Somatosensory evoked potentials elicited by stimulation of lower-limb nerves in amyotrophic lateral sclerosis

To determine lower limb somatosensory modifications in amyotrophic lateral sclerosis (ALS), we studied somatosensory evoked potentials (SEPs) elicited by stimulation of tibial posterior nerves (TP), sural nerves (SN), saphenous internous nerves (SA), and medial plantar nerves (PL) of both limbs in 24 ALS patients, and compared the results with those from 17 normal subjects. Responses were recorded according to the international 10-20 system. Normal sensory conduction velocities of SN, SA and PL and H reflexes in soleus muscles were prerequisites for patient inclusion in this study. The results showed marked alterations in SEPs cortical components of all lower limb nerves, which could be related to abnormal sensory transmission (after spinal N22), or cortical abnormalities. We put forward the hypothesis of impairment of pyramidal control of the sensory system and Clark's column involvement to explain such anomalies. It was concluded that SEPs abnormalities in the lower limbs are a common feature in ALS.