Anal sphincter EMG in the diagnosis of parkinsonian syndromes.
BACKGROUND
The role of electromyography (EMG) recorded from the external anal sphincter (EAS) in the diagnosis of atypical parkinsonian syndromes is a matter for continuous debate. Most studies addressing this issue are retrospective.


METHODS
In this study, we prospectively investigated six patients with Parkinson's Disease (IPD), 14 patients with multiple system atrophy (MSA) and eight with progressive supranuclear palsy (PSP) using EMG of the EAS, motor-evoked potential (MEP) to the EAS and EMG of m. gastrocnemius and nerve conduction velocity measured at the sural nerve. Patients were followed up for 2 years to secure correct diagnosis.


RESULTS
The mean duration of motor unit potentials (MUPs) recorded from the EAS was significantly longer in patients with MSA and PSP compared with MUPs recorded from patients with PD (P < 0.005 for both). There were no signs of diffuse loss of motor neurons or peripheral neuropathy. MEP revealed signs of supranuclear affection in patients with MSA, whereas in patients with PSP the mechanism is a focal loss of motor neurons in Onuf's nucleus.


CONCLUSIONS
Abnormal EMG of the EAS is strongly suggestive of atypical parkinsonism and the pathophysiology may be different in patients with MSA and PSP.
Copenhagen Movement Disorders Centre, Bispebjerg University Hospital, Copenhagen NV, Denmark. k.winge@dadlnet.dk
K
K
Winge
P
P
Jennum
A
A
Lokkegaard
L
L
Werdelin
D000368:Aged; D001003:Anal Canal / Q000503:physiopathology*; D004576:Electromyography / Q000379:methods*; D005071:Evoked Potentials / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000175:diagnosis / Q000503:physiopathology; D020734:Parkinsonian Disorders / Q000175:diagnosis* / Q000503:physiopathology*; D011446:Prospective Studies; D013494:Supranuclear Palsy, Progressive / Q000175:diagnosis / Q000503:physiopathology