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Timmins HC, Thompson AE, Kiernan MC. Diagnostic criteria for amyotrophic lateral sclerosis. Curr Opin Neurol 2024; 37:570-576. [PMID: 39037015 DOI: 10.1097/wco.0000000000001302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
PURPOSE OF REVIEW The present review will discuss the evolution of diagnostic criteria for amyotrophic lateral sclerosis (ALS) and biomarker considerations. RECENT FINDINGS To address the limitations of existing ALS diagnostic criteria, a consortium of key stakeholders developed the Gold Coast consensus criteria (GCC). The GCC has similar or greater sensitivity compared with the revised El Escorial (rEEC) and Awaji criteria (AC), particularly for atypical phenotypes, maintained across disease duration, severity, and site of onset. In addition to improving diagnostic sensitivity, using the GCC in clinical trials may promote an increased enrolment of up to 50% of ALS patients who do not currently meet the full diagnostic eligibility requirements of the rEEC. Future inclusion of genetic biomarkers may mitigate some limitations of the GCC, to further improve diagnostic utility. In advance of such a process, validation of these biomarkers will be required before inclusion as additional criteria. SUMMARY The GCC are simpler to use than previous consensus criteria, with demonstrated greater sensitivity and, enabling an earlier and more definitive ALS diagnosis, thereby facilitating wider enrolment into clinical trials. Broader implementation of the GCC in clinical trial settings is currently underway, globally.
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Affiliation(s)
| | - Alexandra E Thompson
- Neuroscience Research Australia
- Department of Neurology, Royal Prince Alfred Hospital Sydney, Australia
| | - Matthew C Kiernan
- Neuroscience Research Australia
- University of New South Wales
- Department of Neurology, Prince of Wales Hospital
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Vacchiano V, Di Stasi V, Teodorani L, Faini C, Morabito F, Liguori R. Comparative assessment of MScanFit MUNE and quantitative EMG in amyotrophic lateral sclerosis diagnosis: A prospective study. Clin Neurophysiol 2024; 166:66-73. [PMID: 39126873 DOI: 10.1016/j.clinph.2024.07.017] [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: 04/19/2024] [Revised: 05/28/2024] [Accepted: 07/24/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE Motor Unit Number Estimation (MUNE) techniques are crucial in assessing lower motor neuron loss. MScanFit MUNE (MScanFit) is a novel tool which estimates MUNE values from compound muscle action potential (CMAP) scans by considering the probabilistic nature of motor unit firing. We conducted a prospective study to evaluate the diagnostic utility of MScanFit compared to quantitative electromyography (qEMG) in ALS patients. METHODS We enrolled 35 patients diagnosed with amyotrophic lateral sclerosis (ALS) and 14 healthy controls, assessing qEMG and MScanFit MUNE in abductor pollicis brevis, abductor digiti minimi and tibialis anterior muscles. RESULTS We found higher sensitivity of qEMG in detecting abnormalities compared to MScanFit, with a high concordance rate between the two techniques. Notably, a few muscles exhibited abnormal MUNE but normal qEMG findings, suggesting a potential complementary role for MScanFit in ALS diagnosis. Neurophysiological parameters from MScanFit showed good correlations with qEMG measures. Subclinical neurophysiological involvement was observed in muscles with normal strength, emphasizing the importance of sensitive diagnostic tools. CONCLUSION MScanFit demonstrated validity in distinguishing ALS patients from healthy subjects and correlated well with qEMG parameters. SIGNIFICANCE Our study confirmed the diagnostic utility of MScanFit MUNE in ALS, highlighting its role as a supplementary diagnostic tool.
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Affiliation(s)
- Veria Vacchiano
- UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Centro Clinico NeMO, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
| | - Vitantonio Di Stasi
- UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luca Teodorani
- Dipartimento di Scienze Biomediche e Neuromotorie, University of Bologna, Bologna, Italy
| | - Claudia Faini
- Dipartimento di Scienze Biomediche e Neuromotorie, University of Bologna, Bologna, Italy
| | - Francesca Morabito
- UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Rocco Liguori
- UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Centro Clinico NeMO, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie, University of Bologna, Bologna, Italy
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Boran HE, Alaydin HC, Arslan I, Kocak OK, Kılınc H, Cengiz B. Exploring the effect of the nerve conduction distance on the MScanFit method ofmotor unit number estimation (MUNE). Neurophysiol Clin 2024; 54:102991. [PMID: 38970866 DOI: 10.1016/j.neucli.2024.102991] [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: 12/22/2023] [Revised: 05/18/2024] [Accepted: 05/18/2024] [Indexed: 07/08/2024] Open
Abstract
OBJECTIVE MScanFit motor unit number estimation (MUNE) is a sensitive method for detecting motor unit loss and has demonstrated high reproducibility in various settings. In this study, our aim was to assess the outputs of this method when the nerve conduction distance is increased. METHODS MScanFit recordings were obtained from the abductor digiti minimi muscle of 20 healthy volunteers. To evaluate the effect of nerve conduction distance, the ulnar nerve was stimulated from the wrist and elbow respectively. Reproducibility of MUNE, compound muscle action potential (CMAP), and other motor unit parameters were assessed using intraclass correlation coefficients (ICCs). RESULTS Motor unit numbers obtained from stimulation at the wrist and elbow did not significantly differ and exhibited strong consistency in the ICC test (120.3 ± 23.7 vs. 118.5 ± 27.9, p > 0.05, ICC: 0.88). Similar repeatability values were noted for other parameters. However, the Largest Unit (%) displayed notable variability between the two regions and exhibited a negative correlation with nerve conduction distance. CONCLUSION Our findings indicate that MScanFit can consistently calculate motor unit numbers and most of its outputs without substantial influence from nerve conduction distance. Exploring MScanFit's capabilities in various settings could enhance our understanding of its strengths and limitations for extensive use in clinical practice.
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Affiliation(s)
- H Evren Boran
- Department of Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey; Department of Neurology, Section of Clinical Neurophysiology, Faculty of Medicine, Gazi University, Ankara, Turkey; Neuroscience and Neurotechnology Center of Excellence, Ankara, Turkey.
| | - Halil Can Alaydin
- Department of Neurology, Section of Clinical Neurophysiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ilker Arslan
- Department of Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ozlem Kurtkaya Kocak
- Department of Neurology, Section of Clinical Neurophysiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Hasan Kılınc
- Neuroscience and Neurotechnology Center of Excellence, Ankara, Turkey
| | - Bulent Cengiz
- Department of Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey; Department of Neurology, Section of Clinical Neurophysiology, Faculty of Medicine, Gazi University, Ankara, Turkey; Neuroscience and Neurotechnology Center of Excellence, Ankara, Turkey
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Stikvoort García DJL, Goedee HS, van Eijk RPA, van Schelven LJ, van den Berg LH, Sleutjes BTHM. Revisiting distinct nerve excitability patterns in patients with amyotrophic lateral sclerosis. Brain 2024; 147:2842-2853. [PMID: 38662766 DOI: 10.1093/brain/awae131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 08/02/2024] Open
Abstract
Amyotrophic lateral sclerosis is a devastating neurodegenerative disease, characterized by loss of central and peripheral motor neurons. Although the disease is clinically and genetically heterogeneous, axonal hyperexcitability is a commonly observed feature that has been suggested to reflect an early pathophysiological step linked to the neurodegenerative cascade. Therefore, it is important to clarify the mechanisms causing axonal hyperexcitability and how these relate to the clinical characteristics of patients. Measures derived directly from a nerve excitability recording are frequently used as study end points, although their biophysical basis is difficult to deduce. Mathematical models can aid in the interpretation but are reliable only when applied to group-averaged recordings. Consequently, model estimates of membrane properties cannot be compared with clinical characteristics or treatment effects in individual patients, posing a considerable limitation in heterogeneous diseases, such as amyotrophic lateral sclerosis. To address these challenges, we revisited nerve excitability using a new pattern analysis-based approach (principal component analysis). We evaluated disease-specific patterns of excitability changes and established their biophysical origins. Based on the observed patterns, we developed new compound measures of excitability that facilitate the implementation of this approach in clinical settings. We found that excitability changes in amyotrophic lateral sclerosis patients (n = 161, median disease duration = 11 months) were characterized by four unique patterns compared with controls (n = 50, age and sex matched). These four patterns were best explained by changes in resting membrane potential (modulated by Na+/K+ currents), slow potassium and sodium currents (modulated by their gating kinetics) and refractory properties of the nerve. Consequently, we were able to show that altered gating of slow potassium channels was associated with, and predictive of, the rate of progression of the disease on the amyotrophic lateral sclerosis functional rating scale. Based on these findings, we designed four composite measures that capture these properties to facilitate implementation outside this study. Our findings demonstrate that changes in nerve excitability in patients with amyotrophic lateral sclerosis are dominated by four distinct patterns, each with a distinct biophysical origin. Based on this new approach, we provide evidence that altered slow potassium-channel function might play a role in the rate of disease progression. The magnitudes of these patterns, quantified using a similar approach or our new composite measures, have potential as efficient measures to study membrane properties directly in amyotrophic lateral sclerosis patients, and thus aid prognostic stratification and trial design.
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Affiliation(s)
| | - H Stephan Goedee
- Department of Neurology, Brain Centre Utrecht, University Medical Centre Utrecht, Utrecht, 3584CX, The Netherlands
| | - Ruben P A van Eijk
- Department of Neurology, Brain Centre Utrecht, University Medical Centre Utrecht, Utrecht, 3584CX, The Netherlands
- Biostatistics and Research Support, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Universiteitsweg 100, 3584CX, Utrecht, The Netherlands
| | - Leonard J van Schelven
- Department of Medical Technology and Clinical Physics, University Medical Centre Utrecht, 3584CX, Utrecht, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology, Brain Centre Utrecht, University Medical Centre Utrecht, Utrecht, 3584CX, The Netherlands
| | - Boudewijn T H M Sleutjes
- Department of Neurology, Brain Centre Utrecht, University Medical Centre Utrecht, Utrecht, 3584CX, The Netherlands
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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.
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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
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Shin-Yi Lin C, Howells J, Rutkove S, Nandedkar S, Neuwirth C, Noto YI, Shahrizaila N, Whittaker RG, Bostock H, Burke D, Tankisi H. Neurophysiological and imaging biomarkers of lower motor neuron dysfunction in motor neuron diseases/amyotrophic lateral sclerosis: IFCN handbook chapter. Clin Neurophysiol 2024; 162:91-120. [PMID: 38603949 DOI: 10.1016/j.clinph.2024.03.015] [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: 10/03/2023] [Revised: 02/07/2024] [Accepted: 03/12/2024] [Indexed: 04/13/2024]
Abstract
This chapter discusses comprehensive neurophysiological biomarkers utilised in motor neuron disease (MND) and, in particular, its commonest form, amyotrophic lateral sclerosis (ALS). These encompass the conventional techniques including nerve conduction studies (NCS), needle and high-density surface electromyography (EMG) and H-reflex studies as well as novel techniques. In the last two decades, new methods of assessing the loss of motor units in a muscle have been developed, that are more convenient than earlier methods of motor unit number estimation (MUNE),and may use either electrical stimulation (e.g. MScanFit MUNE) or voluntary activation (MUNIX). Electrical impedance myography (EIM) is another novel approach for the evaluation that relies upon the application and measurement of high-frequency, low-intensity electrical current. Nerve excitability techniques (NET) also provide insights into the function of an axon and reflect the changes in resting membrane potential, ion channel dysfunction and the structural integrity of the axon and myelin sheath. Furthermore, imaging ultrasound techniques as well as magnetic resonance imaging are capable of detecting the constituents of morphological changes in the nerve and muscle. The chapter provides a critical description of the ability of each technique to provide neurophysiological insight into the complex pathophysiology of MND/ALS. However, it is important to recognise the strengths and limitations of each approach in order to clarify utility. These neurophysiological biomarkers have demonstrated reliability, specificity and provide additional information to validate and assess lower motor neuron dysfunction. Their use has expanded the knowledge about MND/ALS and enhanced our understanding of the relationship between motor units, axons, reflexes and other neural circuits in relation to clinical features of patients with MND/ALS at different stages of the disease. Taken together, the ultimate goal is to aid early diagnosis, distinguish potential disease mimics, monitor and stage disease progression, quantify response to treatment and develop potential therapeutic interventions.
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Affiliation(s)
- Cindy Shin-Yi Lin
- Faculty of Medicine and Health, Central Clinical School, Brain and Mind Centre, University of Sydney, Sydney 2006, Australia.
| | - James Howells
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Seward Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sanjeev Nandedkar
- Natus Medical Inc, Middleton, Wisconsin, USA and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christoph Neuwirth
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital, St. Gallen, Switzerland
| | - Yu-Ichi Noto
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Roger G Whittaker
- Newcastle University Translational and Clinical Research Institute (NUTCRI), Newcastle University., Newcastle Upon Tyne, United Kingdom
| | - Hugh Bostock
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, Queen Square, WC1N 3BG, London, United Kingdom
| | - David Burke
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Klein CS, Liu H, Xiong Y. Estimation of the number of motor units in the human extensor digitorum brevis using MScanFit. PLoS One 2024; 19:e0302214. [PMID: 38669263 PMCID: PMC11051589 DOI: 10.1371/journal.pone.0302214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/30/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE Our aim was to determine the number and size parameters of EDB motor units in healthy young adults using MScanFit, a novel approach to motor unit number estimation (MUNE). Since variability in MUNE is related to compound muscle action potential (CMAP) size, we employed a procedure to document the optimal EDB electromyographic (EMG) electrode position prior to recording MUNE, a neglected practice in MUNE. METHODS Subjects were 21 adults 21-44 y. Maximum CMAPs were recorded from 9 sites in a 4 cm2 region centered over the EDB and the site with the largest amplitude was used in the MUNE experiment. For MUNE, the peroneal nerve was stimulated at the fibular head to produce a detailed EDB stimulus-response curve or "MScan". Motor unit number and size parameters underlying the MScan were simulated using the MScanFit mathematical model. RESULTS In 19 persons, the optimal recording site was superior, superior and proximal, or superior and distal to the EDB mid-belly, whereas in 3 persons it was proximal to the mid-belly. Ranges of key MScanFit parameters were as follows: maximum CMAP amplitude (3.1-8.5 mV), mean SMUP amplitude (34.4-106.7 μV), mean normalized SMUP amplitude (%CMAP max, 0.95-2.3%), largest SMUP amplitude (82.7-348 μV), and MUNE (43-103). MUNE was not related to maximum CMAP amplitude (R2 = 0.09), but was related to mean SMUP amplitude (R2 = -0.19, P = 0.05). CONCLUSION The EDB CMAP was highly sensitive to electrode position, and the optimal position differed between subjects. Individual differences in EDB MUNE were not related to CMAP amplitude. Inter-subject variability of EDB MUNE (coefficient of variation) was much less than previously reported, possibly explained by better optimization of the EMG electrode and the unique approach of MScanFit MUNE.
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Affiliation(s)
- Cliff S. Klein
- Guangdong Work Injury Rehabilitation Center, Guangzhou, Guangdong, China
| | - Hui Liu
- Guangdong Work Injury Rehabilitation Center, Guangzhou, Guangdong, China
| | - Yuan Xiong
- Guangdong Work Injury Rehabilitation Center, Guangzhou, Guangdong, China
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Pavey N, Hannaford A, Higashihara M, van den Bos M, Kiernan MC, Menon P, Vucic S. Utility of split hand index with different motor unit number estimation techniques in ALS. Clin Neurophysiol 2023; 156:175-182. [PMID: 37967511 DOI: 10.1016/j.clinph.2023.09.018] [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: 08/07/2023] [Revised: 09/04/2023] [Accepted: 09/27/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE Utility of the split hand index (SI) in amyotrophic lateral sclerosis (ALS) has been reported when using the compound muscle action potential (CMAP) amplitude method (SICMAP amp). A motor unit number index (MUNIX) based SI method (SIMUNIX) was purported to exhibit higher sensitivity. The present study assessed the clinical utility of SI, derived by CMAP amplitude, MUNIX and MScan-MUNE (SIMScanFit-MUNE) methods, in ALS. METHODS Sixty-two consecutive patients with neuromuscular symptoms (36 ALS and 26 ALS-mimics) were prospectively recruited. The SI was derived by dividing the product of the CMAP amplitude, MUNIX and MScan-MUNE values recorded over first dorsal interosseous and abductor pollicis brevis by values recorded over abductor digit minimi. RESULTS SICMAP amp, SIMUNIX and SIMScanFit-MUNE were significantly reduced in ALS, with SICMAP amp (area under curve (AUC) = 0.801) and SIMScanFit-MUNE (AUC = 0.805) exhibiting greater diagnostic utility than SIMUNIX (AUC = 0.713). SICMAP amp and SIMScanFit-MUNE exhibited significant correlations with clinical measures of functional disability and weakness of intrinsic hand muscles. CONCLUSIONS SI differentiated ALS from mimic disorders, with SICMAP amp and SIMScanFit-MUNE exhibiting greater utility. SIGNIFICANCE The split hand index represents could serve as a potential diagnostic biomarker in ALS.
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Affiliation(s)
- Nathan Pavey
- Brain and Nerve Research Centre, Concord Clinical School, The University of Sydney, Concord Hospital, Sydney, NSW Australia
| | - Andrew Hannaford
- Brain and Nerve Research Centre, Concord Clinical School, The University of Sydney, Concord Hospital, Sydney, NSW Australia
| | - Mana Higashihara
- Department of Neurology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Mehdi van den Bos
- Brain and Nerve Research Centre, Concord Clinical School, The University of Sydney, Concord Hospital, Sydney, NSW Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, The University of Sydney; and Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Parvathi Menon
- Brain and Nerve Research Centre, Concord Clinical School, The University of Sydney, Concord Hospital, Sydney, NSW Australia
| | - Steve Vucic
- Brain and Nerve Research Centre, Concord Clinical School, The University of Sydney, Concord Hospital, Sydney, NSW Australia.
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McMackin R, Bede P, Ingre C, Malaspina A, Hardiman O. Biomarkers in amyotrophic lateral sclerosis: current status and future prospects. Nat Rev Neurol 2023; 19:754-768. [PMID: 37949994 DOI: 10.1038/s41582-023-00891-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
Disease heterogeneity in amyotrophic lateral sclerosis poses a substantial challenge in drug development. Categorization based on clinical features alone can help us predict the disease course and survival, but quantitative measures are also needed that can enhance the sensitivity of the clinical categorization. In this Review, we describe the emerging landscape of diagnostic, categorical and pharmacodynamic biomarkers in amyotrophic lateral sclerosis and their place in the rapidly evolving landscape of new therapeutics. Fluid-based markers from cerebrospinal fluid, blood and urine are emerging as useful diagnostic, pharmacodynamic and predictive biomarkers. Combinations of imaging measures have the potential to provide important diagnostic and prognostic information, and neurophysiological methods, including various electromyography-based measures and quantitative EEG-magnetoencephalography-evoked responses and corticomuscular coherence, are generating useful diagnostic, categorical and prognostic markers. Although none of these biomarker technologies has been fully incorporated into clinical practice or clinical trials as a primary outcome measure, strong evidence is accumulating to support their clinical utility.
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Affiliation(s)
- Roisin McMackin
- Discipline of Physiology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Academic Unit of Neurology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Peter Bede
- Academic Unit of Neurology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Computational Neuroimaging Group, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Department of Neurology, St James's Hospital, Dublin, Ireland
| | - Caroline Ingre
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Andrea Malaspina
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Orla Hardiman
- Academic Unit of Neurology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, The University of Dublin, Dublin, Ireland.
- Department of Neurology, Beaumont Hospital, Dublin, Ireland.
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Abstract
Although the past two decades have produced exciting discoveries in the genetics and pathology of amyotrophic lateral sclerosis (ALS), progress in developing an effective therapy remains slow. This review summarizes the critical discoveries and outlines the advances in disease characterization, diagnosis, imaging, and biomarkers, along with the current status of approaches to ALS care and treatment. Additional knowledge of the factors driving disease progression and heterogeneity will hopefully soon transform the care for patients with ALS into an individualized, multi-prong approach able to prevent disease progression sufficiently to allow for a dignified life with limited disability.
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Affiliation(s)
- Hristelina Ilieva
- Jefferson Weinberg ALS Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Justin Kwan
- National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD, USA
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11
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Stikvoort García DJL, Sleutjes BTHM, van Schelven LJ, Goedee HS, van den Berg LH. Diagnostic accuracy of nerve excitability and compound muscle action potential scan derived biomarkers in amyotrophic lateral sclerosis. Eur J Neurol 2023; 30:3068-3078. [PMID: 37354059 DOI: 10.1111/ene.15954] [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: 04/03/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND AND PURPOSE The lack of reliable early biomarkers still causes substantial diagnostic delays in amyotrophic lateral sclerosis (ALS). The aim was to assess the diagnostic accuracy of a novel electrophysiological protocol in patients with suspected motor neuron disease (MND). METHODS Consecutive patients with suspected MND were prospectively recruited at our tertiary referral centre for MND in Utrecht, The Netherlands. Procedures were performed in accordance with the Standards for Reporting of Diagnostic Accuracy. In addition to the standard diagnostic workup, an electrophysiological protocol of compound muscle action potential (CMAP) scans and nerve excitability tests was performed on patients' thenar muscles. The combined diagnostic yield of nerve excitability and CMAP scan based motor unit number estimation was compared to the Awaji and Gold Coast criteria and their added value was determined. RESULTS In all, 153 ALS or progressive muscular atrophy patients, 63 disease controls and 43 healthy controls were included. Our electrophysiological protocol had high diagnostic accuracy (area under the curve [AUC] 0.85, 95% confidence interval [95% CI] 0.80-0.90), even in muscles with undetectable axon loss (AUC 0.78, 95% CI 0.70-0.85) and in bulbar-onset patients (AUC 0.85, 95% CI 0.73-0.95). Twenty-four of 33 (73%) ALS patients who could not be diagnosed during the same visit were correctly identified, as well as 8/13 (62%) ALS patients not meeting the Gold Coast criteria and 49/59 (83%) ALS patients not meeting the Awaji criteria during this first visit. CONCLUSIONS Our practical and non-invasive electrophysiological protocol may improve early diagnosis in clinically challenging patients with suspected ALS. Routine incorporation may boost early diagnosis, enhance patient selection and generate baseline measures for clinical trials.
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Affiliation(s)
- D J L Stikvoort García
- Department of Neurology, Brain Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B T H M Sleutjes
- Department of Neurology, Brain Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L J van Schelven
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H S Goedee
- Department of Neurology, Brain Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L H van den Berg
- Department of Neurology, Brain Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
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12
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Vucic S. Clinical utility of far field motor potentials in amyotrophic lateral sclerosis. Muscle Nerve 2023; 68:237-239. [PMID: 37269166 DOI: 10.1002/mus.27852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/09/2023] [Accepted: 05/14/2023] [Indexed: 06/04/2023]
Abstract
See article on pages 257–263 in this issue
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Affiliation(s)
- Steve Vucic
- Brain and Nerve Research Center, The University of Sydney, Sydney, New South Wales, Australia
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13
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Higashihara M, Yamazaki H, Izumi Y, Kobayashi M, Nodera H, Oishi C, Iwata A, Murayama S, Kaji R, Sonoo M. Far-field potential of the compound muscle action potential as a reliable marker in amyotrophic lateral sclerosis. Muscle Nerve 2023; 68:257-263. [PMID: 37086196 DOI: 10.1002/mus.27829] [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: 09/04/2022] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION/AIMS Reliable neurophysiological markers in amyotrophic lateral sclerosis (ALS) are of great interest. The compound muscle action potential (CMAP) amplitude has been a conventional marker, although it is greatly influenced by the electrode position. We propose the far-field potential of the CMAP (FFP-CMAP) as a new neurophysiological marker in ALS. METHODS Patients with ALS and age-matched healthy controls were enrolled. We used a proximal reference (pref) in addition to the conventional distal reference (dref). Routine CMAP was recorded from the belly-dref lead and FFP-CMAP from the dref-pref lead for the ulnar and tibial nerves. Multiple point stimulation motor unit number estimation (MUNE) was also examined in the ulnar nerve. Inter-rater reproducibility was evaluated by two examiners, and some patients were followed up every 3 mo for 1 y. RESULTS We tested 17 patients with ALS and 10 controls. The amplitudes of routine CMAP and FFP-CMAP in the ulnar and tibial nerves, and hypothenar MUNE value in the ulnar nerve were significantly decreased in ALS compared to controls. Ulnar FFP-CMAP achieved the highest inter-rater intraclass correlation coefficient (ICC) value (0.942) when compared with routine CMAP (0.880) and MUNE (0.839). The tibial FFP-CMAP had a higher ICC value (0.986) than the routine CMAP (0.697). In this way, the FFP-CMAP showed high inter-rater reproducibility because its shape was not much influenced by the electrode position. During 1-y follow-up, decline of CMAP, FFP, and MUNE showed significant correlations with the Amyotrophic Lateral Sclerosis Functional Rating Scale - Revised (ALSFRS-R). DISCUSSION The FFP-CMAP shows promise as a reliable marker for ALS.
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Affiliation(s)
- Mana Higashihara
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Hiroki Yamazaki
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yuishin Izumi
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | | | - Hiroyuki Nodera
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
- Department of Neurology, Tenri Hospital, Tenri, Japan
| | - Chizuko Oishi
- Department of Neurology, Kyorin University Hospital, Mitaka, Japan
| | - Atsushi Iwata
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Shigeo Murayama
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Ryuji Kaji
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
- Department of Neurology, Utano National Hospital, Kyoto, Japan
| | - Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan
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Schneider C, Svačina MKR, Kohle F, Sprenger-Svačina A, Fink GR, Lehmann HC. Motor unit number estimation by MScanFit in myotonic dystrophies. J Neurol Sci 2023; 451:120728. [PMID: 37478794 DOI: 10.1016/j.jns.2023.120728] [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: 03/17/2023] [Revised: 06/21/2023] [Accepted: 07/06/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND MScanFit is a new motor unit number estimation (MUNE) technique applied in motor neuron diseases and polyneuropathies to assess clinical progression and underlying disease pathology. So far, its value in myopathies, especially myotonic dystrophies (MD), has not been investigated. METHODS Motor unit loss and characteristics of patients with genetically confirmed MD type 1 (n = 7) and type 2 (n = 5) were investigated using MScanFit of the abductor pollicis brevis muscle and compared to age-matched healthy controls. MUNE measures were correlated with muscle impairment determined by the MRC sum score and handgrip strength. RESULTS MScanFit detected motor unit loss in patients with MD (p = 0.017). There was no significant difference in motor unit loss between MD type 1 and type 2 (p = 0.64). CMAP-discontinuities which, when added up, exceed 50% of the CMAP amplitude were reduced in MD patients (p = 0.0284), but motor unit amplitudes were not significantly different (p = 0.0597). The motor unit loss strongly correlated with the MRC sum score (p = 0.014, Rho = 0.678). CONCLUSIONS Our study shows the feasibility of MScanFit in MD and its potential to serve as a surrogate marker for overall muscle impairment. Motor unit analysis indicates that neurogenic alterations in both MD subtypes might be present.
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Affiliation(s)
- Christian Schneider
- Department of Neurology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany; Department of Neurology, St. Katharinen Hospital, Frechen, Germany.
| | - Martin K R Svačina
- Department of Neurology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Felix Kohle
- Department of Neurology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Alina Sprenger-Svačina
- Department of Neurology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany; Cognitive Neuroscience, Research Center Juelich, Institute of Neuroscience and Medicine (INM-3), Juelich, Germany
| | - Helmar C Lehmann
- Department of Neurology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany; Department of Neurology, Klinikum Leverkusen, Leverkusen, Germany
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15
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Zeppelin Z, Vaeggemose M, Witt A, Hvid LG, Tankisi H. Exploring the peripheral mechanisms of lower limb immobilisation on muscle function using novel electrophysiological methods. Clin Neurophysiol 2023; 151:18-27. [PMID: 37141780 DOI: 10.1016/j.clinph.2023.04.002] [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: 03/04/2023] [Revised: 04/02/2023] [Accepted: 04/06/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To explore the effects of short-term immobilisation and subsequent retraining on peripheral nervous system (PNS) measures using two novel electrophysiological methods, muscle velocity recovery cycles (MVRC) and MScanFit motor unit number estimation (MUNE) alongside lower limb muscle strength, muscle imaging and walking capacity. METHODS Twelve healthy participants underwent 1-week of ankle immobilisation and 2-weeks of retraining. Assessments before and after immobilisation, and after retraining, included MVRC [muscle membrane properties; muscle relative refractory period (MRRP), early and late supernormality], MScanFit, MRI-scans [muscle contractile cross-sectional area (cCSA)], isokinetic dynamometry [dorsal and plantar flexor muscle strength], and 2-minute maximal walk test [physical function]. RESULTS After immobilisation, compound muscle action potential (CMAP) amplitude reduced (-1.35[-2.00;-0.69]mV); mean change [95%CI]) alongside reductions in plantar (but not dorsal) flexor muscle cCSA (-124[-246;3]mm2), dorsal flexor muscle strength (isometric -0.06[-0.10;-0.02]Nm/kg, dynamicslow -0.08[-0.11;-0.04]Nm/kg, dynamicfast no changes), plantar flexor muscle strength (isometric -0.20[-0.30;-0.10]Nm/kg, dynamicslow -0.19[-0.28;-0.09]Nm/kg, dynamicfast -0.12[-0.19;-0.05]Nm/kg) and walking capacity (-31[-39;-23]m). After retraining, all immobilisation-affected parameters returned to baseline levels. In contrast, neither MScanFit nor MVRC were affected apart from slightly prolonged MRRP in gastrocnemius. CONCLUSIONS PNS do not contribute to the changes observed in muscle strength and walking capacity. SIGNIFICANCE Further studies should include both corticospinal and peripheral mechanisms.
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Affiliation(s)
- Zennia Zeppelin
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark
| | - Michael Vaeggemose
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Agnes Witt
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Denmark; The Danish MS Hospitals, Ry and Haslev, Denmark
| | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark; Institute of Clinical Medicine, Aarhus University, Denmark.
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16
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Sørensen DM, Bostock H, Abrahao A, Alaamel A, Alaydin HC, Ballegaard M, Boran E, Cengiz B, de Carvalho M, Dunker Ø, Fuglsang-Frederiksen A, Graffe CC, Jones KE, Kallio M, Kalra S, Krarup C, Krøigård T, Liguori R, Lupescu T, Maitland S, Matamala JM, Moldovan M, Moreno-Roco J, Nilsen KB, Phung L, Santos MO, Themistocleous AC, Uysal H, Vacchiano V, Whittaker RG, Zinman L, Tankisi H. Estimating motor unit numbers from a CMAP scan: Repeatability study on three muscles at 15 centres. Clin Neurophysiol 2023; 151:92-99. [PMID: 37236129 DOI: 10.1016/j.clinph.2023.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/16/2023] [Accepted: 04/15/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess the repeatability and suitability for multicentre studies of MScanFit motor unit number estimation (MUNE), which involves modelling compound muscle action potential (CMAP) scans. METHODS Fifteen groups in 9 countries recorded CMAP scans twice, 1-2 weeks apart in healthy subjects from abductor pollicis brevis (APB), abductor digiti minimi (ADM) and tibialis anterior (TA) muscles. The original MScanFit program (MScanFit-1) was compared with a revised version (MScanFit-2), designed to accommodate different muscles and recording conditions by setting the minimal motor unit size as a function of maximum CMAP. RESULTS Complete sets of 6 recordings were obtained from 148 subjects. CMAP amplitudes differed significantly between centres for all muscles, and the same was true for MScanFit-1 MUNE. With MScanFit-2, MUNE differed less between centres but remained significantly different for APB. Coefficients of variation between repeats were 18.0% for ADM, 16.8% for APB, and 12.1% for TA. CONCLUSIONS It is recommended for multicentre studies to use MScanFit-2 for analysis. TA provided the least variable MUNE values between subjects and the most repeatable within subjects. SIGNIFICANCE MScanFit was primarily devised to model the discontinuities in CMAP scans in patients and is less suitable for healthy subjects with smooth scans.
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Affiliation(s)
- D M Sørensen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark
| | - H Bostock
- UCL Queen Square Institute of Neurology, Queen Square, London, United Kingdom
| | - A Abrahao
- Department of Medicine, University of Toronto, Toronto, Canada
| | - A Alaamel
- Department of Neurology, Akdeniz University Hospital, Antalya, Turkey
| | - H C Alaydin
- Department of Neurology, Gazi University, Ankara, Turkey
| | - M Ballegaard
- Department of Clinical Neurology, Zealand University Hospital, Roskilde, Denmark
| | - E Boran
- Department of Neurology, Gazi University, Ankara, Turkey
| | - B Cengiz
- Department of Neurology, Gazi University, Ankara, Turkey
| | - M de Carvalho
- Faculty of Medicine, iMM, Centro de Estudos Egas Moniz, Universidade de Lisboa, Department of Neurosciences and Mental Health, CHULN, Lisbon, Portugal
| | - Ø Dunker
- Department of Neurology and Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Norway
| | - A Fuglsang-Frederiksen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark; Department of Clinical Institute, Aarhus University, Aarhus, Denmark
| | - C C Graffe
- Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark
| | - K E Jones
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - M Kallio
- Department of Clinical Neurophysiology, Oulu University Hospital, Oulu, Finland
| | - S Kalra
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - C Krarup
- Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark
| | - T Krøigård
- Department of Neurology, Odense University Hospital, Denmark
| | - R Liguori
- Dipertimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - T Lupescu
- Department of Neurology, Agrippa Ionescu Hospital, Bucharest, Romania
| | - S Maitland
- Translational and Clinical Research Institute, Newcastle University, United Kingdom
| | - J M Matamala
- Translational Neurology and Neurophysiology Lab, Department of Neurological Sciences and Biomedical Neuroscience Institute, University of Chile, Santiago, Chile
| | - M Moldovan
- Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark
| | - J Moreno-Roco
- Translational Neurology and Neurophysiology Lab, Department of Neurological Sciences and Biomedical Neuroscience Institute, University of Chile, Santiago, Chile
| | - K B Nilsen
- Department of Neurology and Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Norway
| | - L Phung
- Department of Medicine, University of Toronto, Toronto, Canada
| | - M O Santos
- Faculty of Medicine, iMM, Centro de Estudos Egas Moniz, Universidade de Lisboa, Department of Neurosciences and Mental Health, CHULN, Lisbon, Portugal
| | - A C Themistocleous
- Nuffield Department of Clinical Neurosciences University of Oxford, Oxford, United Kingdom
| | - H Uysal
- Department of Medicine, University of Toronto, Toronto, Canada
| | - V Vacchiano
- Dipertimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - R G Whittaker
- Translational and Clinical Research Institute, Newcastle University, United Kingdom
| | - L Zinman
- UCL Queen Square Institute of Neurology, Queen Square, London, United Kingdom
| | - H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark; Department of Clinical Institute, Aarhus University, Aarhus, Denmark.
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Schneider C, Wassermann MK, Svačina MKR, Wunderlich G, Fink GR, Lehmann HC. Subclinical motor involvement in nonsystemic vasculitic neuropathy determined by the motor unit number estimation method MScanFit. Muscle Nerve 2023; 67:474-480. [PMID: 36905193 DOI: 10.1002/mus.27813] [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: 08/09/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION/AIMS Nonsystemic vasculitic neuropathy (NSVN) is characterized by a predominant lower limb involvement in many patients. Motor unit changes in upper extremity muscles have not been investigated in this subgroup but may be of interest for improving our understanding of the multifocal nature of the disease and counseling of patients about potential future symptoms. In this study we aimed to better understand subclinical motor involvement in the upper extremity muscles of patients with lower limb-predominant NSVN using the new motor unit number estimation (MUNE) method MScanFit. METHODS In this single-center, cross-sectional study, 14 patients with biopsy-proven NSVN, with no clinical signs of upper extremity motor involvement, were investigated and compared with 14 age-matched healthy controls. All participants were assessed clinically and by the MUNE method MScanFit to the abductor pollicis brevis muscle. RESULTS The number of motor units and peak CMAP amplitudes were significantly reduced in patients with NSVN (P = .003 and P = .004, respectively). Absolute median motor unit amplitudes and CMAP discontinuities were not significantly different (P = .246 and P = .1, respectively). CMAP discontinuities were not significantly correlated with motor unit loss (P = .15, rho = 0.4). The number of motor units did not correlate with clinical scores (P = .77, rho = 0.082). DISCUSSION Both MUNE and CMAP amplitudes showed motor involvement in upper extremity muscles in lower limb-predominant NSVN. Overall, there was no evidence of significant reinnervation. Investigations of the abductor pollicis brevis muscle did not show a correlation with overall functional disability of the patients.
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Affiliation(s)
- Christian Schneider
- Department of Neurology, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Meike K Wassermann
- Department of Neurology, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Martin K R Svačina
- Department of Neurology, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Gilbert Wunderlich
- Department of Neurology, Medical Faculty and University Hospital of Cologne, Cologne, Germany
- Center for Rare Diseases, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, Medical Faculty and University Hospital of Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Helmar C Lehmann
- Department of Neurology, Medical Faculty and University Hospital of Cologne, Cologne, Germany
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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.
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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
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Song X, Cui L, Zong Y, Chen M, Lu Z, Xie Q, Zhou P. A single center report of MScanFit motor unit number estimation in five muscles of healthy subjects. Front Hum Neurosci 2023; 16:1078848. [PMID: 36733893 PMCID: PMC9886876 DOI: 10.3389/fnhum.2022.1078848] [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: 10/24/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
The objective of this study was to estimate the number of motor units in 5 muscles from healthy individuals using the MScanFit program based on compound muscle action potential (CMAP) scan recordings. The examined muscles included first dorsal interosseous (FDI), abductor pollicis brevis (APB), abductor digiti minimi (ADM), second lumbrical (SL), and abductor hallucis (AH). CMAP scans were recorded from a total of 24 healthy participants. Motor unit number estimation (MUNE) values were derived from the MScanFit program. The average MUNE was 136.1 ± 31.1 (mean ± standard deviation) for the FDI, 134.9 ± 37.4 for the APB, 127.3 ± 32.3 for the ADM, 39.6 ± 8.3 for the SL, and 143.9 ± 28.9 for the AH muscles. Findings of the study provide useful information of the MScanFit MUNE for the examined muscles of healthy subjects from a single center.
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Affiliation(s)
- Xiaohui Song
- Department of Rehabilitation, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lijun Cui
- Department of Rehabilitation, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ya Zong
- Department of Rehabilitation, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Maoqi Chen
- School of Rehabilitation Science and Engineering, University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
| | - Zhiyuan Lu
- School of Rehabilitation Science and Engineering, University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
| | - Qing Xie
- Department of Rehabilitation, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,*Correspondence: Qing Xie ✉
| | - Ping Zhou
- School of Rehabilitation Science and Engineering, University of Health and Rehabilitation Sciences, Qingdao, Shandong, China,Ping Zhou ✉
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20
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Abstract
The objective was to use bibliometric analysis to create an infographic of motor unit number estimation methods over the past 50 years. The original method was published in 1971, but secondary and tertiary waves of research using alternative methods occurred in the early 2000s and a decade later. A metric of influence was used to determine if different methods had clear peaks of use over the past 50 years. While the original method continues to register influence, the MUNIX method introduced in 2004 stands out as the most influential method to estimate the innervation status of skeletal muscles.
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Zong Y, Lu Z, Xu P, Chen M, Deng L, Li S, Zhang Y, Xie Q, Zhou P. MScanFit motor unit number estimation of abductor pollicis brevis: Findings from different experimental parameters. Front Aging Neurosci 2022; 14:953173. [PMID: 36325193 PMCID: PMC9621390 DOI: 10.3389/fnagi.2022.953173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/26/2022] [Indexed: 11/14/2022] Open
Abstract
MScanFit motor unit number estimation (MUNE) based on the recording of the compound muscle action potential (CMAP) scan has wide applications. This study evaluated the effect of different CMAP scan settings on MScanFit MUNE. CMAP scan of the abductor pollicis brevis (APB) muscle was performed in 10 healthy subjects at a United States (US) research center using different stimulus pulse widths (0.1, 0.2 ms) and total number of stimuli or steps (500, 1,000), and in 12 healthy subjects at a China research center using a 0.1 ms pulse width and 500 steps. MScanFit MUNE was derived using the default model parameters. A significantly higher MUNE was obtained using the shorter than longer pulse width; 84.70 ± 21.56 (500 steps) and 77.90 ± 27.62 (1,000 steps) at a pulse width of 0.1 ms vs. 67.60 ± 18.72 (500 steps) and 62.20 ± 15.82 (1,000 steps) at a pulse width of 0.2 ms (p < 0.05). However, MUNE was unrelated to the number of steps (500 vs. 1,000, p > 0.1). MUNE was significantly higher in persons studied in the China center (136.42 ± 32.46) than the US center (84.70 ± 21.56) despite each center using the same pulse widths and steps (p < 0.001). After excluding the ethnicity, age and experimenter factors, this significant difference is speculated to be partly related to different electrode size used in the two centers. The findings suggest that CMAP scan experimental parameters should remain consistent, so the MScanFit MUNE will not be compromised by non-physiological factors.
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Affiliation(s)
- Ya Zong
- Department of Rehabilitation Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyuan Lu
- School of Rehabilitation Science and Engineering, University of Health and Rehabilitation Sciences, Qingdao, China
| | - Peipei Xu
- Department of Rehabilitation Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Maoqi Chen
- School of Rehabilitation Science and Engineering, University of Health and Rehabilitation Sciences, Qingdao, China
| | - Lianfu Deng
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Department of Orthopaedics, Ruijin Hospital, Shanghai Institute of Traumatology and Orthopaedics, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, and TIRR Memorial Herman Hospital, Houston, TX, United States
| | - Yingchun Zhang
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States
| | - Qing Xie
- Department of Rehabilitation Sciences, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Qing Xie,
| | - Ping Zhou
- School of Rehabilitation Science and Engineering, University of Health and Rehabilitation Sciences, Qingdao, China
- Ping Zhou,
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22
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Tankisi DA, Alaydin HC, Boran E, Cengiz B. Feasibility and reliability of MScanFit motor unit number estimation in peroneus longus muscle. Muscle Nerve 2022; 66:503-507. [PMID: 35763284 DOI: 10.1002/mus.27667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/16/2022] [Accepted: 06/18/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION/AIM Motor unit number estimation (MUNE) methods may be valuable to detect motor involvement earlier than compound muscle action potential (CMAP) amplitude. The most recent MUNE method, MScanFit has been shown to have advantages compared to the previously described methods. However, MScanFit has only been applied in a few lower extremity muscles. We aimed in this study to examine the feasibility and reliability of MScanFit in peroneus longus muscle. METHODS Twenty healthy controls (16 males and 4 females, mean age: 36.05 ± 2.58) were examined twice within a 1-2 week interval. Fibular nerve was stimulated at the knee and CMAP scans were recorded from peroneus longus muscle. From this, MScanFit MUNE and size parameters were calculated as well as the CMAP amplitude. The reliability was examined using coefficient of variation (CV) and intraclass correlation coefficient (ICC). MUNE was correlated with CMAP amplitude using linear regression analysis. RESULTS The CV between sessions was higher for CMAP amplitude (11.63 ± 1.88 %) than MScanFit MUNE (3.13 ± 0.78%). Among the size parameters, mean unit amplitude (μV) showed the lowest CV (11.46 % ± 1.77). Using ICC, CMAP amplitude exhibited good reliability (0.787) whereas that of MScanFit MUNE was excellent (0.902). Reliability was good for all size parameters. There was no significant correlation between MScanFit MUNE and CMAP amplitude (R= 0.25, p>0.05). DISCUSSION MScanFit MUNE is feasible in the peroneus longus muscle with high test-retest reliability in healthy subjects. Studies in patients are needed to examine the sensitivity of this muscle in disease. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Deniz Alp Tankisi
- Department of Neurology, Gazi University Faculty of Medicine, Beşevler, Ankara, Turkey
| | - Halil Can Alaydin
- Department of Neurology, Gazi University Faculty of Medicine, Beşevler, Ankara, Turkey
| | - Evren Boran
- Department of Neurology, Gazi University Faculty of Medicine, Beşevler, Ankara, Turkey
| | - Bulent Cengiz
- Department of Neurology, Gazi University Faculty of Medicine, Beşevler, Ankara, Turkey
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Alaydin HC, Turkmen N, Boran HE, Cengiz B. Estimating the motor unit number of the flexor carpi ulnaris muscle with MScanFit MUNE. Muscle Nerve 2022; 66:212-215. [PMID: 35621353 DOI: 10.1002/mus.27650] [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: 12/08/2021] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION/AIMS MScanFit motor unit number estimation (MUNE) is a promising method for motor unit estimation and is reported to have good reliability in distal and small muscles. In this study, we investigated the reliability of MScanFit MUNE in a proximal forearm muscle, the flexor carpi ulnaris. METHODS Twenty healthy volunteers were included in this study and 15 participants were re-evaluated in a second session. The ulnar nerve was stimulated at the elbow and a compound muscle action potential (CMAP) scan from the flexor carpi ulnaris (FCU) muscle was recorded from each arm. CMAP, MUNE and other motor unit parameters were obtained. Reproducibility was evaluated using intraclass correlation coefficients. RESULTS The average MUNE from 40 FCU muscles was 90.9 (SD: 16.4). MScanFit MUNE and CMAP were not significantly different between the dominant and non-dominant sides. The intraclass correlation coefficient indicated good reliability between sessions for each side (0.81 and 0.8 respectively). DISCUSSION Our results indicate that MScanFit MUNE is a feasible method with good reproducibility for MUNE of the FCU muscle. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Halil Can Alaydin
- Department of Neurology, Gazi University Faculty of Medicine, Ankara, Turkey.,Department of Neurology, Clinical Neurophysiology Division, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Nur Turkmen
- Clinic of Clinical Neurophysiology, Tekirdag Dr. Ismail Fehmi Cumalioglu City Hospital, Tekirdag, Turkey
| | - H Evren Boran
- Department of Neurology, Gazi University Faculty of Medicine, Ankara, Turkey.,Department of Neurology, Clinical Neurophysiology Division, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Bulent Cengiz
- Department of Neurology, Gazi University Faculty of Medicine, Ankara, Turkey.,Department of Neurology, Clinical Neurophysiology Division, Gazi University Faculty of Medicine, Ankara, Turkey
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24
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Nandedkar SD, Barkhaus PE, V Stålberg E. Analysis of the compound muscle action potential scan: Step Index (STEPIX) and Amplitude Index (AMPIX). Clin Neurophysiol 2022; 139:119-127. [DOI: 10.1016/j.clinph.2022.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/24/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
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25
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Sørensen DM, Bostock H, Ballegaard M, Fuglsang-Frederiksen A, Graffe CC, Grötting A, Jones K, Kallio M, Krarup C, Krøigård T, Lupescu T, Maitland S, Moldovan M, Nilsen KB, Pugdahl K, Santos MO, Themistocleous AC, Zlateva SS, Ööpik M, Tankisi H. Assessing inter-rater reproducibility in MScanFit MUNE in a 6-subject, 12-rater "Round Robin" setup. Neurophysiol Clin 2021; 52:157-169. [PMID: 34906430 DOI: 10.1016/j.neucli.2021.11.002] [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: 06/02/2021] [Revised: 11/20/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To assess the inter-rater reliability of MScanFit MUNE using a "Round Robin" research design. METHODS Twelve raters from different centres examined six healthy study participants over two days. Median, ulnar and common peroneal nerves were stimulated, and compound muscle action potential (CMAP)-scans were recorded from abductor pollicis brevis (APB), abductor digiti minimi (ADM) and anterior tibial (TA) muscles respectively. From this we calculated the Motor Unit Number Estimation (MUNE) and "A50", a motor unit size parameter. As statistical analysis we used the measures Limits of Agreement (LOA) and Coefficient of Variation (COV). Study participants scored their perception of pain from the examinations on a rating scale from 0 (no pain) to 10 (unbearable pain). RESULTS Before this study, 41.6% of the raters had performed MScanFit less than five times. The mean MUNE-values were: 99.6 (APB), 131.4 (ADM) and 126.2 (TA), with LOA: 19.5 (APB), 29.8 (ADM) and 20.7 (TA), and COV: 13.4 (APB), 6.3 (ADM) and 5.6 (TA). MUNE-values correlated to CMAP max amplitudes (R2-values were: 0.463 (APB) (p<0.001), 0.421 (ADM) (p<0.001) and 0.645 (TA) (p<0.001)). The average perception of pain was 4. DISCUSSION MScanFit indicates a high level of inter-rater reliability, even with only limited rater experience and is overall reasonably well tolerated by patients. These results may indicate MScanFit as a reliable MUNE method with potential as a biomarker in drug trials.
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Affiliation(s)
| | - Hugh Bostock
- Insitute of Neurology, Queen Square House, London, United Kingdom
| | - Martin Ballegaard
- Deparment of Clinical Neurology, Zealand University Hospital, Roskilde, Denmark
| | | | | | - Arnstein Grötting
- Department of Clinical Neurophysiology, St. Olav Hospital, Trondheim, Norway
| | - Kelvin Jones
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | - Mika Kallio
- Department of Clinical Neurophysiology, Oulu University Hospital, Oulu, Finland
| | - Christian Krarup
- Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Krøigård
- Department of Neurology, Odense University Hospital, Denmark
| | - Tudor Lupescu
- Department of Neurology, Agrippa Ionescu Hospital, Bucharest, Romania
| | - Stuart Maitland
- Newcastle Biomedical Research Centre, Newcastle upon Tyne, United Kingdom
| | - Mihai Moldovan
- Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Kirsten Pugdahl
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark
| | - Miguel Oliveira Santos
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Lisbon, Portugal
| | | | | | - Merle Ööpik
- Deparment of Clinical Neurology, Zealand University Hospital, Roskilde, Denmark
| | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark.
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Stikvoort García DJL, Kovalchuk MO, Goedee HS, van Schelven LJ, van den Berg LH, Franssen H, Sleutjes BTHM. Motor unit integrity in multifocal motor neuropathy: A systematic evaluation with CMAP scans. Muscle Nerve 2021; 65:317-325. [PMID: 34854491 PMCID: PMC9300115 DOI: 10.1002/mus.27469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 11/09/2022]
Abstract
Introduction/Aims Progressive axonal loss in multifocal motor neuropathy (MMN) is often assessed with nerve conduction studies (NCS), by recording maximum compound muscle action potentials (CMAPs). However, reinnervation maintains the CMAP amplitude until a significant portion of the motor unit (MU) pool is lost. Therefore, we performed more informative CMAP scans to study MU characteristics in a large cohort of patients with MMN. Methods We derived the maximum CMAP amplitude (CMAPmax), an MU number estimate (MUNE), and the largest MU amplitude stimulus current required to elicit 5%, 50%, and 95% of CMAPmax (S5, S50, S95) and relative ranges ([S95 − S5] × 100 / S50) from the scans. These metrics were compared with clinical, laboratory, and NCS results. Results Forty MMN patients and 24 healthy controls were included in the study. CMAPmax and MUNE were reduced in MMN patients (both P < .001). Largest MU amplitude as a percentage of CMAPmax was increased in MMN patients (P < .001). Disease duration and treatment duration were not associated with MUNE. Relative range was larger in patients with anti‐GM1 antibodies than in those without anti‐GM1 antibodies (P = .016) and controls (P < .001). The largest MU amplitudes were larger in patients without anti‐GM1 antibodies than in patients with anti‐GM1 antibodies (P = .037) and controls (P = .044). Discussion We found that MU loss is common in MMN and accompanied by enlarged MUs. Presence of anti‐GM1 antibodies was associated with increased relative range of MU thresholds and reduction in largest MU amplitude. Our findings indicate that CMAP scans complement routine NCS, and may have potential for practical monitoring of treatment efficacy and disease progression.
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Affiliation(s)
| | - Maria O Kovalchuk
- Department of Neurology, Brain Centre Utrecht, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - H Stephan Goedee
- Department of Neurology, Brain Centre Utrecht, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Leonard J van Schelven
- Department of Medical Technology and Clinical Physics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology, Brain Centre Utrecht, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Hessel Franssen
- Department of Neurology, Brain Centre Utrecht, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Boudewijn T H M Sleutjes
- Department of Neurology, Brain Centre Utrecht, University Medical Centre Utrecht, Utrecht, The Netherlands
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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.
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28
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Sleutjes BTHM, Bystrup Jacobsen A, Tankisi H, Gorkem Sirin N, Emre Oge A, Henderson RD, van Doorn PA, van den Berg LH, van Eijk RPA. Advancing disease monitoring of amyotrophic lateral sclerosis with the compound muscle action potential scan. Clin Neurophysiol 2021; 132:3152-3159. [PMID: 34749234 DOI: 10.1016/j.clinph.2021.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/20/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine which compound muscle action potential (CMAP) scan-derived electrophysiological markers are most sensitive for monitoring disease progression in amyotrophic lateral sclerosis (ALS), and whether they hold value for clinical trials. METHODS We used four independent patient cohorts to assess longitudinal patterns of a comprehensive set of electrophysiological markers including their association with the ALS functional rating scale (ALSFRS-R). Results were translated to trial sample size requirements. RESULTS In 65 patients, 225 thenar CMAP scan recordings were obtained. Electrophysiological markers showed extensive variation in their longitudinal trajectories. Expressed as standard deviations per month, motor unit number estimation (MUNE) values declined by 0.09 (CI 0.07-0.12), D50, a measure that quantifies CMAP scan discontinuities, declined by 0.09 (CI 0.06-0.13) and maximum CMAP by 0.05 (CI 0.03-0.08). ALSFRS-R declined fastest (0.12, CI 0.08 - 0.15), however the between-patient variability was larger compared to electrophysiological markers, resulting in larger sample sizes. MUNE reduced the sample size by 19.1% (n = 388 vs n = 314) for a 6-month study compared to the ALSFRS-R. CONCLUSIONS CMAP scan-derived markers show promise in monitoring disease progression in ALS patients, where MUNE may be its most suitable derivate. SIGNIFICANCE MUNE may increase clinical trial efficiency compared to clinical endpoints.
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Affiliation(s)
- Boudewijn T H M Sleutjes
- Department of Neurology, Brain Centre Utrecht, Utrecht, the Netherlands; Department of Neurology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands.
| | | | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - N Gorkem Sirin
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A Emre Oge
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Robert D Henderson
- Department of Neurology, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Pieter A van Doorn
- Department of Neurology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Ruben P A van Eijk
- Department of Neurology, Brain Centre Utrecht, Utrecht, the Netherlands; Biostatistics and Research Support, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
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Schneider C, Wassermann MK, Grether NB, Fink GR, Wunderlich G, Lehmann HC. Motor unit number estimation in adult patients with spinal muscular atrophy treated with nusinersen. Eur J Neurol 2021; 28:3022-3029. [PMID: 34216082 DOI: 10.1111/ene.15005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/14/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE The aim was to assess the organization and short-term changes of motor units in adult patients with spinal muscular atrophy (SMA) treated with nusinersen. METHODS In this single-centre cross-sectional and longitudinal study 15 adult patients with SMA type 3 were assessed and compared to 15 age-matched healthy controls and nine patients with amyotrophic lateral sclerosis. Moreover, 10 patients with SMA were followed up after 4-8 months. All patients were investigated clinically and by the motor unit number estimation method MScanFit of the abductor pollicis brevis muscle. RESULTS The number of motor units (p < 0.001) was significantly lower in patients with SMA compared to healthy controls at study entry. Mean unit amplitude, median amplitude and largest unit (p < 0.001) were significantly increased in patients with SMA. Patients with amyotrophic lateral sclerosis showed a significant reduction of compound muscle action potential (p = 0.005) and number of motor units (p = 0.03) compared to patients with SMA, accompanied by a larger median amplitude (p = 0.03). A prospective analysis identified patients with the ability to walk to improve the number of motor units (p = 0.046) accompanied by a decreased median amplitude (p = 0.03). Electrophysiological measures showed a moderate to strong correlation with clinical scores. CONCLUSION Patients with SMA show loss of motor units in distal muscles. MScanFit variables indicate that compound muscle action potential amplitudes are maintained by collateral sprouting. Prospective analyses suggest that milder affected adult patients with SMA preferentially benefit from nusinersen treatment through recovery of smaller motor units. Correlations with clinical scores underline the potential of MScanFit as a surrogate marker.
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Affiliation(s)
| | | | | | - Gereon R Fink
- Department of Neurology, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | | | - Helmar C Lehmann
- Department of Neurology, University of Cologne, Cologne, Germany
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30
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Early axonal loss predicts long-term disability in chronic inflammatory demyelinating polyneuropathy. Clin Neurophysiol 2021; 132:1000-1007. [DOI: 10.1016/j.clinph.2020.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/30/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
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Zheng C, Zhu Y, Yu Q, Zhu D, Li J, Lyu F, Weber R, Qiao K, Jiang J. Quantitative assessment of motor impairment and surgical outcome in Hirayama disease with proximal involvement using motor unit number index. Neurophysiol Clin 2021; 51:375-386. [PMID: 33676826 DOI: 10.1016/j.neucli.2021.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To assess the feasibility of motor unit number index (MUNIX) in quantitatively evaluating Hirayama disease (HD) with proximal involvement and to identify the effectiveness of anterior cervical fusion (ACF) in treating atypical HD with proximal involvement. METHODS This study included 28 atypical HD patients with proximal involvement (proximal-distal vs. distal-proximal groups: 5 vs. 23) and 41 healthy controls. All patients underwent pre- and postoperative 1-year MUNIX tests on abductor pollicis brevis (APB), abductor digiti minimi (ADM), biceps brachii (BB) and deltoid (Del). The disabilities of arm, shoulder and hand (DASH) and Medical Research Council (MRC) scales were also performed in these patients before and one year after operation. RESULTS Preoperatively, the patients in the distal-proximal group showed reduced compound muscle action potential (CMAP), decreased MUNIX and increased motor unit size index (MUSIX) in bilateral distal muscles and symptomatic-side proximal muscles (P < 0.05), and similar abnormalities were also observed in ADM, BB and Del on the symptomatic side in the proximal-distal groups (P < 0.05). Postoperative follow-up analysis identified increased MUNIX in the symptomatic-side proximal muscles with improved motor function in the proximal-distal groups (P < 0.05), and distal-proximal group patients showed an increase in both CMAP and MUSIX in the symptomatic-side proximal muscles (P < 0.05). CONCLUSIONS MUNIX may serve as an available supplementary test to quantitatively evaluate the motor dysfunction and treatment outcome in HD with proximal involvement. ACF procedures can effectively treat these atypical HD patients, especially for those whose symptoms started in proximal muscles.
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Affiliation(s)
- Chaojun Zheng
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yu Zhu
- Department of Physical Medicine and Rehabilitation, Upstate Medical University, State University of New York at Syracuse, Syracuse, NY 10212, USA
| | - Qifeng Yu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Dongqing Zhu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jun Li
- Department of Orthopedics, Shanghai Songjiang District Central Hospital, Shanghai 201600, China
| | - Feizhou Lyu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China; Department of Orthopedics, The Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Robert Weber
- Department of Physical Medicine and Rehabilitation, Upstate Medical University, State University of New York at Syracuse, Syracuse, NY 10212, USA
| | - Kai Qiao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jianyuan Jiang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China.
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Sleutjes BTHM, Ruisch J, Nassi TE, Buitenweg JR, van Schelven LJ, van den Berg LH, Franssen H, Stephan Goedee H. Impact of stimulus duration on motor unit thresholds and alternation in compound muscle action potential scans. Clin Neurophysiol 2021; 132:323-331. [PMID: 33450554 DOI: 10.1016/j.clinph.2020.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/30/2020] [Accepted: 10/26/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the impact of stimulus duration on motor unit (MU) thresholds and alternation within compound muscle action potential (CMAP) scans. METHODS The stimulus duration (0.1, 0.2, 0.6, and 1.0 ms) in thenar CMAP scans and individual MUs of 14 healthy subjects was systematically varied. We quantified variability of individual MU's thresholds by relative spread (RS), MU thresholds by stimulus currents required to elicit target CMAPs of 5% (S5), 50% (S50) and 95% (S95) of the maximum CMAP, and relative range (RR) by 100*[S95-S5]/S50. We further assessed the strength-duration time constant (SDTC). Experimental observations were subsequently simulated to quantify alternation. RESULTS RS, unaffected by stimulus duration, was 1.65% averaged over all recordings. RR increased for longer stimulus duration (11.4% per ms, p < 0.001). SDTC shortened with higher target CMAPs (0.007 ms per 10% CMAP, p < 0.001). Experiments and simulations supported that this may underlie the increased RR. A short compared to long stimulus duration recruited relative more MUs at S50 (more alternation) than at the tails (less alternation). CONCLUSIONS The stimulus duration significantly affects MU threshold distribution and alternation within CMAP scans. SIGNIFICANCE Stimulation settings can be further optimized and their standardization is preferred when using CMAP scans for monitoring neuromuscular diseases.
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Affiliation(s)
- Boudewijn T H M Sleutjes
- Department of Neurology, Brain Centre Utrecht, University Medical Centre Utrecht, Utrecht, the Netherlands.
| | - Janna Ruisch
- Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Thijs E Nassi
- Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Jan R Buitenweg
- Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Leonard J van Schelven
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, the Netherlands
| | - Leonard H van den Berg
- Department of Neurology, Brain Centre Utrecht, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Hessel Franssen
- Department of Neurology, Brain Centre Utrecht, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - H Stephan Goedee
- Department of Neurology, Brain Centre Utrecht, University Medical Centre Utrecht, Utrecht, the Netherlands
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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.
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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
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Okhovat AA, Advani S, Moradi K, Ziaadini B, Panahi A, Nafissi S, Haghi Ashtiani B, Fatehi F. Application of CMAP scan for the evaluation of patients with chronic inflammatory demyelinating polyneuropathy: a prospective study. Neurophysiol Clin 2021; 51:175-181. [PMID: 33423829 DOI: 10.1016/j.neucli.2020.12.005] [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: 09/30/2020] [Revised: 12/26/2020] [Accepted: 12/26/2020] [Indexed: 11/28/2022] Open
Abstract
AIMS We aimed to assess the compound muscle action potential (CMAP) scan in the follow-up of chronic inflammatory demyelinating polyneuropathy (CIDP) patients and investigate the correlation of CMAP scan parameters with functional and standard electrodiagnostic tests. METHODS We evaluated four parameters of abductor pollicis brevis (APB) CMAP scan (i.e., step numbers, step percentage, S10, S90), functional measures (e.g., Medical Research Council Sum Scores), and electrodiagnostic tests, including nerve conduction study (NCS) and motor NCS of the median nerve in the baseline and after six months of treatment. RESULTS Twenty patients completed baseline clinical and electrodiagnostic studies. However, sixteen patients completed the follow-up study. The median of step numbers at baseline was 3.5 (2-4.2), which decreased to 2.5 (0-3) (p = 0.005). After the treatment, step percentage reduced from 28.6 (23.9-38.7) to 13.4 (0-23.6) (p = 0.001). The scores obtained from the clinical scales showed significant recovery of most of the functions, while the alterations of NCSS and NCS of the median nerve were not significant. CONCLUSIONS We found a significant reduction in step number and step percentage after follow-up. This alteration was not reflected in standard electrodiagnostic values. The improvement of functional scales alongside the CMAP scan parameters suggests that the CMAP scan could be considered an appropriate outcome measurement in research and clinical fields.
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Affiliation(s)
- Ali Asghar Okhovat
- Neurology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soroor Advani
- Neurology Department, Shohada Tajrish Hospital, Shahid-Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamyar Moradi
- Neurology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bentolhoda Ziaadini
- Neurology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Panahi
- Neurology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahriar Nafissi
- Neurology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Haghi Ashtiani
- Neurology Department, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farzad Fatehi
- Neurology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Tankişi H. MScanFit motor unit number estimation: A novel method for clinics and research. NEUROL SCI NEUROPHYS 2021. [DOI: 10.4103/nsn.nsn_30_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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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.
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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.
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Witt A, Fuglsang-Frederiksen A, Finnerup N, Kasch H, Tankisi H. Detecting peripheral motor nervous system involvement in chronic spinal cord injury using two novel methods: MScanFit MUNE and muscle velocity recovery cycles. Clin Neurophysiol 2020; 131:2383-2392. [DOI: 10.1016/j.clinph.2020.06.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/14/2020] [Accepted: 06/19/2020] [Indexed: 12/11/2022]
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Kristensen AG, Khan KS, Bostock H, Khan BS, Gylfadottir S, Andersen H, Finnerup NB, Jensen TS, Tankisi H. MScanFit motor unit number estimation and muscle velocity recovery cycle recordings in diabetic polyneuropathy. Clin Neurophysiol 2020; 131:2591-2599. [PMID: 32927215 DOI: 10.1016/j.clinph.2020.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/04/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Motor Unit Number Estimation (MUNE) methods may be valuable in tracking motor unit loss in diabetic polyneuropathy (DPN). Muscle Velocity Recovery Cycles (MVRCs) provide information about muscle membrane properties. This study aimed to examine the utility of the MScanFit MUNE in detecting motor unit loss and to test whether the MVRCs could improve understanding of DPN pathophysiology. METHODS Seventy-nine type-2 diabetic patients were compared to 32 control subjects. All participants were examined with MScanFit MUNE and MVRCs in anterior tibial muscle. Lower limb nerve conduction studies (NCS) in peroneal, tibial and sural nerves were applied to diagnose large fiber neuropathy. RESULTS NCS confirmed DPN for 47 patients (DPN + ), with 32 not showing DPN (DPN-). MScanFit showed significantly decreased MUNE values and increased motor unit sizes, when comparing DPN + patients with controls (MUNE = 71.3 ± 4.7 vs 122.7 ± 3.8), and also when comparing DPN- patients (MUNE = 103.2 ± 5.1) with controls. MVRCs did not differ between groups. CONCLUSIONS MScanFit is more sensitive in showing motor unit loss than NCS in type-2 diabetic patients, whereas MVRCs do not provide additional information. SIGNIFICANCE The MScanFit results suggest that motor changes are seen as early as sensory, and the role of axonal membrane properties in DPN pathophysiology should be revisited.
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Affiliation(s)
- A G Kristensen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark; Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark
| | - K S Khan
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark; Department of Neurology, Aarhus University Hospital, Denmark
| | - H Bostock
- Institute of Neurology, University College London, Queen Square, London, UK
| | - B S Khan
- Department of Neurology, Aarhus University Hospital, Denmark
| | - S Gylfadottir
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark; Department of Neurology, Aarhus University Hospital, Denmark
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Denmark
| | - N B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark; Department of Neurology, Aarhus University Hospital, Denmark
| | - T S Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark; Department of Neurology, Aarhus University Hospital, Denmark
| | - H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark.
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Fileccia E, De Pasqua S, Rizzo G, Di Stasi V, Vacchiano V, Avoni P, Bartolomei I, Pastorelli F, Plasmati R, Donadio V, Salvi F, Liguori R. Denervation findings on EMG in amyotrophic lateral sclerosis and correlation with prognostic milestones: Data from a retrospective study. Clin Neurophysiol 2020; 131:2017-2022. [DOI: 10.1016/j.clinph.2020.04.161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
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Electrodiagnosis of Amyotrophic Lateral Sclerosis: A Review of Existing Guidelines. J Clin Neurophysiol 2020; 37:294-298. [DOI: 10.1097/wnp.0000000000000682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Kesim-Sahin O, Sirin NG, Erbas B, Artug T, Oguz-Akarsu E, Kocasoy-Orhan E, Baslo MB, Mammadova N, Emekli U, Oge AE. Compound muscle action potential scan and MScanFit motor unit number estimation during Wallerian degeneration after nerve transections. Muscle Nerve 2020; 62:239-246. [PMID: 32415858 DOI: 10.1002/mus.26923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Compound muscle action potential (CMAP) scan and MScanFit have been used to understand the consequences of denervation and reinnervation. This study aimed to monitor these parameters during Wallerian degeneration (WD) after acute nerve transections (ANT). METHODS Beginning after urgent surgery, CMAP scans were recorded at 1-2 day intervals in 12 patients with ANT of the ulnar or median nerves, by stimulating the distal stump (DS). Stimulus intensities (SI), steps, returners, and MScanFit were calculated. Studies were grouped according to the examination time after ANT. Results were compared with those of 27 controls. RESULTS CMAP amplitudes and MScanFit progressively declined, revealing a positive correlation with one another. SIs were higher in WD groups than controls. Steps appeared or disappeared in follow-up scans. The late WD group had higher returner% than the early WD and control groups. CONCLUSIONS MScanFit can monitor neuromuscular dysfunction during WD. SIs revealed excitability changes in DS.
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Affiliation(s)
- Ozlem Kesim-Sahin
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nermin Gorkem Sirin
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bahar Erbas
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Pharmacology, Istanbul Bilim University, Istanbul, Turkey
| | - Tugrul Artug
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Electrical and Electronics Engineering, Istanbul Arel University, Istanbul, Turkey
| | - Emel Oguz-Akarsu
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Elif Kocasoy-Orhan
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Baris Baslo
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nermin Mammadova
- Department of Reconstructive and Plastic Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ufuk Emekli
- Department of Reconstructive and Plastic Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Emre Oge
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Neuwirth C, Weber M. Estimating the Number of Motor Neurons: First Go to the Roots Before Cropping the Fruits. Muscle Nerve 2020; 62:154-155. [PMID: 32406530 DOI: 10.1002/mus.26920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Christoph Neuwirth
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Markus Weber
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital St Gallen, St Gallen, Switzerland
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Tankisi H. Surface electromyography – A diagnostic and monitoring biomarker for amyotrophic lateral sclerosis? Clin Neurophysiol 2020; 131:936-937. [DOI: 10.1016/j.clinph.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/04/2020] [Indexed: 11/28/2022]
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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.
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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
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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.
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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
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Zong Y, Lu Z, Zhang L, Li X, Zhou P. Motor unit number of the first dorsal interosseous muscle estimated from CMAP scan with different pulse widths and steps. J Neural Eng 2020; 17:014001. [PMID: 31726441 DOI: 10.1088/1741-2552/ab57cc] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE A compound muscle action potential (CMAP) scan has different settings such as stimulus frequency, duration (or pulse width), and the number of stimuli (or steps). This study aims to evaluate the influence of different stimulation protocols on MScanFit, a recently developed approach to motor unit number estimation (MUNE) from CMAP scan. APPROACH CMAP scans of the first dorsal interosseous (FDI) muscle were performed using four protocols with different pulse widths (0.1 ms, 0.2 ms) and steps (500, 1000) in twelve neurologically intact subjects. For each CMAP scan, the MUNE was derived using MScanFit. MAIN RESULTS Across all subjects, a significantly higher MUNE was obtained using stimulus pulse width of 0.1 ms (500 steps: 107. 7 ± 21.3; 1000 steps: 94.9 ± 22.07) than that using pulse width of 0.2 ms (500 steps: 81.8 ± 9.9; 1000 steps: 77.8 ± 16.1) (p < 0.001). However, no significant difference in MUNE was observed using 500 and 1000 steps (p > 0.1). No cross effect of pulse width and steps was found between four different protocols (p > 0.1). SIGNIFICANCE Given these results, a stimulation protocol of 0.1 ms pulse width and 500 steps is recommended for CMAP scan recording of the FDI muscle toward estimating motor unit number using MScanFit.
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Affiliation(s)
- Ya Zong
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, TIRR Memorial Hermann Research Center, Houston, TX, United States of America. Guangdong Work Injury Rehabilitation Center, Guangzhou, Guangdong, People's Republic of China. Department of Rehabilitation Sciences, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Sleutjes BTHM, Wijngaarde CA, Wadman RI, Otto LAM, Asselman FL, Cuppen I, van den Berg LH, van der Pol WL, Goedee HS. Assessment of motor unit loss in patients with spinal muscular atrophy. Clin Neurophysiol 2020; 131:1280-1286. [PMID: 32305855 DOI: 10.1016/j.clinph.2020.01.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/23/2019] [Accepted: 01/13/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess motor unit (MU) changes in patients with spinal muscular atrophy (SMA) using compound muscle action potential (CMAP) scans. METHODS We performed CMAP scan recordings in median nerves of 24 treatment-naïve patients (median age 39; range 12-75 years) with SMA types 2-4. From each scan, we determined maximum CMAP amplitude (CMAPmax), a motor unit number estimate (MUNE), and D50 which quantifies the largest discontinuities within CMAP scans. RESULTS Median CMAPmax was 8.1 mV (range 0.9-14.6 mV), MUNE was 29 (range 6-131), and D50 was 25 (range 2-57). We found a reduced D50 (<25) in patients with normal CMAPmax (n = 12), indicating MU loss and enlarged MUs due to reinnervation. Lower D50 values were associated with decreased MUNE (P < 0.001, r = 0.68, n = 43). CMAPmax, MUNE and D50 values differed between SMA types (P < 0.001). Lower motor function scores were related to patients with lower CMAPmax, MUNE and D50 values (P < 0.001). CONCLUSIONS The CMAP scan is an easily applicable technique that is superior to routine assessment of CMAPmax in SMA. SIGNIFICANCE The detection of pathological MU changes across the spectrum of SMA may provide important biomarkers for evaluating disease course and monitoring treatment efficacy.
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Affiliation(s)
- Boudewijn T H M Sleutjes
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - Camiel A Wijngaarde
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Renske I Wadman
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Louise A M Otto
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Fay-Lynn Asselman
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Inge Cuppen
- Department of Neurology and Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Leonard H van den Berg
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - W Ludo van der Pol
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - H Stephan Goedee
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
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Oguz Akarsu E, Sirin NG, Kocasoy Orhan E, Erbas B, Dede HO, Baslo MB, Idrisoglu HA, Oge AE. Repeater F-waves in amyotrophic lateral sclerosis: Electrophysiologic indicators of upper or lower motor neuron involvement? Clin Neurophysiol 2019; 131:96-105. [PMID: 31760213 DOI: 10.1016/j.clinph.2019.09.030] [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: 07/27/2019] [Revised: 09/08/2019] [Accepted: 09/25/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To extract insight about the mechanism of repeater F-waves (Frep) by exploring their correlation with electrophysiologic markers of upper and lower motor neuron dysfunction in amyotrophic lateral sclerosis (ALS). METHODS The correlations of Frep parameters with clinical scores and the results of neurophysiological index (NI), MScanfit MUNE, F/M amplitude ratio (F/M%), single and paired-pulse transcranial magnetic stimulation (TMS), and triple stimulation technique (TST) studies, recorded from abductor digiti minimi (ADM) and abductor pollicis brevis (APB) muscles of 35 patients with ALS were investigated. RESULTS Frep parameters were correlated with NI and MScanfit MUNE in ADM muscle and F/M% in both muscles. None of the Frep parameters were correlated with clinical scores or TST and TMS measures. While the CMAP amplitudes were similar in the two recording muscles, there was a more pronounced decrease of F-wave persistence in APB, probably heralding the subsequent split hand phenomenon. CONCLUSION Our findings suggest that the presence and density of Freps are primarily related to the degree of lower motor neuron loss and show no correlation with any of the relatively extensive set of parameters for upper motor neuron dysfunction. SIGNIFICANCE Freps are primarily related to lower motor neuron loss in ALS.
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Affiliation(s)
- Emel Oguz Akarsu
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey.
| | - Nermin Gorkem Sirin
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Elif Kocasoy Orhan
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Bahar Erbas
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey; Demiroglu Bilim University, Faculty of Medicine, Department of Pharmacology, Istanbul, Turkey
| | - Hava Ozlem Dede
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Mehmet Baris Baslo
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Halil Atilla Idrisoglu
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Ali Emre Oge
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
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Reply to "MUNIX value dependence on surface electromyogram properties". Clin Neurophysiol 2019; 130:2290. [PMID: 31668553 DOI: 10.1016/j.clinph.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 11/24/2022]
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Kristensen A, Bostock H, Finnerup N, Andersen H, Jensen T, Gylfadottir S, Itani M, Krøigård T, Sindrup S, Tankisi H. Detection of early motor involvement in diabetic polyneuropathy using a novel MUNE method – MScanFit MUNE. Clin Neurophysiol 2019; 130:1981-1987. [DOI: 10.1016/j.clinph.2019.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/05/2019] [Accepted: 08/12/2019] [Indexed: 12/13/2022]
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