Complex Repetitive Discharges: A Sign of Motor Axonal Reinnervation?

Spectral resonance in Fitzhugh-Nagumo neuron system: relation with stochastic resonance and its role in EMG signal characterization

This paper examines the existence of spectral resonance in the Fitzhugh-Nagumo (FHN) system driven by periodical signal and unbounded noise having Gaussian distribution. It is newly revealed that if the inter-spike-interval (ISI) distribution is accumulated on a single cluster, there exists a dual relationship between stochastic resonance and spectral resonance determined by commonly used metric normalized standard deviation of ISI. Furthermore, the ISI distribution is also concentrated on more than one cluster depending on different driving signal frequency. Consequently, the apparent regular spiking behavior is observed to occur at specified driving signal frequencies which result in a local minimum in entropy function indicating spectral resonance. Therefore it is proposed that occurrence of spectral resonance strongly depends on the shape of ISI distribution tuned by the stochastic and deterministic driving signal parameters and conventional metrics may not indicate entire resonance behavior. Correspondingly, the entropy function is utilized in this paper as an alternative metric to enable the detection of the spectral resonance occurrence. The ISI distribution obtained from the FHN system is investigated to relate the real electromyography (EMG) measurements under different conditions such as myokymia and neuromyotonia. It is seen that ISI distribution observed from myokymic EMG exhibits notably close behavior as in the case of spectral resonance generated by FHN whereas a wider distribution is monitored in the case of neuromyotonia. It is contributed that the modeling and parameterization based on ISI distribution can be potentially used to identify different neural activities.

[EMG phenomena of myogenic hyperexcitability]

The type, distribution pattern and time course of spontaneous muscular activity are important for the diagnostics of neuromuscular diseases in the clinical practice. In neurogenic lesions with motor axonal involvement, pathologic spontaneous activity (PSA) is usually reliably detectable by needle electromyography (EMG) 2-4 weeks after occurrence of the lesion. The distribution pattern correlates with the lesion location. The focus of the present work is the description of the different forms of PSA in myogenic diseases.

Association of Complex Repetitive Discharges With Chronicity and Clinical Symptoms in Radiculopathies

PURPOSE

Complex repetitive discharges (CRDs) are incompletely understood needle electromyography (EMG) waveforms seen in both myopathic and neurogenic disorders including radiculopathies. This study aimed to clarify the significance of CRDs in patients with radiculopathies.

METHODS

This case-control study randomly identified 100 patients with needle EMG evidence of radiculopathy demonstrating at least one CRD in the electrodiagnostically involved myotome between January 2017 and January 2022. These patients were compared with 100 randomly selected patients with EMG evidence of radiculopathy without CRDs controlled for sex, age at EMG testing, and affected nerve root segment. Patient clinical symptoms, neurologic examination, EMG features, and imaging were analyzed. A paired sample t-test for categorial data and χ2 test for nonparametric data were used for statistical analysis with significance defined as P < 0.05.

RESULTS

Patients with radiculopathies with CRDs had longer disease duration averaging 59 months (range 1-480) compared with patients with radiculopathies without CRDs averaging 26 months (range 1-192, P < 0.01). Clinical symptoms of paresthesias and weakness were both significantly more common in patients with radiculopathies with CRDs than those without CRDs (P < 0.01 and 0.01, respectively). Needle EMG demonstrated a greater average number of muscles with neurogenic motor unit potentials per radiculopathy in patients with radiculopathies with CRDs compared with those without CRDs. Imaging studies of patients with radiculopathies with CRDs were more likely to reveal evidence of nerve root compression (P < 0.01).

CONCLUSIONS

The presence of CRDs in patients with radiculopathies is consistent with clinically more symptomatic radiculopathies and a longer duration of nerve root compromise.

Muskelzuckungen und Muskelkrämpfe – Differenzialdiagnosen und elektrophysiologische Diagnostik

Muskelzuckungen und -krämpfe sind Beschwerden, die vom harmlosen Symptom bis hin zu Symptomen einer schwerwiegenden neurologischen Erkrankung reichen können. Eine ausführliche Anamnese, gründliche neurologische Untersuchung und elektrophysiologische Untersuchungen ermöglichen die Unterscheidung der verschiedenen Ätiologien. In diesem Artikel werden verschiedene Ursachen unter Berücksichtigung deren Definition, der elektrophysiologisch zugrunde liegenden Phänomene und deren differenzialdiagnostischer Einordnung dargestellt.

EMG-Phänomene peripherer motorisch axonaler Übererregbarkeit

Bei 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.

Canadian Pioneers of Amyotrophic Lateral Sclerosis: A Brief History

This is an historical account of Canadian pioneers working in amyotrophic lateral sclerosis (ALS) in the 1970s and 1980s. Key contributions included the development of specialized clinics, the ALS Society of Canada, human motor unit estimates in vivo, use of transcranial magnetic stimulation (TMS), the dementias of ALS, the importance of neurofilaments and axonal flow, neuroinflammation and immunity related to ALS, use of tissue culture to study pathogenesis, and the story of ALS in Guam. Their work set the stage for future generations of ALS physicians and scientists to bring about meaningful therapies and hopefully a cure for ALS.