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Kamei N, Nakamae T, Maruyama T, Nakao K, Farid F, Adachi N. Differentiating Neurodegenerative Disease From Compressive Cervical Myelopathy Using Motor-Evoked Potentials. Spine (Phila Pa 1976) 2024; 49:726-732. [PMID: 37040469 DOI: 10.1097/brs.0000000000004675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/28/2023] [Indexed: 04/13/2023]
Abstract
STUDY DESIGN A retrospective case-control study. OBJECTIVE To differentiate neurodegenerative diseases from compressive cervical myelopathy (CCM) using motor-evoked potentials (MEPs). SUMMARY OF BACKGROUND DATA When considering surgery for CCM, it may be necessary to differentiate the condition from a neurodegenerative disease. MATERIALS AND METHODS A total of 30 healthy volunteers, 52 typical CCM patients with single-level compression of the spinal cord at C4-5 or C5-6, 7 patients with amyotrophic lateral sclerosis (ALS), and 12 patients with demyelinating disease of the central nervous system, including 11 patients with multiple sclerosis and 1 patient with neuromyelitis optica spectrum disorder, formed our study population. MEPs were recorded from the bilateral abductor digiti minimi (ADM) and abductor hallucis (AH) muscles using transcranial magnetic stimulation and electrical stimulation of the ulnar and tibial nerves. Central motor conduction time, peripheral conduction time, amplitude of MEPs, and frequency of F waves were evaluated. Receiver operating characteristic curve analysis was used to determine the cutoff value for distinguishing between CCM and ALS. RESULTS Significant differences were observed in the amplitude of MEPs and frequency of F waves evoked by peripheral nerve stimulation between patients with CCM and ALS. The MEP amplitude of AH was more accurate in differentiating between the two diseases compared with ADM (cutoff value, 11.2 mV, sensitivity, 87.5%; specificity, 85.7%). All 7 patients with ALS showed reduced frequency of F waves from ADM or AH, but none of the healthy volunteers or patients with other diseases demonstrated this finding. Moreover, there were no significant differences between CCM and demyelinating disease of the central nervous system in any of the assessments. CONCLUSION The amplitude of MEPs and frequency of F waves evoked by peripheral nerve stimulation could be helpful in differentiating ALS from CCM.
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Affiliation(s)
- Naosuke Kamei
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshio Nakamae
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshiaki Maruyama
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuto Nakao
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Fadlyansyah Farid
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Orthopedic and Traumatology, Hasanuddin University, Makassar, Indonesia
| | - Nobuo Adachi
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Salzinger A, Ramesh V, Das Sharma S, Chandran S, Thangaraj Selvaraj B. Neuronal Circuit Dysfunction in Amyotrophic Lateral Sclerosis. Cells 2024; 13:792. [PMID: 38786016 PMCID: PMC11120636 DOI: 10.3390/cells13100792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/27/2024] [Accepted: 04/30/2024] [Indexed: 05/25/2024] Open
Abstract
The primary neural circuit affected in Amyotrophic Lateral Sclerosis (ALS) patients is the corticospinal motor circuit, originating in upper motor neurons (UMNs) in the cerebral motor cortex which descend to synapse with the lower motor neurons (LMNs) in the spinal cord to ultimately innervate the skeletal muscle. Perturbation of these neural circuits and consequent loss of both UMNs and LMNs, leading to muscle wastage and impaired movement, is the key pathophysiology observed. Despite decades of research, we are still lacking in ALS disease-modifying treatments. In this review, we document the current research from patient studies, rodent models, and human stem cell models in understanding the mechanisms of corticomotor circuit dysfunction and its implication in ALS. We summarize the current knowledge about cortical UMN dysfunction and degeneration, altered excitability in LMNs, neuromuscular junction degeneration, and the non-cell autonomous role of glial cells in motor circuit dysfunction in relation to ALS. We further highlight the advances in human stem cell technology to model the complex neural circuitry and how these can aid in future studies to better understand the mechanisms of neural circuit dysfunction underpinning ALS.
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Affiliation(s)
- Andrea Salzinger
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK; (A.S.); (V.R.); (S.D.S.); (S.C.)
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Vidya Ramesh
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK; (A.S.); (V.R.); (S.D.S.); (S.C.)
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Shreya Das Sharma
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK; (A.S.); (V.R.); (S.D.S.); (S.C.)
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Siddharthan Chandran
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK; (A.S.); (V.R.); (S.D.S.); (S.C.)
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
- Anne Rowling Regenerative Neurology Clinic (ARRNC), University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Bhuvaneish Thangaraj Selvaraj
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK; (A.S.); (V.R.); (S.D.S.); (S.C.)
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
- Anne Rowling Regenerative Neurology Clinic (ARRNC), University of Edinburgh, Edinburgh EH16 4SB, UK
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Tilsley P, Moutiez A, Brodovitch A, Mendili MME, Testud B, Zaaraoui W, Verschueren A, Attarian S, Guye M, Boucraut J, Grapperon AM, Stellmann JP. Neurofilament Light Chain Levels Interact with Neurodegenerative Patterns and Motor Neuron Dysfunction in Amyotrophic Lateral Sclerosis. AJNR Am J Neuroradiol 2024; 45:494-503. [PMID: 38548305 DOI: 10.3174/ajnr.a8154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/08/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND AND PURPOSE Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease involving rapid motor neuron degeneration leading to brain, primarily precentral, atrophy. Neurofilament light chains are a robust prognostic biomarker highly specific to ALS, yet associations between neurofilament light chains and MR imaging outcomes are not well-understood. We investigated the role of neurofilament light chains as mediators among neuroradiologic assessments, precentral neurodegeneration, and disability in ALS. MATERIALS AND METHODS We retrospectively analyzed a prospective cohort of 29 patients with ALS (mean age, 56 [SD, 12] years; 18 men) and 36 controls (mean age, 49 [SD, 11] years; 18 men). Patients underwent 3T (n = 19) or 7T (n = 10) MR imaging, serum (n = 23) and CSF (n = 15) neurofilament light chains, and clinical (n = 29) and electrophysiologic (n = 27) assessments. The control group had equivalent 3T (n = 25) or 7T (n = 11) MR imaging. Two trained neuroradiologists performed blinded qualitative assessments of MR imaging anomalies (n = 29 patients, n = 36 controls). Associations between precentral cortical thickness and neurofilament light chains and clinical and electrophysiologic data were analyzed. RESULTS We observed extensive cortical thinning in patients compared with controls. MR imaging analyses showed significant associations between precentral cortical thickness and bulbar or arm impairment following distributions corresponding to the motor homunculus. Finally, uncorrected results showed positive interactions among precentral cortical thickness, serum neurofilament light chains, and electrophysiologic outcomes. Qualitative MR imaging anomalies including global atrophy (P = .003) and FLAIR corticospinal tract hypersignal anomalies (P = .033), correlated positively with serum neurofilament light chains. CONCLUSIONS Serum neurofilament light chains may be an important mediator between clinical symptoms and neuronal loss according to cortical thickness. Furthermore, MR imaging anomalies might have underestimated prognostic value because they seem to indicate higher serum neurofilament light chain levels.
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Affiliation(s)
- Penelope Tilsley
- From the Centre de Résonance Magnétique Biologique et Médicale (P.T., M.M.E.M., B.T., W.Z., A.V., M.G., A.-M.G., J.-P.S.), Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
- Assistance Publique-Marseille Hospitals (P.T., M.M.E.M., B.T., W.Z., M.G., J.-P.S.), Hôpital de la Timone, CEMEREM, Marseille, France
| | - Antoine Moutiez
- Department of Neuroradiology (A.M., B.T., J.-P.S.), Assistance Publique-Marseille Hospitals, Hôpital de la Timone, Marseille, France
| | - Alexandre Brodovitch
- Immunology Laboratory (A.B., J.B.), Assistance Publique-Marseille Hospitals, Conception Hospital, Marseille, France
| | - Mohamed Mounir El Mendili
- From the Centre de Résonance Magnétique Biologique et Médicale (P.T., M.M.E.M., B.T., W.Z., A.V., M.G., A.-M.G., J.-P.S.), Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
- Assistance Publique-Marseille Hospitals (P.T., M.M.E.M., B.T., W.Z., M.G., J.-P.S.), Hôpital de la Timone, CEMEREM, Marseille, France
| | - Benoit Testud
- From the Centre de Résonance Magnétique Biologique et Médicale (P.T., M.M.E.M., B.T., W.Z., A.V., M.G., A.-M.G., J.-P.S.), Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
- Assistance Publique-Marseille Hospitals (P.T., M.M.E.M., B.T., W.Z., M.G., J.-P.S.), Hôpital de la Timone, CEMEREM, Marseille, France
- Department of Neuroradiology (A.M., B.T., J.-P.S.), Assistance Publique-Marseille Hospitals, Hôpital de la Timone, Marseille, France
| | - Wafaa Zaaraoui
- From the Centre de Résonance Magnétique Biologique et Médicale (P.T., M.M.E.M., B.T., W.Z., A.V., M.G., A.-M.G., J.-P.S.), Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
- Assistance Publique-Marseille Hospitals (P.T., M.M.E.M., B.T., W.Z., M.G., J.-P.S.), Hôpital de la Timone, CEMEREM, Marseille, France
| | - Annie Verschueren
- From the Centre de Résonance Magnétique Biologique et Médicale (P.T., M.M.E.M., B.T., W.Z., A.V., M.G., A.-M.G., J.-P.S.), Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
- Referral Centre for Neuromuscular Diseases and ALS (A.V., S.A., A.-M.G.), Assistance Publique-Marseille Hospitals, Hôpital de la Timone, Marseille, France
| | - Shahram Attarian
- Referral Centre for Neuromuscular Diseases and ALS (A.V., S.A., A.-M.G.), Assistance Publique-Marseille Hospitals, Hôpital de la Timone, Marseille, France
- Institut National de la Santé et de la Recherche Médicale (S.A.,), Marseille Medical Genetics Center, Aix-Marseille University, Marseille, France
| | - Maxime Guye
- From the Centre de Résonance Magnétique Biologique et Médicale (P.T., M.M.E.M., B.T., W.Z., A.V., M.G., A.-M.G., J.-P.S.), Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
- Assistance Publique-Marseille Hospitals (P.T., M.M.E.M., B.T., W.Z., M.G., J.-P.S.), Hôpital de la Timone, CEMEREM, Marseille, France
| | - José Boucraut
- Immunology Laboratory (A.B., J.B.), Assistance Publique-Marseille Hospitals, Conception Hospital, Marseille, France
- Institut National de la Santé et de la Recherche Médicale (J.B.) Institut de Neurosciences des Systèmes Aix-Marseille University, Marseille, France
| | - Aude-Marie Grapperon
- From the Centre de Résonance Magnétique Biologique et Médicale (P.T., M.M.E.M., B.T., W.Z., A.V., M.G., A.-M.G., J.-P.S.), Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
| | - Jan-Patrick Stellmann
- From the Centre de Résonance Magnétique Biologique et Médicale (P.T., M.M.E.M., B.T., W.Z., A.V., M.G., A.-M.G., J.-P.S.), Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
- Assistance Publique-Marseille Hospitals (P.T., M.M.E.M., B.T., W.Z., M.G., J.-P.S.), Hôpital de la Timone, CEMEREM, Marseille, France
- Department of Neuroradiology (A.M., B.T., J.-P.S.), Assistance Publique-Marseille Hospitals, Hôpital de la Timone, Marseille, France
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de Carvalho M, Swash M. Diagnosis and differential diagnosis of MND/ALS: IFCN handbook chapter. Clin Neurophysiol Pract 2023; 9:27-38. [PMID: 38249779 PMCID: PMC10796809 DOI: 10.1016/j.cnp.2023.12.003] [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: 08/23/2023] [Revised: 11/01/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024] Open
Abstract
•Accurate and rapid diagnosis of amyotrophic lateral sclerosis (ALS) is important to prevent erroneous interventions. •The recent Gold Coast criteria are easily applicable and have high sensitivity and specificity. •Future developments will help to distinguish ALS as a specific clinical-pathologic entity. Accurate and rapid diagnosis of amyotrophic lateral sclerosis (ALS) is essential in order to provide accurate information for patient and family, to avoid time-consuming investigations and to permit an appropriate management plan. ALS is variable regarding presentation, disease progression, genetic profile and patient reaction to the diagnosis. It is obviously important to exclude treatable conditions but, in most patients, for experienced neurologists the diagnosis is clear-cut, depending on the presence of progressive upper and lower motor neuron signs. Patients with signs of restricted lower motor neuron (LMN) or upper motor neuron (UMN) dysfunction may present diagnostic difficulty, but electromyography (EMG) is often a determinant diagnostic test since it may exclude other disorders. Transcranial magnetic stimulation may aid detection of UMN dysfunction, and brain and spinal cord MRI, ultrasound and blood neurofilament measurements, have begun to have clinical impact, although none are themselves diagnostic tests. Several sets of diagnostic criteria have been proposed in the past; all rely on clinical LMN and UMN signs in different anatomic territories, EMG changes, exclusion of other disorders, and disease progression, in particular evidence of spreading to other anatomic territories. Fasciculations are a characteristic clinical feature and increased importance is now attached to fasciculation potentials detected by EMG, when associated with classical signs of denervation and reinnervation. The Gold Coast diagnostic criteria rely on the presence of UMN and LMN signs in one (or more) anatomic territory, or LMN signs in two (or more) anatomic territories, recognizing the fundamental clinical requirements of disease progression and exclusion of other diseases. Recent studies confirm a high sensitivity without loss of specificity using these Gold Coast criteria. In considering the diagnosis of ALS a critical question for future understanding is whether ALS should be considered a syndrome or a specific clinico-pathologic entity; this can only be addressed in the light of more complete knowledge.
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Affiliation(s)
- Mamede de Carvalho
- Faculdade de Medicina- Instituto de Medicina Molecular, Centro de Estudos Egas Moniz, Universidade de Lisboa, Lisbon, Portugal
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa-Norte, Lisbon, Portugal
| | - Michael Swash
- Faculdade de Medicina- Instituto de Medicina Molecular, Centro de Estudos Egas Moniz, Universidade de Lisboa, Lisbon, Portugal
- Departments of Neurology and Neurosciences, Barts and the London School of Medicine, Queen Mary University of London and Royal London Hospital, UK
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5
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Pavey N, Hannaford A, Higashihara M, van den Bos M, Kiernan MC, Menon P, Vucic S. Utility of split hand index with different motor unit number estimation techniques in ALS. Clin Neurophysiol 2023; 156:175-182. [PMID: 37967511 DOI: 10.1016/j.clinph.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/04/2023] [Accepted: 09/27/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE Utility of the split hand index (SI) in amyotrophic lateral sclerosis (ALS) has been reported when using the compound muscle action potential (CMAP) amplitude method (SICMAP amp). A motor unit number index (MUNIX) based SI method (SIMUNIX) was purported to exhibit higher sensitivity. The present study assessed the clinical utility of SI, derived by CMAP amplitude, MUNIX and MScan-MUNE (SIMScanFit-MUNE) methods, in ALS. METHODS Sixty-two consecutive patients with neuromuscular symptoms (36 ALS and 26 ALS-mimics) were prospectively recruited. The SI was derived by dividing the product of the CMAP amplitude, MUNIX and MScan-MUNE values recorded over first dorsal interosseous and abductor pollicis brevis by values recorded over abductor digit minimi. RESULTS SICMAP amp, SIMUNIX and SIMScanFit-MUNE were significantly reduced in ALS, with SICMAP amp (area under curve (AUC) = 0.801) and SIMScanFit-MUNE (AUC = 0.805) exhibiting greater diagnostic utility than SIMUNIX (AUC = 0.713). SICMAP amp and SIMScanFit-MUNE exhibited significant correlations with clinical measures of functional disability and weakness of intrinsic hand muscles. CONCLUSIONS SI differentiated ALS from mimic disorders, with SICMAP amp and SIMScanFit-MUNE exhibiting greater utility. SIGNIFICANCE The split hand index represents could serve as a potential diagnostic biomarker in ALS.
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Affiliation(s)
- Nathan Pavey
- Brain and Nerve Research Centre, Concord Clinical School, The University of Sydney, Concord Hospital, Sydney, NSW Australia
| | - Andrew Hannaford
- Brain and Nerve Research Centre, Concord Clinical School, The University of Sydney, Concord Hospital, Sydney, NSW Australia
| | - Mana Higashihara
- Department of Neurology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Mehdi van den Bos
- Brain and Nerve Research Centre, Concord Clinical School, The University of Sydney, Concord Hospital, Sydney, NSW Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, The University of Sydney; and Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Parvathi Menon
- Brain and Nerve Research Centre, Concord Clinical School, The University of Sydney, Concord Hospital, Sydney, NSW Australia
| | - Steve Vucic
- Brain and Nerve Research Centre, Concord Clinical School, The University of Sydney, Concord Hospital, Sydney, NSW Australia.
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Qin J, Cheng Q, Cai Z, Zhang L, Xing T, Xu X, Gao F. Gas chromatography-mass spectrometry-based untargeted metabolomics analysis reveals circulating biomarkers related to wooden breast myopathy in broilers: a preliminary study. Poult Sci 2023; 102:102718. [PMID: 37141813 DOI: 10.1016/j.psj.2023.102718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/06/2023] [Accepted: 04/09/2023] [Indexed: 05/06/2023] Open
Abstract
Approaches for the diagnosis of wooden breast (WB) myopathy in live birds are urgently required before applying intervention strategies to reduce occurrence and severity for the poultry industry. The objective of this study was to characterize the serum metabolic profiles in male broilers affected by WB and to identify biomarkers related to this myopathy. Broilers were categorized into normal (CON) and WB groups based on gross scoring and histological evaluation. Gas chromatography-mass spectrometry-based metabolomics, multivariate analysis, and orthogonal partial least squares discriminant analysis revealed a clear separation between CON and WB. A total of 73 significantly different (P < 0.05) metabolites with 17 upregulated and 56 downregulated were identified, which were mainly involved in pathways of alanine, aspartate, and glutamate metabolism, carbohydrate metabolism, and taurine and hypotaurine metabolism. By using the nested cross-validation function of random forest analysis, 9 significantly altered (P < 0.05) metabolites (cerotinic acid, arabitol, phosphoenolpyruvate, terephthalic acid, cis-gondoic acid, N-acetyl-d-glucosamine, 4-hydroxymandelic acid, caffeine, and xanthurenic acid) were identified as biomarkers with an excellent discriminant performance for WB myopathy. Collectively, this study provides new insights for a deeper understanding of the pathogenesis and provides metabolites as biomarkers for diagnostic utilization of WB myopathy.
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Affiliation(s)
- Jieyi Qin
- Key Laboratory of Animal Origin Food Production and Safety Guarantee of Jiangsu Province, Joint International Research Laboratory of Animal Health and Food Safety, Jiangsu Collaborative Innovation Center of Meat Production and Processing, Quality and Safety Control, National Experimental Teaching Demonstration Center of Animal Science, College of Animal Science and Technology, Nanjing Agricultural University, Nanjing 210095, China
| | - Qingqing Cheng
- Key Laboratory of Animal Origin Food Production and Safety Guarantee of Jiangsu Province, Joint International Research Laboratory of Animal Health and Food Safety, Jiangsu Collaborative Innovation Center of Meat Production and Processing, Quality and Safety Control, National Experimental Teaching Demonstration Center of Animal Science, College of Animal Science and Technology, Nanjing Agricultural University, Nanjing 210095, China
| | - Ziyu Cai
- Key Laboratory of Animal Origin Food Production and Safety Guarantee of Jiangsu Province, Joint International Research Laboratory of Animal Health and Food Safety, Jiangsu Collaborative Innovation Center of Meat Production and Processing, Quality and Safety Control, National Experimental Teaching Demonstration Center of Animal Science, College of Animal Science and Technology, Nanjing Agricultural University, Nanjing 210095, China
| | - Lin Zhang
- Key Laboratory of Animal Origin Food Production and Safety Guarantee of Jiangsu Province, Joint International Research Laboratory of Animal Health and Food Safety, Jiangsu Collaborative Innovation Center of Meat Production and Processing, Quality and Safety Control, National Experimental Teaching Demonstration Center of Animal Science, College of Animal Science and Technology, Nanjing Agricultural University, Nanjing 210095, China
| | - Tong Xing
- Key Laboratory of Animal Origin Food Production and Safety Guarantee of Jiangsu Province, Joint International Research Laboratory of Animal Health and Food Safety, Jiangsu Collaborative Innovation Center of Meat Production and Processing, Quality and Safety Control, National Experimental Teaching Demonstration Center of Animal Science, College of Animal Science and Technology, Nanjing Agricultural University, Nanjing 210095, China.
| | - Xinglian Xu
- Key Laboratory of Animal Origin Food Production and Safety Guarantee of Jiangsu Province, Joint International Research Laboratory of Animal Health and Food Safety, Jiangsu Collaborative Innovation Center of Meat Production and Processing, Quality and Safety Control, National Experimental Teaching Demonstration Center of Animal Science, College of Animal Science and Technology, Nanjing Agricultural University, Nanjing 210095, China
| | - Feng Gao
- Key Laboratory of Animal Origin Food Production and Safety Guarantee of Jiangsu Province, Joint International Research Laboratory of Animal Health and Food Safety, Jiangsu Collaborative Innovation Center of Meat Production and Processing, Quality and Safety Control, National Experimental Teaching Demonstration Center of Animal Science, College of Animal Science and Technology, Nanjing Agricultural University, Nanjing 210095, China
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Reale LA, Dyer MS, Perry SE, Young KM, Dickson TC, Woodhouse A, Blizzard CA. Pathologically mislocalised TDP-43 in upper motor neurons causes a die-forward spread of ALS-like pathogenic changes throughout the mouse corticomotor system. Prog Neurobiol 2023; 226:102449. [PMID: 37011806 DOI: 10.1016/j.pneurobio.2023.102449] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 02/02/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023]
Abstract
Alterations in upper motor neuron excitability are one of the earliest phenomena clinically detected in ALS, and in 97% of cases, the RNA/DNA binding protein, TDP-43, is mislocalised in upper and lower motor neurons. While these are two major pathological hallmarks in disease, our understanding of where disease pathology begins, and how it spreads through the corticomotor system, is incomplete. This project used a model where mislocalised TDP-43 was expressed in the motor cortex, to determine if localised cortical pathology could result in widespread corticomotor system degeneration. Mislocalised TDP-43 caused layer V excitatory neurons in the motor cortex to become hyperexcitable after 20 days of expression. Following cortical hyperexcitability, a spread of pathogenic changes through the corticomotor system was observed. By 30 days expression, there was a significant decrease in lower motor neuron number in the lumbar spinal cord. However, cell loss occurred selectively, with a significant loss in lumbar regions 1-3, and not lumbar regions 4-6. This regional vulnerability was associated with alterations in pre-synaptic excitatory and inhibitory proteins. Excitatory inputs (VGluT2) were increased in all lumbar regions, while inhibitory inputs (GAD65/67) were increased in lumbar regions 4-6 only. This data indicates that mislocalised TDP-43 in upper motor neurons can cause lower motor neuron degeneration. Furthermore, cortical pathology increased excitatory inputs to the spinal cord, to which local circuitry compensated with an upregulation of inhibition. These findings reveal how TDP-43 mediated pathology may spread through corticofugal tracts in ALS and identify a potential pathway for therapeutic intervention.
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8
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Gong Z, Lo WLA, Wang R, Li L. Electrical impedance myography combined with quantitative assessment techniques in paretic muscle of stroke survivors: Insights and challenges. Front Aging Neurosci 2023; 15:1130230. [PMID: 37020859 PMCID: PMC10069712 DOI: 10.3389/fnagi.2023.1130230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
Aging is a non-modifiable risk factor for stroke and the global burden of stroke is continuing to increase due to the aging society. Muscle dysfunction, common sequela of stroke, has long been of research interests. Therefore, how to accurately assess muscle function is particularly important. Electrical impedance myography (EIM) has proven to be feasible to assess muscle impairment in patients with stroke in terms of micro structures, such as muscle membrane integrity, extracellular and intracellular fluids. However, EIM alone is not sufficient to assess muscle function comprehensively given the complex contributors to paretic muscle after an insult. This article discusses the potential to combine EIM and other common quantitative methods as ways to improve the assessment of muscle function in stroke survivors. Clinically, these combined assessments provide not only a distinct advantage for greater accuracy of muscle assessment through cross-validation, but also the physiological explanation on muscle dysfunction at the micro level. Different combinations of assessments are discussed with insights for different purposes. The assessments of morphological, mechanical and contractile properties combined with EIM are focused since changes in muscle structures, tone and strength directly reflect the muscle function of stroke survivors. With advances in computational technology, finite element model and machine learning model that incorporate multi-modal evaluation parameters to enable the establishment of predictive or diagnostic model will be the next step forward to assess muscle function for individual with stroke.
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Affiliation(s)
- Ze Gong
- Research & Development Institute of Northwestern Polytechnical University in Shenzhen, Shenzhen, China
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
| | - Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ruoli Wang
- KTH MoveAbility Lab, Department of Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Le Li
- Research & Development Institute of Northwestern Polytechnical University in Shenzhen, Shenzhen, China
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
- *Correspondence: Le Li,
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Planinc D, Muhamood N, Cabassi C, Iniesta R, Shaw CE, Hodson-Tole E, Bashford J. Fasciculation electromechanical latency is prolonged in amyotrophic lateral sclerosis. Clin Neurophysiol 2023; 145:71-80. [PMID: 36442378 DOI: 10.1016/j.clinph.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In amyotrophic lateral sclerosis (ALS), motor neurons become hyperexcitable and spontaneously discharge electrical impulses causing fasciculations. These can be detected by two noninvasive methods: high-density surface electromyography (HDSEMG) and muscle ultrasonography (MUS). We combined these methods simultaneously to explore the electromechanical properties of fasciculations, seeking a novel biomarker of disease. METHODS Twelve ALS patients and thirteen healthy participants each provided up to 24 minutes of recordings from the right biceps brachii (BB) and gastrocnemius medialis (GM). Two automated algorithms (Surface Potential Quantification Engine and a Gaussian mixture model) were applied to HDSEMG and MUS data to identify correlated electromechanical fasciculation events. RESULTS We identified 4,197 correlated electromechanical fasciculation events. HDSEMG reliably detected electromechanical events up to 30 mm below the skin surface with an inverse correlation between amplitude and depth in ALS muscles. Compared to Healthy-GM muscles (mean = 79.8 ms), electromechanical latency was prolonged in ALS-GM (mean = 108.8 ms; p = 0.0458) and ALS-BB (mean = 112.0 ms; p = 0.0128) muscles. Electromechanical latency did not correlate with disease duration, symptom burden, sum muscle power score or fasciculation frequency. CONCLUSIONS Prolonged fasciculation electromechanical latency indicates impairment of the excitation-contraction coupling mechanism, warranting further exploration as a potential novel biomarker of disease in ALS. SIGNIFICANCE This study points to an electromechanical defect within the muscles of ALS patients.
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Affiliation(s)
- D Planinc
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - N Muhamood
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - C Cabassi
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - R Iniesta
- Department of Biostatistics and Health Informatics, King's College London, United Kingdom
| | - C E Shaw
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - E Hodson-Tole
- Musculoskeletal Sciences and Sports Medicine Research Centre, Manchester Institute of Sport, Department of Life Sciences, Manchester Metropolitan University, United Kingdom
| | - J Bashford
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom. https://twitter.com/@SPiQEneurology
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10
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de Carvalho M, Swash M. Upper and lower motor neuron neurophysiology and motor control. HANDBOOK OF CLINICAL NEUROLOGY 2023; 195:17-29. [PMID: 37562869 DOI: 10.1016/b978-0-323-98818-6.00018-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
This chapter considers the principles that underlie neurophysiological studies of upper motor neuron or lower motor neuron lesions, based on an understanding of the normal structure and function of the motor system. Human motor neurophysiology consists of an evaluation of the active components of the motor system that are relevant to volitional movements. Relatively primitive motor skills include locomotion, much dependent on the spinal cord central pattern generator, reaching, involving proximal and distal muscles activation, and grasping. Humans are well prepared to perform complex movements like writing. The role of motor cortex is critical for the motor activity, very dependent on the continuous sensory feedback, and this is essential for adapting the force and speed control, which contributes to motor learning. Most corticospinal neurons in the brain project to brainstem and spinal cord, many with polysynaptic inhibitory rather than excitatory connections. The monosynaptic connections observed in humans and primates constitute a specialized pathway implicated in fractional finger movements. Spinal cord has a complex physiology, and local reflexes and sensory feedback are essential to control adapted muscular contraction during movement. The cerebellum has a major role in motor coordination, but also consistent roles in sensory activities, speech, and language, in motor and spatial memory, and in psychological activity. The motor unit is the final effector of the motor drive. The complex interplay between the lower motor neuron, its axon, motor end-plates, and muscle fibers allows a relevant plasticity in the movement output.
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Affiliation(s)
- Mamede de Carvalho
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa-Norte, Lisbon, Portugal; Faculdade de Medicina-Instituto de Medicina Molecular-Centro de Estudos Egas Moniz, Universidade de Lisboa, Lisbon, Portugal.
| | - Michael Swash
- Faculdade de Medicina-Instituto de Medicina Molecular-Centro de Estudos Egas Moniz, Universidade de Lisboa, Lisbon, Portugal; Department of Neurology, Barts and London School of Medicine, Queen Mary University of London and Royal London Hospital, London, United Kingdom
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11
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Meo G, Ferraro PM, Cillerai M, Gemelli C, Cabona C, Zaottini F, Roccatagliata L, Villani F, Schenone A, Caponnetto C. MND Phenotypes Differentiation: The Role of Multimodal Characterization at the Time of Diagnosis. Life (Basel) 2022; 12:life12101506. [PMID: 36294940 PMCID: PMC9604895 DOI: 10.3390/life12101506] [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: 08/20/2022] [Revised: 09/13/2022] [Accepted: 09/21/2022] [Indexed: 11/25/2022] Open
Abstract
Pure/predominant upper motor neuron (pUMN) and lower motor neuron (pLMN) diseases have significantly better prognosis compared to amyotrophic lateral sclerosis (ALS), but their early differentiation is often challenging. We therefore tested whether a multimodal characterization approach embedding clinical, cognitive/behavioral, genetic, and neurophysiological data may improve the differentiation of pUMN and pLMN from ALS already by the time of diagnosis. Dunn’s and chi-squared tests were used to compare data from 41 ALS, 34 pLMN, and 19 pUMN cases with diagnoses confirmed throughout a 2-year observation period. Area under the curve (AUC) analyses were implemented to identify the finest tools for phenotypes discrimination. Relative to ALS, pLMN showed greater lower limbs weakness, lower UMN burden, and progression rate (p < 0.001−0.04). PUMN showed a greater frequency of lower limbs onset, higher UMN burden, lower ALSFRS-r and MRC progression rates (p < 0.001−0.03), and greater ulnar compound muscle action potential (CMAP) amplitude and tibial central motor conduction time (CMCT) (p = 0.05−0.03). The UMN progression rate was the finest measure to identify pLMN cases (AUC = 90%), while the MRC progression rate was the finest tool to identify pUMN (AUC = 82%). Detailed clinical and neurophysiological examinations may significantly improve MNDs differentiation, facilitating prognosis estimation and ameliorating stratification strategies for clinical trials enrollment.
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Affiliation(s)
- Giuseppe Meo
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16126 Genoa, Italy
| | - Pilar M. Ferraro
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Correspondence: ; Tel.: +39-01-0353-7040
| | - Marta Cillerai
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16126 Genoa, Italy
| | - Chiara Gemelli
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Corrado Cabona
- Division of Clinical Neurophysiology and Epilepsy Center, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Federico Zaottini
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Luca Roccatagliata
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, 16126 Genoa, Italy
| | - Flavio Villani
- Division of Clinical Neurophysiology and Epilepsy Center, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Angelo Schenone
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16126 Genoa, Italy
| | - Claudia Caponnetto
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
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12
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Iqbal S, Bashford J. A lesson in axonal recovery. Clin Neurophysiol 2022; 143:95-96. [DOI: 10.1016/j.clinph.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 11/25/2022]
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13
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Malanda A, Stashuk DW, Navallas J, Rodríguez-Falces J, Rodríguez-Carreño I, Valle C, Garnés-Camarena O. Automatic jitter measurement in needle-detected motor unit potential trains. Comput Biol Med 2022; 149:105973. [DOI: 10.1016/j.compbiomed.2022.105973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 07/28/2022] [Accepted: 08/13/2022] [Indexed: 11/03/2022]
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14
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Detecting motor unit abnormalities in amyotrophic lateral sclerosis using high-density surface EMG. Clin Neurophysiol 2022; 142:262-272. [PMID: 35902304 DOI: 10.1016/j.clinph.2022.06.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this study was to detect specific motor unit (MU) abnormalities in people with amyotrophic lateral sclerosis (ALS) compared to controls using high-density surface electromyography (HD-SEMG). METHODS Sixteen people with ALS and 16 control subjects. The participants performed ramp up and sustained contractions at 30% of their maximal voluntary contraction. HD-SEMG signals were recorded in the vastus lateralis muscle and decomposed into individual MU firing behavior using a convolution blind source separation method. RESULTS In total, 339 MUs were detected (people with ALS; n = 93, control subjects; n = 246). People with ALS showed significantly higher mean firing rate, recruitment threshold, coefficient of variation of the MU firing rate, MU firing rate at recruitment, and motoneurons excitability than those of control subjects (p < 0.001). The number of MU, MU firing rate, recruitment threshold, and MU firing rate at recruitment were significantly correlated with disease severity (p < 0.001). Multivariable analysis revealed that an increased MU firing rate at recruitment was independently associated with ALS. CONCLUSIONS These results suggest increased excitability at recruitment, which is consistent with neurodegeneration results in a compensatory increase in MU activity. SIGNIFICANCE Abnormal MU firing behavior provides an important physiological index for understanding the pathophysiology of ALS.
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15
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de Carvalho M, Swash M. Imaging motor unit territory. Clin Neurophysiol 2022; 141:88-89. [DOI: 10.1016/j.clinph.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022]
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16
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Martínez-Payá J, Ríos-Díaz J, del Baño-Aledo M, Hervás D, Tembl-Ferrairó J, Sevilla-Mantecón T, Vázquez-Costa J. The cross-sectional area of the median nerve: An independent prognostic biomarker in amyotrophic lateral sclerosis. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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17
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Lee SH, Hwang YS, Jo S, Chung SJ. Pseudodystonia and Neuropathic Tremor in a Patient With Monomelic Amyotrophy. J Mov Disord 2022; 15:181-183. [PMID: 35306790 PMCID: PMC9171307 DOI: 10.14802/jmd.21138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/06/2021] [Accepted: 10/24/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Seung Hyun Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yun Su Hwang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungyang Jo
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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18
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Ahmed N, Baker MR, Bashford J. The landscape of neurophysiological outcome measures in ALS interventional trials: A systematic review. Clin Neurophysiol 2022; 137:132-141. [PMID: 35313253 PMCID: PMC10166714 DOI: 10.1016/j.clinph.2022.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We collated all interventional clinical trials in amyotrophic lateral sclerosis (ALS), which utilised at least one neurophysiological technique as a primary or secondary outcome measure. By identifying the strengths and limitations of these studies, we aim to guide study design in future trials. METHODS We conducted and reported this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight databases were searched from inception. In total, 703 studies were retrieved for screening and eligibility assessment. RESULTS Dating back to 1986, 32 eligible interventional clinical trials were identified, recruiting a median of 30 patients per completed trial. The most widely employed neurophysiological techniques were electromyography, motor unit number estimation (including motor unit number index), neurophysiological index and transcranial magnetic stimulation (including resting motor threshold and short-interval intracortical inhibition). Almost 40% of trials reported a positive outcome with respect to at least one neurophysiological measure. The interventions targeted either ion channels, immune mechanisms or neuronal metabolic pathways. CONCLUSIONS Neurophysiology offers many promising biomarkers that can be utilised as outcome measures in interventional clinical trials in ALS. When selecting the most appropriate technique, key considerations include methodological standardisation, target engagement and logistical burden. SIGNIFICANCE Future trial design in ALS would benefit from a standardised, updated and easily accessible repository of neurophysiological outcome measures.
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Affiliation(s)
- N Ahmed
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London, UK
| | - M R Baker
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - J Bashford
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
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19
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Verdone BM, Cicardi ME, Wen X, Sriramoji S, Russell K, Markandaiah SS, Jensen BK, Krishnamurthy K, Haeusler AR, Pasinelli P, Trotti D. A mouse model with widespread expression of the C9orf72-linked glycine-arginine dipeptide displays non-lethal ALS/FTD-like phenotypes. Sci Rep 2022; 12:5644. [PMID: 35379876 PMCID: PMC8979946 DOI: 10.1038/s41598-022-09593-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/25/2022] [Indexed: 12/14/2022] Open
Abstract
Translation of the hexanucleotide G4C2 expansion associated with C9orf72 amyotrophic lateral sclerosis and frontotemporal dementia (ALS/FTD) produces five different dipeptide repeat protein (DPR) species that can confer toxicity. There is yet much to learn about the contribution of a single DPR to disease pathogenesis. We show here that a short repeat length is sufficient for the DPR poly-GR to confer neurotoxicity in vitro, a phenomenon previously unobserved. This toxicity is also reported in vivo in our novel knock-in mouse model characterized by widespread central nervous system (CNS) expression of the short-length poly-GR. We observe sex-specific chronic ALS/FTD-like phenotypes in these mice, including mild motor neuron loss, but no TDP-43 mis-localization, as well as motor and cognitive impairments. We suggest that this model can serve as the foundation for phenotypic exacerbation through second-hit forms of stress.
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Affiliation(s)
- Brandie Morris Verdone
- Jefferson Weinberg ALS Center, Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA
| | - Maria Elena Cicardi
- Jefferson Weinberg ALS Center, Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA
| | - Xinmei Wen
- Jefferson Weinberg ALS Center, Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sindhu Sriramoji
- Jefferson Weinberg ALS Center, Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA
| | - Katelyn Russell
- Jefferson Weinberg ALS Center, Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA
| | - Shashirekha S Markandaiah
- Jefferson Weinberg ALS Center, Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brigid K Jensen
- Jefferson Weinberg ALS Center, Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA
| | - Karthik Krishnamurthy
- Jefferson Weinberg ALS Center, Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA
| | - Aaron R Haeusler
- Jefferson Weinberg ALS Center, Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA
| | - Piera Pasinelli
- Jefferson Weinberg ALS Center, Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Davide Trotti
- Jefferson Weinberg ALS Center, Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA.
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20
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Zhang S, Yang X, Xu Y, Luo Y, Fan D, Liu X. Application Value of the Motor Unit Number Index in Patients With Kennedy Disease. Front Neurol 2022; 12:705816. [PMID: 34992574 PMCID: PMC8724309 DOI: 10.3389/fneur.2021.705816] [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: 05/06/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to evaluate the usefulness of the motor unit number index (MUNIX) technique in Kennedy disease (KD) and test the correlation between the MUNIX and other clinical parameters. The MUNIX values of the bilateral deltoid, abductor digiti minimi (ADM), quadriceps femoris (QF), and tibialis anterior (TA) were determined and compared with the course of the disease. The MUNIX sum score was calculated by adding the MUNIX values of these 8 muscles. Disability was evaluated using the spinal and bulbar muscular atrophy functional rating scale (SBMAFRS). The MUNIX scores of patients with KD were negatively correlated with the course of the disease (p < 0.05), whereas their motor unit size index (MUSIX) scores were positively correlated with the course the of disease (p < 0.05). MUNIX sum scores were correlated with SBMAFRS scores (r = 0.714, p < 0.05). MUNIX was more sensitive than compound muscle action potentials or muscle strength as an indicator of neuron loss and axonal collateral reinnervation. The MUNIX sum score is an objective and a reliable indicator of disease progression, and it is a potential choice for therapeutic clinical trials. The MUNIX can assess the functional loss of motor axons and is correlated with disability. The MUNIX sum score may be especially suitable as an objective parameter.
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Affiliation(s)
- Shuo Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Xin Yang
- Department of Neurology, Changchun Central Hospital, Changchun, China
| | - Yingsheng Xu
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Yongmei Luo
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China.,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xiaoxuan Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
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21
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Pechirra G, Swash M, de Carvalho M. The senile hand: age effects on intrinsic hand muscle CMAP amplitudes influence split-hand index calculations. Muscle Nerve 2022; 65:463-467. [PMID: 34993957 DOI: 10.1002/mus.27489] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/26/2021] [Accepted: 12/31/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION/AIMS Age can affect hand muscles non-uniformly. We investigated the influence of age on the compound muscle action potential (CMAP) amplitude of the hand muscles and the derived split-hand index (SHI). METHODS We studied 244 subjects investigated for myasthenia gravis but without neuromuscular disorders. Abductor pollicis brevis (APB), first dorsal interosseous (FDI), and abductor digiti minimi (ADM) CMAPs were obtained by supramaximal stimulation at the wrist, recording with surface electrodes while checking the best recording site. We applied Tukey's HSD and Kruskal-Wallis one-way analysis of variance for comparing age groups defined by median and inter-quantile ranges (IQR). Spearman's rank correlation coefficient and linear regression were used for testing age-dependence of measurements. RESULTS Median age was 61.5 years (1st IQR 44.5, 3rd IQR 72.0, range 18-89). Age and neurophysiological measurements were similar between genders. APBCMAP , FDICMAP , ADMCMAP and SHI were correlated with age (p < 0.001). Median and cut-off values were significantly different between age groups. APBCMAP , FDICMAP and ADMCMAP decreased by 0.8/0.7/0.3 mV/year, respectively, and SHI decreased 0.15/year. DISCUSSION The CMAP amplitudes of hand muscles and derived SHI were strongly age-dependent, although this effect was less in ADM. This represents a physiological phenomenon. Future studies using the SHI should consider age effects. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Gonçalo Pechirra
- Faculdade de Medicina-Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - Michael Swash
- Departments of Neurology and Neuroscience, Queen Mary University of London, UK.,Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa-Norte, Lisbon, Portugal
| | - Mamede de Carvalho
- Faculdade de Medicina-Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal.,Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa-Norte, Lisbon, Portugal
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22
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Pasniceanu IS, Atwal MS, Souza CDS, Ferraiuolo L, Livesey MR. Emerging Mechanisms Underpinning Neurophysiological Impairments in C9ORF72 Repeat Expansion-Mediated Amyotrophic Lateral Sclerosis/Frontotemporal Dementia. Front Cell Neurosci 2022; 15:784833. [PMID: 34975412 PMCID: PMC8715728 DOI: 10.3389/fncel.2021.784833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/10/2021] [Indexed: 12/15/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) are characterized by degeneration of upper and lower motor neurons and neurons of the prefrontal cortex. The emergence of the C9ORF72 hexanucleotide repeat expansion mutation as the leading genetic cause of ALS and FTD has led to a progressive understanding of the multiple cellular pathways leading to neuronal degeneration. Disturbances in neuronal function represent a major subset of these mechanisms and because such functional perturbations precede degeneration, it is likely that impaired neuronal function in ALS/FTD plays an active role in pathogenesis. This is supported by the fact that ALS/FTD patients consistently present with neurophysiological impairments prior to any apparent degeneration. In this review we summarize how the discovery of the C9ORF72 repeat expansion mutation has contributed to the current understanding of neuronal dysfunction in ALS/FTD. Here, we discuss the impact of the repeat expansion on neuronal function in relation to intrinsic excitability, synaptic, network and ion channel properties, highlighting evidence of conserved and divergent pathophysiological impacts between cortical and motor neurons and the influence of non-neuronal cells. We further highlight the emerging association between these dysfunctional properties with molecular mechanisms of the C9ORF72 mutation that appear to include roles for both, haploinsufficiency of the C9ORF72 protein and aberrantly generated dipeptide repeat protein species. Finally, we suggest that relating key pathological observations in C9ORF72 repeat expansion ALS/FTD patients to the mechanistic impact of the C9ORF72 repeat expansion on neuronal function will lead to an improved understanding of how neurophysiological dysfunction impacts upon pathogenesis.
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Affiliation(s)
- Iris-Stefania Pasniceanu
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Manpreet Singh Atwal
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Cleide Dos Santos Souza
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Laura Ferraiuolo
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Matthew R Livesey
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
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23
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Lichtenstein T, Sprenger A, Weiss K, Große Hokamp N, Maintz D, Schlamann M, Fink GR, Lehmann HC, Henning TD. MRI DTI and PDFF as Biomarkers for Lower Motor Neuron Degeneration in ALS. Front Neurosci 2021; 15:682126. [PMID: 34512239 PMCID: PMC8428530 DOI: 10.3389/fnins.2021.682126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the utility of nerve magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), and muscle MRI multi-echo Dixon for assessing lower motor neuron (LMN) degeneration in amyotrophic lateral sclerosis (ALS). Methods In this prospective observational cohort study, 14 patients with ALS and 13 healthy controls underwent a multiparametric MRI protocol, including DTI of the sciatic nerve and assessment of muscle proton density fat fraction of the biceps femoris and the quadriceps femoris muscles by a multi-echo Dixon sequence. Results In ALS patients, mean fractional anisotropy values of the sciatic nerve were significantly lower than those of healthy controls. The quadriceps femoris, but not the biceps femoris muscle, showed significantly higher intramuscular fat fractions in ALS. Interpretation Our study provides evidence that multiparametric MRI protocols might help estimate structural nerve damage and neurogenic muscle changes in ALS.
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Affiliation(s)
- Thorsten Lichtenstein
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Alina Sprenger
- Department of Neurology, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Kilian Weiss
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Philips Healthcare, Hamburg, Germany
| | - Nils Große Hokamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marc Schlamann
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital of Cologne, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Helmar C Lehmann
- Department of Neurology, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Tobias D Henning
- Department of Neuroradiology, Center Hospital Luxembourg, Luxembourg City, Luxembourg
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24
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Zhou X, Wang Z, Lin Z, Zhu Y, Zhu D, Xie C, Calcutt NA, Guan Y. Rate-dependent depression is impaired in amyotrophic lateral sclerosis. Neurol Sci 2021; 43:1831-1838. [PMID: 34518934 DOI: 10.1007/s10072-021-05596-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/06/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We investigated rate-dependent depression (RDD) of the Hoffman reflex (H-reflex) in patients with amyotrophic lateral sclerosis (ALS), a degenerative disease with ventral horn involvement. PATIENTS AND METHODS In this case-control study, we enrolled 27 patients with ALS and 30 matched healthy control subjects. Clinical and electrophysiological assessments, as well as RDD in response to various stimulation frequencies (0.5 Hz, 1 Hz, 3 Hz and 5 Hz), were compared between groups. Multiple clinical and electrophysiological factors were also explored to determine any underlying associations with RDD. RESULTS The ALS group showed a significant loss of RDD across all frequencies compared to the control group, most notably following 1 Hz stimulation (19.1 ± 20.3 vs. 34.0 ± 13.7%, p = 0.003). Among factors that might influence RDD, the enlargement of the motor unit potential (MUP) showed a significant relationship with RDD following multifactor analysis of variance (p = 0.007) and Pearson correlation analysis (ρ = - 0.70, p < 0.001), while various upper motor neuron manifestations were not correlated with RDD values (p > 0.05). CONCLUSION We report a loss of RDD in patients with ALS. The strong correlation detected between the RDD deficit and increased MUP suggests that RDD is a sensitive indicator of underlying spinal disinhibition in ALS. TRIAL REGISTRATION ChiCTR2000038848, 10/7/2020 (retrospectively registered), http://www.chictr.org.cn/ .
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Affiliation(s)
- Xiajun Zhou
- Department of Neurology, Renji Hospital, Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Pudong, Shanghai, 200127, China
| | - Ze Wang
- Department of Neurology, Renji Hospital, Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Pudong, Shanghai, 200127, China
| | - Zhi Lin
- Department of Neurology, Renji Hospital, Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Pudong, Shanghai, 200127, China
| | - Ying Zhu
- Department of Neurology, Shanghai International Medical Center, Shanghai, 201318, China
| | - Desheng Zhu
- Department of Neurology, Renji Hospital, Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Pudong, Shanghai, 200127, China
| | - Chong Xie
- Department of Neurology, Renji Hospital, Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Pudong, Shanghai, 200127, China
| | - Nigel A Calcutt
- Department of Pathology, University of California San Diego, San Diego, CA, 92093, USA
| | - Yangtai Guan
- Department of Neurology, Renji Hospital, Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Pudong, Shanghai, 200127, China.
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25
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Weddell T, Bashford J, Wickham A, Iniesta R, Chen M, Zhou P, Drakakis E, Boutelle M, Mills K, Shaw C. First-recruited motor units adopt a faster phenotype in amyotrophic lateral sclerosis. J Physiol 2021; 599:4117-4130. [PMID: 34261189 DOI: 10.1113/jp281310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/04/2021] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Amyotrophic lateral sclerosis (ALS) is an incurable neurodegenerative disorder of motor neurons, carrying a short survival. High-density motor unit recordings permit analysis of motor unit size (amplitude) and firing behaviour (afterhyperpolarization duration and muscle fibre conduction velocity). Serial recordings from biceps brachii indicated that motor units fired faster and with greater amplitude as disease progressed. First-recruited motor units in the latter stages of ALS developed characteristics akin to fast-twitch motor units, possibly as a compensatory mechanism for the selective loss of this motor unit subset. This process may become maladaptive, highlighting a novel therapeutic target to reduce motor unit vulnerability. ABSTRACT Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder with a median survival of 3 years. We employed serial high-density surface electromyography (HDSEMG) to characterize voluntary and ectopic patterns of motor unit (MU) firing at different stages of disease. By distinguishing MU subtypes with variable vulnerability to disease, we aimed to evaluate compensatory neuronal adaptations that accompany disease progression. Twenty patients with ALS and five patients with benign fasciculation syndrome (BFS) underwent 1-7 assessments each. HDSEMG measurements comprised 30 min of resting muscle and 1 min of light voluntary activity from biceps brachii bilaterally. MU decomposition was performed by the progressive FastICA peel-off technique. Inter-spike interval, firing pattern, MU potential area, afterhyperpolarization duration and muscle fibre conduction velocity were determined. In total, 373 MUs (ALS = 287; BFS = 86) were identified from 182 recordings. Weak ALS muscles demonstrated a lower mean inter-spike interval (82.7 ms) than strong ALS muscles (96.0 ms; P = 0.00919) and BFS muscles (95.3 ms; P = 0.0039). Mean MU potential area (area under the curve: 487.5 vs. 98.7 μV ms; P < 0.0001) and muscle fibre conduction velocity (6.2 vs. 5.1 m/s; P = 0.0292) were greater in weak ALS muscles than in BFS muscles. Purely fasciculating MUs had a greater mean MU potential area than MUs also under voluntary command (area under the curve: 679.6 vs. 232.4 μV ms; P = 0.00144). These results suggest that first-recruited MUs develop a faster phenotype in the latter stages of ALS, likely driven by the preferential loss of vulnerable fast-twitch MUs. Inhibition of this potentially maladaptive phenotypic drift may protect the longevity of the MU pool, stimulating a novel therapeutic avenue.
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Affiliation(s)
- Thomas Weddell
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James Bashford
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Aidan Wickham
- Department of Bioengineering, Imperial College London, London, UK
| | - Raquel Iniesta
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Maoqi Chen
- Institute of Rehabilitation Engineering, The University of Rehabilitation, Qingdao, China
| | - Ping Zhou
- Institute of Rehabilitation Engineering, The University of Rehabilitation, Qingdao, China
| | | | - Martyn Boutelle
- Department of Bioengineering, Imperial College London, London, UK
| | - Kerry Mills
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Chris Shaw
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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26
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Shandilya A, Mehan S. Dysregulation of IGF-1/GLP-1 signaling in the progression of ALS: potential target activators and influences on neurological dysfunctions. Neurol Sci 2021; 42:3145-3166. [PMID: 34018075 DOI: 10.1007/s10072-021-05328-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/17/2021] [Indexed: 12/31/2022]
Abstract
The prominent causes for motor neuron diseases like ALS are demyelination, immune dysregulation, and neuroinflammation. Numerous research studies indicate that the downregulation of IGF-1 and GLP-1 signaling pathways plays a significant role in the progression of ALS pathogenesis and other neurological disorders. In the current review, we discussed the dysregulation of IGF-1/GLP-1 signaling in neurodegenerative manifestations of ALS like a genetic anomaly, oligodendrocyte degradation, demyelination, glial overactivation, immune deregulation, and neuroexcitation. In addition, the current review reveals the IGF-1 and GLP-1 activators based on the premise that the restoration of abnormal IGF-1/GLP-1 signaling could result in neuroprotection and neurotrophic effects for the clinical-pathological presentation of ALS and other brain diseases. Thus, the potential benefits of IGF-1/GLP-1 signal upregulation in the development of disease-modifying therapeutic strategies may prevent ALS and associated neurocomplications.
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Affiliation(s)
- Ambika Shandilya
- Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, 142001, India
| | - Sidharth Mehan
- Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, 142001, India.
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27
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Liao SJ, Huang Z, Lai CY, Chen JY, Xiao PY, Cai Q, Yu J. The rostral to caudal gradient of clinical and electrophysiological features in sporadic amyotrophic lateral sclerosis with bulbar-onset. J Int Med Res 2021; 48:300060520956502. [PMID: 32993397 PMCID: PMC7536501 DOI: 10.1177/0300060520956502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective Amyotrophic lateral sclerosis (ALS) with bulbar-onset (BO-ALS) tends to
propagate to the adjacent anatomical regions symptomatically. However, the
spreading pattern of clinical and electrophysiological features is not well
documented. Methods This retrospective study enrolled consecutive patients with sporadic BO-ALS.
The clinical progression and electrophysiological data by electromyography
examination were retrospectively analysed based on information from the
medical records. Results The study enrolled 57 patients: 43 presented with contiguous (37 of 57) or
non-contiguous (6 of 57) progression clinically; and 14 patients did not
present with symptomatic propagation to other spinal segments. Lower motor
neuron dysfunction was more frequently involved in the bulbar and cervical
segments and less in the thoracic and lumbosacral segments. As a result, a
small proportion of patients had intact thoracic paraspinal or leg muscles
or both by electromyography examination. Furthermore, the patients with
diagnostic latency ≤6 months showed a significantly lower incidence of
neurogenic changes in the lumbosacral spinal cord compared with those with
diagnostic latency > 6 months. Conclusion This current study demonstrated a relative rostral–caudal descending gradient
of lower motor neuron dysfunction in patients with BO-ALS. These results
suggest that follow-up EMG might be necessary for a proportion of
patients.
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Affiliation(s)
- Song-Jie Liao
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangdong Provincial Engineering Center For Major Neurological Disease Treatment, Guangdong Provincial Translational Medicine Innovation Platform for Diagnosis and Treatment of Major Neurological Disease, Guangdong Provincial Clinical Research Center for Neurological Diseases, Guangzhou, China
| | - Zi Huang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangdong Provincial Engineering Center For Major Neurological Disease Treatment, Guangdong Provincial Translational Medicine Innovation Platform for Diagnosis and Treatment of Major Neurological Disease, Guangdong Provincial Clinical Research Center for Neurological Diseases, Guangzhou, China
| | - Chong-Yuan Lai
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangdong Provincial Engineering Center For Major Neurological Disease Treatment, Guangdong Provincial Translational Medicine Innovation Platform for Diagnosis and Treatment of Major Neurological Disease, Guangdong Provincial Clinical Research Center for Neurological Diseases, Guangzhou, China
| | - Jing-Yan Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangdong Provincial Engineering Center For Major Neurological Disease Treatment, Guangdong Provincial Translational Medicine Innovation Platform for Diagnosis and Treatment of Major Neurological Disease, Guangdong Provincial Clinical Research Center for Neurological Diseases, Guangzhou, China
| | - Pei-Yao Xiao
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangdong Provincial Engineering Center For Major Neurological Disease Treatment, Guangdong Provincial Translational Medicine Innovation Platform for Diagnosis and Treatment of Major Neurological Disease, Guangdong Provincial Clinical Research Center for Neurological Diseases, Guangzhou, China
| | - Qiong Cai
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangdong Provincial Engineering Center For Major Neurological Disease Treatment, Guangdong Provincial Translational Medicine Innovation Platform for Diagnosis and Treatment of Major Neurological Disease, Guangdong Provincial Clinical Research Center for Neurological Diseases, Guangzhou, China
| | - Jian Yu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangdong Provincial Engineering Center For Major Neurological Disease Treatment, Guangdong Provincial Translational Medicine Innovation Platform for Diagnosis and Treatment of Major Neurological Disease, Guangdong Provincial Clinical Research Center for Neurological Diseases, Guangzhou, China
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28
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Demystifying the spontaneous phenomena of motor hyperexcitability. Clin Neurophysiol 2021; 132:1830-1844. [PMID: 34130251 DOI: 10.1016/j.clinph.2021.03.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/18/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
Possessing a discrete functional repertoire, the anterior horn cell can be in one of two electrophysiological states: on or off. Usually under tight regulatory control by the central nervous system, a hierarchical network of these specialist neurons ensures muscular strength is coordinated, gradated and adaptable. However, spontaneous activation of these cells and their axons can result in abnormal muscular twitching. The muscular twitch is the common building block of several distinct clinical patterns, namely fasciculation, myokymia and neuromyotonia. When attempting to distinguish these entities electromyographically, their unique temporal and morphological profiles must be appreciated. Detection and quantification of burst duration, firing frequency, multiplet patterns and amplitude are informative. A common feature is their persistence during sleep. In this review, we explain the accepted terminology used to describe the spontaneous phenomena of motor hyperexcitability, highlighting potential pitfalls amidst a bemusing and complex collection of overlapping terms. We outline the relevance of these findings within the context of disease, principally amyotrophic lateral sclerosis, Isaacs syndrome and Morvan syndrome. In addition, we highlight the use of high-density surface electromyography, suggesting that more widespread use of this non-invasive technique is likely to provide an enhanced understanding of these motor hyperexcitability syndromes.
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29
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Fasciculation score: a sensitive biomarker in amyotrophic lateral sclerosis. Neurol Sci 2021; 42:4657-4666. [PMID: 33704599 DOI: 10.1007/s10072-021-05166-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 03/04/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of our study was to elucidate the characteristic of fasciculation distributions in amyotrophic lateral sclerosis (ALS) using a fasciculation score (FS) of muscle ultrasound (MUS) and to compare the diagnostic values of three MUS fasciculation parameters in patients. METHODS Thirty ALS patients, 16 ALS mimics, and 10 healthy subjects were involved. MUS of unilateral 10 muscles in each patient and needle electromyography (EMG) of total 204 muscles were performed to detect fasciculations and spontaneous activity respectively in ALS. Control groups underwent only MUS. Fasciculation was graded semiquantitatively with FS. RESULTS Three hundred fifty muscles in ALS and 260 in controls were examined. The fasciculation detection rates, total FS, the number of muscles with fasciculation, and the total number of fasciculations in ALS were all significantly higher than those of controls (P < 0.001). ALS patients exhibited a multifocal continuous pattern of fasciculation in limbs, whereas there were few fasciculations in controls. Compared with other parameters, total FS had the largest area under the curve (AUC) (AUC = 0.899, P < 0.001) in ALS diagnosis. The detection rates of lower motor neuron (LMN) acute lesions by MUS (70.6%) and EMG (72.1%) were nearly the same, and a positive correlation between the FS and spontaneous activity grades (P < 0.001, r = 0.359) was proved. CONCLUSIONS ALS patients exhibited the multifocal continuous pattern of fasciculation in limbs. FS showed high sensitivity and specificity in differentiating ALS from non-ALS patients, and the optimal cut-off value was determined as 4. The combination of MUS and EMG can provide additional information about specific muscles.
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30
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Near-fiber electromyography. Clin Neurophysiol 2021; 132:1089-1104. [PMID: 33774377 DOI: 10.1016/j.clinph.2021.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/28/2021] [Accepted: 02/05/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Describe and evaluate the concepts of near fiber electromyography (NFEMG), the features used, including near fiber motor unit potential (NFMUP) duration and dispersion, which relate to motor unit distal axonal branch and muscle fiber conduction time dispersion, and NFMUP segment jitter, a new measure of the temporal variability of neuromuscular junction transmission (NMJ), and axonal branch and muscle fibre conduction for the near fibres (i.e. NF jitter), and the methods for obtaining their values. METHODS Trains of high-pass filtered motor unit potentials (MUPs) (i.e. NFMUP trains) were extracted from needle-detected EMG signals to assess changes in motor unit (MU) morphology and electrophysiology caused by neuromuscular disorders or ageing. Evaluations using simulated needle-detected EMG data were completed and example human data are presented. RESULTS NFEMG feature values can be used to detect axonal sprouting, conduction slowing and NMJ transmission delay as well as changes in MU fiber diameter variability, and NF jitter. These changes can be detected prior to alterations of MU size or numbers. CONCLUSIONS The evaluations clearly demonstrate and the example data support that NFMUP duration and dispersion reflect MU distal axonal branching, conduction slowing and NMJ transmission delay and/or MU fiber diameter variability and that NFMUP jiggle and segment jitter reflect NF jitter. SIGNIFICANCE NFEMG can detect early changes in MU morphology and/or electrophysiology and has the potential to augment clinical diagnosis and tracking of neuromuscular disorders.
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31
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de Carvalho M, Kiernan MC, Pullman SL, Rezania K, Turner MR, Simmons Z. Neurophysiological features of primary lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2021; 21:11-17. [DOI: 10.1080/21678421.2020.1837174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Mamede de Carvalho
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Matthew C. Kiernan
- Brain and Mind Centre, University of Sydney, and Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Seth L Pullman
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Kourosh Rezania
- Department of Neurology, The University of Chicago, Chicago, IL, USA
| | - MR Turner
- Department of Clinical Neurology, University of Oxford, John Radcliffe Hospital, Oxford, UK, and
| | - Zachary Simmons
- Department of Neurology, Pennsylvania State University, Hershey, PA, US
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32
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Marshall KL, Farah MH. Axonal regeneration and sprouting as a potential therapeutic target for nervous system disorders. Neural Regen Res 2021; 16:1901-1910. [PMID: 33642358 PMCID: PMC8343323 DOI: 10.4103/1673-5374.308077] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Nervous system disorders are prevalent health issues that will only continue to increase in frequency as the population ages. Dying-back axonopathy is a hallmark of many neurologic diseases and leads to axonal disconnection from their targets, which in turn leads to functional impairment. During the course of many of neurologic diseases, axons can regenerate or sprout in an attempt to reconnect with the target and restore synapse function. In amyotrophic lateral sclerosis (ALS), distal motor axons retract from neuromuscular junctions early in the disease-course before significant motor neuron death. There is evidence of compensatory motor axon sprouting and reinnervation of neuromuscular junctions in ALS that is usually quickly overtaken by the disease course. Potential drugs that enhance compensatory sprouting and encourage reinnervation may slow symptom progression and retain muscle function for a longer period of time in ALS and in other diseases that exhibit dying-back axonopathy. There remain many outstanding questions as to the impact of distinct disease-causing mutations on axonal outgrowth and regeneration, especially in regards to motor neurons derived from patient induced pluripotent stem cells. Compartmentalized microfluidic chambers are powerful tools for studying the distal axons of human induced pluripotent stem cells-derived motor neurons, and have recently been used to demonstrate striking regeneration defects in human motor neurons harboring ALS disease-causing mutations. Modeling the human neuromuscular circuit with human induced pluripotent stem cells-derived motor neurons will be critical for developing drugs that enhance axonal regeneration, sprouting, and reinnervation of neuromuscular junctions. In this review we will discuss compensatory axonal sprouting as a potential therapeutic target for ALS, and the use of compartmentalized microfluidic devices to find drugs that enhance regeneration and axonal sprouting of motor axons.
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Affiliation(s)
| | - Mohamed H Farah
- Department of Neurology at Johns Hopkins School of Medicine, Baltimore, MD, USA
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33
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de Carvalho M. Needling the future in ALS. Clin Neurophysiol 2020; 131:1973-1974. [PMID: 32561171 DOI: 10.1016/j.clinph.2020.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Mamede de Carvalho
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Univeridade de Lisboa, Lisbon, Portugal; Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal.
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Duarte ML, Iared W, Oliveira ASB, Dos Santos LR, Peccin MS. Ultrasound versus electromyography for the detection of fasciculation in amyotrophic lateral sclerosis: systematic review and meta-analysis. Radiol Bras 2020; 53:116-121. [PMID: 32336828 PMCID: PMC7170585 DOI: 10.1590/0100-3984.2019.0055] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The objective of this study was to determine the diagnostic accuracy of ultrasound and electromyography for the detection of fasciculation in patients with amyotrophic lateral sclerosis and to compare detection rates between the two methods. By searching the Cochrane Library, MEDLINE, Excerpta Medica, and Latin-American and Caribbean Health Sciences Literature databases, we identified studies evaluating the diagnostic accuracy and fasciculation detection rates of ultrasound and electromyography. The Quality Assessment of Diagnostic Accuracy Studies, version 2, and RTI item bank tools were used for the evaluation of methodological quality. Ultrasound, for 10 s or 30 s, had a higher detection rate than did electromyography in all muscles evaluated. The overall detection rate (in patients) did not differ significantly between ultrasound for 10 s and ultrasound for 30 s. The accuracy of ultrasound for 10 s was 70% in muscles and 85% in patients. The accuracy of ultrasound for 30 s was 82% in patients. Ultrasound provided detection rates superior to those achieved with electromyography, independent of the examination time and muscles evaluated.
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Affiliation(s)
- Márcio Luís Duarte
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Wagner Iared
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | | | | | - Maria Stella Peccin
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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35
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de Carvalho M, Swash M. Motor unit estimation by MRI: Integrating old and new ideas. Clin Neurophysiol 2020; 131:1379-1380. [PMID: 32201104 DOI: 10.1016/j.clinph.2020.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Mamede de Carvalho
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Univeridade de Lisboa, Lisbon, Portugal; Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal.
| | - Michael Swash
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Univeridade de Lisboa, Lisbon, Portugal; Departments of Neurology and Neuroscience, Barts and the London School of Medicine, Queen Mary University of London and Royal London Hospital, UK
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36
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Nasseroleslami B, Dukic S, Broderick M, Mohr K, Schuster C, Gavin B, McLaughlin R, Heverin M, Vajda A, Iyer PM, Pender N, Bede P, Lalor EC, Hardiman O. Characteristic Increases in EEG Connectivity Correlate With Changes of Structural MRI in Amyotrophic Lateral Sclerosis. Cereb Cortex 2020; 29:27-41. [PMID: 29136131 DOI: 10.1093/cercor/bhx301] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a terminal progressive adult-onset neurodegeneration of the motor system. Although originally considered a pure motor degeneration, there is increasing evidence of disease heterogeneity with varying degrees of extra-motor involvement. How the combined motor and nonmotor degeneration occurs in the context of broader disruption in neural communication across brain networks has not been well characterized. Here, we have performed high-density crossectional and longitudinal resting-state electroencephalography (EEG) recordings on 100 ALS patients and 34 matched controls, and have identified characteristic patterns of altered EEG connectivity that have persisted in longitudinal analyses. These include strongly increased EEG coherence between parietal-frontal scalp regions (in γ-band) and between bilateral regions over motor areas (in θ-band). Correlation with structural MRI from the same patients shows that disease-specific structural degeneration in motor areas and corticospinal tracts parallels a decrease in neural activity over scalp motor areas, while the EEG over the scalp regions associated with less extensively involved extra-motor regions on MRI exhibit significantly increased neural communication. Our findings demonstrate that EEG-based connectivity mapping can provide novel insights into progressive network decline in ALS. These data pave the way for development of validated cost-effective spectral EEG-based biomarkers that parallel changes in structural imaging.
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Affiliation(s)
- Bahman Nasseroleslami
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland
| | - Stefan Dukic
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland
| | - Michael Broderick
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland
| | - Kieran Mohr
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland
| | - Christina Schuster
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland
| | - Brighid Gavin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland
| | - Russell McLaughlin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland.,Smurfit Institute of Genetics, Trinity College Dublin, the University of Dublin, College Street, Dublin, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland
| | - Parameswaran M Iyer
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland
| | - Niall Pender
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland.,Beaumont Hospital, Beaumont Road, Dublin, Ireland
| | - Peter Bede
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland.,Beaumont Hospital, Beaumont Road, Dublin, Ireland
| | - Edmund C Lalor
- Trinity College Institute of Neuroscience, Trinity College Dublin, the University of Dublin, Lloyd Building, College Green, Dublin, Ireland.,Trinity Centre for Bioengineering, Trinity College Dublin, the University of Dublin, Trinity Biomedical Sciences Institute, 152-160 Pearse Street, Dublin, Ireland.,Department of Biomedical Engineering and Department of Neuroscience, University of Rochester, Rochester, NY, USA
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland.,Beaumont Hospital, Beaumont Road, Dublin, Ireland.,Trinity College Institute of Neuroscience, Trinity College Dublin, the University of Dublin, Lloyd Building, College Green, Dublin, Ireland
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de Carvalho M, Swash M. Fasciculations: Opening Pandora’s box. Clin Neurophysiol 2020; 131:239-240. [DOI: 10.1016/j.clinph.2019.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 10/30/2019] [Indexed: 11/28/2022]
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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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Bashford J, Wickham A, Iniesta R, Drakakis E, Boutelle M, Mills K, Shaw CE. Preprocessing surface EMG data removes voluntary muscle activity and enhances SPiQE fasciculation analysis. Clin Neurophysiol 2019; 131:265-273. [PMID: 31740273 PMCID: PMC6941467 DOI: 10.1016/j.clinph.2019.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/03/2019] [Accepted: 09/23/2019] [Indexed: 12/11/2022]
Abstract
A novel preprocessing step removes the need for manual selection of relaxed surface EMG data. SPiQE provides reliable fasciculation analysis from raw thirty-minute recordings in ALS. This paves the way for clinical calibration of a potential novel biomarker of disease progression.
Objectives Fasciculations are a clinical hallmark of amyotrophic lateral sclerosis (ALS). The Surface Potential Quantification Engine (SPiQE) is a novel analytical tool to identify fasciculation potentials from high-density surface electromyography (HDSEMG). This method was accurate on relaxed recordings amidst fluctuating noise levels. To avoid time-consuming manual exclusion of voluntary muscle activity, we developed a method capable of rapidly excluding voluntary potentials and integrating with the established SPiQE pipeline. Methods Six ALS patients, one patient with benign fasciculation syndrome and one patient with multifocal motor neuropathy underwent monthly thirty-minute HDSEMG from biceps and gastrocnemius. In MATLAB, we developed and compared the performance of four Active Voluntary IDentification (AVID) strategies, producing a decision aid for optimal selection. Results Assessment of 601 one-minute recordings permitted the development of sensitive, specific and screening strategies to exclude voluntary potentials. Exclusion times (0.2–13.1 minutes), processing times (10.7–49.5 seconds) and fasciculation frequencies (27.4–71.1 per minute) for 165 thirty-minute recordings were compared. The overall median fasciculation frequency was 40.5 per minute (10.6–79.4 IQR). Conclusion We hereby introduce AVID as a flexible, targeted approach to exclude voluntary muscle activity from HDSEMG recordings. Significance Longitudinal quantification of fasciculations in ALS could provide unique insight into motor neuron health.
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Affiliation(s)
- J. Bashford
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
- Corresponding author. https://spiqe.co.uk
| | - A. Wickham
- Department of Bioengineering, Imperial College London, UK
| | - R. Iniesta
- Department of Biostatistics and Health Informatics, King’s College London, UK
| | - E. Drakakis
- Department of Bioengineering, Imperial College London, UK
| | - M. Boutelle
- Department of Bioengineering, Imperial College London, UK
| | - K. Mills
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - CE. Shaw
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
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Marchand‐Pauvert V, Peyre I, Lackmy‐Vallee A, Querin G, Bede P, Lacomblez L, Debs R, Pradat P. Absence of hyperexcitability of spinal motoneurons in patients with amyotrophic lateral sclerosis. J Physiol 2019; 597:5445-5467. [DOI: 10.1113/jp278117] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 09/06/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
| | - Iseline Peyre
- Sorbonne Université Inserm, CNRS, Laboratoire d'Imagerie Biomédicale LIB Paris France
| | | | - Giorgia Querin
- Sorbonne Université Inserm, CNRS, Laboratoire d'Imagerie Biomédicale LIB Paris France
- Neurologie, AP‐HP Hôpital Pitié‐Salpêtrière Paris France
| | - Peter Bede
- Sorbonne Université Inserm, CNRS, Laboratoire d'Imagerie Biomédicale LIB Paris France
- Neurologie, AP‐HP Hôpital Pitié‐Salpêtrière Paris France
- Computational Neuroimaging Group Trinity College Dublin Dublin Ireland
| | | | - Rabab Debs
- Neurologie, AP‐HP Hôpital Pitié‐Salpêtrière Paris France
| | - Pierre‐François Pradat
- Sorbonne Université Inserm, CNRS, Laboratoire d'Imagerie Biomédicale LIB Paris France
- Neurologie, AP‐HP Hôpital Pitié‐Salpêtrière Paris France
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Veltsista D, Papapavlou C, Chroni E. F Wave Analyzer, a system for repeater F-waves detection: Application in patients with amyotrophic lateral sclerosis. Clin Neurophysiol 2019; 130:1954-1961. [PMID: 31472478 DOI: 10.1016/j.clinph.2019.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/23/2019] [Accepted: 08/12/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We assessed the clinical usefulness of repeater F-waves (Freps) analysis in amyotrophic lateral sclerosis (ALS), using an automated computerized system (F Wave Analyzer). METHODS Forty consecutive F-waves were recorded from the ulnar and peroneal nerve in 52 patients with ALS and 52 healthy control subjects. Data were imported into the F Wave Analyzer which identifies Freps and groups them. Parameters of Freps and non repeater F-waves (Fnonreps) were compared. RESULTS Total number of repeating neurons, Freps persistence (100xFreps/40stimuli) and Index Total Freps (100xFreps/total number of F-waves) were significantly higher in the ALS compared to the control group (P ≤ 0.005). There were no consistent differences of F-wave latency or amplitude measurements between Freps and Fnonreps for both studied groups, with the exception of prolonged Freps minimum latency in ALS. CONCLUSION In ALS, the high numbers of Freps, reduced overall F-wave persistence and increased F-wave amplitude measurements in a relatively unaffected nerve-muscle complex reflects excitability alterations of the corresponding motor neuron pool. Overall, automatic analysis facilitates accurate and fast detection of Freps and could be useful in other clinical settings. SIGNIFICANCE Analysis of repeater F-waves is expected to provide new insight regarding ALS pathophysiology and utilized for monitoring in clinical drug trials.
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Affiliation(s)
- Dimitra Veltsista
- Departments of Neurology, School of Medicine, University of Patras, Patras, Greece
| | - Chris Papapavlou
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece
| | - Elisabeth Chroni
- Departments of Neurology, School of Medicine, University of Patras, Patras, Greece.
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Bashford J, Wickham A, Iniesta R, Drakakis E, Boutelle M, Mills K, Shaw C. SPiQE: An automated analytical tool for detecting and characterising fasciculations in amyotrophic lateral sclerosis. Clin Neurophysiol 2019; 130:1083-1090. [PMID: 31078984 PMCID: PMC6553680 DOI: 10.1016/j.clinph.2019.03.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/14/2019] [Accepted: 03/17/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Fasciculations are a clinical hallmark of amyotrophic lateral sclerosis (ALS). Compared to concentric needle EMG, high-density surface EMG (HDSEMG) is non-invasive and records fasciculation potentials (FPs) from greater muscle volumes over longer durations. To detect and characterise FPs from vast data sets generated by serial HDSEMG, we developed an automated analytical tool. METHODS Six ALS patients and two control patients (one with benign fasciculation syndrome and one with multifocal motor neuropathy) underwent 30-minute HDSEMG from biceps and gastrocnemius monthly. In MATLAB we developed a novel, innovative method to identify FPs amidst fluctuating noise levels. One hundred repeats of 5-fold cross validation estimated the model's predictive ability. RESULTS By applying this method, we identified 5,318 FPs from 80 minutes of recordings with a sensitivity of 83.6% (+/- 0.2 SEM), specificity of 91.6% (+/- 0.1 SEM) and classification accuracy of 87.9% (+/- 0.1 SEM). An amplitude exclusion threshold (100 μV) removed excessively noisy data without compromising sensitivity. The resulting automated FP counts were not significantly different to the manual counts (p = 0.394). CONCLUSION We have devised and internally validated an automated method to accurately identify FPs from HDSEMG, a technique we have named Surface Potential Quantification Engine (SPiQE). SIGNIFICANCE Longitudinal quantification of fasciculations in ALS could provide unique insight into motor neuron health.
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Affiliation(s)
- J. Bashford
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - A. Wickham
- Department of Bioengineering, Imperial College London, United Kingdom
| | - R. Iniesta
- Department of Biostatistics and Health Informatics, King’s College London, United Kingdom
| | - E. Drakakis
- Department of Bioengineering, Imperial College London, United Kingdom
| | - M. Boutelle
- Department of Bioengineering, Imperial College London, United Kingdom
| | - K. Mills
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - C. Shaw
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
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Falcão de Campos C, de Carvalho M. Distal myopathy and rapidly progressive dementia associated with a novel mutation in the VCP gene: Expanding inclusion body myopathy with early-onset Paget disease and frontotemporal dementia spectrum. J Clin Neurosci 2019; 64:8-10. [DOI: 10.1016/j.jocn.2019.03.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/29/2019] [Indexed: 11/27/2022]
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Diaphragm ultrasonography in amyotrophic lateral sclerosis: a diagnostic tool to assess ventilatory dysfunction and disease severity. Neurol Sci 2019; 40:2065-2071. [DOI: 10.1007/s10072-019-03938-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 05/13/2019] [Indexed: 12/13/2022]
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Verber NS, Shepheard SR, Sassani M, McDonough HE, Moore SA, Alix JJP, Wilkinson ID, Jenkins TM, Shaw PJ. Biomarkers in Motor Neuron Disease: A State of the Art Review. Front Neurol 2019; 10:291. [PMID: 31001186 PMCID: PMC6456669 DOI: 10.3389/fneur.2019.00291] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/06/2019] [Indexed: 12/17/2022] Open
Abstract
Motor neuron disease can be viewed as an umbrella term describing a heterogeneous group of conditions, all of which are relentlessly progressive and ultimately fatal. The average life expectancy is 2 years, but with a broad range of months to decades. Biomarker research deepens disease understanding through exploration of pathophysiological mechanisms which, in turn, highlights targets for novel therapies. It also allows differentiation of the disease population into sub-groups, which serves two general purposes: (a) provides clinicians with information to better guide their patients in terms of disease progression, and (b) guides clinical trial design so that an intervention may be shown to be effective if population variation is controlled for. Biomarkers also have the potential to provide monitoring during clinical trials to ensure target engagement. This review highlights biomarkers that have emerged from the fields of systemic measurements including biochemistry (blood, cerebrospinal fluid, and urine analysis); imaging and electrophysiology, and gives examples of how a combinatorial approach may yield the best results. We emphasize the importance of systematic sample collection and analysis, and the need to correlate biomarker findings with detailed phenotype and genotype data.
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Affiliation(s)
- Nick S Verber
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Stephanie R Shepheard
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Matilde Sassani
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Harry E McDonough
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Sophie A Moore
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - James J P Alix
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Iain D Wilkinson
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Tom M Jenkins
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Pamela J Shaw
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
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Normal and abnormal voluntary activity. HANDBOOK OF CLINICAL NEUROLOGY 2019; 160:281-301. [PMID: 31277854 DOI: 10.1016/b978-0-444-64032-1.00018-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
An important component of needle EMG entails recording and interpreting the electrical signals generated from motor units during voluntary contraction. The recorded motor unit potentials (MUPs) reflect the number of motor units within a muscle and the distribution and density of muscle fibers within a motor unit within a portion of a muscle. Various MUP parameters are assessed to determine the integrity of the motor units, including recruitment, stability, phases and turns, duration, and amplitude. Each of these parameters is altered in a different way in various neuromuscular diseases. In neurogenic disorders, the earliest changes occur in the recruitment pattern of motor units followed by MUP morphologic changes (increased MUP phases and duration) as reinnervation occurs. MUP instability, indicating impaired neuromuscular transmission, also occurs in reinnervating neurogenic disorders as well as in neuromuscular junction disorders. In myopathies, a reduction in the size of the motor unit is manifested by MUPs of low amplitude and short duration. Interpreting the voluntary MUP changes along with spontaneous activity helps to determine the type, severity, and temporal course of neuromuscular diseases.
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Tsugawa J, Dharmadasa T, Ma Y, Huynh W, Vucic S, Kiernan MC. Fasciculation intensity and disease progression in amyotrophic lateral sclerosis. Clin Neurophysiol 2018; 129:2149-2154. [DOI: 10.1016/j.clinph.2018.07.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/21/2018] [Accepted: 07/15/2018] [Indexed: 12/11/2022]
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de Carvalho M, Barkhaus PE, Nandedkar SD, Swash M. Motor unit number estimation (MUNE): Where are we now? Clin Neurophysiol 2018; 129:1507-1516. [DOI: 10.1016/j.clinph.2018.04.748] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/31/2018] [Accepted: 04/29/2018] [Indexed: 12/13/2022]
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49
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de Carvalho M, Pinto S, Swash M. Diaphragm motor responses to phrenic nerve stimulation in ALS: Surface and needle recordings. Clin Neurophysiol 2018; 129:349-353. [DOI: 10.1016/j.clinph.2017.11.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 10/22/2017] [Accepted: 11/19/2017] [Indexed: 10/18/2022]
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Vázquez‐Costa JF, Mazón M, Carreres‐Polo J, Hervás D, Pérez‐Tur J, Martí‐Bonmatí L, Sevilla T. Brain signal intensity changes as biomarkers in amyotrophic lateral sclerosis. Acta Neurol Scand 2018; 137:262-271. [PMID: 29082510 DOI: 10.1111/ane.12863] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To evaluate the contribution of the demographical, clinical, analytical and genetic factors to brain signal intensity changes in T2-weighted MR images in amyotrophic lateral sclerosis (ALS) patients and controls. METHODS Susceptibility-weighted and FLAIR sequences were obtained in a 3T MR scanner. Iron-related hypointensities in the motor cortex (IRhMC) and hyperintensities of the corticospinal tract (HCT) were qualitatively scored. Age, gender, family history and clinical variables were recorded. Baseline levels of ferritin were measured. C9orf72 was tested in all patients and SOD1 only in familial ALS patients not carrying a C9orf72 expansion. Patients who carried a mutation were categorized as genetic. Associations of these variables with visual scores were assessed with multivariable analysis. RESULTS A total of 102 ALS patients (92 non-genetic and 10 genetic) and 48 controls (28 ALS mimics and 20 healthy controls) were recruited. In controls, IRhMC associated with age, but HCT did not. In ALS patients, both HTC and IRhMC strongly associated with clinical UMN impairment and bulbar onset. The intensity/extent of IRhMC in the different motor homunculus regions (lower limbs, upper limbs and bulbar) were linked to the symptoms onset site. Between genetic and sporadic patients, no difference in IRhMC and HCT was found. CONCLUSIONS IRhMC and HCT are reliable markers of UMN degeneration in ALS patients and are more frequent in bulbar onset patients, independently of the mutation status. Age should be considered when evaluating IRhMC. The regional measurement of IRhMC following the motor homunculus could be used as a measure of disease progression.
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Affiliation(s)
- Juan F. Vázquez‐Costa
- Neuromuscular Research Unit Instituto de Investigación Sanitaria la Fe Valencia Spain
- ALS Unit Department of Neurology Hospital Universitario y Politécnico La Fe Valencia Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) Valencia Spain
| | - Miguel Mazón
- Department of Radiology and Biomedical Imaging Research Group GIBI2 Hospital Universitario y Politécnico La Fe and Instituto de Investigación Sanitaria la Fe Valencia Spain
| | - Joan Carreres‐Polo
- Department of Radiology and Biomedical Imaging Research Group GIBI2 Hospital Universitario y Politécnico La Fe and Instituto de Investigación Sanitaria la Fe Valencia Spain
| | - David Hervás
- Biostatistics Unit Instituto de Investigación Sanitaria la Fe Valencia Spain
| | - Jordi Pérez‐Tur
- Laboratory of Molecular Genetics Institut de Biomedicina de València‐CSIC Valencia Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED) Valencia Spain
- Unidad mixta de Neurología y Genética Instituto de Investigación Sanitaria la Fe (IIS La Fe) Valencia Spain
| | - Luis Martí‐Bonmatí
- Department of Radiology and Biomedical Imaging Research Group GIBI2 Hospital Universitario y Politécnico La Fe and Instituto de Investigación Sanitaria la Fe Valencia Spain
| | - Teresa Sevilla
- Neuromuscular Research Unit Instituto de Investigación Sanitaria la Fe Valencia Spain
- ALS Unit Department of Neurology Hospital Universitario y Politécnico La Fe Valencia Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) Valencia Spain
- Department of Medicine University of Valencia Valencia Spain
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