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Regional motor cortex dysfunction in amyotrophic lateral sclerosis.
- Source :
-
Annals of clinical and translational neurology [Ann Clin Transl Neurol] 2019 Aug; Vol. 6 (8), pp. 1373-1382. Date of Electronic Publication: 2019 Jun 28. - Publication Year :
- 2019
-
Abstract
- Objective: The pathophysiological processes underlying amyotrophic lateral sclerosis (ALS) need to be better understood, although cortical dysfunction has been implicated. Previous transcranial magnetic stimulation (TMS) studies have assessed cortical dysfunction from the hand. The aim of the present study was to determine whether cortical dysfunction was evident across representations of three body regions, and to relate these changes to clinical features of ALS.<br />Methods: In this cross-sectional study, threshold tracking TMS was undertaken in 60 sporadic ALS patients, with motor evoked potential (MEP) responses recorded over the hand (abductor pollicis brevis), lower limb (tibialis anterior), and bulbar (trapezius) regions. The cross-sectional findings were compared to 28 age- and gender-matched controls.<br />Results: Cortical dysfunction was evident across the representation of the three body regions, although the degree and nature of the dysfunction varied. Cortical hyperexcitability, as heralded by reduced short interval intracortical inhibition (SICI), was evident in all cortical regions (hand, P < 0.01; leg, P < 0.05; bulbar, P < 0.05) in ALS patients when compared with healthy control subjects. Importantly, features of cortical hyperexcitability seemed more prominent in clinically affected body regions and correlated with functional disability and muscle weakness. Cortical inexcitability was more prominent in the leg (P < 0.001) and bulbar regions (P < 0.01) when compared with controls.<br />Interpretation: The nature of cortical dysfunction varied across the body regions in ALS, with cortical hyperexcitability being more prominent in the upper limbs while cortical inexcitability was more evident in the lower limbs and bulbar regions. The findings suggest a heterogeneity of cortical pathophysiological processes in ALS.<br /> (© 2019 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals, Inc on behalf of American Neurological Association.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Cross-Sectional Studies
Evoked Potentials, Motor
Female
Hand physiopathology
Healthy Volunteers
Humans
Lower Extremity physiopathology
Male
Middle Aged
Superficial Back Muscles physiopathology
Transcranial Magnetic Stimulation
Amyotrophic Lateral Sclerosis physiopathology
Motor Cortex physiopathology
Subjects
Details
- Language :
- English
- ISSN :
- 2328-9503
- Volume :
- 6
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Annals of clinical and translational neurology
- Publication Type :
- Academic Journal
- Accession number :
- 31402622
- Full Text :
- https://doi.org/10.1002/acn3.50819