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S79. The utility of tibial nerve SEPs in diagnosing lumbar spinal stenosis, comparison with NCS and F-Waves
Abstracts / Clinical Neurophysiology 129 (2018) e142–e212
Parkinsonian syndrome. This new system may provide the personalized rehabilitation in patients with Parkinson related disorders. doi:10.1016/j.clinph.2018.04.437
S78. MRI assessment of neck muscles in patients with unilateral cervical radiculopathy patients—Joon Shik Yoon *, Seok Kang, Hanboram Choi, Kwang-Jae Lee, Jang-Yeol Kim, Seong-Ho Son (Republic of Korea) ⇑
Presenting author.
Introduction: Several recent studies have investigated the changes of multifidus muscles in patients with chronic neck pain. Also, the longus coli muscle, one of the deep cervical flexor muscles, showed smaller cross sectional area (CSA) in patients with chronic neck pain in comparison with healthy people. To our knowledge, there is no study investigating the association between morphological features of cervical paravertebral muscles in electrodiagnosed cervical radiculopathy patients. In this study, we investigate the change in CSA and composition of the cervical flexor and multifidus muscles using the digital data from MRIs of patients with electrodiagnosed cervical radiculopathy. Methods: Twenty-four patients with unilateral cervical radicular pain who had cervical MRI and EMG examinations between 1 January 2015 and 2016 were retrospectively analysed. The inclusion criteria were as follows: (1) patients with the symptoms of unilateral cervical pain or referral to one upper limb, (2) diagnosis of cervical radiculopathy in EMG. Exclusion criteria included: (1) a history of cervical surgery; (2) a history of spinal fracture or injuries; (3) primary or metastatic spinal tumor. Axial slice at the level of C4-5 mid disc level image was selected to calculate the muscle CSA, with their maximal CSAs. Total CSA and functional CSA measurements of the bilateral longus colli, sternocleidomastoid and multifidus muscles were measured by using Image J (version 1.43, National Institutes of Health, Bethesda, Maryland). All muscle measurements were acquired by one investigators. Functional CSA measurement was obtained by using threshold method (including only pixels within lean muscle tissue range). Statistical analysis was performed using SPSSÒ v. 15. Results: The baseline characteristics of the study participants are shown in Table 1. There was no significant difference in total CSA in longus colli, sternocleidomastoid and multifidus muscles between involved and uninvolved groups. Data analysis showed significant difference between the functional CSA of the lognus colli muscle the involved/uninvolved sides (Table 2). Also, there is significant difference in the ratio of longus colli musle (functional longus colli muscle CSA/total longus colli muscle CSA) between the involved and uninvolved sides (P < 0.001). Conclusion: This is the study to show via MRI assessment that patients with cervical radiculopathy have smaller ipsilateral functional CSA of the longus colli muscle LCM in comparison with uninvolved side. Consideration of these muscles in MRI could be helpful in the diagnosis and prognosis of cervical radiculopathy. doi:10.1016/j.clinph.2018.04.438
S79. The utility of tibial nerve SEPs in diagnosing lumbar spinal stenosis, comparison with NCS and F-Waves—Chizuko Oishi *, Yoshikazu Mizoi, Chiba Atsuro, Masahiro Sonoo (Japan) ⇑
Presenting author.
e171
Introduction: Lumbar spinal stenosis (LSS) is a popular cause of lower limb motor and sensory impairments and gait disturbance. SEPs can be a tool to evaluate LSS, and there have been considerable number of studies investigating the utility of dermatomal SEP in evaluating LSS or lumbar radiculopathy. However, few studies investigated the utility of tibial nerve SEPs. Tibial nerve SEPs have an advantage that they can evaluate plural points along the whole course of the peripheral nerve and can localize the lesion site. Three segments of ankle-knee, knee-pelvis, and pelvis-spinal entry can be evaluated by N8o latency, N8o-P15 interval, and P15-N21 interval. In this study, we compared the utility of tibial nerve SEPs with nerve conduction studies (NCS) and F-waves. Methods: We searched our EMG database from 2012 to 2017 with the keyword of ‘‘LSS” or ‘‘lumbar” and SEP examinations. For extracted cases, we retrospectively reviewed clinical and EMG records and MRI images. The entry criteria were as follows: (1) presence of sensory, motor, or gait (typically, intermittent claucication) complaints, (2) unequivocal LSS in lumbar MRI, (3) final diagnosis that the chief complaint was caused by the MRI-documented LSS, (4) Tibial nerve SEPs, motor conduction study (MCS) and F waves of the tibial nerve, and sensory conduction study (SCS) of the sural nerve were conducted for the same lower-limb that was the more affected, (5) no other causes that can explain his or her symptoms, especially neuropathies and diabetes, (6) no prior lumbar surgery. Results: Among 39 patients initially extracted, many have been excluded by the strict inclusion criteria. Finally enrolled were 8 patients (53–82 years, all men). The clinical features of these patients were as follows. Weakness was present in 7 (absent in 1). Sensory symptoms or signs were present in 4 (absent in 4). Intermittent claucication was present in 3 patients. Tibial nerve SEPs were abnormal in 7, and could localize the lesion at the lumbar segment (P15-N21) in 6. Notably, in 3 out of 4 patients without sensory symptoms or signs, tibial nerve SEPs localized the lesion at lumbar segment. The amplitude of the compound muscle action potential (CMAP) of the tibial MCS was reduced in 2 cases, and Fwave latency was prolonged in the same 2 cases. In no cases, Fwaves were abnormal despite normal SEPs. Sural SCS was normal for all cases. In two patients in which tibial nerve SEPs could not localize the lesion, needle EMG confirmed the diagnosis of LSS. Conclusion: Tibial nerve SEPs are useful in diagnosing LSS by localizing the lesion at the lumbar segments. Especially the fact that they documented lumbar lesions in patients lacking sensory symptoms or signs would contribute to the differentiation from amyotrophic lateral sclerosis. The sensitivity of F-waves was much lower than tibial nerve SEPs and added no value to the amplitude of the tibial CMAP. doi:10.1016/j.clinph.2018.04.439
S80. Utility of reduced montage EEG in detecting seizures or seizure-like activity—Kapil Gururangan *, Babak Razavi, Josef Parvizi (USA) ⇑
Presenting author.
Introduction: Standard scalp EEG is used to detect a wide range of cerebral pathologies. However, its utility in emergency and resourcelimited settings may be impeded by delays in setup and interpretation. Past studies have investigated reduced channel arrays as screening tools, but inferred a lower utility in detecting epileptiform abnormalities. The current study tested the utility of reduced (8channel) montage (rm-EEG) covering the lateral hemispheres compared to full (18-channel) montage (fm-EEG) for detection of generalized and hemispheric seizures and seizure-like patterns by
Parkinsonian syndrome. This new system may provide the personalized rehabilitation in patients with Parkinson related disorders. doi:10.1016/j.clinph.2018.04.437
S78. MRI assessment of neck muscles in patients with unilateral cervical radiculopathy patients—Joon Shik Yoon *, Seok Kang, Hanboram Choi, Kwang-Jae Lee, Jang-Yeol Kim, Seong-Ho Son (Republic of Korea) ⇑
Presenting author.
Introduction: Several recent studies have investigated the changes of multifidus muscles in patients with chronic neck pain. Also, the longus coli muscle, one of the deep cervical flexor muscles, showed smaller cross sectional area (CSA) in patients with chronic neck pain in comparison with healthy people. To our knowledge, there is no study investigating the association between morphological features of cervical paravertebral muscles in electrodiagnosed cervical radiculopathy patients. In this study, we investigate the change in CSA and composition of the cervical flexor and multifidus muscles using the digital data from MRIs of patients with electrodiagnosed cervical radiculopathy. Methods: Twenty-four patients with unilateral cervical radicular pain who had cervical MRI and EMG examinations between 1 January 2015 and 2016 were retrospectively analysed. The inclusion criteria were as follows: (1) patients with the symptoms of unilateral cervical pain or referral to one upper limb, (2) diagnosis of cervical radiculopathy in EMG. Exclusion criteria included: (1) a history of cervical surgery; (2) a history of spinal fracture or injuries; (3) primary or metastatic spinal tumor. Axial slice at the level of C4-5 mid disc level image was selected to calculate the muscle CSA, with their maximal CSAs. Total CSA and functional CSA measurements of the bilateral longus colli, sternocleidomastoid and multifidus muscles were measured by using Image J (version 1.43, National Institutes of Health, Bethesda, Maryland). All muscle measurements were acquired by one investigators. Functional CSA measurement was obtained by using threshold method (including only pixels within lean muscle tissue range). Statistical analysis was performed using SPSSÒ v. 15. Results: The baseline characteristics of the study participants are shown in Table 1. There was no significant difference in total CSA in longus colli, sternocleidomastoid and multifidus muscles between involved and uninvolved groups. Data analysis showed significant difference between the functional CSA of the lognus colli muscle the involved/uninvolved sides (Table 2). Also, there is significant difference in the ratio of longus colli musle (functional longus colli muscle CSA/total longus colli muscle CSA) between the involved and uninvolved sides (P < 0.001). Conclusion: This is the study to show via MRI assessment that patients with cervical radiculopathy have smaller ipsilateral functional CSA of the longus colli muscle LCM in comparison with uninvolved side. Consideration of these muscles in MRI could be helpful in the diagnosis and prognosis of cervical radiculopathy. doi:10.1016/j.clinph.2018.04.438
S79. The utility of tibial nerve SEPs in diagnosing lumbar spinal stenosis, comparison with NCS and F-Waves—Chizuko Oishi *, Yoshikazu Mizoi, Chiba Atsuro, Masahiro Sonoo (Japan) ⇑
Presenting author.
e171
Introduction: Lumbar spinal stenosis (LSS) is a popular cause of lower limb motor and sensory impairments and gait disturbance. SEPs can be a tool to evaluate LSS, and there have been considerable number of studies investigating the utility of dermatomal SEP in evaluating LSS or lumbar radiculopathy. However, few studies investigated the utility of tibial nerve SEPs. Tibial nerve SEPs have an advantage that they can evaluate plural points along the whole course of the peripheral nerve and can localize the lesion site. Three segments of ankle-knee, knee-pelvis, and pelvis-spinal entry can be evaluated by N8o latency, N8o-P15 interval, and P15-N21 interval. In this study, we compared the utility of tibial nerve SEPs with nerve conduction studies (NCS) and F-waves. Methods: We searched our EMG database from 2012 to 2017 with the keyword of ‘‘LSS” or ‘‘lumbar” and SEP examinations. For extracted cases, we retrospectively reviewed clinical and EMG records and MRI images. The entry criteria were as follows: (1) presence of sensory, motor, or gait (typically, intermittent claucication) complaints, (2) unequivocal LSS in lumbar MRI, (3) final diagnosis that the chief complaint was caused by the MRI-documented LSS, (4) Tibial nerve SEPs, motor conduction study (MCS) and F waves of the tibial nerve, and sensory conduction study (SCS) of the sural nerve were conducted for the same lower-limb that was the more affected, (5) no other causes that can explain his or her symptoms, especially neuropathies and diabetes, (6) no prior lumbar surgery. Results: Among 39 patients initially extracted, many have been excluded by the strict inclusion criteria. Finally enrolled were 8 patients (53–82 years, all men). The clinical features of these patients were as follows. Weakness was present in 7 (absent in 1). Sensory symptoms or signs were present in 4 (absent in 4). Intermittent claucication was present in 3 patients. Tibial nerve SEPs were abnormal in 7, and could localize the lesion at the lumbar segment (P15-N21) in 6. Notably, in 3 out of 4 patients without sensory symptoms or signs, tibial nerve SEPs localized the lesion at lumbar segment. The amplitude of the compound muscle action potential (CMAP) of the tibial MCS was reduced in 2 cases, and Fwave latency was prolonged in the same 2 cases. In no cases, Fwaves were abnormal despite normal SEPs. Sural SCS was normal for all cases. In two patients in which tibial nerve SEPs could not localize the lesion, needle EMG confirmed the diagnosis of LSS. Conclusion: Tibial nerve SEPs are useful in diagnosing LSS by localizing the lesion at the lumbar segments. Especially the fact that they documented lumbar lesions in patients lacking sensory symptoms or signs would contribute to the differentiation from amyotrophic lateral sclerosis. The sensitivity of F-waves was much lower than tibial nerve SEPs and added no value to the amplitude of the tibial CMAP. doi:10.1016/j.clinph.2018.04.439
S80. Utility of reduced montage EEG in detecting seizures or seizure-like activity—Kapil Gururangan *, Babak Razavi, Josef Parvizi (USA) ⇑
Presenting author.
Introduction: Standard scalp EEG is used to detect a wide range of cerebral pathologies. However, its utility in emergency and resourcelimited settings may be impeded by delays in setup and interpretation. Past studies have investigated reduced channel arrays as screening tools, but inferred a lower utility in detecting epileptiform abnormalities. The current study tested the utility of reduced (8channel) montage (rm-EEG) covering the lateral hemispheres compared to full (18-channel) montage (fm-EEG) for detection of generalized and hemispheric seizures and seizure-like patterns by