ultrasound and neuromuscular disease

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ultrasound and neuromuscular disease

Postby Tohapane66 on July 10th, 2014, 5:13 pm

I'm interested to know if anybody has had experience with ultrasound technology to investigate neuromuscular disease. I did a quick search here but haven't found.

I'm about 7 months in to my twitching, which are 24/7 in feet and calves. I also experience twitching pretty much everywhere else from time to time along with sensory stuff. I had a normal NCV and EMG at 4 months.

My neurologist recently sent me off to a specialised clinic - which has a leading mnd specialist - where ultrasound videos were taken. The neurologist there took about 50-60 films all over the body, mostly in limbs but also in my torso and neck. Each video was about 30 seconds long.The neurologist taking the images could see the fasciculations and showed me.

After this was done they said no further testing required ie no EMG required. They did not provide a detailed report other than to say the echo texture of muscle was normal, fasciculations were present and then mentioned BFS.

Just curious if anybody has familiarity with this approach and has any insight. I didn't really get that much of an explanation about what was going on and I haven't been back to my usual neurologist yet.

Curious
Tom
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Re: ultrasound and neuromuscular disease

Postby Yuliasir on July 10th, 2014, 10:09 pm

Hi Tom,
Ultrasound allows to see major nerves (like median nerve of the arm for example) and even measure its cross-section, therefore it is used extensively for diagnosis of compression syndromes and neuritis, and it helps to assess muscle mass by echogenc patterns.
so it is quite a non-invasive method to see if your main nevers are alive and of normal range (atrophed nerves have significantly less cross section, inflammed have ususally bigger one compared to average plus may demonstrate different exhogenic features compard to healthy one, if high-res US is used), and if your muscles are of normal texture. This allows to avoid such invasive methods as muscle biopsy and EMG in case no suspicious findings are provided by US, so you may quite trust it.
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Re: ultrasound and neuromuscular disease

Postby Tohapane66 on July 10th, 2014, 10:48 pm

Hi Yuliasir

Thanks so much for your response - very kind of you. You are definitely a fountain of knowledge.

I was tested at BMRI in sydney by prof Kiernan's group. You may have heard of him

I had already trusted my original neurologist who said bfs. But he is very thorough and he recommended I get tested further with this guy. But I still have my anxious moments given I'm a newcomer to this.

These guys actually conducted a study on people in the medical profession who had bfs. Apparently around 3/4 of patients in the study thought they had MND. So they said high anxiety in this situation is VERY normal. And also reminded me it is also the old double edge sword that anxiety is a wonderful antagonist for the fasciculations.

Wonder why there has not more use or discussion on this post if it is a valuable non invasive technique.

Thanks again.
Last edited by Tohapane66 on July 11th, 2014, 4:53 am, edited 1 time in total.
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Re: ultrasound and neuromuscular disease

Postby Yuliasir on July 10th, 2014, 11:13 pm

i think it is a relatively new one application. I just had translated some abstracts of various articles related to US as a diagnostic tool for virtually anything (cancer, celiac disease, carpal tunnel syndrome) for the last 10 years so I can tell there is a huge progress in both methods (for example, contrast-enhanced US) and equipment (hi-res US) emerged in the last 3-5 years so it becomes an even more valuable NI tool than before, but to be widely accepted, it need alot of comparison and valiadtion studies to confirm that it is at least not inferior compared to invasive methods. That is probably why most of us still strive to have EMG :))) some even want spinl tap (which is a boo for me for example as it is highly invasive and has high complication rate).

sometimes considering high association of anxiety and fascics I wonder if we really have mild glial inflammation :) it may explain both fascics, pains and mood changes, as some investigations seem ot suppose :))) and we have a fellow member who had developed so much MS like symptomes that she was given a heavy IV cortisole shot. This cured not only all her strange somatic symptomes, but anxiety and all realted mental symptomes too. Unfortunately to prove this, US is not siutable and we need something like PET (which of course has more impact on the patient). Do not think it is a feasible option :)))

good to hear you have benign diagnosis proven by novel methods :)
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Re: ultrasound and neuromuscular disease

Postby TwitchyDoc on July 11th, 2014, 2:33 am

Ultrasound has been proven recently to be more accurate in detection of fasciculations than EMG. I.e. in the tongue, I remember US detected them in 80% while EMG only in a 5% or so. The studies are available in PubMed.

It is not surprising - in EMG, the needle records only the electrical activity of the fibers of the muscle bundle it is inserted in. By way of contrast, US covers larger area of the muscle and fasciculations are readily shown as brief, localized distortions of the muscle mass.
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Re: ultrasound and neuromuscular disease

Postby readytocheckout on July 11th, 2014, 7:01 am

Just when I thought I was done with tests, now I need an ultrasound lol.
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Re: ultrasound and neuromuscular disease

Postby Little Lost on July 12th, 2014, 6:56 am

Hi Tom,

So there is a drive on to utilise ultrasound to detect a range of muscle problems, one parameter includes fasciculations, which as you know can be associated with various conditions, or benign.

Ultrasound allows larger areas to be scanned in half the time than the current restricted EMG needlepoint. Ultrasound are cheaper to use, run, maintain. Importantly the race is on to see if non neuromuscular specialists can be trained to accurately spot fasciculations and other common movements, and also for the development of a lucrative programme such as the potential " Fasci -Scan", so that technicians can carry out the test, and the diagnostic programme will decide what is and what is not a fasciculation.

2 main problems in the development of such approach.

Firstly you need to be sure the technician and technology is correctly picking up TRUE fasciculations. and not what they term "false artifacts", i.e. movements that can mimic them on ultrasound. To prove their technology and trial programmes are valid, they have to run tests which include videoing the fasciculations they then scan. Here is an abstract from a German group who are in this technology race, and published recently. It sounds like what they did with yourself.

The article is called " Excellent interrater agreement for the differentiation of fasciculations and artefacts - A dynamic myosonography study" and it is by a doctor HH Kramer at Department of Neurology, Justus Liebig University. Basically this means they are looking to see if true fasciculations were detected and they used video to prove they were.


What they did was to take total of 11 observers and got them to analyse 25 muscle ultrasound videos acquired from patients. The video files illustrated fasciculations and artefacts (voluntary probe movements, voluntary contractions or swallowing and pulsating vessels) in different muscle groups. They then recorded the accuracy of picking out the true fasciculations which in this study turned out to be Quote " Fasciculations could be distinguished from artefacts with a sensitivity of 90.9% and specificity of 98.5%."

The second problem using ultrasound is that parameters of what is significant and what is not have to be defined. Fasciculations are in all healthy people, so where is the cut off of what is normal. This means doing all the donkey work. Repeat scanning of different patient groups, different disorders, comparing to healthy controls, building up a library of knowledge, developing ranges...you get the idea. what is seen in certain disorders, what is seen in BFS. i.e. the protocols have to be written, and that is what many groups are doing at present.

So that is why I feel you were videoed. It is a 2 way relationship, you get a good investigation by a top neuro, and they get the data for they need for their investigations. You are a BFS case and an excellent addition to their database ( you should have charged them for your time, £5.00 royalty fee per fasciculation.....kidding totally unethical).

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Re: ultrasound and neuromuscular disease

Postby Tohapane66 on July 12th, 2014, 8:03 am

Hi little lost (Helen)

Thanks for your response. They certainly got plenty of video footage of me. All signed away for free. :P

These guys seem pretty good. My neurologist who is very good said these guys were doing great work in field of mnd. He sent me onto them as he is very thorough. Btw I saw that you quoted one of their studies on another post.

They seem confident enough after looking at the footage of fasciculations (and I guess plenty spots were there weren't fasciculations) not to go ahead with emg, diagnosing bfs etc. as I mentioned I never got an in depth report from them. I think they were going to send onto my neurologist.

Yuliasir gave a pretty good run down I thought about looking at muscle density etc. maybe they told me all this but I was a bit spun out at the time so didn't take it all in. I didn't know what to expect when I went in. I previously had NCV and emg in upper and lower limb. Both of which were not my idea of fun. This was much better.

Tom
Last edited by Tohapane66 on July 12th, 2014, 10:27 pm, edited 2 times in total.
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Re: ultrasound and neuromuscular disease

Postby Little Lost on July 12th, 2014, 8:28 pm

I agree with the comments about Yuliasir...she saved me with her posts when I was falling. Her extensive knowledge is fantastic.
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Re: ultrasound and neuromuscular disease

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