*6.3.1. Progressive supranuclear palsy (PSP)*

We performed urodynamic studies in 9 patients with PSP and performed EAS-EMG in 4. Two of these 4 patients exhibited neurogenic changes in MUPs.50 Abnormal sphincter EMG was also reported in 5 of 12 patients by Valldeoriola et al. (1995)71, and in 2 of 8 patients by Palace et al. (1997)38. Libelius and Johansson (2000) also described anal sphincter EMG abnormalities in 2 of 3 patients with PSP.30

Sphincter EMG for Diagnosing MSA and Related Disorders 301

Onuf's nucleus in most advanced cases with ALS27, particularly in patients under

We have reviewed the normal physiology and pathophysiology of the lower urinary tract and the lower gastrointestinal tract, the current methods and interpretations of sphincter EMG, and the application of this technique to various autonomic disorders. Sphincter EMG makes it easier to distinguish MSA from idiopathic Parkinson's disease in the first 5 years after disease onset, reflecting the significant involvement of the sacral spinal cord in MSA. However, abnormal sphincter EMG is also seen in some, though not many, patients with DLB or PSP. It is noteworthy that sphincter denervation leads to severe urinary and fecal incontinence in some female patients with MSA, which severely affects their quality of life. Sphincter EMG and relevant sacral autonomic tests are good diagnostic tools in

, Fuyuki Tateno, Masahiko Kishi and Yohei Tsuyusaki

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[2] Amborova P, Hubkal P, Ulkova I, Hulin I (2003) The pacemaker activity of interstitial

[3] Argiolas A, Melis MR (2005). Central control of penile erection: role of the

[4] Bassotti G, Maggio D, Battaglia E, Giulietti O, Spinozzi F, Reboldi G, Serra AM, Emanuelli G, Chiarioni G (2000) Manometric investigation of anorectal function in early and late stage Parkinson's disease. J Neurol Neurosurg Psychiatry 68; 768-770 [5] Beck RO, Betts CD, Fowler CJ (1994) Genitourinary dysfunction in multiple system

cells of cajal and gastric electrical activity. Physiol Res 52: 275-284

paraventricular nucleus of the hypothalamus. Prog Neurobiol 76: 1-21.

atrophy: clinical features and treatment in 62 cases. J Urol 151: 1336-1341.

*Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan* 

mechanical ventilation.

**7. Conclusions** 

autonomic disorders.

Tomoyuki Uchiyama and Tatsuya Yamamoto *Neurology, Chiba University, Chiba, Japan* 

*Urology, Dokkyo Medical College, Tochigi, Japan* 

Neurourol Urodynam 21: 167-178

**Author details** 

Ryuji Sakakibara\*

Tomonori Yamanishi

**8. References** 

 \*

Corresponding Author

## *6.3.2. Corticobasal degeneration (CBD)*

We performed urodynamic studies in 6 patients with CBD and EAS-EMG in 5 of them. However, none of the 5 patients showed neurogenic changes in the MUPs.60 There is a considerable overlap in the clinical presentation of the parkinsonian form of MSA (MSA-P) and that of PSP. Therefore, we should be cautious in interpreting sphincter EMG in these disorders.
