Quantitative electromyography of the external anal sphincter in Parkinson's disease and multiple system atrophy

Libelius, Rolf; Johansson, Folke

doi:10.1002/1097-4598(200008)23:8<1250::aid-mus14>3.0.co;2-w

Cited by 56 publications

(51 citation statements)

References 26 publications

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“…[7][8][9][10][11][12][13][14][15] Compared with those findings, the overall prevalence rate of neurogenic change in the present study was slightly lower (62%). This is presumably because up to 25% of our patients had a disease duration of one year or less, as early referral to our department has increased recently, and patients are able to come to us without referral.…”

Section: Discussioncontrasting

confidence: 86%

“…5 6 External anal sphincter (EAS) electromyography (EMG) is an established method for detecting neurogenic change of motor unit potentials (MUP), which reflects denervation and reinnervation of the sphincter muscle. 7 The significance of the EAS EMG is well known in MSA, [7][8][9][10][11][12][13][14][15] and it is reported that EAS MUP abnormalities can distinguish MSA from Parkinson's disease in the first five years after disease onset. [7][8][9] However, the prevalence of the abnormalities in the early stages of MSA is unknown.…”

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confidence: 99%

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When is Onuf's nucleus involved in multiple system atrophy? A sphincter electromyography study

Yamamoto

Sakakibara²,

Uchiyama³

et al. 2005

Journal of Neurology, Neurosurgery & Psychiatry

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Background: External anal sphincter (EAS) electromyography (EMG) abnormalities can distinguish multiple system atrophy (MSA) from Parkinson's disease in the first five years after disease onset. However, the prevalence of the abnormalities in the early stages of MSA is unknown. Objectives: To present EAS-EMG data in the various stages of MSA. Methods: 84 patients with ''probable'' MSA were recruited (42 men, 42 women; mean age 62 years (range 47 to 78); mean disease duration 3.2 years (0.5 to 8.0; ,1 year in 25%); 50 cerebellar form (MSA-C), 34 parkinsonian form (MSA-P)). EAS motor unit potential (MUP) analysis and EMG cystometry were carried out in all patients. Results: The overall prevalence of neurogenic change of the EAS MUP was 62%-52% in the first year after disease onset, increasing to 83% by the fifth year (p,0.05); it also increased with severity of gait disturbance (p,0.05), storage and voiding disorders, and detrusor sphincter dyssynergy (NS). The neurogenic change was not correlated with sex, age, MSA-P/C, postural hypotension, constipation, erectile dysfunction in men, underactive or acontractile detrusor, or detrusor overactivity. In 17 incontinent patients without detrusor overactivity or low compliance, urinary incontinence was more severe in those with neurogenic change than in those without (p,0.05). Conclusions: Involvement of Onuf's nucleus in MSA is time dependent. Before the fifth year of illness, the prevalence of neurogenic change does not seem to be high, so a negative result cannot exclude the diagnosis of MSA.

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Section: Discussioncontrasting

confidence: 86%

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confidence: 99%

When is Onuf's nucleus involved in multiple system atrophy? A sphincter electromyography study

Yamamoto

Sakakibara²,

Uchiyama³

et al. 2005

Journal of Neurology, Neurosurgery & Psychiatry

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“…Abnormalities in anal and urethral sphincter EMGs have been reported to identify with good sensitivity and specificity patients with MSA 131, 132. However, other investigators have suggested that patients with advanced PD133, 134 and PSP135, 136 may also have an abnormal sphincter EMG. A promising technique to differentiate MSA from PD with autonomic failure is the heart to mediastinal ratio in SPECT studies using [ 123 I]‐meta‐iodobenzylguanidine, which is structurally similar to norepinephrine and is taken up into postganglionic adrenergic neurons 119, 137.…”

Section: Ancillary Featuresmentioning

confidence: 99%

SIC Task Force appraisal of clinical diagnostic criteria for parkinsonian disorders

et al. 2003

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As there are no biological markers for the antemortem diagnosis of degenerative parkinsonian disorders, diagnosis currently relies upon the presence and progression of clinical features and confirmation depends on neuropathology. Clinicopathologic studies have shown significant false-positive and false-negative rates for diagnosing these disorders, and misdiagnosis is especially common during the early stages of these diseases. It is important to establish a set of widely accepted diagnostic criteria for these disorders that may be applied and reproduced in a blinded fashion. This review summarizes the findings of the SIC Task Force for the study of diagnostic criteria for parkinsonian disorders in the areas of Parkinson's disease, dementia with Lewy bodies, progressive supranuclear palsy, multiple system atrophy, and corticobasal degeneration. In each of these areas, diagnosis continues to rest on clinical findings and the judicious use of ancillary studies.

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“…Unlike these more costly studies, electromyography (EMG) is readily available and relatively easy to perform. A number of studies have described electromyographic evidence for reinnervation of both the external anal sphincter, and the urethral sphincter muscles in MSA patients 21, 38, 40, 41, 43, 52. These findings have been used to argue that degeneration of sacral motor neurons controlling these muscles is a feature of MSA, but not PD.…”

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confidence: 99%

Sphincter electromyography and multiple system atrophy

Nahm

Freeman

2003

Muscle and Nerve

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Electromyographic studies of the sphincter in patients with multiple system atrophy have shown increased duration and polyphasia of motor unit potentials. These electrophysiological markers have been used to argue for the selective degeneration of sacral motor neurons in Onuf's nucleus in patients with multiple system atrophy. Studies comparing sphincter electromyographic changes in patients with multiple system atrophy and Parkinson's disease have shown significant differences between these two patient populations. Despite the controversy surrounding this claim, recent studies using quantitative electromyographic techniques support the view that reinnervation of the anal sphincter muscles may be a useful diagnostic marker for distinguishing multiple system atrophy from Parkinson's disease. A critical review of these data is needed to assess the validity and reliability of electromyographic changes in multiple system atrophy.

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Quantitative electromyography of the external anal sphincter in Parkinson's disease and multiple system atrophy

Cited by 56 publications

References 26 publications

When is Onuf's nucleus involved in multiple system atrophy? A sphincter electromyography study

When is Onuf's nucleus involved in multiple system atrophy? A sphincter electromyography study

SIC Task Force appraisal of clinical diagnostic criteria for parkinsonian disorders

Sphincter electromyography and multiple system atrophy

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