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PO5.10 A Case of Complete Ophthalmoplegia with the Antibody to GT1a Ganglioside
2009 Asian and Oceanian Congress of Clinical Neurophysiology
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and patterns and their clinical associations are similar to the published literature. PO5.9 Clinical and Electroneurophysiological Features of Painful Diabetic Peripheral Neuropathy Hua Pan1 *, Fan Jian1 , Yu-zhou Guan2 , Song-tao Niu1 , Na Chen1 , Liying Cui2 1 Dept. of Neurology, Beijing Tiantan Hospital Attached to Capital Medicine University, China, 2 Dept. of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, China E-mail address: [email protected] Background: To analyze the clinical and electrophysiological features of the painful diabetic peripheral neuropathy (PDPN). Methods: Thirty-two patients with PDPN, whose history was more than 1 year and visual analog scale (VAS) was more than 4, were recruited and investigated. Twenty well-matched healthy volunteers as controls. Conventional motor and sensory nerve conduction velocity (NCV) and quantitative sensory testing (QST) were performed. The relations between VAS and clinic, eletrophysiology were analyzed. Results: NCV of 13 patients showed normal, but in11 of them QST revealed abnormal. The abnormality rates of NCV, QST and NCV+QST were 59.4%, 87.5% and 93.7%, respectively. The relations between VAS and heat pain threshold (HP) of QST, VAS and tibial sensory nerve conduction velocity (SCV) were found. Conclusions: Both small nerve fibers (SNF) and thick myelin fibers were involved, specially SNF in early stage of PDPN. QST is sensitive means for the early diagnosis of PDPN. VAS could be associated with C-nerve fibers and tibial sensory nerve. Combining QST with NCV can give us a comprehensive evaluation of peripheral nerve function. PO5.10 A Case of Complete Ophthalmoplegia with the Antibody to GT1a Ganglioside 1
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Mi-Young Oh *, Se Ho Oh , Kyung Seok Park , Kwang-Woo Lee , Seong-Ho Park1 1 Dept. of Neurology, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Korea, 2 Dept. of Neurology, Seoul National University Hospital, College of Medicine, Seoul National University, Korea E-mail address: [email protected] e syndrome (GBS) is an acute monophasic Background: Guillain Barr´ immune mediated demyelinating disease. Serum antibodies against gangliosides and ganglioside complexes are frequently elevated in GBS. Those antibodies are useful for diagnosis. Kaida et al suggested that the presence of antibody specificity to GD1a/GD1b and/or GD1b/GT1b is significantly associated with severe disability and a requirement for mechanical ventilator. Previous studies described that cases with antiGT1a IgG often had cranial nerve palsy and needed artificial ventilation. We describe a case of complete ophthalmoplegia in GBS with anti-GT1a IgG and IgM, to our knowledge, which has not been reported previously in Korea. Case report: A 51-year old man was admitted to our hospital due to acutely developed bilateral ophthalmoplegia and respiration difficulty which had been worsening over 2 days. Two weeks earlier, he had suffered watery diarrhea. On admission, he was mentally alert. But, he had bilateral complete ptosis, total ophthalmoplegia, facial diplegia and severe bulbar palsy, and quadriplegia. Cerebrospinal fluid examination revealed no pleocytosis (WBC 0 /mm3) and elevated protein (70 mg/dL). An electrophysiologic study on 5 day showed motor dominant polyneuropathy. A total 8 anti-ganglioside auto antibodies were evaluated, but only Anti-GT1a IgG and IgM were positive in his serum. Immunoglobulin was given under the diagnosis of GBS. Afterwards, the patient’s ophthalmoplegia and weakness were moderately improved. Conclusions: We report a case of complete ophthalmoplegia in GBS with anti-GT1a IgG and Ig M. It is rare that complete ophthalmoplegia and complete facial diplegia in GBS. This case support the previous theory that GBS with anti-GT1a IgG often had cranial nerve palsy and associated with severe disability.
PO5.11 Diagnostic Usefulness of Current Perception Threshold in Carpal Tunnel Syndrome Hyo Min Lee *, Chang Hyo Yoon, Jung Im Seok, Dong Kuck Lee Dept. of Neurology, School of Medicine, Catholic University of Daegu, Korea E-mail address: [email protected] Background: Carpal tunnel syndrome (CTS) is the most commonly reported nerve entrapment syndrome. When performing routine nerve conduction studies (NCS) in clinically diagnosed CTS, we sometimes confronted with patients who have no definite electrophysiological evidence of CTS. Current perception threshold (CPT) test can evaluate the functioning of all major subpopulations of sensory nerve. The purpose of this study is to determine clinically usefulness of the CPT test in idiopathic CTS. Methods: We prospectively studied 60 patients (90 hands) who were clinically diagnosed as CTS. Involved hands were grouped into three clinical grades (mild, moderate, severe). NCS was done using a standard technique and equipment. CPT test was measured at the distal interphalangeal joint of second, third and fifth finger with electrical current of 5 Hz, 250 Hz and 2000 Hz in frequency. Results: Of 60 patients (90 hands), 8 (13.1%) were men and 52 (86.9%) were women and the average age was 56.00±8.94 years. Positive rate of NCS is 0.80 (0.72, 0.88). Positive rate of CPT is 0.61 (0.51, 0.71). Sensitivity and specificity of CPT is 0.49 and 0.57. In mild group, most hands showed normal finding at any frequency. But severe group showed high percentage of hands with abnormal value at 250 and 5 Hz stimulation. Conclusions: CPT test showed abnormalities appear progressively from higher to lower frequency stimulations relative to the increasing severity of CTS. We suggested that usefullness of CPT test is lower than NCS in diagnosis of CTS. PO5.12 Neuropsychologic Analysis of Acute Bell’s Palsy Ji Hoon Yoo *, Hyung Ki Hong, Dong Kuck Lee Dept. of Neurology, School of Medicine, Catholic University of Daegu, Korea E-mail address: [email protected] Background: The symptoms and signs of Bell’s palsy were classified into two major categories as disability and impairment. Dysfunction of eating, drinking, speaking, and paralinguistic communication all depend in part or wholly on this system defines the facial neuromotor disability. Dysfunction of facial expression defines the impairment of facial movement. Both neuromotor dysfunction has been found to be one of the most important variable of psychological stress of patients. But relationship between facial neuromotor system impairment, disability, and psychological adjustment has not been well understood. Methods: We have studied a psychological evaluation in patients with acute unilateral facial palsy. We diagnosed 34 facial palsy patients (11 men, 23 women) by neurologic examination, electrophysiologic study and/or brain MRI. We measured scale of impairment (HouseBrackmann scale) and psychosocial adjustment (Beck Anxiety Inventory, Beck Depression Inventory). Results: Thirty four patients with acute unilateral facial palsy were included. Patients were in 3rd 9th decades. The mean grade of HouseBrackmann facial nerve grading scale was 3.68 (SD: 0.91 mean 4, range 1 5). The mean score of BAI and BDI were 13.91 (range; 0 to 47, SD: 9.31, very low anxiety), 16.38 (range; 1 to 41, SD: 8.95, moderate depression). There was no correlation among scores of BAI, BDI and sex, age, HB grade, duration except BAI and duration. Positive correlation between BAI and duration of Bell’s palsy has stastistical significance (p-value 0.038). Conclusions: There was positive correlation between duration of Bell’s palsy and BAI. But there was no correlation between scores of BAI, BDI and other parameters of Bell’s palsy.
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and patterns and their clinical associations are similar to the published literature. PO5.9 Clinical and Electroneurophysiological Features of Painful Diabetic Peripheral Neuropathy Hua Pan1 *, Fan Jian1 , Yu-zhou Guan2 , Song-tao Niu1 , Na Chen1 , Liying Cui2 1 Dept. of Neurology, Beijing Tiantan Hospital Attached to Capital Medicine University, China, 2 Dept. of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, China E-mail address: [email protected] Background: To analyze the clinical and electrophysiological features of the painful diabetic peripheral neuropathy (PDPN). Methods: Thirty-two patients with PDPN, whose history was more than 1 year and visual analog scale (VAS) was more than 4, were recruited and investigated. Twenty well-matched healthy volunteers as controls. Conventional motor and sensory nerve conduction velocity (NCV) and quantitative sensory testing (QST) were performed. The relations between VAS and clinic, eletrophysiology were analyzed. Results: NCV of 13 patients showed normal, but in11 of them QST revealed abnormal. The abnormality rates of NCV, QST and NCV+QST were 59.4%, 87.5% and 93.7%, respectively. The relations between VAS and heat pain threshold (HP) of QST, VAS and tibial sensory nerve conduction velocity (SCV) were found. Conclusions: Both small nerve fibers (SNF) and thick myelin fibers were involved, specially SNF in early stage of PDPN. QST is sensitive means for the early diagnosis of PDPN. VAS could be associated with C-nerve fibers and tibial sensory nerve. Combining QST with NCV can give us a comprehensive evaluation of peripheral nerve function. PO5.10 A Case of Complete Ophthalmoplegia with the Antibody to GT1a Ganglioside 1
1
1
2
Mi-Young Oh *, Se Ho Oh , Kyung Seok Park , Kwang-Woo Lee , Seong-Ho Park1 1 Dept. of Neurology, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Korea, 2 Dept. of Neurology, Seoul National University Hospital, College of Medicine, Seoul National University, Korea E-mail address: [email protected] e syndrome (GBS) is an acute monophasic Background: Guillain Barr´ immune mediated demyelinating disease. Serum antibodies against gangliosides and ganglioside complexes are frequently elevated in GBS. Those antibodies are useful for diagnosis. Kaida et al suggested that the presence of antibody specificity to GD1a/GD1b and/or GD1b/GT1b is significantly associated with severe disability and a requirement for mechanical ventilator. Previous studies described that cases with antiGT1a IgG often had cranial nerve palsy and needed artificial ventilation. We describe a case of complete ophthalmoplegia in GBS with anti-GT1a IgG and IgM, to our knowledge, which has not been reported previously in Korea. Case report: A 51-year old man was admitted to our hospital due to acutely developed bilateral ophthalmoplegia and respiration difficulty which had been worsening over 2 days. Two weeks earlier, he had suffered watery diarrhea. On admission, he was mentally alert. But, he had bilateral complete ptosis, total ophthalmoplegia, facial diplegia and severe bulbar palsy, and quadriplegia. Cerebrospinal fluid examination revealed no pleocytosis (WBC 0 /mm3) and elevated protein (70 mg/dL). An electrophysiologic study on 5 day showed motor dominant polyneuropathy. A total 8 anti-ganglioside auto antibodies were evaluated, but only Anti-GT1a IgG and IgM were positive in his serum. Immunoglobulin was given under the diagnosis of GBS. Afterwards, the patient’s ophthalmoplegia and weakness were moderately improved. Conclusions: We report a case of complete ophthalmoplegia in GBS with anti-GT1a IgG and Ig M. It is rare that complete ophthalmoplegia and complete facial diplegia in GBS. This case support the previous theory that GBS with anti-GT1a IgG often had cranial nerve palsy and associated with severe disability.
PO5.11 Diagnostic Usefulness of Current Perception Threshold in Carpal Tunnel Syndrome Hyo Min Lee *, Chang Hyo Yoon, Jung Im Seok, Dong Kuck Lee Dept. of Neurology, School of Medicine, Catholic University of Daegu, Korea E-mail address: [email protected] Background: Carpal tunnel syndrome (CTS) is the most commonly reported nerve entrapment syndrome. When performing routine nerve conduction studies (NCS) in clinically diagnosed CTS, we sometimes confronted with patients who have no definite electrophysiological evidence of CTS. Current perception threshold (CPT) test can evaluate the functioning of all major subpopulations of sensory nerve. The purpose of this study is to determine clinically usefulness of the CPT test in idiopathic CTS. Methods: We prospectively studied 60 patients (90 hands) who were clinically diagnosed as CTS. Involved hands were grouped into three clinical grades (mild, moderate, severe). NCS was done using a standard technique and equipment. CPT test was measured at the distal interphalangeal joint of second, third and fifth finger with electrical current of 5 Hz, 250 Hz and 2000 Hz in frequency. Results: Of 60 patients (90 hands), 8 (13.1%) were men and 52 (86.9%) were women and the average age was 56.00±8.94 years. Positive rate of NCS is 0.80 (0.72, 0.88). Positive rate of CPT is 0.61 (0.51, 0.71). Sensitivity and specificity of CPT is 0.49 and 0.57. In mild group, most hands showed normal finding at any frequency. But severe group showed high percentage of hands with abnormal value at 250 and 5 Hz stimulation. Conclusions: CPT test showed abnormalities appear progressively from higher to lower frequency stimulations relative to the increasing severity of CTS. We suggested that usefullness of CPT test is lower than NCS in diagnosis of CTS. PO5.12 Neuropsychologic Analysis of Acute Bell’s Palsy Ji Hoon Yoo *, Hyung Ki Hong, Dong Kuck Lee Dept. of Neurology, School of Medicine, Catholic University of Daegu, Korea E-mail address: [email protected] Background: The symptoms and signs of Bell’s palsy were classified into two major categories as disability and impairment. Dysfunction of eating, drinking, speaking, and paralinguistic communication all depend in part or wholly on this system defines the facial neuromotor disability. Dysfunction of facial expression defines the impairment of facial movement. Both neuromotor dysfunction has been found to be one of the most important variable of psychological stress of patients. But relationship between facial neuromotor system impairment, disability, and psychological adjustment has not been well understood. Methods: We have studied a psychological evaluation in patients with acute unilateral facial palsy. We diagnosed 34 facial palsy patients (11 men, 23 women) by neurologic examination, electrophysiologic study and/or brain MRI. We measured scale of impairment (HouseBrackmann scale) and psychosocial adjustment (Beck Anxiety Inventory, Beck Depression Inventory). Results: Thirty four patients with acute unilateral facial palsy were included. Patients were in 3rd 9th decades. The mean grade of HouseBrackmann facial nerve grading scale was 3.68 (SD: 0.91 mean 4, range 1 5). The mean score of BAI and BDI were 13.91 (range; 0 to 47, SD: 9.31, very low anxiety), 16.38 (range; 1 to 41, SD: 8.95, moderate depression). There was no correlation among scores of BAI, BDI and sex, age, HB grade, duration except BAI and duration. Positive correlation between BAI and duration of Bell’s palsy has stastistical significance (p-value 0.038). Conclusions: There was positive correlation between duration of Bell’s palsy and BAI. But there was no correlation between scores of BAI, BDI and other parameters of Bell’s palsy.