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Gündüz A, Ser MH, Çalıkuşu FZ, Tanrıverdi U, Abbaszade H, Hakyemez S, Balkan ILİ, Karaali R, Kantarcı F, Uzun Adatepe N. Increased prevalence of mild myopathic changes in the post-COVID-19 duration. Neurol Res 2024; 46:111-118. [PMID: 37729011 DOI: 10.1080/01616412.2023.2258034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/03/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE There are reports of peripheral nerve and muscle involvement during or after coronavirus disease 2019 (COVID-19), even following a mild infection. Here, we aimed to analyze the objective findings regarding peripheral nerve, neuromuscular junction, and muscle function using electrophysiology in patients with a previous COVID-19 infection. METHODS All consecutive patients with a history of COVID-19 were questioned for post-COVID-19 duration-related neurological complaints via Composite Autonomic Symptom Score-31 (COMPASS-31), modified Toronto Neuropathy score (mTORONTO), and Fatigue Severity Scale (FSS). Patients were dichotomized into two groups based on their scores in the questionnaire. Group 1 (patients with high scores in any area of the questionnaire) and Group 2 (patients with normal scores in all sections of the questionnaire). In the second step, Group 1 was invited to a preplanned hospital visit for electrophysiological analysis, including nerve conduction studies, repetitive nerve stimulation, needle electromyography (EMG), quantitative motor unit potential analysis (qMUP), and single fiber EMG. We included 106 patients in the study. According to the questionnaire, 38 patients constituted Group 1, and 68 formed Group 2. RESULTS Of the 38 patients, 14 accepted and underwent preplanned electrophysiological examinations. Needle EMG revealed small, short, polyphasic MUPs with early recruitment, and qMUP analysis demonstrated an increased percentage of polyphasic potentials in three patients. The examinations in other patients were unremarkable. CONCLUSIONS The high prevalence of complaints and objective myopathic findings in our cohort implicated the role of muscle involvement in the post-COVID-19 duration. Considering the socioeconomic and psychological burden of the post-COVID-19 duration among individuals and societies, a better understanding of the symptoms and myopathy is warranted.
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Affiliation(s)
- Ayşegül Gündüz
- Cerrahpaşa Medical Faculty, Neurology Department, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Merve Hazal Ser
- Cerrahpaşa Medical Faculty, Neurology Department, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Fatma Zehra Çalıkuşu
- Cerrahpaşa Medical Faculty, Neurology Department, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Uygur Tanrıverdi
- Cerrahpaşa Medical Faculty, Neurology Department, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Hikmet Abbaszade
- Cerrahpaşa Medical Faculty, Neurology Department, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Sena Hakyemez
- Cerrahpaşa Medical Faculty, Infectious Diseases Department, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - I Lker İnanç Balkan
- Cerrahpaşa Medical Faculty, Infectious Diseases Department, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Rıdvan Karaali
- Cerrahpaşa Medical Faculty, Infectious Diseases Department, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Fatih Kantarcı
- Radiology Department, Yedikule Surp Pırgiç Armenian Hospital Foundation, Istanbul, Turkey
| | - Nurten Uzun Adatepe
- Cerrahpaşa Medical Faculty, Neurology Department, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Ros LA, Sleutjes BT, Stikvoort García DJ, Goedee HS, Asselman FL, van den Berg LH, van der Pol WL, Wadman RI. Feasibility and tolerability of multimodal peripheral electrophysiological techniques in a cohort of patients with spinal muscular atrophy. Clin Neurophysiol Pract 2023; 8:123-131. [PMID: 37554725 PMCID: PMC10404501 DOI: 10.1016/j.cnp.2023.06.001] [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: 02/19/2023] [Revised: 05/27/2023] [Accepted: 06/17/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE Electrophysiological techniques are emerging as an aid in identifying prognostic or therapeutic biomarkers in patients with spinal muscular atrophy (SMA), but electrophysiological assessments may be burdensome for patients. We, therefore, assessed feasibility and tolerability of multimodal peripheral non-invasive electrophysiological techniques in a cohort of patients with SMA. METHODS We conducted a single center, longitudinal cohort study investigating the feasibility and tolerability of applying multimodal electrophysiological techniques to the median nerve unilaterally. Techniques consisted of the compound muscle action potential scan, motor nerve excitability tests, repetitive nerve stimulation and sensory nerve action potential. We assessed tolerability using the numeric rating scale (NRS), ranging from 0 (no pain) to 10 (worst possible pain), and defined the protocol to be tolerable if the NRS score ≤ 3. The protocol was considered feasible if it could be performed according to test and quality standards. RESULTS We included 71 patients with SMA types 1-4 (median 39 years; range 13-67) and 63 patients at follow-up. The protocol was feasible in 98% of patients and was well-tolerated in up to 90% of patients. Median NRS score was 2 (range 0-6 at baseline and range 0-4 at follow-up (p < 0.01)). None of the patients declined follow-up assessment. CONCLUSIONS Multimodal, peripheral, non-invasive, electrophysiological techniques applied to the median nerve are feasible and well-tolerated in adolescents and adults with SMA types 1-4. SIGNIFICANCE Our study supports the use of non-invasive multimodal electrophysiological assessments in adolescents and adults with SMA types 1-4.
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Affiliation(s)
- Leandra A.A. Ros
- Department of Neurology, University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Boudewijn T.H.M. Sleutjes
- Department of Neurology, University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Diederik J.L. Stikvoort García
- Department of Neurology, University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - H. Stephan Goedee
- Department of Neurology, University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Fay-Lynn Asselman
- Department of Neurology, University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Leonard H. van den Berg
- Department of Neurology, University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | | | - Renske I. Wadman
- Corresponding author at: Department of Neurology, University Medical Center Utrecht, UMC Utrecht Brain Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
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Chu C, Wu P, Chen J, Tsou N, Lin Y, Lo Y, Li S, Chang C, Chen B, Tsai C, Chen Y, Liu T, Chen S. Flexible Optogenetic Transducer Device for Remote Neuron Modulation Using Highly Upconversion-Efficient Dendrite-Like Gold Inverse Opaline Structure. Adv Healthc Mater 2022; 11:e2101310. [PMID: 34971080 DOI: 10.1002/adhm.202101310] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/10/2021] [Indexed: 01/14/2023]
Abstract
A remote optogenetic device for analyzing freely moving animals has attracted extensive attention in optogenetic engineering. In particular, for peripheral nerve regions, a flexible device is needed to endure the continuous bending movements of these areas. Here, a remote optogenetic optical transducer device made from a gold inverse opaline skeleton grown with a dendrite-like gold nanostructure (D-GIOF) and chemically grafted with upconversion nanoparticles (UCNPs) is developed. This implantable D-GIOF-based transducer device can achieve synergistic interaction of the photonic crystal effect and localized surface plasmon resonance, resulting in considerable UCNP conversion efficiency with a negligible thermal effect under low-intensity 980 nm near-infrared (NIR) light excitation. Furthermore, the D-GIOF-based transducer device exhibits remarkable emission power retention (≈100%) under different bending states, indicating its potential for realizing peripheral nerve stimulation. Finally, the D-GIOF-based transducer device successfully stimulates neuronal activities of the sciatic nerve in mice. This study demonstrates the potential of the implantable device to promote remote NIR stimulation for modulation of neural activity in peripheral nerve regions and provides proof of concept for its in vivo application in optogenetic engineering.
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Affiliation(s)
- Chao‐Yi Chu
- Department of Materials Science and Engineering National Yang Ming Chiao Tung University Hsinchu 300 Taiwan, ROC
| | - Pu‐Wei Wu
- Department of Materials Science and Engineering National Yang Ming Chiao Tung University Hsinchu 300 Taiwan, ROC
| | - Jung‐Chih Chen
- Department of Electrical and Computer Engineering National Yang Ming Chiao Tung University Hsinchu 300 Taiwan, ROC
- Department of Biological Science and Technology National Yang Ming Chiao Tung University Hsinchu 300 Taiwan, ROC
- Catholic Mercy Hospital Catholic Mercy Medical Foundation Hsinchu 303 Taiwan, ROC
| | - Nien‐Ti Tsou
- Department of Materials Science and Engineering National Yang Ming Chiao Tung University Hsinchu 300 Taiwan, ROC
| | - You‐Yi Lin
- Material and Chemical Research Laboratories Industrial Technology Research Institute Hsinchu 300 Taiwan, ROC
| | - Yu‐Chun Lo
- The Ph.D. Program for Neural Regenerative Medicine College of Medical Science and Technology Taipei Medical University No. 250 Wu‐Xing St. Taipei 110 Taiwan, ROC
| | - Ssu‐Ju Li
- Department of Biomedical Engineering National Yang Ming Chiao Tung University No.155, Sec. 2, Linong St. Taipei 112 Taiwan, ROC
| | - Ching‐Wen Chang
- Department of Biomedical Engineering National Yang Ming Chiao Tung University No.155, Sec. 2, Linong St. Taipei 112 Taiwan, ROC
| | - Bo‐Wei Chen
- Department of Biomedical Engineering National Yang Ming Chiao Tung University No.155, Sec. 2, Linong St. Taipei 112 Taiwan, ROC
| | - Chia‐Lin Tsai
- Department of Materials Science and Engineering National Yang Ming Chiao Tung University Hsinchu 300 Taiwan, ROC
| | - You‐Yin Chen
- The Ph.D. Program for Neural Regenerative Medicine College of Medical Science and Technology Taipei Medical University No. 250 Wu‐Xing St. Taipei 110 Taiwan, ROC
- Department of Biomedical Engineering National Yang Ming Chiao Tung University No.155, Sec. 2, Linong St. Taipei 112 Taiwan, ROC
| | - Ta‐Chung Liu
- Department of Chemical Engineering Stanford University 450 Serra Mall Stanford CA 94305 USA
| | - San‐Yuan Chen
- Department of Materials Science and Engineering National Yang Ming Chiao Tung University Hsinchu 300 Taiwan, ROC
- Frontier Research Center on Fundamental and Applied Sciences of Matters National Tsing Hua University Hsinchu 300 Taiwan, ROC
- School of Dentistry College of Dental Medicine Kaohsiung Medical University Kaohsiung 807 Taiwan, ROC
- Graduate Institute of Biomedical Science China Medical University Taichung 406 Taiwan, ROC
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Sun XS, Liu WX, Chen ZH, Ling L, Yang F, Wang HF, Cui F, Huang XS. Repetitive Nerve Stimulation in Amyotrophic Lateral Sclerosis. Chin Med J (Engl) 2018; 131:2146-2151. [PMID: 30203787 PMCID: PMC6144859 DOI: 10.4103/0366-6999.240798] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Nowadays, it is widely known that decremental responses in low-frequency repetitive nerve stimulation (LF-RNS) are frequently observed in patients with amyotrophic lateral sclerosis (ALS). The pathological mechanism of this phenomenon remains unknown. This study aimed to illuminate the features of RNS in Chinese patients with ALS. Methods Clinical and electrophysiological data of 146 probable and definite ALS patients who underwent RNS were retrospectively enrolled and analyzed. LF-RNS (3 Hz) was performed in trapezius, deltoid, abductor digiti minimi (ADM), quadriceps femoris, and tibialis anterior. High-frequency RNS (HF-RNS, 10 Hz) was performed only in ADM. The two-sample t-test and Chi-squared test were used for statistical analysis. Results Decremental responses to LF-RNS (≥10%) in at least one muscle were detected in 83 (56.8%) of the cases and were most commonly seen in trapezius and deltoid. The incidence of decremental response was higher in patients with upper limb onset. Incremental responses to HF-RNS (≥60%) in ADM were observed in 6 (5.6%) of the cases. In 106 muscles with decremental response, 62 (57.4%) muscles had a continuous decremental pattern, more than a U-shape pattern (37 cases, 34.3%). Nineteen cases showed definite decrements in LF-RNS tests in trapezius, while no abnormalities were found in the electromyography and neurological examination of the sternocleidomastoid muscle, supplied by the accessory nerve as well. Conclusions Decremental responses in the RNS are commonly observed in ALS patients. The findings regarding the trapezius indicated that some ALS onsets could be initiated by a "dying back" process, with destruction of neuromuscular junctions (NMJs) before motor neurons. Incremental responses in the ADM implied damage of the NMJs involved both the post and presynaptic membranes.
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Affiliation(s)
- Xiao-Sun Sun
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Wen-Xiu Liu
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Zhao-Hui Chen
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Li Ling
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Fei Yang
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Hong-Fen Wang
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Fang Cui
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Xu-Sheng Huang
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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Neuromuscular medicine competency in physical medicine and rehabilitation residents: a method of development and assessment. Am J Phys Med Rehabil 2012; 92:258-66. [PMID: 23128327 DOI: 10.1097/phm.0b013e3182745ed9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This project endeavored to create an educational module including methodology to instruct physical medicine and rehabilitation residents in the evaluation and appropriate treatment of patients with neuromuscular disorders. It further sought to verify acquired competencies in neuromuscular rehabilitation through objective evaluation methodology. An American Association of Neuromuscular and Electrodiagnostic Medicine board-certified physician with 10 yrs of clinical experience in neuromuscular and general rehabilitation trained 19 residents using a standardized competency-based module. The residents were trained through clinical training, lectures, and review of self-assessment examination concepts from the American Academy of Physical Medicine & Rehabilitation syllabus provided in the Archives of Physical Medicine and Rehabilitation. After delivery of the educational module, knowledge acquisition and skill proficiency were measured in (1) completion of neuromuscular history and physical examination satisfactorily, (2) diagnosis and ability to design a patient care management plan via chart stimulated recall examinations, (3) physician-patient interaction via patient surveys, (4) physician-staff interaction via 360-degree global ratings, and (5) ability to write a comprehensive patient care report and to document a patient care management plan in accordance with Medicare guidelines via written patient reports. Assessment tools developed for this program address the basic competencies outlined by the Accreditation Council for Graduate Medical Education. To test the success of the standardized educational module, data were collected on an ongoing basis. The objective measures compared resident self-assessment examination scores in neuromuscular rehabilitation before and after the institution of the comprehensive neuromuscular competency module in the residency program. Nineteen (100%) of 19 residents successfully demonstrated proficiency in every segment of the evaluation module by the end of the postgraduate year 2 inpatient neuromuscular rehabilitation rotation. Furthermore, the residents' proficiency, as demonstrated by the evaluation after the implementation of the standardized educational module, positively correlated with an increase in the residents' self-assessment examination scores in neuromuscular rehabilitation compared with the residents' scores before the educational module implementation throughout all 3 yrs of training. Resident proficiency in the skills and knowledge pertaining to neuromuscular rehabilitation were objectively verified after completion of the standardized educational module. Validation of the assessment tool is evidenced by the collected data correlating with significantly improved self-assessment examination scores, as outlined in the "RESULTS" section. In addition, the clinical development tool was validated by the residents being individually observed performing history and physical examinations and being deemed competent by the American Association of Neuromuscular and Electrodiagnostic Medicine board-certified physical medicine and rehabilitation physician. The standardized educational module and evaluation methodology provide a potential framework for the definition of baseline competency in the clinical training area of neuromuscular rehabilitation.
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Decremental responses to repetitive nerve stimulation (RNS) in motor neuron disease. Clin Neurophysiol 2011; 122:2530-6. [DOI: 10.1016/j.clinph.2011.05.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Revised: 05/24/2011] [Accepted: 05/26/2011] [Indexed: 11/21/2022]
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Hatanaka Y, Oh SJ. Ten-second exercise is superior to 30-second exercise for post-exercise facilitation in diagnosing Lambert-Eaton myasthenic syndrome. Muscle Nerve 2008; 37:572-5. [PMID: 18288711 DOI: 10.1002/mus.20979] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An incremental response after brief exercise or high-rate stimulation on the repetitive nerve stimulation (RNS) test is a critical diagnostic criterion for Lambert-Eaton myasthenic syndrome (LEMS). This prospective study was performed to determine what duration of exercise shows the highest diagnostic sensitivity for LEMS. The compound muscle action potential amplitude in the abductor digiti quinti muscle was obtained at rest and after 5 s, 10 s, 15 s, 20 s, 25 s, and 30 s of exercise. Incremental responses were compared for the different exercise durations in 24 studies performed in nine LEMS patients. The increment was highest with 5-s and 10-s exercises (244%-243%) and lowest with 30-s exercise (84%). A gradual decrease in the increment was noted from 5- to 30-s exercise. A significant difference in the increment was noted between 5- to 10-s and 20-s to 30-s exercise. There was significantly higher diagnostic sensitivity with the 10-s exercise compared with 30-s exercise at 100% increment and 60% increment levels. Higher increment and diagnostic sensitivity were achieved with 10-s exercise than with 30-s exercise. Thus, 10-s exercise should be the standard protocol for the RNS test for LEMS.
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Affiliation(s)
- Yuki Hatanaka
- Department of Neurology, The University of Alabama at Birmingham, Veterans Affairs Medical Center, Birmingham, Alabama 35218, USA
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