title: Electrophysiological differences between Hirayama disease, amyotrophic lateral sclerosis and cervical spondylotic amyotrophy.
abstract: BACKGROUND
  Hirayama disease (HD), amyotrophic lateral sclerosis (ALS) or cervical spondylotic amyotrophy (CSA) may result in atrophy of intrinsic hand and forearm muscles. The incidence of HD is low, and it is rarely encountered in the clinical setting. Consequently, HD is often misdiagnosed as ALS or CSA. It is important to differentiate these diseases because HD is caused by a benign focal lesion that is limited to the upper limbs.
  
  
  METHODS
  The thenar and hypothenar compound muscle action potential (CMAP) amplitude of the upper limbs of 100 HD, 97 ALS and 32 CSA cases were reviewed; 35 healthy individuals were included as controls. Seventy-eight percent, 38% and 69% of patients with HD, ALS or CSA had unilateral involvement; the remaining patients were affected bilaterally. Thenar and hypothenar CMAP amplitude evoked by ulnar stimulation was compared with CMAP evoked by median stimulation.
  
  
  RESULTS
  The ulnar/median CMAP ratio was found to be lower in HD (0.55 ± 0.41, P<0.0001), higher in ALS (2.28 ± 1.15, P<0.0001) and no different in CSA (1.21 ± 0.53, P>0.05) compared with the normal range from previous studies (0.89-1.60) and with the healthy controls (1.15 ± 0.23). Conduction velocities of the sensory and motor nerves, the amplitude of the sensory nerve action potential, and the CMAP amplitude of the unaffected limb were all normal.
  
  
  CONCLUSIONS
  The hand muscles were differentially affected between patients with HD, ALS and CSA. The ulnar/median CMAP ratio could be used to distinguish these three diseases.
authors.forename: Xiang
authors.initials: X
authors.lastname: Jin
authors.affiliation: Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China. jianyuanjiang05@126.com.
authors.forename: Jian-Yuan
authors.initials: JY
authors.lastname: Jiang
authors.forename: Fei-Zhou
authors.initials: FZ
authors.lastname: Lu
authors.forename: Xin-Lei
authors.initials: XL
authors.lastname: Xia
authors.forename: Li-Xun
authors.initials: LX
authors.lastname: Wang
authors.forename: Chao-Jun
authors.initials: CJ
authors.lastname: Zheng
mesh_terms: D000200:Action Potentials; D000293:Adolescent; D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000503:physiopathology*; D016022:Case-Control Studies; D005260:Female; D006225:Hand / Q000294:innervation / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons / Q000502:physiology; D018482:Muscle, Skeletal / Q000503:physiopathology*; D009134:Muscular Atrophy, Spinal / Q000503:physiopathology*; D009431:Neural Conduction; D011984:Sensory Receptor Cells / Q000502:physiology; D014897:Spinal Muscular Atrophies of Childhood / Q000503:physiopathology*; D055009:Spondylosis / Q000503:physiopathology*; D034941:Upper Extremity / Q000503:physiopathology; D055815:Young Adult