EFFECTIVENESS OF PHYSICAL THERAPY IN MYOFASCIAL SYNDROME IN PATIENTS WITH MULTIPLE SCLEROSIS

The aim: Is to conduct a comparative analysis of electroneuromyographic parameters in patients with myofascial pain syndrome with multiple sclerosis under the conditions of using various means of physical therapy. Materials and methods: 105 patients aged 21 to 54 years were examined with MPS in MS. Neurological disorders were verified according to ENMG examinations. 64 patients were enrolled in an experimental group for which a specially designed program was included, which included reflexology and exercise for stretching muscles for 30 days. The control group included 41 patients who underwent a FT course based on therapeutic massage during the same time. Analysis of global ENMG was performed according to functional tests («muscle relaxation» and «maximum arbitrary muscle tension» with m. Tibialis anterior and m. Rectus femoris), M-responses and H-reflexes, polysynaptic responses (PSV) in withdrawal from these muscles during short-term stimulation n. plantaris (number of pulses in series 10, frequency - 20 Hz, duration of a separate stimulation signal - 1 ms, intensity - double threshold of contractile response of the muscles of the sole of the foot) and residual latency as the time of motor impulse on terminal non-myelinated nerve. Testing was performed on the same muscle groups on the left and righ. Results: Before physical therapy during electromyographic testing, a significant decrease in the amplitude of the maximum M response, a decrease in the speed of the impulse in the proximal and distal segments of the peripheral nerve, was found to be significant compared with the control, the ratio of the proximal-distal coefficient and the residual latency index significantly increased, which indicates a demyelinating character lesions of nerve conductors. After reflexotherapy with muscle stretching in 38.0% of the patients of the experimental group, the dynamics of the amplitude of the M-answers on the left and on the right has only a tendency to further increase, while in the other 62.0% of patients, the amplitude of the M-responses increases bilaterally and is 65.7% higher than in the control group. Conclusions: The use of reflexology in conjunction with stretching leads to a reduction in muscle spasticity and pain, as evidenced by electrophysiological indicators that substantiate their feasibility in the practice of physical therapy to improve the functional status of patients with MPS in MS.

DYNAMICS OF NEUROMUSCULAR ACTIVITY IN PATIENTS WITH LOCAL COLD INJURY

The OBJECTIVE was to study the changes of bioelectric activity of muscles in patients with local cold injury of the feet.MATERIAL AND METHODS. Non-invasive method of cutaneous electroneuromyography was used to evaluate the bioelectrical activity of muscles. The study was conducted in 52 patients with local cold injury of III–IV degree of the lower extremities of the late reactive period and the period of granulation and epithelialization. M-response amplitude, residual latency and propagation velocity of the excitation were estimated.RESULTS. In patients with local cold injury, there was a decrease in the bioelectric activity of the limb muscles proximal to the affected area. M-response amplitude and the propagation velocity of the excitation decreased in the patients in the late reactive period, while the residual latency increased. In patients with frostbite limbs during granulation and epithelialization, there was a tendency to restore the level of bioelectrical activity of muscles relative to the late reactive period.CONCLUSION. The basis of the adverse effects of local cold injury was “chronic” endothelial dysfunction and local neuropathy.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

Electroneuromyographical and immunological paralells in patients with diabetes mellitus type 2 complicated with polyneuropathy

This article presents and analyzes the data from a study of the immune status and the role of immune factors in the progression of polyneuropathy in patients with type 2 diabetes mellitus. The relationship between markers of the functional state of myelin and some parameters of the immune system are ascertained. The most sensitive are tibial nerve characteristics and in most cases – the residual latency period, that is the functional state index of myelin of the most dystal nerves’ segments. It was found that the progression of the polyneuropathy severity is accompanied by the secondary demyelination as a result both of the deepening axonopathy process and some immune disorders.

The Neuropathies of Waldenström's Macroglobulinemia (WM) and IgM-MGUS

Background:Neuropathy is common in Waldenström's macroglobulinemia (WM, an IgM-associated lymphoplasmacytic lymphoma) and in IgM-monoclonal gammopathy of undetermined significance (IgM-MGUS). Paraneoplastic or paraimmune mechanisms are thought to be involved in the pathogenesis of these neuropathies. Attempts at distinguishing WM and IgM-MGUS neuropathies are lacking especially among bone marrow (BM) confirmed patients.Methods:Retrospective analyses were performed on BM confirmed WM (N=30) and IgM-MGUS (N=73) neuropathy patients with neurologic assessments and hematologic features.Results:The presence of anemia and quantity of IgM monoclonal protein were significantly greater in WM. Based on multiple neurologic assessments differences were not found for: 1) length of time from neurologic symptom onset to evaluation; 2) chief complaint of painless loss of feeling in the feet, Romberg's sign and tremor; and 3) clinical motor, sensory and reflex abnormalities. Autonomic testing was normal in both diseases. Using nerve conduction (NCS) criteria for demyelination, 62% of IgM-MGUS and 27% of WM met this criteria (p=0.013). IgM MGUS patients had greater terminal conduction slowing by ulnar residual latency calculation (<0.01). The degree of axonal loss as measured by summated compound muscle action potentials and available nerve biopsy was not significantly different between diseases.Conclusion:Although WM and IgM-MGUS must be distinguished for hematologic prognosis and treatment, clinical neuropathy presentations of WM and IgM-MGUS are similar and likely related to comparable axonal loss in both conditions. Despite these similarities, evidence of demyelination was found by electrophysiologic studies much more commonly in IgM-MGUS. This difference may reflect varied immune mechanism(s) in the two disorders.