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The Use of Nerve Conduction Studies in Determining the Short Term Outcome of Bell’s Palsy

The Use of Nerve Conduction Studies in Determining the Short Term Outcome of Bell’s Palsy

The Use of Nerve Conduction Studies in Determining the Short Term Outcome of Bell’s Palsy ORIGINAL ARTICLE The Use of Nerve Conduction Studies in Determining the Short Term Outcome of Bell's Palsy K M[.]

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Peripheral neuropathy in rheumatoid arthritis with special emphasis on nerve conduction studies

Peripheral neuropathy in rheumatoid arthritis with special emphasis on nerve conduction studies

This is to certify that this dissertation work titled “PERIPHERAL NEUROPATHY IN RHEUMATOID ARTHRITIS WITH SPECIAL EMPHASIS ON NERVE CONDUCTION STUDIES” of the candidate Dr.S.ASHOK KUMAR, Post graduate in GENERAL MEDICINE with registration Number 201511152 for the award of M.D.GENERAL MEDICINE in the Branch I. I personally verified the urkund.com website for the purpose of plagiarism check. I found that the uploaded thesis file contains from introduction to conclusion pages and result shows 8% percentage of plagiarism in the dissertation.

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Comparison of standard outpatient screening tools and nerve conduction studies for the diagnosis of diabetic peripheral neuropathy: A Pilot study

Comparison of standard outpatient screening tools and nerve conduction studies for the diagnosis of diabetic peripheral neuropathy: A Pilot study

It is also observed here that 80-85% of the patients with a normal NCS and an abnormal biothesiometer value belong to the mild neuropathy category by biothesiometry(15-25V). This also shows that more number of patients with mild neuropathy diagnosed by biothesiometry are being missed by nerve conduction studies. It could also mean that these are false positive cases and actually don't have neuropathy because nerve conduction studies are normal. Here arises the question as to which is the gold standard. There are no studies so far which have directly compared Nerve conduction studies and biothesiometer. Some consider biothesiometer as the gold standard(32,73) while others consider nerve conduction studies as the gold standard.(33,66,69,70) According to other authors, even nerve conduction studies alone are not sufficient; there must be clinical evidence and electrophysiological evidence to diagnose diabetic neuropathy(48). Ideally patients have to be followed up over years to see if they develop ulcers and the development of ulcer has to be taken as the gold standard. However, since ours is a cross sectional design, we have taken nerve conduction studies alone as gold standard, because it is purely an objective test and keeping the general consensus of majority of the studies. We have used the AAN criteria to define a case of neuropathy based on NCS. We have compared every other screening tool with NCS to determine their sensitivity and specificity.
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Evaluation of Median Nerve in Carpal
Tunnel Syndrome by High Frequency Ultrasound
and Colour Doppler in Comparison with Nerve
Conduction Studies.

Evaluation of Median Nerve in Carpal Tunnel Syndrome by High Frequency Ultrasound and Colour Doppler in Comparison with Nerve Conduction Studies.

A main limitation of our investigation is only patients with nerve conduction studies were included. Although carpal tunnel syndrome is a common health problem, the ratio of carpal tunnel syndrome patients in our investigation may not correspond to that in society. However, the study results are in concordance with data reporting the peak prevalence of carpal tunnel syndrome in women older than 40 years .Another limitation of this study is the lack of a quantitative analysis of the number or density of abnormal intraneural blood vessels. A further limitation of our study is that quantitative analysis of nerve measurements was not performed on a segmental basis—that is, proximal to the carpal tunnel, at the pisiform level, and at the hamate level. Rather, only data on maximal alteration were included in the statistical analysis.
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Hypothyroidism Effect on Motor Nerve Conduction Studies: A Cross

Hypothyroidism Effect on Motor Nerve Conduction Studies: A Cross

Asymptomatic patients were examined by El- Salem & Ammari., (2006) [10] to determine the frequency and pattern of electromyography and nerve conduction studies (NCS) changes in these patients and to see if these changes are reversible or not. Motor neuropathy was more common than sensory neuropathy affecting distal latencies more often than compound muscle action potential amplitudes. These findings favor a demyelinating rather than an axonal process. The median nerve was the most commonly affected nerve (30% of patients). The pattern of involvement was consistent with carpal tunnel syndrome, as it showed slowing of nerve conduction across the wrist. [7]
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Sensitivity of high-resolution ultrasonography in clinically diagnosed carpal tunnel syndrome patients with hand pain and normal nerve conduction studies

Sensitivity of high-resolution ultrasonography in clinically diagnosed carpal tunnel syndrome patients with hand pain and normal nerve conduction studies

CTS diagnosis in 269 (73%) wrists, and was normal in the rest (27%). In the final item by item NCS data check, we found prolonged median sensory distal latency ( > 3.7 msec) in 5 cases and a slowed median conduction velocity at the forearm level ( < 50 m/sec) in other 3 cases. These eight wrists were initially included due to some shortcomings in report generation or data entry and therefore were excluded from data analysis, leaving 103 wrists for the final analysis. The control group was made up of 108 wrists without CTS symptoms. Nine were found to have abnormal median NCS and therefore were excluded, leaving 99 wrists for the final analysis. The recruitment flow diagram is presented in Figure 2.
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Pearls & Oy-sters: False positives in short-segment nerve conduction studies due to ulnar nerve dislocation

Pearls & Oy-sters: False positives in short-segment nerve conduction studies due to ulnar nerve dislocation

subjects via repeated irritation or enhanced expo- sure to injury. Therefore, detection of ulnar nerve dislocation using ultrasonography would be help- ful in evaluating patients with normal conduction velocities in routine nerve conduction study at the across-elbow segment, despite clinical symptoms of highly suspected UNE. If ultrasonography is not available in a clinic, an alternative study could include S-NCS, which should be performed with two elbow positions, with one at less than 90 degrees and the other at full flexion. The appear- ance of conduction delay or block with full flex- ion would support either dislocation or transient compressive neurapraxia, either of which might be important in a symptomatic patient after other causes of symptoms have been excluded. Future studies are needed to investigate the reliability of this potential approach and the importance of dislocation as a predisposing factor for UNE.
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Effectiveness of ultrasonography and nerve conduction studies in the diagnosing of carpal tunnel syndrome: clinical trial on accuracy

Effectiveness of ultrasonography and nerve conduction studies in the diagnosing of carpal tunnel syndrome: clinical trial on accuracy

Well-designed studies that have focused on the diagno- sis of CTS are uncommon. The deficiencies in the de- sign of studies involving clinical and complementary tests for CTS are associated with a super-estimation of the performance of these diagnostic tests and the lack of a universally accepted reference standard for diag- nosing CTS [6, 8–10]. Most CTS diagnostic accuracy studies were unlikely to report results that are applic- able in clinical practice [1, 27]. The current study de- sign followed an algorithm based on evaluating an actual clinical practice routine for diagnosing CTS: from the consecutive and random eligibility of patients based on a high probability of a clinical diagnosis of
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Effect of Thyroid Disorders on Nerve Conduction Studies in Females

Effect of Thyroid Disorders on Nerve Conduction Studies in Females

Introduction: The magnitude of thyroid disorders are increasing globally. In India also there is an increasing incidence even though India is in post iodination phase. Most commonly the thyroid disorder is due to autoimmune pathology. Thyroid disorders affect all systems of the body including nervous system. The affection of neuromuscular problems includes proximal myopathy and various peripheral neuropathies. The early detection of peripheral neuropathy before clinical manifestations using electrophysiological methods helps in prevention of morbidity associated with the complications. Aims and Objectives: This study was carried out to evaluate the changes in the abnormalities in nerve conduction parameters in thyroid disorders and to find out the magnitude of neuropathies. Materials and Methods: The study was conducted at Tirunelveli Medical college hospital after ethical clearance. Proforma was filled in to follow the inclusion criteria and exclusion criteria. 22 hypothyroid,18 hyperthyroid and 25 normal individuals were selected for the study and written informed consent was obtained. The sensory conduction was performed in sural, median and ulnar nerves and motor conduction in tibial, median and ulnar nerves of left side using RMS EMG EP MARG II equipment. Results and discussion: The study found out predominant sensory involvement in both groups. Sensory neuropathy was present in 45.4 % and 61 % of hypothyroid and hyperthyroid individuals respectively. Sensorimotor neuropathy was present in 9.1 % and 5.5 % of hypothyroid and hyperthyroid individuals respectively. The study has diagnosed carpel tunnel syndrome in 36 and 17 % of hypothyroid and hyperthyroid individuals. The involvement of nerves in hypothyroidism is due to less active sodium potassium pumps and hyperthyroidism due to hypermetabolism. Conclusion: The study has highlighted the involvement of peripheral nerves in thyroid disorders and the role of electrophysiological studies in early detection of neuropathies. The study also suggests to evaluate thyroid function in carpal tunnel syndrome.
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<p>Electrodiagnostic Findings in 441 Patients with Ulnar Neuropathy - a Retrospective Study</p>

<p>Electrodiagnostic Findings in 441 Patients with Ulnar Neuropathy - a Retrospective Study</p>

To date, a multitude of research regarding EDx studies focusing on ulnar neuropathy has been published. Because of the high prevalence of ulnar neuropathy at elbow, the majority of these studies have focused on this region. Although our study covers EDx fi ndings in the whole anatomic length of the nerve, we also focused on the elbow region. The diagnosis of UNE has always been challenging and various opinions have been published about it. Newer methods for localization of injury in UNE have also been suggested. 30 Since discussing the most appropriate EDx methods in detail is not within the scope of this study, we will just suf fi ce with a brief review. The studies performed on UNE have largely focused on sensory and motor nerve conduction studies. In Kern ’ s research, the most reliable fi nding in UNE was slowing of across elbow NCV to lower than 50 m/sec. 14 Attention to the position of elbow, anatomical variations of innervation and temperature are important factors to consider while perform- ing an across elbow conduction study. 2,12,21 In a recent study by Omejec, the role of utilizing short-segment nerve con- duction studies (SSNCSs) in localizing entrapment of the ulnar nerve at the elbow was evaluated. 16 In our research, during general assessment, across elbow nerve conduction velocity (NCV) was mentioned in the records in 60% of cases, of which 84% were NT and of these, 75% showed a reduction in conduction speed.
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Tarsal Tunnel Syndrome—A New Way to Diagnose an Old Problem

Tarsal Tunnel Syndrome—A New Way to Diagnose an Old Problem

An audit was made of a one year period when 1210 patients were referred to a clinical neurophysiologist for a electro diagnostic evaluation of suspected peri- pheral nerve pathology. The population of patients was tertiary referrals from hospital based consultants, who were specialists in Orthopaedic Surgery, Rheu- matology, Musculoskeletal Medicine and General Medicine. The age range was 20 - 83 years, with a female to male bias of 53% to 47%. Of these 65% were re- ferred for assessment of suspected Carpal Tunnel Syndrome or Cervical Radicu- lopathy. 10% were referred for assessment of Lumbar Radiculopathy. Brachial plexopathy accounted for 8% of referrals. Suspected pudendal neuropathy ac- counted for 3% of referrals. The remaining 14% were referred for a variety of suspected polyneuropathies and focal neuropathies. Of these 59 patients [4.8%] were referred for assessment of possible Tarsal Tunnel Syndrome. This discrete subset of patients was assessed for both radiculopathy, peripheral neuropathy and had a full assessment of the function of the tibial nerve. Patients with Di- abetes Mellitus were excluded. Patients with Rheumatoid arthritis were included The tibial nerve assessment involved nerve conduction studies to the follow- ing nerves assessing amplitudes and distal latencies (10 parameters)
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A CASE STUDY ON GLYCEMIC INDEX AND DIABETIC PERIPHERAL NEUROPATHY

A CASE STUDY ON GLYCEMIC INDEX AND DIABETIC PERIPHERAL NEUROPATHY

ABSTRACT: The term HbA1c refers to glycated haemoglobin. By measuring glycated haemoglobin (HbA1c), clinicians are able to get an overall picture of what our average blood sugar levels have been over a period of weeks/months. Diabetic neuropathy is generally assessed in clinical practice by a combination of objective and subjective measures. Nerve conduction studies, the distal sural sensory nerves and the bilateral common peroneal and posterior tibial motor nerve was performed in lower limb in female patient of 20-years old suffering from type-I diabetes from past 10-yeras and had poor glycemic control (haemoglobin [HbA1c] 9.56%). Studies showed motor conduction studies (MNCV) and sensory conduction studies (SNCV) of the lower extremities, revealed borderline- prolonged distal latencies, evoked CMAPs of reduced amplitude of common peroneal, posterior tibial (right and left) with reduced conduction velocity was observed and however sural SNAP amplitude recordings in lower limb was normal. F response latencies were markedly prolonged in patient. Electro-diagnostic techniques play an important role in the prognosis of diabetic neuropathy because timely intervention reduces disability and morbidity.
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Congenital Hypomyelination Neuropathy in a Newborn Infant: Unusual Cause of Diaphragmatic and Vocal Cord Paralyses

Congenital Hypomyelination Neuropathy in a Newborn Infant: Unusual Cause of Diaphragmatic and Vocal Cord Paralyses

There is considerable overlap between the clinical presentation as well as nerve conduction studies among the different neuropathies. A nerve biopsy is essential in making the diagnosis. In DSS and CHN the biopsy shows hypomyelination. Some consider CHN to be an extreme form of DSS. Our case is somewhat unusual in that there was absence of on- ion bulb formation. This finding is often, but not always, reported in CHN. Onion bulb formation is a sign of reinnervation. In our patient, there did not seem to be evidence of reinnervation, at least not in the sural nerve. Our case was also unusual in that there was evidence of some Wallerian degeneration in some of the axons. This implies that there is a component of axonopathy in our patient, in addition to the hypomyelination. The EMG also found evi- dence of axonopathy. This is somewhat atypical, be- cause axonopathy is not usually seen in CHN.
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Correction

Correction

Abstract—The authors performed nerve conduction studies in nine PARK2 and eight idiopathic Parkinson disease patients and found a significant reduc- tion of sural sensory nerve action potential (SNAP) amplitude in eight PARK2 patients who mostly remained asymptomatic. These data suggest that sensory axonal neuropathy may be a common clinical feature of PARK2 and a reduced amplitude of sural SNAP could be a diagnostic indicator of PARK2.

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Local effects of acupuncture on the median and ulnar nerves in patients with carpal tunnel syndrome: a pilot mechanistic study protocol

Local effects of acupuncture on the median and ulnar nerves in patients with carpal tunnel syndrome: a pilot mechanistic study protocol

Background: While acupuncture ’ s mechanism of action is not fully understood, there is consensus that the nervous system plays a key role in processing its effects. This research is based on the structural theory of acupuncture, which aims to correlate the location of acupuncture points to peripheral nerves, spinal segments, and spinal plexuses. This mechanistic study explores the close anatomical association between the Pericardium meridian/ median nerve and the Heart meridian/ulnar nerve in an attempt to produce electrophysiologic data measuring acupuncture ’ s direct, nerve-specific effect on the underlying nerves. Specifically, the purpose of this research is to use nerve conduction studies (NCSs) and quantitative sensory testing (QST) to assess for any local, nerve-specific effect of three acupuncture modalities on two anatomically distinct nerves in the forearm — the median and ulnar nerves — in subjects with carpal tunnel syndrome (CTS). The choice of CTS as an injured nerve model allows for comparisons between the response in an injured nerve (median) to that of a healthy one (ulnar).
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Topiramate improves neurovascular function, epidermal nerve fiber morphology, and metabolism in patients with type 2 diabetes mellitus

Topiramate improves neurovascular function, epidermal nerve fiber morphology, and metabolism in patients with type 2 diabetes mellitus

Purpose: To assess the effects of topiramate on C-fiber function, nerve fiber morphology, and metabolism (including insulin sensitivity, obesity, and dyslipidemia) in type 2 diabetes. Patients and methods: We conducted an 18-week, open-label trial treating patients with topiramate. Twenty subjects with type 2 diabetes and neuropathy (61.5 ± 1.29 years; 15 male, 5 female) were enrolled and completed the trial. Neuropathy was evaluated by total neuropathy scores, nerve conduction studies, quantitative sensory tests, laser Doppler skin blood flow, and intraepidermal nerve fibers in skin biopsies.
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Role of concentric needle Single Fiber Electromyography in detection of subclinical motor involvement in carpal tunnel syndrome

Role of concentric needle Single Fiber Electromyography in detection of subclinical motor involvement in carpal tunnel syndrome

The study included 60 subjects, 57 females and 3 males. They were divided into two groups: a patient group and a control group. The patient group included 29 females and 1 male patient. Their ages ranged from 25 to 53 years, with a mean age of 35.4 ± 7.8 years. Patients in- cluded in the study were clinically suspected to have car- pal tunnel syndrome, and their sensory nerve conduction studies showed early starting or mild degrees of entrapment according to the classification of Bland (2000) (The mild degree of entrapment corresponds to delayed median nerve sensory peak latency and normal motor studies, while in early starting entrapment there is normal sensorimotor median nerve conduction stud- ies and positive comparative studies). We used the median-ulnar ring finger antidromic comparative sen- sory studies (American Association of Electrodiagnostic Medicine et al. 2002). We excluded patients with other neuromuscular disorders, proven clinically or electro- diagnostically, e.g., cervical radiculopathy and polyneur- opathy. We also excluded patients with systemic diseases which may be associated with neuropathy, e.g., diabetes mellitus, and patients in whom EMG examin- ation is contraindicated, e.g., bleeding disorders. We also recruited 30 age- and sex-matched healthy volunteers to serve as a control group; their ages ranged from 22 to 43 years with mean age of 32.7 ± 5.9 years.
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Clinical Reasoning: A 65-year-old man with asymmetric weakness and paresthesias

Clinical Reasoning: A 65-year-old man with asymmetric weakness and paresthesias

Nerve conduction studies showed conduction block in left ulnar and median nerves in the forearm, along with mildly slowed sensory velocities of bilateral ulnar and left sural and right median nerve. Sensory nerve action potential amplitudes were mildly reduced in multiple nerves (bilateral median and radial, right ulnar, and left sural). The F-wave latency of left ulnar nerve was also prolonged (;130% of normal). Needle EMG showed neuropathic units in L4/5, L5/S1, and C7-T1- innervated muscles. These findings are consistent with the presence of multiplex mononeuritis with demyelinating pat- tern and polyradiculopathy.
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Ultrasonogrraphy – A Diagnostic Aid for Carpal Tunnel
Syndrome.

Ultrasonogrraphy – A Diagnostic Aid for Carpal Tunnel Syndrome.

26 conditions presenting with similar symptoms e.g. cervical radiculopathy, polyneuropathy, other median nerve entrapment syndromes(94, 107). Although nerve conduction studies are the gold standard test for the confirmation of diagnosis of CTS, they have certain limitations. A small percentage of asymptomatic individuals can have positive NCS. Similarly, a small percentage of patients can have negative NCS despite symptoms suggestive of CTS. Atroshi et al randomly surveyed 2466 individuals in Sweden to find out the incidence of CTS in general population(13). 14.4% complained of pain, tingling and numbness in the distribution of the median nerve. However, only 4.9% of individuals with neuropathic symptoms had positive NCS. Furthermore, 18% of asymptomatic subjects had abnormal NCS9. In severe CTS cases, NCS results may not correlate with the clinical findings due to the varying nature of the impairment in different nerve fibres. In addition, nerve conduction studies will not accurately predict the recovery following release of the carpal tunnel, though neither do any of the other investigations predict this with any certainty (108). Therefore these studies suggest that NCS alone should not be used to diagnose, rather it should be based on presence of clinical symptoms, physical findings and positive nerve conduction studies taken together.
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PRACTICE PARAMETER ELECTRODIAGNOSTIC STUDIES IN ULNAR NEUROPATHY AT THE ELBOW

PRACTICE PARAMETER ELECTRODIAGNOSTIC STUDIES IN ULNAR NEUROPATHY AT THE ELBOW

A total of 19 of the 398 articles and abstracts met five or six literature classification criteria; six of these articles were excluded from subsequent analysis for various reasons. For example, some investigators performed ulnar nerve conduction studies (NCSs) in the course of looking primarily at other phenomena, such as the effects of age on the conduction properties of multiple nerves, the correlation between clinical and electrodiagnostic findings, or the difference between proximal and distal nerve segments; the findings therefore have scant or no applicability to the evaluation of the clinical problem of UNE. Studies of normal control subjects met a maximum of five of five criteria; studies of patients with UNE met a maximum of six of six criteria.
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