Myofascial syndrome as a pathogenetic mechanism for formation of scoliosis in people with multiple sclerosis

The purpose of this research was to conduct a comprehensive analysis of clinical changes and electroneuro­myographic indices in people with multiple sclerosis in combination with various types of functional disorders of posture. The study involved 105 people with multiple sclerosis aged 26–58 who were undergoing rehabilitation at a specialized medical center. The degree of spasticity of the muscles was determined by the modified Ashworth scale. To assess the intensity and nature of pain, a neurologic examination was performed using a visual analogue scale and a McGilovsky pain questionnaire. Interference and stimulation electroneuromyography was used to characterize the functional state of the peripheral neuromotor apparatus of skeletal muscles, the results of which determined the maximum arbitrary contraction of the muscle using quantitative analysis of time, amplitude and frequency parameters, and also determined the speed of the pulse, the amplitude and duration of the F wave, latent period and polyphase M-wave, monosynaptic testing (H-reflex) was carried out. The percentage of Hmax/Mmax was calculated from the electroneuro­myographic results. By the ratio between the maximum and minimum amplitude of the M-response, the number of motor units was calculated. To analyze the denervation-reinvational processes of motor units and degenerative-restorative changes in the muscle fibers, spontaneous fibrillation potentials and positive acute waves were recorded. By the stage of manifestation of pain myofascial syndrome, all patients were divided into three groups, in which the force characteristics decreased by 10.2%, 25.0% and 30.2%, respectively. It is well understood in clinic-instrumental research, that in 67.3% cases of multiple sclerosis the patient also suffers from functional scoliosis. This pathological symptom complex contributes to the creation of not only muscular, but also fascial-ligamental trigger points. They, in turn, are the source of the formation of secondary trigger loci. In terms of the degree of manifestation of subjective pain in the presence of myo-fascial syndrome, all patients were divided into three groups, and depending on the value of individual indicators, three stages of spontaneous fibrillation potentials were identified that clearly correlate with the degree of fibromyalgic syndrome and manifest specific electroneuromyographic disorders in each of these stages. The main pathogenetic mechanism that contributes to the formation of pathological bends of the spine in people with multiple sclerosis is a painful muscular-fascial syndrome. It is provoked by myofascial hypertonia and takes part in the development of cross syndromes, which is also manifested by clear changes in electroneuromyographic parameters in the form of asymmetric muscle tone. This article discusses clinical variants of the course of local muscular-tonic syndromes. Pathogenetic approaches to the prevention of posture disorders in patients with multiple sclerosis are presented here