근육위축가쪽경화증 환자에서 뒤정강신경/ 엄지벌림근부위에서 시행한 신경생리학적 지표의 유용성 = Prospective Study on the Efficiency of Neurophysiological Index Applicated at Posterior Tibial Nerve/Abductor Pollicis Longus in Patients With Amyotrophic Lateral Sclerosis

다국어 초록 (Multilingual Abstract)

Background: Neurophysiological Index (NI) is a sensitive measure of changes during the course of amyotrophic lateral sclerosis (ALS). However, NI applied at the ulnar nerve has limitation in that the initial manifestation of ALS is different among individual patients. This study was aimed to evaluate the efficiency of NI applied to the posterior tibial nerve system in a prospective study of progression in ALS patients.
Methods: The subjects of the study were 22 patients with definite or probable ALS based on revised EL Escorial criteria. NI applied to the ulnar nerve/abductor digiti minimi muscle and the posterior tibial nerve/abductor hallucis muslce, revised ALS functional rating scale, Norris scale, and grip power were obtained at four and eight months of the follow-up.
Results: Overall, NI at both ulnar and posterior tibial nerve systems showed a significant interval change at 4 and 8 months. Although NI in both nerve systems showed significant changes at an interval of 4 months in patients with upper limb onset, NI obtained from the ulnar nerve did not show a difference from the baseline in the lower limb onset patients. Moreover, there was a significant change of NI in the early stage ALS patients, compared to the late stage patients.
Conclusions: In the lower limb onset patients, NI obtained from the posterior tibial nerve is more useful in evaluating the disease progression pattern. Moreover, NI is more effective in the evaluation of the patients in the early stage.

다국어 초록 (Multilingual Abstract)

Background: Neurophysiological Index (NI) is a sensitive measure of changes during the course of amyotrophic lateral sclerosis (ALS). However, NI applied at the ulnar nerve has limitation in that the initial manifestation of ALS is different among individual patients. This study was aimed to evaluate the efficiency of NI applied to the posterior tibial nerve system in a prospective study of progression in ALS patients.
Methods: The subjects of the study were 22 patients with definite or probable ALS based on revised EL Escorial criteria. NI applied to the ulnar nerve/abductor digiti minimi muscle and the posterior tibial nerve/abductor hallucis muslce, revised ALS functional rating scale, Norris scale, and grip power were obtained at four and eight months of the follow-up.
Results: Overall, NI at both ulnar and posterior tibial nerve systems showed a significant interval change at 4 and 8 months. Although NI in both nerve systems showed significant changes at an interval of 4 months in patients with upper limb onset, NI obtained from the ulnar nerve did not show a difference from the baseline in the lower limb onset patients. Moreover, there was a significant change of NI in the early stage ALS patients, compared to the late stage patients.
Conclusions: In the lower limb onset patients, NI obtained from the posterior tibial nerve is more useful in evaluating the disease progression pattern. Moreover, NI is more effective in the evaluation of the patients in the early stage.

참고문헌 (Reference)

1 Brooks BR, "World Federation of Neurology Research Group on Motor Neuron Disease. El Escorial revisited: revised criteria for diagnosis of amyotrophic lateral sclerosis" 1 : 293-299, 2000

2 Swash M, "The neurophysiological index in ALS" 5 : 108-110, 2004

3 Ringel SP, "The natural history of amyotrophic lateral sclerosis" 43 : 1316-1322, 1993

4 Preux PM, "Survival prediction in sporadic amyotrophic lateral sclerosis" 15 : 153-160, 1996

5 de Carvalho M, "Reproducibility of neurophysiological and myometricmeasurement in the ulnar nerve- abductor digiti minimi system" 24 : 1391-1395, 2001

6 de Carvalho M, "Quantitating progression in ALS" 64 : 1783-1785, 2005

7 de Carvalho M, "Neurophysiological measures in amyotrophic lateral sclerosis: markers of progression in clinical trials" 6 : 17-28, 2005

8 de Carvalho M, "Nerve conduction studies in amyotrophic lateral sclerosis" 23 : 344-352, 2000

9 Haverkamp LJ, "Natural history of amyotrophic lateral sclerosis in a database population. Validation of a scoring system and a model for survival prediction" 118 : 707-719, 1995

10 de Carvalho M, "Clinical trials in ALS: a review of the role of clinical and neurophysiological measurements" 6 : 202-212, 2005

11 de Carvalho M, "Clinical and neurophysiological evaluation of progression in amyotrophic lateral sclerosis" 28 : 630-633, 2003

12 de Carvalho M, "Can selection of rapidly progressing patients shorten clinical trials in amyotrophic lateral sclerosis" 63 : 557-560, 2006

13 Kim HY, "Availability of Neurophysiological Index in Amyotrophic Lateral Sclerosis: Application of Neurophysiological Index to Median Nerve/Abductor Digiti Minimi and Posterior Tibial Nerve/Abductor Hallucis" 25 : 16-22, 2007

14 Gubbay SS, "Amytorophic lateral sclerosis. A study of its presentation and prognosis" 232 : 295-300, 1985

15 Ince PG, "Amyotrophic lateral sclerosis: current issues in classification, pathogenesis and molecular pathology" 24 : 104-117, 1998

16 Mitchell JD, "Amyotrophic lateral sclerosis" 369 : 2031-2041, 2007

17 Caroscio JT, "Amyotrophic lateral sclerosis" Neurol Clin 5 : 1-8, 1987