Recording characteristics of monopolar EMG electrodes

Modeling and Reproducibility of Twin Concentric Electrical Impedance Myography

OBJECTIVE

Electrical impedance myography (EIM) is a recent technology to assess muscle health. As of today, the clinical application of EIM has been applied only to evaluate muscle condition using non-invasive surface electrodes in contact with the skin; however, intermediate tissues at the recording site introduce confounding artifacts which reduce the technique's performance as a biomarker of neuromuscular disorders (NMD). Here, we develop and test in humans a new approach using two concentric needles for intramuscular EIM recordings.

METHODS

First, we study the recording characteristics of dual concentric needle EIM via analytical models and finite element models (FEMs). Next, the validity of the models is verified by performing experiments on saline and agar phantoms. Finally, 8 subjects with various neuromuscular diseases were studied measuring tibialis anterior, biceps, deltoid, adductor pollicis brevis, first dorsal interosseous and flexor carpi radialis muscles.

RESULTS

Analytical and FEM simulations are in good agreement with a maximum experimental discrepancy 8% and 9% using gauge needles 26 and 30, respectively. The inter-session reproducibility, as measured by the intraclass correlation coefficients for all muscles studied, was 0.926, which is comparable or exceeds the reproducibility of other well-established electrophysiological tests to assess muscle health.

CONCLUSION

The reproducibility of the technique support future clinical validation of needle EIM for assessment of disease status, either as part of standard patient care or as biomarker measure in clinical trials.

SIGNIFICANCE

Needle EIM has the potential of becoming a valuable diagnostic tool to evaluate NMD in adult population.

The motor unit and quantitative electromyography

Electromyography (EMG) assesses the anatomic motor unit (A-MU), but knowledge of its anatomy, physiology, and changes with pathology is limited. The electrophysiological motor unit (E-MU) and its motor unit potential (E-MUP) represents a fraction of the A-MU. Routine EMG assesses a limited number of E-MUP waveform characteristics (metrics) and their magnitudes qualitatively scaled in a nonlinear manner. Another approach is quantitative EMG (QEMG), whereby 20⁺ E-MUPs are extracted and both basic and derived metrics obtained and values expressed quantitatively. In diseased muscle, many E-MUP metrics may be normal, which complicates diagnostic interpretation. In QEMG, E-MUP metrics can be clustered and statistical analyses performed to assign probabilities that E-MUPs (and the muscle) are normal, neuropathic, or myopathic. In this article we review what is known about the A-MU, the restricted E-MU, E-MUP metrics, and what QEMG offers currently and in the future.

Recording characteristics of electrical impedance-electromyography needle electrodes

OBJECTIVE

Needle EMG remains the standard clinical test for neuromuscular disease (NMD) assessment, but it only characterizes myofiber membrane depolarization. On the other hand, electrical impedance provides non-electrically active structural and compositional data of tissues. Here, we designed a prototype of needle electrode integrating electrical impedance and EMG measurement capabilities, the so-called I-EMG needle electrode.

APPROACH

We use finite element method models to study the impedance recording characteristics of I-EMG needle electrodes. The simulated electrical and mechanical design specifications are then manufactured to create a prototype of an I-EMG needle electrode. We pilot these new needle electrodes by conducting in vivo impedance measurements with muscle at rest on healthy wild-type (wt, n  =  5) and muscular dystrophy (mdx, n  =  5) mice. Comparisons between wt and mdx mice are performed using Mann-Whitney test, two-tailed, p  <  0.05. The electrical characterization of the EMG electrode in the developed I-EMG needles was performed in vitro on saline solution and through EMG detection in wt animal at rest and during voluntary contractions.

RESULTS

Muscle impedance demonstrate good repeatability (p  <  0.05 and p  <  0.005 for resistance and reactance at 50 kHz, respectively) and agreement between different I-EMG needles. Impedance data allows us to discriminate between mdx and wt muscle (p  <  0.05 and p  <  0.005 for resistance and reactance at 10 kHz, respectively). EMG broadband noise power and peak amplitude using the I-EMG needle were similar to that of a commercial monopolar EMG needle. EMG recordings using the I-EMG needle measured electrical activity similar to a standard monopolar needle with muscle at rest and during voluntary contraction.

SIGNIFICANCE

Needle I-EMG technology may offer the opportunity to enhance the diagnostic capability and quantification of NMD beyond that possible with either impedance or EMG techniques separately. Ultimately, needle I-EMG could serve as a new bedside tool to assess NMD without increasing the complexity or duration of the EMG test.

Recording characteristics of electrical impedance myography needle electrodes

OBJECTIVE

Neurologists and physiatrists need improved tools for the evaluation of skeletal muscle condition. Here we evaluate needle electrical impedance myography (EIM), a new minimally invasive approach to determine muscle status that could ultimately become a bedside tool for the assessment of neuromuscular disorders.

APPROACH

We design and study the recording characteristics of tetrapolar EIM needle electrodes combining theory and finite-element model simulations. We then use these results to build and pilot in vivo an EIM needle electrode in the rat gastrocnemius muscle ([Formula: see text]). The dielectric properties of muscle are reported (mean  ±  standard deviation).

RESULTS

The numerical simulations show that the contribution of subcutaneous fat and muscle tissues to needle EIM data is <3% and >97%, respectively, and the sensed volume is [Formula: see text] cm³. Apparent resistivity [Formula: see text] [Formula: see text] cm and relative permittivity [Formula: see text] (dimensionless) measured at 10 kHz are in good agreement with in vivo dielectric properties reported in the literature.

SIGNIFICANCE

The results presented show the feasibility of measuring muscle impedivity in vivo using a needle electrode from 10 kHz to 1 MHz. The development of needle EIM technology can open up a new field of study in electrodiagnostic medicine, with potential applications to both disease diagnosis and biomarker assessment of therapy.

Disrupted central inhibition after transcranial magnetic stimulation of motor cortex in schizophrenia with long-term antipsychotic treatment

Aims. Schizophrenia is a neuropsychiatric disorder associated with mental and motor disturbances. We aimed to investigate motor control, especially central silent period (CSP) in subjects with schizophrenia (n = 11) on long-term antipsychotic treatment compared to healthy controls (n = 9). Methods. Latency and duration of motor evoked potentials (MEPs) and CSPs were measured with the help of single pulse transcranial magnetic stimulation (TMS) and intramuscular electrodes. After stimulation of the dominant and nondominant motor cortex of abductor digiti minimi (ADM) and tibialis anterior (TA) muscle areas, respective responses were measured on the contralateral side. Results. MEPs did not differ significantly between the groups. Multiple CSPs were found predominantly in subjects with schizophrenia, which showed a higher number of CSPs in the dominant ADM and the longest summarized duration of CSPs in the nondominant ADM (P < 0.05) compared to controls. Conclusions. There were multiple CSPs predominantly in the upper extremities and in the dominant body side in subjects with schizophrenia. Behind multiple CSPs may lie an impaired regulation of excitatory or inhibitory neurotransmitter systems in central motor pathways. Further research is needed to clarify the role of the intramuscular recording methods and the effect of antipsychotics on the results.

Recurrent CSPs after Transcranial Magnetic Stimulation of Motor Cortex in Restless Legs Syndrome

Aims. The aim of this study was to investigate the motor control and central silent period (CSP) in restless legs syndrome (RLS). Methods. Transcranial magnetic stimulation was focused on the dominant and nondominant hemispheric areas of motor cortex in six subjects with RLS and six controls. The responses were recorded on the contralateral abductor digiti minimi (ADM) and tibialis anterior (TA) muscles with intramuscular needle electrodes. Results. No significant differences were found in the motor conduction or central motor conduction time, in the latency, or in the duration of the CSPs between or within the groups, but multiple CSPs were observed in both groups. The number of the CSPs was significantly higher in both ADMs and in the dominant TA (P ≤ 0.01) in the RLS group compared to the controls. Conclusion. Descending motor pathways functioned correctly in both groups. The occurrence of the recurrent CSPs predominantly in the RLS group could be a sign of a change of function in the inhibitory control system. Further research is needed to clarify the role of the intramuscular recording technique and especially the role of the subcortical generators in the feedback regulation of the central nervous system in RLS.

Motor unit number estimates and quantitative motor unit analysis in healthy subjects and patients with amyotrophic lateral sclerosis

Limitations associated with global measures of function in patients with amyotrophic lateral sclerosis (ALS) and the qualitative nature of needle electromyography have stimulated the development of alternate means of monitoring disease severity and progression in ALS. Thus, the objective of this study was to examine the ability of one these techniques, decomposition-based quantitative electromyography (DQEMG), to obtain electrophysiological data, including motor unit number estimates (MUNEs), from a group of patients with ALS. The first dorsal interosseous and biceps brachii muscles were studied in 10 healthy subjects and 9 patients with ALS. Following the acquisition of a maximum M wave, needle- and surface-detected EMGs were collected simultaneously during 30-second contractions performed at 10% of the maximum voluntary contraction force to obtain motor unit potential (MUP) trains. DQEMG was then used to extract the surface-detected MUP associated with each MUP train, the mean size of which was divided into the maximum M wave to obtain a MUNE. The results suggest that quantitative electrophysiological data obtained using DQEMG are representative of the pathophysiological changes in the lower motor system in ALS patients, supporting its use in studies documenting the natural history and progression of the disease.

Quantitative electromyography

Quantitative EMG is an MUAP analysis technique providing objective information on the NEE. The concept and techniques are not new; however, with the advancement of computer technology, quantitative EMG is now more easily performed. The study requires solid knowledge of basic neurophysiology and access to the appropriate instrument to provide smooth technique and accurate interpretation. Despite recent technical advances, the original MUAP parameters defined by Buchthal are still widely used today as reference values. It is increasingly recognized that many factors can influence the obtained parameters. The ability to measure something does not mean that it is fully understood. The future of quantitative EMG will depend on increased understanding of the physiologic and pathophysiologic significance of the detailed numeric parameters that are generated.

Concentric and single fiber electrode spatial recording characteristics

A better appreciation of the specific spatial recording characteristics of the single fiber and concentric needle electrode can result in more accurate physiologic and theoretical interpretations of single fiber and quantitative motor unit action potential analysis. We demonstrate by physical modeling that the 90% and 99% amplitude sensitivity envelopes are not simple hemispherical shapes. The 90% sensitivity concentric electrode volume does not extend beyond the insulated portion of the 15 degree beveled surface between the core and cannula and extends only 280 microm perpendicularly from the center of the core's surface. The 99% envelope extends approximately 830 microm perpendicularly from the core's center. This is a much smaller volume of sensitivity than exists for a similarly modeled monopolar electrode. The 90% and 99% envelopes extend to 110 and 320 microm perpendicularly from the exposed single fiber core. Both the single fiber and concentric needle volumes of sensitivity have specific asymmetries described.

Motor unit action potential duration recorded by monopolar and concentric needle electrodes. Physiologic implications

Controversy exists regarding motor unit action potentials (MUAPs) recorded with monopolar v concentric needle electrodes. All investigations to date have used different instrumentation parameters combined with different motor unit potential populations to assess comparative durations for MUAPs. In this investigation, the same MUAP was analyzed for both monopolar and concentric needle electrodes with identical instrumentation parameters. Monopolar needle electrodes were found to record MUAPs with slightly longer durations, a result that reached statistical significance. Manual wideband high-resolution MUAP analysis demonstrated durations approaching 30 ms for both electrodes, which is different from the approximately 10 ms presently measured for both electrode types. A hypothesis was proposed whereby the total duration of current flow, which is directly proportional to muscle fiber length, is the primary determinant of MUAP duration. The physiologic implications of this hypothesis are discussed.

Concentric/monopolar needle electrode modeling: spatial recording territory and physiologic implications

Scaled 20:1 physical models of monopolar and standard concentric needle electrodes are investigated with a constant current bipolar generator to determine the amplitude versus radial distance characteristics of these two electrodes. Each model is examined at three scaled and simulated tissue penetration depths (4, 10 and 20 mm) with measurements documented from 20 to 9000 microns radially in front and behind the models. The monopolar compared to concentric electrode has a smaller response to a standardized stimuli but a flatter response curve at distances of less than 1500 microns. The cannula of the concentric needle also has a flatter response than that of its core. When compared to a remote reference such as that at scaled depths of tissue penetration approximating 4 mm or less the cannula-to-remote reference potential exceeds the amplitude of the core-to-remote reference, recording a net negative potential at 6500 microns in front and 3500 microns behind the core. This study offers an explanation for the clinically observed larger magnitude potentials detected with monopolar compared to concentric electrodes resulting from a larger recording cross-sectional area with more fibers contributing to the potential even though the magnitude of potential at any one location is comparatively smaller in magnitude than that for the concentric electrode. Additionally, the physiologic duration of a motor unit is anticipated to be considerably longer than presently measured clinically with automated methods because of the electrodes' ability to detect such small signals from a large region of the volume conductor.

Monopolar needle electrode spatial recording characteristics

The recording characteristics of the monopolar needle in three dimensions have not been well established. A simple spherical recording territory is commonly assumed with the very tip proposed to have a greater spatial recording sensitivity by some authors. We demonstrate by enlarged physical modeling in a homogeneous volume conductor that the recorded amplitude diminishes more gradually radially away from the conical surface than distally past the tip or proximal to the insulation edge. The sensitivity over the exposed metallic surface is found to be uniformly proportional to the area, which results in relatively less sensitivity at the tip than the middle and proximal portions of the conical recording surface. The overall spatial amplitude recording characteristics can be better described by an apple shape than a sphere, centered at the midportion of the exposed conical surface. A better appreciation of the actual spatial recording characteristics of the monopolar needle electrode can result in more accurate physiologic interpretations of quantitative motor unit analysis.

AAEM minimonograph #16: instrumentation and measurement in electrodiagnostic medicine--Part I

Technical and instrumentation factors play an important role in obtaining reliable information during electrodiagnostic studies. With contemporary electrodiagnostic equipment, neurophysiologic potentials are detected using a variety of electrodes and undergo differential amplification, filtering, conversion to digital form, and finally, analysis and display. Understanding the signal processing principles, limitations, and sources of errors that can occur during this multistep process can improve the technical quality of studies, minimize preventable errors, and improve clinical interpretation. Part I of this minimonograph reviews the basic principles of action potential generation and overviews electrodiagnostic instrumentation. The concept of waveform frequency content is related to the role of filters in suppressing noise while preserving waveform latency, amplitude, and morphology. The electrical characteristics of various surface and needle electrodes influence instrument design and the nature of the potentials recorded. This is especially important in understanding the differences in motor unit characteristics obtained from monopolar and concentric needle electrodes.

Boundary element analysis of the directional sensitivity of the concentric EMG electrode

Assessment of the motor unit architecture based on concentric electrode motor unit potentials requires a thorough understanding of the recording characteristics of the concentric EMG electrode. Previous simulation studies have attempted to include the effect of EMG electrodes on the recorded waveforms by uniformly averaging the tissue potential at the coordinates of one- or two-dimensional electrode models. By employing the boundary element method, this paper improves earlier models of the concentric EMG electrode by including an accurate geometric representation of the electrode, as well as the mutual electrical influence between the electrode surfaces. A three-dimensional sensitivity function is defined from which information about the preferential direction of sensitivity, blind spots, phase changes, rate of attenuation, and range of pick-up radius can be derived. The study focuses on the intrinsic features linked to the geometry of the electrode. The results show that the cannula perturbs the potential distribution significantly. The core and the cannula electrodes measure potentials of the same order of magnitude in all of the pick-up range, except adjacent to the central wire, where the latter dominates the sensitivity function. The preferential directions of sensitivity are determined by the amount of geometric offset between the individual sensitivity functions of the core and the cannula. The sensitivity function also reveals a complicated pattern of phase changes in the pick-up range. Potentials from fibers located behind the tip or along the cannula are recorded with reversed polarity compared to those located in front of the tip. Rotation of the electrode about its axis was found to alter the duration, the peak-to-peak amplitude, and the rise time of waveforms recorded from a moving dipole.

Multifrequency characteristics of disposable and nondisposable EMG needle electrodes

The physical properties of recording electrodes coupled with the input characteristics of recording amplifiers can affect motor unit parameters. In recent years, there has been increased use of disposable needle electrodes; thus, a comparison of impedance characteristics with disposable types is of interest. Impedances at 10, 100, 1000, and 10,000 Hz of eight different electrode models including concentric and monopolar, both disposable and reusable, were measured. For all models of monopolar electrodes, no significant difference in impedance was found between disposable and nondisposable types. Intramodel variability was seen, however, with a twofold difference between minimum and maximum impedances for each model. For concentric electrodes, a moderate difference in impedance was found between disposable and nondisposable types, but less intramodel variability was seen; there was also more intermodel variability. To determine whether the measured impedances could affect recorded motor unit potentials, a theoretical analysis was conducted using typical waveforms along with circuit analysis techniques. Electrode impedances as high as 50 times nominal values caused no significant waveform distortion.