Peripheral neuropathies associated with primary Sjögren syndrome: immunologic profiles of nonataxic sensory neuropathy and sensorimotor neuropathy.

We conducted this study to characterize the relationship between primary Sjögren syndrome (pSS)-associated peripheral neuropathy (PN) and markers of B-cell monoclonal proliferation and chronic activation. The cohort included 120 consecutive patients presenting with definite pSS according to the American-European Consensus Group criteria. Serum markers of chronic B-cell activation included autoantibodies and hypergammaglobulinemia.

Feasibility, reproducibility, risks and benefits of face transplantation: a prospective study of outcomes.

Composite tissue allotransplantations can be indicated when autologous transfers fail to restore human appearance. We report the reproducibility, difficulties, serious adverse events and outcomes of our patients. Five patients were included in a registered clinical research protocol after thorough screenings assessed by an independent expert committee systematically discussing the alternative options.

Treatment of poststroke pain by epidural motor cortex stimulation with a new octopolar lead.

Background: Chronic, drug-resistant neuropathic pain can be treated by surgically implanted motor cortex stimulation (MCS). The leads used for MCS have not been specifically designed for this application.

Objective: To study the value of a new 8-contact lead for MCS therapy in a series of 6 patients with refractory central poststroke pain.

[Small fibre neuropathy: Diagnostic approach and therapeutic issues, and its association with primary Sjögren's syndrome].

This article reviews the diagnostic issues and the therapeutic management of small fibre neuropathy (SFN), and a detailed literature analysis of its association with primary Sjögren's syndrome (pSS). A diagnosis of SFN should be raised in the presence of diffuse neuropathic painful manifestations (burning sensation, paresthesia, pricking, allodynia or hyperesthesia) and neurovegetative signs. The neurological examination and the electroneuromyogram are usually normal.

Intraoperative neurophysiologic mapping of the central cortical region for epidural electrode placement in the treatment of neuropathic pain by motor cortex stimulation.

Neuropathic pain results from injury to the central or peripheral nervous system and can prove itself refractory to classical medical treatment by anticonvulsants and antidepressants. In such cases, motor cortex stimulation is among the neurostimulation techniques available for its symptomatic control. This technique is based on surgical implantation of electrodes over the motor cortical representation of the painful area.

Neurophysiological assessment of spinal cord stimulation in failed back surgery syndrome.

Despite good clinical results, the mechanisms of action of spinal cord stimulation (SCS) for the treatment of chronic refractory neuropathic pain have not yet been elucidated. In the present study, the effects of SCS were assessed on various neurophysiological parameters in a series of 20 patients, successfully treated by SCS for mostly unilateral, drug-resistant lower limb pain due to failed back surgery syndrome. Plantar sympathetic skin response (SSR), F-wave and somatosensory-evoked potentials (P40-SEP) to tibial nerve stimulation, H-reflex of soleus muscle, and nociceptive flexion (RIII) reflex to sural nerve stimulation were recorded at the painful lower limb.

Assessing accuracy of the magnetic resonance imaging-computed tomography fusion images to evaluate the electrode positions in subthalamic nucleus after deep-brain stimulation.

Background: Accurate evaluation of the electrode position in subthalamic nucleus (STN) after deep-brain stimulation (DBS) has rarely been verified before.

Objective: We superimposed the postoperative thin-sliced computed tomography (CT) on the preoperative magnetic resonance imaging (MRI), and the positional information of the implanted electrodes with electrophysiological data was reflected on MRI. The accuracy of this method was assessed by comparing STN demarcated on this method (M-STN) with the electrophysiologically defined STN (E-STN) and with STN on the Schaltenbrand-Wahlen atlas (SW-STN).

The value of neuronavigated rTMS for the treatment of depression.

Repetitive transcranial magnetic stimulation (rTMS) has been increasingly evaluated as a therapeutic tool for the treatment of depression, using various stimulation parameters and protocols. Heterogeneous results have been reported with regard to clinical outcome, at least partly due to the variety of procedures for coil placement above the desired site of stimulation. This article reviews the strategies for coil positioning in the treatment of depression.

Comparison of "standard" and "navigated" procedures of TMS coil positioning over motor, premotor and prefrontal targets in patients with chronic pain and depression.

Since about 15 years, transcranial magnetic stimulation (TMS) is used as a technique to investigate the function of specific cortical regions. Single pulse TMS studies have targeted the dorsolateral premotor cortex (dlPMC) to characterize premotor-motor interactions in movement disorders. Repetitive TMS (rTMS) trials have targeted the dorsolateral prefrontal cortex (dlPFC) to treat depression.

Nerve excitability changes after intravenous immunoglobulin infusions in multifocal motor neuropathy and chronic inflammatory demyelinating neuropathy.

Intravenous immunoglobulin (IVIg) infusions may provide clinical benefits in multifocal motor neuropathy (MMN) and chronic inflammatory demyelinating polyneuropathy (CIDP). The short delay in the clinical response to IVIg therapy is not consistent with a process of remyelination or axonal regeneration. We assessed whether or not the efficacy of IVIg infusions in MMN and CIDP could reflect changes in axonal membrane properties and nerve excitability.

Descending volleys generated by efficacious epidural motor cortex stimulation in patients with chronic neuropathic pain.

Epidural motor cortex stimulation (EMCS) is a therapeutic option for chronic, drug-resistant neuropathic pain, but its mechanisms of action remain poorly understood. In two patients with refractory hand pain successfully treated by EMCS, the presence of implanted epidural cervical electrodes for spinal cord stimulation permitted to study the descending volleys generated by EMCS in order to better appraise the neural circuits involved in EMCS effects. Direct and indirect volleys (D- and I-waves) were produced depending on electrode polarity and montage and stimulus intensity.

Motor cortex rTMS reduces acute pain provoked by laser stimulation in patients with chronic neuropathic pain.

Objective: To assess the modulation of acute provoked pain by repetitive transcranial magnetic stimulation (rTMS) of the motor cortex in patients with chronic neuropathic pain.

Methods: In 32 patients with chronic neuropathic pain affecting one upper limb, laser-evoked potentials (LEPs) (N2 and P2 components) were recorded in response to laser stimulation of the painful or painless hand, before and after active or sham rTMS applied at 10Hz over the motor cortex corresponding to the painful hand. Laser-induced pain was scored on a visual analogue scale.

Late-onset cervicoscapular muscle atrophy and weakness after radiotherapy for Hodgkin disease: a case series.

Patients with cervical or mediastinal Hodgkin disease (HD) classically underwent chemotherapy plus extended-field radiation therapy. We report six patients who gradually developed severe atrophy and weakness of cervical paraspinal and shoulder girdle muscles 5-30 years after mantle irradiation for HD. Although clinical presentation was uniform, including a dropped head syndrome, electrophysiological and pathological findings were rather heterogeneous.

Treatment of Parkinson's disease by cortical stimulation.

Opportunities for the treatment of Parkinson's disease (PD) by cortical stimulation are open. This review outlines the main arguments for the use of cortical stimulation in PD: the widespread cortical dysfunction that could be corrected by cortical stimulation; the main mechanism of action of subthalamic nucleus stimulation that could take place within the primary motor cortex; and the ability of cortical stimulation to modulate basal ganglia activity by exciting cortico-basal ganglia projections. Such neuromodulatory effects could correspond to either stimulus-locked changes in brain rhythms or delayed changes in synaptic plasticity.

Cervical spondylotic amyotrophy presenting as dropped head syndrome.

We report a case of acute-onset dropped head syndrome in a 65-year-old patient in whom the diagnosis of amyotrophic lateral sclerosis (ALS) was initially proposed based on electromyographic signs of neck and shoulder muscle denervation. There were no signs of pyramidal involvement and the clinical and electromyographic signs of motor denervation never evolved beyond the neck and shoulder girdle muscles after a 6-year follow-up period, which argued against ALS. Other causes of dropped head syndrome were carefully ruled out based on clinical findings, electrodiagnostic studies and blood investigations.

Persistent multifocal pseudo-conduction blocks in vasculitic neuropathy without antiganglioside antibodies.

A woman presented with severe multifocal acute axonal neuropathy due to necrotizing vasculitis. Six years later, electrophysiological examination revealed features suggestive of persistent conduction block (CB) with increased temporal dispersion (ITD) affecting the right median and tibial nerves. A clinical case characterized by multifocal CBs that were observed several years after an initial episode of vasculitic neuropathy was recently reported.

A reappraisal of the value of lateral spread response monitoring in the treatment of hemifacial spasm by microvascular decompression.

Background: Lateral spread response (LSR) to the electrical stimulation of a facial nerve branch is a specific electrophysiological feature of primary hemifacial spasm (HFS). The curative treatment of HFS is based on surgical microvascular decompression (MVD). However, the outcome of this procedure is not always satisfactory.

rTMS for suppressing neuropathic pain: a meta-analysis.

Unlabelled: This pooled individual data (PID)-based meta-analysis collectively assessed the analgesic effect of repetitive transcranial magnetic stimulation (rTMS) on various neuropathic pain states based on their neuroanatomical hierarchy. Available randomized controlled trials (RCTs) were screened. PID was coded for age, gender, pain neuroanatomical origins, pain duration, and treatment parameters analyses.

Motor cortex stimulation for the treatment of refractory peripheral neuropathic pain.

Epidural motor cortex stimulation (MCS) has been proposed as a treatment for chronic, drug-resistant neuropathic pain of various origins. Regarding pain syndromes due to peripheral nerve lesion, only case series have previously been reported. We present the results of the first randomized controlled trial using chronic MCS in this indication.