Evaluating the sensitivity of sternocleidomastoid muscle ...

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13908818 ) MND( ALS )Amyotrophic Lateral Sclerosis ( . ) () ( . . Cervical( Spondylosis Myelopathy ( ). (* : *ilkhaniman@yahoo.com : . manouchehriri@yahoo.com kiamarzi_g@yahoo.com . : akbarpour62@yahoo.com . : ) CSM( ALS : . ALS CSM . CSM ALS 34 : . 1387-1385 . . 2 2 . CSM ALS 34 10 : . ALS 2 .) 6/91 9/41( 4/71 95 ALS : . "Ruling in" : 18/4/90 : 3/11/89: Downloaded from rjms.iums.ac.ir at 3:25 IRDT on Sunday April 1st 2018http://rjms.iums.ac.ir/article-1-1833-en.html 13908818 2 )Protrusion( )Bulging( ) Extrusion( ) Flaccid( . ) Spastic( . CSM . ) CSM( ALS . CSM ALS . CSM ALS ALS )EMG( . CSM SCM( Sternocleidomastoid muscle:( )Trapeze muscle( . ALS . )1-7( CSM )1( Makki . )2( Li Makki -T) PSP EMG) ALS 2006 2005 64 T-PSP-EMG 15 . ) 44( 28 15 ) 93( 26 36 ALS 56( ) ) ( ALS ) 25( 9 . 5/10 %93 74% 28/0 . T-PSP EMG ALS .)1( Li 21 ALS ALS EMG .)2( Motor Evoked Potentials)5( Somatosensory Evoked Potentials)6( ALS .)65( Downloaded from rjms.iums.ac.ir at 3:25 IRDT on Sunday April 1st 2018http://rjms.iums.ac.ir/article-1-1833-en.html... 1390 88 18 3 ALS . )SCM- EMG( . ALS )Retrospective Cohort Study ( . 34 CSM ALS 1387 1385 MRI . MRI . . ) Gold Standard( ) Follow Up( -SCM( EMG ( . . DANTEC NEUROMATIC2000 ) SCM( . . . SCM ) ( . . )Quantitative EMG( ) MND( )MUP( . ) Firing Rate( MRI . . CSM ALS . ) p value( . 05/0 17 SPSS . 2 2 Downloaded from rjms.iums.ac.ir at 3:25 IRDT on Sunday April 1st 2018http://rjms.iums.ac.ir/article-1-1833-en.html 13908818 4 ALS MRI - 1 P-Value CSM )20N= ( ALS )14N= ( 440/0 70 30 6/78 4/21 )( )( 201/0 # 2/1153 8/13 3/46 ) ( 029/0 70 100 )( 261/0 70 7/85 )( 001/0 $ 65 1/7 )( 412/0 0 1/7 )( 001/0 $ 80 1/7 )( 001/0 $ 80 1/7 )( 283/0 5 95 6/78 4/21 )( )( 004/0 10 55 35 1/57 9/42 0 MRI )( )( )( 001/0 0 4/71 )( 412/0 100 9/92 )( 339/0 10 0 )( #Mann- Whitney Test, $Chi- squared Test 95 . . . 6/12 2/50 9 ) 5/73( 25 34 . 34 CSM 14 ALS . CSM 20ALS ALS (LMN) 7/85 (UMN) 1/7 . 6/78 . 70 70 CSM 5 80 80 65 . MRI ALS 9/42 1/57 55 10 ALS . CSM 35 Downloaded from rjms.iums.ac.ir at 3:25 IRDT on Sunday April 1st 2018http://rjms.iums.ac.ir/article-1-1833-en.html... 1390 88 18 5 MRI CSM ALS . . ) 4/29( 10 CSM ALS 34 1/44( 15 . ALS ) 6 ALS . ALS 95 . ) 6/91 9/41( 4/71 )82( ALS 8 . ALS 11 5 6 3 . ALS . 9 ALS 13 . ) 4/29( 10 CSM ALS 34 . ALS CSM . 1 . 28 26 ) 44( 93( ) 15 . ALS . ) 10( 4/71 ALS . 95 . ) 6/91 9/41( 4/71 56( 95 74 .)1( ) 86 Downloaded from rjms.iums.ac.ir at 3:25 IRDT on Sunday April 1st 2018http://rjms.iums.ac.ir/article-1-1833-en.html 13908818 6 . . 100 . )Blinding( . 34 CSM ALS MRI . ALS ( "Ruling in" Multivariate Logistic Regression ) . . 1. Makki A, Benatar M. Diagnostic accuracy of thoracic paraspinal electromyography in amyotrophic lateral sclerosis. J Clin Neurophysiol; 2007. 24(3):298-300. 2. Li J, Petajan J. Smith G, Bromberg M. Electromyography of sternocleidomastoid muscle in ALS: a prospective study. Muscle Nerve; 2002. 25(5):725-8. 3. Sonoo M, Kuwabara S, Komori T, Shimizu T, Hirashima F. Utility of trapezius EMG for diagnosis of amyotrophic lateral sclerosis. Muscle Nerve. 2009; 39(1):63-70. 4. Trompetto C, Caponnetto C, Buccolieri A, Marchese R, Abbruzzese G.Responses of masseter muscles to transcranial magnetic stimulation in patients with amyotrophic lateral sclerosis. ElectroencephalogrClinNeurophysiol; 1998. 109(4):309-14. 5. Truffert A, Rsler KM, Magistris MR. Amyotrophic lateral sclerosis versus cervical spondylotic myelopathy: a study using transcranial magnetic stimulation with recordings from the trapezius and limb muscles. ClinNeurophysiol; 2000. 111(6):1031-8. 6. de Carvalho M, Conceio I, Alves M, Lus ML. Somatosensory evoked potentials in the differential diagnosis between spinal cord compression and amyotrophic lateral sclerosis. Acta Neurol Scand; 1995. 92(1):72-6. 7. Kang DX, Fan DS. The electrophysiological study of differential diagnosis between amyotrophic lateral sclerosis and cervical spondylotic myelopathy. Electromyogr Clin Neurophysiol; 1995.35(4):231-8. 8. Cho JY, Sung JJ, Min JH, Lee KW. Clinical utility of trapezius muscle studies in the evaluation of amyotrophic lateral sclerosis. J Clin Neurosci; 2006. 13(9): 908-12. Downloaded from rjms.iums.ac.ir at 3:25 IRDT on Sunday April 1st 2018http://rjms.iums.ac.ir/article-1-1833-en.html... 1390 88 18 7 Original Article Evaluating the sensitivity of sternocleidomastoid muscle electromyography in differential diagnosis of amyotrophic lateral sclerosis from cervical spondylotic myelopathy *Manoochehr Ilkhani, MD. Associate Professor of Neurology, Loqman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran (*Corresponding author). ilkhaniman@yahoo.com Manoochehr Karami, MSc. PhD Candidate, Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran. manouchehriri@yahoo.com Gohar Kiamarzi, MSc. Epidemiologist, Dr. Ilkhanis Electroneurodiagnostic Center, Tehran, Iran. kiamarzi_g@yahoo.com Samaneh Akbar pour, MSc. Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran. akbarpour62@yahoo.com Abstract Background: Differentiation between amyotrophic lateral sclerosis (ALS) and cervical spondylotic myelopathy (CSM) not only for those similar clinical features but also for different handling is very important in clinical practice. Considering that EMG of the sternocleidomastoid muscle (SCM) is using for differential diagnosis of these diseases in Iran, present study was aimed to evaluate the sensitivity of sternocleidomastoid muscle electromyography in differential diagnosis of ALS from CSM. Methods: We conducted a retrospective cohort study. Subjects (34patients) were identified from suspected ALS or CSM patients who referred to Loqhman hospital and evaluated with using of the sternocleidomastoid muscle electromyography (SCM-EMG) between March 2006 and February 2008 as part of the diagnostic workup. Clinical characteristics and MRI results were derived from subjects medical records. Follow-up clinical evaluation during two years after initial diagnostic evaluation was available as a gold standard for confirmation the EMG results. We used two way tables for calculating sensitivity. Results: SCM-EMG was abnormal in 10 (29.4%) patients, all of whom were subsequently diagnosed with ALS. The sensitivity of SCM-EMG was 0.71 (95% CI, 0.42 0.91) for the diagnosis of ALS. Conclusion: Although our findings suggest that SCM-EMG is an extremely useful adjunct for the diagnosis of ALS, but further studies with larger sample size is needed for its application as a useful test Ruling in for the diagnosis of ALS. Keywords: Amyotrophic lateral sclerosis, Cervical spondylosis myelopathy, Sensitivity, Sternocleidomastoid muscle, EMG. 7 Razi Journal of Medical Sciences Vol. 18, No. 88, Sep-Oct 2011 7 Downloaded from rjms.iums.ac.ir at 3:25 IRDT on Sunday April 1st 2018http://rjms.iums.ac.ir/article-1-1833-en.html

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