Increased muscular fatigue in patients with neurogenic muscle weakness: quantification and pathophysiology

The strength of maximum voluntary contraction (MVC) and muscular fatigue measured from ankle dorsiflexors and knee extensors of 15 patients with neurogenic muscle weakness was compared with those of 20 healthy subjects. Muscle weakness, defined as the failure to generate the expected force, was determined by two methods: (1) manual muscle testing and (2) measurement of MVC using a force transducer. Muscle strength was then quantified as the MVC in Newtons (N)/kg body weight. The percent decrease in both MVC (the Fatigue Index [FI]), and rectified-integrated electromyogram (RIEMG) at the end of 60sec of sustained MVC were computed. There were three main findings. (1) Muscle strength was significantly (p less than 0.001) reduced in both muscles of the patient group: in ankle dorsiflexors, means = 1.62 +/- 0.7N/kg vs 4.8 +/- 0.5N/kg; in knee extensors, means = 3.2 +/- 1.8N/kg vs 7.8 +/- 1.5N/kg. (2) Fatigue was significantly greater (p less than 0.01) in the patient group: for ankle dorsiflexors, means = 50 +/- 15% vs 34 +/- 13%; and for knee extensors, means = 62 +/- 17% vs 46 +/- 15%. There was a negative correlation between muscle strength and FI of only the knee extensors of the patients (r = -0.88, p less than 0.001). (3) The mean decline in RIEMG of the two muscles combined was also significantly greater (p less than 0.001) in the patient group (means = 48 +/- 16% vs 2 +/- 11%).(ABSTRACT TRUNCATED AT 250 WORDS)