Motor Unit Action Potential Duration Research Articles

Artificial intelligence-based classification of motor unit action potentials in real-world needle EMG recordings

ObjectiveTo develop an artificial neural network (ANN) for classification of motor unit action potential (MUAP) duration in real-word, unselected and uncleaned needle electromyography (n-EMG) recordings. MethodsTwo nested ANN models were trained, the first discerning muscle rest, contraction and artifacts in n-EMG recordings from 2674 individual muscles from 326 patients obtained as part of daily care. The second ANN model subsequently used segments labeled as contraction for prediction of prolonged, normal and shortened MUAPs. Model performance was assessed in one internal and two external validation datasets of 184, 30 and 50 muscles, respectively. ResultsThe first model discerned rest, contraction and artifacts with an accuracy of 96%. The second model predicted prolonged, normal and shortened MUAPs with an accuracy of 67%, 83% and 68% in the different validation sets. ConclusionsWe developed a two-step ANN that classifies rest, muscle contraction and artifacts from real-world n-EMG recordings with very high accuracy. MUAP duration classification had moderate accuracy. SignificanceThis is the first study to show that an ANN can classify MUAPs in real-world n-EMG recordings highlighting the potential for AI assisted MUAP classification as a clinical tool.

Identification of a Novel ARSA Gene Mutation Through High-Throughput Molecular Diagnosis Method in Two Girls with Late Infantile Metachromatic Leukodystrophy.

Metachromatic leukodystrophy (MLD) is a rare leukoencephalopathy caused by pathogenic mutations in the ARSA gene. It manifests as severe motor symptoms, mental problems, and sometimes, seizures. We aimed to investigate the phenotypic manifestations and genetic causes of MLD in an Iranian family. We present the case of a 3-year-old girl who presented with hypotonia, muscular atrophy, and seizures. Neurological and neuromuscular examinations were performed to evaluate clinical characteristics. Whole exome sequencing (WES) was used to detect disease-causing variants. In silico analysis was performed to predict the pathogenicity of this variant. GROMACS software was utilized for molecular dynamic simulation (MDS). Neurological studies revealed marked slowing of motor conduction velocities and an increased motor unit action potential duration. Brain MRI scan revealed white matter abnormalities. By applying WES, we identified a novel homozygous missense variant (NM_000487.6, c.938G > C, p.R313P) in ARSA. Direct sequencing identified this homozygous variant in her asymptomatic younger sister, whereas both parents carried a heterozygous variant. This mutation has not been reported in genetic databases or in literature. In silico analysis predicted that any variation in this DNA position would cause disease, as it is highly conserved. The c.938G > C variant was classified as a pathogenic variant according to ACMG/AMP guidelines. MDS analysis indicated that c.938G > C had a significant impact on both the structure and stabilization of ARSA, ultimately resulting in impaired protein function. The identification of this variant expands the spectrum of ARSA gene mutations associated with MLD and highlights the importance of genetic testing for the diagnosis of MLD.

Early Activation of Quadriceps With Pressure Biofeedback for the Prevention of Arthrogenic Muscle Inhibition Following Lower Limb Orthopedic Surgeries: A Proof of Concept Clinical Trial

ObjectiveThe purpose of this study was to explore the possible role of pressure biofeedback in the early activation of quadriceps following lower limb orthopedic surgeries. MethodsThis was a proof of concept clinical trial. A single-blinded randomized controlled study was conducted on 24 patients who underwent lower limb surgeries. The experimental group received standardized physiotherapy treatment in addition to pressure biofeedback for quadriceps retraining. The control group received a standardized physiotherapy treatment developed for an inpatient orthopedic setting. The motor unit action potential (MUAP) duration and amplitude were measured using electromyography on the second and sixth postoperative days. ResultsTwenty-four participants, with a mean age for the control group of 58.67 ± 17.21 and the experimental group of 40.1 ± 6.96, were enrolled. No statistical significance in MUAP amplitude for within the groups (F[5,85] = 1.735, P = .135) was found. However, there was a statistical significance between the control and experimental groups in amplitude measured by electromyography (F[1,17] = 49.09, P < .01). There was no statistical significance in MUAP duration for within the groups (F[5,85] = 1.303, P = .270). However, there was a statistical significance in duration (F[1,17] = 71.84, P < .01). ConclusionPressure biofeedback was more effective in the early activation of quadriceps muscle when coupled with conventional exercises compared with conventional exercises alone following lower limb orthopedic surgeries. Early activation of quadriceps could be a contributing factor to preventing arthrogenic muscle inhibition.

Relevant muscle selection for needle electromyography examination in polio survivors

Objectives: Needle electromyography (EMG) has an important role in the diagnosis of poliomyelitis. Since needle EMG is a painful and time consuming procedure, selecting the most effective muscles for needle EMG is important. We aimed to determine the clinically or subclinically affected regions in polio survivors by examining the minimum number of muscles with EMG. Methods: Polio survivors with weakness in at least one limb were included in this retrospective cohort study. The extremities were divided into two groups: 1) Group 1: The extremities with Medical Research Council score of ≤ 1 in at least one muscle, 2) Group 2: Clinically unaffected or mildly to moderately affected extremities that do not meet the criteria of Group 1. The needle EMG findings of the muscles were analyzed. Results: Twenty-nine polio survivors were included in the study. Needle EMG findings of 352 muscles were reviewed. Needle EMG findings in 57 lower extremities and thirty-two upper extremities were analyzed. There was no upper extremity meeting the criteria of Group 1. Thirty-eight lower extremities were included in Group 1. The amplitudes and durations of motor unit action potentials (MUAPs) were not different between the muscles of the Group 1 lower extremities (p &amp;gt; 0.05). Among the muscles of Group 2 upper and lower extremities, the amplitude and duration of MUAPs were higher in the deltoid and the vastus lateralis muscles compared to the other muscles, respectively (p = 0.002 and p = 0.003 for upper extremity muscles; p = 0.005 and p &amp;lt; 0.001 for lower extremity muscles). Conclusions: Using the needle EMG findings, an algorithm was made to determine the affected regions. Thus, the affected regions can be identified by applying needle EMG to a minimum number of muscles.

A new method for measurement of motor unit action potential duration based on correlation, a pilot study.

We present a new, automatic, correlation-based method for measuring the duration of motor unit action potentials (MUAPs). The method seeks to replicate the way an expert elctromyographer uses his or her eyes, calculating the start and end of the MUAP waveform on the basis of the degree of similarity of non-excluded discharges. We analysed 68 potentials from normal deltoid muscles during slight contraction. For each MUAP, two experienced electromyographers manually determined start and end marker positions, which were used as gold standard duration positions (GSP) in our subsequent tests. The novel method was compared with Nandedkar's method and a wavelet transform-based method. To compare the three methods, the differences between the automatic marker positions and GSPs were statistically evaluated using one-factor ANOVA, the estimated mean square error, and a Chi-square test on the numbers of automatic marker placements with gross errors. All these parameters showed smaller values for the novel method and in most of the cases were statistically significant. In addition, the parameters of the new method were subjected to a sensitivity study, showing its good performance within a range of clinically useful parameter values. The new automatic method determined start and end markers in a more accurate and reliable manner than both of the acknowledged state-of-the art methods used in our comparison study. Graphical abstract The description of a new automatic duration measurement algorithm based on the similarity among discharges of the same MUAP. This method gave better results than the Nandedkar method and a highly regarded wavelet-based method. The new correlation-based method also had the lowest rate of gross aberrant errors in automatic placements.

Electromyographic findings in sporadic inclusion body myositis

IntroductionClinically oriented diagnostic criteria can be as specific for diagnosis of sporadic inclusion body myositis (sIBM) as pathological criteria, especially at the time of presentation. EMG may provide an convincing proof that a muscle biopsy should be performed. AimsTo compare the EMG results in patients with sIBM divided into subgroups based on the newest ENMC criteria for sIBM and to obtain the utility of EMG in the diagnostic process at the time of presentation. MethodsWe retrospectively analysed 16 patients with sIBM for motor unit action potential (MUAP) morphology as well as occurrence and distribution of abnormal spontaneous activity (SA) in muscles. ResultsAbnormal SA was recorded in 62.5% of sIBM patients. We found statistically significant differences between subgroups in the incidence of polyphasic MUAPs and high amplitude outliers which were more commonly seen in the “clinico-pathologically defined sIBM”. Duration of MUAP in the tibialis anterior was significantly shorter in “probable sIBM”. Discussion“Pseudo-neurogenic” MUAPs, mainly in lower limb muscles, are more commonly seen in “clinico-pathologically defined sIBM” while myopathic MUAPs with prominent abnormal SA are recorded in patients diagnosed with “probable sIBM”. Both EMG patterns may be suggestive of sIBM and be an indication for further diagnosis.

Electrophysiological and histological changes of paraspinal muscles in adolescent idiopathic scoliosis.

The pathogenesis of adolescent idiopathic scoliosis (AIS) remains poorly understood. To date, potentially involved local changes in the deep paraspinal muscles still remain unknown. Needle electromyography (EMG) and muscle biopsy of paraspinal muscles at convexity and concavity of the AIS main thoracic curve were performed in 25 subjects. In this group, EMG was performed in 16 AIS subjects (12 females, 12-27years), muscle biopsy in 18 AIS subjects (15 females, 11-31years) compared to 10 non-scoliotic controls (6 females, 12-55years). Samples of muscle tissue were removed during corrective surgery and were examined histologically, enzyme histochemically and immunohistochemically. Both methods of EMG and muscle biopsy were performed in 9 subjects (7 women, 12-27years). Right curve convexity was found in 24 AIS subjects. Amplitudes of motor unit action potentials (MUPs) were significantly increased on the AIS curve convexity versus concavity. Turns, duration and phases of MUPs were without any significant changes. In all 18 subjects, the histological examination revealed muscle fiber redistribution with numerical predominance of type I on the curve convexity which strongly correlated with the progression of the Cobb angle. Our findings demonstrate significant changes of muscle fiber redistribution in the paraspinal muscles of AIS with increased proportion of type I on the convexity corresponding to a significantly higher amplitude of MUPs on the same side. A possible explanation of this alteration is a secondary adaptation due to chronic high load demand.

Motor Unit Characteristics after Targeted Muscle Reinnervation.

Targeted muscle reinnervation (TMR) is a surgical procedure used to redirect nerves originally controlling muscles of the amputated limb into remaining muscles above the amputation, to treat phantom limb pain and facilitate prosthetic control. While this procedure effectively establishes robust prosthetic control, there is little knowledge on the behavior and characteristics of the reinnervated motor units. In this study we compared the m. pectoralis of five TMR patients to nine able-bodied controls with respect to motor unit action potential (MUAP) characteristics. We recorded and decomposed high-density surface EMG signals into individual spike trains of motor unit action potentials. In the TMR patients the MUAP surface area normalized to the electrode grid surface (0.25 ± 0.17 and 0.81 ± 0.46, p < 0.001) and the MUAP duration (10.92 ± 3.89 ms and 14.03 ± 3.91 ms, p < 0.01) were smaller for the TMR group than for the controls. The mean MUAP amplitude (0.19 ± 0.11 mV and 0.14 ± 0.06 mV, p = 0.07) was not significantly different between the two groups. Finally, we observed that MUAP surface representation in TMR generally overlapped, and the surface occupied by motor units corresponding to only one motor task was on average smaller than 12% of the electrode surface. These results suggest that smaller MUAP surface areas in TMR patients do not necessarily facilitate prosthetic control due to a high degree of overlap between these areas, and a neural information—based control could lead to improved performance. Based on the results we also infer that the size of the motor units after reinnervation is influenced by the size of the innervating motor neuron.

The effect of recording site on extracted features of motor unit action potential

Motor unit action potential (MUAP), which consists of individual muscle fiber action potentials (MFAPs), represents the electrical activity of the motor unit. The values of the MUAP features are changed by denervation and reinnervation in neurogenic involvement as well as muscle fiber loss with increased diameter variability in myopathic diseases. The present study is designed to investigate how increased muscle fiber diameter variability affects MUAP parameters in simulated motor units. In order to detect this variation, simulated MUAPs were calculated both at the innervation zone where the MFAPs are more synchronized, and near the tendon, where they show increased temporal dispersion. Reinnervation in neurogenic state increases MUAP amplitude for the recordings at both the innervation zone and near the tendon. However, MUAP duration and the number of peaks significantly increased in a case of myopathy for recordings near the tendon. Furthermore, of the new features, “number of peaks×spike duration” was found as the strongest indicator of MFAP dispersion in myopathy. MUAPs were also recorded from healthy participants in order to investigate the biological counterpart of the simulation data. MUAPs which were recorded near to tendon revealed significantly prolonged duration and decreased amplitude. Although the number of peaks was increased by moving the needle near to tendon, this was not significant.

Changes in motor unit behavior following isometric fatigue of the first dorsal interosseous muscle.

The neuromuscular strategies employed to compensate for fatigue-induced muscle force deficits are not clearly understood. This study utilizes surface electromyography (sEMG) together with recordings of a population of individual motor unit action potentials (MUAPs) to investigate potential compensatory alterations in motor unit (MU) behavior immediately following a sustained fatiguing contraction and after a recovery period. EMG activity was recorded during abduction of the first dorsal interosseous in 12 subjects at 20% maximum voluntary contraction (MVC), before and directly after a 30% MVC fatiguing contraction to task failure, with additional 20% MVC contractions following a 10-min rest. The amplitude, duration and mean firing rate (MFR) of MUAPs extracted with a sEMG decomposition system were analyzed, together with sEMG root-mean-square (RMS) amplitude and median frequency (MPF). MUAP duration and amplitude increased immediately postfatigue and were correlated with changes to sEMG MPF and RMS, respectively. After 10 min, MUAP duration and sEMG MPF recovered to prefatigue values but MUAP amplitude and sEMG RMS remained elevated. MU MFR and recruitment thresholds decreased postfatigue and recovered following rest. The increase in MUAP and sEMG amplitude likely reflects recruitment of larger MUs, while recruitment compression is an additional compensatory strategy directly postfatigue. Recovery of MU MFR in parallel with MUAP duration suggests a possible role for metabolically sensitive afferents in MFR depression postfatigue. This study provides insight into fatigue-induced neuromuscular changes by examining the properties of a large population of concurrently recorded single MUs and outlines possible compensatory strategies involving alterations in MU recruitment and MFR.

Reliability of spike triggered averaging of the surface electromyogram for motor unit action potential estimation

The reliability of estimated motor unit parameters using spike triggered averaging (STA) of the surface electromyogram (sEMG) has not been tested thoroughly. We investigated factors that may induce amplitude bias in estimated motor unit action potentials (MUAPs) and shape variations. An sEMG record was simulated. MUAPs were then estimated from the STA of the simulated EMG. Variations in MUAP duration led to under-estimation of real MUAP amplitude, while synchronized firing led to over-estimation of amplitude. Spurious firing resulted in over-estimation of the amplitude of small motor units but under-estimation of the amplitude of large ones. Variability in amplitude and high firing rates had minimal influence on amplitude estimation. High firing rates and variation in MUAP duration led to large variations in MUAP shape. Estimation errors also correlated with shape variations. Recommendations to enhance the accuracy of the STA estimates have been proposed.

표면 운동단위 활동전위 스파이크 검출을 위한 최적의 디지털 저역통과 미분기 선정 방법

The objective of this study is to analyze the performance of digital low-pass differentiators(LPD) and then to provide a method to select effective LPD filter, for detecting spikes of surface motor unit action potentials(MUAP). The successful spike detection of MUAPs is a first important step for EMG signal decomposition. The performances of simple and weighted LPD(SLPD and WLPD) filters are analyzed based on different filter lengths and varying MUAPs from simulated surface EMG signals. The SNR improving coefficient and effective MUAP duration range from the analysis results can be used to select proper LPD filters under the varying conditions of surface EMG.

Motor Unit Number Estimation and Motor Unit Action Potential Analysis in Carpal Tunnel Syndrome

ObjectiveTo evaluate the clinical significance of motor unit number estimation (MUNE) and quantitative analysis of motor unit action potential (MUAP) in carpal tunnel syndrome (CTS) according to electrophysiologic severity, ultrasonographic measurement and clinical symptoms.MethodWe evaluated 78 wrists of 45 patients, who had been diagnosed with CTS and 42 wrists of 21 healthy controls. Median nerve conduction studies, amplitude and duration of MUAP, and the MUNE of the abductor pollicis brevis were measured. The cross sectional area (CSA) of the median nerve at the pisiform and distal radioulnar joint level was determined by high resolution ultrasonography. Clinical symptom of CTS was assessed using the Boston Carpal Tunnel Questionnaire (BCTQ).ResultsThe MUNE, the amplitude and the duration of MUAP of the CTS group were significantly different from those found in the control group. The area under the ROC curve was 0.944 for MUNE, 0.923 for MUAP amplitude and 0.953 for MUAP duration. MUNE had a negative correlation with electrophysiologic stage of CTS, amplitude and duration of MUAP, CSA at pisiform level, and the score of BCTQ. The amplitude and duration of MUAP had a positive correlation with the score of BCTQ. The electrophysiologic stage was correlated with amplitude but not with the duration of MUAP.ConclusionMUNE, amplitude and duration of MUAP are useful tests for diagnosis of CTS. In addition, the MUNE serves as a good indicator of CTS severity.

Application of a novel automatic duration method measurement based on the wavelet transform on pathological motor unit action potentials

To evaluate a recently published automatic duration method based on the wavelet transform applied on normal and pathological motor unit action potentials (MUAPs). We analyzed 313 EMG recordings from normal and pathological muscles during slight contractions. After the extraction procedure, 339 potentials were accepted for analysis: 68 from normal muscles, 124 from myopathic muscles, 20 from chronic neurogenic muscles, 83 from subacute neurogenic muscles and also 44 fibrillation potentials, as an example of very low duration muscular potentials. A "gold standard" of the duration positions (GSP) was obtained for each MUAP from the manual measurements of two senior electromyographists. The results of the novel method were compared to five well-known conventional automatic methods (CAMs). To compare the six methods, the differences between the automatic marker positions and the GSP for the start and end markers were calculated. Then, for the different groups of normal and pathological MUAPs, we applied: a one-factor ANOVA to compare their relative mean differences, the estimated mean square error (EMSE) and a Chi-square test about the rate of automatic marker placements with differences to the GSP greater than 5 ms, taken as gross errors. The mean and the standard deviation of the differences, the EMSE and the gross errors for the novel method were smaller than those observed with the CAMs in the five different MUAP groups and significantly different in most of the cases. The novel automatic duration method is more accurate than other available algorithms in normal and pathological MUAPs. Accurate MUAP duration automatic measurement is an important issue in daily clinical practice.

Motor Unit Action Potential Duration, I: Variability of Manual and Automatic Measurements

The aim of this work is to analyze the variability in manual measurements of motor unit action potential (MUAP) duration and to evaluate the effectiveness of well-known algorithms for automatic measurement. Two electromyographists carried out three independent duration measurements of a set of 240 MUAPs. The intraexaminer and interexaminer variabilities were analyzed by means of the Gage Reproducibility and Repeatability method. The mean of the three closest manually marked positions was considered the gold standard of the duration markers positions (GSP). The results of four well-known automatic methods for estimating MUAP duration were compared to the GSP. Manual measurements of duration showed a lot of variability, with the combined intraoperator and interoperator variability greater than 30%. The greatest difference between manual positions was 11.2 ms. The mean differences between the GSP and those obtained with the four automatic methods ranged between 0.6 and 8.5 ms. Both manual and automatic measurements of MUAP duration show a high degree of variability. More precise methods are needed to improve the accuracy and reliability of the estimates of this parameter.

Motor Unit Action Potential Duration, II: A New Automatic Measurement Method Based on the Wavelet Transform

The aim of this work is to present and evaluate a new algorithm, based on the wavelet transform, for the automatic measurement of motor unit action potential (MUAP) duration. A total of 240 MUAPs were studied. The waveform of each MUAP was wavelet-transformed, and the start and end points were estimated by regarding the maxima and minima points in a particular scale of the wavelet transform. The results of the new method were compared to the gold standard of duration marker positions obtained by manual measurement. The new method was also compared to a conventional algorithm, which we had found to be best in a previous comparative study. To evaluate the new method against manual measurements, the dispersion of automatic and manual duration markers were analyzed in a set of 19 repeatedly recorded MUAPs. The differences between the new algorithm's marker positions and the gold standard of duration marker positions were smaller than those observed with the conventional method. The dispersion of the new algorithm's marker positions was slightly less than that of the manual one. Our new method for automatic measurement of MUAP duration is more accurate than other available algorithms and more consistent than manual measurements.

P32.5 Influence of baseline fluctuation cancellation on automatic measurement of the motor unit action potential duration

The aim of this work is to analyze the influence of a method for baseline fluctuation (BLF) cancellation for electromyographic (EMG) signals on automatic methods for measurement of the motor unit action potential (MUAP) duration. These methods include four conventional automatic methods (CAMs) and a recently published wavelet transform method (WTM). A set of 182 MUAPs from 170 EMG recordings were studied. The CAMs and the WTM were applied to the MUAPs before and after applying BLF cancellation to the recordings. A gold standard of duration marker positions (GSP) ws manually established. The accuracy of each algorithm was estimated as the dfference between its positions and the GSP. Accuracies were compared for the 5 methods and for each method before and after BLF cancellation. A significant difference between accuracy preand post-BLF removal was found in two CAMs; markers were closer to the GSP after BLF removal. For all MUAPs, the differences between WTM markers and the GSP were the smallest, and significant differences were not found for the WTM before and after BLF cancellation. The management of BLF is an important issue in EMG signal processing and BLF removal must be considered in extraction and analyse of MUAP waveforms. The BLF removal method improved the performance of two CAMs for MUAP duration measurement. The WTM was the most accurate and was not affected by BLF. Ignacio Rodriguez Carreno Universidad de Navarra Depto. Metodos Cuantitativos Campus Universitario 31080 Pamplona irodriguezc@unav.es Luis Gila Useros Departamento de Neurofisiologia Clinica Hospital Virgen del Camino 31008 Pamplona luis.gila.useros@cfnavarra.es Armando Malanda Trigueros Universidad Publica de Navarra Depto. Ing. Electrica y Electronica 31006 Pamplona malanda@unavarra.es Javier Navallas Irujo Universidad Publica de Navarra Depto. Ing. Electrica y Electronica 31006 Pamplona javier.navallas@unavarra.es Javier Rodriguez Falces Universidad Publica de Navarra Depto. Ing. Electrica y Electronica 31006 Pamplona javier.rodriguez.falces@gmail.com Sagrario Gomez Elvira Universidad Publica de Navarra Depto. Estadistica e Investigacion Operativa 31006 Pamplona sgomez@unavarra.es

Iliopsoas: A new electromyographic technique and normal motor unit action potential values

Objective To describe a reliable technique of needle electrode examination and present the normal values of motor unit action potential (MUAP) parameters in iliopsoas muscle. Methods Thirty-one normal subjects underwent quantitative electromyographic (QEMG) examination of the iliopsoas muscle, following an ultrasonographically confirmed technique of needle electrode insertion and sampling. The leg under examination was flexed, abducted and externally rotated at the hip joint and also flexed at the knee joint. A slight flexion at the hip joint was used to uncover iliopsoas from the overlying sartorius. This provides enough space at the inguinal region between the sartorius and the femoral neurovascular bundle. Mean and outlier values of MUAP parameters and polyphasia were calculated. Results Our technique was easy to perform and secure in sampling iliopsoas. The mean±SD values for MUAP duration, amplitude, area, area to amplitude ratio, phases and turns were 11.5±1.35 ms, 419±71.5 μV, 633±142.7 μV ms, 1.57±0.25, 3.1±0.32, and 2.9±0.44, respectively. Lower and upper outlier limits for duration, amplitude, area and area to amplitude ratio were 3.6/20.7 ms, 150/930 μV, 100/1567 μV ms, and 0.35/3.07. Mean polyphasia was 12.6% (range 0–30%). Conclusions The suggested EMG technique helped to distinguish iliopsoas from sartorius and at the same time increased the accessibility of its anterior surface. Normal values and outlier limits of the MUAP parameters of iliopsoas have been quantitatively established. Significance This new technique and the normal MUAP values might prove helpful for the examination of iliopsoas, important in the assessment of many neuropathic and, especially, myopathic processes.

Sepsis induces early phrenic nerve neuropathy in rats

The aim of the present study was to investigate the electrophysiology of the phrenic nerve and the diaphragm muscle during sepsis. In total, 26 rats underwent either sham laparotomy or caecal ligation and puncture (CLP). Electrophysiology was evaluated via a phrenic nerve conduction study and needle electromyography of the diaphragm, prior to CLP, 6 and 24 h post-CLP and on day 7. The histopathology of the diaphragm muscle and phrenic nerve was also examined on day 7. In the sepsis group, the phrenic nerve conduction study showed decreased amplitude of compound action potential (CMAP), and prolongation in the duration and the latency of CMAP. The diaphragmatic needle electromyography showed decreased amplitude and frequency of the motor unit action potential (MUP), and prolongation in the duration of MUP, at all time points, compared with the pre-CLP values. The electrophysiological abnormalities were consistent with axonal and demyelinating phrenic nerve neuropathy. Electrophysiological abnormalities were present at 6 h with worsening at 24 h and on day 7. Histopathological examination showed normal muscular fibres and focally slight myelin degenerations of the phrenic nerve fibres. In conclusion, sepsis induced phrenic nerve neuropathy as early as the 6th h in rats.

Quantitative Electromyographic Examination in Myogenic Disorders of 6 Horses

Electromyographic needle examination (EMG), including the semiautomatic quantitative analysis of motor unit action potential (MUAP), is an important diagnostic tool for myopathy in humans. The diagnostic possibilities of this technique have not been fully explored in horses; however, recent studies have shown that MUAP analysis can be performed in conscious horses. To determine the diagnostic possibilities of EMG in horses, we compared the EMG results of the subclavian muscle, the triceps, and the lateral vastus muscle in 6 equine patients thought to have myogenic disorders with those in 7 normal control horses. The EMG results were compared with the results of the histopathologic examination of the lateral vastus muscle in patients and controls. Histopathologic examination showed muscle disease in 3 patients. In the patient group, several types of abnormal spontaneous activities were observed (mainly fibrillation potentials and positive sharp waves), and the MUAPs of the patient group had a markedly shorter duration and lower amplitude than those of the control group. In the subclavian muscle, triceps, and lateral vastus muscle of affected horses, the MUAP duration was 5.0 +/- 0.4 (mean +/- SD), 3.9 +/- 0.3, and 4.7 +/- 1.1 milliseconds, respectively. The MUAP amplitude was 217 +/- 55, 150 +/- 74, and 180 +/- 54 microV; the number of phases was 2.4 +/- 0.2, 2.5 +/- 0.3, and 2.3 +/- 0.1; and the number of turns was 2.6 +/- 0.2, 2.4 +/- 0.2, and 2.8 +/- 0.5, respectively. In conclusion, it appears that the EMG may be a more sensitive method than other techniques for examining muscle biopsies for diagnosis of early-stage myopathy in horses.