- Email: [email protected]
P13-23 Importance of electromyographic assessment of paraspinal muscles in myopathy: evaluation of 78 patients
29th International Congress of Clinical Neurophysiology
S183
P13-19 Motor unit action potentials of the cremaster muscle
and were seen by the authors. We performed concentric needle EMG of the bulbocavernosus muscle and/or external anal sphincter bilaterally in a standardized manner. Results: Most of the referring doctors were non-neurologists. We included 341 patients: 121 men (average age 53±15 years) and 220 women (average age 58±14 years). 45% of patients had normal EMG findings, 23.8% had chronic bilateral abnormalities, 17.3% had chronic unilateral abnormalities, 6.5% had acute bilateral and 1.5% acute unilateral abnormalities. In 5.9% of patients the abnormalities were compatible with upper motor neuron lesion. In 78% of patients both anal sphincter and bulbocavernous muscles were examined, and the latencies of bulbocavernous reflex with detection in anal sphincter and bulbocavernous muscles were compared. The findings were comparable. Men and women had similar results. Conclusions: Almost half of referred patients had normal EMG findings. In the group of patients with abnormalities a minority had acute denervation or signs of a suprasegmental lesion that needed further diagnostic procedures early. Almost twice as many women were referred for uroneurophysiologic testing because of sacral dysfunction, which probably reflects epidemiological differences in prevalence of lower urinary tract and bowel dysfunction between sexes. We interprete the large percentage of normal findings to reflect overuse of uroneurophysiological diagnostics. Clinical criteria for referral should be set more strictly.
T. Ozdemirkiran1 , C. Ertekin2 1 Ataturk Education and Research Hospital, Department of Neurology, Yesilyurt, Izmir, Turkey, 2 Emeritus Professor from Agean University, Medical School Hospital, Departments of Clinical Neurophysiology and Neurology, Bornova, Izmir, Turkey Introduction: Because motor unit action potentials (MUAPs) of human striated cremaster muscle (CM) have not been analysed previously, we examined the MUAPs of the CM to learn more about the physiology of this unusual muscle that works mostly without voluntary control. Method: In this study, MUAPs of human CM were investigated in 31 normal subjects. MUAPs were elicited by either a voluntarily contraction effort or a reflex response to tactile stimulation of the inner thigh. Singlefiber electromyography (SF EMG) using a disposable concentric needle electrode (CNE) was also performed in 10 normal subjects. Results: The total number of MUAPs was 288. Approximately 40% of all MUAPs were classified as simple MUAPs, and the remainder were polyphasic potentials. During tactile stimulation, the MUAPs longer than 20 ms sometimes grouped as a single long potential or as different subgroups with time intervals between them. In SF EMG only 29 potential pairs were obtained. SF EMG using a CNE revealed an increase in jitter and intermittent blocking. The average of mean consecutive differences (MCD) was 73.5 ms. Discussion: These results were similar to those obtained from patients with chronic neurogenic disorders despite the fact that the CMs studied were clinically and functionally normal in our healthy male subjects. These findings suggest that the CM is an embryogenic striated muscle with polyneural innervation both at the muscle fiber and spinal cord level. P13-20 Wide receptive field of cremasteric reflex (CMR) in human adult males T. Ozdemirkiran1 , C. Ertekin2 , Y. Secil1 , F. Tokucoglu1 , N. Gurgor1 , T. Kurt1 1 Department of Neurology, Ataturk Education and Research Hospital, Yesilyurt, Izmir, Turkey, 2 Invited scientist: Emeritus Professor from Agean University, Medical School Hospital, Departments of Clinical Neurophysiology and Neurology, Bornova, Izmir, Turkey Objective: The function of cremasteric reflex (CMR) is important for protection of testes especially against the temperature changes and CMR also contribute the coital/sexual activities. Our aim was to investigate the physiologic function of CMR. Method: Cremaster muscle was investigated with neddle electrode afterward the CMR was elicited by electrical, tactile and cold stimulations using the some spots throughout the anterior aspect of whole body until neck. Fourthy-two adult male volunteers were participated to study. Results: It was found that CMR was tremendously prolonged by ipsilateral very short electrical stimuli at the thigh, much below the pain threshold. Although it is variable interindividually, CMR could be elicited by the stimuli at long distance from sacral to thoracal dermatomes. CMR is more sensitive to cold stimulation at the abdominal region but at the genital region it is more sensitive to tactile and electrical stimulation. Conclusion: Wide receptive field of CMR was proposed to relate with the preservation of testes especially for cold stimulation and the CMR elicited by tactile stimulation was thought to be related with the contribution of the CMR to the sexual functions. Some functional aspects of CMR could be investigated by using distribution of reflexogenic areas. P13-21 Uroneurophysiologic findings in 341 consecutive patients referred because of “sphincter dysfunction” 1
1
M. Rotar , D.B. Vodusek Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia 1
Objective: Electrophysiologic investigation of pelvic floor muscles is a standard diagnostic procedure in patients with urinary and/or anal symptoms suspected to be of neurological origin. Our aim was to review the uroneurophysiologic findings in a group of consecutively referred patients. Methods: We reviewed the uroneurophysiologic findings of patients with symptoms of lower urinary tract or bowel dysfunction who were referred to the EMG laboratory of our institution in the period from 2008 to 2010,
P13-22 Identification of the waveform to show the damage of motor pathway in the free-run EMG of the operations for spinal cord: A case study D. Mishima1 , T. Suwa1 , K. Mii1 , O. Itou2 , N. Yoshitake3 1 The Department of Neurosurgery, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan, 2 Clinical engineer, National Hospital Organization Sagamihara National Hospital, Japan, 3 CareFusion Japan 228 inc., Japan Objective: To investigate what kind of free-run electromyography (fEMG) waveforms appears while the motor pathway is damaged during spinal surgeries. Methods: We recorded the fEMG waveform all through the surgeries. In one case, we accomplished to analyze the fEMG data that was obtained during the operation, the resection of a cervicothracic lesion extramedurally tumor (meningioma). And transcranial stimulation myogenic motor evoked potential (TCS-MEP) was also recorded. The correspondence fEMG data and TCS-MEP one was examined. Results: Several patterns of muscle responses were recorded on fEMG during tumor resection. And a certain waveform of fEMG correlating with the amplitude reduction of compound muscle action potentials (CMAP) on TCS-MEP was identified. It was a swarm of high frequent waveform. The characteristics of a certain waveform were analyzed. They were mono- or poly-phasic constant waveform and appeared and lasted for more than 0.1 seconds. And their frequency was seemed to be more than 20 Hz. Moreover, the amplitude, the area and the interval of muscle response had no correlations with the CMAP amplitude on TCS-MEP. Conclusions: It came to know the motor pathway damaging which was not found out only in the existence of the muscle response on fEMG. The swarm of high frequency waveform might be the response shows the damage of the motor pathway. By using this conspicuous waveform as an indicator, the fEMG monitoring must become useful. P13-23 Importance of electromyographic assessment of paraspinal muscles in myopathy: evaluation of 78 patients D.G.S. Dahani1 , D.M. Al-Hakami1 , D.M.A. Lakhair2 , D.A. Lakhair2 , M. Khan3 1 Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia, 2 Liaquat University of Medical and Health Sciences, Jamshoro Sindh, Pakistan, 3 Aga Khan University Hospital Karachi, Pakistan Introduction: Paraspinal muscles are supplied by posterior ramus, in contrast limb and abdominal muscles by anterior ramus. Voluntary contraction of paraspinal muscles is difficult, making assessment of motor unit potentials difficult and being not used routinely in myopathies. In some situations like vacuolar myopathies its value is essential. Objective: To evaluate the importance of electromyography of paraspinal muscles in myopathy.
S184
Posters
Methods: This is a prospective interventional study. Consent was taken as protocol. Patients referred for myopathy were included and those with diabetes mellitus and age more than 50 years were excluded from the study. Nerve conduction studies and needle exam (concentric needle) performed according to AANEM criteria for myopathy, in addition cervical paraspinal muscles were assessed and patients were encouraged making neck muscles tense for motor unit assessment. Findings were confirmed from qualified neurophysiologist. For data interpretation SPSS version 16 used, results expressed in percentages. Results: Total 78 patients, 51 females and 27 males were included in the study. Inflammatory myopathic findings noted in 60 (76.92%) and noninflammatory in 18 (23.08%). In inflammatory myopathy group 13 (21.66%) showed fibrillation and positive sharp waves in paraspinal muscles but negative in limbs. Among inflammatory myopathy 9 (15%) and in noninflammatory 3 (16.6%) showed myopathic motor units in paraspinal muscles and not in limb muscles. Conclusion: Paraspinal muscle electromyographic assessment is statistically helpful for further evaluation of myopathic disorders particularly if limb muscle electrography does not show fibrillation potentials, positive sharp waves and myopathic motor units or inconclusive findings. Further muscle biopsy is needed to correlate paraspinal muscle predilection or its early involvement in the disease process. P13-24 Diagnostic value of electromyography in evaluation of neural injury in lumbosacral radiculopathies 1
1
1
V. Osejo Altamirano , P. Rojo Alaminos , D. Panova Tzonova , I. Herrera Peco1,2 , G. Ortega Rabbione3 , R. Wix Ramos1 1 Neurophisiology Department, Hospital Universitario “La Princesa”, Madrid, Spain, 2 Medical School, “CEU San Pablo” University, Madrid, Spain, 3 Neurosurgery Department, Hospital Universitario “La Princesa”, Madrid, Spain Objectives: In clinical practice EMG is used as a complementary evaluation along with magnetic resonance imaging (MRI) in the assessment of patients with clinical symptoms of Lumbar Radicular Syndrome (LRS). Needle electromyography (EMG) evaluates the function of nervous roots and is useful in the assessment of neural injury in radiculopathies. The purpose is to determine the value of EMG compared to MRI, in the diagnosis of LRS. Methods: We evaluated the digitilized history of 52 consecutive patients with symptoms of lumbosacral radiculopathies that attended the EMG laboratory between January and December of 2009, reffered by different specialist (neurosurgeons, orthopaedic surgeons, reumathologists, general practicians, etc). The evaluation included comparison of EMG and MRI. A positive patient was defined as the one having root compression and/or discal herniation on MRI. We used Sigmastat 3.5 to calculate bivariate and multiple regression tests for the diagnostic value of each item. Sensitivity and specificity of the variables were also determined. Results: We included 26 men and 26 women, with ages ranging between 33 and 83 years, mean of 60.35 (±1.5) years. Positive EMG included evidence of denervation on the evaluated muscles and/or chronic neurogenic pattern. Quadriceps muscle was related to L2-L3-L4 level injury, anterior Tibial muscle was related to L5 level injury, the Abductor Hallucis and Gastronecmious muscles to S1 level injury. EMG had a sensitivity of 0.95 and a specificity of 0.27, with an odds ratio of 3.3 when compared to MRI. Predictive positive value 0.83. Out of 52 patients only 3 (5%) had signs of denervation without radiological evidence of compression. Conclusion: In presence of symptoms suggestive of radiculopathy, patients should undergo screening that includes EMG to diagnose lesions on nervous roots given the possibility of surgical intervention to treat LRS. P13-25 Sectional neuroanatomy of the pelvic floor J.S. Kass1 , K.H. Taber2 , J.S. Harrell3 , H. Zhang4 , F.Y. Chiou-Tan3 Dept. of Neurology, Baylor College of Medicine, USA, 2 Veteran’s Affairs Mid Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA, 3 Department of Phys Med Rehabil, Baylor College of Medicine, USA, 4 Department of Neurobiology and Anatomy, University of Texas School of Medicine, Houston, TX, USA
1
Background: An increasing number of chemodenervation procedures with botulinum toxin, sacral/pudendal neurostimulator implants, and
electromyographic (EMG) studies are performed in the pelvic floor region for various conditions such as urinary and fecal incontinence. Injection and stimulator electrode placement occur at many sites and may not correlate with routine EMG pin insertion sites. Objective: To provide anatomically accurate schematics of innervation of the pelvic floor with special attention to the muscles and their innervation. These schematics can be used to increase accuracy and minimize complications of chemodenervation, neurostimulator implant and EMG procedures in the pelvic floor region. Methods: Magnetic resonance images and anatomic references of both the male and female pelvis were synthesized to provide the basis for these illustrations. A review of the literature for complications and rates of the procedures is compiled. Results: Cross-sectional schematics for the pelvic floor were drawn as they appear in imaging projections. The level of cross section of both the male and female pelvis was selected to highlight important anatomic landmarks. The major nerves were grouped into twelve color-coded categories. The muscles and skin were labeled and assigned the color of the appropriate nerves. Conclusions: An organized comprehensive map of the sensory and motor innervation of the male and female pelvic floor is presented. It is hoped these schematics will assist in the accuracy and minimize complications of chemodenervation, EMG, and neurostimulator implantation procedures in the pelvic floor region. P13-26 Pneumothorax after needle electromyography of the diaphragm: a case report and critical analysis S. Podnar1 Institute of Clinical Neurophysiology, Division of Neurology, University Medical Centre, Ljubljana, Slovenia 1
Objective: Pneumothorax is a well-known and feared complication of needle electromyography (EMG) of the diaphragm. The literature, however, does not provide a detailed description and critical analysis of this subject. I report my first patient with pneumothorax caused by needle EMG of the diaphragm, and analyze possible causes for this complication. Case report: A 72-year-old patient with neuralgic amyotrophy (affecting the right long thoracic and bilateral phrenic nerves) occuring 5 days after lumbar spine surgery developed a right-sided pneumothorax after his second bilateral needle EMG of the diaphragm performed in the 5th week of his illness. The situation quickly resolved after insertion of the pleural drain. Conclusions: To reduce the possibility of iatrogenic pneumothorax, needle EMG of the diaphragm should be performed only when clearly indicated. Furthermore, only the intercostal spaces lateral to the midclavicular line should be used for needle penetration. Particular care is needed in patients with complete denervation of the diaphragm, because absence of the characteristic bursting pattern of low-amplitude diaphragm MUPs during inspiration may lead to potentially dangerous needle explorations. P13-27 Facioscapulohumeral muscular dystrophy K. Shahdevi1 , I. Werda1 , H. Machlusil1 1 Neurology Department, Faculty of Medicine, Brawijaya University, Malang, Indonesia Background: Facioscapulohumeral muscular dystrophy (FSHD) is a type of myopathy caused by genetic disorder which inherited by autosomal dominant. The incidence and prevalence are rare, with slowly progressive which need complicated examination. There are no specific treatment, but the prognosis is relative good. Case: A 67-years-old man complained about weakness and wasting of the right upper arm muscles and difficulty to whistle since 30 years ago. Then, progressing to left upper arm since 5 years ago. There are also weakness of scapular muscles and progressive dysarthriasince 4 years ago. Since 2 years ago patient also complained about weakness and wasting of the calf muscles in both side, and deafness in right side since 1 year ago. There are family history with same condition in three generations which inherited by autosomal resessive. From the physical examination, there are weakness and atrophy of orbicularis oris, trapezius, biceps brachii, triceps brachii, pectoralis major, deltoideus, latissimus dorsi, serratus anterior, tibialis anterior, peroneus longus and brevis, gastrocnemius in
S183
P13-19 Motor unit action potentials of the cremaster muscle
and were seen by the authors. We performed concentric needle EMG of the bulbocavernosus muscle and/or external anal sphincter bilaterally in a standardized manner. Results: Most of the referring doctors were non-neurologists. We included 341 patients: 121 men (average age 53±15 years) and 220 women (average age 58±14 years). 45% of patients had normal EMG findings, 23.8% had chronic bilateral abnormalities, 17.3% had chronic unilateral abnormalities, 6.5% had acute bilateral and 1.5% acute unilateral abnormalities. In 5.9% of patients the abnormalities were compatible with upper motor neuron lesion. In 78% of patients both anal sphincter and bulbocavernous muscles were examined, and the latencies of bulbocavernous reflex with detection in anal sphincter and bulbocavernous muscles were compared. The findings were comparable. Men and women had similar results. Conclusions: Almost half of referred patients had normal EMG findings. In the group of patients with abnormalities a minority had acute denervation or signs of a suprasegmental lesion that needed further diagnostic procedures early. Almost twice as many women were referred for uroneurophysiologic testing because of sacral dysfunction, which probably reflects epidemiological differences in prevalence of lower urinary tract and bowel dysfunction between sexes. We interprete the large percentage of normal findings to reflect overuse of uroneurophysiological diagnostics. Clinical criteria for referral should be set more strictly.
T. Ozdemirkiran1 , C. Ertekin2 1 Ataturk Education and Research Hospital, Department of Neurology, Yesilyurt, Izmir, Turkey, 2 Emeritus Professor from Agean University, Medical School Hospital, Departments of Clinical Neurophysiology and Neurology, Bornova, Izmir, Turkey Introduction: Because motor unit action potentials (MUAPs) of human striated cremaster muscle (CM) have not been analysed previously, we examined the MUAPs of the CM to learn more about the physiology of this unusual muscle that works mostly without voluntary control. Method: In this study, MUAPs of human CM were investigated in 31 normal subjects. MUAPs were elicited by either a voluntarily contraction effort or a reflex response to tactile stimulation of the inner thigh. Singlefiber electromyography (SF EMG) using a disposable concentric needle electrode (CNE) was also performed in 10 normal subjects. Results: The total number of MUAPs was 288. Approximately 40% of all MUAPs were classified as simple MUAPs, and the remainder were polyphasic potentials. During tactile stimulation, the MUAPs longer than 20 ms sometimes grouped as a single long potential or as different subgroups with time intervals between them. In SF EMG only 29 potential pairs were obtained. SF EMG using a CNE revealed an increase in jitter and intermittent blocking. The average of mean consecutive differences (MCD) was 73.5 ms. Discussion: These results were similar to those obtained from patients with chronic neurogenic disorders despite the fact that the CMs studied were clinically and functionally normal in our healthy male subjects. These findings suggest that the CM is an embryogenic striated muscle with polyneural innervation both at the muscle fiber and spinal cord level. P13-20 Wide receptive field of cremasteric reflex (CMR) in human adult males T. Ozdemirkiran1 , C. Ertekin2 , Y. Secil1 , F. Tokucoglu1 , N. Gurgor1 , T. Kurt1 1 Department of Neurology, Ataturk Education and Research Hospital, Yesilyurt, Izmir, Turkey, 2 Invited scientist: Emeritus Professor from Agean University, Medical School Hospital, Departments of Clinical Neurophysiology and Neurology, Bornova, Izmir, Turkey Objective: The function of cremasteric reflex (CMR) is important for protection of testes especially against the temperature changes and CMR also contribute the coital/sexual activities. Our aim was to investigate the physiologic function of CMR. Method: Cremaster muscle was investigated with neddle electrode afterward the CMR was elicited by electrical, tactile and cold stimulations using the some spots throughout the anterior aspect of whole body until neck. Fourthy-two adult male volunteers were participated to study. Results: It was found that CMR was tremendously prolonged by ipsilateral very short electrical stimuli at the thigh, much below the pain threshold. Although it is variable interindividually, CMR could be elicited by the stimuli at long distance from sacral to thoracal dermatomes. CMR is more sensitive to cold stimulation at the abdominal region but at the genital region it is more sensitive to tactile and electrical stimulation. Conclusion: Wide receptive field of CMR was proposed to relate with the preservation of testes especially for cold stimulation and the CMR elicited by tactile stimulation was thought to be related with the contribution of the CMR to the sexual functions. Some functional aspects of CMR could be investigated by using distribution of reflexogenic areas. P13-21 Uroneurophysiologic findings in 341 consecutive patients referred because of “sphincter dysfunction” 1
1
M. Rotar , D.B. Vodusek Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia 1
Objective: Electrophysiologic investigation of pelvic floor muscles is a standard diagnostic procedure in patients with urinary and/or anal symptoms suspected to be of neurological origin. Our aim was to review the uroneurophysiologic findings in a group of consecutively referred patients. Methods: We reviewed the uroneurophysiologic findings of patients with symptoms of lower urinary tract or bowel dysfunction who were referred to the EMG laboratory of our institution in the period from 2008 to 2010,
P13-22 Identification of the waveform to show the damage of motor pathway in the free-run EMG of the operations for spinal cord: A case study D. Mishima1 , T. Suwa1 , K. Mii1 , O. Itou2 , N. Yoshitake3 1 The Department of Neurosurgery, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan, 2 Clinical engineer, National Hospital Organization Sagamihara National Hospital, Japan, 3 CareFusion Japan 228 inc., Japan Objective: To investigate what kind of free-run electromyography (fEMG) waveforms appears while the motor pathway is damaged during spinal surgeries. Methods: We recorded the fEMG waveform all through the surgeries. In one case, we accomplished to analyze the fEMG data that was obtained during the operation, the resection of a cervicothracic lesion extramedurally tumor (meningioma). And transcranial stimulation myogenic motor evoked potential (TCS-MEP) was also recorded. The correspondence fEMG data and TCS-MEP one was examined. Results: Several patterns of muscle responses were recorded on fEMG during tumor resection. And a certain waveform of fEMG correlating with the amplitude reduction of compound muscle action potentials (CMAP) on TCS-MEP was identified. It was a swarm of high frequent waveform. The characteristics of a certain waveform were analyzed. They were mono- or poly-phasic constant waveform and appeared and lasted for more than 0.1 seconds. And their frequency was seemed to be more than 20 Hz. Moreover, the amplitude, the area and the interval of muscle response had no correlations with the CMAP amplitude on TCS-MEP. Conclusions: It came to know the motor pathway damaging which was not found out only in the existence of the muscle response on fEMG. The swarm of high frequency waveform might be the response shows the damage of the motor pathway. By using this conspicuous waveform as an indicator, the fEMG monitoring must become useful. P13-23 Importance of electromyographic assessment of paraspinal muscles in myopathy: evaluation of 78 patients D.G.S. Dahani1 , D.M. Al-Hakami1 , D.M.A. Lakhair2 , D.A. Lakhair2 , M. Khan3 1 Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia, 2 Liaquat University of Medical and Health Sciences, Jamshoro Sindh, Pakistan, 3 Aga Khan University Hospital Karachi, Pakistan Introduction: Paraspinal muscles are supplied by posterior ramus, in contrast limb and abdominal muscles by anterior ramus. Voluntary contraction of paraspinal muscles is difficult, making assessment of motor unit potentials difficult and being not used routinely in myopathies. In some situations like vacuolar myopathies its value is essential. Objective: To evaluate the importance of electromyography of paraspinal muscles in myopathy.
S184
Posters
Methods: This is a prospective interventional study. Consent was taken as protocol. Patients referred for myopathy were included and those with diabetes mellitus and age more than 50 years were excluded from the study. Nerve conduction studies and needle exam (concentric needle) performed according to AANEM criteria for myopathy, in addition cervical paraspinal muscles were assessed and patients were encouraged making neck muscles tense for motor unit assessment. Findings were confirmed from qualified neurophysiologist. For data interpretation SPSS version 16 used, results expressed in percentages. Results: Total 78 patients, 51 females and 27 males were included in the study. Inflammatory myopathic findings noted in 60 (76.92%) and noninflammatory in 18 (23.08%). In inflammatory myopathy group 13 (21.66%) showed fibrillation and positive sharp waves in paraspinal muscles but negative in limbs. Among inflammatory myopathy 9 (15%) and in noninflammatory 3 (16.6%) showed myopathic motor units in paraspinal muscles and not in limb muscles. Conclusion: Paraspinal muscle electromyographic assessment is statistically helpful for further evaluation of myopathic disorders particularly if limb muscle electrography does not show fibrillation potentials, positive sharp waves and myopathic motor units or inconclusive findings. Further muscle biopsy is needed to correlate paraspinal muscle predilection or its early involvement in the disease process. P13-24 Diagnostic value of electromyography in evaluation of neural injury in lumbosacral radiculopathies 1
1
1
V. Osejo Altamirano , P. Rojo Alaminos , D. Panova Tzonova , I. Herrera Peco1,2 , G. Ortega Rabbione3 , R. Wix Ramos1 1 Neurophisiology Department, Hospital Universitario “La Princesa”, Madrid, Spain, 2 Medical School, “CEU San Pablo” University, Madrid, Spain, 3 Neurosurgery Department, Hospital Universitario “La Princesa”, Madrid, Spain Objectives: In clinical practice EMG is used as a complementary evaluation along with magnetic resonance imaging (MRI) in the assessment of patients with clinical symptoms of Lumbar Radicular Syndrome (LRS). Needle electromyography (EMG) evaluates the function of nervous roots and is useful in the assessment of neural injury in radiculopathies. The purpose is to determine the value of EMG compared to MRI, in the diagnosis of LRS. Methods: We evaluated the digitilized history of 52 consecutive patients with symptoms of lumbosacral radiculopathies that attended the EMG laboratory between January and December of 2009, reffered by different specialist (neurosurgeons, orthopaedic surgeons, reumathologists, general practicians, etc). The evaluation included comparison of EMG and MRI. A positive patient was defined as the one having root compression and/or discal herniation on MRI. We used Sigmastat 3.5 to calculate bivariate and multiple regression tests for the diagnostic value of each item. Sensitivity and specificity of the variables were also determined. Results: We included 26 men and 26 women, with ages ranging between 33 and 83 years, mean of 60.35 (±1.5) years. Positive EMG included evidence of denervation on the evaluated muscles and/or chronic neurogenic pattern. Quadriceps muscle was related to L2-L3-L4 level injury, anterior Tibial muscle was related to L5 level injury, the Abductor Hallucis and Gastronecmious muscles to S1 level injury. EMG had a sensitivity of 0.95 and a specificity of 0.27, with an odds ratio of 3.3 when compared to MRI. Predictive positive value 0.83. Out of 52 patients only 3 (5%) had signs of denervation without radiological evidence of compression. Conclusion: In presence of symptoms suggestive of radiculopathy, patients should undergo screening that includes EMG to diagnose lesions on nervous roots given the possibility of surgical intervention to treat LRS. P13-25 Sectional neuroanatomy of the pelvic floor J.S. Kass1 , K.H. Taber2 , J.S. Harrell3 , H. Zhang4 , F.Y. Chiou-Tan3 Dept. of Neurology, Baylor College of Medicine, USA, 2 Veteran’s Affairs Mid Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA, 3 Department of Phys Med Rehabil, Baylor College of Medicine, USA, 4 Department of Neurobiology and Anatomy, University of Texas School of Medicine, Houston, TX, USA
1
Background: An increasing number of chemodenervation procedures with botulinum toxin, sacral/pudendal neurostimulator implants, and
electromyographic (EMG) studies are performed in the pelvic floor region for various conditions such as urinary and fecal incontinence. Injection and stimulator electrode placement occur at many sites and may not correlate with routine EMG pin insertion sites. Objective: To provide anatomically accurate schematics of innervation of the pelvic floor with special attention to the muscles and their innervation. These schematics can be used to increase accuracy and minimize complications of chemodenervation, neurostimulator implant and EMG procedures in the pelvic floor region. Methods: Magnetic resonance images and anatomic references of both the male and female pelvis were synthesized to provide the basis for these illustrations. A review of the literature for complications and rates of the procedures is compiled. Results: Cross-sectional schematics for the pelvic floor were drawn as they appear in imaging projections. The level of cross section of both the male and female pelvis was selected to highlight important anatomic landmarks. The major nerves were grouped into twelve color-coded categories. The muscles and skin were labeled and assigned the color of the appropriate nerves. Conclusions: An organized comprehensive map of the sensory and motor innervation of the male and female pelvic floor is presented. It is hoped these schematics will assist in the accuracy and minimize complications of chemodenervation, EMG, and neurostimulator implantation procedures in the pelvic floor region. P13-26 Pneumothorax after needle electromyography of the diaphragm: a case report and critical analysis S. Podnar1 Institute of Clinical Neurophysiology, Division of Neurology, University Medical Centre, Ljubljana, Slovenia 1
Objective: Pneumothorax is a well-known and feared complication of needle electromyography (EMG) of the diaphragm. The literature, however, does not provide a detailed description and critical analysis of this subject. I report my first patient with pneumothorax caused by needle EMG of the diaphragm, and analyze possible causes for this complication. Case report: A 72-year-old patient with neuralgic amyotrophy (affecting the right long thoracic and bilateral phrenic nerves) occuring 5 days after lumbar spine surgery developed a right-sided pneumothorax after his second bilateral needle EMG of the diaphragm performed in the 5th week of his illness. The situation quickly resolved after insertion of the pleural drain. Conclusions: To reduce the possibility of iatrogenic pneumothorax, needle EMG of the diaphragm should be performed only when clearly indicated. Furthermore, only the intercostal spaces lateral to the midclavicular line should be used for needle penetration. Particular care is needed in patients with complete denervation of the diaphragm, because absence of the characteristic bursting pattern of low-amplitude diaphragm MUPs during inspiration may lead to potentially dangerous needle explorations. P13-27 Facioscapulohumeral muscular dystrophy K. Shahdevi1 , I. Werda1 , H. Machlusil1 1 Neurology Department, Faculty of Medicine, Brawijaya University, Malang, Indonesia Background: Facioscapulohumeral muscular dystrophy (FSHD) is a type of myopathy caused by genetic disorder which inherited by autosomal dominant. The incidence and prevalence are rare, with slowly progressive which need complicated examination. There are no specific treatment, but the prognosis is relative good. Case: A 67-years-old man complained about weakness and wasting of the right upper arm muscles and difficulty to whistle since 30 years ago. Then, progressing to left upper arm since 5 years ago. There are also weakness of scapular muscles and progressive dysarthriasince 4 years ago. Since 2 years ago patient also complained about weakness and wasting of the calf muscles in both side, and deafness in right side since 1 year ago. There are family history with same condition in three generations which inherited by autosomal resessive. From the physical examination, there are weakness and atrophy of orbicularis oris, trapezius, biceps brachii, triceps brachii, pectoralis major, deltoideus, latissimus dorsi, serratus anterior, tibialis anterior, peroneus longus and brevis, gastrocnemius in