Sonographic analysis of laryngeal elevation during swallowing

Background: Swallowing disorders are common symptoms in many neurological diseases. The aim of this pilot-study was to analyse vertical laryngeal excursion during swallowing non-invasively using ultrasound sonographic techniques in patients with dysphagia compared with healthy volunteers. Methods: Data were obtained from 42 healthy volunteers (mean age: 57 ± 19 years) and 18 patients (mean age: 63 ± 8 years) with dysphagia due to different neurological diseases using a 7.5 MHz linear array probe, which was placed in longitudinal position above the larynx. This allowed visualization of the contour and the acoustic shadow of the hyoid bone and the thyroid cartilage. The distance between the hyoid bone and the upper end of the thyroid cartilage during laryngeal elevation was readily assessed by video-mode function. Results: In healthy subjects we found a mean distance of 220 (± 30) mm at rest; the shortest distance during swallowing of 5 or 10 ml water was 85 (± 11) mm and represents a reduction of 61 % (± 3) under physiological conditions. The mean relative laryngeal elevation in the patients with neurogenic dysphagia was reduced to only 42 % (± 10) (p < 0.0001). Conclusions: Ultrasound is a viable and non-invasive method in the investigation of laryngeal elevation during swallowing. It allows direct visualization of impaired laryngeal motion in patients with neurogenic dysphagia. Received: 29 May 2002, Received in revised form: 10 October 2002, Accepted: 21 October 2002 Correspondence to V. Kuhl, MD     

Electromyography‐related pain: Muscle selection is the key modifiable study characteristic

Introduction: The aim of this study was to estimate the effects of patient, provider, and study characteristics on electromyography (EMG)‐related pain. Methods: Patients undergoing EMG rated their EMG‐related pain after each muscle was studied on a 100‐point visual analog scale (VAS). Investigators recorded the order in which the muscles were sampled, the total time spent with the needle in each muscle, and whether electrical endplate noise was noted. Results: A total of 1781 muscles were studied in 304 patients. Eleven muscles were associated with significantly more or less pain than the others. Endplate noise was associated with more pain (5.4 mm, 95% CI 2.8–7.0). There was a small, but significant effect from needling time (0.02 mm, 95% CI 0.00–0.04). Conclusions: Among factors that electromyographers can control, muscle selection has the greatest impact on pain. Our data include an extensive list of muscle‐specific EMG‐related pain scores. Provider and other study characteristics have little or no impact on EMG‐related pain. Muscle Nerve 49:570–574, 2014     

苍白球内侧部毁损术中靶点的综合定位法

目的介绍综合定位法在苍白球内侧部(Gpi)毁损术中的应用.方法对59例Gpi毁损术中的靶点综合性定位方法进行回顾性总结.先根据Shaltenbrand图谱和姚家庆图谱,确定一个标准的Gpi坐标,X=18 mm, Y=2 mm, Z=-6 mm,再通过MRI定位扫描、粗电极刺激和微电极记录三种方法对标准靶点坐标进行三次修改.最后,在对靶点进行试验性毁损后,制作永久性Gpi毁损灶.结果第一次标准靶点修改例数为50例,修改范围:x=0～4 mm,y=1～2 mm,z=0～3 mm;第二次修改例数为18例,修改范围:x=1～3 mm,y=1～1.5 mm,z=1～1.5 mm;第三次修改例数为9例,修改范围:x=0.5～1 mm,y=0.5mm,z=0.5～1.5 mm,而且大多数仅在z轴上进行修改.所有病例均获得良好手术效果.结论最大限度地利用MRI定位扫描和粗电极刺激所获得的信息,是Gpi毁损术中靶点定位的基本方法,微电极记录技术是靶点Gpi定位的辅助手段.     

The risk of hematoma following extensive electromyography of the lumbar paraspinal muscles

Introduction: The purpose of this study is to provide a controlled trial looking at the risk of paraspinal hematoma formation following extensive paraspinal muscle electromyography. Methods: 54 subjects ages 55–80 underwent MRI of the lumbar spine before or shortly after electromyography using the paraspinal mapping technique. A neuroradiologist, blinded to the temporal relationship between the EMG and MRI, reviewed the MRIs to look for hematomas in or around the paraspinal muscles. Results: Two MRIs demonstrated definite paraspinal hematomas, while 10 were found to have possible hematomas. All hematomas were < 15 mm, and none were close to any neural structures. There was no relationship between MRI evidence of hematoma and either the timing of the EMG or the use of aspirin or other nonsteroidal anti‐inflammatory drugs. Conclusions: Paraspinal electromyography can be considered safe in the general population and those taking nonsteroidal anti‐inflammatory drugs. Muscle Nerve 46:26–30, 2012     

Genome editing in induced pluripotent stem cells rescues TAF1 levels in X‐linked dystonia‐parkinsonism

Background: The most likely genetic cause of X‐linked dystonia‐parkinsonism, a neurodegenerative movement disorder endemic to the Philippines, is a 2672‐bp‐long retrotransposon insertion in intron 32 of the TAF1 gene. The objectives of this study were to investigate whether (1) TAF1 expression is altered in induced pluripotent stem cells and differentiated neuronal models and (2) excision of the retrotransposon insertion restores normal TAF1 expression. Methods: Expression of TAF1 and its neuronal isoform were determined in induced pluripotent stem cells and in induced pluripotent stem cell‐derived cortical neurons and spiny projection neurons using quantitative PCR. Genome editing‐based excision of the retrotransposon insertion was performed on induced pluripotent stem cells from 3 X‐linked dystonia‐parkinsonism patients. Edited and unedited induced pluripotent stem cells from X‐linked dystonia‐parkinsonism patients and controls were differentiated into cortical neurons and spiny projection neurons, and TAF1 expression was compared across groups. Results: TAF1 was reduced in patient‐derived induced pluripotent stem cells (P < 0.05) and spiny projection neurons (P < 0.01). After genome editing, we observed higher TAF1 expression in edited compared with unedited induced pluripotent stem cells (P < 0.0001). In edited spiny projection neurons, TAF1 expression was also increased, but did not reach statistical significance. No expression differences were observed in cortical neurons. Conclusions: (1) TAF1 reduction in X‐linked dystonia‐parkinsonism is likely due to the retrotransposon insertion and is recapitulated in induced pluripotent stem cells and differentiated spiny projection neurons. (2) TAF1 reduction is a tractable molecular phenotype of X‐linked dystonia‐parkinsonism that can be driven by excision of the retrotransposon insertion. (3) Successful rescue of the molecular phenotype in an endogenous, genome‐edited model serves as a proof of principle that may successfully be transferred to other inherited neurodegenerative diseases. © 2018 International Parkinson and Movement Disorder Society     

Consensus statement: Using laryngeal electromyography for the diagnosis and treatment of vocal cord paralysis

Introduction: The purpose of this study was to develop an evidence‐based consensus statement regarding use of laryngeal electromyography (LEMG) for diagnosis and treatment of vocal fold paralysis after recurrent laryngeal neuropathy (RLN). Methods: Two questions regarding LEMG were analyzed: (1) Does LEMG predict recovery in patients with acute unilateral or bilateral vocal fold paralysis? (2) Do LEMG findings change clinical management in these individuals? A systematic review was performed using American Academy of Neurology criteria for rating of diagnostic accuracy. Results: Active voluntary motor unit potential recruitment and presence of polyphasic motor unit potentials within the first 6 months after lesion onset predicted recovery. Positive sharp waves and/or fibrillation potentials did not predict outcome. The presence of electrical synkinesis may decrease the likelihood of recovery, based on 1 published study. LEMG altered clinical management by changing the initial diagnosis from RLN in 48% of cases. Cricoarytenoid fixation and superior laryngeal neuropathy were the most common other diagnoses observed. Conclusions: If prognostic information is required in a patient with vocal fold paralysis that is more than 4 weeks and less than 6 months in duration, then LEMG should be performed. LEMG may be performed to clarify treatment decisions for vocal fold immobility that is presumed to be caused by RLN. Muscle Nerve 53 : 850–855, 2016     

重性抑郁障碍患者药物治疗反应相关自发性神经活动改变的Meta分析

目的探索重性抑郁障碍(MDD)患者与药物治疗反应相关的自发性神经活动改变,寻找与治疗反应相关的影像学指标。方法计算机检索中国知网数据库、万方数据库、维普数据库、PubMed、Embase和Web of Science数据库,收集与MDD患者治疗反应相关的静息态脑功能影像研究,使用AES-SDM进行Meta分析。结果共8篇文章纳入Meta分析,包括288例患者和304例健康对照组。Meta分析结果显示,与健康对照组相比,治疗有效的MDD患者左侧小脑(峰值坐标:X=-22,Y=-78,Z=-18,SDM-Z=1.458)、左侧颞叶(峰值坐标:X=-50,Y=-30,Z=-8,SDM-Z=1.539)及右侧角回(峰值坐标:X=48,Y=-66,Z=36,SDM-Z=1.536)的脑功能活动增加,左侧辅助运动区(峰值坐标:X=-10,Y=-2,Z=72,SDM-Z=-1.107)脑功能活动降低;治疗无效的MDD患者双侧额上回、前扣带回(峰值坐标:X=12,Y=42,Z=-4,SDM-Z=1.526)脑功能活动增加,左侧额下回(峰值坐标:X=-48,Y=16,Z=6,SDM-Z=-1.912)脑功能活动降低。结论小脑半球自发性神经活动的改变可能成为预测MDD患者治疗反应的影像学指标。     

Time course of plasma microparticle concentrations after acute spontaneous basal ganglia hemorrhage

Dong X‐Q, Huang M, Hu Y‐Y, Yu W‐H, Zhang Z‐Y. Time course of plasma microparticle concentrations after acute spontaneous basal ganglia hemorrhage. Acta Neurol Scand: 2011: 123: 280–288. © 2010 John Wiley & Sons A/S. Objectives – To examine the changes in plasma microparticle (MP) levels in patients after intracerebral hemorrhage (ICH) and assess their association with outcome along with biological markers of the acute phase response. Materials and methods – Thirty healthy controls and 86 patients with acute ICH were recruited. Plasma samples were obtained on admission and at days 1, 2, 3, 5, and 7 after ICH. MPs with procoagulant potential were measured with a prothrombinase assay. Results – Plasma MP levels in patients were substantially higher than those in healthy controls during the 7‐day period. Plasma MP levels were strongly associated with outcome and with biological markers of the acute phase response. Multivariate analysis showed baseline plasma MP level was a good predictor of 1‐week mortality (odds ratio, 1.930; 95% confidence interval, 1.229–3.031; P = 0.004). A receiver operating characteristic curve identified the plasma MP cutoff level (8.4 nmol/l phosphatidylserine equivalent) that predicted 1‐week mortality with high sensitivity (90.6%) and specificity (68.5.0%) (P < 0.001). Conclusions – Increased membrane microparticle levels occur after ICH and may contribute to the subsequent brain injury, in association with a poor clinical outcome.     

Zonal organization of the vestibulocerebellum in pigeons (Columba livia): III. Projections of the translation zones of the ventral uvula and nodulus

Previous electrophysiological studies in pigeons have shown that the complex spike activity of Purkinje cells in the medial vestibulocerebellum (nodulus and ventral uvula) is modulated by patterns of optic flow that result from self-translation along a particular axis in three-dimensional space. There are four response types based on the axis of preferred translational optic flow. By using a three axis system, where +X, +Y, and +Z represent rightward, upward, and forward self-motion, respectively, the four cell types are t(+Y), t(-Y), t(-X-Z), and t(-X+Z), with the assumption of recording from the left side of the head. These response types are organized into parasagittal zones. In this study, we injected the anterograde tracer biotinylated dextran amine into physiologically identified zones. The t(-X-Z) zone projected dorsally within the vestibulocerebellar process (pcv) on the border with the medial cerebellar nucleus (CbM), and labeling was found in the CbM itself. The t(-X+Z) zone also projected to the pcv and CbM, but to areas ventral to the projection sites of the t(-X-Z) zone. The t(-Y) zone also projected to the pcv, but more ventrally on the border with the superior vestibular nucleus (VeS). Some labeling was also found in the dorsal VeS and the dorsolateral margin of the caudal descending vestibular nucleus, and a small amount of labeling was found laterally in the caudal margin of the medial vestibular nucleus. The data set was insufficient to draw conclusions about the projection of the t(+Y) zone. These results are contrasted with the projections of the flocculus, compared with the primary vestibular projection, and implications for collimotor function are discussed.     

Prospective investigation of nimodipine for acute vocal fold paralysis

Introduction: Nimodipine has been shown to be beneficial for recovery from acute vocal fold paralysis (AVFP) in an animal model. Methods: prospective, open‐label trial of patients with AVFP was performed using nimodipine. Consecutive patients were evaluated and offered nimodipine therapy. Results: Fifty‐three patients were considered for treatment with nimodipine. Thirteen did not qualify for inclusion, 5 were lost to follow‐up, and 7 had side effects requiring cessation of treatment. Thus 28 patients (30 paralyzed vocal folds) were analyzed. Eighteen of the paralyzed vocal folds experienced recovery of purposeful motion (60%). Historical controls and laryngeal electromyography meta‐analysis suggest no more than a 20% recovery rate from AVFP. Conclusions: This open label study using nimodipine for treatment of AVFP demonstrates tripling of the recovery rate of vocal fold motion compared with historical controls. Further study in a randomized, controlled manner is warranted. Muscle Nerve 50 : 114–118, 2014     

A novel electrodiagnostic assessment of the laryngeal closure reflex

Introduction: We describe a novel, clinically applicable conduction study of the laryngeal nerves. Methods: Seventeen normal volunteer subjects were included. Activation of the sensory territory of the superior laryngeal nerve was performed by administration of low level brief electrical stimuli. The laryngeal closure reflex (LCR) evoked by this stimulus was recorded by needle electrodes. Mean minimal latencies were calculated for each response, and proposed values for the upper limit of normal were determined. Results: Uniform, consistent early ipsilateral responses and late bilateral responses, which exhibit greater variation in latency and morphology, were recorded. Significant side‐to‐side differences in latencies were observed, consistent with the length discrepancy between right and left recurrent laryngeal nerves. Conclusions: This technique yields clear, quantifiable data regarding neurologic integrity of laryngeal function, heretofore unobtainable in the clinical setting. This study may yield clinically relevant information regarding severity and prognosis in patients with laryngeal neuropathic injury. Muscle Nerve 47:432‐436, 2013     

Stereometric estimation of the area of the freeze-fractured membrane

Stereo-pair micrographs of freeze-fracture replicas taken at +6 and ?6 degrees and enlarged 55,000 diameters were precisely aligned on a digitizing pad linked to a plotter and programmable calculator. A point grid spaced at 0.23 μm was placed over the left photo-pair. Under stereoscopic observation, matching points were placed by hand on the right photo-pair for every point in the applied grid that fell over the membrane surface of interest in the left photo-pair. The x, y coordinates of every point in the two photos were read with the digitizer. These data allowed the calculation of the X, Y, Z coordinates of all points in the untilted object space, 3-D reconstruction of the analyzed surface, and estimation of the membrane surface area.     

Truncating CLCN1 mutations in myotonia congenita: Variable patterns of inheritance

Introduction: Myotonia congenita due to protein truncating CLCN1 mutations is associated with variable patterns of inheritance. Methods: Three family kindreds are described, all of whom possess protein truncating mutations (Y33X, fs503X, R894X). One lineage also has coexistent R894X, A313T, and A320V mutations. Results: The Y33X mutation kinship has autosomal recessive inheritance and a severe phenotype when homozygous. The fs503X family has autosomal dominant inheritance and a moderate‐to‐severe phenotype. The A313T mutation kindred also has autosomal dominant inheritance but expresses a mild phenotype, except for the more severely affected compound heterozygotes. Conclusions: Early truncating mutations precluding dimerization are expected to be autosomal recessive and express a severe phenotype, while later mutations may be variable. The pedigrees presented here demonstrate that intrafamilial phenotypic variability may result from a dosage effect of an additional mutation, not necessarily variable expressivity. Mutations that have unexpected patterns of inheritance may represent allelic variability. Muscle Nerve 49:593–600, 2014     

Evaluation of spinal and bulbar muscular atrophy by the clustering index method

Introduction: A reliable electrophysiological marker for clinical trials is increasingly needed in spinal and bulbar muscular atrophy (SBMA). We previously developed a quantitative analysis method for surface electromyography (SEMG), the clustering index (CI) method. Our purpose was to test the utility of the CI method for evaluating lower motor neuron involvement in SBMA patients. Methods: Subjects included 29 SBMA patients and 27 healthy controls. The recording electrode was placed over the abductor digiti minimi (ADM) muscle with a proximal reference. The Z‐score, based on the CI method, was compared with compound muscle action potential (CMAP) amplitude and motor unit number estimation (MUNE), with regard to sensitivity. Results: The Z‐scores of the CI method, CMAP amplitude, and MUNE were abnormal in 100%, 72%, and 93% of the patients, respectively. Interrater reliability of the CI method was sufficiently high. Conclusion: The CI method is promising as a non‐invasive electrophysiological marker in SBMA. Muscle Nerve, 2011     

High-frequency sonography of the volar digital nerves of the hand

Introduction: The purpose of this study is to describe our technique for high‐frequency sonography of the volar digital nerves and to define the course, caliber, and morphology of normal volar digital nerves. Methods: The volar digital nerves of 10 volunteers were imaged in the long axis using a linear ultrasound transducer. Height, weight, glove size, and hand dominance were recorded. Each radial and ulnar nerve was divided into four segments. Segment thickness and depth were measured. A mixed model analysis for repeated measures was utilized (α = 0.05). Results: The average nerve thickness (NT) was 1.1 mm (± 0.01 SE), and the average nerve depth (ND) was 2.8 mm (± 0.04 SE). Neither NT nor ND demonstrated any significant correlation with height, age, weight, body mass index, or glove size. Nerves ranged in thickness from 0.7 to 1.5 mm and in depth from 0.7 to 6.8 mm. Conclusion: High‐frequency sonography permits high‐resolution imaging of the volar digital nerves. Muscle Nerve, 2012     

An implantable system for In Vivo chronic electromyographic study in the larynx

Introduction: Electromyography (EMG) plays an important role in exploring the mechanisms of selective reinnervation. An implantable system can help provide chronological information regarding reinnervation of laryngeal muscles. This study was designed to develop an implantable system for repeated recordings of spontaneous and evoked EMG from laryngeal muscles. Methods: This implantable system has 4 bipolar stimulus cuffs for bilateral recurrent laryngeal nerves (RLNs) and superior laryngeal nerves (SLNs), and 4 EMG recording electrodes for bilateral vocal fold adductors (thyroarytenoid–lateral cricoarytenoid, TA‐LCA) and abductor (posterior cricoarytenoid, PCA) muscles. The system was implanted in 8 canines for up to 41 weeks. Results: The system showed good compatibility. Consistent EMG signals were recorded from both PCA and TA‐LCA muscles. Conclusion: We developed a long‐term implantable EMG system that is simple and capable of obtaining stable EMG recordings from canine laryngeal muscles with minimal risk of device breakage, trauma, or infection. Muscle Nerve 55: 706–714, 2017     

A bi‐directional assessment of the human brain‐anorectal axis

Background Brain‐gut dysfunction has been implicated in gastrointestinal disorders but a comprehensive test of brain‐gut axis is lacking. We developed and tested a novel method for assessing both afferent anorectal‐brain function using cortical evoked potentials (CEP), and efferent brain‐anorectal function using motor evoked potentials (MEP). Methods Cortical evoked potentials was assessed following electrical stimulations of anus and rectum with bipolar electrodes in 26 healthy subjects. Anorectal MEPs were recorded following transcranial magnetic stimulation (TMS) over paramedian motor cortices bilaterally. Anal and rectal latencies/amplitudes for CEP and MEP responses and thresholds for first sensation and pain (mA) were analyzed and compared. Reproducibility and interobserver agreement of responses were examined. Key Results Reproducible polyphasic rectal and anal CEPs were recorded in all subjects, without gender differences, and with negative correlation between BMI and CEP amplitude (r ?0.66, P = 0.001). Transcranial magnetic stimulation evoked triphasic rectal and anal MEPs, without gender differences. Reproducibility for CEP and MEP was excellent (CV <10%). The inter‐rater CV for anal and rectal MEPs was excellent (ICC 97–99), although there was inter‐subject variation. Conclusions & Inferences Combined CEP and MEP studies offer a simple, inexpensive and valid method of examining bidirectional brain‐anorectal axes. This comprehensive method could provide mechanistic insights into lower gut disorders.     

Direction and Predictive Factors for the Shift of Brain Structure During Deep Brain Stimulation Electrode Implantation for Advanced Parkinson's Disease

Objectives. The aims of this study were to clarify the direction and degree of brain shift, and to determine the predictive factors for a brain shift during deep brain stimulation (DBS) of the subthalamic nucleus (STN). Materials and Methods. To evaluate the brain shift during bilateral STN‐DBS, the position of the anterior commissure (AC), posterior commissure (PC), midcommissure point (MC), and tip of the frontal lobe and anterior horn of the lateral ventricle were calculated pre‐ and poststereotactic operations in the three‐dimensional direction employing special software (Leksell SurgiPlan). To determine the predictive factors for a brain shift, patient's age, operation hours, width of the third ventricle, bicaudate index (BCI), and cella media index (CMI) were compared with the shift of MC. Results. In 50 patients, the MC shifted mainly in the posterior direction (y‐axis: 1.27 ± 0.7 mm), and the shifts in the inferior direction (z‐axis: 0.11 ± 0.43 mm) and lateral direction (x‐axis: 0.02 ± 0.39 mm) were small. The shift of the MC in the posterior direction correlated well with the shift of the tip of the anterior lobe and anterior horn. Among the predictive factors examined, namely, the patient's age, operation hours, width of the third ventricle, BCI, and CMI, only the CMI showed a correlation with the shift of the MC (r = 0.42, p < 0.01, Pearson's correlation coefficient; and p < 0.05, logistic regression analysis). Conclusions. In bilateral STN‐DBS, brain shift occurred mainly in the posterior direction, and the CMI is useful for the prediction of a brain shift. Enlargement of the body part of the lateral ventricle is the most reliable factor for predicting a brain shift.     

Hypopharyngeal Wall Exposure within the Surgical Field : The Role of Axial Rotation of the Thyroid Cartilage during Anterior Cervical Surgery

Objective

Esophageal/hypopharyngeal injury can be a disastrous complication of anterior cervical surgery. The amount of hypopharyngeal wall exposure within the surgical field has not been studied. The objective of this study is to evaluate the chance of hypopharyngeal wall exposure by measuring the amount of axial rotation of the thyroid cartilage (ARTC) and posterior projection of the hypopharynx (PPH).

Methods

The study was prospectively designed using intraoperative ultrasonography. We measured the amount of ARTC in 27 cases. The amount of posterior projection of the hypopharynx (PPH) also was measured on pre-operative CT and compared at three different levels; the superior border of the thyroid cartilage (SBTC), cricoarytenoid joint and tip of inferior horn of the thyroid cartilage (TIHTC). The presence of air density was also checked on the same levels.

Results

The angle of ARTC ranged from -6.9° to 29.7°, with no statistical difference between the upper and lower cervical group. The amount of PPH was increased caudally. Air densities were observed in 26 cases at the SBTC, but none at the TIHTC.

Conclusion

Within the confines of the thyroid cartilage, surgeons are required to pay more attention to the status of hypopharynx/esophagus near the inferior horn of the thyroid cartilage. The hypopharynx/esophagus at the TIHTC is more likely to be exposed than at the upper and middle part of the thyroid cartilage, which may increase the risk of injury by pressure. Surgeons should be aware of the fact that the visceral component at C6-T1 surgeries also rotates as much as when the thyroid cartilage is engaged with a retractor. The esophagus at lower cervical levels warrants more careful retraction because it is not protected by the thyroid cartilage.     

Effect of different approaches to target force on transcranial magnetic stimulation responses

Introduction: The aim of this study was to determine whether the manner in which a target force is approached can influence the electromyographic (EMG) and mechanical parameters evoked by transcranial magnetic stimulation (TMS) during brief muscle contractions. Methods: The amplitude of motor‐evoked potentials (MEP) and superimposed twitch and the duration of the silent period were recorded in 8 healthy participants in response to TMS delivered during brief isometric voluntary contractions of the quadriceps maintaining a target force (10% and 50% of maximal voluntary force) or gradually increasing or decreasing to reach this point. Results: MEP and superimposed twitch, unlike the silent period, are influenced by the manner of reaching a low force. Conclusions: Clear instructions must be provided to research participants and patients. Rapidly increasing to a target force without exceeding it and maintaining the force before the delivery of TMS results in stable, representative MEP amplitudes. Muscle Nerve 48 : 430–432, 2013