Highlights ► Electrodiagnostic results are useful in assessing traumatic nerve lesions but limited by an inability to differentiate between neurotmesis and axonotmesis. ► The improved resolution and ...wide availability of ultrasound (US) instruments have made this tool useful in assessing nerve diseases and this may be particularly true in traumatic lesions. ► The current study demonstrated that the information provided by US is useful for a comprehensive diagnosis and to plan the most appropriate therapy in 60% of cases.
To compare a 6-week virtual reality (VR) rehabilitation programme with a conventional rehabilitation programme in patients with Parkinson’s disease.
Prospective, single-blinded, randomised controlled ...trial.
Outpatients.
Fifty-one patients with Parkinson’s disease were assigned at random to a VR rehabilitation programme or a conventional rehabilitation programme.
Both programmes ran for 6 consecutive weeks, with a 40-minute session three times per week.
The Balance Berg Scale (BBS) was used to measure balance. Secondary outcome measures were: Dynamic Gait Index (DGI) to evaluate ability to adapt gait to complex walking tasks; Disabilities of the Arm, Shoulder and Hand (DASH) scale to measure performance of the upper limb; and Short Form 36 (SF-36) to evaluate quality of life.
The VR rehabilitation programme led to an increase in BBS score {45.6 standard deviation (SD) 7.9 vs 49.2 (SD 8.1), mean difference 3.6, 95% confidence interval (CI) 1.3 to 5.9; P=0.003}, DGI score 18.7 (SD 4.7) vs 20.2 (SD 4.2), mean difference 1.6, 95% CI 0.6 to 2.5; P=0.003 and SF-36 mental composite score 37.7 (SD 11.4) vs 43.5 (SD 9.2), mean difference 5.8, 95% CI 0.4 to 11.3; P=0.037, and a decrease in DASH scale score 29.6 (SD 17.5) vs 21.6 (SD 15.1), mean difference −7.9, 95% CI −13.7 to −2.2; P=0.009. In contrast, the conventional rehabilitation programme only led to a decrease in DASH scale score 30.3 (SD 18.1) vs 25.1 (SD 15.8), mean difference −5.2, 95% CI −8.8 to −1.5; P=0.007.
These findings suggest that rehabilitation is useful in Parkinson’s disease, and the VR rehabilitation programme was more effective in determining overall improvement than the conventional rehabilitation programme.
: NCT02807740.
Summary Several papers were published since the first clinical applications of laser evoked potentials (LEPs) in disorders of the nociceptive system. While studies produced until five years ago were ...mostly addressed at identifying lesions of the nociceptive system, more recent papers used LEPs as an instrumental tool for the diagnosis of neuropathic pain. LEPs have also proved useful in demonstrating the pathophysiological mechanisms underlying different types of neuropathic pain (e.g., paroxystic and ongoing neuropathic pain). This is of utmost importance, as pain treatment should take physiopathological mechanisms, rather than etiology into account. Although there are still some limits for the routine use of LEPs as a diagnostic tool, this review of the literature demonstrates that LEP recording has become mandatory for the functional assessment of patients with hypoalgesia or neuropathic pain.
Background and purpose
Muscle‐strengthening, stretching or proprioceptive treatments may slow symptom progression in Charcot—Marie–Tooth (CMT) neuropathy. The aim of the study was to evaluate safety ...and efficacy of treadmill training in CMT1A.
Methods
We planned a multicenter, prospective, randomized, single‐blind, controlled study. We recruited 53 outpatients affected by CMT1A and randomized them into two treatment groups: one underwent stretching and proprioceptive exercise, whereas the other was additionally treated with treadmill training (TreSPE). Primary outcome measures (OMs) were the walking evaluations and secondary OM was the balance assessment. All participants were assessed at baseline and after 3 and 6 months of treatment.
Results
Most patients showed an improvement in at least one OM after 3 months 42/47 (89.4%) and 6 months 38/40 (95%) of treatment. No adverse events were reported in either group.
Conclusions
The most important finding was that both stretching and proprioceptive exercise and treadmill training had an objective benefit on patients affected by CMT disease, without causing overwork weakness. We had a low rate of drop out and did not find deterioration in motor performance. Our results also confirm that applying evidence‐based medicine methods to rehabilitative research is the correct way to test the efficacy of a treatment.
Background and purpose: Recently, ultrasound (US) has been used to assess the peripheral nervous system; however, there is no real study about its possible significant role in routine practice. Our ...study aims to assess the contribution of US as a routine tool in a neurophysiological laboratory.
Methods: The study assesses 130 patients who presented clinical suspicion of peripheral nerve diseases, excluding motor neuron disease, radiculopathy, hereditary and acquired polyneuropathy. All patients were clinically, neurophysiologically and sonographically assessed in the same session by the same neurologist/neurophysiologist. To avoid interpretation bias, two independent and blinded clinicians, different than the examiners performing electrodiagnosis and US, reviewed clinical, neurophysiological and US findings (also data about follow‐up, when available) and classified the contribution of US as follows: Contributive (US had influence on the diagnostic and therapeutic strategies), Confirming (US confirmed the clinical and neurophysiological diagnosis), Non‐Confirming (US findings were normal) and Incorrect (US findings led to incorrect diagnosis).
Results: US impacted, namely modified the diagnostic and therapeutic path in 42.3% of cases (55 patients); US had a confirmatory role in 40% (52 patients); US did not confirm clinical and neurophysiological diagnosis in 17.7% (23 cases); no incorrect US findings were observed.
Conclusion: US complements neurophysiological assessment even in routine practice, and this confirms the increasing interest in US for a multidimensional evaluation of peripheral nerve system diseases.
Carpal tunnel syndrome (CTS), a common entrapment neuropathy involving the median nerve at the wrist, frequently manifests with neuropathic pain. We sought information on pain mechanisms in CTS. We ...studied 70 patients with a diagnosis of CTS (117 CTS hands). We used the DN4 questionnaire to select patients with neuropathic pain, and the Neuropathic Pain Symptom Inventory (NPSI) to assess the intensity of the various qualities of neuropathic pain. All patients underwent a standard nerve conduction study (NCS) to assess the function of non-nociceptive Abeta-fibres, and the cutaneous silent period (CSP) after stimulation of the IIIrd and Vth digits, to assess the function of nociceptive Adelta-fibres. In 40 patients (75 CTS hands) we also recorded laser-evoked potentials (LEPs) in response to stimuli delivered to the median nerve territory and mediated by nociceptive Adelta-fibres. We sought possible correlations between neurophysiological data and the various qualities of neuropathic pain as assessed by the NPSI. We found that the median nerve sensory conduction velocity correlated with paroxysmal pain and abnormal sensations, whereas LEP amplitude correlated with spontaneous constant pain. Our findings suggest that whereas paroxysmal pain and abnormal sensations reflect demyelination of non-nociceptive Abeta-fibres, spontaneous constant pain arises from damage to nociceptive Adelta-fibres.
Highlights • We adopted a novel methodology using patients’ long-term clinical course as the gold standard for myasthenia gravis (MG) diagnosis. • The sensitivity of SFEMG in diagnosing MG was 98% ...and the specificity was 70%, with a positive predictive value of 79% and a negative predictive value of 97%. • Patients with normal findings at SFEMG are unlikely to be affected by MG.
Abstract Objective The aim of this study is twofold. First, to assess the relationships between the cross-sectional area (CSA) of the median nerve (MN) calculated at ultrasound (US) and: (1) ...patient’s perception of his/her symptoms and hand function; (2) clinical severity of CTS; (3) neurophysiological classification; (4) hand distribution of symptoms. Second, to assess the sensitivity of ultrasonography (US) and neurophysiology in the diagnosis of CTS using clinical measures as gold standard. Methods We performed a prospective study by using multidimensional assessment: clinical (Historic and Objective scale, Hi–Ob), neurophysiological, patient-oriented measures (Boston Carpal Tunnel Questionnaire, BCTQ) and high-resolution US. The dominant hands of 54 consecutive patients who were referred to our neurophysiologic laboratory with clinical signs of CTS (43 females, mean age 53.3, range 30–80, SD: 13.1) were examined. Results A statistically significant correlation was found between the CSA of the MN at wrist and (1) hand function (according to BCTQ, r = 0.35, p = 0.01), (2) clinical scale (Hi–Ob scale, r = 0.51, p < 0.00007), (3) neurophysiologic classification ( r = 0.80, p < 0.0000001), and (4) hand distribution of symptoms ( p = 0.017). Neurophysiology showed higher sensitivity than US but in one of 3 cases with normal neurophysiological results, US showed data suggestive of CTS. Conclusions A positive correlation exists between US findings and all the conventional measures of CTS severity. The sensitivity of the combination of US and neurophysiology is higher than the sensitivity of neurophysiology or US alone. US is a useful complementary tool for CTS assessment. Significance Information on the contribution of US in CTS and the interpretation of severity measurements in CTS.
Background and purpose
Charcot−Marie−Tooth (CMT) disease is the most common inherited neuropathy, but therapeutic options have been limited to symptom management. Past pharmacological trials have ...failed, possibly due to insensitive outcome measures (OMs). The aim of the current study was to evaluate the validity and reliability of the 6‐min walk test (6MWT) and StepWatch™ Activity Monitoring (SAM) with other previously validated OMs in CMT disease.
Methods
A prospective multicenter study was performed, consecutively enrolling 168 CMT patients (104 with CMT1A, 27 with CMT1B, 37 with X‐linked CMT) from Italian centers specializing in CMT care.
Results
Statistical analysis showed that the 6MWT was highly related with all previously used OMs. Some, but not all, SAM parameters were related to commonly used OMs but may provide more information about quality of life.
Conclusions
The current study demonstrated the validity and reliability of the 6MWT and SAM as OMs for CMT. Moreover, SAM provides data that correlate better with quality of life measures, making it useful in future rehabilitation trials.
Highlights • Ultrasound (US) nerve assessment is increasingly used for characterising nerve morphology in the study of polyneuropathies. • Previous nerve US studies performed on Charcot–Marie-Tooth ...(CMT) patients showed an increased US pattern at upper limb nerves. • Conversely in most cases the sural nerve had normal cross-sectional area (CSA).
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