Motor nerve conduction parameters in the cat

Traumatic and iatrogenic sciatic nerve injury in 38 dogs and 10 cats: Clinical and electrodiagnostic findings

BACKGROUND

Reports describing sciatic nerve injuries (SNI) and their outcome are scarce in veterinary medicine.

HYPOTHESIS

Describe the causes of traumatic and iatrogenic SNI and evaluate which clinical and electrodiagnostic findings predict outcome.

ANIMALS

Thirty-eight dogs and 10 cats with confirmed SNI referred for neurologic and electrodiagnostic evaluation.

METHODS

Clinical and electrodiagnostic examination results, including electromyography (EMG), motor nerve conduction studies, muscle-evoked potential (MEP), F-waves, sensory nerve conduction studies, and cord dorsum potential (CDP), were retrospectively evaluated. Quality of life (QoL) was assessed based on owner interviews.

RESULTS

Surgery (42%) and trauma (33%) were the most common causes of SNI; in dogs, 24% were caused by bites from wild boars. Ability to flex and extend the tarsus was significantly associated with positive outcome in dogs. Mean time from onset of clinical signs until electrodiagnostic evaluation was 67 ± 65 (range, 7-300) days and 65 ± 108 (range, 7-365) days for dogs and cats, respectively. A cut-off amplitude of 1.45 mV for compound motor action potentials (CMAP) was predictive of positive outcome in dogs (P = .01), with sensitivity of 58% and specificity of 100%.

CONCLUSIONS AND CLINICAL IMPORTANCE

Clinical motor function predicts recovery better than sensory function. Electrodiagnostic findings also may play a role in predicting the outcome of SNI. Application of the proposed CMAP cut-off amplitude may assist clinicians in shortening the time to reassessment or for earlier suggestion of salvage procedures. Owners perceived a good quality of life (QoL), even in cases of hindlimb amputation.

Juvenile-onset motor polyneuropathy in Siberian cats

BACKGROUND

Polyneuropathies are infrequently described in cats. There is a genetic predisposition in several breeds.

OBJECTIVE

To clinically characterize a novel motor polyneuropathy in a family of Siberian cats.

ANIMALS

Thirteen closely related Siberian cats, 4 clinically affected and 9 clinically unaffected individuals.

METHODS

Retrospective study. Clinical data and pedigree information were obtained from the medical records and breeder. Electrodiagnostic testing and muscle and peripheral nerve biopsy samples were obtained from 1 affected cat. Follow-up information was obtained for all affected cats.

RESULTS

Onset of signs was 4 to 10 months in affected cats. Clinical signs were progressive or waxing/waning neuromuscular weakness (4/4), normal sensory function (4/4), and variably decreased withdrawal reflexes (3/4). All cats returned to normal neurologic function within 1 to 4 weeks. All cats had a recurrence of weakness (3/4 had 1 recurrent episode, 1/4 had 3 relapses) from which they recovered fully. In 1 cat, electromyography and motor nerve conduction studies showed multicentric spontaneous activity, normal motor nerve conduction velocity, reduced compound muscle action potential amplitude, and polyphasia. Histologic evaluation of muscle and nerve in that cat showed mild muscle atrophy consistent with recent denervation, endoneurial and perineurial edema, and mild mononuclear cell infiltration within intramuscular nerve branches and a peripheral nerve. Pedigree analysis suggests an autosomal recessive mode of inheritance, although neither a genetically complex/polygenic condition nor an acquired inflammatory polyneuropathy can be ruled-out.

CONCLUSIONS AND CLINICAL IMPORTANCE

We describe a motor polyneuropathy in juvenile Siberian cats characterized by self-limiting weakness with potential relapse.

Evaluation of coexisting polymyositis in feline myasthenia gravis: A case series

Acquired myasthenia gravis (MG) is relatively uncommon in cats. In humans, MG may be associated with other immune-mediated disorders, in particular polymyositis (PM). In this study, we described in-depth electrodiagnostic findings and pathological changes in muscles of cats diagnosed with MG, and assessed the presence of concurrent PM. Six cats with confirmed acetylcholine receptor antibody seropositive MG, and two suspected cases with clinical signs and electrophysiological changes consistent with MG, were reviewed. All animals presented with severe typical signs of generalized weakness and/or fatigability, resembling late-onset MG in humans, in addition to regurgitation. Five cats presented a cranial mediastinal mass, with 3 confirmed as thymoma. Repetitive nerve stimulation revealed a decrement of the compound muscle action potential in all tested cases, starting from low frequencies of stimulation. Serum creatine kinase activity was increased in 6/8 cats. Muscle biopsies performed in 5 cats revealed varying degrees of mixed mononuclear cell infiltrates, positive for the leukocyte markers CD3/CD4/CD8 and CD11b. Further MHC-1/C5b-9 positive sarcolemmal deposits were identified in all tested cases, with or without thymoma. This study documents an association of MG and PM in cats, and provides further support for feline MG as a relevant animal model of human MG.

The design of and chronic tissue response to a composite nerve electrode with patterned stiffness

OBJECTIVE

As neural interfaces demonstrate success in chronic applications, a novel class of reshaping electrodes with patterned regions of stiffness will enable application to a widening range of anatomical locations. Patterning stiff regions and flexible regions of the electrode enables nerve reshaping while accommodating anatomical constraints of various implant locations ranging from peripheral nerves to spinal and autonomic plexi.

APPROACH

Introduced is a new composite electrode enabling patterning of regions of various electrode mechanical properties. The initial demonstration of the composite's capability is the composite flat interface nerve electrode (C-FINE). The C-FINE is constructed from a sandwich of patterned PEEK within layers of pliable silicone. The shape of the PEEK provides a desired pattern of stiffness: stiff across the width of the nerve to reshape the nerve, but flexible along its length to allow for bending with the nerve. This is particularly important in anatomical locations near joints or organs, and in constrained compartments. We tested pressure and volume design constraints in vitro to verify that the C-FINE can attain a safe cuff-to-nerve ratio (CNR) without impeding intraneural blood flow. We measured nerve function as well as nerve and axonal morphology following 3 month implantation of the C-FINE without wires on feline peripheral nerves in anatomically constrained areas near mobile joints and major blood vessels in both the hind and fore limbs.

MAIN RESULTS

In vitro inflation tests showed effective CNRs (1.93  ±  0.06) that exceeded the industry safety standard of 1.5 at an internal pressure of 20 mmHg. This is less than the 30 mmHg shown to induce loss of conduction or compromise blood flow. Implanted cats showed no changes in physiology or electrophysiology. Behavioral signs were normal suggesting healthy nerves. Motor nerve conduction velocity and compound motor action potential did not change significantly between implant and explant (p  >  0.15 for all measures). Axonal density and myelin sheath thickness was not significantly different within the electrode compared to sections greater than 2 cm proximal to implanted cuffs (p  >  0.14 for all measures).

SIGNIFICANCE

We present the design and verification of a novel nerve cuff electrode, the C-FINE. Laminar manufacturing processes allow C-FINE stiffness to be configured for specific applications. Here, the central region in the configuration tested is stiff to reshape or conform to the target nerve, while edges are highly flexible to bend along its length. The C-FINE occupies less volume than other NCEs, making it suitable for implantation in highly mobile locations near joints. Design constraints during simulated transient swelling were verified in vitro. Maintenance of nerve health in various challenging anatomical locations (sciatic and median/ulnar nerves) was verified in a chronic feline model in vivo.

Distal polyneuropathy in an adult Birman cat with toxoplasmosis

Case summary

A 6-year-old female spayed Birman cat presented with a history of weight loss, stiff and short-strided gait in the pelvic limbs and reluctance to jump, progressing to non-ambulatory tetraparesis over 6 weeks. Poor body condition, dehydration and generalised muscle wastage were evident on general examination. Neurological examination revealed mildly depressed mental status, non-ambulatory flaccid tetraparesis and severely decreased proprioception and spinal reflexes in all four limbs. The neuroanatomical localisation was to the peripheral nervous system. Haematology, feline immunodeficiency virus/feline leukaemia virus serology, serum biochemistry, including creatine kinase and thyroxine, thoracic radiographs and abdominal ultrasound did not reveal significant abnormalities. Electromyography revealed fibrillation potentials and positive sharp waves in axial and appendicular muscles. Decreased motor conduction velocities and compound muscle action potential amplitudes were detected in ulnar and sciatic–tibial nerves. Residual latency was increased in the sciatic–tibial nerve. Histologically, several intramuscular nerve branches were depleted of myelinated fibres and a few showed mononuclear infiltrations. Toxoplasma gondii serology titres were compatible with active toxoplasmosis. Four days after treatment initiation with oral clindamycin the cat recovered the ability to walk. T gondii serology titres and neurological examination were normal after 11 and 16 weeks, respectively. Clindamycin was discontinued after 16 weeks. One year after presentation the cat showed mild relapse of clinical signs and seroconversion, which again resolved following treatment with clindamycin.

Relevance and novel information

To our knowledge, this is the first report of distal polyneuropathy associated with toxoplasmosis in a cat. This case suggests the inclusion of toxoplasmosis as a possible differential diagnosis for acquired polyneuropathies in cats.

Electrophysiologic confirmation of heterogenous motor polyneuropathy in young cats

Background

Reports of motor polyneuropathies in young cats are scarce. Further, in‐depth electrophysiologic evaluation to confirm a motor polyneuropathy in young cats of various breeds other than 2 Bengal cats is lacking.

Hypothesis/Objectives

To confirm a motor polyneuropathy in young cats of various breeds.

Animals

Five young cats with heterogenous chronic or relapsing episodes of weakness.

Methods

Retrospective case series. Cats were presented for evaluation of generalized neuromuscular disease and underwent electrophysiologic examination including electromyography, nerve conduction, and repetitive nerve stimulation. Minimum database and muscle and nerve biopsy analyses were carried out. Descriptive statistics were performed.

Results

Disease onset was at 3 months to 1 year of age and in 5 breeds. The most common clinical sign (5 of 5 cats) was weakness. Additional neurologic deficits consisted of palmigrade and plantigrade posture (4/4), low carriage of the head and tail (4/4), and variable segmental reflex deficits (5/5). Motor nerve conduction studies were abnormal for the ulnar (4/4), peroneal (5/5), and tibial (2/2) nerves (increased latencies, reduced amplitudes, slow velocities). A marked decrement was observed on repetitive nerve stimulation of the peroneal nerve in 3 cats for which autoimmune myasthenia gravis was ruled out. All sensory nerve conduction studies were normal. Histologic evaluation of muscle and nerve biopsies supported heterogenous alterations consistent with motor polyneuropathy with distal nerve fiber loss.

Conclusions and Clinical Importance

Heterogenous motor polyneuropathies should be considered in young cats of any breed and sex that are presented with relapsing or progressive generalized neuromuscular disease.

Morphometric parameters of peripheral nerves in calves correlated with conduction velocity

BACKGROUND

Peripheral nerve injuries are the most frequent neurologic disorder in cattle. So far, no physiologic values have been established for the motor nerve conduction velocity (mNCV) in this precocial species.

OBJECTIVES

The electrophysiologic and morphometric reference values of peripheral nerves in calves were determined. It was hypothesized that these parameters would correlate to the high degree of maturity in the first days of life in this species compared to other species.

ANIMALS

Twenty-six healthy calves were used in this study.

METHODS

The mNCV of the radial and the sciatic/common peroneal nerve was measured in all 26 calves. Nerve biopsies from a group of 6 calves were taken to correlate the obtained electrophysiologic data with morphological parameters.

RESULTS

The mean mNCV of the radial nerve was 48.3 ± 10.6 m/s, whereas the mean mNCV of the sciatic/peroneal nerve was with 83.8 ± 5.9 m/s significantly faster (P < .0001). The average fiber diameter was 8.40 ± 2.80 μm (range, 1.98-17.90 μm) and the average g-ratio was 0.61 ± 0.04 SD.

CONCLUSION AND CLINICAL IMPORTANCE

The established reference values for mNCV in calves correlate well with the evaluated morphometric parameters. Attributable to their comparably fast mNCV and high fiber diameters, juvenile calves appear to be much more mature individuals than other mammals. Electrophysiologic characterization of peripheral nerve injury now is feasible in this species.

Motor nerve conduction and repetitive nerve stimulation in captive ring-tailed coati (Nasua nasua)

There are few electrophysiologic studies in wild animals. The aim of this study was to determine normal data for motor nerve conduction studies and repetitive stimulation in sciatic-tibial and ulnar nerves in clinically normal captive coati. Eight adult ring-tailed coatis (Nasua nasua), two females and six males weighing 6-8 kg, were used. Average nerve conduction velocity was 70.81 m/sec (standard deviation [SD] = 3.98) and 56.93 m/ sec (SD = 4.31) for the sciatic-tibial and ulnar nerves, respectively. Repetitive stimulation responses demonstrated minimal variations of the area of the compound muscle action potentials at low (3 Hz) and high (20 Hz) frequencies. The maximal obtained decremental area response was 8%. These normal data of conduction studies may be used in assessing abnormalities for clinical diagnosis. In addition, the obtained normal repetitive stimulation data were similar to dogs and humans and may be used for post- and presynaptic disturbances of the neuromuscular transmission in coatis.

Retrospective study of salinomycin toxicosis in 66 cats

We examined 66 cats with salinomycin intoxication. Salinomycin caused different LMN signs of varying degrees of severity in all cases. Changes in blood work were unspecific, with the most frequent being increased serum creatine kinase activity, leukocytosis, and increased liver enzymes. Pathological electrodiagnostic findings: fibrillation potentials and positive sharp waves were detected in 10 cases, motor nerve conductance velocity was mildly decreased in 8/12 cats, and sensory nerve conductance velocity and repetitive nerve stimulation were normal in all examined cases. In five cases the peripheral neuropathy was confirmed by pathohistology. Fluid therapy and supportive care were used as therapy and 52 cats recovered completely. The probability for complete remission was significantly different between mildly and severely affected cases. It seems that the severity of clinical signs and prognosis correlate well with the amount of toxin ingested. We conclude that early recognition and decontamination combined with supportive care results in complete recovery.

Idiopathic polyradiculoneuropathy in a Bengal cat: electrophysiological findings and 1 year follow-up

This report describes a rapidly progressive loss of motor function in a 16-month-old male neutered Bengal cat, beginning in the pelvic limbs and progressing to involve all limbs and rendering the cat non-ambulatory. The neurological examination revealed flaccid tetraparesis with decreased spinal reflexes but preserved conscious proprioception and skin sensation. Extensive electrophysiological tests were conducted including electromyography, motor and sensory peripheral nerves potential recordings and 'late' potentials, defining the electrodiagnostic characteristics of this disease. Based on the electrophysiological findings, a generalised proximal and predominantly axonal neuropathy affecting the ventral (motor) nerve roots was suspected. As no aetiology was identified, this disease was classified as idiopathic polyradiculoneuropathy. Over a year, the cat presented three separate episodes of tetraparesis, each with a spontaneous complete recovery, consistent with the reportedly good prognosis for this disease.

Muscular dystrophy associated with alpha-dystroglycan deficiency in Sphynx and Devon Rex cats

Recent studies have identified a number of forms of muscular dystrophy, termed dystroglycanopathies, which are associated with loss of natively glycosylated alpha-dystroglycan. Here we identify a new animal model for this class of disorders in Sphynx and Devon Rex cats. Affected cats displayed a slowly progressive myopathy with clinical and histologic hallmarks of muscular dystrophy including skeletal muscle weakness with no involvement of peripheral nerves or CNS. Skeletal muscles had myopathic features and reduced expression of alpha-dystroglycan, while beta-dystroglycan, sarcoglycans, and dystrophin were expressed at normal levels. In the Sphynx cat, analysis of laminin and lectin binding capacity demonstrated no loss in overall glycosylation or ligand binding for the alpha-dystroglycan protein, only a loss of protein expression. A reduction in laminin-alpha2 expression in the basal lamina surrounding skeletal myofibers was also observed. Sequence analysis of translated regions of the feline dystroglycan gene (DAG1) in affected cats did not identify a causative mutation, and levels of DAG1 mRNA determined by real-time QRT-PCR did not differ significantly from normal controls. Reduction in the levels of glycosylated alpha-dystroglycan by immunoblot was also identified in an affected Devon Rex cat. These data suggest that muscular dystrophy in Sphynx and Devon Rex cats results from a deficiency in alpha-dystroglycan protein expression, and as such may represent a new type of dystroglycanopathy where expression, but not glycosylation, is affected.

Laminin alpha2 deficiency-associated muscular dystrophy in a Maine coon cat

A European case of laminin alpha2 deficiency-associated muscular dystrophy in a 12-month-old, female Maine coon pedigree cat is reported. The history and eventual clinical presentation of this cat differed from those of two cats reported in the USA. In this case, the myopathy was characterised by progressively worsening weakness, muscle atrophy and joint contracture. Tendon reflexes were diminished, and motor nerve conduction velocities were slowed. Muscle biopsy demonstrated a dystrophic phenotype with endomysial fibrosis. Occasional thinly myelinated nerve fibres were present within a peripheral nerve specimen. Poorly myelinated fibres were also found at the root level on necropsy specimens. Immunohistochemical staining revealed the absence of laminin alpha2. The cat's family history did not indicate genetic transmission of the disease.

Electrophysiology in neuromuscular disease

Electrophysiologic assessment of the peripheral nervous system is an integral part of the diagnostic workup for neuromuscular disease. This article is designed to provide insight into the importance and limitations of the various testing procedures now available in veterinary electrophysiology and to provide the reader with an understanding of the theory behind each of these procedures. The article also provides a guideline for the interpretation and clinical significance of each of the available tests.

Muscle and nerve biopsy

Biopsy of muscle and nerve is an essential component of the diagnostic plan for animals with suspected neuromuscular disease. This article includes descriptions of the biopsy procedures and information regarding appropriate biopsy site selection and correct handling and processing of the tissues. The normal and pathological appearance of muscle and nerve using routine histochemical and histological techniques are described and illustrated emphasizing the basic myopathic and neuropathic responses of the neuromuscular system.

Laminin alpha 2 (merosin)-deficient muscular dystrophy and demyelinating neuropathy in two cats

We report laminin alpha 2 (merosin) deficiency associated with muscular dystrophy and demyelinating neuropathy in two cats. The cats developed progressive muscle weakness, and atrophy. Either hypotonia or contractures resulted in recumbency, necessitating euthanasia. Muscle biopsies showed dystrophic changes including marked endomysial fibrosis, myofiber necrosis, variability of fiber size, and perimysial lipid accumulation. Immunohistochemistry showed that laminin alpha 2 chain was absent or reduced, while dystrophin and all the components of the dystrophin-associated glycoprotein complex were present and normal. One cat was examined in detail. Motor nerve conduction velocity (MNCV) was decreased, and ultrastructurally the peripheral nerves showed Schwann cell degeneration and demyelination. Brain imaging was not performed, but white matter changes were not apparent in the brain at necropsy. The disease in these cats is similar to primary or secondary merosin (laminin alpha 2)-deficient congenital muscular dystrophy (CMD) in humans and to dystrophia muscularis in mice.

Laser nerve repair by solid protein band technique. II: assessment of long-term nerve regeneration

A total of 18 adult male Wistar rats had left tibial nerve repaired by either the laser-solder technique or a more conventional microsuture technique. The diode laser power was 90 mW and the radiation dose 16 J/mg. Three months postoperatively electrophysiology showed that the average compound muscle action potential (CMAP) of the laser repair group was not significantly different from the CMAP of the sutured nerves. Light microscopy confirmed regeneration of myelinated axons in both groups of animals. The laser-solder technique, when used with such parameters, proved to be a reliable method to achieve satisfactory peripheral nerve anastomosis and nerve regeneration.

Laser-activated solid protein bands for peripheral nerve repair: an vivo study

BACKGROUND AND OBJECTIVE

Severed tibial nerves in rats were repaired using a novel technique, utilizing a semiconductor diode-laser-activated protein solder applied longitudinally across the join. Welding was produced by selective laser denaturation of solid solder bands containing the dye indocyanine green.

STUDY DESIGN/MATERIALS AND METHODS

An in vivo study, using 48 adult male Wistar rats, compared conventional microsuture-repaired tibial nerves with laser solder-repaired nerves. Nerve repairs were characterised immediately after surgery and after 3 months.

RESULTS

Successful regeneration with average compound muscle action potentials of 2.5 +/- 0.5 mV and 2.7 +/- 0.3 mV (mean and standard deviation) was demonstrated for the laser-soldered nerves and the sutured nerves, respectively. Histopathology confirmed comparable regeneration of axons in laser- and suture-operated nerves.

CONCLUSION

The laser-based nerve repair technique was easier and faster than microsuture repair, minimising manipulation damage to the nerve.

Prednisolone-responsive neuropathy in a cat

Chronic relapsing polyneuropathy was diagnosed in a 15‐month‐old cat with a 12‐week history of limb weakness. The clinical course was punctuated by spontaneous remissions and relapse. There were two striking physical findings, weak withdrawal reflexes and atrophy of the proximal and distal limb muscles. Electrophysiological findings typical of a demyelinating motor neuropathy were present, namely small, dispersed compound muscle action potentials, markedly slow motor conduction and denervation potentials that were more prominent dis‐tally. Muscle biopsies showed changes consistent with denervation and a paucity of myelinated axons in intramuscular nerve bundles. The neuropathy responded rapidly and completely to prednisolone administration, which was slowly tapered over several months.