Three different short-interval intracortical inhibition methods in early diagnosis of amyotrophic lateral sclerosis

TY - JOUR

T1 - Three different short-interval intracortical inhibition methods in early diagnosis of amyotrophic lateral sclerosis

AU - Tankisi, Hatice

AU - Pia, Hossein

AU - Strunge, Kristine

AU - Howells, James

AU - Cengiz, Bülent

AU - Samusyte, Gintaute

AU - Koltzenburg, Martin

AU - Fuglsang-Frederiksen, Anders

AU - Bostock, Hugh

PY - 2023/2

Y1 - 2023/2

N2 - Objectives: To compare the utility of conventional amplitude measurements of short-interval intracortical inhibition (A-SICI) with two threshold-tracking (T-SICI) methods, as aids to early diagnosis of amyotrophic lateral sclerosis (ALS). The new parallel threshold-tracking method (T-SICIp) was compared with the previously used serial tracking method (T-SICIs). Methods: 112 consecutive patients referred with the suspicion of ALS and 40 healthy controls were prospectively included. Based on clinical follow-up, patients were divided into 67 patients with motor neuron disease (MND) comprising progressive muscular atrophy (PMA) as well as ALS, and 45 patient controls. SICI was recorded from first dorsal interosseus muscle using the three different protocols. Results: MND patients had significantly reduced T-SICIp, T-SICIs and A-SICI, compared with healthy controls and patient controls, while healthy and patient controls were similar. Paradoxically, T-SICIp was least affected in MND patients with the most upper motor neuron (UMN) signs (Spearman ρ = 0.537, P < 0.0001) whereas there was no correlation for T-SICIs or A-SICI. T-SICIp also provided the best discrimination between patient controls and MND as determined by the receiver operating characteristic (ROC) curves. For patients with no UMN signs, area under ROC curve for 2-3ms inter-stimulus intervals was 0.931 for T-SICIp, 0.771 for T-SICIs and 0.786 for A-SICI. Conclusions: SICI is a sensitive measure for detection of cortical involvement in ALS patients. T-SICIp has higher sensitivity and specificity than T-SICIs and A-SICI, particularly in patients without any upper motor neuron signs.

AB - Objectives: To compare the utility of conventional amplitude measurements of short-interval intracortical inhibition (A-SICI) with two threshold-tracking (T-SICI) methods, as aids to early diagnosis of amyotrophic lateral sclerosis (ALS). The new parallel threshold-tracking method (T-SICIp) was compared with the previously used serial tracking method (T-SICIs). Methods: 112 consecutive patients referred with the suspicion of ALS and 40 healthy controls were prospectively included. Based on clinical follow-up, patients were divided into 67 patients with motor neuron disease (MND) comprising progressive muscular atrophy (PMA) as well as ALS, and 45 patient controls. SICI was recorded from first dorsal interosseus muscle using the three different protocols. Results: MND patients had significantly reduced T-SICIp, T-SICIs and A-SICI, compared with healthy controls and patient controls, while healthy and patient controls were similar. Paradoxically, T-SICIp was least affected in MND patients with the most upper motor neuron (UMN) signs (Spearman ρ = 0.537, P < 0.0001) whereas there was no correlation for T-SICIs or A-SICI. T-SICIp also provided the best discrimination between patient controls and MND as determined by the receiver operating characteristic (ROC) curves. For patients with no UMN signs, area under ROC curve for 2-3ms inter-stimulus intervals was 0.931 for T-SICIp, 0.771 for T-SICIs and 0.786 for A-SICI. Conclusions: SICI is a sensitive measure for detection of cortical involvement in ALS patients. T-SICIp has higher sensitivity and specificity than T-SICIs and A-SICI, particularly in patients without any upper motor neuron signs.

KW - Humans

KW - Amyotrophic Lateral Sclerosis/diagnosis

KW - Transcranial Magnetic Stimulation/methods

KW - Evoked Potentials, Motor/physiology

KW - Motor Neuron Disease

KW - Early Diagnosis

KW - Neural Inhibition/physiology

KW - threshold tracking TMS

KW - short-interval intracortical inhibition

KW - Amyotrophic lateral sclerosis

KW - transcranial magnetic stimulation

KW - conventional TMS

UR - http://www.scopus.com/inward/record.url?scp=85135194682&partnerID=8YFLogxK

U2 - 10.1080/21678421.2022.2101926

DO - 10.1080/21678421.2022.2101926

M3 - Journal article

C2 - 35899374

SN - 1748-2968

VL - 24

SP - 139

EP - 147

JO - Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration

JF - Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration

IS - 1-2

ER -