title: A new neurophysiological approach to assess central motor conduction damage to proximal and distal muscles of lower limbs.
abstract: OBJECTIVE
  To develop a neurophysiological method to explore central motor pathways to proximal and distal muscles of lower limbs.
  
  
  METHODS
  MEPs to transcranial magnetic stimulation using the double cone coil were bilaterally and simultaneously recorded from vastus medialis, tibialis anterior and flexor hallucis brevis. Voluntary facilitation was controlled using a predefined sequence of movements of constant amplitude. Compound motor action potentials elicited by maximal high voltage electrical stimulation of lumbosacral roots (root-CMAPs) were recorded from the same muscles to obtain the corresponding peripheral conduction times. We studied 28 healthy subjects and 28 multiple sclerosis (MS) patients with no or mild motor impairment.
  
  
  RESULTS
  The described facilitation procedure and the averaging of 5 MEPs reduced area variability to about 10%. In MS patients conduction slowing and/or MEP area reduction in at least one muscle was found in 91.7% of cases, with significant correlation with individual motor impairment.
  
  
  CONCLUSIONS
  Combined use of stable MEPs and maximal root-CMAPs was able to detect both conduction slowing and conduction failure in central motor pathways to proximal and distal districts of lower limbs in MS patients.
  
  
  CONCLUSIONS
  The proposed method provides an extensive electrophysiological mapping of central motor impairment of lower limbs in clinical application.
authors.affiliation: 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Centre), AOU San Luigi Gonzaga, Orbassano, Torino, Italy. Electronic address: adisapio2210@gmail.com.
authors.forename: Alessia
authors.initials: A
authors.lastname: Di Sapio
authors.affiliation: 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Centre), AOU San Luigi Gonzaga, Orbassano, Torino, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bertolotto
authors.affiliation: 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Centre), AOU San Luigi Gonzaga, Orbassano, Torino, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Melillo
authors.affiliation: 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Centre), AOU San Luigi Gonzaga, Orbassano, Torino, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Sperli
authors.affiliation: 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Centre), AOU San Luigi Gonzaga, Orbassano, Torino, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Malucchi
authors.affiliation: 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Centre), AOU San Luigi Gonzaga, Orbassano, Torino, Italy.
authors.forename: Walter
authors.initials: W
authors.lastname: Troni
mesh_terms: D000328:Adult; D001931:Brain Mapping / Q000379:methods*; D019054:Evoked Potentials, Motor; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology*; D009431:Neural Conduction / Q000502:physiology*; D052097:Quadriceps Muscle / Q000294:innervation / Q000503:physiopathology; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
keywords: BMRC; BS11; British Medical Research Council scale; CMAP; CMCT; Central motor conduction damage; Eleven Point Box scale; FHB; HVES; Lumbo-sacral roots electrical stimulation; MEP; MS; Motor Evoked Potentials; Multiple sclerosis; PCT; TA; TMS; Transcranial magnetic stimulation; VM; central motor conduction time; compound muscle action potential; flexor hallucis brevis muscle; high voltage electrical stimulation; motor evoked potential; multiple sclerosis; peripheral conduction time; tibialis anterior muscle; transcranial magnetic stimulation; vastus medialis muscle