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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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2
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Risi B, Cotti Piccinelli S, Gazzina S, Labella B, Caria F, Damioli S, Poli L, Padovani A, Filosto M. Prognostic Usefulness of Motor Unit Number Index (MUNIX) in Patients Newly Diagnosed with Amyotrophic Lateral Sclerosis. J Clin Med 2023; 12:5036. [PMID: 37568439 PMCID: PMC10420094 DOI: 10.3390/jcm12155036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
The MUNIX technique allows us to estimate the number and size of surviving motor units (MUs). Previous studies on ALS found correlations between MUNIX and several clinical measures, but its potential role as a predictor of disease progression rate (DPR) has not been thoroughly evaluated to date. We aimed to investigate MUNIX's ability to predict DPR at a six-month follow up. METHODS 24 ALS patients with short disease duration (<24 months from symptoms' onset) were enrolled and divided according to their baseline DPR into two groups (normal [DPR-N] and fast [DPR-F] progressors). MUNIX values were obtained from five muscles (TA, APB, ADM, FDI, Trapezius) and averaged for each subject. RESULTS MUNIX was found to predict DPR at follow up in a multivariable linear regression model; namely, patients with lower MUNIX values were at risk of showing greater DPR scores at follow up. The result was replicated in a simple logistic regression analysis, with the dichotomic category "MUNIX-Low" as the independent variable and the outcome "DPR-F" as the dependent variable. CONCLUSIONS our results pave the way for the use of the MUNIX method as a prognostic tool in early ALS, enabling patients' stratification according to their rates of future decline.
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Affiliation(s)
- Barbara Risi
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (B.R.); (S.C.P.); (B.L.); (A.P.)
- Unit of Neurology, ASST Spedali Civili, 25123 Brescia, Italy;
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25064 Gussago, Italy; (F.C.); (S.D.)
| | - Stefano Cotti Piccinelli
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (B.R.); (S.C.P.); (B.L.); (A.P.)
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25064 Gussago, Italy; (F.C.); (S.D.)
| | - Stefano Gazzina
- Unit of Neurophysiology, ASST Spedali Civili, 25123 Brescia, Italy;
| | - Beatrice Labella
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (B.R.); (S.C.P.); (B.L.); (A.P.)
- Unit of Neurology, ASST Spedali Civili, 25123 Brescia, Italy;
| | - Filomena Caria
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25064 Gussago, Italy; (F.C.); (S.D.)
| | - Simona Damioli
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25064 Gussago, Italy; (F.C.); (S.D.)
| | - Loris Poli
- Unit of Neurology, ASST Spedali Civili, 25123 Brescia, Italy;
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (B.R.); (S.C.P.); (B.L.); (A.P.)
- Unit of Neurology, ASST Spedali Civili, 25123 Brescia, Italy;
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (B.R.); (S.C.P.); (B.L.); (A.P.)
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25064 Gussago, Italy; (F.C.); (S.D.)
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Badini S, Regondi S, Lammi C, Bollati C, Donvito G, Pugliese R. Computational Mechanics of Form-Fitting 3D-Printed Lattice-Based Wrist-Hand Orthosis for Motor Neuron Disease. Biomedicines 2023; 11:1787. [PMID: 37509427 PMCID: PMC10376028 DOI: 10.3390/biomedicines11071787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
Motor neuron disease (MND) patients often experience hand-wrist muscle atrophy resulting in severe social consequences and hampering their daily activities. Although hand-wrist orthosis is commonly used to assist weakened muscles, its effectiveness is limited due to the rapid progression of the disease and the need for customization to suit individual patient requirements. To address these challenges, this study investigates the application of three-dimensional (3D) printing technology to design and fabricate two lattice structures inspired by silkworm cocoons, using poly-ε-caprolactone as feedstock material. Finite element method (FEM) analysis is employed to study the mechanical behavior, enabling control over the geometric configuration incorporated into the hand-wrist orthosis. Through tensile displacement and three-point bending simulations, the stress distribution is examined for both lattice geometries. Geometry-1 demonstrates anisotropic behavior, while geometry-2 exhibits no strict directional dependence due to its symmetry and uniform node positioning. Moreover, the biocompatibility of lattices with human skin fibroblasts is investigated, confirming excellent biocompatibility. Lastly, the study involves semi-structured interviews with MND patients to gather feedback and develop prototypes of form-fitting 3D-printed lattice-based hand-wrist orthosis. By utilizing 3D printing technology, this study aims to provide customized orthosis that can effectively support weakened muscles and reposition the hand for individuals with MND.
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Affiliation(s)
- Silvia Badini
- Nemolab, ASST GOM Niguarda Cà Granda Hospital, 20162 Milan, Italy
| | - Stefano Regondi
- Nemolab, ASST GOM Niguarda Cà Granda Hospital, 20162 Milan, Italy
- NEuroMuscular Omnicenter (NEMO), 20162 Milan, Italy
| | - Carmen Lammi
- Department of Pharmaceutical Sciences, University of Milan, 20133 Milan, Italy
| | - Carlotta Bollati
- Department of Pharmaceutical Sciences, University of Milan, 20133 Milan, Italy
| | - Giordana Donvito
- Nemolab, ASST GOM Niguarda Cà Granda Hospital, 20162 Milan, Italy
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Zoccolella S, Giugno A, Logroscino G. Split phenomena in amyotrophic lateral sclerosis: Current evidences, pathogenetic hypotheses and diagnostic implications. Front Neurosci 2023; 16:1100040. [PMID: 36699516 PMCID: PMC9868395 DOI: 10.3389/fnins.2022.1100040] [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: 11/16/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease and has emerged among the disorders with the largest increasing incidence in Western countries. Although the diagnosis is based on clinical grounds, electromyography (EMG), and nerve conduction studies (NCS) play a crucial role to exclude other potential etiologies of lower motor neuron (LMN) dysfunction. Based on clinical grounds, a peculiar pattern of dissociated atrophy of the intrinsic hand and foot muscles, termed the "split-hand" (SH) and "split-leg" (SL) signs, has been described in a significant proportion of subjects with ALS, even at the early stages of the disease, when symptoms are focal. These signs are rare in neurological and non-neurological diseases other than ALS. In this review, we discussed current evidences concerning SH and SL signs, their pathogenetic hypotheses and neurophysiological findings. We also analyze whether SH and SL signs can be reliable markers in the differential diagnosis and in the prognosis of ALS.
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Affiliation(s)
- Stefano Zoccolella
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”, Tricase, Italy,Neurology Unit, Azienda Sanitaria Locale (ASL) Bari, San Paolo Hospital, Bari, Italy,*Correspondence: Stefano Zoccolella,
| | - Alessia Giugno
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”, Tricase, Italy,Department of Medical Sciences, Institute of Neurology, Magna Græcia University, Catanzaro, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”, Tricase, Italy,Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy
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5
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Split hand index: An early diagnostic biomarker for ALS. Clin Neurophysiol 2022; 144:115-116. [PMID: 36154796 DOI: 10.1016/j.clinph.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 11/23/2022]
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Lu WZ, Lin HA, Hou SK, Lee CF, Bai CH, Lin SF. Split-hand index for amyotrophic lateral sclerosis diagnosis: A frequentist and Bayesian meta-analysis. Clin Neurophysiol 2022; 143:56-66. [PMID: 36116424 DOI: 10.1016/j.clinph.2022.08.020] [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: 04/12/2022] [Revised: 08/02/2022] [Accepted: 08/21/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Preferential wasting of the thenar muscles, the split-hand sign, may be used for early diagnosis of amyotrophic lateral sclerosis (ALS). METHODS Electronic databases were searched for studies assessing the split-hand index (SHI) and the compound muscle action potential (CMAP) amplitudes of abductor pollicis brevis (APB), first dorsal interosseous (FDI), and abductor digiti minimi (ADM). The SHI was obtained by multiplying CMAP amplitudes of APB and FDI and dividing the product by the CMAP amplitude of ADM. The Bayesian analysis was used for validation. RESULTS In total, 17 studies and 1635 patients were included. Our meta-analysis revealed that ALS patients had significantly decreased SHI (standardized mean difference [SMD], -1.60, P < 0.001), CMAP of the APB (SMD, -1.67, P < 0.001), FDI (SMD, -1.12, P < 0.001), and ADM (SMD, -1.09, P < 0.001). The binormal receiver operating characteristic curve analysis showed a threshold of < 7.4 for SHI, and cutoff values of < 6.4 mV for APB and < 8.4 mV for FDI, respectively. The Bayesian analysis validated decreased SHI in ALS patients (posterior mean difference of - 5.91). CONCLUSIONS An SHI of < 7.4 can be used facilitating earlier diagnosis of ALS. SIGNIFICANCE SHI can be used as a standard neurophysiological biomarker for early diagnosis.
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Affiliation(s)
- Wei-Zhen Lu
- Department of Emergency Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Hui-An Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sen-Kuang Hou
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Fan Lee
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Sheng-Feng Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan; School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Reassessing the Diagnostic Utility of the Split Hand Index in Amyotrophic Lateral Sclerosis Patients-The Divide by Zero Problem. Neurol Int 2022; 14:707-715. [PMID: 36135994 PMCID: PMC9503317 DOI: 10.3390/neurolint14030059] [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: 07/24/2022] [Revised: 08/18/2022] [Accepted: 08/25/2022] [Indexed: 11/28/2022] Open
Abstract
We set out to assess the diagnostic utility of the split hand index (SHI) for amyotrophic lateral sclerosis (ALS) and also to see if and how it can be applied to severely atrophied muscles, a frequent finding in this setting. We enrolled 38 patients from our clinic, 19 diagnosed with ALS and 19 controls, matched for age and sex. The SHI was calculated, on both sides, for all the patients. We calculated a SHI of 0 when the abductor pollicis brevis muscle (ABD) or first dorsal interosseous muscle (FDI) compound muscle action potentials (CMAPs) were unobtainable, and we allotted a value of 0.1 mV to abductor digiti minimi muscle (ADM) CMAP, for mathematical purposes, when the value would have been 0. The means differences were large between groups, with a significant variance heterogeneity. We performed a ROC analysis and obtained an accuracy of 0.83 for a SHI of 7.2, p-value < 0.0001. In conclusion, we reaffirm the utility of the SHI in the diagnosis of ALS, especially in limb onset cases, and we think that it can be safely extended to severely atrophied muscles with absent or very low CMAP values, without endangering the sensitivity or specificity.
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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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Hu N, Wang J, Liu M. Split hand in amyotrophic lateral sclerosis: A systematic review and meta-analysis. J Clin Neurosci 2021; 90:293-301. [PMID: 34275566 DOI: 10.1016/j.jocn.2021.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/05/2021] [Accepted: 06/06/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the frequency of split hand (SI) and its diagnostic performance in amyotrophic lateral sclerosis (ALS). METHODS PubMed, EMBASE, OVID and other databases were searched systematically up to March 2021 for relevant reports about the split hand syndrome. Two reviewers screened and selected the titles and abstracts of the studies independently during the database searches and performed full-text reviews and extracted available data. In our study, AACMAP was calculated by AACMAP = APBCMAP/ADMCMAP and split-hand index (SI) was calculated by SICMAP = (APBCMAP × FDICMAP)/ADMCMAP. The mean differences (MD) in APB/ADMCMAP and SICMAP between patients with ALS and control group were calculated (APB the abductor pollicis brevis muscle; ADM the abductor digiti minimi muscle; CMAP compound muscle action potentials). Meta-analysis was performed to determine summary sensitivity, specificity, and area under the curve (AUC) with 95% confidence intervals (CI) for SICMAP. RESULTS Pooled results of five studies including 339 patients showed that 50% (95%CI: 35%-65%) of patients with ALS presented split hand. APB/ADMCMAP in patients with ALS was significantly lower than healthy population (MD: -0.38, 95%CI: -0.48, -0.28). SICMAP in patients with ALS was significantly lower than healthy controls (MD: -5.87, 95%CI: -6.28, -5.46) and neuromuscular controls (MD: -5.60, 95%CI: -5.78, -5.42). Receiver operating characteristic curve analysis showed that the AUC was 0.860 [95%CI: 0.808, 0.911] for SICMAP. The sensitivity and specificity for SICMAP were 78% and 81% (cut-off value: 5.2-11.8), respectively. CONCLUSION Half of ALS patients might show split hand sign. SICMAP could be a potential biomarker in the diagnosis of ALS.
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Affiliation(s)
- Nan Hu
- Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Jingyi Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, China.
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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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11
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Delmont E, Wang F, Lefaucheur JP, Puma A, Breniere C, Beaudonnet G, Cintas P, Collin R, Fortanier E, Grapperon AM, Jomir L, Kribich H, Kouton L, Kuntzer T, Lenglet T, Magot A, Nordine T, Ochsner F, Bolloy G, Pereon Y, Salort-Campana E, Tard C, Vicino A, Verschueren A, Attarian S. Motor unit number index as an individual biomarker: Reference limits of intra-individual variability over time in healthy subjects. Clin Neurophysiol 2020; 131:2209-2215. [PMID: 32707479 DOI: 10.1016/j.clinph.2020.06.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/13/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Motor unit number index (MUNIX) is proposed to monitor neuromuscular disorders. Our objective is to determine the intra-individual variability over time of the MUNIX. METHODS In 11 different hospital centres, MUNIX was assessed twice, at least 3 months apart (range 90-360 days), in tibialis anterior (TA), abductor pollicis brevis (APB), abductor digiti minimi (ADM) and deltoid muscles in 118 healthy subjects. MUNIX sum score 2, 3 and 4 were respectively the sum of the MUNIX of the TA and ADM, of the TA, APB and ADM and of the TA, APB, ADM and deltoid muscles. RESULTS The repeatability of the MUNIX was better for sum scores than for single muscle recordings. The variability of the MUNIX was independent of sex, age, interval between measurements and was lower for experienced than non-experienced operators. The 95th percentile of the coefficient of variability of the MUNIX sum score 2, 3 and 4 were respectively 22%, 18% and 15% for experienced operators. CONCLUSIONS The MUNIX technique must be performed by experienced operators on several muscles to reduce its variability and improve its reliability. SIGNIFICANCE A variation of the MUNIX sum score ≥20% can be interpreted as a significant change of muscle innervation.
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Affiliation(s)
- Emilien Delmont
- Referral Centre for Neuromuscular Diseases and ALS, La Timone Hospital, Marseille, France; Aix-Marseille University, Timone Neuroscience Institute, UMR CNRS 7289, 13005 Marseille, France.
| | - François Wang
- Department of Neurophysiology, CHU Sart Tilman B35, 4000 Liège, Belgium
| | - Jean-Pascal Lefaucheur
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Unité de Neurophysiologie Clinique, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Angela Puma
- Université Côte d'Azur, Peripheral Nervous System and Muscle Department, CHU Nice, France
| | | | - Guillemette Beaudonnet
- Unité de Neurophysiologie Clinique et Epileptologie, CHU Bicêtre, Le Kremlin Bicêtre, France
| | | | - Romain Collin
- Department of Neurophysiology, CHU Sart Tilman B35, 4000 Liège, Belgium
| | - Etienne Fortanier
- Referral Centre for Neuromuscular Diseases and ALS, La Timone Hospital, Marseille, France
| | - Aude-Marie Grapperon
- Referral Centre for Neuromuscular Diseases and ALS, La Timone Hospital, Marseille, France
| | - Laurent Jomir
- Department of Neurology, Hospices Civiles de Lyon, France
| | - Hafida Kribich
- Referral Centre for Neuromuscular Diseases and ALS, La Timone Hospital, Marseille, France
| | - Ludivine Kouton
- Referral Centre for Neuromuscular Diseases and ALS, La Timone Hospital, Marseille, France
| | - Thierry Kuntzer
- Nerve Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Timothee Lenglet
- Department of Clinical Neurophysiology, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Armelle Magot
- Laboratoire d'explorations fonctionnelles, Referral Centre for Neuromuscular Disease Atlantique-Occitanie-Caraïbes, Hôtel-Dieu, 44093 Nantes, France
| | - Tarik Nordine
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Unité de Neurophysiologie Clinique, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - François Ochsner
- Nerve Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Gaëlle Bolloy
- Laboratoire d'explorations fonctionnelles, Referral Centre for Neuromuscular Disease Atlantique-Occitanie-Caraïbes, Hôtel-Dieu, 44093 Nantes, France
| | - Yann Pereon
- Laboratoire d'explorations fonctionnelles, Referral Centre for Neuromuscular Disease Atlantique-Occitanie-Caraïbes, Hôtel-Dieu, 44093 Nantes, France
| | | | - Céline Tard
- U1172 Lille Neuroscience et Cognition, CHU de Lille, Centre de référence des maladies neuromusculaires Nord Est Ile de France, Department of Neurology, Lille, France
| | - Alex Vicino
- Nerve Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Annie Verschueren
- Referral Centre for Neuromuscular Diseases and ALS, La Timone Hospital, Marseille, France
| | - Shahram Attarian
- Referral Centre for Neuromuscular Diseases and ALS, La Timone Hospital, Marseille, France
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