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Objective The aim of the study was to compare the effectiveness of radial extracorporeal shock wave therapy and local corticosteroid injection on pain, function, and nerve conduction studies in the treatment of idiopathic carpal tunnel syndrome. Design A total of 72 patients who were diagnosed as having carpal tunnel syndrome were included in the study. The radial extracorporeal shock wave therapy group received radial extracorporeal shock wave therapy, the local corticosteroid injection group received local corticosteroid injection, and the control group only used a resting hand splint. The patients were evaluated using a Visual Analog Scale-pain, a Visual Analog Scale-numbness, the Boston Symptom Severity Scale, the Boston Functional Status Scale, and handgrip strength tests before treatment 1 and 12 wks after the treatment. Results Both clinical and nerve conduction study parameters improved with all three groups, and this effect continued at the 12th-week follow-up of the patients. The Visual Analog Scale-pain, Visual Analog Scale-numbness, Boston Symptom Severity Scale, and Boston Functional Status Scale scores in the first week after the treatment, as well as Visual Analog Scale-pain and Boston Functional Status Scale scores in the 12th week after the treatment, were significantly lower in the local corticosteroid injection group compared with the other two groups. Conclusions Our study revealed the success of radial extracorporeal shock wave therapy, splint, and local corticosteroid injection, but symptom relief was greater in the first week and 12th week with local corticosteroid injection. © Wolters Kluwer Health, Inc. All rights reserved.

Background. The study of the sensitive portion of the medial plantar nerve is relevant not only in the examination of patients with tibial nerve mononeuropathy or its branches, but also in the diagnosis of polyneuropathies.Objective: to analyze the normative parameters of the sensory potential recorded during the study of the medial plantar nerve by the orthodromic method in healthy adults.Materials and methods. 126 sensitive fibers of the medial plantar nerves were studied on the Dantec Keypoint G4 device (Denmark) in 63 healthy individuals (31 men and 32 women; age from 20 to 80 years). 3 groups were identified taking into account age: group 1 included healthy people aged 20 to 39 years (n = 23); group 2 consisted of people aged 40 to 60 years (n = 20); and 3 – older than 60 years (n = 20). The parameters of the sensory potential of the medial plantar nerve are analyzed.Results. The sensory potential in the study of the sensitive portion of the medial plantar nerve was registered in all 126 healthy subjects. Comparative statistical analysis did not demonstrate significant differences between groups 1–3 in the values of such parameters of the sensory potential as the latency of the onset, the duration of the negative phase and the rate of propagation of excitation. At the same time, in groups 2 and 3, the magnitude of the amplitude from peak to peak of the sensory potential was significantly lower compared to group 1, and averaged 8.92 and 7.86 MV, respectively.Conclusion. Knowledge of the regulatory parameters will allow expanding the use of electroneuromyography of the sensitive portion of the medial plantar nerve in clinical and research practice.

The facial nerve (fn) palsy is a disease of the peripheral nervous system that leads to aesthetic, organic and functional disorders. The causes of the disease are different, the most common is the idiopathic form bell’s palsy. With a conservative approach to therapy, up to 80% of patients note the complete recovery of the lost functions of facial muscles, the others have the likelihood of severe consequences. Electroneuromyography is used to assess the risk of a negative outcome of the disease. In cases of confirmation of severe nerve damage, surgical treatment is suggested. The article presents a clinical case of complete recovery of the function of facial muscles in a patient with severe damage to the a nerve and an unfavorable prognosis. The course of the disease, complications of bell’s palsy and methods of their correction are described. Timely correct choice of treatment tactics and prevention of complications minimizes negative consequences. When working with a patient, a differentiated approach is important depending on the clinical situation.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a peripheral neuropathy, predominantly motor neuropathy, with a progressive or relapse-remitting course. Fatigue is a condition characterized by a physical or mental feeling of lack of energy or lack of motivation for action, which is often present in patients with CIDP.Objective: to assess the severity of asthenia in CIDP patients.Patients and methods. Examinations were made in 34 inpatients treated for documented CIDP that met the international European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) criteria. A study group included patients with CIDP, whereas a comparison group consisted of volunteers without psychiatric illness, who were compensated for somatic diseases.Results and discussion. In the patients with CIDP, the level of fatigue was found to be much higher than normal. Approximately half of the CIDP patients had obvious asthenia. However, the level of fatigue did not correlate with the severity of the course of CIDP.Conclusion. The findings suggest that fatigue is important in patients with CIDP that should be taken into account in the treatment of these patients.

Botulism is a rare but potentially life-threatening neuroparalytic syndrome caused by the action of a neurotoxin caused by the bacterium Clostridium botulinum. Early diagnosis and early treatment is important. In cases where botulism occurs sporadically, there is a need for easily applicable and rapid methods for diagnosis. The patient was admitted to the emergency department with complaints of dysarthria and sleepiness at the age of 7 years. During follow-up, bilateral ptosis, nystagmus, facial asymmetry, double vision and dysphagia developed. Electroneuromyography (ENMG) was performed in our case. It was evaluated as compatible with botulismus. Antitoxin treatment was performed. Six hours after the end of the antitoxin infusion, the ocular findings regressed, swallowing function improved, and dysarthric speech improved. Inconclusion, ENMG is found to be helpful in treatment decisions before toxin detection. Although toxin cannot be detected in patients, ENMG findings play an important role in the diagnosis of botulism.

One of the main causes of pain in the cervical spine, which causes the development of neurological deficit, is the stenosing process of the spinal canal with compression of the neurovascular structures. To determine the tactics of treatment, to predict the consequences of the disease, timely diagnosis of the functional state of neural structures is of great importance. Materials and methods. An informative method for diagnosing stenosing processes of the cervical spine, along with radiography and MRI, is electroneuromyography (ENMG). The analysis was based on 35 patients with a stenosing process of the spinal canal at the cervical level (17 men, 18 women), the average age of patients was 47.7 ± 9.9 years. Results . In the study of changes in the functional state of the axillary, radial, ulnar and median nerves, with stenosing processes, a unidirectional deviation of the entire ENMG complex of indicators of the limb with pain syndrome and contralateral limb was noted. A decrease in the amplitude of the maximum M-responses is recorded due to damage to the peripheral motor neuron and axon degeneration. Selective damage to the slow-conducting anterior motoneurons does not cause a decrease in the speed of impulse conduction due to demyelination. Bilateral changes in late electroneuromyographic phenomena (F-wave) are possibly caused by a general reaction of the peripheral and central nervous systems. Conclusion. In patients with a stenosing process of the cervical spine with severe clinical manifestations, ENMG values can be used both to determine indications for surgical treatment and to assess the dynamics of changes in the postoperative period.

Introduction. When considering the array of biomedical problems associated with facial nerve palsy (FNP), it is apparent that the problem of choosing an effective type of facial nerve transfer is of paramount relevance. Hence, it is to the pursuit of a solution to the above stated problem that our study is devoted. Materials and methods. We analyzed the data obtained as a result of assessing the outcome of 149 patients with trauma-caused FNP who had undergone surgical treatments in the period between 2001-2018. The FN nerve transfer techniques utilized were as such: for group 1 – the use as a donor nerve the branch of the accessory nerve innervating the sternocleidomastoid muscle (n=87); group 2 – the descending branch of the hypoglossal and the branch of the accessory nerve (n=62). Results. In groups 1–2, the FN nerve transfer significantly improved FN function (p Conclusion. The use of the accessory nerve branches to the sternocleidomastoid muscle, as donated, ensures restoration of FN function to levels II-III on the House-Brackmann scale in 89.7% of all operated patients, and the results it achieves do not differ from those of the technically more complex nerve transfer of FN by descending branch of the hypoglossal nerve with combination of branches of the accessory nerve.

International audience; Carpal tunnel syndrome (CTS) is too common a condition not to daily interact with the practitioner, if only because of its entanglement to other pathologies, causal or chance association. The typical symptomatology, with hand paresthesia and morning pain upon waking, is related to a median nerve injury in the confined space of the carpal tunnel, more often by local inflammation and tenosynovitis of the finger flexors (repet-2 itive activity of the hands). SCC may be secondary to situations (pregnancy) or conditions (edema, hypothyroidism ...) which exaggerate the ordinary pathophysiology or cause deposits in the channel (amyloidosis, mucopolysaccharidoses ...). Otherwise, SCC is favored by all neuropathies that cause nerve fragility (especially diabetes). It is sometimes the first sign of these various affections of which it can allow early diagnosis. Electroneuromyographic examination (ENMG) is a key examination to confirm the diagnosis (slowing of sensitive and motor conduction of the median nerve through the carpal tunnel, due to local demyelination), to look for a predisposing neuropathy and for signs of seriousness (amplitude reduction of electrophysiological signals) that indicate axonal loss. In SCC forms with only slowed conduction without sign of seriousness, a splint or infiltration treatment may be attempted. If this medical treatment does not bring healing, or if there are signs of seriousness or unbearable pains, a decompression surgery is indicated. Whether it is performed traditionally or endoscopically, it provides fast relief, even immediate.; Le syndrome du canal carpien (SCC) est une affection trop fréquente pour ne pas interpeller quotidiennement le praticien, ne serait-ce que par son intrication à d'autres pathologies, causales ou d'association fortuite. La symptomatologie typique, faite de paresthésies et de douleurs de la main le matin au réveil, est liée à une atteinte du nerf médian dans l'espace confiné du canal carpien, le plus souvent par inflammation locale et ténosynovite des fléchisseurs des doigts (activité répétitive des mains). Le SCC peut cependant être secondaire à des situations (grossesse) ou des affections (oedème, hypothyroïdie…) qui en accusent la physiopathologie ordinaire ou qui provoquent des dépôts dans le canal (amyloses, mucopolysaccharidoses…). Par ailleurs le SCC est favorisé par toutes les neuropathies qui causent une fragilité nerveuse (diabète notamment). Il est parfois le premier signe de ces diverses affections, dont il peut permettre un diagnostic précoce. L'examen électroneuromyographique (ENMG) est un examen clé pour confirmer le diagnostic (ralentissement de la conduction motrice et sensitive du nerf médian dans le canal carpien, par démyélinisation locale), chercher une neuropathie prédisposante et des signes de gravité (réduction d'amplitude des signaux électrophysiologiques) qui témoignent d'une perte axonale. Dans les formes avec ralentissement de conduction isolé sans signe de gravité, un traitement médical par attelle ou infiltration peut être tenté. S'il n'apporte pas la guérison ou s'il existe des signes de gravité ou des douleurs insupportables, une intervention chirurgicale de décompression est indiquée. Qu'elle se fasse par voie traditionnelle ou endoscopique, elle apporte un soulagement rapide, voire immédiat. Mots clés : syndrome du canal carpien, électroneuromyographie, diabète, amylose, douleur

Chronic inflammatory demyelinating polyneuropathy (CIDP) in patients with diabetes mellitus (DM) occurs approximately 9—11 times more frequently than in the general population. Objective : to assess the characteristics of CIDP in the presence of DM. Patients and methods . A total of 109 patients with CIDP diagnosed according to the international EFNS/PNS criteria were examined. Seventeen patients had type 1 or 2 DM; the remaining 92 patients did not. Results and discussion . The patients with CIDP and DM were found to have significantly more obvious neurological deficit, lower levels of selfservice, and a shorter time to diagnose CIDP than those with CIDP without DM. The concurrence of CIDP and DM is ambiguously assessed. On the one hand, there are indications of a strict correlation between these conditions, and on the other, the absence of this association. Our study showed that more obvious neurological deficit in DM can be related to the additional damaging impact of chronic hyperglycemia as impaired metabolism of nerve fibers and deterioration of their trophism. The autoimmune nerve damage occurring in CIDP is superimposed on the already existing impairments in the microcirculation and dysfunction of peripheral nerves, thereby increasing their damage. Conclusion . The course of CIDP in the presence of DM differs from that of «pure» CIDP, which should be taken into account in managing these patients.

Objective. To justify the possibility of using botulotoxin type A for the prevention of pain syndrome after aesthetic endoprosthesis of the mammary glands.Material and methods.The study included 72 women aged between 21 and 45 to whom were scheduled to perform breast endoprosthesis with silicone implants. All patients were divided into two groups: the first group included 38, the second group – 34 people. Two weeks before the expected date of surgery, botulotoxin type A in an amount of 100 U was injected into the patients of the first group to reduce pain syndrome in the pectoralis major muscle. Patients of the second (control) group were injected with a 0.9% NaCl solution (placebo effect) into the pectoralis major muscle. All patients underwent electroneuromyography (ENMG) to assess the denervation of the pectoralis major muscle before drug administration and two weeks after.Results.The intensity of pain syndrome was evaluated on the 1st-2nd day after surgery using a special questionnaire. In women of the first group, who were injected with botulinum toxin type A two weeks prior the intended surgery, a decrease in the intensity of the pain syndrome was observed, which in most cases allowed not to take analgesics at all. In women of the second group who were injected with a 0.9% NaCl solution, the severity of the pain syndrome reached its maximum values (according to the questionnaire), which required the prescription of analgesics, including narcotic ones, to reduce the severity of the pain syndrome. According to ENMG, when using botulotoxin type A by injecting into the pectoralis major muscle, denervation indices reached 55% compared to the initial ones, while using the saline solution, the ENMG indices did not change.Conclusion.Clinical use of botulotoxin type A injections into the pectoralis major muscle will improve the results of pain syndrome treatment after endoprosthetics of the mammary glands with implants in aesthetic surgery.

Osteoporosis and osteochondrosis have common clinical manifestations: poor posture, reduced flexibility and mobility of the spine, joint pain, fatigue, weakness; both diseases appear most often in old age. Having a lot in common in symptoms, osteoporosis and osteochondrosis differ in etiology, treatment and prognosis. The development of osteoporosis is based on impaired bone remodeling, but it has been established that this process is also important in the pathogenesis of osteochondrosis. The results of previous studies indicate that there is a relationship between the functional state of the neuromotor apparatus and the violation of the structure of bone tissue in the spinal canal stenosis of the lumbar spine. There is data on the study of the nerve conduction and bone mineral density in patients with osteochondrosis of the cervical spine in a small sample. To study the functional state of peripheral nerves and the presence of disorders of bone tissue structure in 2018, 25 patients of the neurosurgical department of Irkutsk Scientific Centre of Surgery and Traumatology were observed with the diagnosis "Dorsopathy, Osteochondrosis of the cervical spine" (М50.1) and 25 volunteers of the control group, representative of the main sex and age. As a result of the examination, all patients of the main group showed sufficiently deep afferent-efferent dysfunctions of the segment apparatus of the cervical spine, while in the control group changes in ENMG indicators showing initial changes in the function of the neuromotor apparatus were observed in 20 % of the examined. The change in bone density was observed in most of the main group examined (72 %), in the control group the decrease in bone density was less frequent (54 %, of which 29 % registered osteopenia). The results of the examination indicate the existence of a relationship between osteochondrosis and osteoporosis - the more symptoms of sensory-motor dysfunction of the root increase in osteochondrosis of the cervical spine, the more often the change in bone density - osteoporosis or osteopenia - is diagnosed.

Design Presentation of clinical cases and literature analysis. Material and methods Clinical observation of patients with congenital cervical spine and shoulder girdle anomalies operated on with neuromonitoring was performed. Operative treatment of Sprengel’s deformity was produced with the use of neuroimaging. Results Surgical treatment resulted in good clinical outcomes without neurological adverse events and good aesthetic and radiological appearance at the descended scapula. Discussion Consideration for intraoperative neuromonitoring should be given to prevent neurological complications at lowering the elevated scapula. Conclusion Review of outcomes showed efficacious application of the most valid methods used to descend the scapula with neuromonitoring. This was supported by clinical and radiological findings of the extent of cranial transposition after appropriate correction and absence of neurological adverse events early postsurgery and at a long-term follow-up. No recurrence of scapular dislocation was observed at a long-term follow-up.

The aim of this research was to study the most important problems in diagnosing a socially significant problem - osteochondrosis of the cervical spine. According to some authors, in the structure of disability and disability associated with pathology of the spine, diseases of the cervical spine occupy one of the leading positions. The paper analyzes data from 41 sources of literature on the pathogenesis and diagnosis of osteochondrosis of the cervical spine. Due to the complexity and ambiguity of the approaches to the diagnosis of osteochondrosis of the cervical spine, this paper analyzes the most important research methods in the diagnosis of this pathology. Attention is focused on the main pathogenetic prerequisites for the occurrence of pain. According to literature data, the main attention in the diagnosis of osteochondrosis of the cervical spine is given to the basic methods: clinical and neurological examination, where the severity of the disorders is determined using scales that include not only an assessment of the intensity of the pain syndrome, but also the determination of a number of neurological disorders. The authors propose the use of a DN4 questionnaire, LANSS scales, neurological impairment scales (N1S); radiation research methods, such as survey spondylography of the cervical spine in direct and lateral projections, functional spondylography of the cervical spine in the position of maximum flexion and extension, multispiral computed tomography, magnetic resonance imaging data, and neurophysiological studies. Radiation research methods can determine pathological changes in the bone tissue itself. Magnetic resonance imaging indices make it possible to assess the degree of pathological changes in the soft tissue anatomical structures of the spinal canal and intervertebral discs. According to the literature, much attention is paid to functional research methods, in particular, electroneuromyography, which allows to assess the level and degree of damage to nerve fiber, the dynamics of the pathological process. Attention is paid to the allocation of marker indicators. All methods are significant, evidence-based, objective and modern and do not exclude the possibility of using data from other research methods. The analysis of the presented literature once again convinces clinicians of the ambiguity and heterogeneity of approaches to the issues of pathogenesis and diagnosis of the cervical spine, which requires further improvement of the proposed methods for clarifying and objectifying the pathological process. An important andjustified is a pathogeneti-cally grounded approach to their study.

The OBJECTIVE was to study the changes of bioelectric activity of muscles in patients with local cold injury of the feet.MATERIAL AND METHODS. Non-invasive method of cutaneous electroneuromyography was used to evaluate the bioelectrical activity of muscles. The study was conducted in 52 patients with local cold injury of III–IV degree of the lower extremities of the late reactive period and the period of granulation and epithelialization. M-response amplitude, residual latency and propagation velocity of the excitation were estimated.RESULTS. In patients with local cold injury, there was a decrease in the bioelectric activity of the limb muscles proximal to the affected area. M-response amplitude and the propagation velocity of the excitation decreased in the patients in the late reactive period, while the residual latency increased. In patients with frostbite limbs during granulation and epithelialization, there was a tendency to restore the level of bioelectrical activity of muscles relative to the late reactive period.CONCLUSION. The basis of the adverse effects of local cold injury was “chronic” endothelial dysfunction and local neuropathy.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a heterogeneous immune-mediated peripheral neuropathy with progressive or relapse-remitting course. Incidence of CIDP ranged between 1 and 8.9/100 000. Recently, most frequent therapies for CIDP treatment was glucocorticosteroids, intravenous immunoglobulin and plasma exchange. In cases of ineffectiveness or lack of effectiveness, cytostatics, monoclonal antibodies and others could be used for CIDP treatment. In the article, authors presented an update data on the use of main methods for CIDP therapy, their mechanisms of action, indication for their use and advantages and disadvantages of each of them.

BACKGROUND: Diabetic distal polyneuropathy (DDPN) is a predictor of diabetic foot syndrome development, ulcer formation and lower limb amputation. An early DDPN diagnosis is therefore relevant. AIM: To investigate the effectiveness and suitability of electroneuromyography (ENMG) for early DDPN diagnosis. MATERIALS AND METHODS: This study was performed in the Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya. L. Tsivyan. A total of 80 participants were examined, including 30 DM2 patients, 30 patents without carbohydrate metabolism disorders, and 20 healthy volunteers aged 2030 years. None of the participants showed clinical signs of distal polyneuropathy (DPN). All participants underwent evaluation of neuropathy symptoms by the Neuropathy Symptom Score scale, neurological assessment using on the scale of Neuropathic Dysfunctional Score and stimulating ENMG. RESULTS: ENMG revealed the presence of neuropathy in 86.7% of DM2 patients. Moreover, among DM2 patients, 12 (40%) presented sensory DDPN, 13 (43.3%) presented sensorimotor neuropathy and 1 (3.3%) presented motor DDPN. The medial and lateral plantar nerves were the most commonly affected (p = 0.018 and p = 0.002, respectively). Among the 30 control individuals, 9 (30%) showed signs of DPN in combination with radiculopathy. ENMG - indicators of DDPN: latency and amplitude and speed for 3 sensory (n. Plantaris lateralis, n. Plantaris medialis, n. Suralis) and 2 motor nerves (n. Peroneus, n. Tibialis) were significantly worse in individuals with DM2 than in the control group, both for those with and without radiculopathy. Among participants with DM2, those sensorimotor DDPN tended to have a longer diabetes duration (p = 0.503), higher levels of HbA1c (p = 0.077) and higher BMI (p = 0.050) than those with sensory neuropathy, although the differences were not significant. CONCLUSION: This study confirms the effectiveness and suitability of ENMG for the early diagnosis of DDPN. Moreover, the optimal ENMG indices necessary for this diagnosis were identified.

Cubital tunnel syndrome (CTS) is manifested as hand sensory and motor impairments due to ulnar nerve compression in the cubital tunnel. The diagnosis is based on clinical data and is confirmed by electroneuromyography and ultrasonography. Conservative treatment methods (avoiding certain postures and movements; elbow splinting or orthosis use; and special exercises) is indicated for early-stage and mild CTS. Surgical treatment is indicated when conservative treatment is ineffective and when a patient has objective hand muscle weakness and atrophy. The paper considers the etiology, pathogenesis, and risk factors of CTS, and principles of its clinical and instrumental diagnosis and treatment in patients with this condition.

Failed block could be one of the adverse results of the conductive anaesthesia. There are situations, when in seemingly perfect technique of the block, properly chosen drug, dosage, adjuvant – the block is not achieved (it does not occur or is incomplete or so-called “mosaic block” occurs). It is necessary to remember about atypical or abnormal nerves branching, possible interneural anastomoses, when looking for the possible cause of it. Information about most common types of interneural anastomosis of arm’s and leg’s long nerves is presented in this article. Knowledge of possible abnormal neural innervation can provide an understanding of inefficacy of some simple blocks, decrease amount of mistakes in data interpretation, that was obtained during electroneuromyographic (ENMG) investigations, improve understanding of clinical pattern in the peripheral nerve injuries, that form anastomosis., Неудачная блокада может быть одним из побочных явлений проводниковой анестезии. Есть ситуации, когда при, казалось бы, идеальной технике блокады, правильно подобранному препарату и его дозировке, адъюванте – эффект блокады не достигается (или появляется так называемая мозаичная блокада). Необходимо помнить об атипичных разветвлениях нервов, возможных межневральных анастомозах как вероятной причине неудачных блокад. Информация о наиболее распространённых типах анастомозов верхних и нижних конечностей приведена в статье. Знания о возможных изменениях нормальной нервной иннервации может обеспечить понимание неэффективности некоторых блокад, снизить количество ошибок в интерпретации данных, полученных во время электронейромиографии, улучшить понимание паттерна клинических изменений при повреждении периферических нервов, образующих анастомоз., Невдала блокада може бути одним із побічних явищ провідникової анестезії. Є ситуації, коли при, здавалось би, ідеальній техніці блокади, правильно підібраному препараті та його дозуванні, ад’юванті – ефект блокади не досягається (або з’являється так звана мозаїчна блокада). Необхідно пам’ятати про атипові чи аномальні розгалуження нервів, можливі міжневральні анастомози, як імовірну причину невдалих блокад. Інформацію про найпоширеніші типи анастомозів верхніх на нижніх кінцівок наведено у статті. Знання щодо можливих змін нормальної іннервації може забезпечити розуміння неефективності деяких блокад, знизити кількість помилок в інтерпретації даних, отриманих під час електронейроміографії, покращити розуміння патерну клінічних змін при ушкодженні периферичних нервів, що утворюють анастомоз.

Spinal muscular atrophy (SMA) is a rare, inherited autosomal recessive disease. Histopathological shreds of evidence related to the condition have suggested degenerative changes at the level of the spinal cord and brain stem. Deletions or mutations in the survival motor neuron 1 (SMN1) gene are the underlying cause of this disease. It is characterized by hypotonia, muscular atrophy, areflexia, fasciculations, and flaccid paralysis. It is further classified into five variants, depending upon the patient's age and clinical features. In this report, we present a rare case of SMA type 2 in a one-year-old female infant who presented with generalized hypotonia and axial body weakness. Besides clinical evaluation, her genetic analysis confirmed that she had a deletion of one of the SMN1 genes. Hence, the diagnosis of SMA type 2 was confirmed. Our study aims to emphasize that clinicians must consider this rare entity whenever a patient presents with the signs and symptoms mentioned above. As the most common cause of death in this disease is respiratory depression, an early diagnosis would prevent complications and help in the parents' genetic counseling.

To evaluate the effectiveness of the developed method of acupuncture in the complex of conservative treatment of pain in patients with osteochondrosis of the cervical spine in the neurosurgical Department of Irkutsk Scientific Centre of Surgery and Traumatology, 58 patients were under observation, 38 of whom were treated with acupuncture. The results of treatment were evaluated by the applying VAS testing and conducting stimulation electroneuromyography. The patients had 9–10 sessions of corporal and auricular acupuncture. Acupuncture was carried out according to 1st or 2nd variants of inhibitory action. When selecting points, the locally segmental principle was used, and the effect was carried out on symmetric points of general action (P7, GI4, GI 11 , E36 , RP6, VB34), on local pain ah shi points, in “near” and “far” points from the pain zone; on standard points of meridians of calming action: sympathetic, sedative and analgesic (points-cracks). Specific pain points were used: in pain in the area of the shoulder girdle – R5, E37, R4: in the rear surface of the chest and region of the scapula – T26, V43, V11; in neuralgia – V60, TR5, VB41. Corporal reflexology “enhance” auricular, we used impact on АТ55, АТ13, АТ22, АТ51, АТ34. In cases of severe pain and musculotonic syndromes, treatment was initiated with effects on auricular points: АР37 point of the cervical spine and АР55 point Shen Men. When comparing the results of VAS testing before and after the treatment, in all patients we noted a decrease in the intensity of pain, and 16 of patients went into the category of “mild cases”. The positive dynamics is confirmed by the data of electroneuromyographic studies: an increase in the amplitude of the M-response and a decrease in latency, a change in the characteristics of the F-wave. The obtained data indicate the high efficiency of acupuncture in the treatment of pain and muscle-tonic syndromes in patients with spinal osteochondrosis.

Background: Diabetic polyneuropathy (DPN) is one of the chronic complications that occur in approximately 80% of diabetes mellitus (DM) patients. This condition is a results of metabolic, vascular, and immunological disorders. Objective: To determine the profile of electroneuromyography (ENMG) examination of DPN patients at neurology clinic of Saiful Anwar General Hospital. Methods: This cross-sectional observational descriptive study was carried out at Saiful Anwar General Hospital Malang from June 1, 2015 to December 31, 2015, with purposive sampling method. A total of 43 DM patients with symptoms of polyneuropathy fulfilling inclusion criteria and no exclusion criteria were examined for ENMG. ENMG examirnation were including distal latency, amplitude and nerve conduction velocity of 4 motoric nerves (median, ulnar, tibial, peroneal) & 3 sensory nerves (median, ulnar, sural), and F waves of ulnar, median and peroneal nerves of the left and right extremities. Results: Of the 43 patients evaluated in this study, the mean sensory sural nerve conduction velocity was 13.01 m/s. The majority type of nerve damage in diabetic polyneuropathy patients in this study were mixed type (52.33% in the median nerve, 60.47% in the ulnar nerve, 72.10% in the tibial nerve, and 54.65% in the peroneal nerve in motor nerve studies and 80.23% in the median nerve and 88.37% in the peroneal nerve in the sensory nerve studies). Conclusion: The nerve damage that occurs in DPN patients at Saiful Anwar general Hospital is severe, with the majority being the axonal demyelinating type, especially in the sensory nerve fibers in the inferior extremities.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired progressive or relapse-remitting immunemediated disease of peripheral nervous system. CIDP has typical and atypical variants. Typical variant includes development of symmetric motor and sensory nerve fibers functions abnormalities. The diagnosis of CIDP reveals on clinical presentation and electrophysiological data. There aren’t any biomarkers of such disease. Cerebrospinal fluid analysis, magnetic resonance tomography of peripheral nerves and nerve biopsy may be additional methods to confirm the diagnosis. Instead of international criteria of CIDP diagnosis and large variety of laboratory and instrumental methods, there are many difficulties to make the appropriate diagnosis. This review discusses current concepts of pathogenesis, clinical diagnostics and laboratory and instrumental methods used for differential diagnosis and confirmation of the diagnosis of CIDP and new areas in CIDP research.

The article presents clinical profile of patients with cervical osteochondrosis and cervicobrachial syndrome, results of cliniconeurological examination including X-ray diagnostics (plain frontal and lateral radiography of cervical spine, functional tests, frontal and lateral X-ray imaging of large joints of upper limbs), MRI of cervical spine, stimulation electroneuromyography and osteodensimetry. Statistical processing with definition of nonparametric test and correlation coefficient was performed using SPSS 22.0.0 software. Pearson and Spearman nonparametric tests were used for correlation analysis. Examination of patients with cervicobrachial syndrome revealed that bone tissue condition of a limb with pain syndrome slightly differs from the bone tissue condition of a healthy limb and is within normal range. Neuromyography showed that abnormality of a functional condition of studied nerves of upper limbs was not pronounced and was registered on both limbs. As a result of our research we can suppose that asymmetric abnormal focus inhibits peripheral and central chains of locomotor system both on injured and healthy limbs. Differences in functional condition of peripheral nerves of upper limbs in patients with cervicobrachial syndrome and healthy people are statistically significant and allow us to consider them as a sign of decompensation which prevent healthy performance.

Diabetic polyneuropathy (DPN) is one of the most common complications of diabetes mellitus. Management of patients with DPN is a complex medical and socioeconomic problem. The article presents the observational study results of 40 patients with type 2 diabetes mellitus complicated by DPN. Patients of the treatment group received Keltikan® complex in combination with basic therapy for 60 days, patients of the control group received only basic therapy. The treatment resulted in the positive changes observed in both groups, while the group taking Keltikan® complex showed more pronounced changes according to the total neurological symptoms (TSS) scale, the neuropathic dysfunctional score (NDS) scale, the neuropathic symptom score (NSS) scale, and also according to the electroneuromyography results.

With osteochondrosis of the lumbar spine and L3, L4 lesions, local overloads of the spinal-motor segment lead to disruption of the functioning of the biokinematic chain "spine-lower limbs". Gonarthrosis is considered as an independent disease requiring surgical treatment. We have not found on the functional state of the peripheral neuromotor apparatus, with taking into account segmental radicular manifestations in patients with grade 3-4 gonarthrosis. We examined the tibial and peroneal nerves, and H-reflex in 51 patients undergoing treatment at the clinical department of traumatology and orthopedics of ISCST In all examined patients we revealed changes in the function of the peripheral nerves of the lower limbs (increase in the threshold values of the M-response to 24.8 mA (norm - 16 mA), a decrease in the direct muscle response amplitude to an average of 0.6 mV (norm - 2.0 mV), a decrease in the rate impulse up to 37-39 m/s (norm - 40 m/s), all changed were more pronounced on the affected limb. The revealed changes in ENMG indices could be due to both degenerative changes in periarticular tissues and radicular syndrome in lumbar osteochondrosis. Changes in reflex excitability were observed in combination with prolapse of the H-reflex in the majority of patients. The data obtained indicate damage to the roots and spinal motoneurons in L3-L4-L5 and a change in the functional state of the peripheral nerves of the lower limbs, indicating a single pathogenetic mechanism of degenerative processes in the knee and spine.

1n 2015-2016 in Scientific-Clinical Department of Neurosurgery of 1rkutsk Scientific Center of Surgery and Traumatology, 22 patients (11 men and 11 women) were examined for osteochondrosis of the cervical spine and neck and upper extremity pain syndrome. Patients underwent clinical and neurological examination, radial methods of investigation (cervical survey radiography in the direct and lateral projections), functional tests (flexion and extension) and functional tests with weights, MSCT and MR1 of the cervical spine, radiographs of large joints of the upper extremities in two projections, stimulation electroneuromyography and osteodensitometry. The article presents the general clinical characteristics of the data of 22 patients with degenerative-dystrophic pathology of cervical spine and shoulder joint syndrome, and a moderate and severe neck and upper extremity pain syndrome. 1n the evaluation of clinical and neurological symptoms, unilateral cervicobrahialgia syndrome was detected in 19 (86 %) patients, cervicobrachialgia syndrome was noted on both sides in 3 patients, the syndrome of cervicocranialgia was noted in 4 patients. All radiographs showed deforming osteoarthritis of the clavicular-acromial joint (11 persons), shoulder (10 persons), elbow joint (4 persons). MR1 revealed a multilevel pathology of intervertebral discs. According to ENMG, there was a disturbance of the functional state of the peripheral nerves of the upper limbs, which manifested itself on both sides. The state of bone tissue of the limb with the pain syndrome was not significantly different from that of the healthy limb, and generally corresponded to the norm. Thus, the materials presented in the article represent the initial data of the examination of patients with the neck and upper extremity pain syndrome in the department of neurosurgery according to the algorithm developed in 1rkutsk Scientific Center of Surgery and Traumatology.

Manifestations of cervical osteochondrosis are largely predetermined by degenerative changes in the most mobile lower cervical spine (C V -C VI , C VI -C VII ). Clinical picture of cervical osteochondrosis depends not so much on the presence of hernial protrusions as on the changes in bone structures with the formation of arthrosis with pain syndrome. In this regard, we found interesting to study relation of electroneuromyographic parameters and bone mineral density in patients with cervical osteochondrosis. A survey of 38 patients with cervical osteochondrosis localized predominantly in the segments C III -C IV , C IV -C V , C V -C VI C VI -C VII there were 20 men and 18 women. Subjective and objective examinations showed pronounced muscular-tonic syndrome (with cervicalgia, cervicocranygia, cervicobrachialgia) in all patients. We studied threshold values, M-response amplitude, nerve conduction in motor fibers of the axillary, radial, medial and ulnar nerves, as well as amplitude and frequency indices characterizing the functional state of the deltoid and trapezius muscles. When studying the state of bone tissue, we measured the speed of sound velocity (SV, m/sec) in the radial bones, determined the T-index - the number of standard deviations from mean for healthy young people, and the Z-index - the number of standard deviationsfrom mean for the age group. Comparative analysis of the results of studies by electroneuromyography and osteodensitometry in patients with cervical osteochondrosis of I-II periods, in the presence of neurotrophic disorders have not revealed changes in bone density. At the same time, in patients with cervical osteochondrosis of the III period in the presence of both protrusions and hernias of C VI -C VII C VII -C VIII discs, a reduction in threshold values of direct muscle response, an increase in the amplitude of evoked potentials, and a shortening of the latent period were recorded in the ENMG. Mineral density in patients with this pathology differed from the norm, indicating the presence of osteopenia.

Objective: diagnostics of erectile disorders within men with diabetic autonomic neuropathy and detection of rehabilitation methods of patients with erectile dysfunction (ED) affected diabetes mellitus (DM).Materials and methods. Thirty patients with DM were examined (15 patients with type 1 and 15 patients with type 2 respectively). Patients with DM had ED mainly of severe form (IIEF-5 from 6 to 16 points). According to the results of conducted examination the patients were prescribed the course of conservative therapy including hosphodiesterase in hibitors of type V, anticholinesterase drugs, drugs of thioctic acid. Conservative therapy was combined with shock wave therapy in the area of the penis. The group for comparison consisted of 15 healthy men (volunteers) without signs of ED (IIEF-5 21–22 points). Immune-enzyme analysis was used for detection of sex hormone status. Ultrasound, dopplerographic and X-ray methods were used for conduction of angiography of pool vessels of internal pudendal artery (IPA). Electroneuromyography of penis nerves was conducted.Results. According to the conducted research patients with DM were diagnosed with cavernous fibrosis, angiosclerosis of IPA and penis vessels in 100 % cases. Axonopathy of motor and sensory nerves of penis was detected in 100 % cases, stenosis and occlusion changes in IPA were detected in 42.9 % cases causing disorder and insufficiency in arterial perfusion in IPA pool.Conclusion. Denervation changes in sensory and motor nerves of penis and hemodynamicly significant perfusion disorders in IPA pool were principal pathogenetic factors of ED within the patients with DM. Decrease of reaction of IPA to the pharmacological stimulation was noted within patients with DM, which was caused by the angiosclerosis and loss of arterial wall elasticity. There was noted inefficiency of conservative therapy within patients with DM and ED at severe stage.

Purpose: assessment of the influence of the level of psychoemotional stress and the effectiveness of mental self-regulation on the functional state of the neuromuscular system and the effectiveness of the sensorimotor activity of highly skilled athletes specializing in complex co-ordination sports (on the example of diving) . Material & Methods: study involved 14 high-class athletes (master of sport, international master of sport, honored master of sports) at the age of 15–30 years. To determine the psychophysiological properties of the nervous system of athletes, the diagnostic complex "Diagnost-1" are used. Electroneuromyography was performed on the neurodiagnostic complex " Nicolet Viking Select " . For a differentiated assessment of the level of stress, the emotional state of the respondents and also for assessing the effectiveness of mental self-regulation, a technique to select colors was used . Result: interrelation between the effectiveness of mental self-regulation and adaptability, the intensity of existing stress, emotional stability and vegetative balance with electroneuromyographic characteristics , strength and functional mobility of nervous processes, the accuracy of reaction to a moving object and the ratio of the reactions of lead and lag, the efficiency of sensorimotor activity are identified . Conclusion: revealed interrelation of the effectiveness of mental self-regulation and adaptability , intensity of existing stress, emotional stability and vegetative balance with typological properties of the higher parts of the central nervous system and electroneuromyographic characteristics of athletes can have prognostic value and be used to optimize the sports development of promising young people.

Hirayama disease (HD) is a rare motor neuron disorder that involves a single upper extremity. It is clinically characterized by weakness and atrophy of the muscles of the hand and forearm. This article presents a 19-year-old woman who visited the orthopedics outpatient clinic with weakness and atrophy in her right hand and was clinically diagnosed with advanced stage carpal tunnel syndrome and scheduled for surgical intervention; she was later diagnosed with HD by an electrophysiological study. As a result, it has been found that a careful electrophysiological study and neurological examination can be used to diagnose HD. In this way, advanced stage carpal tunnel syndrome will be ruled out and patients will be spared from an unnecessary surgical operation.

Key Clinical Message Guillain–Barré syndrome (GBS) may present as distal acute inflammatory demyelinating polyradiculoneuropathy (AIDP), with severe distal demyelination of the peripheral nerves in the absence of radiculitis. Clinical course is benign, and prognosis seems favorable, but nerve conduction studies (NCS) findings at nadir may resemble some chronic forms of polyneuropathy, so close follow‐up during recovery is needed.

Myasthenia gravis (MG) in older adults has not been extensively studied. The prevalence of this disease in older people seems to be higher in recent epidemiological studies. In patients with disease onset after the age of 70, the diagnosis is more difficult as other conditions are more easily taken to be the causal element. The mortality is higher than in young patients, so prompt specific treatment can improve prognosis. We present an 85-year-old female patient with speech disturbance and difficulty in swallowing solids, and neurological examination with palpebral ptosis, disphonia, convergent strabismus and weakness and mild progressive fatigue in arms, with electroneuromyography and acetylcholine receptor antibody who was diagnosed with MG, emphasizing the importance of this entity in geriatric patients.

Обоснование: Местная холодовая травма в общей структуре травматических повреждений в мирное время в зоне с умеренным климатом составляет около 1%, а в Сибири, на Дальнем Востоке и в северных регионах достигает 6–20%. Значимость криотравмы обусловлена сложностью лечения, длительной утратой трудоспособности и высоким процентом посттравматических осложнений с последующей инвалидизацией пострадавших. Ранний прогноз течения позволяет выполнить коррекцию лечения, что способствует снижению общего количества посттравматических осложнений, а в некоторых случаях – и их предотвращение. Цель: Оценить клиническую эффективность предлагаемого способа прогнозирования осложнений местной холодовой травмы, основанного на изучении динамики электронейромиографии (ЭНМГ) у пациентов с местной холодовой травмой III–IV степени. Методы: В исследование включено 60 пациентов с отморожениями III–IV степени нижних конечностей в позднем реактивном периоде. Измерение биоэлектрической активности выполнялось на 5-е сутки от момента получения травмы. Все пострадавшие находились на стационарном лечении в краевом центре термической травмы на базе городской больницы № 1 г. Читы с местной холодовой травмой дистальных сегментов стоп в период с 2018 по 2019 г. Для оценки биоэлектрической активности мышц использован неинвазивный метод накожной ЭНМГ. Результаты: В ходе исследования выявлено, что у пострадавших с местной холодовой травмой происходит выраженное изменение показателей ЭНМГ. Значительное снижение амплитуды М-ответа указывает периферическую «острую» нейропатию, которая связана с нарастающей дисфункцией эндотелия и острым периферическим интравазальным и экстравазальным воспалением. Увеличение уровня повреждения конечности сопровождается усугублением изменений показателей ЭНМГ. Заключение: Исследование параметров периферической иннервации отражает течение посттравматического периода у пациентов с местной холодовой травмой и позволяет выявить различия между его неосложненным и осложненным течением. Предложенный способ прогнозирования способствует выделению группу пациентов с прогнозируемым осложненным течением местной холодовой травмы, что способствует коррекции проводимой комплексной терапии с учетом вероятных патогенетических нарушений., Backgraund: local cold injury in the general structure of traumatic injuries in peacetime in the zone with a moderate climate is about 1%, and in Siberia, the far East and the Northern regions reaches 6–20%. The significance of frostbite is due to the complexity of treatment, long - term disability and a high percentage of post-traumatic complications with subsequent disability of the victims. Early prognosis of the course allows for correction of treatment, which helps to reduce the total number of post-traumatic complications, and in some cases – and their prevention. Aims: to evaluate the clinical effectiveness of the proposed method for predicting complications of local cold injury, based on the study of the dynamics of electroneuromiography in patients with local cold injury of III-IV degree. Materials and methods: The study included 60 patients with frostbite of the III–IV degree of the lower extremities in the late reactive period. Measurement of bioelectric activity was performed on the 5th from the moment of injury, the presence of complications was assessed on day 30. All the victims were hospitalized in the regional center of thermal trauma on the basis of the city hospital No. 1 of Chita with local cold trauma of the distal segments of the feet in the period from 2018 to 2019. To assess the bioelectric activity of muscles used non-invasive cutaneous method of electroneuromyography. Results: In the course of the study, it was found that patients with local cold trauma have a marked change in ENMG indicators. A significant decrease in the amplitude of the M-response indicates peripheral «acute» neuropathy, which is associated with increasing endothelial dysfunction and acute peripheral intravasal and extravasal inflammation. An increase in the level of limb damage is accompanied by an aggravation of changes in ENMG indicators. Conclusions: The study of the parameters of peripheral innervation reflects the course of the post-traumatic period in patients with local cold trauma and allows us to identify differences between its uncomplicated and complicated course. The proposed method of forecasting contributes to the selection of a group of patients with a predicted complicated course of local cold injury, which contributes to the correction of the complex therapy, taking into account the likely pathogenetic disorders., Вестник Национального медико-хирургического Центра им. Н.И. Пирогова, Выпуск 2 2020

BackgroundThis research is recommended by the Myopathy Committee of the Brazilian Society of Rheumatology for the investigation and diagnosis of systemic autoimmune myopathies.BodyA systematic literature review was performed in the Embase, Medline (PubMed) and Cochrane databases, including studies published until October 2018. PRISMA was used for the review, and the articles were evaluated, based on the Oxford levels of evidence. Ten recommendations were developed addressing different aspects of systemic autoimmune myopathy investigation and diagnosis.ConclusionsThe European League Against Rheumatism/ American College of Rheumatology (EULAR/ACR) classification stands out for the diagnosis of systemic autoimmune myopathies. Muscular biopsy is essential, aided by muscular magnetic resonance images and electroneuromyography in complementary research. Analysis of the factors related to prognosis with the evaluation of extramuscular manifestations, and comorbidities and intense investigation regarding differential diagnoses are mandatory.

L’objectif de cette étude est d’évaluer l’utilité de l’échographie dans le diagnostic de syndrome du canal carpien par rapport à l’électroneuromyogramme (ENMG). Il s’agit d’une étude transversale incluant 50 patients sur une période de 6 mois. Tous les patients avaient bénéficié d’une échographie avec mesure de la surface du nerf médian à l’entrée du canal carpien et une étude électroneuromyographique des 2 poignets. La sensibilité et la spécificité de l’échographie ont été comparées à ceux de l’ENMG comme référence. L’âge moyen est de 49,6 ans avec une nette prédominance féminine dans 98%. La majorité des patientes étaient des femmes au foyer. Les paresthésies étaient le motif le plus fréquent de consultation dans 86%. La symptomatologie clinique était bilatérale dans 78% des cas. L’ENMG était pathologique chez 89 poignets (89%). L’échographie était anormale chez 63 poignets (63%) avec une médiane de la surface du nerf médian de 11 mm2. D’après cette étude, la sensibilité d’échographie était de 70%, et la spécificité était de 100% avec une valeur prédictive positive (VPP) de 100% et une valeur prédictive négative (VPN) de 29,7%. On a conclu que l’échographie n’est sensible que pour le syndrome de canal carpien avec une atteinte sévère à l’ENMG.

Objectives: This study aims to investigate whether or not radial deviation developing after wrist involvement of rheumatoid arthritis (RA) is a cause of median nerve swelling. Patients and methods: The study included 51 RA patients (12 males, 39 females; mean age 50.9±8.9 years; range, 18 to 65 years) without carpal tunnel syndrome (CTS) detected by electroneuromyography. Duruöz hand index, visual analog scale, and painDETECT questionnaire were performed in clinical assessment. Radiographic measurements including radial inclination (RI) angle were performed. Using ultrasonography, the median nerve cross-sectional areas (CSAs) were measured from the four levels of the distal one third of the forearm, radioulnar joint, pisiform bone, and hook of hamate, while the ulnar nerve CSAs were measured from the pisiform bone. Results: The study was completed with 102 hands of 51 patients. A negative correlation was found between the RI and the median CSAs measured from the radioulnar joint (R=-0.49; p=0.00), the pisiform bone (R=-0.45; p=0.00), and hook of hamate (R=-0.60, p=0.00). When the hands were divided into three groups according to the ranges of RI specified in the literature, the median nerve CSA was found to be significantly higher in the group with low RI at these levels (p

Purpose:to estimate efficiency of pathogenetic therapy of diabetic polyneuropathy with including of benfotiaminby means of an electroneuromyography. Materials:assessment of efficiency of pathogenetic therapy of diabetic polyneuropathy with including of benfotiaminat patients with various experience of a diabetes mellitus 2 types was carried out. The research included three groups of patients with an experience of diabetes 2 type – 1-3 years (1 group), 3-7 years (the 2nd group), 7-10 years (the 3rd group). The conduction research on nerves of the lower extremities by an electroneuromyography method was the main criterion of efficiency (primary final point). Results:according to ENMG-control statistically significant improvement of conduction on peripheric nerves against the background of therapy by benfotiamin within 12 weeks was shown. More faster improvement of conduction was reached in groups with a smaller experience of a diabetes mellitus (up to 7 years) and at the patients who were earlier receiving courses of pathogenetic therapy. Conclusions:Including of benfotiamin in a complex of therapy of diabetic polyneuropathy allows to achieve reliable improvement of a condition of peripheric nerves from patients with various experience of a diabetes mellitus 2 types.

The urgency of the problem of diabetic distal polyneuropathy (DDPN) is preconditioned by its great prevalence, according to specialized studies data, late diagnostics and serious consequences. The importance of DDPN diagnostics at its early stage doesn’t generate doubts: just at this period disturbance of peripheral nerves is of reciprocal nature and the therapy is effective to the maximum degree. But the objectification of the DDPN diagnosis is difficult: the data of neurologic and electrophysiological tests often do not correspond to the clinical symptoms and signs as these methods evaluate lesions of large nervous fibers whereas in DDPN it’s small fibers that are damaged in the first place. Use of skin biopsy and confocal corneal microscopy for evaluation of small fibers is extremely restricted in a clinical practice. Possibilities of electroneuromyography (ENMG) are analyzed as an option: parameters with their subjective peculiarities, selection of nerves and their number for DDPN diagnostics as a context of topographic neurology and neurophysiology of distal fibers.

The aim of the research was to study electrophysiological values in patients with blade-humerus pain syndrome at cervical osteochondrosis and posttraumatic shoulder injuries. We managed 71patients: 33patients with cervical osteochondrosis and brachialgia getting conservative treatment in the neurosurgical unit of Irkutsk Scientific Center of Surgery and Traumatology (group1) and 38patients with injuries of shoulder joint capsules and ligaments getting treatment in the unit of traumatology and orthopedics (group2). Comparison of electroneuromyographic values in pa-tients of both groups showed unidirectional changes in the values and accentuated decrease in electroneuromyographic parameters on both affected and unaffected extremities. In both cases median nerve was affected most. We registered the decrease in conduction velocity of motor fibers of intact nerves in patients of both groups. Lack of clinical signs of lesion of these nerves can be indicative of functional changes in nerve conduction which reflect generalized reaction on the lesion of certain nerve stems.

Aim: Electroneuromyography (ENMG) is an electrophysiological method of examination for neurophysiological state of motor neuron, peripheral nerve and muscle functions. This study was aimed to investigate the concordance of between referral diagnosis and ENMG diagnosis in patients referred to the electrophysiology laboratory. Methods: A retrospective cohort study is planned. Patients, whose evaluations of ENMG were requested by the orthopedic, neurology and physical therapy and rehabilitation physicians between June 2015 and December 2018, were included in this study. Descriptive statistics and Cohen’s Kappa Test were run for data set analysis.Results: A total of 486 patients are included in the study. Of the 486 patients undergoing ENMG examination, 362 were female (74.5%) and 124 were male (25.5%). The mean age was 46.71±12.41. 35.2% (n=171) of the referral diagnoses were requested by orthopedics, 32.7% (n=159) by physical therapy and rehabilitation and 32.1% (n=156) by neurology clinics. When the consistency between the preliminary diagnosis and post-ENMG diagnosis was examined; 65.4% of the results were found to be compatible. According to the clinics; 76.3% of the requests referred by the neurology clinic and 64.8% of the requests referred by the physical therapy and rehabilitation clinic, 56.1% of the requests referred by the orthopedic clinic were confirmed by ENMG. As a result of the Cohen’s Kappa test, the total (κ) correlation between clinical preliminary diagnosis and ENMG diagnosis was found to be 0.574 (p, Amaç: Elektronöromiyografi (ENMG) motor nöron, perifer sinir ve kas fonksiyonlarının nörofizyolojik olarak değerlendirilmesinde kullanılan yöntemdir. Bu retrospektif çalışmada Nörofizyoloji laboratuvarında değerlendirilmiş olan hastaların klinik ön tanıları ile ENMG tanıları arasındaki uyumun araştırılması amaçlanmıştır. Yöntemler: Çalışmada, Haziran 2015- Aralık 2018 yılları arasında Ortopedi, Nöroloji ve Fizik Tedavi ve Rehabilitasyon (FTR) uzmanları tarafından ENMG istemleri yapılmış olan 486 hastanın sonuçları, ön tanı ile elektrodiagnostik uyumluluğu açısından retrospektif olarak incelendi. Verilerin analizinde betimsel istatistik ve Cohen’s Kappa Testi kullanıldı. ENMG incelemesi yapılan toplam 486 hastanın 362’si kadın (%74,5), 124’ü erkekti (%25,5) ve hastaların yaş ortalaması 46.71±12.41 idi. Bulgular: Hastaların %35,2’sinin (n=171) istemi Ortopedi, %32,7’sinin (n=159) istemi FTR, %32,1’inin (n=156) istemi Nöroloji kliniklerinden yapılmıştı. En çok ön tanı Karpal Tünel Sendromu (%44,4) idi. Ön tanılar ile ENMG sonrasında raporlanan tanılar arasındaki tutarlılık incelendiğinde; sonuçların %65,4 oranında uyumlu olduğu görüldü. Kliniklere göre değerlendirme yapıldığında ise Nöroloji kliniğince yapılan isteklerin %76,3’ü, FTR kliniğince yapılan isteklerin %64,8’i ve Ortopedi kliniğince yapılan isteklerin %56,1’i ENMG ile doğrulanmıştı. Ön tanıların ENMG ile desteklenme oranları incelendiğinde; peroneal nöropati (%78,8) en yüksek orana sahipti. Chen’s Kappa testi sonucunda toplamda klinik ön tanılar ile ENMG tanıları arasındaki uyum (κ) değeri 0,574 olarak bulundu (p

INTRODUCTION[|]Carpal tunnel syndrome (CTS) is the most common and best studied of all focal neuropathies. CTS is a clinical syndrome of numbness, tingling, burning, and/or pain associated with localized compression of the median nerve at the wrist.[¤]METHODS[|]A total of 49 hands of 32 patients who presented at the electrophysiology laboratory of the clinic due to suspected CTS were prospectively enrolled in the study. The patients were evaluated using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale and a visual analog scale (VAS). The LANSS pain scale is an instrument designed for use in a clinical setting to identify patients whose pain is dominated by neuropathic mechanisms. VAS is a subjective register of pain: On a 100-mm horizontal scale, 0 indicates no pain, while 100 indicates maximum pain. The patients were diagnosed using electrophysiology and grouped as mild, moderate, and severe CTS. LANSS pain scale values above 12 and below 12 were compared according to the severity of CTS. The VAS was applied separately to the right hand and left hand. LANSS and VAS results were compared separately.[¤]RESULTS[|]The LANSS pain scale value was found to be 12 or more in cases of mild and severe CTS. The response to the LANSS question related to discoloration (item 2) was greater in the patients with a LANSS score ≥12 (p=0.008), and similarly, the allodynia (item 6) response was significantly higher in the same group (p=0.010). Except for these 2 items, there was no significant difference between patients with a LANSS score of

Comparison of clinical-roentgenologic and electroneuromyographic data was performed for 29 patients, aged 3 - 16 years, at different stages of conservative and surgical treatment for hip joints dysplasia. First group included 18 patients with complicated clinical course; second - 11 patients with favorable process of joint formation. Functional activity of motor neurons, spinal cord and peripheral nerves conductivity was assessed. It was shown that in patients from the 1 st group the ENMG indices were statistically significantly lower than in healthy children ( р

Aim of the work The purpose of this study was to investigate the rheumatoid arthritis (RA) characteristics, functional capacity, depression and anxiety as well as quality of life (QoL) in RA patients with chronic radicular low back and leg pain diagnosis which was determined by using electroneuromyographic (ENMG) evaluation. Patients and methods In this study, 32 female RA patients with radicular low back and leg pain for at least 3 months were recruited. Electroneuromyographic (ENMG) evaluation was performed in all patients and accordingly grouped: group 1: normal ENMG (n = 7; 22%), group 2: patients with polyneuropathy (n = 8; 25%) and group 3: patients with radiculopathy (n = 17; 53%). Disease activity was assessed by disease activity score (DAS28) and functional disability by modified Health Assessment Questionnaire (mHAQ). Arthritis Impact Measurement Scale-2 was used to assess QoL and Beck Inventory for assessment of anxiety and depression. Results The mean age of the patients was 54.7 ± 10.3 years and disease duration 14.9 ± 8.3 years. The DAS-28 and functional disability were significantly increased (p = 0.005 and p = 0.01) in group-2 compared to the other groups. There were no significant differences in the depression and anxiety scores among the 3 groups. Significantly impaired QoL parameters (Hand-finger function, arm function, social activity and pain) were present in the polyneuropathy group. There was no difference in assessment parameters between the normal and radiculopathy groups. Conclusions Chronic radicular low back and leg pain in patients with RA may be due to probable lumbar radiculopathy as well as an indicator for polyneuropathy.

Introduction: We assessed the clinical, epidemiologic, electrophysiological and prognostic characteristics of childhood Guillain-Barré Syndrome admitted to 13 pediatric neurology centers in Turkey. Method: Using a standard data recording form age, sex, duration of symptoms, distribution of weakness at onset, cranial nerve involvement, cerebrospinal fluid findings, electrophysiological findings, duration of hospitalization, requirement of ventilation, treatment and clinical evaluation scale at onset, discharge and 1, 3, 6, and 12 months after discharge were recorded. Results: Among the 236 children with a median age of 6.8 years there was a male to female ratio of 1.3. Based on the electrophysiological features; 84 patients were classified as acute inflammatory demyelinating polyrediculoneuropathy (AIDP), 61 as acute motor axonal neuropathy (AMAN), 21 as acute motor-sensory axonal neuropathy (AMSAN). The incidence of cranial nerve involvement was 16%, and was related to lower clinical scores at discharge and 6 months after discharge. Clinical scale scores between axonal and demyelinating subgroups did not show statistically significant difference except for admission (p

WOS: 000397364700006 PubMed: 28094417 Objectives: This study aimed to investigate the adaptability of the electrical root stimulation technique by achieving normative data from the obturator and femoral nerves of healthy dogs. Methods: For this purpose, two stimulations and recordings were performed on both the obturator and femoral nerves in 40 dogs (22 males and 18 females). Electrical root stimulation was applied via monopolar needle electrodes between the sixth to seventh and fifth to sixth lumbar interarcuate spaces to the obturator and femoral nerves, respectively. Muscle waves were recorded from the gracilis and sartorius muscles of the left and right pelvic limb. Results: The proximal motor nerve conduction velocity was 60.89 +/- 3.93 m/s and 59.87 +/- 4.83 m/s in the obturator and femoral nerves, respectively. Clinical significance: Our results showed that electrical root stimulation could be a useful method to test the integrity of the roots of obturator and femoral nerves and their proximal parts. Scientific and Technological Research Council of TurkeyTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [TUBITAK 1110404]; Scientific and Technological Research Council of TurkeyTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) This study is a part of the research numbered TUBITAK 1110404 that was supported by the Scientific and Technological Research Council of Turkey. We are grateful for the support of the Scientific and Technological Research Council of Turkey.

Carpal tunnel syndrome(CTS) is the most common neuromuscular cause of upper extremity disability. We aimed to investigate the effectiveness of peloid therapy in patients with CTS. This randomized, controlled, single-blind study enrolled 70 patients between the ages of 30 to 65 who had a diagnosis of either mild, mild-to-moderate, or moderate CTS. The patients were randomized into two groups using random number table. In the first group, (Group 1)(n = 35), patients were given splint (every night for 6 weeks) + peloid treatment(five consecutive days a week for 2 weeks) and in the second group, (Group 2)(n = 28), patients received splint treatment(every night for 6 weeks) alone. The patients were assessed by using visual analog scale(VAS) for pain, electroneuromyography(ENMG), the Boston Carpal Tunnel Syndrome Questionnaire(BCTSQ), hand grip strength(HGS), finger grip strength(FGS), and Short Form-12(SF-12). The data were obtained before treatment(W0), immediately after treatment(W2), and one month after treatment(W6). Both in Group 1 and 2, there was a statistically significant improvement in all the evaluation parameters at W2 and W6 when compared to W0(p < 0.05). Comparison of the groups with each other revealed significantly better results for VAS, BCTSQ, mSNCV, SF-12 in Group 1 than in Group 2 at W2(p < 0.05). There was also a statistically significant difference in favor of Group 1 for VAS, BCTSQ, FGS and MCS at W6 when compared to W0 (p < 0.05). The results of our study demonstrated that in patients with CTS; peloid + splint treatment was more effective than splint treatment alone in pain, functionality and life quality both at after treatment(W2) and one month after treatment (W6). We may suggest peloid as a supplementary therapeutic agent in CTS.

Introduction: We aimed to assess central and peripheral nervous system involvement in systemic lupus erythematosus (SLE) patients without any neurological signs and symptoms by performing electrophysiological investigations. Methods: Thirty-eight SLE patients and 35 healthy volunteers participated in this study. Peripheral nerve conduction and brainstem reflexes were evaluated by performing nerve conduction studies (NCSs) and blink reflex (BR) and masseter inhibitory reflex (MIR) recordings. Results: Eleven patients (29%) had an abnormality in at least 1 NCS parameter, and 1 (2.6%) patient was diagnosed with polyneuropathy. The number of patients with abnormal BR and MIR was 23 (60.5%) and 14 (37%), respectively. The contralateral R2 latency of BR and the silent period 1 (SP1) latency of MIR were significantly prolonged in the patients compared with the controls (p=0.015 and p

†‡ § Background/Aims: Infl ammatory bowel disease is a chronic, recurrent disorder that involves multiple organ systems. Polyneuropathy is the most common neurological manifestation. The aim of the present study was to investigate the relationship between polyneuropathy and infl ammatory bowel disease. Methods: The study included 40 patients with infl ammatory bowel disease (20 with ulcerative colitis and 20 with Crohn’s disease) and 24 healthy controls. The patients had no clinical signs or symptoms of polyneuropathy. Nerve conduction studies were performed using an electroneuromyography apparatus. Results: Mean distal motor latencies, conduction velocities, and F wave minimum latencies of the right median nerve were signifi cantly abnormal in the patient group, compared to the healthy controls (p

Aim To determine whether endovenous laser ablation of incompetent greater saphenous vein causes a detectable impairment in saphenous nerve conduction. Material and methods Thirty-five patients (mean age: 44.78 ± 8.6, male/female ratio: 16/19) who were operated on for incompetent greater saphenous veins, underwent electroneuromyography before and two weeks after the operation. Dysesthesia was questioned as to whether having unpleasant abnormal sensation after the operation. Positive electroneuromyography findings for saphenous nerve injury included a sensory nerve action potential amplitude 5.0 ms. Results Thirty-four patients were available at two-week follow-up. All patients achieved complete proximal closure. Three patients (8.8%) had dysesthesia at two weeks. Mean electroneuromyography values were not significantly different between preoperative and postoperative period. Postoperatively, none of the patients had abnormal sensory nerve action potential or latency onset, whereas nerve conduction velocity decreased below the lower limit in two patients. These two patients were not among those having dysesthesia and they had no other complaints. Conclusion Injury to saphenous nerve seems not likely during endovenous laser ablation of incompetent greater saphenous veins, as evidenced by normal electroneuromyography values found after the operation.

WOS: 000361692900009 PubMed: 28360720 Introduction: Fabry disease (FD) is an X-linked recessive inherited disorder characterized by lysosomal alpha-galactosidase deficiency. The purpose of our study was to assess and compare the electroneuromyographic (ENMG) findings of 15 patients with Fabry disease and the electroneurographic (ENG) findings of 15 healthy controls. We have not encountered any similar study in the medical literature of our country. Therefore, we believe that our study will contribute to national literature. Methods: Fifteen patients with Fabry disease, 13 females and 2 males and 15 healthy controls, 13 females and 2 males, were included in the study. The definite diagnosis of patients with Fabry disease was made based on the enzyme level and genetic mutation. The patients with Fabry disease were examined with ENMG, while the healthy control group was examined with ENG. In the patients with a normal ENMG examination, neuropathic pain was attributed to the small fiber involvement. Results: Patients with Fabry disease had neuropathic pain (LANSS score >= 12). While neurological examination was normal in eight patients, glove-and stocking-type hypoesthesia and decreased deep tendon reflexes were observed in five and two patients, respectively. Axonal polyneuropathy was detected in one patient. The ENMG examinations of the other patients were normal. Enzyme replacement therapy could not be initiated in one patient because of pregnancy. The neurological examination of the healthy control group was normal. There was no statistically significant difference between the ENMG features of both groups (p>.05). As in other studies, a routine ENMG examination was normal in our patients with early-stage Fabry disease. Neuropathic pain, seen in patients with Fabry disease in literature, is thought to be due to small fiber involvement. Conclusion: Fabry disease should be considered in the differential diagnosis of patients with neuropathic pain at young ages. It should be kept in mind that ENMG examination can be normal at the early stages. Quantitative sensory test, autonomic tests (R-R interval and sympathetic skin response) and skin biopsy should be performed in such cases. In our country, pediatric physicians work on Fabry disease more than physicians dealing with Fabry disease in adults. Therefore, in this retrospective study, we aimed to draw adult and pediatric neurologists' attention to Fabry disease.