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Kaneko M, Sugiyama Y, Fuse S, Mukudai S, Hirano S. Physiological Effects of Voice Therapy for Aged Vocal Fold Atrophy Revealed by EMG Study. J Voice 2024; 38:376-383. [PMID: 34649741 DOI: 10.1016/j.jvoice.2021.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Age-related voice changes are characterized as breathy, weak and strained, and a deterioration in vocal function in the elderly has been putatively linked to a reduced intensity of speech. They contribute to undesirable voice changes known as presbyphonia. These changes are caused by histological alterations in the lamina propria of the vocal fold mucosa and atrophy of the thyroarytenoid muscle, as well as by decreased respiratory support. There are several clinical studies on presbylarynx dysphonia showing the effectiveness of voice therapy. However, physiological changes of the presbylarynx following voice therapy have not been verified. The purpose of this prospective study was to demonstrate the clinical effectiveness of voice therapy for rehabilitating presbylarynx dysphonia, using vocal function assessments and thyroarytenoid muscular activity detection on laryngeal electromyography (LEMG). METHODS 10 patients who were diagnosed with aged vocal fold atrophy from ages 60 to 87 years (mean age: 72 years) underwent approximately 12 weeks of voice therapy, mainly using forward-focused voice and vocal resistance training. Stroboscopic examination, aerodynamic assessment, acoustic analysis, Voice Handicap Index (VHI)-10, and LEMG were performed pre- and post-voice therapy. Vocal fold vibratory amplitude (VFVA) was measured by image analysis from the stroboscopic examinations. Turns analysis during steady phonation on LEMG was also assessed. RESULTS Maximum phonation time, subglottic pressure, jitter, shimmer, VFVA, and VHI-10 significantly improved after voice therapy. The number of turns per second on LEMG also significantly increased. CONCLUSION Our data suggest that voice therapy may improve vocal function and thyroarytenoid muscle activity in patients with aged vocal fold atrophy.
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Affiliation(s)
- Mami Kaneko
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan.
| | - Yoichiro Sugiyama
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Shinya Fuse
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Shigeyuki Mukudai
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
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Mandeville R, Sanchez B, Johnston B, Bazarek S, Thum JA, Birmingham A, See RHB, Leochico CFD, Kumar V, Dowlatshahi AS, Brown J, Stashuk D, Rutkove SB. A scoping review of current and emerging techniques for evaluation of peripheral nerve health, degeneration, and regeneration: part 1, neurophysiology. J Neural Eng 2023; 20:041001. [PMID: 37279730 DOI: 10.1088/1741-2552/acdbeb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/06/2023] [Indexed: 06/08/2023]
Abstract
Peripheral neuroregeneration research and therapeutic options are expanding exponentially. With this expansion comes an increasing need to reliably evaluate and quantify nerve health. Valid and responsive measures that can serve as biomarkers of the nerve status are essential for both clinical and research purposes for diagnosis, longitudinal follow-up, and monitoring the impact of any intervention. Furthermore, such biomarkers can elucidate regeneration mechanisms and open new avenues for research. Without these measures, clinical decision-making falls short, and research becomes more costly, time-consuming, and sometimes infeasible. As a companion to Part 2, which is focused on non-invasive imaging, Part 1 of this two-part scoping review systematically identifies and critically examines many current and emerging neurophysiological techniques that have the potential to evaluate peripheral nerve health, particularly from the perspective of regenerative therapies and research.
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Affiliation(s)
- Ross Mandeville
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Benjamin Sanchez
- Department Electrical and Computer Engineering, University of Utah, Salt Lake City, UT 84112, United States of America
| | - Benjamin Johnston
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, United States of America
| | - Stanley Bazarek
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, United States of America
| | - Jasmine A Thum
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Austin Birmingham
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Reiner Henson B See
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Carl Froilan D Leochico
- Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Global City, Taguig, The Philippines
- Department of Rehabilitation Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, The Philippines
| | - Viksit Kumar
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Arriyan S Dowlatshahi
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Justin Brown
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Daniel Stashuk
- Department of Systems Design Engineering, University of Waterloo, Ontario N2L 3G1, Canada
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
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Bromberg MB. Quantitative electrodiagnosis of the motor unit. HANDBOOK OF CLINICAL NEUROLOGY 2023; 195:271-286. [PMID: 37562872 DOI: 10.1016/b978-0-323-98818-6.00016-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Electromyography (EMG) focuses on assessment of the motor unit (MU), and a given muscle has several hundred MUs, each innervating hundreds of muscle fibers. Assessment is limited by the recording radius of electrodes, 1-2 fibers with single-fiber electrodes and 7-15 fibers with concentric or monopolar electrodes. Routine qualitative EMG studies rely on observing MUs in free-run mode and qualitatively estimating common metrics. In contrast, quantitative EMG (QEMG) applied to routine studies includes assessment of individual MUs by software available in modern EMG machines with extraction of discrete values for common metrics, and also derived metrics. This results in greater precision and statistical interpretation. Other QEMG techniques assess muscle fiber density within the MU and time variability at the neuromuscular junction. The interference pattern can also be assessed. The number of MUs innervating a muscle can be estimated. Advanced signal processing, called near-fiber EMG, allows for extraction of underlying muscle fiber contributions to MU waveforms. It is also possible to use QEMG to make statistical probabilities of the state of a muscle as to whether normal, myopathic, or neuropathic. Time to acquire QEMG data is minimal. QEMG is most useful in situations where pathology is uncertain.
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Affiliation(s)
- Mark B Bromberg
- Department of Neurology, University of Utah, Salt Lake City, UT, United States.
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Younger DS. Childhood muscular dystrophies. HANDBOOK OF CLINICAL NEUROLOGY 2023; 195:461-496. [PMID: 37562882 DOI: 10.1016/b978-0-323-98818-6.00024-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Infancy- and childhood-onset muscular dystrophies are associated with a characteristic distribution and progression of motor dysfunction. The underlying causes of progressive childhood muscular dystrophies are heterogeneous involving diverse genetic pathways and genes that encode proteins of the plasma membrane, extracellular matrix, sarcomere, and nuclear membrane components. The prototypical clinicopathological features in an affected child may be adequate to fully distinguish it from other likely diagnoses based on four common features: (1) weakness and wasting of pelvic-femoral and scapular muscles with involvement of heart muscle; (2) elevation of serum muscle enzymes in particular serum creatine kinase; (3) necrosis and regeneration of myofibers; and (4) molecular neurogenetic assessment particularly utilizing next-generation sequencing of the genome of the likeliest candidates genes in an index case or family proband. A number of different animal models of therapeutic strategies have been developed for gene transfer therapy, but so far these techniques have not yet entered clinical practice. Treatment remains for the most part symptomatic with the goal of ameliorating locomotor and cardiorespiratory manifestations of the disease.
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Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
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Wang D, Liu L, Xue R, Li Z, Gao Y, Wang T, Kang Y, Wang J, Yin Q, Li N, Han Y. On the establishment of reference values of clouds of electromyography interference pattern by linear regression method and percentile method and comparison of sensitivity and specificity of both methods. Front Neurol 2022; 13:917308. [PMID: 36119703 PMCID: PMC9475198 DOI: 10.3389/fneur.2022.917308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Turn-amplitude clouds were widely used in automatic electromyography (EMG) interference pattern analysis. Earlier works employed the intercept ± 2SD (standard deviation) of the linear regression equation as the upper and lower boundaries of the clouds. The goal of this study was to employ the linear regression method and percentile method to calculate the reference value of turn-amplitude clouds, identify the determining criteria in accordance with the receiver operator characteristic curve (ROC), and analyze the sensitivity and specificity of the linear regression cloud, percentile cloud, and quantitative assessment of the motor unit potential (QMUP). Methods First, we explore what factors affect the number of turns per second and the mean amplitude. Then, their logarithms were taken for the normal test. All muscle data were used to calculate the reference values of percentile clouds. However, the reference values of the linear regression clouds were obtained for the muscles with a bivariate normal distribution, homogeneous variances and a linear correlation. We calculated the prediction interval with the standard errors of the intercept and slope of the linear regression equation, which can determine the upper and lower boundaries of the linear regression clouds. Furthermore, we obtained ROCs of these clouds, which were used as the determining criteria to determine the optimum cut-off values. Finally, our study analyzed the sensitivity and specificity of the linear regression cloud, percentile cloud, and QMUP. Results We here presented the reference values and ROCs of the linear regression clouds and percentile clouds. We suggest the determining criteria be based on ROCs. The areas under the curve (AUC) of both clouds are larger than 0.8, revealing that they have significant diagnostic value. Our results display that the specificities of the linear regression clouds, percentile clouds, and QMUP are almost identical to each other, whereas the sensitivity of percentile cloud is higher than those of QMUP and linear regression clouds. Conclusion According to ROCs, the researchers determine the determining criteria of the linear regression clouds and percentile clouds. Our findings suggest that the percentile clouds possess a wide application range and significant diagnostic value, therefore it may be the optimum for automatic EMG interference pattern analysis.
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Affiliation(s)
- Dan Wang
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lei Liu
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ruohong Xue
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhongming Li
- Department of Human Anatomy and Histoembryology, School of Basic Medical Sciences, Kunming Medical University, Kunming, China
| | - Yuqi Gao
- School of Basic Medical Sciences, Kunming Medical University, Kunming, China
| | - Ting Wang
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanfang Kang
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jingjing Wang
- Department of Clinical Pharmacy, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qiuye Yin
- The First Clinical College of Kunming Medical University, Kunming, China
| | - Najuan Li
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanbing Han
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
- *Correspondence: Yanbing Han
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Masked least-squares averaging in processing of scanning-EMG recordings with multiple discharges. Med Biol Eng Comput 2020; 58:3063-3073. [PMID: 33128161 DOI: 10.1007/s11517-020-02274-x] [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: 04/02/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
Removing artifacts from nearby motor units is one of the main objectives when processing scanning-EMG recordings. Methods such as median filtering or masked least-squares smoothing (MLSS) can be used to eliminate artifacts in recordings with just one discharge of the motor unit potential (MUP) at each location. However, more effective artifact removal can be achieved if several discharges per position are recorded. In this case, processing usually involves averaging the discharges available at each position and then applying a median filter in the spatial dimension. The main drawback of this approach is that the median filter tends to distort the signal waveform. In this paper, we present a new algorithm that operates on multiple discharges simultaneously and in the spatial dimension. We refer to this algorithm as the multi-masked least-squares smoothing (MMLSS) algorithm: an extension of the MLSS algorithm for the case of multiple discharges. The algorithm is tested using simulated scanning-EMG signals in different recording conditions, i.e., at different levels of muscle contraction and for different numbers of discharges per position. The results demonstrate that the algorithm eliminates artifacts more effectively than any previously available method and does so without distorting the waveform of the signal. Graphical abstract The raw scanning-EMG signal, which can be composed by several discharges of the MU, is processed by the MMLSS algorithm so as to eliminate the artifact interference. Firstly, artifacts are detected for each discharge from the raw signal, obtaining a multi-discharge validity mask that indicates the samples that have been corrupted by artifacts. Secondly, a least-squares smoothing procedure simultaneously operating in the spatial dimension and among the discharges is applied to the raw signal. This second step is performed using only the not contaminated samples according to the validity mask. The resulting MMLSS-processed scanning-EMG signal is clean of artifact interference.
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Li C, Jiang A, Ding Q, Hu Y, Wang Y, Tian G, Wang H, Pan S, Cui L, Peng Y. Sensitivity and specificity of single and combined clouds analyses compared with quantitative motor unit potential analysis. Muscle Nerve 2020; 63:225-230. [PMID: 33099787 DOI: 10.1002/mus.27106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Turns-amplitude, number of small segments (NSS)-activity, and envelope-activity clouds are three methods of electromyography (EMG) interference pattern analysis. Our objective was to evaluate the sensitivity and specificity of each individual cloud analysis and combined clouds analysis to compare with that of quantitative motor unit potential (QMUP) analysis. METHODS A total of 379 muscles from 100 patients were analyzed by both QMUP and clouds analyses. Calculation of sensitivity and specificity was based on the clinical diagnosis as the "gold standard." RESULTS For discrimination of abnormal vs normal and neuropathic vs non-neuropathic, combined clouds analysis had greater sensitivity than QMUP analysis and any single cloud analysis, but there were no differences in specificity. For discrimination of myopathic vs non-myopathic, combined clouds analysis and single cloud analysis had greater sensitivity than QMUP analysis, but there were no differences in specificity. DISCUSSION Combined clouds analysis was superior to QMUP and each single cloud analysis for distinguishing normal, myopathic, and neuropathic muscles.
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Affiliation(s)
- Chuqiao Li
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Anqi Jiang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qingyun Ding
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Youfang Hu
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Yao Wang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ge Tian
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Honghao Wang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Suyue Pan
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Yu Peng
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Sonoo M, Ogawa G, Hokkoku K, Stålberg E. Updated size index valid for both neurogenic and myogenic changes. Muscle Nerve 2020; 62:735-741. [PMID: 32940356 DOI: 10.1002/mus.27072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Size index (SI) is a motor unit potential (MUP) parameter in concentric needle electromyography calculated from amplitude and area/amplitude, which can sensitively discriminate between control and neurogenic MUPs. In this study, we investigated the application of SI to myogenic MUPs based on expanded data. METHODS MUPs were collected from the biceps brachii (BB) and tibialis anterior (TA) muscles. Muscles showing unequivocal neurogenic or myogenic changes by visual inspection were selected for patients. In addition to the original SI, a revised SI (rSI) was defined using the logarithmic scale for area/amplitude. The coefficient for area/amplitude was varied and that achieving the best sensitivity both for BB and TA was selected. RESULTS Analyzed were 1619, 340, and 498 MUPs from the BB of 26, 10, and 14 subjects (control, neurogenic, and myogenic), respectively, and 1245, 536, and 473 MUPs from the TA of 23, 18, and 13 subjects (control, neurogenic, and myogenic), respectively. For neurogenic MUPs, the original SI and the newly defined rSIn were similarly sensitive (82.1% and 81.8% sensitivity for SI and rSIn, respectively, for BB, and 68.1% and 69.6% for TA), and were more sensitive than area (72.6% for BB and 57.6% for TA), the most sensitive parameter among conventional ones. For myogenic MUPs, the sensitivity of rSIm was 9.0% for BB and 24.5% for TA, which was not significantly different from duration (7.4% for BB and 21.8% for TA), the most sensitive parameter among conventional ones. CONCLUSIONS SI, rSIn, and rSIm are promising as new MUP parameters.
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Affiliation(s)
- Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan
| | - Go Ogawa
- Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan
| | - Keiichi Hokkoku
- Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan
| | - Erik Stålberg
- Department of Clinical Neurophysiology, Institute of Neuroscience, Uppsala University, Uppsala, Sweden
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10
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Nandedkar SD, Barkhaus PE, Stålberg EV. Form factor analysis of the surface electromyographic interference pattern. Muscle Nerve 2020; 62:233-238. [DOI: 10.1002/mus.26922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Sanjeev D. Nandedkar
- Natus Neuro Hopewell Junction New York
- Department of NeurologyMedical College of Wisconsin Milwaukee Wisconsin
| | - Paul E. Barkhaus
- Department of NeurologyMedical College of Wisconsin Milwaukee Wisconsin
| | - Erik V. Stålberg
- Academic Hospital, Institute of Neurosciences, Uppsala University Uppsala Sweden
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Li C, Jiang A, Wu M, Wang Y, Tian G, Wang H, Pan S, Peng Y. Developing normal number of small segments-activity clouds of the electromyography interference pattern. Muscle Nerve 2020; 61:485-490. [PMID: 31930519 DOI: 10.1002/mus.26806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 12/26/2019] [Accepted: 01/01/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Number of small segments (NSS) and activity analysis is a mature method for electromyographic automatic interference pattern analysis (IPA), but there are few reports on the application of this technique. Our objective was to establish normal reference values of NSS-activity clouds. METHODS The NSS and activity data of the sternocleidomastoid, deltoid, biceps brachii (long head), extensor digitorum communis, abductor digiti minimi, vastus medialis, tibialis anterior, and gastrocnemius (lateral head) muscles were obtained from 34 men and 25 women, aged 15-80 years, using concentric needle electrodes. A linear regression of log(NSS) vs log(activity) was performed and the slope, intercept and standard deviation were calculated for each muscle. These variables were transformed back to the original parameters to yield clouds. RESULTS Normal NSS-activity clouds for the above eight muscles were obtained. CONCLUSIONS Normal reference values of NSS-activity may facilitate detection of early and mild neurogenic and myogenic abnormalities.
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Affiliation(s)
- Chuqiao Li
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Anqi Jiang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Minyi Wu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yao Wang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ge Tian
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Honghao Wang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Suyue Pan
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yu Peng
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Stålberg E, van Dijk H, Falck B, Kimura J, Neuwirth C, Pitt M, Podnar S, Rubin DI, Rutkove S, Sanders DB, Sonoo M, Tankisi H, Zwarts M. Standards for quantification of EMG and neurography. Clin Neurophysiol 2019; 130:1688-1729. [DOI: 10.1016/j.clinph.2019.05.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 12/11/2022]
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The problem of lack of normative data in paediatric EMG and possible solutions. Clin Neurophysiol 2018; 129:672-675. [DOI: 10.1016/j.clinph.2017.11.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 10/19/2017] [Accepted: 11/16/2017] [Indexed: 12/14/2022]
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Abstract
PURPOSE Turns and amplitude analysis (T&A) is a frequently used method for automatic EMG interference pattern analysis. The T&A normal values have only been developed for a limited number of muscles. Our objective was to obtain normal T&A clouds for upper and lower extremity muscles for which no normal values exist in the literature. METHODS The T&A normative data using concentric needle electrodes were obtained from 68 men and 56 women aged 20 to 60 years. RESULTS Normal upper and lower extremity T&A clouds were obtained and presented in this article. CONCLUSION The T&A normal values collected in this study maybe used to detect neurogenic and myopathic abnormalities in men and women at low-to-moderate muscle contractions. The effect of turns-amplitude data obtained at high force level of muscle contraction and its potential to falsely show neurogenic abnormalities are discussed.
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Stålberg E. Between genetics and biology. Is ENMG useful in peripheral neuropathy diagnosis and management? Rev Neurol (Paris) 2016; 172:627-631. [PMID: 27638136 DOI: 10.1016/j.neurol.2016.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/29/2016] [Indexed: 12/14/2022]
Abstract
Neurography and EMG are complementary techniques used in the diagnosis and monitoring of neuropathies. Both assess function of the peripheral nervous system and provide clinically useful information regarding the functional status of peripheral nerves. This information is not readily obtainable using biochemical, genetic or imaging techniques. I will discuss the role of these techniques in the diagnosis and management of neuropathies and some limitations of these techniques. These methods are routinely used in an EMG lab. These are most useful when used in conjunction with clinical examination to answer a well-defined clinical question. Reference values are required for interpretation of the data.
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Affiliation(s)
- E Stålberg
- Department of clinical neurophysiology, Uppsala University, Institute of Neurosciences, University Hospital, 75385 Uppsala, Sverige, Sweden.
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Dommerholt J, Hooks T, Finnegan M, Grieve R. A critical overview of the current myofascial pain literature - March 2016. J Bodyw Mov Ther 2016; 20:397-408. [PMID: 27210859 DOI: 10.1016/j.jbmt.2016.02.015] [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] [Indexed: 10/22/2022]
Abstract
The worldwide interest in myofascial pain syndrome (MPS) and trigger points (TrPs) is reflected in the increasing number of publications. In this overview of the literature, we included 26 studies, case reports and review articles by authors from 18 different countries. Several research groups are exploring the characteristic of TrPs such as Chen and colleagues, who continued their work on the quantification of the taut bands. Meng and colleagues studied the relationships between TrPs and central sensitization, while Yu and colleagues examined the electrophysiological characteristics that occur as a result of active TrPs. Several researchers used objective measurements to determine clinical outcomes, such as Koppenhaver and colleagues who measured objective changes in the function and nociceptive sensitivity of lumbar multifidus muscle subjects with low back pain. Turo and colleagues quantified muscle tissue changes after dry needling in chronic myofascial pain using elastography. Multiple studies explored various treatment options for TrPs, such as dry needling, injections with lidocaine or granisetron, traditional Thai massage, self-myofascial release, kinesiotaping, and monochromatic infrared photo energy, among others.
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Affiliation(s)
- Jan Dommerholt
- Bethesda Physiocare, Bethesda, MD, USA; Myopain Seminars, Bethesda, MD, USA.
| | - Todd Hooks
- New Orleans Pelicans, New Orleans, LA, USA.
| | - Michelle Finnegan
- Bethesda Physiocare, Bethesda, MD, USA; Myopain Seminars, Bethesda, MD, USA.
| | - Rob Grieve
- Department of Allied Health Professions, Faculty of Health and Applied Sciences, University of the West of England, Blackberry Hill, Bristol, United Kingdom.
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Nikolic A, Basta I, Stojanovic VR, Stevic Z, Peric S, Lavrnic D. Myopathic changes detected by quantitative electromyography in patients with MuSK and AChR positive myasthenia gravis. J Clin Neurosci 2016; 27:126-9. [PMID: 26778359 DOI: 10.1016/j.jocn.2015.08.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/10/2015] [Accepted: 08/30/2015] [Indexed: 11/17/2022]
Abstract
Myopathic changes are frequent a electrophysiological finding in patients with muscle specific tyrosine kinase (MuSK) positive myasthenia gravis (MG). The aim of this study was to explore the importance of quantitative electromyography (EMG) in the detection of myopathic changes in MuSK MG patients. Classical and quantitative EMG were performed in 31 MuSK and 28 acetylcholine receptor (AChR) positive MG patients, matched by sex, age, disease duration and severity. Classical EMG revealed the presence of myopathic changes more frequently in MuSK MG compared to AChR MG patients, especially in the facial muscles. Quantitative EMG registered myopathic lesions more frequently than classical EMG, but the frequency was similar between MuSK and AChR MG patients. Quantitative EMG revealed myopathic changes in the majority of both MuSK and AChR positive MG patients. This examination is sensitive, but it cannot be used to differentiate between MG patients belonging to the different disease groups. It should not be used in isolation. Rather, it should complement classical EMG in the detection of myopathic changes.
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Affiliation(s)
- Ana Nikolic
- Neurology Clinic, Department for Neuromuscular Disorders, Clinical Center of Serbia, Dr Subotica 6, 11000 Belgrade, Serbia; Medical Faculty, Belgrade University, Belgrade, Serbia.
| | - Ivana Basta
- Neurology Clinic, Department for Neuromuscular Disorders, Clinical Center of Serbia, Dr Subotica 6, 11000 Belgrade, Serbia; Medical Faculty, Belgrade University, Belgrade, Serbia
| | - Vidosava Rakocevic Stojanovic
- Neurology Clinic, Department for Neuromuscular Disorders, Clinical Center of Serbia, Dr Subotica 6, 11000 Belgrade, Serbia; Medical Faculty, Belgrade University, Belgrade, Serbia
| | - Zorica Stevic
- Neurology Clinic, Department for Neuromuscular Disorders, Clinical Center of Serbia, Dr Subotica 6, 11000 Belgrade, Serbia; Medical Faculty, Belgrade University, Belgrade, Serbia
| | - Stojan Peric
- Neurology Clinic, Department for Neuromuscular Disorders, Clinical Center of Serbia, Dr Subotica 6, 11000 Belgrade, Serbia
| | - Dragana Lavrnic
- Neurology Clinic, Department for Neuromuscular Disorders, Clinical Center of Serbia, Dr Subotica 6, 11000 Belgrade, Serbia; Medical Faculty, Belgrade University, Belgrade, Serbia
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Pan LL, Yu CH, Tsai MW, Wei SH, Chou LW. Estimating the tendency of motor unit recruitment during steady-hold and rapid contractions using surface EMG and Turns-amplitude analysis. Eur J Appl Physiol 2015. [PMID: 26202486 DOI: 10.1007/s00421-015-3223-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to investigate changes in the interference pattern in surface electromyography (EMG), and its relationship with the tendency of motor unit (MU) recruitment during steady-hold and rapid muscle contractions. METHODS Fifteen healthy adults (eight females and seven males, 22.6 ± 1.5 years old) performed steady-hold and rapid isometric contractions of the bicep brachii, adductor pollicis, and tibialis anterior muscles at various force levels. Surface EMG recordings were analyzed using Turns-Amplitude Analysis (TAA). RESULTS During steady-hold contractions, the number of turns per second (T/s) increased exponentially with force during submaximal contractions, and plateaued after force levels of 66, 70 and 57 % MVC for the tibialis anterior, bicep brachii and adductor pollicis muscles, respectively. These force levels were proximate to the maximal recruitment threshold (MaxRT) reported previously. The slopes of the T/s-force relationships before the MaxRT were significantly greater than the slopes after the MaxRT for all three muscles tested. During rapid contraction, the slopes of the T/s-force relationships were significantly lower than the slopes of the steady-hold contraction at 20-40 % MVC in all three muscles, and for 40-60 % MVC in TA muscles. CONCLUSIONS Our results suggested that the changes in the number of turns in surface EMG with respect to muscle force can be used to estimate the force levels at which the majority of the MUs to be recruited, and completion of MU recruitment was observed at lower force levels during rapid muscle contraction.
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Affiliation(s)
- Li-Ling Pan
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112, Taiwan
| | - Chung-Huang Yu
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112, Taiwan
| | - Mei-Wun Tsai
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112, Taiwan
| | - Shun-Hwa Wei
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112, Taiwan
| | - Li-Wei Chou
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112, Taiwan.
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20
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Jose-Cunilleras E, Wijnberg ID. Quantitative motor unit action potential analysis of supraspinatus, infraspinatus, deltoideus and biceps femoris muscles in adult Royal Dutch sport horses. Equine Vet J 2015; 48:234-9. [DOI: 10.1111/evj.12419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 12/29/2014] [Indexed: 11/30/2022]
Affiliation(s)
- E. Jose-Cunilleras
- Servei de Medicina Interna Equina; Department of Animal Medicine and Surgery; Veterinary Faculty; Universitat Autònoma de Barcelona; Bellaterra Spain
| | - I. D. Wijnberg
- Department of Equine Sciences; Faculty of Veterinary Medicine; Utrecht University; The Netherlands
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21
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Bianchi F, Cursi M, Ferrari M, Salonia A, Amadio S, Comi G, Danuser H, Del Carro U, Mattei A. Quantitative EMG of external urethral sphincter in neurologically healthy men with prostate pathology. Muscle Nerve 2014; 50:571-6. [DOI: 10.1002/mus.24189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/17/2014] [Accepted: 01/22/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Francesca Bianchi
- Clinical Neurophysiology Unit; Department of Neurology; San Raffaele Hospital, Via Olgettina; 60, 20132 Milano Italy
| | - Marco Cursi
- Clinical Neurophysiology Unit; Department of Neurology; San Raffaele Hospital, Via Olgettina; 60, 20132 Milano Italy
| | - Matteo Ferrari
- Department of Urology; Lucerne Cantonal Hospital; Lucerne Switzerland
| | - Andrea Salonia
- Department of Urology; University Vita-Salute, San Raffaele Hospital; Milan Italy
| | - Stefano Amadio
- Clinical Neurophysiology Unit; Department of Neurology; San Raffaele Hospital, Via Olgettina; 60, 20132 Milano Italy
| | - Giancarlo Comi
- Clinical Neurophysiology Unit; Department of Neurology; San Raffaele Hospital, Via Olgettina; 60, 20132 Milano Italy
| | - Hansjörg Danuser
- Department of Urology; Lucerne Cantonal Hospital; Lucerne Switzerland
| | - Ubaldo Del Carro
- Clinical Neurophysiology Unit; Department of Neurology; San Raffaele Hospital, Via Olgettina; 60, 20132 Milano Italy
| | - Agostino Mattei
- Department of Urology; Lucerne Cantonal Hospital; Lucerne Switzerland
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22
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Yousefi J, Hamilton-Wright A. Characterizing EMG data using machine-learning tools. Comput Biol Med 2014; 51:1-13. [DOI: 10.1016/j.compbiomed.2014.04.018] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 04/13/2014] [Accepted: 04/24/2014] [Indexed: 11/17/2022]
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23
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Discrimination of axonal neuropathy using sensitivity and specificity statistical measures. Neural Comput Appl 2014. [DOI: 10.1007/s00521-014-1622-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Matur Z, Baslo MB, Öge AE. Quantitative Electromyography of the Frontalis Muscle. J Clin Neurophysiol 2014; 31:48-54. [PMID: 24492446 DOI: 10.1097/01.wnp.0000436895.25373.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Movement is accomplished by the controlled activation of motor unit populations. Our understanding of motor unit physiology has been derived from experimental work on the properties of single motor units and from computational studies that have integrated the experimental observations into the function of motor unit populations. The article provides brief descriptions of motor unit anatomy and muscle unit properties, with more substantial reviews of motoneuron properties, motor unit recruitment and rate modulation when humans perform voluntary contractions, and the function of an entire motor unit pool. The article emphasizes the advances in knowledge on the cellular and molecular mechanisms underlying the neuromodulation of motoneuron activity and attempts to explain the discharge characteristics of human motor units in terms of these principles. A major finding from this work has been the critical role of descending pathways from the brainstem in modulating the properties and activity of spinal motoneurons. Progress has been substantial, but significant gaps in knowledge remain.
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Affiliation(s)
- C J Heckman
- Northwestern University, Evanston, Illinois, USA.
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26
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Blijham PJ, van Engelen BG, Drost G, Stegeman DF, Schelhaas HJ, Zwarts MJ. Diagnostic yield of muscle fibre conduction velocity in myopathies. J Neurol Sci 2011; 309:40-4. [DOI: 10.1016/j.jns.2011.07.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 07/17/2011] [Accepted: 07/20/2011] [Indexed: 12/12/2022]
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Higashihara M, Sonoo M, Yamamoto T, Nagashima Y, Uesugi H, Terao Y, Ugawa Y, Stålberg E, Tsuji S. Evaluation of spinal and bulbar muscular atrophy by the clustering index method. Muscle Nerve 2011; 44:539-46. [PMID: 21826683 DOI: 10.1002/mus.22119] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2011] [Indexed: 11/06/2022]
Abstract
INTRODUCTION A reliable electrophysiological marker for clinical trials is increasingly needed in spinal and bulbar muscular atrophy (SBMA). We previously developed a quantitative analysis method for surface electromyography (SEMG), the clustering index (CI) method. Our purpose was to test the utility of the CI method for evaluating lower motor neuron involvement in SBMA patients. METHODS Subjects included 29 SBMA patients and 27 healthy controls. The recording electrode was placed over the abductor digiti minimi (ADM) muscle with a proximal reference. The Z-score, based on the CI method, was compared with compound muscle action potential (CMAP) amplitude and motor unit number estimation (MUNE), with regard to sensitivity. RESULTS The Z-scores of the CI method, CMAP amplitude, and MUNE were abnormal in 100%, 72%, and 93% of the patients, respectively. Interrater reliability of the CI method was sufficiently high. CONCLUSION The CI method is promising as a non-invasive electrophysiological marker in SBMA.
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Affiliation(s)
- Mana Higashihara
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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28
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Mancuso M, Piazza S, Volpi L, Orsucci D, Calsolaro V, Caldarazzo Ienco E, Carlesi C, Rocchi A, Petrozzi L, Calabrese R, Siciliano G. Nerve and muscle involvement in mitochondrial disorders: an electrophysiological study. Neurol Sci 2011; 33:449-52. [PMID: 21751099 DOI: 10.1007/s10072-011-0703-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 07/01/2011] [Indexed: 11/27/2022]
Abstract
Involvement of the peripheral nervous system in mitochondrial disorders (MD) has been previously reported. However, the exact prevalence of peripheral neuropathy and/or myopathy in MD is still unclear. In order to evaluate the prevalence of neuropathy and myopathy in MD, we performed sensory and motor nerve conduction studies (NCS) and concentric needle electromyography (EMG) in 44 unselected MD patients. NCS were abnormal in 36.4% of cases, and were consistent with a sensori-motor axonal multineuropathy (multifocal neuropathy), mainly affecting the lower limbs. EMG evidence of myopathy was present in 54.5% of patients, again mainly affecting the lower limbs. Nerve and muscle involvement was frequently subclinical. Peripheral nerve and muscle involvement is common in MD patients. Our study supports the variability of the clinical expression of MD. Further studies are needed to better understand the molecular basis underlying the phenotypic variability among MD patients.
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Affiliation(s)
- Michelangelo Mancuso
- Department of Neuroscience, Neurological Clinic, University of Pisa, Via Roma 67, 56126 Pisa, Italy.
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"Clustering Index method": a new technique for differentiation between neurogenic and myopathic changes using surface EMG. Clin Neurophysiol 2011; 122:1032-41. [PMID: 20869308 DOI: 10.1016/j.clinph.2010.08.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 07/29/2010] [Accepted: 08/31/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To establish a non-invasive and quantitative analysis method using single-channel surface EMG (SEMG) for diagnosing neurogenic and myopathic changes. METHODS The subjects consisted of 66 healthy controls, 12 patients with neurogenic diseases, and 18 patients with myopathic diseases. The tibialis anterior muscle was examined using a belly to the adjacent bone lead. From each subject, 20-40 signals of 1 s length were collected of various strengths. A new parameter, the "Clustering Index (CI)", was developed to quantify the uneven distribution of the SEMG signal, and was plotted against the SEMG area. The results were expressed as the Z-score of each subject calculated using linear regression from the normative data. RESULTS When ±2.5 was used as the cut-off value of the Z-score, the specificity was 95%, whereas the sensitivity was 92% (11/12) and 61% (11/18) for the neurogenic and myopathic patients, respectively. There was no overlap of the Z-score values between the neurogenic and myopathic groups. CONCLUSIONS The CI method achieved a reasonably high diagnostic yield in detecting neurogenic or myopathic changes. SIGNIFICANCE This is a new simple and quantitative analysis method using SEMG with good reproducibility, and is promising as a non-invasive complement to needle EMG.
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30
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Chang J, Park YG, Choi YC, Choi JH, Moon JH. Correlation of Electromyogram and Muscle Biopsy in Myopathy of Young Age. Arch Phys Med Rehabil 2011; 92:780-4. [DOI: 10.1016/j.apmr.2010.12.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 12/07/2010] [Accepted: 12/08/2010] [Indexed: 11/26/2022]
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31
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Wijnberg I, Graubner C, Auriemma E, van de Belt A, Gerber V. Quantitative Motor Unit Action Potential Analysis in 2 Paraspinal Neck Muscles in Adult Royal Dutch Sport Horses. J Vet Intern Med 2011; 25:592-7. [DOI: 10.1111/j.1939-1676.2011.0724.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Karandreas N, Kararizou E, Papagianni A, Zambelis T, Kokotis P. Turns-amplitude analysis in normal and myopathic facial muscles. Muscle Nerve 2011; 43:342-7. [PMID: 21321950 DOI: 10.1002/mus.21876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2010] [Indexed: 11/09/2022]
Abstract
The purpose of this study was to assess turns/amplitude analysis (TAA) as an objective alternative to conventional qualitative electromyography (EMG) for detection of myopathy in facial muscles. Normal values of TAA parameters were calculated in the frontalis and mentalis muscles of 26 control subjects. We estimated the slope of the regression line of mean amplitude/turn values (MA) plotted against the number of turns/second (NT) and the resulting clouds. The 95% confidence limits of the cloud data were drawn as an ellipse. The sensitivity of TAA was determined from a group of 35 myopathic patients and specificity from a second group of 25 control subjects. Significant differences for every TAA parameter were found between frontalis and mentalis. Cumulative sensitivity and specificity of TAA for frontalis and mentalis were 74.6%, 56.5%, and 73.3%, 70.8%, respectively. With at least two of the aforementioned criteria abnormal, the sensitivity and specificity for frontalis and mentalis were 61.3%, 82.6%, and 56.7%, 100.0%, respectively.
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Affiliation(s)
- Nikos Karandreas
- Laboratory of Electromyography and Clinical Neurophysiology, Department of Neurology, Aeginition Hospital, University of Athens, 72-74 Vas. Sofias Avenue, Athens 11528, Greece.
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Statham MM, Rosen CA, Nandedkar SD, Munin MC. Quantitative laryngeal electromyography: Turns and amplitude analysis. Laryngoscope 2010; 120:2036-41. [DOI: 10.1002/lary.21046] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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34
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Whither needle EMG? Clin Neurophysiol 2010; 121:1373-1375. [DOI: 10.1016/j.clinph.2010.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 06/28/2010] [Indexed: 11/23/2022]
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Cloud interference pattern analysis (IPA) in thoracic paraspinal muscles in motor neuron disease. ACTA ACUST UNITED AC 2009. [PMID: 20715390 DOI: 10.1016/s1567-424x(08)00028-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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36
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Nandedkar SD, Stålberg EV. Quantitative measurements and analysis in electrodiagnostic studies: present and future. FUTURE NEUROLOGY 2008. [DOI: 10.2217/14796708.3.6.745] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Electrodiagnostic studies (nerve conduction and needle electromyography) are powerful methods to study diseases of nerves and muscles. Conduction studies are performed to assess the continuity, anatomic course, excitability, number of axons and their synaptic connections, while needle electromyography examination is performed to assess the ‘electrical stability’ of the muscle fiber membrane, and the study of motor units (architecture, activation and number). We have reviewed the relationship between the quantitative measurements and the generators of the recorded potentials. Based on these relationships, the expected patterns of abnormalities for different pathologies are tabulated. This gives us a better appreciation of the sensitivity, specificity and usefulness of different tests when planning and conducting an electrodiagnostic examination. The limitations of current methods are indicated to suggest the need for future development.
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Affiliation(s)
| | - Erik V Stålberg
- Department of Clinical Neurophysiology, University Hospital, S-75185 Uppsala, Sweden
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37
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Arabadzhiev TI, Dimitrov GV, Chakarov VE, Dimitrov AG, Dimitrova NA. Changes in intracellular action potential profile affect parameters used in turns/amplitude analysis. Muscle Nerve 2008; 37:713-20. [PMID: 18506716 DOI: 10.1002/mus.21022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The influence of changes in the intracellular action potential (IAP) spatial profile on motor unit potentials (MUPs), number of turns per second (NTs), and mean turn amplitude were simulated and analyzed. We show why measurement of NTs was "the best indicator of neurogenic affection" and why the lower diagnostic yield of turns/amplitude analysis in myopathy could be due to changes in IAP shape caused by elevated free calcium concentration. The results explain the complications observed when interference electromyographic signals obtained during high levels of isometric contractions were analyzed. We show that, in contrast to earlier assumptions, the effect of increased IAP spike duration on NTs was stronger than that of a decrease in muscle fiber propagation velocity (MFPV). The decrease in the NTs could occur without a drop-out of MUs and/or a decrease in their firing rates, and without a change in MFPV and synchronous firing.
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Affiliation(s)
- Todor I Arabadzhiev
- Centre of Biomedical Engineering, Bulgarian Academy of Sciences, Acad. G. Bonchev Str., Bl. 105, Sofia 1113, Bulgaria.
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Arabadzhiev T, Dimitrov G, Dimitrov A, Chakarov V, Dimitrova N. Factors affecting the turns analysis of the interference EMG signal. Biomed Signal Process Control 2008. [DOI: 10.1016/j.bspc.2007.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gregory WT, Clark AL, Simmons K, Lou JS. Determining the shape of the turns-amplitude cloud during anal sphincter quantitative EMG. Int Urogynecol J 2008; 19:971-6. [PMID: 18250946 DOI: 10.1007/s00192-008-0562-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Accepted: 01/07/2008] [Indexed: 10/22/2022]
Abstract
We aimed to compare our normative data for quantitative interference pattern (IP) analysis of the anal sphincter to previously published data. In 28 nulliparous women, we performed IP analysis during quantitative concentric needle electromyography (QEMG) of the anal sphincter. At each sampling site, a 500-ms epoch was analyzed. The data were log transformed. Linear regression lines (with 95% confidence intervals) were calculated from the log transformed variables "turns-second" and "amplitude-turn." These confidence intervals were then transformed back into the original parameters to yield scatterplots with confidence curves. The mean turns-second were 203 (SD 174). The mean amplitude (mcv)-turn was 266 (SD 87). The regression coefficients for the log-transformed variables are constant = 1.5, slope = 0.3, and resultant cloud of raw data has a convex upper boundary. These appear slightly different than previously published reports, potentially influencing the determination of normal and abnormal studies.
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Affiliation(s)
- W Thomas Gregory
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR 97239, USA.
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40
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The electromyographer's guide to the motor unit. Phys Med Rehabil Clin N Am 2007; 18:711-32, vi. [PMID: 17967361 DOI: 10.1016/j.pmr.2007.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This article's purpose is to explain the anatomicophysiologic basis for observations and measurements made by the electromyographer. An electromyographer may be trained in the techniques of electromyography without understanding the anatomicophysiology, and valuable interpretive subtleties may be missed. This article is an attempt to provide that background (ie, the link among anatomy, physiology, and electrodiagnostic findings). It is hoped that with a fuller understanding of the anatomicophysiologic basis of clinical electromyography, subtle observations can be made which will allow a more sophisticated level of interpretation of electromyography results. Such interpretations should improve the electromyographer's capacity to provide useful information to a referring physician and hence, improve the management of a patient.
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Tervonen H, Niemelä M, Lauri ER, Back L, Juvas A, Räsänen P, Roine RP, Sintonen H, Salmi T, Vilkman SE, Aaltonen LM. Dysphonia and dysphagia after anterior cervical decompression. J Neurosurg Spine 2007; 7:124-30. [PMID: 17688050 DOI: 10.3171/spi-07/08/124] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT In this paper, the authors investigate the effects of anterior cervical decompression (ACD) on swallowing and vocal function. METHODS The study comprised 114 patients who underwent ACD. The early group (50 patients) was examined immediately pre- and postoperatively, and the late group (64 patients) was examined at only 3 to 9 months postoperatively. Fifty age- and sex-matched patients from the Department of Otorhinolaryngology-Head and Neck Surgery who had not been intubated in the previous 5 years were used as a control group. All patients in the early and control groups were examined by a laryngologist; patients in the late group were examined by a laryngologist and a neurosurgeon. Videolaryngostroboscopy was performed in all members of the patient and control groups, and the function of the ninth through 12th cranial nerves were clinically evaluated. Data were collected concerning swallowing, voice quality, surgery results, and health-related quality of life. Patients with persistent dysphonia were referred for phoniatric evaluation and laryngeal electromyography (EMG). Those with persistent dysphagia underwent transoral endoscopic evaluation of swallowing function and videofluorography. RESULTS Sixty percent of patients in the early group reported dysphonia and 69% reported dysphagia at the immediate postoperative visit. Unilateral vocal fold paresis occurred in 12%. The prevalence of both dysphonia and dysphagia decreased in both groups 3 to 9 months postoperatively. All six patients with vocal fold paresis in the early group recovered, and in the late group there were two cases of vocal fold paresis. The results of laryngeal EMG were abnormal in 14 of 16 patients with persistent dysphonia. Neither intraoperative factors nor age or sex had any effect on the occurrence of dysphonia, dysphagia, or vocal fold paresis. Most patients were satisfied with the surgical outcome. CONCLUSIONS Dysphonia, dysphagia, and vocal fold paresis are common but usually transient complications of ACD. Recurrent laryngeal nerve damage detected by EMG is not rare. Pre-and postoperative laryngeal examination of ACD patients should be considered.
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Affiliation(s)
- Hanna Tervonen
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital, Finland.
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42
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Quantitative EMG studies to assess facial muscle atrophy in MuSK antibody positive myasthenia gravis. Clin Neurophysiol 2007. [DOI: 10.1016/j.clinph.2007.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Farrugia ME, Kennett RP, Hilton-Jones D, Newsom-Davis J, Vincent A. Quantitative EMG of facial muscles in myasthenia patients with MuSK antibodies. Clin Neurophysiol 2007; 118:269-77. [PMID: 17157556 DOI: 10.1016/j.clinph.2006.10.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2005] [Revised: 09/28/2006] [Accepted: 10/03/2006] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Our aim was to study the pathophysiological process leading to facial muscle atrophy in 13 patients with MuSK antibody positive myasthenia gravis (MuSK-MG), and to compare with findings from 12 acetylcholine receptor antibody positive myasthenia patients (AChR-MG), selected because they suffered from the same degree of disease severity and required similar treatment. METHODS Motor unit action potential (MUAP) and interference pattern analysis from orbicularis oculi (O oculi) and orbicularis oris (O oris) muscles were studied using a concentric needle electrode, and compared with findings in 20 normal subjects, 6 patients receiving botulinum toxin injections (representing a neurogenic model) and 6 patients with a muscle dystrophy (representing a myopathic model). The techniques and control data have been reported previously. RESULTS The mean MUAP durations for O oculi and O oris were significantly reduced (p<0.001) in both MG cohorts when compared with healthy subjects, and were similar to those in the myopathic control group. They were significantly different from those obtained from the neurogenic control group (p<0.001 for both O oculi and O oris). The MUAP findings in O oculi occurred independently from neuromuscular blocking on single fibre EMG (SFEMG) in the same muscle. On turns amplitude analysis (TAA), 50% of MuSK-MG patients and 42% of AChR-MG patients had a pattern in O oculi which was similar to that in the myopathic control group, and 62% of MuSK-MG patients and 50% of AChR-MG patients had a pattern in O oris that was also similar to that in the myopathic control group. The TAA findings for O oculi and O oris in both MG cohorts were different from those obtained from the neurogenic control group. CONCLUSIONS Facial muscle atrophy in MuSK-MG patients is not neurogenic and the pathophysiological changes are akin to a myopathic process. The selected AChR-MG patients also show evidence of a similar pathophysiological process in the facial muscles albeit to a lesser degree. SIGNIFICANCE We propose that muscle atrophy in MuSK-MG is a myopathic process consisting of either muscle fibre shrinkage or loss of muscle fibres from motor units. The duration of disease and long-term steroid treatment may be further contributory factors.
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Affiliation(s)
- Maria E Farrugia
- Department of Clinical Neurophysiology, The Radcliffe Infirmary, Oxford OX2 6HE, UK.
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Fuglsang-Frederiksen A. The role of different EMG methods in evaluating myopathy. Clin Neurophysiol 2006; 117:1173-89. [PMID: 16516549 DOI: 10.1016/j.clinph.2005.12.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2005] [Revised: 11/22/2005] [Accepted: 12/17/2005] [Indexed: 10/25/2022]
Abstract
For the diagnosis of myopathy, EMG may have an important role along with blood tests, muscle biopsies and genetic testing. This review evaluates different EMG methods in the diagnosis of myopathy. These include manual analysis of individual motor unit potentials and multi-motor unit potential analysis sampled at weak effort. At high effort, turns-amplitude analyses such as the cloud analysis and the peak ratio analysis have a high diagnostic yield. The EMG can seldom be used to differentiate between different types of myopathy. In the channelopathies, myotonia, exercise test and cooling of the muscle are helpful. Macro-EMG, single-fibre EMG and muscle fibre conduction velocity analysis have a limited role in myopathy, but provide information about the changes seen. Analysis of the firing rate of motor units, power spectrum analysis, as well as multichannel surface EMG may have diagnostic potential in the future. EMG is of great importance in the diagnosing of patients with myopathy, preferably a needle electrode and quantitative analyses should be used. A combination of a method at weak effort as well as a method at stronger effort seems optimal.
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Affiliation(s)
- Anders Fuglsang-Frederiksen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark.
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Abel EW, Meng H, Forster A, Holder D. Singularity Characteristics of Needle EMG IP Signals. IEEE Trans Biomed Eng 2006; 53:219-25. [PMID: 16485750 DOI: 10.1109/tbme.2005.862548] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Clinical electromyography (EMG) interference pattern (IP) signals can reveal more diagnostic information than their constituents, the motor unit action potentials (MUAPs). Singularities and irregular structures typically characterize the mathematically defined content of information in signals. In this paper, a wavelet transform method is used to detect and quantify the singularity characteristics of EMG IP signals using the Lipschitz exponent (LE) and measures derived from it. The performance of the method is assessed in terms of its ability to discriminate healthy, myopathic and neuropathic subjects and how it compares with traditionally used Turns Analysis (TA) methods and a method recently developed by the authors, interscale wavelet maximum (ISWM). Highly significant intergroup differences were found using the LE method. Most of the singularity measures have a performance similar to that of ISWM and considerably better than that of TA. Some measures such as the ratio of the mean LE value to the number of singular points in the signal have considerably superior performance to both methods. These findings add weight to the view that wavelet analysis methods offer an effective way forward in the quantitative analysis of EMG IP signal to assist the clinician in the diagnosis of neuromuscular disorders.
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Affiliation(s)
- Eric W Abel
- Biomedical Engineering Research Group, University of Dundee, UK.
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Eeg-Olofsson KE. Techniques in pediatric neurophysiology. ACTA ACUST UNITED AC 2005; 57:137-44. [PMID: 16106614 DOI: 10.1016/s1567-424x(09)70351-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Karin Edebol Eeg-Olofsson
- Section of Clinical Neurophysiology, Department of Neuroscience, University Hospital, S-751 85 Uppsala, Sweden.
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Sobrido MJ, Fernández JM, Fontoira E, Pérez-Sousa C, Cabello A, Castro M, Teijeira S, Alvarez S, Mederer S, Rivas E, Seijo-Martínez M, Navarro C. Autosomal dominant congenital fibre type disproportion: a clinicopathological and imaging study of a large family. Brain 2005; 128:1716-27. [PMID: 15857933 DOI: 10.1093/brain/awh511] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Congenital fibre type disproportion (CFTD) is considered a non-progressive or slowly progressive muscle disease with relative smallness of type 1 fibres on pathological examination. Although generally benign, CFTD has a variable natural course and severe progression has been observed in some patients. The pathogenesis of the disorder is unknown and many authors consider CFTD a syndrome with multiple aetiologies rather than a separate clinical entity. A positive family history has been reported in about 40% of cases, but the inheritance pattern is not clear. Both autosomal recessive and dominant modes of inheritance have been suggested. The present paper describes a large, multigenerational kindred that has an inherited myopathy fulfilling the histological criteria of CFTD, with autosomal dominant transmission and high penetrance. The clinical picture, remarkably similar in all affected family members, started in early infancy with mild limb muscle weakness. There was slow progression of symptoms into adulthood, with moderate to severe, mainly proximal, muscle weakness without loss of ambulation. Muscle biopsy from two affected individuals demonstrated predominance of small type 1 muscle fibres without other significant findings. Nerve conduction studies were normal and needle electromyography showed a myopathic pattern. MRI examination performed on three patients from successive generations showed involvement of proximal limb and paraspinal muscles. The clinical and pathological homogeneity in the present family, together with the lack of additional histological abnormalities after decades of disease progression in two affected individuals, supports this being a distinct myopathy with fibre type disproportion. Whether the disease in this family can be regarded as a form of the congenital myopathy known as CFTD or rather a unique condition sharing histological features with CFTD needs further investigation. This is, to our knowledge, the largest kindred with muscle fibre type disproportion reported to date. Our data confirm autosomal dominant inheritance, and this is the first MRI document of this disorder.
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Affiliation(s)
- M J Sobrido
- Department of Pathology and Neuropathology, Hospital do Meixoeiro, Vigo, Spain
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Cengiz B, Kuruoglu HR. Turns-amplitude analysis of the electromyographic recruitment pattern following upper motor neuron lesions. Acta Neurol Scand 2004; 110:403-7. [PMID: 15527454 DOI: 10.1111/j.1600-0404.2004.00322.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the pattern of motor unit recruitment of weak muscles in upper motor neuron (UMN) lesions. MATERIALS AND METHODS Ten patients underwent turns-amplitude analysis (TAA) on the paretic and healthy brachial biceps muscles, in the acute and subacute stages of hemiparesis. The control group comprised 10 age- and sex-matched subjects. RESULTS Although absent in the acute stage, five patients developed a myogenic cloud pattern in their paretic extremities in the subacute stage; which was statistically significant when compared with controls (P = 0.033). Mean amplitude was reduced in both acute and subacute stages of the hemiparesis compared with controls (P = 0.000). The turns/mean amplitude ratio in the subacute stage was increased compared with both the paretic limbs examined in the acute stage (P = 0.000) and to controls (P = 0.000). CONCLUSION Abnormalities in the recruitment of motor units in UMN lesions give rise to a myogenic cloud pattern in the TAA, which is prominent in the third month after the initial insult. This may result from the increase in motor unit activity, while the recruitment of bigger motor units is still defective.
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Affiliation(s)
- B Cengiz
- Department of Neurology, Gazi University Faculty of Medicine, Ankara, Turkey
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Bromberg MB. Motor unit action potential analysis of the paraspinal muscles : Paraspinal muap analysis is useful. Muscle Nerve 2004; 29:451-3. [PMID: 14981748 DOI: 10.1002/mus.10562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Mark B Bromberg
- Department of Neurology, University of Utah, 50 North Medical Drive, Salt Lake City, Utah 84132, USA
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Stålberg E. Chapter 11 Quantitation of EMG, what and why. ACTA ACUST UNITED AC 2004; 57:91-100. [PMID: 16106610 DOI: 10.1016/s1567-424x(09)70347-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Erik Stålberg
- Department of Clinical Neurophysiology, Uppsala University Hospital, S-751 85 Uppsala, Sweden.
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