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. 2024 Jul;70(1):152-156.
doi: 10.1002/mus.28100. Epub 2024 Apr 30.

Upper motor neuron signs in primary lateral sclerosis and hereditary spastic paraplegia

Cláudia Santos Silva  1   2 , Catarina Correia Rodrigues  1 , Maria Fortuna Baptista  1 , Miguel Oliveira Santos  1   2   3 , Marta Gromicho  2 , Vanessa Carvalho  1   2   3 , Leonor Correia Guedes  1   2   3 , Mamede de Carvalho  1   2   3
Affiliations

Upper motor neuron signs in primary lateral sclerosis and hereditary spastic paraplegia

Cláudia Santos Silva et al. Muscle Nerve. 2024 Jul.

Abstract

Introduction/aims: The frequency and distribution of upper motor neuron (UMN) signs in primary lateral sclerosis (PLS) are unknown. We aimed to study the spectrum of UMN signs in PLS and compare it with hereditary spastic paraplegia (HSP).

Methods: We retrospectively analyzed the frequency of different UMN signs, including hyperreflexia (limbs and jaw), limb and tongue spasticity, Babinski, and Hoffman signs, in PLS patients at first observation and compared this respect to onset region and symptom duration. We also compared PLS versus HSP patients.

Results: We included 34 PLS and 20 HSP patients, with a median symptom duration at first visit of 3.0 (interquartile range, IQR = 4.0) and 19.0 (IQR = 22.0) years, respectively. In PLS patients, hyperreflexia of upper (UL) (88.2%) and lower (LL) (91.2%) limbs, and LL spasticity (79.4%) were the most common findings. Spasticity of LL was significantly (p = .012) more frequent in LL-spinal onset subgroup, tongue spasticity in bulbar-onset subgroup (p = .021), and Hoffman sign in UL-spinal onset subgroup (p = .024). The PLS subgroup with shorter disease duration had a higher frequency of abnormal jaw jerk reflex (p = .037). Compared with HSP, PLS patients had a higher frequency of UL hyperreflexia (88.2% vs. 42.1%, p < .001) and UL spasticity (44.1% vs. 0.0%, p < .001). Asymmetric distribution of UMN signs was present in PLS and not in HSP.

Discussion: In PLS, UL UMN signs are nearly always present and UMN sign distribution appears to be associated with onset region. At first observation, bulbar involvement, asymmetrical distribution of UMN signs and UL spasticity may indicate PLS versus HSP.

Keywords: differential diagnosis; hereditary spastic paraplegia; motor neuron disease; primary lateral sclerosis; upper motor neuron signs.

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