Focal clinical and electroencephalographic features in patients with juvenile myoclonic epilepsy.

OBJECTIVE: To identify prevalence and factors associated with occurrence of focal clinical and electroencephalogram (EEG) abnormalities in patients with juvenile myoclonic epilepsy (JME). MATERIALS AND METHODS: Clinical asymmetries in the seizures and focal EEG abnormalities were analyzed in 266 patients with JME. RESULTS: All the patients had myoclonic jerks (MJ) and generalized tonic-clonic seizures (GTCS); 56 (21%) had absence seizures. Asymmetry in clinical seizures was reported in 45 (16.9%) and focal EEG abnormalities were noted in 92 (45.5%) patients. Amplitude asymmetry or focal onset of generalized discharges was noted in 41 (44.6%) and independent focal EEG abnormalities in 30 (32.6%) patients. A statistically significant association was seen with the presence of GTCS and MJ (P = 0.007), a family history of epilepsy (P = 0.001) and drug resistance (P = 0.04) and the occurrence of focal EEG abnormalities. CONCLUSION: Patients with JME showed focal clinical and EEG features. These features should not be misinterpreted as indicative of partial epilepsy.

Second lumbrical and interossei latency difference in Carpal Tunnel Syndrome.

OBJECTIVE: To evaluate the diagnostic value of second lumbrical and interossei distal motor latency difference (2LIDMLD) in diagnosing CTS of different electro-physiological grades of CTS. METHODS: 2LIDMLD was standardized in 120 hands of healthy controls. Subjects with clinically diagnosed CTS and CTS with incidental polyneuropathy were prospectively evaluated with 2LIDMLD in addition to other standard diagnostic tests. Sensitivities of these tests were compared in patients with CTS of varying grades of severity and CTS associated with polyneuropathy. RESULTS: Two hundred and fifty hands of 130 patients met the clinical criteria for CTS. Sensitivity and specificity of 2LIDMLD, palm-wrist distal sensory latency difference (PWDSLD), and median distal motor latency (MDML) were 85.60% and 96.67%, 68.80% and 96.10%, 60.80% and 97%, respectively. Sensitivity of 2LIDMLD in mild CTS was similar to that of PWDSLD. In severe CTS, and CTS with polyneuropathy, 2LIDMLD was the most sensitive test. It was the only test of localizing value in 16% of hands with severe CTS, when all other methods failed due to absent median motor and sensory responses. CONCLUSIONS: 2LIDMLD is a sensitive, specific for diagnosis of all grades of CTS. It is an accurate and reliable method that helps especially in diagnosis of severe CTS and CTS associated with polyneuropathy, when other standard localized tests fail. SIGNIFICANCE: The second lumbrical is relatively less affected in severe carpal tunnel syndrome and median to ulnar comparison, using 2LIDMLD, appears to be a reliable and a valuable technique in the localization of severe CTS and CTS associated with polyneuropathy, especially when the median sensory or motor responses are absent on routine conduction studies.