Role of the peripheral neuromuscular disturbances in the development of severe movement disorders in patients with cerebral palsy

Abstract

The motor stereotype in patients with cerebral palsy (CP) is determined by the magnitude of spasticity and central paresis of muscles, the impaired mechanisms of intermuscular interaction, and the presence of consensual reactions and pathologic synkineses. There are cases of a concomitance of the suprasegmental and segmental structures damages in CP. An attempt has been made to identify and estimate the contribution of the peripheral neuromuscular system lesion in CP patients in its late residual stage. Central nervous system lesion at the central and segmental levels were detected in 12.3% of cases in CP with spastic diplegia with progressive deformities of the lower extremities joints. Needle EMG is the most sensitive technique to detect a lesion at the segmental level: increased duration and higher amplitude motor unit potentials (MUPs) and fewer recruited MUPs were registrated. A turn-amplitude analysis has indicated the shift of cloudy diagram to the left and upwards and the decreased ratio of the number of turns to their mean amplitude. The residual pattern of revealed changes is confirmed by the absence of signs of a current denervation process. The contribution of possible myelodysplasia and transneuronal degeneration of spinal motor neurons at the lumbosacral level to the clinical picture of the CP and orthopedic surgery and rehabilitation tactics are discussed.

Keywords

• детский церебральный паралич
• спастичность
• игольчатая электромиография
• стимуляционная электромиография
• турн-амплитудный анализ
• α-мотонейроны
• денервация
• деформации стоп
• нервно-мышечные расстройства
• клиническая нейрофизиология