The evolution of motor cortical dysfunction in amyotrophic lateral sclerosis

Publication date: Available online 15 March 2017
Source:Clinical Neurophysiology
Author(s): Kazumoto Shibuya, Neil G. Simon, Nimeshan Geevasinga, Parvathi Menon, James Howells, Susanna B. Park, William Huynh, Yu-ichi Noto, Steve Vucic, Matthew C. Kiernan
ObjectiveThe present study aimed to investigate alterations in cortical function in amyotrophic lateral sclerosis (ALS) related to disease progression.MethodsIn total, clinical assessments were evaluated in 189 ALS patients, combined with assessment of cortical function utilizing threshold tracking transcranial magnetic stimulation. Results were compared with disease stage. Disease stage was defined in three ways: (1) as a proportion of disease duration in deceased patients; (2) from the time of ALS onset; and (3) using the ALS rating scale-revised (ALSFRS-R).ResultsProspective studies in ALS patients demonstrated decreased neurophysiological index (p < 0.0001) and decreased compound muscle action potential (CMAP) (p < 0.0001), combined with abnormalities of central function including prolonged central motor conduction time (CMCT) (p < 0.05), increased motor evoked potential/CMAP amplitude ratio (p < 0.0001) and decreased short interval intracortical inhibition (SICI) (p < 0.001). SICI at 3ms (p < 0.05, β = -0.21) and averaged SICI (p < 0.05, β = -0.21) decreased with disease progression, measured using proportion of disease duration. Alternatively, using time from disease onset, CMCT prolonged with disease progression (p < 0.01, β = 0.25), while ALSFRS-R decline correlated with decreased SICI at 3ms (p < 0.01, β = 0.20).ConclusionsClinical measures combined with assessment of cortical function established that SICI decreased with disease progression.SignificanceThese findings may suggest dysfunction of inhibitory interneurons with disease progression.



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