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Modulation of spontaneous motor unit potentials by a new motor cortical magnetic stimulation method in amyotrophic lateral sclerosis

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Abstract

Background

Patients with amyotrophic lateral sclerosis (ALS) show altered cortical excitability. In this study, we measure modulation of spontaneous motor unit potentials (sMUPs) in hand muscles by multifocal cortical stimulation with a newly developed wearable transcranial rotating permanent magnet stimulator (TRPMS).

Methods

We conducted cross-sectional and longitudinal electromyographic assessments in 40 and 20 ALS patients, respectively, of the stimulation-induced peak increase in the count of sMUPs in two hand muscles modulated by unilateral TRPMS stimulation of the primary motor cortex. We measured peak sMUP counts during several short sessions consisting of 10 stimuli over 60 s and 30 s post-stimulation periods. The longitudinal component involved an initial assessment at an early stage of the disease and up to five follow-up assessments at least 3 months apart.

Results

TRPMS stimulation produced no device-related adverse effects. It showed an inverted V-shaped modulation of the peak sMUP counts as a function of ALS functional rating scale revised scores. The ratios of ALS subjects showing peak sMUP count increases between early and intermediate stages (χ2 = 4.086, df = 1, p = 0.043) and intermediate and late stages (χ2 = 4.29, df = 1, p = 0.038) in cross-sectional data were significantly different. Longitudinal assessment also produced a significant (z = 2.31, p = 0.021) result, with all subjects showing a post-initial visit increase in peak sMUP counts.

Conclusions

These results are consistent with delayed onset of upper motor neuronal dysfunction with respect to onset of clinical features. However, the above results need to be confirmed in a larger sample of patients and with multiple lines of evidence.

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Acknowledgements

We are grateful to all patients who participated in this study.

Funding

This study was funded in part by a grant from the Houston Methodist Specialty Physicians Group.

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Authors and Affiliations

  1. Stanley H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX, 77030, USA

    Santosh A. Helekar, Jason Thonhoff, Blessy S. John, Lisa Nguyen, David B. Rosenfield & Stanley H. Appel

  2. Weill Cornell Medical College, New York, NY, 10065, USA

    Santosh A. Helekar, David B. Rosenfield & Stanley H. Appel

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  1. Santosh A. Helekar
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  2. Jason Thonhoff
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  3. Blessy S. John
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  4. Lisa Nguyen
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  5. David B. Rosenfield
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  6. Stanley H. Appel
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Corresponding author

Correspondence to Santosh A. Helekar.

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Conflicts of interest

Santosh Helekar is listed as an inventor on U.S. patent numbers 9456784, 10398907, 10500408 and 10874870 covering the device used in this study. The patents are licensed to Seraya Medical, LLC. The other authors have no competing interests to disclose.

Ethical approval

This study was approved by our Institutional Review Board.

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Helekar, S.A., Thonhoff, J., John, B.S. et al. Modulation of spontaneous motor unit potentials by a new motor cortical magnetic stimulation method in amyotrophic lateral sclerosis. J Neurol 269, 5487–5496 (2022). https://doi.org/10.1007/s00415-022-11214-8

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  • DOI: https://doi.org/10.1007/s00415-022-11214-8

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