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Truffert A, Sukockienė E, Desmaison A, Ališauskienė M, Iancu Ferfoglia R, Guy N. Combined tendon reflex and motor evoked potential recordings in amyotrophic lateral sclerosis. Clin Neurophysiol 2023; 147:88-98. [PMID: 36753809 DOI: 10.1016/j.clinph.2022.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 12/13/2022] [Accepted: 12/18/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVE This retrospective (case-control) collaborative study evaluates tendon reflex recordings combined with transcranial magnetic stimulation motor evoked potentials recordings (T-MEPs) at lower limbs in amyotrophic lateral sclerosis (ALS). METHODS T-MEPs were recorded in 97 ALS patients distinguished according to their patellar reflex briskness. Patients' electrophysiological data were compared with values measured in 60 control patients matched for age and height. Correlations studies between parameters or with some patients' clinical characteristics were also performed. RESULTS The central motor conduction time yields the highest sensitivity (82%) and specificity (93%), allowing twice more upper motor neuron (UMN) dysfunction detection than clinical examination, and being more altered in late stages of the disease. The T response to MEP response amplitude ratio (T/MEP ar) is nearly as sensitive to detect ALS and better identifies abnormal hyperreflexia. It is not correlated with evolutive stage, contrarily to conduction time-related parameters. In addition, T-MEPs detect asymmetries escaping clinical examination. CONCLUSIONS The corticospinal conduction to lower limbs is slowed in ALS. The T/MEP ar helps deciding when patellar reflexes are abnormal in a given patient suspected of ALS. SIGNIFICANCE The T-MEP technique provide powerful electrophysiological biomarkers of UMN involvement in ALS. This simple and painless procedure introduces the clinically useful concept of electrophysiological hyperreflexia and might be expanded to future exploration of proximal upper limbs and bulbar territories.
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Affiliation(s)
- André Truffert
- University of Geneva, Faculty of Medicine, Department of Clinical Neurosciences, Geneva, Switzerland.
| | - Eglė Sukockienė
- Division of Neurology, Geneva University Hospitals, Geneva, Switzerland
| | - Annaïck Desmaison
- CRCSLA et maladies du neurone moteur, Department of Neurology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Miglė Ališauskienė
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Nathalie Guy
- CRCSLA et maladies du neurone moteur, Department of Neurology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; Université Clermont Auvergne, Inserm Neuro-Dol U1107, Clermont-Ferrand, France
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Grapperon AM, Verschueren A, Jouve E, Morizot-Koutlidis R, Lenglet T, Pradat PF, Salachas F, Bernard E, Delstanche S, Maertens de Noordhout A, Guy N, Danel V, Delval A, Delmont E, Rolland AS, Pulse Study Group, Jomir L, Devos D, Wang F, Attarian S. Assessing the upper motor neuron in amyotrophic lateral sclerosis using the triple stimulation technique: A multicenter prospective study. Clin Neurophysiol 2021; 132:2551-2557. [PMID: 34455313 DOI: 10.1016/j.clinph.2021.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/16/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the relevance of transcranial magnetic stimulation (TMS) using triple stimulation technique (TST) to assess corticospinal function in amyotrophic lateral sclerosis (ALS) in a large-scale multicenter study. METHODS Six ALS centers performed TST and conventional TMS in upper limbs in 98 ALS patients during their first visit to the center. Clinical evaluation of patients included the revised ALS Functional Rating Scale (ALSFRS-R) and upper motor neuron (UMN) score. RESULTS TST amplitude ratio was decreased in 62% of patients whereas conventional TMS amplitude ratio was decreased in 25% of patients and central motor conduction time was increased in 16% of patients. TST amplitude ratio was correlated with ALSFRS-R and UMN score. TST amplitude ratio results were not different between the centers. CONCLUSIONS TST is a TMS technique applicable in daily clinical practice in ALS centers for the detection of UMN dysfunction, more sensitive than conventional TMS and related to the clinical condition of the patients. SIGNIFICANCE This multicenter study shows that TST can be a routine clinical tool to evaluate UMN dysfunction at the diagnostic assessment of ALS patients.
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Affiliation(s)
- Aude-Marie Grapperon
- APHM, Timone University Hospital, Referral Center for Neuromuscular Diseases and ALS, ERN Euro-NMD Center, Marseille, France
| | - Annie Verschueren
- APHM, Timone University Hospital, Referral Center for Neuromuscular Diseases and ALS, ERN Euro-NMD Center, Marseille, France
| | - Elisabeth Jouve
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, Department of Clinical Pharmacology and Pharmacovigilance, CIC-CPCET, Marseille, France
| | | | - Timothée Lenglet
- Department of Neurophysiology, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - François Salachas
- Referral Center for ALS, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Emilien Bernard
- Service des pathologies neuromusculaires et du motoneurone, Hospices Civils de Lyon, France
| | - Stéphanie Delstanche
- University of Liège, Centre Hospitalier Régional de la Citadelle, Department of Neurology, Liège, Belgium
| | | | - Nathalie Guy
- CRC SLA et maladie du neurone moteur, U1107-neurodol-UCA, CHU de Clermont-Ferrand, France
| | - Véronique Danel
- University of Lille, Expert center for ALS, CHU-Lille, Lille Neuroscience & Cognition, INSERM, UMR-S1172, LICEND, ACT4ALS-MND network, France
| | - Arnaud Delval
- Department of Clinical Neurophysiology, CHU-Lille, U1172 Lille Neuroscience & Cognition, University of Lille, France
| | - Emilien Delmont
- APHM, Timone University Hospital, Referral Center for Neuromuscular Diseases and ALS, ERN Euro-NMD Center, Marseille, France
| | - Anne-Sophie Rolland
- University of Lille, Expert center for ALS, CHU-Lille, Lille Neuroscience & Cognition, INSERM, UMR-S1172, LICEND, ACT4ALS-MND network, France
| | | | - Laurent Jomir
- Service des pathologies neuromusculaires et du motoneurone, Hospices Civils de Lyon, France
| | - David Devos
- University of Lille, Expert center for ALS, CHU-Lille, Lille Neuroscience & Cognition, INSERM, UMR-S1172, LICEND, ACT4ALS-MND network, France
| | - François Wang
- CHU de Liège, Department of Clinical Neurophysiology, Liège, Belgium
| | - Shahram Attarian
- APHM, Timone University Hospital, Referral Center for Neuromuscular Diseases and ALS, ERN Euro-NMD Center, Marseille, France.
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Xu Y, Chen J, Zhang S, Fan D. Upper Motor Neuron Signs in the Cervical Region of Patients With Flail Arm Syndrome. Front Neurol 2021; 12:610786. [PMID: 33658977 PMCID: PMC7917109 DOI: 10.3389/fneur.2021.610786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/27/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: We investigated upper motor neuron (UMN) signs in the cervical region in a Chinese clinic-based cohort of patients with flail arm syndrome (FAS) by clinical examination and neurophysiological tests such as triple stimulation technique (TST) and pectoralis tendon reflex testing. Methods: A total of 130 consecutive FAS patients from Peking University Third Hospital underwent physical examination and neurophysiological tests at baseline and 3 months, 6 months, 9 months, and 12 months later. Pyramidal signs, pectoralis tendon reflex and TST results were evaluated to estimate the function of cervical spinal UMNs. Results: At the first visit, weakness of the bilateral proximal upper limbs was found in 99 patients, while weakness of a single proximal upper limb was found in 31 patients. There were 49 patients with tendon hyperreflexia, 42 patients with tendon hyporeflexia and 39 patients with tendon areflexia. All except 4 of the patients had brisk pectoralis tendon reflex. The UMN score of the cervical region was 1.7 ± 0.4, and the lower motor neuron score of that region was 3.5 ± 0.3. The TSTtest/TSTcontrol amplitude ratio was 65.7 ± 7.5%. The latency of quantitative detection of the pectoralis tendon reflex was 7.7 ± 1.2 ms. In the follow-up study, the UMN score and the TSTtest/TSTcontrol amplitude ratio decreased, while the lower motor neuron score increased, and the latency of quantitative detection of the pectoralis tendon reflex remained steady. Conclusion: Although the signs of cervical spinal UMN dysfunction in patients with FAS were often concealed by muscle atrophy in the progression of the disease, TST and pectoralis tendon reflex could reveal it.
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Affiliation(s)
- Yingsheng Xu
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Junyi Chen
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Shuo Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Peking University Third Hospital, Beijing, China
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Corazza G, Le Corroller T, Grapperon AM, Salort-Campana E, Verschueren A, Attarian S, Delmont E. Comparison of MRI and motor evoked potential with triple stimulation technique for the detection of brachial plexus abnormalities in multifocal motor neuropathy. Muscle Nerve 2019; 61:325-329. [PMID: 31792993 DOI: 10.1002/mus.26773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Conduction blocks (CB) are the diagnostic hallmark of multifocal motor neuropathy (MMN). Conventional nerve conduction studies cannot detect CB above Erb's point. Our purpose was to compare the performance of the motor evoked potential with triple stimulation technique (MEP-TST) and MRI in the detection of abnormalities of the brachial plexus. METHODS Examinations were performed on 26 patients with MMN (11 definite, 6 probable, 9 possible), of whom 7 had no CB. RESULTS MEP-TST detected proximal CB in 19/26 patients. Plexus MRI showed T2 hyperintensity in 18/26 patients, with nerve enlargement in 14/18. A combination of both techniques increased the detection rate of brachial plexus abnormalities to 96% of patients (25/26). CONCLUSIONS MEP-TST and MRI have high sensitivities for detecting brachial plexus abnormalities. A combination of the two techniques increases the detection rate of supportive criteria for the diagnosis of MMN.
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Affiliation(s)
- Giovanni Corazza
- Referral Centre for Neuromuscular Diseases and ALS, Hôpital La Timone, Marseille, France
| | - Thomas Le Corroller
- Department of Radiology, Institute for Locomotion, Hôpital Sainte-Marguerite, Marseille, France
| | - Aude-Marie Grapperon
- Referral Centre for Neuromuscular Diseases and ALS, Hôpital La Timone, Marseille, France
| | | | - Annie Verschueren
- Referral Centre for Neuromuscular Diseases and ALS, Hôpital La Timone, Marseille, France
| | - Shahram Attarian
- Referral Centre for Neuromuscular Diseases and ALS, Hôpital La Timone, Marseille, France
| | - Emilien Delmont
- Referral Centre for Neuromuscular Diseases and ALS, Hôpital La Timone, Marseille, France.,Aix-Marseille University, Timone Neuroscience Institute, UMR CNRS 7289, Marseille, France
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Oguz Akarsu E, Sirin NG, Kocasoy Orhan E, Erbas B, Dede HO, Baslo MB, Idrisoglu HA, Oge AE. Repeater F-waves in amyotrophic lateral sclerosis: Electrophysiologic indicators of upper or lower motor neuron involvement? Clin Neurophysiol 2019; 131:96-105. [PMID: 31760213 DOI: 10.1016/j.clinph.2019.09.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/08/2019] [Accepted: 09/25/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To extract insight about the mechanism of repeater F-waves (Frep) by exploring their correlation with electrophysiologic markers of upper and lower motor neuron dysfunction in amyotrophic lateral sclerosis (ALS). METHODS The correlations of Frep parameters with clinical scores and the results of neurophysiological index (NI), MScanfit MUNE, F/M amplitude ratio (F/M%), single and paired-pulse transcranial magnetic stimulation (TMS), and triple stimulation technique (TST) studies, recorded from abductor digiti minimi (ADM) and abductor pollicis brevis (APB) muscles of 35 patients with ALS were investigated. RESULTS Frep parameters were correlated with NI and MScanfit MUNE in ADM muscle and F/M% in both muscles. None of the Frep parameters were correlated with clinical scores or TST and TMS measures. While the CMAP amplitudes were similar in the two recording muscles, there was a more pronounced decrease of F-wave persistence in APB, probably heralding the subsequent split hand phenomenon. CONCLUSION Our findings suggest that the presence and density of Freps are primarily related to the degree of lower motor neuron loss and show no correlation with any of the relatively extensive set of parameters for upper motor neuron dysfunction. SIGNIFICANCE Freps are primarily related to lower motor neuron loss in ALS.
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Affiliation(s)
- Emel Oguz Akarsu
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey.
| | - Nermin Gorkem Sirin
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Elif Kocasoy Orhan
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Bahar Erbas
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey; Demiroglu Bilim University, Faculty of Medicine, Department of Pharmacology, Istanbul, Turkey
| | - Hava Ozlem Dede
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Mehmet Baris Baslo
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Halil Atilla Idrisoglu
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Ali Emre Oge
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
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Abstract
PURPOSE To identify upper motor neuron (UMN) dysfunction using the triple stimulation technique (TST) in amyotrophic lateral sclerosis (ALS). METHODS Fifty ALS and 42 non-ALS patients were examined clinically, using conventional transcranial magnetic stimulation and TST. RESULTS For ALS patients presenting with UMN in tested limb, the TST amplitude ratio was abnormal in 25 of 28 patients (89.3%). For ALS patients without UMN signs, 6 of 22 patients (27.3%) had an abnormal TST ratio. When clinical signs were not present, both abnormal resting motor threshold and TST indicated a UMN involvement. In non-ALS patients with central motor conduction disorders, the percentage of patients with an abnormal TST was higher for those presenting with clinical UMN signs (9/12, 75.0%) than for those without these signs (1/8, 12.5%). CONCLUSIONS Triple stimulation technique appears to be an accurate, early measure for detecting clinical and subclinical UMN abnormalities in ALS. Triple stimulation technique could also be useful to investigate central motor conduction abnormalities in other disorders.
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Li C, Liu F, Peng H, Huang Y, Song X, Xie Q, Li Y, Liu Y. The positive effect of venlafaxine on central motor conduction. Clin Neurol Neurosurg 2018; 167:65-69. [PMID: 29454182 DOI: 10.1016/j.clineuro.2018.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/02/2018] [Accepted: 02/11/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Using the triple stimulation technique (TST) and conventional transcranial magnetic stimulation (TMS), this study was designed to investigate the effect of venlafaxine on central motor conduction in healthy adults. PATIENTS AND METHODS In this crossover, self-controlled trial, eight healthy adult volunteers were randomly divided into groups A and B. In group A, the volunteers were administered 1 venlafaxine capsule once daily for 7 consecutive days, followed by a 3-day break. Next, volunteers in this group received 1 placebo capsule once daily for 7 consecutive days. Group B received the treatments in the opposite order. The index finger tapping test, grip strength test, TST and conventional TMS examination for each hand were recorded before and one week after the administration of venlafaxine or placebo. RESULTS Compared to the placebo stage, in the venlafaxine stage, the number of index finger taps was significantly increased for both hands, and the TST amplitude and area ratios were significantly increased. The improvement in the TST amplitude ratio was significantly and positively correlated with the improvements in performance on the index finger tapping test. CONCLUSION Venlafaxine positively regulates central motor conduction in healthy adults.
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Affiliation(s)
- Chunyong Li
- Dept. Cerebral Vascular Disease, The General Hospital of Guangzhou Military Command of PLA, No. 111, Liuhua Avenue, Yuexiu District, Guangzhou, 510010, PR China.
| | - Fuda Liu
- Area 2, Department of Neurology, Jiangmen Central Hospital, No.23, Haibang Street, Beijie, Jiangmen City, Guangdong Province, PR China.
| | - Haiyan Peng
- Dept. Neurology, The General Hospital of Guangzhou Military Command of PLA, No.111, Liuhua Avenue, Yuexiu District, Guangzhou, 510010, PR China.
| | - Yongjun Huang
- Dept. Neurology, The General Hospital of Guangzhou Military Command of PLA, No.111, Liuhua Avenue, Yuexiu District, Guangzhou, 510010, PR China.
| | - Xuezhu Song
- Dept. of Neurology, Shunde Guizhou Hospital, Fushan, Guangdong, PR China.
| | - Qi Xie
- Dept. of Rehabilitation Medicine, The General Hospital of Guangzhou Military Command of PLA, No.111, Liuhua Avenue, Yuexiu, Guangzhou, 510010, PR China.
| | - Yingkai Li
- Dept. of Neurology, The Second People's Hospital of Zhuhai, No. 208, Yuehua Avenue, Zhuhai, Guangdong Province, 510260, PR China.
| | - Yan Liu
- Dept. Cerebral Vascular Disease, The General Hospital of Guangzhou Military Command of PLA, No. 111, Liuhua Avenue, Yuexiu District, Guangzhou, 510010, PR China.
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Motor neuropathies and lower motor neuron syndromes. Rev Neurol (Paris) 2017; 173:320-325. [DOI: 10.1016/j.neurol.2017.03.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/16/2017] [Accepted: 03/29/2017] [Indexed: 12/13/2022]
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Lenglet T, Camdessanché JP. Amyotrophic lateral sclerosis or not: Keys for the diagnosis. Rev Neurol (Paris) 2017; 173:280-287. [PMID: 28461025 DOI: 10.1016/j.neurol.2017.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/06/2017] [Accepted: 04/07/2017] [Indexed: 10/19/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a degenerative motor neuron disease (MND) which prognosis is poor. Early diagnosis permit to set up immediately adapted treatment and cares. Available diagnostic criteria are based on the detection of both central and peripheral motor neuron injury in bulbar, cervical, thoracic and lumbar regions. Electrodiagnostic (EDX) tests are the key tools to identify peripheral motor neuron involvement. Needle examination records abnormal activities at rest, and looks for neurogenic pattern during muscle contraction. Motor unit potentials morphology is modified primary to recruitment. Motor evoked potentials remain the test of choice to identify impairment of central motor neurons. In the absence of diagnostic biomarker of ALS and among essential investigations of suspected MND, a careful clinical and neurophysiological work-up is essential to rule out the differential diagnosis.
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Affiliation(s)
- T Lenglet
- Département de neurophysiologie clinique, Hôpital de la Salpêtrière, Assistance Publique-Hôpitaux de Paris, France; Centre Référent Maladies du Motoneurone et SLA, Hôpital de la Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - J-P Camdessanché
- Service de Neurologie, Hôpital Nord, CHU de Saint-Etienne, France; Centre Référent Maladies du Motoneurone et SLA, CHU de Saint-Etienne, France.
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Duclos Y, Grapperon A, Jouve E, Truillet R, Zemmour C, Verschueren A, Pouget J, Attarian S. Motor-evoked potential gain is a helpful test for the detection of corticospinal tract dysfunction in amyotrophic lateral sclerosis. Clin Neurophysiol 2017; 128:357-364. [DOI: 10.1016/j.clinph.2016.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 12/08/2016] [Accepted: 12/13/2016] [Indexed: 10/20/2022]
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New insights into the clinical neurophysiological assessment of ALS. Neurophysiol Clin 2016; 46:157-63. [PMID: 27364772 DOI: 10.1016/j.neucli.2016.05.070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 12/11/2022] Open
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Lefaucheur JP. Needle EMG study of the external anal sphincter: Diagnostic value in the flail leg variant of ALS. Neurophysiol Clin 2016; 46:153-5. [DOI: 10.1016/j.neucli.2016.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 04/09/2016] [Accepted: 04/09/2016] [Indexed: 12/12/2022] Open
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Feng JT, Zhu Y, Hua XY, Zhu Y, Gu YD, Xu JG, Xu WD. Diagnosing neurogenic thoracic outlet syndrome with the triple stimulation technique. Clin Neurophysiol 2016; 127:886-891. [DOI: 10.1016/j.clinph.2015.04.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 03/22/2015] [Accepted: 04/08/2015] [Indexed: 11/26/2022]
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14
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Mancuso R, Navarro X. Amyotrophic lateral sclerosis: Current perspectives from basic research to the clinic. Prog Neurobiol 2015; 133:1-26. [PMID: 26253783 DOI: 10.1016/j.pneurobio.2015.07.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 07/30/2015] [Accepted: 07/31/2015] [Indexed: 02/07/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by progressive degeneration of upper and lower motoneurons, leading to muscle weakness and paralysis, and finally death. Considerable recent advances have been made in basic research and preclinical therapeutic attempts using experimental models, leading to increasing clinical and translational research in the context of this disease. In this review we aim to summarize the most relevant findings from a variety of aspects about ALS, including evaluation methods, animal models, pathophysiology, and clinical findings, with particular emphasis in understanding the role of every contributing mechanism to the disease for elucidating the causes underlying degeneration of motoneurons and the development of new therapeutic strategies.
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Affiliation(s)
- Renzo Mancuso
- Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Xavier Navarro
- Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain.
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Hofstadt-van Oy U, Keune PM, Muenssinger J, Hagenburger D, Oschmann P. Normative data and long-term test-retest reliability of the triple stimulation technique (TST) in multiple sclerosis. Clin Neurophysiol 2014; 126:356-64. [PMID: 25027641 DOI: 10.1016/j.clinph.2014.05.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Transcranial magnetic stimulation is useful for the assessment of cortico-spinal tract integrity in multiple sclerosis (MS). An advanced approach is the triple stimulation technique (TST), utilizing a combination of central and peripheral stimuli, reducing individual response variability. Although TST measures have been implemented in longitudinal studies, basic methodological data on temporal properties of abnormal TST values in MS are sparse. METHODS Normative TST data were obtained from 48 healthy participants. Longitudinal measures were derived from 17 MS-patients (relapsing-remitting: N=10; clinically isolated syndrome: N=7) prior to, three and twelve months following therapy initiation. Intraclass correlations were used to examine test-retest reliability. Complementary, patient ambulation and cognition were assessed. RESULTS Patient TST parameters were abnormal, involving excellent test-retest reliability and stable mean values. Cognitive and motor performance improved. CONCLUSIONS Results are the first to show that abnormal TST values in MS, reflecting diagnostic utility, are highly reliable in a long-term follow-up. Methodological properties are adequate for a longitudinal implementation of TST. Parameters were insensitive to alterations in cognitive/motor functioning. Sensitivity may be verified in subgroups with different treatment regimes. SIGNIFICANCE Results provide new normative data, support diagnostic utility of TST measures in MS, and confirm their long-term robustness.
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Affiliation(s)
| | - P M Keune
- Department of Neurology, Klinikum Bayreuth, Bayreuth, Germany; Department of Physiological Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany.
| | - J Muenssinger
- Department of Neurology, Klinikum Bayreuth, Bayreuth, Germany
| | - D Hagenburger
- Department of Neurology, Klinikum Bayreuth, Bayreuth, Germany
| | - P Oschmann
- Department of Neurology, Klinikum Bayreuth, Bayreuth, Germany
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Camdessanché JP, Lenglet T. Place des explorations électrophysiologiques dans la sclérose latérale amyotrophique. Presse Med 2014; 43:563-8. [DOI: 10.1016/j.lpm.2014.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 03/21/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022] Open
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17
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Grapperon AM, Verschueren A, Duclos Y, Confort-Gouny S, Soulier E, Loundou AD, Guye M, Cozzone PJ, Pouget J, Ranjeva JP, Attarian S. Association between structural and functional corticospinal involvement in amyotrophic lateral sclerosis assessed by diffusion tensor MRI and triple stimulation technique. Muscle Nerve 2014; 49:551-7. [DOI: 10.1002/mus.23957] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 06/15/2013] [Accepted: 07/09/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Aude-Marie Grapperon
- Department of Neurology and Neuromuscular Diseases; CHU La Timone; 264 rue Saint-Pierre 13385 Marseille France
| | - Annie Verschueren
- Department of Neurology and Neuromuscular Diseases; CHU La Timone; 264 rue Saint-Pierre 13385 Marseille France
| | - Yann Duclos
- Department of Neurology and Neuromuscular Diseases; CHU La Timone; 264 rue Saint-Pierre 13385 Marseille France
| | - Sylviane Confort-Gouny
- Biological and Medical Magnetic Resonance Center (CRMBM) and Center for Metabolic Exploration using Magnetic Resonance (CEMEREM) (UMR 7339); CHU La Timone; Marseilles France
| | - Elisabeth Soulier
- Biological and Medical Magnetic Resonance Center (CRMBM) and Center for Metabolic Exploration using Magnetic Resonance (CEMEREM) (UMR 7339); CHU La Timone; Marseilles France
| | - Anderson D. Loundou
- Department of Methodological Aid to Clinical Research; CHU La Timone; Marseilles France
| | - Maxime Guye
- Biological and Medical Magnetic Resonance Center (CRMBM) and Center for Metabolic Exploration using Magnetic Resonance (CEMEREM) (UMR 7339); CHU La Timone; Marseilles France
| | - Patrick J. Cozzone
- Biological and Medical Magnetic Resonance Center (CRMBM) and Center for Metabolic Exploration using Magnetic Resonance (CEMEREM) (UMR 7339); CHU La Timone; Marseilles France
| | - Jean Pouget
- Department of Neurology and Neuromuscular Diseases; CHU La Timone; 264 rue Saint-Pierre 13385 Marseille France
| | - Jean-Philippe Ranjeva
- Biological and Medical Magnetic Resonance Center (CRMBM) and Center for Metabolic Exploration using Magnetic Resonance (CEMEREM) (UMR 7339); CHU La Timone; Marseilles France
| | - Shahram Attarian
- Department of Neurology and Neuromuscular Diseases; CHU La Timone; 264 rue Saint-Pierre 13385 Marseille France
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Jang W, Park J, Kim JS, Youn J, Oh E, Jo KD, Lee MK, Kim HT. Triple stimulation technique findings in vascular Parkinsonism and Parkinson's disease. Clin Neurophysiol 2014; 125:1834-9. [PMID: 24559661 DOI: 10.1016/j.clinph.2014.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 01/02/2014] [Accepted: 01/03/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE One of the predominant clinical features that differentiates vascular Parkinsonism (VP) from Parkinson's disease (PD) is the pyramidal sign. The triple stimulation technique (TST) is one of the most sensitive methods for comparing upper motor neuron involvement in patients with VP and PD. This study aimed to evaluate the usefulness of the TST as a diagnostic tool for VP. METHODS Thirteen VP patients, 18 PD patients and 10 age-matched healthy controls were enrolled in this study. We obtained basic participant demographic information and transcranial magnetic stimulation (TMS) parameters, including the TST amplitude ratio, from all participants. We compared the TMS parameters among the VP, PD and control groups. RESULTS The TST amplitude ratio was significantly lower in the VP group than in the PD and control groups (71.59 ± 11.86 vs. 96.42 ± 5.11 and 97.70 ± 3.82, respectively; p<0.01). The TST amplitude ratio was positively correlated with scores obtained on the United Parkinson's Disease Rating Scale-III, which reflects motor function. CONCLUSIONS The TST is an effective and easy technique that offers improved diagnostic sensitivity in patients with VP by assessing upper motor neuron involvement. The TST may also represent a useful monitoring tool for evaluating disease progression. SIGNIFICANCE This study is the first to assess pyramidal involvement in patients with VP using the collision technique.
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Affiliation(s)
- Wooyoung Jang
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Jinse Park
- Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, Republic of Korea.
| | - Ji Sun Kim
- Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Eungseok Oh
- Department of Neurology, Chungnam National University Hospital, College of Medicine, Daejun, Republic of Korea
| | - Kwang Deog Jo
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea.
| | - Moon Kyu Lee
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Hee-Tae Kim
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
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Ahdab R, Créange A, Saint-Val C, Farhat WH, Lefaucheur JP. Rapidly progressive amyotrophic lateral sclerosis initially masquerading as a demyelinating neuropathy. Neurophysiol Clin 2013; 43:181-7. [PMID: 23856174 DOI: 10.1016/j.neucli.2013.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 04/30/2013] [Accepted: 05/01/2013] [Indexed: 11/17/2022] Open
Abstract
Rare cases of demyelinating neuropathy have been described in association with amyotrophic lateral sclerosis (ALS). We report two patients with typical ALS whose initial electroneuromyographic (ENMG) presentation could suggest the existence of a process of motor nerve fiber demyelination. However, subsequent ENMG examinations and the fatal course of the disease in a few months rather supported severe ongoing axonal degeneration at the origin of motor nerve conduction abnormalities. Repeated examinations could be required to distinguish between ENMG features of concomitant demyelinating neuropathy and rapidly progressive motor neuron loss in ALS.
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Affiliation(s)
- R Ahdab
- EA 4391, faculté de médecine de Créteil, université Paris Est Créteil, Créteil, France
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Furtula J, Johnsen B, Frandsen J, Rodell A, Christensen PB, Pugdahl K, Fuglsang-Frederiksen A. Upper motor neuron involvement in amyotrophic lateral sclerosis evaluated by triple stimulation technique and diffusion tensor MRI. J Neurol 2013; 260:1535-44. [PMID: 23299622 DOI: 10.1007/s00415-012-6824-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 12/21/2012] [Accepted: 12/24/2012] [Indexed: 11/25/2022]
Abstract
The objective of this study was to evaluate the diagnostic value of triple stimulation technique (TST) and diffusion tensor imaging (DTI) tractography as markers of upper motor neuron (UMN) degeneration in amyotrophic lateral sclerosis (ALS). Fourteen ALS patients fulfilling the El Escorial criteria and 30 control subjects participated in the study. TST amplitude and area ratio were used as an estimate of the degree of central motor conduction failure. DTI fractional anisotropy was used as a quantitative measure of the structural integrity of the corticospinal tract and the posterior limb of the internal capsule. Mean TST amplitude and area ratio were lower in patients than controls, while there were no differences in mean fractional anisotropy of the corticospinal tract or the posterior limb of the internal capsule. TST was abnormal in 7/13 patients (sensitivity 54%) and DTI was abnormal in 3/12 (sensitivity 25%). Combining TST and DTI disclosed abnormalities in 8/11 patients (sensitivity 73%). TST confirmed UMN degeneration in one of every 2.25 patient in the diagnostic categories lower than 'probable' ALS. Using results from TST as a criterion for UMN degeneration, four patients in diagnostic categories lower than 'probable' ALS and without clinical signs of UMN degeneration in the cervical region increased in diagnostic category. Our findings indicate that TST has a significant diagnostic value as an early objective marker of UMN degeneration in ALS, while the value of DTI analysis seems limited.
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Affiliation(s)
- Jasna Furtula
- Department of Clinical Neurophysiology, Aarhus University Hospital, Noerrebrogade 44, Building 10, Parterre, 8000, Aarhus C, Denmark.
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Abstract
Central motor conduction time (CMCT) is the time taken for neural impulses to travel through the central nervous system on their way to the target muscles. When the motor cortex is stimulated with transcranial magnetic stimulation (TMS), CMCT is calculated by subtracting the peripheral conduction time from the motor evoked potential latency elicited by motor cortical TMS. CMCT in infants and children reaches adult level at about age of 6 years for the lower limbs. The alterations of CMCT in various neurological conditions are reviewed in this chapter. Prolongation of CMCT occurs due to slowing of conduction through rapidly conducting corticospinal fibers, as seen in various disorders such as demyelinating diseases (multiple sclerosis, MS), amyotrophic lateral sclerosis, structural lesions in the corticospinal tract such as stroke and compressive myelopathy, and neurodegenerative disorders including multiple system atrophy and progressive supranuclear palsy. As CMCT is prolonged in certain clinical conditions, it is of diagnostic value in some neurological disorders such as myelopathy, amyotrophic lateral sclerosis, and MS when used together with other clinical and electrophysiological measures. It could also be used as a prognostic marker in some of neurological conditions, such as myelopathy and MS.
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Affiliation(s)
- Kaviraja Udupa
- Division of Neurology, Department of Medicine, University of Toronto and Division of Brain Imaging & Behaviour Systems - Neuroscience, Toronto Western Research Institute, Toronto, Canada
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22
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Vucic S, Kiernan MC. Clarifying variability of corticomotoneuronal function in kennedy disease. Muscle Nerve 2011; 44:197-201. [PMID: 21698646 DOI: 10.1002/mus.22017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2010] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Although Kennedy disease (KD) is regarded as a pure lower motor neuron disorder, recent transcranial magnetic stimulation (TMS) studies have reported subclinical corticomotoneuronal dysfunction in KD. To clarify these findings, this study applied novel triple stimulation (TST) and threshold tracking TMS techniques to gain further insights into corticomotoneuronal function in KD. METHODS TMS studies were undertaken in 12 KD patients and 38 age-matched controls. Motor evoked potentials were recorded over the abductor pollicis brevis (threshold tracking TMS) and abductor digiti minimi (TST). RESULTS The mean TSTtest:TSTcontrol amplitude (99 ± 0.7%, normal >93%) and area (98.4 ± 1.6%, normal >92%) ratios were normal in Kennedy disease. In addition, short-interval intracortical inhibition (SICI) was similar in KD and controls (KD: 8.1 ± 1.3%; controls: 10.1 ± 0.7%; P = 0.11), as were the motor evoked potential amplitude, resting motor threshold, intracortical facilitation, and cortical silent period duration. CONCLUSIONS Triple stimulation and threshold tracking TMS techniques have reiterated normal corticomotoneuronal function in KD.
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Affiliation(s)
- Steve Vucic
- Department of Neurology, Sydney Medical School Westmead, University of Sydney, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW 2145, Australia.
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Assessment of motor pathways by magnetic stimulation in human and veterinary medicine. Vet J 2011; 187:174-81. [DOI: 10.1016/j.tvjl.2009.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 12/09/2009] [Accepted: 12/11/2009] [Indexed: 11/22/2022]
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“Everything is hard before it’s easy” – Thomas Fuller. Clin Neurophysiol 2011; 122:7-8. [DOI: 10.1016/j.clinph.2010.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 06/18/2010] [Indexed: 11/20/2022]
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Fluchere F, Verschueren A, Cintas P, Franques J, Serratrice J, Weiller PJ, Azulay JP, Pouget J, Attarian S. Clinical features and follow-up of four new cases of facial-onset sensory and motor neuronopathy. Muscle Nerve 2010; 43:136-40. [DOI: 10.1002/mus.21884] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Prospective, blind study of the triple stimulation technique in the diagnosis of ALS. ACTA ACUST UNITED AC 2010; 11:67-75. [PMID: 19714538 DOI: 10.3109/17482960903171128] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the diagnostic yield of magnetic cortical stimulation with the triple stimulation technique (TST) to identify upper motor neuron (UMN) involvement in patients suspected of having ALS. METHODS Fifty-nine patients were recruited to undergo TST in addition to the standard work-up for suspected motor neuron disease. TST combines transcranial magnetic stimulation of the motor cortex with collision studies, which results in a higher sensitivity in detecting UMN involvement. Primary outcome was the number of abnormal TST results in patients with possible ALS. The positivity rate was converted to the number needed to test with TST (NN-TST) for one extra diagnosis of ALS. RESULTS Fifty patients underwent TST. In the total group (n=59), 18 patients had a motor neuron disorder but did not fulfil criteria for 'probable' or 'definite' ALS. In four of these patients TST was abnormal (NN-TST, 4.5). One TST was erroneously interpreted as abnormal. TST findings were normal in inclusion body myositis and peripheral nerve disorders. CONCLUSION This prospective and blind study confirms open studies of TST in the evaluation of ALS. We suggest that TST can be used to arrive at a diagnosis of 'probable' or 'definite' ALS in patients lacking UMN signs in the upper extremities.
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Rico A, Audoin B, Franques J, Eusebio A, Reuter F, Malikova I, Ali Cherif A, Pouget J, Pelletier J, Attarian S. Motor evoked potentials in clinically isolated syndrome suggestive of multiple sclerosis. Mult Scler 2009; 15:355-62. [DOI: 10.1177/1352458508099612] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of the present study was to determine the sensitivity and the profile of motor evoked potentials (MEP) in patients with clinically isolated syndrome (CIS) suggestive of multiple sclerosis (MS). We measured the central motor conduction time (CMCT), amplitude ratio (AR), and surface ratio (SR) in tibialis anterior and first dorsal interosseous muscles in 22 patients with CIS. In 12 patients, the triple stimulation technique (TST) was also performed. AR was abnormal in 50% of patients, CMCT in 18% of patients, and TST in 25% of patients. AR had the highest sub-clinical sensitivity and the best positive predictive value. In the absence of clinical pyramidal signs, an early AR decrease seems to result from demyelination inducing excessive temporal dispersion of the MEP, while in territories with clinical pyramidal signs, it seems to result from conduction failure, which suggests that clinical pyramidal signs may be attributable to conduction failure. This study demonstrates that MEP, especially the AR, is sensitive to motor pathway dysfunction right from the early stages of MS.
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Affiliation(s)
- A Rico
- Centre de Résonance Magnétique Biologique et Médicale UMR CNRS 6612, Faculté de Médecine, Université de la Méditerranée, Marseille, France; Pôle de Neurosciences Cliniques, Service de Neurologie, Faculté de Médecine de Marseille, Université de la Méditerranée, Hôpital de la Timone, Marseille, France
| | - B Audoin
- Centre de Résonance Magnétique Biologique et Médicale UMR CNRS 6612, Faculté de Médecine, Université de la Méditerranée, Marseille, France; Pôle de Neurosciences Cliniques, Service de Neurologie, Faculté de Médecine de Marseille, Université de la Méditerranée, Hôpital de la Timone, Marseille, France
| | - J Franques
- Pôle de Neurosciences Cliniques, Service de Neurologie et des pathologies neuromusculaires, Faculté de Médecine de Marseille, Université de la Méditerranée, Hôpital de la Timone, Marseille, France
| | - A Eusebio
- Pôle de Neurosciences Cliniques, Service de Neurologie et des pathologies neuromusculaires, Faculté de Médecine de Marseille, Université de la Méditerranée, Hôpital de la Timone, Marseille, France
| | - F Reuter
- Centre de Résonance Magnétique Biologique et Médicale UMR CNRS 6612, Faculté de Médecine, Université de la Méditerranée, Marseille, France; Pôle de Neurosciences Cliniques, Service de Neurologie, Faculté de Médecine de Marseille, Université de la Méditerranée, Hôpital de la Timone, Marseille, France
| | - I Malikova
- Centre de Résonance Magnétique Biologique et Médicale UMR CNRS 6612, Faculté de Médecine, Université de la Méditerranée, Marseille, France; Pôle de Neurosciences Cliniques, Service de Neurologie, Faculté de Médecine de Marseille, Université de la Méditerranée, Hôpital de la Timone, Marseille, France
| | - A Ali Cherif
- Pôle de Neurosciences Cliniques, Service de Neurologie, Faculté de Médecine de Marseille, Université de la Méditerranée, Hôpital de la Timone, Marseille, France
| | - J Pouget
- Pôle de Neurosciences Cliniques, Service de Neurologie et des pathologies neuromusculaires, Faculté de Médecine de Marseille, Université de la Méditerranée, Hôpital de la Timone, Marseille, France
| | - J Pelletier
- Centre de Résonance Magnétique Biologique et Médicale UMR CNRS 6612, Faculté de Médecine, Université de la Méditerranée, Marseille, France; Pôle de Neurosciences Cliniques, Service de Neurologie, Faculté de Médecine de Marseille, Université de la Méditerranée, Hôpital de la Timone, Marseille, France
| | - S Attarian
- Pôle de Neurosciences Cliniques, Service de Neurologie et des pathologies neuromusculaires, Faculté de Médecine de Marseille, Université de la Méditerranée, Hôpital de la Timone, Marseille, France
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