Clinical and electrophysiological study of peripheral nerve functions in patients with chronic renal failure

To study the prevalence and the patterns of peripheral neuropathy in patients with chronic renal failure. The study was conducted on 40 patients with chronic renal failure [CRF] and 20 healthy subjects of matched age and sex [control group]. Patients were divided into 2 groups. Group]: those with chronic renal failure treated conservatively [n=20] and Group II. those with end stage renal disease treated by hemodialysis [n=20]. Patients were selected randomly. The presence of polyneuropathy and its severity was assessed in all participants hi clinical, neurological examination and the following electro-physiological methods: 1] motor nerve conduction of the median, ulnar, tibial and peroneal nerves, 2] sensory nerve conduction studies of the sural, ulnar and radial nerves 3] F-wave study of the median, ulnar, tibial and peroneal nerves; and 4] Soleus H-reflex. The prevalence of polyneuropathy in group 1 and group 2 were 60% and 65%, respectively [with no significant difference between them]. Polyneuropathy was evident clinically in 37.5% of CRF patients and subclinical neuropathy [diagnosed only on electrophysiological basis] was found in 25% of GRE patients. Electrophysiological abnormalities suggested that the pathology was mainly axonopathy as there was a significant reduction of the CMAP amplitudes. The pattern of uremic neuropathy was axonal, affecting sensory fibers more than motor ones. It seemed that the most sensitive tests in detecting uremic neuropathy would be the H reflex, sural sensory nerve conduction, the peroneal and tibial F wave studies and the median, peroneal and tibial motor conduction studies

efficacy of bilateral arm training with rhythmic auditory cueing in stroke rehabilitation: clinical and electrophysiological study

To study the efficacy of repetitive bilateral arm training with rhythmic auditory cueing [BATRAC] on motor recovery in stroke patients clinically and electrophysiologically. Forty patients with chronic hemiplegia were included in the study. All patients participated in BATRAC [3 sessions/week] for six weeks. The upper extremity functional performance was evaluated by the Fugl-Meyer Upper Extremity Motor Performance [FMUEMP] and grip strength. Transcranial magnetic stimulation [TMS] was used to elicit MEP to the abductor digiti minimi. Functional performance and MEP were recorded before and after BATRAC. Following BATRAC there were improvement in functional performance [FMUEMP and grip strength], decrease in TMS threshold, decrease in the central motor conduction time and increase in MEP amplitude. These changes were significant [p<0.01]. Besides, there was a significant positive correlation between pre-rehabilitation MEP amplitudes and the improvement in FMUEMP. BATRAC for 6 consecutive weeks has been proven effective in improving both functional performance [of the paretic upper extremity] and MEP parameters in chronic stroke patients suggesting that functional improvement might has been secondary to central motor excitability changes

Clinical features, electrophysiological findings and naked eye appearance of the median nerve in patients with carpal tunnel syndrome

To study the morphological changes of the median nerve during release of the carpal tunnel and to compare it with electrophysiological and clinical parameters. Patients were subjected to full clinical examination, confirmatory tests [Phalen test and Tinel test], routine laboratory investigations, electrophysiological tests [motor and sensory nerve conduction studies of the median nerve] and median nerve decompression surgery. There were no significant differences between the presence or absence of the different clinical features and the surgical grading and vice versa; there were no significant differences between the presence or absence of different surgical features and the clinical grading. There was no significant relation between the clinical grading and the surgical grading. Some electrodiagnostic findings have a reliable relation with surgical findings rather than with clinical findings in patients with CTS. CMAP, compound muscle action potential; CTS; carpal tunnel syndrome; EMG, electromyography; NCS, nerve conduction study

Electrophysiological procedures in diagnosis of carpal tunnel syndrome

To evaluate some electrophysiological procedures adopted for the diagnosis of carpal tunnel syndrome [CTS] in Egyptian patients. The study was conducted on forty-one patients diagnosed as primary CTS according to the criteria proposed by the American Academy of Electrodiagnostic Medicine [AAEM, 1993]. The control group included thirty apparently healthy volunteers, of matching age and sex to the patients group. All patients and controls were subjected to: history taking, thorough clinical examination and electrophysiological studies that included: 1] Median and ulnar motor study, F-wave and axilllary F central latency, 2] Median and ulnar sensory study, 3] Median and ulnar mixed study and 4] Median lumbrical and ulnar interosseous study. Median motor conduction study revealed delayed distal latency, reduced CMAP amplitude and slowing in the forearm conduction velocity. Median sensory conduction studies revealed delayed sensory peak latency, slowed sensory conduction velocity of the median nerve in the distal segment and reduced SNAP amplitude. Motor and sensory nerve conduction studies of the ulnar nerve were all normal thus excluding the presence of peripheral neuropathy. Median nerve latency to the second lumbrical was prolonged and CMAP amplitude was reduced, also the difference between the median lumbrical and ulnar interosseous distal motor latency was prolonged whereas the ulnar to first palmar interosseous distal latency and CMAP amplitude were within normal The median mixed palm to wrist peak latency was prolonged and the difference between the median and ulnar mixed peak latencies was prolonged, the ulnar mixed palm to wrist peak latency and CMAP amplitude were within normal limits. The sensitivity and specificity for some tests were calculated and the results revealed that the highest sensitivity was for the median sensory peak latency to digit II versus the ulnar peak sensory latency to digit V 91.43%, followed by the median versus ulnar mixed palm to wrist peak latency 87.5%, the median lumbrical versus the ulnar interosseous distal latency 86.11%, median sensory peak latency to digit II 84.29% and lastly the median motor distal latency to the APB muscle 80.65%. The highest specificity was for the median versus ulnar mixed palm to wrist peak latency 100%, that is to say there were no false positive cases. So this test is highly specific, followed by the median sensory peak latency to digit II 95.0%, the median lumbrical versus the ulnar interosseous distal latency 92.5%, the median distal motor latency to the APB 92.5% and lastly the median sensory peak latency to digit II versus the ulnar peak sensory latency to digit V87.5%. The conventional motor and sensory conduction studies of the median nerve are sensitive and that calculating the difference between the median peak latency to digit II and the ulnar peak latency to digit V increases the diagnostic yield of the sensory study and increases the sensitivity of digit II sensory study. The median versus ulnar mixed palm to wrist peak latency is a very specific test that can be used as a screening test in cases of unilateral CTS. The median lumbrical versus ulnar interosseous distal latency is of high sensitivity and specificity

Painful neck movement: an additional differentiating sign between cervical spondylosis and myofascial pain syndrome

To find any specific pattern of pain severity during various neck movements in cervical spondylosis versus the myofascial pain syndrome. The study was carried out on 50 myofascial pain syndrome patients and 60 cervical spondylosis patients. Neck pain during neck flexion, extension, rotation and lateral flexion was measured using a numerical rating scale. Pain score during neck flexion was more in myofascial pain syndrome than in cervical spondylosis patients. On the other hand, neck pain during neck extension was more in cervical spondylosis patients than in myofascial pain syndrome patients. There was no statistical significant difference between both groups as regard rotation and lateral flexion. Moreover, neck extension was more painful than neck flexion in 90% of patients with cervical spondylosis. On the other hand, neck flexion was more painful than extension in myofascial pain syndrome patients. This study suggested that comparing pain severity during neck flexion to that during neck extension could be of help not only in differentiating pain of cervical spondylosis from that of MPS, but also in identifying the main cause of neck pain in patients with clinical signs suggestive of MPS and who have concomitant radiological evidence of cervical spondylosis. This could be of therapeutic value