Neurophysiological aspects in SARS-CoV-2–induced acute respiratory distress syndrome

Patients with coronavirus disease 2019 (COVID-19) often develop acute respiratory failure and acute respiratory distress syndrome (ARDS) that requires intensive care unit (ICU) hospitalization and invasive mechanical ventilation, associated with a high mortality rate. In addition, many patients fail early weaning attempts, further increasing ICU length of stay and mortality. COVID-19 related ARDS can be complicated by neurological involvement with mechanisms of direct central nervous system (CNS) infection and with overlapping para-infective mechanisms of the peripheral nervous system (PNS). We aimed to evaluate the possible involvement of the brainstem and PNS in patients with COVID-19 related ARDS and difficulty in weaning from mechanical ventilation. We evaluated electroencephalogram (EEG), brainstem auditory evoked potentials (BAEPs), electroneurography of the four limbs and the phrenic nerve in 10 patients with respiratory insufficiency due to SARS-CoV-2. All were admitted to intensive care unit and were facing prolonged weaning from mechanical ventilation. All ten patients showed a mild diffuse non-specific slowing of brain electrical activity on the EEG. Four patients had an acute motor axonal neuropathy with absent or reduced amplitude phrenic nerve CMAP while four patients showed impairment of the BAEPs. A patient with peripheral nerve impairment suggestive of Guillain-Barré syndrome (GBS) underwent an intravenous immunoglobulin (IVIg) cycle that led to an improvement in the weaning process and progressive motor improvement. The inclusion of a comprehensive neurological evaluation in COVID-19 patients in ICU facilitated the early identification and effective management of Nervous System involvement

Ulnar Goniometer: a simple device for better neurophysiological evaluation of the Motor Conduction Velocity of the Ulnar Nerve.

OBJECTIVE The use of the Ulnar Goniometer standardizes the method of detecting the Motor Conduction Velocity (MCV) of the Ulnar nerve by keeping the elbow flexed at a fixed angle, thus enabling an easier and more precise measurement. MATERIALS AND METHODS The stimulations were performed by two independent operators. We evaluated 30 participants of both genders with paresthetic symptoms of the upper limbs and 30 healthy and asymptomatic volunteers. Each operator performed the examination without and with the use of the Ulnar Goniometer, detecting the velocity of motor conduction wrist-below elbow and the speed above-elbow (AE) below-elbow (BE). Agreement between the measurements was assessed with intraclass correlation coefficient (ICC). RESULTS The repeatability of the measurements between operators was modest without the use of the support (ICC = 0.152) while a good agreement was found when the operators used the support (ICC = 0.499). DISCUSSION AND CONCLUSIONS The most obvious results of the study were the reduction of the difference between operators using the Ulnar goniometer, the increase in the repeatability of the measurements and the specificity of the test

Goniometro Ulnare: un semplice dispositivo per una migliore valutazione neurofisiologica della velocità di conduzione motoria del nervo ulnare.

OBIETTIVO L’utilizzo del Goniometro Ulnare ha l’obiettivo standardizzare il metodo di rilevazione della Velocità di Conduzione Motoria (VCM) del nervo Ulnare mantenendo il gomito flesso ad un’angolazione standardizzata, favorendo così una più agevole e precisa misurazione. MATERIALI E METODI Le stimolazioni sono state eseguite da due diversi operatori; ogni operatore ha eseguito l'esame senza e con l'uso del Goniometro Ulnare, rilevando la Velocità di conduzione motoria polso-sotto gomito e la velocità sovragomito (above-elbow AE) sottogomito (below-elbow, BE). Abbiamo calcolato il grado di omogeneità tra le misurazioni e il coefficiente di correlazione intraclasse. RISULTATI Valutando 30 partecipanti di ambo i sessi con sintomi parestetici degli arti superiori e 30 volontari sani e asintomatici, la ripetibilità delle misurazioni tra operatori è stata modesta senza l'uso del supporto (ICC = 0,152) mentre si è riscontrato un buon accordo quando gli operatori hanno utilizzato il supporto (ICC = 0,499).. CONCLUSIONI I risultati più evidenti dello studio sono stati la riduzione della differenza tra operatori utilizzando il goniometro Ulnare, l’aumento della riproducibilità della misurazione e della specificità del test

Central conduction abnormalities in patients receiving levodopa-carbidopa intestinal gel infusion

In recent years, several studies have reported a relatively high frequency of polyneuropathy in patients with Parkinson\u2019s disease (PD), in particular, in patients receiving levodopa-carbidopa intestinal gel (LCIG) infusion. In spite of the several patients investigated with nerve conduction studies, no study has prospectively explored a possible central nervous system involvement of patients receiving LCIG infusion. We prospectively evaluated eight PD patients receiving LCIG infusion, who underwent neurophysiological evaluations with nerve conduction studies, visual, somatosensory and motor evoked potentials before LCIG infusion, and 1 and 6\ua0months after. At 6\ua0months follow-up, we found significant reduction in sural nerve SNAP amplitude, increase of central sensory conduction time N22-P40, and increases of central motor conduction time recorded from I dorsal interosseous and tibialis anterior. In PD patients with LCIG infusion, we found a subclinical neurophysiological impairment of both peripheral and central nervous system

Fasting and weight-loss restrictive diet practices among 2,700 cancer survivors: results from the NutriNet-Santé cohort

IF 7.36International audienceNutrition is often used by cancer survivors as a lever to take charge of their own health. However, some dietary behaviors are not currently recommended for patients without medical supervision. Our study aimed at evaluating weight-loss restrictive diets and fasting practices among cancer survivors of the NutriNet-Santé cohort, as well as related socio-demographic and lifestyle factors. In October 2016, 2,741 cancer survivors had completed a specific questionnaire about their practices. Fasting and non-fasting patients (respectively dieting and non-dieting) were compared using logistic regression models. Analyses were weighted according to the age, gender, and cancer location distribution of French cancer cases. 13.8% had already practiced weight-loss restrictive diet as their diagnosis. They were more likely to be women, professionally active, overweight/obese, to use dietary supplements and to have breast cancer (all p < 0.05). 6.0% had already fasted, 3.5% as their diagnosis. They were more likely to be younger, with higher educational level, higher incomes, professionally active, to have a healthy weight, and to use dietary supplements (all p < 0.05). Fasting was associated with the opinion that such practice could improve cancer prognosis (p < 0.0001). Patients who received nutritional information from health care professionals were less likely to practice fasting or weight-loss restrictive diet (0.42[0.27-0.66], p < 0.0001 and 0.49[0.38-0.64], p < 0.0001 respectively). Our study provided original results suggesting that weight-loss restrictive diets are widely practiced by cancer survivors. Fasting was less common in our study though non negligible. Sources of nutritional information received as cancer diagnosis seemed to be a key determinant of these practices