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PubMed2006

Permanent sensory nerve impairment following third molar surgery: a prospective study.

OBJECTIVE: This prospective study reports the proportion of permanent sensory impairment of the inferior alveolar and lingual nerves and the factors influencing such prevalence after the removal of mandibular third molars under local anesthesia. STUDY DESIGN: There were 1,087 patients with 1,087 mandibular third molars removed under local anesthesia from 1998 to 2003. Standardized data collection included the patient's name, age, gender, radiographic position of extracted tooth, grade of surgeon, proximity of the inferior alveolar nerve, and the prevalence of lingual and/or inferior alveolar nerve paresthesia. RESULTS: Inferior alveolar nerve injury was 4.1% 1 week after surgery and decreased to 0.7% after 2 years of follow-up, and alteration in tongue sensation occurred in 6.5% of patients 1 week after surgery and decreased to 1.0% after 2 years of follow-up. CONCLUSION: The experience of the operator was found to be a significant factor in determining both permanent lingual nerve (P=.022) and permanent inferior alveolar nerve paresthesia (P=.026).

Adolescent↗
PubMed2002

Morbidity after procurement of radial arteries in diabetic patients and the elderly undergoing coronary revascularization.

BACKGROUND: The use of radial arteries for coronary revascularization is increasing. There remain concerns regarding alteration of upper extremity function after radial artery procurement. This study evaluates the functional morbidity in higher risk patients. METHODS: Between April 1997 and September 1999, 374 patients underwent unilateral or bilateral radial artery procurement. A questionnaire was used to evaluate symptoms related to motor and sensory function and changes in appearance after radial artery harvest. RESULTS: Two hundred eighty-nine patients were successfully interviewed. The average age was 63 years. Median follow-up was 9.5 months (range, 2 to 23 months). No patient suffered limb loss. Altered gross and fine motor function, residual pain, paresthesias, numbness, pallor, swelling, and altered temperature sensation were compared among diabetic patients, patients older than 70 years, and patients without these characteristics. CONCLUSIONS: Radial artery procurement for elective coronary revascularization can be done with minimal serious morbidity in higher risk patients. The most common symptoms were numbness and paresthesia. Despite the finding of greater residual pain in diabetic patients, we do not believe the use of radial artery conduits is contraindicated in these patients.

Adult↗
PubMed2003

Local side effects observed among long-term users of norplant contraceptive implants.

The prevalence of local signs and symptoms related to the site of insertion of implants, and the association of these signs and symptoms with time of use, skin color and body mass index (BMI) was evaluated among users of the Norplant implant system. Three hundred and three Norplant users attending at the reproductive health clinic of PROFAMILIA in Santo Domingo, Dominican Republic, were asked if they had ever had any discomfort at the site/arm of implant insertion and the implant insertion area was examined and hyperpigmentation and hollowing of the surface was recorded. Half of the subjects reported either pain or paresthesia or both, in almost equal numbers, some time since insertion. Hyperpigmentation was observed in 35.6% and hollowing in 22.4% of the subjects. Report of pain and paresthesia was inversely associated to time of use and to BMI. Hyperpigmentation was directly associated to time of use and darker skin, and hollowing of the arm surface in the implants area with time of use and BMI. Local signs and symptoms were more frequent than previously reported, although they were of mild nature and appeared not to worry most of the users.

Adult↗
PubMed2001

Inhibitory effect of oxcarbazepine on high-frequency firing in peripheral nerve fibers.

We assessed the effects of oxcarbazepine, an antiepileptic derivative of carbamazepine, on discharges in single cutaneous afferent fibers produced by repetitive high-frequency stimulation (mimicking the abnormal excitation of peripheral nerves in neuropathic pain and paresthesia). After intravenous administration of oxcarbazepine, the later responses in the train dropped out without the earlier ones being affected and, thus, the total number of spikes decreased. The latency of the responses to an individual pulse was unchanged. These results, which indicate that oxcarbazepine inhibits the generation of high-frequency firing without affecting impulse conduction, suggest that this drug may be useful against neuropathic pain and paresthesia.

Animals↗
PubMed1997

Successful treatment of painful traumatic mononeuropathy with carbamazepine: insights into a possible molecular pain mechanism.

The delayed onset of painful paresthesias following trauma to a peripheral nerve is a well recognized but poorly understood phenomenon. This report describes an illustrative case of painful paresthesias in the territory of the ilioinguinal nerve, 3 to 6 weeks after an otherwise routine herniorraphy, which subsequently responded dramatically to carbamazepine. The case is considered in light of recent studies which have determined molecular changes which occur in dorsal root ganglion (DRG) neurons following axotomy and neuroma formation. Voltage-dependent sodium (Na+) channels in DRG neurons undergo a change following axotomy, in which there is significant up- and down-regulation of different subpopulations of Na channels over a time frame measured in days to weeks. Such changes may render the DRG neurons hyperexcitable, thus contributing to a neuropathic pain syndrome, yet susceptible to treatment with a sodium channel blocker such as carbamazepine.

Analgesics, Non-Narcotic↗
PubMed1998

Severe progression of ALS/MND after intervertebral discectomy.

We observed seven patients who developed their first signs and symptoms of motor neuron disease together with signs of protrusion/prolapse of intervertebral disc. The age of the patients was between 55 and 67, of which one female and six male patients. All of them suffered from cervical spine pain or low back pain. The female patient and one male patient developed weakness in the small feet muscles as initial symptom and they complained of paresthesia along dermatomes L5S1 and of severe pain. The other five patients developed wasting of the hands muscles. They had a rather mild pain in the cervical spine and early morning paresthesia as well as severe causalgia along dermatomes C5C6 or C6C7. After the diagnosis of compressive radiculopathy in all patients, they underwent surgical treatment and very soon developed very severe progression of muscle wasting which included muscles of limbs, trunk and bulbar innervated muscles with signs and symptoms of lower and upper motor neuron lesion. Five patients died from 12 to 15 months after surgical treatment and two patients are still living.

Aged↗
PubMed1997

Ipsilateral median somatosensory evoked potentials recorded from human somatosensory cortex.

Somatosensory evoked potentials (SEP) to ipsilateral and contralateral median nerve stimulations were recorded from subdural electrode grids over the perirolandic areas in 41 patients with medically refractory focal epilepsies who underwent evaluation for epilepsy surgery. All patients showed clearly defined, high-amplitude contralateral median SEPs. In addition, four patients showed ipsilateral SEPs. Compared with the contralateral SEPs, ipsilateral SEPs were very localized, had a different spatial distribution, were of considerably lower amplitude, had a longer latency (1.2-17.8 ms), did not show an initial negativity, and were markedly attenuated during sleep. Stimulation of the subdural electrodes overlying the sensory hand area was associated with contralateral hand paresthesias, but no ipsilateral hand paresthesias, occurred. It was concluded that subdurally recorded cortical SEPs to ipsilateral stimulation of the median nerve (M) reflect unconscious sensory input from the hand possibly serving fast bimanual hand control. The anatomical pathway of these ipsilateral short-latency MSEPs is not yet known. Transcallosal transmission seems unlikely because of the short delay between the ipsilateral and contralateral responses in selected cases. The infrequent occurrence of ipsilateral subdurally recorded SEPs and their low amplitude and limited distribution suggest that they contribute very little to the short-latency ipsilateral median SEPs recorded on the scalp.

Adolescent↗
PubMed2003

Analgesic and placebo effects of thalamic stimulation.

Numerous clinical studies have reported successful relief of chronic pain with sensory thalamic stimulation. However, even with the extensive use of sensory thalamic stimulation as a clinical tool in the relief of chronic pain, the results are still inconsistent. This discrepancy could probably be explained by the fact that the majority of these studies are case reports or retrospective analyses, which have often used imprecise pain measurements that do not allow a rigorous statistical evaluation of pain relief. None of these studies measured the effect of stimulation on clinical pain for longer than a few hours per day, which is an important aspect considering that clinical pain can vary over time. Moreover, placebo controls are seldom included. In the current study, we measured patients' pain perception at home over a 2-week period, both during days of normal stimulation of the sensory thalamus and during days without stimulation. Patients also came to the laboratory to assess the effects of thalamic and placebo stimulation on clinical pain, experimental heat pain, innocuous air puff and visual stimulation. A potential relation between the perceived paresthesia and analgesic efficacy during thalamic and placebo stimulation was also explored. We found that thalamic stimulation significantly affected clinical and experimental pain perception, but that an important placebo component also exists. On the other hand, neither thalamic nor placebo stimulation affected air puff and visual ratings, suggesting that the effect applies specifically to pain and hence is not caused by a general change in attention. The level of paresthesia elicited during the placebo manipulation was also directly correlated with the degree of placebo pain relief. These results suggest that thalamic stimulation produces a small but significant reduction in pain perception, but that a significant placebo effect also exists.

Adult↗
PubMed2001

Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery? A prospective double-blind, randomized study.

PURPOSE: To test the hypothesis that increasing the nerve length within the treatment volume for trigeminal neuralgia radiosurgery would improve pain relief. METHODS AND MATERIALS: Eighty-seven patients with typical trigeminal neuralgia were randomized to undergo retrogasserian gamma knife radiosurgery (75 Gy maximal dose with 4-mm diameter collimators) using either one (n = 44) or two (n = 43) isocenters. The median follow-up was 26 months (range 1-36). RESULTS: Pain relief was complete in 57 patients (45 without medication and 12 with low-dose medication), partial in 15, and minimal in another 15 patients. The actuarial rate of obtaining complete pain relief (with or without medication) was 67.7% +/- 5.1%. The pain relief was identical for one- and two-isocenter radiosurgery. Pain relapsed in 30 of 72 responding patients. Facial numbness and mild and severe paresthesias developed in 8, 5, and 1 two-isocenter patients vs. 3, 4, and 0 one-isocenter patients, respectively (p = 0.23). Improved pain relief correlated with younger age (p = 0.025) and fewer prior procedures (p = 0.039) and complications (numbness or paresthesias) correlated with the nerve length irradiated (p = 0.018). CONCLUSIONS: Increasing the treatment volume to include a longer nerve length for trigeminal neuralgia radiosurgery does not significantly improve pain relief but may increase complications.

Adult↗
PubMed1991

Recovery from symptoms after carpal tunnel syndrome surgery in males in relation to vibration exposure.

A follow-up study was conducted in forty-one men (fifty-five hands) treated surgically for carpal tunnel syndrome. The number of hours of vibration exposure and exactly which hand tool was used were recorded and each tool was categorized according to vibration level. The patients were divided into a low exposure and a high exposure group. Age at surgery, mean distal latency in the median nerve, and the duration between onset of symptoms and surgery were similar for the two groups. Only one patient experienced nocturnal paresthesia at follow-up in the low exposure group in contrast to twelve in the high exposure group. This corresponded to an age-standardized odds ratio (relative risk) of eighteen for nocturnal paresthesia after surgery in the high exposure group, with the low exposure group as referents. Previous vibration exposure may influence the recovery after carpal tunnel surgery.

Adult↗
PubMed1983

Radial tunnel syndrome: a spectrum of clinical presentations.

A variety of symptoms associated with 15 cases of resistant tennis elbow and resistant radial tunnel pain are described. These included sensations of popping, paresthesias, and paresis. The duration of symptoms averaged 2.3 years before a definitive diagnosis of radial tunnel syndrome was made. Two unique anomalies were contributing factors in the radial nerve entrapment; one case demonstrated a completely tendinous proximal border of the extensor carpi radialis brevis and the other a bifid extensor carpi radialis brevis origin. Excellent pain relief, elimination of popping, and improvement of the paresthesias and paresis was achieved by release of the radial tunnel in cases unresponsive to conservative treatment.

Adult↗
PubMed1985

Carpal tunnel syndrome: associated abnormalities in ulnar nerve function and the effect of carpal tunnel release on these abnormalities.

Twenty of 59 hands (34%) of patients with carpal tunnel syndrome had abnormalities in sensibility testing of both median and ulnar nerves by either two-point discrimination, Semmes-Weinstein monofilament testing, or both. Before surgery, 53% of patients complained of paresthesias and/or numbness in ulnar nerve distribution. Eighty percent of the hands had abnormal Semmes-Weinstein monofilament testing of the ulnar nerve. Thirty-five percent had abnormal two-point discrimination. Forty-one percent had abnormal electromyographic testing of the ulnar nerve. All hands had median nerve decompression alone. Guyon's canal was not released. After surgery, 89% of patients had improvement in paresthesias and/or numbness of the ulnar nerve. Ninety-four percent had improvement in Semmes-Weinstein monofilament testing. Eighty-six percent had improvement in two-point discrimination. Patients with a residual abnormality in ulnar nerve sensibility also had continued abnormality in median nerve sensibility. A significant percentage of patients with carpal tunnel syndrome also have signs and symptoms of ulnar nerve compression. Most improved with carpal tunnel release alone.

Carpal Tunnel Syndrome↗
PubMed1996

Reverse radial artery fascial flap: a treatment for the chronically scarred median nerve in recurrent carpal tunnel syndrome.

Six patients underwent re-exploration of the carpal tunnel for symptoms of recurrent median nerve compression. All patients had previously undergone two or more decompressions. Operative findings revealed evidence of chronic scarring of the median nerve with flattening and perineural fibrosis. Following decompression together with neurolysis and tenosynovectomy, a vascularized fascial flap pedicled distally on the radial artery was used to envelop the median nerve. Follow-up studies of between 12 and 61 months (mean, 25 months) showed improvement of symptoms in all patients, with 2 patients describing complete relief of pain and paresthesia and 4 patients describing mild intermittent pain or paresthesia.

Carpal Tunnel Syndrome↗
PubMedDate not supplied

The carpal tunnel syndrome.

Chronic carpal tunnel syndrome was initially described by James Jackson Putnam in 1880. A number of medical luminaries have also contributed to our understanding of the syndrome, including Paget, Marie, Ramsay Hunt, Phalen. and Osler. Carpal tunnel syndrome is the most common peripheral compression neuropathy. Most cases are idiopathic, with nonspecific tenosynovitis leading to median nerve compression. A number of diseases and other conditions are also associated with chronic carpal tunnel. Patients characteristically complain of nocturnal paresthesias or burning pain. Motor complaints relate to thenar muscular weakness and atrophy. Bedside diagnostic tests include Tinel's and Phalen's signs, and application of pressure over the median nerve by inflating a sphygmomanometer over the wrist. Tinel's sign is the induction of paresthesias by tapping over the site of the median nerve at the wrist. In Phalen's sign, symptoms are reproduced by maximum flexion of the wrist for 60 s. The classically described patients are middle-aged women. In addition, another distinct population is receiving increased attention, the relatively young male and female workers who experience symptoms performing repetitive manual labor.

Adult↗
PubMedDate not supplied

Clinical experience with thioctacid (thioctic acid) in the treatment of distal symmetric polyneuropathy in Korean diabetic patients.

OBJECTIVE: This open-label study was performed to evaluate the efficacy and safety of oral treatment with the antioxidant alpha-lipoic acid (ALA, thioctic acid) in Korean diabetic patients with distal symmetric polyneuropathy (DSP). SUBJECTS AND METHODS: Thioctic acid was administered orally using 600 mg once daily for 8 weeks in 61 diabetic patients with symptomatic polyneuropathy. Neuropathic symptoms (pain, burning sensation, paresthesia, and numbness) were scored at baseline as well as at 4 and 8 weeks following treatment. In addition, neurological assessment was carried out before and after 8 weeks of treatment, and an overall evaluation was performed at the end of treatment. The primary endpoint was the response rate after 8 weeks of treatment, defined as an improvement in the Total Symptom Score (TSS) of > or =30%. RESULTS: Efficacy was evaluated in 38 patients who had completed the study according to the protocol. Safety was evaluated in all 61 patients who had taken the study medication. Fasting blood glucose and HbA(1)c did not change during the study. The response rate after 8 weeks was 71.4%. At 4 weeks, the response rate was 47.4%. The TSS significantly decreased at 4 weeks, which decreased further at 8 weeks (P<.05). All the individual scores for neuropathic symptoms (pain, burning sensation, paresthesia, and numbness) were also significantly reduced at 4 weeks and further decreased at 8 weeks (P<.05). The duration of diabetes, severity and duration of diabetic polyneuropathy, and all the other demographic and metabolic parameters did not demonstrate an effect on the response rate. The parameters of neurological assessment (ankle reflexes, pin-prick test, 10-g monofilament test) and quantitative sensory tests (vibration, warm and cold sensation) were not influenced by 8 weeks of treatment with 600 mg of oral thioctic acid per day. Overall efficacy rated as "good/fair" was 86.8% by the physician and 76.3% by the patients at the end of an 8-week treatment period. Eleven episodes (18.0%) of adverse events (possibly, probably, definitely related) were reported in seven patients (11.5%). CONCLUSION: These findings indicate that oral treatment with thioctic acid at a dose of 600 mg/day for 8 weeks improved symptoms of polyneuropathy in Korean diabetic patients without causing serious adverse events.

Antioxidants↗
PubMedDate not supplied

The prevalence of symptoms of sensorimotor and autonomic neuropathy in Type 1 and Type 2 diabetic subjects.

The aim of this study was to analyze the prevalence and severity of sensorimotor and autonomic neuropathic symptoms within an outpatients diabetic population. A total of 350 consecutive Type 1 (26.9%) and Type 2 diabetic subjects were investigated using the Michigan Neuropathy Screening Instrument (MNSI). The original questionnaire was extended with questions on autonomic neuropathy and to include a six-point scale to rate the severity of symptoms, which were recorded accurately in order to avoid overrating. More than one half of Type 2 and nearly a third of Type 1 diabetic subjects suffer from at least one neuropathic symptom; the former suffered significantly more often from paresthesia (P<.05) and burning pain (P=.05). Less than 10% of the study population had autonomic symptoms. The prevalence of symptomatic polyneuropathy (PNP), diagnosed by an abnormal MNSI together with the presence of any symptom, was 16.0% in Type 1 and 37.5% (P<.001) in Type 2 diabetic subjects. Subjects with an abnormal ankle reflex (54.6%) had in 48.2% any sensorimotor, in 35.1% any autonomic, and in 25.7% any sensorimotor plus autonomic symptoms. The corresponding percentages for subjects with an abnormal vibration perception threshold (VPT; 28.9%) were 59.4%, 46.5%, and 34.7%, respectively. An abnormal ankle reflex was significantly correlated to numbness, and to the the sum of sensorimotor and autonomic symptoms. An abnormal vibration perception was significantly correlated to numbness, to paresthesia pain, and to the sum of sensorimotor and autonomic symptoms. A higher percentage of Type 2 diabetic subjects had symptoms of neuropathy and the most frequent symptoms were numbness, muscle cramps and postural hypotension.

Adult↗
PubMed2003

Clinical benefits in endoscopic thyroidectomy by the axillary approach.

BACKGROUND: Surgical treatments for thyroid diseases require skin incisions that can result in prominent scars, complaints resulting from adhesions, hypesthesia, and paresthesia in the neck. We have developed an endoscopic thyroidectomy using an axillary approach. In this article, we compare our original technique with conventional open surgery from the aspects of surgical invasiveness and patients' complaints after surgery. STUDY DESIGN: Each procedure was performed in 20 patients with follicular tumors. The two groups were similar for age, gender, and the mean diameter of the thyroid tumor. No statistically significant difference in the final pathological diagnosis was found between the two groups. Surgical invasiveness and patients' complaints after surgery were compared using results of the operation and a questionnaire. RESULTS: The operating time for open surgery was significantly shorter than that for endoscopic surgery (p < 0.01). In the endoscopic surgery group, the patient questionnaires revealed that 4 patients had severe anterior chest pain on the first postoperative day. The postoperative pain decreased after, and we could not find any difference between the two groups with regard to postoperative pain. Three months after surgery, one patient who had received an endoscopic procedure complained of slight hypesthesia, and none of the patients complained of discomfort while swallowing. Among the patients who underwent open surgery, 13 patients (65%; p < 0.01) complained of hypesthesia or paresthesia and 6 patients (30%; p < 0.05) complained of discomfort while swallowing. All of the patients treated using the endoscopic procedure were satisfied with the cosmetic results, but 15 patients who underwent open surgery complained of unsatisfactory cosmetic results (p < 0.01). CONCLUSIONS: The incidence of postoperative complaints after endoscopic surgery is considerably lower than that after open surgery.

Adult↗
PubMedDate not supplied

Ultrasound-guided popliteal block demonstrates an atypical motor response to nerve stimulation in 2 patients with diabetes mellitus.

BACKGROUND AND OBJECTIVES: Nerve stimulation is a useful technique to identify peripheral nerves before blockade. We report 2 cases of the failure of nerve stimulation to accurately localize the sciatic nerve in patients with diabetes mellitus undergoing outpatient foot procedures. We also introduce a novel approach to performing a popliteal fossa block using ultrasound guidance. CASE REPORT: Ultrasound-guided popliteal fossa blocks were performed in 2 patients with diabetes mellitus. Both patients failed to develop an appropriate motor response or paresthesia to nerve stimulation. The needle positions were confirmed by ultrasound guidance and injections of local anesthesia were made uneventfully. Appropriate surgical anesthesia was established and the procedures were performed uneventfully. CONCLUSION: Ultrasound facilitated the accurate localization of the sciatic nerve in 2 patients with diabetes mellitus. Neither patient had a paresthesia or muscle twitch below 2.4 mA. There is theoretical concern that patients with underlying neuropathy, such as patients with diabetes mellitus, may have an altered response to either motor or sensory stimulation.

Diabetes Mellitus↗