Papers by Elisabeth Chroni
Subcutaneous immunoglobulin as maintenance therapy for autoimmune autonomic ganglionopathy
Acta Neurologica Belgica, Dec 21, 2023
Acta Neurologica Scandinavica, Apr 1, 1995
A prospective electrophysiological study of phrenic nerve was performed in 59 subjects undergoing... more A prospective electrophysiological study of phrenic nerve was performed in 59 subjects undergoing open-heart surgery. The nerve was stimulated percutaneously at the neck and the diaphragmatic response was recorded with surface electrodes placed over the 8th intercostal space. The latency, amplitude, duration and area of the evoked response were measured before
Journal of Neurology, Neurosurgery, and Psychiatry, Oct 1, 1993
Conventional electrophysiological evaluation of motor nerve conduction velocity depends on measur... more Conventional electrophysiological evaluation of motor nerve conduction velocity depends on measurements of response latency of the fastest fibres, either distally (compound mus- cle action potential-CMAP) or along the entire length of the nerve (minimum F wave latency-FL,,.). Such methods provide no information about fibres with submaximal conduction velocities and may fail to detect lesions which spare fast motor nerve fibres. Latency measurements of statistically sig- nificant numbers of F waves (F chronodispersion),' 2 detect mild neuropathies more sensitively than measurements of CMAP and FL,,, alone. Although described in 1976, F chronodispersion' 2 has only recently been exploited by other groups-5 although simpli-Departnent of
Journal of Pain and Symptom Management, Sep 1, 2006
A randomized, controlled trial was performed to assess the efficacy and safety of vitamin E suppl... more A randomized, controlled trial was performed to assess the efficacy and safety of vitamin E supplementation for prophylaxis against paclitaxel-induced peripheral neuropathy (PIPN). Thirty-two patients undergoing six courses of paclitaxel-based chemotherapy were randomly assigned to receive either chemotherapy with vitamin E (300 mg twice a day, Group I) or chemotherapy without vitamin E supplementation (Group II). A detailed neurological examination and electrophysiological study was performed during and 3 months after chemotherapy. The severity of PIPN was summarized by means of a modified Peripheral Neuropathy (PNP) score. The incidence of neurotoxicity differed significantly between groups, occurring in 3/16 (18.7%) patients assigned to the vitamin E supplementation group and in 10/16 (62.5%) controls (P ¼ 0.03). The relative risk (RR) of developing PIPN was significantly higher in controls than in vitamin E group patients (RR ¼ 0.3, 95% confidence interval (CI) ¼ 0.1e0.9). Mean PNP scores were 2.25 AE 5.1 (range 0e15) for patients in Group I and 11 AE 11.63 (range 0e32) for those in Group II (P ¼ 0.01). Vitamin E supplementation was well tolerated and showed an excellent safety profile. This study shows that vitamin E effectively and safely protects patients with cancer from the occurrence of paclitaxel-induced peripheral nerve damage. A double-blind, placebo-controlled trial is needed to confirm these results.
Motor nerve conduction velocities calculated by F tacheodispersion in patients with anterior horn diseases
PubMed, Jun 1, 1996
F tacheodispersion, a new neurophysiological technique based on F waves, was used to determine th... more F tacheodispersion, a new neurophysiological technique based on F waves, was used to determine the motor nerve conduction velocities in 16 patients with motor neuron disease and 19 patients with sequelae following paralytic poliomyelitis. The findings were compared to two age-matched groups, each consisting of 20 healthy volunteers. In each subject the F wave maximal, minimal, mean conduction velocities and the difference between maximal and minimal velocities of the ulnar and peroneal nerves were calculated. M response distal latency, amplitude and conduction velocity were also measured. There was a statistical significant slowing of one or more of the F wave estimated velocities in the absence of M response abnormalities in 31.3% of nerves in motor neuron disease group and in 27.3% of nerves in the poliomyelitis group; between 6.3% and 37.5%, of the nerves studied showed a significant change in the difference between maximal and minimal conduction velocities. Our results favour the presence of changes of motor fibre conduction properties in some patients with anterior horn diseases.
Joint Bone Spine, Mar 1, 2016
Isolated sixth nerve palsy during acitretin treatment: a retinoid side effect or a mere coincidence?
Journal of The European Academy of Dermatology and Venereology, Aug 1, 2008
1024 © 2008 The Authors JEADV 2008, 22, 1003–1030 Journal compilation © 2008 European Academy of ... more 1024 © 2008 The Authors JEADV 2008, 22, 1003–1030 Journal compilation © 2008 European Academy of Dermatology and Venereology at the site of the undiluted and 1 : 10 diluted sera injection were 2 mm larger than it was at the site of sterile saline injection. The test with undiluted serum was positive in many cases (43 subjects, 37%), in urticaria patients (14 patients, 40%), healthy persons (6 subjects, 30%) and also in patients with other dermatological diseases (23 patients, 38.3%; Table 1). A 10-fold dilution of sera differentiates the patients with unexplained CIU from other dermatologic patients and controls better than undiluted sera. No positive reactions were observed among the healthy subjects, or among the patients with dermatological diseases except for three patients with autoimmune disease (1 patient with scleroderma, 2 patients with lupus erythaematosus) and one patient with psoriasis. In the patients with CIU, the test was positive in 12 cases with 1 : 10 diluted serum and in 2 cases with 1 : 100 diluted serum. These results are comparable with the clinical symptoms of the patients (Table 1). Our results show that the ASST with undiluted serum gives non-specific positive reactions, which can be caused by aggregated Ig, immune complexes, other autoantibodies, etc. The relatively high concentrations of these materials may induce a non-specific histamine release of basophils or mast cells. The basophil histamine release assay, Western blotting and other non-functional assays and flow cytometry using chimeric cell lines expressing the human FcεRIα may be useful for screening the sera, but in the everyday clinical practice, these are quite difficult to accomplish. Accordingly, we suggest the use of 1 : 10 and 1 : 100 dilutions for the test, in order to avoid non-specific reactions, and also to establish a better diagnostic opportunity for patients with autoimmune urticaria. We are working on another dilution set (1 : 10, 1 : 20, 1 : 40, 1 : 80) recently, which will help us to screen patients with CIU more precisely. S Husz, L Mihalyi,* L Kemeny Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary, *Corresponding author, University of Szeged, Department of Dermatology and Allergology, Koranyi fasor 6., H-6701, PO Box 427, Szeged, Hungary, tel. +366 2545 277; fax +366 2545 954; E-mail: [email protected]
Comparison of motor fluctuations and l-dopa-induced dyskinesias in patients with familial and sporadic Parkinson's disease
European Journal of Neurology, Feb 1, 2004
The aim of the present work was to study the characteristics of motor complications in a group of... more The aim of the present work was to study the characteristics of motor complications in a group of familial Parkinson's disease (fPD) patients in comparison with matched sporadic PD (sPD) patients. Fifty-one fPD and 51 sPD patients matched for age and disease duration, used as controls, were included in the study. The Unified Parkinson's Disease Rating Scale was completed during clinical examination and all patients were questioned about the characteristics of motor complications. The mean time from start of L-dopa therapy to the onset of motor fluctuations (MF) and L-dopa-induced dyskinesias (LID) as well as the mean time from symptom onset to the development of MF and LID was significantly shorter in the fPD group of patients. An analysis revealed a higher occurrence of MF and LID in fPD patients in the group with disease duration of 5 years or less. FPD may be associated with a higher prevalence and earlier onset of motor complications during the initial stages of the disease. Genetic factors may contribute to the specific characteristics of motor complications in fPD.
Carpal tunnel syndrome and hand configuration
Muscle & Nerve, 2001
The likelihood that hand configuration is related to the development of carpal tunnel syndrome (C... more The likelihood that hand configuration is related to the development of carpal tunnel syndrome (CTS) was examined in this study. Based on neurophysiological criteria, 50 female subjects with CTS and 50 healthy female controls were selected and their external hand dimensions were measured. Our results showed that the palm length and third digit length were significantly shorter and the palm width larger in the subjects with CTS compared with controls. Regression analysis demonstrated that the hand ratio [(palm + third digit length)/palm width] was significantly correlated with median nerve conduction measurements. The hand ratio may be a simple and useful predictive measurement in determining the tendency for CTS. © 2001 John Wiley & Sons, Inc. Muscle Nerve 24: 1607–1611, 2001
Acta Neurologica Scandinavica, Feb 1, 2005
Motor neuron disease (MND) constitutes a group of degenerative affective disorders that involve u... more Motor neuron disease (MND) constitutes a group of degenerative affective disorders that involve upper and lower motor neurons in various combinations. The term MND includes three main forms: amyotrophic lateral sclerosis (ALS), progressive bulbar palsy (PBP) and progressive spinal muscular atrophy (PSMA) (1). The reportedly annual incidence rates (IRs) of the disease vary from 0.5 to 2.6 per 100,000 population (2-4). Although the pathology of the disease is well defined, its aetiology remains unknown. Many factors, i.e., exposure to lead, manganese, pneumatic drilling, heavy labour, history of trauma or surgery and various diseases including malignant neoplasia and poliomyelitis have been associated with MND. The understanding of MND variability in different populations and its geographical distribution is important clinically and it is expected that it might improve our knowledge in the pathophysiological mechanism involved. This study was set out in order to report the epidemiological, clinical features and outcome of MND in a well-defined geographical area (860,000 inhabitants) of south-western Greece. We were also interested in exploring its association with putative risk factors.
Supportive Care in Cancer, Apr 19, 2006
We developed an innovative home-based HIV self-testing (HIVST) service that included mailing of a... more We developed an innovative home-based HIV self-testing (HIVST) service that included mailing of a free HIVST kit, and providing online real-time instructions and pre-test/post-test counseling (HIVST-OIC). The present parallel-group and non-blinded randomized controlled trial was conducted to evaluate the efficacy of promoting HIVST-OIC in increasing HIV testing rate among 430 men who have sex with men (MSM), with access to online livechat applications in Hong Kong. At month 6, as compared to the control group, the intervention group reported significantly higher prevalence of HIV testing of any type (89.8 vs. 50.7%; relative risk (RR): 1.77; p \ 0.001). Among those who have taken up any HIV testing in the last six months, significant between-group difference was found in multiple male sex partnerships (34.2 vs. 47.7%, RR: 0.72; p = 0.021). HIVST-OIC has a strong potential in increasing prevalence of HIV testing and reducing sexual risk behaviors. Implementation research is warranted.
Segmental myoclonus as the sole manifestation of a choroid plexus papilloma in the posterior fossa
Journal of Neurosurgery, Aug 1, 2001
✓ The authors describe the case of a 22-year-old woman with involuntary contractions of the stern... more ✓ The authors describe the case of a 22-year-old woman with involuntary contractions of the sternocleidomastoid and trapezius muscles that resulted in turning movements of the head. The jerks displayed the clinical and neurophysiological characteristics of segmental myoclonus (SM) restricted to muscles supplied bilaterally by the first four cervical segments. Magnetic resonance imaging disclosed a tumor in the midline above the cisterna magna that was later histologically proven to be a choroid plexus papilloma. The patient's involuntary movements did not extend to other muscle groups or, in particular, to the palate, as one might have expected in the case of brainstem lesions. Myoclonus was the sole clinical manifestation of the tumor in this patient; other signs and symptoms invariably reported in other cases of posterior fossa papilloma, such as increased intracranial pressure or cranial nerve palsies, were absent. Release from suprasegmental control is suggested as a possible pathophysiological mechanism in this case of SM.
Acta Neurologica Belgica, Jul 17, 2015
Normal autoimmune function is dependent on adequate levels of activated vitamin D, 25 hydroxy vit... more Normal autoimmune function is dependent on adequate levels of activated vitamin D, 25 hydroxy vitamin D [25(OH)D]. A recent study presented deficiency of 25(OH)D levels in Swedish MG patients. We aimed to study 25(OH)D levels in patients with MG and autoimmune polyneuropathies (PNP) at a southern latitude in Greece. Plasma levels of 25(OH)D were analyzed in Greek patients with MG (n = 19), immune-mediated PNP (N = 11) and in 30 Greek healthy age-and sex-matched controls. Ten MG patients received supplementation with vitamin D3. The MG Composite Score (MGC) and MG quality of life assessed disease severity in MG patients, whereas the INCAT Disability Scale assessed clinical features in the PNP patients. MG patients with and without vitamin D3 supplementation had higher 25(OH)D levels (mean 58.8 ± 16.3 and 62.0 ± 22.4 nmol/L, respectively) than PNP patients (mean 42.1 ± 11.5 nmol/L, p = 0.01) and healthy controls (mean 45.7 ± 13.8 nmol/L, p = 0.01). Plasma 25(OH)D levels was lower with age in all groups. There were no correlations between 25(OH)D and disease duration, MGC score, or INCAT score. Vitamin D deficiency was found in all Greek patient groups and healthy controls. Levels of 25(OH)D were higher in MG patients with as well as without vitamin D supplementation compared to healthy controls, whereas CIDP/GBS patients had levels similar to controls.
Ulnar F wave generation assessed within 3 days after the onset of stroke in patients with relatively preserved level of consciousness
Clinical Neurology and Neurosurgery, 2007
The present study aimed to detect any significant changes of F wave variables associated with acu... more The present study aimed to detect any significant changes of F wave variables associated with acute hemiparesis in a group of stroke patients with relatively preserved consciousness (Glascow Coma Scale (GCS) score 8 or higher) and to detect the possible clinical significance of F wave recording in acute stroke patients for diagnostic purposes. Thirty-two consecutive patients with mean age 65+/-10.6 years admitted with a diagnosis of acute ischemic or primary hemorrhagic stroke were studied. A series of 40 electrical stimuli were delivered to the ulnar nerve bilaterally in order to obtain F waves. F wave studies were performed within 3 days from stroke's onset. The following variables were estimated and then compared between affected and unaffected side: F persistence, F wave latency, amplitude, duration and chronodispersion. A group of 30 healthy age-matched subjects served as control. F persistence was significantly lower in both affected and unaffected sides as compared to controls. There was no statistical differences of latency values between control and either side of the stroke' patients. A significant decrease of maximum F wave amplitude was detected in both affected and unaffected side as opposed to controls. Separate analysis of the subgroup of 15 patients with stroke and completely normal level of consciousness (GCS score 15) did not showed any significant differences of F wave variables in the affected or unaffected side compared with controls. The F wave persistence is not expected to be suppressed in the first few days after stroke unless the level of consciousness is reduced. The routine F wave studies are not appropriate to evaluate the severity of motor deficit, at least in the immediate period after a stroke incident.
The Significance of F-Chronodispersion in the Electrodiagnosis of Guillain-Barre Syndrome and Other Motor Neuropathies
Archives of neurology, Mar 1, 1992
To the Editor. —We have studied with interest the report on electrodiagnostic abnormalities in co... more To the Editor. —We have studied with interest the report on electrodiagnostic abnormalities in consecutive patients with Guillain-Barre syndrome by Ropper et al1and agree with the authors that F-wave studies are essential in the neurophysiological evaluation of the syndrome. The purpose of this letter is to emphasize the significance of F-chronodispersion2,3in patients who may have normal or borderline electrophysiologic results either in all or in some of the tested motor nerves. We would also like to comment that only 10 stimuli used to study F waves as practiced by the authors is insufficient not only for the study of F-chronodispersion but also for the evaluation of other more commonly used F-wave properties (shortest latency, severity of conduction block), particularly in patients with motor neuropathies.2 F-chronodispersion has been described by one of us (C.P.P.)3to denote the scatter or dispersion of the relative latencies of
European Journal of Cancer Care, Mar 1, 2006
The aim of this study was to evaluate the headache and other neurological symptoms and signs as g... more The aim of this study was to evaluate the headache and other neurological symptoms and signs as guide predictors for the occurrence of brain metastases in cancer patients. We prospectively studied 54 cancer patients with newly appeared headache or with a change in the pattern of an existing headache during the recent months. All patients completed a questionnaire regarding headache's clinical characteristics and existence of accompanying symptoms. They also underwent a detailed neurological, ophthalmologic examination and brain neuroimaging investigation. Brain metastases were diagnosed in 29 patients. Univariate regression analysis showed an association between occurrence of brain metastases and nine clinical symptoms or signs. Multivariate regression analyses emerged only four of them as significant independent predictors. These were: bilateral frontal-temporal headache, more pronounced on the side of metastasis in cases of single metastases, with duration ≥ 8 weeks, pulsating quality and moderate to severe intensity (OR: 11.9; 95% CI. 2.52-56.1), emesis (OR: 10.2; 95% CI. 2.1-55.8), gait instability (OR: 7.4; 95% CI. 1.75-33.9) and extensor plantar response (OR: 12.1; 95% CI. 2.2-120.7). In conclusion, all cancer patients who manifest the above independent clinical predictors should be highly suspected for appearance of brain metastases and therefore should be thoroughly investigated.
Postgraduate Medical Journal, 1995
We describe five patients with previous poliomyelitis who developed multiple sclerosis (two labor... more We describe five patients with previous poliomyelitis who developed multiple sclerosis (two laboratory supported definite and three clinically definite). The initial symptoms of functional deterioration developed a mean of 30 years following poliomyelitis. Initial functional deterioration was due to progressive limb weakness or impaired mobility and in three cases this led to an initial diagnosis of post-polio muscular atrophy. The clinical diagnosis became apparent with the subsequent development of characteristic clinical features, including optic nerve, brainstem, cerebellum, and spinal cord involvement. The occurrence of multiple sclerosis in these patients emphasises that late functional deterioration may be apparently unrelated to previous poliomyelitis. Furthermore, characteristic clinical features may be masked by the severe pre-existing neuromuscular and orthopaedic impair- ment leading to diagnostic delay and confusion with the ill-defined clinical syndrome of progressive post-polio mus- cular atrophy.
Acta Neurologica Scandinavica, Dec 1, 2000
A patient with long-standing, occult pituitary insuf®ciency, who developed painful muscle stiffne... more A patient with long-standing, occult pituitary insuf®ciency, who developed painful muscle stiffness and superimposed spasms, closely resembling stiff-person syndrome, was described. Complete resolution of neuromuscular symptoms with hormone replacement in this case, as well as in a previously reported one, led to the suggestion that a syndrome like stiff-person could represent a rare consequence of multiple pituitary hormone de®ciencies.
Acta dermato-venereologica, Dec 1, 2001
peripheral neuropathy were excluded. All participants gave an The aim of the present prospective ... more peripheral neuropathy were excluded. All participants gave an The aim of the present prospective study was to substantiate informed consent and underwent neurological and neurophysiological possible side eOE ects of short-term oral acitretin therapy (1 mg/ evaluation, before, 1 and 3 months after initiation of acitretin treatkg/day) on peripheral nerve function of 13 patients with severe ment. The clinical evaluation of neuropathy was based on Neuropathy keratinization disorders. Clinical neurological examination Symptom Score (NSS) and Neurologic Disability Score (NDS) (7). NSS selected symptoms such as weakness, numbness or pain, which before and 1 and 3 months after onset of treatment was occur in neuropathy were scored as present (1) or absent (0 ). NDS unremarkable in all patients; however, a signi® cant alteration of functions of cranial nerves, tendon re¯exes, muscle strength and one or more neurophysiological, predominantly sensory, parasensation were scored as no de® cit (0), mild de® cit (1 ), moderate meters was demonstrated in 3 out of 13 patients (23%) after 1 de® cit (2), severe de® cit (3) or absence of function/severest de® cit (4). All neurophysiological studies were unilaterally (right side) performed month and in 9 out of 13 (69%) after 3 months of oral acitretin by the same investigator (E.C.) employing standard methods and by therapy. These ® ndings indicate that oral acitretin might be means of surface stimulation and recording (8). In order to avoid the capable of causing a dysfunction of predominantly sensory nerve eOE ects of high input resistance, only subjects with healthy skin over the ® bres in some individuals. Although in the investigated patients stimulation and recording areas were included in the study. The distal this dysfunction remained subclinical, it seems reasonable to skin temperature was maintained between 32ß C and 34ß C; if necessary, the limb under investigation was warmed up by immersion in a hot suggest that neurological and neurophysiological evaluation of bath. The neurophysiological pro® le consisted of the following paraperipheral nerves should be added to the list of investigations meters: 1. Motor conduction of ulnar and peroneal nerves with measurethat are routinely performed in patients receiving oral acitretin. ments of peak to baseline amplitude of compound muscle action
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Papers by Elisabeth Chroni