Ali, B., Eldon Ismaeel, Z., Mohammed, M., Hamdan, F., Hatim, A. (2021). Changes in the Nerve Conduction of the Paretic Limb in Post-Stroke Patients. , 21(4), 374-382. doi: 10.52573/ipmj.2021.176982
Basmah M. Ali; Zahraa Hussam Eldon Ismaeel; Mohammed Moayad Mohammed; Farqad Bader Hamdan; Aqeel Kareem Hatim. "Changes in the Nerve Conduction of the Paretic Limb in Post-Stroke Patients". , 21, 4, 2021, 374-382. doi: 10.52573/ipmj.2021.176982
Ali, B., Eldon Ismaeel, Z., Mohammed, M., Hamdan, F., Hatim, A. (2021). 'Changes in the Nerve Conduction of the Paretic Limb in Post-Stroke Patients', , 21(4), pp. 374-382. doi: 10.52573/ipmj.2021.176982
Ali, B., Eldon Ismaeel, Z., Mohammed, M., Hamdan, F., Hatim, A. Changes in the Nerve Conduction of the Paretic Limb in Post-Stroke Patients. , 2021; 21(4): 374-382. doi: 10.52573/ipmj.2021.176982

Changes in the Nerve Conduction of the Paretic Limb in Post-Stroke Patients

Iraqi Postgraduate Medical Journal
Article 2, Volume 21, Issue 4, 2022, Pages 374-382    PDF (231.38 K)
Document Type: Research Paper
DOI: 10.52573/ipmj.2021.176982
Authors
Basmah M. Ali* 1; Zahraa Hussam Eldon Ismaeel2; Mohammed Moayad Mohammed* 3; Farqad Bader Hamdan4; Aqeel Kareem Hatim5
1Consultant Specialist in Community Medicine, Medical City / Qazi Al- Harrery - Teaching Hospital, Baghdad, Iraq.
2Specialist in Family Medicine, Medical City/ Baghdad- Teaching Hospital, Baghdad, Iraq.
3Ibn Sena Teaching Hospital, Nineveh Health Directorate, Nineveh, Iraq
4Department of Physiology, College of Medicine, Al-Nahrain University, Baghdad, Iraq.
5Department of Medicine, College of Medicine, Baghdad University, Baghdad, Iraq.
Abstract
BACKGROUND:
Post-stroke motor sequelae can lead to an abnormal limb posture and decreased function that can ultimately increase the susceptibility of the peripheral nerves in that limb to compression, particularly within the early stages of stroke.
OBJECTIVE:
To study nerve conduction in paretic and non-paretic extremity in patients with the first ever-one stroke and to relate these parameters with MRC (Medical Research Council) scale.
METHODS:
Twenty-three patients aged 31-62 years and duration of illness of 3 and 6 months were studied. Thirteen had right hemiparesis and 10 with left hemiparesis. MRC scale was ≥3 in 17 and <2 in 6 patients.
RESULTS:
The median and peroneal distal motor latencies (DML) were prolonged and the peroneal compound muscle action potential (CMAP) amplitude was reduced in the paretic as compared to the non-paretic side. The combined sensory index and the lumbrical/interosseous muscles comparison methods revealed significant differences between the paretic as compared to the non-paretic side.
Median distal sensory latency (DSL), DML, motor conduction velocity (MCV), and peroneal CMAP amplitude of the paretic limb were significantly different between those with ≥3 and those with <2 MRC scale. In the non-paretic upper limbs, the DSL and DML were significantly prolonged in those with <2 MRC when compared to those with ≥3 MRC.
CONCLUSION:
Post-stroke entrapment neuropathy may develop, along with axonal neuropathy symptoms in patients with severe paresis. The more severely affected limbs, the more severe electrophysiologic changes.
 
Keywords
Stroke; Nerve conduction study; MRC scale
References
  1. Picelli A, Tamburin S, Gajofatto F, Zanette G, Praitano M, Saltuari L, et al. Association between severe upper limb spasticity and brain lesion location in stroke patients. Biomed Res Int. 2014; Article ID 162754.
  2. Emami Razavi S Z, Azadvari M. Electrodiagnostic Findings in Post-Stroke Patients, Arch Neurosci. 2019;6:e83417.
  3. van Kuijk AA, Pasman JW, Hendricks HT, Zwarts MJ, Geurts ACH. Predicting hand motor recovery in severe stroke: the role of motor evoked potentials in relation to early clinical assessment. Neurorehabil Neural Repair. 2009;23:45-51.
  4. Scherbakov N, Sandek A, Doehner W. Stroke-related sarcopenia: specific characteristics. J Am Med Dir Assoc. 2015;16:272-276.
  5. Picelli A, Bonetti P, Fontana C, Barausse M, Dambruoso F, Gajofatto F, et al. Is spastic muscle echo intensity related to the response to botulinum toxin type A in patients with stroke? A cohort study. Arch Phys Med Rehabil. 2012;93:1253-1258.
  6. Picelli A, Tamburin S, Cavazza S, Scampoli C, Manca M, Cosma M, et al. Relationship between ultrasonographic, electromyographic, and clinical parameters in adult stroke patients with spastic equinus: an observational study. Arch Phys Med Rehabil. 2014;95:1564-1570.
  7. Berenpas F, Martens AM, Weerdesteyn V, Geurts AC, van Alfen N. Bilateral changes in muscle architecture of physically active people with chronic stroke: a quantitative muscle ultrasound study. Clin Neurophysiol. 2017;128:115-122.
  8. Nam JS, Choe YR, Yoon SY, Yi TI. Upper limb pain and paresthesia in a post-stroke patient treated with ultrasound-guided electrical twitch-obtaining intramuscular stimulation (ETOIMS) of scalene muscles. Brain Neurorehabil. 2018;11:e1
  9. Laufer Y. The effect of walking aids on balance and weight-bearing patterns of patients with hemiparesis in various stance positions. Phys Ther. 2003;83:112-122.
10. Mold JW, Lawler F, Roberts M, Oklahoma Physicians Resource/Research Network Study. The health consequences of peripheral neurological deficits in an elderly cohort. J Am Geriatr Soc. 2008;56:1259-1264.

11. Kabayel L, Balci K, Turgut N, Kabayel DD. Development of entrapment neuropathies in acute stroke patients. Acta Neurol Scand. 2009;120:53-58.

12. Kang JI, Moon YJ, Jeong DK, Choi H. The effect of rhythmic neurodynamic on the upper extremity nerve conduction velocity and the function for stroke patients. J Kor Phys Ther. 2017;29:169-174.

13. İsnaç F, Aşkin A, Şengül İ, Demirdal ÜS, Tosun A. Ultrasonographic and electrophysiologic evaluation of median and ulnar nerves in chronic stroke patients with upper extremity spasticity. Somatosens Mot Res. 2019;36:144-150.

14. Tsur A. Common peroneal neuropathy in patients after the first-time stroke. Isr Med Assoc J. 2007; 9:866-869.

15. Nozoe M, Kubo H, Kanai M,  YamamotoM, Shimada S, Mase K. Peripheral motor nerve conduction abnormality, muscle strength, and muscle wasting in patients with acute stroke: A pilot study. J Clin Neurosci. 2020;75:80-84.

16. Paoloni M, Volpe B, Mangone M, Ioppolo F, Santilli V. Peripheral nerve conduction abnormalities in the nonparetic side of ischemic stroke patients. J Clin Neurophysiol. 2010;27:48-51.

17. Dozono K, Hachisuka A, Wada F, Hachisuka K. Peripheral neuropathies in nonparetic upper extremities of stroke patients induced by excessive use of a walking device. J Stroke Cerebrovasc Dis. 2015;24:1841-1847.

18. Berenpas F, Weerdesteyn V, Geurts AC, van Alfen N. Long-term use of implanted peroneal functional electrical stimulation for stroke-affected gait: the effects on muscle and motor nerve. J Neuro Engineering Rehabil. 2019;16:86.

19. Hermans G, Clerckx B, Vanhullebusch T, Segers J, Vanpee G, Robbeets C, et al. Interobserver agreement of Medical Research Council sum-score and handgrip strength in the intensive care unit. Muscle Nerve. 2012;45(1):18-25.

20. Turan Z, Topaloglu M, Ozyemisci Taskiran O. Medical Research Council-sum score: a tool for evaluating muscle weakness in patients with post-intensive care syndrome. Crit Care. 2020;24:562.

21. Preston DC, Shapiro BE. Electromyography in neuromuscular disorders: fourth edition, Clinical-Electrophysiologic Correlations. Chapter 20, Elsevier, 2020; p. 107-114, 124-128.

22. Moghtaderi A, Dahmardeh M, Dabiri S. Subclinical carpal tunnel syndrome in patients with acute stroke. Ir J Neurol. 2012;11:91-95.

  1. Picelli A, Tamburin S, Berto G, Chemello E, Gandolfi M, Saltuari L, et al. Electrodiagnostic and nerve ultrasonographic features in upper limb spasticity: an observational study. Functional Neurol. 2017; 32:119-122.
24. Akyüz M, Özduran I, Uysal FG, Çamoğlu S, Çakcı A. Nerve conduction examinations in hemiplegic patients. J Turkish Phys Med Rehabilit. 1998;1:425-442.

25. Güneş S, Genç A, Gök H, Gökmen D, Kutlay Ş. Effects of spasticity and hemiplegic posture on median nerve and carpal tunnel in stroke patients: Electrophysiological and ultrasonographic evaluation. J Clin Neurosci. 2020;17:P31-35

26. Chatriwala ZMM, Shende M. Nerve conduction velocity of common peroneal nerve in post stroke patients. An observational study. IOSR-JSPE. 2016;3:50-55.

27. van Kuijk AA, Pasman JW, Hendricks HT, Schelhaas JH, Zwarts MJ, Geurts AC. Supratentorial ischemic stroke: more than an upper motor neuron disorder. J Clin Neurophysiol. 2007;24:450-455.

28. Zeidman LA, Pandey DK. A carpal tunnel grading system including combined sensory index‐diagnosed mild cases: Relation to presenting features and outcomes. Muscle Nerve. 2018;57:45-48.

29. Mustafa MMMA, Nassar N, Amen I, Abdelmohsen H. Combined Sensory Index test versus diagnostic ultrasonography in early detection of carpal tunnel syndrome. QJM. 2020;113(suppl. 1):hcaa064.006.

30. Lee S-H, Kim D-H, Cho H-M, Nam H-S, Park D-S. Diagnostic value of the second lumbrical-interosseous distal motor latency comparison test in severe carpal tunnel syndrome. Ann Rehabil Med. 2016;40:50-55.

31. Yılmaz F, Gündüz OH, Akyüz G. Lumbrical-interosseous recording technique versus routine electrodiagnostic methods in the diagnosis of carpal tunnel syndrome. Turk J Phys Med Rehab. 2017;63:230-238.

32. Odabas FO, Sayin R, Milanlioglu A, Tombul T, Cögen EM, Yildirim G. Electrophysiological analysis of entrapment neuropathies developed in the acute and subacute period in paretic and non-paretic extremities in patients with stroke. J Pak Med Assoc. 2012;62:649-652.

33. Sato Y, Kaji M, Tsuru T. Carpal tunnel syndrome involving unaffected limbs of stroke patients. Stroke. 1999;30:414-418.

 

Statistics
Article View: 249
PDF Download: 117


Journal Management System. Powered by iJournalPro.com