The Investigation of Electrodiagnostic Findings in Patients with Nerve Injury Due to Earthquake: Single Centre Experience

Year 2025, Issue: Early Access

Dilara Mermi , Şule Deveci , Azize Esra Gürsoy

https://doi.org/10.18678/dtfd.1563978

Abstract

Aim: This study aimed to evaluate neuromuscular damage in the patients affected by the earthquakes that struck Kahramanmaraş, Türkiye.
Material and Methods: Patients referred to the electrodiagnostic (EDx) laboratory between February and August 2023, who were trapped under rubble, were included in this study. Demographic data, clinical information (renal failure, serum creatine kinase level, and time spent under the rubble), and EDx results were analyzed.
Results: Thirty-seven patients were included, while three patients with normal nerve conduction studies were excluded. Two (5.9%) of the 34 patients exhibited neurogenic and myogenic changes on EDx performed on days 24 and 25 post-trauma. In the remaining patients, neurogenic changes were observed, with 18 (52.9%) having peripheral nerve injury, 10 (29.4%) having plexopathy, 1 (2.9%) showing root involvement, and 5 (14.7%) of those with peripheral nerve injury presenting with complex involvement. Complete axonal damage was unrelated to the duration spent under the rubble (p=0.294). The presence of regeneration motor unit action potentials (MUAPs) was found statistically significantly related to the timing of the electromyography (EMG) performed (p=0.003), with the earliest regeneration findings observed on day 35. No statistically significant difference was found in the time spent under the rubble according to the regeneration presence (p=0.129).
Conclusion: This study shows that earthquake injuries primarily result in multiple peripheral nerve injuries. The regeneration MUAP occurrence was not related to the duration spent under the rubble. In addition, myogenic and neurogenic MUAPs may appear on EMG in neurogenic injuries caused by compartment syndrome.

Keywords

Earthquake, electromyography, myogenic, neurogenic, peripheral nerve injury

Deprem Nedeni ile Sinir Hasarı Olan Hastaların Elektrodiagnostik Bulgularının İncelenmesi: Tek Merkez Deneyimi

Abstract

Amaç: Bu çalışmanın amacı, Kahramanmaraş, Türkiye’de meydana gelen depremlerden etkilenen hastalarda nöromüsküler hasarın değerlendirmektir.
Gereç ve Yöntemler: Bu çalışmaya, Şubat ve Ağustos 2023 tarihleri arasında elektronöromiyografi (ENMG) laboratuvarına yönlendirilen ve enkaz altında kalmış olan hastalar dahil edilmiştir. Demografik veriler, klinik bilgiler (böbrek yetmezliği, serum kreatin kinaz düzeyi ve enkaz altında geçirilen süre) ve ENMG sonuçları analiz edilmiştir.
Bulgular: Otuz yedi hasta çalışmaya dahil edilirken, sinir iletim çalışmaları normal olan üç hasta çalışma dışı bırakıldı. Travma sonrası 24. ve 25. günlerde yapılan ENMG’de 34 hastanın ikisinde (%5,9) nörojenik ve miyojenik değişiklikler görüldü. Geri kalan hastalarda ise nörojenik değişiklikler gözlenmiş olup, 18 (%52,9)’inde periferik sinir hasarı, 10 (%29,4)’unda pleksopati, 1 (%2,9)’inde kök tutulumu ve periferik sinir hasarı olanların 5 (%14,7)’inde kompleks tutulum izlendi. Tam aksonal hasarın enkaz altında geçirilen süre ile ilişkisi bulunmadı (p=0,294). Rejenerasyon motor ünitesi aksiyon potansiyellerinin (MUAPs) varlığının yapılan elektromiyografi (EMG) zamanlaması ile istatistiksel olarak anlamlı ilişkili olduğu (p=0,003) ve en erken rejenerasyon bulgularının 35. günde gözlendiği bulundu. Rejenerasyon varlığına göre enkaz altında geçen sürede istatistiksel olarak anlamlı bir fark bulunmadı (p=0,129).
Sonuç: Bu çalışma, deprem yaralanmalarının öncelikle çoklu periferik sinir yaralanmalarına neden olduğunu göstermektedir. Rejenerasyon MUAP oluşumu enkaz altında geçirilen süre ile ilişkili değildir. Ek olarak, kompartıman sendromunun neden olduğu nörojenik yaralanmalarda EMG'de miyojenik ve nörojenik MUAP'lar görülebilir.

Keywords

Deprem, elektromiyografi, miyojenik, nörojenik, periferik sinir hasarı

References

• Hussain E, Kalaycıoğlu S, Milliner CWD, Çakır Z. Preconditioning the 2023 Kahramanmaraş (Türkiye) earthquake disaster. Nat Rev Earth Environ. 2023;4(5):287-9.
• Robinson LR. Traumatic injury to peripheral nerves. Muscle Nerve. 2022;66(6):661-70.
• Chaudhry V, Cornblath DR. Wallerian degeneration in human nerves: serial electrophysiological studies. Muscle Nerve. 1992;15(6): 687-93.
• Ferrante MA. The assessment and management of peripheral nerve trauma. Curr Treat Options Neurol. 2018;20(7):25.
• Thesleff S. Trophic functions of the neuron. II. Denervation and regulation of muscle. Physiological effects of denervation of muscle. Ann N Y Acad Sci. 1974;228(0):89-104.
• Dorfman LJ. Quantitative clinical electrophysiology in the evaluation of nerve injury and regeneration. Muscle Nerve. 1990;13(9):822-8.
• Sunderland S. The anatomy and physiology of nerve injury. Muscle Nerve. 1990;13(9):771-84.
• Uzun N, Savrun FK, Kiziltan ME. Electrophysiologic evaluation of peripheral nerve injuries in children following the Marmara earthquake. J Child Neurol. 2005;20(3):207-12.
• Uzun N, Tanriverdi T, Savrun FK, Kiziltan ME, Sahin R, Hanimoglu H, et al. Traumatic peripheral nerve injuries: demographic and electrophysiologic findings of 802 patients from a developing country. J Clin Neuromuscul Dis. 2006;7(3):97-103.
• Gesoglu Demir T, Ethemoplu KB. Clinical, etiological, and electrophysiological characteristics of patients with peripheral nerve damage caused by the February 6 earthquake in Türkiye. Turk J Neurol. 2024;30(3):141-8.
• Preston DC, Shapiro BE. Electromyography and neuromuscular disorders. 4th ed. Appendix: nerve conduction studies: normal adult values, pediatric values. Amsterdam: Elsevier; 2020. p.763.
• Oh SJ. Electromyographic studies in peripheral nerve injuries. South Med J. 1976;69(2):177-82.
• Myers RR, Mizisin AP, Powell HC, Lampert PW. Reduced nerve blood flow in hexachlorophene neuropathy: relationship to elevated endoneurial fluid pressure. J Neuropathol Exp Neurol. 1982;41(4):391-9.
• Broadhurst PK, Robinson LR. Compartment syndrome: Neuromuscular complications and electrodiagnosis. Muscle Nerve. 2020;62(3):300-8.