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P258 Detection of early motor involvement in diabetic polyneuropathy using a novel MUNE method-MScanFit MUNE
Abstracts / Clinical Neurophysiology 128 (2017) e178–e303
Patient and methods: The patient is a 34-year-old woman with drug-resistant TLE, which had started when she was 9 years old. Her MRI revealed left mesial temporal lobe sclerosis. She had 1–5 focal seizures impairing awareness per month. Stress and sadness were the only reported seizure triggers. During her routine presurgical evaluation, a standardized video-EEG study protocol was also applied after taking her consent. Baseline, hyperventilation, intermittent photic stimulation and olfactory stimulations (OS) were performed with a published standard protocol. One ml of odorant solution of ylan-ylang extract was dropped on a cotton ball, and was applied to the middle of both nostrils during 3 min. This activation was repeated twice and followed by 15 min of resting records (post-OS1 and post-OS2). We investigated modulation of epileptiform discharges by OS by counting the interictal spikes. However, a focal seizure has occurred in the first minute of smelling. After 5 months, video-EEG with the same protocol was repeated and increase in spike counts during post-OS periods was documented. Moreover, she was found to have hypo-osmia with Sniffin Sticks test, despite she had no complaints. Conclusion: Our results suggested that olfactory stimulation may trigger reflex seizures and increase interictal spikes in some patients with TLE. Keywords: Olfactor stimulation, Reflex epilepsy, Temporal lobe epilepsy doi:10.1016/j.clinph.2017.07.265
P258 Detection of early motor involvement in diabetic polyneuropathy using a novel MUNE method-MScanFit MUNE—Alexander Gramm Kristensen 1,2,3, Nanna Brix Finnerup 1,3, Henning Andersen 1,4, Troels Staehelin Jensen 1,3, Sif Gylfadottir 1,3, Mustapha Itani 1,5, Søren Sindrup 1,5, Hatice Tankisi 1,2 (1 International Diabetic Neuropathy Consortium, Aarhus University, Denmark, 2 Department of Neurophysiology, Aarhus University Hospital, Denmark, 3 Danish Pain Research Center, Aarhus University, Denmark, 4 Department of Neurology, Aarhus University Hospital, Denmark, 5 Department of Neurology, Odense University, Denmark) Hospital Aim: To examine whether a novel MUNE method so called MScanFit MUNE (MScan) can detect early motor involvement in diabetic polyneuropathy (DPN). Methods: In this study, 100 patients with diabetes mellitus type II will be prospectively included as a part of International Diabetic Neuropathy Consortium (IDNC) project. Preliminary results of 24 patients (18 males, 6 females, mean age: 63, range: (44–74) will be presented here. Nerve conduction studies (NCS) of three motor (median, peroneal, tibial) and three sensory (bilateral sural and median) nerves and MScan in abductor pollicis brevis (APB) muscle were done in all patients.NCS results were compared to laboratory controls. MScan results were compared to 20 age-matched healthy subjects. Results: From NCSs, DPN was classified by Dyck’s criteria. Six of 24 patients (25%) had DPN while 18 patients had normal NCS. None of the 24 patients had decreased CMAP amplitude of median nerve. MScan was abnormal in eight of 24 patients (33%). Of these eight, two patients had DPN and six had normal NCS. Discussion: Normal MScan in patients with DPN may be due to length dependent feature of DPN, thereby unaffected upper extremities as these patients had slight sensory neuropathy. However, MScan could detect abnormality in nerves with normal CMAP amplitude and normal NCS.
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Conclusion: MScan may improve electrodiagnosis of DPN by detection of early motor involvement and motor unit loss. Significance: MScan is a promising novel method which may be useful in quantifying motor unit loss in different neuromuscular disorders including DPN. Keywords: Diabetic polyneuropathy, MScan, MUNE, early motor involvement doi:10.1016/j.clinph.2017.07.266
P259 Object dropping in Carpal Tunnel Syndrome: Clinical and electrophysiological features—Zeliha Matur 1, Emine Tasßkıran 2, _ Ali Emre Öge 3 (1 Istanbul Bilim University, Faculty of Medicine, Department of Neurology, Istanbul, Turkey, 2 Istanbul University, Cerrahpasa School of Medicine, Department of Neurology, _ _ Istanbul, Turkey, 3 Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey) Objectives: Some patients with Carpal Tunnel Syndrome (CTS) complain of dropping objects. In this study, the clinical and electrophysiological features of CTS patients with (wOD) and without object dropping (w/oOD) were compared. Methods: 52 female cases (age range: 21–80) consisting of 20 wOD, 16 CTS w/oOD patients and 16 healthy controls were included. Clinical evaluation included neurological examination, hand preference questionnaire, Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), a questionnaire for frequent object dropping and records of weekly hand usage. Nerve conduction studies (NCSs) were composed of bilateral orthodromic median 2nd finger and ulnar 5th finger sensory NCSs, median-ulnar ring finger sensory latency comparison, and median and ulnar motor NCSs. Median nerve was stimulated at palm, wrist and elbow. Conduction velocity and compound muscle action potential (CMAP) amplitude loss across the wrist was calculated. Results: In wOD cases, mean age was older (59 vs. 53 years), symptom duration (42 vs. 29 months) and weekly occupational hand usage times (47 vs. 39 h) were longer, BCTQ symptom severity (2.9 vs. 2.5) and functional status scores (3.1 vs. 2.4) were higher. Sensory and motor NCSs abnormalities were more prominent on the dominant side in wOD, while they were similar on the nondominant side in both groups. CMAP amplitude loss across the wrist was higher on the dominant side in wOD (27.8% vs. 13.3%). Discussion and conclusion: Frequent object dropping may be a sign of severity and chronicity in CTS. Significance: The relation between frequent object dropping and clinical and electrophysiological severity of CTS was investigated. Keywords: Carpal Tunnel Syndrome, Object dropping, Boston Carpal Tunnel Syndrome Questionnaire, Nerve conduction studies doi:10.1016/j.clinph.2017.07.267
P260 Spindle-shaped high frequency (±100 Hz) oscillatory activity in scalp EEG of children—Anne Mooij 1, Renee Raijmann 2, Floor Jansen 3, Kees Braun 3, Maeike Zijlmans 1 (1 University Medical Centre Utrecht, Department of Neurology and Neurosurgery, Utrecht, The Netherlands, 2 University Medical Centre Utrecht, Faculty of Medicine, Utrecht, The Netherlands, 3 University Medical Centre Utrecht, Department of Paediatric Neurology, Utrecht, The Netherlands)
Patient and methods: The patient is a 34-year-old woman with drug-resistant TLE, which had started when she was 9 years old. Her MRI revealed left mesial temporal lobe sclerosis. She had 1–5 focal seizures impairing awareness per month. Stress and sadness were the only reported seizure triggers. During her routine presurgical evaluation, a standardized video-EEG study protocol was also applied after taking her consent. Baseline, hyperventilation, intermittent photic stimulation and olfactory stimulations (OS) were performed with a published standard protocol. One ml of odorant solution of ylan-ylang extract was dropped on a cotton ball, and was applied to the middle of both nostrils during 3 min. This activation was repeated twice and followed by 15 min of resting records (post-OS1 and post-OS2). We investigated modulation of epileptiform discharges by OS by counting the interictal spikes. However, a focal seizure has occurred in the first minute of smelling. After 5 months, video-EEG with the same protocol was repeated and increase in spike counts during post-OS periods was documented. Moreover, she was found to have hypo-osmia with Sniffin Sticks test, despite she had no complaints. Conclusion: Our results suggested that olfactory stimulation may trigger reflex seizures and increase interictal spikes in some patients with TLE. Keywords: Olfactor stimulation, Reflex epilepsy, Temporal lobe epilepsy doi:10.1016/j.clinph.2017.07.265
P258 Detection of early motor involvement in diabetic polyneuropathy using a novel MUNE method-MScanFit MUNE—Alexander Gramm Kristensen 1,2,3, Nanna Brix Finnerup 1,3, Henning Andersen 1,4, Troels Staehelin Jensen 1,3, Sif Gylfadottir 1,3, Mustapha Itani 1,5, Søren Sindrup 1,5, Hatice Tankisi 1,2 (1 International Diabetic Neuropathy Consortium, Aarhus University, Denmark, 2 Department of Neurophysiology, Aarhus University Hospital, Denmark, 3 Danish Pain Research Center, Aarhus University, Denmark, 4 Department of Neurology, Aarhus University Hospital, Denmark, 5 Department of Neurology, Odense University, Denmark) Hospital Aim: To examine whether a novel MUNE method so called MScanFit MUNE (MScan) can detect early motor involvement in diabetic polyneuropathy (DPN). Methods: In this study, 100 patients with diabetes mellitus type II will be prospectively included as a part of International Diabetic Neuropathy Consortium (IDNC) project. Preliminary results of 24 patients (18 males, 6 females, mean age: 63, range: (44–74) will be presented here. Nerve conduction studies (NCS) of three motor (median, peroneal, tibial) and three sensory (bilateral sural and median) nerves and MScan in abductor pollicis brevis (APB) muscle were done in all patients.NCS results were compared to laboratory controls. MScan results were compared to 20 age-matched healthy subjects. Results: From NCSs, DPN was classified by Dyck’s criteria. Six of 24 patients (25%) had DPN while 18 patients had normal NCS. None of the 24 patients had decreased CMAP amplitude of median nerve. MScan was abnormal in eight of 24 patients (33%). Of these eight, two patients had DPN and six had normal NCS. Discussion: Normal MScan in patients with DPN may be due to length dependent feature of DPN, thereby unaffected upper extremities as these patients had slight sensory neuropathy. However, MScan could detect abnormality in nerves with normal CMAP amplitude and normal NCS.
e261
Conclusion: MScan may improve electrodiagnosis of DPN by detection of early motor involvement and motor unit loss. Significance: MScan is a promising novel method which may be useful in quantifying motor unit loss in different neuromuscular disorders including DPN. Keywords: Diabetic polyneuropathy, MScan, MUNE, early motor involvement doi:10.1016/j.clinph.2017.07.266
P259 Object dropping in Carpal Tunnel Syndrome: Clinical and electrophysiological features—Zeliha Matur 1, Emine Tasßkıran 2, _ Ali Emre Öge 3 (1 Istanbul Bilim University, Faculty of Medicine, Department of Neurology, Istanbul, Turkey, 2 Istanbul University, Cerrahpasa School of Medicine, Department of Neurology, _ _ Istanbul, Turkey, 3 Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey) Objectives: Some patients with Carpal Tunnel Syndrome (CTS) complain of dropping objects. In this study, the clinical and electrophysiological features of CTS patients with (wOD) and without object dropping (w/oOD) were compared. Methods: 52 female cases (age range: 21–80) consisting of 20 wOD, 16 CTS w/oOD patients and 16 healthy controls were included. Clinical evaluation included neurological examination, hand preference questionnaire, Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), a questionnaire for frequent object dropping and records of weekly hand usage. Nerve conduction studies (NCSs) were composed of bilateral orthodromic median 2nd finger and ulnar 5th finger sensory NCSs, median-ulnar ring finger sensory latency comparison, and median and ulnar motor NCSs. Median nerve was stimulated at palm, wrist and elbow. Conduction velocity and compound muscle action potential (CMAP) amplitude loss across the wrist was calculated. Results: In wOD cases, mean age was older (59 vs. 53 years), symptom duration (42 vs. 29 months) and weekly occupational hand usage times (47 vs. 39 h) were longer, BCTQ symptom severity (2.9 vs. 2.5) and functional status scores (3.1 vs. 2.4) were higher. Sensory and motor NCSs abnormalities were more prominent on the dominant side in wOD, while they were similar on the nondominant side in both groups. CMAP amplitude loss across the wrist was higher on the dominant side in wOD (27.8% vs. 13.3%). Discussion and conclusion: Frequent object dropping may be a sign of severity and chronicity in CTS. Significance: The relation between frequent object dropping and clinical and electrophysiological severity of CTS was investigated. Keywords: Carpal Tunnel Syndrome, Object dropping, Boston Carpal Tunnel Syndrome Questionnaire, Nerve conduction studies doi:10.1016/j.clinph.2017.07.267
P260 Spindle-shaped high frequency (±100 Hz) oscillatory activity in scalp EEG of children—Anne Mooij 1, Renee Raijmann 2, Floor Jansen 3, Kees Braun 3, Maeike Zijlmans 1 (1 University Medical Centre Utrecht, Department of Neurology and Neurosurgery, Utrecht, The Netherlands, 2 University Medical Centre Utrecht, Faculty of Medicine, Utrecht, The Netherlands, 3 University Medical Centre Utrecht, Department of Paediatric Neurology, Utrecht, The Netherlands)