Efficacy of transcutaneous electrical nerve stimulation in the treatment of a patient with amyotrophic lateral sclerosis due to syringomyelia

Abstract

This paper demonstrates a clinical case of the development of amyotrophic lateral sclerosis with lesions of the anterior horns of the spinal cord in the cervicothoracic region against the background of syringomyelia.

The main complaints of the patient at the initial request for medical care were associated with weakness and hypotrophy of the right hand. Electrokymography revealed signs of damage to the anterior horns of the spinal cord at the C5–Th1 level with a predominant lesion of the motor fibers of the right median and ulnar nerves. As a result, a diagnosis of amyotrophic lateral sclerosis was made. Magnetic resonance imaging revealed the presence of Chiari I malformation and severe syringomyelia of the cervical and thoracic calving of the spinal cord.

The patient underwent surgical posterior decompression of the foramen magnum. However, the treatment was not effective with the worsening of the neurological deficit in the right hand and the spread of motor deficit and hypotrophy to the left hand.

After the use of transcutaneous electrical neurostimulation of the median and ulnar nerves, there was a significant regression of motor deficit with a decrease in the severity of malnutrition without significant changes in the electromyography parameters of the median and ulnar nerves.

The absence of neurological deficit in the lower extremities, with the preservation of tendon reflexes in the norm, and the absence of pathological reflexes, indicates a high plasticity of the pyramidal tracts at the level of the spinal cord.

Regression of motor deficit after the use of transcutaneous electrical nerve stimulation is due to improvement in the state of altered motor units with hypertrophy of muscle fibers and acceleration of reinnervation processes.

Keywords

amyotrophic lateral sclerosis / syringomyelia / Arnold–Chiari I malformation / cerebrospinal fluid / needle electromyography / transcutaneous electrical nerve stimulation / TENS

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