Subclinical central neuropathy in type II diabetes mellitus

To evaluate central nervous system neuropathic changes in patients with type 2 DM with and without peripheral neuropathy. Thirty patients with type 2 DM were included. They were equally divided into two groups: those with clinical and electrophysiological findings of peripheral neuropathy [Group 1], and those without [group 2]. Fifteen healthy individuals were included as a control [group 3]. All groups were subjected to fasting plasma glucose, glycated hemoglobin [HbA1c] and other necessary tests, in addition to the electrophysiological study including: Somatosensory evoked potentials [SEP], motor evoked potentials [MEP], visual evoked potentials [VEP] and brainstem auditory evoked potentials [BAEP]. Group 1 had statistically significant higher mean values of fasting plasma glucose, HbA1c, urinary albumin excretion [UAE] and serum creatinine compared with group 2. Both diabetic groups had similar changes in VEP P100 latency and its amplitude, MEP central motor conduction time, amplitude percentage quotient and duration of the MEP, and BAEP wave II latency, with statistically significant differences compared to healthy controls. There was a statistically significant delay in all of the BAEP waves' interpeak latencies only in group 1. The other tested parameters of central neuropathy showed statistically significant differences between all studied groups. A statistically significant positive correlation was observed between some of the studied parameters of central neuropathy in diabetic patients and each of the patient age, duration of diabetes, HbA1c, serum total cholesterol, serum triglycerides and UAE. Central neuropathy in type 2 diabetics is not uncommon even in absence of peripheral neuropathy. It is related to the patient's age, duration of diabetes, glycated hemoglobin value, dyslipidemia and diabetic nephropathy. The use of more than one modality of the electrophysiological tests can buffer the fallacies of a single mode

Quantitative sensory testing in the diagnosis of carpal tunnel syndrome

Quantitative sensory testing [QST] is a reliable way of assessing large and small sensory nerve fiber function. Sensory and pain thresholds are among the used procedures. Sensory deficits may be quantified and the data can be used in parametric statistical analysis in research studies and drug trials. Sensory and pain thresholds were measured in 20 patients with clinical features of Carpal Tunnel syndrome [CTS] and positive routine electrophysiological studies [group 1] and 20 similar patients with negative routine electrophysiological studies [group 2]. Twenty apparently normal controls [group 3] were enrolled for comparison. There was a positive correlation between the quantitative perceptive tests [sensory and pain thresholds] with routine electrophysiological studies. Comparing groups 1 and 3 p=0.000 and p=0.001 for sensory and pain thresholds respectively. Pain threshold only showed a statistically significant difference [p=0.003] on comparing groups 2 and 3. Sensory and pain thresholds showed a statistically significant difference on comparing groups 1 and 2 [p=0.000, p=0.04 respectively]. Rapidly conducting fibers were less involved in group 2, explaining the negative results obtained in this group with routine electrophysiological studies. A painful stimulus was used to excite group C fibers that are mostly not tested with routine electrophysiological studies. It seems that type la fibers are primarily tested with routine electrophysiological studies. Quantitative sensory testing is a successful method for evaluation of large populations of patients where routine electrophysiological studies would be impractical. Pain threshold can be a preliminary adjuvant technique in screening CTS patients with negative routine electrophysiological studies

Diagnostic and prognostic role of laryngeal electromyography in vocal fold immobility

Laryngeal electromyography [EMG] was carried out for twenty patients with vocal fold immobility [VCI], diagnosed with indirect laryngoscopy. They were followed up for six months. A control group often subjects was included. The specificity of EMG in detecting VFI was 100%, and sensitivity 80%. Thirteen patients [65%] with abnormal EMG had a lesion of recurrent and superior laryngeal nerves and 3 [15%] had recurrent laryngeal nerve lesion alone. A significant statistical difference was found between EMG of patients and controls regarding all parameters. In cricothyroid, EMG was normal in 7 [35%], signs of reinnervation in 1 [5%], chronic neuropathy in 8 [40%] and denervation in 4 [20%]. EMG of thyroarytenoid was normal in 4 [20%], reinnervation in 3 [15%], chronic neuropathy in 9 [45%] and denervation in 4 [20%]. After six months 4 patients [20%] had full recovery, while 16 patients [80%] had persistent VFI. EMG of thyroarytenoid and cricothyroid showed no significant statistical difference between resolved cases and controls. There was a significant statistical difference between patients with resolved and those with persistent VFI as regards spontaneous activity, recruitment and interference patterns, but no significant statistical difference between the two groups regards MUAPs morphology. The positive predictive value of laryngeal EMG was 93.7%, and negative predictive value was 75%. The sensitivity of EMG in predicting recovery was 93.7%, and specificity 75%. Laryngeal electromyography is a useful adjunct to the diagnosis and prognosis of VFI. It provides information about the site and duration of lesion and differentiates fixation from paralysis. It is helpful in predicting recovery of vocal fold motion after laryngeal nerve injury

Motor evoked potentials in motor neuron disease: parameters of evaluation and its relation to disease severity

Transcranial magnetic stimulation [TMS] is a technique that can activate cortical motor areas and the corticospinal tract without causing discomfort to the patients. To evaluate the parameters of MEP induced by TMS in MND and its relation to the severity of the disease. Twenty five subjects with motor neuron disease [MND] who had been diagnosed as MND using the standard clinical and electrophysiological studies [nerve conduction studies, EMG and the somatosensory evoked potential studies] had been subjected to TMS and the MEP parameters [threshold, central motor conduction time [CMCT], amplitude percentage quotient, phases and duration of the MEPs] were determined. Matched healthy persons were selected as control. Functional evaluation and disease severity assessment had been scored using the ALS Functional Rating Scale [ALSFRS] and the ALS Severity Score [ALSSS] respectively and compared to the control group. A statistical significant difference of all the motor evoked potentials [MEP] parameters of the studied patients and the scale measurements were present when compared with the control group. The mean central conduction time [CMCT] was correlated with the severity of the disease while the amplitude changes were evident in late stages especially when associated with bulbar manifestations whereas there was no correlation between MEP parameters and the functional rating scale. From these findings it would be recommended to use the TMS as a useful tool to determine the extent of the disease as well as to predict severity of motor neuron disease [MND]

Determination of cancer antigen ca 15-3, in breast carcinoma

In breast carcinoma, carbohydrate antigen 15-3 [CA 15-3], a mucin component, is the most important and commonly used tumor marker. It is a transmembrane glycoprotein containing a large extracellular domain of 69 amino acids. Several studies suggested that its evaluation could provide valuable clinical information. Assessment of CA 15-3 can also be useful during treatment of Breast cancer as well as to detect recurrence following primary treatment. CA 15-3 is a breast-cancer-associated antigen defined by reactivity with two monoclonal antibodies, DF3 [raised against a membrane-enriched fraction of human breast cancer] and 115D8 [raised against antigens of human milk fat globule membrane]. The main clinical application of CA 15-3 suggested being in monitoring the response to the treatment and gives reliable information on the recurrence of the disease. The aim of present study is to assess CA 15-3 in patients with breast carcinoma and its usefulness in monitoring and therapy. Serum samples of female patients [n = 56] suspected of or diagnosed with breast carcinoma were analyzed for CA 15-3. Significantly elevated levels were noted in most of the patients and correlated with their malignant tumor status and clinical conditions. It is concluded that CA 15-3 is currently the most widely used circulating cancer marker for breast carcinom·a. CA 15-3 can provide useful information regarding successfulness when comparing pre-operative and post-operative values. In our study, breast carcin9ma patients showed decrease in CA 15-3 levels post-operatively [although most of them still above normal reference range], depicting successfully of treatment and intervention, in addition to suggesting that CA 15-3 concentrations can also provide prognostic information. Furthermore, serial concentrations analyses have the potential both to detect recurrences pre-clinically and to monitor the treatment of metastases breast carcinoma