Muscle & nerve
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We report 2 cases of Lewis-Sumner syndrome (LSS) diagnosed in patients suffering from rheumatoid arthritis undergoing treatment with the antitumor necrosis factor alpha (TNF-alpha) monoclonal antibody infliximab. While experiencing clinical improvement in their arthritic symptoms, both patients experienced sensory deficits and weakness in multiple nerve distributions. They had electrodiagnostic evidence of motor conduction block and subsequent improvement with intravenous immunoglobulin (IVIg). We describe the details of the cases and review the literature on immune-mediated neuropathies associated with anti-TNF-alpha therapy.
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Multicenter Study Clinical Trial
Long-term intensive electrically stimulated cycling by spinal cord-injured people: effect on muscle properties and their relation to power output.
Inactivity and muscular adaptations following spinal cord injury (SCI) result in secondary complications such as cardiovascular disease, obesity, and pressure sores. Functional electrically stimulated (FES) cycling can potentially reduce these complications, but previous studies have provided inconsistent results. We studied the effect of intensive long-term FES cycle training on muscle properties in 11 SCI subjects (mean +/- SEM: 41.8 +/- 2.3 years) who had trained for up to 1 hour/day, 5 days/week, for 1 year. ⋯ Relative force response at 1 HZ decreased, relaxation rate remained unchanged, and fatigue resistance improved significantly. Power output (PO) improved to a lesser extent than quadriceps torque and not to a greater extent than has been reported previously. We need to understand the factors that limit PO in order to maximize the benefits of FES cycling.
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High-resolution ultrasound can demonstrate focal nerve enlargement in entrapment neuropathies. We hypothesized that a ratio between the nerve cross-sectional area at the site of maximal enlargement and at an unaffected site may improve diagnostic accuracy in ulnar neuropathy at the elbow (UNE), when compared to a single measurement at the site of maximal enlargement. ⋯ This represented a significant increase compared with the ratio of 1.1:1 for both comparisons in controls (P < 0.0001). This type of ratio may be particularly useful for assessing entrapment in those with polyneuropathy or obesity, both of which can cause diffuse nerve enlargement.
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The sternocleidomastoid muscle (SCM) is an accessory inspiratory muscle, but it is not investigated systematically in patients with amyotrophic lateral sclerosis (ALS). We aimed to study the involvement of the SCM and to evaluate the role of the diaphragm and SCM on respiratory tests performed in ALS patients. We studied 45 patients (mean age +/- SD: 60.6 +/- 13 years). ⋯ On multiple regression analysis both PImax and SNIP are dependent on SCM Ampl and Diaphr Ampl, but FVC is not. PImax and SNIP determination mostly depend on SCM and diaphragm function, but the FVC is also dependent on expiratory muscle function. We conclude that neck weakness is a clinical sign that indicates a poor prognosis, and the SCM CMAP can contribute to respiratory function evaluation in ALS patients.