Nilgun Arac

Use of levodopa to relieve pain from painful symmetrical diabetic polyneuropathy

&NA; Levodopa has been used to treat some painful conditions and found to be effective in neuropathic pain due to herpes zoster in a double‐blind study. From our anecdotal observations about the efficacy of levodopa on diabetic neuropathic pain, we designed a double‐blind placebo‐controlled study to test levodopa in painful diabetic neuropathy. Twenty‐five out‐patients with painful symmetrical diabetic polyneuropathy were admitted to the study. Fourteen patients were given 100 mg levodopa plus 25 mg benserazide to be taken three times per day for 28 days. Eleven patients were given identical placebo capsules. A blinded neurologist evaluated the patients clinically and performed Visual Analogue Scale (VAS) measurement every week from day 0 to day 28. The results seemed promising and levodopa may be a choice for the control of pain in neuropathy for which we do not have many alternative treatments.

Prognostic value of transcranial magnetic stimulation in acute stroke.

The aim of this study is to evaluate the role of motor-evoked potentials (MEPs) in predicting functional recovery of hemiparesis and hemiplegia in acute stroke patients. Methods Twenty-seven acute stroke patients were evaluated clinically and electrophysiologicaUy within the first week and 3 to 6 months after the event. Ginical assessment included a quantitative evaluation of motor ability and activities of daily living. MEPs were recorded from the abductor pollicis brevis and tibialis anterior muscles bilaterally. Correlations between clinical parameters and MEPs were assessed. Results In the acute period, no MEP could be detected in 17 of 27 patients. In these 17 patients, the clinical scores were worse than in the patients whose MEPs could be elicited. However, in the follow-up period (3 to 6 months), no significant differences in motor function were observed between the two groups. Conclusions In the acute phase of stroke, neurophysiological parameters were correlated with the clinical findings, but MEPs had no value in predicting the outcome of hemiparesis and hemiplegia.

ICE TEST AS A SIMPLE DIAGNOSTIC AID FOR MYASTHENIA GRAVIS

It is known that myasthenia gravis is improved by cold. In two previously reported studies performed on a limited number of myasthenic patients and controls, local cold application to the eyelid was suggested for use as a diagnostic test for ocular myasthenia gravis. In this study, ice test to the eyelid was evaluated as a diagnostic test on 12 myasthenic patients and 15 controls with blepharoptosis and the results were compared with those of edrophonium test.

Motor-evoked potentials from various levels of paravertebral muscles in normal subjects and in patients with focal lesions of the spinal cord.

Study Design. This prospective study includes normal control subjects and patients with focal lesions of the spinal cord investigated by transcranial magnetic stimulation. Objectives. To establish a stable method to elicit motor evoked potentials from cervical to lumbar segmental levels and to apply the method that would allow the localization in patients with restricted cord lesion. Thirty‐four healthy subjects (10 women, 24 men) and 17 patients with focal spinal lesions were admitted to this study. Summary of Background Data. The focal cord lesions and injuries were previously evaluated by the records of lower limb muscles after cortical stimulation, but this method did not demonstrate the vertebral levels at which the lesions were located. Methods. The paravertebral myotomal‐evoked potentials were recorded in different segmental levels (T1, T6, T12, and L3) from paravertebral muscles, using surface and needle electrodes by transcranial magnetic stimulation in normal control subjects and patients. Results. In normal control subjects, paravertebral myotomal‐evoked potentials were obtained from T1, T6, T12, and L3 paravertebral muscles with both recording techniques (surface and needle electrode). From T1 to L3 latencies of paravertebral myotomal‐evoked potentials increased gradually (from 10 msec to 17 msec) in normal control subjects. The levels of spinal cord lesions were obtained reliably in 14 of 17 patients with thoracic‐lumbar spinal cord lesions, by using both electrophysiologic methods. In 11 of 14 patients, the lesions produced total conduction block, at and below the lesion level. In the remaining 3 patients slowing of intersegmental conduction was observed along the focal cord lesion. Conclusions. The paravertebral myotomal‐evoked potentials obtained by surface electrode from paravertebral muscles and by midline needle electrode in the intrinsic rotatory muscles of the spine were useful in localizing lesions in the spinal segments in most of the patients with thoracic‐lumbar cord lesions.

Diagnostic value of electrical stimulation of lumbosacral roots in radiculopathies

Needle electrical stimulation of the lumbosacral roots at the laminar level of the Th12‐L1 or L1‐2 intervertebral spaces were performed in 24 normal subjects and 58 patients with various kinds of lumbar radiculopathy (unilateral L4, L5 and S1 herniated nucleus pulposus and lumber stenosis). The root stimulation method was compared with conventional needle EMG. Lumber electrical stimulation showed root abnormalities objectively in 80% of patients while the diagnostic value of needle EMG was 65%. Therefore, electrical root stimulation is superior to routine EMG for localizing lumbar root involvement. However, the only needle EMG demonstrated the root pathology in 7 cases (12%) and single electrophysiological abnormality was found by the root stimulation in 16 cases (27%). Thus, both electrophysiological methods should be complementary to each other in evaluation of the lumbar radiculopathy.

A special kind of anterior horn cell involvement in juvenile myoclonic epilepsy demonstrated by macro electromyography.

Juvenile myoclonic epilepsy (JME) is not an uncommon seizure disorder, occurring in 5–10% of epileptic patients. A subclinical anterior horn cell involvement has been suggested in some JME patients by concentric needle electromyography (EMG) and turn/amplitude analysis. In this study, 22 JME patients and 17 normal control subjects have been studied with macro EMG, which is a sensitive method to assess the size of motor units. Most JME patients (19 of 22) had a pathologically increased number of individual large macro motor unit action potentials (MUAPs) compared to control subjects. For both biceps brachii and tibialis anterior muscles, means of median macro MUAP amplitudes were significantly greater than those of normal controls, whereas the fiber density values were only slightly increased. This suggested another kind of anterior horn cell involvement in JME than seen in motor neuron diseases.

A stable late soleus EMG response elicited by cortical stimulation during voluntary ankle dorsiflexion

Transcranial electrical or magnetic stimulation was performed in 47 experiments on 42 normal adult subjects. Surface compound muscle action potentials were recorded from the antagonistic tibialis anterior (TA) and soleus (SOL) muscles. A stable late response recorded from SOL during voluntary ankle dorsiflexion is described and called soleus MEP-80. Its origin has been studied with different experimental procedures. (1) It is only obtained during active voluntary dorsiflexion of the ankle within 70-100 msec (mean 86.9 +/- 6.4 msec) whereas passive dorsiflexion does not promote such a response. The size of SOL MEP-80 was always bigger than the primary SOL response. (2) A similar constant response has not been obtained during voluntary plantar flexion from SOL and TA muscles. (3) SOL MEP-80 is not changed significantly by the Jendrassik manoeuvre. (4) It is not obtained or is suppressed when the subject is sitting with the feet free in space. On the other hand, it is obtained when the subject is standing, especially when standing is made difficult. (5) SOL MEP-80 has not been obtained by brain-stem, spinal cord or root stimulation. (6) A later response of longer than 100 msec latency was sometimes obtained at rest but such an S100 soleus response was abolished or transformed to the SOL MEP-80 immediately during ankle dorsiflexion. (7) It is concluded that SOL MEP-80 is a polysynaptic extensor response related to postural mechanisms and originating through convergence of descending motor commands and peripheral sensory feedback.

Cycling mood disturbances and progressive neurological symptoms in a patient with Huntington's disease

Huntingtons disease (HD) is a genetic disorder characterized by movement disturbances, psychiatric symptoms, and cognitive impairment resulting in a subcortical dementia (Cudkowicz and Koroshetz, 1999). Although diagnosis mainly depends on the neurological manifestations (chorea, dystonia, bradykinesia), psychiatric symptoms (personality changes, depression, psychosis, mania) are common in 24% to 79% of the patients, and can emerge before the onset of neurological syndrome (Leroi and Michalon, 1998; De Marchi and Menella, 2000). In a patient sample, neuropsychiatric symptoms were prominent in 98% (Paulsen et al., 2001). Depression is estimated as prevalent as 40% and mania/hypomania is as prevalent as 4.8% (Naarding et al., 2001). It is important to control psychiatric symptoms, both for the patients and their families (Leroi and Michalon, 1998). Also it is challenging to investigate the link between characteristic neuropathological features (degeneration of the head of the caudate nucleus and other striatal areas, as well as frontally pronounced cortical atrophy) and emotional and behavioral disturbances (Tost et al., 2004). The following case report emphasizes the cyclical mood disturbances and the progressive cerebral degeneration with motor symptoms in a HD patient.

A transient dysfunction of the neuromuscular junction due to carbendazim intoxication

Carbendazim (C9H9N3O2; methyl 1-H-benzimidazol-2-yl carbamate) is widely used as an agricultural and horticultural fungicide and pesticide around the world.1No hazardous effects of carbendazim on the health of humans has yet been reported. However, in animals, especially in rats, adverse effects, including testicular atrophy, infertility, ascendant paralysis, respiratory failure, and muscle cramps due to chronic carbendazim exposure have been well documented.2-4 Recently, we have treated a 60 year old female farmer who had been affected by excessive exposure to carbendazim. She was admitted to our clinic 3 days after the intoxication, which occurred when she disinfected nits with mitrasol, which contains carbendazim. She was exposed to carbendazim for 6 hours and at night, after returning from work, she slowly developed ptosis and dysphagia for especially liquid. She was admitted to the local state hospital and given atropine for 3 days because of suspicion of organophosphorus intoxication. However, her complaints persisted …