Morphometric quantification of the cervical limb motor cells in various neuromuscular diseases

ZOOM or Non-ZOOM? Assessing Spinal Cord Diffusion Tensor Imaging Protocols for Multi-Centre Studies

The purpose of this study was to develop and evaluate two spinal cord (SC) diffusion tensor imaging (DTI) protocols, implemented at multiple sites (using scanners from two different manufacturers), one available on any clinical scanner, and one using more advanced options currently available in the research setting, and to use an automated processing method for unbiased quantification. DTI parameters are sensitive to changes in the diseased SC. However, imaging the cord can be technically challenging due to various factors including its small size, patient-related and physiological motion, and field inhomogeneities. Rapid acquisition sequences such as Echo Planar Imaging (EPI) are desirable but may suffer from image distortions. We present a multi-centre comparison of two acquisition protocols implemented on scanners from two different vendors (Siemens and Philips), one using a reduced field-of-view (rFOV) EPI sequence, and one only using options available on standard clinical scanners such as outer volume suppression (OVS). Automatic analysis was performed with the Spinal Cord Toolbox for unbiased and reproducible quantification of DTI metrics in the white matter. Images acquired using the rFOV sequence appear less distorted than those acquired using OVS alone. SC DTI parameter values obtained using both sequences at all sites were consistent with previous measurements made at 3T. For the same scanner manufacturer, DTI parameter inter-site SDs were smaller for the rFOV sequence compared to the OVS sequence. The higher inter-site reproducibility (for the same manufacturer and acquisition details, i.e. ZOOM data acquired at the two Philips sites) of rFOV compared to the OVS sequence supports the idea that making research options such as rFOV more widely available would improve accuracy of measurements obtained in multi-centre clinical trials. Future multi-centre studies should also aim to match the rFOV technique and signal-to-noise ratios in all sequences from different manufacturers/sites in order to avoid any bias in measured DTI parameters and ensure similar sensitivity to pathological changes.

Tissue- and column-specific measurements from multi-parameter mapping of the human cervical spinal cord at 3 T

The aim of this study was to quantify a range of MR parameters [apparent proton density, longitudinal relaxation time T1, magnetisation transfer (MT) ratio, MT saturation (which represents the additional percentage MT saturation of the longitudinal magnetisation caused by a single MT pulse) and apparent transverse relaxation rate R2*] in the white matter columns and grey matter of the healthy cervical spinal cord. The cervical cords of 13 healthy volunteers were scanned at 3 T using a protocol optimised for multi-parameter mapping. Intra-subject co-registration was performed using linear registration, and tissue- and column-specific parameter values were calculated. Cervical cord parameter values measured from levels C1-C5 in 13 subjects are: apparent proton density, 4822 ± 718 a.u.; MT ratio, 40.4 ± 1.53 p.u.; MT saturation, 1.40 ± 0.12 p.u.; T1 = 1848 ± 143 ms; R2* = 22.6 ± 1.53 s(-1). Inter-subject coefficients of variation were low in both the cervical cord and tissue- and column-specific measurements, illustrating the potential of this method for the investigation of changes in these parameters caused by pathology. In summary, an optimised cervical cord multi-parameter mapping protocol was developed, enabling tissue- and column-specific measurements to be made. This technique has the potential to provide insight into the pathological processes occurring in the cervical cord affected by neurological disorders.

Can regional spreading of amyotrophic lateral sclerosis motor symptoms be explained by prion-like propagation?

Progressive accumulation of specific misfolded protein is a defining feature of amyotrophic lateral sclerosis (ALS), similarly seen in Alzheimer disease, Parkinson disease, Huntington disease and Creutzfeldt-Jakob disease. The intercellular transfer of inclusions made of tau, α-synuclein and huntingtin has been demonstrated, revealing the existence of mechanisms reminiscent of those by which prions spread through the nervous system. Evidence for such a prion-like propagation mechanism has now spread to the major misfolded proteins, superoxide dismutase 1 (SOD1) and the 43 kDa transactive response DNA binding protein (TDP-43), implicated in ALS. The focus in this review is on what is known about ALS progression in terms of clinical as well as molecular aspects. Furthermore, the concept of 'propagation' is dissected into contiguous and non-contiguous types, and this concept is expanded to the severity of the focal symptom as well as its regional spread which can be explained by cell to cell propagation in the local neuron pool.

Comparative analysis of motoneuron loss and functional deficits in PMN mice: implications for human motoneuron disease

We have investigated the correlation between functional and morphological deficits in PMN mice, an animal model of human motoneuron disease. Electrophysiologic investigations showed first abnormalities, i.e. reduction of M-response amplitudes, already at postnatal d 13 when the disease was not yet phenotypically apparent, and when motoneuron and motor axon numbers were still normal. After d 27, a loss of more than 30% of motoneuron axons and cell bodies was detectable in the phrenic nerve and facial nucleus, respectively. At that stage, PMN mice showed severe functional and electrophysiological deficits. At later stages of the disease when still more than 50% of motor axons and at least 60% of motoneuron cell bodies were present, the distal compound muscle action potential amplitude decreased by more than 95% in small foot muscles after sciatic nerve stimulation. We conclude that functional deficits precede structural deficits in this animal model of human motoneuron disease. Our findings are in agreement with the concept of the 'sick motoneuron' in this animal model of motoneuron disease rather than the idea of progressive loss of motoneurons resulting in disease only after a significant number of motoneurons has degenerated.

Axonal and perikaryal involvement in chronic inflammatory demyelinating polyneuropathy

OBJECTIVES

To assess the extent of loss of myelinated nerve fibres and spinal motor neuron loss in chronic inflammatory demyelinating polyneuropathy (CIDP), a clinicopathological study was conducted on biopsied sural nerves and necropsied spinal cords from patients with CIDP.

METHODS

The myelinated fibre pathology of 71 biopsied sural nerves and motor neuron pathology of nine necropsied spinal cords at L4 levels in patients with CIDP were quantitatively and immunohistochemically assessed.

RESULTS

Myelinated nerve fibre density was significantly diminished to 65.4% of the control values (p <0.0001), correlating inversely with the extent of segmental demyelination and remyelination (r = -0.43, p < 0.0005) and duration of illness (r = -0.31, p < 0.01). Numbers of large spinal motor neurons in CIDP were variably but significantly diminished (range from 46.0 to 97.6% of the age matched control value (p < 0.005)), and reactive astrogliosis was evident in the ventral horn in CIDP. The frequency of ventral horn neurons exhibiting central chromatolysis and the accumulation of phosphorylated high molecular weight neurofilament protein was significantly higher in CIDP than in controls (p<0.01 and p<0.05).

CONCLUSIONS

The loss of nerve axons and spinal motor neurons is common in CIDP, and extensive in some cases. These neuronal and axonal losses may influence the functional prognosis in CIDP.

Involvement of Onuf's nucleus in amyotrophic lateral sclerosis

The Onufrowicz (Onuf's) nuclei from eight amyotrophic lateral sclerosis (ALS) cases and nine neurological control cases were studied histologically and morphometrically. To clarify the factors relating to the involvement of the Onuf's nucleus in ALS, we correlated the relationships among the age at death, clinical duration, morphometric findings for Onuf's neurons, and neuronal numbers in the posteroposterolateral (PPL) nuclei in the ALS cases with those in neurological controls. Intracytoplasmic inclusions such as Bunina bodies, ubiquitin-reactive inclusions, and conglomerate inclusion were found in the Onuf's neurons in ALS, but not in the controls. The total number of Onuf's neurons in the ALS cases was not decreased, but that of normal-appearing neurons was decreased while that of atrophic neurons was increased. Significantly decreased perikaryal, nuclear and nucleolar areas and decreased perikaryal (P)/nuclear and P/nucleolar area ratios of Onuf's neurons were found in ALS, not only in the atrophic neurons but also in the normal-appearing neurons, compared with the controls. The shrinkage in Onuf's neurons of ALS was different from that seen in the ageing process or in the axonal reactions of controls with atonic bladder. In ALS, the morphometric findings for the Onuf's neurons showed no correlation with age at death, clinical duration, or number of PPL neurons. Our results indicate that in ALS Onuf's nucleus is principally vulnerable to the ALS process, although the degree of degeneration differs from that seen in other motor neurons. The involvement of Onuf's nucleus might be slowed due to factors specific to this nucleus, including the biochemical and autonomic properties of the nucleus; nevertheless, it is histologically classified as part of the somatic cell column.

Immunohistochemical study on choline acetyltransferase in the spinal cord of patients with amyotrophic lateral sclerosis

The authors developed a polyclonal antibody against a fusion protein containing 598 amino acids from a human choline acetyltransferase (ChAT) cDNA and 12 amino acids derived from an expression vector, and examined immunohistochemical reactivity for ChAT in large motor neurons (30 microns and more in somal minimal diameter) of the lumbar spinal cords of four patients with amyotrophic lateral sclerosis (ALS) and of four control cases. In controls, the number of large neurons included in the tissue with a total thickness of 100 microns ranged from 74 to 105 (average 87). About 60-90% (average 80%) of the neurons were positively stained in their perikarya with an anti-human ChAT antibody. In the cases of ALS, the number of large motor neurons was greatly reduced (25-60, average 38). About 4-13% (average 8%) were positively stained. These results indicate that not only large neurons are reduced in number, but also their positivity for ChAT is decreased in the anterior horn of ALS spinal cord.

Disease-specific patterns of neuronal loss in the spinal ventral horn in amyotrophic lateral sclerosis, multiple system atrophy and X-linked recessive bulbospinal neuronopathy, with special reference to the loss of small neurons in the intermediate zone

The ventral horn cells of the fourth lumbar segment were morphometrically analysed in six cases of amyotrophic lateral sclerosis (ALS; there common forms and three pseudopolyneuritic forms), six of multiple system atrophy (MSA) with autonomic failure, four of X-linked recessive bulbospinal neuronopathy (X-BSNP), and seven age-matched autopsy cases of non-neurological disorders. In the common form of ALS, large and medium-sized neurons of the medial and lateral nuclei were markedly lost; small neurons in the intermediate zone were slightly diminished but fairly well preserved. In the pseudopolyneuritic form of ALS, marked loss was present in the large and medium-sized neurons, and in the small neurons located in the intermediate zone as well. In the MSA, in contrast to ALS, there was a marked reduction in small neurons in the intermediate zone, and large and medium-sized neurons of the medial and lateral nuclei tended to be preserved. In X-BSNP, large and medium-sized neurons were almost completely lost and small neurons were also markedly depopulated. These findings indicated that the pattern of neuron loss in the ventral horn is distinct among these diseases depending on size, location and function of the ventral horn cell population. These disease-specific patterns of neuron loss suggest a difference in the process of neuronal degeneration of ventral horn cells among the disease examined.

Methods for estimating numbers of motor units in biceps-brachialis muscles and losses of motor units with aging

This paper presents a new method, here applied to the biceps-brachialis muscles, for estimating motor unit numbers in healthy subjects. This method combines isometric contraction, intramuscular needle electrode recordings, and spike-triggered averaging techniques to measure the sizes of motor unit potentials as recorded in the innervation zone with surface electrodes. The number of motor units is then estimated by division of the maximum biceps-brachialis "M" potential recorded with the same surface electrodes and evoked by supramaximal stimulation of the musculocutaneous nerve, by the mean of at least 10 surface-recorded motor unit potentials. The requisite intramuscular recordings provide additional information as to innervation density, incidence of linked potentials, and impulse blocking, phenomena that are particularly common in neurogenic and myogenic disorders. There was clear evidence of losses of motor units in older subjects: subjects over 60 years of age having approximately half the numbers of motor units of subjects under 60 years of age.

Pattern of involvement in the cervical segments in the early stage of motor neurone disease: a single fibre EMG study

The right and left biceps and first dorsal interosseous muscles of 22 patients with motor neurone disease were studied by single fibre EMG at the time of diagnosis. The mean duration of symptoms was 8.1 months. The fibre density was increased in 87 of the 88 muscles studied. In the first dorsal interosseous muscles the fibre density was increased similarly on both sides, but in the biceps muscles of normal strength the fibre density was more markedly increased on the left than on the right. These findings suggest that in the early stage of the disease certain motor unit pools in the spinal cord are preferentially affected.