- Email: [email protected]
P185 Sensory conduction study of the femoral nerve
S118
Abstracts of the 13th European Congress of Clinical Neurophysiology / Clinical Neurophysiology 119 (2008), S1–S131
servative menagement fails to releive the symptoms, surgical decompression of the entapped nerve can be performed.
nerve surgery, conservative therapy must be considered before reconstructive procedures.
P185 Sensory conduction study of the femoral nerve
P187 Comparison of the effects of the antiepileptic drugs on peripheral nerve conduction
Bademkiran 1 ,
Acarer 1 ,
Colakoglu 1 ,
Ertekin 1 ,
Fikret Ahmet Zafer Cumhur Basra Obay 2 1 Ege University Medical School Department of Neurology; 2 Department of Physiology, Dicle University, Diyarbakir, Turkey; 3 Ege University Medical School, Department of Neurology, Izmir, Turkey
Purpose: There are mostly difficulties in the study of femoral sensory nerve transmission due to muscle artefacts. Moreover, as of today no orthodromic study related to anterior femoral cutaneous nerve (ACFN femoral intermediate cutaneous branch) has been made. In our study, saphenous nerve (SN) which was defined before, infrapatellar nerve (IPBSN) and the newly-defined orthodromic ACFN nerve transmissions have been examined. Method: The present study was undertaken in 50 normal, healthy control subjects. The IPBSN was stimulated medially with a surface electrode 1-2 cm below the patella. SN was stimulated in the side of index medial after saphenous vein. ACFN was conformed from almost 6 cm above the patella. The response was recorded with a needle electrode located close to the nerve 1cm lateral to the femoral artery in the inguinal region. Results: Sensory nerve action potentials were obtained. IPBSN: Mean latency of the first positive peak was found to be 8.1±0.9 ms and; conduction velocity was 54.1±4.4 m/s and response amplitude was 1.3±1.1 µV. SN: Mean latency of the first positive peak was found to be 7.1±0.8 ms and; conduction velocity was 59.2±4.8 m/s and response amplitude was 2.8±1.5 µV.ACFN: Mean latency of the first positive peak was found to be 4.1±1.0 ms and; conduction velocity was 57.4±5.2 m/s and response amplitude was 3.7±2.3 µV. Conclusion: The mostly-common case in the femoral and around the knee is the post traumatic injury. So,femoral sensory nerve transmissions become more important. In our study, the method used is both invasive anc usable in the selected cases.
Ece Boylu 2 , Handan Misirli 1 , Füsun Mayda Domaç 1 , 2 , Mehmet Saraço˘ glu 2 Mehmet Güney Senol ¸ 1 Department of 1st Neurology, Haydarpa¸sa Numune Training and Research Hospital, Istanbul, Turkey; 2 Neurology Department, GATA Haydarpa¸sa Training and Research Hospital, Istanbul, Turkey Purpose: Antiepileptic drugs are effective options for the treatment of neuropathic pain syndromes but some studies have shown antiepileptic drug induced polyneuropathy. In our study we have investigated neurophysiologic effects of antiepileptic drugs in epileptic patients. Methods: Epileptic patients treated for no less than 6 months with standard daily doses of carbamazepine (CBZ), valproate (VA), oxcarbazepine(OXC) and topiramate (TPX) in mono therapy were examined. Patients were divided into 4 groups according to the antiepileptic drugs. For each patient, peroneal, tibial, median and ulnar nerve motor conduction studies and sural, median and ulnar nerve sensory conduction studies were examined at the same temperature. Patients who have any other disease that can effect nerve conduction studies and who have neuropathic symptoms were excluded. Results: A total of 60 epileptic patients were examined. Each group contained 15 patients and twenty healthy subjects were examined as the control group. As compared with the control group prolonged latency of median sensory nerve with a diminished nerve conduction velocity was observed in the CBZ group (p=0.04, p=0.02). Each group was compared with each other and the longest latency of median sensory nerve and sural nerve was found in the CBZ group with a diminished nerve conduction velocity (p=0.013, p=0.016, p=0.023, p=0.014, respectively). There was not a significant difference between the motor conduction studies and the antiepileptic drugs (p>0.05). Conclusion: Valproate, oxcarbazepine and topiramate do not have effects on nerve conduction studies Mild electrophysiological changes may be contributed to carbamazepine therapy. Careful monitoring may reduce the risk of chronic anticonvulsant neuropathy.
P186 Shoulder pain due to spinal accessory nerve injury Kenan Akgun 1 , Ilknur Aktas 2 , Kayihan Uluc 3 University, Cerrahpasa Medical Faculty, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey; 2 Saygi Hospital, Department of Physical Medicine and Rehabilitation; 3 Marmara University Hospital, Department of Neurology, Istanbul, Turkey 1 Istanbul
Purpose: Spinal accessory nerve (SAN) injuries which cause considerable shoulder joint dysfunction and pain are often underdiagnosed or diagnosed late. The aim of this study was to present the clinical features and response to conservative therapy of the patients with late diagnosed SAN injury. Method: Nine patients who presented with shoulder pain and dysfunction and diagnosed as SAN injury on the basis of clinical and electrophysiological examinations were evaluated. All patients were treated initially with a standard physical therapy and rehabilitation program (3 days a week for 3 months), and then received home physical therapy. Pain during rest, activity periods and pain causing sleep disturbances were evaluated using a visual analog scale (VAS). Functional status of the shoulder was evaluated by total Constant scale. Daily living activities were evaluated by shoulder disability questionnaire (SDQ). Results: There were four men and five women with ages ranging from 22 to 76 years. All patients except one were diagnosed in our outpatient clinic. According to the electrophysiological studies, seven patients had partial and two patients had total axonal SAN injury. The delay from the time of injury to diagnosis ranged between 12 and 84 months (mean 26.8 months). The patients were followed for an average of 48.7 months (26–67). Significant improvements were documented in the VAS, Constant scale, and SDQ scores during follow-up. Conclusions: Patients with SAN injury are commonly misdiagnosed leading to unnecessary and inappropriate surgical procedures. Their symptoms may be relieved with conservative therapies. For injuries in which it is late for
P188 Detecting normal and abnormal crossing of the optic nerve fibres: VEP asymmetries versus chiasm Jelka Brecelj 1 , Branka Stirn-Kranjc 2 , Nuška Peˇcariˇc-Megliˇc 3 , Miha Škrbec 4 , Maja Sustar 5 1 Unit for Visual Electrophysiology, Eye Clinic, University Medical Centre, Ljubljana, Slovenia; 2 Department of Paediatric Ophthalmology, Eye Clinic; 3 Clinical Institute for Radiology, Univesity Medical Centre; 4 Clinical Institute for Radiology; 5 Unit for Visual Electrophysiology, Eye Clinic, Slovenia Purpose: Examination of the occipital distribution is a fundamental clinical visual evoked potential (VEP) investigation that distinguishes normal decussation of the optic nerve fibres at the optic chiasm from both congenitally reduced decussation in achiasmia and excess decussation in albinism. VEP asymmetries have been shown to be different in children with achiasmia and albinism, although few studies have compared both of these congenital chiasmal decussation anomalies together, and versus healthy children. This study examined the crossing of the optic nerve fibres at the chiasm according to the occipital distribution of flash VEP waves (N2, P2) and the chiasm coefficient. Method: Four children (7-12 yrs) with achiasmia (two also with hypoplastic right optic tracts), four with albinism (10-15 yrs) and 11 healthy children (4-6 yrs) were included in the study. The VEPs to monocular flash stimulation were recorded from three occipital electrodes. The chiasm coefficient was calculated from the differential inter-hemispheric signals between 0 and 285 ms. Results: The chiasm coefficients showed differences between the healthy children (-0.49 to 0.71) and those with achiasmia (in 2/4: -0.85 and -0.74) and albinism (-0.50 to -0.99). In the other two children with achiasmia plus
Abstracts of the 13th European Congress of Clinical Neurophysiology / Clinical Neurophysiology 119 (2008), S1–S131
servative menagement fails to releive the symptoms, surgical decompression of the entapped nerve can be performed.
nerve surgery, conservative therapy must be considered before reconstructive procedures.
P185 Sensory conduction study of the femoral nerve
P187 Comparison of the effects of the antiepileptic drugs on peripheral nerve conduction
Bademkiran 1 ,
Acarer 1 ,
Colakoglu 1 ,
Ertekin 1 ,
Fikret Ahmet Zafer Cumhur Basra Obay 2 1 Ege University Medical School Department of Neurology; 2 Department of Physiology, Dicle University, Diyarbakir, Turkey; 3 Ege University Medical School, Department of Neurology, Izmir, Turkey
Purpose: There are mostly difficulties in the study of femoral sensory nerve transmission due to muscle artefacts. Moreover, as of today no orthodromic study related to anterior femoral cutaneous nerve (ACFN femoral intermediate cutaneous branch) has been made. In our study, saphenous nerve (SN) which was defined before, infrapatellar nerve (IPBSN) and the newly-defined orthodromic ACFN nerve transmissions have been examined. Method: The present study was undertaken in 50 normal, healthy control subjects. The IPBSN was stimulated medially with a surface electrode 1-2 cm below the patella. SN was stimulated in the side of index medial after saphenous vein. ACFN was conformed from almost 6 cm above the patella. The response was recorded with a needle electrode located close to the nerve 1cm lateral to the femoral artery in the inguinal region. Results: Sensory nerve action potentials were obtained. IPBSN: Mean latency of the first positive peak was found to be 8.1±0.9 ms and; conduction velocity was 54.1±4.4 m/s and response amplitude was 1.3±1.1 µV. SN: Mean latency of the first positive peak was found to be 7.1±0.8 ms and; conduction velocity was 59.2±4.8 m/s and response amplitude was 2.8±1.5 µV.ACFN: Mean latency of the first positive peak was found to be 4.1±1.0 ms and; conduction velocity was 57.4±5.2 m/s and response amplitude was 3.7±2.3 µV. Conclusion: The mostly-common case in the femoral and around the knee is the post traumatic injury. So,femoral sensory nerve transmissions become more important. In our study, the method used is both invasive anc usable in the selected cases.
Ece Boylu 2 , Handan Misirli 1 , Füsun Mayda Domaç 1 , 2 , Mehmet Saraço˘ glu 2 Mehmet Güney Senol ¸ 1 Department of 1st Neurology, Haydarpa¸sa Numune Training and Research Hospital, Istanbul, Turkey; 2 Neurology Department, GATA Haydarpa¸sa Training and Research Hospital, Istanbul, Turkey Purpose: Antiepileptic drugs are effective options for the treatment of neuropathic pain syndromes but some studies have shown antiepileptic drug induced polyneuropathy. In our study we have investigated neurophysiologic effects of antiepileptic drugs in epileptic patients. Methods: Epileptic patients treated for no less than 6 months with standard daily doses of carbamazepine (CBZ), valproate (VA), oxcarbazepine(OXC) and topiramate (TPX) in mono therapy were examined. Patients were divided into 4 groups according to the antiepileptic drugs. For each patient, peroneal, tibial, median and ulnar nerve motor conduction studies and sural, median and ulnar nerve sensory conduction studies were examined at the same temperature. Patients who have any other disease that can effect nerve conduction studies and who have neuropathic symptoms were excluded. Results: A total of 60 epileptic patients were examined. Each group contained 15 patients and twenty healthy subjects were examined as the control group. As compared with the control group prolonged latency of median sensory nerve with a diminished nerve conduction velocity was observed in the CBZ group (p=0.04, p=0.02). Each group was compared with each other and the longest latency of median sensory nerve and sural nerve was found in the CBZ group with a diminished nerve conduction velocity (p=0.013, p=0.016, p=0.023, p=0.014, respectively). There was not a significant difference between the motor conduction studies and the antiepileptic drugs (p>0.05). Conclusion: Valproate, oxcarbazepine and topiramate do not have effects on nerve conduction studies Mild electrophysiological changes may be contributed to carbamazepine therapy. Careful monitoring may reduce the risk of chronic anticonvulsant neuropathy.
P186 Shoulder pain due to spinal accessory nerve injury Kenan Akgun 1 , Ilknur Aktas 2 , Kayihan Uluc 3 University, Cerrahpasa Medical Faculty, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey; 2 Saygi Hospital, Department of Physical Medicine and Rehabilitation; 3 Marmara University Hospital, Department of Neurology, Istanbul, Turkey 1 Istanbul
Purpose: Spinal accessory nerve (SAN) injuries which cause considerable shoulder joint dysfunction and pain are often underdiagnosed or diagnosed late. The aim of this study was to present the clinical features and response to conservative therapy of the patients with late diagnosed SAN injury. Method: Nine patients who presented with shoulder pain and dysfunction and diagnosed as SAN injury on the basis of clinical and electrophysiological examinations were evaluated. All patients were treated initially with a standard physical therapy and rehabilitation program (3 days a week for 3 months), and then received home physical therapy. Pain during rest, activity periods and pain causing sleep disturbances were evaluated using a visual analog scale (VAS). Functional status of the shoulder was evaluated by total Constant scale. Daily living activities were evaluated by shoulder disability questionnaire (SDQ). Results: There were four men and five women with ages ranging from 22 to 76 years. All patients except one were diagnosed in our outpatient clinic. According to the electrophysiological studies, seven patients had partial and two patients had total axonal SAN injury. The delay from the time of injury to diagnosis ranged between 12 and 84 months (mean 26.8 months). The patients were followed for an average of 48.7 months (26–67). Significant improvements were documented in the VAS, Constant scale, and SDQ scores during follow-up. Conclusions: Patients with SAN injury are commonly misdiagnosed leading to unnecessary and inappropriate surgical procedures. Their symptoms may be relieved with conservative therapies. For injuries in which it is late for
P188 Detecting normal and abnormal crossing of the optic nerve fibres: VEP asymmetries versus chiasm Jelka Brecelj 1 , Branka Stirn-Kranjc 2 , Nuška Peˇcariˇc-Megliˇc 3 , Miha Škrbec 4 , Maja Sustar 5 1 Unit for Visual Electrophysiology, Eye Clinic, University Medical Centre, Ljubljana, Slovenia; 2 Department of Paediatric Ophthalmology, Eye Clinic; 3 Clinical Institute for Radiology, Univesity Medical Centre; 4 Clinical Institute for Radiology; 5 Unit for Visual Electrophysiology, Eye Clinic, Slovenia Purpose: Examination of the occipital distribution is a fundamental clinical visual evoked potential (VEP) investigation that distinguishes normal decussation of the optic nerve fibres at the optic chiasm from both congenitally reduced decussation in achiasmia and excess decussation in albinism. VEP asymmetries have been shown to be different in children with achiasmia and albinism, although few studies have compared both of these congenital chiasmal decussation anomalies together, and versus healthy children. This study examined the crossing of the optic nerve fibres at the chiasm according to the occipital distribution of flash VEP waves (N2, P2) and the chiasm coefficient. Method: Four children (7-12 yrs) with achiasmia (two also with hypoplastic right optic tracts), four with albinism (10-15 yrs) and 11 healthy children (4-6 yrs) were included in the study. The VEPs to monocular flash stimulation were recorded from three occipital electrodes. The chiasm coefficient was calculated from the differential inter-hemispheric signals between 0 and 285 ms. Results: The chiasm coefficients showed differences between the healthy children (-0.49 to 0.71) and those with achiasmia (in 2/4: -0.85 and -0.74) and albinism (-0.50 to -0.99). In the other two children with achiasmia plus