HighlightsCTS is an association of symptoms and signs, assumed to be caused by median neuropathy at the wrist (MNW).NCS are currently the best way to document the severity of MNW and contribute to CTS diagnosis.NCS can assist the choice of appropriate treatment for CTS and should be performed before any invasive treatment.Repeat studies should be used for follow-up of conservatively managed patients and those with uncertain diagnoses.Needle EMG is not obligatory and is performed when indicated for differential diagnosis or lesion localization.

Summary: Purpose:To evaluate the effect of slow-frequency repetitive transcranial magnetic stimulation (SF-rTMS) on interictal epileptiform activity and seizure frequency in a patient with medically refractory partial seizures due to focal cortical dysplasia.Methods: A 9-cni circular coil was positioned over the area of cortical dysplasia. One hundred stimuli given at 0.5 Hz at 5% below motor threshold were given biweekly for four consecutive weeks. The EEG was recorded for 30 min before and after the first 100 stimuli. The number of seizures during the month of stimulation was compared with that of the month before stimulation.Results: Stimulation was associated with a 70% reduction in the frequency of seizures and a 77% reduction in the frequency of interictal spikes. No seizures occurred during stimulation.Conclusions: SF-rTMS was safe and well tolerated in this patient. The reduction in seizures and interictal spikes associated with SF-rTMS supports the concept of SF-rTMS-induced cortical inhibition. Key Words: Magnetic-StimulationEpilepsy-Treatment-Dy splasia.Partial seizures due to focal cortical dysplasia rarely respond to treatment with anticonvulsants (1 ). Although advances in the surgical treatment of such lesions have led to improved outcome, the probability of seizure freedom is substantially less than in other localizationrelated epilepsies (2). Other nonpharmacologic treatment options are needed for patients with epilepsy due to focal cortical dysplasia.Electrophysiologic methods of producing changes in cortical excitability became available with the advent of transcranial magnetic stimulation (TMS) ( 3 ) . TMS may be given as a single pulse or as a train of repetitive stimuli (r-TMS). r-TMS is further subdivided into fast frequency (FF r-TMS) for rates >1 Hertz and slow frequency (SF r-TMS) for rates <1 Hertz. Both frequencies induce immediate cortical suppression, but only FF r-TMS produces subsequent cortical excitation (4). Furthermore, FF r-TMS has side effects ranging from subject discomfort to seizure induction (5).In contrast, SF r-TMS is neither painful nor epileptoAccepted September 10, 1999. Address correspondence and reprint requests to Dr. M. Gruenthal at Department of Neurology, University of Louisville School of Medicine, 500 South Preston Street, HSC 113, Louisville, KY 40292, U.S.A. E-mail: MOgrueOl @athena.louisville.edu genic. A pilot trial of SF r-TMS-induced cortical inhibition was found to be effective in treating depression (6). A separate open, uncontrolled trial demonstrated similar result in depressed and schizophrenic patients (7). SF r-TMS reduces motor cortex excitability in humans (8) and reduces amygdala-kindled seizures in rats (9), suggesting a possible therapeutic role in localizationrelated epilepsy. We present a case in which SF r-TMS was used successfully in a patient with medically refractory partial seizures associated with focal cortical dysplasia.

TMS provides a sensitive means for the assessment and monitoring of excitatory and inhibitory upper motor neuron function in motor neuron disease.

Major depression may result from decreased left frontal lobe function with respect to the right. Fast frequency repetitive transcranial magnetic stimulation (FF r-TMS) excites the underlying cortex whereas slow frequency repetitive transcranial magnetic stimulation (SF r-TMS) causes cortical inhibition. Left frontal FF r-TMS attenuates major depression whereas the inhibitory eVects of right frontal SF r-TMS are unknown. This study tested the hypothesis that right frontal SF r-TMS would treat depressed patients with minimal eVect on controls.A psychiatrist administered the Beck depression inventory and Hamilton D depression rating scales to eight depressed patients and six controls before and after the treatment protocol. Eight sessions of 100 right frontal lobe SF r-TMS were given at motor threshold and 0.5 Hz over a 6 week period.No adverse outcomes were noted in either group. A significant antidepressant eVect was noted in depressed patients on the Beck and Hamilton D depression rating scales (p<0.05). No change on either scale was noted in the controls.In conclusion right frontal lobe SF r-TMS is a safe, non-invasive treatment for major depression that deserves further investigation. (J Neurol Neurosurg Psychiatry 1999;67:113-115)

Background: Although the Guillain-Barré syndrome (GBS) can be associated with the seasonal influenza vaccine, there is no definite evidence that GBS is associated with H1N1 influenza vaccination. The objective of this report is to study the occurrence and characteristics of GBS after H1N1 vaccine administration in the United States in 2009. Methods: Data were acquired from the Vaccine Adverse Event Reporting System and supplemented by additional information obtained from the Center for Biologics Evaluation and Research, under the Federal Freedom of Information Act. Results: A total of 62 individuals (mean age 46.51 ± 22.41 years), 33 of whom were men, developed GBS associated with the H1N1 influenza vaccination in 2009. Sixty GBS cases were reported within 6 weeks after vaccination, with 31 cases (50.0%) reported in the first 2 weeks. The estimated rate of occurrence of GBS was 6.2 cases per 10 million vaccinations, which is comparable to the rate of GBS in the general population. Conclusion: The higher rate of GBS reports in the first 6 weeks after H1N1 vaccination suggests that some GBS cases may be triggered by H1N1 vaccination. This warrants early recognition, treatment, and active surveillance in the postvaccination setting.