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Updated: Aug 29, 2025
Assessment of Neuromuscular Function Using Percutaneous Electrical Nerve Stimulation
Published on: September 13, 2015
Temporary reversal of nerve and muscle dysfunction by serial electrical stimulation in critical illness neuromyopathy
Madona Sekhniashvili1, Ulf Bodechtel2, Klaus V Toyka3
1Department of Neurology, University of Leipzig, Germany, Liebigstr. 20, 04103 Leipzig, Germany; Department of Neurology of S. Khechinashvili University Clinic, Tbilisi State Medical University, Chavchavadze Ave. #33, 0179 Tbilisi, Georgia.
Objective:
Critical Illness Neuromyopathy (CIPNM) is a complication in sepsis patients with still enigmatic disease mechanisms. We investigated a novel electrical stimulation method to better define neuromuscular dysfunction in patients with CIPNM.
Methods:
We studied 18 sepsis CIPNM patients on intensive care units, 13 at an early and 5 at a later disease stage, 7 sepsis control, and 8 neuropathy control patients. We applied slow conditioning electrical pulses at motor nerves and directly at the muscle to investigate a facilitation phenomenon (FP) of small or absent compound motor action potentials (CMAPs).
Results:
Serial pulses induced a 2 to 490-fold increase in CMAP amplitudes in 17/18 Intensive Care Unit (ICU)-CIPNM patients (p < 0.001). These effects were short lived and reproducible. Direct muscle stimulation in the tibialis anterior muscle resulted in up to 130-fold FP in 7/9 patients tested (p < 0.01). In 4/5 post-ICU CIPNM patients FP was up to 10-fold. None of the 7 ICU sepsis control patients without CIPNM with similar disease severity and none of 8 neuropathy patients showed FP (p < 0.001). On needle EMG only 5/16 ICU patients tested revealed spontaneous activity.
Conclusions:
Conditioning electrical stimulation detected a functional component of the disease process showing temporary improvement in sepsis-associated CIPNM.
Significance:
New test differentiates functional from degenerative pathology.
