A method for positioning electrodes during surface EMG recordings in lower limb muscles

PURPOSE: The aim of this work is to provide information about the degree of inter-subject uniformity of location of innervation zone (IZ) in 13 superficial muscles of the lower limb. The availability of such information will allow researchers to standardize and optimize their electrode positioning procedure and to obtain accurate and repeatable estimates of surface electromyography (sEMG) signal amplitude, spectral variables and muscle fiber conduction velocity. METHODS: Surface EMG signals from gluteus maximus, gluteus medius, tensor faciae latae, biceps femoris, semitendinosus, vastus medialis obliquus, vastus lateralis, rectus femoris, tibialis anterior, peroneus longus, soleus, gastrocnemius medialis and lateralis muscles of ten healthy male subjects aged between 25 and 34 years (average = 29.2 years, S.D. = 2.5 years) were recorded to assess individual IZ location and signal quality. RESULTS: Tensor faciae latae, biceps femoris, semitendinosus, vastus lateralis, gastrocnemius medialis and lateralis showed a high level of both signal quality and IZ location uniformity. In contrast, rectus femoris, gluteus medius and peroneus longus were found to show poor results for both indexes. Gluteus maximus, vastus medialis obliquus and tibialis anterior were found to show high signal quality but low IZ location uniformity. Finally, soleus muscle was found to show low signal quality but high IZ location uniformity. CONCLUSIONS: This study identifies optimal electrode sites for muscles in the lower extremity by providing a standard landmarking technique for the localization of the IZ of each muscle so that surface EMG electrodes can be properly positioned between the IZ and a tendon.     

Reinnervation of the gastrocnemius muscle by the contralateral S1 nerve root

Functional regeneration after transposition of a ventral nerve root was established in the adult cat. Reconstruction of the ventral root, using microsurgical methods, directed the right S1 ventral nerve root to innervate the left gastrocnemius muscle. Stimulus-induced unit responses were recorded from the left gastrocnemius muscle 5 to 8 months after the root cross, demonstrating the reestablishment of neuromuscular connections. The innervation of the left gastrocnemius muscle by neurons in the right ventral horn of the spinal cord was verified by injecting horseradish peroxidase into the muscle. Horseradish peroxidase reaction product was located in alpha and gamma motor neurons in the right S1 segment of the spinal cord. Computer-assisted determination of the soma area of the labeled neurons was compared with a normal S1 innervation of the gastrocnemius muscle. Analysis of the percentage of cells of a given soma area demonstrated an overall decrease in soma area in the operated animals. Because ventral root reconstruction can result in innervation of a foreign muscle, studies such as this may encourage repair or reconstruction of nerve roots to gain some functional recovery after spinal cord or nerve root injuries.     

Improved Motor Function of Denervated Rat Hindlimb Muscles Induced by Embryonic Spinal Cord Grafts

Loss of motoneurons results in a decrease in force production by skeletal muscles and paralysis. Although it has been shown that missing motoneurons of rats can be replaced by embryonic homotopic neurons, attempts to guide their axons to their target muscles that have lost their innervation have been unsuccessful. In this study attempts were made to guide axons from grafted embryonic motoneurons to their target via a reimplanted ventral root. Adult hosts that received an embryonic graft prelabelled with 5-bromo-2′-deoxyuridine had their L4 ventral root avulsed and reimplanted into the spinal cord. Three to six months later, neurons that had their axons in the L4 ventral ramus were retrogradely labelled with fast blue and diamidino yellow. In five animals that had received an embryonic graft 116 ± 16 cells were retrogradely labelled, and of these at least 15% were of graft origin, since they were positive for 5-bromo-2′-deoxyuridine. In five animals that had their L4 ventral root reimplanted but did not receive a graft, only 12 ± 1.3 cells were retrogradely labelled. However, meaningful functional recovery could be achieved only if the regenerating axons of embryonic motoneurons found in the L4 ventral ramus were able to reverse the loss of force of muscles that had lost their innervation. This study shows that axons of embryonic motoneurons grafted into an adult rat spinal cord, as well as some axons of host origin, can be guided to denervated hindlimb muscles via reimplanted lumbar ventral roots. In normal rats ～30 motor axons innervated the extensor digitorurn longus and 60 innervated the tibialis anterior via the L4 ventral root. In rats that did not receive a graft only 3.7 ± 1.2 axons reached the extensor digitorum longus and 3.5 ± 0.4 reached the tibialis anterior muscle via the implanted L4 ventral root. In animals that had an embryonic graft, 7.6 ± 0.5 axons innervated the extensor digitorum longus and 8.5 ± 0.5 reached the tibialis anterior muscle via the implanted root. In rats without a transplant the maximum tetanic tension elicited by stimulating the implanted L4 root was 16 ± 7 g for the extensor digitorum longus and 53 ± 36 g for the tibialis anterior muscle, whereas the corresponding muscles in animals that had an embryonic graft developed 82 ± 16 and 281 ± 95 g respectively. Thus it appears that the grafted motoneurons contributed to the innervation and functional recovery of the denervated muscles.     

Spinal innervation of flexor hallucis longus in the cat

The segmental levels of the innervation of the flexor hallucis longus (FHL) in the cat have been unclear. To clarify the location of the spinal innervation of the FHL, physiologic techniques were used both to identify the ventral roots supplying the FHL and to relate the distribution of its segmental innervation to that of another calf muscle, the soleus, in the same cat. The soleus was used as a reference because its innervation has been consistently located by several investigators using a variety of techniques. The contributions of the various lumbosacral ventral roots were assessed by measuring the muscle contractions produced by electrically stimulating individual roots. The FHL was found to be supplied only by roots L6 and L7 and the soleus, as reported by previous investigators, only by L7 and S1. In every cat, at least some part of the innervation to the FHL was rostral to that of the soleus. Comparison of these results with those of Sherrington, Romanes, and Jefferson strongly suggests that the FHL in the present study corresponds to the adjacent synergistic muscle labeled flexor digitorum longus by Sherrington and Romanes.     

Innervation and Properties of the Rat FDSBQ Muscle: An Animal Model to Evaluate Voluntary Muscle Strength after Incomplete Spinal Cord Injury

Muscles innervated from spinal segments close to the site of a human spinal cord injury are often under voluntary control but are weak because they are partially paralyzed and partially denervated. Our objective was to develop an animal model of this clinical condition to evaluate strategies to improve voluntary muscle strength. To do so, we examined the spinal and peripheral innervation of the flexor digitorum superficialis brevis quinti (FDSBQ) muscle of the rat foot, characterized the muscle and motor unit properties, and located the FDSBQ motoneurons. Retrograde labeled motoneurons were in L4 to L6 spinal cord. Unilateral stimulation of L4 to S1 ventral roots and recording of evoked force showed that FDSBQ motor axons exited via two ventral roots (L5 and L6 or L6 and S1) in 38% of rats and via one ventral root in 62% of rats. FDSBQ motor axons traveled via two peripheral nerves, the lateral plantar (76% of axons) and sural nerves (24%). Each ventral root contributed motor axons to each nerve branch. Thus, by combining conduction block of one peripheral nerve to induce partial muscle paralysis and ventral root section to induce partial denervation, it is possible to produce in one rat muscle the consequences of many human cervical spinal cord injuries. FDSBQ muscles and motor units were mainly fast-twitch, fatigable, and composed of fast-type muscle fibers. The narrow range of motor unit forces (1-13 mN), the low mean twitch force (5.1 +/- 0.3 mN), and the large number of motoneurons (31 +/- 4) suggest that rat FDSBQ muscle is a good model of distal human musculature which is frequently influenced by spinal cord injury. We conclude that the FDSBQ muscle and its innervation provide a useful animal model in which to study the consequences of many spinal cord injuries which spare some descending inputs but also induce substantial motoneuron death near the lesion.     

Muscle MRI findings of X-linked spinal and bulbar muscular atrophy

We report here muscle MRI findings of the lower limb in X-linked spinal and bulbar muscular atrophy (SBMA). T1-weighted imaging of muscle MRI disclosed that the thigh muscles, including the semimembranosus, biceps femoris longus and the vastus lateralis muscles, showed high intensity signals with atrophy. Contrarily, the sartorius, gracilis and rectus femoris muscles were comparably preserved. Not only the thigh muscles, but also the calf muscles including the gastrocnemius medialis and lateralis, and soleus muscles showed high intensity signals. In amyotrophic lateral sclerosis (ALS), the leg muscles are generally atrophic, but the selective pattern of fatty degeneration, seen in SBMA was not observed. Muscle MRI is a useful method of estimating the distribution and severity of SBMA in affected muscles.     

Muscle responses to radicular stimulation during lumbo-sacral dorsal rhizotomy for spastic diplegia: Insights to myotome innervation

ObjectiveMost of knowledge on muscle radicular innervation was from explorations in root/spinal cord pathologies. Direct and individual access to each of the lumbar-sacral -ventral and dorsal- nerve roots during dorsal rhizotomy for spastic diplegia allows precise study of the corresponding muscle innervation. Authors report the lumbo-sacral segmental myotomal organization obtained from recordings of muscle responses to root stimulation in a 20-children prospective series.MethodsSeven key-muscles in each lower limb and anal sphincter were Electromyography (EMG)-recorded and clinically observed by physiotherapist during L2-to-S2 dorsal rhizotomy. Ventral roots (VR), for topographical mapping, and dorsal roots (DR), for segmental excitability testing, were stimulated, just above threshold for eliciting muscular response.ResultsIn 70% of the muscles studied, VR innervation was pluri-radicular, from 2-to-4 roots, with 1 or 2 roots being dominant at each level. Overlapping was important. Muscle responses to DR stimulation were 1.75 times more extended compared to VR stimulation. Inter-individual variability was important.ConclusionsAccuracy of root identification and stimulation with the used method brings some more precise information to radicular functional anatomy.SignificanceThose neurophysiological findings plead for performing Intra-Operative Neuromonitoring when dealing with surgery in the lumbar-sacral roots.     

Announcement

The purpose of this study was to investigate innervation of transplanted supernumerary hindlimbs in the frog (Xenopus laevis). Motoneurons innervating identified muscles in normal and supernumerary limbs were located by the method of retrograde transport of HRP after intramuscular injection. In the lumbar spinal cord of normal Xenopus, motoneurons supplying medial hindlimb muscles, which are derived from the ventral muscle mass during development, are located at the medial end of the motor column; those innervating lateral, dorsallyderived muscles, lie at the lateral end of the motor column. In animals with supernumerary limbs, motoneurons supplying the transplant usually occupied the same mediolateral position as those supplying the same muscle in the normal limb. However, the rostrocaudal location of these motor pools exhibited greater flexibility. When the transplant was innervated by a rostral nerve of the lumbar plexus, motoneurons supplying gastrocnemius could be located in a region of the spinal cord whose motoneurons do not normally innervate this muscle. There is thus no rigid requirement that gastrocnemius motoneurons be located at specific segmental levels. Motoneurons supplying gastrocnemius in the normal limb on the experimental side showed normal rostrocaudal distributions, indicating little rearrangement of these motor pools. Dorsal root ganglion cells labeled after HRP injection could be concentrated in a ganglion which normally supplies little or no innervation to the injected muscle. The location of these cells confirmed the segmental source of sensory innervation of the extra limb; i.e., there was no stray innervation. Animals with supernumerary limbs exhibited little or no increase in the number of motoneurons on the extra limb side. In contrast, dorsal root ganglion cell populations exhibited a large increase on the experimental side.     

Functional over-load saves motor units in the SOD1-G93A transgenic mouse model of amyotrophic lateral sclerosis

The fastest, most forceful motor units are lost progressively during asymptomatic disease in the SOD1^G93A transgenic mouse model of amyotrophic lateral sclerosis. As the disease progresses the surviving motor units must increase their levels of activity to sustain posture and movement. If activity-dependent conversion of motor units to more fatigue resistant types increased their resilience and hence survival, we hypothesized that an experimental increase in motor unit activity in the hindlimb muscles of the SOD1^G93A transgenic mouse should “save” those motor units that are normally lost in the first 90 days of age. To test this hypothesis, we partially denervated hindlimb muscles in SOD1^G93A and their corresponding control SOD1^WT transgenic mice by avulsion of either L4 or L5 spinal roots at 40 days of age. Whole muscle and single motor unit isometric twitch forces were recorded and the numbers intact motor units in fast-twitch tibialis anterior, medial gastrocnemius, extensor digitorum longus muscles and the slow-twitch soleus muscle were calculated at 90 days of age. We found that the rapid age-dependent decline in numbers of functional motor units in fast-twitch muscles of the SOD1^G93A transgenic mice was dramatically reduced by the functional hyperactivity in the partially denervated muscles and, that these muscles comprised a significantly higher component of type IIA and type IID/X fibers than those muscles that were innervated by nerves in intact spinal roots. We conclude that the vulnerable motor units are saved by increasing their neuromuscular activity and consequently, converting them to slower, less forceful, fatigue resistant motor units.     

A flexible electrode array for determining regions of motor function activated by epidural spinal cord stimulation in rats with spinal cord injury

Epidural stimulation of the spinal cord is a promising technique for the recovery of motor function after spinal cord injury.The key challenges within the reconstruction of motor function for paralyzed limbs are the precise control of sites and parameters of stimulation.To activate lower-limb muscles precisely by epidural spinal cord stimulation,we proposed a high-density,flexible electrode array.We determined the regions of motor function that were activated upon epidural stimulation of the spinal cord in a rat model with complete spinal cord,which was established by a transection method.For evaluating the effect of stimulation,the evoked potentials were recorded from bilateral lowerlimb muscles,including the vastus lateralis,semitendinosus,tibialis anterior,and medial gastrocnemius.To determine the appropriate stimulation sites and parameters of the lower muscles,the stimulation characteristics were studied within the regions in which motor function was activated upon spinal cord stimulation.In the vastus lateralis and medial gastrocnemius,these regions were symmetrically located at the lateral site of L1 and the medial site of L2 vertebrae segment,respectively.The tibialis anterior and semitendinosus only responded to stimulation simultaneously with other muscles.The minimum and maximum stimulation threshold currents of the vastus lateralis were higher than those of the medial gastrocnemius.Our results demonstrate the ability to identify specific stimulation sites of lower muscles using a high-density and flexible array.They also provide a reference for selecting the appropriate conditions for implantable stimulation for animal models of spinal cord injury.This study was approved by the Animal Research Committee of Southeast University,China(approval No.20190720001) on July 20,2019.     

Congenital focal muscle dysplasia in the lower extremities from probable abnormal innervation: a case report.

A two-year-seven-month-old girl with pes equinovarus congenita, muscle hypotonia and weakness limited to the lower extremities is presented. Upon admission to our hospital, she could stand with support but could not walk alone. Serum creatine kinase level was normal and the electromyogram was nondiagnostic. The muscle CT disclosed an almost total absence of bilateral vastus lateralis and medialis, rectus femoris and gastrocnemius muscles. The biopsied vastus lateralis muscle was almost completely replaced by fat tissue, and a small amount of muscle tissue showed uniform type 1 fiber and an aggregate of atrophic fibers in one fascicle. Because of an absence of progressive muscle weakness and neurogenic EMG findings, the authors conclude that the muscle pathology was due to the congenital anomalous condition of probable abnormal innervation to developing muscles.     

Plasminogen activators in the neuromuscular system of the wobbler mutant mouse

Wobbler, the neurological mutant mouse, carries an autosomal recessive gene (wr) and has been characterized as a model of lower motoneuron disorders with associated muscle atrophy, denervation and reinnervation. During normal murine neuromuscular development a decrease in muscle plasminogen activator (PA) activity accompanies synapse maturation. In contrast, experimental denervation in adult mice leads to an increase in muscle PA activity. The purpose of the present study was to determine the possible involvement of PAs in the denervation/ reinnervation phenomena and motoneuron degeneration that characterize the wobbler mutant mouse. We determined the degree of innervation and its characteristics in wobbler mice by measuring choline acetyltransferase (ChAT) activity. We measured ChAT in the spinal cord as well as in two different muscles known to be differentially affected, biceps brachii and gastrocnemius. We found a sharp decrease of ChAT activity in both muscles but not in spinal cord extracts. We estimated the extent of sprouting by the silver/chilinesterase stain. Motoneuron terminal sprouting, not detected in normal animals, was present in 40% of the neuromuscular junctions in wobbler mice. We estimated specific PA activities in biceps brachii and gastrocnemius muscle extracts, as well as spinal cord extracts, using both an amidolytic assay and fibrin zymography. Increased PA, predominantly urokinase-PA (uPA), was observed in wobbler mouse muscle. A greater uPA was detected in biceps brachii muscle than in gastrocnemius muscle, which is less impaired by the mutation. There was no change in spinal cord PA, although tissue type PA (tPA) is the predominant PA type there. The present study demonstrates an activation of a specific serine protease, urokinase PA, in wobbler mouse muscle and may support the hypothesis of its involvement in the pathogenesis of lower motoneuron diseases.     

Longitudinal structure and innervation of two mammalian hindlimb muscles

The possibility of a topographic relationship between the spinal cord and the longitudinal axis of a muscle has been explored in two mammalian hamstring muscles: the rat semitendinosus (ST) and biceps femoris (BF). In both muscles the fibers did not extend the full length of the respective muscle bellies but were arranged in longitudinal arrays. There were two such arrays in BF and three in ST; monopolar recordings revealed that each array had a transverse band of endplates extending across the middle part. By stimulating ventral nerve roots in the lumbosacral outflow, it was found that L5 made the greatest contribution to the innervation of both ST and BF, with lesser inputs coming from adjacent roots. In neither ST or BF was there any evidence of a topographic relationship between the spinal cord and the muscle belly.     

Somatotopic relations between spinal motoneurones and muscle fibres of the cat's musculus peroneus longus

The cat's m.peroneus longus was analyzed with respect to the somatotopic relation between the rostro-caudal site of emergence of ventral root filaments (i.e. rostro-caudal site of motoneurones) and the intramuscular distribution of innervation. Rostro-caudally distinct fractions of ventral roots were stimulated repetitively in order to deplete their respective muscle fibres of glycogen. The intramuscular position of glycogen-depleted fibres was analyzed in transverse sections from different proximo-distal levels. At each level, depleted muscle fibres were dispersed across the whole muscle. No consistent relation was found between the spinal site of origin of a ventral root filament and the proximo-distal distribution of its fibres within the pennate muscle. A significant and evident tendency was found, however, for rostral root filaments (i.e. rostral motoneurones) to inervate a greater number of muscle fibres in anterior than in posterior muscle portions. For caudal root filaments, the opposite pattern of innervation was observed.     

L4-to-L4 nerve root transfer for hindlimb hemiplegia after hypertensive intracerebral hemorrhage

There is no effective treatment for hemiplegia after hypertensive intracerebral hemorrhage.Considering that the branches of L4 nerve roots in the lumbar plexus root control the movement of the lower extremity anterior and posterior muscles,we investigated a potential method of nerve repair using the L4 nerve roots.Rat models of hindlimb hemiplegia after a hypertensive intracerebral hemorrhage were established by injecting autogenous blood into the posterior limb of internal capsule.The L4 nerve root on the healthy side of model rats was transferred and then anastomosed with the L4 nerve root on the affected side to drive the extensor and flexor muscles of the hindlimbs.We investigated whether this method can restore the flexible movement of the hindlimbs of paralyzed rats after hypertensive intracerebral hemorrhage.In a beam-walking test and ladder rung walking task,model rats exhibited an initial high number of slips,but improved in accuracy on the paretic side over time.At 17 weeks after surgery,rats gained approximately 58.2%accuracy from baseline performance and performed ankle motions on the paretic side.At 9 weeks after surgery,a retrograde tracing test showed a large number of fluoro-gold-labeled motoneurons in the left anterior horn of the spinal cord that supports the L4-to-L4 nerve roots.In addition,histological and ultramicrostructural findings showed axon regeneration of motoneurons in the anterior horn of the spinal cord.Electromyography and paw print analysis showed that denervated hindlimb muscles regained reliable innervation and walking coordination improved.These findings suggest that the L4-to-L4 nerve root transfer method for the treatment of hindlimb hemiplegia after hypertensive intracerebral hemorrhage can improve the locomotion of hindlimb major joints,particularly of the distal ankle.Findings from study support that the L4-to-L4 nerve root transfer method can effectively repair the hindlimb hemiplegia after hypertensive intracerebral hemorrhage.All animal experiments were approved by the Animal Ethics Committee of the First Affiliated Hospital of Nanjing Medical University(No.IACUC-1906009)in June 2019.     

Neuroprotection and Axonal Regeneration After Lumbar Ventral Root Avulsion by Re-implantation and Mesenchymal Stem Cells Transplant Combined Therapy

Ventral spinal root avulsion causes complete denervation of muscles in the limb and also progressive death of segmental motoneurons (MN) leading to permanent paralysis. The chances for functional recovery after ventral root avulsion are very poor owing to the loss of avulsed neurons and the long distance that surviving neurons have to re-grow axons from the spinal cord to the corresponding targets. Following unilateral avulsion of L4, L5 and L6 spinal roots in adult rats, we performed an intraspinal transplant of mesenchymal stem cells (MSC) and surgical re-implantation of the avulsed roots. Four weeks after avulsion the survival of MN in the MSC-treated animals was significantly higher than in vehicle-injected rats (45 % vs 28 %). Re-implantation of the avulsed roots in the injured spinal cord allowed the regeneration of motor axons. By combining root re-implantation and MSC transplant the number of surviving MN at 28 days post-injury was higher (60 %) than in re-implantation alone animals (46 %). Electromyographic tests showed evidence of functional re-innervation of anterior tibialis and gastrocnemius muscles by the regenerated motor axons only in rats with the combined treatment. These results indicate that MSC are helpful in enhancing neuronal survival and increased the regenerative growth of injured axons. Surgical re-implantation and MSC grafting combined had a synergic neuroprotective effect on MN and on axonal regeneration and muscle re-innervation after spinal root avulsion.     

MRI findings of benign monomelic amyotrophy of lower limb.

We report here magnetic resonance imaging (MRI) findings of two patients with benign monomelic amyotrophy of lower limb. Both subjects showed unilateral amyotrophy of the lower limb with a benign clinical course, and the affected muscles demonstrated neurogenic changes. On T1- and T2-weighted MRI, marked atrophy and increased signal intensity were found mainly in gastrocnemius and soleus muscles. Moreover, MRI examination also revealed that thigh muscles including semitendinosus, semimembranosus, and vastus intermedius and lateralis muscles were involved in one of the patients. We concluded that muscle MRI is very useful for detecting affected muscles, especially deep skeletal muscles in patients with benign monomelic amyotrophy of lower limb.     

High expression of MHC I in the tibialis anterior muscle of a paraplegic patient

A long-term paraplegic man presented exclusively (>99%) myosin heavy chain I (MHC I) in the tibialis anterior muscle (TA). This was coupled to a slow speed of contraction, a high resistance to fatigue, and a rapid resynthesis of phosphocreatine after an electrically evoked fatiguing contraction when compared with the TA muscles of 9 other paraplegic individuals. In contrast, the MHC composition of his vastus lateralis, gastrocnemius, and soleus muscles was that expected of a muscle from a spinal cord injured individual. This information may be of clinical importance in terms of the expected morphological and functional adaptations of skeletal muscle to different types of electrical stimulation therapy.     

Neurochemical Characterization of the TRPV1-Positive Nociceptive Primary Afferents Innervating Skeletal Muscles in the Rats

Objective

Transient receptor potential vanilloid subfamily type 1 (TRPV1), a most specific marker of the nociceptive primary afferent, is expressed in peptidergic and non-pepetidergic primary afferents innervating skin and viscera. However, its expression in sensory fibers to skeletal muscle is not well known. In this study, we studied the neurochemical characteristics of TRPV1-positive primary afferents to skeletal muscles.

Methods

Sprague-Dawley rats were injected with total 20 µl of 1% fast blue (FB) into the gastrocnemius and erector spinae muscle and animals were perfused 4 days after injection. FB-positive cells were traced in the L4-L5 (for gastrocnemius muscle) and L2-L4 (for erector spinae muscle) dorsal root ganglia. The neurochemical characteristics of the muscle afferents were studied with multiple immunofluorescence with TRPV1, calcitonin gene-related peptide (CGRP) and P2X₃. To identify spinal neurons responding to noxious stimulus to the skeletal muscle, 10% acetic acids were injected into the gastrocnemius and erector spinae muscles and expression of phospho extracellular signal-regulated kinase (pERK) in spinal cords were identified with immunohistochemical method.

Results

TRPV1 was expressed in about 49% of muscle afferents traced from gastrocnemius and 40% of erector spinae. Sixty-five to 60% of TRPV1-positive muscles afferents also expressed CGRP. In contrast, expression of P2X₃ immnoreaction in TRPV1-positive muscle afferents were about 20%. TRPV1-positive primary afferents were contacted with spinal neurons expressing pERK after injection of acetic acid into the muscles.

Conclusion

It is consequently suggested that nociception from skeletal muscles are mediated by TRPV1-positive primary afferents and majority of them are also peptidergic.     

强直性肌营养不良Ⅰ型临床、病理、骨骼肌磁共振特点

目的总结11例强直性肌营养不良Ⅰ型(DM1)患者的临床、病理和双下肢肌肉受累的特点。方法回顾性分析2012年01月至2020年10月就诊于南京鼓楼医院神经内科的11例DM1患者的临床、骨骼肌活检病理及5例双下肢骨骼肌磁共振的特点。结果11例患者均有不同程度的肌强直、伴有肌无力/肌萎缩症状,肌无力/肌萎缩远端重于近端。骨骼肌病理特点:10/11例患者可见Ⅰ型肌纤维轻度萎缩,部分患者可见核内移、核聚集、肌浆块现象。双下肢肌肉磁共振:5例患者双下肢远端脂肪浸润重于近端,双侧肌肉受累程度不对称,大腿肌肉脂肪浸润以股中间肌最严重,小腿肌肉以腓肠肌、比目鱼肌、腓骨长肌最严重。结论骨骼肌磁共振对诊断强直性肌营养不良Ⅰ型有重要的提示意义。