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Information

NCS are carried out by stimulating motor or sensory nerves electrically. Demyelination is characterized by slowing of nerve conduction velocities (NCV), dispersion of evoked compound action potentials, conduction block (decreased amplitude of muscle compound action potentials on proximal, as compared to distal, stimulation of the nerve), and prolongation of distal latencies. In contrast, axonal neuropathies exhibit reduced amplitude of evoked compound action potentials with relative preservation of NCV. EMG records electrical potentials from a needle electrode in muscle, at rest and during voluntary contraction; it is most useful for distinguishing myopathic from neuropathic disorders. Myopathic disorders are marked by small, short-duration, polyphasic muscle action potentials; by contrast, neuropathic disorders are characterized by muscle denervation. Denervation decreases the number of motor units (e.g., an anterior horn cell, its axon, and the motor end plates and muscle fibers it innervates). In long-standing denervation, motor unit potentials become large and polyphasic due to collateral reinnervation of denervated muscle fibers by axonal sprouts from surviving motor axons. Other EMG features of denervation include fibrillations (random, unregulated firing of individual muscle fibers) and fasciculations (random, spontaneous firing of motor units).

Treatment: Polyneuropathy

  • Treatment of the underlying disorder, pain management, and supportive care to protect and rehabilitate damaged tissue all need to be considered.
  • Examples of specific therapies include tight glycemic control in diabetic neuropathy, vitamin replacement for B12 deficiency, IV immune globulin (IVIg) or plasmapheresis for GBS, and immunosuppression for vasculitis.
  • Painful sensory neuropathies can be difficult to treat. Pain management usually begins with tricyclic antidepressants (TCAs), duloxetine hydrochloride, lidocaine patches, or anticonvulsants such as gabapentin or pregabalin (Table 193-2). Topical anesthetic agents including EMLA (lidocaine/prilocaine) and capsaicin cream can provide additional relief.
  • Physical and occupational therapy is important. Proper care of denervated areas prevents skin ulceration, which can lead to poor wound healing, tissue resorption, arthropathy, and ultimately amputation.

Outline

Section 14. Neurology