Motor unit changes in inflammatory myopathy and progressive muscular dystrophy

The aim of present study was to analyse the motor unit (MU) changes in progressive muscle dystrophy (PMD) and in inflammatory myopathy (IM) and to evaluate eventual neurogenic factors in MU reorganisation. The material consisted of 20 patients with (PMD), 20 patients with (IM) and 20 healthy age-matched volunteers. The shape of concentric needle motor unit potentials (cn MUPs), including their duration, amplitude, area, size index and number of phases, the interference pattern and the amplitude and area of macro MUPs were evaluated. The cn emg data satisfied the classical criteria for myopathy in all examined patients, at least in one of the tested muscles. A decreased amplitude and/or area of macro MUPs, compatible with myopathy, were observed in 32 of the 40 patients. In some cases of chronic IM and PDM the long duration polyphasic potentials were recorded. The size index (SI) value of long polyphasic MUPs was usually decreased or normal. This feature indicated that desynchronisation of "myopathic" MUPs results from a reduced number of muscle fibers and their degeneration and regeneration. The results indicated no difference in MU reorganization between PMD and IM and no evidence of neurogenic factors in MU changes.     

The influence of contraction amplitude and firing history on spike-triggered averaged trapezius motor unit potentials

The spike-triggered averaged (STA) technique was used to examine trapezius motor unit potentials and their dependence on contraction amplitude and firing history. Individual motor unit firings were identified by a fine-wire intramuscular electrode, while STA-derived potentials were extracted from the simultaneously recorded surface electromyographic (SEMG) signal. Amplitude-controlled contractions and contractions with typing tasks and mental stress were carried out. STA potentials were mostly derived from 20 s intervals of firing. Motor unit synchrony was estimated by peristimulus time histograms (PSTHs). An association between SEMG amplitude and STA-derived motor unit potentials was found: motor unit area showed a four-fold increase when SEMG amplitude increased from 1.5 to 10.5% of the root mean square-detected SEMG signal at maximal voluntary contraction (%EMG_max). Low- and higher threshold motor unit potentials, all with recruitment thresholds <10% EMG_max, had similar area at the same contraction amplitude. A significant increase in the STA-derived potentials was observed after 3 min of constant-amplitude contractions; however, this difference was reduced after 10 min and no longer present after 30 min of contraction. Motor unit synchrony accounted for, on average, 2.8% additional firings within 2 ms of the triggering motor unit. We conclude that the increase in STA-derived potentials with contraction amplitude is, to a major extent, due to motor unit synchrony, limiting the applicability of this method in postural muscles presenting wide motor unit potentials. The similar area of motor units at same SEMG amplitude may indicate that trapezius motor units recruited below 10% EMG_max are of similar size and thus not organized according to the Henneman size principle.     

Influence of the surface EMG electrode on the compound muscle action potential

The recording characteristics of surface EMG electrodes were investigated. Compound muscle action potential (CMAP) and surface recorded motor unit action potentials were recorded from different muscles, using different surface electrode shapes and sizes. The CMAP was smaller for larger surface electrodes. This was more pronounced in smaller muscles. The CMAP was minimally affected by the geometry of the recording surface. With larger surface electrodes, shunting contributes to the reduction in MUAP amplitude. This is offset by a larger uptake area which gives a much smaller reduction in the CMAP amplitude for the larger muscles.     

Effect of electrode dimensions on motor unit potentials

Different effects of longitudinal and transversal electrode dimensions on nerve or muscle single fibre action potentials detected monopolarly, were reported in the literature. The results were contradictory. We studied motor unit potentials (MUPs) detected at a large distance (typical of surface recording) on the basis of a mathematical model without source simplification. The MUPs were calculated as a single convolution of the first temporal derivative of a realistic intracellular action potential and MU impulse response. The spatial averaging of the MUPs by rectangular plate electrodes was performed through analytical integration of the MU impulse response over the electrode area. The effects of longitudinal dimension of the electrode were stronger than those of a transversal one. The effects were distance dependent. The longitudinal dimension of the electrode influenced the main phases (that reflected the excitation origin and propagation) more than the terminal phases (that reflected the excitation extinction at the muscle fibers' ends). This was due to differences in the character of the potential fields (quadrupole or dipole) during generation of individual MUP phases. It was shown that the relative weight of the individual MUP phases could be stressed or suppressed by a proper choice of electrode dimensions, position and orientation.     

Effects of muscle fibre shortening on the characteristics of surface motor unit potentials

Traditionally, studies dealing with muscle shortening have concentrated on assessing its impact on conduction velocity, and to this end, electrodes have been located between the end-plate and tendon regions. Possible morphologic changes in surface motor unit potentials (MUPs) as a result of muscle shortening have not, as yet, been evaluated or characterized. Using a convolutional MUP model, we investigated the effects of muscle shortening on the shape, amplitude, and duration characteristics of MUPs for different electrode positions relative to the fibre–tendon junction and for different depths of the MU in the muscle (MU-to-electrode distance). It was found that the effects of muscle shortening on MUP morphology depended not only on whether the electrodes were between the end-plate and the tendon junction or beyond the tendon junction, but also on the specific distance to this junction. When the electrodes lie between the end-plate and tendon junction, it was found that (1) the muscle shortening effect is not important for superficial MUs, (2) the sensitivity of MUP amplitude to muscle shortening increases with MU-to-electrode distance, and (3) the amplitude of the MUP negative phase is not affected by muscle shortening. This study provides a basis for the interpretation of the changes in MUP characteristics in experiments where both physiological and geometrical aspects of the muscle are varied.     

Relationships between motor unit size and recruitment threshold in older adults: implications for size principle

As a part of the aging process, motor unit reorganization occurs in which small motoneurons reinnervate predominantly fast-twitch muscle fibers that have lost their innervation. We examined the relationship between motor unit size and the threshold force for recruitment in two muscles to determine whether older individuals might develop an alternative pattern of motor unit activation. Young and older adults performed isometric contractions ranging from 0 to 50% of maximal voluntary contraction in both the first dorsal interosseous (FDI) and tibialis anterior (TA) muscles. Muscle fiber action potentials were recorded with an intramuscular needle electrode and motor unit size was computed using spike-triggered averaging of the global EMG signal (macro EMG), which was also obtained from the intramuscular needle electrode. As expected, older individuals exhibited larger motor units than young subjects in both the FDI and the TA. However, moderately strong correlations were obtained for the macro EMG amplitude versus recruitment threshold relationship in both the young and older adults within both muscles, suggesting that the size principle of motor unit recruitment seems to be preserved in older adults.     

Effects of surface electrode size on computer simulated surface motor unit potentials.

Surface myoelectric signals are recorded in motor nerve conduction, fatigue and kinesiologic studies using discrete electrodes. Single site recordings have limited means to reduce cross-talk and to enhance timing and quantification of relative muscular activity. These limitations are compounded by the effects of the electrode size. A grid electrode would reduce some of these limitations. However, an optimum grid electrode requires detail examination of the effects of the size of individual electrodes and the interelectrode distance. The purpose of this study is to investigate the temporal and spatial effects of the electrode size on surface motor unit potentials (SMUP). Muscle fiber action potentials and surface electrodes are simulated by computer models. Peak to peak amplitude, the mean frequency of SMUP, and the muscle conduction velocity were calculated as functions of the size of the electrode. The random variations of these parameters due to systematic errors are also simulated and investigated.     

"Facial" and standard concentric needle electrodes are not interchangeable

Motor unit action potentials (MUAPs) were recorded using a standard concentric needle (SCN), a "facial" concentric needle (FCN) and a monopolar needle (MN) in the biceps brachii and first dorsal interosseous manus muscles of 7 normal subjects. For each muscle, the MUAP durations were similar for all electrodes. However, the FCN electrode more frequently registered high-amplitude MUAPs compared to the SCN electrode. Hence, the FCN and SCN needles should not be considered interchangeable in assessment of EMG signal amplitude. Although, the pattern of changes in amplitude and duration on FCN and MN recordings is similar, the electrodes have different uptake areas.     

Motor unit potential contribution to surface electromyography

The background of the bioelectric activity of muscle recorded from the surface of the skin (surface electromyography) in terms of the representation of single motor units of the underlying muscle(s) is not very well documented or understood. An insight into the composition of an electromyogram is essential for the proper interpretation of one of the most widely applied electrophysiological techniques. In the present paper, a study of the contribution of single motor unit potentials to the surface electromyogram is presented. To this end, the decline of different components of the motor unit potential with depth of the motor unit is quantified. Experimentally, the action potentials from motor units at several positions in the muscle were recorded by 30 skin surface electrodes. Simultaneous use of scanning electromyography provided information about the actual position and size of the motor unit. Observed linear log–log relationships between motor unit potential magnitudes and distance indicated the usefulness of a power function to describe the motor unit potential's dependence on recording distance. It is shown that different specific surface motor unit potential characteristics fall off differently with depth. The magnitude–distance relationship is shown to be dependent on the recording configuration (unipolar vs. bipolar recording, including the inter-electrode distance) and the chosen motor unit potential parameter (negative peak amplitude, positive peak amplitude and area).     

Selectivity of electromyographic recording techniques: simulation study

A modified line source model was used to simulate single muscle fibre action potentials and their radial decline as measured using a single fibre (SF), concentric needle (CN) and macroelectromyography (EMG) electrode. The 90 per cent attenuation distance, defined as the distance from the fibre at which the peak-to-peak amplitude of the action potential declines to 10 per cent of its value measured near the fibre, was determined. For the CN and macro electrode this distance was 1·4 and 4·1 times, respectively, the distance measured for the SF electrode Based on the decline characteristics obtained from our simulations and experimental data reported in the literature, we inferred that in a normal human biceps muscle the spike component of CN MUAPs is produced mainly by the action potentials of the closest one-six muscle fibres. This inference was used to interpret the changes in MUAP amplitude seen by clinical EMG in neuromuscular diseases. The decline of action potential amplitude with distance from the electrode was least when recordings were made by the macro-EMG electrode. The three electrodes differed in their uptake area and thus recordings made with them provided complementary information about the motor unit architecture and the way it changes in neuromuscular diseases.     

The motor unit potential distribution over the skin surface and its use in estimating the motor unit location

The amplitude of a surface electromyogram is dependent on the number of active motor units, their size and the relative position of the recording electrode. It is not possible to interpret the surface electromyogram quantitatively without disentangling these different aspects. In this study the decline of different components of the motor unit potential with increasing radial distance from the motor unit is quantified. Fifty-two motor units in the biceps brachii muscle were studied using 36-channel surface electromyography combined with intramuscular scanning electromyography. Scanning electromyography was used to locate precisely the motor unit. The dependence of the surface motor unit potential magnitude on the radial distance between the motor unit and the recording electrodes can be described fairly well by an inverse power function. The steepness of this function depends on the chosen motor unit potential parameter and the interelectrode distance, but also varies between motor units. The change of the negative peak amplitude of the motor unit potential over the skin surface can be used to give a fairly accurate estimate of the location of the motor unit under the skin surface. We found that for all practical purposes the depth of a motor unit in the biceps brachii muscle can be estimated as 20% of the distance over the skin surface where motor unit potentials can be recorded with higher amplitudes than 50% of the maximal amplitude recorded at the skin surface caused by activity of the same motor unit.     

Median averaging of electromyographic motor unit action potentials: comparison with other techniques

A technique of extracting individual motor unit action potentials (MUAPs) from EMG signals by median averaging, a modification of an existing method, is presented. To compare different techniques of MUAP extraction, 89 MUAPs were recorded with a concentric needle electrode in the brachial biceps muscle of normal subjects and patients with nerve and muscle diseases. MUAPs were also extracted by another method, called split-sweep median averaging, in which alternate MUAP discharges are averaged independently in two computer buffers until the two averaged signals appear equal on visual inspection by the operator. The amplitude, area, area: amplitude ratio, duration and number of phases and turns of each extracted MUAP were determined by each technique. Overall, there was a strong correlation between all features of the MUAPs extracted by median and splitsweep averaging, although the latter method required, on average, twice as many MUAP discharges to produce acceptable signals. We thus conclude that median averaging is a fast and accurate method that requires relatively few MU discharges to extract MUAP signals from spurious background signals.     

Serial quantitative electrophysiologic studies in sporadic inclusion body myositis

Sporadic inclusion body myositis (S-IBM) is a progressive, acquired myopathic process of unknown etiology. No known, successful or proven treatment exists. Quantitative EMG studies including concentric needle motor unit action potentials, interference pattern, macro-EMG and fiber density have allowed different measures to be made of the motor unit. These different measures allow inferences to be made in how the muscle fibers are distributed within both the normal and diseased motor unit. The present study is an effort to use multiple quantitative EMG measurements from the biceps brachii on a serial basis in order to study chronic changes in the motor unit with disease progression. Twenty-eight studies from 9 patients over a four-year period are shown. We conclude that while the concentric needle electrode is most helpful for diagnosing abnormality, the less selective macro-EMG and surface electrodes are better suited to monitor disease progression, especially in very weak muscles. These observations have practical applications for monitoring disease progression, or conversely, response to treatment.     

Motor unit remodelling in Duchenne muscular dystrophy. Electrophysiological assessment.

Conventional EMG, motor and sensory conduction velocities, averaging analysis of MUPs, SFEMG, and muscle fiber conduction velocity in situ were performed in 14 boys with Duchenne muscular dystrophy (DD) aged 5 to 11 years. MUPs parameters study showed a striking increment of long duration MUPs followed by satellites and increase of polyphasic potentials of variable duration. The main findings in SFEMG examination were increment in fiber density of the motor unit, large MISI and presence of complex potentials of long duration in all patients. Muscle fiber conduction velocity in situ was significantly slower than in controls, with significant decrease in minimum conduction and increased variability (large SD) in propagation velocity values. Low conduction velocity of muscle fibers, long duration of polyphasics and MUPs followed by satellites, and large MISI were significantly related. These findings support the hypotheses which have suggested that the motor unit remodelling in DD is mainly myogenic. The abnormalities in muscle fiber conduction velocity in situ reflect an increased diameter variation of muscle fibers consistent with splitting fibers, small groups of regenerating and necrotic fibers, and fiber diameter variation found in histological studies. Thus, increased variability in fiber diameter may be the cause of complex and long duration MUPs in DD.     

The relation between the surface electromyogram and muscular force.

1. Motor units in the first dorsal interosseus muscle of normal human subjects were recorded by needle electrodes, together with the surface electromyogram (e.m.g.). The wave form contributed by each motor unit to the surface e.m.g. was determined by signal averaging. 2. The peak-to-peak amplitude of the wave form contributed to the surface e.m.g. by a motor unit increased approximately as the square root of the threshold force at which the unit was recruited. The peak-to-peak duration of the wave form was independent of the threshold force. 3. Large and small motor units are uniformly distributed throughout this muscle, and the muscle fibres making up a motor unit may be widely dispersed. 4. The rectified surface e.m.g. was computed as a function of force, based on the sample of motor units recorded. The largest contribution of motor unit recruitment occurs at low force levels, while the contribution of increased firing rate becomes more important at higher force levels. 5. Possible bases for the common experimental observation that the mean rectified surface e.m.g. varies linearly with the force generated by a muscle are discussed. E.m.g. potentials and contractile responses may both sum non-linearly at moderate to high force levels, but in such a way that the rectified surface e.m.g. is still approximately linearly related to the force produced by the muscle.     

Laryngeal electromyography in normal Brazilian population

Quantitative analysis of normal values of motor unit action potentials duration and amplitude of muscles tireoaritenoideus (TA), cricotireoideus (CT), cricoaritenoideus lateralis (CAL), and cricoaritenoideus posterioris (CAP) was performed in 14 adult normal Brazilian volunteers. The recordings were obtained by percutaneously inserted concentric needle electrode. Different motor unit action potentials were manually selected in each muscle for quantitative computerized analysis of duration and amplitude. The mean values for duration and amplitude were respectively 3.8 ms and 413 microV for TA, 4.9 ms and 585 microV for CT 4.1 ms and 388 microV for CAL and 4.5 ms and 475 microV in CAP. There were no similar reports of normal values of motor unit action potentials in Brazilian subjects.     

Influence of motor unit properties on the size of the simulated evoked surface EMG potential

The purpose of the study was to quantify the influence of selected motor unit properties on the simulated amplitude and area of evoked muscle potentials detected at the skin surface. The study was restricted to a motor unit population simulating a hand muscle whose potentials were recorded on the skin over the muscle. Peak-to-peak amplitude and area of the evoked potential were calculated from the summed motor unit potentials and compared across conditions that simulated variation in different motor unit properties. The simulations involved varying the number of activated motor units, muscle fiber conduction velocities, axonal conduction velocities, neuronal activation times, the shape of the intracellular action potential, and recording configurations commonly used over hand muscles. The results obtained for the default condition simulated in this study indicated that ~7% of the motor unit potentials were responsible for 50% of the size of the evoked potential. Variation in the amplitude and area of the evoked muscle potential was directly related to the number of active motor units only when the stimulus activated motor units randomly, and not when activation was based on a parameter such as motor unit size. Independent adjustments in motor unit properties had variable effects on the size of the evoked muscle potential, including when the stimulus activated only a subpopulation of motor units. These results provide reference information that can be used to assist in the interpretation of experimentally observed changes in the size of evoked muscle potentials.     

Recording and identification of single motor units in the free-to-move primate hand

Summary A new technique is described for recording the activity of single motor units in human or monkey hand muscles. A pair of microwire electrodes is introduced into the muscle using a fine needle. After insertion, the needle can be completely removed, leaving the recording microwires in situ. The method allows stable recording of a motor unit during natural movement of the hand and fingers. The identity of a given single motor unit was reflected in the form and amplitude of the motor unit-triggered average (MU-TA), derived by averaging the unrectified surface EMG recorded from the muscle with discharges of the motor unit. The MU-TA of a given unit remained constant despite variations in the form and size of its action potential. Inspection of successive MU-TAs increased confidence that records were taken from one and the same unit over long recording periods. Control experiments in human first dorsal interosseous showed that the peak-to-peak amplitude of the MU-TA was highly correlated with both the twitch force (r= 0.65–0.92, mean 0.82, six subjects) and force threshold (r=0.62–0.93, mean 0.83) of a given unit. Similar findings were obtained for human abductor pollicis brevis (AbPB) motor units. In the monkey, AbPB motor units which were recruited early in a precision grip task and which discharged steadily during the grip had smaller MU-TAs than laterecruited, phasic units. The combination of methods described in this paper enable a single motor unit to be identified and recognised. The relative size of the unit, which is an important parameter in most motor unit studies, can be reliably estimated from the amplitude of the MU-TA. This allows indirect assessment of motor unit size in a free-to-move animal.     

Effect of length change in muscle fibers on conduction velocity in human motor units

Length and conduction velocity were determined in muscle fibers belonging to the single motor unit (right m. vastus medialis) in the living human body. A new method was developed for measuring the length of fibers, i.e., the muscle length was defined to be the distance between the starting point of excitation (motor end-plate) and the distal end of muscle fibers belonging to the particular motor unit. Both points were decided by analyzing the shape of the spike potentials of the motor unit recorded by surface electrodes. The length increased by about 70% (ranging from 48% to 97%) when changing the knee angle from fully extended to the fully flexed position, whereas the conduction velocity decreased by about 26% (ranging from 17 to 36%). It can be considered that the decrease of the conduction velocity when increasing the length of the muscle fibers was mainly due to the decrease in fiber diameter.     

Surface detected potentials of normal and reinnervated motor units: a simulation study for muscles consisted of short fibres

We aimed to check whether the characteristics used up to now in macro EMG to distinguish between normal and reinnervated motor unit potentials (MUPs), were suitable for surface detected MUPs. MUPs produced by normal and reinnervated MUs were simulated with a fast and precise convolution model. An increased number of fibres in the MU territory enhanced the amplitude, area and RMS of the MUP proportionally irrespective of the MU-electrode distance. An increased scatter of the end-plates and greater desynchronization in the fibres' activation decreased the MUP amplitude and affected the temporal characteristics of the MUP (duration of the negative phase and its area to amplitude ratio). The effects were more pronounced at shorter distances. At larger distances, the effect of the MU-electrode distance on temporal and amplitude characteristics of MUPs was much stronger than that of the parameters changed with reinnervation. We conclude that reinnervated MUs consisting of short fibres can not be distinguished from the normal ones by means of characteristics of MUP used in macro EMG. To discriminate reinnervated MUs non-invasively, the MUP amplitude should be normalized in respect of the MU-electrode distance or other MUP characteristics (independent of MU-electrode distance and sensitive to reinnervation) should be used.