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Recent evidence indicates that turning difficulty may correlate with trunk control; however, surface electromyography has not been used to explore trunk muscle activity during turning after stroke. This study investigated trunk muscle activation patterns during standing turns in healthy controls (HCs) and patients with stroke with turning difficulty (TD) and no TD (NTD). The participants with stroke were divided into two groups according to the 180° turning duration and number of steps to determine the presence of TD. The activation patterns of the bilateral external oblique and erector spinae muscles of all the participants were recorded during 90° standing turns. A total of 14 HCs, 14 patients with TD, and 14 patients with NTD were recruited. The duration and number of steps in the turning of the TD group were greater than those of the HCs, independent of the turning direction. However, the NTD group had a significantly longer turning duration than did the HC group only toward the paretic side. Their performance was similar when turning toward the non-paretic side; this result is consistent with electromyographic findings. Both TD and NTD groups demonstrated increased amplitudes of trunk muscles compared with the HC groups. Their trunk muscles failed to maintain consistent amplitudes during the entire movement of standing turns in the direction that they required more time or steps to turn toward (i.e., turning in either direction for the TD group and turning toward the paretic side for the NTD group). Patients with stroke had augmented activation of trunk muscles during turning. When patients with TD turned toward either direction and when patients with NTD turned toward the paretic side, the flexible adaptations and selective actions of trunk muscles observed in the HCs were absent. Such distinct activation patterns during turning may contribute to poor turning performance and elevate the risk of falling. Our findings provide insights into the contribution and importance of trunk muscles during turning and the association with TD after stroke. These findings may help guide the development of more effective rehabilitation therapies that target specific muscles for those with TD.

Aim:The etiology of mastalgia is not fully understood. We evaluated the relationship between electromyography (EMG) measurements of the pectoralis major (PM) muscle and mastalgia in patients with non-cyclic unilateral mastalgia.Methods:Thirty-one patients who were admitted to the breast surgery outpatient clinic due to the complaints of intermittent or continuous unilateral non-cyclic mastalgia for at least one month were included in the study. Data on age, family history, age of menarche, body mass index (BMI), physical examination, breast ultrasonography and mammography findings and amplitudes, latency and cutaneous silent period (CSP) in EMG of the right and left PM muscles were noted.Results:The mean age of the patients was 43.3 (20-65) years; mastalgia affected the left breast and the right breast in 22 (71%) and nine (29%), respectively. Twenty-three patients (74.1%) had a BMI of ≥25 kg/m2. There was a size difference between the two breasts in eleven patients. The EMG results of PM muscles in healthy and mastalgia sides were compared and there was no significant difference observed between the amplitude and resistance parameters. The mastalgia side had significantly higher CSP values.Conclusion:Prolonged CSP suggests that unilateral mastalgia may be associated with pain modulating mechanisms of the central nervous system.

Guillain–Barre Syndrome and JEV Infection Japanese encephalitis virus infection was confirmed in 161 patients in a northern area of Ningxia, China. Signs and symptoms and electromyographic findings...

Diagnosis of amyotrophic lateral sclerosis (ALS) is based on combination of clinical signs and electrophysiological correlates of pathological process which takes place in general. New electrophysiological criteria Awaji-Shima (AS) additionally qualify the complex fasciculations and neurogenically modified potentials of motor units as signs of active lesions of peripheral motor neuron, contrary to previously valid revised El Escorial criteria (rEE). The objective of this research was to determine the clinical significance and advantages of using the AS criteria in patients with ALS. Methods. Thirty patients (59.2 ± 10.9 years, 57% of them with spinal form of the disease) with clinically suspected ALS were monitored from the time of diagnosis until reaching the category of definitive diagnosis or death. The clinical evaluation and electromyographic (EMG) examinations were carried out at 3-month intervals. Results. By applying the AS criteria, the category of probable or definite diagnosis was achieved in all patients with ALS, except in one (96.6%), as contrary to the rEE (33.3%), after 6 months of the follow-up period. The subclinical affection in more than two body regions has been defined through detection of denervation potentials (80% of the patients by using the AS, or 67% by the rEE criteria). The complex fasciculations were registered particularly often in small muscles of the feet (37- 40%). Conclusion. Application of the AS criteria improve the achievment of category of probable or definite diagnosis of ALS by 2.7 months earlier compared to the rEE. This outcome is particularly affected by a higher frequency of positive EMG findings, when the AS criteria were employed. Early determination of diagnosis provides the better perspective and more frequent participation of the ALS patients in pharmacotherapy studies intended to establish new therapeutic options. Dijagnoza amiotrofične lateralne skleroze (LS) zasniva se na kombinaciji kliničkih znakova i elektrofizioloških korelata patološkog procesa koji se odvija u osnovi. Novi elektrofiziološki kriterijumi, Awaji-Shima (AS), dodatno kvalifikuju kompleksne fascikulacije i neurogeno izmenjene potencijale motornih jedinica kao znakove aktivnih lezija perifernog motornog neurona, nasuprot ranije važećim revidiranim El Escorial kriterijumima (rEE). Cilj ovog istraživanja bio je da se utvrdi klinički značaj i prednosti primene AS kriterijuma, kod obolelih od ALS. Metode. 30 bolesnika (59,2 ± 10,9 godina, od kojih 57% sa spinalnom formom bolesti) sa klinički suspektnom ALS, praćeno je od vremena postavljanja dijagnoze do postizanja kategorije definitivne dijagnoze ili smrtnog ishoda. Kod bolesnika su obavljane klinička evaluacija i elektromiografski (EMG) pregledi u tromesečnim intervalima. Rezultati. Primjenom AS kriterijuma, nakon 6 meseci praćenja, kategorija verovatne ili pouzdane dijagnoze postignuta je kod svih bolesnika sa ALS, izuzev jednog (96,6%), nasuprot rEE kriterijuma (33.3%). EMG nalazi bili su pozitivni u ≥ 2 telesna regiona kod 80% bolesnika primenom AS, odnosno 67% primenom rEE. Kompleksne fascikulacije zabeležene su posebno učestalo u malim mišićima stopala (37-40%). Zaključak. Primenom AS kriterijuma kategorija vjerovatne ili pouzdane dijagnoze ALS postiže se za 2,7 meseca ranije, u poređenju sa rEE, na šta posebno utiče veća učestalost pozitivnih EMG nalaza. Ranije utvrđivanje dijagnoze donosi perspektivu veće zastupljenosti obolelih u farmakoterapijskim studijama sa novim terapeutskim agensima.

Calf pseudohypertrophy due to radiculopathy is an exceptional phenomenon rarely described. We report a 67 year old woman with a previous history of lumbar disc surgery consulting by progressive increase for more than a year of evolution painless right calf associated loss of strength. Electromyographic findings showed chronic S1 radiculopathy and radiologically was appreciated in the medial gastrocnemius and soleus rights substitution of normal muscle tissue by adipose tissue without evidence of myopathy or sarcomatous degeneration.

Aims. In this study we analyzed the degree of genetic homozygosity among spina bifida patients with different degrees of neurogenic lesion (N = 82), as well as their clinical and neurological characteristics, compared to healthy control individuals (N = 100). Methods. According to clinical and electromyographic findings, we separately assessed the type of neurogenic lesion (paresis or paralysis). Regarding the degree of neurogenic lesion, patients were classified into three groups: mild, moderate and severe. We analyzed six muscles. For assessing the degree of individual genetic homozygosity, we tested the presence and distribution of 15 homozygous recessive characteristics (HRC). Results. The predominant type of neurogenic lesion was paresis. Every third evaluated muscle was affected in the group with mild neurogenic lesion, while more than half were affected in the group with severe neurogenic lesion. The average values of HRCs among different groups of patients and the control showed the population-genetic differences that exist among them (control HRC/15=3.0&plusmn, 0.2, mild HRC/15=3.6&plusmn, moderate HRC/15=4.8&plusmn, 0.3, severe neurogenic lesion HRC/15=5.0&plusmn, 0.3). Conclusions. Spina bifida patients have a significant increase of recessive homozygosity and a decreased variability compared to the control group. As neurogenic lesions are more severe, more affected muscles are present, as well as the increase of individual recessive homozygosity.

We sought to investigate electromyographic characteristics of Guillain-Barré syndrome (GBS) patients in the recovery phase by using serial electromyography (EMG). We included seven GBS patients and assessed their neurologic function at admission and 2, 3 and 6 months post onset using Hughes Functional Grading Scale scores. All patients underwent serial electromyographic assessment of compound muscle action potentials (CMAPs), mean conduction velocity (MCV), and distal motor latency (DML) of peripheral nerves. F wave was recorded of the median nerve and ulnar nerve. All seven patients had a Hughes Functional Grading Scale score between 3 and 6 at admission, while three patients at 2 months, one patient at 3 months, and no patient at 6 months post GBS onset had a Hughes Functional Grading Scale score between 3 and 6 ( P

Flail arm syndrome (FAS), an atypical presentation of amyotrophic lateral sclerosis (ALS), is characterized by progressive, predominantly proximal, weakness of upper limbs, without involvement of the lower limb, bulbar, or respiratory muscles. When encountering a patient who presents with this symptomatic profile, possible diagnoses include upper limb onset ALS (UL-ALS), and FAS. The lack of information regarding FAS may make differential diagnosis between FAS and UL-ALS difficult in clinical settings. The aim of this study was to compare clinical and electromyographic findings from patients diagnosed with FAS with those from patients diagnosed with UL-ALS. To accomplish this, 18 patients with FAS and 56 patients with UL-ALS were examined. Significant differences were observed between the 2 groups pertaining to the rate of fasciculation, patterns of predominantly affected muscles, and the Medical Research Council scale of the weakest muscle. The presence of upper motor neuron signs and lower motor neuron involvement evidenced through electromyography showed no significant between-group differences.

Emel Oguz Akarsu1, Hurtan Acar2, Feriha Ozer3, Sefer Gunaydin2, Ozger Akarsu4, Tuba Aydemir Ozcan3, Serkan Ozben5, Aytul Mutlu2, Mithat Bedir6, Gulsun Cinarli Gul2, Ozlem Cokar2, Mehmet Burak Aktuglu7 1Umraniye Training and Research Hospital, Neurology Clinic, Istanbul, Turkey 2Haseki Training and Research Hospital, Neurology Clinic, Istanbul, Turkey 3Ordu University Faculty of Medicine, Department of Neurology, Ordu, Turkey 4Kartal Training and Research Hospital, Nephrology Clinic, Istanbul, Turkey 5Kafkas University Faculty of Medicine, Department of Neurology, Kars, Turkey 6Mardin State Hospital, Neurology Clinic, Mardin, Turkey 7Haseki Training and Research Hospital, Family Medicine Clinic, Istanbul, Turkey Original Article / Ozgun Arastirma DO I:10.4274/Tnd.13471

Rippling muscle disease (RMD) is a myopathy with hyperirritability, the pathophysiology for which is uncertain.We report electromyographic findings in a 30-year-old man with RMD. Clinical features included muscle rippling and percussion-induced rapid muscle contractions. Both were associated with bursts of short-duration, low-amplitude spikes, which resembled single muscle fiber discharges. Our case stands in contrast to previously reported cases, which showed either electrical silence or motor unit potential discharges associated with rippling, and may represent muscle fiber hyperexcitability.

Introduction: Patients who require prolonged endotracheal intubation (>48 hours) are at risk of dysphagia. Speech-language pathologists should perform swallowing exercises after extubation due to the high probability of developing aspiration pneumonia. There are no studies describing the use of swallowing techniques employed in post-extubation therapy aided by surface electromyography. Objectives: To evaluate the effects of swallowing function therapy in extubated patients after prolonged orotracheal intubation by means of clinical and electromyographic evaluation. Methods: A total of 15 patients were enrolled in this study (average age 48.6 ± 16.5 years). The study was carried out in three phases: (1) Clinical and electromyographic evaluation using the Dysphagia Risk Assessment Protocol following dysphagia scores criteria, and the measurement of the suprahyoid muscles amplitude (μV) expressed by root mean square (RMS), respectively; (2) swallowing rehabilitation program; and (3) reevaluation of patients after therapy. The Wilcoxon paired test assuming a significance level of 5% was used for statistical analysis. Results: By means of the swallowing scale, it was verified that patients suffered from severe oropharyngeal dysphagia at the first evaluation (80%), but the rehabilitation therapy reduced clinical signs, persistent only in one patient (6.7%) post-therapy, thus, improving swallowing. Significant differences, pre- and post-therapy, for suprahyoid muscles during maximal voluntary isometric contractions of right ( P = .0067) and left ( P = .0215), saliva swallowing by right ( P = .0413) and left ( P = .0151), and liquid swallowing by right ( P = .0479) and left ( P = .0215) sides, were found, as shown by electromyography. Conclusions: Swallowing exercises carried out by extubated patients after prolonged orotracheal intubation increased neuromuscular recruitment of suprahyoid muscles involved with swallowing and reduced dysphagia levels.

ObjectivesTo describe clinicopathologic features of muscular sarcoidosis and the associated sarcoidosis phenotype through a nationwide multicenter study.MethodsPatients were included if they had histologically proven sarcoidosis and symptomatic muscular involvement confirmed by biological, imaging, or histologic examinations.ResultsForty-eight patients (20 males) were studied, with a median age at muscular symptoms onset of 45 years (range 18–71). Four patterns were identified: a nodular pattern (27%); smoldering phenotype (29%); acute, subacute, or progressive myopathic type (35%); and combined myopathic and neurogenic pattern (10%). In all patterns, sarcoidosis was multivisceral with a median of 3 extramuscular organs involved (mostly lungs, lymph nodes, eyes, and skin) and a prolonged course with long-term use of corticosteroids and immunosuppressive drugs. Muscular patterns differed according to clinical presentation (myalgia, nodules, or weakness), electromyographic findings, muscular MRI, and response to sarcoidosis treatment. The myopathic and neuromuscular patterns were more severe.ConclusionThis nationwide study of muscular sarcoidosis allowed the identification of 4 patterns of granulomatous myositis, which differed by phenotypes and the clinical course.

The post-polio syndrome (PPS) is an entity characterized for an episode of muscular weakness and/or abnormal muscular fatigue in individuals that had presented acute polio years before. We report the case of PPS in a patient, 40 years, that thirty-five years after had had paralytic poliomyelitis, developed new symptoms of fatigue, muscular atrophy, dyspnea, difficulties in deambulation and muscular and joint pain. The electromyographic findings revealed injuried neurons of the anterior horn of the marrow and reinnervation after muscular tests.

To develop an index of gait instability from electromyographic information, we made observations on infants from the time they first began to walk independently at about one year of age until around three years of age. From our findings we obtained the following criteria. (1) Very unstable gait: As seen in a child within the first month of learning to walk the vastus medialis is active in the latter half of swing phase, the tibialis anterior and rectus femoris are active during stance phase, and activity of the vastus medialis is continuous. These electromyographic characteristics are not usually seen in subsequent childhood gait or in adult gait, and they serve as markers of very unstable gait. (2) Unstable gait: Activity of the gastrocnemius in the latter half of swing phase is generally noted only within the first three months after a child learns to walk, and that activity is interpreted as a sign of unstable gait. (3) Slightly unstable gait: Activity of the gastrocnemius in the first half of stance phase and continuous activities of the biceps femoris and gluteus maximus from initial contact with the floor until push off are found in children until three years of age. These activities are considered electromyographic markers of slightly unstable gait.

This study was designed to investigate masticatory disturbances in patients with occupational maxillofacial injuries. During the 3 -year 3 -month period from April 1992 through June 1995, 51 patients were examined on the basis of (1) dental findings, (2) mandibular mobility, (3) electromyograms (EMG), (4) occlusal findings by Dental Prescale®, and (5) masticatory efficiency rate calculated from the results of a questionnaire that assessed the ability to chew 173 foods.The following results were obtained:1. Masticatory efficiency rate could be estimated on the basis of occlusal variables assessed with Dental Prescale®. The most important occlusal variable with this method was maximal force.2. At a value of 40% or more, masticatory efficiency rate was correlated with dental findings and mandibular mobility.3. In this same group of patients, masticatory efficiency rate was correlated with electromyographic findings (silent period rate, etc.).4. Variables of the occlusion evaluated with Dental Prescale® were positively correlated with masticatory efficiency rate.5. In patients with a masticatory efficiency rate of 40% or more, masticatory disturbances could be generally estimated from masticatory efficiency rate.6. Many patients with a masticatory efficiency rate of less than 40% had lack of consistency between objective and subjective findings. Masticatory disturbances could therefore not be evaluated correctly by analyzing items (1) to (5) in this group of patients.

Parsonage–Turner syndrome is the term used to describe a neuritis involving the brachial plexus. It may present with symptoms of an isolated peripheral nerve lesion, although the pathology is thought to lie more proximally. A case describing an isolated anterior interosseus nerve palsy due to an acute brachial neuritis is presented where the electromyographic findings confirmed the diagnosis, but also demonstrated the coexistence of a dual pathology in the form of a cervical radiculopathy. The literature is reviewed regarding etiology, treatment, and prognosis.

In some patients with a history of polio, the electromyography is normal, not showing the typical neurogenic signs. The aim of this study was to explain the normal findings in electromyography, especially in paralytic polio.Retrospective study.Concentric needle electromyography, macro electromyography (including single fibre electromyography) and neurography were performed in various combinations in 688 patients with an alleged history of polio.Thirty-five patients with paralytic polio had normal or minimally abnormal neurophysiology. In 6 patients the diagnosis of polio was rejected and was instead found to be other diagnoses. Three patients had a very atypical history. Of the 26 with possible paralytic polio, 17 showed a strong suspicion of previous paralytic polio without any neurophysiological signs of degeneration of the anterior horn cells.If neurophysiological findings are normal in patients with a history of polio, the original diagnosis may be incorrect. However, the absence of electromyography changes does not entirely exclude a previous history of polio with transient functional loss without degeneration of anterior horn cells vulnerable for later functional impairment.

Both intra-anal sponge electromyography (SEMG) and needle electromyography (NEMG) are used to diagnose paradoxical puborectalis contraction (PPC). The aim of this retrospective study was to assess the correlation among SEMG and NEMG and cinedefecography (CD) in the diagnosis of PPC.Between 1992 and 1999, a total of 261 constipated patients underwent both CD and EMG: 64 had NEMG while 197 had SEMG. PPC was diagnosed by EMG when there was failure to achieve a significant decrease in electrical activity of the puborectalis muscle during attempted evacuation. CD criteria for PPC included lack of straightening of the anorectal angle or persistence of the puborectalis impression during evacuation. CD was considered diagnostic and EMG results were thus compared with those of CD. Agreement was calculated using the kappa statistics (kappa) for concordance.Both NEMG and SEMG had low positive predictive rates (33% in NEMG, 28% in SEMG) and high negative predictive rates (91% in NEMG, and 78% in SEMG) when correlated with CD findings. Agreement between NEMG and CD was noted in 46 of 64 patients (72%, kappa=0.274) while there was agreement between SEMG and CD in 120 of 197 patients (61%; kappa=0.067); p0.05 needle vs. sponge.Although both NEMG and SEMG have a low positive predictive values, they have high negative predictive value for PPC. Therefore, neither NEMG nor SEMG alone are optimal tests for diagnosing the presence of PPC.

A very high prevalence of polyneuropathy was observed in shoe and leather workers from the area of Florence. In addition, normal workers showed abnormally low maximal nerve motor conduction velocity. A linear decrease of motor conduction velocity was observed as a function of age and of the length of exposure to solvents. The worker population showed a steeper decrease with age than controls. A higher prevalence of polyneuropathy was observed when the amount of glue used by each worker per day was higher, and when the air volume of the plant was smaller. The subjective symptoms most frequently associated with polyneuropathy were muscle spasms, leg weakness and pain, and arm paresthesiae. Cases of polyneuropathy were more frequent in the workers exposed to solvents and in the older age group. A solvent aetiology of the disease is suggested, and glue substitution and proper hygienic conditions are recommended.

Summary A 11-year-old boy with hypothyroidism developed generalized muscle hypertrophy and proximal muscular weakness. Electromyographic findings were suggestive of myopathy. He had had congenital nystagmus (CN) since early infancy. Although the association of childhood hypothyroidism and CN has been documented before, the triad of hypothyroidism, hypertrophic myopathy and CN exhibited by the patient is believed to be unique.

The clinical and electrophysiological findings in two patients with a deep peroneal neuropathy occurring in the presence of significant innervation of the extensor digitorum brevis muscle by the accessory deep peroneal nerve are reported. This nerve is a branch of the superficial peroneal nerve which was not involved in either cases reported. An awareness of this anatomical variation of innervation of the extensor digitorum brevis muscle is important for the correct clinical and electromyographic evaluations of deep peroneal nerve lesions. The electromyographic findings in this situation are sufficiently characteristic to identify clearly this anatomical variant. From a clinical point of view, residual function in the lateral portion of the extensor digitorum brevis muscle, in the face of an otherwise complete deep peroneal palsy, should suggest this anatomical variation.

Dysphonia hysterica in a woman, aged 54, followed up by means of the observation of the laryngeal figures with the electromyography of the intrinsic laryngeal muscles in the stadium of the hysteric attack and the interval was reported. In the hysteric attack, the disharmony was recognized between the paralyzed vocal chord and the electromyographic findings about the intrinsic laryngeal muscles, and the intrinsic laryngeal muscles showed the continuous activity keeping up a certain musclar tonus, regardless of the respiration and utterance.

A case of polymyalgia rheumatica (PMR) with biopsy-proven giant cell arteritis (GCA) is described in which there were marked abnormalities noted on electromyography (EMG). Spike potentials, positive waves, and fibrillation potentials were seen in the proximal musculature of the upper and lower extremities as well as in the erector spinae muscles. Investigation failed to reveal abnormalities in either creatinine phosphokinase (CPK), aldolase, or muscle obtained at biopsy. The presence of these EMG findings in the PMR-GCA syndrome is unusual. Response to therapy with systemic corticosteroids and normalization of the EMG are documented.

An attempt was made to find a correlation between specific electromyography (EMG) abnormalities with histological findings in muscle biopsies (MB) in 100 patients with neuromuscular disorders. Quantified EMG and MB with histochemistry was made in the same muscle, but on the opposite side, within a period of 3 weeks. The isolated findings of EMG and MB were analysed with a computer through a chi-square test. A statistical relation (p

Electromyographic findings were studied in 32 women and 7 men with progressive systemic sclerosis. Among the 14 patients in group 1, 7 had the CREST syndrome in an early stage while the 14 patients in group 2 had advanced CREST-type lesions. The 18 patients in group 3 had diffuse scleroderma with extensive visceral involvement. In all groups, the mean duration of single potentials was reduced and the percent of polyphasic potentials was above normal in groups 2 and 3. Distal muscles were more involved in group 1, and proximal muscles in group 2. In group 3, involvement of various muscles was nearly equal. Electromyographic changes correlated with the clinical condition of the patients. Overall, the findings in this study are similar to findings from other laboratories.

Marco Mumenthaler, Director der Neurologischen Universitatsklinik Inselspital, Bern. Price, $2.45 (DM 9,80). Pp 383. Georg Thieme Verlag, Stuttgart, Germany. A veritable flood of neurology texts continues to appear and one has difficulty in distinguishing one from another. This soft covered book on neurology by Dr. Mumenthaler is, however, a welcome exception to the usual dreary lot. It is easily carried in a pocket and so can be consulted when needed. The first part has a most excellent review of clinical methods and of the localizing value of abnormal neurological signs. Superb diagrams, tables, and line drawings of common neurological abnormalities encountered at the bedside make this section unique among pocket-sized neurology texts. The diagrams of normal and pathological roentgenographic and electromyographic findings, and of other special tests, are far superior to the often encountered unintelligible photographs. In the second part, neurologic diseases are adequately described, and judiciously selected references are given for those who might want further information, but this should not be necessary for undergraduates. The understanding of neurological disease is again facilitated by drawings and tables, some of which should be of use