SUMMARY Electrophysiological studies were performed on median and ulnar nerves in 234 cases of carpal tunnel syndrome. Abnormalities of the ulnar nerve sensory action potential were found in 39.3%0 of cases. The amplitude of the ulnar nerve sensory action potential was related to the amplitude of the median nerve sensory action potential, and to the median nerve motor conduction velocity in the forearm. The findings suggest that in a significant proportion of patients with carpal tunnel syndrome, a more generalized subclinical neuropathy may be present.The association of ulnar nerve abnormalities with carpal tunnel syndrome has received little attention. In performing routine diagnostic nerve conduction studies in patients with the syndrome, an appreciable incidence of such abnormalities was noted. This stimulated a review of all patients with carpal tunnel syndrome studied over the past five years with particular emphasis on the frequency of ulnar nerve abnormalities and their significance in the pathogenesis of the syndrome. METHODS SUBJECTS There were 234 cases of carpal tunnel syndrome in the series. These comprised 214 patients, 20 of whom had bilateral abnormalities; 119 of the patients were women and 95 were men. Their ages ranged from 19 to 87 (mean, 54) years. Thirty-four control subjects were also studied in whom there was no history or physical sign of neurological disease nor of systemic disorders known to predispose to neuropathy. Their ages ranged from 18 to 77 (mean, 47) years.The criteria used for the diagnosis of carpal tunnel syndrome were a history or physical signs of carpal tunnel syndrome together with one or more of the following three electrophysiological abnormalities (Gilliatt and Sears, 1958): (1) a median motor latency at the wrist greater than 5 0 msec; (2) a median sensory latency at the wrist greater than

Patients with reflex epilepsies may provide insights into cerebral pathophysiology. We report a patient with an unusual form of reflex epilepsy in whom seizures are induced by tooth brushing. Magnetic resonance imaging (MRI) demonstrated a right posterior frontal low-grade tumor predominantly involving the precentral gyrus. Video-telemetry demonstrated right-sided epileptiform activity during a typical induced complex partial seizure. An ictal single photon emission computed tomography (SPECT) scan showed an area of hyperfusion that corresponded to the MRI lesion on coregistration with a surface-matching technique. A subsequent coregistered interictal SPECT scan demonstrated hypoperfusion in the same region. Ours is the first report to demonstrate a structural focus in this unusual form of reflex epilepsy. Possible mechanisms to explain the induction of the seizures are discussed.

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Patients with mild multiple sclerosis (MS) regularly report subjective complaints characterized by generalized cognitive inefficiency. A feature of these complaints is reduced verbal fluency, for example, losing the thread of conversation. Mild MS patients and controls were compared on subjective complaints, verbal fluency, and working memory, and the possible role of working memory was investigated. As predicted, subjective difficulties and verbalfluency each correlated with working memory. Subjective difficulties and verbal fluency were also related. Within the control group, the subjective difficulties were associated only with depression. On the other hand, in the MS group, subjective difficulties were unrelated to affective state but were correlated with working memory. For the patients, partialing out depression and anxiety did not influence any of the correlations involving subjective difficulties, verbal fluency, or working memory. These findings support the proposal that working memory impairment underlies subjective complaints of mild MS patients and that verbal dysfluency is part and parcel of this phenomenon.

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