Myopathy as a cause of Long COVID fatigue: Evidence from quantitative and single fiber EMG and muscle histopathology. (April 2023)

• Record Type: Journal Article
• Authors: Agergaard, Jane; Yamin Ali Khan, Benjamin; Engell-Sørensen, Thomas; Schiøttz-Christensen, Berit; Østergaard, Lars; Hejbøl, Eva K.; Schrøder, Henrik D.; Andersen, Henning; Blicher, Jakob Udby; Holm Pedersen, Thomas; Harbo, Thomas; Tankisi, Hatice; Lehmann Dahl Pedersen, Anders; Fløe Hvass, Andreas; Yamin Ali Khan, Benjamin; Schiøttz-Christensen, Berit; Cömert, Cagla; Laustsen, Christoffer; Bendstrup, Elisabeth; Wood, Gregory; Erik Bøtker, Hans; Tankisi, Hatice; Andersen, Henning; Agergaard, Jane; Palmfeldt, Johan; Skaalum, Kristoffer; Jørgen Østergaard, Lars; Vibholm, Line; Mølhave, Martin; Katrine Jentoft Olsen, Rikke; Eg Jørgensen, Sofie; Hvitfeldt Poulsen, Steen; Leth, Steffen; Sperling Haugen, Søren; Harbo, Thomas; Mogensen, Trine H.; Ullahammer, William; Kim, Won-Yong;
• Is Part Of: Clinical neurophysiology. Volume 148(2023)
• Page Start: 65
• Page End: 75
• Publication Date: 2023-04
• Subjects: Electromyography -- Single fiber electromyography -- Fatigue -- Long COVID -- Muscle biopsy -- Myopathy -- Post-COVID syndrome; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2023.01.010
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: Myopathic changes in qEMG and/or increased jitter in sfEMG were seen in 63% of 84 patients with Long COVID neuromuscular symptoms. Low quality of life score correlated with higher mean jitter values in sfEMG but not with qEMG measures. Electron microscopy showed damage of terminal nerves and motor endplate. Abstract: Objective: To describe neurophysiological abnormalities in Long COVID and correlate quantitative electromyography (qEMG) and single fiber EMG (sfEMG) results to clinical scores and histopathology. Methods: 84 patients with non-improving musculoskeletal Long COVID symptoms were examined with qEMG and sfEMG. Muscle biopsies were taken in a subgroup. Results: Mean motor unit potential (MUP) duration was decreased in ≥ 1 muscles in 52 % of the patients. Mean jitter was increased in 17 % of the patients in tibialis anterior and 25 % in extensor digitorum communis. Increased jitter was seen with or without myopathic qEMG. Low quality of life score correlated with higher jitter values but not with qEMG measures. In addition to our previously published mitochondrial changes, inflammation, and capillary injury, we show now in muscle biopsies damage of terminal nerves and motor endplate with abundant basal lamina material. At the endplate, axons were present but no vesicle containing terminals. The post-synaptic cleft in areas appeared atrophic with short clefts and coarse crests. Conclusions: Myopathic changes are common in Long COVID. sfEMG abnormality is less common but may correlate with clinical scores. sfEMG changes may be due to motor endplate pathology. Significance: These findings may indicate a muscle pathophysiology behind fatigue in Long COVID.