After stroke: changes in peripheral nerve morphology and electrophysiology of the hemiplegia

Release date: 2016-03-17

In the past, electrophysiology was often used to study peripheral nerves in patients with hemiplegia. Some studies have found that the peripheral nerves on the hemiplegia side have normal or no significant changes compared with the non-hemiplegic limbs. Other studies have found that the motor and sensory nerves slow down, the distal latency of motor nerves is prolonged, and the compound muscle action potential (CMAP) amplitude is decreased. Ultrasound imaging has become an effective and reliable diagnostic tool for peripheral neurological assessment because of its advantages of fast, dynamic, high resolution, no radiation and good cost-effectiveness.

To determine whether there were differences in peripheral nerves between the hemiplegic and contralateral sides of stroke patients, Dr. Ugurlu from the Physical and Rehabilitation Training Hospital of Ankara, Turkey, designed the morphological and electrophysiological studies of peripheral nerves after stroke and published the results in Am. J Phys Med Rehabil, Issue 94, 2015.

A total of 33 stroke patients were included in the study, 4 were hemorrhagic and 29 were thromboembolic. There were 18 females and 15 males with an average age of 55.6 years and an average duration of 14.2 months.

Subjects underwent the following assessments: modified Ashworth grading, Brunnstrom exercise recovery grading to assess motor function, and Functional Independence Measure (FIM) for assessing daily living abilities, including self-care, sphincter management, There were 13 scores in the four aspects of metastasis and walking. The Functional Ambition Category (FAC) was used to assess the walking level.

Using a four-channel Dantec Keypoint myoelectric device, measuring the motor nerve conduction velocity, distal latency, initial to peak CMAP of the median, ulnar, sacral, and sacral nerves; and median, ulnar, and sural nerves Peak-to-peak sensory nerve action potentia (SNAP), latency, sensory nerve conduction velocity. A square wave pulse of 30-50 mA and a duration of 0.1 ms was used during the measurement. The patient was placed in a supine position, the skin temperature was maintained at 31-34 degrees, and the room temperature was controlled at 23-25 ​​degrees and remained quiet.

Ultrasound images were collected using a 7-12 MHz linear array probe to measure the diameter and cross-sectional aera (CSA) of the median nerve at the level of the wrist and upper arm (at the midpoint of the upper iliac crest and axillary line) and the sciatic nerve. The diameter and cross-sectional area of ​​the middle thigh (the midpoint of the hip transverse line and the axillary line) were measured without the adventitia.

Statistical analysis was performed using SPSS 15.0 software. The paired t test was used when the temporal side and the healthy side were compared. The correlation between the nerve conduction study, the ultrasound measurement, and the clinical evaluation was based on the Pearson or Spearman rank correlation coefficient. P < 0.05 was considered statistically significant.

The study found that compared with the non-hemiplegic side, the distal sacral latency of the radial nerve was prolonged, the motor conduction velocity was slowed down, the amplitude of the median nerve and the ulnar nerve was decreased, and the transverse area of ​​the median nerve and the sciatic nerve was reduced.

The CMAP amplitude of the median and ulnar nerves of the hemiplegic side was positively correlated with the Brunnstrom motion recovery grading, disease course, and exercise FIM and FAC of the upper limb or hand; while the bilateral SNAP amplitudes of the median and ulnar nerves were negatively correlated with age. On the non-hemiplegic side, the CSA of the median nerve in the upper arm was positively correlated with the f-wave latency of age, body mass index (BMI), median nerve, and phrenic nerve; CSA and BMI of the central sciatic nerve in the middle thigh, and f-wave latency of the median nerve Positive correlation.

On the hemiplegic side, the CSA of the median nerve was positively correlated with the f-wave latency of the median and sacral nerves, while the CSA of the sciatic nerve was positively correlated with the f-wave latency of the median nerve.

The results of this study indicate that the peripheral nerves of the hemiplegic side of stroke patients are involved in both morphological and electrophysiological factors.

Source: Lilac Garden

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