Transcranial magnetic stimulation as a diagnostic and prognostic test in amyotrophic lateral sclerosis

doi:10.1016/0022-510X(95)00056-8

Journal of the Neurological Sciences

Volume 129, Supplement, May 1995, Pages 30-34

https://doi.org/10.1016/0022-510X(95)00056-8 Get rights and content

Abstract

Corticospinal stimulus conduction was investigated after transcranial magnetic stimulation of the motor cortex in 63 patients (20 female, 43 male, 59 ± 12 years) with amyotrophic lateral sclerosis (ALS) and progressive bulbar palsy. Recordings were made bilaterally from the Abductor digiti minimi muscle (ADM) in the hand and the Tibialis anterior muscle (TA) in the leg. Thirteen patients were re-examined after 250 ± 125 days. Eight patients were examined a third time after 552 ± 165 days. At the first investigation central motor conduction time was abnormal to one or more target muscles in 51% (n = 32) of all patients. No significant delay in CMCT developed during follow-up. The average time of survival of patients with normal CMCT at the first investigation was 16.5 ± 7.5 months, and 14.7 ± 8.8 months in patients with abnormal CMCT. This is not a significant difference. It is therefore concluded that transcranial magnetic stimulation is not a sensitive tool in the diagnosis of ALS. Furthermore, CMCT does not provide significant prognostic information.

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Cited by (67)

Upper motor neuron assessment in amyotrophic lateral sclerosis using the patellar tendon reflex and motor-evoked potentials to the lower limbs
2024, Revue Neurologique
Amyotrophic lateral sclerosis (ALS) diagnosis relies on signs of progressive damage to both lower motoneuron (LMN), given by clinical examination and electromyography (EMG), and upper motoneuron (UMN), given by clinical examination only. Recognition of UMN involvement, however, is still difficult, so that diagnostic delay often remains too long. Shortening the time to clinical and genetic diagnosis is essential in order to provide accurate information to patients and families, avoid time-consuming investigations and for appropriate care management. This study investigates whether combined patellar tendon reflex recording with motor-evoked potentials to the lower limbs (T-MEP-LL) is relevant to assess corticospinal function in ALS, so that it might serve as a tool improving diagnosis. T-MEP-LL were recorded in 135 patients with suspected motor neuron disease (MND) from February 2010 to March 2021. The sensitivity, specificity, and ability to improve diagnosis when added to Awaji and Gold Coast criteria were determined. The main finding of the study is that T-MEP-LL can detect UMN dysfunction with a 70% sensitivity and 63% specificity when UMN clinical signs are lacking. The sensitivity reaches 82% when considering all MND patients. Moreover, at first evaluation, using T-MEP-LL to quantify reflex briskness and to measure central conduction time, can improve the diagnostic accuracy. T-MEP-LL is easy to perform and does not need any electrical stimulation, making the test rapid, and painless. By the simultaneous quantification of both UMN and LMN system, it could also help to identify different phenotype with more accuracy than clinical examination in this broad-spectrum pathology. The question whether T-MEP-LL could further be a real biomarker need further prospective studies.
Combined tendon reflex and motor evoked potential recordings in amyotrophic lateral sclerosis
2023, Clinical Neurophysiology
This retrospective (case-control) collaborative study evaluates tendon reflex recordings combined with transcranial magnetic stimulation motor evoked potentials recordings (T-MEPs) at lower limbs in amyotrophic lateral sclerosis (ALS).
T-MEPs were recorded in 97 ALS patients distinguished according to their patellar reflex briskness. Patients’ electrophysiological data were compared with values measured in 60 control patients matched for age and height. Correlations studies between parameters or with some patients’ clinical characteristics were also performed.
The central motor conduction time yields the highest sensitivity (82%) and specificity (93%), allowing twice more upper motor neuron (UMN) dysfunction detection than clinical examination, and being more altered in late stages of the disease. The T response to MEP response amplitude ratio (T/MEP ar) is nearly as sensitive to detect ALS and better identifies abnormal hyperreflexia. It is not correlated with evolutive stage, contrarily to conduction time-related parameters. In addition, T-MEPs detect asymmetries escaping clinical examination.
The corticospinal conduction to lower limbs is slowed in ALS. The T/MEP ar helps deciding when patellar reflexes are abnormal in a given patient suspected of ALS.
The T-MEP technique provide powerful electrophysiological biomarkers of UMN involvement in ALS. This simple and painless procedure introduces the clinically useful concept of electrophysiological hyperreflexia and might be expanded to future exploration of proximal upper limbs and bulbar territories.
Central motor conduction time reveals upper motor neuron involvement masked by lower motor neuron impairment in a significant portion of patients with amyotrophic lateral sclerosis
2020, Clinical Neurophysiology
Citation Excerpt :
Based on these findings, we conclude that the age almost had no influence on the present results for CMCT prolongation in ALS. Prolongation of CMCT in patients with ALS has also been reported previously (Bartousek et al., 1993, Claus et al., 1995, Mills and Nithi, 1998, Schriefer et al., 1989). The CMCT includes the time required for activation of the motor cortical neurons (synaptic delay and utility time), conduction time through the corticospinal tract (CST) from the cortex to the spinal cord, the time for motor neuron activation in the spinal cord (Udupa and Chen, 2013), and the conduction time through the most-proximal part of the peripheral motor nerve within the spinal canal.
We retrospectively investigated the utility of the central motor conduction time (CMCT) in detecting upper motor neuron (UMN) involvements in patients with amyotrophic lateral sclerosis (ALS).
Fifty-two ALS patients and 12 disease control patients participated in this study. Surface electromyograms were recorded from the first dorsal interosseous (FDI) and tibialis anterior (TA) muscles. We stimulated the motor cortex, brainstem, and spinal nerve using transcranial magnetic stimulation (TMS) in order to measure the cortical, brainstem, and spinal latencies. We divided the ALS patients into 2 subgroups (with UMN impairment vs. without UMN impairment) and calculated the rates of abnormal CMCT prolongation judged by their comparison with the normal ranges obtained by the measurement in the control patients.
The CMCTs in the FDI and TA were abnormally prolonged in over 40% of the ALS patients with UMN impairment and in nearly 30% of those without UMN impairment.
CMCT shows UMN dysfunction in ALS patients without clinical UMN impairment.
TMS still has diagnostic utility in a significant portion of ALS patients.
Neurophysiological diagnostics of amyotrophic lateral sclerosis
2017, Neurophysiologie-Labor
Die Amyotrophe Lateralsklerose (ALS) ist eine progrediente, neurodegenerative Erkrankung, die zum Untergang der Motoneurone im motorischen Kortex und im Vorderhorn führt. Zur Diagnose der ALS steht bislang kein zuverlässiger Biomarker zur Verfügung, so dass die Diagnose auf der klinischen Untersuchung und der neurophysiologischen Diagnostik beruht. Den neurophysiologischen Untersuchungsmethoden kommt somit eine entscheidende Rolle in der Diagnose der ALS und ihrer differentialdiagnostischen Abgrenzung zu.
Im Folgenden sollen die in der ALS-Diagnostik etablierten neurophysiologischen Untersuchungen (Elektroneurographie, Elektromyographie, evozierte Potentiale) mit den typischen Veränderungen im Rahmen einer ALS-Erkrankung vorgestellt werden und ein kurzer Ausblick auf vielversprechende neuere Untersuchungstechniken auf dem Gebiet der ALS wie Motor Unit Number Index und Muskelsonographie gegeben werden.
Amyotrophic lateral sclerosis (ALS) is a progressive, neurodegenerative disease leading to the destruction of the motoneurons in the motor cortex and in the anterior horn. For the diagnosis of ALS, no reliable biomarker is available to date. The diagnosis is based on clinical examination and neurophysiological diagnostics.
The neurophysiological examination thus plays a decisive role in the diagnosis of ALS and its differential diagnosis. In the following study, the neurophysiological investigations (electroneurography, electromyography, and evoked potentials) established in ALS diagnostics are presented and a brief outlook on promising newer investigation techniques in the field of ALS such as Motor Unit Number Index and Muscle ultrasonography are given.
Motor-evoked potential gain is a helpful test for the detection of corticospinal tract dysfunction in amyotrophic lateral sclerosis
2017, Clinical Neurophysiology
Citation Excerpt :
However, under these same conditions, MEP gain could discriminate between the two groups. MEP parameters, such as area or amplitude, are not sufficiently sensitive to monitor disease-induced changes (Claus et al., 1995; de Carvalho et al., 1999; Zanette et al., 2002; Mills, 2003). It was suggested to normalize the MEP amplitude by the amplitude of CMAP (de Carvalho et al., 2005), but its sensitivity remains low in ALS (Pouget et al., 2000; Attarian et al., 2005, 2006, 2007).
The detection of upper motor neuron (UMN) dysfunction is necessary for the diagnosis of amyotrophic lateral sclerosis (ALS). However, signs of UMN dysfunction may be difficult to establish. This study aimed to determine whether motor-evoked potential (MEP) gain (MEP area/background electromyographic activity) represents an efficient alternative to assess UMN dysfunction.
MEP area, MEP/compound muscle action potential (CMAP) area ratio, and MEP gain were tested at different force levels in healthy control subjects and ALS patients. Receiver operating characteristic (ROC) curve analyses was used to determine the diagnostic utility of MEP gain and compare it to alternative techniques, namely, diffusion tensor imaging (DTI) and the triple stimulation technique (TST).
MEP gain revealed a significant difference between the patients and healthy control subjects in contrast to MEP area and MEP/CMAP area ratio. The diagnostic utility of MEP gain was comparable with that of TST and superior to that of DTI.
MEP gain can distinguish ALS patients from control subjects and may be helpful for the diagnosis of ALS.
MEP gain appears to be a useful adjunct test and noninvasive method for the assessment of corticospinal dysfunction.
Magnetic Stimulation
2015, Neurophysiologie-Labor
Die Methode der transkraniellen Magnetstimulation wurde im Jahr 1985 von Tony Barker eingeführt. Sie eröffnete die Möglichkeit, nichtinvasiv die Erregbarkeit der Pyramidenzellen im motorischen Kortex zu untersuchen. Außerdem konnte die zentrale motorische Leitungszeit im Gehirn und Rückenmark gemessen werden. Die neurophysiologische Technik trägt zur Diagnostik und Verlaufsbeurteilung neurologischer Krankheiten bei.
The technique of transcranial magnetic stimulation was introduced by Tony Barker in the year 1985. This noninvasive method allows to investigate the excitability of pyramidal cells in the motor cortex. Furthermore, central motor conduction time can be measured in brain and spinal cord. The assessment of central motor conduction is useful in the diagnosis and follow - up investigation of different neurological diseases.

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: This work was supported by the Wilhelm Sander Foundation

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Transcranial magnetic stimulation as a diagnostic and prognostic test in amyotrophic lateral sclerosis

Abstract

A controlled trial of Riluzole in amyotrophic lateral sclerosis

New Engl. J. Med.

Electrical and magnetic transcranial stimulation in patients with corticospinal damage due to stroke or motor neurone disease

Electroenceph. Clin. Neurophysiol.

Central motor conduction: methods and normal results

Muscle Nerve

Central motor conduction in degenerative ataxic disorders

A magnetic stimulation study

J. Neurol. Neurosurg. Psychiat.

Corticospinal conduction studied with magnetic double stimulation in the intact human

J. Neurol. Sci.

Central motor conduction time to upper versus lower extremities

Cortical excitability in amyotrophic lateral sclerosis: a clue to pathogenesis

J. Can. Sci. Neurol.

Cortical magnetic stimulation in amyotrophic lateral sclerosis

Muscle Nerve

Magnetic brain stimulation: Central motor conduction studies in multiple sclerosis

Ann. Neurol.

A review of the pathologic findings in amyotrophic lateral sclerosis