S242
`
`Posters / Clinical Neurophysiology 117 (2006) S121–S336
`
`Background: Peroneal palsy due to compression of the
`common peroneal nerve at the fibular head was described
`as a complication of delivery. We describe peroneal palsy
`caused by proximal nerve compression during childbirth.
`Aims of the study: ENMG and clinical study to establish
`the site of compression.
`Patient and methods: A 27-year-old woman had her sec-
`ond childbirth. The baby was large, 4500 g. The delivery
`was helped with suction. After childbirth there was a total
`left peroneal paresis. Lumbar MRI was normal. The first
`ENMG was performed 3 days after delivery. There was a
`total paresis of the left anterior tibial muscle in EMG.
`However, the motor conduction velocity of the common
`peroneal nerve was bilaterally normal between the popliteal
`space and ankle but the F-response was missing on the left
`side. The sensory response of the superficial peroneal and
`sural nerves as well as the H-reflex of the tibial nerve was
`normal on both sides. Two weeks after delivery there was
`still a total paresis of the left anterior tibial muscle but a
`few motor unit potentials were activated in the short toe
`extensor muscle. The left peroneal F-response appeared.
`3.5 weeks after delivery there were fibrillation potentials
`in the left peroneal muscles. A few motor unit potentials
`were activated. Seven weeks after delivery there still were
`fibrillations in the left peroneal, but not in the L4–L5
`paraspinal muscles. Nine months after delivery there were
`no residual signs of nerve injury of the left peroneal
`nerve.
`Conclusion: There was conduction block in the motor
`axons of the left peroneal nerve leading to a total paresis
`of the anterior tibial muscle. The site of compression was
`not near the neck of fibula. There were no signs of lumbar
`root compression in MRI or paraspinal EMG. The proba-
`ble site of acute injury was at the level of the posterior divi-
`sion of lumbosacral plexus, formed by the 4th and 5th
`lumbar roots, which has a compression-prone site on the
`iliac crest at the pelvic inlet.
`
`doi:10.1016/j.clinph.2006.06.475
`
`voiding dysfunction:
`P28.2 Non-obstructive
`psychogenic or underlying neurogenic?
`S. Malaguti, M. Spinelli, L. Zanollo
`
`Idiopathic,
`
`Niguarda Hospital, Neurourophysiology Spinal Unit, Italy
`
`Background: Since voiding dysfunction can be an
`expression of defective neurogenic control of the lower uri-
`nary tract, sacral nerve modulation by means of implanted
`devices (SNM) is one of the therapeutic options. Unfortu-
`nately, the success of treatment is unpredictable and vari-
`able. Moreover
`because
`the
`pathophysiology
`of
`functional urinary retention (UR) is still poorly under-
`stood, the careful choice of therapy is hindered, thus,
`almost as a rule, multiple treatments are tried in a stepwise
`manner on a trial nd error basis. In our experience a psy-
`
`chopathological findings (by means of Minnesota Multi-
`phase Personality Inventory MMPI2) can be recognized
`as responsible of a predictable failure of the therapy.
`Aim, materials and methods: To assess the hypothesis of
`an underlying neurogenic or prevalent psychogenic
`involvement, we performed a detailed neurophysiological
`investigation (SEP, EMG, ENG, Sacral reflexes, SSR)
`and MMPI2 in a group of 14 female patients (42 years
`mean age) (nine complete and five incomplete UR) without
`overt neurological symptoms nor a history of trauma or
`neurological disease, thus classified from diopathic before
`implanted with SNM.
`Results: Seven patients with positive results of SNM,
`had normal MMPI2 profile and alterations on neurophysi-
`ological assessment. Seven patients had negative results of
`SNM: in five patients both neurophysiology and MMPI2
`fail to detect an underlying involvement (neurogenic nor
`psychogenic);
`in one neurophysiological evaluation was
`normal with MMPI negative and in one only neurogenic
`involvement.
`Conclusions: Neurophysiological diagnostic selection
`and psychological assessment can be useful predictive fac-
`tor of SNM results. Patients with an underlying neurogenic
`alteration show better results in SNM, while patients with
`MMPI2 positive and negative neurophysiology should be
`excluded from SNM implant.
`
`doi:10.1016/j.clinph.2006.06.476
`
`P28.3 Cortical neuroplasticity in sacral neuromodulation:
`Neurophysiological evidences in long term follow up
`S. Malaguti, M. Spinelli, L. Zanollo, M. Citeri,
`J. Tarantola, T. Redaelli
`
`Niguarda Hospital, Neurourophysiology Spinal Unit, Italy
`
`Background: Neurophysiological evaluation (NPE) in
`patients addressed to sacral neuromodulation (SNM)
`revealed an undisclosed neurogenic alteration as a possible
`cause of imbalance in afferent input to cortical area. More-
`over SNM seems to act on the afferent pathway with a spe-
`cific modulating effect related to parameters of stimulation:
`an increase from 21 to 40 Hz leads to a decrease in puden-
`dal somatosensory evoked potentials (PSEPs) P40 latency
`resulting in a sort of facilitation on afferent impulse trans-
`mission suggesting a reset of the processing mechanism.
`Aim: To verify the hypothesis that the imbalance in
`afferent input can be modified by SNM leading to a neuro-
`plastic effect on neurocontrol.
`Patients and methods: From November 2001 to Septem-
`ber 2005 215 pts underwent NPE (T0): in 111 pts (51.62%)
`implanted with SNM PSEPs after 1 (T1) and 24 months
`(T2) were confronted.
`Results: In 4 pts (3.6%) implanted for idiopathic detru-
`sor overactivity, clinical efficacy never was fully achieved
`and with a slow decline in time, a return to PSEPs T0
`
`Petitioner - Avation Medical, Inc.
`Ex. 1017, p. 242
`
`

`

`Posters / Clinical Neurophysiology 117 (2006) S121–S336
`
`S243
`
`P40 was found in T2: SNM can modify the plasticity of
`neurocontrol mechanism, but need to be reinforced, per-
`haps in correlation with the underline pathophysiology of
`symptom. In 5 pts (4.5%) implanted for dysfunctional void-
`ing in whom SNM was switched off with a persistent clin-
`ical efficacy no difference in PSEPs at T1 and T2 was seen:
`if a physiological restoration is achieved with SNM, the
`effect on neurocontrol mechanism persists in a normal
`fashion.
`Conclusion: NPE shed light to the mechanism by which
`central nervous system modify its organization under
`SNM.
`
`doi:10.1016/j.clinph.2006.06.477
`
`P28.4 Role of penile sympathetic skin response in the
`neurophysiological evaluation of erectile dysfunction
`C. Valles Antun˜ a, J.M. Ferna´ndez Go´ mez, S. Escaf,
`J.L. Martı´n Benito, F. Ferna´ndez Gonza´lez
`
`Hospital Universitario Central de Asturias, Neurophysiolo-
`gy, Spain
`
`Introduction: Within the limits of sexual and urinary
`malfunction the sympathetic skin responses (SSR) from
`limbs have been used in the evaluation of possible auto-
`nomic malfunction in patients suffering from erectile dys-
`function (ED).
`Aims: To evaluate the role of penile SSR in the
`assessment of neurological function in males suffering from
`ED.
`Patients and methods: We studied 83 males diagnosed
`of ED. They were clinically evaluated and put to a set
`of neurophysiological tests which included nerve conduc-
`tion studies, evoked potentials, EMG, bulbocavernous
`reflex, quantitative sensory test and SSR from limbs
`and penis.
`Results: In ED patients, the percentage of SSR was con-
`siderably lower in the penis (52%) than in the hand (90%)
`or the sole (89%). We found correlation between SSR per-
`centages and the severity of ED, assessed by means of the
`International Index of Erectile Function (IIEF). Latency of
`SSR show a statistical association between the palm and
`the sole but not with the penis. Regarding the penis, no sig-
`nificant associations were found between the results of the
`two tests used to asses the function of C type fibers (SSR
`and Heat Pain Thresholds).
`Discussion: The simultaneous register of SSR, per-
`formed in the palm, the sole and the penis increased consid-
`erably the diagnostic efficacy of this test. The percentage of
`blockings showed to be useful as an indicator of the affec-
`tation of efferent C fibres. Despite SSR is a polysynaptic
`potential of long latency and regulated by the cerebral cor-
`tex, the results of our study make advisable to value the
`latencies of SSR in the three areas of register and especially
`in the penis, where it seems to have the higher value as
`
`marker or of alterations of anatomic via at lumbosacral
`y/or pudendal level.
`
`doi:10.1016/j.clinph.2006.06.478
`
`P28.5 Peripheral neuromodulation using surface electrode
`for treatment of overactive bladder (oab): initial experience
`F. Monti 1, M. Semenic 1, S. Siracusano 2, S. Ciciliato 2,
`G. Sau 3, G. Pizzolato 1
`
`1 University Hospital Cattinara, Department of Neurology,
`Italy
`2 University Hospital Cattinara, Department of Urology,
`Italy
`3 University Hospital, Department of Neurology, Italy
`
`Percutaneus tibial nerve stimulation is effective even if it
`requires a needle insertion. We report preliminary results of
`posterior tibial nerve neuromodulation (PTNN) using sur-
`face electrode in patients affected by overactive bladder
`(AOB). Twelve female patients (age 54.4 ± 16.0) affected
`by AOB and non-responders to antimuscarinic underwent
`TNM using surface electrode. The voiding diaries, SF-36
`and King’s health questionnaires were administered before
`starting the first week of treatment and at the end of ther-
`apy. A bipolar surface electrical stimulator was placed
`behind the medial malleolus, along the course of the pos-
`terior tibial nerve, with the cathode in proximal position
`and the anode 3 cm distally. Couple electrodes in Ag/Ag
`were used for recording, with the cathode placed over the
`abduttor hallucis muscle belly and the anode on the ten-
`don. A disk ground electrode was placed between the stim-
`ulating and recording electrodes. Electrical square-wave
`stimuli of 0.1 ms duration were utilized. The stimulus
`intensity was set in order to obtain a maximal CMAP
`(compound muscle action potential). Stimulation protocol
`was 1 stim/s for 20 min, and the stimulation was repeated
`twice every week for seven weeks for each subject. We
`observed a statistically significant reduction of voiding fre-
`quencies during night
`(2 ± 0.5 to 1.4 ± 0.5 times –
`p < 0.0001) and day (13.3 ± 1.9 to 8.9 ± 2.5 times –
`p < 0.0001). No side effects were observed. SF-36 and
`KHQ questionnaires showed a statistically significant
`improvement of QoL at the end of therapy. The use of sur-
`face electrode in PTNN seems to be a non-invasive and
`successful treatment option for AOB.
`
`doi:10.1016/j.clinph.2006.06.479
`
`P28.6 Relationship between the autonomic dysfunction of
`multiple
`system atrophy and external anal
`sphincter
`electromyography
`Han Wang
`
`Peking Union Medical College Hospital, Neurology, China
`
`Petitioner - Avation Medical, Inc.
`Ex. 1017, p. 243
`
`