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Din Abdul Jabbar MA, Guo L, Guo Y, Simmons Z, Pioro EP, Ramasamy S, Yeo CJJ. Describing and characterising variability in ALS disease progression. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:34-45. [PMID: 37794802 DOI: 10.1080/21678421.2023.2260838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/07/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND, OBJECTIVES Decrease in the revised ALS Functional Rating Scale (ALSFRS-R) score is currently the most widely used measure of disease progression. However, it does not sufficiently encompass the heterogeneity of ALS. We describe a measure of variability in ALSFRS-R scores and demonstrate its utility in disease characterization. METHODS We used 5030 ALS clinical trial patients from the Pooled Resource Open-Access ALS Clinical Trials database to calculate variability in disease progression employing a novel measure and correlated variability with disease span. We characterized the more and less variable populations and designed a machine learning model that used clinical, laboratory and demographic data to predict class of variability. The model was validated with a holdout clinical trial dataset of 84 ALS patients (NCT00818389). RESULTS Greater variability in disease progression was indicative of longer disease span on the patient-level. The machine learning model was able to predict class of variability with accuracy of 60.1-72.7% across different time periods and yielded a set of predictors based on clinical, laboratory and demographic data. A reduced set of 16 predictors and the holdout dataset yielded similar accuracy. DISCUSSION This measure of variability is a significant determinant of disease span for fast-progressing patients. The predictors identified may shed light on pathophysiology of variability, with greater variability in fast-progressing patients possibly indicative of greater compensatory reinnervation and longer disease span. Increasing variability alongside decreasing rate of disease progression could be a future aim of trials for faster-progressing patients.
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Affiliation(s)
- Muzammil Arif Din Abdul Jabbar
- University of Cambridge, Cambridge, United Kingdom of Great Britain and Northern Ireland
- Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Ling Guo
- Institute for Infocomm Research (I2R), A*STAR, Singapore, Singapore
| | - Yang Guo
- Institute for Infocomm Research (I2R), A*STAR, Singapore, Singapore
| | - Zachary Simmons
- Department of Neurology, Pennsylvania State University College of Medicine, University Park, USA
| | - Erik P Pioro
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Savitha Ramasamy
- Institute for Infocomm Research (I2R), A*STAR, Singapore, Singapore
| | - Crystal Jing Jing Yeo
- Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Lee Kong Chian School of Medicine, Imperial College London and NTU, Singapore, Singapore
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- National Neuroscience Institute, Singapore, Singapore, and
- Duke-NUS Medical School, Singapore, Singapore
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Vacchiano V, Mastrangelo A, Zenesini C, Baiardi S, Avoni P, Polischi B, Capellari S, Salvi F, Liguori R, Parchi P. Elevated plasma p-tau181 levels unrelated to Alzheimer's disease pathology in amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2023; 94:428-435. [PMID: 37012065 DOI: 10.1136/jnnp-2022-330709] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/15/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Phosphorylated-tau181 (p-tau181), a specific marker of Alzheimer's disease (AD) pathology, was found elevated in plasma but not in cerebrospinal fluid (CSF) of patients with amyotrophic lateral sclerosis (ALS). We expanded these findings in a larger patient cohort, exploring clinical/electrophysiological associations, prognostic value and longitudinal trajectories of the biomarker. METHODS We obtained baseline plasma samples from 148 ALS, 12 spinal muscular atrophy (SMA), and 88 AD patients, and 60 healthy controls. Baseline CSF and longitudinal plasma samples were from 130 and 39 patients with ALS. CSF AD markers were measured with the Lumipulse platform, and plasma p-tau181 with SiMoA. RESULTS Patients with ALS showed higher plasma p-tau181 levels than controls (p<0.001) and lower than AD participants (p=0.02). SMA patients had higher levels than controls (p=0.03). In patients with ALS, CSF p-tau and plasma p-tau181 did not correlate (p=0.37). Plasma p-tau181 significantly increased with the number of regions showing clinical/neurophysiological lower motor neurons (LMN) signs (p=0.007) and correlated with the degree of denervation in the lumbosacral area (r=0.51, p<0.0001). Plasma p-tau181 levels were higher in classic and LMN-predominant than in bulbar phenotype (p=0.004 and p=0.006). Multivariate Cox regression confirmed plasma p-tau181 as an independent prognostic factor in ALS (HR 1.90, 95% CI 1.25 to 2.90, p=0.003). Longitudinal analysis showed a significant rise in plasma p-tau181 values over time, especially in fast progressors. CONCLUSIONS Plasma p-tau181 is elevated in patients with ALS, independently from CSF levels, and is firmly associated with LMN dysfunction. The finding indicates that p-tau181 of putative peripheral origin might represent a confounding factor in using plasma p-tau181 for AD pathology screening, which deserves further investigation.
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Affiliation(s)
- Veria Vacchiano
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Andrea Mastrangelo
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Corrado Zenesini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Simone Baiardi
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Patrizia Avoni
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Barbara Polischi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Sabina Capellari
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fabrizio Salvi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Rocco Liguori
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Piero Parchi
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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3
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Colombo E, Doretti A, Scheveger F, Maranzano A, Pata G, Gagliardi D, Meneri M, Messina S, Verde F, Morelli C, Corti S, Maderna L, Silani V, Ticozzi N. Correlation between clinical phenotype and electromyographic parameters in amyotrophic lateral sclerosis. J Neurol 2023; 270:511-518. [PMID: 36183286 DOI: 10.1007/s00415-022-11404-4] [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: 07/15/2022] [Revised: 09/05/2022] [Accepted: 09/26/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Even if electromyography (EMG) is routinely used to confirm the diagnosis of amyotrophic lateral sclerosis (ALS), few studies have analysed the correlation between electrophysiological parameters and clinical characteristics of ALS. We assessed if the quantification of active denervation (AD) and chronic denervation (CD) provides clinicians with information about phenotype, disease progression and survival in ALS patients. METHODS We studied a cohort of 689 ALS patients recording the following parameters: age and site of onset, survival, MRC scale for muscle strength evaluation, burden of upper and lower motor signs as measured with specific scales (PUMNS and LMNS, respectively), ALSFRS-R, progression rate (ΔFS), MITOS and King's Staging systems (KSS). We performed EMG on 11 muscles, and calculated semiquantitative AD and CD scores for each limb, as well as for the bulbar and spinal regions. RESULTS We found a positive correlation between AD and CD scores with LMNS (respectively p = 4.4 × 10-37 and p = 2.8 × 10-45) and a negative correlation with MRC (respectively p = 4.5 × 10-35 and p = 3.0 × 10-35). Furthermore, patients with higher spinal AD and CD scores had significantly lower ALSFRS-R scores, and higher KSS and MITOS stages. Conversely, only AD was associated to higher ΔFS (p = 1.0 × 10-6) and shorter survival (p = 1.1 × 10-5). CONCLUSION Our results confirmed that EMG examination represents not only a diagnostic instrument, but also a prognostic tool. In this context, AD seems to be a reliable predictor of disease's progression and survival while CD better describes functional disability.
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Affiliation(s)
- Eleonora Colombo
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, P.le Brescia 20, 20149, Milan, Italy
| | - Alberto Doretti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, P.le Brescia 20, 20149, Milan, Italy
| | - Francesco Scheveger
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, P.le Brescia 20, 20149, Milan, Italy.,Neurology Residency Program, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Alessio Maranzano
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, P.le Brescia 20, 20149, Milan, Italy.,Neurology Residency Program, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Giulia Pata
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, P.le Brescia 20, 20149, Milan, Italy
| | - Delia Gagliardi
- Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Megi Meneri
- Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Stefano Messina
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, P.le Brescia 20, 20149, Milan, Italy
| | - Federico Verde
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, P.le Brescia 20, 20149, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Claudia Morelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, P.le Brescia 20, 20149, Milan, Italy
| | - Stefania Corti
- Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Luca Maderna
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, P.le Brescia 20, 20149, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, P.le Brescia 20, 20149, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, P.le Brescia 20, 20149, Milan, Italy. .,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.
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Kaźmierski R. Muscle ultrasonography in diagnostics of fasciculations: A lot has been done, but there is still more to do. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:292-295. [PMID: 35148006 DOI: 10.1002/jcu.23102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Radosław Kaźmierski
- Department of Neurology, Collegium Medicum, University of Zielona Góra, Zielona Gora, Poland
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
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Zakharova MN, Abramova AA. Lower and upper motor neuron involvement and their impact on disease prognosis in amyotrophic lateral sclerosis. Neural Regen Res 2022; 17:65-73. [PMID: 34100429 PMCID: PMC8451581 DOI: 10.4103/1673-5374.314289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Amyotrophic lateral sclerosis is a fatal neurodegenerative disease characterized by progressive muscle wasting, breathing and swallowing difficulties resulting in patient’s death in two to five years after disease onset. In amyotrophic lateral sclerosis, both upper and lower motor neurons of the corticospinal tracts are involved in the process of neurodegeneration, accounting for great clinical heterogeneity of the disease. Clinical phenotype has great impact on the pattern and rate of amyotrophic lateral sclerosis progression and overall survival prognosis. Creating more homogenous patient groups in order to study the effects of drug agents on specific manifestations of the disease is a challenging issue in amyotrophic lateral sclerosis clinical trials. Since amyotrophic lateral sclerosis has low incidence rates, conduction of multicenter trials requires certain standardized approaches to disease diagnosis and staging. This review focuses on the current approaches in amyotrophic lateral sclerosis classification and staging system based on clinical examination and additional instrumental methods, highlighting the role of upper and lower motor neuron involvement in different phenotypes of the disease. We demonstrate that both clinical and instrumental findings can be useful in evaluating severity of upper motor neuron and lower motor neuron involvement and predicting the following course of the disease. Addressing disease heterogeneity in amyotrophic lateral sclerosis clinical trials could lead to study designs that will assess drug efficacy in specific patient groups, based on the disease pathophysiology and spatiotemporal pattern. Although clinical evaluation can be a sufficient screening method for dividing amyotrophic lateral sclerosis patients into clinical subgroups, we provide proof that instrumental studies could provide valuable insights in the disease pathology.
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Paoletti M, Diamanti L, Muzic SI, Ballante E, Solazzo F, Foppoli L, Deligianni X, Santini F, Figini S, Bergsland N, Pichiecchio A. Longitudinal Quantitative MRI Evaluation of Muscle Involvement in Amyotrophic Lateral Sclerosis. Front Neurol 2021; 12:749736. [PMID: 34899571 PMCID: PMC8651545 DOI: 10.3389/fneur.2021.749736] [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: 07/29/2021] [Accepted: 10/11/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Biomarkers of disease progression and outcome measures are still lacking for patients with amyotrophic lateral sclerosis (ALS). Muscle MRI can be a promising candidate to track longitudinal changes and to predict response to the therapy in clinical trials. Objective: Our aim is to apply quantitative muscle MRI in the evaluation of disease progression, focusing on thigh and leg muscles of patients with ALS, and to explore the correlation between radiological and clinical scores. Methods: We enrolled newly diagnosed patients with ALS, longitudinally scored using the ALS Functional Rating Scale-Revised (ALSFRS-R), who underwent a 3T muscle MRI protocol including a 6-point Dixon gradient-echo sequence and multi-echo turbo spin echo (TSE) T2-weighted sequence for quantification of fat fraction (FF), cross-sectional area (CSA), and water T2 (wT2). A total of 12 muscles of the thigh and six muscles of the leg were assessed by the manual drawing of 18 regions of interest (ROIs), for each side. A group of 11 age-matched healthy controls (HCs) was enrolled for comparison. Results: 15 patients (M/F 8/7; mean age 62.2 years old, range 29-79) diagnosed with possible (n = 2), probable (n = 12), or definite (n = 1) ALS were enrolled. Eleven patients presented spinal onset, whereas four of them had initial bulbar involvement. All patients performed MRI at T0, nine of them at T1, and seven of them at T2. At baseline, wT2 was significantly elevated in ALS subjects compared to HCs for several muscles of the thigh and mainly for leg muscles. By contrast, FF was elevated in few muscles, and mainly at the level of the thigh. The applied mixed effects model showed that FF increased significantly in the leg muscles over time (mainly in the triceps surae) and that wT2 decreased significantly in line with worsening in the leg subscore of ALSFRS-R, mainly at the leg level and in the anterior and medial compartment of the thigh. Conclusions: Quantitative MRI represents a non-invasive tool that is able to outline the trajectory of pathogenic modifications at the muscle level in ALS. In particular, wT2 was found to be increased early in the clinical history of ALS and also tended to decrease over time, also showing a positive correlation with leg subscore of ALSFRS-R.
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Affiliation(s)
- Matteo Paoletti
- Neuroradiology Department, Advanced Imaging and Radiomics Center, Istituto di Ricovero e Cura di Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Luca Diamanti
- Neuro-Oncology Unit, Istituto di Ricovero e Cura di Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Shaun I Muzic
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Department of Radiology, Fondazione Istituto di Ricovero e Cura di Carattere Scientifico (IRCCS) Policlinico San Matteo, Medical School University of Pavia, Pavia, Italy
| | - Elena Ballante
- Department of Mathematics, University of Pavia, Pavia, Italy.,BioData Science Center, Istituto di Ricovero e Cura di Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Francesca Solazzo
- Neuroradiology Department, Advanced Imaging and Radiomics Center, Istituto di Ricovero e Cura di Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Lia Foppoli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Xeni Deligianni
- Radiology/Division of Radiological Physics, University Hospital of Basel, Basel, Switzerland.,Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Francesco Santini
- Radiology/Division of Radiological Physics, University Hospital of Basel, Basel, Switzerland.,Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Silvia Figini
- Department of Political and Social Sciences, University of Pavia, Pavia, Italy
| | - Niels Bergsland
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States.,IRCCS Fondazione Don Carlo Gnocchi Organizzazione non lucrativa di utilità sociale (ONLUS), Milan, Italy
| | - Anna Pichiecchio
- Neuroradiology Department, Advanced Imaging and Radiomics Center, Istituto di Ricovero e Cura di Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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7
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Chan Y, Alix JJP, Neuwirth C, Barkhaus PE, Castro J, Jenkins TM, McDermott CJ, Shaw PJ, de Carvalho M, Nandedkar S, Stålberg E, Weber M. Reinnervation as measured by the motor unit size index is associated with preservation of muscle strength in amyotrophic lateral sclerosis, but not all muscles reinnervate. Muscle Nerve 2021; 65:203-210. [PMID: 34687220 DOI: 10.1002/mus.27444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION/AIMS The motor unit size index (MUSIX) may provide insight into reinnervation patterns in diseases such as amyotrophic lateral sclerosis (ALS). However, it is not known whether MUSIX detects clinically relevant changes in reinnervation, or if all muscles manifest changes in MUSIX in response to reinnervation after motor unit loss. METHODS Fifty-seven patients with ALS were assessed at 3-month intervals for 12 months in four centers. Muscles examined were abductor pollicis brevis, abductor digiti minimi, biceps brachii, and tibialis anterior. Results were split into two groups: muscles with increases in MUSIX and those without increases. Longitudinal changes in MUSIX, motor unit number index (MUNIX), compound muscle action potential amplitude, and Medical Research Council strength score were investigated. RESULTS One hundred thirty-three muscles were examined. Fifty-nine percent of the muscles exhibited an increase in MUSIX during the study. Muscles with MUSIX increases lost more motor units (58% decline in MUNIX at 12 months, P < .001) than muscles that did not increase MUSIX (34.6% decline in MUNIX at 12 months, P < .001). However, longitudinal changes in muscle strength were similar. When motor unit loss was similar, the absence of a MUSIX increase was associated with a significantly greater loss of muscle strength (P = .002). DISCUSSION MUSIX increases are associated with greater motor unit loss but relative preservation of muscle strength. Thus, MUSIX appears to be measuring a clinically relevant response that can provide a quantitative outcome measure of reinnervation in clinical trials. Furthermore, MUSIX suggests that reinnervation may play a major role in determining the progression of weakness.
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Affiliation(s)
- Young Chan
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - James J P Alix
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Christoph Neuwirth
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital, St. Gallen, Switzerland
| | | | - José Castro
- Department of Neurosciences, Centro Hospitalar Lisboa Norte-Hospital de Santa Maria, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Thomas M Jenkins
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | | | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Mamede de Carvalho
- Department of Neurosciences, Centro Hospitalar Lisboa Norte-Hospital de Santa Maria, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | | | - Erik Stålberg
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Uppsala, Sweden
| | - Markus Weber
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital, St. Gallen, Switzerland
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Roesl C, Evans ER, Dissanayake KN, Boczonadi V, Jones RA, Jordan GR, Ledahawsky L, Allen GCC, Scott M, Thomson A, Wishart TM, Hughes DI, Mead RJ, Shone CC, Slater CR, Gillingwater TH, Skehel PA, Ribchester RR. Confocal Endomicroscopy of Neuromuscular Junctions Stained with Physiologically Inert Protein Fragments of Tetanus Toxin. Biomolecules 2021; 11:1499. [PMID: 34680132 PMCID: PMC8534034 DOI: 10.3390/biom11101499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 01/09/2023] Open
Abstract
Live imaging of neuromuscular junctions (NMJs) in situ has been constrained by the suitability of ligands for inert vital staining of motor nerve terminals. Here, we constructed several truncated derivatives of the tetanus toxin C-fragment (TetC) fused with Emerald Fluorescent Protein (emGFP). Four constructs, namely full length emGFP-TetC (emGFP-865:TetC) or truncations comprising amino acids 1066-1315 (emGFP-1066:TetC), 1093-1315 (emGFP-1093:TetC) and 1109-1315 (emGFP-1109:TetC), produced selective, high-contrast staining of motor nerve terminals in rodent or human muscle explants. Isometric tension and intracellular recordings of endplate potentials from mouse muscles indicated that neither full-length nor truncated emGFP-TetC constructs significantly impaired NMJ function or transmission. Motor nerve terminals stained with emGFP-TetC constructs were readily visualised in situ or in isolated preparations using fibre-optic confocal endomicroscopy (CEM). emGFP-TetC derivatives and CEM also visualised regenerated NMJs. Dual-waveband CEM imaging of preparations co-stained with fluorescent emGFP-TetC constructs and Alexa647-α-bungarotoxin resolved innervated from denervated NMJs in axotomized WldS mouse muscle and degenerating NMJs in transgenic SOD1G93A mouse muscle. Our findings highlight the region of the TetC fragment required for selective binding and visualisation of motor nerve terminals and show that fluorescent derivatives of TetC are suitable for in situ morphological and physiological characterisation of healthy, injured and diseased NMJs.
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Affiliation(s)
- Cornelia Roesl
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
| | - Elizabeth R. Evans
- Public Health England, National Infection Service, Porton Down, Salisbury SP4 0JG, UK; (E.R.E.); (C.C.S.)
| | - Kosala N. Dissanayake
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
| | - Veronika Boczonadi
- Applied Neuromuscular Junction Facility, Bio-Imaging Unit, Biosciences Institute, University of Newcastle-upon-Tyne, Framlington Place, Newcastle-upon-Tyne NE2 4HH, UK; (V.B.); (C.R.S.)
| | - Ross A. Jones
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
| | - Graeme R. Jordan
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
| | - Leire Ledahawsky
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
| | - Guy C. C. Allen
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
| | - Molly Scott
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
| | - Alanna Thomson
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
| | - Thomas M. Wishart
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, College of Medicine and Veterinary Medicine, University of Edinburgh, Easter Bush, Edinburgh EH25 9RG, UK;
| | - David I. Hughes
- Spinal Cord Research Group, Institute of Neuroscience and Psychology, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Richard J. Mead
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Glossop Road, Sheffield S10 2HQ, UK;
| | - Clifford C. Shone
- Public Health England, National Infection Service, Porton Down, Salisbury SP4 0JG, UK; (E.R.E.); (C.C.S.)
| | - Clarke R. Slater
- Applied Neuromuscular Junction Facility, Bio-Imaging Unit, Biosciences Institute, University of Newcastle-upon-Tyne, Framlington Place, Newcastle-upon-Tyne NE2 4HH, UK; (V.B.); (C.R.S.)
| | - Thomas H. Gillingwater
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
| | - Paul A. Skehel
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
| | - Richard R. Ribchester
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
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9
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Vacchiano V, Di Stasi V, Rizzo G, Giannoccaro MP, Donadio V, Bartolomei I, Capellari S, Salvi F, Avoni P, Liguori R. Prognostic value of EMG genioglossus involvement in amyotrophic lateral sclerosis. Clin Neurophysiol 2021; 132:2416-2421. [PMID: 34454268 DOI: 10.1016/j.clinph.2021.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the prognostic value of needle electromyography (EMG) genioglossus involvement in patients with amyotrophic lateral sclerosis (ALS) at diagnosis. METHODS We separately explored the prognostic value of clinical bulbar lower motor neuron (LMN) signs and EMG genioglossus involvement using Cox proportional hazard models adjusted for age, gender, diagnostic delay, presence of bulbar upper motor neuron (UMN) signs, EMG cervical and lumbosacral region involvement, ALSFRS-R score and C9Orf72 gene status. Then, we compared the prognostic value of EMG masseter and genioglossus abnormalities in a subset of patients in whom both muscles were analysed. RESULTS 103 ALS patients were included in the study. Neurophysiological genioglossus involvement was associated with a shorter survival (p = 0.002), a shorter time to moderate dysphagia (p = 0.0001) and to severe dysarthria (p = 0.012). Its prognostic value was still evident in patients without clinical bulbar LMN signs. Bulbar clinical LMN signs were only associated with an earlier onset of moderate dysphagia (p = 0.0001). EMG masseter abnormalities did not reach statistical significance with regard to all the clinical milestones. CONCLUSIONS Genioglossus EMG at diagnosis could provide important information about ALS progression rate. The masseter muscle seems to be less involved in ALS. SIGNIFICANCE EMG genioglossus involvement is a prognostic factor in ALS.
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Affiliation(s)
- Veria Vacchiano
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie, University of Bologna, Bologna, Italy.
| | | | - Giovanni Rizzo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Maria Pia Giannoccaro
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie, University of Bologna, Bologna, Italy
| | - Vincenzo Donadio
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Ilaria Bartolomei
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Sabina Capellari
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie, University of Bologna, Bologna, Italy
| | - Fabrizio Salvi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Patrizia Avoni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie, University of Bologna, Bologna, Italy
| | - Rocco Liguori
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie, University of Bologna, Bologna, Italy
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10
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Vucic S, Ferguson TA, Cummings C, Hotchkin MT, Genge A, Glanzman R, Roet KCD, Cudkowicz M, Kiernan MC. Gold Coast diagnostic criteria: Implications for ALS diagnosis and clinical trial enrollment. Muscle Nerve 2021; 64:532-537. [PMID: 34378224 DOI: 10.1002/mus.27392] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 11/10/2022]
Abstract
Diagnostic criteria for amyotrophic lateral sclerosis (ALS) are complex, incorporating multiple levels of certainty from possible through to definite, and are thereby prone to error. Specifically, interrater variability was previously established to be poor, thereby limiting utility as diagnostic enrollment criteria for clinical trials. In addition, the different levels of diagnostic certainty do not necessarily reflect disease progression, adding confusion to the diagnostic algorithm. Realizing these inherent limitations, the World Federation of Neurology, the International Federation of Clinical Neurophysiology, the International Alliance of ALS/MND Associations, the ALS Association (United States), and the Motor Neuron Disease Association convened a consensus meeting (Gold Coast, Australia, 2019) to consider the development of simpler criteria that better reflect clinical practice, and that could merge diagnostic categories into a single entity. The diagnostic accuracy of the novel Gold Coast criteria was subsequently interrogated through a large cross-sectional study, which established an increased sensitivity for ALS diagnosis when compared with previous criteria. Diagnostic accuracy was maintained irrespective of disease duration, functional status, or site of disease onset. Importantly, the Gold Coast criteria differentiated atypical phenotypes, such as primary lateral sclerosis, from the more typical ALS phenotype. It is proposed that the Gold Coast criteria should be incorporated into routine practice and clinical trial settings.
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Affiliation(s)
- Steve Vucic
- Westmead Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | | | | | | | - Angela Genge
- The Neuro, Montreal Neurological Institute, Montreal, Quebec, Canada
| | | | | | - Merit Cudkowicz
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney & Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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11
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Liao SJ, Huang Z, Lai CY, Chen JY, Xiao PY, Cai Q, Yu J. The rostral to caudal gradient of clinical and electrophysiological features in sporadic amyotrophic lateral sclerosis with bulbar-onset. J Int Med Res 2021; 48:300060520956502. [PMID: 32993397 PMCID: PMC7536501 DOI: 10.1177/0300060520956502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective Amyotrophic lateral sclerosis (ALS) with bulbar-onset (BO-ALS) tends to
propagate to the adjacent anatomical regions symptomatically. However, the
spreading pattern of clinical and electrophysiological features is not well
documented. Methods This retrospective study enrolled consecutive patients with sporadic BO-ALS.
The clinical progression and electrophysiological data by electromyography
examination were retrospectively analysed based on information from the
medical records. Results The study enrolled 57 patients: 43 presented with contiguous (37 of 57) or
non-contiguous (6 of 57) progression clinically; and 14 patients did not
present with symptomatic propagation to other spinal segments. Lower motor
neuron dysfunction was more frequently involved in the bulbar and cervical
segments and less in the thoracic and lumbosacral segments. As a result, a
small proportion of patients had intact thoracic paraspinal or leg muscles
or both by electromyography examination. Furthermore, the patients with
diagnostic latency ≤6 months showed a significantly lower incidence of
neurogenic changes in the lumbosacral spinal cord compared with those with
diagnostic latency > 6 months. Conclusion This current study demonstrated a relative rostral–caudal descending gradient
of lower motor neuron dysfunction in patients with BO-ALS. These results
suggest that follow-up EMG might be necessary for a proportion of
patients.
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Affiliation(s)
- Song-Jie Liao
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangdong Provincial Engineering Center For Major Neurological Disease Treatment, Guangdong Provincial Translational Medicine Innovation Platform for Diagnosis and Treatment of Major Neurological Disease, Guangdong Provincial Clinical Research Center for Neurological Diseases, Guangzhou, China
| | - Zi Huang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangdong Provincial Engineering Center For Major Neurological Disease Treatment, Guangdong Provincial Translational Medicine Innovation Platform for Diagnosis and Treatment of Major Neurological Disease, Guangdong Provincial Clinical Research Center for Neurological Diseases, Guangzhou, China
| | - Chong-Yuan Lai
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangdong Provincial Engineering Center For Major Neurological Disease Treatment, Guangdong Provincial Translational Medicine Innovation Platform for Diagnosis and Treatment of Major Neurological Disease, Guangdong Provincial Clinical Research Center for Neurological Diseases, Guangzhou, China
| | - Jing-Yan Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangdong Provincial Engineering Center For Major Neurological Disease Treatment, Guangdong Provincial Translational Medicine Innovation Platform for Diagnosis and Treatment of Major Neurological Disease, Guangdong Provincial Clinical Research Center for Neurological Diseases, Guangzhou, China
| | - Pei-Yao Xiao
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangdong Provincial Engineering Center For Major Neurological Disease Treatment, Guangdong Provincial Translational Medicine Innovation Platform for Diagnosis and Treatment of Major Neurological Disease, Guangdong Provincial Clinical Research Center for Neurological Diseases, Guangzhou, China
| | - Qiong Cai
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangdong Provincial Engineering Center For Major Neurological Disease Treatment, Guangdong Provincial Translational Medicine Innovation Platform for Diagnosis and Treatment of Major Neurological Disease, Guangdong Provincial Clinical Research Center for Neurological Diseases, Guangzhou, China
| | - Jian Yu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangdong Provincial Engineering Center For Major Neurological Disease Treatment, Guangdong Provincial Translational Medicine Innovation Platform for Diagnosis and Treatment of Major Neurological Disease, Guangdong Provincial Clinical Research Center for Neurological Diseases, Guangzhou, China
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12
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Characterization of Fasciculation Potentials (FPs) in Amyotrophic Lateral Sclerosis (ALS) and Peripheral Nerve Hyperexcitability Syndromes (PNH). BIOMED RESEARCH INTERNATIONAL 2021; 2021:6631664. [PMID: 33997032 PMCID: PMC8110376 DOI: 10.1155/2021/6631664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 03/22/2021] [Accepted: 04/17/2021] [Indexed: 11/18/2022]
Abstract
This study is aimed at investigating the features of fasciculation potentials (FPs) in amyotrophic lateral sclerosis (ALS) and peripheral nerve hyperexcitability syndromes (PNH). Needle electrophysiologic examination (EMG) was performed for 5-15 muscles in the ALS and PNH patients. The spontaneous activity of fasciculations and fibrillations/sharp-waves (fibs-sw) was recorded. The distribution, firing frequency, and waveform parameters of FPs in muscles were calculated and compared. In total, 361 muscles in ALS patients and 124 muscles in PNH patients were examined, with the FP detection rates of 45.1% and 53.2%. Moreover, the ALS patients with the upper limb onset had the highest FP detection rate. Fasciculations occurred more frequently in the upper limbs than in the lower limbs in ALS and PNH. The detection rate of fibs-sw in the bulbar muscle was relatively low, which could be elevated when combining fibs-sw and FPs. Benign FPs in PNH were of smaller amplitude, shorter duration, and fewer phases/turns, compared with malignant FPs in ALS. The FP area in PNH was significantly smaller than that in ALS. The incidence of polyphasic FPs in ALS was distinctly greater than that in PNH. The firing frequency of FPs in PNH was higher than that in ALS. There was no significant difference in the amplitude, duration, phases and turns, and area of FPs between groups with and without fibs-sw in the muscles of normal strength in ALS. Conclusively, it is necessary to detect the FPs in the thoracic and bulbar muscles of patients suspected having ALS. FP parameters in ALS are significantly different from PNH.
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13
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Hannaford A, Pavey N, van den Bos M, Geevasinga N, Menon P, Shefner JM, Kiernan MC, Vucic S. Diagnostic Utility of Gold Coast Criteria in Amyotrophic Lateral Sclerosis. Ann Neurol 2021; 89:979-986. [PMID: 33565111 DOI: 10.1002/ana.26045] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The diagnosis of amyotrophic lateral sclerosis (ALS) remains problematic, with current diagnostic criteria (revised El Escorial [rEEC] and Awaji) being complex and prone to error. Consequently, the diagnostic utility of the recently proposed Gold Coast criteria was determined in ALS. METHODS We retrospectively reviewed 506 patients (302 males, 204 females) to compare the diagnostic accuracy of the Gold Coast criteria to that of the Awaji and rEEC criteria (defined by the proportion of patients categorized as definite, probable, or possible ALS) in accordance with standards of reporting of diagnostic accuracy criteria. RESULTS The sensitivity of Gold Coast criteria (92%, 95% confidence interval [CI] = 88.7-94.6%) was comparable to that of Awaji (90.3%, 95% CI = 86.69-93.2%) and rEEC (88.6, 95% CI = 84.8-91.7%) criteria. Additionally, the Gold Coast criteria sensitivity was maintained across different subgroups, defined by site of onset, disease duration, and functional disability. In atypical ALS phenotypes, the Gold Coast criteria exhibited greater sensitivity and specificity. INTERPRETATION The present study established the diagnostic utility of the Gold Coast criteria in ALS, with benefits evident in bulbar and limb onset disease patients, as well as atypical phenotypes. The Gold Coast criteria should be considered in clinical practice and therapeutic trials. ANN NEUROL 2021;89:979-986.
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Affiliation(s)
- Andrew Hannaford
- Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Nathan Pavey
- Westmead Clinical School, University of Sydney, Sydney, Australia
| | | | | | - Parvathi Menon
- Westmead Clinical School, University of Sydney, Sydney, Australia
| | | | | | - Steve Vucic
- Westmead Clinical School, University of Sydney, Sydney, Australia
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14
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Sensitivity of Awaji Criteria and Revised El Escorial Criteria in the Diagnosis of Amyotrophic Lateral Sclerosis (ALS) at First Visit in a Tunisian Cohort. Neurol Res Int 2021; 2021:8841281. [PMID: 33552600 PMCID: PMC7847325 DOI: 10.1155/2021/8841281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/10/2021] [Accepted: 01/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background Amyotrophic lateral sclerosis (ALS) is a fatal disease whose diagnosis and early management can improve survival. The most used diagnostic criteria are the revised El Escorial criteria (rEEC) and Awaji criteria (AC). The comparison of their sensitivities showed contradictory results. Our study aimed to compare the sensitivities of these two criteria in the diagnosis of definite ALS, at first visit, in a Tunisian hospital cohort. Materials and Methods This was a retrospective study including 173 patients diagnosed with ALS at the Department of Neurology of the Razi Hospital between January 2003 and April 2018.After studying the clinical features of the disease in our study population,each patient was categorized according to the rEEC and AC based on data collected in his medical record during his first visit to our department. Then, we compared the sensitivities of these two criteria in the diagnosis of definite ALS. Results Our Tunisian cohort was characterized by a slower disease progression. The sensitivity of the AC (69.4%) was significantly higher than that of the rEEC (40.5%) (p < 0.001). When the clinical signs evolved for less than 6 months, the sensitivities were 61% for AC and 12% for rEEC (p < 0.001). After 24 months of disease progression, the sensitivities were 78.2% for AC and 69.1% for rEEC (p = 0.063). It was impossible to categorize seventeen patients by the two criteria. Conclusion Our study demonstrated that patients in AC are more sensitive than rEEC in the early diagnosis of ALS in our Tunisian cohort. However, this superiority is gradually reduced during the evolution of the disease.
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15
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Wannop K, Bashford J, Wickham A, Iniesta R, Drakakis E, Boutelle M, Mills K, Shaw C. Fasciculation analysis reveals a novel parameter that correlates with predicted survival in amyotrophic lateral sclerosis. Muscle Nerve 2020; 63:392-396. [DOI: 10.1002/mus.27139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/29/2020] [Accepted: 12/06/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Kate Wannop
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London UK Dementia Research Institute London UK
| | - James Bashford
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London UK Dementia Research Institute London UK
| | - Aidan Wickham
- Department of Bioengineering Imperial College London London UK
| | - Raquel Iniesta
- Department of Biostatistics and Health Informatics, King's College London London UK
| | | | - Martyn Boutelle
- Department of Bioengineering Imperial College London London UK
| | - Kerry Mills
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London UK Dementia Research Institute London UK
| | - Chris Shaw
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London UK Dementia Research Institute London UK
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16
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Avidan R, Fainmesser Y, Drory VE, Bril V, Abraham A. Fasciculation frequency at the biceps brachii and brachialis muscles is associated with amyotrophic lateral sclerosis disease burden and activity. Muscle Nerve 2020; 63:204-208. [PMID: 33216387 DOI: 10.1002/mus.27125] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Fasciculations are most commonly seen in the biceps brachii muscle in amyotrophic lateral sclerosis (ALS). In this study we have explored the association between fasciculation frequency in a single location-biceps brachii and brachialis muscles (BB), and disease burden and activity. METHODS Sonographic muscle studies were performed in 90 ALS patients, 47 of whom were seen in subsequent follow-up. The association between fasciculations frequency at the BB and ALS Functional Rating Scale-Revised (ALSFRS-R) and manual muscle testing (MMT) scores was determined. RESULTS High fasciculation frequency at the BB, where detection rate was the highest, was associated with shorter disease duration, greater muscle thickness, higher MMT scores, and faster rate of decline in ALSFRS-R initially, and MMT subsequently. DISCUSSION High fasciculation frequency at the BB as determined by sonography, is associated with less impairment at time of examination, and a more active disease with a more rapid progression.
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Affiliation(s)
| | - Yaara Fainmesser
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Vivian E Drory
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Alon Abraham
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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Amyotrophic lateral sclerosis weakens spinal recurrent inhibition and post-activation depression. Clin Neurophysiol 2020; 131:2875-2886. [DOI: 10.1016/j.clinph.2020.09.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 08/15/2020] [Accepted: 09/07/2020] [Indexed: 01/07/2023]
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18
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Tamborska A, Bashford J, Wickham A, Iniesta R, Masood U, Cabassi C, Planinc D, Hodson-Tole E, Drakakis E, Boutelle M, Mills K, Shaw C. Non-invasive measurement of fasciculation frequency demonstrates diagnostic accuracy in amyotrophic lateral sclerosis. Brain Commun 2020; 2:fcaa141. [PMID: 33543131 PMCID: PMC7850269 DOI: 10.1093/braincomms/fcaa141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/21/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022] Open
Abstract
Delayed diagnosis of amyotrophic lateral sclerosis prevents early entry into clinical trials at a time when neuroprotective therapies would be most effective. Fasciculations are an early hallmark of amyotrophic lateral sclerosis, preceding muscle weakness and atrophy. To assess the potential diagnostic utility of fasciculations measured by high-density surface electromyography, we carried out 30-min biceps brachii recordings in 39 patients with amyotrophic lateral sclerosis, 7 patients with benign fasciculation syndrome, 1 patient with multifocal motor neuropathy and 17 healthy individuals. We employed the surface potential quantification engine to compute fasciculation frequency, fasciculation amplitude and inter-fasciculation interval. Inter-group comparison was assessed by Welch’s analysis of variance. Logistic regression, receiver operating characteristic curves and decision trees discerned the diagnostic performance of these measures. Fasciculation frequency, median fasciculation amplitude and proportion of inter-fasciculation intervals <100 ms showed significant differences between the groups. In the best-fit regression model, increasing fasciculation frequency and median fasciculation amplitude were independently associated with the diagnosis of amyotrophic lateral sclerosis. Fasciculation frequency was the single best measure predictive of the disease, with an area under the curve of 0.89 (95% confidence interval 0.81–0.98). The cut-off of more than 14 fasciculation potentials per minute achieved 80% sensitivity (95% confidence interval 63–90%) and 96% specificity (95% confidence interval 78–100%). In conclusion, non-invasive measurement of fasciculation frequency at a single time-point reliably distinguished amyotrophic lateral sclerosis from its mimicking conditions and healthy individuals, warranting further research into its diagnostic applications.
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Affiliation(s)
- Arina Tamborska
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - James Bashford
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Aidan Wickham
- Department of Bioengineering, Imperial College London, London, UK
| | - Raquel Iniesta
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Urooba Masood
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Cristina Cabassi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Domen Planinc
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Emma Hodson-Tole
- Department of Life Sciences, Musculoskeletal Sciences and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
| | | | - Martyn Boutelle
- Department of Bioengineering, Imperial College London, London, UK
| | - Kerry Mills
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Chris Shaw
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
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Fileccia E, De Pasqua S, Rizzo G, Di Stasi V, Vacchiano V, Avoni P, Bartolomei I, Pastorelli F, Plasmati R, Donadio V, Salvi F, Liguori R. Denervation findings on EMG in amyotrophic lateral sclerosis and correlation with prognostic milestones: Data from a retrospective study. Clin Neurophysiol 2020; 131:2017-2022. [DOI: 10.1016/j.clinph.2020.04.161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
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20
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de Carvalho M. Needling the future in ALS. Clin Neurophysiol 2020; 131:1973-1974. [PMID: 32561171 DOI: 10.1016/j.clinph.2020.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Mamede de Carvalho
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Univeridade 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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21
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Bashford J, Mills K, Shaw C. The evolving role of surface electromyography in amyotrophic lateral sclerosis: A systematic review. Clin Neurophysiol 2020; 131:942-950. [PMID: 32044239 PMCID: PMC7083223 DOI: 10.1016/j.clinph.2019.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/23/2019] [Accepted: 12/14/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Amyotrophic lateral sclerosis (ALS) is an adult-onset neurodegenerative disease that leads to inexorable motor decline and a median survival of three years from symptom onset. Surface EMG represents a major technological advance that has been harnessed in the development of novel neurophysiological biomarkers. We have systematically reviewed the current application of surface EMG techniques in ALS. METHODS We searched PubMed to identify 42 studies focusing on surface EMG and its associated analytical methods in the diagnosis, prognosis and monitoring of ALS patients. RESULTS A wide variety of analytical techniques were identified, involving motor unit decomposition from high-density grids, motor unit number estimation and measurements of neuronal hyperexcitability or neuromuscular architecture. Some studies have proposed specific diagnostic and prognostic criteria however clinical calibration in large ALS cohorts is currently lacking. The most validated method to monitor disease is the motor unit number index (MUNIX), which has been implemented as an outcome measure in two ALS clinical trials. CONCLUSION Surface EMG offers significant practical and analytical flexibility compared to invasive techniques. To capitalise on this fully, emphasis must be placed upon the multi-disciplinary collaboration of clinicians, bioengineers, mathematicians and biostatisticians. SIGNIFICANCE Surface EMG techniques can enrich effective biomarker development in ALS.
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Affiliation(s)
- J. Bashford
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
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22
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Diagnostic-prognostic value and electrophysiological correlates of CSF biomarkers of neurodegeneration and neuroinflammation in amyotrophic lateral sclerosis. J Neurol 2020; 267:1699-1708. [DOI: 10.1007/s00415-020-09761-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/03/2020] [Accepted: 02/11/2020] [Indexed: 02/07/2023]
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Bashford JA, Wickham A, Iniesta R, Drakakis EM, Boutelle MG, Mills KR, Shaw CE. The rise and fall of fasciculations in amyotrophic lateral sclerosis. Brain Commun 2020; 2:fcaa018. [PMID: 32901231 PMCID: PMC7425399 DOI: 10.1093/braincomms/fcaa018] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Amyotrophic lateral sclerosis is a devastating neurodegenerative disease with a median survival of 3 years from symptom onset. Accessible and reliable biomarkers of motor neuron decline are urgently needed to quicken the pace of drug discovery. Fasciculations represent an early pathophysiological hallmark of amyotrophic lateral sclerosis and can be reliably detected by high-density surface electromyography. We set out to quantify fasciculation potentials prospectively over 14 months, seeking comparisons with established markers of disease progression. Twenty patients with amyotrophic lateral sclerosis and five patients with benign fasciculation syndrome underwent up to seven assessments each. At each assessment, we performed the amyotrophic lateral sclerosis-functional rating scale, sum power score, slow vital capacity, 30-min high-density surface electromyography recordings from biceps and gastrocnemius and the motor unit number index. We employed the Surface Potential Quantification Engine, which is an automated analytical tool to detect and characterize fasciculations. Linear mixed-effect models were employed to account for the pseudoreplication of serial measurements. The amyotrophic lateral sclerosis-functional rating scale declined by 0.65 points per month (P < 0.0001), 35% slower than average. A total of 526 recordings were analysed. Compared with benign fasciculation syndrome, biceps fasciculation frequency in amyotrophic lateral sclerosis was 10 times greater in strong muscles and 40 times greater in weak muscles. This was coupled with a decline in fasciculation frequency among weak muscles of -7.6/min per month (P = 0.003), demonstrating the rise and fall of fasciculation frequency in biceps muscles. Gastrocnemius behaved differently, whereby strong muscles in amyotrophic lateral sclerosis had fasciculation frequencies five times greater than patients with benign fasciculation syndrome while weak muscles were increased by only 1.5 times. Gastrocnemius demonstrated a significant decline in fasciculation frequency in strong muscles (2.4/min per month, P < 0.0001), which levelled off in weak muscles. Fasciculation amplitude, an easily quantifiable surrogate of the reinnervation process, was highest in the biceps muscles that transitioned from strong to weak during the study. Pooled analysis of >900 000 fasciculations revealed inter-fasciculation intervals <100 ms in the biceps of patients with amyotrophic lateral sclerosis, particularly in strong muscles, consistent with the occurrence of doublets. We hereby present the most comprehensive longitudinal quantification of fasciculation parameters in amyotrophic lateral sclerosis, proposing a unifying model of the interactions between motor unit loss, muscle power and fasciculation frequency. The latter showed promise as a disease biomarker with linear rates of decline in strong gastrocnemius and weak biceps muscles, reflecting the motor unit loss that drives clinical progression.
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Affiliation(s)
- James A Bashford
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Correspondence to: James A. Bashford, MRCP, PhD UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, 5 Cutcombe Road, King’s College London, London SE5 9RT, UK E-mail:
| | - Aidan Wickham
- Department of Bioengineering, Imperial College London, London, UK
| | - Raquel Iniesta
- Department of Biostatistics and Health Informatics, King’s College London, London, UK
| | | | | | - Kerry R Mills
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Chris E Shaw
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Klickovic U, Zampedri L, Sinclair CDJ, Wastling SJ, Trimmel K, Howard RS, Malaspina A, Sharma N, Sidle K, Emira A, Shah S, Yousry TA, Hanna MG, Greensmith L, Morrow JM, Thornton JS, Fratta P. Skeletal muscle MRI differentiates SBMA and ALS and correlates with disease severity. Neurology 2019; 93:e895-e907. [PMID: 31391248 PMCID: PMC6745729 DOI: 10.1212/wnl.0000000000008009] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/05/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the use of muscle MRI for the differential diagnosis and as a disease progression biomarker for 2 major forms of motor neuron disorders: spinal bulbar muscular atrophy (SBMA) and amyotrophic lateral sclerosis (ALS). METHODS We applied quantitative 3-point Dixon and semiquantitative T1-weighted and short tau inversion recovery (STIR) imaging to bulbar and lower limb muscles and performed clinical and functional assessments in ALS (n = 21) and SBMA (n = 21), alongside healthy controls (n = 16). Acquired images were analyzed for the presence of fat infiltration or edema as well as specific patterns of muscle involvement. Quantitative MRI measurements were correlated with clinical measures of disease severity in ALS and SBMA. RESULTS Quantitative imaging revealed significant fat infiltration in bulbar (p < 0.001) and limb muscles in SBMA compared to controls (thigh: p < 0.001; calf: p = 0.001), identifying a characteristic pattern of muscle involvement. In ALS, semiquantitative STIR imaging detected marked hyperintensities in lower limb muscles, distinguishing ALS from SBMA and controls. Finally, MRI measurements correlated significantly with clinical scales of disease severity in both ALS and SBMA. CONCLUSIONS Our findings show that muscle MRI differentiates between SBMA and ALS and correlates with disease severity, supporting its use as a diagnostic tool and biomarker for disease progression. This highlights the clinical utility of muscle MRI in motor neuron disorders and contributes to establish objective outcome measures, which is crucial for the development of new drugs.
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Affiliation(s)
- Uros Klickovic
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Luca Zampedri
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Christopher D J Sinclair
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Stephen J Wastling
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Karin Trimmel
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Robin S Howard
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Andrea Malaspina
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Nikhil Sharma
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Katie Sidle
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Ahmed Emira
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Sachit Shah
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Tarek A Yousry
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Michael G Hanna
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Linda Greensmith
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Jasper M Morrow
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - John S Thornton
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria.
| | - Pietro Fratta
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria.
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Geevasinga N, Howells J, Menon P, van den Bos M, Shibuya K, Matamala JM, Park SB, Byth K, Kiernan MC, Vucic S. Amyotrophic lateral sclerosis diagnostic index: Toward a personalized diagnosis of ALS. Neurology 2019; 92:e536-e547. [PMID: 30709964 DOI: 10.1212/wnl.0000000000006876] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 09/28/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The aim of the study was to assess the utility of a novel amyotrophic lateral sclerosis (ALS) diagnostic index (ALSDI). METHODS A prospective multicenter study was undertaken on patients presenting with suspected ALS. The reference standard (Awaji criteria) was applied to all patients at recruitment. Patients were randomly assigned to a training (75%) and a test (25%) cohort. The ALSDI was developed in the training cohort and its diagnostic utility was subsequently assessed in the test cohort. RESULTS A total of 407 patients were recruited, with 305 patients subsequently diagnosed with ALS and 102 with a non-ALS mimicking disorder. The ALSDI reliably differentiated ALS from neuromuscular disorders in the training cohort (area under the curve 0.92, 95% confidence interval 0.89-0.95), with ALSDI ≥4 exhibiting 81.6% sensitivity, 89.6% specificity, and 83.5% diagnostic accuracy. The ALSDI diagnostic utility was confirmed in the test cohort (area under the curve 0.90, 95% confidence interval 0.84-0.97), with ALSDI ≥4 exhibiting 83.3% sensitivity, 84% specificity, and 83.5% diagnostic accuracy. In addition, the diagnostic utility of the ALSDI was confirmed in patients who were Awaji negative at recruitment and in those exhibiting a predominantly lower motor neuron phenotype. CONCLUSION The ALSDI reliably differentiates ALS from mimicking disorders at an early stage in the disease process. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that for patients with suspected ALS, the ALSDI distinguished ALS from neuromuscular mimicking disorders.
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Affiliation(s)
- Nimeshan Geevasinga
- From Westmead Clinical School (N.G., P.M., M.v.d.B., S.V.), Brain and Mind Center (J.H., K.S., J.M.M., S.B.P., M.C.K.), and NHMRC Clinical Trials Centre (K.B.), University of Sydney; and Westmead Hospital (K.B.), Research and Education Network, Sydney, Australia
| | - James Howells
- From Westmead Clinical School (N.G., P.M., M.v.d.B., S.V.), Brain and Mind Center (J.H., K.S., J.M.M., S.B.P., M.C.K.), and NHMRC Clinical Trials Centre (K.B.), University of Sydney; and Westmead Hospital (K.B.), Research and Education Network, Sydney, Australia
| | - Parvathi Menon
- From Westmead Clinical School (N.G., P.M., M.v.d.B., S.V.), Brain and Mind Center (J.H., K.S., J.M.M., S.B.P., M.C.K.), and NHMRC Clinical Trials Centre (K.B.), University of Sydney; and Westmead Hospital (K.B.), Research and Education Network, Sydney, Australia
| | - Mehdi van den Bos
- From Westmead Clinical School (N.G., P.M., M.v.d.B., S.V.), Brain and Mind Center (J.H., K.S., J.M.M., S.B.P., M.C.K.), and NHMRC Clinical Trials Centre (K.B.), University of Sydney; and Westmead Hospital (K.B.), Research and Education Network, Sydney, Australia
| | - Kazumoto Shibuya
- From Westmead Clinical School (N.G., P.M., M.v.d.B., S.V.), Brain and Mind Center (J.H., K.S., J.M.M., S.B.P., M.C.K.), and NHMRC Clinical Trials Centre (K.B.), University of Sydney; and Westmead Hospital (K.B.), Research and Education Network, Sydney, Australia
| | - José Manuel Matamala
- From Westmead Clinical School (N.G., P.M., M.v.d.B., S.V.), Brain and Mind Center (J.H., K.S., J.M.M., S.B.P., M.C.K.), and NHMRC Clinical Trials Centre (K.B.), University of Sydney; and Westmead Hospital (K.B.), Research and Education Network, Sydney, Australia
| | - Susanna B Park
- From Westmead Clinical School (N.G., P.M., M.v.d.B., S.V.), Brain and Mind Center (J.H., K.S., J.M.M., S.B.P., M.C.K.), and NHMRC Clinical Trials Centre (K.B.), University of Sydney; and Westmead Hospital (K.B.), Research and Education Network, Sydney, Australia
| | - Karen Byth
- From Westmead Clinical School (N.G., P.M., M.v.d.B., S.V.), Brain and Mind Center (J.H., K.S., J.M.M., S.B.P., M.C.K.), and NHMRC Clinical Trials Centre (K.B.), University of Sydney; and Westmead Hospital (K.B.), Research and Education Network, Sydney, Australia
| | - Matthew C Kiernan
- From Westmead Clinical School (N.G., P.M., M.v.d.B., S.V.), Brain and Mind Center (J.H., K.S., J.M.M., S.B.P., M.C.K.), and NHMRC Clinical Trials Centre (K.B.), University of Sydney; and Westmead Hospital (K.B.), Research and Education Network, Sydney, Australia
| | - Steve Vucic
- From Westmead Clinical School (N.G., P.M., M.v.d.B., S.V.), Brain and Mind Center (J.H., K.S., J.M.M., S.B.P., M.C.K.), and NHMRC Clinical Trials Centre (K.B.), University of Sydney; and Westmead Hospital (K.B.), Research and Education Network, Sydney, Australia.
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Electrodiagnostic Testing for the Diagnosis and Management of Amyotrophic Lateral Sclerosis. Phys Med Rehabil Clin N Am 2018; 29:669-680. [PMID: 30293622 DOI: 10.1016/j.pmr.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Electrodiagnostic testing provides insight into subclinical aspects of disease in amyotrophic lateral sclerosis and helps to diagnose and exclude other diagnoses. It may also help to manage or track disease progression. Mapping the extent of subclinical disease may guide the clinician to supportive interventions. There is considerable interest in establishing electrodiagnostic biomarkers to monitor disease progression. This article details the usefulness of electrodiagnostic testing across the disease spectrum. A review of clinical presentations and differential diagnoses, diagnostic evaluation, and emerging applications of electrodiagnostic studies to guide management and assess response to treatment interventions are presented with considerations for clinical practice.
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Vázquez-Costa JF, Campins-Romeu M, Martínez-Payá JJ, Tembl JI, Del Baño-Aledo ME, Ríos-Díaz J, Fornés-Ferrer V, Chumillas MJ, Sevilla T. New insights into the pathophysiology of fasciculations in amyotrophic lateral sclerosis: An ultrasound study. Clin Neurophysiol 2018; 129:2650-2657. [PMID: 30292684 DOI: 10.1016/j.clinph.2018.09.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/02/2018] [Accepted: 09/16/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To describe the fasciculation pattern in ALS and to analyse its clinical and pathophysiological significance. METHODS Ultrasound of 19 muscles was performed in 44 patients with a recent diagnosis (<90 days) of ALS. The number of fasciculations was recorded in each muscle and the muscle thickness and strength were additionally measured in limb muscles. A subgroup of patients were electromyographically assessed. RESULTS US was performed in 835 muscles and EMG was available in 263 muscles. US detected fasciculations more frequently than EMG. Fasciculations were widespread, especially in upper limbs onset patients and in the cervical region. Fasciculations' number inversely associated with ALSFR-R and body mass index (BMI) and directly with BMI loss and upper motor neuron (UMN) impairment. Our statistical model suggest that fasciculations increase with the initial lower motor neuron (LMN) degeneration, reach their peak when the muscle became mildly to moderately weak, decreasing afterwards with increasing muscle weakness and atrophy. CONCLUSIONS Our study suggests that both UMN and LMN degeneration trigger fasciculations causing BMI loss. The degree of LMN impairment could account for differences in fasciculations' rates within and between muscles. SIGNIFICANCE In ALS, fasciculations could explain the link between hyperexcitability and BMI loss.
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Affiliation(s)
- J F Vázquez-Costa
- Neuromuscular Research Unit, Instituto de Investigación Sanitaria la Fe (IIS La Fe), Valencia, Spain; ALS Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain.
| | - M Campins-Romeu
- ALS Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J J Martínez-Payá
- ECOFISTEM Research Group, Health Sciences Department, Facultad de Ciencias de la Salud, Universidad Católica de Murcia, Campus de los Jerónimos s/n, 30107 Guadalupe (Murcia), Spain
| | - J I Tembl
- Neurosonology Laboratory, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M E Del Baño-Aledo
- Physiotherapy Department, Facultad de Medicina, Campus de Espinardo 30100, Universidad de Murcia, Spain
| | - J Ríos-Díaz
- Centro de Ciencias de la Salud San Rafael, Universidad Antonio de Nebrija, Madrid, Paseo de la Habana 70 bis, 28036 Madrid, Spain; Fundación San Juan de Dios, Madrid, Spain
| | - V Fornés-Ferrer
- Biostatistics Unit, Instituto de Investigación Sanitaria la Fe (IIS La Fe), Valencia, Spain
| | - M J Chumillas
- Neuromuscular Research Unit, Instituto de Investigación Sanitaria la Fe (IIS La Fe), Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain; ALS Unit, Department of Neurophisiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - T Sevilla
- Neuromuscular Research Unit, Instituto de Investigación Sanitaria la Fe (IIS La Fe), Valencia, Spain; ALS Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain
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Kovalchuk MO, Heuberger JAAC, Sleutjes BTHM, Ziagkos D, van den Berg LH, Ferguson TA, Franssen H, Groeneveld GJ. Acute Effects of Riluzole and Retigabine on Axonal Excitability in Patients With Amyotrophic Lateral Sclerosis: A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial. Clin Pharmacol Ther 2018; 104:1136-1145. [PMID: 29672831 DOI: 10.1002/cpt.1096] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/04/2018] [Accepted: 04/13/2018] [Indexed: 11/07/2022]
Abstract
Increased excitability of motor neurons in patients with amyotrophic lateral sclerosis (ALS) may be a relevant factor leading to motor neuron damage. This randomized, double-blind, three-way crossover, placebo-controlled study evaluated peripheral motor nerve excitability testing as a biomarker of hyperexcitability and assessed the effects of riluzole and retigabine in 18 patients with ALS. We performed excitability testing at baseline, and twice after participants had received a single dose of either 100 mg riluzole, 300 mg retigabine, or placebo. Between- and within-day repeatability was at least acceptable for 14 out of 18 recorded excitability variables. No effects of riluzole on excitability testing were observed, but retigabine significantly decreased strength-duration time-constant (9.2%) and refractoriness at 2 ms (10.2) compared to placebo. Excitability testing was shown to be a reliable biomarker in patients with ALS, and the acute reversal of previously abnormal variables by retigabine justifies long-term studies evaluating the impact on disease progression and survival.
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Affiliation(s)
- Maria O Kovalchuk
- University Medical Center Utrecht, Department of Neurology, Utrecht, the Netherlands
| | | | | | | | | | - Toby A Ferguson
- Biogen, Department of Neurology Research and Early Clinical Development, Cambridge, Massachusetts, USA
| | - Hessel Franssen
- University Medical Center Utrecht, Department of Neurology, Utrecht, the Netherlands
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Cengiz B, Mercan M, Kuruoğlu R. Spinal excitability changes do not influence the mechanisms of split-hand syndrome in amyotrophic lateral sclerosis. Muscle Nerve 2018. [DOI: 10.1002/mus.26123] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Bülent Cengiz
- Clinical Neurophysiology Division, Department of Neurology; Gazi University Faculty of Medicine; Beşevler TR-06510 Ankara Turkey
| | - Metin Mercan
- Clinical Neurophysiology Division, Department of Neurology; Gazi University Faculty of Medicine; Beşevler TR-06510 Ankara Turkey
| | - Reha Kuruoğlu
- Clinical Neurophysiology Division, Department of Neurology; Gazi University Faculty of Medicine; Beşevler TR-06510 Ankara Turkey
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Shimizu T, Bokuda K, Kimura H, Kamiyama T, Nakayama Y, Kawata A, Isozaki E, Ugawa Y. Sensory cortex hyperexcitability predicts short survival in amyotrophic lateral sclerosis. Neurology 2018; 90:e1578-e1587. [PMID: 29602913 DOI: 10.1212/wnl.0000000000005424] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 02/01/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate somatosensory cortex excitability and its relationship to survival prognosis in patients with amyotrophic lateral sclerosis (ALS). METHODS A total of 145 patients with sporadic ALS and 73 healthy control participants were studied. We recorded compound muscle action potential and sensory nerve action potential of the median nerve and the median nerve somatosensory evoked potential (SEP), and we measured parameters, including onset-to-peak amplitude of N13 and N20 and peak-to-peak amplitude between N20 and P25 (N20p-P25p). Clinical prognostic factors, including ALS Functional Rating Scale-Revised, were evaluated. We followed up patients until the endpoints (death or tracheostomy) and analyzed factors associated with survival using multivariate analysis in the Cox proportional hazard model. RESULTS Compared to controls, patients with ALS showed a larger amplitude of N20p-P25p in the median nerve SEP. Median survival time after examination was shorter in patients with N20p-P25p ≥8 μV (0.82 years) than in those with N20p-P25p <8 μV (1.68 years, p = 0.0002, log-rank test). Multivariate analysis identified a larger N20p-P25p amplitude as a factor that was independently associated with shorter survival (p = 0.002). CONCLUSION Sensory cortex hyperexcitability predicts short survival in patients with ALS.
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Affiliation(s)
- Toshio Shimizu
- From the Department of Neurology (T.S., K.B., H.K., T.K., A.K., E.I.), Tokyo Metropolitan Neurological Hospital; Department of Neurology (T.S., Y.U.), Fukushima Medical University School of Medicine; ALS Nursing Care Project (Y.N.), Tokyo Metropolitan Institute of Medical Science; and Advanced Clinical Research Center (Y.U.), Fukushima Global Medical Science Center, Japan.
| | - Kota Bokuda
- From the Department of Neurology (T.S., K.B., H.K., T.K., A.K., E.I.), Tokyo Metropolitan Neurological Hospital; Department of Neurology (T.S., Y.U.), Fukushima Medical University School of Medicine; ALS Nursing Care Project (Y.N.), Tokyo Metropolitan Institute of Medical Science; and Advanced Clinical Research Center (Y.U.), Fukushima Global Medical Science Center, Japan
| | - Hideki Kimura
- From the Department of Neurology (T.S., K.B., H.K., T.K., A.K., E.I.), Tokyo Metropolitan Neurological Hospital; Department of Neurology (T.S., Y.U.), Fukushima Medical University School of Medicine; ALS Nursing Care Project (Y.N.), Tokyo Metropolitan Institute of Medical Science; and Advanced Clinical Research Center (Y.U.), Fukushima Global Medical Science Center, Japan
| | - Tsutomu Kamiyama
- From the Department of Neurology (T.S., K.B., H.K., T.K., A.K., E.I.), Tokyo Metropolitan Neurological Hospital; Department of Neurology (T.S., Y.U.), Fukushima Medical University School of Medicine; ALS Nursing Care Project (Y.N.), Tokyo Metropolitan Institute of Medical Science; and Advanced Clinical Research Center (Y.U.), Fukushima Global Medical Science Center, Japan
| | - Yuki Nakayama
- From the Department of Neurology (T.S., K.B., H.K., T.K., A.K., E.I.), Tokyo Metropolitan Neurological Hospital; Department of Neurology (T.S., Y.U.), Fukushima Medical University School of Medicine; ALS Nursing Care Project (Y.N.), Tokyo Metropolitan Institute of Medical Science; and Advanced Clinical Research Center (Y.U.), Fukushima Global Medical Science Center, Japan
| | - Akihiro Kawata
- From the Department of Neurology (T.S., K.B., H.K., T.K., A.K., E.I.), Tokyo Metropolitan Neurological Hospital; Department of Neurology (T.S., Y.U.), Fukushima Medical University School of Medicine; ALS Nursing Care Project (Y.N.), Tokyo Metropolitan Institute of Medical Science; and Advanced Clinical Research Center (Y.U.), Fukushima Global Medical Science Center, Japan
| | - Eiji Isozaki
- From the Department of Neurology (T.S., K.B., H.K., T.K., A.K., E.I.), Tokyo Metropolitan Neurological Hospital; Department of Neurology (T.S., Y.U.), Fukushima Medical University School of Medicine; ALS Nursing Care Project (Y.N.), Tokyo Metropolitan Institute of Medical Science; and Advanced Clinical Research Center (Y.U.), Fukushima Global Medical Science Center, Japan
| | - Yoshikazu Ugawa
- From the Department of Neurology (T.S., K.B., H.K., T.K., A.K., E.I.), Tokyo Metropolitan Neurological Hospital; Department of Neurology (T.S., Y.U.), Fukushima Medical University School of Medicine; ALS Nursing Care Project (Y.N.), Tokyo Metropolitan Institute of Medical Science; and Advanced Clinical Research Center (Y.U.), Fukushima Global Medical Science Center, Japan
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31
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Siller S, Kasem R, Witt TN, Tonn JC, Zausinger S. Painless motor radiculopathy of the cervical spine: clinical and radiological characteristics and long-term outcomes after operative decompression. J Neurosurg Spine 2018; 28:621-629. [PMID: 29570047 DOI: 10.3171/2017.10.spine17821] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Various neurological diseases are known to cause progressive painless paresis of the upper limbs. In this study the authors describe the previously unspecified syndrome of compression-induced painless cervical radiculopathy with predominant motor deficit and muscular atrophy, and highlight the clinical and radiological characteristics and outcomes after surgery for this rare syndrome, along with its neurological differential diagnoses. METHODS Medical records of 788 patients undergoing surgical decompression due to degenerative cervical spine diseases between 2005 and 2014 were assessed. Among those patients, 31 (3.9%, male to female ratio 4.8 to 1, mean age 60 years) presented with painless compressive cervical motor radiculopathy due to neuroforaminal stenosis without signs of myelopathy; long-term evaluation was available in 23 patients with 49 symptomatic foraminal stenoses. Clinical, imaging, and operative findings as well as the long-term course of paresis and quality of life were analyzed. RESULTS Presenting symptoms (mean duration 13.3 months) included a defining progressive flaccid radicular paresis (median grade 3/5) without any history of radiating pain (100%) and a concomitant muscular atrophy (78%); 83% of the patients were smokers and 17% patients had diabetes. Imaging revealed a predominantly anterior nerve root compression at the neuroforaminal entrance in 98% of stenoses. Thirty stenoses (11 patients) were initially decompressed via an anterior surgical approach and 19 stenoses (12 patients) via a posterior surgical approach. Overall reoperation rate due to new or recurrent stenoses was 22%, with time to reoperation shorter in smokers (p = 0.033). Independently of the surgical procedure chosen, long-term follow-up (mean 3.9 years) revealed a stable or improved paresis in 87% of the patients (median grade 4/5) and an excellent general performance and quality of life. CONCLUSIONS Painless cervical motor radiculopathy predominantly occurs due to focal compression of the anterior nerve root at the neuroforaminal entrance. Surgical decompression is effective in stabilizing or improving motor function with a resulting favorable long-term outcome.
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Miyaji Y, Hatanaka Y, Higashihara M, Kanbayashi T, Tanaka F, Sonoo M. Fasciculation potentials and decremental responses in amyotrophic lateral sclerosis. Clin Neurophysiol 2017; 129:345-348. [PMID: 29288989 DOI: 10.1016/j.clinph.2017.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 10/29/2017] [Accepted: 11/04/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The positive correlation between fasciculation potentials (FPs) and decremental responses in repetitive nerve stimulation test (RNS) in amyotrophic lateral sclerosis (ALS) patients has been described based on only one past study. We revisited this issue. METHODS Subjects consisted of 30 prospectively-enrolled ALS patients on whom both needle EMG and RNS were conducted in the same trapezius muscle. Fasciculation potentials (FPs) were identified off-line from the restored 3-min signal. Firing rate of FPs (FR-FP) per minute was calculated from the total count of FPs of different origins. Correlations between FR-FP, decremental percentage (Decr%) and the amplitude of the initial compound muscle action potential (CMAPamp) in RNS were investigated. RESULTS There was no correlation between FR-FP and Decr% (r = 0.03) or between FR-FP and CMAPamp (r = 0.04). A significant negative correlation was observed between CMAPamp and Decr% (r = -0.56, P < .005). CONCLUSION FPs are not correlated with the decremental response in RNS. SIGNIFICANCE The underlying mechanism for FPs and decremental responses in ALS must be different and unrelated to each other.
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Affiliation(s)
- Yosuke Miyaji
- Department of Neurology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan; Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Yuki Hatanaka
- Department of Neurology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
| | - Mana Higashihara
- Department of Neurology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan; Department of Neurology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaecho, Itabashi-ku, Tokyo 173-0015, Japan.
| | - Takamichi Kanbayashi
- Department of Neurology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
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de Carvalho M, Kiernan MC, Swash M. Fasciculation in amyotrophic lateral sclerosis: origin and pathophysiological relevance. J Neurol Neurosurg Psychiatry 2017; 88:773-779. [PMID: 28490504 DOI: 10.1136/jnnp-2017-315574] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 03/20/2017] [Accepted: 03/29/2017] [Indexed: 12/11/2022]
Abstract
This review considers the origin and significance of fasciculations in neurological practice, with an emphasis on fasciculations in amyotrophic lateral sclerosis (ALS), and in benign fasciculation syndromes. Fasciculation represents a brief spontaneous contraction that affects a small number of muscle fibres, causing a flicker of movement under the skin. While an understanding of the role of fasciculation in ALS remains incomplete, fasciculations derive from ectopic activity generated in the motor system. A proximal origin seems likely to contribute to the generation of fasciculation in the early stages of ALS, while distal sites of origin become more prominent later in the disease, associated with distal motor axonal sprouting as part of the reinnervation response that develops secondary to loss of motor neurons. Fasciculations are distinct from the recurrent trains of axonal firing described in neuromyotonia. Fasciculation without weakness, muscle atrophy or increased tendon reflexes suggests a benign fasciculation syndrome, even when of sudden onset. Regardless of origin, fasciculations often present as the initial abnormality in ALS, an early harbinger of dysfunction and aberrant firing of motor neurons.
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Affiliation(s)
- Mamede de Carvalho
- Department of Neurosciences and Mental Health, Hospital de Santa Maria-CHLN, Lisbon, Portugal.,Institute of Physiology-IMM, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Matthew C Kiernan
- Bushell Chair of Neurology, Sydney Medical School, University of Sydney, Brain & Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Michael Swash
- Institute of Physiology-IMM, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Department of Neurology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Kulkantrakorn K, Suksasunee D. Clinical, electrodiagnostic, and outcome correlation in ALS patients in Thailand. J Clin Neurosci 2017; 43:165-169. [DOI: 10.1016/j.jocn.2017.05.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/22/2017] [Indexed: 10/19/2022]
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Al-Chalabi A, Hardiman O, Kiernan MC, Chiò A, Rix-Brooks B, van den Berg LH. Amyotrophic lateral sclerosis: moving towards a new classification system. Lancet Neurol 2017; 15:1182-94. [PMID: 27647646 DOI: 10.1016/s1474-4422(16)30199-5] [Citation(s) in RCA: 248] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 07/29/2016] [Accepted: 08/04/2016] [Indexed: 12/18/2022]
Abstract
Amyotrophic lateral sclerosis is a progressive adult-onset neurodegenerative disease that primarily affects upper and lower motor neurons, but also frontotemporal and other regions of the brain. The extent to which each neuronal population is affected varies between individuals. The subsequent patterns of disease progression form the basis of diagnostic criteria and phenotypic classification systems, with considerable overlap in the clinical terms used. This overlap can lead to confusion between diagnosis and phenotype. Formal classification systems such as the El Escorial criteria and the International Classification of Diseases are systematic approaches but they omit features that are important in clinical management, such as rate of progression, genetic basis, or functional effect. Therefore, many neurologists use informal classification approaches that might not be systematic, and could include, for example, anatomical descriptions such as flail-arm syndrome. A new strategy is needed to combine the benefits of a systematic approach to classification with the rich and varied phenotypic descriptions used in clinical practice.
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Affiliation(s)
- Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, King's College London, London, UK.
| | - Orla Hardiman
- Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Adriano Chiò
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Benjamin Rix-Brooks
- Carolinas Neuromuscular/ALS-MDA Center, Department of Neurology, Carolinas Medical Center, Carolinas Healthcare System Neurosciences Institute, Charlotte, NC, USA; University of North Carolina School of Medicine-Charlotte Campus, Charlotte, NC, USA
| | - Leonard H van den Berg
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Netherlands
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36
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Lenglet T, Camdessanché JP. Amyotrophic lateral sclerosis or not: Keys for the diagnosis. Rev Neurol (Paris) 2017; 173:280-287. [PMID: 28461025 DOI: 10.1016/j.neurol.2017.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/06/2017] [Accepted: 04/07/2017] [Indexed: 10/19/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a degenerative motor neuron disease (MND) which prognosis is poor. Early diagnosis permit to set up immediately adapted treatment and cares. Available diagnostic criteria are based on the detection of both central and peripheral motor neuron injury in bulbar, cervical, thoracic and lumbar regions. Electrodiagnostic (EDX) tests are the key tools to identify peripheral motor neuron involvement. Needle examination records abnormal activities at rest, and looks for neurogenic pattern during muscle contraction. Motor unit potentials morphology is modified primary to recruitment. Motor evoked potentials remain the test of choice to identify impairment of central motor neurons. In the absence of diagnostic biomarker of ALS and among essential investigations of suspected MND, a careful clinical and neurophysiological work-up is essential to rule out the differential diagnosis.
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Affiliation(s)
- T Lenglet
- Département de neurophysiologie clinique, Hôpital de la Salpêtrière, Assistance Publique-Hôpitaux de Paris, France; Centre Référent Maladies du Motoneurone et SLA, Hôpital de la Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - J-P Camdessanché
- Service de Neurologie, Hôpital Nord, CHU de Saint-Etienne, France; Centre Référent Maladies du Motoneurone et SLA, CHU de Saint-Etienne, France.
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Li DW, Liu M, Cui B, Fang J, Guan YZ, Ding Q, Li X, Cui L. The Awaji criteria increases the diagnostic sensitivity of the revised El Escorial criteria for amyotrophic lateral sclerosis diagnosis in a Chinese population. PLoS One 2017; 12:e0171522. [PMID: 28249004 PMCID: PMC5332033 DOI: 10.1371/journal.pone.0171522] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 01/20/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The accurate and early diagnosis of amyotrophic lateral sclerosis (ALS) is important for extending the life expectancy of patients. However, previous studies that have assessed the diagnostic sensitivities of the Awaji criteria (AC) and the revised El Escorial criteria (rEEC) in patients with ALS have been inconsistent, most of them were consensual regarding the advantage of Awaji over conventional criteria. Our study sought to compare the roles of AC and rEEC in the diagnosis of ALS. METHODS Data from a total of 294 consecutive patients with ALS were collected between January 2014 and August 2015 in the Peking Union Medical College Hospital. The clinical and electrophysiological records of 247 patients were eventually analyzed. The primary outcome measures were the sensitivities of the AC and rEEC for the diagnosis of ALS. RESULTS The sensitivity of probable or definite ALS as diagnosed with the AC (78%) was greater than that of the rEEC (36%, P <0.001). Following the application of the AC, 103 of the 147 patients categorized as probable ALS-laboratory supported from the rEEC were upgraded to probable or definite ALS, and 44 were downgraded to possible ALS. CONCLUSIONS Our data demonstrated that the AC exhibited greater diagnostic sensitivity than the rEEC in a Chinese ALS population. The use of the AC should be considered in clinical practice.
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Affiliation(s)
- Da-Wei Li
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Bo Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jia Fang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yu-Zhou Guan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qingyun Ding
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoguang Li
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Neurosciences Center, Chinese Academy of Medical Sciences, Beijing, China
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Tsuji Y, Noto YI, Shiga K, Teramukai S, Nakagawa M, Mizuno T. A muscle ultrasound score in the diagnosis of amyotrophic lateral sclerosis. Clin Neurophysiol 2017; 128:1069-1074. [PMID: 28343888 DOI: 10.1016/j.clinph.2017.02.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/03/2017] [Accepted: 02/19/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aims of this study are to elucidate the frequencies and distribution of fasciculations using muscle ultrasound in patients with amyotrophic lateral sclerosis (ALS) and those with other conditions mimicking ALS, and subsequently to develop a novel fasciculation score for the diagnosis of ALS. METHODS Ultrasound of 21 muscles was performed to detect fasciculations in 36 consecutive patients suspected of having ALS. We developed a fasciculation ultrasound score that indicated the number of muscles with fasciculations in statistically selected muscles. RESULTS A total of 525 muscles in 25 ALS patients and 231 in 11 non-ALS patients were analysed. Using relative operating characteristic and multivariate logistic regression analysis, we selected the trapezius, deltoid, biceps brachii, abductor pollicis brevis, abdominal, vastus lateralis, vastus medialis, biceps femoris, and gastrocnemius muscles for the fasciculation ultrasound score. The mean scores were higher in the ALS group than those in the non-ALS group (5.3±0.5vs. 0.3±0.7) (mean±SD); p<0.001. CONCLUSIONS Two or more of the fasciculation ultrasound scores showed high sensitivity and specificity in differentiating ALS patients from non-ALS patients. SIGNIFICANCE The fasciculation ultrasound score can be a simple and useful diagnostic marker of ALS.
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Affiliation(s)
- Yukiko Tsuji
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yu-Ichi Noto
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Kensuke Shiga
- Department of Medical Education and Primary Care, Graduate School of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masanori Nakagawa
- North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiki Mizuno
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Reniers W, Schrooten M, Claeys KG, Tilkin P, D’Hondt A, Van Reijen D, Couwelier G, Lamaire N, Robberecht W, Fieuws S, Van Damme P. Prognostic value of clinical and electrodiagnostic parameters at time of diagnosis in patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2017. [DOI: 10.1080/21678421.2017.1288254] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - Kristl G. Claeys
- Neurology Department, University Hospitals, Leuven, Belgium,
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), Leuven, Belgium,
| | - Petra Tilkin
- Neurology Department, University Hospitals, Leuven, Belgium,
| | - Ann D’Hondt
- Neurology Department, University Hospitals, Leuven, Belgium,
| | | | | | - Nikita Lamaire
- Neurology Department, University Hospitals, Leuven, Belgium,
| | - Wim Robberecht
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), Leuven, Belgium,
| | - Steffen Fieuws
- Department of Public Health and Primary Care, I-BioStat, KU Leuven - University of Leuven & University of Hasselt, Leuven, Belgium
| | - Philip Van Damme
- Neurology Department, University Hospitals, Leuven, Belgium,
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), Leuven, Belgium,
- VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium, and
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40
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Babu S, Pioro EP, Li J, Li Y. Optimizing muscle selection for electromyography in amyotrophic lateral sclerosis. Muscle Nerve 2017; 56:36-44. [DOI: 10.1002/mus.25444] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 10/12/2016] [Accepted: 10/18/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Suma Babu
- Neuromuscular Center Desk S90, Department of Neurology; Cleveland Clinic; 9500 Euclid Avenue Cleveland Ohio 44195 USA
| | - Erik P Pioro
- Neuromuscular Center Desk S90, Department of Neurology; Cleveland Clinic; 9500 Euclid Avenue Cleveland Ohio 44195 USA
| | - Jianbo Li
- Department of Quantitative Health Sciences; Learner Research Institute, Cleveland Clinic Foundation; Cleveland Ohio USA
| | - Yuebing Li
- Neuromuscular Center Desk S90, Department of Neurology; Cleveland Clinic; 9500 Euclid Avenue Cleveland Ohio 44195 USA
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Bokuda K, Shimizu T, Kimura H, Yamazaki T, Kamiyama T, Watabe K, Kawata A, Hayashi M, Isozaki E. Quantitative analysis of the features of fasciculation potentials and their relation with muscle strength in amyotrophic lateral sclerosis. Neurol Sci 2016; 37:1939-1945. [PMID: 27541300 DOI: 10.1007/s10072-016-2692-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/16/2016] [Indexed: 12/26/2022]
Abstract
This study aimed to quantitatively analyze fasciculation potentials (FPs) and to investigate their relationship with muscle strength in amyotrophic lateral sclerosis (ALS). Fifty-one patients with sporadic ALS or progressive muscular atrophy (25 men, 26 women, mean age of 68 years) underwent needle EMG. We determined the duration, phase number, and amplitude of FPs from three muscles (upper trapezius, biceps brachii, and tibialis anterior) and examined their relations with muscle strength. In total, 878 FPs were analyzed. FP duration displayed a significant negative relation with the strength of all three muscles; the weaker muscles showed longer durations of FPs than the muscles with normal strength. The amplitude and phase number were not related with muscle strength, but there were significant correlations between the duration and amplitude of FPs in the trapezius and tibialis anterior muscles. The longer duration of FPs in muscles with weak strength suggests that the morphological changes of FPs were caused by temporal dispersion through progressively degenerating and/or immature reinnervating motor branches, and were observed uniformly in different muscles along with disease progression.
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Affiliation(s)
- Kota Bokuda
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan.,Mental Development Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Toshio Shimizu
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan.
| | - Hideki Kimura
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | - Toshihiro Yamazaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | - Tsutomu Kamiyama
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | - Kazuhiko Watabe
- ALS and Neuropathy Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.,Department of Medical Technology (Neuropathology), Kyorin University Faculty of Health Sciences, Tokyo, Japan
| | - Akihiro Kawata
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | - Masaharu Hayashi
- Mental Development Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
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42
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de Carvalho M, Swash M. Lower motor neuron dysfunction in ALS. Clin Neurophysiol 2016; 127:2670-81. [DOI: 10.1016/j.clinph.2016.03.024] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/08/2016] [Accepted: 03/01/2016] [Indexed: 12/11/2022]
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43
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Geevasinga N, Loy CT, Menon P, de Carvalho M, Swash M, Schrooten M, Van Damme P, Gawel M, Sonoo M, Higashihara M, Noto YI, Kuwabara S, Kiernan MC, Macaskill P, Vucic S. Awaji criteria improves the diagnostic sensitivity in amyotrophic lateral sclerosis: A systematic review using individual patient data. Clin Neurophysiol 2016; 127:2684-91. [DOI: 10.1016/j.clinph.2016.04.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/30/2016] [Accepted: 04/01/2016] [Indexed: 12/12/2022]
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44
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Jenkins TM, Alix JJ, Kandler RH, Shaw PJ, McDermott CJ. The role of cranial and thoracic electromyography within diagnostic criteria for amyotrophic lateral sclerosis. Muscle Nerve 2016; 54:378-85. [DOI: 10.1002/mus.25062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 01/05/2016] [Accepted: 01/25/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Thomas M. Jenkins
- Sheffield Institute for Translational Neuroscience; University of Sheffield; 385A Glossop Road Sheffield S10 2HQ UK
| | - James J.P. Alix
- Sheffield Institute for Translational Neuroscience; University of Sheffield; 385A Glossop Road Sheffield S10 2HQ UK
| | - Rosalind H. Kandler
- Department of Clinical Neurophysiology; Royal Hallamshire Hospital; Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield UK
| | - Pamela J. Shaw
- Sheffield Institute for Translational Neuroscience; University of Sheffield; 385A Glossop Road Sheffield S10 2HQ UK
| | - Christopher J. McDermott
- Sheffield Institute for Translational Neuroscience; University of Sheffield; 385A Glossop Road Sheffield S10 2HQ UK
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45
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Simon NG. Lower motor neurons - Counting cogs in the ALS machine. Clin Neurophysiol 2016; 127:2668-9. [PMID: 27102133 DOI: 10.1016/j.clinph.2016.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/21/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Neil G Simon
- St Vincent's Clinical School, University of New South Wales, Australia.
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46
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Kim DG, Hong YH, Shin JY, Park KH, Sohn SY, Lee KW, Park KS, Sung JJ. Split-hand phenomenon in amyotrophic lateral sclerosis: A motor unit number index study. Muscle Nerve 2016; 53:885-8. [DOI: 10.1002/mus.24958] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Dong-Gun Kim
- Department of Neurology; Seoul National University Bundang Hospital, Seoul National University College of Medicine; Seoul Republic of Korea
| | - Yoon-ho Hong
- Department of Neurology, Seoul Metropolitan Government Boramae Medical Center; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Je-young Shin
- Department of Neurology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul Republic of Korea
| | - Kee Hong Park
- Department of Neurology; Gyeongsang National University Hospital; Jinju Korea
| | - Sung-Yeon Sohn
- Department of Neurology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul Republic of Korea
| | - Kwang-Woo Lee
- Department of Neurology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul Republic of Korea
| | - Kyung Seok Park
- Department of Neurology; Seoul National University Bundang Hospital, Seoul National University College of Medicine; Seoul Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul Metropolitan Government Boramae Medical Center; Seoul National University College of Medicine; Seoul Republic of Korea
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47
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Simon NG, Huynh W, Vucic S, Talbot K, Kiernan MC. Motor neuron disease: current management and future prospects. Intern Med J 2015; 45:1005-13. [DOI: 10.1111/imj.12874] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 07/27/2015] [Indexed: 12/11/2022]
Affiliation(s)
- N. G. Simon
- Prince of Wales Clinical School; University of New South Wales; Sydney New South Wales Australia
| | - W. Huynh
- Prince of Wales Clinical School; University of New South Wales; Sydney New South Wales Australia
| | - S. Vucic
- Westmead Clinical School; C24 Westmead Hospital; The University of Sydney; Sydney New South Wales Australia
| | - K. Talbot
- Division of Clinical Neurology; University of Oxford; Oxford UK
| | - M. C. Kiernan
- Brain and Mind Research Institute; Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
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48
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Mancuso R, Navarro X. Amyotrophic lateral sclerosis: Current perspectives from basic research to the clinic. Prog Neurobiol 2015; 133:1-26. [PMID: 26253783 DOI: 10.1016/j.pneurobio.2015.07.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 07/30/2015] [Accepted: 07/31/2015] [Indexed: 02/07/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by progressive degeneration of upper and lower motoneurons, leading to muscle weakness and paralysis, and finally death. Considerable recent advances have been made in basic research and preclinical therapeutic attempts using experimental models, leading to increasing clinical and translational research in the context of this disease. In this review we aim to summarize the most relevant findings from a variety of aspects about ALS, including evaluation methods, animal models, pathophysiology, and clinical findings, with particular emphasis in understanding the role of every contributing mechanism to the disease for elucidating the causes underlying degeneration of motoneurons and the development of new therapeutic strategies.
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Affiliation(s)
- Renzo Mancuso
- Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Xavier Navarro
- Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain.
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49
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de Carvalho M, Costa J, Swash M. Comment on: The Awaji criteria are not always superior to the previous criteria: A meta-analysis. Muscle Nerve 2015; 52:467-8. [DOI: 10.1002/mus.24734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 06/05/2015] [Accepted: 06/09/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Mamede de Carvalho
- Instituto de Medicina Molecular and Institute of Physiology, Faculty of Medicine; University of Lisbon; Portugal
- Department of Neurosciences; Hospital de Santa Maria-Centro Hospitalar Lisboa Norte; Lisbon Portugal
| | - João Costa
- Instituto de Medicina Molecular and Institute of Physiology, Faculty of Medicine; University of Lisbon; Portugal
- Center for Evidence-Based Medicine, Faculty of Medicine; University of Lisbon; Portugal
| | - Michael Swash
- Instituto de Medicina Molecular and Institute of Physiology, Faculty of Medicine; University of Lisbon; Portugal
- Departments of Neurology and Neuroscience, Royal London Hospital; Queen Mary University of London; London United Kingdom
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50
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Jokela ME, Jääskeläinen SK, Sandell S, Palmio J, Penttilä S, Saukkonen A, Soikkeli R, Udd B. Spontaneous activity in electromyography may differentiate certain benign lower motor neuron disease forms from amyotrophic lateral sclerosis. J Neurol Sci 2015; 355:143-6. [PMID: 26059445 DOI: 10.1016/j.jns.2015.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/14/2015] [Accepted: 06/01/2015] [Indexed: 12/12/2022]
Abstract
There is limited data on electromyography (EMG) findings in other motor neuron disorders than amyotrophic lateral sclerosis (ALS). We assessed whether the distribution of active denervation detected by EMG, i.e. fibrillations and fasciculations, differs between ALS and slowly progressive motor neuron disorders. We compared the initial EMG findings of 43 clinically confirmed, consecutive ALS patients with those of 41 genetically confirmed Late-onset Spinal Motor Neuronopathy and 14 Spinal and Bulbar Muscular Atrophy patients. Spontaneous activity was more frequently detected in the first dorsal interosseus and deltoid muscles of ALS patients than in patients with the slowly progressive motor neuron diseases. The most important observation was that absent fibrillations in the first dorsal interosseus muscle identified the benign forms with sensitivities of 66%-77% and a specificity of 93%. The distribution of active denervation may help to separate ALS from mimicking disorders at an early stage.
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Affiliation(s)
- Manu E Jokela
- Division of Clinical Neurosciences, Turku University Hospital, and University of Turku, Turku, Finland, Kiinamyllynkatu 4-8, 20520 Turku, Finland.
| | - Satu K Jääskeläinen
- Department of Clinical Neurophysiology, Turku University Hospital and University of Turku, Turku, Finland
| | - Satu Sandell
- Department of Neurology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Johanna Palmio
- Neuromuscular Research Center, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Sini Penttilä
- Neuromuscular Research Center, Tampere University, Tampere, Finland
| | - Annamaija Saukkonen
- Department of Neurology, Central Hospital of Northern Karelia, Joensuu, Finland
| | - Raija Soikkeli
- Department of Neurophysiology, Central Hospital of Northern Karelia, Joensuu, Finland
| | - Bjarne Udd
- Neuromuscular Research Center, Tampere University and Hospital, Tampere, Finland
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