Alt ekstremite güçsüzlüğü olan polio hastalarının klinik olarak etkilenmeyen ekstremitelerinde iğne elektromiyografi bulgularına göre kas tutulum paterni

Abstract

Amaç: Paralitik poliomiyelit öyküsü olan hastalarda geç dönem nöromüsküler kötüleşme görülebilir. Bu sorunlardan birisi, klinik olarak etkilenmemiş kaslarda yeni bir güçsüzlüğün gelişimidir. Bu klinik olarak etkilenmemiş ekstremite kaslarındaki iğne elektromyografi (EMG) bulgularını saptamayı ve poliomiyelitin fizik tedavi stratejilerine katkıda bulunmayı amaçladık.

Yöntemler: Poliomiyelit sekeli olan hastalar bu retrospektif kohort çalışmasına çalışmaya dahil edildi. Hastaların iğne EMG bulguları gözden geçirildi. Güçsüzlüğü olmayan ekstremite veya kasta nörojenik iğne EMG bulguları varsa, bu kas veya ekstremite subklinik olarak etkilenmiş olarak kabul edildi.

Bulgular: Onsekiz hasta çalışmaya dahil edildi. Yüzdoksan kasın iğne EMG bulguları analiz edildi. Alt ekstremitelerde, klinik olarak etkilenmeyen 25 kasın 18'inde (%72) nörojenik iğne EMG bulguları vardı, 40 üst ekstremite kasının 14’ünde (%35) subklinik tutulum mevcuttu. Alt ekstremite kaslarındaki bu subklinik tutulum, üst ekstremite kaslarına göre anlamlı olarak daha fazla orandaydı (P=0,004). Klinik olarak etkilenmemiş üst ve alt ekstremite kasları içinde, en belirgin nörojenik iğne EMG bulguları sırasıyla deltoid ve vastus lateralis kaslarında idi (sırasıyla; P=0,022 ve P=0,028).

Sonuç: Alt ekstremite güçsüzlüğü olan polio hastalarında subklinik tutulum alt ekstremitede üst ekstremiteden daha belirgindi. Alt ve üst ekstremitelerde en belirgin subklinik kas tutulumu sırasıyla vastus lateralis ve deltoid kaslarındaydı. Bu bulguları dikkate alan fizik tedavi stratejilerinin polio hastaları için faydalı olacağını düşünüyoruz.

Keywords

• Elektromiyografi,Poliomiyelit,Subklinik tutulum

Pattern of muscle involvement according to needle electromyography findings in clinically unaffected extremities of polio survivors with lower extremity weaknesses

Abstract

Aim: Late neuromuscular deterioration may be seen in patients with a history of paralytic poliomyelitis. One of these problems is the development of a new weakness in clinically unaffected muscles. We aimed to determine needle electromyography (EMG) findings in these clinically unaffected limb muscles and to contribute to the physiotherapy strategies of poliomyelitis.

Methods: Patients with sequelae of poliomyelitis were included in this retrospective cohort study. Needle EMG findings of the patients were reviewed. If there were neurogenic needle EMG findings in the limb or muscle with no weakness, this muscle or limb was considered to be a subclinically affected muscle or limb.

Results: Eighteen patients were included in the study. Needle EMG findings of 190 muscles were analyzed. In the lower extremities, 18 (72%) of 25 clinically unaffected muscles had neurogenic needle EMG findings, and 14 (35%) of 40 upper extremity muscles had subclinical involvement. In the lower extremity muscles, this subclinical involvement was significantly higher than in the upper extremity muscles (P=0.004). In clinically unaffected upper and lower extremity muscles, the most prominent neurogenic needle EMG findings were in the deltoideus and vastus lateralis muscles, respectively (P=0.022 and P=0.028, respectively).

Conclusion: Subclinical involvement was more prominent in the lower extremity than in the upper extremity in polio survivors with weakness of lower extremity. The most prominent subclinical muscle involvement in the lower and upper extremities was the vastus lateralis and deltoideus muscles, respectively. We think that physical therapy strategies considering these findings will be beneficial for polio survivors.

Keywords

• Needle electromyography,Poliomyelitis,Subclinical involvement

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