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Journal of Neurology
Published in: Journal of Neurology 6/2013

01-06-2013 | Original Communication

Upper motor neuron involvement in amyotrophic lateral sclerosis evaluated by triple stimulation technique and diffusion tensor MRI

Authors: Jasna Furtula, Birger Johnsen, Jesper Frandsen, Anders Rodell, Peter Broegger Christensen, Kirsten Pugdahl, Anders Fuglsang-Frederiksen

Published in: Journal of Neurology | Issue 6/2013

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Abstract

The objective of this study was to evaluate the diagnostic value of triple stimulation technique (TST) and diffusion tensor imaging (DTI) tractography as markers of upper motor neuron (UMN) degeneration in amyotrophic lateral sclerosis (ALS). Fourteen ALS patients fulfilling the El Escorial criteria and 30 control subjects participated in the study. TST amplitude and area ratio were used as an estimate of the degree of central motor conduction failure. DTI fractional anisotropy was used as a quantitative measure of the structural integrity of the corticospinal tract and the posterior limb of the internal capsule. Mean TST amplitude and area ratio were lower in patients than controls, while there were no differences in mean fractional anisotropy of the corticospinal tract or the posterior limb of the internal capsule. TST was abnormal in 7/13 patients (sensitivity 54 %) and DTI was abnormal in 3/12 (sensitivity 25 %). Combining TST and DTI disclosed abnormalities in 8/11 patients (sensitivity 73 %). TST confirmed UMN degeneration in one of every 2.25 patient in the diagnostic categories lower than ‘probable’ ALS. Using results from TST as a criterion for UMN degeneration, four patients in diagnostic categories lower than ‘probable’ ALS and without clinical signs of UMN degeneration in the cervical region increased in diagnostic category. Our findings indicate that TST has a significant diagnostic value as an early objective marker of UMN degeneration in ALS, while the value of DTI analysis seems limited.
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Metadata
Title
Upper motor neuron involvement in amyotrophic lateral sclerosis evaluated by triple stimulation technique and diffusion tensor MRI
Authors
Jasna Furtula
Birger Johnsen
Jesper Frandsen
Anders Rodell
Peter Broegger Christensen
Kirsten Pugdahl
Anders Fuglsang-Frederiksen
Publication date
01-06-2013
Publisher
Springer-Verlag
Published in
Journal of Neurology / Issue 6/2013
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-012-6824-8

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