Zeki Odabasi

Auditory event-related brain potentials in fibromyalgia syndrome

ObjectiveThe aim of this study was to investigate cognitive functions using auditory event-related brain potentials (ERP) in fibromyalgia syndrome (FMS).MethodsThe P300 component of ERP was studied in 36 female FMS patients and 22 control subjects. The short form 36 (SF-36) medical outcome study was used to determine quality of life. Number of tender points and disease duration were noted. Cognitive functions were evaluated with P300.ResultsThe symptoms were discrepant in FMS (P<0.001). The scores of the eight SF-36 subgroups in FMS patients were significantly lower than in the control group (P<0.001). Fibromyalgia syndrome patients had prolonged latency and reduced amplitude of P300 (P<0.001). No correlation was found between the subgroups of SF-36, tender point count, disease duration, and P300.ConclusionThe results of our study reveal that FMS affects quality of life and dysfunction in cognitive abilities can be determined by brain event-related potentials.

The value of MRI in a case of Tolosa-Hunt syndrome

We report a case of Tolosa-Hunt syndrome (THS) in which the lesion has been demonstrated by magnetic resonance imaging (MRI), computed tomography (CT), and angiography. A healthy 23-year-old man developed an acute painful ophthalmoplegia on the right side. CT and MRI scans revealed asymmetric enlargement of the right cavernous sinus with contrast enhancement extending down to the region of trigeminal ganglion. MRI further delineated the detailed anatomical structures of the region and excluded any infiltration of the surrounding tissues by a mass lesion. Cerebral angiography showed a significant decrease in the calibration of petrous segment and a mild decrease in the calibration of cavernous segment of the ipsilateral internal carotid artery. The patient was treated with oral prednisone, 100 mg daily. Neurological findings totally subsided after 2 weeks on corticosteroid and MRI showed resolution of the lesion in the cavernous sinus. The patient was symptom-free for 6 months after discharge. Our findings have suggested that MRI is the most valuable imaging technique for demonstration and follow-up of lesions in the cavernous sinus that are directly responsible for the symptoms of THS and the lesions can be more extensive than was currently believed.

The effectiveness of triamcinolone acetonide vs. procaine hydrochloride injection in the management of carpal tunnel syndrome: a double-blind randomized clinical trial.

Objective: Corticosteroid injection into the carpal tunnel is frequently used for the treatment of carpal tunnel syndrome (CTS). Steroids are usually mixed with local anesthetics, which have positive effects that can aid the treatment of CTS by inhibiting the spontaneous discharge ability of excitable cells. The aim of this study was 3-fold: (1) to determine the efficacy of triamcinolone acetonide injection in the treatment of CTS, (2) to determine the efficacy of procaine hydrochloride (HCl) in the treatment of CTS, and (3) to compare the efficacy of triamcinolone acetonide and that of procaine HCl in the treatment of CTS. Design: This prospective, randomized, double-blind clinical trial included 99 patients (120 median nerves) with clinical and electrophysiologic evidence of CTS. The 120 median nerves were randomly assigned to one of three groups: group 1 received 40 mg of triamcinolone acetonide, group 2 received 4 ml of 1% procaine HCl, and group 3 received both 40 mg of triamcinolone acetonide and 4 ml of 1% procaine HCl. Clinical and electrophysiologic evaluations were performed at the study onset and at 2 and 6 mos after treatment. Results: At the study onset, there were no statistically significant differences between the groups with respect to distal motor latency, compound motor action potential, compound sensory action potential, sensory nerve conduction velocity, or visual analog scale score; however, distal motor latency, compound sensory action potential amplitude, sensory nerve conduction velocity, and visual analog scale scores improved significantly in each group 2 mos after treatment (P < 0.05), and these improvements persisted at 6 mos after treatment (P < 0.05). Significant differences were not observed between groups 1 and 2 or between groups 1 and 3 with respect to electrophysiologic findings at baseline or 2 or 6 mos after treatment (P > 0.05). Group 3 had better compound sensory action potential amplitude and sensory nerve conduction velocity scores than group 2 did at 6 mos (P < 0.05) and better visual analog scale scores than group 2 did at 2 and 6 mos (P < 0.05). Conclusions: Local procaine HCl injection and steroid injection effectively reduced the symptoms of CTS and equally improved electrophysiologic findings. As such, procaine HCl can be used in CTS patients in whom steroid use is contraindicated.

α-interferon and isoprinosine in adult-onset subacute sclerosing panencephalitis

We report eight patients with adult-onset subacute sclerosing panencephalitis (SSPE), of which, four were treated with oral isoprinosine and four with intraventricular α-interferon plus oral isoprinosine. One of the four patients treated with oral isoprinosine died within two months, and the disease progressed in three patients. Of the four patients treated with oral isoprinosine plus intraventricular α-interferon, one showed mild progression, one remission, and the remaining two showed stabilization. The group of patients is relatively small, but our results suggest that treatment with oral isoprinosine plus α-interferon is effective for SSPE.

New near-nerve needle nerve conduction technique: differentiating epicondylar from cubital tunnel ulnar neuropathy.

At the elbow, the ulnar nerve is compressed most commonly either in the epicondylar groove or at the cubital tunnel. While conventional electrodiagnosis may localize an ulnar neuropathy to the elbow, separating epicondylar syndrome (tardy ulnar nerve palsy) from cubital tunnel syndrome is more difficult. We describe a new method using a near‐nerve needle technique for distinguishing these two types of ulnar neuropathy at the elbow. We placed three active needle electrodes across the elbow: the first was 4 cm above, and the second and third were 1.5 cm and 6 cm below the medial epicondyle, respectively. The latter two points were chosen because of the presence of the cubital tunnel in this segment. Sensory, motor, and mixed nerve conduction studies (NCS) were performed on these two segments (elbow segment and cubital tunnel segment) in 26 normal nerves and normal data were established. We also present 7 cases of epicondylar ulnar nerve palsy and 1 case of cubital tunnel syndrome in which we were able to confirm the diagnosis with the present method. In 3 cases of epicondylar ulnar nerve palsy, the present method accurately localized the lesion when other methods failed. We believe that this method will be helpful in distinguishing cubital tunnel syndrome from epicondylar ulnar nerve palsy, especially in early ulnar neuropathy in which only sensory fibers are involved.

Woodhouse and Sakati syndrome (MIM 241080): report of a new patient.

A 32-year-old male with Woodhouse Sakati syndrome (MIM 241080) is described. Two of the probands brothers also have diabetes mellitus and similar facial features, however they are not dysarthric. An affected older brother died of an unknown cause at age 30. This confirms autosomal recessive inheritance.

Long-term follow-up of patients with adult-onset subacute sclerosing panencephalitis

Subacute sclerosing panencephalitis (SSPE) is a rare infectious central nervous system disease with a poor prognosis. Nineteen patients, 18 males and one female, ranging in age from 18 to 22, mean 19.6+/-1.5 years with SSPE were evaluated. We treated 9 patients with oral isoprinosine and 10 patients with alpha-interferon plus oral isoprinosine and followed up for 16 to 160 months. Of the 9 patients treated with oral isoprinosine, 7 (77.7%) died, one stabilized, and one showed progression. Seven (70%) of 10 patients treated with alpha-interferon plus oral isoprinosine died, one showed progression, and stabilization was observed in two patients. Thus, we suggest that isoprinosine alone or in combination with intraventricular interferon did not change the prognosis in long-term follow-up periods.

Efficacy of Local Lidocaine Application on Anxiety and Depression and Its Curative Effect on Patients with Chronic Tension-Type Headache

Background: Tension-type headache (TTH) is a primary headache disorder. In this study, the efficacy of local lidocaine application on anxiety and depression and its curative effect in patients with chronic TTH was investigated. Methods: Forty-eight patients (24 local lidocaine injection, 24 local saline injection group) with chronic TTH were enrolled in our study. Injections were applied to the trigger points of the muscles that are innervated by C1-C3 and the trigeminal nerve, exit points of the fifth cranial nerve, and around the superior cervical ganglion. Each patient underwent one session every 3 days. Patients were evaluated before and 3 months after the treatment. Results: In both groups, the number of painful days in a month, visual analogue scale values, amount of analgesic use in a month, Hamilton depression score, and Hamilton anxiety score decreased after the treatment. As a result, all of the parameters were found to have improved in both groups (p < 0.05), the results were statistically significant, and the lidocaine groups response to the treatment was better than the placebo group (p < 0.001). Conclusion: Our findings suggest that local lidocaine administration can be an effective method in the treatment of chronic TTH.

Essential palatal myoclonus in monozygotic male twins

Sirs: Palatal myoclonus (PM) is an uncommon movement disorder characterized by vertical oscillation of the soft palate at 1 to 3 Hz and usually bilateral. Occasionally some other brainstem-innervated muscles may be involved. Some authors call it a palatal tremor [10, 12]. We report monozygotic male twins with essential palatal myoclonus. To our knowledge this is the first report in which essential PM can be genetically linked. 39 year old twin brothers were admitted to hospital for treatment of involuntary movements of the soft palate and clicking in both ears. In their medical history it was learned that symptoms developed at the age of 14–15 years in one of them and at the age of 37 years in the other. The patients’ parents were healthy and unrelated. The patients’ general and neurological examination was unremarkable except easily audible clicking in time with the visible rhythmical movements of the soft palate. It was not associated with synchronized movements of eyes, tongue, larynx, diagram, intercostal muscles, extremity or trunk. The patient’s whose soft palate frequency had developed at the age of 14–15 years was 2Hz. symptoms, and was higher than his brother’s whose frequency was 1,5Hz. Chronic treatment with clonazepam, piracetam, valproic acid, amitriptiline and carbamazepine failed to improve PM in the first patient and clonazepam, carbamazepine, valproic acid were administered with no effect in the second. Because the different drugs did not improve the PM, five units of botulinum toxin (Botox®/Allergan) in 0.2 ml. saline solution were injected into each side of tensor veli palatini through a special needle under EMG guidance. The first patient reported some initial difficulty with swallowing, in the second patient there was no severe side effect. Three days after the injections PM and clicking began to diminish and had completely disappeared after 6 days in both of them. They remained free of the PM and clicking at the every three months followup visit for one year in the first patient and six months in the second. The investigations including routine blood chemistry, computed tomography (CT), magnetic resonance imaging (MRI), electroencephalography (EEG), somatosensory evoked potentials (SEP) and brainstem auditory evoked potentials (BAEP) were all normal. There are two forms of palatal myoclonus. Essential palatal myoclonus is characterized by a vertical oscillation of the soft palate at 1 to 3 Hz. unaltered by voluntary actions, and an annoying ear click. There are no other neurological signs or symptoms, and the pathophysiology of essential palatal myoclonus is unknown. Symptomatic palatal myoclonus is nearly always associated with syncronous movements of the eyes, larynx, pharynx, face, diaphragm, cervical and axial muscles. Some authors, however, point to difficulties in classifying their patients with palatal myoclonus as either the essential or the symptomatic type [1, 8, 9, 13]. Symptomatic palatal myoclonus produced by a lesion involving the pathway connecting dendate, red and inferior oliver nuclei. Olivary enlargement can be visible on MRI in some symptomatic cases [4, 5, 9, 13]. The patients may complain only of annoying ear click, the origin of which is uncertain, although many believe it arises from muscles contracting around the eustachian tube. The potential role of heredity in the etiology of essential palatal myoclonus is unknown. These monozygotic twin brothers with essential palatal myoclonus in which symptoms developed at the age of 14–15 years in one of them and at the age of 37 years in the other are of interest for suggesting the hereditary etiology of essential palatal myoclonus. In our monozygotic male twins the first symptoms of palatal myoclonus were noted 22 years later than in the other one. These findings indicate that there is a role of inheritance in the pathogenesis of essential palatal myoclonus but also that some other factors contribute to the clinical presentation of palatal myoclonus. Similar findings have been described in monozygotic twins with idiopathic dystonia and Huntington’s disease [3, 6, 11]. As the relationship between the disease and its genetic linkage could be confirmed in our patients, it might also be thought that the pathology may not be inherited. Successful treatment of essential palatal myoclonus by botulinum toxin has been reported several times [2, 7]. In our monozygotic male twins, five units botulinum toxin in 0.2 ml. saline solution were injected into each side of tensor veli palatini and both cases were rendered free of their myoclonus a few days after injection until 11 months in the first patient and 6 months in the second one. In conclusion, the essential LETTER TO THE EDITORS

Colchicine-induced myopathy with myotonia in a patient with chronic renal failure.

Although colchicine induced myopathy has been described in patients with chronic renal failure, colchicine induced myopathy with myotonia has been reported very rarely. A 49-year-old man with chronic renal failure was hospitalised for investigation of fatigue, malaise and severe pain in all extremities. He was on colchicine therapy for 5 months. Neurological examination showed mildly decreased sensation in a distal symmetric pattern in lower extremities, moderate proximal limb weakness, hyporeflexia and severe myalgia on palpation. No clinical evidence of myotonia was present. Laboratory studies showed elevated creatine phosphokinase (CK), lactic dehydrogenase (LDH), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. Electromyographic (EMG) findings were compatible with myopathy and abundant, widespread myotonic discharges were determined. Muscle biopsy was consistent with vacuolar myopathy. After withdrawal of colchicine, CK, LDH, AST and ALT levels were normalised and the symptoms were disappeared gradually. In conclusion, the detection of myopathic motor unit potentials with myotonic discharges on EMG in patients on colchicine therapy is an important finding and it is possible to suggest that this clue may lead to the invasive procedure of muscle biopsy unnecessary.