EMG power spectrum, turns-amplitude analysis and motor unit potential duration in neuromuscular disorders

The diagnostic value of power spectrum analysis of the needle EMG pattern at a force of 30% of maximum was compared to that of turns-amplitude analysis and to that of manual measurements of motor unit potential (MUP) duration in the brachial biceps muscle of 20 patients with myopathy and 11 patients with neurogenic disorders. In myopathy the power spectrum analysis had the same diagnostic value as the turns-amplitude analysis and MUP duration measurements and the 3 methods supplemented each other. In patients with neurogenic disorders the diagnostic value of the power spectrum analysis as well as that of the turns-amplitude analysis were lesser than that of MUP duration measurement. In diseased muscles the amount of high frequencies increased with increasing ratio of turns to mean amplitude while there was no relation between the power spectrum and the MUP changes. The results suggest that the power spectrum analysis of EMG can be used as a diagnostic tool in patients with neuromuscular disorders.     

Motor unit firing intervals and other parameters of electrical activity in normal and pathological muscle

The analysis of the firing intervals of motor units has been suggested as a diagnostic tool in patients with neuromuscular disorders. Part of the increase in number of turns seen in patients with myopathy could be secondary to the decrease in motor unit firing intervals at threshold force of the motor units, as noted in previous studies. In the brachial biceps muscle we have studied the firing intervals of 164 motor units in 14 controls, 140 motor units in 13 patients with myopathy and 86 motor units in 8 patients with neurogenic disorders, and related the findings to those of the turns analysis and the analysis of properties of individual motor unit potentials. To ensure comparable conditions we have examined motor unit firing intervals and turns at a force of 10% of maximum. The average of motor unit firing intervals and of interval variability was the same in controls and in patients, and the diagnostic yield of the motor unit firing intervals analysis was none. Although the number of turns increased with decreasing motor unit firing intervals, this relation was physiological rather than pathophysiological. In patients with neurogenic disorders, interval variability indicated unstable firing in severely affected muscles.     

The motor unit firing rate and the power spectrum of EMG in humans

The EMG power spectrum is influenced by many factors such as the conduction velocity of the muscle fiber, the action potential of the motor unit, the number of motor units firing near the electrode, and the recording conditions. Model studies of the relation between motor unit firing rate and power spectrum of EMG have produced conflicting results. To examine this relation in vivo the brachial biceps muscle was examined in 14 controls at a force of 10% of maximum. The motor unit firing intervals were obtained from 164 motor units, sampled with a single fiber electrode. The EMG was sampled at 10 sites in each muscle with a concentric electrode and the power spectrum was obtained using fast Fourier transformation. The mean power frequency of the interference pattern as well as the relative power at 1400 Hz both decreased with increasing motor unit firing intervals between subjects. The study thus indicates that the amount of high frequencies in the power spectrum is greater in a subject with a high firing rate of the motor units than in a subject with a low firing rate.     

Number of potential reversals (turns) and amplitude of the pattern of electrical activity of the abductor pollicis brevis muscle in patients with neurogenic diseases

We have quantified the pattern of electrical muscle activity at a force of 0.3 kg, 30% of maximum force, and maximum force in the abductor pollicis brevis muscle of 21 patients with neurogenic disorders (10 with carpal tunnel syndrome, 9 with polyneuropathy and 2 with motor neurone disease) and of 15 normal subjects. In normal subjects, the number of turns, the mean amplitude and the ratio between them were independent of maximum force, age and sex of the subjects. In 21 patients with neurogenic disorders, the cumulative diagnostic yield of the analysis of the pattern of electrical activity was 86% compared to the diagnostic yield of the mean duration and mean amplitude of individual motor unit potentials of 90%. These diagnostic yields in a small distal muscle were of the same order as those of the brachial biceps muscle in previous studies.     

Integrated electrical activity and number of zero crossings during a gradual increase in muscle force in patients with neuromuscular diseases

In the brachial biceps muscle of 17 patients with myopathy and of 14 patients with neurogenic disorders the integrated electrical activity and number of zero crossings per unit time were analysed in 3 sites of each muscle every 100 msec during a gradual increase in force from zero to maximum within 10 sec. The analysis of integrated electrical activity could not discriminate between patients with myopathy and patients with neurogenic disorders. The slope of the linear relation between the square root of integrated electrical activity and force expressed in kilograms was increased in 44% of the patients with myopathy and in 64% of the patients with neurogenic disorders. The increase in slope may be due to increase in the ratio of electrical activity and force of individual motor units. The integrated electrical activity related to a force of 40% of maximum was decreased in about two-thirds of patients with myopathy and in about half of the patients with neurogenic disorders. This decrease in integrated electrical activity may be due to random loss of muscle fibres or to loss of whole motor units respectively. The integrated electrical activity was linearly related to mean amplitude between potential reversals per unit time (turns). The number of zero crossings was increased in 29% of the patients with myopathy and decreased in 70% of the patients with neurogenic disorders at a force of 30% of maximum. The number of zero crossings was linearly related to turns.(ABSTRACT TRUNCATED AT 250 WORDS)     

Electrical muscle activity during a gradual increase in force in patients with neuromuscular diseases

The electrical activity of the brachial biceps muscle from 31 patients with neuromuscular diseases were quantified during a gradual increase in force from zero to maximum within 10 sec. In patients with myopathy the ratio of potential reversals per 100 msec (turns) to mean amplitude was increased more often at 10% and 20% of maximum force than at greater force (i.e., in four-fifths of the patients). Similarly, the mean amplitude as a function of turns was more diagnostic at low than at high force, possibly due to an affection of low threshold motor units. In 14 patients with neurogenic disorders turns was decreased in nearly two-thirds of the patients at a force of 20% and 30% of maximum. In muscles where the force is easily determined it is suggested to quantitate the electrical activity during constant forces of 10% and 30% of maximum. In muscles where the force is difficult to determine the analysis of the ratio of turns to mean amplitude should be performed when motor unit potentials begin to interfere.     

The diagnostic yield of quantified electromyography and quantified muscle biopsy in neuromuscular disorders

Electromyography (EMG), histology, and histochemistry were related in 264 patients with neuromuscular disorders classified according to history and clinical and other laboratory findings. Electromyography and histological and histochemical abnormalities were divided in specific and nonspecific criteria. Specific histochemical criteria alone identified 28% of neurogenic lesions. Criteria of myopathy, obtained from the pattern of electrical activity during 30% of maximal effort, helped to delineate a myopathy when the only abnormality was an increased incidence of polyphasic potentials together with a pattern of full recuitment during maximal effort. Histology, histochemistry, or both, and EMG were concordant with clinical findings in 77% of 188 patients with myopathy and in 91% of 64 patients with neurogenic lesions. The electromyogram was concordant with the clinical classification in 87% of patients with myopathy and in 91% of patients with neurogenic impairment. The biopsy was in agreement with or contributed to the classification in 79% of patients with myopathy and in 92% of patients with neuropathy.     

Concentric-needle versus macro EMG. II. Detection of neuromuscular disorders.

OBJECTIVE: Little is known about the relation and sensitivity of macro-EMG (MA-EMG) compared with concentric-needle EMG (CN-EMG) in the detection of neuromuscular disorders. METHODS: CN-EMGs and MA-EMGs were recorded from the right brachial biceps muscle of 40 healthy subjects, aged 17-83 years, 20 patients with neurogenic disorders, aged 25-75 years, and 20 patients with myopathy, aged 18-76 years. Motor unit action potentials (MUAPs) were examined. RESULTS: In patients with neurogenic disorders CN-MUAP duration, CN-MUAP amplitude, percent polyphasia, MA-MUAP amplitude, MA-MUAP area and fibre density were significantly increased. In patients with myopathy, only fibre density was significantly increased. In patients with neurogenic disorders, the sensitivity of CN-EMG was 80%, and that of MA-EMG 85%. In myopathies, the sensitivity was 50% for each technique. Pooling the results of both EMG techniques, the sensitivity increased to 90% in patients with neurogenic disorders, and to 65% in myogenic disease. CONCLUSIONS: MA-EMG has a similar sensitivity in the detection of neuromuscular disorders as CN-EMG. Particularly when myopathy is suspected, both techniques should be applied if one is unrevealing.     

Changes in muscle fiber conduction velocity, mean power frequency, and mean EMG voltage during prolonged submaximal contractions

Average muscle fiber conduction velocity, mean power frequency, and mean EMG voltage have been measured in human vastus lateralis during prolonged isometric knee extensions at 10, 20, 30, and 40% of the maximum knee extension force. During contractions at 10 and 20% of maximum force, conduction velocity and mean power frequency rose as the contraction progressed, whereas the conduction velocity and mean power frequency fell at 30 and 40% of the maximum force. The mean EMG voltage rose during the contractions, with steeper increases for higher forces. It is argued that two principal factors influence the EMG during prolonged submaximal contractions: firstly, the fatigue of current active motor units, and, secondly, recruitment of fresh motor units. These factors act in opposition to muscle fiber conduction velocity. Recruitment gives an increase in average conduction velocity, whereas fatigue provokes a slowing in conduction velocity.     

The role of different EMG methods in evaluating myopathy.

For the diagnosis of myopathy, EMG may have an important role along with blood tests, muscle biopsies and genetic testing. This review evaluates different EMG methods in the diagnosis of myopathy. These include manual analysis of individual motor unit potentials and multi-motor unit potential analysis sampled at weak effort. At high effort, turns-amplitude analyses such as the cloud analysis and the peak ratio analysis have a high diagnostic yield. The EMG can seldom be used to differentiate between different types of myopathy. In the channelopathies, myotonia, exercise test and cooling of the muscle are helpful. Macro-EMG, single-fibre EMG and muscle fibre conduction velocity analysis have a limited role in myopathy, but provide information about the changes seen. Analysis of the firing rate of motor units, power spectrum analysis, as well as multichannel surface EMG may have diagnostic potential in the future. EMG is of great importance in the diagnosing of patients with myopathy, preferably a needle electrode and quantitative analyses should be used. A combination of a method at weak effort as well as a method at stronger effort seems optimal.     

Turns-amplitude analysis at different sampling frequencies.

In the EMG interference pattern the number of potential reversals of more than 100 microV (i.e., turns) measured may be low if a low sampling frequency is used. This might be more pronounced in a myopathic muscle with small short potentials than in a control muscle, resulting in a decreased diagnostic yield. The influence of sampling frequencies from 6 to 200 kHz on the turns, mean amplitude and ratio of turns to mean amplitude analysed on the interference pattern at a force of 30% of maximum was examined at 10 sites in each of 5 control muscles, 5 myopathic muscles and 5 neurogenic muscles (i.e., 150 sites in all). In this small group of muscles low sampling frequency did not tend to reduce the diagnostic yield of the measurements. Proper reproducibility was obtained with sampling frequencies down to 17 kHz. However, due to systematic errors, measurements obtained with sampling frequencies below 25 kHz require comparable control values or compensations for errors. As time intervals between turns (not studied here) have a skew distribution with many small time intervals a sampling frequency of 50 kHz or higher is probably required.     

Turns-amplitude analysis of the electromyographic recruitment pattern disregarding force measurement. II. Findings in patients with neuromuscular disorders.

Turns-amplitude analysis of the electromyographic recruitment pattern was performed on-line in the brachial biceps muscle of 46 patients with neuromuscular disorders using the mean amplitude as an indicator of force. The parameters, peak-ratio (PR) and number of time intervals (TI) from 0 to 1.5 ms, were increased in patients with myopathy. In patients with neurogenic involvement, the characteristic pattern was a decreased PR and a decreased incidence of TI between 0 and 1.5 ms. The results indicate that the two parameters supplement each other as some of the patients were identified only by one or the other. In patients with myopathy, the method had a higher diagnostic yield than the individual motor unit action potential analysis. The method is objective, fast, and reliable.     

98例神经肌肉病的临床、肌电图与病理研究

目的 探讨肌电图（EMG），肌活检对神经肌肉病的诊断价值。比较EMG，肌活检及初始临床诊断3者之间的关系。方法 将98例神经肌肉病分成肌病。重症肌无力和运动神经元病3组进行研究。结果 肌病组（80例），68.8%(55/80)肌活检，75%（60/80）EMG呈肌源性损害；重症肌无力组（10例）；针极EMG（不包括重视频率电刺激）及肌活检均未显示特异性改变；运动神经元病组（8例），75?/8）肌活检，100%（8/8）EMG呈神经源性损害。结论 肌活检对肌病明确诊断可提供直接信息。对运动神经元病只能做出神经源性损害结果。缺乏特异性。EMG对神经肌肉病只能做出分类诊断；单纯凭借初始临床资料易导致该类疾病误诊。     

Diagnostic yield of the analysis of the pattern of electrical activity of muscle and of individual motor unit potentials in neurogenic involvement.

The pattern of electrical activity and the properties of individual motor unit potentials were analysed in the flexor muscles of the forearm of 15 patients with motor neurone disease and 15 patients with a lesion of the brachial plexus. The best diagnostic yield from the pattern of electrical activity was obtained when the force was 30% of maximum: The number of spikes (turns/15 s) was diminished in 70% of the patients; none showed the increase in turns characteristic of myopathy. The decrease in the number of turns was often associated with an increased incidence of long time intervals between turns and with an increased amplitude between turns. The mean duration of individual motor unit potentials was prolonged in 78% of the patients; none showed the decrease in mean duration characteristic of myopathy. Prolongation of the mean duration of motor unit potentials produced by cooling of normal muscle, led to a decrease in the number of turns. This suggested that the diminished number of turns in neurogenic involvement was due mainly to the prolonged duration of motor unit potentials.     

Analysis of the interference electromyogram of human soleus muscle after exposure to vibration

The properties of m. soleus surface EMG recorded under conditions of voluntary contraction against vibrational stimulation were studied using vibration-triggered averaging and spectral estimates. The averaging procedure indicated EMG bursts locked to the vibration cycle. Narrow peaks appeared in the EMG spectrum at vibration frequency and harmonics. These effects were more pronounced in rectified EMG at low vibration frequencies (30-70 Hz) and in EMG at high frequencies (70-120 Hz). The disappearance of the peak after ischemic blockade preceded that of the tendon reflex. The peak normalized to the EMG power decreased when the force was enlarged. The peak augmented with prolonged contraction under vibration. The results are suggested to reflect alterations of the relative weight of the excitatory inflow through short spindle-motoneuron connections in the overall motoneuron inflow.     

Turns analysis (peak ratio) in EMG using the mean amplitude as a substitute of force measurement

Several modifications of turns and mean amplitude analysis of the electrical activity of muscles have been suggested to avoid measurement of force. Previously we have shown that these modifications may overlook abnormalities if the analysis is performed at high force. A new modification is suggested: analysing the maximal value of the ratio of turns to mean amplitude (peak ratio), using the mean amplitude as an indication of force. It has been applied to a material in which the force was measured. The peak ratio was increased in 82% of 17 patients with myopathy and decreased in 36% of 14 patients with neurogenic disorders.     

The relationship between mean power frequency of the EMG spectrum and muscle fibre conduction velocity

Models of the behaviour of the surface EMG signal during fatigue have assumed that there is a linear relationship between the mean power frequency of the EMG spectrum and muscle fibre conduction velocity. They attribute the fall in mean power frequency during fatigue to a proportionate fall in fibre velocity. Experiments have been performed on human vastus lateralis in which forces ranging from 10% to 90% of the maximum force were sustained for times such that the product of the target force and the time was constant. Muscle fibre conduction velocity was estimated using a cross-correlation technique to determine the lag between two EMG signals. The results confirmed the linearity between mean power frequency and fibre velocity. It is still possible, however, that other factors such as de- and recruitment of fibres and change in motor unit firing rates contribute to the fall in mean power frequency during fatigue. Even if these factors are important, the primary assumption of current EMG models relating mean power frequency and muscle fibre velocity has been confirmed.     

Electromyography (EMG) accuracy compared to muscle biopsy in childhood

Reports show wide variability of electromyography (EMG) in detecting pediatric neuromuscular disorders. The study's aim was to determine EMG/nerve conduction study accuracy compared to muscle biopsy and final clinical diagnosis, and sensitivity for myopathic motor unit potential detection in childhood. Of 550 EMG/nerve conduction studies performed by the same examiner from a pediatric neuromuscular service, 27 children (ages 6 days to 16 years [10 boys; M:F, 1:1.7]) with muscle biopsies and final clinical diagnoses were compared retrospectively. Final clinical diagnoses were congenital myopathies (5 of 27,18%), nonspecific myopathies (biopsy myopathic, final diagnosis uncertain; 6 of 27, 22%), congenital myasthenic syndrome (3 of 27, 11%), juvenile myasthenia gravis (1 of 27, 4%), arthrogryposis multiplex congenita (2 of 27, 7%), hereditary motor and sensory neuropathy (1 of 27, 4%), bilateral peroneal neuropathies (1 of 27, 4%), and normal (8 of 27, 30%). There were no muscular dystrophy or spinal muscular atrophy patients. EMG/nerve conduction studies had a 74% agreement with final clinical diagnoses and 100% agreement in neurogenic, neuromuscular junction, and normal categories. Muscle biopsies concurred with final diagnoses in 87%, and 100% in myopathic and normal categories. In congenital myasthenic syndrome, muscle biopsies showed mild variation in fiber size in 2 of 3 children and were normal in 1 of 3. EMG sensitivity for detecting myopathic motor unit potentials in myopathies was 4 of 11 (36%), greater over 2 years of age (3 of 4, 75%), compared to infants less than 2 years (1 of 7, 14%), not statistically significant (P = .0879). EMGs false-negative for myopathy in infants < 2 years of age were frequently neurogenic (3 of 6, 50%). In congenital myopathies EMG detected myopathic motor unit potentials in 40%, with false-negative results neurogenic (20%) or normal (40%). Because our study has no additional tests for active myopathies, for example Duchenne muscular dystrophy genetic testing, our sensitivity for myopathies is lower than if we used a more global view. In conclusion, EMG detection rate of myopathic motor unit potentials at a young age was low, improving in children over 2 years of age. In neurogenic and neuromuscular junction disorders, the EMG has a very high detection rate. In children with mild to moderate neurogenic EMG findings and normal nerve conduction, a myopathy should always be considered.     

Pattern of electrical activity and force in normal and pathological muscle: S-index of turns and amplitude

Cenkovich et al. (1982) found that a rotated hyperbolic curve fitted the relationship between the logarithm of cumulative amplitude (log A) and the logarithm of turns (log T). They found the intercept of the hyperbola (S-index) to be independent of force and suggested to use the S-index without measurement of the force as a diagnostic criterion. We have applied this modification of the method to our material previously published. In controls we found a slight increase in S-index with increasing force. The S-index was often increased in patients with myopathy and decreased in patients with neurogenic disorders, mostly at low to moderate force. The S-index was not better in discriminating patients from controls than the ratio of turns to mean amplitude.     

The muscle fiber conduction velocity and power spectra in familial hypokalemic periodic paralysis

Surface EMG has been used to determine the average muscle fiber conduction velocity (MFCV) and power spectra of the m. biceps of 10 patients and 15 asymptomatic offspring of a large kinship with familial hypokalemic periodic paralysis (HOPP). The MFCV of the patients was 3.37 +/- 0.35 m/sec (mean +/- SD, n = 9), the median frequency (Fmed) of the power spectra was 55.0 +/- 5.8 Hz (mean +/- SD, n = 9), both values are significantly (P0.001, Student's t-test) lower than the control values: MFCV = 4.55 +/- 0.33 m/sec; Fmed = 88.6 +/- 15.5 Hz (mean +/- SD). In 6 of the 15 asymptomatic relatives, the surface EMG results were also abnormal. It is concluded that the MFCV is reduced in familial HOPP. This results in a predominantly low-frequency content of the power spectra, thereby providing a new model for studying the relationship between the MFCV and the frequency spectrum of surface EMG. Asymptomatic relatives that have inherited the disease probably can be detected with this method.