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German A, Türk M, Schramm A, Regensburger M. Bedeutung der Muskelsonographie in der Detektion von Faszikulationen
bei der ALS. KLIN NEUROPHYSIOL 2023. [DOI: 10.1055/a-2024-6346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
ZusammenfassungBei der amyotrophen Lateralsklerose sind Faszikulationen häufig bereits
in frühen Stadien in mehreren Körperregionen vorzufinden und
haben daher Eingang in die entsprechenden Leitlinien und Diagnosekriterien
gefunden. Während die invasive EMG-Diagnostik unverzichtbar zum Nachweis
von akut- und chronisch-neurogenen Veränderungen des elektrischen
Signalverhaltens motorischer Einheiten und zur Bestätigung von
Faszikulationspotenzialen bleibt, bietet die Muskelsonographie ein
hochsensitives Verfahren, um schnell und nicht-invasiv Faszikulationen in den
verschiedenen Muskel-Etagen zu erfassen. In dieser Übersichtsarbeit
stellen wir die bisherigen Daten zum Einsatz der Muskelsonographie zur
Faszikulationsdetektion dar. Durch ihren Einsatz ermöglicht die
Muskelsonographie im klinischen Alltag eine zielgerichtete und hierdurch
aussagekräftigere EMG-Diagnostik. Aktuelle Forschungsstudien zielen
darauf ab, Faszikulationen sonomorphologisch genauer zu charakterisieren, zu
quantifizieren und als Verlaufsparameter zu untersuchen.
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Affiliation(s)
- Alexander German
- Molekular-Neurologische Abteilung,
Friedrich-Alexander-Universität Erlangen-Nürnberg,
Erlangen
| | - Matthias Türk
- Neurologische Klinik, Friedrich-Alexander-Universität
Erlangen-Nürnberg, Erlangen
- Zentrum für Seltene Erkrankungen Erlangen (ZSEER),
Erlangen
| | | | - Martin Regensburger
- Molekular-Neurologische Abteilung,
Friedrich-Alexander-Universität Erlangen-Nürnberg,
Erlangen
- Zentrum für Seltene Erkrankungen Erlangen (ZSEER),
Erlangen
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2
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Posa A, Kornhuber M. EMG-Phänomene peripherer motorisch axonaler
Übererregbarkeit. KLIN NEUROPHYSIOL 2021. [DOI: 10.1055/a-1536-9243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungBei der Nadel-Elektromyographie (EMG) besitzen Phänomene der vermehrten
Erregbarkeit von Muskelfasern und von motorischen Axonen Bedeutung für
die Diagnostik neuromuskulärer Erkrankungen. Zur motorisch axonalen
Übererregbarkeit gehören spontane Phänomene wie
Faszikulationen, spontane kontinuierliche Einzelentladungen der motorischen
Einheit (SKEME), Myokymien, neuromyotone Entladungsserien und Krampi. Ferner
gehören dazu reizinduzierte Phänomene wie manche A-Wellen,
reizinduzierte komplex repetitive Entladungen oder tetanischen Spasmen bei
Elektrolytstörungen. In der vorliegenden Übersicht wird der
Kenntnisstand zu den verschiedenen Phänomenen motorisch axonaler
Übererregbarkeit referiert. Ein Schwerpunkt liegt dabei auf den SKEME
als neuem Mitglied der Gruppe spontaner Potenziale aus dem motorischen Axon.
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Affiliation(s)
- Andreas Posa
- Universitätsklinik für Neurologie,
Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
| | - Malte Kornhuber
- Universitätsklinik für Neurologie,
Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
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3
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Liu J, Li Y, Niu J, Zhang L, Fan J, Guan Y, Cui L, Liu M. Fasciculation differences between ALS and non-ALS patients: an ultrasound study. BMC Neurol 2021; 21:441. [PMID: 34758775 PMCID: PMC8579676 DOI: 10.1186/s12883-021-02473-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background Fasciculation is an important sign for the diagnosis of amyotrophic lateral sclerosis (ALS). Our study aimed to analyze the difference in fasciculation detected with muscle ultrasonography (MUS) between ALS patients and non-ALS patients with symptoms resembling ALS. Methods Eighty-eight ALS patients and fifty-four non-ALS (eight multifocal motor neuropathy, 32 chronic inflammatory demyelinating polyneuropathy/Charcot-Marie-Tooth, and 14 cervical spondylopathy or lumbar spondylopathy) patients were recruited. MUS was performed on 19 muscle groups in cervical, lumbosacral, bulbar, and thoracic regions for each patient. The intensity of fasciculation was divided into five grades based on firing frequency and number in the involved muscle groups. Results The overall detection rates were 72.8% in ALS and 18% in non-ALS patients. The fasciculation grades (median [IQR]) were 2 (0–3) in ALS and 0 (0–0) in non-ALS patients (P < 0.001). Fasciculations were observed in four regions for ALS patients and primarily distributed in proximal limbs. Fasciculations in non-ALS patients were primarily low-grade and mostly distributed in distal limbs. Discussion The fasciculation grade was higher in ALS than non-ALS patients. The distribution pattern of fasciculation was different between ALS and non-ALS patients. Conclusions The fasciculation grade and distribution pattern detected with MUS could help distinguish ALS from non-ALS patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02473-5.
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Affiliation(s)
- Jingwen Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Li
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingwen Niu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Zhang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Fan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuzhou Guan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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4
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Ma J, Wen Q, Pang X, Huang S, Zhang J, Wang J, Chang X, Guo J, Zhang W. Fasciculation score: a sensitive biomarker in amyotrophic lateral sclerosis. Neurol Sci 2021; 42:4657-4666. [PMID: 33704599 DOI: 10.1007/s10072-021-05166-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 03/04/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of our study was to elucidate the characteristic of fasciculation distributions in amyotrophic lateral sclerosis (ALS) using a fasciculation score (FS) of muscle ultrasound (MUS) and to compare the diagnostic values of three MUS fasciculation parameters in patients. METHODS Thirty ALS patients, 16 ALS mimics, and 10 healthy subjects were involved. MUS of unilateral 10 muscles in each patient and needle electromyography (EMG) of total 204 muscles were performed to detect fasciculations and spontaneous activity respectively in ALS. Control groups underwent only MUS. Fasciculation was graded semiquantitatively with FS. RESULTS Three hundred fifty muscles in ALS and 260 in controls were examined. The fasciculation detection rates, total FS, the number of muscles with fasciculation, and the total number of fasciculations in ALS were all significantly higher than those of controls (P < 0.001). ALS patients exhibited a multifocal continuous pattern of fasciculation in limbs, whereas there were few fasciculations in controls. Compared with other parameters, total FS had the largest area under the curve (AUC) (AUC = 0.899, P < 0.001) in ALS diagnosis. The detection rates of lower motor neuron (LMN) acute lesions by MUS (70.6%) and EMG (72.1%) were nearly the same, and a positive correlation between the FS and spontaneous activity grades (P < 0.001, r = 0.359) was proved. CONCLUSIONS ALS patients exhibited the multifocal continuous pattern of fasciculation in limbs. FS showed high sensitivity and specificity in differentiating ALS from non-ALS patients, and the optimal cut-off value was determined as 4. The combination of MUS and EMG can provide additional information about specific muscles.
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Affiliation(s)
- Jing Ma
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, 030000, People's Republic of China
| | - Qi Wen
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, 030000, People's Republic of China
| | - Xiaomin Pang
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, 030000, People's Republic of China
| | - Shan Huang
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, 030000, People's Republic of China
| | - Jing Zhang
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, 030000, People's Republic of China
| | - Juan Wang
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, 030000, People's Republic of China
| | - Xueli Chang
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, 030000, People's Republic of China
| | - Junhong Guo
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, 030000, People's Republic of China
| | - Wei Zhang
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, 030000, People's Republic of China.
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5
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Religious Participation: Does It Matter for Sustainable Culture and Entertainment Consumption? SUSTAINABILITY 2021. [DOI: 10.3390/su13147999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous research has studied the correlations between income, education, and sustainable culture and entertainment consumption. The correlation between religion as an informal institution and culture and entertainment consumption is often neglected. Based on this background, this paper attempts to explore the correlation between religious participation (as a proxy for religion) and three kinds of sustainable culture and entertainment consumption. Using the data from the Chinese General Social Survey in 2017 to perform empirical analysis, it is found that religious participation is negatively correlated with the sustainable culture and entertainment consumption. Two-stage least squares and propensity score matching method were employed, verifying the robustness of this result. Additionally, the full sample was divided into sub-samples to discuss the heterogeneous correlation between religious participation and sustainable culture and entertainment consumption. The results suggest that in the low income group and the low marketization degree group, religious participation is most relevant to the sustainable culture and entertainment consumption. This paper contributes to enriching current research.
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6
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Kneppe K, Czell D. [Brivaracetam-A good alternative for the treatment of muscle cramps]. DER NERVENARZT 2020; 91:1130-1133. [PMID: 32990789 DOI: 10.1007/s00115-020-01001-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Muscle cramps are suddenly occurring involuntary, mostly painful contractions of a single muscle, rarely of a muscle group. They can be idiopathic or occur in various neuromuscular diseases and can sometimes substantially impair the quality of life due to the frequency and strength. Only a few drugs are available for the effective treatment of cramps. RESULTS In this case series we report on five patients with cramps of different origin who responded well to treatment with brivaracetam. DISCUSSION Brivaracetam is actually used for the treatment of epileptic seizures. It binds to the synaptic vesicle protein 2A (SV2A), which also occurs in nerves and nerve roots. The SV2A regulates the exocytotic release of neurotransmitters, which could explain the effect of brivaracetam on muscle cramps. CONCLUSION Further studies are needed to demonstrate the effect of brivaracetam on muscle cramps.
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Affiliation(s)
- Katharina Kneppe
- Department of Medicine, Neurology, Spital Linth, Uznach, Schweiz
| | - David Czell
- Department of Medicine, Neurology, Spital Linth, Uznach, Schweiz.
- Neurologen am Zürichsee, Spital Männedorf, Asylstraße 10, 8708, Männedorf, Schweiz.
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7
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Tamborska A, Bashford J, Wickham A, Iniesta R, Masood U, Cabassi C, Planinc D, Hodson-Tole E, Drakakis E, Boutelle M, Mills K, Shaw C. Non-invasive measurement of fasciculation frequency demonstrates diagnostic accuracy in amyotrophic lateral sclerosis. Brain Commun 2020; 2:fcaa141. [PMID: 33543131 PMCID: PMC7850269 DOI: 10.1093/braincomms/fcaa141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/21/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022] Open
Abstract
Delayed diagnosis of amyotrophic lateral sclerosis prevents early entry into clinical trials at a time when neuroprotective therapies would be most effective. Fasciculations are an early hallmark of amyotrophic lateral sclerosis, preceding muscle weakness and atrophy. To assess the potential diagnostic utility of fasciculations measured by high-density surface electromyography, we carried out 30-min biceps brachii recordings in 39 patients with amyotrophic lateral sclerosis, 7 patients with benign fasciculation syndrome, 1 patient with multifocal motor neuropathy and 17 healthy individuals. We employed the surface potential quantification engine to compute fasciculation frequency, fasciculation amplitude and inter-fasciculation interval. Inter-group comparison was assessed by Welch’s analysis of variance. Logistic regression, receiver operating characteristic curves and decision trees discerned the diagnostic performance of these measures. Fasciculation frequency, median fasciculation amplitude and proportion of inter-fasciculation intervals <100 ms showed significant differences between the groups. In the best-fit regression model, increasing fasciculation frequency and median fasciculation amplitude were independently associated with the diagnosis of amyotrophic lateral sclerosis. Fasciculation frequency was the single best measure predictive of the disease, with an area under the curve of 0.89 (95% confidence interval 0.81–0.98). The cut-off of more than 14 fasciculation potentials per minute achieved 80% sensitivity (95% confidence interval 63–90%) and 96% specificity (95% confidence interval 78–100%). In conclusion, non-invasive measurement of fasciculation frequency at a single time-point reliably distinguished amyotrophic lateral sclerosis from its mimicking conditions and healthy individuals, warranting further research into its diagnostic applications.
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Affiliation(s)
- Arina Tamborska
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - James Bashford
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Aidan Wickham
- Department of Bioengineering, Imperial College London, London, UK
| | - Raquel Iniesta
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Urooba Masood
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Cristina Cabassi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Domen Planinc
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Emma Hodson-Tole
- Department of Life Sciences, Musculoskeletal Sciences and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
| | | | - Martyn Boutelle
- Department of Bioengineering, Imperial College London, London, UK
| | - Kerry Mills
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Chris Shaw
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
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8
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Bashford J, Masood U, Wickham A, Iniesta R, Drakakis E, Boutelle M, Mills K, Shaw C. Fasciculations demonstrate daytime consistency in amyotrophic lateral sclerosis. Muscle Nerve 2020; 61:745-750. [PMID: 32208527 DOI: 10.1002/mus.26864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/10/2020] [Accepted: 03/16/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Fasciculations represent early neuronal hyperexcitability in amyotrophic lateral sclerosis (ALS). To aid calibration as a disease biomarker, we set out to characterize the daytime variability of fasciculation firing. METHODS Fasciculation awareness scores were compiled from 19 ALS patients. In addition, 10 ALS patients prospectively underwent high-density surface electromyographic (HDSEMG) recordings from biceps and gastrocnemius at three time-points during a single day. RESULTS Daytime fasciculation awareness scores were low (mean: 0.28 muscle groups), demonstrating significant variability (coefficient of variation: 303%). Biceps HDSEMG recordings were highly consistent for fasciculation potential frequency (intraclass correlation coefficient [ICC] = 95%, n = 19) and the interquartile range of fasciculation potential amplitude (ICC = 95%, n = 19). These parameters exhibited robustness to observed fluctuations in data quality parameters. Gastrocnemius demonstrated more modest levels of consistency overall (44% to 62%, n = 20). DISCUSSION There was remarkable daytime consistency of fasciculation firing in the biceps of ALS patients, despite sparse and intermittent awareness among patients' accounts.
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Affiliation(s)
- James Bashford
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Urooba Masood
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Aidan Wickham
- Department of Bioengineering, Imperial College London, London, UK
| | - Raquel Iniesta
- Department of Biostatistics and Health Informatics, King's College, London, UK
| | | | - Martyn Boutelle
- Department of Bioengineering, Imperial College London, London, UK
| | - Kerry Mills
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Chris Shaw
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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Juan W, Fang L, Qi W, Jing M, Shan H, Jing Z, Xueli C, Wei Z, Junhong G. Muscle ultrasonography in the diagnosis of amyotrophic lateral sclerosis. Neurol Res 2020; 42:458-462. [PMID: 32138623 DOI: 10.1080/01616412.2020.1738100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Wang Juan
- Department of Neurology, First Hospital, Shanxi Medical University, Taiyuan, China
| | - Liu Fang
- Department of Neurology, First Hospital, Shanxi Medical University, Taiyuan, China
| | - Wen Qi
- Department of Neurology, First Hospital, Shanxi Medical University, Taiyuan, China
| | - Ma Jing
- Department of Neurology, First Hospital, Shanxi Medical University, Taiyuan, China
| | - Huang Shan
- Department of Neurology, First Hospital, Shanxi Medical University, Taiyuan, China
| | - Zhang Jing
- Department of Neurology, First Hospital, Shanxi Medical University, Taiyuan, China
| | - Chang Xueli
- Department of Neurology, First Hospital, Shanxi Medical University, Taiyuan, China
| | - Zhang Wei
- Department of Neurology, First Hospital, Shanxi Medical University, Taiyuan, China
| | - Guo Junhong
- Department of Neurology, First Hospital, Shanxi Medical University, Taiyuan, China
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Abraham A, Drory VE, Fainmesser Y, Lovblom LE, Bril V. Quantitative sonographic evaluation of muscle thickness and fasciculation prevalence in healthy subjects. Muscle Nerve 2019; 61:234-238. [PMID: 31725905 DOI: 10.1002/mus.26758] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 10/28/2019] [Accepted: 11/12/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND In the current study, we aimed to determine normative values for muscle thickness and fasciculation prevalence in healthy subjects. METHODS We performed a prospective study from October to December 2018 in 65 healthy subjects. All subjects underwent quantitative sonographic evaluation of muscle thickness and fasciculation prevalence in the following 8 muscles: Biceps brachii, abductor pollicis brevis, first dorsal interosseous, abductor digiti minimi, quadriceps, tibialis anterior, extensor digitorum brevis, and abductor hallucis brevis. RESULTS Subject ages ranged from 21 to 82 years, with 63% women. Normative values for muscle thickness were determined using the fifth percentile. Multivariate regression analysis showed that sex, age, body mass index, and hand dominance affected muscle thickness. Fasciculations were observed frequently only in distal muscles. CONCLUSIONS Normal values for muscle thickness were determined, and may enhance neuromuscular ultrasound sensitivity and serve as a basis for future studies. Larger series are needed to confirm these values.
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Affiliation(s)
- Alon Abraham
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Vivian E Drory
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yaara Fainmesser
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Leif E Lovblom
- Division of Endocrinology and Metabolism, Department of Medicine, Sinai Health System, and Lunenfeld Tanenbaum Research Institute, University of Toronto, Toronto, Canada
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada.,Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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11
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Which kinds of fasciculations are missed by ultrasonography in ALS? Clin Neurophysiol 2019; 131:237-238. [PMID: 31703938 DOI: 10.1016/j.clinph.2019.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 12/12/2022]
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12
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Blackman G, Cherfi Y, Morrin H, Ellis CM, Bashford J, Ruths F, David AS. The Association Between Benign Fasciculations and Health Anxiety: A Report of Two Cases and a Systematic Review of the Literature. PSYCHOSOMATICS 2019; 60:499-507. [DOI: 10.1016/j.psym.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/14/2022]
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13
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Stålberg E, van Dijk H, Falck B, Kimura J, Neuwirth C, Pitt M, Podnar S, Rubin DI, Rutkove S, Sanders DB, Sonoo M, Tankisi H, Zwarts M. Standards for quantification of EMG and neurography. Clin Neurophysiol 2019; 130:1688-1729. [DOI: 10.1016/j.clinph.2019.05.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 12/11/2022]
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14
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Bashford J, Wickham A, Iniesta R, Drakakis E, Boutelle M, Mills K, Shaw C. SPiQE: An automated analytical tool for detecting and characterising fasciculations in amyotrophic lateral sclerosis. Clin Neurophysiol 2019; 130:1083-1090. [PMID: 31078984 PMCID: PMC6553680 DOI: 10.1016/j.clinph.2019.03.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/14/2019] [Accepted: 03/17/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Fasciculations are a clinical hallmark of amyotrophic lateral sclerosis (ALS). Compared to concentric needle EMG, high-density surface EMG (HDSEMG) is non-invasive and records fasciculation potentials (FPs) from greater muscle volumes over longer durations. To detect and characterise FPs from vast data sets generated by serial HDSEMG, we developed an automated analytical tool. METHODS Six ALS patients and two control patients (one with benign fasciculation syndrome and one with multifocal motor neuropathy) underwent 30-minute HDSEMG from biceps and gastrocnemius monthly. In MATLAB we developed a novel, innovative method to identify FPs amidst fluctuating noise levels. One hundred repeats of 5-fold cross validation estimated the model's predictive ability. RESULTS By applying this method, we identified 5,318 FPs from 80 minutes of recordings with a sensitivity of 83.6% (+/- 0.2 SEM), specificity of 91.6% (+/- 0.1 SEM) and classification accuracy of 87.9% (+/- 0.1 SEM). An amplitude exclusion threshold (100 μV) removed excessively noisy data without compromising sensitivity. The resulting automated FP counts were not significantly different to the manual counts (p = 0.394). CONCLUSION We have devised and internally validated an automated method to accurately identify FPs from HDSEMG, a technique we have named Surface Potential Quantification Engine (SPiQE). SIGNIFICANCE Longitudinal quantification of fasciculations in ALS could provide unique insight into motor neuron health.
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Affiliation(s)
- J. Bashford
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - A. Wickham
- Department of Bioengineering, Imperial College London, United Kingdom
| | - R. Iniesta
- Department of Biostatistics and Health Informatics, King’s College London, United Kingdom
| | - E. Drakakis
- Department of Bioengineering, Imperial College London, United Kingdom
| | - M. Boutelle
- Department of Bioengineering, Imperial College London, United Kingdom
| | - K. Mills
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - C. Shaw
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
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Bibbings K, Harding PJ, Loram ID, Combes N, Hodson-Tole EF. Foreground Detection Analysis of Ultrasound Image Sequences Identifies Markers of Motor Neurone Disease across Diagnostically Relevant Skeletal Muscles. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1164-1175. [PMID: 30857760 PMCID: PMC6481588 DOI: 10.1016/j.ultrasmedbio.2019.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/15/2019] [Accepted: 01/19/2019] [Indexed: 06/09/2023]
Abstract
Diagnosis of motor neurone disease (MND) includes detection of small, involuntary muscle excitations, termed fasciculations. There is need to improve diagnosis and monitoring of MND through provision of objective markers of change. Fasciculations are visible in ultrasound image sequences. However, few approaches that objectively measure their occurrence have been proposed; their performance has been evaluated in only a few muscles; and their agreement with the clinical gold standard for fasciculation detection, intramuscular electromyography, has not been tested. We present a new application of adaptive foreground detection using a Gaussian mixture model (GMM), evaluating its accuracy across five skeletal muscles in healthy and MND-affected participants. The GMM provided good to excellent accuracy with the electromyography ground truth (80.17%-92.01%) and was robust to different ultrasound probe orientations. The GMM provides objective measurement of fasciculations in each of the body segments necessary for MND diagnosis and hence could provide a new, clinically relevant disease marker.
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Affiliation(s)
- Kate Bibbings
- School of Healthcare Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - Peter J Harding
- Crime and Well-Being Big Data Centre, Manchester Metropolitan University, Manchester, United Kingdom; Elements Technology Platforms Ltd., Cheshire, United Kingdom
| | - Ian D Loram
- School of Healthcare Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - Nicholas Combes
- Department of Neurophysiology, Preston Royal Hospital, Lancashire Teaching Hospital Trust, Preston, United Kingdom
| | - Emma F Hodson-Tole
- School of Healthcare Sciences, Manchester Metropolitan University, Manchester, United Kingdom.
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Supranormal Sensory Nerve Action Potential Amplitude Correlates of Sensory Symptoms. J Clin Neurophysiol 2019; 36:224-228. [DOI: 10.1097/wnp.0000000000000564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Tsugawa J, Dharmadasa T, Ma Y, Huynh W, Vucic S, Kiernan MC. Fasciculation intensity and disease progression in amyotrophic lateral sclerosis. Clin Neurophysiol 2018; 129:2149-2154. [DOI: 10.1016/j.clinph.2018.07.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/21/2018] [Accepted: 07/15/2018] [Indexed: 12/11/2022]
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Noto YI, Simon NG, Selby A, Garg N, Shibuya K, Shahrizaila N, Huynh W, Matamala JM, Dharmadasa T, Park SB, Vucic S, Kiernan MC. Ectopic impulse generation in peripheral nerve hyperexcitability syndromes and amyotrophic lateral sclerosis. Clin Neurophysiol 2018; 129:974-980. [DOI: 10.1016/j.clinph.2018.01.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/15/2017] [Accepted: 01/14/2018] [Indexed: 12/11/2022]
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Tonson A, Noble KE, Meyer RA, Rozman MR, Foley KT, Slade JM. Age Reduces Microvascular Function in the Leg Independent of Physical Activity. Med Sci Sports Exerc 2018; 49:1623-1630. [PMID: 28709153 DOI: 10.1249/mss.0000000000001281] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The microvasculature is critical in the control of blood flow. Aging and reduced physical activity (PA) may both decrease microvascular function. PURPOSE The primary aim was to evaluate the influence of age on microvascular function in adults with similar PA levels. Secondary aims were to assess the reliability of muscle functional magnetic resonance imaging in older adults (OA) and the relationship between PA and microvascular function in OA. METHODS Microvascular blood-oxygen-level dependent (BOLD) responses were measured in young adults (YA, n = 12, mean ± SD age = 21 ± 1 yr old, PA = 239 ± 73 × 10 counts per day) and OA (n = 13, 64 ± 4 yr old, PA = 203 ± 48 × 10 counts per day). Functional magnetic resonance images (3T, echo planar BOLD) of the leg were acquired after brief (1 s) maximal voluntary isometric contractions. The test-retest reliability of BOLD responses and the Pearson correlation between peak BOLD and PA were assessed in a group of OA (OA-r) with a broad range of PA (66 ± 5 yr old, n = 9, PA range = 54 × 10 to 674 × 10 counts per day). RESULTS Peak BOLD microvascular responses were reduced for OA compared with YA. OA peak BOLD was 27% lower in the soleus (3.3% ± 0.8% OA vs 4.5% ± 1.4% YA; P = 0.017) and 40% lower in the anterior compartment (1.6% ± 0.6% OA vs 2.7% ± 1.1% YA; P = 0.006). Coefficients of variation were 8.6% and 11.8% for peak BOLD in the soleus and anterior compartment, respectively, with an intraclass correlation of 0.950 for both muscle regions. The correlation between peak BOLD and PA was r ≥ 0.715, P ≤ 0.030. CONCLUSIONS Aging was associated with reduced microvascular function in leg muscles, independent of PA. The findings also revealed good reliability for BOLD magnetic resonance imaging in OA for the soleus and anterior compartment muscles.
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Affiliation(s)
- Anne Tonson
- 1Department of Physiology, Michigan State University, East Lansing, MI; 2Department of Radiology, Michigan State University, East Lansing, MI; and 3Department of Family Medicine, Michigan State University, East Lansing, MI
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Regensburger M, Tenner F, Möbius C, Schramm A. Detection radius of EMG for fasciculations: Empiric study combining ultrasonography and electromyography. Clin Neurophysiol 2017; 129:487-493. [PMID: 29208351 DOI: 10.1016/j.clinph.2017.10.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/14/2017] [Accepted: 10/29/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aims of this study were to investigate the detection radius and sensitivity of EMG for fasciculations. METHODS Muscle ultrasonography was performed simultaneously to EMG recordings in patients with fasciculations in the context of amyotrophic lateral sclerosis. Ultrasonography and EMG parameters were analyzed for selected fasciculations. RESULTS A total of 381 fasciculations were detected by ultrasonography in 18 muscles of 10 patients. Out of these, 125 (33%) were EMG-negative. In contrast, none of the fasciculations detected by EMG were ultrasonography-negative. EMG detection probability decreased significantly with increasing distance from the center of the fasciculation. EMG detection rate was 98% when the EMG needle was located within the fasciculation and 50% at 7.75 mm distance from the fasciculation center. In addition, EMG detection depended significantly on cross-sectional area of the fasciculation and presence of neurogenic changes. CONCLUSIONS For detecting the same fasciculations, EMG is less sensitive than ultrasonography. EMG detection probability decreases sharply at a distance comparable to motor unit size. SIGNIFICANCE These results extend previous knowledge about superior sensitivity of ultrasonography for fasciculations. Moreover, our novel bimodal detection method provides first in vivo data about the EMG detection radius for fasciculations in a clinical setting.
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Affiliation(s)
- Martin Regensburger
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Department of Molecular Neurology, FAU, Erlangen, Germany; Department of Stem Cell Biology, FAU, Erlangen, Germany.
| | - Felix Tenner
- Institute of Photonic Technologies, FAU, Erlangen, Germany; Graduate School in Advanced Optical Technologies, FAU, Erlangen, Germany
| | - Cornelia Möbius
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Axel Schramm
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Neuropraxis, Fürth, Germany
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Johansson MT, Ellegaard HR, Tankisi H, Fuglsang-Frederiksen A, Qerama E. Fasciculations in nerve and muscle disorders - A prospective study of muscle ultrasound compared to electromyography. Clin Neurophysiol 2017; 128:2250-2257. [PMID: 29028499 DOI: 10.1016/j.clinph.2017.08.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 08/15/2017] [Accepted: 08/28/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We examined the clinical utility of muscle ultrasound (MUS) in detecting fasciculations in patients with nerve and muscle disorders (NMD) and investigated the impact on diagnostic sensitivity when combining electromyography (EMG) and MUS. METHODS We included 58 consecutive patients suspected to have NMD and 38 healthy subjects (HS). Patients and HS underwent MUS in 14 skeletal and two bulbar muscles and the video recordings of the MUS were anonymised. Only patients underwent EMG. RESULTS The follow-up diagnoses were: 15 Amyotrophic lateral sclerosis (ALS), 15 polyneuropathy, 14 patients had other diagnoses (disease-control group) and 14 patients had no pathological findings. MUS detected more muscles with fasciculations among ALS patients compared to all other groups. In ALS patients, the dominating pattern of fasciculations was continuous (45%). More proximal muscles showed fasciculations among ALS patients compared to all other patient groups. MUS was more sensitive than EMG in detecting fasciculations (58% vs. 48%). When combining the two methods, the sensitivity in detecting fasciculations increased to 65%. Fasciculations in nine muscles could predict the ALS diagnosis with high sensitivity and specificity. CONCLUSIONS MUS is a sensitive tool in detecting fasciculations in patients with NMD and performs well compared to EMG in diagnosing ALS. SIGNIFICANCE MUS may add valuable information in the clinic, especially in diagnosing ALS.
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Affiliation(s)
- M T Johansson
- Department of Neurophysiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark
| | - H R Ellegaard
- Department of Neurophysiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark
| | - H Tankisi
- Department of Neurophysiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark
| | - A Fuglsang-Frederiksen
- Department of Neurophysiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark
| | - E Qerama
- Department of Neurophysiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark.
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de Carvalho M, Kiernan MC, Swash M. Fasciculation in amyotrophic lateral sclerosis: origin and pathophysiological relevance. J Neurol Neurosurg Psychiatry 2017; 88:773-779. [PMID: 28490504 DOI: 10.1136/jnnp-2017-315574] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 03/20/2017] [Accepted: 03/29/2017] [Indexed: 12/11/2022]
Abstract
This review considers the origin and significance of fasciculations in neurological practice, with an emphasis on fasciculations in amyotrophic lateral sclerosis (ALS), and in benign fasciculation syndromes. Fasciculation represents a brief spontaneous contraction that affects a small number of muscle fibres, causing a flicker of movement under the skin. While an understanding of the role of fasciculation in ALS remains incomplete, fasciculations derive from ectopic activity generated in the motor system. A proximal origin seems likely to contribute to the generation of fasciculation in the early stages of ALS, while distal sites of origin become more prominent later in the disease, associated with distal motor axonal sprouting as part of the reinnervation response that develops secondary to loss of motor neurons. Fasciculations are distinct from the recurrent trains of axonal firing described in neuromyotonia. Fasciculation without weakness, muscle atrophy or increased tendon reflexes suggests a benign fasciculation syndrome, even when of sudden onset. Regardless of origin, fasciculations often present as the initial abnormality in ALS, an early harbinger of dysfunction and aberrant firing of motor neurons.
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Affiliation(s)
- Mamede de Carvalho
- Department of Neurosciences and Mental Health, Hospital de Santa Maria-CHLN, Lisbon, Portugal.,Institute of Physiology-IMM, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Matthew C Kiernan
- Bushell Chair of Neurology, Sydney Medical School, University of Sydney, Brain & Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Michael Swash
- Institute of Physiology-IMM, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Department of Neurology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Van Hillegondsberg L, Carr J, Brey N, Henning F. Using Eulerian video magnification to enhance detection of fasciculations in people with amyotrophic lateral sclerosis. Muscle Nerve 2017; 56:1063-1067. [PMID: 28500626 DOI: 10.1002/mus.25690] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2017] [Indexed: 11/10/2022]
Abstract
INTRODUCTION This study seeks to determine whether the use of Eulerian video magnification (EVM) increases the detection of muscle fasciculations in people with amyotrophic lateral sclerosis (PALS) compared with direct clinical observation (DCO). METHODS Thirty-second-long video recordings were taken of 9 body regions of 7 PALS and 7 controls, and fasciculations were counted by DCO during the same 30-s period. The video recordings were then motion magnified and reviewed by 2 independent assessors. RESULTS In PALS, median fasciculation count per body region was 1 by DCO (range 0-10) and 3 in the EVM recordings (range 0-15; P < 0.0001). EVM revealed more fasciculations than DCO in 61% of recordings. In controls, median fasciculation count was 0 for both DCO and EVM. DISCUSSION Compared with DCO, EVM significantly increased the detection of fasciculations in body regions of PALS. When it is used to supplement clinical examination, EVM has the potential to facilitate the diagnosis of ALS. Muscle Nerve 56: 1063-1067, 2017.
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Affiliation(s)
- Ludo Van Hillegondsberg
- Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, 7505, South Africa
| | - Jonathan Carr
- Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, 7505, South Africa.,Centre for Research in Neurodegenerative Disease, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Naeem Brey
- Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, 7505, South Africa
| | - Franclo Henning
- Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, 7505, South Africa.,Centre for Research in Neurodegenerative Disease, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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O'gorman CM, Weikamp JG, Baria M, Van Den Engel-hoek L, Kassardjian C, Van Alfen N, Boon AJ. Detecting fasciculations in cranial nerve innervated muscles with ultrasound in amyotrophic lateral sclerosis. Muscle Nerve 2017; 56:1072-1076. [DOI: 10.1002/mus.25676] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2017] [Indexed: 11/10/2022]
Affiliation(s)
| | - Janneke G. Weikamp
- Department of Rehabilitation, Donders Centre for Neuroscience; Radboud University Medical Center; Nijmegen The Netherlands
| | - Michael Baria
- Department of Physical Medicine and Rehabilitation; The Ohio State University Wexner Medical Center; Columbus Ohio USA
| | - Lenie Van Den Engel-hoek
- Department of Rehabilitation, Donders Centre for Neuroscience; Radboud University Medical Center; Nijmegen The Netherlands
| | | | - Nens Van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Center for Neuroscience; Radboud University Medical Center; Nijmegen The Netherlands
| | - Andrea J. Boon
- Department of Neurology; Mayo Clinic; Rochester Minnesota 55905 USA
- Department of Physical Medicine and Rehabilitation; Mayo Clinic; Rochester Minnesota USA
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Noto YI, Shibuya K, Shahrizaila N, Huynh W, Matamala JM, Dharmadasa T, Kiernan MC. Detection of fasciculations in amyotrophic lateral sclerosis: The optimal ultrasound scan time. Muscle Nerve 2017; 56:1068-1071. [DOI: 10.1002/mus.25607] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 02/05/2017] [Accepted: 02/06/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Yu-ichi Noto
- Brain and Mind Centre; Sydney Medical School, University of Sydney; 94 Mallett Street, Camperdown, Sydney New South Wales 2040 Australia
| | - Kazumoto Shibuya
- Brain and Mind Centre; Sydney Medical School, University of Sydney; 94 Mallett Street, Camperdown, Sydney New South Wales 2040 Australia
| | - Nortina Shahrizaila
- Brain and Mind Centre; Sydney Medical School, University of Sydney; 94 Mallett Street, Camperdown, Sydney New South Wales 2040 Australia
| | - William Huynh
- Brain and Mind Centre; Sydney Medical School, University of Sydney; 94 Mallett Street, Camperdown, Sydney New South Wales 2040 Australia
| | - José M. Matamala
- Brain and Mind Centre; Sydney Medical School, University of Sydney; 94 Mallett Street, Camperdown, Sydney New South Wales 2040 Australia
| | - Thanuja Dharmadasa
- Brain and Mind Centre; Sydney Medical School, University of Sydney; 94 Mallett Street, Camperdown, Sydney New South Wales 2040 Australia
| | - Matthew C. Kiernan
- Brain and Mind Centre; Sydney Medical School, University of Sydney; 94 Mallett Street, Camperdown, Sydney New South Wales 2040 Australia
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Tsuji Y, Noto YI, Shiga K, Teramukai S, Nakagawa M, Mizuno T. A muscle ultrasound score in the diagnosis of amyotrophic lateral sclerosis. Clin Neurophysiol 2017; 128:1069-1074. [PMID: 28343888 DOI: 10.1016/j.clinph.2017.02.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/03/2017] [Accepted: 02/19/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aims of this study are to elucidate the frequencies and distribution of fasciculations using muscle ultrasound in patients with amyotrophic lateral sclerosis (ALS) and those with other conditions mimicking ALS, and subsequently to develop a novel fasciculation score for the diagnosis of ALS. METHODS Ultrasound of 21 muscles was performed to detect fasciculations in 36 consecutive patients suspected of having ALS. We developed a fasciculation ultrasound score that indicated the number of muscles with fasciculations in statistically selected muscles. RESULTS A total of 525 muscles in 25 ALS patients and 231 in 11 non-ALS patients were analysed. Using relative operating characteristic and multivariate logistic regression analysis, we selected the trapezius, deltoid, biceps brachii, abductor pollicis brevis, abdominal, vastus lateralis, vastus medialis, biceps femoris, and gastrocnemius muscles for the fasciculation ultrasound score. The mean scores were higher in the ALS group than those in the non-ALS group (5.3±0.5vs. 0.3±0.7) (mean±SD); p<0.001. CONCLUSIONS Two or more of the fasciculation ultrasound scores showed high sensitivity and specificity in differentiating ALS patients from non-ALS patients. SIGNIFICANCE The fasciculation ultrasound score can be a simple and useful diagnostic marker of ALS.
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Affiliation(s)
- Yukiko Tsuji
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yu-Ichi Noto
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Kensuke Shiga
- Department of Medical Education and Primary Care, Graduate School of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masanori Nakagawa
- North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiki Mizuno
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Pamphlett R, Kum Jew S. Age-Related Uptake of Heavy Metals in Human Spinal Interneurons. PLoS One 2016; 11:e0162260. [PMID: 27611334 PMCID: PMC5017773 DOI: 10.1371/journal.pone.0162260] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 08/21/2016] [Indexed: 12/12/2022] Open
Abstract
Toxic heavy metals have been implicated in the loss of spinal motoneurons in amyotrophic lateral sclerosis/motor neuron disease (ALS/MND). Motoneuron loss in the spinal anterior horn is severe in ALS/MND at the time of death, making this tissue unsuitable for examination. We therefore examined spinal cords of people without muscle weakness to look for any presence of heavy metals that could make these neurons susceptible to damage. Spinal cord samples from 50 individuals aged 1–95 y who had no clinical or histopathological evidence of spinal motoneuron loss were studied. Seven μm formalin-fixed paraffin-embedded sections were stained for heavy metals with silver nitrate autometallography (AMGHM) which detects intracellular mercury, silver or bismuth. Neurons in the spinal cord were classified as interneurons or α-motoneurons based on their site and cell body diameter. Spinal interneurons containing heavy metals were present in 8 of 24 people (33%) aged 61–95 y, but not at younger ages. These AMGHM interneurons were most numerous in the lumbar spinal cord, with moderate numbers in the caudal cervical cord, few in the rostral cervical cord, and almost none in the thoracic cord. All people with AMGHM interneurons had occasional AMGHM staining in α-motoneurons as well. In one man AMGHM staining was present in addition in dorsomedial nucleus and sensory neurons. In conclusion, heavy metals are present in many spinal interneurons, and in a few α-motoneurons, in a large proportion of older people. Damage to inhibitory interneurons from toxic metals in later life could result in excitotoxic injury to motoneurons and may underlie motoneuron injury or loss in conditions such as ALS/MND, multiple sclerosis, sarcopenia and calf fasciculations.
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Affiliation(s)
- Roger Pamphlett
- Discipline of Pathology, Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Neuropathology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- * E-mail:
| | - Stephen Kum Jew
- Discipline of Pathology, Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Czell D, Goldman B, Weber M. Distribution Of fasciculations in healthy adults after exercise: An ultrasound study. Muscle Nerve 2016; 54:132-5. [DOI: 10.1002/mus.25034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2016] [Indexed: 12/13/2022]
Affiliation(s)
- David Czell
- Neuromuscular Diseases Unit /ALS Clinic, Cantonal Hospital St. Gallen; St. Gallen Switzerland
- Neurology/Department Medicine; Cantonal Hospital Winterthur; 8401 Winterthur Switzerland
| | - Beatrice Goldman
- Neuromuscular Diseases Unit /ALS Clinic, Cantonal Hospital St. Gallen; St. Gallen Switzerland
| | - Markus Weber
- Neuromuscular Diseases Unit /ALS Clinic, Cantonal Hospital St. Gallen; St. Gallen Switzerland
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Abstract
Muscle ultrasound is an ideal imaging modality that allows for noninvasive, radiation-free point-of-care neuromuscular imaging. There are many potential applications of muscle ultrasound, including identification of abnormal muscle movements such as fasciculations, evaluation of muscle trauma, identification of physiologic parameters such as pennation angle, accurate performance of chemodenervation, and improved accuracy of challenging electrodiagnostic studies such as phrenic nerve conduction studies or needle electromyogram (EMG) of the diaphragm. Tissue Doppler imaging can be used to help identify inflammatory myopathies. With computer-assisted quantification, muscle ultrasound has high sensitivity and specificity in the diagnosis of pediatric neuromuscular disease and amyotrophic lateral sclerosis, and is a valuable addition to other diagnostic techniques for neuromuscular disease. When used as a first-line screening tool it can obviate the need for more invasive procedures such as EMG or muscle biopsy in certain patients. This chapter provides an overview of the fundamentals, clinical applications, and validation of muscle ultrasound for patients with neuromuscular disorders.
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Affiliation(s)
- Sigrid Pillen
- Department of Sleep Medicine, Kempenhaeghe Expertise Center for Epileptology, Sleep Medicine and Neurocognition, Heeze, The Netherlands.
| | - Andrea Boon
- Department of Physical Medicine and Rehabilitation and Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Nens Van Alfen
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
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Sleutjes BTHM, Gligorijević I, Montfoort I, van Doorn PA, Visser GH, Blok JH. Identifying fasciculation potentials in motor neuron disease: A matter of probability. Muscle Nerve 2015; 53:227-33. [PMID: 26012503 DOI: 10.1002/mus.24712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 05/13/2015] [Accepted: 05/20/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Fasciculations, the spontaneous activity of single motor units (MUs) are characteristic, but nonspecific for motor neuron disease (MND). We aimed to identify MU discharge properties to optimally differentiate MND patients from healthy controls. METHODS High-density surface electromyography recordings were performed in the thenar muscles during 10 min of rest. MU discharges were classified as "isolated" when the interspike intervals (ISIs) before and after were > 250 ms, "continual" when both ISIs were ≤ 250 ms, or as "other". RESULTS In patients (n = 30) compared with controls (n = 14), more MUs were active (9 vs. 3, P < 0.001) and generated relatively more isolated discharges (35% vs. 10%, P = 0.01). Two or more MUs with isolated discharges occurred more frequently in patients compared with controls (24% vs. <1% of 10-s windows, P < 0.001). CONCLUSIONS More frequent occurrence of multiple MUs showing isolated discharges may improve identification of patients with MND.
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Affiliation(s)
- Boudewijn T H M Sleutjes
- Department of Clinical Neurophysiology, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | | | - Inger Montfoort
- Department of Clinical Neurophysiology, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC, University Medical Centre Rotterdam, The Netherlands
| | - Gerhard H Visser
- Department of Clinical Neurophysiology, SEIN Heemstede, The Netherlands
| | - Joleen H Blok
- Department of Clinical Physics, Máxima Medical Centre, Veldhoven, The Netherlands
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Sleutjes BTHM, Montfoort I, van Doorn PA, Visser GH, Blok JH. Increased supernormality in patients with multiplet discharges: Evidence for a common pathophysiological mechanism behind multiplets and fasciculations. Clin Neurophysiol 2014; 126:1440-5. [PMID: 25468238 DOI: 10.1016/j.clinph.2014.10.145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 10/16/2014] [Accepted: 10/21/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine whether there is a relation between electrically evoked multiplet discharges (MDs) and motor axonal excitability properties. We hypothesized that electrically evoked MDs share their underlying pathophysiological mechanism with fasciculations. METHODS High-density surface EMG and motor nerve excitability recordings of the thenar muscles were performed in 22 patients with motor neuron disease (MND) in their differential diagnosis and who were referred for EMG examination. RESULTS Supernormality (hyperexcitable phase following the refractory period) was significantly increased in patients with MDs (n=10) compared to patients without MDs (n=12) (25.5% vs 17.0%; p=0.02). Depolarizing threshold electrotonus differed significantly between both groups as well (TEdpeak, 76.6% vs 66.6%, p<0.01; TEd90-100ms, 51.7% vs 44.3%, p<0.01) CONCLUSIONS: Our findings imply that the same pathophysiological excitability changes are involved in generating MDs and fasciculations. Yet, MDs may be quantified more easily, and may be more specific for abnormal distal excitability than fasciculations, because fasciculations may originate along the motor axon as well as in the neuron cell body. SIGNIFICANCE MDs are potentially useful as objective measure of increased distal axonal excitability at individual motor unit level and might complement clinical studies in MND.
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Affiliation(s)
| | | | - Pieter A van Doorn
- Department of Neurology, Erasmus MC, University Medical Centre Rotterdam, The Netherlands
| | - Gerhard H Visser
- Department of Clinical Neurophysiology, The Netherlands; Department of Clinical Neurophysiology, SEIN Heemstede, The Netherlands
| | - Joleen H Blok
- Department of Clinical Neurophysiology, The Netherlands; Department of Clinical Physics, Reinier de Graaf Hospital Delft, The Netherlands
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Jahanmiri-Nezhad F, Barkhaus PE, Rymer WZ, Zhou P. Spike sorting paradigm for classification of multi-channel recorded fasciculation potentials. Comput Biol Med 2014; 55:26-35. [PMID: 25450215 DOI: 10.1016/j.compbiomed.2014.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 09/19/2014] [Accepted: 09/25/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Fasciculation potentials (FPs) are important in supporting the electrodiagnosis of Amyotrophic Lateral Sclerosis (ALS). If classified by shape, FPs can also be very informative for laboratory-based neurophysiological investigations of the motor units. METHODS This study describes a Matlab program for classification of FPs recorded by multi-channel surface electromyogram (EMG) electrodes. The program applies Principal Component Analysis on a set of features recorded from all channels. Then, it registers unsupervised and supervised classification algorithms to sort the FP samples. Qualitative and quantitative evaluation of the results is provided for the operator to assess the outcome. The algorithm facilitates manual interactive modification of the results. Classification accuracy can be improved progressively until the user is satisfied. The program makes no assumptions regarding the occurrence times of the action potentials, in keeping with the rather sporadic and irregular nature of FP firings. RESULTS Ten sets of experimental data recorded from subjects with ALS using a 20-channel surface electrode array were tested. A total of 11891 FPs were detected and classified into a total of 235 prototype template waveforms. Evaluation and correction of classification outcome of such a dataset with over 6000 FPs can be achieved within 1-2 days. Facilitated interactive evaluation and modification could expedite the process of gaining accurate final results. CONCLUSION The developed Matlab program is an efficient toolbox for classification of FPs.
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Affiliation(s)
- Faezeh Jahanmiri-Nezhad
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA; Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA.
| | - Paul E Barkhaus
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - William Zev Rymer
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Ping Zhou
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, and TIRR Memorial Hermann Research Center, Houston, TX, USA; Biomedical Engineering Program, University of Science and Technology of China, Hefei, China
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Leite MAA, Orsini M, de Freitas MRG, Pereira JS, Gobbi FHP, Bastos VH, de Castro Machado D, Machado S, Arrias-Carrion O, de Souza JA, Oliveira AB. Another Perspective on Fasciculations: When is it not Caused by the Classic form of Amyotrophic Lateral Sclerosis or Progressive Spinal Atrophy? Neurol Int 2014; 6:5208. [PMID: 25309711 PMCID: PMC4192433 DOI: 10.4081/ni.2014.5208] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 03/28/2014] [Indexed: 12/25/2022] Open
Abstract
Fasciculations are visible, fine and fast, sometimes vermicular contractions of fine muscle fibers that occur spontaneously and intermittently. The aim of this article is to discuss the main causes for fasciculations and their pathophysiology in different sites of the central/peripheral injury and in particular to disprove that the presence of this finding in the neurological examination is indicative of amyotrophic lateral sclerosis. Undoubtedly, most fasciculations have a distal origin in the motor nerve both in normal subjects and in patients with motor neuron disease. Most of them spread to other dendritic spines often producing an antidromic impulse in the main axon. The clinical and neurophysiological diagnosis must be thorough. It may often take long to record fasciculations with electroneuromyography. In other cases, temporal monitoring is necessary before the diagnosis. The treatment, which may be adequate in some cases, is not always necessary.
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Affiliation(s)
- Marco Antonio Araujo Leite
- Neurology Service, Movement Disorders Unit, Fluminense Federal University , Niterói, Rio de Janeiro, Brazil
| | - Marco Orsini
- Neurology Service, Movement Disorders Unit, Fluminense Federal University , Niterói, Rio de Janeiro, Brazil
| | - Marcos R G de Freitas
- Neurology Service, Movement Disorders Unit, Fluminense Federal University , Niterói, Rio de Janeiro, Brazil
| | - João Santos Pereira
- Neurology Service, Movement Disorders Unit, Fluminense Federal University , Niterói, Rio de Janeiro, Brazil ; Neurology Service, Rio de Janeiro University , Brazil
| | | | - Victor Hugo Bastos
- Departament of Physiotherapy, Piaui Federal University , Parnaíba, Brazil
| | | | - Sergio Machado
- Physical Activity Neuroscience, Physical Activity Sciences Postgraduate Program, Salgado de Oliveira University , Niterói, Brazil
| | - Oscar Arrias-Carrion
- Movement Disorders and Sleep Unit, General Hospital Dr. Manuel Gea González, Secretaria de México D.F. , México
| | - Jano Alves de Souza
- Neurology Service, Movement Disorders Unit, Fluminense Federal University , Niterói, Rio de Janeiro, Brazil
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Muscle ultrasonography: A diagnostic tool for amyotrophic lateral sclerosis. Clin Neurophysiol 2012; 123:1662-7. [DOI: 10.1016/j.clinph.2011.11.262] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 11/12/2011] [Accepted: 11/27/2011] [Indexed: 01/13/2023]
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Kleine BU, Boekestein WA, Arts IM, Zwarts MJ, Jurgen Schelhaas H, Stegeman DF. Fasciculations and their F-response revisited: High-density surface EMG in ALS and benign fasciculations. Clin Neurophysiol 2012; 123:399-405. [DOI: 10.1016/j.clinph.2011.06.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 05/06/2011] [Accepted: 06/07/2011] [Indexed: 11/26/2022]
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Orsini M, Sztajnbok FR, Oliveira AB, Araújo Leite MA, Júnior SP, de Freitas MRG, Nascimento OJM, Silva JG, Sholer MP, Guimarães FS, Pereira AC, de Menezes SLS, da Silva Catharino AM, Bino F. Benign fasciculations and corticosteroid use: possible association? An update. Neurol Int 2011; 3:e11. [PMID: 22053258 PMCID: PMC3207230 DOI: 10.4081/ni.2011.e11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 08/30/2011] [Indexed: 12/12/2022] Open
Abstract
Fasciculations are characterized by visible subtle and fast contractions of muscle, even wormlike in movement, by the contraction of a fascicle of muscle fibers. The authors present the case study of a 28-year-old patient with the appearance of migratory and diffuse fasciculations with an onset after partial tapering off of oral corticosteroides (60 mg total dose) indicated for treatment of Minimal change Glomerulopathy. Clinical Neurological physical exam allied with an ENMG, besides other complementary laboratory exams were used for screening the above-mentioned patient. Afterwards, current research relating to the topic at hand was made in order to update the data available in the Bireme, Scielo and PubMed Data Banks using the following key words: Fasciculation's, motor neuron disease, and benign fasciculations in the Portuguese, English as well as Spanish language. Although fasciculation's are most commonly associated with Motor neuron disease as well as with certain metabolic disorders, they may also be present in individuals with absolutely no underlying pathological disorders. In our case, fasciculation potentials that have been present for six months, with no other signs of a neurogenic disorder as well as absence of laboratory findings, the patient received a diagnosis of Benign Fasciculation Syndrome (BFS).We believe that the use of corticosteroides in high doses with subsequent tapering contributed to the fasciculation's, especially due to the changes that this causes on the ionic channels. Fasciculation's are symptoms seen in a large range of conditions, and also being the main symptom of the so-called Benign Fasciculation Syndrome. We have presented an example of this clinical syndrome in a patient whose complaint was fasciculation's, with complete clinical remission of symptoms following complete tapering off of corticosteroid six months previously.
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Affiliation(s)
- Marco Orsini
- Neurology Service - Antonio Pedro University Hospital - Federal Fluminense University - HUAP - UFF
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Abstract
OBJECTIVE To review the current research of new emerging diagnostic technology for non-invasive physiological monitoring of exercise and fitness. As a personal trainer, I believe that exercise can improve the conditions of several diseases and/or events such as stroke, post-traumatic head injury, spinal cord injury, and a multitude of other diseases. This compilation of information will allow health care providers tools of a non-invasive manner to promote healing and health that go beyond the initial event. Allowing patients continued managed care beyond what is believed to be their plateau. MATERIAL AND METHOD Review science-based research involving non-invasive technology, including cardiovascular evaluations: heart rate monitors, near-infrared spectroscopy, blood pressure, and electrocardiography; motor capabilities: surface electromyography and manual testers, i.e. dynamometer, and digital and video photography; radiological monitoring: magnetic resonance imaging, three-dimensional computer tomography, and laser Doppler. RESULTS This investigation has found that a new approach should be implemented for non-invasive physiological monitoring of exercise and fitness through development and utilization across a wide variety of equipment, and monitoring technology. This non-invasive methodology will not only motivate but encourage individuals to begin and remain compliant with an exercise program allowing a variety of health care providers to assist in patient care. DISCUSSION We need to shift the paradigm from taking care of the sick to maintaining the health of our patients. This can be accomplished with non-invasive evaluation, tracking, and monitoring tools. Many of the suggestions for monitoring are used in a clinical setting rather than a general fitness environment. These monitoring tests need to be economical as well as available for continual re-evaluation.
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