Clinical Neurophysiology 120(2009) Suppl.

1, S23S32

Platform presentations
Session PF1. Electrophysiological Techniques for Evaluating Neuromuscular Disorders
PF1.1 Enhanced Gain of Blink Reex Responses to Ipsilateral Supraorbital Nerve Afferent Inputs and Other Clinical Prognostic Factors for Outcome of Facial Neuropathy Jong-Un Chun *, Gun-Sei Oh, Soo-Joo Lee, Bo-Ram Lee, Soo-Jin Yoon Dept. of Neurology, Eulji University College of Medicine, Korea E-mail address: j1chju@kornet.net Background: Patients with facial neuropathy may present with transient hyperkinetic movement in the side of contralateral to the paralysis. Such phenomenon is known to evoked by sensitization of reex responses to afferent inputs from the unprotected cornea and to evaluated by R2c/R2 ratio of blink reex (BR) test. To evaluate the clinical value of BR and clinical factors for predicting the outcome in Bells palsy patients. Methods: BR test was conducted among 105 patients with acute unilateral lower motor neuron type facial palsy two to three weeks after onset and 96 normal controls. A modied House Brackman facial paralysis grading system was used to evaluate the recovery of facial weakness in serial follow-up examination. Correlation between demographic data, clinical presenting symptoms and signs, R2c/R2 ratio of BR test, side-to-side CMAP amplitude comparison, side-to-side NET threshold difference and the nal outcome were analyzed by multiple logistic regressions to determine the signicant clinical prognostic factor. Results: Duration between onset and treatment longer than 7 days, severe facial paralysis, hearing disturbance, history of recurrence, larger R2c/R2 ratio, larger difference of side-to-side CMAP amplitude and side-to-side NET threshold were the signicant prognostic factors for unfavorable outcome of treatment. Conclusions: Our result suggest that patients with delayed initiation of oral steroid, severe facial weakness, hearing disturbance, history of recurrence and more enhanced BR gain to inputs from the paralyzed side compared to those of the non-paralyzed side were signicant poor prognositc factor. Except for side-to-side CMAP amplitude and NET threshold comparison, R2c/R2 ratio of BR test should be considered to evaluate prognosis of facial neuropathy. PF1.2 Hand Anthropometry, Assessment Questionnaire and Severity Degree of Carpal Tunnel Syndrome. Is There Any Correlation between Them? Roxantin Utami1 *, Asriningrum2 , J. Eko Wahono2 , M. Hasan Machfoed3 , Mudjiani Basuki2 1 Neurology, Airlangga University dr. Soetomo General Hospital, Indonesia, 2 Dept. of Neurology, Airlangga University, Indonesia, 3 Dept. of Neurology, Airlangga University, Indonesia E-mail address: roxantinutami@ymail.com Background: Carpal Tunnel Syndrome (CTS) is one of the most common peripheral neuropathies in the form of compression to the median nerve. The incident rates of CTS are 120/100.000 in women, while in men are 60/100.000. Although in the majority of patients, the exact cause and pathogenesis of CTS is unclear, several factors have been proposed, such as inammations, anatomical anomalies, etc. The narrow of the tunnel size cross sectionally is also representing the individual predisposition factor for the occurrence of CTS. Hand anthropometry is a method to measure the carpal tunnel anatomically. The aim of this study was to nd correlation between: (1) hand anthropometry and severity degree of CTS, (2) CTSAQ and severity degree of CTS. Methods: The study population was the CTS suspected patients of outpatient neurological clinic of Dr. Soetomo Hospital Surabaya, Indonesia, who were referred to the electromyography (EMG) laboratory. The study inclusion criterion was the patient with diagnosis of CTS conrmed by the EMG who agreed to follow the study. A self-administered questionnaire for the assessment of severity of symptoms and functional status in patients who have CTS. The median nerve was stimulated at the wrist 13 cm proximal to the recording electrode, and the antidromic sensory nerve action potentials (SNAPs) were recorded and measured. Results: Coefsient correlation between wrist ratio 0.7 with degree of severity of CTS r = 0.515, p = 0.004, while wrist ratio <0.7 r = 0.086, p = 0.594. Coefcient correlation between CTSAQ symptom and functional with degree of severity of CTS, each r = 0.204, p = 0.087; r = 0.097, p = 0.423. Conclusions: Only wrist ratio 0.7 have correlation with degree of severity of CTS. And there is no correlation between CTSAQ with degree of severity of CTS. PF1.3 How Many Motor Unit Potentials to Sample in Diagnostic Needle EMG? L.K. Prashanth1 *, M. Veerendrakumar1 , D.K. Subbukrishna2 , N. Gayathri3 1 Dept. of Neurology, National Institute of Mental Health and Neurosciences, India, 2 Dept. of Biostatistics, National Institute of Mental Health and Neurosciences, India, 3 Dept. of Neuropathology, National Institute of Mental Health and Neurosciences, India E-mail address: drprashanth_lk@yahoo.com Background: In quantitative electromyography (EMG), as a standard, 20 30 Motor Unit Potentials (MUPs) are sampled. During routine diagnostic EMG, sampling 20 30 MUPs is tedious. However, the minimum number of MUPs required for denitive diagnosis is not certain. This study is to ascertain the minimum number of MUPs required for categorization as neurogenic/myopathic process. 25:7) with Methods: Thirty-two patients (age 30.412.4 years; M:F limb girdle syndrome underwent quantitative MUP analysis using Dantec Counterpoint MK II EMG system. Based upon clinical features, muscle biopsy ndings (n-20) and non-MUP features in EMG, patients were diagnosed to have Myopathic process (MP)-21, Neurogenic process (NP)-5, and Uncertain pathology (UP)-6. In each subject, 30 MUPs were sampled from biceps brachii muscle (MRC grade power 3) and mean MUP parameters were determined; values beyond mean 2SD were considered abnormal. Using outlier analysis and multiple of ve analyses (MOFA) 5, 10, 15, 20, 25, and 30 MUPs-minimum numbers of MUPs required for diagnostic categorization was assessed Results: Among 21 patients categorized as MP, diagnostic yields of MOFA at 5 and 30 MUPs were: duration 47.6% and 66.6%, amplitude 4.7% 61.9% and 57.1%, size index 38.1% and 52.4%. and 0%, thickness Similarly, among the 5 NP patients, diagnostic yields were: duration 60% and 80%, amplitude 60% and 60%, thickness 20% and 20%, Size Index 40% and 40%. Outlier analysis revealed that among patients with histological diagnosis of MP, number of MUPs required to get a third outlier was 5.02.7 for duration, 11.48.0 for amplitude, 7.35.0 for thickness and 5.62.0 for size index. In biopsy conrmed NP patients, number of MUPs required for third outlier was 3.30.6 for all the parameters.

1388-2457/ $34.00 2009 International Federation of Clinical Neurophysiology. Published by Elsevier Ltd. All rights reserved.

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Platform presentations: Session PF1. Electrophysiological Techniques for Evaluating Neuromuscular Disorders PF1.6 Somatosensory Evoked Potentials as a Predictor for Functional Recovery of the Upper Limb in Patients with Stroke Mohammed A.W. Al-Rawi1 , Farqad B. Hamdan2 *, A. Kareem AbdulMuttalib3 1 Falujah Hospital, Anbar Health Dept., Iraq, 2 Dept. of Physiology, College of Medicine, Al-Nahrain University, Iraq, 3 Medicine, College of Medicine, Mutta University, Jordan E-mail address: farqadbhamdan@yahoo.com Background: Predicting motor recovery in the arm of patients with stroke is generally based on clinical examination. However, neurophysiologic measures may also have a predictive value. We sought to assess the value of somatosensory evoked potentials (SSEPs) in predicting motor recovery of the upper limb and to determine whether any of the SSEPs components can predict the severity of the decit so that it can document the size of the stroke (lacunar or large-vessel stroke). Methods: In all, 22 patients who had had a rst-ever stroke and presented with obvious motor decit of the arm were examined in terms of 3 clinical variables (motor performance, muscle tone, and overall disability) and for SSEPs. Clinical (Medical Research Council [MRC] scale and Barthel index scores) and neurophysiologic examinations were done at entry to the study (rst week poststroke) and 3 months after stroke. Results: Signicantly low mean MRC scale score was found at rst week versus after 3 months of stroke and in patients with large-vessel as compared with lacunar stroke both at rst week and after 3 months. The mean Barthel index score was signicantly higher after 3 months than at rst week, whereas it was signicantly lower in large vessel as compared with lacunar stroke both at rst week and after 3 months of Q5 stroke. Signicantly prolonged N20 latency, low peak-to-peak amplitude (PPA), and low amplitude ratio were found in patients with stroke as compared with control subjects. None of the neurophysiologic parameters were different in the patients with stroke between rst week and third month. The MRC score and PPAwere correlated well with the outcome MRC and Barthel index scores after 3 months. N20 latency correlates with the outcomeMRCscore but not with the outcome Barthel index Q6 score. Interestingly, the N20 latency was signicantly different in lacunar form large vessel stroke. Conclusions: The muscle power (MRC score) is the main outcome predictor in patients with stroke. PPA is the main SSEPs component with high prognostic value in stroke. The SSEPs N20 latency can predict (even roughly) the size of cerebral infarction (whether lacunar or large-vessel stroke).

Conclusions: During routine diagnostic EMG, by use of duration and thickness criteria, a sample of 5 MUPs may sufce to arrive at diagnosis in 50% of patients. PF1.4 Usefulness of Autonomic Function Tests for Evaluation of Neurocardiogenic Syncope Eun-Ok Ha *, Ki-Jong Park, Sunhye Kim, Heeyoung Kang, Kyusik Kang, Nack-Cheon Choi, Oh-Young Kwon, Byeong Hoon Lim Neurology, Gyeongsang National University Hospital, Korea E-mail address: neuro1227@naver.com Background: Neurocardiogenic syncope is caused by an abnormal or exaggerated autonomic response to various stimuli. The mechanism is poorly understood but involves reex mediated changes in heart rate or vascular tone, caused by activation of cardiac C bers. Autonomic function tests are widely accepted useful diagnostic tools of neurocardiogenic syncope. However, they have argument with diagnostic yield of neurocardiogenic syncope We evaluated the usefulness of various autonomic function tests (head-up tilt testing, sympathetic skin response, quantitative sweat axon reex test (QSART), Valsava test, heart rate variation to deep breathing) in patients with neurocardiogenic syncope. Methods: We included 53 patients with neurocaridogenic syncope. They had been diagnosed as the neurocardiogenic syncope by clinical manifestation, and excluded by other tests such as brain MRI, ECG, EEG, and echocardiography. Various autonomic function tests were performed in all patients. Results: The results obtained were: 26 patients (46.43%) had a abnormal nding on head up tilt table test. 24 patients (45.28%) had an abnormal nding on QSART. 12 patients (21.82%) had an abnormal nding on valsava test. 1 patient (1.89%) had an abnormal nding on heart rate variation to deep breathing test. Conclusions: QSART and head-up tilt testing is useful diagnostic tool for the diagnosis of neurocardiogenic syncope. However, there were showed low sensitivity. Therefore, the careful history, physical examination and various autonomic function tests are need to accurate diagnosis of neurocardiogenic syncope. PF1.5 Far-Field Potentials (FFPs) Contaminating Ulnar CMAPs: Investigation from the 2l/Io Method Katsumi Kurokawa1 *, Masahiro Sonoo2 , Mana Higashihara3 , Hiroko Kurono2 , Yuki Hatanaka2 , Teruo Shimizu2 1 Dept. of Neurology, Hiroshima City Asa Hospital, Japan, 2 Dept. of Neurology, Teikyo University School of Medicine, Japan, 3 Dept. of Neurology, Graduate School of Medicine, The University of Tokyo, Japan E-mail address: kkurokawa2002@hotmail.com Background: We have investigated the far-eld potential (FFP) components contaminating median, ulnar and radial compound muscle action potential (CMAP). The waveforms of FFPs were quite different among nerves and their generating mechanism is still unclear. In the present study, we aimed to elucidate the generating mechanism of FFPs in ulnar and median CMAPs by investigating the 2l/Io method (2nd lumbricalis and 1st palmar interosseous recording; Prestons method). Methods: Subjects were ve healthy volunteers. We placed electrodes over the bellies of the 2l/IoP1, ADM, IOD1 and APB muscles, and at the tip of the digits II, V and I. The common proximal reference was placed at the forearm. We recorded the CMAPs following supramaximal stimulation of the median and ulnar nerves at the wrist. We also obtained routine CMAPs of each muscle. Results: Ulnar nerve stimulation elicited large FFPs with negativepositive-negative three phases at the tip of the index nger, even larger than those over the little nger, whereas those following median nerve stimulation were small. The onset latencies of both the negative FFPs over the nger tips and the CMAPs of IOP1 and IOD1 by the bellyproximal recordings following ulnar nerve stimulation were similar, and were earlier than those of routine IOP1 and IOD1 CMAPs with distal references. Conclusions: The present and other studies of ours have suggested that at least the initial negative phase of the ulnar FFPs is generated by the interosseous muscles. The early onset of these negative FFPs indicates that they were generated by the commencement of the action potentials at these muscles, instead of their termination.