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Concentric needle reference jitter values of voluntarily activated orbicularis oculi and frontalis muscles in Sudanese population
Abstracts / Journal of the Neurological Sciences 357 (2015) e79–e82
A. Musa, A. Ahmed. Physiology, Faculty of Medicine/University of Khartoum, Khartoum, Sudan
doi:10.1016/j.jns.2015.08.280
206 WFN15-0914 Neurophysiology 1 Pattern reversal visual evoked potentials in primary open angle glaucoma M.K. Jhaa, N. Limbub, D. Thakurb, B.P. Badhuc, B.H. Paudelb. aPhysiology, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; b Department of Basic and Clinical Physiology, BP Koirala Institute of Health Sciences, Dharan, Nepal; cDepartment of Ophthalmology, BP Koirala Institute of Health Sciences, Dharan, Nepal
DP
Background: Single fiber electromyography (SFEMG) is the most sensitive neurophysiological test in diagnosing neuromuscular junction disorders, particularly myasthenia gravis (MG). Objectives: There is very little published work comparing jitter values of the orbicularis oculi (OOc) & frontalis muscles together. Only one study used single fiber (SF) had compared reference jitter values of OOc and frontalis together performing axonal stimulation method. Other studies compared jitter values of myasthenic patients. The aim of our study was to establish and to compare normal (reference) jitter values of voluntarily activated (V-) orbicularis oculi& frontalis muscles using disposable concentric needle (CN) in the same normal subject. Methods and patients: Prospectively 62 healthy volunteers (20-males & 42-females) were included in the study, their ages ranged (18– 70 years) and mean age (43.2 ± 14.0 years).CN-jitter values were expressed as the mean consecutive difference (MCD) of 30 potential pairs in μs. Ethical clearance was obtained from the Ethical Committee at the Faculty of Medicine, University of Khartoum. Subject's informed consent was obtained. Results: The mean jitter, mean of individual fiber pairs jitter & mean outliers jitter values with (upper 95% Confidence Limit — CL) for [OOc] were [26.9 ± 3.3 (31.97), 26.1 ± 8.9 (41.8) & 38.5 ± 5.7 (49.0) μs respectively] & for [frontalis] were [27.1 ± 3.0 (31.32), 26.4 ± 9.4 (42.9) & 39.9 ± 5 (49.2) μs respectively]. No significant statistical difference was found between CN jitter values of V-OOc & V-frontalis muscles. Conclusion: The suggested practical upper limits for mean jitter & for outliers jitter values were (32, 49 μs) for OOc & (32, 50 μs) for frontalis. We had established reference values for the parameters that label the patient as having positive jitter test. The study was unique in that it established and compared between CN-jitter values of (V-OOc & V-frontalis) in the same individual in a large number of healthy subjects.
proximal. The onset of this weakness was not preceded by upper respiratory tract infection, diarrhea or febrile illness. Results: On examination there was symmetrical weakness of the distal foot flexors and extensors (power ranges 0–3), lower limb reflexes varies from diminished to absent. Tone was normal in the majority and flaccid in some of the patients. All modalities of sensation are intact except for disturbance of light touch in two patients. All patients were investigated for other causes of neuropathies. Neurophysiological investigations revealed signs of predominant demyelination with axonal degeneration. Patients showed very good response to immunoglobulin infusion (i.e. recovery of weakness after one to three months). Immunological studies are undergoing. Conclusion: This is a preliminary report of a very uncommon presentation of acute motor neuropathy in diabetic patients. The cause possibly might be immune-mediated nerve damage but this has to be confirmed when we recruit more patients with detailed immune-profile studies.
OF
204 WFN15-0720 Neurophysiology 1 Concentric needle reference jitter values of voluntarily activated orbicularis oculi and frontalis muscles in Sudanese population
RO
e80
RR
doi:10.1016/j.jns.2015.08.279
EC
TE
Background: Visual evoked potentials (VEPs) assess the integrity of the visual pathways from the optic nerve to the occipital cortex. Primary open angle glaucoma is bilateral condition with optic atrophy and visual field defect. Optic disc cupping and visual field loss have been associated with prolongation of latency of VEP. Therefore, we studied the ocular glaucomatous damage and VEP abnormalities. Objectives: To study VEPs and ophthalmic variables in primary open angle glaucoma (POAG). Methods: Pattern reversal VEP tests were done in consenting 20 primary open angle glaucoma eyes and 40 normal control eyes. Statistical tests (paired t-test and Mann–Whitney test) were applied. Results: In POAG cases the refractive error [3.51 ± 1.88 vs. 1.88 ± 1.11, D, p = 0.001], cup disc ratio in percent [66.00 ± 16.98 vs. 28.50 ± 5.80, p = 0.000], intraocular pressure [19.55 ± 2.08 vs. 11.65 ± 1.64, mm Hg, p = 0.000] and automated visual field pattern standard deviation [4.13 ± 6.96 vs. 1.64 ± 0.45, dB, p = 0.000] were significantly more than in control. The visual acuity [0.41 ± 0.29 vs. 1.00 ± 0.00, p = 0.000], foveal visual sensitivity [25.92 ± 6.88 vs. 33.48 ± 1.75, dB, p = 0.000] and automated visual field mean deviation [−9.63 ± 10.58 vs. 0.07 ± 1.54, dB, p = 0.000] were significantly less in cases than in control. Among VEP variables pattern reversal latency N75 [68.53 ±12.34 vs. 67.30 ± 5.09, ms] and P100 [103.21 ± 10.82 vs. 98.25 ± 4.05, ms] were increased in cases but were not significant whereas N145 [149.00 ± 15.75 vs. 137.52 ± 15.20, ms, p = 0.011], was increased significantly in cases. The pattern reversal amplitude N75 [1.97 ± .35 vs. 2.47 ± .58, μV, p = 0.001], amplitude P100 [3.09 ± .46 vs. 6.07 ±1.44, μV, p = 0.000] and amplitude N145 [2.21 ± .58 vs. 4.45 ± 1.99, μV, p = 0.000] were decreased significantly in cases. Conclusion: POAG caused deterioration in all the ophthalmic variables measured with increase in latency and decrease in amplitude which signifies that there is glaucomatous damage.
CO
205 WFN15-0782 Neurophysiology 1 Acute and subacute motor neuropathy in diabetic patients case reports
UN
A. Ahmeda, A. Musab. aNeurophysiology/Neurology, Faculty of Medicine/ University of Khartoum, Khartoum, Sudan; bNeurophysiology, Faculty of Medicine/University of Khartoum, Khartoum, Sudan Background: Diabetic neuropathy is the most common complication of diabetes mellitus (DM), affecting as many as 50% of patients with type 1 and type 2 DM. There are four main types of diabetic neuropathy: Peripheral neuropathy, Autonomic neuropathy, Radiculo-plexus neuropathy (diabetic-amyotrophy), and Mononeuropathy. Objectives: To describe the clinical presentation, electrophysiological investigations and in the future the immunological profile of such patients. Patients and methods: Seven type II diabetic patients were selected for the study. Ethical approval and patients' informed consent have been obtained. They are all presented with acute and subacute onset of predominantly lower limb distal muscle weakness, on occasion
doi:10.1016/j.jns.2015.08.281
A. Musa, A. Ahmed. Physiology, Faculty of Medicine/University of Khartoum, Khartoum, Sudan
doi:10.1016/j.jns.2015.08.280
206 WFN15-0914 Neurophysiology 1 Pattern reversal visual evoked potentials in primary open angle glaucoma M.K. Jhaa, N. Limbub, D. Thakurb, B.P. Badhuc, B.H. Paudelb. aPhysiology, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; b Department of Basic and Clinical Physiology, BP Koirala Institute of Health Sciences, Dharan, Nepal; cDepartment of Ophthalmology, BP Koirala Institute of Health Sciences, Dharan, Nepal
DP
Background: Single fiber electromyography (SFEMG) is the most sensitive neurophysiological test in diagnosing neuromuscular junction disorders, particularly myasthenia gravis (MG). Objectives: There is very little published work comparing jitter values of the orbicularis oculi (OOc) & frontalis muscles together. Only one study used single fiber (SF) had compared reference jitter values of OOc and frontalis together performing axonal stimulation method. Other studies compared jitter values of myasthenic patients. The aim of our study was to establish and to compare normal (reference) jitter values of voluntarily activated (V-) orbicularis oculi& frontalis muscles using disposable concentric needle (CN) in the same normal subject. Methods and patients: Prospectively 62 healthy volunteers (20-males & 42-females) were included in the study, their ages ranged (18– 70 years) and mean age (43.2 ± 14.0 years).CN-jitter values were expressed as the mean consecutive difference (MCD) of 30 potential pairs in μs. Ethical clearance was obtained from the Ethical Committee at the Faculty of Medicine, University of Khartoum. Subject's informed consent was obtained. Results: The mean jitter, mean of individual fiber pairs jitter & mean outliers jitter values with (upper 95% Confidence Limit — CL) for [OOc] were [26.9 ± 3.3 (31.97), 26.1 ± 8.9 (41.8) & 38.5 ± 5.7 (49.0) μs respectively] & for [frontalis] were [27.1 ± 3.0 (31.32), 26.4 ± 9.4 (42.9) & 39.9 ± 5 (49.2) μs respectively]. No significant statistical difference was found between CN jitter values of V-OOc & V-frontalis muscles. Conclusion: The suggested practical upper limits for mean jitter & for outliers jitter values were (32, 49 μs) for OOc & (32, 50 μs) for frontalis. We had established reference values for the parameters that label the patient as having positive jitter test. The study was unique in that it established and compared between CN-jitter values of (V-OOc & V-frontalis) in the same individual in a large number of healthy subjects.
proximal. The onset of this weakness was not preceded by upper respiratory tract infection, diarrhea or febrile illness. Results: On examination there was symmetrical weakness of the distal foot flexors and extensors (power ranges 0–3), lower limb reflexes varies from diminished to absent. Tone was normal in the majority and flaccid in some of the patients. All modalities of sensation are intact except for disturbance of light touch in two patients. All patients were investigated for other causes of neuropathies. Neurophysiological investigations revealed signs of predominant demyelination with axonal degeneration. Patients showed very good response to immunoglobulin infusion (i.e. recovery of weakness after one to three months). Immunological studies are undergoing. Conclusion: This is a preliminary report of a very uncommon presentation of acute motor neuropathy in diabetic patients. The cause possibly might be immune-mediated nerve damage but this has to be confirmed when we recruit more patients with detailed immune-profile studies.
OF
204 WFN15-0720 Neurophysiology 1 Concentric needle reference jitter values of voluntarily activated orbicularis oculi and frontalis muscles in Sudanese population
RO
e80
RR
doi:10.1016/j.jns.2015.08.279
EC
TE
Background: Visual evoked potentials (VEPs) assess the integrity of the visual pathways from the optic nerve to the occipital cortex. Primary open angle glaucoma is bilateral condition with optic atrophy and visual field defect. Optic disc cupping and visual field loss have been associated with prolongation of latency of VEP. Therefore, we studied the ocular glaucomatous damage and VEP abnormalities. Objectives: To study VEPs and ophthalmic variables in primary open angle glaucoma (POAG). Methods: Pattern reversal VEP tests were done in consenting 20 primary open angle glaucoma eyes and 40 normal control eyes. Statistical tests (paired t-test and Mann–Whitney test) were applied. Results: In POAG cases the refractive error [3.51 ± 1.88 vs. 1.88 ± 1.11, D, p = 0.001], cup disc ratio in percent [66.00 ± 16.98 vs. 28.50 ± 5.80, p = 0.000], intraocular pressure [19.55 ± 2.08 vs. 11.65 ± 1.64, mm Hg, p = 0.000] and automated visual field pattern standard deviation [4.13 ± 6.96 vs. 1.64 ± 0.45, dB, p = 0.000] were significantly more than in control. The visual acuity [0.41 ± 0.29 vs. 1.00 ± 0.00, p = 0.000], foveal visual sensitivity [25.92 ± 6.88 vs. 33.48 ± 1.75, dB, p = 0.000] and automated visual field mean deviation [−9.63 ± 10.58 vs. 0.07 ± 1.54, dB, p = 0.000] were significantly less in cases than in control. Among VEP variables pattern reversal latency N75 [68.53 ±12.34 vs. 67.30 ± 5.09, ms] and P100 [103.21 ± 10.82 vs. 98.25 ± 4.05, ms] were increased in cases but were not significant whereas N145 [149.00 ± 15.75 vs. 137.52 ± 15.20, ms, p = 0.011], was increased significantly in cases. The pattern reversal amplitude N75 [1.97 ± .35 vs. 2.47 ± .58, μV, p = 0.001], amplitude P100 [3.09 ± .46 vs. 6.07 ±1.44, μV, p = 0.000] and amplitude N145 [2.21 ± .58 vs. 4.45 ± 1.99, μV, p = 0.000] were decreased significantly in cases. Conclusion: POAG caused deterioration in all the ophthalmic variables measured with increase in latency and decrease in amplitude which signifies that there is glaucomatous damage.
CO
205 WFN15-0782 Neurophysiology 1 Acute and subacute motor neuropathy in diabetic patients case reports
UN
A. Ahmeda, A. Musab. aNeurophysiology/Neurology, Faculty of Medicine/ University of Khartoum, Khartoum, Sudan; bNeurophysiology, Faculty of Medicine/University of Khartoum, Khartoum, Sudan Background: Diabetic neuropathy is the most common complication of diabetes mellitus (DM), affecting as many as 50% of patients with type 1 and type 2 DM. There are four main types of diabetic neuropathy: Peripheral neuropathy, Autonomic neuropathy, Radiculo-plexus neuropathy (diabetic-amyotrophy), and Mononeuropathy. Objectives: To describe the clinical presentation, electrophysiological investigations and in the future the immunological profile of such patients. Patients and methods: Seven type II diabetic patients were selected for the study. Ethical approval and patients' informed consent have been obtained. They are all presented with acute and subacute onset of predominantly lower limb distal muscle weakness, on occasion
doi:10.1016/j.jns.2015.08.281