• Radiation Oncology Journal
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• v.24 no.2
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• pp.88-95
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• 2006

Purpose: We evaluated whether Cyberknife radiosurgery is an effective and safe method of therapy for medically intractable trigeminal neuralgia (TN). Materials and Methods: We retrospectively analyzed the outcome of 26 patients, who failed to surgery or were not suitable candidates for invasive intervention and were treated by Cyberknife radiosurgery between March 2004 and May 2005. Radiosurgery doses of $60{\sim}64 Gy$ were delivered to the 80% isodose line prescribed to an 6 mm length of the nerve, sparing the most proximal 3 mm away from the trigeminal nerve root entry zone (median dose: 64 Gy). Results: Follow-up period was $3{\sim}15$ months (median follow-up period: 9 months) Preliminary results from a cohort of 26 patients undergoing Cyberknife radiosurgery for TN showed that pain relief was achieved in 50% (13/26) of patients within the first 24 hrs after treatment. At last follow-up, 96.2% (25/26) of patients reported early pain relief within 7 days. Treatment failure developed in 2 of 26. Poor response occurred in one patient and relapse was observed in the other patient. 3 patients had hypoesthesia (11.5%), which was the only complication observed with any of our patients. Conclusion: With these results, authors assumed that Cyberknife radiosurgery for TN could be one of safe and effective therapeutic methods.

• Journal of Korean Neurosurgical Society
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• v.40 no.5
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• pp.336-341
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• 2006

Objective : The authors conducted a retrospective study to evaluate the preservation rates of serviceable hearing and to determine its prognostic factors after gamma knife stereotactic radiosurgery[GK SRS] in the patient with vestibular schwannomas. Methods : Between December 1997 and March 2005, 54 patients with a sporadic vestibular schwannoma and serviceable hearing [Gardner Robertson grade I-II] were enrolled in this study. Electronic database of medical records and radiological examinations before and after GK SRS were investigated to the last follow up. The mean marginal dose was $12.3{\pm}0.7Gy$. The mean maximum dose delivered to the tumor center was 24.7Gy [$22{\sim}30Gy$]. The median tumor volume was 2cc [$0.1{\sim}9.1cc$]. The median follow-up period of magnetic resonance[MR] imaging was 31 months [$6{\sim}99\;months$], and the mean follow-up period of audiometry was 24 months [$4{\sim}70\;months$]. Results : The tumor control rate was 100% in the patients with the follow up period more than 2 years. The trigeminal and facial nerve preservation rates were 98% and 100%, respectively. Twenty-eight [52%] of the 54 patients preserved serviceable hearing and 16 [30%] patients retained their pre-GK G-R grade level after GK SRS. In the univariate and multivariate analysis, there was no significant prognostic factor in preservation of the serviceable hearing. Conclusion : The hearing preservation rate is still unsatisfactory compared with the results of other cranial nerve preservation and tumor control in the treatment of vestibular schwannoma by GK SRS. More sophisticated strategy during and after GK SRS is necessary to improve long-term hearing preservation.

• Annals of Clinical Neurophysiology
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• v.12 no.2
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• pp.47-54
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• 2010

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy caused by compression of the median nerve beneath the transverse carpal ligament. CTS can be correctly diagnosed by the patients' description of symptoms and electrophysiological tests that measure nerve conduction through the wrist. Many previous studies reported various risk factors of CTS, such as obesity, diabetes mellitus, thyroid disease and trauma. Obesity is associated with both hyperlipidemia and CTS. This study focused on the relationship between severity of CTS and serum lipid level. Methods: One hundred fourteen patients with CTS and 74 controls were divided into four groups according to the severity; normal, mild, moderate and severe. And then serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL-C) and high-density lipoprotein (HDL-C) were measured in each group. Results: There was a positive correlation between TG and CTS severity (p<0.001). But TC, LDL-C and HDL-C were not correlated with CTS severity. Conclusions: These results suggest that high serum TG may act as an aggravating factor of CTS.

• Annals of Clinical Neurophysiology
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• v.1 no.2
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• pp.160-167
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• 1999

Although somatosensory evoked potentials(SSEPs) have been utilized as the useful diagnostic tools in evaluating the wide variety of pathological conditions, such as focal lesions affecting the somatosensory pathways, demyelinating diseases, and detecting the clinically occult abnormality, their neural generators is still considerably uncertain. To appreciate the basis for uncertainties about the origins of SSEPs, consider criteria that must be met to establish a causal relationship between activity in a neural structure and a spine/ scalp-recorded potential. Electrode locations and channel derivations for SSEPs recordings are based on two principles:(1) the waveforms are best recorded from electrode sites on the body surface closest to the presumed generator sources along the somatosensory pathways, and(2) studies of the potential-field distribution of each waveform of interest dictate the best techniques to be used. In this article, authors will describe followings focused on ;(1) the concepts of near field potentials(NFPs) and far field potentials(FFPs) - the voltage of NFPs is highly dependent upon recording electrode position, FFPs are unlike NFPs in that they are widely distributed, their latencies and amplitudes are independent of recording electrode.(2) appropriate montage settings to detect the significant potentials in the median nerve and posterior tibial nerve SSEPs(3) neural generators of various potentials(P9, N13, P14, N18, N20, P37) and their clinical significance in interpretating the results of SSEPs. Especially, Characteristics of N18(longduration, small superimposed inflection) suggested that N18 is a complex wave with multiple generators including brainstem structures and thalamic nuclei. And N18 might be used as the parameter of braindeath. Precise understanding on these facts provide an adequate basis utilizing SSEPs for numerous clinical purposes.

• The Journal of the Korean bone and joint tumor society
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• v.4 no.2
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• pp.88-93
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• 1998

Neurilemoma usually discovered incidentally, is a benign nerve-sheath tumor which has been described as a painless mass. In most cases, the size of the mass was smaller than 5cm. However, it was reported that there were masses, sometimes associated with local tenderness and pain, whose size was over 6cm. Then, we have found there is a relationship between mass size and neurologic symptoms, as well as with, postoperative complications. It is important to diagnose early and to treat it. Twenty neurilemoma patients, who were treated at Keimyung University Dongsan Medical Center were analyzed using their clinical symptoms, pathologic findings, radiologic findings and complications. There was no sexual difference in tumor incidence. The anatomical locations of tumors were as follows. ; upper extremities in 15 cases(69%), axilla in 1 case(4%) and lower extremities in 6 cases(27%). Symptoms were palpable mass in 22 cases, local tenderness in 8 cases(36%), radiating pain in 6 cases(27%) and paresthesia in 6 cases(27%), Median nerve was involved most frequently(33%). There were 2 patients(10%) with multiple symptoms. Tumor enucleation was done in all cases. The size of tumors in longest axis was smaller than 2cm in 2 cases, between 2 and 4cm in 11 cases and more than 5cm in 9 cases. There was no case of malignant transformation or recurrence. In conclusion, incidence of clinical symptom and postoperative complications are increased with the size of the tumor especially over the 5cm. Preoperative MRI finding was the most accurate method of diagnosis and most helpful in determining surgical resection margin.

• Physical Therapy Korea
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• v.21 no.4
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• pp.1-8
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• 2014

Transcranial direct current stimulation (tDCS) is a neuromodulatory technique that delivers low-intensity direct current to cortical areas, thereby facilitating or inhibiting spontaneous neuronal activity. This study was designed to investigate changes in various sensory functions after tDCS. We conducted a single-center, single-blinded, randomized trial to determine the effect of a single session of tDCS with the current perception threshold (CPT) in 50 healthy volunteers. Nerve conduction studies were performed in relation to the median sensory and motor nerves on the dominant hand to discriminate peripheral nerve lesions. The subjects received anodal tDCS with 1 mA for 15 minutes under two different conditions, with 25 subjects in each groups: the conditions were as follows tDCS on the primary motor cortex (M1) and sham tDCS on M1. We recorded the parameters of the CPT a with Neurometer$^{(R)}$ at frequencies of 2000, 250, and 5 Hz in the dominant index finger to assess the tactile sense, fast pain and slow pain, respectively. In the test to measure CPT values of the M1 in the tDCS group, the values of the distal part of the distal interphalangeal joint of the second finger statistically increased in all of 2000 Hz (p=.000), 250 Hz (p=.002), and 5 Hz (p=.008). However, the values of the sham tDCS group decreased in all of 2000 Hz (p=.285), 250 Hz (p=.552), and 5 Hz (p=.062), and were not statistically significant. These results show that M1 anodal tDCS can modulate sensory perception and pain thresholds in healthy adult volunteers. The study suggests that tDCS may be a useful strategy for treating central neurogenic pain in rehabilitation medicine.

• Annals of Clinical Neurophysiology
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• v.5 no.2
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• pp.177-180
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• 2003

Background and Objectives: A nerve conduction study (NCS) has been known as a useful method to evaluate the therapeutic effect of operation in carpal tunnel syndrome (CTS). To evaluate the temporal relationship between symptomatic and electrophysiological improvement, we compared the preoperative symptoms and electrophysiological results with postoperative those. Methods: We analyzed the NCS changes before and after minimal release of carpal tunnel in 26 patients (34 hands) with CTS. The time of postoperative symptomatic changes, postoperative electrophysiological changes and temporal relationship between symptomatic and electrophysiological changes were evaluated. Results: The mean age was $49{\pm}13$ years. The proportion of males to female was 8 and 92 percent. The median interval days between date of operation and those of postoperative NCS was 28.5 days. Postoperative symptoms improved in 17 hands, slightly improved in 13 hands, and have not changed in 4 hands. Electrophysiological improvements after operation were observed in 26 hands, and mostly appeared within 2 months. Symptomatic relief accompanied with electrophysiological improvement reported in 13 hands (50%). Moreover, the four hands with symptom, not relieved by decompression, showed electrophysiological improvement. Conclusions: In this study, electrophysiological improvement was in consistency with symptomatic relief to some extent, but we got the result of disagreement between electrophysiological and symptomatic improvement.

• Journal of Acupuncture Research
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• v.36 no.2
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• pp.100-106
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• 2019

Background: In Korean medicine, carpal tunnel syndrome is treated by stimulating the acupoints around the wrist. Although a deep understanding of anatomy and guidance is needed to stimulate these acupoints to avoid undesirable side-effects, currently there are no published guidelines for acupotomy treatment. The aim of this study is to evaluate the effectiveness and safety of fluoroscopy-guided acupotomy compared with conventional acupotomy treatment. Methods: This is a randomized, patient-assessor, patient blind, parallel clinical trial. A total of 30 patients will be enrolled at Wonkwang University Gwangju Hospital, and will be allocated to either an experimental group or a control group. The experimental group will be treated using fluoroscopy-guided acupotomy and the control group will be treated using the conventional acupotomy method. Results: The primary outcome measure will be identification of a cross-section area of the median nerve measured by ultrasonography, and the secondary outcome measure will be the alleviation of pain measured by the Visual Analogue Scale, improvement in the Nerve Conduction Study, Tinel test, Phalen's test, EuroQol 5-dimension scale, and Boston Carpal Tunnel Questionnaire score. Safety components will be measured by monitoring vital signs, electrocardiographs, blood tests, general chemical tests, urine tests and pregnancy tests. In addition, observations for adverse effects will be performed during the trial. Conclusion: This study will provide a more effective, and less harmful way of treating carpal tunnel syndrome compared with conventional acupotomy. Fluoroscopy-guided acupotomy will help practitioners to be accurate in direction and depth of the needle for treating carpal tunnel syndrome.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.16 no.1
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• pp.53-66
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• 2021

Objectives The purpose of this scoping review is to investigate the trends and gaps in existing research on neural mobilization in Korea and to suggest further directions for study. Methods A scoping review was sequentially conducted according to the five steps outlined by Arksey and O'Malley, and the PRISMA-ScR checklist. We searched five domestic databases (RISS, DBpia, KISS, ScienceON, and KMBASE) and identified relevant literature reported until April 15, 2021. The key search terms used were "Neural mobilization" and "Neurodynamic". Results Of the 1383 studies identified in the search, 50 were finally selected. Of these, 45 studies were in the field of medicine and pharmacy and physical therapy as the most common sub-field. Thirty-eight of the 50 studies (76%) were randomized controlled trials. Neural mobilization was most frequently used in the treatment of stroke (n = 13) and of various neuromusculoskeletal diseases such as cervical radiculopathy (n = 8) and low back pain (n = 5). The main targets of neural mobilization were the median nerve (n = 20) and sciatic nerve (n = 14). The most commonly used technique for neural mobilization was that developed by Butler and Jones in 1991 (n = 10). Conclusions This is the first scoping review of neural mobilization in Korea. We believe that further research on neural mobilization with other types of research design is necessary to investigate the utility of neural mobilization and to establish standard protocols. Our findings indicate that neural mobilization can be considered as an intervention for neuromusculoskeletal diseases in Korean medicine.

• Clinical Pain
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• v.18 no.2
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• pp.70-75
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• 2019

Objective: The purpose of this study is to evaluate the usefulness of infrared thermography in patients with carpal tunnel syndrome by comparing with electrodiagnostic and ultrasonographic findings. Method: From January 2014 to October 2017, electrodiagnosis, ultrasound, and digital infrared thermal image (DITI) of unilateral carpal tunnel syndrome diagnosed in a single hospital were retrospectively analyzed. The subjects with bilateral symptoms of carpal tunnel syndrome, peripheral vascular disease, diabetes, thyroid disease, fibromyalgia, rheumatic disease, systemic infection, inflammation, malignant tumor, and other musculoskeletal disorders such as finger osteoarthritis, peripheral neuropathy, cervical radiculopathy, and the previous history of surgery were excluded. Results: Of 53 patients diagnosed with carpal tunnel syndrome, 11 were male and 42 were female. The visual analogue scale was 4.9 ± 1.9, and the duration of symptom was 11.8 ± 12.5 months. There was no statistically significant difference in the body surface temperature between the unaffected and affected sides. The severity of symptoms, electrodiagnostic findings, and cross-sectional area of the median nerve significantly correlates to each other. The temperature difference between the second fingers of the affected and unaffected sides showed a weak correlation with the amplitude of sensory nerve action potential and onset latency of compound muscle action potential, when there was no significant correlation with the other parameters. Conclusion: The difference in temperature on the surface of the body, which can be confirmed by DITI, is little diagnostic value when DITI is performed in unilateral carpal tunnel syndrome patients, especially when compared with ultrasonography.