Evaluation of Elbow Stretch Reflex Using a Portable Hand-driven Isokinetic System in Normal Adults

OBJECTIVE: To evaluate normal healthy persons without spasticity to observe normal findings of the elbow stretch reflex using a newly developed, portable, hand-driven spasticity-measuring system. METHOD: Thirty normal persons without any disease involving the central or peripheral nervous system were enrolled in this study. The portable hand-driven isokinetic system is able to measure the joint angle, angular velocity, electromyographic (EMG) signals, and torque during elbow passive extension-flexion. One set of 10 passive elbow extension and flexion movements was performed for data acquisition at each angular velocity, including 60, 90, 120, 150 and 180 degrees per second (degrees/sec). Electromyographic data were collected from the biceps brachii and the triceps brachii. Torque data were collected from sensors around the wrist. RESULTS: We were able to detect EMG activity and torque in all subjects by using the new portable hand-driven isokinetic system. EMG activity and torque increased with incremental increase of angular velocities. The joint angle of maximal EMG activity according to different angular velocities did not show any significant difference (116degrees-127degrees in elbow extension and 37degrees-66degrees in elbow flexion). The joint angles of maximal torque according to different angular velocities were not significantly different either. CONCLUSION: Using the portable hand-driven isokinetic system on the elbows of normal subjects, we were able to obtain expected results. By considering our normal findings of the elbow stretch reflex using this system, we propose that the various aspects of spasticity-related data can be measured successfully.

Suppression of Seizure by Cathodal Transcranial Direct Current Stimulation in an Epileptic Patient: A Case Report

Epilepsy is an intractable disease, though many treatment modalities have been developed. Recently, noninvasive transcranial direct current stimulation (tDCS), which can change brain excitability, was introduced and has been applied for therapeutic purposes regarding epilepsy. A suppression of seizures was experienced by cathodal tDCS in a medication refractory pediatric epileptic patient. The patient was an 11-year-old female who had focal cortical dysplasia of the cerebral hemisphere. The patient was treated with antiepileptic drugs but the mean seizure frequency was still eight episodes per month. The tDCS cathode was placed at the midpoint of P4 and T4 in the 10-20 EEG system where the abnormal wave was observed on a sleep EEG. Two mA of tDCS was applied 20 minutes a day, five days a week for two weeks. During a two-month period after treatment termination, only six seizure attacks occurred, and the duration of each seizure episode also decreased. tDCS was applied under the same conditions for another two weeks. For two months after the second treatment session, only one seizure attack occurred, and it showed great improvement compared to the eight seizure attacks per month before the tDCS treatment. The medications were not changed, and there were no notable side effects that were caused by tDCS.

Motor Evoked Potentials of the Upper Extremities in Healthy Children

OBJECTIVE: To evaluate and compare the organization of descending motor pathways to upper extremity muscles among healthy children. METHOD: The healthy children were 16 males and 7 females aged 1-19 years (average, 9 years), and eight healthy adults were enrolled as the control group. Transcranial magnetic stimulation was applied to bilateral motor cortices, and motor evoked potentials (MEPs) were recorded using surface electrodes from the first dorsal interossei (FDI), the biceps brachii (BIC), and the deltoid (DEL) muscles. The onset latency, central motor conduction time (CMCT), and amplitude were obtained during a relaxed state. RESULTS: MEPs of FDI were obtained from subjects aged 13 months. The frequency of obtaining MEPs in proximal and distal muscles increased with age, although there was a less frequent incidence of obtaining MEPs in the proximal BIC and DEL muscles compared with those in the distal FDI muscle. MEP amplitudes increased with age, whereas latencies were relatively constant. CMCTs showed a similar pattern of maturation, and adult values were obtained by 13-years-of-age. CONCLUSION: These results suggest that the proximal and distal muscles of the upper extremities show different maturation and organization patterns.