Neurophysiologie clinique = Clinical neurophysiology
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To evaluate effectiveness and safety of intrathecal baclofen administration (ITB) testing with continuous infusion via an external pump before the implantation of an internal one in ambulatory spastic patients with cerebral palsy (CP). ⋯ Tests of ITB using a continuous infusion by an external pump allowed precise evaluation of the effects of different ITB doses on walking ability, enabling prediction of how the patient would respond to an internal pump. All patients showed ambulatory improvement with ITB.
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Myoclonus is a movement disorder characterized by the occurrence of an involuntary abrupt muscle contraction causing a sudden unexpected jerk. Many other movement disorders can present with the same jerky, shock-like appearance. This paper reviews the clinical and neurophysiologic arguments supporting the distinction between true myoclonus and various imitators, including chorea, ballism, tics, dystonia, stereotypy, tremor and restless limbs. To be differentiated from myoclonus, these movement disorders, despite their heterogeneity, are distinctive through the patterned profile of muscle activation, the longer duration of the muscle contraction, the conditions in which they occur, and their suppressibility at will.
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A huge number of neurological disorders are associated with myoclonus. This paper describes these disorders whose diagnosis partly relies on the presence of myoclonus. The diagnostic approach is related to certain clinical features of myoclonus, which, after their integration in the clinical context, help orientate towards diagnosis. ⋯ Myoclonus with focal neurological signs may be observed in thalamic lesions, responsible for unilateral asterixis or unilateral myoclonus superimposed on dystonic posture. Segmental spinal myoclonus or propriospinal myoclonus may be associated with several spinal-cord disorders. Myoclonus associated with peripheral nerve lesions is exceptional or even questionable for some of these.
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To evaluate the feasibility of a continuous neurophysiologic monitoring (electroencephalography (EEG)-somatosensory evoked potentials (SEPs)) in the neuro-intensive care unit (NICU), taking into account both the technical and medical aspects that are specific of this environment. ⋯ EEG and EP waveforms collected in NICU were of comparable quality to routine clinical measurements and contained the same clinical information. A continuous SEP monitoring in a comatose and sedated patient in NICU is not technically more difficult and potentially less useful than in operating room. This monitoring appears to be feasible provided the observance of some requirement regarding setting, electrodes, montages, personnel integration, consulting and software.
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Diagnostic value of vestibular evoked myogenic potentials in cerebellar and lower-brainstem strokes.
Vestibular evoked myogenic potentials (VEMPs) provide assessment of vestibular function. They consist in picking up compound muscle action potentials in the sternocleidomastoid (SCM) muscles in response to auditory stimulation of the vestibulum. VEMP testing has found application mainly in peripheral vestibular disorders, whereas reports about VEMPs in central vestibular lesions are rather scarce. ⋯ Cerebellar strokes do not influence VEMPs. Moreover, despite previous reports, we were unable to find at a group level any statistically significant VEMP changes in patients with lower-brainstem strokes as compared with controls. Therefore, VEMPs do not appear a suitable tool for assessment of brainstem integrity in patients with posterior fossa strokes. However, they could constitute a sensitive method for documentation of involvement of the central vestibular pathways in patients with brainstem stroke.