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Yang C, Liu G, Chen X, Le W. Cerebellum in Alzheimer's disease and other neurodegenerative diseases: an emerging research frontier. MedComm (Beijing) 2024; 5:e638. [PMID: 39006764 PMCID: PMC11245631 DOI: 10.1002/mco2.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
The cerebellum is crucial for both motor and nonmotor functions. Alzheimer's disease (AD), alongside other dementias such as vascular dementia (VaD), Lewy body dementia (DLB), and frontotemporal dementia (FTD), as well as other neurodegenerative diseases (NDs) like Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS), Huntington's disease (HD), and spinocerebellar ataxias (SCA), are characterized by specific and non-specific neurodegenerations in central nervous system. Previously, the cerebellum's significance in these conditions was underestimated. However, advancing research has elevated its profile as a critical node in disease pathology. We comprehensively review the existing evidence to elucidate the relationship between cerebellum and the aforementioned diseases. Our findings reveal a growing body of research unequivocally establishing a link between the cerebellum and AD, other forms of dementia, and other NDs, supported by clinical evidence, pathological and biochemical profiles, structural and functional neuroimaging data, and electrophysiological findings. By contrasting cerebellar observations with those from the cerebral cortex and hippocampus, we highlight the cerebellum's distinct role in the disease processes. Furthermore, we also explore the emerging therapeutic potential of targeting cerebellum for the treatment of these diseases. This review underscores the importance of the cerebellum in these diseases, offering new insights into the disease mechanisms and novel therapeutic strategies.
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Affiliation(s)
- Cui Yang
- Institute of Neurology Sichuan Provincial People's Hospital School of Medicine University of Electronic Science and Technology of China Chengdu China
| | - Guangdong Liu
- Institute of Neurology Sichuan Provincial People's Hospital School of Medicine University of Electronic Science and Technology of China Chengdu China
| | - Xi Chen
- Institute of Neurology Sichuan Provincial People's Hospital School of Medicine University of Electronic Science and Technology of China Chengdu China
| | - Weidong Le
- Institute of Neurology Sichuan Provincial People's Hospital School of Medicine University of Electronic Science and Technology of China Chengdu China
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Murthy VD, McLarty E, Woolard KD, Parker RL, Kortz G, King JN, Poppenga RH, Knipe MF, Dickinson PJ. Case Report: MRI, Clinical, and Pathological Correlates of Bromethalin Toxicosis in Three Dogs. Front Vet Sci 2022; 9:879007. [PMID: 35558887 PMCID: PMC9087846 DOI: 10.3389/fvets.2022.879007] [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: 02/18/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
Bromethalin toxicosis is an increasingly common clinical presentation in dogs that may be fatal depending on the extent of intoxication. Antemortem diagnosis of bromethalin toxicosis was achieved in three dogs by demonstration of the active metabolite desmethylbromethalin in fat or serum. Magnetic resonance imaging (MRI) findings were consistent with a diffuse leukoencephalopathy with restricted diffusion and prominent involvement of the corticospinal motor tracts on T2-weighted and diffusion-weighted sequences. Imaging findings were confirmed in one non-surviving dog at necropsy. Resolution of MRI abnormalities was demonstrated in one surviving dog that was consistent with the associated resolution of clinical signs. Initial findings in these dogs support further investigation of specific MRI patterns in cases of leukoencephalopathy to aid differential diagnosis. While antemortem detection of bromethalin and its metabolites confirms exposure, quantitation may be informative as a prognostic biomarker.
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Affiliation(s)
- Vishal D. Murthy
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States
| | - Ehren McLarty
- Department of Surgical and Radiological Sciences, University of California, Davis, Davis, CA, United States
| | - Kevin D. Woolard
- Department of Pathology, Microbiology and Immunology, University of California, Davis, Davis, CA, United States
| | - Rell L. Parker
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Gregg Kortz
- Department of Neurology, VCA Sacramento Veterinary Referral Center, Sacramento, CA, United States
| | - Jamie N. King
- Department of Neurology, VCA Sacramento Veterinary Referral Center, Sacramento, CA, United States
| | - Robert H. Poppenga
- California Animal Health and Food Safety Laboratory System, University of California, Davis, Davis, CA, United States
| | - Marguerite F. Knipe
- Department of Surgical and Radiological Sciences, University of California, Davis, Davis, CA, United States
| | - Peter J. Dickinson
- Department of Surgical and Radiological Sciences, University of California, Davis, Davis, CA, United States
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Sugiyama Y, Oishi T, Yamashita A, Murata Y, Yamamoto T, Takashima I, Isa T, Higo N. Neuronal and microglial localization of secreted phosphoprotein 1 (osteopontin) in intact and damaged motor cortex of macaques. Brain Res 2019; 1714:52-64. [PMID: 30790559 DOI: 10.1016/j.brainres.2019.02.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/12/2019] [Accepted: 02/17/2019] [Indexed: 01/06/2023]
Abstract
We previously reported that mRNA encoding secreted phosphoprotein 1 (SPP1), also known as osteopontin, is preferentially expressed in large neurons in layer V of the macaque motor cortex, most of which are presumed to be corticospinal tract neurons. As a first step to elucidating the cellular function of SPP1 in macaque neurons, we examined the localization of SPP1 in the primary motor cortex (M1) of the macaque by using immunohistochemistry. SPP1 immunoreactivity was found to be localized in the cell bodies of neurons, but not outside the cells, indicating that SPP1 was not secreted from these neurons. The results of electron microscope analysis and double-labeling analysis with marker proteins suggested that SPP1 was localized in the mitochondria of neurons. The distributions of SPP1 in the neurons corresponded to those of integrin αV, a putative receptor for SPP1. The distribution of SPP1 was also investigated in macaques whose M1 had been lesioned. We found that SPP1 was secreted by proliferated microglia in the lesioned area. Double-labeling analysis indicated that SPP1 immunoreactivity in the microglia was colocalized with CD44, another putative receptor for SPP1. Success rates in the small-object-retrieval task were positively correlated with SPP1 immunoreactivity in the neurons in the perilesional area. SPP1 has multiple roles in the macaque motor cortex, and it may be a key protein during recovery of hand movement after brain damage.
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Affiliation(s)
- Yoko Sugiyama
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Ibaraki 305-8568, Japan; Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki 305-8574, Japan
| | - Takao Oishi
- Systems Neuroscience Section, Primate Research Institute, Kyoto University, Inuyama, Aichi 484-8506, Japan
| | - Akiko Yamashita
- Division of Biology, Department of Liberal Education, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Yumi Murata
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Ibaraki 305-8568, Japan
| | - Tatsuya Yamamoto
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Ibaraki 305-8568, Japan; Department of Physical Therapy, Faculty of Medical and Health Sciences, Tsukuba International University, Tsuchiura, Ibaraki 300-0051, Japan
| | - Ichiro Takashima
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Ibaraki 305-8568, Japan; Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki 305-8574, Japan
| | - Tadashi Isa
- Department of Neuroscience, Graduate School of Medicine, Kyoto University, Yoshida-konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Noriyuki Higo
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Ibaraki 305-8568, Japan.
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Turner MR, Eisen A, Kiernan MC, Ravits J, Swash M. Kinnier Wilson's puzzling features of amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2018; 89:657-666. [PMID: 29122933 DOI: 10.1136/jnnp-2017-317217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Martin R Turner
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Andrew Eisen
- Department of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew C Kiernan
- Brain and Mind Centre, Sydney Medical School, The University of Sydney; Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - John Ravits
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
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Swash M. Sensorimotor integration is problematic in amyotrophic lateral sclerosis. Clin Neurophysiol 2018; 129:849-850. [DOI: 10.1016/j.clinph.2018.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
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Beyond fractional anisotropy in amyotrophic lateral sclerosis: the value of mean, axial, and radial diffusivity and its correlation with electrophysiological conductivity changes. Neuroradiology 2018; 60:505-515. [PMID: 29564498 DOI: 10.1007/s00234-018-2012-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 02/26/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE This paper aims to analyze the contribution of mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) in the detection of microstructural abnormalities in amyotrophic lateral sclerosis (ALS) and to evaluate the degree of agreement between structural and functional changes through concomitant diffusion tensor imaging (DTI), transcranial magnetic stimulation (TMS), and clinical assessment. METHODS Fourteen patients with ALS and 11 healthy, age- and gender-matched controls were included. All participants underwent magnetic resonance imaging including DTI. TMS was additionally performed in ALS patients. Differences in the distribution of DTI-derived measures were assessed using tract-based spatial statistical (TBSS) and volume of interest (VOI) analyses. Correlations between clinical, imaging, and neurophysiological findings were also assessed through TBSS. RESULTS ALS patients showed a significant increase in AD and MD involving the corticospinal tract (CST) and the pre-frontal white matter in the right posterior limb of the internal capsule (p < 0.05) when compared to the control group using TBSS, confirmed by VOI analyses. VOI analyses also showed increased AD in the corpus callosum (p < 0.05) in ALS patients. Fractional anisotropy (FA) in the right CST correlated significantly with upper motor neuron (UMN) score (r = - 0.79, p < 0.05), and right abductor digiti minimi central motor conduction time was highly correlated with RD in the left posterior internal capsule (r = - 0.81, p < 0.05). No other significant correlation was found. CONCLUSION MD, AD, and RD, besides FA, are able to further detect and characterize neurodegeneration in ALS. Furthermore, TMS and DTI appear to have a role as complementary diagnostic biomarkers of UMN dysfunction.
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Stämpfli P, Sommer S, Czell D, Kozerke S, Neuwirth C, Weber M, Sartoretti-Schefer S, Seifritz E, Gutzeit A, Reischauer C. Investigation of Neurodegenerative Processes in Amyotrophic Lateral Sclerosis Using White Matter Fiber Density. Clin Neuroradiol 2018; 29:493-503. [DOI: 10.1007/s00062-018-0670-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/19/2018] [Indexed: 12/20/2022]
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Sangari S, Giron A, Marrelec G, Pradat PF, Marchand-Pauvert V. Abnormal cortical brain integration of somatosensory afferents in ALS. Clin Neurophysiol 2017; 129:874-884. [PMID: 29317192 DOI: 10.1016/j.clinph.2017.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/25/2017] [Accepted: 12/11/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Infraclinical sensory alterations have been reported at early stages of amyotrophic lateral sclerosis (ALS). While previous studies mainly focused on early somatosensory evoked potentials (SEPs), late SEPs, which reflect on cortical pathways involved in cognitive-motor functions, are relatively underinvestigated. Early and late SEPs were compared to assess their alterations in ALS. METHODS Median and ulnar nerves were electrically stimulated at the wrist, at 9 times the perceptual threshold, in 21 ALS patients without clinical evidence of sensory deficits, and 21 age- and gender-matched controls. SEPs were recorded at the Erb point using surface electrodes and using a needle inserted in the scalp, in front of the primary somatosensory area (with reference electrode on the ear lobe). RESULTS Compared to controls, ALS patients showed comparable peripheral (N9) and early cortical component (N20, P25, N30) reductions, while the late cortical components (N60, P100) were more depressed than the early ones. CONCLUSIONS The peripheral sensory alteration likely contributed to late SEP depression to a lesser extent than that of early SEPs. SIGNIFICANCE Late SEPs may provide new insights on abnormal cortical excitability affecting brain areas involved in cognitive-motor functions.
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Affiliation(s)
- Sina Sangari
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, Inserm, Laboratoire d'Imagerie Biomédicale, F-75013 Paris, France
| | - Alain Giron
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, Inserm, Laboratoire d'Imagerie Biomédicale, F-75013 Paris, France
| | - Guillaume Marrelec
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, Inserm, Laboratoire d'Imagerie Biomédicale, F-75013 Paris, France
| | - Pierre-François Pradat
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, Inserm, Laboratoire d'Imagerie Biomédicale, F-75013 Paris, France; Département de Neurologie, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France
| | - Véronique Marchand-Pauvert
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, Inserm, Laboratoire d'Imagerie Biomédicale, F-75013 Paris, France.
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Bede P, Hardiman O. Longitudinal structural changes in ALS: a three time-point imaging study of white and gray matter degeneration. Amyotroph Lateral Scler Frontotemporal Degener 2017; 19:232-241. [DOI: 10.1080/21678421.2017.1407795] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Peter Bede
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland and
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Orla Hardiman
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland and
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
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Mountney A, Boutté AM, Cartagena CM, Flerlage WF, Johnson WD, Rho C, Lu XC, Yarnell A, Marcsisin S, Sousa J, Vuong C, Zottig V, Leung LY, Deng-Bryant Y, Gilsdorf J, Tortella FC, Shear DA. Functional and Molecular Correlates after Single and Repeated Rat Closed-Head Concussion: Indices of Vulnerability after Brain Injury. J Neurotrauma 2017; 34:2768-2789. [PMID: 28326890 DOI: 10.1089/neu.2016.4679] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Closed-head concussive injury is one of the most common causes of traumatic brain injury (TBI). Isolated concussions frequently produce acute neurological impairments, and individuals typically recover spontaneously within a short time frame. In contrast, brain injuries resulting from multiple concussions can result in cumulative damage and elevated risk of developing chronic brain pathologies. Increased attention has focused on identification of diagnostic markers that can prognostically serve as indices of brain health after injury, revealing the temporal profile of vulnerability to a second insult. Such markers may demarcate adequate recovery periods before concussed patients can return to required activities. We developed a noninvasive closed-head impact model that captures the hallmark symptoms of concussion in the absence of gross tissue damage. Animals were subjected to single or repeated concussive impact and examined using a battery of neurological, vestibular, sensorimotor, and molecular metrics. A single concussion induced transient, but marked, acute neurological impairment, gait alterations, neuronal death, and increased glial fibrillary acidic protein (GFAP) expression in brain tissue. As expected, repeated concussions exacerbated sensorimotor dysfunction, prolonged gait abnormalities, induced neuroinflammation, and upregulated GFAP and tau. These animals also exhibited chronic functional neurological impairments with sustained astrogliosis and white matter thinning. Acute changes in molecular signatures correlated with behavioral impairments, whereas increased times to regaining consciousness and balance impairments were associated with higher GFAP and neuroinflammation. Overall, behavioral consequences of either single or repeated concussive impact injuries appeared to resolve more quickly than the underlying molecular, metabolic, and neuropathological abnormalities. This observation, which is supported by similar studies in other mTBI models, underscores the critical need to develop more objective prognostic measures for guiding return-to-play decisions.
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Affiliation(s)
- Andrea Mountney
- 1 Brain Trauma Neuroprotection and Neurorestoration Branch, Walter Reed Army Institute of Research , Silver Spring, Maryland
| | - Angela M Boutté
- 1 Brain Trauma Neuroprotection and Neurorestoration Branch, Walter Reed Army Institute of Research , Silver Spring, Maryland
| | - Casandra M Cartagena
- 1 Brain Trauma Neuroprotection and Neurorestoration Branch, Walter Reed Army Institute of Research , Silver Spring, Maryland
| | - William F Flerlage
- 1 Brain Trauma Neuroprotection and Neurorestoration Branch, Walter Reed Army Institute of Research , Silver Spring, Maryland
| | - Wyane D Johnson
- 1 Brain Trauma Neuroprotection and Neurorestoration Branch, Walter Reed Army Institute of Research , Silver Spring, Maryland
| | - Chanyang Rho
- 1 Brain Trauma Neuroprotection and Neurorestoration Branch, Walter Reed Army Institute of Research , Silver Spring, Maryland
| | - Xi-Chu Lu
- 1 Brain Trauma Neuroprotection and Neurorestoration Branch, Walter Reed Army Institute of Research , Silver Spring, Maryland
| | - Angela Yarnell
- 2 Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research , Silver Spring, Maryland
| | - Sean Marcsisin
- 3 Division of Experimental Therapeutics, Military Malaria Research, Walter Reed Army Institute of Research , Silver Spring, Maryland
| | - Jason Sousa
- 3 Division of Experimental Therapeutics, Military Malaria Research, Walter Reed Army Institute of Research , Silver Spring, Maryland
| | - Chau Vuong
- 3 Division of Experimental Therapeutics, Military Malaria Research, Walter Reed Army Institute of Research , Silver Spring, Maryland
| | - Victor Zottig
- 3 Division of Experimental Therapeutics, Military Malaria Research, Walter Reed Army Institute of Research , Silver Spring, Maryland
| | - Lai-Yee Leung
- 1 Brain Trauma Neuroprotection and Neurorestoration Branch, Walter Reed Army Institute of Research , Silver Spring, Maryland
| | - Ying Deng-Bryant
- 1 Brain Trauma Neuroprotection and Neurorestoration Branch, Walter Reed Army Institute of Research , Silver Spring, Maryland
| | - Janice Gilsdorf
- 1 Brain Trauma Neuroprotection and Neurorestoration Branch, Walter Reed Army Institute of Research , Silver Spring, Maryland
| | - Frank C Tortella
- 1 Brain Trauma Neuroprotection and Neurorestoration Branch, Walter Reed Army Institute of Research , Silver Spring, Maryland
| | - Deborah A Shear
- 1 Brain Trauma Neuroprotection and Neurorestoration Branch, Walter Reed Army Institute of Research , Silver Spring, Maryland
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McCombe PA, Wray NR, Henderson RD. Extra-motor abnormalities in amyotrophic lateral sclerosis: another layer of heterogeneity. Expert Rev Neurother 2017; 17:561-577. [PMID: 27983884 DOI: 10.1080/14737175.2017.1273772] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease defined by the presence of muscle weakness. The motor features of disease are heterogeneous in site of onset and progression. There are also extra-motor features in some patients. The genetic basis for extra-motor features is uncertain. The heterogeneity of ALS is an issue for clinical trials. Areas covered: This paper reviews the range and prevalence of extra-motor features associated with ALS, and highlights the current information about genetic associations with extra-motor features. Expert commentary: There are extra-motor features of ALS, but these are not found in all patients. The most common is cognitive abnormality. More data is required to ascertain whether extra-motor features arise with progression of disease. Extra-motor features are reported in patients with a range of causative genetic mutations, but are not found in all patients with these mutations. Further studies are required of the heterogeneity of ALS, and genotype/phenotype correlations are required, taking note of extra-motor features.
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Affiliation(s)
- P A McCombe
- a The University of Queensland Centre for Clinical Research and Department of Neurology, Royal Brisbane and Women's Hospital , Brisbane , Australia
| | - N R Wray
- b The University of Queensland Institute for Molecular Bioscience , Brisbane , Australia
| | - R D Henderson
- a The University of Queensland Centre for Clinical Research and Department of Neurology, Royal Brisbane and Women's Hospital , Brisbane , Australia
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Bede P, Iyer PM, Schuster C, Elamin M, Mclaughlin RL, Kenna K, Hardiman O. The selective anatomical vulnerability of ALS: 'disease-defining' and 'disease-defying' brain regions. Amyotroph Lateral Scler Frontotemporal Degener 2016; 17:561-570. [PMID: 27087114 DOI: 10.3109/21678421.2016.1173702] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A large multiparametric MRI study has been undertaken to evaluate anatomical patterns of basal ganglia, white matter and cortical grey matter involvement in ALS. Unaffected brain regions are mapped in patients with significant disability. Multiple white matter diffusivity measures, cortical grey matter density alterations, basal ganglia volumes and subcortical grey matter atrophy patterns are evaluated. Results demonstrated a strikingly selective anatomical vulnerability pattern in ALS that preferentially affects specific grey matter structures, commissural white matter tracts and basal ganglia regions, suggestive of networkwise neurodegeneration in ALS. In conclusion, ALS pathology exhibits predilection for selective and inter-connected anatomical sites that can be comprehensively characterized in vivo by multiparametric neuroimaging. The systematic characterization of unaffected brain regions in ALS has implications for the development of classifier analyses and elucidation of disease biology. The involvement and sparing of contiguous brain regions raises important pathophysiological, phylogenetic and ontogenetic questions regarding ALS pathogenesis and disease spread.
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Affiliation(s)
- Peter Bede
- a Quantitative Neuroimaging Group, Academic Unit of Neurology , Biomedical Sciences Institute, Trinity College Dublin , Ireland
| | - Parameswaran M Iyer
- a Quantitative Neuroimaging Group, Academic Unit of Neurology , Biomedical Sciences Institute, Trinity College Dublin , Ireland
| | - Christina Schuster
- a Quantitative Neuroimaging Group, Academic Unit of Neurology , Biomedical Sciences Institute, Trinity College Dublin , Ireland
| | - Marwa Elamin
- a Quantitative Neuroimaging Group, Academic Unit of Neurology , Biomedical Sciences Institute, Trinity College Dublin , Ireland
| | - Russell L Mclaughlin
- a Quantitative Neuroimaging Group, Academic Unit of Neurology , Biomedical Sciences Institute, Trinity College Dublin , Ireland
| | - Kevin Kenna
- a Quantitative Neuroimaging Group, Academic Unit of Neurology , Biomedical Sciences Institute, Trinity College Dublin , Ireland
| | - Orla Hardiman
- a Quantitative Neuroimaging Group, Academic Unit of Neurology , Biomedical Sciences Institute, Trinity College Dublin , Ireland
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Clark R, Blizzard C, Dickson T. Inhibitory dysfunction in amyotrophic lateral sclerosis: future therapeutic opportunities. Neurodegener Dis Manag 2015; 5:511-25. [DOI: 10.2217/nmt.15.49] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In amyotrophic lateral sclerosis, motor neuron hyperexcitability and inhibitory dysfunction is emerging as a potential causative link in the dysfunction and degeneration of the motoneuronal circuitry that characterizes the disease. Interneurons, as key regulators of excitability, may mediate much of this imbalance, yet we know little about the way in which inhibitory deficits perturb excitability. In this review, we explore inhibitory control of excitability and the potential contribution of altered inhibition to amyotrophic lateral sclerosis disease processes and vulnerabilities, identifying important windows of therapeutic opportunity and potential interventions, specifically targeting inhibitory control at key disease stages.
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Affiliation(s)
- Rosemary Clark
- Menzies Institute for Medical Research, University of Tasmania, Hobart TAS 7000, Australia
| | - Catherine Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart TAS 7000, Australia
| | - Tracey Dickson
- Menzies Institute for Medical Research, University of Tasmania, Hobart TAS 7000, Australia
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Prell T, Hartung V, Tietz F, Penzlin S, Ilse B, Schweser F, Deistung A, Bokemeyer M, Reichenbach JR, Witte OW, Grosskreutz J. Susceptibility-weighted imaging provides insight into white matter damage in amyotrophic lateral sclerosis. PLoS One 2015; 10:e0131114. [PMID: 26110427 PMCID: PMC4481412 DOI: 10.1371/journal.pone.0131114] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/28/2015] [Indexed: 11/20/2022] Open
Abstract
Background Amyotrophic lateral sclerosis (ALS) is a fatal, progressive neurodegenerative disorder, characterised by widespread white matter damage. There is growing evidence that disturbances in iron metabolism contribute to white matter alterations. Materials & Methods We analysed the data of susceptibility-weighted imaging (SWI) of white matter in a cohort of 27 patients with ALS and 30 healthy age-matched controls. Results Signal alterations were found on SWI in the corpus callosum; along the corticospinal tract (subcortical motor cortex, posterior limb of the internal capsule and brainstem levels) and in the subgyral regions of frontal, parietal, temporal, occipital and limbic lobes. Alterations of white matter in the corpus callosum correlated with disease severity as assessed by the revised ALS functional rating scale. Conclusion SWI is capable of indicating iron and myelin disturbances in white matter of ALS patients. The SWI patterns observed in this study suggest that widespread alterations due to iron disturbances occur in patients with ALS and correlate with disease severity.
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Affiliation(s)
- Tino Prell
- Hans-Berger Department of Neurology, Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany
- * E-mail:
| | - Viktor Hartung
- Department of Radiology, HELIOS Kreiskrankenhaus Gotha, 99867, Gotha, Germany
| | - Florian Tietz
- Hans-Berger Department of Neurology, Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany
| | - Susanne Penzlin
- Hans-Berger Department of Neurology, Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany
| | - Benjamin Ilse
- Department of Neurology, University of Göttingen, 37075, Göttingen, Germany
| | - Ferdinand Schweser
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, New York, United States of America
- MRI Clinical and Translational Research Center, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, New York, United States of America
| | - Andreas Deistung
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
| | - Martin Bokemeyer
- Department of Neuroradiology, Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany
| | - Jürgen R. Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
| | - Otto W. Witte
- Hans-Berger Department of Neurology, Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany
| | - Julian Grosskreutz
- Hans-Berger Department of Neurology, Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany
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de Carvalho M, Eisen A, Krieger C, Swash M. Motoneuron firing in amyotrophic lateral sclerosis (ALS). Front Hum Neurosci 2014; 8:719. [PMID: 25294995 PMCID: PMC4170108 DOI: 10.3389/fnhum.2014.00719] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/27/2014] [Indexed: 01/09/2023] Open
Abstract
Amyotrophic lateral sclerosis is an inexorably progressive neurodegenerative disorder involving the classical motor system and the frontal effector brain, causing muscular weakness and atrophy, with variable upper motor neuron signs and often an associated fronto-temporal dementia. The physiological disturbance consequent on the motor system degeneration is beginning to be well understood. In this review we describe aspects of the motor cortical, neuronal, and lower motor neuron dysfunction. We show how studies of the changes in the pattern of motor unit firing help delineate the underlying pathophysiological disturbance as the disease progresses. Such studies are beginning to illuminate the underlying disordered pathophysiological processes in the disease, and are important in designing new approaches to therapy and especially for clinical trials.
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Affiliation(s)
- Mamede de Carvalho
- Institute of Physiology and Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon Lisbon, Portugal ; Department of Neurosciences, Hospital Santa Maria, Faculty of Medicine, University of Lisbon Lisbon, Portugal
| | - Andrew Eisen
- Emeritus Professor of Neurology, University of British Columbia Vancouver, BC, Canada
| | - Charles Krieger
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby BC, Canada ; Department of Medicine (Neurology), University of British Columbia, Vancouver BC, Canada
| | - Michael Swash
- Institute of Physiology and Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon Lisbon, Portugal ; Department of Neurosciences, Hospital Santa Maria, Faculty of Medicine, University of Lisbon Lisbon, Portugal ; Institute of Neuroscience, Barts and The London School of Medicine, Queen Mary University of London London, UK
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Abhinav K, Yeh FC, El-Dokla A, Ferrando LM, Chang YF, Lacomis D, Friedlander RM, Fernandez-Miranda JC. Use of diffusion spectrum imaging in preliminary longitudinal evaluation of amyotrophic lateral sclerosis: development of an imaging biomarker. Front Hum Neurosci 2014; 8:270. [PMID: 24808852 PMCID: PMC4010737 DOI: 10.3389/fnhum.2014.00270] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 04/10/2014] [Indexed: 11/13/2022] Open
Abstract
Previous diffusion tensor imaging (DTI) studies have shown white matter pathology in amyotrophic lateral sclerosis (ALS), predominantly in the motor pathways. Further these studies have shown that DTI can be used longitudinally to track pathology over time, making white matter pathology a candidate as an outcome measure in future trials. DTI has demonstrated application in group studies, however its derived indices, for example fractional anisotropy, are susceptible to partial volume effects, making its role questionable in examining individual progression. We hypothesize that changes in the white matter are present in ALS beyond the motor tracts, and that the affected pathways and associated pattern of disease progression can be tracked longitudinally using automated diffusion connectometry analysis. Connectometry analysis is based on diffusion spectrum imaging and overcomes the limitations of a conventional tractography approach and DTI. The identified affected white matter tracts can then be assessed in a targeted fashion using High definition fiber tractography (a novel white matter MR imaging technique). Changes in quantitative and qualitative markers over time could then be correlated with clinical progression. We illustrate these principles toward developing an imaging biomarker for demonstrating individual progression, by presenting results for five ALS patients, including with longitudinal data in two. Preliminary analysis demonstrated a number of changes bilaterally and asymmetrically in motoric and extramotoric white matter pathways. Further the limbic system was also affected possibly explaining the cognitive symptoms in ALS. In the two longitudinal subjects, the white matter changes were less extensive at baseline, although there was evidence of disease progression in a frontal pattern with a relatively spared postcentral gyrus, consistent with the known pathology in ALS.
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Affiliation(s)
- Kumar Abhinav
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh PA, USA
| | - Fang-Cheng Yeh
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh PA, USA
| | - Ahmed El-Dokla
- Department of Neurology, University of Pittsburgh Medical Center Pittsburgh, PA, USA
| | - Lisa M Ferrando
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh PA, USA
| | - Yue-Fang Chang
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh PA, USA
| | - David Lacomis
- Department of Neurology, University of Pittsburgh Medical Center Pittsburgh, PA, USA
| | - Robert M Friedlander
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh PA, USA ; Walter Dandy Endowed Professor of Neurosurgery and Neurobiology, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Pittsburgh, PA, USA
| | - Juan C Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh PA, USA
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17
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Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration. Amyotroph Lateral Scler Frontotemporal Degener 2013. [DOI: 10.3109/21678421.2013.838413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Prell T, Grosskreutz J. The involvement of the cerebellum in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14:507-15. [DOI: 10.3109/21678421.2013.812661] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Keil C, Prell T, Peschel T, Hartung V, Dengler R, Grosskreutz J. Longitudinal diffusion tensor imaging in amyotrophic lateral sclerosis. BMC Neurosci 2012; 13:141. [PMID: 23134591 PMCID: PMC3531302 DOI: 10.1186/1471-2202-13-141] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 10/31/2012] [Indexed: 12/11/2022] Open
Abstract
Background Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder, caused by progressive loss of motor neurons. Changes are widespread in the subcortical white matter in ALS. Diffusion tensor imaging (DTI) detects pathological changes in white matter fibres in vivo, based on alterations in the degree (diffusivity, ADC) and directedness (fractional anisotropy, FA) of proton movement. Methods 24 patients with ALS and 24 age-matched controls received 1.5T DTI. FA and ADC were analyzed using statistical parametric mapping. In 15 of the 24 ALS patients, a second DTI was obtained after 6 months. Results Decreased FA in the corticospinal tract (CST) and frontal areas confirm existing results. With a direct comparison of baseline and follow-up dataset, the progression of upper motor neuron degeneration, reflected in FA decrease, could be captured along the CST and in frontal areas. The involvement of cerebellum in the pathology of ALS, as suspected from functional MRI studies, could be confirmed by a reduced FA (culmen, declive). These structural changes correlated well with disease duration, ALSFRS-R, and physical and executive functions. Conclusion DTI detects changes that are regarded as prominent features of ALS and thus, shows promise in its function as a biomarker. Using the technique herein, we could demonstrate DTI changes at follow-up which correlated well with clinical progression.
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Affiliation(s)
- Carsten Keil
- Department of Neurology, Jena University Hospital, Erlanger Allee 101, Jena 07747, Germany
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20
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Cirillo M, Esposito F, Tedeschi G, Caiazzo G, Sagnelli A, Piccirillo G, Conforti R, Tortora F, Monsurrò MR, Cirillo S, Trojsi F. Widespread microstructural white matter involvement in amyotrophic lateral sclerosis: a whole-brain DTI study. AJNR Am J Neuroradiol 2012; 33:1102-8. [PMID: 22300932 PMCID: PMC8013257 DOI: 10.3174/ajnr.a2918] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 09/23/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The extensive application of advanced MR imaging techniques to the study of ALS has undoubtedly improved our knowledge of disease pathophysiology, even if the actual spread of the neurodegenerative process throughout the central nervous system is not fully understood. The present study aimed to detect WM patterns of microstructural abnormalities to better investigate the pathologic process in ALS, within but also beyond CSTs, in a whole-brain analysis. MATERIALS AND METHODS DTI was performed in 19 patients with ALS and 20 matched healthy controls, by using whole-brain TBSS and VOI analyses. RESULTS We observed a significant decrease of FA in the body of CC of the ALS group (P < .05). At the VOI level, both FA decrease and RD increase in the body of CC significantly correlated with the UMN score (P = .003 and P = .02). Additionally, significant voxelwise positive correlations between FA and the ALSFRS-R were detected in the WM tracts underneath the left premotor cortex (P < .05). CONCLUSIONS The correlations between reduction of FA and increase of RD in the body of CC with the UMN score indicate that the WM degeneration in the CC is strictly related to the ALS pyramidal impairment, while the correlation between FA and ALSFRS-R in the associative tracts underneath the left premotor cortex might reflect the progressive spread of the disease from the motor toward the extramotor areas.
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Affiliation(s)
- M Cirillo
- Department of Neurological Sciences, Second University of Naples, Naples, Italy
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21
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de Carvalho M, Turkman A, Swash M. Motor unit firing in amyotrophic lateral sclerosis and other upper and lower motor neurone disorders. Clin Neurophysiol 2012; 123:2312-8. [PMID: 22627021 DOI: 10.1016/j.clinph.2012.04.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 02/25/2012] [Accepted: 04/01/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Motor unit recruitment order and firing rate was investigated in healthy subjects, and in small numbers of patients 50years ago. We aimed to investigate firing rate in different disorders, testing the same target muscle with normal strength, to evaluate possible application in diagnosing upper motor neuron (UMN) lesion. METHODS We studied motor unit firing in the tibialis anterior muscle in six groups of subjects; normal subjects (n=45), patients with amyotrophic lateral sclerosis (ALS) (n=36), primary lateral sclerosis (PLS) (n=21), progressive muscular atrophy (PMA) (n=14), various upper motor neurone lesions (n=16) and polyneuropathy (n=42). In all these subjects the tibialis anterior muscle was of normal strength. Motor units were recruited during slight contraction in order to study 2-5 motor units at each recording site, using a standard concentric needle electrode, so that 20-22 motor units were recorded in each muscle. We analysed the coefficient of variation (CV) for amplitude, area, duration and firing rate in these motor units, and the correlation between motor unit potential size and recruitment order. RESULTS The mean MU firing rate in this task was similar in each group. No recruitment order was disclosed within the limits of the study task. The CV of firing rate was decreased in UMN and PLS groups. ALS patients with marked spasticity showed a lower CV of motor unit firing rate. The CV of amplitude, area and duration was similar between groups. CONCLUSIONS These results in tibialis anterior indicate that physiological modulation of lower motor neuron (LMN) firing rate is decreased in patients with lower limb spasticity. The variability of MU discharges tends to be greater in diseases affecting the LMN. SIGNIFICANCE These results suggest that, notwithstanding the simplicity of the task we have used, the physiological variability of motor unit firing may be a useful variable in assessing UMN involvement in motor system disorders.
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Pigmented creatine deposits in Amyotrophic Lateral Sclerosis central nervous system tissues identified by synchrotron Fourier Transform Infrared microspectroscopy and X-ray fluorescence spectromicroscopy. Neuroscience 2010; 166:1119-28. [DOI: 10.1016/j.neuroscience.2010.01.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 01/06/2010] [Accepted: 01/08/2008] [Indexed: 11/18/2022]
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Ciccarelli O, Behrens TE, Johansen-Berg H, Talbot K, Orrell RW, Howard RS, Nunes RG, Miller DH, Matthews PM, Thompson AJ, Smith SM. Investigation of white matter pathology in ALS and PLS using tract-based spatial statistics. Hum Brain Mapp 2009; 30:615-24. [PMID: 18172851 DOI: 10.1002/hbm.20527] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE We aimed to investigate differences in fractional anisotropy (FA) between primary lateral sclerosis (PLS) and amyotrophic lateral sclerosis (ALS) and the relationship between FA and disease progression using tract-based spatial statistics (TBSS). METHODS Two scanners at two different sites were used. Differences in FA between ALS patients and controls scanned in London were investigated. From the results of this analysis, brain regions were selected to test for (i) differences in FA between controls, patients with ALS and patients with PLS scanned in Oxford and (ii) the relationship between FA and disease progression rate in the Oxford patient groups. RESULTS London ALS patients showed a lower FA than controls in several brain regions. Oxford patients with PLS showed a lower FA than ALS patients and than controls in the body of the corpus callosum and in the white matter adjacent to the right primary motor cortex (PMC), while ALS patients showed reduced FA compared with PLS patients in the white matter adjacent to the superior frontal gyrus. Significant correlations were found between disease progression rate and (i) FA in the white matter adjacent to the PMC in PLS, and (ii) FA along the cortico-spinal tract and in the body of the corpus callosum in ALS. CONCLUSIONS We described significant FA changes between PLS and ALS, suggesting that these two presentations of motor neuron disease show different features. The significant correlation between FA and disease progression rate in PLS suggests the tissue damage reflected in FA changes contributes to the disease progression rate.
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Affiliation(s)
- Olga Ciccarelli
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, Queen Square, London.
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Polvikoski TM, Murray A, Harper PS, Neal JW. Familial motor neurone disease with dementia: phenotypic variation and cerebellar pathology. J Neurol Neurosurg Psychiatry 2003; 74:1516-20. [PMID: 14617708 PMCID: PMC1738228 DOI: 10.1136/jnnp.74.11.1516] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To characterise the neuropathological phenotypes of two affected individuals from a family with an unusual clinical phenotype resembling motor neurone disease and dementia. METHODS Histological sections of cerebral cortex, basal ganglia, brain stem, cerebellum, and spinal cord were stained with haematoxylin-eosin, luxol fast blue, silver stains, anti-tau, anti-ubiquitin, anti-alpha-synuclein, and anti-neurofilament. RESULTS Numerous ubiquitin positive, tau and alpha-synuclein negative intraneuronal inclusions were present in the cerebral cortex (particularly within the dentate gyrus), cerebellar cortex, brain stem, and spinal cord. The cerebellar ubiquitinated inclusions were located in the proximal dendrite of the Purkinje cells. Loss of Purkinje cells and occasional silver and neurofilament positive axonal swellings (torpedoes) were also seen within the cerebellar cortex. The main difference between the two cases was the severity of the spinal cord involvement: no significant pathology was present within one, but obvious motor neurone disease within the other. CONCLUSIONS The clinical and neuropathological findings in this family are best described as an example of familial motor neurone disease with dementia. Intraneuronal ubiquitin inclusions together with agyrophilic, neurofilament positive torpedoes were present within the cerebellar cortex, both previously unrecognised findings in this group of diseases.
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Affiliation(s)
- T M Polvikoski
- Department of Histopathology, University Hospital of Wales, Heath Park, Cardiff, UK
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Toosy AT, Werring DJ, Orrell RW, Howard RS, King MD, Barker GJ, Miller DH, Thompson AJ. Diffusion tensor imaging detects corticospinal tract involvement at multiple levels in amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2003; 74:1250-7. [PMID: 12933929 PMCID: PMC1738665 DOI: 10.1136/jnnp.74.9.1250] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Histopathological studies of amyotrophic lateral sclerosis (ALS) are of end stage disease. Diffusion tensor imaging (DTI) provides the opportunity to investigate indirectly corticospinal tract pathology of ALS in vivo. METHODS DTI was used to study the water diffusion characteristics of the corticospinal tracts in 21 patients with ALS and 14 normal controls. The authors measured the fractional anisotropy (FA) and mean diffusivity (MD) along the pyramidal tracts from the internal capsules down to the pyramids. A mixed model regression analysis was used to compare FA and MD between the ALS and control groups. RESULTS FA showed a downward linear trend from the cerebral peduncles to the pyramids and was lower in the ALS group than controls at multiple levels of the corticospinal tract. At the internal capsules, FA was higher on the right. MD showed an upward trend, progressing caudally from the internal capsules to the pyramids. MD was higher at the level of the internal capsule in the ALS group, but caudally this difference was not maintained. No correlations were found between clinical markers of disability and water diffusion indices. CONCLUSIONS These findings provide insights into the pathological processes of ALS. Differences in diffusion characteristics at different anatomical levels may relate to underlying tract architecture or the distribution of pathological damage in ALS. Further development may permit monitoring of progression and treatment of disease.
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Affiliation(s)
- A T Toosy
- The NMR Research Unit, Institute of Neurology, University College London, London, UK
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26
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Shaw PJ, Eggett CJ. Molecular factors underlying selective vulnerability of motor neurons to neurodegeneration in amyotrophic lateral sclerosis. J Neurol 2000; 247 Suppl 1:I17-27. [PMID: 10795883 DOI: 10.1007/bf03161151] [Citation(s) in RCA: 158] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Current research evidence suggests that genetic factors, oxidative stress and glutamatergic toxicity, with damage to critical target proteins and organelles, may be important contributory factors to motor neuron injury in amyotrophic lateral sclerosis (ALS). Various molecular and neurochemical features of human motor neurons may render this cell group differentially vulnerable to such insults. Motor neurons are large cells with long axonal processes which lead to requirements for a high level of mitochondrial activity and a high neurofilament content compared to other neuronal groups. The lack of calcium buffering proteins parvalbumin and calbindin D28k and the low expression of the GluR2 AMPA receptor subunit may render human motor neurons particularly vulnerable to calcium toxicity following glutamate receptor activation. Motor neurons also have a high perisomatic expression of the glutamate transporter protein EAAT2 and a very high expression of the cytosolic free radical scavenging enzyme Cu/Zn superoxide dismutase (SOD1) which may render this cell group vulnerable in the face of genetic or post-translational alterations interfering with the function of these proteins. More detailed characterisation of the molecular features of human motor neurons in the future may allow the strategic development of better neuroprotective therapies for the benefit of patients afflicted by ALS.
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Affiliation(s)
- P J Shaw
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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27
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Abstract
The El Escorial criteria for the diagnosis of amyotrophic lateral sclerosis (ALS) were introduced in 1990 to provide a standardised and diagnostically reliable approach to the early recognition of this disease. It is still unclear, however, whether these are the best criteria available for the early diagnosis of ALS. We applied these criteria retrospectively to clinical material available from 34 cases of autopsy proven ALS in an attempt to validate their usefulness in a pathological series. The clinical material was reviewed and specific clinical signs and anatomical levels of involvement recorded. Only signs listed in the criteria were included in the analysis. The El Escorial criteria for clinically definite ALS demonstrated high sensitivity and accuracy when validated in this clinicopathological study. Neuroimaging and electromyography were important in shortening the time in which patients were given a diagnosis of clinically definite ALS. Other diagnostic dilemmas in ALS and the role of early diagnosis of this disease are discussed.
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Affiliation(s)
- B R Brooks
- ALS Clinical Research Center, University of Wisconsin Hospital and Clinics, Clinical Science Center, Madison 53972-5132, USA.
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28
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Ince PG, Lowe J, Shaw PJ. Amyotrophic lateral sclerosis: current issues in classification, pathogenesis and molecular pathology. Neuropathol Appl Neurobiol 1998; 24:104-17. [PMID: 9634206 DOI: 10.1046/j.1365-2990.1998.00108.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The classification of amyotrophic lateral sclerosis (ALS) is reconsidered in the light of developments in the molecular pathogenesis and histopathology of the condition. A current view is encapsulated in the El Escorial World Federation of Neurology criteria for the diagnosis of ALS. While intended for research purposes, use of these criteria for entry into clinical trials may result in the exclusion of some patient groups with related disorders that are likely to share aetiological mechanisms but which are not classified as 'definite ALS' or 'probable ALS'. The relationship between ALS and the more restricted motor disorders of progressive lateral sclerosis and progressive muscular atrophy, together with cerebral degenerations including ALS-dementia and ALS-related frontal lobe dementia, are reviewed. The possibility is raised that they all represent syndromic manifestations of a similar pathogenetic cascade whose clinical phenotype depends upon the anatomical selectivity of involvement in each individual. The new evidence regarding the central role of oxidative stress and abnormal glutamatergic neurotransmission in familial and sporadic ALS seem applicable across these disorders. New evidence regarding the molecular pathology of inclusion bodies in these various syndromes, including ubiquitinated inclusions and hyaline conglomerate inclusions, shows striking similarities between them. Marked differences in the anatomical distribution of lesions determine the predominance and type of motor and cognitive features in each syndrome. This concept of a clinicopathological spectrum is potentially of equal relevance to other late onset neurodegenerative disorders including multisystem atrophies, the Lewy body disorders and various manifestations of Alzheimer's disease. It will gain increasing importance as therapies evolve from the symptomatic to those directed at underlying pathogenetic events.
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Affiliation(s)
- P G Ince
- Department of Neuropathology, Newcastle General Hospital, University of Newcastle upon Tyne, UK
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Mochizuki Y, Mizutani T, Takasu T. Amyotrophic lateral sclerosis with marked neurological asymmetry: clinicopathological study. Acta Neuropathol 1995; 90:44-50. [PMID: 7572078 DOI: 10.1007/bf00294458] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We attempted to correlate the marked neurological asymmetry observed in two amyotrophic lateral sclerosis patients with their histopathological lesions. Patient 1, a 52-year-old man, developed dysarthria and dysphagia, followed by muscle weakness in the left arm and then of the left leg. Patient 2, a 44-year-old man, developed muscle weakness in the left hand, left leg, tongue with left-sided predominance, right hand and right leg in that order of progression. Both patients exhibited moderate to marked left-sided predominant involvement of the lower motor neuron system, accompanied by retained or hyperactive deep tendon reflexes on the left side in the early stage of their illness. Most of the asymmetry in the lower motor neuron system involvement persisted until the death of the patients. Histopathological examinations, including semiquantitative analysis, revealed that both patients exhibited left-sided predominant degeneration of the lower motor neuron system at those spinal cord levels where the neurological asymmetry was of a moderate to marked degree. In addition left-sided predominant degeneration of the lateral corticospinal tracts was seen in both patients and right-sided predominant involvement of Betz cells in the leg area of the motor cortex of patient 1. This pattern of both the neurological and histopathological asymmetry suggested the probable existence of an intimate somatotopically related linkage between the upper motor neuron system degeneration and lower motor neuron system degeneration in both patients.
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Affiliation(s)
- Y Mochizuki
- Department of Neurology, Nihon University School of Medicine, Tokyo, Japan
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30
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Anand P, Parrett A, Martin J, Zeman S, Foley P, Swash M, Leigh PN, Cedarbaum JM, Lindsay RM, Williams-Chestnut RE. Regional changes of ciliary neurotrophic factor and nerve growth factor levels in post mortem spinal cord and cerebral cortex from patients with motor disease. Nat Med 1995; 1:168-72. [PMID: 7585015 DOI: 10.1038/nm0295-168] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Ciliary neurotrophic factor (CNTF) rescues motor neurons in animal models of injury and neurodegeneration, and disruption of the mouse CNTF gene results in motor neuron degeneration in mature adults. Glial cells increase nerve growth factor (NGF) expression in neuropathological conditions, and the sensory system can be affected in the amyotrophic lateral sclerosis (ALS) type of motor neuronic disease. We therefore studied CNTF and NGF levels in post mortem spinal cord and cerebral cortex from patients with ALS and matched controls. We report a marked decrease of CNTF in the ventral horn of spinal cord in ALS, with no change in cerebral motor cortex. In contrast, NGF levels were decreased in ALS cerebral motor cortex, where the corticospinal tract originates, but increased in the lateral column of spinal cord, which includes the region of corticospinal tract degeneration in ALS. Both CNTF and NGF levels were decreased in ALS dorsal spinal cord.
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Affiliation(s)
- P Anand
- Department of Neurology, London Hospital Medical College, Royal London Hospital, Whitechapel, UK
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31
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Affiliation(s)
- P N Leigh
- University Department of Neurology, Institute of Psychiatry, De Crespigny Park, London, UK
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32
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Chou SM, Norris FH. Amyotrophic lateral sclerosis: lower motor neuron disease spreading to upper motor neurons. Muscle Nerve 1993; 16:864-9. [PMID: 8332139 DOI: 10.1002/mus.880160810] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Contrary to the recently reemphasized notion that the primary neuron involved in amyotrophic lateral sclerosis (ALS) is the cortical (upper) motor neuron (UMN), we believe that the lower motor neuron (LMN) is primarily involved by the retrograde transport of pathogens from neuromuscular junctions, and the disease process spreads monosynaptically to the UMN. Pathologically and epidemiologically, the LMN hypothesis is more logical than the UMN in light of the recent understanding of neuroaxonal transport systems, particularly in regard to anterograde cytoskeleton transport and the kinetics of the force promoting slow axonal transport. By correlating the early pathologic findings, i.e., the swelling of the initial axons and formation of intracytoplasmic inclusions in the LMN, ALS may be regarded as a disease of axonal transport, especially its slow component (SCa). Therapeutic intervention to facilitate SCa should be attempted in ALS.
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Affiliation(s)
- S M Chou
- ALS Research Foundation, San Francisco, California 94115
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Ince P, Stout N, Shaw P, Slade J, Hunziker W, Heizmann CW, Baimbridge KG. Parvalbumin and calbindin D-28k in the human motor system and in motor neuron disease. Neuropathol Appl Neurobiol 1993; 19:291-9. [PMID: 8232749 DOI: 10.1111/j.1365-2990.1993.tb00443.x] [Citation(s) in RCA: 213] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Calbindin D-28k and parvalbumin are neuronal calcium binding proteins of interest in relation to neurodegenerative diseases. Expression of calbindin and parvalbumin may be one of the determinants of selective vulnerability in these disorders. The distribution of these proteins was surveyed in the normal human motor system and in motor neuron disease (MND) using immunocytochemistry in formalin fixed post-mortem tissues. CNS tissues from 14 MND patients (mean age 61.2 years, mean post-mortem delay 24.6 h) and seven controls (mean age 62.6 years, mean post-mortem delay 25.3 h) were studied. Preliminary studies on the effects of fixation were performed. In normal cases upper and lower motor neurons showed absent expression of both proteins. Several neuronal groups characteristically spared in MND showed varying patterns of immunoreactivity: oculomotor neurons showed parvalbumin staining of the perikaryon; the thoracic preganglionic sympathetic neurons showed calbindin staining in perikarya. Onuf's nucleus showed calbindin staining in the neuropil only. In motor neuron disease a loss of ventral horn interneurons and calbindin immunoreactive processes was observed with no other disease related changes in the spinal cord, brain-stem, or motor cortex. These findings are consistent with the hypothesis that the distribution of these proteins is one determinant of selective vulnerability to the neurodegenerative processes in MND acting via disturbance of neuronal calcium homeostasis.
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Affiliation(s)
- P Ince
- MRC Neurochemical Pathology Unit, University of Newcastle upon Tyne, UK
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Gregory R, Mills K, Donaghy M. Progressive sensory nerve dysfunction in amyotrophic lateral sclerosis: a prospective clinical and neurophysiological study. J Neurol 1993; 240:309-14. [PMID: 8326338 DOI: 10.1007/bf00838169] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Sensory nerve function was determined in 19 patients with amyotrophic lateral sclerosis (ALS), using a battery of clinical and neurophysiological tests. This assessment was repeated on 12 patients after intervals of 6-18 months. Twelve controls were also studied. In the ALS group, only 2 patients had noticed mild sensory symptoms and none had sensory signs. Between successive studies the vibration thresholds increased, but not to a significant degree. ALS patients showed a significant fall in amplitude of the sensory nerve action potentials in the median, radial, and sural nerves (P < 0.04); sensory nerve conduction velocity did not alter. The median nerve somatosensory evoked potential N19 latency showed a highly significant increase (P < 0.008). Significant subclinical deterioration in sensory nerve function occurs in ALS, and parallels the progressive motor decline. Neuronal degeneration in ALS is not restricted to motor neurons.
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Affiliation(s)
- R Gregory
- Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK
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Abstract
The cause of amyotrophic lateral sclerosis is unknown. In this review clinical and scientific data that are pertinent to understanding this disease are reviewed. There are currently several major controversies concerning the possible role of immunological factors, genetic factors, environmental toxins, and viral infection in pathogenesis. These concepts must be considered in relation to what is known about the disease in all its aspects, including epidemiological data, information on the classical and molecular pathology of the disease, and on associated involvement of other systems, e.g., the spinocerebellar pathways and frontal dementia. Only when all this information is assimilated can full understanding of the disease and, hopefully, a logical approach to treatment and prevention, be achieved.
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Affiliation(s)
- M Swash
- Department of Clinical Neuroscience, Royal London Hospital, UK
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Affiliation(s)
- M Swash
- Department of Neurology, Royal London Hospital, UK
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Eisen A, Kim S, Pant B. Amyotrophic lateral sclerosis (ALS): a phylogenetic disease of the corticomotoneuron? Muscle Nerve 1992; 15:219-24. [PMID: 1549143 DOI: 10.1002/mus.880150215] [Citation(s) in RCA: 170] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
It is proposed that the primary cell involved in amyotrophic lateral sclerosis (ALS) is the corticomotoneuron. The spinal motoneuron becomes affected as a result of antegrade effects. This hypothesis does not negate most of the presently popular theories regarding the pathogenesis of ALS, but directs focus to one cell type--the corticomotoneuron. It takes cognizance of the complex, monosynaptic, corticomotoneuronal-spinomotoneuronal connections that have evolved in primates, and especially in man. It might explain the lack of any natural or thus far induced animal model which closely mimics the human disease. Threshold measurements to transcotical magnetic stimulation might be used to test the hypothesis. Replication of ALS in an animal is only likely to succeed in a nonhuman primate.
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Affiliation(s)
- A Eisen
- Department of Medicine, University of British Columbia, Canada
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Swash M. Amyotrophic lateral sclerosis: a phylogenetic disease of the corticomotoneuron? Comments on the hypothesis. Muscle Nerve 1992; 15:226-8. [PMID: 1549145 DOI: 10.1002/mus.880150217] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- M Swash
- Department of Neurology, Royal London Hospital, United Kingdom
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Abstract
In motor neuron disease there is a characteristic pattern of nerve cell loss and degeneration of related pathways. In surviving anterior horn cells several morphologically distinct, but generally non-specific, intracytoplasmic inclusion bodies have been recognized. Recently accumulations of previously unrecognized ubiquitinated material have been described in surviving neurons, which cannot be demonstrated with routine histological methods. These changes appear unique to this disease, and provide a new insight into the underlying pathology that may help understand the pathogenesis of this intriguing disorder. In this article we review the new information on the clinical, toxicological and pathological features of the disease.
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Affiliation(s)
- J E Martin
- Department of Morbid Anatomy, London Hospital, Whitechapel
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