Multi-electrode electromyography: developing electrical cross-sectional imaging of skeletal muscle.

在周围神经和肌肉疾病的研究中，针状肌电图(EMG)是一种重要的诊断方法。对于运动神经元疾病，一种运动系统的无情进行性退化，它是唯一可用的诊断测试。然而，目前的肌电技术在过去50年里几乎没有进步。肌电监测涉及将一根金属针穿过皮肤插入肌肉，并记录肌肉纤维产生的电活动。影响运动神经或肌肉的疾病会在这种电活动中产生特征性的变化。信号是从针尖的一个点记录下来的，这就是当前技术的根本局限性。由于只使用一个记录面，这种“单通道”记录由来自数十个单独肌肉纤维的重叠电信号组成，解开这些信号以确定肌肉纤维在肌肉中是如何排列的可能是困难的。此外，采样的肌肉体积很小，这意味着为了诊断广泛传播的疾病，如运动神经元病，针必须在几块肌肉中重新定位几次。这增加了患者的痛苦，意味着一些检查可能需要一个多小时才能完成。我们的建议是适应和发展现有的微加工技术来制造一种新型的肌电电极，其直径与传统的针相似，它将沿着针从点同时记录。这将允许快速和准确地定位肌肉中的每个单独的肌肉纤维，而不需要针头移动，有效地产生肌肉的电子横断面图像。这将大大提高测试的准确性，并显著减少所需的时间。我们的团队由皇家维多利亚医院、纽卡斯尔和纽卡斯尔大学的临床医生和基础科学家组成。我们已经利用纽卡斯尔大学的微型制造设施开发了多个电极，用于记录大脑内部的电活动。我们将对这些技术进行改造，以适应人类肌肉的记录，并将在人类志愿者身上进行测试。我们在开发新的软件来分析来自多通道记录的数据方面也有丰富的经验，我们将开发一套程序来实时显示肌肉结构和功能。这将允许临床医生在收集结果时查看结果，从而决定是否已经得出诊断结果，或者是否需要进一步研究肌肉。我们的最终目标是开发一个临床适用的原型系统，然后我们将与一家商业医疗器械公司合作开发。在英国，每年大约有10万例肌电检查。即使我们的系统将每个人所需的时间减少10分钟，这也将为NHS节省大量成本，除此之外，患者还可以从改善诊断和减少不适方面受益。我们相信，这项技术是可以实现的，并将像磁共振成像对放射学的发展一样对肌电图产生革命性的影响。

Needle electromyography (EMG) is an essential diagnostic test in the investigation of patients with peripheral nerve and muscle disease. For conditions such as motor neuron disease, a relentlessly progressive degeneration of the motor system, it is the only diagnostic test available. However, current EMG technology has barely advanced in the past 50 years. EMG involves inserting a metal needle through the skin into a muscle, and recording the electrical activity produced by the muscle fibres. Diseases affecting the motor nerves or the muscle produce characteristic changes in this electrical activity. The signal is recorded from a single point at the needle tip, and herein lies the fundamental limitation of current technology. Since only a single recording surface is used, this 'single channel' recording consists of overlapping electrical signals from dozens of individual muscle fibres, and untangling these to work out how the muscle fibres are arranged within the muscle can be difficult. Furthermore, the volume of muscle sampled is tiny, meaning that in order to diagnose a widespread disease, such as motor neuron disease, the needle has to be repositioned several times within several muscles. This increases the pain for the patient and means that some studies can take over an hour to perform. Our proposal is to adapt and develop existing microfabrication techniques to produce a novel EMG electrode, of similar diameter to a conventional needle, which will record simultaneously from 64 points along the needle. This will allow the rapid and accurate localisation of each individual muscle fibre within the muscle without the need for needle movement, in effect producing an electrical cross-sectional image of the muscle. This will massively increase the accuracy of the test and significantly reduce the time taken. Our group consists of clinicians and basic scientists based within the Royal Victoria Infirmary, Newcastle and Newcastle University. We have already developed multi-electrodes for recording electrical activity from within the brain, using microfabrication facilities within Newcastle University. We will adapt these to record from human muscle, and will test these in human volunteers. We also have extensive experience in developing novel software to analyse the data from multi-channel recordings, and we will develop a suite of programs to display muscle structure and function in real-time. This will allow clinicians to view the results as they are collected allowing them to decide whether a diagnosis has been reached or if further muscles need to be studied. Our ultimate aim is to develop a prototype clinically applicable system which we will then develop in partnership with a commercial medical instrument company. There are approximately 100,000 EMGs performed each year in the UK. Even if our system reduces the time taken by ten minutes each, this will have a massive cost saving for the NHS, quite apart from the benefits to patients in terms of improved diagnosis and reduced discomfort. We believe that this technique is achievable, and will be as revolutionary for EMG as the development of magnetic resonance imaging has been for radiology.