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Background and aim: Carpal tunnel syndrome (CTS) is a compressive neuropathy caused by compression of the median nerve in the carpal tunnel. It is the most common entrapment neuropathy. According to different studies, the prevalence of CTS among adults (15–65 years old) in Western Europe ranged from 0.29% to 43%. CTS affects middle-aged active workers and is associated with high healthcare costs and a hefty economic burden. It is thus essential to diagnose CTS early and refer the patient to further investigation and treatment. In this study, we aimed to evaluate the accuracy of the clinical CTS diagnosis before the nerve conduction studies were performed on the referred patients.Methods: The concordance of clinical diagnoses was assessed by comparing referral diagnoses with diagnoses confirmed by electroneuromyography. All the patients referred for electroneuromyography to Mykolas Marcinkevičius Hospital between August 2023 and February 2024 were included in this research. The age, sex, referral and final diagnoses of the enrolled patients were taken from their outpatient charts. The obtained data were summarized and processed with Microsoft Office Excel 365, and the data analysis was performed with IBM SPSS Statistics.Results: The most common reasons that patients were referred to perform NCS were suspected carpal tunnel syndrome (30.7%), cubital tunnel syndrome (13.5%), other upper extremity mononeuropathies (16.2%), and polyneuropathies (15.5%). The most common diagnosis after consultation was carpal tunnel syndrome (42.6%), followed by pathologies of nerve roots or plexuses (14.5%). Out of 91 patients referred to electroneurography due to suspicion of CTS, 67 (73.6%) were confirmed cases, whereas, for 12 (13.2%) patients, no abnormalities were detected during NCS.Conclusion: Our analysis supports the theory that the electrodiagnostic examination is essential to specify and confirm the diagnosis of CTS, thus avoiding hyperdiagnosis and preventing patients from excessive surgical treatment.

Multifocal motor neuropathy is a rare motor neuron disease characterised by a progressive, gradual loss of muscle strength, although sensory functions are preserved. The worldwide frequency of this disease is estimated at 1 person per 100,000 people. MMN is diagnosed when there are characteristic clinical signs, electroneuromyography test results support the clinical findings, and other possible diagnoses are excluded. To prove the progressive course of the disease, the patient must be under long-term medical supervision, since the deteriorating state of the patient may imitate other diseases affecting the motor neuron, such as amyotrophic lateral sclerosis, chronic inflammatory demyelinating polyneuropathy, spinal muscular atrophy, and other. We present the clinical case of a 71-year-old patient who presented to the Neurology Department of the Hospital of Lithuanian University of Health Sciences Kauno Klinikos. She complained of pain in her right hip and progressing weakness of the right foot which had lasted for a year. After laboratory tests, long-term supervision, and exclusion of other diagnoses, the patient was diagnosed with an atypical type of multifocal motor neuropathy responsive to treatment with intravenous immunoglobulin.

Multifocal motor neuropathy is a rare motor neuron disease characterised by a progressive, gradual loss of muscle strength, although sensory functions are preserved. The worldwide frequency of this disease is estimated at 1 person per 100,000 people. MMN is diagnosed when there are characteristic clinical signs, electroneuromyography test results support the clinical findings, and other possible diagnoses are excluded. To prove the progressive course of the disease, the patient must be under long-term medical supervision, since the deteriorating state of the patient may imitate other diseases affecting the motor neuron, such as amyotrophic lateral sclerosis, chronic inflammatory demyelinating polyneuropathy, spinal muscular atrophy, and other. We present the clinical case of a 71-year-old patient who presented to the Neurology Department of the Hospital of Lithuanian University of Health Sciences Kauno Klinikos. She complained of pain in her right hip and progressing weakness of the right foot which had lasted for a year. After laboratory tests, long-term supervision, and exclusion of other diagnoses, the patient was diagnosed with an atypical type of multifocal motor neuropathy responsive to treatment with intravenous immunoglobulin. [ABSTRACT FROM AUTHOR]

Introduction. Electroneuromyography (ENMG) is a useful diagnostic test for the evaluation of neuromuscular disorders. The procedure is considered unpleasant or even painful due to the use of electrical stimuli and needle electrodes. In this study, we investigated the influence of demographic factors on the perception of pain during ENMG examination as well as the connection between the perception of pain and the extent of the examination, the presence of chronic pain, its characteristics, and levels of anxiety and depression in patients. Methods. 400 patients who were referred to ENMG examination participated in a questionnaire survey after the procedure. The questionnaire included rating of pain intensity experienced during ENMG procedure using numerical rating scale (NRS), basic demographic information, information about the extent of the examination, questions about previously experienced pain, and the Hospital Anxiety and Depression Scale (HADS). Results. The mean of NRS score was 3.76±2.6. There was a negative correlation between pain intensity during ENMG and education level (r=-0.12, p=0.03). There was a significant (p=0.011) correlation between the intensity of pain and the extent of ENMG examination. The procedure was more painful for the patients who experienced continuous pain before the procedure (p=0.002), and the intensity correlated with qualitative aspects of pain. There was a significant correlation between pain intensity during the examination and the emotional state of the patient (p

Diabetic polyneuropathy is the most common and problematic complication of diabetes, often accompanied by disabling complications. Polyneuropathy can occur at the earliest stage of diabetes in patients with impaired glucose tolerance therefore its early and timely diagnosis is very important. Polyneuropathy caused by impaired glucose tolerance is neuropathy of sensory nerves with prominent early involvement of the small-diameter unmyelinated nerve fibers or thin myelinated axons. As large myelinated nerve fibers in glucose dysmetabolism remain intact and standard neurophysiological testing can not identify small fiber damage early diagnosis of diabetic neuropathy has many gaps. The aim of this article is to review and summarize the diagnostic possibilities of diabetic polyneuropathy at the earliest stage while peripheral nerve lesions are reversible. [ABSTRACT FROM AUTHOR]

Aim. to investigate the properties of central and periferal inervation in Parkinson disease (PD) using transcranial magnetic stimulation (TMS) and electroneurography (ENG), also to evaluate the impact of PD on the qua lity of life (QOL). Materials and methods. Participants underwent neurological examination, including UPDRS III scale (PD patients) and responded to SF-36 questionnaire. Neurophysiological studies were performed bilaterally on the ulnar nerve and abductor digiti minimi muscle, using Nicolet Viking and Magstim 200 electrodiagnostic system. Results. 17 PD patients and 14 healthy controls participated in the study. Peripheral nerve conduction was in the normal range in both groups. CuSP measures were similar in both groups, but greater standard deviation was observed in the PD group. CSP was shorter in the more affected side (MAS) of the PD group and that difference was statistically significant in patients with a more advanced PD stage (p=0.0439). A negative correlation between the duration of time since the last dose of PD medication and the duration of CuSP (r=0.583) a nd positive correlation between CSP and CuSP in the MAS of PD patients were observed. QOL in the PD group was significantly worse in 4 of 8 scores of the SF-36 questionnaire. Conclusions, impairment of inhibitory networks can be considered as a pathophysiological mechanism in PD. Further studies are needed to evaluate the impact of clinical variables on the mea su res of neurophy siologica I tests, also to establish a common mechanism affecting the duration of both CuSP and CSP. PD had a significant effect on the patients' QOL. [ABSTRACT FROM AUTHOR]

The cardinal symptom of myopathies is muscle weakness. Electrodiagnostic testing (EDX) in myopathies aims to elucidate the origin of muscle weakness, i.e., if the disorder is myopathic or neurogenic. It may also serve to document the distribution of muscle weakness and the disease course. Nerve conduction studies are helpful in the work-up of muscle disorders. Sensory nerve conductions should be normal, and motor nerve conduction studies may demonstrate reduced stimulation responses corresponding to muscle wasting. Needle myography can be used to estimate the size of motor units. In muscle diseases, degeneration of muscle fibres causes motor unit potentials (MUPs) to decrease in size. In neuropathies, unaffected nerve fibres may reinnervate denervated muscle fibres, hence increasing MUP size. MUPs are quantified by quantitative myography. The patient performs a liminal muscle contraction, recruiting only few MUPs at once, which can be recognized and reproduced. This lengthyand cumbersome procedure may be examiner-dependent, since recognizing and sampling of MUPs is influenced by the examiners judgement. The sensitivity of classic "Buchthal"-MUP analysis to detect myopathy or neuropathy is low. Modern automated MUP detection methods attempt to simplify the procedure and to increase its reliability. Needle myography can also show abnormal recruitment patterns in muscle disease. In myopathies, voluntary activation generates early recruitment, and dense interference patterns of small amplitude. Neuropathies generate high amplitude patterns with reduced recruitment. Recruitment anomalies can be estimated semiquantitatively or using computerized analyses (e.g., "Willison-Analysis"). In this ENMG teaching course, the EDX techniques mentioned above will be described and reviewed. Their useful ness for the work-up of muscle disorders will be critically discussed. [ABSTRACT FROM AUTHOR]