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Chen M, Bashford J, Zhou P. Motor Unit Number Estimation (MUNE) Free of Electrical Stimulation or M Wave Recording: Feasibility and Challenges. Front Aging Neurosci 2022; 14:799676. [PMID: 35221991 PMCID: PMC8873975 DOI: 10.3389/fnagi.2022.799676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maoqi Chen
- Faculty of Rehabilitation Engineering, University of Health and Rehabilitation Sciences, Qingdao, China
| | - James Bashford
- Department of Basic and Clinical Neuroscience, UK Dementia Research Institute, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Ping Zhou
- Faculty of Rehabilitation Engineering, University of Health and Rehabilitation Sciences, Qingdao, China
- *Correspondence: Ping Zhou
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Sirin NG, Oguz Akarsu E, Kocasoy Orhan E, Erbas B, Artug T, Dede HO, Baslo MB, Idrisoglu HA, Oge AE. Parameters derived from compound muscle action potential scan for discriminating amyotrophic lateral sclerosis‐related denervation. Muscle Nerve 2019; 60:400-408. [DOI: 10.1002/mus.26644] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 07/13/2019] [Accepted: 07/16/2019] [Indexed: 12/11/2022]
Affiliation(s)
- N. Gorkem Sirin
- Department of Neurology, Istanbul Faculty of MedicineIstanbul University Istanbul Turkey
| | - Emel Oguz Akarsu
- Department of Neurology, Istanbul Faculty of MedicineIstanbul University Istanbul Turkey
| | - Elif Kocasoy Orhan
- Department of Neurology, Istanbul Faculty of MedicineIstanbul University Istanbul Turkey
| | - Bahar Erbas
- Department of Neurology, Istanbul Faculty of MedicineIstanbul University Istanbul Turkey
| | - Tugrul Artug
- Electrical and Electronics EngineeringIstanbul Arel University Istanbul Turkey
| | - H. Ozlem Dede
- Department of Neurology, Istanbul Faculty of MedicineIstanbul University Istanbul Turkey
| | - M. Baris Baslo
- Department of Neurology, Istanbul Faculty of MedicineIstanbul University Istanbul Turkey
| | - Halil A. Idrisoglu
- Department of Neurology, Istanbul Faculty of MedicineIstanbul University Istanbul Turkey
| | - A. Emre Oge
- Department of Neurology, Istanbul Faculty of MedicineIstanbul University Istanbul Turkey
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Simon NG, Ralph JW, Lomen-Hoerth C, Poncelet AN, Vucic S, Kiernan MC, Kliot M. Quantitative ultrasound of denervated hand muscles. Muscle Nerve 2015; 52:221-30. [DOI: 10.1002/mus.24519] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Neil G. Simon
- Department of Neurology; University of California; San Francisco, San Francisco California USA
- Neuroscience Research Australia; PO Box 1165, Randwick NSW 2031 Australia
- Prince of Wales Clinical School, University of New South Wales; Australia
| | - Jeffrey W. Ralph
- Department of Neurology; University of California; San Francisco, San Francisco California USA
| | - Catherine Lomen-Hoerth
- Department of Neurology; University of California; San Francisco, San Francisco California USA
| | - Ann N. Poncelet
- Department of Neurology; University of California; San Francisco, San Francisco California USA
| | - Steve Vucic
- Neuroscience Research Australia; PO Box 1165, Randwick NSW 2031 Australia
- Westmead Clinical School; C24 Westmead Hospital; The University of Sydney; NSW 2006 Australia
| | - Matthew C. Kiernan
- Brain and Mind Research Institute, The University of Sydney; Mallett St Camperdown Australia
| | - Michel Kliot
- Department of Neurological Surgery; Northwestern Feinberg School of Medicine; Chicago Illinois USA
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Gooch CL, Doherty TJ, Chan KM, Bromberg MB, Lewis RA, Stashuk DW, Berger MJ, Andary MT, Daube JR. Motor unit number estimation: A technology and literature review. Muscle Nerve 2014; 50:884-93. [PMID: 25186553 DOI: 10.1002/mus.24442] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Clifton L. Gooch
- Department of Neurology; University of South Florida; Tampa Florida USA
| | - Timothy J. Doherty
- Department of Physical Medicine and Rehabilitation; University of Western Ontario; London Ontario Canada
- Department of Clinical Neurological Sciences; University of Western Ontario; London Ontario Canada
- Schulich School of Medicine and Dentistry; University of Western Ontario; London Ontario Canada
| | - K. Ming Chan
- Division of Physical Medicine and Rehabilitation/Centre for Neuroscience; University of Alberta; Edmonton Alberta Canada
| | - Mark B. Bromberg
- Department of Neurology; University of Utah; Salt Lake City Utah USA
| | - Richard A. Lewis
- Department of Neurology; Cedars-Sinai; Los Angeles California USA
| | - Dan W. Stashuk
- Systems Design Engineering; University of Waterloo; Waterloo Ontario Canada
| | - Michael J. Berger
- School of Kinesiology; University of Western Ontario; London Ontario Canada
- Schulich School of Medicine and Dentistry; University of Western Ontario; London Ontario Canada
| | - Michael T. Andary
- College of Osteopathic Medicine; Michigan State University; East Lansing Michigan USA
| | - Jasper R. Daube
- Department of Neurology; Mayo Clinic; Rochester Minnesota USA
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Stevens DES, Harwood B, Power GA, Doherty TJ, Rice CL. Anconeus motor unit number estimates using decomposition-based quantitative electromyography. Muscle Nerve 2014; 50:52-9. [PMID: 24123180 DOI: 10.1002/mus.24092] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 10/02/2013] [Accepted: 10/04/2013] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Motor unit number estimates (MUNEs) provide important information in health, aging, and disease, and can be determined using decomposition-enhanced spike-triggered averaging (DE-STA). Discrimination of surface-detected motor unit potentials (S-MUPs) has been limited to contractile forces of ∽30% maximum voluntary contraction (MVC), which is insufficient to recruit a representative sample of the entire MU pool in most muscles. Unique features of the anconeus may permit MUNEs at high muscle activation levels. METHODS In 10 men (25 ± 3 years), anconeus MUNEs were performed using DE-STA at 10%, 30%, and 50% root-mean-square of MVC (RMS(MVC)). RESULTS The mean compound muscle action potential of the anconeus was ∽6 mV, and average S-MUP amplitudes were ∽100 μV, 145 μV, and 235 μV at 10%, 30%, and 50% RMS(MVC), resulting in low average MUNEs of 58, 38, and 25, respectively. CONCLUSIONS Elbow extensor force-EMG relationships suggest full recruitment of the anconeus MU pool at 50% RMS(MVC), thus providing a representative sample for MUNE.
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Affiliation(s)
- Daniel E S Stevens
- Canadian Centre for Activity and Aging, School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
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Bocci T, Pecori C, Giorli E, Briscese L, Tognazzi S, Caleo M, Sartucci F. Differential motor neuron impairment and axonal regeneration in sporadic and familiar amyotrophic lateral sclerosis with SOD-1 mutations: lessons from neurophysiology. Int J Mol Sci 2011; 12:9203-15. [PMID: 22272128 PMCID: PMC3257125 DOI: 10.3390/ijms12129203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Revised: 11/11/2011] [Accepted: 11/29/2011] [Indexed: 11/22/2022] Open
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a degenerative disorder of the motor system. About 10% of cases are familial and 20% of these families have point mutations in the Cu/Zn superoxide dismutase 1 (SOD-1) gene. SOD-1 catalyses the superoxide radical (O−2) into hydrogen peroxide and molecular oxygen. The clinical neurophysiology in ALS plays a fundamental role in differential diagnosis between the familial and sporadic forms and in the assessment of its severity and progression. Sixty ALS patients (34 males; 26 females) were enrolled in the study and examined basally (T0) and every 4 months (T1, T2, and T3). Fifteen of these patients are SOD-1 symptomatic mutation carriers (nine males, six females). We used Macro-EMG and Motor Unit Number Estimation (MUNE) in order to evaluate the neuronal loss and the re-innervation process at the onset of disease and during follow-up period. Results and Discussion: SOD-1 mutation carriers have a higher number of motor units at the moment of diagnosis when compared with the sporadic form, despite a more dramatic drop in later stages. Moreover, in familiar SOD-1 ALS there is not a specific time interval in which the axonal regeneration can balance the neuronal damage. Taken together, these results strengthen the idea of a different pathogenetic mechanism at the base of sALS and fALS.
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Affiliation(s)
- Tommaso Bocci
- Unit of Neurology, Department of Neuroscience, Pisa University Medical School, Pisa 56126, Italy; E-Mails: (T.B.); (C.P.); (E.G.); (L.B.); (S.T.)
- Department of Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Siena 53100, Italy
| | - Chiara Pecori
- Unit of Neurology, Department of Neuroscience, Pisa University Medical School, Pisa 56126, Italy; E-Mails: (T.B.); (C.P.); (E.G.); (L.B.); (S.T.)
| | - Elisa Giorli
- Unit of Neurology, Department of Neuroscience, Pisa University Medical School, Pisa 56126, Italy; E-Mails: (T.B.); (C.P.); (E.G.); (L.B.); (S.T.)
- Department of Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Siena 53100, Italy
| | - Lucia Briscese
- Unit of Neurology, Department of Neuroscience, Pisa University Medical School, Pisa 56126, Italy; E-Mails: (T.B.); (C.P.); (E.G.); (L.B.); (S.T.)
| | - Silvia Tognazzi
- Unit of Neurology, Department of Neuroscience, Pisa University Medical School, Pisa 56126, Italy; E-Mails: (T.B.); (C.P.); (E.G.); (L.B.); (S.T.)
| | - Matteo Caleo
- CNR Neuroscience Institute, Pisa 56124, Italy; E-Mail:
| | - Ferdinando Sartucci
- Unit of Neurology, Department of Neuroscience, Pisa University Medical School, Pisa 56126, Italy; E-Mails: (T.B.); (C.P.); (E.G.); (L.B.); (S.T.)
- CNR Neuroscience Institute, Pisa 56124, Italy; E-Mail:
- Department of Neuroscience, SD of Neurology, Cisanello Hospital, Pisa University Medical School, Pisa 56124, Italy
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +39-050-996760; Fax: +39-050-996767
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Sartucci F, Moscato G, Rossi C, Caleo M, Bocci T, Murri L, Giannini F, Rossi A. Macro-EMG and MUNE Changes in Patients with Amyotrophic Lateral Sclerosis: One-Year Follow Up. Int J Neurosci 2011; 121:257-66. [DOI: 10.3109/00207454.2010.550404] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Clinical trials in amyotrophic lateral sclerosis have significantly evolved over the last decade. New outcome measures have been developed that have reduced the sample size requirement as compared with survival studies. There has been increasing recognition that dose-ranging studies are crucial to full evaluation of experimental agents. While the requirements of late stage trials have not changed, many new designs have been suggested for earlier phase development. While no design achieves the perfect balance of sensitivity and efficiency, clinical trialists continue to work toward the goals of smaller and shorter trials so that more compounds can be studied concurrently.
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Miller TM, Kogelnik AM, Olney RK. Proposed modification to data analysis for statistical motor unit number estimate. Muscle Nerve 2004; 29:700-6. [PMID: 15116374 DOI: 10.1002/mus.20028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Motor unit number estimation (MUNE) is an important electrophysiological technique for quantitative measurement of motor neuron loss. Although commonly used, there is no consensus concerning the optimal procedure for statistical MUNE, particularly regarding several operator-dependent variables. To assess the variables, we analyzed 500 sequential, submaximal compound muscle action potential (CMAP) responses at three or four stimulus intensities in 10 controls and 10 patients with amyotrophic lateral sclerosis (ALS). In both controls and ALS patients, we found that posttest filtering data based on 20% or 25% windows or 2, 2.5, or 3 SD excludes <5% of data. Windows of 10% or 15% excluded <5% of data in controls but not in ALS patients. Excluding data based on +/-2 SD, the coefficient of variation for final MUNE was 12% in controls and 6% in ALS patients. Group sizes of 30 or 50 and sample sizes of 300 to 500 sequential CMAP responses per run yielded the lowest coefficient of variation. We propose that statistical MUNE data should be analyzed based on excluding data >2 SD from the mean, because this is operator independent, includes the majority of data, effectively excludes clearly outlying data, such as fasciculations or movement artifact, and has a reasonable coefficient of variation.
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Affiliation(s)
- Timothy M Miller
- Department of Neurology, University of California San Francisco, San Francisco, California, USA.
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Lomen-Hoerth C, Slawnych MP. Statistical motor unit number estimation: from theory to practice. Muscle Nerve 2003; 28:263-72. [PMID: 12929186 DOI: 10.1002/mus.10351] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Statistical motor unit number estimation (MUNE) is one of several experimental techniques used to estimate the number of lower motor neurons innervating a given muscle. All are fairly reproducible and have been applied successfully in monitoring neurogenic disease progression. Quantitating the number of lower motor neurons is important, since the compound muscle action potential (CMAP) and strength may not change as rapidly over time due to the confounding effect of reinnervation. MUNE techniques differ in the way they obtain samples of surface-recorded motor unit potentials (SMUP). Statistical MUNE is based on Poisson statistics, uses surface stimulation, and is useful in testing distal, superficial nerves. This review focuses on the theory behind the development of the technique, critiques the publications resulting from applying the technique in control and disease subjects, and discusses the future developments needed for clinical utility.
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Affiliation(s)
- Catherine Lomen-Hoerth
- Department of Neurology, University of California, San Francisco, 505 Parnassus Avenue, Room M348, San Francisco, California 94143, USA.
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Chapter 13 Neurography – motor and sensory nerve conduction studies. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1567-4231(09)70123-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Abstract
The diagnosis of amyotrophic lateral sclerosis (ALS) per se may be challenging since there is no single diagnostic test for ALS (with the exception of finding a mutation in the SOD1 gene). Additionally, the disease may begin focally and resemble a variety of other neurologic disorders that share clinical features with ALS. This latter point emphasizes an important imperative for the clinician--the need to consider a broad range of peripheral and central nervous system disorders in the process of differential diagnosis of ALS, especially when the disease is in its early stages. The authors review the diagnostic criteria for ALS and discuss which features to consider in determining the degree of certainty or level of confidence in the diagnosis. The authors then enumerate the important differential diagnostic possibilities that emerge from a careful consideration of the clinical features and comment on neuroimaging studies and laboratory tests employed in the diagnostic process. Next, the authors turn their attention to the important role played by electrophysiologic studies in the diagnostic evaluation of the patient with suspected ALS. The authors then return to a focused consideration of selected disorders in the differential diagnosis of ALS and conclude with a summary of their diagnostic approach for this disease.
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Affiliation(s)
- David A Chad
- University of Massachusetts Medical School, UMass Memorial Health Care, Department of Neurology, University of Massachusetts Medical Center, 55 Lake Ave., North Worcester, MA 01605, USA.
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