Соловьянович Сергей Викторович
Врач-невролог высшей квалификационной категории, нейрофизиолог
Электронейромиография (ЭНМГ) — это комплексное электрофизиологическое исследование, необходимое для определения функционального состояния периферической нервной системы и мышц. Методика позволяет выявлять патологические изменения на самых ранних стадиях.
Различают электромиографию (ЭМГ) и электронейрографию (ЭНГ).
Электромиография – исследование электрической активности мышц в состоянии покоя и при их сокращении, а электронейрография – метод оценки скорости проведения электрического сигнала по нервам. Современный алгоритм исследования, как правило, включает оба метода.
Как известно, нервный импульс зарождается в головном мозге и по дороге к мышце проходит огромное число нервных путей, нейронов спинного мозга, нервных сплетений. Полноценное движение организма обеспечивается только при правильном взаимодействии нервного импульса и мышц. При поражении нервов это взаимодействие нарушается, и возникают различные заболевания с такими симптомами, как непроизвольное сокращение мышц, слабость, онемение в нижних и верхних конечностях, повышенная мышечная утомляемость, сокращение мышечной массы и др. При наличии подобных симптомов ЭНМГ является незаменимым исследованием, позволяющим установить причину и точную локализацию повреждения того или иного периферического нерва.
- регистрацию и анализ параметров вызванных потенциалов (ВП) мышцы и нерва (латентный период, форма, амплитуда и длительность ВП);
- определение числа функционирующих двигательных единиц (ДЕ);
- определение скорости проведения импульса (СПИ) по двигательным и чувствительным волокнам периферических нервов;
- подсчет мотосенсорного и краниокаудального коэффициентов, коэффициентов асимметрии и отклонения от нормы.
Cуть метода
В основе ЭНМГ лежит применение электрической стимуляции нерва с последующим анализом параметров вызванных потенциалов, регистрируемых с иннервируемой мышцы или нервного ствола. Стимуляция нерва в двух находящихся на определенном расстоянии друг от друга точках позволяет определить время, в течение которого волна возбуждения проходит между точками стимуляции. Таким образом вычисляется скорость проведения импульса по нервным волокнам.
Чаще всего данным методом исследуются срединный, локтевой, большеберцовый, малоберцовый, реже локтевой и седалищный нервы. В случаях, когда стимуляция нервов в двух точках затруднена (напр., мышечно-костный нерв руки, плечевое сплетение, бедренный нерв, лицевой, межреберный нервы), косвенное представление о СПИ можно получить с помощью измерения латентного периода М-ответа при однократном раздражении с одной точки.
По снижению амплитуды М-ответа при повторной электрической стимуляции нерва можно судить о наличии нервно-мышечной утомляемости. Диагностическим критерием миастенического синдрома является наличие прогрессирующего снижения амплитуды М-ответа (феномена декремента) при частоте стимуляции от 30 до 50 имп/с. Также в исследовании нервно-мышечного утомления применяются фармакологические тесты.
Скорость проведения импульса (СПИ) зависит от многих параметров, в первую очередь от диаметра и степени миелинизации нервного волокна, возраста пациента, времени суток, воздействия лекарственных препаратов. СПИ также различна на разных участках нерва.
СПИ прямо пропорциональна диаметру волокна: выраженная в метрах в секунду, она в 6 раз превышает диаметр волокна, выраженный в микрометрах. Однако, учитывая, что ствол нерва составляют волокна с разным диаметром и разной степенью миелинизации, данное соотношение не является абсолютным.
Электромиография показана при любых проблемах мышечной ткани, после травм и для выявления динамики на протяжении лечения заболевания. Противопоказания минимизированы, что делает ЭМГ популярной и часто используемой. Данная диагностика — единственный метод, который точно устанавливает место, где имеется повреждение нервного волокна, дает точные данные о причине дисфункции. Для беспроблемного проведения исследования убедитесь, что у больного нет проблем с сердечно-сосудистой системой и психологического расстройства.
Что это такое?
Электромиография – это метод диагностического исследования, который исследует биоэлектрические потенциалы, образующиеся в мышечной ткани, когда идет возбуждение нервов. Открыл эту методику Пипереом Г. При проведении электромиографии используют аппарат электромиограф. Он усиливает и регистрирует биопотенциалы мышечной и нервной системы. Использующееся современное компьютерное оборудование способно зафиксировать даже незначительные электроимпульсы, которые считываются на автомате, а в дальнейшем производится спектральный анализ полученной информации.
Показания
Электромиография конечностей назначается, если у больного есть подозрения или он жалуется на:
- боли в мышцах;
- систематическую слабость;
- возникновение периодических судорог;
- миотонию (затрудненное расслабление мышц после их долгого, сильного сокращения);
- миастению (ослабленность мускулатуры);
- миопатию (атрофию мышечной ткани);
- полимиозит;
- безпричинную потерю мышечной массы;
- миоклонию (непроизвольные мышечные сокращения);
- синдром Паркинсона;
- тремор конечностей;
- микроинсульт;
- радикулопатию после травмы позвонков или при грыже;
- признаки бокового амиотрофического склероза;
- склероз рассеянного типа;
- какие-либо изменения в позвоночном столбе дистрофического характера;
- полинейропатию или нейропатию.
Также показания к проведению электромиографии это:
- травмирование у человека нервных сплетений;
- необходимость точного введения ботокса (детям с ДЦП или в косметологических целях);
- контроль во время лечения.
Пациент должен быть готов к тому, что процедура будет повторяться еще несколько раз (имеются в виду процедуры, которые будут проводиться в процессе лечения). Это нужно для отслеживания динамики во время терапии, если таковая будет присутствовать.
Противопоказания
Миография невредный и безболезненный метод, что говорит о его безопасности. Данное обследование допускается проводить детям.
Несмотря на вышеперечисленные преимущества, есть и противопоказания в виде:
- инфекционных и неинфекционных болезней острого характера;
- заболеваний ЦНС;
- наличия эпилепсии;
- серьезных неврологических отклонений;
- патологий сердечной мышцы и сосудов в острой стадии;
- присутствия повреждений на кожных покровах (сыпь, гнойники, раны);
- наличия кардиостимулятора.
Игольчатая электромиография не проводится, если человек:
- носитель ВИЧ-инфекции, гепатита и т. п.;
- страдает гемофилией и заболеваниями, связанными со свертываемостью крови;
- жалуется на систематические и длительные кровотечения;
- имеет высокий болевой порог.
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Электромиографию можно сделать нескольких типов. Разница их в том, какой электрод используется во время процедуры. Бывает ЭМГ стимуляционной или игольчатой. Имейте в виду, что каждый вид проводится при определенных заболеваниях. Выбор делает врач, поставив предварительный диагноз. Иногда назначаются два типа.
Стимуляционная (ЭНМГ электронейромиография)
Стимуляционная электромиография — это неинвазивное поверхностное исследование, которое дает возможность определить мышечную и нервную активность на большой площади. Данный вариант диагностики безболезнен.
Такая электромиография мышц способна указать, на какой степени заболевание, уровень, как проходит процесс, все о его распространенности, характер и даже механизм развития.
Игольчатая (дополнительная ЭМГ)
Игольчатая электромиография подразумевает под собой локальное введение специальной иглы (электрода) в мышцу. Именуют инвазивной методикой, которая целесообразна для исследования определенного элемента. Большую площадь обследовать не получится. Такой тип миографии разрешен с восьмилетнего возраста, если отсутствуют какие-либо патологии нервной системы.
Как подготовиться?
ЭМГ это один из видов обследования, который не подразумевает под собой какие-либо специальные подготовительные меры. Но, предварительно учтите, что нежелателен прием лекарственных средств, которые возбуждают нервную систему или тонизирует мускулатуру.
Также до процедуры нецелесообразно есть ту пищу и пить напитки, которые возбуждают, а именно:
- шоколад и любые продукты с его содержанием;
- кока-колу;
- кофе и какао;
- крепкий чай;
- энергетики;
- спиртные напитки.
Предварительно следует отказаться от табакокурения.
Если планируется игольчатая электромиография, то нельзя пить лекарства, которые понижают свертываемость крови.
Как проводится?
Электромиография мышц проводится амбулаторно или при стационаре. Есть некоторая разница в проведении игольчатой и поверхностной ЭМГ.
Рассмотрим технику проведения на нижних и верхних конечностях отдельно.
Нижних конечностей
Если выбор пал на игольчатый способ, то действия будут следующие:
- Больного просят занять полулежащее, лежачее положение. Обязательное условие — полное расслабление исследуемых мышц на начальном этапе, после нужно немного их напрячь.
- Специалист наносит на кожные покровы области ног специальный раствор, обрабатывает антисептиком.
- Вводятся электроды-иглы.
- Начинается диагностика. Первый этап — в расслабленном состоянии. Второй — в напряжении.
Все происходящее записывается на электромиограмме. Результаты изучаются специалистом. Дополнительная электромиография нижних конечностей может осуществляться на конкретно выбранном участке (на икроножной мышце, седалищном нерве).
После манипуляции иногда возникают неприятные ощущения, боли. Устранить такой дискомфорт помогут обезболивающие препараты. Еще один неприятный момент после электромиографии— появление небольшой гематомы в месте введения электрода. Через несколько дней синяк проходит сам собой.
Если проводится стимуляционная электромиография ног, то:
- Пациента кладут на кушетку.
- На площадь ног (при таком методе это большая площадь) наносят специальный раствор.
- Накожно накладываются тонкие пластины (электроды).
- Происходит изучение мышечной ткани в расслабленном и напряженном состоянии.
После такого вида никаких неприятных ощущений не наблюдается и человек может возвращаться к привычной жизни.
Верхних конечностей
Если планируется электромиография верхних конечностей, то технология та же, только больной может занять положение сидя. Если ему удобнее лечь, специалист против не будет. Врач-невролог напомнит, что данная поза должна дать возможность полностью расслабить мускулатуру рук.
При игольчатой электромиографии обрабатывается небольшая область и в эту зону вводят иглы-электроды. При поверхностной могут исследоваться большие площади.
Длительность манипуляций зависит от диагностируемой области и используемого типа электромиографии. Если область незначительна, может хватить и двадцати минут. При исследовании всей области рук или ног длительность процедуры растягивается на час.
Расшифровка электромиографии
Результат электромиографии может быть неточным, если у человека присутствуют проблемы со свертываемостью крови, а также при наличии толстого слоя жировой клетчатки.
- При наличии миозита или дистрофии мышц наблюдается сниженная осцилляция.
- Если у человека поражена периферическая нервная система, присутствует урежение осцилляций. Если ее вовсе нет — это знак того, что нервные волокна разрушены.
- При постепенном снижении осцилляции можно говорить о миотонических синдромах.
- Если активность резкая — признак заболевания спинного мозга (точнее его нейронов), такая патология относится к генетическим болезням.
- Периодическая активность связана с болезнью Паркинсона.
Опытный и квалифицированный специалист в данной отрасли без труда даст верную расшифрову электромиограммы.
Преимущества и недостатки
Исходя из вышеизложенной информации, выделим плюсы и минусы электромиограммы:
К преимуществам электромиографии отнесем:
- отсутствие болей во время и после процедуры (только единицы после игольчатой миографии чувствуют дискомфорт);
- возможность многоразового проведения;
- не нужно специально готовиться к процедуре;
- методика полностью изучена и проверена.
Недостатки электромиографии заключаются в:
- длительности проведения процедуры (от получаса до часа);
- информативна диагностика только в комплексе с иными обследованиями;
- при использовании игольчатых электродов возможны неприятные ощущения;
- противопоказания при нервных расстройствах и проблемах со свертываемостью крови (при игольчатой ЭМГ).
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Где сделать?
Приведем примеры медицинских центров, где вы сможете сделать электромиографию. Записаться на обследование можно путем звонка по указанному номеру телефона. Если есть возможность, можно прийти лично в клинику.
| Наименование мед. центра | Адрес | Телефон |
| Клиника Доктор Сан на Марата | г. Санкт-Петербург, м. Звенигородская, улица Марата, дом 78 | 81-22-43-19-60 |
улица Академика Байкова, дом 8
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Сколько стоит?
Стоимость электромиографии может отличаться, иногда довольно-таки значительно, начиная от 500 рублей и заканчивая 8000 рублей. Зависит цена от месторасположения клиники, квалификации врачей, типа диагностики, исследуемой области и пр.
Чтобы уточнить сумму на электромиографию, следует обратиться непосредственно в выбранную клинику. Для этого необязательно идти по указанному адресу, достаточно одного телефонного звонка.
Вывод
Чтобы сделать электромиографию рук или ног, не нужно готовиться заранее и отказывать себе в пище и пр. Данная диагностика имеет массу плюсов и проводится даже в детском возрасте. Тип ЭМГ определяет лечащий врач, при необходимости назначается сразу два исследования. Результаты будут известны в тот же день. Чтобы поставить четкий диагноз иногда недостаточно одной электромиографии. Могут дать направление и на другие диагностические мероприятия.
Преимущества проведения электронейромиографии в «СМ-Клиника»
- Для проведения процедуры мы используем современное высокоточное оборудование. Это позволяет нам получить максимально достоверные результаты и при необходимости назначить оптимальный курс лечения.
- Врачи-неврологи, выполняющие исследование, прошли специальное обучение, а их высокий профессионализм гарантирует корректность проведения процедуры и верную интерпретацию результатов.
- Мы предлагаем доступные цены на электронейромиографию, чтобы обследование мог пройти каждый пациент.
Зачем нужно проходить электронейромиографию
Электронейромиография – один из наиболее информативных методов исследования позволяющий на ранней стадии выявить различные неврологические заболевания, затрагивающие нервы и мышцы.
Первичная электромиография проводится для получения информации необходимой для постановки и подтверждения диагноза. Проведение ЭНМГ дает возможность выяснить, на каком уровне рефлекторной цепи имеется патология и насколько она серьезна.
Во время проведения лечения выявленного заболевания ЭМГ может проводится несколько раз с определенным интервалом для оценки эффективности терапии.
Показания к проведению электронейромиографии
Решение о проведении ЭНМГ принимает врач-невролог, основываясь на существующем диагнозе, осмотре пациента, имеющихся жалобах. Сделать электронейромиографию необходимо в следующих случаях:
- при наличии жалоб на мышечные боли, спазмы, судороги или же слабость в ногах или руках, при тунельном синдроме (когда нерв зажат в костном канале сухожилиями мышц);
- при грыжах межпозвонковых дисков и корешковом синдроме;
- при поражениях мышц и нарушениях мышечного тонуса: мышечной дистрофии, миотонии, миопатии, миастении;
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| Наименование услуги | Цена (руб.)* |
| Электронейромиография лица: вызванный кожно-симпатический потенциал | 3 400 |
| Электронейромиография лица: круговой мышцы глаза, круговой мышцы рта (лицевой нерв) | 3 400 |
| Электронейромиография лица: блинк-рефлекс (тройничный нерв) | 3 950 |
| Электронейромиография игольчатая (1 мышца) | 3 400 |
| Электронейромиография: Н-рефлекс | 3 400 |
| Электронейромиография: тетанизация | 4 500 |
| Стимуляционная электронейромиография одной верхней конечности (1 чувствительный нерв) | 1 700 |
| Стимуляционная электронейромиография одной верхней конечности (1 нерв) | 3 400 |
| Стимуляционная электронейромиография одной верхней конечности (2 нерва) | 4 500 |
| Стимуляционная электронейромиография одной верхней конечности (все нервы) | 6 750 |
| Стимуляционная электронейромиография одной нижней конечности (1 двигательный нерв) | 2 850 |
| Стимуляционная электронейромиография одной нижней конечности (все нервы) | 6 750 |
| Дополнителое исследование к стимуляционной электронейромиографии одной верхней конечности при туннельном синдроме (самостоятельно не проводится) | 2 850 |
* Администрация клиники принимает все меры по своевременному обновлению размещенного на сайте прайс-листа, однако во избежание возможных недоразумений, советуем уточнять стоимость услуг в регистратуре или в контакт-центре по телефону +7 (495)
Размещенный прайс не является офертой. Медицинские услуги оказываются на основании договора.
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