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Erschienen in: Journal of Neurology 9/2018

11.07.2018 | Original Communication

Extrapyramidal deficits in ALS: a combined biomechanical and neuroimaging study

verfasst von: Maryse Feron, Annabelle Couillandre, Eya Mseddi, Nicolas Termoz, Malek Abidi, Eric Bardinet, Daniel Delgadillo, Timothée Lenglet, Giorgia Querin, Marie-Laure Welter, Nadine Le Forestier, François Salachas, Gaelle Bruneteau, Maria del Mar Amador, Rabab Debs, Lucette Lacomblez, Vincent Meininger, Mélanie Pélégrini-Issac, Peter Bede, Pierre-François Pradat, Giovanni de Marco

Erschienen in: Journal of Neurology | Ausgabe 9/2018

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Abstract

Introduction

Extrapyramidal deficits are poorly characterised in amyotrophic lateral sclerosis (ALS) despite their contribution to functional disability, increased fall risk and their quality-of-life implications. Given the concomitant pyramidal and cerebellar degeneration in ALS, the clinical assessment of extrapyramidal features is particularly challenging.

Objective

The comprehensive characterisation of postural instability in ALS using standardised clinical assessments, gait analyses and computational neuroimaging tools in a prospective study design.

Methods

Parameters of gait initiation in the anticipatory postural adjustment phase (APA) and execution phase (EP) were evaluated in ALS patients with and without postural instability and healthy controls. Clinical and gait analysis parameters were interpreted in the context of brain imaging findings.

Results

ALS patients with postural instability exhibit impaired gait initiation with an altered APA phase, poor dynamic postural control and significantly decreased braking index. Consistent with their clinical profile, “unsteady” ALS patients have reduced caudate and brain stem volumes compared to “steady” ALS patients.

Interpretation

Our findings highlight that the ALS functional rating scale (ALSFRS-r) does not account for extrapyramidal deficits, which are major contributors to gait impairment in a subset of ALS patients. Basal ganglia degeneration in ALS does not only contribute to cognitive and behavioural deficits, but also adds to the heterogeneity of motor disability.
Glossar
ALS
Amyotrophic lateral sclerosis
APA
Anticipatory postural adjustment
CoM
Centre of mass
CoP
Centre of foot pressure
EP
Execution phase
FO
Foot-off of the swing leg
FO2
Foot-off of the stance leg
GM
Grey matter
HC
Healthy control
MRI
Magnetic resonance imaging
CN
Caudate nucleus
L
Stride length
NPI-ALS
ALS patients without postural instability
PI-ALS
ALS patients with postural instability
PD
Parkinson’s disease
PU
Putamen
VBM
Voxel-based morphometry
V 1
Minimum vertical velocity of the CoM
V 2
CoM vertical velocity of the CoM at time of foot contact
V m
Maximum anteroposterior velocity of the CoM
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Metadaten
Titel
Extrapyramidal deficits in ALS: a combined biomechanical and neuroimaging study
verfasst von
Maryse Feron
Annabelle Couillandre
Eya Mseddi
Nicolas Termoz
Malek Abidi
Eric Bardinet
Daniel Delgadillo
Timothée Lenglet
Giorgia Querin
Marie-Laure Welter
Nadine Le Forestier
François Salachas
Gaelle Bruneteau
Maria del Mar Amador
Rabab Debs
Lucette Lacomblez
Vincent Meininger
Mélanie Pélégrini-Issac
Peter Bede
Pierre-François Pradat
Giovanni de Marco
Publikationsdatum
11.07.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
Journal of Neurology / Ausgabe 9/2018
Print ISSN: 0340-5354
Elektronische ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-018-8964-y

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