Compensation of the Postural Instability in Patients with Acute Unilateral Vestibular Neuritis: The Usefulness of Computerized Dynamic Posturography as an Objective Indicator / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the usefulness of computerized dynamic posturography (CDP) in patients with acute vestibular neuritis (AVN) by identifying the recovery period of Sensory Organization Test (SOT) and comparing the result of SOT with those of the vestibulo-ocular reflex (VOR) tests and subjective symptoms. SUBJECTS AND METHOD: A prospective study was conducted on 41 patients who were diagnosed with AVN. The SOT was measured daily until the equilibrium composite score recovered the normal value. A survey, composing of questionnaires on Visual Analogue Scale (VAS), Dizziness Handicap Inventory (DHI), motion sensitive quotient (MSQ) and Activities-Specific Balance Confidence Scale (ABC), was conducted on the patient's initial visit and on the day the normal value of SOT was recovered. Videonystagmography and the caloric test were also performed, and the results were compared with those of the SOT. RESULTS: The mean duration from the onset of vertigo to the recovery of SOT scores was 3.7±2.9 days (median 3.0 days) and that from the onset of vertigo to the disappearance of spontaneous nystagmus was 17.1±27.2 days (median 6.0 days). The scores of 4 questionnaires (VAS, DHI, MSQ, and ABC) were significantly different between the initial day and the day of recovery to the normal value of SOT (p<0.001). However, the velocity of spontaneous nystagmus on the initial visit and the degree of canal paresis from the caloric test showed no significant correlations to recovery duration from the onset of vertigo to the normalization of SOT score. CONCLUSION: The recovery duration of vestibulospinal reflex (VSR) is much shorter than that of VOR in patients with AVN. The recovery of subjective symptoms showed close correlation with the recovery of VSR, but the results of VSR was not correlated with that of VOR. Therefore, CDP could be a very useful test for monitoring the resolution of subjective symptoms in patients with AVN.

Diagnostic value of computerized dynamic posturography in the assessment of peripheral vestibular disorders

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> This study aims to determine the sensitivity, specificity, positive predictive value and negative  predictive  value  of  Computerized  Dynamic  Posturography  (CDP)  in  properly  labeling patients with peripheral vestibular disorders by Videonystagmography (VNG) as having vestibular dysfunction.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case - Control Study<br /><strong>Setting:</strong> Tertiary Private Hospital<br /><strong>Subjects:</strong> Twenty-three (23) patients aged 18 and above with no history of hypertension or cardiovascular disease and no intake of anti-vertigo medications for at least 48 hours prior to testing and with complete VNG and CDP results obtained on the same day or at least  two  days  apart  were  included  in  the  study. Cases were defined as those  diagnosed with a peripheral  vestibular  disorder  by VNG  while  controls  were  defined as those with  normal VNG results.  Sensitivity, specificity, positive predictive value and negative  predictive value of CDP in labeling those with peripheral vestibular disorders as vestibular were determined using VNG as gold standard.<br /><strong>RESULTS:</strong> There were 11 cases  (4  males, 7 females) and 12 controls (8  males,  4  females).  Using VNG  as  the  gold  standard  for  diagnosing  peripheral  vestibular  disorders,  CDP  had  a  sensitivity of 45.45% and specificity of 66.67% with Positive Predictive Value(PPV) of 55.56% and Negative Predictive Value(NPV) of 57.14%  in  assessing  peripheral vestibular disorders among the adults tested.  Interestingly, 33.33% of patients with normal VNG may actually have had a vestibular dysfunction that could be detected by CDP.<br /><strong>CONCLUSION:</strong> Prospective studies with larger sample sizes utilizing VNG and CDP are recommended in order to verify our findings.</p>

Clinical Outcomes of Diffractive Multifocal Toric Intraocular Lens Implantation

PURPOSE: To evaluate the clinical outcomes of patients with diffractive multifocal toric intraocular lens (IOL) implantation. METHODS: Thirty-four eyes of 26 patients underwent diffractive multifocal toric IOL. Uncorrected visual acuity (UCVA) at distant, intermediate and near and residual refractive astigmatism were measured on the first day, at 2 weeks, and 1, 3 and 6 months postoperatively. Optical quality obtained using the Optical Quality Analysis System II (OQAS II), high-order aberrations (HOA) and patient satisfaction questionnaire were evaluated 3 months postoperatively. RESULTS: At the 6 month postoperative visit, the mean UCVA at distant, intermediate (63 cm, 100 cm) and near were 0.06 +/- 0.07, 0.18 +/- 0.11, 0.16 +/- 0.12 and 0.03 +/- 0.06 (log MAR), respectively. The refractive astigmatism decreased significantly from -1.66 +/- 1.04 D to -0.54 +/- 0.32 D at 6 months postoperatively (p < 0.01). The means of objective scatter index, modulation transfer function (MTF) cut-off value, Strehl ratio and pseudo-accommodation range measured by OQAS II were 1.33 +/- 0.67, 37.24 +/- 9.67 cdp, 0.22 +/- 0.09 and 3.08 +/- 0.53 D, respectively. HOA scores for 5 mm and 6 mm were 0.30 +/- 0.09 and 0.49 +/- 0.15, respectively; 82.3% of the patients were satisfied with the postoperative results, 79.4% of the patients reported they would recommend the procedure to others, and 14.7% of patients reported moderate or severe visual disturbance at night. CONCLUSIONS: Implantation of a diffractive multifocal toric IOL in patients with cataract and corneal astigmatism provided excellent distant, intermediate, and near visual outcomes, good optical quality and high patient satisfaction.

Clinical Outcomes of Patients with Refractive Aspheric Multifocal IOL Implantation

PURPOSE: To evaluate the clinical outcomes of patients with refractive aspheric multifocal intraocular lens (IOL) (Lentis Mplus(R) LS-313) implantation. METHODS: Sixty-eight eyes of 53 patients received refractive aspheric multifocal IOL implantation. Uncorrected visual acuity (UCVA) at a long distanc, as well as intermediate and near distances were measured on the first day, after two weeks, and during the first, third and sixth months postoperatively. Optical quality was evaluated using the Optical Quality Analysis System II (OQAS II). High-order aberrations (HOA) and patient satisfaction questionnaires were evaluated at three months post-operation. RESULTS: At the six-month postoperative visit, the mean UCVA at a long, two intermediate (63 cm, 100 cm) and a near distance were 0.06 +/- 0.07, 0.18 +/- 0.14, 0.15 +/- 0.13 and 0.11 +/- 0.10 log MAR, respectively. The means of the objective scatter index, modulation transfer function (MTF) cut off value, Strehl ratio and pseudo-accommodation range measured by OQAS II were 1.20 +/- 0.69, 34.15 +/- 9.53 cdp, 0.17 +/- 0.05 and 3.09 +/- 0.25 D, respectively. HOA of 5 mm and 6 mm were each 0.61 +/- 0.14 and 1.07 +/- 0.20, respectively. Eighty-two percent of patients were satisfied with the postoperative results, and 71% of the patients reported that they would recommend the procedure to others, while 24% of patients reported moderate or severe visual disturbance at night. CONCLUSIONS: Implantation of the refractive aspheric multifocal IOLs in patients with cataracts provided excellent distant, intermediate, and near visual outcomes and high patient satisfaction as well as presbyopia correction.

Facilitators and Barriers in the Use of a Checklist by Insurance Physicians during Work Ability Assessments in Depressive Disorder

OBJECTIVES: Depressive disorder (DD) is a complex disease, and the assessment of work ability in patients with DD is also complicated. The checklist depression (CDp) has recently been developed to support such work ability assessments and has been recommended for implementation in insurance medicine, starting with an analysis of the organisational and social contexts. The aim of this study was to identify the potential facilitators and barriers in the use of the CDp by insurance physicians (IPs) during work ability assessments of employees on sick leave due to DD. METHODS: A qualitative research was conducted based on semi-structured interviews. The participants were IPs with at least one year of work experience in performing work ability assessments. The interviews were audiotaped, transcribed and analysed qualitatively. RESULTS: Ten IPs (7 males, 3 females; mean 53 years) were interviewed. Important facilitators, which emerged for use of the CDp, were an oral introduction for colleagues and staff, support from management, valuing the increased transparency in work ability assessments with using the CDp, having adequate time for assessments as well as modification of the appearance (colour, plasticised form) and content (clarifying aspects of the examples) of the assessment tool. The fear of the loss of autonomy, lack of added value of the CDp, high workload, inadequate instructions and lack of time were mentioned as barriers. CONCLUSION: Adequate introduction to the use of CDp and the fear of the loss of autonomy of IPs need special attention in planning its implementation.

Effect of a Needle Aspiration in Patients with Lymphedema / 한국호스피스완화의료학회지

PURPOSE: Lymphedemas are tissue fluid swellings, usually on the arms or legs, and occur as a result of impaired lymphatic drainage. Presently, the most effective treatment available is complete decongestive physiotherapy (CDP). However, this therapy is ineffective in some patients and surgery may be indicated. Herein, we examined the efficacy of minimally invasive needle aspiration of the most enlarged areas in hypodermic adipose tissues, of patients who had failed CDP. METHODS: We included 21 patients who were diagnosed with lymphedema stage II-III in the upper or lower extremities and visited the lymphedema clinic at a university hospital from September 1, 2003 to February 28, 2004. All patients had been treated with CDP at least once, but had failed to respond to the therapy for more than one year. Nine patients had breast cancer and 12 had cervical cancer. We identified the area with the most severe edema by using MRI and performed a 16-gauge angio-needle aspiration on the area. The patients were followed up for 3 months. Effectiveness of the treatment was evaluated by comparing the volume of edema before and after the treatment using Wilcoxon signed rank-test. RESULTS: The mean reduction ratio of the volume of edema comparison normal volume was 41.1+/-35.3% (P=0.001). There were no major or minor operative complications except localized hemorrhage. CONCLUSION: We conclude that a needle aspiration prior to other surgical treatments is relatively safe and effective for those patients who are unresponsive to CDP.

The Effects of Antiepileptic Drugs on Balance in Older People

BACKGROUND: The purpose of this study was to quantitatively assess the subclinical balance dysfunction in elderly people taking antiepileptic drugs. METHODS: We recruited sixty-three patients who were at least 50 years old, without complaint of dizziness or imbalance, and on a stable dose of carbamazepine, lamotrigine or levetiracetam. Their balance scores were compared with those of newly diagnosed untreated age- and sex-matched epilepsy patients (n=21). All the subjects underwent balance measurements that included an activities-specific balance confidence scale, quantitative caloric and rotational chair testing and posturography. The spectral frequency analysis of body sway while standing upright was also investigated. Sensory organization (SOT) and motor control tests were done by computerized dynamic posturography (CDP). RESULTS: The sway distance and area of center of pressure significantly increased in the patients treated with carbamazepine. Spectral frequency analysis of this group showed a significantly increased spectral power at low and middle frequencies on the antero-posterior (Y) plane and at low frequencies on the lateral (X) plane. CDP showed no significant differences in SOT results among the groups. However, motor control test revealed increased latencies and slowed adaptations in the carbamazepine group. CONCLUSIONS: These findings suggest that newer drugs such as lamotrigine or levetiracetam may induce less disequilibrium than carbamazepine in older people on monotherapy for epilepsy. The disturbance is likely related to slowed central postural reflexes.

The Feasibility Test of Korean Medication Algorithm for the Treatment with Schizophrenic Patients(II): The Problem for Applying Algorithm to the Real Clinical Situation and Opinion of Revision / 대한정신약물학회지

OBJECTIVES: The Korean College of Neuropsychopharmacology and the Korean Academy of Schizophrenia developed the Korean medication algorithm project for schizophrenia (KMAP) to aid clinical decisions. The purpose of this study was to investigate problems and revision of Korean Medication Algorithm for Schizophrenia after feasibility test. METHODS: A total of 108 schizophrenia patients were enrolled at 19 centers and treated according to the algorithm. Prescribing investigators were able to change the recommended treatment strategies of the algorithm if necessary. All subjects were assessed over a 4-month period. Appropriateness of choice, dosage, duration and switch of antipsychotics and definition of treatment response were examined. RESULTS: Compliance of 1(st) choice antipsychotics in KMAP was favorable. Atypical antipsychotics which is a 1(st) stage drug selected first was above 84%, especially in case of no previous medical history was nearly all. In case that shift of stage was needed, there is a trend that combination treatment stage (6(th) stage) and clozapine treatment stage (5(th) stage) were preferred to rather than 3(rd) stage and 4(th) stage (typical antipsychotics and atypical antipsychotics treatment stage). The rates of switching antipsychotics at the time points other than CDP (critical decision points) was low and the reason was almost the side effects. So the compliance of CDPs in KMAP was good in case of insufficiency of treatment response. Also the reasons why many investigators continued using current antipsychotics without switching despite insufficiency of treatment response were definition of treatment response, discrepancy between brief symptom rating scale for negative symptom and decision of clinicians. In addition, compliance of co-existence symptoms and side effect of medication in KMAP was favorable. CONCLUSION: It is some difference from clinical practice such as stage of antipsychotics, definition of treatment response and usefulness of brief symptom rating scale for negative symptom. But the majority apart from points of preceding paragraph is feasible in clinical practice. These results are essential to revise the next version of KMAP.

Comparison of Coagulation Factor Activities of Cryoprecipitate-depleted plasma(CDP) Prepared by Two Different Methods / 대한수혈학회지

BACKGROUND: Cryoprecipitate depleted plasma(CDP) that is selectively used for therapeutic plasma exchange for the thrombotic thrombocytopenic purpura(TTP). We evaluated coagulation factor activities of CDP prepared by two different methods to use CDP as a blood component and induce a new guideline. METHODS: We studied 32 units of CDP were made from FFP collected from 16 donors. To prepare CDP, units of FFP were thawed in a 4degrees C water bath for 1 to 2 hours(rapid thawing) or thawed in a 1 to 6degrees C refrigerator for 14 to 16 hours(overnight thawing). Then CDP were refrozen within 1 hours, stored at -45degrees C and re-thawed in three weeks later. We measured prothrombin time(PT), activated partial prothrombin time(aPTT), fibrinogen, coagulation factor V, VIII, von willebrend factor(vWF) and vWF multimer of CDP at the time of preparation, after re-freezing and re-thawing. And we compared them with the results of platelet poor plasma(PPP). RESULTS: The mean volume of CDP was 129+/-12mL. We found all measured factors of CDP except factor V were significantly lower or longer than those of PPP. In the comparision of thawing method, rapid thawing CDP showed longer PT, higher activities of fibrinogen and factor VIII, lower activities of vWF than those of overnight thawing with no significant change of factor V. No significant changes were notified in all factors between the results of CDP within 1 hour of preparation and those of after re-freezing and re-thawing. CONCLUSIONS: CDP prepared by rapid thawing is more recommendable for therapeutic plasma exchange for TTP. CDP prepared by re-freezing and re-thawing can be used as a CDP just prepared from FFP.

Computerized Dynamic Posturography to Detect Unsteadiness in Aged Patients with Large-Fiber Peripheral Neuropathy

BACKGROUND: Large-fiber peripheral neuropathy is prevalent in the elderly and risk of falling is higher in patients with it. This study`s aim is to see if, using computerized dynamic posturography(CDP), sway patterns differ between patients with large-fiber peripheral neuropathy and normal control subjects and, if it did, to compare CDP with conventional electromyography(EMG) as screening tools for large-fiber perip- heral neuropathy. METHODS: Thirty patients who came to the neurophysiology laboratory with a preliminary diagnosis of peripheral neuropathy(made by their referring physicians) were compared with 30 nonmatched control subjects. All subjects received a neurologic examination and underwent CDP and conventional EMG. RESULTS: CDP showed abnormal sway patterns only in patients who had EMG abnormalities consistent with large fiber peripheral neuropathy. These sway patterns differed significantly from those of the control subjects. Center of gravity(COG) wandered farther and faster per unit of time in the patients with polyneu- ropathy than in control subjects. It means that the control mechanism provided by peripheral nerves limi- ting total displacement and the speed of COG wandering is defective in the patients with large-fiber peri- pheral neuropathy. CONCLUSION: CDP seems to be a useful and well-tolerated screening test for patients with a history suggestive of peripheral neuropathy, and results of CDP agree with those of conventional EMG. Moreover, posturography directly measures increased sway in these patients and may be used as a screening test for risk of falls in this population of old age.

Computerized Dynamic Posturography to Detect Unsteadiness in Aged Patients with Large-Fiber Peripheral Neuropathy

BACKGROUND: Large-fiber peripheral neuropathy is prevalent in the elderly and risk of falling is higher in patients with it. This study`s aim is to see if, using computerized dynamic posturography(CDP), sway patterns differ between patients with large-fiber peripheral neuropathy and normal control subjects and, if it did, to compare CDP with conventional electromyography(EMG) as screening tools for large-fiber perip- heral neuropathy. METHODS: Thirty patients who came to the neurophysiology laboratory with a preliminary diagnosis of peripheral neuropathy(made by their referring physicians) were compared with 30 nonmatched control subjects. All subjects received a neurologic examination and underwent CDP and conventional EMG. RESULTS: CDP showed abnormal sway patterns only in patients who had EMG abnormalities consistent with large fiber peripheral neuropathy. These sway patterns differed significantly from those of the control subjects. Center of gravity(COG) wandered farther and faster per unit of time in the patients with polyneu- ropathy than in control subjects. It means that the control mechanism provided by peripheral nerves limi- ting total displacement and the speed of COG wandering is defective in the patients with large-fiber peri- pheral neuropathy. CONCLUSION: CDP seems to be a useful and well-tolerated screening test for patients with a history suggestive of peripheral neuropathy, and results of CDP agree with those of conventional EMG. Moreover, posturography directly measures increased sway in these patients and may be used as a screening test for risk of falls in this population of old age.

The Effects of GABA-receptor Antagonists on the Spinal Cord Stimulation-induced Antinociception in Cats / 대한마취과학회지

BACKGROUND: Spinal cord stimulation (SCS) is a clinical off spring of the gate-control theory and known as an effective treatment for pain from a neurogenic origin. The prolonged pain relief following a short stimulation period is believed to be related with the GABAergic system. The aims of this study were to see if the SCS, similar to that being used in clinical condition, suppressed the nociceptive transmission in the spinal dorsal horn, and if so, which type of GABA receptor may be involved in the antinociceptive process. METHODS: The cord dorsum potential (CDP) was recorded at the dorsal root entry zone of the lumbosacral enlargement for a long time period (60 min) in response to electrical stimulation of the dorsal root, respectively, after SCS in anesthetized cats. CDP was recorded after intrathecal application of bicuculline (GABA (A) receptor antagonist) and phaclofen (GABA (B) receptor antagonist) and 20 min after SCS that followed the intrathecal application of bicuculline or phaclofen. Asigma- and C-fiber wave responses were differentiated according to the conduction velocity. RESULTS: The C-fiber wave decreased significantly after SCS but the Asigma-fiber wave did not on the CDP. After intrathecal administration of bicuculline, the Asigma- and C-fiber waves increased significantly and bicuculline also prevented a SCS-induced reduction of the C-fiber wave. Phaclofen did not change the amplitude of Asigma- and C-fiber wave. When the phaclofen was administered intrathecally, SCS did not decrease the amplitude of the Asigma- and C-fiber waves. CONCLUSIONS: In conclusion, the present results indicate that SCS suppresses C-fiber transmission of acute nociceptive electrical stimuli and both GABA (A) and (B) receptors mediate the long-lasting antinociceptive effect of SCS.

Evaluation of Vestibulo-spinal Reflex Using Modified Romberg Test / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Romberg test is a simple, inexpensive modality to test the vestibulo-spinal reflex. However, it is not a quantitative measure and has low sensitivity and specificity. We investigated the effectiveness of the modified Romberg test in evaluating equilibrium ability in dizzy patients by comparing it with the computerized dynamic posturography. MATERIALS AND METHODS: The study was conducted on 63 patients with various degrees of dizziness. Computerized dynamic posturography(CDP) was performed and equilibrium ability was measured with the modified Romberg test. Modifications were made in two ways : heel-to-toe standing(test 1) and standing on sponge(test 2). RESULTS: Correlation coefficients between the modified Romberg test and the vestibular dysfunction score of CDP were 0.62 and 0.52, respectively, and they were statistically significant(P<0.01). The Receiver Operating Characteristics(ROC) curve showed that the area index of tests 1 and 2 were 0.86 and 0.78, respectively. CONCLUSIONS: The modified Romberg tests showed fairly good correlation with the vestibular dysfunction score of CDP. Further modifications are required to use the modified Romberg test as an accurate diagnostic tool in the evaluation of dizzy patients.

Correlation between Berg Balance Scale and Sensory Organization Test of Computerized Dynamic Posturography in Brain Injured Patients

OBJECTIVE: To examine the correlation between Berg balance scale (BBS) which is tool for assessing the clinical balance function and sensory organization test (SOT) of computerized dynamic posturography (CDP) in brain injured patients. METHOD: Thirty patients with brain injury were assessed on the BBS and SOT of CDP. BBS consists of 14 items and each item is graded on a five point ordinal scale (0~4), yielding a total of 56 points. According to its characteristics, each item was divided 3 groups, which were sitting, standing and position change. Six equilibrium scores (EQ) were determined by SOT of CDP (EquiTest System , Version 5.08) under 6 conditions, and somatosensory, visual, vestibular ratios were analyzed by 6 EQ scores. RESULTS: EQ 5 was correlated with reaching forward item (r=0.513), turning 360 degrees item (r=0.537), stool stepping item (r=0.529) of BBS (p<0.01). EQ 6 was correlated with turning 360 degrees item (r=0.498) of BBS (p<0.01). Sum of standing item group scores was correlated with EQ 5 (r=0.478), EQ 6 (r=0.464), and sum of position change item scores was correlated with EQ 5 (r=0.622), EQ 6 (r=0.514) (p<0.01). Vestibular ratio was correlated with BBS total score (r=0.552, p<0.01). CONCLUSION: We concluded that vestibular ratio of SOT was correlated with BBS, especially position change item group. Therefore BBS is a good tool for evaluating vestibular function in brain injured patients.

The Effects of Spinal Cord Stimulation on the Spinal Nociceptive Process Evaluated by Cord Dorsum Potential in Cats / 대한마취과학회지

BACKGROUND: The pain-inhibitory effects of spinal cord stimulation (SCS) may be exerted at two alternative or complementary levels, segmentally or supraspinally. However the actual pathways, site of action, and synaptic relays are poorly understood. No data is available which concerns the changes in cord dorsum potential (CDP) associated with a single neuronal level, after SCS. METHODS: SCS was performed in normal and spinalized cats. At the lumbosacral enlargement, CDP and extracellular single cell activity in response to electrical stimulation of Asigma- or C-fiber of the dorsal root or sciatic nerve were recorded. RESULTS: The resulting CDP consisted of characteristic waves of Asigma- and C-fiber with a different time latency. CDP sno significant differences in the amplitude of Asigma- and C-fiber wave between the normal and spinalized cats. In both groups, CDP showed decrease in the amplitude of C-fiber wave. Single cell responses were either increased or decreased after SCS. The C- response changed more marKedly than the A-response in both the normal and spinalized cats. In the bicuculline administered cats, single cell responses increased after SCS, but no change was found in the amplitude of CDP. CONCLUSIONS: The above results might indicate that SCS suppresses C-fiber transmission of nociceptive electrical stimuli via a segmental inhibitory mechanism, and that SCS is more effective in blocKing the transmission of nociceptive electrical stimuli via the C-fiber than Asigma-fiber.

The Changes in Cord Dorsum Potential after Spinal Cord Stimulation / 대한마취과학회지

BACKGROUND: Spinal cord stimulation(SCS) evolved as a direct clinical application of the famous gate-control theory, the idea of activating the central collaterals of large afferent fibers contained in the dorsal column. It is well known that the cord dorsum potential(CDP) evoked by stimulation of dorsal roots or peripheral nerves can be recorded from the cord surface in spinal animals. However, there have been no data about the changes in CDP after SCS. METHODS: Using ball-type electrode, CDP was recorded at the dorsal root entry zone of lumbosacral enlargement in anesthetized cats. The dorsal root was stimulated electrically to activate Adelta-fiber(single pulse of 0.2 ms duration and 1 mA intensity) and C-fiber(single pulse of 0.2 ms duration and 10 mA intensity). Potentials were averaged 10 times and measured before(control) and immediately after, and 10, 20, 30, 40, 50, 60 min after SCS for 20 min. RESULTS: CDP elicited by dorsal root stimulation consisted of the characteristic waves of Adelta-fiber and C-fiber with different time latency. CDP showed significant decrease in the amplitude of C-fiber wave immediately after SCS(75.0+/-8.8%), and 20 min(69.0+/-7.9%), 30 min(75.1+/-4.4%), 40 min(75.4+/-4.4%), 50 min(78.3+/-5.9%), but not 10 min and 60 min, after SCS. However there were no statistically significant decrease in the amplitude of Adelta-fiber wave after SCS. CONCLUSIONS: The above results indicates that SCS suppresses the transmission of nociceptive electrical stimuli via C-fiber, while SCS has little influence on the transmission of electrical nociceptive stimuli via Adelta-fiber.

A study of posture in 112 healthy korean population using computerized dynamic posturography

OBJECTIVE: To study normal values of wnwry organimtion test(SOT) and motor control test(MCT) of computerized dynamic posturography(CDP) in the healthy Koreans. BACKGROUND: Balance is made up of three biological functions ; sensory input, motor output, and CNS integration. But, there has been no method for assessing the sensory, motor, and CNS integration function quantitatively. CDP is a tool for assessing the balance function quantitatively under a variety of tasks. METHODS: To assess the balance using CDP, I studied equilibrium score(ES) of SOT and weight symmetry, latency, and adaptation seems of MCT in 112 Korean healthy population. Arbitarily I divided the population into two groups, under 60 years and over 60 years of age. In SOT, I studied the contribution of each sense to maintaining equilibrium when other senses were either absent or provided with inaccurate information. MCT provoked autonomic postural reactions through a series of sudden anterior and posterior support surface translations. In MCT, I studied latencies in sudden translation of fact plate. RESULTS: The study group was 112 Korean healthy population with a mean age of 47 +/- 26 years. In SOT, the range of median equilibrium seems were from 68 to 93 under 60 years group, 58 to 91 over 60 years group. In MCT, during sudden anterior and posterior pertubation, weight symmetries were 101 +/- 24.8 under 60 years group and 104 + 30. 1 over 60 years group. Median latencies were 116 to 141msec under 60 years, 127 to 130msec over 60 down test of MCT the mean adaptation scores were 60 years. 64 to 75 and 48 to 73 over 60 years, respectively. CONCLUSION: This study could be a baseline control data in sensory, motor, and CNS integration function of balance in dizziness patient using CDP.

Correlations between MRI and Vestibular Function Test in Central Vestibular Disorder

BACKGROUND & OBJECTIVE: Although some authors (Hamid et at.(1988) ; Moschner et at. (1994)) described that the vestibular function test (VFT) is useful in the differential diagnosis of central vestibular disorders, the reliability of VFT is not well established. The purpose of this study is to know the sensitivity and specificity of VFT for the diagnosis of central vestibular dysfunction. This study correlates VFT and MRI findings in the patients with central vestibular disorder. METHODS: Among the patients who were given VFT and brain MRI study, we selected 131 patients whose VFT results were not compatible with the peripheral vestibular dysfunction. Also we classified the MRI and VFT findings into groups of brainstem or cerebellar lesions and others. We got the sensitivity and specificity of VFT for the diagnosis of central vestibular dysfunction and the differentiation of brainstem or cerebellar lesions from others. Then we compared the results of VFT in each group. Results : 1. Among 71 patients with central vestibular disorder demonstrated by VFT, 41 patients showed lesions in MRI imaging. Among 60 patients whose VFT results were normal, 9 patients were found to have central lesions by MRI. Overall the sensitivity and specificity of VFT for diagnosing the central lesions were 82.0%, 63.0% respectively. 2. Common features in all central vestibular dysfunction patients are abnormalities in CDP and saccade reflex testing. 3. Overall the sensitivity and specificity of VFT for differentiating the brainstem or cerebellar lesions from others were 41.1%, 95.8% respectively. The percentage of patients who showed increased vestibulo-ocular reflex (VOR) gain during gaze fixation test is highly correlated with group of brainstem or cerebellar lesions detected in MRI( p < 0.001). Conclusion : VFT is a sensitive study in detecting and predicting the lesions of central vestibular system. But the ability to differentiate and localize the central lesions is remained to be improved. Key Words ; Vestibular Disorder, Electronystagmography, Rotating chair test, Vestibular function test, Posturography, MRI.