Testing For Nerve Damage Vid

Today's post from news-medical.net (see link below) looks at common testing methods for neurological dysfunction. If you have ever been tested for nerve damage and been given a nerve damage diagnosis based on the results, you may be none the wiser coming out of the testing room than before you went in. This article explains exactly what sort of neurological testing is currently available and how each one works, so after reading it, you may be a little more enlightened as to what they were looking for. That said, many sensible doctors and neurologists can give you the same diagnosis based on your story and symptoms alone, without going to the expense of what can be an unreliable series of tests. Many people end up being given an idiopathic neuropathy diagnosis, purely based on the fact that the tests can't pin point the cause of your nerve damage and in many cases can't explain what seem to be 'negative' results. For that reason, many people leave the neurologist feeling somewhat cheated by the testing system and disbelieved and mistrusted as well. This leads to frustration on the part of the patient and delays in effective symptom treatment. Nevertheless, it's a double-edged coin because both doctor and patient may want the testing in order to prove the existence of your condition and not leave everybody in doubt. It's very unsatisfactory all round but if you are or have been tested, it's useful to know the why's and wherefore's of the tests and this article does just that.

Neurophysiology And Nerve Conduction StudiesBy Liji Thomas, MD Last Updated: Oct 31, 2016

Neurophysiology is a discipline within the health sciences which deals with the measurement and assessment of nervous system function rather than the anatomy of the nervous system. It helps to diagnose and monitor the progress of nervous disorders.

Neurophysiological assessment is performed via electrodes attached to the patient’s skin, and in many cases the patient’s cooperation is essential.





Clinical neurophysiology is a branch of this discipline which is hospital-based, and has to do with measuring neurological parameters, in a research setting, at the patient’s bedside, in intensive care units, or in a dedicated hospital laboratory. Clinical neurophysiologists test and record the function of the brain, spinal cord, spinal nerve roots, peripheral nerves (sensory and motor) and muscles, to help diagnose various disorders of the nervous system. They may use computerized imaging, magnetic, electrical, or electronic ways to record nervous activity, nerve impulse conduction, and coordination with the muscular response.

Some conditions in which this is useful include epilepsy, Parkinson’s disease, and motor neuron disease.

Tests used in neurophysiology

Diagnostic evaluations undertaken in the department of neurophysiology include:
Electroencephalogram (EEG)
Evoked Potentials (EPs)
Nerve conduction studies (NCS)
Electromyography (EMG) 

Electroencephalogram (EEG)

The EEG is a record of brain function. Electrodes are attached to the scalp in various areas, corresponding to the lobes of the brain, to pick up the electrical potentials from the cortex of the brain. This is of particular use in patients suffering from epilepsy.

Evoked potentials (EPs)

Evoked potentials occur in response to a visual stimulus. They are of use mainly in nervous diseases such as optic neuritis or multiple sclerosis.

Nerve conduction studies

In many conditions it is necessary to test the way the peripheral nervous system functions, by measuring the speed of passage of nerve impulses through the motor and sensory nerves. This is by recording the effect of applying a small electrical current to the nerves to be tested.

The test, also called a nerve conduction velocity test, helps to determine if the nerve has been damaged or destroyed.

Surface patch electrodes are attached to the skin. One supplies stimulation to the nerve. The other records the resulting nerve impulse. The speed of conduction is calculated using the distance between the electrodes and the time gap between the stimulation and the arrival of the resultant electrical impulse at the other electrode. Each nerve is tested separately.

Electromyography

Electromyography is a related test which inserts slender electrodes into the voluntary muscles, to diagnose conditions such as motor neuron disease and radiculopathy. It measures the electrical activity in the muscle fibers, and shows if the muscles or nerves are damaged, and if so, to what extent and at what location.

More specialized tests in neurophysiology include:
Ambulatory EEG for long-term monitoring
Video telemetry
Sleep studies
Monitoring patients during neurosurgical procedures, such as scoliosis surgery, where the spinal cord integrity has to be mapped throughout
Tests of visual neuron functioning

Neurophysiologists may develop a greater interest in specific areas such as epilepsy and its origin as well as corrective surgery, Parkinson’s disease and sub-thalamic nuclear ablation, and mapping the cortex in various disorders.

The responsibilities of a neurophysiologist include supervising and supporting technicians in the wards, operation theaters, and departmental laboratories. They must report EEGs and interpret EMGs to diagnose various neuromuscular conditions.

References
https://www.healthcareers.nhs.uk/explore-roles/medicine/clinical-neurophysiology
http://jnnp.bmj.com/content/76/suppl_2/ii23.full
https://www.uclh.nhs.uk/OurServices/ServiceA-Z/MEDSPEC/NPHYS/Pages/Home.aspx
http://www.uhs.nhs.uk/OurServices/Brainspineandneuromuscular/NeuromuscularWERMANS/Diagnosisandtreatment/Nerveconductionstudiesandelectromyography.aspx
http://www.hopkinsmedicine.org/healthlibrary/test_procedures/neurological/nerve_conduction_velocity_ncv_92,P07657/
 
http://www.news-medical.net/health/Neurophysiology-Nerve-Conduction-Studies.aspx

Nerve Damage Complications From Diabetes Mustnt Be Underestimated

Today's post from tudiabetes.org (see link below) is the story of a diabetes patient living with neuropathy (amongst other things) who is forced to lose a toe and it offers a salutary lesson in the consequences of certain life choices. The important thing is to avoid becoming diabetic in the first place but hey, that's easier said than done. Can't preach here but sometimes reading someone else's account of their medical history can shake you up a little and maybe persuade you to change a few things to make your health picture a little less alarming. The risk of losing parts of your feet due to neuropathic complications is all too real for some patients.

This little piggy
Roger212 Aug 3rd 2016

Diabetes Complications and other Conditions

I have never been a 'good' diabetic. Compliance with rules is just not in my nature. I was diagnosed in 1967, at the age of 18, after I had gone into hospital
for a relatively minor surgery. Two weeks after that diagnosis, I was
launched back into the world, scared and not completely sure of what
came next. The nurses had taught me all about doing injections, and I
had a shiny glass syringe and a box of one-time use needles. I also
had a diet booklet from the dietician, prescribing a 2,000 calorie
diet. Two thousand calories? Come on, I was a teenager. I ate 2,000
calories for breakfast.

Diabetes ended my plans for a military career, but I had finishing high school and getting into University to worry about, so I took my 16 units of Lente
insulin daily, avoided sweets and did pretty much what I wanted. In
those days we couldn't test for blood sugar, so we had to test for
urine sugar until the 90s. My tests always showed 4% or higher, the
highest a test could go. I saw my GPs mostly, although once in a
while they would send me to hospital for “stabilization.”

In my thirties I went through a period of heavy drinking. I don't know if it's coincidence, but it was at this time I lost the sight in my left eye. I went back
and forth between the right eye and the left eye for a few years, but
was blind in both eyes for only a week. I recovered most of my
eyesight through laser and a couple of actual eye surgeries, and a
very, very good ophthalmologist. This cost me a job, as my company
decided “your position is no longer required.” Yeah.

Skip ahead a few years, and I'm in my fifties, now equipped with human insulin and a blood glucose meter. My blood glucose management is better, but still not
good. In around 2005, I had my first foot infection. It involved my
left big toe and first toe, and they turned black. Due to the good
offices of the surgeon my GP sent me to, These toes recovered nicely,
and in six months or so looked as if they had never had a problem.

For several years I had recurring infections in toes on both feet. The usual course of events was that my toe or toes would turn black, and after antibiotics and frequent dressing changes they would slowly recover. I quickly knew
all of the staff at the wound clinic by their first names, and they
treated me wonderfully, and still do today.

So, at this point I had racked up neuropathy, nephropathy, retinopathy, cataracts, heart disease, a strange condition that gives me vertical double vision, mild liver and kidney problems, and arthritis. That last one may not
be due to diabetes, as it runs in my family. Oh! Oddly enough, I
suffer from depression, although I am medicated and able to hold it
at bay, but I don't smile much.

My last toe problem occurred in 2013 on a trip, at Heathrow airport. I was travelling with my daughter who was on a business trip to Paris and London. She noticed blood on the floor when I came out of the bathroom in the
morning. My right big toenail had become detached, and we dealt with
it with some bandaids my daughter had, and bought some supplies when
we got to Paris. I limped through the rest of the trip, and got back
to the wound clinic, where the doctor saved me again.
I continued to go to the wound clinic monthly for medical pedicures. They handed that job off to a podiatrist who shares office space with the clinic. At one of these pedicures, in March this year, the podiatrist discovered a
sore on the end of my middle right toe.

So now it was back to the wound clinic for antibiotics and dressing changes. After two months, I brought up the possibility of an amputation, as we seemed to be getting nowhere with the toe. Furthermore, I was having considerable
pain from the toe. The doctor wanted to wait awhile, but in June
X-rays revealed that the bones in the toe were fully infected. So we
agreed on an amputation, and set the following Wednesday, June 22, as
the date.

I had thought the process of amputation would require some fanfare – a hospital stay, hospital food, pretty nurses, all that. However, it was done in the
clinic, on the same cot I lie on for dressing changes or pedicures.
The doctor took off the dressing, wiped the toe down and gave me some
local anaesthetic. Then, while we chatted back and forth, he
cheerfully removed the toe. No pain, no fuss. I saw the toe go into a
specimen jar, and called out, “Wait, wait! I've changed my mind!”

The doctor said, “Ya want me to put it back? Too late!” and we all had a laugh. They are used to me at the clinic. In a matter of minutes the wound was
bandaged, and I walked out of the clinic with a note to come back at
7:30 the following morning. I had walked into the clinic at 7:25, and
walked out at 7:50, less one toe, but the pain from the toe was gone,
and stayed gone.

Along with my family and friends we came up with a bunch of jokes about only being able to count to 19, having difficulty playing “This little piggy.” After
all, do you drop the one that had roast beef, or the one that had
none, or go to the fourth toe and say “This little piggy had tofu,”
because then the next little piggy wouldn't want any, and could go
“Wee, wee...” oh, never mind!

All jokes aside, it isn't easy to give up a toe. It seems like a small thing, and I recognized the necessity, but when it got down to the crunch, I felt saddened. I
have known for fifty years that something like this could happen.
Thank God that I have made it this far without going blind, as has
happened to people I know. I also know people who have lost legs.
Some of those have subsequently lost their lives, so I know it could
be worse, and could get worse. But as I mentioned, I suffer from
depression, and am beginning to do a lot of sitting around with time
to think.

The wound appears to be healing well, and it seems by mid August it will be healed. This
should allow me to return to my activities such as woodwork,
swimming, walking and maybe even riding my bicycle, but two weeks ago
the doctor showed me X-rays that show the second toe is infected in
the bone, and therefore must go, too. So, the piggy that stayed at
home is to be evicted.

This did not improve my mood. It puts my recovery off until late September, and cancels any thoughts I may have had of doing much this summer. I spent a week with my daughter recently, and had to do my own dressing changes,
which is something I am unwilling to repeat. I should be able to
dance at my daughter's wedding on October 1 if nothing else goes
awry. I thought at one time that removing the toe would be the end of
the problem for now, but of course that is not true. I now have to
deal with the possibility of losing half a foot, and after that, half
my lower leg.

I try not to sit around dwelling on the problem or its infinite possibilities. There are things I can do, and I do them. I am trying to be careful about my
bgs, and waiting for the day when the doctor says, “There, Roger!
You're all healed. You don't have to come back here any more.” That
will be the best present I could have.

I said at the outset that I have not been a 'good' diabetic, but I'm still here after 50 years.

I know I have done things wrong during the course of this whole
thing, and I don't need to hear about it. The thing a diabetic
doesn't need to hear when faced with complications is, “You could
have prevented this if....” This is just my experience of losing a
toe. Whether you see it as inspiration or cautionary tale is up to
you. I hope you have gained something from it.

LATE BREAKING NEWS!

Just before submitting this, I saw the doctor at the clinic, and he thinks my second toe may get better, so we are holding off removing it until it gets a chance to improve. So, the second piggy has a stay of execution. We'll wait
and see.
Roger N. Tulk (Roger212)
 
http://www.tudiabetes.org/forum/t/this-little-piggy/55179

Muscular Stem Cells May Repair Nerve Damage

Today's post from sciencedaily.com (see link below) talks about a new development in stem cell therapy, which could lead to several breakthroughs in the treatment of nerve damage and neuropathy. In this case, stem cells from human muscle tissue were able to repair nerve damage and improve function in mice. This depends on the stem cells being implanted at the site of the nerve injury, which suggests that it will only be effective if the place of injury is identified. For many people with neuropathy, identifying where the nerve damage is in the body is a very difficult process. Nevertheless, scientists are now trying to work out how muscular stem cells can trigger repair in damaged nerves. Another case of 'watch this space' I'm afraid but an interesting one.

Stem cells from muscle can repair nerve damage after injury 
University of Pittsburgh Schools of the Health Sciences March 18, 2014

Summary:

Stem cells derived from human muscle tissue were able to repair nerve damage and restore function in an animal model of sciatic nerve injury. The findings suggest that cell therapy of certain nerve diseases, such as multiple sclerosis, might one day be feasible.

Stem cells derived from human muscle tissue were able to repair nerve damage and restore function in an animal model of sciatic nerve injury, according to researchers at the University of Pittsburgh School of Medicine. The findings, published online today in the Journal of Clinical Investigation, suggest that cell therapy of certain nerve diseases, such as multiple sclerosis, might one day be feasible.

To date, treatments for damage to peripheral nerves, which are the nerves outside the brain and spinal cord, have not been very successful, often leaving patients with impaired muscle control and sensation, pain and decreased function, said senior author Johnny Huard, Ph.D., professor of orthopaedic surgery, and Henry J. Mankin Chair in Orthopaedic Surgery Research, Pitt School of Medicine, and deputy director for cellular therapy, McGowan Institute for Regenerative Medicine.

"This study indicates that placing adult, human muscle-derived stem cells at the site of peripheral nerve injury can help heal the lesion," Dr. Huard said. "The stem cells were able to make non-neuronal support cells to promote regeneration of the damaged nerve fiber."

The researchers, led by Dr. Huard and Mitra Lavasani, Ph.D., first author and assistant professor of orthopaedic surgery, Pitt School of Medicine, cultured human muscle-derived stem/progenitor cells in a growth medium suitable for nerve cells. They found that, with prompting from specific nerve-growth factors, the stem cells could differentiate into neurons and glial support cells, including Schwann cells that form the myelin sheath around the axons of neurons to improve conduction of nerve impulses.

In mouse studies, the researchers injected human muscle-derived stem/progenitor cells into a quarter-inch defect they surgically created in the right sciatic nerve, which controls right leg movement. Six weeks later, the nerve had fully regenerated in stem-cell treated mice, while the untreated group had limited nerve regrowth and functionality. Twelve weeks later, treated mice were able to keep their treated and untreated legs balanced at the same level while being held vertically by their tails. When the treated mice ran through a special maze, analyses of their paw prints showed eventual restoration of gait. Treated and untreated mice experienced muscle atrophy, or loss, after nerve injury, but only the stem cell-treated animals had regained normal muscle mass by 72 weeks post-surgery.

"Even 12 weeks after the injury, the regenerated sciatic nerve looked and behaved like a normal nerve," Dr. Lavasani said. "This approach has great potential for not only acute nerve injury, but also conditions of chronic damage, such as diabetic neuropathy and multiple sclerosis."

Drs. Huard and Lavasani and the team are now trying to understand how the human muscle-derived stem/progenitor cells triggered injury repair, as well as developing delivery systems, such as gels, that could hold the cells in place at larger injury sites.

Story Source:

The above story is based on materials provided by University of Pittsburgh Schools of the Health Sciences. Note: Materials may be edited for content and length.

http://www.sciencedaily.com/releases/2014/03/140318190035.htm