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The 8th Summer School of ASNER, The Romanian Society of

Electrodiagnostic Neurophysiology

SDV2018, Eforie Nord, Romania14-16 July 2017

Abstract book

www.asner.org

ASNER SDV2017 Eforie Nord, 14-16 July 2017– Abstract book8th Summer School of the Romanian Society of Electrodiagnostic Neurophysiology

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Scientific partners:

SocietateaNațională deNeuroștiințe

.RO


Dear Friends,

It’s again July, and that means it is again time for theSummer School in Clinical Neurophysiology. We arenow starting this scientific event for the 8th time, so Isuppose we are entitled to call it a tradition. Some ofyou have participated every year, many of you haveattended this school a few times, and others arenewcomers, but all of us have one thing in common,namely our passion for neurophysiology. We haveprepared a scientific program that will contain aplenary session, and, workshops in both EEG, EMG.Again, we have important guests who have acceptedour invitation for this event.

So we are expecting two days of intense scientificactivity, in a beautiful environment, and maybe willtake a few minutes to enjoy the beautiful beach andthe sea, to chat, to make new friends.

Welcome to the 8th Edition of the Summer School inClinical Neurophysiology !

Sincerely,

Tudor Lupescu M.D. Ph.D.

ASNER President

[email protected]

http://www.asner.org

https://www.facebook.com/asner.org/

Ioana Mindruta, M.D. Ph.D.

ASNER Vice-President

Neurology Department, “Carol Davila” University ofMedicine and Pharmacy, Bucharest, Romania

[email protected]

Ionela Codita, M.D. Ph.D.

ASNER Secretary

Neurology Department of Elias UniversityEmergency Hospital, Bucharest, Romania

[email protected]

Ana-Maria Cobzaru, M.D.

ASNER Treasurer

Neurology Department, “Carol Davila” University ofMedicine and Pharmacy, Bucharest, Romania

[email protected]

Mihai Moldovan, MD, PhD

ASNER Scientific director

Copenhagen University, Denmark and “Carol Davila”University of Medicine and Pharmacy, Bucharest,Romania

[email protected]

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Friday July 8th

12.00 – 13.00 Welcome cocktail

13.00 – 13.15 – Opening remarks

13:15-14:15 Sudoscan (20 min presentation + 40 minworkshop)

14:15-16:15 EMG workshop

Painful legs and moving Toes - recognize what youknow (Mircea Moldovan)

Case presentation (Ana-Maria Cobzaru )

Electrodiagnostic Examination (Christian Krarup)

Blink reflex (Mircea Moldovan)

16.15 - 16.30 Coffee Break

16.30 -18.00 EEG workshop - video EEG long termmonitoring

Video EEG long term monitoring: How to recordseizures or other clinical events - Irina Popa

Video EEG monitoring - Seizure onset patterns couldpredict global seizure dynamics (Mihai Malaia)

Video EEG monitoring in children - general setup andobjectives (Oana Tarta)

Free time

Saturday, July 9th

Plenary Session 1 (Chair Tudor Lupescu)

9:00-10:00 Neurogenic disorders vs myopathy(Christian Krarup)

10:00-10:15 EMG – Waveforms and cases (TudorLupescu)

10:15-10:45 Nerve excitability testing –“introduction” (Mihai Moldovan)

10:45-11:00 Coffee break

Plenary Session 2 (Chair Ioana Mindruta)

11:00-11:20 Connectivity in the brain - gaininginsight in the epileptogenic networks (IoanaMindruta)

11:20-12:00 Hippocampal sclerosis (Sanda Petrutiu)

12:00-12:20 FDG PET/CT scan studies - techniqueand application in epilepsy (Oreste Straciuc)

12:20-12:40 PET scan and anatomo-electro-clinicalcorrelation in focal epilepsy - Anca Arbune

12.40-13.00 Merk Symposia (20 min)

13.00-15:00 – Lunch

15:00 - 16.30 Nerve excitability testing – “hands-on”

(Mihai Moldovan)

16:30-17:00 Coffee Break

17.00 -18.30 EEG workshop - Semiology of epilepticseizures - recordings and testing

Irina Popa - semiology of seizures in adult population

Semiology of seizures in children (Oana Tarta)

Cognitive testing during video EEG monitoring(Andrei Daneasa)

Discussion

19.00 Get together dinner

Sunday, July 10th

9.00-12.00 cases/presentations (Chair IonelaCodita)

Neuralgic amyotrophy - case report (Ionela Codita)

Lateral plantar nerve neuropathy (Andreea Moldovan)

Common peroneal nerve palsy due to type-2 diabetesmellitus and rapid weight loss – a case report (M. M.Martoiu)

EMG Quiz/ Discussions4


The neurophysiological examination is an extensionof the clinical neurological examination, and thereforeit should be based on the history and objectivefindings. This relationship will be presented in caseswith motor and sensory symptoms and will includedifferential assessment of neurogenic weakness andmyopathy. The presentation will include the differentmethods that are applicable in these situations, and itis the hope that interaction with the audience will leadto a fruitful dialogue.

Education and training:

CK received his MD from the University ofCopenhagen in 1975 and trained in Neurology andClinical

Neurophysiology at Rigshospitalet (Copenhagen),Queen Square (London) and NINCDS (NIH,Bethesda).

He received his Doctorate in Medical Sciences onstudies on excitation-contraction coupling in striatedmuscle in 1984.

Appointments:

CK was appointed Visiting Scientist at NIH (1982-84); Chief of Clinical Neurophysiology (Brigham &Women’s Hospital, Boston), Assistant/AssociateProfessor (Harvard Medical School), andResearchAssociate (MIT) (1984-1990); Head of theDepartment of Clinical Neurophysiology (1992-2015)and Senior Consultant (Rigshospitalet, Copenhagen)and Professor of Clinical Neurophysiology (2015 –current).

Awards and Honors:

1978, First Prize for research proposal, MuscularDystrophy Group of Denmark

1988, Annual Prize of the Polio Foundation ofDenmark

1991, Elected member (corresponding) of theAmerican Neurological Association (ANA)

1999, Muusfeldt-prize for research inElectrophysiology

2003-2004, President of the European NeurologicalSociety

2003, Honourary Fellow of the Royal College ofPhysicians London (FRCP)

2015, Honourary Fellow of the European Academy ofNeurology (FEAN)

Neurogenic disorders vs myopathy

Department of Clinical Neurophysiology, theNeuroscience Center, Rigshospitalet

Department of Clinical Medicine and Center forNeuroscience, University of Copenhagen

Christian Krarup

Christian Krarup

MD, DMSc, FRCP, FEAN

Professor of ClinicalNeurophysiology

[email protected]

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Electromyography is a beautiful tool in the hands ofphysicians. Specialized in neuromuscular disorders.In many cases, changes in some numerical parametersand configuration of waveforms point very exactlyabout the nature of a disease, it’s stage, sometimesduration, and evolution, and also may also suggestappropriate treatment. The presentation will showsuch situations and demonstrate that, EMG with fariclinical reasoning cn be very helpful.

Tudor Lupescu obtained his medical degree from“Carol Davila” University of Medicine in Bucharest,in 1989. After 3 years of training at Colentina ClinicalHospital he became Specialist in Neurology in 1994.Since 2006 he is running the Neurology Departmental Agrippa Ionescu Hospital in Bucharest. 1998, hequalified as Consultant Neurologist. Since his earlyyears of training in Neurology, Tudor Lupescu hasshown a special interest in Clinical Neurophysiology.In 2000 he earned a Competence in ClinicalNeurophysiology (EEG, EMG, and EvokedPotentials). 1997 he was the first to use TranscranialMagnetic Stimulation in Romania. This was also thesubject of his PhD thesis presented in 2005. Since2008, Tudor Lupescu is President of ASNER –Romanian Society of ElectrodiagnosticNeurophysiology. He is also founding member andvicepresident of the the Romanian Society of DiabeticNeuropathy.

Dr Tudor Lupescu is associate memberof the American Academy of Neurology, andassociate member of the American Association ofNeuromuscular and Electrodiagnostic Medicine.Between 2008 and 2014 he was also member of theNeurophysiology Subcommittee of ENS, and since2015, he is member of the NeurophysiologySubcommittee of the European Academy ofNeurology.

EMG – Waveforms and cases

Tudor Lupescu,

Tudor Dimitrie Lupescu

MD, Ph.D.

[email protected]

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Agrippa Ionescu Hospital, Bucharest

RoNeuro Institute for Neurological Research andDiagnosis


In the the human brain, the term “connectivity” refersto structural, functional or effective connectivity.Intracranial electrical stimulation represents the mostdirect way of investigating the effective connectivity,as it is based on the same type of signals the brainnormally uses. A method that maps the effectiveconnectivity revealed by the electrical stimulation ofepileptogenic and non-epileptogenic brain structuresto assemble an effective connectome (EC). In patientswith refractory epilepsy implanted with depthelectrodes for presurgical evaluation effectiveconnectivity was assesed by analyzing the responsesto single pulse electrical stimulation (SPES).Stimulation pulses having variable amplitude wereapplied to each pair of adjacent contacts andresponses evoked by stimulation were recorded fromother contacts located in other brain areas. Earlyresponses (10–110 ms) on the stimulation-activatedcontacts were weighted by the epileptogencity of eacharea and averaged for each patient, resulting in apatient-level physiological effective connectome(EC). The population level EC is computed byaveraging the connections of the individual ECs, on astructure by structure basis. The effective connectomecan be used as a reference tool for differential analysisof altered versus normal brain connectivity inepileptic patients.

48-year old, neurologist, with competence inelectrophysiology and special interest in epileptology,mainly invasive presurgical exploration for epilepsysurgery, neurostimulation and brain connectivity. PhDthesis on “Sleep studies in epileptic syndromes” in2006.

Current position at the University EmergencyHospital in Bucharest in the Epilepsy and SleepMonitoring Unit and also hospital coordinator of theNational Programs for Pharmacoresistant Epilepsyand Rare Disorders.

Academic affiliation - lecturer in neurology at theUniversity of Medicine and Pharmacy “Carol Davila”of Bucharest.

Vicepresident of Romanian Association for ClinicalElectrodiagnosis (ASNER) since 2009.

Connectivity in the brain - gaining insight in theepileptogenic networks

Ioana Mindruta

Lecturer, MD, PhD

[email protected]

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1Neurology Department, University EmergencyHospital, Bucharest, Romania

2Neurology Department, Carol Davila University ofMedicine and Pharmacy, Bucharest, Romania

3Physics Department, University of Bucharest,Bucharest, Romania

4Neurosurgery Department University of Texas,Health Science Centre at Houston, TX

5Neurosurgery Department, Bagdasar-ArseniEmergency Hospital, Bucharest, Romania

6FHC Inc, Bowdoin ME, USA

Ioana Mindruta 1,2, Cristian Donos 3,4, Jean Ciurea5, Andrei Barborica 3,6


Conventional nerve conduction studies provideinformation about the number of conducting axons aswell as their conduction velocity along theinvestigated segment, a surrogate marker ofmyelination. In contrast, nerve excitability testingasses ion channel function and resting membranepotential at the site of stimulation providing an uniqueinsight into the disease mechanisms.

From the patients’s perspective, excitability testing isa simple continuation of conventional studies. Thetest is commonly performed on the median nervemotor and sensory axons stimulated at wrist. A testtakes about 15 minutes and consists of a sequence ofmeasures controlled automatically by a computer: 1)charge-duration, threshold electrotonus, current-threshold and recovery cycle. Results are given as aset of numeric excitability indices derived from themeasures. Deviations from control values isinterpreted based on a increasing number of literaturereports in different pathologies. A mathematicalmodel is available to aid the interpretation.

The presentation will illustrate “hands-on” thepractical steps leading to recording/analysis of annerve excitability test and illustrate the interpretation.

Mihai Moldovan obtained his medical degree from“Carol Davila” University Bucharest in 1999 and PhDdegree in neurophysiology from CopenhagenUniversity in 2004 where he continues his academiccareer.

•2016, ‘P.K.Thomas’ prize of the European Academyof Neurology.

• Since 2014, elected full member in the EuropeanDana Alliance for the Brain (EDAB).

• Since 2013, serving on general council of Federationof European Neuroscience Societies (FENS) andInternational Brain Research Organization (IBRO).

• Since 2012, President of the National NeuroscienceSociety of Romania (SNN), a FENS member.

• Since 2012, editorial board member for ClinicalNeurophysiology, the official scientific journal of theInternational Federation of Clinical Neurophysiology(IFCN).

• Since 2009, Scientific director of the Romaniansociety for electrodiagnostic neurophysiology(ASNER), an IFCN member.

• Since 2009, Invited professor and research directorassociated to the Department of Physiology andFundamental Neurosciences, "Carol Davila”University of Medicine and Pharmacy, BucharestRomania;

Nerve excitability testing – “hands-on”

1) Copenhagen University DK;

2) Carol Davila University, Bucharest, RO

Mihai Moldovan (1,2)

Mihai Moldovan

Assoc. Prof., MD, Ph.D.

[email protected]

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Painful legs and moving toes syndrome is a raredisorder. In the1971-2010 interval, there werepublished data only about 72 patients.

The syndrome is characterized by spontaneous pain inthe lower limbs, associated with involuntarymovements of the fingers and toes, sometimes of thefoot. The diagnosis is mainly clinical.

Electrodiagnostic examination with surface electrodesregisters the movements of flexion, extension of thefingers, and feet as an actogram or brief musclecontractions.

Usually, treatment consists in therapy with physicalagents, medication with anticonvulsants, andbenzodiazepines, which seem to be the more effectiveGABAergic agents.

We present the case of a patient 70+ yrs. old,suspected of polyneuropathy in the context of a type 2Diabetes mellitus, under oral medication for pains inthe lower limbs with sensation of numbness andfrequent muscle cramps.

Clinical myotatic reflexes are present, with superficialdistal monofilament hypoesthesia 0.5 measuringrange, with deep vibration sense tuning fork 64Hz/6thdegree.

Neuro-graphic parameter values were compatible withmixed, predominantly axonal polyneuropathyaddiction long declassification Dyck 1a. During theexamination were observed involuntary, spontaneous,independent movements; irregular and bilateral,known to the patient from a long time. Registeringwith surface electrodes evidenced pseudo-rhythmicmovements of interosseous leg muscles and EDBmuscle, of 100-300 ms duration.

Clinical and Electrodiagnostic was appreciated as asyndrome of painful legs with involuntary movementsof fingers.

Conclusion: Semiology knowledge contributes to amore accurate diagnosis of some rarer diseases.

Dr. Mircea Moldovan, graduate of the “Carol Davila”University Bucharest, Doctor of Medical Sciences,MD is a neurologist at the Hospital “Elias” Bucharestsince 1968. Throughout his career, he had acontinuous interest for clinical neurophysiology. Inthe 80s, his main interest was the EEG and evokedpotentials under the guidance of Prof Dr VVoiculescu. In the 90s, his interest expanded to theperipheral conduction studies and EMG. During hispioneering work in Romanian clinicalneurophysiology, Mircea Moldovan advocated thediagnostic importance of clinical neurophysiology forneurological practice through talks at nationalscientific meetings and scientific publications. Mostimportantly, however, through his wealth of practicalexperience and didactic spirit, he helped initiate inclinical neurophysiology generations of youngneurologists. During the last decade, with thetransformation of “Elias” hospital neurology into auniversity department and re-formalizing his skills inEMG (2003) and EEG (2004), Dr. Mircea Moldovandeveloped his preoccupation for clinicalneurophysiology teaching. Together with Dr. IonelaCodita he carries out practical demonstrations of post-graduate courses organized by Professor Dr. PaneaEMG. In addition, Dr. Mircea Moldovan contributedto re-launch of the clinical neurophysiology society inRomania as founding member of ASNER 2009.

Painful legs and moving toes: Recognize wat youknow

Neurology Department of Elias University EmergencyHospital, Bucharest

Mircea Moldovan, Cecilia Albu, Ionela Codita, EGeorgescu

Mircea Moldovan

MD, PhD

[email protected]

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Reflexul de clipire (Blink reflex)-metoda tehnicaelectrofiziologica simpla

Reflexul de clipire este o metoda tehnicaelectrofiziologica de explorare a nervilor cranienitrigemen si facial putand detecta anomalii la nivelulintregului arc reflex de conexiune al acestora Seprezinta 3 situatii care arata importanta efectuariiacestei metode ,simple,rapide si relevante -boalaCMT tip 1 -polineuropatia cronica inflamatorie -paralizia internucleara.


Brachial neuritis, also known as neuralgicamyotrophy or Parsonage Turner Syndrome, is a raresyndrome, of unknown etiology, affecting mainly thelower motor neurons of the brachial plexus orindividual nerves.

We present a case of a 37 year-old male, complainingof acute onset of left shoulder pain, followed byproximal weakness of the left arm and leftsupraspinatus, infraspinatus and deltoid musclesatrophy.

Nerve conduction studies were performed for thesuperior limbs but there were not found anyabnormalities compatible with scapular neuropathy orupper brachial plexopathy.

Needle EMG showed denervation in the deltoid,suprascapular , infrascapular si romboid muscles.

The examination of paraspinal muscles offered proofagainst C5-C6 radiculopathy , leaving viable a singlediagnosis that is of neuralgic amyotrophy.

Ionela Codita is currently working as a SeniorNeurologist in the Neurology Department of EliasUniversity Emergency Hospital in Bucharest.

She earned a Competence in ClinicalNeurophysiology in 2005. During her practice, dr.Codita attended many courses and teaching programsin the field of Clinical Neurophysiology such as:scholarship in Neuro-physiopathology field atPoliclinical Institute of San Donato Milanese, Italy(2002-2004), “Training Course in EMG andNeurography”-Uppsala, Sweden (2009), InternationalSFEMG and QEMG Course–Kobe, Japan (2010),VIREPA distance learning courses on “EEG in thediagnosis and management of epilepsy – BasicCourse 6th edition” (September 2011- March 2012)and “EEG SCORE course-1st edition”( November2012-March 2013), the international educationalcourse “Dinalund Summer School on EEG andEpilepsy” (July 2012) and educational course:”Brainstem and Peripheral Nervous System-Neurophysiological Monitoring”- Groningen,Netherlands (Nov 2016).

She manifests interest in Peripheral Neuropathies,Motor Neuron Diseases, Myopathies andIntraoperative Neuromonitoring. Dr. Ionela Codita isa member of the Romanian Society of Neurology andshe is the Secretary of ASNER-The RomanianAssociation for Clinical Electrodiagnosis, since 2013.

Neuralgic amyotrophy - case report

Ionela Codita,

Andreea Banica, Maria Melania Martoiu, MadalinaVoichtescu

Neurology Department of Elias University EmergencyHospital, Bucharest

Ionela Codita

MD

[email protected]

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Hippocampal sclerosis (HS) was first described byBouchet and Cazauvielh in 1825. Later the termmesial temporal sclerosis (MTS) was used to definethe histopathological complex of alterations in theamygdala, uncus and temporal lobe often associatedwith HS. This includes a distinctive pattern ofneuronal loss, gliosis and reorganisation in thefollowing sectors: CA1, CA3 and CA4, relativelysparing CA2. HS can be detected using MRI(increased signal on T2 weighted images and FLAIR,decreased signal on T1). HS is believed to causeabout 20% of all epilepsies in adults and isresponsible for about 86% of neurosurgicalprocedures. The etiology and pathogenesis of HSremains unclear. A previous history of febrile seizuresand status epilepticus during the first years of life arethe most common antecedents and possible cause forHS. It is still unknown whether previous abnormalityin the hippocampus existed or not. Dual pathologydefines the finding of coexistent HS and otherhistological alteration such as: microdisgenesis,cortical dysplasia, hamartomas, small tumors andcavernomas (5-20%). It was difficult to demonstratethat patients with pharmacoresistant, temporalepilepsy suffer from continuous hippocampal damage.

Clinical presentation is typical. EEG pattern isalready well known. Several studies have concludedthat patients with MTLEHS are more likely todevelop intractable seizures than patients with otherMRI abnormalities. Without surgery the prognosis ofmedically refractory patients with MTLEHS isrelatively poor. We consider that as many patients aspossible with MTLEHS which is resistant to medicaltreatment should benefit from surgical treatment.

Am absolvit facultatea de Medicină Generală încadrul UMF Iuliu Haţieganu Cluj Napoca în anul1985. Din anul 1991 îmi desfăşor activitatea înClinica Neurologie I din cadrul Spitalului ClinicJudeţean de Urgenţă Tîrgu Mureş. Din anul 1999 suntmedic primar neurolog. Începând cu anul 2004 înurma cursurilor de electroneurofiziologie (EEG, PE,EMG) efectuate la Spitalul Clinic Colentina Bucureştişi la Spitalul Clinic Universitar Elias Bucureşti amobţinut comptenţa în electroencefalografie. De atuncidomeniul principal de activitate a fost epilepsiaparticipând activ la cursuri, congrese, studii clinice. Încadrul clinicii şi ambulatorului de specialitate deneurologie monitorizez şi conduc tratamentulpacienţilor epileptici, mulţi dintre aceştia beneficiindşi de examinare video EEG.

Hippocampal sclerosis

Spitalului Clinic Judeţean de Urgenţă Tîrgu Mureş

Petruţiu Sanda Hortensia

Dr. Petruţiu Sanda Hortensia

[email protected]

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Epilepsy is characterized by transient alterations inbrain synchronization resulting in seizures with awide spectrum of manifestations. Seizure severity andrisks for patients depend on the evolution and spreadof the hypersynchronous discharges. Information onthis not only would improve our understanding ofictal epileptic activity but is also of interest toovercome present-day limitations to EEG-basedwarning and intervention systems, allowing toprovide specific reactions to upcoming seizure types.Here, we investigate the possibility to predict thefuture development of an epileptic seizure during thefirst seconds of recordings from their electrographiconset zone. Based on intracranial EEG recordings of493 ictal events from 26 patients from the EuropeanEpilepsy Database and the Epilepsy Center ofFreiburg University Hospital, a set of 25 time andfrequency domain features was computed, using non-overlapping one second time windows, from the firstthree, five or ten seconds from the seizure debut.Three random forest classifiers were trained to predictthe future evolution of the seizure, to distinguishbetween subclinical events, simple partial, complexpartial and secondarily generalized seizures. Resultsshow that early seizure type prediction is possiblebased on a single EEG channel located in the seizureonset zone with correct prediction rates of 76.2% ±14.5% for distinguishing subclinical electro-graphical events from clinically manifest seizures,75% ± 16.8% for distinguishing partial fromsecondary generalized seizures, and 71.4% ± 17.2%for distinguishing between simple and complexpartial seizures. These findings provide the basis fordeveloping systems for specific early warning ofpatients and healthcare providers, and for targetingEEG-based closed-loop intervention approaches toelectrographic patterns with a high inherent risk tobecome clinically manifest.

28 year old, 3rd year neurology intern at theUniversity Emergency Hospital Bucharest with aspecial interest in epileptology. Graduated UMF“Carol Davila” Bucharest with honors (3rd of mypromotion). Involved in the Romanian EpilepsySurgery Program with work and experience focusedupon presurgical evaluation, implantation design viathe SEEG technique, invasive monitoring and directelectrical stimulation, resection proposal,intraoperative functional mapping and postoperativefollow up. Completed 2 grants: 3 months EANDepartment to Department Co-operation in FreiburgEpilepsiezentrum, Germany and 6 months IFCNResearch Award in Danish Epilepsy Center,Dianalund, Denmark. Member of InternationalLeague against Epilepsy, International Federation ofClinical Neurophysilogy and E-pilepsy Consortium.Research interest in electrophysiology, in particularconnectomics, brain mapping, biomarkers of theepileptogenic zone and electrical source imaging.Published original research abstracts and articles, onebook chapter and held awarded speeches at Europeanevents in the field. As non-medical interests I ampassionate about all fields of cognitive sciences butespecially keen on the study of consciousness and thephilosophical literature derived from it.

Seizure onset patterns could predict global seizuredynamics

Neurology Department, University EmergencyHospital, Bucharest, Romania

Mihai Dragos MALIIA,

Cristian Donos, Ioana Mindruta, MatthiasDümpelmann, Andreas Schulze- Bonhage

Malaia Dragos-Mihai, MD

[email protected]

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In childhood, because of the lack of maturation of thebrain, epileptic seizure could have different clinicaldata comparing with adults.

Because there are a lot of epileptic syndromes atdifferent ages with different types of semiology, someof them with specific treatment, the completediagnosis is necessary.

Only using long term video-EEG recording andseeing clinical data concomitant withelectroencephalography background, the correctclinical description is possible.

This presentation will exemplify different types ofepileptic seizures in children at different ages, inorder to create a pattern-recognition for advancedneurologists who treat epilepsy at all ages.

Semiology of seizures in children

Clinica De Neurologie Pediatrica, Spitalul Clinic DePsihiatrie 'Al Obregia', Bucuresti, Romania

Oana Tarta Arsene

Epileptic or atypical paroxysmal events in childrenare very frequent. Because most of the times, whenthe neurologist is consulting the child, he doesn’thave any of the events, the diagnosis is made after thehistory described by the parents or a home videorecording which most of the time is not complete.

Because there are a lot of nonepileptic paroxysmalevents or drug resistant seizures in children, in orderto have a correct diagnosis a specialized recording isneeded.

Using different clinical cases, this presentation willunderline the stages of recommendation, evaluationand conclusion of video-EEG monitoring in childrenof different ages and different pathologies.

Video EEG monitoring in children (general setupand objectives)

Clinica De Neurologie Pediatrica, Spitalul Clinic DePsihiatrie 'Al Obregia', Bucuresti, Romania

Oana Tarta Arsene

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Una din cauzele leziunilor nervilor periferici este sicompresiunea cronica in anumite ”tuneluriosteoligamentare “ , unde nervii sunt vulnerabili prinsituarea lor intre os si canalul ligamentar. In acestecazuri una din portiuni este mobila si determina prinmiscare repetata afectarea functiei motorii sausenzitive.

Compresiunea nervului tibial in spatele maleoleimediale este mai putin frecventa si afectarea nervuluicutanat lateral este mai putin obisnuita .

Se prezinta cazul unei paciente IA,18ani, cunoscutacu luxatie bilaterala de sold corectata ortopedic ,examinata pentru parestezii pe partea externa apiciorului stang in afara zonelor de inervatie alenervului peroneal superficial si nervului sural .

Examenul clinic si cel neurografic au fost compatibilecu o leziune de nerv cutanat lateral in contextulmodificarilor pozitionale determinate de valg gleznabilateral .

Lateral plantar nerve neuropathy

SUU Elias, Bucuresti, Romania

Andreea Moldovan

Mircea Moldovan

Background:

The common peroneal nerve – terminal branch of thesciatic nerve – provides the dorsiflexion of the footand toes, abduction and external rotation of the leg,while also supporting the arch of the foot. Commonperoneal nerve palsy is the most common disorder ofthe inferior legs, due to various causes.

Objectives, method and results:

We are presenting the case of a 57-year-old woman,smoker, with history of alcohol abuse and high bloodpressure, admitted in the Neurology Department ofthe Elias Emergency Hospital for weakness in theright leg (distally) and postural instability with acuteonset, following important weight loss (~ 20kg duringthe last couple of months). Clinical examination –distal right crural monoparesis, posture of adduction,internal rotation and foot drop, limited dorsiflexion,abduction and eversion of the foot, stepped gait,hepatosplenomegaly. Bloodwork – high bloodglucose levels, high level of HbA1c (12,6%), hepaticcytolysis, thrombocytopenia, positive markers forhepatitic virus C, presence of oncological biomarkers(alpha-fetoprotein, CA 19-9, CEA). Native cerebralCT scan without lesions. Electroneurography showsfocal right common peroneal nerve neuropathy, withconduction block at the level of the fibular head.

Conclusion, discussion:

The neurological symptoms associated with commonperoneal nerve dysfunction can be taken into accountwhen facing rapid and important weight loss, severede nutrition and decompensation of a type-2 diabetesmellitus. The individual symptoms in this particularcase (muscle weakness and postural instability) wereconsidered the manifestation of the recentlydiagnosed decompensated type-2 diabetes mellitus ina patient with microangiopathy and severe denutritionand immunosuppressive disease (chronic C virushepatitis) – in process of investigation for neoplasticethicology .

Common peroneal nerve palsy due to type-2diabetes mellitus and rapid weight loss – a casereport

1 Neurology Department, Elias Emergency Hospital,Bucharest, Romania

2 „Carol Davila” University of Medicine andPharmacy, Bucharest, Romania

M. M. Martoiu1, A. Bănică1, L. Popa1, I. Codiţă1, C.Panea1,2, Simona Petrescu1,2

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Cancer versus epilepsy. It is difficult to compare twodiseases and somehow useless, but the dramaticimpact of human life in the same.

Goal of nuclear medicine and medical imagingcombined in PET/CT technology is nowadays mainlycancer diagnostic. Yet the evaluation of brain functionmust be at least at the same level of concern.Detecting a glucose uptake defect in a focal epilepticpatient may give a chance to an appropriate surgicaltreatment. Therefore in this material we want topresent the value of FDG PET/CT in diagnostic ofintractable epilepsy. Definition of the method andradiotracer, basic principle and description of theinvestigation steps and case reports are included afteran experience of more than 1 year of activity and 73epileptic patients scanned in Pozitron DiagnosztikaPET/CT center from Oradea.

Adjustment of PET scan protocol, fusion withdedicated MRI exam and co-registration of dataattached to the clinical scenario and EEG profile areequal important for an accurate diagnostic.Interdisciplinary approach and team work directed byneurologist is the proper conclusion.

Data şi locul naşterii: 09.05.1965, Oradea

Absolvent al Universităţii de Medicină şi FarmacieTimişoara - 1991

Medic primar radiodiagnostic din 2003 cu competenţeîn Ecografie, CT, IRM si PET/CT

Doctor in stiinte medicale din anul 2004

Conferenţiar universitar în anatomie, radiologie şiimagistică medicală,

Şef disciplina – radiologie, Facultatea de Medicină şiFarmacie,

Universitatea din Oradea

Medic şef – Centrul PET/CT Pozitron-DiagnosztikaOradea din anul 2008, Centru ce a primit in 2013acreditarea EARL din partea Societatii Europene deMedicina Nucleara. In activitatea de 9 ani au fostinvestigati peste 10.000 de pacienti oncologici,respectiv 50 pacienti cu epilepsie.

Membru al Societatii Romane de Radiologie siImagistica Medicala

FDG PET/CT scan studies - technique andapplication in epilepsy

PET/CT Pozitron-Diagnosztika, Oradea

Oreste Straciuc,

Ioana Mandruta, Dana Craiu, Oana Tarta-Arsene,Crenguta Oncu

Assoc. Prof. Oreste Straciuc

MD, PhD

[email protected]

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