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Biomedical subjects

Cumhur Ertekin

Publications and source records attributed to Cumhur Ertekin.

At least 19 recordsLinked to original sources
PubMed2007

Sensory conduction study of the infrapatellar branch of the saphenous nerve.

Although neuropathies of the infrapatellar nerve (infrapatellar branch of the saphenous nerve, IPBSN) have been reported clinically, no electrophysiological method has been defined to evaluate IPBSN conduction. We therefore studied a total of 60 saphenous nerves and 60 IPBSNs from 36 volunteers. The IPBSN was stimulated medially with a surface electrode 2 cm below the patella. The response was recorded with a needle electrode located close to the nerve 1 cm lateral to the femoral artery in the inguinal region. Sensory nerve action potentials were obtained from each subject; mean latency of the first positive peak was 8.1 +/- 0.9 ms, conduction velocity was 54 +/- 4.4 m/s, and response amplitude was 1.3 +/- 1.1 microV. The method that we describe may be an easy and useful electrophysiological test for neuropathies of the IPBSN.

Adolescent↗
PubMed2006

Adductor T and H reflexes in humans.

In the belief that changes in the adductor reflex (AR) may be helpful in evaluating lumbar root and plexus lesions, expression of the AR was studied in 43 healthy human subjects. ARs elicited with an electronic reflex hammer were recorded from the inner side of the proximal thigh using needle and surface electrodes, and patellar reflexes (PRs) were recorded simultaneously. These reflexes were obtained by tapping the ipsilateral medial aspect of the knee, the contralateral patellar tendon, the ipsilateral and contralateral anterior superior iliac spines, and the Achilles tendon. The H reflex of the obturator nerve was also evaluated in 17 cases. ARs were evoked consistently by tapping the ipsilateral medial aspect of the knee and by contralateral patellar tap, and by tapping ipsilateral and contralateral anterior superior iliac spines when a needle recording electrode was used. Sometimes an Achilles tendon tap also elicited the AR ipsilaterally. By contrast, the PR could only be elicited by a tap to the ipsilateral patellar tendon. ARs have somewhat different features than other well-known tendon reflexes such as the PR and are recorded consistently when a needle electrode is used, being elicited from both distal and proximal areas of the legs by tapping the Achilles tendon or anterior superior iliac spines unilaterally or bilaterally. Their role in evaluating lumbar root disease and monitoring adductor spasticity merits investigation.

Achilles Tendon↗
PubMed2005

Electrophysiologic identification and evaluation of stylohyoid and posterior digastricus muscle complex.

PURPOSE: To identify the function of stylohyoid and posterior digastricus (STH-PD) muscle complex by the EMG techniques. METHODS: Unaffected sides of the faces of 30 patients with facial paralysis or hemifacial spasm were investigated. A concentric needle electrode was inserted to the STH-PD muscle complex and another concentric needle electrode was inserted to the orbicularis oris (OO) muscle. Simultaneous recording were obtained from two muscles using electrical stimulation (ES) (in 25 cases) and magnetic coil stimulation (MS) (in 15 cases); and both in 10 cases. Afterwards, the function of STH-PD was studied such as whistling, lip pursing, swallowing, jaw opening and closing. RESULTS: (1) The motor latency of compound muscle action potential (CMAP) of the STH-PD muscle was shorter than that of OO. (2) When the facial nerve was stimulated more distally than the stylomastoid foramen, the CMAP elicited from the STH-PD muscle complex immediately disappeared. (3) Ipsilateral MS was able to elicit the motor evoked potential (MEP) from STH-PD either at intracranially (half of cases) or at the extracranially. While OO muscle was always stimulated intracranially by MS. (4) The STH-PD muscle complex could not be basically recruited by the mimicry except lip pursing. The main recruitment were provided by swallowing and jaw opening. Cortical MS were facilitated during swallowing (5) Late reflex responses appeared in the STH-PD muscle complex during infraorbital-trigeminal and facial nerve ES. CONCLUSION: The STH-PD muscle complex is identified electrophysiologically. Although it is innervated by the facial nerve, its functions are mainly related with jaw opening and oropharyngeal swallowing. However, it is activated by the lip pursing.

Action Potentials↗
PubMed2005

Cutaneous silent periods of the vastus medialis evoked by the stimulation of lateral femoral cutaneous nerve.

OBJECTIVE: Cutaneous silent period (CSP), which is a spinal reflex mediated by A-delta cutaneous afferents, is transient suppression of the electromyographic activity. In this study, our aim is to investigate CSPs of vastus medialis muscle (vm-CSP) evoked by the stimulation of the lateral femoral cutaneous nerve (LFCN) in healthy controls and in patients with meralgia paresthetica (MP). METHODS: Twenty-one patients with MP (17 unilateral, 4 bilateral) and 27 healthy controls were included. Nerve conduction studies of LFCN and vm-CSP were analyzed in all subjects. A stimulus train consisting of five electrical shocks was applied to the skin at the anterolateral side of the thigh for recording of the vm-CSP. RESULTS: Nerve conduction abnormalities of LFCN were observed in all patients with MP. Mean duration of vm-CSP was 69.7+/-9.2ms, and mean onset latency was 44.7+/-6.9 in healthy controls. Onset latency of vm-CSP was significantly prolonged and the duration of vm-CSP was significantly shortened in patients with MP. Vm-CSP abnormalities were observed in 20/25 extremities with MP. CONCLUSIONS: Dysfunction of A-delta afferents may cause these findings in patients with MP. Additionally, spinal modulation of pain may also play a role in the explanation of our findings. SIGNIFICANCE: The present study demonstrates the CSP alterations in the patients with entrapment neuropathy of a cutaneous nerve.

Adult↗
PubMed2005

Corticonuclear innervation to facial muscles in normal controls and in patients with central facial paresis.

Recently it has been proposed that corticobulbar innervation of the lower facial muscles is bilateral, that is from both right and left sides of the motor cortex. The objectives of this study were, i) to evaluate the corticonuclear descending fibers to the perioral muscles and, ii) to determine how central facial palsy (CFP) occurs and often recovers rapidly following a stroke. Eighteen healthy volunteers and 28 patients with a previous history of a stroke and CFP (mean ages: 51 and 61 years) were investigated by TMS (transcranial magnetic stimulation) with a figure of eight coil. Intracranial facial nerve and cortical motor evoked potentials (MEPs) were recorded from the perioral muscles. The periorbital MEPs were also studied. The absence of MEPs in both perioral muscles with TMS of the affected hemisphere was the most obvious abnormality. Also, central conduction time was significantly prolonged in the remaining patients. The mean amplitude of the affected hemisphere MEPs was diminished. The amplitudes of the unaffected hemisphere MEPs recorded from the intact side were enhanced especially in the first week following the stroke. During TMS, only the blink reflexes were elicited from the periorbital muscles due to stimulus spreading to trigeminal afferent nerve fibers. It is concluded that perioral muscles are innervated by the corticobulbar tract bilaterally. CFP caused by a stroke is generally incomplete and mild because of the ipsilateral cortical and multiple innervations out of the infarction area, and recovers fast through cortical reorganisation.

Adult↗
PubMed2005

Sympathetic skin response recorded from the genital region in normal and diabetic women.

AIM OF THE STUDY: An electrophysiological technique assessing the sympathetic skin activity related to sudomotor function from the genital skin has been described previously in normal adult man. The problems of the genitourinary tracts and the sexual disorders are difficult to analyse in women. In this paper, a method for recording the genital sympathetic skin responses (g-SSR) has been described in normal women and the objective changes were demonstrated in female patients with diabetes mellitus. MATERIAL AND METHOD: Our study comprised 20 healthy adult women (mean age 42.5 years) and 20 diabetic women (mean age 52.8 years). We examined both left hand sympathetic skin responses (SSR) and genital region SSR by electrophysiological methods. Superficial Ag-AgCl electrodes were placed on perineum in front of the anal sphincter and 1-1.5 cm lateral to right labia majora for recording after the stimulation of the right median nerve. All g-SSRs from both recording sites were analysed, latency and amplitudes were compared in normal subjects and patients. RESULTS: It has been clearly demonstrated that the g-SSR is easily obtained from all normal female subjects in labia majora-perineum montage. In seven of 20 diabetic patients g-SSR could not be elicited. Mean amplitude was significantly reduced in diabetic group according to normal subjects (P < 0.05). CONCLUSION: It was concluded that the method described in this study is easily applied and objectively evaluated for the female patients with genitourinary and sexual problems.

Adult↗
PubMed2005

Electrophysiological evaluation of the genitofemoral nerve in patients with inguinal hernia.

Groin pain in the lower abdomen but including the ilioinguinal region is frequent after inguinal hernia operations, but the integrity of the nerves in this region, including the genitofemoral nerve (GFN), has not been investigated. We studied GFN motor conduction time to the cremasteric muscle (CM), the CM electromyogram (EMG), and the CM reflex in 30 patients with unilateral inguinal hernia who underwent herniorrhaphy and in 26 similar patients who had no surgical intervention. Among the 30 patients undergoing herniorrhaphy, 14 (47%) showed motor involvement of the GFN, whereas 6 of the 26 (23%) patients not treated surgically had involvement of the GFN. These findings indicate that subclinical motor involvement of the GFN can be demonstrated by electrophysiological methods and is common after inguinal herniorrhaphy. Based on patient complaints, the herniated mass may also be responsible for motor involvement of the GFN in some patients before surgery.

Adult↗
PubMed2005

Preswallowing dystonia.

A patient is described with some dystonic features related to the preswallowing period of oropharyngeal swallowing in the muscles of deglutition sequentially. This case may be called a "preswallowing dystonia."

Deglutition Disorders↗
PubMed2005

Cricopharyngeal muscle electromyography in laryngopharyngeal reflux.

OBJECTIVES/HYPOTHESIS: The objective was to determine whether laryngopharyngeal reflux was associated with an electrophysiological abnormality of the main part of the upper esophageal sphincter, namely, the cricopharyngeal muscle, which could be related to laryngopharyngeal reflux symptoms. STUDY DESIGN: A prospective study of 20 patients with symptoms of laryngopharyngeal reflux. METHODS: The diagnosis was based on clinical, laryngoscopic, and ambulatory 24-hour pH monitoring findings. Double-probe pH monitoring was performed with placement of the distal and proximal probes 5 cm above the proximal border of the lower esophageal sphincter and 15 cm proximal to the distal probe, in or just beneath the upper esophageal sphincter. Electromyographic recordings were obtained simultaneously on submental and cricopharyngeal muscles during water swallowing. The peak of the submental electromyographic amplitude and its duration was measured using bipolar surface electrodes placed under the chin. The electromyographic features of the cricopharyngeal muscle were investigated by means of concentric needle electrodes inserted percutaneously both in 20 normal subjects and in 20 patients with laryngopharyngeal reflux. RESULTS: All electrophysiological parameters were normal in all of the patients. The durations of foreburst revealed significant correlation with the number of reflux episodes and acid exposure time (P = .026 and P = .044, respectively). CONCLUSION: The duration of the foreburst correlating with acid exposure time and number of reflux episodes suggested that foreburst duration was extended because of the irritation caused by the acid reflux.

Adult↗
PubMed2005

Effects of lamotrigine on the symptoms and life qualities of patients with post polio syndrome: a randomized, controlled study.

The aim of this study is to find out if lamotrigine gives symptomatic relief and enhances quality of life in patients with post-polio syndrome. Thirty patients were randomly assigned to receive or not to receive lamotrigine treatment. Lamotrigine at a daily dose of 50-100 mg was given to the fifteen patients, and fifteen patients were used as the control group. Interventional advice and home exercises were given to all of the patients. Clinical assessments were made at baseline and repeated at the second and fourth weeks by the physician who was unaware of medication. The severity of pain, fatigue and muscle cramps were rated on a visual analogue scale. Health-related quality of life was measured using the Nottingham Health Profile. The patient's perceived level of fatigue was assessed using Fatigue Severity Scale. Comparing to the baseline values, statistically significant improvements were obtained in the mean scores of VAS, NHP and FSS at two weeks and four weeks in the patients on lamotrigine. No significant improvements were reported in the control group. These preliminary results indicate that lamotrigine relieves the symptoms and improves the life qualities of patients with post polio syndrome.

Adult↗
PubMed2004

Oropharyngeal dysphagia in polymyositis/dermatomyositis.

The nature of the oropharyngeal dysphagia in polymyositis/dermatomyositis (PM/DM) has been investigated by EMG methods. Nineteen patients with PM/DM were studied. The oropharyngeal phase of swallowing was evaluated by the electrophysiological methods measuring the laryngeal relocation time, pharyngeal transit time and the triggering of the pharyngeal phase of swallowing reflex. The EMG of cricopharyngeal muscle of the upper esophageal sphincter was also recorded in 10 patients. The patients have been compared with a group of 22 healthy controls matched with age and gender. Dysphagia limit was also measured for all patients and control subjects. Fourteen out of 19 patients could not swallow 20 ml or less amount of water at one go and divided the bolus into two or more pieces (piecemeal deglutition) in comparison to normal subjects. In PM/DM patients, the triggering of the swallowing reflex for the voluntarily initiated swallow was normal while the pharyngeal phase of swallowing was significantly prolonged. The cricopharyngeal sphincter muscle EMG demonstrated severe abnormalities in halves of the patients investigated. These findings demonstrated the weakness of the striated oropharyngeal muscles. Cricopharyngeal sphincter muscle was affected less frequently and showed either hyperreflexic or hyporeflexic states during swallowing. It is concluded that the pharyngeal stage of oropharyngeal swallowing is mainly involved in patients with PM/DM.

Adult↗
PubMed2004

Lateral pectoral nerve conduction.

The aim of this study was to measure the motor conduction time (MCT) and velocity of the lateral pectoral nerve (LPN) in normal subjects and patients with neuropathy. For the LPN, we determined thus the average MCT was 3.9 m/s using Erb stimulation with needle recording, and the average motor conduction velocity was 70.6 m/s using Erb stimulation and axilla stimulation with needle recordings in normal subjects. In patients, prolonged MCT in LPN was found in 3 of 6 patients with unilateral plexopathy and 3 of 4 patients with polyneuropathy. It was determined that MCT and motor conduction velocity in LPN was as sensitive as biceps brachii MCT in patients with unilateral plexopathy. Furthermore, the motor conduction velocity in the LPN may be beneficial to elucidate the localization of involvement in polyneuropathies, such as distal or proximo-distal.

Adolescent↗
PubMed2004

Differential corticomotor control of a muscle adjacent to a painful joint.

OBJECTIVE: To assess the effects of chronic knee pain on neural control of the nearby quadriceps muscle. METHODS: Motor-evoked potentials (MEP) in response to transcranial magnetic stimulation (TMS) of the motor cortex, maximal M responses, patellar tendon responses, and EMG activity during maximal isometric contraction were recorded from the right vastus medialis oblique (VMO) and vastus lateralis (VL) muscles in 13 patients with chronic patellofemoral pain syndrome (PPS) and 13 healthy volunteers. MEP and maximal M responses were also recorded from the right extensor digitorum brevis (EDB) muscle. RESULTS: MEP amplitudes from VMO and VL were larger in patients with PPS than in controls. On the other hand, maximal M responses, EMG activity with maximal voluntary contraction, and tendon responses were smaller in patients than in controls. Motor-evoked responses and maximal M responses of the EDB muscle did not show significant difference between the 2 groups. CONCLUSIONS: These results indicate that chronic knee pain modulates central motor control of an adjacent muscle.

Adult↗
PubMed2003

The value of scintigraphy in the evaluation of oropharyngeal dysphagia.

Healthy adults can swallow boluses of 20 ml water in a single swallow. Individuals with impaired swallowing, however, may be unable to do so, instead requiring two or more swallows; this phenomenon is called "piecemeal deglutition". The term "dysphagia limit" refers to the volume at which piecemeal deglutition occurs. The aim of our study was to investigate the potential value of scintigraphic evaluation of piecemeal deglutition and dysphagia limit in patients with dysphagia, based on correlation with the results of submental electromyography (SM-EMG) and laryngeal sensor monitoring (LS). The study population comprised 24 patients with dysphagia secondary to neurological disorders and ten normal adults, who formed a control group. In the scintigraphic evaluation, subjects underwent four separate dynamic studies using 5, 10, 15 and 20 ml of water containing 0.5 mCi technetium-99m labelled sulphur colloid, and time-activity curves (TACs) were created for each study. Static thoracic images were also recorded in order to detect airway aspiration Observation of two or more peaks on TACs within the 10-s acquisition period was considered a sign of piecemeal deglutition. If piecemeal deglutition occurred at or below 20 ml, this volume was regarded as the dysphagia limit. Piecemeal deglutition was not found in any normal subjects; by contrast, it was observed in 14 of the 24 (58%) patients on scintigraphy and in 17 (71%) patients on EMG and LS. In three patients, signs of the airway aspiration were observed on static thoracic images. Scintigraphic and electrophysiological findings were in agreement in 19 patients (79%), and the correlation between scintigraphy and the electrophysiological methods for the evaluation of dysphagia was statistically significant (r=0.57, P=0.003). The novel finding of this study is the demonstration of piecemeal deglutition and dysphagia limit on scintigraphic studies in patients with neurogenic dysphagia. Based on this finding we consider that scintigraphic evaluations of piecemeal deglutition and dysphagia limit could be of value especially in centres which do not have electrophysiological test facilities. The technique should be added to the list of standard scintigraphic methods for the evaluation of patients with oropharyngeal dysphagia.

Administration, Oral↗
PubMed2003

Neurophysiology of swallowing.

UNLABELLED: Swallowing is a complex motor event that is difficult to investigate in man by neurophysiological experiments. For this reason, the characteristics of the brain stem pathways have been studied in experimental animals. However, the sequential and orderly activation of the swallowing muscles with the monitoring of the laryngeal excursion can be recorded during deglutition. Although influenced by the sensory and cortical inputs, the sequential muscle activation does not alter from the perioral muscles caudally to the cricopharyngeal sphincter muscle. This is one evidence for the existence of the central pattern generator for human swallowing. The brain stem swallowing network includes the nucleus tractus solitarius and nucleus ambiguus with the reticular formation linking synaptically to cranial motoneuron pools bilaterally. Under normal function, the brain stem swallowing network receives descending inputs from the cerebral cortex. The cortex may trigger deglutition and modulate the brain stem sequential activity. The voluntarily initiated pharyngeal swallow involves several cortical and subcortical pathways. The interactions of regions above the brain stem and the brain stem swallowing network is, at present, not fully understood, particularly in humans. Functional neuroimaging methods were recently introduced into the human swallowing research. It has been shown that volitional swallowing is represented in the multiple cortical regions bilaterally but asymmetrically. Cortical organisation of swallowing can be continuously changed by the continual modulatory ascending sensory input with descending motor output. SIGNIFICANCE: Dysphagia is a severe symptom complex that can be life threatening in a considerable number of patients. Three-fourths of oropharyngeal dysphagia is caused by neurological diseases. Thus, the responsibility of the clinical neurologist and neurophysiologist in the care for the dysphagic patients is twofold. First, we should be more acquainted with the physiology of swallowing and its disorders, in order to care for the dysphagic patients successfully. Second, we need to evaluate the dysphagic problems objectively using practical electromyography methods for the patients' management. Cortical and subcortical functional imaging studies are also important to accumulate more data in order to get more information and in turn to develop new and effective treatment strategies for dysphagic patients.

Brain↗
PubMed2002

Electrophysiological evaluation of pharyngeal phase of swallowing in patients with Parkinson's disease.

We studied the various physiological aspects of oropharyngeal swallowing in Parkinson's disease (PD). Fifty-eight patients with PD were investigated by clinical and electrophysiological methods that measured the oropharyngeal phase of swallowing. All patients except 1 had mild to moderate degree of disability score. Dysphagia was demonstrated in 53% of all patients in whom the test of dysphagia limit was abnormal. All PD patients with or without dysphagia displayed the following abnormalities: (1) the triggering of the swallowing reflex was prolonged probably due to inadequate bolus control in the mouth and tongue and/or a specific delay in the execution of the swallowing reflex; (2) the duration of the pharyngeal reflex time was extremely prolonged due to slowness of the sequential muscle movements, especially those of the suprahyoid-submental muscles; (3) cricopharyngeal muscle of the upper oesophageal sphincter was found to be electrophysiologically normal; and (4) the electrophysiological phenomena in PD patients could not be strongly correlated with the degree of the disability and clinical score of the PD. It was concluded that various motor disorders of PD have considerable influence on oropharyngeal swallowing: hypokinesia, reduced rate of spontaneous swallowing, and the slowness of segmented but coordinated sequential movements rather than any abnormalities in the central pattern generator of the bulbar center. Some compensatory mechanisms in the course of PD may explain the benign nature of swallowing disorder until the terminal stage of the disease. Similarly, the swallowing problems of PD are not only related with the dopamine deficiency; some other nondopaminergic mechanisms may also be involved.

Adult↗
PubMed2002

Electromyography of human cricopharyngeal muscle of the upper esophageal sphincter.

The cricopharyngeus (CP) is a striated muscle sphincter situated at the pharyngoesophageal junction. The upper esophageal sphincter is comprised of the striated CP muscle and nonmuscular components at the level of the cricoid cartilage. This review describes the basic anatomy and physiology of the CP muscle, its central and peripheral relationship, methods of investigating it, and electrophysiological properties related to deglutition. The main function of the CP muscle is to control flow between the pharynx and esophagus. The CP sphincter muscle is tonically contracted at rest and relaxes during swallowing, belching, and vomiting. Electromyography (EMG) of the CP sphincter muscle has been undertaken frequently in a variety of subhuman species with the aim of understanding deglutition, whereas it has seldom been reported in healthy human subjects and patients. Increased knowledge of the physiology and anatomy of the human CP sphincter muscle is not only important scientifically but is necessary for advancing the diagnosis and treatment of oropharyngeal dysphagia, for which neurological causes are responsible in 80% of cases.

Animals↗