1
|
Grapperon AM, Harlay V, Boucekine M, Devos D, Rolland AS, Desnuelle C, Delmont E, Verschueren A, Attarian S. Could the motor unit number index be an early prognostic biomarker for amyotrophic lateral sclerosis? Clin Neurophysiol 2024; 163:47-55. [PMID: 38703699 DOI: 10.1016/j.clinph.2024.04.013] [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: 03/14/2023] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To evaluate the associations between motor unit number index (MUNIX) and disease progression and prognosis in amyotrophic lateral sclerosis (ALS) in a large-scale longitudinal study. METHODS MUNIX was performed at the patient's first visit, at 3, 6, and 12 months in 4 muscles. MUNIX data from the patients were compared with those from 38 age-matched healthy controls. Clinical data included the revised ALS functional rating scale (ALSFRS-R), the forced vital capacity (FVC), and the survival of the patients. RESULTS Eighty-two patients were included at baseline, 62 were evaluated at three months, 48 at six months, and 33 at twelve months. MUNIX score was lower in ALS patients compared to controls. At baseline, MUNIX was correlated with ALSFRS-R and FVC. Motor unit size index (MUSIX) was correlated with patient survival. Longitudinal analyses showed that MUNIX decline was greater than ALSFRS-R decline at each evaluation. A baseline MUNIX score greater than 378 predicted survival over the 12-month period with a sensitivity of 82% and a specificity of 56%. CONCLUSIONS This longitudinal study suggests that MUNIX could be an early quantitative marker of disease progression and prognosis in ALS. SIGNIFICANCE MUNIX might be considered as potential indicator for monitoring disease progression.
Collapse
Affiliation(s)
- Aude-Marie Grapperon
- APHM, Timone University Hospital, Referral Center for Neuromuscular Diseases and ALS, ERN Euro-NMD Center, Marseille, France.
| | - Vincent Harlay
- APHM, Timone University Hospital, Referral Center for Neuromuscular Diseases and ALS, ERN Euro-NMD Center, Marseille, France
| | - Mohamed Boucekine
- Aix Marseille University, Center for Studies and Research on Health Services and Quality of Life, Marseille, France
| | - David Devos
- Department of Medical Pharmacology, Expert Center of ALS Lille University, INSERM UMRS_1772, Lille University Hospital, LICEND COEN Centre, LilNCog - Lille Neuroscience & Cognition, 59000, ACT4ALS-MND Network, France
| | - Anne-Sophie Rolland
- Department of Medical Pharmacology, Expert Center of ALS Lille University, INSERM UMRS_1772, Lille University Hospital, LICEND COEN Centre, LilNCog - Lille Neuroscience & Cognition, 59000, ACT4ALS-MND Network, France
| | - Claude Desnuelle
- Côte d'Azur University, Medical Faculty of Nice, Department of Neurology, Nice, France
| | - Emilien Delmont
- APHM, Timone University Hospital, Referral Center for Neuromuscular Diseases and ALS, ERN Euro-NMD Center, Marseille, France
| | - Annie Verschueren
- APHM, Timone University Hospital, Referral Center for Neuromuscular Diseases and ALS, ERN Euro-NMD Center, Marseille, France
| | - Shahram Attarian
- APHM, Timone University Hospital, Referral Center for Neuromuscular Diseases and ALS, ERN Euro-NMD Center, Marseille, France; Aix Marseille University, Inserm, GMGF, Marseille, France
| |
Collapse
|
2
|
Yu Z, Zhang H, Wang Y. Analysis of surgical treatment of cervical spondylotic amyotrophy. Front Surg 2024; 11:1409283. [PMID: 38939077 PMCID: PMC11208474 DOI: 10.3389/fsurg.2024.1409283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/29/2024] [Indexed: 06/29/2024] Open
Abstract
Background Cervical spondylotic amyotrophy (CSA) is a special type of cervical spondylosis based on cervical degeneration, which is mainly manifested by weakness and atrophy of upper limb muscles without obvious sensory impairment. Various diagnostic and treatment strategies used; however, discrepancies exist. We tried to discuss diagnosing and treating CSA. Methods 15 patients with CSA were diagnosed in the Orthopedics Department of the First Affiliated Hospital of Zhengzhou University, aged 42-70 years old. The duration of preoperative symptoms of amyotrophy was 6 to 240 months. 12 patients received surgical treatment, and 3 patients received conservative treatment. The patients were divided into two groups according to the site of preoperative amyotrophy. The manual muscle test was used to evaluate the patients' muscle strength pre-and postoperatively. Results During postoperative follow-up, the muscle strength of 12 patients improved to different degrees compared to before surgery. The improvement effect was excellent in 2 cases, good in 6, and moderate in 4. There was no decrease in postoperative muscle strength compared with that before surgery. The satisfaction rate of the effect was 66.7%. The two groups had no statistically significant difference in preoperative muscle strength. The postoperative muscle strength of the proximal group was significantly better than that of the distal group. Conclusion The surgical effect of CSA of the proximal type is significantly better than that of the distal type. The recovery effect of amyotrophy after surgery for distal type CSA is poor; thus, surgical treatment should be carefully considered.
Collapse
Affiliation(s)
- Zhong Yu
- Department of Emergency, Honghui Hospital, Xi'an Jiaotong Uinversity, Xi'an, China
| | - Haofuzi Zhang
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Yanjun Wang
- Department of Emergency, Honghui Hospital, Xi'an Jiaotong Uinversity, Xi'an, China
| |
Collapse
|
3
|
Vucic S, de Carvalho M, Bashford J, Alix JJP. Contribution of neurophysiology to the diagnosis and monitoring of ALS. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 176:87-118. [PMID: 38802184 DOI: 10.1016/bs.irn.2024.04.001] [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: 05/29/2024]
Abstract
This chapter describes the role of neurophysiological techniques in diagnosing and monitoring amyotrophic lateral sclerosis (ALS). Despite many advances, electromyography (EMG) remains a keystone investigation from which to build support for a diagnosis of ALS, demonstrating the pathophysiological processes of motor unit hyperexcitability, denervation and reinnervation. We consider development of the different diagnostic criteria and the role of EMG therein. While not formally recognised by established diagnostic criteria, we discuss the pioneering studies that have demonstrated the diagnostic potential of transcranial magnetic stimulation (TMS) of the motor cortex and highlight the growing evidence for TMS in the diagnostic process. Finally, accurately monitoring disease progression is crucial for the successful implementation of clinical trials. Neurophysiological measures of disease state have been incorporated into clinical trials for over 20 years and we review prominent techniques for assessing disease progression.
Collapse
Affiliation(s)
- Steve Vucic
- Brain and Nerve Research Centre, Concord Clinical School and Department of Neurology, Concord Repatriation General Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Mamede de Carvalho
- Instituto de Medicina Molecular João Lobo Antunes, Centro de Estudos Egas Moniz, Faculty of Medicine, Universidade de Lisboa, Lisboa, Portugal; Department of Neurosciences, CHULN, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - James Bashford
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - James J P Alix
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom.
| |
Collapse
|
4
|
Sleutjes BTHM, Stikvoort García DJL, van Doorn PA, Goedee HS, van den Berg LH. Simulating progressive motor neuron degeneration and collateral reinnervation in motor neuron diseases using a dynamic muscle model based on human single motor unit recordings. J Neural Eng 2023; 20:056039. [PMID: 37774693 DOI: 10.1088/1741-2552/acfe9d] [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: 12/20/2022] [Accepted: 09/29/2023] [Indexed: 10/01/2023]
Abstract
Objective.To simulate progressive motor neuron loss and collateral reinnervation in motor neuron diseases (MNDs) by developing a dynamic muscle model based on human single motor unit (MU) surface-electromyography (EMG) recordings.Approach.Single MU potentials recorded with high-density surface-EMG from thenar muscles formed the basic building blocks of the model. From the baseline MU pool innervating a muscle, progressive MU loss was simulated by removal of MUs, one-by-one. These removed MUs underwent collateral reinnervation with scenarios varying from 0% to 100%. These scenarios were based on a geometric variable, reflecting the overlap in MU territories using the spatiotemporal profiles of single MUs and a variable reflecting the efficacy of the reinnervation process. For validation, we tailored the model to generate compound muscle action potential (CMAP) scans, which is a promising surface-EMG method for monitoring MND patients. Selected scenarios for reinnervation that matched observed MU enlargements were used to validate the model by comparing markers (including the maximum CMAP and a motor unit number estimate (MUNE)) derived from simulated and recorded CMAP scans in a cohort of 49 MND patients and 22 age-matched healthy controls.Main results.The maximum CMAP at baseline was 8.3 mV (5th-95th percentile: 4.6 mV-11.8 mV). Phase cancellation caused an amplitude drop of 38.9% (5th-95th percentile, 33.0%-45.7%). To match observations, the geometric variable had to be set at 40% and the efficacy variable at 60%-70%. The Δ maximum CMAP between recorded and simulated CMAP scans as a function of fitted MUNE was -0.4 mV (5th-95th percentile = -4.0 - +2.4 mV).Significance.The dynamic muscle model could be used as a platform to train personnel in applying surface-EMG methods prior to their use in clinical care and trials. Moreover, the model may pave the way to compare biomarkers more efficiently, without directly posing unnecessary burden on patients.
Collapse
Affiliation(s)
- Boudewijn T H M Sleutjes
- Department of Neurology, Brain Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Pieter A van Doorn
- Department of Neurology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H Stephan Goedee
- Department of Neurology, Brain Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology, Brain Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
5
|
Xue S, Gao F, Wu X, Xu Q, Weng X, Zhang Q. MUNIX repeatability evaluation method based on FastICA demixing. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:16362-16382. [PMID: 37920016 DOI: 10.3934/mbe.2023730] [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: 11/04/2023]
Abstract
To enhance the reproducibility of motor unit number index (MUNIX) for evaluating neurological disease progression, this paper proposes a negative entropy-based fast independent component analysis (FastICA) demixing method to assess MUNIX reproducibility in the presence of inter-channel mixing of electromyography (EMG) signals acquired by high-density electrodes. First, composite surface EMG (sEMG) signals were obtained using high-density surface electrodes. Second, the FastICA algorithm based on negative entropy was employed to determine the orthogonal projection matrix that minimizes the negative entropy of the projected signal and effectively separates mixed sEMG signals. Finally, the proposed experimental approach was validated by introducing an interrelationship criterion to quantify independence between adjacent channel EMG signals, measuring MUNIX repeatability using coefficient of variation (CV), and determining motor unit number and size through MUNIX. Results analysis shows that the inclusion of the full (128) channel sEMG information leads to a reduction in CV value by $1.5 \pm 0.1$ and a linear decline in CV value with an increase in the number of channels. The correlation between adjacent channels in participants decreases by $0.12 \pm 0.05$ as the number of channels gradually increases. The results demonstrate a significant reduction in the number of interrelationships between sEMG signals following negative entropy-based FastICA processing, compared to the mixed sEMG signals. Moreover, this decrease in interrelationships becomes more pronounced with an increasing number of channels. Additionally, the CV of MUNIX gradually decreases with an increase in the number of channels, thereby optimizing the issue of abnormal MUNIX repeatability patterns and further enhancing the reproducibility of MUNIX based on high-density surface EMG signals.
Collapse
Affiliation(s)
- Suqi Xue
- School of Artificial Intelligence, Hangzhou Dianzi University, Hangzhou 310018, China
| | - Farong Gao
- School of Artificial Intelligence, Hangzhou Dianzi University, Hangzhou 310018, China
| | - Xudong Wu
- Department of Orthopedics, Zhoushan Hospital of Traditional Chinese Medicine, Zhoushan 316000, China
| | - Qun Xu
- School of Artificial Intelligence, Hangzhou Dianzi University, Hangzhou 310018, China
| | - Xuecheng Weng
- School of Artificial Intelligence, Hangzhou Dianzi University, Hangzhou 310018, China
| | - Qizhong Zhang
- School of Artificial Intelligence, Hangzhou Dianzi University, Hangzhou 310018, China
| |
Collapse
|
6
|
Risi B, Cotti Piccinelli S, Gazzina S, Labella B, Caria F, Damioli S, Poli L, Padovani A, Filosto M. Prognostic Usefulness of Motor Unit Number Index (MUNIX) in Patients Newly Diagnosed with Amyotrophic Lateral Sclerosis. J Clin Med 2023; 12:5036. [PMID: 37568439 PMCID: PMC10420094 DOI: 10.3390/jcm12155036] [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: 06/18/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
The MUNIX technique allows us to estimate the number and size of surviving motor units (MUs). Previous studies on ALS found correlations between MUNIX and several clinical measures, but its potential role as a predictor of disease progression rate (DPR) has not been thoroughly evaluated to date. We aimed to investigate MUNIX's ability to predict DPR at a six-month follow up. METHODS 24 ALS patients with short disease duration (<24 months from symptoms' onset) were enrolled and divided according to their baseline DPR into two groups (normal [DPR-N] and fast [DPR-F] progressors). MUNIX values were obtained from five muscles (TA, APB, ADM, FDI, Trapezius) and averaged for each subject. RESULTS MUNIX was found to predict DPR at follow up in a multivariable linear regression model; namely, patients with lower MUNIX values were at risk of showing greater DPR scores at follow up. The result was replicated in a simple logistic regression analysis, with the dichotomic category "MUNIX-Low" as the independent variable and the outcome "DPR-F" as the dependent variable. CONCLUSIONS our results pave the way for the use of the MUNIX method as a prognostic tool in early ALS, enabling patients' stratification according to their rates of future decline.
Collapse
Affiliation(s)
- Barbara Risi
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (B.R.); (S.C.P.); (B.L.); (A.P.)
- Unit of Neurology, ASST Spedali Civili, 25123 Brescia, Italy;
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25064 Gussago, Italy; (F.C.); (S.D.)
| | - Stefano Cotti Piccinelli
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (B.R.); (S.C.P.); (B.L.); (A.P.)
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25064 Gussago, Italy; (F.C.); (S.D.)
| | - Stefano Gazzina
- Unit of Neurophysiology, ASST Spedali Civili, 25123 Brescia, Italy;
| | - Beatrice Labella
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (B.R.); (S.C.P.); (B.L.); (A.P.)
- Unit of Neurology, ASST Spedali Civili, 25123 Brescia, Italy;
| | - Filomena Caria
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25064 Gussago, Italy; (F.C.); (S.D.)
| | - Simona Damioli
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25064 Gussago, Italy; (F.C.); (S.D.)
| | - Loris Poli
- Unit of Neurology, ASST Spedali Civili, 25123 Brescia, Italy;
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (B.R.); (S.C.P.); (B.L.); (A.P.)
- Unit of Neurology, ASST Spedali Civili, 25123 Brescia, Italy;
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (B.R.); (S.C.P.); (B.L.); (A.P.)
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25064 Gussago, Italy; (F.C.); (S.D.)
| |
Collapse
|
7
|
Vucic S, Menon P, Huynh W, Mahoney C, Ho KS, Hartford A, Rynders A, Evan J, Evan J, Ligozio S, Glanzman R, Hotchkin MT, Kiernan MC. Efficacy and safety of CNM-Au8 in amyotrophic lateral sclerosis (RESCUE-ALS study): a phase 2, randomised, double-blind, placebo-controlled trial and open label extension. EClinicalMedicine 2023; 60:102036. [PMID: 37396808 PMCID: PMC10314176 DOI: 10.1016/j.eclinm.2023.102036] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 07/04/2023] Open
Abstract
Background CNM-Au8® is a catalytically-active gold nanocrystal neuroprotective agent that enhances intracellular energy metabolism and reduces oxidative stress. The phase 2, randomised, double-blind, placebo-controlled trial and open label extension RESCUE-ALS trial evaluated the efficacy and safety of CNM-Au8 for treatment of amyotrophic lateral sclerosis (ALS). Methods RESCUE-ALS and its long-term open label extension (OLE) were conducted at two multidisciplinary ALS clinics located in Sydney, Australia: (i) the Brain and Mind Centre and (ii) Westmead Hospital. The double-blind portion of RESCUE-ALS was conducted from January 16, 2020 (baseline visit, first-patient first-visit (FPFV)) through July 13, 2021 (double-blind period, last-patient last-visit (LPLV)). Participants (N = 45) were randomised 1:1 to receive 30 mg of CNM-Au8 or matching placebo daily over 36 weeks in addition to background standard of care, riluzole. The primary outcome was mean percent change in summed motor unit number index (MUNIX), a sensitive neurophysiological biomarker of lower motor neuron function. Change in total (or summated) MUNIX score and change in forced vital capacity (FVC) were secondary outcome measures. ALS disease progression events, ALS Functional Rating Scale (ALSFRS-R) change, change in quality of life (ALSSQOL-SF) were assessed as exploratory outcome measures. Long-term survival evaluated vital status of original active versus placebo randomisation for all participants through at least 12 months following last-patient last-visit (LPLV) of the double-blind period. RESCUE-ALS and the open label study are registered in clinicaltrials.gov with registration numbers NCT04098406 and NCT05299658, respectively. Findings In the intention-to-treat (ITT) population, there was no significant difference in the summated MUNIX score percent change (LS mean difference: 7.7%, 95% CI: -11.9 to 27.3%, p = 0.43), total MUNIX score change (18.8, 95% CI: -56.4 to 94.0), or FVC change (LS mean difference: 3.6, 95% CI: -12.4 to 19.7) between the active and placebo treated groups at week 36. In contrast, survival analyses through 12-month LPLV demonstrated a 60% reduction in all-cause mortality with CNM-Au8 treatment [hazard ratio = 0.408 (95% Wald CI: 0.166 to 1.001, log-rank p = 0.0429). 36 participants entered the open label extension (OLE), and those initially randomised to CNM-Au8 exhibited a slower rate of disease progression, as measured by time to the occurrence of death, tracheostomy, initiation of non-invasive ventilatory support, or gastrostomy tube placement. CNM-Au8 was well-tolerated, and no safety signals were observed. Interpretation CNM-Au8, in combination with riluzole, was well-tolerated in ALS with no identified safety signals. While the primary and secondary outcomes of this trial were not significant, the clinically meaningful exploratory results support further investigation of CNM-Au8 in ALS. Funding The RESCUE-ALS was substantially funded by a grant from FightMND. Additional funding was provided by Clene Australia Pty Ltd.
Collapse
Affiliation(s)
- Steve Vucic
- Brain and Nerve Research Centre, Concord Clinical School and Department of Neurology, Concord Repatriation General Hospital, The University of Sydney, Sydney, Australia
| | - Parvathi Menon
- Brain and Nerve Research Centre, Concord Clinical School and Department of Neurology, Concord Repatriation General Hospital, The University of Sydney, Sydney, Australia
| | - William Huynh
- Brain and Mind Centre, University of Sydney, and Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Colin Mahoney
- Brain and Mind Centre, University of Sydney, and Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Karen S. Ho
- Clene Nanomedicine, Inc., Salt Lake City, UT, USA
| | | | | | - Jacob Evan
- Clene Nanomedicine, Inc., Salt Lake City, UT, USA
| | - Jeremy Evan
- Clene Nanomedicine, Inc., Salt Lake City, UT, USA
| | | | | | | | - Matthew C. Kiernan
- Brain and Mind Centre, University of Sydney, and Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| |
Collapse
|
8
|
Xu Q, Xue S, Gao F, Wu Q, Zhang Q. Evaluation method of motor unit number index based on optimal muscle strength combination. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:3854-3872. [PMID: 36899608 DOI: 10.3934/mbe.2023181] [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: 06/18/2023]
Abstract
Repeatability is an important attribute of motor unit number index (MUNIX) technology. This paper proposes an optimal contraction force combination for MUNIX calculation in an effort to improve the repeatability of this technology. In this study, the surface electromyography (EMG) signals of the biceps brachii muscle of eight healthy subjects were initially recorded with high-density surface electrodes, and the contraction strength was the maximum voluntary contraction force of nine progressive levels. Then, by traversing and comparing the repeatability of MUNIX under various combinations of contraction force, the optimal combination of muscle strength is determined. Finally, calculate MUNIX using the high-density optimal muscle strength weighted average method. The correlation coefficient and the coefficient of variation are utilized to assess repeatability. The results show that when the muscle strength combination is 10, 20, 50 and 70% of the maximum voluntary contraction force, the repeatability of MUNIX is greatest, and the correlation between MUNIX calculated using this combination of muscle strength and conventional methods is high (PCC > 0.99), the repeatability of the MUNIX method improved by 11.5-23.8%. The results indicate that the repeatability of MUNIX differs for various combinations of muscle strength and that MUNIX, which is measured with a smaller number and lower-level contractility, has greater repeatability.
Collapse
Affiliation(s)
- Qun Xu
- School of Artificial Intelligence, Hangzhou Dianzi University, Hangzhou 310018, China
| | - Suqi Xue
- School of Artificial Intelligence, Hangzhou Dianzi University, Hangzhou 310018, China
| | - Farong Gao
- School of Artificial Intelligence, Hangzhou Dianzi University, Hangzhou 310018, China
| | - Qiuxuan Wu
- School of Artificial Intelligence, Hangzhou Dianzi University, Hangzhou 310018, China
| | - Qizhong Zhang
- School of Artificial Intelligence, Hangzhou Dianzi University, Hangzhou 310018, China
| |
Collapse
|
9
|
Fournier CN. Considerations for Amyotrophic Lateral Sclerosis (ALS) Clinical Trial Design. Neurotherapeutics 2022; 19:1180-1192. [PMID: 35819713 PMCID: PMC9275386 DOI: 10.1007/s13311-022-01271-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/20/2022] Open
Abstract
Thoughtful clinical trial design is critical for efficient therapeutic development, particularly in the field of amyotrophic lateral sclerosis (ALS), where trials often aim to detect modest treatment effects among a population with heterogeneous disease progression. Appropriate outcome measure selection is necessary for trials to provide decisive and informative results. Investigators must consider the outcome measure's reliability, responsiveness to detect change when change has actually occurred, clinical relevance, and psychometric performance. ALS clinical trials can also be performed more efficiently by utilizing statistical enrichment techniques. Innovations in ALS prediction models allow for selection of participants with less heterogeneity in disease progression rates without requiring a lead-in period, or participants can be stratified according to predicted progression. Statistical enrichment can reduce the needed sample size and improve study power, but investigators must find a balance between optimizing statistical efficiency and retaining generalizability of study findings to the broader ALS population. Additional progress is still needed for biomarker development and validation to confirm target engagement in ALS treatment trials. Selection of an appropriate biofluid biomarker depends on the treatment mechanism of interest, and biomarker studies should be incorporated into early phase trials. Inclusion of patients with ALS as advisors and advocates can strengthen clinical trial design and study retention, but more engagement efforts are needed to improve diversity and equity in ALS research studies. Another challenge for ALS therapeutic development is identifying ways to respect patient autonomy and improve access to experimental treatment, something that is strongly desired by many patients with ALS and ALS advocacy organizations. Expanded access programs that run concurrently to well-designed and adequately powered randomized controlled trials may provide an opportunity to broaden access to promising therapeutics without compromising scientific integrity or rushing regulatory approval of therapies without adequate proof of efficacy.
Collapse
Affiliation(s)
- Christina N Fournier
- Department of Neurology, Emory University, Atlanta, GA, USA.
- Department of Veterans Affairs, Atlanta, GA, USA.
| |
Collapse
|
10
|
Chen M, Bashford J, Zhou P. Motor Unit Number Estimation (MUNE) Free of Electrical Stimulation or M Wave Recording: Feasibility and Challenges. Front Aging Neurosci 2022; 14:799676. [PMID: 35221991 PMCID: PMC8873975 DOI: 10.3389/fnagi.2022.799676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maoqi Chen
- Faculty of Rehabilitation Engineering, University of Health and Rehabilitation Sciences, Qingdao, China
| | - James Bashford
- Department of Basic and Clinical Neuroscience, UK Dementia Research Institute, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Ping Zhou
- Faculty of Rehabilitation Engineering, University of Health and Rehabilitation Sciences, Qingdao, China
- *Correspondence: Ping Zhou
| |
Collapse
|
11
|
Zhang S, Yang X, Xu Y, Luo Y, Fan D, Liu X. Application Value of the Motor Unit Number Index in Patients With Kennedy Disease. Front Neurol 2022; 12:705816. [PMID: 34992574 PMCID: PMC8724309 DOI: 10.3389/fneur.2021.705816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to evaluate the usefulness of the motor unit number index (MUNIX) technique in Kennedy disease (KD) and test the correlation between the MUNIX and other clinical parameters. The MUNIX values of the bilateral deltoid, abductor digiti minimi (ADM), quadriceps femoris (QF), and tibialis anterior (TA) were determined and compared with the course of the disease. The MUNIX sum score was calculated by adding the MUNIX values of these 8 muscles. Disability was evaluated using the spinal and bulbar muscular atrophy functional rating scale (SBMAFRS). The MUNIX scores of patients with KD were negatively correlated with the course of the disease (p < 0.05), whereas their motor unit size index (MUSIX) scores were positively correlated with the course the of disease (p < 0.05). MUNIX sum scores were correlated with SBMAFRS scores (r = 0.714, p < 0.05). MUNIX was more sensitive than compound muscle action potentials or muscle strength as an indicator of neuron loss and axonal collateral reinnervation. The MUNIX sum score is an objective and a reliable indicator of disease progression, and it is a potential choice for therapeutic clinical trials. The MUNIX can assess the functional loss of motor axons and is correlated with disability. The MUNIX sum score may be especially suitable as an objective parameter.
Collapse
Affiliation(s)
- Shuo Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Xin Yang
- Department of Neurology, Changchun Central Hospital, Changchun, China
| | - Yingsheng Xu
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Yongmei Luo
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China.,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xiaoxuan Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
| |
Collapse
|
12
|
Ibrahem AK, Al-Mahdawi AM, Hamdan FB. Motor unit number estimation versus compound muscle action potential in the evaluation of motor unit loss in amyotrophic lateral sclerosis. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00301-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Motor neuron loss is the primary pathologic feature of amyotrophic lateral sclerosis (ALS). An estimate of the number of surviving motor units (MUs) represents a direct measure of the disease state in ALS. The objective of the study is to compare MU number estimation (MUNE) using the multipoint stimulation method (MPS) and compound muscle action potentials (CMAP) amplitude in patients with ALS.
Methods
Twenty-eight patients with ALS with a disease duration of 3–48 months were studied. Nerve conduction study of the median, ulnar, tibial, common peroneal, and sural nerves were done. Besides, electromyography (EMG) of cranio-bulbar, cervical, thoracic and lumbosacral muscles, and MPS-MUNE.
Results
MUNE is decreased in patients with ALS. MUNE was positively correlated with CMAP amplitude, medical research council (MRC) scale, and ALS functional rating scale (ALS-FRS). On the contrary, MUNE was negatively correlated with MUAP duration. Case detection by the MUNE methods was high as compared to that of CMAP amplitude.
Conclusions
MUNE is highly specific and more sensitive than CMAP amplitude in detecting the neurophysiologic abnormalities in patients with ALS. Case detection by MUNE is three times more than CMAP amplitudes. The rate of decline of motor units using the MPS-MUNE is more sensitive than the MRC score and ALSFRS-R when expressed as the percentage change from baseline.
Collapse
|
13
|
Chan Y, Alix JJP, Neuwirth C, Barkhaus PE, Castro J, Jenkins TM, McDermott CJ, Shaw PJ, de Carvalho M, Nandedkar S, Stålberg E, Weber M. Reinnervation as measured by the motor unit size index is associated with preservation of muscle strength in amyotrophic lateral sclerosis, but not all muscles reinnervate. Muscle Nerve 2021; 65:203-210. [PMID: 34687220 DOI: 10.1002/mus.27444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION/AIMS The motor unit size index (MUSIX) may provide insight into reinnervation patterns in diseases such as amyotrophic lateral sclerosis (ALS). However, it is not known whether MUSIX detects clinically relevant changes in reinnervation, or if all muscles manifest changes in MUSIX in response to reinnervation after motor unit loss. METHODS Fifty-seven patients with ALS were assessed at 3-month intervals for 12 months in four centers. Muscles examined were abductor pollicis brevis, abductor digiti minimi, biceps brachii, and tibialis anterior. Results were split into two groups: muscles with increases in MUSIX and those without increases. Longitudinal changes in MUSIX, motor unit number index (MUNIX), compound muscle action potential amplitude, and Medical Research Council strength score were investigated. RESULTS One hundred thirty-three muscles were examined. Fifty-nine percent of the muscles exhibited an increase in MUSIX during the study. Muscles with MUSIX increases lost more motor units (58% decline in MUNIX at 12 months, P < .001) than muscles that did not increase MUSIX (34.6% decline in MUNIX at 12 months, P < .001). However, longitudinal changes in muscle strength were similar. When motor unit loss was similar, the absence of a MUSIX increase was associated with a significantly greater loss of muscle strength (P = .002). DISCUSSION MUSIX increases are associated with greater motor unit loss but relative preservation of muscle strength. Thus, MUSIX appears to be measuring a clinically relevant response that can provide a quantitative outcome measure of reinnervation in clinical trials. Furthermore, MUSIX suggests that reinnervation may play a major role in determining the progression of weakness.
Collapse
Affiliation(s)
- Young Chan
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - James J P Alix
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Christoph Neuwirth
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital, St. Gallen, Switzerland
| | | | - José Castro
- Department of Neurosciences, Centro Hospitalar Lisboa Norte-Hospital de Santa Maria, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Thomas M Jenkins
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | | | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Mamede de Carvalho
- Department of Neurosciences, Centro Hospitalar Lisboa Norte-Hospital de Santa Maria, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | | | - Erik Stålberg
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Uppsala, Sweden
| | - Markus Weber
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital, St. Gallen, Switzerland
| |
Collapse
|
14
|
Mini-Review: Induced pluripotent stem cells and the search for new cell-specific ALS therapeutic targets. Neurosci Lett 2021; 755:135911. [PMID: 33892003 DOI: 10.1016/j.neulet.2021.135911] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/05/2021] [Accepted: 04/17/2021] [Indexed: 12/30/2022]
Abstract
Amongst the most important discoveries in ALS pathobiology are the works demonstrating that multiple cell types contribute to disease onset and progression. However, a significant limitation in ALS research is the inability to obtain tissues from ALS patient brain and spinal cord during the course of the disease. In vivo modeling has provided insights into the role of these cell subtypes in disease onset and progression. However, in vivo models also have shortcomings, including the reliance on a limited number of models based upon hereditary forms of the disease. Therefore, using human induced pluripotent stem cells (iPSC) reprogrammed from somatic cells of ALS patients, with both hereditary and sporadic forms of the disease, and differentiated into cell subtypes of both the central nervous system (CNS) and peripheral nervous system (PNS), have become powerful complementary tools for investigating basic mechanisms of disease as well as a platform for drug discovery. Motor neuron and other neuron subtypes, as well as non-neuronal cells have been differentiated from human iPSC and studied for their potential contributions to ALS pathobiology. As iPSC technologies have advanced, 3D modeling with multicellular systems organised in microfluidic chambers or organoids are the next step in validating the pathways and therapeutic targets already identified. Precision medicine approaches with iPSC using either traditional strategies of screening drugs that target a known pathogenic mechanism as well as "blind-to-target" drug screenings that allow for patient stratification based on drug response rather than clinical characteristics are now being employed.
Collapse
|
15
|
Vucic S, Kiernan MC, Menon P, Huynh W, Rynders A, Ho KS, Glanzman R, Hotchkin MT. Study protocol of RESCUE-ALS: A Phase 2, randomised, double-blind, placebo-controlled study in early symptomatic amyotrophic lateral sclerosis patients to assess bioenergetic catalysis with CNM-A u8 as a mechanism to slow diseas e progression. BMJ Open 2021; 11:e041479. [PMID: 33431491 PMCID: PMC7802642 DOI: 10.1136/bmjopen-2020-041479] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is an adult-onset, progressive and universally fatal neurodegenerative disorder. In Europe, Australia and Canada, riluzole is the only approved therapeutic agent for the treatment of ALS, while in the USA, riluzole and edaravone have been approved by the Food and Drug Administration (FDA) . Neither riluzole nor edaravone treatment has resulted in substantial disease-modifying effects. There is, therefore, an urgent need for drugs that result in safe and effective treatment. Here, we present the design and rationale for the phase 2 RESCUE-ALS study, investigating the novel nanocatalytic drug, CNM-Au8, as a therapeutic intervention that enhances the metabolic and energetic capacity of motor neurones. CNM-Au8 is an aqueous suspension of clean-surfaced, faceted gold nanocrystals that have extraordinary catalytic capabilities, that enhance efficiencies of key metabolic reactions, while simultaneously reducing levels of reactive oxygen species. This trial utilises a novel design by employing motor unit number index (MUNIX), measured by electromyography, as a quantitative measure of lower motor neurone loss and as an early marker of ALS disease progression. METHODS AND ANALYSIS This is a multicentre, randomised, double-blind, parallel group, placebo-controlled study of the efficacy, safety, pharmacokinetics and pharmacodynamics of CNM-Au8 in ALS patients. Patients will be randomised 1:1 to either receive 30 mg of CNM-Au8 once daily or matching placebo over a 36-week double-blind treatment period. Efficacy will be assessed as the change in motor neurone loss as measured by electromyography (eg, MUNIX, the primary endpoint; and secondary endpoints including MScanFit, motor unit size index, Split Hand Index, Neurophysiology Index). Exploratory endpoints include standard clinical and quality of life assessments. ETHICS AND DISSEMINATION RESCUE-ALS was approved by the Western Sydney Local Health District Human Research Ethics Committee (Ethics Ref: 2019/ETH12107). Results of the study will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04098406.
Collapse
Affiliation(s)
- Steve Vucic
- Department of Neurology, Westmead Hospital and Western Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Parvathi Menon
- Department of Neurology, Westmead Hospital and Western Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - William Huynh
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Karen S Ho
- Clene Nanomedicine, Salt Lake City, Utah, USA
| | | | | |
Collapse
|
16
|
Gunes T, Sirin NG, Sahin S, Kose E, Isak B. Use of CMAP, MScan fit-MUNE, and MUNIX in understanding neurodegeneration pattern of ALS and detection of early motor neuron loss in daily practice. Neurosci Lett 2020; 741:135488. [PMID: 33217503 DOI: 10.1016/j.neulet.2020.135488] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The pattern of lower motor neuron (LMN) degeneration in amyotrophic lateral sclerosis (ALS), i.e., dying-back (from the nerve ending to cell body) or dying-forward (from the cell body to nerve ending), has been widely discussed. In this study, we aimed to evaluate LMN loss using compound muscle action potential (CMAP), motor unit number index (MUNIX), and MScan-fit-based motor unit number estimation (MUNE) to understand the pattern of neurodegeneration in ALS. METHODS Twenty-five patients were compared with 25 controls using CMAP amplitude and area, MUNIX, and MScan-fit MUNE in three proximal and distal muscles innervated by the ulnar nerve. RESULTS Unlike the controls, the CMAP area, MScan-fit MUNE, and MUNIX recorded in ALS patients showed more neurodegeneration in distal muscles than proximal muscles. In ALS patients with unaffected CMAP amplitudes (n = 13), the CMAP area, MScan-fit MUNE, and MUNIX showed subtle motor unit loss of 30.7 %, 53.8 %, and 38.4 %, respectively. CONCLUSION The CMAP area, MScan-fit MUNE, and MUNIX showed neurodegeneration earlier than the reduction in CMAP amplitude. These tests confirmed dying-back neurodegeneration, while only MUSIX showed re-innervation in ALS.
Collapse
Affiliation(s)
- Taskin Gunes
- Department of Neurology, Marmara University Hospital, Istanbul, Turkey; VM Maltepe Medicalpark Hospital, Istanbul, Turkey.
| | | | - Sevki Sahin
- Department of Neurology, Maltepe University Hospital, Istanbul, Turkey.
| | - Ercan Kose
- Department of Neurology, Sultan 2. Abdulhamit Han Training and Research Hospital, Istanbul, Turkey.
| | - Baris Isak
- Department of Neurology, Marmara University Hospital, Istanbul, Turkey.
| |
Collapse
|
17
|
Lawley A, Abbas A, Seri S, Rajabally YA. Peripheral nerve electrophysiology studies in relation to fatigue in patients with chronic inflammatory demyelinating polyneuropathy. Clin Neurophysiol 2020; 131:2926-2931. [PMID: 32928696 DOI: 10.1016/j.clinph.2020.08.011] [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: 12/04/2019] [Revised: 07/07/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To explore the relationship between fatigue, standard electrophysiological parameters and number and size of functioning motor units in patients with chronic inflammatory demyelinating polyneuropathy (CIDP). METHODS Experienced fatigue was assessed using the linearly-weighted, modified Rasch-built fatigue severity scale (R-FSS) and the multidimensional Checklist of Individual Strength (CIS). Averaged electrophysiology values were calculated from multiple nerves. Motor Unit Number Index (MUNIX) technique was utilised to assess motor unit function. Assessments were repeated in 15 patients receiving regular intravenous immunoglobulin therapy, with changes in parameters calculated. RESULTS R-FSS and CIS scores did not correlate MUNIX or MUSIX sum scores from 3 different muscles. Inverse correlation was observed only between distal CMAP area and R-FSS but not CIS scores. However, changes in distal CMAP area and R-FSS scores on repeat assessment were not correlated. CONCLUSIONS Experienced fatigue does not appear to correlate with loss of functioning motor units in patients with CIDP. Changes in experienced fatigue on repeat assessment did not correlate with changes in any of the electrophysiological parameters, suggesting fatigue experienced in CIDP is not strongly correlated with peripheral nerve dysfunction. SIGNIFICANCE Nerve conduction studies and MUNIX values do not appear to be useful surrogate markers for fatigue in CIDP.
Collapse
Affiliation(s)
- Andrew Lawley
- School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, UK; Department of Clinical Neurophysiology, The Birmingham Women's and Children's Hospital NHS Foundation Trust, UK
| | - Ahmed Abbas
- Inflammatory Neuropathy Clinic, University Hospitals Birmingham, Birmingham, UK
| | - Stefano Seri
- School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, UK; Department of Clinical Neurophysiology, The Birmingham Women's and Children's Hospital NHS Foundation Trust, UK
| | - Yusuf A Rajabally
- Inflammatory Neuropathy Clinic, University Hospitals Birmingham, Birmingham, UK; Aston Medical School, Aston University, Birmingham, UK.
| |
Collapse
|
18
|
Bashford J, Mills K, Shaw C. The evolving role of surface electromyography in amyotrophic lateral sclerosis: A systematic review. Clin Neurophysiol 2020; 131:942-950. [PMID: 32044239 PMCID: PMC7083223 DOI: 10.1016/j.clinph.2019.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/23/2019] [Accepted: 12/14/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Amyotrophic lateral sclerosis (ALS) is an adult-onset neurodegenerative disease that leads to inexorable motor decline and a median survival of three years from symptom onset. Surface EMG represents a major technological advance that has been harnessed in the development of novel neurophysiological biomarkers. We have systematically reviewed the current application of surface EMG techniques in ALS. METHODS We searched PubMed to identify 42 studies focusing on surface EMG and its associated analytical methods in the diagnosis, prognosis and monitoring of ALS patients. RESULTS A wide variety of analytical techniques were identified, involving motor unit decomposition from high-density grids, motor unit number estimation and measurements of neuronal hyperexcitability or neuromuscular architecture. Some studies have proposed specific diagnostic and prognostic criteria however clinical calibration in large ALS cohorts is currently lacking. The most validated method to monitor disease is the motor unit number index (MUNIX), which has been implemented as an outcome measure in two ALS clinical trials. CONCLUSION Surface EMG offers significant practical and analytical flexibility compared to invasive techniques. To capitalise on this fully, emphasis must be placed upon the multi-disciplinary collaboration of clinicians, bioengineers, mathematicians and biostatisticians. SIGNIFICANCE Surface EMG techniques can enrich effective biomarker development in ALS.
Collapse
Affiliation(s)
- J. Bashford
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | | | | |
Collapse
|
19
|
Higashihara M, Menon P, van den Bos M, Pavey N, Vucic S. Reproducibility of motor unit number index and MScanFit motor unit number estimation across intrinsic hand muscles. Muscle Nerve 2020; 62:192-200. [PMID: 32077117 DOI: 10.1002/mus.26839] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/09/2020] [Accepted: 02/15/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION We sought to evaluate the reproducibility of the motor unit number index (MUNIX) and MScanFit motor unit number estimation (MScan) when recording was performed over intrinsic hand muscles. METHODS The compound muscle action potential (CMAP) amplitude, MUNIX, and MScan were measured from the abductor pollicis brevis (APB), first dorsal interosseous (FDI), and abductor digit minimi (ADM) muscles from 15 healthy volunteers on three different occasions. RESULTS The reproducibility of CMAP amplitudes was excellent, with intraclass correlation coefficients (ICC) of 0.86 (APB), 0.90 (FDI), and 0.96 (ADM). Motor unit number index (ICCAPB 0.73, ICCFDI 0.85, ICCADM 0.85) and MScan (ICCAPB 0.86, ICCFDI 0.83, ICCADM 0.81) were highly reproducible across the three muscles. There were no significant correlations between MUNIX and MScan coefficients of variation (CV) and CMAP amplitude CVs. DISCUSSION Reproducibility of MUNIX and MScan was not significantly different across the intrinsic hand muscles and was independent of CMAP amplitude variability.
Collapse
Affiliation(s)
- Mana Higashihara
- Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
| | - Parvathi Menon
- Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
| | - Mehdi van den Bos
- Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
| | - Nathan Pavey
- Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
| | - Steve Vucic
- Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
| |
Collapse
|
20
|
Motor unit number index (MUNIX) in the quantitative assessment of severity and surgical outcome in cervical spondylotic amyotrophy. Clin Neurophysiol 2019; 130:1465-1473. [DOI: 10.1016/j.clinph.2019.05.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/05/2019] [Accepted: 05/05/2019] [Indexed: 12/11/2022]
|
21
|
Moldovan M, Vucic S. Is Motor Unit Number Index (MUNIX) an index of Compound Muscle Action Potential amplitude rather than motor unit number? Clin Neurophysiol 2019; 130:1686-1687. [PMID: 31303432 DOI: 10.1016/j.clinph.2019.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 06/29/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Mihai Moldovan
- Faculty of Health and Medical Sciences, Department of Neuroscience, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark.
| | - Steve Vucic
- Department of Neurology, Westmead Hospital, Cnr Hawkesbury and Darcy Roads, Westmead, NSW 2145, Australia.
| |
Collapse
|
22
|
Wang J, Zuzzio K, Walker CL. Systemic Dental Pulp Stem Cell Secretome Therapy in a Mouse Model of Amyotrophic Lateral Sclerosis. Brain Sci 2019; 9:brainsci9070165. [PMID: 31337114 PMCID: PMC6680809 DOI: 10.3390/brainsci9070165] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 12/13/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a devastating motor neuron (MN) disease with no cure. Accumulating evidence indicates ALS involves a complex interaction between central glia and the peripheral immune response and neuromuscular interface. Stem cell secretomes contain various beneficial trophic factors and cytokines, and we recently demonstrated that administration of the secretome of adipose-derived stem cells (ASCs) during early neuromuscular junction (NMJ) denervation in the mutant superoxide dismutase (mSOD1G93A) ALS mouse ameliorated NMJ disruption. In the present study, we hypothesized that administration of dental pulp stem cell secretome in the form of conditioned medium (DPSC-CM) at different stages of disease would promote NMJ innervation, prevent MN loss and extend lifespan. Our findings show that DPSC-CM significantly improved NMJ innervation at postnatal day (PD) 47 compared to vehicle treated mSOD1G93A mice (p < 0.05). During late pre-symptomatic stages (PD70-P91), DPSC-CM significantly increased MN survival (p < 0.01) and NMJ preservation (p < 0.05), while reactive gliosis in the ventral horn remained unaffected. For DPSC-CM treated mSOD1G93A mice beginning at symptom onset, post-onset days of survival as well as overall lifespan was significantly increased compared to vehicle treated mice (p < 0.05). This is the first study to show therapeutic benefits of systemic DPSC secretome in experimental ALS, and establishes a foundation for future research into the treatment effects and mechanistic analyses of DPSC and other stem cell secretome therapies in ALS.
Collapse
Affiliation(s)
- Junmei Wang
- Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, IN 46202, USA
| | - Kirstin Zuzzio
- Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, IN 46202, USA
| | - Chandler L Walker
- Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, IN 46202, USA.
- Neuromuscular Research Group, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN 46202, USA.
| |
Collapse
|
23
|
Verber NS, Shepheard SR, Sassani M, McDonough HE, Moore SA, Alix JJP, Wilkinson ID, Jenkins TM, Shaw PJ. Biomarkers in Motor Neuron Disease: A State of the Art Review. Front Neurol 2019; 10:291. [PMID: 31001186 PMCID: PMC6456669 DOI: 10.3389/fneur.2019.00291] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/06/2019] [Indexed: 12/17/2022] Open
Abstract
Motor neuron disease can be viewed as an umbrella term describing a heterogeneous group of conditions, all of which are relentlessly progressive and ultimately fatal. The average life expectancy is 2 years, but with a broad range of months to decades. Biomarker research deepens disease understanding through exploration of pathophysiological mechanisms which, in turn, highlights targets for novel therapies. It also allows differentiation of the disease population into sub-groups, which serves two general purposes: (a) provides clinicians with information to better guide their patients in terms of disease progression, and (b) guides clinical trial design so that an intervention may be shown to be effective if population variation is controlled for. Biomarkers also have the potential to provide monitoring during clinical trials to ensure target engagement. This review highlights biomarkers that have emerged from the fields of systemic measurements including biochemistry (blood, cerebrospinal fluid, and urine analysis); imaging and electrophysiology, and gives examples of how a combinatorial approach may yield the best results. We emphasize the importance of systematic sample collection and analysis, and the need to correlate biomarker findings with detailed phenotype and genotype data.
Collapse
Affiliation(s)
- Nick S Verber
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Stephanie R Shepheard
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Matilde Sassani
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Harry E McDonough
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Sophie A Moore
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - James J P Alix
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Iain D Wilkinson
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Tom M Jenkins
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Pamela J Shaw
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| |
Collapse
|
24
|
Chipika RH, Finegan E, Li Hi Shing S, Hardiman O, Bede P. Tracking a Fast-Moving Disease: Longitudinal Markers, Monitoring, and Clinical Trial Endpoints in ALS. Front Neurol 2019; 10:229. [PMID: 30941088 PMCID: PMC6433752 DOI: 10.3389/fneur.2019.00229] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 02/22/2019] [Indexed: 12/13/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) encompasses a heterogeneous group of phenotypes with different progression rates, varying degree of extra-motor involvement and divergent progression patterns. The natural history of ALS is increasingly evaluated by large, multi-time point longitudinal studies, many of which now incorporate presymptomatic and post-mortem assessments. These studies not only have the potential to characterize patterns of anatomical propagation, molecular mechanisms of disease spread, but also to identify pragmatic monitoring markers. Sensitive markers of progressive neurodegenerative change are indispensable for clinical trials and individualized patient care. Biofluid markers, neuroimaging indices, electrophysiological markers, rating scales, questionnaires, and other disease-specific instruments have divergent sensitivity profiles. The discussion of candidate monitoring markers in ALS has a dual academic and clinical relevance, and is particularly timely given the increasing number of pharmacological trials. The objective of this paper is to provide a comprehensive and critical review of longitudinal studies in ALS, focusing on the sensitivity profile of established and emerging monitoring markers.
Collapse
Affiliation(s)
| | - Eoin Finegan
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Stacey Li Hi Shing
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Peter Bede
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
25
|
Alix JJP, Neuwirth C, Gelder L, Burkhardt C, Castro J, de Carvalho M, Gawel M, Goedee S, Grosskreutz J, Lenglet T, Moglia C, Omer T, Schrooten M, Nandedkar S, Stalberg E, Barkhaus PE, Furtula J, van Dijk JP, Baldinger R, Costa J, Otto M, Sandberg A, Weber M. Assessment of the reliability of the motor unit size index (MUSIX) in single subject "round-robin" and multi-centre settings. Clin Neurophysiol 2019; 130:666-674. [PMID: 30870802 DOI: 10.1016/j.clinph.2019.01.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 11/16/2018] [Accepted: 01/03/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The motor unit size index (MUSIX) is incorporated into the motor unit number index (MUNIX). Our objective was to assess the intra-/inter-rater reliability of MUSIX in healthy volunteers across single subject "round robin" and multi-centre settings. METHODS Data were obtained from (i) a round-robin assessment in which 12 raters (6 with prior experience and 6 without) assessed six muscles (abductor pollicis brevis, abductor digiti minimi, biceps brachii, tibialis anterior, extensor digitorum brevis and abductor hallucis) and (ii) a multi-centre study with 6 centres studying the same muscles in 66 healthy volunteers. Intra/inter-rater data were provided by 5 centres, 1 centre provided only intra-rater data. Intra/inter-rater variability was assessed using the coefficient of variation (COV), Bland-Altman plots, bias and 95% limits of agreement. RESULTS In the round-robin assessment intra-rater COVs for MUSIX ranged from 7.8% to 28.4%. Inter-rater variability was between 7.8% and 16.2%. Prior experience did not impact on MUSIX values. In the multi-centre study MUSIX was more consistent than the MUNIX. Abductor hallucis was the least reliable muscle. CONCLUSIONS The MUSIX is a reliable neurophysiological biomarker of reinnervation. SIGNIFICANCE MUSIX could provide insights into the pathophysiology of a range of neuromuscular disorders, providing a quantitative biomarker of reinnervation.
Collapse
Affiliation(s)
- James J P Alix
- Sheffield Institute for Translational Neuroscience, University of Sheffield, 385A Glossop Road, Sheffield S10 2HQ, UK.
| | - Christoph Neuwirth
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital, St. Gallen, Switzerland
| | - Lucy Gelder
- Statistical Services Unit, University of Sheffield, UK
| | - Christian Burkhardt
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital, St. Gallen, Switzerland
| | - José Castro
- Department of Neurosciences, Hospital de Santa Maria, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal
| | - Mamede de Carvalho
- Department of Neurosciences, Hospital de Santa Maria, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal
| | - Malgorzata Gawel
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Stephan Goedee
- Brain Centre Rudolf Magnus, Department of Neurology and Neurosurgery, UMC Utrecht, Utrecht, The Netherlands
| | - Julian Grosskreutz
- Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Timothée Lenglet
- Département de Neurophysiologie, Groupe hospitalier Pitié-Salpêtrière, APHP, Paris, France
| | - Cristina Moglia
- ALS Centre of Torino, Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Taha Omer
- Trinity College Biomedical Science Institute (TBSI) and Beaumont Hospital, Dublin, Ireland
| | - Maarten Schrooten
- Department of Neurology, University Hospital Leuven, Leuven, Belgium
| | - Sanjeev Nandedkar
- Natus Medical, Inc., 15 Dartantra Drive, Hopewell Junction, NY 12533, USA
| | - Erik Stalberg
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Sweden
| | - Paul E Barkhaus
- Milwaukee Veterans Administration Medical Center and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jasna Furtula
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Reto Baldinger
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital, St. Gallen, Switzerland
| | - Joao Costa
- Department of Neurosciences, Hospital de Santa Maria, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal
| | - Marit Otto
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Arne Sandberg
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Sweden
| | - Markus Weber
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital, St. Gallen, Switzerland
| |
Collapse
|
26
|
Jacobsen AB, Bostock H, Tankisi H. Following disease progression in motor neuron disorders with 3 motor unit number estimation methods. Muscle Nerve 2018; 59:82-87. [DOI: 10.1002/mus.26304] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Anna Bystrup Jacobsen
- Department of Clinical Neurophysiology; Aarhus University Hospital; Nørrebrogade 44, 8000 Aarhus C Denmark
| | - Hugh Bostock
- Institute of Neurology; University College London; London UK
| | - Hatice Tankisi
- Department of Clinical Neurophysiology; Aarhus University Hospital; Nørrebrogade 44, 8000 Aarhus C Denmark
| |
Collapse
|
27
|
Fatehi F, Grapperon AM, Fathi D, Delmont E, Attarian S. The utility of motor unit number index: A systematic review. Neurophysiol Clin 2018; 48:251-259. [PMID: 30287192 DOI: 10.1016/j.neucli.2018.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 09/04/2018] [Accepted: 09/11/2018] [Indexed: 12/11/2022] Open
Abstract
The need for a valid biomarker for assessing disease progression and for use in clinical trials on amyotrophic lateral sclerosis (ALS) has stimulated the study of methods that could measure the number of motor units. Motor unit number index (MUNIX) is a newly developed neurophysiological technique that was demonstrated to have a good correlation with the number of motor units in a given muscle, even though it does not necessarily accurately express the actual number of viable motor neurons. Several studies demonstrated the technique is reproducible and capable of following motor neuron loss in patients with ALS and peripheral polyneuropathies. The main goal of this review was to conduct an extensive review of the literature using MUNIX. We conducted a systematic search in English medical literature published in two databases (PubMed and SCOPUS). In this review, we aimed to answer the following queries: Comparison of MUNIX with other MUNE techniques; the reproducibility of MUNIX; the utility of MUNIX in ALS and preclinical muscles, peripheral neuropathies, and other neurological disorders.
Collapse
Affiliation(s)
- Farzad Fatehi
- Reference Center for Neuromuscular Diseases and ALS, Timone University Hospital, 13385 Marseille, France; Department of Neurology, Iranian Center of Neurological Research, Neuroscience Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Aude-Marie Grapperon
- Reference Center for Neuromuscular Diseases and ALS, Timone University Hospital, 13385 Marseille, France
| | - Davood Fathi
- Department of Neurology, Iranian Center of Neurological Research, Neuroscience Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Emilien Delmont
- Reference Center for Neuromuscular Diseases and ALS, Timone University Hospital, 13385 Marseille, France
| | - Shahram Attarian
- Reference Center for Neuromuscular Diseases and ALS, Timone University Hospital, 13385 Marseille, France; Inserm, GMGF, Aix-Marseille University, Marseille, 13385 France.
| |
Collapse
|
28
|
Higashihara M, Menon P, van den Bos M, Geevasinga N, Vucic S. Reproducibility of motor unit number index and multiple point stimulation motor unit number estimation in controls. Muscle Nerve 2018; 58:660-664. [PMID: 30194855 DOI: 10.1002/mus.26339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Reproducibility of the multiple point stimulation motor unit number estimation (MPS-MUNE) technique was compared with the recently developed motor unit number index (MUNIX) technique. METHODS MPS-MUNE and MUNIX were performed on 15 healthy subjects at 3 different time-points by the same examiner. Reproducibility was analyzed using intraclass correlation coefficient (ICC) and coefficient of variation (CV). RESULTS ICC values for MUNIX and MPS-MUNE were excellent across 3 tests (0.80 and 0.77, respectively), although CV values were significantly lower for MUNIX than MPS-MUNE (P < 0.01). In addition, test-retest reproducibility was better for MUNIX, a finding largely attributable to poor reproducibility of the single motor unit action potential area. MUNIX (R = -0.48, P < 0.05) and MPS-MUNE (R = -0.53, P < 0.05) were significantly correlated with age. DISCUSSION MUNIX demonstrated better intrarater reproducibility and may be a more reliable neurophysiological biomarker than MPS-MUNE. Muscle Nerve 58: 660-664, 2018.
Collapse
Affiliation(s)
- Mana Higashihara
- Department of Neurology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Parvathi Menon
- Westmead Clinical School, Cnr. Hawkesbury and Darcy Road, University of Sydney, New South Wales, 2145, Australia
| | - Mehdi van den Bos
- Westmead Clinical School, Cnr. Hawkesbury and Darcy Road, University of Sydney, New South Wales, 2145, Australia
| | - Nimeshan Geevasinga
- Westmead Clinical School, Cnr. Hawkesbury and Darcy Road, University of Sydney, New South Wales, 2145, Australia
| | - Steve Vucic
- Westmead Clinical School, Cnr. Hawkesbury and Darcy Road, University of Sydney, New South Wales, 2145, Australia
| |
Collapse
|
29
|
Intraspinal Transplantation of the Adipose Tissue-Derived Regenerative Cells in Amyotrophic Lateral Sclerosis in Accordance with the Current Experts' Recommendations: Choosing Optimal Monitoring Tools. Stem Cells Int 2018; 2018:4392017. [PMID: 30158984 PMCID: PMC6109475 DOI: 10.1155/2018/4392017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/26/2018] [Accepted: 06/14/2018] [Indexed: 12/11/2022] Open
Abstract
Stem cells (SCs) may constitute a perspective alternative to pharmacological treatment in neurodegenerative diseases. Although the safety of SC transplantation has been widely shown, their clinical efficiency in amyotrophic lateral sclerosis (ALS) is still to be proved. It is not only due to a limited number of studies, small treatment groups, and fast but nonlinear disease progression but also due to lack of objective methods able to show subtle clinical changes. Preliminary guidelines for cell therapy have recently been proposed by a group of ALS experts. They combine clinical, neurophysiological, and functional assessment together with monitoring of the cytokine level. Here, we describe a pilot study on transplantation of autologous adipose-derived regenerative cells (ADRC) into the spinal cord of the patients with ALS and monitoring of the results in accordance with the current recommendations. To show early and/or subtle changes within the muscles of interest, a wide range of clinical and functional tests were used and compared in order to choose the most sensitive and optimal set. Additionally, an analysis of transplanted ADRC was provided to develop standards ensuring the derivation and verification of adequate quality of transplanted cells and to correlate ADRC properties with clinical outcome.
Collapse
|
30
|
Bas J, Delmont E, Fatehi F, Salort-Campana E, Verschueren A, Pouget J, Lefebvre MN, Grapperon AM, Attarian S. Motor unit number index correlates with disability in Charcot-Marie-Tooth disease. Clin Neurophysiol 2018; 129:1390-1396. [PMID: 29729594 DOI: 10.1016/j.clinph.2018.04.359] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 03/11/2018] [Accepted: 04/08/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to assess the usefulness of motor unit number index (MUNIX) technique in Charcot-Marie-Tooth disease and test the correlation between MUNIX and clinical impairment. METHODS MUNIX technique was performed in the abductor pollicis brevis (APB), the abductor digiti minimi (ADM) and the tibialis anterior (TA) muscles in the nondominant side. A MUNIX sum score was calculated by adding the MUNIX of these 3 muscles. Muscle strength was measured using the MRC (medical research council) scale. Disability was evaluated using several functional scales, including CMT neuropathy score version 2 (CMTNSv2) and overall neuropathy limitation scale (ONLS). RESULTS A total of 56 CMT patients were enrolled. The MUNIX scores of the ADM, APB and TA muscles correlated with the MRC score of the corresponding muscle (p < 0.01). The MUNIX sum score correlated with the clinical scales CMTNSv2 (r = -0.65, p < 0.01) and ONLS (r = -0.57, p < 0.01). CONCLUSION MUNIX correlates with muscle strength and clinical measurements of disability in patients with CMT disease. SIGNIFICANCE The MUNIX technique evaluates motor axonal loss and correlates with disability. The MUNIX sum score may be a useful outcome measure of disease progression in CMT.
Collapse
Affiliation(s)
- Joachim Bas
- Referral Center for Neuromuscular Diseases and ALS, La Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Emilien Delmont
- Referral Center for Neuromuscular Diseases and ALS, La Timone University Hospital, Aix-Marseille University, Marseille, France; Aix-Marseille University, UMR 7286, Medicine Faculty, Marseille, France
| | - Farzad Fatehi
- Referral Center for Neuromuscular Diseases and ALS, La Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Emmanuelle Salort-Campana
- Referral Center for Neuromuscular Diseases and ALS, La Timone University Hospital, Aix-Marseille University, Marseille, France; Aix-Marseille University, Inserm, GMGF, Marseille, France
| | - Annie Verschueren
- Referral Center for Neuromuscular Diseases and ALS, La Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Jean Pouget
- Referral Center for Neuromuscular Diseases and ALS, La Timone University Hospital, Aix-Marseille University, Marseille, France; Aix-Marseille University, Inserm, GMGF, Marseille, France
| | - Marie-Noëlle Lefebvre
- CIC-CPCET, La Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Aude-Marie Grapperon
- Referral Center for Neuromuscular Diseases and ALS, La Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Shahram Attarian
- Referral Center for Neuromuscular Diseases and ALS, La Timone University Hospital, Aix-Marseille University, Marseille, France; Aix-Marseille University, Inserm, GMGF, Marseille, France.
| |
Collapse
|
31
|
Nandedkar SD, Barkhaus PE, Stålberg EV, Neuwirth C, Weber M. Motor unit number index: Guidelines for recording signals and their analysis. Muscle Nerve 2018; 58:374-380. [DOI: 10.1002/mus.26099] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2018] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - Erik V. Stålberg
- University Hospital; Uppsala Sweden
- Institute of Neurosciences; Uppsala Sweden
| | | | | |
Collapse
|
32
|
The utility of motor unit number estimation methods versus quantitative motor unit potential analysis in diagnosis of ALS. Clin Neurophysiol 2018; 129:646-653. [DOI: 10.1016/j.clinph.2018.01.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 11/30/2017] [Accepted: 01/03/2018] [Indexed: 12/12/2022]
|
33
|
Escorcio‐Bezerra ML, Abrahao A, Nunes KF, De Oliveira Braga NI, Oliveira ASB, Zinman L, Manzano GM. Motor unit number index and neurophysiological index as candidate biomarkers of presymptomatic motor neuron loss in amyotrophic lateral sclerosis. Muscle Nerve 2018; 58:204-212. [DOI: 10.1002/mus.26087] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Marcio Luiz Escorcio‐Bezerra
- Department of Neurology and NeurosurgeryEscola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo, 65004039‐002São Paulo SP Brazil
| | - Agessandro Abrahao
- Department of Neurology and NeurosurgeryEscola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo, 65004039‐002São Paulo SP Brazil
- Sunnybrook Health Sciences Centre, Division of Neurology, Department of MedicineUniversity of TorontoToronto Ontario Canada
| | - Karlo Faria Nunes
- Department of Neurology and NeurosurgeryEscola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo, 65004039‐002São Paulo SP Brazil
| | - Nadia Iandoli De Oliveira Braga
- Department of Neurology and NeurosurgeryEscola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo, 65004039‐002São Paulo SP Brazil
| | - Acary Souza Bulle Oliveira
- Department of Neurology and NeurosurgeryEscola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo, 65004039‐002São Paulo SP Brazil
| | - Lorne Zinman
- Sunnybrook Health Sciences Centre, Division of Neurology, Department of MedicineUniversity of TorontoToronto Ontario Canada
| | - Gilberto Mastrocola Manzano
- Department of Neurology and NeurosurgeryEscola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo, 65004039‐002São Paulo SP Brazil
| |
Collapse
|
34
|
Miralles F. Motor unit number index (MUNIX) derivation from the relationship between the area and power of surface electromyogram: a computer simulation and clinical study. J Neural Eng 2018; 15:036013. [PMID: 29424359 DOI: 10.1088/1741-2552/aaae19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The motor unit number index (MUNIX) is a technique based on the surface electromyogram (sEMG) that is gaining acceptance as a method for monitoring motor neuron loss, because it is reliable and produces less discomfort than other electrodiagnostic techniques having the same intended purpose. MUNIX assumes that the relationship between the area of sEMG obtained at increasing levels of muscle activation and the values of a variable called 'ideal case motor unit count' (ICMUC), defined as the product of the ratio between area and power of the compound muscle action potential (CMAP) by that of the sEMG, is described by a decreasing power function. Nevertheless, the reason for this comportment is unknown. The objective of this work is to investigate if the definition of MUNIX could derive from more basic properties of the sEMG. APPROACH The CMAP and sEMG epochs obtained at different levels of muscle activation from (1) the abductor pollicis brevis (APB) muscle of persons with and without a carpal tunnel syndrome (CTS) and (2) from a computer model of sEMG generation previously published were analysed. MAIN RESULTS MUNIX reflects the power relationship existing between the area and power of a sEMG. The exponent of this function was smaller in patients with motor CTS than in the rest of the subjects. The analysis of the relationship between the area and power of a sEMG could aid in distinguishing a MUNIX reduction due to a motoneuron loss from that due to a loss of muscle fibre. SIGNIFICANCE MUNIX is derived from the relationship between the area and power of a sEMG. This relationship changes when there is a loss of motor units (MUs), which partially explains the diagnostic sensibility of MUNIX. Although the reasons for this change are unknown, it could reflect an increase in the proportion of MUs of great amplitude.
Collapse
Affiliation(s)
- Francesc Miralles
- Gabinet d'Electrodiagnòstic, Servei de Neurologia, Hospital Universitari Son Espases, Carretera de Valldemossa, 79., 07010 Palma de Mallorca, Illes Balears, Spain
| |
Collapse
|
35
|
Benmouna K, Milants C, Wang FC. Correlations between MUNIX and adapted multiple point stimulation MUNE methods. Clin Neurophysiol 2018; 129:341-344. [DOI: 10.1016/j.clinph.2017.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/12/2017] [Accepted: 11/06/2017] [Indexed: 12/13/2022]
|
36
|
Escorcio-Bezerra ML, Abrahao A, Santos-Neto D, de Oliveira Braga NI, Oliveira ASB, Manzano GM. Why averaging multiple MUNIX measures in the longitudinal assessment of patients with ALS? Clin Neurophysiol 2017; 128:2392-2396. [PMID: 29096211 DOI: 10.1016/j.clinph.2017.09.104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 07/31/2017] [Accepted: 09/10/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess the impact of averaging multiple MUNIX trials on the follow-up of patients with amyotrophic lateral sclerosis (ALS). METHODS We determined the percent relative change (%RC) of MUNIX, in healthy subjects and patients with ALS, by subtracting the MUNIX value in the second visit from the first. Both the mean of a set of three MUNIX (mean-MUNIX) and the first MUNIX sample (single-MUNIX) were evaluated. Then, we studied the sensitivity to detect relative changes over time and the statistical dispersion of the %RC from these two parameters. RESULTS We found that the mean-MUNIX %RC has lower mean coefficient of variation than the single-MUNIX %RC in all muscles. The mean-MUNIX also resulted in more ALS patients with significant %RC, i.e., outside reference limits. CONCLUSION The mean-MUNIX resulted in less dispersed values of %RC in patients with ALS and thus, increased the precision of the technique. The mean-MUNIX resulted also in an increase in the sensitivity to track changes over time in these patients. SIGNIFICANCE The mean-MUNIX should be considered in any ALS follow-up study as a more reliable approach and as a way of potentially reducing the sample size needed for the study.
Collapse
|
37
|
Motor unit number index (MUNIX) in patients with anti-MAG neuropathy. Clin Neurophysiol 2017; 128:1264-1269. [DOI: 10.1016/j.clinph.2017.04.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 04/06/2017] [Accepted: 04/26/2017] [Indexed: 12/12/2022]
|
38
|
Reproducibility, and sensitivity to motor unit loss in amyotrophic lateral sclerosis, of a novel MUNE method: MScanFit MUNE. Clin Neurophysiol 2017; 128:1380-1388. [DOI: 10.1016/j.clinph.2017.03.045] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/20/2017] [Accepted: 03/27/2017] [Indexed: 11/18/2022]
|
39
|
Grimaldi S, Duprat L, Grapperon AM, Verschueren A, Delmont E, Attarian S. Global motor unit number index sum score for assessing the loss of lower motor neurons in amyotrophic lateral sclerosis. Muscle Nerve 2017; 56:202-206. [PMID: 28164325 DOI: 10.1002/mus.25595] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/18/2017] [Accepted: 01/25/2017] [Indexed: 11/11/2022]
Abstract
INTRODUCTION We propose a motor unit number index (MUNIX) global sum score in amyotrophic lateral sclerosis (ALS) to estimate the loss of functional motor units. METHODS MUNIX was assessed for 18 ALS patients and 17 healthy controls in 7 muscles: the abductor pollicis brevis (APB), abductor digiti minimi (ADM), tibialis anterior (TA), deltoid, trapezius, submental complex, and orbicularis oris. RESULTS MUNIX was significantly lower in ALS patients than in healthy controls for the APB, ADM, TA, and trapezius muscles. The MUNIX sum score of 4 muscles (ADM + APB + trapezius + TA) was lower in ALS patients (P = 0.01) and was correlated with clinical scores. DISCUSSION The global MUNIX sum score proposed in this study estimates the loss of lower motor neurons in several body regions, including the trapezius, and is correlated with clinical impairment in ALS patients. Muscle Nerve 56: 202-206, 2017.
Collapse
Affiliation(s)
- Stephan Grimaldi
- Reference Center for Neuromuscular Diseases and ALS, APHM, University Hospital of Marseille/Timone University Hospital, 264 rue Saint Pierre, 13005, Marseille, France
| | - Lauréline Duprat
- Reference Center for Neuromuscular Diseases and ALS, APHM, University Hospital of Marseille/Timone University Hospital, 264 rue Saint Pierre, 13005, Marseille, France
| | - Aude-Marie Grapperon
- Reference Center for Neuromuscular Diseases and ALS, APHM, University Hospital of Marseille/Timone University Hospital, 264 rue Saint Pierre, 13005, Marseille, France
| | - Annie Verschueren
- Reference Center for Neuromuscular Diseases and ALS, APHM, University Hospital of Marseille/Timone University Hospital, 264 rue Saint Pierre, 13005, Marseille, France
| | - Emilien Delmont
- Reference Center for Neuromuscular Diseases and ALS, APHM, University Hospital of Marseille/Timone University Hospital, 264 rue Saint Pierre, 13005, Marseille, France
| | - Shahram Attarian
- Reference Center for Neuromuscular Diseases and ALS, APHM, University Hospital of Marseille/Timone University Hospital, 264 rue Saint Pierre, 13005, Marseille, France.,Aix Marseille University, INSERM, GMGF, Marseille, France
| |
Collapse
|
40
|
The Motor Unit Number Index of Subclinical Abnormality in Amyotrophic Lateral Sclerosis. J Clin Neurophysiol 2017; 33:564-568. [PMID: 27295331 DOI: 10.1097/wnp.0000000000000296] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Diagnosis of amyotrophic lateral sclerosis (ALS) at an early stage is challenging, thus making the enrollment of these patients in clinical trials infeasible. In this study, we investigated the potential usability of motor unit number index (MUNIX) to detect denervation of clinically intact muscles of ALS patients. METHODS Thirty-two first dorsal interosseous muscles of 26 ALS patients were evaluated with both MUNIX and needle electromyography. RESULTS The mean MUNIX value of first dorsal interosseous muscles was 131 in the control group, whereas it was 48, 34, 15, and 8 for Medical Research Council scales of 5, 4, 3, and 2, respectively, in the ALS patients. The optimal cutoff point gave a sensitivity of 0.89 and a specificity of 1.0. Among 9 intact first dorsal interosseous muscles of the ALS patients, 8 showed MUNIX values below the cutoff point, whereas only 2 first dorsal interosseous muscles showed denervation on needle electromyography. CONCLUSIONS MUNIX could serve as a sensitive technique to detect denervation of clinically intact muscles of ALS patients.
Collapse
|
41
|
Gilmore KJ, Allen MD, Doherty TJ, Kimpinski K, Rice CL. Electrophysiological and neuromuscular stability of persons with chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2017; 56:413-420. [DOI: 10.1002/mus.25516] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/07/2016] [Accepted: 12/09/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Kevin J. Gilmore
- School of Kinesiology; The University of Western Ontario; London ON Canada
| | - Matti D. Allen
- School of Medicine Queen's University Kingston ON Canada
| | - Timothy J. Doherty
- Department of Clinical Neurological Sciences; Schulich School of Medicine and Dentistry, The University of Western Ontario; London ON Canada
- Department of Physical Medicine and Rehabilitation; Schulich School of Medicine and Dentistry, The University of Western Ontario; London ON Canada
| | - Kurt Kimpinski
- School of Kinesiology; The University of Western Ontario; London ON Canada
- Department of Clinical Neurological Sciences; Schulich School of Medicine and Dentistry, The University of Western Ontario; London ON Canada
| | - Charles L. Rice
- School of Kinesiology; The University of Western Ontario; London ON Canada
- Department of Anatomy and Cell Biology; Schulich School of Medicine and Dentistry, The University of Western Ontario; London ON Canada
| |
Collapse
|
42
|
Swash M. MUNIX in the clinic in ALS: MUNE comes of age. Clin Neurophysiol 2017; 128:482-483. [DOI: 10.1016/j.clinph.2016.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 12/12/2022]
|
43
|
Motor Unit Number Index (MUNIX) detects motor neuron loss in pre-symptomatic muscles in Amyotrophic Lateral Sclerosis. Clin Neurophysiol 2017; 128:495-500. [DOI: 10.1016/j.clinph.2016.11.026] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/03/2016] [Accepted: 11/20/2016] [Indexed: 11/22/2022]
|
44
|
Escorcio-Bezerra ML, Oliveira ASB, De Oliveira Braga NI, Manzano GM. Improving the reproducibility of motor unit number index. Muscle Nerve 2017; 55:635-638. [PMID: 27438087 DOI: 10.1002/mus.25260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 12/12/2022]
|
45
|
Abstract
The motor unit comprises the anterior horn cell, its axon, and the muscle fibers that it innervates. Although the true number of motor units is unknown, the number of motor units appears to vary greatly between different muscles and between different individuals. Assessment of the number and function of motor units is needed in diseases of the anterior horn cell and other motor nerve disorders. Amyotrophic lateral sclerosis is the most important disease of anterior horn cells. The need for an effective biomarker for assessing disease progression and for use in clinical trials in amyotrophic lateral sclerosis has stimulated the study of methods to measure the number of motor units. Since 1970 a number of different methods, including the incremental, F-wave, multipoint, and statistical methods, have been developed but none has achieved widespread applicability. Two methods (MUNIX and the multipoint incremental method) are in current use across multiple centres and are discussed in detail in this review, together with other recently published methods. Imaging with magnetic resonance and ultrasound is increasingly being applied to this area. Motor unit number estimates have also been applied to other neuromuscular diseases such as spinal muscular atrophy, compression neuropathies, and prior poliomyelitis. The need for an objective measure for the assessment of motor units remains tantalizingly close but unfulfilled in 2016.
Collapse
Affiliation(s)
- Robert D Henderson
- Department of Neurology, Royal Brisbane & Women's Hospital and University of Queensland Centre for Clinical Research, Herston, Brisbane, 4006, Australia.
| | - Pamela A McCombe
- Department of Neurology, Royal Brisbane & Women's Hospital and University of Queensland Centre for Clinical Research, Herston, Brisbane, 4006, Australia
| |
Collapse
|
46
|
Philibert M, Grapperon AM, Delmont E, Attarian S. Monitoring the short-term effect of intravenous immunoglobulins in multifocal motor neuropathy using motor unit number index. Clin Neurophysiol 2017; 128:235-240. [PMID: 27988478 DOI: 10.1016/j.clinph.2016.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 10/30/2016] [Accepted: 11/12/2016] [Indexed: 12/12/2022]
|
47
|
Neuwirth C, Burkhardt C, Weber M. Motor unit number index in the nasalis muscle in healthy subjects and patients with amyotrophic lateral sclerosis. Muscle Nerve 2016; 54:733-7. [PMID: 26970219 DOI: 10.1002/mus.25100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 02/25/2016] [Accepted: 03/03/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Motor unit number index (MUNIX) is a quick and feasible electrophysiological technique that estimates the number of motor neurons in limb muscles in healthy and amyotrophic lateral sclerosis (ALS) subjects. In this study we explored the feasibility, reliability, and differences of MUNIX in nasalis muscles in healthy subjects and ALS patients. METHODS MUNIX of the nasalis muscle of 50 healthy and 20 ALS subjects with bulbar involvement was compared. Functional impairment was evaluated by the ALS Functional Rating Scale-Revised and its bulbar subscore. RESULTS MUNIX was well tolerated and quickly performed. Bulbar ALS patients showed non-significant lower nasalis MUNIX values and a lower functional bulbar subscore. Intra- and interrater reliability showed high intraclass correlation coefficients (ICCs) in healthy subjects (0.87) and ALS patients (0.92). CONCLUSION MUNIX of the nasalis muscle is a reproducible method, but it showed no significant difference between healthy and bulbar ALS subjects and seems not to be a useful marker of disease progression in ALS. Muscle Nerve 54: 733-737, 2016.
Collapse
Affiliation(s)
- Christoph Neuwirth
- Neuromuscular Diseases Centre, ALS Clinic, Kantonsspital St. Gallen, Rorschacherstrasse 95, CH-9007, St. Gallen, Switzerland.
| | - Christian Burkhardt
- Neuromuscular Diseases Centre, ALS Clinic, Kantonsspital St. Gallen, Rorschacherstrasse 95, CH-9007, St. Gallen, Switzerland
| | - Markus Weber
- Neuromuscular Diseases Centre, ALS Clinic, Kantonsspital St. Gallen, Rorschacherstrasse 95, CH-9007, St. Gallen, Switzerland
| |
Collapse
|
48
|
New insights into the clinical neurophysiological assessment of ALS. Neurophysiol Clin 2016; 46:157-63. [PMID: 27364772 DOI: 10.1016/j.neucli.2016.05.070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 12/11/2022] Open
|
49
|
Escorcio-Bezerra ML, Abrahao A, de Castro I, Chieia MAT, de Azevedo LA, Pinheiro DS, de Oliveira Braga NI, de Oliveira ASB, Manzano GM. MUNIX: Reproducibility and clinical correlations in Amyotrophic Lateral Sclerosis. Clin Neurophysiol 2016; 127:2979-2984. [PMID: 27458836 DOI: 10.1016/j.clinph.2016.06.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 05/05/2016] [Accepted: 06/12/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To study the reproducibility, diagnostic yield to detect denervation, and clinical correlations of the Motor Unit Number Index (MUNIX) in subjects with Amyotrophic Lateral Sclerosis (ALS). METHODS MUNIX evaluation was performed in three muscles twice on the same day to assess reproducibility. Cut-off values for the MUNIX were based on data from 51 healthy subjects (controls) to evaluate the sensitivity of the technique to detect denervation in 30 subjects with ALS. RESULTS The method had good reproducibility. The variability was greater in the ALS group. In 23 ALS subjects (77%), low MUNIX values were detected. Most of the muscles with low MUNIX had also low compound muscle action potential (CMAP) and strength, but these parameters were normal in 9% of muscles. According to ROC curve analysis, MUNIX was generally accurate (AUC=0.9504) for discriminating between healthy individuals and subjects with at least one denervated muscle. CONCLUSIONS MUNIX variability was higher in the ALS group. The method showed good diagnostic performance for the detection of denervation in a sample of patients with ALS. SIGNIFICANCE This study demonstrated that in addition to being a quantitative tool MUNIX can detect denervation in subjects with ALS.
Collapse
Affiliation(s)
| | | | - Isac de Castro
- Department of Medicine, Division of Molecular Medicine, University of São Paulo School of Medicine (FMUSP), Brazil
| | | | | | | | | | | | | |
Collapse
|
50
|
Blasco H, Vourc'h P, Pradat PF, Gordon PH, Andres CR, Corcia P. Further development of biomarkers in amyotrophic lateral sclerosis. Expert Rev Mol Diagn 2016; 16:853-68. [PMID: 27275785 DOI: 10.1080/14737159.2016.1199277] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is an idiopathic neurodegenerative disease usually fatal in less than three years. Even if standard guidelines are available to diagnose ALS, the mean diagnosis delay is more than one year. In this context, biomarker discovery is a priority. Research has to focus on new diagnostic tools, based on combined explorations. AREAS COVERED In this review, we specifically focus on biology and imaging markers. We detail the innovative field of 'omics' approach and imaging and explain their limits to be useful in routine practice. We describe the most relevant biomarkers and suggest some perspectives for biomarker research. Expert commentary: The successive failures of clinical trials in ALS underline the need for new strategy based on innovative tools to stratify patients and to evaluate their responses to treatment. Biomarker data may be useful to improve the designs of clinical trials. Biomarkers are also needed to better investigate disease pathophysiology, to identify new therapeutic targets, and to improve the performance of clinical assessments for diagnosis and prognosis in the clinical setting. A consensus on the best management of neuroimaging and 'omics' methods is necessary and a systematic independent validation of findings may add robustness to future studies.
Collapse
Affiliation(s)
- H Blasco
- a UMR INSERM U930 , Université François-Rabelais de Tours , Tours , France.,b Laboratoire de Biochimie et de Biologie Moléculaire , Hôpital Bretonneau, CHRU de Tours , Tours , France
| | - P Vourc'h
- a UMR INSERM U930 , Université François-Rabelais de Tours , Tours , France.,b Laboratoire de Biochimie et de Biologie Moléculaire , Hôpital Bretonneau, CHRU de Tours , Tours , France
| | - P F Pradat
- c Département des Maladies du Système Nerveux, Assistance Publique-Hôpitaux de Paris , Hôpital de la Salpêtrière , Paris , France.,d Sorbonne Universités, UPMC Université Paris 06, CNRS, INSERM , Laboratoire d'Imagerie Biomédicale , Paris , France
| | - P H Gordon
- e Neurology Unit, Northern Navajo Medical Center , Shiprock , NM , USA
| | - C R Andres
- a UMR INSERM U930 , Université François-Rabelais de Tours , Tours , France.,b Laboratoire de Biochimie et de Biologie Moléculaire , Hôpital Bretonneau, CHRU de Tours , Tours , France
| | - P Corcia
- a UMR INSERM U930 , Université François-Rabelais de Tours , Tours , France.,b Laboratoire de Biochimie et de Biologie Moléculaire , Hôpital Bretonneau, CHRU de Tours , Tours , France.,f Centre SLA , Service de Neurologie et Neurophysiologie Clinique, CHRU de Tours , Tours , France
| |
Collapse
|