Sphincter EMG as a diagnostic tool in autonomic disorders

Abstract

Multiple system atrophy (MSA) is a neurodegenerative disease presenting with a combination of parkinsonian, cerebellar, and autonomic (including cardiovascular, urinary, and anorectal) dysfunction. It is pathologically defined, but at present lacks a definitive clinical diagnostic test. The majority of patients with probable MSA have an abnormal sphincter EMG. Patients with idiopathic Parkinson's disease do not show marked sphincter EMG abnormalities. Therefore, these abnormalities can be used to distinguish MSA from idiopathic Parkinson's disease in the first 5 years after disease onset. In contrast, similar sphincter EMG abnormalities are found in some, though not many, patients with dementia with Lewy bodies, pure autonomic failure, progressive supranuclear palsy, and spinocerebellar ataxia type 3. Thus, the limitations of the sphincter EMG test should also be kept in mind. Sphincter EMG and relevant sacral autonomic tests are diagnostic tools for autonomic disorders, reflecting the common and significant involvement of the sacral cord in MSA.

Neurologic diseases that cause female urinary retention

“…), while the latter (underactivity) presumably reflects lesions in the bladder facilitatory area (Barrington's nucleus, sacral intermediolateral nucleus, etc.) [14,15]. In our study, underactive detrusor was the most common contributor to MSA while bladder capacity was the least common.…”

“…More recently, age-related LS [9,10] and lifestyle-related DPN [11,12] have been added to this list [14,15,16]. However, it remains unclear to what extent these neurologic diseases contribute to female urinary retention.…”

“…Low maximum Watts Factor (< 10 watts/m 2 ) or weak/very weak on the Schäfer nomogram is defined as underactive (weak) detrusor (although originally developed for men, we tentatively applied this figure in women). We also analyzed the motor unit potential of the sphincter muscles [14].…”

“…symptoms appear as postural hypotension and pelvic organ dysfunction, and bladder dysfunction is the most common (90-100%) [14]. Bladder dysfunction in typical cases is a combination of urinary urgency/ frequency caused by detrusor overactivity, and large PVR, caused by detrusor underactivity, with or without detrusor-sphincter dyssynergia.…”

A young man with herpes simplex encephalitis: Andrew and Nathan type urodynamic abnormality

“…The methods and definitions used for the urodynamic study and sphincter EMG conformed to the standards proposed by the International Continence Society [6,7].…”