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Split Phenomenon of Fasciculation between Antagonistic Muscles in Amyotrophic Lateral Sclerosis: An Ultrasound Study

Published online by Cambridge University Press:  15 May 2023

Nan Hu ,
Yi Li ,
Jingwen Liu ,
Liying Cui  and
Mingsheng Liu Open the ORCID record for Mingsheng Liu [Opens in a new window]
Nan Hu
Affiliation:
Department of Neurology, Peking Union Medical College Hospital, Beijing, China
Yi Li
Affiliation:
Department of Neurology, Peking Union Medical College Hospital, Beijing, China
Jingwen Liu
Affiliation:
Department of Neurology, Peking Union Medical College Hospital, Beijing, China
Liying Cui
Affiliation:
Department of Neurology, Peking Union Medical College Hospital, Beijing, China
Mingsheng Liu*
Affiliation:
Department of Neurology, Peking Union Medical College Hospital, Beijing, China
*
Corresponding author: Mingsheng Liu, Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China. Email: liumingsheng_pumch@163.com
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Abstract:

Objective:

Paresis of muscle groups in patients with amyotrophic lateral sclerosis (ALS) tends to present split phenomena. We explored the split phenomenon of fasciculation in multiple antagonistic muscle groups in ALS patients.

Methods:

One hundred and forty ALS patients and 66 non-ALS patients were included from a single ALS center. Muscle ultrasonography (MUS) was performed to detect fasciculation in elbow flexor-extensor, wrist flexor-extensor, knee flexor-extensor, and ankle flexor-extensor. Split phenomena of fasciculation between different antagonistic muscle groups were summarized, and the possible influence factors were analyzed through stratified analysis.

Results:

The frequency of split phenomenon of fasciculation intensity was significantly higher than those of muscle strength (26.1% vs. 7.1% for elbow flexor-extensor, 38.3% vs. 5.7% for wrist flexor-extensor, 37.9% vs. 3.0% for knee extensor-flexor, and 33.6% vs. 14.4% for ankle flexor-extensor) (P < 0.01). For muscles with 0–1 level of muscle strength (the Medical Research Council, MRC, score), significance difference in mean fasciculation intensity was observed only in ankle flexor-extensor. For muscles with 2–5 level of muscle strength, significant dissociation of fasciculation grade was common, especially among patients with slow rapid progression rate and both upper and lower motor neuron (UMN and LMN) involvement. As for non-ALS patients, no significant difference was observed in fasciculation intensity between antagonistic muscles.

Conclusion:

Split phenomenon of fasciculation between antagonistic muscles was common and relatively specific in ALS patients. Muscle strength, progression rate, and UMN involvement were influence factors of the split phenomenon of fasciculation intensity.

Résumé :

RÉSUMÉ :

Étude du phénomène de fasciculation entre les muscles antagonistes dans la sclérose latérale amyotrophique, par échographie.

Objectif :

La parésie de certains groupes musculaires chez les patients atteints de sclérose latérale amyotrophique (SLA) tend à se manifester par un phénomène de dissociation musculaire. L’étude visait donc à examiner le phénomène de fasciculation qui se produit dans différents groupes de muscles antagonistes chez des patients atteints de SLA.

Méthode :

Ont participé à l’étude 140 patients atteints de SLA et 66 sujets épargnés par la maladie, provenant d’un seul centre de traitement de la SLA. Une échographie des muscles (EM) a été effectuée afin de permettre la détection du phénomène de fasciculation des groupes fléchisseurs/extenseurs (F/E) du coude, du poignet, de genou et de la cheville. Le phénomène de fasciculation observé entre les différents groupes de muscles antagonistes a été décrit dans un résumé, et une analyse stratifiée a permis d’étudier l’influence possible de différents facteurs.

Résultats :

La fréquence de l’intensité des fasciculations était passablement plus élevée que celle de la force musculaire (groupe F/E du coude : 26,1 % contre [c.] 7,1 %; groupe F/E du poignet : 38,3 % c. 5,7 %; groupe F/E du genou : 37,9 % c. 3,0 %; groupe F/E de la cheville : 33,6 % c. 14,4 %) (p < 0,01). En ce qui concerne la force musculaire de degré 01 (selon l’échelle du Medical Research Council [MRC [R.U.}], un écart important de l’intensité moyenne des fasciculations n’a été observé que dans le groupe F/E de la cheville. Pour ce qui est de la force musculaire de degré 25, une dissociation importante du degré de fasciculation était fréquente, surtout chez les patients présentant une évolution lente ou rapide de la maladie et une atteinte des motoneurones supérieurs et inférieurs (MNS et MNI). Quant aux sujets exempts de la SLA, aucun écart important de l’intensité des fasciculations n’a été relevé entre les muscles antagonistes.

Conclusion :

Le phénomène de fasciculation entre les muscles antagonistes était fréquent et relativement spécifique de la SLA. La force musculaire, la vitesse d’évolution de la maladie et l’atteinte des MNS se sont révélées des facteurs qui influent sur l’intensité du phénomène de fasciculation.

Keywords

Amyotrophic lateral sclerosisSplit phenomenonFasciculation
Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 51 , Issue 2 , March 2024 , pp. 187 - 195
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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