Stimulated Single-fiber Electromyography Research Articles

Single-fiber electromyography, nerve conduction studies, and conventional electromyography in patients with critical-illness polyneuropathy: evidence for a lesion of terminal motor axons.

Nine patients at risk for critical illness polyneuropathy (CIP) were included in a prospective study. We performed nerve conduction studies, electromyography, and a stimulation single-fiber electromyography (SFEMG). Five of 9 patients were diagnosed as CIP because they developed abnormal spontaneous activity during the follow-up period. Their SFEMG revealed a significant increase in mean jitter (25%, P < 0.005). In 4 patients without abnormal spontaneous activity there was no significant increase in the mean jitter, although 1 of the latter 4 patients showed an increased jitter, indicating that abnormal SFEMG may precede abnormal spontaneous activity. Nerve conduction studies did not show any significant changes in both patient groups. Our findings suggest that CIP is a primarily axonal motor neuropathy. The increased jitter in patients with CIP indicates that CIP is a primarily axonal neuropathy with a lesion of terminal motor axons.

Endplate dysfunction in healthy muscle following a period of disuse.

The objective of this study was to test the hypothesis that muscle disuse can result in abnormal neuromuscular transmission. Six healthy volunteers (2 females, mean age = 33 years) participated in the study. Cast immobilization of one leg, for a period of 4 weeks, was used as a model of disuse; the contralateral leg was used as a control. Three testing sessions, consisting of stimulation single fiber electromyography of the soleus muscle bilaterally, were done before, immediately after, and 4 weeks after cast removal. The main outcome measure was neuromuscular jitter, measured as the mean of the consecutive differences (MCD) of single muscle fiber potentials. A mean MCD was calculated for each muscle, and the data from all subjects was pooled to calculate a sample mean MCD. The control side showed good reproducibility of results between testing sessions. The experimental side showed a significant increase of the sample mean MCD after casting when compared to: preimmobilization values (P < 0.001), and to the control side (P < 0.001). After 4 weeks of recovery, the sample mean MCD returned to preimmobilization values. This study presents evidence that muscle disuse, without any neuromuscular disease, can result in a reversible dysfunction of neuromuscular transmission.

Endplate dysfunction in healthy muscle following a period of disuse

The objective of this study was to test the hypothesis that muscle disuse can result in abnormal neuromuscular transmission. Six healthy volunteers (2 females, mean age = 33 years) participated in the study. Cast immobilization of one leg, for a period of 4 weeks, was used as a model of disuse; the contralateral leg was used as a control. Three testing sessions, consisting of stimulation single fiber electromyography of the soleus muscle bilaterally, were done before, immediately after, and 4 weeks after cast removal. The main outcome measure was neuromuscular jitter, measured as the mean of the consecutive differences (MCD) of single muscle fiber potentials. A mean MCD was calculated for each muscle, and the data from all subjects was pooled to calculate a sample mean MCD. The control side showed good reproducibility of results between testing sessions. The experimental side showed a significant increase of the sample mean MCD after casting when compared to: preimmobilization values (P < 0.001), and to the control side (P < 0.001). After 4 weeks of recovery, the sample mean MCD returned to preimmobilization values. This study presents evidence that muscle disuse, without any neuromuscular disease, can result in a reversible dysfunction of neuromuscular transmission. © 1996 John Wiley & Sons, Inc.

Extrafusal and intrafusal muscle effects in experimental botulinum toxin-A injection

The effects of botulinum toxin-A was compared on both extrafusal and intrafusal muscle fibers in the biceps femoris of Wistar rats. Four days after injection no action potentials were elicited with stimulation single-fiber electromyography on the injected side. Fourteen days after injection, jitter became measurable and these values were increased on the injected side. Extrafusal muscle fibers began to atrophy on the 4th day and this continued to the 14th day postinjection. Atrophy was also evident and progressive in intrafusal muscle fibers. Increased terminal innervation ratios, end-plate spread of cholinesterase, and increased density of very small myelinated fibers in large intramuscular nerves were observed 14 days postinjection. Both extrafusal and intrafusal fibers are cholinergically innervated, and both were progressively affected by botulinum toxin, perhaps varying in degree only. In addition to partial denervation, Botulinum toxin effects in dystonia may also be related to modified spindle afferent discharge.

PS-34-2 Stimulated single fiber electromyography in myasthenia gravis and Lambert-Eaton myasthenic syndrome

Neuronal degradation accompanied by axonal degeneration has been known to occur in lower motor neurons following a stroke. In the present study, the functional integrity of neuromuscular transmission was assessed, utilizing a sensitive electrodiagnostic method consisting of stimulated single-fiber electromyography (SFEMG), along with axonal microstimulation, in paralytic muscles of stroke patients. Neuromuscular jitter was measured in the hemiplegic side extensor digitorum communis (EDC) as well as in anterior tibial (AT) muscles for 28 stroke patients and also for 13 age-matched controls. The disease duration, i.e. from the onset of stroke until the stimulated SFEMG examination, extended from 2 months to 8 years. Mean jitters obtained in EDC and AT muscles of stroke patients were found to be significantly greater than those in normal controls. Mean jitters obtained in severely weak muscles of stroke patients were greater than those in moderately weak muscles. Positive correlations were noted between the increased jitter and the disease duration from the onset of stroke until the time of the stimulated SFEMG test. These findings demonstrate a dysfunction of neuromuscular transmission in the paralytic muscles of stroke patients and suggests that trans-synaptic degeneration of motor neurons may occur in stroke. Furthermore, the neuronal degradation in stroke was positively correlated with the course duration of the disease.

PS-34-6 Stimulated single fiber electromyography in rat

PS-34-6 Stimulated single fiber electromyography in rat

Assessment of Stimulated Single-Fiber Electromyography in Paralytic Muscles of Patients with Spinal Cord Injury

Neuronal dropout accompanied with axonal degeneration may occur below the level of cord lesion after spinal cord injury (SCI). By using a sensitive electrodiagnostic method of stimulated single fiber electromyography (SFEMG), it is possible to assess the functional integrity of neuromuscular transmission in paralytic muscles of SCI. Neuromuscular jitter and fiber density were measured in 21 anterior tibial muscles of 18 patients with SCI and 11 muscles in 11 normal controls. The results showed an increased mean jitter value but without increased fiber density in SCI patients. There is a positive correlation between the increased jitter and the disease duration from the onset of cord lesion to the time of SFHMG test. This provides an electrophysiological evidence of axonal degeneration and dysfunction of neuromuscular transmission below the level of cord lesion in SCI. Also the neural degeneration may become prominent in the later course of the disease.

Assessment of Stimulated Single-Fiber Electromyography in Paralytic Muscles of Patients with Spinal Cord Injury

Assessment of Stimulated Single-Fiber Electromyography in Paralytic Muscles of Patients with Spinal Cord Injury

Stimulation frequency-dependent neuromuscular junction transmission defects in patients with prior poliomyelitis

Generalized fatigue and muscle fatiguability are major symptoms of post-poliomyelitis syndrome (PPS), and may be due to neuromuscular junction transmission defects, as suggested by increased jitter on single fiber electromyography (SFEMG). To determine the etiology of this defect, we studied jitter at low (1, 5 Hz) and high (10, 15, 20 Hz) frequency stimulation with stimulation SFEMG in 17 post-polio patients with muscle fatiguability, and in 9 normal controls. In 5 of 17 PPS patients and in 1 of 9 controls, jitter was significantly higher (unpaired t-test, P < 0.05) at high frequency stimulation (HFS). In the remaining PPS patients and controls there was no significant difference in jitter at high and low stimulation frequencies. PPS patients with increased jitter at HFS had a significantly longer time interval since acute polio (mean 48.5 years) than PPS patients without increased jitter at HFS (mean 40 years; P < 0.05), but were not distinguished by other historical or clinical criteria. We conclude that the neuromuscular junction defect in post-polio patients is similar to that observed in amyotrophic lateral sclerosis, and is probably due to ineffective conduction along immature nerve sprouts and exhaustion of acetylcholine stores. The appearance of an increase in jitter with HFS in post-polio patients may be dependent upon time after acute polio.

Stimulated single fibre electromyography in normal dogs

ABSTRACTA technique for the evaluation of neuromuscular transmission using single fibre electromyography was developed for the peroneus longus muscle of dogs. Individual muscle fibre action potentials were recorded in 10 dogs, with a specialised needle electrode, during repetitive axon‐al stimulation at the motor point of the right peroneus longus muscle. Variability in latency from stimulus artefact to action potential was evaluated for 50 to 100 consecutive discharges for several fibres in the muscle of each dog. Latency variability (jitter) was expressed as the mean of consecutive differences (MCD) in latency for each muscle fibre. A mean of MCDS was calculated for the muscle of each animal. The upper limits of normal for the peroneus longus suggested by this study are 30 us (for individual muscle fibres) and 19 μs (for mean of group of fibres).

Anticholinesterase-responsive neuromuscular junction transmission defects in post-poliomyelitis fatigue

Disabling generalized fatigue and muscle fatiguability are common features of post-poliomyelitis syndrome (PPS). In 17 fatigued PPS patients, we measured jitter on stimulation single-fiber electromyography (S-SFEMG) for at least 3.5 min before and after i.v. injection of 10 mg edrophonium. We observed reduction in jitter (defined as a significant difference in jitter means before and after edrophonium, unpaired t-test P < 0.05) in 7 patients, no change in 8, and a significant increase in 2 patients. Blinded to their edrophonium results, the 17 patients were treated with pyridostigmine 180 mg/day for 1 month, with a subjective improvement of fatigue in 9 patients, and with a significant reduction in mean Hare fatigue scores in the entire group of 17 patients ( pre = 2.71, and post = 1.71; Wilcoxan signed rank sum test, P < 0.05). Edrophonium-induced reduction of jitter on S-SFEMG was significantly associated with pyridostigmine-induced subjective improvement of fatigue (Fisher's exact test, P < 0.04). A significant reduction in fatigue with pyridostigmine was observed only in the 7 patients who experienced a significant reduction in jitter with edrophonium (Wilcoxan signed rank sum test, P = 0.03). In addition, the 9 pyridostigmine responders experienced a significant reduction in jitter means pre- and post-edrophonium (100% vs. 88%, Bonferroni corrected, P < 0.01). We conclude that neuromuscular transmission as measured by jitter on S-SFEMG can improve with edrophonium in a proportion of PPS patients, and that generalized fatigue and muscle fatiguability in some patients with PPS may be due to anticholinesterase-responsive NMJ transmission defects.

Electrical Microstimulation with Single-Fiber Electromyography

This article reviews the essential technical principles and findings with electrical microstimulation as used in conjunction with single-fiber electromyography (SFEMG). It highlights the details in the microphysiology of the motor unit that can be conveniently studied with these methods, particularly the neuromuscular transmission at the individual motor endplates, muscle fiber recovery functions, and a variety of late responses. The differences, advantages, and disadvantages of the stimulation method of jitter measurement, compared to the original method, in the voluntarily activated muscle are described. Special attention is given to the pitfalls of the technique. Indications for clinical use of stimulation SFEMG in the electromyography laboratory are suggested.

Single‐fiber electromyography in experimental autoimmune myasthenia gravis

The sensitivity of stimulated single-fiber electromyography in the detection of early abnormalities in neuromuscular transmission in experimental autoimmune myasthenia gravis (EAMG) was tested. Increased jitter and blocking were seen up to 3 weeks before clinical illness or decrement developed. Stimulation at 10 Hz appeared more sensitive in detection of abnormalities than stimulation at 3 or 5 Hz. Jitter values did not correlate with anti-Torpedo acetylcholine receptor (AChR), nor with anti-rat AChR antibody titer. No correlation was found between jitter and AChR loss or AChR-antibody complexes in muscle. It is concluded that, in addition to AChR loss and the presence of AChR-antibody complexes, other factors must determine the neuromuscular dysfunction in EAMG and possibly myasthenia gravis.

Stimulation SFEMG in myasthenia gravis.

The diagnostic usefulness of single-fiber electromyography (SFEMG) in the diagnosis of neuromuscular transmission disorders is well established. Increased jitter is one of the earliest indications of abnormality. In patients with severe weakness, tremor, or altered consciousness, performance of the study is difficult because of the degree of cooperation needed. We studied five patients and eight normal subjects with voluntary and stimulation SFEMG techniques. Our results, in search of normal values and changes with pathology, revealed differences in the values of jitter and the percentage of abnormal fibers between both techniques. The mean consecutive difference (MCD) is smaller (on average 30% less), and the percentage of abnormal fibers is lower (on average 10% less) with the stimulation technique. These differences are largely explained by the jitter measurement of one endplate with the stimulation technique versus two endplates with the voluntary. They may also be related, however, to the difference in motor unit populations sampled with each technique.