Clinical utility of trapezius muscle studies in the evaluation of amyotrophic lateral sclerosis

Cho, Joong-Yang; Sung, Jung Joon; Min, Ju-Hong; Lee, Kwang-Woo

doi:10.1016/j.jocn.2006.01.044

Cited by 11 publications

(12 citation statements)

References 26 publications

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“…Qualitative assessment remains the most popular method employed for the evaluation of voluntary activity in daily EMG practice. Many previous studies that investigated EMGs of the cranial muscles in ALS also employed qualitative assessment3, 27, 30 or gave no detailed description on the method of evaluation for voluntary activities 5, 6, 10, 28. A qualitative method would be sufficiently reliable if performed by a trained examiner,7, 12 but it would not be free from subjective biases.…”

Section: Discussionmentioning

confidence: 99%

“…We classified each ALS patient into the following diagnostic categories according to the EEC: clinically definite, probable, probable laboratory supported, possible, and suspected. The EMG findings of the tongue were considered in determining the EEC category, but those of the SCM and trapezius were not, because these muscles have been considered to have both cranial and cervical innervations 6, 27. The “clinically suspected” category had been defined in the first version of the El Escorial criteria,42 corresponding to pure lower motor neuron disease, or progressive muscular atrophy (PMA).…”

Section: Methodsmentioning

confidence: 99%

“…Recently, some investigators have reported frequent abnormalities in EMG of the sternocleidomastoid muscle (SCM) or the upper trapezius muscle in ALS patients 6, 19, 27. However, the relative utility of these muscles in comparison with the tongue in the diagnosis of ALS has not been investigated fully, nor is it clear whether these muscles can be relaxed more easily than the tongue.…”

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confidence: 99%

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Utility of trapezius EMG for diagnosis of amyotrophic lateral sclerosis

et al. 2008

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Needle electromyography (EMG) of the tongue is traditionally used as a key to the diagnosis of amyotrophic lateral sclerosis (ALS), although relaxation of the tongue is often difficult to achieve. Recently, frequent abnormalities in the EMGs of the sternocleidomastoid (SCM) and upper trapezius muscles in ALS have been reported. To elucidate the diagnostic utility of these muscles we performed a multicenter prospective study to examine EMGs of the tongue (genioglossus), SCM, and trapezius in 104 ALS or suspected ALS patients. We also examined EMGs of the SCM and trapezius in 32 cervical spondylosis (CS) patients. We mainly evaluated fibrillation potentials/positive sharp waves (Fib/PSWs) and fasciculation potentials. Complete relaxation was achieved in 85% of ALS patients in the trapezius, but in only 6% of patients in the tongue. Fib/PSWs were observed in 8%, 13%, and 45% of ALS patients in the tongue, SCM, and trapezius, respectively, whereas fasciculation potentials were observed in 1%, 7%, and 39%, respectively. Abnormal spontaneous activity of any type was found in 9%, 17%, and 63% of patients, respectively. The high frequency of abnormal spontaneous activity in the trapezius was similar among the different diagnostic categories, and even 72% of clinically suspected ALS (progressive muscular atrophy) patients showed them in their trapezius. We did not observe Fib/PSWs or fasciculation potentials in any of our CS patients, thus these findings have excellent specificity. Tongue EMG added little utility over the clinical sign of tongue atrophy. Abnormal spontaneous activity in the trapezius would be more useful for the early diagnosis of ALS.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Utility of trapezius EMG for diagnosis of amyotrophic lateral sclerosis

et al. 2008

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“…Regarding bulbar muscles, beyond facial and tongue muscles, the value of neurogenic EMG signs (including spontaneous activity) in SCM and trapezius muscles should be emphasized, even in patients without bulbar symptoms [16,36,50,60]. In particular, it has been shown that needle EMG or motor evoked potential (MEP) abnormalities in the trapezius muscle was of high diagnostic value to differentiate ALS from cervical spondylotic myeloradiculopathy [84,89,98].…”

Section: Specific Interest Of Some Muscles To Be Studied With Needle Emgmentioning

confidence: 99%

“…Also, an easy way to improve the diagnostic yield of MEPs in ALS is, as for needle EMG, to specifically explore some muscle territories, such as the SCM or trapezius muscles [16,36,89] and facial or oral muscles [2,3,39,88,91].…”

Section: Motor Evoked Potentialsmentioning

confidence: 99%