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PubMed2005

Quality of life, clinical and neurophysiological picture in patients operated on for lumbar stenosis.

BACKGROUND: In lumbar stenosis (LS) patients, clinical, neuroradiological and neurophysiological findings were not related to validated measurements of the outcomes that are more relevant to patients such as functional status and symptoms. METHOD: We have retrospectively studied 30 patients surgically treated for LS. We have evaluated the patients by means of self-administered questionnaires (SF-36), clinical examination, and neuroradiological and neurophysiological measurements and we have registered preoperative and follow-up clinical and neurophysiological findings. Finally we evaluated the relations between patient-oriented data and validated conventional clinical and neurophysiological measurements. FINDINGS: The comparison between pre- and post-operative clinical picture showed an improvement of most parameters tested. The comparison between pre- and post-operative neurophysiological picture revealed worsening of most tested parameters. The comparison between the current sample and the Italian normative data for the SF-36 showed a worsening of physical aspects of health related quality of life; conversely there was an improvement of some mental domains. CONCLUSIONS: In our sample of LS patients the most compromised SF-36 domain was Role-Physical that measures the difficulty in every-day activities due to physical problems. Conversely, the clinical findings showed a significant improvement after surgery: patients reported in particular lower sciatica after surgical treatment, but the neurophysiological evaluation did not show any improvement.

Aged↗
PubMed1993

Follow-up of neurophysiological tests and CT in late-onset cerebellar ataxia and multiple system atrophy.

The follow-up of neurophysiological tests (brain-stem auditory evoked potentials; blink reflex; sensory, motor and visual evoked potentials) and CT was investigated in 21 patients with late-onset cerebellar ataxia (CA) or multiple system atrophy. The study included an initial investigation and a follow-up examination on average 25.3 months later (minimum 8, maximum 36). Patients were divided into four groups: (1) those with pure CA after a minimum course of 5 years; (2) those with pure CA with pathological neurophysiological findings at the last examination; (3) those who at the first examination clinically presented with pure CA, but at the last examination were seen to have developed a multisystem disorder; (4) those with multiple system atrophy (mostly olivopontocerebellar atrophy) presenting additional non-cerebellar signs of involvement. Conforming to a strict interpretation of pure CA, group 1 patients invariably exhibited normal neurophysiological findings at all examinations. All patients in group 4, except for 2 only at the first examination, showed pathological changes in at least one of the neurophysiological tests. The main conclusion of this paper is that individuals who according to clinical criteria were initially classified as having CA but finally developed a multisystem disorder already had pathological neurophysiological findings at the initial examination (group 3). The increasing frequency of pathology in the several neurophysiological tests together with the progression of the disease is obviously of prognostic significance. CT revealed cerebellar atrophy without apparent involvement of brain-stem structures in all patients with CA; the majority of patients with multiple system atrophy also had atrophy of the brain-stem, pointing to olivopontocerebellar atrophy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

Neurophysiological findings in long-term survivors of acute lymphoblastic leukaemia in childhood treated with the BFM protocol 81 SR-A/B.

UNLABELLED: Monitoring of therapy-related late effects after acute lymphoblastic leukaemia (ALL) therapy in childhood has become an increasingly important field in posttherapeutic patient surveillance. The usefulness of neurophysiological investigations (e.g. EEG, evoked potentials (EP)) as part of these attempts is controversial. The present report focuses on this problem and the question whether and to what extent routinely performed EEG recordings and visual evoked potentials (VEP) were correlated with further measures of CNS integrity. EEGs and VEPs were recorded in 163 asymptomatic long-term survivors of ALL in childhood during a large retrospective multicentre study evaluating CNS late sequelae following antileukaemic therapy. Fifty-two ALL long-term survivors (4.5-10.6 years after end of therapy, median: 8.8 years), who had been treated according to BFM-81 SR-A (n = 30) or SR-B (n = 22) were selected for this analysis focusing on therapy-related CNS late effects. Therapy protocols differed with regard to the mode for CNS prophylaxis: SR-A, cranial irradiation with intrathecal methotrexate; SR-B, intrathecal and iv methotrexate. Neurophysiological findings were correlated with illness- and treatment-related parameters, as well as with data on the morphological, neurological and psychological status of the CNS. At the time of follow-up neurophysiological measures were abnormal in 28/52 cases (53.8%). Neither illness- nor therapy-specific differences in CNS prophylaxis showed any relationship to EEG/VEP outcome any relationship to EEG/VEP outcome in this reduced group of the whole study population. Children with EEG/VEP abnormalities showed a significantly higher incidence of structural CNS disturbances compared to those with inconspicuous neurophysiological recordings (60.9% vs 31.8%). However, in this special subject group there was no specific neurophysiological finding for a specific morphological substrate, neurological or psychological deficiency and vice versa. CONCLUSION: Routinely performed EEG/VEP investigations are not very helpful measures to predict the presence or degree of behavioural deficiencies, neurological disturbances, or morphological CNS abnormalities. Patients who received cranial irradiation or systemic methotrexate applications showed the same incidence of neurophysiological disturbances without evidence for specific neurotoxic correlates.

Adolescent↗
PubMedDate not supplied

Routine neurophysiologic tremor analysis as a diagnostic tool for essential tremor: a prospective study.

The objective of the current study was to investigate the diagnostic potential of the routine tremor neurophysiologic analysis for the diagnosis of essential tremor (ET) in patients with postural tremor syndrome. Three hundred consecutive outpatients attending for postural tremor were included. Accelerometry and surface electromyography was performed between 1 and 4 weeks after the first clinical visit. A final clinical diagnosis (mean follow-up period, 53 months) of the postural tremor syndrome was made by two neurologists blind to the neurophysiologic results. Six neurophysiologic criteria for the diagnosis of ET were applied to define the neurophysiologic examination as compatible or not compatible with ET (all criteria must be present): (1) rhythmic burst of postural tremor on EMG; (2) tremor frequency greater than or equal to 4 Hz; (3) absence of rest tremor or, if present, frequency 1.5 Hz lower than the postural tremor; (4) absence of tremor latency from rest to postural position; (5) changes of the dominant frequency peak less or equal to 1 Hz after the weight load test; and (6) no changes in tremor amplitude after mental concentration. The neurophysiologic criteria for ET showed a sensitivity of 97.7%, a specificity of 82.3%, a positive predictive value of 95.1%, a negative predictive value of 91.1%, and positive probability ratio of 5.5. The odds ratio was 198.43 (95% CI, 66.03 to 596.35). For the diagnosis of ET in patients with postural tremor, routine neurophysiologic tests have high diagnostic and predictive value that justifies its practice in movement disorders clinics.

Acceleration↗
PubMed2006

Characterization of neurophysiologic alerts during anterior cervical spine surgery.

STUDY DESIGN: A retrospective review of neurophysiologic alerts during anterior cervical surgery. OBJECTIVES: To examine incidence and types of neurophysiologic alerts and their correlation with new postoperative neurologic deficits after anterior cervical discectomy or corpectomy procedures. SUMMARY OF BACKGROUND DATA: Although multimodality neurophysiologic monitoring has been shown to predict iatrogenic neurologic injuries in scoliosis surgeries, their role in degenerative or trauma-related anterior cervical spine surgery is still unclear. MATERIALS AND METHODS: We retrospectively reviewed 1,445 patients who underwent anterior cervical discectomy or corpectomy and arthrodesis with neurophysiologic monitoring that included transcranial electrical motor-evoked potentials (tceMEP), somatosensory-evoked potentials (SSEP), and spontaneous electromyography (EMG). Intraoperative alerts were analyzed for type, perceived cause, actions taken to reverse or minimize the possible spinal cord injury, and any new postoperative neurologic deficits. RESULTS: There were 267 (18.4%) procedures that had either minor (spontaneous, sustained EMG) or major (tceMEP/SSEP amplitude reduction) alerts. Patients who underwent corpectomies had 28% increased risk of having a major neurophysiologic alert compared with those who had discectomies. Diagnosis of cervical spondylotic myelopathy or trauma increased the risk of having a major neurophysiologic alert 30% and 76%, respectively, compared with cervical radiculopathy. Eight surgeries were aborted due to persistent tceMEP/SSEP amplitude loss, but none resulted in new postoperative neurologic deficits. Two patients had halo-vest applied due to early termination of surgery. One of these patients ultimately could not receive definitive surgical stabilization. DISCUSSION AND CONCLUSION: Diagnosis of cervical spondylotic myelopathy or trauma and cervical corpectomy procedures increase the risk for having major intraoperative alerts. In case of persistent tceMEP/SSEP amplitude loss, consider delaying potentially harmful interventions, such as premature termination of the procedure or methylprednisolone infusion, until a new neurologic deficit is verified with an awake-clinical examination.

Adult↗
PubMed2006

Multimodality intraoperative neurophysiologic monitoring findings during surgery for adult tethered cord syndrome: analysis of a series of 44 patients with long-term follow-up.

STUDY DESIGN: Prospective analysis of a consecutive series in which multimodality intraoperative neurophysiologic monitoring was used as an adjunct to microneurosurgery for adult tethered cord syndrome. The results of multimodality intraoperative neurophysiologic monitoring were compared with the "gold standard" (neurologic outcomes). OBJECTIVE: To assess the sensitivity, specificity, and positive and negative predictive values of multimodality intraoperative neurophysiologic monitoring in surgery for adult tethered cord syndrome. SUMMARY OF BACKGROUND DATA: Although intraoperative electrophysiologic techniques may help to minimize neural injury during spinal microneurosurgery, to our knowledge, no study has quantitatively evaluated the value of multimodality intraoperative neurophysiologic monitoring in the management of adult tethered cord syndrome. METHODS: Multimodality intraoperative neurophysiologic monitoring included posterior tibial nerve somatosensory evoked potentials (SSEPs), continuous electromyographic (EMG) monitoring of the L2 to S4 myotomes, and evoked EMG. Follow-up neurologic evaluations were performed for at least 1 year. RESULTS: A total of 44 consecutive patients, including 19 males and 25 females (aged 43 +/- 15 years), who underwent microsurgery for adult tethered cord syndrome were evaluated. After surgery, new neurologic deficits, including 1 transient and 1 permanent, developed in 2 patients. There was 1 patient who had persistent posterior tibial nerve SSEP amplitude reduction following microsurgical manipulation. In 1 patient, a transient posterior tibial nerve SSEP amplitude reduction prompted a change in microneurosurgical strategy. This patient awoke with no new postoperative neurologic deficits. For SSEPs, the sensitivity was 50% and specificity 100%. EMG bursts were recorded in 36 patients (82%). The 2 patients with postoperative neurologic worsening had EMG activity in the myotomes, where their new deficits presented. Continuous EMG had a sensitivity of 100% and a specificity of 19%. CONCLUSIONS: To our knowledge, this is the largest series to date reporting the use of multimodality intraoperative neurophysiologic monitoring in the surgical management of adult tethered cord syndrome. Posterior tibial nerve SSEPs have high specificity, but low sensitivity, for predicting new neurologic deficits. In contrast, continuous EMG showed high sensitivity and low specificity. Evoked EMG accurately identified functional neural tissue. The combined recording of SSEPs in concert with continuous and evoked EMGs may provide a useful adjunct to complex microsurgery for adult tethered cord syndrome.

Adult↗
PubMed1989

Prevalence of spina bifida occulta in patients with functional disorders of the lower urinary tract and its relation to urodynamic and neurophysiological measurements.

OBJECTIVE: To determine the relation between neurophysiological abnormalities and the radiological detection of spina bifida occulta in patients with dysfunction of the lower urinary tract. DESIGN: Blind assessment and subsequent decoding of mixed batch of abdominal radiographs from patients with and without urological symptoms for evidence of spina bifida occulta and comparison of results with those of previous control series. SETTING: Review study among tertiary referrals to an incontinence clinic of a city hospital. PATIENTS: One hundred and thirty eight adults with proved urodynamic abnormalities in whom neurophysiological measurements were available. INTERVENTIONS: None. END POINT: Correlation of neurophysiological abnormalities in lower urinary tract dysfunction with presence and type of spina bifida occulta and level of opening of posterior sacral arcs. MEASUREMENTS AND MAIN RESULTS: On decoding radiographs those from patients without urological symptoms showed a similar prevalence of spina bifida occulta to that in the control series (631/2707 controls; 23%). By contrast, patients with urological symptoms had a significantly increased prevalence of spina bifida occulta at S1 and S2 and a higher level of opening of posterior sacral arcs. The increased prevalence of the bony defect was particularly striking in men with urgency and instability and in women with stress incontinence. No significant correlation was found between any particular neurophysiological abnormality and the presence of spina bifida. CONCLUSIONS: In patients with dysfunction of the lower urinary tract neurophysiological abnormalities may be associated with congenital dysraphic lesions in the lower lumbar spine and sacrum. There appears to be no direct causal relation between the radiological and neurophysiological abnormalities but the findings suggest a common aetiological factor.

Adult↗
PubMed1993

Rapid neurophysiological effects of corticosterone on medullary neurons: relationship to stress-induced suppression of courtship clasping in an amphibian.

Courtship clasping of females by male roughskin newts (Taricha granulosa) is rapidly blocked by exposure to corticosterone (CORT). This behavioral effect appears to result from CORT binding to a receptor in neuronal membranes. The present study investigated effects of intraperitoneal CORT administration on neurophysiological properties of extracellularly recorded single medullary neurons in acutely prepared newts. CORT produced multiple neurophysiological effects that emerged within 3 min of injection and increased in magnitude during the next 20-30 min. Spontaneously active and sensory-responsive neurons showed a decline or cessation of firing concomitant with a loss of sensory responsiveness, especially to cloacal pressure, a clasp-facilitating stimulus in behaving newts. After CORT administration, reticulospinal neurons that were backfired (antidromically activated) by spinal cord stimulation, exhibited reduced antidromic action potential amplitude, slowed rates of spike generation and other indications of reduced excitability. Comparable effects of CORT were also evident in newts with a premedullary brainstem transection, indicating a direct hormone action on the caudal neuraxis. Dexamethasone (DEX), a glucocorticoid that binds poorly to the CORT membrane receptor and has little effect on clasping, had little or no direct neurophysiological effect, but DEX injection 30 min before CORT interfered with the neurophysiological action of CORT. The rapidity, time course and specificity to CORT of these neurophysiological effects are consistent with mediation through the CORT membrane receptor. In addition, the pattern and dose sensitivity of these neurophysiological actions plus their occurrence in the medulla, suggest that they could underlie the CORT effect on courtship clasping.

Action Potentials↗
PubMedDate not supplied

Neurophysiologic features in glutaric aciduria type I.

Neurophysiologic abnormalities are frequently seen in organic acidemias, but knowledge of the specific changes in the different types of organic acidemias is lacking. We studied electroencephalogram (EEG), visual evoked potential (VEP) and brain-stem auditory evoked response (BAER) in seven children with glutaric aciduria type I (GA1) to assess the neurophysiologic features in this rare inborn error of metabolism. Age at the time of the diagnosis ranged between 3 months and 36 months. Age at the time of neurophysiologic evaluation ranged between 11 months and 36 months. At the time of neurophysiologic evaluation, severe global developmental delay was seen in four patients, dystonia in four patients, motor delay in two patients, and axial hypotonia in two patients; macrocephaly, spasticity, moderate mental retardation and borderline intelligence were each seen in one patient. One patient had autistic features characterized by lack of language and social skills, poor eye contact and stereotypical behavior. Three of seven patients showed abnormal EEG findings. Two patients showed asymmetry with intermittent occipital delta slowing in one hemisphere. This finding probably indicates underlying cerebral dysfunction, and is not a specific feature. However, it suggests that these patients may develop abnormal EEG features during the course of the disease, and thus a baseline EEG may be useful for comparison over time. One patient showed high amplitude bursts of beta in the occipital regions with left predominance while on clonazepam and baclofen. We believe this finding was due to medication effect, and that what we observed was an exaggarated response to benzodiazepine. The clinical significance of this finding is unclear. VEP and BAER were available in four patients, and we found abnormalities in three of them. Neurophysiologic evaluation may be helpful in patients with GA1 as in other types of organic acidemias to help detect subtle changes that are not reflected by neurological examination or neuroimaging studies, and it may guide future treatment plans. Detailed neurophysiologic analysis in a large series of GA1 may yield further information regarding the extent of cerebral dysfunction.

Amino Acid Metabolism, Inborn Errors↗
PubMedDate not supplied

[Indications of neurophysiological studies in lower back pain].

INTRODUCTION: Between 60% and 90% of people in developed countries experience lower back pain at some time in their life and it is therefore one of the most frequent reasons for visiting the specialist in neurology. On many occasions there is no correlation between the symptoms, the clinical pathology and the radiological features. AIM. To determine suitable indications and the appropriate time to conduct neurophysiological studies in lower back pain. DEVELOPMENT: We review the neurophysiological techniques that are most commonly used today and the most frequent findings in patients with acute, subacute or chronic lower back pain, and acute or chronic lumbar-radicular pain. CONCLUSIONS: There is no scientific evidence to prove that neurophysiological studies provide information that modifies the conservative treatment that must be established in patients with acute, subacute or chronic lower back pain, and acute lumbar-radicular pain. In patients with subacute or chronic lumbar-radicular pain, the first neurophysiological studies must be conducted between three weeks and six months after the onset of symptoms. Electromyography is the most sensitive neurophysiological test. Neurophysiological studies are carried out provided that their findings involve changes in the patient's therapeutic attitude, in the pre-operative evaluation and to confirm the extent of injury; they therefore offer prognostic data.

Diagnostic Techniques, Neurological↗
PubMedDate not supplied

Clinical neurophysiology referral patterns to a tertiary hospital--a prospective audit.

BACKGROUND: Cork University Hospital (CUH) provides a tertiary service for all neurophysiology referrals in the Southern Health Board region. AIM: To ascertain the number, source, symptoms and diagnosis of neurophysiology referrals at CUH. METHODS: We did a prospective audit of the referral patterns to the neurophysiology department over a 12 -week period. RESULTS: Of 635 referrals, 254 had electromyograms (EMG), 359 had electro-encephalograms (EEG), 18 had visual evoked potentials (VEP), three had somato-sensory evoked potentials (SSEP) and one had multiple sleep latency tests (MSLT). We analysed the demographic pattern, reason for referrals, the average waiting time for neurophysiology tests and the patterns of diagnosis in this audit. CONCLUSIONS: Patients from County Cork are making more use of the neurophysiology services than patients from other counties within the Southern Health Board. The average waiting time for an EEG was 32 days and for an EMG was 74 days. However, more than 35% of those patients waiting for an EEG or an EMG had their tests done within four weeks of referral. The appointments of EEG and EMG were assigned on the basis of clinical need.

Adolescent↗
PubMedDate not supplied

A randomized controlled trial of intensive neurophysiology education in chronic low back pain.

OBJECTIVES: Cognitive-behavioral pain management programs typically achieve improvements in pain cognitions, disability, and physical performance. However, it is not known whether the neurophysiology education component of such programs contributes to these outcomes. In chronic low back pain patients, we investigated the effect of neurophysiology education on cognitions, disability, and physical performance. METHODS: This study was a blinded randomized controlled trial. Individual education sessions on neurophysiology of pain (experimental group) and back anatomy and physiology (control group) were conducted by trained physical therapist educators. Cognitions were evaluated using the Survey of Pain Attitudes (revised) (SOPA(R)), and the Pain Catastrophizing Scale (PCS). Behavioral measures included the Roland Morris Disability Questionnaire (RMDQ), and 3 physical performance tasks; (1) straight leg raise (SLR), (2) forward bending range, and (3) an abdominal "drawing-in" task, which provides a measure of voluntary activation of the deep abdominal muscles. Methodological checks evaluated non-specific effects of intervention. RESULTS: There was a significant treatment effect on the SOPA(R), PCS, SLR, and forward bending. There was a statistically significant effect on RMDQ; however, the size of this effect was small and probably not clinically meaningful. DISCUSSION: Education about pain neurophysiology changes pain cognitions and physical performance but is insufficient by itself to obtain a change in perceived disability. The results suggest that pain neurophysiology education, but not back school type education, should be included in a wider pain management approach.

Adult↗
PubMed1999

[Neurophysiologic techniques in the diagnosis of erectile dysfunction: study of 105 cases].

OBJECTIVE: To present the results of the neurophysiological diagnostic evaluation in patients with erectile dysfunction. METHODS: 105 consecutive patients with complaints of erectile dysfunction were evaluated. The patients were divided into five groups according to their history: surgery/trauma, diabetes, vascular disease, toxicity, and no antecedents. Neurophysiological examination, laboratory tests, hormone and vascular studies were performed. Patient evaluation included neurophysiological studies on nerve conduction velocity (NCV), bulbocavernosus reflex (BCR), spinal and scalp somatosensory evoked potentials from the posterior tibial nerves (SEPt) and from the dorsal penile nerve (SEPp). In selected cases, electromyography and neuroimaging studies were done. RESULTS: 71 patients (67.62%) showed organic alterations; 57 of these patients had abnormal neurophysiological tests. Ranked in order of incidence, the tests were abnormal for NCV in 46/105 patients, SEPt 37/105, BCR 35/105 and SEPp in 30/105 patients. The incidence of BCR abnormalities was higher than that of the NCV only in the surgery/trauma group, probably due to a higher prevalence of local injuries, while NCV showed the highest incidence of abnormal results in the other groups of patients. Only 8 patients showed normal NCV with abnormal BCR, SEPp and/or SEPt (14.04% of patients had neurophysiological disturbances). CONCLUSION: In this study, most of our patients showed vascular, neurologic or both abnormalities, and were rarely associated with other factors. In our view, NCV is the technique of choice in the assessment of neurological disorders in patients with erectile dysfunction, whereas the other less sensitive tests are considered to be indicated basically in erectile dysfunction highly suspected as having an underlying neurogenic cause.

Adult↗
PubMed1991

History of neurophysiology in Japan.

The progress of the neurophysiological research in Japan during the past 45 years is related. Modern Japanese neurophysiology started immediately after the end of World War 2. The introduction of microelectrode techniques contributed greatly to most fields of Japanese neurophysiology. These techniques were used to study most neurophysiological phenomena: sensory physiology including vision, audition, chemical sensitivity, and other modalities; learning and memory. These techniques plus lesions, transplants, and behavioral physiology were used to study circadian rhythm, posture and motor control, and sex. These and other techniques were used to study neural plasticity, immunity, membrane excitability, pain and other psychophysiological functions. The disciplines advanced quickly into multidiscipline approaches into not only electrophysiological, but biophysical, biochemical and immunological research fields. From the past research results our neurophysiologists can be expected to advance rapidly toward further development in the future of Japanese neurophysiology.

Animals↗
PubMed1997

Neurophysiological classification of carpal tunnel syndrome: assessment of 600 symptomatic hands.

Following the AAEM electrodiagnostic guidelines, we developed a neurophysiological classification of carpal tunnel syndrome (CTS). Six hundred hands with clinical CTS (mean age 51.4 yr., female/male ratio 5.5/1, right/left ratio 1.8/1) were prospectively evaluated and divided into six classes of severity only on the basis of median nerve electrodiagnostic findings: extreme CTS (EXT-absence of thenar motor responses), severe CTS (SEV-absence of sensory response and abnormal distal motor latency-DML), moderate CTS (MOD-abnormal digit-wrist conduction and abnormal DML), mild CTS (MILD-abnormal digit wrist conduction and normal DML), minimal CTS (MIN-exclusive abnormal segmental and/or comparative study), and negative CTS (NEG-normal findings at all tests). Using this neurophysiological classification, the CTS groups appeared normally distributed (EXT 3% of cases, SEV 14%, MOD 36%, MILD 24%, MIN 21%, NEG 3%), and the age of patients and clinical findings appeared to be related to neurophysiological abnormalities. Significant differences in median neurophysiological parameters not included in the classification (such as palm-wrist sensory conduction velocity) were observed in the different CTS groups. The analysis of the groups showed that: 1) the majority of advanced cases (SEV and EXT) occurred in older patients (60-80 years), 2) most of the milder cases (MIN and MILD) occurred in young female patients. The aim of this study was to standardise the neurophysiological evaluation of CTS.

Adult↗
PubMed2000

Cognitive function and neurophysiological evaluation in early-treated hypothyroid children.

In this study, we assessed cognitive function and neurophysiological development in congenitally hypothyroid (CH) children. We performed a cross-sectional study at the outpatient Pediatric Clinic and Department of Neurophysiology at San Raffaele Hospital, Milan. The study enrolled 25 CH patients (6.00-10.83 years of age) detected by neonatal screening, and 34 healthy control children (4-11 years of age). Patients and controls had comparable scores at neuropsychological tests (WISC-R), and at auditory P300 tests. In contrast, we found significantly longer LLSEP latencies in CH patients (p < 0.03). CH patients treated 30 days after birth showed lower scores at neuropsychological tests, but not at neurophysiological tests, compared to patients who started the replacement therapy earlier. Patients with more severe fetal hypothyroidism (T4 levels at diagnosis < or = 2 micrograms/dl) had lower neuropsychological scores, and similar neurophysiological results, compared with patients with moderate fetal hypothyroidism. The severity of fetal hypothyroidism and early treatment influence the mental outcome of CH patients. Neurophysiological results show that central nervous system damage occurs in some patients despite early treatment.

Child↗
PubMed2005

Improvement of functional outcome after radical surgery in glioblastoma patients: the efficacy of a navigation-guided fence-post procedure and neurophysiological monitoring.

This retrospective study investigated the functional outcomes of patient with glioblastoma receiving radical surgery before and after the adoption of the navigation-guided fence-post (NGFP) procedure and neurophysiological monitoring. We investigated 42 glioblastoma patients receiving radical surgery in our institute between 1980 and 2005. Of the 42 patients, 18 patients from 1980 to 1996 (1st term) underwent radical surgery without navigation system guidance, NGFP, or neurophysiological monitoring; 11 patients from 1997 to 2002 (2nd term) underwent surgery with simple navigation system guidance but without NGFP procedure or neurophysiological monitoring, and 13 patients from 2003 to 2005 (3rd term) underwent surgery with the NGFP procedure and neurophysiological monitoring as appropriate. There were no significance differences between any of the three term groups in age, gender, preoperative KPS score, or 'surgical staging for glioma' according to the difficulty of surgery. The rates of 95% or greater volume reduction in each term were 38.9%, 54.5% and 76.9%. The rates of morbidity were 38.9%, 18.1% and 0%. The change in KPS scores (delta KPS) before and after the perioperative period in each term were -16.1 +/- 6.6 SEM, -9.0 +/- 5.8 SEM and +8.5 +/- 3.7 SEM, respectively. The delta KPS in the 3rd term was significantly better than those of 1st and 2nd terms (P < 0.01, Kruskal-Wallis rank test). The rate of patients who were discharged to home and who resumed daily useful life without assistance was 38.9%, 63.6% and 84.6% in each term, respectively. The mean survival times in each term were 9.9, 14.0 and 16.8 months. The introduction of the NGFP procedure and neurophysiological monitoring in glioblastoma radical surgery improved the functional outcome of patients.

Brain Neoplasms↗
PubMed1985

Effect of different degrees of brain ischemia and tissue lactic acidosis on the short-term recovery of neurophysiologic and metabolic variables.

The recovery of the EEG and somatosensory evoked responses (SER) as compared with recovery of the cerebral energy state was studied in rats during recirculation following different degrees of brain ischemia with varying tissue lactic acidosis. Reversible complete and incomplete ischemia was induced either by increasing the intracranial pressure (compression ischemia) or by carotid artery clamping combined with arterial hypotension. In incomplete ischemia the degree of tissue lactic acidosis was varied by manipulations of blood and brain glucose levels. Animals with an increase in brain lactate to about 25 mumol X g-1 (whole brain wet weight) during ischemia showed persistent failure of both cerebral energy metabolism and neurophysiologic restitution during the recirculation phase; if less than 20 mumol X g-1 metabolic recovery was almost complete. Despite a similar restitution of tissue energy metabolism in these animals, neurophysiologic recovery was inversely proportional to brain lactate concentrations during ischemia. At similar levels of ischemic tissue lactic acidosis, and despite a similar recovery of cortical energy state, the neurophysiologic restitution was clearly inferior after complete ischemia to that following incomplete ischemia. Three conclusions were drawn: (i) neurophysiologic variables were more sensitive indicators of postischemic persistent cerebral dysfunction than the cerebral energy state; (ii) the degree to which lactate accumulated in the ischemic brain influenced neurophysiologic restitution even if concentrations critical for metabolic recovery were not attained; and (iii) incomplete ischemia was less harmful than complete ischemia provided that tissue lactic acidosis was not excessive.

Acidosis↗