P83-F Reinnervation in masseteric nerve supercharge bypass in primary reconstruction of facial nerve

Abstracts / Clinical Neurophysiology 130 (2019) e21–e116

Conclusions: neuromuscular ultrasound resulted a simple, fast and easy method, painless and risk-free, able to provide useful functional and structural information in ALS pt. Furthermore, diaphragm US may allow to point out concomitant respiratory failure. Moreover is desirable that US become an indispensable tool of the diagnostic armamentarium of the neuromuscular physician in pt. with ALS. doi:10.1016/j.clinph.2019.04.530

P82-F Carpal tunnel syndrome—Fricz Eva (Eva Fricz, Lille, France)

Objectives: Carpal tunnel syndrome (CTS) is a widely distributed upper limb nerve compression. CTS is relatively easy to recognise with timely diagnosis of sympto. The elimination of risks and professional conservative therapy can prevent the radical interventions. Methods: In our study we worked with 8 patients, 7 of them had signs of CTS in both hands. The diagnosis was based on history, physical examinations and an electroneurographia test (ENG). All of the patients completed a questionnaire about their subjective symptoms before the objective physical examinations. The used physiotherapy was modified for the severity of the sympto. Advice on workplace task modification was given to all patients. Results: Main symptoms are tingling, numbness, nocturnal pain and weakness in the distribution of the median nerve in the hand. Objective results represented a decrease in the range of motion, waste of force in the hand and thenar atrophy. After the treatment the waste of the abductor pollicis has disappeared at all patients, weakness and deficits of motion were found in one person. We recognised a significant improvement in the specific tests. Discussion: Occupational factors, overstrain of the hands are important causes of CTS. Loss of sensory feedback and pain is more often presented than motor function loss. After the treatment the symptoms of patients were reduced or disappeared. Conclusions: CTS can be often effectively treated with complex physiotherapy and workplace task modifications, but there isn’t a complete recovery in all cases. doi:10.1016/j.clinph.2019.04.531

P83-F Reinnervation in masseteric nerve supercharge bypass in primary reconstruction of facial nerve—Stepanka Brusakova a,*, Petr Vachata b, Jan Lodin a,b, Martin Sames b (a Neurologicke oddelení MNUL, Krajska zdravotni, a.s., Usti nad Labem, Czech Republic, b Neurochirurgicka klinika Fakulty zdravotnickych studii Univerzity J.E. Purkyne v Usti nad Labem a Krajske zdravotni, a. s. – Masarykovy nemocnice v Usti nad Labem, o.z, Czech Republic) ⇑

Corresponding author.

Background: Facial paralysis is a severe disease. A wide variety of surgical procedures to facial nerve reconstruction are available. We demonstrate reinnervation after infratemporal end-to-end anastomosis following nerve rerouting and concomitant masseteric nerve transfer to the side of facial nerve trunk. Masseteric nerve transfer seems to have strong reinnervation potential. Material and methods: Patient presented with complete unilateral facial nerve palsy on the left side with the absence of clinical movement and no signs of reinnervation on needle electromyography. The

e91

ipsilateral masseteric muscle nerve electromyography and function was without deterioration. After reconstruction, the patient was regularly clinically and electromyographically evaluated throughout a three-month postoperative period. Results: The first control showed no electromyographic signs of reinnervation. Reinnervation in both upper and lower part of face after six months was observed with richer and more mature voluntary activity in orbicularis oris muscle. Synkinetic activity with biting was observed. Three months later, the patient achieved facial symmetry at rest and palpebral closing significantly improved with a residual 3 mm gap. Electrophysiological evaluation 12 months after surgery showed improved reinnervation of mimic muscles during biting and relaxation of chewing muscles at both donor nerve sites, as well as clinical recovery of the capacity to spontaneously blink, complete eyelid closure and initials signs of smile. Conclusions: Double innervation of muscular transfer allows additional target muscle reinnervation, with simultaneous preservation of donor nerve function. Electromyography needle evaluation 12 months after surgery declares independent reinnervation through both donors. doi:10.1016/j.clinph.2019.04.532

P84-F Subacute polyneuropathy partially responsive to immunomodulatory treatment coexisting with POLG mutation— Malgorzata Lukawska a,*, Anna Potulska-Chromik a, Marta Lipowska a, Monika Nojszewska a, Edyta Maj b, Marek Gołe˛biowski b, Tomasz Mazurczak c, Magdalena Kaliszewska d, Katarzyna Ton´ska d, Anna Kostera-Pruszczyk a (a Medical University of Warsaw, Department of Neurology, Warsaw, Poland, b Medical University of Warsaw, Department of Radiology, Warsaw, Poland , c National Research Institute for Mother and Child, Department of Child Neurology, Warsaw, Poland, d University of Warsaw, Institute of Genetics and Biotechnology, Faculty of Biology, Warsaw, Poland) ⇑

Corresponding author.

Background: During the last few years, the correlation between mitochondrial disorders and autoimmune diseases has been reported. Autoimmune polyneuropathies were concomitant with symptoms related to the polymerase c (POLG) mutations. POLG is involved in mitochondrial DNA (mtDNA) replication and maintenance. Material and methods: We present a case of a16-year-old girl with W748S mutation of POLG region with a 1,5-year history of slowly progressive walking difficulties. Results: In the neurological examination the girl had ataxic gait with sensory disturbances in lower extremities with areflexia. Nerve conduction studies (NCS) demonstrated axonal–demyelinating sensorimotor polyneuropathy of the lower limbs. Additionally, magnetic resonance imaging (MRI) of the lumbar spine revealed gadolinium enhancement of the spinal roots and an examination of cerebrospinal fluid showed dissemination. The immunomodulatory treatment with intravenous methylprednisolone and intravenous immunoglobulin (IVIg) was started. Conclusions: The IVIg and IVMP treatment led to marked improvement of her abnormal gait and improved resolution of abnormalities of touch, temperature sensation and improved proprioception. The W748S mutations were commonly reported and associated with variable phenotypes, most often Alpers syndrome, but also polyneuropathy. However, electrodiagnostic features and partial