Fasciculation electromechanical latency is prolonged in amyotrophic lateral sclerosis

Objective: In amyotrophic lateral sclerosis (ALS), motor neurons become hyperexcitable and sponta-neously discharge electrical impulses causing fasciculations. These can be detected by two noninvasive methods: high-density surface electromyography (HDSEMG) and muscle ultrasonography (MUS). We combined these methods simultaneously to explore the electromechanical properties of fasciculations, seeking a novel biomarker of disease.Methods: Twelve ALS patients and thirteen healthy participants each provided up to 24 minutes of recordings from the right biceps brachii (BB) and gastrocnemius medialis (GM). Two automated algo-rithms (Surface Potential Quantification Engine and a Gaussian mixture model) were applied to HDSEMG and MUS data to identify correlated electromechanical fasciculation events.Results: We identified 4,197 correlated electromechanical fasciculation events. HDSEMG reliably detected electromechanical events up to 30 mm below the skin surface with an inverse correlation between amplitude and depth in ALS muscles. Compared to Healthy-GM muscles (mean = 79.8 ms), elec-tromechanical latency was prolonged in ALS-GM (mean = 108.8 ms; p = 0.0458) and ALS-BB (mean = 112. 0 ms; p = 0.0128) muscles. Electromechanical latency did not correlate with disease duration, symptom burden, sum muscle power score or fasciculation frequency.Conclusions: Prolonged fasciculation electromechanical latency indicates impairment of the excitation- contraction coupling mechanism, warranting further exploration as a potential novel biomarker of dis-ease in ALS.Significance: This study points to an electromechanical defect within the muscles of ALS patients.(c) 2022 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. This is an openaccess article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).