2015 Peripheral nervous system involvement in chronic spinal

脊髓损伤后的周围神经病变

PERIPHERALNERVOUSSYSTEMINVOLVEMENTINCHRONICSPINALCORDINJURY

HATICETANKISI,MD,PhD,1KIRSTENPUGDAHL,MSc,PhD,1MIKKELMYLIUSRASMUSSEN,MD,2,3DORTECLEMMENSEN,MD,2YAZANF.RAWASHDEH,MD,PhD,4PETERCHRISTENSEN,MD,DMSc,3KLAUSKROGH,MD,DMSc,5andANDERSFUGLSANG-FREDERIKSEN,MD,DMSc1

DepartmentofClinicalNeurophysiology,AarhusUniversityHospital,Nørrebrogade44,DK-8000,AarhusC,DenmarkTheSpinalCordResearchCentre,DepartmentofNeurosurgery,AarhusUniversityHospital,Aarhus,Denmark3

PelvicFloorUnit,DepartmentofSurgery,AarhusUniversityHospital,Aarhus,Denmark4

DepartmentofUrology,AarhusUniversityHospital,Aarhus,Aarhus,Denmark5

NeurogastroenterologyUnit,DepartmentofHepatologyandGastroenterology,AarhusUniversityHospital,Aarhus,Denmark

21

Accepted3March2015

ABSTRACT:Introduction:Uppermotorneurondisordersarebelievedtoleavetheperipheralnervoussystem(PNS)intact.InthisstudyweexaminedwhetherthereisevidenceofPNSinvolvementinspinalcordinjury(SCI).Methods:Twelvesub-jectswithchroniclowcervicalorthoracicSCIwereincludedprospectively.Needleelectromyographywasdonein10differ-entmusclesineachsubjectbilaterally.Nerveconductionstud-ies(NCS)wereconductedinthefibular,tibial,andfemoralmotorandfibularandsuralsensorynerves.Results:Halfthesubjectshadwidespreadabnormalspontaneousactivity(SA),andtheamountofSAcorrelatedinverselywithreflexactivityandnervelength.Fibularnerveentrapmentacrossthekneewasseenin6subjects,andsciaticnerveentrapmentwasseenin1.Apartfromentrapmentneuropathies,NCSchangeswerefoundpredominantlyinmotornerves.Conclusion:Thepres-enceofwidespreadelectrophysiologicchangesoutsideentrap-mentsitesindicatesthatSCIhasasignificantimpactontheentirePNS,affectingthemotorpartpredominantly.

MuscleNerve52:1016–1022,2015

In

needleelectromyography(EMG),detectionofabnormalspontaneousactivity(SA)mainlyintheformof brillationpotentials( bs)andpositivesharpwaves(PSWs)istheclinical“goldstandard”fordiagnosingdenervatedskeletalmuscle.Although bsandPSWshavebeendescribedinskeletal1–3musclesinaseriesofreportsinbothcere-bralandspinalcordlesions,4,5itisstillwidelyassumedamongneurophysiologiststhatanuppermotorneuron(UMN)lesionshouldleavethe

AdditionalSupportingInformationmaybefoundintheonlineversionofthisarticle.

Abbreviations:AH,abductorhallucis;ASIA,AmericanSpinalInjuryAsso-ciation;CMAP,compoundmuscleactionpotential;EDB,extensordigito-rumbrevis;EMG,electromyography;Fib,fibrillationpotential;GC,gastrocnemius;LMN,lowermotorneuron;NCS,nerveconductionstud-ies;PL,peroneuslongus;PNS,peripheralnervoussystem;PSW,positivesharpwave;RF,rectusfemoris;SA,spontaneousactivity;SCI,spinalcordinjury;SNAP,sensorynerveactionpotential;SSEP,shortlatencysomato-sensoryevokedpotential;TA,tibialisanterior;UMN,uppermotorneuron;VL,vastuslateralis;VM,vastusmedialis

Keywords:electromyography;nerveconductionstudy;peripheralnerv-oussystem;spinalcordinjury;spontaneousactivity

ThisworkwassupportedinpartbygrantsfromtheLundbeckFoundation,Copenhagen,Denmark.

Correspondenceto:H.Tankisi;e-mail:hatitank@rm.dk

V

C2015WileyPeriodicals,Inc.Publishedonline10March2015inWileyOnlineLibrary(http://www.77cn.com.cn).DOI10.1002/mus.24644

1016EDxinSCI

lowermotorneuron(LMN)anatomicallyintact,

withanormalaxonextendingtotheperiphery.Overall,thereareinconsistenciesinstudiesofabnormalSAinpatientswithspinalcordinjury(SCI).SomestudiesofSCIshowedalargernum-berof bs/PSWsindistalmusclescomparedwithproximalmuscles,suggestingapositivecorrelationbetweenthedegreeof bs/PSWsandthelengthoftheperipheralaxon,4,6whereas,inanotherstudy,therewasnodifferenceinthenumberof bs/PSWsbetweenproximalanddistalmuscles.5Withregardto bs/PSWsanddegreeofre exactivity/spasticity,somestudiesfoundanegativecorrelation,4,65,7whereasothersdidnotcon rmthiscorrelation.Becausenewtherapiesandrehabili-tationinterventions,thatis,functionalelectricalstimulation,neuroanastomosis,8andcell-andstem-cell–basedtherapies,9forUMNdisordersarebeingdeveloped,con rmingnormalperipheralnervefunctioniscrucial.

Thisstudywasdoneprospectivelyaspartofthepreoperativeevaluationoftheperipheralnervoussystem(PNS)insubjectswithcompleteorincom-pletechronicSCIwhowereundergoingneuroa-nastomosisofL5andS2ventralnerverootstoobtainbladderandeventuallybowelcontrol.8,10–12Theaimsofthestudywereto:(1)examineforLMNinvolvementotherthannerveentrapmentsinsubjectswithSCIbydeterminingthepatternofnerveconductionstudy(NCS)changesandthefrequencyofabnormalSA;(2)assesswhetherthereisacorrelationbetweenthedegreeof bs/PSWsandre exactivity,and(3)determinewhetherthelengthoftheaxonplaysaroleinthepatternof bs/PSWsbycomparingproximalanddistalmuscles.

METHODS

Thisstudyincluded12subjects(11menand1woman)withameanageof41.7years(range19–63years).Allsubjectshadtraumaticchronic(>1yearpostinjury)cervicalorthoracicSCIclassAorBontheAmericanSpinalInjuryAssociation(ASIA)scale.13Meandurationoftimesinceinjury

MUSCLE&NERVE

December2015

脊髓损伤后的周围神经病变

Table1.Subjects’demographics.

Patellarreflexes

Subject123456789101112

Yearssinceinjury

235551191713222

Gender/age(y)

M/55M/63M/22M/36M/35W/19M/62M/52M/31M/34M/45M/47

LevelTh9C5C7Th3C4Th10Th9Th4C8C5C7Th8

AISscore

ABBAAAAABBAA

–111111–––1111111111111111R

L–111111–––1111111111111111

R

Achillesreflexes–111111111––11111111111–11

–111111111––11111111111–11L

M,man;W,woman;R,right;L,left.Reflexesgradedasfollows:–5areflexia;15hyporeflexia;115normalreflex;and1115hyperreflexia.

was6.3(range1–19)years.Eightsubjectswerediagnosedwithcompleteinjury(ASIAclassA),and4subjectshadincompletesensoryinjury(ASIAclassB)byclinicalexamination(Table1).Noneofthesubjectshadapre-existingneurologiccondition,thatis,peripheralneuropathy,orweretakingmedicationsknowntocauseperipheralneu-ropathy,lowerlimbnerveinjury,lowbackinjury,orlowerlimbfracturebeforeoraftertheS …… 此处隐藏：24505字，全部文档内容请下载后查看。喜欢就下载吧 ……