Electrophysiological comparison study between effectiveness of the treatment modalities (Baclofen and Tizanidine drug) on spasticity management

Background: Baclofen and tizanidine are both used for the treatment of muscle spasticity of spinal origin. patients and methods: This study was conducted in Ibn Al-Quf hospital for spinal cord injuries from the period December 2011 to June 2012. All of the participants gave written consent to participate in the study. The patients were divided into 2 groups: Group (I): Baclofen with physiotherapy treatment group; and Group (II): Tizanidine with physiotherapy treatment groups .H-reflex measurements were performed. parameters were studied: H-reflex latency, M wave latency, H-reflex conduction velocity, H-reflex duration, H-reflex amplitude. Results: All the patients had symptoms of spasticity at any time during the day with a Modified Ashworth Scale (MAS) before performing the H-reflex study. highly significant improvement in the H/M ratio when comparing positive controls to the two groups while the H/M ratio in the negative controls shows no significant difference with group I and group II. A significant correlation was noticed between the height of control subjects & H-reflex latency (P= 0.002), significant positive correlation was also found (P=0.028) between the height & M wave latency in the control subjects, The results revealed that the type of treatment did not affect the H-reflex and F wave parameters except for the H/M ratio. conclusion: H-reflex can provide information regarding neural function after spinal cord injury and the H/M ratio can be used as a good indicator for both spasticity assessment and response to treatment. Tizanidine hydrochloride is useful in the management of spasticity caused by SCI and can be used as a routine drug treatment although liver function tests should be periodically monitored.

Determining the utility of minimum F-wave latency alterations in the electrodiagnosis of ulnar neuropathy at the elbow

ABSTRACT Background: Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy. There is little information about the application of F-wave studies for evaluation of UNE. Objective: The aim of this study was to evaluate the diagnostic value of minimum F-wave (F-min) latency alterations by comparing this with nerve conduction analyses in UNE-suspected patients. Methods: Ninety-four UNE-suspected patients were admitted to this study. Sensory and motor nerve conduction and F-wave analyses on the median and ulnar nerves were performed on both upper extremities. Results: A total of 188 upper extremities of 94 patients were examined. Their mean age was 41.4±12.9 years, and 69 patients were female (73.4%). The mean ulnar-nerve across-elbow motor conduction velocity (MCV) in the affected arms was significantly slower than the velocity in healthy arms. The mean ulnar-nerve F-min latencies were significantly longer in the affected arms. Fifty-one patients were electrophysiologically diagnosed as presenting UNE (54.2%). Significantly slower mean ulnar-nerve across-elbow MCV, longer mean ulnar-nerve F-min latency and longer distal onset latency were detected in UNE-positive arms. Lastly, patients who were symptomatic but had normal nerve conduction were evaluated separately. Only the mean ulnar F-min latency was significantly longer in this group, compared with the healthy arms. Conclusion: Our study confirmed the utility of F-min latency measurements in the electrodiagnosis of UNE. F-wave latency differences can help in making an early diagnosis to provide better treatment options.

Electrical activity in rat retina in a streptozotocin-induced diabetes model

Objectives: Diabetic retinopathy remains the major cause of blindness among the working-age population of developed countries. Considering this, experimental models of diabetes involving laboratory animals are important for assessing clinically significant methods to determine early pathologic alterations of the retina. The early detection of diabetic retinopathy in combination with a search for new pathogenetic targets will enable focusing on new strategies to limit the development of critical changes in the retina and to prolong retinal functioning during the development of diabetes mellitus. Aim: This study aimed to define parameters of electroretinography test that identifies changes due to retinal impairment in diabetes. Methods: Experimental diabetes was induced in Wistar rats by intraperitoneally injecting streptozocin (65 mg/kg; group DM). The control group (CB) received intraperitoneal injections of the vehicle, i.e. citric buffer. On each consecutive day of the experiment, all rats received insulin detemir (2 u/kg). Ophthalmoscopy and electroretinography were conducted before initiating the experiment and after 50, 58 and 66 days of injectin sptreptozocin. Results: Amid 2u\kg insulin injection the glucose level in venous blood in DM group amounted to 30-40 mM. The ophthalmoscopy showed that the optic nerve disk paled by the 50th day, with its line erasing. During electroretinography, wave amplitude in oscillatory potential test tended to decrease. -wave latency of photopic system increased with -wave latency of photopic system and - and -waves latency of scotopic system not altering. In addition, the amplitude of rhythmic stimulation of 8 and 12 Hz decreased. Conclusion: The most apparent parameters of electroretinography for modelling streptozocin-induced diabetes are wave amplitude during the oscillatory potential test, photopic B-wave latency and the amplitude of rhythmic stimulation. These results suggest that in diabetes, ischaemic injury is an important cause of early dysfunction of inner retinal layers.

Systematic Assessment of Clinical Methods to Diagnose and Monitor Diabetic Retinal Neuropathy

Purpose. Diabetic retinal neuropathy refers to retinal neural tissue damage occurring before the structural retinal changes of diabetic retinopathy and fulfils many of the criteria for causality for the subsequent vasculopathy. Developing reliable means of measuring neuronal damage in diabetes may be important in efforts to prevent retinopathy of a clinically significant and irreversible stage. This study aimed at systematically assessing current clinical measurements of diabetic retinal neuropathy so that future studies may utilise a consensual battery of tests in studying this poorly understood disease state between a healthy retina and one that is retinopathic. Methods. A systematic search of the medical literature since 1984 was performed on PUBMED and EMBASE, and the evidence supporting each identified method as an indicator for clinically important diabetic retinal neuropathy was graded relatively as compelling, medium, or weak according to criteria assessing its relationship to subsequent diabetic retinopathy, quality of supporting studies, and published reproducibility. Results. The systematic search yielded 6432 results. Subsequent assessment by two independent investigators identified 601 multiple subject studies in humans assessing clinical aspects of the retinal structure, function, or psychophysics in the prediabetic retina. The 933 separate instances of clinical methods assessed as being supported by relatively “compelling” evidence included colour vision changes, flash ERG b-wave latency, flash multifocal b-wave latency, scotopic b-wave and oscillatory potentials in ERG, and contrast sensitivity. Conclusion. The results showed moderately poor quality of extant evidence and indicate the best clinical methods for assessing diabetic retinal neuropathy that remain to be confirmed. This is the first systematic assessment of the medical literature aiming at assessing the breadth and validity of these methods and represents an early step in identifying and developing clinical endpoints for use in trials designed to identify at-risk patients or prevent diabetic retinopathy.

Conduction studies of phrenic nerve in healthy children

Background. Unlike parameters of phrenic nerve conduction in healthy adults characterized by stability, in children variations with age are observed. The objective is to investigate the M-wave latency and amplitude in electroneurographic (ENG) examination of the phrenic nerve in healthy children of different ages for development of a normative database of neurophysiological data.Materials and methods. 48 healthy children (28 girls and 20 boys) were examined. Mean age was 9.19 ± 5.43 years (1–18 years). ENG examination of the phrenic nerve was performed with the modified standard procedure of stimulation at the level of the outer margin of the lower third of the sternocleidomastoid muscle with registration of M-wave from standard diaphragm point and parallel registration of the muscle activity from m.deltoideus and m.serratus anterior.Results. Mean values of the M-response latency were 5.64 ± 1.25 ms, amplitude – 0.66 ± 0.34 mV. For age-differentiated subgroups 1–2 years (n = 7), 3–5 years (n = 9), 6–12 years (n = 15), and 13–18 years (n = 17), the latency was 4.96 ± 1.94; 5.01 ± 1.13; 5.42 ± 0.84, and 6.44 ± 1.43 ms, respectively; the amplitude was 1.01 ± 0.37; 0.87 ± 0.31; 0.61 ± 0.24, and 0.45 ± 0.21 mV, respectively. The M-response amplitude values in children aged 1–2 years significantly differed from the values in children aged 6–12 and 13–18 years.Conclusion. ENG examination of the phrenic nerve is a technically uncomplicated procedure, and the obtained data is easy to interpret. During phrenic nerve ENG in children, it is necessary to take age variability of the M-wave latency and amplitude into account. The M-wave amplitude in healthy toddlers (1–2 years old) was significantly lower than in children aged 6–18 years.

Audiological assessment in organophosphorous poisoning

<p class="abstract"><strong>Background:</strong> Organophosphate (OP) poisoning is a common cause of significant mortality and morbidity all over the world. In Asia, OP poisoning is the most common form of fatal self harm. Previous studies have suggested hearing loss due to OP poisoning. The aim of the study was to study audiological assessment in the patients with OP poisoning.</p><p class="abstract"><strong>Methods:</strong> 26 patients (age &lt;50 years) of OP poisoning over a period of one year were included in the study following ethical approval from Institute Ethics Committee. 25 healthy subjects served as control. Each subject was subjected to brainstem evoked response audiometry (BERA) examination. </p><p class="abstract"><strong>Results:</strong> 50% patients with OP poisoning were aged between 20-29 years. Male outnumbered females in the patients (M:F- 17:9) as well as controls (M:F- 17:8). Only absolute wave-v latency (ms) was statistically significantly prolonged in cases when compared with controls in both right (0.035) as well as left ears (0.048). We found no statistical significant difference in interpeak wave I-III, III-V, I-V latency of both ears in cases when compared with controls. On second assessment in the patients, we observed a statistical significant decrease in absolute wave III and V latency, and interpeak I-III interval in right ear when compared with wave latency at first assessment. In left ear on second assessment, a significant decrease in absolute wave I, III, and V latency was observed in the patients.</p><p class="abstract"><strong>Conclusions:</strong> OP compounds may affect entire neural auditory pathway. Further studies with a large sample size are required for the assessment.</p>

Cognitive P300 Potential in Retired Sportsmen with a Career in Contact Sports

SummaryEleven retired sportsmen, who had a career in contact sports (three boxers, four footballers, four wrestlers) and one cyclist with a history of several falls from a bicycle and had been diagnosed with a cerebrovascular trauma, were investigated with auditory cognitive P300. The age range was aged between 26 and 63 years. Ten out of the twelve presented cognitive wave latency between 512 msec and 928 msec. This finding made us conclude that repetitive minor head injuries (mHI) that they inevitably had experienced during their carrier has led to cognitive problems in older age.