural changes of raphe nuclei detected by brain parenchyma sonography and diffusion tensor imaging in Parkinson's disease associated with depression M. Mijajlovic, M. Svetel, E. Stefanova, I. Petrovic, V. Kostic. Neurology Clinic, Clinical Center of Serbia and School of Medicine University of Belgrade, Belgrade, Serbia Objectives: Transcranial parenchymal sonography (TCS) showed decreased echogenicity of the brainstem raphe (BR) in depression in Parkinson's disease (PD). Magnetic resonance imaging and histopathological studies confirmed the hypothesis of a structural changes of the BR in depression in PD. We compared fractional anisotropy (FA) values and apparent diffusion coefficients (ADC) of the BR in depressed and non-depressed PD patients in comparison to TCS findings, to investigate possible structural changes of BR. Methods: 53 PD patients with depression (PD+ D+), 51 PD patients without depression (PD+ D−) and 50 healthy individuals (PD− D−) were included. PD patients with and without depression were matched for age, disease stage and duration. Echogenicity of BR was rated using TCS with a two point scale (grade 1: normal BR echogenicity same as red nuclei, grade 0: hypoechogenic, invisible or interrupted BR). ADC and FA values were calculated using SPM7 software. Results: Significant increase of mean ADC (t-test, each, P b 0.0001) and significant decrease of mean FA values (t-test, each, P b 0.0001) were found in patients with hypoechogenic BR compared with patients with normal raphe echogenicity. Mean FA values were significantly decreased in dorsal and ventral part of the BR in PD+ D+ patients but only in ventral part of the BR in PD+ without depression in comparison with healthy subjects (t-test, each, P b 0.0001). Conclusion: Our findings confirm structural changes of the BR in depression associated with PD which may reflect the pathogenic role of the basal limbic system and its projections in the pathogenesis of depression in PD. doi:10.1016/j.jns.2013.07.459
Abstract—WCN 2013 No: 816 Topic: 2—Movement Disorders Carpal tunnel syndrome in patients with Parkinson's Disease: An electrodiagnostic and ultrasonographic study S.B. Koha, J.S. Yoonb, S.J. Kimb, S.N. Yangb, S.J. Wonc, H.J. Kangb. a Neurology, Korea University, Seoul, Republic of Korea; bPhysical Medicine and Rehabilitation, Korea University, Seoul, Republic of Korea; c Physical Medicine and Rehabilitation, Yeouido St. Mary's Hospital, Seoul, Republic of Korea Introduction: Tremor is one of the cardinal symptoms of Parkinson's Disease (PD) and may cause cumulative traumatic injury to nerves of the hands. Carpal tunnel syndrome, in particular, may be caused by median nerve trauma. The aim of this study is to analyze the electrodiagnostic and ultrasonographic results of patients with PD and to verify the effect of hand movement in PD on the median nerve.
Methods: We recruited 31 hands of healthy controls (60.25 ± 14.67 years) and 81 hands of patients with PD (64.95 ± 11.13 years). The patients with PD were divided by Hoehn and Yahr (H&Y) clinical stage into two groups: mild and advanced. Clinical symptoms of patients with PD were measured by Unified Parkinson's Disease Rating Scale (UPDRS), and quality of life was measured by Parkinson's Disease Questionnaire. Median nerve conduction and cross-sectional area by ultrasonography were also evaluated. Results: Eighteen patients were classified in the mild group and 23 in the advanced group by H&Y stage. Median nerve cross-sectional area in patients with PD was significantly larger than that of the control group. Electrophysiologic findings of the median nerve were not significantly different between patients with PD and the control group. Total UPDRS score was not significantly correlated with cross-sectional area of the median nerve, but the severity of tremor was significantly correlated with cross-sectional area of the median nerve. Conclusions: Carpal tunnel syndrome diagnosed by ultrasound was frequent in PD, and tremor may be a risk factor for the development of median nerve pathology.
doi:10.1016/j.jns.2013.07.460
Abstract—WCN 2013 No: 821 Topic: 2—Movement Disorders An electrophysiological and kinesiological method for assessing spasticity M. Gürbüza, F. Kızılaya, S. Bilginb, Y. Albayrakb, H. Uysala. aNeurology Department, Akdeniz University, Antalya, Turkey; bFaculty of Engineering, Akdeniz University, Antalya, Turkey This study defines the electrophysiological characteristics of Patellar T reflex. Normal and spasticity changes by utilizing movement features of knee joint during the reflex and it also attempts to develop a measurement method to be used in spasticity. Normal and spasticity behaviors were examined with the electrophysiological records obtained from m. Quadriceps femoris and m. biceps femoris muscles. Medium and late latency responses in relevant muscles were examined with kinesiological parameter in subgroups in which the spasticity of patients was evaluated in accordance with clinical Ashworth scale. In the normal group, angular velocity was 57.95 ± 16.64 °/s. Latency of Patellar T reflex was 17.93 ± 1.94 ms and its amplitude was measured was 6404 ± 2859 μV. In cerebral spasticity group, angular velocity was 61.32 ± 20.61 °/s. Latency of Patellar T reflex was 17.6 ± 2.45 ms and its amplitude was 7551 ± 3939 μV. While BF-MLR could not be obtained in normal cases, it was established to be 54.73 ± 10.18 ms latency in cerebral spastics. It seems possible to produce a parameter that would assess and rate spasticity. Electrophysiological and kinesiological parameters failed to separately differentiate normal and spastics in compliance with Ashworth, but they could manage to differentiate between normal and spastic cases together. The parameter that was 69.61 ± 32.56 in normal cases decreased to 50.52 ± 28.98 in Ashworth 1, to 32.00 ± 14.90 in Ashworth 2, and finally to 14.48 ± 22.83 in Ashworth 3, and these changes was statistically significant. Consequently, it is possible to note that the pendulum of patellar T reflex could differentiate between spasticity and normal by electrophysiological and kinesiological evaluation.
doi:10.1016/j.jns.2013.07.461
Abstracts / Journal of the Neurological Sciences 333 (2013) e109–e151
Scores could be helpful to predict dementia. Non-tremor motor deficits could be predictive factors for frontal cognitive decline and dementia.
doi:10.1016/j.jns.2013.07.458
Abstract—WCN 2013 No: 796 Topic: 2—Movement Disorders Structural changes of raphe nuclei detected by brain parenchyma sonography and diffusion tensor imaging in Parkinson's disease associated with depression M. Mijajlovic, M. Svetel, E. Stefanova, I. Petrovic, V. Kostic. Neurology Clinic, Clinical Center of Serbia and School of Medicine University of Belgrade, Belgrade, Serbia Objectives: Transcranial parenchymal sonography (TCS) showed decreased echogenicity of the brainstem raphe (BR) in depression in Parkinson's disease (PD). Magnetic resonance imaging and histopathological studies confirmed the hypothesis of a structural changes of the BR in depression in PD. We compared fractional anisotropy (FA) values and apparent diffusion coefficients (ADC) of the BR in depressed and non-depressed PD patients in comparison to TCS findings, to investigate possible structural changes of BR. Methods: 53 PD patients with depression (PD+ D+), 51 PD patients without depression (PD+ D−) and 50 healthy individuals (PD− D−) were included. PD patients with and without depression were matched for age, disease stage and duration. Echogenicity of BR was rated using TCS with a two point scale (grade 1: normal BR echogenicity same as red nuclei, grade 0: hypoechogenic, invisible or interrupted BR). ADC and FA values were calculated using SPM7 software. Results: Significant increase of mean ADC (t-test, each, P b 0.0001) and significant decrease of mean FA values (t-test, each, P b 0.0001) were found in patients with hypoechogenic BR compared with patients with normal raphe echogenicity. Mean FA values were significantly decreased in dorsal and ventral part of the BR in PD+ D+ patients but only in ventral part of the BR in PD+ without depression in comparison with healthy subjects (t-test, each, P b 0.0001). Conclusion: Our findings confirm structural changes of the BR in depression associated with PD which may reflect the pathogenic role of the basal limbic system and its projections in the pathogenesis of depression in PD. doi:10.1016/j.jns.2013.07.459
Abstract—WCN 2013 No: 816 Topic: 2—Movement Disorders Carpal tunnel syndrome in patients with Parkinson's Disease: An electrodiagnostic and ultrasonographic study S.B. Koha, J.S. Yoonb, S.J. Kimb, S.N. Yangb, S.J. Wonc, H.J. Kangb. a Neurology, Korea University, Seoul, Republic of Korea; bPhysical Medicine and Rehabilitation, Korea University, Seoul, Republic of Korea; c Physical Medicine and Rehabilitation, Yeouido St. Mary's Hospital, Seoul, Republic of Korea Introduction: Tremor is one of the cardinal symptoms of Parkinson's Disease (PD) and may cause cumulative traumatic injury to nerves of the hands. Carpal tunnel syndrome, in particular, may be caused by median nerve trauma. The aim of this study is to analyze the electrodiagnostic and ultrasonographic results of patients with PD and to verify the effect of hand movement in PD on the median nerve.
Methods: We recruited 31 hands of healthy controls (60.25 ± 14.67 years) and 81 hands of patients with PD (64.95 ± 11.13 years). The patients with PD were divided by Hoehn and Yahr (H&Y) clinical stage into two groups: mild and advanced. Clinical symptoms of patients with PD were measured by Unified Parkinson's Disease Rating Scale (UPDRS), and quality of life was measured by Parkinson's Disease Questionnaire. Median nerve conduction and cross-sectional area by ultrasonography were also evaluated. Results: Eighteen patients were classified in the mild group and 23 in the advanced group by H&Y stage. Median nerve cross-sectional area in patients with PD was significantly larger than that of the control group. Electrophysiologic findings of the median nerve were not significantly different between patients with PD and the control group. Total UPDRS score was not significantly correlated with cross-sectional area of the median nerve, but the severity of tremor was significantly correlated with cross-sectional area of the median nerve. Conclusions: Carpal tunnel syndrome diagnosed by ultrasound was frequent in PD, and tremor may be a risk factor for the development of median nerve pathology.
doi:10.1016/j.jns.2013.07.460
Abstract—WCN 2013 No: 821 Topic: 2—Movement Disorders An electrophysiological and kinesiological method for assessing spasticity M. Gürbüza, F. Kızılaya, S. Bilginb, Y. Albayrakb, H. Uysala. aNeurology Department, Akdeniz University, Antalya, Turkey; bFaculty of Engineering, Akdeniz University, Antalya, Turkey This study defines the electrophysiological characteristics of Patellar T reflex. Normal and spasticity changes by utilizing movement features of knee joint during the reflex and it also attempts to develop a measurement method to be used in spasticity. Normal and spasticity behaviors were examined with the electrophysiological records obtained from m. Quadriceps femoris and m. biceps femoris muscles. Medium and late latency responses in relevant muscles were examined with kinesiological parameter in subgroups in which the spasticity of patients was evaluated in accordance with clinical Ashworth scale. In the normal group, angular velocity was 57.95 ± 16.64 °/s. Latency of Patellar T reflex was 17.93 ± 1.94 ms and its amplitude was measured was 6404 ± 2859 μV. In cerebral spasticity group, angular velocity was 61.32 ± 20.61 °/s. Latency of Patellar T reflex was 17.6 ± 2.45 ms and its amplitude was 7551 ± 3939 μV. While BF-MLR could not be obtained in normal cases, it was established to be 54.73 ± 10.18 ms latency in cerebral spastics. It seems possible to produce a parameter that would assess and rate spasticity. Electrophysiological and kinesiological parameters failed to separately differentiate normal and spastics in compliance with Ashworth, but they could manage to differentiate between normal and spastic cases together. The parameter that was 69.61 ± 32.56 in normal cases decreased to 50.52 ± 28.98 in Ashworth 1, to 32.00 ± 14.90 in Ashworth 2, and finally to 14.48 ± 22.83 in Ashworth 3, and these changes was statistically significant. Consequently, it is possible to note that the pendulum of patellar T reflex could differentiate between spasticity and normal by electrophysiological and kinesiological evaluation.
doi:10.1016/j.jns.2013.07.461