Abstract
OBJECTIVES—to find out if conventional and automatic needle EMG of the tongue can be helpful in the diagnosis and differentiation of limb and bulbar onset amyotrophic lateral sclerosis. METHODS—Motor unit action potential (MUAP) analysis and peak ratio interference pattern analysis were performed in the right genioglossus muscle of 30 healthy subjects aged 30-81 years, 10 patients aged 49-73 years with limb onset amyotrophic lateral sclerosis, and eight patients aged 52-75 years with bulbar onset amyotrophic lateral sclerosis. Electrical activity was sampled via standard concentric needle electrodes with a commercially available EMG recorder. RESULTS—Normal mean (2SD) MUAP duration was 6.6 (1.5) ms. Normal mean (2SD) MUAP amplitude was 224 (97.4) µV. Normal mean (2SD) peak ratio (PR), turns/second (T/s), amplitude/turn (A/T), and time intervals (TI1, TI2, TI3) were 1.68 (0.56), 732 (303.9), 446 (180.3) µV, 2.62 (0.34), 2.31 (0.14), and 1.01 (0.50) respectively. Mean MUAP duration and amplitude were significantly increased in limb onset (P=0.0001 and P=0.013) and bulbar onset amyotrophic lateral sclerosis (P=0.0001 and P=0.017). Peak ratio indices stayed unchanged in limb onset amyotrophic lateral sclerosis but were significantly decreased (PR, T/s, A/T, TI1, and TI2) or increased (TI3) in bulbar onset disease. The sensitivity of the MUAP analysis was 70% in limb and 75% in bulbar onset amyotrophic lateral sclerosis. The sensitivity of the peak ratio interference pattern analysis was 20% in limb and 100% in bulbar onset amyotrophic lateral sclerosis. Subclinical involvement of the tongue was found in 20% of the patients with limb onset amyotrophic lateral sclerosis and could be more accurately assessed with MUAP analysis than with automatic EMG. CONCLUSIONS—both conventional and automatic needle EMG of the tongue are valuable electrophysiological devices to assess the clinical and subclinical involvement of the tongue in patients with limb and bulbar onset amyotrophic lateral sclerosis.
Full Text
The Full Text of this article is available as a PDF (140.7 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Enderby P., Crow E. Frenchay Aphasia Screening Test: validity and comparability. Disabil Rehabil. 1996 May;18(5):238–240. doi: 10.3109/09638289609166307. [DOI] [PubMed] [Google Scholar]
- Finsterer J., Wogritsch C., Pokieser P., Vesely M., Ulrich W., Grisold W., Mamoli B. Light chain myeloma with oro-pharyngeal amyloidosis presenting as bulbar paralysis. J Neurol Sci. 1997 Apr 15;147(2):205–208. doi: 10.1016/s0022-510x(96)05326-9. [DOI] [PubMed] [Google Scholar]
- Jüde H. D., Drechsler F., Neuhauser B. Elementare elektromyographische Analyse und Bewegungsmuster des M. myloglossus. Dtsch Zahnarztl Z. 1975 Jul;30(7):457–461. [PubMed] [Google Scholar]
- Kang D. X., Fan D. S. The electrophysiological study of differential diagnosis between amyotrophic lateral sclerosis and cervical spondylotic myelopathy. Electromyogr Clin Neurophysiol. 1995 Jun-Jul;35(4):231–238. [PubMed] [Google Scholar]
- Liguori R., Dahl K., Fuglsang-Frederiksen A. Turns-amplitude analysis of the electromyographic recruitment pattern disregarding force measurement. I. Method and reference values in healthy subjects. Muscle Nerve. 1992 Dec;15(12):1314–1318. doi: 10.1002/mus.880151204. [DOI] [PubMed] [Google Scholar]
- Nirkko A. C., Rösler K. M., Hess C. W. Sensitivity and specificity of needle electromyography: a prospective study comparing automated interference pattern analysis with single motor unit potential analysis. Electroencephalogr Clin Neurophysiol. 1995 Feb;97(1):1–10. doi: 10.1016/0924-980x(94)00248-6. [DOI] [PubMed] [Google Scholar]
- Norris F. H., Jr, Calanchini P. R., Fallat R. J., Panchari S., Jewett B. The administration of guanidine in amyotrophic lateral sclerosis. Neurology. 1974 Aug;24(8):721–728. doi: 10.1212/wnl.24.8.721. [DOI] [PubMed] [Google Scholar]
- Praud J. P., D'Allest A. M., Delaperche M. F., Bobin S., Gaultier C. Diaphragmatic and genioglossus electromyographic activity at the onset and at the end of obstructive apnea in children with obstructive sleep apnea syndrome. Pediatr Res. 1988 Jan;23(1):1–4. doi: 10.1203/00006450-198801000-00001. [DOI] [PubMed] [Google Scholar]
- Shimizu T., Miyamoto K., Hayashi H., Nagashima T., Hirose K., Tanabe H. [Congenital facioscapulohumeral muscular dystrophy associated with tongue atrophy and sensorineural hearing disturbance]. Rinsho Shinkeigaku. 1991 Apr;31(4):433–438. [PubMed] [Google Scholar]
- Tsuda N., Yamamoto K., Fukusako T., Morimatsu M. [A case of unilateral lingual atrophy and ipsilateral muscular atrophy supplied by trigeminal nerve--in relation to progressive facial hemiatrophy]. Rinsho Shinkeigaku. 1991 Sep;31(9):1007–1009. [PubMed] [Google Scholar]