Area-to-amplitude ratio of the terminal phase of the belly-tendon detected motor unit potentials could be used to recognize reinnervated motor units

Besides the increased number of fibres, the reinnervated motor units (MUs) are characterised by an increased scattering the end-plates, greater desynchronization in the fibres' activation, greater dispersion in the diameters of the MU fibres and thus in propagation velocities along them. As a result, desynchronization in the moments, at which the excitation waves reach the fibres' ends, increases in reinnervated MUs. The possibility to recognize reinnervated MUs in short (hand) muscles on the basis of changes in duration of the terminal (second) phase of the belly-tendon detected motor unit potentials (MUPs) was examined by numerical experiments. A convolution model that took into account the finite fibre length, was used to calculate MUPs for distances typical of surface detection. It was shown that the ratio between the area of the terminal phase and its amplitude, as a measure of duration of the terminal phase, was sensitive to desynchronisation of the waves of excitation. The ratio was independent of the distance from the MU axis and of the volume conductor properties. Basing on the results obtained, we can conclude that the ratio reflects main functional compensations in reinnervated MUs and could be used for discrimination between reinnervated and normal MUs.     

Peculiarities of extracellular potentials produced by deep muscles. Part 2: motor unit potentials

The potential fields generated by single fibres far from the sources are non-propagating. This suggests that there should be differences in the features of surface motor unit (MU) potentials (MUPs) detected from deep and superficial muscles. We explored the features using a simulation approach. We have shown that the non-propagating character and similar shapes among surface MUPs recorded over a wide area above deep muscles with monopolar or longitudinal single differential (LSD) electrodes are natural. Contrary to close distances, at large radial distances single differentiation did not emphasize MUP main phase relative weight. The position of the end plate area could be estimated with LSD detections only for MUs with long (123 mm) almost symmetric fibres. With short fibres, the LSD main phase was masked by the outlined terminal phases. This could be misleading in MUP analysis since the terminal phases reflect standing sources. The highly asymmetric fibres could yield peculiar MUP shapes resembling MUPs of two distinct MUs. We have shown that the relative weight of terminal phases at large fibre-electrode distance decreases under abnormal peripheral conditions. However, the changes in membrane depolarization due to fatigue or pathology could be assessed non-invasively also from deep muscles.     

A morphological analysis of the macro motor unit potential

The technique of macro EMG is used to investigate the motor unit architecture in a number of pathological conditions. Amplitude and area are the most commonly used criteria, but these parameters alone are not sufficient to assess the complexity of the macro MUP morphology. In an attempt to examine the morphology of the macro MUP in more detail, additional measures were investigated including, (i) average power, (ii) duration, and (iii) number of phases. Macro MUP duration was defined as the time parameter that contains a particular fraction (90%) of the total power of the potential. The above mentioned parameters were evaluated for normal subjects and for patients suffering with motor neuron disease (MND), spinal muscular atrophy (SMA), and Becker's muscular dystrophy (BMD). It is shown that high amplitude and average power macro MUPs give shorter macro MUP duration than macro MUPs with normal amplitude. In contrast, in low amplitude macro MUPs there is a tendency towards a higher duration measure, as compared with the duration of the normal amplitude macro MUPs. Also, t–test results for the duration measure gave a significant difference between the NOR–MND, and no significant difference between the NOR–BMD and NOR–SMA groups at P<0.05. Significant difference between the NOR and the three disease groups investigated was obtained for the parameters log amplitude, log area, and log average power. The number of phases was not significantly different between the NOR and the rest of the groups. In conclusion, the average power and duration parameters can possibly be used as additional discriminators to detect abnormalities of the macro motor unit potential in both needle and surface EMG but further investigation is necessary.     

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.     

The presence of unknown layer of skin and fat is an obstacle to a correct estimation of the motor unit size from surface detected potentials

To overcome problems with a strong distance-dependence of the motor unit potentials (MUPs), different methods to estimate the MU location and size have been proposed. Distance-independence of the exponent of the power function, that describes the MUP distance decline, and homogeneity of the volume conductor, are assumed in all methods. Some of them consider the exponent value as unique, irrespective of persons, muscles and their functional state. One method estimates the current exponent value. We evaluate this method by computer simulation of MUPs in infinite and semi-infinite volume conductor. Our results show that although the first assumption is not fulfilled, it does not affect considerably the estimate of the MU location and size obtained for infinite or semi-infinite homogeneous volume conductor. The errors of the MU location can be insignificant even in inhomogeneous volume conductor with a layer of lower conductivity (skin and fat) between the muscle tissue and electrode. The accurate location of the MU electrical axis is, however, not a sufficient condition for a correct MU size estimation that depends considerably on actual parameters of the layer. Thus, the surface EMG could hardly be considered as non-invasive alternative to macro EMG for detection of the enlarged MUs.     

The increase in surface EMG could be a misleading measure of neural adaptation during the early gains in strength

Purpose

To test the validity of using the increase in surface EMG as a measure of neural adaptation during the early gains in strength.

Methods

Simulation of EMG signals detected by surface bipolar electrode with 20-mm inter-pole distance at different radial distances from the muscle and longitudinal distances from the end-plate area. The increases in the root mean square (RMS) of the EMG signal due to possible alteration in the neural drive or elevation of the intracellular negative after-potentials, detected in fast fatigable muscle fibres during post-tetanic potentiation and assumed to accompany post-activation potentiation, were compared.

Results

Lengthening of the intracellular action potential (IAP) profile due to elevation of the negative after-potentials could affect amplitude characteristics of surface EMG detected at any axial distance stronger than alteration in the neural drive. This was irrespective of the fact that the elevation of IAP negative after-potential was applied to fast fatigable motor units (MUs) only, while changes in frequency of activation (simulating neural drive changes) were applied to all MUs. In deeper muscles, where the fibre-electrode distance was larger, the peripheral effect was more pronounced. The normalization of EMG amplitude characteristics to an M-wave one could result only in partial elimination of peripheral factor influence

Conclusions

The increase in RMS of surface EMG during the early gains in strength should not be directly related to the changes in the neural drive. The relatively small but long-lasting elevated free resting calcium after high-resistance strength training could result in force potentiation and EMG increase.     

Comparison of amplitudes of surface macro motor unit potentials recorded from various muscle sites

Peak-to-peak amplitudes and total areas of surface macro motor unit potentials (S-MMUPs) were measured in 19 healthy volunteers. While participants maintained minimal isometric muscle contraction of the left biceps brachii, motor unit potentials (MUPs) were recorded from a needle and surface electrodes. The largest MUP recorded by the needle electrode was designated the trigger source. Electrical activities from the surface electrodes, which emerged synchronously with the trigger-potential, were averaged by the spike-triggered averaging (STA) technique. When the surface electrodes were placed over the muscle belly at a right angle to the muscle fibers, the S-MMUP amplitude and area decreased gradually with the distance of the electrodes from the point of insertion of the needle electrode. In contrast, when the surface electrodes were arranged parallel to the muscle fibers, the S-MMUP amplitude and area did not always decrease. In addition, negative peak positions in individual S-MMUPs showed a time delay along the muscle fibers. The placement and size of the surface electrodes, as well as the depth of the needle electrode, must be carefully considered when MUPs are analyzed by the STA technique. Muscle fiber conduction velocity (MFCV) is measurable by the STA technique combined with surface electrodes.     

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.     

Disintegration of the motor unit in post-polio syndrome. Part II. Electrophysiological findings in patients with post-polio syndrome

The aim of the study is to investigate the motor unit abnormalities in late postpolio muscular atrophy (PPMA) as compared to those found in patients who had polio 20-30 years prior to examination without any new clinical signs. The quantitative concentric needle EMG and a single fiber EMG techniques were employed. Spontaneous activity, the parameters of individual motor units potentials (MUP), number of complex potentials and their stability, jitter and blocking as well as fiber density (FD) have been evaluated. In PPMA patients (5 subjects) we found in newly weakened muscles: spontaneous activity, high percentage of complex potentials, increased jitter, increased FD. The EMG findings in muscles previously affected but without any signs of progression have been similar. In the patients with stable nonprogressing postpolio muscle atrophy (12) all MUP-s parameters indicated changes similar to PPMA but less marked in initially affected muscle with complete or incomplete recovery as well as sometimes in initially clinically unaffected muscles. These findings suggest that the signs of ongoing reinnervation processes persist many years after polio and that PPMA occurring later in life represents disintegration of the previously reinnervated motor units. It is still unclear whether this disintegration depends on decompensation by different factors of fully reinnervated motor units or whether most of the motor units after polio never regained a stable reinnervation.     

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.     

Extracellular potentials of human motor myelinated nerve fibers in normal case and in amyotrophic lateral sclerosis

The extracellular potentials of human motor myelinated fibres in an unbounded volume conductor, in normal case and in amyotrophic lateral sclerosis (ALS) are studied. Using our previous double-cable models of the fibres, the spatial and temporal distributions of the intracellular potentials are obtained. The intracellular potentials are then used as input to a line source model that allows to calculate the corresponding spatial and temporal distributions of the extracellular potentials at various radial distances in the surrounding volume conductor. For the normal and ALS cases, the radial decline of the peak-to-peak amplitude of the extracellular potential depends on the radial distance of the field point and increases with the increase of the distance. For given radial distances, two cases of spatial distributions of the extracellular potentials are investigated: the first case, based on the intracellular potentials at the times of nodal potential maxima and the second case, based on the intracellular potentials at the time interval from 0.2 ms to 1.0 ms at increments of 0.1 ms. For the same radial distances, the temporal distributions of the extracellular potentials are also explored. It is shown that in the case of adaptation, the temporal distributions of the extracellular potentials in the normal and ALS cases correspond well with electromyograms (EMG) from healthy subjects and ALS patients as reported in the literature. Simulation results indicate that the used models are rather promising tools in studying the main properties of compound action potentials in ALS patients which up till now have not been sufficiently well understood.     

Effect of spatial filtering on crosstalk reduction in surface EMG recordings

Increasing the selectivity of the detection system in surface electromyography (EMG) is beneficial in the collection of information of a specific portion of the investigated muscle and to reduce the contribution of undesired components, such as non-propagating components (due to generation or end-of-fibre effects) or crosstalk from nearby muscles. A comparison of the ability of different spatial filters to reduce the amount of crosstalk in surface EMG measurements was conducted in this paper using simulated signals. It focused on the influence of different properties of the muscle anatomy (changing subcutaneous layer thickness, skin conductivity, fibre length) and detection system (single, double and normal double differential, with two inter-electrode distances - IED) on the amount of crosstalk present in the measurements. A cylindrical multilayer (skin, subcutaneous tissue, muscle, bone) analytical model was used to simulate single fibre action potentials (SFAPs). Fibres were grouped together in motor units (MUs) and motor unit action potentials (MUAPs) were obtained by adding the SFAPs of the corresponding fibres. Interference surface EMG signals were obtained, modelling the recruitment of MUs and rate coding. The average rectified value (ARV) and mean frequency (MNF) content of the EMG signals were studied and used as a basis for determining the selectivity of each spatial filter. From these results it was found that the selectivity of each spatial filter varies depending on the transversal location of the measurement electrodes and on the anatomy. An increase in skin conductivity favourably affects the selectivity of normal double differential filters as does an increase in subcutaneous layer thickness. An increase in IED decreases the selectivity of all the analysed filters.     

Late reinnervation of the rat soleus muscle is differentially suppressed by chronic stimulation and by ectopic innervation

Soleus (SOL) and extensor digitorum longus (EDL) muscles in adult rats were kept denervated for 2 months by four repeated freezes at 2-week intervals of the sciatic nerve. Reinnervation was studied in the absence or presence of chronic muscle stimulation, starting 1 month before reinnervation began. In addition, reinnervation was studied in SOL muscles where a previously transplanted fibular (FIB) nerve had formed ectopic neuromuscular junctions outside the original endplate area. After repeated freezes only, reinnervation was complete judged by tension measurements and histochemical examinations in SOL (n = 7) and EDL (n = 8) muscles. In directly stimulated muscles reinnervation was incomplete, and the force tensions evoked from indirect stimulation was on average 87 (n = 5) and 82% (n = 5) of direct muscle stimulation in SOL and EDL muscles, respectively. Of ectopically innervated SOL muscle fibres, only 26% became reinnervated in 12 muscles. Denervation and reinnervation increased the number of muscle fibres in stimulated (n = 4) and unstimulated (n = 5) EDL muscles by 18 and 15%, respectively. In stimulated (n = 4) and unstimulated (n = 7) SOL muscles, on the other hand, the number of muscle fibres remained normal. The stronger suppression of reinnervation in ectopically reinnervated compared to chronically stimulated SOL fibres indicates that reinnervation can also be suppressed by activity independent influences from the foreign nerve.     

Innervation ratio is an important determinant of force in normal and reinnervated rat tibialis anterior muscles.

1. The technique of glycogen depletion and periodic acid-Schiff (PAS) staining, which identifies glycogen-free muscle fibers, was used to directly count the number (N) and measure the cross-sectional area (CSA) of muscle fibers in single motor units (MUs) from normal and reinnervated tibialis anterior (TA) muscles. Indirect estimates, derived from the proportions of muscle fiber types to MU types, were also made, and force per unit area (or specific force, SF) was calculated. Previous results using direct and indirect approaches have been contradictory. To shed more light on this issue, the relative contributions of N, mean fiber area (A), and SF to muscle-unit force were determined by the use of both methods. 2. TA muscles were examined in experimental rats 3.5-10 mo after cutting and resuturing the common peroneal nerve in one hindlimb and in muscles in age-matched control rats. Ventral roots were dissected to isolate and characterize single MUs according to contraction speed, sag, and fatigability. One unit per muscle was selected for repetitive tetanic stimulation designed to deplete muscle fiber glycogen stores. Muscles were removed for identification of the unit with the PAS reaction and histochemical fiber typing by the use of modified standard techniques. 3. In the total population of MUs sampled, isometric tetanic force ranged from 5 to 441 mN in normal muscles and from 5 to 498 mN in reinnervated muscles, and the mean values were not significantly different. In the smaller sample of glycogen-depleted units from normal muscle, for a force range of 14-217 mN, N varied from 57 to 202, and A varied from 1,135 +/- 45 to 6,706 +/- 172 (SE) microns2. Within each unit the variation in fiber area is broad. After reinnervation, for a force range of 30-278 mN, N varied from 70 to 374, and A varied from 1,694 +/- 81 to 5,425 +/- 93 microns2. Mean fiber number was 153 +/- 18 in reinnervated muscle, which is significantly higher (P less than 0.01) than the normal value of 121 +/- 9. 4. The contribution of N and A to MU tetanic force was assessed by plotting each factor as a function of force on a log-log scale. N accounts for 39% and A for 49% of the variation in force in normal muscle. The contributions are changed after reinnervation where N, accounting for 65% of force, appears to compensate for the reduced range in A, which accounts for only 19% of the variation in force.(ABSTRACT TRUNCATED AT 400 WORDS)     

The formation of synapses in reinnervated and cross-reinnervated adult avian muscle

1. A study has been made of the formation of synapses in spontaneously reinnervated and cross-reinnervated anterior latissimus dorsi (ALD) and posterior latissimus dorsi (PLD) muscles of adult fowls.2. Denervated ALD and PLD muscle fibres have a uniform and high sensitivity to iontophoretically applied acetylcholine (ACh). During early reinnervation the sensitivity distribution to ACh of the ALD muscle fibres begins to return to normal before synaptic potentials can be evoked. The normal ACh sensitivity distribution of PLD muscle fibres is also restored after reinnervation. After cross-reinnervation of the ALD and PLD muscles the ACh sensitivity distribution of many of the muscle fibres is again restored to normal.3. Reinnervating and cross-reinnervating ALD nerve terminals showed a greater than normal degree of facilitation of transmitter release when a test impulse was applied at various intervals after a conditioning impulse. Cross-reinnervating PLD nerve terminals showed facilitation of transmitter release rather than the normal depression in a conditioning-test impulse sequence.4. The distribution of nerve terminals over the surface of spontaneously reinnervated and cross-reinnervated ALD and PLD muscle fibres has been determined from an examination of the sensitivity distribution to applied ACh, the graded versus all-or-none nature of the evoked potential and the distribution of cholinesterase stained synapses.5. The results suggest that the innervation pattern of individual ALD and PLD muscle fibres is restored both after spontaneous reinnervation and cross-reinnervation.     

Influence of motor unit synchronization on amplitude characteristics of surface and intramuscularly recorded EMG signals

The increase in muscle strength without noticeable hypertrophic adaptations is very important in some sports. Motor unit (MU) synchronisation and higher rate of MU activation are proposed as possible mechanisms for such a strength and electromyogram (EMG) increase in the early phase of a training regimen. Root mean square and/or integrated EMG are amplitude measures commonly used to estimate the adaptive changes in efferent neural drive. EMG amplitude characteristics could change also because of alteration in intracellular action potential (IAP) spatial profile. We simulated MUs synchronization under different length of the IAP profile. Different synchronization was simulated by variation of the percent of discharges in a referent MU, to which a variable percent of remaining MUs was synchronized. Population synchrony index estimated the degree of MU synchronization in EMG signals. We demonstrate that the increase in amplitude characteristics due to MU synchronization is stronger in surface than in intramuscularly detected EMG signals. However, the effect of IAP profile lengthening on surface detected EMG signals could be much stronger than that of MU synchronization. Thus, changes in amplitude characteristics of surface detected EMG signals with progressive strength training could hardly be used as an indicator of changes in neural drive without testing possible changes in IAPs.     

Adaptive fuzzy k-NN classifier for EMG signal decomposition

An adaptive fuzzy k-nearest neighbour classifier (AFNNC) for EMG signal decomposition is presented and evaluated. The developed classifier uses an adaptive assertion-based classification approach for setting a minimum classification threshold. The similarity criterion used for grouping motor unit potentials (MUPs) is based on a combination of MUP shapes and two modes of use of motor unit firing pattern information: passive and active. The performance of the developed classifier was evaluated using synthetic signals with specific properties and experimental signals and compared with the performance of an adaptive template matching classifier, the adaptive certainty classifier (ACC). Across the sets of simulated and experimental EMG signals used for comparison, the AFNNC had better average classification performance overall, but due to the assignment of higher numbers of MUPs it made relatively more errors. Nonetheless, these increased error rates would still be acceptable for most clinical uses of decomposed EMG data. An independent and a related set of simulated signals were used for testing. For the independent simulated signals of varying intensity, the AFNNC had on average an improved correct classification rate (CCr) (8.1%) but an increased error rate (Er) (1.5%) compared to ACC. For the related simulated signals with varying amounts of shape and/or firing pattern variability, the AFNNC on average had an improved CCr (5%) but a slightly increased Er (0.3%) compared to ACC. For experimental signals, the AFNNC on average had improved CCr (6%) but an increased Er (2.1%) compared to ACC. The greatest gains in AFNNC performance relative to that of the ACC occurred when the variability of MUP shapes within motor unit potential trains was high suggesting that compared to a template matching assignment strategy the NN assignment paradigm is better able to ameliorate the classification problems caused by MUP instability.     

Facioscapulohumeral muscular dystrophy. A quantitative electromyographic study

BACKGROUND: Quantitative electromyography (EMG) using different needle techniques has not been performed or reported on a relatively large group of patients with facioscapulohumeral muscular dystrophy (FSHD). Purpose: To establish statistically: (1) correlations between clinical features of patients (age, disease duration and degree of weakness) and quantitative needle EMG/SFEMG,; (2) correlations between different EMG parameters in the patient group, and (3) quantitative EMG differences comparing patients with a healthy control group. METHODS: Nerve conduction studies, and needle EMG (motorunit analysis, MacroEMG, SFEMG) were performed on Mm. triceps brachii and Mm. tibialis anterior according to standard techniques on 20 patients with FSHD. RESULTS: Nerve conduction studies were normal. In Mm. triceps brachii and, to a lesser extent, Mm. tibialis anterior motorunit analysis and MacroEMG showed myopathic changes, that correlated with patient clinical parameters. In Mm. triceps brachii (but not in Mm. tibialis anterior) EMG results were statistically different in patients compared to control group data. The most sensitive indicators of a myopathy were MUP duration (motorunit analysis) and MUP area (MacroEMG). In the Mm. triceps brachii SFEMG revealed correlations between worsening pooled MCD data and patient clinical parameters. Pooled MCD results did not correlate with other MUP parameters. SFEMG showed abnormal jitter only in 2 patients with the longest disease duration. CONCLUSION: Quantitative EMG results are compatible with a mild, slowly progressive myopathy. The most sensitive indicators of early muscle disease were MUP duration (motorunit analysis) and MUP area (MacroEMG) that would not be detected on "routine" EMG SFEMG showed subtle, progressive worsening of neuromuscular junction physiology. However, quantitative EMG and SFEMG showed that muscle fiber degeneration and loss followed a course independent of muscle fiber regeneration and reinnervation.     

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.     

Botulinum toxin in the masseter muscle: Lingering effects of denervation

Botulinum neurotoxins (BoNTs) are paralytic agents used to treat a variety of conditions in jaw muscles. Although their effect is considered temporary, there are reports of persistent functional changes. Using rabbits that received BoNT injection in one masseter muscle, the recovery of neuromuscular connection was investigated using nerve stimulation to evoke an electromyographic (EMG) response, and the recovery of muscle fibers was investigated using histological morphometry and bromodeoxyuridine (BrdU) immunohistochemistry. One month after treatment, evoked EMG was greatly reduced in both amplitude and duration, indicating that little reinnervation had taken place. Muscle fibers were atrophied and collagenous tissue was increased. Three months after treatment, evoked EMG duration was normal, indicating that at least some neuromuscular junctions were functional. Histologically, some muscle fibers were hypertrophied, some were still atrophied, and some appeared to have died. Fibrosis was still apparent amid slight increases in dividing cells and regenerating fibers. The histological effects of BoNT were evident although attenuated at a distance of about 1 cm from the injection level, but no regional differences could be discerned for the evoked EMGs. In conclusion, there were persistent muscular deficits seen 3 months after BoNT treatment that may have been caused by the failure of some affected muscle fibers to become reinnervated.