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Zoccolella S, Milella G, Giugno A, Filardi M, D'Errico E, Tamburrino L, Devitofrancesco V, Damato R, Piomboni F, Misceo S, Logroscino G. Nerve conduction study on the split-hand plus index in Amyotrophic lateral sclerosis: correlations with lower motor neuron impairment. Neurol Sci 2024:10.1007/s10072-024-07582-w. [PMID: 38743164 DOI: 10.1007/s10072-024-07582-w] [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: 04/20/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION In the arms of patients with Amyotrophic lateral sclerosis (ALS) two peculiar patterns of dissociated muscular atrophy have been described: the split-hand sign (with predominant atrophy of the lateral aspect of the hand, compared to hypothenar eminence) and the split-hand-plus sign (SHPS), a predominant abductor pollicis brevis (ABP) atrophy with sparing of flexor pollicis longus (FPL). AIMS In this case-control study, we evaluated the diagnostic utility of a neurophysiological indicator of SHPS and assessed its association with clinical features. METHODS We prospectively studied 59 incident ALS patients, 61 patients with ALS-mimic disorders (OND) and 61 non-neurological controls (NNCs). ABP and FPL compound muscle action potentials (CMAP) amplitudes were obtained by supramaximal stimulation of median nerve at elbow. Split-hand plus index (SHPI) was calculated according to the formula: APB-CMAP/FPL-CMAP. RESULTS SHPI was significantly lower in ALS compared to OND patients and NNCs (p < 0.0001). SHPI value < 1 was observed in 2% of NNCs and 9% of OND patients and demonstrated an accuracy of 71% in differentiating ALS from OND and an accuracy of 74% in differentiating ALS from NNC. SHPI was associated with higher LMN score, and higher disease severity as quantified by the ALSFRS-r. CONCLUSION Our results indicate that SHPI is a reliable indicator to distinguish ALS patients from ONDs and NNCs. SHPI was significantly associated to the degree of lower motor neuron impairment but showed no association with upper motoneuron impairment.
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Affiliation(s)
- Stefano Zoccolella
- Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Via Caposcardicchio snc, Bari, Italy.
- Center for Neurodegenerative Disease and The Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Cardinale G. Panico" Tricase, Lecce, Italy.
| | - Giammarco Milella
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Alessia Giugno
- Center for Neurodegenerative Disease and The Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Cardinale G. Panico" Tricase, Lecce, Italy
| | - Marco Filardi
- Center for Neurodegenerative Disease and The Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Cardinale G. Panico" Tricase, Lecce, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Eustachio D'Errico
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Ludovica Tamburrino
- Center for Neurodegenerative Disease and The Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Cardinale G. Panico" Tricase, Lecce, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Vito Devitofrancesco
- Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Via Caposcardicchio snc, Bari, Italy
| | - Rosaria Damato
- Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Via Caposcardicchio snc, Bari, Italy
| | - Fulvia Piomboni
- Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Via Caposcardicchio snc, Bari, Italy
| | - Salvatore Misceo
- Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Via Caposcardicchio snc, Bari, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Disease and The Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Cardinale G. Panico" Tricase, Lecce, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
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Zoccolella S, Milella G, Giugno A, Devitofrancesco V, Damato R, Tamburrino L, Misceo S, Filardi M, Logroscino G. Neurophysiological indices for split phenomena: correlation with age and sex and potential implications in amyotrophic lateral sclerosis. Front Neurol 2024; 15:1371953. [PMID: 38515451 PMCID: PMC10956616 DOI: 10.3389/fneur.2024.1371953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/19/2024] [Indexed: 03/23/2024] Open
Abstract
Background Split phenomena (SP) are characterized by patterns of differential muscle wasting and atrophy, which are highly prevalent in amyotrophic lateral sclerosis (ALS) patients. Several neurophysiological indicators, including the split-hand index (SHI), split-leg index (SLI), and split-elbow index (SEI), have been proposed to assess SP. Nevertheless, their cutoff values and the impact of age and sex on these measures remain unclear. Methods We prospectively collected neurophysiological data from 300 healthy adult subjects. The following indices were measured from compound muscle action potentials (CMAPs): SHI [abductor pollicis brevis (APBcmap) x first dorsal interosseous (FDI)cmap/adductor digiti minimi (ADMcmap)], SEI (BICEPScmap/TRICEPScmap), SLI (extensor digit brevis (EDB)cmap/abductor Hallucis (AH)cmap), and the neurophysiological ratios APBcmap /ADMcmap and FDIcmap/ADMcmap. Multiple linear regression analysis was used to investigate the association between age, sex, CMAPs, and neurophysiological indicators. Results The median SHI was 10.4, with a median APBcmap/ADMcmap ratio of 0.9 and a median FDIcmap/ADMcmap ratio of 1.2. The median SEI was 1.6 (IQR:1.1-2.4) and the median SLI was 0.7 (IQR:0.5-1.0). Negative associations were observed between age, most of the CMAPs, and all the neurophysiological indices, except for SLI. The male subjects exhibited significantly higher CMAP values for the first dorsal interosseous (FDI), biceps, and SHI compared to the female participants. Conclusion Our findings highlight the importance of age- and sex-adjusted normative data for SP indices, which could enhance their diagnostic accuracy and clinical utility in patients with ALS. The SL index appears to be the most reliable indicator, as it showed no significant association with age or sex.
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Affiliation(s)
- Stefano Zoccolella
- Neurology Unit, San Paolo Hospital, Azienda Sanitaria Locale (ASL) Bari, Bari, Italy
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”, Tricase, Italy
| | - Giammarco Milella
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Alessia Giugno
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”, Tricase, Italy
| | - Vito Devitofrancesco
- Neurology Unit, San Paolo Hospital, Azienda Sanitaria Locale (ASL) Bari, Bari, Italy
| | - Rosaria Damato
- Neurology Unit, San Paolo Hospital, Azienda Sanitaria Locale (ASL) Bari, Bari, Italy
| | - Ludovica Tamburrino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”, Tricase, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Salvatore Misceo
- Neurology Unit, San Paolo Hospital, Azienda Sanitaria Locale (ASL) Bari, Bari, Italy
| | - Marco Filardi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”, Tricase, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”, Tricase, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
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Prado MB, Hamoy-Jimenez G, Adiao KJ. Characteristic and management motor neuron disease in the largest tertiary hospital in the Philippines: A one-year period cross sectional analytic study. J Clin Neurosci 2023; 112:68-72. [PMID: 37104886 DOI: 10.1016/j.jocn.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/02/2023] [Accepted: 04/21/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Motor neuron disease (MND) is largely understudied in many underdeveloped and developing countries, including the Philippines. The practice and management of MND is generally insufficient, and thus, the quality of life of these patients are consequently compromised. OBJECTIVES The aim of this study is to determine the clinical profile and describe the management of MND patients seen in the largest tertiary hospital in the Philippines for one year. METHODS This is a cross-sectional study of MND patients diagnosed clinically and via electromyogram-nerve conduction study (EMG NCS) in the Philippine General Hospital (PGH) from January to December 2022. Clinical characteristics, diagnostics and management information were obtained and summarized. RESULTS The incidence of MND in our neurophysiology unit was 4.3% (28/648), with amyotrophic lateral sclerosis (ALS) being the most common variant (67.9%, n = 19). Male to Female ratio was 1:1, with the median age of onset of 55 (36-72) years old and median onset duration to diagnosis of 1.5 (0.25-8) years. Limb onset was more prevalent (82.14%, n = 23) with upper limbs initially involved (79.1%, n = 18). Split hand syndrome was found in almost half (53.6%) of the patients. The median ALS functional rating score-revised (ALSFRS-R) and medical research council (MRC) scores were 34 (8-47) and 42(16-60) respectively while the median King's clinical stage was 3 (1-4). Only half of the patients were able to undergo magnetic resonance imaging (MRI) and only one had neuromuscular ultrasound. Only one of the 28 patients was able to take riluzole, and only one was on oxygen support. None had gastrostomy and none used non-invasive ventilation. CONCLUSION This study showed that the management of MND in the Philippines is largely inadequate and further improvement in the health care system in handling rare neurologic cases must be implemented to enhance their quality of life.
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Affiliation(s)
- Mario B Prado
- Department of Physiology, College of Medicine, University of the Philippines-Manila, Manila, Philippines; Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines-Manila, Manila, Philippines; Section of Adult Neurology, Department of the Neurosciences, Philippine General Hospital, University of the Philippines-Manila, Manila, Philippines.
| | | | - Karen Joy Adiao
- Section of Adult Neurology, Department of the Neurosciences, Philippine General Hospital, University of the Philippines-Manila, Manila, Philippines.
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Split-elbow sign in the PRO-ACT and Southern Italy ALS cohorts: a potential marker of disease severity and lower motor neuron involvement? J Neurol 2023; 270:3204-3212. [PMID: 36917342 DOI: 10.1007/s00415-023-11660-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Split phenomena in ALS refers to the preferential dysfunction of some groups of muscles over others. The split-elbow sign (SE) is characterized by the predominant weakness of the biceps compared to the triceps, but available results are conflicting. OBJECTIVES To evaluate the prevalence of the SE in two independent cohorts: the randomized controlled trial-based PRO-ACT cohort (n = 500) and a monocentric cohort of patients with ALS from Southern Italy (n = 144); to investigate the demographic and clinical variables associated with the SE sign. METHODS Wilcoxon signed-rank test was used to compare biceps with triceps power in the same limb measured by hand-held dynamometry in the PRO-ACT cohort and Medical Research Council (MRC) in our cohort. Each limb was considered independently and not paired within the same individual. The arm where the triceps was stronger than the biceps was defined SE + , whereas the arm where the biceps was stronger than the triceps was considered SE-. A backward stepwise multivariate logistic regression was used to analyze the relationship between clinical and demographic variables and SE. PENN Upper Motor Neuron and Devine scales were used to evaluate the different upper (UMN) and lower (LMN) motor neuron impairments between the SE + and SE- arms. RESULTS In both cohorts, the biceps were on average stronger than the triceps, and the SE sign was present in 41% of the PRO-ACT cohort and just 30% of the Southern Italy cohort. The multivariate logistic regression revealed that older age (OR: 1.45; p = 0.01), male gender (OR: 1.55; p = 0.002), spinal onset (OR: 1.59; p = 0.007), and higher disease severity (OR: 1.70; p = 0.001) were significant predictors of the SE sign in the PRO-ACT cohort. Conversely, in Southern Italy patients, only a lower ALSFRS-R score was a significant determinant of the SE (OR: 8.47; p = 0.008). Finally, SE + arms exhibited a significantly higher median Devine sub-score compared to SE- [1 vs 0, p = < 0.05], while arms SE- showed a significantly higher median PUMNS sub-score [2 vs 0; p = < 0.05)]. CONCLUSION In our study, most patients with ALS do not show SE. Patients with SE are more likely older, males, with spinal onset, a higher degree of disease severity, and predominant and wider LMN impairment.
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The Sensitivity and Specificity of Split-Hand Index Using Muscle Sonography. Can J Neurol Sci 2023; 50:228-233. [PMID: 35190003 DOI: 10.1017/cjn.2022.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The split-hand index (SHI) (first dorsal interosseous (FDI) × abductor pollicis brevis (APB)/abductor digiti minimi muscle (ADM)) has been suggested as a useful measure for amyotrophic lateral sclerosis (ALS) diagnosis, using electrophysiological and sonographic indices. In the present study, we aimed to explore the specificity of SHI derived by muscle ultrasound (MUS) for the diagnosis of ALS and spinal muscular atrophy (SMA). METHODS Healthy controls (n = 65) were prospectively recruited at the Prosserman Family Neuromuscular clinic at Toronto General Hospital, from October to December 2018. In addition, 181 patients with ALS (n = 91), SMA (n = 33), polyneuropathy (n = 35), and myopathy (n = 22) were prospectively recruited at the neuromuscular clinic at Tel Aviv Sourasky Medical Center, from December 2018 to December 2020. All subjects underwent quantitative sonographic evaluation of muscle thickness, including the right APB, FDI, and ADM muscles. Area under curve (AUC), sensitivity, and specificity were determined for differentiating between groups. RESULTS Although SHI showed good to excellent accuracy for differentiating each patient subgroup from controls (AUC 0.83-0.92), poorer diagnostic accuracy was shown for differentiating between different patient subgroups (AUC 0.54-0.74). CONCLUSIONS Sonographic SHI is useful for differentiating patients from healthy controls, but might be not specific for motor neuron disease.
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Zoccolella S, Giugno A, Logroscino G. Split phenomena in amyotrophic lateral sclerosis: Current evidences, pathogenetic hypotheses and diagnostic implications. Front Neurosci 2023; 16:1100040. [PMID: 36699516 PMCID: PMC9868395 DOI: 10.3389/fnins.2022.1100040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease and has emerged among the disorders with the largest increasing incidence in Western countries. Although the diagnosis is based on clinical grounds, electromyography (EMG), and nerve conduction studies (NCS) play a crucial role to exclude other potential etiologies of lower motor neuron (LMN) dysfunction. Based on clinical grounds, a peculiar pattern of dissociated atrophy of the intrinsic hand and foot muscles, termed the "split-hand" (SH) and "split-leg" (SL) signs, has been described in a significant proportion of subjects with ALS, even at the early stages of the disease, when symptoms are focal. These signs are rare in neurological and non-neurological diseases other than ALS. In this review, we discussed current evidences concerning SH and SL signs, their pathogenetic hypotheses and neurophysiological findings. We also analyze whether SH and SL signs can be reliable markers in the differential diagnosis and in the prognosis of ALS.
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Affiliation(s)
- Stefano Zoccolella
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”, Tricase, Italy,Neurology Unit, Azienda Sanitaria Locale (ASL) Bari, San Paolo Hospital, Bari, Italy,*Correspondence: Stefano Zoccolella,
| | - Alessia Giugno
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”, Tricase, Italy,Department of Medical Sciences, Institute of Neurology, Magna Græcia University, Catanzaro, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”, Tricase, Italy,Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy
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Yamada S, Hashizume A, Hijikata Y, Inagaki T, Ito D, Kishimoto Y, Kinoshita F, Hirakawa A, Shimizu S, Nakamura T, Katsuno M. Mexiletine in spinal and bulbar muscular atrophy: a randomized controlled trial. Ann Clin Transl Neurol 2022; 9:1702-1714. [PMID: 36208052 PMCID: PMC9639628 DOI: 10.1002/acn3.51667] [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] [Received: 08/07/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 11/22/2022] Open
Abstract
Objective Patients with spinal and bulbar muscular atrophy (SBMA) often experience muscular weakness under cold exposure. Methods In our previously conducted observational study, we assessed nerve conduction and grip strength to examine the effect of cold exposure on motor function, based on which we conducted a randomized controlled trial to evaluate the efficacy and safety of mexiletine hydrochloride in SBMA (MEXPRESS). Results In the observational study, 51 consecutive patients with SBMA and 18 healthy controls (HCs) were enrolled. Of the patients with SBMA, 88.0% experienced cold paresis. Patients with SBMA exhibited greater prolongation of ulnar nerve distal latency under cold (SBMA, 5.6 ± 1.1 msec; HC, 4.3 ± 0.6 msec; p <0.001); the change in the distal latencies between room temperature and cold exposure conditions correlated with the change in grip power. In the MEXPRESS trial, 20 participants took mexiletine or lactose, three times a day for 4 weeks with a crossover design. There was no difference in distal latencies at room temperature and under cold exposure between mexiletine and placebo groups as the primary endpoint. However, tongue pressure and 10‐sec grip and release test under cold exposure were improved in the mexiletine group. There were no serious adverse events throughout the study period. Interpretation Cold paresis is common and associated with prolongation of distal latency in SBMA. The results of the phase II clinical trial revealed that mexiletine showed short‐term safety, but it did not restore cold exposure‐induced prolongation of distal latency.
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Affiliation(s)
- Shinichiro Yamada
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Atsushi Hashizume
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Hijikata
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomonori Inagaki
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daisuke Ito
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiyuki Kishimoto
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumie Kinoshita
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinobu Shimizu
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Tomohiko Nakamura
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Nagoya, Japan
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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.
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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.
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Shibuya K, Otani R, Suzuki YI, Kuwabara S, Kiernan MC. Neuronal Hyperexcitability and Free Radical Toxicity in Amyotrophic Lateral Sclerosis: Established and Future Targets. Pharmaceuticals (Basel) 2022; 15:ph15040433. [PMID: 35455429 PMCID: PMC9025031 DOI: 10.3390/ph15040433] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 02/04/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a devastating disease with evidence of degeneration involving upper and lower motor neuron compartments of the nervous system. Presently, two drugs, riluzole and edaravone, have been established as being useful in slowing disease progression in ALS. Riluzole possesses anti-glutamatergic properties, while edaravone eliminates free radicals (FRs). Glutamate is the excitatory neurotransmitter in the brain and spinal cord and binds to several inotropic receptors. Excessive activation of these receptors generates FRs, inducing neurodegeneration via damage to intracellular organelles and upregulation of proinflammatory mediators. FRs bind to intracellular structures, leading to cellular impairment that contributes to neurodegeneration. As such, excitotoxicity and FR toxicities have been considered as key pathophysiological mechanisms that contribute to the cascade of degeneration that envelopes neurons in ALS. Recent advanced technologies, including neurophysiological, imaging, pathological and biochemical techniques, have concurrently identified evidence of increased excitability in ALS. This review focuses on the relationship between FRs and excitotoxicity in motor neuronal degeneration in ALS and introduces concepts linked to increased excitability across both compartments of the human nervous system. Within this cellular framework, future strategies to promote therapeutic development in ALS, from the perspective of neuronal excitability and function, will be critically appraised.
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Affiliation(s)
- Kazumoto Shibuya
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan; (K.S.); (R.O.); (Y.-i.S.); (S.K.)
| | - Ryo Otani
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan; (K.S.); (R.O.); (Y.-i.S.); (S.K.)
| | - Yo-ichi Suzuki
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan; (K.S.); (R.O.); (Y.-i.S.); (S.K.)
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan; (K.S.); (R.O.); (Y.-i.S.); (S.K.)
| | - Matthew C. Kiernan
- Brain and Mind Centre, Department of Neurology, University of Sydney, Royal Prince Alfred Hospital, Sydney 2050, Australia
- Correspondence:
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Martinez-Rojas VA, Juarez-Hernandez LJ, Musio C. Ion channels and neuronal excitability in polyglutamine neurodegenerative diseases. Biomol Concepts 2022; 13:183-199. [DOI: 10.1515/bmc-2022-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/14/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
Polyglutamine (polyQ) diseases are a family composed of nine neurodegenerative inherited disorders (NDDs) caused by pathological expansions of cytosine-adenine-guanine (CAG) trinucleotide repeats which encode a polyQ tract in the corresponding proteins. CAG polyQ repeat expansions produce neurodegeneration via multiple downstream mechanisms; among those the neuronal activity underlying the ion channels is affected directly by specific channelopathies or indirectly by secondary dysregulation. In both cases, the altered excitability underlies to gain- or loss-of-function pathological effects. Here we summarize the repertoire of ion channels in polyQ NDDs emphasizing the biophysical features of neuronal excitability and their pathogenic role. The aim of this review is to point out the value of a deeper understanding of those functional mechanisms and processes as crucial elements for the designing and targeting of novel therapeutic avenues.
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Affiliation(s)
- Vladimir A. Martinez-Rojas
- Institute of Biophysics (IBF), Trento Unit, National Research Council (CNR) , Via Sommarive 18 , 38123 Trento , Italy
| | - Leon J. Juarez-Hernandez
- Institute of Biophysics (IBF), Trento Unit, National Research Council (CNR) , Via Sommarive 18 , 38123 Trento , Italy
| | - Carlo Musio
- Institute of Biophysics (IBF), Trento Unit, National Research Council (CNR) , Via Sommarive 18 , 38123 Trento , Italy
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11
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Tsuneyama A, Shibuya K, Misawa S, Suzuki YI, Suichi T, Kojima Y, Nakamura K, Kano H, Prado MJ, Kuwabara S. Fatigue and activity-dependent conduction block in neuromuscular disorders. Clin Neurophysiol Pract 2022; 7:71-77. [PMID: 35313602 PMCID: PMC8933635 DOI: 10.1016/j.cnp.2022.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 10/27/2022] Open
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12
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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.
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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
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13
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Corcia P, Bede P, Pradat PF, Couratier P, Vucic S, de Carvalho M. Split-hand and split-limb phenomena in amyotrophic lateral sclerosis: pathophysiology, electrophysiology and clinical manifestations. J Neurol Neurosurg Psychiatry 2021; 92:1126-1130. [PMID: 34285065 DOI: 10.1136/jnnp-2021-326266] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/05/2021] [Indexed: 11/03/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder affecting the upper and lower motor neurons. A key clinical feature of ALS is the absence of accurate, early-stage diagnostic indicators. 'Split-hand syndrome' was first described in ALS at the end of the last century and a considerable body of literature suggests that the split-hand phenomenon may be an important clinical feature of ALS. Considering the published investigations, it is conceivable that the 'split-hand syndrome' results from the associated upper and lower motor neuron degeneration, whose interaction remains to be fully clarified. Additionally, other split syndromes have been described in ALS involving upper or lower limbs, with a nuanced description of clinical and neurophysiological manifestations that may further aid ALS diagnosis. In this review, we endeavour to systematically present the spectrum of the 'split syndromes' in ALS from a clinical and neurophysiology perspective and discuss their diagnostic and pathogenic utility.
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Affiliation(s)
- Philippe Corcia
- Centre Constitutif de Référence SLA, CHU Bretonneau, Tours, France
| | - Peter Bede
- Computational Neuroimaging Group, Trinity College Dublin, Ireland.,Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, France
| | - Pierre-François Pradat
- Neurology, Hopital Pitie-Salpetriere, Paris, France.,LIB, Université Pierre et Marie Curie Faculté de Médecine, Paris, Île-de-France, France
| | | | - Steve Vucic
- Westmead Clinical School, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Mamede de Carvalho
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisbon, Lisbon, Portugal.,Department of Neurosciences and Mental Health, Hospital de Santa Maria, Lisboa, Portugal
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14
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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.
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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.
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Clenbuterol-sensitive delayed outward potassium currents in a cell model of spinal and bulbar muscular atrophy. Pflugers Arch 2021; 473:1213-1227. [PMID: 34021780 DOI: 10.1007/s00424-021-02559-6] [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: 01/26/2021] [Revised: 03/09/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
Spinal and bulbar muscular atrophy (SBMA) is a neuromuscular disease caused by polyglutamine (polyQ) expansions in the androgen receptor (AR) gene. SBMA is characterized by selective dysfunction and degeneration of motor neurons in the brainstem and spinal cord through still unclear mechanisms in which ion channel modulation might play a central role as for other neurodegenerative diseases. The beta2-adrenergic agonist clenbuterol was observed to ameliorate the SBMA phenotype in mice and patient-derived myotubes. However, the underlying molecular mechanism has yet to be clarified. Here, we unveil that ionic current alterations induced by the expression of polyQ-expanded AR in motor neuron-derived MN-1 cells are attenuated by the administration of clenbuterol. Our combined electrophysiological and pharmacological approach allowed us to reveal that clenbuterol modifies delayed outward potassium currents. Overall, we demonstrated that the protection provided by clenbuterol restores the normal function through the modulation of KV2-type outward potassium currents, possibly contributing to the protective effect on motor neuron toxicity in SBMA.
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16
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Vucic S. Split-hand sign: clinical feature of spinal bulbar muscular atrophy? J Neurol Neurosurg Psychiatry 2020; 91:1143-1144. [PMID: 33004430 DOI: 10.1136/jnnp-2020-324969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/06/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Steve Vucic
- Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
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