title: Can lesions to the motor cortex induce amyotrophic lateral sclerosis?
abstract: A recent staging effort for amyotrophic lateral sclerosis (ALS) has demonstrated that the TDP-43 neuropathology may initiate focally in the motor cortex in the majority of patients. We searched our data bank for patients with lesions of the motor cortex which preceded disease onset. We performed a search of our patient- and MRI-data bank and screened 1,835 patients with amyotrophic lateral sclerosis for frontal lobe/motor cortex lesions. We found 18 patients with definite ALS who had documented and defined lesions of the motor cortex, which preceded the initial ALS symptoms by 8-42 years. In the vast majority (15/18) of the patients, the onset of ALS was closely related to the focal lesion since it started in a body region reflecting the damaged cortical area. The findings suggest that initial lesions to the motor cortex may be a contributing initiating factor in some patients with ALS or determine the site of onset in individuals pre-disposed to ALS.
authors.affiliation: Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
authors.forename: Angela
authors.initials: A
authors.lastname: Rosenbohm
authors.forename: Jan
authors.initials: J
authors.lastname: Kassubek
authors.forename: Patrick
authors.initials: P
authors.lastname: Weydt
authors.forename: Nicolai
authors.initials: N
authors.lastname: Marroquin
authors.forename: Alexander E
authors.initials: AE
authors.lastname: Volk
authors.forename: Christian
authors.initials: C
authors.lastname: Kubisch
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Huppertz
authors.forename: Markus
authors.initials: M
authors.lastname: Weber
authors.forename: Peter M
authors.initials: PM
authors.lastname: Andersen
authors.forename: Jochen H
authors.initials: JH
authors.lastname: Weishaupt
authors.forename: Albert C
authors.initials: AC
authors.lastname: Ludolph
mesh_terms: D000058:Accidental Falls; D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000209:etiology*; D001344:Autopsy; D001930:Brain Injuries / Q000150:complications / Q000473:pathology; D004185:Disability Evaluation; D005260:Female; D005625:Frontal Lobe / Q000293:injuries; D020197:Head Injuries, Penetrating / Q000150:complications; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000293:injuries* / Q000473:pathology; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology / Q000628:therapy; D013702:Temporal Lobe / Q000293:injuries; D055815:Young Adult