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WS3-4 Human cremaster muscle (CM) and cremasteric reflex (CMR)
29th International Congress of Clinical Neurophysiology changes in motor unit potential analysis of sphincter electromyography (EMG) (external). Since involvement of the sacral Onuf’s nucleus is extremely uncommon in idiopathic Parkinson’s disease (iPD), sphincter EMG can become a practical method to distinguish MSA from iPD. If sphincter does not relax properly on evacuation, it shows obstructed pattern in the urodynamic pressure-flow analysis. Detrusor (bladder)external sphincter dyssynergia is such a condition that originates from higher malfunction in MSA. Only recently, peripheral nerve lesion, e.g., e syndrome, is shown to cause detrusor-internal sphincter Guillain Barr´ dyssynergia, due probably to increased peripheral nerve firing and ephaptic transmission. We need to treat the sphincter properly in order to maximize the quality of life in patients and to avoid urinary complications. WS3-2 Neurophysiology of pelvic floor A. Tello1 1 Clinical Neurophysiology Department. Hospital Espanol de Mexico, Mexico Pelvic floor disorders affect one in four adult women of all ages. The etiology of these disorders is multifactorial and results from a combination of risk factors. The clinical picture varies and can be presented as pelvic organ prolapse, fecal or urinary incontinence and sexual dysfunction. With a comprehensive neurological history and physical examination, the clinician might suggest the diagnosis as to where or which of the control mechanism is affected. However, most times, it is difficult to draw a conclusion on clinical grounds only, as normal pelvic floor function involves several neural paths, both peripheral and central controllers, and somatic and autonomic nervous systems. Given the complexity of the system, it is recommended to perform, in addition to anatomic studies, electrodiagnostic tests, designed to investigate pelvic floor dysfunction of neural controllers. A number of tests are performed to evaluate pelvic floor muscles and external anal sphincter, including pudendal nerve conduction studies, sacral reflexes, somatosensory evoked potentials and motor evoked potentials. When lower motor neuron lesion is suspected, EMG of anal and urethral sphincters is the most appropriate test, since information about denervation/reinnervation can be drawn from this method. If the lesion is at the level of the sacral level, besides EMG examination, sacral reflexes give important information. Pudendal nerve terminal motor latencies (PNTMLs), examines conduction of nerve fibers rather than levels of innervation, and examine large myelinated fibers conduction rather than that of the unmyelinated fibers which enclose the autonomic innervation. In cases of upper motor neuron dysfunction, the utility of SEPs and MEPs is less clear. This discussion reviews the clinical usefulness, the strengths and pitfalls of each technique, in establishing the integrity of the peripheral innervation of the pelvic floor and how the combination of different methods help to determine the level of the lesion. WS3-3 Clinical study
neurophysiological tests in uroneurology
1
D.B. Vodusek Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
1
Neurophysiological tests are used in clinical practice for assessment of individual patients with uroanogenital disorders or pelvic pain to diagnose nervous system lesions, and to define dysfunction. Needle EMG and conduction studies (particularly bulbocavernosus reflex) are useful in diagnosing lesions within the lower (S2-S4) sacral reflex arcs, and are more sensitive (whereas SEPs are less sensitive) than clinical examination to detect abnormality. Sympathetic skin response recording is still mostly a research tool. Kinesiological sphincter EMG recordings demonstrate detrusor/sphincter, and bowel/sphincter discoordination in patients with CNS lesions. Application of sphincter EMG has revealed myogenic urethral sphincter hyperactivity as cause for urinary retention in women, thus defining a new clinical syndrome (Fowler syndrome). Neurophysiological methods have demonstrated the (partly) neuropathic cause of “genuine” stress urinary and anal incontinence. In conclusion, neurophysiological tests remain interesting for clinical research in patients with uroanogenital dysfunction. EMG with sacral reflex recording is diagnostic in patients with suspected conus, cauda equina, sacral root, pudendal and levator ani nerve involvement, and defines lower motor neuron and reflex arc lesions due to trauma, compression, inflammation and dysraphism.
S77 WS3-4 Human cremaster muscle (CM) and cremasteric reflex (CMR) C. Ertekin1 Department of Neurology and Clinical Neurophysiology, Ege University, Izmir, Turkey
1
Human CM and CMR have not been systematically studied by the neurophysiological methods in spite of their important functional role in the preservation of the spermatogenesis and ejaculation. In this communication, our previous and present related studies are summarized. Needle EMG analysis including C-SFEMG shows that MUAPs were similar to those obtained from chronic neurogenic atrophy but the CM functions are normal in the healthy adult males investigated. Although the voluntary control of CM is not required for the most part, Magnetic Coil Stimulation to scalp and L1-L3 root levels produces clear cut Motor responses. Central motor conduction time was longer than lower abdominal muscles. Genitofemoral nerve motor conduction to CM is comparable to similar peripheral nerves. Hystochemistry of CM demonstrates that CM is a striated muscle but fibers have multiple motor end plates. CMR is elicited from thoracic to sacral dermatomes but varied among the subjects. CMR is more sensitive to abdominal cold stimulation and highly responsive to tactile stimuli at the genitalia. There is a reflex linkage between the upper lumbar and the lower sacral spinal segments studied by CMR and bulbocavernosus reflex. This spinal circuit may be related with the ejaculatory process in man. It is concluded that human CM and CMR is different physiologically and morphologically from the other skeletal muscles and reflexes probably due to different embryological development of CM. WS4. Restoration of injured peripheral nerve function WS4-1 Neurophysiological measures following total C7 nerve transection Y. Zhu1 1 EMG Laboratory, Huashan Hospital, Fudan University, Shanghai, China Over the past two decades, cervical seventh nerve from the uninjured contralateral plexus has become a new source of axon donor to reinnervate the median nerve in patients with total brachial plexus avulsion lesion. A vascularized ulnar nerve graft is interposed between this and the median nerve within the injured limb to restore hand function. Several studies have reported that power in wrist and digital flexors might reach MRC3 to MRC4; the patients might be able to localize accurately touch to the thumb, index and middle finger. On the donor side, after the total C7 nerve transection the clinical recovery of the sensory and motor function is good. We have performed the following neurophysiological studies: 1. Wallerian degeneration: C7 nerve transection causes maximal reduction of the amplitude of the sensory nerve action potential (SNAP) in digit 1, 2, 3, and 4 by the 8th day post operation. 2. Cutaneous sensation and the size of SNAP: The initial decrease in pinprick perception gradually recovers to normal by from 2 to 10 months post operation. Assessed by the reduction of the amplitude of digital SNAP, the C7 root distribution is predominately in digit 2 and 3 (>67%), and also in digit 1 (50%) and 4 (40%). 3. Mapping of C7 dermatome: It covers much of the conventional C6 dermatome on the lateral aspect of the forearm, along with the index, middle fingers and thumb. 4. H-reflex from flexor carpi radialis (FCR): FCR is innervated by the C6 and C7 roots. The H-reflex is absent after C7 nerve transfer and reappears months later in the majority of cases. 5. Digital SEP: A decrement of over 70% in the amplitude of digital SNAP does not affect the latency or amplitude of the first cortical response. WS4-2 Electrodiagnosis as a prognostic factor H. Kwon1 1 Department of Physical Medicine & Rehabilitation, College of medicine, Korea University, Seoul, Korea The nature of injury is critical factor in deterniming the severity of the injury and the prognosis for full recovery. Compression neuropathy,
neurophysiological tests in uroneurology
1
D.B. Vodusek Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
1
Neurophysiological tests are used in clinical practice for assessment of individual patients with uroanogenital disorders or pelvic pain to diagnose nervous system lesions, and to define dysfunction. Needle EMG and conduction studies (particularly bulbocavernosus reflex) are useful in diagnosing lesions within the lower (S2-S4) sacral reflex arcs, and are more sensitive (whereas SEPs are less sensitive) than clinical examination to detect abnormality. Sympathetic skin response recording is still mostly a research tool. Kinesiological sphincter EMG recordings demonstrate detrusor/sphincter, and bowel/sphincter discoordination in patients with CNS lesions. Application of sphincter EMG has revealed myogenic urethral sphincter hyperactivity as cause for urinary retention in women, thus defining a new clinical syndrome (Fowler syndrome). Neurophysiological methods have demonstrated the (partly) neuropathic cause of “genuine” stress urinary and anal incontinence. In conclusion, neurophysiological tests remain interesting for clinical research in patients with uroanogenital dysfunction. EMG with sacral reflex recording is diagnostic in patients with suspected conus, cauda equina, sacral root, pudendal and levator ani nerve involvement, and defines lower motor neuron and reflex arc lesions due to trauma, compression, inflammation and dysraphism.
S77 WS3-4 Human cremaster muscle (CM) and cremasteric reflex (CMR) C. Ertekin1 Department of Neurology and Clinical Neurophysiology, Ege University, Izmir, Turkey
1
Human CM and CMR have not been systematically studied by the neurophysiological methods in spite of their important functional role in the preservation of the spermatogenesis and ejaculation. In this communication, our previous and present related studies are summarized. Needle EMG analysis including C-SFEMG shows that MUAPs were similar to those obtained from chronic neurogenic atrophy but the CM functions are normal in the healthy adult males investigated. Although the voluntary control of CM is not required for the most part, Magnetic Coil Stimulation to scalp and L1-L3 root levels produces clear cut Motor responses. Central motor conduction time was longer than lower abdominal muscles. Genitofemoral nerve motor conduction to CM is comparable to similar peripheral nerves. Hystochemistry of CM demonstrates that CM is a striated muscle but fibers have multiple motor end plates. CMR is elicited from thoracic to sacral dermatomes but varied among the subjects. CMR is more sensitive to abdominal cold stimulation and highly responsive to tactile stimuli at the genitalia. There is a reflex linkage between the upper lumbar and the lower sacral spinal segments studied by CMR and bulbocavernosus reflex. This spinal circuit may be related with the ejaculatory process in man. It is concluded that human CM and CMR is different physiologically and morphologically from the other skeletal muscles and reflexes probably due to different embryological development of CM. WS4. Restoration of injured peripheral nerve function WS4-1 Neurophysiological measures following total C7 nerve transection Y. Zhu1 1 EMG Laboratory, Huashan Hospital, Fudan University, Shanghai, China Over the past two decades, cervical seventh nerve from the uninjured contralateral plexus has become a new source of axon donor to reinnervate the median nerve in patients with total brachial plexus avulsion lesion. A vascularized ulnar nerve graft is interposed between this and the median nerve within the injured limb to restore hand function. Several studies have reported that power in wrist and digital flexors might reach MRC3 to MRC4; the patients might be able to localize accurately touch to the thumb, index and middle finger. On the donor side, after the total C7 nerve transection the clinical recovery of the sensory and motor function is good. We have performed the following neurophysiological studies: 1. Wallerian degeneration: C7 nerve transection causes maximal reduction of the amplitude of the sensory nerve action potential (SNAP) in digit 1, 2, 3, and 4 by the 8th day post operation. 2. Cutaneous sensation and the size of SNAP: The initial decrease in pinprick perception gradually recovers to normal by from 2 to 10 months post operation. Assessed by the reduction of the amplitude of digital SNAP, the C7 root distribution is predominately in digit 2 and 3 (>67%), and also in digit 1 (50%) and 4 (40%). 3. Mapping of C7 dermatome: It covers much of the conventional C6 dermatome on the lateral aspect of the forearm, along with the index, middle fingers and thumb. 4. H-reflex from flexor carpi radialis (FCR): FCR is innervated by the C6 and C7 roots. The H-reflex is absent after C7 nerve transfer and reappears months later in the majority of cases. 5. Digital SEP: A decrement of over 70% in the amplitude of digital SNAP does not affect the latency or amplitude of the first cortical response. WS4-2 Electrodiagnosis as a prognostic factor H. Kwon1 1 Department of Physical Medicine & Rehabilitation, College of medicine, Korea University, Seoul, Korea The nature of injury is critical factor in deterniming the severity of the injury and the prognosis for full recovery. Compression neuropathy,