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P081 Polyneuropathy changes in hemodialysis patients
S92
Abstracts of the 13th European Congress of Clinical Neurophysiology / Clinical Neurophysiology 119 (2008), S1–S131
stimulus with different settings, keeping the test stimulus equal in duration to the conditioning stimulus: A, 0.5 ms duration, current set for just maximal SNAP; B, 0.5 ms, current 140% of maximal; andC, 0.1 ms, just maximal. Similar stimulus settings were applied to rat saphenous nerves in-vitro. Results: Relative refractory period was longest with stimulus setting A (3.67±1.05 ms), followed by B (3.44±1.05 ms) and C (3.27±1.06 ms). Differences between the groups are all statistically significant (p<0.01, paired t-test). Superexcitability was greater with 0.5 ms stimuli (A: -20.47±1.4%, B: -20.3±1.4%) than with 0.1ms (C: -16.6±1.06%, p<0.01, paired t-test). Similarly, subexcitability was not different with 0.5 ms stimuli (A: 10.3±1.0%, B: 9.4±1.0%), but less pronounced with 0.1ms (C: 6.8±0.9%, p<0.05, paired t-test). In the rat in-vitro model we found similar findings between the different stimulus configurations. Conclusion: When estimated by threshold tracking, relative refractory period depends on the duration and amplitude of the conditioning stimulus, while superexcitability and subexcitability depend on stimulus duration.
P080 Gender, age and body constitution as risk factors for common focal neuropathies Carmen Martinez Aparicio 1 , Björn Falck 2 , Leena Puksa 2 of Clinical Neurophysiology, University Hospital Virgen de las Nieves, Granada, Spain; 2 Department of Clinical Neurophysiology, University Hospital of Turku, Finland; 3 Department of Clinical Neurophysiology, University of Tartu, Estonia 1 Department
Group I: patients with glomerulonephritis – GN; Group II: patients with tubulointerstitial nephritis – TIN; Group III: patients with other kidney diseases – OKD. We compare biochemical parameters and dialysis adequacy (KT/V) and Nerve conduction velocity (NCV) of peroneal, tibial and sural nerves. Biochemical parameters were satisfactory for patients on chronic HD. Polyneuropathy symptoms were found in 42% of patients. Pathological neurophysiological parameters were found in over 95% patients. Mean values of all analyzed neurophysiological parameters, except peroneal nerve, were pathological. Significant correlation was found between peroneal NCV, peroneal F wave, tibial NCV and urea; tibial distal latency DL and KT/V and hemoglobin concentrations; sural NCV and glucose. The this study, we registered patological neurophysiological parameters in patients on HD, and the worse polyneuropathy changes were found in patients with glomerulonephritis. Significant correlation between neurophysiological parameters and KT/V as well as concentrations of, parathyroid hormone (PTH) and potassium were found in patients with GN; neurophysiological parameters and KT/V, concentrations of glucose, and potassium in patients with TIN; and neurophysiological parameters and potassium concentration in patients with OKD. The most sensitive parameters in this study were snsitive NCV of sural nerve and F wave. Neurophysiological parameters were in correlation with dialysis adequacy, serum urea, glucose and hemoglobin level as well as with concentrations of PTH and potassium.
Purpose: To study risk factors for common neuropathies seen in routine EMG studies. Marerial and methods: All patients referred for the first time for EMG between May 2006 and March 2007 at departments of clinical neurophysiology at the University hospitals in Turku, Finland and Tartu, Estonia and a private neurophysiological clinic in Turku were studied. Only the patient’s first visit was included, follow-up studies were excluded. The patient data field of the EMG equipment included age, gender, height, weight and diagnosis from the study. The patients with no abnormalities found on EMG served as the reference population. Results: Altogether 2010 patients were studied (1157 women and 853 men). 976 (530 women and 546 men) patients had abnormal findings. Carpal tunnel syndrome (CTS) was twice as common in females as men. Morton’s metatarsalgia was mostly seen in women. Ulnar neuropathy at the elbow was twice as common in men as women. Obesity increased the risk for CTS. Meralgia paresthetica occurred only in obese patients. Lumbar radiculopathy patients tended to be older than the patients without neuropathies. In women with cervical radiculopathy mild obesity was more common. Conclusions: This is not a population based epidemiological study due to bias in the referral pattern. This is true particularly for diabetic polyneuropathy and lumbar radiculopathies, only a fraction of all patients with diabetic polyneuropathy or lumbar radiculopathies are referred for EMG. For these disorders the study is misleading. However, most focal peripheral neuropathies be referred for EMG and we think that this represents a true sample of the patients. Age, gender and BMI are significant risk factors for several neuropathies seen in the EMG lab. Women are more likely to have CTS and Morton’s metatarsalgia than men. Obesity is a significant risk factor for CTS and particularly in meralgia paresthetica.
P082 Thermal sensory testing (Thermotest) in polyneuropathies
P081 Polyneuropathy changes in hemodialysis patients
P083 Blink reflex excitability in non-paralyzed side after facial nerve palsy
D.
Matanovic 1 ,
Jovanovic 2
D. of Physical Medicine and Rehabilitation, Serbia; 2 Institute of Urology and Nephrology, Clinical Center of Serbia, Serbia
1 Clinic
Uremic polyneuropathy is a common complication in patients with advanced chronic renal failure, patients with end-stage renal failure as well as in those on dialysis, but the underlying mechanism is unknown. The aim of study was to analyze frequency and causes of polyneuropathy in patients on hemodialysis (HD). We examine 41 patients (26 men), aged between 26 and 74 (55.7±11.8) who were on chronic HD in our center from 3 to 28 (13.2±6.3) years, divided into 3 groups:
Susana Santiago-Pérez, Teresa Ferrer Hospital LA PAZ, Madrid SPAIN Purpose: To analyze the usefulness of Thermotest use in the diagnosis of neuropathies. Method:Thermal stimuli are applied (method of limits) in 357 patients with clinical diagnosis of polyneuropathy: 169 diabetes mellitus (DM), 22 small-fibre neuropathy (SFN), 20 Friedreich’s ataxia (FA) and 146 neuropathies of several causes. Thermotest is performed in 349 hands and 357 feet. Warm and cold thresholds (WT, CT), thermal limen (TL), frequency of paradoxical responses (PR) and fatigue are calculated. Neurophysiological examination (NFE) with electroneurography and electromyography is previously performed. Results: Thermotest has significant correlation with symptoms (hypoesthesia and allodynia), physical examination (hypoesthesia and hypo-areflexia) and abnormal NFE (p < 0.01). PR and fatigue appears in 16,2% and 27,5%. In patients with dysesthesias or allodynia, Thermotest is the only conclusive study in 26.9% of patients whereas NFE is abnormal in 11.5% (p < 0.01). If patients are grouped according to neuropathy type, there are significant differences between Thermotest and NFE (p < 0.01). In SFN Thermotest is most frequently conclusive (4.5% NFE vs. 27.3% Thermotest). NFE is the election test in FA (95% abnormal), nonetheless 50% of FA patients have also impaired Thermotest. Conclusions: Thermotest is the election test for the evaluation of SFN and patients complaining of dysesthesias and allodynia. Thermotest and NFE are complementary techniques to determine the overlapping and impairment degree of small and large-myelinated fibres.
Sevki Sahin 1 , Mehmet Yaman 2 , Meral Erdemir Kiziltan 3 1 Department of Neurology, Faculty of Medicine, Maltepe University, Istanbul, Turkey; 2 Department of Neurology, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey; 3 Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey Purpose: Peripheral facial palsy (PFP) may trigger compensatory changes including an increased blink rate and muscular overactivity even blepharospasm on the contralateral side of the paralysis. With the double-shock technique, enhancement of blink reflex (BR) excitability demonstrated both paralysed and non-paralysed side (NPS) in cases with residual weakness after
Abstracts of the 13th European Congress of Clinical Neurophysiology / Clinical Neurophysiology 119 (2008), S1–S131
stimulus with different settings, keeping the test stimulus equal in duration to the conditioning stimulus: A, 0.5 ms duration, current set for just maximal SNAP; B, 0.5 ms, current 140% of maximal; andC, 0.1 ms, just maximal. Similar stimulus settings were applied to rat saphenous nerves in-vitro. Results: Relative refractory period was longest with stimulus setting A (3.67±1.05 ms), followed by B (3.44±1.05 ms) and C (3.27±1.06 ms). Differences between the groups are all statistically significant (p<0.01, paired t-test). Superexcitability was greater with 0.5 ms stimuli (A: -20.47±1.4%, B: -20.3±1.4%) than with 0.1ms (C: -16.6±1.06%, p<0.01, paired t-test). Similarly, subexcitability was not different with 0.5 ms stimuli (A: 10.3±1.0%, B: 9.4±1.0%), but less pronounced with 0.1ms (C: 6.8±0.9%, p<0.05, paired t-test). In the rat in-vitro model we found similar findings between the different stimulus configurations. Conclusion: When estimated by threshold tracking, relative refractory period depends on the duration and amplitude of the conditioning stimulus, while superexcitability and subexcitability depend on stimulus duration.
P080 Gender, age and body constitution as risk factors for common focal neuropathies Carmen Martinez Aparicio 1 , Björn Falck 2 , Leena Puksa 2 of Clinical Neurophysiology, University Hospital Virgen de las Nieves, Granada, Spain; 2 Department of Clinical Neurophysiology, University Hospital of Turku, Finland; 3 Department of Clinical Neurophysiology, University of Tartu, Estonia 1 Department
Group I: patients with glomerulonephritis – GN; Group II: patients with tubulointerstitial nephritis – TIN; Group III: patients with other kidney diseases – OKD. We compare biochemical parameters and dialysis adequacy (KT/V) and Nerve conduction velocity (NCV) of peroneal, tibial and sural nerves. Biochemical parameters were satisfactory for patients on chronic HD. Polyneuropathy symptoms were found in 42% of patients. Pathological neurophysiological parameters were found in over 95% patients. Mean values of all analyzed neurophysiological parameters, except peroneal nerve, were pathological. Significant correlation was found between peroneal NCV, peroneal F wave, tibial NCV and urea; tibial distal latency DL and KT/V and hemoglobin concentrations; sural NCV and glucose. The this study, we registered patological neurophysiological parameters in patients on HD, and the worse polyneuropathy changes were found in patients with glomerulonephritis. Significant correlation between neurophysiological parameters and KT/V as well as concentrations of, parathyroid hormone (PTH) and potassium were found in patients with GN; neurophysiological parameters and KT/V, concentrations of glucose, and potassium in patients with TIN; and neurophysiological parameters and potassium concentration in patients with OKD. The most sensitive parameters in this study were snsitive NCV of sural nerve and F wave. Neurophysiological parameters were in correlation with dialysis adequacy, serum urea, glucose and hemoglobin level as well as with concentrations of PTH and potassium.
Purpose: To study risk factors for common neuropathies seen in routine EMG studies. Marerial and methods: All patients referred for the first time for EMG between May 2006 and March 2007 at departments of clinical neurophysiology at the University hospitals in Turku, Finland and Tartu, Estonia and a private neurophysiological clinic in Turku were studied. Only the patient’s first visit was included, follow-up studies were excluded. The patient data field of the EMG equipment included age, gender, height, weight and diagnosis from the study. The patients with no abnormalities found on EMG served as the reference population. Results: Altogether 2010 patients were studied (1157 women and 853 men). 976 (530 women and 546 men) patients had abnormal findings. Carpal tunnel syndrome (CTS) was twice as common in females as men. Morton’s metatarsalgia was mostly seen in women. Ulnar neuropathy at the elbow was twice as common in men as women. Obesity increased the risk for CTS. Meralgia paresthetica occurred only in obese patients. Lumbar radiculopathy patients tended to be older than the patients without neuropathies. In women with cervical radiculopathy mild obesity was more common. Conclusions: This is not a population based epidemiological study due to bias in the referral pattern. This is true particularly for diabetic polyneuropathy and lumbar radiculopathies, only a fraction of all patients with diabetic polyneuropathy or lumbar radiculopathies are referred for EMG. For these disorders the study is misleading. However, most focal peripheral neuropathies be referred for EMG and we think that this represents a true sample of the patients. Age, gender and BMI are significant risk factors for several neuropathies seen in the EMG lab. Women are more likely to have CTS and Morton’s metatarsalgia than men. Obesity is a significant risk factor for CTS and particularly in meralgia paresthetica.
P082 Thermal sensory testing (Thermotest) in polyneuropathies
P081 Polyneuropathy changes in hemodialysis patients
P083 Blink reflex excitability in non-paralyzed side after facial nerve palsy
D.
Matanovic 1 ,
Jovanovic 2
D. of Physical Medicine and Rehabilitation, Serbia; 2 Institute of Urology and Nephrology, Clinical Center of Serbia, Serbia
1 Clinic
Uremic polyneuropathy is a common complication in patients with advanced chronic renal failure, patients with end-stage renal failure as well as in those on dialysis, but the underlying mechanism is unknown. The aim of study was to analyze frequency and causes of polyneuropathy in patients on hemodialysis (HD). We examine 41 patients (26 men), aged between 26 and 74 (55.7±11.8) who were on chronic HD in our center from 3 to 28 (13.2±6.3) years, divided into 3 groups:
Susana Santiago-Pérez, Teresa Ferrer Hospital LA PAZ, Madrid SPAIN Purpose: To analyze the usefulness of Thermotest use in the diagnosis of neuropathies. Method:Thermal stimuli are applied (method of limits) in 357 patients with clinical diagnosis of polyneuropathy: 169 diabetes mellitus (DM), 22 small-fibre neuropathy (SFN), 20 Friedreich’s ataxia (FA) and 146 neuropathies of several causes. Thermotest is performed in 349 hands and 357 feet. Warm and cold thresholds (WT, CT), thermal limen (TL), frequency of paradoxical responses (PR) and fatigue are calculated. Neurophysiological examination (NFE) with electroneurography and electromyography is previously performed. Results: Thermotest has significant correlation with symptoms (hypoesthesia and allodynia), physical examination (hypoesthesia and hypo-areflexia) and abnormal NFE (p < 0.01). PR and fatigue appears in 16,2% and 27,5%. In patients with dysesthesias or allodynia, Thermotest is the only conclusive study in 26.9% of patients whereas NFE is abnormal in 11.5% (p < 0.01). If patients are grouped according to neuropathy type, there are significant differences between Thermotest and NFE (p < 0.01). In SFN Thermotest is most frequently conclusive (4.5% NFE vs. 27.3% Thermotest). NFE is the election test in FA (95% abnormal), nonetheless 50% of FA patients have also impaired Thermotest. Conclusions: Thermotest is the election test for the evaluation of SFN and patients complaining of dysesthesias and allodynia. Thermotest and NFE are complementary techniques to determine the overlapping and impairment degree of small and large-myelinated fibres.
Sevki Sahin 1 , Mehmet Yaman 2 , Meral Erdemir Kiziltan 3 1 Department of Neurology, Faculty of Medicine, Maltepe University, Istanbul, Turkey; 2 Department of Neurology, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey; 3 Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey Purpose: Peripheral facial palsy (PFP) may trigger compensatory changes including an increased blink rate and muscular overactivity even blepharospasm on the contralateral side of the paralysis. With the double-shock technique, enhancement of blink reflex (BR) excitability demonstrated both paralysed and non-paralysed side (NPS) in cases with residual weakness after