Functional compensation of human motor units in health and disease

[Peripheral nerves' function recovery by intratissual electric stimulation]

An intratissual electrical stimulation, accompanied by irritation of their central neurons, is used to recover the function of damaged peripheral nerves. Treatment results exceeded those with the use of cutaneous electrical stimulation, which is confirmed by comparative results of trial animal experiments. The time and quality of peripheral nerves' function recovery in comparison of intratissual and cutaneous electrical stimulation methods remain unknown.

OBJECTIVE

To evaluate the time and quality of peripheral nerves' functions recovery after their suturing and conducting two different methods of electrical stimulation, namely intratissual and cutaneous, in projection of central neurons of damaged spinal nerves in the postoperative period.

MATERIAL AND METHODS

The basic technical parameters of the method of peripheral nerves' functions recovery in the postoperative period were ptacticed. Postoperative rehabilitation treatment was performed in 77 patients with traumatic peripheral nerves' injuries at the level of the forearm: in 42 with intratissual electrical stimulation, in 35 - using cutaneous one with similar characteristics of electrical current and concomitant pharmacological therapy. The follow-up duration was 2 years.

RESULTS

A significant (in 4-6 times) reduction in time of treatment and a greater improvement in qualitative indicators when using intratissual electrical stimulation compared to the use of cutaneous stimulation were obtained. The effectiveness of the restorative therapy was dependent on the number of procedures, and a complete recovery of the damaged peripheral nerves' functions was observed after three courses of intratissual electrical stimulation.

CONCLUSION

The time and degree of recovery of peripheral nerves' functions depends on the functional activity of their central neurons at the level of the spinal cord. The activation of these neurons by low-frequency electrical current allows to activate their trophic function. Thus, the cutaneous electrical stimulation does not cause the necessary level of irritation of the neurons due to the fact that the skin is a barrier to electrical current, which reduces its impact in 200-500 times. The intratissual electrical stimulation allows to solve the problem by supplying the needle-electrode much closer to the «target». The proposed method of intratissual electrical stimulation has shown its advantage over cutaneous electrical stimulation, significantly reducing the duration of the restorative treatment and increasing its qualitative indicators.

Critical illness-associated weakness and related motor disorders

Weakness of limb and respiratory muscles that occurs in the course of critical illness has become an increasingly common and serious complication of adult and pediatric intensive care unit patients and a cause of prolonged ventilatory support, morbidity, and prolonged hospitalization. Two motor disorders that occur singly or together, namely critical illness polyneuropathy and critical illness myopathy, cause weakness of limb and of breathing muscles, making it difficult to be weaned from ventilatory support, commencing rehabilitation, and extending the length of stay in the intensive care unit, with higher rates of morbidity and mortality. Recovery can take weeks or months and in severe cases, and may be incomplete or absent. Recent findings suggest an improved prognosis of critical illness myopathy compared to polyneuropathy. Prevention and treatment are therefore very important. Its management requires an integrated team approach commencing with neurologic consultation, creatine kinase (CK) measurement, detailed electrodiagnostic, respiratory and neuroimaging studies, and potentially muscle biopsy to elucidate the etiopathogenesis of the weakness in the peripheral and/or central nervous system, for which there may be a variety of causes. These tenets of care are being applied to new cases and survivors of the coronavirus-2 disease pandemic of 2019. This chapter provides an update to the understanding and approach to critical illness motor disorders.

Effects of age on force steadiness: A literature review and meta-analysis

The variability of force is indicative of the biological variability inherent in the human motor system. Previous literature showed inconsistent findings of the effect of age on the variability of force and hence a systematic review was performed. Twenty studies were included in this systematic review, of which twelve provided sufficient data to determine effect sizes for the effect of age. After determining the pooled effect size, the effect of sample size on dichotomized effect sizes (significant vs. non-significant) was determined. Also, the effect of possible determinants, age difference between age groups, dominance of investigated limb, muscle group, muscle location (proximal vs. distal and upper vs. lower extremity) and target force level on effect size (categorized as small, medium, or large) were investigated. A large pooled effect size of age was found (r_total=0.67, 95% CI [0.61; 0.72]). No relation between sample size and effect size significance was found, indicative of no lack of power in the studies reviewed. No relations were found of associations between age difference, upper vs. lower extremity muscle location, and dominance and effect size. Significant relations of effect size with muscle group, proximal vs. distal muscle location and target force level were found. Also, an interaction effect of muscle group and target force level was suggested. The meta-analysis results are in line with motor unit loss as the main cause of the effect of ageing on force steadiness and this effect can partially explain decreased motor performance associated with ageing.

Increased motor unit potential shape variability across consecutive motor unit discharges in the tibialis anterior and vastus medialis muscles of healthy older subjects

OBJECTIVE

To study the potential utility of using near fiber (NF) jiggle as an assessment of neuromuscular transmission stability in healthy older subjects using decomposition-based quantitative electromyography (DQEMG).

METHODS

The tibialis anterior (TA) and vastus medialis (VM) muscles were tested in 9 older men (77 ± 5 years) and 9 young male control subjects (23 ± 0.3 years). Simultaneous surface and needle-detected electromyographic (EMG) signals were collected during voluntary contractions, and then analyzed using DQEMG. Motor unit potential (MUP) and NF MUP parameters were analyzed.

RESULTS

NF jiggle was significantly increased for both the TA and VM in the old age group relative to the younger controls (P<0.05). NF jiggle was significantly higher in the TA compared to VM (P<0.05). For TA, NF jiggle was negatively correlated with MUNE, and positively correlated with S-MUP amplitude, NF count, MUP duration, MUP peak-to-peak voltage, and MUP area (P<0.05). For VM, NF jiggle was positively correlated with NF count and MUP area (P<0.05), and no significant correlations were found between NF jiggle and S-MUP amplitude, MUP duration, or MUP peak-to-peak voltage (MUNE was not calculated for VM, so no correlation could be made).

CONCLUSIONS

Healthy aging is associated with neuromuscular transmission instability (increased NF jiggle) and MU remodeling, which can be measured using DQEMG.

SIGNIFICANCE

NF jiggle derived from DQEMG can be a useful method of identifying neuromuscular dysfunction at various stages of MU remodeling and aging.

A computational model of motor neuron degeneration

To explore the link between bioenergetics and motor neuron degeneration, we used a computational model in which detailed morphology and ion conductance are paired with intracellular ATP production and consumption. We found that reduced ATP availability increases the metabolic cost of a single action potential and disrupts K+/Na+ homeostasis, resulting in a chronic depolarization. The magnitude of the ATP shortage at which this ionic instability occurs depends on the morphology and intrinsic conductance characteristic of the neuron. If ATP shortage is confined to the distal part of the axon, the ensuing local ionic instability eventually spreads to the whole neuron and involves fasciculation-like spiking events. A shortage of ATP also causes a rise in intracellular calcium. Our modeling work supports the notion that mitochondrial dysfunction can account for salient features of the paralytic disorder amyotrophic lateral sclerosis, including motor neuron hyperexcitability, fasciculation, and differential vulnerability of motor neuron subpopulations.

Intra-rater reliability of motor unit number estimation and quantitative motor unit analysis in subjects with amyotrophic lateral sclerosis

OBJECTIVES

To assess the intra-rater reliability of decomposition-enhanced spike-triggered averaging (DE-STA) motor unit number estimation (MUNE) and quantitative motor unit potential analysis in the upper trapezius (UT) and biceps brachii (BB) of subjects with amyotrophic lateral sclerosis (ALS) and to compare the results from the UT to control data.

METHODS

Patients diagnosed with clinically probable or definite ALS completed the experimental protocol twice with the same evaluator for the UT (n=10) and BB (n=9).

RESULTS

Intra-rater reliability for the UT was good for the maximum compound muscle action potential (CMAP) (ICC=0.88), mean surface-detected motor unit potential (S-MUP) (ICC=0.87) and MUNE (ICC=0.88), and for the BB was moderate for maximum CMAP (ICC=0.61), and excellent for mean S-MUP (ICC=0.94) and MUNE (ICC=0.93). A significant difference between tests was found for UT MUNE. Comparing subjects with ALS to control subjects, UT maximum CMAP (p<0.01) and MUNE (p<0.001) values were significantly lower, and mean S-MUP values significantly greater (p<0.05) in subjects with ALS.

CONCLUSIONS

This study has demonstrated the ability of the DE-STA MUNE technique to collect highly reliable data from two separate muscle groups and to detect the underlying pathophysiology of the disease.

SIGNIFICANCE

This was the first study to examine the reliability of this technique in subjects with ALS, and demonstrates its potential for future use as an outcome measure in ALS clinical trials and studies of ALS disease severity and natural history.

Neurophysiological approach to disorders of peripheral nerve

Disorders of the peripheral nerve system (PNS) are heterogeneous and may involve motor fibers, sensory fibers, small myelinated and unmyelinated fibers and autonomic nerve fibers, with variable anatomical distribution (single nerves, several different nerves, symmetrical affection of all nerves, plexus, or root lesions). Furthermore pathological processes may result in either demyelination, axonal degeneration or both. In order to reach an exact diagnosis of any neuropathy electrophysiological studies are crucial to obtain information about these variables. Conventional electrophysiological methods including nerve conduction studies and electromyography used in the study of patients suspected of having a neuropathy and the significance of the findings are discussed in detail and more novel and experimental methods are mentioned. Diagnostic considerations are based on a flow chart classifying neuropathies into eight categories based on mode of onset, distribution, and electrophysiological findings, and the electrophysiological characteristics in each type of neuropathy are discussed.

A novel fixed-target task to determine articulatory speed constraints in persons with amyotrophic lateral sclerosis

PURPOSE

The goal of this study was to determine if talkers with ALS are limited in their ability to increase lower lip and jaw speed at an early stage of the disease when their speaking rate and intelligibility are only minimally or not affected.

METHOD

A novel metronome paced fixed-target task was used to assess movement speed capacities during lower lip and jaw oscillations in seven talkers with ALS and seven age and gender matched controls.

RESULTS

Lower lip peak speeds were significantly lower in talkers with mild ALS than in healthy talkers suggesting a lower lip speed constraint in talkers with mild ALS. Jaw peak speeds tended to be lower, but jaw displacements tended to be larger in talkers with mild ALS than in healthy talkers. Because greater speeds are typically expected for larger displacements, outcomes also suggest a jaw speed constraint in talkers with mild ALS.

CONCLUSIONS

Lower lip and jaw peak speeds may be sensitive measures to identify bulbar motor performance decline at an early stage of the disease when speaking rate and intelligibility are only minimally affected.

LEARNING OUTCOMES

The reader will be able to explain two different articulatory strategies to increase speaking rate and understand why fast speech tasks and diadochokinetic pseudo-speech tasks are not suited to assess articulatory speed capacity in healthy and impaired talkers. The reader will also be able to explain how orofacial movement speed capacity can be tested using a fixed-target task and how ALS affects lower lip and jaw speed capacities during the early stages of the disease.

Evaluation of spinal and bulbar muscular atrophy by the clustering index method

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.

"Clustering Index method": a new technique for differentiation between neurogenic and myopathic changes using surface EMG

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.

Motor unit number estimate as a predictor of motor dysfunction in an animal model of type 1 diabetes

Peripheral neuropathy is a common complication of diabetes that leads to severe morbidity. In this study, we investigated the sensitivity of motor unit number estimate (MUNE) to detect early motor axon dysfunction in streptozotocin (STZ)-treated mice. We compared the findings with in vitro changes in the morphology and electrophysiology of the neuromuscular junction. Adult Thy1-YFP and Swiss Webster mice were made diabetic following three interdaily intraperitoneal STZ injections. Splay testing and rotarod performance assessed motor activity for 6 wk. Electromyography was carried out in the same time course, and compound muscle action potential (CMAP) amplitude, latency, and MUNE were estimated. Two-electrode voltage clamp was used to calculate quantal content (QC) of evoked transmitter release. We found that an early reduction in MUNE was evident before a detectable decline of motor activity. CMAP amplitude was not altered. MUNE decrease accompanied a drop of end-plate current amplitude and QC. We also observed small axonal loss, sprouting of nerve endings, and fragmentation of acetylcholine receptor clusters at the motor end plate. Our results suggest an early remodeling of motor units through the course of diabetic neuropathy, which can be readily detected by the MUNE technique. The early detection of MUNE anomalies is significant because it suggests that molecular changes associated with pathology and leading to neurodegeneration might already be occurring at this stage. Therefore, trials of interventions to prevent motor axon dysfunction in diabetic neuropathy should be administered at early stages of the disorder.

Precision in isometric precision grip force is reduced in middle-aged adults

We investigated age related changes in the control of precision grip in 29 healthy adults spanning early adulthood to middle age (21-67 years). Subjects performed a visually guided, isometric precision grip ramp-and-hold force-tracking task. Target force levels were 3, 6, and 9 N. Precision and performance of force regulation was quantified. Larger errors were made during the ramp than during the hold phase. Age correlated positively with the amount of error at the lowest (3 N) force level in both phases. Force onsets were systematically earlier in middle-aged subjects and the average slope of the force during the ramp decreased with increasing age. The results show that precision during low grip force control decreases already during middle age and those subjects may modify their force generation strategies to compensate for early and subtle degenerative changes in the motor system before decline in grip strength is apparent.

Reductions in motor unit number estimates (MUNE) precede motor neuron loss in the plasma membrane calcium ATPase 2 (PMCA2)-heterozygous mice

The potential of MUNE as a unique electrophysiological tool to detect early motor unit abnormalities during a clinically silent period was investigated in the plasma membrane calcium ATPase 2 (PMCA2)-heterozygous mice. There was a significant reduction in MUNE in the PMCA2-heterozygous mice as compared to the wild type littermates at two months of age. In contrast, the compound motor action potential (CMAP) was not altered. The conduction velocity (CV) of the sensory nerve and sensory nerve action potentials (SNAP) were not modified indicating lack of major sensory deficits. Interestingly, despite a decline in MUNE at this age, no changes were detected in choline acetyl transferase (ChAT) positive motor neuron number in the ventral horn of the lumbar spinal cord. Hindlimb grip strength, a test that evaluates clinical dysfunction, was also similar to that of the wild type controls. However, motor neuron number significantly decreased by five months suggesting that a drop in MUNE preceded motor neuron loss. In the two-month-old PMCA2-null mice, reduced MUNE measurements coincided with lower motor neuron number and decreased hindlimb grip strength. The fall in motor neuron number was already detectable at three weeks, the earliest time studied, and became more pronounced by five months. Our results show that even partial reductions in PMCA2 levels are sufficient to cause delayed death of motor neurons and that MUNE may be a reliable and sensitive approach to detect pathology prior to cell loss and in the absence of overt clinical signs.

Mechanomyographic and electromyographic responses to stimulated and voluntary contractions in the dorsiflexors of young and old men

The effect of age on mechanomyography (MMG) has not been examined for electrically evoked contractions. Similar to torque, we expected that postactivation potentiation of the MMG would differ between young and old subjects. Additionally, under voluntary conditions, we compared normalized MMG and electromyographic (EMG) signals in relation to torque, and expected that MMG, unlike EMG, would be affected by age. In 10 young and 10 old men, electrical stimulation was delivered before and after a 10-s maximal voluntary contraction (MVC) to assess potentiation of contractile (twitch torque; Pt), electrical (M-wave amplitude), and mechanical (MMG amplitude) properties of the dorsiflexors. Subsequently, subjects performed voluntary contractions at 20%, 40%, 60%, 80%, and 100% MVC for calculation of normalized MMG-torque and EMG-torque relationships. Following the MVC, Pt and evoked MMG were larger than at rest in both groups, but M-wave amplitude was unchanged. Twitch potentiation was greater in young than old, whereas evoked MMG was unaffected by age. Under voluntary conditions, values for MMG and EMG were similar between groups, except for greater MMG at MVC in young men. The shape of MMG and EMG relationships to torque was similar only in young men. Using the aging model, our results indicate that potentiation of the mechanical components (MMG) differ from those of twitch torque. Furthermore, the comparison of normalized voluntary MMG with age provides additional support for the concept of age-related motor unit remodeling.

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.

Motor unit number estimates in the tibialis anterior muscle of young, old, and very old men

The rate of motor unit (MU) loss and its influence on the progression of sarcopenia is not well understood. Therefore, the main purpose of this study was to estimate and compare numbers of MUs in the tibialis anterior (TA) of young men ( approximately 25 years) and two groups of older men ( approximately 65 years and >/=80 years). Decomposition-enhanced spike-triggered averaging was used to collect surface and intramuscular electromyographic signals during isometric dorsiflexions at 25% of maximum voluntary contraction. The mean surface-MU potential size was divided into the maximum M wave to calculate the motor unit number estimate (MUNE). The MUNE was significantly reduced in the old (91) compared to young (150) men, and further reduced in the very old men (59). Despite the smaller MUNE at age 65, strength was not reduced until beyond 80 years. This suggests that age-related MU loss in the TA does not limit function until a critical threshold is reached.

Motor Unit Estimate Number in the Anterior Tibial Muscle: Normative Data versus Findings in Critically Ill Patients in Intensive Care Units

OBJECTIVES

To determine the number of motor units (MUNEs) in the anterior tibial muscle of normal subjects for comparison with those of severely paretic or paralytic muscles of critically ill patients in intensive care units.

RESULTS

The mean MUNE for 24 normal subjects (194 +/- 5; mean +/- standard deviation) was similar to that of the 22 patients with critical illness (184 +/- 10). However, both the mean amplitude of the evoked compound muscle action potential (CMAP) and of the single motor unit action potential (S-MUAP) among patients were approximately one third of those in normal subjects.

CONCLUSION

Critically ill patients in this study demonstrated normal MUNEs with reduced CMAP and S-MUAP amplitudes in the setting of severe clinical weakness, suggestive of predominantly myopathic injury. MUNE may provide a valuable tool for distinguishing between neuropathy and myopathy in critically ill patients.

Long-term follow-up of patients with nonparalytic poliomyelitis

OBJECTIVE

To examine patients with previous nonparalytic poliomyelitis in search of muscle atrophy, weakness, and other late symptoms of poliomyelitis.

DESIGN

A mailed questionnaire followed up with neurologic and neurophysiologic examinations of respondents who reported symptoms possibly related to the late sequelae of polio.

SETTING

Neurology department at a university hospital.

PARTICIPANTS

Thirty-nine of 47 patients diagnosed with nonparalytic poliomyelitis and hospitalized at a Norwegian hospital between 1950 and 1954, during the Norwegian polio epidemic.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Electromyography to determine function of the anterior tibialis, vastus lateralis, and biceps brachii muscles; nerve conduction studies of the sural, peroneal, and tibial nerves; motor and sensory nerve conduction velocity, and compound muscle and sensory nerve action potentials, and distal latencies.

RESULTS

Twenty-five of 47 patients (53.2%) reported symptoms possibly related to the late sequelae of poliomyelitis. Eight of 20 examined symptomatic patients had normal neurologic and neurophysiologic findings, whereas 9 others had other medical conditions that could explain the symptoms. Three patients (6.7%) had neurologic and neurophysiologic findings and development of symptoms consistent with motoneuron damage.

CONCLUSION

Some nonparalytic patients may have subclinical acute motoneuron damage with subsequent development and manifestation of motor weakness and neuromuscular symptoms many years later. These symptoms should be considered a differential diagnosis in patients who have a history of nonparalytic poliomyelitis.

Prevalence of denervation in paraspinal and foot intrinsic musculature

OBJECTIVE

The primary purpose of this investigation was to determine the prevalence of abnormal spontaneous activity (positive sharp waves (PSWs) and fibrillation potentials (FPs)) in selected lumbosacral paraspinal and foot intrinsic muscles in an asymptomatic healthy population.

DESIGN

This was a prospective assessment of 50 individuals without history or physical findings suggestive of peripheral neuromuscular disease whereby a monopolar needle electrode was located in the unilateral L4 and L5 paraspinal as well as abductor hallucis and extensor digitorum brevis muscles. These muscles were extensively evaluated for the presence of PSWs, FPs, and fasciculation potentials.

RESULTS

Ten subjects per decade from 20-59 yr and ten subjects from 60-80 yr comprised the 50 participants (28 women), resulting in a mean age of 45+/-15.9 (range, 20-76) yr. A single individual (prevalence, 2%) demonstrated fibrillation potentials in the extensor digitorum brevis, and FPs and PSWs were detected in two subjects' (4% prevalence) L4/L5 paraspinal muscles. Ninety-four percent of the subjects had fasciculation potentials in the abductor hallucis, whereas 60% had these waveforms in the extensor digitorum brevis. Only 6% of subjects had fasciculation potentials in the L4 but not L5 paraspinal muscles. All subjects demonstrated both prototypical and "atypical" appearing endplate spikes in all of the muscles examined.

CONCLUSIONS

We failed to confirm the previously reported prevalence of FPs and PSWs in both the paraspinal and foot intrinsic musculature. Atypical appearing endplate spikes, however, display configurations similar to FPs and PSWs and were present in all subjects. Failure to pay close attention to the discharge rate and rhythm of endplate spikes can lead to misinterpreting these waveforms as FPs and PSWs. It is likely that the previously reported high prevalence of spontaneous activity in healthy persons resulted from not fully appreciating the similarity between innervated and denervated spontaneous single muscle fiber discharge configurations.

Comparative analysis of motoneuron loss and functional deficits in PMN mice: implications for human motoneuron disease

We have investigated the correlation between functional and morphological deficits in PMN mice, an animal model of human motoneuron disease. Electrophysiologic investigations showed first abnormalities, i.e. reduction of M-response amplitudes, already at postnatal d 13 when the disease was not yet phenotypically apparent, and when motoneuron and motor axon numbers were still normal. After d 27, a loss of more than 30% of motoneuron axons and cell bodies was detectable in the phrenic nerve and facial nucleus, respectively. At that stage, PMN mice showed severe functional and electrophysiological deficits. At later stages of the disease when still more than 50% of motor axons and at least 60% of motoneuron cell bodies were present, the distal compound muscle action potential amplitude decreased by more than 95% in small foot muscles after sciatic nerve stimulation. We conclude that functional deficits precede structural deficits in this animal model of human motoneuron disease. Our findings are in agreement with the concept of the 'sick motoneuron' in this animal model of motoneuron disease rather than the idea of progressive loss of motoneurons resulting in disease only after a significant number of motoneurons has degenerated.

Age-related changes in the twitch contractile properties of human thenar motor units

The purpose of this study was to examine the effects of aging on the contractile and electrophysiological properties of human thenar motor units (MUs). Percutaneous electrical stimulation of single motor axons within the median nerve was used to isolate and examine the twitch tensions, contractile speeds, and surface-detected MU action potential (S-MUAP) sizes of 48 thenar MUs in 17 younger subjects (25-53 yr) and 44 thenar MUs in 9 older subjects (64-77 yr). A wide range of twitch tensions, contractile speeds, and S-MUAP sizes was observed in both age groups. However, older subjects had significantly larger MU twitch tensions and slower MU twitch contraction and half-relaxation times. These changes were accompanied by increased S-MUAP sizes. These findings suggest that the human thenar MU pool undergoes significant age-related increase in MU size and slowing of contractile speed. Such adaptation may help to overcome previously reported age-related losses of thenar MUs.

Motor neuron disease: a primary disorder of corticomotoneurons?

It has been suggested that the primary site of damage in motor neuron disease (MND) is the cortical motor neuron, with secondary degeneration of spinal motor neurons. To test this hypothesis, we sought to determine if loss of corticomotoneurons in MND precedes spinal motor neuron loss. The density of corticomotoneurons was measured in 18 MND and 9 control cases using 10-microns horizontal sections of motor cortex in the hand/arm region. The density of spinal motor neurons was measured in 10-microns transverse sections of the lower cervical spinal cord. Corticomotoneuron and spinal motor neuron densities were decreased in MND cases compared to controls, but in MND cases there was poor correlation (r2 = 0.06) between corticomotoneuron and spinal motor neuron densities. The results indicate that corticomotoneuron and spinal motor neurons are lost at different rates in different MND patients, and that corticomoteneuron loss is unlikely to be a primary event in MND.

Effects of ageing on the motor unit: a brief review

This review briefly summarizes the current state of knowledge regarding age related changes in skeletal muscle, followed by a more in-depth review of ageing effects on animal and human motor units (MUs). Ageing in humans is generally associated with reductions in muscle mass (atrophy), leading to reduced voluntary and electrically evoked contractile strength by the 7th decade for most muscle groups studied. As well, contraction and one-half relaxation times are typically prolonged in muscles of the elderly. Evidence from animal and human studies points toward age associated MU loss as the primary mechanism for muscle atrophy, and such losses may be greatest among the largest and fastest MUs. However, based on studies in animals and humans, it appears that at least some of the surviving MUs are able to partially compensate for MU losses, as indicated by an increase in the average MU size with age. The fact that muscles in the elderly have fewer, but on average larger and slower, MUs has important implications for motor control and function in this population.

Force, fatigue, and the cross-sectional area of wrist extensor muscles after radial nerve grafting

The force and fatigue of the wrist extensor muscles during maximal voluntary and tetanic contractions were measured and compared in the injured and noninjured extremities of 11 patients with radial nerve gap injury and in 9 normal volunteers. The cross-sectional area (CSA) of the wrist extensor muscles was determined by magnetic resonance imaging and was correlated with force. In the patient group, an average of three (range, 2-4) sural nerve cable grafts, measuring 11.5 +/- 5 cm (range, 5-20 cm) in length, were sutured to the nerve stumps at least 9 years before this study. Differences in the CSA values of the injured and noninjured arms were compared, and a ratio was established (CSAR). The mean CSAR was 82.9% +/- 14.3. These differences were not statistically significant (P > 0.10, paired t-test). Despite very well-recovered muscular mass, the maximal voluntary contraction force was found to be incompletely recovered by up to 62.7% +/- 23, when compared with the noninjured side (P < 0.05, paired t-test). The fraction maximal voluntary contraction force/CSA had decreased by up to 76.4% +/- 25.5 (P < 0.05, paired t-test). An increased fatigability of the affected muscles persisted in all patients. The patients' noninjured extremity behaved in the same way as that of the dominant extremity of normal volunteers with regard to force, lever, and CSA values.(ABSTRACT TRUNCATED AT 250 WORDS)

Unusual motor unit firing behavior in older adults

Motor unit firing behavior was studied in the first dorsal interosseus (FDI) and tibialis anterior (TA) muscles of 10 aged subjects during slow, isometric contractions. Previous study in younger individuals had shown that motor units are recruited and derecruited in an orderly manner whereby the early-recruited units are the last to be derecruited. However, there were several examples in the old subjects in which some high-threshold motor units were derecruited at much lower levels of force. Concurrent antagonist firing in an effort to maintain the required precision is considered a likely candidate for such prolonged motor unit activation.

Org.2766 improves functional and electrophysiological aspects of regenerating sciatic nerve in the rat

The beneficial effect of short-term (8 days) melanocortin therapy on regenerating peripheral nerves is demonstrated using functional and electrophysiological tests. Following a crush lesion of the rat sciatic nerve, recovery of sensory function is monitored by assessing the responsiveness of the rat to a small electric current applied to the footsole. Recovery of motor function is assessed by means of an analysis of walking patterns. Normalization of the walking pattern reflects reinnervation of different muscle groups. The motor and H-reflex related sensory nerve conduction velocity of the regenerated nerves are longitudinally investigated in the same rats in which the recovery of motor and sensory function had been assessed previously. Functional tests show an enhanced recovery under melanocortin therapy, but in the end both saline- and melanocortin-treated rats show 100% recovery. However, when compared to the contralateral sciatic nerve, in the peptide-treated animals motor nerve conduction in the regenerated nerves has fully recovered after about 90 days following the crush lesion and the sensory conduction after about 120 days, whereas in the saline-treated rats a deficit of 20-40% in both motor and sensory conduction remains. This difference is observed even 214 days following crush.

Changes in human skeletal muscles due to ageing. Histological and histochemical observations on autopsy material

Morphological changes in human skeletal muscle with ageing are reported. Samples from the deltoid and the vastus lateralis muscles from 126 subjects, aged 20-80 years, were studied by light microscopy. The patients died suddenly due to accidents or from fatal diseases. Until their death, they had preserved normal physical activity corresponding to their age. Chronic diseases, inactivity or neuromuscular diseases which are known to lead to changes in the muscles were excluded. The frequency of neurogenic changes of muscles increased with increasing age. These results correlated with electrophysiological and morphological changes in the peripheral nerves due to ageing reported by other investigators. The neurogenic changes in persons over 70 years were overlapped by a type-2 fibre atrophy.

Closed loop control for restoration of movement in paralyzed muscle

A basic closed loop control system is described for controlling movement of paralyzed skeletal muscle in humans. The system is based around a Z80 microprocessor with 20K of memory. The system involves sensors to detect the amount of movement in muscle or the tension generated by that muscle, a computer-controlled stimulator, and electrodes placed on the surface of the skin above skeletal muscle for sequential activation of the muscle with electrical stimulation. Applications are described in the system for two types of control; hand control in quadriplegics, and standing and walking in both paraplegics and quadriplegics. Both systems offer a unique challenge to the design engineering in terms of being able to control movement in skeletal muscle for rehabilitation.

The effects of chronic muscular activity on age-related changes in single fiber electromyography

Single fiber electromyography ( SFEMG ) of the extensor digitorum communis (EDC) muscle and nerve conduction studies were performed on healthy, active elderly men (66-77 years old) to assess age-related changes in neuromuscular physiology and the effect of long-term increased muscular activity on these changes. The following two groups were studied: a control group and a group composed of men with occupationally greater usage of hand extensors. Fiber density and mean jitter were essentially the same in both groups; however, in the hand-user group there was greater variability in mean jitter and a significant increase in the prevalence of potential pairs with increased jitter or blocking. In both groups, slower nerve conduction velocities and lower amplitudes of sensory and motor evoked potentials tended to correlate with increased jitter and fiber density. These electrophysiological changes in healthy aged men are consistent with an extremely mild process of nerve terminal denervation and reinnervation. Although long-term increased synaptic activity did not greatly alter the rate or extent of this process, it did produce a higher incidence of abnormal potential pairs and greater variability in mean jitter.

Macro EMG

A new EMG recording technique called macro EMG is described. The recording electrode is the cannula of the modified single fiber electromyography (SFEMG) electrode. By means of spike triggered averaging, the contribution from all muscle fibers in a motor unit is extracted. The resulting signal reflects the number and size of muscle fibers in one motor unit. This paper presents the details of the technique, the neurophysiological basis for generation of the macro EMG signal, and the typical findings in normal and diseased muscles. Finally, examples are given of the additional information that can be obtained by combining investigations with SFEMG, conventional EMG, and macro EMG in the same muscles.

Macro EMG in healthy subjects of different ages

The findings of the recently developed technique of Macro EMG in healthy subjects of different ages are described. The characteristics of the Macro motor unit potential which probably reflects the relative size of the whole motor unit are presented together with suggested normal data for the three muscles studied. An increase in size of the Macro motor unit potential was found with age, particularly after the age of 60 years. Possible factors determining the Macro EMG signal and the age related changes are discussed.

Changes in motor unit populations in motor neurone disease

In motor neurone disease changes in the functional properties of motor units, including the surface voltage, latency, conduction velocity, and response to repetitive stimulation, were investigated. Progression was marked by motor unit loss, increase in the proportion of larger motor unit potentials, and inclusion of motor unit potentials larger than normal in the remaining motor unit population. Even late in the disease, motor unit potentials with a low surface voltage persisted. The relationship between motor unit potentials, surface voltage, and latency, present in control subjects, broke down in motor neurone disease, large motor unit potentials having abnormally long latencies and small motor unit potentials unexpectedly short latencies. Amplitude decrements were more frequent and severe in motor unit potentials at later stages in the disease, particularly in those units with lower surface voltages. In one surviving motor unit potential there was evidence suggestive of functional recovery. The observations point to complex changes in the functional properties of motor units in motor neurone disease.

Motor unit fibre density in the extensor digitorum communis muscle. Single fibre electromyographic study in normal subjects at different ages

A single fibre EMG study is presented from extensor digitorum communis muscle in sujbects aged 10 to 89 years. The average number of single muscle fibre action potentials generated by muscle fibres in the same motor unit within the uptake area of the electrode is used as a measure of the motor unit fibre density. The fibre density increases slowly during life with a faster progression after the age 70 years. The number of recordings indicating impaired nerve or neuromuscular impulse transmission increases at the same time. The findings indicate degenerative loss of motor neurones with aging, compensated for by reinnervation. The changes are relatively slight in the extensor digitorum communis muscle as compared with other muscles, permitting early pathological changes in this muscle to be recognized independently of age factors.

The effects of motor cortical stimulation on the excitability of spinal motoneurons in man

The pyramidal tract and particularly the direct cortico-motoneuronal components (DCM) have become increasingly important in the higher primates. Minimal single pulse precentral stimulation in man evokes EMG discharges from the contralateral hand muscles with a latency of 18-21 milliseconds. The excitability changes produced by such cortical stimulation on the upper limb H-reflex has been observed to include a short duration early facilitation probably corresponding to the DCM input and a later, longer lasting facilitation mediated by the same and probably other corticofugal projections. Potentiation of the H-reflex in the upper libs by means of postcentral excitation required much higher single pulse stimulus intensities and the changes in excitability produced on the spinal motoneurons could have been explained by physical extension of the stimulus current to the precentral region. Isometric contraction potentiated the H-reflex produced by combinations of precentral cortical and peripheral nerve stimulation but no direct evidence was found to support a possible transcortical basis for the V2 stretch reflex.

Variation of motor unit size in the human extensor digitorum brevis and thenar muscles

One physiological method for estimating the motor unit number in a muscle depends on dividing into the maximum compound muscle action potential, the potential average of the first few motor unit potentials excited by a motor nerve stimulus above motor threshold. To be valid, such an average unit potential size must be representative of the whole motor unit population. This assumption may not be justified. The present study has shown that there are single motor units in healthy and abnormal, thenar, and EDB motor unit populations, many times larger than any motor unit excited close to the motor threshold. This finding suggests that previously reported motor unit estimates may not only be an overestimate of the true motor unit population number, but have excluded much larger motor units with higher thresholds. Low motor unit estimates in neuropathies may result from a change in the order of activation of motor units with the appearance of larger motor units, normally of higher threshold among the first few just above the motor threshold.