Sensitivity of transcranial magnetic stimulation of cortico-bulbar vs. cortico-spinal tract involvement in Amyotrophic Lateral Sclerosis (ALS)
| Autor: | H. C. Hopf, S. Wicht, Peter P. Urban |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Adult
Male Hypoglossal Nerve medicine.medical_treatment Pyramidal Tracts Facial Muscles Lesion Electromagnetic Fields Nerve Fibers Tongue Physical Stimulation medicine Humans Amyotrophic lateral sclerosis Aged Upper motor neuron business.industry Amyotrophic Lateral Sclerosis Extremities Anatomy Middle Aged medicine.disease Facial nerve body regions Transcranial magnetic stimulation Facial Nerve medicine.anatomical_structure Neurology Corticospinal tract Disease Progression Female Corticobulbar tract Neurology (clinical) medicine.symptom business Hypoglossal nerve |
| Zdroj: | Journal of Neurology. 248:850-855 |
| ISSN: | 1432-1459 0340-5354 |
| Popis: | Background An upper motor neuron (UMN) lesion in amyotrophic lateral sclerosis (ALS) is often difficult to identify because clinical signs may be discrete or masked by severe simultaneous LMN lesions. We compared the diagnostic sensitivity of transcranial magnetic stimulation (TMS) to cranial muscles and limb muscles in the detection of UMN lesions. Design We investigated corticobulbar and corticospinal tract function to the tongue/orofacial muscles and abductor digiti minimi/tibial anterior muscles with TMS in 51 patients with ALS to compare the diagnostic yield in the detection of UMN dysfunction. An UMN lesion was assumed when the following were found: the peripheral conduction time and amplitude of the M-wave were within the normal range, the response to cortical stimulation was absent, the TMS evoked/M-wave amplitude ratio was reduced, and the central motor conduction time or the interside difference was delayed (> mean+2.5 SD). Results On the basis of these criteria a UMN lesion to the orofacial muscles was identified in 24 patients (47 %), to the tongue in 27 (53 %), and to the upper and lower limbs in 13 (25 %) and 22 patients (43 %), respectively. Combined abnormalities from all sites increased the diagnostic yield to 39 patients (76 %). TMS of the limb muscles confirmed a UMN lesion in only 15 (54 %) of the 28 patients with clinically confirmed UMN involvement. This number increased to 23 patients (82 %) if tongue and orofacial muscles were taken into acount. Conclusion Our results indicate the early and in most cases subclinical corticobulbar tract involvement of the central motor pathways to the orofacial muscles and tongue in ALS. TMS of the tongue and orofacial muscles had a higher sensitivity in identifying UMN lesions than that of the upper and lower limbs. |
| Databáze: | OpenAIRE |
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