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Okhovat AA, Advani S, Ziaadini B, Panahi A, Salehizadeh S, Nafissi S, Haghi Ashtiani B, Rajabally YA, Fatehi F. The value of MUNIX as an objective electrophysiological biomarker of disease progression in CIDP. Muscle Nerve 2022; 65:433-439. [PMID: 35040150 DOI: 10.1002/mus.27498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 12/31/2021] [Accepted: 01/09/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION/AIMS Objective outcome measures to monitor treatment response and guide treatment are lacking in chronic inflammatory demyelinating polyneuropathy (CIDP). We aimed to evaluate the motor unit number index (MUNIX) as an outcome measurement in patients with CIDP and investigate the correlation of MUNIX with functional and standard electrodiagnostic tests in a single follow-up study. METHODS We evaluated MUNIX of the abductor pollicis brevis (APB), abductor digiti minimi (ADM), and tibialis anterior (TA) muslces bilaterally. Muscle force was assessed by Medical Research Council sumscores (MRCSS). Functional measures used were the Overall Neuropathy Limitation Score (ONLS) and the Rasch-built Overall Disability Scale (R-ODS) at baseline and after six months of treatment. Standard electrophysiology was evaluated by the Nerve Conduction Study Score (NCSS). RESULTS Twenty patients were included at baseline, and 16 completed the follow-up study. Significant correlations were found between the MUNIX sumscore and both MRCSS and NCSS at baseline, between both the pinch strength and grip and upper limb MUNIX at baseline and follow-up, and between MUNIX of TA and both lower limb MRCSS with lower limb ONLS at baseline and follow-up. Significant correlations also were found between MUNIX sumscore change and MRCSS change, R-ODS change, and ONLS change. DISCUSSION MUNIX changes correlated with strength and electrophysiological improvements in CIDP patients. This suggests that MUNIX may represent a useful objective biomarker for patient follow-up.
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Affiliation(s)
- Ali Asghar Okhovat
- Neurology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soroor Advani
- Neurology Department, Shohada Tajrish Hospital, Shahid-Beheshti University of Medical Sciences, Tehran, Iran
| | - Bentolhoda Ziaadini
- Neurology Research center, Kerman University of Medical Sciences, Kerman, Iran
| | - Akram Panahi
- Neurology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeideh Salehizadeh
- Neurologist, Tehran University of Medical Sciences, Sina Hospital, Tehran, Iran
| | - Shahriar Nafissi
- Neurology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Haghi Ashtiani
- Neurology Department, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Farzad Fatehi
- Neurology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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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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Neuwirth C, Weber M. Estimating the Number of Motor Neurons: First Go to the Roots Before Cropping the Fruits. Muscle Nerve 2020; 62:154-155. [PMID: 32406530 DOI: 10.1002/mus.26920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Christoph Neuwirth
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Markus Weber
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital St Gallen, St Gallen, Switzerland
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Franques J. [Chronic inflammatory demyelinating polyneuropathy: Diagnosis and therapeutic update]. Rev Med Interne 2019; 40:808-815. [PMID: 31677862 DOI: 10.1016/j.revmed.2019.07.007] [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: 01/13/2019] [Revised: 06/19/2019] [Accepted: 07/17/2019] [Indexed: 10/25/2022]
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathies are acquired demyelinating neuropathies belonging to the group of autoimmune neuropathies. Since specific biological markers are present in less than 10% of cases, the diagnosis is based on the clinical and electrophysiological analysis of each patient. Furthermore, a decision-making algorithm ranking all other available paraclinical tools will guide the physician to the diagnosis of atypical forms. In nearly 80% of cases, these dysimmune neuropathies are responsive to first-line treatments, namely intravenous immunoglobulins, corticosteroids and plasma exchanges. A second line treatment may be proposed in case of no response, intolerance or inaccessibility to the three reference treatments. While some immunosuppressants or monoclonal antibodies can sometimes be very effective, there is currently no predictive marker or recommendation available to determine which treatment will be most appropriate for which patient.
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Affiliation(s)
- J Franques
- Hôpital européen, 6, rue Désirée-Clary, 13003 Marseille, France; Hôpital La Casamance, 33, boulevard des Farigoules, 13400 Aubagne, France.
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Lawley A, Seri S, Rajabally YA. Motor unit number index (MUNIX) in chronic inflammatory demyelinating polyneuropathy: A potential role in monitoring response to intravenous immunoglobulins. Clin Neurophysiol 2019; 130:1743-1749. [DOI: 10.1016/j.clinph.2019.06.231] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 05/30/2019] [Accepted: 06/28/2019] [Indexed: 02/07/2023]
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Cirillo G, Todisco V, Ricciardi D, Tedeschi G. Clinical‐neurophysiological correlations in chronic inflammatory demyelinating polyradiculoneuropathy patients treated with subcutaneous immunoglobulin. Muscle Nerve 2019; 60:662-667. [DOI: 10.1002/mus.26669] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Giovanni Cirillo
- Division of Neurology and NeurophysiopathologyUniversity of Campania “Luigi Vanvitelli” Naples Italy
- Division of Human Anatomy–Laboratory of Neuronal Networks MorphologyUniversity of Campania “Luigi Vanvitelli” Naples Italy
| | - Vincenzo Todisco
- Division of Neurology and NeurophysiopathologyUniversity of Campania “Luigi Vanvitelli” Naples Italy
| | - Dario Ricciardi
- Division of Neurology and NeurophysiopathologyUniversity of Campania “Luigi Vanvitelli” Naples Italy
| | - Gioacchino Tedeschi
- Division of Neurology and NeurophysiopathologyUniversity of Campania “Luigi Vanvitelli” Naples Italy
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Cirillo G, Todisco V, Tedeschi G. Long-term neurophysiological and clinical response in patients with chronic inflammatory demyelinating polyradiculoneuropathy treated with subcutaneous immunoglobulin. Clin Neurophysiol 2018; 129:967-973. [DOI: 10.1016/j.clinph.2018.01.070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/22/2017] [Accepted: 01/21/2018] [Indexed: 11/30/2022]
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Bas J, Delmont E, Fatehi F, Salort-Campana E, Verschueren A, Pouget J, Lefebvre MN, Grapperon AM, Attarian S. Motor unit number index correlates with disability in Charcot-Marie-Tooth disease. Clin Neurophysiol 2018; 129:1390-1396. [PMID: 29729594 DOI: 10.1016/j.clinph.2018.04.359] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 03/11/2018] [Accepted: 04/08/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to assess the usefulness of motor unit number index (MUNIX) technique in Charcot-Marie-Tooth disease and test the correlation between MUNIX and clinical impairment. METHODS MUNIX technique was performed in the abductor pollicis brevis (APB), the abductor digiti minimi (ADM) and the tibialis anterior (TA) muscles in the nondominant side. A MUNIX sum score was calculated by adding the MUNIX of these 3 muscles. Muscle strength was measured using the MRC (medical research council) scale. Disability was evaluated using several functional scales, including CMT neuropathy score version 2 (CMTNSv2) and overall neuropathy limitation scale (ONLS). RESULTS A total of 56 CMT patients were enrolled. The MUNIX scores of the ADM, APB and TA muscles correlated with the MRC score of the corresponding muscle (p < 0.01). The MUNIX sum score correlated with the clinical scales CMTNSv2 (r = -0.65, p < 0.01) and ONLS (r = -0.57, p < 0.01). CONCLUSION MUNIX correlates with muscle strength and clinical measurements of disability in patients with CMT disease. SIGNIFICANCE The MUNIX technique evaluates motor axonal loss and correlates with disability. The MUNIX sum score may be a useful outcome measure of disease progression in CMT.
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Affiliation(s)
- Joachim Bas
- Referral Center for Neuromuscular Diseases and ALS, La Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Emilien Delmont
- Referral Center for Neuromuscular Diseases and ALS, La Timone University Hospital, Aix-Marseille University, Marseille, France; Aix-Marseille University, UMR 7286, Medicine Faculty, Marseille, France
| | - Farzad Fatehi
- Referral Center for Neuromuscular Diseases and ALS, La Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Emmanuelle Salort-Campana
- Referral Center for Neuromuscular Diseases and ALS, La Timone University Hospital, Aix-Marseille University, Marseille, France; Aix-Marseille University, Inserm, GMGF, Marseille, France
| | - Annie Verschueren
- Referral Center for Neuromuscular Diseases and ALS, La Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Jean Pouget
- Referral Center for Neuromuscular Diseases and ALS, La Timone University Hospital, Aix-Marseille University, Marseille, France; Aix-Marseille University, Inserm, GMGF, Marseille, France
| | - Marie-Noëlle Lefebvre
- CIC-CPCET, La Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Aude-Marie Grapperon
- Referral Center for Neuromuscular Diseases and ALS, La Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Shahram Attarian
- Referral Center for Neuromuscular Diseases and ALS, La Timone University Hospital, Aix-Marseille University, Marseille, France; Aix-Marseille University, Inserm, GMGF, Marseille, France.
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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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