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KMID : 0860920040060020170
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Journal of the Korean Association EMG-Electrodiagnostic Medicine
2004 Volume.6 No. 2 p.170 ~ p.176
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Electrophysilolgic Characteristics of Chronic Complex RegionalPain Syndrome in Post-stroke Patients
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Seo Kyoung-Ho
Lim Jae-Young
Shin Hyung-Ik
Paik Nam-Jong
Han Tai-Ryoon
Lee In-Sik
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Abstract
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Objective: A criticism about the cause related to the central and peripheral nervous system are persisting
in the complex regional pain syndrome (CRPS) which occurred after stroke. The purpose of this study is
to find out the possible factors leading to serious complications such as profound atrophy and persistent
pain in post-stroke patient with chronic CRPS through electrophysiologic evaluation.
Method: Ten patients who reached the chronic state after development of CRPS and 12 patient who did
not experience CRPS (non-CRPS) were included in this study. All subjects underwent nerve conduction
and electromyographic examination in both upper limbs. None of them had peripheral nerve disorders
including carpal tunnel syndrome and brachial plexus damage and they had no definite difference in duration
of illness, muscle power, Brunnstrom stage, and the degree of spasticity between both groups. The
ratio of difference in amplitude and area of compound muscle action potentials (CMAP) of median and
ulnar nerve in both hands and amplitude of median sensory nerve action potentials (SNAP) were examined
on nerve conduction study. Abnormal spontaneous activity (ASA) in abductor pollicis brevis, abductor
digiti quinti, extensor carpi radialis, biceps brachii, and paraspinal muscles were also examined.
Results: Amplitude of CMAP in hemiplegic hand in CRPS was markedly decreased (47.3±17.8% of
unaffected hand) compared to decrease of non-CRPS group (72.8±14.2% of unaffected hand). The similar
findings were detected in area of CMAP. ASAs obtained at hand muscles of CRPS groups were significantly
more than those of non-CRPS group. However, there was no definite difference in SNAP amplitude
of CRPS group at both sides.
Conclusion: Remarkable decrease of the CMAP in chronic, atrophic CRPS is considered as a result
from neurogenic change besides a non-neurogenic muscle atrophy like disuse. Our results support that the
main change depends on motoneuron cell level considering the electrophysiologic characteristics.
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KEYWORD
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Stroke, Complex regional pain syndrome, Electromyography
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