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Wu J, Ye S, Liu X, Xu Y, Fan D. The burden of upper motor neuron involvement is correlated with the bilateral limb involvement interval in patients with amyotrophic lateral sclerosis: a retrospective observational study. Neural Regen Res 2025; 20:1505-1512. [PMID: 39075916 DOI: 10.4103/nrr.nrr-d-23-01359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 01/12/2024] [Indexed: 07/31/2024] Open
Abstract
JOURNAL/nrgr/04.03/01300535-202505000-00032/figure1/v/2024-07-28T173839Z/r/image-tiff Amyotrophic lateral sclerosis is a rare neurodegenerative disease characterized by the involvement of both upper and lower motor neurons. Early bilateral limb involvement significantly affects patients' daily lives and may lead them to be confined to bed. However, the effect of upper and lower motor neuron impairment and other risk factors on bilateral limb involvement is unclear. To address this issue, we retrospectively collected data from 586 amyotrophic lateral sclerosis patients with limb onset diagnosed at Peking University Third Hospital between January 2020 and May 2022. A univariate analysis revealed no significant differences in the time intervals of spread in different directions between individuals with upper motor neuron-dominant amyotrophic lateral sclerosis and those with classic amyotrophic lateral sclerosis. We used causal directed acyclic graphs for risk factor determination and Cox proportional hazards models to investigate the association between the duration of bilateral limb involvement and clinical baseline characteristics in amyotrophic lateral sclerosis patients. Multiple factor analyses revealed that higher upper motor neuron scores (hazard ratio [HR] = 1.05, 95% confidence interval [CI] = 1.01-1.09, P = 0.018), onset in the left limb (HR = 0.72, 95% CI = 0.58-0.89, P = 0.002), and a horizontal pattern of progression (HR = 0.46, 95% CI = 0.37-0.58, P < 0.001) were risk factors for a shorter interval until bilateral limb involvement. The results demonstrated that a greater degree of upper motor neuron involvement might cause contralateral limb involvement to progress more quickly in limb-onset amyotrophic lateral sclerosis patients. These findings may improve the management of amyotrophic lateral sclerosis patients with limb onset and the prediction of patient prognosis.
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Affiliation(s)
- Jieying Wu
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Shan Ye
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xiangyi Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Yingsheng Xu
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, 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
- Key Laboratory for Neuroscience, National Health Commission/Ministry of Education, Peking University, Beijing, China
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2
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Albadawi EA. Microstructural Changes in the Corpus Callosum in Neurodegenerative Diseases. Cureus 2024; 16:e67378. [PMID: 39310519 PMCID: PMC11413839 DOI: 10.7759/cureus.67378] [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] [Accepted: 08/21/2024] [Indexed: 09/25/2024] Open
Abstract
The corpus callosum, the largest white matter structure in the brain, plays a crucial role in interhemispheric communication and cognitive function. This review examines the microstructural changes observed in the corpus callosum across various neurodegenerative diseases, including Alzheimer's disease, Parkinson's disease, Huntington's disease, and amyotrophic lateral sclerosis (ALS). New neuroimaging studies, mainly those that use diffusion tensor imaging (DTI) and advanced tractography methods, were put together to show how changes have happened in the organization of white matter and the connections between them. Some of the most common ways the corpus callosum breaks down are discussed, including less fractional anisotropy, higher mean diffusivity, and atrophy in certain regions. The relationship between these microstructural changes and cognitive decline, motor dysfunction, and disease progression is explored. Additionally, we consider the potential of corpus callosum imaging as a biomarker for early disease detection and monitoring. Studies show that people with these disorders have lower fractional anisotropy and higher mean diffusivity in the corpus callosum, often in ways that are specific to the disease. These changes often happen before gray matter atrophy and are linked to symptoms, which suggests that the corpus callosum could be used as an early sign of neurodegeneration. The review also highlights the implications of these findings for understanding disease mechanisms and developing therapeutic strategies. Future directions, including the application of advanced imaging techniques and longitudinal studies, are discussed to elucidate the role of corpus callosum degeneration in neurodegenerative processes. This review underscores the importance of the corpus callosum in understanding the pathophysiology of neurodegenerative diseases and its potential as a target for therapeutic interventions.
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Affiliation(s)
- Emad A Albadawi
- Department of Basic Medical Sciences, College of Medicine, Taibah Univeristy, Madinah, SAU
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3
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Müller HP, Abrahao A, Beaulieu C, Benatar M, Dionne A, Genge A, Frayne R, Graham SJ, Gibson S, Korngut L, Luk C, Welsh RC, Zinman L, Kassubek J, Kalra S. Temporal and spatial progression of microstructural cerebral degeneration in ALS: A multicentre longitudinal diffusion tensor imaging study. Neuroimage Clin 2024; 43:103633. [PMID: 38889523 PMCID: PMC11231599 DOI: 10.1016/j.nicl.2024.103633] [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: 10/04/2023] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE The corticospinal tract (CST) reveals progressive microstructural alterations in ALS measurable by DTI. The aim of this study was to evaluate fractional anisotropy (FA) along the CST as a longitudinal marker of disease progression in ALS. METHODS The study cohort consisted of 114 patients with ALS and 110 healthy controls from the second prospective, longitudinal, multicentre study of the Canadian ALS Neuroimaging Consortium (CALSNIC-2). DTI and clinical data from a harmonized protocol across 7 centres were collected. Thirty-nine ALS patients and 61 controls completed baseline and two follow-up visits and were included for longitudinal analyses. Whole brain-based spatial statistics and hypothesis-guided tract-of-interest analyses were performed for cross-sectional and longitudinal analyses. RESULTS FA was reduced at baseline and longitudinally in the CST, mid-corpus callosum (CC), frontal lobe, and other ALS-related tracts, with alterations most evident in the CST and mid-CC. CST and pontine FA correlated with functional impairment (ALSFRS-R), upper motor neuron function, and clinical disease progression rate. Reduction in FA was largely located in the upper CST; however, the longitudinal decline was greatest in the lower CST. Effect sizes were dependent on region, resulting in study group sizes between 17 and 31 per group over a 9-month interval. Cross-sectional effect sizes were maximal in the upper CST; whereas, longitudinal effect sizes were maximal in mid-callosal tracts. CONCLUSIONS Progressive microstructural alterations in ALS are most prominent in the CST and CC. DTI can provide a biomarker of cerebral degeneration in ALS, with longitudinal changes in white matter demonstrable over a reasonable observation period, with a feasible number of participants, and within a multicentre framework.
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Affiliation(s)
| | - Agessandro Abrahao
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Christian Beaulieu
- Department of Biomedical Engineering, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Benatar
- Neuromuscular Division, Department of Neurology, University of Miami, Miami, FL, United States
| | - Annie Dionne
- Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Angela Genge
- Department of Neurology, McGill University, Montreal, Quebec, Canada
| | - Richard Frayne
- Departments of Radiology and Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Simon J Graham
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Summer Gibson
- Neuromuscular Medicine Division, University of Utah, Salt Lake City, Utah, United States
| | - Lawrence Korngut
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Collin Luk
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; Divison of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Robert C Welsh
- Department of Psychiatry and Biobehavioral Science, UCLA, Los Angeles, CA, United States
| | - Lorne Zinman
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany; German Centre of Neurodegenerative Diseases (DZNE), Ulm, Germany
| | - Sanjay Kalra
- Department of Biomedical Engineering, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Divison of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada.
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4
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Trubshaw M, Gohil C, Yoganathan K, Kohl O, Edmond E, Proudfoot M, Thompson AG, Talbot K, Stagg CJ, Nobre AC, Woolrich M, Turner MR. The cortical neurophysiological signature of amyotrophic lateral sclerosis. Brain Commun 2024; 6:fcae164. [PMID: 38779353 PMCID: PMC11109820 DOI: 10.1093/braincomms/fcae164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/11/2024] [Accepted: 03/09/2024] [Indexed: 05/25/2024] Open
Abstract
The progressive loss of motor function characteristic of amyotrophic lateral sclerosis is associated with widespread cortical pathology extending beyond primary motor regions. Increasing muscle weakness reflects a dynamic, variably compensated brain network disorder. In the quest for biomarkers to accelerate therapeutic assessment, the high temporal resolution of magnetoencephalography is uniquely able to non-invasively capture micro-magnetic fields generated by neuronal activity across the entire cortex simultaneously. This study examined task-free magnetoencephalography to characterize the cortical oscillatory signature of amyotrophic lateral sclerosis for having potential as a pharmacodynamic biomarker. Eight to ten minutes of magnetoencephalography in the task-free, eyes-open state was recorded in amyotrophic lateral sclerosis (n = 36) and healthy age-matched controls (n = 51), followed by a structural MRI scan for co-registration. Extracted magnetoencephalography metrics from the delta, theta, alpha, beta, low-gamma, high-gamma frequency bands included oscillatory power (regional activity), 1/f exponent (complexity) and amplitude envelope correlation (connectivity). Groups were compared using a permutation-based general linear model with correction for multiple comparisons and confounders. To test whether the extracted metrics could predict disease severity, a random forest regression model was trained and evaluated using nested leave-one-out cross-validation. Amyotrophic lateral sclerosis was characterized by reduced sensorimotor beta band and increased high-gamma band power. Within the premotor cortex, increased disability was associated with a reduced 1/f exponent. Increased disability was more widely associated with increased global connectivity in the delta, theta and high-gamma bands. Intra-hemispherically, increased disability scores were particularly associated with increases in temporal connectivity and inter-hemispherically with increases in frontal and occipital connectivity. The random forest model achieved a coefficient of determination (R2) of 0.24. The combined reduction in cortical sensorimotor beta and rise in gamma power is compatible with the established hypothesis of loss of inhibitory, GABAergic interneuronal circuits in pathogenesis. A lower 1/f exponent potentially reflects a more excitable cortex and a pathology unique to amyotrophic lateral sclerosis when considered with the findings published in other neurodegenerative disorders. Power and complexity changes corroborate with the results from paired-pulse transcranial magnetic stimulation. Increased magnetoencephalography connectivity in worsening disability is thought to represent compensatory responses to a failing motor system. Restoration of cortical beta and gamma band power has significant potential to be tested in an experimental medicine setting. Magnetoencephalography-based measures have potential as sensitive outcome measures of therapeutic benefit in drug trials and may have a wider diagnostic value with further study, including as predictive markers in asymptomatic carriers of disease-causing genetic variants.
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Affiliation(s)
- Michael Trubshaw
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, OX3 7JX, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Chetan Gohil
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, OX3 7JX, UK
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK
| | - Katie Yoganathan
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, OX3 7JX, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Oliver Kohl
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, OX3 7JX, UK
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK
| | - Evan Edmond
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, OX3 7JX, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Malcolm Proudfoot
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Alexander G Thompson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Kevin Talbot
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Charlotte J Stagg
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, OX3 7JX, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Anna C Nobre
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, OX3 7JX, UK
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK
| | - Mark Woolrich
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, OX3 7JX, UK
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK
| | - Martin R Turner
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, OX3 7JX, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
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Thompson AG, Taschler B, Smith SM, Turner MR. Premorbid brain structure influences risk of amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2024; 95:360-365. [PMID: 38050140 PMCID: PMC10958375 DOI: 10.1136/jnnp-2023-332322] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/25/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a disease of the motor network associated with brain structure and functional connectivity alterations that are implicated in disease progression. Whether such changes have a causal role in ALS, fitting with a postulated influence of premorbid cerebral architecture on the phenotypes associated with neurodegenerative disorders is not known. METHODS This study considered causal effects and shared genetic risk of 2240 structural and functional MRI brain scan imaging-derived phenotypes (IDPs) on ALS using two sample Mendelian randomisation, with putative associations further examined with extensive sensitivity analysis. Shared genetic predisposition between IDPs and ALS was explored using genetic correlation analysis. RESULTS Increased white matter volume in the cerebral hemispheres was causally associated with ALS. Weaker causal associations were observed for brain stem grey matter volume, parieto-occipital white matter surface and volume of the left thalamic ventral anterior nucleus. Genetic correlation was observed between ALS and intracellular volume fraction and isotropic free water volume fraction within the posterior limb of the internal capsule. CONCLUSIONS This study provides evidence that premorbid brain structure, in particular white matter volume, contributes to the risk of ALS.
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Affiliation(s)
| | - Bernd Taschler
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Stephen M Smith
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Castro J, Pedrosa T, Alves I, Simão S, Swash M, de Carvalho M. A neurophysiological approach to mirror movements in amyotrophic lateral sclerosis. Clin Neurophysiol 2024; 158:27-34. [PMID: 38142663 DOI: 10.1016/j.clinph.2023.12.002] [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: 05/29/2023] [Revised: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVE To investigate mirror activity in amyotrophic lateral sclerosis (ALS) patients, using a simple paradigm of signal quantification. METHODS Patients were asked to perform a brief isometric maximum contraction of the abductor digiti minimi (ADM) or tibialis anterior (TA) on one side, while relaxing the contralateral side of the body. Both sides were investigated. Signals were stored and analyzed offline, for quantification of electromyographic signal. Clinical signs of upper motor neuron (UMN) dysfunction, transcranial magnetic stimulation (TMS) for the upper (UL) and lower limbs (LL), the ADM ipsilateral cortical silent period (iSP) and the Edinburgh Cognitive and Behavioral ALS Screen (ECAS) cognitive scale were also investigated. RESULTS 42 ALS patients were included. In the 4 investigated muscles the amount of mirror activity was significantly higher than in the matched healthy group. The amount of mirror activity was similar between sides, but significantly higher in UL and LL with abnormal TMS results for ADM (p = 0.005) and TA (p = 0.002), as well as in UL with abnormal iSP values (p = 0.009). No association was found between mirror activity and clinical signs of UMN involvement. CONCLUSIONS Mirror activity is a common phenomenon in ALS. Mirror activity intensity corresponds to the severity of UMN dysfunction, as measured by TMS, and probably derives from the abnormal transcallosal inhibition as mirrored by iSP abnormality. SIGNIFICANCE Mirror activity is increased in ALS and is associated with abnormal transcallosal inhibition and UMN dysfunction.
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Affiliation(s)
- José Castro
- Instituto de Fisiologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Department of Neurosciences and Mental Health, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal.
| | - Tomás Pedrosa
- Departamento de Bioengenharia, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Inês Alves
- Instituto de Fisiologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Sara Simão
- Instituto de Fisiologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Michael Swash
- Departments of Neurology and Neuroscience, Barts and the London School of Medicine, Queen Mary University of London, United Kingdom
| | - Mamede de Carvalho
- Instituto de Fisiologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Department of Neurosciences and Mental Health, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
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Eisen A, Vucic S, Mitsumoto H. History of ALS and the competing theories on pathogenesis: IFCN handbook chapter. Clin Neurophysiol Pract 2023; 9:1-12. [PMID: 38213309 PMCID: PMC10776891 DOI: 10.1016/j.cnp.2023.11.004] [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: 09/21/2023] [Revised: 11/07/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegenerative disorder of the human motor system, first described in the 19th Century. The etiology of ALS appears to be multifactorial, with a complex interaction of genetic, epigenetic, and environmental factors underlying the onset of disease. Importantly, there are no known naturally occurring animal models, and transgenic mouse models fail to faithfully reproduce ALS as it manifests in patients. Debate as to the site of onset of ALS remain, with three competing theories proposed, including (i) the dying-forward hypothesis, whereby motor neuron degeneration is mediated by hyperexcitable corticomotoneurons via an anterograde transsynaptic excitotoxic mechanism, (ii) dying-back hypothesis, proposing the ALS begins in the peripheral nervous system with a toxic factor(s) retrogradely transported into the central nervous system and mediating upper motor neuron dysfunction, and (iii) independent hypothesis, suggesting that upper and lower motor neuron degenerated independently. Transcranial magnetic stimulation studies, along with pathological and genetic findings have supported the dying forward hypothesis theory, although the science is yet to be settled. The review provides a historical overview of ALS, discusses phenotypes and likely pathogenic mechanisms.
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Affiliation(s)
- Andrew Eisen
- Division of Neurology, Department of Medicine, University of British Columbia, Canada
| | - Steve Vucic
- Director Brain and Nerve Research Center, Clinical School, University of Sydney, Australia
| | - Hiroshi Mitsumoto
- Wesley J. Howe Professor of Neurology, Columbia University, The Neurological Institute of New York, and New York-Presbyterian Hospital/Columbia University Medical Center, United States
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Abstract
Although the past two decades have produced exciting discoveries in the genetics and pathology of amyotrophic lateral sclerosis (ALS), progress in developing an effective therapy remains slow. This review summarizes the critical discoveries and outlines the advances in disease characterization, diagnosis, imaging, and biomarkers, along with the current status of approaches to ALS care and treatment. Additional knowledge of the factors driving disease progression and heterogeneity will hopefully soon transform the care for patients with ALS into an individualized, multi-prong approach able to prevent disease progression sufficiently to allow for a dignified life with limited disability.
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Affiliation(s)
- Hristelina Ilieva
- Jefferson Weinberg ALS Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Justin Kwan
- National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD, USA
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Rajagopalan V, Pioro EP. Graph network measures reveal distinct white matter abnormalities in motor and extra-motor brain regions of two UMN-predominant ALS subtypes. J Neurol Sci 2023; 452:120765. [PMID: 37672915 DOI: 10.1016/j.jns.2023.120765] [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: 05/09/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Routine clinical magnetic resonance imaging (MRI) shows bilateral corticospinal tract (CST) hyperintensity in some patients with upper motor neuron (UMN)-predominant ALS (ALS-CST+) but not in others (ALS-CST-). Although, similar in their UMN features, the ALS-CST+ patient group is significantly younger in age, has faster disease progression and shorter survival than the ALS-CST- patient group. Reasons for the differences are unclear. METHOD In order to evaluate more objective MRI measures of these ALS subgroups, we used diffusion tensor images (DTI) obtained using single shot echo planar imaging sequence from 1.5 T Siemens MRI Scanner. We performed an exploratory whole brain white matter (WM) network analysis using graph theory approach on 45 ALS patients (ALS-CST+) (n = 21), and (ALS-CST-) (n = 24) and neurological controls (n = 14). RESULTS Significant (p < 0.05) differences in nodal degree measure between ALS patients and controls were observed in motor and extra motor regions, supplementary motor area, subcortical WM regions, cerebellum and vermis. Importantly, WM network abnormalities were significantly (p < 0.05) different between ALS-CST+ and ALS-CST- subgroups. Compared to neurologic controls, both ALS subgroups showed hubs in the right superior occipital gyrus and cuneus as well as significantly (p < 0.05) reduced small worldness supportive of WM network damage. CONCLUSIONS Significant differences between ALS-CST+ and ALS-CST- subgroups of WM network abnormalities, age of onset, symptom duration prior to MRI, and progression rate suggest these patients represent distinct clinical phenotypes and possibly pathophysiologic mechanisms of ALS.
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Affiliation(s)
- Venkateswaran Rajagopalan
- Department of Electrical and Electronics Engineering, Birla Institute of Technology and Science Pilani, Hyderabad Campus, Hyderabad 500078, India
| | - Erik P Pioro
- Neuromuscular Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA; Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
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Milella G, Zoccolella S, Urso D, Nigro S, Tamburrino L, Gnoni V, Filardi M, Logroscino G. Different patterns of spreading direction and motor neurons involvement in a cohort of limb-onset amyotrophic lateral sclerosis patients from Southern Italy: Potential implication on disease course or progression? Brain Behav 2023; 13:e2899. [PMID: 37208847 PMCID: PMC10275554 DOI: 10.1002/brb3.2899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/09/2022] [Accepted: 01/09/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Currently, there is a lack of knowledge concerning where the pathological process starts and how the neurodegeneration spreads during the course of amyotrophic lateral sclerosis (ALS). AIMS This study aims to evaluate the spreading direction of the disease and the corresponding clinical characteristics in a cohort of patients with limb-onset ALS. PATIENTS AND METHODS Consecutive incident ALS patients referring to an ALS tertiary center from Southern Italy, between 2015 and 2021, were recruited in the study. According to the initial directions of spread, patients were dichotomized into horizontal spreading pattern (HSP) or vertical spreading pattern (VSP) groups. RESULTS Among 137 newly diagnosed ALS, 87 presented a spinal onset. Ten patients with pure LMN were not included in the study. All cases reported a clear spread direction. The frequency of HSP and VSP spreading was similar overall (47 vs. 30). The prevalence of HSP was higher (74% vs. 50%) in patients with upper limb-onset (UL-ALS), compared to patients with lower limb-onset (LL-ALS; p < .05). Conversely, the occurrence of VSP spread was threefold higher in patients with LL-ALS, compared to UL-ALS (p < .05). Patients with VSP showed a wider upper motor neuron impairment, whereas the involvement of LMN resulted greater in patients with HSP. Patients with HSP exhibited a greater drop of ALSFRS-r sub-score in the region of onset, while VSP showed a slighter but more diffuse reduction of ASLFRS-r subscore in more body districts beyond the site of onset. Patients with VSP were also characterized by a higher median progression rate and an earlier median bulbar involvement, compared to HSP. CONCLUSIONS Our findings suggested investigating the spreading direction of ALS among patients with spinal onset, to better delineate the clinical profiles of patients with ALS, and predict an earlier impairment of bulbar muscle and a more rapid progression of the disease.
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Affiliation(s)
- Giammarco Milella
- Department of Basic Medicine, Neuroscience and Sense OrgansUniversity of Bari Aldo MoroBariItaly
| | - Stefano Zoccolella
- ASL BariSan Paolo Hospital, Neurology UnitMilanItaly
- Center for Neurodegenerative Diseases and the Aging Brain University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”TricaseItaly
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”TricaseItaly
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”TricaseItaly
| | - Ludovica Tamburrino
- Center for Neurodegenerative Diseases and the Aging Brain University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”TricaseItaly
| | - Valentina Gnoni
- Center for Neurodegenerative Diseases and the Aging Brain University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”TricaseItaly
| | - Marco Filardi
- Department of Basic Medicine, Neuroscience and Sense OrgansUniversity of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging Brain University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”TricaseItaly
| | - Giancarlo Logroscino
- Department of Basic Medicine, Neuroscience and Sense OrgansUniversity of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging Brain University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”TricaseItaly
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Nancy M, Andrea OC, Tarannum B, Maryam O. Brain Magnetic Resonance Imaging (MRI) in Spinal Muscular Atrophy: A Scoping Review. J Neuromuscul Dis 2023:JND221567. [PMID: 37125560 DOI: 10.3233/jnd-221567] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND 5q Spinal Muscular Atrophy (SMA) is a prototypical lower motor neuron disorder. However, the characteristic early motor impairment raises the question on the scope of brain involvement with implications for further investigations on the brain as a potential therapeutic target. OBJECTIVE To review changes across the SMA clinical spectrum reported on brain magnetic resonance imaging (MRI). METHODS We conducted a scoping review of existing literature on PubMed and EMBASE. Two reviewers searched and retrieved relevant articles on magnetic resonance brain imaging in individuals with SMA censoring to April 2022. Full-text articles published in peer-reviewed journals or abstracts accepted to conferences in English and French were included. RESULTS Twelve articles were identified describing a total of 39 patients [age range: 11 days to 41 years old, type 0 (n = 5), type 1 (n = 4), type 2 (n = 2), type 3 (n = 22), type 4 (n = 6)]. All reported structural changes and did not explore other MRI modalities. In individuals with infantile onset SMA, cortical and subcortical brain abnormalities in white matter, basal ganglia, thalamus, hippocampus, and high intensity areas around lateral ventricles and thalami were reported over time. In individuals with later-onset SMA, reduced cerebellar and lobular volume were observed as well as increased grey matter density in motor areas. CONCLUSIONS Limited data on brain imaging in SMA highlights both cortical and subcortical involvement in SMA, supporting the hypothesis that changes are not restricted to lower motor neuron pathways. Further studies are needed to determine the extent and prevalence of structural and functional brain changes across SMA types.
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Affiliation(s)
- Mugisha Nancy
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Oliveira-Carneiro Andrea
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Behlim Tarannum
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Oskoui Maryam
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- Departments of Pediatrics and Neurology Neurosurgery, McGill University, Montreal, Quebec, Canada
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12
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Diffusion Tensor Imaging in Amyotrophic Lateral Sclerosis: Machine Learning for Biomarker Development. Int J Mol Sci 2023; 24:ijms24031911. [PMID: 36768231 PMCID: PMC9915541 DOI: 10.3390/ijms24031911] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Abstract
Diffusion tensor imaging (DTI) allows the in vivo imaging of pathological white matter alterations, either with unbiased voxel-wise or hypothesis-guided tract-based analysis. Alterations of diffusion metrics are indicative of the cerebral status of patients with amyotrophic lateral sclerosis (ALS) at the individual level. Using machine learning (ML) models to analyze complex and high-dimensional neuroimaging data sets, new opportunities for DTI-based biomarkers in ALS arise. This review aims to summarize how different ML models based on DTI parameters can be used for supervised diagnostic classifications and to provide individualized patient stratification with unsupervised approaches in ALS. To capture the whole spectrum of neuropathological signatures, DTI might be combined with additional modalities, such as structural T1w 3-D MRI in ML models. To further improve the power of ML in ALS and enable the application of deep learning models, standardized DTI protocols and multi-center collaborations are needed to validate multimodal DTI biomarkers. The application of ML models to multiparametric MRI/multimodal DTI-based data sets will enable a detailed assessment of neuropathological signatures in patients with ALS and the development of novel neuroimaging biomarkers that could be used in the clinical workup.
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13
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Yasui M, Koh J, Nakayama Y, Sakata M, Hiwatani Y, Ishiguchi H, Ito H. Diagnostic utility of susceptibility-weighted imaging in amyotrophic lateral sclerosis. J Neurol Sci 2023; 444:120524. [PMID: 36563605 DOI: 10.1016/j.jns.2022.120524] [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: 08/05/2022] [Revised: 11/09/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022]
Abstract
Susceptibility-weighted imaging (SWI) was developed as a diagnostic tool for amyotrophic lateral sclerosis (ALS). However, its sensitivity and specificity are insufficient for accurate diagnosis. Herein, we investigated a new, simple evaluation method for SWI as a diagnostic marker for ALS. We retrospectively investigated 36 patients with ALS and 19 healthy controls. The low signal intensity was semi-quantitatively evaluated on SWI using the motor cortex low intensity (MCLI) score: the sum score of the visual evaluation for the signal intensity of the bilateral primary motor cortices (orofacial, upper-limb, and lower-limb regions) from 0 (isointense) to 2 (markedly hypointense) with a total of 12 points. The mean MCLI score of two independent raters was significantly higher in ALS (median [interquartile range]; 5 [4-6]) than in controls (0 [0-1]), p < 0.0001. When the cutoff value of the MCLI score was set to 3, the area under the receiver operating characteristic curve was 0.973, and the sensitivity and specificity were 0.92 and 1.00, respectively. The MCLI score was not significantly correlated with age, disease duration, and ALS functional rating scale-revised (FRS-R), but was significantly correlated with the progression rate (∆FRS) (ρ = 0.39, p = 0.021) and upper motor neuron score (ρ = 0.51, p = 0.0014). Therefore, MCLI scoring is a useful diagnostic marker for ALS as the MCLI score was correlated with the UMN and ∆FRS scores.
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Affiliation(s)
- Masaaki Yasui
- Department of Neurology, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama, Japan
| | - Jinsoo Koh
- Department of Neurology, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama, Japan.
| | - Yoshiaki Nakayama
- Department of Neurology, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama, Japan
| | - Mayumi Sakata
- Department of Neurology, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama, Japan
| | - Yasuhiro Hiwatani
- Department of Neurology, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama, Japan
| | - Hiroshi Ishiguchi
- Department of Neurology, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama, Japan
| | - Hidefumi Ito
- Department of Neurology, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama, Japan
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14
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Peter J, Ferraioli F, Mathew D, George S, Chan C, Alalade T, Salcedo SA, Saed S, Tatti E, Quartarone A, Ghilardi MF. Movement-related beta ERD and ERS abnormalities in neuropsychiatric disorders. Front Neurosci 2022; 16:1045715. [PMID: 36507340 PMCID: PMC9726921 DOI: 10.3389/fnins.2022.1045715] [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: 09/15/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Movement-related oscillations in the beta range (from 13 to 30 Hz) have been observed over sensorimotor areas with power decrease (i.e., event-related desynchronization, ERD) during motor planning and execution followed by an increase (i.e., event-related synchronization, ERS) after the movement's end. These phenomena occur during active, passive, imaged, and observed movements. Several electrophysiology studies have used beta ERD and ERS as functional indices of sensorimotor integrity, primarily in diseases affecting the motor system. Recent literature also highlights other characteristics of beta ERD and ERS, implying their role in processes not strictly related to motor function. Here we review studies about movement-related ERD and ERS in diseases characterized by motor dysfunction, including Parkinson's disease, dystonia, stroke, amyotrophic lateral sclerosis, cerebral palsy, and multiple sclerosis. We also review changes of beta ERD and ERS reported in physiological aging, Alzheimer's disease, and schizophrenia, three conditions without overt motor symptoms. The review of these works shows that ERD and ERS abnormalities are present across the spectrum of the examined pathologies as well as development and aging. They further suggest that cognition and movement are tightly related processes that may share common mechanisms regulated by beta modulation. Future studies with a multimodal approach are warranted to understand not only the specific topographical dynamics of movement-related beta modulation but also the general meaning of beta frequency changes occurring in relation to movement and cognitive processes at large. Such an approach will provide the foundation to devise and implement novel therapeutic approaches to neuropsychiatric disorders.
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Affiliation(s)
- Jaime Peter
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Francesca Ferraioli
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Dave Mathew
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Shaina George
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Cameron Chan
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Tomisin Alalade
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Sheilla A. Salcedo
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Shannon Saed
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Elisa Tatti
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States,*Correspondence: Elisa Tatti,
| | - Angelo Quartarone
- IRCCS Centro Neurolesi Bonino Pulejo-Piemonte, Messina, Italy,Angelo Quartarone,
| | - M. Felice Ghilardi
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States,M. Felice Ghilardi,
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15
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Simonsson O, Bouso JC, Kurth F, Araújo DB, Gaser C, Riba J, Luders E. Preliminary evidence of links between ayahuasca use and the corpus callosum. Front Psychiatry 2022; 13:1002455. [PMID: 36386967 PMCID: PMC9643584 DOI: 10.3389/fpsyt.2022.1002455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background Recent research suggests that ayahuasca and its alkaloid-containing ingredients may be helpful in the treatment and prevention of certain movement and neurodegenerative disorders. However, such research is still in its infancy and more studies in normative samples seem necessary to explore effects of ayahuasca on clinically relevant brain structures, such as the corpus callosum. Aims The purpose of the present study was to investigate links between ayahuasca use and callosal structure in a normative sample. Methods Using structural imaging data from 22 ayahuasca users and 22 matched controls we compared the thickness of the corpus callosum between both groups at 100 equidistant points across the entire midsagittal surface. In addition, we investigated point-wise correlations between callosal thickness and the number of past ayahuasca sessions. Results The corpus callosum was significantly thicker within the isthmus in the ayahuasca group than in the control group. There was also a significant positive correlation between callosal thickness and the number of past ayahuasca sessions within the rostral body, albeit none of these effects survived corrections for multiple comparisons. No region was significantly thicker in the control than in the ayahuasca group, and no callosal region was negatively linked to ayahuasca use, even at uncorrected significance thresholds. Conclusion This study provides preliminary evidence of links between ayahuasca use and the corpus callosum. However, future studies need to replicate these findings, preferably using larger sample sizes and ideally also utilizing longitudinal research designs, to draw any practical conclusion and offer implications for follow-up clinical research.
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Affiliation(s)
- Otto Simonsson
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Sociology, University of Oxford, Oxford, United Kingdom
| | - José Carlos Bouso
- ICEERS–International Center for Ethnobotanical Education, Research and Services, Barcelona, Spain
- Medical Anthropology Research Center (MARC), Universitat Rovira i Virgili, Tarragona, Spain
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Florian Kurth
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - Dráulio B. Araújo
- Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil
- Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Christian Gaser
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Jordi Riba
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Eileen Luders
- School of Psychology, University of Auckland, Auckland, New Zealand
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Laboratory of Neuro Imaging, School of Medicine, University of Southern California, Los Angeles, CA, United States
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16
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Del Tredici K, Braak H. Neuropathology and neuroanatomy of TDP-43 amyotrophic lateral sclerosis. Curr Opin Neurol 2022; 35:660-671. [PMID: 36069419 DOI: 10.1097/wco.0000000000001098] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Intracellular inclusions consisting of the abnormal TDP-43 protein and its nucleocytoplasmic mislocalization in selected cell types are hallmark pathological features of sALS. Descriptive (histological, morphological), anatomical, and molecular studies all have improved our understanding of the neuropathology of sporadic amyotrophic lateral sclerosis (sALS). This review highlights some of the latest developments in the field. RECENT FINDINGS Increasing evidence exists from experimental models for the prion-like nature of abnormal TDP-43, including a strain-effect, and with the help of neuroimaging-based studies, for spreading of disease along corticofugal connectivities in sALS. Progress has also been made with respect to finding and establishing reliable biomarkers (neurofilament levels, diffusor tensor imaging). SUMMARY The latest findings may help to elucidate the preclinical phase of sALS and to define possible mechanisms for delaying or halting disease development and progression.
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Affiliation(s)
- Kelly Del Tredici
- Clinical Neuroanatomy Section, Department of Neurology, Center for Biomedical Research, University of Ulm, Ulm, Germany
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17
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Juengling FD, Wuest F, Kalra S, Agosta F, Schirrmacher R, Thiel A, Thaiss W, Müller HP, Kassubek J. Simultaneous PET/MRI: The future gold standard for characterizing motor neuron disease-A clinico-radiological and neuroscientific perspective. Front Neurol 2022; 13:890425. [PMID: 36061999 PMCID: PMC9428135 DOI: 10.3389/fneur.2022.890425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/20/2022] [Indexed: 01/18/2023] Open
Abstract
Neuroimaging assessment of motor neuron disease has turned into a cornerstone of its clinical workup. Amyotrophic lateral sclerosis (ALS), as a paradigmatic motor neuron disease, has been extensively studied by advanced neuroimaging methods, including molecular imaging by MRI and PET, furthering finer and more specific details of the cascade of ALS neurodegeneration and symptoms, facilitated by multicentric studies implementing novel methodologies. With an increase in multimodal neuroimaging data on ALS and an exponential improvement in neuroimaging technology, the need for harmonization of protocols and integration of their respective findings into a consistent model becomes mandatory. Integration of multimodal data into a model of a continuing cascade of functional loss also calls for the best attempt to correlate the different molecular imaging measurements as performed at the shortest inter-modality time intervals possible. As outlined in this perspective article, simultaneous PET/MRI, nowadays available at many neuroimaging research sites, offers the perspective of a one-stop shop for reproducible imaging biomarkers on neuronal damage and has the potential to become the new gold standard for characterizing motor neuron disease from the clinico-radiological and neuroscientific perspectives.
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Affiliation(s)
- Freimut D. Juengling
- Division of Oncologic Imaging, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
- Faculty of Medicine, University Bern, Bern, Switzerland
| | - Frank Wuest
- Division of Oncologic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Sanjay Kalra
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
- Department of Neurology, University of Alberta, Edmonton, AB, Canada
| | - Federica Agosta
- Division of Neuroscience, San Raffaele Scientific Institute, University Vita Salute San Raffaele, Milan, Italy
| | - Ralf Schirrmacher
- Division of Oncologic Imaging, University of Alberta, Edmonton, AB, Canada
- Medical Isotope and Cyclotron Facility, University of Alberta, Edmonton, AB, Canada
| | - Alexander Thiel
- Lady Davis Institute for Medical Research, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Wolfgang Thaiss
- Department of Nuclear Medicine, University of Ulm Medical Center, Ulm, Germany
- Department of Diagnostic and Interventional Radiology, University of Ulm Medical Center, Ulm, Germany
| | - Hans-Peter Müller
- Department of Neurology, Ulm University Medical Center, Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, Ulm University Medical Center, Ulm, Germany
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18
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Kauthankar AA, Jaseemudheen M. Diffusion Tensor Imaging in Spinal Cord Injury: A Review. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2022. [DOI: 10.1055/s-0042-1751068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AbstractMagnetic resonance diffusion tensor imaging (DTI) is a recent technique that can measure the direction and magnitude of diffusion of water. It is widely being utilized to evaluate several brain and spinal cord pathologies. The objective of this review is to evaluate the importance of the DTI in patients with spinal cord injury (SCI). It aims to review various articles on DTI SCI and includes both animal and human studies. This will help to describe the current status of the clinical applications of DTI and show its potential as a helpful instrument in clinical practice. The PubMed database was searched for articles relating to the application of DTI in SCI. Relevant articles were also used for the review. A variety of DTI parameters have been studied in various articles. The standard parameters are fractional anisotropy (FA) values, apparent diffusion coefficient (ADC) values, radial diffusivity values, and axial diffusivity values, followed by tractography. FA and ADC values are the most commonly used parameters. The findings observed in most of the studies are increased FA and reduced ADC values following injury to the spinal cord. DTI data metrics possess the potential to become a potent clinical tool in patients with SCI. It is helpful for diagnosis, prognosis, treatment planning, as well as to evaluate the recovery. Nonetheless, to overcome the limitations and determine its reliability clinically, more research has to be performed.
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Affiliation(s)
- Akshada Atchut Kauthankar
- Department of Radio-diagnosis and Imaging, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - M.M Jaseemudheen
- Department of Radio-diagnosis and Imaging, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
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19
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El Mendili MM, Grapperon AM, Dintrich R, Stellmann JP, Ranjeva JP, Guye M, Verschueren A, Attarian S, Zaaraoui W. Alterations of Microstructure and Sodium Homeostasis in Fast Amyotrophic Lateral Sclerosis Progressors: A Brain DTI and Sodium MRI Study. AJNR Am J Neuroradiol 2022; 43:984-990. [PMID: 35772800 DOI: 10.3174/ajnr.a7559] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/10/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE While conventional MR imaging has limited value in amyotrophic lateral sclerosis, nonconventional MR imaging has shown alterations of microstructure using diffusion MR imaging and recently sodium homeostasis with sodium MR imaging. We aimed to investigate the topography of brain regions showing combined microstructural and sodium homeostasis alterations in amyotrophic lateral sclerosis subgroups according to their disease-progression rates. MATERIALS AND METHODS Twenty-nine patients with amyotrophic lateral sclerosis and 24 age-matched healthy controls were recruited. Clinical assessments included disease duration and the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale. Patients were clinically differentiated into fast (n = 13) and slow (n = 16) progressors according to the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale progression rate. 3T MR imaging brain protocol included 1H T1-weighted and diffusion sequences and a 23Na density-adapted radial sequence. Quantitative maps of diffusion with fractional anisotropy, mean diffusivity, and total sodium concentration were measured. The topography of diffusion and sodium abnormalities was assessed by voxelwise analyses. RESULTS Patients with amyotrophic lateral sclerosis showed significantly higher sodium concentrations and lower fractional anisotropy, along with higher sodium concentrations and higher mean diffusivity compared with healthy controls, primarily within the corticospinal tracts, corona radiata, and body and genu of the corpus callosum. Fast progressors showed wider-spread abnormalities mainly in the frontal areas. In slow progressors, only fractional anisotropy measures showed abnormalities compared with healthy controls, localized in focal regions of the corticospinal tracts, the body of corpus callosum, corona radiata, and thalamic radiation. CONCLUSIONS The present study evidenced widespread combined microstructural and sodium homeostasis brain alterations in fast amyotrophic lateral sclerosis progressors.
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Affiliation(s)
- M M El Mendili
- From the Aix Marseille University (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), Centre national de la recherche scientifique, The Center for Magnetic Resonance in Biology and Medicine, Marseille, France .,APHM, Hopital de la Timone (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), CEMEREM, Marseille, France
| | - A-M Grapperon
- From the Aix Marseille University (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), Centre national de la recherche scientifique, The Center for Magnetic Resonance in Biology and Medicine, Marseille, France.,APHM, Hopital de la Timone (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), CEMEREM, Marseille, France.,APHM, Hôpital de la Timone (A.-M.G., R.D., S.A.), Referral Centre for Neuromuscular Diseases and ALS, Marseille, France
| | - R Dintrich
- From the Aix Marseille University (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), Centre national de la recherche scientifique, The Center for Magnetic Resonance in Biology and Medicine, Marseille, France.,APHM, Hopital de la Timone (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), CEMEREM, Marseille, France.,APHM, Hôpital de la Timone (A.-M.G., R.D., S.A.), Referral Centre for Neuromuscular Diseases and ALS, Marseille, France
| | - J-P Stellmann
- From the Aix Marseille University (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), Centre national de la recherche scientifique, The Center for Magnetic Resonance in Biology and Medicine, Marseille, France.,APHM, Hopital de la Timone (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), CEMEREM, Marseille, France
| | - J-P Ranjeva
- From the Aix Marseille University (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), Centre national de la recherche scientifique, The Center for Magnetic Resonance in Biology and Medicine, Marseille, France.,APHM, Hopital de la Timone (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), CEMEREM, Marseille, France
| | - M Guye
- From the Aix Marseille University (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), Centre national de la recherche scientifique, The Center for Magnetic Resonance in Biology and Medicine, Marseille, France.,APHM, Hopital de la Timone (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), CEMEREM, Marseille, France
| | - A Verschueren
- From the Aix Marseille University (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), Centre national de la recherche scientifique, The Center for Magnetic Resonance in Biology and Medicine, Marseille, France.,APHM, Hopital de la Timone (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), CEMEREM, Marseille, France
| | - S Attarian
- APHM, Hôpital de la Timone (A.-M.G., R.D., S.A.), Referral Centre for Neuromuscular Diseases and ALS, Marseille, France
| | - W Zaaraoui
- From the Aix Marseille University (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), Centre national de la recherche scientifique, The Center for Magnetic Resonance in Biology and Medicine, Marseille, France.,APHM, Hopital de la Timone (M.M.E.M., A.-M.G., R.D., J.-P.S., J.-P.R., M.G., A.V., W.Z.), CEMEREM, Marseille, France
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20
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Münch M, Müller HP, Behler A, Ludolph AC, Kassubek J. Segmental alterations of the corpus callosum in motor neuron disease: A DTI and texture analysis in 575 patients. Neuroimage Clin 2022; 35:103061. [PMID: 35653913 PMCID: PMC9163839 DOI: 10.1016/j.nicl.2022.103061] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/15/2022] [Accepted: 05/26/2022] [Indexed: 10/29/2022]
Abstract
INTRODUCTION Within the core neuroimaging signature of amyotrophic lateral sclerosis (ALS), the corpus callosum (CC) is increasingly recognized as a consistent feature. The aim of this study was to investigate the sensitivity and specificity of the microstructural segmental CC morphology, assessed by diffusion tensor imaging (DTI) and high-resolution T1-weighted (T1w) imaging, in a large cohort of ALS patients including different clinical phenotypes. METHODS In a single-centre study, 575 patients with ALS (classical phenotype, N = 432; restricted phenotypes primary lateral sclerosis (PLS) N = 55, flail arm syndrome (FAS) N = 45, progressive bulbar palsy (PBP) N = 22, lower motor neuron disease (LMND) N = 21) and 112 healthy controls underwent multiparametric MRI, i.e. volume-rendering T1w scans and DTI. Tract-based fractional anisotropy statistics (TFAS) was applied to callosal tracts of CC areas I-V, identified from DTI data (tract-of-interest (TOI) analysis), and texture analysis was applied to T1w data. In order to further specify the callosal alterations, a support vector machine (SVM) algorithm was used to discriminate between motor neuron disease patients and controls. RESULTS The analysis of white matter integrity revealed predominantly FA reductions for tracts of the callosal areas I, II, and III (with highest reductions in callosal area III) for all ALS patients and separately for each phenotype when compared to controls; texture analysis demonstrated significant alterations of the parameters entropy and homogeneity for ALS patients and all phenotypes for the CC areas I, II, and III (with again highest reductions in callosal area III) compared to controls. With SVM applied on multiparametric callosal parameters of area III, a separation of all ALS patients including phenotypes from controls with 72% sensitivity and 73% specificity was achieved. These results for callosal area III parameters could be improved by an SVM of six multiparametric callosal parameters of areas I, II, and III, achieving a separation of all ALS patients including phenotypes from controls with 84% sensitivity and 85% specificity. DISCUSSION The multiparametric MRI texture and DTI analysis demonstrated substantial alterations of the frontal and central CC with most significant alterations in callosal area III (motor segment) in ALS and separately in all investigated phenotypes (PLS, FAS, PBP, LMND) in comparison to controls, while no significant differences were observed between ALS and its phenotypes. The combination of the texture and the DTI parameters in an unbiased SVM-based approach might contribute as a neuroimaging marker for the assessment of the CC in ALS, including subtypes.
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Affiliation(s)
| | | | - Anna Behler
- Department of Neurology, University of Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, University of Ulm, Germany; German Center for Neurodegenerative Diseases (DZNE), Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Germany; German Center for Neurodegenerative Diseases (DZNE), Ulm, Germany.
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21
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Rajagopalan V, Pioro EP. Graph theory network analysis provides brain MRI evidence of a partial continuum of neurodegeneration in patients with UMN-predominant ALS and ALS-FTD. Neuroimage Clin 2022; 35:103037. [PMID: 35597032 PMCID: PMC9123271 DOI: 10.1016/j.nicl.2022.103037] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 04/20/2022] [Accepted: 05/04/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Our routine clinical neuroimaging showed hyperintense signal along the corticospinal tract only in some but not all patients with upper motor neuron (UMN)-predominant ALS. ALS patients with CST hyperintensity (ALS-CST+) and those without CST hyperintensity (ALS-CST-) present with nearly identical clinical UMN-predominant symptoms. Some previous studies have suggested that ALS patients with frontotemporal dementia (FTD) are on a continuum with ALS patients without FTD, while others have not. We aimed to determine whether: (a) ALS-CST+, ALS-CST-, and ALS-FTD patients show differential sites of predominant neurodegeneration occurring primarily cortically in the perikaryon or subcortically in the white matter (WM), or (b) UMN-predominant ALS is on a continuum with ALS-FTD. METHODS Exploratory whole brain grey matter (GM) voxel-based morphometry and WM network analysis using graph theory approach were performed. In this exploratory study, MRI data from 58 ALS patients (ALS-FTD, n = 15; ALS-CST+, n = 19; ALS-CST-, n = 24) and 14 neurological controls were obtained. RESULTS Significant differences in degree measures (evaluating WM networks) were observed between ALS patients and controls in frontal, motor, extra-motor, subcortical, and cerebellar regions. GM atrophy was observed only in the ALS-FTD subgroup and not in the other ALS subgroups. CONCLUSION Although WM network disruption by the ALS disease process showed different patterns between ALS-CST+, ALS-CST-, and ALS-FTD subgroups, there were some overlaps, particularly in prefrontal regions and between ALS-CST+ and ALS-FTD patients. Our preliminary findings suggest a partial continuum of, at least, WM degeneration between these subgroups with predominance of cortical pathology ("neuronopathy") in ALS-FTD patients and subcortical WM pathology ("axonopathy") in ALS-CST+ and ALS-CST- patients.
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Affiliation(s)
- Venkateswaran Rajagopalan
- Department of Electrical and Electronics Engineering, Birla Institute of Technology and Science Pilani, Hyderabad Campus, Hyderabad 500078, India
| | - Erik P Pioro
- Neuromuscular Center, Department of Neurology, Neurological Institute, United States; Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, United States; Neuromuscular Division, The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States.
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22
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Pandya S, Maia PD, Freeze B, Menke RAL, Talbot K, Turner MR, Raj A. Modeling seeding and neuroanatomic spread of pathology in amyotrophic lateral sclerosis. Neuroimage 2022; 251:118968. [PMID: 35143975 PMCID: PMC10729776 DOI: 10.1016/j.neuroimage.2022.118968] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 01/26/2022] [Accepted: 02/02/2022] [Indexed: 12/12/2022] Open
Abstract
The neurodegenerative disorder amyotrophic lateral sclerosis (ALS) is characterized by the progressive loss of upper and lower motor neurons, with pathological involvement of cerebral motor and extra-motor areas in a clinicopathological spectrum with frontotemporal dementia (FTD). A key unresolved issue is how the non-random distribution of pathology in ALS reflects differential network vulnerability, including molecular factors such as regional gene expression, or preferential spread of pathology via anatomical connections. A system of histopathological staging of ALS based on the regional burden of TDP-43 pathology observed in postmortem brains has been supported to some extent by analysis of distribution of in vivo structural MRI changes. In this paper, computational modeling using a Network Diffusion Model (NDM) was used to investigate whether a process of focal pathological 'seeding' followed by structural network-based spread recapitulated postmortem histopathological staging and, secondly, whether this had any correlation to the pattern of expression of a panel of genes implicated in ALS across the healthy brain. Regionally parcellated T1-weighted MRI data from ALS patients (baseline n=79) was studied in relation to a healthy control structural connectome and a database of associated regional cerebral gene expression. The NDM provided strong support for a structural network-based basis for regional pathological spread in ALS, but no simple relationship to the spatial distribution of ALS-related genes in the healthy brain. Interestingly, OPTN gene was identified as a significant but a weaker non-NDM contributor within the network-gene interaction model (LASSO). Intriguingly, the critical seed regions for spread within the model were not within the primary motor cortex but basal ganglia, thalamus and insula, where NDM recapitulated aspects of the postmortem histopathological staging system. Within the ALS-FTD clinicopathological spectrum, non-primary motor structures may be among the earliest sites of cerebral pathology.
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Affiliation(s)
- Sneha Pandya
- Department of Radiology, Weill Cornell Medicine, 1300 York Avenue, New York, NY, United States.
| | - Pedro D Maia
- Department of Mathematics, University of Texas at Arlington, TX, United States
| | - Benjamin Freeze
- Scripps Health/MD Anderson Cancer Center, Department of Radiology, CA, United States
| | - Ricarda A L Menke
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, West Wing Level 6, Oxford OX2 7PZ, United Kingdom
| | - Kevin Talbot
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Martin R Turner
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, West Wing Level 6, Oxford OX2 7PZ, United Kingdom; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
| | - Ashish Raj
- Department of Radiology, Weill Cornell Medicine, 1300 York Avenue, New York, NY, United States; Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94121, United States.
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23
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Middei S. Neuroimaging Applications for Diagnosis and Therapy of Pathologies in the Central and Peripheral Nervous System. Brain Sci 2022; 12:brainsci12020207. [PMID: 35203970 PMCID: PMC8870331 DOI: 10.3390/brainsci12020207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Silvia Middei
- Institute of Biochemistry and Cell Biology, National Research Council, Via E. Ramarini 32, 00015 Monterotondo, Italy;
- European Brain Research Institute, Viale Regina Elena 295, 00161 Rome, Italy
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24
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Donatelli G, Costagli M, Cecchi P, Migaleddu G, Bianchi F, Frumento P, Siciliano G, Cosottini M. Motor cortical patterns of upper motor neuron pathology in amyotrophic lateral sclerosis: A 3 T MRI study with iron-sensitive sequences. NEUROIMAGE: CLINICAL 2022; 35:103138. [PMID: 36002961 PMCID: PMC9421531 DOI: 10.1016/j.nicl.2022.103138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/05/2022] [Accepted: 07/27/2022] [Indexed: 11/11/2022] Open
Abstract
M1 regions associated with the body site of onset are frequently affected at MRI. The simultaneous involvement of both homologous M1 regions is frequent. The T2* hypointensity in non-contiguous M1 regions seems rare.
Background Patterns of initiation and propagation of disease in Amyotrophic Lateral Sclerosis (ALS) are still partly unknown. Single or multiple foci of neurodegeneration followed by disease diffusion to contiguous or connected regions have been proposed as mechanisms underlying symptom occurrence. Here, we investigated cortical patterns of upper motor neuron (UMN) pathology in ALS using iron-sensitive MR imaging. Methods Signal intensity and magnetic susceptibility of the primary motor cortex (M1), which are associated with clinical UMN burden and neuroinflammation, were assessed in 78 ALS patients using respectively T2*-weighted images and Quantitative Susceptibility Maps. The signal intensity of the whole M1 and each of its functional regions was rated as normal or reduced, and the magnetic susceptibility of each M1 region was measured. Results The highest frequencies of T2* hypointensity were found in M1 regions associated with the body sites of symptom onset. Homologous M1 regions were both hypointense in 80–93 % of patients with cortical abnormalities, and magnetic susceptibility values measured in homologous M1 regions were strongly correlated with each other (ρ = 0.88; p < 0.0001). In some cases, the T2* hypointensity was detectable in two non-contiguous M1 regions but spared the cortex in between. Conclusions M1 regions associated with the body site of onset are frequently affected at imaging. The simultaneous involvement of both homologous M1 regions is frequent, followed by that of adjacent regions; the affection of non-contiguous regions, instead, seems rare. This type of cortical involvement suggests the interhemispheric connections as one of the preferential paths for the UMN pathology diffusion in ALS.
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25
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Ishaque A, Ta D, Khan M, Zinman L, Korngut L, Genge A, Dionne A, Briemberg H, Luk C, Yang YH, Beaulieu C, Emery D, Eurich DT, Frayne R, Graham S, Wilman A, Dupré N, Kalra S. Distinct patterns of progressive gray and white matter degeneration in amyotrophic lateral sclerosis. Hum Brain Mapp 2021; 43:1519-1534. [PMID: 34908212 PMCID: PMC8886653 DOI: 10.1002/hbm.25738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 01/17/2023] Open
Abstract
Progressive cerebral degeneration in amyotrophic lateral sclerosis (ALS) remains poorly understood. Here, three-dimensional (3D) texture analysis was used to study longitudinal gray and white matter cerebral degeneration in ALS from routine T1-weighted magnetic resonance imaging (MRI). Participants were included from the Canadian ALS Neuroimaging Consortium (CALSNIC) who underwent up to three clinical assessments and MRI at four-month intervals, up to 8 months after baseline (T0 ). Three-dimensional maps of the texture feature autocorrelation were computed from T1-weighted images. One hundred and nineteen controls and 137 ALS patients were included, with 81 controls and 84 ALS patients returning for at least one follow-up. At baseline, texture changes in ALS patients were detected in the motor cortex, corticospinal tract, insular cortex, and bilateral frontal and temporal white matter compared to controls. Longitudinal comparison of texture maps between T0 and Tmax (last follow-up visit) within ALS patients showed progressive texture alterations in the temporal white matter, insula, and internal capsule. Additionally, when compared to controls, ALS patients had greater texture changes in the frontal and temporal structures at Tmax than at T0 . In subgroup analysis, slow progressing ALS patients had greater progressive texture change in the internal capsule than the fast progressing patients. Contrastingly, fast progressing patients had greater progressive texture changes in the precentral gyrus. These findings suggest that the characteristic longitudinal gray matter pathology in ALS is the progressive involvement of frontotemporal regions rather than a worsening pathology within the motor cortex, and that phenotypic variability is associated with distinct progressive spatial pathology.
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Affiliation(s)
- Abdullah Ishaque
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Daniel Ta
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Muhammad Khan
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Lorne Zinman
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Lawrence Korngut
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Angela Genge
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, Montreal, Canada
| | - Annie Dionne
- Département des Sciences Neurologiques, Hôpital de l'Enfant-Jésus, CHU de Québec, Quebec City, Canada
| | - Hannah Briemberg
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Collin Luk
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Yee-Hong Yang
- Department of Computing Science, University of Alberta, Edmonton
| | - Christian Beaulieu
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
| | - Derek Emery
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Richard Frayne
- Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Calgary, Canada
| | - Simon Graham
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Alan Wilman
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
| | - Nicolas Dupré
- Neuroscience Axis, CHU de Québec, Université Laval, Quebec City, Canada.,Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Sanjay Kalra
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada.,Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
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26
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Ardesch DJ, Scholtens LH, de Lange SC, Roumazeilles L, Khrapitchev AA, Preuss TM, Rilling JK, Mars RB, van den Heuvel MP. Scaling Principles of White Matter Connectivity in the Human and Nonhuman Primate Brain. Cereb Cortex 2021; 32:2831-2842. [PMID: 34849623 PMCID: PMC9247419 DOI: 10.1093/cercor/bhab384] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/14/2022] Open
Abstract
Brains come in many shapes and sizes. Nature has endowed big-brained primate species like humans with a proportionally large cerebral cortex. Comparative studies have suggested, however, that the total volume allocated to white matter connectivity-the brain's infrastructure for long-range interregional communication-does not keep pace with the cortex. We investigated the consequences of this allometric scaling on brain connectivity and network organization. We collated structural and diffusion magnetic resonance imaging data across 14 primate species, describing a comprehensive 350-fold range in brain size across species. We show volumetric scaling relationships that indeed point toward a restriction of macroscale connectivity in bigger brains. We report cortical surface area to outpace white matter volume, with larger brains showing lower levels of overall connectedness particularly through sparser long-range connectivity. We show that these constraints on white matter connectivity are associated with longer communication paths, higher local network clustering, and higher levels of asymmetry in connectivity patterns between homologous areas across the left and right hemispheres. Our findings reveal conserved scaling relationships of major brain components and show consequences for macroscale brain circuitry, providing insights into the connectome architecture that could be expected in larger brains such as the human brain.
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Affiliation(s)
- Dirk Jan Ardesch
- Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, 1081 HV, Amsterdam, the Netherlands
| | - Lianne H Scholtens
- Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, 1081 HV, Amsterdam, the Netherlands
| | - Siemon C de Lange
- Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, 1081 HV, Amsterdam, the Netherlands.,Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, 1105 BA Amsterdam, the Netherlands
| | - Lea Roumazeilles
- Wellcome Centre for Integrative Neuroimaging, Department of Experimental Psychology, University of Oxford, Oxford OX1 3SR, UK
| | - Alexandre A Khrapitchev
- Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford OX3 7DQ, UK
| | - Todd M Preuss
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA.,Center for Translational Social Neuroscience, Emory University, Atlanta, GA 30329, USA.,Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - James K Rilling
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA.,Center for Translational Social Neuroscience, Emory University, Atlanta, GA 30329, USA.,Department of Anthropology, Emory University, Atlanta, GA 30322, USA.,Silvio O. Conte Center for Oxytocin and Social Cognition, Emory University, Atlanta, GA 30322, USA.,Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA 30322, USA
| | - Rogier B Mars
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, AJ 6525, Nijmegen, the Netherlands.,Wellcome Centre for Integrative Neuroimaging, Centre for fMRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Martijn P van den Heuvel
- Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, 1081 HV, Amsterdam, the Netherlands.,Department of Child Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, 1081 HV, Amsterdam, the Netherlands
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27
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Ogura A, Kawabata K, Watanabe H, Choy SW, Bagarinao E, Kato T, Imai K, Masuda M, Ohdake R, Hara K, Nakamura R, Atsuta N, Nakamura T, Katsuno M, Sobue G. Fiber-specific white matter analysis reflects upper motor neuron impairment in amyotrophic lateral sclerosis. Eur J Neurol 2021; 29:432-440. [PMID: 34632672 DOI: 10.1111/ene.15136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE To clarify the relationship between fiber-specific white matter changes in amyotrophic lateral sclerosis (ALS) and clinical signs of upper motor neuron (UMN) involvement, we performed a fixel-based analysis (FBA), a novel framework for diffusion-weighted imaging analysis. METHODS We enrolled 96 participants, including 48 nonfamilial ALS patients and 48 age- and sex-matched healthy controls (HCs), in this study and conducted whole-brain FBA and voxel-based morphometry analysis. We compared the fiber density (FD), fiber morphology (fiber cross-section [FC]), and a combined index of FD and FC (FDC) between the ALS and HC groups. We performed a tract-of-interest analysis to extract FD values across the significant regions in the whole-brain analysis. Then, we evaluated the associations between FD values and clinical variables. RESULTS The bilateral corticospinal tracts (CSTs) and the corpus callosum (CC) showed reduced FD and FDC in ALS patients compared with HCs (p < 0.05, familywise error-corrected), and the comparison of FCs revealed no region that was significantly different from another. Voxel-based morphometry showed cortical volume reduction in the regions, including the primary motor area. Clinical scores showed correlations with FD values in the CSTs (UMN score: rho = -0.530, p < 0.001; central motor conduction time [CMCT] in the upper limb: rho = -0.474, p = 0.008; disease duration: rho = -0.383, p = 0.007; ALS Functional Rating Scale-Revised: rho = 0.340, p = 0.018). In addition, patients whose CMCT was not calculated due to unevoked waves also showed FD reduction in the CSTs. CONCLUSIONS Our findings suggest that FD values in the CST estimated via FBA can be potentially used in evaluating UMN impairments.
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Affiliation(s)
- Aya Ogura
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuya Kawabata
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hirohisa Watanabe
- Brain and Mind Research Center, Nagoya University, Nagoya, Japan.,Department of Neurology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Shao Wei Choy
- Center for Intelligent Signal and Imaging Research, Universiti Teknologi PETRONAS, Seri Iskandar, Malaysia
| | - Epifanio Bagarinao
- Brain and Mind Research Center, Nagoya University, Nagoya, Japan.,Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshiyasu Kato
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazunori Imai
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michihito Masuda
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Reiko Ohdake
- Brain and Mind Research Center, Nagoya University, Nagoya, Japan
| | - Kazuhiro Hara
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryoichi Nakamura
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Atsuta
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomohiko Nakamura
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Gen Sobue
- Brain and Mind Research Center, Nagoya University, Nagoya, Japan.,Research Division of Dementia and Neurodegenerative Disease, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Aichi Medical University, Nagakute, Japan
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28
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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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29
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McKenna MC, Corcia P, Couratier P, Siah WF, Pradat PF, Bede P. Frontotemporal Pathology in Motor Neuron Disease Phenotypes: Insights From Neuroimaging. Front Neurol 2021; 12:723450. [PMID: 34484106 PMCID: PMC8415268 DOI: 10.3389/fneur.2021.723450] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/22/2021] [Indexed: 01/18/2023] Open
Abstract
Frontotemporal involvement has been extensively investigated in amyotrophic lateral sclerosis (ALS) but remains relatively poorly characterized in other motor neuron disease (MND) phenotypes such as primary lateral sclerosis (PLS), progressive muscular atrophy (PMA), spinal muscular atrophy (SMA), spinal bulbar muscular atrophy (SBMA), post poliomyelitis syndrome (PPS), and hereditary spastic paraplegia (HSP). This review focuses on insights from structural, metabolic, and functional neuroimaging studies that have advanced our understanding of extra-motor disease burden in these phenotypes. The imaging literature is limited in the majority of these conditions and frontotemporal involvement has been primarily evaluated by neuropsychology and post mortem studies. Existing imaging studies reveal that frontotemporal degeneration can be readily detected in ALS and PLS, varying degree of frontotemporal pathology may be captured in PMA, SBMA, and HSP, SMA exhibits cerebral involvement without regional predilection, and there is limited evidence for cerebral changes in PPS. Our review confirms the heterogeneity extra-motor pathology across the spectrum of MNDs and highlights the role of neuroimaging in characterizing anatomical patterns of disease burden in vivo. Despite the contribution of neuroimaging to MND research, sample size limitations, inclusion bias, attrition rates in longitudinal studies, and methodological constraints need to be carefully considered. Frontotemporal involvement is a quintessential clinical facet of MND which has important implications for screening practices, individualized management strategies, participation in clinical trials, caregiver burden, and resource allocation. The academic relevance of imaging frontotemporal pathology in MND spans from the identification of genetic variants, through the ascertainment of presymptomatic changes to the design of future epidemiology studies.
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Affiliation(s)
- Mary Clare McKenna
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
| | - Philippe Corcia
- Department of Neurology-Neurophysiology, CRMR ALS, Tours, France.,UMR 1253 iBrain, University of Tours, Tours, France.,LITORALS, Federation of ALS Centres: Tours-Limoges, Limoges, France
| | - Philippe Couratier
- LITORALS, Federation of ALS Centres: Tours-Limoges, Limoges, France.,ALS Centre, Limoges University Hospital (CHU de Limoges), Limoges, France
| | - We Fong Siah
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
| | | | - Peter Bede
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland.,Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, France
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Tahedl M, Murad A, Lope J, Hardiman O, Bede P. Evaluation and categorisation of individual patients based on white matter profiles: Single-patient diffusion data interpretation in neurodegeneration. J Neurol Sci 2021; 428:117584. [PMID: 34315000 DOI: 10.1016/j.jns.2021.117584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/13/2021] [Accepted: 07/19/2021] [Indexed: 12/18/2022]
Abstract
The majority of radiology studies in neurodegenerative conditions infer group-level imaging traits from group comparisons. While this strategy is helpful to define phenotype-specific imaging signatures for academic use, the meaningful interpretation of single scans of individual subjects is more important in everyday clinical practice. Accordingly, we present a computational method to evaluate individual subject diffusion tensor data to highlight white matter integrity alterations. Fifty white matter tracts were quantitatively evaluated in 132 patients with amyotrophic lateral sclerosis (ALS) with respect to normative values from 100 healthy subjects. Fractional anisotropy and radial diffusivity alterations were assessed individually in each patient. The approach was validated against standard tract-based spatial statistics and further scrutinised by the assessment of 78 additional data sets with a blinded diagnosis. Our z-score-based approach readily detected white matter degeneration in individual ALS patients and helped to categorise single subjects with a 'blinded diagnosis' as likely 'ALS' or 'control'. The group-level inferences from the z-score-based approach were analogous to the standard TBSS output maps. The benefit of the z-score-based strategy is that it enables the interpretation of single DTI datasets as well as the comparison of study groups. Outputs can be summarised either visually by highlighting the affected tracts, or, listing the affected tracts in a text file with reference to normative data, making it particularly useful for clinical applications. While individual diffusion data cannot be visually appraised, our approach provides a viable framework for single-subject imaging data interpretation.
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Affiliation(s)
- Marlene Tahedl
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland; Department of Psychiatry and Psychotherapy, Institute for Psychology, University of Regensburg, Germany
| | - Aizuri Murad
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
| | - Jasmin Lope
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
| | - Peter Bede
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland; Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, France.
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31
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The Upper Motor Neuron-Improved Knowledge from ALS and Related Clinical Disorders. Brain Sci 2021; 11:brainsci11080958. [PMID: 34439577 PMCID: PMC8392624 DOI: 10.3390/brainsci11080958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 11/17/2022] Open
Abstract
Upper motor neuron (UMN) is a term traditionally used for the corticospinal or pyramidal tract neuron synapsing with the lower motor neuron (LMN) in the anterior horns of the spinal cord. The upper motor neuron controls resting muscle tone and helps initiate voluntary movement of the musculoskeletal system by pathways which are not completely understood. Dysfunction of the upper motor neuron causes the classical clinical signs of spasticity, weakness, brisk tendon reflexes and extensor plantar response, which are associated with clinically well-recognised, inherited and acquired disorders of the nervous system. Understanding the pathophysiology of motor system dysfunction in neurological disease has helped promote a greater understanding of the motor system and its complex cortical connections. This review will focus on the pathophysiology underlying progressive dysfunction of the UMN in amyotrophic lateral sclerosis and three other related adult-onset, progressive neurological disorders with prominent UMN signs, namely, primary lateral sclerosis, hereditary spastic paraplegia and primary progressive multiple sclerosis, to help promote better understanding of the human motor system and, by extension, related cortical systems.
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Abstract
OBJECTIVE Advanced neuroimaging techniques may offer the potential to monitor disease progression in amyotrophic lateral sclerosis (ALS), a neurodegenerative, multisystem disease that still lacks therapeutic outcome measures. We aim to investigate longitudinal functional and structural magnetic resonance imaging (MRI) changes in a cohort of patients with ALS monitored for one year after diagnosis. METHODS Resting state functional MRI, diffusion tensor imaging (DTI), and voxel-based morphometry analyses were performed in 22 patients with ALS examined by six-monthly MRI scans over one year. RESULTS During the follow-up period, patients with ALS showed reduced functional connectivity only in some extramotor areas, such as the middle temporal gyrus in the left frontoparietal network after six months and in the left middle frontal gyrus in the default mode network after one year without showing longitudinal changes of cognitive functions. Moreover, after six months, we reported in the ALS group a decreased fractional anisotropy (P = .003, Bonferroni corrected) in the right uncinate fasciculus. Conversely, we did not reveal significant longitudinal changes of functional connectivity in the sensorimotor network, as well as of gray matter (GM) atrophy or of DTI metrics in motor areas, although clinical measures of motor disability showed significant decline throughout the three time points. CONCLUSION Our findings highlighted that progressive impairment of extramotor frontotemporal networks may precede the appearance of executive and language dysfunctions and GM changes in ALS. Functional connectivity changes in cognitive resting state networks might represent candidate radiological markers of disease progression.
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Kamagata K, Andica C, Kato A, Saito Y, Uchida W, Hatano T, Lukies M, Ogawa T, Takeshige-Amano H, Akashi T, Hagiwara A, Fujita S, Aoki S. Diffusion Magnetic Resonance Imaging-Based Biomarkers for Neurodegenerative Diseases. Int J Mol Sci 2021; 22:ijms22105216. [PMID: 34069159 PMCID: PMC8155849 DOI: 10.3390/ijms22105216] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 12/27/2022] Open
Abstract
There has been an increasing prevalence of neurodegenerative diseases with the rapid increase in aging societies worldwide. Biomarkers that can be used to detect pathological changes before the development of severe neuronal loss and consequently facilitate early intervention with disease-modifying therapeutic modalities are therefore urgently needed. Diffusion magnetic resonance imaging (MRI) is a promising tool that can be used to infer microstructural characteristics of the brain, such as microstructural integrity and complexity, as well as axonal density, order, and myelination, through the utilization of water molecules that are diffused within the tissue, with displacement at the micron scale. Diffusion tensor imaging is the most commonly used diffusion MRI technique to assess the pathophysiology of neurodegenerative diseases. However, diffusion tensor imaging has several limitations, and new technologies, including neurite orientation dispersion and density imaging, diffusion kurtosis imaging, and free-water imaging, have been recently developed as approaches to overcome these constraints. This review provides an overview of these technologies and their potential as biomarkers for the early diagnosis and disease progression of major neurodegenerative diseases.
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Affiliation(s)
- Koji Kamagata
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (C.A.); (Y.S.); (W.U.); (T.A.); (A.H.); (S.F.); (S.A.)
- Correspondence:
| | - Christina Andica
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (C.A.); (Y.S.); (W.U.); (T.A.); (A.H.); (S.F.); (S.A.)
| | - Ayumi Kato
- Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan;
| | - Yuya Saito
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (C.A.); (Y.S.); (W.U.); (T.A.); (A.H.); (S.F.); (S.A.)
| | - Wataru Uchida
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (C.A.); (Y.S.); (W.U.); (T.A.); (A.H.); (S.F.); (S.A.)
| | - Taku Hatano
- Department of Neurology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (T.H.); (T.O.); (H.T.-A.)
| | - Matthew Lukies
- Department of Diagnostic and Interventional Radiology, Alfred Health, Melbourne, VIC 3004, Australia;
| | - Takashi Ogawa
- Department of Neurology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (T.H.); (T.O.); (H.T.-A.)
| | - Haruka Takeshige-Amano
- Department of Neurology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (T.H.); (T.O.); (H.T.-A.)
| | - Toshiaki Akashi
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (C.A.); (Y.S.); (W.U.); (T.A.); (A.H.); (S.F.); (S.A.)
| | - Akifumi Hagiwara
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (C.A.); (Y.S.); (W.U.); (T.A.); (A.H.); (S.F.); (S.A.)
| | - Shohei Fujita
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (C.A.); (Y.S.); (W.U.); (T.A.); (A.H.); (S.F.); (S.A.)
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (C.A.); (Y.S.); (W.U.); (T.A.); (A.H.); (S.F.); (S.A.)
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Functional and structural impairment of transcallosal motor fibres in ALS: a study using transcranial magnetic stimulation, diffusion tensor imaging, and diffusion weighted spectroscopy. Brain Imaging Behav 2021; 15:748-757. [PMID: 32306281 DOI: 10.1007/s11682-020-00282-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Imaging studies showed that the structure of the corpus callosum (CC) is affected in amyotrophic lateral sclerosis (ALS). Some clinical studies also suggest that interhemispheric connectivity is altered, since mirror movements seem to occur in ALS. Finally, reduced interhemispheric inhibition (IHI), studied by transcranial magnetic stimulation (TMS), has been reported. It is not known whether there is any association between these findings. Here, we studied the integrity of the CC in ALS on the morphological, the functional, the electrophysiological, and the clinical level. Twenty-seven right-handed ALS patients and 21 healthy right-handed controls were included. Mirror activity (MA) was quantified using surface EMG. Diffusion tensor imaging tractography was used to segment the CC and quantify fractional anisotropy (FA). We studied the diffusivity of the intra-axonal markers N-acetylaspartate+N-acetyl aspartyl glutamate D(tNAA) within the CC. IHI was studied as a marker of CC function using a double-pulse TMS protocol. ALS patients showed significantly decreased FA in the motor segment of the CC (p < 0.01), and IHI was significantly reduced compared to controls (p = 0.01). However, no differences were observed regarding D(tNAA) and MA. The morphological as well as the functional integrity of the CC are altered in ALS. IHI was reduced in ALS, associated with decreased FA in the motor CC. Patients did not exhibit increased MA. Also, no differences within the CC were observed using diffusion-weighted spectroscopy. IHI might serve as a marker of transcallosal pathway disruption in ALS, even before clinical deficits become apparent.
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Müller HP, Lulé D, Roselli F, Behler A, Ludolph AC, Kassubek J. Segmental involvement of the corpus callosum in C9orf72-associated ALS: a tract of interest-based DTI study. Ther Adv Chronic Dis 2021; 12:20406223211002969. [PMID: 33815737 PMCID: PMC7989124 DOI: 10.1177/20406223211002969] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/24/2021] [Indexed: 12/11/2022] Open
Abstract
Background: C9orf72 hexanucleotide repeat expansions are associated with widespread cerebral alterations, including white matter alterations. However, there is lack of information on changes in commissure fibres. Diffusion tensor imaging (DTI) can identify amyotrophic lateral sclerosis (ALS)-associated patterns of regional brain alterations at the group level. The objective of this study was to investigate the structural connectivity of the corpus callosum (CC) in ALS patients with C9orf72 expansions. Methods: DTI-based white matter mapping was performed by a hypothesis-guided tractwise analysis of fractional anisotropy (FA) maps for 25 ALS patients with C9orf72 expansion versus 25 matched healthy controls. Furthermore, a comparison with a patient control group of 25 sporadic ALS patients was performed. DTI-based tracts that originate from callosal sub-areas I to V were identified and correlated with clinical data. Results: The analysis of white matter integrity demonstrated regional FA reductions for tracts of the callosal areas II and III for ALS patients with C9orf72 expansions while FA reductions in sporadic ALS patients were observed only for tracts of the callosal area III; these reductions were correlated with clinical parameters. Conclusion: The tract-of-interest-based analysis showed a microstructural callosal involvement pattern in C9orf72-associated ALS that included the motor segment III together with frontal callosal connections, as an imaging signature of the C9orf72-associated overlap of motor neuron disease and frontotemporal pathology.
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Affiliation(s)
| | - Dorothée Lulé
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Anna Behler
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Jan Kassubek
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, Ulm, 89081, Germany
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Distaso E, Milella G, Mezzapesa DM, Introna A, D'Errico E, Fraddosio A, Zoccolella S, Dicuonzo F, Simone IL. Magnetic resonance metrics to evaluate the effect of therapy in amyotrophic lateral sclerosis: the experience with edaravone. J Neurol 2021; 268:3307-3315. [PMID: 33655342 PMCID: PMC8357666 DOI: 10.1007/s00415-021-10495-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Edaravone was approved as a new treatment for amyotrophic lateral sclerosis (ALS), although there are different opinions on its effectiveness. Magnetic resonance (MRI) measures appear promising as diagnostic and prognostic indicators of disease. However, published studies on MRI using to monitor treatment efficacy in ALS are lacking. PURPOSE The objective of this study was to investigate changes in brain MRI measures in patients treated with edaravone. METHODS Thirteen ALS patients assuming edaravone (ALS-EDA) underwent MRI at baseline (T0) and after 6 months (T6) to measure cortical thickness (CT) and fractional anisotropy (FA) of white matter (WM) tracts. MRI data of ALS-EDA were compared at T0 with those of 12 control subjects (CS), and at T6 with those of 11 ALS patients assuming only riluzole (ALS-RIL), extracted from our ALS cohort using a propensity-score-matching. A longitudinal MRI analysis was performed in ALS-EDA between T6 and T0. RESULTS At T0, ALS-EDA showed a cortical widespread thinning in both hemispheres, particularly in the bilateral precentral gyrus, and a reduction of FA in bilateral corticospinal tracts, in comparison to CS. Thinning in bilateral precentral cortex and significant widespread reduction of FA in several WM tracts were observed in ALS-EDA at T6 compared to T0. At T6, no significant differences in MRI measures of ALS-EDA versus ALS-RIL were found. CONCLUSIONS Patients treated with edaravone showed progression of damage in the motor cortex and several WM tracts, at a six-month follow-up. Moreover, this study showed no evidence of a difference between edaravone and riluzole.
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Affiliation(s)
- Eugenio Distaso
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Giammarco Milella
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Domenico Maria Mezzapesa
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Alessandro Introna
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Eustachio D'Errico
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Angela Fraddosio
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | | | - Franca Dicuonzo
- Neuroradiology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Isabella Laura Simone
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy.
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Liu X, Du L, Zhang B, Zhao Z, Gao W, Liu B, Liu J, Chen Y, Wang Y, Yu H, Ma G. Alterations and Associations Between Magnetic Susceptibility of the Basal Ganglia and Diffusion Properties in Alzheimer's Disease. Front Neurosci 2021; 15:616163. [PMID: 33664645 PMCID: PMC7921325 DOI: 10.3389/fnins.2021.616163] [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: 10/11/2020] [Accepted: 01/12/2021] [Indexed: 11/28/2022] Open
Abstract
This study adopted diffusion tensor imaging to detect alterations in the diffusion parameters of the white matter fiber in Alzheimer’s disease (AD) and used quantitative susceptibility mapping to detect changes in magnetic susceptibility. However, whether the changes of susceptibility values due to excessive iron in the basal ganglia have correlations with the alterations of the diffusion properties of the white matter in patients with AD are still unknown. We aim to investigate the correlations among magnetic susceptibility values of the basal ganglia, diffusion indexes of the white matter, and cognitive function in patients with AD. Thirty patients with AD and nineteen healthy controls (HCs) were recruited. Diffusion indexes of the whole brain were detected using tract-based spatial statistics. The caudate nucleus, putamen, and globus pallidus were selected as regions of interest, and their magnetic susceptibility values were measured. Compared with HCs, patients with AD showed that there were significantly increased axial diffusivity (AxD) in the internal capsule, superior corona radiata (SCR), and right anterior corona radiata (ACR); increased radial diffusivity (RD) in the right anterior limb of the internal capsule, ACR, and genu of the corpus callosum (GCC); and decreased fractional anisotropy (FA) in the right ACR and GCC. The alterations of RD values, FA values, and susceptibility values of the right caudate nucleus in patients with AD were correlated with cognitive scores. Besides, AxD values in the right internal capsule, ACR, and SCR were positively correlated with the magnetic susceptibility values of the right caudate nucleus in patients with AD. Our findings revealed that the magnetic susceptibility of the caudate nucleus may be an MRI-based biomarker of the cognitive dysfunction of AD and abnormal excessive iron distribution in the basal ganglia had adverse effects on the diffusion properties of the white matter.
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Affiliation(s)
- Xiuxiu Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Lei Du
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China.,Graduate School of Peking Union Medical College, Beijing, China
| | - Bing Zhang
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Institute of Brain Science, Nanjing University, Nanjing, China
| | - Zifang Zhao
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Wenwen Gao
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Bing Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China.,Graduate School of Peking Union Medical College, Beijing, China
| | - Jian Liu
- Department of Ultrasound Diagnosis, China-Japan Friendship Hospital, Beijing, China
| | - Yue Chen
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Yige Wang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China.,Graduate School of Peking Union Medical College, Beijing, China
| | - Hongwei Yu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Guolin Ma
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
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Cheng L, Yuan Y, Tang X, Zhou Y, Luo C, Liu D, Zhang Y, Zhang J. Structural and functional underpinnings of precentral abnormalities in amyotrophic lateral sclerosis. Eur J Neurol 2021; 28:1528-1536. [PMID: 33404153 DOI: 10.1111/ene.14717] [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: 12/13/2020] [Accepted: 01/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder characterized by the loss of both upper and lower motor neurons. Studies using various magnetic resonance imaging (MRI) analytical approaches have consistently identified significant precentral abnormalities in ALS, whereas their structural and functional underpinnings remain poorly understood. METHODS Using cortical thickness, fractional anisotropy (FA), and effective connectivity, we performed a multimodal MRI study to examine the structural and functional alterations associated with precentral abnormalities in patients with ALS (n = 60) compared with healthy controls (n = 60). RESULTS Cortical thickness analysis revealed significant cortical thinning in the right precentral gyrus (PCG), superior frontal gyrus, and superior temporal gyrus in patients with ALS. Tractwise white matter microstructure analyses revealed decreased FA in the tracts connected to the PCG cluster in patients with ALS involving the right corticospinal tract and the middle posterior body of the corpus callosum. Additionally, the cortical thickness of the PCG cluster was found to be positively correlated with FA of the tracts connected to the PCG cluster, suggesting that these two structural features are tightly coupled. Using spectral dynamic causal modelling, effective connectivity analysis among the three regions with cortical thinning revealed decreased self-inhibitory influence in the PCG cluster in patients with ALS, which might be an endophenotypic manifestation of an imbalance in inhibitory and excitatory neurotransmitters in this region. CONCLUSIONS The present data shed new light on the structural and functional underpinnings of precentral abnormalities in ALS.
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Affiliation(s)
- Luqi Cheng
- Key Laboratory for Neuroinformation of the Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Yumin Yuan
- School of Intelligent Technology and Engineering, Chongqing University of Science and Technology, Chongqing, China
| | - Xie Tang
- Key Laboratory for Neuroinformation of the Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuan Zhou
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Chunxia Luo
- Department of Neurology, First Affiliated Hospital, Third Military Medical University, Chongqing, China
| | - Daihong Liu
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, and Chongqing Cancer Hospital, Chongqing, China
| | - Yuanchao Zhang
- Key Laboratory for Neuroinformation of the Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, and Chongqing Cancer Hospital, Chongqing, China
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Agarwal S, Highton-Williamson E, Caga J, Howells J, Dharmadasa T, Matamala JM, Ma Y, Shibuya K, Hodges JR, Ahmed RM, Vucic S, Kiernan MC. Motor cortical excitability predicts cognitive phenotypes in amyotrophic lateral sclerosis. Sci Rep 2021; 11:2172. [PMID: 33500476 PMCID: PMC7838179 DOI: 10.1038/s41598-021-81612-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 12/30/2020] [Indexed: 12/31/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) are well-recognised as an extended disease spectrum. This study hypothesised that cortical hyperexcitability, an early pathophysiological abnormality in ALS, would distinguish cognitive phenotypes, as a surrogate marker of pathological disease burden. 61 patients with ALS, matched for disease duration (pure motor ALS, n = 39; ALS with coexistent FTD, ALS-FTD, n = 12; ALS with cognitive/behavioural abnormalities not meeting FTD criteria, ALS-Cog, n = 10) and 30 age-matched healthy controls. Cognitive function on the Addenbrooke's cognitive examination (ACE) scale, behavioural function on the motor neuron disease behavior scale (MiND-B) and cortical excitability using transcranial magnetic stimulation (TMS) were documented. Cortical resting motor threshold (RMT), lower threshold indicating hyperexcitability, was lower in ALS-FTD (50.2 ± 6.9) compared to controls (64.3 ± 12.6, p < 0.005), while ALS-Cog (63.3 ± 12.7) and ALS (60.8 ± 13.9, not significant) were similar to controls. Short interval intracortical inhibition (SICI) was reduced across all ALS groups compared to controls, indicating hyperexcitability. On receiver operating characteristic curve analysis, RMT differentiated ALS-FTD from ALS (area under the curve AUC = 0.745, p = 0.011). The present study has identified a distinct pattern of cortical excitability across cognitive phenotypes in ALS. As such, assessment of cortical physiology may provide more precise clinical prognostication in ALS.
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Affiliation(s)
- Smriti Agarwal
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia. .,Neurology Unit, A5, Box 165, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
| | | | - Jashelle Caga
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia
| | - James Howells
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia
| | - Thanuja Dharmadasa
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia
| | - José M Matamala
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia
| | - Yan Ma
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kazumoto Shibuya
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia
| | - John R Hodges
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia
| | - Rebekah M Ahmed
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia.,Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Steve Vucic
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre and Sydney Medical School, University of Sydney, Sydney, Australia.,Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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40
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Ahmed RM, Steyn F, Dupuis L. Hypothalamus and weight loss in amyotrophic lateral sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2021; 180:327-338. [PMID: 34225938 DOI: 10.1016/b978-0-12-820107-7.00020-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a devastating progressive neurodegenerative disorder. While initially pathophysiology was thought to be restricted to motor deficits, it is increasingly recognized that patients develop prominent changes in weight and eating behavior that result from and mediate the underlying neurodegenerative process. These changes include alterations in metabolism, lipid levels, and insulin resistance. Emerging research suggests that these alterations may be mediated through changes in the hypothalamic function, with atrophy of the hypothalamus shown in both ALS patients and also presymptomatic genetic at-risk patients. This chapter reviews the evidence for hypothalamic involvement in ALS, including melanocortin pathways and potential treatment targets.
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Affiliation(s)
- Rebekah M Ahmed
- Memory and Cognition Clinic, Department of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Central Sydney Medical School and Brain & Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Frederik Steyn
- School of Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia; Department of Neurology, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Luc Dupuis
- Université de Strasbourg, Inserm, UMR-S 1118, Centre de Recherches en Biomédecine, Strasbourg, France.
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41
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Castro J, Swash M, de Carvalho M. The cutaneous silent period in motor neuron disease. Clin Neurophysiol 2020; 132:660-665. [PMID: 33358125 DOI: 10.1016/j.clinph.2020.10.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/07/2020] [Accepted: 10/27/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the cutaneous silent period (CSP) by measuring its onset latency, duration and amount signal suppression in patients with motor neuron disease (MND) grouped according to the intensity of upper motor neuron involvement (UMN), and to test the effect of contralateral hand contraction. METHODS Painful stimulation was applied at the V finger, and contraction recorded from the abductor digiti minimi (ADM) muscle (baseline condition). Afterwards, CSP was studied during strong contralateral ADM contraction (test condition). 10-15 consecutive traces were recorded for each condition, signals were rectified, averaged, and analyzed offline. RESULTS 46 patients were investigated, 15 with progressive muscular atrophy (PMA), 16 with typical amyotrophic lateral sclerosis (ALS), 15 with primary lateral sclerosis/predominant UMN-ALS (PLS+UMN-ALS), and 28 controls. In the baseline condition, all MND groups showed delayed onset latencies (p = 0.001). There was no significant difference in the CSP duration. Suppression was lower in the PLS + UMN-ALS group (p = 0.004). In the control group, contralateral contraction did not change CSP, but onset latency shortened significantly in the PMA group. CONCLUSIONS CSP onset latency is delayed in all investigated groups of MND, including in PMA, indicating subclinical UMN involvement. Changes in CSP can indicate UMN lesion in MND. SIGNIFICANCE CSP should be explored to identify UMN involvement in MND.
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Affiliation(s)
- José Castro
- Instituto de Fisiologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Department of Neurosciences and Mental Health, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Michael Swash
- Instituto de Fisiologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Departments of Neurology and Neuroscience, Barts and the London School of Medicine, Queen Mary University of London, United Kingdom
| | - Mamede de Carvalho
- Instituto de Fisiologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Department of Neurosciences and Mental Health, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
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42
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van den Bos MAJ, Higashihara M, Geevasinga N, Menon P, Kiernan MC, Vucic S. Pathophysiological associations of transcallosal dysfunction in ALS. Eur J Neurol 2020; 28:1172-1180. [PMID: 33220162 DOI: 10.1111/ene.14653] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/05/2020] [Indexed: 12/28/2022]
Abstract
AIM Involvement of the corpus callosum has been identified as a feature of amyotrophic lateral sclerosis (ALS), particularly through neuropathological studies. The aim of the present study was to determine whether alteration in transcallosal function contributed to the development of ALS, disease progression and thereby functional disability. METHODS Transcallosal function and motor cortex excitability were assessed in 17 ALS patients with results compared to healthy controls. Transcallosal inhibition (interstimulus intervals (ISI) of 8-40 ms), short interval intracortical facilitation (SICF) and inhibition (SICI) were assessed in both cerebral hemispheres. Patients were staged utilising clinical and neurophysiological staging assessments. RESULTS In ALS, there was prominent reduction of transcallosal inhibition (TI) when recorded from the primary and secondary motor cortices compared to controls (F = 23.255, p < 0.001). This reduction of TI was accompanied by features indicative of cortical hyperexcitability, including reduction of SICI and increase in SICF. There was a significant correlation between the reduction in TI and the rate of disease progression (R = -0.825, p < 0.001) and reduction in muscle strength (R = 0.54, p = 0.031). CONCLUSION The present study has established that dysfunction of transcallosal circuits was an important pathophysiological mechanism in ALS, correlating with greater disability and a faster rate of disease progression. Therapies aimed at restoring the function of transcallosal circuits may be considered for therapeutic approaches in ALS.
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Affiliation(s)
| | - Mana Higashihara
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.,Department of Neurology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | | | - Parvathi Menon
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Matthew C Kiernan
- Department of Neurology, Brain and Mind Centre, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Steve Vucic
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
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Gabel MC, Broad RJ, Young AL, Abrahams S, Bastin ME, Menke RAL, Al‐Chalabi A, Goldstein LH, Tsermentseli S, Alexander DC, Turner MR, Leigh PN, Cercignani M. Evolution of white matter damage in amyotrophic lateral sclerosis. Ann Clin Transl Neurol 2020; 7:722-732. [PMID: 32367696 PMCID: PMC7261765 DOI: 10.1002/acn3.51035] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To characterize disease evolution in amyotrophic lateral sclerosis using an event-based model designed to extract temporal information from cross-sectional data. Conventional methods for understanding mechanisms of rapidly progressive neurodegenerative disorders are limited by the subjectivity inherent in the selection of a limited range of measurements, and the need to acquire longitudinal data. METHODS The event-based model characterizes a disease as a series of events, each comprising a significant change in subject state. The model was applied to data from 154 patients and 128 healthy controls selected from five independent diffusion MRI datasets acquired in four different imaging laboratories between 1999 and 2016. The biomarkers modeled were mean fractional anisotropy values of white matter tracts implicated in amyotrophic lateral sclerosis. The cerebral portion of the corticospinal tract was divided into three segments. RESULTS Application of the model to the pooled datasets revealed that the corticospinal tracts were involved before other white matter tracts. Distal corticospinal tract segments were involved earlier than more proximal (i.e., cephalad) segments. In addition, the model revealed early ordering of fractional anisotropy change in the corpus callosum and subsequently in long association fibers. INTERPRETATION These findings represent data-driven evidence for early involvement of the corticospinal tracts and body of the corpus callosum in keeping with conventional approaches to image analysis, while providing new evidence to inform directional degeneration of the corticospinal tracts. This data-driven model provides new insight into the dynamics of neuronal damage in amyotrophic lateral sclerosis.
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Affiliation(s)
- Matt C. Gabel
- Department of NeuroscienceClinical Imaging Sciences CentreBrighton and Sussex Medical SchoolUniversity of SussexBrightonEast SussexUnited Kingdom
| | - Rebecca J. Broad
- Department of NeuroscienceTrafford CentreBrighton and Sussex Medical SchoolUniversity of SussexBrightonEast SussexUnited Kingdom
| | - Alexandra L. Young
- Centre for Medical Image ComputingDepartment of Computer ScienceUniversity College LondonGower StreetLondonWC1E 6BTUnited Kingdom
| | - Sharon Abrahams
- Department of PsychologySchool of Philosophy, Psychology & Language SciencesEuan MacDonald Centre for Motor Neurone Disease ResearchUniversity of EdinburghEdinburghUnited Kingdom
| | - Mark E. Bastin
- Department of PsychologySchool of Philosophy, Psychology & Language SciencesEuan MacDonald Centre for Motor Neurone Disease ResearchUniversity of EdinburghEdinburghUnited Kingdom
| | - Ricarda A. L. Menke
- Wellcome Centre for Integrative NeuroimagingFMRIBNuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUnited Kingdom
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUnited Kingdom
| | - Ammar Al‐Chalabi
- Department of Basic and Clinical NeuroscienceKing's College LondonMaurice Wohl Clinical Neuroscience InstituteLondonUnited Kingdom
- Department of NeurologyKing’s College HospitalLondonUnited Kingdom
| | - Laura H. Goldstein
- Department of PsychologyInstitute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUnited Kingdom
| | | | - Daniel C. Alexander
- Centre for Medical Image ComputingDepartment of Computer ScienceUniversity College LondonGower StreetLondonWC1E 6BTUnited Kingdom
| | - Martin R. Turner
- Wellcome Centre for Integrative NeuroimagingFMRIBNuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUnited Kingdom
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUnited Kingdom
| | - P. Nigel Leigh
- Department of NeuroscienceTrafford CentreBrighton and Sussex Medical SchoolUniversity of SussexBrightonEast SussexUnited Kingdom
| | - Mara Cercignani
- Department of NeuroscienceClinical Imaging Sciences CentreBrighton and Sussex Medical SchoolUniversity of SussexBrightonEast SussexUnited Kingdom
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44
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Bede P, Chipika RH. Commissural fiber degeneration in motor neuron diseases. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:321-323. [PMID: 32290711 DOI: 10.1080/21678421.2020.1752253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Peter Bede
- Computational Neuroimaging Group (CNG), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Rangariroyashe H Chipika
- Computational Neuroimaging Group (CNG), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
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45
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Müller H, Dreyhaupt J, Roselli F, Schlecht M, Gorges M, Ludolph A, Kassubek J. P17 MRI volumetry and microtexture analysis of focal alterations of the callosal area III in primary lateral sclerosis. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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46
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Abstract
Primary lateral sclerosis (PLS) is a rare neurodegenerative disorder at the upper motor neurone extreme of the spectrum of motor neurone disease. The diagnosis is clinical and based on the characteristic features of slowly progressive spasticity beginning in the lower limbs, or more rarely with spastic dysarthria, typically presenting around 50 years of age. The absence of lower motor neurone involvement is considered to be a defining feature, but confident distinction of PLS from upper motor neurone-predominant forms of amyotrophic lateral sclerosis may be difficult in the first few years. Corticobulbar involvement in PLS is frequently accompanied by emotionality. While there may be dysphagia, gastrostomy is rarely required to maintain nutrition. Cognitive dysfunction is recognised, though dementia is rarely a prominent management issue. PLS is not necessarily life shortening. Specialised multidisciplinary care is recommended. Increasing international research cooperation is required if the aspiration of dedicated therapeutic trials for PLS is to be achieved.
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Affiliation(s)
- Martin R Turner
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Kevin Talbot
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
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47
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Wittstock M, Wilde N, Grossmann A, Kasper E, Teipel S. Mirror Movements in Amyotrophic Lateral Sclerosis: A Combined Study Using Diffusion Tensor Imaging and Transcranial Magnetic Stimulation. Front Neurol 2020; 11:164. [PMID: 32210909 PMCID: PMC7067896 DOI: 10.3389/fneur.2020.00164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/21/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disorder predominantly affecting the motor system. In a number of patients, mirror movements (MMs) suggest involvement of transcallosal fiber tracts in conjunction with upper motor neuron involvement. The aim of the study was to elucidate functional and structural alterations of callosal integrity in ALS patients with MMs. Methods: Nineteen patients with ALS displaying MMs and 20 controls underwent clinical assessment, transcranial magnetic stimulation (TMS), and diffusion tensor imaging (DTI). TBSS (tract based spatial statistics) was performed. We investigated ipsilateral silent period (iSP) as a measure of transcallosal inhibition, and diffusion changes in the corpus callosum and corticospinal tract (CST) as measure of structural integrity. Results: In ALS patients TMS revealed a longer mean iSP latency than controls. Twelve ALS patients (63.2%) showed loss of iSP, but none of the controls. Using region of interest analysis, fractional anisotropy (FA) values of the CST were significantly lower in ALS patients compared with controls, but diffusion parameters of the corpus callosum did not differ between patients and controls. The lack of diffusion changes in the corpus callosum was confirmed in whole brain tract based statistics, assessing FA as well as mean, radial, and axial diffusivity. There was a significant negative correlation between resting motor threshold and FA values of the CST, but not between iSP and FA of the corpus callosum. Conclusion: In conclusion the study failed to show microstructural changes in the corpus callosum in conjunction with MMs. One possible reason may be that functional disturbance of transcallosal pathways precede microstructural changes in the corpus callosum.
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Affiliation(s)
| | - Nora Wilde
- Department of Neurology, University Medicine Rostock, Rostock, Germany
| | - Annette Grossmann
- Institute of Diagnostic and Interventional Radiology, University Medicine Rostock, Rostock, Germany
| | - Elisabeth Kasper
- DZNE, German Centre for Neurodegenerative Diseases, Rostock, Germany
| | - Stefan Teipel
- DZNE, German Centre for Neurodegenerative Diseases, Rostock, Germany
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48
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Swash M, Burke D, Turner MR, Grosskreutz J, Leigh PN, deCarvalho M, Kiernan MC. Occasional essay: Upper motor neuron syndrome in amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2020; 91:227-234. [PMID: 32054724 DOI: 10.1136/jnnp-2019-321938] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/17/2019] [Accepted: 10/24/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Michael Swash
- Barts and the London School of Medicine, QMUL, Instituto de Medicina Molecular, Faculdade de Medicina, Univeridade de Lisboa, London, UK
| | - David Burke
- University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Julian Grosskreutz
- Universitätsklinikum Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - P Nigel Leigh
- Trafford Centre for Biomedical Research, Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Mamede deCarvalho
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Univeridade de Lisboa, and Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Matthew C Kiernan
- University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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49
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Tu S, Wang C, Menke RAL, Talbot K, Barnett M, Kiernan MC, Turner MR. Regional callosal integrity and bilaterality of limb weakness in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:396-402. [PMID: 32106716 DOI: 10.1080/21678421.2020.1733020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background and Objectives: The corpus callosum is a site of pathological involvement in the neurodegenerative disorder amyotrophic lateral sclerosis (ALS). The corpus callosum shows widespread cortical connectivity topographically distributed along its length. Initial limb weakness in ALS is typically unilateral, becoming bilateral with disease progression. The precise anatomical substrate for this spread is uncertain. The present study investigated sub-regional variations in corpus callosum integrity in ALS, and whether these reflect a relationship with the development of unilateral or bilateral limb weakness. Methods: Sporadic ALS patients were categorized into unilateral (n = 14) or bilateral (n = 25) limb weakness at the time of assessment and underwent diffusion tensor imaging. Probabilistic bundle-specific tracking was carried out using MRtrix and TractSeg to parcellate the corpus callosum into seven anatomical segments (rostrum; genu; rostral body; anterior midbody; posterior midbody; isthmus; splenium). White matter tract integrity was assessed in all segments and compared with MRI data acquired from 25 healthy controls. Results: In the combined patient group, the most prominent differences in diffusivity metrics were in the rostral body, posterior midbody and isthmus of the corpus callosum (p < 0.04). Loss of corpus callosum integrity was most prominent in the sub-group with unilateral limb weakness at the time of scanning (p < 0.05). Conclusions: Corpus callosum involvement in ALS is detectable across multiple segments, in keeping with a widespread cortical distribution of pathology. The association of unilateral limb weakness with greater loss of corpus callosum integrity informs connectivity-based hypotheses of symptom propagation in ALS.
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Affiliation(s)
- Sicong Tu
- Brain and Mind Centre, The University of Sydney, Sydney, Australia.,Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Chenyu Wang
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Ricarda A L Menke
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Kevin Talbot
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Michael Barnett
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | | | - Martin R Turner
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
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50
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Müller HP, Dreyhaupt J, Roselli F, Schlecht M, Ludolph AC, Huppertz HJ, Kassubek J. Focal alterations of the callosal area III in primary lateral sclerosis: An MRI planimetry and texture analysis. NEUROIMAGE-CLINICAL 2020; 26:102223. [PMID: 32114375 PMCID: PMC7049663 DOI: 10.1016/j.nicl.2020.102223] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/17/2022]
Abstract
The regional pattern of cerebral alterations in PLS includes the area III of the CC. Callosal alterations of the texture parameters entropy and homogeneity were shown in PLS. Texture and macrostructure of the callosal area III is targeted as a neuroimaging marker in PLS.
Background The regional distribution of cerebral morphological alterations in primary lateral sclerosis (PLS) is considered to include the area III of the corpus callosum (CC). Objective The study was designed to investigate regional white matter (WM) alterations in the callosal area III by T1 weighted magnetic resonance imaging (T1w-MRI) data in PLS patients compared with healthy controls, in order to identify atrophy and texture changes in vivo. Methods T1w-MRI-based white matter mapping was used to perform an operator-independent CC-segmentation for the different areas of the CC in 67 PLS patients vs 82 matched healthy controls and vs 85 ALS patients. The segmentation was followed by texture analysis of the separated CC areas for the PLS patients vs controls and vs ALS patients. Results PLS was associated with significant atrophy in the area III of the CC (but not in the other callosal segments), while the alterations in the ALS patients were much more variable and were not significant at the group level. Furthermore, significant regional alterations of the texture parameters entropy and homogeneity in this area were shown in PLS patients and in ALS patients. Conclusions This T1w-MRI study demonstrated focused regional CC atrophy and texture alterations limited to the callosal area III (which comprises fibers projecting into the primary motor cortices) in PLS, in comparison to a higher variability in CC size in ALS.
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Affiliation(s)
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, University of Ulm, Germany
| | | | | | | | | | - Jan Kassubek
- Department of Neurology, University of Ulm, Germany.
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