Measurement of excitation-contraction coupling time in critical illness myopathy

Objective: This study aimed to develop a simple and reliable technique to assess excitation-contraction (E-C) coupling for early diagnosis of critical illness myopathy (CIM). Methods: We prospectively performed clinical and electrophysiological examinations on patients admitted to intensive care unit (ICU). In addition to full neurological examinations and routine nerve conduction study, motor related potential (MRP) was recorded using an accelerometer attached to the base of hallux after tibial nerve stimulation, and E-C coupling time (ECCT) was measured from the latency difference between soleus compound muscle action potential (CMAP) and MRP. Results: Of 41 patients evaluated, 25 met the criteria for ICU-acquired weakness, 23 of whom had CIM. The time to the first electrophysiological examination (time to first test) correlated negatively with CMAP and with MRP. Conversely, a positive correlation was observed between the time to first test and ECCT. E-C coupling impairment occurred in most of our patients with CIM by the third day of ICU admission, and prolonged ECCT could be the earliest detectable abnormality. Conclusions: The ECCT measurement is an easy and reliable technique to detect reduced muscle membrane excitability in the early stage of CIM. Significance: The ECCT measured by our method using an accelerometer may be a parameter that predicts the development of CIM. (C) 2021 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.