Misra U K, Kalita J
Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
J Neurol. 1998 Nov;245(11):741-4. doi: 10.1007/s004150050278.
The role of clinical and magnetic resonance imaging (MRI) features on the prognosis of acute transverse myelitis has been studied, but the role of electromyography (EMG) changes, although reported, has not been investigated. Seventeen patients with acute transverse myelitis were subjected to clinical evaluation, MRI scanning and concentric needle EMG. The outcome was defined on the basis of a 3-month Barthel Index (BI) score as good or poor. The EMG changes in these groups were compared. All of the patients had complete paraplegia (power grade 0), except 1 who had grade III power. Mild upper limb weakness was present in 6 patients. Joint position and vibration sense were impaired in the lower limbs, and a horizontal limit to sensory loss to pinprick was present in all of the patients. Spinal MRI was abnormal in 12 of 14 patients. EMG of the lower limb muscles in the acute stage (within 15-30 days of onset) revealed fibrillations or sharp waves or both in 11 patients. At 3-month follow-up, the lower limb power had improved in 8 and upper limbs in all 6 patients. The EMG changes also improved in 6 patients; fibrillations either disappeared or were markedly reduced. The motor unit potentials (MUPs) were of long duration, polyphasic with reduced recruitment. In 5 patients, however, no MUPs could be recorded and fibrillations persisted. Lower limb hypotonia and fibrillations on EMG were significantly related to the 3-month outcome. EMG evidence of denervation in the lower limb muscles in acute transverse myelitis suggests a poor outcome as assessed by 3-month Barthel index score.
临床及磁共振成像（MRI）特征对急性横贯性脊髓炎预后的作用已得到研究，但肌电图（EMG）变化的作用虽有报道，却尚未得到深入探究。17例急性横贯性脊髓炎患者接受了临床评估、MRI扫描及同心针肌电图检查。根据3个月的巴氏指数（BI）评分将预后定义为良好或不佳，并对这些组中的肌电图变化进行了比较。除1例肌力为III级外，所有患者均出现完全性截瘫（肌力0级）。6例患者存在轻度上肢无力。所有患者下肢的关节位置觉和振动觉均受损，且针刺觉感觉丧失存在水平界限。14例患者中有12例脊髓MRI异常。急性期（发病15 - 30天内）下肢肌肉的肌电图显示，11例患者出现纤颤电位或正锐波或两者皆有。在3个月的随访中，8例患者下肢肌力有所改善，所有6例上肢无力的患者上肢肌力均有改善。6例患者的肌电图变化也有所改善；纤颤电位要么消失，要么明显减少。运动单位电位（MUPs）持续时间长，多相，募集减少。然而，有5例患者无法记录到MUPs，纤颤电位持续存在。下肢肌张力减低及肌电图上的纤颤电位与3个月的预后显著相关。急性横贯性脊髓炎患者下肢肌肉失神经支配的肌电图证据表明，以3个月巴氏指数评分评估的预后较差。
