| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Department of Neurology and the Human Motor Physiology Laboratory (Drs. Triggs and Young), the University of Florida College of Medicine, Gainesville, FL; and the Department of Neurology and EMG Laboratory (Drs. Menkes, Onorato, Tan, Sander, Soto, Chiappa, and Cros) and Pathology (Dr. Newell), Massachusetts General Hospital, Boston, MA.
Address correspondence and reprint requests to Dr. Didier Cros, EMG Laboratory, Massachusetts General Hospital, Boston, MA 02114.
OBJECTIVE: To evaluate the sensitivity of transcranial magnetic stimulation (TMS) to identify upper motor neuron involvement in patients with motor neuron disease.
BACKGROUND: Diagnosis of ALS depends on upper and lower motor neuron involvement. Lower motor neuron involvement may be documented with electromyography, whereas definite evidence of upper motor neuron involvement may be elusive. A sensitive, noninvasive test of upper motor neuron function would be useful.
METHODS: TMS and clinical assessment in 121 patients with motor neuron disease.
RESULTS: TMS revealed evidence of upper motor neuron dysfunction in 84 of 121 (69%) patients, including 30 of 40 (75%) patients with only probable upper motor neuron signs and unsuspected upper motor neuron involvement in 6 of 22 (27%) patients who had purely lower motor neuron syndromes clinically. In selected cases, upper motor neuron involvement identified with TMS was verified in postmortem examination. Increased motor evoked potential threshold was the abnormality observed most frequently and was only weakly related to peripheral compound muscle action potential amplitude. In a subset of 12 patients reexamined after 11 ± 6 months, TMS showed progression of abnormalities, including progressive inexcitability of central motor pathways and loss of the normal inhibitory cortical stimulation silent period.
CONCLUSIONS: TMS provides a sensitive means for the assessment and monitoring of excitatory and inhibitory upper motor neuron function in motor neuron disease.
This article has been cited by other articles:
|
|
 |
|
  A Rico, B Audoin, J Franques, A Eusebio, F Reuter, I Malikova, A Ali Cherif, J Pouget, J Pelletier, and S Attarian Motor evoked potentials in clinically isolated syndrome suggestive of multiple sclerosis Multiple Sclerosis, March 1, 2009; 15(3): 355 - 362. [Abstract] [PDF]
|
|
|
|
 |
|
 A. G. Floyd, Q. P. Yu, P. Piboolnurak, M. X. Tang, Y. Fang, W. A. Smith, J. Yim, L. P. Rowland, H. Mitsumoto, and S. L. Pullman Transcranial magnetic stimulation in ALS: Utility of central motor conduction tests Neurology, February 10, 2009; 72(6): 498 - 504. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Vucic, G. A. Nicholson, and M. C. Kiernan Cortical hyperexcitability may precede the onset of familial amyotrophic lateral sclerosis Brain, June 1, 2008; 131(6): 1540 - 1550. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. J. Triggs and D. Cros Case 40-2007 -- A 38-Year-Old Man with Weakness in the Hands N. Engl. J. Med., December 27, 2007; 357(26): 2707 - 2715. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Vucic, A. V Krishnan, and M. C Kiernan Fatigue and activity dependent changes in axonal excitability in amyotrophic lateral sclerosis J. Neurol. Neurosurg. Psychiatry, November 1, 2007; 78(11): 1202 - 1208. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Vucic and M. C Kiernan Abnormalities in cortical and peripheral excitability in flail arm variant amyotrophic lateral sclerosis J. Neurol. Neurosurg. Psychiatry, August 1, 2007; 78(8): 849 - 852. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Mitsumoto, A. M. Ulug, S. L. Pullman, C. L. Gooch, S. Chan, M. -X. Tang, X. Mao, A. P. Hays, A. G. Floyd, V. Battista, et al. Quantitative objective markers for upper and lower motor neuron dysfunction in ALS Neurology, April 24, 2007; 68(17): 1402 - 1410. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Feuillet, J. Pelletier, L. Suchet, A. Rico, A. Ali Cherif, J. Pouget, and S. Attarian Prospective clinical and electrophysiological follow-up on a multiple sclerosis population treated with interferon beta-1 a: a pilot study Multiple Sclerosis, April 1, 2007; 13(3): 348 - 356. [Abstract] [PDF]
|
|
|
|
|
|
S. Vucic and M. C. Kiernan Novel threshold tracking techniques suggest that cortical hyperexcitability is an early feature of motor neuron disease Brain, September 1, 2006; 129(9): 2436 - 2446. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. N. O'Neill, R. G. Gonzalez, D. P. Cros, R. H. Ackerman, R. H. Brown Jr., and A. Stemmer-Rachamimov Case records of the Massachusetts General Hospital. Case 22-2006--a 77-year-old man with a rapidly progressive gait disorder. N. Engl. J. Med., July 20, 2006; 355(3): 296 - 304. [Full Text] [PDF]
|
|
|
|
|
|
M R Turner, A D Osei-Lah, A Hammers, A Al-Chalabi, C E Shaw, P M Andersen, D J Brooks, P N Leigh, and K R Mills Abnormal cortical excitability in sporadic but not homozygous D90A SOD1 ALS J. Neurol. Neurosurg. Psychiatry, September 1, 2005; 76(9): 1279 - 1285. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. J. Triggs, G. Ghacibeh, U. Springer, and D. Bowers Lateralized asymmetry of facial motor evoked potentials Neurology, August 23, 2005; 65(4): 541 - 544. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Turner, A. Hammers, A. Al-Chalabi, C. E. Shaw, P. M. Andersen, D. J. Brooks, and P. N. Leigh Distinct cerebral lesions in sporadic and 'D90A' SOD1 ALS: studies with [11C]flumazenil PET Brain, June 1, 2005; 128(6): 1323 - 1329. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R Nardone, E Buffone, I Florio, and F Tezzon Changes in motor cortex excitability during muscle fatigue in amyotrophic lateral sclerosis J. Neurol. Neurosurg. Psychiatry, March 1, 2005; 76(3): 429 - 431. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Kaufmann, S. L. Pullman, D. C. Shungu, S. Chan, A. P. Hays, M. L. Del Bene, M. A. Dover, M. Vukic, L. P. Rowland, and H. Mitsumoto Objective tests for upper motor neuron involvement in amyotrophic lateral sclerosis (ALS) Neurology, May 25, 2004; 62(10): 1753 - 1757. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. R. Mills The natural history of central motor abnormalities in amyotrophic lateral sclerosis Brain, November 1, 2003; 126(11): 2558 - 2566. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Zhai, F. Pagan, J. Statland, J. A. Butman, and M. K. Floeter Primary lateral sclerosis: A heterogeneous disorder composed of different subtypes? Neurology, April 22, 2003; 60(8): 1258 - 1265. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. P. Rowland and N. A. Shneider Amyotrophic Lateral Sclerosis N. Engl. J. Med., May 31, 2001; 344(22): 1688 - 1700. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
