The co-dispersion index for the measurement of fiber type distribution patterns

Simulating progressive motor neuron degeneration and collateral reinnervation in motor neuron diseases using a dynamic muscle model based on human single motor unit recordings

Objective.To simulate progressive motor neuron loss and collateral reinnervation in motor neuron diseases (MNDs) by developing a dynamic muscle model based on human single motor unit (MU) surface-electromyography (EMG) recordings.Approach.Single MU potentials recorded with high-density surface-EMG from thenar muscles formed the basic building blocks of the model. From the baseline MU pool innervating a muscle, progressive MU loss was simulated by removal of MUs, one-by-one. These removed MUs underwent collateral reinnervation with scenarios varying from 0% to 100%. These scenarios were based on a geometric variable, reflecting the overlap in MU territories using the spatiotemporal profiles of single MUs and a variable reflecting the efficacy of the reinnervation process. For validation, we tailored the model to generate compound muscle action potential (CMAP) scans, which is a promising surface-EMG method for monitoring MND patients. Selected scenarios for reinnervation that matched observed MU enlargements were used to validate the model by comparing markers (including the maximum CMAP and a motor unit number estimate (MUNE)) derived from simulated and recorded CMAP scans in a cohort of 49 MND patients and 22 age-matched healthy controls.Main results.The maximum CMAP at baseline was 8.3 mV (5th-95th percentile: 4.6 mV-11.8 mV). Phase cancellation caused an amplitude drop of 38.9% (5th-95th percentile, 33.0%-45.7%). To match observations, the geometric variable had to be set at 40% and the efficacy variable at 60%-70%. The Δ maximum CMAP between recorded and simulated CMAP scans as a function of fitted MUNE was -0.4 mV (5th-95th percentile = -4.0 - +2.4 mV).Significance.The dynamic muscle model could be used as a platform to train personnel in applying surface-EMG methods prior to their use in clinical care and trials. Moreover, the model may pave the way to compare biomarkers more efficiently, without directly posing unnecessary burden on patients.

Spatial distribution of fiber types within skeletal muscle fascicles from Standardbred horses

Skeletal muscle fascicles from superficial and deep portions of semitendinosus (ST) and gluteus medius (GM) muscles from Standardbred trotters were analyzed with regard to muscle fiber type proportion (types I, IIA, and IIB) and spatial distribution. Muscle fibers within a fascicle were divided into four layers (L(1-4)) from the fascicle periphery toward the center. The observed proportions of fiber types among layers were found to be statistically significantly different from a random distribution of fiber types. Type IIB fibers predominated in the peripheral layer, type I fibers prevailed in the layer underneath, and proportions close to the mean of the whole fascicles were observed in the central layer. This pattern of spatial distribution of fiber types within the layers of the fascicles was observed at all four muscle sampling sites. The functional significance of the common pattern is unknown, but possible functional roles are discussed.

Fiber grouping in the feline vestibular nerve before and after labyrinthectomy

The vestibular nerve is composed of fibers with a wide spectrum of diameters. The fibers of largest diameter are known to innervate the type I hair cells of the cristae, while the small-diameter fibers innervate the type II hair cells. Midsized fibers (dimorphic fibers) represent neurons that innervate both type I and type II hair cells. Reports by others have commented on the tendency for clustering of fibers with like diameters. Rigorous statistical proof for or against clustering has not yet been presented. The explanation for this is, in part, the mathematic complexity of analyzing clustering in a system composed of three elements. We report a new method for analysis of fiber clustering and apply this method to large-, medium-, and small-diameter fibers in the feline vestibular nerve. The fiber grouping in the caudal and rostral ends of the vestibular nerves of six normal animals is compared to that in similar areas of the nerves of five animals 12 to 17 months after unilateral labyrinthectomy. No statistically significant clustering of fiber types was found in the rostral portion of either the control or the labyrinthectomized animals. In the caudal portion of the control nerves, clustering of the large fibers was demonstrated (p < .005, chi2 test). This clustering was not demonstrated after labyrinthectomy. An explanation of these findings is discussed. The method used in this study to analyze fiber clustering may be applicable to other nerve systems of greater complexity.

A fractal characterization of the type II fiber distribution in the extensor digitorum longus and soleus muscles of the adult rat

A method is proposed for the quantitative characterization of fiber type spatial distribution by means of the (correlation) fractal dimension. The method is applied to type II fiber distributions of the soleus and extensor digitorum longus muscles of the adult rat. The results obtained suggest that these distributions have fractal properties with a strong tendency for spreading, more pronounced in soleus muscle. The density of muscle fibers or the age do not seem to alter the features of the distribution. Computer-generated random patterns have virtually the same fractal dimension as the extensor digitorum longus distributions but fail to approximate those of the soleus muscle. This fractal method could find application as an alternative in the quantitative assessment of the fiber type grouping.

A quantitative histochemical study of the spatial distribution of intrafascicular fibre types in the porcine masseter and soleus muscles

The distribution of intrafascicular type I and II muscle fibres together with proportions of edge- and centrally located type I and II fibres within whole fascicles were analysed by myosin ATP-ase histochemistry in 241 porcine masseter fascicles (six masseter muscles) and compared with result from 63 pig soleus fascicles (five soleus muscles). All fascicles were from 11 domestic pigs (1 yr old, 70-90 kg body weight, all female). The proportions of type I fibres (slow) and type II fibres (fast) on the edge of fascicles differed significantly from the proportions centrally. All the soleus fascicles had higher proportions of centrally located type I fibres. Only seven out of 241 (3%) masseter fascicles diverged in this respect and showed reversed intrafascicular fibre-type proportions with more edge-located type I fibres. Analysis of the fascicular distribution of type I and II fibres revealed that the porcine masseter had type II fibres as the predominant type. Between 68-87% of the total fibres were type II (p < 0.001). The intrafascicular content of type I fibres increased towards the deep part of the masseter. In four of five soleus muscles the type II fibre population was dominant (p < 0.01). However, one soleus revealed equal proportions of type I and II fibres.

Muscle hypertrophy secondary to the tethered cord syndrome

Segmental muscle enlargement occurs in a variety of neurogenic conditions. We present a case with calf hypertrophy, likely produced by partial denervation and continuous neuromuscular irritability, which was caused by a tethered spinal cord that was demonstrated by MRI. Muscle MRI correlated with muscle biopsy findings in which atrophy and hypertrophy were accompanied by rimmed vacuoles.

An augmented computer model of motor unit reorganization in neurogenic diseases of skeletal muscle

A computer model of denervation and complete reinnervation in skeletal muscle was originally developed for the purpose of furthering an understanding of the underlying mechanisms of motor unit reorganization in neurogenic diseases. We now describe its successor, a computer model for investigating different rates of denervation and reinnervation, as well as incomplete reinnervation. The new model introduces the concept of permanent denervation and features enhanced interactive control over the distribution of motor unit centers and additional measures of dispersion and co-dispersion of muscle fibers. The use of this model for investigating pathophysiologically significant issues in denervating diseases is illustrated with five different sets of parameters. These simulate some of the processes that may be operational in chronic spinal muscular atrophy, amyotrophic lateral sclerosis, and progressive postpolio muscular dystrophy. The enhanced model will allow in-depth analysis of the influence of hypothesized pathophysiological processes on clinical, electrophysiological and pathological outcomes in human disease.

Quantitative morphometric study of muscle in inclusion body myositis

Clinical and electromyographic findings do not clearly distinguish inclusion body myositis (IBM) from chronic polymyositis (PM). The rimmed vacuoles and filamentous nuclear and cytoplasmic inclusions that characterize IBM are often sparse and may be overlooked; conversely, these features may occasionally be seen in other diseases. Preliminary studies suggested that muscle fiber hypertrophy occurred more frequently in IBM than in PM. To investigate whether fiber hypertrophy can be used to improve the ability to separate IBM from PM, we report a morphometric analysis of 28 IBM cases, 22 PM and 22 dermatomyositis (DM) cases. The analysis, using a computer automated system, included proportion of hypertrophied fibers and also fiber type proportions, average fiber diameter, proportion of atrophic and angulated fibers, and the co-dispersion index (CDI). The proportion of hypertrophied fibers was greater in IBM than the other two conditions (IBM (mean +/- SEM) 31.0 +/- 4.7% and 12.2 +/- 2.4% for type 1 and type 2 fibers, respectively, compared to 9.8 +/- 3.0% and 3.3 +/- 1.7% in PM, and 7.7 +/- 2.7% and 3.9 +/- 1.9% in DM). These differences were statistically significant (P < 0.05) in both sexes for type 1 fibers and in women for type 2 fibers. Also, the average fiber size and hypertrophy factors for type 1 and type 2 fibers were increased in IBM compared to PM and DM. This study confirms that the presence of muscle fiber hypertrophy in biopsies from IBM patients may help differentiate them from other clinically similar inflammatory myopathies.

Determination of the early age of onset of equine recurrent laryngeal neuropathy. 1. Muscle pathology

The age of onset of equine recurrent laryngeal neuropathy has not been ascertained, although the clinical condition of left laryngeal hemiplegia ("roaring") has been recognized for centuries. The purpose of this study was to evaluate the laryngeal muscles of draft horse foals for the presence of fiber-type grouping, indicating denervation and reinnervation, and to determine if histological evidence of recurrent laryngeal neuropathy was present. Abductor and adductor laryngeal muscles from the left and right sides were collected immediately after euthanasia from male draft horse foals, six less than 2 weeks and four 6 months of age, and stained for myosin ATPase. A morphometric test was used to objectively evaluate several areas from each muscle for fiber-type grouping. Extensive fiber-type grouping which was characteristic of recurrent laryngeal neuropathy was found in one of the young foals and all of the older foals. Four of the young foals had some areas of fiber-type grouping suggestive of mild, early changes associated with recurrent laryngeal neuropathy. One of the young foals had no fiber-type grouping present in any of the laryngeal muscles evaluated. These findings suggest an early age of onset of recurrent laryngeal neuropathy.

Modeling fiber type grouping by a binary Markov random field

A new approach to the quantification of fiber type grouping is presented, in which the distribution of histochemical type in a muscle cross section is regarded as a realization of a binary Markov random field (BMRF). Methods for the estimation of the parameters of this model are discussed. The first order BMRF, which is used in this article, contains 2 parameters: alpha and beta. The parameter beta is of prime importance, as it is an interaction parameter which governs the degree of type grouping. The value of this parameter is estimated for 9 muscle biopsies. The interpretation of the results is discussed.

Spatial distribution of motor unit fibres in fast- and slow-twitch rat muscles with special reference to age

The spatial arrangement and morphometrical properties of the muscle fibres within single motor units (motor unit fibres) were studied in fast-twitch units of the tibialis anterior (TA) and in slow-twitch units of the soleus, using a computer-assisted model. The motor unit fibres were identified by the glycogen-depletion technique and the position of each fibre was defined by (x, y)-coordinates. The distance between each fibre and the nearest motor unit fibre (nearest-neighbour distance), and the distance between each fibre and each of the other fibres in the unit (interfibre distance), was calculated and plotted. Comparisons were made between young adult (3-6 months) and old (20-25 months) rats. In old animals, the motor units of TA and the soleus were larger (P less than 0.05 and P less than 0.01), contained an increased number of muscle fibres (P less than 0.01) and covered a larger portion of the muscle cross-section (P less than 0.01 and P less than 0.1). These changes indicate the presence of an age-related denervation-reinnervation process in both types of muscles. In the young adult group, the fast-twitch motor unit fibres of TA were non-randomly arranged (P less than 0.05-0.01) whereas the fibre arrangement within the slow-twitch motor units of the soleus was not significantly different from random. In old animals, the fibre arrangement was non-random in both fast- and slow-twitch motor units. In TA, the distribution of nearest-neighbour distances showed an increased (P less than 0.05) proportion of short distances in old age, whereas the distribution of interfibre distances was unchanged. In the soleus, the distribution of interfibre distances showed an age-related displacement to the left at short distances (P less than 0.05) and to the right at long distances (P less than 0.01), but the distribution of nearest-neighbour distances was not significantly altered. It is concluded that motor unit fibres are non-randomly arranged in the fast-twitch motor units studied and that a non-random rearrangement of motor unit fibres takes place in both fast- and slow-twitch units during the ageing process. This age-related rearrangement is secondary to a denervation-reinnervation process and it appears as if different types of reinnervation predominate in fast- and slow-twitch units.

Arrangement of fiber types within fascicles of human vastus lateralis muscle

A total of 106 fascicles at 6 predetermined areas of the vastus lateralis muscle from 9 healthy men, aged 18 to 40 years, were analyzed. Fibers in a fascicle were divided into layers according to their relation to the perimysium. In each layer the proportions of type 1 and 2, subdivided into 2a, 2b, and 2c fibers were determined and normalized by the fiber type proportion in the whole fascicle. A consistent arrangement of fiber types within the fascicles was obtained, regardless of subject, sampling site, fiber type proportion, and fascicle size. A high proportion of 2b fibers on the border, a prevalence of type 1 fibers in the layer beneath, and a rather uniform distribution of 2a fibers in all layers are the main characteristics of the distribution of fibers in a fascicle. Developmental processes in fiber type differentiation most probably constitute the basis for fiber type arrangement, which can further be influenced by local factors.

Spatial distribution of fiber types in skeletal muscle: test for a random distribution

A statistical test is introduced for the assessment of fiber type grouping based on the number of neighboring fibers of different histochemical type. It is conceptually simple and can be applied to regular and irregular fiber patterns alike. One important feature of this test is that it has more power than existing ones, which means that deviations from a normal situation can be detected in an earlier stage than with any other method. The dependency of the outcome of the test on type-specific size differences is rather small. Moreover, a method is given to correct for this bias. With the aid of the test it is shown that in normal muscle tissue of young persons a slight segregation of fiber type is a common situation.

Stereological analysis of three-dimensional structure organization of surfaces in multiphase specimens: statistical methods and model-inferences

In a multiphase material the structural components or phases are everywhere in contact with each other. The relative area of surface contact between various phases is an important aspect of the short-range ordering or organization of the structure. The stereological quantitation of such specific interfaces is a simple and well-known technique. The proper statistical definition of realistic models for the frequency of contact and the quantitative estimation of phase-specific affinities is studied. The meaningful interpretation of sets of estimated affinities poses a major problem of statistical inference which is dealt with in detail and illustrated by a worked-out biological example.

A computer model of denervation-reinnervation in skeletal muscle

A computer model of the process of denervation and complete reinnervation of skeletal muscle has been developed for the purpose of exploring underlying mechanisms and for use in the development of new clinical and research tools for evaluating neuromuscular disease. Progressive motor neuron death and reinnervation in this model reproduces the fiber-type grouping, increased fiber density, and minimal increase of motor unit size seen in human chronic denervating diseases. Studies using the model suggest that (1) preferential involvement of motor units of one type could account for the abnormal fiber-type proportions observed in some diseases, (2) reinnervation by axons innervating adjacent fibers is compatible with single fiber multielectrode study results in that it does not produce a large increase in motor unit area, and (3) such reinnervation is sufficient to account for the increases in motor unit density that have been observed. The model has also been used in the development and testing of the Codispersion Index, a measure of the codistribution of two fiber types, which is useful in detecting fiber-type grouping.

Automated system for the analysis of muscle and nerve biopsies

An automated system has been developed for morphometric analysis of muscle and nerve fibers as seen in routine biopsy tissue preparations. This system, which is suitable both for research and clinical applications, is now in routine use at New England Medical Center Hospital. It is designed around commonly available hardware and uses our own custom software. Special sample preparation is not required, and the system will process almost any biopsy that is free from obvious artifact and suitable for manual assessment. In a typical biopsy, the system provides nearly full automation for the edge (boundary) determination of over 90%of the fibers encountered. An efficient, interactive mode allows for rapid analysis of the remaining 10%. Once fiber boundaries are determined, the system provides fully automatic measurement of the usual parameters such as fiber diameter, as well as a number of parameters not routinely measured with existing manual techniques. Typical analysis times are 35 min for muscle and 2 h for nerve. Complete report generation is provided, with hardcopy available in the pathologist's office. This paper describes the operational aspects of the use of the automated analysis system in routine biopsy work.

Recent views on amyotrophic lateral sclerosis with emphasis on electrophysiological studies

Peripheral electrophysiological studies are of particular value of elucidating the anatomy and pathophysiology of neuromuscular diseases, but they can also help in providing clues to the etiology of the disease. Recent studies of the motor units in chronic denervating conditions including amyotrophic lateral sclerosis (ALS) are reviewed. These indicate that reinnervation is a relatively active process which compensates for the progressive loss of motoneurons in ALS until more than 50% of the motoneurons have died. There seems to be no predilection for death of motoneurons of any particular size in ALS. Fasciculations may arise both proximally and distally. The dying-back change is not a major feature of ALS. These and other data cast doubt on the etiological theories that ALS arises from premature aging of motoneurons, deficiency of motoneuron trophic factors, or an inhibitor of a motoneuronal sprouting factor, and point to the need to study metabolic changes intrinsic to the motoneuron in ALS.

Morphological detection of neurogenic muscle disorders: how can statistical methods aid diagnosis?

The light microscopical observation of groups of histochemically similar muscle fibres, referred to as fibre-type grouping, is commonly considered to be evidence of a denervation and reinnervation process affecting the spinal motor neurons or the peripheral nerves. It can be difficult to assess whether such groups have occurred by chance or are due to a slowly progressive pathological process in an early stage of development. Consequently, there is a need for one or more objective methods for assessing the fibre-type arrangement in healthy and diseased human muscles. The purposes here are to review the methods for the detection of fibre-type grouping that have been published in the last two decades, to describe some unsolved problems, and to indicate some likely lines of development.

A simple test for the random arrangement of muscle fibres

The random arrangement of a given muscle fibre class has been assessed by estimating 'mean cluster size' in transverse sections of skeletal muscle. The method was found to be useful when the proportion of the fibre class of interest was low. The statistical distribution of this measure was investigated by computer simulation using a hexagonal lattice model of muscle fibre arrangement. An approximate significance test was developed by considering the extreme points of the distribution. Minor changes to the hexagonal lattice model were incorporated to give a more realistic representation of fibre arrangement and these were found to give very similar results to the simpler model.

Postpoliomyelitis muscle pseudohypertrophy

A 62-year-old patient who had had acute paralytic poliomyelitis in early childhood developed bilateral lower limb muscle pseudohypertrophy. The pseudohypertrophy was caused primarily by an enormous excess of adipose tissue replacing muscle fibers, and, in part, by work hypertrophy of muscle fibers.

Comparison of electrophysiological and histochemical methods for assessing the spatial distribution of muscle fibres of a motor unit within muscle

The spatial distribution of muscle fibres of a motor unit has been examined in patients with a variety of neuromuscular disorders using the fibre density (FD) technique of single fibre EMG and the enclosed fibre count (EFC) method, and the results of the two approaches compared. Agreement between the findings occurred in 64% of cases; an increase in both parameters was seen only in neurogenic conditions. FD was found to be more sensitive to minor disturbances of motor unit architecture as seen in myopathies and mild neurogenic states, and this factor together with sampling differences accounted for most of the discrepancies between the two methods. The finding of normal FD and EFC values in the presence of fibre type disproportion helped to exclude reinnervation as the cause by confirming the predominantly diffuse distribution of muscle fibres.