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Bilgin Topçuoğlu Ö, Çetintaş Afşar G, Alibaş H, Uluç K. Impact of obstructive sleep apnea on neuromuscular transmission- a descriptive study. Cranio 2024; 42:292-297. [PMID: 34228607 DOI: 10.1080/08869634.2021.1952016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: Obstructive sleep apnea (OSA) is a sleep disorder accompanied by intermittent hypoxia. Neuromuscular transmission (NT) is known to be disturbed under chronic hypoxia. In this descriptive study, it has been aimed to test NT under intermittent hypoxia in OSA. Methods: Thirty-nine newly diagnosed OSA patients without any comorbidities or conditions that alter NT were included in the study. Jitter analysis was performed using a concentric needle electrode. Results: The mean jitter value of 39 OSA patients was 25.9 ± 3.7 μs. When compared to the mean reference jitter values, patients in the present study had significantly higher jitter (p < 0.001). Seven (17.9%) patients met the electrophysiological criteria for NT failure. Conclusion: The authors propose that intermittent hypoxia can be the trigger for NT failure in OSA. The interaction between increased oxidative stress and disturbed mitochondrial functions may also contribute.
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Affiliation(s)
| | - Gülgün Çetintaş Afşar
- Department of Chest Diseases, Sureyyapasa Chest Diseases and Thorax Surgery Training and Research Hospital, Istanbul, Turkey
| | - Hande Alibaş
- Department of Neurology, Marmara University, Medical School, Istanbul, Turkey
| | - Kayıhan Uluç
- Department of Neurology, Marmara University, Medical School, Istanbul, Turkey
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2
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Kouyoumdjian JA, Graca CR. Concentric needle jitter: Reference values in stimulated Tibialis Anterior muscle. Front Neurol 2022; 13:957174. [PMID: 35937059 PMCID: PMC9355656 DOI: 10.3389/fneur.2022.957174] [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: 05/30/2022] [Accepted: 06/23/2022] [Indexed: 12/04/2022] Open
Abstract
Calculating the reference values for jitter parameters utilizing a disposable concentric needle have been already done for the most often tested muscles. Jitter, expressed as the mean consecutive difference (MCD), was measured in the Tibialis Anterior (TA), not routinely tested muscle. Jitter measurement was taken using the intramuscular microaxonal stimulation technique in 32 healthy subjects. The mean MCD and the mean MCD of the 27th value from the 32 subjects had a normal distribution and were 19.79 ± 2.72 μs and 26.88 ± 3.56 μs, respectively. The suggested limit for the mean MCD is ≥ 26 μs and for the individual values is > 34 μs.
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Affiliation(s)
- João Aris Kouyoumdjian
- Neuromuscular Investigation Laboratory, Department of Neurological Sciences, Psychiatry and Medical Psychology, State Medical School (FAMERP), São Paulo, Brazil
| | - Carla Renata Graca
- Neuromuscular Investigation Laboratory, Department of Neurological Sciences, Psychiatry and Medical Psychology, State Medical School (FAMERP), São Paulo, Brazil
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Kouyoumdjian JA, Paiva GP, Stålberg E. Concentric Needle Jitter in 97 Myasthenia Gravis Patients. Front Neurol 2020; 11:600680. [PMID: 33281737 PMCID: PMC7691317 DOI: 10.3389/fneur.2020.600680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/13/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives: To estimate the jitter parameters (single-fiber electromyography) in myasthenia gravis patients mostly by electrical activation in Frontalis, Orbicularis Oculi, and Extensor Digitorum muscles using a concentric needle electrode. Methods: Between 2009 and 2019, a total of 97 myasthenia gravis patients, 52 male, and mean age 54 years were included. Results: Any abnormal jitter parameter in individual muscles was 90.5% (Frontalis), 88.5% (Orbicularis Oculi), and 86.6% (Extensor Digitorum). Any jitter parameter combining Orbicularis Oculi and Frontalis muscle was abnormal in 100% for the ocular, and in 92.9% for the generalized myasthenia gravis. The most abnormal muscle was Orbicularis Oculi for the generalized, and Frontalis for the ocular myasthenia gravis. The decrement was abnormal in 78.4%, 85.9% for the generalized, and 25% for the ocular myasthenia gravis. The mean jitter ranged from 14.2 to 86 μs (mean 33.3 μs) for the ocular myasthenia gravis and from 14.4 to 220.4 μs (mean 66.3 μs) for the generalized myasthenia gravis. The antibody titers tested positive in 86.6%, 91.8% for the generalized, and 50% for the ocular myasthenia gravis. Thymectomy was done in 48.5%, thymoma was found in 19.6%, and myasthenic crisis occurred by 21.6%. Conclusion: The jitter parameters achieved a 100% abnormality in ocular myasthenia gravis if both the Orbicularis Oculi and Frontalis muscles were tested. There was a high jitter abnormality in generalized myasthenia gravis cases with one muscle tested, with about a 2% increase in sensitivity when a second is added. Concentric needle electrode jitter had high sensitivity similar to the single fiber electrode (93.8%), followed by antibody titers (86.6%), and abnormal decrement (78.4%).
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Affiliation(s)
- João Aris Kouyoumdjian
- Laboratório Investigação Neuromuscular, Faculdade Estadual Medicina São José do Rio Preto, São Paulo, Brazil
| | - Gabriel Pina Paiva
- Laboratório Investigação Neuromuscular, Faculdade Estadual Medicina São José do Rio Preto, São Paulo, Brazil
| | - Erik Stålberg
- Department of Clinical Neurophysiology, Institute of Neurosciences, Uppsala University, Uppsala, Sweden
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An investigation on the effects of carbamazepine and sodium valproate on neuromuscular transmission. Acta Neurol Belg 2020; 120:545-548. [PMID: 28940165 DOI: 10.1007/s13760-017-0839-y] [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: 08/08/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Abstract
The aim of this study was to investigate the effects of sodium valproate (SV) and carbamazepine (CBZ) on neuromuscular transmission using single-fibre electromyography (SFEMG) in patients with epilepsy. We performed SFEMG during the voluntary contraction of extensor digitorum communis muscle. 30 epileptic patients taking SV, 25 epileptic patients taking CBZ, and 25 age-matched healthy volunteers were included in the study. Mean jitter values (MCD) of subjects taking SV and CBZ were compared with normal controls. MCD values of subjects taking SV and CBZ were statistically significantly higher than those of control group. Review of the correlation between disease duration and MCD values of patients showed that MCD values were increased with the prolonged use of drugs, and thus, indicated a positive relationship between these two parameters. These results suggest that both SV and CBZ reduce neuromuscular transmission in patients without a neuromuscular junction disease.
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Musa AMM, Ahmed AEM. Reference Jitter Values for Concentric Needle Electrode of Orbicularis Oculi and Frontalis Muscles Using Voluntary Activation Method in Sudanese Population. Sci Rep 2020; 10:1031. [PMID: 31974444 PMCID: PMC6978519 DOI: 10.1038/s41598-020-58037-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 01/09/2020] [Indexed: 11/18/2022] Open
Abstract
Single fibre electromyography is the most sensitive neurophysiological test for the diagnosis of neuromuscular junction disorders, particularly myasthenia gravis. The study aimed at establishing concentric needle (CN) normal jitter values for voluntarily activated orbicularis-oculi (V-OOc) & Frontalis (V-FRO) muscles in Sudanese population. 57 healthy volunteers (20 males & 37 females) were included in the study (mean Age 43.6 ± 14.2 years, range 18–70 years). V-OOc and V-FRO were tested in the same individual using CN. Jitter values were expressed as the mean consecutive difference (MCD) of 30 potential pairs in microseconds. The mean jitter, mean individual fibre pairs jitter & mean outliers jitter values with (upper 95% Confidence Limit-CL) for [OOc] were [26.9 ± 3.3 (31.97), 26.1 ± 8.9 (41.8) & 38.5 ± 5.7 (49.0) µs] & for [FRO] were [27.1 ± 3.0 (31.32), 26.4 ± 9.4 (42.9) & 39.9 ± 5 (49.2) µs] respectively. The suggested practical upper limits for mean jitter & for outliers were (32, 49 µs) for OOc & (31, 49 µs) for FRO. Our CN-jitter values were within the range of the few published studies. The study was unique in that it established and compared between CN reference jitter values of two voluntarily activated facial muscles (V-OOc & V-FRO) in the same individual in large number of healthy subjects.
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Affiliation(s)
- Afraa M M Musa
- Department of Physiology, Faculty of Medicine, University of Khartoum, El Qasr Street, Khartoum, P.O. BOX 102, Sudan.
| | - Ammar E M Ahmed
- Department of Physiology, Faculty of Medicine, University of Khartoum, El Qasr Street, Khartoum, P.O. BOX 102, Sudan
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6
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Concentric or monopolar electrode for jitter determination in orbicularis oculi. Clin Neurophysiol 2018; 129:2552-2556. [DOI: 10.1016/j.clinph.2018.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 08/29/2018] [Accepted: 09/23/2018] [Indexed: 11/20/2022]
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Sirin NG, Kocasoy Orhan E, Durmus H, Deymeer F, Baslo MB. Repetitive nerve stimulation and jitter measurement with disposable concentric needle electrode in newly diagnosed myasthenia gravis patients. Neurophysiol Clin 2018; 48:261-267. [DOI: 10.1016/j.neucli.2018.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/13/2018] [Accepted: 01/19/2018] [Indexed: 10/17/2022] Open
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8
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Clinical and CN-SFEMG evaluation of neostigmine test in myasthenia gravis. Neurol Sci 2018; 39:341-345. [PMID: 29330628 DOI: 10.1007/s10072-017-3194-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022]
Abstract
Neostigmine test (NT) is a pharmacological test, demonstrating a clinical improvement in patients affected by myasthenia gravis (MG). We aim to compare clinical evaluation and neurophysiological recordings by concentric-needle single-fiber electromyography (CN-SFEMG) in response to acute administration of neostigmine in ocular and generalized MG patients. Twenty-three MG patients (10 with ocular MG and 13 with generalized MG) were evaluated before and after 90 min neostigmine 0.5-mg administration. Clinical responsiveness was assessed by MG composite (MGC) scale. Neurophysiological evaluation by CN-SFEMG considered analysis of mean value of consecutive differences (MCD), single-pair jitter, and blocks. MGC scores significantly improved after NT in generalized MG patients (MGC 11.1 ± 7.6 vs 9.1 ± 6.7, p = 0.02), whereas the improvement was not significant in the ocular group. CN-SFEMG recordings significantly improved after NT in generalized MG patients (MCD 58.9 ± 18.8 vs 45.9 ± 23.2 μs, p = 0.003; single-pair jitter 49.8 ± 26.9 vs 24.1 ± 26.7%, p = 0.0001; blocks 6.2 ± 9.5 vs 2.6 ± 7.4%, p = 0.03) as well as in ocular MG patients (MCD 50.8 ± 22.7 vs 40.1 ± 22.9 μs, p = 0.01; single-pair jitter 35.9 ± 23.7 vs 20.0 ± 25.1%, p = 0.001). CN-SFEMG is a reliable tool to evaluate responsiveness to acute administration of neostigmine in MG. Moreover, neurophysiological modifications to NT could show subclinical improvement in ocular MG better than that of the clinical scale.
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9
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Pitfalls and errors in measuring jitter. Clin Neurophysiol 2017; 128:2233-2241. [DOI: 10.1016/j.clinph.2017.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/24/2017] [Accepted: 09/10/2017] [Indexed: 11/23/2022]
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10
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Liu MS, Niu JW, Li Y, Guan YZ, Cui LY. Quantitating Changes in Jitter and Spike Number Using Concentric Needle Electrodes in Amyotrophic Lateral Sclerosis Patients. Chin Med J (Engl) 2017; 129:1036-40. [PMID: 27098787 PMCID: PMC4852669 DOI: 10.4103/0366-6999.180533] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Single-fiber electromyography (SFEMG) has been suggested as a quantitative method for supporting chronic partial denervation in amyotrophic lateral sclerosis (ALS) by the revised EI Escorial criteria. Although concentric needle (CN) electrodes have been used to assess jitter in myasthenia gravis patients and healthy controls, there are few reports using CN electrodes to assess motor unit instability and denervation in neurogenic diseases. The aim of this study was to determine whether quantitative changes in jitter and spike number using CN electrodes could be used for ALS studies. Methods: Twenty-seven healthy controls and 23 ALS patients were studied using both CN and single-fiber needle (SFN) electrodes on the extensor digitorum communis muscle with an SFEMG program. The SFN-jitter and SFN-fiber density data were measured using SFN electrodes. The CN-jitter and spike number were measured using CN electrodes. Results: The mean CN-jitter was significantly increased in ALS patients (47.3 ± 17.0 μs) than in healthy controls (27.4 ± 3.3 μs) (P < 0.001). Besides, the mean spike number was significantly increased in ALS patients (2.5 ± 0.5) than in healthy controls (1.7 ± 0.3) (P < 0.001). The sensitivity and specificity in the diagnosis of ALS were 82.6% and 92.6% for CN-jitter (cut-off value: 32 μs), and 91.3% and 96.3% for the spike number (cut-off value: 2.0), respectively. There was no significant difference between the SFN-jitter and CN-jitter in ALS patients; meanwhile, there was no significant difference between the SFN-jitter and CN-jitter in healthy controls. Conclusion: CN-jitter and spike number could be used to quantitatively evaluate changes due to denervation-reinnervation in ALS.
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Affiliation(s)
| | | | | | | | - Li-Ying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
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11
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Guan Y, Ding Q, Liu M, Niu J, Cui L. Single-fiber EMG with concentric electrodes in lambert-eaton myasthenia. Muscle Nerve 2016; 56:253-257. [PMID: 27935068 DOI: 10.1002/mus.25500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 11/26/2016] [Accepted: 11/30/2016] [Indexed: 11/07/2022]
Abstract
INTRODUCTION We analyzed jitter recordings made with concentric needle electrode (CNE) single-fiber electromyography (SFEMG) in Lambert-Eaton myasthenia (LEM). METHODS Fifteen subjects diagnosed with LEM were studied using CNE-SFEMG in the extensor digitorum (ED) and tibialis anterior (TA) muscles. CNE-SFEMG in the ED and TA was also used to evaluate 12 and 10 healthy controls (HCs), respectively. RESULTS Ten men and 5 women were diagnosed with LEM based on an increase of 100% in compound muscle action potential amplitude during 50 Hz repetitive nerve stimulation. All patients exhibited markedly greater jitter in the ED (88.8 ± 23.2 µs) and TA (92.2 ± 30.2 µs) than HCs (28.3 ± 3.4 µs and 30.9 ± 5.1 µs, respectively). CONCLUSIONS CNE-SFEMG is sensitive for discovering abnormalities in neuromuscular transmission in LEM. Muscle Nerve 56: 253-257, 2017.
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Affiliation(s)
- Yuzhou Guan
- Department of Neurology, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Wangfujing, Dongcheng, Beijing, China, 100730
| | - Qingyun Ding
- Department of Neurology, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Wangfujing, Dongcheng, Beijing, China, 100730
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Wangfujing, Dongcheng, Beijing, China, 100730
| | - Jingwen Niu
- Department of Neurology, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Wangfujing, Dongcheng, Beijing, China, 100730
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Wangfujing, Dongcheng, Beijing, China, 100730
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C.N. Machado F, A. Kouyoumdjian JOÃO, E. Marchiori P. Diagnostic accuracy of concentric needle jitter in myasthenia: Prospective study. Muscle Nerve 2016; 55:190-194. [DOI: 10.1002/mus.25229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 06/03/2016] [Accepted: 06/24/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Flavia C.N. Machado
- Department of Neurology; Medical School, Universidade de São Paulo; São Paulo Brazil
- Fleury Medicina e Saúde; São Paulo Brazil
| | - JOÃO A. Kouyoumdjian
- Neuromuscular Investigation Laboratory; Faculdade Medicina São José do Rio Preto; São Paulo Brazil
| | - Paulo E. Marchiori
- Department of Neurology; Medical School, Universidade de São Paulo; São Paulo Brazil
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13
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Chiou-Tan FY, Gilchrist JM. Repetitive nerve stimulation and single-fiber electromyography in the evaluation of patients with suspected myasthenia gravis or Lambert-Eaton myasthenic syndrome: Review of recent literature. Muscle Nerve 2015; 52:455-62. [DOI: 10.1002/mus.24745] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Faye Y. Chiou-Tan
- Department of Physical Medicine and Rehabilitation; Baylor College of Medicine; Houston Texas USA
| | - James M. Gilchrist
- Department of Neurology; Southern Illinois University School of Medicine; Springfield Illinois USA
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Plomp JJ, Morsch M, Phillips WD, Verschuuren JJGM. Electrophysiological analysis of neuromuscular synaptic function in myasthenia gravis patients and animal models. Exp Neurol 2015; 270:41-54. [PMID: 25620417 DOI: 10.1016/j.expneurol.2015.01.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/07/2015] [Accepted: 01/16/2015] [Indexed: 12/21/2022]
Abstract
Study of the electrophysiological function of the neuromuscular junction (NMJ) is instrumental in the understanding of the symptoms and pathophysiology of myasthenia gravis (MG), an autoimmune disorder characterized by fluctuating and fatigable muscle weakness. Most patients have autoantibodies to the acetylcholine receptor at the NMJ. However, in recent years autoantibodies to other crucial postsynaptic membrane proteins have been found in previously 'seronegative' MG patients. Electromyographical recording of compound and single-fibre muscle action potentials provides a crucial in vivo method to determine neuromuscular transmission failure while ex vivo (miniature) endplate potential recordings can reveal the precise synaptic impairment. Here we will review these electrophysiological methods used to assess NMJ function and discuss their application and typical results found in the diagnostic and experimental study of patients and animal models of the several forms of MG.
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Affiliation(s)
- Jaap J Plomp
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Marco Morsch
- Motor Neuron Disease Research Group, Macquarie University, Sydney, Australia
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Jitter analysis with concentric needle electrodes in the extensor digitorum communis for the diagnosis of myasthenia gravis: a pilot study. Chin Med J (Engl) 2014. [DOI: 10.1097/00029330-201409200-00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Papathanasiou ES, Zamba-Papanicolaou E. Single fiber electromyography: What type of needle should I use? Clin Neurophysiol 2013; 124:2077-8. [DOI: 10.1016/j.clinph.2013.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 05/25/2013] [Accepted: 05/28/2013] [Indexed: 10/26/2022]
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Gulbas G, Kaplan Y, Kamisli O, Ermis H, Kamisli S, Ozcan C. Neuromuscular transmission in hypoxemic patients with chronic obstructive pulmonary disease. Respir Physiol Neurobiol 2013; 189:112-6. [PMID: 23886635 DOI: 10.1016/j.resp.2013.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 07/16/2013] [Accepted: 07/16/2013] [Indexed: 11/18/2022]
Abstract
Many studies have focused on the systemic effects of chronic obstructive pulmonary disease (COPD), but none has examined neuromuscular junction transmission (NMT). We evaluated NMT dysfunction using single-fiber electromyography (SFEMG) in patients with COPD. Twenty patients with COPD and 20 age-matched healthy controls were included in the study. All patients and controls underwent SFEMG. Abnormal NMT was found in seven of 20 patients (35%), but in none of the control subjects. The COPD patients were subgrouped according to the presence of hypoxemia. The patients with normoxemia were classified as Group 1, and the patients with hypoxemia were classified as Group 2. Abnormal NMT was found in six patients in Group 2 and in one in Group 1. While there was significant difference in terms of abnormal NMT between Group 2 and the controls, there was none between Group 1 and the controls. Our results show that NMT abnormalities can be present in hypoxemic patients with COPD.
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Affiliation(s)
- Gazi Gulbas
- Inonu University, Department of Pulmonary Diseases, Turkey.
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Abstract
Because of certain restrictions in medical praxis, reusable materials are only allowed in some countries. This also applies to electrodes for electromyography; the special single-fiber electromyography electrode must be replaced. This article gives some details of the possibilities of using an alternative-a small concentric needle electrode. Practical hints, reference values, and the application in diagnostic work for myasthenia gravis are summarized.
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Affiliation(s)
- Erik Stålberg
- Department of Clinical Neurophysiology, Uppsala University, Sweden.
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Kouyoumdjian JA, Stålberg E. Stimulated jitter with concentric needle in 42 myasthenia gravis patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:237-43. [DOI: 10.1590/0004-282x20130008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 10/26/2012] [Indexed: 11/22/2022]
Abstract
Objective: To estimate jitter parameters in myasthenia gravis in stimulated frontalis and extensor digitorum muscles using the concentric needle electrode. Methods: Forty-two confirmed myasthenia gravis patients, being 22 males (aged 45.6±17.2 years-old) were studied. Jitter was expressed as the mean consecutive difference (MCD). Results: MCD in extensor digitorum was 61.6 µs (abnormal in 85.7%) and in frontalis 57.3 µs (abnormal in 88.1%). Outliers represented 90.5% for extensor digitorum and 88.1% for frontalis. At least one jitter parameter was abnormal in 90.5% of the combined studies. Acetylcholine receptor antibody was abnormal in 85.7% of the cases. Conclusions: Stimulated jitter recordings measured from muscles using concentric needle electrode can be used for myasthenia gravis diagnosis with high sensitivity. Extensive normative studies are still lacking and, therefore, borderline findings should be judged with great caution.
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Affiliation(s)
- João Aris Kouyoumdjian
- Faculdade de Medicina de São José do Rio Preto (FAMERP); Neuromuscular Investigation Laboratory, Brazil
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20
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Kouyoumdjian JA, Stålberg EV. Concentric needle jitter on voluntary activated frontalis in 20 healthy subjects. Muscle Nerve 2013; 47:440-2. [DOI: 10.1002/mus.23710] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2012] [Indexed: 11/11/2022]
Affiliation(s)
- João A. Kouyoumdjian
- Faculdade de Medicina de São José do Rio Preto (FAMERP); Department of Neurological Sciences; Rua Luiz Antônio da Silveira 1661 15025-020 São José do Rio Preto São Paulo Brazil
| | - Erik V. Stålberg
- Department of Clinical Neurophysiology; University Hospital; Institute of Neuroscience Uppsala University; Uppsala Sweden
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21
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Affiliation(s)
- Donald B. Sanders
- Neuromuscular Section; Division of Neurology; Duke University Medical Center; Durham North Carolina 27710 USA
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Abstract
This article reviews the use of electrodiagnostic testing in disorders of neuromuscular transmission and discusses the differences between various presynaptic and postsynaptic disorders. Attention is paid to quality control issues that influence the sensitivity of repetitive nerve stimulation and single fiber electromyography. Electrodiagnostic testing, when used as an extension of the clinician's history and physical examination, will provide appropriate direction in establishing the diagnosis.
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Affiliation(s)
- James F Howard
- Neuromuscular Disorders Section, Department of Neurology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7025, USA.
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Narayanaswami P, Pantoja-Galicia N, Betensky RA, Rutkove SB. Application of futility analysis to refine jitter recordings in myasthenia gravis. Muscle Nerve 2012; 45:486-91. [PMID: 22431080 DOI: 10.1002/mus.22340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The current practice of single-fiber electromyography (SFEMG) requires that 20 fiber pairs with normal jitter be collected to exclude myasthenia gravis (MG). We applied principles of futility analysis from clinical trials in an attempt to reduce that requirement. METHODS We utilized conditional power futility analysis to assess the probability of an abnormal 20-pair SFEMG based on ongoing analysis of jitter as each pair is collected. Rules for early test termination in the presence of 0, 1, or 2 abnormal pairs were identified. These rules were then applied to previously collected SFEMG data. RESULTS SFEMG could be stopped at just 12 pairs if all are normal and at 17 pairs if 1 is abnormal. The rules successfully determined when SFEMG could be stopped in 104 of 106 (98%) studies originally reported to be normal. CONCLUSIONS If the first 12 SFEMG pairs have normal jitter, the study can be terminated and interpreted as normal.
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Affiliation(s)
- Pushpa Narayanaswami
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, TCC-8, 330 Brookline Avenue, Boston, Massachusetts 02215, USA.
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Kouyoumdjian JA, Stålberg EV. Concentric needle jitter in stimulated frontalis in 20 healthy subjects. Muscle Nerve 2012; 45:276-8. [DOI: 10.1002/mus.22306] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Neuromuscular Disorders. Neurology 2012. [DOI: 10.1007/978-0-387-88555-1_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Concentric needle jitter on stimulated frontalis and extensor digitorum in 20 myasthenia gravis patients. Muscle Nerve 2011; 44:912-8. [DOI: 10.1002/mus.22203] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Reference values for voluntary and stimulated single-fibre EMG using concentric needle electrodes: a multicentre prospective study. Clin Neurophysiol 2011; 123:613-20. [PMID: 21889397 DOI: 10.1016/j.clinph.2011.07.044] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 07/13/2011] [Accepted: 07/21/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study is to establish reference values for single-fibre electromyography (SFEMG) using concentric needles in a prospective, multicentre study. METHODS Voluntary or stimulated SFEMG at the extensor digitorum communis (EDC) or frontalis (FRO) muscles was conducted in 56-63 of a total of 69 normal subjects below the age of 60years at six Japanese institutes. The cut-off values for mean consecutive difference (MCD) of individual potentials were calculated using +2.5 SD or 95% prediction limit (one-tail) of the upper 10th percentile MCD value for individual subjects. RESULTS The cut-off values for individual MCD (+2.5 SD) were 56.8μs for EDC-V (voluntary SFEMG for EDC), 58.8μs for EDC-S (stimulated SFEMG for EDC), 56.8μs for FRO-V (voluntary SFEMG for FRO) and 51.0μs for FRO-S (stimulated SFEMG for FRO). The false positive rates using these cut-off values were around 2%. CONCLUSIONS The +2.5 SD and 95% prediction limit might be two optimal cut-off values, depending on the clinical question. The obtained reference values were larger than those reported previously using concentric needles, but might better coincide with conventional values. SIGNIFICANCE This is the first multicentre study reporting reference values for SFEMG using concentric needles. The way to determine cut-off values and the statistically correct definition of the percentile were discussed.
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Selvan VA. Single-fiber EMG: A review. Ann Indian Acad Neurol 2011; 14:64-7. [PMID: 21654930 PMCID: PMC3108086 DOI: 10.4103/0972-2327.78058] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 02/01/2011] [Accepted: 02/05/2011] [Indexed: 11/05/2022] Open
Affiliation(s)
- V Arul Selvan
- Walton Center for Neurology and Neurosurgery, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
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Kouyoumdjian JA, Stålberg EV. Concentric needle jitter on stimulated Orbicularis Oculi in 50 healthy subjects. Clin Neurophysiol 2011; 122:617-622. [DOI: 10.1016/j.clinph.2010.07.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 07/05/2010] [Accepted: 07/09/2010] [Indexed: 11/24/2022]
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