Repeater F-waves in amyotrophic lateral sclerosis: Electrophysiologic indicators of upper or lower motor neuron involvement?

• Published in: Clinical neurophysiology Vol. 131; no. 1; pp. 96 - 105
• Main Authors: Oguz Akarsu, Emel, Sirin, Nermin Gorkem, Kocasoy Orhan, Elif, Erbas, Bahar, Dede, Hava Ozlem, Baslo, Mehmet Baris, Idrisoglu, Halil Atilla, Oge, Ali Emre
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2020
• Subjects: Amyotrophic lateral sclerosis; Amyotrophic Lateral Sclerosis - physiopathology; Case-Control Studies; Electrophysiological Phenomena; Evoked Potentials - physiology; Female; Humans; Male; Median Nerve - physiopathology; Middle Aged; Motor Neurons - physiology; MScanFit MUNE; Muscle, Skeletal - innervation; Neural Conduction - physiology; Neurophysiological Monitoring; Repeater F-wave; Split hand; Transcranial magnetic stimulation; Transcranial Magnetic Stimulation - methods; Triple stimulation technique; Ulnar Nerve - physiopathology; MScanFit MUNE; Triple stimulation technique; Amyotrophic lateral sclerosis; Repeater F-wave; Transcranial magnetic stimulation; Split hand
• ISSN: 1388-2457; 1872-8952
• DOI: 10.1016/j.clinph.2019.09.030

•Repeater F-waves (Frep) seem to be related to lower motor neuron loss in ALS.•None of the transcranial magnetic stimulation measures was correlated with Frep in ALS.•Lower F-wave persistence in APB muscle may predict the subsequent split hand phenomenon. To extract insight about the mechanism of repeater F-waves (Frep) by exploring their correlation with electrophysiologic markers of upper and lower motor neuron dysfunction in amyotrophic lateral sclerosis (ALS). The correlations of Frep parameters with clinical scores and the results of neurophysiological index (NI), MScanfit MUNE, F/M amplitude ratio (F/M%), single and paired-pulse transcranial magnetic stimulation (TMS), and triple stimulation technique (TST) studies, recorded from abductor digiti minimi (ADM) and abductor pollicis brevis (APB) muscles of 35 patients with ALS were investigated. Frep parameters were correlated with NI and MScanfit MUNE in ADM muscle and F/M% in both muscles. None of the Frep parameters were correlated with clinical scores or TST and TMS measures. While the CMAP amplitudes were similar in the two recording muscles, there was a more pronounced decrease of F-wave persistence in APB, probably heralding the subsequent split hand phenomenon. Our findings suggest that the presence and density of Freps are primarily related to the degree of lower motor neuron loss and show no correlation with any of the relatively extensive set of parameters for upper motor neuron dysfunction. Freps are primarily related to lower motor neuron loss in ALS.