NEL DOLORE NEUROPATICO Michelangelo Buonocore · NEL DOLORE NEUROPATICO Michelangelo Buonocore ......
Transcript of NEL DOLORE NEUROPATICO Michelangelo Buonocore · NEL DOLORE NEUROPATICO Michelangelo Buonocore ......
L’ELETTROMIOGRAFIA NEL DOLORE NEUROPATICO
Michelangelo Buonocore
Fondazione Maugeri – Istituto Scientifico di Pavia Servizio di Neurofisiopatologia
Laboratorio di Biopsia Cutanea Neurodiagnostica
Electromyography (EMG) is a diagnostic procedure to assess the health of muscles and the nerve cells that control them (motor neurons). A nerve conduction study, another part of an EMG, uses electrodes taped to the skin (surface electrodes) to measure the speed and strength of signals traveling between two or more points.
http://www.mayoclinic.org
DEFINIZIONE DI ELETTROMIOGRAFIA
Electromyography (EMG) Strictly defined, the recording and study of insertion, spontaneous, and voluntary activity of muscle with a recording electrode (either a needle electrode for invasive EMG or a surface electrode for kinesiologic studies). The term is also commonly used to refer to an electrodiagnostic medicine consultation, but its use in this context is discouraged.
https://www.aanem.org
DEFINIZIONE DI ELETTROMIOGRAFIA
Electroneurography (ENG) The recording and study of the action potentials of peripheral nerve. Synonymous with nerve conduction studies.
https://www.aanem.org
DEFINIZIONE DI ELETTRONEUROGRAFIA
Electroneuromyography (ENMG) The combined studies of electromyography and electroneurography. Synonymous with clinical electromyography. See preferred term electrodiagnostic medicine consultation.
https://www.aanem.org
DEFINIZIONE DI ELETTRONEUROMIOGRAFIA
NEUROPATHIC PAIN
Pain arising as a direct consequence of a lesion or disease affecting the somatosensory system
DEFINIZIONE DI DOLORE NEUROPATICO
Treede et al. 2008
Pain usually arises as a consequence of activation of primary nociceptive afferents by actually or potentially tissue-damaging stimuli and processing of this activity within the nociceptive system. This type of pain is physiologic. Pain, however, may also arise by activity generated within the nociceptive system (?) without adequate stimulation of its peripheral sensory endings. For these clinical conditions, the term neuropathic pain has been introduced.
Treede et al 2008
DOLORE NEUROPATICO – NO RECETTORI ATTIVATI
Because of the lack of a specific diagnostic tool
for neuropathic pain,
a grading system of definite, probable, and possible
neuropathic pain is proposed
Treede et al. Neurology 2008
NO STRUMENTI DIAGNOSTICI SPECIFICI PER NP
… it is essential to demonstrate
in the individual patient that this disorder
does affect the somatosensory system (evidence for neural damage).
Treede et al. Neurology 2008
The neurologic diagnosis depends on the answers to two questions:
“Where is the lesion?”
(anatomy)
“What type of lesion?” (pathology, including pathophysiology)
These principles also apply to neuropathic pain
…
Treede et al. Neurology 2008
L’Elettromiografia (EMG + ENG)
studia solo fibre di grande calibro, siano esse motorie o sensitive (sistema lemniscale). non studia le piccole fibre del sistema nocicettivo/spino-talamico
EMG E DOLORE NEUROPATICO
L’EMG propriamente detto può essere utile per la diagnosi di dolore
neuropatico dimostrando la presenza di:
Lesioni radicolari
Lesioni di nervi misti
Lesioni di nervi motori
It needs to be stressed that patients with somatosensory deficits
do not necessarily have pain
Treede et al. Neurology 2008
DIAGNOSI STRUMENTALE
Dick et al. 1998
Nessuna diagnosi algologica andrebbe mai fatta sulla base di un
risultato anormale ottenuto nel corso di una valutazione strumentale
DIAGNOSI ALGOLOGICA
NEUROFISIOLOGIA NEUROIMMAGINI
CLINICA
NEUROPATOLOGIA (ES. BIOPSIA CUTANEA)
PSICOFISIOLOGIA (ES. QST)
Percorso diagnostico
Buonocore e Bonezzi
INTERVISTA DEL PAZIENTE
ESAME OBIETTIVO
IPOTESI DI MECCANISMO FISIOPATOLOGICO
IMPOSTAZIONE DELLA TERAPIA CONFERMA STRUMENTALE