Nerve Conduction Study In Different Clinical Grades Of Diabetic Foot

Background:Diabetic neuropathy is one of the commonest late complications of diabetes. Diabetic neuropathy can be either peripheral or autonomic. Nerve conduction study (NCS) is the recording and measurement of the compound nerve and muscle action potentials elicited in response to an electrical stimulus. Currently, the principal uses of NCV(Nerve Conduction velocity) study are to evaluate paresthesias (numbness, tingling, burning) and /or weakness of arms or legs.Methods:All patients diagnosed as diabetic foot were sent for Nerve Conduction Study after obtaining their written informed consent. Three nerves were studied; two motor nerves, Common peroneal and Tibial nerves, and one purely sensory nerve, Sural nerve.Results:Mixed type neuropathy with bilateral lower limb involvement was the most common type encountered.Interpretation and Conclusion:Mixed type of neuropathy was the most common in my study with respect to sensory and motor types of neuropathy; and also axonal and demyelinating types of neuropathy.Number of patients with bilateral neuropathy detected by NCVstudy in my study is more than that detected clinically and the difference is significant by applying the test of significance. Hence, NCVis a better study to detect nerve conduction abnormalities than clinical examination in diabetic foot

Clinical outcome of Gullian-Barre Syndrome in a tertiary care teaching hospital A prospective observational study

Background: Gullian-Barre Syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy (AIDP) with autoimmune background. The clinical management of GBS is by nerve conduction velocity (NCV) and supportive care, intravenous immunoglobulin’s (IVIG) and Plasmapheresis. We have studied the clinical outcome of Gullian-Barre Syndrome patients visiting to the tertiary care hospital in Andhra Pradesh. Material and methods: A cross sectional study was conducted in a tertiary care teaching hospital at Andhra Pradesh in 50 patients over the period of 2 years. Neurological examination like higher mental functions, cranial nerves, motor system, sensory system and autonomic system was done for all patients. Descriptive analysis of clinical presentation, type of GBS, occurrence of complications and final outcome was also done. Results: A total of 50 participants were included in the study. Majority (52%) of the study participants were aged below 40 years. Diabetes mellitus (DM) and hypertension (HTN) were the Vasa VK, Chowdary DB, Kalyani OM. Clinical outcome of Gullian-Barre Syndrome in a tertiary care teaching hospital – A prospective observational study. IAIM, 2016; 3(1): 105-109. Page 106 most common co-existing illnesses reported in 8% and 6% of study population respectively. Conclusion: The majority of the Guillain-Barre Syndrome patients recovered smoothly without going for complications. Prognostic outcome was poor in our study with increasing age and co-existing illness like diabetes mellitus or ischemic heart disease.

Ondansetron versus Amitriptyline in the Treatment of Peripheral Neuropathy: A Randomized Double Blind Prospective Clinical Study.

Background and Objective: Clinical trials have shown the potential use of 5-HT3 receptor antagonists like Ondansetron, Tropisetron and Zacopride in a number of disorders of gastrointestinal tract and the central nervous system such as cancer chemotherapy induced vomiting, anxiety, depression, schizophrenia and migraine. Various experimental and clinical studies also point the usefulness of Ondansetron in neuropathic pain. Therefore, the present study was conducted to find out whether Ondansetron could be used as an alternative to a standard drug, Amitriptyline in the treatment of peripheral neuropathy. Methodology: A randomized double blind prospective clinical study was conducted on Original Research Article British Journal of Medicine & Medical Research, 4(26): 4444-4454, 2014 4445 thirty six patients of peripheral neuropathy divided into two groups of equal number of patients. Group 1 received Ondansetron 8 mg per day while Group 2 received Amitriptyline 25 mg per day. Patients were being evaluated on the basis of improvements (decrease) in LANSS (Leeds Assessment of Neuropathic Symptoms and Signs), VAS (Visual Analogue Scale) and NCV (Nerve Conduction Velocity) for six weeks. Student’s ttest and/or repeated measure ANOVA followed by Bonferoni correlation was used to compare sets of paired observations. The Friedman test followed by multiple comparisons was used to compare the data which was not normally distributed. Results: LANSS and VAS scores showed significant improvements in the 1st and 2nd visit in both the groups. NCV showed improvement in Ondansetron group with less number of adverse effects compared to that of Amitriptyline. NCV in Amitriptyline group demonstrated significant increase in one of the parameters, F-waves, indicating a worsening in left tibial nerve (p=0.036), whereas no such change was found in the group treated with Ondansetron. Conclusion: Ondansetron has beneficial role in peripheral neuropathy by improving its sensory component as it significantly decreased LANSS and VAS scores. Our results also demonstrated that Ondansetron was at least as efficacious as Amitriptyline in the treatment of peripheral neuropathy with lesser adverse effects.

Causes and prevention of Ptosis after Temporal muscle transfer in Lagophthalmos in the Patients with leprosy / 나학회지

Facial nerve paralysis in leprosy adversely affects facial regions from the forehead to the lip. In particular, lagophthalmos in patients with leprosy causes exposure keratitis, corneal and conjunctival dryness which can progress blindness and disfigurement. The function of the eyelids is controlled by the oculomotor nerve and the facial nerve. In leprosy patients the oculomotor nerve continues to function causing the levator muscle to lift the eyelids. However, paralysis of the facial nerve prevents the orbicularis oculi muscle from closing the eyelids, resulting in lagophthalmos. Various methods were developed to correct lagophthalmos, one of which was temporal muscle transfer(TMT) reported in 1934 by Gillies. Since we noted relatively high occurrence of ptosis as a complication in patients treated previously with the TMT, we performed other surgical procedures for laglphthalmos over 15 years, not to make the ptosis. Although most of the patients quite improved post-operatively, partial lid-gap frequently persisted. It may be related to involutional changes and paralyzed orbicularis muscle. Recently, we conducted 4 different TMT methods for last 4 years to reduce ptosis. The methods used included Brown & McDowell, McCord & Codner, modified Gillies & Anderson, and modified Gillies. Seventy-five TMT operations in 60 patients(26 males and 34 females) were done between 2011 and 2014. The age range of the patients was 54~87 years(the mean was 70.1). Fifteen patients had bilateral TMT procedures. As a result, ptosis appeared in 14(18.7%) out of 75 TMT procedures for 4 years. Four technical points should be considered for the initial assessment to prevent or reduce the incidence of ptosis. The first is the increase of the length of temporalis muscle flap to approximately 8cm with a parallel course to the lateral canthus, which will reduce the oblique pull. Second, the width of the fascia sling in the upper eyelid is narrow(3~4mm) to reduce weight on the eyelid. Third, the fascia sling in the upper lid is not tied with that of the lower lid at the medial canthal tendon to reduce tension. Lastly, the fascia sling in the upper eyelid is shallow(subdermal level) in location and as near as possible to the lid margin.

Feature of Nerve Conduction Study in people affected by leprosy / 나학회지

BACKGROUND: Nerve conduction study(NCV) in elderly patients is considered as a useful diagnostic tool for elderly patients with peripheral neuropathy. OBJECTIVE: Here the author investigates parameters of NCV in elderly Hansen patients out of Sorokdo hospital and compares them with those of healthy elders. METHODS: The author enrolled 28 patients who were visiting OPD for surgical wound care. Out of them 8 patients were dropped off because of hypersensitive response to the test stimulation or having failed to attatch the electrodes on severely deformed hands and fingers. Consequently parameters of NCV such as latency, amplitude, and conduction velocity in upper extremities of 20 patients were investigated and compared with those of healthy elders at similar age range. RESULTS: The patients were 12 in male and 73 years old on the average. In sensory nerve study, the parameters for median nerve showed 5.52+/-3.5msec in latency, 23.01+/-16.71uV in amplitude, and 29.03+/-13.16m/s in conduction velocity. For ulnar nerve, 5.82+/-3.76, 19.48+/-11.51, and 27.61+/-13.19 respectively. In motor nerve study, parameters for median nerve showed 9.35+/-1.64, 3.45+/-2.03, 47.95+/-9.91 respectively. And for ulnar nerve, they were 9.13+/-1.20, 2.95+/-2.50, and 43.70+/-7.24 respectively. In comparison with healthy elders, latency for Hansen patients was prolonged longer, lower amplitude, and also slower nerve conduction velocity. CONCLUSION: This study was performed for elderly Hansen patients for the first time demestically. Even the results may not be generalized for the whole Hansen patients because of the limited number of study cases and not being standarized according to the grade of disability, this study may be considered as a useful reference for further NCV for Hansen patients.

Effect of Percutaneous Laser Disc Decompression on Phospholipase A2 and Nerve Conduction Velocity in Rabbit with Prolapse of Intervertebral Disc / 中国康复理论与实践

@#Objective To explore the mechanism of percutaneous laser disc decompression (PLDD) for treating prolapse of intervertebral disc. Methods 15 rabbits were divided into 3 groups randomly: sham group, model group with PLDD treatment, model group without PLDD treatment. The nerve conduction velocity (NCV) of L6 nerve root and the activity of phospholipase A2 (PLA2) in the intervertebral disc of L5-6 were determined 2 weeks after the initial surgery. Results NCV in the group with PLDD was significantly faster than that in the group without PLDD (P<0.001); NCV in the group without PLDD was significantly lower than that in the sham group (P<0.001). The activity of PLA2 in the group with PLDD was significantly lower than that in the group without PLDD (P<0.001); The activity of PLA2 in the group without PLDD was significantly higher than that in the sham group (P<0.001). Conclusion The activity of PLA2 in the herniated discs is higher than that in normal discs, which result in NCV falls remarkably. The PLDD can reduces chemical factors such as PLA2.

Toward the Clinical Assessment in Cervical Spondylosis Associated with Paresthesia / 全日本鍼灸学会雑誌

As you know, we have met with the patients suffered from cervical spondylosis with so to speak paresthesia in daily living. We planned, this time, to search for how clinical assessment about like that kind of paresthesia was to be in practical scene.<br>The subjects of this studies, they were cared in the out-patient programs, the department of rehabilitation medicine at Teikyo University, 26 cervical spondylosis patients complained of any paresthesia on their arms.<br>In the first place, to clarify the differences between the normal and patient groups clinicaly, we were planing to check and count sensory and motor conduction velocity, somato-sensory evoked potential and latency of each component. And then, plethysmogram was also checked but decidedly, there was no significant difference between the normal and innormal group statistically.<br>Accordingly, it has become clear that we had so many items which was to be solved scientifically in these investigations. And that we got to know its difficulities and possibilities to put like this clinical assessment in practice.