Neurology -- Correspondence for Hammad et al., 69 (24) 2236-2242

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M. Hammad, A. Silva, J. Glass, J. T. Sladky, and M. Benatar
Clinical, electrophysiologic, and pathologic evidence for sensory abnormalities in ALS
Neurology 2007; 69: 2236-2242 [Abstract] [Full text] [PDF]

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Clinical, electrophysiologic, and pathologic evidence for sensory abnormalities in ALS: Georgios Amoiridis, Dimitrios Tsimoulis, Ioanna Ameridou (12 March 2008)

Clinical, electrophysiologic, and pathologic evidence for sensory abnormalities in ALS 12 March 2008

Georgios Amoiridis,
Assist. Prof. of Neurology, Department of Neurology, University of Crete
PO Box 2208, 71003 Heraklion, Greece,
Dimitrios Tsimoulis, Ioanna Ameridou
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Re: Clinical, electrophysiologic, and pathologic evidence for sensory abnormalities in ALS

amoirid{at}med.uoc.gr Georgios Amoiridis, et al.

We read the article by Hammad et al. with interest. [1] The authors found sensory symptoms in 32% (33 of 103 patients), abnormal sural sensory nerve action potentials in 27% (28 of 103 patients) and abnormalities in sural nerve biopsies in 91% (20 of 22 biopsies).
Data have shown that the incidence of motor fibers in the sural nerve of healthy subjects was 10.1%. [2] The pathologic findings in this and other studies can not be explained by the existence of motor fibers in the sural nerve, [1,3] but it can be assumed that in individuals with motor fibers in the sural nerve suffering from a motor neuron disease, the morphologic examination of the sural nerve will provide pathologic findings. [2] It is possible that some pathologic findings in the biopsies in this study represent degenerated motor fibers. [1]
The latter could explain some of the discrepancy between the relatively lower clinical (32%) and electrophysiological (27%) incidence of sensory abnormalities, compared to the very high morphologic evidence (91%) of sural nerve involvement. [1]
We agree with the authors that in motor neuron disease, subtle involvement of other systems can occur but in clinical and neurophysiologic practice, sensory symptoms or findings should prompt the consideration of alternative diagnoses.
References
1.Hammad M, Silva A, Glass J, Sladky JT, Benatar M. Clinical, electrophysiologic, and pathologic evidence for sensory abnormalities in ALS. Neurology 2007;69:2236-2242.
2.Amoiridis G, Sch�ls L, Ameridis N, Przuntek H. Motor fibers in the sural nerve of humans. Neurology 1997;49:1725-1728.
3.Bradley WG, Good P, Rasool CG, Adelman LS. Morphometric and biochemical studies of peripheral nerves in amyotrophic lateral sclerosis. Ann Neurol 1983;14:267-277.
Disclosure: The authors report no conflicts of interest.
The authors were offered the opportunity to respond but declined.