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Chen M, Lu Z, Li X, Zong Y, Xie Q, Li S, Zhou P. Compound muscle action potential (CMAP) scan examination of paretic and contralateral muscles reveals motor unit alterations after stroke. SCIENCE CHINA. LIFE SCIENCES 2023; 66:2604-2613. [PMID: 37258801 PMCID: PMC11057326 DOI: 10.1007/s11427-022-2308-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/19/2023] [Indexed: 06/02/2023]
Abstract
This study presents a novel compound muscle action potential (CMAP) examination of motor unit changes in paretic muscle post stroke. CMAP scan of the first dorsal interosseous (FDI) muscle was performed bilaterally in 16 chronic stroke subjects. Various parameters were derived from the CMAP scan to examine paretic muscle changes, including CMAP amplitude, D50, step index (STEPIX) and amplitude index (AMPIX). A significant decrease in CMAP amplitude and STEPIX was observed in paretic muscles compared with contralateral muscles (CMAP amplitude: paretic (9.0±0.5) mV, contralateral (11.3±0.9) mV, P=0.024; STEPIX: paretic 101.2±7.6, contralateral 121.9±6.5, P=0.020). No significant difference in D50 and AMPIX was observed between the paretic and contralateral sides (P>0.05). The findings revealed complex paretic muscle changes including motor unit degeneration, muscle fiber denervation, reinnervation and atrophy, providing useful insights to help understand neuromuscular mechanisms associated with weakness and other functional deterioration post stroke. The CMAP scan experimental protocols and the applied processing methods are noninvasive, convenient, and automated, offering practical benefits for clinical application.
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Affiliation(s)
- Maoqi Chen
- School of Rehabilitation Science and Engineering, University of Health and Rehabilitation Sciences, Qingdao, 266071, China
| | - Zhiyuan Lu
- School of Rehabilitation Science and Engineering, University of Health and Rehabilitation Sciences, Qingdao, 266071, China.
| | - Xiaoyan Li
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
- Fischell Department of Bioengineering, University of Maryland at College Park, College Park, MD, 20742, USA
| | - Ya Zong
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Qing Xie
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, TX, 77030, USA
- TIRR Memorial Hermann Research Center, TIRR Memorial Hermann Hospital, Houston, TX, 77030, USA
| | - Ping Zhou
- School of Rehabilitation Science and Engineering, University of Health and Rehabilitation Sciences, Qingdao, 266071, China
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Zhang S, Yang X, Xu Y, Luo Y, Fan D, Liu X. Application Value of the Motor Unit Number Index in Patients With Kennedy Disease. Front Neurol 2022; 12:705816. [PMID: 34992574 PMCID: PMC8724309 DOI: 10.3389/fneur.2021.705816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to evaluate the usefulness of the motor unit number index (MUNIX) technique in Kennedy disease (KD) and test the correlation between the MUNIX and other clinical parameters. The MUNIX values of the bilateral deltoid, abductor digiti minimi (ADM), quadriceps femoris (QF), and tibialis anterior (TA) were determined and compared with the course of the disease. The MUNIX sum score was calculated by adding the MUNIX values of these 8 muscles. Disability was evaluated using the spinal and bulbar muscular atrophy functional rating scale (SBMAFRS). The MUNIX scores of patients with KD were negatively correlated with the course of the disease (p < 0.05), whereas their motor unit size index (MUSIX) scores were positively correlated with the course the of disease (p < 0.05). MUNIX sum scores were correlated with SBMAFRS scores (r = 0.714, p < 0.05). MUNIX was more sensitive than compound muscle action potentials or muscle strength as an indicator of neuron loss and axonal collateral reinnervation. The MUNIX sum score is an objective and a reliable indicator of disease progression, and it is a potential choice for therapeutic clinical trials. The MUNIX can assess the functional loss of motor axons and is correlated with disability. The MUNIX sum score may be especially suitable as an objective parameter.
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Affiliation(s)
- Shuo Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Xin Yang
- Department of Neurology, Changchun Central Hospital, Changchun, China
| | - Yingsheng Xu
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Yongmei Luo
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China.,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xiaoxuan Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
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Boulay C, Delmont E, Audic F, Chabrol B, Attarian S. Motor unit number index: A potential electrophysiological biomarker for pediatric spinal muscular atrophy. Muscle Nerve 2021; 64:445-453. [PMID: 34255873 DOI: 10.1002/mus.27372] [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: 07/28/2020] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION/AIMS In adult spinal muscular atrophy (SMA), the motor unit number index (MUNIX) has been shown to be an useful electrophysiological biomarker. This study evaluated the feasibility and the clinical relevance of using the MUNIX technique for patients with pediatric SMA (Ped-SMA) and correlated MUNIX results with clinical scores. METHODS Fourteen patients with type II Ped-SMA (11 females; median age 11 y [interquartile range (IQR), 4.8-17 y]) and 14 controls (nine females; median age 10.75 y [IQR, 6.5-13.4 y]) were enrolled and matched by sex, age, height, weight, and body mass index. Clinical examination included manual muscle testing, dynamometry (grasp and pinch), and motor function measure (MFM). The MUNIX technique was evaluated in the abductor digiti minimi (ADM) and abductor pollicis brevis (APB) on two sides when possible. RESULTS In the patients with Ped-SMA, the MUNIX and compound muscle action potential (CMAP) amplitudes were significantly decreased and the motor size unit index (MUSIX) was significantly increased in the ADM and APB when compared to controls. The intraclass correlation coefficient was good for the intrarater variability of the CMAP amplitude, MUNIX, and MUSIX in the ADM (0.95, 0.83, and 0.89, respectively) and the APB (0.98, 0.96, and 0.94, respectively). The total CMAP amplitude correlated with the grasp and pinch scores (P < .05), and the MUNIX measurements correlated with the MFM scores. DISCUSSION The MUNIX technique, which accurately estimated lower motor neuron loss and the number of remaining functional motor units, was shown to be a useful electrophysiological biomarker for disease progression and a potential biomarker for treatment response.
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Affiliation(s)
- Christophe Boulay
- Neuropediatric Department, Children Timone University Hospital, Aix-Marseille University, Marseille, France.,Reference Center for Neuromuscular Diseases and ALS Timone University Hospital, Aix-Marseille University, Marseille, France.,Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Emilien Delmont
- Reference Center for Neuromuscular Diseases and ALS Timone University Hospital, Aix-Marseille University, Marseille, France.,Aix-Marseille University, UMR 7286, Medicine Faculty, Marseille, France
| | - Frédérique Audic
- Neuropediatric Department, Children Timone University Hospital, Aix-Marseille University, Marseille, France.,Reference Center for Neuromuscular Diseases and ALS Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Brigitte Chabrol
- Neuropediatric Department, Children Timone University Hospital, Aix-Marseille University, Marseille, France.,Reference Center for Neuromuscular Diseases and ALS Timone University Hospital, Aix-Marseille University, Marseille, France.,Aix-Marseille University, Inserm UMR S 910, Medical Genetics and Functional Genomics, Marseille, France
| | - Shahram Attarian
- Reference Center for Neuromuscular Diseases and ALS Timone University Hospital, Aix-Marseille University, Marseille, France.,Aix-Marseille University, Inserm UMR S 910, Medical Genetics and Functional Genomics, Marseille, France
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Gomes de Sousa MW, Escorcio-Bezerra ML, Pinto WBVR, Souza PVS, de Oliveira Braga NI, Oliveira ASB, Manzano GM. Motor unit number index (MUNIX) in myopathic disorders: Clinical correlations and potential pitfalls. Neurophysiol Clin 2019; 49:329-334. [PMID: 31331650 DOI: 10.1016/j.neucli.2019.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 07/02/2019] [Accepted: 07/06/2019] [Indexed: 12/13/2022] Open
Abstract
Our aim was to study motor unit number index (MUNIX) in myopathic disorders. We studied 11 patients with myopathy, and healthy controls. We obtained MUNIX, compound muscle action potential (CMAP), motor unit size index (MUSIX) and alpha (α, power exponent from MUNIX equation) measurements from three different muscles. MUNIX and CMAP were significantly lower in one muscle. This MUNIX decrease may not be related to motor neuron loss, but rather to muscle fiber atrophy. MUSIX and α did not change and may be useful in determining whether the MUNIX decrease is indeed due to motor unit loss.
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Nandedkar SD, Barkhaus PE, Stålberg EV, Neuwirth C, Weber M. Motor unit number index: Guidelines for recording signals and their analysis. Muscle Nerve 2018; 58:374-380. [DOI: 10.1002/mus.26099] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2018] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - Erik V. Stålberg
- University Hospital; Uppsala Sweden
- Institute of Neurosciences; Uppsala Sweden
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Miralles F. Motor unit number index (MUNIX) derivation from the relationship between the area and power of surface electromyogram: a computer simulation and clinical study. J Neural Eng 2018; 15:036013. [PMID: 29424359 DOI: 10.1088/1741-2552/aaae19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The motor unit number index (MUNIX) is a technique based on the surface electromyogram (sEMG) that is gaining acceptance as a method for monitoring motor neuron loss, because it is reliable and produces less discomfort than other electrodiagnostic techniques having the same intended purpose. MUNIX assumes that the relationship between the area of sEMG obtained at increasing levels of muscle activation and the values of a variable called 'ideal case motor unit count' (ICMUC), defined as the product of the ratio between area and power of the compound muscle action potential (CMAP) by that of the sEMG, is described by a decreasing power function. Nevertheless, the reason for this comportment is unknown. The objective of this work is to investigate if the definition of MUNIX could derive from more basic properties of the sEMG. APPROACH The CMAP and sEMG epochs obtained at different levels of muscle activation from (1) the abductor pollicis brevis (APB) muscle of persons with and without a carpal tunnel syndrome (CTS) and (2) from a computer model of sEMG generation previously published were analysed. MAIN RESULTS MUNIX reflects the power relationship existing between the area and power of a sEMG. The exponent of this function was smaller in patients with motor CTS than in the rest of the subjects. The analysis of the relationship between the area and power of a sEMG could aid in distinguishing a MUNIX reduction due to a motoneuron loss from that due to a loss of muscle fibre. SIGNIFICANCE MUNIX is derived from the relationship between the area and power of a sEMG. This relationship changes when there is a loss of motor units (MUs), which partially explains the diagnostic sensibility of MUNIX. Although the reasons for this change are unknown, it could reflect an increase in the proportion of MUs of great amplitude.
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Affiliation(s)
- Francesc Miralles
- Gabinet d'Electrodiagnòstic, Servei de Neurologia, Hospital Universitari Son Espases, Carretera de Valldemossa, 79., 07010 Palma de Mallorca, Illes Balears, Spain
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Peng Y, Zhang Y. Improving the repeatability of Motor Unit Number Index (MUNIX) by introducing additional epochs at low contraction levels. Clin Neurophysiol 2017; 128:1158-1165. [PMID: 28511128 DOI: 10.1016/j.clinph.2017.03.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/25/2017] [Accepted: 03/27/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the repeatability of (Motor Unit Number Index) MUNIX under repeatability conditions, specify the origin of variations and provide strategies for quality control. METHODS MUNIX calculations were performed on the bicep brachii muscles of eight healthy subjects. Negative effect of suboptimal electrode positions on MUNIX accuracy was eliminated by employing the high-density surface electromyography technique. MUNIX procedures that utilized a variety of surface interferential pattern (SIP) epoch recruitment strategies (including the original MUNIX procedure, two proposed improvement strategies and their combinations) were described. For each MUNIX procedure, ten thousands of different SIP pools were constructed by randomly recruiting necessary SIP epochs from a large SIP epoch pool (3 datasets, 9 independent electromyography recordings at different contraction levels per dataset and 10 SIP epochs per recording) and implemented for MUNIX calculation. The repeatability of each MUNIX procedure was assessed by summarizing the resulting MUNIX distribution and compared to investigate the effect of SIP epoch selection strategy on repeatability performance. RESULTS SIP epochs selected at lower contraction levels have a stronger influence on the repeatability of MUNIX than those selected at higher contraction levels. MUNIX under repeatability conditions follows a normal distribution and the standard deviation can be significantly reduced by introducing more epochs near the MUNIX definition line. CONCLUSIONS The MUNIX technique shows an inherent variation attributable to SIP epochs at low contraction levels. It is recommended that more epochs should be sampled at these low contraction levels to improve the repeatability. SIGNIFICANCE The present study thoroughly documented the inherent variation of MUNIX and the causes, and offered practical solutions to improve the repeatability of MUNIX.
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Affiliation(s)
- Yun Peng
- Department of Biomedical Engineering, Cullen College of Engineering, University of Houston, Houston, TX 77204, USA
| | - Yingchun Zhang
- Department of Biomedical Engineering, Cullen College of Engineering, University of Houston, Houston, TX 77204, USA; Guangdong Provincial Work Injury Rehabilitation Center, Guangzhou, Guangdong 510000, China.
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Peng Y, He J, Yao B, Li S, Zhou P, Zhang Y. Motor unit number estimation based on high-density surface electromyography decomposition. Clin Neurophysiol 2016; 127:3059-3065. [PMID: 27472541 DOI: 10.1016/j.clinph.2016.06.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 05/19/2016] [Accepted: 06/18/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To advance the motor unit number estimation (MUNE) technique using high density surface electromyography (EMG) decomposition. METHODS The K-means clustering convolution kernel compensation algorithm was employed to detect the single motor unit potentials (SMUPs) from high-density surface EMG recordings of the biceps brachii muscles in eight healthy subjects. Contraction forces were controlled at 10%, 20% and 30% of the maximal voluntary contraction (MVC). Achieved MUNE results and the representativeness of the SMUP pools were evaluated using a high-density weighted-average method. RESULTS Mean numbers of motor units were estimated as 288±132, 155±87, 107±99 and 132±61 by using the developed new MUNE at 10%, 20%, 30% and 10-30% MVCs, respectively. Over 20 SMUPs were obtained at each contraction level, and the mean residual variances were lower than 10%. CONCLUSIONS The new MUNE method allows a convenient and non-invasive collection of a large size of SMUP pool with great representativeness. It provides a useful tool for estimating the motor unit number of proximal muscles. SIGNIFICANCE The present new MUNE method successfully avoids the use of intramuscular electrodes or multiple electrical stimuli which is required in currently available MUNE techniques; as such the new MUNE method can minimize patient discomfort for MUNE tests.
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Affiliation(s)
- Yun Peng
- Department of Biomedical Engineering, Cullen College of Engineering, University of Houston, Houston, TX 77204, USA
| | - Jinbao He
- School of Electronic and Information Engineering, Ningbo University of Technology, Ningbo, China
| | - Bo Yao
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, and TIRR Memorial Hermann Research Center, Houston, TX, USA
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, and TIRR Memorial Hermann Research Center, Houston, TX, USA
| | - Ping Zhou
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, and TIRR Memorial Hermann Research Center, Houston, TX, USA
| | - Yingchun Zhang
- Department of Biomedical Engineering, Cullen College of Engineering, University of Houston, Houston, TX 77204, USA; Guangdong Provincial Work Injury Rehabilitation Center, Guangzhou 510000, China.
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Zhou P, Li X, Li S, Nandedkar SD. A dilemma in stroke application: Standard or modified motor unit number index? Clin Neurophysiol 2016; 127:2756-2759. [PMID: 27417048 DOI: 10.1016/j.clinph.2016.05.185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 04/25/2016] [Accepted: 05/16/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Ping Zhou
- Guangdong Provincial Work Injury Rehabilitation Center, Guangzhou, China; Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston and TIRR Memorial Hermann Research Center, Houston, TX, USA.
| | - Xiaoyan Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston and TIRR Memorial Hermann Research Center, Houston, TX, USA
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston and TIRR Memorial Hermann Research Center, Houston, TX, USA
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