Multiple sclerosis: assessment of lesional levels by means of transcranial stimulation

Conduction in the Pyramidal Tracts (PTs) was studied in 30 healthy volunteers and 17 patients with definite Multiple Sclerosis. Central motor conduction time (CMCT) was assessed employing unipolar electrical transcranial stimulation and studies of the peripheral conduction time. Fourteen out of the seventeen studied patients showed CMCT abnormalities. No significative correlation was found between the intensity of muscle weakness and the slowness of conduction in the corresponding PTs. Subclinical abnormalities were detected in more than half of the studied patients. CMCT slowness showed a good correlation with the time course of the disease in the cortico-cervical (CCT) but not in the cortico-lumbar (CLT) tracts. Evidence favoring the existence of two different lesional levels along the PSs was found in 9 out of the 14 patients studied with recordings in the hand and leg muscles. Two patterns of abnormalities gave support to this conclusion. The first consisted of slowed conduction or inexcitability in both the CCT and CLT at one side, while only one of the contralateral PTs was impaired. In the second one, the 4 explored PTs showed a slowed conduction, but in addition, CMCT difference between the CLT and CCT was longer than normal. Both patterns suggest that one lesional level could be situated between the internal capsula and the lower cervical cord and the other in the spine below the 8th cervical methamera or in the corona radiata.