Differences in Dysfunction of Thenar and Hypothenar Motoneurons in Amyotrophic Lateral Sclerosis

Jia, Fang; Liu, Mingsheng; Guan, Yuzhou; Li, Xiaoguang; Li, Dawei; Cui, Bo; Shen, Dongchao; Ding, Qi

doi:10.3389/fnhum.2016.00099

Cited by 13 publications

(9 citation statements)

References 34 publications

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“…Our NCSs variables of the FDI and ADM and F-wave values of the ADM in HCs and patients with ALS showed a close resemblance to the previous findings (Peioglou-Harmoussi et al, 1985; Kuwabara et al, 2008; Buschbacher et al, 2015; Fang et al, 2016). In the present study, ALS patients with an unaffected hand did not show significant changes in DML, CMAP amplitude, or MCV recorded over the FDI and ADM in contrast with HCs.…”

Section: Discussionsupporting

confidence: 89%

“…However, Wilbourn (2000) reported the finding of split-hand in ALS in 1992, as well as in other diseases with only LMN dysfunction, and suggested that the lesion responsible for the ALS split-hand was at the level of the cervical anterior horn cell (Schelhaas et al, 2003). Further, Fang et al (2016) found differences between the dysfunction of spinal motoneurons innervating the APB and the ADM in ALS. Thus, in the present study, we examined the hypothesis that spinal mechanisms contribute to split-hand in ALS.…”

Section: Introductionmentioning

confidence: 89%

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Split-Hand Syndrome in Amyotrophic Lateral Sclerosis: Differences in Dysfunction of the FDI and ADM Spinal Motoneurons

et al. 2019

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The F-wave test allows for the non-invasive assessment of spinal motoneuron excitability. We investigated the difference in spinal motoneuron dysfunction between the first dorsal interosseous (FDI) and abductor digit minimi (ADM) muscles by investigating F-waves and to assess the contribution of spinal mechanisms to split-hand syndrome in patients with amyotrophic lateral sclerosis (ALS). Sixty-five consecutive ALS patients and twenty age- and gender-matched healthy controls (HCs) were enrolled. Motor nerve conduction studies and F-waves were performed bilaterally on median and ulnar nerves in all subjects. HCs revealed prominently longer F-wave latencies, lower chronodispersion, mean F-wave amplitude, and mean and maximal F/M amplitude ratio ( P < 0.001) in the FDI compared to the ADM. However, no significant differences in almost all F-wave parameters between the FDI and ADM were observed in ALS patients with affected hands except the minimal and mean F-wave latency. These data suggest that excitability is greatly changed in the spinal motoneurons innervating the FDI. Furthermore, the mean F-wave amplitude ( r = 0.454, P = 0.002) of the FDI was significantly correlated with the FDI/ADM CMAP amplitude ratio in ALS patients with affected hands but not of the ADM. Our findings suggested that the dysfunction of spinal motoneurons between the FDI and ADM was different in ALS, and spinal motoneuron dysfunction was associated with development of the split-hand phenomenon.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 89%

Split-Hand Syndrome in Amyotrophic Lateral Sclerosis: Differences in Dysfunction of the FDI and ADM Spinal Motoneurons

et al. 2019

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“…CMAP amplitude changes, which are affected by degeneration and compensatory reinnervation, make this parameter relatively insensitive, especially in the early stages of ALS (15). F-waves can reflect subtle, subclinical spinal motor neuron alterations and may be more sensitive to early motor unit loss (8, 9, 16). Thus, we studied EDB and AH F-wave characteristics in patients with ALS, which may help to further elucidate differential foot muscle involvement in neurodegenerative processes.…”

Section: Discussionmentioning

confidence: 99%

“…CMAP amplitudes and F-waves are useful parameters for evaluating motoneuron loss. Previous studies have also indicated that the F-wave can be used to directly assess changes in spinal motoneurons excitability (8) and can reflect subclinical anterior horn cell dysfunction (9). However, to our knowledge, no study has investigated differences in spinal motoneurons dysfunction between the EDB and AH in patients with ALS.…”

Section: Introductionmentioning

confidence: 99%

Reassessment of Split-Leg Signs in Amyotrophic Lateral Sclerosis: Differential Involvement of the Extensor Digitorum Brevis and Abductor Hallucis Muscles

et al. 2019

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Background: The muscle patterns involved in the “split-leg” syndrome of amyotrophic lateral sclerosis (ALS) remains controversial. We sought to evaluate and reassess the pattern of the extensor digitorum brevis (EDB) and the abductor hallucis (AH) muscles' involvement in split-leg syndrome in ALS. Methods: We recruited 60 consecutive patients with ALS and 25 healthy controls (HCs). Compound muscle action potentials (CMAPs) and F-waves were recorded over the EDB and AH muscles in all subjects. For comparison, we classified patients into two categories based on the presence or absence of lower limbs symptoms. Results: The EDB/AH CMAP amplitude ratio was significantly reduced in patients with affected legs (0.33 ± 0.21, P = 0.007), whereas patients with unaffected legs had a ratio similar to that of the HCs. The EDB/AH ratios for the F-wave latencies, mean F-wave amplitude, mean F/M amplitude ratio, and the persistence of the total repeater F-wave shapes (index Freps) of the EDB-AH, were significantly increased in the affected leg group, whereas the EDB/AH ratio for F-wave persistence was significantly reduced. These findings indicated a greater loss of lower motor neurons (LMNs) innervating the EDB and dysfunction of spinal motoneurons innervating the EDB. In the unaffected leg group, the EDB, but not the AH, F-wave latencies, mean and maximal F/M amplitude ratios, and index Freps were significantly altered. Receiver operating characteristic curve analysis suggested that the EDB F-wave latencies, mean F/M amplitude ratios, and index Freqs (area under the curve [AUC] > 0.8) more strongly differentiated patients with ALS from the HCs compared to the EDB/AH CMAP amplitude ratio (AUC = 0.61). Notably, the EDB maximal F-wave latency and index Freqs reliably differentiated patients with unaffected legs (HCs), with AUCs of 0.83 (95% CI 0.76–0.91) and 0.81 (95% CI 0.72–0.89), sensitivities of 76 and 78%, and specificities of 76 and 78%, respectively. Conclusions: These results suggest preferential EDB compared to AH involvement in the split-leg syndrome of ALS. The EDB maximal F-wave latency and index Freqs robustly differentiated patients with ALS from HCs, which might facilitate an earlier identification of ALS.

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“…A recent study found that when compared to patients with cervical spondylotic myelopathy, even ALS patients without a split-hand clinic had a significantly lower ulnar/median DML ratio, and associated this condition with the prominence of distal axonopathy in the median nerve (15). On the other hand, another study indicated that the difference that was defined in the APB and ADM muscles was not only present in distal motor latency and amplitude, but also in F responses (17). Our ALS patient group consisted of all patients with limb-onset, regardless of the lower or upper extremity, however, the split-hand phenomenon was prominent even in patients' first EMGs.…”

Section: Discussionmentioning

confidence: 99%

Amyotrofik lateral skleroz erken tanısında sinir iletim çalışmaları ve ayrık el bulgusunun önemi

et al. 2022

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Amaç: Amyotrofik Lateral Skleroz' da (ALS) özellikle başlangıç döneminde klinik ve muayene bulgularının heterojenliği erken tanıda zorluklara yol açmaktadır. 'Ayrık el' işareti, ALS' de tenar kasların hipotenar kaslardan daha belirgin olarak etkilenmesini tanımlamak için kullanılır. Bu çalışmada erken tanıyı destekleyen bulguları artırmak için hastaların kliniğimizdeki ilk sinir iletim çalışmalarının sonuçları araştırıldı ve kontrol grubuyla karşılaştırıldı. Gereç ve Yöntem: Kliniğimizde ALS tanısı ile takip edilen 75 hasta çalışmaya dahil edildi. Hastaların ilk elektronöromyografi bulguları 70 sağlıklı kontrol ile karşılaştırıldı: Distal motor latans (DML), bileşik kas aksiyon potansiyeli (CMAP) amplitüdü, median, ulnar, peroneal ve tibial sinirlerin motor iletim hızları; distal latanslar, amplitüdler ve duyusal iletim hızları değerlendirildi. Ayrıca ulnar/median DML ve ulnar/median CMAP amplitüd oranları karşılaştırıldı. Bulgular: ALS grubunda kontrol grubuna göre median, ulnar, peroneal ve tibial sinirlerin DML' leri anlamlı olarak daha uzundu ve CMAP amplitüdleri anlamlı olarak daha küçüktü p˂0.05). Median, ulnar ve sural sinirlerin duyusal iletimleri gruplar arasında istatistiksel olarak farklı değildi. Hastaların ulnar/median DML oranı kontrollere göre daha düşüktü (0.73/0.80;p=0.003); ulnar/median CMAP amplitüd oranı ise daha yüksekti (1.40/1.11; p=0.002). Sonuç: ALS hastalarının erken dönemde motor sinir iletimlerinde uzamış DML ve düşük amplitüdler gözlendi. Bu çalışmada sonuçlarımız, ekstremite başlangıçlı ALS' nin (hem üst hem de alt) erken döneminde bile Ayrık el fenomeninin varlığını ve önemini desteklemektedir. Bulgularımız, ALS' nin spesifik muayene ve elektrofizyoloji bulgularının oldukça heterojen olduğu başlangıç döneminde dahi sinir iletim çalışmaları ve Ayrık el işaretinin erken tanıda önemli ipuçları olduğunu düşündürmektedir.

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Differences in Dysfunction of Thenar and Hypothenar Motoneurons in Amyotrophic Lateral Sclerosis

Cited by 13 publications

References 34 publications

Split-Hand Syndrome in Amyotrophic Lateral Sclerosis: Differences in Dysfunction of the FDI and ADM Spinal Motoneurons

Split-Hand Syndrome in Amyotrophic Lateral Sclerosis: Differences in Dysfunction of the FDI and ADM Spinal Motoneurons

Reassessment of Split-Leg Signs in Amyotrophic Lateral Sclerosis: Differential Involvement of the Extensor Digitorum Brevis and Abductor Hallucis Muscles

Amyotrofik lateral skleroz erken tanısında sinir iletim çalışmaları ve ayrık el bulgusunun önemi

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