Hostname: page-component-848d4c4894-nmvwc Total loading time: 0 Render date: 2024-06-26T14:48:55.717Z Has data issue: false hasContentIssue false

Electromyography in Disorders of Muscle Tone

Published online by Cambridge University Press:  05 January 2016

Andrew Eisen*
Affiliation:
Neuromuscular Diseases Unit (EMG), The Vancouver General Hospital, Vancouver
*
The Neuromuscular Diseases Unit (EMG), The Vancouver General Hospital, 855 West 12th Ave, Vancouver, B.C, Canada V5Z 1M9
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

No single clinical electrophysiological test can evaluate disorders of muscle tone. These disorders, symptomatic of a variety of diseases have a multifactorial physiological basis. The several tests used are complimentary each aiming to study different aspects of spinal and supraspinal reflexes which become deranged. The H reflex and F wave (H max/M max and F max/M max ratios) measure motoneuron pool excitability in general. The tendon reflex includes spindle mechanisms bypassed by the H reflex and, with limitations, comparison of H max/M max and T max/M max yields information about the -y system. Tonic vibration of a tendon inhibits the H reflex from the same muscle. The TVR measures autogenous presynaptic inhibition exerted by the la afferents of the muscle. Recurrent inhibition via Renshaw cells is evaluated by studying the effect of collision on the H reflex. Reciprocal inhibition of the la afferents can be assessed by measuring H reflex change induced by stimulating la afferents from antagonists. Changes in the H reflex recovery cycle measure polysynaptic influences on spinal motoneuron excitability. Cutaneomuscular (flexor) reflexes measure poly- and oligosynaptic excitatory drive to spinal motoneurons and the blink reflex evaluates the excitatory drive to brainstem motoneurons. Long loop (segmental) responses can be evaluated by limb pertubation using a torque motor or electrical stimulation applied during voluntary muscle contraction. Finally needle electromyography is a more relevant test in several disorders of muscle tone such as the stiff-man syndrome and Isaacs' syndrome.

Type
Research Article
Copyright
Copyright © Canadian Neurological Sciences Federation 1987

References

REFERENCES

1.Young, RR, Delwaide, PJ. Spasticity. N Eng J Med 1981; 304: 2833.Google ScholarPubMed
2.Rothwell, JC, Obeso, JA, Day, BL, et al. Pathophysiology of dystonias. In: Motor Control Mechanisms in Health and Disease. Desmedt, JE, ed. Raven Press, New York, 1983; 851863.Google Scholar
3.Burke, D. Stretch reflex activity in the spastic patient. In: Kyoto Symposia (EEG Suppl No. 36). Burser, PA, Cobb, WA, Okuma, T, eds. Elsevier, Amsterdam, 1982; 172178.Google Scholar
4.Davidoff, RA. Antispasticity drugs: Mechanisms of action. Ann Neurol 1985; 17: 107116.CrossRefGoogle ScholarPubMed
5.Brooks, VB. The neural basis of motor control. Oxford University Press, New York and Oxford, 1986: 111128.Google Scholar
6.Burke, D. Critical examination of the case for or against fusimotor involvement in disorders of muscle tone. In: Motor Control Mechanisms in Health Disease. Desmedt, JE, ed. Raven Press, New York, 1983; 133150.Google ScholarPubMed
7.Struppler, A. Some new aspects of spasticity as revealed by clinical neurophysiology. In: Clinical Neurophysiology in Spasticity: Contribution to Assessment and Pathophysiology. Delwaide, PJ, Young, RR, eds. Elsevier, Amsterdam, 1985.Google Scholar
8.Delwaide, PJ. Electrophysiological analysis of the mode of action of muscle relaxants in spasticity. Ann Neurol 1985; 17: 9095.CrossRefGoogle ScholarPubMed
9.Angel, RW, Hoffmann, WW. The H reflex in normal, spastic and rigid subjects. Arch Neurol 1963; 8: 591596.CrossRefGoogle Scholar
10.Iles, JF, Roberts, RC. Presynaptic inhibition of monosynaptic reflexes in the lower limbs of subjects with upper motoneuron disease. J Neurol Neurosurg Psychiat 1986; 49: 937944.CrossRefGoogle ScholarPubMed
11.Delwaide, PJ, Martinelli, P, Crenna, P. Clinical neurophysiological measurements of spinal reflex activity. In: Spasticity: Disordered Motor Control. Year Book Medical Publishers, Chicago, 1980; 345371.Google Scholar
12.Delwaide, PJ. Are there modifications in spinal cord functions of parkinsonian patients? In: Clinical Neurophysiology in parkinsonism. Delwaide, PJ, Agnoli, A, eds. Elsevier, Amsterdam, 1985; 1932.Google Scholar
13.Bathien, N, Rondot, P. Reciprocal continuous inhibition in rigidity of parkinsonism. J Neurol Neurosurg Psychiat 1977; 40: 2024.CrossRefGoogle ScholarPubMed
14.Bathien, N, Rondot, P. Assessment of motor functions in extra-pyramidal disorders. In: Recent Achievements in Restorative Neurology. 1. Upper Motor Neuron Functions and Dysfunctions. Eccles, J, Dimitrijevic, eds. Karger, Basel, 1985; 211221.Google Scholar
15.Pierrot-Deseilligny, E. Étude par le réflexe monosynaptique (reflex H) de certains méchanismes impliqués dans la régulation tonique posturale normale et pathologique. Thèse Faculté de Médecine de Paris, 1966.Google Scholar
16.Ashby, P, Verrier, M, Carleton, S, et al. Vibratory inhibition of the monosynaptic reflex and presynaptic inhibition in man. In: Spasticity: Disordered MotorControl. Feldman, RG, Young, RR, Koella, WP, eds. Year Book Medical Publishers, Chicago, 1980: 335344.Google Scholar
17.Gilles, D, Lance, JW, Neilson, PD, et al. Presynaptic inhibition of the monosynaptic reflex by vibration. J Physiol 1969; 205: 329339.CrossRefGoogle Scholar
18.Delwaide, P. Etude expérimentale de l’hyperréflexie tendineuse en clinique neurologique. Brussels, Editions Arscia Bruxelles, 1971.Google Scholar
19.Burke, D, Ashby, P. Are spinal presynaptic inhibitory mechanisms suppressed in spasticity? J Neurol Sci 1972; 15: 321326.CrossRefGoogle ScholarPubMed
20.Ashby, P, Verrier, MNeurophysiological changes following spinal cord lesions in man. Can J Neurol Set 1975; 2: 91100.CrossRefGoogle ScholarPubMed
21.Ashby, P, Verrier, M. Neurophysiological changes in hemiplegia: Possible explanation for the initial disparity between muscle tone and tendon reflexes. Neurology 1976; 26: 11451151.CrossRefGoogle ScholarPubMed
22.Martinelli, P, De Pasqua, V, Delwaide, PJ. Réflexes évoqués par la stimulation du nerf tibial postérieur versus réflexe tendineux chez l’homme. Rev Electroencéphalogr Neurophysiol Clin 1979; 9: 7681.CrossRefGoogle Scholar
23.Delwaide, PJ, Schoenen, J, Burton, L. Central actions of neurotropic drugs assessed by reflex studies in man. In: Desmedt, JE, ed. Motor Control Mechanisms in Health and Disease. New York, Raven, 1983; 977996.Google ScholarPubMed
24.Sax, DS, Johnson, TL. Spinal reflex activity in man: Measurement in relation to spasticity. In: Spasticity: Disordered Motor Control. Feldman, RG, Young, RR, Koella, WP, eds. Year Book Medical Publishers, Chicago, 1980; 301313;Google Scholar
25.Sax, DS, Johnson, TL, Cooper, IS. Reflex activity in extrapyramidal disorders. Adv Neurol 1976; 14: 285296.Google Scholar
26.Pierrot-Deseilligny, E, Katz, R, Hultbom, H. Functional organization of recurrent inhibition in man: Changes preceding and accompanying voluntary movements. In: Motor Control Mechanisms in Health and Disease. Desmedt, JE, ed. Raven Press, New York, 1983; 443457.Google Scholar
27.Katz, R, Pierrot-Deseilligny, E. Recurrent inhibition of alpha-moto-neurons in patients with upper motor neuron lesions. Brain 1982; 105: 103124.CrossRefGoogle ScholarPubMed
28.Tanaka, R. Reciprocal la inhibitory pathway in normal man and in patients with motor disorders. In: Motor Control Mechanisms in Health and Disease. Desmedt, JE, ed. Raven Press, New York, 1983; 433441.Google Scholar
29.Day, BL, Rothwell, JC, Marsden, CD. Transmission in the spinal reciprocal la inhibitory pathway preceding willed movements of the human wrist. Neurosc Lett 1983; 37: 245250.CrossRefGoogle Scholar
30.Day, BL, Marsden, CD, Obeso, JA, et al. Reciprocal inhibition between the muscles of the human forearm. J Physiol 1984; 349: 519534.CrossRefGoogle ScholarPubMed
31.Fisher, MA. Physiology and clinical use of the F response. AAEE Minimonograph No 13, Johnson Co., Rochester, MN, 1980.Google Scholar
32.Kimura, J. Electrodiagnosis in Disorders of Nerve and Muscle: Principals and Practice. Philadelphia, FA Davis, 1983: 353377.Google Scholar
33.Yates, SK, Brown, WE. Characteristics of the F response: Single motor unit study. J Neurol Neurosurg Psychiatry 1974; 42: 161170.CrossRefGoogle Scholar
34.Schiller, HH, Stalberg, E.Fresponses studied with single fibre EMG in normal subjects and spastic patients. J Neurol Neurosurg Psychiatry 1978; 41: 4553.CrossRefGoogle ScholarPubMed
35.Eisen, A, Hoirch, M, White, J, et al. Sensory group la proximal of conduction velocity. Muscle & Nerve 1984; 7: 636641.CrossRefGoogle Scholar
36.Eisen, A, Odusote, K. Amplitude of the F wave: A potential means of documenting spasticity. Neurology 1979; 29: 13061309.CrossRefGoogle Scholar
37.Potts, FA, Shahani, BT, Young, RR. F response amplitude and its relationship to the motor unit. Neurology 1981; 31: 66.Google Scholar
38.Peiglou-Harmoussi, S, Fawcett, PRW, Howel, D, et al. F-responses in syringomyelia. J Neurol Sci 1986; 75: 293304.CrossRefGoogle Scholar
39.Fisher, MA, Shanani, BT, Young, RR. Assessing segmental excitability after acute rostral lesions. 1. The F response. Neurology 1978; 28: 12651271.CrossRefGoogle Scholar
40.Fisher, MA. F response analysis of motor disorders of central origin. J Neurol Sci 1983; 62: 1322.CrossRefGoogle ScholarPubMed
41.Abbruzzese, G, Vische, M, Ratto, S, et al. Assessment of motor neuron excitability in parkinsonian rigidity by F wave. J Neurol 1985; 232: 246249.CrossRefGoogle ScholarPubMed
42.Lee, RG, Tatton, WG. Motor responses to sudden limb displacements in primates with specific CNS lesions and in human patients with motor system disorders. Can J Neurol Sci 1975; 2: 285293.CrossRefGoogle ScholarPubMed
43.Marsden, CD, Merton, PA, Morton, HB, et al. The effect of lesions of the central nervous system on long-latency stretch reflexes in the human thumb. In: Cerebral Motor Control in Man: Long Loop Mechanisms. Desmedt, JE, ed. Karger, Basel, 1978; 334341.Google Scholar
44.Lee, RG, Murphy, JT, Tatton, WG. Long-latency myotatic reflexes in man: Mechanism, functional significance and changes in patients with Parkinson’s disease or hemiplegia. In: Motor Control Mechanisms in Health and Disease. Desmedt, JE, ed. Raven Press, New York, 1983; 489508.Google Scholar
45.Mortimer, JA, Webster, DD. Relationships between quantitative measures of rigidity and tremor and electromyographic responses to load perturbations in unselected normal subjects and Parkinson patients. In: Cerebral Motor Control in Man; Long Loop Mechanisms. Desmedt, JE, ed. Karger, Basel, 1978; 342360.Google Scholar
46.Eisen, A, Burton, K, Larsen, A, et al. A new indirect method for measuring spinal cord conduction velocity in man. Electroen-cephalog Clin Neurophysiol 1984; 59: 204213.CrossRefGoogle ScholarPubMed
47.Upton, ARM, McComas, AJ, Sica, REP. Potentiation of “late” responses evoked in muscles during effort. J Neurol Neurosurg Psychiatry 1971; 34: 699711.CrossRefGoogle ScholarPubMed
48.Stanley, EF. Reflexes evoked in human thenar muscles during voluntary activity and their conduction pathways. J Neurol Neurosurg Psychiatry 1978; 41: 10161023.CrossRefGoogle ScholarPubMed
49.Jenner, JR, Stephens, JA. Cutaneous reflex responses and their central nervous pathway studied in man. J Physiol 1982; 333: 405419.CrossRefGoogle ScholarPubMed
50.Eisen, A, Hoirch, M, Fink, M, et al. Noninvasive measurement of central sensory and motor conduction. Neurology 1985; 35: 503509.CrossRefGoogle ScholarPubMed
51.Conrad, B, Aschoff, JC. Effects of voluntary isometric and isotonic activity on late transcortical reflex components in normal subjects and hemiparetic patients. Electroenceph Clin Neurophysiol 1977, 42: 107116.CrossRefGoogle ScholarPubMed
52.Iles, JF. Responses in human pretibial muscles to sudden stretch and electrical stimulation. Exp Brain Res 1977; 30: 451470.CrossRefGoogle Scholar
53.Kimura, J. The blink reflex as a clinical test. In: Electrodiagnosis in Clinical Neurology, Aminoff, MJ, ed. Churchill Livingstone, New York, 1986; 347383.Google Scholar
54.Garland, HG. Parkinsonism. Br Med J 1952; 1: 153155.CrossRefGoogle ScholarPubMed
55.Nappi, G, Sandrini, G, Arrigo, A. Blink reflex habituation as a tool for clinical and pharmacological research in Parkinson’s disease. In: Clinical Neurophysiology in Parkinsonism. Delwaide, PJ, Agnoli, A, eds. Elsevier, Amsterdam, 1985; 3348.Google Scholar
56.Kimura, J, Wilkinson, JT, Damasio, H, et al. Blink reflex in patients with hemispheric cerebrovascular accident (CVA). J Neurol Sci 1985; 67: 1528.CrossRefGoogle ScholarPubMed
57.Shahani, BT, Young, RR. Human flexor reflexes. J Neurol Neurosurg Psychiat 1971; 34: 616627.CrossRefGoogle ScholarPubMed
58.Shahani, , Young, RR. The flexor reflex in spasticity. In: Spasticity: Disordered Motor Control. Feldman, RG, Young, RR, Koella, WP, eds. Year Book Medical Publishers, Chicago, 1980; 287300.Google Scholar
59.Meinck, HM, Benecke, R, Kuster, S, et al. Cutaneomuscular (flexor)reflex organization in normal man and in patients with motor disorders. In: MotorControl Mechanisms in Health and Disease. Desmedt, JE, ed. Raven Press, New York, 1983; 787796.Google ScholarPubMed
60.Isaacs, H.Syndrome of continuous muscle fiber activity. J Neurol Neurosurg Psychiat 1961; 24: 319325.CrossRefGoogle Scholar
61.Warmolts, JR, Mendell, JR. Neuromyotonia: Impulse-induced repetitive discharges in motor nerves in peripheral neuorpathy. Ann Neurol 1980; 7: 245250.CrossRefGoogle Scholar
62.Isaacs, H, Heffron, JJA. The syndrome of “continuous muscle fiber activity” cured: Further studies. J Neurol Neurosurg Psychiat 1974, 37: 1231.CrossRefGoogle Scholar
63.Jablecki, C, Schultz, P. Single fiber recordings in the Schwartz-Jampel syndrome. Muscle & Nerve 1982; 5(S): 6469.Google ScholarPubMed
64.Gordon, EE, Janusko, DM, Kaufman, I. A critical survey of stiff-man syndrome. Am J Med 1967; 42: 582599.CrossRefGoogle ScholarPubMed
65.Miller, F, Korsvik, MS. Baclofen in the treatment of stiff-man syndrome. Ann Neurol 1981; 9: 511512.CrossRefGoogle ScholarPubMed