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Diagnostic utility of threshold tracking TMS paradigms in early amyotrophic lateral sclerosis

2025Artigo científico Acesso aberto
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dc.contributor.authorCalma, Aicee Dawn
dc.contributor.authorPavey, Nathan
dc.contributor.authorSantos Silva, Cláudia
dc.contributor.authorvan den Bos, Mehdi A.J.
dc.contributor.authorYiannikas, Con
dc.contributor.authorFarrar, Michelle A.
dc.contributor.authorKiernan, Matthew C
dc.contributor.authorMenon, Parvathi
dc.contributor.authorVucic, Steve
dc.date.accessioned2025-06-03T14:08:41Z
dc.date.available2025-06-03T14:08:41Z
dc.date.issued2025
dc.description© 2025 The Author(s). Published by Elsevier B.V. on behalf of International Federation of Clinical Neurophysiology. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).pt_PT
dc.description.abstractObjective: Threshold tracking transcranial magnetic stimulation (TMS) has exhibited utility as a diagnostic technique in Amyotrophic Lateral Sclerosis (ALS). Different threshold tracking paradigms have recently been proposed. The present study assessed the diagnostic utility of serial ascending and parallel threshold tracking TMS in ALS. Methods: Threshold tracking TMS was undertaken on 90 prospectively recruited participants suspected of ALS. Short interval intracortical inhibition (SICI) was recorded with serial ascending and parallel threshold tracking paradigms between Interstimulus Interval (ISI) 1-to-7 ms. The primary outcome measure was differences in diagnostic utility of the paradigms in differentiating ALS from ALS mimicking disorders using receiver operating characteristic (ROC) analysis (DeLong statistical method). Results: Reduction in SICI reliably differentiated ALS from mimic disorders, irrespective of the threshold tracking paradigm. Comparison of area under the curve (AUC) established a significantly higher value for mean SICI (1-7 ms) with the serial ascending SICI paradigm (0.81, 95 % confidence interval 0.72-0.91) compared to the parallel paradigm (SICI 0.72, 95 % confidence interval 0.61-0.83, p = 0.0065). The better diagnostic utility of serial ascending paradigm was evident for SICI recorded between 1-to-5 ms, and was maintained irrespective of disease onset site, degree of functional impairment, and the degree of lower motor neuron dysfunction. A comparable diagnostic utility across threshold tracking paradigms was evident in ALS participants who presented with a relative paucity of upper motor neuron signs. Conclusion: While threshold tracking TMS reliably differentiated ALS from mimic disorders, the present study established better diagnostic utility with the serial ascending threshold tracking TMS paradigm. Significance: The serial ascending threshold tracking TMS should be used in a clinical setting as a diagnostic tool for ALS.pt_PT
dc.description.sponsorshipThe work was supported by funding from the National Health and Medical Research Institute (Ideas Grant: 2010812), and Betty Laidlaw Award (MND Institute of Australia)pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationClin Neurophysiol. 2025 Jun:174:105-113pt_PT
dc.identifier.doi10.1016/j.clinph.2025.03.044pt_PT
dc.identifier.eissn1872-8952
dc.identifier.issn1388-2457
dc.identifier.urihttp://hdl.handle.net/10400.5/101240
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.relation.publisherversionhttps://www.sciencedirect.com/journal/clinical-neurophysiologypt_PT
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/pt_PT
dc.subjectAmyotrophic Lateral Sclerosispt_PT
dc.subjectShort Interval Intracortical Inhibitionpt_PT
dc.subjectThreshold Tracking TMSpt_PT
dc.subjectTranscranial Magnetic Stimulationpt_PT
dc.titleDiagnostic utility of threshold tracking TMS paradigms in early amyotrophic lateral sclerosispt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage113pt_PT
oaire.citation.startPage105pt_PT
oaire.citation.titleClinical Neurophysiologypt_PT
oaire.citation.volume174pt_PT
person.familyNameSantos Silva
person.givenNameCláudia
person.identifier.ciencia-id211D-4BEE-28DD
person.identifier.orcid0000-0003-4495-6314
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublicationfc8ee92f-0134-4cb4-a2fe-bcf07fc2353d
relation.isAuthorOfPublication.latestForDiscoveryfc8ee92f-0134-4cb4-a2fe-bcf07fc2353d

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