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Hearn SL, Stino AM, Howard IM, Malhotra G, Robinson L. Serial electrodiagnostic testing: Utility and indications in adult neurological disorders. Muscle Nerve 2024; 69:670-681. [PMID: 38549195 DOI: 10.1002/mus.28083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 05/08/2024]
Abstract
Although existing guidelines address electrodiagnostic (EDX) testing in identifying neuromuscular conditions, guidance regarding the uses and limitations of serial (or repeat) EDX testing is limited. By assessing neurophysiological change longitudinally across time, serial electrodiagnosis can clarify a diagnosis and potentially provide valuable prognostic information. This monograph presents four broad indications for serial electrodiagnosis in adult peripheral neurological disorders. First, where clinical change has raised suspicion for a new or ongoing lesion, EDX reassessment for spatial spread of abnormality, involvement of previously normal muscle or nerve, and/or evolving pathophysiology can clarify a diagnosis. Second, where diagnosis of a progressive neuromuscular condition is uncertain, electrophysiological data from a second time point can confirm or refute suspicion. Third, to establish prognosis after a static nerve injury, a repeat study can assess the presence and extent of reinnervation. Finally, faced with a limited initial study (as when complicated by patient or environmental factors), a repeat EDX study can supplement missing or limited data to provide needed clarity. Repeat EDX studies carry certain limitations, however, such as with prognostication in the setting of remote or chronic lesions, sensory predominant fascicular injury, or mild axonal injury. Nevertheless, serial electrodiagnosis remains a valuable and underused tool in the diagnostic and prognostic evaluation of neuromuscular conditions.
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Affiliation(s)
- Sandra L Hearn
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Amro Maher Stino
- Division of Neuromuscular Medicine, Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ileana M Howard
- Department of Rehabilitation Medicine, University of Washington, Washington, USA
| | - Gautam Malhotra
- Altair Health, Morristown, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Lawrence Robinson
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
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Allevi F, Abate N, Bolognesi F, Tarabbia F, Rabbiosi D, Bellasio MM, Lozza A, Biglioli F. Is pre-operative electromyography a reliable tool in differentiating acute and chronic facial palsy? A preliminary evaluation in patients treated with triple innervation facial reanimation. J Craniomaxillofac Surg 2024:S1010-5182(24)00139-2. [PMID: 38734508 DOI: 10.1016/j.jcms.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/01/2024] [Indexed: 05/13/2024] Open
Abstract
Electromyographic evaluation is a reliable tool for confirming facial palsy and assessing its severity. It allows differentiating facial paresis and paralysis, and further distinguishes acute palsies, still showing muscle fibrillations, from chronic cases. This article aims to show that EMG fibrillations might represent a better criterion to differentiate acute and chronic palsies than the standard 18-24 months' cut-off usually employed for classification and treatment purposes. We performed a cohort study using the eFACE tool for comparing triple innervation facial reanimation results in patients with EMG fibrillation treated <12 months, 12-18 months, and >18 months from paralysis onset. Patients showed a statistically significant post-operative improvement in all eFACE items, both in the whole sample and in the three groups. Only the deviation from the optimal score for the gentle eye closure item in group 2 didn't reach statistical significance (p = 0.173). The post-operative results were comparable in the three groups, as the Kruskal-Wallis test showed a difference only for the platysmal synkinesis item scores, which were significantly lower in group 3 (p = 0.025).
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Affiliation(s)
- Fabiana Allevi
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy.
| | - Nicole Abate
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Federico Bolognesi
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Filippo Tarabbia
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Dimitri Rabbiosi
- Department of Otorhinolaryngology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | | | - Federico Biglioli
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
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Mandeville R, Sanchez B, Johnston B, Bazarek S, Thum JA, Birmingham A, See RHB, Leochico CFD, Kumar V, Dowlatshahi AS, Brown J, Stashuk D, Rutkove SB. A scoping review of current and emerging techniques for evaluation of peripheral nerve health, degeneration, and regeneration: part 1, neurophysiology. J Neural Eng 2023; 20:041001. [PMID: 37279730 DOI: 10.1088/1741-2552/acdbeb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/06/2023] [Indexed: 06/08/2023]
Abstract
Peripheral neuroregeneration research and therapeutic options are expanding exponentially. With this expansion comes an increasing need to reliably evaluate and quantify nerve health. Valid and responsive measures that can serve as biomarkers of the nerve status are essential for both clinical and research purposes for diagnosis, longitudinal follow-up, and monitoring the impact of any intervention. Furthermore, such biomarkers can elucidate regeneration mechanisms and open new avenues for research. Without these measures, clinical decision-making falls short, and research becomes more costly, time-consuming, and sometimes infeasible. As a companion to Part 2, which is focused on non-invasive imaging, Part 1 of this two-part scoping review systematically identifies and critically examines many current and emerging neurophysiological techniques that have the potential to evaluate peripheral nerve health, particularly from the perspective of regenerative therapies and research.
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Affiliation(s)
- Ross Mandeville
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Benjamin Sanchez
- Department Electrical and Computer Engineering, University of Utah, Salt Lake City, UT 84112, United States of America
| | - Benjamin Johnston
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, United States of America
| | - Stanley Bazarek
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, United States of America
| | - Jasmine A Thum
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Austin Birmingham
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Reiner Henson B See
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Carl Froilan D Leochico
- Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Global City, Taguig, The Philippines
- Department of Rehabilitation Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, The Philippines
| | - Viksit Kumar
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Arriyan S Dowlatshahi
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Justin Brown
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Daniel Stashuk
- Department of Systems Design Engineering, University of Waterloo, Ontario N2L 3G1, Canada
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
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Effect of Massage Therapy in Regulating Wnt/β-Catenin Pathway on Retarding Denervated Muscle Atrophy in Rabbits. J Manipulative Physiol Ther 2022. [DOI: 10.1016/j.jmpt.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Yang C, Xu J, Chen J, Li S, Cao Y, Zhu Y, Xu L. Experimental study of brachial plexus and vessel compression: evaluation of combined central and peripheral electrodiagnostic approach. Oncotarget 2017; 8:50618-50628. [PMID: 28881588 PMCID: PMC5584177 DOI: 10.18632/oncotarget.16817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/09/2017] [Indexed: 11/25/2022] Open
Abstract
Introduction We sought to investigate the reliability of a new electrodiagnostic method for identifying Electrodiagnosis of Brachial Plexus & Vessel Compression Syndrome (BPVCS) in rats that involves the application of transcranial electrical stimulation motor evoked potentials (TES-MEPs) combined with peripheral nerve stimulation compound muscle action potentials (PNS-CMAPs). Results The latencies of the TES-MEP and PNS-CMAP were initially elongated in the 8-week group. The amplitudes of TES-MEP and PNS-CMAP were initially attenuated in the 16-week group. The isolateral amplitude ratio of the TES-MEP to the PNS-CMAP was apparently decreased, and spontaneous activities emerged at 16 weeks postoperatively. Materials and Methods Superior and inferior trunk models of BPVCS were created in 72 male Sprague Dawley (SD) rats that were divided into six experimental groups. The latencies, amplitudes and isolateral amplitude ratios of the TES-MEPs and PNS-CMAPs were recorded at different postoperative intervals. Conclusions Electrophysiological and histological examinations of the rats’ compressed brachial plexus nerves were utilized to establish preliminary electrodiagnostic criteria for BPVCS.
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Affiliation(s)
- Chaoqun Yang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianguang Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Chen
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Shulin Li
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu Cao
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yi Zhu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Lei Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
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Ruven C, Li W, Li H, Wong WM, Wu W. Transplantation of Embryonic Spinal Cord Derived Cells Helps to Prevent Muscle Atrophy after Peripheral Nerve Injury. Int J Mol Sci 2017; 18:ijms18030511. [PMID: 28264437 PMCID: PMC5372527 DOI: 10.3390/ijms18030511] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/10/2017] [Accepted: 02/22/2017] [Indexed: 02/07/2023] Open
Abstract
Injuries to peripheral nerves are frequent in serious traumas and spinal cord injuries. In addition to surgical approaches, other interventions, such as cell transplantation, should be considered to keep the muscles in good condition until the axons regenerate. In this study, E14.5 rat embryonic spinal cord fetal cells and cultured neural progenitor cells from different spinal cord segments were injected into transected musculocutaneous nerve of 200–300 g female Sprague Dawley (SD) rats, and atrophy in biceps brachii was assessed. Both kinds of cells were able to survive, extend their axons towards the muscle and form neuromuscular junctions that were functional in electromyographic studies. As a result, muscle endplates were preserved and atrophy was reduced. Furthermore, we observed that the fetal cells had a better effect in reducing the muscle atrophy compared to the pure neural progenitor cells, whereas lumbar cells were more beneficial compared to thoracic and cervical cells. In addition, fetal lumbar cells were used to supplement six weeks delayed surgical repair after the nerve transection. Cell transplantation helped to preserve the muscle endplates, which in turn lead to earlier functional recovery seen in behavioral test and electromyography. In conclusion, we were able to show that embryonic spinal cord derived cells, especially the lumbar fetal cells, are beneficial in the treatment of peripheral nerve injuries due to their ability to prevent the muscle atrophy.
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Affiliation(s)
- Carolin Ruven
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Hong Kong, China.
| | - Wen Li
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Hong Kong, China.
| | - Heng Li
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Hong Kong, China.
| | - Wai-Man Wong
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Hong Kong, China.
| | - Wutian Wu
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Hong Kong, China.
- State Key Laboratory of Brain and Cognitive Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China.
- Joint Laboratory for CNS Regeneration, Jinan University and The University of Hong Kong, GHM Institute of CNS Regeneration, Jinan University, Guangzhou 510000, China.
- Guangdong Engineering Research Center of Stem Cell Storage and Clinical Application, Saliai Stem Cell Science and Technology, Guangzhou 510000, China.
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Andrade N, Kent M, Howerth EW, Radlinsky MG. Evaluation of Pharyngeal Function in Dogs with Laryngeal Paralysis Before and After Unilateral Arytenoid Lateralization. Vet Surg 2015; 44:1021-8. [DOI: 10.1111/vsu.12410] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Natalia Andrade
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine; University of Georgia; Athens Georgia
| | - Marc Kent
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine; University of Georgia; Athens Georgia
| | - Elizabeth W. Howerth
- Department of Pathology, College of Veterinary Medicine; University of Georgia; Athens Georgia
| | - MaryAnn G. Radlinsky
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine; University of Georgia; Athens Georgia
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Abstract
BACKGROUND AND PURPOSE There are few reports in the literature of adverse effects resulting from massage therapy (MT) and no reports of brachial plexus injury (BPI) associated with MT. This case report describes an uncommon case of BPI that developed after a session of MT and reviews previously published reports of peripheral nerve injury following MT. CASE DESCRIPTION A 58-year-old Asian woman developed sudden unilateral paralysis of her left shoulder girdle after a session of MT. A diagnosis of acute BPI was suspected due to her recent history and the results of several examinations. The results of electrodiagnostic studies indicated a possible location for the lesion and ultimately led to a different diagnosis. OUTCOMES The patient regularly participated in a twice-weekly rehabilitation program targeting the left shoulder. The rehabilitation program included supervised passive range of motion, strengthening, and stretching exercises as well as a home exercise program. A 12-month follow-up showed the patient had achieved gradual recovery of shoulder strength, resolution of limitations of range of motion, and relief of shoulder pain. DISCUSSION This is believed to be the first report of BPI associated with MT. This case report serves as a reminder to massage therapists and physical therapists that MT of the neck should be carefully performed to avoid injury. Further studies will help design safer and more effective MT for the future.
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Partial block by riluzole of muscle sodium channels in myotubes from amyotrophic lateral sclerosis patients. Neurol Res Int 2014; 2014:946073. [PMID: 25548669 PMCID: PMC4273590 DOI: 10.1155/2014/946073] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 11/18/2014] [Indexed: 12/13/2022] Open
Abstract
Denervated muscles undergo fibrillations due to spontaneous activation of voltage-gated sodium (Na(+)) channels generating action potentials. Fibrillations also occur in patients with amyotrophic lateral sclerosis (ALS). Riluzole, the only approved drug for ALS treatment, blocks voltage-gated Na(+) channels, but its effects on muscle Na(+) channels and fibrillations are yet poorly characterized. Using patch-clamp technique, we studied riluzole effect on Na(+) channels in cultured myotubes from ALS patients. Needle electromyography was used to study fibrillation potentials (Fibs) in ALS patients during riluzole treatment and after one week of suspension. Patients were clinically characterized in all recording sessions. In myotubes, riluzole (1 μM, a therapeutic concentration) reduced Na(+) current by 20%. The rate of rise and amplitude of spikes evoked by depolarizing stimuli were also reduced. Fibs were detected in all patients tested during riluzole treatment and riluzole washout had no univocal effect. Our study indicates that, in human myotubes, riluzole partially blocks Na(+) currents and affects action potentials but does not prevent firing. In line with this in vitro finding, muscle Fibs in ALS patients appear to be largely unaffected by riluzole.
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Wu P, Chawla A, Spinner RJ, Yu C, Yaszemski MJ, Windebank AJ, Wang H. Key changes in denervated muscles and their impact on regeneration and reinnervation. Neural Regen Res 2014; 9:1796-809. [PMID: 25422641 PMCID: PMC4239769 DOI: 10.4103/1673-5374.143424] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 11/29/2022] Open
Abstract
The neuromuscular junction becomes progressively less receptive to regenerating axons if nerve repair is delayed for a long period of time. It is difficult to ascertain the denervated muscle's residual receptivity by time alone. Other sensitive markers that closely correlate with the extent of denervation should be found. After a denervated muscle develops a fibrillation potential, muscle fiber conduction velocity, muscle fiber diameter, muscle wet weight, and maximal isometric force all decrease; remodeling increases neuromuscular junction fragmentation and plantar area, and expression of myogenesis-related genes is initially up-regulated and then down-regulated. All these changes correlate with both the time course and degree of denervation. The nature and time course of these denervation changes in muscle are reviewed from the literature to explore their roles in assessing both the degree of detrimental changes and the potential success of a nerve repair. Fibrillation potential amplitude, muscle fiber conduction velocity, muscle fiber diameter, mRNA expression levels of myogenic regulatory factors and nicotinic acetylcholine receptor could all reflect the severity and length of denervation and the receptiveness of denervated muscle to regenerating axons, which could possibly offer an important clue for surgical choices and predict the outcomes of delayed nerve repair.
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Affiliation(s)
- Peng Wu
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA ; Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China ; Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Aditya Chawla
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA ; Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Cong Yu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Michael J Yaszemski
- Departments of Orthopedic Surgery and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | | | - Huan Wang
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA ; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
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Pond A, Marcante A, Zanato R, Martino L, Stramare R, Vindigni V, Zampieri S, Hofer C, Kern H, Masiero S, Piccione F. History, Mechanisms and Clinical Value of Fibrillation Analyses in Muscle Denervation and Reinnervation by Single Fiber Electromyography and Dynamic Echomyography. Eur J Transl Myol 2014; 24:3297. [PMID: 26913128 PMCID: PMC4749004 DOI: 10.4081/ejtm.2014.3297] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This work reviews history, current clinical relevance and future of fibrillation, a functional marker of skeletal muscle denervated fibers. Fibrillations, i.e., spontaneous contraction, in denervated muscle were first described during the nineteenth century. It is known that alterations in membrane potential are responsible for the phenomenon and that they are related to changes in electrophysiological factors, cellular metabolism, cell turnover and gene expression. They are known to inhibit muscle atrophy to some degree and are used to diagnose neural injury and reinnervation that are occurring in patients. Electromyography (EMG) is useful in determining progress, prognosis and efficacy of therapeutic interventions and their eventual change. For patients with peripheral nerve injury, and thus without the option of volitional contractions, electrical muscle stimulation may be helpful in preserving the contractility and extensibility of denervated muscle tissue and in retarding/counteracting muscle atrophy. It is obvious from the paucity of recent literature that research in this area has declined over the years. This is likely a consequence of the decrease in funding available for research and the fact that the fibrillations do not appear to cause serious health issues. Nonetheless, further exploration of them as diagnostic tools in long-term denervation is merited, in particular if Single Fiber EMG (SFEMG) is combined with Dynamic Echomyography (DyEM), an Ultra Sound muscle approach we recently designed and developed to explore denervated and reinnervating muscles.
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Affiliation(s)
- Amber Pond
- Anatomy Department, Southern Illinois University School of Medicine, Carbondale, IL USA
| | - Andrea Marcante
- CIR-Myo, Rehabilitation and Physical Medicine Unit, Department of Neurosciences, University of Padova, Italy
| | - Riccardo Zanato
- CIR-Myo, Radiology, Department of Medicine, University of Padova, Italy
| | - Leonora Martino
- CIR-Myo, Radiology, Department of Medicine, University of Padova, Italy
| | - Roberto Stramare
- CIR-Myo, Radiology, Department of Medicine, University of Padova, Italy
| | - Vincenzo Vindigni
- CIR-Myo, Plastic Surgery, Department of Neuroscience, University of Padova, Italy
| | | | - Christian Hofer
- Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Vienna, Austria
| | | | - Stefano Masiero
- CIR-Myo, Rehabilitation and Physical Medicine Unit, Department of Neurosciences, University of Padova, Italy
| | - Francesco Piccione
- Clinical Neurophysiology, San Camillo Hospital I.R.C.C.S., Venezia-Lido, Italy
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Jiang GL, Gu YD, Zhang LY, Shen LY, Yu C, Xu JG. Randomized, double-blind, and placebo-controlled trial of clenbuterol in denervated muscle atrophy. ISRN PHARMACEUTICS 2011; 2011:981254. [PMID: 22389867 PMCID: PMC3263717 DOI: 10.5402/2011/981254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 06/21/2011] [Indexed: 12/21/2022]
Abstract
Objectives. β2-adrenergic agonists, such as clenbuterol, have been shown to promote the hypertrophy of healthy skeletal muscles and to ameliorate muscle wasting in a few pathological conditions in both animals and humans. We intended to investigate the clinical efficacy of clenbuterol on attenuating denervation-induced muscle atrophy. Methods. A double-blind, placebo-controlled, parallel, and randomized trial was employed. 71 patients, suffering from brachial plexus injuries, were given either clenbuterol (60 μg, bid) or placebo for 3 months. Before and at the end of the study, patients were given physical examinations, biopsies of biceps brachii, electromyograms (EMGs), and other laboratory tests. Results. Compared with placebo treatment, clenbuterol significantly mitigated the decreases in cross-sectional areas of type I and II muscle fibers and alleviated the reduction in fibrillation potential amplitudes, without any adverse effects. Conclusions. Clenbuterol safely ameliorated denervated muscle atrophy in this cohort; thus larger clinical studies are encouraged for this or other β2 agonists on denervation-induced muscle atrophy.
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Affiliation(s)
- Guang-Liang Jiang
- Department of Hand Surgery, Huashan Hospital of Fudan University, Shanghai 200040, China
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Abstract
Physiologic assessment of diseases of the motor unit from the anterior horn cells to the muscles relies on a combination of needle electromyography (EMG) and nerve conduction studies (NCS). Both require a unique combination of knowledge of peripheral nervous system anatomy, physiology, pathophysiology, diseases, techniques, and electricity is necessary. Successful, high-quality, reproducible EMG depends on the skills of a clinician in patient interaction during the physical insertion and movement of the needle while recording the electrical signals. These must be combined with the skill of analyzing electric signals recorded from muscle by auditory pattern recognition and semiquantitation.1052 This monograph reviews the techniques of needle EMG and waveform analysis and describes the types of EMG waveforms recorded during needle EMG.
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Affiliation(s)
- Jasper R Daube
- Mayo Clinic, Department of Neurology, Rochester, Minnesota, USA
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18
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Differential skeletal muscle gene expression after upper or lower motor neuron transection. Pflugers Arch 2009; 458:525-35. [DOI: 10.1007/s00424-009-0643-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 12/29/2008] [Accepted: 01/27/2009] [Indexed: 10/21/2022]
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Blijham PJ, ter Laak HJ, Schelhaas HJ, van Engelen BGM, Stegeman DF, Zwarts MJ. Relation between muscle fiber conduction velocity and fiber size in neuromuscular disorders. J Appl Physiol (1985) 2006; 100:1837-41. [PMID: 16424073 DOI: 10.1152/japplphysiol.01009.2005] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To determine the relation between muscle fiber conduction velocity (MFCV) and muscle fiber diameter (MFD) in pathological conditions, we correlated invasively measured MFCV values with MFD data obtained from muscle needle biopsies in 96 patients with various neuromuscular disorders. MFCV was significantly correlated with MFD and independent of the underlying disorder. Pathological diameter changes were fiber-type dependent, with corresponding MFCVs. A linear equation expresses the relation well: MFCV (m/s) = 0.043·MFD (μm) + 0.83. We conclude that fiber diameter determines MFCV largely independent of the underlying neuromuscular disorders studied.
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Affiliation(s)
- P J Blijham
- Department of Clinical Neurophysiology, Institute of Neurology 920, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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Abstract
Individual muscle fibers in denervated muscle demonstrate repetitive, spontaneous contraction. Such fibrillation activity disappears in denervated muscle if reinnervation occurs, but this relationship has not been formally studied. To test whether the disappearance of fibrillation can be used to track nerve regeneration, we quantified the presence and subsequent disappearance of electromyographic (EMG) fibrillation potentials and fibrillation-related movement in the rat tongue after unilateral hypoglossal nerve crush at two locations. In mice, fibrillation movement of vibrissae were monitored after unilateral facial nerve crush and compared with the return of symmetrical vibrissae sweeping movements. In both of these rodent cranial motor systems, there was a conspicuous loss of fibrillation at a time when reinnervation is known to take place, suggesting that the visual appearance of fibrillation-related movement can be used as a simple, noninvasive means of tracking nerve regeneration in these popular experimental motor systems.
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Affiliation(s)
- James T Heaton
- Department of Surgery, Massachusetts General Hospital, One Bowdoin Square, 11th Floor, Boston, MA 02114, USA.
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Wang H, Gu Y, Xu J, Shen L, Li J. Comparative study of different surgical procedures using sensory nerves or neurons for delaying atrophy of denervated skeletal muscle. J Hand Surg Am 2001; 26:326-31. [PMID: 11279580 DOI: 10.1053/jhsu.2001.22522] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
To observe the effect of sensory components on muscle atrophy, 4 surgical procedures applying sensory nerves or neurons to the denervated muscle were conducted in a rat model: sensory nerve implantation (group B), sensory motor nerve crossover (group C), dorsal root ganglia implantation (group D), and implantation of preganglionically avulsed sensory nerve (group E). Rats with complete denervation served as controls (group A). The degree of muscle atrophy was evaluated after surgery by fibrillation potential amplitude, muscle wet weight, muscle fiber cross-sectional area, collagen content, and protein content. Compared with group A, the results in groups B, D, and E were superior 1 month after surgery and the results in groups B, C, and E were superior 3 months after surgery. Implantation of normal or preganglionically avulsed sensory nerve delayed atrophy. Dorsal root ganglia implantation only had a short-term trophic influence. In the animal model setting, sensory motor nerve crossover is effective only after it is maintained for at least 3 months.
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Affiliation(s)
- H Wang
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical University, 12 Wulumuqi Zhong Road, Shanghai 200040, People's Republic of China
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