Castro José, Swash Michael, de Carvalho Mamede
Instituto de Fisiologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Department of Neurosciences and Mental Health, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal.
Instituto de Fisiologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Departments of Neurology and Neuroscience, Barts and the London School of Medicine, Queen Mary University of London, United Kingdom.
Neurophysiol Clin. 2023 Aug;53(4):102843. doi: 10.1016/j.neucli.2022.102843. Epub 2023 Jan 29.
We investigated the cutaneous silent period (CutSP) as a measure of upper motor neuron (UMN) dysfunction in amyotrophic lateral sclerosis.
The onset latency, duration, and amount of EMG suppression of the CutSP were compared with clinical UMN signs in 24 patients with amyotrophic lateral sclerosis (ALS). UMN signs were quantified using a clinical index and transcranial magnetic stimulation (TMS). Central motor conduction time (CMCT), cortical motor threshold and motor evoked potential amplitudes were assessed as measures of UMN dysfunction. CutSP was studied in abductor digit minimi (ADM) and tibialis anterior (TA) EMG recordings following stimulation of the 5th finger and sural nerves respectively. Non-parametric tests and binomial logistic regression were applied to evaluate the data.
CutSP onset latency was increased in ALS patients, compared to healthy controls, both for ADM and TA muscles. In limbs with clinical UMN signs or abnormal TMS findings, the CutSP onset latency was particularly increased. There was a significant positive correlation between CutSP onset latency and the UMN score in both upper and lower limbs. In TA muscles there was also a negative correlation between CutSP onset latency and EMG suppression. The logistic regression model based on CutSP parameters correctly classified more than 70% of the cases regarding the presence of clinical signs of UMN lesion, in both upper and lower limbs. The results were not significant for TMS.
We conclude that upper limb CutSP changes associates with UMN lesion in ALS. This neurophysiological measurement merits further investigation in ALS.
我们研究了皮肤静息期（CutSP）作为肌萎缩侧索硬化症上运动神经元（UMN）功能障碍的一种测量指标。
比较了24例肌萎缩侧索硬化症（ALS）患者CutSP的起始潜伏期、持续时间和肌电图抑制量与临床UMN体征。使用临床指数和经颅磁刺激（TMS）对UMN体征进行量化。评估中枢运动传导时间（CMCT）、皮质运动阈值和运动诱发电位幅度作为UMN功能障碍的指标。分别在刺激小指展肌（ADM）和胫前肌（TA）的肌电图记录中研究CutSP，刺激分别通过刺激第5指和腓肠神经进行。应用非参数检验和二项逻辑回归来评估数据。
与健康对照相比，ALS患者ADM和TA肌肉的CutSP起始潜伏期均增加。在有临床UMN体征或TMS检查结果异常的肢体中，CutSP起始潜伏期尤其增加。上肢和下肢的CutSP起始潜伏期与UMN评分之间均存在显著正相关。在TA肌肉中，CutSP起始潜伏期与肌电图抑制之间也存在负相关。基于CutSP参数的逻辑回归模型在上下肢中关于UMN病变临床体征的存在正确分类了超过70%的病例。TMS的结果不显著。
我们得出结论，上肢CutSP变化与ALS中的UMN病变相关。这种神经生理学测量在ALS中值得进一步研究。
