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S38. Boston questionnaire and neurophysiological findings in carpal tunnel syndrome in Sri Lanka
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Abstracts / Clinical Neurophysiology 129 (2018) e142–e212
leg examination was unremarkable. Deep tendon reflexes were preserved except for the right ankle jerk which was absent. Sensory examination disclosed only a right-sided pinprick gradient from the toes to the mid-foot. Serum protein electrophoresis with immunofixation was normal and anti-GM1 antibodies were absent. Lumbar spine MRI was unremarkable. MRI of the right leg showed atrophy of the posterior compartment of the thigh and proximal calf. Nerve conduction studies revealed partial conduction block and temporal dispersion of left ulnar and bilateral median motor responses in the forearm, mild median motor conduction slowing through the forearms, an absent right tibial motor response, and absent sural sensory responses. The abnormal sensory responses argue against multifocal motor neuropathy. These findings were interpreted as being consistent with MADSAM with secondary axonal loss particularly in the leg where motor and sensory responses were unevocable. Conclusion: MADSAM typically presents with upper limbs weakness. The striking feature in this patient was the longstanding right leg weakness which overshadowed the left hand weakness. The importance of more extensive clinical and electrodiagnostic evaluation in patients presenting with focal neurological complaints is born out in this patient in whom diagnostic demyelinative findings were evident only in the less affected upper limbs. doi:10.1016/j.clinph.2018.04.397
S38. Boston questionnaire and neurophysiological findings in carpal tunnel syndrome in Sri Lanka—Vajira S. Weerasinghe *, Malindi Wijayasiri, Nipuna T. Weerasinghe, Padmini Dahanayake, RGL Shiroma, Tharaka Dassanayake, Nadie Ratnayake (Sri Lanka) ⇑
Presenting author.
Introduction: Although the common clinical presentation of carpal tunnel syndrome (CTS) is the presence of numbness or pain in the hand, many attempts have been made to develop a score based on clinical findings. Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) is a standardised, patient-based outcome measure of symptom severity and functional status. It has been widely used in different populations. The objective of this study was to find out BCTQ findings among Sri Lankan patients suspected with CTS and correlate the findings with neurophysiological parameters. Methods: In a group of 147 patients suspected of carpal tunnel syndrome (CTS) based on the presence of numbness or pain in the hand, BCTQ was administered as an interview-based questionnaire format and the nerve conduction tests were performed on the median and ulnar nerves using a Natus EMG machine at the Neurophysiological Unit of the Teaching Hospital, Peradeniya, Sri Lanka. Neurophysiological grading was done according to the scale described by Bland in 2000. Results: Mean age was 49.4 ± 11.9 years. BCTQ symptom and functional scores showed no correlation with the severity of CTS grading. In BCTQ, questions on numbness (r = 0.3, P < 0.001), numbness at night (r = 0.3, P < 0.05) and numbness causing waking up (r = 0.2, P < 0.05) were significantly correlated with the severity of CTS grading. Mean symptom and functional scores were comparable with a previous Indian study which showed a lower score than that was reported for the western CTS patients. In 19.7% of patients neurophysiological findings were normal. Conclusion: Neurophysiological severity in CTS could be predicted by the scores related to numbness in BCTQ. doi:10.1016/j.clinph.2018.04.398
S39. 7-Year serial neurosonographic findings in a patient with axonal Charcot-Marie-Tooth disease—Sang Beom Kim *, Yu Yong Shin, Joong-Yang Cho (Republic of Korea) ⇑
Presenting author.
Introduction: Ultrasonography has been used widely for identifying pathology of peripheral nerve. In this study, we compare the ultrasonographic findings in the median and ulnar nerves in patients with axonal type of Charcot-Marie-Tooth (CMT) 2A disease annually for 7 years. Methods: Median nerve and ulnar nerve ultrasound studies were performed in 19 patients with CMT2A. One patient is followed up with nerve cross sectional areas (CSA) study annually or biennially for 7 years. Results: Median and ulnar nerve CSAs were similar or slightly increased in CMT2A, compared with 1st study. But in clinically deteriorated patients such as worsening difficulties of hand grip or gait, nerve CSA were moderately enlarged. Conclusion: In demyelinating polyneuropathies, which are hereditary or acquired, enlarged nerve CSA is well known. But change of nerve CSA in axonal neuropathy is controversial. In this study, we found moderate increase of nerve CSA in some CMT2A patients. Further studies involving more CMT2A patients are needed to elucidate the natural history and neurosonographic features of hereditary axonal neuropathies. doi:10.1016/j.clinph.2018.04.399
S40. Acute and subacute motor neuropathy in type II diabetic patients—Ammar Ahmed 1,2,*, Afraa Musa 2 (1 United Kingdom, 2 Sudan) ⇑
Presenting author.
Introduction: Diabetic neuropathy is the most common complication of diabetes mellitus (DM), affecting as many as 50% of patients with type 1 and type 2 DM. There are four main types of diabetic neuropathy; Peripheral neuropathy, autonomic neuropathy, radiculo-plexus neuropathy (diabetic-amyotrophy) and mononeuropathy. The aim of the study was to describe the clinical presentation, electrophysiological investigations and in the future the immunological profile of such patients. Methods: Seven type II diabetic patients were selected for the study. Ethical approval and patients’ informed consent have been obtained. They are all presented with acute and subacute onset of predominantly lower limb distal muscle weakness, on occasion proximal. The onset of this weakness was not preceded by upper respiratory tract infection, diarrhea or febrile illness. Results: On examination there was symmetrical weakness of the distal foot flexors and extensors (power ranges 0–3), lower limb reflexes varies from diminished to absent. Tone was normal in the majority and flaccid in some of the patients. All modalities of sensation are intact except for disturbance of light touch in two patients. All patients were investigated for other causes of neuropathies. Neurophysiological investigations revealed signs of predominant demyelination with axonal degeneration. Patients showed very good response to immunoglobulin infusion (i.e. recovery of weakness after one to three months). Immunological studies are undergoing. Conclusion: This was a preliminary report of a very uncommon presentation of acute motor neuropathy in diabetic patients. The cause possibly might be immune-mediated nerve damage but this
Abstracts / Clinical Neurophysiology 129 (2018) e142–e212
leg examination was unremarkable. Deep tendon reflexes were preserved except for the right ankle jerk which was absent. Sensory examination disclosed only a right-sided pinprick gradient from the toes to the mid-foot. Serum protein electrophoresis with immunofixation was normal and anti-GM1 antibodies were absent. Lumbar spine MRI was unremarkable. MRI of the right leg showed atrophy of the posterior compartment of the thigh and proximal calf. Nerve conduction studies revealed partial conduction block and temporal dispersion of left ulnar and bilateral median motor responses in the forearm, mild median motor conduction slowing through the forearms, an absent right tibial motor response, and absent sural sensory responses. The abnormal sensory responses argue against multifocal motor neuropathy. These findings were interpreted as being consistent with MADSAM with secondary axonal loss particularly in the leg where motor and sensory responses were unevocable. Conclusion: MADSAM typically presents with upper limbs weakness. The striking feature in this patient was the longstanding right leg weakness which overshadowed the left hand weakness. The importance of more extensive clinical and electrodiagnostic evaluation in patients presenting with focal neurological complaints is born out in this patient in whom diagnostic demyelinative findings were evident only in the less affected upper limbs. doi:10.1016/j.clinph.2018.04.397
S38. Boston questionnaire and neurophysiological findings in carpal tunnel syndrome in Sri Lanka—Vajira S. Weerasinghe *, Malindi Wijayasiri, Nipuna T. Weerasinghe, Padmini Dahanayake, RGL Shiroma, Tharaka Dassanayake, Nadie Ratnayake (Sri Lanka) ⇑
Presenting author.
Introduction: Although the common clinical presentation of carpal tunnel syndrome (CTS) is the presence of numbness or pain in the hand, many attempts have been made to develop a score based on clinical findings. Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) is a standardised, patient-based outcome measure of symptom severity and functional status. It has been widely used in different populations. The objective of this study was to find out BCTQ findings among Sri Lankan patients suspected with CTS and correlate the findings with neurophysiological parameters. Methods: In a group of 147 patients suspected of carpal tunnel syndrome (CTS) based on the presence of numbness or pain in the hand, BCTQ was administered as an interview-based questionnaire format and the nerve conduction tests were performed on the median and ulnar nerves using a Natus EMG machine at the Neurophysiological Unit of the Teaching Hospital, Peradeniya, Sri Lanka. Neurophysiological grading was done according to the scale described by Bland in 2000. Results: Mean age was 49.4 ± 11.9 years. BCTQ symptom and functional scores showed no correlation with the severity of CTS grading. In BCTQ, questions on numbness (r = 0.3, P < 0.001), numbness at night (r = 0.3, P < 0.05) and numbness causing waking up (r = 0.2, P < 0.05) were significantly correlated with the severity of CTS grading. Mean symptom and functional scores were comparable with a previous Indian study which showed a lower score than that was reported for the western CTS patients. In 19.7% of patients neurophysiological findings were normal. Conclusion: Neurophysiological severity in CTS could be predicted by the scores related to numbness in BCTQ. doi:10.1016/j.clinph.2018.04.398
S39. 7-Year serial neurosonographic findings in a patient with axonal Charcot-Marie-Tooth disease—Sang Beom Kim *, Yu Yong Shin, Joong-Yang Cho (Republic of Korea) ⇑
Presenting author.
Introduction: Ultrasonography has been used widely for identifying pathology of peripheral nerve. In this study, we compare the ultrasonographic findings in the median and ulnar nerves in patients with axonal type of Charcot-Marie-Tooth (CMT) 2A disease annually for 7 years. Methods: Median nerve and ulnar nerve ultrasound studies were performed in 19 patients with CMT2A. One patient is followed up with nerve cross sectional areas (CSA) study annually or biennially for 7 years. Results: Median and ulnar nerve CSAs were similar or slightly increased in CMT2A, compared with 1st study. But in clinically deteriorated patients such as worsening difficulties of hand grip or gait, nerve CSA were moderately enlarged. Conclusion: In demyelinating polyneuropathies, which are hereditary or acquired, enlarged nerve CSA is well known. But change of nerve CSA in axonal neuropathy is controversial. In this study, we found moderate increase of nerve CSA in some CMT2A patients. Further studies involving more CMT2A patients are needed to elucidate the natural history and neurosonographic features of hereditary axonal neuropathies. doi:10.1016/j.clinph.2018.04.399
S40. Acute and subacute motor neuropathy in type II diabetic patients—Ammar Ahmed 1,2,*, Afraa Musa 2 (1 United Kingdom, 2 Sudan) ⇑
Presenting author.
Introduction: Diabetic neuropathy is the most common complication of diabetes mellitus (DM), affecting as many as 50% of patients with type 1 and type 2 DM. There are four main types of diabetic neuropathy; Peripheral neuropathy, autonomic neuropathy, radiculo-plexus neuropathy (diabetic-amyotrophy) and mononeuropathy. The aim of the study was to describe the clinical presentation, electrophysiological investigations and in the future the immunological profile of such patients. Methods: Seven type II diabetic patients were selected for the study. Ethical approval and patients’ informed consent have been obtained. They are all presented with acute and subacute onset of predominantly lower limb distal muscle weakness, on occasion proximal. The onset of this weakness was not preceded by upper respiratory tract infection, diarrhea or febrile illness. Results: On examination there was symmetrical weakness of the distal foot flexors and extensors (power ranges 0–3), lower limb reflexes varies from diminished to absent. Tone was normal in the majority and flaccid in some of the patients. All modalities of sensation are intact except for disturbance of light touch in two patients. All patients were investigated for other causes of neuropathies. Neurophysiological investigations revealed signs of predominant demyelination with axonal degeneration. Patients showed very good response to immunoglobulin infusion (i.e. recovery of weakness after one to three months). Immunological studies are undergoing. Conclusion: This was a preliminary report of a very uncommon presentation of acute motor neuropathy in diabetic patients. The cause possibly might be immune-mediated nerve damage but this