Background: Peripheral nervous injury and neuromuscular complications from methamphetamine abuse has not been reported. The mechanism is not yet identified.Methods: Eight patients with lower extremity weakness following methamphetamine abuse were reported during December 2009 to May 2010.Results: Patients presented with lower extremity weakness. All patients were co-abusers of methamphetamine and opioids. Other clinical manifestations comprised of distal paresthesia of the lower extremities with progression to proximal portions, with minimal sensory involvement in the distal of the lower extremities. Electrodiagnostic findings were consistent with lumbosacral Radiculopathy. Vital signs were unremarkable and all laboratory tests were within normal limits. Follow-up examination after three months showed improvement of weakness in 3 patients.Conclusion: For patients with a history of illicit drug abuse and acute neuromuscular weakness, methamphetamine or heroin toxicity should be taken into account. Hence, urine morphine and amphetamine/ methamphetamine tests should be performed and serum lead and thallium levels should be evaluated. In addition, rhabdomyolysis and myoglobinuria should be worked up.

Carpal Tunnel syndrome (CTS) is one of the most common peripheral entrapment neuropathy in upper extremity. This syndrome is more common in women. It manifests with pain of the hand, arm and forearme. This study confirms that some patients with CTS have also cervical radiculopathy.In this study 113 patients who electro diagnostically confirmed CTS were studied for association of radiculopathy. Majority of patients were between 20 to 50 years old. The mean symptom duration was 21.3 month. %16.7 of cases had double crush syndrome (CTS associated with radiculopathy).

Background: Active muscular trigger points (aMTPs) presenting with radiating pain can interfere in diagnosis and treatment of patients suffering from lumbosacral radiculopathy.Objectives: We aimed to diagnose and evaluate the trigger point therapy on the outcome of pain in patients with lumbosacral radiculopathy.Materials and Methods: A total of 98 patients were enrolled suffered with chronic pain andlumbosacral radiculopathy at L4-L5 and L5-S1 who were candidates of non-surgical management. All patients received conservative modalities, including bed rest, non-steroidal anti-inflammatory agents (NSAID), and physiotherapy. These treatments continued for a week. Patients were examined for the presence of trigger points in their lower extremities. Those who had trigger points were divided into 2 groups (TP and N). Patients in TP group underwent trigger point injection therapy. No further therapy was done for the N group. Pain scores and straight leg raise (SLR) test in both groups were collected and analyzed on the seventh and 10th days of the therapy. Results were analyzed by paired t test and chi-square test.Results: Out of 98 patients, 64 had trigger points. Thirty-two patients were assigned to each group. Pain scores (Mean±SD) in TP group was 7.12±1.13 and in N group was 6.7±1.16, P=0.196. Following the treatment, pain scores were 2.4±1.5 in TP group and 4.06±1.76 in N group P=0.008. SLR test became negative in all patients in TP group but only in 6 (19%) patients in N group, P=0.001.Conclusions: Results show that trigger point injection therapy in patients suffering from chronic lumbosacral radiculopathy with trigger points can significantly improve their recovery, and conservative therapy may not be adequate.

Background: S1 radiculopathy is a high prevalence illness and its early diagnosis is of crucial importance. Several reports have revealed the efficacy of magnetic stimulation in diagnosis of this condition. We conducted this study to compare MMEP latency and MMEP amplitude in patients with S1 radiculopathy and healthy controls in Shohadaye Tajreash Hospital in 2007.Materials and Methods: This historical cohort study investigated 31 patients with S1 radiculopathy (according to clinical history and physical examination) and 33 healthy controls. H-reflex, MMEP latency and MMEP amplitude were evaluated in both groups. Patients and controls were not informed about the type of study and performers were unaware of the participants condition. Results were analyzed using statistical tests.Results: There was not significant difference between cases and controls regarding age and sex. Mean MMEP latency was 15.23±2.47ms and 13.42±1.6ms in patients and controls, respectively (P<0.05) and mean MMEP amplitude was 0.55±0.53µv and 1.29±1.22µv in patients and controls, respectively (P<0.06). We found abnormal MMEP latency in 12.2% of controls and 48.4% of patients (P<0.005) and abnormal MMEP amplitude in 87.9% of controls and 100% of patients (P<0.06).Conclusion: MMEP latency seems to be efficient in diagnosis of S1 radiculopathy. A study with a precise diagnostic design is recommended.

Background and Objectives: A remarkable number of out patients referred to physical medicine, orthopedic, neurologic clinics are the ones with the chief complaint of sensory-motor dysfunction in the distribution of median nerve on hands and upper limbs. Usually, it is thought these symptoms & singns are due to carpal tunnel syndrome (CTS) existence. However, in the majority of cases symptoms are not eliminated in spite of the most invasive treatments (e.g. surgical release of median nerve at wrist). Further studies such as electrodiagnosis confirm radiculopathy in these patients. Several studies in past years have estimated the synchronous prevalence of CTS and Radiculopathy to be 22 to 70 percent. On the basis of these the double crush syndrome theory has been suggested. Estimation of synchronous prevalence of CTS and radiculopathy is a way to confirm this theory.Materials and Methods: This study is a descriptive study. The patients studied were persons with the numerous complaints in the upper limb and cervical area that had existence of radiculopathy in them been confirmed by several means such as physical examination and Electrodiagnosis. 183 patients were entered in the study and they considered from the aspect of synchronous prevalence of CTS.Results: from 183 patients entered in the study, due to bilateral radiculopathies in both upper limbs in some patients, the total number of upper limbs studied was 264. Among them the existence of synchronous CTS in 96 upper limbs was confirmed (36.6%). Percentages of different roots radiculopthies prevalence were as following: C6; 75%, C7: 93.75% and C8: 3.12% Conclusion: According to 36.6% prevalence of synchronous CTS in patients with cervical radiculopathy, this rate is less than that of previous studies but more than that of recent studies.Although frequency of involved roots in this study doesn’t fit with previous studies but match with electrodiagnosis texts.

Lumbosacral radiculopathy is a challenging diagnosis, and Electrodiagnostic study (EDX) is a good complementary test for Magnetic Resonance Imaging (MRI). Physical examination, MRI and electrodiagnosis have different diagnostic values in this regard. MRI can provide anatomical evidence and is useful in choosing a treatment process, but it could also have false positive results. In this study, we assessed the correlation of clinical and electrodiagnostic findings in patients with positive MRI findings for S1 radiculopathy. EDX was performed for 87 patients referred with clinical and MRI diagnosis of S1 radiculopathy. The consistency between EDX results, MRI, and clinical findings were evaluated by Pearson chi 2 and odds ratio. Fifty-eight percent of patients had disc protrusion, and 42% had extrusion. Physical examination revealed absent Achilles reflex in 83% and decreased S1 dermatome sensation in 65%. In this study, EDX sensitivity was about 92%. The highest consistency among EDX parameters and physical examination findings was between absent Hreflex and decreased Achilles reflex (OR=6. 20, P=0. 014), but there was no significant consistency between Hreflex and neither muscular weakness nor SLR test result (P>0. 05). There was also no relationship between type of disc herniation in MRI and H reflex. There was correlation between H-reflex abnormalities and absent ankle reflex in patients with unilateral L5-S1 disc herniation in MRI. Results of this study showed that in patients with positive MRI for L5-S1 disc protrusion and S1 nerve root compression, it is still beneficial to perform EDX for selected patients.

Background: Carpal tunnel syndrome (CTS) is the most common form of localized peripheral neuropathy. CTS and cervical radiculopathy (CR) often co-occur and is known as double crush syndrome (DCS).Aim: This study aimed at determining frequency of CR in patients with CTS referred to electrodiagnosis department of Rasht Imam Reza clinic.Materials and Methods: This was a descriptive cross-sectional study on 117 patients with CTS referred to Imam Reza clinic. The patients’ data were recorded through a questionnaire including electrodiagnosis test results, patients’ demographic data, medical history, primary diagnosis and related results and electromyogram (EMG)/nerve conduction velocity (NCV) tests results. NCV test shows CTS type (unilateral and bilateral) as well as its severity, while EMG test determines co-occurrence of CR and CTS, type and severity of DCS. Finally, the data were entered into SPSS 19, and analyzed using statistical tests.Results: Out of 117 patients with primary diagnosis of CTS, 21 (17.9%) were male and 96 (82.1%) female, with a mean age of 46.5 years. The highest frequency (41.5%) in patients with CTS belonged to housewives. 48 patients (41%) had bilateral CTS and 69 patients (59%) suffered from unilateral one. 41 patients had DCS (35%): 25 patients (61%) unilateral DCS with moderate severity and mostly C7 radiculopathy (70.7%). Using binary logistic regression analysis (method=ENTER), age and body mass index (BMI) were the two effective variables on development of simultaneous CTS and cervical spines involvement (P<0.0001).Conclusion: Knowing the presence of simultaneous CR and CTS is important in treatment and surgical outcore the patients with CTS should be always examined for DCS.

Background: F-wave study, part of electrodiagnostic study, has had a controversial sensitivity in the diagnosis of lumbosacral radiculopathy.Objectives: We aimed to compare F wave parameters obtained from the tibial nerve of both extremities in patients with unilateral S1 radiculopathy.Materials and Methods: The study was done from March to September 2015 in the Electrodiagnostic laboratory of an academic hospital affiliated to Isfahan University of Medical Sciences.19 consecutive patients with clinically and electromyographically approved diagnosis of unilateral S1 radiculopathy entered the study. F-wave parameters (F minimum latency, F maximum latency, F chronodispersion and F persistence) were recorded from tibial nerve of both extremities. Patients with diabetes, bilateral S1 radiculopathy or any other disease known to affect peripheral nerves were excluded from the study.Results: Of nineteen participants, 11 were men. Their mean±SD of age was 46.6±13.7 years. There were no significant differences between mean of F wave parameters recorded from affected and unaffected sides. Also, it was shown that, there was a positive correlation between these parameters in two extremities.Conclusion: The current study compared various F-wave parameters and the results did not support employing F-wave study as a sensitive method for detecting unilateral S1 radiculopathy.