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Dede HÖ, Sirin NG, Kocasoy-Orhan E, Idrisoglu HA, Baslo MB. Changes in motor unit bioelectrical activity recorded at two different sites in a muscle. Neurophysiol Clin 2020; 50:113-118. [PMID: 32171639 DOI: 10.1016/j.neucli.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The objective of this study was to compare the properties of bioelectrical signals of motor units recorded at different sites in the muscles of controls, patients with myopathy and patients with motor neuron disease (MND). METHODS Five controls, 10 patients with myopathy and 11 patients with MND were included. Electrophysiologic tests were performed in the biceps brachii (BB) muscle from two recording sites. Site 1 was near the belly of the muscle and Site 2 was 5cm distal from Site 1, near the tendon. Multi-motor unit potential (MUP) analysis, jitter analysis, and peak number count were calculated from the signals recorded using a concentric needle electrode (CN). RESULTS At Site 2, duration was longer, number of phases was higher and amplitudes were smaller in MUPs compared with those recorded at Site 1. This significant difference between recording site and patient groups was related to neurogenic muscles. Jitter analysis showed no significant difference except an intergroup difference between the patient groups and controls. The peak number calculated using the CN was greater when recorded from Site 1 in concordance with MUP analysis. CONCLUSION Duration of MUP was longer and amplitude was smaller when the recording electrode was placed distally along the muscle near the tendon in neurogenic muscles, probably related to increased temporal dispersion. However, changing the position of the needle did not provide further information in distinguishing myogenic muscles.
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Affiliation(s)
- Hava Özlem Dede
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, 34100 Istanbul Capa, Fatih Turkey.
| | - Nermin Gorkem Sirin
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, 34100 Istanbul Capa, Fatih Turkey
| | - Elif Kocasoy-Orhan
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, 34100 Istanbul Capa, Fatih Turkey
| | - Halil Atilla Idrisoglu
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, 34100 Istanbul Capa, Fatih Turkey
| | - Mehmet Baris Baslo
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, 34100 Istanbul Capa, Fatih Turkey
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Dede HÖ, Şırın NG, Kocasoy-Orhan E, Idrısoğlu HA, Baslo MB. Electrophysiological Findings of Subclinical Lower Motor Neuron Involvement in Degenerative Upper Motor Neuron Diseases. ACTA ACUST UNITED AC 2019; 57:228-233. [PMID: 32952426 DOI: 10.29399/npa.23387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/26/2019] [Indexed: 12/11/2022]
Abstract
Introduction The present study is an examination of possible subclinical involvement of lower motor neuron (LMN) in patients with primary lateral sclerosis (PLS) and hereditary spastic paraparesis (HSP) electrophysiologically. Methods Nine PLS patients and 5 HSP patients were prospectively analyzed. Jitter measurement with concentric needle electrode (25 mm, 30 G) (CN-jitter) recorded from right extensor digitorum muscle during voluntary contraction with 1 kHz high-pass frequency filter set. European Myelopathy Score (EMS) was used to evaluate disability. The relationship between disability score and jitter values was investigated. Results HSP patients had suffered from the disease for longer period of time (p<0.001). Mean jitter values of patients with PLS and HSP were 26.5±12.1 µs and 30.8±34.8 µs, and the number of individual high jitters (>43 microseconds) observed in the PLS and HSP groups was 16/180 and 9/100, respectively without a significant intergroup difference. The ratio of patients with an abnormal jitter study were higher in HSP group (60%) compared to PLS (22%) (p<0.05). Potential pairs with blocking were present in HSP group (7 of 100 potential pairs) but not seen in PLS patients. EMS values were significantly lower in patients having potential pairs with high jitter and blocking compared to those without high jitter and blocking. Conclusion The present study has demonstrated that early signs of LMN dysfunction can be detected electrophysiologically by CN-jitter in patients with UMN involvement. These electrophysiological findings in these patients with longer disease duration and lower clinical scores may be explained by spreading of the disease to LMNs or transsynaptic degeneration and its contribution in disease progression.
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Affiliation(s)
- Hava Özlem Dede
- Department of Clinic Neurophysiology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Nermin Görkem Şırın
- Department of Clinic Neurophysiology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Elif Kocasoy-Orhan
- Department of Clinic Neurophysiology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Halil Atilla Idrısoğlu
- Department of Clinic Neurophysiology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Barış Baslo
- Department of Clinic Neurophysiology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
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Sanders DB, Arimura K, Cui L, Ertaş M, Farrugia ME, Gilchrist J, Kouyoumdjian JA, Padua L, Pitt M, Stålberg E. Guidelines for single fiber EMG. Clin Neurophysiol 2019; 130:1417-1439. [PMID: 31080019 DOI: 10.1016/j.clinph.2019.04.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/30/2019] [Accepted: 04/06/2019] [Indexed: 12/13/2022]
Abstract
This document is the consensus of international experts on the current status of Single Fiber EMG (SFEMG) and the measurement of neuromuscular jitter with concentric needle electrodes (CNE - CN-jitter). The panel of authors was chosen based on their particular interests and previous publications within a specific area of SFEMG or CN-jitter. Each member of the panel was asked to submit a section on their particular area of interest and these submissions were circulated among the panel members for edits and comments. This process continued until a consensus was reached. Donald Sanders and Erik Stålberg then edited the final document.
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Affiliation(s)
| | - Kimiyoshi Arimura
- Department of Neurology and Geriatrics, Kagoshima University, Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
| | - LiYing Cui
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
| | | | | | - James Gilchrist
- Southern Illinois University School of Medicine, Springfield, IL USA.
| | | | - Luca Padua
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Department of Geriatrics, Neurosciences and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Matthew Pitt
- Department of Clinical Neurophysiology, Great Ormond Street Hospital, London, UK.
| | - Erik Stålberg
- Department of Clinical Neurophysiology, Uppsala University, Uppsala, Sweden.
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Sirin NG, Kocasoy Orhan E, Durmus H, Deymeer F, Baslo MB. Repetitive nerve stimulation and jitter measurement with disposable concentric needle electrode in newly diagnosed myasthenia gravis patients. Neurophysiol Clin 2018; 48:261-267. [DOI: 10.1016/j.neucli.2018.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/13/2018] [Accepted: 01/19/2018] [Indexed: 10/17/2022] Open
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Pitfalls and errors in measuring jitter. Clin Neurophysiol 2017; 128:2233-2241. [DOI: 10.1016/j.clinph.2017.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/24/2017] [Accepted: 09/10/2017] [Indexed: 11/23/2022]
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Baslo MB, Coban A, Baykan B, Tutkavul K, Karli N, Saip S, Orhan EK, Ertas M. Investigation of Neuromuscular Transmission in Some Rare Types of Migraine. Cephalalgia 2016; 27:1201-5. [DOI: 10.1111/j.1468-2982.2007.01417.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to delineate any dysfunction of neuromuscular transmission (NMT) by single-fibre electromyography (SFEMG) in some rare types of migraine. Recent studies have shown subclinical dysfunction of NMT in migraine with aura and cluster headache by using SFEMG, whereas another recent study has shown NMT to be normal in familial hemiplegic migraine (FHM) with CACNA1A mutations. Thirty patients with rare primary headache syndromes [18 with sporadic hemiplegic migraine (SHM), six with FHM and six with basilar-type migraine (BM)] and 15 healthy control subjects without any headache complaints underwent nerve conduction studies, EMG and SFEMG during voluntary contraction of the extensor digitorum communis muscle. Ten to 20 different potential pairs were recorded and individual jitter values calculated. The results obtained from patient groups were compared with those from the normal subjects. Of 600 individual jitter values of the patients, 27 (4.5%) were abnormally high, whereas only 3/205 (1.5%) jitter values from normal subjects were abnormal. Abnormal NMT was found in 4/30 (13.3%) patients (three SHM and one BM), but in none of the control subjects. Only in SHM patients was the number of individual abnormal jitter values slightly but significantly different from normal controls. The present study demonstrates that subclinical NMT abnormality is slightly present in only SHM and BM patients, but not in FHM patients.
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Affiliation(s)
- MB Baslo
- Department of Neurology, Istanbul University, Istanbul Faculty of Medicine
| | - A Coban
- Department of Neurology, Istanbul University, Istanbul Faculty of Medicine
| | - B Baykan
- Department of Neurology, Istanbul University, Istanbul Faculty of Medicine
| | - K Tutkavul
- Clinic of Neurology, Haydarpasa Numune Education and Research Hospital, Istanbul
| | - N Karli
- Department of Neurology, Uludag University, Faculty of Medicine, Bursa
| | - S Saip
- Department of Neurology, Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - EK Orhan
- Department of Neurology, Istanbul University, Istanbul Faculty of Medicine
| | - M Ertas
- Department of Neurology, Istanbul University, Istanbul Faculty of Medicine
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Coban A, Baslo MB, Baykan B, Tutkavul K, Orhan EK, Ertas M. Subclinical Neuromuscular Transmission Abnormality Detected by Single-Fibre EMG is More Pronounced in Cluster Headache Than in Migraine With Aura. Cephalalgia 2016; 27:788-92. [PMID: 17598760 DOI: 10.1111/j.1468-2982.2007.01341.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim was to investigate neuromuscular transmission (NMT) by single-fibre EMG (SFEMG) in a large series of patients having migraine with aura (MA) or cluster headache (CH). Recent studies using SFEMG have shown subclinical dysfunction of NMT in MA and CH. Forty-three patients having MA, 51 with CH and 38 healthy control subjects underwent nerve conduction studies, EMG and SFEMG during voluntary contraction of the extensor digitorum communis muscle. Twenty different potential pairs were recorded and individual, mean and total abnormal individual jitter values were calculated. The results obtained from MA patients were compared with those from CH patients. In MA patients, 32 of 860 jitters were abnormally high, whereas 73 of 1020 of the jitters showed this abnormality in CH patients. None of the control subjects, five MA patients (11.6%) and 11 CH patients (21.6%) were designated as having subclinical NMT abnormality. Thus, patients having junction dysfunction were significantly more common in the CH group. The subclinical NMT abnormality shown by SFEMG is more common in CH than in MA. These two primary headache syndromes may have some shared functional abnormality of NMT constituents which is more evident in CH.
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Affiliation(s)
- A Coban
- Department of Neurology, Clinical Neurophysiology and Headache Subunits, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Chiou-Tan FY, Gilchrist JM. Repetitive nerve stimulation and single-fiber electromyography in the evaluation of patients with suspected myasthenia gravis or Lambert-Eaton myasthenic syndrome: Review of recent literature. Muscle Nerve 2015; 52:455-62. [DOI: 10.1002/mus.24745] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Faye Y. Chiou-Tan
- Department of Physical Medicine and Rehabilitation; Baylor College of Medicine; Houston Texas USA
| | - James M. Gilchrist
- Department of Neurology; Southern Illinois University School of Medicine; Springfield Illinois USA
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Orhan EK, Deymeer F, Oflazer P, Parman Y, Baslo MB. Jitter analysis with concentric needle electrode in the masseter muscle for the diagnosis of generalised myasthenia gravis. Clin Neurophysiol 2013; 124:2277-82. [DOI: 10.1016/j.clinph.2013.04.344] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 03/30/2013] [Accepted: 04/28/2013] [Indexed: 10/26/2022]
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Reference voluntary jitter values using disposable monopolar needle electrodes in the extensor digitorum communis muscle. Clin Neurophysiol 2010; 121:887-9. [DOI: 10.1016/j.clinph.2010.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Revised: 02/11/2010] [Accepted: 03/08/2010] [Indexed: 11/22/2022]
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Ertas M, Bolay H, Kocasoy-Orhan E, Hanagasi H, Baykan B. Subclinical Impairment of Neuromuscular Transmission in Transient Global Amnesia. Cogn Behav Neurol 2007; 20:179-83. [PMID: 17846517 DOI: 10.1097/wnn.0b013e318051809d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the neuromuscular transmission (NMT) of the patients with transient global amnesia (TGA) using single fiber electromyography (SFEMG). BACKGROUND The pathophysiology of TGA remains unknown and several elements support the hypothesis of a shared background with migraine. Recent studies showed that some migraineurs have subclinical abnormalities of NMT by using SFEMG. We aimed to test the patients with TGA using SFEMG. METHODS We investigated 6 patients diagnosed with TGA according to published criteria and 5 healthy volunteers with similar ages. SFEMG during voluntary contraction of the extensor digitorum communis muscle, nerve conduction studies and concentric needle electromyography were performed and 20 single fiber potential pairs were recorded from each subject and individual and mean jitter values were calculated. RESULTS Three patients with TGA showed pronounced NMT failure by SFEMG, whereas none of the controls disclosed this abnormality. The mean jitter value of TGA patients (35+/-33) was greater than that of the control subjects (25+/-15) (P=0.006). Seventeen of the 120 individual jitter values of the TGA group and only 3 (from 3 different volunteers) of the 100 individual jitter values of the control group exceeded upper normal limit (P=0.004). CONCLUSIONS These results suggest that TGA shares the same type of subclinical abnormality of NMT observed in migraine patients in recent studies.
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Affiliation(s)
- Mustafa Ertas
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Tutkavul K, Baslo MB, Ertas M, Tireli H. Evaluation of neuromuscular transmission by using monopolar needle electrode. Acta Neurol Scand 2006; 114:340-5. [PMID: 17022783 DOI: 10.1111/j.1600-0404.2006.00634.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the value of single-fibre electromyography (SFEMG) with monopolar electrode (MNPE) in revealing neuromuscular transmission dysfunction. MATERIAL AND METHODS We examined the extensor digitorum communis muscle by using single-fibre electrode (SFE) and MNPE sequentially, in randomly assigned 20 healthy volunteers and in 17 patients with known myasthenia gravis (MG). The high-pass filter setting was 3 kHz for MNPE. Ten individual jitter values were calculated for each electrode in every muscle. Repetitive nerve stimulation (RNS) test on trapezius muscle was performed on 15 patients. RESULTS In controls, the mean jitter values were 27 +/- 9 (10-59) micro s with SFE, and 21 +/- 7.2 (9-56) micro s with MNPE (P = 0.001). In the MG group, the mean jitter values were 52.4 +/- 38 (12-221) micro s with SFE, and 51.8 +/- 34.7 (12-179) micro s with MNPE. Both electrodes identified junction dysfunction in 14 patients. RNS revealed decrement in four patients but 11. CONCLUSION SFEMG with SFE is still the gold standard; however, SFEMG with MNPE is superior to RNS like SFEMG with SFE.
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Affiliation(s)
- K Tutkavul
- 2nd Clinic of Neurology, Haydarpasa Numune Education and Research Hospital, Uskūdar/Istanbul, Turkey.
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