Neuromuscular Investigation Laboratory

Rio de Janeiro, Brazil

Neuromuscular Investigation Laboratory

Rio de Janeiro, Brazil
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C.N. Machado F.,University of Sao Paulo | A. Kouyoumdjian J.O.A.O.,Neuromuscular Investigation Laboratory | E. Marchiori P.,University of Sao Paulo
Muscle and Nerve | Year: 2017

Introduction: The aim of this study was to estimate jitter parameters in the orbicularis oculi muscle using a concentric needle electrode (CNE) in patients with myasthenia gravis (MG) and to determine its diagnostic accuracy for jitter analysis (CNEMG-jitter). Methods: CNEMG-jitter was performed in 20 healthy subjects and 33 MG patients using the voluntary contraction technique. Receiver operating characteristic (ROC) curves were constructed to determine cut-off points with the best sensitivity/specificity combination for jitter analysis. Results: CNEMG-jitter yielded high positivity rates for ocular MG (92.3%) and generalized MG (100%). The ROC curve cut-off point that provided the highest sensitivity without false positives was 24.7 μs for mean jitter and 33.1 μs for the 18th highest value. Sensitivity was 93.9% for both parameters. Diagnostic accuracy of CNEMG-jitter was > 96%. Conclusions: CNEMG-jitter yielded high sensitivity and specificity rates. Our reference values were lower than previously published values, possibly due to less technical variation between the different recordings. Muscle Nerve 55: 190–194, 2017. © 2016 Wiley Periodicals, Inc.


PubMed | University of Granada, Vithas Virgen del Mar Hospital, Mayo Medical School, Uppsala University and 7 more.
Type: Journal Article | Journal: Muscle & nerve | Year: 2016

The aim of this study was to create reference values for jitter measured with concentric needle electrodes.Operators worldwide contributed recordings from orbicularis oculi (OO), frontalis (FR), and extensor digitorum (ED) muscles in healthy controls. Criteria for acceptable signal quality were agreed upon in advance. Fifteen or 20 recordings of acceptable quality from each muscle were required for voluntary and electrical stimulation recordings, respectively.Recordings from 59 to 92 subjects were obtained for each muscle and activation type. Outlier limits for mean consecutive difference and individual jitter data for voluntary activation were: OO, 31 and 45 s; FR, 28 and 38 s; ED, 30 and 43 s; and for electrical stimulation they were: OO, 27 and 36 s; FR, 21 and 28 s; ED, 24 and 35 s.Reference jitter values from concentric needle electrode recordings were developed from signals of defined quality while seeking to avoid creating supernormal values.


Kouyoumdjian J.A.,Neuromuscular Investigation Laboratory | Graca C.R.,Neuromuscular Investigation Laboratory | Ferreira V.F.M.,Neuromuscular Investigation Laboratory
Neurology India | Year: 2017

Background: Peripheral nerve injuries (PNIs) remain an important health problem often leading to severe motor disabilities predominantly in the younger population. Objective: To analyze our experience of clinical and electrodiagnostic evaluation (EDX) of PNIs over a 26-year period. Materials and Methods: Between 1989 and 2014, 1124 consecutive patients with 1418 PNIs were referred for clinical as well as EDX evaluation. These PNIs involved upper and lower limbs as well as the facial nerves. Patients with iatrogenic lesions and spinal cord/spinal root lesions were excluded from this analysis. Brachial plexus (BP) injuries with associated or not with root avulsions were considered as one particular nerve and was include in the study as BP. The etiological categories of the sustained trauma included vehicular accidents, penetrating injuries, falls, gunshot wounds, car accidents involving pedestrians, sports injuries, and miscellaneous injuries. Results: The mean age of our patients was 34.2 years and most were males (76.7%). Majority (80.9%) of the PNIs were isolated injuries. Combined lesions most commonly involved the ulnar and median nerves. Upper-limb PNIs accounted for 72.6% of our patients. The ulnar nerve was injured most often, either singly or in combination. Vehicular accidents were the most common causes of injury (46.4%), affecting the brachial BP or the radial, fibular, or sciatic nerves. Penetrating trauma (23.9%) commonly affected the ulnar and the median nerves. Falls and gunshot wounds frequently affected the ulnar, radial, and median nerves. Sports injuries, mostly soccer related, affected predominantly the fibular nerves. BP injuries were considerably more common in accidents involving motorcycles than those involving cars (46.1% vs. 17.1%), and root avulsions was more frequently associated in these cases. Conclusions: Most PNIs were caused by vehicular accidents and penetrating trauma, and affected young men. Overall, ulnar nerve, primary BP, and median nerve PNIs were the most prevalent lesions. © 2017 Neurology India, Neurological Society of India.


Kouyoumdjian J.A.,Neuromuscular Investigation Laboratory | Stalberg E.V.,Uppsala University
Muscle and Nerve | Year: 2012

Normative data for jitter parameters using a disposable concentric needle have been presented in a few studies. Jitter, expressed as the mean consecutive difference (MCD), was measured in the frontalis muscle in 20 subjects by percutaneous bar stimulation of the temporal nerve branch. The mean MCD for individual studies (20) and for all potentials (600) were 16.05 ± 2.73 μs and 16.05 6 5.96 μs, respectively. The suggested limit for mean MCD is 22 μs and for outliers is 28 μs. © 2011 Wiley Periodicals, Inc.


Kouyoumdjian J.A.,Neuromuscular Investigation Laboratory | Fanani A.C.S.,Neuromuscular Investigation Laboratory | Stalberg E.V.,Uppsala University
Muscle and Nerve | Year: 2011

Introduction: Our objective was to study jitter parameters using a concentric needle electrode (CNE) in the extensor digitorum (ED) and frontalis (FR) muscles. Methods: Twenty myasthenia gravis (MG) patients, mean age 44.5 years, were studied. Percutaneous (FR) and intramuscular needle (ED) stimulation approaches were used. Jitter was expressed as the mean consecutive difference (MCD). The filter settings were from 1000 HZ to 10 kHZ. Results: Abnormal MCD was found in 85% for both ED and FR and in 90% when combining the two muscles. An abnormal percentage of outliers was found in 90% for ED and 85% for FR. The mean MCD did not show a difference for ED and FR, but the percentage of outliers and blocking were higher in FR. Abnormality was found in 93.7% (generalized) and in 75% (ocular) of MG cases. For ED outliers abnormality was greater than the MCD. Conclusion: CNE jitter is reliable for investigation of MG, although borderline findings should be judged with caution. © 2011 Wiley Periodicals, Inc.


Naves T.G.,Neuromuscular Investigation Laboratory | Kouyoumdjian J.A.,Neuromuscular Investigation Laboratory
Arquivos de Neuro-Psiquiatria | Year: 2010

Objective: To establish nerve conduction parameters for carpal tunnel syndrome (CTS) electrodiagnosis in the elderly. Method: Thirty healthy subjects (65-86 years), 9 male and 21 female, were studied. Routine median and ulnar sensory and motor nerve conduction studies, median mixed palmar latency, comparative latency techniques median to ulnar (sensory, mixed and motor lumbrical-interossei), median to radial (sensory), and combined sensory index (CSI) were performed in both hands. results: The upper limits of normality (97.5%) were: median sensory distal latency 3.80 ms (14 cm); median motor distal latency 4.30 ms (8 cm); median palmar latency 2.45 ms (8 cm); lumbrical-interossei latency difference 0.60 ms (8 cm); comparative median to radial 0.95 ms (10 cm); comparative median to ulnar 0.95 ms (14 cm); comparative palmar median to ulnar 0.50 ms (8 cm); and CSI 2.20 ms. Sensory and mixed latencies were measured at peak. conclusion: Our results establish new nerve conduction parameters for mild CTS electrodiagnosis in the elderly and will be helpful to reduce the number of false positive cases in this age.


Kouyoumdjian J.A.,Neuromuscular Investigation Laboratory | Stalberg E.,Uppsala University
Arquivos de Neuro-Psiquiatria | Year: 2013

Objective: To estimate jitter parameters in myasthenia gravis in stimulated frontalis and extensor digitorum muscles using the concentric needle electrode. Methods: Forty-two confirmed myasthenia gravis patients, being 22 males (aged 45.6±17.2 years-old) were studied. Jitter was expressed as the mean consecutive difference (MCD). Results: MCD in extensor digitorum was 61.6 μs (abnormal in 85.7%) and in frontalis 57.3 μs (abnormal in 88.1%). Outliers represented 90.5% for extensor digitorum and 88.1% for frontalis. At least one jitter parameter was abnormal in 90.5% of the combined studies. Acetylcholine receptor antibody was abnormal in 85.7% of the cases. Conclusions: Stimulated jitter recordings measured from muscles using concentric needle electrode can be used for myasthenia gravis diagnosis with high sensitivity. Extensive normative studies are still lacking and, therefore, borderline findings should be judged with great caution.


PubMed | Neuromuscular Investigation Laboratory
Type: Comparative Study | Journal: Muscle & nerve | Year: 2011

Our objective was to study jitter parameters using a concentric needle electrode (CNE) in the extensor digitorum (ED) and frontalis (FR) muscles.Twenty myasthenia gravis (MG) patients, mean age 44.5 years, were studied. Percutaneous (FR) and intramuscular needle (ED) stimulation approaches were used. Jitter was expressed as the mean consecutive difference (MCD). The filter settings were from 1000 HZ to 10 kHZ.Abnormal MCD was found in 85% for both ED and FR and in 90% when combining the two muscles. An abnormal percentage of outliers was found in 90% for ED and 85% for FR. The mean MCD did not show a difference for ED and FR, but the percentage of outliers and blocking were higher in FR. Abnormality was found in 93.7% (generalized) and in 75% (ocular) of MG cases. For ED outliers abnormality was greater than the MCD.CNE jitter is reliable for investigation of MG, although borderline findings should be judged with caution.


PubMed | Neuromuscular Investigation Laboratory
Type: Journal Article | Journal: Muscle & nerve | Year: 2012

Normative data for jitter parameters using a disposable concentric needle have been presented in a few studies. Jitter, expressed as the mean consecutive difference (MCD), was measured in the frontalis muscle in 20 subjects by percutaneous bar stimulation of the temporal nerve branch. The mean MCD for individual studies (20) and for all potentials (600) were 16.05 2.73 s and 16.05 5.96 s, respectively. The suggested limit for mean MCD is 22 s and for outliers is 28 s.


PubMed | Neuromuscular Investigation Laboratory
Type: Journal Article | Journal: Arquivos de neuro-psiquiatria | Year: 2013

To estimate jitter parameters in myasthenia gravis in stimulated frontalis and extensor digitorum muscles using the concentric needle electrode.Forty-two confirmed myasthenia gravis patients, being 22 males (aged 45.617.2 years-old) were studied. Jitter was expressed as the mean consecutive difference (MCD).MCD in extensor digitorum was 61.6 s (abnormal in 85.7%) and in frontalis 57.3 s (abnormal in 88.1%). Outliers represented 90.5% for extensor digitorum and 88.1% for frontalis. At least one jitter parameter was abnormal in 90.5% of the combined studies. Acetylcholine receptor antibody was abnormal in 85.7% of the cases.Stimulated jitter recordings measured from muscles using concentric needle electrode can be used for myasthenia gravis diagnosis with high sensitivity. Extensive normative studies are still lacking and, therefore, borderline findings should be judged with great caution.

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