Κυριακή, 12 Αυγούστου 2018

Two in, two out: maintaining your marriage in EMS

Your partner at home can be your best resource in regard to your mental health

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Ulnar neuropathy with abnormal non-localizing electrophysiology: clinical, electrophysiological and ultrasound findings

Publication date: Available online 12 August 2018

Source: Clinical Neurophysiology

Author(s): Luciana Pelosi, Dominic Ming Yin Tse, Eoin Mulroy, Andrew M. Chancellor, Michael R. Boland

Abstract
Objective

To systematically study demographic, clinical, electrophysiological and nerve ultrasound characteristics of ulnar neuropathy with abnormal non-localizing electrophysiology (NL-UN) and further define the utility of ultrasound over and above the conventional electro-diagnostic approach.

Method

NL-UNs were prospectively identified from 113 consecutive referrals with suspected ulnar neuropathy. All received electro-diagnostic tests and ulnar nerve ultrasound. NL-UN severity was graded using clinical and electrophysiological scales.

Results

In 64 of 113 referrals, an ulnar mono- neuropathy was confirmed by electrophysiology. Sixteen of these 64 (25%) had NL-UN, predominantly males (14 out of 16 patients) with severe or moderate clinical and electrophysiological ratings. Ultrasound showed focal ulnar neuropathy at the elbow in 13 out of 16, and diffuse ulnar nerve abnormality in three, and identified a likely or possible causative mechanism in 11.

Conclusion

A significant proportion (a quarter) of ulnar neuropathies with abnormal electrophysiology were NL-UN, of heterogeneous etiology; the majority were males with significant disability and axonal loss. Ultrasound had a significant role in localization and classification that facilitated management.

Significance

To our knowledge, this is the first systematic prospective study that analyzes the demographic, clinical, electrophysiological and ultrasound characteristics of NL-UN in a routine clinical neurophysiology setting.



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Ulnar neuropathy with abnormal non-localizing electrophysiology: clinical, electrophysiological and ultrasound findings

Ulnar neuropathy, the second most common mono-neuropathy, is usually due to focal nerve pathology at the elbow, with an estimated incidence of 24.7/105/year (Mondelli et al., 2005). It typically presents with paraesthesia or sensory loss in the little and ring fingers and weakness of ulnar innervated muscles. Diagnosis is usually based on clinical findings and abnormal electrophysiology. Electrodiagnostic tests can localize the lesion by demonstrating focal conduction slowing, with or without temporal dispersion and conduction block across the elbow (AAEM, 1999a), with a sensitivity varying from 38 to 89% (AAEM,1999b).

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Intra-operative cortical motor mapping using subdural grid electrodes in children undergoing epilepsy surgery evaluation and comparison with the conventional extra-operative motor mapping

Epilepsy surgery can be highly effective and associated with favourable cognitive, functional and seizure-free outcomes in carefully selected patients.(Dwivedi et al., 2017) Epileptogenic foci in children with epilepsy are commonly extra-temporal and may be in close proximity to eloquent areas, such as the motor cortex. Thus, it is vital to accurately map the motor cortex to prevent post-operative motor deficits.

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Multifactorial etiology for tolerance to Deep Brain Stimulation for “essential tremor syndrome”

We write this letter in response to the commentary by Wagle Shukla and Okun (2018) on our recently published article in Clinical Neurophysiology, 'Objective predictors of 'early tolerance' to ventral intermediate nucleus of thalamus deep brain stimulation in essential tremor patients' (Merchant et al. 2018), which makes for a worthwhile follow-up discussion on this topic. Based on the recently published MDS consensus criteria, essential tremor (ET) can be best described as a syndrome (Bhatia et al.

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Multifactorial etiology for tolerance to Deep Brain Stimulation for “essential tremor syndrome”

Publication date: Available online 12 August 2018

Source: Clinical Neurophysiology

Author(s): Shabbir Hussain I. Merchant



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Intra-operative cortical motor mapping using subdural grid electrodes in children undergoing epilepsy surgery evaluation and comparison with the conventional extra-operative motor mapping

Publication date: Available online 12 August 2018

Source: Clinical Neurophysiology

Author(s): Puneet Jain, Robyn Whitney, Samuel Strantzas, Blathnaid McCoy, Ayako Ochi, Hiroshi Otsubo, O Carter Snead, Shelly Weiss, Elizabeth Donner, Elizabeth Pang, Rohit Sharma, Amrita Viljoen, Anne Keller, James M. Drake, James T. Rutka, Cristina Go

Abstract
Objectives

The objective of this study was to review our experience with intra-operative "train of five" stimulation using subdural grid for motor mapping in children undergoing epilepsy surgery evaluation.

Methods

Twenty consecutive children below 18-years of age with drug-refractory epilepsy who underwent invasive-EEG monitoring using subdural-grid placement and intra-operative motor mapping using direct cortical stimulation by sub-dural grid elecrodes (IODCS-SDG) at our institution between January-2016 and June-2017 were reviewed. Stimulation was delivered through the subdural-grid electrodes using a train-of-five pulses and muscle responses were recorded by motor-evoked-potentials (MEPs). Intra-operative direct cortical stimulation delivered through a ball-tipped probe (IODCS-probe) and extra-operative motor-mapping (EODCS-SDG) were also performed.

Results

IODCS-SDG was completed in 20 patients and subsequent EODCS-SDG was done in 17/20 patients. MEP responses were more commonly obtained in the deltoid (19/20), extensor-digitorum-communis (20/20) and first-dorsal-interosseus (19/20). The median thresholds varied between 40 V and 60 V for the six muscle groups. The respective IODCS-probe thresholds tended to be similar. No stimulation-provoked seizures or anaesthesia-related complications were noted during IODCS-SDG. EODCS-SDG could not be completed in 4/17 children and mapping data obtained was frequently inadequate. . Nine patients demonstrated 100% concordance between IODCS-SDG and EODCS-SDG for the common mapped body regions. Stimulation-provoked seizures during EODCS-SDG were seen in 6/17 (35.3%) and after-discharges in 7/17 (41.2%) children.

Conclusions

IODCS-SDG could be performed safely in children with drug refractory epilepsy undergoing invasive EEG monitoring.

Significance

IODCS-SDG may be a useful adjunct to EODCS-SDG in motor mapping for children.



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W. Va. fire dept. receives 2 donated AEDs

"These devices will enable the department to access a person who is in sudden cardiac arrest and take the required steps to provide care," Chief Rick Cary said

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