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Motor-evoked potentials in amyotrophic lateral sclerosis: potential implications in detecting subclinical UMN involvement in lower motor neuron phenotype
BACKGROUND: In amyotrophic lateral sclerosis (ALS), the involvement of lower motor neuron is well defined by electromyography, whereas a reliable marker of upper motor neuron (UMN) damage still lacks. Aim of the study was to estimate the role of transcranial magnetic stimulation (TMS)-induced motor-...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7674351/ https://www.ncbi.nlm.nih.gov/pubmed/32676769 http://dx.doi.org/10.1007/s00415-020-10073-5 |
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author | Zoccolella, Stefano Mastronardi, Antonella Scarafino, Antonio Iliceto, Giovanni D’Errico, Eustachio Fraddosio, Angela Tempesta, Irene Morea, Antonella Scaglione, Gaspare Introna, Alessandro Simone, Isabella Laura |
author_facet | Zoccolella, Stefano Mastronardi, Antonella Scarafino, Antonio Iliceto, Giovanni D’Errico, Eustachio Fraddosio, Angela Tempesta, Irene Morea, Antonella Scaglione, Gaspare Introna, Alessandro Simone, Isabella Laura |
author_sort | Zoccolella, Stefano |
collection | PubMed |
description | BACKGROUND: In amyotrophic lateral sclerosis (ALS), the involvement of lower motor neuron is well defined by electromyography, whereas a reliable marker of upper motor neuron (UMN) damage still lacks. Aim of the study was to estimate the role of transcranial magnetic stimulation (TMS)-induced motor-evoked potentials (MEPs) as marker of subclinical UMN involvement. METHODS: Clinical evidence of UMN damage was prospectively compared to MEPs in 176 ALS patients diagnosed between 2011 and 2014, and classified according to existing diagnostic criteria. Finally, we evaluated the appearance of clinical UMN signs and the level of diagnostic certainty in ALS after 1 year of follow-up. RESULTS: At presentation, abnormal MEPs were found in 80% of patients with clinical evidence of UMN damage and in 72% of patients without clinical involvement of UMN. Among these latter, 61% showed appearance of UMN clinical signs after 1 year. Approximately 70% of patients with clinical lower motor neuron (LMN) phenotype showed MEP abnormalities, while they were considered not classifiable ALS according to Airlie house or Awaji criteria. Furthermore, abnormal MEPs in absence of clinical UMN signs at baseline were found in 80% of spinal ALS that after 1-year developed UMN signs at limbs, compared to 50% of bulbar ALS. CONCLUSIONS: TMS is a reliable marker of subclinical UMN damage particularly among LMN phenotype and ensure an early ALS diagnosis in ~ 70% of such cases. |
format | Online Article Text |
id | pubmed-7674351 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-76743512020-11-30 Motor-evoked potentials in amyotrophic lateral sclerosis: potential implications in detecting subclinical UMN involvement in lower motor neuron phenotype Zoccolella, Stefano Mastronardi, Antonella Scarafino, Antonio Iliceto, Giovanni D’Errico, Eustachio Fraddosio, Angela Tempesta, Irene Morea, Antonella Scaglione, Gaspare Introna, Alessandro Simone, Isabella Laura J Neurol Original Communication BACKGROUND: In amyotrophic lateral sclerosis (ALS), the involvement of lower motor neuron is well defined by electromyography, whereas a reliable marker of upper motor neuron (UMN) damage still lacks. Aim of the study was to estimate the role of transcranial magnetic stimulation (TMS)-induced motor-evoked potentials (MEPs) as marker of subclinical UMN involvement. METHODS: Clinical evidence of UMN damage was prospectively compared to MEPs in 176 ALS patients diagnosed between 2011 and 2014, and classified according to existing diagnostic criteria. Finally, we evaluated the appearance of clinical UMN signs and the level of diagnostic certainty in ALS after 1 year of follow-up. RESULTS: At presentation, abnormal MEPs were found in 80% of patients with clinical evidence of UMN damage and in 72% of patients without clinical involvement of UMN. Among these latter, 61% showed appearance of UMN clinical signs after 1 year. Approximately 70% of patients with clinical lower motor neuron (LMN) phenotype showed MEP abnormalities, while they were considered not classifiable ALS according to Airlie house or Awaji criteria. Furthermore, abnormal MEPs in absence of clinical UMN signs at baseline were found in 80% of spinal ALS that after 1-year developed UMN signs at limbs, compared to 50% of bulbar ALS. CONCLUSIONS: TMS is a reliable marker of subclinical UMN damage particularly among LMN phenotype and ensure an early ALS diagnosis in ~ 70% of such cases. Springer Berlin Heidelberg 2020-07-16 2020 /pmc/articles/PMC7674351/ /pubmed/32676769 http://dx.doi.org/10.1007/s00415-020-10073-5 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Original Communication Zoccolella, Stefano Mastronardi, Antonella Scarafino, Antonio Iliceto, Giovanni D’Errico, Eustachio Fraddosio, Angela Tempesta, Irene Morea, Antonella Scaglione, Gaspare Introna, Alessandro Simone, Isabella Laura Motor-evoked potentials in amyotrophic lateral sclerosis: potential implications in detecting subclinical UMN involvement in lower motor neuron phenotype |
title | Motor-evoked potentials in amyotrophic lateral sclerosis: potential implications in detecting subclinical UMN involvement in lower motor neuron phenotype |
title_full | Motor-evoked potentials in amyotrophic lateral sclerosis: potential implications in detecting subclinical UMN involvement in lower motor neuron phenotype |
title_fullStr | Motor-evoked potentials in amyotrophic lateral sclerosis: potential implications in detecting subclinical UMN involvement in lower motor neuron phenotype |
title_full_unstemmed | Motor-evoked potentials in amyotrophic lateral sclerosis: potential implications in detecting subclinical UMN involvement in lower motor neuron phenotype |
title_short | Motor-evoked potentials in amyotrophic lateral sclerosis: potential implications in detecting subclinical UMN involvement in lower motor neuron phenotype |
title_sort | motor-evoked potentials in amyotrophic lateral sclerosis: potential implications in detecting subclinical umn involvement in lower motor neuron phenotype |
topic | Original Communication |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7674351/ https://www.ncbi.nlm.nih.gov/pubmed/32676769 http://dx.doi.org/10.1007/s00415-020-10073-5 |
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