Hand function in systemic sclerosis: a clinical and ultrasonographic study

To evaluate hand impairment and functional disability in scleroderma patients using clinical and ultrasonographic [US] measures. Fifteen scleroderma patients and 10 age and sex-matched healthy controls were studied. Patients underwent clinical examination including modified Rodnan skin score. Hand function assessment included pinch and grip strength measurement, finger range of motion [ROM] assessment, Hand Mobility in Scleroderma [HAMIS] test and Hand Functional Index [HFI]. Hand disability was assessed by Health Assessment Questionnaire [HAQ], Scleroderma HAQ Visual Analogue Scale [SHAQ VAS] and Cochin scale. US hand examination included measuring hand skin thickness, screening of the finger flexor and extensor tendons, measuring cartilage thickness of the 2nd MCP joint, anteroposterior thickness of the flexor retinaculum, and surface area of the median nerve. Nine patients had healed digital ulcers while only one patient had active ulcers. Seven patients had arthralgia in the hand joints. The patients had a significant decrease in grip strength and finger ROM. By US, patients showed significant increase in hand skin thickness and flexor retinaculum thickness and a significant decrease in median nerve surface area. Hand disability measures showed variable significant correlations with pinch and grip strength and hand mobility measures which were significantly correlated with US skin thickness of the 2nd inter-metacarpal web space. Hand disability in scleroderma was mainly related to impaired hand mobility and also diminished strength. The use of US in adjunct to clinical examination refines the evaluation of hand impairment in scleroderma

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]

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 motor evoked potentials [MEP] induced by TMS in motor neuron disease [MND] and their relations 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, 5MG 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. Ten matched healthy persons were selected as control. Functional evaluation and disease severity assessment had been scored using the amyotrophic lateral sclerosis [ALS] Functional Rating Scale [ALSFRS] and the ALS Severity Score [ALSSS] respectively and compared to the control group. There was a statistical significant difference of all the studied parameters between patients and 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 to predict the severity of MND