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Objectives: to determine whether the pattern of peripheral neuropathy among Saudi types 2 diabetics has association with B12 status and glycemic control. Method: A cross section hospital based study. The pattern of diabetic neuropathy was determined by nerve conductive velocity (NCV) test, level of vitamin b12 was assayed among the study population and the glycemic control was determined according to Hba1c level. Results: A total of thirty three patients were enrolled in these study twenty one females and twelve males. The age ranged between 79 and 34 with the mean (SD) of 57 of these 17 (51.5%) used oral hypoglycemic agents and 16 (48.5%) were using insulin. HbAc1 more than 7 was found in 28 (84.8%) of the patients reflecting poor control. The nerve conduction study testing revealed that sensory axonal demyelination 6(18.2%), bilateral neuropathy 8 (24.2%), Right Carpal tunnel syndrome 5(15.2%), Left Carpal tunnel syndrome 0 (00%), mild axonal neuropathy 4 (12.1%) and 10 (30.3%) were found to have normal nerve conduction study test. The level of vitamin B12 was found 2(6%) was deficiency 400 pg/ml. Conclusion: It could be concluded from this study that there is no association between pattern of peripheral neuropathy and B12 level in type II diabetics. Similarly no relation exists between Hb Ac1 level and pattern of peripheral neuropathy.

Background and Objective of the Study: Most of the individuals classify themselves as right or left handed but it is not entirely clear whether handedness should be determined based on preference inventories, hand performance tasks, or a combination of both. The strength and significance of the relationship between hand preference and performance asymmetries have always been contested. Materials and Methods: This cross-sectional study has evaluated different performance measures to predict hand preference among a total of 150 1st year medical students. The performance measures included work done by ergography, nerve conduction velocity test, and bimanual coordination test. Results: A statistically significant correlation was found between hand performance and preference measures (P < 0.05 was considered as significant). Conclusion: This study helps to understand the degree of hand dominance on various performance tasks. In particular to medical profession, this study may help in the modifications of the instruments and training given to medical students in improving their bimanual dexterity.

Electrophysiological tests, especially, electromyogram (EMG) and nerve conduction velocity (NCV) test are commonly used in clinical practice for diagnosis of muscle and nerve diseases. Report-writing of these tests can be problematic for under-experienced physicians and time-consuming for experienced physicians. In this paper, we apply several neural based natural language generation (NLG) methods to automatically generate diagnosis reports, a first attempt in this domain. Specifically, we use tabular diagnostic records of electrophysiological tests to generate Findings & Impression, which together constitute the diagnostic report. We further use gram-based metrics to evaluate our models and conduct a case study for the result.

The obturator nerve lies deep within the pelvis, and it can be damaged by direct injury during surgery. In this study, nerve conduction was used to confirm an obturator nerve injury in a patient who presented with hip adductor weakness following gynecological surgery for endometrial cancer. A 56-year-old woman complained of weakness in the right adductor muscles after a laparoscopic hysterectomy due to endometrial cancer. Seven days after surgery, the degree of weakness of the right hip adductor was Medical Research Council (MRC) Scale 1; thus, a nerve conduction velocity test was conducted. To obtain the compound muscle action potentials of the obturator nerve, stimulation was performed (1.5 cm inferior and 1.5 cm lateral to the pubic tubercle) with a surface electrical simulator and recording (midpoint of the right medial thigh) of the adductor muscles. The compound muscle action potentials of the right obturator nerve showed lower amplitude (left side: 2.7 mV vs. right side: 0.3 mV) and delayed onset latency (left side: 3.2 ms vs. right side: 2.2 ms). These results indicate a partial right obturator neuropathy. Therefore, nerve conduction could be useful to diagnose an early-stage obturator nerve injury and provide information on the degree of damage.

Background: Drug toxicity, vasculitis, entrapment neuropathy, and amyloidosis are among the various different reasons of peripheral neuropathy in rheumatoid arthritis (RA). We aimed to determine the cross-sectional areas (CSA) of the peroneal and tibial nerves in patients with RA who had neuropathic symptoms, and to determine a cutoff value for peroneal and tibial nerves CSA by ultrasonography (USG) to diagnose polyneuropathy (PN) in patients with RA. Materials and Methods: Sixty-nine patients with RA and thirty healthy controls were included in this cross-sectional study. According to nerve conduction study (NCS) test, patients with RA were divided into two groups, diagnosed as having PN or not. Demographic data, laboratory findings, CSA of bilateral peroneal and tibial nerves, NCS values, and painDETECT (PD-Q) scores of all patients were assessed. Disease duration, disease activity score 28, duration of neuropathic symptoms, and Health Assessment Questionnaire of patients with RA were also determined. Results: No statistically significant difference was found among the groups in terms of age, gender, and laboratory findings. However, a statistically significant difference was found among these three groups in comparison with PD-Q, NCS values, and nerve CSA (P < 0.05). Seropositivity was statistically higher in the group with PN. When peroneal nerve CSA cutoff value was taken as 20 mm2, sensitivity and specificity values were 96.6% and 79.6%, respectively, for the diagnosis of PN (area under the curve [AUC] = 0.962). When tibial nerve CSA cutoff value was taken as 8.5 mm2, the sensitivity and specificity values were 93.1% and 71.6%, respectively, for the diagnosis of PN (AUC = 0.897). Conclusion: USG can be used as a noninvasive diagnostic modality in the assessment of RA-associated PN. © 2020 Indian Journal of Rheumatology Published by Wolters Kluwer - Medknow.

Introduction Carpal tunnel syndrome (CTS) is prevalent in workers who utilize hand-held vibration tools, engage in tasks involving repetitive wrist movements, and suffer from wrist overuse. Although electrical injuries involving the median nerve are a relatively rare but plausible cause of CTS, the related literature is limited. Here, we report a case of CTS in which the symptoms developed after an electrical injury, and review the related literature. Case summary The patient was a right-handed male electrician who often used hand tools but had no symptoms of CTS before the injury, with the left hand as the point of entry. Typical symptoms of CTS manifested after the electrical injury, and a nerve conduction velocity test confirmed the presence of severe CTS in the left hand. Therefore, we believe that the symptoms can be largely attributed to the electrical injury. Conclusions The available literature supports the occurrence of delayed compressive neuropathy caused by scarring from substantial cutaneous burns in patients with electrical injuries. This case shows that electrical injuries may cause CTS in the absence of severe scarring through other mechanisms such as direct injuries to the nerve. Therefore, patients with electrical burns should be routinely examined for peripheral nerve compression symptoms in follow-ups, even when there are minimal cutaneous burns.

Background and objective We report the case of a patient who presented with right dorsal scapular neuropathy after a trigger point injection into the right rhomboid major muscle. Through a nerve conduction study and electromyography, we demonstrated dorsal scapular nerve injury in this patient. Case report A 38-year-old man complained that his right shoulder functioned less optimally during push-up exercises after a trigger point injection 4 weeks prior. Physical examination revealed mildly reduced right shoulder retractor muscle strength compared with the left side. We performed a nerve conduction velocity test and electromyography 5 weeks after the injection. The compound muscle action potential of the right dorsal scapular nerve showed low amplitude (left vs. right side: 5.2 vs. 1.6 mV) and delayed latency (left vs. right side: 4.9 vs. 6.8 ms). Positive sharp wave (1+) and mildly reduced recruitment were seen on electromyography of the rhomboid major muscle. The findings of the nerve conduction velocity test and electromyography indicated partial right dorsal scapular neuropathy. The nerve injury seemed to have been caused by the needle inserted during trigger point injection. Conclusion Clinicians should pay attention to the occurrence of dorsal scapular nerve injury when performing trigger point injection into the rhomboid muscle.

Introduction. Diabetic peripheral neuropathy (DPN) is the most common but least recognised and understood long term complication of type 2 diabetic patients (T2DM). There is a close association between obesity and type 2 diabetes as well as its complications. Nerve conduction study is an important non-invasive diagnostic modality used in the detection of diabetic peripheral neuropathy. Obesity is associated with increased oxidative stress and lipid peroxidation is thought to play a crucial role in the development of diabetic neuropathy. The aim of this study is to see the correlation of nerve conduction velocity parameters viz nerve conduction velocity and nerve conduction amplitude with the total body fat mass and oxidative stress markers. Methods. The study included 90 type 2 diabetes patients with clinically suggestible symptoms of diabetic peripheral neuropathy (DPN). 50 type 2 diabetic subjects without peripheral neuropathy served as control. Total body fat mass was measured using bioelectric impedance analysis. Oxidative stress markers viz total antioxidant capacity and malondialdehyde were measured using elisa kit. Nerve conduction study both motor and sensory was carried out in relevant nerves. Results. Serum levels of total antioxidant capacity and super oxide dismutase were significantly decreased in type 2 diabetic with neuropathy as compared to the ones without neuropathy. Serum levels of malondialdehyde, on the other hand, was significantly elevated. Motor nerve conduction velocity (MNCV) of ulnar and common peroneal nerve and sensory nerve conduction velocity of ulnar and sural showed a significantly decreased conduction velocity as compared to control. The total body fat mass showed a significant negative correlation with the motor conduction velocity of median, posterior tibial and sensory conduction velocity of median and sural nerve. Conclusion. The nerve conduction velocity test and total body fat mass evaluation is a cost- effective tool for earlier detection of neuropathy in type 2 diabetes patient.

Spinal schwannomas are benign and round encapsulated neoplasms of Schwann cell progenitors. Schwannomas are relatively common and can come in a number of different variants that include cellular, plexiform, or melanotic. Diagnosis begins with a thorough history and neurological examination. Other diagnostic tests include imaging, electromyogram, and nerve conduction velocity test data. Spinal schwannomas can be intradural or extradural, or rarely intramedullary. The tumor location is important for surgical approach and treatment strategy. Often affected nerve roots can be sacrificed without substantial motor deficit. Here we review the current surgical approaches and treatments for several types of schwannoma. Also reviewed are dumbbell tumor management, potential complications, as well as usefulness of neural monitoring.

BACKGROUND SLE (systemic lupus erythematous) is an autoimmune disease, which can lead to damage to any organ in the body mediated by tissue binding autoantibodies. It is not that uncommon in North Eastern part of India. Mainly, the female sex in their reproductive age group are affected. Of all the complications, neuropsychiatric complication is also a common manifestation of SLE. The aim of the study is to- 1. Find the incidence of peripheral neuropathy in SLE patients. 2. Its association with morbidity. MATERIALS AND METHODS Patients were enrolled from 1st September 2010 to 31st August 2011 who attend the Department of Medicine, Assam Medical College, Dibrugarh. A total of 73 patients were enrolled. All patients were above 12 years of age. SLE was diagnosed by 1997 updated ACR criteria. Peripheral neuropathy was diagnosed via nerve conduction velocity test. RESULTS Of the 73 patients, 39 patients had evidence of peripheral neuropathy. Of the 39 patients, 28 patients were asymptomatic. The remaining 11 symptomatic patients mainly complained of pins and needles in their feet and 2 additionally complained of tingling sensation in the lower limbs. CONCLUSION From the study, it is seen that the sural nerve is the most common nerve to be affected in SLE. So, doing Nerve Conduction Study (NCS) on the sural nerve singly could be taken as a screening test to diagnose peripheral neuropathy in SLE patients. But, as the number of patients in the study was less, a study with larger number of patients would be required to confirm that the sural nerve is the most common nerve to be affected in SLE.

Ulnar nerve compression at guyon’s canal is rare and very few cases have been reported in literature. It can be missed due to its rarity. Symptoms vary from pain and paresthesia to wasting and significant loss of muscle strength, with significant deformities of the hand. The diagnosis is made by detailed history and examination, electromyography, nerve conduction velocity test, ultrasound and magnetic resonance imaging. Early decompression of nerve is treatment of choice. Here we are presenting a case of compression of ulnar nerve in guyon’s canal due to ganglionic cyst.

Objective To present the case of axillary nerve neuropathy associated with valproic acid (VPA) poisoning. Case report A 26-year-old man was hospitalized because of a suicide attempt with VPA overdose. Toxicology analysis revealed high serum VPA level (2,896 µmol/L; therapeutic range: 350 - 690 µmol/L). Three days after admission, the patient complained of weakness in his right arm. Neurological examination revealed weakness of flexion and abduction of the right arm and loss of sensation in the skin over the lateral upper right arm. A nerve conduction velocity test was normal in the ulnar, radial, median, musculocutaneous, and suprascapular nerves. Compound muscle action potential showed reduced amplitude and prolonged latencies in the right axillary nerve taken from Erb's point and absent taken from distal stimulation point. Right axillary nerve paresis was diagnosed and the patient underwent a physical therapy program, which resulted in gradual recovery. Discussion In the presented case, other possible causes of neuropathy were excluded by medical history, laboratory and radiological tests, and clinical course of the disease.The temporal relationship between the VPA poisoning and the occurrence of neuropathy supports the hypothesis of a VPA-caused axillary neuropathy. According to the Naranjo's Adverse Drug Reaction (ADR) Probability Scale, VPA-induced neuropathy was rated "probable". Conclusion VPA-induced neuropathy may be a serious ADR, but it is potentially preventable and reversible. Thus, clinicians should be aware of this rare ADR.

Botulinum toxin type A (BoNT/A) is made naturally by certain bacteria. BoNT/A works by paralyzing specific kinds of nerve cells. BoNT/A can be used to treat many illnesses that affect either nerves or the muscles with which they communicate. In the article “Botulinum Toxin for Diabetic Neuropathic Pain: A Randomized Double-Blind Crossover Trial,” Dr. Yuan and associates describe how BoNT/A might be used to treat the kind of nerve pain that develops in some people who have diabetes.1 The study compares whether injecting BoNT/A into the skin is better at reducing neuropathic pain than injecting a placebo (saline, salt water) into the skin. Dr. Yuan and colleagues looked carefully at 20 people who had neuropathic pain due to type 2 diabetes. Each person had been diagnosed with diabetes for at least 3 years. Patients with neuropathy experienced either paresthesias (prickling, tingling, or numbness) or a specific kind of pain (burning, itchy, shooting, etc.) in both of their feet up to the ankle or mid-shin. Doctors assessed the pain by 1) physical examination, 2) a specific questionnaire for pain, and 3) a specific test of nerve function. The nerve test is called a nerve conduction velocity test. It is designed to see how well patients’ nerves can transmit electrical signals. If the nerve is damaged, as happens in diabetes, the signals carried by the nerves are either slower or weaker than normal. As in all studies, there are reasons to include specific participants. This makes sure that the group is alike and that the results are solid. For instance, only people with proven polyneuropathy due to diabetes were included. Since a specific treatment was being studied, only people who had not changed …

Last year in the month of August and September there had been an increased incidence of Japanese Encephalitis being reported all over West Bengal, India. Keeping this public and medical interest in the backdrop, the authors are reporting a 28 years old female patient admitted to the medical ward with acute onset flaccid paralysis of both lower limbs, diplopia, nasal intonation of voice, difficulty in swallowing and features suggesting facial nerve palsy. The intensivist was called for management of gradually worsening respiratory failure and the patient was put on mechanical ventilator after being shifted to Intensive Therapy Unit. On neurological examination, power of lower limb was diminished with sixth and seventh cranial nerve palsy. The patient was diagnosed to have Japanese Encephalitis infection by a four-fold rise in virus-specific antibody detected in paired acute and convalescent sera by enzyme-linked immunosorbent assay. In nerve conduction velocity test she had bilateral symmetrical demyelinating sensory>>motor polyradiculoneuropathy suggestive of Sural nerve sparing acute inflammatory demyelinating polyneuropathy. Cerebrospinal fluid study revealed albumino-cytological dissociation. She was off the ventilator after 3 days of full course of plasmapheresis and she gradually regained her motor power with physiotherapy and nursing care. Japanese Encephalitis patients are mainly admitted with feature of central nervous system insults and have poor prognosis. Syndromic association of Japanese Encephalitis with sixth/seventh cranial nerve palsy having Guillain-Barre Syndrome without any features of meningo-encephalitis is a rare phenomenon and there are very few case reports in literature regarding this topic. This case report highlights the successful management of such rare experience.

The functional state of the forearm muscles in individuals exposed to long-term vibration (dressers with a duration of current employment of 7–15 years, n = 12) was assessed using turn–amplitude analysis of the integrated surface electromyogram (EMG), the nerve conduction velocity test, and the conventional motor unit action potential electromyographic test. A significant increase in the EMG amplitude and the number of turns upon graded effort, as well as a decrease in the maximal ratio of the number of turns to the average amplitude of the electromyogram from the right m. flexor carpi radialis of the dressers, was revealed, which is indicative of secondary muscular disorders connected with the specific features of the occupational movement pattern and long-term exposure to vibration.

A 9-year-old female developed bilateral leg weakness on the same day she received an influenza vaccination. Her condition had gradually worsened during the 5 months prior to her presentation. She had no family history of hereditary disease. Physical examination revealed muscle atrophy without fasciculation in all four limbs. Muscle power in the proximal and distal limbs was 3 of 5, and the deep tendon reflexes of the lower limbs were decreased bilaterally, but there was no sensory function impairment, urinary incontinence, or other autonomic nerve system dysfunction. Nerve conduction velocity test revealed axonal degeneration with demyelination in both upper and lower limbs. Lumbar puncture

The aim of this study was to compare the sensitivity, specificity, and pain associated with nerve conduction velocity testing and a new modality, the Pressure-Specified Sensory Device, in the diagnosis of carpal tunnel syndrome. The authors evaluated 79 patients, including 26 control subjects, and made the diagnosis of carpal tunnel syndrome based on the patient's history and physical examination. Both tests were then performed on each patient. The testers were blinded to the diagnosis and to any other test results. A 0 to 10-point visual analog pain scale was used to record the patient's reported testing discomfort. The sensitivity, specificity, and mean pain scale scores were calculated for each testing modality and compared. The nerve conduction velocity test had a sensitivity of 80% and a specificity of 77% whereas the sensitivity of the Pressure-Specified Sensory Device was 91% and the specificity was 82%. The difference between the tests was not significant. There was, however, a significant difference in the pain scores: nerve conduction velocity, 2.7 points; Pressure-Specified Sensory Device, 0.9 points (p < 0.001). This study shows that the Pressure-Specified Sensory Device is as sensitive and specific as nerve conduction velocity testing in the diagnosis of carpal tunnel syndrome, and is significantly less painful for the patient.

In this study, we discussed about a new diagnostic technique of peripheral nervous disturbance using biomagnetic measurement. The magnetic fleld around a limb after nerve stim- ulation was simulated for the cases when some of the nerve flbers composing the nerve are lacked. As a result, disappearance of a pair of peaks of in- and out-∞ux was observed. The magnetic fleld seems to be re∞ective on the change of the distribution of the number of nerve flbers inside a nerve. 1. INTRODUCTION The nerve conduction velocity test is a general method to diagnose diabetic neuropathy or any other malfunctions of peripheral nerves. Usually in this test, the conduction velocity of skin potential generated by the compound action potential of the nerve is measured. However as the most part of the skin potential is contributed to by thick nerve flbers, degeneration of thin nerve flbers is di-cult to flnd with this test (1). Measurement of magnetic fleld as the substitute of skin potential has an advantage to analyze the property of compound action potential. The action potential of a nerve flber is possible to generate a pair of positive and negative peaks, whose location re∞ects the depth and the thickness of the flber. On the contrary, the magnetic fleld of it has two pairs of peaks of in- and outmagnetic ∞ux (2). As each location re∞ects the depth and the thickness of the flber, the more implications about morphology seemed to be obtained. To investigate the relationship between compound action potential and the magnetic fleld of its produce, the magnetic fleld around a limb after electric current stimulation was simulated. 2. METHODS

Meralgia paresthetica is commonly caused by a focal entrapment of lateral femoral cuteneous nerve while it passes the inguinal ligament. Common symptoms are paresthesias and numbness of the upper lateral thigh area. Pregnancy, tight cloths, obesity, position of surgery and the tumor in the retroperitoneal space could be causes of meralgia paresthetica. A 29-year-old female patient underwent an emergency cesarean section under spinal anesthesia without any problems. But two days after surgery, the patient complained numbness and paresthesia in anterolateral thigh area. Various neurological examinations and L-spine MRI images were all normal, but the symptoms persisted for a few days. Then, electromyogram and nerve conduction velocity test of the trunk and both legs were performed. Test results showed left lateral cutaneous nerve injury and meralgia paresthetica was diagnosed. Conservative treatment was implemented and the patient was free of symptoms after 1 month follow-up.

The ability to determine the characteristics of peripheral nerve fiber size distributions would provide additional information to clinicians for the diagnosis of specific pathologies of the peripheral nervous system. Investigation of these conditions, using electro-diagnostic techniques, is advantageous in the sense that such techniques tend to be minimally invasive yet provide valuable diagnostic information. One of the principal electro-diagnostic tools available to the clinician is the nerve conduction velocity test. While the peripheral nerve conduction velocity test can provide useful information to the clinician regarding the viability of the nerve under study, it is a single parameter test that yields no detailed information about the characteristics of the functioning nerve fibers within the nerve trunk. In previous work, the efficacy of the group delay and simulated annealing approach was demonstrated in the context of a simulation study where deterministic functions were used to represent the single fiber evoked potentials. In this study we present a modification to the approach discussed previously that is applicable to non-deterministic functions of sampled data.

The ability to determine the characteristics of peripheral nerve fiber size distributions would provide additional information to clinicians for the diagnosis of specific pathologies of the peripheral nervous system. Investigation of these conditions, using electro-diagnostic techniques, is advantageous in the sense that such techniques tend to be minimally invasive yet provide valuable diagnostic information. One of the principal electro-diagnostic tools available to the clinician is the nerve conduction velocity test. While the peripheral nerve conduction velocity test can provide useful information to the clinician regarding the viability of the nerve under study, it is a single parameter test that yields no detailed information about the characteristics of the functioning nerve fibers within the nerve trunk. In this study we present a technique based on a decomposition of the maximal compound evoked potential and subsequent determination of the group delay of the contributing nerve fibers. The fiber group delay is then utilized as an initial estimation of the nerve fiber size distribution and the concomitant temporal propagation delays of the associated single fiber evoked potentials to a reference electrode. Subsequently the estimated single fiber evoked potentials are optimized against the template maximal compound evoked potential using a simulated annealing algorithm. Simulation studies, based on deterministic single fiber action potential functions, are used to demonstrate the robustness of the proposed technique in the presence of noise associated with variations in distance between the nerve fibers and the recording electrodes between the two recording sites.

The ability to determine the characteristics of peripheral nerve fiber size distributions would provide additional information to clinicians for the diagnosis of specific pathologies of the peripheral nervous system. Investigation of these conditions, using electrodiagnostic techniques, is advantageous in the sense that such techniques tend to be minimally invasive yet provide valuable diagnostic information. One of the principal electrodiagnostic tools available to the clinician is the nerve conduction velocity test. While the peripheral nerve conduction velocity test can provide useful information to the clinician regarding the viability of the nerve under study, it is a single-parameter test that yields no detailed information about the characteristics of the functioning nerve fibers within the nerve trunk. In this study, we present a technique based on decomposition of the maximal compound evoked potential and subsequent determination of the group delay of the contributing nerve fibers. The fiber group delay is then utilized as an initial estimation of the nerve fiber size distribution and the associated temporal propagation delays of the single-fiber-evoked potentials to a reference electrode. Simulation studies, based on deterministic single-fiber action potential functions, are used to demonstrate the robustness of the proposed technique in the presence of simulated noise associated with the recording process.

544 Background: Neurotoxicity is the most frequent dose-limiting toxicity of oxaliplatin. Cumulative sensory peripheral neurotoxicity results in discontinuation of chemotherapy for cancer and impairs neurological function irreversibly. To develop new strategies to continue chemotherapy according to the treatment plan without more severe neurotoxicity, objective assessment tools for oxaliplatin-induced peripheral neuropathy (OIPN) are needed. The clanging tuning fork test (CTFT) and the nerve conduction velocity test (NCVT) are widely used forbenign neuropathies. However, little is known about their clinical usefulness for OIPN. Methods: Colorectal cancer patients were prospectively monitored at baseline and during chemotherapy with modified FOLFOX6. The incidence and severity of OIPN were recorded using NCI-CTC grading (ver. 4.0). CTFT was conducted every 2 weeks and NCVT every 8 weeks. A generalized estimating equation model was used to examine the correlations between NCI-CTC grade and CTFT/NCVT. The accuracy of the assessment was evaluated using receiver operating characteristic (ROC) curve analysis. Results: Twenty-one patients without peripheral sensory neuropathy (PSN) were enrolled. Mean CTFT values were 13.4 ± 0.7 sec at baseline, 14.1 ± 0.4 sec with grade 0 PSN, 14.0 ± 0.4 sec with grade 1 PSN, 12.5 ± 0.7 sec with grade 2 PSN, and 7.5 ± 0.9 sec with grade 3 PSN. The mean CTFT value with grade 3 PSN was significantly shorter than with the other grades (p

Organophosphate poisoning is an important cause of suicides in hospital admission. The present case is of a female presenting with loss of power in all four limbs two weeks following a suicidal attempt. Nerve conduction velocity test revealed axonal type of motor neuropathy in bilateral median and ulnar nerve and peroneal and tibial nerves were unexcitable bilaterally. Therefore, in all cases of neuropathy, ingestion of organophosphate, either accidental or suicidal should be looked for even if the initial phases of intoxication are not clinically well defined.

Propafenone hydrochloride, a class IC antiarrhyth­ mic drug, is used in the treatment of ventricular and supraventricular arrhythmias. Herein we describe a patient with episodic jabbing and crushing pain in his hands and feet, aching in his forearms, and hyperesthesias of his extremities. He had been taking propafenone for 1 year because of ventricular arrhythmias. Results of a nerve conduction velocity test were abnormal. Electron microscopic findings on a sural nerve biopsy specimen represented distal small fiber neuropathy. Findings on a thermoregulatory sweat test and on autonomic tests were abnormal, compatible with a distal small tiber neuropathy. To our knowledge, peripheral neuropathy has not previously been reported to occur with use of propafenone. In this patient, propafenone seemed to be responsible for the development of peripheral neuropathy, which resolved after use of the drug had been discontinued.

Objectives: To investigate whether chronic occupational exposure to organophosphates among ricefield workers in a rice institute is related to electrodiagnostically detectable measures of multiple peripheral neuropathy, that is, to investigate whether rotation in areas of work would improve the conduction velocities of those workers found to have peripheral neuropathy, after being shifted from an exposed to a nonexposed status in their work. Design: A 2-year prospective research. Setting: Academic medical center. Participants: 24 male workers with exposure to organophosphates and a well-matched control group of 64 men from the general population who were not exposed to organophosphates. Interventions: All participants in the study and control groups were tested electrodiagnostically for peripheral neuropathy work-up. Those positive for peripheral neuropathy in the study (exposed) group were rotated from their field of work to a nonexposed status for 1 year. A repeated electromyographic nerve conduction velocity test was conducted after 1 year in all participants in the study group. Main Outcome Measures: The chi-square test was used to determine the association between exposure to organophosphate and multiple peripheral neuropathy. The Wilcoxon signed-rank test was used to test for differences in the electrodiagnostic data for the years 2001 and 2002. Results: 6 of 24 participants in the study group had multiple peripheral neuropathy, while 20 of 64 participants in the control group had multiple peripheral neuropathy ( P =.707). Only 4 cases of those diagnosed with peripheral neuropathy in 2001 improved in nerve conduction velocities in their repeat testing in 2002 ( P =.096). Level of statistical significance was set at .05. Conclusions: The results failed to show an association between chronic occupational organophosphate exposure and multiple peripheral neuropathy. Likewise, the nerve conduction velocities of those workers with peripheral neuropathy did not improve 1 year after being shifted from an exposed status to a nonexposed status.