Jia Shuangshuang, Sun Chenjing, Zhong Xiaoling, Wang Kunyu, Wang Zhiwei, Qi Xiaokun, Qiu Feng
Navy Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, 230032, Anhui Province, China.
Department of Neurology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China.
Ann Indian Acad Neurol. 2023 May-Jun;26(3):241-246. doi: 10.4103/aian.aian_496_22. Epub 2023 Apr 7.
It is a challenge to differentiate multiple system atrophy parkinsonism (MSA-P), Parkinson's disease (PD), and progressive supranuclear palsy (PSP). We aimed to explore the value of external anal-sphincter electromyography (EAS-EMG) and urethral-sphincter electromyography (US-EMG) in differential diagnosis with MSA-P, PD, and PSP.
A total of 149 subjects, including 27 MSA-P, 100 PD, and 22 PSP, were recruited. The average duration and amplitude of motor unit potentials (MUPs), percentage of polyphasic MUPs, amplitude during strong contraction, and recruitment pattern during maximal voluntary contraction were recorded. The differences in EAS-EMG and US-EMG results between MSA-P, PD, and PSP were analyzed.
In EAS-EMG examination, the average duration of MUPs of MSA-P was significantly longer than that of PD and PSP; the percentage of polyphasic MUPs and the ratio of simple phase and simple-mix phase of MSA-P and PSP were significantly higher than that of PD; the amplitude during strong contraction of MSA-P was significantly lower than that of PD. In US-EMG examination, the average duration of MUPs in male MSA-P was significantly longer than that in male PD and PSP; the ratio of simple phase and simple-mix phase in male MSA-P was significantly higher than that in male PD; there was no statistical difference in US-EMG indexes between male PD and PSP male. And because only one female PSP was examined, only female MSA-P and PD were compared, the average duration of MUPs in female MSA-P was significantly longer than that in female PD; the ratio of simple phase and simple-mix phase in female MSA-P was significantly higher than that in female PD.
The average duration of MUPs and the ratio of the simple phase and simple-mix phase of EAS-EMG and US-EMG all can provide the basis for the differential diagnosis between MSA-P and PD. US-EMG can be used as a supplement to differentiate MSA-P from PD when EAS-EMG is limited. The only discriminating indicator between MSA-P and PSP seems to be the average duration of MUPs of EAS-EMG and US-EMG. There is still a lack of diagnostic electromyography indicators between PD and PSP.
鉴别多系统萎缩帕金森型（MSA-P）、帕金森病（PD）和进行性核上性麻痹（PSP）具有挑战性。我们旨在探讨肛门外括约肌肌电图（EAS-EMG）和尿道括约肌肌电图（US-EMG）在MSA-P、PD和PSP鉴别诊断中的价值。
共招募了149名受试者，包括27例MSA-P、100例PD和22例PSP。记录运动单位电位（MUPs）的平均时限和波幅、多相MUPs的百分比、强力收缩时的波幅以及最大自主收缩时的募集模式。分析MSA-P、PD和PSP之间EAS-EMG和US-EMG结果的差异。
在EAS-EMG检查中，MSA-P的MUPs平均时限显著长于PD和PSP；MSA-P和PSP的多相MUPs百分比以及单相和单混相的比例显著高于PD；MSA-P强力收缩时的波幅显著低于PD。在US-EMG检查中，男性MSA-P的MUPs平均时限显著长于男性PD和PSP；男性MSA-P的单相和单混相比例显著高于男性PD；男性PD和男性PSP之间的US-EMG指标无统计学差异。由于仅检查了1例女性PSP，仅比较了女性MSA-P和PD，女性MSA-P的MUPs平均时限显著长于女性PD；女性MSA-P的单相和单混相比例显著高于女性PD。
EAS-EMG和US-EMG的MUPs平均时限以及单相和单混相比例均可为MSA-P与PD的鉴别诊断提供依据。当EAS-EMG受限，US-EMG可作为区分MSA-P与PD的补充手段。EAS-EMG和US-EMG的MUPs平均时限似乎是MSA-P与PSP之间唯一的鉴别指标。PD与PSP之间仍缺乏诊断性肌电图指标。
