Facio-scapulo-humeral muscular dystrophy in a patient with one paretic leg due to poliomyelitis

Neuralgic amyotrophy: variable expression in 40 patients

This study looks at disease diversity, location of lesions, and progression of neuralgic amyotrophy (NA). Forty patients (28 male and 12 female, age range 15 to 70 years) were clinically examined. Muscle atrophy, weakness, and sensory impairment were assessed. Needle EMG and conduction velocities were performed. Careful clinical, electrophysiological, laboratory, and radiological studies excluded other illness. Twenty-two patients were followed for 2 years. Antecedent fever and upper-respiratory tract infection was seen in 22 cases. Pain of sudden onset was always the initial symptom, followed by weakness, mainly in the proximal muscles of shoulder. The affectation was bilateral in 7 cases. Seven cases had a recurrent form of the disease. Clinical and electrophysiological findings suggest axonal lesions of the peripheral nerves, occurring singly (mononeuritis) or in various combinations (mononeuropathy multiplex). Unusual features, such as VII and XI cranial nerves, phrenic nerve, and lateral antebrachial cutaneous nerve affectation, were found. Follow-up showed good function recovery at variable times, even in 1 case with associated myotonic dystrophy (MD). NA is a well-defined entity, with variable clinical expression and data consistent with mononeuropathy or mononeuropathy multiplex, axonal in type. The overall prognosis is good. The progression in a patient with MD suggests that the capability of muscle fiber membrane to accept regenerating nerve sprouts remains in dystrophic muscles.

Reinnervation of dystrophic muscles

OBJECTIVE

To analyse the regenerating capability of the peripheral nerve fibers and the capability of the muscle fibers to accept the regenerating and new nerve sprouts in myotonic dystrophy (MD).

MATERIAL AND METHODS

One male, aged 58 years, diagnosed of MD at the age of 30 years, suffered neuralgic amyotrophy in the right shoulder girdle 4 weeks before admission. Needle EMG and nerve conduction studies were performed on admission and 6, 12, and 18 months later.

RESULTS

On admission there were atrophy and absence of voluntary contraction in deltoids, supra- and infraspinatus muscles. EMG showed abundant fibrillations, positive sharp waves and myotonic bursts in these muscles without voluntary activity, consistent with axonal neuropathy of both axillary and suprascapular nerves. The follow-up showed signs of reinnervation 6 months later and slight loss of long duration and high amplitude MUPs at 18 months of evolution, with good clinical recovery. This is compatible with chronic neurogenic atrophy, presumably as an expression of type grouping.

CONCLUSIONS

The reinnervation capability of the nerve fibers and the capability of muscle fibers membrane to accept regenerating and new nerve sprout remain in MD. Myotonic bursts persist after total denervation.

Reinnervation in Duchenne muscular dystrophy

Motor neuron abnormalities have been implicated in the pathogenesis of Duchenne muscular dystrophy. Evidence concerning the effect of injury on motor neurons of human Duchenne muscular dystrophy (DMD) is lacking. We report a DMD patient having, in addition, an obstetric paresis on his left arm. EMG and muscle histochemistry showed signs of reinnervation superimposed on myopathy in his left arm. This suggests that sprouting is preserved in DMD motor neurons and that muscle fibers retain the capability of accepting reinnervation.

Crossed disynaptic inhibition of sacral motoneurones

1. Intracellular recording was made from motoneurones in lower sacral (S2 and S3) segments of the spinal cord in cats, to analyse the neuronal organization of the inhibition evoked in these motoneurones from contralateral afferents. 2. It was confirmed that stimulation of the lowest threshold afferents of contralateral dorsal roots evokes i.p.s.p.s with latencies similar to those of disynaptic i.p.s.p.s. evoked from group Ia muscle spindle afferents in limb motoneurones. 3. The crossed disynaptic i.p.s.p.s in sacral motoneurones were found to be mediated by interneurones which are themselves inhibited by Renshaw cells, these interneurones and Renshaw cells being activated from the dorsal and ventral roots respectively, on the side of the body opposite to the location of the inhibited motoneurones. 4. In unanaesthetized decerebrate preparations crossed recurrent facilitation of sacral motoneurones was evoked with a time course similar to that of recurrent facilitation of lumbar motoneurones. It was taken to indicate a tonic inhibition of sacral motoneurones by interneurones responsible for their crossed disynaptic inhibition, and a disinhibition following stimulation of contralateral ventral roots. 5. In anaesthetized preparations crossed recurrent inhibition appeared, instead of the recurrent facilitation, in more than one half of the tested motoneurones. 6. A comparison of the input from ipsilateral and contralateral afferents to identified motoneurones of tail muscles with the input to pudendal motoneurones led to the conclusion that crossed disynaptic inhibition is evoked specifically in tail motoneurones. 7. Intracellular staining of sacral motoneurones with horseradish peroxidase revealed that the tail motoneurones and others with crossed disynaptic inhibition differ from the pudendal motoneurones in their location and in a number of morphological features; tail motoneurones are larger, they have differently directed dendrites and they show more extensively branched initial axon collaterals which appeared to ramify only within the ventral and lateral parts of the ipsilateral ventral horn. 8. One Renshaw cell which was stained with horseradish peroxidase was found to project contralaterally, after giving a number of axon collaterals ipsilaterally.

Dystrophia myotonica. A model of combined neural and myopathic muscle atrophy

Reports on clinical, electrophysiological and histological studies in dystrophia myotonica have shown that the peripheral nerves are usually not intact. In a few patients the neuropathy exceeds the myopathy. On the basis of these findings some authors believe that muscle changes in dystrophia myotonica are entirely due to the nerve lesions. However, despite the commonly found evidence of neuropathy, electromyographic and muscle biopsy findings are reported usually as "myopathic". Furthermore, clinical and laboratory findings indicate that the degree of muscle atrophy and peripheral nerve changes are unrelated. This report attempts to explain the discrepancies by suggesting that the "myopathic" and "neuropathic" changes in the muscle fibres in dystrophia myotonica are independent processes.

Duchenne muscular dystrophy and poliomyelitis. A study of dystrophic-denervated muscle

A systematic study of dystrophy-denervation in human muscle showed minimal morphometabolic differences between dystrophic and dystrophic-denervated muscle. The only certain conclusion is that denervation influences the rhythm of evolution of the dystrophy without impressing any of the few characteristics considered at present as peculiar to denervation.