Biomedical subjects

S L Notermans

Publications and source records attributed to S L Notermans.

At least 19 recordsLinked to original sources

PubMed1998

EEG findings in patients with vascular parkinsonism.

OBJECTIVES: To investigate whether the conventional and quantitative EEGs of patients with vascular parkinsonism (VP) differ from those of idiopathic Parkinson's disease (PD) patients. MATERIAL AND METHODS: The EEGs of 13 patients with vascular parkinsonism and 14 patients with idiopathic Parkinson's disease were scored on a simple scale regarding aspects of conventional EEG variables. Alpha band power asymmetry and EEG slowing (increased delta and theta power) were calculated by the neurometrics method of quantitative EEG data evaluation. RESULTS: Analysis of both conventional and quantitative EEG data shows that VP patients had significantly less EEG slowing than PD patients. CONCLUSION: This study shows that the EEG in a group of patients with vascular parkinsonism differ from a patient group with idiopathic Parkinson's disease. Our results indicate that VP patients are not PD patients with subcortical vascular lesions, because then they would have had at least as much EEG slowing as PD patients.

Aged↗

PubMed1996

Akinetic mutism with bithalamic infarction. Neurophysiological correlates.

A 42-year-old man presented with akinetic mutism, caused by bilateral thalamic infarction, resulting in a temporary amnesic syndrome and, finally, selective downgaze palsy. Electroencephalographic recording in the initial phase showed generalized spike- and-wave discharges, similar to those found in animal studies after lesion or stimulation of specific thalamic nuclei. Analysis of magnetic resonance images (MRI) of the head showed that the centre of ischemic necrosis particularly involved the intralaminar thalamic nuclei and a small part of the rostral mesencephalon. The findings support the previously suggested involvement of cortico-thalamo-mesencephalic circuitry in the initiation of motor responses, and the association of the non-specific thalamic nuclei with the appearance of generalized epileptiform phenomena in cases of reduced vigilance.

Adult↗

PubMed1996

Subclinical beriberi polyneuropathy in the low income group: an investigation with special tools on possible patients with suspected complaints.

OBJECTIVE: To determine the prevalence rate of subclinical beriberi polyneuropathy (PNP) in the low income group and to present new methods for early detection. DESIGN: We conducted a prospective, randomized observational study on all patients from family members of non-PNP patients presenting to the outpatient neurologic clinic of the Dr Soetomo Hospital in 1989 in Surabaya, Indonesia. MATERIAL AND METHODS: The 53 group I patients belonged to the low income series, whereas the 56 group II patients were from the mid- and high-income groups. We analyzed their diets and determined their blood thiamine levels. Neurologic, internal, psychiatric as well as neurophysiologic examinations were performed on all patients. RESULTS: The prevalence rate of subclinical beriberi PNP of the apparently healthy subjects of the low income group was 66% compared with 12.5% among the mid and high income groups. The exposure odds ratio was 13.6 (95% Cl, 2.78 to 8.04) indicating that the low income group ran a greater risk of developing beriberi PNP than the mid and high income groups. CONCLUSION: Most of our low income group patients had an inadequate diet, especially concerning deficient thiamine intake. Analysis of the diets revealed, that they were usually rich in carbohydrate especially steamed milled rice, whereas intake of fat and thiamine was low, protein was just sufficient. The calorie intake was marginal. Carbohydrate rich and non fat calories in the diet with low thiamine intake may provoke beriberi.

Adolescent↗

PubMed1995

Effect of steady hypothermia and normothermia on multimodality evoked potentials in human poikilothermia.

OBJECTIVE: To assess the effects of steady-state spontaneous hypothermia on multimodality evoked potentials and on peripheral nerve conduction in human poikilothermia. DESIGN AND SETTING: Case series at a university hospital. PATIENTS: Four patients (four women, aged 28 to 37 years) with acquired poikilothermia. MAIN OUTCOME MEASURES: Short-latency somatosensory, brain-stem auditory, and visual evoked potentials as well as motor and sensory peripheral nerve conduction velocity during steady-state spontaneous hypothermia and normothermia. RESULTS: The marked latency prolongation of all evoked potentials and decreased peripheral nerve conduction velocity observed during steady-state spontaneous hypothermia (mean +/- SD core temperature, 33.5 +/- 0.3 degrees C) compared with normothermia (36.9 +/- 0.4 degrees C) agrees with previous findings during short-term induced hypothermia. CONCLUSIONS: The unequivocal effect of sustained mild spontaneous hypothermia on evoked potentials and peripheral nerve conduction velocity underlines the importance of meticulous attention to even small alterations in core temperature in interpreting neurophysiological investigations.

Adult↗

PubMed1995

Electrophysiologic examination of subclinical beriberi polyneuropathy.

We performed electroneurophysiologic studies on patients with subclinical beriberi polyneuropathy (PNP) for early detection and early treatment of this disease. The subjects were 35 subclinical PNP patients admitted to the in- and outpatient clinics of the Dr. Soetomo Hospital, Surabaya, Indonesia, in 1989. The results showed that out of all the neurophysiological evaluations assessed, reduced amplitudes of the distal latency of the peroneal motor nerve, H-reflex, and pathological EMG findings in the leg muscles were the most frequently occurring abnormalities, followed by reduction of the proximal amplitude of the peroneal motor and distal amplitude of the sural sensory nerve. However the motor conduction velocities of the peroneal, posterior tibial and median motor nerves were all within normal limits. The distal amplitudes of the motor (peroneal and median) and sensory (sural and median) nerves were more affected than the distal latency times. The motor nerves were more often and more seriously affected than the sensoric nerves.

Adolescent↗

PubMed1994

High-dose intravenous immunoglobulin treatment in cryptogenic West and Lennox-Gastaut syndrome; an add-on study.

In an add-on pilot study, a group of 15 children with cryptogenic and intractable West syndrome (3) and Lennox-Gastaut syndrome (12) received intravenous immunoglobulin (IVIg, 0.4 g/kg body weight per day for 5 consecutive days, followed by the same dose once every 2 weeks for 3 months). Five patients had been treated previously with ACTH without success. The reduction in clinical seizures averaged 70%. Electroencephalographic (EEG) recordings revealed a mean reduction in epileptic discharges of 40%. In all 15 patients, acceleration of EEG background activity occurred, and psychomotor development improved. Prior to IVIg administration, CSF examinations were normal. After IVIg administration, the serum total IgG concentration increased by an average of 76%, and the CSF IgG concentration by 44%. According to our data, IVIg crosses the blood-CSF barrier, and might be effective in the treatment of West syndrome and Lennox-Gastaut syndrome. We suggest it should be considered when other treatments, such as ACTH, have failed.

Child↗

PubMed1994

Use of sacral reflex latency measurements in the evaluation of neural function of spinal cord injury patients: a comparison of neuro-urophysiological testing and urodynamic investigations.

Complete suprasacral spinal cord injury is followed by great changes in the neural control and function of the lower urinary tract. In the literature there is some controversy about the relationship between detrusor function and results of neurophysiological tests of sacral root conduction after the spinal shock phase. Therefore, we studied this relationship in a group of 73 patients with clinical as well as neurophysiological documented complete suprasacral spinal cord injury, and compared sacral reflex latency measurements (bulbocavernosus and urethro-anal reflexes) with detrusor function, documented by urodynamic investigation. A high incidence of sacral reflex latency abnormalities was found. Comparison of sacral reflex latencies with detrusor reflex activity showed a statistical significant correlation. No such relationship could be found between urodynamic characteristics of the detrusor in patients with detrusor hyperreflexia and sacral reflex latency measurements. We conclude that sacral reflex latency measurements can give an indication about the existence of reflex detrusor activity. On the other hand, these neurophysiological measurements do not provide a reliable indication of the detrusor function after complete spinal cord injury.

Adolescent↗

PubMed1994

Erectile dysfunction in diabetic men: the neurological factor revisited.

In the literature the importance of the neurological factor in the etiology of erectile dysfunction in patients with diabetes mellitus is subject to debate. We report on the findings of neurophysiological investigations in 27 impotent and 30 potent diabetic patients, as well as 102 impotent nondiabetic patients. Additionally, hormonal and vascular evaluations were done. The neurophysiological evaluations consisted of assessment of somatic as well as autonomic sensory nerves, by measuring the latencies of somatosensory evoked potentials of the posterior tibial and pudendal nerves, and of the bulbocavernosus and urethro-anal reflexes. The results show a higher incidence of more severe peripheral and autonomic sensory neuropathy in impotent diabetic men. Also, a preponderance of abnormal intracavernous pharmacological tests, suggesting vasculogenic impotence, was found in impotent diabetic patients. No important endocrinological differences were found among the 3 groups under investigation. Significant differences occurred for plasma glucose and glycosylated hemoglobin. We conclude that diabetic urogenital sensory neuropathy has a crucial role in the etiology of diabetic impotence. Angiopathy seems to be of secondary importance. The results show that poor diabetes regulation is associated with diabetic impotence.

Adult↗

PubMed1994

Transcranial Doppler ultrasonography: influence on scheduling of angiography and delayed surgery for ruptured intracranial aneurysms.

The role of transcranial Doppler ultrasound (TCD) was studied retrospectively in relation to the management of 73 patients with a subarachnoid hemorrhage due to a ruptured intracranial aneurysms. TCD velocity measurements provided very valuable data to assist scheduling of angiography and delayed surgery. Angiography and surgery were planned significantly sooner in the TCD examined group of patients with TCD velocities indicative for the absence of vasospasm than in the group of patients who did not have TCD examinations. The cerebral circulatory resistance index (R), calculated as: (maximum systolic velocity--end diastolic velocity)/maximum systolic velocity, and changes in R did not predict a change in clinical grade or outcome.

Adult↗

PubMed1993

Variability and interrelationships of surface EMG parameters during local muscle fatigue.

The inter- and intraindividual variability of the frequency power density spectral and surface EMG amplitude parameters and of the muscle fiber conduction velocity (MFCV) is studied in 26 healthy volunteers during fatiguing isometric ischemic intermittent exercise of the m. biceps brachii at 80% of the maximal voluntary contraction level, with a contraction rate of 30/min. No significant age effects were found. Males were significantly stronger compared with females. The higher initial SEMG amplitude and the stronger shift of the frequency power density spectrum (PDS) to lower frequencies appear to be significantly correlated with males. Fatigue induces an almost proportional compression of the SEMG frequency content. The muscle fiber conduction velocity has the highest intraindividual reproducibility (r = 0.81). Despite the definite and strong influence of the MFCV on the PDS, the shift of the PDS can not be explained by a change of MFCV alone.

Adult↗

PubMed1993

A statistical approach to fiber diameter distribution in human sural nerve.

Fifty-one normal sural nerve biopsies were obtained from 800 diagnostic biopsies. The external diameter distribution of myelinated fibers was described using the sum of two beta probability density functions, describing the thin as well as the thick fiber group. A cross-sectional study using these distribution functions showed increasing values of the peak of the larger fiber group, the diameter of the thickest fibers, and the separation between the smaller and the larger groups until the beginning of adult life. The transition from a uni- into a bimodal histogram occurred gradually between 7 and 13 months. Total transverse fascicular area increased with age, whereas fiber density decreased significantly with age. The number of fibers remained stable over age. The relative proportion of the numbers of fibers in both groups described by one of the beta distributions remained constant over age. This occurred despite a marked decrease in the number of small fibers with a diameter less than, e.g., 6.5 microns. The results indicated an outgrowth of especially the larger myelinated fibers with age. This process continues with decreasing intensity into adult life.

Adolescent↗

PubMed1993

Somatosensory evoked potentials and cognitive sequelae in children with closed head-injury.

In search of a prognostic indicator for residual cognitive function loss in children after closed head-injury, the somatosensory evoked potential P300 has been studied in a prospective follow-up study of 17 patients with mild and moderately severe head-injuries. The P300 response was measured in the acute phase after patients regained consciousness. In addition the duration of coma and of post-traumatic amnesia were recorded. An age-matched control group of 20 healthy children supplied age-related normative evoked potential data. During a two-years follow-up period the presence of residual disorders in various faculties was evaluated at fixed time intervals after discharge. Correlation analyses revealed that, where the duration of coma and of post-traumatic amnesia qualify as general predictors of sequelae, the long-latency somatosensory evoked potential P300 correlated specifically with long-term deficits in the field of school performance.

Achievement↗

PubMed1992

Motor evoked potentials from the bladder on magnetic stimulation of the cauda equina: a new technique for investigation of autonomic bladder innervation.

Although neurophysiological techniques have become widely accepted in the diagnostic evaluation of urogenital tract dysfunction, arguments have been forwarded to question their validity. Current techniques merely deal with somatosensory nerves, whereas micturition and sexual functions depend on autonomic motor nerve function as well. This study presents a new technique of motor evoked potentials obtained after magnetic stimulation of the cauda equina. Bladder and pelvic floor motor evoked potentials could be measured with concentric needle electrodes. Mean latency was 35.6 msec. for bladder motor evoked potentials and 10.6 msec. for pelvic floor motor evoked potentials. The technique was easy to perform, and provided consistent and objective data. No harmful side effects were noted.

Adult↗

PubMed1992

Beriberi cardiomyopathy.

In Indonesia beriberi is still endemic, but subclinical cases are not uncommon. Three patients suffering from beriberi presented with different clinical manifestations. One had the classical features of Shoshin beriberi and the other two had the non-alcoholic cardiac beriberi (chronic type). The cardiac symptoms of all three patients responded dramatically to thiamine tetrahydrofurfuryl disulfide; there was also some improvement of their polyneuropathy, consistent with the neurophysiologic findings and somatosensory evoked potentials (SSEPs). We conclude that SSEPs provide additional clinical information on beriberi polyneuropathy. The mortality of untreated cardiovascular beriberi is high. In view of the harmless nature of the treatment, a good case could be made for routine administration of thiamine to all patients in whom heart failure is present without clear evidence of the cause.

Adult↗

PubMed1992

Spinal monitoring during vertebral column surgery under continuous alfentanil infusion.

An anaesthetic technique for surgical procedures on the vertebral column is described consisting of a continuous infusion of a short acting opioid, alfentanil, and a muscle relaxant, vecuronium, in combination with positive pressure ventilation using a nitrous oxide/oxygen mixture. It is shown that the two standard forms of spinal monitoring, wake-up testing and somatosensory cortical evoked potentials, can be employed effectively using this anaesthetic technique. Wake-up testing was performed in 23 patients. Average wake-up time was 10 min (SD 3.7 min). Evoked responses suitable for spinal monitoring could be obtained in 60 of 61 patients.

Adolescent↗

PubMed1991

Fatigue in type I fiber predominance: a muscle force and surface EMG study on the relative role of type I and type II muscle fibers.

The relative proportions of fiber types within muscle and the characteristics of these fiber types are important determinants of the surface electromyogram (SEMG) during fatigue. In this study, patients suffering from congenital myopathy characterized by a strong type I fiber predominance were studied. Six patients with 95-100% type I fibers, 2 patients with 80% type I fibers, and 12 healthy volunteers participated in an ischemic, isomeric, intermittent exercise test of m. quadriceps femoris at 80% MVC. Considering the results of the morphometric analysis of muscle biopsy specimen and of the anthropometric estimated muscle-bone volume, it was found that type I muscle fibers had a lower force generating capacity than type II fibers. The initial conduction velocity along the muscle fiber membrane (MFCV) was low in patients with 95-100% type I fibers. During the ischemic exercise test, the 95-100% type I fibers showed less fatigability than type II fibers, which was reflected by a nearby absent decrease of the muscle membrane excitability as measured by the MFCV, and only a slight increase of the SEMG amplitude compared with patients having 80% type I fibers and controls. The absence of a definite MFCV decrease was related to the nearby lacking lactate formation in 95-100% type I fibers.

Adolescent↗

PubMed1991

Force and fatigue in human type I muscle fibres. A surface EMG study in patients with congenital myopathy and type I fibre predominance.

An isometric ischaemic intermittent m.biceps brachii exercise test is performed by 4 patients suffering from congenital myopathies which are characterized by a 100% type I fibre predominance, and by 26 healthy volunteers. Thirty contractions per minute are made at an 80% of maximal voluntary contraction level. It is found that type I muscle fibres have a fourfold lower force-generating capacity than type II muscle fibres. The EMG amplitude shows that more EMG voltage is needed per unit force in the patients with 100% type I fibres compared with controls. Under standardized fatiguing circumstances the power density frequency spectrum shows a weaker shift to lower frequencies in patients with 100% type I muscle fibres compared with controls. The muscle fibre conduction velocity (MFCV) of type I muscle fibres shows no decline during ischaemic exercise indicating an unimpaired muscle membrane excitability.

Adult↗

PubMed1990

Thiamine tetraphydrofurfuryl disulfide in nutritional polyneuropathy.

An open trial with thiamine tetrahydrofurfuryl disulphide (TTFD) was carried out on 44 patients with nutritional polyneuropathy who were admitted to the Neurological Department, Dr. Soetomo Hospital, Surabaya, Indonesia, Thirty-four patients showed improvement of their motor functions (P less than 0.01) with slight restoration of sensory function and reflexes (P less than 0.1). Of the 18 patients who were re-examined electrophysiologically 3 months later, 6 showed remarkable improvements. No side-effects were observed during TTFD treatment. It seemed that nutritional polyneuropathy in our low socio-economic patients was mostly caused by thiamine deficiency.

Adolescent↗