title: Proton magnetic resonance spectroscopy and transcranial magnetic stimulation for the detection of upper motor neuron degeneration in ALS patients.
abstract: 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.
authors.affiliation: Department of Neurology, University of Bonn, Sigmund-Freud-Str. 25, D-53105, Bonn, Germany. c.pohl@uni-bonn.de
authors.forename: C
authors.initials: C
authors.lastname: Pohl
authors.forename: W
authors.initials: W
authors.lastname: Block
authors.forename: F
authors.initials: F
authors.lastname: Träber
authors.forename: S
authors.initials: S
authors.lastname: Schmidt
authors.forename: H
authors.initials: H
authors.lastname: Pels
authors.forename: C
authors.initials: C
authors.lastname: Grothe
authors.forename: H H
authors.initials: HH
authors.lastname: Schild
authors.forename: T
authors.initials: T
authors.lastname: Klockgether
mesh_terms: D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000378:metabolism* / Q000473:pathology* / Q000503:physiopathology; D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000378:metabolism; D002794:Choline / Q000378:metabolism; D004558:Electric Stimulation / Q000379:methods*; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D009046:Motor Neurons / Q000378:metabolism / Q000473:pathology*; D009431:Neural Conduction / Q000502:physiology; D010525:Peripheral Nerves / Q000473:pathology / Q000503:physiopathology; D011237:Predictive Value of Tests; D017966:Pyramidal Cells / Q000378:metabolism / Q000473:pathology*; D050781:Transcranial Magnetic Stimulation
chemical_list: D001224:Aspartic Acid; C000179:N-acetylaspartate; D002794:Choline