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Al‐Zuhairy A, Jakobsen J, Moldovan M, Krarup C. Axonal loss at time of diagnosis as biomarker for long-term disability in chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2022; 66:715-722. [PMID: 36217677 PMCID: PMC9828077 DOI: 10.1002/mus.27722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/16/2022] [Accepted: 08/27/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION/AIMS We hypothesized that early, pretreatment axonal loss would predict long-term disability, supported by a pilot study of selected patients with chronic inflammatory demyelinating polyneuropathy (CIDP). To further test this hypothesis, we examined a larger consecutive group of CIDP patients. METHODS Needle electromyography and motor and sensory nerve conduction studies were carried out in 30 CIDP patients at pretreatment and follow-up 5 to 28 years later. Changes in amplitudes were expressed as axonal Z scores and changes in conduction as demyelination Z scores and correlated with findings of the Inflammatory Rasch-built Overall Disability Scale (I-RODS), the Neuropathy Impairment Score (NIS), and isokinetic dynamometry (IKS). RESULTS At follow-up, the median I-RODS score was 73, the NIS was 23, and the IKS was 56%. The median axonal Z score was unchanged at follow-up. Conversely, the corresponding demyelination Z scores improved. The initial axonal loss was correlated with the clinical outcome and was an independent predictor of outcome by multivariate regression analysis. Axonal loss at follow-up was also correlated with the clinical outcome. Only the follow-up demyelination Z score was correlated with the clinical outcomes. Furthermore, the latency until treatment initiation was predictive of all three clinical outcome scores at follow-up, and of axonal loss and demyelination at follow-up. DISCUSSION The present study findings indicate that pretreatment axonal loss at diagnosis in CIDP is predictive of long-term disability, neurological impairment, and strength. A delay in treatment is associated with more pronounced axonal loss and a worse clinical outcome.
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Affiliation(s)
- Ali Al‐Zuhairy
- Department of NeurologyCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - Johannes Jakobsen
- Department of NeurologyCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - Mihai Moldovan
- Department of Clinical NeurophysiologyRigshospitalet and Department of Neuroscience, University of CopenhagenCopenhagenDenmark
| | - Christian Krarup
- Department of Clinical NeurophysiologyRigshospitalet and Department of Neuroscience, University of CopenhagenCopenhagenDenmark
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Cardoso de Oliveira M, Naville Watanabe R, Kohn AF. Electrophysiological and functional signs of Guillain-Barré syndrome predicted by a multiscale neuromuscular computational model. J Neural Eng 2022; 19. [DOI: 10.1088/1741-2552/ac91f8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/14/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Objective. The diagnosis of nerve disorders in humans has relied heavily on the measurement of electrical signals from nerves or muscles in response to electrical stimuli applied at appropriate locations on the body surface. The present study investigated the demyelinating subtype of Guillain-Barré syndrome using multiscale computational model simulations to verify how demyelination of peripheral axons may affect plantar flexion torque as well as the ongoing electromyogram (EMG) during voluntary isometric or isotonic contractions. Approach. Changes in axonal conduction velocities, mimicking those found in patients with the disease at different stages, were imposed on a multiscale computational neuromusculoskeletal model to simulate subjects performing unipodal plantar flexion force and position tasks. Main results. The simulated results indicated changes in the torque signal during the early phase of the disease while performing isotonic tasks, as well as in torque variability after partial conduction block while performing both isometric and isotonic tasks. Our results also indicated changes in the root mean square values and in the power spectrum of the soleus EMG signal as well as changes in the synchronisation index computed from the firing times of the active motor units. All these quantitative changes in functional indicators suggest that the adoption of such additional measurements, such as torques and ongoing EMG, could be used with advantage in the diagnosis and be relevant in providing extra information for the neurologist about the level of the disease. Significance. Our findings enrich the knowledge of the possible ways demyelination affects force generation and position control during plantarflexion. Moreover, this work extends computational neuroscience to computational neurology and shows the potential of biologically compatible neuromuscular computational models in providing relevant quantitative signs that may be useful for diagnosis in the clinic, complementing the tools traditionally used in neurological electrodiagnosis.
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Goedee HS, Rajabally YA. Evidence base for investigative and therapeutic modalities in chronic inflammatory demyelinating polyneuropathy and multifocal motor neuropathy. Neurodegener Dis Manag 2022; 12:35-47. [PMID: 35007438 DOI: 10.2217/nmt-2021-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chronic inflammatory demyelinating polyneuropathy, its variants and multifocal motor neuropathy belong to a spectrum of peripheral nerve disorders with complex dysimmune disease mechanisms. Awareness of the unique clinical phenotypes but also heterogeneity between patients is vital to arrive at early suspicion and ordering appropriate tests. This includes requirements for optimal electrodiagnostic protocol, aimed to capture sufficient electrophysiologic evidence for relevant abnormalities, a case-based approach on the eventual need to further expand the diagnostic armamentarium and correct reading of their results. Considerable phenotypical variation, diverse combinations of abnormalities found on diagnostic tests and heterogeneity in disease course and treatment response, all contribute to widespread differences in success rates on timely diagnosis and optimal treatment. We aim to provide a practical overview and guidance on relevant diagnostic and management strategies, including pitfalls and present a summary of the relevant novel developments in this field.
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Affiliation(s)
- Hendrik Stephan Goedee
- Brain Center UMC Utrecht, Department of Neurology & Neurosurgery, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Yusuf A Rajabally
- Inflammatory Neuropathy Clinic, Department of Neurology, University Hospitals Birmingham, Birmingham, UK.,Aston Medical School, Aston University, Birmingham, UK
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Zhang S, Yang X, Xu Y, Luo Y, Fan D, Liu X. Application Value of the Motor Unit Number Index in Patients With Kennedy Disease. Front Neurol 2022; 12:705816. [PMID: 34992574 PMCID: PMC8724309 DOI: 10.3389/fneur.2021.705816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to evaluate the usefulness of the motor unit number index (MUNIX) technique in Kennedy disease (KD) and test the correlation between the MUNIX and other clinical parameters. The MUNIX values of the bilateral deltoid, abductor digiti minimi (ADM), quadriceps femoris (QF), and tibialis anterior (TA) were determined and compared with the course of the disease. The MUNIX sum score was calculated by adding the MUNIX values of these 8 muscles. Disability was evaluated using the spinal and bulbar muscular atrophy functional rating scale (SBMAFRS). The MUNIX scores of patients with KD were negatively correlated with the course of the disease (p < 0.05), whereas their motor unit size index (MUSIX) scores were positively correlated with the course the of disease (p < 0.05). MUNIX sum scores were correlated with SBMAFRS scores (r = 0.714, p < 0.05). MUNIX was more sensitive than compound muscle action potentials or muscle strength as an indicator of neuron loss and axonal collateral reinnervation. The MUNIX sum score is an objective and a reliable indicator of disease progression, and it is a potential choice for therapeutic clinical trials. The MUNIX can assess the functional loss of motor axons and is correlated with disability. The MUNIX sum score may be especially suitable as an objective parameter.
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Affiliation(s)
- Shuo Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Xin Yang
- Department of Neurology, Changchun Central Hospital, Changchun, China
| | - Yingsheng Xu
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Yongmei Luo
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China.,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xiaoxuan Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
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5
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Early axonal loss predicts long-term disability in chronic inflammatory demyelinating polyneuropathy. Clin Neurophysiol 2021; 132:1000-1007. [DOI: 10.1016/j.clinph.2020.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/30/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
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6
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Zheng C, Zhu Y, Yu Q, Zhu D, Li J, Lyu F, Weber R, Qiao K, Jiang J. Quantitative assessment of motor impairment and surgical outcome in Hirayama disease with proximal involvement using motor unit number index. Neurophysiol Clin 2021; 51:375-386. [PMID: 33676826 DOI: 10.1016/j.neucli.2021.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To assess the feasibility of motor unit number index (MUNIX) in quantitatively evaluating Hirayama disease (HD) with proximal involvement and to identify the effectiveness of anterior cervical fusion (ACF) in treating atypical HD with proximal involvement. METHODS This study included 28 atypical HD patients with proximal involvement (proximal-distal vs. distal-proximal groups: 5 vs. 23) and 41 healthy controls. All patients underwent pre- and postoperative 1-year MUNIX tests on abductor pollicis brevis (APB), abductor digiti minimi (ADM), biceps brachii (BB) and deltoid (Del). The disabilities of arm, shoulder and hand (DASH) and Medical Research Council (MRC) scales were also performed in these patients before and one year after operation. RESULTS Preoperatively, the patients in the distal-proximal group showed reduced compound muscle action potential (CMAP), decreased MUNIX and increased motor unit size index (MUSIX) in bilateral distal muscles and symptomatic-side proximal muscles (P < 0.05), and similar abnormalities were also observed in ADM, BB and Del on the symptomatic side in the proximal-distal groups (P < 0.05). Postoperative follow-up analysis identified increased MUNIX in the symptomatic-side proximal muscles with improved motor function in the proximal-distal groups (P < 0.05), and distal-proximal group patients showed an increase in both CMAP and MUSIX in the symptomatic-side proximal muscles (P < 0.05). CONCLUSIONS MUNIX may serve as an available supplementary test to quantitatively evaluate the motor dysfunction and treatment outcome in HD with proximal involvement. ACF procedures can effectively treat these atypical HD patients, especially for those whose symptoms started in proximal muscles.
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Affiliation(s)
- Chaojun Zheng
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yu Zhu
- Department of Physical Medicine and Rehabilitation, Upstate Medical University, State University of New York at Syracuse, Syracuse, NY 10212, USA
| | - Qifeng Yu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Dongqing Zhu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jun Li
- Department of Orthopedics, Shanghai Songjiang District Central Hospital, Shanghai 201600, China
| | - Feizhou Lyu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China; Department of Orthopedics, The Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Robert Weber
- Department of Physical Medicine and Rehabilitation, Upstate Medical University, State University of New York at Syracuse, Syracuse, NY 10212, USA
| | - Kai Qiao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jianyuan Jiang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China.
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Moss KR, Bopp TS, Johnson AE, Höke A. New evidence for secondary axonal degeneration in demyelinating neuropathies. Neurosci Lett 2021; 744:135595. [PMID: 33359733 PMCID: PMC7852893 DOI: 10.1016/j.neulet.2020.135595] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/31/2020] [Accepted: 12/19/2020] [Indexed: 12/28/2022]
Abstract
Development of peripheral nervous system (PNS) myelin involves a coordinated series of events between growing axons and the Schwann cell (SC) progenitors that will eventually ensheath them. Myelin sheaths have evolved out of necessity to maintain rapid impulse propagation while accounting for body space constraints. However, myelinating SCs perform additional critical functions that are required to preserve axonal integrity including mitigating energy consumption by establishing the nodal architecture, regulating axon caliber by organizing axonal cytoskeleton networks, providing trophic and potentially metabolic support, possibly supplying genetic translation materials and protecting axons from toxic insults. The intermediate steps between the loss of these functions and the initiation of axon degeneration are unknown but the importance of these processes provides insightful clues. Prevalent demyelinating diseases of the PNS include the inherited neuropathies Charcot-Marie-Tooth Disease, Type 1 (CMT1) and Hereditary Neuropathy with Liability to Pressure Palsies (HNPP) and the inflammatory diseases Acute Inflammatory Demyelinating Polyneuropathy (AIDP) and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). Secondary axon degeneration is a common feature of demyelinating neuropathies and this process is often correlated with clinical deficits and long-lasting disability in patients. There is abundant electrophysiological and histological evidence for secondary axon degeneration in patients and rodent models of PNS demyelinating diseases. Fully understanding the involvement of secondary axon degeneration in these diseases is essential for expanding our knowledge of disease pathogenesis and prognosis, which will be essential for developing novel therapeutic strategies.
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Affiliation(s)
- Kathryn R Moss
- Department of Neurology, Neuromuscular Division, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Taylor S Bopp
- Department of Neurology, Neuromuscular Division, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Anna E Johnson
- Department of Neurology, Neuromuscular Division, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Ahmet Höke
- Department of Neurology, Neuromuscular Division, Johns Hopkins School of Medicine, Baltimore, MD, United States.
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8
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Grüter T, Motte J, Fisse AL, Bulut Y, Köse N, Athanasopoulos D, Otto S, Yoon MS, Schneider-Gold C, Gold R, Pitarokoili K. Pathological spontaneous activity as a prognostic marker in chronic inflammatory demyelinating polyneuropathy. Eur J Neurol 2020; 27:2595-2603. [PMID: 32794258 DOI: 10.1111/ene.14476] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Monitoring of the disease course of patients with chronic inflammatory demyelinating polyneuropathy (CIDP) remains challenging because nerve conduction studies do not adequately correlate with functional disability. The prognostic value of pathological spontaneous activity (PSA) in needle electromyography (EMG) in different CIDP subgroups in a longitudinal context has, to date, not been analysed. We aimed to determine whether PSA was a prognostic marker or a marker of disease activity in a cohort of patients with CIDP. METHODS A total of 127 patients with CIDP spectrum disorder were retrospectively analysed over 57 ± 47 months regarding the occurrence of PSA (fibrillations and positive sharp waves). The presence of PSA at diagnosis, newly occurring PSA, and continuously present PSA were longitudinally correlated with clinical disability using the Inflammatory Neuropathy Cause and Treatment Overall Disability Sum Score (INCAT-ODSS) and CIDP subtype. RESULTS Pathological spontaneous activity occurred in 49.6% of all CIDP patients at first diagnosis. More frequent evidence of PSA was significantly associated with a higher INCAT-ODSS at the last follow-up. Continuous and new occurrence of PSA were associated with higher degree of disability at the last follow-up. The majority of patients with sustained evidence of PSA were characterized by an atypical phenotype, higher degree of disability, and the need for escalation of treatment. CONCLUSIONS Pathological spontaneous activity was associated with a higher degree of disability and occurred more frequently in atypical CIDP variants according to the longitudinal data of a large cohort of patients with CIDP. Our results showed that EMG examination was an adequate marker for disease progression and should be evaluated during the disease course.
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Affiliation(s)
- T Grüter
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany
| | - J Motte
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany
| | - A L Fisse
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany
| | - Y Bulut
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany
| | - N Köse
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - D Athanasopoulos
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany
| | - S Otto
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - M-S Yoon
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany.,Department of Neurology, Evangelisches Krankenhaus Hattingen, Hattingen, Germany
| | - C Schneider-Gold
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - R Gold
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany
| | - K Pitarokoili
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany
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Zheng C, Chen Z, Zhu Y, Lyu F, Ma X, Weber R, Tian D, Jiang J, Xia X. Motor unit number index in quantitatively assessing motor root lesions and monitoring treatment outcomes in patients with lumbosacral radiculopathy. Muscle Nerve 2020; 61:759-766. [PMID: 32129891 DOI: 10.1002/mus.26854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 02/24/2020] [Accepted: 02/29/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Chaojun Zheng
- Department of OrthopedicsHuashan Hospital, Fudan University Shanghai China
| | - Zhenhao Chen
- Department of OrthopedicsHuashan Hospital, Fudan University Shanghai China
| | - Yu Zhu
- Department of Physical Medicine and RehabilitationUpstate Medical University, State University of New York at Syracuse Syracuse, New York USA
| | - Feizhou Lyu
- Department of OrthopedicsHuashan Hospital, Fudan University Shanghai China
- Department of OrthopedicsThe Fifth People's Hospital, Fudan University Shanghai China
| | - Xiaosheng Ma
- Department of OrthopedicsHuashan Hospital, Fudan University Shanghai China
| | - Robert Weber
- Department of Physical Medicine and RehabilitationUpstate Medical University, State University of New York at Syracuse Syracuse, New York USA
| | - Dong Tian
- Department of Hand SurgeryHuashan Hospital, Fudan University Shanghai China
| | - Jianyuan Jiang
- Department of OrthopedicsHuashan Hospital, Fudan University Shanghai China
| | - Xinlei Xia
- Department of OrthopedicsHuashan Hospital, Fudan University Shanghai China
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Higashihara M, Menon P, van den Bos M, Pavey N, Vucic S. Reproducibility of motor unit number index and MScanFit motor unit number estimation across intrinsic hand muscles. Muscle Nerve 2020; 62:192-200. [PMID: 32077117 DOI: 10.1002/mus.26839] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/09/2020] [Accepted: 02/15/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION We sought to evaluate the reproducibility of the motor unit number index (MUNIX) and MScanFit motor unit number estimation (MScan) when recording was performed over intrinsic hand muscles. METHODS The compound muscle action potential (CMAP) amplitude, MUNIX, and MScan were measured from the abductor pollicis brevis (APB), first dorsal interosseous (FDI), and abductor digit minimi (ADM) muscles from 15 healthy volunteers on three different occasions. RESULTS The reproducibility of CMAP amplitudes was excellent, with intraclass correlation coefficients (ICC) of 0.86 (APB), 0.90 (FDI), and 0.96 (ADM). Motor unit number index (ICCAPB 0.73, ICCFDI 0.85, ICCADM 0.85) and MScan (ICCAPB 0.86, ICCFDI 0.83, ICCADM 0.81) were highly reproducible across the three muscles. There were no significant correlations between MUNIX and MScan coefficients of variation (CV) and CMAP amplitude CVs. DISCUSSION Reproducibility of MUNIX and MScan was not significantly different across the intrinsic hand muscles and was independent of CMAP amplitude variability.
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Affiliation(s)
- Mana Higashihara
- Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
| | - Parvathi Menon
- Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
| | - Mehdi van den Bos
- Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
| | - Nathan Pavey
- Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
| | - Steve Vucic
- Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
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11
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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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Fatehi F, Grapperon AM, Fathi D, Delmont E, Attarian S. The utility of motor unit number index: A systematic review. Neurophysiol Clin 2018; 48:251-259. [PMID: 30287192 DOI: 10.1016/j.neucli.2018.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 09/04/2018] [Accepted: 09/11/2018] [Indexed: 12/11/2022] Open
Abstract
The need for a valid biomarker for assessing disease progression and for use in clinical trials on amyotrophic lateral sclerosis (ALS) has stimulated the study of methods that could measure the number of motor units. Motor unit number index (MUNIX) is a newly developed neurophysiological technique that was demonstrated to have a good correlation with the number of motor units in a given muscle, even though it does not necessarily accurately express the actual number of viable motor neurons. Several studies demonstrated the technique is reproducible and capable of following motor neuron loss in patients with ALS and peripheral polyneuropathies. The main goal of this review was to conduct an extensive review of the literature using MUNIX. We conducted a systematic search in English medical literature published in two databases (PubMed and SCOPUS). In this review, we aimed to answer the following queries: Comparison of MUNIX with other MUNE techniques; the reproducibility of MUNIX; the utility of MUNIX in ALS and preclinical muscles, peripheral neuropathies, and other neurological disorders.
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Affiliation(s)
- Farzad Fatehi
- Reference Center for Neuromuscular Diseases and ALS, Timone University Hospital, 13385 Marseille, France; Department of Neurology, Iranian Center of Neurological Research, Neuroscience Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Aude-Marie Grapperon
- Reference Center for Neuromuscular Diseases and ALS, Timone University Hospital, 13385 Marseille, France
| | - Davood Fathi
- Department of Neurology, Iranian Center of Neurological Research, Neuroscience Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Emilien Delmont
- Reference Center for Neuromuscular Diseases and ALS, Timone University Hospital, 13385 Marseille, France
| | - Shahram Attarian
- Reference Center for Neuromuscular Diseases and ALS, Timone University Hospital, 13385 Marseille, France; Inserm, GMGF, Aix-Marseille University, Marseille, 13385 France.
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13
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Higashihara M, Menon P, van den Bos M, Geevasinga N, Vucic S. Reproducibility of motor unit number index and multiple point stimulation motor unit number estimation in controls. Muscle Nerve 2018; 58:660-664. [PMID: 30194855 DOI: 10.1002/mus.26339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Reproducibility of the multiple point stimulation motor unit number estimation (MPS-MUNE) technique was compared with the recently developed motor unit number index (MUNIX) technique. METHODS MPS-MUNE and MUNIX were performed on 15 healthy subjects at 3 different time-points by the same examiner. Reproducibility was analyzed using intraclass correlation coefficient (ICC) and coefficient of variation (CV). RESULTS ICC values for MUNIX and MPS-MUNE were excellent across 3 tests (0.80 and 0.77, respectively), although CV values were significantly lower for MUNIX than MPS-MUNE (P < 0.01). In addition, test-retest reproducibility was better for MUNIX, a finding largely attributable to poor reproducibility of the single motor unit action potential area. MUNIX (R = -0.48, P < 0.05) and MPS-MUNE (R = -0.53, P < 0.05) were significantly correlated with age. DISCUSSION MUNIX demonstrated better intrarater reproducibility and may be a more reliable neurophysiological biomarker than MPS-MUNE. Muscle Nerve 58: 660-664, 2018.
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Affiliation(s)
- Mana Higashihara
- Department of Neurology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Parvathi Menon
- Westmead Clinical School, Cnr. Hawkesbury and Darcy Road, University of Sydney, New South Wales, 2145, Australia
| | - Mehdi van den Bos
- Westmead Clinical School, Cnr. Hawkesbury and Darcy Road, University of Sydney, New South Wales, 2145, Australia
| | - Nimeshan Geevasinga
- Westmead Clinical School, Cnr. Hawkesbury and Darcy Road, University of Sydney, New South Wales, 2145, Australia
| | - Steve Vucic
- Westmead Clinical School, Cnr. Hawkesbury and Darcy Road, University of Sydney, New South Wales, 2145, Australia
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14
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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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Benmouna K, Milants C, Wang FC. Correlations between MUNIX and adapted multiple point stimulation MUNE methods. Clin Neurophysiol 2018; 129:341-344. [DOI: 10.1016/j.clinph.2017.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/12/2017] [Accepted: 11/06/2017] [Indexed: 12/13/2022]
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16
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Garg N, Howells J, Yiannikas C, Vucic S, Krishnan AV, Spies J, Bostock H, Mathey EK, Pollard JD, Park SB, Kiernan MC. Motor unit remodelling in multifocal motor neuropathy: The importance of axonal loss. Clin Neurophysiol 2017; 128:2022-2028. [DOI: 10.1016/j.clinph.2017.07.414] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/27/2017] [Accepted: 07/18/2017] [Indexed: 12/13/2022]
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17
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Motor unit number index (MUNIX) in patients with anti-MAG neuropathy. Clin Neurophysiol 2017; 128:1264-1269. [DOI: 10.1016/j.clinph.2017.04.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 04/06/2017] [Accepted: 04/26/2017] [Indexed: 12/12/2022]
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18
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Reproducibility, and sensitivity to motor unit loss in amyotrophic lateral sclerosis, of a novel MUNE method: MScanFit MUNE. Clin Neurophysiol 2017; 128:1380-1388. [DOI: 10.1016/j.clinph.2017.03.045] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/20/2017] [Accepted: 03/27/2017] [Indexed: 11/18/2022]
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19
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Otto M, Markvardsen L, Tankisi H, Jakobsen J, Fuglsang-Frederiksen A. The electrophysiological response to immunoglobulin therapy in chronic inflammatory demyelinating polyneuropathy. Acta Neurol Scand 2017; 135:656-662. [PMID: 27546708 DOI: 10.1111/ane.12663] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To characterize changes in motor nerve conduction studies (MNCS) and motor unit number index (MUNIX) following treatment with subcutaneous immunoglobulin and to assess whether these changes are related to muscle strength. METHODS Data from 23 patients participating in a randomized, controlled trial were analyzed. MNCS and MUNIX were performed before and after 12 weeks of treatment. Isokinetic strength (IMS) was measured in various muscles together with grip strength (GS). RESULTS Proximally evoked compound muscle action potential (CMAP) amplitudes and MUNIX tended to be better preserved in treated patients (P=.049 and .045). Changes in other parameters did not differ between groups. There was no correlation between changes in electrophysiological parameters and IMS. Changes in GS were related to median nerve motor conduction velocity, distal motor latency, CMAP amplitudes, and distally evoked CMAP duration (P=.013-.035). CONCLUSION Proximally evoked CMAP amplitudes appear to be the best MNCS parameter to assess treatment outcome in chronic inflammatory demyelinating polyneuropathy.
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Affiliation(s)
- M. Otto
- Department of Clinical Neurophysiology; Aarhus University Hospital; Aarhus Denmark
| | - L. Markvardsen
- Department of Neurology; Aarhus University Hospital; Aarhus Denmark
| | - H. Tankisi
- Department of Clinical Neurophysiology; Aarhus University Hospital; Aarhus Denmark
| | - J. Jakobsen
- Department of Neurology; Aarhus University Hospital; Aarhus Denmark
- Neuroscience Center; Rigshospitalet; Copenhagen Denmark
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20
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Gilmore KJ, Allen MD, Doherty TJ, Kimpinski K, Rice CL. Electrophysiological and neuromuscular stability of persons with chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2017; 56:413-420. [DOI: 10.1002/mus.25516] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/07/2016] [Accepted: 12/09/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Kevin J. Gilmore
- School of Kinesiology; The University of Western Ontario; London ON Canada
| | - Matti D. Allen
- School of Medicine Queen's University Kingston ON Canada
| | - Timothy J. Doherty
- Department of Clinical Neurological Sciences; Schulich School of Medicine and Dentistry, The University of Western Ontario; London ON Canada
- Department of Physical Medicine and Rehabilitation; Schulich School of Medicine and Dentistry, The University of Western Ontario; London ON Canada
| | - Kurt Kimpinski
- School of Kinesiology; The University of Western Ontario; London ON Canada
- Department of Clinical Neurological Sciences; Schulich School of Medicine and Dentistry, The University of Western Ontario; London ON Canada
| | - Charles L. Rice
- School of Kinesiology; The University of Western Ontario; London ON Canada
- Department of Anatomy and Cell Biology; Schulich School of Medicine and Dentistry, The University of Western Ontario; London ON Canada
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Abstract
The motor unit comprises the anterior horn cell, its axon, and the muscle fibers that it innervates. Although the true number of motor units is unknown, the number of motor units appears to vary greatly between different muscles and between different individuals. Assessment of the number and function of motor units is needed in diseases of the anterior horn cell and other motor nerve disorders. Amyotrophic lateral sclerosis is the most important disease of anterior horn cells. The need for an effective biomarker for assessing disease progression and for use in clinical trials in amyotrophic lateral sclerosis has stimulated the study of methods to measure the number of motor units. Since 1970 a number of different methods, including the incremental, F-wave, multipoint, and statistical methods, have been developed but none has achieved widespread applicability. Two methods (MUNIX and the multipoint incremental method) are in current use across multiple centres and are discussed in detail in this review, together with other recently published methods. Imaging with magnetic resonance and ultrasound is increasingly being applied to this area. Motor unit number estimates have also been applied to other neuromuscular diseases such as spinal muscular atrophy, compression neuropathies, and prior poliomyelitis. The need for an objective measure for the assessment of motor units remains tantalizingly close but unfulfilled in 2016.
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Affiliation(s)
- Robert D Henderson
- Department of Neurology, Royal Brisbane & Women's Hospital and University of Queensland Centre for Clinical Research, Herston, Brisbane, 4006, Australia.
| | - Pamela A McCombe
- Department of Neurology, Royal Brisbane & Women's Hospital and University of Queensland Centre for Clinical Research, Herston, Brisbane, 4006, Australia
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22
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Philibert M, Grapperon AM, Delmont E, Attarian S. Monitoring the short-term effect of intravenous immunoglobulins in multifocal motor neuropathy using motor unit number index. Clin Neurophysiol 2017; 128:235-240. [PMID: 27988478 DOI: 10.1016/j.clinph.2016.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 10/30/2016] [Accepted: 11/12/2016] [Indexed: 12/12/2022]
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23
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Farschtschi S, Gelderblom M, Buschbaum S, Bostock H, Grafe P, Mautner VF. Muscle action potential scans and ultrasound imaging in neurofibromatosis type 2. Muscle Nerve 2016; 55:350-358. [PMID: 27422240 DOI: 10.1002/mus.25256] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The neuropathy in patients with neurofibromatosis type 2 (NF2) is difficult to quantify and follow up. In this study we compared 3 methods that may help assess motor axon pathology in NF2 patients. METHODS Nerve conduction studies in median nerves were supplemented by deriving motor unit number estimates (MUNEs) from compound muscle action potential (CMAP) scans and by high-resolution ultrasound (US) peripheral nerve imaging. RESULTS CMAP amplitudes and nerve conduction velocity were normal in the vast majority of affected individuals, but CMAP scan MUNE revealed denervation and reinnervation in many peripheral nerves. In addition, nerve US imaging enabled monitoring of the size and number of schwannoma-like fascicular enlargements in median nerve trunks. CONCLUSION In contrast to conventional nerve conduction studies, CMAP scan MUNE in combination with US nerve imaging can quantify the NF2-associated neuropathy and may help to monitor disease progression and drug treatments. Muscle Nerve 55: 350-358, 2017.
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Affiliation(s)
- Said Farschtschi
- Department of Neurology, University Medical Centre Hamburg-Eppendorf Hospital, Hamburg, Germany
| | - Mathias Gelderblom
- Department of Neurology, University Medical Centre Hamburg-Eppendorf Hospital, Hamburg, Germany
| | - Sabriena Buschbaum
- Department of Neurology, University Medical Centre Hamburg-Eppendorf Hospital, Hamburg, Germany
| | - Hugh Bostock
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - Peter Grafe
- Physiological Genomics, Institute of Physiology, Ludwig-Maximilians University Munich, Pettenkoferstrasse 12, 80336, Munich, Germany
| | - Victor F Mautner
- Department of Neurology, University Medical Centre Hamburg-Eppendorf Hospital, Hamburg, Germany
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Delmont E, Benvenutto A, Grimaldi S, Duprat L, Philibert M, Pouget J, Grapperon AM, Salort-Campana E, Sévy A, Verschueren A, Attarian S. Motor unit number index (MUNIX): Is it relevant in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)? Clin Neurophysiol 2016; 127:1891-4. [DOI: 10.1016/j.clinph.2015.12.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/14/2015] [Accepted: 12/06/2015] [Indexed: 12/12/2022]
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