Implementing Motor Unit Number Index (MUNIX) in a large clinical trial: Real world experience from 27 centres

Neuwirth, Christoph; Braun, Nathalie; Claeys, Kristl G.; Bucelli, Robert C.; Fournier, Christina; Bromberg, Mark B.; Petri, Susanne; Goedee, Stephan; Lenglet, Timothée; Leppanen, Ron; Canosa, Antonio; Goodman, Ira; Al‐Lozi, Muhammad; Ohkubo, Takuya; Hübers, Annemarie; Atassi, Nazem; Abrahão, Agessandro; Funke, Andreas; Appelfeller, M.; Tümmler, A.; Finegan, Eoin; Glass, Jonathan D.; Babu, Suma; Ladha, Shafeeq; Kwast-Rabben, Olga; Juntas-Moralès, Raul; Coffey, Amina; Chaudhry, Vinay; Vu, Tuan; Saephanh, Chow; Newhard, Colleen; Zakrzewski, Marion; Rosier, Esther; Hamel, Nancy; Raheja, Divisha; Raaijman, Jesper; Ferguson, Toby A.; Weber, Markus

doi:10.1016/j.clinph.2018.04.614

Cited by 53 publications

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“…The twofold higher CMAP amplitudes yielded with an isolectric referential reduces the potential measurement floor effect from too small a CMAP. Previous and ongoing (NCT02611674) studies estimating the motor unit number index (MUNIX) have also used the knee as the referential site, which may improve the utility of this technique as it is not measurable when the CMAP amplitude is below 0.5 mV . Improving the floor effect may also be useful in severe axonal neuropathies when the EDB recording is absent and a response from the TA cannot be measured.…”

Section: Discussionmentioning

confidence: 99%

Optimal E2 (reference) electrode placement in fibular motor nerve conduction studies recording from the tibialis anterior muscle

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elucidate a definitive time frame in which recovery was obtained. In addition, the scope of analysis was limited because of the small sample and lack of controls. However, the time of recovery was similar to that in a previous EMG outcome study. 3 This report describes EMG findings of recovery after decompression of paralabral cysts at the suprascapular or spinoglenoid notch with arthroscopy or ultrasound-guided aspiration. Our results show that neurophysiological findings of nerve entrapment normalized after decompression. Long-term studies with more patients and follow-ups are required to determine time to recovery.We thank Nicole Hurwitz, BS, and Jennifer Cheng, PhD, for their assistance with the manuscript preparation process.Ethical Publication Statement: We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. 2. Fehrman DA, Orwin JF, Jennings RM. Suprascapular nerve entrapment by ganglion cysts: a report of 6 cases with arthroscopic findings and review of the literature. Arthroscopy 1995;11 (6):727-734. 3. Feinberg JH, Nguyen ET, Boachie-Adjei K, Gribbin C, Lee SK, Daluiski A, et al. The electrodiagnostic natural history of Parsonage-Turner syndrome. Muscle Nerve 2017;56(4):737-743. 4. Ferretti A, De Carli A, Fontana M. Injury of the suprascapular nerve at the spinoglenoid notch. The natural history of infraspinatus atrophy in volleyball players. Am J Sports Med 1998;26(6):759-763. 5. Zehetgruber H, Noske H, Lang T, Wurnig C. Suprascapular nerve entrapment. A meta-analysis. Int Orthop 2002;26(6):339-343. 6. Arriaza R, Ballesteros J, Lopez-Vidriero E. Suprascapular neuropathy as a cause of swimmer's shoulder: results after arthroscopic treatment in 4 patients. Am J Sports Med 2013;41(4):887-893. 7. Shah AA, Butler RB, Sung SY, Wells JH, Higgins LD, Warner JJ. Clinical outcomes of suprascapular nerve decompression. J Shoulder Elbow Surg 2011;20(6):975-982. 8. Krarup C, Boeckstyns M, Ibsen A, Moldovan M, Archibald S. Remodeling of motor units after nerve regeneration studied by quantitative electromyography. Clin Neurophysiol 2016;127(2):1675-1682. 9. Hill LJ, Jelsing EJ, Terry MJ, Strommen JA. Evaluation, treatment, and outcomes of suprascapular neuropathy: a 5-year review. PM R 2014; 6(9):774-780. 10. Westerheide KJ, Dopirak RM, Karzel RP, Snyder SJ. Suprascapular nerve palsy secondary to spinoglenoid cysts: results of arthroscopic treatment. Arthroscopy 2006;22(7):721-727. 11. Lafosse L, Tomasi A, Corbett S, Baier G, Willems K, Gobezie R. Arthroscopic release of suprascapular nerve entrapment at the suprascapular notch: technique and preliminary results. Arthroscopy 2007;23(1):34-42. 12. Fernandes MR, Fernandes RJ. Indirect arthroscopic decompression of spinoglenoid cyst with suprascapular neuropathy: report of two cases and literature review. Rev Bras Ortop 2010;45(3):306-311.Additional supporting information may be found in the online version of this article.

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Section: Discussionmentioning

confidence: 99%

Optimal E2 (reference) electrode placement in fibular motor nerve conduction studies recording from the tibialis anterior muscle

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“…To control for the experience-related variations and improve the automation of MUNIX calculation, in this study, the MUNIX repeatability was evaluated by taking into consideration all three previously proposed methods. This explains that the relatively low trial-to-trial CV compared to previously reported results (9,33). In this study, the performance of mMUNIX have been assessed by PCC and CV.…”

Section: Discussionmentioning

confidence: 83%

“…Variations in compound muscle action potential (CMAP) signals and surface EMG contraction signals, and randomness of surface interferential patterns (SIP) selection can affect MUNIX results. Furthermore, suboptimal electrode placement has been suggested as the most recurrent source of errors and systematic mistakes (9). The repeatability of MUNIX has been reported in both healthy and patient subjects, measured by coefficient of variation (CV), interclass correlation coefficients (ICC) and/or correlation coefficients (CC) (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, suboptimal electrode placement has been suggested as the most recurrent source of errors and systematic mistakes (9). The repeatability of MUNIX has been reported in both healthy and patient subjects, measured by coefficient of variation (CV), interclass correlation coefficients (ICC) and/or correlation coefficients (CC) (8)(9)(10)(11). CV values up to 52.9% has been observed in healthy and ALS patients (10,(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

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A Preliminary Study of Effects of Channel Number and Location on the Repeatability of Motor Unit Number Index (MUNIX)

et al. 2020

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Motor Unit Number Index (MUNIX) is a technique that provides a susceptive biomarker for monitoring innervation conditions in patients with neurodegenerative diseases. A satisfactory repeatability is essential for the interpretation of MUNIX results. This study aims to examine the effect of channel number and location on the repeatability of MUNIX. In this study, 128 channels of high-density surface electromyography (EMG) signals were recorded from the biceps brachii muscles of eight healthy participants, at 10, 20, 30, 40, 50, 60, 70, 80, and 100% of maximal voluntary contraction. The repeatability was defined by the coefficient of variation (CV) of MUNIX estimated from three experiment trials. Single-channel MUNIX (sMUNIX) was calculated on a channel-specific basis and a multi-channel MUNIX (mMUNIX) approach as the weighted average of multiple sMUNIX results. Results have shown (1) significantly improved repeatability with the proposed mMUNIX approach; (2) a higher variability of sMUNIX when the recording channel is positioned away from the innervation zone. Our results have demonstrated that (1) increasing the number of EMG channels and (2) placing recording channels close to the innervation zone (IZ) are effective methods to improve the repeatability of MUNIX. This study investigated two potential causes of MUNIX variations and provided novel perspectives to improve the repeatability, using high-density surface EMG. The mMUNIX technique proposed can serve as a promising tool for reliable neurodegeneration evaluation.

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“…The multicentre setting of clinical trials provide an ideal environment to evaluate the association between a biomarker and classical clinical endpoints, and to determine its reliability, test-retest validity and site variability (15). Biomarkers should be defined as to their potential utility in all phases of clinical development (e.g.…”

Section: Considerationsmentioning

confidence: 99%

TRICALS: creating a highway toward a cure

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Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration

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A change in our current approach toward drug development is required to improve the likelihood of finding effective treatment for patients with amyotrophic lateral sclerosis (ALS). The aim of the Treatment Research Initiative to Cure ALS (TRICALS) is to extend the collective effort with industry and consolidate drug development paths. TRICALS has begun a series of meetings on how to best move the field forward collaboratively, thereby addressing five major topics in ALS clinical trials: (1) preclinical research, (2) biomarker development, (3) eligibility criteria, (4) efficacy endpoints and (5) innovative trial design. There is an appetite for ongoing discussions of these major topics in clinical trials between representatives from academia, patient advocacy groups, industry partners and funding bodies. Industry is open to fundamentally change drug development for ALS and shorten the time to effective therapy for patients by implementing promising innovations in biomarker development, trial design, and patient selection. There is however, a pressing need from all stakeholders for regulatory discussions and amendments of current guidelines to successfully adopt innovation in future clinical development lines.

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Implementing Motor Unit Number Index (MUNIX) in a large clinical trial: Real world experience from 27 centres

Cited by 53 publications

References 21 publications

Optimal E2 (reference) electrode placement in fibular motor nerve conduction studies recording from the tibialis anterior muscle

Optimal E2 (reference) electrode placement in fibular motor nerve conduction studies recording from the tibialis anterior muscle

A Preliminary Study of Effects of Channel Number and Location on the Repeatability of Motor Unit Number Index (MUNIX)

TRICALS: creating a highway toward a cure

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