Abstract
Evidence of upper motor neuron (UMN) dysfunction is essential in making the diagnosis of amyotrophic lateral sclerosis (ALS). Central motor conduction (CMC) abnormalities detected using transcranial magnetic stimulation (TMS) are presumed to reflect UMN dysfunction. CMC is, however, often normal in patients with classical sporadic ALS. The aim of the study was to determine whether the utility of the CMC measure in ALS could be enhanced. We measured CMC to four pairs of muscles (abductor digiti minimi (ADM), biceps, vastus medialis (VM) and abductor hallucis (AH) in 20 controls and 25 ALS patients. The commonest abnormality detected in the ALS patients was an absent MEP, found in 11 patients (44 %) and in 25 of 200 muscles examined. Studying a minimum of three muscles increased the probability of detecting UMN dysfunction. Weakness in the muscle as well as selecting a distal rather than a proximal muscle was significantly associated with an abnormal CMC. Interside differences in CMC were significantly more pronounced in the patient group. In 30% of patients a significant interside difference in AH CMC time was the sole abnormality, suggesting mild UMN dysfunction on the side with the longer CMC.
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Abbreviations
- ALS:
-
Amyotrophic lateral sclerosis
- ADM:
-
Abductor digiti minimi
- AH:
-
Abductor hallucis
- CMC:
-
Central motor conduction
- CMCT:
-
Central motor conduction time
- MEP:
-
Motor evoked potential
- MRI:
-
Magnetic resonance imaging
- MRS:
-
Magnetic resonance spectroscopy
- PET:
-
Positron emission tomography
- TA:
-
Tibialis anterior
- TMS:
-
Transcranial magnetic stimulation
- TST:
-
Triple stimulation technique
- UMN:
-
Upper motor neuron
- VM:
-
Vastus medialis
References
Barker AT, Jalinous R, Freeston IL (1985) Non-invasive magnetic stimulation of human motor cortex. Lancet 1:1106–1107
Barker AT, Freeston IL, Jalinous R, Jarratt JA (1986) Clinical evaluation of conduction time measurements in central motor pathways using magnetic stimulation of human brain. Lancet 1:1325–1326
Berardelli A (1990) Cortical stimulation in patients with motor disturbances. In: Berardelli A, Benecke R (eds) Motor Disturbances II. Academic Press Limited, pp 17–30
Berardelli A, InghillerI M, Cruccu G, Mercuri B, Manfredi M (1991) Electrical and magnetic transcranial stimulation in patients with corticospinal damage due to stroke or motor neurone disease. Electroencephalogr Clin Neurophysiol 81:389–396
Brooks BR (1994) El Escorial World Federation of Neurology criteria for the diagnosis of amyotrophic lateral sclerosis. Subcommittee on Motor Neuron Diseases/Amyotrophic Lateral Sclerosis of the World Federation of Neurology Research Group on Neuromuscular Diseases and the El Escorial “Clinical limits of amyotrophic lateral sclerosis” workshop contributors. J Neurol Sci 124:96–107
Brooks BR, Miller RG, Swash M, Munsat TL World Federation of Neurology Research Group on Motor Neuron, D, (2000) El Escorial revisited: revised criteria for the diagnosis of amyotrophic lateral sclerosis. Amyotroph Lateral Scler Other Motor Neuron Disord 1:293–299
Swash M (2000) Clinical features and diagnosis of amyotrophic lateral sclerosis. In: Brown RH, Meninger V, Swash M (eds) Amyotrophic Lateral Sclerosis. Martin Dunitz Ltd, London, pp 3–30
Claus D, Brunholzl C, Kerling FP, Henschel S (1995) Transcranial magnetic stimulation as a diagnostic and prognostic test in amyotrophic lateral sclerosis. J Neurol Sci 129:30–34
Day BL, Dressler D, Hess CW, Maertens de Noordhout A, Marsden CD, Mills KR, Murray NM, Nakashima K, Rothwell J, Thompson PD (1990) Direction of current in magnetic stimulation coils used for percutaneous activation of brain, spinal cord and peripheral nerve. J Physiol 430:617
De Carvalho M, Turkman A, Swash M (2003) Motor responses evoked by transcranial magnetic stimulation and peripheral nerve stimulation in the ulnar innervation in amyotrophic lateral sclerosis: the effect of upper and lower motor neuron lesion. J Neurol Sci 210:83–90
Di Lazzaro V, Restuccia D, Colosimo C, Tonali P (1992) The contribution of magnetic stimulation of the motor cortex to the diagnosis of cervical spondylotic myelopathy. Correlation of central motor conduction to distal and proximal upper limb muscles with clinical and MRI findings. Electroencephalogr Clin Neurophysiol 85:311–320
Eisen A, Shytbel W, Murphy K, Hoirch M (1990) Cortical magnetic stimulation in amyotrophic lateral sclerosis. Muscle Nerve 13:146–151
Hugon J, Lubeau M, Tabaraud F, Chazot F, Vallat JM, Dumas M (1987) Central motor conduction in motor neuron disease. Ann Neurol 22:544–546
Ingram DA, Swash M (1987) Central motor conduction is abnormal in motor neuron disease. J Neurol Neurosurg Psychiatry 50:159–166
Jalinous R (2003) Guide to magnetic stimulation. The Magstim Co. Ltd., Spring Gardens, Whitland, Wales, UK
Magistris MR, Rosler KM, Truffert A, Myers JP (1998) Transcranial stimulation excites virtually all motor neurons supplying the target muscle.A demonstration and a method improving the study of motor evoked potentials. Brain 121:437–450
Mills KR, Nithi KA (1998) Peripheral and central motor conduction in amyotrophic lateral sclerosis. J Neurol Sci 159:82–87
Mills KR (1999) Brain stimulation in a clinical setting. In: Mills KR (ed) Magnetic stimulation of the human nervous system. Oxford University Press, Oxford, pp 168–192
Mills KR (1999) Stimulation of peripheral nerves. In: Mills, KR (ed) Magnetic stimulation of the human nervous system. Oxford University Press, Oxford, pp 116–136
Mulder DW (1984) Motor neuron disease. In: Rowland LP (ed) Motor neurone diseases. Raven Press, New York, pp 1525–1536
Pioro EP (2000) Imaging in amyotrophic lateral sclerosis. In Brown RH, Meininger V, Swash M (eds) Amyotrophic Lateral Sclerosis. Martin Dunitz, London, pp 187–208
Pohl C, Block W, Karitzky J, Traber F, Schmidt S, Grothe C, Lamerichs R, Schild H, Klockgether T (2001) Proton magnetic resonance spectroscopy of the motor cortex in 70 patients with amyotrophic lateral sclerosis. Arch Neurol 58:729–735
Pouget J, Trefouret S, Attarian S (2000) Transcranial magnetic stimulation (TMS): compared sensitivity of different motor response parameters in ALS. Amyotroph Lateral Scler Other Motor Neuron Disord 1:S45–S49
Rosler KM, Truffert A, Hess CW, Magistris MR (2000) Quantification of upper motor neuron loss in amyotrophic lateral sclerosis. Clin Neurophysiol 111:2208–2218
Rossini PM (1988) The Anatomic and Physiologic basis of Motor evoked potentials. Neurol Clin 6:751–769
Rossini PM, Pauri F (1999) Central motor conduction time studies. Electroencephalogr Clin Neurophysiol 51(Suppl):199–211
Samii A, Luciano CA, Dambrosia JM, Hallett M (1998) Central motor conduction time: reproducibility and discomfort of different methods. Muscle Nerve 21:1445–1450
Schriefer TN, Hess CW, Mills KR, Murray NM (1989) Central motor conduction studies in motor neurone disease using magnetic brain stimulation. Electroencephalogr Clin Neurophysiol 74:431–437
Schulte-Mattler WJ, Muller T, Zierz S (1999) Transcranial magnetic stimulation compared with upper motor neuron signs in patients with amyotrophic lateral sclerosis. J Neurol Sci 170:51–56
Schwartz MS, Swash M (1982) Pattern of involvement in the cervical segments in the early stage of motor neurone disease: A single fibre EMG study. Acta Neurol Scand 65:424–431
Triggs WJ, Menkes D, Onorato J, Yan RS, Young MS, Newell K, Sander HW, Soto O, Chiappa KH, Cros D (1999) Transcranial magnetic stimulation identifies upper motor neuron involvement in motor neuron disease. Neurology 53:605–611
Truffert A, Rosler KM, Magistris MR (2000) Amyotrophic lateral sclerosis versus cervical spondylotic myelopathy: a study using transcranial magnetic stimulation with recordings from the trapezius and limb muscles. Clin Neurophysiol 111:1031–1038
Urban PP, Vogt T, Hopf HC (1998) Corticobulbar tract involvement in amyotrophic lateral sclerosis. A transcranial magnetic stimulation study. Brain 121:1099–1108
Urban PP, Wicht S, Hopf HC (2001) Sensitivity of transcranial magnetic stimulation of cortico-bulbar vs. cortico-spinal tract involvement in Amyotrophic Lateral Sclerosis (ALS). J Neurol 248:850–855
Wohlfart G, Swank RL (1941) Pathology of amyotrophic lateral sclerosis: fiber analysis of the ventral roots and pyramidal tracts of the spinal cord. Arch Neurol Psychiatr 46:783–799
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Financial support from the Wellcome Trust is gratefully acknowledged.
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Osei-Lah, A.D., Mills, K.R. Optimising the detection of upper motor neuron function dysfunction in amyotrophic lateral sclerosis—a transcranial magnetic stimulation study. J Neurol 251, 1364–1369 (2004). https://doi.org/10.1007/s00415-004-0545-6
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DOI: https://doi.org/10.1007/s00415-004-0545-6