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Needle electromyography (EMG) of the genioglossus muscle is a useful tool in patients with swallowing problems, that are common in many muscle and nerve diseases. Characteristic changes in motor unit potentials (MUPs) can be distinguished with MUP and interference pattern (IP) analysis. The purpose of this study was to establish reference intervals for MUP parameters using template operated multi-MUP analysis and to evaluate the IP features in the genioglossus muscle (GM) of healthy adults. We studied 28 healthy volunteers (11 men, 17 women, mean age 39 ± 12 years) with standard disposable concentric EMG needles (recording area 0.07 mm2) and an EMG system with standard settings (filters: 5 Hz–10 kHz), using an inframandibular approach. For each MUP parameter (amplitude, duration, turns) mean values and outlier limits (5th and 95th percentile) were calculated from the first 20 sampled MUPs. Data from IP plots (turns/amplitude, activity/envelope and activity/NSS) were collected in order to build normal clouds which contain >90% of the data points. MUP parameters obtained from the GM are similar to those published in literature. IP analysis is not available for healthy GM to our knowledge and could be an objective tool to quantitate the degree of abnormality in muscle and nerve diseases.

The prediction of neurologic outcome in comatose patients after cardiac arrest (CA) has been investigated and the findings were summarized in a practice parameter of the American Academy of Neurology (1). These guidelines did not include the EEG as a reliable outcome indicator but recent studies on continuous EEG recorded during TH have re-evaluated the role of EEG (2–4). These studies underline the utility of a simplified classification system of EEG patterns and point to which pattern attains reliable predictive value both for good and bad outcomes. These reports are of high clinical relevance because, until today, the possibility of identifying early prognostic indicators of good outcome in patients surviving to CA has not been investigated. At the best of our knowledge, only few multicentre prospective studies (4–6) analyzed the prognostic value of EEG and SEP recorded in the same patient after CA as single predictor but none analyzed the diagnostic accuracy of the association of these two tests. We present the study protocol of Italian Multicentre Study about prognostic value of EEG and SEP in comatose patients after CA (ProNeCA) proposed by study group of “Intraoperative and Intensive Care Clinical Neurophysiology” of the Italian Society of Clinical Neurophysiology.

Dysphagia is common and under-diagnosed in Myotonic Dystrophy (DM1), leading to nutritional derangement and ab-ingestis pneumonia. We tried to define the prevalence of dysphagia and to understand underlying mechanisms through an integrated swallowing evaluation on DM1 patients. Our protocol includes: laryngeal accelerometric sensor, submental and cricopharyngeal (CP) muscles EMG to evaluate Dysphagia Limit (DL) (volume at which a second swallow becomes necessary to swallow a water bolus) and swallowing jitter; needle EMG of genioglossus muscle (G-EMG); fiberoptic endoscopic swallowing evaluation (FEES), clinical swallowing scales. Our results in 10 DM1 patients (6M-4F, mean age 46 ± 10), compared to 6 healthy subjects (3M-3F, mean age 30 ± 3), showed myotonic discharges (9/10 patients) in G-EMG; reduction in DL in all DM1 patients; abnormal swallowing jitter in 6/10 patients, with 5 of them showing anomalies in temporal features of the swallowing reflex; myotonia in CP muscle in 3 patients. 2 patients did not show dysphagia at FEES; penetration signs were present in 4 and 5 patients respectively with liquids and semisolids. Our data confirm that swallowing problems are common in DM1. DL and swallowing jitter are the most sensitive altered parameters in these patients. We are extending this protocol to a larger cohort of patients.

A 31-year-old woman came to Emergency Room in February 2014 for acute onset of cervical pain, vomiting and diplopia. Neurological examination showed right sixth nerve palsy, absent tendon reflexes and ataxia. General examination showed axillary skin lesions. Cerebrospinal fluid analysis showed low glucose and high total cell count; brain and spinal cord gadolinium-enhanced MRI was not conclusive. Neurophysiological evaluation (electroneurography, electromyography, blink reflex), was normal. Symptoms partially spontaneously resolved and she was discharged. Two days after she was re-admitted because of worsening of pain and vomiting, cranial multineuropathy, arm paralysis, ataxia. Neurophysiological study showed slow conduction velocities, reduced CMAP and SAP amplitudes, absent F waves, abnormal blink reflex and reduced muscle recruitment. Pain and vomiting were not referable to these findings, another MRI was not conclusive. Last MRI, performed one month after symptoms onset, documented meningeal carcinomatosis. Skin lesions biopsy disclosed gastric cancer cells, subsequent gastroscopy allowed to diagnose linitis plastica; she died shortly after the diagnosis. Peripheral or central nervous system involvement in paraneoplastic syndromes is not rare, but this case is peculiar for clinical presentation and association between paraneoplastic neuropathy and a rare primitive gastric cancer. Only cerebrospinal fluid analysis and neurophysiological tests early documented the worsening of clinical conditions.

SLSEPs are useful in evaluation of post anoxic comatose patients (PAC), and are a negative, but not positive, prognostic factor for awake. N60 is a component of MLSPEs, evoked by painful simultaneously stimulation of bilateral median nerve. Literature data suggests that MLSEPs could have a positive prognostic value for awake in post anoxic comatose patients, but latency normative data are not available. Aim of the study is to set the MLSEPs recording method in ICU, to determine normative data, and to apply it for evaluation of PAC patients with no negative prognosis factors for awake (bilateral N20 absence, no EEG activity). The better recording method was defined as follows: referential derivation, stimulation parameters: 0.2 ms, 3.3 Hz, 42 mA for healthy subjects and 50 mA for comatose patients. N60 peak latency normative data were collected from 21 healthy subjects. MLSEPs were applied to PAC patients. Nine patients have been enrolled, of these three patients underwent to MLSEPs study (Six patients did not match inclusion criteria). Latencies normative data are reported. MLSEPs were detected in 2 of the three studied patients. They awaked. In the third patient MLSEPs were absent and did never awake. Our data seems to confirm that early presence of MLSEPs in PAC patients may be a prognostic positive marker for awake.

The aim of this study is to develop the better stimulation and recording protocol of D-SEP to study pelvic floor dermatomal (L1/L2, S2, S3 and S4), and to collect normative data in healthy subjects. We paid attention to place stimulation electrode in specific dermatomal region but not to stimulate directly sensitive nerve. Stimulation sites: L1/L2 internal face of anterior side of thigh, 5–6 cm distal to pubic symphysis, S2 posterior side of thigh, 2 cm medial to the midline and 7 cm distal to gluteal fold, S4 perianal zone. Stimulation of S3 was different for male and female: male: each side of penis, female: on clitoris. We recorded from L2 and Cz′. Stimulation parameters: duration 0,2 ms, rate 0,1 Hz, intensity 4× sensory threshold. Subjects: 12. Studied parameters: peak latency of P40, N50 and P60, side-to-side difference latency, peak to peak amplitude of P40. Results (mean ± SD): P40 latency: L1/L2 (n. 22) 37,78 ± 13,56 ms, S2 (n. 19) 39,56 ± 8,85 ms, S3 (n.16) 43,81 ± 11,2 ms, S4 (n. 22) 39,72 ± 8,11 ms; mean side to side difference latency of P40: L1/L2 (n.10) 2,7 + 7,1 ms, S2 (n.9) 2,3 + 7,6 ms, S3 (n. 5) 1,6 + 1,1 msec, S4 (n.10) 2,4 + 5,2 ms. Peak to peak amplitude L1/L2 (n. 22) 2.10 + 3.67 microV, S2 (n. 19) 1,70 + 1,70 microV, S3 (n. 16) 2,91 + 4,85 microV, S4 (n. 22) 1,85 + 4,18 microV. These normative data could be useful for a careful neurophysiological evaluation of pelvic floor, in addition to standard tests.