Detecting motor unit abnormalities in amyotrophic lateral sclerosis using high-density surface EMG

Objective: The purpose of this study was to detect specific motor unit (MU) abnormalities in people with amyotrophic lateral sclerosis (ALS) compared to controls using high-density surface electromyography (HD-SEMG).Methods: Sixteen people with ALS and 16 control subjects. The participants performed ramp up and sus-tained contractions at 30% of their maximal voluntary contraction. HD-SEMG signals were recorded in the vastus lateralis muscle and decomposed into individual MU firing behavior using a convolution blind source separation method.Results: In total, 339 MUs were detected (people with ALS; n = 93, control subjects; n = 246). People with ALS showed significantly higher mean firing rate, recruitment threshold, coefficient of variation of the MU firing rate, MU firing rate at recruitment, and motoneurons excitability than those of control subjects (p < 0.001). The number of MU, MU firing rate, recruitment threshold, and MU firing rate at recruitment were significantly correlated with disease severity (p < 0.001). Multivariable analysis revealed that an increased MU firing rate at recruitment was independently associated with ALS.Conclusions: These results suggest increased excitability at recruitment, which is consistent with neu-rodegeneration results in a compensatory increase in MU activity. Significance: Abnormal MU firing behavior provides an important physiological index for understanding the pathophysiology of ALS.(c) 2022 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.