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P214: Study of sympathetic skin response in diabetic patients with soft tissue rheumatism of the hand
Abstracts of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339
was to assess the frequency of BMN in a cohort of patients with ICTS and a group of healthy controls to determine whether it comprises a predisposing factor. Methods: 50 patients (40 women) with clinically and electrophysiologically confirmed CTS and 50 age and sex- matched healthy controls underwent ultrasonographic imaging of their carpal tunnel in both wrists for BMN detection, measurements of carpal tunnel ratio and cross sectional area of median nerve. Their height, weight, body mass index, external dimensions of hand and wrist (hand ratio, wrist ratio) were noted. Results: BMN was found by ultrasonography in 4 out of 50 subjects (8%) in both groups. In the ICTS groups there were 3 women and in the control group 2 women, while in both groups 1 subject had bilateral BMN and 3 had unilateral. Subjects with BMN in the two groups did not differ significantly as regards to height, weight, body mass index and the anthropometric, external or ultrasonographic measurements, except for electrophysiological findings (sensory conduction velocity and distal motor latency) that discriminated the two groups. Conclusions: BMN does not seem to constitute a risk factor for ICTS nor is associated with a particular hand/wrist shape.
P214 Study of sympathetic skin response in diabetic patients with soft tissue rheumatism of the hand S. N. Fargaly, H. Al-moghazy, D. Mohasseb Faculty of Medicine, Alexandria University, PM & R, Alexandria, Egypt Background: Physicians have long recognized the association between diabetes mellitus (DM) and several pathologic conditions of the hand. The most commonly recognized conditions are trigger finger, tenosynovitis, Dupuytren’s disease (DD), carpal tunnel syndrome (CTS), and limited joint mobility (LJM) [1]. However, there is a paucity of data regarding the presence of a possible relation between those hand lesions and diabetic autonomic neuropathy. Aim: To investigate the relationship between sympathetic dysfunction and diabetic hand soft tissue lesions. Patients: Group 1 contained 20 diabetic patients with one or more hand soft tissue lesions. Group 2 contained 20 diabetic patients without any hand pathology and 20 healthy control subjects. Methods: Patients with DM were thoroughly evaluated clinically and assessed for the presence of diabetic autonomic neuropathy (DAN) using tilt table test before proceeding to the electrophysiological tests which were (1) sensory and motor conduction studies of median, ulnar, and radial nerves; (2) sympathetic skin response (SSR). Results: 5 patients had trigger finger, 2 had tenosynovitis, 1 had Dupuytren’s contracture, 6 had CTS, 2 had LJM and 4 had combined CTS and trigger finger. Abnormal SSR was detected in 10 patients in group 1 and in 11 in group 2 (in the form of absent response or delayed latencies). There was no statistically significant difference between group 1 and 2 regarding the frequency of SSR abnormalities. There was a statistically significant relationship between the presence of CTS in group1 patients and abnormal SSR results. There was statistically significant relationship between positive tilt table test results in group 1 patients and abnormal SSR in the same group. There was statistically significant relationship between the duration of DM and abnormal SSR results in group1 patients. Conclusions: Diabetic patients with CTS tend to have prolonged SSR of the hand. Further studies are recommended to study other factors responsible for the occurrence of diabetic soft tissue lesions Reference: [1] Mota M, Panus C, Mota E, Sfredel V, Patrascu A, Vanghelie L, et al. Hand abnormalities of the patients with diabetes mellitus. Rom J Intern Med 2001; 38:89 -95.
P215 Anti-ganglioside complex IgM antibodies and immune-mediated neuropathies: a novel case of acute motor conduction block neuropathy (AMCBN)? A case report R. Aste 1 , P. Tacconi 2 , E. Salaris 1 ASL 5 Oristano - P.O. San Martino, Diagnostica Neurologica, Oristano, Italy; 2 AOU Cagliari, Clinica Neurologica - Department of Cardiovascular and Neurological Sciences, Cagliari, Italy 1
Introduction: Acute motor conduction block neuropathy (AMCBN) has
S105
been described as unusual presentation of different immuno-mediated peripheral nerve pathologies: Guillain-Barré syndrome (GBS), acute motor axonal neuropathy (AMAN), multifocal motor neuropathy (MMN). Diverse anti-ganglioside antibodies associations were observed, but antiGM1/GT1A/GT1B IgM complex has never been reported. Objective: To report a patient with acute motor neuropathy, conduction blocks and anti-GM1/GT1A/GT1B IgM complex antibodies. Methods: A 24-year-old female was admitted to our department complaining about recent onset of tingling and weakness in both hands. Three months erlyer she was diagnosed with type 1 diabetes arised after a journey in Eritrea, were she complained fever, diarrhea, and ambulation difficulties treated with antiobiotics. Neurological examination showed mild heel ambulation impairment, bilateral lower limb hyporeflexia, mild bilateral hand-grip weakness, mild stocking-glove hypoesthesia; cranial nerve exam was normal, nor patient complained about dysphagia or dyspnea. Nerve conduction study evidenced a primary motor polyneuropathy with segmental demyelination, conduction blocks and F-wave abnormalities. No significant involvement of sensory conductions nor reduction of distal compound motor action potential (CMAP) were observed. Lumbar punctur revealed incresed proteins (97.8 mG/dL) with normal count cell; immunoblotting disclosed elevated titer of IgM anti-GM1, anti-GT1A and anti-GT1B. Patient was treated with IvIG (0.4 mg/kg/day) for 5 days without a significant benefit till two months later when, after an initial clinical and instrumental motor worsening, she reported clinical recovery and nerve conduction improving.
Figure 1. Left median (A) and ulnar (B) motor nerve conduction 10, 40 and 60 days after clinical onset.
Conclusions: In our patient clinical course and electrophysiological findings were not suggestive of AMAN, GBS or GBS-variants, nor typical for MMN. AMCBN remains the most plausible explanation of her symptoms and nerve conduction features. Immunological profile suggests new possible AMCBN anti-ganglioside associations.
P218 Preliminary reports of use of low intensity laser for entrapment neuropathy T. Monteiro, T. Dias Fernandes, G. Luvizutto, M.F. Zeugner Bertotti, L. Resende Botucatu Medical School, Neurology, Psychology and Psychiatry, Botucatu, Brazil Introduction: The carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. After surgery different types of complication may occur, than search for new clinical forms of treatment is necessary. There are controversies about the efficacy of laser on CTS [1–3]. The aim of this study was to test the effectiveness of low intensity laser therapy in patients with CTS. Methods: Patients with clinical and ENMG diagnosis of CTS never previously treated were included. Sensory and motor conduction studies were performed by conventional described techniques. Low intensity laser treatment was by 660 nm wave length, average power of 30 nw, continuous operation area of 0.06 cm2 , fluence of irradiation of 10 J/cm2 , exposure of 10 seconds per point, totaling 6 points of irradiation on the carpal tunnel, from the proximal to the distal sense. Laser was positioned at 90° to the skin, 2 sessions per week during 3 months were performed (24 sessions). Results: To this moment 12 hands of 9 patients were studied, all reported
was to assess the frequency of BMN in a cohort of patients with ICTS and a group of healthy controls to determine whether it comprises a predisposing factor. Methods: 50 patients (40 women) with clinically and electrophysiologically confirmed CTS and 50 age and sex- matched healthy controls underwent ultrasonographic imaging of their carpal tunnel in both wrists for BMN detection, measurements of carpal tunnel ratio and cross sectional area of median nerve. Their height, weight, body mass index, external dimensions of hand and wrist (hand ratio, wrist ratio) were noted. Results: BMN was found by ultrasonography in 4 out of 50 subjects (8%) in both groups. In the ICTS groups there were 3 women and in the control group 2 women, while in both groups 1 subject had bilateral BMN and 3 had unilateral. Subjects with BMN in the two groups did not differ significantly as regards to height, weight, body mass index and the anthropometric, external or ultrasonographic measurements, except for electrophysiological findings (sensory conduction velocity and distal motor latency) that discriminated the two groups. Conclusions: BMN does not seem to constitute a risk factor for ICTS nor is associated with a particular hand/wrist shape.
P214 Study of sympathetic skin response in diabetic patients with soft tissue rheumatism of the hand S. N. Fargaly, H. Al-moghazy, D. Mohasseb Faculty of Medicine, Alexandria University, PM & R, Alexandria, Egypt Background: Physicians have long recognized the association between diabetes mellitus (DM) and several pathologic conditions of the hand. The most commonly recognized conditions are trigger finger, tenosynovitis, Dupuytren’s disease (DD), carpal tunnel syndrome (CTS), and limited joint mobility (LJM) [1]. However, there is a paucity of data regarding the presence of a possible relation between those hand lesions and diabetic autonomic neuropathy. Aim: To investigate the relationship between sympathetic dysfunction and diabetic hand soft tissue lesions. Patients: Group 1 contained 20 diabetic patients with one or more hand soft tissue lesions. Group 2 contained 20 diabetic patients without any hand pathology and 20 healthy control subjects. Methods: Patients with DM were thoroughly evaluated clinically and assessed for the presence of diabetic autonomic neuropathy (DAN) using tilt table test before proceeding to the electrophysiological tests which were (1) sensory and motor conduction studies of median, ulnar, and radial nerves; (2) sympathetic skin response (SSR). Results: 5 patients had trigger finger, 2 had tenosynovitis, 1 had Dupuytren’s contracture, 6 had CTS, 2 had LJM and 4 had combined CTS and trigger finger. Abnormal SSR was detected in 10 patients in group 1 and in 11 in group 2 (in the form of absent response or delayed latencies). There was no statistically significant difference between group 1 and 2 regarding the frequency of SSR abnormalities. There was a statistically significant relationship between the presence of CTS in group1 patients and abnormal SSR results. There was statistically significant relationship between positive tilt table test results in group 1 patients and abnormal SSR in the same group. There was statistically significant relationship between the duration of DM and abnormal SSR results in group1 patients. Conclusions: Diabetic patients with CTS tend to have prolonged SSR of the hand. Further studies are recommended to study other factors responsible for the occurrence of diabetic soft tissue lesions Reference: [1] Mota M, Panus C, Mota E, Sfredel V, Patrascu A, Vanghelie L, et al. Hand abnormalities of the patients with diabetes mellitus. Rom J Intern Med 2001; 38:89 -95.
P215 Anti-ganglioside complex IgM antibodies and immune-mediated neuropathies: a novel case of acute motor conduction block neuropathy (AMCBN)? A case report R. Aste 1 , P. Tacconi 2 , E. Salaris 1 ASL 5 Oristano - P.O. San Martino, Diagnostica Neurologica, Oristano, Italy; 2 AOU Cagliari, Clinica Neurologica - Department of Cardiovascular and Neurological Sciences, Cagliari, Italy 1
Introduction: Acute motor conduction block neuropathy (AMCBN) has
S105
been described as unusual presentation of different immuno-mediated peripheral nerve pathologies: Guillain-Barré syndrome (GBS), acute motor axonal neuropathy (AMAN), multifocal motor neuropathy (MMN). Diverse anti-ganglioside antibodies associations were observed, but antiGM1/GT1A/GT1B IgM complex has never been reported. Objective: To report a patient with acute motor neuropathy, conduction blocks and anti-GM1/GT1A/GT1B IgM complex antibodies. Methods: A 24-year-old female was admitted to our department complaining about recent onset of tingling and weakness in both hands. Three months erlyer she was diagnosed with type 1 diabetes arised after a journey in Eritrea, were she complained fever, diarrhea, and ambulation difficulties treated with antiobiotics. Neurological examination showed mild heel ambulation impairment, bilateral lower limb hyporeflexia, mild bilateral hand-grip weakness, mild stocking-glove hypoesthesia; cranial nerve exam was normal, nor patient complained about dysphagia or dyspnea. Nerve conduction study evidenced a primary motor polyneuropathy with segmental demyelination, conduction blocks and F-wave abnormalities. No significant involvement of sensory conductions nor reduction of distal compound motor action potential (CMAP) were observed. Lumbar punctur revealed incresed proteins (97.8 mG/dL) with normal count cell; immunoblotting disclosed elevated titer of IgM anti-GM1, anti-GT1A and anti-GT1B. Patient was treated with IvIG (0.4 mg/kg/day) for 5 days without a significant benefit till two months later when, after an initial clinical and instrumental motor worsening, she reported clinical recovery and nerve conduction improving.
Figure 1. Left median (A) and ulnar (B) motor nerve conduction 10, 40 and 60 days after clinical onset.
Conclusions: In our patient clinical course and electrophysiological findings were not suggestive of AMAN, GBS or GBS-variants, nor typical for MMN. AMCBN remains the most plausible explanation of her symptoms and nerve conduction features. Immunological profile suggests new possible AMCBN anti-ganglioside associations.
P218 Preliminary reports of use of low intensity laser for entrapment neuropathy T. Monteiro, T. Dias Fernandes, G. Luvizutto, M.F. Zeugner Bertotti, L. Resende Botucatu Medical School, Neurology, Psychology and Psychiatry, Botucatu, Brazil Introduction: The carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. After surgery different types of complication may occur, than search for new clinical forms of treatment is necessary. There are controversies about the efficacy of laser on CTS [1–3]. The aim of this study was to test the effectiveness of low intensity laser therapy in patients with CTS. Methods: Patients with clinical and ENMG diagnosis of CTS never previously treated were included. Sensory and motor conduction studies were performed by conventional described techniques. Low intensity laser treatment was by 660 nm wave length, average power of 30 nw, continuous operation area of 0.06 cm2 , fluence of irradiation of 10 J/cm2 , exposure of 10 seconds per point, totaling 6 points of irradiation on the carpal tunnel, from the proximal to the distal sense. Laser was positioned at 90° to the skin, 2 sessions per week during 3 months were performed (24 sessions). Results: To this moment 12 hands of 9 patients were studied, all reported