Proton magnetic resonance spectroscopy and transcranial magnetic stimulation for the detection of upper motor neuron degeneration in ALS patients

• Published in: Journal of the neurological sciences 2001-09, Vol.190 (1), p.21-27
• Main Authors: Pohl, Christoph, Block, Wolfgang, Träber, Frank, Schmidt, Stephan, Pels, Hendrik, Grothe, Christoph, Schild, Hans H, Klockgether, Thomas
• Format: Article
• Language: English
• Subjects: Adult; Aged; Amyotrophic lateral sclerosis; Amyotrophic Lateral Sclerosis - metabolism; Amyotrophic Lateral Sclerosis - pathology; Amyotrophic Lateral Sclerosis - physiopathology; Aspartic Acid - analogs & derivatives; Aspartic Acid - metabolism; Biological and medical sciences; Central motor conduction; Choline - metabolism; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Electric Stimulation - methods; Female; Humans; Magnetic Resonance Spectroscopy - instrumentation; Magnetic Resonance Spectroscopy - methods; Male; Medical sciences; Middle Aged; Motor Cortex - metabolism; Motor Cortex - pathology; Motor Cortex - physiopathology; Motor neuron disease; Motor Neurons - metabolism; Motor Neurons - pathology; Neural Conduction - physiology; Neurology; Peripheral Nerves - pathology; Peripheral Nerves - physiopathology; Predictive Value of Tests; Proton magnetic resonance spectroscopy; Pyramidal Cells - metabolism; Pyramidal Cells - pathology; Transcranial Magnetic Stimulation; Upper motor neuron
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/S0022-510X(01)00568-8

Transcranial magnetic stimulation (TMS) was compared to proton magnetic resonance spectroscopy ( 1H-MRS) for the detection of upper motor neuron loss or dysfunction in 49 ALS patients classified according to the El Escorial criteria. Abnormal NAA/Cho ratios were detected in 53% of ALS patients. Abnormal TMS results (i.e. cortical inexcitability or prolonged CMCT's) were obtained in 63% of ALS patients. If one or both methods were considered for diagnosis of upper motor neuron degeneration/dysfunction, the percentage of abnormal findings was 77%, whilst in 39% of all patients both methods produced abnormal results. Compared to TMS, 1H-MRS detected more patients with upper motor neuron involvement in the suspected El Escorial subgroup (42% versus 25%), whereas TMS detected more patients with upper motor neuron involvement in the possible (81% versus 50%), probable (71% versus 57%) and definite El Escorial subgroup (71% versus 64%). We conclude that the combined use of 1H-MRS and TMS increases diagnostic accuracy for the detection of upper motor neuron involvement in ALS patients.