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Oguz-Akarsu E, Sirin NG, Artug T, Erbas B, Orhan EK, Idrisoğlu HA, Ketenci A, Baslo MB, Oge AE. Automatic detection of F-waves and F-MUNE in Two Types of Motor Neuron Diseases. Muscle Nerve 2022; 65:422-432. [PMID: 35020950 DOI: 10.1002/mus.27494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 01/02/2022] [Accepted: 01/06/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION/AIMS Motor unit number estimation by F-waves (F-MUNE) is an uncommonly used MUNE technique. The aim of this study was to analyze the sensitivity of F-MUNE values elicited with newly developed software in motor neuron diseases. METHODS F-waves were recorded by 300 submaximal stimuli from abductor digiti minimi (ADM) and abductor pollicis brevis (APB) muscles of 35 patients with amyotrophic lateral sclerosis, 18 with previous poliomyelitis, and 20 controls. The software extracted the surface motor unit action potentials (sMUAP) and calculated the F-MUNE values. CMAP Scans were also recorded to obtain step% and MScanFit. RESULTS sMUAP amplitudes were higher and F-MUNE values were lower in both muscles of the patients than in controls. F-MUNE values were able to distinguish the patients from controls. Significant correlations were found between F-MUNE and MScanFit in patient groups. DISCUSSION The new F-MUNE software gave promising results in revealing motor unit loss caused by motor neuron diseases.
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Affiliation(s)
- Emel Oguz-Akarsu
- Departments of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Neurology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Nermin Gorkem Sirin
- Departments of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tugrul Artug
- Department of Electrical and Electronics Engineering, Faculty of Engineering, Izmir Democracy University, Izmir, Turkey
| | - Bahar Erbas
- Departments of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Pharmacology, Faculty of Medicine, Demiroglu Bilim University, Istanbul, Turkey
| | - Elif Kocasoy Orhan
- Departments of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Atilla Idrisoğlu
- Departments of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aysegul Ketenci
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Baris Baslo
- Departments of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Emre Oge
- Departments of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Hannaford A, Higashihara M, Pavey N, van den Bos M, Geevasinga N, Vucic S, Menon P. Split-hand index: A diagnostic and prognostic marker in amyotrophic lateral sclerosis across varying regions of onset. Clin Neurophysiol 2021; 132:2130-2135. [PMID: 34284248 DOI: 10.1016/j.clinph.2021.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The split-hand index (SI), a reliable diagnostic marker of amyotrophic lateral sclerosis (ALS), was prospectively assessed for differences across ALS subtypes and between the onset side of clinical symptoms or the dominant and contralateral sides. In addition, the prognostic utility of the SI was longitudinally assessed. METHODS Two hundred and forty-five ALS patients underwent measurement of SI on both sides compared with 126 neuromuscular mimic disorders (NMD). A subset of patients (N = 45) underwent longitudinal assessment of SI. RESULTS The SI was significantly reduced (SI RIGHT ALS 5.47(4.2), SINMD 9.0 (5.0); P < 0.001; SILEFT ALS 5.5 (4.1), SI NMD 9.4 (5.0), P < 0.001) on both sides in all ALS patients with prominent reduction on the onset side in upper limb onset ALS (SI RIGHT P < 0.001; SI LEFT P < 0.05) and in Awaji definite/probable diagnostic category (SI RIGHT P < 0.05; SI LEFT P < 0.05). Longitudinal studies disclosed that the rate of SI decline correlated with the decline in ALSFRS-R (r = 0.21, P < 0.05). CONCLUSION The SI is reduced in all ALS subtypes most prominently in upper limb onset disease, on the side of clinical onset, and in patients with Awaji definite/probable diagnostic category. SIGNIFICANCE The split-hand index is a reliable diagnostic and outcome biomarker across ALS subtypes and may have potential utility in a clinical trial setting, although further multicenter studies are required to confirm this.
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Affiliation(s)
- Andrew Hannaford
- Westmead Hospital, Sydney, Australia; University of Sydney, Australia
| | - Mana Higashihara
- Westmead Hospital, Sydney, Australia; Tokyo Metropolitan Geriatric Hospital, Japan
| | - Nathan Pavey
- Westmead Hospital, Sydney, Australia; University of Sydney, Australia
| | - Mehdi van den Bos
- Westmead Hospital, Sydney, Australia; University of Sydney, Australia
| | | | - Steve Vucic
- Westmead Hospital, Sydney, Australia; University of Sydney, Australia
| | - Parvathi Menon
- Westmead Hospital, Sydney, Australia; University of Sydney, Australia.
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Ranieri F, Mariotto S, Dubbioso R, Di Lazzaro V. Brain Stimulation as a Therapeutic Tool in Amyotrophic Lateral Sclerosis: Current Status and Interaction With Mechanisms of Altered Cortical Excitability. Front Neurol 2021; 11:605335. [PMID: 33613416 PMCID: PMC7892772 DOI: 10.3389/fneur.2020.605335] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/22/2020] [Indexed: 12/14/2022] Open
Abstract
In the last 20 years, several modalities of neuromodulation, mainly based on non-invasive brain stimulation (NIBS) techniques, have been tested as a non-pharmacological therapeutic approach to slow disease progression in amyotrophic lateral sclerosis (ALS). In both sporadic and familial ALS cases, neurophysiological studies point to motor cortical hyperexcitability as a possible priming factor in neurodegeneration, likely related to dysfunction of both excitatory and inhibitory mechanisms. A trans-synaptic anterograde mechanism of excitotoxicity is thus postulated, causing upper and lower motor neuron degeneration. Specifically, motor neuron hyperexcitability and hyperactivity are attributed to intrinsic cell abnormalities related to altered ion homeostasis and to impaired glutamate and gamma aminobutyric acid gamma-aminobutyric acid (GABA) signaling. Several neuropathological mechanisms support excitatory and synaptic dysfunction in ALS; additionally, hyperexcitability seems to drive DNA-binding protein 43-kDA (TDP-43) pathology, through the upregulation of unusual isoforms directly contributing to ASL pathophysiology. Corticospinal excitability can be suppressed or enhanced using NIBS techniques, namely, repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), as well as invasive brain and spinal stimulation. Experimental evidence supports the hypothesis that the after-effects of NIBS are mediated by long-term potentiation (LTP)-/long-term depression (LTD)-like mechanisms of modulation of synaptic activity, with different biological and physiological mechanisms underlying the effects of tDCS and rTMS and, possibly, of different rTMS protocols. This potential has led to several small trials testing different stimulation interventions to antagonize excitotoxicity in ALS. Overall, these studies suggest a possible efficacy of neuromodulation in determining a slight reduction of disease progression, related to the type, duration, and frequency of treatment, but current evidence remains preliminary. Main limitations are the small number and heterogeneity of recruited patients, the limited "dosage" of brain stimulation that can be delivered in the hospital setting, the lack of a sufficient knowledge on the excitatory and inhibitory mechanisms targeted by specific stimulation interventions, and the persistent uncertainty on the key pathophysiological processes leading to motor neuron loss. The present review article provides an update on the state of the art of neuromodulation in ALS and a critical appraisal of the rationale for the application/optimization of brain stimulation interventions, in the light of their interaction with ALS pathophysiological mechanisms.
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Affiliation(s)
- Federico Ranieri
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, Naples, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University, Rome, Italy
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Cai Q, Xu W, Liao S, Liang Y, Wu C, Li X. Clinical and Physiological Significance of F-Wave in Spinocerebellar Ataxia Type 3. Front Neurol 2020; 11:571341. [PMID: 33117264 PMCID: PMC7550721 DOI: 10.3389/fneur.2020.571341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/24/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To evaluate the characteristics of F-wave in spinocerebellar ataxia type 3 (SCA3) patients and preclinical carriers of SCA3 gene mutation (PreSCA3), and explore the relationship between disease severity and F-wave parameters and evaluate F-wave parameters as potential biomarkers for monitoring of disease progression in SCA3. Methods: We performed F-wave recordings in median, ulnar and tibial nerves of 39 SCA3 patients, 20 PreSCA3, and 27 healthy controls, and compared F-wave parameters between them. Results: In all nerves studied, the mean F-wave amplitude, maximum F-wave amplitude, and F/M amplitude ratio were significantly increased in the SCA3 patients in comparison with the normal controls. And the minimal F-wave latency of SCA3 patients was significantly prolonged and the F-wave persistence (%) was significantly decreased in the median nerve. For the PreSCA3, the maximum F-wave amplitude was significantly higher than normal controls for both median, ulnar, and tibial nerves. The mean F-wave amplitude and F/M amplitude ratio in all nerves were comparable between PreSCA3 and normal controls. The frequency of giant F-wave and frequency of patients with giant F-wave were similar between PreSCA3 and SCA3. The values of F/M amplitude ratio in both median, ulnar, and tibial nerves were correlated positively with disease severity and disease duration. Conclusion: Significant F-wave abnormalities occur in patients with SCA3, even in PreSCA3. F-wave may therefore reveal subclinical alterations and provide objective parameters for evaluating the progression of SCA3.
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Affiliation(s)
- Qiong Cai
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,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
| | - Wenxiao Xu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,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
| | - Songjie Liao
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,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
| | - Yinxing Liang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,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
| | - Chao Wu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,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
| | - Xunhua Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,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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Wang ZL, Liu M, Cai Z, Ding Q, Hu Y, Cui L. A prospective study on split-hand index as a biomarker for the diagnosis of amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:574-583. [PMID: 32608275 DOI: 10.1080/21678421.2020.1779299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the practical diagnostic utility of split-hand index (SI) values calculated from F-wave persistence (SIFP) and the F/M amplitude ratio (SIF/M) for differentiating patients with amyotrophic lateral sclerosis (ALS) from other conditions. Methods: This prospective study recruited consecutive patients from Peking Union Medical College Hospital, China, between June 2019 and December 2019. Patients 18-80 years old who had clinical neuromuscular symptoms affecting the upper limbs and required electrophysiological examinations to aid diagnosis were eligible. Compound muscle action potentials (CMAPs) and F-waves recorded from the abductor pollicis brevis (APB), first dorsal interosseous muscle (FDI), and abductor digiti minimi (ADM) were examined. SIFP and SIF/M were calculated as: SI = (APB × FDI)/ADM. The sensitivity and specificity of SIFP and SIF/M in differentiating ALS from non-ALS conditions were derived using receiver operating characteristic (ROC) curves. Results: A total of 309 participants, comprising 91 (29.4%) with ALS and 218 (70.6%) with other neuromuscular disorders, were enrolled after 54 were excluded. SIFP was significantly reduced and SIF/M increased in the ALS group compared with the non-ALS group (p < 0.001). By ROC curve analysis, an SIFP cutoff of 73.3 showed 85.7% sensitivity and 80.7% specificity for differentiating ALS from non-ALS. SIF/M and SICMAP showed lower sensitivity (67% and 75.8%, respectively, p < 0.001) than SIFP for ALS diagnosis. SIFP and SIF/M combined did not outperform SIFP alone. Conclusion: SIFP could be a sensitive, noninvasive neurophysiological diagnostic marker for ALS patients with affected upper limbs. In particular, an SIFP value of 73.3 might be the optimal cutoff for diagnosing ALS.
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Affiliation(s)
- Zhi-Li Wang
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China, and
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China, and
| | - Zhengyi Cai
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China, and
| | - Qingyun Ding
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China, and
| | - Youfang Hu
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China, and
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China, and.,Neuroscience Center, Chinese Academy of Medical Sciences, Beijing, China
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6
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Electrodiagnosis of Amyotrophic Lateral Sclerosis: A Review of Existing Guidelines. J Clin Neurophysiol 2020; 37:294-298. [DOI: 10.1097/wnp.0000000000000682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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7
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Pereira M, Swash M, de Carvalho M. Immobility and F-waves: Impact on lower motor neuron excitability. Muscle Nerve 2020; 61:480-484. [PMID: 31998973 DOI: 10.1002/mus.26817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/12/2020] [Accepted: 01/21/2020] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Immobility of the upper limbs has been associated with reduction of F-wave frequency. However, there are no similar studies on lower limb (LL) F-waves. We investigated the impact of LL rest on F-wave and H-reflex parameters. METHODS The LLs of 14 healthy participants were studied after 90 minutes rest. F-waves (frequency, latencies, chronodispersion, and mean amplitude) and H-reflexes (latency and recruitment curve) were investigated bilaterally. In seven participants the protocol was repeated, but the temperature of one limb was reduced. RESULTS Immobility only changed F-wave latencies, which increased significantly (mean value of 2 ms, P < .01). Limb cooling did not influence results. DISCUSSION Contrary to what occurred in cervical lower motor neurons (LMN), LL LMNs did not show a reduced F-wave response to immobility, but their latency increased significantly. This could have been due to reduced Renshaw inhibition of small LMNs, thus facilitating their response to antidromic stimulation and causing delayed late responses.
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Affiliation(s)
- Mariana Pereira
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Univeridade de Lisboa, Lisbon, Portugal
| | - Michael Swash
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Univeridade de Lisboa, Lisbon, Portugal.,Department of Neurology and Neuroscience, Barts and the London School of Medicine, Queen Mary University of London and Royal London Hospital, United Kingdom
| | - 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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Oguz Akarsu E, Sirin NG, Kocasoy Orhan E, Erbas B, Dede HO, Baslo MB, Idrisoglu HA, Oge AE. Repeater F-waves in amyotrophic lateral sclerosis: Electrophysiologic indicators of upper or lower motor neuron involvement? Clin Neurophysiol 2019; 131:96-105. [PMID: 31760213 DOI: 10.1016/j.clinph.2019.09.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/08/2019] [Accepted: 09/25/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To extract insight about the mechanism of repeater F-waves (Frep) by exploring their correlation with electrophysiologic markers of upper and lower motor neuron dysfunction in amyotrophic lateral sclerosis (ALS). METHODS The correlations of Frep parameters with clinical scores and the results of neurophysiological index (NI), MScanfit MUNE, F/M amplitude ratio (F/M%), single and paired-pulse transcranial magnetic stimulation (TMS), and triple stimulation technique (TST) studies, recorded from abductor digiti minimi (ADM) and abductor pollicis brevis (APB) muscles of 35 patients with ALS were investigated. RESULTS Frep parameters were correlated with NI and MScanfit MUNE in ADM muscle and F/M% in both muscles. None of the Frep parameters were correlated with clinical scores or TST and TMS measures. While the CMAP amplitudes were similar in the two recording muscles, there was a more pronounced decrease of F-wave persistence in APB, probably heralding the subsequent split hand phenomenon. CONCLUSION Our findings suggest that the presence and density of Freps are primarily related to the degree of lower motor neuron loss and show no correlation with any of the relatively extensive set of parameters for upper motor neuron dysfunction. SIGNIFICANCE Freps are primarily related to lower motor neuron loss in ALS.
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Affiliation(s)
- Emel Oguz Akarsu
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey.
| | - Nermin Gorkem Sirin
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Elif Kocasoy Orhan
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Bahar Erbas
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey; Demiroglu Bilim University, Faculty of Medicine, Department of Pharmacology, Istanbul, Turkey
| | - Hava Ozlem Dede
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Mehmet Baris Baslo
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Halil Atilla Idrisoglu
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Ali Emre Oge
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
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Veltsista D, Papapavlou C, Chroni E. F Wave Analyzer, a system for repeater F-waves detection: Application in patients with amyotrophic lateral sclerosis. Clin Neurophysiol 2019; 130:1954-1961. [PMID: 31472478 DOI: 10.1016/j.clinph.2019.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/23/2019] [Accepted: 08/12/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We assessed the clinical usefulness of repeater F-waves (Freps) analysis in amyotrophic lateral sclerosis (ALS), using an automated computerized system (F Wave Analyzer). METHODS Forty consecutive F-waves were recorded from the ulnar and peroneal nerve in 52 patients with ALS and 52 healthy control subjects. Data were imported into the F Wave Analyzer which identifies Freps and groups them. Parameters of Freps and non repeater F-waves (Fnonreps) were compared. RESULTS Total number of repeating neurons, Freps persistence (100xFreps/40stimuli) and Index Total Freps (100xFreps/total number of F-waves) were significantly higher in the ALS compared to the control group (P ≤ 0.005). There were no consistent differences of F-wave latency or amplitude measurements between Freps and Fnonreps for both studied groups, with the exception of prolonged Freps minimum latency in ALS. CONCLUSION In ALS, the high numbers of Freps, reduced overall F-wave persistence and increased F-wave amplitude measurements in a relatively unaffected nerve-muscle complex reflects excitability alterations of the corresponding motor neuron pool. Overall, automatic analysis facilitates accurate and fast detection of Freps and could be useful in other clinical settings. SIGNIFICANCE Analysis of repeater F-waves is expected to provide new insight regarding ALS pathophysiology and utilized for monitoring in clinical drug trials.
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Affiliation(s)
- Dimitra Veltsista
- Departments of Neurology, School of Medicine, University of Patras, Patras, Greece
| | - Chris Papapavlou
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece
| | - Elisabeth Chroni
- Departments of Neurology, School of Medicine, University of Patras, Patras, Greece.
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The ‘neurophysiological index’ predicts survival in amyotrophic lateral sclerosis. Clin Neurophysiol 2019; 130:1684-1685. [DOI: 10.1016/j.clinph.2019.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 05/27/2019] [Indexed: 12/13/2022]
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11
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Wang ZL, Liu M, Ding Q, Hu Y, Cui L. Split-hand index in amyotrophic lateral sclerosis: an F-wave study. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:562-567. [PMID: 31364874 DOI: 10.1080/21678421.2019.1646770] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Zhi-Li Wang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China and
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China and
| | - Qingyun Ding
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China and
| | - Youfang Hu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China and
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China and
- Neuroscience Center, Chinese Academy of Medical Sciences, Beijing, China
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12
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Wang ZL, Cui L, Liu M, Zhang K, Liu S, Ding Q, Hu Y. Reassessment of Split-Leg Signs in Amyotrophic Lateral Sclerosis: Differential Involvement of the Extensor Digitorum Brevis and Abductor Hallucis Muscles. Front Neurol 2019; 10:565. [PMID: 31191446 PMCID: PMC6548849 DOI: 10.3389/fneur.2019.00565] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/13/2019] [Indexed: 12/11/2022] Open
Abstract
Background: The muscle patterns involved in the “split-leg” syndrome of amyotrophic lateral sclerosis (ALS) remains controversial. We sought to evaluate and reassess the pattern of the extensor digitorum brevis (EDB) and the abductor hallucis (AH) muscles' involvement in split-leg syndrome in ALS. Methods: We recruited 60 consecutive patients with ALS and 25 healthy controls (HCs). Compound muscle action potentials (CMAPs) and F-waves were recorded over the EDB and AH muscles in all subjects. For comparison, we classified patients into two categories based on the presence or absence of lower limbs symptoms. Results: The EDB/AH CMAP amplitude ratio was significantly reduced in patients with affected legs (0.33 ± 0.21, P = 0.007), whereas patients with unaffected legs had a ratio similar to that of the HCs. The EDB/AH ratios for the F-wave latencies, mean F-wave amplitude, mean F/M amplitude ratio, and the persistence of the total repeater F-wave shapes (index Freps) of the EDB-AH, were significantly increased in the affected leg group, whereas the EDB/AH ratio for F-wave persistence was significantly reduced. These findings indicated a greater loss of lower motor neurons (LMNs) innervating the EDB and dysfunction of spinal motoneurons innervating the EDB. In the unaffected leg group, the EDB, but not the AH, F-wave latencies, mean and maximal F/M amplitude ratios, and index Freps were significantly altered. Receiver operating characteristic curve analysis suggested that the EDB F-wave latencies, mean F/M amplitude ratios, and index Freqs (area under the curve [AUC] > 0.8) more strongly differentiated patients with ALS from the HCs compared to the EDB/AH CMAP amplitude ratio (AUC = 0.61). Notably, the EDB maximal F-wave latency and index Freqs reliably differentiated patients with unaffected legs (HCs), with AUCs of 0.83 (95% CI 0.76–0.91) and 0.81 (95% CI 0.72–0.89), sensitivities of 76 and 78%, and specificities of 76 and 78%, respectively. Conclusions: These results suggest preferential EDB compared to AH involvement in the split-leg syndrome of ALS. The EDB maximal F-wave latency and index Freqs robustly differentiated patients with ALS from HCs, which might facilitate an earlier identification of ALS.
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Affiliation(s)
- Zhi-Li Wang
- 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.,Neuroscience Center, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Kang Zhang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuangwu Liu
- 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
| | - Youfang Hu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Wang ZL, Cui L, Liu M, Zhang K, Liu S, Ding Q. Split-Hand Syndrome in Amyotrophic Lateral Sclerosis: Differences in Dysfunction of the FDI and ADM Spinal Motoneurons. Front Neurosci 2019; 13:371. [PMID: 31133773 PMCID: PMC6517473 DOI: 10.3389/fnins.2019.00371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/01/2019] [Indexed: 12/11/2022] Open
Abstract
The F-wave test allows for the non-invasive assessment of spinal motoneuron excitability. We investigated the difference in spinal motoneuron dysfunction between the first dorsal interosseous (FDI) and abductor digit minimi (ADM) muscles by investigating F-waves and to assess the contribution of spinal mechanisms to split-hand syndrome in patients with amyotrophic lateral sclerosis (ALS). Sixty-five consecutive ALS patients and twenty age- and gender-matched healthy controls (HCs) were enrolled. Motor nerve conduction studies and F-waves were performed bilaterally on median and ulnar nerves in all subjects. HCs revealed prominently longer F-wave latencies, lower chronodispersion, mean F-wave amplitude, and mean and maximal F/M amplitude ratio (P < 0.001) in the FDI compared to the ADM. However, no significant differences in almost all F-wave parameters between the FDI and ADM were observed in ALS patients with affected hands except the minimal and mean F-wave latency. These data suggest that excitability is greatly changed in the spinal motoneurons innervating the FDI. Furthermore, the mean F-wave amplitude (r = 0.454, P = 0.002) of the FDI was significantly correlated with the FDI/ADM CMAP amplitude ratio in ALS patients with affected hands but not of the ADM. Our findings suggested that the dysfunction of spinal motoneurons between the FDI and ADM was different in ALS, and spinal motoneuron dysfunction was associated with development of the split-hand phenomenon.
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Affiliation(s)
- Zhi-Li Wang
- 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
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Kang Zhang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuangwu Liu
- 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
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Amin Lari A, Ghavanini AA, Bokaee HR. A review of electrophysiological studies of lower motor neuron involvement in amyotrophic lateral sclerosis. Neurol Sci 2019; 40:1125-1136. [PMID: 30877611 DOI: 10.1007/s10072-019-03832-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/07/2019] [Indexed: 02/08/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease involving both the upper and lower motor neuron diseases. In this review, we studied and compared different articles regarding the electrodiagnostic criteria for diagnosis of lower motor neuron pathology in ALS. We reviewed the most recent articles and metaanalysis regarding various lower motor neuron electrodiagnostic methods for ALS and their sensitivities. We concluded that Awaji Shima criteria is by far the most sensitive criteria for diagnosis of ALS.
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Affiliation(s)
- Ali Amin Lari
- Canadian Neurologic Center, Mississauga, ON, Canada.
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15
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Analysis of clinical and electrophysiological characteristics of 150 patients with amyotrophic lateral sclerosis in China. Neurol Sci 2018; 40:363-369. [DOI: 10.1007/s10072-018-3633-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/01/2018] [Indexed: 12/13/2022]
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16
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Fang J, Cui L, Liu M, Guan Y, Li X, Li D, Cui B, Shen D, Ding Q. Differences in Dysfunction of Thenar and Hypothenar Motoneurons in Amyotrophic Lateral Sclerosis. Front Hum Neurosci 2016; 10:99. [PMID: 27014030 PMCID: PMC4780404 DOI: 10.3389/fnhum.2016.00099] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/23/2016] [Indexed: 12/01/2022] Open
Abstract
This study aimed to determine differences in spinal motoneuron dysfunction between the abductor pollicis brevis (APB) and the abductor digiti minimi (ADM) in amyotrophic lateral sclerosis (ALS) patients based on studying F-waves. Forty ALS patients and 20 normal controls (NCs) underwent motor nerve conduction studies on both median and ulnar nerves, including F-waves elicited by 100 electrical stimuli. The F-wave persistence (P < 0.05), index repeating neuron (RN; P < 0.001), and index repeater F-waves (Freps; P < 0.001) significantly differed between the APB and the ADM in the NC participants. For the hands of the ALS patients that lacked detectable wasting or weakness and exhibited either no or mild impairment of discrete finger movements, significantly reduced F-wave persistence (P < 0.001), increased index RN (P < 0.001), and increased index Freps (P < 0.001) were observed in APB in comparison with the normal participants, with relatively normal ADM F-wave parameters. For the hands of ALS patients that exhibited wasting and weakness, the mean F-wave amplitude (P < 0.05), the F/M amplitude ratio (P < 0.05), F-wave persistence (P < 0.001), index RN (P < 0.05), and index Freps (P < 0.05) significantly differed between APB and ADM. The differences in the dysfunction of motoneurons innervating APB and ADM are unique manifestations in ALS patients. The F-wave persistence (P = 0.002), index RN (P < 0.001), and index Freps (P < 0.001) in the APB seemed to differentiate ALS from the NCs more robustly than the ADM/APB Compound muscle action potential (CMAP) amplitude ratio. Thus, F-waves may reveal subclinical alterations in anterior horn cells, and may potentially help to distinguish ALS from mimic disorders.
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Affiliation(s)
- Jia Fang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing, China; Neuroscience Center, Chinese Academy of Medical SciencesBeijing, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Yuzhou Guan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Xiaoguang Li
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Dawei Li
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Bo Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Dongchao Shen
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Qingyun Ding
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
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Hirasawa S, Shimizu M, Marui Y, Kishimoto M, Okuno S. Establishment of a method to measure length of the ulnar nerve and standardize F-wave values in clinically normal beagles. J Vet Med Sci 2015; 76:1603-7. [PMID: 25649942 PMCID: PMC4300375 DOI: 10.1292/jvms.14-0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We designed a new method of
measuring the length of the ulnar nerve and determining standard values for F-wave
parameters of the ulnar nerve in clinically normal beagles. Nerve length must be precisely
measured to determine F-wave latency and conduction velocity. The length of the forelimb
has served as the length of the ulnar nerve for F-wave assessments, but report indicates
that F-wave latency is proportional to the length of the pathway traveled by nerve
impulses. Therefore, we measured the surface distance from a stimulus point to the spinous
process of the first thoracic vertebra (nerve length 1) and the anterior horn of the
scapula (nerve length 2) as landmarks through the olecranon and the shoulder blade
acromion. The correlation coefficients between the shortest F-wave latency and the length
of nerves 1, 2 or the forelimb were 0.61, 0.7 and 0.58. Nerve length 2 generated the
highest value. Furthermore, the anterior horn of the scapula was easily palpated in any
dog regardless of well-fed body. We concluded that nerve length 2 was optimal for
measuring the length of the ulnar nerve.
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Affiliation(s)
- Shun Hirasawa
- Department of Veterinary Diagnostic Imaging, Faculty of Agriculture, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo 183-8509, Japan
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Joyce NC, Carter GT. Electrodiagnosis in persons with amyotrophic lateral sclerosis. PM R 2013; 5:S89-95. [PMID: 23523708 DOI: 10.1016/j.pmrj.2013.03.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 03/15/2013] [Indexed: 12/12/2022]
Abstract
Electrophysiology remains an important tool in the evaluation of patients presenting with signs and symptoms of motor neuron disease. The electrodiagnostic study should include peripheral nerve conduction studies and needle electromyography to both exclude treatable disease and gather evidence regarding a diagnosis of amyotrophic lateral sclerosis (ALS). The recent changes in the revised El Escorial criteria, recommended by the Awaji-shima consensus group, have increased the diagnostic significance of fasciculation potentials to equal that of fibrillation and positive sharp-wave potentials in the needle electromyography examination of patients suspected of having ALS. In addition, electrophysiologic evidence is now considered equivalent to clinical signs and symptoms in reaching a diagnostic certainty of ALS. These changes, strategies for the design, and implementation of an effective electrodiagnostic evaluation, in addition to electrophysiologic techniques and their relationship to the evaluation of a patient with ALS, are reviewed and discussed.
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Affiliation(s)
- Nanette C Joyce
- Department of Physical Medicine and Rehabilitation, University of California, Davis School of Medicine, 4860 Y St, Suite 3850, Sacramento, CA 95817, USA.
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de Carvalho MLL, Motta R, Battaglia MA, Brichetto G. Urinary disorders in amyotrophic lateral sclerosis subjects. ACTA ACUST UNITED AC 2011; 12:352-5. [DOI: 10.3109/17482968.2011.574141] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Okuno S, Kobayashi T, Orito K. F-wave conduction velocity, persistence, and amplitude for the tibial nerve in clinically normal cats. Am J Vet Res 2008; 69:261-4. [PMID: 18241024 DOI: 10.2460/ajvr.69.2.261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To establish a method of F-wave evaluation and to determine normative values of F-wave parameters, including F-wave conduction velocity, persistence, and amplitude for the tibial nerve in cats. ANIMALS 30 clinically normal cats. PROCEDURES F-waves elicited in the interosseous muscles by stimulation of the tibial nerve were recorded, and linear regression analyses of the shortest latency versus the length of the tibial nerve and the limb length were performed. F-wave persistence was calculated by dividing the number of recorded F-waves by the number of stimuli. RESULTS The correlation coefficient between F-wave latency and nerve length was 0.92, and that between F-wave latency and limb length was 0.58. Mean +/- SD F-wave conduction velocity of the tibial nerve was calculated to be 97.1 +/- 5.0 m/s. Linear regression analysis yielded the regression equation as follows: F-wave latency (milliseconds) = 2.60 + (0.02 x nerve length [mm]). Mean F-wave persistence and amplitude were 98.7 +/- 2.3% and 1.01 +/- 0.62 mV, respectively. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that nerve length should be used for nerve conduction studies of F-waves in felids. The regression equation for F-wave latency, conduction velocity, persistence, and amplitude may contribute to the diagnosis of nervous system diseases or injury in cats, such as trauma to the spinal cord or diabetic neuropathy.
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Affiliation(s)
- Seiichi Okuno
- Animal Clinic Kobayashi, 715-1 Sakai Fukaya Saitama 366-0813, Japan
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Argyriou AA, Polychronopoulos P, Talelli P, Chroni E. F wave study in amyotrophic lateral sclerosis: Assessment of balance between upper and lower motor neuron involvement. Clin Neurophysiol 2006; 117:1260-5. [PMID: 16678483 DOI: 10.1016/j.clinph.2006.03.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Revised: 02/20/2006] [Accepted: 03/01/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We sought to record significant F wave variable changes in ALS patients having no advanced disease. Furthermore, an interpretation of these F wave abnormalities in the context of upper (UMN) and lower motor neuron (LMN) dysfunction was attempted. METHODS Standard motor and sensory conduction study was performed to the ulnar nerves of 23 patients with ALS (13 males and 10 females with mean age 67.2+/-5.3 years), having a clinically predominant LMN syndrome. A series of 40 electrical stimuli were also delivered to both their ulnar nerves in order to obtain F waves. The following F wave variables were estimated: F persistence, F wave latency, amplitude, duration and F chronodispersion. Twenty-three, age-and gender-matched healthy volunteers served as controls. RESULTS Both the distal and proximal ulnar a-CMAPs (P=0.001) and the MCV (P=0.014) values were significantly decreased in patients, than the controls. The sensory conduction study was normal. The ulnar F wave persistence in the ALS patients was significantly lower than that of the controls (P=0.0007). The mean (P=0.0001), minimal (P=0.0001) and maximal (P=0.0001) F wave latencies were significantly prolonged, the F wave amplitudes (P=0.0001) were significantly higher and the F wave chronodispersion (P=0.014) was significantly increased in the patients than the controls. CONCLUSIONS Significant F wave abnormalities occur in patients with ALS, even those patients having no advanced disease. Increased F wave amplitudes combined with low persistence is a pattern consistent with ALS. SIGNIFICANCE Our results show that patients with ALS having predominantly LMN involvement also have electrophysiological UMN dysfunction.
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Affiliation(s)
- Andreas A Argyriou
- EMG Laboratory, Department of Neurology, The University of Patras Medical School, P.O. Box 1045, 26504 Rion-Patras, Greece
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22
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Chroni E, Katsoulas G, Argyriou AA, Sakellaropoulos GC, Polychronopoulos P, Nikiforidis G. Level of consciousness as a conditioning factor of F wave generation in stroke patients. Clin Neurophysiol 2006; 117:315-9. [PMID: 16386953 DOI: 10.1016/j.clinph.2005.10.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Revised: 10/19/2005] [Accepted: 10/22/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The current study aimed to investigate whether the level of consciousness influenced the F wave generation, as an independent factor. METHODS Forty three patients with acute stroke were divided according to their level of consciousness in two groups; to those with Glasgow scale (GCS) score 3-7 indicating coma (group I) and those with GCS score 8-15 (group II). A series of 40 electrical stimuli were delivered to the ulnar nerve bilaterally in order to obtain F waves. The following variables were estimated and then compared between groups: F persistence, F wave latency, amplitude and duration. All studies were performed within 3 days from the onset of the stroke symptoms. RESULTS The main finding to emerge was the significantly reduced F wave persistence in the group of patients with low GCS score as opposed to patients allocated in the group with GCS score 8-15. This result is referred to F waves obtained from both the affected and unaffected limb. F wave minimum latency was also prolonged in the group with low GCS score, whilst the comparison of all other F wave variables revealed no significant differences between groups I and II. F wave persistence measurements did not differ between the affected and unaffected sides. Stroke location and type (ischemic or hemorrhagic) were not associated with alterations of F wave measurements. CONCLUSIONS Our results on stroke patients suggest that generation of F waves, expressed by the F wave persistence is associated with the level of consciousness. SIGNIFICANCE F wave study may be useful as an objective measure in documenting the severity of consciousness impairment.
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Affiliation(s)
- Elisabeth Chroni
- Department of Neurology, University of Patras Medical School, P.O. Box 1045, 26504 Rion-Patras, Greece.
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de Carvalho M, Scotto M, Lopes A, Swash M. Clinical and neurophysiological evaluation of progression in amyotrophic lateral sclerosis. Muscle Nerve 2003; 28:630-3. [PMID: 14571468 DOI: 10.1002/mus.10469] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There is a need for a sensitive neurophysiological measure of disease progression in following the course of patients with amyotrophic lateral sclerosis (ALS). We studied two groups of nine ALS patients, one with slow progression (Group A) and the other with rapid progression (Group B). We evaluated muscle strength scores using the Medical Research Council (MRC) scale in limb and trunk muscles, forced vital capacity (FVC), and ALS functional rating scale (ALS-FRS) scores. Maximal voluntary isometric contraction (MVIC) of the abductor digiti minimi muscle (ADM) was measured, using a digital device. We also measured M-wave amplitude and area in the ADM, and the distal motor latency and F-wave frequency in the ulnar nerve; from these data, the neurophysiological index (NI) was calculated, as described previously. In both groups, the NI was the most sensitive measure of change, with the smallest coefficient of variation. We conclude that the NI, which requires no special technology and no new clinical or technical skills to use, is sensitive to change, and therefore may be useful in clinical trials, as well as in a clinical setting.
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Affiliation(s)
- Mamede de Carvalho
- Department of Neurology, Hospital de Santa Maria, EMG Laboratory, Centro de Estudos Egas Moniz, Faculty of Medicine, Institute for Molecular Medicine, University of Lisbon, Lisbon, Portugal
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