Background: Amblyopia is a case where one or less commonly, both eyes have impaired visual performance, even with the best optical correction and no visible disease of the visual system. Objectives: ...To assess contrast sensitivity tests (CST) and pattern visual evoked potentials (PVEP) results in amblyopic children who have already started occlusion therapy for durations ranging from 6 to 12 months. Methods: This cross-sectional study was conducted on 200 eyes of 50 patients with monocular amblyopia and 50 age and sex matched controls. Both patients and controls underwent ophthalmological assessment, PVEP, and CST. Results: There was no statistically significant difference in the results of P100 latencies of qualitative PVEP in amblyopic eyes compared to non-amblyopic eyes and control eyes, while the qualitative CST showed a highly statistically significant difference, being affected in 98% of amblyopic eyes compared to unaffected eyes (4%) and control eyes (4%). The maximum contrast level and minimal contrast level of quantitative CST were significantly lower in amblyopic eyes compared to non-amblyopic and control eyes. The cutoff value of maximal contrast level at mean frequencies of 2.5 ± 0.9 Hz, and a range of (1.1–4.1) for amblyopic eyes is ≤21 dB, while the cutoff value of minimal contrast level at mean frequencies of 13.4 ± 2.6 Hz, and a range of (6.7–18) for amblyopic eyes is ≤12 dB. Conclusion: Detection of amblyopia by CST is a noninvasive and easy procedure, which represents a promising tool to support the diagnosis of amblyopia.
To examine the use of Double Crush Syndrome (DCS) hypothesis in CTS patients in order to support or disguard the theory.
This study was conducted on 80 adult patients, 40 presenting with brachialgia ...(Group I) and 40 patients claiming of failed CT release operation (Group II). Diagnostic work up included neurological examination, MRI of cervical spine, Phalens, Tinel’s sign, EMG examination and motor and sensory nerve conduction studies.
EMG examination and nerve conduction studies results show 10 cases with CTS (25%), 20 cases (50%) with DCS and 10 cases (25%) with cervical radiculopathy in group I, while group II proved 10 cases (25%) with CTS and 30 cases (75%) with DCS. Accordingly, studied patients showed 20 cases with CTS (25%), 50 cases with DCS (62.5%) and only 10 cases with cervical radiculopathy alone (12.5%). When comparing the first nerve conduction studies of Group II before the operation and the follow up nerve conduction studies of the same group after the operation we found 32 cases (80%) with improvement of the NCS and 8 cases (20%) with deterioration of the nerve conduction studies results.
The double crush syndrome element should be excluded whenever examining for CTS, to guide for treatment.
DCS hypothesis was supported by this sudy.
The double crush concept has gained some popularity among chiropractors because it seems to provide a rationale for evaluating the condition of the cervical roots when treating CTS, which was supported by this study.
Background
Diabetes mellitus is a clinical syndrome characterized by hyperglycemia caused by respective or absolute deficiency of insulin. Painful neuropathy in diabetic population is popular, ...impacting numerous chronic diabetic patients. Although antidepressants, anticonvulsants, and opioid agonists are useful in alleviating painful neuropathy, they produce a diversity of side effects and are occasionally ineffective. Hence, there is presently a need to pursue safe, non-invasive, and effective therapeutic opportunities. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive mechanism used in releasing neuropathic pain. TMS pulses—when applied repetitively—can modulate cortical plasticity, consequently causing excitability or inhibition according to the rate of stimulation.
Objectives
The aim of this study is to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in improving resistant chronic diabetic neuropathic pain.
Subjects and methods
Twenty patients were recruited and divided equally into two groups: insulin-dependent (group A) and non-insulin-dependent (group B). A high-frequency (10 Hz) rTMS stimulation protocol was applied to both groups for five consecutive days over lower limbs motor cortex. VAS score and nerve conduction studies were compared before and after rTMS sessions.
Results
Highly significant improvements in VAS and nerve conduction studies (
p
> 0.01) were detected for both patient cohorts following the administration of the rTMS protocol.
Conclusion
According to our study, rTMS significantly reduced painful diabetic neuropathy. rTMS may produce its analgesic effects, inducing motor cortex plasticity and activating descending inhibitory pain control systems.
•In the acute stage of optic neuritis; PVEP latencies and ONSD are significantly delayed.•These changes are not correlated to each other.•In unilateral cases ONSD measured by TOS is specific but with ...average sensitivity.•PVEP is still the best choice with high specificity and sensitivity.•ONSD cannot differentiate between MS cases and non-MS cases.
Optic neuritis (ON) is an inflammatory demyelinating condition that causes acute - usually monocular - visual loss. It is highly associated with multiple sclerosis (MS). In general, ON is a clinical diagnosis based upon the history and examination findings. Objective: The aim was to assess the diagnostic accuracy of measuring optic nerve sheath diameter (ONSD) by ultrasound in acute optic neuritis. Methods: This is a prospective observational study with matched controls carried out on 25 patients and 25 controls. All patients presented with first attack of an acute demyelinating ON. Both patients and controls were submitted to clinical assessment, pattern and flash visual evoked potential and trans-orbital sonography (TOS) to measure the optic nerve sheath diameter (ONSD). Results: The ONSD was significantly thicker in patients with unilateral (0.6 ± 0.05 cm) and bilateral (0.6 ± 0.1 cm) optic neuritis compared to controls (0.52 ± 0.06 cm). P-value was < 0.001 and 0.04 respectively, with a cutoff value 0.57 cm. A significant negative correlation was found between the thickness of the ONSD and the visual acuity (r= −0.613, P-value <0.05). No correlation was found between the age of the patients and ONSD or between ONSD and latency of P-VEP. TOS showed 68% sensitivity and 88% specificity in diagnosing cases of ON. Conclusion: ONSD measured by TOS is a noninvasive, inexpensive bed-side test, which represent a supporting tool to confirm the clinical diagnosis of ON. Yet its sensitivity and specificity are lower than P-VEP.
Background
Spinal cord injury is associated with urinary and erectile dysfunction.
Objective
This study compared the efficacy of transcutaneous electrical nerve stimulation (TENS) with pelvic floor ...biofeedback (PFBFB) training in the treatment of bladder and erectile dysfunction for male patients with traumatic partial spinal cord injury.
Methods
The study included 30 male patients with bladder and erectile dysfunction (precipitancy overactive bladder) after traumatic partial spinal cord injury above the level of T12 within 6-18 months after injury. Patients were randomly divided into two equal groups: the study group was subjected to TENS and pelvic floor exercises and the control group was subjected to PFBFB training in addition the exercises. Patients were assessed before and after treatment by means of cystometric measurements, electromyography activity of pelvic-floor muscles, and International Index of Erectile Function (IIEF-5) Questionnaire.
Results
Before treatment, there was no significant difference in cystometric measurements, pelvic-floor muscle strength, and IIEF-5 score. In the TENS group, the treatment produced significant improvement in bladder volume at first desire to void (P = 0.001), maximum bladder capacity (P = 0.001) and maximum flow rate (P = 0.001), detrusor pressure at maximum flow (P = 0.002), strength of pelvic floor muscles (P = 0.001), and IIEF-5 score (P = 0.001). PFBFB training resulted in significant improvement only in the maximum flow rate (P = 0.042).
Conclusion
TENS of pelvic floor muscles is a promising, safe, effective, and inexpensive physical therapy technique to improve urinary and erectile dysfunction in patients with partial suprasacral spinal cord injuries.
Stroke is the most leading cause to functional disability and gait problems. The purpose of this study was to determine the effect of transcranial direct current stimulation on selected gait ...kinematics in stroke patients.
Thirty male stroke patients participated in this study. The patients were assigned randomly into two equal groups (study and control). Patients in the study group received Anodal tDCS in addition to selected physical therapy program for stroke patients. Patients in the control group received selected physical therapy program only including: strengthening exercises, stretching exercises, weight bearing, balance exercises and gait training. The Outcome Measures: Biodex gait trainer 2 TM was used to assess selected gait kinematics (step cycle, walking speed) before and after four weeks training period (end of treatment) for both groups.
There was a statistically significant increase in walking speed and step cycle in both group. The improvement in gait parameters post treatment was significantly higher in the study group compared to the control group
Transcranial direct current stimulation is effective in improving selected gait kinematics in stroke patients when added to the selected physical therapy program.
Brain fingerprinting is a forensic science technique that uses electroencephalography (EEG) to determine whether specific information is stored in a subject’s brain. It does this by measuring ...electrical brainwave responses to pictures that are presented on a computer screen; P300 wave is a specific event-related potential (ERP) component that has the potential for detecting concealed information in the brain. Objectives: this work aimed to evaluate the appearance of P 300 wave in response to relevant visual stimuli and its absence to irrelevant ones and to evaluate the latency and amplitude of P300 wave in response to well-known persons and places.
This is a cross sectional prospective study carried out on 225 normal individuals at Clinical Neurophysiology Unit, Faculty of Medicine, Cairo University. It comprised both sexes aged from 18 to 70 years old; participants were divided into 3 groups. An endogenous ERP;P300 wave was seen evoked in response to rare, presented, recognized, meaningful stimulus, the peak amplitude was calculated and peak latency was measured from the time of stimulus onset.
A photo of a person or place known to the test subject elicited a well-marked P300 response, while that of an unknown personality or place didn’t generate noticeable response. P300 wave latency and amplitude was recorded. There was a significant association between P300 amplitude and latency with age and educational level.
P300 wave is valuable in detecting concealed knowledge stored in the participant’s brain and is an objective and reliable test.
The objective of our study is to reduce resistant diabetic polyneuropathic pain using repetitive transcranial magnetic stimulation (rTMS).
Diabetes mellitus is a clinical syndrome characterized by ...hyperglycemia caused by relative or absolute deficiency of insulin in the body. Painful neuropathy is a common complication in chronic diabetes. Although painful neuropathy responds to antidepressants, anticonvulsants and opioid agonists, these drugs proved to have different side effects and are sometimes not effective. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive, safe and effective mechanism used in relieving neuropathic pain. According to pulses given, it can modulate cortical plasticity, consequently causing excitability or inhibition according to the rate of stimulation.
Twenty patients were randomly selected and divided into two groups: Insulin dependent (group A) and non-Insulin dependent (group B), each group contains10 patients. High frequency 10Hz stimulation protocol is applied on both groups for 5 consecutive days, repetitive transcranial magnetic stimulation was applied over lower limbs’ motor cortex, VAS score and nerve conduction studies were compared before and after the sessions.
Highly significant improvement of VAS score and nerve conduction studies (p-value<0.01) were detected after the sessions.
To the best of our knowledge, this study is one of the first studies to apply rTMS over lower limb motor cortex in treating patients suffering from diabetic neuropathic pain by activating pain control systems as well as improving their nerve conduction studies. Improvement of nerve conduction studies is a result of pyramidal tract excitation, accordingly spinal synaptic plasticity.
According to our study, we found that rTMS significantly reduced painful diabetic neuropathy. rTMS may produce its analgesic effects, inducing motor cortex plasticity and activating descending inhibitory pain control systems.
Background
The multifocal visual evoked potential (mfVEP) is a useful tool for evaluating optic nerve disease and visual defects secondary to optic nerve or retinal ganglion cell damage.
Objective
...The aim of this study was to establish technical guidelines and normative values of the peak time and amplitude of the mfVEP in adolescents.
Participants and methods
This is a prospective study conducted on 20 healthy adolescents (40 eyes) 10 girls and 10 boys. Their age ranged between 10 and 15 years with a mean of 12.50 1.48. Monocular mfVEP was obtained from each eye separately. The peak time and amplitude of the P1 wave of each individual response were measured and then expressed in the form of four quadrants.
Results
The peak time and amplitude of the P1 wave showed no statistical differences between the four quadrants and no correlation to the age. There were no statistically significant differences between girls and boys or between left and right eyes regarding the peak time and the amplitude of the P1 wave.
Conclusion
We obtained normative data of mfVEP of the adolescents in our lab as a preliminary work for further application in different neuro-ophthalmological disorders.
To assess the influence of combined repetitive transcranial magnetic stimulation (rTMS) with tradmill training on cognitive and motor performance in Parkinson’s disease (PD) patients.
Forty-five PD ...male and female patients participated in this study. Age ranged from 55 to 70years. The patients were assigned into three equal groups; two control groups (GI&GII) and one study group (GIII). The first control group (GI) treated by a designed physical therapy program; and the second control group (GII) treated by the same program in addition to aerobic exercise on treadmill for 20min. The study group (GIII) received (5Hz) rTMS followed by the same program as (GII). The treatment program was conducted three sessions per week, for four weeks; the duration of each session ranged from 40 to 55min. Biodex balance system, key board tapping and two-dimensional motion analysis were used to assess balance, bradykinesia and gait; respectively. PD cognitive rating scale and auditory event related potential (P300) were used to evaluate cognitive functions pre- and post-treatment.
Pre-treatment there was a non-significant difference in the mean values of all variables in the three groups. Post-treatment there was a significant improvement in spatiotemporal gait parameters and bradykinesia in the three groups with more improvement in (GIII) (P<0.05). Improvement in balance and cognitive functions was observed only in (GII&GIII). There was a significant difference in variables of dynamic balance indices between both groups.
Treadmill training combined with rTMS has a positive effect on both cognitive and motor performance in PD patient.
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