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Higashihara M, Pavey N, Menon P, van den Bos M, Shibuya K, Kuwabara S, Kiernan MC, Koinuma M, Vucic S. Reduction in short interval intracortical inhibition from the early stage reflects the pathophysiology in amyotrophic lateral sclerosis: A meta-analysis study. Eur J Neurol 2024; 31:e16281. [PMID: 38504632 PMCID: PMC11235657 DOI: 10.1111/ene.16281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/13/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND AND PURPOSE Cortical hyperexcitability has been identified as a diagnostic and pathogenic biomarker of amyotrophic lateral sclerosis (ALS). Cortical excitability is assessed by transcranial magnetic stimulation (TMS), a non-invasive neurophysiological technique. The TMS biomarkers exhibiting highest sensitivity for cortical hyperexcitability in ALS remain to be elucidated. A meta-analysis was performed to determine the TMS biomarkers exhibiting the highest sensitivity for cortical hyperexcitability in ALS. METHODS A systematic literature review was conducted of all relevant studies published in the English language by searching PubMed, MEDLINE, Embase and Scopus electronic databases from 1 January 2006 to 28 February 2023. Inclusion criteria included studies reporting the utility of threshold tracking TMS (serial ascending method) in ALS and controls. RESULTS In total, more than 2500 participants, incorporating 1530 ALS patients and 1102 controls (healthy, 907; neuromuscular, 195) were assessed with threshold tracking TMS across 25 studies. Significant reduction of mean short interval intracortical inhibition (interstimulus interval 1-7 ms) exhibited the highest standardized mean difference with moderate heterogeneity (-0.994, 95% confidence interval -1.12 to -0.873, p < 0.001; Q = 38.61, p < 0.05; I2 = 40%). The reduction of cortical silent period duration along with an increase in motor evoked potential amplitude and intracortical facilitation also exhibited significant, albeit smaller, standardized mean differences. CONCLUSION This large meta-analysis study disclosed that mean short interval intracortical inhibition reduction exhibited the highest sensitivity for cortical hyperexcitability in ALS. Combined findings from this meta-analysis suggest that research strategies aimed at understanding the cause of inhibitory interneuronal circuit dysfunction could enhance understanding of ALS pathogenesis.
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Affiliation(s)
- Mana Higashihara
- Department of NeurologyTokyo Metropolitan Institute for Geriatrics and GerontologyTokyoJapan
| | - Nathan Pavey
- Brain and Nerve Research CenterUniversity of SydneySydneyNew South WalesAustralia
| | - Parvathi Menon
- Brain and Nerve Research CenterUniversity of SydneySydneyNew South WalesAustralia
| | - Mehdi van den Bos
- Brain and Nerve Research CenterUniversity of SydneySydneyNew South WalesAustralia
| | - Kazumoto Shibuya
- Neurology, Graduate School of MedicineChiba UniversityChibaJapan
| | - Satoshi Kuwabara
- Neurology, Graduate School of MedicineChiba UniversityChibaJapan
| | - Matthew C. Kiernan
- Neuroscience Resarch AustraliaUniversity of New South WalesSydneyNew South WalesAustralia
- Department of NeurologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Masayoshi Koinuma
- Faculty of Pharmaceutical SciencesTeikyo Heisei UniversityTokyoJapan
- Healthy Aging Innovation CenterTokyo Metropolitan Institute for Geriatrics and GerontologyTokyoJapan
| | - Steve Vucic
- Brain and Nerve Research CenterUniversity of SydneySydneyNew South WalesAustralia
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Manganotti P, Michelutti M, Furlanis G, Deodato M, Buoite Stella A. Deficient GABABergic and glutamatergic excitability in the motor cortex of patients with long-COVID and cognitive impairment. Clin Neurophysiol 2023; 151:83-91. [PMID: 37210757 PMCID: PMC10170904 DOI: 10.1016/j.clinph.2023.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Attention, working memory and executive processing have been reported to be consistently impaired in Neuro-Long coronavirus disease (COVID). On the hypothesis of abnormal cortical excitability, we investigated the functional state of inhibitory and excitatory cortical regulatory circuits by single "paired-pulse" transcranial magnetic stimulation (ppTMS) and Short-latency Afferent Inhibition (SAI). METHODS We compared clinical and neurophysiological data of 18 Long COVID patients complaining of persistent cognitive impairment with 16 Healthy control (HC) subjects. Cognitive status was evaluated by means of the Montreal Cognitive Assessment (MoCA) and a neuropsychological evaluation of the executive function domain; fatigue was scored by the Fatigue Severity Scale (FSS). Resting motor threshold (RMT), the amplitude of the motor evoked potential (MEP), Short Intra-cortical Inhibition (SICI), Intra-cortical Facilitation (ICF), Long-interval Intracortical Inhibition (LICI) and Short-afferent inhibition (SAI) were investigated over the motor (M1) cortex. RESULTS MoCA corrected scores were significantly different between the two groups (p = 0.023). The majority of the patients' performed sub-optimally in the neuropsychological assessment of the executive functions. The majority (77.80%) of the patients reported high levels of perceived fatigue in the FSS. RMT, MEPs, SICI and SAI were not significantly different between the two groups. On the other hand, Long COVID patients showed a reduced amount of inhibition in LICI (p = 0.003) and a significant reduction in ICF (p < 0.001). CONCLUSIONS Neuro-Long COVID patients performing sub-optimally in the executive functions showed a reduction of LICI related to GABAb inhibition and a reduction of ICF related to glutamatergic regulation. No alteration in cholinergic circuits was found. SIGNIFICANCE These findings can help to better understand the neurophysiological characteristics of Neuro-Long COVID, and in particular, motor cortex regulation in people with "brain fog".
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Affiliation(s)
- Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy.
| | - Marco Michelutti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Manuela Deodato
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
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Dietmann A, Blanquet M, Rösler KM, Scheidegger O. Effects of high resistance muscle training on corticospinal output during motor fatigue assessed by transcranial magnetic stimulation. Front Physiol 2023; 14:1125974. [PMID: 36969602 PMCID: PMC10036808 DOI: 10.3389/fphys.2023.1125974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/27/2023] [Indexed: 03/12/2023] Open
Abstract
Introduction: Central fatigue refers to a reduced drive of motor cortical output during exercise, and performance can be enhanced after training. However, the effects of training on central fatigue remain unclear. Changes in cortical output can be addressed non-invasively using transcranial magnetic stimulation (TMS). The aim of the study was to compare responses to TMS during a fatiguing exercise before and after a 3 weeks lasting resistance training, in healthy subjects.Methods: The triple stimulation technique (TST) was used to quantify a central conduction index (CCI = amplitude ratio of central conduction response and peripheral nerve response) to the abductor digiti minimi muscle (ADM) in 15 subjects. The training consisted of repetitive isometric maximal voluntary contractions (MVC) of ADM for 2 min twice a day. Before and after this training, TST recordings were obtained every 15 s during an 2 min exercise of MVC of the ADM, where subjects performed repetitive contractions of the ADM, and repeatedly during a recovery period of 7 min.Results: There was a consistent decrease of force to approximately 40% of MVC in all experiments and in all subjects, both before and after training. In all subjects, CCI decreased during exercise. While before training, theCCI decreased to 49% (SD 23.7%) after 2 min of exercise, it decreased after training onlyto 79% (SD 26.4%) after exercise (p < 0.01).Discussion: The training regimen increased the proportion of target motor units that could be activated by TMS during a fatiguing exercise. The results point to a reduced intracortical inhibition, which may be a transient physiological response to facilitate the motor task. Possible underlying mechanisms at spinal and supraspinal sites are discussed.
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Affiliation(s)
- Anelia Dietmann
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland, Bern, Switzerland
| | - Marisa Blanquet
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland, Bern, Switzerland
| | - Kai Michael Rösler
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland, Bern, Switzerland
- Neurozentrum Basel, Bellevue Medical Group, Basel, Switzerland
| | - Olivier Scheidegger
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland, Bern, Switzerland
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- *Correspondence: Olivier Scheidegger ,
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Versace V, Ortelli P, Dezi S, Ferrazzoli D, Alibardi A, Bonini I, Engl M, Maestri R, Assogna M, Ajello V, Pucks-Faes E, Saltuari L, Sebastianelli L, Kofler M, Koch G. Co-ultramicronized palmitoylethanolamide/luteolin normalizes GABA B-ergic activity and cortical plasticity in long COVID-19 syndrome. Clin Neurophysiol 2023; 145:81-88. [PMID: 36455453 PMCID: PMC9650483 DOI: 10.1016/j.clinph.2022.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/26/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Transcranial magnetic stimulation (TMS) studies showed that patients with cognitive dysfunction and fatigue after COVID-19 exhibit impaired cortical GABAB-ergic activity, as revealed by reduced long-interval intracortical inhibition (LICI). Aim of this study was to test the effects of co-ultramicronized palmitoylethanolamide/luteolin (PEA-LUT), an endocannabinoid-like mediator able to enhance GABA-ergic transmission and to reduce neuroinflammation, on LICI. METHODS Thirty-nine patients (26 females, mean age 49.9 ± 11.4 years, mean time from infection 296.7 ± 112.3 days) suffering from persistent cognitive difficulties and fatigue after mild COVID-19 were randomly assigned to receive either PEA-LUT 700 mg + 70 mg or PLACEBO, administered orally bid for eight weeks. The day before (PRE) and at the end of the treatment (POST), they underwent TMS protocols to assess LICI. We further evaluate short-latency afferent inhibition (SAI) and long-term potentiation (LTP)-like cortical plasticity. RESULTS Patients treated with PEA-LUT but not with PLACEBO showed a significant increase of LICI and LTP-like cortical plasticity. SAI remained unaffected. CONCLUSIONS Eight weeks of treatment with PEA-LUT restore GABAB activity and cortical plasticity in long Covid patients. SIGNIFICANCE This study confirms altered physiology of the motor cortex in long COVID-19 syndrome and indicates PEA-LUT as a candidate for the treatment of this post-viral condition.
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Affiliation(s)
- Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Italy.
| | - Paola Ortelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Italy
| | - Sabrina Dezi
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Italy
| | - Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Italy
| | - Alessia Alibardi
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Italy
| | - Ilenia Bonini
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Italy
| | - Michael Engl
- Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Italy
| | - Roberto Maestri
- Department of Biomedical Engineering, Scientific Institute of Montescano - IRCCS, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Martina Assogna
- Experimental Neuropsychophysiology Lab, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Valentina Ajello
- Department of Cardiac Anesthesia, Tor Vergata University Hospital, Rome, Italy
| | | | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Italy
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Italy
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Giacomo Koch
- Experimental Neuropsychophysiology Lab, Santa Lucia Foundation IRCCS, Rome, Italy,Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
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Ortelli P, Ferrazzoli D, Sebastianelli L, Maestri R, Dezi S, Spampinato D, Saltuari L, Alibardi A, Engl M, Kofler M, Quartarone A, Koch G, Oliviero A, Versace V. Altered motor cortex physiology and dysexecutive syndrome in patients with fatigue and cognitive difficulties after mild COVID-19. Eur J Neurol 2022; 29:1652-1662. [PMID: 35138693 PMCID: PMC9111319 DOI: 10.1111/ene.15278] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/02/2022] [Indexed: 11/28/2022]
Abstract
Background and purpose Fatigue and cognitive difficulties are reported as the most frequently persistent symptoms in patients after mild SARS‐CoV‐2 infection. An extensive neurophysiological and neuropsychological assessment of such patients was performed focusing on motor cortex physiology and executive cognitive functions. Methods Sixty‐seven patients complaining of fatigue and/or cognitive difficulties after resolution of mild SARS‐CoV‐2 infection were enrolled together with 22 healthy controls (HCs). Persistent clinical symptoms were investigated by means of a 16‐item questionnaire. Fatigue, exertion, cognitive difficulties, mood and ‘well‐being’ were evaluated through self‐administered tools. Utilizing transcranial magnetic stimulation of the primary motor cortex (M1) resting motor threshold, motor evoked potential amplitude, cortical silent period duration, short‐interval intracortical inhibition, intracortical facilitation, long‐interval intracortical inhibition and short‐latency afferent inhibition were evaluated. Global cognition and executive functions were assessed with screening tests. Attention was measured with computerized tasks. Results Post COVID‐19 patients reported a mean of 4.9 persistent symptoms, high levels of fatigue, exertion, cognitive difficulties, low levels of well‐being and reduced mental well‐being. Compared to HCs, patients presented higher resting motor thresholds, lower motor evoked potential amplitudes and longer cortical silent periods, concurring with reduced M1 excitability. Long‐interval intracortical inhibition and short‐latency afferent inhibition were also impaired, indicating altered GABAB‐ergic and cholinergic neurotransmission. Short‐interval intracortical inhibition and intracortical facilitation were not affected. Patients also showed poorer global cognition and executive functions compared to HCs and a clear impairment in sustained and executive attention. Conclusions Patients with fatigue and cognitive difficulties following mild COVID‐19 present altered excitability and neurotransmission within M1 and deficits in executive functions and attention.
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Affiliation(s)
- Paola Ortelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Roberto Maestri
- IRCCS Istituti Clinici Scientifici Maugeri, Montescano, Italy
| | - Sabrina Dezi
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Danny Spampinato
- Non-invasive Brain Stimulation Unit, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, United Kingdom
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Alessia Alibardi
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Michael Engl
- Medical Direction, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Angelo Quartarone
- Department of Biomedical Science and Morphological and Functional Images, University of Messina, Italy.,IRCCS Centro "Bonino Pulejo", Messina, Italy.,The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, Department of Neurology, NYU School of Medicine, New York, NY, USA
| | - Giacomo Koch
- Non-invasive Brain Stimulation Unit, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Neuroscience and Rehabilitation, University of Ferrara, Italy
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, Toledo, Spain
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
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6
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Versace V, Sebastianelli L, Ferrazzoli D, Romanello R, Ortelli P, Saltuari L, D'Acunto A, Porrazzini F, Ajello V, Oliviero A, Kofler M, Koch G. Intracortical GABAergic dysfunction in patients with fatigue and dysexecutive syndrome after COVID-19. Clin Neurophysiol 2021; 132:1138-1143. [PMID: 33774378 PMCID: PMC7954785 DOI: 10.1016/j.clinph.2021.03.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/27/2021] [Accepted: 03/01/2021] [Indexed: 12/14/2022]
Abstract
Objective A high proportion of patients experience fatigue and impairment of cognitive functions after coronavirus disease 2019 (COVID-19). Here we applied transcranial magnetic stimulation (TMS) to explore the activity of the main inhibitory intracortical circuits within the primary motor cortex (M1) in a sample of patients complaining of fatigue and presenting executive dysfunction after resolution of COVID-19 with neurological manifestations. Methods Twelve patients who recovered from typical COVID-19 pneumonia with neurological complications and complained of profound physical and mental fatigue underwent, 9 to 13 weeks from disease onset, a psychometric evaluation including a self-reported fatigue numeric-rating scale (FRS, Fatigue Rating Scale) and the Frontal Assessment Battery (FAB). Intracortical activity was evaluated by means of well-established TMS protocols including short-interval intracortical inhibition (SICI), reflecting GABAA-mediated inhibition, long-interval intracortical inhibition (LICI), a marker of GABAB receptor activity, and short-latency afferent inhibition (SAI) that indexes central cholinergic transmission. TMS data were compared to those obtained in a control group of ten healthy subjects (HS) matched by age, sex and education level. Results Post-COVID-19 patients reported marked fatigue according to FRS score (8.1 ± 1.7) and presented pathological scores at the FAB based on Italian normative data (12.2 ± 0.7). TMS revealed marked reduction of SICI, and disruption of LICI as compared to HS. SAI was also slightly diminished. Conclusions The present study documents for the first time reduced GABAergic inhibition in the M1 in patients who recovered from COVID-19 with neurological complications and manifested fatigue and dysexecutive syndrome. Significance TMS may serve as diagnostic tool in cognitive disturbances and fatigue in post-COVID-19 patients.
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Affiliation(s)
- Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy.
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Roberto Romanello
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Paola Ortelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Alessia D'Acunto
- Non-Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Francesco Porrazzini
- Non-Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Valentina Ajello
- Department of Cardiac Anesthesia, Tor Vergata University Hospital, Rome, Italy
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, Toledo, Spain
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Giacomo Koch
- Non-Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy; Department of Neuroscience and Rehabilitation, University of Ferrara, Italy
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Alruwaili AR, Pannek K, Henderson RD, Gray M, Kurniawan ND, McCombe PA. Serial MRI studies over 12 months using manual and atlas-based region of interest in patients with amyotrophic lateral sclerosis. BMC Med Imaging 2020; 20:90. [PMID: 32746800 PMCID: PMC7397614 DOI: 10.1186/s12880-020-00489-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 07/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by loss of upper and lower motor neurons. There is a need for an imaging biomarker to track disease progression. Previously, magnetic resonance imaging (MRI) has shown loss of grey and white matter in the brain of patients with ALS compared to controls. We performed serial diffusion tractography imaging (DTI) study of patients with ALS looking for changes over time. METHODS On all subjects (n = 15), we performed three MRI studies at 6 month intervals. DTI changes were assessed with tract-based spatial statistics (TBSS) and region of interest (ROI) studies. Cortic-spinal tract (CST) was selected for our ROI at the upper level; the posterior limb of internal capsule (PLIC), and a lower level in the pons. RESULTS There was no significant change in DTI measures over 12 months of observation. Better correlation of manual and atlas-based ROI methods was found in the posterior limb of the internal capsule than the pons. CONCLUSION While previous DTI studies showed significant differences between ALS subjects and controls, within individual subjects there is little evidence of progression over 12 months. This suggests that DTI is not a suitable biomarker to assess disease progression in ALS.
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Affiliation(s)
- Ashwag R Alruwaili
- The University of Queensland, Centre for Clinical Research, Brisbane, Australia. .,King Saud University, Riyadh, Saudi Arabia. .,School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Kerstin Pannek
- Australian E-Health Research Centre, CSIRO, Brisbane, Australia
| | - Robert D Henderson
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,The Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
| | - Marcus Gray
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia.,Gehrmann Laboratory, University of Queensland, Brisbane, QLD, Australia
| | - Nyoman D Kurniawan
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia
| | - Pamela A McCombe
- The University of Queensland, Centre for Clinical Research, Brisbane, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,The Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
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Morales-Estrella JL, Aboussouan LS. Sleep Disturbances in Patients with Disorders of the Nerve and Muscle Diseases. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00140-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Dharmadasa T, Matamala JM, Huynh W, Zoing MC, Kiernan MC. Motor neurone disease. HANDBOOK OF CLINICAL NEUROLOGY 2018; 159:345-357. [PMID: 30482326 DOI: 10.1016/b978-0-444-63916-5.00022-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Motor neurone disease (MND) patients exhibit poor gait, balance, and postural control, all of which significantly increases their risk of falling. Falls are frequent in the MND population, and are associated with an increased burden of disease. The complex interplay of both motor and extramotor manifestations in this disease contributes to the heterogeneous and multifactorial causes of such dysfunction. This review highlights the pathophysiologic influence of motor degeneration in gait disturbance, but also the additional influence on postural instability from other inputs such as cognitive impairment, autonomic dysregulation, cerebellar dysfunction, sensory impairment, and extrapyramidal involvement. In various combinations, these impairments are responsible for reduced gait speed and alteration in gait cycle, as well as structurally more variable and disorganized gait patterns. Based on these features, this chapter will also provide disease-specific interventions to assess, manage, and prevent falls in the MND cohort.
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Affiliation(s)
| | | | - William Huynh
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Margaret C Zoing
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.
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10
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Aboussouan LS, Mireles-Cabodevila E. Sleep in Amyotrophic Lateral Sclerosis. CURRENT SLEEP MEDICINE REPORTS 2017. [DOI: 10.1007/s40675-017-0094-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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11
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Shibuya K, Park SB, Geevasinga N, Huynh W, Simon NG, Menon P, Howells J, Vucic S, Kiernan MC. Threshold tracking transcranial magnetic stimulation: Effects of age and gender on motor cortical function. Clin Neurophysiol 2016; 127:2355-61. [DOI: 10.1016/j.clinph.2016.03.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/05/2016] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
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Nazemi M, Raad MH, Arzoomanian CS, Ghasemzadeh A. Fatigue and Depression in Iranian Amyotrophic Lateral Sclerosis Patients in Tehran in 2012. Electron Physician 2016; 8:2194-8. [PMID: 27123230 PMCID: PMC4844488 DOI: 10.19082/2194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 11/12/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease with a progressive and rapid course. Fatigue and depression are common among ALS patients. The aim of this study was to determine the relationship between depression and fatigue in Iranian ALS patients. Methods In this 2012 cross-sectional study, 40 ALS patients, including 22 females and 18 males, were selected through consecutive relapsing-remitting, and 40 age- and gender-matched health controls (HCs) were recruited from Loghman Hakim Hospital in Tehran, Iran. The Persian version of the Fatigue Severity Scale (FSS-Per) questionnaire and depression substance of Hospital Anxiety and Depression Scale (HADS) were used to assess fatigue and depression. Data were analyzed using the Kolmogorov-Sminov Test, Levene’s test, Independent Samples t-test, and Pearson product-moment correlation coefficient. Results We identified a significant and positive relationship between fatigue and depression in patients with ALS (p=0.000). Furthermore, the scores of fatigue and depression in ALS patients were higher than in non-ALS patients. Conclusion The results indicated that there was a relationship between fatigue and depression in ALS patients and that early intervention services can improve these symptoms. Further studies are suggested to investigate the direction of such relationship.
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Affiliation(s)
- Maryam Nazemi
- Master in Personality Psychology, Education and Psychology Faculty, Islamic Azad University, Karaj Branch, Karaj, Iran
| | - Marjan Hassani Raad
- Master in General Psychology, Education and Psychology Faculty, Islamic Azad University, Tehran Science and Research Branch, Tehran, Iran
| | - Christineh Serob Arzoomanian
- Master in Clinical psychology, Education and Psychology Faculty, Islamic Azad University, Roudehen Branch, Roudehen, Iran
| | - Azizreza Ghasemzadeh
- Lecturer in Rehabilitation Science, University of Applied Sciences, Tehran Welfare Organization, Tehran, Iran
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Glass JD. Calming the excitement in ALS. Neurology 2016; 86:1468-9. [DOI: 10.1212/wnl.0000000000002506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Panitz S, Kornhuber M, Hanisch F. The checklist individual strength (CIS20-R) in patients with amyotrophic lateral sclerosis - a longitudinal study. Acta Neurol Scand 2015; 131:372-80. [PMID: 25639482 DOI: 10.1111/ane.12349] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Fatigue may be underestimated symptom in amyotrophic lateral sclerosis (ALS). The self-administered checklist individual strength (CIS20-R) was used to measure both physical and mental fatigue in ALS. MATERIALS AND METHODS Fatigue was measured in 51 consecutive patients with ALS using the fatigue severity scale (FSS) and the CIS20-R (four dimensions: subjective fatigue experience, concentration, motivation, activity). The questionnaire scores were compared with disease and progression parameters [revised ALS functional rating scale (ALS-FRS-R), MRC sum score, slow vital capacity (slow VC)]. Patients had follow-ups at six and 12 months. RESULTS At baseline (mean age: 57.9 years ± 12.3, mean disease duration: 15.8 months ± 12.7) clinical relevant fatigue was seen in 49% in FSS and 40% in CIS20-R. FSS and CIS20-R (except the subscale for concentration) were steadily increasing in the course of the disease. CIS1 (subjective fatigue) but not FSS showed a correlation to the ALS-FRS-R and the progression of the ALS-FRS-R after 12 months. There was a moderate positive correlation between FSS and CIS20-R. CONCLUSIONS The CIS20-R is a sensitive tool to detect clinically relevant fatigue in early stages of ALS. Both physical and mental (motivation) dimensions of fatigue steadily increase during the course of the disease in ALS.
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Affiliation(s)
- S. Panitz
- Department of Neurology; Martin-Luther-University Halle-Wittenberg; Halle Saale Germany
| | - M. Kornhuber
- Department of Neurology; Martin-Luther-University Halle-Wittenberg; Halle Saale Germany
| | - F. Hanisch
- Department of Neurology; Martin-Luther-University Halle-Wittenberg; Halle Saale Germany
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Brown KE, Neva JL, Ledwell NM, Boyd LA. Use of transcranial magnetic stimulation in the treatment of selected movement disorders. Degener Neurol Neuromuscul Dis 2014; 4:133-151. [PMID: 32669907 PMCID: PMC7337234 DOI: 10.2147/dnnd.s70079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 04/23/2014] [Indexed: 11/23/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is a valuable technique for assessing the underlying neurophysiology associated with various neuropathologies, and is a unique tool for establishing potential neural mechanisms responsible for disease progression. Recently, repetitive TMS (rTMS) has been advanced as a potential therapeutic technique to treat selected neurologic disorders. In healthy individuals, rTMS can induce changes in cortical excitability. Therefore, targeting specific cortical areas affected by movement disorders theoretically may alter symptomology. This review discusses the evidence for the efficacy of rTMS in Parkinson’s disease, Huntington’s disease, amyotrophic lateral sclerosis, and multiple sclerosis. It is hoped that gaining a more thorough understanding of the timing and parameters of rTMS in individuals with neurodegenerative disorders may advance both clinical care and research into the most effective uses of this technology.
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Affiliation(s)
| | - Jason L Neva
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Lara A Boyd
- Graduate Program in Rehabilitation Science.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Simon NG, Ayer G, Lomen-Hoerth C. Is IVIg therapy warranted in progressive lower motor neuron syndromes without conduction block? Neurology 2013; 81:2116-20. [PMID: 24212395 DOI: 10.1212/01.wnl.0000437301.28441.7e] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the likelihood of response to IV immunoglobulin (IVIg) by studying consecutive patients presenting with progressive, asymmetric, pure lower motor neuron (LMN) limb weakness, and to determine the clinical phenotype of those who respond. METHODS Thirty-one consecutive patients with progressive, focal-onset LMN limb weakness, without evidence of clinical upper motor neuron signs; sensory, respiratory, or bulbar involvement; or evidence of motor nerve conduction block on electrodiagnostic studies, were prospectively included in this study. Each patient underwent treatment with IVIg (2 g/kg) for a minimum of 3 months. Electrodiagnostic studies, a neuromuscular symptom score, and expanded Medical Research Council sum score were documented before and after IVIg treatment. The final diagnosis was determined after prolonged clinical follow-up. RESULTS Only 3 of 31 patients (10%) responded to IVIg. All responders demonstrated distal upper limb-onset weakness, EMG abnormalities confined to the clinically weak muscles, and a normal creatine kinase. This set of features was also identified in 31% of nonresponders presenting with distal upper limb weakness. Sex, age at onset, number of involved limb regions, and the duration of symptoms before treatment were not significantly different between groups. CONCLUSION The findings of the present study do not support uniform use of IVIg in patients presenting with progressive asymmetric LMN limb weakness. It is suggested that IVIg treatment be limited to patients who demonstrate clinical and laboratory features suggestive of multifocal motor neuropathy. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that IVIg will not improve muscle function in 90% of patients with progressive, asymmetric, pure LMN weakness.
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Affiliation(s)
- Neil G Simon
- From the Department of Neurology (N.G.S., C.L.-H.), University of California, San Francisco; and Walgreens IG Program (G.A.), Chicago, IL
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Scheidegger O, Kamm CP, Humpert SJ, Rösler KM. Corticospinal output during muscular fatigue differs in multiple sclerosis patients compared to healthy controls. Mult Scler 2012; 18:1500-6. [DOI: 10.1177/1352458512438722] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: In multiple sclerosis (MS), fatigue is a common and often disabling symptom. It has multiple causes with central motor fatigue playing an important role. Objective: The objective of this study was to analyse the central motor conduction changes in relation to muscle contraction force during muscle fatigue and recovery in MS patients compared to healthy controls. Methods: A total of 23 MS patients with fatigue and 13 healthy subjects were assessed during 2 minutes of fatiguing exercise of the abductor digiti minimi muscle of the hand and the subsequent 7 minutes of recovery. Central motor conduction was quantified by transcranial magnetic stimulation using the triple stimulation protocol and calculating a central conduction index (CCI). Results: Force declined to 36% of the pre-exercise level (SD 16%; p < 0.01) in MS patients and to 44% (SD 9%, p < 0.01) in healthy subjects (group differences, not statistically significant). The decline of the CCI was significantly less marked in patients (–20%, SD 26%, p < 0.05) than in healthy subjects (–57%, SD 15%, p < 0.05; group differences, p < 0.05). The decline of force and CCI were not correlated in either group. Conclusions: During a fatiguing exercise, the decline in central motor conduction is significantly less pronounced in MS patients than healthy subjects, although the reduction of force is similar.
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Affiliation(s)
- O Scheidegger
- Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - CP Kamm
- Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - SJ Humpert
- Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - KM Rösler
- Inselspital, Bern University Hospital and University of Bern, Switzerland
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