B. Uludag - Academia.edu (original) (raw)
Papers by B. Uludag
Muscle & nerve, 1997
WOS: A1997VZ33200026PubMed ID: 899559
Muscle & nerve, 1996
WOS: A1996UF72700028PubMed ID: 861857
Journal of Neurology, 1998
Sirs: Juvenile distal spinal muscular atrophy (JDSMA), first described by Hirayama et al. [1] in ... more Sirs: Juvenile distal spinal muscular atrophy (JDSMA), first described by Hirayama et al. [1] in 1959, constitutes a separate entity among motor neuron diseases. It is sometimes also referred to as monomelic amyotrophy [2]. The main clinical features are: (1) Juvenile insidious onset, (2) chronic weakness and wasting localized to the upper limbs, (3) lack of autonomic, sphincter, pyramidal tract and sensory involvement other than lower motor neuron signs confined to one or both upper extremities, (4) lack of a family history, (5) normal routine biochemical examinations, (6) arrest of progression in 2–3 years, (7) denervation shown in needle EMG with normal nerve conduction velocities, (8) atrophy of the lower cervical cord on computed tomography or magnetic resonance imaging [3, 4]. The disease selectively affects the anterior horn cells in the lower cervical cord. Although the condition was initially thought to affect only persons of Japanese and Indian extraction, it has since been described in young persons from various parts of the world [5–13]. We report a patient from Turkey with typical JDSMA accompanying the Arnold-Chiari type 1 malformation. A 17-year-old man was admitted to hospital because of a 4-year history of weakness and wasting of hands and forearms. At the age of 13 years his left hand grip was noticed to be weak with wasting of the first dorsal interosseus muscle, followed by wasting of the thenar and hypothenar eminences which later progressed to the right side, in the same order. He was examined at another institute, but no clear diagnosis was made. A year later the disease had progressed to the forearm and triceps muscles and then stabilized. His past medical history was non-contributory, and there was no family history. On examination he had atrophy and weakness of triceps, forearm and small hand muscles on both sides except for the brachioradialis muscles (Fig. 1). Tendon reflexes were absent in the upper extremities but were normal in the lower. The plantar responses were flexor. Ataxia, extrapyramidal signs, sensory disturbances, Horner’s sign and abnormalities in sweating and urination were all absent. Complete blood count, blood biochemical analysis including creatine kinase and cerebrospinal fluid analysis were in the normal range. Nerve conduction studies were normal. Needle EMG of the upper extremities demonstrated chronic and active denervation in muscles innervated by C7–T1 segments. No abnormality was found in the lower extremities. Magnetic resonance imaging revealed the ArnoldChiari type 1 malformation in addition to an abnormally thin lower cervical cord (Fig. 2). Our patient’s history, clinical examination and laboratory findings were typical of JDSMA, except for an Arnold-Chiari type 1 malformation, demonstrated on magnetic resonance imaging, not associated with a syrinx. The aetiology of JDSMA is unknown. Magnetic resonance imaging studies have described structural alterations of the lower cervical cord, reflecting anterior horn atrophy [14]. Hirayama et al. [3] suggested anterior horn cell ischaemia from vascular insufficiency in the lower cervical cord in their pathological study. Okumura and Homma [15], on the other hand, proposed that mechanical cord compression in the absence of spondylotic changes, is the responsible mechanism, and they performed anterior spinal fusion of their seven patients to prevent flexion myelopaLETTER TO THE EDITORS J Neurol (1998) 245 :561–562 © Springer-Verlag 1998
Journal of Clinical Neurophysiology, 1996
The sacral cord conduction time of the soleus H-reflex was investigated in 30 normal adult subjec... more The sacral cord conduction time of the soleus H-reflex was investigated in 30 normal adult subjects using three different methods. (1) The posterior tibial nerve was stimulated at the popliteal fossa by graded electric shocks, and the recordings were made from different lumbar epidural intervertebral levels. The afferent action potentials from the dorsal roots and the reflexively evoked efferent action potentials from the ventral roots were recorded. The time interval between the negative peaks of the ventral and dorsal root potentials was used to calculate the approximate sacral cord reflex delay time, which was found to be 1.3 ms. on average. (2) The sacral cord reflex delay time was found to be about 2.0 ms using the conduction time of the afferent, that of the efferent limbs and total reflex time of the soleus H-response. (3) By stimulating the lumbosacral roots at the epidural levels and using the difference between the soleus H and M response latencies, the sacral cord reflex delay was determined to be approximately 2.4 ms. These findings indicated that the soleus H-reflex is exclusively monosynaptic. It is proposed that in humans the synaptic transmission at the sacral cord is approximately 0.4 ms.
Turkish Neurosurgery, 2021
In this report, we present the case of a 21-year-old female with midbrain tremor involving atypic... more In this report, we present the case of a 21-year-old female with midbrain tremor involving atypical features, treated using a pedinculopontine nucleus lesion. Different targets for the treatment of midbrain tremor using radiofrequency lesion have been reported. In this case, stimulation of the thalamic ventralis intermedius nucleus and subthalamic nucleus produced no satisfactory improvement in tremor frequency and amplitude. A third goal was to obtain a significant response in terms of these outcomes with pedinculopontine nucleus stimulation. According to the literature, this is the first case of midbrain tremor treated with a pedinculopontine nucleus radiofrequency thermocoagulation lesion.
31st International Epilepsy Congress -- SEP 05-09, 2015 -- Istanbul, TURKEYWOS: 00036575650049
The Journal of Prosthetic Dentistry, 2010
Journal of Neurology, Neurosurgery & Psychiatry, 2001
31st International Epilepsy Congress -- SEP 05-09, 2015 -- Istanbul, TURKEYWOS: 00036575650031
To the Editor: We thank Dr. Finsterer and colleagues for repeating our work and for giving us the... more To the Editor: We thank Dr. Finsterer and colleagues for repeating our work and for giving us the opportunity to present further data on more of our patients (Table 1). According to us and also to Gilchrist et al. (l) , turn-amplitude (T/A) ratio analysis has a lower diagnostic sensitivity than conventional electromyography (EMG). In our juvenile myoclonic epilepsy (JME) cases, we first made at least four needle EMG recordings and then used the T/A analysis (2). The results of our conventional EMG evaluations, including some additional cases that we examined after our previous report, showed that of 3 1 cases, 11 had subclinical involvement of anterior horn cells (Fig. 1). In 7 of these 1 1 cases, T/A values were in excess of normal limits for the muscle investigated. The reason for this is that the T/A ratio fails to reflect neurogenic changes unless they are pronounced ( 1 ) (StHlberg, personal communication). This may explain four of the differences between our findings and those of Finsterer et al., (3) who investigated the biceps muscle without using a
NeuroRehabilitation, 2007
Hand motor representation area expands towards the area of the perioral facial motor cortex in pa... more Hand motor representation area expands towards the area of the perioral facial motor cortex in patients with peripheral facial paralysis (PFP) and in hemifacial spasm cases treated with botulinum toxin. In this current study, we aimed to investigate the changes both in the ipsilateral and contralateral facial motor cortex areas in patients with PFP with transcranial magnetic stimulation (TMS). Thirty healthy individuals and 41 patients with unilateral PFP with partial or total axonal degeneration participated in this study. Motor evoked potentials (MEPs) of perioral muscles elicited by TMS of the intracranial portion of the facial nerve and motor cortex, were recorded. TMS was delivered through a figure-of-eight coil. Mapping of the cortical representation of perioral muscles were also studied in 13 of 41 patients and in 10 of control subjects. Mean amplitude of the intact perioral MEPs elicited by the ipsilateral hemisphere TMS, was significantly higher in patients than the control subjects. There was also a mild enlargement of the mean cortical representation area of intact perioral muscles on both hemispheres though it was not significant. We have concluded that there was a cortical reorganization in the hemisphere contralateral to the paralytic side resulting in an increase at corticofugal output related to intact perioral muscles.
The American journal of gastroenterology, 1997
Different variables of oropharyngeal swallowing change in response to bolus volume and consistenc... more Different variables of oropharyngeal swallowing change in response to bolus volume and consistency as determined by manometric/videofluoroscopic studies. But the subject is debatable especially from the physiologic point of view. No electrophysiologic studies are available on human subjects. The effects of bolus volume and viscosity on different variables of oropharyngeal swallowing were investigated using electrophysiologic methods. Mechanical upward and downward laryngeal movements and submental electromyographic (SM-EMG) activity of the laryngeal elevator muscles were recorded during dry and 3-, 10-, and 20-ml water swallowing in 14 normal subjects. Cricopharyngeus (CP) muscle was investigated during 3- and 10-ml water swallowing in 10 normal subjects. Semisolid and liquid swallowing were compared in eight normal subjects. The total duration of SM-EMG, time necessary for larynx elevation, CP-EMG pause related with upper esophageal sphincter opening and swallowing variability (jit...
Pain, 1998
Levodopa has been used to treat some painful conditions and found to be effective in neuropathic ... more Levodopa has been used to treat some painful conditions and found to be effective in neuropathic pain due to herpes zoster in a doubleblind study. From our anecdotal observations about the efficacy of levodopa on diabetic neuropathic pain, we designed a double-blind placebo-controlled study to test levodopa in painful diabetic neuropathy. Twenty-five outpatients with painful symmetrical diabetic polyneuropathy were admitted to the study. Fourteen patients were given 100 mg levodopa plus 25 mg benserazide to be taken three times per day for 28 days. Eleven patients were given identical placebo capsules. A blinded neurologist evaluated the patients clinically and performed Visual Analogue Scale (VAS) measurement every week from day 0 to day 28. The results seemed promising and levodopa may be a choice for the control of pain in neuropathy for which we do not have many alternative treatments.
Muscle & Nerve, 2005
The few electrophysiologic studies of the cremasteric muscle (CM) have mainly been restricted to ... more The few electrophysiologic studies of the cremasteric muscle (CM) have mainly been restricted to the cremaster reflex with no reference to central and peripheral nerve conduction to the muscle, probably for technical reasons.Twenty-six normal adult male volunteers were studied by transcranial magnetic cortical stimulation (TMS) and stimulation of thoracolumbar roots. The genitofemoral nerve (GFN) was stimulated electrically at the anterior superior iliac spine and a needle electrode was inserted into the CM for conduction studies. The motor latency to the CM from the cortical TMS ranged from 20 to 33 ms among the subjects (25.8 +/- 2.9 ms, mean +/- SD). Magnetic stimulation of the lumbar roots produced a motor response of the CM within 9.6 +/- 1.9 ms (range, 6-15). The central motor conduction time to the CM was 16.5 +/- 2.8 ms (range, 10-21). Stimulation of the GFN produced a compound muscle action potential with a mean value of 6.4 +/- 1.8 (range, 4-10) ms in 23 of the 26 cases. Thus, central motor nerve fibers to the CM motor neurons exist, and there may be a representation area for the CM in the cerebral cortex. The GFN motor conduction time to the CM may have clinical utility, such as in the evaluation of the groin pain due to surgical procedures in the lower abdomen.
Muscle & Nerve, 2005
Groin pain in the lower abdomen but including the ilioinguinal region is frequent after inguinal ... more Groin pain in the lower abdomen but including the ilioinguinal region is frequent after inguinal hernia operations, but the integrity of the nerves in this region, including the genitofemoral nerve (GFN), has not been investigated. We studied GFN motor conduction time to the cremasteric muscle (CM), the CM electromyogram (EMG), and the CM reflex in 30 patients with unilateral inguinal hernia who underwent herniorrhaphy and in 26 similar patients who had no surgical intervention. Among the 30 patients undergoing herniorrhaphy, 14 (47%) showed motor involvement of the GFN, whereas 6 of the 26 (23%) patients not treated surgically had involvement of the GFN. These findings indicate that subclinical motor involvement of the GFN can be demonstrated by electrophysiological methods and is common after inguinal herniorrhaphy. Based on patient complaints, the herniated mass may also be responsible for motor involvement of the GFN in some patients before surgery.
Muscle & Nerve, 1996
ABSTRACT Motor conduction velocity is expected to be normal or nearly normal in amyotrophic later... more ABSTRACT Motor conduction velocity is expected to be normal or nearly normal in amyotrophic lateral sclerosis (ALS). Some studies have suggested that pathology may be present in the proximal axons. Indeed, some investigators have shown a decrease in the proximal conduction velocity in ALS by using motor conduction velocity measurements and H-reflex and F-response recordings, but they could not delineate the precise region of the conduction pathology. In this study, unlike the ones carried out previously, the most proximal segment has been studied in 11 patients with ALS, 13 normal controls, and 5 patients with sequel of poliomyelitis (SPM) by recording sensory and motor spinal root potentials. While no conduction pathology, H-reflex, or F-response abnormalities were found in ALS patients compared to normal subjects, it was shown that conduction velocity decreased in the proximal segment of the lower motor neuron of the ventral root. Despite motor neuron pathology in SPM, there was no proximal motor conduction slowing compared with that in normal subjects.
Muscle & Nerve, 1997
Juvenile myoclonic epilepsy (JME) is not an uncommon seizure disorder, occurring in 5-10% of epil... more Juvenile myoclonic epilepsy (JME) is not an uncommon seizure disorder, occurring in 5-10% of epileptic patients. A subclinical anterior horn cell involvement has been suggested in some JME patients by concentric needle electromyography (EMG) and turn/amplitude analysis. In this study, 22 JME patients and 17 normal control subjects have been studied with macro EMG, which is a sensitive method to assess the size of motor units. Most JME patients (19 of 22) had a pathologically increased number of individual large macro motor unit action potentials (MUAPs) compared to control subjects. For both biceps brachii and tibialis anterior muscles, means of median macro MUAP amplitudes were significantly greater than those of normal controls, whereas the fiber density values were only slightly increased. This suggested another kind of anterior horn cell involvement in JME than seen in motor neuron diseases.
Muscle & Nerve, 1995
This article describes a combined electrophysiological and mechanical method used to measure lary... more This article describes a combined electrophysiological and mechanical method used to measure laryngeal movements and related submental EMG activity during swallowing. The mechanical upward and downward movements of the larynx were detected using a piezoelectric sensor while the submental integrated EMG (SM-EMG) was recorded. Measurements were performed in 29 human subjects. The interval between the onsets of the two sensor signal deflections was used as a measure of the time the larynx remained in its superior position during swallowing. In 10 subjects, the cricopharyngeus muscle (CP) of the upper esophageal spinchter showed a continuous tonic EMG activity except during swallowing. All the parameters measured were influenced by the type and volume of the bolus material. The method presented in this study proved its usefulness in the study of the physiology of deglutition as well as in its objective clinical evaluation in patients with dysphagia.
Knee Surgery, Sports Traumatology, Arthroscopy, 1998
Journal of the Neurological Sciences, 1996
Trigemino-ccrvicid rcflcxcs, rcccmfecf from the semispinalis capitis muscle(SCM) in the posterior... more Trigemino-ccrvicid rcflcxcs, rcccmfecf from the semispinalis capitis muscle(SCM) in the posteriorneck, wele studiedin 35 healthy volunteel-s, in responseto electl-ical stimulationof the supri.ux-bital trigcminalnerve and glabellar tapping. Simultaneous responses evoked from the ipsilateral orbicularis oculi muscle (OOM)were also I-ecordcdi.e. blink reflexes. Electrical stimulation of the supraorbital nerve elicited a reflex response with a latency of about 50 ms from the ipsilateral SCM whichwas called C3. An early reflexresponse,which sometimeshad two componentswith latencies of 1X ms and 35 ms, was elicited with glahellar taps. They were called Cl and C2 rcspcctivcly. When C 1 and C2 wem elicited with usual glabellar taps, C3 was suppressed. Withelectricalstimulation,suppressionof C 1 and C2 was noted, thoughC3 could easily be obtained. Electrophysiological characteristics of Cl (and C2) were compatible with an oligosynaptic, innocuous reflex, whereas C3 seemed to be multisyaaptic and rmciceptive in nature. A negative interaction between these two reflexes was observed.
Muscle & nerve, 1997
WOS: A1997VZ33200026PubMed ID: 899559
Muscle & nerve, 1996
WOS: A1996UF72700028PubMed ID: 861857
Journal of Neurology, 1998
Sirs: Juvenile distal spinal muscular atrophy (JDSMA), first described by Hirayama et al. [1] in ... more Sirs: Juvenile distal spinal muscular atrophy (JDSMA), first described by Hirayama et al. [1] in 1959, constitutes a separate entity among motor neuron diseases. It is sometimes also referred to as monomelic amyotrophy [2]. The main clinical features are: (1) Juvenile insidious onset, (2) chronic weakness and wasting localized to the upper limbs, (3) lack of autonomic, sphincter, pyramidal tract and sensory involvement other than lower motor neuron signs confined to one or both upper extremities, (4) lack of a family history, (5) normal routine biochemical examinations, (6) arrest of progression in 2–3 years, (7) denervation shown in needle EMG with normal nerve conduction velocities, (8) atrophy of the lower cervical cord on computed tomography or magnetic resonance imaging [3, 4]. The disease selectively affects the anterior horn cells in the lower cervical cord. Although the condition was initially thought to affect only persons of Japanese and Indian extraction, it has since been described in young persons from various parts of the world [5–13]. We report a patient from Turkey with typical JDSMA accompanying the Arnold-Chiari type 1 malformation. A 17-year-old man was admitted to hospital because of a 4-year history of weakness and wasting of hands and forearms. At the age of 13 years his left hand grip was noticed to be weak with wasting of the first dorsal interosseus muscle, followed by wasting of the thenar and hypothenar eminences which later progressed to the right side, in the same order. He was examined at another institute, but no clear diagnosis was made. A year later the disease had progressed to the forearm and triceps muscles and then stabilized. His past medical history was non-contributory, and there was no family history. On examination he had atrophy and weakness of triceps, forearm and small hand muscles on both sides except for the brachioradialis muscles (Fig. 1). Tendon reflexes were absent in the upper extremities but were normal in the lower. The plantar responses were flexor. Ataxia, extrapyramidal signs, sensory disturbances, Horner’s sign and abnormalities in sweating and urination were all absent. Complete blood count, blood biochemical analysis including creatine kinase and cerebrospinal fluid analysis were in the normal range. Nerve conduction studies were normal. Needle EMG of the upper extremities demonstrated chronic and active denervation in muscles innervated by C7–T1 segments. No abnormality was found in the lower extremities. Magnetic resonance imaging revealed the ArnoldChiari type 1 malformation in addition to an abnormally thin lower cervical cord (Fig. 2). Our patient’s history, clinical examination and laboratory findings were typical of JDSMA, except for an Arnold-Chiari type 1 malformation, demonstrated on magnetic resonance imaging, not associated with a syrinx. The aetiology of JDSMA is unknown. Magnetic resonance imaging studies have described structural alterations of the lower cervical cord, reflecting anterior horn atrophy [14]. Hirayama et al. [3] suggested anterior horn cell ischaemia from vascular insufficiency in the lower cervical cord in their pathological study. Okumura and Homma [15], on the other hand, proposed that mechanical cord compression in the absence of spondylotic changes, is the responsible mechanism, and they performed anterior spinal fusion of their seven patients to prevent flexion myelopaLETTER TO THE EDITORS J Neurol (1998) 245 :561–562 © Springer-Verlag 1998
Journal of Clinical Neurophysiology, 1996
The sacral cord conduction time of the soleus H-reflex was investigated in 30 normal adult subjec... more The sacral cord conduction time of the soleus H-reflex was investigated in 30 normal adult subjects using three different methods. (1) The posterior tibial nerve was stimulated at the popliteal fossa by graded electric shocks, and the recordings were made from different lumbar epidural intervertebral levels. The afferent action potentials from the dorsal roots and the reflexively evoked efferent action potentials from the ventral roots were recorded. The time interval between the negative peaks of the ventral and dorsal root potentials was used to calculate the approximate sacral cord reflex delay time, which was found to be 1.3 ms. on average. (2) The sacral cord reflex delay time was found to be about 2.0 ms using the conduction time of the afferent, that of the efferent limbs and total reflex time of the soleus H-response. (3) By stimulating the lumbosacral roots at the epidural levels and using the difference between the soleus H and M response latencies, the sacral cord reflex delay was determined to be approximately 2.4 ms. These findings indicated that the soleus H-reflex is exclusively monosynaptic. It is proposed that in humans the synaptic transmission at the sacral cord is approximately 0.4 ms.
Turkish Neurosurgery, 2021
In this report, we present the case of a 21-year-old female with midbrain tremor involving atypic... more In this report, we present the case of a 21-year-old female with midbrain tremor involving atypical features, treated using a pedinculopontine nucleus lesion. Different targets for the treatment of midbrain tremor using radiofrequency lesion have been reported. In this case, stimulation of the thalamic ventralis intermedius nucleus and subthalamic nucleus produced no satisfactory improvement in tremor frequency and amplitude. A third goal was to obtain a significant response in terms of these outcomes with pedinculopontine nucleus stimulation. According to the literature, this is the first case of midbrain tremor treated with a pedinculopontine nucleus radiofrequency thermocoagulation lesion.
31st International Epilepsy Congress -- SEP 05-09, 2015 -- Istanbul, TURKEYWOS: 00036575650049
The Journal of Prosthetic Dentistry, 2010
Journal of Neurology, Neurosurgery & Psychiatry, 2001
31st International Epilepsy Congress -- SEP 05-09, 2015 -- Istanbul, TURKEYWOS: 00036575650031
To the Editor: We thank Dr. Finsterer and colleagues for repeating our work and for giving us the... more To the Editor: We thank Dr. Finsterer and colleagues for repeating our work and for giving us the opportunity to present further data on more of our patients (Table 1). According to us and also to Gilchrist et al. (l) , turn-amplitude (T/A) ratio analysis has a lower diagnostic sensitivity than conventional electromyography (EMG). In our juvenile myoclonic epilepsy (JME) cases, we first made at least four needle EMG recordings and then used the T/A analysis (2). The results of our conventional EMG evaluations, including some additional cases that we examined after our previous report, showed that of 3 1 cases, 11 had subclinical involvement of anterior horn cells (Fig. 1). In 7 of these 1 1 cases, T/A values were in excess of normal limits for the muscle investigated. The reason for this is that the T/A ratio fails to reflect neurogenic changes unless they are pronounced ( 1 ) (StHlberg, personal communication). This may explain four of the differences between our findings and those of Finsterer et al., (3) who investigated the biceps muscle without using a
NeuroRehabilitation, 2007
Hand motor representation area expands towards the area of the perioral facial motor cortex in pa... more Hand motor representation area expands towards the area of the perioral facial motor cortex in patients with peripheral facial paralysis (PFP) and in hemifacial spasm cases treated with botulinum toxin. In this current study, we aimed to investigate the changes both in the ipsilateral and contralateral facial motor cortex areas in patients with PFP with transcranial magnetic stimulation (TMS). Thirty healthy individuals and 41 patients with unilateral PFP with partial or total axonal degeneration participated in this study. Motor evoked potentials (MEPs) of perioral muscles elicited by TMS of the intracranial portion of the facial nerve and motor cortex, were recorded. TMS was delivered through a figure-of-eight coil. Mapping of the cortical representation of perioral muscles were also studied in 13 of 41 patients and in 10 of control subjects. Mean amplitude of the intact perioral MEPs elicited by the ipsilateral hemisphere TMS, was significantly higher in patients than the control subjects. There was also a mild enlargement of the mean cortical representation area of intact perioral muscles on both hemispheres though it was not significant. We have concluded that there was a cortical reorganization in the hemisphere contralateral to the paralytic side resulting in an increase at corticofugal output related to intact perioral muscles.
The American journal of gastroenterology, 1997
Different variables of oropharyngeal swallowing change in response to bolus volume and consistenc... more Different variables of oropharyngeal swallowing change in response to bolus volume and consistency as determined by manometric/videofluoroscopic studies. But the subject is debatable especially from the physiologic point of view. No electrophysiologic studies are available on human subjects. The effects of bolus volume and viscosity on different variables of oropharyngeal swallowing were investigated using electrophysiologic methods. Mechanical upward and downward laryngeal movements and submental electromyographic (SM-EMG) activity of the laryngeal elevator muscles were recorded during dry and 3-, 10-, and 20-ml water swallowing in 14 normal subjects. Cricopharyngeus (CP) muscle was investigated during 3- and 10-ml water swallowing in 10 normal subjects. Semisolid and liquid swallowing were compared in eight normal subjects. The total duration of SM-EMG, time necessary for larynx elevation, CP-EMG pause related with upper esophageal sphincter opening and swallowing variability (jit...
Pain, 1998
Levodopa has been used to treat some painful conditions and found to be effective in neuropathic ... more Levodopa has been used to treat some painful conditions and found to be effective in neuropathic pain due to herpes zoster in a doubleblind study. From our anecdotal observations about the efficacy of levodopa on diabetic neuropathic pain, we designed a double-blind placebo-controlled study to test levodopa in painful diabetic neuropathy. Twenty-five outpatients with painful symmetrical diabetic polyneuropathy were admitted to the study. Fourteen patients were given 100 mg levodopa plus 25 mg benserazide to be taken three times per day for 28 days. Eleven patients were given identical placebo capsules. A blinded neurologist evaluated the patients clinically and performed Visual Analogue Scale (VAS) measurement every week from day 0 to day 28. The results seemed promising and levodopa may be a choice for the control of pain in neuropathy for which we do not have many alternative treatments.
Muscle & Nerve, 2005
The few electrophysiologic studies of the cremasteric muscle (CM) have mainly been restricted to ... more The few electrophysiologic studies of the cremasteric muscle (CM) have mainly been restricted to the cremaster reflex with no reference to central and peripheral nerve conduction to the muscle, probably for technical reasons.Twenty-six normal adult male volunteers were studied by transcranial magnetic cortical stimulation (TMS) and stimulation of thoracolumbar roots. The genitofemoral nerve (GFN) was stimulated electrically at the anterior superior iliac spine and a needle electrode was inserted into the CM for conduction studies. The motor latency to the CM from the cortical TMS ranged from 20 to 33 ms among the subjects (25.8 +/- 2.9 ms, mean +/- SD). Magnetic stimulation of the lumbar roots produced a motor response of the CM within 9.6 +/- 1.9 ms (range, 6-15). The central motor conduction time to the CM was 16.5 +/- 2.8 ms (range, 10-21). Stimulation of the GFN produced a compound muscle action potential with a mean value of 6.4 +/- 1.8 (range, 4-10) ms in 23 of the 26 cases. Thus, central motor nerve fibers to the CM motor neurons exist, and there may be a representation area for the CM in the cerebral cortex. The GFN motor conduction time to the CM may have clinical utility, such as in the evaluation of the groin pain due to surgical procedures in the lower abdomen.
Muscle & Nerve, 2005
Groin pain in the lower abdomen but including the ilioinguinal region is frequent after inguinal ... more Groin pain in the lower abdomen but including the ilioinguinal region is frequent after inguinal hernia operations, but the integrity of the nerves in this region, including the genitofemoral nerve (GFN), has not been investigated. We studied GFN motor conduction time to the cremasteric muscle (CM), the CM electromyogram (EMG), and the CM reflex in 30 patients with unilateral inguinal hernia who underwent herniorrhaphy and in 26 similar patients who had no surgical intervention. Among the 30 patients undergoing herniorrhaphy, 14 (47%) showed motor involvement of the GFN, whereas 6 of the 26 (23%) patients not treated surgically had involvement of the GFN. These findings indicate that subclinical motor involvement of the GFN can be demonstrated by electrophysiological methods and is common after inguinal herniorrhaphy. Based on patient complaints, the herniated mass may also be responsible for motor involvement of the GFN in some patients before surgery.
Muscle & Nerve, 1996
ABSTRACT Motor conduction velocity is expected to be normal or nearly normal in amyotrophic later... more ABSTRACT Motor conduction velocity is expected to be normal or nearly normal in amyotrophic lateral sclerosis (ALS). Some studies have suggested that pathology may be present in the proximal axons. Indeed, some investigators have shown a decrease in the proximal conduction velocity in ALS by using motor conduction velocity measurements and H-reflex and F-response recordings, but they could not delineate the precise region of the conduction pathology. In this study, unlike the ones carried out previously, the most proximal segment has been studied in 11 patients with ALS, 13 normal controls, and 5 patients with sequel of poliomyelitis (SPM) by recording sensory and motor spinal root potentials. While no conduction pathology, H-reflex, or F-response abnormalities were found in ALS patients compared to normal subjects, it was shown that conduction velocity decreased in the proximal segment of the lower motor neuron of the ventral root. Despite motor neuron pathology in SPM, there was no proximal motor conduction slowing compared with that in normal subjects.
Muscle & Nerve, 1997
Juvenile myoclonic epilepsy (JME) is not an uncommon seizure disorder, occurring in 5-10% of epil... more Juvenile myoclonic epilepsy (JME) is not an uncommon seizure disorder, occurring in 5-10% of epileptic patients. A subclinical anterior horn cell involvement has been suggested in some JME patients by concentric needle electromyography (EMG) and turn/amplitude analysis. In this study, 22 JME patients and 17 normal control subjects have been studied with macro EMG, which is a sensitive method to assess the size of motor units. Most JME patients (19 of 22) had a pathologically increased number of individual large macro motor unit action potentials (MUAPs) compared to control subjects. For both biceps brachii and tibialis anterior muscles, means of median macro MUAP amplitudes were significantly greater than those of normal controls, whereas the fiber density values were only slightly increased. This suggested another kind of anterior horn cell involvement in JME than seen in motor neuron diseases.
Muscle & Nerve, 1995
This article describes a combined electrophysiological and mechanical method used to measure lary... more This article describes a combined electrophysiological and mechanical method used to measure laryngeal movements and related submental EMG activity during swallowing. The mechanical upward and downward movements of the larynx were detected using a piezoelectric sensor while the submental integrated EMG (SM-EMG) was recorded. Measurements were performed in 29 human subjects. The interval between the onsets of the two sensor signal deflections was used as a measure of the time the larynx remained in its superior position during swallowing. In 10 subjects, the cricopharyngeus muscle (CP) of the upper esophageal spinchter showed a continuous tonic EMG activity except during swallowing. All the parameters measured were influenced by the type and volume of the bolus material. The method presented in this study proved its usefulness in the study of the physiology of deglutition as well as in its objective clinical evaluation in patients with dysphagia.
Knee Surgery, Sports Traumatology, Arthroscopy, 1998
Journal of the Neurological Sciences, 1996
Trigemino-ccrvicid rcflcxcs, rcccmfecf from the semispinalis capitis muscle(SCM) in the posterior... more Trigemino-ccrvicid rcflcxcs, rcccmfecf from the semispinalis capitis muscle(SCM) in the posteriorneck, wele studiedin 35 healthy volunteel-s, in responseto electl-ical stimulationof the supri.ux-bital trigcminalnerve and glabellar tapping. Simultaneous responses evoked from the ipsilateral orbicularis oculi muscle (OOM)were also I-ecordcdi.e. blink reflexes. Electrical stimulation of the supraorbital nerve elicited a reflex response with a latency of about 50 ms from the ipsilateral SCM whichwas called C3. An early reflexresponse,which sometimeshad two componentswith latencies of 1X ms and 35 ms, was elicited with glahellar taps. They were called Cl and C2 rcspcctivcly. When C 1 and C2 wem elicited with usual glabellar taps, C3 was suppressed. Withelectricalstimulation,suppressionof C 1 and C2 was noted, thoughC3 could easily be obtained. Electrophysiological characteristics of Cl (and C2) were compatible with an oligosynaptic, innocuous reflex, whereas C3 seemed to be multisyaaptic and rmciceptive in nature. A negative interaction between these two reflexes was observed.