Navigated transcranial magnetic stimulation possibilities in difficult diagnostic cases upper motor neuron lesions – case report
https://doi.org/10.17650/2222-8721-2015-5-2-32-37
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized with lesions of both upper and lower motor neurons. In accordance with modern diagnostics criteria, only clinical symptoms are used for revealing lesions of the upper motor neuron with the ALS, which often causes serious difficulties. Absence of the pyramidal syndrome does not allow diagnosing ALS, and the diagnosis of progressive muscular atrophy should be set in these cases. We describe a case of an isolated generalized lesion of the lower motor neuron with the signs of cortical motor neurons lesion revealed in the course of navigational transcranial magnetic stimulation. Possible reasons for difficulties in detecting pyramidal syndrome are discussed together with the necessity of working out the criteria of instrumental diagnostics of lesions of the upper motor neuron in ALS.
About the Authors
I. S. Bakulin
Research Center of Neurology
Russian Federation
80, Volokolamskoe Shosse, Moscow, 125367
Russian Federation
80, Volokolamskoe Shosse, Moscow, 125367
A. V. Chervyakov
Research Center of Neurology
Russian Federation
80, Volokolamskoe Shosse, Moscow, 125367
Russian Federation
80, Volokolamskoe Shosse, Moscow, 125367
M. N. Zakharova
Research Center of Neurology
Russian Federation
80, Volokolamskoe Shosse, Moscow, 125367
Russian Federation
80, Volokolamskoe Shosse, Moscow, 125367
N. A. Suponeva
Research Center of Neurology
Russian Federation
80, Volokolamskoe Shosse, Moscow, 125367
Russian Federation
80, Volokolamskoe Shosse, Moscow, 125367
M. A. Piradov
Research Center of Neurology
Russian Federation
80, Volokolamskoe Shosse, Moscow, 125367
Russian Federation
80, Volokolamskoe Shosse, Moscow, 125367
References
1. Kiernan M.C., Vucic S., Cheah B.C. et al. Amyotrophic lateral sclerosis. Lancet 2011;377(9769):942–55.
2. Báumer D., Talbot K., Turner M.R. Advances in motor neuron disease. J R Soc Med 2014;107(1):14–21.
3. Brooks B.R., Miller R.G., Swash M. El Escorial revisited: revised criteria for the diagnosis of amyotrophic lateral sclerosis. Amyotroph Lateral Scler Other Motor Neuron Disord 2000;1(5):293–9.
4. Rowland L.P. Progressive muscular atrophy and other lower motor neuron syndromes of adults. Muscle Nerve 2010;41(2):161–5.
5. Kim W.K., Liu X., Sandner J. et al. Study of 962 patients indicates progressive muscular atrophy is a form of ALS. Neurology 2009;73(20):1686–92.
6. Ince P.G., Evans J., Knopp M. Corticospinal tract degeneration in the progressive muscular atrophy variant of ALS. Neurology 2003;60(8):1252–8.
7. Kaufmann P., Pullman S.L., Shungu D.C. Objective tests for upper motor neuron involvement in amyotrophic lateral sclerosis (ALS). Neurology 2004;62(10):1753–7.
8. Floyd A.G., Yu Q.P., Piboolnurak P. Transcranial magnetic stimulation in ALS: utility of central motor conduction tests. Neurology 2009;72(6):498–504.
9. Wijesekera L.C., Leigh P.N. Amyotrophic lateral sclerosis. Orphanet J Rare Dis 2009;4:3–25.
10. Ruohonen J., Karhu J. Navigated transcranial magnetic stimulation. Neurophysiol Clin 2010;40(1):7–17.
11. Червяков А.В., Пирадов М.А., Савицкая Н.Г. и др. Новый шаг к персонифицированной медицине. Навигационная система транскраниальной магнитной стимуляции NBS eXimia Nexstim. Анналы клинической и экспериментальной неврологии 2012;6(1):37–47. [Chervyakov A.V., Piradov M.A., Savitskaya N.G. et al. A new step to personified medicine. navigational NBS eXimia Nexstim system of transcranial magnetic stimulation. Annali klinicheskoy i experimentalnoy nevrologii = Annals of Clinical and Experimental Neurology 2012;6(1):37–47. (In Russ.)].
12. Червяков А.В., Пирадов М.А., Назарова М.А. и др. Картирование моторного представительства m. abductor pollicis brevis у здоровых добровольцев с применением навигационной транскраниальной магнитной стимуляции NBS eXimia Nexstim. Анналы клинической и экспериментальной неврологии 2012;6(3):14–7. [Chervyakov A.V., Piradov M.A., Nazarova M.A. et al. Mapping of motor representation m. abductor pollicis brevis with healthy subjects with application of NBS eXimia Nexstim System of transcranial magnetic stimulation. Annali Clinicheskoy i experimentalnoy nevrologii = Annals of Clinical and Experimental Neurology 2012; 6(3):14–7. (In Russ.)].
13. Triggs W.J., Menkes D., Onorato J. et al. Transcranial magnetic stimulation identifies upper motor neuron involvement in motor neuron disease. Neurology 1999;53:605–11.
14. Рушкевич Ю.Н., Забродец Г.В., Лихачев С.А. Ультразвуковая визуализация мышц в диагностике бокового амиотрофического склероза. Нервно-мышечные болезни 2014;(1):30–6. [Rushkevich Yu.N., Zabrodets G.V., Likhachev S.A. Ultrasonic imaging of muscles in the course of diagnostics of lateral amyotrophic sclerosis. Nervnomyshechnye bolezni = Neuromuscular Diseases 2014;(1):30–6. (In Russ.)].
15. Swash M. Why are upper motor neuron signs difficult to elicit in amyotrophic lateral sclerosis? J Neurol Neurosurg Psychiatry 2012;83(6):659–62. Боковой амиотрофический склероз. Под ред. И.А. Завалишина. М.: Евразия+, 2007. С. 51–131. [Lateral Amyotrophic Sclerosis. I.A. Zavalishin (ed.). Moscow: Eurasia+, 2007. pp. 51–131. (In Russ.)].
16. Stephens B., Guiloff R.J., Navarette R. et al. Widespread loss of neuronal populations in the spinal ventral horn in motor neuron disease. J Neurol Sci 2006;244:41–58.
17. Van den Berg-Vos R.M., Visser J., Franssen H. Sporadic lower motor neuron disease with adult onset: classification of subtypes. Brain 2003;126(Pt 5):1036–47.
18. Visser J., van den Berg-Vos R.M., Franssen H. Disease course and prognostic factors of progressive muscular atrophy. Arch Neurol 2007;64(4):522–8.
19. Karam C., Scelsa S.N., Macgowan D.J. The clinical course of progressive bulbar palsy. Amyotroph Lateral Scler 2010;11(4):364–8.
20. Bowser R. Turner M., Shefner J. Biomarkers in amyotrophic lateral sclerosis: opportunities and limitations. Nat Rev Neurol. 2011; 7(11):631-8.
21. Wang S., Melhem E.R., Poptani H. et al. Neuroimaging in amyotrophic lateral sclerosis. Neurotherapeutics 2011; 8(1):63–71.
22. Vucic S., Ziemann U., Eisen A. et al. Transcranial magnetic stimulation and amyotrophic lateral sclerosis: pathophysiological insights. J Neurol Neurosurg Psychiatry 2013;84(10):1161–70.
23. Захарова М.Н., Авдюнина И.А., Лысогорская Е.В. и др. Рекомендации по оказанию паллиативной помощи при боковом амиотрофическом склерозе. Нервно-мышечные болезни 2014;(4):4–11. [Zakharova M.N., Avdyunina I.A., Lysogorskaya E.V. et al. Recommendations for palliative care with lateral amyotrophic sclerosis. Nervno-myshechnye bolezni = Neuromuscular Diseases 2014;4:4–11. (In Russ.)].
24. Testa D., Lovati R., Ferrarini M. et al. Survival of 793 patients with amyotrophic lateral sclerosis diagnosed over a 28-year period. Amyotroph Lateral Scler Other Motor Neuron Disord 2004;5(4):208–12.
25. Vucic S., Cheah B.C., Yiannikas C. et al. Cortical excitability distinguishes ALS from mimic disorders. Clin Neurophysiol 2011;122(9):1860–6.
26. Chervyakov A.V., Bakulin I.S., Savitskaya N.G. et al. Navigated transcranial magnetic stimulation in amyotrophic lateral sclerosis. Muscle Nerve 2015;51: 125–31.
Review
For citations:
Bakulin I.S., Chervyakov A.V., Zakharova M.N., Suponeva N.A., Piradov M.A. Navigated transcranial magnetic stimulation possibilities in difficult diagnostic cases upper motor neuron lesions – case report. Neuromuscular Diseases. 2015;5(2):32-37. (In Russ.) https://doi.org/10.17650/2222-8721-2015-5-2-32-37
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