Complete bilateral internal ophthalmoplegia as sole clinical sign of botulism: confirmation of diagnosis by single fibre electromyography

Summary A case of complete bilateral internal ophthalmoplegia as the sole clinical sign of botulism is reported. Diagnosis was immediately confirmed by single-fibre electromyography (SFEMG), which revealed abnormally high blocking (14.3%), contrasting with moderately increased jitter (mean consecutive difference in the extensor digitorum communis muscle, 43.9 s). After giving equine botulinum antitoxin and simultaneous forced emptying of the bowels, ocular symptoms completely disappeared within 2 days. Six days, 5 weeks and 6 months after the first SFEMG study, the jitter was still abnormal, even becoming more so with time. Blocking, however, was only rarely observed in the follow-up studies. It is concluded that SFEMG may serve as a useful and sensitive method for the rapid diagnosis of botulinum intoxication, even in cases where no clinical signs of general muscular weakness are apparent.This paper was presented in part at the Congress of the International Medical Society of Motor Disturbances (ISMD), Rome, Italy, 2–4 June 1988     

Reversal of profound paralysis: use of large doses of edrophonium to antagonize vecuronium and pancuronium induced neuromuscular blockade

The ability to evoke reversal of dense vecuronium- and pancuronium-induced paralysis (T1 10% of control) with edrophonium 1.0 mg.kg-1 was studied using train-of-four nerve stimulation and electromyographic monitoring. Two different end-points, train-of-four ratios of 0.5 and 0.7, were used to define "adequate reversal", and the results for both relaxants were compared. Reversal was reliable and rapid for vecuronium if either ratio was used with times of 2.8 (1.5) and 9 (3) min required to achieve ratios of 0.5 and 0.7, respectively. However, if the block was due to pancuronium, reversal was unreliable with 2 of 9 and 4 of 9 patients not achieving ratios of 0.5 and 0.7, respectively. Reversal was also markedly prolonged in this group with a mean time of 37 (23) min to achieve a ratio of 0.7, and in almost half these patients a supplementary dose of edrophonium was required.     

Neuromuscular function and mechanical efficiency of human leg extensor muscles during jumping exercises

The influence of prestretch amplitude on the mechanical efficiency was examined with 5 subjects, who performed 5 different series of vertical jumps, each of which differed with respect to the mechanics of the knee joint action during the prestretch (eccentric) phase of the contact on the floor. Electromyographic activity was recorded from the major extensor muscles during the entire work period of 1 min per series. In addition, expired air was collected during the test and recovery for determination of energy expenditure. Mechanical work was calculated from the vertical displacement of the body during the jumps. The results indicated that high net efficiency of 38.7% was observed in condition where amplitude of knee bending in eccentric phase was small. In large range motion the corresponding net efficiency was 30.1%. In jumps where no prestretching of extensor muscles ocurred the net efficiency was 19.7%. The high efficiency of small amplitude jumps was characterized by low myoelectrical activity of the leg extensor muscles during the positive (concentric) work phase. In addition, the small amplitude jumps had shorter transition time in the stretch-shortening cycle, high average eccentric force and high stretching speed. Therefore the results suggest that the restitution of elastic energy, which was also related to the length change and stiffness of the muscles during stretch, plays an important role in regulating the mechanical efficiency of work.     

Correlation-based decomposition of surface electromyograms at low contraction forces

The paper studies a surface electromyogram (SEMG) decomposition technique suitable for identification of complete motor unit (MU) firing patterns and their motor unit action potentials (MUAPs) during low-level isometric voluntary muscle contractions. The algorithm was based on a correlation matrix of measurements, assumed unsynchronised (uncorrelated) MU firings, exhibited a very low computational complexity and resolved the superimposition of MUAPs. A separation index was defined that identified the time instants of an MU's activation and was eventually used for reconstruction of a complete MU innervation pulse train. In contrast with other decomposition techniques, the proposed approach worked well also when the number of active MUs was slightly underestimated, if the MU firing patterns partly overlapped and if the measurements were noisy. The results on synthetic SEMG show 100% accuracy in the detection of innervation pulses down to a signal-to-noise ratio (SNR) of 10 dB, and 93±4.6% (mean± standard deviation) accuracy with 0 dB additive noise. In the case of real SEMG, recorded with an array of 61 electrodes from biceps brachii of five subjects at 10% maximum voluntary contraction, seven active MUs with a mean firing rate of 14.1 Hz were identified on average.     

Experimental muscle pain changes motor control strategies in dynamic contractions

This study investigated the effect of muscle pain on muscle activation strategies during dynamic exercises. Ten healthy volunteers performed cyclic elbow flexion/extension movements at maximum speed for 2 min after injection of (1) hypertonic (painful) saline in the biceps brachii, (2) hypertonic saline in both biceps brachii and triceps brachii, and (3) isotonic (nonpainful) saline in the biceps brachii muscle. Surface electromyographic (EMG) signals were collected from the upper trapezius, biceps brachii, triceps brachii, and brachioradialis muscles (to estimate EMG amplitude) and with an electrode arrays from biceps brachii (to estimate muscle fiber conduction velocity [CV]). In all conditions, the acceleration of the movement decreased throughout the exercise, and kinematic parameters were not altered by pain. With respect to the control condition, pain induced a decrease of the biceps brachii (mean ± SE, –23±4%) and brachioradialis (–10±0.4%) integrated EMG (IEMG) in the beginning of the exercise, and an increase (45±3.5%) of the upper trapezius IEMG at all time points during the exercise. The biceps brachii IEMG decreased over time during the nonpainful exercises (–11±0.6%) while it remained constant in the painful condition. Biceps brachii CV decreased during painful conditions (–12.8±2.2%) while it remained constant during the nonpainful condition. In conclusion, muscle pain changes the motor control strategy to sustain the required dynamic task both in the relative contribution between synergistic muscles and in the motor unit activation within the painful muscle. Such a changed motor strategy may be highly relevant in models of occupational musculoskeletal pain conditions.     

Electromyographic and affective responses of episodic tension-type headache patients and headache-free controls during stressful task performance

Thirty-four subjects meeting diagnostic criteria for episodic tension-type headache and 42 who rarely experienced headaches participated in two laboratory sessions in which cephalic electromyographic (EMG) activity, electrodermal activity, heart rate, and finger temperature were recorded. Subjects performed relaxation, choice reaction time, psychomotor tracking, voluntary muscle contraction, and cold pressor tasks. Headache subjects showed significantly greater EMG activity than controls during baseline and stressful task performance. During relaxation, both groups reduced EMG activity from baseline levels, and there was no significant difference in EMG level between the groups during relaxation. Headache subjects reported higher levels of subjective anxiety, depression, anger, and stress than controls. Headache subjects also reported higher levels of pain than controls, and headache subjects reported greater pain during stressful task performance relative to baseline and recovery periods.This research was supported by NIH Grant R01-NS-25114.     

Effects of spontaneously chosen crank rate variations on electromyographic responses in sub-maximal arm exercise in inexperienced subjects

The aim of the present study was to compare electromyographic responses during arm exercises with a crank rate chosen spontaneously (T_S) or set at 20% below or above (T_–20, T₊₂₀) the spontaneously chosen crank rate (SCCR). Ten male physical education students performed arm exercises with intensities ranging from 20% to 80% of maximal power. Muscular activity levels were analysed for the biceps brachii and the triceps brachii muscles using integrated rectified surface electromyography (iEMG). All values were presented as the mean and standard deviation. During T_S, the sum of iEMG for the two muscles studied was significantly (P<0.05) lower than during T₊₂₀ for each power output. No significant differences were observed in iEMG values between T_S and T_–20. The hypothesis that SCCR relates to a minimisation of muscle activation during an upper body exercise was not confirmed. Variations superior or inferior to a 20% increase of the iEMG responses do not influence it. Moreover, the selection of crank rates depends on the power output and the SCCR increased significantly (P<0.05) with increasing power output.     

甲状腺功能亢进性肌病的肌电图分析

目的 :通过对甲状腺功能亢进患者的肌电图检测 ,以了解其对甲状腺功能亢进性肌病的应用价值。方法 :对 5 2例甲状腺功能亢进患者进行常规肌电图检测。结果 :发现甲状腺功能亢进患者在无肌病症状体征时肌电图可出现异常。结论 :提示过多的甲状腺激素可能是引起肌肉受损并出现肌电异常的基础 ;表明肌电对检测甲状腺功能亢进性肌肉损害较为敏感 ,可发现临床的肌肉损害。肌电图的恢复可作为观测甲状腺功能亢进得到有效控制的一种指标。     

基于体表生理信号的呼吸功能监测仪研制

目的：研制一款基于体表心电、膈肌电和胸阻抗信号的呼吸功能监测仪原理样机,可在家庭、医疗急救等场合实现对呼吸功能的持续监测。方法：以STM32F411VET6单片机开发系统为平台,用一对Ag/AgCl电极作为高频激励信号的输出和心电、胸阻抗信号的检测电极,另一对Ag/AgCl电极作为膈肌电信号检测电极,两对电极同时检测心电、膈肌电和胸阻抗信号。系统硬件主要包括心电信号检测电路、胸阻抗信号检测电路、膈肌电信号检测电路、恒流源激励电路以及微控制器。系统采用12 V可充电锂电池供电,模拟信号通过单片机A/D转换成数字信号,通过SDIO接口存储于SD卡。在完成样机制作和性能测试之后,采集13例因呼吸功能障碍实施机械通气患者和13例健康成年人的信号,计算15个与呼吸功能相关的参数,比较机械通气患者与健康对照组参数之间的差异,验证了呼吸功能监测仪的可靠性。结果：样机采集信号的信噪比>10 dB、共模抑制比>80 dB,样机漏电流<30μA。机械通气患者的吸气时间、呼气时间、潮气量、胸阻抗峰峰值、胸阻抗1 s变化量、膈肌电低频功率、膈肌电高频功率、高频比低频、膈肌放电面积、膈肌放电时...     

Automatic decomposition electromyography in idiopathic inflammatory myopathies

Automatic decomposition electromyography (ADEMG) is a commercially available software package with installed reference values that enables the objective measurement of motor unit action potentials (MUAPs). To assess the diagnostic yield of this package in idiopathic inflammatory myopathies (IIM) we performed biceps brachii ADEMG in 17 patients with polymyositis, dermatomyositis and inclusion body myositis. Results were compared with those in 12 controls, and with the results of conventional EMG of the biceps and other muscles. Decreased mean values for MUAP duration occurred significantly more frequently in IIM patients than in controls; other MUAP characteristics did not differ. In IIM patients, decreased mean amplitude and increased mean number of turns occurred significantly less frequently on ADEMG than did corresponding abnormalities on conventional biceps EMG. Decreased mean values for duration and amplitude, and increased mean values for number of turns were seen significantly less often on ADEMG than corresponding abnormalities on conventional EMG of four different, individually chosen muscles. Overall evaluation of ADEMG resulted in a diagnosis of possible myopathy in 1 and probable myopathy in 8 patients, whereas overall evaluation of conventional EMG led to a diagnosis suggestive of IIM in 13 patients. We conclude that, although measurement of mean MUAP duration might be valuable in IIM diagnosis, our results do not favour the use of biceps brachii ADEMG and the installed reference values for the diagnosis of IIM. We suggest modifications to improve ADEMG's applicability.