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In the study, Patellar T Reflex has been evaluated with tapping force measurement and Deep Tendon Reflex grading. Tapping force is measured with an electronic tendon hammer which is designed by us also can be used as a trigger system for determination of patellar T response. System was tested in Akdeniz University Medicine Faculty Neurology Department EMG Laboratory. In the study at least ten trace were obtained from 10 subjects and a total of 100 traces evaluations were performed. The experiment group consisted of people with no neurological disorders. The expected impact of the study is presenting the relationship between tendon reflexes that trigged with applied force to the tendon, deep tendon reflex grading and EMG response as quantitative rating. This led to further understanding of the important role that the reflex behavior in the neurological examination. Also, other departments that can use that study explained at results section.

In this study, in healthy groups and facial transplantation patient, Gabor Wavelet transform based on appearance was adopted for recognition neutral and 6 emotional facial expressions consisting of angry, scared, happy, hate, confused and sad. The aim is to examine the ratio of regional performing facial mimics of face transplantation patient acording to healthy groups during each expressions. The system consists two phases; in the first stage, facial images of the healthy group were used for the training and test input, and in the second stage, the images of facial transplantation patient were used for the test input of trained system. Feature vectors were obtained from face images which convolved with Gabor filter (5-scales, 8-orientations) banks to feature extraction from the location of the eyes and mouth which is the most prominent region, while performing expressions. This feature vectors were classified by K-nearest neighbor classifier. The results were evaluated for normal groups and transplant patients.

Background Spasticity is a motor impairment due to lesions in the brain and spinal cord. Despite being a well-known problem, difficulties remain in the assessment of the condition. The electrophysiological and kinesiological characteristics of the patellar pendulum changes during the movement triggered by the patellar T reflex could be used to assess spasticity. Methods Features of the patellar pendulum during the patellar T reflex were considered using a goniometric approach in spastic patients evaluated with the Ashworth scale. Medium and late latency responses in the rectus and biceps femoris muscles were examined electrophysiologically. For each pendulum, the maximum angle extension during an oscillation of the knee joint, maximal extension time, angular velocities of extensions of the knee joint and frequency of motion due to the patellar reflex were calculated. The damping of the amplitude in the pendulum was calculated. Results The spasticity group consisted of 65 patients (38 males and 27 females) with a mean age of 47.6 ± 14.0 years. The normal control group consisted of 25 individuals (19 males and six females) with a mean age of 32.1 ± 10 years. The biceps and rectus femoris long latency late responses were not observed in the normal cases. The biceps femoris medium latency response was observed only in 24 % of healthy individuals; conversely, late responses were observed in 84 % of patients. Activation of the antagonist muscles at a certain level of spasticity created a notching phenomenon. Amplitude of the reflex response and mean angular velocity of the first oscillation present in a dichotomic nature in the spasticity groups. Frequency of the first pendular oscillation increased with the increase of the Ashworth scale, while the damping ratio decreased with increasing scale. The Ashworth scale showed a correlation with the damping ratio. The damping ratio strongly distinguished the spastic subgroups and showed a strong negative correlation with the Ashworth scale. Conclusions The Ashworth scale presents a good correlation with kinesiological parameters, but it is only possible to differentiate normal and spastic cases with electrophysiologic parameters. Furthermore, the notching phenomenon could be evaluated as a determinant of spasticity.

Measuring complexity of dynamical systems is a mighty tool for electrophysiological signal processing. There are plenty of entropies for estimating complexity measure. Approximate entropy (ApEn), sample entropy (SampEn), fuzzy entropy (FuzzyEn), wavelet entropy (WE) and wavelet packet entropy (WPE) was used for surface EMG feature extraction for face movements classification. Linear discriminant analysis (LDA) selected for classification. Classification performance was determined by mean square error (MSE) for different window sizes. Fuzzy entropy is the most robust and succeeding method of them. Principal component analysis used to improve classification performance however just results of approximate entropy feature were refined. MSE of wavelet entropy and wavelet packet entropy are also decent methods for this classification problem.

Objective: Using a single patient case study, we aimed to look at the interaction between full face transplantation and subsequent somatosensory representation in the cortex. Methods: We present a patient with full face transplantation who has recovered primary sensory modalities. The patient also has facial sensations such as touch perception in sensory examinations of the hands and fingers. Results: fMRI findings show interactions between the cortical representations of the face and hand. Conclusion: This phenomenon is one of the well-known referred sensations and reveals how face transplantation relates to cortical plasticity.

Migraine attacks associated with brainstem and cerebellar system dysfunction and aural symptoms of basilar artery area were first described by Bickerstaff. A twenty-five year-old woman was evaluated because of severe vertigo, imbalance, left lateral weakness, speech disturbance along with pulsatile headache. These symptoms occurred twice in a six months. The patient was treated with progesterone because of infertility at that time. Bilateral cerebellar infarct by MRI and hypoplasia of the left Pl segment of posterior cerebral artery were detected by angiography. © 2005 VSP.

We report a new clinical variant of epidermolysis bullosa simplex with muscular dystrophy (EBS-MD) that was associated with cardiac involvement. A 33-year-old patient had atrial fibrillation, pericardial effusion, and hypokinetic left ventricular cardiac walls. The muscle biopsy material revealed diffuse endomysial fibrosis and small atrophic muscle fibers with rounded contours. A positive desmin expression with abnormal localization in the subsarcolemmal groups was observed. We concluded that patients with EBS-MD should be investigated carefully when there are associated cardiac findings.

Summary: Purpose: Mesial temporal sclerosis (MTS) is characterized by neuronal loss in the hippocampus. Studies on experimental models and patients with intractable epilepsy suggest that apoptosis may be involved in neuronal death induced by recurrent seizures. Methods: We searched evidence for apoptotic cell death in temporal lobes resected from drug-resistant epilepsy patients with MTS by using the terminal deoxynucleotidyl transferase (TdT) and digoxigenin-11-dUTP (TUNEL) method and immunohistochemistry for Bcl-2, Bax, and caspase-cleaved actin fragment, fractin. The temporal lobe specimens were obtained from 15 patients (six women and nine men; mean age, 29 ± 8 years). Results: Unlike that in normal adult brain, we observed Bcl-2 immunoreactivity in some of the remaining neurons dispersed throughout the hippocampus proper as well as in most of the reactive astroglia. Bax immunopositivity was increased in almost all neurons. Fractin immunostaining, an indicator of caspase activity, was detected in ∼10% of these neurons. Des pite increased Bax expression and activation of caspases, we could not find evidence for DNA fragmentation by TUNEL staining. We also could not detect typical apoptotic changes in nuclear morphology by Hoechst-33258 or hematoxylin counterstaining. Conclusions: These data suggest that either apoptosis is not involved in cell loss in MTS, or a very slow rate of cell demise may have precluded detecting TUNEL-positive neurons dying through apoptosis. Increased Bax expression and activation of caspases support the latter possibility.

Study Design: Single subject (male, 34 years-of-age) case report. Objectives: To describe a unique case of plasma cell granuloma (PCG) with simultaneous brain and spinal cord involvement. Setting: Private hospital, capital city, Turkey. Methods: The patient presented with headache and paraplega. T2 weighted MR images showed multiple hyperintense cerebral, cerebellar, brainstem and spinal cord lesions that enhanced homogeneously with contrast medium. The patient was operated on, and the two intramedullary spinal cord lesions at T11 and T12 were totally excised. Results: After 3 months of an intense physiotherapy programme the patient was able to walk with help. Conclusion: We report for the first time, the occurrence of multiple, simultaneous brain and intramedullary spinal cord plasma cell granulomas.

Facial transplantation is defined as transfer of facial tissue from a donor to a patient who has suffered facial loss as a result of total denervation. Loss of facial tissue in the patient’s transplant history is important for synaptic change. Our study aims to develop neurophysiological approaches by defining the change of motor representations in the brain. In this study, Transcranial Magnetic Stimulation (TMS) is used to create Orbicularis Oris (O.Oris) and Abductor Pollicis Brevis (APB) muscles representation maps in facial transplant cases. Control group is established to identify brain presentation changes in facial transplant cases. The position, amplitude and latency values of muscular action potentials induced by magnetic stimulation are determined by signal processing methods. The results are mapped on 3-D human model. In the first case, the hot spot is identified as FC5 (4.66 mV to 5 ms) in the face mapping. When the face mapping of the patient is compared with the control group, the hot spot amplitude value is acquired as 64.25% and the latency value is 1.01% higher. In this case, the facial responses become more lateral. In the second case, the hot spot is found as AF7 (1.41 mV to 5.40 ms), and 50.29% decreases in amplitude value and 9.09% increases in latency value occur in the face mapping. It is observed that the facial responses are enlarged anteriorly and hand responses are detected in the face area. The results which denote the existence of the brain plasticity in the face transplant patients can be evaluated in the planning of rehabilitation processes. This study is supported by TUBITAK with 215E012 project number.

Diabetic polyneuropathy (DPN) is a complication of diabetes involving complex mechanisms. The introduction of automated threshold-tracking has led to a number of abnormal axonal excitability findings associated with diabetes without neuropathy (DWN) and DPN. The first abnormality described was a striking resistance to ischaemia in DWN. Superexcitability measurements showed that this ischaemic resistance was not due to a depolarized resting potential, but was related to the mean blood glucose over 24 h, indicating a rapid effect of glucose on nerve metabolism. Glycaemic control by insulin treatment in patients with diabetic neuropathy restored sensitivity to ischaemia. In contrast to DWN, patients with established DPN exhibited ‘fanning-in’ of threshold electrotonus and reduced superexcitability, indicating membrane depolarization. Using the rate of recovery of excitability following maximum voluntary contraction as a measure of electrogenic sodium pump activity, excitability measurements indicated that sodium pump function was normal in DWN, but reduced in DPN, accounting for the membrane depolarization. Further excitability studies have attempted to determine changes, other than resistance to ischaemia, that precede the development of neuropathy. Evidence that depolarization precedes neuropathy has been found both in Type 1 and Type 2 diabetics. An ischaemic cause was suggested by the finding that excitability abnormalities correlated better with vascular-related factors than with HgbA1c. Recently excitability studies have moved on from assessing pathophysiology to treatment. In Type 1 DWN, glycaemic control by continuous insulin infusion preserved membrane potential much better than comparable control by multiple injections, perhaps because glucose variability can cause microvascular dysfunction.

Objective Length dependent peripheral neuropathy is the most common complication of diabetes mellitus (DM). As no curative treatment for diabetic polyneuropathy (DMP) is available, its prevention and early detection is very important. Axonal excitability is defined as the capability of nodal and paranodal pathological changes in DMP. The aim of present study was to determine alterations in axonal excitability findings in tibial nerve by comparing median nerve axonal excitability findings in Type 1 DMP. Methods The total 284 patients, who were followed up for Type 1 DM according to criteria of American Diabetes Association, were screened in this study. Six DMP patients, 10 random non-polyneuropathy cases and 14 healthy control subjects were examined by threshold tracking method (TROND protokol) from median and tibial nerve. Results Even if there is not prominent difference in median nerve axonal excitability studies in PNP and DM patients there was prominent pathological findings in tibial nerve. The strength–duration time constant was significantly longer in DPN Type 1 patients than in normal patients. Supernormality was significantly smaller in DPN patients. Threshold electrotonus studies showed abnormalities in patients with DPN that smaller threshold changes by long depolarizing and hyperpolarizing conditioning current named as “fanning-in”. Conclusion This study confirms that there was significantly alteration in axonal excitability findings in DMP in tibial nerve. Comparisons median and tibial nerve axonal excitability findings have potential to show the length dependent polyneuropathic pathological status in axonal excitability studies.

Spasticity is a movement disorder developing after upper motor neuron lesion. It is the tonus increase associated with movement velocity of extremity muscles, and thus it affects the daily lives of patients. It is quite a common disease as it develops due to lesions in brain and spinal cord. This study defines the electrophysiological characteristics of Patellar T reflex and patellar pendulum which triggered by patellar T reflex. Spasticity changes the responses by utilizing movement features of knee joint during the reflex and pendulum. Muscular-Skeletal simulation is employed to validate and visualize spasticity condition by calculating muscular forces and activation levels compared to EMG data. Also the study attempts to develop a measurement method to be used in spasticity.

In this study, it is aimed to obtain Patella T-Reflex kinesiologic parameters on spasticity patients by using image processing methods and thereby extracting objective data for the evaluation of spasticity patients. For this reason, the movement of Patella T-reflex response to knee joint was recorded with the help of a camera after three LED markers placed on the knee joint. For the correctness of the pattern of the movements, data were compared with two-axis goniometer of Biometric Ltd company and thereby it was shown that the reflex patterns are identical. Thereon, using the software we have developed, the Patella T-reflex kinesiologic parameters were calculated and data were obtained for objective evaluation of the Spasticity patients.

In this study, fractal dimension which used to analysis complexity of the biomedical signals used to determine active channels when performing 24 fingers and wrist movements. The results compared withroot mean square (RMS) and mean absolute value (MAV) features. Higuchi fractal dimension (HFD) method was choosen that has high accuracy and linear with theoretical fractal dimension values nevertheless the method is noise sensitive. The noise sensitivity problem was overcomed with filtering the signal. Mean Higuchi fractal dimension feature determined using sliding window and active movements obtained that are above of thechoosen thresholds for each channels. Correlation of active chanels for each movements which was obtained with RMS and HFD features was discussed. Thus a new method was submitted which based on HFD instead of RMS adn MAV features.

In this study, a structure based ona Self Organizing Map (SOM) depending on RMS(Root Mean Square), MAV(Mean Absolute Value) and MF(Mean Frequency) features was formed in recording the EMG(Elektromyogram) signals during the performof 24 different movements in hand and fingers to detect of active electrodes.Recorded data with surface EMG electrodes, from 24 channels with 2 kHz sampling frequency as bipolar primarily ispreprocessed. In preprocessing, these data were filtered with 50 Hz notch filter, 3–450 Hz frequency band was selected using the 6th order Butterworth band-pass filter.RMS, MAV and MF features extracting from this EMG data were defined as SOM classifier input. Then, active channels in the classifier output were found for each features and resultswere compared with each other.

Objectives : The present study explored whether testing tendon jerks during voluntary contraction of the test muscle would improve reproducibility by effectively ‘clamping' the excitability of the motoneurone pool at firing threshold. Methods : Tendon jerk reflexes of soleus, tibialis anterior and vastus lateralis and the soleus H reflex were recorded in 12 healthy subjects at rest and during voluntary contractions of 10–20% of maximum. Recordings were repeated 8–10 times in 5 subjects, in whom reflex symmetry was also determined. Results : Not all tendon jerk reflexes could be recorded at rest, and the variability of latency and amplitude was high. All reflexes could be recorded in each subject during contractions. The latency of tendon jerk reflexes decreased by approximately 2 ms during contractions, but H-reflex latency decreased by only 0.2–0.3 ms. For the tendon jerks, an asymmetry of >3.0 ms at rest and >2.5 ms contracting would be outside 3 SD of the normal mean. In repeat studies, the coefficient of variation of reflex latency was Conclusions : A voluntary contraction could potentiate the tendon jerk by a number of mechanisms, but the most important is probably enhancement of the excitability of the motoneurone pool. The present techniques should increase the value of tendon reflex testing when assessing possible peripheral nerve, plexus and root disturbances.

It is stated that motor and sensory innervations of transplanted face of patients often completed in 6–9 months in the literature. However, we observed clinically a problem in facial mimics and the expression of emotions. So it is aimed that, those performed face transplant, the evaluation of differences of emotional mimics in face from normal subjects. Three male patients who underwent a complete face transplant were studied. Surface EMG recordings have been recorded from patients and 10 healthy individuals. The expressions of emotions have been recorded with surface electrodes during basic emotions. An angry facial expression activity has been observed predominantly in the bottom face. Fair facial expression; there is distribution differences. Happiness facial expression; significant activity and amplitude differences was detected in the bottom. Hate facial expression; different amplitude distributions have been observed predominantly in the bottom. Surprise facial expression; an activity has been observed in the upper face with different amplitude. Sad facial expression; two of the patients distinct activity has been detected in the bottom. The expression of emotions are different from healthy individuals in patients. Face transplant patients have difficulties to express of emotions. TUBITAK Project Number: 113E182.

Generally, spinal muscular atrophy (SMA) is believed to be a pure motor neuron disease. We retrospectively evaluated our electrodiagnostic findings in SMA type 1 patients to demonstrate co-existence of sensorimotor neuropathies.Electroneuromyographic (ENMG) studies in 15 patients (11 boys, 4 girls) were reviewed independently by 2 neurophysiologists. Upper extremity findings were compared with normal right arm controls.Patient ages ranged from 1.5 to 26 months. Four SMA patients (26.7%) had decreased sensory nerve action potentials (SNAPs) or sensory nerve conduction velocities. Of them, median SNAPs could not be elicited in 3, and sural SNAPs could not be elicited in 2. Compound muscle action potential amplitudes were severely decreased in 14 (93.3%) and normal in 1.Survival motor neuron 1 (SMN1) gene analysis should be considered if clinical features are consistent with SMA, even if pathological or electrophysiological findings demonstrate peripheral sensorimotor polyneuropathies.

Lomber pleksus'un proksimal iletim zamanının değerlendirilmesi, klinik nörofizyolojinin önemli sorunlarından birisidir. Bu çalışmada, genellikle yapıldığı gibi, lomber pleksusun sadece distal parçasını araştırmak yerine, hem distal hem proksimal parçasını araştırmayı amaçladık. Bu çalışmada 109 sağlıklı erişkin olguda, periferik elektrik uyarım ve lomber manyetik uyarımla genitofemoral, obturator ve femoral sinirin motor iletim zamanı ölçülerek, ayrıca adduktor ve kuadriseps kas grubunda H refleksi metodu kullanarak farklı proksimal ileti metotları çalışıldı. Çalışmanın anatomik kısmı 20 yetişkin kadavrada femoral, obturator, genitofemoral sinir ve proksimal kökler diseke edilerek uygulandı. Ligamentum inguinale'den spinal seviyeye ortalama toplam mesafe femoral sinirde 392.4±13.3mm, obturator sinirde yaklaşık olarak 382.8±11.1, genitofemoral sinirde ise 353.1±12.5mm olarak ölçüldü. H- refleksi metodu ile, kadavradan elde edilen mesafe kullanılarak femoral ve obturator sinirin proksimal iletim zamanı 62.5±6.1 ve 53.6±7.4 m/sn olarak saptandı. Periferik elektrik uyarım ve lomber manyetik uyarım ile femoral, obturator ve genitofemoral sinirin proksimal ileti hızı sırası ile 59.1±13.3, 52.7±14.9, 58.7±0.8 m/sn olarak ölçüldü. Her iki metotla da proksimal ileti hızları arasında istatistiksel olarak farklılık gözlenmedi. Her iki yaklaşım da olgulara göre proksimal ileti hızını değerlendirmek için tercih edilebilir., Scientific Background: One of the matters in clinical neurophysiology is evaluation of the proximal conduction time along the lumbar plexus. Objectives: Instead of investigating only distal segment of the nerve from the groin as is generally done we aimed to investigate both proximal and distal parts of the nerves originating from the lumbar plexus. Material and Methods: In this paper different proximal conduction methods were studied in 109 healthy adult human subjects by measuring proximal motor conduction time of femoral, obturator and genitofemoral nerve along the lumbar plexus using both by using lumbar magnetic and peripheral electrical stimulation and by using the H-reflex methods in adductor and quadriceps muscle group. The anatomical parts of the study were applied on 20 human adult cadavers, dissecting femoral, obturator genitofemoral nerve and roots proximally. Results: The total distance from ligamentum inguinale to spinal level was 392.4±13.3mm in femoral nerve. The total distance was approximately 382.8±11.1mm in obturator nerve and the total distance was approximately 353.1±12.5 mm in genitofemoral nerve. With the H reflex method, using the distance obtained from the cadaver, femoral and obturator nerve proximal conduction velocity were determined to be 62.5±6.1 m/sec and 53.6±7.4 m/sec, respectively. Using lumbar magnetic stimulation and the peripheral electrical stimulation, proximal conduction velocities in femoral, obturator and genitofemoral nerves were determined to be 59.1±13.3m/sec, 52.7±14.9 and 58.7±0.8 m/sec, respectively. Conclusions: No statistical differences were found between the proximal conduction velocities elicited by both methods. Either approach is preferable to evaluate proximal conduction time.

Objectives: We have investigated whether magnetic stimulation of the sural nerve can evoke a flexor reflex recorded from the ipsilateral short head of the biceps femoris muscle. Methods: The sural nerve was subjected to magnetic stimulation as well as by single-pulse electrical stimulation in healthy subjects. Results: In 87% of the participants, a reflex response was elicited from the short head of biceps femoris muscle by magnetic stimulation of the sural nerve. In terms of latency and amplitude, this reflex response was similar to the flexor reflex response evoked from the same muscle by single-pulse electrical stimulation of the sural nerve. Discussion: Findings indicate that flexor reflexes can easily be evoked from the short head of the biceps femoris muscle by magnetic stimulation of the sural nerve. The late component of the flexor reflex may not only be elicited via nociceptive afferents but may also involve non-nociceptive afferents.

Persistent primitive proatlantal intersegmental artery (proatlantal artery I) is an anastomotic channel between the carotid and vertebrobasilar arterial systems. Persistence of this embryonic anastomosis is very rare. The "top of the basilar" syndrome is usually due to occlusion of thalamoperforating arteries by emboli that rise from the vertebrobasilar arterial system. In this case, however, the emboli stemmed from atherosclerotic plaques in the carotid system. A 55-year-old woman was hospitalized with top of the basilar syndrome. A brain scan showed hypodense lesions extending from the mesencephalon to both thalami. Digital subtraction angiography of the cerebral circulation was performed, which revealed a proatlantal artery I on the left side. In addition, atheromatous plaques were seen along the internal and common carotid arteries on the same side. The occurrence of proatlantal artery I is extremely rare. Top of the basilar syndrome is also rarely encountered. To our knowledge, this is the first report of a patient with both conditions.

A case of Behçet's disease associated with Sweet's syndrome is presented. The onset was neurological symptoms and oral aphthae. Subsequently, genital ulcers developed. Coexistence of Sweet's syndrome and Behçet's disease has been reported only in few patients. On reviewing the literature, we propose that Sweet's syndrome is one of the associated diseases of Behçet's disease.

Clonus is an involuntary rhythmic muscle contraction after sudden muscle stretch that occurs as a result of a lesion in the upper motor neurons. The real mechanism behind clonus remains obscure. The objective of this study was to investigate the effects of central-acting tizanidine treatment and peripheral extremity cooling on clonus.Thirty-eight patients with upper motor neuron involvement and sustained clonus.The 38 patients were divided into 3 groups: cold group (n=19), tizanidine group (n=13), and patient control group (n=6). A separate group of 21 able-bodied volunteers served as controls for the cold group. The physiologic effects of cold application were measured in the able-bodied group and compared with the effects in the patients in the cold group. All participants were evaluated by clinical and electrophysiologic measurements.Changes in clinical and electrophysiologic measurements in the cold group were statistically significant compared with those of the tizanidine and patient control groups.Subsequent and long-term cold application induced prolonged inhibitory effects on clonus. Tizanidine had no significant effect on clonus. Suppression of clonus by cold highlights the importance of peripheral input in relation to central mechanisms.

PubMedID: 18489821 Objective: The strength-duration time constant (SDTC) is a measure of axonal excitability and depends on the biophysical properties of the axonal membrane. The strength-duration time constant can provide information about Na+ channel function. We aimed to examine changes in the SDTCs of motor and sensory fibers in the median nerves in patients with alcoholic polyneuropathy. Methods and results: We measured the SDTCs of motor and sensory fibers in 17 patients with alcoholic polyneuropathy (15 men and two women) after stimulating the right median nerve at the wrist. The results were compared with ten healthy age-matched subjects (six men and four women). In patients, the SDTC and rheobase for the motor fibers were 370.8 ± 97.4 µs and 3.9 + 1.7 mA; for the sensory fibers, the SDTC and rheobase were 464.7 ± 104.3 µs and 3.3 ± 1.9 mA. In controls, the SDTC and rheobase for the motor fibers were 359.3 ± 103.5 µs and 3.5 ± 1.9 mA; for the sensory fibers, the SDTC and rheobase were 478.9 ± 113.9 µs and 2.1 ± 1.5 mA. Sensory fibers had significantly longer SDTCs and lower rheobase than motor fibers in patients and controls. However, when the values of the patients and controls were compared, a statistically significant difference was only found for the rheobase of sensory fibers (p = 0.037). Conclusions: Although alcoholic neuropathy corresponds to the pattern of axonopathy, it did not act on the SDTC of the median nerve, which depends on the biophysical properties of the axonal membrane at the node of Ranvier. The process causing axonal degeneration in alcoholic neuropathy may affect internodal channels other than nodal channels or the Na+-K+ ATP pump. © 2008 W.S. Maney & Son Ltd.

Uysal, Hilmi/0000-0002-6063-377X WOS: 000250874100020 PubMed: 17925658 High voltage electrical injuries usually cause devastating consequences for patients, most of which result in permanent disability. Spinal cord injury (SCI) caused by high voltage electrical injury is uncommon in the literature. We present a 29-year-old male patient who was diagnosed as having delayed SCI after high voltage electrical injury. The patient developed muscle weakness in the lower extremities with the loss of pinprick sensation below the fifth cervical spinal segment, 2 days after the high voltage electrical injury. Magnetic resonance imaging of the brain, cervical and thoracic spine was normal. Nerve conduction and needle electromyography studies were normal, except for bilateral tibial and left median somatosensoryevoked potentials. The findings on initial examination and neurophysical investigation showed incomplete cervical SCI at the C5 level. He was able to walk with a pair of canes and bilateral ankle-foot orthosis at the end of the 2-month rehabilitation. Follow-up physical and electrophysiological examination of the patient 15 months after injury showed further improvement. The patient was able to walk with a pair of canes without orthoses. Electrophysiological studies are useful instruments in the diagnosis and follow-up of these patients. Early rehabilitation is essential to obtain a favorable outcome in patients with SCI caused by high voltage electrical injury.

Objective We aimed to investigate electrophysiologically the intersegmental reflex circuit from sacral to lumbar cord segments in normopotent adult men, in patients with spinal cord injury and in patients with premature ejaculation. Methods Reflex EMG activity of the cremasteric (CM) and bulbocavernosus (BC) muscles was recorded simultaneously by needle electrodes during electrical stimulation of the upper lumbar and sacral dermatomes, respectively. Thirty-three healthy male volunteers, 16 patients with spinal cord injury (SCI) at the thoracic or cervical levels, and 26 men with premature ejaculation (PME) were included in the study. Results In controls, upper lumbar dermatomal stimulation (ULS) at the inner side of thigh only elicited a reflex response from the CM muscle and did not produce a regular response from the lower sacral myotomes such as in the BC muscle. However lower sacral dermatomal stimulation (LSS) at the dorsal nerve of penis consistently evoked reflex responses from both CM and BC muscles. These basic electrophysiological features were not different in patients with SCI. LSS did not elicit a reflex response from the CM muscle in about 39% of patients with PME, while the BC reflex was obtained from all patients with PME. Conclusions The neurophysiological pattern in BC and CM muscles during sacral or lumbar dermatomal stimulation reflects the sacrolumbar intersegmental reflex linkage that may be related to the ejaculatory process in men. The intersegmental sacrolumbar reflex circuit may be functionally disturbed in some patients with PME. Significance Interaction between the reflex activity of sacral to lumbar dermatomes could prove useful in defining electrophysiological mechanisms related to ejaculation in men.

PubMedID: 17408800 We sought to examine the changes in the strength-duration time constant (SDTC) of the median nerve in diabetic polyneuropathy. The SDTC is a measure of axonal excitability and depends on the biophysical properties of the axonal membrane. It may provide some information about Na+ channel functioning. Forty-nine diabetic patients (30 men, 19 women; mean age, 54.6 ± 9.4 years) and 15 age-matched healthy subjects (11 men, 4 women; mean age, 53.1 ± 7.6 years) participated in the study. SDTC and rheobase values were 384.5 ± 97.9 µs and 4.6 ± 2.4 mA in patients and 313.8 ± 46.7 µs and 6.0 ± 2.6 mA in controls. The SDTC was found to be significantly different between the two groups (P = .009 for SDTC and P = .066 for rheobase). Fasting glucose and HbA1c levels of patients were 206.6 ± 88.7 mg/dL and 8.8 ± 2.4%, and these were not correlated with SDTC or rheobase (P < .05). We suggest that longer SDTC, indicating increased axonal excitability may develop in patients with polyneuropathy associated with uncontrolled diabetes. © 2007 Elsevier Ireland Ltd. All rights reserved.

Objective: To evaluate upper extremity shortness in patients with hemiplegic cerebral palsy (HCP) and to investigate the association between extremity shortness, motor level, and muscle tone. Design: Prospective, controlled study. Subjects: Forty-two children with HCP and 29 healthy children. Methods: Radiographs of the involved and the uninvolved humerus, forearm, and hands were obtained with a radiographic ruler placed adjacent to the extremity. The lengths and the diameters of both the diaphyses and metaphyses of the humerus, ulna, radius, and the second and the fifth metacarpal bones were measured in patients and the control group. The discrepancy was calculated as a percentage compared with the normal side. The Ashworth Scale was used in the evaluation of spasticity, and the Brunnstrom recovery staging was used in the motor evaluation. Results: Children with HCP had significant differences in bone lengths and diameters compared with control children. There was no significant correlation between the upper extremity Brunnstrom stagings and the differences of bone length and diameter. A significant correlation was observed between the hand Brunnstrom staging and percentage difference of the bone length and diameter. The spasticity level showed no relation to the differences in bone length and diameter. Conclusions: Children with HCP have significant side-to-side limb-length discrepancy when compared with control children. The discrepancy increases with age. The extent of shortening did not appear to be related to upper extremity function and spasticity. The extremity shortness showed a relation to hand function.

Uysal, Hilmi/0000-0002-6063-377X WOS: 000243226400014 PubMed: 16896989 Acute ulnar neuropathy at the wrist is an extremely uncommon condition, at times requiring a high index of suspicion for the diagnosis. Clinical presentations of ulnar nerve lesions at the wrist and hand show variations due to the complex anatomic course of the nerve in distal sites. We report a case of acute ulnar neuropathy at the wrist caused by a ganglion in Guyon's canal, being initially misinterpreted as flexor tenosynovitis. The accurate diagnosis of selective distal motor neuropathy of ulnar nerve was made electrophysiologically. Magnetic resonance imaging revealed a well defined soft tissue mass consistent with a ganglion, compressing the ulnar nerve in Guyon's canal. Entrapment neuropathies are one of the common conditions handled by physiatrists. Ulnar nerve lesions at the wrist should be kept in mind in the differential diagnosis of patients with wrist or hand pain. Magnetic resonance imaging is a useful method in the anatomical evaluation of acute focal neuropathies.

PubMedID: 16875875 Objective: To evaluate the possible effects of sex and age on strength-duration time constant (SDTC). Methods: The SDTC of 126 healthy volunteers was measured following stimulation of right median nerve at the wrist. Variations in values were evaluated according to sex and age. Results: The SDTC was 438.6 ± 114.5 µs in women and 396.2 ± 90.3 in men (P = .023). In men, as age increased, so did SDTC. However, this was not true in women. Comparing the values of women and men, aged below 40, demonstrated a difference in excitability, confined to younger patients. Conclusions: As SDTC depends on the biophysical properties of the axonal membrane and can provide some information about Na+ channel function, these data raise the possibility of a difference in Na+ channel function between men and women and a difference in the conductance with age. Significance: The age- and sex-related differences shown in this study suggest a possible biochemical or hormonal influence on axonal excitability. © 2006 International Federation of Clinical Neurophysiology.

Mesial temporal sclerosis (MTS) is characterized by neuronal loss in the hippocampus. Studies on experimental models and patients with intractable epilepsy suggest that apoptosis may be involved in neuronal death induced by recurrent seizures.We searched evidence for apoptotic cell death in temporal lobes resected from drug-resistant epilepsy patients with MTS by using the terminal deoxynucleotidyl transferase (TdT) and digoxigenin-11-dUTP (TUNEL) method and immunohistochemistry for Bcl-2, Bax, and caspase-cleaved actin fragment, fractin. The temporal lobe specimens were obtained from 15 patients (six women and nine men; mean age, 29 +/- 8 years).Unlike that in normal adult brain, we observed Bcl-2 immunoreactivity in some of the remaining neurons dispersed throughout the hippocampus proper as well as in most of the reactive astroglia. Bax immunopositivity was increased in almost all neurons. Fractin immunostaining, an indicator of caspase activity, was detected in approximately 10% of these neurons. Despite increased Bax expression and activation of caspases, we could not find evidence for DNA fragmentation by TUNEL staining. We also could not detect typical apoptotic changes in nuclear morphology by Hoechst-33258 or hematoxylin counterstaining.These data suggest that either apoptosis is not involved in cell loss in MTS, or a very slow rate of cell demise may have precluded detecting TUNEL-positive neurons dying through apoptosis. Increased Bax expression and activation of caspases support the latter possibility.

Parkinson’s disease is a movement disorder characterized by an increase in muscle tone. Rigidity affects motor capacity and daily functions of the patients. Aim of the study is analyzing electrophysiologically and kinesiologically features of the patellar pendulum that was triggered by patella T reflex in the Parkinson patients with rigidity. Method: We stimulated patella T reflex by an electronic triggered reflex hammer and recorded muscle action potenteials by surface electrodes from quadriceps femoris and biceps femoris muscles. We analyzed electrophysiological features of patellar T reflex and also analyzed characteristics of the patellar pendulum during the reflex motion in patients with rigidity and normal subjects. Joint angle changes and instantaneous angular velocity during reflex was measured with a goniometric approach. Results: Twenty five normal subjects included study as a control group. Patella T reflex had 17.9±1.9 milliseconds latency and 6404.1±2860.0 microvolt amplitude. Initial time of joint motion was 51.5±9.9 milliseconds and it was measured with an accelerometer. The pendulum count was 4.8±1.5. Angle of joint motion was 18.3±5.6°; extension time was 317.4±23.4 milliseconds; instantaneous angular velocity was 58.0±16.6 degrees/second; frequency was 1.0±0.1. Damping ratio of the pendulum was calculated as 0.6±0.2. A parameter was developed using by significant kinesiological findings and it was 60.3±16.1 degrees/second*Hz. There were 45 Parkinson’s disease patients in the rigidity group. Patella T

A 54-year-old woman was admitted to our clinic with frequent convulsions. Subsequently she developed a toxic look, rigidity, confusion and severe encephalopathy. Salmonella typhii was isolated from the blood cultures and she was diagnosed with Salmonella encephalopathy. The prominent electrophysiological finding was the frontal intermittent rhythmic delta activity (FIRDA) in electroencephalograph (EEG). After treatment EEG revealed normal activity. The presence of FIRDA is not a specific finding but this kind of EEG change has not been reported before. Diffuse encephalopathy due to endotoxins might be the reason. We propose that S. typhii encephalopathy was the cause of FIRDA which is a sign of diffuse encephalopathy.

The role of nitric oxide (NO) in childhood bacterial meningitis was investigated by determining the levels of nitrate/nitrite, stable end products of NO metabolism, in cerebrospinal fluid (CSF). Eighteen children with bacterial meningitis and 18 as a control group were included in the study. Mean (+/- SD) CSF nitrate/nitrite levels were 27.6 +/- 26 micromol/l in the bacterial meningitis group and 3.2 +/- 1.8 micromol/l in the control group (p = 0.0005). We found no correlation between CSF nitrate/nitrite levels and CSF white blood cell count (r = 0.22), protein (r = 0.26) or tumour necrosis factor alpha (TNF-alpha) levels (r = 0.046), but a moderate negative correlation between CSF nitrate/nitrite and glucose levels (r = -0.46).

WCN 2013 No: 1757 Topic: 36 — Other Topic Effects of hyperventilation on axonal excitability parameters in diabetic polyneuropathy D. Yerdelen, G. Akca, F. Kizilay, M.K. Balci, H. Uysal. Department of Neurology, Baskent University, Adana, Turkey; Department of Neurology, Akdeniz University, Faculty of Medicine, Antalya, Turkey; Internal Medicine and Endocrinology Department, Akdeniz University, Faculty of Medicine, Antalya, Turkey Axonal excitability is a physiological concept connected with the characteristics of myelin and membrane of the peripheral nerve. Evaluation of axonal excitability provides important information about the peripheral nerve. It has not been one of the routine electrophysiological evaluations but suitable for use in experimental studies and helps in understanding pathological conditions and gives important information about pathophysiology. The mechanisms of diabetic polyneuropathy have not been understood clearly. We used the short TROND protocol to measure the axonal excitability parameters in 11 healthy subjects and 7 patients with diabetes mellitus (DM) with polyneuropathy. The short TROND protocol was performed before and at the 20th minute of deep hyperventilation of healthy subjects and diabetic patients. Venous blood pH, pO2, and pCO2 values were recorded before hyperventilation and at the 20th minute of hyperventilation. The “hyperventilation score” was evaluated before and after the hyperventilation by asking the patient the degree of the numbness in the extremities and face or by seeing the carpopedal spasm. Although, significant changes in pH values occurred, the “hyperventilation scale score” of the DM group was lower than the score of the control group. When the values of DM and control group after hyperventilation were compared, Ted (10–20 ms), Ted (40–60 ms), Ted (90–100 ms), Ted (peak) and superexcitability at 5 ms were statistically significant. There was a significant change in the hyperpolarization section of threshold electrotonus during hyperventilation in patients with DM. DM patients have different responses to hyperventilation, and pH changes have different effects on diabetic polyneuropathy when compared with healthy subjects. doi:10.1016/j.jns.2013.07.2252 Abstract — WCN 2013 No: 1703 Topic: 36 — Other Topic A case of Hashimoto encephalopathy: Clinical presentation, neuroimaging and treatment WCN 2013 No: 1703 Topic: 36 — Other Topic A case of Hashimoto encephalopathy: Clinical presentation, neuroimaging and treatment C.P. Hoi, H. Ng, L.R. Jin, M.F. Su. Internal Medicine, Neurology, Centro Hospitalar Conde de Sao Januario, Macau SAR, China; Internal Medicine, Centro Hospitalar Conde de Sao Januario, Macau SAR, China Background: Hashimoto encephalopathy (HE) is a rare encephalopathy with positive antithyroid antibodies and normal thyroid function. Objective: The objective of this study was to describe the clinical presentation, neuroimaging and treatment of Hashimoto encephalopathy. Patients and methods: We report a 62-year-old female patient whose clinical presentation, neuroimaging, and response to steroid therapy fulfilled the diagnostic criteria of HE. Results: The neuroimaging changes in this patient were multiple lacunar infarction in bilateral cerebral hemispheres. She was found with high serum anti-thyroid antibody concentrations. After high doses of corticosteroid therapy, her clinical symptoms were significantly improved. At the same time, the titers of serum antithyroid antibodies obviously decreased after steroid treatment. Conclusion: This case illustrates the importance of considering rare but treatable causes of encephalopathy in a patient presenting with rapidly progressive cognitive dysfunction with/without the history of abnormality of thyroid function. doi:10.1016/j.jns.2013.07.2253 Abstract — WCN 2013 No: 1946 Topic: 36 — Other Topic Cross-border mobility of junior neurologists to and within the European Union: A major challenge for the health care system WCN 2013 No: 1946 Topic: 36 — Other Topic Cross-border mobility of junior neurologists to and within the European Union: A major challenge for the health care system A. Macerollo, E.T. Varga, O. Gyorfi, X. Kobeleva, W. Struhal, J. Sellner. Sobell Department of Motor Neuroscience and Movement Disorders, National Hospital of Neurology and Neurosurgery, Institute of Neurology, University College London, London, UK; Department of Neuroscience and Sense Organs, Aldo Moro University, Bari, Italy; Department of Neurology, University of Szeged, Hungary Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary; 2nd Clinic of Neurology, Mures County Emergency Hospital, Targu-Mures, Romania; Department of Neurology, Medizinische Hochschule Hannover, Hannover, Germany; Department of Neurology, General Hospital of the City of Linz, Linz, Austria; Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Klinikum rechts der Isar, Technische Universitat Munchen, Munchen, Germany Background: There is a dynamic flow of medical doctors within and to Europe, particularly since the entry of more countries to the European Union (EU) in 2004 and 2007. Objective: To assess interest and motives for cross-border mobility among residents and junior neurologists from member states of the EU and neighboring countries. Abstracts / Journal of the Neurological Sciences e629 (2013) e629–e678 e649

The present study was undertaken to evaluate the antiseizure activity spectrum of insulin against various behavioral seizure models in rats. Insulin was injected intraperitoneally (i.p.) at a test dose of 1 U/kg. Dextrose (3 g/kg) was administered simultaneously with insulin to counteract its hypoglycemic effect and induce a normoglycemic state. Insulin was found to significantly decrease the incidence, intensity and mortality rate and prolong the latency of generalized tonic-clonic convulsions induced by pentylenetetrazole (60 mg/kg i.p.) and significantly decrease the intensity and mortality rate and prolong the latency of generalized tonic-clonic convulsions induced by penicillin (2000 U/intracerebrocortical). Insulin was not only found to prolong the latency of all the seizure components but was found to reduce the incidence of focal myoclonic twitches and generalized tonic-clonic convulsions induced by kainic acid (12 mg/kg i.p.) as well. Insulin was shown to be ineffective to suppress ouabain (5 micrograms/intracerebroventricular) induced seizures. These findings indicate that insulin possesses a broad spectrum of antiseizure activity in rats. Interaction with brain Na(+)-K(+)-ATPase has been discussed as a possible mechanism of action.

Retinal migraine is not uncommon, but permanent sequelae are rare. We describe the case of a 23-year-old woman who had suffered from retinal migraine for five years. After a typical migraine attack a left nasal quadranopsia persisted. Fluorescein angiography showed a branch retinal arterial occlusion. Other causes were ruled out by appropriate laboratory techniques. Her visual field defect has persisted for eleven months.

WOS: 000250351700007, PubMed ID: 18247234