Relevant muscle selection for needle electromyography examination in polio survivors

Year 2021, Volume: 7 Issue: 5, 440 - 446, 04.09.2021

Halit Fidancı İlker Öztürk Zülfikar Arlıer

https://doi.org/10.18621/eurj.679456

Abstract

Objectives: Needle electromyography (EMG) has an important role in the diagnosis of poliomyelitis. Since needle EMG is a painful and time consuming procedure, selecting the most effective muscles for needle EMG is important. We aimed to determine the clinically or subclinically affected regions in polio survivors by examining the minimum number of muscles with EMG.

Methods: Polio survivors with weakness in at least one limb were included in this retrospective cohort study. The extremities were divided into two groups: 1) Group 1: The extremities with Medical Research Council score of ≤ 1 in at least one muscle, 2) Group 2: Clinically unaffected or mildly to moderately affected extremities that do not meet the criteria of Group 1. The needle EMG findings of the muscles were analyzed.

Results: Twenty-nine polio survivors were included in the study. Needle EMG findings of 352 muscles were reviewed. Needle EMG findings in 57 lower extremities and thirty-two upper extremities were analyzed. There was no upper extremity meeting the criteria of Group 1. Thirty-eight lower extremities were included in Group 1. The amplitudes and durations of motor unit action potentials (MUAPs) were not different between the muscles of the Group 1 lower extremities (p > 0.05). Among the muscles of Group 2 upper and lower extremities, the amplitude and duration of MUAPs were higher in the deltoid and the vastus lateralis muscles compared to the other muscles, respectively (p = 0.002 and p = 0.003 for upper extremity muscles; p = 0.005 and p < 0.001 for lower extremity muscles).

Conclusions: Using the needle EMG findings, an algorithm was made to determine the affected regions. Thus, the affected regions can be identified by applying needle EMG to a minimum number of muscles.

Keywords

electrodiagnosis, needle electromyography, poliomyelitis, polio survivors

References

• 1. Agre JC, Rodriquez AA, Tafel JS. Late effects of polio: critical review of the literature on neuromuscular function. Arch Phys Med Rehabil 1991;72:923-31.
• 2. Horstmann DM. Epidemiology of poliomyelitis and allied diseases – 1963. Yale J Biol Med 1963;36:5-26.
• 3. Bodian D. Histopathological basis of clinical findings in poliomyelitis. Am J Med 1949;6:563-78.
• 4. Kidd D, Williams AJ, Howard RS. Poliomyelitis. Postgrad Med J 1996;72:641-7.
• 5. Lo JK, Robinson LR. Postpolio syndrome and late effects of poliomyelitis. Part 1. Pathogenesis, biomechanical considerations, diagnosis, and investigations. Muscle Nerve 2018;58:751-9.
• 6. Jubelt B, Cashman NR. Neurological manifestations of the post-polio syndrome. Crit Rev Neurobiol 1987;3:199-200.
• 7. McComas AJ, Quartly C, Griggs RC. Early and late losses of motor units after poliomyelitis. Brain 1997;120:1415-21.
• 8. Stalberg E, Grimby G. Dynamic electromyography and muscle biopsy changes in a 4-year follow-up: study of patients with a history of polio. Muscle Nerve 1981;4:524-8.
• 9. Fidancı H, Öztürk İ, Köylüoğlu AC, Buturak Ş, Arlıer Z. Pattern of muscle involvement according to needle electromyography findings in clinically unaffected extremities of polio survivors with lower extremity weaknesses. J Surg Med 2019;3:635-9.
• 10. Kleyweg R, Van der Meche F, Schimtz P. Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain-Barre syndrome. Muscle Nerve 1991;14:1103-9.
• 11. Aids to the examination of peripheral nervous system. Memorandum No.45. London, HMSO. 1976.
• 12. Chen S, Andary M, Buschbacher R, Del Toro D, Smith B, So Y, et al. Electrodiagnostic reference values for upper and lower limb nerve conduction studies in adult populations. Muscle Nerve 54: 371-7.
• 13. Daube JR, Rubin DI. Needle electromyography. Muscle Nerve 2009;39:244-70.
• 14. Sharrard WJ. The distribution of the permanent paralysis in the lower limb in poliomyelitis; a clinical and pathological study. J Bone Joint Surg Br 1955;37:540-58.
• 15. Kumar K, Kapahtia NK. The pattern of muscle involvement in poliomyelitis of upper limb. Int Orthop 1986;10:11-5.
• 16. Ravits J, Hallett M, Baker M, Nilsson J, Dalakas MC. Clinical and electromyographic studies of postpoliomyelitis muscular atrophy. Muscle Nerve 1990;13:667-74.
• 17. Şenol MG, Kaplan C, Ozdağ F, Saraçoğlu M. How long denervation take in poliomyelitis? Or is it a lifetime? Neurosci Rural Pract 2018;8:511-5.
• 18. Tarulli AW, Raynor EM. Lumbosacral radiculopathy. Neurol Clin 2007;25:387-405.