Sex differences in the detection of motor unit action potentials identified using high-density surface electromyography

Brain-body mechanisms contribute to sexual dimorphism in amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is the most common form of human motor neuron disease. It is characterized by the progressive degeneration of upper and lower motor neurons, leading to generalized motor weakness and, ultimately, respiratory paralysis and death within 3-5 years. The disease is shaped by genetics, age, sex and environmental stressors, but no cure or routine biomarkers exist for the disease. Male individuals have a higher propensity to develop ALS, and a different manifestation of the disease phenotype, than female individuals. However, the mechanisms underlying these sex differences remain a mystery. In this Review, we summarize the epidemiology of ALS, examine the sexually dimorphic presentation of the disease and highlight the genetic variants and molecular pathways that might contribute to sex differences in humans and animal models of ALS. We advance the idea that sexual dimorphism in ALS arises from the interactions between the CNS and peripheral organs, involving vascular, metabolic, endocrine, musculoskeletal and immune systems, which are strikingly different between male and female individuals. Finally, we review the response to treatments in ALS and discuss the potential to implement future personalized therapeutic strategies for the disease.

Characterising sex-related differences in lower- and higher-threshold motor unit behaviour through high-density surface electromyography

Emerging questions in neuromuscular physiology revolve around whether males and females share similar neural control in diverse tasks across a broad range of intensities. In order to explore these features, high-density electromyography was used to record the myoelectrical activity of biceps brachii during trapezoidal isometric contractions at 35% and 70% of maximal voluntary force (MVF) on 11 male and 13 female participants. Identified motor units were then classified as lower-threshold (recruited at ≤30%MVF) and higher-threshold (recruited at >30%MVF). The discharge rate, interspike interval variability, recruitment and derecruitment thresholds, and estimates of neural drive to motor neurons were assessed. Female lower-threshold motor units showed higher neural drive (P < 0.001), accompanied by higher discharge rate at recruitment (P = 0.006), plateau (P = 0.001) and derecruitment (P = 0.001). On the other hand, male higher-threshold motor units showed greater neural drive (P = 0.04), accompanied by higher discharge rate at recruitment (P = 0.005), plateau (P = 0.04) and derecruitment (P = 0.01). Motor unit discharge rate normalised by the recruitment threshold was significantly higher in female lower-threshold motor units (P < 0.001), while no differences were observed in higher-threshold motor units. Recruitment and derecruitment thresholds are higher in males across all intensities (P < 0.01). However, males and females have similar activation and deactivation strategies, as evidenced by similar recruitment-to-derecruitment ratios (P > 0.05). This study encompasses a broad intensity range to analyse motor unit sex-related differences, highlighting higher neural drive and discharge rates in female lower-threshold motor units, elevated recruitment and derecruitment thresholds in males, and convergences in activation and deactivation strategies. HIGHLIGHTS: What is the central question of the study? Do male and female motor units behave similarly in low- and high-intensity contractions? What is the main finding and its importance? Female motor units show higher discharge rates in low-intensity tasks and lower discharge rates in high-intensity tasks, with no differences in recruitment behaviour. A broader inter-spike interval variability was also observed in females. These findings underline that there are sex-specific differences concern the firing strategies based on task intensity.

Sex differences in laterality of motor unit firing behavior of the first dorsal interosseous muscle in strength-matched healthy young males and females

PURPOSE

The purpose of this study was to compare laterality in motor unit firing behavior between females and males.

METHODS

Twenty-seven subjects (14 females) were recruited for this study. The participants performed ramp up and hold isometric index finger abduction at 10, 30, and 60% of their maximum voluntary contraction (MVC). High-density surface electromyography (HD-sEMG) signals were recorded in the first dorsal interosseous (FDI) muscle and decomposed into individual motor unit (MU) firing behavior using a convolution blind source separation method.

RESULTS

In total, 769 MUs were detected (females, n = 318 and males, n = 451). Females had a significantly higher discharge rate than males at each relative torque level (10%: male dominant hand, 13.4 ± 2.7 pps vs. female dominant hand, 16.3 ± 3.4 pps; 30%: male dominant hand, 16.1 ± 3.9 pps vs. female dominant hand, 20.0 ± 5.0 pps; and 60%: male dominant hand, 19.3 ± 3.8 vs. female dominant hand, 25.3 ± 4.8 pps; p < 0.0001). The recruitment threshold was also significantly higher in females than in males at 30 and 60% MVC. Furthermore, males exhibited asymmetrical discharge rates at 30 and 60% MVC and recruitment thresholds at 30 and 60% MVC, whereas no asymmetry was observed in females.

CONCLUSION

In the FDI muscle, compared to males, females exhibited different neuromuscular strategies with higher discharge rates and recruitment thresholds and no asymmetrical MU firing behavior. Notably, the findings that sex differences in neuromuscular activity also occur in healthy individuals provide important information for understanding the pathogenesis of various diseases.

Sex disparities of human neuromuscular decline in older humans

Females typically live longer than males but, paradoxically, spend a greater number of later years in poorer health. The neuromuscular system is a critical component of the progression to frailty, and motor unit (MU) characteristics differ by sex in healthy young individuals and may adapt to ageing in a sex-specific manner due to divergent hormonal profiles. The purpose of this study was to investigate sex differences in vastus lateralis (VL) MU structure and function in early to late elderly humans. Intramuscular electromyography signals from 50 healthy older adults (M/F: 26/24) were collected from VL during standardized submaximal contractions and decomposed to quantify MU characteristics. Muscle size and neuromuscular performance were also measured. Females had higher MU firing rate (FR) than males (P = 0.025), with no difference in MU structure or neuromuscular junction transmission (NMJ) instability. All MU characteristics increased from low- to mid-level contractions (P < 0.05) without sex × level interactions. Females had smaller cross-sectional area of VL, lower strength and poorer force steadiness (P < 0.05). From early to late elderly, both sexes showed decreased neuromuscular function (P < 0.05) without sex-specific patterns. Higher VL MUFRs at normalized contraction levels previously observed in young are also apparent in old individuals, with no sex-based difference of estimates of MU structure or NMJ transmission instability. From early to late elderly, the deterioration of neuromuscular function and MU characteristics did not differ between sexes, yet function was consistently greater in males. These parallel trajectories underscore the lower initial level for older females and may offer insights into identifying critical intervention periods. KEY POINTS: Females generally exhibit an extended lifespan when compared to males, yet this is accompanied by a poorer healthspan and higher rates of frailty. In healthy young people, motor unit firing rate (MUFR) at normalized contraction intensities is widely reported to be higher in females than in age-matched males. Here we show in 50 people that older females have higher MUFR than older males with little difference in other MU parameters. The trajectory of decline from early to late elderly does not differ between sexes, yet function is consistently lower in females. These findings highlight distinguishable sex disparities in some MU characteristics and neuromuscular function, and suggest early interventions are needed for females to prevent functional deterioration to reduce the ageing health-sex paradox.

Supraspinal, spinal, and motor unit adjustments to fatiguing isometric contractions of the knee extensors at low and high submaximal intensities in males

Contraction intensity is a key factor determining the development of muscle fatigue, and it has been shown to induce distinct changes along the motor pathway. The role of cortical and spinal inputs that regulate motor unit (MU) behavior during fatiguing contractions is poorly understood. We studied the cortical, spinal, and neuromuscular response to sustained fatiguing isometric tasks performed at 20% and 70% of the maximum isometric voluntary contraction (MVC), together with MU behavior of knee extensors in healthy active males. Neuromuscular function was assessed before and after performance of both tasks. Cortical and spinal responses during exercise were measured via stimulation of the motor cortex and spinal cord. High-density electromyography was used to record individual MUs from the vastus lateralis (VL). Exercise at 70%MVC induced greater decline in MVC (P = 0.023) and potentiated twitch force compared with 20%MVC (P < 0.001), with no difference in voluntary activation (P = 0.514). Throughout exercise, corticospinal responses were greater during the 20%MVC task (P < 0.001), and spinal responses increased over time in both tasks (P ≤ 0.042). MU discharge rate increased similarly after both tasks (P ≤ 0.043), whereas recruitment and derecruitment thresholds were unaffected (P ≥ 0.295). These results suggest that increased excitability of cortical and spinal inputs might be responsible for the increase in MU discharge rate. The increase in evoked responses together with the higher MU discharge rate might be required to compensate for peripheral adjustments to sustain fatiguing contractions at different intensities.NEW & NOTEWORTHY Changes in central nervous system and muscle function occur in response to fatiguing exercise and are specific to exercise intensity. This study measured corticospinal, neuromuscular, and motor unit behavior to fatiguing isometric tasks performed at different intensities. Both tasks increased corticospinal excitability and motor unit discharge rate. Our findings suggest that these acute adjustments are required to compensate for the exercise-induced decrements in neuromuscular function caused by fatiguing tasks.

Intrinsic motoneuron properties in typical human development

Motoneuron properties and their firing patterns undergo significant changes throughout development and in response to neuromodulators such as serotonin. Here, we examined the age-related development of self-sustained firing and general excitability of tibialis anterior motoneurons in a young development (7-17 years), young adult (18-28 years) and adult (32-53 years) group, as well as in a separate group of participants taking selective serotonin reuptake inhibitors (SSRIs, aged 11-28 years). Self-sustained firing, as measured by ΔF, was larger in the young development (∼5.8 Hz, n = 20) compared to the young adult (∼4.9 Hz, n = 13) and adult (∼4.8 Hz, n = 8) groups, consistent with a developmental decrease in self-sustained firing mediated by persistent inward currents (PIC). ΔF was also larger in participants taking SSRIs (∼6.5 Hz, n = 9) compared to their age-matched controls (∼5.3 Hz, n = 26), consistent with increased levels of spinal serotonin facilitating the motoneuron PIC. Participants in the young development and SSRI groups also had higher firing rates and a steeper acceleration in initial firing rates (secondary ranges), consistent with the PIC producing a steeper acceleration in membrane depolarization at the onset of motoneuron firing. In summary, both the young development and SSRI groups exhibited increased intrinsic motoneuron excitability compared to the adults, which, in the young development group, was also associated with a larger unsteadiness in the dorsiflexion torque profiles. We propose several intrinsic and extrinsic factors that affect both motoneuron PICs and cell discharge which vary during development, with a time course similar to the changes in motoneuron firing behaviour observed in the present study. KEY POINTS: Neurons in the spinal cord that activate muscles in the limbs (motoneurons) undergo increases in excitability shortly after birth to help animals stand and walk. We examined whether the excitability of human ankle flexor motoneurons also continues to change from child to adulthood by recording the activity of the muscle fibres they innervate. Motoneurons in children and adolescents aged 7-17 years (young development group) had higher signatures of excitability that included faster firing rates and more self-sustained activity compared to adults aged ≥18 years. Participants aged 11-28 years of age taking serotonin reuptake inhibitors had the highest measures of motoneuron excitability compared to their age-matched controls. The young development group also had more unstable contractions, which might partly be related to the high excitability of the motoneurons.

How many motor units is enough? An assessment of the influence of the number of motor units on firing rate calculations

The number of motor units included in calculations of mean firing rates varies widely in the literature. It is unknown how the number of decomposed motor units included in the calculation of firing rate per participant compares to the total number of active motor units in the muscle, and if this is different for males and females. Bootstrapped distributions and confidence intervals (CI) of mean motor unit firing rates decomposed from the tibialis anterior were used to represent the total number of active motor units for individual participants in trials from 20 to 100 % of maximal voluntary contraction. Bootstrapped distributions of mean firing rates were constructed using different numbers of motor units, from one to the maximum number for each participant, and compared to the CIs. A probability measure for each number of motor units involved in firing rate was calculated and then averaged across all individuals. Motor unit numbers required for similar levels of probability increased as contraction intensity increased (p < 0.001). Increased levels of probability also required higher numbers of motor units (p < 0.001). There was no effect of sex (p ≥ 0.97) for any comparison. This methodology should be repeated in other muscles, and aged populations.

Sex differences in knee extensor torque control

There is currently equivocal evidence regarding sex-related differences in measures of muscle force and torque control. To that end, we investigated sex differences in knee extensor muscle torque control, using both magnitude- and complexity-based measures, across contraction intensities typical of activities of daily living. 50 participants (25 male, median age [and interquartile range] 23.0 [20.0-33.0]; 25 female, median age [and interquartile range] 21.0 [20.0-40.5]) performed a series of intermittent isometric knee extensor contractions at 10, 20 and 40% maximal voluntary contraction (MVC). Torque was measured in N·m and torque control was quantified according to the magnitude (standard deviation [SD], coefficient of variation [CV]) and complexity (approximate entropy [ApEn], detrended fluctuation analysis [DFA] α) of torque fluctuations. Males exhibited a significantly greater absolute magnitude (i.e., SD) of knee extensor torque fluctuations during contractions at 10% (P = 0.011), 20% (P = 0.002) and 40% MVC (P = 0.003), though no sex differences were evident when fluctuations were normalised to mean torque output (i.e., CV). Males exhibited significantly lower ApEn during contractions at 10% (P = 0.002) and 20% MVC (P = 0.024) and significantly greater DFA α during contractions at 10% (P = 0.003) and 20% MVC (P = 0.001). These data suggest sex differences in muscle torque control strategies and highlight the need to consider both the magnitude and complexity of torque fluctuations when examining sex differences in muscle force control.

Peptidergic modulation of motor neuron output via CART signaling at C bouton synapses

The intensity of muscle contraction, and therefore movement vigor, needs to be adaptable to enable complex motor behaviors. This can be achieved by adjusting the properties of motor neurons, which form the final common pathway for all motor output from the central nervous system. Here, we identify roles for a neuropeptide, cocaine- and amphetamine-regulated transcript (CART), in the control of movement vigor. We reveal distinct but parallel mechanisms by which CART and acetylcholine, both released at C bouton synapses on motor neurons, selectively amplify the output of subtypes of motor neurons that are recruited during intense movement. We find that mice with broad genetic deletion of CART or selective elimination of acetylcholine from C boutons exhibit deficits in behavioral tasks that require higher levels of motor output. Overall, these data uncover spinal modulatory mechanisms that control movement vigor to support movements that require a high degree of muscle force.

Sex-differences in the longitudinal recovery of neuromuscular function in COVID-19 associated acute respiratory distress syndrome survivors

Introduction

Patients admitted to the intensive care unit (ICU) following severe acute respiratory syndrome 2 (SARS-CoV-2) infection may have muscle weakness up to 1 year or more following ICU discharge. However, females show greater muscle weakness than males, indicating greater neuromuscular impairment. The objective of this work was to assess sex differences in longitudinal physical functioning following ICU discharge for SARS-CoV-2 infection.

Methods

We performed longitudinal assessment of physical functioning in two groups: 14 participants (7 males, 7 females) in the 3-to-6 month and 28 participants (14 males, 14 females) in the 6-to-12 month group following ICU discharge and assessed differences between the sexes. We examined self-reported fatigue, physical functioning, compound muscle action potential (CMAP) amplitude, maximal strength, and the neural drive to the tibialis anterior muscle.

Results

We found no sex differences in the assessed parameters in the 3-to-6-month follow-up, indicating significant weakness in both sexes.Sex differences emerged in the 6-to-12-month follow-up. Specifically, females exhibited greater impairments in physical functioning, including lower strength, walking lower distances, and high neural input even 1 year following ICU-discharge.

Discussion

Females infected by SARS-CoV-2 display significant impairments in functional recovery up to 1 year following ICU discharge. The effects of sex should be considered in post-COVID neurorehabilitation.

Estimates of persistent inward currents in lower limb motoneurons are larger in females than in males

Noninvasive recordings of motor unit (MU) spike trains help us understand how the nervous system controls movement and how it adapts to various physiological conditions. The majority of participants in human and nonhuman animal physiology studies are male, and it is assumed that mechanisms uncovered in these studies are shared between males and females. However, sex differences in neurological impairment and physical performance warrant the study of sex as a biological variable in human physiology and performance. To begin addressing this gap in the study of biophysical properties of human motoneurons, we quantified MU discharge rates and estimates of persistent inward current (PIC) magnitude in both sexes. We decomposed MU spike trains from the tibialis anterior (TA), medial gastrocnemius (MG), and soleus (SOL) using high-density surface electromyography and blind source separation algorithms. Ten participants of each sex performed slow triangular (10 s up and down) isometric contractions to a peak of 30% of their maximum voluntary contraction. We then used linear mixed-effects models to determine if peak discharge rate and estimates of PICs were predicted by the fixed effects of sex, muscle, and their interaction. Despite a lack of sex-differences in peak discharge rates across all muscles, estimates of PICs were larger [χ2(1) = 6.26, P = 0.012] in females [4.73 ± 0.242 pulses per second (pps)] than in males (3.81 ± 0.240 pps). These findings suggest that neuromodulatory drive, inhibitory input, and/or biophysical properties of motoneurons differ between the sexes and may contribute to differences in MU discharge patterns.NEW & NOTEWORTHY Sex-related differences in motoneuron analyses have emerged with greater inclusion of female participants, however, mechanisms for these differences remain unclear. Estimates of persistent inward currents (i.e., ΔF) in motoneurons of the lower limb muscles were larger in females than in males. This suggests neuromodulatory drive, monoaminergic signaling, intrinsic motoneuron properties, and/or descending motor commands may differ between the sexes, which provides a potential mechanism underlying previously reported sex-related differences in motoneuron discharge patterns.

Motor Unit Discharge Characteristics and Conduction Velocity of the Vastii Muscles in Long-Term Resistance-Trained Men

PURPOSE

Adjustments in motor unit (MU) discharge properties have been shown after short-term resistance training; however, MU adaptations in long-term resistance-trained (RT) individuals are less clear. Here, we concurrently assessed MU discharge characteristics and MU conduction velocity in long-term RT and untrained (UT) men.

METHODS

Motor unit discharge characteristics (discharge rate, recruitment, and derecruitment threshold) and MU conduction velocity were assessed after the decomposition of high-density electromyograms recorded from vastus lateralis (VL) and vastus medialis (VM) of RT (>3 yr; n = 14) and UT ( n = 13) during submaximal and maximal isometric knee extension.

RESULTS

Resistance-trained men were on average 42% stronger (maximal voluntary force [MVF], 976.7 ± 85.4 N vs 685.5 ± 123.1 N; P < 0.0001), but exhibited similar relative MU recruitment (VL, 21.3% ± 4.3% vs 21.0% ± 2.3% MVF; VM, 24.5% ± 4.2% vs 22.7% ± 5.3% MVF) and derecruitment thresholds (VL, 20.3% ± 4.3% vs 19.8% ± 2.9% MVF; VM, 24.2% ± 4.8% vs 22.9% ± 3.7% MVF; P ≥ 0.4543). There were also no differences between groups in MU discharge rate at recruitment and derecruitment or at the plateau phase of submaximal contractions (VL, 10.6 ± 1.2 pps vs 10.3 ± 1.5 pps; VM, 10.7 ± 1.6 pps vs 10.8 ± 1.7 pps; P ≥ 0.3028). During maximal contractions of a subsample population (10 RT, 9 UT), MU discharge rate was also similar in RT compared with UT (VL, 21.1 ± 4.1 pps vs 14.0 ± 4.5 pps; VM, 19.5 ± 5.0 pps vs 17.0 ± 6.3 pps; P = 0.7173). Motor unit conduction velocity was greater in RT compared with UT individuals in both VL (4.9 ± 0.5 m·s -1 vs 4.5 ± 0.3 m·s -1 ; P < 0.0013) and VM (4.8 ± 0.5 m·s -1 vs 4.4 ± 0.3 m·s -1 ; P < 0.0073).

CONCLUSIONS

Resistance-trained and UT men display similar MU discharge characteristics in the knee extensor muscles during maximal and submaximal contractions. The between-group strength difference is likely explained by superior muscle morphology of RT as suggested by greater MU conduction velocity.

Firing behavior of single motor units of the tibialis anterior in human walking as non-invasively revealed by HDsEMG decomposition

Objective.Investigation of the firing behavior of motor units (MUs) provides essential neuromuscular control information because MUs are the smallest organizational component of the neuromuscular system. The MUs activated during human infants' leg movements and rodent locomotion, mainly controlled by the spinal central pattern generator (CPG), show highly synchronous firing. In addition to spinal CPGs, the cerebral cortex is involved in neuromuscular control during walking in human adults. Based on the difference in the neural control mechanisms of locomotion between rodent, human infants and adults, MU firing behavior during adult walking probably has some different features from the other populations. However, so far, the firing activity of MUs in human adult walking has been largely unknown due to technical issues.Approach.Recent technical advances allow noninvasive investigation of MU firing by high-density surface electromyogram (HDsEMG) decomposition. We investigated the MU firing behavior of the tibialis anterior (TA) muscle during walking at a slow speed by HDsEMG decomposition.Main results.We found recruitment threshold modulation of MU between walking and steady isometric contractions. Doublet firings, and gait phase-specific firings were also observed during walking. We also found high MU synchronization during walking over a wide range of frequencies, probably including cortical and spinal CPG-related components. The amount of MU synchronization was modulated between the gait phases and motor tasks. These results suggest that the central nervous system flexibly controls MU firing to generate appropriate force of TA during human walking.Significance.This study revealed the MU behavior during walking at a slow speed and demonstrated the feasibility of noninvasive investigation of MUs during dynamic locomotor tasks, which will open new frontiers for the study of neuromuscular systems in the fields of neuroscience and biomedical engineering.