The relationship between surface potentials and the number of active motor units

Bayesian statistical MUNE method

We have developed a new method of motor unit number estimation (MUNE) for assessing diseases such as amyotrophic lateral sclerosis (ALS). We used data from the whole stimulus-response curve and then performed a Bayesian statistical analysis. The Bayesian method uses mathematical equations that express the basic elements of motor unit activation after electrical stimulation and allows for the sources of variability and uncertainty in this formulation. The Bayesian MUNE method was used to determine the most probable number of motor units in 8 normal subjects, 49 ALS subjects, and 3 subjects with progressive lower motor neuron (LMN) weakness. In normals the number of motor units was calculated to be 75-85 in hand and 40-58 in foot muscles. In ALS subjects the number of motor units per muscle was less than in normal subjects. In 17 ALS subjects and 3 subjects with LMN weakness the median, ulnar, or peroneal nerve was studied on repeated occasions over an average of 189 days (range 63-1,071) and the number of motor units progressively declined, with a half-life ranging from 62-834 days. The results of our MUNE technique were reproducible on replicate studies. A Bayesian statistical MUNE method is a new approach that can be used to study ALS patients serially for assessment and treatment trials.

A simulation study of the electromyographic volley at initiation of rapid isometric contractions in the first dorsal interosseous muscle

Monopolar surface electromyograms (EMGs) of rapid isometric abduction of the first dorsal interosseous muscle (FDI) were initiated from an EMG volley that was characterized by a negative potential lasting over several tens of milliseconds. An EMG model was developed to study how the EMG volley was generated. EMGs were defined as the linear summations of surface-recorded action potential trains originating from single motor units (MUs). All action potential trains had the same discharge pattern but different recruitment thresholds, depending on the potential amplitude. Real action potentials in single MUs in FDI were recorded with a monopolar surface electrode, one of which was used as a prototype wave in simulation. The model predicted an initial negative potential comparable to that of the EMG volley observed in rapid contractions of FDI. Results from our simulation studies suggest that the EMG volley is caused by at least two independent factors: (1) the negative phase of the action potential is greater in area than the positive one, in which the effect is enhanced by the high discharge rate of many MUs; (2) many MUs are recruited within a short time in an orderly fashion starting from those with small action potentials to those with large ones.

Invited review: motor unit estimation: methods, results, and present status

The renewed interest in motor unit estimation (counting) has coincided with the introduction of computer-based methodology and with the application of the technique to proximal as well as distal muscles. The advantages and disadvantages of the different methods are considered, together with the assumptions inherent in this type of examination. In normal subjects, the extensor digitorum brevis (EDB) muscle has approximately 200 motor units while each of the intrinsic muscles of the hand has about 100 units; larger muscles in the limbs contain greater numbers of units. Beyond the age of 60 years, there is a decline in the number of functioning motor units in both proximal and distal muscles. In denervating disorders, motor unit estimation is useful for diagnosis and assessment; abnormal values may often be observed in muscles judged clinically to be unaffected. Serial studies have enabled the rate of motor unit loss to be determined in ALS and in spinal muscular atrophy. Depletion of motor units has also been found following upper motoneuron lesions caused by injury to the spinal cord or by cerebral hemorrhage; trans-synaptic dysfunction has been presumed responsible. Rather surprisingly, reduced numbers of motor units have been observed in a variety of myopathic disorders; of these, the most consistent abnormalities have been reported in myotonic muscular dystrophy.

A review of techniques employed to estimate the number of motor units in a muscle

Being the smallest functional units under neural control, motor units play an integral role in muscle physiology. However, at the present time, there does not exist any widely accepted technique for quantifying or estimating the number of motor units in a muscle. Specifically, the existing techniques are the increment-counting technique, a technique based on spike-triggered averaging, and a macro-EMG based technique which vary in invasiveness from noninvasive to highly invasive, respectively. We discuss each of these techniques, along with their associated shortcomings, in detail.

Failure of neuromuscular transmission and contractility during muscle fatigue

In previous studies of muscle fatigue, tension was monitored from whole muscle, while action potentials were recorded from a few muscle fibers. To compare more accurately changes in these responses, an in vitro fluid electrode technique was employed to record the action potential of whole muscle simultaneously with tension during fatigue induced by nerve stimulation in the rat extensor digitorum longus (EDL), soleus, and diaphragm muscles. In each muscle, tension declined from the start of stimulation, while action potential amplitude initially increased slightly and then declined most rapidly in EDL, more slowly in diaphragm, and most slowly in soleus. Direct stimulation of the fatigued muscle produced the greatest increase in tension in EDL, next in diaphragm, and least in soleus. These results indicate that while failure of excitation-contraction coupling or of the contractile mechanism is the initial cause of fatigue in all the muscles studied, and remains the predominant cause throughout in the soleus muscle, failure of neuromuscular transmission plays an important role in fatigue after the first 15 seconds in EDL, and to a lesser extent, after the first 90 seconds in diaphragm.

Motor units in a fast-twitch muscle of normal and dystrophic mice

Isometric contractions of motor units, isolated functionally by ventral root splitting were recorded from extensor digitorum longus muscles of normal and dystrophic mice of the strain C57BL/6J dy2J/dy2J. Motor unit tetanic tension was significantly lower and both time to peak tension and to half-relaxation of the twitch were significantly prolonged in dystrophic mice relative to age-matched controls. In control mice, motor unit tetanic tension averaged 4.98% of whole muscle tension, corresponding to twenty motor units. Two out of fifteen dystrophic mice exhibited an apparent decrease in the number of motor units, but the data from the remaining thirteen mice indicated no change in relative motor unit size, and hence in the number of motor units. The two mice in which changes were seen were the most severely affected and it is suggested that the apparent reduction in the number of units might be due to some units becoming so small as to be unmeasurable. No evidence was obtained for a population of units with normal characteristics within the dystrophic muscles. There was no clear relationship between tetanic tension and the time to peak tension or to half-relaxation in units from control mice. In dystrophic mice, however, a significant correlation was seen. This possibly reflects two simultaneous effects of the dystrophic process, a loss of tension accompanied by slowing of the twitch.

Evoked responses in normal and diseased muscle with particular reference to twitch potentiation

The compound muscle action potential and isometric twitch tension evoked by single and repetitive electrical stimuli are indicators of the number of motor units activated and of the contractile properties of the muscle. The action potentials and mechanical responses were recorded in proximal and distal muscles in patients with myasthenia gravis and myopathy and compared with findings in normal subjects. In normal muscle, at low rates of stimulation (2-3 s-1) the decrement was at most 5% in the action potential and 15-24% in the twitch tension. Tetanic stimuli (50 s-1) were unsuitable for diagnostic purposes because of movement artefact. In patients with myasthenia gravis, the incidence and size of the decrement of evoked responses were greater in the platysma than in the elbow flexors and the adductor pollicis (ADP) muscles. The 2-3 times greater post-tetanic facilitation (PTF) of the action potential in the platysma than in extremity muscles also indicates a more severe functional block in facial muscle. The PTF is an indicator of recruitment of blocked fibres. The maximal decrement was grossly related to the titre of antibodies against the acetylcholine receptor. To reveal failure of neuromuscular transmission in patients with myasthenia gravis without a decrement, a small dose of d-tubocurarine (0.2 mg in 30 ml of saline) was injected i.v. in the upper arm in a regional curare test. The sensitivity was greater in patients with myasthenia gravis than in controls and in patients with myopathy. Potentiation of twitch tension reflects contractile properties. In normal muscle twitch potentiation in the staircase (1-3 s-1, 100 s in duration) and after tetanus (50 s-1, 1.5 s in duration) was 2-3 times greater in the platysma than in the elbow flexors and ADP, presumably related to the greater proportion of fast-twitch fibers in facial muscle. The amplitude of the action potential and the twitch tension varied proportionally with the number of fibers activated and the difference in the decrements of the action potential and the twitch during the staircase in some patients with myasthenia gravis showed that the staircase phenomenon was diminished suggesting abnormalities in the excitation-contraction coupling. The diminution of the staircase and post-tetanic potentiation (PTP) in myopathy also indicates impairment of the excitation-contraction coupling. In rats with severe chronic myasthenia gravis, the staircase and PTP were decreased even when the failing neuromuscular transmission was circumvented by applying direct stimuli to the extensor digitorum longus muscle (EDL).