Electrodiagnostic Changes in Patient With Multiple Sclerosis

Electrodiagnostic Changes in Patient With Multiple Sclerosis Abstract Although demyelination along the axons is the main manifestation of Multiple sclerosis (MS), peripheral nervous system (PNS) could be affected potentially too. In some studies PNS involvement is estimated to be more than 50 percent in MS patients. Accordingly, objective tests to confirm the severity of PNS involvement might be crucial in patients management. Modern technological advances lead to innovation of computerized electrodiagnostic (EDX) techniques in recent years. Nerve conduction studies (NCS) provide reliable data about neuropathies. Although the frequency of PNS involvement varies in different population of MS patients, recognizing clinical and subclinical PNS impairments in MS patients is important for the treatment. Introduction Among the central nervous system (CNS) demyelinating disorders, multiple sclerosis (MS) is a chronic inflammatory disease which is the most common form of neurologic impairments in young adults (1). Myelin destruction is the main pathophysiology of MS which is an immune-mediated process and leads to plaque formation in patients` central nervous system (2). MS symptoms evaluation is based on musculoskeletal dysfunction and stiffness. MS disease onset is almost in the third or fourth decade of patient’s life. It is estimated that over 2 million people suffer from MS all around the world and half of the MS global population live in Europe (3). The International Panel on the diagnosis of MS defined the diagnostic criteria of MS in 2000 which was revised in 2010(4, 5). Although demyelination along the axons is the main manifestation of MS, peripheral nervous system (PNS) could be affected potentially in MS. PNS axonal destruction might occur in a considerable percent of MS patients (6). Changes in nerve conduction velocity (NCV) parameters could demonstrate MS by electrodiagnostic assessment of peripheral nerve. About 5% of MS patients develop peripheral nerve impairment and changes in NCV (7). PNS involvement in MS might be associated with malnutrition or drug toxicity, so its diagnosis is important in patient with MS. Pathology studies about MS in recent years have shown that gray matter involvement and brain atrophy might happen in the early stages of the disease in addition to white matter demyelination (8). In Pogorzelski et al. study the rate of nerve impairment in MS patients PNS is estimated to be 74.2% (9). Warabi, et al. demonstrated that 10.3% of MS patients revealed changes in NCV and about half of the patients with PNS disorders might have two involved nerves (10). MS diagnosis has three parts; patients history and information, clinical, and paraclinical examinations. These steps could raise the accuracy of diagnosis and result in narrowing the differential diagnosis (3). In recent decades peripheral and generalized neuropathies have become common; neurological examinations in neuropathies are essential, but not enough and do not have sufficient diagnostic accuracy. Accordingly, objective tests that could confirm the severity of neuropathies might be crucial in patients` management. Modern technological advances lead to innovation of computerized electrodiagnostic (EDX) tools in recent years. Nerve conduction studies (NCS) provide reliable data about neuropathies (10). Motor nerve conduction examinations have been performed on a mixed nerve with motor and sensory axons. In these types of studies stimulations have been conducted on a specific part in each course (11). Depolarization induced with electrical pulse has produced action potentials in axons. Induced evoked potentials in motor axons move into distal and proximal direction from the stimulus point (12). Action potentials would be transferred from neuromuscular junctions in milliseconds all over the muscular fibers. These electrical activities along muscles fibers have been detected as compound muscle action potential (CMAP) (13). Various variables could be measured from CAMP such as latency, amplitude, area under the curve, duration, and motor conduction velocity. By measuring the amplitude and area of CAMP, the frequency of induced action potentials in muscle`s fibers could be estimated and thereby count of axons would be stimulated (14). Discussion There are some suggestive nerve conduction criteria for axonal distraction, like decreased distal evoked CMAP or SNAP; proximal reductions might happen due to demyelination impairments (15). Form different studies it can be concluded that in most of the axonal and demyelinating polyneuropathies there is statistical correlation between slow conduction in motor or sensory nerves and amplitude reduction (16). SNAP/CMAP amplitude in some cases could distinct between axonal and demyelinating polyneuropathies (12). In Table 1 elctrodiagnostic assessment of PNS in MS patients is shown. Table 1: Elctrodiagnostic assessment of peripheral nervous system in MS patients *Expanded Disability Status Scale In various studies, elctrodiagnostic tests have been established as reliable methods to detect the subclinical peripheral nerve conduction disorders. Significant amplitude F-wave disturbance might be related with hand spasticity in SP.MS (22). Some studies demonstrated the presentation of PNS involvement in MS as sensory abnormalities, whereas others consist on both sensory and motor disorders. It seems that peripheral neuropathy in MS affects motor neurons particularly and peripheral abnormalities might be result from central demyelination (18). On the other hand the role of peripheral demyelination events in MS peripheral signs and symptoms has not been identified completely. Number of factors could explain the changes in nerve stimulation responses in MS patients. Delayed recovery cycle might lead to impairment in supernormality. Gender, age, temperature, and immunomodulatory treatments in MS might have an impact on nerve stimulation responses. Na+/K+ ATPase pump dysfunction result from metabolic changes could lead to axonal membrane depolarization and recovery cycle disturbance. Change in temperature has a great impact on sodium channel kinetics and impress the action potential duration and amplitude (19). In feys, et al. study sensory conduction velocity was normalized after cooling, but motor conduction velocity was remained impaired after 20 minutes (23). Another theory for PNS involvement in MS is antigenic cross-reactivity, which might happen due to peripheral demyelination. It is obvious that gross demyelination in PNS does not occur in MS, and peripheral myelin has structural impairment in most cases and this could lead to create a resistant zone and intermodal leakage. Anti chondroitin sulphatase antibody, anti myelin associated glycoprotein antibody, and anti gangliosides antibody have been described in PNS involvement in MS (21). Electrodiagnostic tests for PNS involvement in MS patients could find evidence of minor PNS or fiber pathology in early stages (22). Although PNS involvement frequency in MS varies in different population, recognizing clinical and subclinical PNS impairments in MS patient is important.

Consumer Culture and Identity Essay -- Cultural Identity Essays

Introduction Fonseca (2008) defines Consumer culture as a process that â€Å"represents a condition in which consumption is seen as having the role of increasingly mediating certain aspects of social relations and consumption has the symbolic ability to represent affiliation to a certain group and its lifestyles, as well as to generate a sense of identity.† The mention of identity in Fonseca’s definition brings about an understanding of the impact consumer culture can have on social agents, and not just on the economic or capitalism that comes with consumption. This essay will discuss the relationship between Consumer culture and Identity. The essay is divided into five parts; the first section is an introduction into what Consumer culture is, the second section is also an introduction into what Identity is and how it is used in the context of the essay, the third section deals with the crisis of identity in modern day, the fourth section introduces consumption in a contemporary society, the fifth section explains the impact consumption have on identity (how we reflect on ourselves and use goods to shape our identity). This essay concludes by using Giddens (1991) argument about the modern dynamic reflectivity has an impact in the process of reconstructing ones identity when it comes in contact with the post traditional setting, to show that the relation between consumer culture and identity is that Identity is formed as consumption takes place. Introduction to Consumer Culture The word â€Å"culture† has been defined as â€Å"one of the two or three most complicated words in English Language† (William; 1958). Over the years the meaning of the word has changed and varied in different parts of the world. In 1881, Taylor defined culture a... ...society: Myths and structures (Vol. 53). Sage. Beck, U., & Beck-Gernsheim, E. (1995). The normal chaos of love. Cambridge: Polity Press. Blumer, H. (1969). Symbolic interactionism. Englewood Cliffs, NJ: Prentice-Hall Davis, J. (2007). The Promise of Potential. Minnesota: JD Coaching and Consulting. Dittmar, H. 1992. The Social Psychology of Material Possessions: To Have Is To Be, Hertfordshire, Harvester Wheatsheaf. Giddens, A. (1991). Modernity and self-identity: self and identity in the late modern age. Cambridge: Polity. Lury, C. 1996. Consumer Culture, Cambridge, Polity Press. Sassatelli, R. (2007). Consumer culture: History, theory and politics. Sage. Slater, D. (1997). Consumer culture and modernity. Blackwell Publishing: Malden Stryker, S. (1980). Symbolic interactionism: A social structural version. Menlo Park: Benjamin Cummings.

Life and Work of Ed Clark Essay

Hailed from the Storyville in the state of New Orleans, Edward Clark had made his imprint to the Visual and Arts field of the African American History. Born on 1926, he studied at Art Institute of Chicago for his four years degree from year 1947 to 1951. After he finished his bachelor’s degree, he studied again in Paris at L’Academie de la Grande Chaumiere during the year 1952. In his years in Paris, the academe where he was into influenced him a lot to pursue more and one his talent in painting and arts. His instructor named Edouard Georg of the L’Academie de la Grande Chaumiere, encouraged him to paint and make arts works and pieces. But before his study in Paris, he already received good words and encouragement from his instructor in Art Institute of Chicago named Louis Ritman. However, though much appreciated by Clark, neither of the two had become inspiration for him to make his own work. It was the painting entitled â€Å"The Football Game† created by Nicolas de Stael. He had seen the painting when he was in Paris the same year 1952 in an exhibit in Salon d’Automne. After he lived in Paris, France, he came back to New York to continue his art profession and career. Clark became one of the charter members of the Tenth Street’s Brata gallery. This was where the works of the famous artists like Sal Romano and John Krushenick were displayed and shown. Also, the works of George Sugarman, Al Held, and Ronald Bladen were shown there. During the year 1957, his work with a shaped canvass had been displayed on the same gallery where he had been a member in a Christmas group show. It was described in an article of Lawrence Campbell on Art News as the first and one of its kind. His works for over the five decades of being an abstract artist have been known internationally. With his work displayed in 1957 in the Brata gallery, which was a work in a shaped canvass, he was the very first painter to be credited having an innovated work. In time, his kind of work had influenced the contemporary art during the years of 1950 and 1960. He became known of his works in large-shaped canvasses, his strong impact brush strokes, and his choice of colors in every masterpiece he made. And because of these things about him and he had made, he had been called as an â€Å"Abstract Impressionist. Aside from the work that had been exhibited at Brata gallery, another work of Clark made him famous was the one that had been placed and displayed at his Alma Mater Art Institute of Chicago. This work of Clark belonged to the permanent collection of the Art Institute of Chicago. After his very successful career as abstract artist in New York, he came back in France where he made his very first oval painting. To date, this was almost a decade after he firstly done his push broom technique in making his masterpieces. With his push broom technique, he was able to move himself freely while painting on the canvass, as a result, his strokes were big and bolded, and these made him more different among other abstract artist. Clark was always open for new creation and styles of his work. Aside from the push broom technique that he had first used, he also used the method similar to â€Å"pouring sand. † However, it was just inspired by the mentioned method and Clark made use of the dry pigments, this time on the paper instead on large canvass. During his times, it was the post war years of realism and years of abstraction. Also, the paintings of other artists were concentrated on the civil rights issue and racial clamors between the white men and black men. Clark, though addressed almost the same issue, had delivered his works in a very different, although he was using large canvasses alike with other artists that time. After the 1950s, it was the Black Arts Movement and Abstraction that hounded the field of visual and arts. Black men asserted their culture authority in line with the civil rights they were asserting on the past decade. Clark also belonged to these artist where African American Arts were much honed.

Why Do People Conform - 1363 Words

The causes of conformity among individuals have long been debated and researched in recent decades. It is for this reason that conformity is an intriguing psychological concept. It causes sound-minded individuals to go against their best judgement, to engage in behaviour which they usually would not engage in, even accept and welcome an idea they internally disagree with, all in order to not be a deviant from the group. It is thus interesting to look at the factors which cause people to conform, to do what they see others doing, to rely on the judgements of the group, and to ignore their own senses and perceptions. It is the reasons for the individuals desire to conform that I will be discussing in this paper.†¦show more content†¦In Aschs experiments, a group of eight individuals (one subject and seven confederates) sat in a room and verbally stated which of the three unequal lines matched a given line. The subject was seated so that he made his verbal judgement last, or cl ose to it. The task was simple and straight-forward and the correct answers were obvious. When the confederates were each calling out correct answers the subject agreed. However, when the confederates unanimously agreed on a wrong answer the subject had either to disagree with a unanimous majority of seemingly normal, healthy, intelligent people, or to give an answer he knew was incorrect by the evidence of his own senses. Aschs study proved startling. In the trials about one third of the subjects conformed at least once. People were clearly choosing what they knew to be wrong answer so as to not deviate from the group. What do these studies show us about people, and their reasons for conforming? I believe that the individuals desire to be correct plays a key role in this type of conformity. People often rely on social cues around them, in a given situation, when making judgements. 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