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Metwally NAE, Hasan MM, Abd Elaziz AES, Elhadad AF, Ibraheem KS, Ali MAA, Elsalam HAA. Assessment of intraepidermal nerve fiber density and neurophysiological studies in patients with idiopathic polyneuropathy. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00548-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background
Idiopathic polyneuropathy is an asymmetrical, length-dependent neuropathy in which neurophysiology demonstrates axonal damage involving large fibers, along with insidious onset and slow progression over 6 months, with no identified etiology in spite of thorough investigations. This study aimed to evaluate the diagnostic role of clinical, electrophysiological, and histopathological studies in patients with idiopathic polyneuropathy.
Methods
Case–control study included 20 patients with clinical and neurophysiological evidence of sensory or sensory–motor neuropathy with no apparent etiology after laboratory investigation were recruited from 127 patients with sensory–motor neuropathy of unknown etiology (the patients group). Twenty apparently healthy individuals, age- and sex-matched, with no neuropathy symptoms (the control group), were recruited from the Neurology Clinic of Al-Azhar University, Assuit.
Results
Age of onset of patients with idiopathic polyneuropathy (44–70) years, duration of illness (1–6) years, 60% had painful neuropathy, diagnostic neuropathic pain questioner (DN4 score) (5–7), abnormal pin brick (80%), abnormal vibration (90%), abnormal fine touch (75%), distal weakness (70%), and lost ankle reflex (90%). In the control group, there were substantial differences with respect to prolonged latency, diminished sympathetic skin response amplitude, and significant intraepidermal nerve fiber density reduction in skin biopsy cases. In diagnosing idiopathic polyneuropathy, the specificity and sensitivity of sympathetic skin response were (80–86)% and (81–89.5)%, respectively, whereas those of diminished intraepidermal nerve fiber density were (92.5%) and (97.5%), respectively.
Conclusion
The assessment of intraepidermal nerve fiber density had an important good diagnostic role in cases presented with polyneuropathy.
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Farias Zuniga A, Keir PJ. Thirty Minutes of Sub-diastolic Blood Flow Occlusion Alters Carpal Tunnel Tissue Function and Mechanics. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1110-1121. [PMID: 35300878 DOI: 10.1016/j.ultrasmedbio.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/05/2022] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
There is evidence that carpal tunnel syndrome (CTS) development is driven by vascular factors, specifically those resulting from ischemia and edema. The purpose of this study was to investigate the vascular hypothesis of CTS development by quantifying the temporal effects of 30 min of sub-diastolic brachial blood flow occlusion on median nerve edema, intraneural blood flow velocity, nerve function as measured through nerve conduction study (NCS), tendon-connective tissue mechanics and carpal tunnel tissue stiffness. Forty healthy volunteers underwent 30 min of sub-diastolic brachial occlusion while an NCS and ultrasound examination were performed consecutively every 5 min. Motor latency (p < 0.001), sensory conduction velocity (p < 0.001), sensory amplitude (p = 0.04), nerve blood flow (p < 0.001), peak relative flexor digitorum superficialis tendon-sub-synovial connective tissue displacement (p = 0.02) and shear strain (p = 0.04) were significantly affected by partial ischemia. Our results highlight the dependency of carpal tunnel tissue function on adequate blood flow.
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Affiliation(s)
- Amanda Farias Zuniga
- McMaster Occupational Biomechanics Laboratory, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Peter J Keir
- McMaster Occupational Biomechanics Laboratory, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada.
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Clemastine improves electrophysiologic and histomorphometric changes through promoting myelin repair in a murine model of compression neuropathy. Sci Rep 2021; 11:20886. [PMID: 34686718 PMCID: PMC8536687 DOI: 10.1038/s41598-021-00389-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022] Open
Abstract
Compression neuropathies are common and debilitating conditions that result in variable functional recovery after surgical decompression. Recent drug repurposing studies have verified that clemastine promotes functional recovery through enhancement of myelin repair in demyelinating disease. We investigated the utility of clemastine as a treatment for compression neuropathy using a validated murine model of compression neuropathy encircling the compression tube around the sciatic nerve. Mice received PBS or clemastine solution for 6 weeks of compression phase. Mice taken surgical decompression received PBS or clemastine solution for 2 weeks of decompression phase. Electrodiagnostic, histomorphometric, and Western immunoblotting analyses were performed to verify the effects of clemastine. During the compression phase, mice treated with clemastine had significantly decreased latency and increased amplitude compared to untreated mice that received PBS. Histomorphometric analyses revealed that mice treated with clemastine had significantly higher proportions of myelinated axons, thicker myelin, and a lower G-ratio. The expression levels of myelin proteins, including myelin protein zero and myelin associated glycoprotein, were higher in mice treated with clemastine. However, the electrophysiologic and histomorphometric improvements were observed regardless of clemastine treatment in mice taken surgical decompression. Mice treated with clemastine during compression of the sciatic nerve demonstrated that clemastine treatment attenuated electrophysiologic and histomorphometric changes caused by compression through promoting myelin repair.
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Farias Zuniga A, Ghavanini AA, Israelian G, Keir PJ. Ultrasound examination predicts 6-month progression in carpal tunnel syndrome patients. J Orthop Res 2021; 39:609-618. [PMID: 33098574 DOI: 10.1002/jor.24893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/03/2020] [Accepted: 10/21/2020] [Indexed: 02/04/2023]
Abstract
Carpal tunnel syndrome (CTS) is a peripheral neuropathy resulting from chronic median nerve compression. Chronic compression leads to neurological changes that are quantified through nerve conduction studies (NCS). Although NCS represents the gold standard in CTS assessment, they provide limited prognostic value. Several studies have identified ultrasound as a tool in diagnosing and potentially predicting the progression of CTS in patients. The purpose of this study was to evaluate the predictive value of ultrasound examination in CTS patients. Twenty patients recruited at their first visit with the neurologist completed two NCS and ultrasound examinations approximately 6 months apart. Ultrasound examination consisted of B-mode, pulse-wave Doppler and colour Doppler ultrasound videos and images to quantify median nerve cross-sectional area, intraneural blood flow velocity in three wrist postures (15° flexion, neutral, and 30° extension), and displacement of the flexor digitorum superficialis (FDS) tendon and the adjacent subsynovial connective tissue (SSCT) of the middle finger during repetitive finger flexion-extension cycles. A questionnaire was administered to assess the work-relatedness of CTS. Linear regression analyses revealed that intraneural blood flow velocity (R2 = 0.36, p = .03), assessed in wrist flexion, and relative FDS-SSCT displacement (R2 = 0.27, p = .04) and shear strain index (R2 = 0.28, p = .04) were significant predictors of nerve sensory and motor changes at 6 months. Results suggest the possibility of using a battery of ultrasound measures as viable markers to predict median nerve functional changes within 6 months.
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Affiliation(s)
| | - Amer A Ghavanini
- Canadian Neurologic Center, Mississauga, Ontario, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Division of Neurology, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Gaspar Israelian
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Division of Neurology, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Peter J Keir
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
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Fujino T, Yuzawa H, Kinoshita T, Shinohara M, Okishige K, Ikeda T. A case of successful cryoballoon ablation of paroxysmal atrial fibrillation originating from a persistent left superior vena cava. J Cardiol Cases 2019; 20:77-80. [PMID: 31497169 DOI: 10.1016/j.jccase.2019.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/07/2019] [Accepted: 04/11/2019] [Indexed: 10/26/2022] Open
Abstract
We present a paroxysmal atrial fibrillation (AF) patient who had frequent AF events originating from a persistent left superior vena cava (PLSVC) with an unsuccessful catheter ablation using a non-irrigated radiofrequency catheter and was successfully cured by a successful PLSVC isolation using a second-generation cryoballoon catheter (28-mm, second-generation cryoballoon, Arctic Front Advance, Medtronic, Minneapolis, MN, USA). <Learning objective: This is the first case report illustrating a successful ablation of a persistent left superior vena cava in a patient with drug-resistant atrial fibrillation (AF) using a second-generation cryoballoon (CB) with a good outcome. By choosing an appropriate position and attaching the CB fixedly, the CB ablation was able to cure the AF smoothly without any complications including left phrenic nerve palsy or left coronary artery stenosis. An intracardiac electrocardiogram and 3-dimensional mapping system could detect conducted ectopic beats initiating AF.>.
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Affiliation(s)
- Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Hitomi Yuzawa
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Toshio Kinoshita
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Masaya Shinohara
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Kaoru Okishige
- Heart Center, Yokohama-city Bay Red Cross Hospital, Yokohama, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
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Papageorgiou S, Krikonis K, Quinton JF, Gnirs K. MOTOR AND SENSORY NERVE CONDUCTION STUDY IN THE FERRET. J Exot Pet Med 2018. [DOI: 10.1053/j.jepm.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Klupp E, Cervantes B, Sollmann N, Treibel F, Weidlich D, Baum T, Rummeny EJ, Zimmer C, Kirschke JS, Karampinos DC. Improved Brachial Plexus Visualization Using an Adiabatic iMSDE-Prepared STIR 3D TSE. Clin Neuroradiol 2018; 29:631-638. [DOI: 10.1007/s00062-018-0706-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/03/2018] [Indexed: 12/12/2022]
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9
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Merrill CA, Ferreira J, Parrino A, Moss IL. Team Approach: Upper-Extremity Numbness. JBJS Rev 2018; 6:e3. [PMID: 29894340 DOI: 10.2106/jbjs.rvw.17.00166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Christian A Merrill
- Departments of Orthopaedic Surgery (C.A.M., J.F., A.P., and I.L.M.) and Neurosurgery (I.L.M.), UConn Health Musculoskeletal Institute, University of Connecticut, Farmington, Connecticut
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10
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Gooch CL. Building a better MUNIX: New and improved, but does it hit the mark? Muscle Nerve 2018; 58:330-331. [PMID: 29742792 DOI: 10.1002/mus.26163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 04/18/2018] [Accepted: 05/05/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Clifton L Gooch
- Department of Neurology, University of South Florida Morsani College of Medicine, 12901 Bruce B. Downs Boulevard, MDC 55, Tampa, Florida, 33612-4799, USA
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Oudeman J, Verhamme C, Engbersen MP, Caan MWA, Maas M, Froeling M, Nederveen AJ, Strijkers GJ. Diffusion tensor MRI of the healthy brachial plexus. PLoS One 2018; 13:e0196975. [PMID: 29742154 PMCID: PMC5942843 DOI: 10.1371/journal.pone.0196975] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/24/2018] [Indexed: 12/17/2022] Open
Abstract
Introduction Diffusion Tensor MRI (DT-MRI) is a promising tool for the evaluation of brachial plexus pathology. Therefore, we introduce and evaluate a fast DT-MRI protocol (8min33s scanning with 5–10 min postprocessing time) for the brachial plexus. Materials and methods Thirty healthy volunteers within three age-groups (18–35, 36–55, and > 56) received DT-MRI of the brachial-plexus twice. Means of fractional-anisotropy (FA), mean-diffusivity (MD), axial-diffusivity (AD), and radial-diffusivity (RD) for the individual roots and trunks were evaluated. A stepwise forward approach was applied to test for correlations with age, sex, body-mass-index (BMI), bodysurface, height, and bodyweight. Within-subject, intra-rater, and inter-rater repeatability were assessed using Bland-Altman analysis, coefficient of variation (CV), intraclass-correlation (ICC), and minimal detectable difference (MDD). Results No differences between sides and root levels were found. MD, AD, and RD correlated (P < 0.05) with bodyweight. Within-subject quantification proved repeatable with CVs for FA, MD, AD, and RD of 16%, 12%, 11%, and 14%, respectively. Discussion The DT-MRI protocol was fast and repeatable. Found correlations should be considered in future studies of brachial plexus pathology.
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Affiliation(s)
- Jos Oudeman
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
- * E-mail:
| | - Camiel Verhamme
- Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Mattan W. A. Caan
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Mario Maas
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center, Utrecht, the Netherlands
| | - Aart J. Nederveen
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Gustav J. Strijkers
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands
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Novel method for earlier detection of phrenic nerve injury during cryoballoon applications for electrical isolation of pulmonary veins in patients with atrial fibrillation. Heart Rhythm 2016; 13:1810-6. [DOI: 10.1016/j.hrthm.2016.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Indexed: 11/17/2022]
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13
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Brito A, Fedosov SN, Miller JW, Green R, Uauy R, Allen LH. Reply to LR Solomon. Am J Clin Nutr 2016; 103:1379. [PMID: 27140535 DOI: 10.3945/ajcn.116.133322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alex Brito
- From the USDA/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA (AB; LHA, e-mail: ); Department of Molecular Biology and Genetics, Aarhus University, Aarhus, Denmark (SNF); Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ (JWM); Department of Pathology and Laboratory Medicine, University of California, Davis, CA (JWM, RG); and the Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile (RU)
| | - Sergey N Fedosov
- From the USDA/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA (AB; LHA, e-mail: ); Department of Molecular Biology and Genetics, Aarhus University, Aarhus, Denmark (SNF); Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ (JWM); Department of Pathology and Laboratory Medicine, University of California, Davis, CA (JWM, RG); and the Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile (RU)
| | - Joshua W Miller
- From the USDA/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA (AB; LHA, e-mail: ); Department of Molecular Biology and Genetics, Aarhus University, Aarhus, Denmark (SNF); Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ (JWM); Department of Pathology and Laboratory Medicine, University of California, Davis, CA (JWM, RG); and the Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile (RU)
| | - Ralph Green
- From the USDA/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA (AB; LHA, e-mail: ); Department of Molecular Biology and Genetics, Aarhus University, Aarhus, Denmark (SNF); Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ (JWM); Department of Pathology and Laboratory Medicine, University of California, Davis, CA (JWM, RG); and the Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile (RU)
| | - Ricardo Uauy
- From the USDA/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA (AB; LHA, e-mail: ); Department of Molecular Biology and Genetics, Aarhus University, Aarhus, Denmark (SNF); Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ (JWM); Department of Pathology and Laboratory Medicine, University of California, Davis, CA (JWM, RG); and the Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile (RU)
| | - Lindsay H Allen
- From the USDA/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA (AB; LHA, e-mail: ); Department of Molecular Biology and Genetics, Aarhus University, Aarhus, Denmark (SNF); Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ (JWM); Department of Pathology and Laboratory Medicine, University of California, Davis, CA (JWM, RG); and the Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile (RU)
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Oudeman J, Coolen BF, Mazzoli V, Maas M, Verhamme C, Brink WM, Webb AG, Strijkers GJ, Nederveen AJ. Diffusion-prepared neurography of the brachial plexus with a large field-of-view at 3T. J Magn Reson Imaging 2015; 43:644-54. [DOI: 10.1002/jmri.25025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 07/22/2015] [Indexed: 12/20/2022] Open
Affiliation(s)
- Jos Oudeman
- Department of Radiology; Academic Medical Center; Amsterdam The Netherlands
| | - Bram F. Coolen
- Department of Radiology; Academic Medical Center; Amsterdam The Netherlands
| | - Valentina Mazzoli
- Department of Radiology; Academic Medical Center; Amsterdam The Netherlands
- Biomedical NMR; Department of Biomedical Engineering; Eindhoven University of Technology; Nijmegen The Netherlands
- Orthopaedic Research Lab; Radboud University Medical Center; Nijmegen The Netherlands
| | - Mario Maas
- Department of Radiology; Academic Medical Center; Amsterdam The Netherlands
| | - Camiel Verhamme
- Department of Neurology; Academic Medical Center; Amsterdam The Netherlands
| | - Wyger M. Brink
- Department of Radiology; Leiden University Medical Center; Leiden The Netherlands
| | - Andrew G. Webb
- Department of Radiology; Leiden University Medical Center; Leiden The Netherlands
| | - Gustav J. Strijkers
- Biomedical NMR; Department of Biomedical Engineering; Eindhoven University of Technology; Nijmegen The Netherlands
- Biomedical Engineering and Physics; Academic Medical Center; Amsterdam The Netherlands
| | - Aart J. Nederveen
- Department of Radiology; Academic Medical Center; Amsterdam The Netherlands
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15
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Nockolds CL, Hosker GL, Kiff ES. Compound muscle action potential of the external anal sphincter. Colorectal Dis 2014; 15:1289-94. [PMID: 23758958 DOI: 10.1111/codi.12315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 12/16/2012] [Accepted: 01/08/2013] [Indexed: 01/23/2023]
Abstract
AIM Pudendal nerve terminal motor latency (PNTML) assesses distal innervation of the external anal sphincter (EAS) but it is insensitive to early nerve damage. We propose to extend the assessment of PNTML to the measurement of the compound muscle action potential (CMAP) of the EAS to understand its progressive denervation. METHOD Ninety women with faecal incontinence were prospectively examined and compared with 36 asymptomatic women who acted as controls. PNTML was performed bilaterally and the muscle response analysed for CMAP to include amplitude, area and duration. Anorectal manometry was measured by a station-pull technique using a water-filled microballoon. spss version 11.5 was used for statistical analysis. RESULTS In asymptomatic women the CMAP on the left side was greater in nulliparous (n = 7) than parous (n = 27, P < 0.05) individuals. There was a positive correlation with maximum squeeze pressure and area on the left side (P < 0.05, r = 0.397). In women with faecal incontinence, CMAP on the left side had a negative correlation with age (n = 75, P < 0.05), there was no correlation with parity or anorectal manometry. Nulliparous asymptomatic women had a greater CMAP (P < 0.05) on the left side than asymptomatic parous women and parous women with faecal incontinence. Right-side measurements were not conclusive. CONCLUSION Compound muscle action potential demonstrated progressive denervation with age in women with faecal incontinence but did not reliably identify early signs of denervation in asymptomatic women. The area on the left side related to muscle function in asymptomatic women but not in women with faecal incontinence. CMAP can distinguish between parous women with faecal incontinence and nulliparous asymptomatic women but is not a useful test of function of the EAS.
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Affiliation(s)
- C L Nockolds
- Colorectal Surgery, South Manchester NHS Trust, Manchester, UK; Warrell Unit, St Mary's Hospital, Manchester, UK
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Kowalski M, Ellenbogen KA, Koneru JN. Prevention of phrenic nerve injury during interventional electrophysiologic procedures. Heart Rhythm 2014; 11:1839-44. [DOI: 10.1016/j.hrthm.2014.06.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Indexed: 11/26/2022]
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Recordings of diaphragmatic electromyograms during cryoballoon ablation for atrial fibrillation accurately predict phrenic nerve injury. Heart Rhythm 2014; 11:369-74. [DOI: 10.1016/j.hrthm.2013.11.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Indexed: 01/30/2023]
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ANDRADE JASONG, DUBUC MARC, FERREIRA JOSE, GUERRA PETERG, LANDRY EVELYN, COULOMBE NICOLAS, RIVARD LENA, MACLE LAURENT, THIBAULT BERNARD, TALAJIC MARIO, ROY DENIS, KHAIRY PAUL. Histopathology of Cryoballoon Ablation-Induced Phrenic Nerve Injury. J Cardiovasc Electrophysiol 2013; 25:187-94. [DOI: 10.1111/jce.12296] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/19/2013] [Accepted: 08/21/2013] [Indexed: 11/27/2022]
Affiliation(s)
- JASON G. ANDRADE
- Electrophysiology Service, Montreal Heart Institute; Université de Montréal; Montreal Canada
| | - MARC DUBUC
- Electrophysiology Service, Montreal Heart Institute; Université de Montréal; Montreal Canada
| | - JOSE FERREIRA
- Department of Pathology, Hôpital Maisonneuve-Rosemont; Université de Montréal; Montreal Canada
| | - PETER G. GUERRA
- Electrophysiology Service, Montreal Heart Institute; Université de Montréal; Montreal Canada
| | - EVELYN LANDRY
- Electrophysiology Service, Montreal Heart Institute; Université de Montréal; Montreal Canada
| | | | - LENA RIVARD
- Electrophysiology Service, Montreal Heart Institute; Université de Montréal; Montreal Canada
| | - LAURENT MACLE
- Electrophysiology Service, Montreal Heart Institute; Université de Montréal; Montreal Canada
| | - BERNARD THIBAULT
- Electrophysiology Service, Montreal Heart Institute; Université de Montréal; Montreal Canada
| | - MARIO TALAJIC
- Electrophysiology Service, Montreal Heart Institute; Université de Montréal; Montreal Canada
| | - DENIS ROY
- Electrophysiology Service, Montreal Heart Institute; Université de Montréal; Montreal Canada
| | - PAUL KHAIRY
- Electrophysiology Service, Montreal Heart Institute; Université de Montréal; Montreal Canada
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Franceschi F, Koutbi L, Mancini J, Attarian S, Prevôt S, Deharo JC. Novel electromyographic monitoring technique for prevention of right phrenic nerve palsy during cryoballoon ablation. Circ Arrhythm Electrophysiol 2013; 6:1109-14. [PMID: 24114777 DOI: 10.1161/circep.113.000517] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Right phrenic nerve palsy (PNP) is the most frequent complication of cryoballoon ablation. Diaphragmatic electromyography can predict PNP with a comfortable safety margin. Our goal was to evaluate the feasibility, efficacy, and safety of electromyography-guided PN monitoring using a novel hepatic vein approach for prevention of PNP. METHODS AND RESULTS This study includes 57 patients (47 males) indicated for cryoballoon ablation for treatment of atrial fibrillation. During right superior pulmonary vein ablation, the PN was paced at 60 beats per minute and diaphragmatic compound motor action potential (CMAP) amplitude was recorded via a quadripolar catheter positioned in a subdiaphragmatic hepatic vein. If a 30% drop in CMAP amplitude was observed, ablation was discontinued with forced deflation. Reliable recording of CMAP before ablation was feasible in 50 of 57 patients (88%). In 7 patients (12%), stable PN pacing could not be achieved. In 44 of 50 patients, CMAP amplitude remained constant during cryoapplication. The mean value of CMAP amplitude was 639.7±240.5 µV; mean variation was 13±4.3%. In 6 of 50 patients (12%) including 5 treated with a 23-mm cryoballoon and 1 with a 28-mm cryoballoon, the 30% reduction cutoff was reached and cryoablation was discontinued. Recovery of CMAP amplitude after discontinuing cryoablation took <60 seconds in all cases. No PNP or complication related to PN monitoring occurred. CONCLUSIONS Recording of diaphragmatic CMAP using a catheter positioned in a subdiaphragmatic hepatic vein seems feasible during cryoballoon ablation. Electromyography-guided PN monitoring seems safe and potentially helpful for prevention of PNP.
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Cappellari AM, Bona AR, Lukasova K. Electrophysiological study of medial and lateral branches of the superficial radial nerve. Muscle Nerve 2012; 47:105-7. [PMID: 23169242 DOI: 10.1002/mus.23483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2012] [Indexed: 11/09/2022]
Abstract
INTRODUCTION In this study we sought to establish a new technique for nerve conduction study (NCS) of medial and lateral branches of the superficial radial nerve (SRN). METHODS Antidromic NCS were performed on 60 healthy subjects, recording the sensory nerve action potential (SNAP) from the dorsomedial and dorsolateral aspects of the phalanx of the thumb. The main trunk of SRN was also investigated. RESULTS SNAPs were easily recorded in all subjects, and normative latency and amplitude data were collected. CONCLUSIONS We propose a simple and reliable technique to investigate nerve conduction of the terminal branches of the SRN, which could be useful in some focal and systemic pathologies.
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Affiliation(s)
- Alberto M Cappellari
- Department of Neuroscience, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, University of Milan, Milan 20122, Italy.
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Roll SC, Case-Smith J, Evans KD. Diagnostic accuracy of ultrasonography vs. electromyography in carpal tunnel syndrome: a systematic review of literature. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:1539-1553. [PMID: 21821353 DOI: 10.1016/j.ultrasmedbio.2011.06.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 05/29/2011] [Accepted: 06/21/2011] [Indexed: 05/31/2023]
Abstract
A plethora of research investigates sonography vs. electrodiagnostic testing (EDX) for diagnosis of carpal tunnel syndrome (CTS). Through database searches, hand searches and communication with authors, 582 abstracts published from 1999 to 2009 were identified. A comprehensive systematic review process resulted in inclusion of 23 studies. Significant methodologic discrepancies among the studies limited the ability to complete a meta-analysis to identify specific diagnostic thresholds. Instead, the data were reviewed to provide implications for clinical utility of sonography as a screening tool as a compliment to EDX and to suggest continued and future research. The largest cross-sectional area of the median nerve within the carpal tunnel region has high potential for clinical screening, especially in individuals with severe CTS. Identifying swelling of the nerve through comparative measurements, qualitative analysis and Doppler techniques all require further investigation. Screening protocols may be enhanced through exploration of sonography in patients with mild CTS and false-negative EDX.
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Affiliation(s)
- Shawn C Roll
- The Ohio State University, College of Medicine, Columbus, OH 43210, USA
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Kim H, Ku SY, Sung JJ, Kim SH, Choi YM, Kim JG, Moon SY. Association between hormone therapy and nerve conduction study parameters in postmenopausal women. Climacteric 2011; 14:488-91. [DOI: 10.3109/13697137.2011.553972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Franceschi F, Dubuc M, Guerra PG, Delisle S, Romeo P, Landry E, Koutbi L, Rivard L, Macle L, Thibault B, Talajic M, Roy D, Khairy P. Diaphragmatic electromyography during cryoballoon ablation: a novel concept in the prevention of phrenic nerve palsy. Heart Rhythm 2011; 8:885-91. [PMID: 21256978 DOI: 10.1016/j.hrthm.2011.01.031] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Accepted: 01/18/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hemidiaphragmatic paralysis is the most frequent complication associated with cryoballoon ablation for atrial fibrillation. To date, no preventive strategy has proved effective. OBJECTIVE We sought to assess the feasibility of diaphragmatic electromyography during cryoballoon ablation, explore the relationship between altered signals and phrenic nerve palsy, and define characteristic changes that herald hemidiaphragmatic paralysis. METHODS Cryoballoon ablation was performed in the right superior pulmonary vein or superior vena cava in 16 mongrel dogs weighing 37.7 ± 2.4 kg, at sites determined by phrenic nerve capture. During ablation, the phrenic nerve was paced at 60 bpm from the superior vena cava while recording diaphragmatic compound motor action potentials (CMAPs) by esophageal decapolar catheters. Diaphragmatic excursion was monitored by fluoroscopy and abdominal palpation. RESULTS Before ablation, the CMAP amplitude was 592 (interquartile range 504, 566) μV, initial latency 21.5 ± 4.2 ms, peak latency 64.7 ± 21.1 ms, and duration 101.7 ± 13.3 ms. Hemidiaphragmatic paralysis was obtained in all dogs 62 ± 34 seconds into the cryoapplication. The CMAP amplitude decreased exponentially, with no patterned changes in latencies and duration. Discriminatory analyses by receiver-operating curve characteristics identified a 30% reduction in CMAP amplitude as the most predictive cutoff value for hemidiaphragmatic paralysis (c-statistic 0.965; P<.0001). This criterion presaged diaphragmatic paralysis, as detected by abdominal palpation, by 31 ± 23 seconds. CONCLUSION Diaphragmatic electromyographic signals could be reliably recorded during cryoballoon ablation. An exponential decrease in CMAP amplitude precedes diaphragmatic paralysis, with a 30% reduction yielding the best discriminatory potential. A promising safety margin was detected, which merits prospective validation.
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Affiliation(s)
- Frédéric Franceschi
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
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The Influence of the Reference Electrode on the Compound Muscle Action Potential of the Flexor Digiti Minimi Brevis. Am J Phys Med Rehabil 2010; 89:570-5. [DOI: 10.1097/phm.0b013e3181ddd1cb] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bibliography. Current world literature. Neuro-muscular diseases: nerve. Curr Opin Neurol 2007; 20:600-4. [PMID: 17885452 DOI: 10.1097/wco.0b013e3282efeb3b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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