뇌졸중 환자의 민성 복합 부위 동통 증후군의 전기생리학적 특성
Electrophysilolgic Characteristics of Chronic Complex RegionalPain Syndrome in Post-stroke Patients
서경호, 임재영, 신형익, 백남종, 한태륜, 이인식,
소속 상세정보
서경호 ( Seo Kyoung-Ho )
한일병원 재활의학과
임재영 ( Lim Jae-Young )
서울대학교 의과대학 재활의학교실
신형익 ( Shin Hyung-Ik )
서울대학교 의과대학 재활의학교실
백남종 ( Paik Nam-Jong )
서울대학교 의과대학 재활의학교실
한태륜 ( Han Tai-Ryoon )
서울대학교 의과대학 재활의학교실
이인식 ( Lee In-Sik )
건국대학교 의학전문대학원 재활의학교실
KMID : 0860920040060020170
Abstract
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.
키워드
Stroke;Complex regional pain syndrome;Electromyography
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