Sympathetic skin response in carpal tunnel syndrome

Sympathetic skin response [SSR] is most frequently used in diagnosing functional impairment of non-myelinated postganglionic sympathetic fibers. Early diagnosis of autonomic dysfunction is important in patients with carpal tunnel syndrome [CTS] as the earlier the diagnosis the more effective the treatment. Aim of this work was to measure the SSR in patients with CTS to detect its relation with possible autonomic dysfunction. This study included 18 patients [23 hands] with CTS, graded according to Bland [2000]. SSR measurement was done, and the latency and amplitude were measured. Clinical manifestations of autonomic dysfunction were present in 6 hands [26%]. There was statistically high significant longer disease duration among patients with autonomic dysfunction in comparison to those without. Among our patients, 3 hands [13%] had no elicited SSR. This was associated with very severe carpal tunnel syndrome, female sex, and long disease duration. There was a statistically high significant difference between patients and controls as regards the latency of SSR with no significant difference as regards the amplitude. There was a statistically high significant positive correlation between the SSR latency and the grading of CTS, and statistically high significant negative correlation between the amplitude of SSR and the grading of CTS. SSR can be used in the electrodiagnostic workup for patients with carpal tunnel syndrome where it can be used as a method for detection of autonomic dysfunction in these patients

Motor evoked potentials as a predictor for upper limb function following acute stroke

To record the MEPs in the affected upper limb of hemiplegic patients in order to study its role in the prediction of functional and motor recovery of the upper limb in cases of acute stroke. This study included 30 patients suffering from acute stroke, all of them were subjected to history taking, clinical and neurological examination and clinical assessment scales [initially and after three months of conventional physiotherapy] including Medical Research Council [MRC] scale, Nine Hole Peg test [NHPT] and action research arm test [ARAT]. Also, all patients and controls were subjected to MEPs recording in order to evaluate resting motor threshold, MEP amplitude and central motor conduction Time [CMCT]. The mean of initial MRC scale, NHPT and ARAT was 1.73 +/- 1.17, 4.23 +/- 2.34 and 21.53 +/- 14.42 respectively. As regards MEPs, the mean of resting motor threshold [mamp], MEP amplitude [microv] and CMCT [msec] were 109.57, 0.56 and 11.28 respectively showing a highly significant difference from the control group whose mean values were 73.4, 2.98 and 7 respectively. Patients were divided according to initial CMCT into three groups: group I and II [patients with normal and delayed CMCT respectively] and Group III [patients with absent MEP]. On comparing the initial and follow up motor and functional recovery according to the clinical scales [MRC, NHPT and ARAT] in the three patient groups, group I and II exhibited highly significant [P<0.01] higher scores than group III. Correlation study showed a significant negative correlation between CMCT and MRC scale and ARAT, also there was a significant positive correlation between CMCT and NHPT while no significant correlation was found between resting motor threshold or amplitude of MEPs and the follow up clinical scales. Predictive value of CMCT for improvement of different scores [MRC, NHPT and ARAT] was 22, 38 and 36.6% respectively. CMCT of MEPs was the parameter with the highest predictive value to functional improvement of affected upper limb in stroke patients. These data can be helpful for clinicians to plan the program of rehabilitation according to the expected recovery of motor function

Microvascular abnormalities in juvenile onset systemic lupus erythematosus

To assess the microvascular abnormalities in patients with juvenile onset systemic lupus erythematosus [SLE] using the nailfold capillaroscopy [NFC] and to measure the levels of anti-annexin V antibody [a-AXV Ab] titer to correlate them with each other and with renal affection. This study was conducted on twenty patients with juvenile onset SLE and ten healthy controls. All the patients and controls were subjected to history taking and clinical examination, laboratory investigations especially kidney function tests, ANA and anti-ds-DNA and quantitative assay of a-AXV Ab titer. SLE disease activity index and NFC were also performed. The mean capillary number and length in the patients was 7.05 +/- 1.76 and 477.1 +/- 157.01 respectively, showing a significant difference from the controls [10 +/- 1.05 and 315 +/- 105.01 respectively], while there was no significant difference regarding capiliary width. Tortuous capillaries were found in 13 patients showing a significant difference from the controls having hairpin capillaries. Organized capillaries were found in 3 patients and all the controls. The mean a-AXV Ab titer in patients was 226.45 +/- 117.66 AU/ml showing a significant difference from the controls [5.6 +/- 1.71 AU/ml]. Proteinuria showed a positive significant correlation with a-AXV Ab titer, capillary width and length [r=0.530, 0.457 and 0.447 respectively] while it was negatively correlated with capillary number [r=-0.459]. Anti-AXV Ab titer was positively correlated with capillary length [r= 0.509]. At cut-off value 160 AU/ml, a-AXV Ab titer showed sensitivity [Sn] and specificity [Sp] 100% in discriminating lupus nephritis [LN] from negative LN while capillary length showed Sn and Sp 100 and 70% at cut-off 370 and capillary width had 70% Sn and 80% Sp at cut-off 20 NEC is of value in detecting micro vascular abnormalities in juvenile onset SLE and its analysis especially capillary length in combination with a-AXV Ab titer may be helpful in raising suspicion for lupus nephritis

Vestibular dysfunction in systemic sclerosis

Systemic sclerosis is a chronic connective tissue disease characterized by multisystem affection. Nervous system involvement in the form of peripheral and cranial nerve affection has been reported in systemic sclerosis [SSc] patients. To study the possible occurrence of vestibular dysfunction in SSc and to determine its nature [peripheral or central]. Also, we aimed to correlate any vestibular involvement with clinical and laboratory data of the patients. Fifteen female patients suffering from SSc were included in this study. All patients were subjected to careful history taking, clinical examination, basic audiological examination, vestibular test battery in the form of Vestibular Evoked Myogenic Potentials [VEMP] and Videonystagmography [VNG]. VNG included bithermal caloric test to assess the semicircular canal and superior vestibular nerve while the oculomotor test battery was used to assess the central pathway. Out of the 15 female patients included in this study, nine patients was suffering from limited SSc [60%] while six patients had diffuse SSc [40%]. The mean age was 37.56 +/- 11.89 years with mean disease duration 8.43 +/- 7.3 years. The results of our study showed a high incidence of vestibular dysfunction in SSc patients where 13 patients [86.66%] showed abnormality in one or more of vestibular tests, 12 patients [80%] having abnormal VEMP results and 3 patients [19.99%] having abnormal caloric test. Our study showed that Systemic sclerosis has definite vestibular involvement. The results of VEMP and VNG showed definite peripheral vestibular pattern of dysfunction. Our results revealed peripheral vestibular dysfunction which is suspected to be due to vascular or inflammatory vestibular neuropathy

Comparison between repetitive peripheral magnetic stimulation [RPMS] and botulinum toxin -A injection in management of spasticity

To compare between the use of repetitive peripheral magnetic stimulation and botulinum toxin-A injection in management of spasticity in patients with paraparesis. Twenty three patients suffering from spastic paraparesis due to traumatic spinal cord injury were included in this study. Assessment included spasm frequency scale [SFS], adductor tone scale, Modified Ashworth scale [MMAS], clonus score, Medical research council scale for muscle power testing. Patients were divided into two groups, group A [10 patients]: received botulinum toxin type A injection and group B [13 patients]: received repetitive peripheral magnetic stimulation [RPMS] one session daily for 3 successive days. All patients were reassessed at 4, 7 and 30 days from the start of therapy. There was no significant difference in the neurological baseline data after 4 and 7 days in group A patients. However, after 30 days, there was a statistically significant decrease in the spasticity scales. After four days therapy, there was highly significant difference [p<0.01] in the neurological scales with decreased spasticity scales in group B compared to group A. After seven days, there was highly significant difference [p<0.01] between group A and B with decreased spasm frequency and clonus score scales in group A. After 30 days, there was a highly significant difference [p<0.01] between group A and B with decreased adductor tone, modified ashworth, spasm frequency scales, clonus and functional independence measure scores in group A. RPMS and botulinum toxin A injection can be used complementary to each other as RPMS has immediate and short term effects on spasticity while botulinum toxin A has delayed and long term effects on muscle tone