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Introduction: The aim of this study is to demonstrate the conduction disturbance at the neuromuscular junction in a cranial muscle by measuring jitter with a concentric needle (CN) electrode in the diagnosis of Amyotrophic Lateral Sclerosis (ALS) and to investigate the utility of evaluating the peak number as an ongoing reinnervation marker. Method: Twelve patients diagnosed with ALS were included in this study. Single fiber electromyography (SFEMG) was performed using a CN electrode during the voluntary contraction of the right extensor digitorum communis (EDC) and left frontalis muscles. Results: In SFEMG from the right EDC muscle, the mean jitter value was high in all of them. The average jitter calculated in EDC muscles was 57.76±24.17 µs. The mean jitter value in the frontal muscles was 28.91±10.21 µs. In all patients, the number of CN electrode peaks was more than 4 in the EDC muscle and above 4 in 91.67% of the frontal muscle. Conclusion: Detection of high jitter in SFEMG examination indicates that the examined muscle undergoes a denervation-reinnervation process in the case of increased peak number values. When such a determination is made in the extremity muscles, it becomes important for the diagnosis of ALS. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to show whether radiologically diffusion tractography imaging (DTI) and electrophysiologically F responses methods support clinical examination in Amyotrophic Lateral Sclerosis (ALS). It is to determine the relationships between these two methods. Materials and Methods: Patients with a definite diagnosis of ALS according to the Revised-El Escorial and Awaji criteria at any stage of the disease, who applied to the Electromyography (EMG) laboratory of the Neurology Clinic of Istanbul University Cerrahpaşa, Cerrahpaşa Medical Faculty, prospectively and crosssectionally, were included in the study. The revised ALS functional rating scale (ALSFRS-R) was scored. Electrophysiological studies included routine nerve conduction studies, F responses and needle EMG. In radiological examinations, diffusion tractography imaging (DTI) maps were obtained in brain and cervical Magnetic Resonance Imaging (MRI) and diffusivity and fractional anisotropy (FA) values were compared. Results: The mean age of the 12 volunteer patients included in the study was 55.92±9.68 (43-72), and consisted of 4 female and 8 male individuals. The mean ALSFRS-R score was 35.75±7.86 (24-46). MRI was performed in 11 of the patients, spinal imaging could not be performed in one patient. The mean age of the 11 patients who were imaging was 56.4±9.8 years and the disease duration was 2.7±1.9 years. Low values of DTI-FA were found to be associated with poor respiratory and speech scores as assessed by linear regression analysis. Repeater F responses in the ulnar nerves were also associated with a high ALSFRS-R score. Conclusion: In our study, we observed that low values of DTI-FA were associated with poor respiratory and speech scores. Showing the correlation of low FA with a vital function such as respiration may indicate that this technique will be helpful in the prognosis and progression of the disease. The increase of repeater F responses in the ulnar nerves in those with high ALSFRS-R scores suggests that it is worth investigating whether ALS can be used in differentiating from other anterior horn diseases. The results of this study suggest that DTI-FA, which is an advanced radiological evaluation, and repeater F responses as an electrophysiological method may support early diagnosis in ALS. [ABSTRACT FROM AUTHOR]