Electrophysiological recordings in patients with spinal cord injury: significance for predicting outcome.
The clinical assessment of the level, extent and severity of spinal cord injury (SCI) can be supplemented by electrophysiological recordings. These techniques also provide an early diagnosis of neurological deficits in patients with acute SCI and are of prognostic value even in uncooperative patients. Electrophysiological recordings (motor evoked potentials (MEP) and somato-sensory evoked potentials (SSEP)) are of similar significance in predicting functional outcome of ambulatory capacity, hand- and bladder function as the clinical examination according to the ASIA standards. EMG, neurographic and reflex recordings of acute SCI patients within spinal shock are even more sensitive in assessing an associated damage of the peripheral motor pathways (ie of motoneurones and nerve roots) than the clinical examination and allow the possibility of predicting the development of muscle tone or muscle atrophy. The evaluation of impairment of the autonomic nervous system after SCI by clinical examination is restricted. In contrast, recordings of the sympathetic skin response (SSR) can provide information about the extent and level of lesions of the spinal sympathetic nervous system which are related to autonomic dysfunction. Therefore, electrophysiological recordings supplementary to the clinical examination are helpful for planning and selecting the appropriate therapeutical approaches within the rehabilitation programme. Furthermore, they allow the prediction of functional outcome and the objective assessment of recovery of specific parts of the spinal and peripheral fibre tracts.
Curt
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Swiss Paraplegic Centre, University Hospital Balgrist, Zürich.
Dietz
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D004576:Electromyography; D004594:Electrophysiology / Q000379:methods; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012018:Reflex; D012680:Sensitivity and Specificity; D013116:Spinal Cord / Q000502:physiology; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000503:physiopathology