Electrophysiologic studies in critical illness associated weakness: myopathy or neuropathy – a reappraisal

Objective: Unexplained weakness in critically ill patients is recognized with increasing frequency. However, it is debated whether the condition is a peripheral neuropathy or a myopathy. Diagnostic difficulties can arise from multiple sources that are not generally a factor in other neuromuscular co...

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Bibliographic Details
Published in:Clinical neurophysiology 2001-09, Vol.112 (9), p.1586-1593
Main Authors: Trojaborg, Werner, Weimer, Louis H, Hays, Arthur P
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Cell Count
Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction
Critical Illness
Critical illness myopathy
Direct muscle stimulation
Electric Stimulation
Electromyography
Electrophysiology
Female
Humans
Male
Medical sciences
Middle Aged
Motor Neurons - pathology
Motor Neurons - physiology
Motor unit number estimate
Muscle Weakness - pathology
Muscle Weakness - physiopathology
Muscle, Skeletal - pathology
Muscular Diseases - pathology
Muscular Diseases - physiopathology
Nervous system (semeiology, syndromes)
Nervous System Diseases - pathology
Nervous System Diseases - physiopathology
Neural Conduction - physiology
Neurology
Neurons, Afferent - physiology
Peripheral Nerves - pathology
Quantitative EMG
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Summary:Objective: Unexplained weakness in critically ill patients is recognized with increasing frequency. However, it is debated whether the condition is a peripheral neuropathy or a myopathy. Diagnostic difficulties can arise from multiple sources that are not generally a factor in other neuromuscular conditions. Conventional electrodiagnostic techniques may provide only non-specific data, clinical examination is often hampered, and muscle biopsy is not a practical screening tool. Method: To improve diagnostic yield, we studied 22 consecutive patients with critical illness associated weakness with additional electrodiagnostic techniques, including direct muscle stimulation, quantitative electromyography, and motor unit number estimation. Results: The applied techniques supported an underlying myopathy in all the patients examined. The diagnosis was confirmed by muscle biopsy in 9 patients. Additional lesser features of neuropathy were concomitantly present in one patient who also underwent sural nerve biopsy. Conclusions: The study suggests that myopathy is much more common than polyneuropathy in critical illness. Suspicion of this entity should be high in this setting even without exposure to corticosteroids or non-depolarizing blocking agents.
ISSN:1388-2457
1872-8952
DOI:10.1016/S1388-2457(01)00572-7