P32-S Application of decomposition based quantitative EMG (DQEMG) to focal neuropathies

Abstract

Background EMG signals can be decomposed into their constituent motor unit potential trains and further analyzed using specific signal processing algorithms which provide novel and useful information regarding the temporal and electrophysiological behaviour and morphological attributes of motor units. In low to moderate stages of focal neuropathies (when only focal demyelination or low axonal sensory affection is registered) traditional needle EMG evaluation is usually normal. However, DQEMG provides evidence of motor unit instability in a significant portion of otherwise normal muscles. Material and methods 20 case and 9 control subjects were studied with median and ulnar ENG, quantitative EMG and DQEMG (abductor pollicis brevis, first dorsal interosseus or abductor digiti minimi). Patients with symptoms suggesting focal median or ulnar neuropathies were selected as cases, except for those showing low-median compound muscle action potential amplitudes or needle EMG abnormalities. Control subjects were included when no ENG nor needle EMG abnormalities findings were encountered. Results 75% of cases with any focal demyelinating finding showed instability features in DQEMG, which were also found in 43% of the normal ENG and control groups. Applying more restrictive DQEMG criteria, instability was found in 63% of cases with focal ENG alterations and 43% with normal ENG, while the control group showed no abnormalities. Conclusions Decomposition-based quantitative EMG is a novel and more powerful tool for detecting abnormalities in motor unit potentials, compared with the classical quantitative or semi-quantitative needle EMG analysis.