Association between clinical condition and F-waves changes in the acute phase of stroke

ABSTRACT

Objective To relate F-waves with clinical and laboratory exams in the acute phase of stroke.

Methods Inclusion criteria for this cross-sectional study were: hemiplegia, absence of previous cranial trauma, myopathy, diabetes, alcoholism or other known causes of peripheral neuropathy, and normal sensory and motor conduction. The National Institutes of Health Stroke Scale (NIHSS) score, glycemia, glucosilate hemoglobin, and CPK were obtained at admission by routine blood exams. After hospital admission, the F-wave latencies and persistence were obtained from the deep peroneal nerve using symmetrical techniques.

Results Evaluation of 20 individuals – mean age 66 years, 50% male and 85% Caucasian – showed association of F-wave persistence with glycemia (r = 0.71; p < 0.001) and NIHSS categorized (NIHSS 1-7 = 65.0 x NIHSS 9-23 = 100; p = 0.004). Multivariate analysis found only association of F-wave persistence with glycemia β = 0.59 (0.44–0.74); p < 0.001.

Conclusion The increase in the persistence of F-waves are associated with hyperglycemia in the acute phase of stroke.

RESUMO

Objetivo Relacionar as ondas-F com exames clínicos e laboratoriais na fase aguda do acidente vascular cerebral (AVC). Os critérios de inclusão para este estudo transversal foram: hemiplegia, ausência de trauma craniano, miopatia, diabetes, alcoolismo ou outra causa conhecida de neuropatia periférica, além de condução sensorial e motora normal. O National Institutes of Health Stroke Scale (NIHSS), glicemia, hemoglobina glicada e CPK foram obtidos na admissão por meio de exames de rotina. Após a admissão hospitalar, a latência e persistência das ondas-F foram obtidas por meio da estimulação do nervo fibular profundo utilizando técnicas simétricas. Foram avaliados 20 indivíduos – média de idade 66 anos, 50% homem e 85% caucasianos – apresentaram associação univariada da persistência das ondas-F com glicemia (r = 0.71; p < 0.001) e NIHSS categorizado (NIHSS 1–7 = 65.0 x NIHSS 9-23 = 100; p = 0.004). Na regressão multivariada foi encontrado associação somente entre persistência de ondas-F com glicemia β = 0.59(0.44–0.74); p < 0.001.

Conclusão O aumento da persistência de ondas-F está associado com maior nível de glicemia na fase aguda do AVC.

stroke - brain waves - electrophysiology

acidente vascular cerebral - ondas encefálicas - eletrofisiologia

Publication History

Received: 14 December 2015

Accepted: 13 June 2016

Article published online:
06 September 2023

• References

• 1 Feigin VL, Forouzanfar MH, Krishnamurthi R et al. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet. 18;383(9913):245-54. doi:10.1016/S0140-6736(13)61953-4
• 2 Raffin CN, Fernandes JG, Evaristo EF, Siqueira Neto JI, Friedrich M, Puglia P et al. Revascularização clínica e intervencionista no acidente vascular cerebral isquêmico agudo: opinião nacional. Arq Neuropsiquiatr. 2006;64(2A):342-8. doi:10.1590/S0004-282X2006000200034
• 3 McComas AJ, Sica RE, Upton AR, Aguilera N. Functional changes in motoneurones of hemiparetic patients. J Neurol Neurosurg Psychiatry. 1973;36(2):183-93. doi:10.1136/jnnp.36.2.183
• 4 Lukács M, Vécsei L, Beniczky S. Changes in muscle fiber density following a stroke. Clin Neurophysiol. 2009;120(8):1539-42. doi:10.1016/j.clinph.2009.06.001
• 5 Lukács M. Electrophysiological signs of changes in motor units after ischaemic stroke. Clin Neurophysiol. 2005;116(7):1566-70. doi:10.1016/j.clinph.2005.04.005
• 6 Brown WF, Snow R. Denervation in hemiplegic muscles. Stroke. 1990;21(12):1700-4. doi:10.1161/01.STR.21.12.1700
• 7 Benecke R, Berthold A, Conrad B. Denervation activity in the EMG of patients with upper motor neuron lesions: time course, local distribution and pathogenetic aspects. J Neurol. 1983;230(3):143-51. doi:10.1007/BF00313625
• 8 Chroni E, Katsoulas G, Argyriou AA, Sakellaropoulos GC, Polychronopoulos P, Nikiforidis G. Level of consciousness as a conditioning factor of F wave generation in stroke patients. Clin Neurophysiol. 2006;117(2):315-9. doi:10.1016/j.clinph.2005.10.018
• 9 Kimura J. Electrodiagnosis in diseases of nerve and muscle: principles and practice. 3rd ed. New York: Oxford University Press; 2001. p. 439-49.
• 10 Mesrati F, Vecchierini MF. F-waves: neurophysiology and clinical value. Neurophysiol Clin. 2004;34(5):217-43. doi:10.1016/j.neucli.2004.09.005
• 11 Rickham PP. Human experimentation: code of ethics of the World Medical Association: declaration of Helsinki, BMJ. 1964;2(5402):177. doi:10.1136/bmj.2.5402.177
• 12 Genuth S, Alberti KG, Bennett P, Buse J, Defronzo R, Kahn R et al. Follow-up report on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003;26(11):3160-7. doi:10.2337/diacare.26.11.3160
• 13 Milanov IG. A comparison of methods to assess the excitability of lower motoneurones. Can J Neurol Sci. 1992;19(1):64-8. doi:10.1017/S0317167100042554
• 14 Fisher MA, Shahani BT, Young RR. Assessing segmental excitability after acute rostral lesions. I. The F response. Neurology. 1978;28(12):1265-71. doi:10.1212/WNL.28.12.1265
• 15 Drory VE, Neufeld MY, Korczyn AD. F-wave characteristics following acute and chronic upper motor neuron lesions. Electromyogr Clin Neurophysiol. 1993;33(7):441-6.
• 16 The National Institute of Neurological Disorders; Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333(24):1581-7. doi:10.1056/NEJM199512143332401
• 17 Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359(13):1317-29. doi:10.1056/NEJMoa0804656
• 18 Fisher MA. F response latencies and durationS in upper motor neuron syndromes. Electromyogr Clin Neurophysiol. 1986;26(5-6):327-32.
• 19 Liberson WT, Chen LCY, Fok SK, Patel KK, Yu GH, Fried P. “H” reflexes and “F” waves in hemiplegics. Electromyogr Clin Neurophysiol 1977;17(3-4):247-64. doi:
• 20 Bischoff C, Stålberg E, Falxk B, Puksa L. Significance of A-waves recorded in routine motor nerve conduction studies. Electroencephalogr Clin Neurophysiol. 1996;101(6):528-33. doi:10.1016/S0013-4694(96)96553-4
• 21 Chroni E, Argyriou AA, Katsoulas G, Polychronopoulos P. Ulnar F wave generation assessed within 3 days after the onset of stroke in patients with relatively preserved level of consciousness. Clin Neurol Neurosurg. 2007;109(1):27-31. doi:10.1016/j.clineuro.2006.04.008
• 22 Helgason CM. Blood glucose and stroke. Curr Treat Options Cardiovasc Med 2012;14(3):284-7. doi:10.1007/s11936-012-0178-5
• 23 Luitse MJ, Biessels GJ, Rutten GE, Kappelle LJ. Diabetes, hyperglycaemia, and acute ischaemic stroke. Lancet Neurol. 2012;11(3):261-71. doi:10.1016/S1474-4422(12)70005-4
• 24 Yamazaki Y, Harada S, Tokuyama S. Post-ischemic hyperglycemia exacerbates the development of cerebral ischemic neuronal damage through the cerebral sodium-glucose transporter. Brain Res. 2012;1489:113-20. doi: 10.1016/j.brainres.2012.10.020
• 25 Muir KW, McCormick M, Baird T, Ali M. prevalence, predictors and prognosis of post-stroke hyperglycaemia in acute stroke trials: individual patient data pooled analysis from the Virtual International Stroke Trials Archive (VISTA). Cerebrovasc Dis Extra. 2011;1(1):17-27. doi:10.1159/000324319
• 26 Rosso C, Pires C, Corvol JC, Baronnet F, Crozier S, Leger A et al. Hyperglycaemia, insulin therapy and critical penumbral regions for prognosis in acute stroke: further insights from the INSULINFARCT trial. PLoS One. 2015;10:e0120230. doi:10.1371/journal.pone.0120230
• 27 Yoo DS, Chang J, Kim JT, Choi MJ, Choi J, Choi KH et al. Various blood glucose parameters that indicate hyperglycemia after intravenous thrombolysis in acute ischemic stroke could predict worse outcome. PLoS One. 2014;9(4):e94364. doi:10.1371/journal.pone.0094364
• 28 Shirabe S, Kinoshita I, Matsuo H, Takashima H, Nakamura T, Tsujihata M et al. Resistance to ischemic conduction block of the peripheral nerve in hyperglycemic rats: an electrophysiological study. Muscle Nerve. 1988;11(6):582-7. doi: 10.1002/mus.880110610
• 29 Erdoğan C, Cenikli U, Değirmenci E, Oğuzhanoğlu A. Effect of hyperglycemia on conduction parameters of tibial nerve’s fibers to different muscles: a rat model. J Neurosci Rural Pract. 2013;4(1):9-12. doi:10.4103/0976-3147.105602
• 30 Halonen JP, Rönnemaa T. Peripheral nerve conduction in healthy subjects during short-term hyperglycemia. Electromyogr Clin Neurophysiol. 1998;38(6):355-8. doi:
• 31 Allen C, Shen G, Palta M, Lotz B, Jacobson R, D’Alessio D. Long-term hyperglycemia is related to peripheral nerve changes at a diabetes duration of 4 years. The Wisconsin Diabetes Registry. Diabetes Care. 1997;20(7):1154-8. doi:10.2337/diacare.20.7.1154