The Value of Neural Electromyography in Diagnosis and Differential Diagnosis of Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (Amyotrophic Lateral Sclerosis, ALS) and cervical spondylotic myelopathy (Cervical Spondylotic Myelopathy, CSM) is two sets of etiology, pathogenesis, course and outcome is different, but clinically misdiagnosed disease. CSM can cure disease, surgery can significantly improve the signs and symptoms of ALS is currently no effective drug treatment, early diagnosis can help both treatment and prognosis, the 29 patients with clinically suspected ALS patients with nerve map, three limb muscles EMG (Electromyogram, EMG) of the sternocleidomastoid muscle EMG (Sternocleidomastoid Muscle Electromyogram, SCM-EMG) examination, combined with a detailed history taking and neurological physical examination, to explore the EMG abnormal characteristics and sternocleidomastoid EMG value in the differential diagnosis. Clinical data and methods. Data of 29 patients are 2002.12 to 2003.5 Second Affiliated Hospital, Zhejiang University, Zhejiang University master's degree thesis and out-patients, including 23 males and 6 females, duration of 2 months to 7 years, an average of 20.3 months , age of onset: 18-year-old Diao 9 years, an average of 45.4 ± 16.2 years, of which the first symptom is a single upper limb weakness with muscle atrophy in 16 cases, the dual upper limb weakness with muscle atrophy six cases, two cases of single lower limb weakness with muscle atrophy , lower extremity weakness with muscle atrophy in 1 case, slurred speech associated with dysphagia in 4 cases, accompanied by numbness eight cases, fasciculations 15 cases, 29 cases were patients with sphincter dysfunction. Nervous system examination shows: limbs fishy reflection hyperthyroidism seven cases, hyperthyroidism the lower limbs Yong reflection and upper limbs Look reflection basic normal or diminished in 7 cases, 6 cases of the upper limbs fishy reflex hyperactivity, limbs Yong reflection basic normal nine cases, double Hoffmann's (+) 6 cases, Babinski 'S levy double tight corner (+) in 7 cases, single tight corner (+) l cases of suspicious cases, the pathological reflex negative in 15 cases, tongue muscle atrophy eight cases, the tongue muscle Cambodia chatter 9 cases, cervical MRI examination revealed cervical disc herniation 10 cases of yellow ligament thickening, cervical bone hyperplasia cases, cervical disc with the dural sac and (or) spinal cord compression five cases. 2. Methods All cases Denmark Medtronic Keypoint 3 * Version the four guided neurophysiological detector test, using concentric needle electrodes for EMG detection method according to domestic standards, the results to determine the normal standard of the room, sternocleidomastoid EMG normal the reference domestic the Kang Dexuan proposed the normal standard, each inspection muscle for more than three limbs muscle including deltoid, wins bone anterior muscle, the first dorsal interosseous muscle abductor muscle, fat, two muscle, quadriceps, all patients the conventional additional surveying bilateral sternocleidomastoid EMG recorded the muscle resting spontaneous potential; 20 different light contraction motor unit potential, and measured average motor unit time limits, average volatility, the polyphasic percentage; heavy contraction of motor units raised 2 / Zhejiang University, a master's degree in Proceedings types and peak potential, 147 were detected in muscle, nerve map of the laboratory method of measuring and normal range, detection of median nerve, ulnar nerve, wins nerves, fat nerve motor nerve conduction velocity and amplitude and latency of the median nerve, ulnar nerve, fat intestinal nerve sensory nerve conduction velocity and volatility, the incubation period, a total of 203 detect nerve, which sports 116 nerve sensory nerve 87. 1.29 cases ALS and CSM diagnosis of difficulties were divided into two groups, Group A: 24 patients based on clinical considerations for ALS, ALS diagnostic criteria for reference the world neurology Union the (World the Federation of NeurologyWFN) proposed in 1998 EL Escortal of amendments diagnostic criteria, sternocleidomastoid and H limb EMG Figure prompted a wide range of neurogenic damage. 24 patients in the two cases sternocleidomastoid and three-limb EMG picture shows a wide range of neurogenic damage, the nerve map prompts the arm sensory conduction velocity slowed down, cervical HLL prompted disc herniation, dural sac, with varying degrees of cervical spinal cord compression, combined with clinical considerations for the coexistence of ALS and CSM. Group B: 5 patients based on clinical considerations for CSM CSM diagnostic criteria with reference to the second session of the Chinese Medical Association of cervical spondylosis symposium revised standard. EMG shows unilateral or bilateral upper limb abnormalities, the sternocleidomastoid EMG no case abnormal. 2. In the 24 cases of ALS patients, changes in the frequency of occurrence of different electrophysiological neurogenic damage in descending order: to extend the average duration of the motor unit 23 side 05.8%), the average amplitude increased to 23 cases 05.8% polyphasic reduce the number of motor units increased 23 cases 05.8O (raised relative to pure phase or pure - mixed phase) 22 cases p. 7%), positive sharp waves Zhejiang University master's degree thesis 183 patients with portal 5%) the huge potential of 16 cases the calendar 6.7% fasciculations potential 16 cases 6.7O man-made fiber fibrillation potential 6 * 5% with the the duration of the extension, fibrillation potentials, positive sharp waves detection rate decreased, the detection rate for the duration of the statistical level data analysis suggests the presence of negative correlation. duration of tl 9/9 o) l Diao 8 u6.7o> 5 1/3 (33.3%) in 24 cases of ALS patients, muscle abnormalities positive rate in descending order for 23 cases: first dorsal interosseous muscle 05.8 % deltoid 19 cases (7.2% sternocleidomastoid 18 cases (7%), wins