Motor unit number estimates and quantitative motor unit analysis in healthy subjects and patients with amyotrophic lateral sclerosis
Corresponding Author
Shaun G. Boe PhD
School of Kinesiology, University of Western Ontario, London, Ontario, Canada
School of Kinesiology, University of Western Ontario, London, Ontario, CanadaSearch for more papers by this authorDaniel W. Stashuk PhD
Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
Search for more papers by this authorTimothy J. Doherty MD, PhD
School of Kinesiology, University of Western Ontario, London, Ontario, Canada
Departments of Clinical Neurological Sciences and Rehabilitation Medicine, University of Western Ontario, University Hospital, London Health Sciences Centre, 339 Windermere Road, London, Ontario N6A 5A5, Canada
Search for more papers by this authorCorresponding Author
Shaun G. Boe PhD
School of Kinesiology, University of Western Ontario, London, Ontario, Canada
School of Kinesiology, University of Western Ontario, London, Ontario, CanadaSearch for more papers by this authorDaniel W. Stashuk PhD
Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
Search for more papers by this authorTimothy J. Doherty MD, PhD
School of Kinesiology, University of Western Ontario, London, Ontario, Canada
Departments of Clinical Neurological Sciences and Rehabilitation Medicine, University of Western Ontario, University Hospital, London Health Sciences Centre, 339 Windermere Road, London, Ontario N6A 5A5, Canada
Search for more papers by this authorAbstract
Limitations associated with global measures of function in patients with amyotrophic lateral sclerosis (ALS) and the qualitative nature of needle electromyography have stimulated the development of alternate means of monitoring disease severity and progression in ALS. Thus, the objective of this study was to examine the ability of one these techniques, decomposition-based quantitative electromyography (DQEMG), to obtain electrophysiological data, including motor unit number estimates (MUNEs), from a group of patients with ALS. The first dorsal interosseous and biceps brachii muscles were studied in 10 healthy subjects and 9 patients with ALS. Following the acquisition of a maximum M wave, needle- and surface-detected EMGs were collected simultaneously during 30-second contractions performed at 10% of the maximum voluntary contraction force to obtain motor unit potential (MUP) trains. DQEMG was then used to extract the surface-detected MUP associated with each MUP train, the mean size of which was divided into the maximum M wave to obtain a MUNE. The results suggest that quantitative electrophysiological data obtained using DQEMG are representative of the pathophysiological changes in the lower motor system in ALS patients, supporting its use in studies documenting the natural history and progression of the disease. Muscle Nerve, 2007
REFERENCES
- 1 The Amyotrophic Lateral Sclerosis Functional Rating Scale. Assessment of activities of daily living in patients with amyotrophic lateral sclerosis. The ALS CNTF treatment study (ACTS) phase I–II Study Group. Arch Neurol 1996; 53: 141–147.
- 2 Andres PL, Finison LJ, Conlon T, Thibodeau LM, Munsat TL. Use of composite scores (megascores) to measure deficit in amyotrophic lateral sclerosis. Neurology 1988; 38: 405–408.
- 3 Andres PL, Hedlund W, Finison L, Conlon T, Felmus M, Munsat TL. Quantitative motor assessment in amyotrophic lateral sclerosis. Neurology 1986; 36: 937–941.
- 4 Bischoff C, Stälberg E, Falck B, Eeg-Olofsson KE. Reference values of motor unit action potentials obtained with multi-MUAP analysis. Muscle Nerve 1994; 17: 842–851.
- 5 Boe SG, Stashuk DW, Brown WF, Doherty TJ. Decomposition-based quantitative electromyography: effect of force on motor unit potentials and motor unit number estimates. Muscle Nerve 2005; 31: 365–373.
- 6 Boe SG, Stashuk DW, Doherty TJ. Motor unit number estimation by decomposition-enhanced spike-triggered averaging: control data, test–retest reliability, and contractile level effects. Muscle Nerve 2004; 29: 693–699.
- 7 Boe SG, Stashuk DW, Doherty TJ. Within-subject reliability of motor unit number estimates and quantitative motor unit analysis in a distal and proximal upper limb muscle. Clin Neurophysiol 2006; 117: 596–603.
- 8 Bromberg MB. Motor unit estimation: reproducibility of the spike-triggered averaging technique in normal and ALS subjects. Muscle Nerve 1993; 16: 466–471.
- 9 Bromberg MB. Electrodiagnostic studies in clinical trials for motor neuron disease. J Clin Neurophysiol 1998; 15: 117–128.
- 10 Bromberg MB, Forshew DA, Nau KL, Bromberg J, Simmons Z, Fries TJ. Motor unit number estimation, isometric strength, and electromyographic measures in amyotrophic lateral sclerosis. Muscle Nerve 1993; 16: 1213–1219.
- 11 Bromberg MB, Larson WL. Relationships between motor-unit number estimates and isometric strength in distal muscles in ALS/MND. J Neurol Sci 1996; 139( suppl): 38–42.
- 12 Brooks BR, Miller RG, Swash M, Munsat TL. El Escorial revisited: revised criteria for the diagnosis of amyotrophic lateral sclerosis. Amyotroph Lateral Scler Other Motor Neuron Disord 2000; 1: 293–299.
- 13 Brown WF. Functional compensation of human motor units in health and disease. J Neurol Sci 1973; 20: 199–209.
- 14 Brown WF, Jaatoul N. Amyotrophic lateral sclerosis. Electrophysiologic study (number of motor units and rate of decay of motor units). Arch Neurol 1974; 30: 242–248.
- 15 Cedarbaum JM, Stambler N. Performance of the Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS) in multicenter clinical trials. J Neurol Sci 1997; 152( suppl 1): S1–9.
- 16 Chad DA. Electrodiagnostic approach to the patient with suspected motor neuron disease. Neurol Clin 2002; 20: 527–555.
- 17 Cudkowicz M, Qureshi M, Shefner J. Measures and markers in amyotrophic lateral sclerosis. NeuroRx 2004; 1: 273–283.
- 18 de Carvalho M, Scotto M, Lopes A, Swash M. Quantitating progression in ALS. Neurology 2005; 64: 1783–1785.
- 19 Dengler R, Konstanzer A, Kuther G, Hesse S, Wolf W, Struppler A. Amyotrophic lateral sclerosis: macro-EMG and twitch forces of single motor units. Muscle Nerve 1990; 13: 545–550.
- 20 Doherty TJ, Stashuk DW. Decomposition-based quantitative electromyography: methods and initial normative data in five muscles. Muscle Nerve 2003; 28: 204–211.
- 21 Eisen A, Swash M. Clinical neurophysiology of ALS. Clin Neurophysiol 2001; 112: 2190–2201.
- 22
Emeryk-Szajewska B,
Kopec J,
Karwanska A.
The reorganization of motor units in motor neuron disease.
Muscle Nerve
1997;
20:
306–315.
10.1002/(SICI)1097-4598(199703)20:3<306::AID-MUS7>3.0.CO;2-F CAS PubMed Web of Science® Google Scholar
- 23 Fuglevand AJ, Winter DA, Patla AE. Models of recruitment and rate coding organization in motor-unit pools. J Neurophysiol 1993; 70: 2470–2488.
- 24 Howard JE, McGill KC, Dorfman LJ. Properties of motor unit action potentials recorded with concentric and monopolar needle electrodes: ADEMG analysis. Muscle Nerve 1988; 11: 1051–1055.
- 25 Kaufmann P, Levy G, Thompson JL, Delbene ML, Battista V, Gordon PH, et al. The ALSFRSr predicts survival time in an ALS clinic population. Neurology 2005; 64: 38–43.
- 26
Kent-Braun JA,
Walker CH,
Weiner MW,
Miller RG.
Functional significance of upper and lower motor neuron impairment in amyotrophic lateral sclerosis.
Muscle Nerve
1998;
21:
762–768.
10.1002/(SICI)1097-4598(199806)21:6<762::AID-MUS8>3.0.CO;2-5 CAS PubMed Web of Science® Google Scholar
- 27 Kimura F, Fujimura C, Ishida S, Nakajima H, Furutama D, Uehara H, et al. Progression rate of ALSFRS-R at time of diagnosis predicts survival time in ALS. Neurology 2006; 66: 265–267.
- 28
Kuwabara S,
Mizobuchi K,
Ogawara K,
Hattori T.
Dissociated small hand muscle involvement in amyotrophic lateral sclerosis detected by motor unit number estimates.
Muscle Nerve
1999;
22:
870–873.
10.1002/(SICI)1097-4598(199907)22:7<870::AID-MUS9>3.0.CO;2-O CAS PubMed Web of Science® Google Scholar
- 29 McComas AJ, Sica RE, Campbell MJ, Upton AR. Functional compensation in partially denervated muscles. J Neurol Neurosurg Psychiatry 1971; 34: 453–460.
- 30 McGuire D, Garrison L, Armon C, Barohn R, Bryan W, Miller R, et al. Relationship of the Tufts Quantitative Neuromuscular Exam (TQNE) and the Sickness Impact Profile (SIP) in measuring progression of ALS. Neurology 1996; 46: 1442–1444.
- 31 McNeil CJ, Doherty TJ, Stashuk DW, Rice CL. Motor unit number estimates in the tibialis anterior muscle of young, old, and very old men. Muscle Nerve 2005; 31: 461–467.
- 32 McNeil CJ, Doherty TJ, Stashuk DW, Rice CL. The effect of contraction intensity on motor unit number estimates of the tibialis anterior. Clin Neurophysiol 2005; 116: 1342–1347.
- 33 Munsat TL, Andres PL, Finison L, Conlon T, Thibodeau L. The natural history of motoneuron loss in amyotrophic lateral sclerosis. Neurology 1988; 38: 409–413.
- 34 Nandedkar SD, Barkhaus PE, Sanders DB, Stälberg EV. Analysis of amplitude and area of concentric needle EMG motor unit action potentials. Electroencephalogr Clin Neurophysiol 1988; 69: 561–567.
- 35 Nandedkar SD, Sanders DB. Recording characteristics of monopolar EMG electrodes. Muscle Nerve 1991; 14: 108–112.
- 36 Schmidt EP, Drachman DB, Wiener CM, Clawson L, Kimball R, Lechtzin N. Pulmonary predictors of survival in amyotrophic lateral sclerosis: use in clinical trial design. Muscle Nerve 2006; 33: 127–132.
- 37 Stälberg E. Macro EMG, a new recording technique. J Neurol Neurosurg Psychiatry 1980; 43: 475–482.
- 38 Stalberg E, Fawcett PR. Macro EMG in healthy subjects of different ages. J Neurol Neurosurg Psychiatry 1982; 45: 870–878.
- 39 Stashuk DW. Decomposition and quantitative analysis of clinical electromyographic signals. Med Eng Phys 1999; 21: 389–404.
- 40 Tackmann W, Vogel P. Fibre density, amplitudes of macro-EMG motor unit potentials and conventional EMG recordings from the anterior tibial muscle in patients with amyotrophic lateral sclerosis. A study on 51 cases. J Neurol 1988; 235: 149–154.
- 41 Wohlfart G. Collateral regeneration from residual motor nerve fibers in amyotrophic lateral sclerosis. Neurology 1957; 7: 124–134.
- 42 Wohlfart G. Collateral regeneration in partially denervated muscles. Neurology 1958; 8: 175–180.
Citing Literature
