Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology
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Small fiber neuropathy (SFN) may involve somatic and autonomic fibers. Assessment of somatic epidermal nerve fiber density (ENFs) is considered the gold standard test in the diagnosis of SFN. By contrast, autonomic involvement in SFN is more difficult to ascertain. Here we investigate peripheral sympathetic outflow by microneurography in patients with selective small nerve fiber involvement of different origin with and without autonomic symptoms to ascertain the ability of microneurography and the corresponding skin organ effector responses (sympathetic skin activity-SSR and skin vasomotor reflex-SVR) to disclose autonomic involvement. ⋯ Microneurographic evaluation of sympathetic activity, technically more difficult than indirect tests, was a useful functional tool contributing to the diagnosis and extension of autonomic involvement in SFN. Our data showed that the skin sympathetic branch is more often involved than the muscle sympathetic branch in SFN.
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To establish the methodology for recording corticobulbar motor evoked potentials (CoMEPs) from cricothyroid muscles (CTHY) elicited by transcranial electrical (TES) and direct cortical stimulation (DCS). ⋯ This new and rather simple method adds a new tool in exploration of the functional organisation of motor cortex and corticobulbar pathways for laryngeal muscles. Furthermore, it has great potential to intra-operatively monitor its functional integrity.
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Clinical Trial
Botulinum toxin has an increased effect when targeted toward the muscle's endplate zone: a high-density surface EMG guided study.
To compare the effect of endplate-targeted injections of a low Botulinum neurotoxin type A (BoNT-A) dose with that of injections at defined distances from the motor endplate zone. ⋯ Precise endplate-targeted injections increase the effect of BoNT-A and may thus prove to reduce required dosage and treatment costs.