Needle Electromyography Research Articles

Evaluation of Split Hand Syndrome in Early Diagnosis of Amyotrophic Lateral Sclerosis by Nerve Conduction Study as a Diagnostic Tool

Background: Amyotrophic lateral sclerosis (ALS), a degenerative disease of the motor neurons that can present diversly. Needle electromyography (EMG) is the gold standard investigation for the diagnosis of ALS. Split hand syndrome (SHS) demonstrated by nerve conduction study (NCS); a noninvasive tool could be useful in diagnosing ALS. This study aimed to assess SHS by NCS in ALS. Methods: This diagnostic accuracy case-control study included 37 cases of ALS and 37 age and gender-matched controls. Compound muscle action potential (CMAP) and distal motor latency (DML) of median and ulnar nerves and the ratio of median and ulnar CMAP and DML were compared between study groups. The diagnostic validity testing of electrophysiological SHS was also done. Results: The mean age of the ALS and control groups were similar, 39.8±2.7 and 39.3±2.6 years, respectively. Sixteen (43.2%) ALS patients were in 30-59 years age group. Male-female ratio was 5.2. In the ALS group, median-ulnar CMAP ratio was lower and median-ulnar DML ratio was prolonged than the control. The diagnostic efficacy of median-ulnar CMAP ratio and DML ratio were calculated. A median-ulnar CMAP ratio cut-off value ≤1 showed 70% sensitivity, 97% specificity, 96% positive predictive value and 77% negative predictive value. A median-ulnar DML ratio cut-off value ≥1.5 showed 48% sensitivity, 89% specificity, 82% positive predictive value and 65% negative predictive value. Conclusion: NCS demonstrating SHS can be an important tool in the early diagnosis of ALS. J Bangladesh Coll Phys Surg 2024; 42: 350-354

The quality of the electrodiagnostic referral system and the electrodiagnostic patterns in a sample of Egyptian patients

BackgroundElectrodiagnosis is a localizing, diagnostic, and prognostic tool for individuals with suspected neuromuscular diseases. In addition to detailed history taking and thorough clinical examination, correct execution and interpretation of these tests can provide vital insights into the underlying neuromuscular disorders and frequently guide the need for proper management decision. The request for an electrodiagnosis examination should include brief clinical information and a provisional clinical diagnosis; this enhances the efficient easy performance of the test. The current study aims to detect the pattern of neuromuscular diseases in the Alexandria Main University Hospital, Egypt, and to evaluate the quality of the referral system to the electrodiagnosis unit.ResultsThe study included 371 patients, out of which, 65% were referred from the Governmental Specialized Medical Councils and the Neurosurgery department. Although sensory complaints were the main reason for referral, yet 28.8% of patients did not show any electrodiagnosis abnormality. A compatible referral note led to shorter test times and fewer electromyography needle insertions.ConclusionDisorders of the peripheral nerves are the most frequent neuromuscular diseases referred to the electrodiagnosis unit with carpal tunnel syndrome being the most common disorder. A compatible referral letter is necessary when requesting an electrodiagnosis test, to save the physician time and focus on targeted procedures.

Relationship between fatigue and quantitative electromyography findings in patients with myasthenia gravis

BackgroundFatigue is a common complaint among patients with myasthenia gravis (MG). In this study, we investigated the alterations in muscle morphology in patients with MG experiencing fatigue using quantitative electromyography (QEMG), and explored the relationship between electrophysiological findings and the severity of both fatigue and disease. MethodsWe performed QEMG of the biceps brachii muscle using the peak ratio method and multi-motor unit potential (MUP) analysis across three groups: 18 MG patients with fatigue, 34 MG patients without fatigue, and 33 healthy subjects. Stimulated single-fiber EMG was performed on the frontalis muscle. The severity of perceived fatigue and disease was subsequently assessed using the quantitative myasthenia gravis (QMG) score, the MG-activities of daily living (MG-ADL) profile, self-reported fatigue questionnaires, and handgrip strength measurements. ResultsThe QEMG study revealed a reduced mean MUP duration and size index (SI), in addition to an increased peak ratio in patients with MG (p < 0.05), which tended to be more pronounced in those experiencing fatigue. Compared to healthy subjects, MG patients with fatigue displayed a myopathic pattern characterised by a high peak ratio, short duration, and small-amplitude MUPs, without any increase in the number of phases or small time intervals. The mean peak ratio was positively correlated with the QMG, MG-ADL, and Fatigue Impact Scale total and physical subscores (p < 0.05). Further, MG patients with fatigue exhibited reduced maximum grip strength, which was positively correlated with the mean MUP duration, amplitude, SI, and thickness, and negatively correlated with the mean peak ratio (p < 0.05). No significant differences were observed in the jitter or block measurements (p > 0.05). ConclusionsThe present study investigated electrophysiological findings that were not considered or theorised in prior studies on patients with MG experiencing fatigue. The results of this study suggest that myopathic changes may be a critical pathophysiological component underlying the fatigue associated with MG.

Anatomical validation of needle placement for cervical paraspinal mapping of the multifidus.

The paraspinal muscles are an important component of electrodiagnostic testing for radiculopathy. In the cervical region, a protocol for cervical paraspinal mapping assumes accurate placement of the electromyography (EMG) needle into the cervical multifidus. However, there is scant information regarding the accuracy of needle placement in that muscle. This study examines the accuracy of this protocol in sampling the intended multifidus muscle of cadavers. An experienced electromyographer directed needles to multifidus at C5, C7, and T2 spinous processes of 19 embalmed cadavers, and injected color dyes. Separately another examiner dissected the cadavers, noting whether the dye was in the correct location and whether its trajectory approached any "danger zones" of nerve, artery, or joint. The dye was in the multifidus muscle 100% of the time and hit the intended bony target in 79%, 73%, and 79% of C5, C7, and T2 insertions. No insertion was found in a danger zone. The results indicate modest accuracy for EMG needle placement as proposed in the clinical protocol. Clinical utility of this method requires more work including the establishment of norms, sensitivities, specificities, and clinical impact.

Proposed criteria for the O'Sullivan McLeod syndrome: Case series and literature review

AbstractWe aimed to summarize the clinical characteristics of the O'Sullivan McLeod syndrome and propose the diagnostic criteria of the syndrome. We reviewed our database to identify patients with the O'Sullivan McLeod syndrome. Online databases including PubMed, EMBASE, and OVID were also searched for relevant cases. We identified a total of 24 cases, including 3 cases from our database and 21 ones from online searching. A predominance of male was observed [17 (73.9%)] with median onset age of 31 (range: 15–56) years old. The median (range) disease duration was 9 (0.5–28) years at the time of the visit. All patients showed involvement of hands and ~1/3 patients reported weakness and atrophy of right/left forearm. The upper arm was scarcely affected (8.7%). Needle electromyography suggested chronic denervation in C7‐T1 among the majority of involved cases (over 78%). Cervical magnetic resonance imaging showed longitudinal T2‐hypertenssive signals among 5/14 (35.7%) patients, which confined to the anterior horn area. No patients showed responsiveness to immunotherapy. Ten patients remained clinical stable during follow‐up, nine ones manifested chronic progressive course. The O'Sullivan and McLeod syndrome, characterized by progressive weakness and atrophy in upper limbs, might be an incurable disorder of lower motor neuron. Onset in early adulthood, the plateau period of over 12 months and years of chronic progression in clinical manifestations might be supportive indicators for the diagnosis of the syndrome. The prognosis is relatively good with no effective treatment.

Utility of the Repetitive Nerve Stimulation Test and Needle EMG in the Trapezius Muscle for the Early Diagnosis of ALS.

To document the utility of decremental responses in the repetitive nerve stimulation test (RNS) and spontaneous activities in needle electromyography (EMG) in the trapezius muscle for the diagnosis of amyotrophic lateral sclerosis. Subjects were retrospectively identified from our EMG database. Cervical spondylosis was represented as a disease control group. We investigated the sensitivity and specificity of RNS and EMG in the trapezius muscle and those of diagnostic criteria including the Gold Coast criteria (GCC). We reviewed 120 patients with amyotrophic lateral sclerosis and 17 patients with cervical spondylosis. "RNS or EMG" achieved the highest sensitivity (85%). The specificity was the highest for RNS (94%). Addition of RNS of the deltoid muscle achieved 98% sensitivity in the upper-limb onset amyotrophic lateral sclerosis. The sensitivity of the GCC was very high (88%). Neurophysiological parameters investigated in this study having close to 100% specificities or sensitivities are useful as complements to the GCC.

Comparison of muscle response in patients treated with rigid and flexible fixed functional appliances.

The present study was undertaken to evaluate and compare muscle activity after the treatment with rigid and flexible fixed functional appliance. The study was conducted on 14 skeletal Class II malocclusion patients in the age group of 13-17 years, divided into two groups comprising 7 patients in each group. Group I was treated with a rigid fixed functional appliance (MPA IV), and Group II was treated with a flexible fixed functional appliance (Churro Jumper). Masseter and anterior temporalis muscle activities were recorded using needle electromyography (EMG) at postural rest, saliva swallowing, and clenching during five intervals (T0 to T4) during fixed functional appliance treatment. Unpaired t-test, Mann-Whitney U, and Wilcoxon sign rank test were applied for statistical analysis, and a P value of <.05 was considered statistically significant. Group I (MPA IV) showed a significant increase in EMG activity during postural rest position (P = 0.003, P = 0.001), swallowing (P = 0.013, P = 0.005), and clenching (P = 0.001, P = 0.002) in masseter and anterior temporalis muscle, respectively. Group II (Churro jumper) also showed a significant increase in EMG activity during postural rest position (P = 0.000, P = 0.000), swallowing (P = 0.001, P = 0.000), and clenching (P = 0.001, P = 0.000) in masseter and anterior temporalis muscle, respectively. Both rigid (MPA IV) and flexible (Churro Jumper) fixed functional appliances caused a significant increase in EMG activity of masseter and anterior temporalis muscle during postural rest position, swallowing, and clenching in 6 months of the observation period, but the flexible appliance (Churro Jumper) showed more significant increase.

Trauma of the peripheral nervous system. Part 1. Clinical picture, instrumental diagnostics

The peripheral nervous system injuries can lead to long-term or total disability of the patient. The article presents the classification of peripheral nervous system injuries, and clinical picture. Such methods of instrumental diagnostics as stimulation electroneuromyography, needle electromyography, ultrasound diagnostics, magnetic resonance imaging are described.

Utility of the Clustering Index method for diagnosing neuromuscular disorders as compared with needle electromyography.

Concentric needle electromyography (CNEMG) is an essential examination for evaluating neuromuscular disorders, although pain is a drawback. Clustering Index (CI) method is a non-invasive quantitative analysis for surface electromyography (SEMG) that evaluates whether the signal area is clustered into the few large motor unit potentials (MUPs) or is evenly distributed. However, the diagnostic yield of the CI method in comparison with CNEMG is not known. In this study, we aimed to compare the sensitivity of the CI method with MUP parameters in CNEMG for diagnosing neurogenic or myogenic disorders. We retrospectively identified patients for whom both SEMG and CNEMG were performed on the same tibialis anterior (TA) muscle. In CNEMG, seven MUP parameters were evaluated, including size index (SI) and revised size indices for neurogenic (rSIn) and myogenic (rSIm) disorders. Identified were 21 patients with neurogenic and 21 patients with myogenic disorders. Control data were constructed from 30 control subjects. The sensitivities of the CI method for the neurogenic and myogenic groups were 76% and 62%, respectively, which were not significantly different from MUP parameters, except for being significantly higher than those of amplitude and duration for myopathy (24%). Among MUP parameters, the sensitivities of rSIn (62%) and rSIm (57%) for myopathy were significantly higher than those of amplitude and duration. The CI method significantly correlated with the strength of the TA muscle in myopathy. The CI method, having comparable diagnostic yields to MUP parameters, is promising as a non-invasive diagnostic measure.

Atypical Facio-Scapulo-Humeral Dystrophy with facial sparing: a case report

Facio-Scapulo-Humeral Dystrophy (FSHD) is an autosomal dominant and third most common inherited muscular dystrophy. Typical phenotype of FSHD initially affects the muscles of the face and upper arm. Atypical FSHD refers to genetically confirmed FSHD with phenotypic variations. Scapulo-Humeral Dystrophy (SHD) is the most common atypical form of FSDH characterized by no facial muscle weakness on clinical examination, while other signs remain consistent with FSHD. We report a 31-year-old male who presented with foot drop and had an unexpected presentation as SHD. Provisional diagnosis of SHD was based on careful medical history, physical examination findings, modest rise in muscle enzymes, and needle electromyography findings of myopathy. Muscle biopsy suggested dystrophic changes which supported the diagnosis of FSHD with facial sparing. Rehabilitation plan included patient and family counseling/education, lifestyle modifications, energy conservation strategies, right ankle foot orthosis, and therapeutic exercises with regular follow-up for monitoring of the disease.

Intercostal nerve electrodiagnostic testing in rib fractures.

Intercostal nerve injury can occur after rib fractures, resulting in denervation of the abdominal musculature. Loss of innervation to the rectus abdominis and intercostal muscles can cause pain, atrophy, and eventual eventration, which may be an underrecognized and thus undertreated complication of rib fractures. We investigated the clinical utility of intercostal nerve electrodiagnostic testing following rib fractures to diagnose and localize nerve injury at levels T7 and below. Five patients with displaced bicortical rib fractures involving the 7th-11th ribs and clinical eventration of the ipsilateral abdominal wall underwent intercostal nerve conduction studies (NCS) and needle electromyography (EMG) on the affected side. EMG of the rectus abdominis and intercostal muscles was performed with ultrasound guidance, and ultrasound measurements of rectus abdominis thickness were obtained to assess for atrophy. Average patient age was 59.4 years and average body mass index (BMI) was 31.5 kg/m2. Intercostal NCS and EMG were able to reliably diagnose and localize intercostal nerve damage after rib fractures. Ultrasound demonstrated an average rectus abdominis transverse cross-sectional thickness of 0.534 cm on the affected side, compared with 1.024 cm on the non-affected side. Intercostal electrodiagnostic studies can diagnose and localize intercostal nerve damage after displaced rib fractures. Musculoskeletal ultrasound can be used to diagnose and quantify rectus abdominis atrophy and to accurately and safely guide needle EMG to the intercostal and rectus abdominis muscles.

Neuromuscular disease auxiliary diagnosis using a portable magnetomyographic system.

The measurement of electromyography (EMG) signals with needle electrodes is widely used in clinical settings for diagnosing neuromuscular diseases. Patients experience pain during needle EMG testing. It is significant to develop alternative diagnostic modalities. This paper proposes a portable magnetomyography (MMG) measurement system for neuromuscular disease auxiliary diagnosis. Firstly, the design and operating principle of the system are introduced. The feasibility of using the system for auxiliary diagnosis of neuromuscular diseases is then studied. The magnetic signals and needle EMG signals of thirty subjects were collected and compared. It is found that the amplitude of muscle magnetic field signal increases during mild muscle contraction, and the signal magnitudes of the patients are smaller than those of normal subjects. The diseased muscles tested in the experiment can be distinguished from the normal muscles based on the signal amplitude, using a threshold value of 6 pT. The MMG diagnosis results align well with the needle EMG diagnosis. In addition, the MMG measurement indicates that there is a persistence of spontaneous activity in the diseased muscle. The experimental results demonstrate that it is feasible to auxiliary diagnose neuromuscular diseases using the portable MMG system, which offers the advantages of non-contact and painless measurements. After more in-depth, systematic, and quantitative research, the portable MMG could potentially be used for auxiliary diagnosis of neuromuscular diseases.

Linking LRP12 CGG repeat expansion to inherited peripheral neuropathy.

The causative genes for over 60% of inherited peripheral neuropathy (IPN) remain unidentified. This study endeavours to enhance the genetic diagnostic rate in IPN cases by conducting screenings focused on non-coding repeat expansions. We gathered data from 2424 unrelated Japanese patients diagnosed with IPN, among whom 1555 cases with unidentified genetic causes, as determined through comprehensive prescreening analyses, were selected for the study. Screening for CGG non-coding repeat expansions in LRP12, GIPC1 and RILPL1 genes was conducted using PCR and long-read sequencing technologies. We identified CGG repeat expansions in LRP12 from 44 cases, establishing it as the fourth most common aetiology in Japanese IPN. Most cases (29/37) exhibited distal limb weakness, without ptosis, ophthalmoplegia, facial muscle weakness or bulbar palsy. Neurogenic changes were frequently observed in both needle electromyography (97%) and skeletal muscle tissue (100%). In nerve conduction studies, 28 cases primarily showed impairment in motor nerves without concurrent involvement of sensory nerves, consistent with the phenotype of hereditary motor neuropathy. In seven cases, both motor and sensory nerves were affected, resembling the Charcot-Marie-Tooth (CMT) phenotype. Importantly, the mean CGG repeat number detected in the present patients was significantly shorter than that of patients with LRP12-oculopharyngodistal myopathy (p<0.0001). Additionally, GIPC1 and RILPL1 repeat expansions were absent in our IPN cases. We initially elucidate LRP12 repeat expansions as a prevalent cause of CMT, highlighting the necessity for an adapted screening strategy in clinical practice, particularly when addressing patients with IPN.

Different Muscles, Lower Cutoff Values: Does it Truly Improve the Diagnostic Sensitivity of Repetitive Nerve Stimulation in Myasthenia Gravis?

ABSTRACT Context: This study evaluated the diagnostic accuracy of repetitive nerve stimulation (RNS) compared with single-fiber electromyography (SF-EMG) in generalized myasthenia gravis (MG). Aims: The aim of the study was to determine the diagnostic sensitivity of RNS in various muscles and assess the effect of varying decrement cutoff values on diagnostic efficacy. Setting and Design: This was a prospective study of 34 confirmed generalized MG patients. Subjects and Methods: RNS was performed on five muscles. Clinical features, autoantibody presence, and SF-EMG jitter rates recorded from the frontalis muscle were analyzed. Patients were classified according to the MG Foundation of America classification. Statistical Analysis: SPSS version 23 was used for descriptive statistics, comparisons of categorical and quantitative data, and correlation analysis, with the significance level set at P &lt; 0.05. Results: Among the patients (58.8% males and mean age = 59.47 ± 13.37 years), SF-EMG detected increased jitter in 91.2%, whereas RNS identified a significant decrease of 50% across at least one muscle. The decremental response was &gt;10% in the abductor digiti minimi (ADM), trapezius, nasalis, abductor pollicis brevis, and extensor indicis proprius muscles in 5.9%, 26.5%, 29.4%, 11.8%, and 29.4% of patients, respectively. A sensitivity improvement at lower decrement values was observed only in the ADM muscle. A significant correlation was found between decreases in the trapezius muscle and seropositivity. Conclusions: Optimal muscle selection improves RNS diagnostic accuracy in MGs. The study recommends incorporating the spinal accessory and radial nerves in RNS due to their high sensitivity, although modifying the decrement cutoff value has a limited overall effect.

Electrophysiological Insights: Using Repetitive Nerve Stimulation to Monitor Clinical Status and Remission in Myasthenia Gravis

ABSTRACT Objective: Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disorder with a variable course that complicates the prediction of remission. This study aimed to evaluate the utility of repetitive nerve stimulation (RNS) in monitoring clinical status through the assessment of decremental response rates in the nasalis and trapezius muscles during treatment. Subjects and Methods: A prospective study was conducted with 52 patients diagnosed with generalized MG. Patients underwent clinical assessments, including tests for anti-acetylcholine receptor and anti-muscle-specific kinase antibodies, and were classified according to the Myasthenia Gravis Foundation of America classification. Electrophysiological testing through RNS and single-fiber electromyography was performed. Data analysis involved comparing the RNS decrement rates with clinical and demographic variables. Follow-up for assessing remission spans 2 years. Results: Among the 52 patients, 53.8% achieved clinical remission. In the remission group, 14.3% of the patients exhibited a decremental response compared with 70.8% in the nonremission group, particularly in the nasalis and trapezius muscles, in the follow-up RNS conducted 2 years after the initial assessment (P &lt; 0.05). The remission group presented significantly lower rates of antibody positivity and less bulbar involvement. Interestingly, initial clinical severity did not correlate significantly with remission. Conclusion: This study demonstrated the usefulness of RNS in assessing the clinical status of MG patients and evaluating the effectiveness of current therapeutic strategies. These findings suggest that focusing on specific muscle responses in RNS can provide valuable information for patient management.

Analysis of the characteristics of patients with amyotrophic lateral sclerosis with neuromuscular junction dysfunction prior to motor neuron degeneration

Objective: To investigate the clinical and electrophysiological characteristics of patients with amyotrophic lateral sclerosis (ALS) with positive repetitive nerve stimulation (RNS) test results on the accessory nerve and negative needle electromyography (EMG) test results on the sternocleidomastoid with the goal to enrich the knowledge of disease progression in patients with ALS. Methods: The clinical data of 612 patients diagnosed with ALS at the Neurology Department of the First Medical Center, Chinese PLA General Hospital from June 2016 to August 2022 were collected. In total, 267 cases had undergone EMG tests on the sternocleidomastoid following a positive 3 Hz RNS test result on the accessory nerve, who were selected as the study subjects. The differences in clinical indicators were compared between RNS (+)/EMG (-) group and RNS (+)/EMG (+) group. A binomial distribution model with multiple variables was built to quantitatively analyze the major factors and their effects. Results: At the initial visit, 15.8% of patients with ALS were 3 Hz RNS (+) on the accessory nerve and EMG (-) on the ipsilateral sternocleidomastoid, accounting for 36.3% of RNS (+) patients. The decremental range of the 3 Hz RNS test delivered to the accessory nerve in these patients [-14% (-19%, -12%)] was lower than that in patients with RNS (+)/EMG (+) [-17% (-23%, -13%)] (P<0.05), while the ratio of upper limb onset (64.9%) and non-definite diagnosis (28.9%) were higher [54.7% and 13.5% for patients with RNS (+)/EMG (+), P<0.05]. Furthermore, the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) score [40 (37, 42)], body mass index (BMI) [23.8 (22.0, 25.4) kg/m2] and forced vital capacity (FVC) [92.8% (76.6%, 103.8%)] were higher in patients with RNS(+)/EMG(+) (P<0.05). The multivariate model suggested that, in patients with RNS (+)/EMG (-), the ratio of upper limb onset to lower limb onset was 1.04, while that of upper limb onset to bulbar onset was 2.02, and that of lower limb onset to bulbar onset was 1.94. The ratio of non-definite ALS to definite ALS was 1.13. The ALSFRS-R score, BMI, and FVC had a protective contribution to the electrophysiological function of the motor neurons. The ratio of the effect size of the ALSFRS-R or BMI to that of FVC was 3.37 and 1.14, respectively. Conclusions: Patients with ALS that were 3 Hz RNS (+) on the accessory nerve and EMG (-) on the ipsilateral sternocleidomastoid had a smaller decremental range of the compound muscle action potential amplitude, and a higher proportion of upper limb onset and non-definite ALS. A higher ALSFRS-R score, BMI, and FVC have a protective effect to the electrophysiological function of motor neurons. The effect size of the ALSFRS-R score is the largest, followed by BMI and FVC.

The choice of method of electroneuromyogaphy in remote consequences of gunshot and mine-blast injuries of limb nerves

Objective. Clarification of the nature of damage and degree of functional disorders in the remote consequences of gunshot and mine-blast injuries of limb nerves using neurophysiological techniques (NP) of functional diagnostics (stimulation and needle electromyography), correlation of these data with the nerve damage characteristics determined during surgical interventions (operative findings). Materials and methods. 480 military personnel and civilians, men aged 18-64 years (average age 33.5 years), with gunshot and mine-blast injuries of limb nerves (LNI) within 1 to 11 months after injury were examined. A total of 1400 EMG studies were conducted. Clinical-neurological methods were used to determine the level, degree, and nature of LNI. Results. Among the examined 480 patients, complete nerve damage was detected in 299, and partial in 181. Causes of nerve damage included: shrapnel, gunshot, mine-blast injuries, nerve rupture due to bone fractures, injuries by sharp objects, iatrogenic damage. In 62.3% of cases of complete LNI surgical interventions were performed using the technique of neurotization using branches of donor nerves. Provided anatomical integrity of nerve structures and presence of conductivity during EMG testing, external or internal neurolysis was performed. Surgical intervention timing: up to 6 months post-injury - 68.1% of cases; up to 3 months - 31.9%. Based on the results of comprehensive clinical-NP research, adapted schemes for assessing NP data corresponding to each pathohistological type of LNI were developed, and NP criteria for classifying consequences of LNI into three degrees of severity of functional deficit - mild, moderate, and severe were proposed. Conclusions. Criteria for choosing the optimal NP diagnostic methodology for the remote consequences of gunshot and mine-blast injuries of limb nerves have been determined. Comprehensive clinical-instrumental diagnostics allows to objectify the level and degree of limb nerve damage, signs of neuromuscular apparatus recovery, provides information for planning of the surgical tactics and subsequent rehabilitation therapy.

Single-fiber EMG in Migraine with or without Aura: Search for Correlations with Disability and Headache Intensity

Single-fiber EMG in Migraine with or without Aura: Search for Correlations with Disability and Headache Intensity

Concomitant Botulinum Toxin Injections for Neurogenic Detrusor Overactivity and Spasticity-A Retrospective Analysis of Practice and Safety.

As multiple indications for botulinum toxin injections (BTIs) can coexist for neurological patients, there are to date no description of concomitant injections (CIs) to treat both spasticity and neurogenic detrusor overactivity incontinence (NDOI) in patients with spinal cord injuries (SCIs) and multiple sclerosis (MS). We therefore identified patients followed at our institution by health data hub digging, using a specific procedure coding system in use in France, who have been treated at least once with detrusor and skeletal muscle BTIs within the same 1-month period, over the past 5 years (2017-2021). We analyzed 72 patients representing 319 CIs. Fifty (69%) were male, and the patients were mostly SCI (76%) and MS (18%) patients and were treated by a mean number of CIs of 4.4 ± 3.6 [1-14]. The mean cumulative dose was 442.1 ± 98.8 U, and 95% of CIs were performed within a 72 h timeframe. Among all CIs, five patients had symptoms evocative of distant spread but only one had a confirmed pathological jitter in single-fiber EMG. Eleven discontinued CIs for surgical alternatives: enterocystoplasty (five), tenotomy (three), intrathecal baclofen (two) and neurotomy (one). Concomitant BTIs for treating both spasticity and NDOI at the same time appeared safe when performed within a short delay and in compliance with actual knowledge for maximum doses.

Unique clinical and electrophysiological features in the peripheral nerve system in patients with sialidosis – a case series study

BackgroundTo investigate the peripheral nervous system involvement in S sialidosis with typical features of myoclonus, seizure, and giant waves in somatosensory evoked potentials suggesting hyperexcitability in the central nervous system.MethodsThe clinical presentation of patients with genetically confirmed sialidosis was recorded. Neurophysiological studies, including nerve conduction studies (NCSs), F-wave studies, and needle electromyography (EMG), were performed on these patients.ResultsSix patients (M/F: 2:4) were recruited. In addition to the classical presentation, intermittent painful paresthesia was noted in four patients, and three of whom reported it as the earliest symptom. In the NCSs, one patient had reduced compound muscle action potential amplitudes in the right ulnar nerve, while another patient had prolonged distal motor latency in the bilateral tibial and peroneal nerves. Prolonged F-wave latency (83.3%), repeater F-waves (50%), and neurogenic polyphasic waves in EMG (in 2 out of 3 examined patients) were also noted. Interestingly, a very late response was noted in the F-wave study of all patients, probably indicating lesions involving the proximal peripheral nerve or spinal cord.ConclusionIn addition to the central nervous system, the peripheral nervous system is also involved in sialidosis, with corresponding clinical symptoms. Further study on these phenomena is indicated.