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1.
J Korean Med Sci ; 37(10): e50, 2022 Mar 14.
Article in English | MEDLINE | ID: covidwho-1771025

ABSTRACT

As coronavirus disease 2019 (COVID-19) has spread worldwide, the rate of COVID-19 vaccination uptake is encouraging. Neurological complications associated with COVID-19 vaccines such as stroke, Guillain-Barré syndrome, and Bell's palsy have been reported. Recently, late-onset myasthenia gravis (MG) following COVID-19 vaccination has been reported. To date, however, there has been no evidence of increased risk of early-onset MG following COVID-19. Here, we report a case of a patient with new-onset MG that arose after receiving a COVID-19 vaccine. A 33-year-old woman suddenly experienced generalized weakness and diplopia on the evening she had received the second dose of the Pfizer-BioNTech COVID-19 vaccine. The temporal relationship suggests that this new-onset MG is related to the vaccination. It also implies that COVID-19 vaccination could trigger early-onset MG symptoms in patients at risk of MG.


Subject(s)
/adverse effects , Myasthenia Gravis/etiology , Adult , Electromyography , Female , Humans , Myasthenia Gravis/diagnosis , Myasthenia Gravis/physiopathology , Neostigmine/pharmacology , Republic of Korea , Time Factors
2.
J Korean Med Sci ; 37(7): e58, 2022 Feb 21.
Article in English | MEDLINE | ID: covidwho-1704893

ABSTRACT

Guillain-Barre syndrome (GBS) is an immune-mediated acute polyradiculoneuropathy and commonly occurs after a preceding infection or immunization sequalae. Following the severe acute respiratory syndrome-coronavirus-2 virus pandemic with co-introduction of massive vaccinations, several GBS cases associated with coronavirus disease 2019 (COVID-19) infection per se or after vaccination for COVID-19 were reported internationally. Herein, we report two cases of Korean GBS presenting with tetraplegia after two different COVID-19 vaccinations (42-year old man by AstraZeneca and 48-year woman by Pfizer vaccines) within four weeks after vaccination. The patients were diagnosed with clinical examination, serial electromyography, and compatible laboratory results and improved after comprehensive rehabilitative treatment and intravenous immunoglobulin therapy. Furthermore, we performed an electrodiagnostic follow-up study of each case to examine their unique characteristics.


Subject(s)
/adverse effects , Guillain-Barre Syndrome/pathology , Quadriplegia/pathology , Vaccination/adverse effects , Adult , COVID-19/prevention & control , Electromyography , Female , Guillain-Barre Syndrome/rehabilitation , Guillain-Barre Syndrome/therapy , Humans , Immunoglobulins, Intravenous/therapeutic use , Male , Middle Aged , Quadriplegia/rehabilitation , Quadriplegia/therapy , SARS-CoV-2/immunology
3.
J Korean Med Sci ; 37(5): e32, 2022 Feb 07.
Article in English | MEDLINE | ID: covidwho-1674310

ABSTRACT

Dermatomyositis (DM) is one of the uncommon multi-organ idiopathic inflammatory myopathies that has been reported following the hepatitis B, Influenza, tetanus toxoid, H1N1, and BCG vaccines. However, an association with the coronavirus disease 2019 (COVID-19) vaccine is yet to be reported. In this case, we present the case of a 43-year-old Asian Indian female who was diagnosed with DM 10 days after receiving the second dosage of BNT162b2 mRNA COVID-19 vaccination, in the absence of any additional triggering factors. The diagnosis was established based on physical examination, serological antibodies, magnetic resonance imaging of the muscles, skin biopsy, and electromyography. She received standard treatment for DM, including oral high doses of prednisolone, hydroxychloroquine, mycophenolate, and physiotherapy. The treatment successfully reversed skin changes and muscle weakness. This is the first reported case of classic DM complicated by interstitial lung disease following COVID-19 vaccination. More clinical and functional studies are needed to elucidate this association. Clinicians should be aware of this unexpected adverse event following COVID-19 vaccination and arrange for appropriate management.


Subject(s)
/adverse effects , Dermatomyositis/diagnosis , Adult , COVID-19/prevention & control , COVID-19/virology , Dermatomyositis/etiology , Electromyography , Female , Humans , Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/etiology , Magnetic Resonance Imaging , Muscle, Skeletal/diagnostic imaging , SARS-CoV-2/isolation & purification , Skin/pathology , Vaccination/adverse effects
4.
Sensors (Basel) ; 21(21)2021 Oct 28.
Article in English | MEDLINE | ID: covidwho-1512562

ABSTRACT

Monitoring physical activity in medical and clinical rehabilitation, in sports environments or as a wellness indicator is helpful to measure, analyze and evaluate physiological parameters involving the correct subject's movements. Thanks to integrated circuit (IC) technologies, wearable sensors and portable devices have expanded rapidly in monitoring physical activities in sports and tele-rehabilitation. Therefore, sensors and signal acquisition devices became essential in the tele-rehabilitation path to obtain accurate and reliable information by analyzing the acquired physiological signals. In this context, this paper provides a state-of-the-art review of the recent advances in electroencephalogram (EEG), electrocardiogram (ECG) and electromyogram (EMG) signal monitoring systems and sensors that are relevant to the field of tele-rehabilitation and health monitoring. Mostly, we focused our contribution in EMG signals to highlight its importance in rehabilitation context applications. This review focuses on analyzing the implementation of sensors and biomedical applications both in literature than in commerce. Moreover, a final review discussion about the analyzed solutions is also reported at the end of this paper to highlight the advantages of physiological monitoring systems in rehabilitation and individuate future advancements in this direction. The main contributions of this paper are (i) the presentation of interesting works in the biomedical area, mainly focusing on sensors and systems for physical rehabilitation and health monitoring between 2016 and up-to-date, and (ii) the indication of the main types of commercial sensors currently being used for biomedical applications.


Subject(s)
Electrocardiography , Sports , Electroencephalography , Electromyography , Monitoring, Physiologic
5.
Biomed Res Int ; 2021: 2624860, 2021.
Article in English | MEDLINE | ID: covidwho-1484096

ABSTRACT

BACKGROUND: People with multiple sclerosis (MS) suffer from symptoms related to neural control, such as reduced central activation, lower muscle activity, and accentuated spasticity. A forced 9-week home confinement related to COVID-19 in Spain may have worsened these symptoms. However, no study has demonstrated the impact of home confinement on neuromuscular mechanisms in the MS population. This study was aimed at analyzing the effects of a 9-week home confinement on central activation, muscle activity, contractile function, and spasticity in MS patients. METHODS: Eighteen participants were enrolled in the study. Left and right knee extensor maximum voluntary isometric contraction (MVIC), maximal neural drive via peak surface electromyography (EMG) of the vastus lateralis, central activation ratio (CAR), and muscle contractile function via electrical stimulation of the knee extensor muscles, as well as spasticity using the pendulum test, were measured immediately before and after home confinement. RESULTS: Seventeen participants completed the study. CAR significantly decreased after lockdown (ES = 1.271, p < 0.001). Regarding spasticity, there was a trend to decrease in the number of oscillations (ES = 0.511, p = 0.059) and a significant decrease in the duration of oscillations (ES = 0.568, p = 0.038). Furthermore, in the left leg, there was a significant decrease in the first swing excursion (ES = 0.612, p = 0.027) and in the relaxation index (ES = 0.992, p = 0.001). Muscle contractile properties, MVIC, and EMG variables were not modified after confinement. CONCLUSIONS: The results suggest that a home confinement period of 9 weeks may lead to an increase in lower limb spasticity and a greater deficit in voluntary activation of the knee extensors.


Subject(s)
COVID-19 , Multiple Sclerosis/physiopathology , Muscle, Skeletal/physiopathology , Communicable Disease Control , Electric Stimulation , Electromyography , Female , Humans , Isometric Contraction , Knee/physiology , Male , Middle Aged , Muscle Contraction , Muscle Spasticity , Muscle, Skeletal/physiology , Quadriceps Muscle/physiology
7.
Clin Neurophysiol ; 132(12): 3019-3024, 2021 12.
Article in English | MEDLINE | ID: covidwho-1466232

ABSTRACT

OBJECTIVE: Neurological manifestations in patients with coronavirus disease 2019 (COVID-19) have been reported from early features of anosmia and dysgeusia to widespread involvement of the central nervous system, peripheral nervous system, as well as the neuromuscular junction and muscle. Our study objective is to evaluate the electromyography and nerve conduction study (EMG/NCS) findings among COVID-19 patients and look for possible correlations. METHODS: This is a hospital-based retrospective observational study. All COVID-19 patients between the period of 1st January 2020 to 31st December 2020 undergoing an EMG/NCS were included. RESULTS: Eighteen patients (12 male and 6 female) were included. Mean age was 55 ± 12 years. 11 patients required intubation for a mean period of 18.6 days (range: 3-37 days). Electrodiagnostic findings were consistent with a myopathy in a majority of these patients (82%). Five of them also had a concurrent axonal neuropathy. In the remaining patients who did not require intubation (n = 7), three patients had myopathic EMG changes and one had Guillain Barre syndrome. CONCLUSION: At this time, there are no neuromuscular-specific recommendations for patients who contract COVID-19. Only time and additional data will unveil the varying nature and potential neurological sequelae of COVID-19. SIGNIFICANCE: Myopathic EMG changes are commonly seen in critically ill COVID-19 patients, especially with a prolonged hospital stay.


Subject(s)
COVID-19/complications , Electromyography , Muscular Diseases/diagnosis , Nervous System Diseases/diagnosis , Neural Conduction , Adult , Aged , Comorbidity , Female , Guillain-Barre Syndrome/diagnosis , Humans , Intubation, Intratracheal/statistics & numerical data , Length of Stay , Male , Middle Aged , Muscle, Skeletal , Retrospective Studies
8.
Headache ; 60(10): 2389-2405, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-1455545

ABSTRACT

OBJECTIVE: In this experimental study, we aimed to determine whether guided music listening (GML) - a music intervention based on models of mood mediation and attention modulation - modulates masticatory muscle activity and awake bruxism in subjects with chronic painful muscular temporomandibular disorders (TMD myalgia, mTMD), a condition causing a significant burden to patients, their families, and healthcare systems. BACKGROUND: Awake bruxism - a stress behavior characterized by clenching of the teeth - is a strong contributor to chronic mTMD. GML modulates psychological stress and motor responses and could thus reduce muscle activity in chronic musculoskeletal conditions, including mTMD. METHODS: We recorded the electromyographic (EMG) activity in the right masseter of 14 women with chronic (>6 months) mTMD (median [IQR] = 39.5.3 [24.3] years) and 15 pain-free women (median [IQR] = 30.0 [3.5] years) during a GML session, including 3 music (stressful, relaxing, and participants' favorite music) and a no-music (pink noise) control blocks, each lasting 15 minutes. We measured the motor effort of the right masseter relative to the participants' maximum voluntary contraction (MVC), the muscular effort to maintain mandibular posture (EMGposture ), and to produce spontaneous awake bruxism episodes (EMGbruxism ), and the duration and frequency of spontaneous awake bruxism episodes. We tested between-group and within-group (between blocks) differences, as well as the effect of the interaction group by experimental block on these outcome measures. RESULTS: In both groups, EMGposture was significantly affected by the interaction group by experimental block (P < .001). Compared to pink noise [mean (95% CI); mTMD: 2.2 (1.6-2.8) %MVC; Controls: 1.1 (0.5-1.7) %MVC], EMGposture increased during the stressful music block [contrast estimate (95% CI); mTMD: +0.8 (0.7-0.8) %MVC; Controls: +0.3 (0.3-0.4) %MVC; both P < .001], and decreased during the relaxing [mTMD: -0.4 (-0.5 to -0.4) %MVC; Controls: -0.3 (-0.4 to -0.3) %MVC; both P < .001] and favorite [mTMD: -0.5 (-0.6 to -0.5) %MVC; Controls: -0.5 (-0.5 to -0.4) %MVC; both P < .001] music blocks. EMGposture was greater in mTMD individuals than controls during the favorite music [contrast estimate (95% CI): +1.1 (0.2-1.9) %MVC; P = .019] and the pink noise [+1.1 (0.2-2.0) %MVC; P = .014] blocks. EMGbruxism was significantly affected by the interaction group by experimental block (P < .001). In mTMD participants, compared to the pink noise block [mean (95% CI); 23.8 (16.0-31.6) %MVC], EMGbruxism increased during the stressful music block [contrast estimate (95% CI); +10.2 (8.6-11.8) %MVC], and decreased during the relaxing [-6.2 (-8.1 to -4.3) %MVC; P < .001] and favorite [-10.2 (-12.2 to -9.1) %MVC; P < .001] music blocks. These effects were not observed in the control group [mean (95% CI); pink noise: 19.3 (10.9-27.6); stressful: 21.2 (12.9-29.4) %MVC; relaxing: 21.6 (13.3-29.9) %MVC; favorite: 24.2 (15.8-32.7) %MVC; all P > .05]. EMGbruxism was significantly greater in mTMD participants than controls during the stressful music block [contrast estimate (95% CI): +12.9 (1.6-24.2) %MVC; P = .026). GML did not affect the duration or the frequency of awake bruxism in either group (median [IQR], mTMD: 23.5 [96.7] s, range 1-1300 seconds; Controls: 5.5 [22.5], range 0-246 seconds; P = .108). The frequency of awake bruxism episodes was greater in the mTMD group compared to controls only during the pink noise block (median [IQR], mTMD: 5 [15.3] episodes, range 0-62 episodes; Controls: 1 [3] episode, range 0-27 episodes; P = .046). No significant between-group differences were found in either the overall time spent engaging in awake bruxism (median [IQR], mTMD: 23.5 [96.7] s, range 1-1300 seconds; Controls: 5.5 [22.5], range 0-246 seconds; P = .108), or during each block (all P > .05). CONCLUSIONS: In subjects with chronic mTMD, relaxing music and the individual's favorite music decreased the muscular effort during spontaneous awake bruxism episodes by 26% and 44% (relative changes), respectively. In contrast, stressful music increases it by about 43%. Because of its positive effects on awake bruxism, GML with selected music could be a promising and non-invasive component of a multimodal approach for the management of chronic mTMD.


Subject(s)
Bruxism , Chronic Pain , Music Therapy , Music , Myalgia , Temporomandibular Joint Disorders , Adult , Bruxism/complications , Bruxism/physiopathology , Bruxism/psychology , Bruxism/therapy , Chronic Pain/etiology , Chronic Pain/physiopathology , Chronic Pain/psychology , Chronic Pain/therapy , Electromyography , Female , Humans , Masseter Muscle/physiopathology , Middle Aged , Myalgia/etiology , Myalgia/physiopathology , Myalgia/psychology , Myalgia/therapy , Temporomandibular Joint Disorders/physiopathology , Temporomandibular Joint Disorders/psychology , Temporomandibular Joint Disorders/therapy
9.
J Biomech ; 126: 110620, 2021 09 20.
Article in English | MEDLINE | ID: covidwho-1415534

ABSTRACT

Trunk exoskeletons are wearable devices that support humans during physically demanding tasks by reducing biomechanical loads on the back. While most trunk exoskeletons are rigid devices, more lightweight soft exoskeletons (exosuits) have recently been developed. One such exosuit is the HeroWear Apex, which achieved promising results in the developers' own work but has not been independently evaluated. This paper thus presents an evaluation of the Apex with 20 adult participants during multiple brief tasks: standing up from a stool with a symmetric or asymmetric load, lifting a unilateral or bilateral load from the floor to waist level, lifting the same bilateral load with a 90-degree turn to the right, lowering a bilateral load from waist level to floor, and walking while carrying a bilateral load. The tasks were performed in an ABA-style protocol: first with exosuit assistance disengaged, then with it engaged, then disengaged again. Four measurement types were taken: electromyography (of the erector spinae, rectus abdominis, and middle trapezius), trunk kinematics, self-report ratings, and heart rate. The exosuit decreased the erector spinae electromyogram by about 15% during object lifting and lowering tasks; furthermore, participants found the exosuit mildly to moderately helpful. No adverse effects on other muscles or during non-lifting tasks were noted, and a decrease in middle trapezius electromyogram was observed for one task. This confirms that the HeroWear Apex could reduce muscle demand and fatigue. The results may transfer to other exoskeletons with similar design principles, and may inform researchers working with other wearable devices.


Subject(s)
Exoskeleton Device , Lifting , Adult , Biomechanical Phenomena , Electromyography , Humans , Muscle, Skeletal , Walking
10.
PLoS One ; 16(9): e0257295, 2021.
Article in English | MEDLINE | ID: covidwho-1410610

ABSTRACT

Among tennis coaches and players, the standard volley and drop volley are considered basically similar, but muscles need to be relaxed (deactivation) just at the moment of impact when hitting the drop volley. However, this is not evidence-based. The aim of this study was to clarify racket head trajectory and muscle activity during the drop volley and to compare them with those of the standard volley. We hypothesized that 1) the racket head would move less forward for the drop volley than for the standard volley and 2) the wrist and elbow muscles be relaxed for the drop volley at the time of ball impact. Eleven male college students with sufficient tennis experience volunteered to participate in this study. Wireless EMG sensors recorded activation of the four arm muscles. Each subject performed the standard volley or the drop volley with both a forehand and a backhand from a position near the net. Four high speed video cameras (300 Hz) were set up on the court to measure ball speed and racket head trajectory. Returned ball speed of the drop volley was significantly lower than that of the standard volley (p < 0.05). The racket head moved less forward than in the standard volley, supporting the first hypothesis. Muscle activity of the drop volley, just before and after ball impact for both the forehand and backhand, was lower than that of the standard volley. However, the activity was in the form of a gradual increase as impact time approached, rather than a sudden deactivation (relaxation), which did not support the second hypothesis. For the drop volley, lower muscle activity in the forearm enabled a softer grip and thus allowed a "flip" movement of the racket to diminish the speed of the returned ball.


Subject(s)
Muscle, Skeletal/injuries , Tennis/injuries , Biomechanical Phenomena , Electromyography , Forearm , Hand , Hand Strength , Humans , Male , Movement , Wrist Joint , Young Adult
11.
Neurol Sci ; 42(12): 4893-4898, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1391890

ABSTRACT

INTRODUCTION: Neurological complications of SARS-CoV-2 disease have received growing attention, but only few studies have described to date clinical and neurophysiological findings in COVID patients during their stay in intensive care units (ICUs). Here, we neurophysiologically assessed the presence of either critical illness neuropathy (CIP) or myopathy (CIM) in ICU patients. MATERIALS AND METHODS: Patients underwent a neurophysiological assessment, including bilateral examination of the median, ulnar, deep peroneal and tibial motor nerves and of the median, ulnar, radial and sural sensory nerves. Needle electromyography (EMG) was performed for both distal and proximal muscles of the lower and upper limbs. In order to differentiate CIP from CIM, Direct Muscle Stimulation (DMS) was applied either to the deltoid or tibialis anterior muscles. Peak to peak amplitudes and onset latencies of the responses evoked by DMS (DMSamp, DMSlat) or by motor nerve stimulation (MNSamp, MNSlat) were compared. The ratio MNSamp to DMSamp (NMR) and the MNSlat to DMSlat difference (NMD: MNSlat - DMSlat) were also evaluated. RESULTS: Nerve conduction studies showed a sensory-motor polyneuropathy with axonal neurogenic pattern, as confirmed by needle EMG. Both MNSamp and NMR were significantly reduced when compared to controls (p < 0.0001), whereas MNSlat and NMD were markedly increased (p = 0.0049). CONCLUSIONS: We have described COVID patients in the ICU with critical illness neuropathy (CIP). COVID-related CIP could have implications for the functional recovery and rehabilitation strategies.


Subject(s)
COVID-19 , Muscular Diseases , Polyneuropathies , Critical Illness , Electromyography , Humans , Neural Conduction , Polyneuropathies/complications , SARS-CoV-2
12.
J Clin Neuromuscul Dis ; 23(1): 24-30, 2021 Sep 01.
Article in English | MEDLINE | ID: covidwho-1371756

ABSTRACT

OBJECTIVES: COVID-19 is a novel coronavirus that emerged in 2019 and is responsible for a global pandemic. Numerous neurologic manifestations have been described in the literature regarding COVID-19, but most studies are focused on the central nervous system. The authors have noted an association between prior COVID-19 infection and the development of a systemic neuropathy that manifests with asymmetric sensorimotor loss in the peripheral nervous system. We describe 4 cases of mononeuropathy multiplex that were diagnosed after COVID-19 infection. METHODS: All patients included were treated for severe COVID-19 infection at New York Presbyterian Hospital and subsequently referred to the Columbia Peripheral Neuropathy Center for persistent neuropathy. RESULTS: Patient history, COVID-19 disease course, and mononeuropathy multiplex diagnostic evaluation of the 4 patients are recounted. CONCLUSIONS: We postulate a connection between COVID-19 and the development of mononeuropathy multiplex with implications in prognostication, rehabilitation strategies, and future treatments.


Subject(s)
COVID-19/complications , Mononeuropathies/etiology , Aged , Diabetes Mellitus, Type 2/complications , Electrodiagnosis , Electromyography , Female , Humans , Hypertension , Male , Middle Aged , Mononeuropathies/diagnosis , Neural Conduction , Neurologic Examination , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , Retrospective Studies
13.
Neurol Sci ; 42(10): 3973-3979, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1321760

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is associated to neuromuscular symptoms in up to 10.7% of hospitalized patients. Nevertheless, the extent of muscular involvement in infected subjects with no signs of myopathy has never been assessed with neurophysiological investigations. METHODS: Over a 3-week period - from April 30 through May 20, 2020 - a total of 70 patients were hospitalized in the Internal Medicine Ward of the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico in Milan, Italy. After excluding patients who underwent invasive ventilation and steroid treatment, 12 patients were evaluated. Nerve conduction studies (NCS) included the analysis of conduction velocity, amplitude, and latency for bilateral motor tibial, ulnar nerves, and sensory sural and radial nerves. Unilateral concentric-needle electromyography (EMG) was performed evaluating at least 4 areas of 8 selected muscles. For each muscle, spontaneous activity at rest, morphology, and recruitment of motor unit action potentials (MUAPs) were evaluated. RESULTS: While nerve conduction studies were unremarkable, needle electromyography showed myopathic changes in 6 out of 12 subjects. All patients were asymptomatic for muscular involvement. Clinical features and laboratory findings did not show relevant differences between patients with and without myopathic changes. CONCLUSION: Our data show that in SARS-CoV-2 infection muscular involvement can occur despite the absence of clinical signs or symptoms and should be considered part of the disease spectrum. The application of muscle biopsy to unravel the mechanisms of myofiber damage on tissue specimens could help to clarify the pathogenesis and the treatment response of coronavirus-mediated injury.


Subject(s)
COVID-19 , Muscular Diseases , Electromyography , Humans , Neural Conduction , SARS-CoV-2
15.
BMJ Case Rep ; 13(10)2020 Oct 29.
Article in English | MEDLINE | ID: covidwho-1304206

ABSTRACT

We report the first case of Guillain-Barré syndrome (GBS) associated with SARS-CoV-2 infection in Japan. A 54-year-old woman developed neurological symptoms after SARS-CoV-2 infection. We tested for various antiganglioside antibodies, that had not been investigated in previous cases. The patient was diagnosed with GBS based on neurological and electrophysiological findings; no antiganglioside antibodies were detected. In previous reports, most patients with SARS-CoV-2-infection-related GBS had lower limb predominant symptoms, and antiganglioside antibody tests were negative. Our findings support the notion that non-immune abnormalities such as hyperinflammation following cytokine storms and microvascular disorders due to vascular endothelial damage may lead to neurological symptoms in patients with SARS-CoV-2 infection. Our case further highlights the need for careful diagnosis in suspected cases of GBS associated with SARS-CoV-2 infection.


Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/etiology , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , COVID-19 , Electromyography/methods , Female , Guillain-Barre Syndrome/therapy , Humans , Hypesthesia/diagnosis , Hypesthesia/etiology , Japan , Middle Aged , Muscle Weakness/diagnosis , Muscle Weakness/etiology , Pandemics/prevention & control , Pandemics/statistics & numerical data , Rare Diseases , Risk Assessment , Severity of Illness Index , Treatment Outcome
16.
J Electromyogr Kinesiol ; 59: 102566, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1260782

ABSTRACT

We aimed to investigate the impact of time on fine-wire (fw) electromyography (EMG) signal amplitude, and to determine whether any attenuation is confounded by task type. Twenty healthy participants were instrumented with fw and surface (s) EMG electrodes at the biceps brachii bilaterally. Participants held a weight statically with one arm and with the other arm either repeated the same task following a maximum voluntary contraction (MVC) or repeated dynamic elbow flexion/extension contractions. Each task was repeated for 30 s every five minutes over two hours. EMG amplitude was smoothed and normalized to time = 0. Stable median power frequency of the s-EMG ruled out the confounding influence of fatigue. Repeated-measures ANCOVAs determined the effect of electrode type and time (covariate) on EMG amplitude and the confounding impact of task type. During the isometric protocol, fw-EMG amplitude reduced over time (p = 0.002), while s-EMG amplitude (p = 0.895) and MPF (p > 0.05) did not change. Fw-EMG amplitude attenuated faster during the dynamic than the isometric protocol (p = 0.008) and there was evidence that the MVC preceding the isometric protocol impacted the rate of decline (p = 0.001). We conclude that systematic signal attenuation of fw-EMG occurs over time and is more pronounced during dynamic tasks.


Subject(s)
Elbow Joint , Isometric Contraction , Electromyography , Humans , Muscle, Skeletal , Range of Motion, Articular
17.
J Clin Neuromuscul Dis ; 22(4): 228-231, 2021 Jun 01.
Article in English | MEDLINE | ID: covidwho-1238256

ABSTRACT

ABSTRACT: Elsberg syndrome is a rare cause of lumbosacral radiculitis with concomitant thoracic and lumbosacral myelitis that can be seen after an acute or reactivated viral infection. After the initial coronavirus surge in New York City, a 68-year-old man developed progressive lower extremity weakness and a defined sensory level at the lower abdomen. He had highly elevated SARS-CoV-2 IgG antibodies despite an absence of preceding COVID-19 symptoms. Serial electrodiagnostic testing revealed absent lower extremity late responses, with otherwise normal distal sensorimotor conductions. Electromyography revealed active neurogenic changes and reduced motor unit recruitment in the L3-L4 myotomes. Treatment with methylprednisolone and intravenous immunoglobulin was followed by minimal clinical improvement but re-emergence of the lower extremity late responses on electrodiagnostic testing. We report here, to the best of our knowledge, the first case of suspected COVID-19-associated Elsberg syndrome, which expands the spectrum of neuromuscular manifestations associated with SARS-CoV-2 infection and sheds light on ways to approach diagnostic and treatment options for these patients.


Subject(s)
COVID-19/complications , Myelitis/etiology , Radiculopathy/etiology , Aged , Anti-Inflammatory Agents/therapeutic use , Electrodiagnosis , Electromyography , Humans , Immunoglobulin G/analysis , Magnetic Resonance Imaging , Male , Methylprednisolone/therapeutic use , Muscle Weakness/etiology , Myelitis/diagnosis , Neural Conduction , Radiculopathy/diagnosis , Spine/diagnostic imaging , Syndrome , Treatment Outcome
18.
Clin Neurophysiol ; 132(8): 1974-1981, 2021 08.
Article in English | MEDLINE | ID: covidwho-1237654

ABSTRACT

OBJECTIVE: To investigate the peripheral nerve and muscle function electrophysiologically in patients with persistent neuromuscular symptoms following Coronavirus disease 2019 (COVID-19). METHODS: Twenty consecutive patients from a Long-term COVID-19 Clinic referred to electrophysiological examination with the suspicion of mono- or polyneuropathy were included. Examinations were performed from 77 to 255 (median: 216) days after acute COVID-19. None of the patients had received treatment at the intensive care unit. Of these, 10 patients were not even hospitalized. Conventional nerve conduction studies (NCS) and quantitative electromyography (qEMG) findings from three muscles were compared with 20 age- and sex-matched healthy controls. RESULTS: qEMG showed myopathic changes in one or more muscles in 11 patients (55%). Motor unit potential duration was shorter in patients compared to healthy controls in biceps brachii (10.02 ± 0.28 vs 11.75 ± 0.21), vastus medialis (10.86 ± 0.37 vs 12.52 ± 0.19) and anterior tibial (11.76 ± 0.31 vs 13.26 ± 0.21) muscles. All patients with myopathic qEMG reported about physical fatigue and 8 patients about myalgia while 3 patients without myopathic changes complained about physical fatigue. CONCLUSIONS: Long-term COVID-19 does not cause large fibre neuropathy, but myopathic changes are seen. SIGNIFICANCE: Myopathy may be an important cause of physical fatigue in long-term COVID-19 even in non-hospitalized patients.


Subject(s)
COVID-19/complications , COVID-19/physiopathology , Fatigue/etiology , Fatigue/physiopathology , Muscular Diseases/etiology , Muscular Diseases/physiopathology , Adult , Aged , COVID-19/diagnosis , Electromyography/trends , Fatigue/diagnosis , Female , Humans , Male , Middle Aged , Muscular Diseases/diagnosis , Neural Conduction/physiology , Registries , Time Factors
19.
Can J Neurol Sci ; 49(1): 38-48, 2022 01.
Article in English | MEDLINE | ID: covidwho-1216414

ABSTRACT

BACKGROUND: In January 2020, the first case of Guillain Barre syndrome (GBS) due to COVID-19 was documented in China. GBS is known to be postinfectious following several types of infections. Although causality can only be proven through large epidemiological studies, we intended to study this association by a thorough review of the literature. METHODS: We searched PubMed, EMBASE, and Google scholar and included all papers with English or Spanish full text and original data of patients with GBS and recent COVID infection. Variables of interest were demographics, diagnostic investigations, and the latency between arboviral and neurological symptoms. Further variables were pooled to identify GBS clinical and electrophysiological variants, used treatments, and outcomes. The certainty of GBS diagnosis was verified using Brighton criteria. RESULTS: We identified a total of 109 GBS cases. Ninety-nine cases had confirmed COVID-19 infection with an average age of 56.07 years. The average latency period between the arboviral symptoms and neurologic manifestations for confirmed COVID-19 cases was 12.2 d. The predominant GBS clinical and electromyography variants were the classical sensorimotor GBS and acute demyelinating polyneuropathy respectively. Forty cases required intensive care, 33 cases required mechanical ventilation, and 6 cases were complicated by death. CONCLUSIONS: Studies on COVID-19-related GBS commonly reported sensorimotor demyelinating GBS with frequent facial palsy. The time between the onset of infectious and neurological symptoms suggests a postinfectious mechanism. Early diagnosis of GBS in COVID-19 patients is important as it might be associated with a severe disease course requiring intensive care and mechanical ventilation.


Subject(s)
Bell Palsy , COVID-19 , Guillain-Barre Syndrome , Electromyography , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/etiology , Humans , Middle Aged , SARS-CoV-2
20.
Acta Neurol Scand ; 144(2): 161-169, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1199639

ABSTRACT

BACKGROUND: Critical illness polyneuropathy and myopathy (CIPNM) is a frequent neurological manifestation in patients with acute respiratory distress syndrome (ARDS) from coronavirus disease 2019 (COVID-19) infection. CIPNM diagnosis is usually limited to clinical evaluation. We compared patients with ARDS from COVID-19 and other aetiologies, in whom a neurophysiological evaluation for the detection of CIPNM was performed. The aim was to determine if there were any differences between these two groups in frequency of CINPM and outcome at discharge from the intensive care unit (ICU). MATERIALS AND METHODS: This was a single-centre retrospective study performed on mechanically ventilated patients consecutively admitted (January 2016-June 2020) to the ICU of Careggi Hospital, Florence, Italy, with ARDS of different aetiologies. Neurophysiological evaluation was performed on patients with stable ventilation parameters, but marked widespread hyposthenia (Medical Research Council score <48). Creatine phosphokinase (CPK), lactic dehydrogenase (LDH) and mean morning glycaemic values were collected. RESULTS: From a total of 148 patients, 23 with COVID-19 infection and 21 with ARDS due to other aetiologies, underwent electroneurography/electromyography (ENG/EMG) recording. Incidence of CIPNM was similar in the two groups, 65% (15 of 23) in COVID-19 patients and 71% (15 of 21) in patients affected by ARDS of other aetiologies. At ICU discharge, subjects with CIPNM more frequently required ventilatory support, regardless the aetiology of ARDS. CONCLUSION: ENG/EMG represents a useful tool in the identification of the neuromuscular causes underlying ventilator wean failure and patient stratification. A high incidence of CIPNM, with a similar percentage, has been observed in ARDS patients of all aetiologies.


Subject(s)
COVID-19 , Electrodiagnosis , Muscular Diseases , Polyneuropathies , Respiration, Artificial , Respiratory Distress Syndrome , Adult , COVID-19/complications , COVID-19/epidemiology , Critical Illness , Electromyography , Female , Humans , Intensive Care Units/statistics & numerical data , Italy/epidemiology , Male , Middle Aged , Muscular Diseases/diagnosis , Muscular Diseases/epidemiology , Muscular Diseases/etiology , Muscular Diseases/physiopathology , Polyneuropathies/diagnosis , Polyneuropathies/epidemiology , Polyneuropathies/etiology , Polyneuropathies/physiopathology , Respiration, Artificial/statistics & numerical data , Respiratory Distress Syndrome/complications , Respiratory Distress Syndrome/epidemiology , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , Retrospective Studies
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