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Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_III | Pages 313 - 313
1 Mar 2004
Kapetanos G Potoupnis M Markou K Kimiskidis V Symeonides P Pournaras J
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Aims: This study was designed to evaluate the postural effects on nystagmus response, during caloric vestibular stimulation. Methods: 43 female patients with right thoracic idiopathic scoliosis (mean age =13.5, scoliotic curves:20û– 40û) and 31 non-scoliotic healthy subjects (mean age=13.1) entered the study. In all patients was performed an electronystagmographic study of labyrinthine function with caloric stimulation. We evaluated: the frequency, the amplitude, the slow phase velocity of nystagmus. The differences in labyrinthine sensitivity were evaluated with the use of unilateral weakness parameter, while differences in left- and right- beating nystagmus evaluated by estimating the directional preponderance parameter. Results: 19 patients from the study group (44.2%), revealed unilateral weakness of the left labyrinth, while 24 patients from the study group (55.8%) had normal caloric responses. On contrary, only one patient of the control group (3.2%) revealed unilateral weakness of the left labyrinth (> 20%). These differences were statistical signiþcant (p< 0.05, Chi-Square test).17 patients from the study group (39.5%) revealed directional preponderance of the right-beating nystagmus. All these patients had also left unilateral weakness. Conclusions: From the above results we can conclude that in 17 patients from the study group the right labyrinth was preponderant, while in other 2 patients there was signiþcant evidence for this. The results are discussed with special reference to aetiology in idiopathic scoliosis.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_III | Pages 313 - 313
1 Mar 2004
Potoupnis M Kapetanos G Kimiskidis V Markou K Symeonides P Pournaras J
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Aims: The underlying cause of Idiopathic Scoliosis (IS) remains enigmatic. Recently, an increasing number of studies disclosed Central Nervous System (CNS) abnormalities and asymmetries sometimes involving the corticospinal tracts. The present study was designed to investigate the motor system of scoliotic patients with transcranial magnetic stimulation. Methods:21 female patients with right IS (mean age=12.7, scoliotic curves:20û–40û) and 20 normal subjects (mean age=13.8) entered the study. Recordings were made with surface electrodes from 1st dorsal interosseous and abductor hallucis muscles. Corticomotor threshold (LT, UT, MT) was deþned at rest in 1% steps using the method of Mills & Nithi. Central motor conduction time (CMCT) was calculated using the F-wave method. Silent period (SP) measurements were done using a standardized protocol at 130% MT stimulus intensity. Other parameters included cortex to muscle latencies, F- and M-wave latencies, UT-LT range, amplitude and area of MEPs. Electrophysiological data were correlated with several clinical characteristics including handedness, degrees of the scoliotic curve and the Pedriolet and Nash indexes. Normality of data distribution was tested using the Kolmogorov-Smirnov test and thereafter appropriate statistical tests were used. Results: In 14 patients lower limbs were also tested and it was found that asymmetry of facilitated Cx-M was 1.4±0.75ms in IS (vs 0.71±0.47 in controls, p=0.059). It correlated signiþcantly with Nash & Moe and Perdriole indexes (Spearmanñs r=0,554 and 0.575 respectively, p< 0.05) and showed a trend towards signiþcance with degrees of scoliotic curve (Pearsonñs r=0.531, p=0.062). Conclusions: There are no signiþcant asymmetries or pathological alterations in the motor system of patients with IS. However, an increased asymmetry of facilitated


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_III | Pages 232 - 232
1 Mar 2003
Kapetanos G Potoupnis M Kimiskidis V Markou K Papagiannopoulos S Symeonides P Kazis A Pournaras J
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Introduction: Immature individuals with known neuromotor disorders are subject to the development of scoliosis; therefore a subclinical dysfunction or anatomic abnormality of the neurologic system has been hypothesized as a causative factor of adolescent idiopathic scoliosis.

In previous clinical studies, authors have tested a wide range of functions, including proprioception, postural equilibrium, oculovestibular complex and vibratory sensation and multiple techniques, including electronystagmography, electroencephalography and electromyography in select scoliotic patient populations

Material and Methods: The present study was designed to investigate the motor system of scoliotic patients with magnetic stimulation. female patients 12 to 14 years old (mean age=13.36) with right idiopathic scoliosis (curves:20–40°) (study group) and 20 normal subjects in the same age group (mean age=12.6) (control group) entered the study. Magnetic stimulation of the brain was performed with a figure of eight coil angled 45° to the parasagittal plane and positioned so as to overly the hand area.

Transcranial stimulation was performed with a Magstim 200 stimulator (Magstim Co, Dyfed, Wales). Stimulation was performed with a figure of 8 coil for upper limbs and a double cone coil for lower limbs. Recordings were made with surface electrodes from 1st dorsal interosseous and abductor hallucis muscles. Threshold measurements included upper (UT) and lower threshold (LT), defined as the stimulus intensities producing MEPs with a propability of 100 and 0%, respectively. Mean threshold (MT) was the mean of UT and LT. Cortical latencies of MEP’s during muscle activation were also measured.

Results: In the patients’ right hemisphere UT,MT and LT were 46.5±8.2, 41.6±7.6 and 36.6±7.3% respectively and the activated cortical latency was 18.6±l.lms.

In the left hemisphere UT, MT and LT were 45.9±9.8, 41.4±9.1 and 36.9±8.7%, respectively and the activated cortical latency was 18.3±0.8ms. These differences were not statistically significant (p> 0.05, t-test). The side-to-side difference of UT,MT and LT were 4.5±2.4, 4.3±2.8 and 4.4±3.7.

None of all the above parameters differed significantly from those of the control group (p> 0.05, t-test).

The differences in the corticomotor excitability in the upper and lower extremities were not statistical significant.

Conclusion: In the study group revealed asymmetries between left and right hemisphere in cortical latencies of MEP’s facillitated.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_III | Pages 231 - 231
1 Mar 2003
Potoupnis M Kapetanos G Dangilas A Markou K Kimiskidis V Symeonides P Pournaras J
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Introduction: The cause of idiopathic scoliosis remains unknown, although research has possibly eliminated some hypothetical causes.

The fact that many patients with idiopathic scoliosis appear to be out of balance, has led many researchers to postulate that a brain stem abnormality involving the vestibular system in the cause of this condition.

Material and Methods: Forty – five female patients 12 to 14 years old (mean age 13.5) with right thoracic idiopathic scoliosis (scoliotic curves:20°–40°, study group) and 31 non-scoliotic healthy subjects in the same age group (mean age=13.1, control group) were included in this study.

An electronystagmographic study of labyrinthine function with caloric stimulation was performed in all patients. The nystagmus was recorded with the electronystagmographic technique (ENG) using Hartmann device. The recordings were performed in a dark, silent room with the tested subject in the supine position and with it’s eyes closed.

We evaluated: the frequency, the amplitude and the slow phase velocity of nystagmus.

The differences in labyrinthine sensitivity were evaluated with the use of unilateral weakness parameter, while differences in left – and right – beating nystagmus evaluated by estimating the directional preponderance parameter.

Results: No one children of the study presented spontaneous or positional nystagmus.

Nineteen patients from the study group (44.2%), revealed unilateral weakness (difference between left and right labyrinth > 20%) of the left labyrinth.

Seventeen patients from the study group (39.5%) revealed directional preponderance of the right-beating nystagmus. These differences were statistical significant (p< 0.05, Chi-Square test). Seventeen patients from the study group revealed both left unilateral weakness and directional preponderance of the right labyrinth, while two patients revealed only left unilateral weakness. A significant correlation was found between the degree of the curvature and the percentage of unilateral weakness.

Conclusion: It is very difficult to draw any conclusions as to whether a vestibular imbalance may be a contributory factor to adolescent idiopathic scoliosis or whether the vestibular findings are secondary to the spine deformity.