1
|
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.
Collapse
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
| |
Collapse
|
2
|
Holzapfel K, Naumann M. Ultrasound Detection of Vagus Nerve Atrophy in Bulbar Amyotrophic Lateral Sclerosis. J Neuroimaging 2020; 30:762-765. [PMID: 33167079 DOI: 10.1111/jon.12761] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/18/2020] [Accepted: 06/29/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND PURPOSE Neuromuscular ultrasound in amyotrophic lateral sclerosis (ALS) is of increasing interest. As bulbar symptoms are commonly developed by most ALS patients during disease, the aim of our study was to find possible sonographic changes of vagus nerve size in bulbar affected ALS patients. METHODS We investigated 24 ALS patients and 19 controls without neuromuscular disorders. In ALS patients, bulbar affection was documented clinically (eg, dysarthria, dysphagia, and fasciculations) or subclinically using ultrasound and electromyography of bulbar muscles. Vagus nerve ultrasound was performed in all participants bilaterally at the level of the thyroid gland. RESULTS The cross-sectional area (CSA) of the vagus nerve in bulbar affected ALS patients (mean CSA right/left 1.9 ± .7 mm²/1.8 ± .6 mm²) was significantly reduced on both sides compared to controls (mean CSA right/left 2.2 ± .6 mm²/2.0 ± .3 mm²) - right: P = .0387, left: P = .0386. Receiver operating characteristic curve analysis of the vagus nerve CSA yielded a sensitivity of 66.7% and a specificity of 63.2% (cutoff value 1.85 mm²). Vagus nerve CSA did not correlate significantly with age in controls (right: P = .45, left: P = .66). In controls and ALS patients, there was no significant difference of vagus nerve CSA between the right and left sides (controls: P = .43; patients: P = .86). CONCLUSION Our study demonstrates vagus nerve atrophy in bulbar affected ALS patients. Further studies are warranted investigating the relevance of our finding for monitoring disease progression in ALS.
Collapse
Affiliation(s)
- Korbinian Holzapfel
- Department of Neurology and Clinical Neurophysiology, University of Augsburg, Augsburg, Germany
| | - Markus Naumann
- Department of Neurology and Clinical Neurophysiology, University of Augsburg, Augsburg, Germany
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Levendowski DJ, St Louis EK, Strambi LF, Galbiati A, Westbrook P, Berka C. Comparison of EMG power during sleep from the submental and frontalis muscles. Nat Sci Sleep 2018; 10:431-437. [PMID: 30584382 PMCID: PMC6287659 DOI: 10.2147/nss.s189167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Submentalis electromyography (sEMG) and frontalis electromyography (fEMG) muscle activities have been used to assist in the staging of sleep and detection of disruptions in sleep. This study was designed to assess the concordance between sEMG and fEMG power, by and across sleep stages. METHODS Forty-three records with simultaneous acquisition of differential signals from the submental and frontalis muscles were evaluated. Sleep stages were assigned using the poly-somnography signals based on majority agreement of five technicians. The sEMG and fEMG signals were identically filtered and aligned prior to cross-correlation analysis. RESULTS A strong concordance between sEMG and fEMG power was observed, with 95% of the records exhibiting at least moderate agreement. During rapid eye movement (REM) sleep, sEMG power was significantly less than fEMG power, but exhibited four times greater across-subject variability. fEMG power during wake and non-REM (NREM) sleep was greater than sEMG power, but with 50% less variability. Differences in wake and N1 mean power and between the other sleep stages were more distinct in the fEMG recordings. Relative changes in sEMG and fEMG power across wake, NREM, and REM stages were essentially identical with median by-subject cross correlations of 0.98 and interquartile ranges of 0.97 and 0.99, respectively. CONCLUSION The fEMG and sEMG power values were similar during wakefulness and sleep; however, the frontalis exhibits substantially less between-subject variability. This study established face validity for the use of fEMG in the detection of wake and stages of sleep, and for future applications toward assessment of quantitative REM sleep muscle activity in REM sleep behavior disorder.
Collapse
Affiliation(s)
| | - Erik K St Louis
- Center for Sleep Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Luigi Ferini Strambi
- Department of Clinical Neurosciences, San Raffaele Scientific Institute, Sleep Disorders Center Università Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Galbiati
- Department of Clinical Neurosciences, San Raffaele Scientific Institute, Sleep Disorders Center Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Chris Berka
- Advanced Brain Monitoring, Carlsbad, CA,USA,
| |
Collapse
|
5
|
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
| |
Collapse
|
6
|
Li XY, Liang ZH, Han C, Wei WJ, Song CL, Zhou LN, Liu Y, Li Y, Ji XF, Liu J. Transplantation of autologous peripheral blood mononuclear cells in the subarachnoid space for amyotrophic lateral sclerosis: a safety analysis of 14 patients. Neural Regen Res 2017; 12:493-498. [PMID: 28469667 PMCID: PMC5399730 DOI: 10.4103/1673-5374.202918] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
There is a small amount of clinical data regarding the safety and feasibility of autologous peripheral blood mononuclear cell transplantation into the subarachnoid space for the treatment of amyotrophic lateral sclerosis. The objectives of this retrospective study were to assess the safety and efficacy of peripheral blood mononuclear cell transplantation in 14 amyotrophic lateral sclerosis patients to provide more objective data for future clinical trials. After stem cell mobilization and collection, autologous peripheral blood mononuclear cells (1 × 109) were isolated and directly transplanted into the subarachnoid space of amyotrophic lateral sclerosis patients. The primary outcome measure was incidence of adverse events. Secondary outcome measures were electromyography 1 week before operation and 4 weeks after operation, Functional Independence Measurement, Berg Balance Scale, and Dysarthria Assessment Scale 1 week preoperatively and 1, 2, 4 and 12 weeks postoperatively. There was no immediate or delayed transplant-related cytotoxicity. The number of leukocytes, serum alanine aminotransferase and creatinine levels, and body temperature were within the normal ranges. Radiographic evaluation showed no serious transplant-related adverse events. Muscle strength grade, results of Functional Independence Measurement, Berg Balance Scale, and Dysarthria Assessment Scale were not significantly different before and after treatment. These findings suggest that peripheral blood mononuclear cell transplantation into the subarachnoid space for the treatment of amyotrophic lateral sclerosis is safe, but its therapeutic effect is not remarkable. Thus, a large-sample investigation is needed to assess its efficacy further.
Collapse
Affiliation(s)
- Xiao-Yan Li
- Regenerative Medicine Center, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Zhan-Hua Liang
- Neurological Department, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Chao Han
- Regenerative Medicine Center, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Wen-Juan Wei
- Regenerative Medicine Center, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Chun-Li Song
- Electromyography Department, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Li-Na Zhou
- Electromyography Department, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Yang Liu
- Regenerative Medicine Center, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Ying Li
- Regenerative Medicine Center, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Xiao-Fei Ji
- Neurological Department, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Jing Liu
- Regenerative Medicine Center, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| |
Collapse
|