Fasciculation detection using motor unit MRI (MUMRI)

Plain English summary of protocol

Background and study aims
Motor units are the basic building blocks of our skeletal muscles, and each one comprises a single nerve cell and several dozen muscle fibres. Normally several motor units are activated in a co-ordinated fashion resulting in a smooth movement, such as happens during walking or gripping an object. However, sometimes individual motor units fire at random; you may have noticed this after strenuous exercise when it is not uncommon to see tiny ‘quivering’ movements in your muscles. We call these tiny movements fasciculation. Although fasciculation can be a normal phenomenon, in some causes of muscle weakness it happens to a much greater degree, including at rest. Fasciculation can be visible by eye and may be noticed by a doctor during a clinical examination. However, this is only the case for fasciculation in motor units close to the skin surface. In other patients, fasciculation occurs deeper in the muscle where it is not easily visible by eye. In these patients, fasciculation can be detected using techniques such as ultrasound or electromyography of the muscles. These are useful techniques and provide a continuous recording of what is happening in the muscle, but are limited because they only record from part of the muscle at once. More recently, it has become possible to detect fasciculation using magnetic resonance imaging (MRI). We call this technique motor unit MRI (MUMRI). This has the advantage of seeing the whole of the muscle at once.

We have already used MUMRI on our local NHS scanners as part of a research study. We now wish to study how effective different makes and strength of MRI scanners are at detecting fasciculation using MUMRI. To do this we need to test MUMRI on a wide range of scanners across several centres to see if they all give similar results. This is an important step towards eventually rolling MUMRI out across the NHS.

This study does not involve treatment, but will help us to decide the best way to detect fasciculation in patients. This will ultimately help to improve the way we diagnose patients with diseases in which fasciculation is seen. We will record fasciculations using MUMRI in 4 body regions (head and neck, arms, trunk and legs). The study will lead to new information about the relative sensitivity of each type of scanner in detecting fasciculation in both deep and superficial muscles in each of the 4 body regions relevant to the diagnostic criteria of ALS. To compare the total fasciculation frequency (number of events detected in a 3-minute recording) for a given body region detected by each of the scanner makes and magnet strengths.

Who can participate?
To participate in this study you need to meet the following inclusion criteria:
1.. Adult male or female, willing and able to give informed consent
2. Aged 18 years old or over
3. ALS patients with definite or probable motor neuron disease based on the Awaji criteria, or currently under investigation for possible ALS

If you meet any of the following exclusion criteria then you cannot participate in this study:
1. Contra-indication to MRI scanning
2. Implanted cardiac defibrillator
3. Inability to lie flat in the MRI scanner
4. ALS patients in an advanced disease stage (ALSFRS-R < 25) with respiratory insufficiency
(forced vital capacity (FVC) < 60%), on non-invasive ventilation or receiving percutaneous gastrostomy feeding

What does the study involve?
The study is a single visit to site and will involve a clinical assessment which will be approximately 30 minutes, to collect information about your condition and your medical history. You will then undergo an MRI scan which will last approximately 1 hour. Your head and neck, upper limbs, trunk and legs will be scanned during this session.
What are the possible benefits and risks of participating?
This study itself will not directly benefit you. The information we get will improve our understanding of how human motor units fasciculate in different muscles, and to show which type of MRI scanner and magnet strength provides the most useful information. We hope that in the future this will help with the diagnosis of patients with diseases that cause excessive fasciculation.
The MRI scanner uses a powerful magnet, and we cannot perform the scan if you have a heart pacemaker, certain kinds of metal implants, or have had metal fragments in your eyes. Before the MRI scan the radiographers will perform a careful screening questionnaire to make sure that none of these apply to you. Provided that you do not have any metal implants, there are no known side effects of being exposed to magnetic fields and there is no radiation or other known danger associated with having an MRI scan. Studies which have looked for any effects of MRI scanning on pregnant subjects have not shown any side effects on the mother or child. However, we exclude participants who are, or may be pregnant as a routine precaution.
Occasionally people find lying in the scanner a little claustrophobic. To minimise any feelings of anxiety and to offer support, the researcher will talk through the process of the scan with you first and what you could expect. They will also remind you that you would be free to leave the scanner at any time should you wish. You will also have access to a two-way communication system with the researcher operating the scan so that you can communicate any feelings of anxiety or distress if you were to feel claustrophobic. You will be monitored throughout the scan and if you appear to show any signs of distress the scan will be stopped. The scanner also makes a range of noises which can be quite loud, so you will be provided with headphones and earplugs to reduce the noise. These headphones also let you listen to music during the scan and allow the radiographer performing the scan to communicate with you throughout the scan to check that you remain comfortable. You will be provided with a hand held buzzer, which you can use to alert the radiographers and end the scan at any point.
When having any kind of scan, there is always a small possibility that an abnormality of which you were unaware could be observed on the images. However, the scans are not being taken for diagnostic purposes, so there is no guarantee that the scans would detect any abnormality which may be present. The scans that we collect will be reviewed by a radiologist (a specialist doctor who reports MRI scans). If anything out of the ordinary is observed, they will then advise on what further investigations might be necessary.

Where is the study run from?
The study is run from 6 centres across England and Scotland: Newcastle Upon Tyne Hospitals NHS Foundation Trust, NHS Tayside, Oxford University Hospitals NHS Foundation Trust, King’s College Hospitals NHS Foundation Trust, Sheffield Teaching Hospitals NHS Foundation Trust and Leeds Teaching Hospitals NHS Foundation Trust.

When is the study starting and how long is it expected to run for?
February 2025 to June 2026

Who is funding the study?
LifeArc and Medical Research Council (MRC)

Who is the main contact?
Roger Whittaker, Professor of Clinical Neurophysiology
Roger.Whittaker@newcastle.ac.uk

Contact information

Prof Roger Whittaker
Principal investigator, Scientific, Public

Translational and Clinical Research Institute
Faculty of Medical Sciences
Newcastle University
Newcastle Upon Tyne
NE2 4HH
United Kingdom

ORCID ID	0000-0002-3403-0182
Phone	+44 191 2083543
Email	Roger.whittaker@newcastle.ac.uk

Study information

Eligibility

Locations

Countries of recruitment

• United Kingdom
• England
• Scotland

Study participating centres

Results and Publications

Editorial Notes

04/06/2026: Trial's existence confirmed by NHS HRA.