{"title":"肌萎缩性脊髓侧索硬化症患者分手加指数的神经传导研究:与下运动神经元损伤的相关性。","authors":"Stefano Zoccolella, Giammarco Milella, Alessia Giugno, Marco Filardi, Eustachio D'Errico, Ludovica Tamburrino, Vito Devitofrancesco, Rosaria Damato, Fulvia Piomboni, Salvatore Misceo, Giancarlo Logroscino","doi":"10.1007/s10072-024-07582-w","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>In the arms of patients with Amyotrophic lateral sclerosis (ALS) two peculiar patterns of dissociated muscular atrophy have been described: the split-hand sign (with predominant atrophy of the lateral aspect of the hand, compared to hypothenar eminence) and the split-hand-plus sign (SHPS), a predominant abductor pollicis brevis (ABP) atrophy with sparing of flexor pollicis longus (FPL).</p><p><strong>Aims: </strong>In this case-control study, we evaluated the diagnostic utility of a neurophysiological indicator of SHPS and assessed its association with clinical features.</p><p><strong>Methods: </strong>We prospectively studied 59 incident ALS patients, 61 patients with ALS-mimic disorders (OND) and 61 non-neurological controls (NNCs). ABP and FPL compound muscle action potentials (CMAP) amplitudes were obtained by supramaximal stimulation of median nerve at elbow. Split-hand plus index (SHPI) was calculated according to the formula: APB-CMAP/FPL-CMAP.</p><p><strong>Results: </strong>SHPI was significantly lower in ALS compared to OND patients and NNCs (p < 0.0001). SHPI value < 1 was observed in 2% of NNCs and 9% of OND patients and demonstrated an accuracy of 71% in differentiating ALS from OND and an accuracy of 74% in differentiating ALS from NNC. SHPI was associated with higher LMN score, and higher disease severity as quantified by the ALSFRS-r.</p><p><strong>Conclusion: </strong>Our results indicate that SHPI is a reliable indicator to distinguish ALS patients from ONDs and NNCs. SHPI was significantly associated to the degree of lower motor neuron impairment but showed no association with upper motoneuron impairment.</p>","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":null,"pages":null},"PeriodicalIF":2.7000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Nerve conduction study on the split-hand plus index in Amyotrophic lateral sclerosis: correlations with lower motor neuron impairment.\",\"authors\":\"Stefano Zoccolella, Giammarco Milella, Alessia Giugno, Marco Filardi, Eustachio D'Errico, Ludovica Tamburrino, Vito Devitofrancesco, Rosaria Damato, Fulvia Piomboni, Salvatore Misceo, Giancarlo Logroscino\",\"doi\":\"10.1007/s10072-024-07582-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>In the arms of patients with Amyotrophic lateral sclerosis (ALS) two peculiar patterns of dissociated muscular atrophy have been described: the split-hand sign (with predominant atrophy of the lateral aspect of the hand, compared to hypothenar eminence) and the split-hand-plus sign (SHPS), a predominant abductor pollicis brevis (ABP) atrophy with sparing of flexor pollicis longus (FPL).</p><p><strong>Aims: </strong>In this case-control study, we evaluated the diagnostic utility of a neurophysiological indicator of SHPS and assessed its association with clinical features.</p><p><strong>Methods: </strong>We prospectively studied 59 incident ALS patients, 61 patients with ALS-mimic disorders (OND) and 61 non-neurological controls (NNCs). ABP and FPL compound muscle action potentials (CMAP) amplitudes were obtained by supramaximal stimulation of median nerve at elbow. Split-hand plus index (SHPI) was calculated according to the formula: APB-CMAP/FPL-CMAP.</p><p><strong>Results: </strong>SHPI was significantly lower in ALS compared to OND patients and NNCs (p < 0.0001). SHPI value < 1 was observed in 2% of NNCs and 9% of OND patients and demonstrated an accuracy of 71% in differentiating ALS from OND and an accuracy of 74% in differentiating ALS from NNC. SHPI was associated with higher LMN score, and higher disease severity as quantified by the ALSFRS-r.</p><p><strong>Conclusion: </strong>Our results indicate that SHPI is a reliable indicator to distinguish ALS patients from ONDs and NNCs. 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引用次数: 0
摘要
简介在肌萎缩侧索硬化症(ALS)患者的手臂上,有两种特殊的分离性肌肉萎缩模式:分裂手征(与下跖突相比,手外侧的肌肉萎缩占主导地位)和分裂手加征(SHPS),分裂手加征主要表现为拇收肌萎缩,而拇长屈肌萎缩。目的:在这项病例对照研究中,我们评估了SHPS神经电生理指标的诊断效用,并评估了其与临床特征的关联:我们前瞻性地研究了 59 名 ALS 患者、61 名 ALS 模拟障碍(OND)患者和 61 名非神经病学对照组(NNC)。通过刺激肘部正中神经获得 ABP 和 FPL 复合肌肉动作电位(CMAP)振幅。分手加指数(SHPI)的计算公式为结果:结果:ALS 患者的 SHPI 明显低于 OND 患者和 NNC 患者(P我们的研究结果表明,SHPI 是区分 ALS 患者与 OND 和 NNC 的可靠指标。SHPI与下运动神经元受损程度明显相关,但与上运动神经元受损程度无关。
Nerve conduction study on the split-hand plus index in Amyotrophic lateral sclerosis: correlations with lower motor neuron impairment.
Introduction: In the arms of patients with Amyotrophic lateral sclerosis (ALS) two peculiar patterns of dissociated muscular atrophy have been described: the split-hand sign (with predominant atrophy of the lateral aspect of the hand, compared to hypothenar eminence) and the split-hand-plus sign (SHPS), a predominant abductor pollicis brevis (ABP) atrophy with sparing of flexor pollicis longus (FPL).
Aims: In this case-control study, we evaluated the diagnostic utility of a neurophysiological indicator of SHPS and assessed its association with clinical features.
Methods: We prospectively studied 59 incident ALS patients, 61 patients with ALS-mimic disorders (OND) and 61 non-neurological controls (NNCs). ABP and FPL compound muscle action potentials (CMAP) amplitudes were obtained by supramaximal stimulation of median nerve at elbow. Split-hand plus index (SHPI) was calculated according to the formula: APB-CMAP/FPL-CMAP.
Results: SHPI was significantly lower in ALS compared to OND patients and NNCs (p < 0.0001). SHPI value < 1 was observed in 2% of NNCs and 9% of OND patients and demonstrated an accuracy of 71% in differentiating ALS from OND and an accuracy of 74% in differentiating ALS from NNC. SHPI was associated with higher LMN score, and higher disease severity as quantified by the ALSFRS-r.
Conclusion: Our results indicate that SHPI is a reliable indicator to distinguish ALS patients from ONDs and NNCs. SHPI was significantly associated to the degree of lower motor neuron impairment but showed no association with upper motoneuron impairment.
期刊介绍:
Neurological Sciences is intended to provide a medium for the communication of results and ideas in the field of neuroscience. The journal welcomes contributions in both the basic and clinical aspects of the neurosciences. The official language of the journal is English. Reports are published in the form of original articles, short communications, editorials, reviews and letters to the editor. Original articles present the results of experimental or clinical studies in the neurosciences, while short communications are succinct reports permitting the rapid publication of novel results. Original contributions may be submitted for the special sections History of Neurology, Health Care and Neurological Digressions - a forum for cultural topics related to the neurosciences. The journal also publishes correspondence book reviews, meeting reports and announcements.