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Posa A, Kornhuber M. [EMG phenomena of myogenic hyperexcitability]. DER NERVENARZT 2024; 95:553-559. [PMID: 38193935 PMCID: PMC11178624 DOI: 10.1007/s00115-023-01597-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/10/2024]
Abstract
The type, distribution pattern and time course of spontaneous muscular activity are important for the diagnostics of neuromuscular diseases in the clinical practice. In neurogenic lesions with motor axonal involvement, pathologic spontaneous activity (PSA) is usually reliably detectable by needle electromyography (EMG) 2-4 weeks after occurrence of the lesion. The distribution pattern correlates with the lesion location. The focus of the present work is the description of the different forms of PSA in myogenic diseases.
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Affiliation(s)
- Andreas Posa
- Universitätsklinik für Neurologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - Malte Kornhuber
- Universitätsklinik für Neurologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
- Klinik für Neurologie, Helios Klinik Sangerhausen, Sangerhausen, Deutschland
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2
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Rubin DI, Lamb CJ. Motor unit potential recruitment reference values in common upper and lower extremity muscles. Clin Neurophysiol 2024:S1388-2457(24)00150-0. [PMID: 38777641 DOI: 10.1016/j.clinph.2024.05.001] [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: 02/15/2024] [Revised: 04/30/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE To define reference values for motor unit (MU) recruitment during needle EMG of six commonly examined muscles at low to moderate contraction. METHODS Needle examination was performed for each muscle in a total of 111 subjects without neuromuscular disorders. Fastest firing rates and recruitment ratios (RRs) were calculated in at least 5 sites within each muscle. Upper limits of normal based on 97th percentile for fastest MU firing rates and RRs were calculated for each muscle. The means of fastest firing rates were compared among muscles using the Friedman and Wilcoxon signed rank tests. RESULTS The upper limits of normal were 12-15 Hz for fastest firing rates and were slightly higher in the deltoid and triceps than the other muscles. CONCLUSION Firing rates >15 Hz recorded at multiple sites within a single muscle exceed the 97th percentile of normal subjects and may suggest reduced MU recruitment. In some muscles, rates >12 Hz might support mildly reduced recruitment. Recruitment ratios varied depending on number of firing MUs, whereas the fastest firing MU rate did not. SIGNIFICANCE The determination of reference values for fastest MU firing rates can help to identify mild reduction in recruitment with more accuracy.
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Affiliation(s)
- Devon I Rubin
- Electromyography Laboratory, Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
| | - Christopher J Lamb
- Electromyography Laboratory, Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
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3
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Zhao Z, Yu H, Wisniewski DJ, Cea C, Ma L, Trautmann EM, Churchland MM, Gelinas JN, Khodagholy D. Formation of Anisotropic Conducting Interlayer for High-Resolution Epidermal Electromyography Using Mixed-Conducting Particulate Composite. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024:e2308014. [PMID: 38600655 DOI: 10.1002/advs.202308014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/07/2024] [Indexed: 04/12/2024]
Abstract
Epidermal electrophysiology is a non-invasive method used in research and clinical practices to study the electrical activity of the brain, heart, nerves, and muscles. However, electrode/tissue interlayer materials such as ionically conducting pastes can negatively affect recordings by introducing lateral electrode-to-electrode ionic crosstalk and reducing spatial resolution. To overcome this issue, biocompatible, anisotropic-conducting interlayer composites (ACI) that establish an electrically anisotropic interface with the skin are developed, enabling the application of dense cutaneous sensor arrays. High-density, conformable electrodes are also microfabricated that adhere to the ACI and follow the curvilinear surface of the skin. The results show that ACI significantly enhances the spatial resolution of epidermal electromyography (EMG) recording compared to conductive paste, permitting the acquisition of single muscle action potentials with distinct spatial profiles. The high-density EMG in developing mice, non-human primates, and humans is validated. Overall, high spatial-resolution epidermal electrophysiology enabled by ACI has the potential to advance clinical diagnostics of motor system disorders and enhance data quality for human-computer interface applications.
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Affiliation(s)
- Zifang Zhao
- Department of Electrical Engineering, Columbia University, New York, 10027, USA
| | - Han Yu
- Department of Electrical Engineering, Columbia University, New York, 10027, USA
| | - Duncan J Wisniewski
- Department of Electrical Engineering, Columbia University, New York, 10027, USA
| | - Claudia Cea
- Department of Electrical Engineering, Columbia University, New York, 10027, USA
| | - Liang Ma
- Department of Biomedical Engineering, Columbia University, New York, 10027, USA
| | - Eric M Trautmann
- Department of Neuroscience, Columbia University, New York, NY, 10032, USA
- Zuckerman Mind Brain Behavior Institute, Columbia University, New York, 10027, USA
| | - Mark M Churchland
- Department of Neuroscience, Columbia University, New York, NY, 10032, USA
- Zuckerman Mind Brain Behavior Institute, Columbia University, New York, 10027, USA
- Kavli Institute for Brain Science, Columbia University, New York, 10032, USA
- Grossman Center for the Statistics of Mind, Columbia University, New York, USA
| | - Jennifer N Gelinas
- Department of Biomedical Engineering, Columbia University, New York, 10027, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, 10032, USA
| | - Dion Khodagholy
- Department of Electrical Engineering, Columbia University, New York, 10027, USA
- Department of Electrical Engineering, University of California, Irvine, CA, 92697, USA
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4
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Sun Y, Pahwa S, Vasireddy RP, Barty A, Raslau FD. Pearls & Oy-sters: Bibrachial Amyotrophy From a Dural Tear. Neurology 2024; 102:e209256. [PMID: 38484224 DOI: 10.1212/wnl.0000000000209256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/10/2024] [Indexed: 03/19/2024] Open
Abstract
Bibrachial amyotrophy signifies a clinical phenotype characterized by weakness in both upper extremities with preserved strength in the face, neck, and lower extremities. The underlying causes of bibrachial amyotrophy are broad. We report a patient exhibiting bibrachial amyotrophy who initially received a diagnosis of amyotrophic lateral sclerosis (ALS); however, his clinical course and NCS/EMG were atypical for ALS. Further evaluation demonstrated dural tears with CSF leak, resulting in a compressive extradural fluid collection, ventral myelopathy, and intracranial hypotension. Dural tear and ALS have overlapping features, including the manifestation of the bibrachial amyotrophy phenotype and the presence of T2 hyperintensities in the anterior horn cells, recognized by an "owl's eye" appearance on spine MRI. Clinical and radiologic vigilance is required to identify rare cases of dural tear causing ventral myelopathy that manifest as bibrachial amyotrophy.
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Affiliation(s)
- Yuyao Sun
- From the Departments of Neurology (Y.S., R.P.V., F.D.R.), Neurosurgery (S.P., F.D.R.), and Radiology (S.P., A.B., F.D.R.), University of Kentucky, Lexington
| | - Shivani Pahwa
- From the Departments of Neurology (Y.S., R.P.V., F.D.R.), Neurosurgery (S.P., F.D.R.), and Radiology (S.P., A.B., F.D.R.), University of Kentucky, Lexington
| | - Rani Priyanka Vasireddy
- From the Departments of Neurology (Y.S., R.P.V., F.D.R.), Neurosurgery (S.P., F.D.R.), and Radiology (S.P., A.B., F.D.R.), University of Kentucky, Lexington
| | - Andrew Barty
- From the Departments of Neurology (Y.S., R.P.V., F.D.R.), Neurosurgery (S.P., F.D.R.), and Radiology (S.P., A.B., F.D.R.), University of Kentucky, Lexington
| | - Flavius D Raslau
- From the Departments of Neurology (Y.S., R.P.V., F.D.R.), Neurosurgery (S.P., F.D.R.), and Radiology (S.P., A.B., F.D.R.), University of Kentucky, Lexington
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5
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Berger MJ, Adewuyi AA, Doherty C, Hanlan AK, Morin C, O'Connor R, Sharma R, Sproule S, Swong KN, Wu H, Franz CK, Brown E. Segmental infralesional pathological spontaneous activity in subacute traumatic spinal cord injury. Muscle Nerve 2024; 69:403-408. [PMID: 38294062 DOI: 10.1002/mus.28053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/13/2024] [Accepted: 01/21/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION/AIMS There is a dearth of knowledge regarding the status of infralesional lower motor neurons (LMNs) in individuals with traumatic cervical spinal cord injury (SCI), yet there is a growing need to understand how the spinal lesion impacts LMNs caudal to the lesion epicenter, especially in the context of nerve transfer surgery to restore several key upper limb functions. Our objective was to determine the frequency of pathological spontaneous activity (PSA) at, and below, the level of spinal injury, to gain an understanding of LMN health below the spinal lesion. METHODS Ninety-one limbs in 57 individuals (53 males, mean age = 44.4 ± 16.9 years, mean duration from injury = 3.4 ± 1.4 months, 32 with motor complete injuries), were analyzed. Analysis was stratified by injury level as (1) C4 and above, (2) C5, and (3) C6-7. Needle electromyography was performed on representative muscles innervated by the C5-6, C6-7, C7-8, and C8-T1 nerve roots. PSA was dichotomized as present or absent. Data were pooled for the most caudal infralesional segment (C8-T1). RESULTS A high frequency of PSA was seen in all infralesional segments. The pooled frequency of PSA for all injury levels at C8-T1 was 68.7% of the limbs tested. There was also evidence of PSA at the rostral border of the neurological level of injury, with 58.3% of C5-6 muscles in those with C5-level injuries. DISCUSSION These data support a high prevalence of infralesional LMN abnormalities following SCI, which has implications to nerve transfer candidacy, timing of the intervention, and donor nerve options.
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Affiliation(s)
- Michael J Berger
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Adenike A Adewuyi
- Regenerative Neurorehabilitation Laboratory, Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Christopher Doherty
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amy K Hanlan
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Cynthia Morin
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Russ O'Connor
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Radhika Sharma
- Regenerative Neurorehabilitation Laboratory, Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Shannon Sproule
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin N Swong
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Harvey Wu
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colin K Franz
- Regenerative Neurorehabilitation Laboratory, Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Erin Brown
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Anderson RS, Chu AK, Rylander H, Binversie EE, Duncan ID, Baker L, Salamat S, Patterson MM, Gruel J, Kohler NL, Kearney HK, Ale SM, Momen MM, Muir P, Svaren JP, Johnson R, Sample SJ. Pathologic classification of a late-onset peripheral neuropathy in a spontaneous Labrador retriever dog model. J Comp Neurol 2024; 532:e25596. [PMID: 38439568 PMCID: PMC10914337 DOI: 10.1002/cne.25596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/21/2023] [Accepted: 02/09/2024] [Indexed: 03/06/2024]
Abstract
Late-onset peripheral neuropathy (LPN) is a heritable canine neuropathy commonly found in Labrador retrievers and is characterized by laryngeal paralysis and pelvic limb paresis. Our objective was to establish canine LPN as a model for human hereditary peripheral neuropathy by classifying it as either an axonopathy or myelinopathy and evaluating length-dependent degeneration. We conducted a motor nerve conduction study of the sciatic and ulnar nerves, electromyography (EMG) of appendicular and epaxial musculature, and histologic analysis of sciatic and recurrent laryngeal nerves in LPN-affected and control dogs. LPN-affected dogs exhibited significant decreases in compound muscle action potential (CMAP) amplitude, CMAP area, and pelvic limb latencies. However, no differences were found in motor nerve conduction velocity, residual latencies, or CMAP duration. Distal limb musculature showed greater EMG changes in LPN-affected dogs. Histologically, LPN-affected dogs exhibited a reduction in the number of large-diameter axons, especially in distal nerve regions. In conclusion, LPN in Labrador retrievers is a common, spontaneous, length-dependent peripheral axonopathy that is a novel animal model of age-related peripheral neuropathy that could be used for fundamental research and clinical trials.
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Affiliation(s)
- Ryan S. Anderson
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706:
| | - Alexander K. Chu
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706:
| | - Helena Rylander
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706:
| | - Emily E. Binversie
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706:
| | - Ian D. Duncan
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706:
| | - Lauren Baker
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706:
| | - Shahriar Salamat
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 750 Highland Ave, Madison, WI 53726
| | - Margaret M. Patterson
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706:
| | - Jordan Gruel
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706:
| | - Nyah L. Kohler
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706:
| | - Hannah K Kearney
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706:
| | - Shelby M. Ale
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706:
| | - Mehdi M. Momen
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706:
| | - Peter Muir
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706:
| | - John P. Svaren
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706:
| | - Rebecca Johnson
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706:
| | - Susannah J Sample
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706:
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7
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Kim YI, Lee SH, Jung JH, Kim SY, Ko N, Lee SJ, Oh SJ, Ryu JS, Ko D, Kim W, Kim K. 18F-ASEM PET/MRI targeting alpha7-nicotinic acetylcholine receptor can reveal skeletal muscle denervation. EJNMMI Res 2024; 14:8. [PMID: 38252356 PMCID: PMC10803689 DOI: 10.1186/s13550-024-01067-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 12/31/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The increased expression of the nicotinic acetylcholine receptor (nAChR) in muscle denervation is thought to be associated with electrophysiological acetylcholine supersensitivity after nerve injury. Hence, we investigated the utility of the 18F-ASEM alpha7-nAChR targeting radiotracer as a new diagnostic method by visualizing skeletal muscle denervation in mouse models of sciatic nerve injury. METHODS Ten-week-old C57BL/6 male mice were utilized. The mice were anesthetized, and the left sciatic nerve was resected after splitting the gluteal muscle. One week (n = 11) and three weeks (n = 6) after the denervation, 18F-ASEM positron emission tomography/magnetic resonance imaging (PET/MRI) was acquired. Maximum standardized uptake values (SUVmax) of the tibialis anterior muscle were measured for the denervated side and the control side. Autoradiographic evaluation was performed to measure the mean counts of the denervated and control tibialis anterior muscles at one week. In addition, immunohistochemistry was used to identify alpha7-nAChR-positive areas in denervated and control tibialis anterior muscles at one week (n = 6). Furthermore, a blocking study was conducted with methyllycaconitine (MLA, n = 5). RESULTS 18F-ASEM PET/MRI showed significantly increased 18F-ASEM uptake in the denervated tibialis anterior muscle relative to the control side one week and three weeks post-denervation. SUVmax of the denervated muscles at one week and three weeks showed significantly higher uptake than the control (P = 0.0033 and 0.0277, respectively). The relative uptake by autoradiography for the denervated muscle was significantly higher than in the control, and immunohistochemistry revealed significantly greater alpha7-nAChR expression in the denervated muscle (P = 0.0277). In addition, the blocking study showed no significant 18F-ASEM uptake in the denervated side when compared to the control (P = 0.0796). CONCLUSIONS Our results suggest that nAChR imaging with 18F-ASEM has potential as a noninvasive diagnostic method for peripheral nervous system disorders.
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Affiliation(s)
- Yong-Il Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
| | - Jin Hwa Jung
- Convergence Medicine Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Seog-Young Kim
- Convergence Medicine Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Nare Ko
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Sang Ju Lee
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung Jun Oh
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dabin Ko
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Won Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Kyunggon Kim
- Convergence Medicine Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
- Department of Biomedical Sciences, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Clinical Proteomics Core Laboratory, Convergence Medicine Research Center, Asan Medical Center, Seoul, Republic of Korea
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8
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Bazarek S, Sten M, Thum J, Mandeville R, Magee G, Brown JM. Supinator to Posterior Interosseous Nerve Transfer for Recovery of Hand Opening in the Tetraplegic Patient: A Case Series. Neurosurgery 2024:00006123-990000000-01022. [PMID: 38224237 PMCID: PMC11073769 DOI: 10.1227/neu.0000000000002819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/17/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cervical spinal cord injury results in devastating loss of function. Nerve transfers can restore functional use of the hand, the highest priority function in this population to gain independence. Transfer of radial nerve branches innervating the supinator to the posterior interosseous nerve (SUP-PIN) has become a primary intervention for the recovery of hand opening, but few outcome reports exist to date. We report single-surgeon outcomes for this procedure. METHODS The SUP-PIN transfer was performed on adults with traumatic spinal cord injury resulting in hand paralysis. Outcome measures include Medical Research Council strength grade for extension of each digit, and angles representing critical apertures: the first web space opening of the thumb, and metacarpophalangeal angle of the remaining fingers. Factors affecting these measurements, including preserved tone and spasticity of related muscles, were also assessed. RESULTS Twenty-three adult patients with a C5-7 motor level underwent SUP-PIN transfers on 36 limbs (median age 31 years, interquartile range [21.5, 41]). The median interval from injury to surgery was 10.5 (8.2, 6.5) months, with 9 (7.5, 11) months for the acute injuries and 50 (32, 66) months for the chronic (>18 months) injuries. Outcomes were observed at a mean follow-up of 22 (14, 32.5) months. 30 (83.3%) hands recovered at least antigravity extension of the thumb and 34 (94.4%) demonstrated successful antigravity strength for the finger extensors, providing adequate opening for a functional grasp. Chronic patients (>18 months after injury) showed similar outcomes to those who had earlier surgery. Supination remained strong (at least M4) in all but a single patient and no complications were observed. CONCLUSION SUP-PIN is a reliable procedure for recovery of finger extension. Chronic patients remain good candidates, provided innervation of target muscles is preserved. Higher C5 injuries were more likely to have poor outcomes.
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Affiliation(s)
- Stanley Bazarek
- Department of Neurosurgery, Harvard Medical School, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Margaret Sten
- Department of Neurosurgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jasmine Thum
- Department of Neurosurgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ross Mandeville
- Department of Neurosurgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Grace Magee
- Department of Neurosurgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Justin M Brown
- Department of Neurosurgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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9
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Rubin DI, Lamb CJ. The role of electrodiagnosis in focal neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:43-59. [PMID: 38697746 DOI: 10.1016/b978-0-323-90108-6.00010-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Electrodiagnostic (EDX) testing plays an important role in confirming a mononeuropathy, localizing the site of nerve injury, defining the pathophysiology, and assessing the severity and prognosis. The combination of nerve conduction studies (NCS) and needle electromyography findings provides the necessary information to fully assess a nerve. The pattern of NCS abnormalities reflects the underlying pathophysiology, with focal slowing or conduction block in neuropraxic injuries and reduced amplitudes in axonotmetic injuries. Needle electromyography findings, including spontaneous activity and voluntary motor unit potential changes, complement the NCS findings and further characterize chronicity and degree of axon loss and reinnervation. EDX is used as an objective marker to follow the progression of a mononeuropathy over time.
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Affiliation(s)
- Devon I Rubin
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States.
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10
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Rohlén R, Lubel E, Grandi Sgambato B, Antfolk C, Farina D. Spatial decomposition of ultrafast ultrasound images to identify motor unit activity - A comparative study with intramuscular and surface EMG. J Electromyogr Kinesiol 2023; 73:102825. [PMID: 37757604 DOI: 10.1016/j.jelekin.2023.102825] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
The smallest voluntarily controlled structure of the human body is the motor unit (MU), comprised of a motoneuron and its innervated fibres. MUs have been investigated in neurophysiology research and clinical applications, primarily using electromyographic (EMG) techniques. Nonetheless, EMG (both surface and intramuscular) has a limited detection volume. A recent alternative approach to detect MUs is ultrafast ultrasound (UUS) imaging. The possibility of identifying MU activity from UUS has been shown by blind source separation (BSS) of UUS images, using optimal separation spatial filters. However, this approach has yet to be fully compared with EMG techniques for a large population of unique MU spike trains. Here we identify individual MU activity in UUS images using the BSS method for 401 MU spike trains from eleven participants based on concurrent recordings of either surface or intramuscular EMG from forces up to 30% of the maximum voluntary contraction (MVC) force. We assessed the BSS method's ability to identify MU spike trains from direct comparison with the EMG-derived spike trains as well as twitch areas and temporal profiles from comparison with the spike-triggered-averaged UUS images when using the EMG-derived spikes as triggers. We found a moderate rate of correctly identified spikes (53.0 ± 16.0%) with respect to the EMG-identified firings. However, the MU twitch areas and temporal profiles could still be identified accurately, including at 30% MVC force. These results suggest that the current BSS methods for UUS can accurately identify the location and average twitch of a large pool of MUs in UUS images, providing potential avenues for studying neuromechanics from a large cross-section of the muscle. On the other hand, more advanced methods are needed to address the convolutive and partly non-linear summation of velocities for recovering the full spike trains.
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Affiliation(s)
- Robin Rohlén
- Department of Biomedical Engineering, Lund University, Lund, Sweden.
| | - Emma Lubel
- Department of Bioengineering, Imperial College London, London, UK
| | | | | | - Dario Farina
- Department of Bioengineering, Imperial College London, London, UK.
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Gupta R, Johnston TR, Chen VY, Gonzales LP, Steward O. Human Motor Endplate Survival after Chronic Peripheral Nerve Injury. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.12.23296760. [PMID: 37873401 PMCID: PMC10592993 DOI: 10.1101/2023.10.12.23296760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Objective Degeneration of motor endplates (MEPs) in denervated muscle is thought to be a key factor limiting functional regeneration after peripheral nerve injury (PNI) in humans. However, there is currently no paradigm to determine MEP status in denervated human muscle to estimate likelihood of reinnervation success. Here, we present a quantitative analysis of MEP status in biopsies of denervated muscles taken during nerve repair surgery and ensuing functional recovery. Methods This is a retrospective single-surgeon cohort study of patients (n=22) with upper extremity PNI confirmed with electromyography (EMG), treated with nerve transfers. Muscle biopsies were obtained intra-operatively from 10 patients for MEP morphometric analysis. Age at time of surgery ranged from 22-77 years and time from injury to surgery ranged from 2.5-163 months. Shoulder range of motion (ROM) and Medical Research Council (MRC) scores were recorded pre-op and at final follow-up. Results Surviving MEPs were observed in biopsies of denervated muscles from all patients, even those greater than six months from injury. Average postoperative ROM improvement (assessed between 6-9 months post-surgery) was: forward flexion 84.3 ± 51.8°, abduction 62.5 ± 47.9°, and external rotation 25.3 ± 28.0°. Interpretation While it is believed that MEP degeneration 6 months post-injury prevents reinnervation, this data details MEP persistence beyond this timepoint along with significant functional recovery after nerve surgery. Accordingly, persistence of MEPs in denervated muscles may predict the extent of functional recovery from nerve repair surgery.
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Affiliation(s)
- Ranjan Gupta
- University of California, Irvine, Department of Orthopaedics
| | | | - Vivian Y. Chen
- University of California, Irvine, Department of Orthopaedics
| | | | - Oswald Steward
- University of California, Irvine, Reeve-Irvine Research Center
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12
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Skolka MP, Hass RM, Rubin DI, Laughlin RS. Association of Complex Repetitive Discharges With Chronicity and Clinical Symptoms in Radiculopathies. J Clin Neurophysiol 2023:00004691-990000000-00104. [PMID: 37820203 DOI: 10.1097/wnp.0000000000001036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
PURPOSE Complex repetitive discharges (CRDs) are incompletely understood needle electromyography (EMG) waveforms seen in both myopathic and neurogenic disorders including radiculopathies. This study aimed to clarify the significance of CRDs in patients with radiculopathies. METHODS This case-control study randomly identified 100 patients with needle EMG evidence of radiculopathy demonstrating at least one CRD in the electrodiagnostically involved myotome between January 2017 and January 2022. These patients were compared with 100 randomly selected patients with EMG evidence of radiculopathy without CRDs controlled for sex, age at EMG testing, and affected nerve root segment. Patient clinical symptoms, neurologic examination, EMG features, and imaging were analyzed. A paired sample t-test for categorial data and χ2 test for nonparametric data were used for statistical analysis with significance defined as P < 0.05. RESULTS Patients with radiculopathies with CRDs had longer disease duration averaging 59 months (range 1-480) compared with patients with radiculopathies without CRDs averaging 26 months (range 1-192, P < 0.01). Clinical symptoms of paresthesias and weakness were both significantly more common in patients with radiculopathies with CRDs than those without CRDs (P < 0.01 and 0.01, respectively). Needle EMG demonstrated a greater average number of muscles with neurogenic motor unit potentials per radiculopathy in patients with radiculopathies with CRDs compared with those without CRDs. Imaging studies of patients with radiculopathies with CRDs were more likely to reveal evidence of nerve root compression (P < 0.01). CONCLUSIONS The presence of CRDs in patients with radiculopathies is consistent with clinically more symptomatic radiculopathies and a longer duration of nerve root compromise.
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Affiliation(s)
- Michael P Skolka
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, U.S.A; and
| | - Reece M Hass
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, U.S.A; and
| | - Devon I Rubin
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, U.S.A
| | - Ruple S Laughlin
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, U.S.A; and
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Gomez-Tames J, Yu W. Electro-localization method using a muscle conductive phantom for needle position detection towards medical training. Biomed Phys Eng Express 2023; 9:055030. [PMID: 37595567 DOI: 10.1088/2057-1976/acf1a6] [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] [Received: 01/25/2023] [Accepted: 08/18/2023] [Indexed: 08/20/2023]
Abstract
Simulation in healthcare can help train, improve, and evaluate medical personnel's skills. In the case of needle insertion/manipulation inside the muscle during an nEMG examination, a training simulator Requires estimating the position of the needle to output the electrical muscle activity in real time according to the training plan. External cameras can be used to estimate the needle location; however, different error sources can make its implementation difficult and new medical sensing technologies are needed. This study introduces and demonstrates the feasibility of a conductive phantom that serves as the medium for needle insertion and senses the 3D needle position based on a technique named electro-localization for the first time. The proposed conductive phantom is designed so that different voltage distributions are generated in the phantom using electrodes placed on its borders. The needle is inserted in the phantom, and the recorded voltages are mapped to spatial coordinates using a finite element method (FEM)-based computational model of the conductive phantom to estimate the 3D needle tip position. Experimental and simulation results of phantom voltage distributions agreed. In 2D mapping (no depth consideration), the needle position error was 1.7 mm, which was marginally reduced if only the central area of the phantom was used (1.5 mm). In 3D mapping, the error was 4 mm. This study showed the feasibility of using a conductive muscle phantom as a new embedded sensor that estimates needle position for medical training of nEMG without relying on external sensors.
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Affiliation(s)
- Jose Gomez-Tames
- Graduate School of Science and Engineering, Chiba University, Chiba 263-8522, Japan
- Center for Frontier Medical Engineering, Chiba University, Chiba 263-8522, Japan
| | - Wenwei Yu
- Graduate School of Science and Engineering, Chiba University, Chiba 263-8522, Japan
- Center for Frontier Medical Engineering, Chiba University, Chiba 263-8522, Japan
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14
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Rohlén R, Carbonaro M, Cerone GL, Meiburger KM, Botter A, Grönlund C. Spatially repeatable components from ultrafast ultrasound are associated with motor unit activity in human isometric contractions . J Neural Eng 2023; 20:046016. [PMID: 37437598 DOI: 10.1088/1741-2552/ace6fc] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/12/2023] [Indexed: 07/14/2023]
Abstract
Objective.Ultrafast ultrasound (UUS) imaging has been used to detect intramuscular mechanical dynamics associated with single motor units (MUs). Detecting MUs from ultrasound sequences requires decomposing a velocity field into components, each consisting of an image and a signal. These components can be associated with putative MU activity or spurious movements (noise). The differentiation between putative MUs and noise has been accomplished by comparing the signals with MU firings obtained from needle electromyography (EMG). Here, we examined whether the repeatability of the images over brief time intervals can serve as a criterion for distinguishing putative MUs from noise in low-force isometric contractions.Approach.UUS images and high-density surface EMG (HDsEMG) were recorded simultaneously from 99 MUs in the biceps brachii of five healthy subjects. The MUs identified through HDsEMG decomposition were used as a reference to assess the outcomes of the ultrasound-based components. For each contraction, velocity sequences from the same eight-second ultrasound recording were separated into consecutive two-second epochs and decomposed. To evaluate the repeatability of components' images across epochs, we calculated the Jaccard similarity coefficient (JSC). JSC compares the similarity between two images providing values between 0 and 1. Finally, the association between the components and the MUs from HDsEMG was assessed.Main results.All the MU-matched components had JSC > 0.38, indicating they were repeatable and accounted for about one-third of the HDsEMG-detected MUs (1.8 ± 1.6 matches over 4.9 ± 1.8 MUs). The repeatable components (JSC > 0.38) represented 14% of the total components (6.5 ± 3.3 components). These findings align with our hypothesis that intra-sequence repeatability can differentiate putative MUs from noise and can be used for data reduction.Significance.This study provides the foundation for developing stand-alone methods to identify MU in UUS sequences and towards real-time imaging of MUs. These methods are relevant for studying muscle neuromechanics and designing novel neural interfaces.
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Affiliation(s)
- Robin Rohlén
- Department of Biomedical Engineering, Lund University, Lund, Sweden
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Marco Carbonaro
- Department of Electronics and Telecommunication, Laboratory for Engineering of the Neuromuscular System (LISiN), Politecnico di Torino, Turin, Italy
- PoliToBIOMed Lab, Politecnico di Torino, Turin, Italy
| | - Giacinto L Cerone
- Department of Electronics and Telecommunication, Laboratory for Engineering of the Neuromuscular System (LISiN), Politecnico di Torino, Turin, Italy
- PoliToBIOMed Lab, Politecnico di Torino, Turin, Italy
| | - Kristen M Meiburger
- PoliToBIOMed Lab, Politecnico di Torino, Turin, Italy
- Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Alberto Botter
- Department of Electronics and Telecommunication, Laboratory for Engineering of the Neuromuscular System (LISiN), Politecnico di Torino, Turin, Italy
- PoliToBIOMed Lab, Politecnico di Torino, Turin, Italy
| | - Christer Grönlund
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden
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Kulchutisin P, Sowithayasakul T, Pumklin J, Piyapattamin T. Electromyographic Evaluations of Masticatory Muscle Activity between Patients with Skeletal Class I and III Relationships. Eur J Dent 2023; 17:910-916. [PMID: 36513336 PMCID: PMC10569853 DOI: 10.1055/s-0042-1758064] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the muscle activity of the masseter muscle (MM) and anterior temporal muscle (TA) of patients with skeletal Class I and III during maximum voluntary clenching (MVC) at the intercuspal position (ICP) and during chewing. MATERIALS AND METHODS Twenty patients were divided into Steiner's skeletal Class I and III groups. MM and TA activity during each task was measured by using surface electromyography. Averaged MM and TA activity during both tasks, symmetry of each muscle activity, synergy between ipsilateral MMs and TAs, and muscle effort were compared. STATISTICAL ANALYSIS Means and standard deviations of intergroup variables were compared by an independent sample t-test for parametric evaluations or by the Mann-Whitney U test for nonparametric evaluations. A probability value of p less than 0.05 was considered significant. RESULTS Averaged MM activity and muscle synergy during MVC at the ICP in skeletal Class III patients were lower than that in skeletal Class I patients. Neither symmetry nor muscle effort during both tasks was different. CONCLUSION Masticatory muscle performance of skeletal Class III patients was inferior to that of skeletal Class I patients.
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Affiliation(s)
- Pakwan Kulchutisin
- Department of Preventive Dentistry, Faculty of Dentistry, Naresuan University, Phitsanulok, Thailand
| | - Thanaporn Sowithayasakul
- Department of Restorative Dentistry, Faculty of Dentistry, Naresuan University, Phitsanulok, Thailand
| | - Jittima Pumklin
- Department of Restorative Dentistry, Faculty of Dentistry, Naresuan University, Phitsanulok, Thailand
| | - Thosapol Piyapattamin
- Department of Preventive Dentistry, Faculty of Dentistry, Naresuan University, Phitsanulok, Thailand
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Ahad MA, Baidya S, Tarek MN. Comparison of Circular and Rectangular-Shaped Electrodes for Electrical Impedance Myography Measurements on Human Upper Arms. MICROMACHINES 2023; 14:1179. [PMID: 37374764 DOI: 10.3390/mi14061179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023]
Abstract
Electrical Impedance Myography (EIM) is a painless, noninvasive approach for assessing muscle conditions through the application of a high-frequency, low-intensity current to the muscle region of interest. However, besides muscle properties, EIM measurements vary significantly with changes in some other anatomical properties such as subcutaneous skin-fat (SF) thickness and muscle girth, as well as non-anatomical factors, such as ambient temperature, electrode shape, inter-electrode distance, etc. This study has been conducted to compare the effects of different electrode shapes in EIM experiments, and to propose an acceptable configuration that is less dependent on factors other than the cellular properties of the muscle. Initially, a finite element model with two different kinds of electrode shapes, namely, rectangular (the conventional shape) and circular (the proposed shape) was designed for a subcutaneous fat thickness ranging from 5 mm to 25 mm. The study concludes, based on the FEM study, that replacing the conventional electrodes with our proposed electrodes can decrease the variation in EIM parameters due to changes in skin-fat thickness by 31.92%. EIM experiments on human subjects with these two kinds of electrode shapes validate our finite element simulation results, and show that circular electrodes can improve EIM effectiveness significantly, irrespective of muscle shape variation.
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Affiliation(s)
- Mohammad A Ahad
- Department of Electrical and Computer Engineering, Georgia Southern University, Statesboro, GA 30458, USA
| | - Somen Baidya
- Department of Electrical and Computer Engineering, Georgia Southern University, Statesboro, GA 30458, USA
| | - Md Nurul Tarek
- Department of Electrical and Computer Engineering, Georgia Southern University, Statesboro, GA 30458, USA
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17
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Grönfors H, Himanen SL, Martikkala L, Kallio M, Mäkelä K. Median nerve ultrasound cross sectional area and wrist-to-forearm ratio in relation to carpal tunnel syndrome related axonal damage and patient age. Clin Neurophysiol Pract 2023; 8:81-87. [PMID: 37215684 PMCID: PMC10196766 DOI: 10.1016/j.cnp.2023.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 05/24/2023] Open
Abstract
Objective Primary objective was to retrospectively examine the effects of patient age and carpal tunnel syndrome (CTS) related axon loss on median nerve (MN) high resolution ultrasound (HRUS) in younger and older patients. HRUS parameters evaluated in this study were MN cross sectional area at the wrist (CSA) and wrist-to-forearm ratio (WFR). Methods The material comprised 467 wrists of 329 patients. The patients were categorized into younger (<65 years) and older (≥65 years) groups. Patients with moderate to extreme CTS were included in the study. Axon loss of the MN was assessed by needle EMG and graded by the interference pattern (IP) density. The association between axon loss and CSA and WFR was studied. Results The older patients had smaller mean CSA and WFR values compared to the younger patients. CSA correlated positively to the CTS severity only in the younger group. However, WFR correlated positively to CTS severity in both groups. In both age groups, CSA and WFR correlated positively with IP reduction. Conclusions Our study complemented recent findings on the effects of patient age on the CSA of the MN. However, although the MN CSA did not correlate with the CTS severity in older patients, the CSA increased in respect to the amount of axon loss. Also, as a new result, we presented the positive association of WFR with CTS severity among older patients. Significance Our study supports the recently speculated need for different MN CSA and WFR cut-off values for younger and older patients in assessing the severity of CTS. With older patients, WFR may be a more reliable parameter to assess the CTS severity than the CSA. CTS related axonal damage of the MN is associated to additional nerve enlargement at the carpal tunnel intel site.
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Affiliation(s)
- Henri Grönfors
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
| | - Sari-Leena Himanen
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
- Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre and Hospital Pharmacy, Elämänaukio 2, 33520 Tampere, Finland
| | - Lauri Martikkala
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
| | - Mika Kallio
- Department of Clinical Neurophysiology, Oulu University Hospital, Kajaanintie 50, 90220, PL 10, 90029 OYS, Finland
- Research Unit of Medical Imaging, Physics and Technology; University of Oulu, Kajaanintie 50, 90220; PL 10, 90029 OYS, Finland
| | - Katri Mäkelä
- Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre and Hospital Pharmacy, Elämänaukio 2, 33520 Tampere, Finland
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18
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Alix JJP, Plesia M, Schooling CN, Dudgeon AP, Kendall CA, Kadirkamanathan V, McDermott CJ, Gorman GS, Taylor RW, Mead RJ, Shaw PJ, Day JC. Non-negative matrix factorisation of Raman spectra finds common patterns relating to neuromuscular disease across differing equipment configurations, preclinical models and human tissue. JOURNAL OF RAMAN SPECTROSCOPY : JRS 2023; 54:258-268. [PMID: 38505661 PMCID: PMC10947050 DOI: 10.1002/jrs.6480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/04/2022] [Accepted: 11/02/2022] [Indexed: 03/21/2024]
Abstract
Raman spectroscopy shows promise as a biomarker for complex nerve and muscle (neuromuscular) diseases. To maximise its potential, several challenges remain. These include the sensitivity to different instrument configurations, translation across preclinical/human tissues and the development of multivariate analytics that can derive interpretable spectral outputs for disease identification. Nonnegative matrix factorisation (NMF) can extract features from high-dimensional data sets and the nonnegative constraint results in physically realistic outputs. In this study, we have undertaken NMF on Raman spectra of muscle obtained from different clinical and preclinical settings. First, we obtained and combined Raman spectra from human patients with mitochondrial disease and healthy volunteers, using both a commercial microscope and in-house fibre optic probe. NMF was applied across all data, and spectral patterns common to both equipment configurations were identified. Linear discriminant models utilising these patterns were able to accurately classify disease states (accuracy 70.2-84.5%). Next, we applied NMF to spectra obtained from the mdx mouse model of a Duchenne muscular dystrophy and patients with dystrophic muscle conditions. Spectral fingerprints common to mouse/human were obtained and able to accurately identify disease (accuracy 79.5-98.8%). We conclude that NMF can be used to analyse Raman data across different equipment configurations and the preclinical/clinical divide. Thus, the application of NMF decomposition methods could enhance the potential of Raman spectroscopy for the study of fatal neuromuscular diseases.
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Affiliation(s)
- James J. P. Alix
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
- Neuroscience InstituteUniversity of SheffieldSheffieldUK
| | - Maria Plesia
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
| | - Chlöe N. Schooling
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
- Department of Automatic Control and Systems EngineeringUniversity of SheffieldSheffieldUK
| | - Alexander P. Dudgeon
- Biophotonics Research UnitGloucestershire Hospitals NHS Foundation TrustGloucesterUK
- Biomedical Spectroscopy, School of Physics and AstronomyUniversity of ExeterExeterUK
- Interface Analysis Centre, School of PhysicsUniversity of BristolBristolUK
| | - Catherine A. Kendall
- Biophotonics Research UnitGloucestershire Hospitals NHS Foundation TrustGloucesterUK
| | | | - Christopher J. McDermott
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
- Neuroscience InstituteUniversity of SheffieldSheffieldUK
| | - Gráinne S. Gorman
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
- NHS Highly Specialised Service for Rare Mitochondrial DisordersNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Robert W. Taylor
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
- NHS Highly Specialised Service for Rare Mitochondrial DisordersNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Richard J. Mead
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
- Neuroscience InstituteUniversity of SheffieldSheffieldUK
| | - Pamela J. Shaw
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
- Neuroscience InstituteUniversity of SheffieldSheffieldUK
| | - John C. Day
- Interface Analysis Centre, School of PhysicsUniversity of BristolBristolUK
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19
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Tannemaat MR, Kefalas M, Geraedts VJ, Remijn-Nelissen L, Verschuuren AJM, Koch M, Kononova AV, Wang H, Bäck THW. Distinguishing normal, neuropathic and myopathic EMG with an automated machine learning approach. Clin Neurophysiol 2023; 146:49-54. [PMID: 36535091 DOI: 10.1016/j.clinph.2022.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/30/2022] [Accepted: 11/26/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Distinguishing normal, neuropathic and myopathic electromyography (EMG) traces can be challenging. We aimed to create an automated time series classification algorithm. METHODS EMGs of healthy controls (HC, n = 25), patients with amyotrophic lateral sclerosis (ALS, n = 20) and inclusion body myositis (IBM, n = 20), were retrospectively selected based on longitudinal clinical follow-up data (ALS and HC) or muscle biopsy (IBM). A machine learning pipeline was applied based on 5-second EMG fragments of each muscle. Diagnostic yield expressed as area under the curve (AUC) of a receiver-operator characteristics curve, accuracy, sensitivity, and specificity were determined per muscle (muscle-level) and per patient (patient-level). RESULTS Diagnostic yield of the classification ALS vs. HC was: AUC 0.834 ± 0.014 at muscle-level and 0.856 ± 0.009 at patient-level. For the classification HC vs. IBM, AUC was 0.744 ± 0.043 at muscle-level and 0.735 ± 0.029 at patient-level. For the classification ALS vs. IBM, AUC was 0.569 ± 0.024 at muscle-level and 0.689 ± 0.035 at patient-level. CONCLUSIONS An automated time series classification algorithm can distinguish EMGs from healthy individuals from those of patients with ALS with a high diagnostic yield. Using longer EMG fragments with different levels of muscle activation may improve performance. SIGNIFICANCE In the future, machine learning algorithms may help improve the diagnostic accuracy of EMG examinations.
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Affiliation(s)
- M R Tannemaat
- Leiden University Medical Centre, Department of Neurology, The Netherlands.
| | - M Kefalas
- Leiden Institute of Advanced Computer Science, The Netherlands
| | - V J Geraedts
- Leiden University Medical Centre, Department of Neurology, The Netherlands; Leiden University Medical Centre, Department of Clinical Epidemiology, The Netherlands
| | - L Remijn-Nelissen
- Leiden University Medical Centre, Department of Neurology, The Netherlands
| | - A J M Verschuuren
- Leiden University Medical Centre, Department of Neurology, The Netherlands
| | - M Koch
- Leiden Institute of Advanced Computer Science, The Netherlands
| | - A V Kononova
- Leiden Institute of Advanced Computer Science, The Netherlands
| | - H Wang
- Leiden Institute of Advanced Computer Science, The Netherlands
| | - T H W Bäck
- Leiden Institute of Advanced Computer Science, The Netherlands
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20
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Gupta HV, Skolka MP, Laughlin RS, Rubin DI. Incidental complex repetitive discharges on needle electromyography. Muscle Nerve 2023; 67:162-165. [PMID: 36416248 DOI: 10.1002/mus.27757] [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: 05/17/2022] [Revised: 11/14/2022] [Accepted: 11/20/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION/AIMS Complex repetitive discharges (CRDs) are spontaneous electromyography (EMG) waveforms often associated with chronic neurogenic or myopathic diseases, but incidentally identified CRDs have also been described. In this study we describe the distribution and possible significance of incidentally seen CRDs in otherwise normal electrodiagnostic studies. METHODS A retrospective chart review was performed of all patients with CRDs incidentally documented on otherwise normal electrodiagnostic studies at Mayo Clinic from January 2013 through December 2020. Each patient's clinical symptoms, referral reason, electrodiagnostic report, and imaging studies were analyzed using descriptive statistics. RESULTS Ninety-four patients (86 females; mean age, 62 years; range, 20 to 86 years) and 107 CRDs were studied. The most common neuromuscular reasons for electrodiagnostic referrals included radiculopathy, peripheral neuropathy, and myopathy. Mean symptom duration was 43 months (range, 1 to 312 months). Eighty-five patients had a CRD identified in one muscle (range, in all patients, one to five muscles). CRDs were identified most frequently in tensor fasciae latae (n = 21), biceps brachii (n = 16), and gluteus maximus (n = 9). Of the 58 patients in whom imaging was available, 46 (79%) had abnormalities that corresponded to the myotome in which the CRDs were visualized, most commonly L5 (n = 19) and C6 (n = 12). Of these 46 patients, 28 (61%) were referred for radicular or limb pain. DISCUSSION CRDs can be incidentally noted on otherwise normal electrodiagnostic studies, most commonly in L5 and C6 myotomes. The mechanism of CRDs in the absence of electrodiagnostic features of axon loss or remodeling is unknown.
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Affiliation(s)
- Harsh V Gupta
- Department of Neurology, Mayo Clinic, Jacksonville, Florida
| | | | | | - Devon I Rubin
- Department of Neurology, Mayo Clinic, Jacksonville, Florida
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21
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Favretto MA, Andreis FR, Cossul S, Negro F, Oliveira AS, Marques JLB. Differences in motor unit behavior during isometric contractions in patients with diabetic peripheral neuropathy at various disease severities. J Electromyogr Kinesiol 2023; 68:102725. [PMID: 36436278 DOI: 10.1016/j.jelekin.2022.102725] [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: 12/29/2021] [Revised: 09/14/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to determine whether HD-sEMG is sensitive to detecting changes in motor unit behavior amongst healthy adults and type 2 diabetes mellitus (T2DM) patients presenting diabetic peripheral neuropathy (DPN) at different levels. Healthy control subjects (CON, n = 8) and T2DM patients presenting no DPN symptoms (ABS, n = 8), moderate DPN (MOD, n = 18), and severe DPN (SEV, n = 12) performed isometric ankle dorsiflexion at 30 % maximum voluntary contraction while high-density surface EMG (HD-sEMG) was recorded from the tibialis anterior muscle. HD-sEMG signals were decomposed, providing estimates of discharge rate, motor unit conduction velocity (MUCV), and motor unit territory area (MUTA). As a result, the ABS group presented reduced MUCV compared to CON. The groups with diabetes presented significantly larger MUTA compared to the CON group (p < 0.01), and the SEV group presented a significantly lower discharge rate compared to CON and ABS (p < 0.01). In addition, the SEV group presented significantly higher CoVforce compared to CON and MOD. These results support the use of HD-SEMG as a method to detect peripheral and central changes related to DPN.
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Affiliation(s)
- Mateus André Favretto
- Institute of Biomedical Engineering, Department of Electrical and Electronic Engineering, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil.
| | - Felipe Rettore Andreis
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Sandra Cossul
- Institute of Biomedical Engineering, Department of Electrical and Electronic Engineering, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Francesco Negro
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | | | - Jefferson Luiz Brum Marques
- Institute of Biomedical Engineering, Department of Electrical and Electronic Engineering, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
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Planinc D, Muhamood N, Cabassi C, Iniesta R, Shaw CE, Hodson-Tole E, Bashford J. Fasciculation electromechanical latency is prolonged in amyotrophic lateral sclerosis. Clin Neurophysiol 2023; 145:71-80. [PMID: 36442378 DOI: 10.1016/j.clinph.2022.11.005] [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: 03/01/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In amyotrophic lateral sclerosis (ALS), motor neurons become hyperexcitable and spontaneously discharge electrical impulses causing fasciculations. These can be detected by two noninvasive methods: high-density surface electromyography (HDSEMG) and muscle ultrasonography (MUS). We combined these methods simultaneously to explore the electromechanical properties of fasciculations, seeking a novel biomarker of disease. METHODS Twelve ALS patients and thirteen healthy participants each provided up to 24 minutes of recordings from the right biceps brachii (BB) and gastrocnemius medialis (GM). Two automated algorithms (Surface Potential Quantification Engine and a Gaussian mixture model) were applied to HDSEMG and MUS data to identify correlated electromechanical fasciculation events. RESULTS We identified 4,197 correlated electromechanical fasciculation events. HDSEMG reliably detected electromechanical events up to 30 mm below the skin surface with an inverse correlation between amplitude and depth in ALS muscles. Compared to Healthy-GM muscles (mean = 79.8 ms), electromechanical latency was prolonged in ALS-GM (mean = 108.8 ms; p = 0.0458) and ALS-BB (mean = 112.0 ms; p = 0.0128) muscles. Electromechanical latency did not correlate with disease duration, symptom burden, sum muscle power score or fasciculation frequency. CONCLUSIONS Prolonged fasciculation electromechanical latency indicates impairment of the excitation-contraction coupling mechanism, warranting further exploration as a potential novel biomarker of disease in ALS. SIGNIFICANCE This study points to an electromechanical defect within the muscles of ALS patients.
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Affiliation(s)
- D Planinc
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - N Muhamood
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - C Cabassi
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - R Iniesta
- Department of Biostatistics and Health Informatics, King's College London, United Kingdom
| | - C E Shaw
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - E Hodson-Tole
- Musculoskeletal Sciences and Sports Medicine Research Centre, Manchester Institute of Sport, Department of Life Sciences, Manchester Metropolitan University, United Kingdom
| | - J Bashford
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom. https://twitter.com/@SPiQEneurology
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23
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Electrodiagnostic Studies in Degenerative Cervical Myelopathy. Clin Spine Surg 2022; 35:403-409. [PMID: 36447344 DOI: 10.1097/bsd.0000000000001413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/03/2022] [Indexed: 12/05/2022]
Abstract
The diagnosis of degenerative cervical myelopathy can generally be made with a thorough history, physical examination, and spinal imaging. Electrodiagnostic studies, consisting of nerve conduction studies and electromyography, are a useful adjunct when the clinical picture is inconsistent or there is concern for overlapping pathology. Electrodiagnostic studies may be particularly helpful in identifying cases of myeloradiculopathy, when there is combined nerve root and spinal cord injury, both with regards to prognosis and guiding surgical treatment. Electrodiagnostic studies are a useful adjunct for the spine surgeon and should be used when there are features atypical for degenerative cervical myelopathy or when there is suspicion for a concomitant disease process.
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24
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Nandedkar SD, Barkhaus PE, Stålberg EV. Motor unit recruitment and firing rate at low force of contraction. Muscle Nerve 2022; 66:750-756. [PMID: 36214178 DOI: 10.1002/mus.27737] [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: 06/28/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION/AIMS A prevailing concept of motor unit (MU) recruitment used for calculating recruitment ratio (RR) suggests a progressive linear increase in firing rate (FR). The objective of this study is to assess its validity. METHODS Concentric needle electromyography (EMG) recordings were made in normal muscle and abnormal muscle of patients with neurogenic findings. Signals recorded at low force were visually decomposed to study MU FR at onset, recruitment of a second MU, and recruitment of more MUs with further increases in force. RESULTS We observed one to six MUs discharging at a rate < 15 Hz in normal muscles at low force. The MU FR was 5-8 Hz at onset. With increasing force, FR increased by 3-5 Hz and then idled at <15 Hz while other MUs were recruited. The recruitment frequency (RF) and RR had low sensitivity and were abnormal mainly in moderately to severely weak muscles. DISCUSSION Our data are consistent with FR analysis results described by other investigators. It does not support a progressive linear increase in MU FR with recruitment. A revised model for MU recruitment at low effort during gradual increase in force is presented. On subjective assessment, the FR of the fastest firing MU can help detect MU loss in neurogenic processes.
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Affiliation(s)
- Sanjeev D Nandedkar
- Clinical Applications, Natus Medical Inc, Hopewell Junction, New York, USA.,Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Paul E Barkhaus
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Erik V Stålberg
- Academic Hospital, Dept Clin Neurophysiology, Uppsala University, Uppsala, Sweden
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25
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Kinugawa K, Mano T, Nakagawa Y, Hotta N, Sugie K. Case report: Unilateral masticatory atrophy caused by pure trigeminal motor neuropathy. Radiol Case Rep 2022; 17:4542-4545. [PMID: 36189157 PMCID: PMC9520091 DOI: 10.1016/j.radcr.2022.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/04/2022] [Accepted: 09/11/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kaoru Kinugawa
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Tomoo Mano
- Department of Neurology, Nara Medical University, Kashihara, Japan
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan
- Corresponding author.
| | - Yosuke Nakagawa
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Naoki Hotta
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Kashihara, Japan
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26
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Yoo J, Yoo I, Youn I, Kim SM, Yu R, Kim K, Kim K, Lee SB. Residual one-dimensional convolutional neural network for neuromuscular disorder classification from needle electromyography signals with explainability. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 226:107079. [PMID: 36191354 DOI: 10.1016/j.cmpb.2022.107079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/25/2022] [Accepted: 08/20/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Neuromuscular disorders are diseases that damage our ability to control body movements. Needle electromyography (nEMG) is often used to diagnose neuromuscular disorders, which is an electrophysiological test measuring electric signals generated from a muscle using an invasive needle. Characteristics of nEMG signals are manually analyzed by an electromyographer to diagnose the types of neuromuscular disorders, and this process is highly dependent on the subjective experience of the electromyographer. Contemporary computer-aided methods utilized deep learning image classification models to classify nEMG signals which are not optimized for classifying signals. Additionally, model explainability was not addressed which is crucial in medical applications. This study aims to improve prediction accuracy, inference time, and explain model predictions in nEMG neuromuscular disorder classification. METHODS This study introduces the nEMGNet, a one-dimensional convolutional neural network with residual connections designed to extract features from raw signals with higher accuracy and faster speed compared to image classification models from previous works. Next, the divide-and-vote (DiVote) algorithm was designed to integrate each subject's heterogeneous nEMG signal data structures and to utilize muscle subtype information for higher accuracy. Finally, feature visualization was used to identify the causality of nEMGNet diagnosis predictions, to ensure that nEMGNet made predictions on valid features, not artifacts. RESULTS The proposed method was tested using 376 nEMG signals measured from 57 subjects between June 2015 to July 2020 in Seoul National University Hospital. The results from the three-class classification task demonstrated that nEMGNet's prediction accuracy of nEMG signal segments was 62.35%, and the subject diagnosis prediction accuracy of nEMGNet and the DiVote algorithm was 83.69 %, over 5-fold cross-validation. nEMGNet outperformed all models from previous works on nEMG diagnosis classification, and heuristic analysis of feature visualization results indicate that nEMGNet learned relevant nEMG signal characteristics. CONCLUSIONS This study introduced nEMGNet and DiVote algorithm which demonstrated fast and accurate performance in predicting neuromuscular disorders based on nEMG signals. The proposed method may be applied in medicine to support real-time electrophysiologic diagnosis.
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Affiliation(s)
- Jaesung Yoo
- School of Electrical Engineering, Korea University, Seoul, Republic of Korea
| | - Ilhan Yoo
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Ina Youn
- Department of Computer Science, New York University, NY, USA
| | - Sung-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ri Yu
- Department of Software and Computer Engineering, Department of Artificial Intelligence, Ajou University
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Keewon Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Seung-Bo Lee
- Department of Medical Informatics: Keimyung University School of Medicine, Daegu, Republic of Korea.
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27
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Franz S, Eck U, Schuld C, Heutehaus L, Wolf M, Wilder-Smith E, Schulte-Mattler W, Weber MA, Rupp R, Weidner N. Lower motoneuron dysfunction impacts spontaneous motor recovery in acute cervical spinal cord injury. J Neurotrauma 2022; 40:862-875. [PMID: 36006372 PMCID: PMC10162119 DOI: 10.1089/neu.2022.0181] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Paresis after spinal cord injury is caused by damage to upper and lower motoneurons and may differentially impact neurological recovery. This prospective monocentric longitudinal observational study investigated the extent and severity of lower motoneuron dysfunction and its impact on upper extremity motor recovery after acute cervical spinal cord injury. Pathological spontaneous activity at rest and/or increased discharge rates of motor unit action potentials recorded by needle electromyography (EMG) were taken as parameters for lower motoneuron dysfunction and its relation to the extent of myelopathy in the first available spine MRI was determined. Motor recovery was assessed by standardized neurological examination within the first 4 weeks (acute stage) and up to 1 year (chronic stage) after injury. Eighty-five muscles of 17 individuals with cervical spinal cord injury (neurological level of injury from C1 to C7) and a median age of 54 (28-59) were examined. The results showed that muscles with signs of lower motoneuron dysfunction peaked at the lesion center (Χ²[2,n=85]=6.6, p=0.04) and that the severity of lower motoneuron dysfunction correlated with T2-weighted hyperintense MRI signal changes in routine spine MRI at the lesion site (spearman ρ=0.31, p=0.01). Muscles exhibiting signs of lower motoneuron dysfunction, as indicated by pathological spontaneous activity at rest and/or increased discharge rates of motor unit action potentials, were associated with more severe paresis in both the acute and chronic stages after spinal cord injury (spearman ρ acute=-0.22, p=0.04 and chronic=-0.31, p=0.004). Moreover, the severity of lower motoneuron dysfunction in the acute stage was also associated with a greater degree of paresis (spearman ρ acute=-0.24, p=0.03 and chronic=-0.35, p=0.001). While both muscles with and without signs of lower motoneuron dysfunction were capable of regaining strength over time, those without lower motoneuron dysfunctions had a higher potential to reach full strength. Muscles with signs of lower motoneuron dysfunction in the acute stage displayed increased amplitudes of motor unit action potentials with chronic-stage needle EMG, indicating reinnervation through peripheral collateral sprouting as compensatory mechanism (Χ²[1,n=72]=4.3, p=0.04). Thus, lower motoneuron dysfunction represents a relevant factor contributing to motor impairment and recovery in acute cervical spinal cord injury. Defined recovery mechanisms (peripheral reinnervation) may at least partially underlie spontaneous recovery in respective muscles. Therefore, assessment of lower motoneuron dysfunction could help refine prediction of motor recovery following spinal cord injury.
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Affiliation(s)
- Steffen Franz
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
- Address correspondence to: Steffen Franz, MD, Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstraße 200 a, 69118 Heidelberg, Germany
| | - Ute Eck
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Schuld
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Laura Heutehaus
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Marcel Wolf
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Einar Wilder-Smith
- Department of Neurology, Kantonsspital Lucerne, Lucerne, Switzerland
- Department of Neurology, Inselspital Bern, University of Bern, Bern, Switzerland
| | | | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
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28
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Silverman J, Dengler J, Song C, Robinson LR. Pre-operative electrodiagnostic planning for upper limb peripheral nerve transfers in cervical spinal cord injury: A Narrative Review. PM R 2022. [PMID: 35726540 DOI: 10.1002/pmrj.12868] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 02/13/2022] [Accepted: 05/31/2022] [Indexed: 11/08/2022]
Abstract
Peripheral nerve transfer (PNT) to improve upper limb function following cervical spinal cord injury (SCI) involves the transfer of supralesional donor nerves under voluntary control to intralesional or sublesional lower motor neurons not under voluntary control. Appropriate selection of donor and recipient nerves and surgical timing impact functional outcomes. While the gold standard of nerve selection is intra-operative nerve stimulation, preoperative electrodiagnostic (EDX) evaluation may help guide surgical planning. Currently there is no standardized preoperative EDX protocol. This study reviews the EDX workup preceding peripheral nerve transfer surgery in cervical SCI, and proposes an informed EDX protocol to assist with surgical planning. The PICO (Population, Intervention, Comparison, Outcome) framework was used to formulate relevant MeSH terms and identify published cases of PNT in cervical SCI in Medline, Embase, CINAHL, and Emcare databases in the last 10 years. The electrodiagnostic techniques evaluating putative donor nerves, recipient nerve branches, time-sensitivity of nerve transfer and other electrophysiological parameters were summarized to guide creation of a preoperative EDX protocol. Needle electromyography (EMG) was the most commonly used EDX technique to identify healthy donor nerves. Although needle EMG has also been used on recipient nerves, compound muscle action potential (CMAP) amplitudes may provide a more accurate determination of recipient nerve health and time-sensitivity for nerve transfer. While there has been progress in pre-surgical EDX evaluation, EMG and NCS approaches are quite variable, and each has limitations in their utility for pre-operative planning. There is need for standardization in the EDX evaluation preceding peripheral nerve transfer surgery to assist with donor and recipient nerve selection, surgical timing and to optimize outcomes. Based on results of this review, herein we propose the PreSCIse (PRotocol for Electrodiagnosis in SCI Surgery of the upper Extremity) pre-operative EDX panel to achieve said goals through an interdisciplinary and patient-centered approach. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jordan Silverman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jana Dengler
- Division of Plastic and Reconstructive Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Cimon Song
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lawrence R Robinson
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
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29
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Patel MS, Daher M, Fuller DA, Abboud JA. Incidence, Risk Factors, Prevention, and Management of Peripheral Nerve Injuries Following Shoulder Arthroplasty. Orthop Clin North Am 2022; 53:205-213. [PMID: 35365265 DOI: 10.1016/j.ocl.2021.11.006] [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: 02/02/2023]
Abstract
In this article, the authors review the incidence and causes of iatrogenic peripheral nerve injuries following shoulder arthroplasty and provide preventative measures to decrease nerve injury rate and management options. They describe common direct and indirect causes of injury such as laceration and retractor use versus arm positioning and lengthening, respectively. Preventative measures include an understanding of anatomy and high-risk locations in the shoulder, minimizing extreme ranges of arm motion and utilization of intraoperative nerve monitoring. Lastly, the authors review diagnosis and management of neurologic symptoms including how and when to use electrodiagnostic studies, nerve grafts, transfers, or muscle/tendon transfers.
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Affiliation(s)
- Manan S Patel
- Department of Orthopaedic Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Mohammad Daher
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - David A Fuller
- Department of Orthopaedic Surgery, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Joseph A Abboud
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut Street 5th Floor, Philadelphia, PA 19107, USA.
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30
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Vodovar D, Chevillard L, Caillé F, Risède P, Pottier G, Auvity S, Mégarbane B, Tournier N. Mechanisms of respiratory depression induced by the combination of buprenorphine and diazepam in rats. Br J Anaesth 2022; 128:584-595. [PMID: 34872716 DOI: 10.1016/j.bja.2021.10.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/05/2021] [Accepted: 10/28/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The safety profile of buprenorphine has encouraged its widespread use. However, fatalities have been attributed to benzodiazepine/buprenorphine combinations, by poorly understood mechanisms of toxicity. Mechanistic hypotheses include (i) benzodiazepine-mediated increase in brain buprenorphine (pharmacokinetic hypothesis); (ii) benzodiazepine-mediated potentiation of buprenorphine interaction with opioid receptors (receptor hypothesis); and (iii) combined effects of buprenorphine and benzodiazepine on respiratory parameters (pharmacodynamic hypothesis). METHODS We studied the neuro-respiratory effects of buprenorphine (30 mg kg-1, i.p.), diazepam (20 mg kg-1, s.c.), and diazepam/buprenorphine combination in rats using arterial blood gas analysis, plethysmography, and diaphragm electromyography. Pretreatments with various opioid and gamma-aminobutyric acid receptor antagonists were tested. Diazepam impact on brain 11C-buprenorphine kinetics and binding to opioid receptors was studied using positron emission tomography imaging. RESULTS In contrast to diazepam and buprenorphine alone, diazepam/buprenorphine induced early-onset sedation (P<0.05) and respiratory depression (P<0.001). Diazepam did not alter 11C-buprenorphine brain kinetics or binding to opioid receptors. Diazepam/buprenorphine-induced effects on inspiratory time were additive, driven by buprenorphine (P<0.0001) and were blocked by naloxonazine (P<0.01). Diazepam/buprenorphine-induced effects on expiratory time were non-additive (P<0.001), different from buprenorphine-induced effects (P<0.05) and were blocked by flumazenil (P<0.01). Diazepam/buprenorphine-induced effects on tidal volume were non-additive (P<0.01), different from diazepam- (P<0.05) and buprenorphine-induced effects (P<0.0001) and were blocked by naloxonazine (P<0.05) and flumazenil (P<0.05). Compared with buprenorphine, diazepam/buprenorphine decreased diaphragm contraction amplitude (P<0.01). CONCLUSIONS Pharmacodynamic parameters and antagonist pretreatments indicate that diazepam/buprenorphine-induced respiratory depression results from a pharmacodynamic interaction between both drugs on ventilatory parameters.
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Affiliation(s)
- Dominique Vodovar
- Inserm UMRS-1144, Paris, France; Université de Paris, Paris, France; Université Paris-Saclay - CEA - CNRS - Inserm - BioMaps, Orsay, France; Paris Poison Center, Assistance Publique - Hôpitaux de Paris, Paris, France; Department of Medical and Toxicological Critical Care, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Lucie Chevillard
- Inserm UMRS-1144, Paris, France; Université de Paris, Paris, France
| | - Fabien Caillé
- Université Paris-Saclay - CEA - CNRS - Inserm - BioMaps, Orsay, France
| | | | - Géraldine Pottier
- Université Paris-Saclay - CEA - CNRS - Inserm - BioMaps, Orsay, France
| | - Sylvain Auvity
- Université Paris-Saclay - CEA - CNRS - Inserm - BioMaps, Orsay, France
| | - Bruno Mégarbane
- Inserm UMRS-1144, Paris, France; Université de Paris, Paris, France; Department of Medical and Toxicological Critical Care, Assistance Publique - Hôpitaux de Paris, Paris, France.
| | - Nicolas Tournier
- Université Paris-Saclay - CEA - CNRS - Inserm - BioMaps, Orsay, France
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31
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Zein M, Tummala S, Prince L, Fu JB. Review of Needle Electromyography Complications in Thrombocytopenic Cancer Patients. Muscle Nerve 2022; 65:452-456. [PMID: 35040143 PMCID: PMC8930444 DOI: 10.1002/mus.27499] [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: 07/01/2021] [Revised: 12/31/2021] [Accepted: 01/08/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION/AIMS Needle electromyography (EMG) is understood to be a relatively safe procedure based on clinical experience. There are no evidence-based guidelines for EMG procedures in thrombocytopenic patients. The purpose of this study was to determine whether there is an increased risk of bleeding complications associated with needle EMG in patients with thrombocytopenia. METHODS This retrospective study included patients with a primary cancer and thrombocytopenia who underwent needle EMG between January 1, 2016 and October 30, 2020. Patient medical records were reviewed for demographics, diagnoses, platelet counts within a 7-day period of EMG examination, concurrent use of anti-coagulants or anti-platelet medications, number of sites sampled by needle EMG including anatomical differentiation of paraspinal, deep and superficial limb muscles, and associated complications not limited to bleeding within 30 days of EMG examination. RESULTS The initial data search identified 198 patients with a documented diagnosis of thrombocytopenia; 124 met criteria and were included in the study. 1001 total muscle sample sites were documented with 111 sites in paraspinal muscles, 876 sites in superficial limb muscles and 14 sites within deep limb muscles. Five patients were concurrently using therapeutic anti-coagulation and three patients were using anti-platelet medications. There were no clinically significant complications, but 5 minor incidents were documented in the medical records within 30 days post-EMG examination. DISCUSSION Our findings suggest that bleeding complications from standard needle EMG in oncology patients with documented thrombocytopenia are rare. Testing of high risk-muscles in this patient population appears to be safe.
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Affiliation(s)
- Mazen Zein
- Department of Palliative, Rehabilitation & Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sudhakar Tummala
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laura Prince
- Department of Palliative, Rehabilitation & Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jack B Fu
- Department of Palliative, Rehabilitation & Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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32
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Seliverstova EG, Sinkin MV, Kordonsky AY, Aleinikova IB, Tikhomirov IV, Grin AA. [Electrodiagnostic evaluation in differential diagnosis and neurosurgical treatment of radiculopathies caused by spine disorders. Diagnostic value and methodology]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:109-118. [PMID: 35412720 DOI: 10.17116/neiro202286021109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED One of the most common causes of radiculopathy requiring neurosurgical treatment is a herniated disc. Magnetic resonance imaging (MRI) is still the main diagnostic approach for this lesion. However, MRI does not allow assessing the functional state of the root. Neurophysiological examination assesses the function of peripheral nervous system. These methods are used for differential diagnosis of causes of neurological symptoms and determine the level of the nerve root injury. OBJECTIVE To assess the role of electromyography including paraspinal muscle mapping in diagnosis of radiculopathies following spine diseases. MATERIAL AND METHODS We have analyzed literature data in the Scopus, Pubmed, and RSCI databases and selected 93 references for primary reviewing. Final analysis enrolled the manuscripts with a detailed description of neurophysiological examinations and data on sensitivity/specificity of these methods. RESULTS Needle electromyography (EMG) is the most informative neurophysiological method for diagnosis of radicular damage. Sensitivity of EMG is up to 90% for lumbosacral radiculopathy. Electromyography of the paraspinal muscles can be used in case of of cervical, thoracic and lumbar radiculopathy in addition to EMG of limb muscles. Therefore sensitivity increases to 100%. Diagnostic value of nerve conduction study (NCS) is low, and performing NCS without EMG is not useful. CONCLUSION In neurosurgical practice electrodiagnostic (EDX) should be performed for differential diagnosis of radiculopathy and peripheral nervous system lesions, to determine the level of radicular compression, and when physical examination does not correspond with neuroimaging or MRI is not possible to perform.
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Affiliation(s)
- E G Seliverstova
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - M V Sinkin
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A Yu Kordonsky
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - I B Aleinikova
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - I V Tikhomirov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - A A Grin
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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33
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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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34
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Abstract
Neuroelectrophysiology is an old science, dating to the 18th century when electrical activity in nerves was discovered. Such discoveries have led to a variety of neurophysiological techniques, ranging from basic neuroscience to clinical applications. These clinical applications allow assessment of complex neurological functions such as (but not limited to) sensory perception (vision, hearing, somatosensory function), and muscle function. The ability to use similar techniques in both humans and animal models increases the ability to perform mechanistic research to investigate neurological problems. Good animal to human homology of many neurophysiological systems facilitates interpretation of data to provide cause-effect linkages to epidemiological findings. Mechanistic cellular research to screen for toxicity often includes gaps between cellular and whole animal/person neurophysiological changes, preventing understanding of the complete function of the nervous system. Building Adverse Outcome Pathways (AOPs) will allow us to begin to identify brain regions, timelines, neurotransmitters, etc. that may be Key Events (KE) in the Adverse Outcomes (AO). This requires an integrated strategy, from in vitro to in vivo (and hypothesis generation, testing, revision). Scientists need to determine intermediate levels of nervous system organization that are related to an AO and work both upstream and downstream using mechanistic approaches. Possibly more than any other organ, the brain will require networks of pathways/AOPs to allow sufficient predictive accuracy. Advancements in neurobiological techniques should be incorporated into these AOP-base neurotoxicological assessments, including interactions between many regions of the brain simultaneously. Coupled with advancements in optogenetic manipulation, complex functions of the nervous system (such as acquisition, attention, sensory perception, etc.) can be examined in real time. The integration of neurophysiological changes with changes in gene/protein expression can begin to provide the mechanistic underpinnings for biological changes. Establishment of linkages between changes in cellular physiology and those at the level of the AO will allow construction of biological pathways (AOPs) and allow development of higher throughput assays to test for changes to critical physiological circuits. To allow mechanistic/predictive toxicology of the nervous system to be protective of human populations, neuroelectrophysiology has a critical role in our future.
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Affiliation(s)
- David W Herr
- Neurological and Endocrine Toxicology Branch, Public Health and Integrated Toxicology Division, CPHEA/ORD, U.S. Environmental Protection Agency, Washington, NC, United States
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35
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Posa A, Kornhuber M. EMG-Phänomene peripherer motorisch axonaler
Übererregbarkeit. KLIN NEUROPHYSIOL 2021. [DOI: 10.1055/a-1536-9243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungBei der Nadel-Elektromyographie (EMG) besitzen Phänomene der vermehrten
Erregbarkeit von Muskelfasern und von motorischen Axonen Bedeutung für
die Diagnostik neuromuskulärer Erkrankungen. Zur motorisch axonalen
Übererregbarkeit gehören spontane Phänomene wie
Faszikulationen, spontane kontinuierliche Einzelentladungen der motorischen
Einheit (SKEME), Myokymien, neuromyotone Entladungsserien und Krampi. Ferner
gehören dazu reizinduzierte Phänomene wie manche A-Wellen,
reizinduzierte komplex repetitive Entladungen oder tetanischen Spasmen bei
Elektrolytstörungen. In der vorliegenden Übersicht wird der
Kenntnisstand zu den verschiedenen Phänomenen motorisch axonaler
Übererregbarkeit referiert. Ein Schwerpunkt liegt dabei auf den SKEME
als neuem Mitglied der Gruppe spontaner Potenziale aus dem motorischen Axon.
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Affiliation(s)
- Andreas Posa
- Universitätsklinik für Neurologie,
Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
| | - Malte Kornhuber
- Universitätsklinik für Neurologie,
Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
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36
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Marquardt RJ, Levin KH. Electrodiagnostic Assessment of Radiculopathies. Neurol Clin 2021; 39:983-995. [PMID: 34602222 DOI: 10.1016/j.ncl.2021.06.011] [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: 11/17/2022]
Abstract
This article discusses the electrodiagnostic assessment of radiculopathy. Relevant anatomy initially is reviewed followed by discussion surrounding the approach to nerve conduction studies and needle electrode examination when it comes to radiculopathy evaluation. Pitfalls of the electrodiagnosis versus clinical diagnosis of radiculopathy and the definitions of acute versus chronic, and active versus inactive, are reviewed.
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Affiliation(s)
- Robert J Marquardt
- Neuromuscular Center, Department of Neurology, Cleveland Clinic, 9500 Euclid Avenue, Desk S90, Cleveland, OH 44195, USA
| | - Kerry H Levin
- Neuromuscular Center, Department of Neurology, Cleveland Clinic, 9500 Euclid Avenue, Desk S90, Cleveland, OH 44195, USA.
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37
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Dhawan PS. Electrodiagnostic Assessment of Plexopathies. Neurol Clin 2021; 39:997-1014. [PMID: 34602223 DOI: 10.1016/j.ncl.2021.06.006] [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: 11/30/2022]
Abstract
Disorders of the brachial and lumbosacral plexus are complex and may occur as a consequence of trauma, compression, inflammatory disorders, malignant infiltration, or delayed effects of radiation therapy. An understanding of plexus anatomy and surrounding structures will allow the electromyographer to facilitate an efficient and comprehensive assessment of the plexus. A careful and thorough electrodiagnostic assessment allows for localization within the plexus and may provide important information about underlying pathology and prognosis.
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Affiliation(s)
- Priya Sai Dhawan
- Department of Neurology, University of British Columbia, Koerner Pavilion, UBC Hospital, S192-2211 Westbrook Mall, North Vancouver, British Columbia V6T 2B5, Canada.
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38
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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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39
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Velasco‐Bosom S, Karam N, Carnicer‐Lombarte A, Gurke J, Casado N, Tomé LC, Mecerreyes D, Malliaras GG. Conducting Polymer-Ionic Liquid Electrode Arrays for High-Density Surface Electromyography. Adv Healthc Mater 2021; 10:e2100374. [PMID: 33991046 DOI: 10.1002/adhm.202100374] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/15/2021] [Indexed: 11/07/2022]
Abstract
Surface electromyography (EMG) is used as a medical diagnostic and to control prosthetic limbs. Electrode arrays that provide large-area, high density recordings have the potential to yield significant improvements in both fronts, but the need remains largely unfulfilled. Here, digital fabrication techniques are used to make scalable electrode arrays that capture EMG signals with mm spatial resolution. Using electrodes made of poly(3,4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT:PSS) composites with the biocompatible ionic liquid (IL) cholinium lactate, the arrays enable high quality spatiotemporal recordings from the forearm of volunteers. These recordings allow to identify the motions of the index, little, and middle fingers, and to directly visualize the propagation of polarization/depolarization waves in the underlying muscles. This work paves the way for scalable fabrication of cutaneous electrophysiology arrays for personalized medicine and highly articulate prostheses.
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Affiliation(s)
| | - Nuzli Karam
- Electrical Engineering Division University of Cambridge Cambridge CB3 0FA UK
| | | | - Johannes Gurke
- Electrical Engineering Division University of Cambridge Cambridge CB3 0FA UK
| | - Nerea Casado
- POLYMAT University of the Basque Country UPV/EHU Avda. Tolosa 72, Donostia‐San Sebastián Gipuzkoa 20018 Spain
| | - Liliana C. Tomé
- POLYMAT University of the Basque Country UPV/EHU Avda. Tolosa 72, Donostia‐San Sebastián Gipuzkoa 20018 Spain
- LAQV/REQUIMTE, Chemistry Department NOVA School of Science and Technology Caparica 2829‐516 Portugal
| | - David Mecerreyes
- POLYMAT University of the Basque Country UPV/EHU Avda. Tolosa 72, Donostia‐San Sebastián Gipuzkoa 20018 Spain
- Ikerbasque Basque Foundation for Science Bilbao E‐48011 Spain
| | - George G. Malliaras
- Electrical Engineering Division University of Cambridge Cambridge CB3 0FA UK
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40
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Okubo Y, Kaneoka K, Hasebe K, Matsunaga N, Imai A, Hodges PW. Differential activation of psoas major and rectus femoris during active straight leg raise to end range. J Electromyogr Kinesiol 2021; 60:102588. [PMID: 34455371 DOI: 10.1016/j.jelekin.2021.102588] [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] [Received: 02/03/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study was to investigate the activation of the hip flexor and abdominal muscles during an active straight leg raise (ASLR) to end range of hip flexion. Data were recorded from nine healthy men. Fine-wire electromyography (EMG) electrodes were inserted into psoas major (PM), and surface electrodes were placed over rectus femoris (RF), rectus abdominis, obliquus externus abdominis (OE), and obliquus internus abdominis/transversus abdominis (OI/TrA). EMG and kinematic data were obtained during concentric, hold (at end range) and eccentric phases of an ASLR. Concentric and eccentric movements were divided into three phases (early, mid, and late). Onsets of EMG relative to the onset of the ALSR movement and EMG amplitudes in each phase were compared between muscles. Onsets of the PM (-33 ± 245 ms) and RF (-3 ± 119 ms) EMG prior to leg elevation were significantly earlier than those of the OE and OI/TrA. PM EMG showed highest activation in the late concentric, hold, early eccentric phase, and was significantly higher than RF EMG. OI/TrA EMG was significantly greater in mid and late concentric, hold, and early eccentric phase than other phases. During the ASLR, unlike RF, PM EMG continues to increase towards the end range of hip flexion. Activation of OI/TrA muscle may be involved in control trunk and pelvic movement.
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Affiliation(s)
- Yu Okubo
- Faculty of Health and Medical Care, Satama Medical University, Saitama, Japan; Faculty of Sport Sciences, Waseda University, Saitama, Japan.
| | - Koji Kaneoka
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Kiyotaka Hasebe
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Naoto Matsunaga
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Atsushi Imai
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Paul W Hodges
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
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41
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Robinson LR, Binhammer P. Role of electrodiagnosis in nerve transfers for focal neuropathies and brachial plexopathies. Muscle Nerve 2021; 65:137-146. [PMID: 34331718 DOI: 10.1002/mus.27376] [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: 12/21/2020] [Revised: 07/13/2021] [Accepted: 07/18/2021] [Indexed: 12/16/2022]
Abstract
Over the past 2 decades, the surgical treatment of brachial plexus and peripheral nerve injuries has advanced considerably. Nerve transfers have become an important surgical tool in addition to nerve repair and grafting. Electrodiagnosis has traditionally played a role in the diagnosis and localization of peripheral nervous system injuries, but a different approach is needed for surgical decision-making and monitoring recovery. When patients have complete or severe injuries they should be referred to surgical colleagues early after injury, as outcomes are best when nerve transfers are performed within the first 3 to 6 mo after onset. Patients with minimal recovery of voluntary activity are particularly challenging, and the presence of a few motor unit action potentials in these individuals should be interpreted on the basis of timing and evidence of ongoing reinnervation. Evaluation of potential recipient and donor muscles, as well as redundant muscles, for nerve transfers requires an individualized approach to optimize the chances of a successful surgical intervention. Anomalous innervation takes on new importance in these patients. Communication between surgeons and electrodiagnostic medicine specialists (EMSs) is best facilitated by a joint collaborative clinic. Ongoing monitoring of recovery post-operatively is critical to allow for decision making for continued surgical and rehabilitation treatments. Different electrodiagnostic findings are expected with resolution of neurapraxia, distal axon sprouting, and axonal regrowth. As new surgical techniques become available, EMSs will play an important role in the assessment and treatment of these patients with severe nerve injuries.
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Affiliation(s)
- Lawrence R Robinson
- Physical Medicine & Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Paul Binhammer
- Plastic & Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
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42
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Villa D, Ardolino G, Borellini L, Cogiamanian F, Vergari M, Savojardo V, Peyvandi F, Barbieri S. Subclinical myopathic changes in COVID-19. Neurol Sci 2021; 42:3973-3979. [PMID: 34304328 PMCID: PMC8310558 DOI: 10.1007/s10072-021-05469-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/07/2021] [Indexed: 12/25/2022]
Abstract
Introduction Coronavirus disease 2019 (COVID-19) is associated to neuromuscular symptoms in up to 10.7% of hospitalized patients. Nevertheless, the extent of muscular involvement in infected subjects with no signs of myopathy has never been assessed with neurophysiological investigations. Methods Over a 3-week period — from April 30 through May 20, 2020 — a total of 70 patients were hospitalized in the Internal Medicine Ward of the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico in Milan, Italy. After excluding patients who underwent invasive ventilation and steroid treatment, 12 patients were evaluated. Nerve conduction studies (NCS) included the analysis of conduction velocity, amplitude, and latency for bilateral motor tibial, ulnar nerves, and sensory sural and radial nerves. Unilateral concentric-needle electromyography (EMG) was performed evaluating at least 4 areas of 8 selected muscles. For each muscle, spontaneous activity at rest, morphology, and recruitment of motor unit action potentials (MUAPs) were evaluated. Results While nerve conduction studies were unremarkable, needle electromyography showed myopathic changes in 6 out of 12 subjects. All patients were asymptomatic for muscular involvement. Clinical features and laboratory findings did not show relevant differences between patients with and without myopathic changes. Conclusion Our data show that in SARS-CoV-2 infection muscular involvement can occur despite the absence of clinical signs or symptoms and should be considered part of the disease spectrum. The application of muscle biopsy to unravel the mechanisms of myofiber damage on tissue specimens could help to clarify the pathogenesis and the treatment response of coronavirus-mediated injury. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-021-05469-8.
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Affiliation(s)
- Davide Villa
- U.O. Neurofisiopatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy.,Dipartimento Di Fisiopatologia Medico-Chirurgica E Dei Trapianti, Università Degli Studi Di Milano, Milan, Italy
| | - Gianluca Ardolino
- U.O. Neurofisiopatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy
| | - Linda Borellini
- U.O. Neurofisiopatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy.
| | - Filippo Cogiamanian
- U.O. Neurofisiopatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy
| | - Maurizio Vergari
- U.O. Neurofisiopatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy
| | - Valeria Savojardo
- U.O. Medicina Generale Ad Alta Intensità Di Cura, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy
| | - Flora Peyvandi
- Dipartimento Di Fisiopatologia Medico-Chirurgica E Dei Trapianti, Università Degli Studi Di Milano, Milan, Italy.,Centro Emofilia E Trombosi Angelo Bianchi Bonomi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy
| | - Sergio Barbieri
- U.O. Neurofisiopatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy
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43
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Mix FM, Sucher BM, Brooks JE. Stingray-Induced Tarsal Tunnel Syndrome. Cureus 2021; 13:e16761. [PMID: 34513381 PMCID: PMC8405374 DOI: 10.7759/cureus.16761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 11/05/2022] Open
Abstract
This case report involves a 17-year-old male referred for electrodiagnostic (EDX) evaluation with symptoms of tarsal tunnel syndrome after being stung by a stingray. EDX testing revealed moderate axonal injury localized to the tarsal tunnel. Subsequent exploratory surgery removed a stingray barb from the tarsal tunnel. The patient's symptoms nearly completely resolved at five weeks postoperative follow-up. EDX evaluation of this patient with delayed recovery proved to be a valuable component of management.
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Affiliation(s)
- Felicia M Mix
- Physical Medicine and Rehabilitation, Burrell College of Osteopathic Medicine, Las Cruces, USA
| | - Benjamin M Sucher
- Physical Medicine and Rehabilitation, Electromyography Labs of Arizona Arthritis & Rheumatology Associates, Phoenix, USA
| | - Joseph E Brooks
- Physical Medicine and Rehabilitation, Genesis Health System, Davenport, USA
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44
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Vescio B, Quattrone A, Nisticò R, Crasà M, Quattrone A. Wearable Devices for Assessment of Tremor. Front Neurol 2021; 12:680011. [PMID: 34177785 PMCID: PMC8226078 DOI: 10.3389/fneur.2021.680011] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/05/2021] [Indexed: 12/28/2022] Open
Abstract
Tremor is an impairing symptom associated with several neurological diseases. Some of such diseases are neurodegenerative, and tremor characterization may be of help in differential diagnosis. To date, electromyography (EMG) is the gold standard for the analysis and diagnosis of tremors. In the last decade, however, several studies have been conducted for the validation of different techniques and new, non-invasive, portable, or even wearable devices have been recently proposed as complementary tools to EMG for a better characterization of tremors. Such devices have proven to be useful for monitoring the efficacy of therapies or even aiding in differential diagnosis. The aim of this review is to present systematically such new solutions, trying to highlight their potentialities and limitations, with a hint to future developments.
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Affiliation(s)
| | - Andrea Quattrone
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Græcia University, Catanzaro, Italy
| | - Rita Nisticò
- Neuroimaging Unit, Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Catanzaro, Italy
| | - Marianna Crasà
- Department of Medical and Surgical Sciences, Neuroscience Research Center, Magna Græcia University, Catanzaro, Italy
| | - Aldo Quattrone
- Neuroimaging Unit, Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Catanzaro, Italy.,Department of Medical and Surgical Sciences, Neuroscience Research Center, Magna Græcia University, Catanzaro, Italy
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45
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Florczynski M, Paul R, Leroux T, Baltzer H. Prevention and Treatment of Nerve Injuries in Shoulder Arthroplasty. J Bone Joint Surg Am 2021; 103:935-946. [PMID: 33877057 DOI: 10.2106/jbjs.20.01716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Nerve injuries during shoulder arthroplasty have traditionally been considered rare events, but recent electrodiagnostic studies have shown that intraoperative nerve trauma is relatively common. ➤ The brachial plexus and axillary and suprascapular nerves are the most commonly injured neurologic structures, with the radial and musculocutaneous nerves being less common sites of injury. ➤ Specific measures taken during the surgical approach, component implantation, and revision surgery may help to prevent direct nerve injury. Intraoperative positioning maneuvers and arm lengthening warrant consideration to minimize indirect injuries. ➤ Suspected nerve injuries should be investigated with electromyography preferably at 6 weeks and no later than 3 months postoperatively, allowing for primary reconstruction within 3 to 6 months of injury when indicated. Primary reconstructive options include neurolysis, direct nerve repair, nerve grafting, and nerve transfers. ➤ Secondary reconstruction is preferred for injuries presenting >12 months after surgery. Secondary reconstructive options with favorable outcomes include tendon transfers and free functioning muscle transfers.
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Affiliation(s)
- Matthew Florczynski
- Departments of Orthopaedic Surgery (M.F., R.P., and T.L.) and Plastic and Reconstructive Surgery (R.P. and H.B.), University of Toronto, Toronto, Ontario, Canada
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46
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Zohar O, Khatib M, Omar R, Vishinkin R, Broza YY, Haick H. Biointerfaced sensors for biodiagnostics. VIEW 2021. [DOI: 10.1002/viw.20200172] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Orr Zohar
- Department of Chemical Engineering and the Russell Berrie Nanotechnology Institute Technion–Israel Institute of Technology Haifa Israel
| | - Muhammad Khatib
- Department of Chemical Engineering and the Russell Berrie Nanotechnology Institute Technion–Israel Institute of Technology Haifa Israel
| | - Rawan Omar
- Department of Chemical Engineering and the Russell Berrie Nanotechnology Institute Technion–Israel Institute of Technology Haifa Israel
| | - Rotem Vishinkin
- Department of Chemical Engineering and the Russell Berrie Nanotechnology Institute Technion–Israel Institute of Technology Haifa Israel
| | - Yoav Y. Broza
- Department of Chemical Engineering and the Russell Berrie Nanotechnology Institute Technion–Israel Institute of Technology Haifa Israel
| | - Hossam Haick
- Department of Chemical Engineering and the Russell Berrie Nanotechnology Institute Technion–Israel Institute of Technology Haifa Israel
- School of Advanced Materials and Nanotechnology Xidian University Xi'an Shaanxi P. R. China
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47
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Berger MJ, Robinson L, Krauss EM. Lower Motor Neuron Abnormality in Chronic Cervical Spinal Cord Injury: Implications for Nerve Transfer Surgery. J Neurotrauma 2021; 39:259-265. [PMID: 33626968 DOI: 10.1089/neu.2020.7579] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Nerve transfer surgery (NT) constitutes an exciting option to improve upper limb functions in chronic spinal cord injury (SCI), but requires intact sublesional lower motor neuron (LMN) health. The purpose of this study was to characterize patterns of LMN abnormality in nerve-muscle groups that are the potential recipients of NT, using a standardized electrodiagnostic examination, in individuals with chronic SCI (injury duration >2 years, injury levels C4-T1). The LMN abnormality was determined using a semihierarchical approach, combining the amplitude compound muscle action potential (CMAP) and abnormal spontaneous activity on needle electromyography (EMG). Ten participants (46 potential recipient muscles) were included (median age, 42.5 years; six males and four females; median duration from injury, 15.5 years). A high frequency of LMN abnormality was observed (87%), although there was substantial variation within and between individuals. No statistically significant discordance was observed between LMN abnormality on CMAP and EMG (p = 0.24), however, 50% of muscles with normal CMAP demonstrated abnormal spontaneous activity. The high frequency of LMN abnormality in recipient nerve-muscle groups has implications to candidate selection for NT surgery in chronic SCI and supports the important role of the pre-operative electrodiagnostic examination. Our results further support the inclusion of both CMAP and needle EMG parameters for characterization of LMN health. Although the number of nerve-muscle groups with normal LMN health was small (13%), this underscores the neurophysiological potential of some patients with chronic injuries to benefit from NT surgery.
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Affiliation(s)
- Michael J Berger
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lawrence Robinson
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Emily M Krauss
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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48
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Inglis JG, Gabriel DA. Sex differences in the modulation of the motor unit discharge rate leads to reduced force steadiness. Appl Physiol Nutr Metab 2021; 46:1065-1072. [PMID: 33667116 DOI: 10.1139/apnm-2020-0953] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to evaluate the relationship between the variability in the motor unit inter-pulse interval and force steadiness at submaximal and maximal force outputs between the sexes. Twenty-four male and 24 female participants were recruited to perform isometric dorsiflexion contractions at 20, 40, 60, 80, and 100% maximum voluntary contraction. Tibialis anterior myoelectric signal was recorded by an intramuscular electrode. Females had lower force steadiness (coefficient of variation of force (CoV-Force), 27.3%, p < 0.01) and a greater coefficient of variation of motor unit action potential inter-pulse interval (CoV-IPI), compared with males (9.6%, p < 0.01). There was no significant correlation between the normalized CoV-IPI and CoV-Force (r = 0.19, p > 0.01), but there was a significant repeated measures correlation between the raw scores for root-mean-square force error and the standard deviation of motor unit discharge rate (r = 0.65, p < 0.01). Females also had a greater incidence of doublet discharges on average across force levels (p < 0.01). The sex differences may result from motor unit behaviours (i.e., doublet and rapid discharges, synchronization, rate coding or recruitment), leading to lower force steadiness and greater CoV-IPI in females. Novelty: Sex differences in force steadiness may be due to neural strategies. Females have lower force steadiness compared with males. Greater incidence of doublet discharges in females may result in lesser force steadiness.
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Affiliation(s)
- J Greig Inglis
- Electromyographic Kinesiology Laboratory, Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada.,Electromyographic Kinesiology Laboratory, Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada
| | - David A Gabriel
- Electromyographic Kinesiology Laboratory, Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada.,Electromyographic Kinesiology Laboratory, Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada
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49
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Shelly S, Shouman K, Paul P, Engelstad J, Amrami KK, Spinner RJ, Dubey D, Vazquez Do Campo R, Dyck PJ, Klein CJ, Dyck PJB. Expanding the Spectrum of Chronic Immune Sensory Polyradiculopathy: CISP-Plus. Neurology 2021; 96:e2078-e2089. [PMID: 33653905 PMCID: PMC8166448 DOI: 10.1212/wnl.0000000000011792] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/28/2021] [Indexed: 12/24/2022] Open
Abstract
Objective Sensory loss with normal nerve conduction studies (NCS) from focal sensory root inflammatory demyelination is characteristic of chronic immune sensory polyradiculopathy (CISP). However, nonpure cases involving motor and distal sensory nerves exist (CISP-plus). We hypothesize that CISP-plus and CISP are fundamentally part of the same syndrome through comparison of clinical, neurophysiologic, and pathologic features. Methods CISP-plus (primary dorsal root with lesser motor and sensory nerve involvement) and CISP cases were retrospectively analyzed (1986–2019). Results We identified 44 CISP-plus and 28 CISP cases (n = 72) with 86% (38/44) of patients with CISP-plus and 79% (22/28) of patients with CISP experiencing imbalance. On examination, large fiber sensory loss was present in 98% (43/44) of patients with CISP-plus and 96% (27/28) of patients with CISP. Gait ataxia was evident in 93% (41/44) of patients with CISP-plus and 79% (22/28) of patients with CISP. Mild distal weakness was common in CISP-plus (75%, 33/44). NCS showed mild abnormalities in all patients with CISP-plus and were normal (by definition) in all patients with CISP. Elevated CSF protein, slowing of somatosensory evoked potentials, and MRI root enhancement occurred in most CISP-plus and CISP cases. Eleven CISP-plus nerve biopsies showed loss of large myelinated fibers and onion-bulb formations, most prominent in rootlet biopsies. Immunotherapy resulted in marked improvement of gait ataxia in 84% (27/32) of patients with CISP-plus and 93% (13/14) of patients with CISP with return to normal neurologic examination in half (25/46). Conclusion The recognition of CISP-plus expands the spectrum of CIDP by combining CISP-plus (predominant sensory polyradiculopathy with mild motor and sensory nerve involvement) with pure CISP (focal sensory polyradiculopathy) together as proximal sensory CIDP.
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Affiliation(s)
- Shahar Shelly
- From the Departments of Neurology (S.S., K.S., P.P., D.D., R.V.D.C., P.J.D., C.J.K., P.J.B.D.), Laboratory Medicine and Pathology (J.E., D.D., C.J.K.), Radiology (K.K.A.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN
| | - Kamal Shouman
- From the Departments of Neurology (S.S., K.S., P.P., D.D., R.V.D.C., P.J.D., C.J.K., P.J.B.D.), Laboratory Medicine and Pathology (J.E., D.D., C.J.K.), Radiology (K.K.A.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN
| | - Pritikanta Paul
- From the Departments of Neurology (S.S., K.S., P.P., D.D., R.V.D.C., P.J.D., C.J.K., P.J.B.D.), Laboratory Medicine and Pathology (J.E., D.D., C.J.K.), Radiology (K.K.A.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN
| | - JaNean Engelstad
- From the Departments of Neurology (S.S., K.S., P.P., D.D., R.V.D.C., P.J.D., C.J.K., P.J.B.D.), Laboratory Medicine and Pathology (J.E., D.D., C.J.K.), Radiology (K.K.A.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN
| | - Kimberly K Amrami
- From the Departments of Neurology (S.S., K.S., P.P., D.D., R.V.D.C., P.J.D., C.J.K., P.J.B.D.), Laboratory Medicine and Pathology (J.E., D.D., C.J.K.), Radiology (K.K.A.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN
| | - Robert J Spinner
- From the Departments of Neurology (S.S., K.S., P.P., D.D., R.V.D.C., P.J.D., C.J.K., P.J.B.D.), Laboratory Medicine and Pathology (J.E., D.D., C.J.K.), Radiology (K.K.A.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN
| | - Divyanshu Dubey
- From the Departments of Neurology (S.S., K.S., P.P., D.D., R.V.D.C., P.J.D., C.J.K., P.J.B.D.), Laboratory Medicine and Pathology (J.E., D.D., C.J.K.), Radiology (K.K.A.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN
| | - Rocio Vazquez Do Campo
- From the Departments of Neurology (S.S., K.S., P.P., D.D., R.V.D.C., P.J.D., C.J.K., P.J.B.D.), Laboratory Medicine and Pathology (J.E., D.D., C.J.K.), Radiology (K.K.A.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN
| | - Peter J Dyck
- From the Departments of Neurology (S.S., K.S., P.P., D.D., R.V.D.C., P.J.D., C.J.K., P.J.B.D.), Laboratory Medicine and Pathology (J.E., D.D., C.J.K.), Radiology (K.K.A.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN.
| | - Christopher J Klein
- From the Departments of Neurology (S.S., K.S., P.P., D.D., R.V.D.C., P.J.D., C.J.K., P.J.B.D.), Laboratory Medicine and Pathology (J.E., D.D., C.J.K.), Radiology (K.K.A.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN
| | - P James B Dyck
- From the Departments of Neurology (S.S., K.S., P.P., D.D., R.V.D.C., P.J.D., C.J.K., P.J.B.D.), Laboratory Medicine and Pathology (J.E., D.D., C.J.K.), Radiology (K.K.A.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN.
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Shen H, Gardner AM, Vyas J, Ishida R, Tawfik VL. Modeling Complex Orthopedic Trauma in Rodents: Bone, Muscle and Nerve Injury and Healing. Front Pharmacol 2021; 11:620485. [PMID: 33597884 PMCID: PMC7882733 DOI: 10.3389/fphar.2020.620485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/21/2020] [Indexed: 12/24/2022] Open
Abstract
Orthopedic injury can occur from a variety of causes including motor vehicle collision, battlefield injuries or even falls from standing. Persistent limb pain is common after orthopedic injury or surgery and presents a unique challenge, as the initiating event may result in polytrauma to bone, muscle, and peripheral nerves. It is imperative that we understand the tissue-specific and multicellular response to this unique type of injury in order to best develop targeted treatments that improve healing and regeneration. In this Mini Review we will first discuss current rodent models of orthopedic trauma/complex orthotrauma. In the second section, we will focus on bone-specific outcomes including imaging modalities, biomechanical testing and immunostaining for markers of bone healing/turnover. In the third section, we will discuss muscle-related pathology including outcome measures of fibrosis, muscle regeneration and tensile strength measurements. In the fourth section, we will discuss nervous system-related pathology including outcome measures of pain-like responses, both reflexive and non-reflexive. In all sections we will consider parallels between preclinical outcome measures and the functional and mechanistic findings of the human condition.
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Affiliation(s)
- Huaishuang Shen
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, United States.,Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Aysha M Gardner
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, United States
| | - Juhee Vyas
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, United States
| | - Ryosuke Ishida
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, United States.,Department of Anesthesiology, Shimane University, Shimane, Japan
| | - Vivianne L Tawfik
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, United States.,Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, United States
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