Correlation between specific histological and electromyographic findings in neuromuscular disorders

Werneck, Lineu Cesar; Lima, José Geraldo Camargo; Koehler, Henrique

doi:10.1590/S0004-282X1988000300006

Abstracts

An attempt was made to find a correlation between specific electromyography (EMG) abnormalities with histological findings in muscle biopsies (MB) in 100 patients with neuromuscular disorders. Quantified EMG and MB with histochemistry was made in the same muscle, but on the opposite side, within a period of 3 weeks. The isolated findings of EMG and MB were analysed with a computer through a chi-square test. A statistical relation (p<0.01) was found between the isolated findings of MB and EMG in only 6.99% (39 in 558 attempts) of the abnormalities expected to occur in myopathy and denervation. Also was found 2.51% (14 in 558 attempts) of inconsistences with the current literature.

Estudo de 100 pacientes com doenças neuromusculares, procurando verificar a correlação entre, anormalidades específicas da eletromiografia (EMG) com alterações histológicas da biópsia muscular (BM). Foi realizada EMG quantificada e BM com histoquímica do mesmo músculo mas em lados opostos, sendo os procedimentos realizados no máximo dentro do período de três semanas. As alterações isoladas da EMG e da BM foram analisadas pelo teste do chi-quadrado e, auxílio de computador. Relação estatística adequada (p<0.01) foi encontrada entre os dados isolados da BM e EMG em somente 6,99% (39 em 558 testes) das anormalidades esperadas em miopatias e desinervações. Também foram encontradas 2,51% (14 em 558 testes) de inconsistências com os dados publicados atualmente, com referência à patogênese das alterações. Nos comentários é feita revisão da patogenia das principais alterações histológicas e eletromiográficas que podem confundir achados de miopatia com desinervações. Concluindo, os autores acreditam que os dados incompatíveis e a falta de relação da maioria dos dados pode ser decorrente do método utilizado, utilização inadequada de um dos métodos, tentativas de obter relações que os métodos não permitem ou a que os conceitos entre os achados eletromiográficos e histológicos devem ser revistos.

Lineu Cesar Werneck^I; José Geraldo Camargo Lima^II; Henrique Koehler^III

^IAdjunct Professor (Neurology) - Division of Neurology, Internal Medicine Department and Division of Biometry and Statistics, Agrarial Sciences Department, Universidade Federal do Paraná, Curitiba; Neurology Department, Escola Paulista de Medicina, São Paulo

^IIFull Professor (Neurology) - Division of Neurology, Internal Medicine Department and Division of Biometry and Statistics, Agrarial Sciences Department, Universidade Federal do Paraná, Curitiba; Neurology Department, Escola Paulista de Medicina, São Paulo

^IIIAssistant Professor (Agrarial Sciences) - Division of Neurology, Internal Medicine Department and Division of Biometry and Statistics, Agrarial Sciences Department, Universidade Federal do Paraná, Curitiba; Neurology Department, Escola Paulista de Medicina, São Paulo

SUMMARY

An attempt was made to find a correlation between specific electromyography (EMG) abnormalities with histological findings in muscle biopsies (MB) in 100 patients with neuromuscular disorders. Quantified EMG and MB with histochemistry was made in the same muscle, but on the opposite side, within a period of 3 weeks. The isolated findings of EMG and MB were analysed with a computer through a chi-square test. A statistical relation (p<0.01) was found between the isolated findings of MB and EMG in only 6.99% (39 in 558 attempts) of the abnormalities expected to occur in myopathy and denervation. Also was found 2.51% (14 in 558 attempts) of inconsistences with the current literature.

RESUMO

Estudo de 100 pacientes com doenças neuromusculares, procurando verificar a correlação entre, anormalidades específicas da eletromiografia (EMG) com alterações histológicas da biópsia muscular (BM). Foi realizada EMG quantificada e BM com histoquímica do mesmo músculo mas em lados opostos, sendo os procedimentos realizados no máximo dentro do período de três semanas. As alterações isoladas da EMG e da BM foram analisadas pelo teste do chi-quadrado e, auxílio de computador. Relação estatística adequada (p<0.01) foi encontrada entre os dados isolados da BM e EMG em somente 6,99% (39 em 558 testes) das anormalidades esperadas em miopatias e desinervações. Também foram encontradas 2,51% (14 em 558 testes) de inconsistências com os dados publicados atualmente, com referência à patogênese das alterações. Nos comentários é feita revisão da patogenia das principais alterações histológicas e eletromiográficas que podem confundir achados de miopatia com desinervações. Concluindo, os autores acreditam que os dados incompatíveis e a falta de relação da maioria dos dados pode ser decorrente do método utilizado, utilização inadequada de um dos métodos, tentativas de obter relações que os métodos não permitem ou a que os conceitos entre os achados eletromiográficos e histológicos devem ser revistos.

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Divisão de Doenças Neuromusculares, Especialidade de Neurologia, Departamento de Clínica Médica - Hospital de Clínicas, Universidade Federal do Paraná - Rua General Carneiro 181 - 80000 Curitiba PR - Brasil

1. Ackerman GA - Substituted naphthol AS phosphate derivatives for the localization of leukocyte alkaline phosphatase activity. Lab Invest 11: 563, 1962.
2. Astrom KE, Adams RA - Pathological reaction of the skeletal muscle fiber in man. In Walton J (ed): Disorders of Voluntary Muscle. Churchill Livinngstone, Edinburg, 1981.
3. Borenstein S, Desmedt JE - Range of variation in motor unit potentials during reservation after traumatic nerve lesion in humans. Ann Neurol 8: 460, 1980.
4. Buchthal F - The electromyogram: its value in the diagnosis of neuromuscular disorders. World Neurol 3: 16, 1962.
5. Buchthal F - Electrophysiological signs of myopathic as related with muscle biopsy. Acta Neurol 32: 1, 1977.
6. Buchthal F, Kamieniecka Z - The diagnostic yield of quantified electromyography and quantified muscle biopsy in neuromuscular disorders. Muscle & Nerve 5: 266, 1982.
7. Burstone MS - Histochemical comparison of naphthol AS-phosphatase for the demonstration of phosphatase. J Nat Cancer Inst 20: 601, 1958.
8. Castaigne P, Cathala H-P, Rouques C, Beaussart-Boulenge L, Dammame P, Jarnot N - Confrontation de données eletromyographiques et histoenzymologiques musculaires en pathologie neuro-musculaire humaine. Rév Neurol 130: 5, 1974.
9. Cullen MJ, Mastaglia FL - Pathological reaction of skeletal muscle. In Mastaglia FL, Walton J (eds): Skeletal Muscle Pathology. Churchill Livingstone, Edinburg, 1982.
10. Desmedt JE, Borenstein S - Relationship of spontaneous fibrillation potentials to muscle fibre segmentation in human muscular dystrophy. Nature 258-531, 1975.
11. Desmedt JE, Borenstein S - Regeneration in Duchenne muscular dystrophy: electromyographic evidence. Arch Neurol 33: 642, 1976.
12. Drachmann DB, Murphy SR., Nigan MP, Hill JR - «Myopathic» changes in chronically denervated muscle. Arch Neurol 16: 14, 1967.
13. Dubowitz V - Pathology of experimentally re-innervated skeletal muscle. J Neurol Neurosurg Psychiat 39: 99, 1967.
14. Dubowitz V, Brooke MH - Muscle Biopsy: a Modern Approach. WB Saunders, London,1973.
15. Engel WK, Brooke MH - Muscle biopsy as a clinical diagnostic aid. In Fields WS (ed): Neurological Diagnostic Techiques. Charles C. Thomas, Springfield, 1968.
16. Hausmanowa-Petrusewicz I, Emeryk B, Wasowicz B, Kopec A - Electromyography in neuro-muscular diagnostics. Electromyography 7: 203, 1967.
17. Hausmanowa-Petrusewicz I, Jedrzejowska H - Correlation between electromyographic findings and muscle biopsy in cases of neuromuscular disease. J Neurol Sci 13: 85, 1971.
18. Jennekens FG- Neurogenic disorders of muscle. In Mastaglia FD, Walton J (eds): Skeletal Muscle Pathology. Churchill Livingstone, Edinburg, 1982.
19. Karpati G, Engel WK - «Type grouping» in skeletal muscles after experimental reinnervation. Neurology 18: 447, 1968.
20. Kugelberger F, Adstrom L, Abbruzzese M - Mapping of motor unit in experimentally reinervated rat muscle: interpretation of histochemical and atrophic fibre patterns in neurogenic lesions. J Neurol Neurosurg Psychiat 33 :319, 1970.
21. Lang AG, Partanen VSJ - «Satellite potentials» and the duration of the motor unit potentials in normal, neuropathic and myopathic muscle. J Neurol Sci 27: 513, 1976.
22. Nie NH, Hull CH, Jenkins JG, Brenner KS, Bent DH - Statistical Package for the Social Sciences, McGraw-Hill, New York, 1975.
23. Petajan JH, Thurman DJ - EMG and histochemical findings in neurogenic atrophy with electrode localisation. J Neurol Neurosurg Psychiat 44: 1050, 1981.
24. Pickett JB - Late components of motor unit potentials in a patient with myoglobinuria. Ann Neurol 3: 461, 1978.
25. Sandstedt PER - Effects of previous electromyographic examination studied by frequency analysis, muscle biopsy and creatine kinase. Acta Neurol Scand 64: 303, 1981.
26. Schmalbruch H - Muscle fibre splitting and regeneration in diseased human muscle. Neuropathol Appl Neurobiol 2: 3, 1976.
27. Schwartz MS, Moosa A, Dubowitz V - Correlation of single fibre EMG and muscle histochemistry using an open biopsy recording techniques. J Neurol Sci 31: 369, 1977.
28. Siegel S - Nonparametric Statistics for the Behavioral Sciences. McGraw-Hill, New York, 1956.
29. Steel RGD, Torrie JE - Principles and Procedures of Statistics. McGraw-Hill, New York, 1960.
30. Swash M, Schwartz MS - Implications of longitudinal muscle fibre splitting in neurogenic and myopathic disorders. J Neurol Neurosurg Psychiat 40: 1152, 1977.
31. Swinscow TDV - Statistics at Square One. British Med Assoc, London, 1978.
32. Warmolts JR, Engel WK - Open biopsy electromyography: I. Correlation of motor unit behavior with histochemical muscle fibre type in human limb muscle. Arch Neurol 27: 512, 1972.
33. Warmolts JR, Mendel JR - Open-biopsy electromyography: direct correlation of a pattern of excessively recruited, pathologically small motor unit potentials with histologic evidence of neuropathy. Arch Neurol 36: 406, 1979.
34. Werneck LC - O valor da biópsia muscular em neurologia; análise de 290 exames a fresco e pela histoquímica. Rev Bras Cl Terap (supl) 10: 2, 1981.
35. Werneck LC, Lima JGC - Muscle biopsy correlated with electromyography: study of 100 cases. Arq Neuro-Psiquiat (São Paulo) 46 :156, 1988.

Correlation between specific histological and electromyographic findings in neuromuscular disorders

Correlação entre anormalidades específicas da histologia e da eletromiografia em doenças neuromusculares

Publication Dates

Publication in this collection
17 June 2011
Date of issue
Sept 1988

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Ackerman GA - Substituted naphthol AS phosphate derivatives for the localization of leukocyte alkaline phosphatase activity. Lab Invest 11: 563, 1962.

[2] 2. Astrom KE, Adams RA - Pathological reaction of the skeletal muscle fiber in man. In Walton J (ed): Disorders of Voluntary Muscle. Churchill Livinngstone, Edinburg, 1981.

[3] 3. Borenstein S, Desmedt JE - Range of variation in motor unit potentials during reservation after traumatic nerve lesion in humans. Ann Neurol 8: 460, 1980.

[4] 4. Buchthal F - The electromyogram: its value in the diagnosis of neuromuscular disorders. World Neurol 3: 16, 1962.

[5] 5. Buchthal F - Electrophysiological signs of myopathic as related with muscle biopsy. Acta Neurol 32: 1, 1977.

[6] 6. Buchthal F, Kamieniecka Z - The diagnostic yield of quantified electromyography and quantified muscle biopsy in neuromuscular disorders. Muscle & Nerve 5: 266, 1982.

[7] 7. Burstone MS - Histochemical comparison of naphthol AS-phosphatase for the demonstration of phosphatase. J Nat Cancer Inst 20: 601, 1958.

[8] 8. Castaigne P, Cathala H-P, Rouques C, Beaussart-Boulenge L, Dammame P, Jarnot N - Confrontation de données eletromyographiques et histoenzymologiques musculaires en pathologie neuro-musculaire humaine. Rév Neurol 130: 5, 1974.

[9] 9. Cullen MJ, Mastaglia FL - Pathological reaction of skeletal muscle. In Mastaglia FL, Walton J (eds): Skeletal Muscle Pathology. Churchill Livingstone, Edinburg, 1982.

[10] 10. Desmedt JE, Borenstein S - Relationship of spontaneous fibrillation potentials to muscle fibre segmentation in human muscular dystrophy. Nature 258-531, 1975.

[11] 11. Desmedt JE, Borenstein S - Regeneration in Duchenne muscular dystrophy: electromyographic evidence. Arch Neurol 33: 642, 1976.

[12] 12. Drachmann DB, Murphy SR., Nigan MP, Hill JR - «Myopathic» changes in chronically denervated muscle. Arch Neurol 16: 14, 1967.

[13] 13. Dubowitz V - Pathology of experimentally re-innervated skeletal muscle. J Neurol Neurosurg Psychiat 39: 99, 1967.

[14] 14. Dubowitz V, Brooke MH - Muscle Biopsy: a Modern Approach. WB Saunders, London,1973.

[15] 15. Engel WK, Brooke MH - Muscle biopsy as a clinical diagnostic aid. In Fields WS (ed): Neurological Diagnostic Techiques. Charles C. Thomas, Springfield, 1968.

[16] 16. Hausmanowa-Petrusewicz I, Emeryk B, Wasowicz B, Kopec A - Electromyography in neuro-muscular diagnostics. Electromyography 7: 203, 1967.

[17] 17. Hausmanowa-Petrusewicz I, Jedrzejowska H - Correlation between electromyographic findings and muscle biopsy in cases of neuromuscular disease. J Neurol Sci 13: 85, 1971.

[18] 18. Jennekens FG- Neurogenic disorders of muscle. In Mastaglia FD, Walton J (eds): Skeletal Muscle Pathology. Churchill Livingstone, Edinburg, 1982.

[19] 19. Karpati G, Engel WK - «Type grouping» in skeletal muscles after experimental reinnervation. Neurology 18: 447, 1968.

[20] 20. Kugelberger F, Adstrom L, Abbruzzese M - Mapping of motor unit in experimentally reinervated rat muscle: interpretation of histochemical and atrophic fibre patterns in neurogenic lesions. J Neurol Neurosurg Psychiat 33 :319, 1970.

[21] 21. Lang AG, Partanen VSJ - «Satellite potentials» and the duration of the motor unit potentials in normal, neuropathic and myopathic muscle. J Neurol Sci 27: 513, 1976.

[22] 22. Nie NH, Hull CH, Jenkins JG, Brenner KS, Bent DH - Statistical Package for the Social Sciences, McGraw-Hill, New York, 1975.

[23] 23. Petajan JH, Thurman DJ - EMG and histochemical findings in neurogenic atrophy with electrode localisation. J Neurol Neurosurg Psychiat 44: 1050, 1981.

[24] 24. Pickett JB - Late components of motor unit potentials in a patient with myoglobinuria. Ann Neurol 3: 461, 1978.

[25] 25. Sandstedt PER - Effects of previous electromyographic examination studied by frequency analysis, muscle biopsy and creatine kinase. Acta Neurol Scand 64: 303, 1981.

[26] 26. Schmalbruch H - Muscle fibre splitting and regeneration in diseased human muscle. Neuropathol Appl Neurobiol 2: 3, 1976.

[27] 27. Schwartz MS, Moosa A, Dubowitz V - Correlation of single fibre EMG and muscle histochemistry using an open biopsy recording techniques. J Neurol Sci 31: 369, 1977.

[28] 28. Siegel S - Nonparametric Statistics for the Behavioral Sciences. McGraw-Hill, New York, 1956.

[29] 29. Steel RGD, Torrie JE - Principles and Procedures of Statistics. McGraw-Hill, New York, 1960.

[30] 30. Swash M, Schwartz MS - Implications of longitudinal muscle fibre splitting in neurogenic and myopathic disorders. J Neurol Neurosurg Psychiat 40: 1152, 1977.

[31] 31. Swinscow TDV - Statistics at Square One. British Med Assoc, London, 1978.

[32] 32. Warmolts JR, Engel WK - Open biopsy electromyography: I. Correlation of motor unit behavior with histochemical muscle fibre type in human limb muscle. Arch Neurol 27: 512, 1972.

[33] 33. Warmolts JR, Mendel JR - Open-biopsy electromyography: direct correlation of a pattern of excessively recruited, pathologically small motor unit potentials with histologic evidence of neuropathy. Arch Neurol 36: 406, 1979.

[34] 34. Werneck LC - O valor da biópsia muscular em neurologia; análise de 290 exames a fresco e pela histoquímica. Rev Bras Cl Terap (supl) 10: 2, 1981.

[35] 35. Werneck LC, Lima JGC - Muscle biopsy correlated with electromyography: study of 100 cases. Arq Neuro-Psiquiat (São Paulo) 46 :156, 1988.