Propagated insertional activity: a model of positive sharp wave generation

In this study we utilized a dual monopolar needle recording technique to assess propagated electromyographic insertional activity from the same single muscle fiber in order to characterize different categories of insertional activity. A total of six combinations of insertional activity were identified. Only two fundamental types of single muscle-fiber insertional discharge configurations were generated: biphasic initially-negative and monophasic positive. The propagated waveforms corresponding to these two insertional discharges were primarily triphasic initially-positive and, only rarely, monophasic positive. The monophasic positive insertional activity generated at the inserting electrode site is postulated to arise from a depolarization zone adjacent to a needle-induced peri-electrode membrane crush. The monophasic positive discharge was utilized as a model for positive sharp wave generation. It is postulated that the majority of positive sharp waves are initiated at the inserting electrode adjacent to a needle-induced zone of muscle membrane crush in contrast to the previous supposition that positive sharp waves are blocked fibrillation potentials.     

Single muscle fiber discharge transformations: Fibrillation potential to positive sharp wave

It is presently believed that a fibrillation potential (FP) can transform into a positive sharp wave (PSW) by displaying a number of individual transitional potentials with a high degree of morphological variation between different sets of independent transformations. Clinically obtained examples of FP-to-PSW transformations and a myotonic discharge transformation are simulated by a finite fiber computer model. The simulations demonstrate that the two clinical FP-to-PSW examples may well be the result of two independent muscle fibers synchronously firing for a short period of time such that their separate waveforms summate at the electrode to create a false impression of one potential changing into another through a specific series of transitional waveforms. The transition characterized by the myotonic discharge is substantiated through modeling to define the most reasonable transitional series of waveform morphologies for a single muscle fiber. The combination of clinical examples, histological needle electrode muscle penetration studies, and simulations of single muscle fiber discharge transitions support the hypothesis that a needle recording electrode is capable of inducing a variable degree of mechanical compression with a commensurate amount of action potential blockade. The degree of action potential blockade directly contributes to the clinically observed configuration for the single muscle fiber discharge in both innervated and denervated tissues. © 1998 John Wiley & Sons, Inc. Muscle Nerve 21: 1759–1768, 1998     

Normal needle electromyographic insertional activity morphology: A clinical and simulation study

Needle electromyographic insertional activity waveform morphology, and mechanisms of generation, have received little attention. This study analyzes the individual component waveforms that contribute to the burst of electrical activity known as insertional activity. One hundred monopolar needle insertions were slowly performed and high speed recorded to allow better separation of the contributing individual component waveforms. Analysis of the many waveforms recorded demonstrates several classes of potentials. All of these could be reconstructed by the summation of two basic or elementary waveform patterns: a biphasic initially negative spike with or without a “prepotential” similar to an end-plate spike, and the biphasic initially positive spike with a slowly declining negative phase, similar to a positive sharp wave, though shorter in duration. The relationship between these elementary waveforms and their hypothesized generator sources is discussed. © 1998 John Wiley & Sons, Inc. Muscle Nerve 21:910–920, 1998.