Enhanced low-threshold motor unit capacity during endurance tasks in patients with spinal muscular atrophy using pyridostigmine

Laura E Habets, Bart Bartels, Jeroen A L Jeneson, Fay-Lynn Asselman, Marloes Stam, Camiel A Wijngaarde, Renske I Wadman, Ruben P A van Eijk, Dick F Stegeman, W Ludo van der Pol

Research output: Contribution to journalArticleAcademicpeer-review

11 Downloads (Pure)


Objective: To investigate the electrophysiological basis of pyridostigmine enhancement of endurance performance documented earlier in patients with spinal muscular atrophy (SMA). Methods: We recorded surface electromyography (sEMG) in four upper extremity muscles of 31 patients with SMA types 2 and 3 performing endurance shuttle tests (EST) and maximal voluntary contraction (MVC) measurements during a randomized, double blind, cross-over, phase II trial. Linear mixed effect models (LMM) were used to assess the effect of pyridostigmine on (i) time courses of median frequencies and of root mean square (RMS) amplitudes of sEMG signals and (ii) maximal RMS amplitudes during MVC measurements. These sEMG changes over time indicate levels of peripheral muscle fatigue and recruitment of new motor units, respectively. Results: In comparison to a placebo, patients with SMA using pyridostigmine had fourfold smaller decreases in frequency and twofold smaller increases in amplitudes of sEMG signals in some muscles, recorded during ESTs (p < 0.05). We found no effect of pyridostigmine on MVC RMS amplitudes. Conclusions: sEMG parameters indicate enhanced low-threshold (LT) motor unit (MU) function in upper-extremity muscles of patients with SMA treated with pyridostigmine. This may underlie their improved endurance. Significance: Our results suggest that enhancing LT MU function may constitute a therapeutic strategy to reduce fatigability in patients with SMA.

Original languageEnglish
Pages (from-to)100-106
Number of pages7
JournalClinical Neurophysiology
Early online date20 Jul 2023
Publication statusPublished - Oct 2023


  • Fatigability
  • Muscle electrical activation
  • Neuromuscular junction
  • Pyridostigmine
  • Spinal muscular atrophy


Dive into the research topics of 'Enhanced low-threshold motor unit capacity during endurance tasks in patients with spinal muscular atrophy using pyridostigmine'. Together they form a unique fingerprint.

Cite this