Effort-induced mirror movements: A study of transcallosal inhibition in humans

During sustained, fatiguing maximal voluntary contraction of muscles of one hand, muscles of the other hand gradually become activated also. Such effort-induced mirror movements indicate a decreased ability of the central nervous system (CNS) to selectively control individual muscles. We studied whether altered transcallosal inhibition (TCI) contributed to this phenomenon. TCI was determined in ten healthy subjects by measuring the ipsilateral silent period (iSP) and the contralateral silent period (cSP) during a sustained contraction of the abductor digiti minimi, induced by focal unihemispheric ipsilateral transcranial magnetic stimulation. Mirror movements occurred in all subjects in response to the effort. There was a bilateral increase in cSPs and a parallel increase in the iSP in the contralateral working muscle. In contrast, the iSP in the mirroring muscle remained unchanged, explained by a balance of increased crossed pyramidal inhibition (cSP) and decreased transcallosal inhibition. In finely tuned unimanual movements, mirroring activity of the contralateral hand is suppressed by TCI originating in the working hemisphere. During sustained, effortful contractions, the outflow of the contralateral hemisphere is increased due to reduced TCI. Effort-induced mirror contractions are thus the result of disinhibition of contralateral crossed projections rather than disinhibition of ipsilateral uncrossed pathway

Ultrasonographic Identification of Fibromuscular Bands Associated with Neurogenic Thoracic Outlet Syndrome: The "Wedge-Sickle" Sign.

Thoracic outlet syndrome (TOS) is a disorder characterized by compression of the lower trunk of the brachial plexus, most often in association with anomalous congenital fibromuscular bands in the scalenic region. Early diagnosis is important, because the neurologic deficit associated with TOS may be irreversible. Using high-resolution ultrasound, we investigated 20 consecutive patients with clinical signs suggestive of TOS (all females, average age: 40.4 +/- 14.9 y) and 25 control patients. In 19 patients, we identified a hyper-echoic fibromuscular structure at the medial edge of the middle scalene muscle, which indented the lower trunk of the brachial plexus ("wedge-sickle sign"). It was associated with the significant enlargement (p < 0.0001) and hypo-echogenicity of the lower trunk. This novel and distinctive ultrasonographic sign allows pre-surgical identification of anomalous fibromuscular bands causing TOS. It is especially useful in patients without neurologic deficit, in whom the diagnosis may not be as straightforward

High resolution ultrasonography of peripheral nerves: measurements on 14 nerve segments in 56 healthy subjects and reliability assessments.

Purpose: The aim of this study was to assess different aspects of reliability in high-resolution ultrasonography (HRUS) of the peripheral nerves and to establish reference values for the most frequently examined nerve segments. Materials and Methods: A nerve size parameter, the cross-sectional area (CSA) of the C5, C6 and C7 cervical roots, the median, ulnar, radial, superficial radial, peroneal, tibial, and the sural nerves was measured using HRUS at a total of 14 predefined anatomical sites in two different cohorts of Results: The mean CSA of the 14 nerve segments ranged from 2 to 10mm2. The intra-rater, interrater and inter-equipment reliability was high with intraclass correlation coefficients of 0.93, 0.98, and 0.86, respectively. The CSA values showed no consistent correlation with age, height, and body weight, but males had significantly larger values than females for nerve segments on the armafter correcting for age,weight and height in multivariate analysis. CSA values did not differ when two independent cohorts were compared. Conclusion: Peripheral nerve ultrasonography is a reliable and reproducible diagnostic method in the hands of experienced examiners. Normal values for several upper and lower extremity nerves are provided by our study. healthy subjects (n = 56), and the inter-rater, intra- rater and inter-equipment reliability of measurements was assessed

Epilepszia betegségteher felmérés Magyarországon

Tanulmányomban a 2008 októberében kezdődött Epilepszia Betegségteher Felmérés Magyarországon módszertanát és eredményeit szeretném bemutatni és összehasonlítani a nemzetközi adatokkal. Az epilepszia a felnőtteknél a neurológiai betegségek közül a második leggyakoribb megbetegedés (Magyarországon kb.50-60.000 fő). A keresztmetszeti, kérdőíves felmérés az Egészség-gazdaságtani és Egészségügyi Technológiaelemzési Kutatóközpont és három budapesti Epilepszia Centrum együttműködésében zajlott, több mint 100 beteg bevonásával. A kérdőív egy általános epilepszia kérdőívből és két generikus életminőség kérdőívből (EQ-5D és SF-36) állt. Az eredmények alátámasztották, hogy a terápia-rezisztens betegek éves társadalmi költsége az átlagnál jóval magasabb, főleg a rokkant nyugdíj költsége miatt, és jelentős életminőség romlás is megfigyelhető, elsősorban a rohamtól való félelem miatt

The significance of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome.

OBJECTIVE: A retrospective study to investigate the utility of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome (CTS). METHODS: 118 hands of 87 patients with electrophysiologically confirmed CTS and 44 control hands of 23 subjects were assessed. Cross-sectional areas (CSA) of the median nerve were measured at the tunnel inlet, outlet, and forearm. Longitudinal diameters (LAPD) were measured at the inlet, proximal tunnel, distal tunnel, and outlet. RESULTS: CSA at the outlet (median: 18mm2) and its palm-to-forearm-ratio (median: 2.7) were significantly larger than CSA at the inlet (median: 15mm2) and its wrist-to-forearm-ratio (median: 2.2) (p<0.001). 27% of the hands showed enlargement only at the outlet versus 13% only at the inlet. LAPD jump was significantly greater, suggesting relief of higher pressure, at the outlet/distal tunnel versus inlet/proximal tunnel (p<0.001). CONCLUSION: Median nerve enlargement in CTS is greater at the tunnel outlet than at the inlet. We postulate that this is explained by the progressive increase of pressure within the tunnel from proximal to distal. SIGNIFICANCE: The addition of CSA outlet measurements to inlet measurements increased CTS ultrasonographic diagnostic sensitivity and accuracy by 15% and 10%, respectively

LADA type diabetes, celiac diasease, cerebellar ataxia and stiff person syndrome. A rare association of autoimmune disorders.

Celiac disease--in its typical form--is a chronic immune-mediated enteropathy with typical clinical symptoms that develops against gliadin content of cereal grains, and is often associated with other autoimmune diseases. In cases of atypical manifestation classic symptoms may be absent or mild, and extra-intestinal symptoms or associated syndromes dominate clinical picture. The authors present a longitudinal follow-up of such a case. A 63-years old woman was diagnosed with epilepsy at the age of 19, and with progressive limb ataxia at the age of 36, which was initially thought to be caused by cerebellar atrophy, later probably by stiff person syndrome. At the age 59, her diabetes mellitus manifested with type 2 diabetic phenotype, but based on GAD positivity later was reclassified as type 1 diabetes. Only the last check-up discovered the celiac disease, retrospectively explaining the entire disease course and neurological symptoms. By presenting this case, the authors would like to draw attention to the fact that one should think of the possibility of celiac disease when cerebellar ataxia, progressive neurological symptoms and diabetes are present at the same time. An early diagnosis may help to delay the progression of disease and help better treatment

Szérumbiomarkerek akut lumbalis-lumbosacralis fájdalomban

Inflammation contributes to the pathogenesis of low back pain and sciatica. Growing evidence suggests that elevated levels of some inflammatory biomarkers are associated with these conditions. Much of the research evaluating the association between pro- and anti-inflammatory cytokines, chemokines, other regulatory molecules, and low back pain and sciatica, focused on patients with chronic low back pain, while fewer studies addressed the issue of detectable biomarkers in the acute phase. Previous studies suggest that pro-inflammatory cytokines such as TNF-alpha, IL-6, and IL-8 and anti-inflammatory IL-4 and IL-10 play an important role in the inflammatory response following intervertebral disc herniation. According to the approach of personalized medicine it is important to identify subsets of patients within the acute patient group regarding etiology, prognosis and treatment. In addition, if we can identify subgroups based on levels of pro-inflammatory biomarkers, where inflammation may be the leading cause of pain, we assume that this subgroup would likely be effectively treated with anti-inflammatory medication. The efficacy of TNF-alpha inhibitors and IL-6 inhibitors in treating low back pain and sciatica has already been tested in clinical trials, but further studies are required. Overall, identification of circulating biomarkers of acute low back pain and sciatica may assist in refining personalized diagnosis and treatment. Further research is needed to evaluate the role of inflammation in acute low back pain and sciatica, to identify what methods are appropriate for evaluation in clinical practice, and whether there are biomarkers of prognostic value in these patients

Ultrasonography of MADSAM neuropathy: Focal nerve enlargements at sites of existing and resolved conduction blocks

Using the emerging technique of peripheral nerve ultrasonography, multiple focal nerve swellings corresponding to sites of existing conduction blocks have been described in demyelinating polyneuropathies. We report two cases of multifocal acquired demyelinating sensory and motor neuropathy (MADSAM). In the first, multiple focal nerve enlargements were detected by ultrasound at sites of previous conduction blocks, well after complete clinical and electrophysiological resolution. In the second case, existing proximal conduction blocks could be localized by ultrasound. Our cases highlight the importance of nerve ultrasound in identifying conduction blocks and demonstrate that ultrasonographic morphological changes may outlast functional recovery in demyelinating neuropathies. © 2012 Elsevier B.V