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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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Moccellin AS, Rett MT, Driusso P. Existe alteração na função dos músculos do assoalho pélvico e abdominais de primigestas no segundo e terceiro trimestre gestacional? FISIOTERAPIA E PESQUISA 2016. [DOI: 10.1590/1809-2950/14156523022016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo deste estudo é comparar a função dos músculos do assoalho pélvico no segundo e terceiro trimestre gestacional de primigestas. Foi desenvolvido em duas unidades de Saúde da Família do município de Aracaju (SE). As gestantes foram submetidas a três avaliações da função dos músculos do assoalho pélvico por meio da eletromiografia de superfície: até 16 semanas gestacionais, entre a 24ª-28ª e 34ª-36ª semanas gestacionais. Foram registrados valores de repouso, contrações voluntárias máximas e contrações sustentadas. Os dados foram tabulados no Microsoft Excel e analisados estatisticamente no programa Statistica. Adotou-se um nível de significância de 5% (p≤0,05). Participaram do estudo 19 primigestas, com média de idade de 21,74±3,65 anos. Houve aumento da massa corporal no 3º trimestre gestacional em relação ao período pré-gestacional e diminuição da média do sinal dos músculos do assoalho pélvico durante o repouso ao longo das três avaliações. A musculatura abdominal diminuiu a média do sinal no repouso e durante a contração sustentada nas avaliações 2 e 3 comparadas à avaliação 1. Pode-se concluir que outros fatores, além dos relacionados ao aumento da massa corporal materna, podem estar associados à sobrecarga nos MAP durante a gestação logo no primeiro trimestre. Essa sobrecarga pode fazer que as gestantes apresentem um tônus muscular próximo ao limite superior de referência, alterando o padrão de atividade eletromiográfica principalmente no repouso, a fim de manter a função de sustentação dos órgãos pélvicos e de continência.
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Jian F, Pan H, Zhang Z, Lin J, Chen N, Zhang L, Wu Q, Wang H, Wang Y, Cui L, Tang X. Sphincter electromyography in diabetes mellitus and multiple system atrophy. Neurourol Urodyn 2014; 34:669-74. [PMID: 25042298 DOI: 10.1002/nau.22639] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 04/24/2014] [Indexed: 11/10/2022]
Abstract
AIMS Abnormalities of external anal sphincter electromyography (EAS-EMG) characterize multiple system atrophy (MSA) and focal cauda equina or conus medullaris lesions. This study is designed to determine whether and how diabetic polyneuropathy (DPN) affects EAS as compared to the abnormalities seen in MSA. METHODS We conducted multi-motor unit potential (MUP) analysis of EAS in 22 healthy controls, 32 diabetes mellitus (DM) patients without neuropathy, 38 DPN patients, and 68 MSA patients. RESULTS DPN patients had a significant (P < 0.01) increase in MUP mean duration, mean amplitude, percentage of long duration MUPs, and satellite rate, but to a lesser extent than MSA. Mean duration and satellite rate showed the least overlap among different groups in individual value distributions. CONCLUSIONS Compared with MSA, DPN affects EAS to a lesser degree as judged by neurogenic MUP abnormalities in EMG. Mean duration and satellite rate may serve as the most discriminating aspects in MUP analysis of EAS.
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Affiliation(s)
- Fan Jian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hua Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zaiqiang Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jinxi Lin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Na Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Lei Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Qing Wu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Han Wang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Xiaofu Tang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
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Abstract
The neurophysiological techniques currently available to evaluate anorectal disorders include concentric needle electromyography (EMG) of the external anal sphincter, anal nerve terminal motor latency (TML) measurement in response to transrectal electrical stimulation or sacral magnetic stimulation, motor evoked potentials (MEPs) of the anal sphincter to transcranial magnetic cortical stimulation, cortical recording of somatosensory evoked potentials (SEPs) to anal nerve stimulation, quantification of electrical or thermal sensory thresholds (QSTs) within the anal canal, sacral anal reflex (SAR) latency measurement in response to pudendal nerve or perianal stimulation, and perianal recording of sympathetic skin responses (SSRs). In most cases, a comprehensive approach using several tests is helpful for diagnosis: needle EMG signs of sphincter denervation or prolonged TML give evidence for anal motor nerve lesion; SEP/QST or SSR abnormalities can suggest sensory or autonomic neuropathy; and in the absence of peripheral nerve disorder, MEPs, SEPs, SSRs, and SARs can assist in demonstrating and localizing spinal or supraspinal disease. Such techniques are complementary to other methods of investigation, such as pelvic floor imaging and anorectal manometry, to establish the diagnosis and guide therapeutic management of neurogenic anorectal disorders.
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Affiliation(s)
- Jean-Pascal Lefaucheur
- Service de Physiologie, Explorations Fonctionnelles, Centre Hospitalier Universitaire Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
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Podnar S, Mrkaić M, Vodusek DB. Reinnervation of anal sphincter muscle by low and high-threshold motor neurones. Neurophysiol Clin 2001; 31:293-9. [PMID: 11817271 DOI: 10.1016/s0987-7053(01)00271-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The external anal sphincter (EAS) has continuously active low-threshold and recruitable high-threshold motor units (MUs), the latter being 'larger'. On performing concentric needle electromyography (EMG) of the EAS, the high-threshold MUs seemed to reveal more neuropathic changes than the low-threshold MUs. To verify this hypothesis, low- and high-threshold motor unit potentials (MUPs) were compared in patients with neuropathic EAS and controls. Fifteen subjects without pelvic disorders and 29 patients with sequela after cauda equina lesions were studied. In patients, only muscles ipsilateral to severe perianal sensory loss were included. MUPs were sampled using multi-MUP analysis during relaxation ('low-threshold'), and on activation ('high-threshold' MUs). MUP parameters of low- and high-threshold MUs from controls and patients were compared, as was the sensitivity and specificity with which MUPs were classified as normal or pathological (using discriminant analysis). MUP changes due to reinnervation, and the sensitivity and specificity in classifying MUPs as normal or pathological were not significantly different between the low- and high-threshold MUPs. Stronger activation of EAS does not improve discrimination between neuropathic and normal MUPs. New EMG techniques for sampling sphincter MUPs at higher activation levels would seem not to yield additional information.
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Affiliation(s)
- S Podnar
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center, SI-1525 Ljubljana, Slovenia.
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Podnar S, Vodusek DB, Stâlberg E. Standardization of anal sphincter electromyography: normative data. Clin Neurophysiol 2000; 111:2200-7. [PMID: 11090773 DOI: 10.1016/s1388-2457(00)00416-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Electromyography (EMG) of the external anal sphincter (EAS) is important in the evaluation of conus/cauda lesions, the differential diagnosis of parkinsonism and anal incontinence. The aim of our study was to establish normative data in a sufficiently large group of healthy subjects, using a rigorously standardized examination technique. METHODS Sixty-four subjects (aged 19-83 years) without pelvic or neurological disorders were included. Motor unit potentials (MUPs)/interference pattern (IP) samples were obtained from the EAS using multi-MUP and turn/amplitude analyses, respectively. The effect of age, gender, parity, and constipation on MUP/IP parameters was studied. For MUP parameters the lower/upper limits for mean values, and 'outlier' limits, and for IP parameters normal 'clouds' were calculated. RESULTS From 112 muscles 15-30 MUPs were sampled. As no effect of evaluated factors on mean values could be demonstrated, common reference values were calculated. Lower/higher limits for mean values were: amplitude 148/661 microV, duration 3.2/7.8 ms, area 87/625 microVms, and number of phases 2. 3/3.7. 'Outlier' limits for individual MUPs were: amplitude 84/1315 microV, duration 1.6/13.8 ms, area 46/1222 microVms, number of phases 2/6. From 95 muscles 2706 IP samples were obtained. CONCLUSIONS The presented normative data should allow valid quantitative EMG of the EAS muscle in patients.
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Affiliation(s)
- S Podnar
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Centre Ljubljana, SI-1525, Ljubljana, Slovenia.
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Abstract
Sacral reflexes consist of motor responses in the pelvic floor and sphincter muscles evoked by stimulation of sensory receptors in pelvic skin, anus, rectum, or pelvic viscera. These responses may be elicited by physical or electrical stimuli. They have been used in research studies of the pathophysiology of pelvic floor and anorectal disorders and many have been recommended for diagnostic use. These reflexes are described and discussed in this review. More rigorous evaluation of their value in the clinical assessment and care of patients with pelvic floor and sphincter disorders is required. Currently direct comparisons of the value of particular responses are generally not available, and few of these reflexes have proven validity for use in clinical diagnosis.
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Affiliation(s)
- E M Uher
- Department of Neurology, Royal London Hospital, United Kingdom
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Podnar S, Vodusek DB, Trsinar B, Rodi Z. A method of uroneurophysiological investigation in children. ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY 1997; 104:389-92. [PMID: 9344074 DOI: 10.1016/s0168-5597(97)00053-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Characteristics and reproducibility of bulbocavernosus reflex (BCR) and pudendal somatosensory evoked potentials (PSEP) elicited by mechanical stimulation in children were tested. Twenty-five male children aged 5-14 years without uroneurological complaints were enrolled in the study. In addition to electrical stimulation, a specially constructed electromechanical hammer triggered by an oscilloscope was used for mechanical stimulation of distal penis. All responses were detected by surface electrodes. The latencies and amplitudes of averaged as well as latencies of single BCR on single and double electrical stimuli were determined. Mechanical stimulation was described as much less unpleasant than electrical stimulation. Both mechanical/electrical stimulation elicited consistent and reproducible responses in high percentages of children (BCR: average, 80%/71%, single, 94%/100%; PSEP: 96%/96%, respectively). BCR latencies were significantly longer and PSEP amplitudes were significantly higher on mechanical stimulation. The compliance with mechanical was much better than with the electrical stimulation and the former can be recommended for clinical use. The effective mechanical stimulus delivered by a particular mechanical stimulator has a characteristic 'delay' (as to the actual point of triggering the oscilloscope ray) which influences the latency reading of responses; appropriate control data are therefore necessary.
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Affiliation(s)
- S Podnar
- Institute of Clinical Neurophysiology, Medical Centre Ljubljana, Zaloska, Slovenia
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Abstract
Electrophysiologic tests of the sacral neuromuscular system and its suprasegmental control may be divided into EMG and methods involving stimulation (i.e., evoked potential and sacral reflex testing). The latter group of methods tests the function of defined parts of the motor or sensory nervous system, or reflex arcs. There already is ample experience with testing the somatic sensory pathways (pudendal SEP) and the (somatic) sacral reflex arc, whereas other methods (testing the motor system and tests involving visceral afferents and sympathetic efferents) need further study to establish their proper place in everyday clinical diagnostics. The application of these methods in research has led to important advances in our understanding of nervous system involvement in different pathologic conditions leading to neurogenic sacral dysfunctions. If applied in individual patients, these methods should however, be used and interpreted with restraint; they should be considered in patients with probable or proved nervous system lesions, those in whom additional clarification regarding proof of, localization of, and the nature (i.e., axonal versus demyelinative) of the lesion is relevant for diagnosis and prognosis. If applied in patients with central nervous system involvement, evoked potential studies may be used on their own; but, in the author's opinion, in patients with putative peripheral nervous system involvement these tests should be considered, as a rule, only as an extension of a needle EMG exploration. It is expected that further experience will clarify the sensitivity and specificity of the available methods. The already available methods certainly will gain a place in the operating room helping the surgeon in selected procedures involving the pelvis and particularly conus and cauda equina better to identify neuromuscular structures and to monitor their function throughout the operation in order to prevent subsequent development of lesions.
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Affiliation(s)
- D B Vodusek
- Department of Neurology, Medical Faculty, University Medical Centre, Ljubljana, Slovenia
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Knowledge-based expert systems. Clin Neurophysiol 1995. [DOI: 10.1016/b978-0-7506-1183-1.50021-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Vodusek DB. Individual motor unit analysis in the diagnosis of urethral sphincter innervation. J Neurol Neurosurg Psychiatry 1989; 52:812-3. [PMID: 2746284 PMCID: PMC1032053 DOI: 10.1136/jnnp.52.6.812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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