Patients can develop motor disorders in intensive care units (ICU) that in some cases amount to flaccid tetraparesis with a more or less grave prognosis. ICU-acquired neuro-muscular disorders have various possible origins, including necrotic or catabolic myopathies and sensori-motor axonal neuropathies. Electrophysiological testing differentiates these pathophysiological entities better than clinical examination. It has been proposed that direct muscle stimulation in addition to conventional electroneuromyography improves electrodiagnostic reliability in ICU paralysis, however, it has rarely been studied. Using this technique, the authors have shown that the majority of ICU-acquired pareses are of myopathic origin (JP Lefaucheur et al., J Neurol. Neurosurg. Psychiatry, in press; available on-line as an e-publication).

The contribution of myopathic processes to ICU-acquired paresis is probably underestimated. Direct muscle stimulation permits a better understanding of the mechanisms of these disorders. It remains to be seen whether this advance will have significant consequences for treatment and prognosis.

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