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Article abstract Neuro@neurolist.mcg.edu (Neurolist) is a discussion list for neurologists. This Internet tool, established in 1994, allows the worldwide community of neurologists to communicate quickly and efficiently using e-mail, web browsers, and newsreaders. Neurolist currently has 584 members in 51 countries. Between June 1997 and October 1998, 6179 messages were transmitted by Neurolist. Most of the list’s posts (70%) concerned patient care and neurologic diseases. Users may subscribe at the web site: . The service is free.

Failure to demonstrate abnormalities on diagnostic tests in patients felt certain to have a disease is all too common, especially when symptoms are mild to moderate. One strategy used in such cases is to perform multiple tests hoping that one will confirm the clinical suspicion. An example of this strategy is found in carpal tunnel syndrome where multiple tests are often used to confirm the diagnosis. Unfortunately, this approach is often erroneous. Since no diagnostic test can perfectly discriminate between normal and abnormal, critical values are set at levels where most subjects are correctly classified. Using this methodology, approximately 2.5% of patients who are normal will be mistakenly called abnormal. This type I error, is additive when additional independent tests are performed. Since no two tests for a single condition are completely independent, the total error is less than the sum of the individual errors for each test. Even after accounting for interdependency, the total error of combined tests may be unacceptably high. If a single, highly discriminating, test is not available and multiple tests are used, abnormalities in more than a single test are needed to distinguish between normals and abnormals. © 1994 John Wiley & Sons, Inc.

Background To study the effects of a pre-germinated brown rice diet (PR) on diabetic neuropathy in streptozotocin (STZ)-induced diabetic rats. Methods The effects of a PR diet on diabetic neuropathy in STZ-induced diabetic rats were evaluated and compared with those fed brown rice (BR) or white rice (WR) diets with respect to the following parameters: blood-glucose level, motor-nerve conduction velocity (NCV), sciatic-nerve Na+/K+-ATPase activity, and serum homocysteine-thiolactonase (HTase) activity. Results Compared with diabetic rats fed BR or WR diets, those fed a PR diet demonstrated significantly lower blood-glucose levels (p < 0.001), improved NCV (1.2- and 1.3-fold higher, respectively), and increased Na+/K+-ATPase activity (1.6- and 1.7-fold higher, respectively). The PR diet was also able to normalize decreased serum homocysteine levels normally seen in diabetic rats. The increased Na+/K+-ATPase activity observed in rats fed PR diets was associated with elevations in HTase activity (r = 0.913, p < 0.001). The in vitro effect of the total lipid extract from PR bran (TLp) on the Na+/K+-ATPase and HTase activity was also examined. Incubation of homocysteine thiolactone (HT) with low-density lipoprotein (LDL) in vitro resulted in generation of HT-modified LDL, which possessed high potency to inhibit Na+/K+-ATPase activity in the sciatic nerve membrane. The inhibitory effect of HT-modified LDL on Na+/K+-ATPase activity disappeared when TLp was added to the incubation mixture. Furthermore, TLp directly activated the HTase associated with high-density lipoprotein (HDL). Conclusion PR treatment shows efficacy for protecting diabetic deterioration and for improving physiological parameters of diabetic neuropathy in rats, as compared with a BR or WR diet. This effect may be induced by a mechanism whereby PR intake mitigates diabetic neuropathy by one or more factors in the total lipid fraction. The active lipid fraction is able to protect the Na+/K+-ATPase of the sciatic-nerve membrane from the toxicity of HT-modified LDL and to directly activate the HTase of HDL.

Of 50 normal subjects, 23 (46%) had at least one false positive electrodiagnostic test for carpal tunnel syndrome (CTS). There were 30% of the subjects who exhibited an abnormal median to ulnar sensory amplitude ratio of less than 1.1. In 7 subjects 8 extremities (14%) revealed prolonged residual latencies, and 4 extremities in 4 subjects (8%) had a difference of 0.4 msec between the median and ulnar palmar sensory latencies. The results of this study indicate that certain reported criteria for CTS are abnormal in a high percentage of normal subjects, thereby making them of limited value in the diagnosis of CTS. Of all the criteria studied, it appears that the comparison of the median to ulnar sensory latency across the carpal tunnel is of greatest potential value. However, even here a more conservative difference of 0.5 msec between median and ulnar nerves must be used to avoid false positive tests for CTS.

we studied a 3-month-old boy who had opsoclonus in association with acute bacterial meningitis. The CSF IgG and IgM were elevated acutely, gradually returning to normal with clinical improvement. Correspondingly, CSF cytomorphology showed excessive plasmocytosis and a higher proportion of reactive lymphocytes than expected in an acute bacterial meningitis. These abnormalities in CSF cytology are effects of an abnormal immune response in the CNS, and provide evidence to support an immunopathic basis to opsoclonus.

We studied the fate of skeletal muscle obtained from patients with amyotrophic lateral sclerosis (ALS) after transplantation into immunodeficient nude mice. The transplanted muscle consistently survived in the nude mice without immunological rejection. The myofibers in these muscles underwent degeneration, followed by regeneration, maturation, and eventual functional innervation by the mouse motor neurons. The ability to grow diseased human muscle successfully over a prolonged period in nude mice offers an in vivo model to study the etiology of ALS and possibly of other neuromuscular disorders.

This is the supplemental materialof the research article "Characterization of LRP4/agrin Antibodies from a Patient with Myasthenia Gravis" in neurology, It contains the following information: supplemental clinic information of the patient with MG,supplemental methods, supplemental figures.

A 25-year-old woman with Kearns-Sayre syndrome (KSS) had complete external ophthalmoplegia, short stature, ataxia, cardiac conduction defects, and pigmentary retinopathy. Muscle biopsy revealed ragged-red fibers. Electron microscopy showed increased numbers of mitochondria with disordered structure and paracrystalline inclusions. Enzymatic analysis revealed a deficiency of complex II of the mitochondrial respiratory chain, and, more specifically, a deficiency of succinic dehydrogenase, although both subunits of this enzyme proved to be present by immunologic analysis. Therapy with vitamin cofactors did not result in short-term improvement. This appears to be the first report of complex II deficiency in a patient with KSS.

A common symptom of myasthenia gravis is eyelid ptosis. Often, the edrophonium test is negative, particularly in ocular myasthenia gravis. Myasthenic weakness is often improved by cold. We applied ice packs to the eye in 10 myasthenic patients and 7 disease controls. Eight of 10 patients with myasthenia gravis improved, whereas none of the controls improved. The ice pack test is useful in the diagnosis of myasthenia gravis.