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PubMedDate not supplied

[Post-surgical or traumatic anal incontinences. Prospective study in 40 patients explorated by endorectal ultrasonography and electromyography].

OBJECTIVES: Anal endosonography is used to assess anal canal structure and external anal sphincter. The purpose of this study was to compare findings at anal endosonography with electromyographic tests in patients with faecal incontinence. METHODS: Fourty patients (31 women; median age: 47 years) were referred for exploration of the anal sphincter: 15 patients had previous anal surgery, 16 patients had obstetrical trauma, 3 patients had accidental trauma, 6 women had obstetrical trauma and previous anal surgery. RESULTS: Anal endosonography demonstrated an external sphincter defect in 19 patients (partial n = 4, complete n = 15); 18 of these patients had an electromyographic study: an external sphincter defect was demonstrated by mapping in 15 cases; 3 partial defects were not found. Eight patients had associated pudendal nerve terminal motor latency delayed due to neuropathic impairment of pudendal nerve. Surgery was performed in 12 patients; external sphincter lesion was confirmed in all cases. CONCLUSIONS: Anal endosonography and electromyography mapping easily recognize external sphincter disruption with high concordance. Partial defects are better diagnosed by anal endosonography. A study of pudendal nerve terminal motor latency is useful in the exploration of faecal incontinence because pudendal neuropathy occurs frequently in association with a sphincter defect.

Adult↗
PubMed1994

Reliability of measuring isometric and isokinetic peak torque, rate of torque development, integrated electromyography, and tibial nerve conduction velocity.

To determine the reliability of measures used in neuromuscular diagnosis and rehabilitation, 23 adults underwent identical testing on two occasions. Intraclass correlation coefficients (ICC) showed the reliability of peak torque measurement to depend both on the movement tested and velocity of contraction (leg extension ICC = 0.64-0.94, plantar flexion ICC = 0.55-0.76, leg press ICC = 0.72-0.91). Peak rate of torque development (RTD) and the percentage of peak torque at peak RTD were not reliable for any movement (ICC = 0.02-0.28). Mean RTD between 30% and 60% of peak torque was unreliable for leg press (ICC = 0.46), yet fairly reliable for both knee extension (ICC = 0.61) and plantar flexion (ICC = 0.63). Mean integrated electromyography (IEMG) showed fair to good reliability for isometric and 1.05 rad.s-1 leg press (ICC = 0.66, 0.90, respectively), and plantar flexion and leg extension (ICC = 0.75-0.89). Tibial nerve conduction velocity was highly reliable (ICC = 0.89). A range of reliabilities can be expected when measuring these variables, and must be considered when interpreting neuromuscular data.

Adult↗
PubMed1994

The carpal tunnel syndrome. Relationship between median distal motor latency and graded results of needle electromyography.

Needle Electromyography (NEMG) was performed in 228 patients who had been diagnosed by means of motor and sensory median nerve conductions of having Carpal Tunnel Syndrome (CTS). Evaluating abnormal spontaneous muscle activity (fibrillations, positive sharp waves, fasciculation potentials and myokymic discharges) and recruitment pattern, 51.7% of them showed abnormal NEMG. According to the amount of abnormality found, the studies were classified into: normal, grade 1, grade 2 and grade 3. Median Distal Motor Latency (DML) to APB was prolonged beyond the upper confidence limit in 155 (68%) hands, showing a mean value of 5.69 +/- 2.79 msec. Statistically significant difference (p < 0.001) of DML mean value among patients with a NEMG "normal", "grade 1" or "grade 2" have been found. We revise previous reports about NEMG on the CTS and discuss practical consequences of our findings.

Action Potentials↗
PubMed1994

Sensory evoked facial muscle electromyography for the quantification of acute labor pain.

Assessment of the adequacy of epidural analgesia for acute pain management can be difficult on occasion. This investigation used non-invasive sensory evoked facial muscle electromyography (SEFE) as well as a Verbal Assessment Scores (VAS) to assess severe pain in healthy parturients during the first stage of active labor. Institutional Review Board approval and patient informed consent were obtained from 12 healthy parturients who were in active labor and who had requested epidural analgesia for labor pain. SEFE microvoltage was recorded prior to epidural placement when a patient reported severe pain and again when a patient reported no pain with a subsequent uterine contraction. VAS assessments (0 = no pain and 10 = the worst pain ever experienced) were also recorded at identical time intervals. Statistical analysis was done using the paired two tailed Student's t-test. Each patient served as their own control. A statistically significant decrease in SEFE microvoltage (p < 0.001) was noted when analgesia was established (VAS = 0) in each patient. It was concluded in this pilot study that SEFE can be effective in quantifying acute severe nociception and thus can provide a continuous objective indicator of the effectiveness of analgesic regimens in an acute obstetric pain setting. Its applicability in other acute pain areas remains to be investigated.

Acute Disease↗
PubMedDate not supplied

Facial electromyography and chloral hydrate in the young dental patient.

The purpose of this report is to describe facial electromyography (EMG) as a monitoring technique and to demonstrate the relationship of EMG amplitude to rated patient behavior during sedative trials using variable doses of chloral hydrate (CH) [25, 50, and 70 mg/kg]. Twenty healthy, uncooperative children (mean age = 30.7 +/- 4.8 months) participated in this institutionally approved double-blind, repeated-measures study. Following baseline vital signs, administration of CH, and a 45-min period, the children were secured in a Papoose Board (Olympic Medical Group, Seattle, WA) with electronic monitors attached including the EMG. EMG amplitude was recorded continuously by computer and each visit was videotaped for later analysis of behavior using the Ohio State University Behavior Rating Scale (OSUBRS). Statistical analysis using SPSS/PC+ V2.0 (SPSS Inc., Chicago, IL) included descriptive statistics of the study sample, one-way ANOVA, and Pearson Product-Moment Correlation Coefficient to determine differences in EMG amplitude as a function of CH dose and associations between per cent of rated behavioral categories of the OSUBRS to EMG amplitude, respectively. The results indicated a significant difference in EMG amplitude, per cent crying and quietness as a function of dose (F = 3.87, P < 0.03; F = 4.64, P < 0.01; F = 3.38, P < 0.04, respectively). Scheffe post-hoc analysis indicated that the difference was between 25 and 70 mg/kg doses. Significant correlations were noted between EMG amplitude and per cent crying and quietness (R = 0.640, P < 0.001; R = -0.664, P < 0.001), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1993

Electromyography of the pelvic diaphragm and anal sphincter in dogs with perineal hernia.

The innervation of the levator ani and coccygeal muscles and the external anal sphincter was studied by anatomic dissection in 6 clinically normal male dogs and by electrical stimulation in 5 clinically normal male dogs. Variations in innervation occasionally were found that were comparable to those reported in previous studies. Electromyographic recordings were made from the levator ani and coccygeal muscles and from the anal sphincter in 40 dogs during perineal hernia repair. Spontaneous potentials of 4 types were found in 35 dogs: fibrillation potentials, positive sharp waves, complex repetitive discharges, and fasciculations. Biopsy specimens of the cranial part of the levator ani muscle were taken in 12 dogs during perineal hernia repair. Histologic examination revealed atrophy in 7 specimens. Spontaneous potentials were recorded from all muscles with histologic evidence of atrophy. All examinations of the levator ani muscle concerned the cranial part of this muscle, because the caudal part was absent in all 40 dogs. From combined results of electromyography and histologic examination, it was concluded that atrophy of the muscles of the pelvic diaphragm, which develops in some dogs with perineal hernia, is likely to be of neurogenic origin. Nerve damage is localized in the sacral plexus proximal to the muscular branches of the pudendal nerve or in the muscular branches separately.

Anal Canal↗
PubMed1993

Dynamic electromyography in functional surgery for upper limb spasticity.

Surgery to improve upper limb function after stroke, closed head injury, or other causes of acquired spasticity is generally accomplished by a combination of muscle transfer, lengthening, and/or release. Dynamic electromyography can be used to identify voluntary muscle action, delineate the deforming motor forces when spasticity is present, and provide guidance for surgical planning to improve prehensile hand function.

Arm↗
PubMed1995

[What is the role of the pubococcygeal and puborectal muscles in patients with obstructive defecation disorders? An electromyography study].

BACKGROUND: We believe that the M. levator ani plays little or no role in obstructed defaecation, and that the concept of "paradoxical" puborectalis muscle activity is misleading. The main aim of the study was to investigate the function of the pubococcygeal muscle during simulated defaecation and to compare this with the electromyographic activity of the puborectal muscle. METHODS AND RESULTS: In a prospective electromyographic study of 18 women (average age 53 years) with obstructive defecation disorder the activity of the pubococcygeal muscle and the puborectal muscle was investigated at rest, during contraction and straining. The control group consisted of 18 healthy women with an average age of 54 years. The function of the pubococcygeal muscle and the puborectal muscle was largely the same in both, study and control group. No statistically significant differences in the amplitude were found between the two groups at rest during contraction and maximum strain. CONCLUSION: We therefore conclude that the increase in activity of the voluntary muscle of the pelvic floor observed on electromyography during defaecation does not indicate automatically a pathologic condition but is a possible functional state at this moment.

Adult↗
PubMed1995

Electromyography analysis of the rectus abdominis and external oblique muscles of children 8 to 10 years old.

The objective of this work was to study through in the electromyography the upper and lower umbilical rectus abdominis and the anterior and posterior parts of the external oblique muscles of children 8 to 10 years old. The children studied practice artistic and rhythmical gymnastic sports at the training and learning level and the study was made during abdominal exercise in the dorsal decubitus position on the ground and on a board. The children were divided into 2 groups: Group I - ten already trained children; Group II - nineteen learners. The participants in Group I practiced an average of 5 times a week and those in Group II practiced 2 times a week. The exercises analyzed were: on the ground, lifting the legs 30, 20 and 10 cm high with the knees flexed 90 degrees; flexing the trunk while maintaining the legs elevated and the knees flexed; flexing the trunk with homo and heterolateral rotation of the trunk while maintaining the legs elevated and the knees flexed. On the board, flexing the trunk with the knees flexed 90 degrees on top of the board inclined 30, 20 and 10 cm; flexing the trunk with rotation of the trunk homo and heterolateral with the knees flexed on the board inclined 30, 20 and 10 cm. The results showed that the superior umbilical part of the rectus abdominis muscle presented more intense action potential than the inferior-umbilical part; the more intense action potential occurred at the flexing of the trunk and at the flexing of the trunk with homo and heterolateral rotation. The anterior part of the external oblique muscle presented more intense action potential than the posterior part; the more intense action potential occurred at the flexing of the trunk and at the flexing of the trunk with heterolateral rotation. In both of the muscles the more intense action potential occurred between 45 and 60 degrees of flexing the trunk; the children in Group I presented more intense action potential than those in Group II; the exercise of lifting the flexed legs did not prove efficient for strengthening the analyzed abdominal muscle structure.

Abdominal Muscles↗
PubMed1994

Predictability of recovery from Bell's palsy using evoked electromyography.

The role of surgery in the treatment of idiopathic facial paralysis (Bell's Palsy) has been the subject of much controversy. Some have advocated aggressive surgical therapy to prevent nerve injury based on evoked electromyography (EEMG) results. The present study analyzes the outcome of 23 patients who presented with Bell's palsy and were evaluated with EEMG. Of the 15 patients who showed greater than 90 percent compound action potential reduction in the affected side, a widely used criterion for surgical decompression of the facial nerve, almost half (47%) had normal to near-normal recovery, and only three (20%) had residual severe dysfunction. Results infer that patients who meet surgical criteria based on EEMG results but who do not undergo surgery do not show a greater morbidity. The authors conclude that conservative criteria should be used when recommending facial nerve decompression.

Adolescent↗
PubMed1977

Preoperative and postoperative dynamic electromyography as an aid in planning tendon transfers in children with cerebral palsy.

Electromyography was used to supplement clinical evaluation in planning tendon transfers in twenty-four children with cerebral palsy. Sixteen flexible deformities of the hind part of the foot, four internally rotated lower limbs, and four flexible deformities of the forearm and wrist were studied. When deforming muscles were active exclusively in one portion of either the gait cycle or a function of an upper extremity, appropriate tendon transfers were performed. When continuous muscle activity was noted, tendon lengthening was utilized. The desired function was obtained in all twenty-four patients six months after operation.

Cerebral Palsy↗
PubMed1996

[Electromyography as a diagnostic aid in tetanus].

In developing countries tetanus is still a real problem because of its high incidence and mortality. In all countries with high medical standards it has become rare. For this reason many clinicians are no longer familiar with the disease and its diagnosis. Until now no laboratory test has been readily available to confirm or rule out tetanus. However, the diagnosis can be performed by a simple and readily available electromyogram (EMG). We performed EMGs in 13 patients in whom tetanus was suspected but whose case history or clinical findings left some doubt. In 7 cases the EMG was typical for tetanus, showing spontaneous activity of motor units which could not be suppressed voluntarily and with shortening or absence of the silent period after a stretch reflex or after electrical stimulation of the nerve. In 2 cases we found one of the two diagnostic features. In all these 9 cases the diagnosis of tetanus was confirmed by the further development of the disease. In the remaining 4 patients the EMG was normal and in the course it was confirmed that they were not suffering from tetanus. Therefore, we consider electromyography a very useful and reliable tool either to confirm or rule out the diagnosis of tetanus.

Adult↗
PubMed1996

Evaluation of pedicle screw insertion monitored by intraoperative evoked electromyography.

The insertion of pedicle screws monitored by evoked electromyography (EMG) was prospectively evaluated in the 132 consecutive patients. The technique involved constant-voltage stimulation and was statistically evaluated at both the arbitrary 20- and 40-V settings. The patients were postoperatively evaluated clinically and radiographically. Computed tomography (CT) scanning was performed for new neurologic deficits. Results were divided into three groups: type 1, a negative EMG response; type 2, a positive EMG response, but no corrective action taken; and type 3, a positive EMG response and corrective action undertaken. Nonparametric statistics were used to evaluate the results at both the 20- and 40-V settings. In the type 3 group, in which corrective action was undertaken, there were no neurologic injuries or screw removals, a statistically significant result. Looking at the two intensity levels, at 20- and 40-V settings, there were no statistically significant differences in the three classifications at either intensity level. We concluded the evoked EMG for monitoring pedicle screw insertion is an efficacious adjunct. A positive response at < 20 V with the constant-voltage technique warrants corrective action.

Adult↗
PubMed1996

[Needle electromyography in the thoracic paraspinal muscles of motor neuron disease].

Usefulness of needle electromyography (EMG) in the thoracic paraspinal muscles was investigated in 22 patients with amyotrophic lateral sclerosis (ALS). All patients revealed denervation changes in the thoracic paraspinal muscles, though the EMG findings were insufficient to fulfill the WFN criteria of lower motor neuron sign. We could not diagnose three patients as having ALS at their first visits by conventional EMG. One patient had restricted neurogenic change within one limb and two patients had cervical spondylosis causing difficulty to diagnose anterior horn cell involvement at the cervical level. In these patients, however, we believed to having ALS because of the neurogenic findings of EMG in the thoracic paraspinal muscles. Afterwards, they became clinically definite ALS. On relation to respiratory function, patients with acute denervation potentials (fibrillation potentials) in upper thoracic paraspinal muscles innervated by Th1 approximately Th4 had respiratory dysfunction (% VC is less than 80). Two patients had the acute denervation potentials in the upper thoracic paraspinal muscles before the decrease in % VC. We conclude that needle EMG testing in thoracic paraspinal muscle is useful to diagnose ALS in early stage and to predict respiratory failure in ALS patients.

Adult↗
PubMed1996

[How reliably does electromyography differentiate myopathies and neurogenic diseases?].

Electromyography is an essential part of neuromuscular diagnosis. Due to practicability, it mostly relies on qualitative judgement. Therefore, it is examiner dependent, and critical assessment of the EMG report is crucial. This may be furthered by (1) acquaintance with the genesis of the EMG, which has recently been rendered more transparent by computer simulation, and (2) experience with examiner-independent, quantitative diagnostic algorithms. By both approaches, it is intended to familiarize the reader with modern quality standards of EMG diagnosis. The diagnostic algorithm used to this end is discriminant MUP classification, which separated neurogenic and myopathic conditions without recourse to examiner judgements. This success shows that quantitative EMG, which has become available for routine practice, will add weight to EMG differential diagnosis.

Adult↗
PubMed1996

[Anal sphincter electromyography, bulbocavernosus reflex and pudendal somatosensory evoked potentials in diagnosis of neurogenic lumbosacral lesions with disorders of bladder and large intestine emptying and erectile dysfunction].

The diagnostic value of anal sphincter electromyography (EMG), electrical bulbocavernosus reflex (BCR) and pudendal somatosensory evoked potentials (SEP) was studied in 16 male patients with disturbances of bladder function or defecation or with erectile dysfunction (ED) of at least several weeks' duration. All 16 patients had proven neurogenic disorders in the lumbosacral region. Eleven presented with bladder dysfunction, four with defecation problems, and nine with ED (some had more than one symptom). Fifteen patients had a pathological sphincter EMG, 14 patients a pathological BCR, and six patients a pathological pudendal SEP. Thus, the sphincter EMG was the most sensitive technique in the diagnosis of chronic pudendal lesions. However, pure afferent lesions cannot be detected by the sphincter EMG. In this case, the BCR, using unilateral stimulation of the dorsal nerves of the penis, provides the opportunity to distinguish between afferent and efferent lesions of the sacral reflex arc.

Adult↗