Relapsing-remitting painful ophthalmoplegia due to orbital myositis.

We describe a woman with a long history of relapsing-remitting painful ophthalmoplegia in a seasonal pattern, due to an isolated orbital myositis that was--at our observation--classified in the context of the so-called SAPHO syndrome. She had been previously treated with corticosteroid therapy, but the association with immunosuppressive drugs produced a more prompt resolution of both the headache and ophthalmoplegia, and of the magnetic resonance imaging pictures of isolated myositis as well.

Central motor conduction time in children and adolescents with insulin-dependent diabetes mellitus (IDDM).

Measurement of central motor conduction time (CMCT) after percutaneous magnetic stimulation of the brain is an electrophysiological method that may discover subclinical impairment of central nervous system (CNS). In order to detect an impairment of CNS, we measured CMCT right (R) and left (L) after percutaneous stimulation of the brain in 34 patients affected by insulin-dependent diabetes mellitus (IDDM) (16 males and 18 females), aged 16.4 +/- 4.1 years (7.3-23.2 years), with duration of disease 7.6 +/- 4.9 years (7/12-16 years), and HbA1c annual mean 7.41 +/- 1.1% (n.v. 5.14 +/- 0.84%). Twenty-three sex- and age-matched healthy subjects served as controls. In our IDDM patients we observed a delay of CMCT R (P < 0.0005) and L (P < 0.0005) as compared to controls. No correlation was found between CMCT (R and L) and chronologic age, duration of disease, peroneal motor nerve conduction velocity. No association was observed between CMCT (R and L) and HLA antigens. On the basis of IDDM duration, patients were divided into 2 groups (G): G I (9 pts) with IDDM < 2 years and G II (25 pts) with IDDM > 5 years, 12 of them with precocious signs of one or more microangiopathic complications. No difference in CMCT (R and L) was observed between the 2 groups and between G I and controls; G II patients had a longer delay of CMCT R (P < 0.0001) and L (P < 0.0001) than controls. In G II patients, a positive correlation between CMCT R and HbA1c of the 5 years before the test (P < 0.025) was also observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical and neurophysiological study in diabetic children and adolescents.

We investigated 82 unselected insulin dependent diabetes mellitus children and adolescents by clinical and electrophysiological evaluation to assess the frequency of diabetic neuropathy and to relate the results to age and height of patients, duration of illness and degree of metabolic control. Clinical abnormalities were found in about 1/3 of patients: these signs of diabetic neuropathy were related to the age and the duration of diabetes but not to the degree of metabolic control. Neurophysiological study showed alterations, especially of sensory nerve conduction. These results were seen to be related to height and age of patients and duration of illness but not to the degree of metabolic control, probably due to the young age of the patients. Our study confirms that diabetic neuropathy is a heterogeneous disorder that may be caused by the interaction of host susceptibility and vascular, metabolic and perhaps environmental components also in diabetic children.

Neurophysiological markers of central and peripheral involvement of the nervous system in HIV-infection.

Peroneal motor and sural sensory conduction velocities (MNCVs/SNCVs), somatosensory evoked potentials to median nerve stimulation (MN-SEPs) and motor evoked potentials (MEPs) to transcranial stimulation were examined in 138 HIV-infected patients (in the different stages of the disease), 20 seronegative intravenous drug abusers (IVDAs), and 20 healthy subjects. Findings of peroneal MNCV slowing in patients ranged from 16% (asymptomatic HIV patients) to 63% (AIDS) and of sural SNCV slowing from 13% to 40%. Altered MN-SEPs ranged from 10% to 30%, and MEPs ranged from 44% to 72%, mostly due to a prolongation of the central motor conduction time (CMCT). All seronegative IVDAs showed patterns within the normal range. Electrophysiological techniques were helpful in demonstrating early and subclinical alterations in HIV patients.

Multimodal evoked potentials in diabetics.

In the present study we performed brainstem auditory evoked potentials, pattern electroretinogram and visual evoked potentials for the identification of a subclinical involvement of central auditory and visual pathways in diabetes mellitus. We tested 30 patients, and a neurophysiological central nervous system involvement was demonstrated in 23.3% of them. The mean values of patients and controls were significantly different for most of the evoked potential parameters. Some of these parameters were linearly related with duration of the disease, clinical score and peripheral nerve conduction velocities.

Local venous lactate changes and spectral analysis of surface EMG during fatiguing isometric efforts in intrinsic hand muscles.

In this study relationships between local venous lactate concentrations and power spectrum changes in surface EMG due to fatiguing isometric contractions were investigated. Two different isometric efforts of the opponents pollicis muscle, 25% and 50% of maximum voluntary contraction, were examined. In 25% of maximum voluntary contraction no changes in local venous lactate were observed, whereas mean power frequency values of surface EMG shifted significantly towards lower frequencies. On the contrary, in 50% of maximum voluntary contraction lactate significantly increased and was related to the mean power frequency shifts of the surface EMG. These data suggest that lactate plays a role in muscle fatigue only in a limited intensity range of isometric muscle contractions.

Surface-EMG analysis of rectus femoris in patients with spastic hemiparesis undergoing rehabilitation treatment.

In the present study a surface-EMG investigation of the rectus femoris muscle was performed in patients with spastic hemiparesis before and after rehabilitation treatment. The EMG activity was detected during 50% of the maximum voluntary contraction by means of FFT automatic analysis; the mean power frequency (MPF) and the time-course of the frequencies of the surface-EMG signals showed significant changes after physiokinesitherapy. In hemiparetic patients a particular distribution of the frequencies of the surface-EMG signals towards the lowest values were observed. These findings could be related to the preferential atrophy of type II fibers which has been demonstrated in morphological studies. Furthermore the surface-EMG analysis after a period of rehabilitation treatment showed some significant modifications of MPF and time-course of the EMG signals. These changes corresponded to an improvement of the spasticity as evaluated by clinical rating-scale. This neurophysiological investigation seem to be a simple and reliable method for better evaluating some effects of the rehabilitation therapy.

Abnormalities of central motor conduction in asymptomatic HIV-positive patients. Significance and prognostic value.

Percutaneous magnetic stimulation of the brain and spinal cord is a technique developed to demonstrate early and subclinical abnormalities in corticomotoneuron pathways. Central motor conduction time (CMCT) was evaluated in 58 HIV-seropositive patients neurologically asymptomatic (CDC groups II and III) and in two control groups. CMCT was abnormal in about 50% of HIV-seropositive patients. These electrophysiological abnormalities seem to have a negative prognostic value since about 64% of the patients with abnormal parameters seem to progress more rapidly to AIDS stages.

Neuropsychological and neurophysiological abnormalities in HIV-infection. Their relevance and predictive value.

A group of n. 86 HIV-pts. (CDC stages from II to IV) were cross-sectionally studied with neuropsychological and neurophysiological methods. The percentage of abnormalities detected even among pre-AIDS stages is very high (from 25 to 50% of the cases). Sensibility and specificity of the above investigations is discussed. Their possible predictive role (evolution to successive stages of asymptomatic pts. and development of CNS pathology) is also evaluated based on a medium-term clinical follow-up (18-24 months).

Somatosensory evoked potentials in Charcot-Marie-Tooth disease.

SEPs by median nerve stimulation have been performed in 18 adult patients (12 males and 6 females) affected by CMTD (type I, 13 patients; type II, 5 patients). All patients underwent MCV studies (median, ulnar, peroneal nerve), SCV studies (median and sural nerve), VEP, BAEP. N9 and N13 peaks were not detectable in 7/13 and 5/13 cases (HMSN type I) while cortical N19 were always recorded. Latency values of all responses were moderately or markedly delayed in all cases with HMSN type I, but proved normal or slightly delayed in HMSN type II cases. The prolonged latencies were mainly related to slowing of peripheral conduction. N9-N13 inter-peak was abnormally prolonged in 2 cases and N13-N19 in 2 other cases; both were prolonged in another case. In another 3 cases an abnormal BAEP was recorded. The few patients with abnormal CCT and BAEP probably belong to a borderline form between HMSN and hereditary ataxias.

Peripheral nerve conduction velocity in normal infants and children.

Maximum motor conduction velocity of the median, ulnar and peroneal nerves and maximum sensory conduction velocity of the median nerve have been studied in 635 children, below 12 years of age, free from peripheral nervous system disease. The children fell into four age-group: from 0 to 1 year; from 1 to 3 years: from 3 to 6 years; from 6 to 12 years. No normal values were recorded for the sensory conduction velocity of the median nerve under the age of one year. The motor conduction velocity values significantly rise for the median and ulnar nerves up to 1 year, for the peroneal nerve up to 3 years. The sensory conduction velocity values of median nerve increase significantly up to 6 years.

Steroid-responsive and dependent stiff-man syndrome: a clinical and electrophysiological study of two cases.

Two female patients with the typical clinical and electrophysiological features of the stiff-man syndrome, both responded to steroid treatment. ACTH infusion produced an immediate clinical relief of muscle contracture and cramps, with parallel marked reduction of the EMG pattern of continuous spontaneous activity in agonist and antagonist muscles. Apart from this effect, a more delayed response to oral prednisone was observed in both cases and steroid-dependence in one of them, who also exhibited instrumental and laboratory findings suggesting an inflammatory process. These data lead us to consider a possible dysimmune pathogenesis of some cases with the stiff-man syndrome.

Activity of oxiracetam in patients with organic brain syndrome: a neuropsychological study.

Oxiracetam is a new psychotropic drug that has been shown to positively affect processes both in animals and in patients with impaired brain function. The aim of this study was the evaluation of the effects of oxiracetam treatment on clinical symptoms in 43 patients with organic brain syndrome (OBS). After a 2-week washout period, patients were assigned to either oxiracetam or placebo, according to a randomized, double-blind, between-patients design. Both oxiracetam and placebo were orally given bid for 8 weeks; daily dose of oxiracetam was 2 X 800 mg. In OBS patients with a mild to moderate degree of cognitive impairment, oxiracetam showed to improve cognitive functions, logical performance, and attention. Other behavioral and functional parameters were also positively modified.

[The role of drug therapy in the treatment of nerve root lesions caused by compression. Clinical and electrophysiological study of 30 patients operated on for the removal of herniated disks]. / Ruolo della terapia farmacologica nel trattamento delle lesioni radicolari da compressione. Studio clinico ed elettrofisiologico in 30 pazienti operati di asportazione di ernia discale.

The therapeutic efficacy of two neurotrophic substances (exogenic gangliosides and Vitamin B12) is examined in 30 cases of patients suffering from postoperative radiculopathy after the excision of herniated discs. All patients were subjected to clinical examination as well as electromyography and electroneuronography. Check-ups 10 and 60 days after surgery revealed a much greater improvement among the treated than the untreated patients and that statistically significant clinical and electrophysiological improvement was only found among those treated with exogenic gangliosides.

Acute i.v. vincamine teprosilate administration: quantified investigation in elderly subjects.

The EEG changes in elderly subjects with chronic cerebrovascular disorders (CCVD) are well known and have been described by many authors. Vincamine teprosilate (Teproside), a drug supposed to act on the electrical activity of the brain, has the properties of modifying and, to some extent, improving age-related changes. Ten subjects, whose age ranged from 60 to 70 years, underwent the trial. Each received 1 ampoule i.v. of the active drug and 1 ampoule of placebo (or vice versa) after a 48-hour wash-out period, according to a double-blind randomized schedule. EEG recordings were performed at time 0 and then 30 min, 1 h, 2 h, and 4 h after injection. A double effect of vincamine teprosilate could be observed at the quantified EEG: 1) an early effect, i.e., an improvement of the EEG pattern within the first hour following administration; and (2) a slow-occurring effect that prevented negative EEG modifications from taking place at the fourth hour following administration.