Biomedical subjects

W N Löscher

Publications and source records attributed to W N Löscher.

At least 19 recordsLinked to original sources

PubMed2005

Cortical motor activation patterns following hand transplantation and replantation.

We studied cortical activation patterns by functional MRI in a patient who received bilateral hand transplantation after amputation 6 years ago and in a patient who had received unilateral hand replantation within 2 hours after amputation. In the early postoperative period, the patient who had had the hand transplantation revealed strong activation of a higher motor area, only weak activation of the primary sensorimotor motor cortex and no activation of the primary somatosensory cortex. At 1-year follow-up, a small increase in primary sensorimotor motor cortex activation was observed. Activation of the primary somatosensory cortex was only seen at the 2 year follow-up. By contrast, after hand replantation, the activation pattern was similar to that of the uninjured hand within 6 weeks. This included activation of the primary sensorimotor motor cortex, higher motor areas and primary somatosensory cortex. Transplantation after long-standing amputation results in cortical reorganization occurring over a 2-year period. In contrast, hand replantation within a few hours preserves a normal activation pattern.

Adult↗

PubMed2004

Decompression without anterior transposition: an effective minimally invasive technique for cubital tunnel syndrome.

Cubital tunnel syndrome represents the second most common compression neuropathy in the upper limb. There are three main surgical procedures to deal with this issue, namely simple decompression, medial epicondylectomy and anterior transposition. Nevertheless, optimal surgical treatment is still open to question. In the past three years we performed decompression of the nerve with or without external neurolysis and epineuriotomy on 52 patients (55 extremities). Preoperative diagnostic procedures included functional hand status, neurophysiological evaluation, X-ray of the elbow and neurosonography. Patients were then divided into three groups according to the staging criteria of Dellon. After an average follow-up of 13 months, the outcome was evaluated by complete examination of hand function, electrophysiological studies and interview with the patients. Postoperatively, two-point discrimination as well as strength improved significantly. Postoperative grip was 28.78 kg (79.8 % of the other hand), compared to 20.31 kg (58 % of the other hand) preoperatively (p = 0.000). Evaluation of each stage individually showed that the best functional outcome was achieved by the minimum-staged group with improvements in strength and sensory in all patients and total relief in two-thirds. In the severe-staged group, improvement could still be found in 75 % of the patients. Evaluation of conduction velocities showed highly significant improvements for both motor and sensory conduction velocities. In summary, simple decompression, if necessary modified with external neurolysis and epineuriotomy, showed high success rates in all stages. Decompression is a minimally invasive procedure, but very effective for mild as well as for severe cases and therefore the optimal treatment in cubital tunnel syndrome.

Adult↗

PubMed2000

Clinical predominance of proximal upper limb weakness in CMT1A syndrome.

We report an Austrian family with proximal muscle weakness and wasting predominantly of the shoulder girdle musculature, normal or slightly reduced distal muscle power, mild foot deformity, absent or reduced tendon reflexes in the lower limbs, and normal or slightly diminished sensation. Electrophysiologically, motor nerve conduction velocities were slowed to less than 33 m/s, distal latencies were prolonged, and compound motor action potentials were low. Sensory nerve conduction velocities were extremely reduced or no sensory potentials were recordable. Genetic testing in three affected individuals revealed a duplication of the chromosomal region 17p11.2. In addition, genetic testing for facioscapulohumeral muscular dystrophy (FSHD) revealed a 33 kb EcoRI fragment on chromosome 4q35 in one affected individual and in the clinically normal parent, whereas in a second affected person normal DNA-sizes were observed. These clinical findings define a new phenotypic variant associated with the Charcot-Marie-Tooth 1A duplication. This may be due to a mutation in another gene contained in the 1.5 Mb duplication although mutations in the peripheral myelin protein 22 gene have been excluded. Alternatively, the genetic background of other genes in the family may modify the phenotypic expression, as found in other inherited diseases. The unusual phenotype cannot be explained by the concomitant presence of FSHD despite some evidence for coexistance in one individual.

Adult↗

PubMed2000

Comparison of second lumbrical and interosseus latencies with standard measures of median nerve function across the carpal tunnel: a prospective study of 450 hands.

The second lumbrical-interosseus distal motor latency (2LI-DML) was compared prospectively in 450 hands. Median nerve function was assessed by standard motor and sensory electrophysiological tests. In a control group of 100 hands the upper limit of normal for the 2LI-DML was 0.5 ms. In all hands studied the correlation coefficients of 2LI-DML were higher with sensory nerve tests than with motor studies. Carpal tunnel syndrome (CTS) was diagnosed clinically in 276 hands, and 174 showed no clinical signs of CTS. The 2LI-DML was prolonged in 269 of the 276 hands, with clinical signs of CTS and normal in 170 of 174 non-CTS hands. Thus the 2LI-DML resulted in a sensitivity of 97.5%. On the other hand, combining the standard tests yielded a sensitivity of 98.5 %. In 31 of 36 additional hands a lumbrical response was recorded, although motor and sensory responses form standard median nerve conduction studies were absent, and the 2LI-DML was substantially prolonged. The 2LI-DML therefore represents a highly sensitive, fast, easy-to-perform, and cost-efficient method to study median nerve function across the wrist and may help to localize the lesion in cases in which standard electrophysiological methods fail.

Adolescent↗

PubMed2000

Significance of peripheral afferent input to the alpha-motoneurone pool for enhancement of tremor during an isometric fatiguing contraction.

The objective of this study was to investigate the contribution of peripheral afferent input to the enhancement of isometric tremor during a sustained submaximal isometric contraction. It was hypothesised that during muscle fatigue, when excitatory drive is high, peripheral afferent input may augment oscillations in the stretch reflex arc and result in bursting motor-unit activity and increased tremor. Nine healthy subjects maintained isometric plantar flexions at 30% of their maximum voluntary contraction until the limit of endurance, under three test conditions. Two paradigms were used to reduce afferent input to the triceps surae alpha-motoneurone pool: (1) continued vibration of the Achilles tendon, and (2) ischaemic partial block of the tibial nerve. These were compared to a control experiment, in which there was no intervention. By recording H-reflexes from the gastrocnemius and soleus muscles, it was possible to assess the effectiveness of reducing the afferent input. When H-reflex suppression had stabilised, the fatiguing contraction was commenced and tremor was computed from the continuously recorded torque signal. Superimposed maximum twitches were elicited as indirect measures of excitatory drive. The increase in tremor root mean square throughout the fatiguing contraction was significantly less for both the vibration and ischaemic conditions. Furthermore, tremor mean power frequency decreased significantly with endurance time in the control experiment, while no significant change was seen in the other two experimental conditions. It is concluded that the enhancement of isometric tremor seen during a fatiguing submaximal isometric contraction is facilitated by peripheral afferent input to the alpha-motoneurone pool.

Adult↗

PubMed2000

Load-dependence of fatigue related changes in tremor around 10 Hz.

OBJECTIVES: The aim of the study was to investigate the effects of different loads on tremor around 10 Hz during fatiguing contractions. METHODS: Eighteen healthy volunteers performed sustained isometric knee extensions at 30%, 50% and 70% maximum voluntary contraction (MVC). During the fatiguing contractions, mechanical recordings were made with a high-resolution force sensor. Tremor-power was calculated for the 6-20 Hz frequency window as a function of time normalized to endurance time. RESULTS: Initial tremor power was different between the high and low load tasks. Changes of tremor with contraction time differed between the three tasks, in that tremor of the 30% MVC contraction showed the least decrease throughout the sustained contraction, whilst that of the 50% and 70% MVC showed progressively higher decreases. At failure, all 3 contractions merged to the same tremor level. CONCLUSION: Load-dependent, fatigue-related 6-20 Hz tremor changes during sustained submaximum voluntary contractions seem mainly the consequence of recruitment of new units and fatigue-related properties of the high threshold motor units of muscles.

Adult↗

PubMed2000

Phenotypic and genotypic heterogeneity in hereditary motor neuronopathy type V: a clinical, electrophysiological and genetic study.

We report on a large four-generation Austrian family with autosomal dominant distal hereditary motor neuronopathy type V (distal HMN V). Forty-seven at-risk family members, of whom 21 were definitely affected, underwent detailed clinical, electrophysiological and genetic studies. The age at onset was in the second decade of life in most affected individuals, but clinical presentation was rather variable. While the majority of patients were primarily disabled by progressive asymmetrical wasting of the thenar and the first dorsal interosseus muscles, others had marked foot deformity and gait disturbance with the occasional absence of hand involvement. Sensation sense was normal except for the reduced response to vibration. Many individuals showed brisk tendon reflexes and some elevated muscle tone in the lower limbs, but extensor plantar responses were rarely observed. Electrophysiological evaluation revealed normal or reduced motor nerve conduction velocities, normal or prolonged distal motor latencies, and low compound motor action potentials, depending on the degree of muscle wasting. Sensory nerve studies were usually within the normal range or slightly to moderately abnormal in older or severely affected persons. Electromyography showed high-amplitude motor unit potentials and reduced recruitment compatible with anterior horn cell degeneration. Central motor conduction times were prolonged in two-thirds of the patients. Molecular genetic studies excluded Charcot-Marie-Tooth 1A syndrome and proximal spinal muscular atrophy linked to chromosome 5q as well as the known gene loci for distal HMN II on chromosome 12q, HMN V on chromosome 7p and juvenile amyotrophic lateral sclerosis on chromosome 9q. The findings in this family thus provide detailed clinical and electrophysiological information on HMN V and demonstrate broad phenotypic variability in this disorder. Hallmark features are discussed that appear to be most reliable to differentiate this type of HMN V from other variants of hereditary neuropathies, and a set of diagnostic criteria is proposed. Furthermore, this is the first report of prolonged central motor conduction times in HMN V, which indicates additional involvement of the central motor pathways in this disease. Finally, molecular genetic studies demonstrate genetic heterogeneity, suggesting the existence of at least a second genetic subtype in HMN V.

Adolescent↗

PubMed1999

[Hereditary motor-sensory neuropathies (Charcot-Marie-Tooth syndrome) and related neuropathies. Current classification and genotype-phenotype correlation].

Charcot-Marie-Tooth (CMT) disease is the most common inherited disorder of the peripheral nervous system with an incidence of 40:100,000. Clinically, it is characterized by distal muscle weakness and wasting, primarily of the legs and later of the arms, foot deformity, diminished or absent tendon reflexes, and mild-to-moderate sensory loss. Molecular genetic studies over the past 2 decades have revealed the genetic heterogeneity of this disorder and the identification of different genes or gene loci, respectively. Therefore, a current CMT classification though constantly changing due to ongoing detection of further genetic defects must take into consideration both phenotypic and genotypic criteria. Since certain clinical features appear to be associated with specific genetic subtypes, we provide a detailed description of characteristic phenotypic variants to facilitate differential diagnosis and allow more precise referral to subsequent genetic investigations.

Charcot-Marie-Tooth Disease↗

PubMed1996

Excitatory drive to the alpha-motoneuron pool during a fatiguing submaximal contraction in man.

1. This study was undertaken to examine changes of excitatory drive to the triceps surae alpha-motoneuron pool during fatiguing submaximal isometric contractions in man. Eight healthy subjects maintained isometric plantar flexions at 30 percent of maximum voluntary contraction (MVC) until the limit of endurance (range, 6-9 min). 2. Excitability of the alpha-motoneuron pool to Ia afferent stimulation (H reflex), electromyograms (EMG) and maximum compound motor unit action potentials (Mmax) from the lateral (LG) and medial heads (MG) of the gastrocnemius as well as from the soleus muscle (Sol) were recorded throughout the contraction. Superimposed maximum twitch torques (twitch occlusion) and isometric torque fluctuations (tremor) were also recorded as indirect measures of excitatory drive. 3. H reflexes were studied at different levels of underlying voluntary contraction to assess the relationship between H reflex amplitude and excitatory drive. With increasing levels of underlying contraction up to MVC, superimposed H reflex amplitude increased for LG in six subjects, for MG in all eight and for Sol in five. In the remaining cases, H reflex amplitude first increased and then plateaued between 30-50% of MVC. 4. H/Mmax ratios increased during fatigue in those muscles that showed an H reflex amplitude increase with high levels of underlying contraction. In these cases, LG and MG H/Mmax increased significantly after about 50 and 20% of endurance time onward, respectively, whereas Sol H/Mmax demonstrated a significant increase up to 40% of endurance time. 5. EMG root mean square (r.m.s.) increased linearly throughout the contraction for all three muscles, while tremor r.m.s. increased in a non-linear way, with a steeper increase from 60% of endurance time onward. Superimposed twitch amplitude decreased significantly from 25% of endurance time onward. 6. It is concluded that during fatiguing isometric contractions at 30% of MVC, the excitatory drive to the triceps surae alpha-motoneuron pool increases. This is thought to be a compensatory mechanism to facilitate recruitment of new, unfatigued motor units (MUs), and/or to increase MU firing rates. The facts that the twitch is not abolished at endurance limit and that the EMG does not attain its unfatigued MVC level are strong indications that central fatigue occurred during the sustained submaximal contraction.

Action Potentials↗

PubMed1996

Central fatigue during a long-lasting submaximal contraction of the triceps surae.

Our purpose was to study central fatigue and its dependence on peripheral reflex inhibition during a sustained submaximal contraction of the triceps surae. In 11 healthy subjects, superimposed twitches, surface electromyograms (EMG) from the medial head of the gastrocnemius (MG) and soleus (SOL) muscles, maximal compound motor action potentials (M(max)), tracking error and tremor were recorded during sustained fatiguing contractions at a torque level corresponding to 30% of maximal voluntary contraction (MVC). When the endurance limit (401 +/- 91 s) of the voluntary contraction (VC-I) was reached, the triceps surae could be electrically stimulated to the same torque level for an additional 1 min in 10 of the 11 subjects. These subjects were then able to continue the contraction voluntarily (voluntary contraction II, VC-II) for another 85 +/- 48 s. At the endurance limit of VC-I, the superimposed twitch was larger than during the unfatigued MVC, while there was no significant difference between the twitch at the endurance limit of VC-II and MVC. The EMG amplitude of both MG and SOL at the endurance limit of VC-I was significantly less than that during the MVC. While the EMG amplitude of MG increased further during VC-II, SOL EMG remained unchanged, neither muscle reaching their unfatigued MVC values. This difference was diminished for SOL by taking into account its decrease in M(max) found during VC-II, and relative EMG levels approached their MVC values. These results clearly indicate that a higher voluntary muscle activation was achievable after 1 min of electrical muscle stimulation, which continued metabolic stress and contractile fatigue processes but allowed for supraspinal, muscle spindle and/or motoneuronal recovery. It is concluded that peripheral reflex inhibition of alpha-motoneurons via small-diameter muscle afferents is of minor significance for the development of the central fatigue that was found to occur during the first voluntary contraction.

Adult↗

PubMed1996

Recurrent inhibition of soleus alpha-motoneurons during a sustained submaximal plantar flexion.

During 10 min of sustained isometric plantar flexion at 20% of maximal voluntary contraction, recurrent inhibition of soleus alpha-motoneurons was studied in 9 healthy subjects (age 22-37 years). Recurrent inhibition was brought about by a conditioning H-reflex and assessed by a test H-reflex delivered 10 ms later. The amplitude of the test H-reflex during the tenth minute of the contraction (16.9 +/- 13.2% of the maximal compound motor action potential) was significantly increased as compared to that during the first minute (9.8 +/- 7.6%), while the conditioning H-reflex remained unchanged. Concomitantly, muscle fatigue was evidenced by a significant increase in amplitude of the soleus electromyogram. The increase of the test-H-reflex amplitude implies that a decrease in recurrent inhibition occurred during the sustained submaximal contraction, which contrasts results from studies on maximal voluntary contractions. These results indicate a modulation of soleus Renshaw interneurons, which is likely to serve the purpose of optimising motor unit recruitment and firing rates of this muscle during a sustained submaximal contraction.

Adult↗

PubMed1995

Application of the correlation integral to respiratory data of infants during REM sleep.

Non-linear time sequence analysis has been performed on infant sleep measurement data in order to obtain more information about the respiratory processes. As a first step, respiration data during REM sleep were analysed with methods from non-linear dynamics, especially, the correlation integral and the slope of its log-log plot, representing the correlation dimension. Before calculation of the correlation integral, a special kind of filtering has to be applied to the data. This filtering algorithm is a state space and singular value decomposition-based noise reduction method, and it is used to separate the noise and signal subspaces. The dynamics of a signal (in our case data from the respiratory process) and its degrees of freedom can be characterised by the correlation integral and by the correlation dimension, respectively. The main result of this study is that the highly irregular-looking breathing patterns during REM sleep could be described by a deterministic system, and finally the physiological significance of this finding is discussed.

Electroencephalography↗

PubMed1995

Influence of gastrocnemius muscle length on triceps surae torque development and electromyographic activity in man.

The present study was designed to determine the relative contribution of the gastrocnemius muscle to isometric plantar flexor torque production at varying knee angles, while investigating the activation of the gastrocnemius muscle at standardised non-optimal lengths. Voluntary plantar flexor torque, supramaximally stimulated twitch torque and myoelectric activity (EMG) from the triceps surae were measured at different knee angles. Surface and intra-muscular EMG were recorded from the soleus muscle and the medial and lateral heads of the gastrocnemius muscle in 10 male subjects. With the ankle angle held constant, knee angle was changed in steps of 30 degrees ranging from 180 degrees (extended) to 60 degrees (extreme flexion), while voluntary torque from a 5-s contraction was determined at 10 different levels of voluntary effort, ranging from 10% of maximal effort to maximal effort. To assess effort, supramaximal twitches were superimposed on all voluntary contractions, and additionally during rest. Maximal plantar flexor torque and resting twitch torque decreased significantly in a sigmoidal fashion with increasing knee flexion to 60% of the maximum torque at 180 degrees knee angle. For similar levels of voluntary effort, the EMG root mean square (RMS) of gastrocnemius was less with increased knee flexion, whereas soleus RMS remained unchanged. From these data, it is concluded that the contribution of gastrocnemius to plantar flexor torque is at least 40% of the total torque in the straight leg position. The decrease of gastrocnemius EMG RMS with decreasing muscle length may be brought about by a decrease in the number of fibres within the EMG electrode recording volume and/or impaired neuromuscular transmission.

Adult↗

PubMed1994

Electromyographic responses of the human triceps surae and force tremor during sustained submaximal isometric plantar flexion.

The objective was to investigate electromyographic activity (EMG) and isometric force tremor (IFT) changes during a sustained sub-maximal isometric contraction in two muscles acting upon the same joint but differing in muscle fibre composition. Surface and intra-muscular EMG activity from the gastrocnemius and soleus muscles and IFT were recorded during an exhausting isometric plantar flexion (30% of maximal voluntary contraction). Surface EMG amplitude (RMS) of both gastrocnemius and soleus muscles increased significantly over time. Gastrocnemius EMG RMS increased in a non-linear fashion while soleus EMG RMS increased linearly. A significant linear decrease of surface EMG mean power frequency (MPF) was observed over time for both muscles. The decrease in gastrocnemius MPF was significantly greater than that for soleus. Intra-muscular EMG results showed similar trends. Correlations of intramuscular EMG RMS and MPF with time were, however, characterized by lower correlation coefficients than those from the surface EMG. Isometric force tremor RMS significantly increased non-linearly with duration of contraction, while IFT MPF showed a significant linear decrease with time. Changes in surface EMG RMS were correlated to changes seen in IFT RMS, in particular, for the predominantly fast twitch gastrocnemius muscle. Correlation coefficients of surface EMG MPF and IFT MPF were lower than RMS correlations. The associated changes in IFT and EMG with fatigue indicate alterations in motor unit firing rate, recruitment and synchronization. The muscle specificity of the EMG and IFT changes suggests a coupling to muscle fibre type composition, although differences in the relative force contribution of each muscle could also affect the results.

Adult↗

PubMed1993

Myo-electric signals from two extrinsic hand muscles and force tremor during isometric handgrip.

The objective of the present study was to investigate the myo-electric signs of muscle fatigue and the isometric force tremor of two extrinsic hand muscles, extensor digitorum communis and flexor digitorum superficialis, during isometric power grip. In addition, the synergy between flexor and extensor muscles and hand differences in a right-handed population have been studied. During isometric hand-dynamometry the myo-electric signal was recorded using surface electrodes and isometric force tremor was recorded using a special load cell. Eight subjects participated in this study and contractions were performed at 20%, 40%, 60% and 80% of maximal voluntary contraction (MVC) with left and right hands. The decrease of mean power frequency (MPF) with duration of contraction was greater in the left extensor as compared to the ipsilateral flexor muscle. No differences in the decrease in MPF with the duration of the contraction were found between the right extensor and flexor muscles. Isometric force tremor root mean square did not change during contractions at a given contraction level. Isometric tremor amplitude increased from 20% to 60% MVC and decreased at higher contraction levels. Tremor amplitude was higher in the left hand at all contraction levels but 60% MVC. These data would suggest differences in fatiguability and muscle fibre composition between the dominant and nondominant hand, which may be due to preferred use. The significance of force tremor for the evaluation of recruitment order and muscle fatigue is discussed.

Adult↗

PubMed1993

[Microvib--a test battery for studies of physiological tremor].

4 simple tests to investigate physiological tremors in different load conditions on the musculo-skeletal system have been developed with regard to the Austromir space missions. Some new results on normal tremors from the space experiments as well as from ground studies using these tests are discussed. It is proposed to introduce these experimental methods in the area of clinics to evaluate precision of motor control.

Adult↗

PubMed1990

Neurological status, sleep apnea frequency and blood oxygenation in six weeks old infants.

A study was carried out to investigate the correlation between sleep apnea frequency, blood oxygenation and neurological condition in 21 infants at six weeks of age with inconspicuous medical history. Polygraphic recordings of respiratory behaviour and transcutaneous blood gas monitoring lasted for at least five hours. To quantify the results of the neurological examination we established a neurological optimality score (NOS). We found statistically significant correlations between several indexes of apneas and indexes of blood oxygenation and NOS. Thus, a reduced NOS was strongly correlated with higher apnea frequencies and with pronounced drops of transcutaneous PO2-values. In addition all but one infant who were diagnosed as having a sleep apnea syndrome showed a greater than ten percent reduction of NOS. Some pathophysiological considerations to explain our findings are put forward and the possible role of the neuromodulator adenosine is emphasized.

Humans↗

PubMedDate not supplied

[The Graz SIDS Risk Questionnaire: I. Development and validation].

Based on the results from semistructured interviews with parents of fifty SIDS victims and of fifty matched controls we developed a SIDS risk questionnaire, the so-called SRFB Graz. In a retrospective study this questionnaire was applied to 65 SIDS victims and 195 comparable controls. By statistical analysis a cut point was computed, which discriminates SIDS cases from controls with a sensitivity of 86% and a specificity of 95%.

Austria↗