Tarsal tunnel syndrome in patients with rheumatoid arthritis, electrophysiological and ultrasound study

Tarsal tunnel syndrome [TTS] is an entrapment neuropathy of the tibial nerve at the ankle. Rheumatoid arthritis is one of the systemic causes that has been responsible for TTS. In this study thirty feet of patients diagnosed as rheumatoid arthritis with complaints of burning pain or paresthesia on the plantar aspect of the foot and toes with 15 feet of age and sex matched control subjects were included. The aim of this study: To detect TTS among patients with rheumatoid arthritis. All patients included in this study were subjected to history taking, clinical examination [general and local], nerve conduction studies and ultrasonography of both tarsal tunnels. In this study, we detected the presence of TTS in rheumatoid arthritis patients group and none was found in the control group. A total of 28 cases were confirmed as having TTS. In the patients group a strong statistically significant correlations were found between ultrasonographic and electrodiagnostic findings. So it is concluded that TTS is detected in patients suffering from rheumatoid arthritis and that the use of both methods could lead to more reliable confirmed diagnosis which could lead to better management

Pelvic floor electrophysiology patterns associated with faecal incontinence

Pelvic floor electrophysiological tests are essential for assessment of patients with faecal incontinence. The present study was conducted to determine the patterns of pelvic floor electrophysiology that are associated with faecal incontinence. The present study included 40 patients with faecal incontinence and 20 apparently healthy subjects as a control group. All patients were subjected to history taking, clinical examination, proctosigmoidoscopy, anal manometry and electrophysiological studies. Electrophysiological studies included pudendal nerve motor conduction study, pudendo-anal reflex, needle electromyography of the external anal sphincter and puborectalis muscles, pudendal somatosensory evoked potential and tibial somatosensory evoked potential. The control group was subjected to electrophysiological studies which include pudendal nerve motor conduction study, pudendo anal reflex, pudendal somatosensory evoked potential and tibial somatosensory evoked potential. The most common pelvic floor electrodiagnostic pattern characteristic of faecal incontinence was pudendal neuropathy, abnormal pudendo-anal reflex, denervation of the external anal sphincter and puborectalis at rest, incomplete interference pattern of the external anal sphincter and puborectalis at squeezing and cough and a localized defect in the external anal sphincter. There were characteristic pelvic floor electrodiagnostic patterns for faecal incontinence

Giant and absent somatosensory evoked potentials in children with cerebral palsy with and without epilepsy

Many studies have reported the relationship between giant somato-sensory evoked potentials [SEP] and myoclonic epilepsy in adults and children. However there are few reports about giant SEP and absent SEP in children with cerebral palsy. To assess the diagnostic significance of giant SEP and absent SEP in children with cerebral palsy with and without epilepsy. The study included 25 children [10 boys and 15 girls] with cerebral palsy, 10 of them with a history of epilepsy. The age of all the CP children was 5.2 +/- 2.3 years. Ten healthy children of matched age, sex and height were included in the study as a control group. SEP to median [N20] and posterior tibial [P40] nerves stimulation was recorded. Giant SEP was defined as that bigger than 3 SD of the mean amplitude in normal children. Inter-ictal EEG recordings were done for all the patient population as well as for the controls. The peak latency of N20 in normal children was: 16.2 ms +/- 1.1 ms while its amplitude was: 7.5 micro.V +/- 2.6 micro V. The peak latency of P40 in normal children was: 31.3 ms +/- 3.2 ms while its amplitude was: 4.8 micro V +/- 1.8 micro V. Giant SEP was considered if the amplitude was more than 15.3 micro V for N20 and 10.2 micro V for P40. SEP was absent in 5 CP children without epilepsy [33.3%] and a patient [10%] with epilepsy. All of them were severely handicapped. On the other hand 4 CP children with epilepsy [myoclonic seizures] [40%] showed giant SEP while none of the CP children without epilepsy showed giant SEP. EEG recordings were unremarkable in 10 patients [40%]. Abnormal EEG findings were: focal paroxysmal discharges in 5 children [20%], polyspike and slow wave complexes In 4 children [16%] and abnormal background activity in 6 children [24%]. Both groups of CP children [with and without epilepsy] showed significant increase of the SEP latency and significant decrease of the SEP amplitude of the median and posterior tibial nerves compared to the control group. Giant SEP being present in CP children only with epilepsy, suggests that it is related to a state of cortical hyper-excitability. Absent SEP is present in CP children with and without epilepsy, but more in severely handicapped children. So absent SEP is attributed to the severity of neurological disorder

Sympathetic and somatic neuropathy in patients with scleroderma

Peripheral neurologic involvement is regarded as uncommon in systemic sclerosis. On the other hands, some studies showed that the peripheral nervous system is often affected in systemic sclerosis though it is not clearly understood whether the involvement represents a primary or a secondary event. Nonetheless, a number of patients develop parasthesia and neuropathic pain in their hands and occasionally precede the onset of clinical edema. To assess the sympathetic and somatic neuropathy in patients with scleroderma. Ten patients with scleroderma diagnosed according to the ACR criteria for systemic sclerosis 1980 as well as 10 healthy volunteers were included in the study. Included clinical neurological examination, semi-quantitative sensory testing, standard nerve conduction study of median, ulnar, common peroneal and sural nerves, needle EMG of the 1[st] dorsal interosseous and tibialis anterior, and electrically evoked sympathetic skin response [SSR] of the hand. Sensory symptoms was found in 5 patients, decrease of pinprick sensation was found in 4 patients, decrease of vibration sense was found in 4 patients, damped deep tendon jerks was found in 4 patients, unilateral facial parasthesia and hyposthesia in 2 patients. Nerve conduction study revealed low amplitude of the SNAP in 3 patients, slow sensory conduction in 2 patients and carpal tunnel syndrome in 4 patients. Slow motor conduction was found in the common peroneal nerve of a patient. Four patients showed poor SSR. The other 6 patients showed significant decrease of the amplitude and delayed latency of the SSR compared to the control subjects. Peripheral neuropathy in patients with scleroderma is not uncommon. It is predominantly sensory and sympathetic and seems to be non length dependent

Rheumatoid arthritis: early induction of disease remission

To evaluate the efficacy of tumor necrosis factor-alpha [TNF-alpha] blockade as bridge-therapy combined with methotrexate [MTX] in induction of early remission in rheumatoid arthritis patients. Patients and Sixty six patients with rheumatoid arthritis with poor prognostic disease features were enrolled in the current study. All had moderate to severe disease activity with unsatisfactory response to disease modifying antirheumatic drugs [DMARDs] mono-therapy. Patients were randomized into 3 groups: Group 1 were the patients who received TNF-alpha blockade therapy in combination with methotrexate [MTX] for 6 weeks than they were maintained on MTX alone for 18 weeks, group 2 included patients who received MTX mono-therapy and patients in group 3 who received prednisolone according to micro-dose regimen with MTX. All patients underwent initial full clinical examination as well as laboratory investigations [baseline evaluation]. The following disease activity parameters were determined at baseline, 6 weeks and 24 weeks after being enrolled in the study: Global patieny's and global physician's assessment scores, patients's pain score, number of tender as well as swollen joints, Health assessment questionnaire, serum C-reactive protein, erythrocyte sedimentation rate as well as morning stiffness duration. Standard plain X-rays were carried out for both hands, wrists, ankles as well as the forefeet. Joint erosions were assessed according to Larsen's score. Induction of disease remission after the 1st 6 weeks of therapy occurred in 45.45%, 27.27%, 36.36% in group1, 2 and 3 respectively, reflecting the higher efficacy of TNF-alpha blockade therapy in induction of early disease remission. After 18 weeks of stopping TNF-alpha blockad and maintaining the patients of group1 on MTX [24 weeks from start of the study], the 3 study groups showed comparable disease control revealing the absence of superiority of TNF-alpha blockade therapy compared with prednisolone-MTX combination as well as MTX monotherapy. On the other hand radiological evaluation of joint damage showed comparable incidence of joint erosions in the 3 groups reflecting equal efficacy of the 3 treatment regimens in controlling joint destruction. In view of results of the current study it can be concluded that TNF-alpha blockade is an effective therapy in RA that can induce early disease remission, however, this induced remission was not associated with superior efficacy in protection of joint damage compared with MTX mono-therapy and combined MTX-steroid therapy