Нервно-мышечные болезни. 2018; 8: 53-58
Электронейрографическое исследование диафрагмального нерва у здоровых детей
https://doi.org/10.17650/2222-8721-2018-8-2-53-58Аннотация
Введение. В отличие от параметров проведения по диафрагмальному нерву у здоровых взрослых, которые отличаются устойчивостью, у детей в норме с возрастом наблюдается разброс показателей.
Цель исследования – изучение латентности и амплитуды М-ответа при электронейрографическом (ЭНГ) исследовании диафрагмального нерва у здоровых детей разного возраста для создания нормативной базы нейрофизиологических данных.
Материалы и методы. Обследованы 48 здоровых детей (28 девочек и 20 мальчиков). Средний возраст составил 9,19 ± 3,43 года (1–18 лет). ЭНГ-исследование диафрагмального нерва проводили с использованием модифицированной 3-канальной регистрации М-ответа с диафрагмы при стимуляции правого диафрагмального нерва в области внешнего края нижней трети грудино-ключично-сосцевидной мышцы при параллельном контролировании наличия вызванных ответов с дельтовидной, передней зубчатой мышц, что позволяет избежать нежелательных артефактов исследования.
Результаты. Получены средние значения латентности М-ответа 5,64 ± 1,25 мс и амплитуды – 0,66 ± 0,34 мВ. При разделении группы детей на возрастные подгруппы 1–2 года (n = 7), 3–5 лет (n = 9), 6–12 лет (n = 15) и 13–18 лет (n = 17) латентность составила 4,96 ± 1,94; 5,01 ± 1,13; 5,42 ± 0,84 и 6,44 ± 1,43 мс и амплитуда – 1,01 ± 0,37; 0,87 ± 0,31; 0,61 ± 0,24 и 0,45 ± 0,21 мВ соответственно. Показатели амплитуды М-ответа у детей 1–2 лет достоверно отличались от таковых у детей в возрасте 6–12 и 13–18 лет.
Заключение. ЭНГ-исследование диафрагмального нерва является простым в исполнении и интерпретации результатов методом. При проведении ЭНГ диафрагмального нерва у детей необходимо учитывать возрастную вариабельность латентности и амплитуды М-ответа. Показатели амплитуды М-ответа у здоровых детей раннего возраста (1–2 года) достоверно выше таковых у детей 6–18 лет.
Список литературы
1. Perotto A.O., Delagi E.F., Iazzetti J., Daniel M. Аnatomical guide for the electromyographer: the limbs and trunk. 5th edn. Thomas C.C. Publisher, LTD., 2011. 378 p.
2. Podnar S. Idiopathic phrenic neuropathies: a case serias and review of the literature. Muscle Nerve 2015;52(6):986–92. DOI: 10.1002/mus.24673. PMID: 25846409.
3. Gaber T.A.-Z.K. Case studies in neurological rehabilitation. Cambridge University Press, 2008. 193 p.
4. Jenkins J.A., Sakamuri S., Katz J.S. et al. Phrenic nerve conduction studies as a biomarker of respiratory insufficiency in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2016;17(3–4):213–20. DOI: 10.3109/21678421.2015.1112406. PMID: 26618854.
5. Smith B.K., Corti M., Martin A.D. et al. Altered activation of the diaphragm in late-onset Pompe disease. Respir Physiol Neurobiol 2016;222:11–5. DOI: 10.1016/j.resp.2015.11.013. PMID: 26612101.
6. Heinbecker P., Bishop G.H., O’Leary J.L. Functional and histologic studies of somatic and autonomic nerves of man. Arch Neur Psych 1936;35(6):1233–55. DOI: 10.1001/archneurpsyc.1936.02260060075007.
7. Sarnoff S.J., Hardenbergh E., Whittenberger J.L. Electrophrenic respiration. Am J Physiol 1948;155(1):1–9. DOI: 10.1152/ajplegacy.1948.155.1.1. PMID: 18102659.
8. Davis J.N. Phrenic nerve conduction in man. J Neurol Neurosurg Psychiatry 1967;30(5):420–6. DOI: 10.1136/ jnnp.30.5.420. PMID: 4294147.
9. Moosa A. Phrenic nerve conduction in children. Dev Med Child Neurol 1981;23(4):434–48. DOI: 10.1111/j.1469-8749.1981. tb02016.x. PMID: 7274591.
10. MacLean I.C., Mattioni T.A. Phrenic nerve conduction studies: a new technique and its application in quadriplegic patients. Arch Phys Med Rehabil 1981;25:229–36. PMID: 6972202.
11. Carvalho M., Alves M., Sales-Luís M.L. Neurophysiologic study of the phrenic nerve. Acta Med Port 1991;4(6):297–300. PMID: 1807093.
12. Zifko U., Chen R., Remtulla H. et al. Respiratory electrophysiological studies in Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry 1996;60(2):191–4. DOI: 10.1136/jnnp.60.2.191. PMID: 8708652.
13. Similowski T., Mehiri S., Duguet A. et al. Comparison of magnetic and electrical phrenic nerve stimulation in assessment of phrenic nerve conduction time. J Appl Physiol 1997;82(4):1190–9. DOI: 10.1152/jappl.1997.82.4.1190. PMID: 9104856.
14. Lee H.J., DeLisa J. Manual of nerve conduction study and surface anatomy for needle electromyography. 4th edn. Philadelphia, 2004. 301 p.
15. Preston D.C., Shapiro B.E. Electromyography and neuromuscular disorders. 3rd edn.. Saunders, Philadelfia, 2013. 664 p.
16. Martinez de Posadas M.C., Liste H., Cottini C. Aranafe N. Combined phrenic nerve conduction and diaphragmatic ultrasound, in children’s neuro muscular diseases. J Neurol Sci 1997;150(1):S95. DOI: http://dx.doi.org/10.1016/S0022-510X(97)85305-1.
17. Imai T., Shizukawa H., Imaizumi H. et al. Phrenic nerve conduction in infancy and early childhood. Muscle Nerve 2000;23(6):915–8. DOI: 10.1002/(SICI)1097-4598(200006)23:6<915::AIDMUS11>3.0.CO;2-T. PMID: 10842268.
18. Russell R.I., Helps B.A., Helms P.J. Normal values for phrenic nerve latency in children. Muscle Nerve 2001;24(11):1548–50. DOI: 10.1002/mus.1181. PMID: 11745959.
19. Aminoff M.J. Aminoff’s electrodiagnosis in clinical neurology. 6th edn. Saunders, Philadelphia, 2012.
20. Войтенков В.Б., Команцев В.Н., Скрипченко Н.В. и др. Возрастная динамика состояния периферической нервной системы и мышц конечностей у здоровых людей. Успехи геронтологии 2017;130(1):78–83.
Neuromuscular Diseases. 2018; 8: 53-58
Conduction studies of phrenic nerve in healthy children
https://doi.org/10.17650/2222-8721-2018-8-2-53-58Abstract
Background. Unlike parameters of phrenic nerve conduction in healthy adults characterized by stability, in children variations with age are observed. The objective is to investigate the M-wave latency and amplitude in electroneurographic (ENG) examination of the phrenic nerve in healthy children of different ages for development of a normative database of neurophysiological data.
Materials and methods. 48 healthy children (28 girls and 20 boys) were examined. Mean age was 9.19 ± 5.43 years (1–18 years). ENG examination of the phrenic nerve was performed with the modified standard procedure of stimulation at the level of the outer margin of the lower third of the sternocleidomastoid muscle with registration of M-wave from standard diaphragm point and parallel registration of the muscle activity from m.deltoideus and m.serratus anterior.
Results. Mean values of the M-response latency were 5.64 ± 1.25 ms, amplitude – 0.66 ± 0.34 mV. For age-differentiated subgroups 1–2 years (n = 7), 3–5 years (n = 9), 6–12 years (n = 15), and 13–18 years (n = 17), the latency was 4.96 ± 1.94; 5.01 ± 1.13; 5.42 ± 0.84, and 6.44 ± 1.43 ms, respectively; the amplitude was 1.01 ± 0.37; 0.87 ± 0.31; 0.61 ± 0.24, and 0.45 ± 0.21 mV, respectively. The M-response amplitude values in children aged 1–2 years significantly differed from the values in children aged 6–12 and 13–18 years.
Conclusion. ENG examination of the phrenic nerve is a technically uncomplicated procedure, and the obtained data is easy to interpret. During phrenic nerve ENG in children, it is necessary to take age variability of the M-wave latency and amplitude into account. The M-wave amplitude in healthy toddlers (1–2 years old) was significantly lower than in children aged 6–18 years.
References
1. Perotto A.O., Delagi E.F., Iazzetti J., Daniel M. Anatomical guide for the electromyographer: the limbs and trunk. 5th edn. Thomas C.C. Publisher, LTD., 2011. 378 p.
2. Podnar S. Idiopathic phrenic neuropathies: a case serias and review of the literature. Muscle Nerve 2015;52(6):986–92. DOI: 10.1002/mus.24673. PMID: 25846409.
3. Gaber T.A.-Z.K. Case studies in neurological rehabilitation. Cambridge University Press, 2008. 193 p.
4. Jenkins J.A., Sakamuri S., Katz J.S. et al. Phrenic nerve conduction studies as a biomarker of respiratory insufficiency in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2016;17(3–4):213–20. DOI: 10.3109/21678421.2015.1112406. PMID: 26618854.
5. Smith B.K., Corti M., Martin A.D. et al. Altered activation of the diaphragm in late-onset Pompe disease. Respir Physiol Neurobiol 2016;222:11–5. DOI: 10.1016/j.resp.2015.11.013. PMID: 26612101.
6. Heinbecker P., Bishop G.H., O’Leary J.L. Functional and histologic studies of somatic and autonomic nerves of man. Arch Neur Psych 1936;35(6):1233–55. DOI: 10.1001/archneurpsyc.1936.02260060075007.
7. Sarnoff S.J., Hardenbergh E., Whittenberger J.L. Electrophrenic respiration. Am J Physiol 1948;155(1):1–9. DOI: 10.1152/ajplegacy.1948.155.1.1. PMID: 18102659.
8. Davis J.N. Phrenic nerve conduction in man. J Neurol Neurosurg Psychiatry 1967;30(5):420–6. DOI: 10.1136/ jnnp.30.5.420. PMID: 4294147.
9. Moosa A. Phrenic nerve conduction in children. Dev Med Child Neurol 1981;23(4):434–48. DOI: 10.1111/j.1469-8749.1981. tb02016.x. PMID: 7274591.
10. MacLean I.C., Mattioni T.A. Phrenic nerve conduction studies: a new technique and its application in quadriplegic patients. Arch Phys Med Rehabil 1981;25:229–36. PMID: 6972202.
11. Carvalho M., Alves M., Sales-Luís M.L. Neurophysiologic study of the phrenic nerve. Acta Med Port 1991;4(6):297–300. PMID: 1807093.
12. Zifko U., Chen R., Remtulla H. et al. Respiratory electrophysiological studies in Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry 1996;60(2):191–4. DOI: 10.1136/jnnp.60.2.191. PMID: 8708652.
13. Similowski T., Mehiri S., Duguet A. et al. Comparison of magnetic and electrical phrenic nerve stimulation in assessment of phrenic nerve conduction time. J Appl Physiol 1997;82(4):1190–9. DOI: 10.1152/jappl.1997.82.4.1190. PMID: 9104856.
14. Lee H.J., DeLisa J. Manual of nerve conduction study and surface anatomy for needle electromyography. 4th edn. Philadelphia, 2004. 301 p.
15. Preston D.C., Shapiro B.E. Electromyography and neuromuscular disorders. 3rd edn.. Saunders, Philadelfia, 2013. 664 p.
16. Martinez de Posadas M.C., Liste H., Cottini C. Aranafe N. Combined phrenic nerve conduction and diaphragmatic ultrasound, in children’s neuro muscular diseases. J Neurol Sci 1997;150(1):S95. DOI: http://dx.doi.org/10.1016/S0022-510X(97)85305-1.
17. Imai T., Shizukawa H., Imaizumi H. et al. Phrenic nerve conduction in infancy and early childhood. Muscle Nerve 2000;23(6):915–8. DOI: 10.1002/(SICI)1097-4598(200006)23:6<915::AIDMUS11>3.0.CO;2-T. PMID: 10842268.
18. Russell R.I., Helps B.A., Helms P.J. Normal values for phrenic nerve latency in children. Muscle Nerve 2001;24(11):1548–50. DOI: 10.1002/mus.1181. PMID: 11745959.
19. Aminoff M.J. Aminoff’s electrodiagnosis in clinical neurology. 6th edn. Saunders, Philadelphia, 2012.
20. Voitenkov V.B., Komantsev V.N., Skripchenko N.V. i dr. Vozrastnaya dinamika sostoyaniya perifericheskoi nervnoi sistemy i myshts konechnostei u zdorovykh lyudei. Uspekhi gerontologii 2017;130(1):78–83.
