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Neuralgic amyotrophy (NA), also referred to as idiopathic brachial plexitis and Parsonage-Turner syndrome, is a peripheral nerve disorder characterized by acute severe shoulder pain followed by progressive upper limb weakness and muscle atrophy. While NA is incompletely understood and often difficult to diagnose, early recognition may prevent unnecessary tests and interventions and, in some situations, allow for prompt treatment, which can potentially minimize adverse long-term sequalae. High-resolution ultrasound (HRUS) has become a valuable tool in the diagnosis and evaluation of NA. Pathologic HRUS findings can be grouped into four categories: nerve swelling, swelling with incomplete constriction, swelling with complete constriction, and fascicular entwinement, which may represent a continuum of pathologic processes. Certain ultrasound findings may help predict the likelihood of spontaneous recovery with conservative management versus the need for surgical intervention. We recommend relying heavily on history and physical examination to determine which nerves are clinically affected and should therefore be assessed by HRUS. The nerves most frequently affected by NA are the suprascapular, long thoracic, median and anterior interosseous nerve (AIN) branch, radial and posterior interosseous nerve (PIN) branch, axillary, spinal accessory, and musculocutaneous. When distal upper limb nerves are affected (AIN, PIN, superficial radial nerve), the lesion is almost always located in their respective fascicles within the parent nerve, proximal to its branching point. The purpose of this review is to describe a reproducible, standardized, ultrasonographic approach for evaluating suspected NA, and to share reliable techniques and clinical considerations when imaging commonly affected nerves., (© 2022 The Authors. Muscle & Nerve published by Wiley Periodicals LLC.)

Introduction: Our aim in this study was to identify the prevalence and clinical characteristics of LRP4/agrin-antibody-positive double-seronegative myasthenia gravis (DNMG)., Methods: DNMG patients at 16 sites in the United States were tested for LRP4 and agrin antibodies, and the clinical data were collected., Results: Of 181 DNMG patients, 27 (14.9%) were positive for either low-density lipoprotein receptor-related protein 4 (LRP4) or agrin antibodies. Twenty-three DNMG patients (12.7%) were positive for both antibodies. More antibody-positive patients presented with generalized symptoms (69%) compared with antibody-negative patients (43%) (P ≤ .02). Antibody-positive patients' maximum classification on the Myasthenia Gravis Foundation of America (MGFA) scale was significantly higher than that for antibody-negative patients (P ≤ .005). Seventy percent of antibody-positive patients were classified as MGFA class III, IV, or V compared with 39% of antibody-negative patients. Most LRP4- and agrin-antibody-positive patients (24 of 27, 89%) developed generalized myathenia gravis (MG), but with standard MG treatment 81.5% (22 of 27) improved to MGFA class I or II during a mean follow-up of 11 years., Discussion: Antibody-positive patients had more severe clinical disease than antibody-negative patients. Most DNMG patients responded to standard therapy regardless of antibody status., (© 2020 The Authors. Muscle & Nerve published by Wiley Periodicals, Inc.)

Purpose of Review: The purpose of our manuscript is to review the current evidence supporting the use of complementary and alternative medicine (CAM) in neuromuscular disease, specifically in painful peripheral neuropathy (PPN). We outline the therapeutic challenges of this debilitating condition and describe the best evidence for incorporating such therapies into clinical practice. The most studied modalities include lifestyle modifications with diet and exercise, supplements, and acupuncture. CAM therapies such as yoga, meditation, electrical stimulation, neuromodulatory devices, and cannabis are mentioned as emerging therapies., Recent Findings: Current data suggests that targeted lifestyle modifications, including aerobic exercise and diet modifications that promote weight loss, may improve the natural course of diabetic painful neuropathy and potentially other types of neuropathy. A number of studied dietary supplements and vitamins including B vitamins, vitamin D, alpha-lipoic acid, and acetyl-L-carnitine improve both subjective and objective neuropathic measures. A wide range of neuromodulatory devices and electrical stimulation modalities demonstrate mixed results, and further studies are needed to confirm their benefit. Finally, acupuncture and yoga both demonstrate benefit in a variety of PPNs. Multiple CAM therapies show efficacy in the treatment of PPN. From the strongest level of evidence to the least, lifestyle modifications including exercise and diet; supplements including B12, alpha lipoic acid, acetyl-L-carnitine, and vitamin D in deficient patients; followed by acupuncture and yoga may alleviate symptoms of PPN.

Background: Ayurveda is an ancient medicine practice that is emerging in the United States as a complementary and alternative treatment for chronic illness. Type 2 diabetes is a chronic illness that has major long-term implications for individuals suffering from the disease as well as the health-care system as a whole. Modifications in diet, exercise, and lifestyle are all important factors in successful treatment of type 2 diabetes and are incorporated into the ancient Indian medicinal practice of Ayurveda. Review Summary: This review summarizes the available evidence for the use of Ayurvedic therapies in the treatment of type 2 diabetes. For the treatment of type 2 diabetes, Ayurvedic practices primarily emphasizes the use of herbal supplements; however, exercise, weight management, and various supplemental procedures are included in Ayurvedic practices. The goal of Ayurvedic practices on the treatment of type 2 diabetes like in Western medicine focuses on bringing the hemoglobin A1c (HbA1c) value into a therapeutic range. Where Ayurveda differs is that it looks at the functionality of a person in the context of striking a balance between the life forces or doshas that each individual possesses. Finally, this article includes a case study received from AyurVAID clinic in Bangalore, India that details the specific Ayurvedic intervention used in a patient, bringing his HbA1c from a level of 11.2 to 5.7 over the course of 9 months., Conclusion: Patients with type 2 diabetes may inquire about current complementary and alternative therapies available for the treatment of their disease. Awareness of such modalities is necessary for effective patient counseling and care. The benefits of offering a wide array of treatment options include possible reduction of HbA1c and of comorbidities with adjunct use of supplements and mind-body practices.

Introduction: Inclusion body myositis (IBM) can have clinical and electrodiagnostic features similar to other neuromuscular diseases, making it a diagnostic challenge. This prospective study was designed to determine the accuracy of forearm ultrasound for IBM., Methods: Sixty adults were recruited (15 with IBM, 15 with amyotrophic lateral sclerosis [ALS], 15 with other myopathies, and 15 healthy controls), and each underwent ultrasound of the bilateral forearms (imaging the flexor digitorum profundus and flexor carpi ulnaris muscles). Three clinicians with varying ultrasound expertise assigned a diagnosis of IBM, ALS, other myopathy, or control, based on images alone., Results: Intrarater reliability was moderately strong. Interrater reliability varied based on clinician experience. Sensitivity was 73.33% and 66.67% for the expert raters. Specificity was strong for all 3 clinicians (93.33%, 84.44%, and 91.11%)., Discussion: Neuromuscular ultrasound of the forearm is reliable and accurate for the diagnosis of IBM, although sensitivity was higher among experienced clinicians. Muscle Nerve 59:478-481, 2019., (© 2019 Wiley Periodicals, Inc.)

Reliable assessment of brachial plexus disorders can be challenging due to the complexity of the anatomy and variation of potential pathology. Electrodiagnostic testing can be both uncomfortable for the patient and inconclusive. Ultrasound can serve as a complement to clinical assessment, electrodiagnostic testing, and other imaging modalities. This study describes a systematic approach for performing neuromuscular ultrasound for suspected pathology in the brachial plexus. The literature regarding techniques for brachial plexus ultrasound was reviewed. A team composed of specialists in neurology, physiatry, anesthesiology, orthopedic surgery, and vascular surgery used this as the basis for describing standardized techniques for performing brachial plexus ultrasound. Four standard views, along with other supplemental views, are described for the evaluation of the brachial plexus. An illustrative case is presented. Ultrasound is a high-resolution point of care diagnostic tool that allows assessment of structural pathology affecting the brachial plexus. Muscle Nerve 58: 618-624, 2018., (© 2018 Wiley Periodicals, Inc.)

Nutrition education is globally lacking in medical training, despite the fact that dietary habits are a crucial component of physician self-care, disease prevention, and treatment. Research has shown that a physician's health status directly affects the quality of their preventative health counseling and patient outcomes, yet on average less than 20 hours over 4 years of medical education is spent teaching nutrition. This leaves providers with a gap in knowledge regarding this critical component of health. In a recent study, only 14% of resident physicians reported being adequately trained to provide nutritional counseling. Educating health-care professionals on how to eat well provides an opportunity to improve physician and patient well-being.

Introduction: Magnet therapy has been proposed as a treatment for neurologic conditions. In this this trial we assessed the feasibility and efficacy of a magnet inserted into a wristband for carpal tunnel syndrome (CTS)., Methods: Twenty-two patients with mild to moderate CTS were randomized to wear a high-dose or low-dose "sham" magnetic wristband for 6 weeks. The primary outcome was the Symptom Severity Scale (SSS) of the Boston Carpal Tunnel Questionnaire. Secondary measures were nerve conduction studies (NCS), median nerve ultrasound, and compliance., Results: Compliance for both groups was >90%. Improvements in the mean SSS, NCS, and median nerve ultrasound did not reach statistical significance., Discussion: Magnet therapy via wristband is well-tolerated. Further investigations in larger populations are needed to determine efficacy. Muscle Nerve 58: 310-313, 2018., (© 2018 Wiley Periodicals, Inc.)

Introduction: An ultrahigh-frequency (70 MHZ) ultrasound device has recently been approved for human use. This study seeks to determine whether this device facilitates counting of fascicles within the median nerve at the wrist., Methods: Twenty healthy volunteers underwent imaging of the median nerve at the wrist bilaterally. The number of fascicles in each nerve was counted by two independent raters., Results: The mean fascicle number was 22.68. Correlation was strong between the two raters (r = 0.68, P < 0.001). Age, sex, body mass index, and nerve area did not predict fascicle number. Those with bifid median nerves and persistent median arteries had lower fascicle density than those without anatomic anomalies (1.79 vs. 2.29; P = 0.01)., Discussion: Fascicles within the median nerve at the wrist can be readily imaged. Ultrahigh-frequency ultrasound technology may be informative in a variety of disorders affecting the peripheral nervous system. Muscle Nerve 56: 819-822, 2017., (© 2017 Wiley Periodicals, Inc.)

Although many neurologic conditions are common, cures are rare and conventional treatments are often limited. Many patients, therefore, turn to complementary and alternative medicine (CAM). The use of selected, evidence-based CAM therapies for the prevention and treatment of migraine, carpal tunnel syndrome, and dementia are presented. Evidence is growing many of modalities, including nutrition, exercise, mind-body medicine, supplements, and acupuncture., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Introduction: Neuromuscular ultrasound is valid, reliable, and accurate, but it is not known whether combining it with electrodiagnostic studies leads to better outcomes in individuals with focal neuropathies., Methods: One hundred twenty individuals with focal neuropathy, based on history, examination, and electrodiagnosis, were enrolled in this study. All patients underwent neuromuscular ultrasound and were randomized to either have their ultrasound results sent to the referring physician or not have them sent. Outcomes were assessed at 6 months by evaluators blinded to group assignment., Results: The Overall Disability Sum Score and 7 of 8 domains of the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) showed more improvement in the "report sent" group, although only the general health perception domain was significant (P = 0.005)., Conclusions: Most 6-month outcomes did not reach statistical significance between the 2 groups. However, the "report sent" group had trends toward better outcomes, with significance being reached in the general health perception domain of the SF-36., (© 2015 Wiley Periodicals, Inc.)

Background and Purpose: The modified Rankin Scale (mRS) is a popular primary stroke outcome measure, but its usefulness is limited by suboptimal reliability (inter-rater agreement)., Methods: We developed and tested the reliability of a simplified mRS questionnaire (smRSq) in 50 patients after stroke seen in outpatient clinics. Randomly chosen paired raters administered the smRSq within 20 minutes of each other and the ratings were blinded until the end of this study., Results: Agreement among the raters was 78%, the kappa statistic was 0.72 (95% CI, 0.58-0.86), and the weighted kappa(w) statistic taking into account the extent of disagreement was 0.82 (95% CI, 0.72-0.92). The average time to administer the smRSq was 1.67 minutes., Conclusions: The smRSq appears to have very good reliability that is similar to that of a structured interview mRS and is considerably less time-consuming.

A comparison was made between metabolic parameters during exercise in patients with implanted dual sensor VVIR pacemakers. We analyzed two groups of patients with implanted dual sensor responsive pacemakers. The first group was composed of 14 patients (mean age 37.7 years) who had implanted Topaz pacemakers. The second group of 9 patients had a Legend Plus (mean age 44.7 years). A control group consisted of 54 healthy individuals (mean age 40.4 years). Testing was performed on treadmill, using a stepwise staircase loading CAEP protocol. Directly measured and mathematically calculated parameters used in assessment of metabolic impact of pacemaker function were: minute ventilation (MV), MV/body surface, MV/body mass unit, oxygen consumption, oxygen consumption/body surface, oxygen consumption/heart rate (oxygen pulse), oxygen consumption/body mass unit, carbon dioxide production, respiratory index. The majority of the observed parameters revealed no statistically significant difference between the control group and the patients with dual sensor or single sensor controlled rate response. However, oxygen pulse showed a statistically significant difference when comparing the group with single sensor controlled rate response with dual sensor controlled rate response and control group (p < 0.05). Other parameters indicating an advantage of dual sensor controlled rate were the time period of reaching anaerobic threshold (respiratory index) and exercise duration. They both displayed a statistically significant difference between dual sensor controlled rate response and single sensor rate response (p < 0.05) with no significant difference compared to control group (p > 0.05).