Surface recording of muscle activity

Transcription

1 3 rd Congress of the European Academy of Neurology Amsterdam, The Netherlands, June 24 27, 2017 Hands-on Course 5 Electromyography: Surface, needle conventional and single fiber - Level 1-2 Surface recording of muscle activity Markus Kofler Zirl, Austria markus.kofler@i-med.ac.at

2 EAN Hands-on Course 5 Electromyography: Surface, needle conventional and single fiber Level 1-2 Chairperson: Presentations: Christian Krarup, Copenhagen, Denmark Markus Kofler, Zirl, Austria Christian Krarup, Copenhagen, Denmark Sanjeev Nandedkar, Hopewell Junction, United States EAN Hands-on Course 5 Electromyography: Surface, needle conventional and single fiber SURFACE RECORDING OF MUSCLE ACTIVITY Markus Kofler Zirl, Austria The author has no conflict of interest in relation to this manuscript 1

3 Needle EMG: diagnosis of neuromuscular diseases Surface EMG: assessment of motor control UTILITY OF SURFACE EMG Quantification of EMG activity direct muscle responses or reflexes excitatory or inhibitory activity for the assessment of motor control Identification of latency and duration of muscle activity in prime mover or postural muscle in relation to events (reaction time) Propagation of electrical impulses along muscle fibers Correlation of EMG with muscle strength Evaluation of muscle fatigue (peripheral and central) 2

4 BMCA BRAIN MOTOR CONTROL ASSESSMENT Quantification of EMG activity spinal cord injury Dimitrijevic MR, Kaulas BA, McKay WB, Vrbová G. Restorative neurology of spinal cord injury, Oxford University Press, BMCA BRAIN MOTOR CONTROL ASSESSMENT Quantification of EMG activity spinal cord injury Dimitrijevic MR, Kaulas BA, McKay WB, Vrbová G. Restorative neurology of spinal cord injury, Oxford University Press,

5 BMCA BRAIN MOTOR CONTROL ASSESSMENT Quantification of EMG activity spinal cord injury Dimitrijevic MR, Kaulas BA, McKay WB, Vrbová G. Restorative neurology of spinal cord injury, Oxford University Press, BMCA BRAIN MOTOR CONTROL ASSESSMENT Quantification of EMG activity spinal cord injury Dimitrijevic MR, Kaulas BA, McKay WB, Vrbová G. Restorative neurology of spinal cord injury, Oxford University Press,

6 BMCA BRAIN MOTOR CONTROL ASSESSMENT Quantification of EMG activity spinal cord injury Dimitrijevic MR, Kaulas BA, McKay WB, Vrbová G. Restorative neurology of spinal cord injury, Oxford University Press, BMCA BRAIN MOTOR CONTROL ASSESSMENT Quantification of EMG activity spinal cord injury Dimitrijevic MR, Kaulas BA, McKay WB, Vrbová G. Restorative neurology of spinal cord injury, Oxford University Press,

7 BMCA BRAIN MOTOR CONTROL ASSESSMENT Quantification of EMG activity spinal cord injury Dimitrijevic MR, Kaulas BA, McKay WB, Vrbová G. Restorative neurology of spinal cord injury, Oxford University Press, TREMOR IN PARKINSON S DISEASE EMG Accelerometer Quantification of EMG activity - tremor Fast Fourier transformation 6

8 ORTHOSTATIC TREMOR Accelerometer Quantification of EMG activity - tremor Fast Fourier transformation ESSENTIAL vs. DYSTONIC HEAD TREMOR Essential tremor head unsupported, at rest head turning to right Quantification of EMG activity - tremor Dystonic tremor Valls-Solé J, Tolosa ES, Nobbe F, Dieguez E, Munoz E, Sanz P, Valldeoriola F. Neurophysiological investigations in patients with head tremor. Mov Disord 1997,12:

9 PSYCHOGENIC vs. ORGANIC TREMOR normal subject psychogenic tremor Accelerometer: contralateral wrist extensors Imperative signal: visual stimulus SRT paradigm: press switch Quantification of EMG activity - tremor Parkinson s tremor essential tremor Kumru H, Valls-Sole J, Valldeoriola F, et al. Transient arrest of psychogenic tremor induced by contralateral ballistic movements. Neuroscience Letters 2004,370: PSYCHOGENIC vs. ORGANIC TREMOR Dual task: voluntary contralateral tremor Quantification of EMG activity - tremor Reaction time in psychogenic tremor Reaction time in essential tremor Reaction time in Parkinson s tremor Kumru H, Begeman M, Tolosa E, Valls-Solé J: Dual task interference in psychogenic tremor. Movement Disorders 2007, 22:

10 CORTICAL vs. BRAINSTEM MYOCLONUS Quantification of EMG activity myoclonus Caviness JN. The clinical neurophysiology of myoclonus. In: Movement Disorders. Edited by Hallett M, vol. 1. Amsterdam: Elsevier; 2003: CORTICAL MYOCLONUS Quantification of EMG activity myoclonus Caviness JN. The clinical neurophysiology of myoclonus. In: Movement Disorders. Edited by Hallett M, vol. 1. Amsterdam: Elsevier; 2003:

11 PROPRIOSPINAL MYOCLONUS Quantification of EMG activity myoclonus Brown P, Rothwell JC, Thompson PD, Marsden CD: Propriospinal myoclonus: evidence for spinal "pattern" generators in humans. Mov Disord 1994,9: MYOCLONUS vs. VOLUNTARY TWITCH Quantification of EMG activity myoclonus Differentiating psychogenic from organic myoclonus: incremental burst onset with longer duration; inconsistency in amplitude, frequency, distribution; reduction with distraction; spontaneous periods of remission; subject to placebo and suggestion Caviness JN. The clinical neurophysiology of myoclonus. In: Movement Disorders. Edited by Hallett M, vol. 1. Amsterdam: Elsevier; 2003:

12 STARTLE REACTION Quantification of EMG activity startle reaction Valls-Solé J, Kumru H, Kofler M. Interaction between startle and voluntary reaction in humans. Exp Brain Res 2008;187: Kofler M, Müller J, Reggiani L, Valls-Solé J. Influence of age on auditory startle responses in humans. Neurosci Lett 2001,307:65-68 Kofler M, Müller J, Rinnerthaler-Weichbold M, Valls-Solé J. Laterality of auditory startle responses in humans. Clin Neurophysiol 2008,119: Kofler M, Müller J, Valls-Solé J. Auditory startle responses as a probe of brainstem function in healthy subjects and patients with movement disorders. Suppl Clin Neurophysiol 2006:58; STARTLE REACTION Quantification of EMG activity startle reaction 11

13 PSYCHOGENIC STARTLE REACTION Quantification of EMG activity startle reaction Thompson PD, et al. Voluntary stimulus-sensitive jerks and jumps mimicking myoclonus or pathological startle syndromes. Mov Disord 1992,7: POLYSYNAPTIC SOMATOSENSORY REFLEXES INVOLVING MUSCLE RESPONSES Stimulus at rest during sustained contraction Electrical cutaneous afferents blink reflex (R1, R2, R3) cutaneomuscular reflex (E1, E2) cutaneous silent period (CSP) voluntary potential (V) masseteric inhibitory reflex (MIR) Electrical reflex myoclonus (C wave) long loop reflex (LLR1, LLR2, LLR3) Quantification of EMG activity reflexes cutaneous or mixed w/ muscle and joint afferents Tactile, stretch Vibration flexor withdrawal reflex (R2, R3) palmomental reflex (PMR) somatosensory startle reflex (SSR) masseter reflex T wave tonic vibratory reflex (TVR) mixed nerve silent period (MNSP) masseteric inhibitory reflex (MIR) stretch-induced silent period stretch reflex (M2, M3) 12

14 TRIGEMINO-TRIGEMINAL REFLEXES right MAS left MAS 10 ms Averaging of rectified EMG Quantification of EMG activity reflexes 5 ms right MAS left MAS 50 chin taps 50 electrical stimuli to mental nerve TRIGEMINO-FACIAL REFLEXES Stim Rec Rec R Quantification of EMG activity reflexes L Schwingenschuh P, et al. The blink reflex recovery cycle differs between essential and presumed psychogenic blepharospasm. Neurology 2011,76: Differentiating psychogenic from organic blepharospasm by constructing blink reflex excitability recovery curve 13

15 TRIGEMINO-FACIAL REFLEXES Quantification of EMG activity reflexes Kofler M, Kumru H, Schaller J, Saltuari L: Blink reflex prepulse inhibition and excitability recovery: influence of age and sex. Clin Neurophysiol 2013,124: CUTANEOMUSCULAR REFLEXES Quantification of EMG activity reflexes 14

16 CUTANEOMUSCULAR REFLEXES Quantification of EMG activity reflexes INHIBITORY REFLEXES Quantification of EMG activity reflexes 15

17 PRE-MOVEMENT MODULATION OF SURFACE EMG Quantification of EMG activity reflexes Schieppati M, Nardone A, Musazzi M: Modulation of the Hoffmann reflex by rapid muscle contraction or release. Human Neurobiology 1986,5:59-66 PRE-MOVEMENT MODULATION OF SURFACE EMG Quantification of EMG activity reflexes 16

18 MODULATION OF SURFACE EMG Quantification of EMG activity reflexes MODULATION OF SURFACE EMG Supraspinal facilitation of the soleus H reflex Quantification of EMG activity reflexes 17

19 MODULATION OF SURFACE EMG Flexor withdrawal reflex Somatosensory startle reflex Quantification of EMG activity reflexes Differentiating startle from flexor withdrawal reflex: prepulses suppress startle, but not withdrawal Alvarez-Blanco S, Leon L, Valls-Sole J: The startle reaction to somatosensory inputs: different response pattern to stimuli of upper and lower limbs. Exp Brain Res 2009,195: REACTION TIME Reaction time 18

20 REACTION TIME PARAMETERS Reaction time PATTERNED BALLISTIC MOVEMENTS Reaction time Valls-Solé J, Rothwell JC, Goulart F, Cossu G, Muñoz E. Patterned ballistic movements triggered by a startle in healthy humans. Journal of Physiology 1999,516:

21 PATTERNED BALLISTIC MOVEMENTS Reaction time Different motor sets cause different starting points, hence different ensuing ballistic movement patterns Castellote JM, Valls-Solé J, Sanegre MT. Ballistic reactions under different motor sets. Experimental Brain Research 2004,158:35-42 REACTION TIME and STARTREACT Reaction time StartReact phenomenon Valls-Solé J, Rothwell JC, Goulart F, Cossu G, Muñoz E. Patterned ballistic movements triggered by a startle in healthy humans. Journal of Physiology 1999,516:

22 REACTION TIME and STARTREACT Reaction time Reaction time in patients with PSP is slower than in any other type of parkinsonian syndromes Valldeoriola F, Valls-Solé J, Tolosa, E, Ventura PJ, et al. Effects of a startling acoustic stimulus on reaction time in different parkinsonian syndromes. Neurology 1998,51: MUSCLE FIBER CONDUCTION VELOCITY Matrix of electrodes attached over muscle of interest for localization of 1. motor unit action potential propagation (2 to 8 m/s) 2. innervation zone Multichannel surface EMG 21

23 MUSCLE FIBER CONDUCTION VELOCITY Multichannel surface EMG Farina D, Zagari D, Gazzoni M, Merletti R. Reproducibility of muscle-fiber conduction velocity estimates using multichannel surface EMG techniques. Muscle Nerve 2004,29: INNERVATION ZONE IZ Multichannel surface EMG Time (s) 22

24 CORRELATION OF EMG WITH MUSCLE STRENGTH Muscle strength Clarys JP, et al. Critical appraisal and hazards of surface electromyography data acquisition in sport and exercise. Asian J Sports Med 2010,1:69-80 CORRELATION OF EMG WITH MUSCLE STRENGTH Muscle strength 23

25 CORRELATION OF EMG WITH MUSCLE STRENGTH Muscle strength Kofler M, Kumru H, et al. Muscle force up to 50% of maximum does not affect cutaneous silent periods in thenar muscles. Clinical Neurophysiology 2007,118: PERIPHERAL and CENTRAL MUSCLE FATIGUE L L R R Muscle fatigue Fig. 5. A: typical example of an M wave seen in the control condition (interrupted line), immediately after fatigue (thick line) and after a 20-min of recovery (thin line). Post M, Bayrak S, Kernell D, Zijdewind I: Contralateral muscle activity and fatigue in the human first dorsal interosseous muscle. J Appl Physiol 2008,105: