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McKinnon ML, Hill NJ, Carp JS, Dellenbach B, Thompson AK. Methods for automated delineation and assessment of EMG responses evoked by peripheral nerve stimulation in diagnostic and closed-loop therapeutic applications. J Neural Eng 2023; 20:10.1088/1741-2552/ace6fb. [PMID: 37437593 PMCID: PMC10445400 DOI: 10.1088/1741-2552/ace6fb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/12/2023] [Indexed: 07/14/2023]
Abstract
Objective.Surface electromyography measurements of the Hoffmann (H-) reflex are essential in a wide range of neuroscientific and clinical applications. One promising emerging therapeutic application is H-reflex operant conditioning, whereby a person is trained to modulate the H-reflex, with generalized beneficial effects on sensorimotor function in chronic neuromuscular disorders. Both traditional diagnostic and novel realtime therapeutic applications rely on accurate definitions of the H-reflex and M-wave temporal bounds, which currently depend on expert case-by-case judgment. The current study automates such judgments.Approach.Our novel wavelet-based algorithm automatically determines temporal extent and amplitude of the human soleus H-reflex and M-wave. In each of 20 participants, the algorithm was trained on data from a preliminary 3 or 4 min recruitment-curve measurement. Output was evaluated on parametric fits to subsequent sessions' recruitment curves (92 curves across all participants) and on the conditioning protocol's subsequent baseline trials (∼1200 per participant) performed nearHmax. Results were compared against the original temporal bounds estimated at the time, and against retrospective estimates made by an expert 6 years later.Main results.Automatic bounds agreed well with manual estimates: 95% lay within ±2.5 ms. The resulting H-reflex magnitude estimates showed excellent agreement (97.5% average across participants) between automatic and retrospective bounds regarding which trials would be considered successful for operant conditioning. Recruitment-curve parameters also agreed well between automatic and manual methods: 95% of the automatic estimates of the current required to elicitHmaxfell within±1.4%of the retrospective estimate; for the 'threshold' current that produced an M-wave 10% of maximum, this value was±3.5%.Significance.Such dependable automation of M-wave and H-reflex definition should make both established and emerging H-reflex protocols considerably less vulnerable to inter-personnel variability and human error, increasing translational potential.
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Affiliation(s)
| | - N. Jeremy Hill
- National Center for Adaptive Neurotechnologies, Stratton VA Medical Center, Albany, NY, USA
- Electrical and Computer Engineering Dept., State University of New York at Albany, NY, USA
| | - Jonathan S. Carp
- National Center for Adaptive Neurotechnologies, Stratton VA Medical Center, Albany, NY, USA
- School of Public Health, State University of New York at Albany, NY, USA
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Vigneri S, Bono V. Can we improve our electrophysiological evaluation in C9ORF72 ALS? Muscle Nerve 2023; 67:E7. [PMID: 36566356 DOI: 10.1002/mus.27778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 12/26/2022]
Affiliation(s)
- Simone Vigneri
- Casa di Cura Santa Maria Maddalena, Neurology and Neurophysiology Service, Occhiobello, Italy
| | - Valeria Bono
- Ospedale Civico Benfratelli, Department of Neurology and Stroke Unit, Palermo, Italy
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Ferrea S, Junker F, Korth M, Gruhn K, Grehl T, Schmidt-Wilcke T. Cortical Thinning of Motor and Non-Motor Brain Regions Enables Diagnosis of Amyotrophic Lateral Sclerosis and Supports Distinction between Upper- and Lower-Motoneuron Phenotypes. Biomedicines 2021; 9:biomedicines9091195. [PMID: 34572380 PMCID: PMC8468309 DOI: 10.3390/biomedicines9091195] [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: 08/01/2021] [Revised: 08/29/2021] [Accepted: 09/06/2021] [Indexed: 12/01/2022] Open
Abstract
Background: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder clinically characterized by muscle atrophy and progressive paralysis. In addition to the classical ALS affecting both the upper and lower motoneurons (UMN and LMN), other subtypes with the predominant (or even exclusive) affection of the UMN or LMN have been identified. This work sought to detect specific patterns of cortical brain atrophy in the UMN and LMN phenotypes to distinguish these two forms from the healthy state. Methods: Using high-resolution structural MRI and cortical thickness analysis, 38 patients with a diagnosis of ALS and predominance of either the UMN (n = 20) or the LMN (n = 18) phenotype were investigated. Results: Significant cortical thinning in the temporal lobe was found in both the ALS groups. Additionally, UMN patients displayed a significant thinning of the cortical thickness in the pre- and postcentral gyrus, as well as the paracentral lobule. By applying multivariate analyses based on the cortical thicknesses of 34 brain regions, ALS patients with either a predominant UMN or LMN phenotype were distinguished from healthy controls with an accuracy of 94% and UMN from LMN patients with an accuracy of 75%. Conclusions: These findings support previous hypothesis that neural degeneration in ALS is not confined to the sole motor regions. In addition, the amount of cortical thinning in the temporal lobe helps to distinguish ALS patients from healthy controls, that is, to support or discourage the diagnosis of ALS, while the cortical thickness of the precentral gyrus specifically helps to distinguish the UMN from the LMN phenotype.
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Affiliation(s)
- Stefano Ferrea
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University Dusseldorf, 40225 Dusseldorf, Germany; (F.J.); (T.S.-W.)
- Correspondence:
| | - Frederick Junker
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University Dusseldorf, 40225 Dusseldorf, Germany; (F.J.); (T.S.-W.)
| | - Mira Korth
- Evangelisches Krankenhaus Hattingen, 45525 Hattingen, Germany;
| | - Kai Gruhn
- Neuro Center Mettmann, 40822 Mettmann, Germany;
| | - Torsten Grehl
- ALS Outpatient Clinic, Alfried Krupp Krankenhaus Rüttenscheid, 45131 Essen, Germany;
| | - Tobias Schmidt-Wilcke
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University Dusseldorf, 40225 Dusseldorf, Germany; (F.J.); (T.S.-W.)
- Neurologisches Zentrum, Bezirksklinikum Mainkofen, 94469 Deggendorf, Germany
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Ceccanti M, Pozzilli V, Cambieri C, Libonati L, Onesti E, Frasca V, Fiorini I, Petrucci A, Garibaldi M, Palma E, Bendotti C, Fabbrizio P, Trolese MC, Nardo G, Inghilleri M. Creatine Kinase and Progression Rate in Amyotrophic Lateral Sclerosis. Cells 2020; 9:cells9051174. [PMID: 32397320 PMCID: PMC7291088 DOI: 10.3390/cells9051174] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/29/2020] [Accepted: 05/06/2020] [Indexed: 11/16/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with no recognized clinical prognostic factor. Creatinine kinase (CK) increase in these patients is already described with conflicting results on prognosis and survival. In 126 ALS patients who were fast or slow disease progressors, CK levels were assayed for 16 months every 4 months in an observational case-control cohort study with prospective data collection conducted in Italy. CK was also measured at baseline in 88 CIDP patients with secondary axonal damage and in two mouse strains (129SvHSD and C57-BL) carrying the same SOD1G93A transgene expression but showing a fast (129Sv-SOD1G93A) and slow (C57-SOD1G93A) ALS progression rate. Higher CK was found in ALS slow progressors compared to fast progressors in T1, T2, T3, and T4, with a correlation with Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) scores. Higher CK was found in spinal compared to bulbar-onset patients. Transgenic and non-transgenic C57BL mice showed higher CK levels compared to 129SvHSD strain. At baseline mean CK was higher in ALS compared to CIDP. CK can predict the disease progression, with slow progressors associated with higher levels and fast progressors to lower levels, in both ALS patients and mice. CK is higher in ALS patients compared to patients with CIDP with secondary axonal damage; the higher levels of CK in slow progressors patients, but also in C57BL transgenic and non-transgenic mice designs CK as a predisposing factor for disease rate progression.
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Affiliation(s)
- Marco Ceccanti
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
| | - Valeria Pozzilli
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
| | - Chiara Cambieri
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
| | - Laura Libonati
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
| | - Emanuela Onesti
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
| | - Vittorio Frasca
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
| | - Ilenia Fiorini
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
| | - Antonio Petrucci
- Centre for Neuromuscular and Neurological Rare Diseases, San Camillo Forlanini Hospital, 00152 Rome, Italy;
| | - Matteo Garibaldi
- Neuromuscular Disease Centre, Department of Neurology, Mental Health and Sensory Organs (NESMOS), Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy;
| | - Eleonora Palma
- Department of Physiology and Pharmacology, Laboratory Affiliated to Istituto Pasteur Italia, Sapienza University of Rome, 00185 Rome, Italy;
| | - Caterina Bendotti
- Laboratory Molecular Neurobiology, Department of Neuroscience, Istituto di Ricerche Famacologiche Mario Negri-IRCCS, 20156 Milan, Italy; (C.B.); (P.F.); (M.C.T.); (G.N.)
| | - Paola Fabbrizio
- Laboratory Molecular Neurobiology, Department of Neuroscience, Istituto di Ricerche Famacologiche Mario Negri-IRCCS, 20156 Milan, Italy; (C.B.); (P.F.); (M.C.T.); (G.N.)
| | - Maria Chiara Trolese
- Laboratory Molecular Neurobiology, Department of Neuroscience, Istituto di Ricerche Famacologiche Mario Negri-IRCCS, 20156 Milan, Italy; (C.B.); (P.F.); (M.C.T.); (G.N.)
| | - Giovanni Nardo
- Laboratory Molecular Neurobiology, Department of Neuroscience, Istituto di Ricerche Famacologiche Mario Negri-IRCCS, 20156 Milan, Italy; (C.B.); (P.F.); (M.C.T.); (G.N.)
| | - Maurizio Inghilleri
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
- Correspondence: ; Tel.: +39-0-6499-14122
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Pozzilli V, Giona F, Ceccanti M, Cambieri C, Frasca V, Onesti E, Libonati L, Di Bari S, Fiorini I, Cardarelli L, Santopietro M, Inghilleri M. A case of motor neuron involvement in Gaucher disease. Mol Genet Metab Rep 2019; 21:100540. [PMID: 31844629 PMCID: PMC6895677 DOI: 10.1016/j.ymgmr.2019.100540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/01/2019] [Accepted: 11/03/2019] [Indexed: 12/13/2022] Open
Abstract
Gaucher disease (GD) is a genetic disorder characterized by an accumulation of glucosylceramide in cells in the monocyte-macrophage system. We describe a case of a 33-year-old man with a previous diagnosis of type 3 GD who displayed a progressive weakening of the limbs followed by upper motor neuron involvement. A diagnosis of definite Amyotrophic Lateral Sclerosis was made. This is the first reported case of concurrent Gaucher disease and the ALS phenotype in the same patient.
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Affiliation(s)
- V Pozzilli
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - F Giona
- Haematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - M Ceccanti
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - C Cambieri
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - V Frasca
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - E Onesti
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - L Libonati
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - S Di Bari
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - I Fiorini
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - L Cardarelli
- Haematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - M Santopietro
- Haematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - M Inghilleri
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University, Rome, Italy
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Hyperreflexia as an upper motor neuron sign in amyotrophic lateral sclerosis. Clin Neurophysiol 2019; 130:1405-1406. [PMID: 31171431 DOI: 10.1016/j.clinph.2019.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 05/23/2019] [Indexed: 11/20/2022]
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