Cíl: Cílem studie bylo zhodnotit přínos elektrofyziologického vyšetření v diferenciální diagnostice lumbální spinální stenózy (LS) a diabetické polyneuropatie (DPN). Soubor a metodika: Elektrofyziologické vyšetření bylo provedeno u 68 pacientů s klinicky symptomatickou LS, u 28 pacientů s DPN a 32 zdravých dobrovolníků. Výsledky: Vyšetřené elektrofyziologické parametry z horních končetin (latence F vlny n. ulnaris a amplituda senzitivního neurogramu n. radialis), všechny hodnocené latence z dolních končetin (F vlny n. tibialis, H reflexu m. soleus, spinální latence MEP) a amplituda senzitivního neurogramu n. suralis signifikantně odlišovaly pacienty s LS a DPN. ROC analýza nicméně prokázala pouze dva elektrofyziologické parametry jako efektivní nezávislé faktory pro odlišení pacientů s LS a DPN: latenci ulnarisové F vlny (optimální diskriminační hodnota je 24,2 ms, senzitivita 82,7 % a specificita 63,9 %) a amplitudu senzitivního neurogramu n. radialis (optimální diskriminační hodnota je 10,5 ?V, senzitivita 75,5 % a specificita 58,2 %). Vícerozměrná diskriminační analýza poskytla kanonické skóre s nejsilnější prediktivní hodnotou. Závěry: Elektrofyziologické vyšetření z horních končetin je užitečné v diferenciální diagnostice LS a DPN, nicméně nejlepší diskriminační efekt vykazuje kanonické skóre, které zahrnuje několik elektrofyziologických parametrů. Klíčová slova: lumbální spinální stenóza – diabetická polyneuropatie – elektrofyziologické vyšetření – elektromyografie Autoři deklarují, že v souvislosti s předmětem studie nemají žádné komerční zájmy. Redakční rada potvrzuje, že rukopis práce splnil ICMJE kritéria pro publikace zasílané do biomedicínských časopisů., Aim: To evaluate validity of electrophysiological examination in the differential diagnostics of lumbar spinal stenosis (LS) and diabetic polyneuropathy (DPN). Methods: Electrophysiological parameters were examined in 68 patients with clinically symptomatic LS, in 28 patients with DPN, and in a group of 32 healthy volunteers. Results: Electrophysiological parameters evaluated from the upper extremities (F-wave latency of the ulnar nerve and radial SNAP amplitude), all the latencies measured in the lower extremities (tibial F-wave, soleus H-reflex and spinal latency of MEP), and the sural SNAP amplitude contributed significantly to distinguishing the LS from DPN patients. ROC analysis, however, disclosed only two electrophysiological parameters as effective in independent discrimination between the LS and DPN patient groups: ulnar F-wave latency (cut-off point at 24.2 ms, sensitivity 82.7% and specificity 63.9%); and radial SNAP amplitude (cut-off point at 10.5 ?V, sensitivity 75.5%, specificity 58.2%). Multivariate discrimination provided a canonical score with the most powerful predictive value of all. Conclusions: Electrophysiological examination evaluated from the upper extremities proved very useful in the differential diagnostics of LS and DPN, but the most powerful predictive value was obtained by using a canonical score involving several electrophysiological parameters., and B. Adamová, R. Kopacik, S. Voháňka, L. Dusek, J. Bednarik
Increased excitability of the spinal motor system has been observed after loud and unexpe cted acoustic stimuli (AS) preceding H-reflexes. The paradigm has been proposed as an electrophysiological marker of reticulospinal tract activity in humans. The brainstem reticular formation also maintains dense anatomical interconnections wi th the cortical motor system. When a startling AS is delivered, prior to transcranial magnetic stimulation (TMS), the AS produces a suppression of motor evoked potential (MEP) amplitud e in hand and arm muscles of healthy subjects. Here we analyzed the conditioning effect of a startling AS on MEP amplitude evoked by TMS to the primary motor leg area. Ten healthy volunteers participated in two experiments that used a conditioning-test paradigm. In the first experiment, a startling AS preceded a suprathreshold transcranial test stimulus. The interstimulus interval (ISI) varied between 20 to 160 ms. When given alone, the test stimulus evoked a MEP amplitude of approximately 0.5 mV in the slightly preinervated soleus muscle (SOL). In the seco nd experiment, the startling AS was used to condition the size of the H-reflex in SOL muscle. Mean MEP amplitude was calc ulated for each ISI. The conditioning AS suppressed MEP amplitude at ISIs of 30-80 ms. By contrast, H-reflex amplitude was augmented at ISIs of 100- 200 ms. In conclusions, acoustic stimulation exerts opposite and ISI-specific effects on the amplitude of MEPs and H-reflex in the SOL muscle, indicating different mechanism of auditory-to-motor interactions at cortical and spinal level of motor system., T: V. Ilic ... [et al.]., and Obsahuje bibliografii a bibliografické odkazy
It is well known that the training level of a muscle belongs to the parameters that affect the H-reflex response amplitude. The aim of this study was to investigate the effects of training type on H- and T-reflex response parameters. For this purpose, 20 long-distance athletes (group I, test group), 18 short-distance athletes (group II, test group) and 20 non-trained subjects (group III, control group) were involved in this study in which the H- and T-reflex amplitude and latency values were measured. The H-reflex amplitude and latency values found in groups I, II and III were 3.64±0.28 mV and 26.88±1.45 ms, 3.17±0.26 mV and 26.19±1.89 ms, and 6.07±0.34 mV and 26.77±1.32 ms, respectively. The T-reflex amplitude and latency values of the groups I, II and III were 3.30±0.18 mV and 32.01±1.02 ms, 3.11±0.20 mV and 31.47±1.16 ms, 4.24±0.21 mV and 31.47±1.16 ms, respectively. There was no statistically significant difference between the groups with respect to latencies of H- and T-reflexes (p>0.05). In both test groups, the amplitudes of the H-reflex and T-reflex were significantly smaller than the control group (p<0.05). The results of this study suggest that training of muscles affect the H- and T-reflex response parameters., R. Ozmerdivenli, S. Bulut, T. Urat, A. Ayar., and Obsahuje bibliografii