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2.
Clin Neurophysiol ; 132(8): 1974-1981, 2021 08.
Article in English | MEDLINE | ID: mdl-34020890

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
3.
Sci Rep ; 9(1): 17593, 2019 11 26.
Article in English | MEDLINE | ID: mdl-31772352

ABSTRACT

Cortical hyperexcitability has been found in early Amyotrophic Lateral Sclerosis (ALS) and is hypothesized to be a key factor in pathogenesis. The current pilot study aimed to investigate cortical inhibitory/excitatory balance in ALS using short-echo Magnetic Resonance Spectroscopy (MRS). Patients suffering from ALS were scanned on a 3 T Trio Siemens MR scanner using Spin Echo Full Intensity Acquired Localized (SPECIAL) Magnetic Resonance Spectroscopy in primary motor cortex and the occipital lobe. Data was compared to a group of healthy subjects. Nine patients completed the scan. MRS data was of an excellent quality allowing for quantification of a range of metabolites of interest in ALS. In motor cortex, patients had Glutamate/GABA and GABA/Cr- ratios comparable to healthy subjects. However, Glutamate/Cr (p = 0.002) and the neuronal marker N-acetyl-aspartate (NAA/Cr) (p = 0.034) were low, possibly due to grey-matter atrophy, whereas Glutathione/Cr (p = 0.04) was elevated. In patients, NAA levels correlated significantly with both hand strength (p = 0.027) and disease severity (p = 0.016). In summary SPECIAL MRS at 3 T allows of reliable quantification of a range of metabolites of interest in ALS, including both excitatory and inhibitory neurotransmitters. The method is a promising new technique as a biomarker for future studies on ALS pathophysiology and monitoring of disease progression.


Subject(s)
Amyotrophic Lateral Sclerosis/metabolism , Glutamic Acid/analysis , Magnetic Resonance Spectroscopy/methods , Motor Cortex/chemistry , Occipital Lobe/chemistry , gamma-Aminobutyric Acid/analysis , Aged , Amyotrophic Lateral Sclerosis/pathology , Amyotrophic Lateral Sclerosis/physiopathology , Aspartic Acid/analogs & derivatives , Aspartic Acid/analysis , Atrophy , Choline/analysis , Creatine/analysis , Disease Progression , Female , Glutamine/analysis , Glutathione/analysis , Gray Matter/pathology , Hand Strength , Humans , Inositol/analysis , Male , Middle Aged , Motor Cortex/pathology , Occipital Lobe/pathology , Pilot Projects , Severity of Illness Index , Single-Blind Method
4.
Clin Neurophysiol ; 128(7): 1380-1388, 2017 07.
Article in English | MEDLINE | ID: mdl-28461135

ABSTRACT

OBJECTIVE: To examine inter- and intra-rater reproducibility and sensitivity to motor unit loss of a novel motor unit number estimation (MUNE) method, MScanFit MUNE (MScan), compared to two traditional MUNE methods; Multiple point stimulation MUNE (MPS) and Motor Unit Number Index (MUNIX). METHODS: Twenty-two ALS patients and 20 sex- and age-matched healthy controls were included. MPS, MUNIX, and MScan were performed twice each by two blinded physicians. Reproducibility of MUNE values was assessed by coefficient of variation (CV) and intra class correlation coefficient (ICC). Ability to detect motor unit loss was assessed by ROC curves and area under the curve (AUC). The times taken for each of the methods were recorded. RESULTS: MScan was more reproducible than MPS and MUNIX both between and within operators. The mean CV for MScan (12.3%) was significantly lower than for MPS (24.7%) or MUNIX (21.5%). All methods had ICC>0.94. MScan and Munix were significantly quicker to perform than MPS (6.3mvs. 13.2m). MScan (AUC=0.930) and MPS (AUC=0.899) were significantly better at discriminating between patients and healthy controls than MUNIX (AUC=0.831). CONCLUSIONS: MScan was more consistent than MPS or MUNIX and better at distinguishing ALS patients from healthy subjects. SIGNIFICANCE: MScan may improve detection and assessment of motor unit loss.


Subject(s)
Amyotrophic Lateral Sclerosis/diagnosis , Amyotrophic Lateral Sclerosis/physiopathology , Electromyography/standards , Motor Neurons/physiology , Recruitment, Neurophysiological/physiology , Adult , Aged , Aged, 80 and over , Electromyography/methods , Female , Humans , Male , Middle Aged , Reproducibility of Results , Single-Blind Method
5.
J Oral Rehabil ; 36(6): 427-34, 2009 Jun.
Article in English | MEDLINE | ID: mdl-19422433

ABSTRACT

Training of specific muscles causes plastic changes in corticomotor pathways which may underlie the effect of various clinical rehabilitation procedures. The paired pulse transcranial magnetic stimulation (ppTMS) technique can be used to assess short interval intra-cortical inhibitory (SICI) and intra-cortical facilitatory (ICF) networks. This study examined changes in SICI and ICF in tongue motor cortex after tongue training in 11 healthy volunteers using ppTMS. Paired pulse TMS was applied to the 'hot-spot' for the tongue motor cortex and motor-evoked potentials (MEPs) were recorded from tongue muscles. In tongue motor cortex, bilateral SICI (P < 0.019) and ICF (P < 0.001) was detected before and after training. There were no significant effects of training on single MEPs or SICI/ICF (P > 0.063). The success rate improved during training (P < 0.001) and changes in success were correlated to changes in single MEP amplitude (P < 0.006) but not to SICI/ICF (P > 0.113). This first study of SICI/ICF after tongue training showed no training-related changes in intra-cortical inhibitory or facilitatory networks. However, there was an association between task performance and changes in corticomotor excitability. Further studies are required to determine the clinical utility of muscle specific training for oral rehabilitation purposes.


Subject(s)
Brain Injuries/physiopathology , Cerebral Cortex/physiology , Evoked Potentials, Motor/physiology , Muscle Contraction/physiology , Tongue/physiology , Adult , Brain Injuries/rehabilitation , Electromyography , Female , Humans , Male , Middle Aged , Neural Pathways/physiology , Psychomotor Performance/physiology , Transcranial Magnetic Stimulation/methods
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