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Vucic S, Stanley Chen KH, Kiernan MC, Hallett M, Benninger DH, Di Lazzaro V, Rossini PM, Benussi A, Berardelli A, Currà A, Krieg SM, Lefaucheur JP, Long Lo Y, Macdonell RA, Massimini M, Rosanova M, Picht T, Stinear CM, Paulus W, Ugawa Y, Ziemann U, Chen R. Clinical diagnostic utility of transcranial magnetic stimulation in neurological disorders. Updated report of an IFCN committee. Clin Neurophysiol 2023; 150:131-175. [PMID: 37068329 PMCID: PMC10192339 DOI: 10.1016/j.clinph.2023.03.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/28/2023] [Accepted: 03/09/2023] [Indexed: 03/31/2023]
Abstract
The review provides a comprehensive update (previous report: Chen R, Cros D, Curra A, Di Lazzaro V, Lefaucheur JP, Magistris MR, et al. The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol 2008;119(3):504-32) on clinical diagnostic utility of transcranial magnetic stimulation (TMS) in neurological diseases. Most TMS measures rely on stimulation of motor cortex and recording of motor evoked potentials. Paired-pulse TMS techniques, incorporating conventional amplitude-based and threshold tracking, have established clinical utility in neurodegenerative, movement, episodic (epilepsy, migraines), chronic pain and functional diseases. Cortical hyperexcitability has emerged as a diagnostic aid in amyotrophic lateral sclerosis. Single-pulse TMS measures are of utility in stroke, and myelopathy even in the absence of radiological changes. Short-latency afferent inhibition, related to central cholinergic transmission, is reduced in Alzheimer's disease. The triple stimulation technique (TST) may enhance diagnostic utility of conventional TMS measures to detect upper motor neuron involvement. The recording of motor evoked potentials can be used to perform functional mapping of the motor cortex or in preoperative assessment of eloquent brain regions before surgical resection of brain tumors. TMS exhibits utility in assessing lumbosacral/cervical nerve root function, especially in demyelinating neuropathies, and may be of utility in localizing the site of facial nerve palsies. TMS measures also have high sensitivity in detecting subclinical corticospinal lesions in multiple sclerosis. Abnormalities in central motor conduction time or TST correlate with motor impairment and disability in MS. Cerebellar stimulation may detect lesions in the cerebellum or cerebello-dentato-thalamo-motor cortical pathways. Combining TMS with electroencephalography, provides a novel method to measure parameters altered in neurological disorders, including cortical excitability, effective connectivity, and response complexity.
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Affiliation(s)
- Steve Vucic
- Brain, Nerve Research Center, The University of Sydney, Sydney, Australia.
| | - Kai-Hsiang Stanley Chen
- Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Matthew C Kiernan
- Brain and Mind Centre, The University of Sydney; and Department of Neurology, Royal Prince Alfred Hospital, Australia
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, Maryland, United States
| | - David H Benninger
- Department of Neurology, University Hospital of Lausanne (CHUV), Switzerland
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Paolo M Rossini
- Department of Neurosci & Neurorehab IRCCS San Raffaele-Rome, Italy
| | - Alberto Benussi
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli; Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Currà
- Department of Medico-Surgical Sciences and Biotechnologies, Alfredo Fiorini Hospital, Sapienza University of Rome, Terracina, LT, Italy
| | - Sandro M Krieg
- Department of Neurosurgery, Technical University Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Jean-Pascal Lefaucheur
- Univ Paris Est Creteil, EA4391, ENT, Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Yew Long Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, and Duke-NUS Medical School, Singapore
| | | | - Marcello Massimini
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi di Milano, Milan, Italy; Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences University of Milan, Milan, Italy
| | - Thomas Picht
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Cluster of Excellence: "Matters of Activity. Image Space Material," Humboldt University, Berlin Simulation and Training Center (BeST), Charité-Universitätsmedizin Berlin, Germany
| | - Cathy M Stinear
- Department of Medicine Waipapa Taumata Rau, University of Auckland, Auckland, Aotearoa, New Zealand
| | - Walter Paulus
- Department of Neurology, Ludwig-Maximilians-Universität München, München, Germany
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Japan
| | - Ulf Ziemann
- Department of Neurology and Stroke, Eberhard Karls University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany; Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Otfried-Müller-Straße 27, 72076 Tübingen, Germany
| | - Robert Chen
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital-UHN, Division of Neurology-University of Toronto, Toronto Canada
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Muceli S, Poppendieck W, Holobar A, Gandevia S, Liebetanz D, Farina D. Blind identification of the spinal cord output in humans with high-density electrode arrays implanted in muscles. SCIENCE ADVANCES 2022; 8:eabo5040. [PMID: 36383647 PMCID: PMC9668292 DOI: 10.1126/sciadv.abo5040] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Invasive electromyography opened a new window to explore motoneuron behavior in vivo. However, the technique is limited by the small fraction of active motoneurons that can be concurrently detected, precluding a population analysis in natural tasks. Here, we developed a high-density intramuscular electrode for in vivo human recordings along with a fully automatic methodology that could detect the discharges of action potentials of up to 67 concurrently active motoneurons with 99% accuracy. These data revealed that motoneurons of the same pool receive common synaptic input at frequencies up to 75 Hz and that late-recruited motoneurons inhibit the discharges of those recruited earlier. These results constitute an important step in the population coding analysis of the human motor system in vivo.
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Affiliation(s)
- Silvia Muceli
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | | | - Aleš Holobar
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
| | - Simon Gandevia
- Neuroscience Research Australia and University of New South Wales, Randwick, Sydney, New South Wales, Australia
| | - David Liebetanz
- Department of Neurology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, UK
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Driven to decay: Excitability and synaptic abnormalities in amyotrophic lateral sclerosis. Brain Res Bull 2018; 140:318-333. [PMID: 29870780 DOI: 10.1016/j.brainresbull.2018.05.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/26/2018] [Accepted: 05/31/2018] [Indexed: 12/11/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common motor neuron (MN) disease and is clinically characterised by the death of corticospinal motor neurons (CSMNs), spinal and brainstem MNs and the degeneration of the corticospinal tract. Degeneration of CSMNs and MNs leads inexorably to muscle wastage and weakness, progressing to eventual death within 3-5 years of diagnosis. The CSMNs, located within layer V of the primary motor cortex, project axons constituting the corticospinal tract, forming synaptic connections with brainstem and spinal cord interneurons and MNs. Clinical ALS may be divided into familial (∼10% of cases) or sporadic (∼90% of cases), based on apparent random incidence. The emergence of transgenic murine models, expressing different ALS-associated mutations has accelerated our understanding of ALS pathogenesis, although precise mechanisms remain elusive. Multiple avenues of investigation suggest that cortical electrical abnormalities have pre-eminence in the pathophysiology of ALS. In addition, glutamate-mediated functional and structural alterations in both CSMNs and MNs are present in both sporadic and familial forms of ALS. This review aims to promulgate debate in the field with regard to the common aetiology of sporadic and familial ALS. A specific focus on a nexus point in ALS pathogenesis, namely, the synaptic and intrinsic hyperexcitability of CSMNs and MNs and alterations to their structure are comprehensively detailed. The association of extramotor dysfunction with neuronal structural/functional alterations will be discussed. Finally, the implications of the latest research on the dying-forward and dying-back controversy are considered.
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Kudina LP, Andreeva RE. Triplet firing origin in human motor units: emerging hypotheses. Exp Brain Res 2015; 234:837-44. [PMID: 26661335 DOI: 10.1007/s00221-015-4514-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 11/25/2015] [Indexed: 12/12/2022]
Abstract
A specific feature of motor unit (MU) firing behaviour is rhythmic trains of single discharges at low rate resulting from the prolonged motoneuronal afterhyperpolarization. However, some MUs exhibit occasional doublets with uniquely short interspike intervals (2.5-20.0 ms). Motoneuronal delayed depolarization is commonly accepted to be doublet underlying mechanism. Apart from doublets, much scarcer MU triple discharges were described, but their mechanisms are disputable. The aim of the present study was to analyse MU triplet firing origin in healthy humans. MU triple discharges occasionally arising during gentle voluntary muscle contractions were compared with those arising in axons during motor nerve stimulation. Firing pattern was analysed in 109 MUs of four muscles: the tibialis anterior, the flexor carpi ulnaris, the abductor pollicis brevis, and the abductor digiti minimi. Our findings present evidence that during voluntary contractions two kinds of MU triplet firing can be occasionally observed: "true" motoneuronal triplets (interspike intervals of 3.6-17.3 ms) with the delayed depolarization as the possible underlying mechanism and axonal triple discharges including the M-response and F-wave. The findings can be useful not only for understanding mechanisms of the very rare motoneuronal firing in healthy humans but also for estimation of pathological triplet firing origin.
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Affiliation(s)
- Lydia P Kudina
- Institute for Information Transmission Problems (Kharkevich Institute), Russian Academy of Sciences, 19, Bol'shoi Karetnyi pereulok, Moscow, Russia, 127994.
| | - Regina E Andreeva
- Institute for Information Transmission Problems (Kharkevich Institute), Russian Academy of Sciences, 19, Bol'shoi Karetnyi pereulok, Moscow, Russia, 127994
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Motor unit firing pattern: evidence for motoneuronal or axonal discharge origin? Neurol Sci 2015; 37:37-43. [PMID: 26238963 DOI: 10.1007/s10072-015-2354-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/29/2015] [Indexed: 12/12/2022]
Abstract
In neuromuscular diseases, a fasciculation origin is disputed. In some reports, it was suggested that motor unit firing pattern alone is evidence for motoneuronal or axonal fasciculations; namely interspike intervals of approximately 5 ms (doublet intervals) provide evidence for the axonal firing. To clarify the reliability of the suggestion, we compared doublet intervals originated in motoneurons and their axons in healthy humans. For this aim, the H-reflex and M-response of single motor units were elicited during gentle voluntary muscle contractions. Peri-stimulus time histograms allowed reliable judgment about a doublet origin: motoneuronal (at the H-reflex latency) or axonal (at the M-response latency). Significant difference between motoneuronal and axonal doublet intervals was absent. It was concluded that doublet interval alone cannot be the reliable criterion for an axonal firing origin; additional evidences are needed for this conclusion, for example, the appearance of the F-wave. The approach may be used as an additional estimation of mechanisms underlying motor unit diseases.
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de Carvalho M, Eisen A, Krieger C, Swash M. Motoneuron firing in amyotrophic lateral sclerosis (ALS). Front Hum Neurosci 2014; 8:719. [PMID: 25294995 PMCID: PMC4170108 DOI: 10.3389/fnhum.2014.00719] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/27/2014] [Indexed: 01/09/2023] Open
Abstract
Amyotrophic lateral sclerosis is an inexorably progressive neurodegenerative disorder involving the classical motor system and the frontal effector brain, causing muscular weakness and atrophy, with variable upper motor neuron signs and often an associated fronto-temporal dementia. The physiological disturbance consequent on the motor system degeneration is beginning to be well understood. In this review we describe aspects of the motor cortical, neuronal, and lower motor neuron dysfunction. We show how studies of the changes in the pattern of motor unit firing help delineate the underlying pathophysiological disturbance as the disease progresses. Such studies are beginning to illuminate the underlying disordered pathophysiological processes in the disease, and are important in designing new approaches to therapy and especially for clinical trials.
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Affiliation(s)
- Mamede de Carvalho
- Institute of Physiology and Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon Lisbon, Portugal ; Department of Neurosciences, Hospital Santa Maria, Faculty of Medicine, University of Lisbon Lisbon, Portugal
| | - Andrew Eisen
- Emeritus Professor of Neurology, University of British Columbia Vancouver, BC, Canada
| | - Charles Krieger
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby BC, Canada ; Department of Medicine (Neurology), University of British Columbia, Vancouver BC, Canada
| | - Michael Swash
- Institute of Physiology and Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon Lisbon, Portugal ; Department of Neurosciences, Hospital Santa Maria, Faculty of Medicine, University of Lisbon Lisbon, Portugal ; Institute of Neuroscience, Barts and The London School of Medicine, Queen Mary University of London London, UK
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Piotrkiewicz M, Sebik O, Binboğa E, Młoźniak D, Kuraszkiewicz B, Türker KS. Double discharges in human soleus muscle. Front Hum Neurosci 2013; 7:843. [PMID: 24367319 PMCID: PMC3856367 DOI: 10.3389/fnhum.2013.00843] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 11/19/2013] [Indexed: 11/13/2022] Open
Abstract
Double discharges (doublets) were recorded from human soleus (SOL), where they have never been reported before. The data analyzed in this study were collected from 12 healthy volunteers. The subjects were recruited for other studies, concerning: (1) estimation of motoneurons' (MNs) afterhyperpolarization (AHP) duration and (2) analysis of motor unit responses to nerve stimulation, and were not trained to voluntarily evoke doublets. The majority of intradoublet intervals fell into the commonly accepted range 2-20 ms. However, two SOL MNs from one presented exceptional doublets of intradoublet interval about 37 ms. This interval was virtually identical with the interval between second and third discharge in the few triplets recorded from another subject. It is hypothesized that triplets are generated by the delayed depolarization with the second narrow hump, which is the same as the hump responsible for exceptional doublets.
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Affiliation(s)
- Maria Piotrkiewicz
- Polish Academy of Sciences, Department of Engineering of Nervous and Muscular System, Nałęcz Institute of Biocybernetics and Biomedical Engineering, Warsaw Poland
| | - Oğuz Sebik
- Laboratory of Neuromuscular Research, Koç University School of Medicine, Istanbul Turkey
| | - Erdal Binboğa
- Faculty of Medicine, Department of Biophysics, Ege University, Izmir Turkey
| | - Dariusz Młoźniak
- Polish Academy of Sciences, Department of Engineering of Nervous and Muscular System, Nałęcz Institute of Biocybernetics and Biomedical Engineering, Warsaw Poland
| | - Bożenna Kuraszkiewicz
- Polish Academy of Sciences, Department of Engineering of Nervous and Muscular System, Nałęcz Institute of Biocybernetics and Biomedical Engineering, Warsaw Poland
| | - Kemal S Türker
- Laboratory of Neuromuscular Research, Koç University School of Medicine, Istanbul Turkey
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Kudina LP, Andreeva RE. Delayed depolarization and firing behavior of human motoneurons during voluntary muscle contractions. Front Hum Neurosci 2013; 7:793. [PMID: 24302909 PMCID: PMC3831088 DOI: 10.3389/fnhum.2013.00793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 10/30/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lydia P. Kudina
- Department of Bioinformatics, Institute for Information Transmission Problems (Kharkevich Institute), Russian Academy of SciencesMoscow, Russia
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Maathuis EM, Drenthen J, van Doorn PA, Visser GH, Blok JH. Multiplet discharges after electrical stimulation: New evidence for distal excitability changes in motor neuron disease. ACTA ACUST UNITED AC 2012; 13:514-20. [DOI: 10.3109/17482968.2012.669386] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Piotrkiewicz M, Kudina L. Analysis of motoneuron responses to composite synaptic volleys (computer simulation study). Exp Brain Res 2012; 217:209-21. [PMID: 22198533 PMCID: PMC3282905 DOI: 10.1007/s00221-011-2987-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 12/09/2011] [Indexed: 01/07/2023]
Abstract
This paper deals with the analysis of changes in motoneuron (MN) firing evoked by repetitively applied stimuli aimed toward extracting information about the underlying synaptic volleys. Spike trains were obtained from computer simulations based on a threshold-crossing model of tonically firing MN, subjected to stimulation producing postsynaptic potentials (PSPs) of various parameters. These trains were analyzed as experimental results, using the output measures that were previously shown to be most effective for this purpose: peristimulus time histogram, raster plot and peristimulus time intervalgram. The analysis started from the effects of single excitatory and inhibitory PSPs (EPSPs and IPSPs). The conclusions drawn from this analysis allowed the explanation of the results of more complex synaptic volleys, i.e., combinations of EPSPs and IPSPs, and the formulation of directions for decoding the results of human neurophysiological experiments in which the responses of tonically firing MNs to nerve stimulation are analyzed.
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Affiliation(s)
- Maria Piotrkiewicz
- Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland.
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Finsterer J. Perspectives of Kennedy's disease. J Neurol Sci 2010; 298:1-10. [PMID: 20846673 DOI: 10.1016/j.jns.2010.08.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Revised: 08/15/2010] [Accepted: 08/23/2010] [Indexed: 12/17/2022]
Abstract
Kennedy's disease, also known as bulbospinal muscular atrophy (BSMA), is a rare, adult-onset, X-linked, recessive trinucleotide, polyglutamine (poly-G) disorder, caused by expansion of an unstable CAG-tandem-repeat in exon 1 of the androgen-receptor (AR) gene on chromosome Xq11-12. Poly-Q-expanded AR accumulates in nuclei, undergoes fragmentation and initiates degeneration and loss of motor neurons and dorsal root ganglia. Phenotypically, patients present with weakness and wasting of the facial, bulbar and extremity muscles, sensory disturbances, and endocrinological disturbances, such as gynecomastia and reduced fertility. In the limb muscles weakness and wasting may be symmetric or asymmetric, proximal or distal, or may predominate at the lower or upper limb muscles. There may be mild to severe hyper-CK-emia, elevated testosterone or other sexual hormones, abnormal motor and sensory nerve conduction studies, and neuropathic or rarely myopathic alterations on muscle biopsy. BSMA is diagnosed if the number of CAG-repeats exceeds 40. No causal therapy is available but symptomatic therapy may be beneficial for weakness, tremor, endocrinological abnormalities, muscle cramps, respiratory failure, or dysphagia. The course is slowly progressive and the ability to walk lost only late in life. Only few patients require ventilatory support and life expectancy is only slightly compromised.
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Affiliation(s)
- J Finsterer
- Krankenanstalt Rudolfstiftung, Vienna, Austria.
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Repetitive doublet firing of motor units: evidence for plateau potentials in human motoneurones? Exp Brain Res 2010; 204:79-90. [PMID: 20508919 DOI: 10.1007/s00221-010-2298-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 05/07/2010] [Indexed: 12/12/2022]
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Corticomotoneuronal dysfunction: A process specific to amyotrophic lateral sclerosis? Clin Neurophysiol 2009; 120:1881-1882. [DOI: 10.1016/j.clinph.2009.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 08/11/2009] [Accepted: 08/11/2009] [Indexed: 12/13/2022]
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