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Corcia P, Couratier P, Ingre C. Could PLS represent a UMN-predominant ALS syndrome? Rev Neurol (Paris) 2024:S0035-3787(24)00529-0. [PMID: 38782644 DOI: 10.1016/j.neurol.2024.04.006] [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: 10/28/2023] [Revised: 03/15/2024] [Accepted: 04/09/2024] [Indexed: 05/25/2024]
Abstract
Primary lateral sclerosis (PLS) is a motor neuron condition marked by pure upper motor neuron (UMN) degeneration. PLS represents around 3% of all motor neuron diseases. Classically the prognosis of PLS is less severe than those of amyotrophic lateral sclerosis (ALS). This explains the necessity to distinguish both conditions as early as possible. The key hallmark between the two diseases is the involvement of the lower motor neuron (LMN) system which is classically considered spared in PLS contrary to ALS. Although it seemed clinically easy to distinguish PLS from ALS with the aid of clinical and complementary examinations, there is a large body of evidence highlighting that the LMN system might be impaired in PLS. This led us to suggest that PLS might be considered as an almost pure UMN ALS phenotype.
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Affiliation(s)
- P Corcia
- Coordination Centre for Rare Disease Reference Centres (CRMR) ALS and other motor neurone diseases (FILSLAN), CHRU Bretonneau, 2, boulevard Tonnellé, 37000 Tours, France; UMR 1253 iBrain, Tours University, Inserm, 10, boulevard Tonnellé, 37000 Tours, France.
| | - P Couratier
- Coordination Centre for Rare Disease Reference Centres (CRMR) ALS and other motor neurone diseases (FILSLAN), CHU de Limoges, 2, Avenue Martin Luther King, 87000 Limoges, France
| | - C Ingre
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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2
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Vacchiano V, Bonan L, Liguori R, Rizzo G. Primary Lateral Sclerosis: An Overview. J Clin Med 2024; 13:578. [PMID: 38276084 PMCID: PMC10816328 DOI: 10.3390/jcm13020578] [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: 12/12/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Primary lateral sclerosis (PLS) is a rare neurodegenerative disorder which causes the selective deterioration of the upper motor neurons (UMNs), sparing the lower motor neuron (LMN) system. The clinical course is defined by a progressive motor disability due to muscle spasticity which typically involves lower extremities and bulbar muscles. Although classically considered a sporadic disease, some familiar cases and possible causative genes have been reported. Despite it having been recognized as a rare but distinct entity, whether it actually represents an extreme end of the motor neuron diseases continuum is still an open issue. The main knowledge gap is the lack of specific biomarkers to improve the clinical diagnostic accuracy. Indeed, the diagnostic imprecision, together with some uncertainty about overlap with UMN-predominant ALS and Hereditary Spastic Paraplegia (HSP), has become an obstacle to the development of specific therapeutic trials. In this study, we provided a comprehensive analysis of the existing literature, including neuropathological, clinical, neuroimaging, and neurophysiological features of the disease, and highlighting the controversies still unsolved in the differential diagnoses and the current diagnostic criteria. We also discussed the current knowledge gaps still present in both diagnostic and therapeutic fields when approaching this rare condition.
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Affiliation(s)
- Veria Vacchiano
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, 40139 Bologna, Italy; (V.V.); (R.L.)
| | - Luigi Bonan
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy;
| | - Rocco Liguori
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, 40139 Bologna, Italy; (V.V.); (R.L.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy;
| | - Giovanni Rizzo
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, 40139 Bologna, Italy; (V.V.); (R.L.)
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3
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Oliveira Santos M, Swash M, de Carvalho M. Current challenges in primary lateral sclerosis diagnosis. Expert Rev Neurother 2024; 24:45-53. [PMID: 38093670 DOI: 10.1080/14737175.2023.2295010] [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: 10/14/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Primary lateral sclerosis (PLS) is a rare, adult-onset and slowly progressive motor neuron disorder whose clinical core is characterized by upper motor neuron (UMN) dysfunction. Its formal diagnosis is clinically based and disease duration-dependent. Differentiating PLS from other disorders involving UMN can be challenging, particularly in the early stages. AREAS COVERED Our review covers and discusses different aspects of the PLS field, including the diagnostic criteria and its limitations, its differential diagnosis and their major pitfalls, and the actual role of neurophysiology, neuroimaging, genetics, and molecular biomarkers. Symptomatic treatment of the different manifestations is also addressed. The authors searched MEDLINE and Scopus. They also searched the reference lists of articles identified by our search strategy and reviewed and selected those deemed relevant. They selected papers and studies based on the quality of the report, significance of the findings, and on the author's critical appraise and expertise. EXPERT OPINION It is important to investigate novel molecular biomarkers and plan multicenter clinical trials for PLS. However, this will require a large international project to recruit enough patients, particularly given the diagnostic uncertainty of the current clinical criteria. A better understanding of PLS pathophysiology is crucial for designing disease-targeted therapies.
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Affiliation(s)
- Miguel Oliveira Santos
- Institute of Physiology, Instituto de Medicina Molecular João Lobo Antunes, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Michael Swash
- Institute of Physiology, Instituto de Medicina Molecular João Lobo Antunes, Centro de Estudos Egas Moniz, 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, London, UK
| | - Mamede de Carvalho
- Institute of Physiology, Instituto de Medicina Molecular João Lobo Antunes, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
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Alves I, Gromicho M, Oliveira Santos M, Pinto S, Pronto-Laborinho A, Swash M, de Carvalho M. Demographic changes in a large motor neuron disease cohort in Portugal: a 27 year experience. Amyotroph Lateral Scler Frontotemporal Degener 2023:1-11. [PMID: 37295966 DOI: 10.1080/21678421.2023.2220747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/22/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023]
Abstract
Objective: Motor Neuron Diseases (MND) have a large clinical spectrum, being the most common amyotrophic lateral sclerosis (ALS) but there is significant clinical heterogeneity. Our goal was to investigate this heterogeneity and any potential changes during a long period. Methods: We performed a retrospective cohort study among a large Portuguese cohort of MND patients (n = 1550) and investigated changing patterns in clinical and demographic characteristics over the 27-year period of our database. With that aim, patients were divided into three 9-year groups according to the date of their first visit to our unit: P1, 1994-2002; P2, 2003-2011; P3, 2012-2020. Results: The overall cohort's clinical and demographic characteristics are consistent with clinical experience, but our findings point to gradual changes over time. Time pattern analysis revealed statistically significant differences in the distribution of clinical phenotypes, the average age of onset, diagnostic delay, the proportin of patients using respiratory support with noninvasive ventilation (NIV), time to NIV, and survival. Across time, in the overall cohort, we found an increasing age at onset (p = 0.029), a decrease of two months in diagnostic delay (p < 0.001) and a higher relative frequency of progressive muscular atrophy patients. For ALS patients with spinal onset, from P1 to P2, there was a more widespread (54.8% vs 69.4%, p = 0.005) and earlier (36.9 vs 27.2 months, p = 0.05) use of NIV and a noteworthy 13-month increase in median survival (p = 0.041). Conclusions: Our results probably reflect better comprehensive care, and they are relevant for future studies exploring the impact of new treatments on ALS patients.
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Affiliation(s)
- Inês Alves
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
| | - Marta Gromicho
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
| | - Miguel Oliveira Santos
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa-Norte, Lisboa, Portugal, and
| | - Susana Pinto
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Pronto-Laborinho
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
| | - Michael Swash
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
- Departments of Neurology and Neuroscience, Barts and the London School of Medicine, Queen Mary University of London, United Kingdom
| | - Mamede de Carvalho
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa-Norte, Lisboa, Portugal, and
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Barone C, Qi X. Altered Metabolism in Motor Neuron Diseases: Mechanism and Potential Therapeutic Target. Cells 2023; 12:1536. [PMID: 37296656 PMCID: PMC10252517 DOI: 10.3390/cells12111536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/21/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
Motor Neuron Diseases (MND) are neurological disorders characterized by a loss of varying motor neurons resulting in decreased physical capabilities. Current research is focused on hindering disease progression by determining causes of motor neuron death. Metabolic malfunction has been proposed as a promising topic when targeting motor neuron loss. Alterations in metabolism have also been noted at the neuromuscular junction (NMJ) and skeletal muscle tissue, emphasizing the importance of a cohesive system. Finding metabolism changes consistent throughout both neurons and skeletal muscle tissue could pose as a target for therapeutic intervention. This review will focus on metabolic deficits reported in MNDs and propose potential therapeutic targets for future intervention.
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Affiliation(s)
| | - Xin Qi
- Department of Physiology and Biophysics, School of Medicine Case Western Reserve University, Cleveland, OH 44106-4970, USA;
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6
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Palha Ribeiro A, Tomas AS, Oliveira C. Primary Lateral Sclerosis: Can Rocuronium Be an Option? Cureus 2023; 15:e35773. [PMID: 37025717 PMCID: PMC10071450 DOI: 10.7759/cureus.35773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/08/2023] Open
Abstract
Primary lateral sclerosis (PLS) is a neurodegenerative motor neuron disorder that is characterized by corticospinal and corticobulbar dysfunction. In this disease, muscle relaxants in general anesthesia should be used with extreme caution. A 67-year-old woman with a history of PLS was scheduled for laparoscopic gastrostomy due to long-term dysphagia. In the preoperative assessment, she presented a tetrapyramidal syndrome with generalized muscle weakness. A priming dose of 5 mg of rocuronium was administered and the train-of-four (TOF) ratio (T4/T1) after 60 seconds was 70% so induction was followed with fentanyl, propofol, and additional 40 mg of rocuronium. After 90 seconds when T1 was lost, the patient was intubated. During surgery, the TOF ratio increased progressively until 65%, 22 minutes after a final bolus of 10 mg of rocuronium. Prior to emergence, 150 mg of sugammadex was given and neuromuscular block reversal was evidenced with a TOF ratio > 90%. As it was decided to perform the surgery laparoscopically, general anesthesia with a neuromuscular blockade was necessary. Since it is reported that patients with motor neuron diseases show an increased sensibility to non-depolarizing muscle relaxants (NDMR), these agents should be used cautiously. Adversely to what studies document, no augmented responsiveness was shown in TOF monitoring, so the standard dose of 0.6 mg/kg of rocuronium was safely given. A final bolus of NDMR was administered after 54 minutes, demonstrating a similar pharmacokinetics profile in terms of duration of action as reported in several studies (45-70 minutes). In addition, a full and rapid neuromuscular blockade recovery with 2 mg/kg of sugammadex was seen, as previously demonstrated in a case series.
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7
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Marzoughi S, Pfeffer G, Cashman N. Primary lateral sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:89-99. [PMID: 37620095 DOI: 10.1016/b978-0-323-98817-9.00021-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Like motor neuron diseases (MNDs) refer to a constellation of primarily sporadic neurodegenerative diseases characterized by a progressive loss of upper and/or lower motor neurons. Primary lateral sclerosis (PLS) is considered a neurodegenerative disorder that is characterized by a gradually progressive course affecting the central motor systems, designated by the phrase "upper motor neurons." Despite significant development in neuroimaging, neurophysiology, and molecular biology, there is a growing consensus that PLS is of unknown etiology. Currently there is no disease-modifying treatment for PLS, or prospective randomized trials being carried out, partly due to the rarity of the disease and lack of significant understanding of the underlying pathophysiology. Consequently, the approach to treatment remains largely symptomatic. In this chapter we provide an overview of primary lateral sclerosis including clinical and electrodiagnostic considerations, differential diagnosis, updates in genetics and pathophysiology, and future directions for research.
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Affiliation(s)
- Sina Marzoughi
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Gerald Pfeffer
- Department of Neurosciences, Division of Neurology, University of Calgary, Calgary, AB, Canada
| | - Neil Cashman
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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8
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Cai H, Zhang B, Huang B, Wang L, Wang L. A case of vertebral artery compression syndrome mimicking primary lateral sclerosis. Int J Neurosci 2022; 132:1178-1181. [PMID: 33349090 DOI: 10.1080/00207454.2020.1867853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/22/2020] [Accepted: 12/17/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Vertebral artery compression syndrome (VACS) is an under-recognised condition that may be misdiagnosed as motor neuron disease. We report a case presenting features initially suggestive of primary lateral sclerosis (PLS) but later found to be VACS. CASE PRESENTATION A 65-year-old man with hypertension was referred to our neurology department in the suspect of PLS. He presented with a 10-year history of involuntary jerk of the left lower limb, which ascended to the left upper limb 9 years later. He also developed intermittent painful spasms with a tendency to drag his left leg. His symptoms fluctuated with blood pressure. Neurological examination revealed upper motor neuron signs without lower motor neuron or sensory involvement. Electrophysiology studies were unremarkable. Brain MRI disclosed the left side of medulla oblongata was compressed by the tortuous left vertebral artery. Diffusion tensor tractography confirmed the corresponding corticospinal tract disruption. He was diagnosed with VACS and treated with antispasmodic medications and antihypertensive drugs. CONCLUSIONS VACS should be considered into the differential diagnoses of PLS. A thorough clinical assessment and careful interpretation of brain MRI with advanced diffusion neuroimages can help confirm the diagnosis.
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Affiliation(s)
- Huimin Cai
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Bin Zhang
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Biao Huang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lijuan Wang
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Limin Wang
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Zhao G, Hu J, Gao M, Zhu Y, Hong Y. Excessive selenium affects neural development and locomotor behavior of zebrafish embryos. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 238:113611. [PMID: 35526456 DOI: 10.1016/j.ecoenv.2022.113611] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 06/14/2023]
Abstract
Selenium is an essential micronutrient derived from daily diet to maintain the normal growth and development of vertebrates. Excessive selenium intake will induce cardiovascular toxicity, reproductive toxicity and neurotoxicity. However, there have been few studies of the toxic effects of selenium on neural development and locomotor behavior. In this study, newly fertilized zebrafish embryos were treated with selenium. As a result, selenium treatment at the concentration of 0.5 µM decreased the moving speed and distance and blunted the touch response of zebrafish embryos. TUNEL assay and immunofluorescence analysis revealed that selenium induced nervous system impairment including promoted cell apoptosis, proliferation and neuroinflammation, and decreased neurons in zebrafish embryos. RNA-seq and RT-PCR results indicated that selenium treatment significantly decreased the expression of the dopaminergic neuron, motor neuron, GABAergic neuron and neurotransmitter transport marker genes in zebrafish embryos. The expression of PPAR signaling pathway marker genes was significantly down-regulated in selenium-treated embryos. Two PPAR agonists (rosiglitazone and bezafibrate) and an anti-cancer drug (cisplatin) were tested for their effects to alleviate selenium-induced locomotor defects. Rosiglitazone and bezafibrate could restore the expression of some neural marker genes but could not fully rescue the selenium-induced locomotor behavior defects. The supplementation of cisplatin could restore the dysfunctional locomotor behavior and the abnormal expression of the PPAR and neural marker genes to almost the normal levels. In conclusion, the results of this study reveal that selenium-induced neural development and locomotor behavior defects are caused by multiple complex factors including PPAR signaling, and all the factors might be recovered by cisplatin through unknown mechanisms.
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Affiliation(s)
- Guang Zhao
- School of Life Science, Key Laboratory of Aquatic Resources and Utilization of Jiangxi, Nanchang University, Nanchang 330031, China
| | - Jun Hu
- School of Life Science, Key Laboratory of Aquatic Resources and Utilization of Jiangxi, Nanchang University, Nanchang 330031, China
| | - Meng Gao
- School of Life Science, Key Laboratory of Aquatic Resources and Utilization of Jiangxi, Nanchang University, Nanchang 330031, China
| | - Yuejie Zhu
- School of Life Science, Key Laboratory of Aquatic Resources and Utilization of Jiangxi, Nanchang University, Nanchang 330031, China
| | - Yijiang Hong
- School of Life Science, Key Laboratory of Aquatic Resources and Utilization of Jiangxi, Nanchang University, Nanchang 330031, China.
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Hassan A, Mittal SO, Hu WT, Josephs KA, Sorenson EJ, Ahlskog JE. Does limited EMG denervation in early primary lateral sclerosis predict amyotrophic lateral sclerosis? Amyotroph Lateral Scler Frontotemporal Degener 2022; 23:554-561. [PMID: 35170382 DOI: 10.1080/21678421.2022.2039714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Objective: We assessed whether a cohort of patients with primary lateral sclerosis (PLS) and limited electromyography (EMG) motor unit denervation changes evolve into amyotrophic lateral sclerosis (ALS) with prolonged follow-up. Methods: We initially ascertained all PLS patients diagnosed at Mayo Clinic-Rochester (1990-2016). Of 64 total cases, 43 had normal EMGs ("pure" PLS) during the first 4 years after symptom onset and were the focus of a prior publication, documenting absence of evolution to ALS. The remaining 21 patients had limited motor unit changes on EMG needle examination (denervation and most with fibrillation or fasciculation potentials) but insufficient to raise a strong suspicion of ALS; these 21 patients were followed to determine whether they evolved into ALS. Results: Of these 21 patients, the median follow-up was 7 years' disease duration (range: 4-27 years; IQR 5-8.5). They included 11 females (52%) with median onset-age of 57 years (range: 42-72 years). Two patients (10%) subsequently met revised El Escorial criteria for ALS after 7 and 13 years, respectively. The remainder had stable EMG changes with a persistent PLS phenotype. Among these remaining 19 patients, the PLS course was somewhat more aggressive than our previously reported series of 43 patients devoid of EMG denervation. The paraparetic variant was more common than the hemiparetic and bulbar variants, similar to "pure" PLS. Conclusions: Among PLS patients with definite but limited EMG denervation, 2/21 (10%) later developed ALS. The patients in this series had a more progressive clinical course compared to our previously reported pure PLS cases.
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Affiliation(s)
- Anhar Hassan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Shivam O Mittal
- Department of Neurology, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates, and
| | - William T Hu
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | | | - J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Sahni V, Shnider SJ, Jabaudon D, Song JHT, Itoh Y, Greig LC, Macklis JD. Corticospinal neuron subpopulation-specific developmental genes prospectively indicate mature segmentally specific axon projection targeting. Cell Rep 2021; 37:109843. [PMID: 34686320 PMCID: PMC8653526 DOI: 10.1016/j.celrep.2021.109843] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/27/2021] [Accepted: 09/26/2021] [Indexed: 11/11/2022] Open
Abstract
For precise motor control, distinct subpopulations of corticospinal neurons (CSN) must extend axons to distinct spinal segments, from proximal targets in the brainstem and cervical cord to distal targets in thoracic and lumbar spinal segments. We find that developing CSN subpopulations exhibit striking axon targeting specificity in spinal white matter, which establishes the foundation for durable specificity of adult corticospinal circuitry. Employing developmental retrograde and anterograde labeling, and their distinct neocortical locations, we purified developing CSN subpopulations using fluorescence-activated cell sorting to identify genes differentially expressed between bulbar-cervical and thoracolumbar-projecting CSN subpopulations at critical developmental times. These segmentally distinct CSN subpopulations are molecularly distinct from the earliest stages of axon extension, enabling prospective identification even before eventual axon targeting decisions are evident in the spinal cord. This molecular delineation extends beyond simple spatial separation of these subpopulations in the cortex. Together, these results identify candidate molecular controls over segmentally specific corticospinal axon projection targeting.
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Affiliation(s)
- Vibhu Sahni
- Department of Stem Cell and Regenerative Biology, Center for Brain Science, Harvard University, Cambridge, MA 02138, USA
| | - Sara J Shnider
- Department of Stem Cell and Regenerative Biology, Center for Brain Science, Harvard University, Cambridge, MA 02138, USA
| | - Denis Jabaudon
- Department of Stem Cell and Regenerative Biology, Center for Brain Science, Harvard University, Cambridge, MA 02138, USA
| | - Janet H T Song
- Department of Stem Cell and Regenerative Biology, Center for Brain Science, Harvard University, Cambridge, MA 02138, USA
| | - Yasuhiro Itoh
- Department of Stem Cell and Regenerative Biology, Center for Brain Science, Harvard University, Cambridge, MA 02138, USA
| | - Luciano C Greig
- Department of Stem Cell and Regenerative Biology, Center for Brain Science, Harvard University, Cambridge, MA 02138, USA
| | - Jeffrey D Macklis
- Department of Stem Cell and Regenerative Biology, Center for Brain Science, Harvard University, Cambridge, MA 02138, USA.
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12
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Canna A, Trojsi F, Di Nardo F, Caiazzo G, Tedeschi G, Cirillo M, Esposito F. Combining structural and metabolic markers in a quantitative MRI study of motor neuron diseases. Ann Clin Transl Neurol 2021; 8:1774-1785. [PMID: 34342169 PMCID: PMC8419394 DOI: 10.1002/acn3.51418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/13/2021] [Accepted: 06/18/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To assess the performance of a combination of three quantitative MRI markers (iron deposition, basal neuronal metabolism, and regional atrophy) for differential diagnosis between amyotrophic lateral sclerosis (ALS) and primary lateral sclerosis (PLS). METHODS In total, 33 ALS, 12 PLS, and 28 healthy control (HC) subjects underwent a 3T MRI study including single- and multi-echo sequences for gray matter (GM) volumetry and quantitative susceptibility mapping (QSM) and a pseudo-continuous arterial spin labeling (ASL) sequence for cerebral blood flow (CBF) measurement. Mean values of QSM, CBF, and GM volumes were extracted in the motor cortex, basal ganglia, thalamus, amygdala, and hippocampus. A generalized linear model was applied to the three measures to binary discriminate between groups. The diagnostic performances were evaluated via receiver operating characteristic analyses. RESULTS A significant discrimination was obtained: between ALS and HCs in the left and right motor cortex, where QSM increases were respectively associated with disability scores and disease duration; between PLS and ALS in the left motor cortex, where PLS patients resulted significantly more atrophic; between ALS and HC in the right motor cortex, where GM volumes were associated with upper motor neuron scores. Significant discrimination between ALS and HC was achieved in subcortical structures only combining all three parameters. INTERPRETATION While increased QSM values in the motor cortex of ALS patients is a consolidated finding, combining QSM, CBF, and GM volumetry shows higher diagnostic potential for differentiating ALS patients from HC subjects and, in the motor cortex, between ALS and PLS.
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Affiliation(s)
- Antonietta Canna
- Department of Advanced Medical and Surgical SciencesUniversity of Campania "Luigi Vanvitelli”NaplesItaly
| | - Francesca Trojsi
- Department of Advanced Medical and Surgical SciencesUniversity of Campania "Luigi Vanvitelli”NaplesItaly
| | - Federica Di Nardo
- Department of Advanced Medical and Surgical SciencesUniversity of Campania "Luigi Vanvitelli”NaplesItaly
| | - Giuseppina Caiazzo
- Department of Advanced Medical and Surgical SciencesUniversity of Campania "Luigi Vanvitelli”NaplesItaly
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical SciencesUniversity of Campania "Luigi Vanvitelli”NaplesItaly
| | - Mario Cirillo
- Department of Advanced Medical and Surgical SciencesUniversity of Campania "Luigi Vanvitelli”NaplesItaly
| | - Fabrizio Esposito
- Department of Advanced Medical and Surgical SciencesUniversity of Campania "Luigi Vanvitelli”NaplesItaly
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13
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Barohn RJ, Fink JK, Heiman-Patterson T, Huey ED, Murphy J, Statland JM, Turner MR, Elman L. The clinical spectrum of primary lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2021; 21:3-10. [PMID: 33602013 DOI: 10.1080/21678421.2020.1837178] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Primary lateral sclerosis is a distinct entity that has recently been classified as a "restricted phenotype" of ALS. It is characterized by a pattern of isolated upper motor neuron involvement that often begins in the legs and spreads diffusely. Distinction from other conditions requires careful consideration of clinical presentation and time course of disease. Mills' Syndrome is a rare unilateral variant of primary lateral sclerosis. Cognitive and behavioral involvement may occur.
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Affiliation(s)
- Richard J Barohn
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - John K Fink
- Department of Neurology, Ann Arbor Veterans Affairs Medical Center, University of Michigan, Ann Arbor, MI, USA
| | - Terry Heiman-Patterson
- Department of Neurology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Edward D Huey
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jennifer Murphy
- Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
| | - Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Martin R Turner
- Nuffield Department of Neurosciences, University of Oxford, Oxford, UK
| | - Lauren Elman
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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14
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Molecular Pathology of ALS: What We Currently Know and What Important Information Is Still Missing. Diagnostics (Basel) 2021; 11:diagnostics11081365. [PMID: 34441299 PMCID: PMC8391180 DOI: 10.3390/diagnostics11081365] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/25/2021] [Accepted: 07/25/2021] [Indexed: 12/23/2022] Open
Abstract
Despite an early understanding of amyotrophic lateral sclerosis (ALS) as a disease affecting the motor system, including motoneurons in the motor cortex, brainstem, and spinal cord, today, many cases involving dementia and behavioral disorders are reported. Therefore, we currently divide ALS not only based on genetic predisposition into the most common sporadic variant (90% of cases) and the familial variant (10%), but also based on cognitive and/or behavioral symptoms, with five specific subgroups of clinical manifestation—ALS with cognitive impairment, ALS with behavioral impairment, ALS with combined cognitive and behavioral impairment, the fully developed behavioral variant of frontotemporal dementia in combination with ALS, and comorbid ALS and Alzheimer’s disease (AD). Generally, these cases are referred to as amyotrophic lateral sclerosis-frontotemporal spectrum disorder (ALS-FTSD). Clinical behaviors and the presence of the same pathognomonic deposits suggest that FTLD and ALS could be a continuum of one entity. This review was designed primarily to compare neuropathological findings in different types of ALS relative to their characteristic locations as well as the immunoreactivity of the inclusions, and thus, foster a better understanding of the immunoreactivity, distribution, and morphology of the pathological deposits in relation to genetic mutations, which can be useful in specifying the final diagnosis.
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15
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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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16
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Geevasinga N, Van den Bos M, Menon P, Vucic S. Utility of Transcranial Magnetic Simulation in Studying Upper Motor Neuron Dysfunction in Amyotrophic Lateral Sclerosis. Brain Sci 2021; 11:brainsci11070906. [PMID: 34356140 PMCID: PMC8304017 DOI: 10.3390/brainsci11070906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 11/16/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is characterised by progressive dysfunction of the upper and lower motor neurons. The disease can evolve over time from focal limb or bulbar onset to involvement of other regions. There is some clinical heterogeneity in ALS with various phenotypes of the disease described, from primary lateral sclerosis, progressive muscular atrophy and flail arm/leg phenotypes. Whilst the majority of ALS patients are sporadic in nature, recent advances have highlighted genetic forms of the disease. Given the close relationship between ALS and frontotemporal dementia, the importance of cortical dysfunction has gained prominence. Transcranial magnetic stimulation (TMS) is a noninvasive neurophysiological tool to explore the function of the motor cortex and thereby cortical excitability. In this review, we highlight the utility of TMS and explore cortical excitability in ALS diagnosis, pathogenesis and insights gained from genetic and variant forms of the disease.
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17
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Vucic S, Pavey N, Haidar M, Turner BJ, Kiernan MC. Cortical hyperexcitability: Diagnostic and pathogenic biomarker of ALS. Neurosci Lett 2021; 759:136039. [PMID: 34118310 DOI: 10.1016/j.neulet.2021.136039] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 03/04/2021] [Accepted: 06/01/2021] [Indexed: 02/06/2023]
Abstract
Cortical hyperexcitability is an early and intrinsic feature of both sporadic and familial forms of amyotrophic lateral sclerosis (ALS).. Importantly, cortical hyperexcitability appears to be associated with motor neuron degeneration, possibly via an anterograde glutamate-mediated excitotoxic process, thereby forming a pathogenic basis for ALS. The presence of cortical hyperexcitability in ALS patients may be readily determined by transcranial magnetic stimulation (TMS), a neurophysiological tool that provides a non-invasive and painless method for assessing cortical function. Utilising the threshold tracking TMS technique, cortical hyperexcitability has been established as a robust diagnostic biomarker that distinguished ALS from mimicking disorders at early stages of the disease process. The present review discusses the pathophysiological and diagnostic utility of cortical hyperexcitability in ALS.
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Affiliation(s)
- Steve Vucic
- Western Clinical School, University of Sydney, Sydney, Australia.
| | - Nathan Pavey
- Western Clinical School, University of Sydney, Sydney, Australia
| | - Mouna Haidar
- Florey Institute of Neuroscieace and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Bradley J Turner
- Florey Institute of Neuroscieace and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
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18
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Fullam T, Statland J. Upper Motor Neuron Disorders: Primary Lateral Sclerosis, Upper Motor Neuron Dominant Amyotrophic Lateral Sclerosis, and Hereditary Spastic Paraplegia. Brain Sci 2021; 11:brainsci11050611. [PMID: 34064596 PMCID: PMC8151104 DOI: 10.3390/brainsci11050611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/02/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022] Open
Abstract
Following the exclusion of potentially reversible causes, the differential for those patients presenting with a predominant upper motor neuron syndrome includes primary lateral sclerosis (PLS), hereditary spastic paraplegia (HSP), or upper motor neuron dominant ALS (UMNdALS). Differentiation of these disorders in the early phases of disease remains challenging. While no single clinical or diagnostic tests is specific, there are several developing biomarkers and neuroimaging technologies which may help distinguish PLS from HSP and UMNdALS. Recent consensus diagnostic criteria and use of evolving technologies will allow more precise delineation of PLS from other upper motor neuron disorders and aid in the targeting of potentially disease-modifying therapeutics.
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19
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Gazulla J, Izquierdo-Alvarez S, Ruiz-Fernández E, Berciano J. Initial Cerebellar Ataxia in Hereditary Adult-Onset Primary Lateral Sclerosis. Case Rep Neurol 2021; 13:414-421. [PMID: 34326749 PMCID: PMC8299400 DOI: 10.1159/000515157] [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: 01/21/2021] [Accepted: 02/09/2021] [Indexed: 12/13/2022] Open
Abstract
Cerebellar ataxia preceding the apparition of primary lateral sclerosis (PLS) is reported herein. Three individuals from 2 independent kindreds experienced ataxia before developing clinical signs of PLS. Disease onset was during the sixth decade or later, and an insidious onset, with progression exceeding 11 years, was observed. Pathochrony was homogenous, consisting of initial gait instability, followed by hand dysmetria 2 years later. During a 5-year follow-up, cerebellar ataxia remained the sole clinical manifestation, preceding the appearance of muscle stiffness, which progressed to a paraparesis, and then to a purely spastic quadriparesis, over 4 years; pseudobulbar dysarthria and dysphagia appeared later. At this disease stage, limb spasticity, hyperactive jaw and limb stretch reflexes, extensor plantar responses, and a spastic dysarthria were found on examination; limb dysmetria and an ataxo-spastic gait were also found. No muscle atrophy or fasciculation was observed. Among ancillary tests, electromyographic studies performed 6 years after disease onset revealed normal motor unit action potentials and absence of spontaneous activity, in 2 individuals. MRI revealed normal cerebellum and brainstem in 2 cases. Inheritance was dominant in both kindreds, and extensive genetic testing was negative. It is concluded that cerebellar ataxia preceded the appearance of a purely spastic spinobulbar syndrome (which fulfilled the clinical diagnostic criteria for PLS) during a 5-year period in 3 patients with a hereditary, adult-onset form of PLS; subsequent disease progression was equivalent to that of sporadic PLS. Further studies are needed to fully delineate the clinical and genetic spectra of adult-onset PLS.
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Affiliation(s)
- José Gazulla
- Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Silvia Izquierdo-Alvarez
- Section of Genetics, Department of Clinical Biochemistry, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - José Berciano
- Department of Neurology, Hospital Universitario Marqués de Valdecilla (IDIVAL), University of Cantabria, CIBERNED, Santander, Spain
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20
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Hassan A, Mittal SO, Hu WT, Josephs KA, Sorenson EJ, Ahlskog JE. Natural History of "Pure" Primary Lateral Sclerosis. Neurology 2021; 96:e2231-e2238. [PMID: 33637635 DOI: 10.1212/wnl.0000000000011771] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/13/2021] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To assess whether primary lateral sclerosis (PLS), classified as pure when the EMG is normal, converts to amyotrophic lateral sclerosis (ALS) after longitudinal follow-up. METHODS Retrospective chart review was performed of patients with pure PLS at Mayo Clinic in Rochester, MN (1990-2016). Inclusion criteria required a normal EMG during the first 4 years of symptoms. RESULTS Forty-three patients had pure PLS (25 female, 58%) with a median onset age of 50 years (range 38-78 years) and median follow-up at 9 years' disease duration (range 4-36 years). The ascending paraparesis phenotype (n = 30, 70%) was most common, followed by hemiparetic onset (n = 9, 21%) and bulbar onset (n = 4, 9%). Among the 30 paraparetic-onset cases, bladder symptoms (n = 18, 60%) and dysarthria (n = 15, 50%) were more common than pseudobulbar affect (n = 9, 30%) and dysphagia (n = 8, 27%). By the last follow-up, 17 of 30 (56%) used a cane and 6 (20%) required a wheelchair. The paraparetic variant, compared with hemiparetic and bulbar onset, had the youngest onset (48 vs 56 vs 60 years, respectively; p = 0.02). Five patients died; 1 patient required a feeding tube; and none required permanent noninvasive ventilation. Two patients developed an idiopathic multisystem neurodegenerative disorder, which surfaced after 19 and 20 years. Two patients developed minor EMG abnormalities. The remainder 39 had persistently normal EMGs. CONCLUSIONS Pure PLS did not convert to ALS after a median of 9 years' disease duration follow-up in our study population. The ascending paraparetic phenotype was most common, with earlier onset and frequent bladder involvement. After years of pure PLS, <5% develop a more pervasive neurodegenerative disorder.
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Affiliation(s)
- Anhar Hassan
- From the Department of Neurology (A.H., K.A.J., E.J.S., J.E.A.), Mayo Clinic, Rochester, MN; Department of Neurology (S.O.M.), Cleveland Clinic Abu Dhabi, United Arab Emirates; and Department of Neurology (W.T.H.), Emory University, Atlanta, GA.
| | - Shivam Om Mittal
- From the Department of Neurology (A.H., K.A.J., E.J.S., J.E.A.), Mayo Clinic, Rochester, MN; Department of Neurology (S.O.M.), Cleveland Clinic Abu Dhabi, United Arab Emirates; and Department of Neurology (W.T.H.), Emory University, Atlanta, GA
| | - William T Hu
- From the Department of Neurology (A.H., K.A.J., E.J.S., J.E.A.), Mayo Clinic, Rochester, MN; Department of Neurology (S.O.M.), Cleveland Clinic Abu Dhabi, United Arab Emirates; and Department of Neurology (W.T.H.), Emory University, Atlanta, GA
| | - Keith A Josephs
- From the Department of Neurology (A.H., K.A.J., E.J.S., J.E.A.), Mayo Clinic, Rochester, MN; Department of Neurology (S.O.M.), Cleveland Clinic Abu Dhabi, United Arab Emirates; and Department of Neurology (W.T.H.), Emory University, Atlanta, GA
| | - Eric J Sorenson
- From the Department of Neurology (A.H., K.A.J., E.J.S., J.E.A.), Mayo Clinic, Rochester, MN; Department of Neurology (S.O.M.), Cleveland Clinic Abu Dhabi, United Arab Emirates; and Department of Neurology (W.T.H.), Emory University, Atlanta, GA
| | - J Eric Ahlskog
- From the Department of Neurology (A.H., K.A.J., E.J.S., J.E.A.), Mayo Clinic, Rochester, MN; Department of Neurology (S.O.M.), Cleveland Clinic Abu Dhabi, United Arab Emirates; and Department of Neurology (W.T.H.), Emory University, Atlanta, GA
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21
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Utility of intrathecal baclofen pump in primary lateral sclerosis. J Neurol Sci 2020; 420:117227. [PMID: 33239209 DOI: 10.1016/j.jns.2020.117227] [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: 08/09/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 11/23/2022]
Abstract
Primary lateral sclerosis is a disorder categorized by insidious onset of progressive upper motor neuron dysfunction without lower motor neuron involvement. PLS often presents with gradual-onset, progressive lower extremity stiffness and pain due to muscle spasticity. Intrathecal Baclofen pumps (ITB) have been used to effectively treat spasticity in several neurologic conditions including MS and spinal cord injury. This study aimed at reviewing a cohort of PLS patients with spasticity requiring ITB to assess the clinical course, benefits, and complications in these patients. A series of 5 patients were identified who were diagnosed with PLS and received ITB as treatment for spasticity. The average age of the patients at the time of ITB insertion was 56.4 years. The average length of treatment was 10.4 years with a range of 4-15 years. All patients reported improvement in spasticity as measured by clinical examinations and Ashworth scores; 1/5 had complications with the pump related to migration of catheter. No patients required permanent removal of the ITB. ITB is a safe and effective treatment for spasticity in PLS and should be considered in other patients.
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22
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Paganoni S, De Marchi F, Chan J, Thrower SK, Staff NP, Datta N, Kisanuki YY, Drory V, Fournier C, Pioro EP, Goutman SA, Atassi N, Jeon M, Caldwell S, Mcdonough T, Gentile C, Liu J, Turner M, Denny C, Felice K, Green M, Scarberry S, Abu-Saleh S, Nefussy B, Hastings D, Kim S, Swihart B, Arcila-Londono X, Newman DS, Silverman M, Genge A, Salmon K, Elman L, Mccluskey L, Almasy K, Gotkine M, Goslin K, Cummings A, Edwards EK, Rivner M, Bouchard K, Quarles B, Kwan J, Jaffa M, Baloh R, Allred P, Walk D, Maiser S, Manousakis G, Ferment V, Fernandes JAM, Thaisetthawatkul P, Heimes D, Phillips M, Sams L, Kahler M, Corcoran A, Larriviere DG, Chotto S, Juba G. The NEALS primary lateral sclerosis registry. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:74-81. [PMID: 32915077 DOI: 10.1080/21678421.2020.1804591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Primary lateral sclerosis (PLS) is a neurodegenerative disease characterized by progressive upper motor neuron dysfunction. Because PLS patients represent only 1 to 4% of patients with adult motor neuron diseases, there is limited information about the disease's natural history. The objective of this study was to establish a large multicenter retrospective longitudinal registry of PLS patients seen at Northeast ALS Consortium (NEALS) sites to better characterize the natural progression of PLS. Methods: Clinical characteristics, electrophysiological findings, laboratory values, disease-related symptoms, and medications for symptom management were collected from PLS patients seen between 2000 and 2015. Results: The NEALS registry included data from 250 PLS patients. Median follow-up time was 3 years. The mean rate of functional decline measured by ALSFRS-R total score was -1.6 points/year (SE:0.24, n = 124); the mean annual decline in vital capacity was -3%/year (SE:0.55, n = 126). During the observational period, 18 patients died, 17 patients had a feeding tube placed and 7 required permanent assistive ventilation. Conclusions: The NEALS PLS Registry represents the largest available aggregation of longitudinal clinical data from PLS patients and provides a description of expected natural disease progression. Data from the registry will be available to the PLS community and can be leveraged to plan future clinical trials in this rare disease.
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Affiliation(s)
- Sabrina Paganoni
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | - Fabiola De Marchi
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | - James Chan
- Department of Biostatistics, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Sara K Thrower
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | | | - Neil Datta
- Hospital for Special Care, New Britain, CT/University of Connecticut School of Medicine, Farmington, CT, USA
| | - Yaz Y Kisanuki
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vivian Drory
- Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | | | - Erik P Pioro
- Neuromuscular Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Nazem Atassi
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | | | - Maryangel Jeon
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah Caldwell
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | - Timothy Mcdonough
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | - Caroline Gentile
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | - Jianing Liu
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Kevin Felice
- Hospital for Special Care, New Britain, CT/University of Connecticut School of Medicine, Farmington, CT, USA
| | - Misty Green
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stephanie Scarberry
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | | | - Debbie Hastings
- Neuromuscular Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sangri Kim
- Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Blake Swihart
- Neurology, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - Angela Genge
- Montreal Neurological Institute & Hospital, Montreal, Canada
| | | | - Lauren Elman
- Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Leo Mccluskey
- Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Kelly Almasy
- Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Marc Gotkine
- Department of Neurology, The Agnes Ginges Center for Human Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | | | | | - Michael Rivner
- Department of Neurology, Augusta University, Augusta, GA, USA
| | - Kristy Bouchard
- Department of Neurology, Augusta University, Augusta, GA, USA
| | - Brandy Quarles
- Department of Neurology, Augusta University, Augusta, GA, USA
| | - Justin Kwan
- University of Maryland Medical Center, College Park, MD, USA
| | - Matthew Jaffa
- University of Maryland Medical Center, College Park, MD, USA
| | - Robert Baloh
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Peggy Allred
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David Walk
- Department of Neurology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Samuel Maiser
- Department of Neurology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Georgios Manousakis
- Department of Neurology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Valerie Ferment
- Department of Neurology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - J Americo M Fernandes
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Deborah Heimes
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Laura Sams
- Department of Neuroscience, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Melissa Kahler
- Department of Neuroscience, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Alecia Corcoran
- Department of Neuroscience, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | | | | | - Gracy Juba
- Ochsner Health System, New Orleans, LA, USA
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23
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Floeter MK, Wu T. Longitudinal evaluation of upper motor neuron burden scales in primary lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2020; 22:23-29. [PMID: 32657626 DOI: 10.1080/21678421.2020.1790609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess whether published scales for measuring upper motor neuron burden (UMNB) show longitudinal change in patients with primary lateral sclerosis (PLS). Design: Retrospective calculation of three UMNB scales on a prospectively collected dataset from 53 patients with PLS enrolled in a longitudinal natural history study with at least 2 evaluation visits. UMNB scales were calculated according to their published descriptions. Non-linear trends over time of UMNB scale scores and slopes were calculated for each patient and correlations between UMNB scores and clinical measures were assessed. Results: All three UMNB scales exhibited increasing scores over the first 7.8 years of symptoms, with a flattening in slope after approximately 8 years. A scale used in imaging studies and the UPENN UMNS scale provided a better fit to the dataset than the MGH UMNB scale. All three UMNB scales exhibited moderate correlations with some clinical measures of movement, such as finger-tapping rate and timed gait. Correlations were strongest for the UPENN UMNS, which was also moderately correlated with the revised ALS functional rating scale. Conclusion: In a cohort of PLS patients enrolled in a natural history study, the three UMNB scales exhibited modest linear increases over the first 8 years of symptoms, followed by a plateau. Future clinical trials in PLS should consider stratification of patients by disease duration. UMNB scales may be useful secondary outcomes, but more sensitive primary outcome measures are needed for clinical trials for PLS.
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Affiliation(s)
- Mary Kay Floeter
- Motor Neuron Disorder Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Tianxia Wu
- Biostatistics Unit, Clinical Trials Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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24
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Turner MR, Barohn RJ, Corcia P, Fink JK, Harms MB, Kiernan MC, Ravits J, Silani V, Simmons Z, Statland J, van den Berg LH, Mitsumoto H. Primary lateral sclerosis: consensus diagnostic criteria. J Neurol Neurosurg Psychiatry 2020; 91:373-377. [PMID: 32029539 PMCID: PMC7147236 DOI: 10.1136/jnnp-2019-322541] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/27/2019] [Accepted: 12/27/2019] [Indexed: 02/06/2023]
Abstract
Primary lateral sclerosis (PLS) is a neurodegenerative disorder of the adult motor system. Characterised by a slowly progressive upper motor neuron syndrome, the diagnosis is clinical, after exclusion of structural, neurodegenerative and metabolic mimics. Differentiation of PLS from upper motor neuron-predominant forms of amyotrophic lateral sclerosis remains a significant challenge in the early symptomatic phase of both disorders, with ongoing debate as to whether they form a clinical and histopathological continuum. Current diagnostic criteria for PLS may be a barrier to therapeutic development, requiring long delays between symptom onset and formal diagnosis. While new technologies sensitive to both upper and lower motor neuron involvement may ultimately resolve controversies in the diagnosis of PLS, we present updated consensus diagnostic criteria with the aim of reducing diagnostic delay, optimising therapeutic trial design and catalysing the development of disease-modifying therapy.
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Affiliation(s)
- Martin R Turner
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Richard J Barohn
- Department of Neurology, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Philippe Corcia
- ALS Centre, Department of Neurology, CHRU Bretonneau, Tours, France
| | - John K Fink
- Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew B Harms
- Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, USA
| | - Matthew C Kiernan
- Bushell Chair of Neurology, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.,Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - John Ravits
- Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Vincenzo Silani
- Department of Neurology & Laboratory of Neuroscience, Istituto Auxologico Italiano IRCCS, Milano, Italy.,Department of Pathophysiology & Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milano, Italy
| | - Zachary Simmons
- Neurology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Jeffrey Statland
- Department of Neurology, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | | | - Hiroshi Mitsumoto
- Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, USA
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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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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: 7] [Impact Index Per Article: 1.8] [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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27
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Gazulla J, Ferrer I, Berciano J. Reader response: The underacknowledged PPA-ALS: A unique clinicopathologic subtype with strong heritability. Neurology 2020; 94:282-283. [DOI: 10.1212/wnl.0000000000008919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kassubek J, Müller HP. Advanced neuroimaging approaches in amyotrophic lateral sclerosis: refining the clinical diagnosis. Expert Rev Neurother 2020; 20:237-249. [PMID: 31937156 DOI: 10.1080/14737175.2020.1715798] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: In the last decade, multiparametric magnetic resonance imaging (MRI) has achieved tremendous advances in applications to amyotrophic lateral sclerosis (ALS) to increase the understanding of the associated pathophysiology. The aim of this review is to summarize recent progress in the development of MRI-based techniques aiming to support the clinical diagnosis in ALS.Areas covered: The review of structural and functional MRI applications to ALS and its variants (restricted phenotypes) is focused on the potential of MRI techniques which contribute to the diagnostic work-up of patients with the clinical presentation of a motor neuron disease. The potential of specific MRI methods for patient diagnosis and monitoring is discussed, and the future design of clinical MRI applications to ALS is conceptualized.Expert opinion: Current multiparametric MRI allows for the use as a clinical biological marker and a technical instrument in the clinical diagnosis of patients with ALS and also of patients with ALS variants. Composite neuroimaging indices of specific anatomical areas derived from different MRI techniques might guide in the diagnostic applications to ALS. Such a development of ALS-specific MRI-based composite scores with sufficient discriminative power versus ALS mimics at an individual level requires standardized advanced protocols and comprehensive analysis approaches.
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Affiliation(s)
- Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
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Nwabuobi L, Tomishon D, Shneider NA, Fahn S, Vonsattel JP, Cortes E. Multiple System Atrophy With Predominant Striatonigral Degeneration and TAR DNA-Binding Protein of 43 kDa Pathology: An Unusual Variant of Multiple System Atrophy. Mov Disord Clin Pract 2019; 6:661-666. [PMID: 31745474 DOI: 10.1002/mdc3.12823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/24/2019] [Accepted: 06/13/2019] [Indexed: 12/11/2022] Open
Abstract
Background The pathological hallmark in MSA is oligodendrocytic glial cytoplasmic inclusions (GCIs) containing α-synuclein, in addition to neuronal loss and astrogliosis especially involving the striatonigral and olivopontocerebellar systems. Rarely, TAR DNA-binding protein of 43 kDa (TDP-43), a component of ubiquitinated inclusions observed mainly in amyotrophic lateral sclerosis and frontotemporal lobar degeneration has been demonstrated in cases of MSA and, more recently, was shown to colocalize with α-synuclein pathology in GCIs in 2 patients. Methods A 66-year-old woman presented with a syndrome characterized by spasticity, dysautonomia, bulbar dysfunction, and parkinsonism. Symptoms progressed until her death at age 74. Neuropathological evaluation was performed at the New York Brain Bank at Columbia University. Results On gross examination, there was striking severe volume loss of the left striatum compared to mild involvement of the right striatum. Microscopically, neuronal loss and gliosis of the putamen and globus pallidus were severe on the left side, in contrast to mild involvement on the right side. Immunohistochemistry for α-synuclein revealed widespread GCIs. The sections subjected to TDP-43 antibodies showed a few GCIs with definite nucleocytoplasmic translocation of the labeling within the lenticular nucleus and within the paracentral cortex. Conclusions This report adds to the evidence that TDP-43 and α-synuclein colocalize in GCIs. Whether this coexistence contributes to the pathogenesis of a subset of MSA patients or is an age-related process is not known. More cases with these peculiar pathological hallmarks might help determine whether TDP-43 contributes to neurodegeneration in a subset of patients with MSA.
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Affiliation(s)
- Lynda Nwabuobi
- Department of Neurology Columbia University Medical Center New York New York USA
| | - Darya Tomishon
- Department of Neurology Columbia University Medical Center New York New York USA
| | - Neil A Shneider
- Department of Neurology Columbia University Medical Center New York New York USA
| | - Stanley Fahn
- Department of Neurology Columbia University Medical Center New York New York USA
| | - Jean Paul Vonsattel
- Department of Pathology Columbia University Medical Center New York New York USA
| | - Etty Cortes
- Department of Pathology Columbia University Medical Center New York New York USA
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Hirsch-Reinshagen V, Alfaify OA, Hsiung GYR, Pottier C, Baker M, Perkerson RB, Rademakers R, Briemberg H, Foti DJ, Mackenzie IR. Clinicopathologic correlations in a family with a TBK1 mutation presenting as primary progressive aphasia and primary lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:568-575. [PMID: 31244341 DOI: 10.1080/21678421.2019.1632347] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Mutations in the TANK binding kinase 1 gene (TBK1) are associated with amyotrophic lateral sclerosis and/or frontotemporal dementia; however, the range of clinical phenotypes and neuropathological changes associated with these mutations have not yet been completely elucidated. We present the detailed clinical, neuroimaging, and neuropathological features of two brothers carrying the TBK1 p.Gly272_Thr331del mutation. Both presented with very similar and unusual clinical features including primary progressive aphasia and asymmetric-onset primary lateral sclerosis (PLS). Repeated electrophysiological studies failed to reveal any lower motor neuron involvement. Neuropathological evaluation of both cases revealed frontotemporal lobar degeneration with TDP-43 proteinopathy type B and selective involvement of upper motor neurons with TDP-43 inclusions. The stereotypical clinical presentation and neuropathological findings in these cases widen the phenotypic spectrum of TBK1 mutations and provide insights into the pathogenesis of PLS.
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Affiliation(s)
| | - Omar A Alfaify
- Division of Neurology, University of British Columbia , Vancouver , Canada , and
| | - Ging-Yuek R Hsiung
- Division of Neurology, University of British Columbia , Vancouver , Canada , and
| | - Cyril Pottier
- Department of Neuroscience, Mayo Clinic , Jacksonville , FL , USA
| | - Matt Baker
- Department of Neuroscience, Mayo Clinic , Jacksonville , FL , USA
| | | | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic , Jacksonville , FL , USA
| | - Hanna Briemberg
- Division of Neurology, University of British Columbia , Vancouver , Canada , and
| | - Dean J Foti
- Division of Neurology, University of British Columbia , Vancouver , Canada , and
| | - Ian R Mackenzie
- Division of Neuropathology, University of British Columbia , Vancouver , Canada
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Gazulla J, Ferrer I, Izquierdo-Alvarez S, Alvarez S, Sánchez-Alcudia R, Bestué-Cardiel M, Seral M, Benavente I, Sierra-Martínez E, Berciano J. Hereditary primary lateral sclerosis and progressive nonfluent aphasia. J Neurol 2019; 266:1079-1090. [DOI: 10.1007/s00415-019-09235-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 02/01/2019] [Accepted: 02/05/2019] [Indexed: 12/31/2022]
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Pinto WBVR, Debona R, Nunes PP, Assis ACD, Lopes CG, Bortholin T, Dias RB, Naylor FGM, Chieia MAT, Souza PVS, Oliveira ASB. Atypical Motor Neuron Disease variants: Still a diagnostic challenge in Neurology. Rev Neurol (Paris) 2019; 175:221-232. [PMID: 30846210 DOI: 10.1016/j.neurol.2018.04.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/31/2018] [Accepted: 04/10/2018] [Indexed: 11/20/2022]
Abstract
Motor neuron disease (MND) represents a wide and heterogeneous expanding group of disorders involving the upper or lower motor neurons, mainly represented by amyotrophic lateral sclerosis (ALS), primary lateral sclerosis, progressive muscular atrophy and progressive bulbar palsy. Primary motor neuronopathies are characterized by progressive degenerative loss of anterior horn cell motoneurons (lower motor neurons) or loss of giant pyramidal Betz cells (upper motor neurons). Despite its well-known natural history, pathophysiological and clinical characteristics for the most common MND, atypical clinical presentation and neurodegenerative mechanisms are commonly observed in rare clinical entities, so-called atypical variants of MND-ALS, including flail-leg syndrome, flail-arm syndrome, facial-onset sensory and motor neuronopathy (FOSMN), finger extension weakness and downbeat nystagmus (FEWDON-MND) and long-lasting and juvenile MND-ALS. Herein, we provide a review article presenting clinical, genetic, pathophysiological and neuroimaging findings of atypical variants of MND-ALS in clinical practice.
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Affiliation(s)
- W B V R Pinto
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil
| | - R Debona
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil
| | - P P Nunes
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil
| | - A C D Assis
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil
| | - C G Lopes
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil
| | - T Bortholin
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil
| | - R B Dias
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil
| | - F G M Naylor
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil
| | - M A T Chieia
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil
| | - P V S Souza
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil.
| | - A S B Oliveira
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil
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Finegan E, Chipika RH, Shing SLH, Hardiman O, Bede P. Primary lateral sclerosis: a distinct entity or part of the ALS spectrum? Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:133-145. [PMID: 30654671 DOI: 10.1080/21678421.2018.1550518] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Primary lateral sclerosis (PLS) has been traditionally viewed as a distinct upper motor neuron condition (UMN) but is increasingly regarded as a sub-phenotype within the amyotrophic lateral sclerosis (ALS) spectrum. Despite established diagnostic criteria, formal diagnosis can be challenging and the protracted diagnostic journey and uncertainty about longer-term prognosis cause considerable distress to patients and caregivers. PLS patients are invariably excluded from ALS clinical trials, while PLS pharmacological trials are lacking. There remains an unmet need for diagnostic biomarkers for upper motor neuron predominant conditions and prognostic indicators regarding prognosis, survival, and risk of conversion to ALS. Validated biomarkers will not only have implications for individualized patient care but also serve as outcome measures in pharmaceutical trials. Given the paucity of post-mortem studies in PLS, novel pathological insights are generally inferred from state-of-the-art imaging studies. Computational neuroimaging has already contributed significantly to the characterization of PLS-associated pathology in vivo and has underscored the role of neuro-inflammation, the presence of extra-motor changes, and confirmed pathological patterns similar to ALS. This systematic review assesses the current state of PLS research across clinical, neuroimaging and neuropathological domains from a combined clinical and academic perspective. We discuss patterns of pathological overlap with other ALS phenotypes, examine if the biological processes of PLS warrant therapeutic strategies distinct from ALS, and evaluate the evidence that classes PLS as a distinct clinico-pathological entity.
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Affiliation(s)
- Eoin Finegan
- a Computational Neuroimaging Group, Academic Unit of Neurology , Biomedical Sciences Institute, Trinity College , Dublin , Ireland
| | - Rangariroyashe H Chipika
- a Computational Neuroimaging Group, Academic Unit of Neurology , Biomedical Sciences Institute, Trinity College , Dublin , Ireland
| | - Stacey Li Hi Shing
- a Computational Neuroimaging Group, Academic Unit of Neurology , Biomedical Sciences Institute, Trinity College , Dublin , Ireland
| | - Orla Hardiman
- a Computational Neuroimaging Group, Academic Unit of Neurology , Biomedical Sciences Institute, Trinity College , Dublin , Ireland
| | - Peter Bede
- a Computational Neuroimaging Group, Academic Unit of Neurology , Biomedical Sciences Institute, Trinity College , Dublin , Ireland
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Weidman EK, Schweitzer AD, Niogi SN, Brady EJ, Starikov A, Askin G, Shahbazi M, Wang Y, Lange D, Tsiouris AJ. Diffusion tensor imaging and quantitative susceptibility mapping as diagnostic tools for motor neuron disorders. Clin Imaging 2019; 53:6-11. [DOI: 10.1016/j.clinimag.2018.09.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/04/2018] [Accepted: 09/24/2018] [Indexed: 12/11/2022]
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Olney NT, Bischof A, Rosen H, Caverzasi E, Stern WA, Lomen-Hoerth C, Miller BL, Henry RG, Papinutto N. Measurement of spinal cord atrophy using phase sensitive inversion recovery (PSIR) imaging in motor neuron disease. PLoS One 2018; 13:e0208255. [PMID: 30496320 PMCID: PMC6264489 DOI: 10.1371/journal.pone.0208255] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 11/14/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The spectrum of motor neuron disease (MND) includes numerous phenotypes with various life expectancies. The degree of upper and lower motor neuron involvement can impact prognosis. Phase sensitive inversion recovery (PSIR) imaging has been shown to detect in vivo gray matter (GM) and white matter (WM) atrophy in the spinal cord of other patient populations but has not been explored in MND. METHODS In this study, total cord, WM and GM areas of ten patients with a diagnosis within the MND spectrum were compared to those of ten healthy controls (HC). Patients' diagnosis included amyotrophic lateral sclerosis (ALS), primary lateral sclerosis, primary muscular atrophy, facial onset sensory and motor neuronopathy and ALS-Frontotemporal dementia. Axial 2D PSIR images were acquired at four cervical disc levels (C2-C3, C3-C4, C5-C6 and C7-T1) with a short acquisition time (2 minutes) protocol. Total cross-sectional areas (TCA), GM and WM areas were measured using a combination of highly reliable manual and semi-automated methods. Cord areas in MND patients were compared with HC using linear regression analyses adjusted for age and sex. Correlation of WM and GM areas in MND patients was explored to gain insights into underlying atrophy patterns. RESULTS MND patients as a group had significantly smaller cervical cord GM area compared to HC at all four levels (C2-C3: p = .009; C3-C4: p = .001; C5-C6: p = .006; C7-T1: p = .002). WM area at C5-C6 level was significantly smaller (p = .001). TCA was significantly smaller at C3-C4 (p = .018) and C5-C6 (p = .002). No significant GM and WM atrophy was detected in the two patients with predominantly bulbar phenotype. Concomitant GM and WM atrophy was detected in solely upper or lower motor neuron level phenotypes. There was a significant correlation between GM and WM areas at all four levels in this diverse population of MND. CONCLUSION Spinal cord GM and WM atrophy can be detected in vivo in patients within the MND spectrum using a short acquisition time 2D PSIR imaging protocol. PSIR imaging shows promise as a method for quantifying spinal cord involvement and thus may be useful for diagnosis, prognosis and for monitoring disease progression.
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Affiliation(s)
- Nicholas T. Olney
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California, United States of America
- Department of Neurology, University of California San Francisco Amyotrophic Lateral Sclerosis Center, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Antje Bischof
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- Department of Neurology and Immunology Clinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Howard Rosen
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California, United States of America
| | - Eduardo Caverzasi
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
| | - William A. Stern
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
| | - Catherine Lomen-Hoerth
- Department of Neurology, University of California San Francisco Amyotrophic Lateral Sclerosis Center, University of California San Francisco, San Francisco, California, United States of America
| | - Bruce L. Miller
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California, United States of America
| | - Roland G. Henry
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
| | - Nico Papinutto
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
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Abstract
ALS is a neurodegenerative disease in which the primary symptoms result in progressive neuromuscular weakness. Recent studies have highlighted that there is significant heterogeneity with regard to anatomical and temporal disease progression. Importantly, more recent advances in genetics have revealed new causative genes to the disease. New efforts have focused on the development of biomarkers that could aid in diagnosis, prognosis, and serve as pharmacodynamics markers. Although traditional pharmaceuticals continue to undergo trials for ALS, new therapeutic strategies including stem cell transplantation studies, gene therapies, and antisense therapies targeting some of the familial forms of ALS are gaining momentum.
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Müller HP, Agosta F, Gorges M, Kassubek R, Spinelli EG, Riva N, Ludolph AC, Filippi M, Kassubek J. Cortico-efferent tract involvement in primary lateral sclerosis and amyotrophic lateral sclerosis: A two-centre tract of interest-based DTI analysis. NEUROIMAGE-CLINICAL 2018; 20:1062-1069. [PMID: 30343251 PMCID: PMC6198122 DOI: 10.1016/j.nicl.2018.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/02/2018] [Accepted: 10/05/2018] [Indexed: 01/19/2023]
Abstract
Background After the demonstration of a corticoefferent propagation pattern in amyotrophic lateral sclerosis (ALS) by neuropathological studies, this concept has been used for in vivo staging of individual patients by diffusion tensor imaging (DTI) techniques, both in `classical` ALS and in restricted phenotypes such as primary lateral sclerosis (PLS). Objective The study was designed to investigate that microstructural changes according to the neuropathologically defined ALS alteration pattern in PLS patients could be confirmed to be identical to ´classical´ ALS patients. The novelty in this approach is that the results were independent of the subject samples and the data acquisition parameters (as was validated in two samples from two different centres). That way, reproducibility across (international) centres in addition to harmonisation/standardisation of data analysis has been addressed, for the possible use of MRI-based staging to stratify patients in clinical trials. Methods Tractwise analysis of fractional anisotropy (FA) maps according to the ALS-staging pattern was applied to DTI data (pooled from two ALS centres) of 88 PLS patients and 88 ALS patients with a ‘classical’ phenotype in comparison to 88 matched controls in order to identify white matter integrity alterations. Results In the tract-specific analysis, alterations were identical for PLS and ALS in the tract systems corresponding to the ALS staging pattern, independent of the subject samples and the data acquisition parameters. The individual categorisation into ALS stages did not differ between PLS and ALS patients. Conclusions This DTI study in a two-centre setting demonstrated that the neuropathological stages can be mapped in vivo in PLS with high reproducibility and that PLS-associated cerebral propagation, although showing the same corticofugal patterns as ALS, might have a different time course of neuropathology, in analogy to its much slower clinical progression rates. Neuropathological ALS-stages are mapped in vivo in PLS with high reproducibility. Bicentric DTI supports the hypothesis that PLS is a phenotype variant of ALS. PLS-associated propagation shows corticofugal patterns resembling those observed in ALS.
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Affiliation(s)
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Edoardo Gioele Spinelli
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Nilo Riva
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Germany.
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Clark MG, Smallwood Shoukry R, Huang CJ, Danielian LE, Bageac D, Floeter MK. Loss of functional connectivity is an early imaging marker in primary lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:562-569. [PMID: 30299161 DOI: 10.1080/21678421.2018.1517180] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The clinical diagnosis of primary lateral sclerosis can only be made after upper motor neuron symptoms have progressed for several years without developing lower motor neuron signs. The goal of the study was to identify neuroimaging changes that occur early in primary lateral sclerosis, prior to clinical diagnosis. METHODS MRI scans were obtained on 13 patients with adult-onset progressive spasticity for five years or less who were followed longitudinally to confirm a clinical diagnosis of primary lateral sclerosis. Resting state functional MRI, diffusion tensor imaging, and anatomical images were obtained. These "pre-PLS" patients were compared to 18 patients with longstanding, established primary lateral sclerosis and 28 controls. RESULTS Pre-PLS patients had a marked reduction in seed-based resting-state motor network connectivity compared to the controls and patients with longstanding disease. White matter regions with reduced fractional anisotropy were similar in the two patient groups compared to the controls. Patients with longstanding disease had cortical thinning of the precentral gyrus. A slight thinning of the right precentral gyrus was detected in initial pre-PLS patients' scans. Follow-up scans in eight pre-PLS patients 1-2 years later showed increasing motor connectivity, thinning of the precentral gyrus, and no change in diffusion measures of the corticospinal tract or callosal motor region. CONCLUSIONS Loss of motor functional connectivity is an early imaging marker in primary lateral sclerosis. This differs from literature descriptions of amyotrophic lateral sclerosis, warranting further studies to test whether resting-state functional MRI can differentiate between amyotrophic lateral sclerosis and primary lateral sclerosis at early disease stages.
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Affiliation(s)
- Michael G Clark
- a National Institute of Neurological Disorders and Stroke , National Institutes of Health , Bethesda , MD , USA
| | - Rachel Smallwood Shoukry
- a National Institute of Neurological Disorders and Stroke , National Institutes of Health , Bethesda , MD , USA
| | - Caleb J Huang
- a National Institute of Neurological Disorders and Stroke , National Institutes of Health , Bethesda , MD , USA
| | - Laura E Danielian
- a National Institute of Neurological Disorders and Stroke , National Institutes of Health , Bethesda , MD , USA
| | - Devin Bageac
- a National Institute of Neurological Disorders and Stroke , National Institutes of Health , Bethesda , MD , USA
| | - Mary Kay Floeter
- a National Institute of Neurological Disorders and Stroke , National Institutes of Health , Bethesda , MD , USA
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Müller HP, Kassubek J. MRI-Based Mapping of Cerebral Propagation in Amyotrophic Lateral Sclerosis. Front Neurosci 2018; 12:655. [PMID: 30319338 PMCID: PMC6168650 DOI: 10.3389/fnins.2018.00655] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/31/2018] [Indexed: 11/13/2022] Open
Abstract
Neuropathological studies revealed the propagation of amyotrophic lateral sclerosis (ALS) in a sequence of four separate disease-related regional patterns. Diffusion tensor imaging (DTI)-based analysis was established for the individual mapping of sequential disease spreading in ALS as the in vivo transfer to neuroimaging. The aim of this review is to summarize cross-sectional and longitudinal results of these technical approaches in ALS as an in vivo tool to image ALS propagation stages. This concept was also applied to restricted phenotypes of ALS, e.g., lower motor neuron disease (LMND) or primary lateral sclerosis (PLS). In summary, the regional disease patterns in the course of ALS have been successfully mapped by DTI in vivo both cross-sectionally and longitudinally so that this technique might have the potential as a read-out in clinical trials.
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Affiliation(s)
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
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Primary lateral sclerosis and the amyotrophic lateral sclerosis–frontotemporal dementia spectrum. J Neurol 2018; 265:1819-1828. [DOI: 10.1007/s00415-018-8917-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/22/2018] [Accepted: 05/25/2018] [Indexed: 12/16/2022]
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Müller HP, Gorges M, Kassubek R, Dorst J, Ludolph AC, Kassubek J. Identical patterns of cortico-efferent tract involvement in primary lateral sclerosis and amyotrophic lateral sclerosis: A tract of interest-based MRI study. NEUROIMAGE-CLINICAL 2018; 18:762-769. [PMID: 29785360 PMCID: PMC5959739 DOI: 10.1016/j.nicl.2018.03.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/28/2018] [Accepted: 03/14/2018] [Indexed: 12/15/2022]
Abstract
Background There is an ongoing debate whether primary lateral sclerosis (PLS) should be regarded as an independent disease entity separate from amyotrophic lateral sclerosis (ALS) or as a slowly progressive variant of ALS. Objective The study was designed to investigate specific white matter alterations in diffusion tensor imaging (DTI) data from PLS patients by a hypothesis-guided tract-of-interest-based approach compared with ‘classical’ ALS patients and healthy controls, in order to identify microstructural changes according to the neuropathologically defined ALS affectation pattern in vivo. Methods DTI-based white matter mapping was performed both by an unbiased voxelwise statistical comparison and by a hypothesis-guided tractwise analysis of fractional anisotropy (FA) maps according to the ALS-staging pattern for 50 PLS and 50 ALS patients vs 50 matched controls. Results The analysis of white matter integrity by regional FA reductions demonstrated the characteristic alteration patterns along the CST and also in frontal and prefrontal brain areas in PLS patients and ALS patients. In the tract-specific analysis according to the ALS-staging pattern, PLS and ALS affectation patterns showed identical significant alterations of ALS-related tract systems when compared with controls and no differences when compared with each other. Conclusions This DTI study showed the same microstructural affectation patterns in PLS patients as in ALS, in support of the hypothesis that PLS is a phenotypical variant of ALS. PLS showed significant alterations in ALS-related tract systems. DTI shows identical microstructural alteration patterns of PLS and ALS in vivo. DTI supports the hypothesis that PLS is a phenotypical variant of ALS.
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Affiliation(s)
| | | | | | | | | | - Jan Kassubek
- Department of Neurology, University of Ulm, Germany.
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Ramanathan RS, Rana S. Demographics and clinical characteristics of primary lateral sclerosis: case series and a review of literature. Neurodegener Dis Manag 2018; 8:17-23. [PMID: 29316850 DOI: 10.2217/nmt-2017-0051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Primary lateral sclerosis (PLS) is a form of motor neuron disease involving only upper motor neurons. In some patients presenting as PLS, the disease progresses to involve lower motor neurons and thereby converting to amyotrophic lateral sclerosis (ALS). However, pure forms of PLS do exist. Our aim was to study epidemiological and clinical characteristics of pure PLS patients treated at our neuromuscular clinic. METHODS We retrospectively reviewed 15 patients from July 2011 to October 2014 with PLS treated at the neuromuscular disorder clinic at our hospital. Data collection included patient demographics, age and site of onset, duration of symptoms and duration of follow-up. We also studied clinical features such as bulbar involvement; pseudobulbar affect; depression; spasms/pain; bladder involvement; diagnostic work up, in other words, MRI; brain/electromyography findings; clinical course, namely years to wheelchair; and need for gastrostomy tube requirement baclofen pump placement. We also tried to find a correlation between PLS and environmental factors such as urban/suburban/rural living, consumption of well water, socioeconomic status/occupation and history of trauma. RESULTS Male-to-female ratio was 1:2, mean age at onset of symptoms was 58.6 years, with the oldest patient being an 84-year-old female at the time of onset of symptoms. Mean duration of follow-up was 51 months. Mean duration of symptoms was 77.4 months. About eight (53%) patients presented with bulbar symptoms in the form of spastic speech and dysphagia, pseudobulbar affect, developed depression and had bladder involvement. Seven (47%) patients presented with symmetric spasticity in the extremities. A third of the patients required baclofen for spasticity and a third required gastrostomy tube placement for dysphagia. None of them had abnormal neuroimaging or electrodiagnostic testing. Only one patient had history of trauma. About half of the patients were from lower socioeconomic status as well as middle class. One of the patients had consumed well water during younger years and three (20%) patients lived in the rural area. CONCLUSION Though on review of literature there is no clear consensus about the existence of PLS as a distinct disease entity, we believe that there are rare cases of motor neuron disease with progressive upper motor neuron symptoms that throughout their course never convert to ALS. Our series highlights the demographic and clinical features of these patients and underscores the longer survival of these patients when compared with ALS.
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Affiliation(s)
| | - Sandeep Rana
- Temple University School of Medicine, Neurology Residency Program Director, Neuromuscular Department Director, Allegheny Health Network, 420 E North Ave, Suite 206, Pittsburgh, PA 15212, USA
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Álvarez N, Díez L, Avellaneda C, Serra M, Rubio M. Relevance of the pyramidal syndrome in amyotrophic lateral sclerosis. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2016.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Álvarez N, Díez L, Avellaneda C, Serra M, Rubio M. Relevancia del síndrome piramidal en la esclerosis lateral amiotrófica. Neurologia 2018; 33:8-12. [DOI: 10.1016/j.nrl.2016.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 11/30/2022] Open
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van Es MA, Hardiman O, Chio A, Al-Chalabi A, Pasterkamp RJ, Veldink JH, van den Berg LH. Amyotrophic lateral sclerosis. Lancet 2017; 390:2084-2098. [PMID: 28552366 DOI: 10.1016/s0140-6736(17)31287-4] [Citation(s) in RCA: 755] [Impact Index Per Article: 107.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 03/13/2017] [Accepted: 03/20/2017] [Indexed: 12/12/2022]
Abstract
Amyotrophic lateral sclerosis is characterised by the progressive loss of motor neurons in the brain and spinal cord. This neurodegenerative syndrome shares pathobiological features with frontotemporal dementia and, indeed, many patients show features of both diseases. Many different genes and pathophysiological processes contribute to the disease, and it will be necessary to understand this heterogeneity to find effective treatments. In this Seminar, we discuss clinical and diagnostic approaches as well as scientific advances in the research fields of genetics, disease modelling, biomarkers, and therapeutic strategies.
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Affiliation(s)
- Michael A van Es
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland; Department of Neurology, Beaumont Hospital, Beaumont, Ireland
| | - Adriano Chio
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy; Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, Turin, Italy; Neuroscience Institute of Turin, Turin, Italy
| | - Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK; NIHR Dementia Biomedical Research Unit, King's College London, London, UK
| | - R Jeroen Pasterkamp
- Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Jan H Veldink
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Leonard H van den Berg
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands.
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Walhout R, Verstraete E, van den Heuvel MP, Veldink JH, van den Berg LH. Patterns of symptom development in patients with motor neuron disease. Amyotroph Lateral Scler Frontotemporal Degener 2017; 19:21-28. [PMID: 29037065 DOI: 10.1080/21678421.2017.1386688] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate whether symptom development in motor neuron disease (MND) is a random or organized process. METHODS Six hundred patients with amyotrophic lateral sclerosis (ALS), upper motor neuron (UMN) or lower motor neuron (LMN) phenotypes were invited for a questionnaire concerning symptom development. A binomial test was used to examine distribution of symptoms from site of onset. Development of symptoms over time was evaluated by Kaplan-Meier analysis. RESULTS There were 470 respondents (ALS = 254; LMN = 100; UMN = 116). Subsequent symptoms were more often in the contralateral limb following unilateral limb onset (ALS: arms p = 1.05 × 10-8, legs p < 2.86 × 10-15; LMN phenotype: arms p = 6.74 × 10-9, legs p = 6.26 × 10-6; UMN phenotype: legs p = 4.07 × 10-14). In patients with limb onset, symptoms occurred significantly faster in the contralateral limb, followed by the other limbs and lastly by the bulbar region. Patterns of non-contiguous symptom development were also reported: leg symptoms followed bulbar onset in 30%, and bulbar symptoms followed leg onset in 11% of ALS patients. CONCLUSIONS Preferred spread of symptoms from one limb to the contralateral limb, and to adjacent sites appears to be a characteristic of MND phenotypes, suggesting that symptom spread is organized, possibly involving axonal connectivity. Non-contiguous symptom development, however, is not uncommon, and may involve other factors.
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Affiliation(s)
- Renée Walhout
- a Department of Neurology, Brain Center Rudolf Magnus , University Medical Center Utrecht , Utrecht , The Netherlands and
| | - Esther Verstraete
- a Department of Neurology, Brain Center Rudolf Magnus , University Medical Center Utrecht , Utrecht , The Netherlands and
| | - Martijn P van den Heuvel
- b Department of Psychiatry, Brain Center Rudolf Magnus , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Jan H Veldink
- a Department of Neurology, Brain Center Rudolf Magnus , University Medical Center Utrecht , Utrecht , The Netherlands and
| | - Leonard H van den Berg
- a Department of Neurology, Brain Center Rudolf Magnus , University Medical Center Utrecht , Utrecht , The Netherlands and
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Goutman SA. Diagnosis and Clinical Management of Amyotrophic Lateral Sclerosis and Other Motor Neuron Disorders. Continuum (Minneap Minn) 2017; 23:1332-1359. [DOI: 10.1212/con.0000000000000535] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Wais V, Rosenbohm A, Petri S, Kollewe K, Hermann A, Storch A, Hanisch F, Zierz S, Nagel G, Kassubek J, Weydt P, Brettschneider J, Weishaupt JH, Ludolph AC, Dorst J. The concept and diagnostic criteria of primary lateral sclerosis. Acta Neurol Scand 2017; 136:204-211. [PMID: 27858953 DOI: 10.1111/ane.12713] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Primary lateral sclerosis (PLS) is commonly considered as a motor neuron disease (MND) variant which almost exclusively affects upper motor neurons (UMN). There is still no consensus whether PLS should be regarded as an independent disease entity separate from amyotrophic lateral sclerosis (ALS) or as a comparatively slowly progressive variant of ALS. Given these different views, clinical diagnosis of PLS is a challenge. In this multicenter study, we analyzed clinical features of patients diagnosed with PLS in four specialized MND centers. MATERIAL AND METHODS We retrospectively analyzed clinical, laboratory, imaging, and electrophysiological data of 76 patients with PLS diagnosed in four specialized ALS centers. We analyzed the concept of the disease based on our findings and an extensive review of the literature. RESULTS We found that 79% of patients showed asymmetrical symptoms, 60% showed clinical or electrophysiological signs of lower motor neuron (LMN) involvement after a mean of 8.4 ± 5.0 years, and extrapyramidal and/or non-motoric symptoms were frequently observed. Interestingly, none of the patients diagnosed with PLS fulfilled the diagnostic criteria proposed by Pringle et al. in 1992. CONCLUSIONS Our data show that PLS as a disease entity is still not well enough defined and that there are different concepts about its clinical presentation. We believe that further prospective longitudinal studies are needed in order to refine diagnostic criteria to reflect current clinical practice. Furthermore, neuropathological and neuroimaging approaches might help to arrange PLS in the MND spectrum and its classification.
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Affiliation(s)
- Verena Wais
- Department of Neurology; University of Ulm; Ulm Germany
| | | | - Susanne Petri
- Department of Neurology; University of Hannover; Hannover Germany
| | - Katja Kollewe
- Department of Neurology; University of Hannover; Hannover Germany
| | - Andreas Hermann
- Department of Neurology; Division for Neurodegenerative Diseases; Dresden University of Technology; Dresden Germany
- German Center for Neurodegenerative Diseases (DZNE); Dresden Germany
| | - Alexander Storch
- Department of Neurology; Division for Neurodegenerative Diseases; Dresden University of Technology; Dresden Germany
- German Center for Neurodegenerative Diseases (DZNE); Dresden Germany
- Department of Neurology; University Medical Center Rostock; Rostock Germany
| | - Frank Hanisch
- Department of Neurology; Evangelisches Krankenhaus Königin Elisabeth Herzberge; Berlin Germany
| | - Stephan Zierz
- Department of Neurology; University of Halle; Halle Germany
| | - Gabriele Nagel
- Institute for Epidemiology and Medical Biometry; University of Ulm; Ulm Germany
| | - Jan Kassubek
- Department of Neurology; University of Ulm; Ulm Germany
| | - Patrick Weydt
- Department of Neurology; University of Ulm; Ulm Germany
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Grad LI, Rouleau GA, Ravits J, Cashman NR. Clinical Spectrum of Amyotrophic Lateral Sclerosis (ALS). Cold Spring Harb Perspect Med 2017; 7:cshperspect.a024117. [PMID: 28003278 DOI: 10.1101/cshperspect.a024117] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is primarily characterized by progressive loss of motor neurons, although there is marked phenotypic heterogeneity between cases. Typical, or "classical," ALS is associated with simultaneous upper motor neuron (UMN) and lower motor neuron (LMN) involvement at disease onset, whereas atypical forms, such as primary lateral sclerosis and progressive muscular atrophy, have early and predominant involvement in the UMN and LMN, respectively. The varying phenotypes can be so distinctive that they would seem to have differing biology. Because the same phenotypes can have multiple causes, including different gene mutations, there may be multiple molecular mechanisms causing ALS, implying that the disease is a syndrome. Conversely, multiple phenotypes can be caused by a single gene mutation; thus, a single molecular mechanism could be compatible with clinical heterogeneity. The pathogenic mechanism(s) in ALS remain unknown, but active propagation of the pathology neuroanatomically is likely a primary component.
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Affiliation(s)
- Leslie I Grad
- Djavad Mowafaghian Centre for Brain Health, Department of Medicine (Neurology), University of British Columbia, Vancouver V6T 2B5, Canada
| | - Guy A Rouleau
- Montreal Neurological Institute and Hospital, McGill University, Montréal H3A 2B4, Canada
| | - John Ravits
- Department of Neurosciences, University of California, San Diego, La Jolla, California 92093
| | - Neil R Cashman
- Djavad Mowafaghian Centre for Brain Health, Department of Medicine (Neurology), University of British Columbia, Vancouver V6T 2B5, Canada
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de Vries BS, Rustemeijer LM, van der Kooi AJ, Raaphorst J, Schröder CD, Nijboer TC, Hendrikse J, Veldink JH, van den Berg LH, van Es MA. A case series of PLS patients with frontotemporal dementia and overview of the literature. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:534-548. [DOI: 10.1080/21678421.2017.1354996] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Bálint S. de Vries
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands,
| | - Laura M.M. Rustemeijer
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands,
| | - Anneke J. van der Kooi
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,
| | - Joost Raaphorst
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands,
| | - Carin D. Schröder
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands,
| | - Tanja C.W. Nijboer
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands,
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands, and
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan H. Veldink
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands,
| | - Leonard H. van den Berg
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands,
| | - Michael A. van Es
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands,
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