Assessment of electromyograghic findings in peroneus tertius, tibialis posterior and dorsal interoseous pedis muscles in patients with axonal polyneuropathy

Ghasemi, Majid; Rajaei, Zahra; Khorvash, Fariborz; Asadi, Bahador; Rezvani, Majid

Assessment of electromyograghic findings in peroneus tertius, tibialis posterior and dorsal interoseous pedis muscles in patients with axonal polyneuropathy

Authors

¹ Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran

² Medical University of AJA, Tehran, Iran

³ Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Axonal polyneuropathy (APN) is a common kind of neurologic disorders, which is normally diagnosed by electrodiagnostic methods. Different muscles were studied to find a muscle, which can be considered as a reliable site for early diagnosis of mild APN; this muscle should be easily activated by patient, has the highest sensitivity to EMG changes of APN, and has the lowest rate of false positive results in normal subjects.
Materials and Methods: Based on the inclusion and exclusion criteria, 32 patients were recruited, and all of them underwent needle EMG of 3 different muscles including Peroneus tertius (PT), tibialis posterior (TP), and dorsal interoseous pedis (DIP). EMG Findings of different muscles [Motor Unite Action Potential (MUAP) duration, MUAP amplitude, polyphasic MUAP, fibrillation potential (FP), and the ability of subjects to contract special muscle] were recorded and compared.
Results: Mean of MUAP amplitude was significantly different between all 3 muscles (P-values < 0.001). PT showed a significantly higher frequency of polyphasic MUAP than others (P-value: 0.001). The frequency of FP was significantly lower in TP than PT and DIP (P-values: 0.03 and 0.001, respectively). DIP showed significantly shorter MUAP duration than PT and TP (P-values 0.002 and 0.003, respectively). All cases were able to activate TP and PT voluntarily though only 20 patients could activate DIP (P-value < 0.0001).
Conclusion: The higher frequency of polyphasic MUAP, the higher frequency of FP, and finally, the ability of all patients in activation of PT voluntarily, all support the usefulness of PT for EMG studies in APN patients.

Keywords

References

1.	Rosenberg NR, Portegies P, de Visser M, Vermeulen M. Diagnostic investigation of patients with chronic polyneuropathy: Evaluation of a clinical guideline. J Neurol Neurosurg Psychiatry 2001;71:205-9.
2.	England JD, Asbury AK. Peripheral neuropathy. Lancet 2004;363:2151-61.
3.	Boon AJ, Harper CM. Electromyographic sensitivity of peroneus tertius relative to abductor hallucis in assessment of peripheral neuropathy. Muscle Nerve 2009;40:629-32.
4.	Boon AJ, Harper CM. Needle EMG of abductor hallucis and peroneus tertius in normal subjects. Muscle Nerve 2003;27:752-6.
5.	Morgenlander JC, Sanders DB. Spontaneous EMG activity in the extensor digitorum brevis and abductor hallucis muscles in normal subjects. Muscle Nerve 1994;17:1346-7.
6.	England JD, Gronseth GS, Franklin G, Miller RG, Asbury AK, Carter GT, et al. Distal symmetric polyneuropathy: A definition for clinical research: Report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2005;64:199-207.
7.	Pfeiffer G. The diagnostic power of motor unit potential analysis: An objective bayesian approach. Muscle Nerve 1999;22:584-91.
8.	Rodriguez I, Gila L, Malanda A, Gurtubay IG, Mallor F, Gomez S, et al. Motor unit action potential duration, I: Variability of manual and automatic measurements. J Clin Neurophysiol 2007;24:52-8.
9.	Daube JR, Rubin DI. Needle electromyography. Muscle Nerve 2009;39:244-70.
10.	Dyck PJ, Litchy WJ, Lehman KA, Hokanson JL, Low PA, O'Brien PC. Variables influencing neuropathic endpoints: The Rochester Diabetic Neuropathy Study of Healthy Subjects. Neurology 1995;45:1115-21.

Advanced Biomedical Research