1
|
Taniguchi S, Matsuura Y, Takehara T, Yamada A, Shiko Y, Nakagawa K, Ohtori S. Thumb Pronation Angle in Thumb Opposition Evaluated by the Nail Tip Angle of Thumb-Ring Finger Opposition. Hand (N Y) 2024:15589447241236249. [PMID: 38491921 DOI: 10.1177/15589447241236249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
BACKGROUND This study aimed to devise the method for the evaluation of the thumb pronation angle and calculate its reference value. METHODS The study was conducted from October 2021 to March 2022, and 600 hands of 300 healthy volunteers were included in this study. The participants were divided into 6 age groups with 50 participants each. In study 1, 12 participants from group 1 were randomly selected, which included 6 male and 6 female participants. We measured the thumb pronation angle using FASTRAK system and the nail tip angle of thumb-ring finger opposition (T-R angle) and also evaluated the relation between them. In study 2, we measured the T-R angle of 600 hands of 300 healthy volunteers. The T-R angle mean (SD) and 95% confidence interval (CI) of each age group were calculated as reference values. RESULTS The thumb pronation angle was correlated with the T-R angle. The T-R angle mean (SD) and 95% CI of the 6 groups were as follows: group 1, 142.5° (12.4) and 117.7 to 167.3; group 2, 139.9° (10.1) and 119.7 to 160.1; group 3, 142.3° (9.7) and 122.9 to 160.5; group 4, 140.2° (12.6) and 115.0 to 165.4; group 5, 138.3° (11.9) and 114.5 to 162.1; and group 6, 135.4° (13.0) and 109.4 to 161.4. The 95% CI tended to decrease with an increasing age. CONCLUSIONS The T-R angle was a suitable evaluation method for the thumb pronation angle, and it should be evaluated by age groups.
Collapse
Affiliation(s)
- Shinji Taniguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan
- Department of Orthopaedic Surgery, Toho University School of Medicine, Sakura, Japan
| | - Yusuke Matsuura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | | | - Ayae Yamada
- Department of Rehabilitation, Chiba University Hospital, Japan
| | - Yuki Shiko
- Clinical Research Center, Graduate School of Medicine, Chiba University, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University School of Medicine, Sakura, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan
| |
Collapse
|
2
|
Lu WZ, Lin HA, Hou SK, Lee CF, Bai CH, Lin SF. Split-hand index for amyotrophic lateral sclerosis diagnosis: A frequentist and Bayesian meta-analysis. Clin Neurophysiol 2022; 143:56-66. [PMID: 36116424 DOI: 10.1016/j.clinph.2022.08.020] [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: 04/12/2022] [Revised: 08/02/2022] [Accepted: 08/21/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Preferential wasting of the thenar muscles, the split-hand sign, may be used for early diagnosis of amyotrophic lateral sclerosis (ALS). METHODS Electronic databases were searched for studies assessing the split-hand index (SHI) and the compound muscle action potential (CMAP) amplitudes of abductor pollicis brevis (APB), first dorsal interosseous (FDI), and abductor digiti minimi (ADM). The SHI was obtained by multiplying CMAP amplitudes of APB and FDI and dividing the product by the CMAP amplitude of ADM. The Bayesian analysis was used for validation. RESULTS In total, 17 studies and 1635 patients were included. Our meta-analysis revealed that ALS patients had significantly decreased SHI (standardized mean difference [SMD], -1.60, P < 0.001), CMAP of the APB (SMD, -1.67, P < 0.001), FDI (SMD, -1.12, P < 0.001), and ADM (SMD, -1.09, P < 0.001). The binormal receiver operating characteristic curve analysis showed a threshold of < 7.4 for SHI, and cutoff values of < 6.4 mV for APB and < 8.4 mV for FDI, respectively. The Bayesian analysis validated decreased SHI in ALS patients (posterior mean difference of - 5.91). CONCLUSIONS An SHI of < 7.4 can be used facilitating earlier diagnosis of ALS. SIGNIFICANCE SHI can be used as a standard neurophysiological biomarker for early diagnosis.
Collapse
Affiliation(s)
- Wei-Zhen Lu
- Department of Emergency Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Hui-An Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sen-Kuang Hou
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Fan Lee
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Sheng-Feng Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan; School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
3
|
Reassessing the Diagnostic Utility of the Split Hand Index in Amyotrophic Lateral Sclerosis Patients-The Divide by Zero Problem. Neurol Int 2022; 14:707-715. [PMID: 36135994 PMCID: PMC9503317 DOI: 10.3390/neurolint14030059] [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: 07/24/2022] [Revised: 08/18/2022] [Accepted: 08/25/2022] [Indexed: 11/28/2022] Open
Abstract
We set out to assess the diagnostic utility of the split hand index (SHI) for amyotrophic lateral sclerosis (ALS) and also to see if and how it can be applied to severely atrophied muscles, a frequent finding in this setting. We enrolled 38 patients from our clinic, 19 diagnosed with ALS and 19 controls, matched for age and sex. The SHI was calculated, on both sides, for all the patients. We calculated a SHI of 0 when the abductor pollicis brevis muscle (ABD) or first dorsal interosseous muscle (FDI) compound muscle action potentials (CMAPs) were unobtainable, and we allotted a value of 0.1 mV to abductor digiti minimi muscle (ADM) CMAP, for mathematical purposes, when the value would have been 0. The means differences were large between groups, with a significant variance heterogeneity. We performed a ROC analysis and obtained an accuracy of 0.83 for a SHI of 7.2, p-value < 0.0001. In conclusion, we reaffirm the utility of the SHI in the diagnosis of ALS, especially in limb onset cases, and we think that it can be safely extended to severely atrophied muscles with absent or very low CMAP values, without endangering the sensitivity or specificity.
Collapse
|
4
|
Pechirra G, Swash M, de Carvalho M. The senile hand: age effects on intrinsic hand muscle CMAP amplitudes influence split-hand index calculations. Muscle Nerve 2022; 65:463-467. [PMID: 34993957 DOI: 10.1002/mus.27489] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/26/2021] [Accepted: 12/31/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION/AIMS Age can affect hand muscles non-uniformly. We investigated the influence of age on the compound muscle action potential (CMAP) amplitude of the hand muscles and the derived split-hand index (SHI). METHODS We studied 244 subjects investigated for myasthenia gravis but without neuromuscular disorders. Abductor pollicis brevis (APB), first dorsal interosseous (FDI), and abductor digiti minimi (ADM) CMAPs were obtained by supramaximal stimulation at the wrist, recording with surface electrodes while checking the best recording site. We applied Tukey's HSD and Kruskal-Wallis one-way analysis of variance for comparing age groups defined by median and inter-quantile ranges (IQR). Spearman's rank correlation coefficient and linear regression were used for testing age-dependence of measurements. RESULTS Median age was 61.5 years (1st IQR 44.5, 3rd IQR 72.0, range 18-89). Age and neurophysiological measurements were similar between genders. APBCMAP , FDICMAP , ADMCMAP and SHI were correlated with age (p < 0.001). Median and cut-off values were significantly different between age groups. APBCMAP , FDICMAP and ADMCMAP decreased by 0.8/0.7/0.3 mV/year, respectively, and SHI decreased 0.15/year. DISCUSSION The CMAP amplitudes of hand muscles and derived SHI were strongly age-dependent, although this effect was less in ADM. This represents a physiological phenomenon. Future studies using the SHI should consider age effects. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Gonçalo Pechirra
- Faculdade de Medicina-Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - Michael Swash
- Departments of Neurology and Neuroscience, Queen Mary University of London, UK.,Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa-Norte, Lisbon, Portugal
| | - Mamede de Carvalho
- Faculdade de Medicina-Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal.,Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa-Norte, Lisbon, Portugal
| |
Collapse
|
5
|
Hu N, Wang J, Liu M. Split hand in amyotrophic lateral sclerosis: A systematic review and meta-analysis. J Clin Neurosci 2021; 90:293-301. [PMID: 34275566 DOI: 10.1016/j.jocn.2021.06.015] [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: 03/16/2021] [Revised: 05/05/2021] [Accepted: 06/06/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the frequency of split hand (SI) and its diagnostic performance in amyotrophic lateral sclerosis (ALS). METHODS PubMed, EMBASE, OVID and other databases were searched systematically up to March 2021 for relevant reports about the split hand syndrome. Two reviewers screened and selected the titles and abstracts of the studies independently during the database searches and performed full-text reviews and extracted available data. In our study, AACMAP was calculated by AACMAP = APBCMAP/ADMCMAP and split-hand index (SI) was calculated by SICMAP = (APBCMAP × FDICMAP)/ADMCMAP. The mean differences (MD) in APB/ADMCMAP and SICMAP between patients with ALS and control group were calculated (APB the abductor pollicis brevis muscle; ADM the abductor digiti minimi muscle; CMAP compound muscle action potentials). Meta-analysis was performed to determine summary sensitivity, specificity, and area under the curve (AUC) with 95% confidence intervals (CI) for SICMAP. RESULTS Pooled results of five studies including 339 patients showed that 50% (95%CI: 35%-65%) of patients with ALS presented split hand. APB/ADMCMAP in patients with ALS was significantly lower than healthy population (MD: -0.38, 95%CI: -0.48, -0.28). SICMAP in patients with ALS was significantly lower than healthy controls (MD: -5.87, 95%CI: -6.28, -5.46) and neuromuscular controls (MD: -5.60, 95%CI: -5.78, -5.42). Receiver operating characteristic curve analysis showed that the AUC was 0.860 [95%CI: 0.808, 0.911] for SICMAP. The sensitivity and specificity for SICMAP were 78% and 81% (cut-off value: 5.2-11.8), respectively. CONCLUSION Half of ALS patients might show split hand sign. SICMAP could be a potential biomarker in the diagnosis of ALS.
Collapse
Affiliation(s)
- Nan Hu
- Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Jingyi Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, China.
| |
Collapse
|
6
|
Liu J, Wang Z, Shen D, Yang X, Liu M, Cui L. Split phenomenon of antagonistic muscle groups in amyotrophic lateral sclerosis: relative preservation of flexor muscles. Neurol Res 2020; 43:372-380. [PMID: 33372862 DOI: 10.1080/01616412.2020.1866354] [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: 12/12/2022]
Abstract
Objective: In addition to the split hand sign, other split phenomena of different muscles also exist in amyotrophic lateral sclerosis (ALS). We analyzed the incidence of split phenomena in multiple antagonistic muscle groups in ALS patients and explored whether clinical factors affected their occurrence.Methods: 618 ALS patients were included from a single ALS center. Muscle strength in upper and lower limbs was evaluated using the modified Medical Research Council (MRC) scoring system (range from 1 to 13). Split phenomena between different antagonistic muscle groups were summarized, and the correlations with clinical factors were analyzed.Results: Split phenomena were detected in 22.3% antagonistic muscles for flexion and extension of the elbow, 11.9% for the wrist, 23.9% for fingers, 18.2% for the ankle, and 14.7% for toes. These manifestations were characterized by preferential wasting of the elbow, wrist, and finger extensor muscles compared with the flexor muscles, and the ankle and toe dorsiflexor muscles compared with the plantar flexor muscles. The presence of muscle wasting was more common when the muscle strength was stronger than a modified MRC grade 6. No definite correlation was found between split phenomena and clinical factors, including age-at-onset, gender, disease duration, the region of onset, and pyramidal tract damage.Discussion: Split phenomena of antagonistic muscle groups widely exist in ALS patients. No definitive and consistent clinical factors were observed that affected the occurrence of these phenomena.
Collapse
Affiliation(s)
- Jingwen Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhili Wang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Dongchao Shen
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xunzhe Yang
- 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
| | - 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
| |
Collapse
|
7
|
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
| |
Collapse
|
8
|
de Carvalho M, Swash M. The “split-leg” syndrome in ALS: specific or variable? Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:615-616. [DOI: 10.1080/21678421.2019.1643376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mamede de Carvalho
- Institute of Physiology Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal,
- Department of Neurosciences and Mental Health, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal, and
| | - Michael Swash
- Institute of Physiology Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal,
- Departments of Neurology and Neuroscience, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| |
Collapse
|
9
|
Choi H, Choi JH, Kang S, Yoon JS, Son SH. Pilot study: Differences in echo intensity ratios between ulnar and median innervated muscles in ulnar neuropathy. Muscle Nerve 2019; 60:387-391. [PMID: 31294856 DOI: 10.1002/mus.26631] [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: 06/03/2018] [Revised: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study evaluated muscle echo intensity (EI) ratio in patients with ulnar neuropathy at the elbow (UNE) and healthy controls. METHODS In this prospective study, 28 patients with electrodiagnostically confirmed unilateral UNE and 12 healthy controls were ultrasonographically assessed for EI ratios of the hypothenar and thenar muscles. The affected and unaffected hands between the UNE patients and controls and patient subgroups (subdivided according to electrodiagnostic severity) were compared to determine any significant differences. RESULTS In patients with UNE, the EI ratio of the hypothenar to thenar muscles was significantly higher for the affected side than for the unaffected side (1.08 ± 0.11 and 0.97 ± 0.18, respectively) or the control group (0.95 ± 0.05). A significant difference in the EI ratio was observed among the subgroups (mild vs. severe subgroup, P < 0.01). CONCLUSIONS Ultrasonographic EI measurement may be a useful parameter in the evaluation and screening of UNE.
Collapse
Affiliation(s)
- Hanboram Choi
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jun Ho Choi
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seok Kang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seong-Ho Son
- Department of Mechanical Engineering, Soonchunhyang University, Asan, 31538, Korea
| |
Collapse
|
10
|
de Carvalho M, Swash M. The split hand in amyotrophic lateral sclerosis: a possible role for the neuromuscular junction. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:368-375. [DOI: 10.1080/21678421.2019.1606245] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mamede de Carvalho
- Faculty of Medicine, Institute of Physiology Unit, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal,
- Department of Neurosciences and Mental Health, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal, and
| | - Michael Swash
- Faculty of Medicine, Institute of Physiology Unit, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal,
- Department of Neurology and Neuroscience, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| |
Collapse
|
11
|
Fang J, Liu MS, Guan YZ, Du H, Li BH, Cui B, Ding QY, Cui LY. Pattern Differences of Small Hand Muscle Atrophy in Amyotrophic Lateral Sclerosis and Mimic Disorders. Chin Med J (Engl) 2017; 129:792-8. [PMID: 26996473 PMCID: PMC4819298 DOI: 10.4103/0366-6999.178953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Amyotrophic lateral sclerosis (ALS) and some mimic disorders, such as distal-type cervical spondylotic amyotrophy (CSA), Hirayama disease (HD), and spinobulbar muscular atrophy (SBMA) may present with intrinsic hand muscle atrophy. This study aimed to investigate different patterns of small hand muscle involvement in ALS and some mimic disorders. Methods: We compared the abductor digiti minimi/abductor pollicis brevis (ADM/APB) compound muscle action potential (CMAP) ratios between 200 ALS patients, 95 patients with distal-type CSA, 88 HD patients, 43 SBMA patients, and 150 normal controls. Results: The ADM/APB CMAP amplitude ratio was significantly higher in the ALS patients (P < 0.001) than that in the normal controls. The ADM/APB CMAP amplitude ratio was significantly reduced in the patients with distal-type CSA (P < 0.001) and the HD patients (P < 0.001) compared with that in the normal controls. The patients with distal-type CSA had significantly lower APB CMAP amplitude than the HD patients (P = 0.004). The ADM/APB CMAP amplitude ratio was significantly lower in the HD patients (P < 0.001) than that in the patients with distal-type CSA. The ADM/APB CMAP amplitude ratio of the SBMA patients was similar to that of the normal controls (P = 0.862). An absent APB CMAP and an abnormally high ADM/APB CMAP amplitude ratio (≥4.5) were observed exclusively in the ALS patients. Conclusions: The different patterns of small hand muscle atrophy between the ALS patients and the patients with mimic disorders presumably reflect distinct pathophysiological mechanisms underlying different disorders, and may aid in distinguishing between ALS and mimic disorders.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Li-Ying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| |
Collapse
|
12
|
Singh RJ, Preethish-Kumar V, Polavarapu K, Vengalil S, Prasad C, Nalini A. Reverse split hand syndrome: Dissociated intrinsic hand muscle atrophy pattern in Hirayama disease/brachial monomelic amyotrophy. Amyotroph Lateral Scler Frontotemporal Degener 2016; 18:10-16. [DOI: 10.1080/21678421.2016.1223140] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ravinder-Jeet Singh
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India,
| | - Veeramani Preethish-Kumar
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru, India, and
| | - Kiran Polavarapu
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru, India, and
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India,
| | - Chandrajit Prasad
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India,
| |
Collapse
|
13
|
Mori A, Yamashita S, Nakajima M, Hori H, Tawara A, Matsuo Y, Misumi Y, Ando Y. CMAP decrement as a potential diagnostic marker for ALS. Acta Neurol Scand 2016; 134:49-53. [PMID: 26434688 DOI: 10.1111/ane.12510] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We previously reported that decrement of compound muscle action potential (CMAP) by repetitive nerve stimulation (RNS) was greater in the median nerves than in the ulnar nerves of patients with amyotrophic lateral sclerosis (ALS). The aim of this study was to evaluate whether CMAP decrement by RNS is a feasible marker for the differentiation of ALS from other diseases. MATERIALS & METHODS We performed RNS in the median and ulnar nerves of 51 patients with ALS and 40 patients with other diseases. RESULTS The CMAP decrement was significantly greater in the median nerves of patients with ALS, compared to the disease control patients. In the median nerves of patients with ALS, CMAP decrement was significantly greater in the cervical region-onset group than in the other region-onset group. CONCLUSIONS The finding of CMAP decrement in the median nerves can be useful for differentiating ALS patients with cervical region onset from other controls with active neuropathic diseases.
Collapse
Affiliation(s)
- A. Mori
- Department of Neurology; Graduate School of Medical Sciences; Kumamoto University; Chuo-ku Kumamoto Japan
| | - S. Yamashita
- Department of Neurology; Graduate School of Medical Sciences; Kumamoto University; Chuo-ku Kumamoto Japan
| | - M. Nakajima
- Department of Neurology; Graduate School of Medical Sciences; Kumamoto University; Chuo-ku Kumamoto Japan
| | - H. Hori
- Department of Neurology; Graduate School of Medical Sciences; Kumamoto University; Chuo-ku Kumamoto Japan
| | - A. Tawara
- Department of Neurology; Graduate School of Medical Sciences; Kumamoto University; Chuo-ku Kumamoto Japan
| | - Y. Matsuo
- Department of Neurology; Graduate School of Medical Sciences; Kumamoto University; Chuo-ku Kumamoto Japan
| | - Y. Misumi
- Department of Neurology; Graduate School of Medical Sciences; Kumamoto University; Chuo-ku Kumamoto Japan
| | - Y. Ando
- Department of Neurology; Graduate School of Medical Sciences; Kumamoto University; Chuo-ku Kumamoto Japan
| |
Collapse
|
14
|
Dissociated lower limb muscle involvement in amyotrophic lateral sclerosis. J Neurol 2015; 262:1424-32. [DOI: 10.1007/s00415-015-7721-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 03/22/2015] [Accepted: 03/23/2015] [Indexed: 12/13/2022]
|
15
|
Menon P, Kiernan MC, Vucic S. ALS pathophysiology: Insights from the split-hand phenomenon. Clin Neurophysiol 2014; 125:186-93. [DOI: 10.1016/j.clinph.2013.07.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 07/16/2013] [Accepted: 07/22/2013] [Indexed: 12/13/2022]
|
16
|
de Carvalho M. A handful of promises. Clin Neurophysiol 2013; 125:5. [PMID: 24064247 DOI: 10.1016/j.clinph.2013.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 08/12/2013] [Accepted: 08/13/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Mamede de Carvalho
- Clinical and Translational Physiology Unit, Physiology Institute, Faculty of Medicine-Instituto de Medicina Molecular, University of Lisbon, Av. Professor Egas Moniz, Lisbon 1649-028, Portugal.
| |
Collapse
|
17
|
Bae JS, Simon NG, Menon P, Vucic S, Kiernan MC. The puzzling case of hyperexcitability in amyotrophic lateral sclerosis. J Clin Neurol 2013; 9:65-74. [PMID: 23626643 PMCID: PMC3633193 DOI: 10.3988/jcn.2013.9.2.65] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 08/24/2012] [Accepted: 08/24/2012] [Indexed: 12/11/2022] Open
Abstract
The development of hyperexcitability in amyotrophic lateral sclerosis (ALS) is a well-known phenomenon. Despite controversy as to the underlying mechanisms, cortical hyperexcitability appears to be closely related to the interplay between excitatory corticomotoneurons and inhibitory interneurons. Hyperexcitability is not a static phenomenon but rather shows a pattern of progression in a spatiotemporal aspect. Cortical hyperexcitability may serve as a trigger to the development of anterior horn cell degeneration through a 'dying forward' process. Hyperexcitability appears to develop during the early disease stages and gradually disappears in the advanced stages of the disease, linked to the destruction of corticomotorneuronal pathways. As such, a more precise interpretation of these unique processes may provide new insight regarding the pathophysiology of ALS and its clinical features. Recently developed technologies such as threshold tracking transcranial magnetic stimulation and automated nerve excitability tests have provided some clues about underlying pathophysiological processes linked to hyperexcitability. Additionally, these novel techniques have enabled clinicians to use the specific finding of hyperexcitability as a useful diagnostic biomarker, enabling clarification of various ALS-mimic syndromes, and the prediction of disease development in pre-symptomatic carriers of familial ALS. In terms of nerve excitability tests for peripheral nerves, an increase in persistent Na+ conductances has been identified as a major determinant of peripheral hyperexcitability in ALS, inversely correlated with the survival in ALS. As such, the present Review will focus primarily on the puzzling theory of hyperexcitability in ALS and summarize clinical and pathophysiological implications for current and future ALS research.
Collapse
Affiliation(s)
- Jong Seok Bae
- Department of Neurology, College of Medicine, Inje University, Busan, Korea. ; Neuroscience Research Australia, Sydney, Australia
| | | | | | | | | |
Collapse
|
18
|
Split-hand to diagnosis shot. Clin Neurophysiol 2013; 124:219-20. [DOI: 10.1016/j.clinph.2012.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 08/22/2012] [Accepted: 08/23/2012] [Indexed: 11/23/2022]
|
19
|
Menon P, Bae JS, Mioshi E, Kiernan MC, Vucic S. Split-hand plus sign in ALS: Differential involvement of the flexor pollicis longus and intrinsic hand muscles. Amyotroph Lateral Scler Frontotemporal Degener 2012; 14:315-8. [DOI: 10.3109/21678421.2012.734521] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
20
|
Pennisi M, Raggi A, Barone R, Muglia M, Citrigno L, Cantone M, Lanza G, Pennisi G, Ferri R, Bella R. Phenotypic heterogeneity in hereditary motor neuropathy type V: a new case report series. Acta Neurol Belg 2012; 112:57-64. [PMID: 22427291 DOI: 10.1007/s13760-012-0042-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 01/13/2012] [Indexed: 02/07/2023]
Abstract
Previous studies have revealed a wide phenotypic heterogeneity in hereditary motor neuropathy type V in which upper and lower motor neurons and peripheral motor axons are variously affected, even within the same family. In this case series, we describe the genetic, clinical and electrophysiological features of patients belonging to a four-generation Italian family. Because of a possible anticipation phenomenon, the disorder became apparent at an earlier age as it passed to the next generation, with a median age of onset of 65 years for the first 2 generations, 32 for the third, and 13.5 for the fourth. The symptoms at onset varied considerably among the sufferers, with a predominant impairment of the hands in seven cases, the impairment of the four limbs in one patient and only of the lower limbs in another. Also muscle atrophy was variable, from very mild to severe (wasting of the distal muscles of the limbs). Moreover, electrophysiological results were heterogeneous, including cases with isolated and with diffuse axonal motor neuropathy, and one case of motor sensory polyneuropathy. A novel polymorphism G→T was also found in the Berardinelli-Seip congenital lipodystrophy 2 gene on intron 4. This broad phenotypic and genotypic spectrum calls the clinician attention to this rare and still insufficiently known disease.
Collapse
Affiliation(s)
- Manuela Pennisi
- Biochemistry and Molecular Biology Section, Department of Chemistry, University of Catania, Catania, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Yamashita S, Sakaguchi H, Mori A, Kimura E, Maeda Y, Hirano T, Uchino M. Significant CMAP decrement by repetitive nerve stimulation is more frequent in median than ulnar nerves of patients with amyotrophic lateral sclerosis. Muscle Nerve 2012; 45:426-8. [DOI: 10.1002/mus.22301] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
22
|
Lindberg P, Ody C, Feydy A, Maier MA. Precision in isometric precision grip force is reduced in middle-aged adults. Exp Brain Res 2008; 193:213-24. [PMID: 18953529 DOI: 10.1007/s00221-008-1613-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 10/07/2008] [Indexed: 11/29/2022]
Abstract
We investigated age related changes in the control of precision grip in 29 healthy adults spanning early adulthood to middle age (21-67 years). Subjects performed a visually guided, isometric precision grip ramp-and-hold force-tracking task. Target force levels were 3, 6, and 9 N. Precision and performance of force regulation was quantified. Larger errors were made during the ramp than during the hold phase. Age correlated positively with the amount of error at the lowest (3 N) force level in both phases. Force onsets were systematically earlier in middle-aged subjects and the average slope of the force during the ramp decreased with increasing age. The results show that precision during low grip force control decreases already during middle age and those subjects may modify their force generation strategies to compensate for early and subtle degenerative changes in the motor system before decline in grip strength is apparent.
Collapse
|
23
|
Kuwabara S, Sonoo M, Komori T, Shimizu T, Hirashima F, Inaba A, Misawa S, Hatanaka Y. Dissociated small hand muscle atrophy in amyotrophic lateral sclerosis: Frequency, extent, and specificity. Muscle Nerve 2008; 37:426-30. [DOI: 10.1002/mus.20949] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|