• Annals of Clinical Neurophysiology
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• v.6 no.2
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• pp.85-91
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• 2004

Background: Needle electromyography (EMG) and motor evoked potential (MEP) of the genioglossus (tongue) are difficult to perform in evaluations of the craniobulbar region in amyotrophic lateral sclerosis (ALS). Therefore, we investigated the yields of needle EMG and MEP recorded from the upper trapezius, since it receives innervation from the lower medulla and upper cervical cord. Methods: Needle EMG and MEP of the upper trapezius were obtained in 17 consecutive ALS patients. The needle EMG parameters recorded included abnormal spontaneous activity and motor unit action potential (MUAP) morphology. An upper motor neuron (UMN) lesion was presumed when either response to cortical stimulation was absent, or the central conduction time was delayed (>mean+2SD). Results: Of the five patients with bulbar-onset ALS, four had abnormalities in the upper trapezius and four in the tongue by needle EMG. In contrast, of the 12 patients with limb-onset ALS, 11 had abnormalities in the upper trapezius, and only five in the tongue. When MEP was performed, it was found that three of the five patients with bulbar symptoms and three of the six patients with isolated limb involvement had abnormal MEP findings. Conclusions: Electrophysiological studies of the upper trapezius are more sensitive those of the tongue in patients without bulbar symptoms. Thus, needle EMG and MEP of the upper trapezius are alternative tools for assessing bulbar and rostral neuraxial involvement in the diagnosis of ALS.

• Annals of Clinical Neurophysiology
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• v.1 no.1
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• pp.19-25
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• 1999

Background & Objectives : In cerebral palsy, spastic paraplegia is one of the most crippling motor manifestations. Reducing the spasticity may improve gait and decrease the incidence of lower-extremity deformities. The spasticity may result from abnormally increased afferent signals via dorsal roots onto interneurons and anterior horn and spreading of reflex activation to other muscle groups. To assess the influence of dorsal rhizotomy to spasticity, the authors analyzed five cerebral palsy patients with spastic paraplegia. Methods : The operation entailed and L1-2 laminectomy, ultrasonographic localization of conus medullaris and identification of lumbosacral dorsal roots. The innervation patterns of each dorsal root were examined by electromyography (EMG) responses to electrical stimulation. Tetanic stimulation was applied to individual rootlets of each root after reflex threshold was determined. the reflex responses were graded and rootlets producing high grade response were selected and cut. Short-term postoperative evaluations were performed. Results : Intraoperative EMG monitoring was satisfactorily performed in all five cases. One month after the operations, all patients showed greatly reduced spasticity which was measured by the instrumental gait analysis. Bilateral knee and ankle jerks were normalized and tip-toe gait with scissoring disappeared in all patients. Conclusion : Intraoperative EMG monitoring seems useful for the selective dorsal rhizotomy to reduce spasticity.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.23 no.2
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• pp.93-98
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• 2012

Botulinum toxins are the most potent toxins known to mankind. Botulinum toxin acts by blocking the cholinergic neuromuscular or the cholinergic autonomic innervation of exocrine glands and smooth muscles. Seven distinct antigenic botulinum toxins (A, B, C, D, E, F and G) produced by different strains of Clostridium botulinum have been described and only A and B type of botulinum toxins were clinically used. Toxins were consisted of a heavy chain with a molecular weight of 100 kD and a light chain with a molecular weight of 50 kD. Toxins are bound with an astounding selectivity to glycoprotein structures located on the cholinergic nerve terminal. Subsequently light chain of toxin is internalized and cleaves different proteins of the acetylcholine transport protein cascade transporting the acetylcholine vesicle from the intracellular space into the synaptic cleft. After a decade of therapeutic application of the toxin, no anaphylaxis or deaths have been reported and systemic adverse effects have not been reported so far. However the toxin's immunologic properties can lead to the stimulation of antibody production, potentially rendering further treatments ineffective. Botulinum toxin is a safe and effective treatment. Use of botulinum toxin in clinical medicine has grown exponentially in recent years, and many parts of the human body are now being targeted for therapeutic purposes.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.11 no.2
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• pp.178-184
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• 2000

Laryngeal evoked EMG is the objective and quantitative method to measure the innervation of laryngeal muscle. If there is a mobility disorder of vocal cords, the cause and location of neural lesion co be understood by the laryngeal evoked EMG and if there is a vocal cord paralysis, the degree of recovery and the policy of treatment can be determined by it. Recently, the studies of reinnervation after recurrent laryngeal nerve injury have been actively carried out. Laryngeal evoked EMC is useful to these studies. The aim of study is to know whether noninvasive methods for stimulating the recurrent laryngeal nerve and for recording of compound action potential(CAP) using surface electrode are as useful as the invasive method using needle electrode. We obtained EMG of laryngeal muscle by various stimulating and recording methods : 1) Direct nerve stimulation by placing nerve cuff electrode made out of silastic tube and platinum wire and recording by insertion of hook wire electrode into posterior cricoarytenoid(PCA) and thyroarytenoid(TA) muscles, respectively. 2) Recording of compound action potential by surface electrode after stimulation of recurrent laryngeal nerve by the insertion of 27 gauge of needle electrode. 3) Recording of compound action potential by surface electrode after stimulating the recurrent laryngeal nerve by transcutaneous blunt rod electrode at tracheoesophageal groove. The amplitude, duration and latency of the CAP evoked by recurrent laryngeal nerve stimulation were compared among the three groups. The amplitude of CAP was smallest in the group recorded from posterior cricoarytenoid and hyroarytenoid muscle, and that recorded by surface electrode after stimulation by needle electrode was largest. The difference in amplitude between the group by hook wire recording and the two groups by surface electrode recording was significant statistically. There is no significant difference in duration and latency among three groups. Since the waveform of CAP from all three methods has similar duration, latency, we concluded that noninvasive method is a useful as invasive methods.

• The Journal of Korean Obstetrics and Gynecology
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• v.23 no.4
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• pp.155-163
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• 2010

Purpose: The aim of the study was to compare the characteristics of the autonomic innervation of the heart in polycystic ovary syndrome(PCOS) patients with regulary cycling controls. Methods: We studied 21 patients visiting $\bigcirc\bigcirc$hospital from 25th June 2009 to 25th June 2010. The subjects were categorized in two groups, 11 PCOS patients and 10 healthy regularly cycling controls. We studied the difference of Heart rate variability (HRV) between two groups by Independent samples T-test using SPSS for windows(version 17.0). Results: The Standard deviation of all normal R-R intervals (SDNN), The spuare root of the sum of the spuare of difference between adjacent normal R-R intervals (RMS-SD) of PCOS group was non-significantly lower than non-PCOS group. High frequency power (HF) and Normalized high frequency power (HF norm) of PCOS group was significantly higher than non-PCOS group. Normalized low frequency power (LF norm) of PCOS was signficantly lower than non-PCOS group. The results means increased sympathetic and decreased vagal modulation. Total power (TP), Very low frequency power (VLF) of PCOS group was non-significantly lower than non-PCOS group. Low frequency power (LF), LF/HF ratio of PCOS group was non-significantly higher than non-PCOS group. Conclusion: The results suggest that PCOS can be related to decreased activity of parasympathetic nervous system.

• The Korean Journal of Pain
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• v.12 no.2
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• pp.238-241
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• 1999

Intractable pain arising from disorders of the viscera and somatic structures within the pelvis and perineum often poses difficult problems for the pain pratitioner. The reason for this difficulty is that the region contains diverse anatomic structures with mixed somatic, visceral, and autonomic innervation affecting bladder and bowel control and sexual function. Clinically, sympathetic pain in the perineum has a distinctly vague, burning, and poorly localized quality and is frequently associated with the sensation of urgency. Although various approaches have been proposed for the management of intractable perineal pain, their efficacy and applications are limited. Historically, neurolytic blockade in this region has been focused mainly on somatic rather than sympathetic components. The efficacy of neurolytic ganglion impar block has been demonstrated in treating perineal pain without significant somatovisceral dysfunctions for patient with advanced cancer in 1990. The introduction of superior hypogastric plexus block in 1990 demonstrated its effectiveness in patients with cancer related pelvic pain. In our report, five patients had advanced cancer (rectal caner 3; cervix cancer 1; metastases to sacral portion of renal cell cancer 1). Localized perineal pain was present in all cases and was characterized as burning and urgent with 9~10/10 pain intensity. After neurolytic block of ganglion impar, patients experiened incomplete pain reduction (7~8/10), as determined by the VAS (visual analogue scale), and change in pain site. We then treated with superior hypogastric plexus block, which produced satisfactory pain relief (to less than 4/10), without complication.

• The Journal of Korean Physical Therapy
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• v.26 no.5
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• pp.280-289
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• 2014

Purpose: This study was conducted in order to determine the stimulation variables which should be considered when neuromuscular electrical stimulation (NMES) is applied for a muscle under the normal innervation to minimize muscle fatigue and increase force-generating ability. Methods: A total of 23 healthy men participated in the study and all subjects were randomly assigned to the 1:1 group, 1:3 group, 1:5 group, and control group with on-off ratio of NMES. The subjects performed a fatigue task, consisting of 10 times of isometric contraction sustained by NMES. NMES using Russian current stimulation was applied to muscle fatigue and divided into three sessions by pulse frequency (10 bps, 30 bps, 90 bps). The EMG was recorded using an MP 100 system from the quadriceps femoris muscle in four groups. Results: The differences of delta MdF and delta MF of between on-off ratio groups of 10 bps, 30 bps, and 90 bps pulse frequencies were very significant (p<0.05). According to the results of post hoc of 10, 90 bps, it was greater in the 1:1 group and the 1:3 group compared with the 1:5 group, and no fatigue was observed in the control group. In 30 bps, it was greater in the 1:1 group compared with 1:3, 1:5, and control group (p<.05). Conclusion: Among NMES variables to minimize muscle fatigue, the larger on-off ratio by pulse frequency showed the lower muscle fatigue. Therefore, on-off ratio needs to be great enough, and will be more efficient with the frequency 30 bps rather than of 10 bps and 90 bps.

• Journal of Physiology & Pathology in Korean Medicine
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• v.27 no.4
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• pp.374-382
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• 2013

In Oriental medicine, urinary incontinence is defined involuntary voiding of urine. This study was performed to investigate the treatment on urinary incontinence through the literature of oriental medicine. This study reviews the therapy method of urinary incontinence based on 63 books of oriental medicine and 20 papers about the treatment of urinary incontinence. Herbal medicine has been used as urinary incontinence treatment. One of herbal remedy is selected according to the symptoms, and then herbal products are supplemented such as warm-hot, convergence medicines. Acupuncture and moxibustion therapy has been performed with herbal medicine, electroacupuncture, pharmacopuncture, conservation therapy such as Kegel exercise, timed voiding and extracorporeal magnetic innervation for incontinence treatment. The treatment of urinary incontinence by oriental medicine includes auricular acupuncture, external medical treatment and taoist methods. There is a lack of related study about these therapy.

• Archives of Plastic Surgery
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• v.33 no.5
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• pp.557-562
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• 2006

Purpose: Advanced carcinoma of the tongue is a devastating disease which may cause severe speech or swallowing dysfunction. But, none to date has provided all of the complex functions of the tongue. The purpose of this study is to review our experiences with individuals who underwent glossectomy followed by reconstruction using free tissue transfer. Methods: Between February 1998 and February 2005, twenty-four patients underwent glossectomy followed by free tissue transfer reconstruction. The defects of tongue caused by partial or subtotal glossectomy were reconstructed by means of radial forearm or lateral thigh free flap with nerve innervation. Especially for the patients who underwent total glossectomy, we reconstructed deglutition muscles anatomically with nerve reinnervation, a procedure that allows the grafted muscle to maintain good tongue bulk without obvious atrophy. Results: Patients were reviewed to determine their functional outcome as it related to speech, deglutition, and aspiration. All patients achieved oral intake of a soft diet and acceptable speech. Conclusion: Although reconstruction following glossectomy using free tissue transfer is not ideal, this procedure is safe and reliable, and provides predictable results. A future challenge is the development of a surgical procedure for reconstruction of a tongue that maintains mobility and sensation using neurotized flaps.

• Proceedings of the Korean Society for Emotion and Sensibility Conference
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• 2000.04a
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• pp.290-300
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• 2000

One of the most important topics in attentional and emotional modulation of cardiac responses is time course of cardiac chronotropic response. The reason lies in dual innervation of heart, which leads to occurrence of several phases of cardiac response during exposure to affective stimuli, determined by the balance of sympathetic and parasympathetic influences. Cardiac chronotropic reactivity thus represents quite effective measure capable to trace the moment when attending and orienting processes (i.e., sensory intake of stimulus) prime relevant behavioral response (ile., emotion with approach or avoidance tendencies). The aim of this study was to find the time course of heart rate (HR) responses typical for negative (disgust, surprise, fear, anger) and positive (happiness, pleasant erotic) affective pictures and to identify cardiac response dissociation for emotions with different action tendencies such as "approach" (surprise, anger, happiness) and "avoidance" (fear, sadness, disgust). Forty college students participated in this study where cardiac responses to slides from IAPS intended to evoke basic emotions (surprise, fear, anger, sadness, disgust, happiness, pleasant-erotic). Inter-beat intervals of HR were analyzed on every 10 sec basis during 60 sec long exposure to affective visual stimuli. Obtained results demonstrated that differentiation was observed at the very first 10s of exposure (anger-fear, surprise-sad, surprise-erotic, surprise-happiness paris), reaching the peak of dissociation at 30s (same pairs plus surprise-disgust and surprise-fear) and was still effective for some pairs (surprise-erotic, surprise-sad) even at 50s and 60s. discussed are potential cardiac autonomic mechanisms underlying attention and emotion processes evoked by affective stimulation and theoretical considerations implicated to understand the role of differential cardiac reactivity in the behavioral context (e.g., approach-avoidance tendencies, orienting-defense responses).