Persistent neuromuscular dysfunction in long COVID: A quantitative and single fiber EMG follow-up study, 2026, Khan et al.

SNT Gatchaman

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Persistent neuromuscular dysfunction in long COVID: A quantitative and single fiber EMG follow-up study
Khan; Fanella; Harbo; Agergaard; Schiøttz-Christensen; Hejbøl; Schrøder; Pedersen; Fuglsang-Fredriksen; Andersen; Østergaard; Tankisi

OBJECTIVE
Persistent symptoms after SARS CoV-2 infection, often designated as "long COVID”, continue to be an ongoing health issue. Previously, we reported electromyography (EMG) and single fiber EMG (SFEMG) abnormalities in long COVID. This study aimed to assess the long-term neuromuscular manifestations of long COVID.

METHODS
In this follow-up study, fifty patients (39 females and 11 males, mean age at baseline: 48.1 ± 9.3 years) with long COVID showing myopathic (EMG and/or abnormal SFEMG at diagnosis were re-evaluated. The disease duration was 1.2 ± 0.6 years at baseline. The mean follow-up interval was 1.38 years. Quantitative EMG (qEMG) was performed on the biceps brachii (BB), vastus medialis (VM), and tibialis anterior (TA), while SFEMG was performed on the extensor digitorum communis (EDC) and TA, at baseline and follow-up on the same muscles and side. EMG, SFEMG, and clinical scores were compared using paired parametric or nonparametric tests.

RESULTS
Fatigue Assessment Scale (FAS) scores were unchanged (35.8 ± 7.7 vs 34.0 ± 9.4; p > 0.05). Motor unit potential (MUP) amplitudes and durations increased in BB, TA, and VM (p = 0.0001), while the frequency of polyphasic potentials remained unchanged (p > 0.05). SFEMG findings in TA and EDC were also unchanged (p > 0.05). At baseline, 78% of individuals showed myopathic qEMG and 54% abnormal SFEMG; at follow-up, 18% had myopathic qEMG, 56% abnormal SFEMG, and 40% showed normal EMG and SFEMG.

DISCUSSION
Myopathic changes decreased over time; however, SFEMG abnormalities and clinical scores remained persistent. These findings suggest ongoing neuromuscular dysfunction, although other mechanisms may also contribute to persistent long COVID symptoms.

Web | DOI | PDF | Neurophysiologie Clinique | Open Access
 
Follow-on from Myopathic changes in patients with long-term fatigue after COVID-19 (2021) and Myopathy as a cause of Long COVID fatigue: Evidence from quantitative and single fiber EMG and muscle histopathology (2023)

Our research group was the first to identify pathological markers of disease processes in patients with long COVID, using quantitative electromyography (qEMG) and muscle biopsy studies suggesting post-COVID myopathy. Later, we showed abnormalities in single-fiber EMG (SFEMG), suggesting a neuromuscular transmission defect. Our findings are supported by a recent study, where 59.4% of individuals with persistent fatigue following COVID-19 showed abnormal jitter on SFEMG, and other studies reported that in long COVID, muscle biopsies demonstrated myopathic changes.

Recent studies have begun to compare the disease state of long COVID with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), which is concerning, as ME/CFS is often lifelong. The clinical implications of the neuromuscular changes observed in electrophysiological examinations in ME/CFS remain poorly understood, and the prognosis for recovery is currently unknown.
 
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