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Vucic S, de Carvalho M, Bashford J, Alix JJP. Contribution of neurophysiology to the diagnosis and monitoring of ALS. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 176:87-118. [PMID: 38802184 DOI: 10.1016/bs.irn.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
This chapter describes the role of neurophysiological techniques in diagnosing and monitoring amyotrophic lateral sclerosis (ALS). Despite many advances, electromyography (EMG) remains a keystone investigation from which to build support for a diagnosis of ALS, demonstrating the pathophysiological processes of motor unit hyperexcitability, denervation and reinnervation. We consider development of the different diagnostic criteria and the role of EMG therein. While not formally recognised by established diagnostic criteria, we discuss the pioneering studies that have demonstrated the diagnostic potential of transcranial magnetic stimulation (TMS) of the motor cortex and highlight the growing evidence for TMS in the diagnostic process. Finally, accurately monitoring disease progression is crucial for the successful implementation of clinical trials. Neurophysiological measures of disease state have been incorporated into clinical trials for over 20 years and we review prominent techniques for assessing disease progression.
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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, NSW, Australia
| | - Mamede de Carvalho
- Instituto de Medicina Molecular João Lobo Antunes, Centro de Estudos Egas Moniz, Faculty of Medicine, Universidade de Lisboa, Lisboa, Portugal; Department of Neurosciences, CHULN, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - James Bashford
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - James J P Alix
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom.
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Hansen NJ, Woodman K, Buoy S, Mao S, Barbon CEA, Lai SY, Fuller CD, Hutcheson KA, Sanchez B. Tongue electrical impedance myography correlates with functional, neurophysiologic, and clinical outcome measures in long-term oropharyngeal cancer survivors with and without hypoglossal neuropathy: An exploratory study. Head Neck 2024; 46:581-591. [PMID: 38133080 PMCID: PMC10922903 DOI: 10.1002/hed.27618] [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: 11/08/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND This pilot study analyzed correlations between tongue electrical impedance myography (EIM), standard tongue electromyography (EMG), and tongue functional measures in N = 4 long-term oropharyngeal cancer (OPC) survivors. METHODS Patients were screened for a supportive care trial (NCT04151082). Hypoglossal nerve function was evaluated with genioglossus needle EMG, functional measures with the Iowa oral performance instrument (IOPI), and multi-frequency tissue composition with tongue EIM. RESULTS Tongue EIM conductivity was higher for patients with EMG-confirmed cranial nerve XII neuropathy than those without (p = 0.005) and in patients with mild versus normal EMG reinnervation ratings (16 kHz EIM: p = 0.051). Tongue EIM correlated with IOPI strength measurements (e.g., anterior maximum isometric lingual strength: r2 = 0.62, p = 0.020). CONCLUSIONS Tongue EIM measures related to tongue strength and the presence of XII neuropathy. Noninvasive tongue EIM may be a convenient adjunctive biomarker to assess tongue health in OPC survivors.
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Affiliation(s)
- Nathan J. Hansen
- Department of Electrical and Computer Engineering, The University of Utah, Salt Lake City, Utah, USA
| | - Karin Woodman
- Department of Neurology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Sheila Buoy
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Shitong Mao
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Carly E. A. Barbon
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen Y. Lai
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
- Division of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - C. David Fuller
- Division of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Katherine A. Hutcheson
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
- Division of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Benjamin Sanchez
- Department of Electrical and Computer Engineering, The University of Utah, Salt Lake City, Utah, USA
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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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Schooling CN, Healey T, McDonough HE, French SJ, McDermott CJ, Shaw PJ, Kadirkamanathan V, Alix JJ. Tensor electrical impedance myography identifies bulbar disease progression in amyotrophic lateral sclerosis. Clin Neurophysiol 2022; 139:69-75. [DOI: 10.1016/j.clinph.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 11/17/2022]
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Luo X, Wang S, Sanchez B. Modeling and simulation of needle electrical impedance myography in nonhomogeneous isotropic skeletal muscle. IEEE JOURNAL OF ELECTROMAGNETICS, RF AND MICROWAVES IN MEDICINE AND BIOLOGY 2022; 6:103-110. [PMID: 35434441 PMCID: PMC9012450 DOI: 10.1109/jerm.2021.3091515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective Needle electrical impedance myography (EIM) is a recently developed technique for neuromuscular evaluation. Despite its preliminary successful clinical application, further understanding is needed to aid interpreting EIM outcomes in nonhomogeneous skeletal muscle measurements. Methods The framework presented models needle EIM measurements in a bidomain isotropic model. Finite element method (FEM) simulations verify the validity of our model predictions studying two cases: a spherical volume surrounded by tissue and a two-layered tissue. Results Our models show that EIM is influenced by the vicinity of tissue with different electrical properties. The apparent resistance, reactance and phase relative errors between our theoretical predictions and FEM simulations in the spherical volume case study are ≤0.2%, ≤1.2% and ≤1.0%, respectively. For the two-layered tissue model case study, the relative errors are ≤2%. Conclusions We propose a bio-physics driven analytical framework describing needle EIM measurements in a nonhomogeneous bidomain tissue model. Clinical impact Our theoretical predictions may lead to new ways for interpreting needle EIM data in neuromuscular diseases that cause compositional changes in muscle content, e.g. connective tissue deposition within the muscle. These changes will manifest themselves by changing the electric properties of the conductor media and will impact impedance values.
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Affiliation(s)
- Xuesong Luo
- Department of Automation Science and Electric Engineering, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing 100083, China,Sanchez Research Lab, Department of Electrical and Computer Engineering, Sorenson Molecular Biotechnology Building, 36 South Wasatch Drive, University of Utah, Salt Lake City, UT 84112, USA
| | - Shaoping Wang
- Department of Automation Science and Electric Engineering, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing 100083, China
| | - Benjamin Sanchez
- Sanchez Research Lab, Department of Electrical and Computer Engineering, Sorenson Molecular Biotechnology Building, 36 South Wasatch Drive, University of Utah, Salt Lake City, UT 84112, USA
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Wang H, Zheng J, Yu Q, Fan Z, Lo WLA, Li L, Wang C. Electrical Properties of Lumbar Paraspinal Muscles in Young Adults With and Without Chronic Low Back Pain Based on Electrical Impedance Myography: A Cross-Sectional Study. Front Neurol 2022; 12:789589. [PMID: 35250793 PMCID: PMC8891446 DOI: 10.3389/fneur.2021.789589] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/20/2021] [Indexed: 12/21/2022] Open
Abstract
Background Lumbar paraspinal muscle (LPM) is important in spinal stabilization in patients with chronic low back pain (CLBP). However, the electrical properties of LPM in patients with CLBP remain unclear. Electrical impedance myography (EIM) is a novel and non-invasive technique that provides a simple quantitative evaluation of electrical properties of the LPM. Purpose This study aimed to apply EIM to assess the electrical properties of the LPM between patients with CLBP and healthy control (HC). Methods Thirty participants (15 CLBP participants; 15 healthy controls) were enrolled in the study. Participants in the CLBP group were asked to complete the visual analog scale (VAS), Oswestry Disability Index (ODI), and Roland–Morris Disability Questionnaire (RDQ) to assess the pain intensity and disability in daily life. Independent sample t-tests were adopted to analyze the basic characteristics between the two groups. At 5, 50, 100, and 200 kHz current frequencies, the electrical properties were measured on each side of the LPM. The EIM parameters of resistance (R), reactance (X), phase angle (PA), and Z value were analyzed by one-way analysis of variance (ANOVA), with age as covariate. Spearman's rank correlation coefficient analysis was applied to explore the relationships between the questionnaires and the EIM parameters. Results The R and Z values of bilateral LPM in the CLBP group were significantly larger than those in the HC group; the PA decreased and the X did not change at these four tested current frequencies. At 5 kHz, Z and R on the right side were non-significantly different between patients and HCs. Correlation analysis showed that at 50 kHz, ODI and RDQ scores correlated negatively with the R of the bilateral LPM (r = 0.523, r = 0.581, respectively; p < 0.05). RDQ scores correlated positively with the PA of the right LPM (r = 0.521, p < 0.05). Conclusion The electrical properties of the bilateral LPM differed between CLBP participants and healthy individuals, regardless of the different frequencies used. These altered electrical properties of the LPM in the patients with CLBP correlated to some extent with disability in daily life.
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Affiliation(s)
- Hongjiang Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiaxuan Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiuhua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ziyan Fan
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Le Li
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an, China
- *Correspondence: Le Li
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Chuhuai Wang
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Schooling CN, Jamie Healey T, McDonough HE, French SJ, McDermott CJ, Shaw PJ, Kadirkamanathan V, Alix JJP. Tensor electrical impedance myography identifies clinically relevant features in amyotrophic lateral sclerosis. Physiol Meas 2021; 42. [PMID: 34521070 DOI: 10.1088/1361-6579/ac2672] [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: 02/26/2021] [Accepted: 09/14/2021] [Indexed: 11/12/2022]
Abstract
Objective.Electrical impedance myography (EIM) shows promise as an effective biomarker in amyotrophic lateral sclerosis (ALS). EIM applies multiple input frequencies to characterise muscle properties, often via multiple electrode configurations. Herein, we assess if non-negative tensor factorisation (NTF) can provide a framework for identifying clinically relevant features within a high dimensional EIM dataset.Approach.EIM data were recorded from the tongue of healthy and ALS diseased individuals. Resistivity and reactivity measurements were made for 14 frequencies, in three electrode configurations. This gives 84 (2 × 14 × 3) distinct data points per participant. NTF was applied to the dataset for dimensionality reduction, termed tensor EIM. Significance tests, symptom correlation and classification approaches were explored to compare NTF to using all raw data and feature selection.Main Results.Tensor EIM provides highly significant differentiation between healthy and ALS patients (p< 0.001, AUROC = 0.78). Similarly tensor EIM differentiates between mild and severe disease states (p< 0.001, AUROC = 0.75) and significantly correlates with symptoms (ρ= 0.7,p< 0.001). A trend of centre frequency shifting to the right was identified in diseased spectra, which is in line with the electrical changes expected following muscle atrophy.Significance.Tensor EIM provides clinically relevant metrics for identifying ALS-related muscle disease. This procedure has the advantage of using the whole spectral dataset, with reduced risk of overfitting. The process identifies spectral shapes specific to disease allowing for a deeper clinical interpretation.
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Affiliation(s)
- Chlöe N Schooling
- Sheffield Institute for Translational Neuroscience, University of Sheffield, United Kingdom.,Department of Automatic Control and Systems Engineering, University of Sheffield, United Kingdom
| | - T Jamie Healey
- Department of Clinical Engineering, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom
| | - Harry E McDonough
- Sheffield Institute for Translational Neuroscience, University of Sheffield, United Kingdom
| | - Sophie J French
- Sheffield Institute for Translational Neuroscience, University of Sheffield, United Kingdom
| | | | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, United Kingdom
| | - Visakan Kadirkamanathan
- Department of Automatic Control and Systems Engineering, University of Sheffield, United Kingdom
| | - James J P Alix
- Sheffield Institute for Translational Neuroscience, University of Sheffield, United Kingdom
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Salvioni C, Oda AL, Orsini M, Pauli M, Frabasile LM, Alves PCL, Borges RM, Sierra HNM, Menegatti G, Ottoboni Pinho M, Souza Bulle Oliveira A. Association between Body Composition and Dysphagia in Patients with Amyotrophic Lateral Sclerosis. Neurol Int 2021; 13:315-327. [PMID: 34294670 PMCID: PMC8299330 DOI: 10.3390/neurolint13030032] [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: 04/07/2021] [Revised: 06/01/2021] [Accepted: 07/07/2021] [Indexed: 01/01/2023] Open
Abstract
Background: The influence of changes in body composition on swallowing in patients with Amyotrophic Lateral Sclerosis (ALS) is unknown. Understanding the interrelation between body compartments and dysphagia may establish specific treatments related to both nutritional aspects as to myofunctional ones designed to delay swallowing loss. Aim: The aim of the study was to evaluate the relationship between body composition and dysphagia during the course of the disease. Methods: The protocol of this study included assessments carried out quarterly for one year and included: analysis of body composition by multi-frequency segmental bioimpedance, nutritional diagnosis, maximum strength test of the tongue and lips, analysis of swallowing using the Functional Oral Intake Score (FOIS) and Swallowing Rating Scale of the American Speech-Language-Hearing Association (ASHA), speech intelligibility and analysis of disease severity. To measure the degree of relationship between quantitative variables, Spearman’s correlation was used. Results: Thirty-four patients were evaluated, 28 Spinal Group and 6 Bulbar Group. The results did not show any significant differences in the analysis of body composition between the groups. Positive associations were found between body compartments and swallowing analysis. The phase angle showed a strong correlation between the FOIS scales (r = 0.74, p < 0.01), ASHA (r = 0.77, p < 0.01) and tongue (r = 0.66, p < 0.01). Conclusions: Changes in body compartments were related to swallowing functionality and speech intelligibility in ALS patients, emphasizing the importance of analyzing body compartments for decision making by the interdisciplinary team. Although these preliminary data were collected in a small sample size, they serve to motivate future studies in this area.
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Affiliation(s)
- Cristina Salvioni
- Department of Clinical Neurology, Federal University of Sao Paulo, 04023-900 Sao Paulo, Brazil; (A.L.O.); (M.P.); (L.M.F.); (P.C.L.A.); (R.M.B.); (H.N.M.S.); (G.M.); (M.O.P.); (A.S.B.O.)
- Correspondence:
| | - Adriana Leico Oda
- Department of Clinical Neurology, Federal University of Sao Paulo, 04023-900 Sao Paulo, Brazil; (A.L.O.); (M.P.); (L.M.F.); (P.C.L.A.); (R.M.B.); (H.N.M.S.); (G.M.); (M.O.P.); (A.S.B.O.)
| | - Marco Orsini
- Department of Medicine, Iguacu University—UNIG and Master Program in Neurology—Vassouras University—USS, 28300-000 Rio de Janeiro, Brazil;
| | - Michele Pauli
- Department of Clinical Neurology, Federal University of Sao Paulo, 04023-900 Sao Paulo, Brazil; (A.L.O.); (M.P.); (L.M.F.); (P.C.L.A.); (R.M.B.); (H.N.M.S.); (G.M.); (M.O.P.); (A.S.B.O.)
| | - Luciana M. Frabasile
- Department of Clinical Neurology, Federal University of Sao Paulo, 04023-900 Sao Paulo, Brazil; (A.L.O.); (M.P.); (L.M.F.); (P.C.L.A.); (R.M.B.); (H.N.M.S.); (G.M.); (M.O.P.); (A.S.B.O.)
| | - Percilia C. L. Alves
- Department of Clinical Neurology, Federal University of Sao Paulo, 04023-900 Sao Paulo, Brazil; (A.L.O.); (M.P.); (L.M.F.); (P.C.L.A.); (R.M.B.); (H.N.M.S.); (G.M.); (M.O.P.); (A.S.B.O.)
| | - Rosana M. Borges
- Department of Clinical Neurology, Federal University of Sao Paulo, 04023-900 Sao Paulo, Brazil; (A.L.O.); (M.P.); (L.M.F.); (P.C.L.A.); (R.M.B.); (H.N.M.S.); (G.M.); (M.O.P.); (A.S.B.O.)
| | - Helena N. M. Sierra
- Department of Clinical Neurology, Federal University of Sao Paulo, 04023-900 Sao Paulo, Brazil; (A.L.O.); (M.P.); (L.M.F.); (P.C.L.A.); (R.M.B.); (H.N.M.S.); (G.M.); (M.O.P.); (A.S.B.O.)
| | - Gabriela Menegatti
- Department of Clinical Neurology, Federal University of Sao Paulo, 04023-900 Sao Paulo, Brazil; (A.L.O.); (M.P.); (L.M.F.); (P.C.L.A.); (R.M.B.); (H.N.M.S.); (G.M.); (M.O.P.); (A.S.B.O.)
| | - Márcio Ottoboni Pinho
- Department of Clinical Neurology, Federal University of Sao Paulo, 04023-900 Sao Paulo, Brazil; (A.L.O.); (M.P.); (L.M.F.); (P.C.L.A.); (R.M.B.); (H.N.M.S.); (G.M.); (M.O.P.); (A.S.B.O.)
| | - Acary Souza Bulle Oliveira
- Department of Clinical Neurology, Federal University of Sao Paulo, 04023-900 Sao Paulo, Brazil; (A.L.O.); (M.P.); (L.M.F.); (P.C.L.A.); (R.M.B.); (H.N.M.S.); (G.M.); (M.O.P.); (A.S.B.O.)
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Luo X, Sanchez B. In silicomuscle volume conduction study validates in vivomeasurement of tongue volume conduction properties using a user tongue array depressor. Physiol Meas 2021; 42. [PMID: 33690188 DOI: 10.1088/1361-6579/abed36] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/09/2021] [Indexed: 01/24/2023]
Abstract
Objective.Electrophysiological assessment of the tongue volume conduction properties (VCPs) using our novel multi-electrode user tongue array (UTA) depressor has the promise to serve as a biomarker in patients with bulbar dysfunction. However, whetherin vivodata collected using the UTA depressor accurately reflect the tongue VCPs remains unknown.Approach.To address this question, we performedin silicosimulations of the depressor with an accurate anatomical tongue finite element model (FEM) using healthy human tongue VCP values, namely the conductivity and the relative permittivity, in the sagittal plane (i.e. longitudinal direction) and axial and coronal planes (i.e. transverse directions). We then established the relationship between tongue VCP values simulated from our model to measured human data.Main results.Experimental versus simulated tongue VCP values including their spatial variation were in good agreement with differences well within the variability of the experimental results. Tongue FEM simulations corroborate the feasibility of our UTA depressor in assessing tongue VCPs.Significance.The UTA depressor is a new non-invasive and safe tool to measure tongue VCPs. These electrical properties reflect the tongue's ionic composition and cellular membrane integrity and could serve as a novel electrophysiological biomarker in neurological disorders affecting the tongue.
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Affiliation(s)
- Xuesong Luo
- Sanchez Research Lab, Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, UT 84112-9206, United States of America
| | - Benjamin Sanchez
- Sanchez Research Lab, Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, UT 84112-9206, United States of America
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Abstract
PURPOSE OF REVIEW This review draws together the most recent findings in ALS biomarker research from biochemical, imaging and neurophysiology techniques. RECENT FINDINGS The potential of circulating RNA is highlighted, including new retrieval techniques. With ongoing genetic clinical trials, the need for pharmacodynamic biomarkers is essential. There is a strong case for neurofilament proteins being validated in ALS; their biomarker profile is discussed. Oxidative stress and neuroinflammation studies offer insight into disease mechanisms and offer good biomarker potential. Recent metabolic studies include investigation of lipid profiles, creatinine and ferritin. The potential of chitinase proteins as pharmacodynamic and prognostic biomarkers is highlighted. The role of tau and amyloidβ is debated, as evidenced by the articles presented here. Proteomic approaches provide unbiased discoveries of novel biomarkers, together with confirmation of previous findings. The use of imaging techniques is outlined to demonstrate selective atrophy, volume loss, muscle and tract involvement. In-vivo imaging is discussed with reference to histone deacetylase, oxidative stress, neuroinflammation and metabolic changes. New applications of electrophysiology demonstrate objective muscle biomarkers and brain network perturbations. SUMMARY The biomarker research field continues to provide insight into the disease. Multicentre collaborations are needed to validate these promising recent findings.
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Schooling CN, Jamie Healey T, McDonough HE, French SJ, McDermott CJ, Shaw PJ, Kadirkamanathan V, Alix JJP. Modelling and analysis of electrical impedance myography of the lateral tongue. Physiol Meas 2021; 41:125008. [PMID: 33207324 DOI: 10.1088/1361-6579/abcb9b] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Electrical impedance myography (EIM) performed on the centre of the tongue shows promise in detecting amyotrophic lateral sclerosis (ALS). Lateral recordings may improve diagnostic performance and provide pathophysiological insights through the assessment of asymmetry. However, it is not known if electrode proximity to the muscle edge, or electrode rotation, distort spectra. We evaluated this using finite element-based modelling. APPROACH Nine thousand EIM from patients and healthy volunteers were used to develop a finite element model for phase and magnitude. Simulations varied electrode proximity to the muscle edge and electrode rotation. LT-Spice simulations assessed disease effects. Patient data were assessed for reliability, agreement and classification performance. MAIN RESULTS No effect on phase spectra was seen if all electrodes remained in contact with the tissue. Small effects on magnitude were observed. Cole-Cole circuit simulations indicated capacitance reduced with disease severity. Lateral tongue muscle recordings in both patients and healthy volunteers were reproducible and symmetrical. Combined lateral/central tongue EIM improved disease classification compared to either placement alone. SIGNIFICANCE Lateral EIM tongue measurements using phase angle are feasible. Such measurements are reliable, find no evidence of tongue muscle asymmetry in ALS and improve disease classification. Lateral measurements enhance tongue EIM in ALS.
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Affiliation(s)
- Chlöe N Schooling
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom. Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, United Kingdom
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de Carvalho M. Needling the future in ALS. Clin Neurophysiol 2020; 131:1973-1974. [PMID: 32561171 DOI: 10.1016/j.clinph.2020.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Mamede de Carvalho
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Univeridade de Lisboa, Lisbon, Portugal; Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal.
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