Tankisi, H;
Nielsen, CS-Z;
Howells, J;
Cengiz, B;
Samusyte, G;
Koltzenburg, M;
Blicher, JU;
... Bostock, H; + view all
(2021)
Early diagnosis of amyotrophic lateral sclerosis by threshold tracking and conventional transcranial magnetic stimulation.
European Journal of Neurology
, 28
(9)
pp. 3030-3039.
10.1111/ene.15010.
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Abstract
BACKGROUND: Short-interval intracortical inhibition by threshold tracking (T-SICI) has been proposed as a diagnostic tool for amyotrophic lateral sclerosis (ALS), but has not been compared directly with conventional amplitude measurements (A-SICI). This study compared A-SICI and T-SICI for sensitivity and clinical usefulness as biomarkers for ALS. METHODS: 104 consecutive patients referred with suspicion of ALS were prospectively included, and subsequently divided into 62 patients with motor neuron disease (MND) and 42 patient controls (ALS mimics) by clinical-follow-up. T-SICI and A-SICI recorded in first dorsal interosseus (index test) were compared with recordings from 53 age-matched healthy controls. The reference standard was the Awaji criteria. Clinical scorings, conventional nerve conduction studies and electromyography were also performed on the patients. RESULTS: MND patients had significantly reduced T-SICI and A-SICI compared with the healthy and patient control groups, which were similar. Sensitivity and specificity for discriminating MND patients from patient controls were high (areas under ROC curves 0.762 and 0.810 for T-SICI and A-SICI respectively at 1-3.5ms). Paradoxically, T-SICI was most reduced in MND patients with the fewest upper motor neuron (UMN) signs (Spearman ρ=0.565, P=4.3×10-6 ). CONCLUSIONS: A-SICI and T-SICI are both sensitive measures for the detection of cortical involvement in MND patients, and may help early diagnosis of ALS, with T-SICI most abnormal before UMN signs have developed. The gradation in T-SICI from pathological facilitation in patients with minimal UMN signs to inhibition in those with the most UMN signs may be due to progressive degeneration of the subset of UMNs experiencing facilitation.
| Type: | Article |
|---|---|
| Title: | Early diagnosis of amyotrophic lateral sclerosis by threshold tracking and conventional transcranial magnetic stimulation |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/ene.15010 |
| Publisher version: | https://doi.org/10.1111/ene.15010 |
| Language: | English |
| Additional information: | © 2021 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
| Keywords: | Amyotrophic lateral sclerosis, Conventional TMS, Short-interval intracortical inhibition, Threshold tracking TMS, Transcranial magnetic stimulation |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Clinical and Movement Neurosciences |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10131290 |
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