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Critical-illness-Myopathie und -Neuropathie (CRIMYN)

Elektroneurographische Klassifikation

Critical illness myopathy and neuropathy (CRIMYN)

Electroneurographic classification

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Zusammenfassung

Hintergrund

In der vorliegenden Studie wurden verschiedene Schweregrade und Schädigungsmuster elektroneurographischer Veränderungen anhand einer Clusteranalyse bei Patienten mit Critical-illness-Myopathie und -Neuropathie (CRIMYN) erfasst.

Methode

Es wurden 30 Patienten mit Sepsis/SIRS prospektiv elektroneurographisch untersucht. Als Referenz dienten 63 gesunde Probanden. Bei den Patienten wurden ab der 1. Woche wöchentlich und nach einem halben Jahr die Neurographie an 6 motorischen und an 4 sensiblen Nerven durchgeführt. Aus den Differenzen der erfassten 20 Parameter (jeweils Amplituden und Nervenleitgeschwindigkeiten) zu altersentsprechenden Normwerten wurden mittels einer Clusteranalyse verschiedene Schädigungsmuster klassifiziert.

Ergebnisse

Insgesamt ergaben sich bei der parallelen Betrachtung der neurographischen Parameter 4 verschiedene Schweregrade (Cluster). Cluster I: normale sensible und motorische Parameter, enthält alle Probanden und 3 Patienten. Cluster II: leichte beinbetonte motorische Schädigung, 5 Patienten. Cluster III: mäßige sensomotorische Schädigung an oberen und unteren Extremitäten, 12 Patienten. Cluster IV: schwere sensomotorische Schädigung an allen Extremitäten, 10 Patienten.

Schlussfolgerung

Im Rahmen elektroneurographischer Verlaufsuntersuchungen bei Sepsispatienten zeigten sich 4 verschiedene Schädigungsprofile mit unterschiedlichem Schweregrad. Damit ist eine Differenzierung der Schwere neuromuskulärer Störungen als weiteres Organversagen bei der Sepsis möglich. Diese lässt prognostische Aussagen zu und dient als Grundlage für eine Korrelation mit weiteren klinischen und paraklinischen Sepsisparametern.

Summary

Background

Critical Illness Myopathy and Neuropathy (CRIMYN) frequently coexist with severe sepsis and is associated with prolonged weaning from mechanical ventilation and prolonged ICU length of stay. We aimed to classify different levels as well as patterns of impairment with regard to electrophysiological disturbances in CRIMYN patients by cluster analysis.

Methods

A total of 30 patients with sepsis/SIRS were studied prospectively. Motor and sensory conduction studies were performed from six motor and four sensory nerves on a weekly basis from admission until discharge and finally after 6 months. A control group of 63 healthy persons was examined simultaneously using the same criteria.

Different patterns of electrophysiological disturbances were classified by cluster analysis based on differences to reference values of 20 parameters, compound muscle action potential (CMAP), sensory nerve action potential (SNAP) and motor and sensor conduction velocity (NCV).

Results

Four different clusters were identified: cluster 1 showing normal values for CMAP, SNAP and NCV in all nerves (3 patients and all test persons), cluster 2 showing pathological values for CMAP in the lower extremities and the other parameters were normal (5 patients), cluster 3 showing moderately pathological values for CMAP, SNAP and sensory NCV in upper and lower extremities and motor NCV in lower extremities (12 patients) and cluster 4 showing severe disturbances of CMAP, SNAP and NCV in upper and lower extremities (10 patients).

Conclusion

A total of four different clusters of electrophysiological impairment can be identified in patients with sepsis/SIRS, which enables further differentiation of the severity of neuromuscular disturbances in sepsis-associated organ failure. This might be useful as a prognostic parameter and can be correlated with additional clinical and paraclinical parameters related to sepsis.

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Authors and Affiliations

  1. Klinik und Poliklinik für Neurologie, Universität Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland

    P. Baum & J. Claßen

  2. Klinik und Poliklinik für Anästhesie und Intensivmedizin, Universität Leipzig, Leipzig, Deutschland

    S. Bercker

  3. Neurologische Abteilung, Paracelsus-Klinik, Zwickau, Deutschland

    W. Hermann

  4. Abteilung Mathematik, Universität für angewandte Wissenschaften, Mittweida, Deutschland

    T. Villmann

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  1. P. Baum
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  2. S. Bercker
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  4. J. Claßen
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  5. W. Hermann
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Correspondence to P. Baum.

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Baum, P., Bercker, S., Villmann, T. et al. Critical-illness-Myopathie und -Neuropathie (CRIMYN). Nervenarzt 82, 468–474 (2011). https://doi.org/10.1007/s00115-010-3094-5

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