ABSTRACT: In dystonic and spastic movement disorders, abnormalities of motor control and somatosensory processing as well as cortical modulations associated with clinical improvement after botulinum toxin A (BoNT-A) treatment have been reported, but electrophysiological evidence remains controversial. In the present observational study, we aimed to uncover central correlates of post-stroke spasticity (PSS) and BoNT-A-related changes in the sensorimotor cortex by investigating the cortical components of somatosensory evoked potentials (SEPs). Thirty-one chronic stroke patients with PSS of the upper limb were treated with BoNT-A application into the affected muscles and physiotherapy. Clinical and electrophysiological evaluations were performed just before BoNT-A application (W0), then 4 weeks (W4) and 11 weeks (W11) later. PSS was evaluated with the modified Ashworth scale (MAS). Median nerve SEPs were examined in both upper limbs with subsequent statistical analysis of the peak-to-peak amplitudes of precentral P22/N30 and postcentral N20/P23 components. At baseline (W0), postcentral SEPs were significantly lower over the affected cortex. At follow up, cortical SEPs did not show any significant changes attributable to BoNT-A and/or physiotherapy, despite clear clinical improvement. Our results imply that conventional SEPs are of limited value in evaluating cortical changes after BoNT-A treatment and further studies are needed to elucidate its central actions.

• MeSH
• botulotoxiny typu A aplikace a dávkování   MeSH
• cévní mozková příhoda komplikace   patofyziologie   MeSH
• dospělí MeSH
• horní končetina inervace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• následné studie MeSH
• nervosvalové látky aplikace a dávkování   MeSH
• nervus medianus účinky léků   patofyziologie   MeSH
• rehabilitace po cévní mozkové příhodě metody   MeSH
• senioři MeSH
• somatosenzorické evokované potenciály účinky léků   MeSH
• somatosenzorické korové centrum účinky léků   patofyziologie   MeSH
• svalová spasticita diagnóza   farmakoterapie   etiologie   patofyziologie   MeSH
• terapie cvičením metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

Objectives: Occupational carpal tunnel syndrome (CTS) due to upper extremity overuse has in recent years been the most commonly recognized occupational disease in the Czech Republic and its prevalence has steadily increased. This pilot observation aimed to assess the effects of exercise techniques and oral enzyme therapy in automotive plant workers with early CTS. Patients and Methods: The observation comprised automotive plant assembly line workers in whom nerve conduction study revealed incipient CTS. The subjects were divided into three groups: a group practicing exercise techniques (exercising; N=15), a group receiving oral enzyme therapy (N=16), and a group of controls (N=14). Subjects in the control group were only observed without any specific intervention, which is a common procedure in incipient CTS. Throughout 9-week observation, the workers did their jobs. Prior to and after that period, the workers' CTS-related symptoms were ascertained through structured interviews with a physician and the following median nerve parameters were measured: sensory conduction velocity (SCV) and distal motor latency (DML). Results: In both the exercise and enzyme therapy groups, statistically significant decreases in the total score for symptoms were achieved (p<0.0001), unlike controls. On final examination, both treated groups demonstrated significantly increased SCV as compared with the initial values (p=0.00013 and p<0.0001, respectively); in controls, the mean SCV did not significantly change. Similarly, a statistically significant shortening of DML was noted in the enzyme therapy group (p=0.008). Conclusion: The results showed the efficiency of both exercise and oral enzyme therapy in incipient CTS. These methods may be recommended for preventing more severe forms of CTS.

• MeSH
• dospělí MeSH
• elektromyografie MeSH
• enzymoterapie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci z povolání diagnostické zobrazování   patofyziologie   terapie   MeSH
• nervové vedení fyziologie   MeSH
• nervus medianus patofyziologie   MeSH
• syndrom karpálního tunelu diagnostické zobrazování   patofyziologie   terapie   MeSH
• techniky fyzikální terapie MeSH
• terapie cvičením * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

• MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony MeSH
• nervus medianus chirurgie   patofyziologie   MeSH
• neurochirurgické výkony metody   MeSH
• syndrom karpálního tunelu * diagnóza   etiologie   patofyziologie   terapie   MeSH
• Check Tag
• lidé MeSH

Úvod: Prevalence Martin-Gruberovy anastomózy (MGA), spojky n. medianus a ulnaris na předloktí se uvádí v rozmezí 15–39 %. Existují tři různé typy MGA, kdy motorická vlákna jsou v oblasti paže a lokte vedena skrze n. medianus a zásobují svaly ruky inervované n. ulnaris (m. abductor digiti minimi, m. interosseus dorsalis primus či m. adductor pollicis). Soubor a metodika: V pěti EMG laboratořích bylo unifikovanou technikou vyšetřeno 292 zdravých osob ve věku 20–67 let, průměr 39,4 let: 166 žen (256 rukou) a 126 mužů (201 rukou), celkem 457 rukou. Byla provedena motorická a senzitivní neurografie n. ulnaris a n. medianus. Pro detekci MGA mělo zásadní význam hodnocení amplitudy CMAP pro n. ulnaris a n. medianus při stimulaci z oblasti lokte a zápěstí. Výsledky: V našem souboru 457 vyšetřených rukou jsme na 90 rukou našli 109 výskytů MGA. U 30 rukou se jednalo o MGA-I, u 57 rukou o MGA-II a u 22 rukou o MGA-III. Izolované typy MGA se vyskytly v 73 případech, Na 17 rukou se vyskytla kombinace dvou, ojediněle dokonce všech tří typů MGA současně. Závěr: V souboru 292 osob zdravých osob jsme na 457 hodnocených rukou našli MGA v 19,7 %. Nejčastěji se vyskytoval typ MGA-II (12,5 %).

Objective: Martin-Gruber anastomosis (MGA) is a median-to-ulnar nerve communication in the forearm; three types of MGA occur. Typically, motor fibres course through the median nerve in the upper arm and elbow, however, they supply the ulnar-innervated muscles of the hand: abductor digiti minimi (ADM) – MGA-I; first dorsal interosseous (FDI) – MGA-II; or adductor pollicis – MGA-III. The objective was to determine the prevalence of MGA in a study group of healthy volunteers. Methods: Two hundred and ninety-two healthy participants (457 arms) were enrolled. Motor and sensory nerve conduction studies of the ulnar and median nerves were performed. Ulnar and median nerve compound muscle action potential amplitudes were obtained on stimulation at the elbow and wrist. Results: We found 109 cases of MGA in 90 arms (MGA-I in 30 arms; MGA-II in 57 arms; MGA-III in 22 arms). We found isolated MGA types in 73 arms, a combination of two types in 15 arms, and occasionally (2 arms) a simultaneous combination of all three types. Conclusion: The prevalence of MGA was 19.7%. Most frequently, we found MGA-II (prevalence = 12.5%). Significance: MGA does not produce any clinical signs. However, it can change EMG results. The neurophysiologist must be able to logically interpret such findings.

• Klíčová slova
• Martin-Gruberova anastomóza,
• MeSH
• dospělí MeSH
• elektromyografie metody   využití   MeSH
• klinická studie jako téma MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• nervus medianus * patofyziologie   MeSH
• nervus ulnaris * patofyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH

OBJECTIVES: Carpal tunnel syndrome (CTS) is a common occupational disease. The aim was to assess the effect of preventive measures in automotive assembly workers. MATERIAL AND METHODS: The analysis summarizes data from annual crosssectional studies. The 7-year analysis of data was based on medical records obtained from an occupational physician and inspections carried out at the workplace where targeted preventive measures were introduced, including better ergonomic arrangement of the workplace, technical adjustments facilitating the work, preventive nerve conduction studies (NCS) testing of the median nerve once a year, switching of workers and their targeted rotation within the workplace. The NCS testing of median nerve conduction at the wrist was the basic objective method for assessment of the prevalence and severity of CTS. Over the study period, the sample comprised 1804 workers at risk for repetitive overuse of the upper extremities, of whom 281 were females with a mean age of 38.5 years and 1523 were males with a mean age of 31.4 years. RESULTS: Over the study period, a total of 13 cases of CTS were recognized as an occupational disease in the plant, 8 of which occurred within the first 2 years from the initiation of production. Introduction of preventive measures decreased the prevalence of median neuropathy from 18.3% of examined extremities in 2011 to 10.5% in 2013 (p = 0.003). In early 2014, the production pace increased and this was accompanied by a rise in abnormal NCS findings to 16.9%. Over the study period, the rate of sensorimotor neuropathy decreased in favor of merely sensory neuropathies, which have been most frequent since 2013. The percentage of employees whose contracts were terminated due to median neuropathy decreased steadily from 5.5% to 0.4%. CONCLUSIONS: Targeted prevention of work-related CTS is effective as evidenced by the decrease in the prevalence of median neuropathy detected by NCS. Int J Occup Med Environ Health 2017;30(1):45-54.

• MeSH
• automobily MeSH
• dospělí MeSH
• ergonomie MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• nemoci z povolání epidemiologie   prevence a kontrola   MeSH
• nervové vedení * MeSH
• nervus medianus patofyziologie   MeSH
• poranění z opakovaného přetěžování epidemiologie   prevence a kontrola   MeSH
• prevalence MeSH
• syndrom karpálního tunelu epidemiologie   prevence a kontrola   MeSH
• zápěstí MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: Studies have shown slow healing of peripheral nerve injury in elderly patients. Carpal tunnel syndrome (CTS) is the most frequent compressive mononeuropathy, affecting mostly older people and females. Few studies have assessed electrophysiological differences between younger and older patients. We aimed to evaluate age-dependent differences in electrophysiological parameters preoperatively and postoperatively over a 100-day postoperative period. METHOD: This retrospective study included 258 hands of patients who underwent conventional open-technique carpal tunnel syndrome surgery. Patients with paresthesia in the median nerve distribution or with impaired sensation or abnormal findings in sensory and motor median nerve conduction studies were enrolled. The age dependence of the preoperative values of distal motor latency, amplitude of the compound motor action potential and sensory conduction velocity was estimated using regression analysis. RESULTS: Statistically significant age dependence was found for the preoperative distal motor latency, compound motor action potential, amplitude and sensory conduction velocity. The repair of segmental demyelination was nearly twice as slow in the older group, at a 5 % significance level, even when comparing groups with the same preoperative distal motor latency. CONCLUSIONS: Analysis of preoperative nerve conduction parameters indicates that surgery for carpal tunnel syndrome is performed later in older patients.

• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• motorické evokované potenciály MeSH
• nervové vedení fyziologie   MeSH
• nervus medianus patofyziologie   MeSH
• neurologické vyšetření MeSH
• obnova funkce * MeSH
• parestezie etiologie   MeSH
• poruchy senzitivity etiologie   patofyziologie   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stárnutí * MeSH
• syndrom karpálního tunelu patofyziologie   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Lambertův-Eatonův myastenický syndrom je vzácnou autoimunitní presynaptickou poruchou nervosvalového přenosu. Je charakterizován svalovou slabostí, hyporeflexií a autonomní dysfunkcí. Bývá často spojen s nádory, nejčastěji malobuněčným karcinomem plic. Je onemocněním středního a vyššího věku. Výskyt u dětí je zcela raritní. Autoři prezentují případ 12letého chlapce s abnormní chůzí při proximální slabosti dolních končetin, s lehkou oboustrannou ptózou, hyporeflexií a xerostomií. Diagnóza byla potvrzena nálezem výrazného inkrementu při vysokofrekvenční repetitivní nervové stimulaci a nálezem protilátek proti P/Q-typu kalciových kanálů. Spojení s nádorovým onemocněním jsme neprokázali, asociovanou autoimunitou je vitiligo. Kortikoidy, azatioprin a pyridostigmin zlepšily slabost pacienta.

Lambert-Eaton myasthenic syndrome is a rare autoimunne presynaptic disorder of neuromuscular transmission. It is characterised by muscle weakness, hyporeflexia and autonomic dysfunction. The syndrome is often associated with small cell lung carcinomas. It is a disease of middle and older age. Rare cases have been reported in children. We present a 12-year boy with abnormal gait, slight bilateral ptosis, hyporeflexia, xerostomia and vitiligo without evidence of neoplasms. High- frequency repetitive nerve stimulation with a large increment and a P/Q- type calcium- channel antibodies level confirmed the diagnosis of the syndrome. Corticosteroids, azathioprine and pyridostigmine improved patient´s weakness.

• Klíčová slova
• slabost, kalciové kanály, inkrement,
• MeSH
• dítě MeSH
• elektromyografie MeSH
• Lambertův-Eatonův myastenický syndrom diagnóza   farmakoterapie   patofyziologie   MeSH
• lidé MeSH
• methylprednisolon terapeutické užití   MeSH
• motorické evokované potenciály MeSH
• nervus medianus patofyziologie   MeSH
• nervus ulnaris patofyziologie   MeSH
• neurologické poruchy chůze MeSH
• neurologické vyšetření MeSH
• protilátky krev   MeSH
• pyridostigmin-bromid terapeutické užití   MeSH
• svalová slabost MeSH
• vápníkové kanály - typ P imunologie   krev   MeSH
• vápníkové kanály - typ Q imunologie   krev   MeSH
• vitiligo imunologie   MeSH
• xerostomie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

The objective of this study is to determine cut-off points for the crosssectional areas of the median nerve proximal and distal to carpal tunnel in moderate and severe Carpal Tunnel Syndrome (CTS) and compare the results of our study with those available in the literature. Forty-three patients with upper limb pain other than CTS and 36 patients with idiopathic CTS enrolled into the study. The diagnosis and categorization of CTS were based on electrophysiologic criteria of the American Academy of Neurology. Median nerve cross-sectional areas were measured. Arithmetic mean values and standard deviation of each variable were measured. Student t-test and chi-squared test were applied to compare continuous and dichotomous variables between CTS and non-CTS control groups. Ultimately the diagnostic performances of the test characteristics including sensitivity, specificity, positive and negative predictive values were measured. Mean cross-sectional area of the nerve is higher in moderate than severe CTS proximal and distal to carpal tunnel. We accepted cut-off points of 11.5 mm² and 13.5 mm² for cross-sectional areas of the proximal and distal portions of carpal canal respectively. The sensitivity, specificity, positive and negative predictive values for the proximal inlet are 83%, 90.7%, 65.5% and 55.7%; and for the distal outlet are 36.1%, 93%, 81.2% and 63.4% respectively. We suggest that ultrasound is a good diagnostic modality for patients referred to tertiary care centers which categorized as moderate CTS.

• MeSH
• akční potenciály MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• nervus medianus patofyziologie   ultrasonografie   MeSH
• senzitivita a specificita MeSH
• syndrom karpálního tunelu diagnóza   patofyziologie   ultrasonografie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

STUDY DESIGN: Clinical, neuroradiologic, and neurophysiologic description of 21 patients with compressive cervical spondylotic myelopathy (CCSM). OBJECTIVE: To describe the utility of cutaneous silent periods (CSPs) for functional evaluation of mild CCSM. SUMMARY OF BACKGROUND DATA: Electroneurography, electromyography, and somatosensory and motor evoked potentials (SEPs, MEPs) are routinely used for comprehensive functional neurophysiological evaluation of CCSM. CSPs have been reported in various intramedullary spinal cord lesions, however, they have not been systematically studied in mild CCSM. METHODS: We investigated 21 patients with multilevel CCSM as documented by magnetic resonance imaging. We recorded CSPs in thenar muscles after noxious digit II stimulation and compared them with median and tibial nerve SEPs and MEPs obtained from abductor digiti minimi and tibialis anterior muscles. Electroneurography and electromyography were obtained in affected myotomes. RESULTS: CSP onset and end latencies were delayed, and CSP duration was shortened, in CCSM patients. CSP abnormalities were present in 17 patients of whom all, but 1 presented with intramedullary magnetic resonance imaging hyperintensity. All 11 limbs affected by hypalgesia and thermhypesthesia had abnormal CSPs, whereas no spinothalamic deficit was noted in any limb with normal CSPs. CSP onset latency was inversely correlated with JOA score and N13 amplitude, and was positively correlated with central motor conduction time to abductor digiti minimi. CSP duration was inversely correlated with central motor conduction time to tibialis anterior. Electromyographic abnormalities were found in 7 patients. CONCLUSION: We confirm the value of neurophysiological evaluation of CCSM. MEPs were more frequently abnormal than SEPs. CSP abnormalities were almost equally sensitive as upper limb MEPs, and were highly associated with spinothalamic dysfunction. The high correlation of CSP abnormalities with corticospinal tract dysfunction suggests supraspinal influence on CSPs. Our findings corroborate the utility of CSP testing in the comprehensive assessment of intramedullary spinal cord dysfunction in CCSM.

• MeSH
• dospělí MeSH
• elektromyografie MeSH
• financování organizované MeSH
• kosterní svaly inervace   MeSH
• krční obratle MeSH
• lidé středního věku MeSH
• lidé MeSH
• motorické evokované potenciály fyziologie   MeSH
• nemoci míchy patofyziologie   MeSH
• nervové vedení fyziologie   MeSH
• nervový systém - fyziologické jevy MeSH
• nervus medianus patofyziologie   MeSH
• nervus tibialis patofyziologie   MeSH
• senioři MeSH
• somatosenzorické evokované potenciály fyziologie   MeSH
• spinální stenóza patofyziologie   MeSH
• spondylóza patofyziologie   MeSH
• studie případů a kontrol MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH

The authors present the results of the study carried out in South Moravia, Czech Republic, in a group of 140 patients (76 women and 64 men) with occupational carpal tunnel syndrome (CTS). The time-lag between the occupational disease certification and the investigation ranged from 2 to 14 years. The mean age of persons at the diagnosis was 44.5 +/- 7.4. years, and the duration of hazardous occupational exposure was 19.8 +/- 9.8 years. Repetitive and excessive strain of upper extremities was observed in 59% of patients and locally transmitted vibrations to the hands or vibration combined with repetitive and excessive strain of upper extremities in 41% of patients. Following the CTS certification as an occupational diseases, 98% of patients were removed from exposure to etiologic factors. During a follow-up examination, 19% of patients evaluated their health condition as better or recovered, deterioration was reported by 28%, and unchanged condition by 63% of subjects. Surgery was performed on 61% of patients. The comparison of the examination outcome at CTS certification as an occupational disease with the follow-up examination indicated significant improvement of distal motor latency, but the complete recovery of the median nerve conduction was found only in 13% of patients.

• MeSH
• časové faktory MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci z povolání epidemiologie   etiologie   prevence a kontrola   MeSH
• nervus medianus patofyziologie   MeSH
• pracovní expozice škodlivé účinky   prevence a kontrola   MeSH
• rizikové faktory MeSH
• ruka inervace   MeSH
• syndrom karpálního tunelu epidemiologie   etiologie   prevence a kontrola   MeSH
• vibrace škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH