title: Neurophysiological evaluation of segmental motor neuron function of the thoracic cord in chronic SCI.
abstract: METHODS
  Pilot study.
  
  
  OBJECTIVE
  The aim of the study was to develop a neurophysiological method to diagnose the cranial as well as the caudal level of a complete thoracic spinal cord injury (SCI) with higher precision than today's protocols.
  
  
  METHODS
  SCI unit Karolinska University Hospital, Stockholm, Sweden.
  
  
  METHODS
  Bipolar needle electromyography was recorded in intercostal spaces of five patients with chronic, complete thoracic SCI. Tests were performed during rest, during voluntary activation and during activation of lower body spasticity. Magnetic resonance imaging (MRI) was performed in each patient according to a protocol optimized for imaging near metal implants.
  
  
  RESULTS
  Three distinct patterns were found in each patient. Above the lesion we found voluntary activated, normal motor unit potentials (MUPs). At the neurological level and a varying number of segments below, denervated intercostal segments with fibrillation potentials and positive sharp waves appeared. Below the neurological level, normal MUP activated in concert with lower body spasticity was found. The number of denervated segments showed a significant correlation to the length of spinal cord discontinuity on MRI (r=0.97, P<0.05).
  
  
  CONCLUSIONS
  Intercostal neurophysiology in combination with MRI optimized for imaging near metal implants can be used to determine the extent of a chronic complete thoracic SCI, both anatomically and functionally. The described method increases the sensitivity to detect delicate neurological changes related to the dynamic of the pathology that follows SCI and may be useful in analyzing outcome in clinical trials.
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Frostell
authors.forename: P
authors.initials: P
authors.lastname: Mattsson
authors.forename: J K E
authors.initials: JK
authors.lastname: Persson
authors.forename: B
authors.initials: B
authors.lastname: Hedman
authors.forename: J
authors.initials: J
authors.lastname: Nordblom
authors.forename: A
authors.initials: A
authors.lastname: Lindenryd
authors.forename: K
authors.initials: K
authors.lastname: Trok
authors.forename: L
authors.initials: L
authors.lastname: Brundin
authors.forename: M
authors.initials: M
authors.lastname: Svensson
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D004185:Disability Evaluation; D004576:Electromyography / Q000379:methods*; D006801:Humans; D007366:Intercostal Muscles / Q000294:innervation / Q000503:physiopathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016472:Motor Neuron Disease / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D009046:Motor Neurons / Q000502:physiology; D009128:Muscle Spasticity / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D009469:Neuromuscular Junction / Q000503:physiopathology; D010264:Paraplegia / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D010865:Pilot Projects; D011237:Predictive Value of Tests; D019736:Prostheses and Implants / Q000592:standards; D013116:Spinal Cord / Q000473:pathology* / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000150:complications / Q000175:diagnosis*; D013904:Thoracic Vertebrae / Q000293:injuries / Q000473:pathology; D015599:Trauma Severity Indices; D055815:Young Adult