Identification and classification of involuntary leg muscle contractions in electromyographic records from individuals with spinal cord injury.

Involuntary muscle contractions (spasms) are common after human spinal cord injury (SCI). Our aim was to compare how well two raters independently identified and classified different types of spasms in the same electromyographic records (EMG) using predefined rules. Muscle spasms were identified by the presence, timing and pattern of EMG recorded from paralyzed leg muscles of four subjects with chronic cervical SCI. Spasms were classified as one of five types: unit, tonic, clonus, myoclonus, mixed. In 48h of data, both raters marked the same spasms most of the time. More variability in the total spasm count arose from differences between muscles (84%; within subjects) than differences between subjects (6.5%) or raters (2.6%). Agreement on spasm classification was high (89%). Differences in spasm count, and classification largely occurred when EMG was marked as a single spasm by one rater but split into multiple spasms by the other rater. EMG provides objective measurements of spasm number and type in contrast to the self-reported spasm counts that are often used to make clinical decisions about spasm management. Data on inter-rater agreement and discrepancies on muscle spasm analysis can both drive the design and evaluation of software to automate spasm identification and classification.

Systemic hypothermia in acute cervical spinal cord injury: a case-controlled study.

INTRODUCTION: Systemic hypothermia remains a promising neuroprotective strategy. There has been recent interest in its use in patients with spinal cord injury (SCI). In this article, we describe our extended single center experience using intravascular hypothermia for the treatment of cervical SCI. METHODS: Thirty-five acute cervical SCI patients received modest (33 °C) intravascular hypothermia for 48 h. Neurological outcome was assessed by the International Standards for Neurological Classification of Spinal Cord Injury scale (ISNCSCI) developed by the American Spinal Injury Association. Local and systemic complications were recorded. RESULTS: All patients were complete ISNCSCI A on admission, but four converted to ISNCSCI B in <24 h post injury. Hypothermia was delivered in 5.76 (±0.45) hours from injury if we exclude four cases with delayed admission (>18 h). Fifteen of total 35 patients (43%) improved at least one ISNCSCI grade at latest follow up 10.07 (±1.03) months. Even excluding those patients who converted from ISNCSCI A within 24 h, 35.5% (11 out of 31) improved at least one ISNCSCI grade. Both retrospective (n=14) and prospective (n=21) groups revealed similar number of respiratory complications. The overall risk of any thromboembolic complication was 14.2%. CONCLUSION: The results are promising in terms of safety and improvement in neurological outcome. To date, the study represents the largest study cohort of cervical SCI patients treated by modest hypothermia. A multi-center, randomized study is needed to determine if systemic hypothermia should be a part of SCI patients' treatment for whom few options exist.

Clinical variants of Guillain-Barre syndrome: some aspects of differential diagnosis.

Acute Inflammatory Demyelinating Polyneuropathy--Guillain-Barre syndrome (GBS) affects spinal roots, peripheral and cranial nerves. Various clinical variants of GBS have been described. Isolated cranial nerve involvement without prominent signs of GBS is considered as rare variant of this disease. The aim of the study was to identify clinical characteristics of various forms of GBS particularly in rare variants of the disease. 57 patients with GBS were evaluated based on clinical and electrophysiological data. The following forms of GBS were revealed: 27 had acute inflammatory demyelinating polyradiculoneuropathy, 9--acute motor axonal neuropathy, 12--acute motor and sensory axonal neuropathy, 5--Fisher syndrome and 3--facial diplegia (rare clinical variant). 50 patients were graded 3 or more according to Hughes functional grading scale. Seasonal preponderance was found in spring (March-May) and autumn (September-November). 23 patients received IVIG and 34 were treated by plasma exchange within two weeks after onset. Follow up study revealed: 46 recovered satisfactory, 8 were persistently disabled, 3 died during admission to hospital. Guillain-Barre syndrome showed seasonal distribution and high frequency of axonal forms. Intravenous immunoglobulin therapy was more effective than plasma exchange. Poor outcomes were likely due to severe condition (required mechanical ventilation) and axonal forms. It is crucial to timely identify rare variants of GBS which recover with appropriate treatment.

Restoring movement to paralyzed limbs by treating nerve root avulsion: a seven year retrospective.

Traumatic injury of major nerve roots of extremities paralyzes the limb and causes high degree of disability. The aim of the study was to evaluate outcomes of surgical treatment of upper and lower limb nerve root avulsion using various microsurgical techniques to reconstruct the function of the extremity. 31 contralateral nerve transfer surgeries were performed on 17 patients with upper and lower extremities nerve root avulsion. Neurological and EMG examinations were carried out. To assess the return of function in the patient's hand Medical Research Council grading systems were used; to evaluate the return of function in the patient's leg we developed special microsurgical techniques. Excellent and good outcomes were received after thoracodorsal to musculocutaneous, spinal accessory to suprascapular or axillar in comparison to unlar to median or femoral transfer. Spinal accessory to suprascapular nerve transfer revealed better shoulder abduction than in case of spinal accessory to axillary transfer. It is concluded that contralateral nerve transfer represents a reliable and potent neurotizer that allows restoration of paralyzed limb function in surgical treatment of nerve root avulsion. Early reveal the better outcome.