Cutaneous silent period in ulnar neuropathy at the elbow

Mondelli, Mauro; Aretini, Alessandro

doi:10.1002/mus.27452

Cited by 4 publications

(6 citation statements)

References 38 publications

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“…The CSP was obtained by stimulating the third and fourth digits with ring electrodes and recording from the abductor brevis pollicis (ABP) and the abductor digiti minimi (ADM) muscles of the non-dominant hand, respectively, using surface electrodes, in compliance with standard protocols [ 32 , 33 ]. The onset latency was measured at the beginning of the abrupt EMG suppression, and the end latency at the recovery of EMG activity in each trace.…”

Section: Methodsmentioning

confidence: 99%

Early detection of nerve involvement in presymptomatic TTR mutation carriers: exploring potential markers of disease onset

Romano,

Guglielmino,

Bisogni

et al. 2023

Neurol Sci

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Background Hereditary transthyretin (ATTRv) amyloidosis is a heterogeneous, progressive, multisystemic disease with a life-threatening course if left untreated. Given the current availability of effective therapies, close follow-up of presymptomatic TTR mutation carriers is essential to recognize disease onset at the earliest sign. In addition to routine techniques, in recent years several novel tools have been proposed, although a consensus on their use has not been reached yet. In this paper, we aimed to evaluate possible markers of neuropathic disease onset intended to discriminate clinically asymptomatic carriers from early symptomatic patients, thus allowing timely treatment initiation. Methods Thirty-eight presymptomatic carriers were enrolled. Clinical and electrophysiological findings at first evaluation and follow-up were collected. All carriers underwent an extensive clinical and instrumental evaluation according to the standard clinical practice. One or more non-routine investigations, whose use in this field is not yet validated (henceforth “unconventional”), were additionally assessed in a subgroup of individuals. Results Based on the exclusive use of routine investigations, it was possible to define disease onset in 4/38 carriers during the follow-up. Employing additionally one or more “unconventional” tests, abnormal findings, indicative of a possible “conversion” to symptomatic disease, were detected in further 12 cases. More than half of our study cohort showed findings suggestive of small nerve fiber (SF) involvement at either invasive or non-invasive tests. Conclusions A close, multidisciplinary monitoring of presymptomatic TTR mutation carriers is fundamental, and diagnostic workup should include both routine and “unconventional” tests. Assessment of SF involvement is important also in non-endemic countries.

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Section: Methodsmentioning

confidence: 99%

Early detection of nerve involvement in presymptomatic TTR mutation carriers: exploring potential markers of disease onset

Romano,

Guglielmino,

Bisogni

et al. 2023

Neurol Sci

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“…28 We also measured the mean onset latency and duration of 10 consecutive CSPs of each participant and the grand mean (mean of the mean values) of these two CSP parameters stimulating the third (D3) and fifth digits (D5) recording from FDI and abductor pollicis brevis (APB) muscles. 24 Three to six days after performing NCV and CSP, we carried out SSR to the same patients and control group. First, we conducted a clinical interview on symptoms of autonomic dysfunction in the ulnar region of the hand (i.e., excessive sweating, dry, red or purple discoloration, and swelling of the fourth and fifth digits).…”

Section: Participants and Methodsmentioning

confidence: 99%

“…The details of the patients, control group, and electrodiagnostic testing were extensively reported in this previous study. 24 Briefly, the diagnosis of UNE was based on the history, clinical findings, and slowing of motor conduction velocity (MCV) of the ulnar nerve across the elbow based on the criteria of the American Association of Neuromuscular & Electrodiagnostic Medicine. 25 We excluded the patients with a history and signs of other disorders of the peripheral nervous system, of central nervous system, motor neuron diseases, diabetes, history of alcoholism, surgery, and trauma of the cervical spine and upper limb.…”

Section: Participants and Methodsmentioning

confidence: 99%

“…These results were likely caused by the damage of afferent fibers of CPS involving thin myelinated A-delta sensory fibers of the ulnar nerve. 24 The main aim of the current study was to evaluate the function of sympathetic unmyelinated fibers of the ulnar nerve through SSR in the same cohort of UNE patients as in our previous study. The secondary aim was to assess the relations between SSR parameters of the ulnar nerve and the clinical and electrophysiological severity of the injury to the large and small myelinated sensory fibers of the ulnar nerve tested with conventional NCV study and CSP.…”

Section: Introductionmentioning

confidence: 97%

“…These results were likely caused by the damage of afferent fibers of CPS involving thin myelinated A-delta sensory fibers of the ulnar nerve. 24…”

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confidence: 99%

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Sympathetic Skin Response in Ulnar Neuropathy at the Elbow

Mondelli¹,

Aretini²

2022

Journal of Clinical Neurophysiology

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Introduction: The sympathetic skin response (SSR) reflects the function of sudomotor sympathetic unmyelinated fibers. This study evaluates SSR abnormalities in ulnar neuropathy at the elbow (UNE). Methods: Sympathetic skin response was obtained after electrical stimulation of the glabella recording simultaneously from the hand palm (P), third digit (M3) and fifth digit ipsilateral (U5) and contralateral (cU5) to the side of UNE. Ten consecutive SSRs were recorded from each recording side of all participants. Results: The authors enrolled 31 patients (mean age 54.3 ± 11.4 years) and 25 subjects of a control group (mean age 52.6 ± 11.3 years). The mean of the areas and the area of the largest response of U5-SSR were significantly lower in the patients (106.9 ± 68.9 and 127.8 ± 79.7 μV/s, respectively) than in control group (161.8 ± 116.6 and 197.2 ± 143.3 μV/s, respectively) and in the affected than in the unaffected sides of the patients (155.3 ± 84.8 and 197.7 ± 103.3 μV/s, respectively); there were no differences in U5-SSR latencies and P-SSR and M3-SSR parameters. U5-SSR mean areas and U5-SSR largest area were reduced in 29% and 26% of patients, respectively. The differences between patients and control group and the number of patients with U5-SSR abnormalities increased when the ratios of M3/U5-SSR and U5/cU5-SSR areas were considered. U5-SSR area was related to UNE clinical severity and to some parameters of the ulnar nerve conduction velocity and cutaneous silent period. Conclusions: Sympathetic skin response is useful to demonstrate abnormalities of sympathetic fibers even if UNE patients do not complain for sympathetic symptoms. The SSR abnormalities were evident only if electrophysiological damage of myelinated fibers was moderate or severe.

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