Longitudinalna elektrofiziološka študija pri bolnikih z dedno nagnjenostjo h kompresijskim parezam v obdobju več kot 10 let : diplomsko delo

Potočnik, Tanja (author), Leonardis, Lea (mentor)

Uvod: Dedna nagnjenost h kompresijskim parezam (HNPP) je avtosomna dominantna periferna nevropatija, za katero so značilne ponavljajoče okvare perifernega živčevja, povezane z izgubo senzorike in mišično šibkostjo, pogosto po manjši poškodbi ali kompresiji na več mestih. Meritve prevajanja po živčevju pri HNPP kažejo na podaljšane čase prevajanja perifernih živcev z rahlo zmanjšano ali normalno hitrostjo prevajanja po motoričnem živcu, lokalizirano (fokalno) upočasnitev na pogostih utesnitvenih mestih in razpršene nepravilnosti vzdolž senzornih živcev. Namen: Želeli smo ugotoviti, ali pride do sprememb vrednosti prevajanja po perifernih živcih pri bolnikih s HNPP po daljšem časovnem obdobju (najmanj 10 let). Pričakovali smo poslabšanje rezultatov EMG preiskave zaradi seštevanja kompresij. Metode dela: Najprej smo pridobili soglasje etične komisije in nato povabili 23 bolnikov s HNPP na meritve prevajanj po perifernem živčevju. Preiskave se je udeležilo 15 bolnikov s HNPP. Izvedli smo meritve prevajanja po medianem, ulnarnem, fibularnem in tibialnem motoričnem živcu ter po medianem, ulnarnem, radialnem, suralnem in superficialnem peronealnem senzoričnem živcu. Podatki, vključeni v končno analizo spremembe motoričnega prevajanja, so bili končni čas prevajanja, amplituda valov M, hitrost prevajanja in latenca F valov vseh štirih motoričnih živcev. Podatki, vključeni v končno analizo spremembe senzoričnega prevajanja, so bili latenca, amplituda in hitrost prevajanja medianega, ulnarnega in suralnega senzoričnega živca. Rezultate smo statistično analizirali s T-testom za odvisne vzorce v programu SPSS. Rezultati: Po analiziranju podatkov motoričnega prevajanja po vseh živcih smo ugotovili statistično pomembno podaljšanje končnega časa prevajanja in podaljšanje latence vala F. Po analiziranju podatkov senzoričnega prevajanja po vseh živcih smo ugotovili statistično pomembno podaljšanje latence in znižanje amplitude nevrograma. Razprava in zaključek: Po primerjavi vrednosti prevajanja po perifernem živčevju v najmanj desetletnem obdobju, lahko trdimo, da pride do poslabšanja rezultatov. Razlika je vidna predvsem pri tistih vrednostih, ki so najbolj odvisne od seštevanja posameznih fokalnih demielinizacij skozi čas. V nadaljevanju bi bilo potrebno za lažjo primerjavo vrednosti za posamezne živce ponovno opraviti meritve čez deset let na sistematičnem pregledu brez akutnega poslabšanja. Tako bi lahko primerjali tudi rezultate za tiste živce, za katere smo imeli premalo podatkov iz prve preiskave.

• Language: Slovenian
• Keywords: diplomska dela, fizioterapija, dedna nagnjenost h kompresijskim parezam, meritve prevajanj po perifernem živčevju
• Work type: Bachelor thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [T. Potočnik]
• Year: 2017
• Number of pages: 40 str., [1] str. pril.
• PID: 20.500.12556/RUL-99578
• COBISS.SI-ID: 5391467
• Publication date in RUL: 04.02.2018

Secondary language

• Language: English
• Title: Longitudinal electrophysiological study of patients with hereditary neuropathy with liability to pressure palsies : bachelorʹs degree

Abstract

Introduction: Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal dominant peripheral neuropathy. HNPP patients exhibit variously located recurrent peripheral nerve palsies in connection with sensory loss, often precipitated by a minor trauma or compression. Studies on nerve conduction reveal prolonged distal motor latencies, mildly decreased motor nerve conduction velocities predominantly at nerve entrapment sites, and altered sensory nerve action potentials. Aim: The purpose of our research was to identify changes in the studies of nerve conduction of patients with HNPP after a longer period of time (at least 10 years). We expected a deterioration of results due to the summation of compressions. Methods: Our study featured 15 patients with HNPP. We performed nerve conduction studies of the median, ulnar, fibular, and tibial motor nerves, as well as of the median, ulnar, radial, sural, and superficial peroneal sensory nerves. The data included in the final motor nerve conduction analysis were distal latency, amplitude, conduction velocity, and F wave latency of all four nerves. The data included in the final sensory nerve conduction analysis were latency, amplitude, and conduction velocity of the median, ulnar, and sural nerves. We statistically analysed the results with the Dependent T-test, using the Paired Sampled T-test in SPSS Statistics. Ethical approval was obtained for the study. Results: Having statistically analysed the data of the two motor nerve conduction studies, we found statistically significant prolonged distal motor latencies and F-wave latencies. After a statistical analysis of the data of the two sensory nerve conduction studies, we found statistically significant prolonged latencies and a statistically significant decline in the amplitude. Discussion and conclusion: Having compared the results of the two nerve conduction studies at least a decade apart, we can conclude that there is a deterioration of results. Changes are mostly seen in values most affected by mielin. For a more accrued comparison of the results, another nerve conduction study without an acutely worsened medical state of the patients is required. This would also enable us to compare the results of certain other nerves for which the data from the first study was insufficient for us to use.

• Keywords: diploma theses, physiotherapy, hereditary neuropathy with liability to pressure palsies, nerve conduction studies