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Brain diffusion tensor imaging changes linked to the split hand phenomenon in amyotrophic lateral sclerosis.

Seol-Hee Baek1, Woo-Suk Tae2, Dorothee Auer3,4,5

  • 1Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.

Scientific Reports
|April 11, 2025
PubMed
Summary

The split-hand phenomenon in amyotrophic lateral sclerosis (ALS) is linked to white matter changes in the brain's corticospinal tract. This suggests early degeneration in the corticospinal tract may contribute to this specific ALS symptom.

Keywords:
Amyotrophic lateral sclerosisAxonal degenerationCorticospinal tractDiffusion tensor imagingPathophysiologySplit-hand phenomenon

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Area of Science:

  • Neuroscience
  • Neurology
  • Biomedical Imaging

Background:

  • The split-hand phenomenon is an early and specific clinical sign observed in amyotrophic lateral sclerosis (ALS).
  • The underlying neuropathological basis, particularly concerning white matter integrity in the brain, remains incompletely understood.

Purpose of the Study:

  • To investigate the association between the split-hand phenomenon in ALS patients and white matter degeneration.
  • To explore the relationship between the split-hand index (SHI) and diffusion tensor imaging (DTI) metrics within the corticospinal tract (CST).

Main Methods:

  • Prospective recruitment of 35 patients with clinically definite or probable ALS.
  • Assessment of the split-hand index (SHI) using nerve conduction studies.
  • Brain diffusion tensor imaging (DTI) was performed to evaluate white matter integrity, focusing on the corticospinal tract (CST).

Main Results:

  • Positive correlations were found between the SHI and axial diffusivity (AD) and mode of anisotropy (MO) values in the CST.
  • No significant correlations were observed between SHI and fraction anisotropy (FA), mean diffusivity (MD), or radial diffusivity (RD) scalars.
  • Patients with bilateral split-hand phenomenon exhibited reduced AD in the left CST and reduced MO in the bilateral CST compared to those without the phenomenon.

Conclusions:

  • The split-hand phenomenon in ALS is associated with specific white matter degenerative changes within the corticospinal tract.
  • DTI metrics, particularly AD and MO, may serve as potential biomarkers for assessing CST integrity in relation to the split-hand phenomenon in ALS.