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P39-F Evaluation of visual pathways with visual evoked potentials in vitamin B12 deficiency patients
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Abstracts / Clinical Neurophysiology 130 (2019) e21–e116
P37-F Predictors of cognitive impairment in patients with mine blast injury—OleksanSolonovych * (The State Institution ‘‘romodanov Neurosurgery Institute, National Academy Of Medical Science Of Ukraine”, Kiev, Ukraine) ⇑
Corresponding author.
Background: Mine blast injury is accompanied by traumatic brain injury (TBI) in 60–100% of cases. TBI is associated with cognitive impairment (CI). However, predictors of CI in this patients (pts) are studied insufficiently. Material and methods: 115 men aged 18 to 45 years with mild TBI caused by using of mine-blasting weapons. Cognitive functions were evaluated by using MoCA test, HADS scale. Cognitive dysfunction was defined as MoCa 6 25 scores. Besides routine examination, neurophysiological methods such as quantitative electroencephalography (qEEG) and cognitive evoked potentials P300 (CEP P300), were performed. Results. In binary logistic regression predictors CI were complaints on headache and fatigability (OR 2.52, 95% CI 2.6–59.7, p = 0.02), increased tendon reflexes (OR, 2.6, 95% CI 1.24–2.32, p = 0.017), higher HADS anxiety level (OR-1.8, 95% CI 1.59–2.2, p = 0.04), changes of alpha rhythm frequency (OR-1.02, 95% CI 1.01– 1.04, p = 0.004), decrease of alpha rhythm amplitudes (OR - 1.07, 95% CI 1.03–1.11, p < 0.001), dysfunction of nonspecific median structures (OR 1.02, 95% CI 1.0–1.04, p = 0.033), decrease of P3 peak amplitude (OR 2.6, 95% CI 1.14–5.9, p = 0.003) and increase of CEP P300 latency (OR 1.07, 95% CI 1.03–1.12, p = 0.002). In multinomial logistic regression the independent predictors of CI were decrease of alpha rhythm amplitudes, decrease of P3 peak amplitude and increase of CEP P300 latency. Conclusions: changes in qEEG and CEP P300 parameters are reliable independent predictors of CI in pts with TBI affected by mine blast trauma. doi:10.1016/j.clinph.2019.04.489
P38-F Motor evoked potentials elicited by TMS in Hirayama disease – Systematic review of the literature—Jan Bembenek a,*, _ Bozena Kłysz b, Iwona Kurkowska-Jastrze˛bska b (a Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland, b 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland) ⇑
Corresponding author.
Background: Hirayama disease (HD) is a rare motor disorder mainly affecting young men. It is characterized by atrophy and unilateral weakness of forearm and hand muscles corresponding to a C7-T1 myotome distribution. The progression is usually selflimiting. The etiology of HD is not fully understood. Motor evoked potentials (MEPs) seems to be useful in pyramidal tracts damage evaluation. Material and methods: We searched PubMed for original papers evaluating the use of transcranial magnetic stimulation elicited MEPs in HD until 02.01.2019 using key words: ‘‘motor evoked potentials Hirayama” and ‘‘transcranial magnetic stimulation Hirayama”. Results: We found six articles using the above key words which met inclusion criteria. Number of participants was small (78 and 55 control group), diagnostic procedures and methodology varied. Abnormal central motor conduction time was found in 17.1% of patients in one study whereas it was normal in 2 other studies. Peripheral motor latency (PML) was evaluated in one study which
found abnormally increased PMLs in at least one tested muscle in 16/41 (39.0%) of HD patients. Abnormal MEP parameters were found in 3 studies in 14.3–100% patients. They were not evaluated in one study and in two were normal in standard and flexed neck position. In one study inconsistent results in MEP size after neck flexion in patients after treatment with neck collar were found. Conclusions: Although MEP parameters may be abnormal in some HD patients, these have not been thoroughly assessed yet. Further studies are indispensable to evaluate their usefulness in assessing pyramidal tracts in HD. doi:10.1016/j.clinph.2019.04.490
P39-F Evaluation of visual pathways with visual evoked potentials in vitamin B12 deficiency patients—Hacer Erdem Tilki *, Onur Yıldız, Sß eyda Bayil (Departmant of Neurology, Ondokuz Mayis University, Samsun, Turkey) ⇑
Corresponding author.
Background: Vitamin b12 is a water-soluble vitamin and a wide variety of neurologic symptoms and signs were encountered including ataxia, loss of sensation, muscle weakness, hyperactive reflexes, incontinence, also it may not cause any symptoms in many patients. Material and methods: In our study, we have included asymptomatic patients. The diagnosis of vitamin B12 deficiency was based on low serum vitamin B12 level (<150 pg/ml). Forty patients with vitamin b12 deficiency and control group were included in the study. Vitamin B12 levels were intended to determine the existence of a possible relationship between P100 latency and amplitude values. Results: Visual acuity was found normal in all the patients. The mean vitamin B12 level was 96 pg/ml in the patient group and 374 pg/ml in the control group. Eight patient (20%) with vitamin B12 deficiency was determined megaloblastic anemia. In vitamin B12 deficiency patients mean P100 latency was 104 ± 8 ms and mean amplitude was 8.1 ± 4 uV. Patients with vitamin B12 deficiency P100 latency compared to the control group was significantly prolonged (P < 0.01). P100 wave amplitude did not find a significant difference between the cases and controls. Similarly, the P100 latency values of patients with hyperhomocysteinemia and megaloblastic anemia was significantly prolonged (P < 0.01). The possible reason for delayed latencies in vitamin B12 deficiency could be demyelination in visual pathways. Conclusions: As a result, pattern shift visual evoked responses may identify the subtle changes in the visual pathways easily in vitamin b12 deficiency patients even when there is no evidence of clinical abnormality. doi:10.1016/j.clinph.2019.04.491
P40-F The relationship between age and SICI parameters obtained with threshold tracking TMS—Søren Ørskov *, Christina Shen-Zhuang Nielsen, Kirsten Pugdahl, Anders FuglsangFrederiksen, Hatice Tankisi (Aarhus University, Århus N, Denmark) ⇑
Corresponding author.
Background: Recently developed threshold tracking TMS (TT-TMS) paired pulse techniques have been shown to be of benefit in clinical diagnostic practice. Reduced Short Interval Cortical Inhibition (SICI) with increasing age has been shown in several studies using
Abstracts / Clinical Neurophysiology 130 (2019) e21–e116
P37-F Predictors of cognitive impairment in patients with mine blast injury—OleksanSolonovych * (The State Institution ‘‘romodanov Neurosurgery Institute, National Academy Of Medical Science Of Ukraine”, Kiev, Ukraine) ⇑
Corresponding author.
Background: Mine blast injury is accompanied by traumatic brain injury (TBI) in 60–100% of cases. TBI is associated with cognitive impairment (CI). However, predictors of CI in this patients (pts) are studied insufficiently. Material and methods: 115 men aged 18 to 45 years with mild TBI caused by using of mine-blasting weapons. Cognitive functions were evaluated by using MoCA test, HADS scale. Cognitive dysfunction was defined as MoCa 6 25 scores. Besides routine examination, neurophysiological methods such as quantitative electroencephalography (qEEG) and cognitive evoked potentials P300 (CEP P300), were performed. Results. In binary logistic regression predictors CI were complaints on headache and fatigability (OR 2.52, 95% CI 2.6–59.7, p = 0.02), increased tendon reflexes (OR, 2.6, 95% CI 1.24–2.32, p = 0.017), higher HADS anxiety level (OR-1.8, 95% CI 1.59–2.2, p = 0.04), changes of alpha rhythm frequency (OR-1.02, 95% CI 1.01– 1.04, p = 0.004), decrease of alpha rhythm amplitudes (OR - 1.07, 95% CI 1.03–1.11, p < 0.001), dysfunction of nonspecific median structures (OR 1.02, 95% CI 1.0–1.04, p = 0.033), decrease of P3 peak amplitude (OR 2.6, 95% CI 1.14–5.9, p = 0.003) and increase of CEP P300 latency (OR 1.07, 95% CI 1.03–1.12, p = 0.002). In multinomial logistic regression the independent predictors of CI were decrease of alpha rhythm amplitudes, decrease of P3 peak amplitude and increase of CEP P300 latency. Conclusions: changes in qEEG and CEP P300 parameters are reliable independent predictors of CI in pts with TBI affected by mine blast trauma. doi:10.1016/j.clinph.2019.04.489
P38-F Motor evoked potentials elicited by TMS in Hirayama disease – Systematic review of the literature—Jan Bembenek a,*, _ Bozena Kłysz b, Iwona Kurkowska-Jastrze˛bska b (a Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland, b 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland) ⇑
Corresponding author.
Background: Hirayama disease (HD) is a rare motor disorder mainly affecting young men. It is characterized by atrophy and unilateral weakness of forearm and hand muscles corresponding to a C7-T1 myotome distribution. The progression is usually selflimiting. The etiology of HD is not fully understood. Motor evoked potentials (MEPs) seems to be useful in pyramidal tracts damage evaluation. Material and methods: We searched PubMed for original papers evaluating the use of transcranial magnetic stimulation elicited MEPs in HD until 02.01.2019 using key words: ‘‘motor evoked potentials Hirayama” and ‘‘transcranial magnetic stimulation Hirayama”. Results: We found six articles using the above key words which met inclusion criteria. Number of participants was small (78 and 55 control group), diagnostic procedures and methodology varied. Abnormal central motor conduction time was found in 17.1% of patients in one study whereas it was normal in 2 other studies. Peripheral motor latency (PML) was evaluated in one study which
found abnormally increased PMLs in at least one tested muscle in 16/41 (39.0%) of HD patients. Abnormal MEP parameters were found in 3 studies in 14.3–100% patients. They were not evaluated in one study and in two were normal in standard and flexed neck position. In one study inconsistent results in MEP size after neck flexion in patients after treatment with neck collar were found. Conclusions: Although MEP parameters may be abnormal in some HD patients, these have not been thoroughly assessed yet. Further studies are indispensable to evaluate their usefulness in assessing pyramidal tracts in HD. doi:10.1016/j.clinph.2019.04.490
P39-F Evaluation of visual pathways with visual evoked potentials in vitamin B12 deficiency patients—Hacer Erdem Tilki *, Onur Yıldız, Sß eyda Bayil (Departmant of Neurology, Ondokuz Mayis University, Samsun, Turkey) ⇑
Corresponding author.
Background: Vitamin b12 is a water-soluble vitamin and a wide variety of neurologic symptoms and signs were encountered including ataxia, loss of sensation, muscle weakness, hyperactive reflexes, incontinence, also it may not cause any symptoms in many patients. Material and methods: In our study, we have included asymptomatic patients. The diagnosis of vitamin B12 deficiency was based on low serum vitamin B12 level (<150 pg/ml). Forty patients with vitamin b12 deficiency and control group were included in the study. Vitamin B12 levels were intended to determine the existence of a possible relationship between P100 latency and amplitude values. Results: Visual acuity was found normal in all the patients. The mean vitamin B12 level was 96 pg/ml in the patient group and 374 pg/ml in the control group. Eight patient (20%) with vitamin B12 deficiency was determined megaloblastic anemia. In vitamin B12 deficiency patients mean P100 latency was 104 ± 8 ms and mean amplitude was 8.1 ± 4 uV. Patients with vitamin B12 deficiency P100 latency compared to the control group was significantly prolonged (P < 0.01). P100 wave amplitude did not find a significant difference between the cases and controls. Similarly, the P100 latency values of patients with hyperhomocysteinemia and megaloblastic anemia was significantly prolonged (P < 0.01). The possible reason for delayed latencies in vitamin B12 deficiency could be demyelination in visual pathways. Conclusions: As a result, pattern shift visual evoked responses may identify the subtle changes in the visual pathways easily in vitamin b12 deficiency patients even when there is no evidence of clinical abnormality. doi:10.1016/j.clinph.2019.04.491
P40-F The relationship between age and SICI parameters obtained with threshold tracking TMS—Søren Ørskov *, Christina Shen-Zhuang Nielsen, Kirsten Pugdahl, Anders FuglsangFrederiksen, Hatice Tankisi (Aarhus University, Århus N, Denmark) ⇑
Corresponding author.
Background: Recently developed threshold tracking TMS (TT-TMS) paired pulse techniques have been shown to be of benefit in clinical diagnostic practice. Reduced Short Interval Cortical Inhibition (SICI) with increasing age has been shown in several studies using