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Volosin M, Horváth J. Force and electromyography reflections of sensory action-effect weighting during pinching. Hum Mov Sci 2022; 84:102969. [PMID: 35704968 DOI: 10.1016/j.humov.2022.102969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/29/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022]
Abstract
Ideomotor theories suggest that different action-effects are not equally important in goal-directed actions, and that task-relevant information are weighted stronger during the representation of actions. This stronger weighting of task-relevant action-effects might also enable to utilize them as retrieval cues of the corresponding motor patterns. The aim of the present study was to investigate how the consistent presence or absence of a sound action-effect influenced the retrieval of the motor components of a simple, everyday action (pinching) as reflected by the pattern of force application and surface electromyogram (sEMG) recorded from the abductor pollicis brevis (APB) and first dorsal interosseous (FDI). Participants applied pairs of pinch impulses to a force sensitive resistor (FSR). The presence or absence of a sound action-effect and the between-action interval (BAI, 2 or 4 s) were manipulated blockwise, whereas the target force level (low or high) was randomly cued from trial to trial. When actions resulted in a sound, force and sEMG activity were reduced. This effect was more pronounced for low target force level trials, which is compatible with a stronger weighting of the sound action-effect when the intensity of the tactile and proprioceptive action-effects is low. Surprisingly, the FDI activity was more variable within actions pairs in the 2 s BAI conditions, which suggests that action pairs separated by the longer time interval might have been represented differently from those separated by the shorter interval.
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Affiliation(s)
- Márta Volosin
- Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Magyar Tudósok körútja 2, H-1117 Budapest, Hungary; Institute of Psychology, University of Szeged, Egyetem utca 2, H-6722 Szeged, Hungary.
| | - János Horváth
- Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Magyar Tudósok körútja 2, H-1117 Budapest, Hungary; Institute of Psychology, Károli Gáspár University of the Reformed Church in Hungary, Bécsi út 324, H-1037 Budapest, Hungary.
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52
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Schulte-Mattler W, Bischoff C. EMG und Neurografie – ein Update. KLIN NEUROPHYSIOL 2022. [DOI: 10.1055/a-1759-9988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Elektromyografie (EMG) und Elektroneurografie (ENG) gelten als bewährte
Methoden, deren Anfänge aber schon Jahrzehnte zurückliegen. In
dieser Arbeit werden jüngere Entwicklungen beschrieben und die Rolle von
EMG und ENG in wichtigen Situationen diskutiert, nämlich bei
traumatische Nervenläsionen, Nervenkompressionssyndromen,
Polyneuropathien, Motoneuronerkrankungen, Myopathien, neuromuskulären
Transmissionsstörungen und bei muskulärer
Überaktivität.
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53
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Dietrich M. Technische Grundlagen der Neurographie/Evozierten Potentiale
Teil I Differenzverstärker und Elektroden. KLIN NEUROPHYSIOL 2022. [DOI: 10.1055/a-1799-5607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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54
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Deep Learning-Based Surface Nerve Electromyography Data of E-Health Electroacupuncture in Treatment of Peripheral Facial Paralysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8436741. [PMID: 35685899 PMCID: PMC9173966 DOI: 10.1155/2022/8436741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022]
Abstract
This study was aimed at exploring the application value of electroacupuncture in the treatment of peripheral facial palsy using surface nerve electromyogram (EMG) image data based on deep learning. The surface nerve EMG recognition model was constructed based on multiview convolutional neural network, and the differences between it and the traditional single-view convolutional neural network were analyzed. Meanwhile, the influence of the multiview aggregation method based on pooling of view and decision fusion on facial recognition accuracy was compared and analyzed. 150 patients with peripheral facial paralysis were randomly divided into the control group (n = 70, basic treatment) and treatment group (n = 80, basic treatment + electroacupuncture). After 4 weeks of treatment, the therapeutic effect was evaluated by surface EMG parameters based on Horsfall-Barratt (H-B) scale and multiview convolutional neural network. The results showed that the face recognition accuracy of multiview convolutional neural networks was significantly higher than that of all single-view convolutional neural networks. The multiview aggregation network proposed in this research had a higher accuracy in facial recognition than the pooling of the view method and decision fusion-based multiview aggregation method. According to the evaluation results of H-B scale, the number of patients who recovered, significantly effective, effective, and ineffective in the control group was 39, 17, 3, and 11, respectively. The number of patients in the treatment group who recovered, significantly effective, effective, and ineffective was 51, 15, 9, and 5, respectively. Total effective rate of patients in the control group was 84.29%, and that of the treatment group was 93.75%, which was significantly higher than the control group (P < 0.05). According to surface EMG assessment results, compared with the control group, the mean root mean square (RMS), median frequency (MF), and mean power frequency (MPF) of the buccal and frontalis muscles in the treatment group increased significantly (P < 0.05). Compared with that before treatment, the mean buccal and frontalis RMS of patients in the control and treatment groups increased significantly after treatment (P < 0.05). In conclusion, electroacupuncture treatment could significantly improve the muscle strength of patients with peripheral facial paralysis.
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55
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Alaydin HC, Turkmen N, Boran HE, Cengiz B. Estimating the motor unit number of the flexor carpi ulnaris muscle with MScanFit MUNE. Muscle Nerve 2022; 66:212-215. [PMID: 35621353 DOI: 10.1002/mus.27650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION/AIMS MScanFit motor unit number estimation (MUNE) is a promising method for motor unit estimation and is reported to have good reliability in distal and small muscles. In this study, we investigated the reliability of MScanFit MUNE in a proximal forearm muscle, the flexor carpi ulnaris. METHODS Twenty healthy volunteers were included in this study and 15 participants were re-evaluated in a second session. The ulnar nerve was stimulated at the elbow and a compound muscle action potential (CMAP) scan from the flexor carpi ulnaris (FCU) muscle was recorded from each arm. CMAP, MUNE and other motor unit parameters were obtained. Reproducibility was evaluated using intraclass correlation coefficients. RESULTS The average MUNE from 40 FCU muscles was 90.9 (SD: 16.4). MScanFit MUNE and CMAP were not significantly different between the dominant and non-dominant sides. The intraclass correlation coefficient indicated good reliability between sessions for each side (0.81 and 0.8 respectively). DISCUSSION Our results indicate that MScanFit MUNE is a feasible method with good reproducibility for MUNE of the FCU muscle. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Halil Can Alaydin
- Department of Neurology, Gazi University Faculty of Medicine, Ankara, Turkey.,Department of Neurology, Clinical Neurophysiology Division, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Nur Turkmen
- Clinic of Clinical Neurophysiology, Tekirdag Dr. Ismail Fehmi Cumalioglu City Hospital, Tekirdag, Turkey
| | - H Evren Boran
- Department of Neurology, Gazi University Faculty of Medicine, Ankara, Turkey.,Department of Neurology, Clinical Neurophysiology Division, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Bulent Cengiz
- Department of Neurology, Gazi University Faculty of Medicine, Ankara, Turkey.,Department of Neurology, Clinical Neurophysiology Division, Gazi University Faculty of Medicine, Ankara, Turkey
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Jende JME, Mooshage C, Kender Z, Kopf S, Groener JB, Heiland S, Juerchott A, Nawroth P, Bendszus M, Kurz FT. Magnetic Resonance Neurography Reveals Smoking-Associated Decrease in Sciatic Nerve Structural Integrity in Type 2 Diabetes. Front Neurosci 2022; 15:811085. [PMID: 35242003 PMCID: PMC8886720 DOI: 10.3389/fnins.2021.811085] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/17/2021] [Indexed: 12/23/2022] Open
Abstract
Objective It is controversially discussed in how far smoking contributes to diabetic polyneuropathy (DPN) in type 2 diabetes (T2D). Diffusion-weighted magnetic resonance neurography (MRN) at 3 Tesla has been shown to provide objective values for structural nerve integrity in patients with T2D. The aim of this study was to investigate the contribution of cigarette smoking on structural nerve integrity in T2D. Methods This cross-sectional prospective cohort study investigated the structural integrity of the sciatic nerve in 10 smokers, 40 never-smokers, and 20 ex-smokers with T2D and 10 healthy control subjects, using diffusion tensor imaging MRN at 3 Tesla and semi-automated nerve fiber tracking. Results were correlated with clinical, electrophysiological, and serological data. Results The sciatic nerve’s fractional anisotropy (FA), a parameter for structural nerve integrity, was significantly lower in smokers with T2D when compared to controls (p = 0.002) and never-smokers (p = 0.015), and lower in ex-smokers when compared to controls (p = 0.015). In addition, sciatic nerve radial diffusivity, a marker of myelin damage, was increased in smokers versus controls and never-smokers (p = 0.048, p = 0.049, respectively). Furthermore, FA in T2D patients was negatively correlated with clinical and electrophysiological markers of DPN. FA also showed negative correlations with the pulse wave velocity, a marker of arterial stiffness and associated microangiopathy, in controls (r = −0.70; p = 0.037), never-smokers (r = −0.45; p = 0.004), ex-smokers (r = −0.55; p = 0.009), and a similar trend in smokers (r = −0.63; p = 0.076). Negative correlations were found between FA and skin auto-fluorescence, a marker of tissue advanced glycation end product accumulation and therefore long-term glycemic stress in T2D, in never-smokers (r = −0.39; p = 0.020) and smokers (r = −0.84; p = 0.004), but not in ex-smokers (r = −0.07; p = 0.765). Conclusion The findings indicate that smoking contributes to sciatic nerve damage in T2D, potentially worsening DPN due to glycemic stress and less microangiopathy-associated myelin damage in active smokers, while angiopathic effects predominate in ex-smokers. To stop smoking may therefore pose a promising preventive measure to slow the progression of DPN in T2D.
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Affiliation(s)
- Johann M E Jende
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Mooshage
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Zoltan Kender
- Department of Endocrinology, Diabetology and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Kopf
- Department of Endocrinology, Diabetology and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany.,German Center of Diabetes Research, München-Neuherberg, Germany
| | - Jan B Groener
- Department of Endocrinology, Diabetology and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany.,German Center of Diabetes Research, München-Neuherberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.,Division of Experimental Radiology, Department of Neuroradiology, Heidelberg, Germany
| | - Alexander Juerchott
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Nawroth
- Department of Endocrinology, Diabetology and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany.,German Center of Diabetes Research, München-Neuherberg, Germany.,Joint Institute for Diabetes and Cancer at Helmholtz-Zentrum Munich and Heidelberg University, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix T Kurz
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Radiology (E010), German Cancer Research Center, Heidelberg, Germany
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The characteristics of pain and dysesthesia in patients with diabetic polyneuropathy. PLoS One 2022; 17:e0263831. [PMID: 35176062 PMCID: PMC8853492 DOI: 10.1371/journal.pone.0263831] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/28/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction/aims Patients with diabetic polyneuropathy (DPN) may experience paresthesia, dysesthesia, and pain. We aimed to characterize the predictors, symptoms, somatosensory profile, neuropathy severity, and impact of painful DPN and dysesthetic DPN. Methods This study was a cross-sectional study of type 2 diabetes patients with confirmed DPN, diagnosed using widely accepted methods including a clinical examination, skin biopsy, and nerve conduction studies. Findings Of 126 patients with confirmed DPN, 52 had DPN without pain or dysesthesia, 21 had dysesthetic DPN, and 53 painful DPN. Patients with painful DPN were less physically active and suffered from more pain elsewhere than in the feet compared to patients with DPN without pain. Patients with painful DPN had the largest loss of small and large sensory fiber function, and there was a gradient of larger spatial distribution of sensory loss from DPN without dysesthesia/pain to dysesthetic DPN and to painful DPN. This could indicate that patients with dysesthesia had more severe neuropathy than patients without dysesthesia but less than patients with painful DPN. Patients with dysesthetic and painful DPN had higher symptom scores for depression and fatigue than those without dysesthesia/pain with no difference between dysesthetic and painful DPN. Conclusions There was a gradient of increasing sensory loss from DPN without dysesthesia/pain to dysesthetic DPN and to painful DPN. Pain and dysesthesia are common in DPN and both interfere with daily life. It is therefore important to consider dysesthesia when diagnosing and treating patients with neuropathy.
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58
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Wang H, Zheng J, Yu Q, Fan Z, Lo WLA, Li L, Wang C. Electrical Properties of Lumbar Paraspinal Muscles in Young Adults With and Without Chronic Low Back Pain Based on Electrical Impedance Myography: A Cross-Sectional Study. Front Neurol 2022; 12:789589. [PMID: 35250793 PMCID: PMC8891446 DOI: 10.3389/fneur.2021.789589] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/20/2021] [Indexed: 12/21/2022] Open
Abstract
Background Lumbar paraspinal muscle (LPM) is important in spinal stabilization in patients with chronic low back pain (CLBP). However, the electrical properties of LPM in patients with CLBP remain unclear. Electrical impedance myography (EIM) is a novel and non-invasive technique that provides a simple quantitative evaluation of electrical properties of the LPM. Purpose This study aimed to apply EIM to assess the electrical properties of the LPM between patients with CLBP and healthy control (HC). Methods Thirty participants (15 CLBP participants; 15 healthy controls) were enrolled in the study. Participants in the CLBP group were asked to complete the visual analog scale (VAS), Oswestry Disability Index (ODI), and Roland–Morris Disability Questionnaire (RDQ) to assess the pain intensity and disability in daily life. Independent sample t-tests were adopted to analyze the basic characteristics between the two groups. At 5, 50, 100, and 200 kHz current frequencies, the electrical properties were measured on each side of the LPM. The EIM parameters of resistance (R), reactance (X), phase angle (PA), and Z value were analyzed by one-way analysis of variance (ANOVA), with age as covariate. Spearman's rank correlation coefficient analysis was applied to explore the relationships between the questionnaires and the EIM parameters. Results The R and Z values of bilateral LPM in the CLBP group were significantly larger than those in the HC group; the PA decreased and the X did not change at these four tested current frequencies. At 5 kHz, Z and R on the right side were non-significantly different between patients and HCs. Correlation analysis showed that at 50 kHz, ODI and RDQ scores correlated negatively with the R of the bilateral LPM (r = 0.523, r = 0.581, respectively; p < 0.05). RDQ scores correlated positively with the PA of the right LPM (r = 0.521, p < 0.05). Conclusion The electrical properties of the bilateral LPM differed between CLBP participants and healthy individuals, regardless of the different frequencies used. These altered electrical properties of the LPM in the patients with CLBP correlated to some extent with disability in daily life.
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Affiliation(s)
- Hongjiang Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiaxuan Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiuhua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ziyan Fan
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Le Li
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an, China
- *Correspondence: Le Li
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Chuhuai Wang
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Tankisi H, Bostock H, Grafe P. A test to determine the site of abnormal neuromuscular refractoriness. Clin Neurophysiol Pract 2022; 7:1-6. [PMID: 34984248 PMCID: PMC8693356 DOI: 10.1016/j.cnp.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/18/2021] [Accepted: 11/07/2021] [Indexed: 10/26/2022] Open
Abstract
Objective The relative refractory period (RRP) of motor axons is an important parameter in nerve excitability tests of the recovery cycle (RC). Abnormalities may have a site in the axonal membrane, the neuromuscular junction, or in a dysfunction of the muscle. We aimed in this study to determine the site of abnormality, using a modified protocol of the conventional RC test, whereby an additional supramaximal stimulus is added at the same interstimulus interval as in RC recordings (RCSM). Methods Twenty-four healthy subjects aged 37.8 ± 2.4 years (mean ± SE) were examined with median nerve excitability testing using RC and RCSM protocols at normal temperature (34.1 ± 0.2 °C). The recordings were repeated in 12 subjects after selective cooling of the thenar muscle (25.2 ± 0.7 °C) and in 12 subjects after cooling the nerve trunk at the wrist (24.9 ± 0.3 °C). Results After cooling the nerve, RRP measured with RC and RCSM were prolonged similarly (medians by 1.8 ms, and 2.1 ms respectively). In contrast, cooling the muscle prolonged RRP measured with RC (by 1.3 ms), but did not significantly prolong RRP measured with RCSM. RRPs measured by RC and RCSM were significantly different when cooling was at the muscle (P = 5.10-4), but not when cooling was at the nerve (P = 0.57). Conclusions A difference between RC and RCSM indicates abnormal excitability distal to the axonal membrane under the stimulating electrode. Significance Combining RCSM with the conventional RC protocol should help to localize the site of abnormal neuromuscular refractoriness.
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Affiliation(s)
- Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hugh Bostock
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Peter Grafe
- Institute of Physiology, Ludwig-Maximilians University Munich, Germany
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Ma JY, Liu XY, Zhang S, Fan DS. Ultra-early amplitude decrement after repetitive nerve stimulation supports early neuromuscular junction injury in amyotrophic lateral sclerosis: a prospective cross-sectional study. Neural Regen Res 2022; 17:655-660. [PMID: 34380907 PMCID: PMC8504376 DOI: 10.4103/1673-5374.320998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The dying-back hypothesis holds that the damage to neuromuscular junctions and distal axons in amyotrophic lateral sclerosis occurs at the earliest stage of the disease. Previous basic studies have confirmed early damage to neuromuscular junctions, but it is difficult to obtain such evidence directly in clinical practice. In this prospective cross-sectional study, we recruited 22 patients with early amyotrophic lateral sclerosis with disease duration < 12 months and with clinical symptoms limited to the upper limbs. We also recruited 32 healthy controls. Repetitive nerve stimulation was performed, and patients were followed for 12 months. We found a significant change in the response to repetitive nerve stimulation in amyotrophic lateral sclerosis patients without spontaneous electromyographic activity. Patients that were prone to denervation had an increased decrement response of target muscles after repetitive nerve stimulation. These results suggest that changes in response to repetitive nerve stimulation may occur before denervation in amyotrophic lateral sclerosis patients. The damage to lower motor neurons is more obvious in patients with a higher percentage of repetitive never stimulation-related amplitude decrements. This study was approved by the Institutional Ethics Committee of Peking University Third Hospital (approval No. M2017198) on August 24, 2017.
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Affiliation(s)
- Jing-Yue Ma
- Department of Neurology, Peking University Third Hospital; Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xiang-Yi Liu
- Department of Neurology, Peking University Third Hospital; Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Shuo Zhang
- Department of Neurology, Peking University Third Hospital; Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Dong-Sheng Fan
- Department of Neurology, Peking University Third Hospital; Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
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The additional diagnostic value of motor nerve excitability testing in chronic axonal neuropathy. Clin Neurophysiol Pract 2022; 7:27-33. [PMID: 35128215 PMCID: PMC8803553 DOI: 10.1016/j.cnp.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022] Open
Abstract
Nerve excitability testing was correlated with conventional nerve conduction studies. Nerve excitability testing was similar in patients with and without neuropathy and normal nerve conduction. There is no support for the potential additional diagnostic value of nerve excitability testing in mixed etiology neuropathy.
Objective To explore potential differences in motor nerve excitability testing (NET) variables at group levels between patients with a clinical diagnosis of polyneuropathy (PNP), which did not fulfil diagnostic criteria of conventional nerve conduction studies (NCS) and patients without polyneuropathy. Such differences could support a role for NET in increasing the diagnostic sensitivity of NCS in chronic axonal PNP. Methods Motor NET was performed using the median nerve in patients with a clinical suspicion of PNP in addition to conventional NCS, skin biopsies, corneal confocal microscopy and structured clinical evaluation including scoring of neuropathy symptoms and signs. Results Of the 57 patients included, 32 had PNP, half of which had NCS, which fulfilled criteria for PNP (NCS+ PNP). There were no significant differences for any of the NET variables between PNP patients with non-diagnostic conventional NCS (NCS− PNP) and patients without PNP. Rheobase was increased, and Ted (undershoot) and subexcitability were decreased in NCS+ PNP. Sural amplitude, peroneal nerve F-wave latency and tibial nerve F-wave-latency were correlated with subexcitability, and tibial nerve motor amplitude was correlated with rheobase. Conclusions NET was correlated with conventional NCS and no differences were found between NCS− PNP patients and patients without PNP. Significance NET does not seem to offer any additional diagnostic value in chronic mixed etiology neuropathy.
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Verdugo RJ, Matamala JM, Inui K, Kakigi R, Valls-Solé J, Hansson P, Bernhard Nilsen K, Lombardi R, Lauria G, Petropoulos IN, Malik RA, Treede RD, Baumgärtner U, Jara PA, Campero M. Review of techniques useful for the assessment of sensory small fiber neuropathies: Report from an IFCN expert group. Clin Neurophysiol 2022; 136:13-38. [DOI: 10.1016/j.clinph.2022.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 02/09/2023]
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63
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Menon D, Mansfield P, Cordice D, Studer C, O’Leary M, Sheean G, Bril V. A pilot study of a novel transmembranous electromyography device for assessment of oral cavity and oropharyngeal muscles. Muscle Nerve 2021; 65:303-310. [DOI: 10.1002/mus.27479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 12/19/2021] [Accepted: 12/23/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Deepak Menon
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, University of Toronto Toronto Canada
| | - Perry Mansfield
- Senta Clinic, Division of Otolaryngology – Head and Neck Surgery San Diego California USA
| | - Derrick Cordice
- Senta Clinic, Division of Otolaryngology – Head and Neck Surgery San Diego California USA
| | | | - Michael O’Leary
- Senta Clinic, Division of Otolaryngology – Head and Neck Surgery San Diego California USA
| | | | - Vera Bril
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, University of Toronto Toronto Canada
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Gylfadottir SS, Itani M, Kristensen AG, Tankisi H, Jensen TS, Sindrup SH, Bennett D, Nyengaard JR, Finnerup NB, Karlsson P. Analysis of Macrophages and Peptidergic Fibers in the Skin of Patients With Painful Diabetic Polyneuropathy. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 9:9/1/e1111. [PMID: 34764216 PMCID: PMC8587735 DOI: 10.1212/nxi.0000000000001111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/04/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVES The mechanisms of pain in patients with diabetic polyneuropathy are unknown. Studies have suggested a role of inflammation and increased neuropeptides peripherally in pain generation. This study examined the possible skin markers of painful diabetic polyneuropathy (P-DPN): macrophages, substance P (SP), and calcitonin gene-related peptide (CGRP). METHODS The participants were included from a large Danish cross-sectional clinical study of type 2 diabetes. We diagnosed definite diabetic polyneuropathy using the Toronto criteria and used the Neuropathic Pain Special Interest Group classification for defining P-DPN. We included 60 skin biopsies from patients with diabetic polyneuropathy-30 with P-DPN and 30 with nonpainful diabetic polyneuropathy (NP-DPN)-and 30 biopsies from healthy controls of similar age and sex. The biopsies were stained using PGP 9.5, IbA1, and SP and CGRP primary markers. RESULTS There was increased macrophage density in patients with P-DPN (8.0%) compared with that in patients with NP-DPN (5.1%, p < 0.001), and there was increased macrophage density in patients with NP-DPN (5.1%) compared with that in healthy controls (3.1%, p < 0.001). When controlling for neuropathy severity, body mass index, age, and sex, there was still a difference in macrophage density between patients with P-DPN and patients with NP-DPN. Patients with P-DPN had higher median nerve fiber length density (274.5 and 155 mm-2 for SP and CGRP, respectively) compared with patients with NP-DPN (176 and 121 mm-2 for SP and CGRP, respectively, p = 0.009 and 0.04) and healthy controls (185.5 and 121.5 mm-2 for SP and CGRP, respectively), whereas there was no difference between patients with NP-DPN and controls without diabetes (p = 0.64 and 0.49, respectively). The difference between P-DPN and NP-DPN for SP and CGRP was significant only in female patients, although a trend was seen in male patients. DISCUSSION The findings point to a possible involvement of the innate immune system in the pathogenesis of neuropathic pain in patients with DPN, although markers of activated macrophages were not measured in this study.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Pall Karlsson
- From the Danish Pain Research Center (S.S.G., T.S.J., N.B.F., P.K.), Department of Clinical Medicine, Aarhus University; Research Unit for Neurology (M.I., S.H.S.), Odense University Hospital, Odense, Denmark, University of Southern Denmark, Odense; Department of Clinical Neurophysiology (A.G.K., H.T.), Aarhus University Hospital; Department of Neurology (S.S.G., T.S.J., N.B.F.), Aarhus University Hospital, Denmark; Nuffield Department of Clinical Neurosciences (D.B.), University of Oxford, United Kingdom; Core Center for Molecular Morphology (J.R.N., P.K.), Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University; and Department of Pathology (J.R.N.), Aarhus University Hospital, Denmark.
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The role of potassium in muscle membrane dysfunction in end-stage renal disease. Clin Neurophysiol 2021; 132:3125-3135. [PMID: 34740043 DOI: 10.1016/j.clinph.2021.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/15/2021] [Accepted: 09/01/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Uremic myopathy is a condition seen in end-stage renal disease (ESRD), characterized by muscle weakness and muscle fatigue, in which the pathophysiology is uncertain. The aim of this study was to assess the role of abnormal serum constituents in ESRD patients by relating them to the excitability properties of the tibialis anterior muscle, at rest and during electrically induced muscle activation, by recording muscle velocity recovery cycles (MVRC) and frequency ramp responses. METHODS Eighteen ESRD patients undergoing hemodialysis were evaluated by blood sample, MVRC, and frequency ramp (before and near the end of dialysis treatment), quantitative electromyography, and nerve conduction studies. Patients were compared to 24 control subjects. RESULTS In patients, muscle relative refractory period, early supernormality, late supernormality after 5 conditioning stimuli, and latency of the last of 15 and 30 frequency ramp pulses were strongly associated with potassium levels (p < 0.01), showing depolarization before and normalization in the end of hemodialysis. CONCLUSIONS In ESRD patients, the muscle membrane is depolarized, mainly due to hyperkalemia. SIGNIFICANCE Since normal muscle fatigue has been attributed to potassium-induced depolarization, it seems likely that this mechanism is also a major cause of the exaggerated muscle fatigue and weakness in ESRD patients.
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66
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Kaiserova M, Kastelikova A, Grambalova Z, Otruba P, Zapletalova J, Mensikova K, Rosales R, Kanovsky P. Temperature sensation in Parkinson's disease measured by quantitative sensory testing: a single-center, case-control study. Int J Neurosci 2021:1-6. [PMID: 34666599 DOI: 10.1080/00207454.2021.1991922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The pathophysiology of abnormal temperature sensation in Parkinson's disease (PD) remains unclear. Abnormal thermal detection does not seem to depend on the dopaminergic deficit, suggesting that other systems play a role in these changes, probably both central and peripheral. METHODS We measured thermal detection thresholds (TDT) using quantitative sensory testing (QST) in 28 patients with PD and compared them with 15 healthy controls. RESULTS Of 28 patients, 21% had increased TDT according to the normative data. TDT were higher on the dominant side. No correlation between TDT and disease duration, severity of motor impairment, and dopaminergic therapy was observed. 50% of the patients had difficulty differentiating between warm and cold stimuli, as TDT were within the normal range in most of these patients. CONCLUSIONS Twenty-one percent of the patients in our study had increased TDT according to the normative data. Abnormal thermal detection was more pronounced on the dominant side. Abnormal differentiation between the thermal stimuli suggest impaired central processing of thermal information.
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Affiliation(s)
- Michaela Kaiserova
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic
| | - Anetta Kastelikova
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic
| | - Zuzana Grambalova
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic
| | - Pavel Otruba
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic
| | - Jana Zapletalova
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic
| | - Katerina Mensikova
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic
| | - Raymond Rosales
- The Neuroscience Institute, Department of Neurology and Psychiatry, University of Santo Tomas University Hospital, Manila, Philippines
| | - Petr Kanovsky
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic
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Lehtilahti M, Kallio M, Majamaa K, Kärppä M. Phenotype of Patients With Charcot-Marie-Tooth With the p.His123Arg Mutation in GDAP1 in Northern Finland. NEUROLOGY-GENETICS 2021; 7:e629. [PMID: 34632054 PMCID: PMC8495501 DOI: 10.1212/nxg.0000000000000629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/22/2021] [Accepted: 08/11/2021] [Indexed: 11/24/2022]
Abstract
Background and Objectives Mutations in the ganglioside-induced differentiation-associated protein 1 (GDAP1) gene cause autosomal dominant or autosomal recessive forms of Charcot-Marie-Tooth disease (CMT). Our aim was to study the clinical phenotype of patients with CMT caused by heterozygous p.His123Arg in GDAP1. Methods Twenty-three Finnish patients were recruited from a population-based cohort and through family investigation. Each patient was examined clinically and electrophysiologically. The Neuropathy Symptom Score and the Neuropathy Disability Score (NDS) were used in clinical evaluation. Results The median age at onset of symptoms was 17 years among patients with p.His123Arg in GDAP1. Motor symptoms were markedly more common than sensory symptoms at onset. All patients had distal weakness in lower extremities, and 17 (74%) patients had proximal weakness. Muscle atrophy and pes cavus were also common. Nineteen (82%) patients had sensory symptoms such as numbness or pain. The disease progressed with age, and the NDS increased 8.5 points per decade. Electrodiagnostic testing revealed length-dependent, sensory and motor axonal polyneuropathy. EDx findings were asymmetrical in 14 patients. Genealogic study of the families suggested a founder effect. Discussion We found that CMT in patients with p.His123Arg in GDAP1 is relatively mild and slow in progression.
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Affiliation(s)
- Maria Lehtilahti
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital (M.L., K.M., M.Kärppä); Research Unit of Clinical Neuroscience, University of Oulu (M.L., K.M., M.Kärppä); Department of Neurology, Oulu University Hospital (M.L., K.M., M.Kärppä); Department of Clinical Neurophysiology, Medical Research Center Oulu, Oulu University Hospital (M.Kallio); Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu (M.Kallio), Oulu, Finland
| | - Mika Kallio
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital (M.L., K.M., M.Kärppä); Research Unit of Clinical Neuroscience, University of Oulu (M.L., K.M., M.Kärppä); Department of Neurology, Oulu University Hospital (M.L., K.M., M.Kärppä); Department of Clinical Neurophysiology, Medical Research Center Oulu, Oulu University Hospital (M.Kallio); Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu (M.Kallio), Oulu, Finland
| | - Kari Majamaa
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital (M.L., K.M., M.Kärppä); Research Unit of Clinical Neuroscience, University of Oulu (M.L., K.M., M.Kärppä); Department of Neurology, Oulu University Hospital (M.L., K.M., M.Kärppä); Department of Clinical Neurophysiology, Medical Research Center Oulu, Oulu University Hospital (M.Kallio); Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu (M.Kallio), Oulu, Finland
| | - Mikko Kärppä
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital (M.L., K.M., M.Kärppä); Research Unit of Clinical Neuroscience, University of Oulu (M.L., K.M., M.Kärppä); Department of Neurology, Oulu University Hospital (M.L., K.M., M.Kärppä); Department of Clinical Neurophysiology, Medical Research Center Oulu, Oulu University Hospital (M.Kallio); Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu (M.Kallio), Oulu, Finland
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Patel K, Horak HA. Electrodiagnosis of Common Mononeuropathies: Median, Ulnar, and Fibular (Peroneal) Neuropathies. Neurol Clin 2021; 39:939-955. [PMID: 34602220 DOI: 10.1016/j.ncl.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This article addresses common mononeuropathies seen in the electrodiagnostic laboratory. The most common mononeuropathies-median neuropathy at the wrist (carpal tunnel syndrome), ulnar neuropathy at the elbow, and fibular (peroneal) neuropathy at the fibular head-are reviewed. The causes, clinical presentations, approached to the electrodiagnostic studies (including nerve conduction studies and needle electromyography), and the typical findings are discussed.
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Affiliation(s)
- Kamakshi Patel
- University of Texas Medical Branch (UTMB), 301 University Boulevard, JSA 9.128, Galveston, TX 77555, USA
| | - Holli A Horak
- University of Arizona College of Medicine- Tucson, 1501 North Campbell Avenue, Room 6212a, Tucson, AZ 87524, USA.
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Abstract
Needle electromyography (EMG) waveforms recorded during needle EMG help to define the type, temporal course, and severity of a neuromuscular disorder. Accurate interpretation of EMG waveforms is a critical component of an electrodiagnostic examination. This article reviews the significance of spontaneous EMG waveforms and changes in voluntary motor unit potentials in neuromuscular disorders.
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70
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Katzberg HD, Abraham A. Electrodiagnostic Assessment of Neuromuscular Junction Disorders. Neurol Clin 2021; 39:1051-1070. [PMID: 34602214 DOI: 10.1016/j.ncl.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Please verify edits, "These techniques", or specify. This article reviews advanced electrodiagnostic techniques used to assess for neuromuscular junction disorders, including repetitive nerve stimulation, conventional or concentric-needle single-fiber electromyography (SFEMG), and stimulated SFEMG. These techniques have high sensitivity but limited specificity. Novel methods currently under investigation are discussed, including vestibular ocular myogenic potential and oculography analysis.
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Affiliation(s)
- Hans D Katzberg
- Division of Neurology, University Health Network, Toronto General Hospital, 200 Elizabeth Street, 5ES-306, Toronto, Ontario M5G 2C4, Canada.
| | - Alon Abraham
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
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71
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Diagnostik von Myopathien bei Kindern und Jugendlichen. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01319-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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72
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Paparella G, Ceccanti M, Colella D, Cannavacciuolo A, Guerra A, Inghilleri M, Berardelli A, Bologna M. Bradykinesia in motoneuron diseases. Clin Neurophysiol 2021; 132:2558-2566. [PMID: 34479133 DOI: 10.1016/j.clinph.2021.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/23/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Only few studies investigated voluntary movement abnormalities in patients with motoneuron diseases (MNDs) or their neurophysiological correlates. We aimed to kinematically assess finger tapping abnormalities in patients with amyotrophic lateral sclerosis (ALS) and primary lateral sclerosis (PLS), as compared to healthy controls (HCs), and their relationship with motoneuron involvement. METHODS Fourteen ALS and 5 PLS patients were enrolled. Finger tapping was assessed by a motion analysis system. Patients underwent a central motor conduction time assessment, a motor nerve conduction study, and needle electromyography. Data were compared to those of 79 HCs using non-parametric tests. Possible relationships between clinical, kinematic, and neurophysiological data were assessed in patients. RESULTS As a major finding, ALS and PLS patients performed finger tapping slower than HCs. In both conditions, movement slowness correlated with muscle strength. In ALS, movement slowness also correlated with the amplitude of the compound muscle action potential recorded from the muscles involved in the task and with denervation activity. No correlations were found between slowness, measures of upper motoneuron involvement, and other clinical and neurophysiological data. CONCLUSIONS This study provides novel information on voluntary movement abnormalities in MNDs. SIGNIFICANCE The results highlight the pathophysiological role of motoneurons in generating movement slowness.
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Affiliation(s)
| | - Marco Ceccanti
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | | | | | | | - Alfredo Berardelli
- IRCCS Neuromed Pozzilli (IS), Italy; Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - Matteo Bologna
- IRCCS Neuromed Pozzilli (IS), Italy; Department of Human Neurosciences, Sapienza University of Rome, Italy
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73
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Gabr RM, El Salmawy DA, Basheer MA, Khairy M, Elkholy SH. Relation between the severity of liver cirrhosis and neurological symptoms, nerve conduction study results, and motor unit number estimation. J Viral Hepat 2021; 28:1312-1318. [PMID: 34048134 DOI: 10.1111/jvh.13552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/02/2021] [Accepted: 05/16/2021] [Indexed: 01/29/2023]
Abstract
Liver cirrhosis is a global health problem that can be associated with several neurological manifestations. We aimed to assessment of the relation between the severity of the liver cirrhosis and the neurological symptoms, nerve conduction studies (NCS), as well as detecting subclinical neuropathic affection using motor unit number estimation (MUNE) technique. This cross-sectional study was conducted on 56 cirrhotic patients and 61 age- and sex-matched healthy controls. Neurological manifestations, Child-Pugh classification, Model for End-Stage Liver Disease score, NCS and MUNE using a modified spike-triggered averaging technique were studied. Forty-five (80.3%) of the cirrhotic patients had neurological manifestations. Muscle cramps were the most frequently reported manifestation, followed by fatigue and then numbness. NCS abnormality was significantly related to the presence of neurological symptoms (p < 0.001) and not only to peripheral numbness. Only fatigue was significantly related to the lower MUNE values (p < 0.017). Child-Pugh classification progression was significantly related to the presence of fatigue and abnormal NCS results (p < 0.001); no similar relation was detected between the Child-Pugh classification and the MUNE value (p = 0.103). Higher MELD scores were significantly related to NCS abnormalities (p = 0.014) and negatively correlated, although not significantly, with the MUNE values (r = -0.246 and p = 0.067). The progression of liver cirrhosis was related to the presence of neurological manifestations and nerve conduction abnormalities. Nerve conduction abnormalities may be present even in the absence of clinical numbness. A decline in motor unit number could explain the pathophysiology of fatigue in cirrhotic patients.
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Affiliation(s)
- Reem M Gabr
- Clinical Neurophysiology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina A El Salmawy
- Clinical Neurophysiology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mye A Basheer
- Clinical Neurophysiology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa Khairy
- Endemic Medicine Department and Hepatology unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Saly H Elkholy
- Clinical Neurophysiology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
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Agergaard J, Leth S, Pedersen TH, Harbo T, Blicher JU, Karlsson P, Østergaard L, Andersen H, Tankisi H. Reply to "Maybe myopathic EMG but not myopathy" and to "Exclude differentials before attributing post-COVID fatigue to myopathy". Clin Neurophysiol 2021; 132:2326-2327. [PMID: 34326011 DOI: 10.1016/j.clinph.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Affiliation(s)
- J Agergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - S Leth
- Department of Medicine, Regional Hospital Unit West, Jutland, Denmark
| | - T H Pedersen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - T Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - J U Blicher
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; Centre of Functionally Integrated Neuroscience, Aarhus University, Aarhus, Denmark
| | - P Karlsson
- Danish Pain Research Center, Aarhus University, Denmark
| | - L Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.
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Xia X, Li Y, Wang Y, Xia J, Lin Y, Zhang X, Liu Y, Zhang J. Functional role of dorsolateral prefrontal cortex in the modulation of cognitive bias. Psychophysiology 2021; 58:e13894. [PMID: 34227119 DOI: 10.1111/psyp.13894] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 05/31/2021] [Accepted: 06/18/2021] [Indexed: 12/11/2022]
Abstract
Human cognition is often biased. It is a fundamental question in psychology how cognitive bias is modulated in the human brain. Automatic action tendency is a typical cognitive bias. The dorsolateral prefrontal cortex (DLPFC) is a crucial area for processing various behavioral tasks. We investigated the functional role of DLPFC in the modulation of cognitive bias by testing the automatic action tendency during automatic and regulated behavioral tasks. Unilateral intermittent or continuous theta burst stimulation (excitatory iTBS or inhibitory cTBS) was used to manipulate the left or right DLPFC excitability and assess the changes in automatic action tendency during a manikin task. An approaching behavior with positive stimulus and avoiding behavior with negative stimulus were performed in an automatic task. An approaching behavior with negative stimulus and avoiding behavior with positive stimulus were performed in a regulated task. Reaction time was measured. We confirmed the automatic action tendency that reaction time for performing an automatic task was shorter than that for performing a regulated task. The automatic action tendency was enhanced after left DLPFC excitatory iTBS and was abolished after left DLPFC inhibitory cTBS stimulation. On the other hand, right DLPFC excitatory iTBS accelerated the avoiding behaviors and right DLPFC inhibitory cTBS accelerated approaching behaviors. The results suggest that left DLPFC modulates the automatic action tendency while the right DLPFC modulates the direction of behavioral tasks. We conclude that left DLPFC and right DLPFC are key nodes in modulating the cognitive bias while their functional roles are different.
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Affiliation(s)
- Xue Xia
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Yansong Li
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Yanqiu Wang
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Jing Xia
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Yitong Lin
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Xiaoxiao Zhang
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Yu Liu
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Jian Zhang
- School of Psychology, Shanghai University of Sport, Shanghai, China
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Marquetand J, Middelmann T, Dax J, Baek S, Sometti D, Grimm A, Lerche H, Martin P, Kronlage C, Siegel M, Braun C, Broser P. Optically pumped magnetometers reveal fasciculations non-invasively. Clin Neurophysiol 2021; 132:2681-2684. [PMID: 34274216 DOI: 10.1016/j.clinph.2021.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This proof-of-principle-study evaluated the extent to which spontaneous activity (SA) of the muscle can be detected via non-invasive magnetomyography (MMG) with optically pumped magnetometers (OPM). METHODS Five patients, who together exhibited all forms of SA (fibrillations, positive sharp waves, fasciculations, myotonic discharges, complex-repetitive discharges) with conventional needle electromyography (EMG), were studied by OPM-MMG and simultaneous surface EMG (sEMG) while at rest, during light muscle activation, and when a muscle stretch reflex was elicited. Three healthy subjects were measured as controls. SA was considered apparent in the OPM-MMG if a signal could be visually detected that corresponded in shape and frequency to the SA in the respective needle EMG. RESULTS SA in the context of fasciculations could be detected in 2 of 5 patients by simultaneous OPM-MMG/sEMG. Other forms of SA could not be detected at rest, during light muscle activation, or after provocation of a muscle stretch reflex. CONCLUSIONS Results show that fasciculations could be detected non-invasively via a new method (OPM). SIGNIFICANCE We show that other forms of SA are not detectable with current OPM and propose necessary technical solutions to overcome this circumstance. Our results motivate to pursue OPM-MMG as a new clinical neurophysiological diagnostic.
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Affiliation(s)
- Justus Marquetand
- Department of Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; Department of Neural Dynamics and Magnetoencephalography, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; MEG-Center, University of Tübingen, Tübingen, Germany.
| | - Thomas Middelmann
- Department of Biosignals, Physikalisch-Technische Bundesanstalt (PTB), Berlin, Germany
| | - Juergen Dax
- Department of Neural Dynamics and Magnetoencephalography, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; MEG-Center, University of Tübingen, Tübingen, Germany
| | - Sangyeob Baek
- Department of Neural Dynamics and Magnetoencephalography, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; MEG-Center, University of Tübingen, Tübingen, Germany
| | - Davide Sometti
- Department of Neural Dynamics and Magnetoencephalography, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; MEG-Center, University of Tübingen, Tübingen, Germany
| | - Alexander Grimm
- Department of Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Holger Lerche
- Department of Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Pascal Martin
- Department of Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Cornelius Kronlage
- Department of Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Markus Siegel
- Department of Neural Dynamics and Magnetoencephalography, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; MEG-Center, University of Tübingen, Tübingen, Germany; Center for Integrative Neuroscience, University of Tübingen, Tübingen, Germany
| | - Christoph Braun
- Department of Neural Dynamics and Magnetoencephalography, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; MEG-Center, University of Tübingen, Tübingen, Germany; CIMeC, Center for Mind/Brain Sciences, University of Trento, Rovereto, Italy; DiPsCo, Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy
| | - Philip Broser
- Children's Hospital of Eastern Switzerland, Sankt Gallen, Switzerland
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Tankisi H. Ulnar neuropathy at the elbow: Is ultrasound a substitute or supplement to electrodiagnostic tests? Clin Neurophysiol 2021; 132:2253-2254. [PMID: 34130910 DOI: 10.1016/j.clinph.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/19/2022]
Affiliation(s)
- H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Leandri G, Schenone A, Leandri M. Detection of movement related cortical potentials in freehand drawing on digital tablet. J Neurosci Methods 2021; 360:109231. [PMID: 34081997 DOI: 10.1016/j.jneumeth.2021.109231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/01/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cortical activity connected to movements has been investigated long since, and is related, among other factors, to saliency of the gesture. However, experiments performed on movements in actual situations are rare, as most of them have been performed in laboratory simulations. Besides, no research seems to have been carried out on subjects during freehand drawing. NEW METHOD We propose a method based upon a commercial drawing tablet and wireless pen, that has been synchronized with EEG recording by means of a piezoelectric sensor attached to the pen tip. Complete freedom of movement is allowed, and any kind of drawing style can be performed using currently available graphics software. RESULTS EEG recordings during meaningful drawing were compared with recordings where the pen was tapped and shifted on tablet without specific purpose. With reference to T0 event (pen touching tablet), several components could be observed in pre- and post-T0 epochs. The most important appeared to be a triphasic wave (N-150, P-40 and N + 30), where P-40 showed a striking difference between drawing and tap session, being much larger in the former. COMPARISON WITH EXISTING METHODS Onset of muscle EMG is usually employed for synchronization. In complex and free gestures too many muscles are active to allow reliable identification of such reference. Our method provides a precise trigger event easily detected without movement constraints. CONCLUSIONS With this method it will be possible to record EEG activity related to creative aspects of drawing and explore other skilled movements.
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Affiliation(s)
- Gaia Leandri
- Universitat Politecnica de Valencia, Departamento de Expresión Gráfica Arquitectónica, Camino de Vera, s/n, 46022, Valencia, Spain; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili (DINOGMI), Università degli Studi di Genova, Largo Daneo 3, 16132, Genova, Italy.
| | - Angelo Schenone
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili (DINOGMI), Università degli Studi di Genova, Largo Daneo 3, 16132, Genova, Italy; UO Clinica Neurologica, IRCCS. Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy.
| | - Massimo Leandri
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili (DINOGMI), Università degli Studi di Genova, Largo Daneo 3, 16132, Genova, Italy.
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79
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Schulte-Mattler WJ. Myo-Neurografie 1990–2020 entlang der „Wissenspunkte für die EMG-Prüfung“ der DGKN. KLIN NEUROPHYSIOL 2021. [DOI: 10.1055/a-1305-0863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungDie „Wissenspunkte für die EMG-Prüfung“ der DGKN (https://dgkn.de/images/richtlinien/RL18_EMG_Wissenpunkte.pdf) sind zuletzt vor 10 Jahren bearbeitet worden. Diese letzte Aktualisierung hatte nur zu geringen Änderungen geführt. Fast alle dieser Punkte sind so im Wesentlichen unverändert aufgelistet, seit der Autor dieser Zeilen EMG betreibt, also seit mehr als 30 Jahren. Hier soll der Versuch unternommen werden, anhand dieser Punkte aufzuzeigen, was sich in dieser Zeit verändert hat, was neu ist, aber auch, was weggefallen ist – oder wegfallen sollte.
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Affiliation(s)
- Wilhelm J. Schulte-Mattler
- Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg, Zentrum für Altersmedizin, Regensburg
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80
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Reijntjes RH, Potters WV, Kerkhof FI, van Zwet E, van Rossum IA, Verhamme C, Tannemaat MR. Deriving reference values for nerve conduction studies from existing data using mixture model clustering. Clin Neurophysiol 2021; 132:1820-1829. [PMID: 34130250 DOI: 10.1016/j.clinph.2021.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 03/23/2021] [Accepted: 04/10/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE to obtain locally valid reference values (RVs) from existing nerve conduction study (NCS) data. METHODS we used age, sex, height and limb temperature-based mixture model clustering (MMC) to identify normal and abnormal measurements on NCS data from two university hospitals. We compared MMC-derived RVs to published data; examined the effect of using different variables; validated MMC-derived RVs using independent data from 26 healthy control subjects and investigated their clinical applicability for the diagnosis of polyneuropathy. RESULTS MMC-derived RVs were similar to published RVs. Clustering can be achieved using only sex and age as variables. MMC is likely to yield reliable results with fewer abnormal than normal measurements and when the total number of measurements is at least 300. Measurements from healthy controls fell within the 95% MMC-derived prediction interval in 97.4% of cases. CONCLUSIONS MMC can be used to obtain RVs from existing data, providing a locally valid, accurate reflection of the (ab)normality of an NCS result. SIGNIFICANCE MMC can be used to generate locally valid RVs for any test for which sufficient data are available.1.
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Affiliation(s)
- R H Reijntjes
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.
| | - W V Potters
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands.
| | - F I Kerkhof
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.
| | - E van Zwet
- Department of Biostatistics, Leiden University Medical Center, Leiden, the Netherlands.
| | - I A van Rossum
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.
| | - C Verhamme
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands.
| | - M R Tannemaat
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.
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81
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Agergaard J, Leth S, Pedersen TH, Harbo T, Blicher JU, Karlsson P, Østergaard L, Andersen H, Tankisi H. Myopathic changes in patients with long-term fatigue after COVID-19. Clin Neurophysiol 2021; 132:1974-1981. [PMID: 34020890 PMCID: PMC8102077 DOI: 10.1016/j.clinph.2021.04.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 12/15/2022]
Abstract
Objective To investigate the peripheral nerve and muscle function electrophysiologically in patients with persistent neuromuscular symptoms following Coronavirus disease 2019 (COVID-19). Methods Twenty consecutive patients from a Long-term COVID-19 Clinic referred to electrophysiological examination with the suspicion of mono- or polyneuropathy were included. Examinations were performed from 77 to 255 (median: 216) days after acute COVID-19. None of the patients had received treatment at the intensive care unit. Of these, 10 patients were not even hospitalized. Conventional nerve conduction studies (NCS) and quantitative electromyography (qEMG) findings from three muscles were compared with 20 age- and sex-matched healthy controls. Results qEMG showed myopathic changes in one or more muscles in 11 patients (55%). Motor unit potential duration was shorter in patients compared to healthy controls in biceps brachii (10.02 ± 0.28 vs 11.75 ± 0.21), vastus medialis (10.86 ± 0.37 vs 12.52 ± 0.19) and anterior tibial (11.76 ± 0.31 vs 13.26 ± 0.21) muscles. All patients with myopathic qEMG reported about physical fatigue and 8 patients about myalgia while 3 patients without myopathic changes complained about physical fatigue. Conclusions Long-term COVID-19 does not cause large fibre neuropathy, but myopathic changes are seen. Significance Myopathy may be an important cause of physical fatigue in long-term COVID-19 even in non-hospitalized patients.
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Affiliation(s)
- J Agergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - S Leth
- Department of Medicine, Regional Hospital Unit West, Jutland, Denmark
| | - T H Pedersen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - T Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - J U Blicher
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; Centre of Functionally Integrated Neuroscience, Aarhus University, Aarhus, Denmark
| | - P Karlsson
- Danish Pain Research Center, Aarhus University, Denmark
| | - L Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.
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82
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Bartl M, Krahn A, Riggert J, Paulus W. Needle EMG induced muscle bleeding complication after guideline approved discontinuation of anticoagulation. Clin Neurophysiol Pract 2021; 6:109-114. [PMID: 33981918 PMCID: PMC8081989 DOI: 10.1016/j.cnp.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 02/14/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022] Open
Abstract
After needle EMG an intramuscular hematoma, requiring surgical evacuation, occurred. Anticoagulation was paused according to guidelines; one patient had an undetected genetic disorder of platelet function. Substituting apixaban for enoxaparin may have contributed to the complications.
Introduction Needle electromyography (EMG) is an essential part of electrodiagnosis (EDX) in neuromuscular disorders. As in all invasive procedures there is a risk of bleeding complications, but which is rare according to the current literature. Controlled, prospective studies that include patients under anticoagulation or antiplatelet therapy are lacking and would be difficult to conduct. Case reports We describe two patients with no history of coagulopathy who developed an intramuscular hematoma after needle EMG. They had been under therapeutic anticoagulation but this had been discontinued, and their standard coagulation parameters had returned to normal prior to the EMG. One patient was found to have a rare genetic defect in thromboxane synthesis with associated markedly impaired platelet aggregation, while no obvious cause of the bleeding was found in the second patient. However, it could have been due to an unexpectedly strong anticoagulatory response to the oral anticoagulant apixaban. Conclusion One must be aware of the increased risk of bleeding events in patients with therapeutic anticoagulation. These can occur even when the recommendations regarding discontinuation of anticoagulant drugs for the procedure have been followed. The patient must be actively questioned for ongoing use of NSAIDs, and if pain therapy is required alternatives with no antiplatelet activity should be given. A larger data pool of adverse EMG events would aid in risk assessment and decision making.
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Affiliation(s)
- Michael Bartl
- Department of Clinical Neurophysiology, University Medical Center, Goettingen, Robert Koch Str. 40, D37075 Göttingen, Germany
| | - Arne Krahn
- Department of Clinical Neurophysiology, University Medical Center, Goettingen, Robert Koch Str. 40, D37075 Göttingen, Germany
| | - Joachim Riggert
- Department of Transfusion Medicine, University Medical Center, Goettingen, Robert Koch Str. 40, D37075 Göttingen, Germany
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Goettingen, Robert Koch Str. 40, D37075 Göttingen, Germany
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Karlsson P, Provitera V, Caporaso G, Stancanelli A, Saltalamacchia AM, Borreca I, Manganelli F, Santoro L, Jensen TS, Nolano M. Increased peptidergic fibers as a potential cutaneous marker of pain in diabetic small fiber neuropathy. Pain 2021; 162:778-786. [PMID: 32833793 DOI: 10.1097/j.pain.0000000000002054] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/12/2020] [Indexed: 12/14/2022]
Abstract
ABSTRACT Diabetic polyneuropathy (DPN) is a common complication of diabetes and is often associated with neuropathic pain. The mechanisms underlying development and maintenance of painful DPN are largely unknown, and quantification of intraepidermal nerve fiber density from skin biopsy, one of the neuropathological gold standard when diagnosing DPN, does not differentiate between patients with and without pain. Identification of possible pain pathophysiological biomarkers in patients with painful DPN may increase our knowledge of mechanisms behind neuropathic pain. Animal models of painful DPN have been shown to have an increased density of peptidergic nerve fibers (substance P and calcitonin gene-related peptide). In this study, we performed a detailed skin biopsy analysis in a well-characterized group of DPN patients with primarily small fiber involvement, with and without pain, and in healthy controls and test for correlation between skin biopsy findings and pain intensity and quantitative sensory testing. We found that although there was no difference in intraepidermal nerve fiber density using protein gene product 9.5 between patients with and without pain, patients with pain had increased density of dermal peptidergic fibers containing substance P and calcitonin gene-related peptide compared with patients with painless DPN and healthy controls. Peptidergic nerve fiber density correlated with pain ratings in patients with pain (R = 0.33; P = 0.019), but not with quantitative sensory testing results. In this article, we show, for the first time in humans, an increased density of dermal peptidergic fibers in painful DPN. These findings provide new insight in the pathophysiological mechanisms of pain in diabetes and open the research towards new therapeutic targets.
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Affiliation(s)
- Pall Karlsson
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Core Center for Molecular Morphology, Section for Stereology and Microscopy , Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Vincenzo Provitera
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Neurology, Institute of Telese Terme, Italy
| | - Giuseppe Caporaso
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Neurology, Institute of Telese Terme, Italy
| | - Annamaria Stancanelli
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Neurology, Institute of Telese Terme, Italy
| | - Anna Maria Saltalamacchia
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Neurology, Institute of Telese Terme, Italy
| | - Ilaria Borreca
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Neurology, Institute of Telese Terme, Italy
| | - Fiore Manganelli
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Lucio Santoro
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Troels Staehelin Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maria Nolano
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Neurology, Institute of Telese Terme, Italy
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
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Tankisi A, Pedersen TH, Bostock H, Z'Graggen WJ, Larsen LH, Meldgaard M, Elkmann T, Tankisi H. Early detection of evolving critical illness myopathy with muscle velocity recovery cycles. Clin Neurophysiol 2021; 132:1347-1357. [PMID: 33676846 DOI: 10.1016/j.clinph.2021.01.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/29/2020] [Accepted: 01/19/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the sensitivity of muscle velocity recovery cycles (MVRCs) for detecting altered membrane properties in critically ill patients, and to compare this to conventional nerve conduction studies (NCS) and quantitative electromyography (qEMG). METHODS Twenty-four patients with intensive care unit acquired weakness (ICUAW) and 34 healthy subjects were prospectively recruited. In addition to NCS (median, ulnar, peroneal, tibial and sural nerves) and qEMG (biceps brachii, vastus medialis and anterior tibial muscles), MVRCs with frequency ramp were recorded from anterior tibial muscle. RESULTS MVRC and frequency ramp parameters showed abnormal muscle fiber membrane properties with up to 100% sensitivity and specificity. qEMG showed myopathy in 15 patients (63%) while polyneuropathy was seen in 3 (13%). Decreased compound muscle action potential (CMAP) amplitude (up to 58%) and absent F-waves (up to 75%) were frequent, but long duration CMAPs were only seen in one patient with severe myopathy. CONCLUSIONS Altered muscle fiber membrane properties can be detected in patients with ICUAW not yet fulfilling diagnostic criteria for critical illness myopathy (CIM). MVRCs may therefore serve as a tool for early detection of evolving CIM. SIGNIFICANCE CIM is often under-recognized by intensivists, and large-scale longitudinal studies are needed to determine its incidence and pathogenesis.
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Affiliation(s)
- A Tankisi
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - T H Pedersen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - H Bostock
- Institute of Neurology, University College London, Queen Square House, London, United Kingdom
| | - W J Z'Graggen
- Departments of Neurology and Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - L H Larsen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - M Meldgaard
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - T Elkmann
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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85
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Barkhaus PE, Nandedkar SD. Atypical fibrillation and fasciculation potentials: An exercise in waveform identification and analysis. Muscle Nerve 2021; 63:657-660. [PMID: 33565086 DOI: 10.1002/mus.27199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/03/2021] [Accepted: 02/06/2021] [Indexed: 11/09/2022]
Abstract
No consensus criteria exist for recording and analyzing waveforms in clinical electromyography (EMG). There have been significant technical improvements in recent decades that are under-used in both routine practice and research. In current practice, disciplined techniques in acquisition and analysis of signals are required to appropriately define them. As an example, we describe such an exercise in acquisition and analysis. During a routine study, atypical spontaneous activity was encountered. High-quality digital recordings were stored for off-line analysis. These revealed waveforms that could be isolated and quantitatively defined using basic instrumentation available on most modern EMG systems: "slow" firing fibrillation potentials and a repeating fasciculation potential. Subjective analysis alone could not have identified them. To improve accuracy in identification and understanding of these waveforms, we propose criteria for data collection and signal analysis. This is critical for quality in routine practice, education, and proper reporting of electrophysiological signals.
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Affiliation(s)
| | - Sanjeev D Nandedkar
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Natus Medical Inc, Hopewell Junction, New York, USA
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86
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Shahrizaila N. Non-invasive electromyography as a disease biomarker: Are we only scratching the surface? Clin Neurophysiol 2021; 132:808-809. [PMID: 33558128 DOI: 10.1016/j.clinph.2021.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Nortina Shahrizaila
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia.
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87
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Okhovat AA, Advani S, Moradi K, Ziaadini B, Panahi A, Nafissi S, Haghi Ashtiani B, Fatehi F. Application of CMAP scan for the evaluation of patients with chronic inflammatory demyelinating polyneuropathy: a prospective study. Neurophysiol Clin 2021; 51:175-181. [PMID: 33423829 DOI: 10.1016/j.neucli.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/26/2020] [Accepted: 12/26/2020] [Indexed: 11/28/2022] Open
Abstract
AIMS We aimed to assess the compound muscle action potential (CMAP) scan in the follow-up of chronic inflammatory demyelinating polyneuropathy (CIDP) patients and investigate the correlation of CMAP scan parameters with functional and standard electrodiagnostic tests. METHODS We evaluated four parameters of abductor pollicis brevis (APB) CMAP scan (i.e., step numbers, step percentage, S10, S90), functional measures (e.g., Medical Research Council Sum Scores), and electrodiagnostic tests, including nerve conduction study (NCS) and motor NCS of the median nerve in the baseline and after six months of treatment. RESULTS Twenty patients completed baseline clinical and electrodiagnostic studies. However, sixteen patients completed the follow-up study. The median of step numbers at baseline was 3.5 (2-4.2), which decreased to 2.5 (0-3) (p = 0.005). After the treatment, step percentage reduced from 28.6 (23.9-38.7) to 13.4 (0-23.6) (p = 0.001). The scores obtained from the clinical scales showed significant recovery of most of the functions, while the alterations of NCSS and NCS of the median nerve were not significant. CONCLUSIONS We found a significant reduction in step number and step percentage after follow-up. This alteration was not reflected in standard electrodiagnostic values. The improvement of functional scales alongside the CMAP scan parameters suggests that the CMAP scan could be considered an appropriate outcome measurement in research and clinical fields.
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Affiliation(s)
- Ali Asghar Okhovat
- Neurology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soroor Advani
- Neurology Department, Shohada Tajrish Hospital, Shahid-Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamyar Moradi
- Neurology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bentolhoda Ziaadini
- Neurology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Panahi
- Neurology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahriar Nafissi
- Neurology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Haghi Ashtiani
- Neurology Department, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farzad Fatehi
- Neurology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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88
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A novel statistical decimal pattern-based surface electromyogram signal classification method using tunable q-factor wavelet transform. Soft comput 2021. [DOI: 10.1007/s00500-020-05205-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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89
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Day TJ. Proximal fibular nerve conduction studies to tibialis anterior: Optimal E2 (reference electrode) placement. Muscle Nerve 2020; 63:344-350. [PMID: 33244766 DOI: 10.1002/mus.27127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Several E2 (reference electrode) positions are described for fibular (peroneal) nerve conduction studies to tibialis anterior (TA). METHODS This study compared the contribution of different E2 sites to the TA motor response, using remote referential recordings and different bipolar montages. RESULTS The medial knee contributes minimal electrical activity to the bipolar TA recordings, whereas tibial, ankle, and toe references resulted in very similar, moderate amplitude contributions consistent with far field potentials. These observations were very similar in controls and in patients with lower leg symptoms and signs. CONCLUSIONS Standard montages using distal leg or foot E2 sites result in lower amplitudes with distortion arising from the E2 electrode, compared with the TA-Knee montage. Optimal measurement of the TA motor response is achieved using a medial knee reference, without compromising measures of fibular nerve conduction across the knee.
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Affiliation(s)
- Timothy J Day
- Department of Clinical Neurophysiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
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90
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Witt A, Fuglsang-Frederiksen A, Finnerup N, Kasch H, Tankisi H. Detecting peripheral motor nervous system involvement in chronic spinal cord injury using two novel methods: MScanFit MUNE and muscle velocity recovery cycles. Clin Neurophysiol 2020; 131:2383-2392. [DOI: 10.1016/j.clinph.2020.06.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/14/2020] [Accepted: 06/19/2020] [Indexed: 12/11/2022]
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91
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Measuring latency distribution of transcallosal fibers using transcranial magnetic stimulation. Brain Stimul 2020; 13:1453-1460. [PMID: 32791313 PMCID: PMC7417270 DOI: 10.1016/j.brs.2020.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Neuroimaging technology is being developed to enable non-invasive mapping of the latency distribution of cortical projection pathways in white matter, and correlative clinical neurophysiological techniques would be valuable for mutual verification. Interhemispheric interaction through the corpus callosum can be measured with interhemispheric facilitation and inhibition using transcranial magnetic stimulation. OBJECTIVE To develop a method for determining the latency distribution of the transcallosal fibers with transcranial magnetic stimulation. METHODS We measured the precise time courses of interhemispheric facilitation and inhibition with a conditioning-test paired-pulse magnetic stimulation paradigm. The conditioning stimulus was applied to the right primary motor cortex and the test stimulus was applied to the left primary motor cortex. The interstimulus interval was set at 0.1 ms resolution. The proportions of transcallosal fibers with different conduction velocities were calculated by measuring the changes in magnitudes of interhemispheric facilitation and inhibition with interstimulus interval. RESULTS Both interhemispheric facilitation and inhibition increased with increment in interstimulus interval. The magnitude of interhemispheric facilitation was correlated with that of interhemispheric inhibition. The latency distribution of transcallosal fibers measured with interhemispheric facilitation was also correlated with that measured with interhemispheric inhibition. CONCLUSIONS The data can be interpreted as latency distribution of transcallosal fibers. Interhemispheric interaction measured with transcranial magnetic stimulation is a promising technique to determine the latency distribution of the transcallosal fibers. Similar techniques could be developed for other cortical pathways.
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92
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Estraneo A, Ciapetti M, Gaudiosi C, Grippo A. Not only pulmonary rehabilitation for critically ill patients with COVID-19. J Neurol 2020; 268:27-29. [PMID: 32676766 PMCID: PMC7364126 DOI: 10.1007/s00415-020-10077-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Anna Estraneo
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.
- Neurology Unit, SM Della Pietà General Hospital, Nola, Italy.
| | - Marco Ciapetti
- Cure Intensive del Trauma E Delle Gravi Insufficienze D'organo, AOU Careggi, Florence, Italy
| | | | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
- SODc Neurofisiopatologia, AOU Careggi, Florence, Italy
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93
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Lamb CJ, Rubin DI. Sensitivity and specificity of repetitive nerve stimulation with lower cutoffs for abnormal decrement in myasthenia gravis. Muscle Nerve 2020; 62:381-385. [PMID: 32530515 DOI: 10.1002/mus.26999] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The sensitivity of repetitive nerve stimulation (RNS) in myasthenia gravis (MG) is dependent on the cutoff for abnormal decrement. METHODS RNS data of adults with and without MG from 2014 to 2017 were reviewed retrospectively. The maximum reliable RNS amplitude/area decrement before and after exercise from facial, spinal accessory (SA), ulnar, and fibular nerves was recorded. Sensitivity/specificity using 5%, 7%, and 10% cutoffs were calculated. RESULTS Seventy-nine of 141 patients had MG (46 generalized, 21 ocular, 12 bulbar). A total of 608 unique RNS recordings were analyzed. Overall RNS sensitivity/specificity at ≥5%, ≥7%, and ≥10% amplitude cutoffs were as follows: SA, 65.6%/86.3%, 49.2%/94.1%, and 29.5%/96.1%; facial, 51.0%/82.5%, 43.1%/95.0%, and 37.3%/100%; ulnar, 43.6%/100%, 41.0%/100%, and 41.0%/100%; and fibular, 52.6%/89.5%, 42.1%/94.7%, and 42.1%/100%. DISCUSSION Lowering amplitude cutoff from 10% to 7% increased or maintained sensitivity with little loss in specificity. Post-exercise and area analysis resulted in increased sensitivity in some circumstances.
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Affiliation(s)
| | - Devon I Rubin
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
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94
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Yang L, Wang P. Somatic Nerve Reconstruction and Reinnervation. Somatosens Mot Res 2020. [DOI: 10.5772/intechopen.91755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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95
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Existing Guidelines in Electrodiagnostic Testing of Neuromuscular Disorders. J Clin Neurophysiol 2020; 37:275-276. [DOI: 10.1097/wnp.0000000000000667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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96
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Garcia MAC, Souza VH, Lindolfo-Almas J, Matsuda RH, Nogueira-Campos AA. Motor potential evoked by transcranial magnetic stimulation depends on the placement protocol of recording electrodes: a pilot study. Biomed Phys Eng Express 2020; 6:047003. [PMID: 33444285 DOI: 10.1088/2057-1976/ab950a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE There seems to be no consensus in the literature regarding the protocol of surface electromyography (sEMG) electrode placement for recording motor evoked potentials (MEP) in transcranial magnetic stimulation (TMS) applications. Thus, the aim of this study was to investigate the effect on the MEP amplitude bytwo different protocols for electrode placement. METHODS sEMG electrodes were placed on three upper arm muscles (biceps brachii, flexor carpi radialis, and flexor pollicis brevis) of six right-handed subjects following two different protocols (1 and 2), which varied according to the interelectrode distance and location relative to the muscle. TMS pulses were applied to the hotspot of biceps brachii, while sEMGwas recorded from the two protocols and for each muscle simultaneously. MAIN RESULTS Greater MEP amplitudes were obtained for Protocol 1 compared to Protocol 2 (P < 0.05). SIGNIFICANCE Different electrode placement protocols may result in distinct MEP amplitudes, which should be taken into account when adjusting the intensity on single and repetitive TMS sessions.
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Affiliation(s)
- Marco Antonio Cavalcanti Garcia
- Programa de Pós-Graduação em Ciências da Reabilitação e Desempenho Físico-Funcional, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil. Laboratório de Neurofisiologia Cognitiva, Departamento de Fisiologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil. Laboratório de Biomagnetismo, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
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97
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Ni Z, Vial F, Avram AV, Leodori G, Pajevic S, Basser PJ, Hallett M. Measuring conduction velocity distributions in peripheral nerves using neurophysiological techniques. Clin Neurophysiol 2020; 131:1581-1588. [PMID: 32417700 DOI: 10.1016/j.clinph.2020.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine how long it takes for neural impulses to travel along peripheral nerve fibers in living humans. METHODS A collision test was performed to measure the conduction velocity distribution of the ulnar nerve. Two stimuli at the distal and proximal sites were used to produce the collision. Compound muscle or nerve action potentials were recorded to perform the measurements on the motor or mixed nerve, respectively. Interstimulus interval was set at 1-5 ms. A quadri-pulse technique was used to measure the refractory period and calibrate the conduction time. RESULTS Compound muscle action potential produced by the proximal stimulation started to emerge at the interstimulus interval of about 1.5 ms and increased with the increment in interstimulus interval. Two groups of motor nerve fibers with different conduction velocities were identified. The mixed nerve showed a wider conduction velocity distribution with identification of more subgroups of nerve fibers than the motor nerve. CONCLUSIONS The conduction velocity distributions in high resolution on a peripheral motor and mixed nerve are different and this can be measured with the collision test. SIGNIFICANCE We provided ground truth data to verify the neuroimaging pipelines for the measurements of latency connectome in the peripheral nervous system.
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Affiliation(s)
- Zhen Ni
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, United States
| | - Felipe Vial
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, United States; Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Alexandru V Avram
- National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, United States
| | | | - Sinisa Pajevic
- Mathematical and Statistical Computing Laboratory, Center for Information Technology, National Institutes of Health, United States
| | - Peter J Basser
- Section on Quantitative Imaging and Tissue Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States.
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, United States.
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Reliability and reproducibility of visual e-norms plateau identification. Clin Neurophysiol Pract 2020; 5:83-86. [PMID: 32368700 PMCID: PMC7184101 DOI: 10.1016/j.cnp.2020.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 03/17/2020] [Accepted: 03/26/2020] [Indexed: 11/30/2022] Open
Abstract
Obtaining normal values for electrophysiologic studies is an arduous task. Evidence shows that visual assessment of the e-norms plateau permits deriving normal values from one's own laboratory data. No statistically significant difference was found between nerve conduction parameter Means obtained by different observers identifying the e-norms plateau.
Objective To derive normal values from a lab’s own diagnostic studies, the e-norms method relies on the proper identification of the e-norms plateau to derive descriptive statistics of the variable under study. This work was undertaken to compare the inter and intra-rater reliability of visual identification of the plateau by different raters analyzing laboratory nerve conductions study data. Methods Twenty raters were asked to visually identify the inflection points delineating an e-norms plateau to derive the Mean value of nerve conduction study laboratory data while blinded to the parameter they were analyzing. After a delay of 1–3 months, the same raters were asked to repeat some of the e-norms plateaus identification to assess delayed intra-rater reproducibility. Results Mean values derived from the identified plateau data were compared between raters (inter-rater) using a two factor ANOVA without replication. For the immediate inter-rater no statistically significant difference was found between the Means obtained by the different raters. For the delayed intra-rater, differences were found between raters. Conclusions This study suggests that visual identification of the e-norms plateau inflection point is reliable between raters but more research is needed to assess reproducibility for the same raters. Significance E-norms is a promising method for deriving reference values using data that is available in most electrophysiology laboratories.
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Tankisi H. Surface electromyography – A diagnostic and monitoring biomarker for amyotrophic lateral sclerosis? Clin Neurophysiol 2020; 131:936-937. [DOI: 10.1016/j.clinph.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/04/2020] [Indexed: 11/28/2022]
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Lirio-Romero C, Torres-Lacomba M, Gómez-Blanco A, Acero-Cortés A, Retana-Garrido A, de la Villa-Polo P, Sánchez-Sánchez B. Electromyographic biofeedback improves upper extremity function: a randomized, single-blinded, controlled trial. Physiotherapy 2020; 110:54-62. [PMID: 32718746 DOI: 10.1016/j.physio.2020.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine the effects of a 6-week surface electromyographic biofeedback intervention on the re-learning of upper extremity motor function in subjects with paretic upper extremity after stroke. DESIGN A randomized controlled trial. SETTING State Centre of Attention to Brain Injury, Madrid, Spain. PARTICIPANTS Thirty-eight participants in the sub-acute post-stroke stage were recruited and randomly allocated into either the surface electromyographic biofeedback (sEMG-BFB) or sham biofeedback (BFB) groups. INTERVENTIONS The sEMG-BFB group (n=19) received the intervention focused on re-learning scapulothoracic control during arm-reaching tasks involving shoulder abduction. The sham BFB group (n=19) received a sham intervention. OUTCOME MEASURES Upper extremity motor function assessed using the Fugl-Meyer Assessment-Upper Extremity Scale (66 points), the glenohumeral active range of motion, and the electromyographic amplitude signal of the middle deltoid and upper trapezius muscles were collected at baseline, after the intervention, and at the one-month follow-up. RESULTS Compared with the sham BFB group, the sEMG-BFB group experienced significant increases in upper extremity motor function after the intervention. The mean differences between groups were as follows: 4.79 points (95% CI 2.92 to 6.66) after the intervention; 6.55 points (95% CI 3.75 to 9.34) at the one-month follow-up; improved active range of motion 15.75 points (95% CI 6 to 30) after the intervention and electromyographic activity in the upper trapezius muscle changed in favour of the sEMG-BFB. CONCLUSIONS In the short term, a 6-week sEMG-BFB intervention effectively improved paretic upper limb motor function. Future research is needed to determine if the sEMG-BFB intervention has any long-term effects. Clinical trial number registration: NCT02974465 (ClinicalTrials.gov).
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Affiliation(s)
- Cristina Lirio-Romero
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain
| | - María Torres-Lacomba
- Physiotherapy in Women's Health (FPSM) Research Group, University of Alcalá, Madrid, Spain.
| | | | | | | | - Pedro de la Villa-Polo
- Physiotherapy in Women's Health (FPSM) Research Group, University of Alcalá, Madrid, Spain
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