Background
The brain magnetic resonance imaging (MRI) findings seen in patients with Bell's palsy are abnormal contrast enhancement of affected facial nerves. Previous evaluation included mainly patients who had experienced palsy for several weeks and there are no studies to date on patients with late stage of Bell’s palsy. This study investigated the findings of MRI of Bell's palsy after 3 months of symptom onset to assess how long the enhancement last.
Methods
Among the patients with Bell's palsy (idiopathic unilateral facial palsy) who visited the hospital, 9 patients who underwent contrast-enhanced MRI of the internal auditory canal after 3 months of symptom onset were reviewed retrospectively. MRI examination results were investigated along with the patient's clinical symptoms and electrodiagnostic test results. Based on the MRI results, the frequency of abnormal contrast enhancement and contrast-enhanced areas were investigated.
Results
9 patients were included. 6 of them did MRI imaging because of incomplete recovery of facial palsy and the others did because of complication of facial palsy including synkinesis and hemifacial spasm. Time interval between symptom onset and evaluation was 17 months (3-84). Of 9 patients, 2 showed abnormal enhancement of affected nerve and they performed MRI after 5 months and 12 months of symptom onset, respectively.
Conclusions
Abnormal enhancement of facial nerve in Bell’s palsy could last up to one year. This awareness can be helpful in interpretation of MRI of Bell’s palsy.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease characterized by the degeneration of upper motor neurons in the brainstem and spinal cord and lower motor neurons. ALS was first described by Jean-Martin Charcot in 1874 based on clinical features and postmortem examinations. In 1990, the first diagnostic criteria for ALS were developed based on clinical features. Subsequently, three additional diagnostic criteria were published. In this article, we introduce the clinical features, diagnostic criteria, and diseases that need to be differentiated in ALS.

Hereditary spastic paraplegia (HSP) is a heterogeneous group of monogenic neurodegenerative disorders characterized by progressive spasticity of the lower limbs. The clinical features and imaging abnormalities vary greatly according to the affected genes. HSP is classified clinically as pure and complex forms, depending upon the presence or absence of additional neurological defects other than spastic lower limbs. Despite the recent advances in next-generation sequencing technology and its wide availability, a genetic diagnosis of HSP is still not made in more than half of all suspected cases of HSP. In this review, we summarized the various phenotypes of relatively common HSP in clinical practice according to the inheritance pattern, highlighting their clinical, radiological, and neurophysiological features. We further discussed the practical approach to patients with suspected HSP in the current era of next-generation sequencing.

Transcranial magnetic stimulation (TMS) is a safe and noninvasive tool for investigating the cortical excitability of the human brain and the neurophysiological functions of GABAergic, glutamatergic, and cholinergic neural circuits. Neurophysiological biomarkers based on TMS parameters can provide information on the pathophysiology of dementia, and be used to diagnose Alzheimer’s disease and differentiate different types of dementia. This review introduces the basic principles of TMS, TMS devices and stimulating paradigms, several neurophysiological measurements, and the clinical implications of TMS for Alzheimer’s disease.

Citations

• Transcranial application of magnetic pulses for improving brain drug delivery efficiency via intranasal injection of magnetic nanoparticles
  Eunbi Ye, Eunkyoung Park, Eunseon Kim, Jung Eun Lee, Seung Ho Yang, Sung-Min Park
  Biomedical Engineering Letters.2023; 13(3): 417.     CrossRef
• Implantable acousto-optic window for monitoring ultrasound-mediated neuromodulation in vivo
  Sungho Lee, Keunhyung Lee, Myunghwan Choi, Jinhyoung Park
  Neurophotonics.2022;[Epub]     CrossRef
• Transcranial Magnetic Stimulation in the Treatment of Neurological Diseases
  Fahad A. Somaa, Tom A. de Graaf, Alexander T. Sack
  Frontiers in Neurology.2022;[Epub]     CrossRef

Postural tachycardia syndrome (POTS) is the most common form of orthostatic intolerance in young people. However, it is still considered an underrecognized disorder and so deserves more attention from clinicians. This review covers the diagnostic challenges, correlations between the symptoms, evidence of autoimmune involvement in the pathogenesis, and treatment strategies in POTS.

This paper introduces new diagnostic criteria and differential diagnosis of orthostatic dizziness to help clinicians to diagnose hemodynamic orthostatic dizziness. Clinicians need to be able to discriminate hemodynamic orthostatic dizziness from other types of dizziness that are induced or aggravated when standing or walking. Measurements of the orthostatic blood pressure and heart rate are important when screening hemodynamic orthostatic dizziness. Detailed history-taking, a physical examination, and laboratory tests are essential for finding the cause of hemodynamic orthostatic dizziness. The differential diagnosis of hemodynamic orthostatic dizziness is crucial because it can be caused by various autonomic neuropathies.

Citations

• Mareo y vértigo ortostático, funcional y cinetosis
  Liliana F. Invencio-Da-Costa, Carmen Sánchez-Blanco, Raquel Yáñez-González, Hortensia Sánchez-Gómez, Paula Peña-Navarro, Sofía Pacheco-López, Susana Marcos-Alonso, Cristina Nicole Almeida-Ayerve, Luis Cabrera-Pérez, Victoria Díaz-Sánchez
  Revista ORL.2023; 15(3): e31540.     CrossRef

Guillain-Barre syndrome (GBS) is acute inflammatory demyelinating polyradiculoneuropathy, which is often related to post-infectious etiology. However, GBS has also been reported to be caused by non-infectious factors such as trauma. This report describes a rare case of post-traumatic GBS with dramatic response to immunoglobulin therapy. And here, we also discussed about the importance of differential diagnosis with critical illness polyneuropathy.

Citations

• MultiSpace Deep Fascial Infection in the Head and Neck Patient Complicated with Guillain-Barre Syndrome: Case Report with a Literature Review
  Fengxia Fan, Hongli Ni, Wanjie Luo, Qingchuan Yi
  Ear, Nose & Throat Journal.2025;[Epub]     CrossRef

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune-mediated neuropathy with heterogeneous features. Appropriate treatment will produce a favorable outcome, but a poor treatment response and severe disability have also been reported. The roles of the clinical phenotypes and electrophysiological features of CIDP as well as of autoantibodies against nodal and paranodal proteins have been highlighted previously due to their association with the treatment response and long-term prognosis. This review addresses the diverse factors associated with the prognosis of CIDP.

Citations

• Tendon-Sparing Extraocular Muscle Enlargement Associated With Chronic Inflammatory Demyelinating Polyradiculoneuropathy
  Antonios D. Dimopoulos, Anne Barmettler
  Ophthalmic Plastic & Reconstructive Surgery.2024; 40(2): e38.     CrossRef

Electrodiagnostic tests (EDX) is essential for the diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP). EDX could provide information about demyelinating pathology in the peripheral nerves. According to phenotypes, CIDP could be classified several phenotypes, which has different clinical manifestations, EDX could present a different distribution pattern of demyelinating lesions. In addition, EDX could be useful markers for predicting treatment response of prognosis of CIDP.

Guillain-Barré syndrome (GBS) is nowadays consider as an umbrella term that has heterogenous presentation depend on their subtypes. GBS is clinical diagnosis and its diagnosis can be supported by laboratory findings from cerebral spinal fluid study, nerve conduction study, anti-ganglioside antibodies, spinal magnetic resonance imaging and nerve ultrasound. Understanding atypical subtypes and GBS mimicking diseases are crucial for correct diagnosis. Both proper medical care for respiratory and autonomic dysfunction and immunotherapy are essential to improve outcome of GBS. Here, we summarized the current concept on diagnosis, immunopathophysiology and treatment of GBS.

Clinical evaluations, nerve conduction studies, and electromyography play major complementary roles in electrophysiologic diagnoses. Electromyography can be used to assess pathologic changes and localize lesions occurring in locations ranging from motor units to anterior-horn cells. Successfully performing electromyography requires knowledge of the anatomy, physiology, and pathology of the peripheral nervous system as well as sufficient skill and interpretation ability. Electromyography techniques include acquiring data from visual/auditory signals and performing needle positioning, semiquantitation, and interpretation. Here we introduce the basic concepts of electromyography to guide clinicians in performing electromyography appropriately.

Citations

• Artificial intelligence for automatic classification of needle EMG signals: A scoping review
  S. de Jonge, W.V. Potters, C. Verhamme
  Clinical Neurophysiology.2024; 159: 41.     CrossRef
• Flexible Electrode by Hydrographic Printing for Surface Electromyography Monitoring
  Xiong Zeng, Ying Dong, Xiaohao Wang
  Materials.2020; 13(10): 2339.     CrossRef

Electrodiagnostic studies such as nerve conduction studies (NCS) and needle electromyography (EMG) provide important and complementary information for evaluating patients with suspected neuromuscular disorders. NCS and needle EMG are reasonably safe diagnostic investigations and are generally associated with only mild transient discomfort when performed by experienced physicians. However, there is the risk of complications in some patients, because NCS involve the administration of electric current and EMG involves inserting a needle percutaneously into muscle tissue. This article reviews the potential risks of NCS and needle EMG.

Citations

• Bioelectric medicine: unveiling the therapeutic potential of micro-current stimulation
  Hana Lee, Seungkwan Cho, Doyong Kim, Taehyun Lee, Han Sung Kim
  Biomedical Engineering Letters.2024; 14(3): 367.     CrossRef
• Needle electromyography does not meaningfully impact findings in MR‐neurography/−myography
  Stefan Sondermann, Tobias Boppel, Katharina Fieseler, Peter Schramm, Tobias Bäumer, Peter Trillenberg
  Muscle & Nerve.2024; 69(4): 409.     CrossRef

The paraproteinemia is a disorder in which a single clone of plasma cells (monoclonal gammopathy) is responsible for the proliferation of monoclonal proteins (M-proteins). Approximately 10% of patients with idiopathic peripheral neuropathy have monoclonal gammopathy. Some M-proteins have the properties of an antibody to the components of peripheral nerve myelin, but the pathophysiological relationship between the neuropathy and the M-protein is often obscure. The relationship between peripheral neuropathy and monoclonal gammopathy requires the appropriate neurological and hematological investigations for precise diagnosis and treatment. In this review, we provide an update on the causal associations between peripheral neuropathy and monoclonal gammopathy as well as characteristics of clinical and electrophysiologic features.

Background
Acute transverse myelitis(ATM) is a group of disorders characterized by focal inflammation of the spinal cord and resultant neural injury. It can be diagnosed by Transverse Myelitis Consortium WorkingGroup(TMCWG) criteria. But there are some cases which were not satisfied with idiopathic ATM criteria, both clinically and radiologically, especially in acute stage. So we analyzed 27 cases retrospectively, which were diagnosed as idiopathic ATM.
Methods
All the records of the patients at Gil Medical Center with a diagnosis of idiopathic ATM from 2001 to 2005 were reviewed. And clinical manifestations including neurological examination, radiologic features and cerebrospinal fluid (CSF) findings were analyzed.
Results
Among the patients(20 men and 7 women; mean age, 45.3 years), 11 cases could not be diagnosed as idiopathic ATM according to the TMCWG criteria ; 6 cases did not have well marginated upper sensory level and 5 cases were not satisfied with spinal cord inflammation.
Conclusions
Although most cases of suspected idiopathic ATM were suitable for TMCWG criteria, some cases were not satisfied with this diagnostic criteria, especially in acute stage. Subsequent study might be needed to evaluate the reliability and clinical application of the criteria.

The diagnosis of peripheral neuropathy had been performed by electrophysiologic studies and neurologic examination. However, Magnetic Resonance Imaging (MRI) has recently been proposed as a supplementary tool for its diagnosis. A 55-year-old woman presented with back pain and painful proximal weakness of the right leg. Neurologic examination and electrophysiologic studies suggested an upper lumbar plexopathy. MRI disclosed the signal change in lumbar plexus with the atrophy of the innervating muscles. We report a patient with idiopathic lumbar plexopathy confirmed by MRI.

Background
Acute brachial plexitis is an acute idiopathic inflammatory disease affecting brachial plexus, which is characterized by initial severe pain in shoulder followed by profound weakness of affected arm. This is a retrospective study to evaluate the clinical and electrophysiological profile of acute brachial plexitis. Methods: Sixteen patients with acute brachial plexitis were sampled. The electrodiagnostic studies included motor and sensory nerve conduction studies (NCSs) of the median and ulnar, sensory NCSs of medial and lateral antebrachial cutaneous nerves, and needle electromyography (EMG) of selected muscles of upper extremities and cervical paraspinal muscles. The studies were performed on both sides irrespective of the clinical involvement. Results: In most of our patient, upper trunk was predominantly affected (14 patients, 87.50%). Only two patients showed either predominant lower trunk affection or diffuse affection of brachial plexus. All had an acute pain followed by the development of muscle weakness of shoulder girdle after a variable interval (7

Although various criteria on the diagnosis of diabetic neuropathy are applied from trial to trial, being tailored in concert with its purpose, the utmost evidences of the diagnosis are subjective symptoms and objective signs of neurologic deficit. The application and interpretation of auxiliary electrophysiological test including nerve conduction study (NCS) should be made on the context of clinical pictures. The evaluation of the functions of small, thinly myelinated or unmyelinated nerve fibers has been increasingly stressed recently with the advent of newer techniques, e.g., measurement of intraepidermal fiber density, quantitative sensory testing, and autonomic function test. And the studies with those techniques have shed light to the nature of the evolution of diabetic neuropathy. The practical application of these techniques to the diagnosis of diabetic neuropathy in the individual patients, however, should be made cautiously due to several shortcomings: limited accessibility, wide overlapping zone between norm and abnormality with resultant unsatisfactory sensitivity and specificity, difficulty in performing subsequent tests, unproven quantitative correlation with clinical deficit, and invasiveness of some technique. NCS, as an extension of clinical examination, is still the most reliable electrophysiological test in evaluating neuropathy and gives the invaluable information about the nature of neuropathy, whereas the newer techniques need more refinement of the procedure and interpretation, and the accumulation of large scaled data of application to be considered as established diagnostic tools of peripheral neuropathy.

Background
The aim of this study is to identify the correlation between ultrasonographic findings of median nerve andclinical scale and electrophysiologic data in carpal tunnel syndrome. Methods: Forty three patients (79 hands) with electrophysiologicallyconfirmed carpal tunnel syndrome were evaluated. Clinical symptoms were examined by Historical-Objective(Hi-Ob) scale. Electrophysiologic data and Padua scale were used for severity of electrophysiology. In ultrasonographic study,cross sectional area and flattening ratio of median nerve were measured at distal wrist crease level (DWC), 1cm proximalto distal wrist crease level, and 1cm distal to distal wrist crease level. The correlation between Hi-Ob scale, electrophysiologicdata and ultrasonography was measured with Spearman rank test. Results: The mean Hi-Ob scale was 2.4. Mean Padua scalewas 4.0. In ultrasnonographic study, cross sectional area and flattening ratio were 0.112 cm2

Low back pain is a common clinical condition with heterogeneous causes and challenges to manage. High prevalence andnumerous assessments result in an enormous socioeconomic burden. Clinician must conduct efficient and stepwise evaluationprocess to rule out serious spinal pathology, neurologic involvement, and identify risk factors for chronicity. The processcan be achieved through the focused history taking and physical examination. Certain factors related to serious spinalpathology include age (>50 years), trauma, unexplained fever, recent urinary or skin infection, unrelenting night or rest pain,unexplained weight loss, osteoporosis, immunosuppression, steroid use, and widespread neurological symptoms. In non-specificlow back pain, diagnostic imaging and laboratory studies are often unnecessary and can disturb an appropriate management.For the management of acute low back pain, patient education and medication such as acetaminophen, non-steroidalanti-inflammatory drugs, and muscle relaxants are recommended. For chronic low back pain, behavior therapy, back exercise,and spinal manipulation are beneficial. The evidence based approach could improve success rate of management, result inprevention of acute low back pain from being chronic intractable pain.