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P30-18 Function of A-delta fibres in carpal tunnel syndrome: A study using the cutaneous silent period
S284 P30-18 Function of A-delta fibres in carpal tunnel syndrome: A study using the cutaneous silent period M.J. Pablo1 , P. Tamargo1 , F. Romero1 , I. Benavente1 Department of Clinical Neurophysiology, San Jorge Hospital, Huesca, Spain 1
Objectives: Electrophysiological evaluation of carpal tunnel syndrome (CTS) deals mainly with large myelinated fast conducting fibres. However, frequently, patients with CTS complain of annoying dysesthetic pain, which suggests that small myelinated fibres, not well assessed by current electrodiagnostic methods, may be involved as well. Our objective was to evaluate the small myelinated fibres in different grades of CTS by mean of Cutaneous Silent Period (CuSP), a spinal inhibitory reflex mediated by A-delta fibres, and also to study its relationship with neuropathic pain. Methods: The sample consisted of 308 patients in the case group (CTS patients: 46 mild, 144 moderate and 118 severe) and 82 people in the control group. A pilot study was performed previously. Sample size was calculated according to the variance of the CuSP duration from finger II-APB. CTS was diagnosed following the criteria and recommendations of the AANEM. Cutaneous silent period was obtained by delivering single painful stimuli in finger II, the response was recorded in abductor pollicis brevis (APB) and abductor digiti minimi (ADM) muscles, and with stimuli in finger V and recorded in APB muscle. The presence, latency and duration of the CuSP were studied. Results: The results showed no responses in a small percentage of severe CTS. In the rest of the severe CTS, and the moderate/severe cases, the latency was increased and the duration was decreased. No alterations were found in the CuSP in mild and moderate cases. All the patients suffering from neuropathic pain showed abnormalities of CuSP. Conclusion: Our results showed that the study of the CuSP provides information about A-delta fibres function that cannot be studied by routine electrophysiologic techniques. Moreover, CTS allows us to identify patients with neuropathic pain. P30-19 Correlation between serum lipid level and neurophysiological findings in patients with carpal tunnel syndrome Y.H. Hong1 , S.H. Yeo1 , I.S. Joo1 1 Department of Neurology, Ajou University School of Medicine, Suwon, Korea Objective: Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. Many previous studies reported various risk factors of CTS, such as obesity, DM, thyroid disease, trauma and so on. This study is focused on the relationship between severity of CTS and serum lipid level. Methods: 114 CTS patients and 74 controls were divided into 4 groups according to the neurophysiological severity; normal, mild, moderate and severe. Serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL-C) and high-density lipoprotein (HDL-C) were measured. The association between neurophysiological findings and serum lipid level (TC, TG, LDL-C, HDL-C) in each group was analyzed. Results: There was a positive correlation between TG and CTS severity (P < 0.001), especially in moderate and severe CTS patients. But, TC, LDL-C and HDL-C were not correlated with CTS severity. Conclusions: These results suggest that high serum TG might cause CTS and, therefore, strict control of serum TG could be important to prevent or treat CTS in these patients. P30-20 Clinical characteristics of carpal tunnel syndrome in diabetic patients S.Y. Kim1 Department of Neurology, College of Medicine, Ulsan University Hospital, Ulsan, Korea
1
Background: This study investigated the clinical symptoms and signs of carpal tunnel syndrome (CTS) in patients with diabetes. Methods: The non-dominant hands of 105 consecutive patients with diabetes or carpal tunnel syndrome (CTS) were examined. The patients were divided into three groups: diabetic patients who had demyelinating median neuropathy (diabetic CTS group); diabetic patients who did not have demyelinating median neuropathy (diabetic non-CTS group); and non-diabetic patients with carpal tunnel syndrome (non-diabetic CTS group). The symptoms of CTS (pain, paresthesias, numbness, awakening,
Posters weakness, and clumsiness) were scored using questionnaires. The signs of CTS (Tinel sign, Phalen sign, thenar atrophy, and abductor pollicis brevis (APB) weakness) were evaluated in a neurological examination. Standard electrodiagnostic testing was done. The Michigan Neuropathy Screening Instrument (MNSI) was used to evaluate the severity of the diabetic neuropathy. General demographics, neuropathic score, number of nerves involved, and the score for each CTS symptom and sign were compared among groups to identify the characteristic symptoms and signs of CTS in the diabetic CTS group. Results: Compared with the diabetic non-CTS group, the diabetic CTS group had a longer duration of diabetes (p = 0.000) and the level of neuropathic severity was more grave (p = 0.014). In the diabetic CTS group, the mean scores for pain and paresthesias were lower than in the non-diabetic CTS group (p = 0.047 and p = 0.049, respectively). By contrast, the mean scores for numbness and weakness did not differ significantly from the non-diabetic CTS group and were higher than in the diabetic non-CTS group (p = 0.023 and p = 0.018, respectively). Conclusion: In diabetic patients, the disease duration and severity of neuropathy are important factors that are related to CTS. The high sensory threshold in diabetic polyneuropathy results in less pain and fewer paresthesias associated with CTS. P30-21 Entrapment neuropathy in neuro-muscular clinic for 9 years N. Hirota1 , M. Hirota1 , T. Sakurai2 , M. Sonobe2 Department of Neurology, Shiga Medical Center for Adults, Moriyama, Japan, 2 Department of Neurology, Otsu Municipal Hospital, Otsu, Japan
1
Objective: Entrapment neuropathy is one of common targets in electrophysiological examination. We evaluate frequency of entrapment neuropathy in Neuro-muscular clinic performing electrophysiological examinations. Methods: We retrospectively analyzed numbers of entrapment neuropathy in patients examined at Neuro-muscular clinic of Otsu Municipal Hospital. We examined 2995 consecutive patients electrophysiologically with nerve conduction study (NCS) and electromyography (EMG) between 2001 and 2009. The subjects were 1500 men and 1495 women whose age at examination ranged from 1 to 96 years (mean: 56 years). Results: Carpal tunnel syndrome (CTS) was the most common form of entrapment neuropathy and seen in 745 patients. In 317 patients of them CTS was present on both hands. Ulnar neuropathy was seen in 122 patients and 5 of them were due to entrapment at Guyon canal. Peroneal neuropathy was seen in 51 patients, radial nerve entrapment in 31, meralgia paresthetica in 8 and tarsal tunnel syndrome in 5 patients. CTS was present in 152 of 445 patients with diabetes. As polyneuropathy was seen in 297 of patients with DM, CTS was the second commonest electrophysiological abnormality in diabetes. Conclusions: CTS is the most frequently-appearing diagnosis in entrapment neuropathy. CTS is present on both hands in about half of patients with CTS. For proper electrophysiological diagnosis of CTS NCS should be done on both hands. In patients with diabetes NCS for CTS is as important as for polyneuropathy. Comparing to CTS and ulnar neuropathy, other entrapment neuropathy is less common. In most of cases routine protocol of NCS including median, ulnar, tibial and sural nerves is suitable and technically easy to do screening for entrapment neuropathy as well as polyneuropathy. P30-22 A focal conduction block in a case of tarsal tunnel syndrome D.F. Almeida1 , S.F. Zuniga1 , L. Scremin1 , S.J. Oh2 Department of Medicine, University of Maringa, Maringa, Brazil, 2 Department of Neurology, University of Alabama at Birmingham, Birmingham, USA
1
Objectives: To present a conduction block in a case of MRI and surgery proven tarsal tunnel syndrome (TTS) by the motor nerve conduction and the inching technique. Case report: A 46 year-old woman presented with left foot pain, impaired light touch and pinprick sensation in the plantar surface and positive Tinel sign over the tarsal tunnel (TT). There were no weakness or muscle atrophy. The routine motor nerve conduction study of the left medial plantar nerve (MPN) with the abductor hallucis muscle and lateral plantar nerve (LPN) with the abductor digiti quinti muscle showed low CMAP amplitude and prolonged distal latency when compared with the right
Objectives: Electrophysiological evaluation of carpal tunnel syndrome (CTS) deals mainly with large myelinated fast conducting fibres. However, frequently, patients with CTS complain of annoying dysesthetic pain, which suggests that small myelinated fibres, not well assessed by current electrodiagnostic methods, may be involved as well. Our objective was to evaluate the small myelinated fibres in different grades of CTS by mean of Cutaneous Silent Period (CuSP), a spinal inhibitory reflex mediated by A-delta fibres, and also to study its relationship with neuropathic pain. Methods: The sample consisted of 308 patients in the case group (CTS patients: 46 mild, 144 moderate and 118 severe) and 82 people in the control group. A pilot study was performed previously. Sample size was calculated according to the variance of the CuSP duration from finger II-APB. CTS was diagnosed following the criteria and recommendations of the AANEM. Cutaneous silent period was obtained by delivering single painful stimuli in finger II, the response was recorded in abductor pollicis brevis (APB) and abductor digiti minimi (ADM) muscles, and with stimuli in finger V and recorded in APB muscle. The presence, latency and duration of the CuSP were studied. Results: The results showed no responses in a small percentage of severe CTS. In the rest of the severe CTS, and the moderate/severe cases, the latency was increased and the duration was decreased. No alterations were found in the CuSP in mild and moderate cases. All the patients suffering from neuropathic pain showed abnormalities of CuSP. Conclusion: Our results showed that the study of the CuSP provides information about A-delta fibres function that cannot be studied by routine electrophysiologic techniques. Moreover, CTS allows us to identify patients with neuropathic pain. P30-19 Correlation between serum lipid level and neurophysiological findings in patients with carpal tunnel syndrome Y.H. Hong1 , S.H. Yeo1 , I.S. Joo1 1 Department of Neurology, Ajou University School of Medicine, Suwon, Korea Objective: Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. Many previous studies reported various risk factors of CTS, such as obesity, DM, thyroid disease, trauma and so on. This study is focused on the relationship between severity of CTS and serum lipid level. Methods: 114 CTS patients and 74 controls were divided into 4 groups according to the neurophysiological severity; normal, mild, moderate and severe. Serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL-C) and high-density lipoprotein (HDL-C) were measured. The association between neurophysiological findings and serum lipid level (TC, TG, LDL-C, HDL-C) in each group was analyzed. Results: There was a positive correlation between TG and CTS severity (P < 0.001), especially in moderate and severe CTS patients. But, TC, LDL-C and HDL-C were not correlated with CTS severity. Conclusions: These results suggest that high serum TG might cause CTS and, therefore, strict control of serum TG could be important to prevent or treat CTS in these patients. P30-20 Clinical characteristics of carpal tunnel syndrome in diabetic patients S.Y. Kim1 Department of Neurology, College of Medicine, Ulsan University Hospital, Ulsan, Korea
1
Background: This study investigated the clinical symptoms and signs of carpal tunnel syndrome (CTS) in patients with diabetes. Methods: The non-dominant hands of 105 consecutive patients with diabetes or carpal tunnel syndrome (CTS) were examined. The patients were divided into three groups: diabetic patients who had demyelinating median neuropathy (diabetic CTS group); diabetic patients who did not have demyelinating median neuropathy (diabetic non-CTS group); and non-diabetic patients with carpal tunnel syndrome (non-diabetic CTS group). The symptoms of CTS (pain, paresthesias, numbness, awakening,
Posters weakness, and clumsiness) were scored using questionnaires. The signs of CTS (Tinel sign, Phalen sign, thenar atrophy, and abductor pollicis brevis (APB) weakness) were evaluated in a neurological examination. Standard electrodiagnostic testing was done. The Michigan Neuropathy Screening Instrument (MNSI) was used to evaluate the severity of the diabetic neuropathy. General demographics, neuropathic score, number of nerves involved, and the score for each CTS symptom and sign were compared among groups to identify the characteristic symptoms and signs of CTS in the diabetic CTS group. Results: Compared with the diabetic non-CTS group, the diabetic CTS group had a longer duration of diabetes (p = 0.000) and the level of neuropathic severity was more grave (p = 0.014). In the diabetic CTS group, the mean scores for pain and paresthesias were lower than in the non-diabetic CTS group (p = 0.047 and p = 0.049, respectively). By contrast, the mean scores for numbness and weakness did not differ significantly from the non-diabetic CTS group and were higher than in the diabetic non-CTS group (p = 0.023 and p = 0.018, respectively). Conclusion: In diabetic patients, the disease duration and severity of neuropathy are important factors that are related to CTS. The high sensory threshold in diabetic polyneuropathy results in less pain and fewer paresthesias associated with CTS. P30-21 Entrapment neuropathy in neuro-muscular clinic for 9 years N. Hirota1 , M. Hirota1 , T. Sakurai2 , M. Sonobe2 Department of Neurology, Shiga Medical Center for Adults, Moriyama, Japan, 2 Department of Neurology, Otsu Municipal Hospital, Otsu, Japan
1
Objective: Entrapment neuropathy is one of common targets in electrophysiological examination. We evaluate frequency of entrapment neuropathy in Neuro-muscular clinic performing electrophysiological examinations. Methods: We retrospectively analyzed numbers of entrapment neuropathy in patients examined at Neuro-muscular clinic of Otsu Municipal Hospital. We examined 2995 consecutive patients electrophysiologically with nerve conduction study (NCS) and electromyography (EMG) between 2001 and 2009. The subjects were 1500 men and 1495 women whose age at examination ranged from 1 to 96 years (mean: 56 years). Results: Carpal tunnel syndrome (CTS) was the most common form of entrapment neuropathy and seen in 745 patients. In 317 patients of them CTS was present on both hands. Ulnar neuropathy was seen in 122 patients and 5 of them were due to entrapment at Guyon canal. Peroneal neuropathy was seen in 51 patients, radial nerve entrapment in 31, meralgia paresthetica in 8 and tarsal tunnel syndrome in 5 patients. CTS was present in 152 of 445 patients with diabetes. As polyneuropathy was seen in 297 of patients with DM, CTS was the second commonest electrophysiological abnormality in diabetes. Conclusions: CTS is the most frequently-appearing diagnosis in entrapment neuropathy. CTS is present on both hands in about half of patients with CTS. For proper electrophysiological diagnosis of CTS NCS should be done on both hands. In patients with diabetes NCS for CTS is as important as for polyneuropathy. Comparing to CTS and ulnar neuropathy, other entrapment neuropathy is less common. In most of cases routine protocol of NCS including median, ulnar, tibial and sural nerves is suitable and technically easy to do screening for entrapment neuropathy as well as polyneuropathy. P30-22 A focal conduction block in a case of tarsal tunnel syndrome D.F. Almeida1 , S.F. Zuniga1 , L. Scremin1 , S.J. Oh2 Department of Medicine, University of Maringa, Maringa, Brazil, 2 Department of Neurology, University of Alabama at Birmingham, Birmingham, USA
1
Objectives: To present a conduction block in a case of MRI and surgery proven tarsal tunnel syndrome (TTS) by the motor nerve conduction and the inching technique. Case report: A 46 year-old woman presented with left foot pain, impaired light touch and pinprick sensation in the plantar surface and positive Tinel sign over the tarsal tunnel (TT). There were no weakness or muscle atrophy. The routine motor nerve conduction study of the left medial plantar nerve (MPN) with the abductor hallucis muscle and lateral plantar nerve (LPN) with the abductor digiti quinti muscle showed low CMAP amplitude and prolonged distal latency when compared with the right