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Laure Inghilleri M, Alonso S, Moron H, Ruiz H, Bastide S, Coudray S. The value of ultrasound-guidance of nerves and muscles for patient tolerance and parameters electrodiagnostic studies. Clin Neurophysiol Pract 2024; 9:78-84. [PMID: 38357416 PMCID: PMC10864755 DOI: 10.1016/j.cnp.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
Objective To assess impact of ultrasound guidance (USG) on patient's perception of nerve conduction studies (NCS). Methods In this single-center, randomized, sham-controlled, parallel, single-blind trial, we evaluated ultrasound (US) in identifying NCS stimulation site. Consecutive adults (18-80 old) without neuropathy referred for NCS were electronically randomized 1:1 to USG or Sham US. The primary outcome was sensory supramaximal intensity (SSMI) for each site/nerve; motor supramaximal intensity (MSMI), amplitudes, number of non-routine muscle punctured, Visual Analogue Scale (VAS), satisfaction were secondary outcomes. Results 290 participants were randomized, with 145 in the USG and 144 Sham US groups, respectively. No difference in SSMI, CMAP or SNAP, VAS, satisfaction was recorded. With USG, the median at the elbow and fibular MMSI were lower (p = 0.04; p = 0.02). With normal NCS or overweight and obese subgroups patients had lower median SSMI (p = 0.05/ p = 0.02), higher median and sural SNAP with normal NCS (p = 0.04; p = 0.007) and the sural SNAP for the expert US subgroup (p = 0.02). Conclusions USG is useful for nerves, that are anatomically variable or in obesity. The sural SNAP gain with US in the normal NCS subgroup could facilitate routine NCS. Significance In standard NCS the USG does not modify the patient's tolerance.Trial Registration: clinicaltrials.gov (NCT03868189).
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Affiliation(s)
- Marie Laure Inghilleri
- Neuromuscular Disorder Unit, Department of Neurophysiology, CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Sandrine Alonso
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Hélène Moron
- Neuromuscular Disorder Unit, Department of Neurophysiology, CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Hector Ruiz
- Neuromuscular Disorder Unit, Department of Neurophysiology, CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Sophie Bastide
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Sarah Coudray
- Neuromuscular Disorder Unit, Department of Neurophysiology, CHU Nîmes, Univ Montpellier, Nîmes, France
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Wei KC, Wu CH, Wang TG. The Application of Ultrasound Guidance in Electrodiagnostic Studies - A Narrative Review. J Med Ultrasound 2023; 31:263-267. [PMID: 38264590 PMCID: PMC10802882 DOI: 10.4103/jmu.jmu_104_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/05/2022] [Accepted: 01/03/2023] [Indexed: 01/25/2024] Open
Abstract
Electrodiagnostic studies, including nerve conduction study and electromyography, were conducted based on surface anatomy in a conventional manner. However, the anatomical variations and difficulty in the identification of target nerves or muscles render the accuracy of electrodiagnostic studies questionable. In recent years, high-resolution ultrasound (US) has been used to scan both the peripheral nerves and musculoskeletal system. Furthermore, an increasing number of clinicians have incorporated US into electrodiagnostic studies to achieve accurate sampling and prevent potential unwanted tissue injuries. In this review article, we present summarized information about the utility of US in assisting electrodiagnostic studies.
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Affiliation(s)
- Kuo-Chang Wei
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Cathay General Hospital, Taipei, Taiwan
| | - Chueh-Hung Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
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Variant Median Nerve Anatomy: Ultrasound Evidence of a Pseudoconduction Block. J Clin Neuromuscul Dis 2021; 22:209-213. [PMID: 34019005 DOI: 10.1097/cnd.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A conduction block at a noncompressible site warrants further investigation. METHODS AND MATERIALS A 36-year-old woman with a history of Hodgkin lymphoma and chemotherapy-induced polyneuropathy developed bilateral hand numbness and paresthesias. Workup revealed bilateral carpal tunnel syndrome and an apparent superimposed conduction block of the median nerve in the forearm. Given the history of cancer, there was concern for an infiltrative or an immune-mediated process. RESULTS Neuromuscular ultrasound demonstrated that the median nerve descended the upper extremity along an atypical path, deep along the posteromedial aspect of the upper arm, and relatively medially in the forearm. Ultrasound-directed nerve stimulation revealed there was no conduction block. This anatomical variant has been rarely described and has not been reported previously to mimic conduction block or been documented via ultrasound. CONCLUSIONS This case demonstrates that neuromuscular ultrasound may supplement the electrodiagnostic study and limit confounding technical factors because of rare anatomic variation.
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Hellman A, Maietta T, Clum A, Byraju K, Raviv N, Staudt MD, Jeannotte E, Ghoshal G, Shin D, Neubauer P, Williams E, Heffter T, Burdette C, Qian J, Nalwalk J, Pilitsis JG. Pilot study on the effects of low intensity focused ultrasound in a swine model of neuropathic pain. J Neurosurg 2021; 135:1508-1515. [PMID: 33862597 PMCID: PMC10804417 DOI: 10.3171/2020.9.jns202962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors' laboratory has previously demonstrated beneficial effects of noninvasive low intensity focused ultrasound (liFUS), targeted at the dorsal root ganglion (DRG), for reducing allodynia in rodent neuropathic pain models. However, in rats the DRG is 5 mm below the skin when approached laterally, while in humans the DRG is typically 5-8 cm deep. Here, using a modified liFUS probe, the authors demonstrated the feasibility of using external liFUS for modulation of antinociceptive responses in neuropathic swine. METHODS Two cohorts of swine underwent a common peroneal nerve injury (CPNI) to induce neuropathic pain. In the first cohort, pigs (14 kg) were iteratively tested to determine treatment parameters. liFUS penetration to the L5 DRG was verified by using a thermocouple to monitor tissue temperature changes and by measuring nerve conduction velocity (NCV) at the corresponding common peroneal nerve (CPN). Pain behaviors were monitored before and after treatment. DRG was evaluated for tissue damage postmortem. Based on data from the first cohort, a treatment algorithm was developed, parameter predictions were verified, and neuropathic pain was significantly modified in a second cohort of larger swine (20 kg). RESULTS The authors performed a dose-response curve analysis in 14-kg CPNI swine. Specifically, after confirming that the liFUS probe could reach 5 cm in ex vivo tissue experiments, the authors tested liFUS in 14-kg CPNI swine. The mean ± SEM DRG depth was 3.79 ± 0.09 cm in this initial cohort. The parameters were determined and then extrapolated to larger animals (20 kg), and predictions were verified. Tissue temperature elevations at the treatment site did not exceed 2°C, and the expected increases in the CPN NCV were observed. liFUS treatment eliminated pain guarding in all animals for the duration of follow-up (up to 1 month) and improved allodynia for 5 days postprocedure. No evidence of histological damage was seen using Fluoro-Jade and H&E staining. CONCLUSIONS The results demonstrate that a 5-cm depth can be reached with external liFUS and alters pain behavior and allodynia in a large-animal model of neuropathic pain.
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Affiliation(s)
- Abigail Hellman
- Departments of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | - Teresa Maietta
- Departments of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | - Alicia Clum
- Departments of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | - Kanakaharini Byraju
- Departments of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | - Nataly Raviv
- Department of Neurosurgery, Albany Medical College, Albany, New York
| | - Michael D. Staudt
- Department of Neurosurgery, Albany Medical College, Albany, New York
| | - Erin Jeannotte
- Department of Animals Resources Facility, Albany Medical College, Albany, New York
| | | | - Damian Shin
- Departments of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | | | | | | | | | - Jiang Qian
- Department of Pathology, Albany Medical College, Albany, New York
| | - Julia Nalwalk
- Departments of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | - Julie G. Pilitsis
- Department of Neurosurgery, Albany Medical College, Albany, New York
- Departments of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
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Wei KC, Chiu YH, Wu CH, Liang HW, Wang TG. Ultrasound guidance may have advantages over landmark-based guidance for some nerve conduction studies. Muscle Nerve 2021; 63:472-476. [PMID: 33399235 DOI: 10.1002/mus.27165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Precise placement of stimulating and recording electrodes is vital when performing nerve conduction studies (NCSs). In this study, we aimed to determine whether ultrasonography (US) was more precise in localizing the superficial radial nerve (SRN), dorsal ulnar cutaneous nerve (DUCN), ulnar nerve (UN) crossing the cubital tunnel, and radial nerve (RN) crossing the spiral groove (SG) compared to conventional techniques. METHODS Thirty healthy young subjects (15 male) were recruited. Each subject underwent both landmark-based and US-guided NCS. Onset latencies and amplitudes of compound motor action potentials (CMAPs) and sensory nerve action potentials (SNAPs), and stimulation levels (ie, intensity × duration) required to obtain maximal CMAP amplitudes were compared between the two techniques. RESULTS The mean CMAP amplitudes of the UN above the cubital tunnel (9.55 ± 1.96 vs 8.96 ± 1.94 mV, P = .030), UN below the cubital tunnel (10.11 ± 2.07 vs 9.37 ± 1.95 mV, P < .001), and RN below the SG (5.21 ± 1.56 vs 4.34 ± 1.03 mV, P < .001) were significantly greater using US-guided NCSs compared to landmark-based NCSs. The mean onset latency of the DUCN was significantly shorter using US-guided NCSs (1.49 ± 0.15 vs 1.57 ± 0.14 ms, P = .020). The required stimulation level in the UN and RN was significantly lower using US-guided NCSs. CONCLUSIONS When performing NCSs, US guidance provides a more precise localization of the stimulator and electrodes for the DUCN, UN, and RN, while providing comparable localization for the SRN, compared to landmark-based techniques.
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Affiliation(s)
- Kuo-Chang Wei
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Hsiang Chiu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chueh-Hung Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Huey-Wen Liang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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Cartwright MS, White DL, Hollinger JS, Krzesniak‐Swinarska M, Caress JB, Walker FO. Ultrasound guidance for sural nerve conduction studies. Muscle Nerve 2019; 59:705-707. [DOI: 10.1002/mus.26465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/07/2019] [Accepted: 03/10/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Michael S. Cartwright
- Department of NeurologyWake Forest School of Medicine Winston‐Salem North Carolina USA 27157
| | - David L. White
- Department of NeurologyWake Forest School of Medicine Winston‐Salem North Carolina USA 27157
| | - Jared S. Hollinger
- Department of NeurologyWake Forest School of Medicine Winston‐Salem North Carolina USA 27157
| | | | - James B. Caress
- Department of NeurologyWake Forest School of Medicine Winston‐Salem North Carolina USA 27157
| | - Francis O. Walker
- Department of NeurologyWake Forest School of Medicine Winston‐Salem North Carolina USA 27157
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