共查询到20条相似文献,搜索用时 31 毫秒
1.
José Manuel Matamala James Howells Thanuja Dharmadasa William Huynh Susanna B. Park David Burke Matthew C. Kiernan 《Clinical neurophysiology》2018,129(7):1472-1478
Objective
To evaluate the excitability of sensory axons in patients with amyotrophic lateral sclerosis (ALS).Methods
Comprehensive sensory nerve excitability studies were prospectively performed on 28 sporadic ALS patients, compared to age-matched controls. Sensory nerve action potentials were recorded from digit 2 following median nerve stimulation at the wrist. Disease severity was measured using motor unit number estimation (MUNE), the revised ALS Functional Rating Scale (ALSFRS-R) and the MRC scale.Results
There were no significant differences in standard and extended measures of nerve excitability between ALS patients and controls. These unchanged excitability measures included accommodation to long-lasting hyperpolarization and the threshold changes after two supramaximal stimuli during the recovery cycle. Excitability parameters did not correlate with MUNE, ALSFRS-R, APB MRC scale or disease duration.Conclusions
This cross-sectional study has identified normal axonal membrane properties in myelinated sensory axons of ALS patients. Previously described sensory abnormalities could be the result of axonal fallout, possibly due to a ganglionopathy, or to involvement of central sensory pathways rostral to gracile and cuneate nuclei.Significance
These results demonstrate the absence of generalized dysfunction of the membrane properties of sensory axons in ALS in the face of substantial deficits in motor function. 相似文献2.
Benjamin C. Cheah Cindy S.Y. Lin Susanna B. Park Steve Vucic Arun V. Krishnan Matthew C. Kiernan 《Clinical neurophysiology》2012,123(12):2460-2467
Objective
To elucidate longitudinal changes in axonal function in amyotrophic lateral sclerosis (ALS) patients, and to relate such changes with motor unit loss and functional impairment.Methods
37 ALS patients (age, 53.7 ± 1.7 years; 22 males) were studied using axonal excitability techniques at baseline and 12 weeks follow-up.Results
Longitudinal measurements across excitability parameters suggested increasing K+ channel dysfunction, with further increases in depolarising threshold electrotonus (90–100 ms, baseline, 46.8 ± 1.0%; follow-up, 48.7 ± 0.8%; P = 0.02) and superexcitability (baseline, −24.0 ± 1.2%; 12 weeks, −26.0 ± 1.2%; P = 0.04). Patients with preserved compound muscle action potential (CMAP) amplitude at follow-up developed more severe changes in axonal excitability than those in whom CMAP decreased from baseline, suggesting that the most pronounced disease effects were on motor axons immediately prior to axonal loss in ALS patients. Fine motor decline was associated with more severe changes in axonal excitability, suggesting that functional impairment was related to axonal dysfunction.Conclusions
Longitudinal changes in axonal excitability in ALS patients suggest increasing K+ channel dysfunction in motor axons.Significance
Axonal excitability studies enable investigation of longitudinal changes in axonal ion channel dysfunction, and thereby the processes that potentially contribute to axonal degeneration in ALS. 相似文献3.
Yoshiko Shibuta Hiroyuki Nodera Atsuko Nodera Takahiro Okita Kotaro Asanuma Yuishin Izumi Ryuji Kaji 《Clinical neurophysiology》2010,121(12):2117-2120
Objective
Slow potassium current (IKs) is important in controlling nerve excitability and its impairment is known in various neurological diseases, including amyotrophic lateral sclerosis (ALS). IKs gives rise to the late subexcitability phase of the recovery cycle, which can be amplified by the use of multiple conditioning pulses. The clinical utility of this technique has not previously been explored.Methods
Nerve excitability tests, including recovery cycles with single and double conditioning pulses 4 ms apart (RC and RC2, respectively) were performed in patients with ALS and control subjects. Late subexcitability values obtained by RC and RC2 were compared in both groups.Results
RC2 was well tolerated in all the subjects. The threshold changes in late subexcitability by RC2 were greater than those by RC in both groups (mean (%): RC, 16.0/13.3; RC2, 34.9/29.4 (Control/ALS)). The ALS group showed lower threshold changes than controls by both methods. Statistical analysis between the ALS and control groups provided smaller P value by RC2 (P = 0.018) than by RC (P = 0.046). Also, RC2 provided non-significant, but slightly more distinguishing non-parametric rank analysis and greater Area Under the Curve (AUC) by Receiver Operating Characteristic (ROC). RC2 produced more identifiable single peak for late subexcitability than RC in an ALS patient whose late subexcitability was decreased.Conclusions
Two conditioning stimuli provide greater threshold change for late subexcitability and possibly clearer identification of a peak threshold change than conventional recovery cycle. The findings obtained by this new protocol reinforce the previously reported impairment of IKs in ALS.Significance
Amplification of IKs by double conditioning pulses is applicable in humans and may help elucidating its clinical significance in pathophysiology in neurological diseases. 相似文献4.
Yu-ichi Noto Neil G. Simon Alexis Selby Nidhi Garg Kazumoto Shibuya Nortina Shahrizaila William Huynh José M. Matamala Thanuja Dharmadasa Susanna B. Park Steve Vucic Matthew C. Kiernan 《Clinical neurophysiology》2018,129(5):974-980
Objective
To elucidate differences in the distribution and firing frequency of fasciculations between peripheral nerve hyperexcitability syndromes and amyotrophic lateral sclerosis (ALS) and to explore the generator site of fasciculations.Methods
Ultrasound of 14 preselected muscles was performed in patients with peripheral hyperexcitability and ALS. The distribution and firing frequency of fasciculations were calculated. Cortical excitability assessment was also done by threshold tracking transcranial magnetic stimulation.Results
In total, 518 muscles from 37 peripheral hyperexcitability patients and 756 muscles from 54 ALS patients were examined. Regarding the detection rate, 74% of muscles in ALS patients demonstrated fasciculations, compared with 34% of muscles in peripheral hyperexcitability patients (P?<?0.001). The number of unique repeating focal muscle fasciculation movements per muscle and firing frequency of individual fasciculations in ALS were both significantly higher than those in peripheral hyperexcitability (P?<?0.001). Furthermore, cortical silent period duration negatively correlated with the number and firing frequency of fasciculations in ALS (P?<?0.05). A similar relationship was not evident in peripheral hyperexcitability.Conclusions
In ALS patients, fasciculations were more widespread, greater in number and higher in firing frequency than in peripheral hyperexcitability patients.Significance
A significant proportion of fasciculations in ALS may be influenced by changes in central excitability. 相似文献5.
Tankisi H Otto M Pugdahl K Johnsen B Fuglsang-Frederiksen A 《Clinical neurophysiology》2012,123(10):2099-2105
Objective
To get a better understanding of pathophysiology in polyneuropathies (PNPs) by correlating compound muscle action potential (CMAP) amplitude with duration.Methods
A total of 145 motor nerve conduction studies (MNCS) in 53 axonal and 132 MNCS in 45 demyelinating PNPs were analyzed. Peroneal and tibial MNCS were done by surface stimulation while for median and ulnar nerves near nerve or surface stimulations were used. CMAP amplitude and duration were compared in axonal and demyelination PNPs. Relationships between amplitude and duration of distally and proximally evoked CMAP were examined using regression analysis.Results
CMAP amplitude was lower and duration was increased in all examined nerves in demyelinating PNPs than in axonal PNPs. In demyelinating PNPs, an inverse linear correlation between amplitude and duration was seen in distally and proximally evoked CMAP in all examined nerves. In axonal PNPs, there was no correlation in any of the nerves neither in distally nor in proximally evoked CMAP.Conclusions
Distal CMAP duration and the relationship between CMAP amplitude and duration show supplementary electrodiagnostic potential in demyelinating PNPs.Significance
More knowledge about the relation between amplitude and duration in axonal lesions and demyelination may help to reveal the pathophysiology in PNPs. Significant correlation between amplitude and duration in demyelination may suggest that the severe decrease in amplitude in demyelinating PNPs is probably due to the increase in duration secondary to temporal dispersion. 相似文献6.
Jeremy P.M. Mogk Lynn M. Rogers Wendy M. Murray Eric J. Perreault James W. Stinear 《Clinical neurophysiology》2014,125(10):2046-2054
Objective
We investigated how multi-joint changes in static upper limb posture impact the corticomotor excitability of the posterior deltoid (PD) and biceps brachii (BIC), and evaluated whether postural variations in excitability related directly to changes in target muscle length.Methods
The amplitude of individual motor evoked potentials (MEPs) was evaluated in each of thirteen different static postures. Four functional postures were investigated that varied in shoulder and elbow angle, while the forearm was positioned in each of three orientations. Posture-related changes in muscle lengths were assessed using a biomechanical arm model. Additionally, M-waves were evoked in the BIC in each of three forearm orientations to assess the impact of posture on recorded signal characteristics.Results
BIC-MEP amplitudes were altered by shoulder and elbow posture, and demonstrated robust changes according to forearm orientation. Observed changes in BIC-MEP amplitudes exceeded those of the M-waves. PD-MEP amplitudes changed predominantly with shoulder posture, but were not completely independent of influence from forearm orientation.Conclusions
Results provide evidence that overall corticomotor excitability can be modulated according to multi-joint upper limb posture.Significance
The ability to alter motor pathway excitability using static limb posture suggests the importance of posture selection during rehabilitation aimed at retraining individual muscle recruitment and/or overall coordination patterns. 相似文献7.
Objective
The intensity of transcranial magnetic stimulation (TMS) is typically adjusted by changing the amplitude of the induced electrical field, while its duration is fixed. Here we examined the influence of two different pulse durations on several physiological parameters of primary motor cortex excitability obtained using single pulse TMS.Methods
A Magstim Bistim2 stimulator was used to produce TMS pulses of two distinct durations. For either pulse duration we measured, in healthy volunteers, resting and active motor thresholds, recruitment curves of motor evoked potentials in relaxed and contracting hand muscles as well as contralateral (cSP) and ipsilateral (iSP) cortical silent periods.Results
Motor thresholds decreased by 20% using a 1.4 times longer TMS pulse compared to the standard pulse, while there was no significant effect on threshold adjusted measurements of cortical excitability. The longer pulse duration reduced pulse-to-pulse variability in cSP.Conclusions
The strength of a TMS pulse can be adjusted both by amplitude or pulse duration. TMS pulse duration does not affect threshold-adjusted single pulse measures of motor cortex excitability.Significance
Using longer TMS pulses might be an alternative in subjects with very high motor threshold. Pulse duration might not be relevant as long as TMS intensity is threshold-adapted. This is important when comparing studies performed with different stimulator types. 相似文献8.
Baumann F Henderson RD Gareth Ridall P Pettitt AN McCombe PA 《Clinical neurophysiology》2012,123(10):2092-2098
Objective
To use our Bayesian method of motor unit number estimation (MUNE) to evaluate lower motor neuron degeneration in ALS.Methods
In subjects with ALS we performed serial MUNE studies. We examined the repeatability of the test and then determined whether the loss of MUs was fitted by an exponential or Weibull distribution.Results
The decline in motor unit (MU) numbers was well-fitted by an exponential decay curve. We calculated the half life of MUs in the abductor digiti minimi (ADM), abductor pollicis brevis (APB) and/or extensor digitorum brevis (EDB) muscles. The mean half life of the MUs of ADM muscle was greater than those of the APB or EDB muscles. The half-life of MUs was less in the ADM muscle of subjects with upper limb than in those with lower limb onset.Conclusions
The rate of loss of lower motor neurons in ALS is exponential, the motor units of the APB decay more quickly than those of the ADM muscle and the rate of loss of motor units is greater at the site of onset of disease.Significance
This shows that the Bayesian MUNE method is useful in following the course and exploring the clinical features of ALS. 相似文献9.
Sina Sangari Alain Giron Guillaume Marrelec Pierre-François Pradat Véronique Marchand-Pauvert 《Clinical neurophysiology》2018,129(4):874-884
Objectives
Infraclinical sensory alterations have been reported at early stages of amyotrophic lateral sclerosis (ALS). While previous studies mainly focused on early somatosensory evoked potentials (SEPs), late SEPs, which reflect on cortical pathways involved in cognitive-motor functions, are relatively underinvestigated. Early and late SEPs were compared to assess their alterations in ALS.Methods
Median and ulnar nerves were electrically stimulated at the wrist, at 9 times the perceptual threshold, in 21 ALS patients without clinical evidence of sensory deficits, and 21 age- and gender-matched controls. SEPs were recorded at the Erb point using surface electrodes and using a needle inserted in the scalp, in front of the primary somatosensory area (with reference electrode on the ear lobe).Results
Compared to controls, ALS patients showed comparable peripheral (N9) and early cortical component (N20, P25, N30) reductions, while the late cortical components (N60, P100) were more depressed than the early ones.Conclusions
The peripheral sensory alteration likely contributed to late SEP depression to a lesser extent than that of early SEPs.Significance
Late SEPs may provide new insights on abnormal cortical excitability affecting brain areas involved in cognitive-motor functions. 相似文献10.
Objective
Amyotrophic lateral sclerosis (ALS) is a severe neurodegenerative disease associated with short survival due to respiratory failure. We aimed to test the predictive value of the phrenic nerve motor response for survival, in a large population of ALS patients.Methods
We included 254 ALS patients followed in our tertiary centre from 1997 to 2006, in whom phrenic nerve stimulation was performed according to the study inclusion and exclusion criteria. ALS was spinal onset in 175 and bulbar onset in 79 patients. The following features were recorded at entry: gender, age at presentation, onset region, diagnostic delay, forced vital capacity (FVC), ALS functional rating scale (ALS-FRS) including the respiratory subscore of the reviewed ALS-FRS and mean amplitude of motor responses by phrenic nerve stimulation (PhrenAmpl).Results
Survival analysis was evaluated by Kaplan–Meier log-rank test and multivariate Cox proportional hazards. Independent factors negatively affecting survival were bulbar onset, short diagnostic delay, FVC and small PhrenAmpl for the total population. Small PhrenAmpl and short diagnostic delay were also independent factors for both spinal and bulbar-onset patients; age at onset and FVC were also independent predictors in bulbar-onset patients.Conclusion
Phrenic nerve stimulation is a non-volitional test that can be performed quickly in most patients; it is a powerful predictor of survival in ALS.Significance
Phrenic nerve stimulation should be considered as an additional test for respiratory assessment in ALS. 相似文献11.
Chaojun Zheng Yu Zhu Cong Nie Feizhou Lu Dongqing Zhu Robert Weber Jianyuan Jiang 《Clinical neurophysiology》2018,129(7):1383-1389
Objective
To investigate the changes in motor axonal excitability properties in cervical spondylotic amyotrophy (CSA).Methods
Threshold tracking was used to measure the median motor axons in 21 patients with CSA, 10 patients with cervical spondylotic radiculopathy (CSR) and 16 normal controls.Results
Compared with normal controls, patients with distal-type CSA showed increased threshold electrotonus hyperpolarization (TEh [90–100]) and increased superexcitability on the symptomatic side (P?<?0.05), which are suggestive of distal motor axonal hyperpolarization, presumably due to motor axonal regeneration. More importantly, compared with normal controls and CSR cases, both distal- and proximal-type CSA cases showed lower accommodation during depolarising currents (reduced S2 accommodation, decreased TEd [undershoot] and/or lower subexcitability) (P?<?0.05), indicating that slow K+ conductance may be less active in motor axons in patients with CSA.Conclusions
The present study demonstrated changes in motor axonal excitability in patients with CSA compared with both normal controls and patients with CSR.Significance
Less expression of slow K+ conductance may confer greater instability in membrane potential in CSA, thereby presumably contributing to the increased vulnerability of motor axons in patients with CSA. 相似文献12.
Unn Kristin Haukvik Peter Saetre Thomas McNeil Petr S. Bjerkan Ole A. Andreassen Thomas Werge Erik G. Jönsson Ingrid Agartz 《Progress in neuro-psychopharmacology & biological psychiatry》2010
Background
Smaller hippocampal volume has repeatedly been reported in schizophrenia patients. Obstetric complications (OCs) and single nucleotide polymorphism (SNP) variation in schizophrenia susceptibility genes have independently been related to hippocampal volume. We investigated putative independent and interaction effects of severe hypoxia-related OCs and variation in four hypoxia-regulated schizophrenia susceptibility genes (BDNF, DTNBP1, GRM3 and NRG1) on hippocampal volume in schizophrenia patients and healthy controls.Methods
Clinical assessment, structural MRI scans, and blood samples for genotyping of 32 SNPs were obtained from 54 schizophrenia patients and 53 control subjects. Information on obstetric complications was collected from original birth records.Results
Severe OCs were related to hippocampal volume in both patients with schizophrenia and healthy control subjects. Of the 32 SNPs studied, effects of severe OCs on hippocampal volume were associated with allele variation in GRM3 rs13242038, but the interaction effect was not specific for schizophrenia. SNP variation in any of the four investigated genes alone did not significantly affect hippocampal volume.Conclusions
The findings suggest a gene–environment (G × E) interaction between GRM3 gene variants and severe obstetric complications on hippocampus volume, independent of a diagnosis of schizophrenia. Due to the modest sample size, the results must be considered preliminary and require replication in independent samples. 相似文献13.
Bandaru VC Boddu DB Mridula KR Akhila B Alladi S Laxmi V Pathapati R Neeraja M Kaul S 《Clinical neurology and neurosurgery》2012,114(2):120-123
Background
Limited data exists about the role of Chlamydia pneumoniae elderly patients with acute ischemic stroke.Objective
To study the role of C. pneumoniae in elderly patients (age more than 65 years) with acute ischemic stroke and its impact on stroke out come.Methods
We recruited 100 elderly patients with acute ischemic stroke and 100 age and sex matched controls over a period of 2 years. IgG and IgA anti C. pneumoniae antibodies were measured by microimmunofluorescence technique in patients and controls. Good outcome was defined as a Modified Rankin score (mRS) of ≤2.Results
We found C. pneumoniae antibodies in 35% stroke patients and in 18% control subjects (p = 0.01). Good out come at 90 days follow up was found in 20/35(57.1%) seropositive stroke patients compared to 37/65(56.9%) seronegative stroke patients (p = 0.9).Conclusions
C. pneumoniae antibody positivity was independently associated with ischemic stroke in elderly patients and its presence does not alter the stroke outcome. 相似文献14.
Taro Kishi Masashi Ikeda Tsuyoshi Kitajima Yoshio Yamanouchi Yoko Kinoshita Kunihiro Kawashima Tomo Okochi Tomoko Tsunoka Takenori Okumura Toshiya Inada Hiroshi Ujike Mitsuhiko Yamada Naohisa Uchimura Ichiro Sora Masaomi Iyo Norio Ozaki Nakao Iwata 《Progress in neuro-psychopharmacology & biological psychiatry》2009
Background
A recent study reported an association between rs2234693, which influences enhancer activity levels in estrogen receptor alpha gene (ESR1), and schizophrenia. This study reported that schizophrenic patients with the CC genotype have significantly lower ESR1 mRNA levels in the prefrontal cortex than patients with other genotypes. The symptoms of methamphetamine induced psychosis are similar to those of paranoid type schizophrenia. Therefore, we conducted an association analysis of rs2234693 with Japanese methamphetamine induced psychosis patients.Method
Using rs2234693, we conducted a genetic association analysis of case-control samples (197 methamphetamine induced psychosis patients and 197 healthy controls). The age and sex of the control subjects did not differ from those of the methamphetamine induced psychosis patients.Results
We detected a significant association between ESR1 and methamphetamine induced psychosis patients in allele/genotype-wise analysis. For further interpretation of these associations, we performed single marker analysis of subjects divided by sex. Rs2234693 was associated with male methamphetamine induced psychosis.Discussion
Our results suggest that rs2234693 in ESR1 may play a role in the pathophysiology of Japanese methamphetamine induced psychosis patients. 相似文献15.
Ngo ST Baumann F Ridall PG Pettitt AN Henderson RD Bellingham MC McCombe PA 《Clinical neurophysiology》2012,123(10):2080-2091
Objective
To assess the relationship between Bayesian MUNE and histological motor neuron counts in wild-type mice and in an animal model of ALS.Methods
We performed Bayesian MUNE paired with histological counts of motor neurons in the lumbar spinal cord of wild-type mice and transgenic SOD1G93A mice that show progressive weakness over time. We evaluated the number of acetylcholine endplates that were innervated by a presynaptic nerve.Results
In wild-type mice, the motor unit number in the gastrocnemius muscle estimated by Bayesian MUNE was approximately half the number of motor neurons in the region of the spinal cord that contains the cell bodies of the motor neurons supplying the hindlimb crural flexor muscles. In SOD1G93A mice, motor neuron numbers declined over time. This was associated with motor endplate denervation at the end-stage of disease.Conclusion
The number of motor neurons in the spinal cord of wild-type mice is proportional to the number of motor units estimated by Bayesian MUNE. In SOD1G93A mice, there is a lower number of estimated motor units compared to the number of spinal cord motor neurons at the end-stage of disease, and this is associated with disruption of the neuromuscular junction.Significance
Our finding that the Bayesian MUNE method gives estimates of motor unit numbers that are proportional to the numbers of motor neurons in the spinal cord supports the clinical use of Bayesian MUNE in monitoring motor unit loss in ALS patients. 相似文献16.
Utako Takechi Kaoru Matsunaga Ryoji Nakanishi Hiroaki Yamanaga Nobuki Murayama Kosuke Mafune Sadatoshi Tsuji 《Clinical neurophysiology》2014,125(10):2055-2069
Objective
A general lack of longitudinal studies on interhemispheric interactions following stroke led us to use transcranial magnetic stimulation (TMS) to examine changes in corticospinal/intracortical excitability and transcallosal inhibition over a 1-year period following subcortical stroke.Methods
We measured TMS parameters such as motor threshold (MT), short-interval intracortical inhibition (SICI), and ipsilateral silent period (iSP) and evaluated clinical scores at three time-points (T1, T2, and T3) in 24 patients and 25 age-matched healthy subjects.Results
At T1, we observed reduced MTs and SICIs with prolonged iSPs in the unaffected hemisphere (UH). In contrast, increased MTs and reduced SICIs were observed in the affected hemisphere (AH). These abnormalities gradually reduced and no MEP response to TMS at T1 predicted a worse prognosis. The prolonged iSP at T1 was associated with more severe impairments, but it did not necessarily predict a worse prognosis after 1 year.Conclusions
UH excitability was increased at the post-acute time-period, which may have resulted in enhanced transcallosal inhibition to the AH. However, it is unclear whether there was a causal relationship between the enhanced transcallosal inhibition and the extent of clinical recovery.Significance
This is the first study to demonstrate changes in transcallosal inhibition over a longitudinal period following stroke. 相似文献17.
Objective
In studies of phrenic nerve (PN) conduction in amyotrophic lateral sclerosis (ALS) both motor response amplitude and latency have been reported as abnormal. However, correlation with diaphragm motor unit loss, and with diaphragmatic function has not been fully evaluated.Methods
We studied 83 patients with ALS, and 21 patients referred with clinically suspected phrenic nerve lesions whose studies were normal. PN responses elicited by percutaneous electrical stimulation in the neck were recorded using superficial electrodes placed at the surface markings of the diaphragm on the chest wall, and a concentric needle electrode inserted into the diaphragmatic costal fibres. Electromyography of diaphragm was performed to analyse motor unit morphology and recruitment.Results
The 21 controls and 83 ALS patients were matched for age. In controls, the only significant correlation between surface and needle recording was for negative-peak amplitude (p?=?0.03). In ALS patients, amplitudes and negative-peak area were highly correlated (p?<?0.001), as were PN motor latencies (p?=?0.002). Forced vital capacity (FVC) was highly correlated with both amplitude (p?<?0.001) and PN latency (p?<?0.02), whichever electrode was used. PN amplitude recording with needle electrode was consistent with EMG findings in the diaphragm.Conclusion
In ALS, PN motor amplitude/area and latency measurements recorded by surface electrodes are highly correlated with needle EMG findings in the diaphragm. CMAP amplitude/area measurements showed high correlation with FVC.Significance
In ALS, amplitude/area of the motor PN response, recorded by surface or needle electrodes, correlates with dysfunction of the diaphragm. 相似文献18.
Background
While some regard the flail arm syndrome as a variant of amyotrophic lateral sclerosis (ALS), others have argued that it is a distinct clinical entity. Consequently, the present study applied novel central and peripheral nerve excitability techniques to further explore disease pathophysiology in flail arm syndrome.Methods
Cortical and peripheral nerve excitability studies were undertaken in 11 flail arm patients, defined by muscle weakness limited to the proximal aspects of the upper limbs for at least 24 months.Results
Mean age at disease onset (60.3 years) was similar to other ALS phenotypes (58.3 years), with strong male predominance (male:female distribution: flail arm 10:1; ALS 1.5:1; p<0.05) and prolonged disease duration (flail arm 62.5 months; ALS 15.8 months; p<0.05). There was evidence of cortical hyperexcitability in flail arm patients, similar to findings in ALS, with reduction in short interval intracortical inhibition (flail arm 0.8 (0.6)%; ALS 4.1 (1.1)%; controls 8.5 (1.0)%; p<0.0001) and resting motor threshold (flail arm 53.4 (2.8)%; ALS 56.6 (1.8)%; controls 60.7 (1.5)%; p<0.05), along with an increase in motor evoked potential amplitude (flail arm 49.5 (9.0)%; ALS 44.4 (4.9)%; controls 25.8 (2.8)%; p<0.05). Peripheral nerve excitability studies demonstrated changes consistent with upregulation in persistent Na+ currents and reduction of slow K+ conductances, similar to findings in ALS.Conclusion
This study has demonstrated the presence of cortical hyperexcitability in flail arm syndrome, along with abnormalities in peripheral nerve excitability, findings consistent with previous studies in other ALS phenotypes. By demonstrating the presence of upper motor neuron dysfunction, the present study suggests that the flail arm syndrome is an unusual variant of ALS.The “man‐in‐the barrel” syndrome is clinically characterised by severe bilateral weakness of the shoulder girdle musculature, originally reported in the setting of cerebral infarction.1 A neurogenic variant of “man‐in‐the barrel” syndrome resulting from cervical anterior horn cell loss has been reported.2,3 While the “man‐in‐the barrel” syndrome was first described by Vulpian,4 and elegantly illustrated by Gowers,5 later studies by Hu and colleagues2 reaffirmed the original observations that this phenotype was a variant of amyotrophic lateral sclerosis (ALS).Others have argued that the neurogenic “man‐in‐the‐barrel” syndrome represents a entity distinct from ALS (brachial amyotrophic diplegia3). Indeed, the flail arm syndrome or “brachial amyotrophic diplegia” may be clinically differentiated from classic ALS by the unique pattern of muscle weakness, absence of upper motor neuron signs in the affected upper limbs and prolonged survival.2,3The diagnosis of ALS relies on the presence of a combination of upper and lower motor neuron features with evidence of disease progression over time.6 Clinical evidence of upper motor neuron (UMN) dysfunction may be elusive,7 particularly in the early stages of ALS, or when UMN dysfunction becomes obscured by severe motor neuron loss. Given the uncertainties of the neurogenic “man‐in‐the‐barrel” syndrome, the aim of the present study was to implement novel cortical threshold tracking transcranial magnetic stimulation techniques to further explore disease pathophysiology compared with more typical ALS phenotypes. 相似文献19.
Lee SY Chen SL Chang YH Chu CH Huang SY Tzeng NS Wang CL Lin SH Lee IH Yeh TL Yang YK Lu RB 《Progress in neuro-psychopharmacology & biological psychiatry》2012,37(2):247-251
Objective
Many physiological and pathological processes, such as infections, environmental toxins, and ionizing radiation increase bodily concentrations of oxidizing substances, known as free radicals, which lead to neurodegenerative disorders. Sleep is one of the most important factors contributing to health; however, insomnia is among the most prevalent health complaints.Methods
In this study, for the first time in the literature, we investigated the effects of primary insomnia on certain oxidative stress biomarkers. For this purpose, glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), and myeloperoxidase (MPO) activities and levels of reduced glutathione (GSH) and malondialdehyde (MDA) were measured in 30 patients with primary insomnia and 30 healthy volunteersResults
Our results show that the patients with primary insomnia had significantly lower GSH-Px activity and higher MDA levels compared with the controls.Conclusion
These results may indicate the important role of sleep in attenuating oxidative stress. 相似文献20.