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P64-S Reduced phosphene prevalence in ALS despite normal threshold
Abstracts / Clinical Neurophysiology 130 (2019) e21–e116
of the CMAP amplitude (SI%5, SI%50, SI%95), absolute range width (ARW) (SI%95-SI%5), relative width (RW) (SI95 SI5)/SI5], all step parameters and D50 which reflect the MU motor unit loss and reinnervation were analyzed. The new motor unit number estimation (MUNE) method, MscanFit was also calculated. Results: There were no significant differences in ages, maximum CMAP amplitudes and MScanFit MUNE between the groups. PS group median and ulnar D50 values (46.76 ± 10.98, 46.19 ± 12.42 respectively) were lower than control group (37.21 ± 17.37, 36.44 ± 11.99) (p < 0.05). Median nerve,excitability parameters of patients (SI 5%; 14.81 ± 6.97, SI 50%; 19.07 ± 9.2, SI 95%; 24.06 ± 11.52), ARW (9.26 ± 5.79), RW (0.65 ± 0.31) were higher than those of the controls (SI 5%; 9.64 ± 2.57, SI 50%; 11.64 ± 3.27, SI 95%; 13.64 ± 3.66, ARW; 4.00 ± 1.56, RW; 0.42 ± 0.13) (p < 0.05). Median and ulnar nerve step size parameters, step number and step% in the patients were also significantly higher (p < 0.05). Conclusions: CMAP Scan can show reduced axonal excitability and reveal insidious MU loss and reinnervation in presumably unaffected muscles of PS, regardless of the decrease in CMAP amplitudes or a significant reduction in MUNE values. doi:10.1016/j.clinph.2019.04.591
P64-S Reduced phosphene prevalence in ALS despite normal threshold—Bülent Cengiz *, Halt Fidancı, Hande Baltacı, Ece Türksoy, Reha Kuruog˘lu (Gazi University Medical Faculty Department of Neurology Neurology Division, Ankara, Turkey) ⇑
Corresponding author.
Introduction: Although ALS is one of the most common degenerative diseases of the motor neuron system, symptoms, and findings of the disease are not always restricted solely to the motor system. Certain clinical and electrophysiological findings observed in ALS patients imply some sensorial abnormalities. The aim of this study to investigate whether visual sensorial involvement occurs in ALS patients. For this, we investigated occipital cortex excitability with the phosphene threshold method. Method: Twenty-one ALS patients and 16 healthy controls were included in the study. Visual cortex TMS was performed using a standard round coil. TMS was performed in a semi-dark room. Eyes of participants were closed with an eye mask. Coil was placed vertically to 7 cm above the inion. Right, and left occipital cortices were stimulated at the same session. Short interval intracortical inhibition (SICI) and resting motor threshold (RMT) were also studied as well as ALSFRS-R scores in patients. Results: Phosphenes were elicited in 13 (81.2%) of controls, 9 (42.9%) of ALS patients (p = 0.041). Mean phosphene thresholds obtained with the occipital TMS was no difference between two groups (p > 0.05). No correlation was found between the phosphene threshold and ALSFRS-R scores, SICI, RMT (p > 0.05) Discussion: Results of this study indicated a reduced prevalence of phosphene in connection with decreased occipital cortex excitability in ALS patients for the first time. This finding may indicate the loss of function of V1, V2/V3 or abnormal connectivity between V1 and V2/ V3, regardless of clinical status or motor cortex excitability of the patients. doi:10.1016/j.clinph.2019.04.592
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P65-S Impaired short and long latency afferent inhibition in ALS—Bülent Cengiz *, Halit Fidancı, Yeliz Kıyak Keçeli, Hande Baltacı, Reha Kuruog˘lu (Gazi University Medical Faculty, Ankara, Turkey) ⇑
Corresponding author.
Objective: To test the hypothesis of impaired cholinergic activity in amyotrophic lateral sclerosis (ALS), we studied the short latency (SAI) and long latency (LAI) afferent inhibition. Methods: Transcranial magnetic stimulation (TMS) was delivered to the left M1. Central motor conduction time (CMCT) and motor action potential (MEP) latency were obtained. Right ulnar nerve was stimulated at the wrist preceding the TMS 21 ms for SAI and 200 ms for LAI. Results: Twenty-one ALS patients and 17 healthy controls participated in the study. Mean CMCT (p = 0.009) and MEP latency (p = 0.02) were significantly prolonged in patients. The SAI paradigm resulted in inhibition in all healthy individuals (100%), whereas inhibition was observed in 13 out of 21 (62%) patients. Mean SAI and LAI (p < 0.05) values were significantly reduced in patients. Conclusion: LAI as well as SAI, modulated by the cholinergic system, are impaired in ALS, probably unrelated to increased cortical excitability or cognitive dysfunction. doi:10.1016/j.clinph.2019.04.593
P66-S Corticospinal function in poliomyelitis survivors—Nermin Gorkem Sirin a,*, Bahar Erbas a, Gulsah Gula b, Emel Oguz-Akarsu a, Hava Ozlem Dede a, Elif Kocasoy-Orhan a, Mehmet Baris Baslo a, Aysegul Ketenci b, Halil Atilla Idrisoglu a, Ali Emre Oge a (a Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey, b Istanbul University, Istanbul Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey) ⇑
Corresponding author.
Background: Poliomyelitis survivors (PS) become candidates to post-polio syndrome (PPS) in their later lives. The mechanism of PPS has been suggested to be multifactorial involving cortical, spinal and peripheral mechanisThe aim of this study was to evaluate TMS parameters in PS and to compare them with those of amyotrophic lateral sclerosis (ALS) patients and controls. Material and methods: Single and paired TMS, contralateral and ipsilateral silent period (SP) and triple stimulation technique (TST) were performed by recording from abductor digiti minimi (ADM) and abductor pollicis brevis (APB) muscles of 18 PS, 31 ALS patients and 21 controls. The results were compared with mixed ANOVA and nonparametric independent tests. Results: No significant difference was present for within and between subject factors except those for the different interstimuli intervals. Resting motor threshold and MEP/M% in ADM, MEP amplitudes and latencies and TST% in both ADM and APB were significantly different. In posthoc analyses, MEP latencies were higher and TST% were lower in both ADM and APB in ALS group (20.7 ± 4.2 ms, 22.4 ± 5.0 ms, 83.1 ± 42.2, 72.3 ± 29.9) as compared to PS (18.3 ± 1.0 ms, 19.2 ± 2.0 ms, 101.6 ± 15.9, 98.1 ± 14.9), MEP/M% in ADM were lower in PS group (56.0 ± 13.4) as compared to controls
of the CMAP amplitude (SI%5, SI%50, SI%95), absolute range width (ARW) (SI%95-SI%5), relative width (RW) (SI95 SI5)/SI5], all step parameters and D50 which reflect the MU motor unit loss and reinnervation were analyzed. The new motor unit number estimation (MUNE) method, MscanFit was also calculated. Results: There were no significant differences in ages, maximum CMAP amplitudes and MScanFit MUNE between the groups. PS group median and ulnar D50 values (46.76 ± 10.98, 46.19 ± 12.42 respectively) were lower than control group (37.21 ± 17.37, 36.44 ± 11.99) (p < 0.05). Median nerve,excitability parameters of patients (SI 5%; 14.81 ± 6.97, SI 50%; 19.07 ± 9.2, SI 95%; 24.06 ± 11.52), ARW (9.26 ± 5.79), RW (0.65 ± 0.31) were higher than those of the controls (SI 5%; 9.64 ± 2.57, SI 50%; 11.64 ± 3.27, SI 95%; 13.64 ± 3.66, ARW; 4.00 ± 1.56, RW; 0.42 ± 0.13) (p < 0.05). Median and ulnar nerve step size parameters, step number and step% in the patients were also significantly higher (p < 0.05). Conclusions: CMAP Scan can show reduced axonal excitability and reveal insidious MU loss and reinnervation in presumably unaffected muscles of PS, regardless of the decrease in CMAP amplitudes or a significant reduction in MUNE values. doi:10.1016/j.clinph.2019.04.591
P64-S Reduced phosphene prevalence in ALS despite normal threshold—Bülent Cengiz *, Halt Fidancı, Hande Baltacı, Ece Türksoy, Reha Kuruog˘lu (Gazi University Medical Faculty Department of Neurology Neurology Division, Ankara, Turkey) ⇑
Corresponding author.
Introduction: Although ALS is one of the most common degenerative diseases of the motor neuron system, symptoms, and findings of the disease are not always restricted solely to the motor system. Certain clinical and electrophysiological findings observed in ALS patients imply some sensorial abnormalities. The aim of this study to investigate whether visual sensorial involvement occurs in ALS patients. For this, we investigated occipital cortex excitability with the phosphene threshold method. Method: Twenty-one ALS patients and 16 healthy controls were included in the study. Visual cortex TMS was performed using a standard round coil. TMS was performed in a semi-dark room. Eyes of participants were closed with an eye mask. Coil was placed vertically to 7 cm above the inion. Right, and left occipital cortices were stimulated at the same session. Short interval intracortical inhibition (SICI) and resting motor threshold (RMT) were also studied as well as ALSFRS-R scores in patients. Results: Phosphenes were elicited in 13 (81.2%) of controls, 9 (42.9%) of ALS patients (p = 0.041). Mean phosphene thresholds obtained with the occipital TMS was no difference between two groups (p > 0.05). No correlation was found between the phosphene threshold and ALSFRS-R scores, SICI, RMT (p > 0.05) Discussion: Results of this study indicated a reduced prevalence of phosphene in connection with decreased occipital cortex excitability in ALS patients for the first time. This finding may indicate the loss of function of V1, V2/V3 or abnormal connectivity between V1 and V2/ V3, regardless of clinical status or motor cortex excitability of the patients. doi:10.1016/j.clinph.2019.04.592
e111
P65-S Impaired short and long latency afferent inhibition in ALS—Bülent Cengiz *, Halit Fidancı, Yeliz Kıyak Keçeli, Hande Baltacı, Reha Kuruog˘lu (Gazi University Medical Faculty, Ankara, Turkey) ⇑
Corresponding author.
Objective: To test the hypothesis of impaired cholinergic activity in amyotrophic lateral sclerosis (ALS), we studied the short latency (SAI) and long latency (LAI) afferent inhibition. Methods: Transcranial magnetic stimulation (TMS) was delivered to the left M1. Central motor conduction time (CMCT) and motor action potential (MEP) latency were obtained. Right ulnar nerve was stimulated at the wrist preceding the TMS 21 ms for SAI and 200 ms for LAI. Results: Twenty-one ALS patients and 17 healthy controls participated in the study. Mean CMCT (p = 0.009) and MEP latency (p = 0.02) were significantly prolonged in patients. The SAI paradigm resulted in inhibition in all healthy individuals (100%), whereas inhibition was observed in 13 out of 21 (62%) patients. Mean SAI and LAI (p < 0.05) values were significantly reduced in patients. Conclusion: LAI as well as SAI, modulated by the cholinergic system, are impaired in ALS, probably unrelated to increased cortical excitability or cognitive dysfunction. doi:10.1016/j.clinph.2019.04.593
P66-S Corticospinal function in poliomyelitis survivors—Nermin Gorkem Sirin a,*, Bahar Erbas a, Gulsah Gula b, Emel Oguz-Akarsu a, Hava Ozlem Dede a, Elif Kocasoy-Orhan a, Mehmet Baris Baslo a, Aysegul Ketenci b, Halil Atilla Idrisoglu a, Ali Emre Oge a (a Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey, b Istanbul University, Istanbul Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey) ⇑
Corresponding author.
Background: Poliomyelitis survivors (PS) become candidates to post-polio syndrome (PPS) in their later lives. The mechanism of PPS has been suggested to be multifactorial involving cortical, spinal and peripheral mechanisThe aim of this study was to evaluate TMS parameters in PS and to compare them with those of amyotrophic lateral sclerosis (ALS) patients and controls. Material and methods: Single and paired TMS, contralateral and ipsilateral silent period (SP) and triple stimulation technique (TST) were performed by recording from abductor digiti minimi (ADM) and abductor pollicis brevis (APB) muscles of 18 PS, 31 ALS patients and 21 controls. The results were compared with mixed ANOVA and nonparametric independent tests. Results: No significant difference was present for within and between subject factors except those for the different interstimuli intervals. Resting motor threshold and MEP/M% in ADM, MEP amplitudes and latencies and TST% in both ADM and APB were significantly different. In posthoc analyses, MEP latencies were higher and TST% were lower in both ADM and APB in ALS group (20.7 ± 4.2 ms, 22.4 ± 5.0 ms, 83.1 ± 42.2, 72.3 ± 29.9) as compared to PS (18.3 ± 1.0 ms, 19.2 ± 2.0 ms, 101.6 ± 15.9, 98.1 ± 14.9), MEP/M% in ADM were lower in PS group (56.0 ± 13.4) as compared to controls