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Acute Quadriplegic Myopathy Unrelated to Steroids or Paralyzing Agents: Quantitative EMG Studies

  • Ahmet Höke (a1), Douglas W. Zochodne (a1) and N. B. Rewcastle (a2)

Abstract

Background:

Quadriplegic myopathy (QM) and its variants generally are described in critically ill patients who are exposed to steroids and nondepolarizing muscle blocking agents (NDMBAs).

Methods:

A patient with sepsis who was not exposed to steroids or an NDMBA infusion developed QM and was studied using serial quantitative electromyography.

Results:

Clinical and electrophysiological studies identified evidence of a severe myopathy and muscle biopsy showed necrosis, calcifications and selective loss of myosin filaments in non-necrotic fibers. Her clinical recovery paralleled rises in motor unit action potential (MUAP) amplitudes studied by serial automatic decomposition electromyography (ADEMG).

Conclusion:

QM can develop with sepsis and without significant exposure to steroids and NDMBAs. ADEMG can be a useful tool in electrophysiological evaluation of critically ill patients with weakness.

RÉSUMÉ Introduction:

La myopathie quadriplégique (MQ) et ses variantes sont généralement décrites chez des patients dont l’état est critique et qui sont exposés à des stéroïdes et à des bloquants musculaires non dépolarisants (BMNDs).

Méthodes:

Une patiente atteinte de septicémie, qui n’avait pas été exposée à des stéroïdes ou à une perfusion de BMND, a développé une MQ. Nous avons procédé chez cette patiente à une étude électromyographique quantitative sériée.

Réltats:

Les études cliniques et électrophysiologiques ont montré des manifestations de myopathie sévère, et à la biopsie musculaire, on a observé une nécrose, des calcifications et une perte sélective des filaments de myosine dans les fibres qui n’étaient pas nécrotiques. Sa récupération Clinique a été parallèle à l’augmentation de l’amplitude des potentiels d’action des unités motrices notée à l’électromyographie de décomposition automatique sériée (ÉMGDA).

Conclusions:

Une MQ peut survenir chez les patients septiques, sans exposition significative à des stéroïdes et à des BMNDs. L’ÉMGDA peut être un outil précieux dans l’évaluation électrophysiologique de patients en état critique qui présentent de la faiblesse musculaire.

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References

Hide All
1. MacFarlane, IA, Rosenthal, FD. Severe myopathy after statusasthmaticus. Lancet 1977;2:615.
2. Danon, MJ, Carpenter, S. Myopathy with thick filament (myosin)loss following prolonged paralysis with vecuronium during steroid treatment. Muscle Nerve 1991;14:1131–9.
3. McGill, KC, Dorfman, LJ. Automatic decomposition electromyogra-phy (ADEMG): validation and normative data in brachial biceps. Electroencephalogr Clin Neurophysiol 1985;61:453–61.
4. Van Marle, W, Woods, KL. Acute hydrocortisone myopathy. Br MedJ 1980;281:271–2.
5. Helliwell, TR, Coakley, JH, Wagenmakers, AJ, Griffiths, RD, Campbell, IT, Green, CJ, et al. Necrotizing myopathy in critically ill patients. J Pathol 1991;164:307–14.
6. Ramsay, DA, Zochodne, DW, Robertson, DM, Nag, S, Ludwin, SK. Asyndrome of acute severe muscle necrosis in intensive care unitpatients. J Neuropathol Exp Neurol 1993;52:387–98.
7. Zochodne, DW, Ramsay, DA, Saly, V, Shelley, S, Moffatt, S. Acutenecrotizing myopathy of intensive care: electrophysiological studies. Muscle Nerve 1994;17:285–92.
8. Lacomis, D, Giuliani, MJ, Van Cott, A, Kramer, DJ. Acute myopathyof intensive care: clinical, electromyographic, and pathological aspects. Ann Neurol 1996;40:645–54.
9. Matsubara, S, Okada, T, Yoshida, M. Mitochondrial changes in acutemyopathy after treatment of respiratory failure with mechanical ventilation (acute relaxant-steroid myopathy). Acta Neuropathol(Berl) 1994;88:475–8.
10. Fischer, JR, Baer, RK. Acute myopathy associated with combineduse of corticosteroids and neuromuscular blocking agents. Ann Pharmacother 1996;30:1437–45.
11. al-Lozi, MT, Pestronk, A, Yee, WC, Flaris, N, Cooper, J. Rapidlyevolving myopathy with myosin-deficient muscle fibers. Ann Neurol 1994;35:273–9.
12. Hanson, P, Dive, A, Brucher, JM, Bisteau, M, Dangoisse, M, Deltombe, T. Acute corticosteroid myopathy in intensive care patients. Muscle Nerve 1997;20:1371–80.
13. Showalter, CJ, Engel, AG. Acute quadriplegic myopathy: analysis ofmyosin isoforms and evidence for calpain-mediated proteolysis. Muscle Nerve 1997;20:316–22.
14. Barohn, RJ, Jackson, CE, Rogers, SJ, Ridings, LW, McVey, AL. Prolonged paralysis due to nondepolarizing neuromuscular blocking agents and corticosteroids. Muscle Nerve 1994;17:647–54.
15. Rich, MM, Teener, JW, Raps, EC, Schotland, DL, Bird, SJ. Muscle iselectrically inexcitable in acute quadriplegic myopathy. Neurology 1996;46:731–6.
16. Rich, MM, Bird, SJ, Raps, EC, McCluskey, LF, Teener, JW. Direct muscle stimulation in acute quadriplegic myopathy. MuscleNerve 1997;20:665–73.
17. Hirano, M, Ott, BR, Raps, EC, Minetti, C, Lennihan, L, et al. Acutequadriplegic myopathy: a complication of treatment with steroids, nondepolarizing blocking agents, or both. Neurology 1992;42:2082–7.
18. Massa, R, Carpenter, S, Holland, P, Karpati, G. Loss and renewal ofthick myofilaments in glucocorticoid-treated rat soleus after denervation and reinnervation. Muscle Nerve 1992;15:1290–8.
19. The Compendium of Pharmaceuticals and Specialties. Ottawa: Canadian Pharmaceutical Association, 1995.
20. Minetti, C, Hirano, M, Morreale, G, Pedemonte, M, Cordone, G, et al. Ubiquitin expression in acute steroid myopathy with loss of myosin thick filaments. Muscle Nerve 1996;19:94–6.
21. Bolton, CF. Neuromuscular complications of sepsis. Intensive Care Med 1993;19:S58–63.
22. Bolton, CF. Sepsis and the systemic inflammatory responsesyndrome: neuromuscular manifestations. Crit Care Med 1996;24:1408–16.
23. Zochodne, DW, Bolton, CF, Wells, GA, Gilbert, JJ, Hahn, AF, et al. Critical illness polyneuropathy. A complication of sepsis and multiple organ failure. Brain 1987;110:819–41.
24. Zochodne, DW, Bolton, CF. Neuromuscular disorders in criticalillness. Baillieres Clin Neurol 1996;5:645–71.
25. Deconinck, N, Van Parijs, V, Beckers-Bleukx, G, Van den Bergh, P. Critical illness myopathy unrelated to corticosteroids or neuromuscular blocking agents. Neuromuscular Disorders 1998;8:186–92.
26. Bolton, CF, Ramsay, DA, Rutledge, F. Acute quadriplegic myopathy(AQM), sepsis and systemic inflammatory response syndrome(SIRS). Neurology 1998;50:242–3.

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Acute Quadriplegic Myopathy Unrelated to Steroids or Paralyzing Agents: Quantitative EMG Studies

  • Ahmet Höke (a1), Douglas W. Zochodne (a1) and N. B. Rewcastle (a2)

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