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. 2020 Oct 31;10(11):806.
doi: 10.3390/brainsci10110806.

TMS Correlates of Pyramidal Tract Signs and Clinical Motor Status in Patients with Cervical Spondylotic Myelopathy

Giuseppe Lanza  1   2 , Valentina Puglisi  3 , Luisa Vinciguerra  3 , Francesco Fisicaro  4 , Carla Vagli  5 , Mariagiovanna Cantone  6 , Giovanni Pennisi  1 , Manuela Pennisi  4 , Rita Bella  7
Affiliations

TMS Correlates of Pyramidal Tract Signs and Clinical Motor Status in Patients with Cervical Spondylotic Myelopathy

Giuseppe Lanza et al. Brain Sci. .

Abstract

Background: While the association between motor-evoked potential (MEP) abnormalities and motor deficit is well established, few studies have reported the correlation between MEPs and signs of pyramidal tract dysfunction without motor weakness. We assessed MEPs in patients with pyramidal signs, including motor deficits, compared to patients with pyramidal signs but without weakness.

Methods: Forty-three patients with cervical spondylotic myelopathy (CSM) were dichotomized into 21 with pyramidal signs including motor deficit (Group 1) and 22 with pyramidal signs and normal strength (Group 2), and both groups were compared to 33 healthy controls (Group 0). MEPs were bilaterally recorded from the first dorsal interosseous and tibialis anterior muscle. The central motor conduction time (CMCT) was estimated as the difference between MEP latency and peripheral latency by magnetic stimulation. Peak-to-peak MEP amplitude and right-to-left differences were also measured.

Results: Participants were age-, sex-, and height-matched. MEP latency in four limbs and CMCT in the lower limbs were prolonged, and MEP amplitude in the lower limbs decreased in Group 1 compared to the others. Unlike motor deficit, pyramidal signs were not associated with MEP measures, even when considering age, sex, and height as confounding factors.

Conclusions: In CSM, isolated pyramidal signs may not be associated, at this stage, with MEP changes.

Keywords: cervical spondylotic myelopathy; clinical neuroscience; corticospinal conduction; degenerative cervical myelopathy; motor status; motor-evoked potentials; pyramidal signs; transcranial magnetic stimulation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Examples of motor-evoked potential (MEP) recorded for each study group (left side: upper limb; right side: lower limb): (A) Group 0: healthy controls; (B) Group 1: patients with signs of pyramidal tract dysfunction including motor deficit; (C) Group 2: patients with signs of pyramidal tract dysfunction without motor deficit. Amp = MEP amplitude; FDI = first dorsal interosseous muscle; L = left; Lat = MEP latency; MEP = motor-evoked potential; R = right; TA = tibialis anterior muscle; 50 ms = temporal resolution of the screen (sweep) for upper limb recordings; 100 ms = temporal resolution of the screen (sweep) for lower limb recordings; 1 mV = amplification factor of the screen; numbers in bold = values significantly different to control at the group level.
Figure 2
Figure 2
Box-plots of the motor-evoked potentials (MEPs): intergroup analysis (0 vs. 1 vs. 2). Group 0: healthy controls; Group 1: patients with signs of pyramidal tract dysfunction including motor deficit; Group 2: patients with signs of pyramidal tract dysfunction without motor deficit. Amp = MEP amplitude; CMCT = central motor conduction time; FDI = first dorsal interosseous muscle; L = left; Lat = MEP latency; R = right; TA = tibialis anterior muscle; whiskers = interquartile range; * = p < 0.05.
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