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Koysuren A, Temucin CM. Concentric needle jitter analysis of the genioglossus muscle in patients with motor neuron disease. Neurol Res 2024; 46:578-582. [PMID: 38591728 DOI: 10.1080/01616412.2024.2339096] [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: 11/29/2023] [Accepted: 03/30/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVES Difficulty relaxing the genioglossus muscle makes the evaluation of spontaneous activity problematic in patients with motor neuron disease (MND). We performed jitter analysis using conventional disposable concentric needle electrodes (CNEs) of the voluntarily activated genioglossus muscle in patients with and without MND to detect the denervation-reinnervation process. METHODS CNE jitter analysis was performed at the genioglossus muscle in 21 MND(+) patients and 22 MND(-) subjects. The jitter analysis was considered abnormal if the jitter values exceeded these limits for the mean consecutive difference (MCD) or the individual MCD in more than 10% of readings. RESULTS Seventeen MND(+) patients (81%) had at least three abnormal individual jitter values whereas denervation findings were obtained in eleven of them during the needle electromyographic examination at genioglossus muscle. None of the MND(-) subjects showed CNE jitter abnormality. CONCLUSION CNE jitter analysis of genioglossus muscle may provide an useful information that may be suggestive of a diagnosis of MND/ALS.
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Affiliation(s)
- Aydan Koysuren
- Department of Neurology, Hacettepe University Medical School, Ankara, Turkey
| | - Cagri Mesut Temucin
- Department of Neurology, Hacettepe University Medical School, Ankara, Turkey
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Fidancı H, Buturak Ş, Öztürk İ, Arlıer Z. Needle electromyography abnormalities in the upper trapezius muscle in neuromuscular disorders. Turk J Med Sci 2023; 53:233-242. [PMID: 36945948 PMCID: PMC10387837 DOI: 10.55730/1300-0144.5578] [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: 04/19/2022] [Accepted: 10/22/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND : Needle electromyography (EMG) abnormalities in the trapezius muscle (TM) can be seen in neuromuscular disorders. The aim was to determine the characteristics of needle EMG abnormalities observed in the TM in neuromuscular disorders. METHODS The data of patients who applied to the Clinical Neurophysiology Laboratory of University of Health Sciences Adana City Training and Research Hospital between December 2018 and October 2021 were reviewed. Polio survivors, amyotrophic lateral sclerosis (ALS) patients, patients with sensorimotor polyneuropathy, patients with spinal cord lesions involving C2/C3/C4 segments, patients with spinal accessory nerve (SAN) lesions, neuralgic amyotrophy (NA) patients, and patients with myopathy were included. Needle EMG findings of the upper TM of the patients were analyzed. Positive sharp waves, fibrillation potentials, fasciculation potentials, myotonic discharges, and motor unit action potential (MUAP) changes were considered needle EMG abnormalities. RESULTS Eighty-one polio survivors, 23 ALS patients, 39 patients with sensorimotor polyneuropathy, 10 patients with cervical spinal lesions, eight NA patients, seven patients with SAN lesions, and three patients with myopathy were included in the study. Fifteen (65.2%) ALS patients, 18 (22.2%) polio survivors, three (30%) patients with cervical spinal lesions, two (5.1%) patients with sensorimotor neuropathy, one (12.5%) NA patient, seven (100%) patients with SAN lesions, and two (66.7%) patients with myopathies had at least one needle EMG abnormality in the TM. Fasciculation potentials in the TM were seen in 10 (43.5%) ALS patients. In four patients with SAN lesions and one polio survivor, MUAP could not be obtained from the TM. DISCUSSION There may be more frequent needle EMG abnormalities, particularly in ALS patients and patients with SAN lesions. Since the number of patients with myopathy included in this study was low, it is difficult to comment on the needle EMG features of the TM for these patients. In addition, this study indicated that fasciculation potentials in the TM are typical in ALS patients and that MUAP may not be obtained from the TM in patients with SAN lesions.
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Affiliation(s)
- Halit Fidancı
- Division of Clinical Neurophysiology, Department of Neurology,University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Şencan Buturak
- Department of Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - İlker Öztürk
- Department of Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Zülfikar Arlıer
- Department of Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
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3
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Early diagnosis of amyotrophic lateral sclerosis based on fasciculations in muscle ultrasonography: A machine learning approach. Clin Neurophysiol 2022; 140:136-144. [DOI: 10.1016/j.clinph.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/26/2022] [Accepted: 06/12/2022] [Indexed: 11/22/2022]
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4
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Rosow L, Lomen-Hoerth C. Treatment and Management of Adult Motor Neuron Diseases. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00012-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Duarte ML, Iared W, Oliveira ASB, Dos Santos LR, Peccin MS. Ultrasound versus electromyography for the detection of fasciculation in amyotrophic lateral sclerosis: systematic review and meta-analysis. Radiol Bras 2020; 53:116-121. [PMID: 32336828 PMCID: PMC7170585 DOI: 10.1590/0100-3984.2019.0055] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The objective of this study was to determine the diagnostic accuracy of ultrasound and electromyography for the detection of fasciculation in patients with amyotrophic lateral sclerosis and to compare detection rates between the two methods. By searching the Cochrane Library, MEDLINE, Excerpta Medica, and Latin-American and Caribbean Health Sciences Literature databases, we identified studies evaluating the diagnostic accuracy and fasciculation detection rates of ultrasound and electromyography. The Quality Assessment of Diagnostic Accuracy Studies, version 2, and RTI item bank tools were used for the evaluation of methodological quality. Ultrasound, for 10 s or 30 s, had a higher detection rate than did electromyography in all muscles evaluated. The overall detection rate (in patients) did not differ significantly between ultrasound for 10 s and ultrasound for 30 s. The accuracy of ultrasound for 10 s was 70% in muscles and 85% in patients. The accuracy of ultrasound for 30 s was 82% in patients. Ultrasound provided detection rates superior to those achieved with electromyography, independent of the examination time and muscles evaluated.
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Affiliation(s)
- Márcio Luís Duarte
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Wagner Iared
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | | | | | - Maria Stella Peccin
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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6
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Civardi C, Collini A, Mazzini L, Monaco F, Geda C. Single-pulse transcranial magnetic stimulation in amyotrophic lateral sclerosis. Muscle Nerve 2019; 61:330-337. [PMID: 31837153 DOI: 10.1002/mus.26780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 12/04/2019] [Accepted: 12/07/2019] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Transcranial magnetic stimulation (TMS) is one of the best methods to identify changes in the corticospinal tract. We used single-pulse TMS at the beginning of the disease and in the follow-up in a group of patients with amyotrophic lateral sclerosis (ALS). METHODS We evaluated the corticospinal tract in the bulbar, upper, and lower regions in 55 patients with ALS, and we monitored them for a period of 24 months. Data were correlated with clinical scales. RESULTS An increase of central motor conduction time (CMCT) was the most sensitive marker of upper motor neuron involvement. The resting motor threshold, CMCT, and the central silent period increased linearly with disease duration and upper/lower motor neuron involvement. DISCUSSION Transcranial magnetic stimulation could be an essential neurophysiological technique in the early phase of ALS because it has been shown to be useful in detecting subclinical upper motor neuron involvement. Multiple evaluations of several regions increase TMS sensitivity.
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Affiliation(s)
| | | | - Letizia Mazzini
- ALS Centre Department of Neurology Maggiore della Carità University Hospital, Novara, Italy
| | - Francesco Monaco
- Department of Neurology Maggiore della Carità University Hospital, Novara, Italy
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7
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Takahashi T, Hanakita J, Minami M, Tomita Y, Sasagasako T, Kanematsu R. Cervical Spondylotic Amyotrophy: Case Series and Review of the Literature. Neurospine 2019; 16:579-588. [PMID: 31607092 PMCID: PMC6790744 DOI: 10.14245/ns.1938210.105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/14/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Cervical spondylotic amyotrophy (CSA) is a relatively rare entity caused by cervical degenerative spinal diseases and characterized by motor weakness accompanied by remarkable muscle atrophy in the upper extremities without significant sensory deficits or spastic paraparesis in the lower extremities. Postoperative outcomes and predictive prognostic factors vary among previous reports. In the present report, we describe the surgical results in patients who were surgically treated for CSA and present a literature review. METHODS In total, 33 patients with CSA were retrospectively analyzed. Correlations between the surgical outcome and the following factors were statistically analyzed: age, sex, type of impaired muscle, preoperative severity of motor weakness, number of levels of cord or root compression, presence of a T2 high-intensity area in the spinal cord, cervical kyphosis, and methods of surgical procedure. RESULTS On postoperative neurological evaluation, 25 patients (75.8%) had favorable outcomes and 8 had unfavorable outcomes (proximal type, 72.2%; distal type, 78.6%). Patients with favorable outcomes were significantly younger than those with unfavorable outcomes (p=0.013). Patient's characteristics except for age and radiological factors were not correlated to surgical outcome. CONCLUSION The present study focused on the surgical results in patients who were surgically treated for CSA along with updated information from a literature review. Improvement of motor weakness is expected with acceptable prevalence although higher age can be a negative factor. Surgical outcomes and predictive factors related to a poor prognosis were determined and compared with those of previous articles.
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Affiliation(s)
| | - Junya Hanakita
- Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Manabu Minami
- Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Yosuke Tomita
- Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Tomoki Sasagasako
- Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Ryo Kanematsu
- Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
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8
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Bokuda K, Shimizu T, Kimura H, Morishima R, Kamiyama T, Kawata A, Nakayama Y, Isozaki E. Relationship between EMG-detected and ultrasound-detected fasciculations in amyotrophic lateral sclerosis: A prospective cohort study. Clin Neurophysiol 2019; 131:259-264. [PMID: 31506234 DOI: 10.1016/j.clinph.2019.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/12/2019] [Accepted: 08/16/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Fasciculation potentials (FP) are an important consideration in the electrophysiological diagnosis of ALS. Muscle ultrasonography (MUS) has a higher sensitivity in detecting fasciculations than electromyography (EMG), while in some cases, it is unable to detect EMG-detected fasciculations. We aimed to investigate the differences of FP between the muscles with and without MUS-detected fasciculations (MUS-fas). METHODS Thirty-one consecutive patients with sporadic ALS were prospectively recruited and in those, both needle EMG and MUS were performed. Analyses of the amplitude, duration, and number of phases of EMG-detected FPs were performed for seven muscles per patient, and results were compared between the muscles with and without MUS-fas in the total cohort. RESULTS The mean amplitude and phase number of FP were significantly lower in patients with EMG-detected FP alone (0.39 ± 0.25 mV and 3.21 ± 0.88, respectively) than in those with both FP and MUS-fas (1.22 ± 0.92 mV and 3.74 ± 1.39, respectively; p < 0.0001 and p = 0.017, Welch's t-test). CONCLUSION Small FP may be undetectable with MUS. MUS cannot replace EMG in the diagnostic approach for ALS. SIGNIFICANCE Clinicians should use a combination of EMG and MUS for the detection and quantitative analysis of fasciculation in ALS.
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Affiliation(s)
- Kota Bokuda
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan; ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
| | - Toshio Shimizu
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan; ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Hideki Kimura
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Ryo Morishima
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Tsutomu Kamiyama
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Akihiro Kawata
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan; ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Yuki Nakayama
- ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
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Menon P, Yiannikas C, Kiernan MC, Vucic S. Regional motor cortex dysfunction in amyotrophic lateral sclerosis. Ann Clin Transl Neurol 2019; 6:1373-1382. [PMID: 31402622 PMCID: PMC6689694 DOI: 10.1002/acn3.50819] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The pathophysiological processes underlying amyotrophic lateral sclerosis (ALS) need to be better understood, although cortical dysfunction has been implicated. Previous transcranial magnetic stimulation (TMS) studies have assessed cortical dysfunction from the hand. The aim of the present study was to determine whether cortical dysfunction was evident across representations of three body regions, and to relate these changes to clinical features of ALS. METHODS In this cross-sectional study, threshold tracking TMS was undertaken in 60 sporadic ALS patients, with motor evoked potential (MEP) responses recorded over the hand (abductor pollicis brevis), lower limb (tibialis anterior), and bulbar (trapezius) regions. The cross-sectional findings were compared to 28 age- and gender-matched controls. RESULTS Cortical dysfunction was evident across the representation of the three body regions, although the degree and nature of the dysfunction varied. Cortical hyperexcitability, as heralded by reduced short interval intracortical inhibition (SICI), was evident in all cortical regions (hand, P < 0.01; leg, P < 0.05; bulbar, P < 0.05) in ALS patients when compared with healthy control subjects. Importantly, features of cortical hyperexcitability seemed more prominent in clinically affected body regions and correlated with functional disability and muscle weakness. Cortical inexcitability was more prominent in the leg (P < 0.001) and bulbar regions (P < 0.01) when compared with controls. INTERPRETATION The nature of cortical dysfunction varied across the body regions in ALS, with cortical hyperexcitability being more prominent in the upper limbs while cortical inexcitability was more evident in the lower limbs and bulbar regions. The findings suggest a heterogeneity of cortical pathophysiological processes in ALS.
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Affiliation(s)
- Parvathi Menon
- Westmead HospitalSydneyNew South WalesAustralia
- University of SydneySydneyNew South WalesAustralia
| | - Con Yiannikas
- University of SydneySydneyNew South WalesAustralia
- Concord HospitalSydneyNew South WalesAustralia
| | - Matthew C. Kiernan
- University of SydneySydneyNew South WalesAustralia
- Brain and Mind InstituteSydneyNew South WalesAustralia
| | - Steve Vucic
- Westmead HospitalSydneyNew South WalesAustralia
- University of SydneySydneyNew South WalesAustralia
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10
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Cervical spondylotic amyotrophy: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2293-2301. [PMID: 31037421 DOI: 10.1007/s00586-019-05990-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/22/2019] [Accepted: 04/22/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Cervical spondylotic amyotrophy (CSA) is characterized by upper limb muscle weakness and atrophy, without sensory deficits. The pathophysiology of CSA has been attributed to selective injury to the ventral nerve root and/or anterior horn of the spinal cord. This review aimed to delineate the history of CSA and to describe the epidemiology, etiology, pathophysiology, classification, clinical features, radiological and electrophysiological assessment, diagnosis, differential diagnosis, natural history and treatment of CSA. METHODS A comprehensive search of PubMed, EMBASE, Cochrane library and Web of Science databases was conducted, from their inception to April 3, 2018. RESULTS Clinically, CSA is classified into three types: a proximal-type (involving the scapular muscles, deltoid and biceps), a distal-type (involving the triceps and muscles of the forearm and hand) and a diffuse-type (involving features of both the distal- and proximal-type). Diagnosis requires documentation of muscle atrophy, without significant sensory deficits, supported by careful neurological, radiological and neurophysiological assessments, with amyotrophic lateral sclerosis, Parsonage-Turner syndrome, rotator cuff tear and Hirayama disease being the principle differential diagnoses. Conservative management of CSA includes cervical traction, neck immobilization and physical therapy, with vitamin B12 or E administration being useful in some patients. Surgical treatment, including anterior decompression and fusion or laminoplasty, with or without foraminotomy, is indicated after conservative treatment failure. Factors associated with a poor outcome include the distal-type CSA, long symptom duration, older age and greater preoperative muscle weakness. CONCLUSION Although the disease process of CSA is self-limited, treatment remains challenging, leaving scope for future studies. These slides can be retrieved under Electronic Supplementary Material.
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Amin Lari A, Ghavanini AA, Bokaee HR. A review of electrophysiological studies of lower motor neuron involvement in amyotrophic lateral sclerosis. Neurol Sci 2019; 40:1125-1136. [PMID: 30877611 DOI: 10.1007/s10072-019-03832-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/07/2019] [Indexed: 02/08/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease involving both the upper and lower motor neuron diseases. In this review, we studied and compared different articles regarding the electrodiagnostic criteria for diagnosis of lower motor neuron pathology in ALS. We reviewed the most recent articles and metaanalysis regarding various lower motor neuron electrodiagnostic methods for ALS and their sensitivities. We concluded that Awaji Shima criteria is by far the most sensitive criteria for diagnosis of ALS.
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Affiliation(s)
- Ali Amin Lari
- Canadian Neurologic Center, Mississauga, ON, Canada.
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12
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Yunusova Y, Plowman EK, Green JR, Barnett C, Bede P. Clinical Measures of Bulbar Dysfunction in ALS. Front Neurol 2019; 10:106. [PMID: 30837936 PMCID: PMC6389633 DOI: 10.3389/fneur.2019.00106] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/28/2019] [Indexed: 12/31/2022] Open
Abstract
Bulbar impairment represents a hallmark feature of Amyotrophic Lateral Sclerosis (ALS) that significantly impacts survival and quality of life. Speech and swallowing dysfunction are key contributors to the clinical heterogeneity of ALS and require well-timed and carefully coordinated interventions. The accurate clinical, radiological and electrophysiological assessment of bulbar dysfunction in ALS is one of the most multidisciplinary aspects of ALS care, requiring expert input from speech-language pathologists (SLPs), neurologists, otolaryngologists, augmentative alternative communication (AAC) specialists, dieticians, and electrophysiologists—each with their own evaluation strategies and assessment tools. The need to systematically evaluate the comparative advantages and drawbacks of various bulbar assessment instruments and to develop integrated assessment protocols is increasingly recognized. In this review, we provide a comprehensive appraisal of the most commonly utilized clinical tools for assessing and monitoring bulbar dysfunction in ALS based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) evaluation framework. Despite a plethora of assessment tools, considerable geographical differences exist in bulbar assessment practices and individual instruments exhibit considerable limitations. The gaps identified in the literature offer unique opportunities for the optimization of existing and development of new tools both for clinical and research applications. The multicenter validation and standardization of these instruments will be essential for guideline development and best practice recommendations.
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Affiliation(s)
- Yana Yunusova
- Department of Speech Language Pathology, University of Toronto, Toronto, ON, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Volcal Tract Visualization Lab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Emily K Plowman
- Swallowing Systems Core, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, United States
| | - Jordan R Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, United States.,Speech and Hearing Biosciences and Technology Program, Harvard University, Cambridge, MA, United States
| | - Carolina Barnett
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Peter Bede
- Computational Neuroimaging Group, Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
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13
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Vázquez-Costa JF, Campins-Romeu M, Martínez-Payá JJ, Tembl JI, Del Baño-Aledo ME, Ríos-Díaz J, Fornés-Ferrer V, Chumillas MJ, Sevilla T. New insights into the pathophysiology of fasciculations in amyotrophic lateral sclerosis: An ultrasound study. Clin Neurophysiol 2018; 129:2650-2657. [PMID: 30292684 DOI: 10.1016/j.clinph.2018.09.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/02/2018] [Accepted: 09/16/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To describe the fasciculation pattern in ALS and to analyse its clinical and pathophysiological significance. METHODS Ultrasound of 19 muscles was performed in 44 patients with a recent diagnosis (<90 days) of ALS. The number of fasciculations was recorded in each muscle and the muscle thickness and strength were additionally measured in limb muscles. A subgroup of patients were electromyographically assessed. RESULTS US was performed in 835 muscles and EMG was available in 263 muscles. US detected fasciculations more frequently than EMG. Fasciculations were widespread, especially in upper limbs onset patients and in the cervical region. Fasciculations' number inversely associated with ALSFR-R and body mass index (BMI) and directly with BMI loss and upper motor neuron (UMN) impairment. Our statistical model suggest that fasciculations increase with the initial lower motor neuron (LMN) degeneration, reach their peak when the muscle became mildly to moderately weak, decreasing afterwards with increasing muscle weakness and atrophy. CONCLUSIONS Our study suggests that both UMN and LMN degeneration trigger fasciculations causing BMI loss. The degree of LMN impairment could account for differences in fasciculations' rates within and between muscles. SIGNIFICANCE In ALS, fasciculations could explain the link between hyperexcitability and BMI loss.
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Affiliation(s)
- J F Vázquez-Costa
- Neuromuscular Research Unit, Instituto de Investigación Sanitaria la Fe (IIS La Fe), Valencia, Spain; ALS Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain.
| | - M Campins-Romeu
- ALS Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J J Martínez-Payá
- ECOFISTEM Research Group, Health Sciences Department, Facultad de Ciencias de la Salud, Universidad Católica de Murcia, Campus de los Jerónimos s/n, 30107 Guadalupe (Murcia), Spain
| | - J I Tembl
- Neurosonology Laboratory, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M E Del Baño-Aledo
- Physiotherapy Department, Facultad de Medicina, Campus de Espinardo 30100, Universidad de Murcia, Spain
| | - J Ríos-Díaz
- Centro de Ciencias de la Salud San Rafael, Universidad Antonio de Nebrija, Madrid, Paseo de la Habana 70 bis, 28036 Madrid, Spain; Fundación San Juan de Dios, Madrid, Spain
| | - V Fornés-Ferrer
- Biostatistics Unit, Instituto de Investigación Sanitaria la Fe (IIS La Fe), Valencia, Spain
| | - M J Chumillas
- Neuromuscular Research Unit, Instituto de Investigación Sanitaria la Fe (IIS La Fe), Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain; ALS Unit, Department of Neurophisiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - T Sevilla
- Neuromuscular Research Unit, Instituto de Investigación Sanitaria la Fe (IIS La Fe), Valencia, Spain; ALS Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain
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14
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Menon P, Kiernan MC, Vucic S. Cortical excitability varies across different muscles. J Neurophysiol 2018; 120:1397-1403. [PMID: 29975162 DOI: 10.1152/jn.00148.2018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The aim of the present study was to determine whether significant differences in cortical excitability were evident across different body regions in healthy humans. Threshold tracking transcranial magnetic stimulation (TMS) was undertaken in 28 healthy controls. Short-interval intracortical inhibition [SICI between interstimulus intervals (ISI) 1-7 ms], intracortical facilitation (ICF, between ISI 10-30 ms), resting motor threshold (RMT), cortical silent period (CSP) duration (generated at stimulus intensity 150% RMT), and motor evoked potential amplitude were recorded from the abductor pollicis brevis (APB), tibialis anterior (TA), and trapezius muscles. These muscles were selected as they are frequently affected in neurodegenerative diseases, such as amyotrophic lateral sclerosis. SICI and ICF are measured as a percentage difference between conditioned and an unconditioned test response. SICI was significantly greater when recorded over the APB (9.9 ± 1.5%) and TA (8.6 ± 1.4%) muscles compared with the trapezius (4.5 ± 1.9%, P < 0.05). The CSP duration was significantly shorter (CSPtrapezius, 131.0 ± 6.3 ms; CSPTA, 175.7 ± 9.9 ms; CSPAPB, 188.3 ± 4.0 ms; P < 0.001) and ICF greater ( P < 0.01) in the trapezius muscle. There were no significant correlations between inhibitory and facilitatory processes recorded across the three muscles. The present study established significant differences in cortical excitability across three body regions, with evidence of more prominent inhibition and less facilitation in the limb muscles. NEW & NOTEWORTHY Cortical excitability of muscles with differing motor functions was assessed using threshold tracking transcranial magnetic stimulation. Significantly greater intracortical inhibition and less facilitation were evident over the limb muscles. These findings could relate to differences in the functional organization of the corticomotoneuronal system innervating different muscle regions.
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Affiliation(s)
- Parvathi Menon
- Western Clinical School, University of Sydney , Sydney , Australia.,Westmead Hospital, University of Sydney , Sydney , Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney and Royal Prince Alfred Hospital , Sydney , Australia
| | - Steve Vucic
- Western Clinical School, University of Sydney , Sydney , Australia.,Westmead Hospital, University of Sydney , Sydney , Australia
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15
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Miyaji Y, Hatanaka Y, Higashihara M, Kanbayashi T, Tanaka F, Sonoo M. Fasciculation potentials and decremental responses in amyotrophic lateral sclerosis. Clin Neurophysiol 2017; 129:345-348. [PMID: 29288989 DOI: 10.1016/j.clinph.2017.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 10/29/2017] [Accepted: 11/04/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The positive correlation between fasciculation potentials (FPs) and decremental responses in repetitive nerve stimulation test (RNS) in amyotrophic lateral sclerosis (ALS) patients has been described based on only one past study. We revisited this issue. METHODS Subjects consisted of 30 prospectively-enrolled ALS patients on whom both needle EMG and RNS were conducted in the same trapezius muscle. Fasciculation potentials (FPs) were identified off-line from the restored 3-min signal. Firing rate of FPs (FR-FP) per minute was calculated from the total count of FPs of different origins. Correlations between FR-FP, decremental percentage (Decr%) and the amplitude of the initial compound muscle action potential (CMAPamp) in RNS were investigated. RESULTS There was no correlation between FR-FP and Decr% (r = 0.03) or between FR-FP and CMAPamp (r = 0.04). A significant negative correlation was observed between CMAPamp and Decr% (r = -0.56, P < .005). CONCLUSION FPs are not correlated with the decremental response in RNS. SIGNIFICANCE The underlying mechanism for FPs and decremental responses in ALS must be different and unrelated to each other.
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Affiliation(s)
- Yosuke Miyaji
- Department of Neurology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan; Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Yuki Hatanaka
- Department of Neurology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
| | - Mana Higashihara
- Department of Neurology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan; Department of Neurology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaecho, Itabashi-ku, Tokyo 173-0015, Japan.
| | - Takamichi Kanbayashi
- Department of Neurology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
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16
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A Novel Scoring System Associated With Surgical Outcome of Distal-type Cervical Spondylotic Amyotrophy. Clin Spine Surg 2017; 30:E1182-E1189. [PMID: 27231832 DOI: 10.1097/bsd.0000000000000389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
STUDY DESIGN A single-center retrospective study. OBJECTIVE To elucidate the pathology of distal-type cervical spondylotic amyotrophy (CSA) and to assess predictive factors and a novel scoring system associated with surgical outcome. SUMMARY AND BACKGROUND Because of its rarity, the pathophysiology and surgical outcome of distal-type CSA are less well understood compared with proximal-type CSA. METHOD Surgical procedures were performed in 13 patients with distal-type CSA. Patients were classified into 2 groups: those with good recovery of muscle power (group 1, n=4) and those with fair recovery (group 2, n=9). All patients underwent magnetic resonance imaging. Central motor conduction time was recorded in abductor digit minim and compound muscle action potentials (CMAPs) were recorded in extensor carpi dig. Predictive factors associated with surgical outcome and a scoring system based on clinical, radiologic, and electrophysiological findings were evaluated. Twelve of 13 patients were scored for the following features: (1) duration of symptoms ≥13 months, (2) initial manual muscle testing ≤1, (3) multiple compressions in magnetic resonance imaging, (4) CMAPs amplitudes on affected side <1 mV, (5) CMAPs amplitudes on normal side <7.2 mV, (6) central motor conduction time longer than 7.4 ms, (7) the ratio of CMAPs amplitudes comparison with the normal side <50%. RESULT At final follow-up, 2 patients were graded excellent, 2 good, 9 fair, and 0 poor. None of the predictive factors was significantly different between groups 1 and 2. The mean score in group 2 (5.12±1.12) was significantly higher than for group 1 (2±1.15; P=0.006). Although all 8 patients in group 2 scored ≥4 points, all 4 patients in group 1 scored ≤3. CONCLUSIONS Comprehensive assessment using a scoring system is useful for predicting the surgical outcome of distal-type CSA. Surgeons should be aware that a score of ≥4 points correlates with poor surgical outcome on motor function.
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17
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de Carvalho M, Kiernan MC, Swash M. Fasciculation in amyotrophic lateral sclerosis: origin and pathophysiological relevance. J Neurol Neurosurg Psychiatry 2017; 88:773-779. [PMID: 28490504 DOI: 10.1136/jnnp-2017-315574] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 03/20/2017] [Accepted: 03/29/2017] [Indexed: 12/11/2022]
Abstract
This review considers the origin and significance of fasciculations in neurological practice, with an emphasis on fasciculations in amyotrophic lateral sclerosis (ALS), and in benign fasciculation syndromes. Fasciculation represents a brief spontaneous contraction that affects a small number of muscle fibres, causing a flicker of movement under the skin. While an understanding of the role of fasciculation in ALS remains incomplete, fasciculations derive from ectopic activity generated in the motor system. A proximal origin seems likely to contribute to the generation of fasciculation in the early stages of ALS, while distal sites of origin become more prominent later in the disease, associated with distal motor axonal sprouting as part of the reinnervation response that develops secondary to loss of motor neurons. Fasciculations are distinct from the recurrent trains of axonal firing described in neuromyotonia. Fasciculation without weakness, muscle atrophy or increased tendon reflexes suggests a benign fasciculation syndrome, even when of sudden onset. Regardless of origin, fasciculations often present as the initial abnormality in ALS, an early harbinger of dysfunction and aberrant firing of motor neurons.
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Affiliation(s)
- Mamede de Carvalho
- Department of Neurosciences and Mental Health, Hospital de Santa Maria-CHLN, Lisbon, Portugal.,Institute of Physiology-IMM, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Matthew C Kiernan
- Bushell Chair of Neurology, Sydney Medical School, University of Sydney, Brain & Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Michael Swash
- Institute of Physiology-IMM, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Department of Neurology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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18
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Caress JB. Optimal muscle selection in amyotrophic lateral sclerosis and the end of the 4-limb EMG. Muscle Nerve 2017; 56:4-6. [DOI: 10.1002/mus.25662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 03/20/2017] [Accepted: 04/05/2017] [Indexed: 11/08/2022]
Affiliation(s)
- James B. Caress
- Department of Neurology; Wake Forest School of Medicine; 1 Medical Center Boulevard Winston-Salem North Carolina 27157 USA
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19
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Wang Y, Xiao Z, Chu H, Liang J, Wu X, Dong H, Yan Y, Lu Z. Correlations between slow-rate repetitive nerve stimulation and characteristics associated with amyotrophic lateral sclerosis in Chinese patients. J Phys Ther Sci 2017; 29:737-743. [PMID: 28533621 PMCID: PMC5430284 DOI: 10.1589/jpts.29.737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 01/17/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To clarify the features associated with decrements in compound muscle action
potentials (CMAP) during slow-rate repetitive nerve stimulation (RNS) of muscles involved
in amyotrophic lateral sclerosis (ALS) in mainland China. [Subjects and Methods] A
retrospective study of decremental responses to slow-rate RNS was performed to compare
patients with ALS to those with myasthenia gravis (MG). [Results] A significant decrement
(>5%) was observed in at least one muscle in 54% of ALS patients. The trapezius muscle
was the most commonly affected (67%). In the ALS group, the CMAP amplitude evoked by the
first stimulus was negatively correlated with the CMAP decrement in ulnar but not
accessory nerves. Additionally, a positive decrement was associated with disease
progression but not gender, age at onset, disease duration, region of onset, ALSFRS-R
scores, or ALS diagnostic subgroup in ALS. Furthermore, the incidence of positive
decrements and the decremental percentages were significantly higher in myasthenia gravis
(MG) than in ALS. [Conclusions] The lower CMAP amplitude by the first RNS stimulus was
more likely to induce a positive decrement in the ulnar nerve in ALS patients. The
positive decremental responses to RNS observed in ALS indicate the faster progress of the
disease, which is helpful for evaluating prognoses.
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Affiliation(s)
- Yan Wang
- Department of Neurology, Institution of Neuropsychiatry Research, Renmin Hospital of Wuhan University, China
| | - Zheman Xiao
- Department of Neurology, Institution of Neuropsychiatry Research, Renmin Hospital of Wuhan University, China
| | - Hong Chu
- Department of Neurology, Institution of Neuropsychiatry Research, Renmin Hospital of Wuhan University, China
| | - Jingjing Liang
- Department of Neurology, Institution of Neuropsychiatry Research, Renmin Hospital of Wuhan University, China
| | - Xu Wu
- Department of Neurology, Institution of Neuropsychiatry Research, Renmin Hospital of Wuhan University, China
| | - Hongjuan Dong
- Department of Neurology, Institution of Neuropsychiatry Research, Renmin Hospital of Wuhan University, China
| | - Yang Yan
- Department of Neurology, Renhe Hospital of Three Gorges University, China
| | - Zuneng Lu
- Department of Neurology, Institution of Neuropsychiatry Research, Renmin Hospital of Wuhan University, China
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20
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Utility of repetitive nerve stimulation test for ALS diagnosis. Clin Neurophysiol 2017; 128:823-829. [DOI: 10.1016/j.clinph.2017.02.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 02/11/2017] [Accepted: 02/26/2017] [Indexed: 11/23/2022]
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21
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Babu S, Pioro EP, Li J, Li Y. Optimizing muscle selection for electromyography in amyotrophic lateral sclerosis. Muscle Nerve 2017; 56:36-44. [DOI: 10.1002/mus.25444] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 10/12/2016] [Accepted: 10/18/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Suma Babu
- Neuromuscular Center Desk S90, Department of Neurology; Cleveland Clinic; 9500 Euclid Avenue Cleveland Ohio 44195 USA
| | - Erik P Pioro
- Neuromuscular Center Desk S90, Department of Neurology; Cleveland Clinic; 9500 Euclid Avenue Cleveland Ohio 44195 USA
| | - Jianbo Li
- Department of Quantitative Health Sciences; Learner Research Institute, Cleveland Clinic Foundation; Cleveland Ohio USA
| | - Yuebing Li
- Neuromuscular Center Desk S90, Department of Neurology; Cleveland Clinic; 9500 Euclid Avenue Cleveland Ohio 44195 USA
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22
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Noto YI, Simon N, Shibuya K, Matamala JM, Dharmadasa T, Kiernan MC. Dynamic muscle ultrasound identifies upper motor neuron involvement in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:404-410. [PMID: 28613097 DOI: 10.1080/21678421.2017.1286355] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of the present study was to elucidate the pattern of change in bulbar muscles using ultrasound in patients diagnosed with amyotrophic lateral sclerosis (ALS). METHODS Changes in the mylohyoid and geniohyoid muscle complex (mylohyoid-geniohyoid-muscle-complex) thickness were recorded while swallowing 5 ml of water using M-mode ultrasound in 30 ALS patients compared to 20 healthy controls. The ratio of mylohyoid-geniohyoid-muscle-complex thickness as determined by the maximum thickness of mylohyoid-geniohyoid-muscle-complex during swallowing divided by thickness at rest, was compared between ALS patients and controls, with the correlation between thickness ratio, echogenicity and clinical parameters assessed. RESULTS Overall, the thickness ratio in ALS patients was 1.39 ± 0.23 (mean ± SD) compared to 1.55 ± 0.17 in controls (p < 0.05). In sub-analysis, the thickness ratio was significantly decreased in ALS patients with bulbar-onset disease compared to those with limb-onset disease (p < 0.01) and controls (p < 0.01). Thickness ratio negatively correlated with the severity of upper motor neuron involvement in the bulbar region (p < 0.05). CONCLUSIONS Bulbar muscle ultrasound represents a novel method to detect impaired mobility and thereby provides an objective assessment of upper motor neuron involvement in the bulbar region of ALS patients.
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Affiliation(s)
- Yu-Ichi Noto
- a Brain and Mind Centre , Sydney Medical School, University of Sydney , Sydney , NSW , Australia and
| | - Neil Simon
- b St Vincent's Clinical School , University of New South Wales , Kensington , NSW , Australia
| | - Kazumoto Shibuya
- a Brain and Mind Centre , Sydney Medical School, University of Sydney , Sydney , NSW , Australia and
| | - José M Matamala
- a Brain and Mind Centre , Sydney Medical School, University of Sydney , Sydney , NSW , Australia and
| | - Thanuja Dharmadasa
- a Brain and Mind Centre , Sydney Medical School, University of Sydney , Sydney , NSW , Australia and
| | - Matthew C Kiernan
- a Brain and Mind Centre , Sydney Medical School, University of Sydney , Sydney , NSW , Australia and
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23
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Shellikeri S, Green JR, Kulkarni M, Rong P, Martino R, Zinman L, Yunusova Y. Speech Movement Measures as Markers of Bulbar Disease in Amyotrophic Lateral Sclerosis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2016; 59:887-899. [PMID: 27679842 PMCID: PMC5345561 DOI: 10.1044/2016_jslhr-s-15-0238] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/19/2015] [Accepted: 12/18/2015] [Indexed: 05/20/2023]
Abstract
PURPOSE The goal of this study was to identify the effects of amyotrophic lateral sclerosis (ALS) on tongue and jaw control, both cross-sectionally and longitudinally. The data were examined in the context of their utility as a diagnostic marker of bulbar disease. METHOD Tongue and jaw movements were recorded cross-sectionally (n = 33 individuals with ALS, 13 controls) and longitudinally (n = 10 individuals with ALS) using a three-dimensional electromagnetic articulography system during the production of the sentence Buy Bobby a puppy. The movements were examined for evidence of changes in size, speed, and duration and with respect to disease severity and time in the study. RESULTS Maximum speed of tongue movements and movement durations were significantly different only at an advanced stage of bulbar ALS compared with the healthy control group. The longitudinal analysis revealed a reduction in tongue movement size and speed with time at early stages of disease, which was not seen cross-sectionally. As speaking rate declined, tongue movements decreased in maximum speed, whereas jaw movements increased in maximum speed. CONCLUSIONS Longitudinal analyses of sentence-level kinematic data show their sensitivity to early bulbar impairment. A change in articulatory kinematics can serve as a useful diagnostic marker for bulbar ALS and to track bulbar disease progression in a clinical setting.
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Affiliation(s)
| | | | - Madhura Kulkarni
- Sunnybrook Health Sciences Centre, Biological Sciences, University of Toronto, Ontario, Canada
| | | | | | - Lorne Zinman
- ALS/MND Clinic, Sunnybrook Health Sciences Centre, Department of Neurology, University of Toronto, Ontario, Canada
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24
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Pan H, Jian F, Lin J, Chen N, Zhang Z, Wang Y, Cui L, Kimura J. Needle electromyography of the frontalis muscle in patients with amyotrophic lateral sclerosis. Muscle Nerve 2016; 54:1093-1096. [PMID: 27367360 DOI: 10.1002/mus.25236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Hua Pan
- Department of Neurology, Beijing Tiantan Hospital; Capital Medical University; Beijing 100050 China
| | - Fan Jian
- Department of Neurology, Beijing Tiantan Hospital; Capital Medical University; Beijing 100050 China
| | - Jinxi Lin
- Department of Neurology, Beijing Tiantan Hospital; Capital Medical University; Beijing 100050 China
| | - Na Chen
- Department of Neurology, Beijing Tiantan Hospital; Capital Medical University; Beijing 100050 China
| | - Zaiqiang Zhang
- Department of Neurology, Beijing Tiantan Hospital; Capital Medical University; Beijing 100050 China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital; Capital Medical University; Beijing 100050 China
| | - Liying Cui
- Department of Neurology; Peking Union Medical College Hospital, Chinese Academy of Medical Science; Beijing China
| | - Jun Kimura
- Division of Clinical Electrophysiology, Department of Neurology, College of Medicine; University of Iowa; Iowa City Iowa USA
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25
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Bokuda K, Shimizu T, Kimura H, Yamazaki T, Kamiyama T, Watabe K, Kawata A, Hayashi M, Isozaki E. Quantitative analysis of the features of fasciculation potentials and their relation with muscle strength in amyotrophic lateral sclerosis. Neurol Sci 2016; 37:1939-1945. [PMID: 27541300 DOI: 10.1007/s10072-016-2692-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/16/2016] [Indexed: 12/26/2022]
Abstract
This study aimed to quantitatively analyze fasciculation potentials (FPs) and to investigate their relationship with muscle strength in amyotrophic lateral sclerosis (ALS). Fifty-one patients with sporadic ALS or progressive muscular atrophy (25 men, 26 women, mean age of 68 years) underwent needle EMG. We determined the duration, phase number, and amplitude of FPs from three muscles (upper trapezius, biceps brachii, and tibialis anterior) and examined their relations with muscle strength. In total, 878 FPs were analyzed. FP duration displayed a significant negative relation with the strength of all three muscles; the weaker muscles showed longer durations of FPs than the muscles with normal strength. The amplitude and phase number were not related with muscle strength, but there were significant correlations between the duration and amplitude of FPs in the trapezius and tibialis anterior muscles. The longer duration of FPs in muscles with weak strength suggests that the morphological changes of FPs were caused by temporal dispersion through progressively degenerating and/or immature reinnervating motor branches, and were observed uniformly in different muscles along with disease progression.
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Affiliation(s)
- Kota Bokuda
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan.,Mental Development Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Toshio Shimizu
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan.
| | - Hideki Kimura
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | - Toshihiro Yamazaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | - Tsutomu Kamiyama
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | - Kazuhiko Watabe
- ALS and Neuropathy Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.,Department of Medical Technology (Neuropathology), Kyorin University Faculty of Health Sciences, Tokyo, Japan
| | - Akihiro Kawata
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | - Masaharu Hayashi
- Mental Development Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
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26
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New insights into the clinical neurophysiological assessment of ALS. Neurophysiol Clin 2016; 46:157-63. [PMID: 27364772 DOI: 10.1016/j.neucli.2016.05.070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 12/11/2022] Open
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27
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Jenkins TM, Alix JJ, Kandler RH, Shaw PJ, McDermott CJ. The role of cranial and thoracic electromyography within diagnostic criteria for amyotrophic lateral sclerosis. Muscle Nerve 2016; 54:378-85. [DOI: 10.1002/mus.25062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 01/05/2016] [Accepted: 01/25/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Thomas M. Jenkins
- Sheffield Institute for Translational Neuroscience; University of Sheffield; 385A Glossop Road Sheffield S10 2HQ UK
| | - James J.P. Alix
- Sheffield Institute for Translational Neuroscience; University of Sheffield; 385A Glossop Road Sheffield S10 2HQ UK
| | - Rosalind H. Kandler
- Department of Clinical Neurophysiology; Royal Hallamshire Hospital; Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield UK
| | - Pamela J. Shaw
- Sheffield Institute for Translational Neuroscience; University of Sheffield; 385A Glossop Road Sheffield S10 2HQ UK
| | - Christopher J. McDermott
- Sheffield Institute for Translational Neuroscience; University of Sheffield; 385A Glossop Road Sheffield S10 2HQ UK
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28
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Abstract
Fasciculations and fasciculation potentials (FPs) have been long known as a characteristic feature of amyotrophic lateral sclerosis (ALS). In this article, the history of the researches on fasciculation and FPs is first reviewed. The word and concept of fasciculation was first properly defined by Denny-Brown and Pennybacker (1938). It is noteworthy that they already stressed the necessity of strict discrimination of FPs from the "contraction fasciculation", a remnant of large voluntary motor unit potentials (MUPs), in this early milestone paper. FPs are rarely observed in neurogenic diseases other than ALS or disorders presenting with conduction block, i. e. they retain a high specificity in ALS diagnosis. Despite such usefulness, FPs were devaluated in the revised El-Escorial criteria. It is welcome that their value has been restored in the newer Awaji criteria. In the actual practice, correct identification of FPs would be a critical point. Remnant of voluntary MUPs is the greatest FP mimic to be differentiated. The key point for differentiation is the firing rhythm. FPs are characterized by a low-frequency and quite irregular firing, showing clustering of discharges. In contrast, voluntary MUPs are characterized by a semiregular firing.
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Affiliation(s)
- Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine
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29
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Shimizu T, Fujimaki Y, Nakatani-Enomoto S, Matsubara S, Watabe K, Rossini PM, Ugawa Y. Complex fasciculation potentials and survival in amyotrophic lateral sclerosis. Clin Neurophysiol 2014; 125:1059-64. [DOI: 10.1016/j.clinph.2013.10.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 10/09/2013] [Accepted: 10/21/2013] [Indexed: 10/26/2022]
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30
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Tankisi H, Otto M, Pugdahl K, Fuglsang-Frederiksen A. Spontaneous electromyographic activity of the tongue in amyotrophic lateral sclerosis. Muscle Nerve 2013; 48:296-8. [DOI: 10.1002/mus.23781] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Hatice Tankisi
- Department of Neurophysiology; Aarhus University Hospital; Nørrebrogade 44; DK - 8000; Aarhus C; Denmark
| | - Marit Otto
- Department of Neurophysiology; Aarhus University Hospital; Nørrebrogade 44; DK - 8000; Aarhus C; Denmark
| | - Kirsten Pugdahl
- Department of Neurophysiology; Aarhus University Hospital; Nørrebrogade 44; DK - 8000; Aarhus C; Denmark
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Løseth S, Torbergsen T. [Electromyography (EMG) and neurography in patients with severe neuromuscular diseases]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2013; 133:174-8. [PMID: 23344603 DOI: 10.4045/tidsskr.12.0184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Many neuromuscular diseases are potentially severe, and EMG and neurography are methods used in the assessment of these conditions. METHOD The article is based on the authors' knowledge and experience, with special emphasis on the use of these methods in the assessment of severe diseases affecting striated muscle and peripheral nerves. A PubMed search was performed with the cut-off fifteen years back in time, and in addition a discretionary selection was made of articles known to the authors. RESULTS EMG is the most valuable method for assessing myopathy, and neurography provides most information about neuropathy, but the methods are complementary. These examinations are the most sensitive for diagnosing some conditions (for example myasthaenia) A high level of expertise is necessary for diagnosing these conditions. INTERPRETATION EMG and neurography are important and often necessary means of assessing patients with severe neuromuscular disease.
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Affiliation(s)
- Sissel Løseth
- Nevrologisk- og nevrofysiologisk avdeling, Universitetssykehuset Nord-Norge, Norway.
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32
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Kılıç S, Gazioglu S, Serap Zengin K, Ülkü Dübüş H, Boz C. Cervical vestibular evoked myogenic potentials to air-conducted sound in early amyotrophic lateral sclerosis. Neurophysiol Clin 2012; 42:119-23. [DOI: 10.1016/j.neucli.2012.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 12/27/2011] [Accepted: 01/01/2012] [Indexed: 10/14/2022] Open
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Noto YI, Misawa S, Kanai K, Shibuya K, Isose S, Nasu S, Sekiguchi Y, Fujimaki Y, Nakagawa M, Kuwabara S. Awaji ALS criteria increase the diagnostic sensitivity in patients with bulbar onset. Clin Neurophysiol 2012; 123:382-5. [DOI: 10.1016/j.clinph.2011.05.030] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 05/22/2011] [Accepted: 05/25/2011] [Indexed: 11/28/2022]
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Higashihara M, Sonoo M, Imafuku I, Fukutake T, Kamakura K, Inoue K, Hatanaka Y, Shimizu T, Tsuji S, Ugawa Y. Fasciculation potentials in amyotrophic lateral sclerosis and the diagnostic yield of the Awaji algorithm. Muscle Nerve 2012; 45:175-82. [DOI: 10.1002/mus.22299] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Decremental responses to repetitive nerve stimulation (RNS) in motor neuron disease. Clin Neurophysiol 2011; 122:2530-6. [DOI: 10.1016/j.clinph.2011.05.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Revised: 05/24/2011] [Accepted: 05/26/2011] [Indexed: 11/21/2022]
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Sonoo M, Higashihara M, Hokkoku K. [Electrodiagnosis of ALS: its practical aspects]. Rinsho Shinkeigaku 2011; 51:1111-1113. [PMID: 22277500 DOI: 10.5692/clinicalneurol.51.1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Electrodiagnostic methods, especially needle EMG plays an important role for the ALS diagnosis. Existing diagnostic criteria such as revised El Escorial criteria (R-EEC) and Awaji algorithm have a drawback of low sensitivity. Our study revealed that the percentage of patients classified as confirmed ALS, i.e. clinically probable (laboratory supported) or higher, was 43% using the R-EEC and 37% using the Awaji algorithm. Needle EMG can strongly suggest ALS beyond these criteria. Fasciculation potentials (FPs) are sufficiently specific for ALS, and we have argued its diagnostic utitlity in ALS diagnosis. FPs are rare in other neurogenic diseases, such as cervical or lumbar spine disorders and spinal and bulbar muscular atrophy. Profuse FPs observed in both upper and lower limbs would strongly suggest ALS. EMG of the upper trapezius muscle is useful since it is easily relaxed, and the spontaneous activities in this muscle are sufficiently sensitive and specific for ALS. Inclusion body myositis (IBM) might be confused with ALS, but its differentiation is actually easy since a normal recruitment in a chronically weak muscle definitely indicates myopathy. Furthermore, EMG of the flexor digitorum profundus muscle in IBM patients would reveal typical myopathic, i.e. low-amplitude and thin, motor unit potentials.
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Affiliation(s)
- Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine
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Xu YS, Zheng JY, Zhang S, Fan DS. Upper trapezius electromyography aids in the early diagnosis of bulbar involvement in amyotrophic lateral sclerosis. ACTA ACUST UNITED AC 2011; 12:345-8. [DOI: 10.3109/17482968.2011.582647] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Affiliation(s)
- Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine
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Prospective, blind study of the triple stimulation technique in the diagnosis of ALS. ACTA ACUST UNITED AC 2010; 11:67-75. [PMID: 19714538 DOI: 10.3109/17482960903171128] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the diagnostic yield of magnetic cortical stimulation with the triple stimulation technique (TST) to identify upper motor neuron (UMN) involvement in patients suspected of having ALS. METHODS Fifty-nine patients were recruited to undergo TST in addition to the standard work-up for suspected motor neuron disease. TST combines transcranial magnetic stimulation of the motor cortex with collision studies, which results in a higher sensitivity in detecting UMN involvement. Primary outcome was the number of abnormal TST results in patients with possible ALS. The positivity rate was converted to the number needed to test with TST (NN-TST) for one extra diagnosis of ALS. RESULTS Fifty patients underwent TST. In the total group (n=59), 18 patients had a motor neuron disorder but did not fulfil criteria for 'probable' or 'definite' ALS. In four of these patients TST was abnormal (NN-TST, 4.5). One TST was erroneously interpreted as abnormal. TST findings were normal in inclusion body myositis and peripheral nerve disorders. CONCLUSION This prospective and blind study confirms open studies of TST in the evaluation of ALS. We suggest that TST can be used to arrive at a diagnosis of 'probable' or 'definite' ALS in patients lacking UMN signs in the upper extremities.
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Simmons Z. What's in the Literature? J Clin Neuromuscul Dis 2009; 10:202-207. [PMID: 19494733 DOI: 10.1097/cnd.0b013e3181a7b35f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Peripheral neuropathies are among the most common disorders seen by neuromuscular specialists. Several of the articles in this issue's review focus on diagnosis, treatment, and prognosis of disorders of peripheral nerve, including some which address important issues relating to chronic inflammatory demyelinating polyneuropathy. Motor neuron diseases continue to be somewhat disproportionately represented, likely due to the devastating nature of amyotrophic lateral sclerosis. The TAR DNA-binding protein-43 (TDP-43) story as outlined in 2 of the articles is fascinating, particularly with regard to etiopathogenesis, whereas other articles focus on epidemiology, diagnosis, treatment, and symptom management, including some insights into Kennedy disease. Myotonic dystrophy and other muscle diseases are presented with some welcome news on treatment and management.
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