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ID 4 – EMG in differential diagnosis of lumbosacral plexopathies
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Abstracts / Clinical Neurophysiology 127 (2016) e18–e132
ID 399 – Investigation of patients with hippocampal sclerosis associated with unusual epileptic foci—E.N. Vanli-Yavuz a,b, H. Yener a, N. Bebek a, C. Gurses a, A. Gokyigit a, B. Baykan a (a Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Clinical Neurophysiology Unit, Istanbul, Turkey, b Koc University Hospital, Neurology Unit, Istanbul, Turkey) Rationale: Hippocampal sclerosis (HS) is usually associated with anterior temporal spikes/sharp waves in EEG. We aimed to investigate the differences between HS patients with unusual epileptic foci in comparison to typical foci. Methods: 126 patients followed up with HS were evaluated. All MRIs were investigated for the presence of two major criteria of HS diagnosis, namely T1 atrophy and T2 hyperintensity. All EEG and video-EEG investigations (a total of 496) were re-evaluated for unusual epileptic activities except T1/2, F7/8, T3/4 foci. Postoperative seizure outcomes were investigated according to the Engel classification. Results: There were 20 patients (9 males; 7 with bilateral HS) with unusual foci with a follow-up duration of 107.8 ± 89.3 months. Their findings were compared to 106 patients with usual HS. Statistical analysis could not show any difference between these groups. All but 2 showed drug-resistant course; 5 had status epilepticus and 5 had mental retardation without reaching statistical significance. Ten were operated and 7 of them were grouped as Engel classification 1. Conclusion: Our study showed that unusual epileptic foci could be seen in 15.9% of HS patients. Although they had drug resistant course, they might show good post-operative outcome, when preoperative diagnostics were appropriately planned. doi:10.1016/j.clinph.2015.11.293
PS-02-05 Electromyography, neuromuscular disorders I
ID 4 – EMG in differential diagnosis of lumbosacral plexopathies—E. Ehler (Department of Neurology, Regional Hospital and University of Pardubice, Czech Republic)
Introduction: Lumbosacral plexus consists of ventral branches of roots L1-S4 and is divided in two relatively separate portions. The lumbar plexus originates in L1, L2, L3 and part of L4 and frequently receives contribution from Th12. The sacral plexus consists of lower branch L4 and ventral branches L5-S4. EMG examination of lumbal and sacral plexopathies often yields suboptimal results. Electrodiagnosis of lumbal plexopathy relies on needle EMG. Routine motor and sensory nerve conductions studies are unavailable for most of its terminal branches. For the sacral plexopathy the motor and sensory amplitudes of the peroneal, tibial, ischiadicus and suralis nerve may help by showing axonal involvement. Conversely, reduced nerve conduction velocities can point to a more diffuse demyelinating neuropathy. Aim: Evaluation of the role of various neurophysiological methods in diagnostic work up in various lumbosacral plexopathies. Methods: In motor nerve conduction studies not only common stimulations points but also proximal root stimulation with use of magnetic coil can be exploited. In sensory nerve conduction studies the needle stimulation or needle registration is an option. For diagnosis of plexus or root lesion F-wave studies or H-reflex (also for femoral nerve) can be used. Somatosensory evoked potentials may be important for setting the diagnosis. Not only distal – easy
accessible – muscles, but also proximal and paraspinal muscles should be investigated. Results: Some typical case reports are displayed with clinical findings and neuroimaging correlates (diabetic radiculo-plexopathy, autoimmune lumbosacral plexopathy, neoplastic, traumatic, ischemic and inflammatory plexopathies). Conclusion: EMG has an important role in differential diagnostics of plexopathies. The use of various electrodiagnostic methods demand broad spectre of skills in EMG laboratory and deep knowledge of individual plexopathies. doi:10.1016/j.clinph.2015.11.294
ID 9 – Agreement between clinical and neurophysiologic diagnoses of carpal tunnel syndrome—V. Martic, N. Komatina (Clinic for Neurology, Military Medical Academy, Belgrade, Serbia) The objective of this study was to determine sensitivity and specificity of clinical examination for diagnosis of carpal tunnel syndroma (CTS) against the neurophysiologic evaluation. The sample included 181 patients who were referred to a neurologist for further diagnosis of pain and parestesias in the arm (81 women, mean age 42 ± 14 years; 100 men 52 ± 16 years). In 181 patients, clinical findings were considered positive for CTS in 37 patients. The neurophysiologic findings for CTS were positive in 60 patients. Both clinical and neurophysiological findings were positive in 31 patients and both findings were negative in 115 patients (sensitivity 0.51, specificity 0.95). Low sensitivity and high specificity suggests that it is easier to exclude rather than to accurately diagnose CTS based on clinical examination alone. Thus, there is a need for neurophysiologic evaluation of patients with complains in the arm. doi:10.1016/j.clinph.2015.11.295
ID 18 – Electrophysiological findings in idiopathic acute polyradiculoneuritis concurrent with myasthenia gravis in a West Highland White Terrier dog—G.D. Stanciu, M. Musteata, G. Solcan (Neurology, Faculty of Veterinary Medicine in Iasi, Iasi, Romania) Background: The concurrent development of idiopathic acute canine polyra-diculoneuritis (IACP) and myasthenia gravis (MG) have a rare occurrence in both veterinary and human medicine. Aim: This study describes the electrophysiological aspects of these two diseases when concurrent. Methods: The tests were carried out using the Neuropack, MEB 9400 Electrodiagnostic System, in an 11-years-old dog diagnosed with IACP based on clinical and electrophysiological findings and with positive titer for acetylcholine receptor antibodies (AChR). Results: Important indicators of IACP were positive sharp waves and complex repetitive discharges which characterized electromyogram; polyphasic action potentials with marked dispersion; signs of demyelination at electroneurography and an increase latency of Fwaves. Cerebrospinal fluid had a normal number of cells with increased protein content. In addition a reduction with 18% in the
Abstracts / Clinical Neurophysiology 127 (2016) e18–e132
ID 399 – Investigation of patients with hippocampal sclerosis associated with unusual epileptic foci—E.N. Vanli-Yavuz a,b, H. Yener a, N. Bebek a, C. Gurses a, A. Gokyigit a, B. Baykan a (a Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Clinical Neurophysiology Unit, Istanbul, Turkey, b Koc University Hospital, Neurology Unit, Istanbul, Turkey) Rationale: Hippocampal sclerosis (HS) is usually associated with anterior temporal spikes/sharp waves in EEG. We aimed to investigate the differences between HS patients with unusual epileptic foci in comparison to typical foci. Methods: 126 patients followed up with HS were evaluated. All MRIs were investigated for the presence of two major criteria of HS diagnosis, namely T1 atrophy and T2 hyperintensity. All EEG and video-EEG investigations (a total of 496) were re-evaluated for unusual epileptic activities except T1/2, F7/8, T3/4 foci. Postoperative seizure outcomes were investigated according to the Engel classification. Results: There were 20 patients (9 males; 7 with bilateral HS) with unusual foci with a follow-up duration of 107.8 ± 89.3 months. Their findings were compared to 106 patients with usual HS. Statistical analysis could not show any difference between these groups. All but 2 showed drug-resistant course; 5 had status epilepticus and 5 had mental retardation without reaching statistical significance. Ten were operated and 7 of them were grouped as Engel classification 1. Conclusion: Our study showed that unusual epileptic foci could be seen in 15.9% of HS patients. Although they had drug resistant course, they might show good post-operative outcome, when preoperative diagnostics were appropriately planned. doi:10.1016/j.clinph.2015.11.293
PS-02-05 Electromyography, neuromuscular disorders I
ID 4 – EMG in differential diagnosis of lumbosacral plexopathies—E. Ehler (Department of Neurology, Regional Hospital and University of Pardubice, Czech Republic)
Introduction: Lumbosacral plexus consists of ventral branches of roots L1-S4 and is divided in two relatively separate portions. The lumbar plexus originates in L1, L2, L3 and part of L4 and frequently receives contribution from Th12. The sacral plexus consists of lower branch L4 and ventral branches L5-S4. EMG examination of lumbal and sacral plexopathies often yields suboptimal results. Electrodiagnosis of lumbal plexopathy relies on needle EMG. Routine motor and sensory nerve conductions studies are unavailable for most of its terminal branches. For the sacral plexopathy the motor and sensory amplitudes of the peroneal, tibial, ischiadicus and suralis nerve may help by showing axonal involvement. Conversely, reduced nerve conduction velocities can point to a more diffuse demyelinating neuropathy. Aim: Evaluation of the role of various neurophysiological methods in diagnostic work up in various lumbosacral plexopathies. Methods: In motor nerve conduction studies not only common stimulations points but also proximal root stimulation with use of magnetic coil can be exploited. In sensory nerve conduction studies the needle stimulation or needle registration is an option. For diagnosis of plexus or root lesion F-wave studies or H-reflex (also for femoral nerve) can be used. Somatosensory evoked potentials may be important for setting the diagnosis. Not only distal – easy
accessible – muscles, but also proximal and paraspinal muscles should be investigated. Results: Some typical case reports are displayed with clinical findings and neuroimaging correlates (diabetic radiculo-plexopathy, autoimmune lumbosacral plexopathy, neoplastic, traumatic, ischemic and inflammatory plexopathies). Conclusion: EMG has an important role in differential diagnostics of plexopathies. The use of various electrodiagnostic methods demand broad spectre of skills in EMG laboratory and deep knowledge of individual plexopathies. doi:10.1016/j.clinph.2015.11.294
ID 9 – Agreement between clinical and neurophysiologic diagnoses of carpal tunnel syndrome—V. Martic, N. Komatina (Clinic for Neurology, Military Medical Academy, Belgrade, Serbia) The objective of this study was to determine sensitivity and specificity of clinical examination for diagnosis of carpal tunnel syndroma (CTS) against the neurophysiologic evaluation. The sample included 181 patients who were referred to a neurologist for further diagnosis of pain and parestesias in the arm (81 women, mean age 42 ± 14 years; 100 men 52 ± 16 years). In 181 patients, clinical findings were considered positive for CTS in 37 patients. The neurophysiologic findings for CTS were positive in 60 patients. Both clinical and neurophysiological findings were positive in 31 patients and both findings were negative in 115 patients (sensitivity 0.51, specificity 0.95). Low sensitivity and high specificity suggests that it is easier to exclude rather than to accurately diagnose CTS based on clinical examination alone. Thus, there is a need for neurophysiologic evaluation of patients with complains in the arm. doi:10.1016/j.clinph.2015.11.295
ID 18 – Electrophysiological findings in idiopathic acute polyradiculoneuritis concurrent with myasthenia gravis in a West Highland White Terrier dog—G.D. Stanciu, M. Musteata, G. Solcan (Neurology, Faculty of Veterinary Medicine in Iasi, Iasi, Romania) Background: The concurrent development of idiopathic acute canine polyra-diculoneuritis (IACP) and myasthenia gravis (MG) have a rare occurrence in both veterinary and human medicine. Aim: This study describes the electrophysiological aspects of these two diseases when concurrent. Methods: The tests were carried out using the Neuropack, MEB 9400 Electrodiagnostic System, in an 11-years-old dog diagnosed with IACP based on clinical and electrophysiological findings and with positive titer for acetylcholine receptor antibodies (AChR). Results: Important indicators of IACP were positive sharp waves and complex repetitive discharges which characterized electromyogram; polyphasic action potentials with marked dispersion; signs of demyelination at electroneurography and an increase latency of Fwaves. Cerebrospinal fluid had a normal number of cells with increased protein content. In addition a reduction with 18% in the