RESUMEN
Carpal tunnel syndrome (CTS) is the most common cause of peripheral compressive neuropathy and consists of compression of the median nerve in the wrist. Although there are several etiologies, idiopathic is the most prevalent origin, and among the forms of treatment for CTS, conservative is the most indicated. However, despite the high prevalence in and impact of this syndrome on the healthcare system, there are still controversies regarding the best therapeutic approach for patients. Therefore, noting that some studies point to vitamin D deficiency as an independent risk factor, which increases the symptoms of the syndrome, this study evaluated the role of vitamin D supplementation and its influence on pain control, physical examination and response electroneuromyography to conservative treatment of carpal tunnel syndrome. For this, the sample consisted of 14 patients diagnosed with CTS and hypovitaminosis D, who were allocated into two groups. The control group received corticosteroid treatment, while the experimental group received corticosteroid treatment associated with vitamin D. Thus, from this study, it can be concluded that patients who received vitamin D, when compared to those who did not receive it, showed improvement in the degree of pain intensity, a reduction in symptom severity and an improvement in some electroneuromyographic parameters.
Asunto(s)
Síndrome del Túnel Carpiano , Electromiografía , Deficiencia de Vitamina D , Vitamina D , Humanos , Síndrome del Túnel Carpiano/tratamiento farmacológico , Vitamina D/uso terapéutico , Femenino , Deficiencia de Vitamina D/tratamiento farmacológico , Deficiencia de Vitamina D/complicaciones , Masculino , Persona de Mediana Edad , Adulto , Resultado del Tratamiento , Suplementos Dietéticos , Corticoesteroides/administración & dosificación , Nervio Mediano/fisiopatología , AncianoRESUMEN
Upper limb nerve injuries are common, and their treatment poses a challenge for physicians and surgeons. Experimental models help in minimum exploration of the functional characteristics of peripheral nerve injuries of forelimbs. This study was conducted to characterize the functional recovery (1, 3, 7, 10, 14, and 21 days) after median and ulnar nerve crush in mice and analyze the histological and biochemical markers of nerve regeneration (after 21 days). Sensory-functional impairments appeared after 1 day. The peripheral nerve morphology, the nerve structure, and the density of myelin proteins [myelin protein zero (P0) and peripheral myelin protein 22 (PMP22)] were analyzed after 21 days. Cold allodynia and fine motor coordination recovery occurred on the 10th day, and grip strength recovery was observed on the 14th day after injury. After 21 days, there was partial myelin sheath recovery. PMP22 recovery was complete, whereas P0 recovery was not. Results suggest that there is complete functional recovery even with partial remyelination of median and ulnar nerves in mice.
Asunto(s)
Nervio Mediano/fisiopatología , Recuperación de la Función , Remielinización , Nervio Cubital/fisiopatología , Animales , Masculino , Nervio Mediano/lesiones , Nervio Mediano/metabolismo , Ratones , Proteína P0 de la Mielina/metabolismo , Proteínas de la Mielina/metabolismo , Compresión Nerviosa , Nervio Cubital/lesiones , Nervio Cubital/metabolismoRESUMEN
Background: Carpal tunnel syndrome (CTS) represents 90% of entrapment neuropathies. Severity may be greater in older patients. Aim: To describe the electrophysiological findings in adult patients with CTS and determine if severity is related to age. Material and Methods: Descriptive and retrospective study of electrophysiological findings in patients over 18 years of age with clinical suspicion of CTS, studied between January 2011 and December 2015. Neurophysiological severity was classified in 3 grades, comparing them by age, gender and laterality. Results: Of 1156 patients subjected to electrophysiological studies due to a clinical suspicion of CTS, 690 (60%) had electrophysiological features of the disease. In 274 patients (24%) the compromise was mild, in 162 (14%) it was moderate and in 254 (22%) it was severe. There was a positive association between age and CTS severity (p < 0.01). Severity was significantly greater in males than females (p < 0.01). Bilateral CTS was present in 471 patients (68%), which was associated with increased age and severity (p < 0.01). Conclusions: Electrophysiological severity in CTS increases with age. Other factors associated with higher severity are male gender and bilateral disease.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Índice de Severidad de la Enfermedad , Síndrome del Túnel Carpiano/fisiopatología , Factores de Edad , Electromiografía , Síndrome del Túnel Carpiano/diagnóstico , Factores Sexuales , Estudios Retrospectivos , Nervio Mediano/fisiopatología , Conducción NerviosaRESUMEN
INTRODUCTION: We sought to compare median nerve elasticity between leprosy patients (LPs) and healthy volunteers (HVs) using ultrasound elastography (UE). METHODS: Two radiologists independently measured the strain ratio of the median nerve/flexor digitorum superficialis muscle (MN/FDSM) of 18 LP and 18 HV using real-time freehand UE. Statistical analysis included intra-class correlation coefficients (ICC) and Mann-Whitney test. RESULTS: The MN/FDSM strain ratios of the LP and HV were 2.66 ± 1.30 and 3.52 ± 0.93, respectively (P < 0.05). We observed a significantly lower MN/FDSM strain ratio in LP with reactions (types 1 and 2 cutaneous reactions associated with or without neuritis) (2.30 ± 0.91) compared with LP without reactions (3.60 ± 1.70). We found no significant differences between HV and LP without reactions. The intra- and inter-observer ICCs were 0.50 (95% confidence interval [CI], 0.11-0.72) and 0.34 (95% CI, 0.28-0.52), respectively. CONCLUSIONS: MN/FDSM strain ratios were significantly lower in LP with reactions. UE may be useful for nerve elasticity evaluation in leprosy. Muscle Nerve 56: 393-398, 2017.
Asunto(s)
Diagnóstico por Imagen de Elasticidad/métodos , Lepra/diagnóstico por imagen , Nervio Mediano/diagnóstico por imagen , Músculo Esquelético/diagnóstico por imagen , Ultrasonografía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Antebrazo/diagnóstico por imagen , Antebrazo/inervación , Antebrazo/fisiopatología , Humanos , Lepra/fisiopatología , Masculino , Nervio Mediano/fisiopatología , Persona de Mediana Edad , Músculo Esquelético/fisiopatología , Estudios Prospectivos , Adulto JovenAsunto(s)
Factores de Edad , Síndrome del Túnel Carpiano/fisiopatología , Electromiografía , Índice de Severidad de la Enfermedad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Síndrome del Túnel Carpiano/diagnóstico , Femenino , Humanos , Masculino , Nervio Mediano/fisiopatología , Persona de Mediana Edad , Conducción Nerviosa , Estudios Retrospectivos , Factores Sexuales , Adulto JovenRESUMEN
OBJECTIVE: To determine the reliability of neuroconduction studies by comparing two observers and detecting minimum changes when diagnosing carpal tunnel syndrome. METHODS: Sixty-nine patients referred for electrophysiological study due to suspected carpal tunnel syndrome were studied. The patients underwent two examinations, performed by two evaluators, on two different days. Sensory and motor latencies of the median and ulnar nerves were evaluated; all were classified as negative, incipient, mild, moderate, severe or extreme. Relative interval variation, intraclass correlation coefficient, kappa index, limit of agreement and minimum detectable change were estimated. RESULTS: The relative variation of motor nerve latency of the median nerve was -6.8% to 15.9%, with intraclass correlation coefficient of 0.98 for the difference of median-ulnar nerve latency. The minimum detected change was 0.4ms, while the relative interval variation of sensory latency of the median nerve was -5.0% to 11%, with intraclass correlation coefficient of 0.95 for difference with the ulnar nerve. The minimum detectable change was 0.2ms. Electrophysiological classification agreed in 93% of the cases, with a kappa index of 0.89. CONCLUSIONS: Sensory and motor latencies of the median nerve, as well as the difference between them and the ulnar nerve, are reliable measures. The minimum detectable change obtained in our study helps clinicians to establish whether changes in latencies in consecutive or post-treatment studies are significant.
OBJETIVO: Determinar la confiabilidad entre dos observadores y el cambio mínimo detectable de los estudios de neuroconducción para diagnosticar el síndrome de túnel carpiano. MÉTODOS: Se estudiaron 69 pacientes remitidos para estudio electrofisiológico por sospecha de síndrome de túnel carpiano. A los pacientes, se les realizaron dos exámenes, dos días diferentes, por dos evaluadores. Se evaluaron las latencias sensitivas y motoras de los nervios mediano y cubital; todos fueron clasificados como negativos, incipientes, leves, moderados, severos o extremos. Se calculó la variación relativa entre ensayos, el coeficiente de correlación intraclase, el índice de kappa, el límite de acuerdo y el cambio mínimo detectable. RESULTADOS: La variación relativa entre ensayos de la latencia motora del nervio mediano fue de -6,8 % a 15,9 % con coeficiente de correlación intraclase de 0,98 para la diferencia con la latencia del nervio cubital. El cambio mínimo detectable fue de 0,4ms. La variación relativa entre ensayos de la latencia sensitiva del nervio mediano fue -5,0 % a 11 % con coeficiente de correlación intraclase de 0,95 para la diferencia con el nervio cubital. El cambio mínimo detectable fue de 0,2ms. La clasificación ele trofisiológica coincidió en 93 % de los casos, índice de kappa de 0,89. CONCLUSIONES: Las latencias sensitivas y motoras del nervio mediano así como la diferencia de estas con el nervio cubital son medidas confiables. El cambio mínimo detectable obtenido en nuestro estudio le sirve al clínico para establecer si los cambios de las latencias en estudios consecutivos o después del tratamiento son significativos.
Asunto(s)
Síndrome del Túnel Carpiano/diagnóstico , Nervio Mediano/fisiopatología , Conducción Nerviosa , Nervio Cubital/fisiopatología , Adulto , Síndrome del Túnel Carpiano/fisiopatología , Electrofisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Reproducibilidad de los ResultadosRESUMEN
PURPOSE: To determine whether there is a correlation between the cross-sectional area (CSA) of the median nerve, as measured using ultrasound, and the distal motor and/or sensory latencies as measured on nerve conduction studies. METHODS: Patients with clinical signs and symptoms of carpal tunnel syndrome were prospectively enrolled in this study. Subjects underwent ultrasound measurement of the CSA of the median nerve at the carpal tunnel inlet by a fellowship-trained hand surgeon, followed by nerve conduction studies (NCS) by a certified electrodiagnostic technician who was blinded to the results of the ultrasound examination. Pearson correlations were performed to compare CSA and NCS. RESULTS: Pearson correlation was r = 0.57 between CSA and distal motor latency and r = 0.47 between CSA and distal sensory latency. Correlation was r = 0.81 between distal motor latency and distal sensory latency. CONCLUSIONS: There is a correlation between CSA of the median nerve and NCS. Further research is necessary to determine which test correlates better with patient symptoms and function. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.
Asunto(s)
Síndrome del Túnel Carpiano/diagnóstico , Síndrome del Túnel Carpiano/cirugía , Nervio Mediano/fisiopatología , Conducción Nerviosa , Ultrasonografía/métodos , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Examen Neurológico/métodos , Estudios Prospectivos , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVES: We, herein, analyzed the effect of swimming on nociception threshold and peripheral nerve regeneration in lean and obese rats submitted to median nerve compression. METHODS: To induce obesity, newborn male Wistar rats received injections of monosodium glutamate (MSG), whereas the control (CTL) group received saline. The animals were separated into 6 groups; control and obese (CTL and MSG), control and obese with lesion (CTL LES and MSG LES), and control and obese with lesion submitted to physical exercise (CTL LES PE and MSG LES PE). RESULTS: Median nerve compression reduced nociception threshold in CTL LES and MSG LES rats. Swimming effectively altered nociception only in CTL LES PE animals. Lean and obese animals displayed histological differences, when compared to sedentary animals, and exercise improved axon regeneration in both groups. The brain-derived neurotrophic factor and GAP 43 protein expression was greater in animals submitted to nervous compression without alteration by exercise. DISCUSSION: In conclusion, swimming, a conservative treatment for peripheral nerve lesions, was not able to improve the nociception threshold in obese rats.
Asunto(s)
Síndromes de Compresión Nerviosa/fisiopatología , Síndromes de Compresión Nerviosa/rehabilitación , Nocicepción/fisiología , Obesidad/complicaciones , Umbral del Dolor/fisiología , Natación , Análisis de Varianza , Animales , Animales Recién Nacidos , Índice de Masa Corporal , Factor Neurotrófico Derivado del Encéfalo/metabolismo , Modelos Animales de Enfermedad , Proteína GAP-43/metabolismo , Regulación de la Expresión Génica/efectos de los fármacos , Regulación de la Expresión Génica/fisiología , Masculino , Nervio Mediano/fisiopatología , Síndromes de Compresión Nerviosa/patología , Obesidad/inducido químicamente , Dimensión del Dolor , Condicionamiento Físico Animal , Ratas , Ratas Wistar , Glutamato de Sodio/farmacologíaRESUMEN
INTRODUCTION: SPOAN (spastic paraplegia, optic atrophy, and neuropathy) syndrome is an autosomal recessive neurodegenerative disorder identified in a large consanguineous Brazilian family. METHODS: Twenty-seven patients with SPOAN syndrome (20 women), aged 4-58 years, underwent nerve conduction studies (NCS) of the median, ulnar, tibial, and fibular nerves, and sensory NCS of the median, ulnar, radial, sural, and superficial fibular nerves. RESULTS: Sensory nerve action potentials were absent in the lower limbs and absent in >80% of upper limbs. Motor NCS had reduced amplitudes and borderline velocities in the upper limbs and absent compound muscle action potentials (CMAPs) in the lower limbs. CONCLUSIONS: The neuropathy in SPOAN syndrome is a severe, early-onset sensory-motor axonal polyneuropathy. Normal NCS seem to rule-out this condition.
Asunto(s)
Potenciales de Acción/fisiología , Trastornos Heredodegenerativos del Sistema Nervioso/fisiopatología , Conducción Nerviosa/fisiología , Atrofia Óptica/fisiopatología , Paraplejía/fisiopatología , Adolescente , Adulto , Brasil , Niño , Preescolar , Estudios Transversales , Femenino , Trastornos Heredodegenerativos del Sistema Nervioso/etnología , Trastornos Heredodegenerativos del Sistema Nervioso/genética , Humanos , Masculino , Nervio Mediano/fisiopatología , Persona de Mediana Edad , Atrofia Óptica/etnología , Atrofia Óptica/genética , Paraplejía/etnología , Paraplejía/genética , Nervio Peroneo/fisiopatología , Nervio Radial/fisiopatología , Nervio Sural/fisiopatología , Síndrome , Nervio Cubital/fisiopatología , Adulto JovenRESUMEN
To evaluate ultrasonographic (US) cross-sectional areas (CSAs) of peripheral nerves, indexes of the differences between CSAs at the same point (∆CSAs) and between tunnel (T) and pre-tunnel (PT) ulnar CSAs (∆TPTs) in leprosy patients (LPs) and healthy volunteers (HVs). Seventy-seven LPs and 49 HVs underwent bilateral US at PT and T ulnar points, as well as along the median (M) and common fibular (CF) nerves, to calculate the CSAs, ∆CSAs and ∆TPTs. The CSA values in HVs were lower than those in LPs (p < 0.0001) at the PT (5.67/9.78 mm2) and T (6.50/10.94 mm2) points, as well as at the M (5.85/8.48 mm2) and CF (8.17/14.14 mm2) nerves. The optimum CSA- receiver operating characteristic (ROC) points and sensitivities/specificities were, respectively, 6.85 mm2 and 68-85% for the PT point, 7.35 mm2 and 71-78% for the T point, 6.75 mm2 and 62-75% for the M nerve and 9.55 mm2 and 81-72% for the CF nerve. The ∆CSAs of the LPs were greater than those of the HVs at the PT point (4.02/0.85; p = 0.007), T point (3.71/0.98; p = 0.0005) and CF nerve (2.93/1.14; p = 0.015), with no difference found for the M nerve (1.41/0.95; p = 0.17). The optimum ∆CSA-ROC points, sensitivities, specificities and p-values were, respectively, 1.35, 49%, 80% and 0.003 at the PT point, 1.55, 55-85% and 0.0006 at the T point, 0.70, 58-50% and 0.73 for the M nerve and 1.25, 54-67% and 0.022 for the CF nerve. The ∆TPT in the LPs was greater than that in the HVs (4.43/1.44; p <0.0001). The optimum ∆TPT-ROC point was 2.65 (90% sensitivity/41% specificity, p < 0.0001). The ROC analysis of CSAs showed the highest specificity and sensitivity at the PT point and CF nerve, respectively. The PT and T ∆CSAs had high specificities (> 80%) and ∆TPT had the highest specificity (> 90%). New sonographic peripheral nerve measurements (∆CSAs and ∆TPT) provide an important methodological improvement in the detection of leprosy neuropathy.
Asunto(s)
Lepra/diagnóstico por imagen , Nervio Mediano/diagnóstico por imagen , Enfermedades del Sistema Nervioso Periférico/diagnóstico por imagen , Nervio Peroneo/diagnóstico por imagen , Nervio Cubital/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anatomía Transversal , Estudios de Casos y Controles , Niño , Femenino , Humanos , Lepra/complicaciones , Lepra/fisiopatología , Masculino , Nervio Mediano/fisiopatología , Persona de Mediana Edad , Enfermedades del Sistema Nervioso Periférico/etiología , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Nervio Peroneo/fisiopatología , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Nervio Cubital/fisiopatología , Ultrasonografía , Adulto JovenRESUMEN
To evaluate ultrasonographic (US) cross-sectional areas (CSAs) of peripheral nerves, indexes of the differences between CSAs at the same point (∆CSAs) and between tunnel (T) and pre-tunnel (PT) ulnar CSAs (∆TPTs) in leprosy patients (LPs) and healthy volunteers (HVs). Seventy-seven LPs and 49 HVs underwent bilateral US at PT and T ulnar points, as well as along the median (M) and common fibular (CF) nerves, to calculate the CSAs, ∆CSAs and ∆TPTs. The CSA values in HVs were lower than those in LPs (p < 0.0001) at the PT (5.67/9.78 mm2) and T (6.50/10.94 mm2) points, as well as at the M (5.85/8.48 mm2) and CF (8.17/14.14 mm2) nerves. The optimum CSA- receiver operating characteristic (ROC) points and sensitivities/specificities were, respectively, 6.85 mm2 and 68-85% for the PT point, 7.35 mm2 and 71-78% for the T point, 6.75 mm2 and 62-75% for the M nerve and 9.55 mm2 and 81-72% for the CF nerve. The ∆CSAs of the LPs were greater than those of the HVs at the PT point (4.02/0.85; p = 0.007), T point (3.71/0.98; p = 0.0005) and CF nerve (2.93/1.14; p = 0.015), with no difference found for the M nerve (1.41/0.95; p = 0.17). The optimum ∆CSA-ROC points, sensitivities, specificities and p-values were, respectively, 1.35, 49%, 80% and 0.003 at the PT point, 1.55, 55-85% and 0.0006 at the T point, 0.70, 58-50% and 0.73 for the M nerve and 1.25, 54-67% and 0.022 for the CF nerve. The ∆TPT in the LPs was greater than that in the HVs (4.43/1.44; p <0.0001). The optimum ∆TPT-ROC point was 2.65 (90% sensitivity/41% specificity, p < 0.0001). The ROC analysis of CSAs showed the highest specificity and sensitivity at the PT point and CF nerve, respectively. The PT and T ∆CSAs had high specificities (> 80%) and ∆TPT had the highest specificity (> 90%). New sonographic peripheral nerve measurements (∆CSAs and ∆TPT) provide an important methodological improvement in the detection of leprosy neuropathy.
Asunto(s)
Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Lepra , Nervio Mediano , Enfermedades del Sistema Nervioso Periférico , Nervio Peroneo , Nervio Cubital , Anatomía Transversal , Estudios de Casos y Controles , Lepra/complicaciones , Lepra/fisiopatología , Nervio Mediano/fisiopatología , Enfermedades del Sistema Nervioso Periférico/etiología , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Nervio Peroneo/fisiopatología , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Nervio Cubital/fisiopatologíaRESUMEN
INTRODUCTION: Cross-modal plasticity has been extensively studied in deaf adults with neuroimaging studies, yielding valuable results. A recent study in our laboratory with deaf-blind children found evidence of cross-modal plasticity, revealed in over-representation of median nerve somatosensory evoked potentials (SEP N20) in left hemisphere parietal, temporal and occipital regions. This finding led to asking whether SEP N20 changes are peculiar to deaf-blindness or are also present in sighted deaf children. OBJECTIVE: Assess cross-modal plasticity in deaf child cochlear implant candidates using neurophysiological techniques (visual evoked potentials and median nerve somatosensory evoked potentials). METHODS: Participants were 14 prelingually deaf children assessed in the Cuban Cochlear Implant Program. Flash visual-evoked potentials and SEP N20 were recorded at 19 scalp recording sites. Topographic maps were obtained and compared to those of control group children with normal hearing. Analysis took into account duration of hearing loss. RESULTS: Topographic maps of flash visual-evoked potentials did not show changes in deaf child cochlear implant candidates. However, SEP N20 from right median nerve stimulation did show changes from expansion of cortical activation into the left temporal region in deaf children aged ≥7 years, which was interpreted as neurophysiological evidence of cross-modal plasticity, not previously described for this technique and type of somatosensory stimulus. We interpret this finding as due in part to duration of deafness, particularly related to handedness, since expansion was selective for the left hemisphere in the children, who were all right-handed. CONCLUSIONS: Cortical over-representation of SEP N20 in the left temporal region is interpreted as evidence of cross-modal plasticity that occurs if the deaf child does not receive a cochlear implant early in life-before concluding the critical period of neural development-and relies on sign language for communication.
Asunto(s)
Implantación Coclear , Sordera/fisiopatología , Potenciales Evocados Somatosensoriales/fisiología , Potenciales Evocados Visuales/fisiología , Plasticidad Neuronal/fisiología , Adolescente , Estudios de Casos y Controles , Niño , Preescolar , Cuba , Trastornos Sordoceguera/fisiopatología , Estimulación Encefálica Profunda , Potenciales Postsinápticos Excitadores/fisiología , Femenino , Pérdida Auditiva Sensorineural/fisiopatología , Humanos , Masculino , Nervio Mediano/fisiopatología , Estudios ProspectivosRESUMEN
OBJECTIVE: Some case reports have suggested primary hyperparathyroidism (PHPT) and peripheral polyneuropathy (PPN) are associated; however, there are no reports of studies examining this possible relationship. The aim of this study was to evaluate peripheral nerve conduction in subjects with PHPT. METHODS: The study involved 17 patients with PHPT. Mean patient age was 60.5 ± 12.9 years, serum calcium concentration was 11.5 ± 1.0 mg/dL, and the serum parathyroid hormone (PTH) level was 315 ± 569 pg/dL. The control group comprised 17 individuals without PHPT. The mean age of controls was 60.8 ± 12.5 years and the serum calcium concentration was 9.8 ± 0.3 mg/dL. Motor and sensory nerve conduction was assessed by electroneurography (ENG). RESULTS: The following ENG parameters differed significantly between the PHPT and control groups: right (R) sural sensory nerve action potential conduction velocity (52.7 ± 6.3 m/s versus 58.0 ± 8.0 m/s; P = .041); R median compound muscle action potential (CMAP) amplitude (7.4 ± 1.6 mV versus 8.9 ± 1.7 mV; P = .002); R median CMAP latency (4.3 ± 1.2 ms versus 3.6 ± 0.6 ms; P = .032); R tibial CMAP latency (4.2 ± 1.1 ms versus 3.3 ± 0.4 ms; P = .001). The neurological examination was normal in all patients. CONCLUSION: Our data demonstrate an association between PHPT and peripheral neurological alterations, consistent with subclinical sensory-motor PPN.
Asunto(s)
Hiperparatiroidismo Primario/fisiopatología , Sistema Nervioso Periférico/fisiopatología , Polineuropatías/etiología , Potenciales de Acción , Anciano , Calcio/sangre , Estudios Transversales , Femenino , Humanos , Hipercalcemia/etiología , Hiperparatiroidismo Primario/sangre , Hiperparatiroidismo Primario/metabolismo , Masculino , Nervio Mediano/metabolismo , Nervio Mediano/fisiopatología , Persona de Mediana Edad , Neuronas Motoras/metabolismo , Conducción Nerviosa , Hormona Paratiroidea/sangre , Sistema Nervioso Periférico/metabolismo , Polineuropatías/fisiopatología , Células Receptoras Sensoriales/metabolismo , Índice de Severidad de la Enfermedad , Nervio Sural/metabolismo , Nervio Sural/fisiopatología , Nervio Tibial/metabolismo , Nervio Tibial/fisiopatologíaRESUMEN
BACKGROUND: Somatosensory evoked potentials (SSEP) have been described as excellent indicators of the degree of medullar injury in degenerative and metabolic diseases of the central nervous system (CNS). The prevalence of neural tube defects (NTD) is 6 cases/10,000 live newborns worldwide. It is thought that genetic as well as environmental factors contribute to the etiology of NTD. The objective of this study was to analyze and compare the latencies obtained by means of SSEP in a clinically healthy monkey vs. rhesus monkeys with intrauterine surgery in order to simulate surgically the neural tube defect (myelomengocele) by performing an intrauterine laminectomy and in which later the defect was corrected. METHODS: This study was performed using three non-human primates of the Macaca mulatta species. There were practice intrauterine surgeries in two monkeys to simulate the neurological defect produced by myelomeningocele, using the third monkey as control. For statistical methodology four monkeys were used. They were born by natural birth without any surgical manipulation. With the cesarean-obtained products, stimulation was performed of the tibial and median nerve. RESULTS: We observed that the hind limbs were the most affected, in particular, the left afferent of the monkey. The spinal cord was exposed to amniotic fluid, and there were no significant differences in the forelimbs. CONCLUSIONS: The use of SSEP provides valuable information regarding preservation of sensorial functions in a variety of experimental neurological abnormalities.
Asunto(s)
Potenciales Evocados Somatosensoriales , Terapias Fetales , Implantes Experimentales , Laminectomía/métodos , Nervio Mediano/fisiopatología , Meningomielocele/fisiopatología , Nervio Tibial/fisiopatología , Animales , Cesárea , Parto Obstétrico , Modelos Animales de Enfermedad , Femenino , Pierna/inervación , Macaca mulatta , Meningomielocele/embriología , Meningomielocele/etiología , Meningomielocele/cirugía , Embarazo , Tiempo de Reacción , Mallas QuirúrgicasRESUMEN
Although the majority of peripheral-nerve regeneration studies are carried out on the sciatic nerve, lesions of the upper extremities are more common in humans and usually lead to significant physical disabilities. The present study was driven by the hypothesis that a combination of strategies, namely grafts of mesenchymal stem cells (MSC) and resorbable polycaprolactone (PCL) conduits would improve median-nerve regeneration after transection. Mouse median nerves were transected and sutured to PCL tubes that were filled with either green fluorescent protein (GFP(+)) MSC in DMEM or with DMEM alone. During the post-operative period, animals were tested weekly for flexor digitorum muscle function by means of the grasping test. After 8 weeks, the proximal and middle portions of the PCL tube and the regenerating nerves were harvested and processed for light and electron microscopy. The flexor digitorum muscle was weighed and subjected to biochemical analysis for creatine phosphokinase (CK) levels. Scanning electron microscopy of the PCL tube 8 weeks after implantation showed clear signs of wall disintegration. MSC-treated animals showed significantly larger numbers of myelinated and unmyelinated nerve fibers and blood vessels compared with DMEM-treated animals. The flexor digitorum muscle CK levels were significantly higher in the MSC-treated animals, but muscle weight values did not differ between the groups. Compared with the DMEM-treated group, MSC-treated animals showed, by the grasping test, improved functional performance throughout the period analyzed. Immunofluorescence for S-100 and GFP showed, in a few cases, double-labeled cells, suggesting that transplanted cells may occasionally transdifferentiate into Schwann cells. Our data demonstrate that the polycaprolactone conduit filled with MSC is capable of significantly improving the median-nerve regeneration after a traumatic lesion.
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Creatina Quinasa/metabolismo , Nervio Mediano/fisiopatología , Trasplante de Células Madre Mesenquimatosas , Músculo Esquelético/fisiopatología , Poliésteres , Animales , Diferenciación Celular , Miembro Anterior , Nervio Mediano/irrigación sanguínea , Nervio Mediano/lesiones , Nervio Mediano/ultraestructura , Células Madre Mesenquimatosas/citología , Ratones , Ratones Endogámicos C57BL , Músculo Esquelético/enzimología , Músculo Esquelético/inervación , Fibras Nerviosas Mielínicas/ultraestructura , Regeneración Nerviosa , Células de Schwann/citologíaRESUMEN
Nerve conduction is profoundly affected in Spinocerebellar ataxia 2 (SCA2) even before the onset of the disease, but there is no information regarding its progression to the final stage of SCA2. In order to study the progression patterns of nerve conduction abnormalities in SCA2 we performed a prospective follow up evaluation of sensory and motor conduction in 21 SCA2 mutation carriers-initially presymptomatics- and 19 non-SCA2 mutation carriers during 20years. The earliest electrophysiological alterations were the reduction of sensory amplitudes in median and sural nerves, which could be found 8 to 5years prior disease onset and in the last 4years of the preclinical stage respectively. These abnormalities were followed by the increase of sensory latencies and decrease of conduction velocities. Sensory amplitudes progressively decreased during the follow-up clinical stage, rendering almost all patients with abnormal amplitudes and lack of sensory potentials, with faster progression rates in patients with larger CAG repeat lengths. Peripheral motor nerves showed the later involvement. These findings were used to define three distinct stages that describe the progression of the peripheral neuropathy. We suggest that sensory amplitudes could be useful biomarkers to assess the progression of peripheral nerve involvement and therefore to evaluate future clinical trials of therapeutic agents.
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Enfermedades del Sistema Nervioso Periférico/diagnóstico , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Ataxias Espinocerebelosas/diagnóstico , Ataxias Espinocerebelosas/fisiopatología , Adolescente , Adulto , Ataxinas , Biomarcadores/análisis , Niño , Estudios de Cohortes , Progresión de la Enfermedad , Electrodiagnóstico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Nervio Mediano/metabolismo , Nervio Mediano/fisiopatología , Persona de Mediana Edad , Proteínas del Tejido Nervioso/genética , Conducción Nerviosa/genética , Enfermedades del Sistema Nervioso Periférico/genética , Valor Predictivo de las Pruebas , Estudios Prospectivos , Tiempo de Reacción/genética , Sensibilidad y Especificidad , Células Receptoras Sensoriales/fisiología , Índice de Severidad de la Enfermedad , Ataxias Espinocerebelosas/genética , Nervio Sural/metabolismo , Nervio Sural/fisiopatología , Factores de TiempoRESUMEN
BACKGROUND: Previous works showed potentially beneficial effects of a single session of peripheral nerve sensory stimulation (PSS) on motor function of a paretic hand in patients with subacute and chronic stroke. OBJECTIVE: To investigate the influence of the use of different stimulus intensities over multiple sessions (repetitive PSS [RPSS]) paired with motor training. METHODS: To address this question, 22 patients were randomized within the second month after a single hemispheric stroke in a parallel design to application of 2-hour RPSS at 1 of 2 stimulus intensities immediately preceding motor training, 3 times a week, for 1 month. Jebsen-Taylor test (JTT, primary endpoint measure), pinch force, Functional Independence Measure (FIM), and corticomotor excitability to transcranial magnetic stimulation were measured before and after the end of the treatment month. JTT, FIM scores, and pinch force were reevaluated 2 to 3 months after the end of the treatment. RESULTS: Baseline motor function tests were comparable across the 2 RPSS intensity groups. JTT improved significantly in the lower intensity RPSS group but not in the higher intensity RPSS group at month 1. This difference between the 2 groups reduced by months 2 to 3. CONCLUSIONS: These results indicate that multiple sessions of RPSS could facilitate training effects on motor function after subacute stroke depending on the intensity of stimulation. It is proposed that careful dose-response studies are needed to optimize parameters of RPSS stimulation before designing costly, larger, double-blind, multicenter clinical trials.
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Actividad Motora , Músculo Esquelético/fisiopatología , Paresia/rehabilitación , Corteza Somatosensorial/fisiopatología , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/fisiopatología , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Femenino , Lateralidad Funcional , Mano/fisiopatología , Humanos , Masculino , Nervio Mediano/fisiopatología , Persona de Mediana Edad , Músculo Esquelético/inervación , Paresia/etiología , Paresia/fisiopatología , Recuperación de la Función , Accidente Cerebrovascular/complicaciones , Estimulación Magnética Transcraneal , Estimulación Eléctrica Transcutánea del Nervio/métodos , Resultado del TratamientoRESUMEN
OBJECTIVE: To compare a long-term carpal tunnel syndrome (CTS) on nerve conduction studies (NCS) in hands treated non-surgically. METHOD: We retrospectively selected 261 symptomatic CTS hands (166 patients), all of them confirmed by NCS. In all cases, at least 2 NCS were performed in an interval greater than 12 months. Cases with associated polyneuropathy were excluded. NCS parameters for CTS electrodiagnosis included a sensory conduction velocity (SCV) < or =46.6 m/s (wrist to index finger, 14 cm) and distal motor latency (DML) > or =4.25 ms (wrist to APB, 8 cm). RESULTS: 92.8% were women; mean age was 49 years (20-76); the mean interval between NCS was 47 months (12-150). In the first exam, the median sensory nerve action potential (SNAP) and the compound action muscular potential were absent in 9.8% and 1.9%, respectively. In the second/last exam, SCV worsened in 54.2%, remained unchanged in 11.6% and improved in 34.2%. SNAP amplitude worsened in 57.7%, remained unchanged in 13.1% and improved in 29.2%. DML worsened in 52.9%, remained unchanged in 7.6% and improved in 39.5%. Overall, NCS parameters worsened in 54.9%, improved in 34.3% and remained unchanged in 10.8%. CONCLUSION: Long-term changing in NCS of CTS hands apparently were not related to clinical symptomatology and could lead to some difficulty in clinical correlation and prognosis. Aging, male gender and absent SNAP were more related to NCS worsening, regardless the mean interval time between the NCS.
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Síndrome del Túnel Carpiano/fisiopatología , Mano/inervación , Nervio Mediano/fisiopatología , Conducción Nerviosa/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Electromiografía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Remisión Espontánea , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE: To compare a long-term carpal tunnel syndrome (CTS) on nerve conduction studies (NCS) in hands treated non-surgically. METHOD: We retrospectively selected 261 symptomatic CTS hands (166 patients), all of them confirmed by NCS. In all cases, at least 2 NCS were performed in an interval greater than 12 months. Cases with associated polyneuropathy were excluded. NCS parameters for CTS electrodiagnosis included a sensory conduction velocity (SCV) <46.6 m/s (wrist to index finger, 14 cm) and distal motor latency (DML) >4.25 ms (wrist to APB, 8 cm). RESULTS: 92.8 percent were women; mean age was 49 years (20-76); the mean interval between NCS was 47 months (12-150). In the first exam, the median sensory nerve action potential (SNAP) and the compound action muscular potential were absent in 9.8 percent and 1.9 percent, respectively. In the second/last exam, SCV worsened in 54.2 percent, remained unchanged in 11.6 percent and improved in 34.2 percent. SNAP amplitude worsened in 57.7 percent, remained unchanged in 13.1 percent and improved in 29.2 percent. DML worsened in 52.9 percent, remained unchanged in 7.6 percent and improved in 39.5 percent. Overall, NCS parameters worsened in 54.9 percent, improved in 34.3 percent and remained unchanged in 10.8 percent. CONCLUSION: Long-term changing in NCS of CTS hands apparently were not related to clinical symptomatology and could lead to some difficulty in clinical correlation and prognosis. Aging, male gender and absent SNAP were more related to NCS worsening, regardless the mean interval time between the NCS.
OBJETIVO: Comparar evolutivamente parâmetros de condução nervosa (CN) na síndrome do túnel do carpo (STC) em mãos não submetidas à cirurgia. MÉTODO: Foram selecionadas retrospectivamente 261 mãos (166 pacientes) com STC sintomática confirmadas por CN e que posteriormente realizaram exame controle com intervalo >12 meses; foram excluídos casos com polineuropatia. Os parâmetros eletrodiagnósticos anormais foram: velocidade de condução sensitiva (VCS) <46,6 m/s, segmento pulso-II dedo, e latência distal motora (LDM) >4,25 ms, segmento pulso-APB (8 cm). RESULTADOS: 92,8 por cento eram mulheres; a média de idade foi 49 anos (20-76); o tempo médio entre os exames foi 47 meses (12-150); 9,8 por cento e 1,9 por cento não apresentaram potenciais de ação do nervo sensitivo (PANS) e potenciais de ação muscular compostos, no primeiro exame. No segundo exame a VCS piorou em 54,2 por cento, ficou igual em 11,6 por cento e melhorou em 34,2 por cento; a amplitude do PANS piorou em 57,7 por cento, ficou igual em 13,1 por cento e melhorou em 29,2 por cento; a LDM piorou em 52,9 por cento, ficou igual em 7,6 por cento e melhorou em 39,5 por cento. Incluindo todos os parâmetros eletrofisiológicos, houve piora em 54,9 por cento, melhora em 34,3 por cento e permaneceram sem alterações 10,8 por cento. CONCLUSÃO: As anormalidades da CN na STC podem oscilar ao longo do tempo e aparentemente independem da sintomatologia clínica, dificultando a correlação e prognóstico; idade mais avançada, sexo masculino e PANS ausentes no primeiro exame foram as variáveis que tiveram menor percentual de melhora evolutiva, independentemente do intervalo entre os exames.
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Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Síndrome del Túnel Carpiano/fisiopatología , Mano/inervación , Nervio Mediano/fisiopatología , Conducción Nerviosa/fisiología , Electromiografía , Estudios de Seguimiento , Remisión Espontánea , Estudios Retrospectivos , Adulto JovenRESUMEN
STUDY DESIGN: Cross-sectional study. OBJECTIVES: To observe if there is a relationship between the level of injury by the American Spinal Cord Injury Association (ASIA) and cortical somatosensory evoked potential (SSEP) recordings of the median nerve in patients with quadriplegia. SETTING: Rehabilitation Outpatient Clinic at the university hospital in Brazil. METHODS: Fourteen individuals with quadriplegia and 8 healthy individuals were evaluated. Electrophysiological assessment of the median nerve was performed by evoked potential equipment. The injury level was obtained by ASIA. N(9), N(13) and N(20) were analyzed based on the presence or absence of responses. The parameters used for analyzing these responses were the latency and the amplitude. Data were analyzed using mixed-effect models. RESULTS: N(9) responses were found in all patients with quadriplegia with a similar latency and amplitude observed in healthy individuals; N(13) responses were not found in any patients with quadriplegia. N(20) responses were not found in C5 patients with quadriplegia but it was present in C6 and C7 patients. Their latencies were similar to healthy individuals (P>0.05) but the amplitudes were decreased (P<0.05). CONCLUSION: This study suggests that the SSEP responses depend on the injury level, considering that the individuals with C6 and C7 injury levels, both complete and incomplete, presented SSEP recordings in the cortical area. It also showed a relationship between the level of spinal cord injury assessed by ASIA and the median nerve SSEP responses, through the latency and amplitude recordings.