Onder Us

Medial plantar and dorsal sural nerve conduction studies increase the sensitivity in the detection of neuropathy in diabetic patients

OBJECTIVE Clinical utility of nerve conduction studies (NCS) of the medial plantar and dorsal sural nerves in the early detection of polyneuropathy have already been shown separately. However, at present, there is no data about the combined assessment of these two nerves in distal sensory neuropathy. In the present study, we aimed to evaluate the medial plantar and dorsal sural NCS in a group of diabetic patients with distal sensory neuropathy (DSN) and in healthy controls. METHODS Thirty healthy and 30 diabetic adult patients were included. In all subjects, peripheral motor and sensory NCS were performed bilaterally with surface electrodes on the lower limbs including medial plantar and dorsal sural nerves. In addition, motor and sensory nerves were studied unilaterally on the upper limb. RESULTS In all patients, nerve action potential (NAP) amplitudes of sural and superficial peroneal nerves were within normal ranges, but in the patient group mean value was significantly lower than in the controls. Among clinically defined 30 DSN patients, medial plantar NAP amplitude was abnormal in 18 (60%) and dorsal sural nerve amplitude was abnormal in 13 (40%) of the patients bilaterally. Additionally, the onset NCV of the dorsal sural nerve was significantly slower in patients than controls (P=0.038). Evaluation of both of these nerves increased the sensitivity up to 70% in the detection of neuropathy. CONCLUSIONS Bilateral NCS assessment of both of the medial plantar and dorsal sural nerves together increases the rate of diagnosis of diabetic distal sensory neuropathy compared to assessment of either of these nerves. SIGNIFICANCE Assessment of medial plantar in addition to dorsal sural NCS together increases the sensitivity in the detection of neuropathy and allows earlier diagnosis, especially when routine NCS are normal.

Evaluation of the angiotensin-converting enzyme insertion/deletion polymorphism and the risk of ischaemic stroke.

Angiotensin-converting enzyme (ACE) gene polymorphism has been associated with increased incidence of stroke in some populations, although contradictory results have been reported. The aim of this study was to determine the allelic frequency and the genotypic distribution for ACE gene polymorphism in Turkish patients with ischemic stroke compared to appropriate healthy controls and to correlate the genetic findings with stoke type. One hundred and eight patients with ischemic stroke versus 79 healthy controls were studied for the presence of ACE gene polymorphism detected by PCR. Genotypes were defined as DD, II and ID according to the presence of the D (deletion) and I (insertion) alleles. There was no statistically significant difference in either the genotypic distribution or allelic frequency between the patients versus healthy controls (chi2 = 0.105; df = 1; p = 0.430). There was also no significant difference for ACE genotype distribution and allelic frequency within the stroke group classified according to Bamford criteria (chi2 = 4.827; df = 3; p = 0.185). Our data supports lack of association between DD genotype and/or D allele and ischemic stroke or subtypes of ischaemic stroke in the Turkish population.

Evaluation of peripheral and autonomic neuropathy among patients with newly diagnosed impaired glucose tolerance

We have aimed to investigate the presence of peripheral and autonomic neuropathy in individuals who had been diagnosed with impaired glucose tolerance (IGT) on the basis of an oral glucose tolerance test, by comparing with age‐matched healthy subjects with an oral glucose tolerance test (OGTT) in normoglycemic ranges.

Predictors of refractoriness in a Turkish status epilepticus data bank

Refractory status epilepticus (RSE) is known to constitute approximately 10-50% of all cases of status epilepticus (SE) and is associated with significant morbidity and mortality. In the present study, data from a prospectively collected SE database were analyzed. Patients with RSE (defined as a SE episode requiring a second line of intravenous treatment following intravenous phenytoin) were compared with patients with nonrefractory SE (NRSE); 290 episodes of SE were identified, of which 108 (38%) were defined as RSE. Univariate analysis revealed that age, female gender, SE type, SE duration, and acute etiology were associated with refractoriness, whereas electroencephalographic patterns were not. Nonconvulsive SE, which is probably associated with delays in treatment initiation, was a predictor of RSE, although it was not retained as a predictor in multivariate analysis. In the latter analysis, female gender (odds ratio: 1.815, 95% CI: 1.053-3.126) and acute etiology (odds ratio: 0.619, 95% CI: 0.429-0.894) were shown to be the only significant independent predictors of refractoriness.

The utility of lumbar paraspinal mapping in the diagnosis of lumbar spinal stenosis.

Yagci I, Gunduz OH, Ekinci G, Diracoglu D, Us O, Akyuz G: The utility of lumbar paraspinal mapping in the diagnosis of lumbar spinal stenosis. Objective:The aim of this prospective, blinded and controlled study is to evaluate the utility of lumbar paraspinal mapping in the diagnosis of lumbar spinal stenosis. Design:The subjects were assessed and allocated into three groups according to clinical and radiologic features with a standardized assessment protocol. These three groups were clinical and radiologic lumbar spinal stenosis, radiologic lumbar spinal stenosis, and the control group. The measurements of magnetic resonance imaging studies were performed by a blinded radiologist. An electromyographer who was masked to patients’ data performed all the nerve conduction tests, lower-limb needle electromyography, and lumbar paraspinal mapping. The relations of clinical, radiologic, and electrophysiologic findings were investigated. Results:Sixty-two patients were enrolled in the study. Two patients were eliminated because electrophysiologic studies showed polyneuropathy. There were 28, 16, and 16 patients in clinical and radiologic lumbar spinal stenosis, radiologic lumbar spinal stenosis, and control groups, respectively. In the clinical and radiologic lumbar spinal stenosis group, the findings of limb needle electromyography were inconsistent with 50% acute and 46.4% chronic radiculopathy. However, the paraspinal mapping showed that there were fibrillation potentials and positive sharp waves in at least two levels in 92.8% of the patients in clinical and radiologic lumbar spinal stenosis. The mean total paraspinal mapping score was 33.64 ± 21.17, which was significantly higher than the radiologic lumbar spinal stenosis and control groups. In the radiologic lumbar spinal stenosis group, the findings of paraspinal mapping were normal in 93.8% of the patients. Paraspinal mapping technique was found to be better correlated to the clinical findings than magnetic resonance imaging in asymptomatic patients. In the control group, 6 of 14 patients had high total paraspinal mapping scores (range, 0–9). Those patients with higher paraspinal mapping scores in the control group were mostly diagnosed with acute monoradiculopathy caused by disc herniation. Conclusions:Paraspinal mapping technique is a sensitive method in the diagnosis of lumbar spinal stenosis and reflects physiology of nerve roots better than the limb electromyography.

Normative data of sympathetic skin response and RR interval variation in Turkish children.

Sympathetic skin response (SSR) and RR interval variation (RRIV) are used commonly for the assessment of sympathetic and parasympathetic nervous system function, respectively. We determined the normal values of SSR and RRIV in 23 (14 females, nine males) Turkish children aged 5 to 14 (mean 9.86, SD 2.48) years. SSR was recorded on the hands and feet during the electrical stimulation of both median and posterior tibial nerves, respectively. Similar response was elicited on both feet during the stimulation of the right median nerve. RRIV testing was performed during rest on the supine position and deep inspiration at a frequency of 6 times/min. The SSR was elicited in all children. The mean SSR latencies recorded on the feet during the stimulation of median or posterior tibial nerve were significantly more prolonged than those recorded at the hands (P < 0.001). There was no significant difference between the mean latencies of SSR recorded at the ipsilateral and contralateral palms or soles. The mean latencies recorded at the sole during stimulation of the median nerve were not significantly different compared to those that recorded at the sole during the posterior tibial nerve (P > 0.05). The SSR amplitudes were not assessed because of great variability and rapid habituation. The mean RRIV (46.54+/-11.29%) during deep breathing was significantly increased as compared to that (35.90+/-10.63%) during rest (P < 0.003). As a result, SSR and RRIV are preferred non-invasive tests for evaluation of autonomic nervous system in children. The SSR is useful and reliable if it is obtained in the optimum technical conditions. Further research is necessary to establish strict criteria for abnormality.

Determination of nerve conduction abnormalities in patients with impaired glucose tolerance

Recent studies have shown that impaired glucose tolerance (IGT) is associated with dysfunction in the peripheral and autonomic nerves. The aim of this study was to determine the electrophysiological abnormalities of IGT. To determine electrophysiological abnormality in the large sensorimotor and sudomotor autonomic nerves with IGT patients, 43 patients and 34 healthy subjects have been studied. Subjective neuropathy symptoms, neurological examination and the electrophysiological findings were evaluated. When conduction of large somatic fibers only was evaluated, the ratio of electrophysiological abnormality was found to be 21%. In addition, where sympathetic skin response was evaluated the sudomotor autonomic abnormality ratio was 28% in upper extremities, 53% in lower extremities, and 16% in upper and lower extremities together. The percentages of abnormal electrophysiological parameters in different motor and sensory nerves were 39.5% in the peroneal motor nerve, 20.9% in the median motor and sural sensory nerves, 18.6% in the median sensory nerve, 16.3% in the tibial motor nerve, 14% in the ulnar sensory nerve, and 2.3% in the ulnar motor nerve. While distal motor latency was the most frequent abnormal parameter in the median and tibial motor nerves, the amplitude changes in the peroneal and ulnar motor nerves were also prominent. In sensory evaluation, the onset latency in the median-ulnar sensory nerves and the amplitude in the sural sensory nerve were found to be evident abnormalities.

The effect of piracetam on ataxia : clinical observations in a group of autosomal dominant cerebellar ataxia patients

Objectives:  Autosomal dominant cerebellar ataxias are clinically and genetically heterogeneous neurodegenerative disorders. There is no known treatment to prevent neuronal cell death in these disorders. Current treatment is purely symptomatic; ataxia is one of the most disabling symptoms and represents the main therapeutic challenge. A previous case report suggesting benefit from administration of high dose piracetam inspired the present study of the efficacy of this agent in patients with cerebellar ataxia. Piracetam is a low molecular weight derivative of γ‐aminobutyric acid. Although little is known of its mode of action, its efficacy has been documented in a wide range of clinical indications, such as cognitive disorders, dementia, vertigo and dyslexia, as well as cortical myoclonus. The present report investigated the role of high dose piracetam in patients with cerebellar ataxia.

A comparison of sural nerve conduction studies in patients with impaired oral glucose tolerance test

Objective –  Monitoring of the sural nerve is a sensitive method for detection of neuropathies. We examined different methods of studying sural nerve conduction in a group of patients with impaired glucose tolerance (IGT) in the same study.

Visual and auditory event related potentials in epileptic children : a comparison with normal and abnormal MRI findings

Visual and auditory event related potentials (VERPs and AERPs) in 32 epileptic children with magnetic resonance imaging (MRI) abnormalities and 18 with normal MRI were recorded and compared to the data of 21 healthy children. Of all 50 epileptic children (34 male, 16 female) aged 14.42+/-4.27 (7-20) years, 21 were medically intractable and receiving polytherapy. The mean latencies of N2 and P3 components of VERPs and AERPs in all epileptic children were significantly higher than those of the controls (P<0.05). Epileptic children with structural abnormalities had more prolonged latencies of N2 and P3 components of AERPs and VERPs than those of the healthy children (P<0.05). The epileptic children with normal MRI had significantly more prolonged latency of N2 and P3 of VERPs and P3 of AERPs than those of the controls (P<0.05). The difference of the mean latency of N2 and P3 components or the mean amplitude of P3 components of ERPs between the two epileptic groups was insignificant. The type of medication (mono- versus polytherapy) did not affect the wave components of ERPs. We suggest that epileptic activity, itself, leads to prolonged N2 and P3 components of AERPs and VERPs. The presence of structural abnormality indicated by imaging is not a predictor of ERPs abnormalities.