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Mirror movements and ipsilateral motor evoked potentials in ALS
Klaus Krampfl1, Bahram Mohammadi, Leonid Komissarow
1Department of Neurology, Medical University of Hannover, Hannover, Germany.
Summary
Mirror movements (MMs) can help detect early upper motor neuron (UMN) involvement in amyotrophic lateral sclerosis (ALS). Electromyography and transcranial magnetic stimulation (TMS) significantly improve the identification of these UMN signs in ALS patients.
Area of Science:
- Neurology
- Neurophysiology
Background:
- Detecting upper motor neuron (UMN) involvement in early amyotrophic lateral sclerosis (ALS) is challenging.
- Mirror movements (MMs) represent contralateral coactivation of hand muscles and may serve as an early UMN sign.
Purpose of the Study:
- To evaluate the utility of mirror movements (MMs) for detecting UMN involvement in amyotrophic lateral sclerosis (ALS).
Main Methods:
- Clinical assessment, electromyography (EMG), and transcranial magnetic stimulation (TMS) were used to study MMs.
- Ipsilateral motor evoked potentials (IMEPs) were specifically investigated using TMS.
- The study included patients with varying ALS classifications and control groups.
Main Results:
- MMs were clinically observed in 27% and electromyographically in 50% of ALS patients.
- IMEPs were detected in 61% of all ALS patients and 47% of suspected ALS patients via TMS.
- Prolonged central motor conduction times were noted in 27% of ALS patients.
Conclusions:
- Mirror movements, particularly when assessed with EMG and TMS (IMEPs), can significantly enhance the detection of UMN involvement in early-stage ALS.
- This method offers improved diagnostic capabilities for identifying early neurological changes in ALS.