PracticeUpdate

Ultrasonography Valuable in Confirmation of Carpal Tunnel Syndrome

U ltrasonography has been found to be valuable for confirming carpal tunnel syndrome, suggest outcomes from two prospective studies reported at ICNMD 2018. Atchayaram Nalini, MD, of the National InstituteofMentalHealthandNeurosciences in Bengaluru, India, explained that carpal tunnel syndrome is the most common entrapment neuropathy (prevalence 3.8%). Ultrasonographic measurements are suffi- ciently accurate in the diagnosis of carpal tunnel syndrome, allow differential diagno- sis, and support the surgeon. Dr. Nalini and colleagues compared the sensitivity of electrodiagnosis and high resolution nerve ultrasound in carpal tunnel syndrome. “Some patients fear electrical stimulation and may be good candidates for exam- ination using ultrasonography,” Dr. Nalini told Elsevier’s PracticeUpdate . Ultrasonography was performed using the Philips Epiq 7G, linear 5 to 18Hz globulin use and treatment outcomes were assessed. The point prevalence of multifocal motor neuropathy in Austria was found to be 0.65 out of 100,000. The male-to-female ratio was 2.2:1, and median age of symp- tom onset was 45 years. Mean diagnostic delay was 5.4 ± 8.33 years. Mean diagnostic delay was 17 years when symptoms began between 1982 and 1986, and 0.9 years when symptom onset was between 2012 and 2017. Multifocal motor neuropathy typically began in the upper extremity (77.2%) and in distal muscles (87.7%). Conduction block was found in 95% of individuals, most fre- quently in the ulnar and median nerves. Forty-three percent showed immune globulin M antibodies against GM1.

Ultrasonography is an effective, sensitive, and less expensive alternative toMRI to confirmcarpal tunnel syndrome

transducer. Median nerve cross-sectional area was recorded transversely at level of pisiform and scaphoid bones parallel to each other (carpal tunnel inlet). Distal-to- proximal ratio was calculated 4 cm from the distal crease in the forearm. Nerve conductions were performed as per standard procedure. Magnetic resonance neurography axial and sagittal images employed a tempo- romandibular surface coil, fat saturation, and flow suppression. A total of 30 participants were studied. Female to male ratio was 4:1. Mean age

Dr. Atchayaram Nalini

Immune Globulins Continue to Be theMost Effective Treatment for Multifocal Motor Neuropathy Most patients still deteriorate over the long term

I mmune globulins continue to be effective, but most patients still deteriorate over the long term. Eva-Maria Oberreiter, MD, of the Medical University of Innsbruck, Austria, and col- leagues surveyed Austrian individuals with multifocal motor neuropathy to review epi- demiological and clinical features and their response to treatment. They also compared results with those of published studies. Austrian neurologists were contacted through the Austrian Neurological Society and asked to provide anonymized data on individuals with multifocal motor neurop- athy in their care. A total of 57 individuals reported were diagnosed between 1993 and 2017. Clinical, electrophysiological, and lab- oratory data, as well as IV immune

Overall, 51 of 57 individuals were treated with IV immune globulin at median inter- vals of 4 weeks at a mean dosage of 1.55 g/kg of body weight. High muscle strength was a favorable prognostic fac- tor. Elevated serum immune globulin M anti-GM1 antibody titer, muscle atrophy, and long intervals of treatment were neg- ative prognostic factors. Duration of treatment correlated with outcome: the longer the treatment, the worse the outcome. IV immune globulin improved muscle strength but frequently lost effectiveness after >7 years. Dr. Oberreiter explained that multifocal motor neuropathy is a rare immune-me- diated neuropathy that leads to slowly progressive, asymmetric muscle weak- nesses. Electrophysiological motor

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PRACTICEUPDATE CONFERENCE SERIES • ICNMD 2018