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Direct muscle stimulation in acute quadriplegic myopathy
Author(s) -
Rich Mark M.,
Bird Shawn J.,
Raps Eric C.,
McCluskey Leo F.,
Teener James W.
Publication year - 1997
Publication title -
muscle and nerve
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.025
H-Index - 145
eISSN - 1097-4598
pISSN - 0148-639X
DOI - 10.1002/(sici)1097-4598(199706)20:6<665::aid-mus2>3.0.co;2-6
Subject(s) - medicine , myopathy , stimulation , neuromuscular transmission , compound muscle action potential , anesthesia , muscle weakness , electrophysiology , anatomy
We have previously found that muscle is electrically inexcitable in severe acute quadriplegic myopathy (AQM). In contrast, muscle retains normal electrical excitability in peripheral neuropathy. To study the relationship between muscle electrical excitability and all types of flaccid weakness occurring in the intensive care unit, we identified 14 critically ill, weak patients and measured the amplitude of compound muscle action potentials (CMAPs) obtained with direct muscle stimulation (dmCMAP) and with nerve stimulation (neCMAP). In 11 of 14 patients dmCMAP amplitudes were reduced and the ratio of the neCMAP amplitude to the dmCMAP amplitude (nerve/muscle ratio) was indicative of loss of muscle electrical excitability. In 2 other patients, the nerve/muscle ratio indicated neuropathy. Direct muscle stimulation may allow differentiation of AQM from neuropathy even in comatose or encephalopathic critically ill patients. AQM may be more common than has previously been appreciated. © 1997 John Wiley & Sons, Inc. Muscle Nerve, 20, 665–673, 1997.