Brain, Vol 121, Issue 6 1109-1116, Copyright © 1998 by Oxford University Press
D Kidd, PD Thompson, BL Day, JC Rothwell, BE Kendall, AJ Thompson, CD Marsden and WI McDonald
The purpose of this study was to relate abnormalities of motor conduction
time to the presence of spinal cord MRI lesions in progressive multiple
sclerosis and to investigate the relationship between changes in motor
conduction over time and clinical and MRI changes. Central motor conduction
time (CMCT), serial MRI of the brain and spinal cord, and clinical
evaluations were carried out in 20 patients with primary and secondary
progressive multiple sclerosis. CMCT was carried out at the beginning and
end of the study whilst the clinical and MRI examinations occurred at
monthly intervals for 12 months. Median CMCT to abductor pollicis brevis
was 14.8 ms (range 8.8- 27.4 ms). The response latency to tibialis anterior
correlated with disability measured on the Expanded Disability Status
Scale. Latencies to upper limb muscles correlated with cervical MRI lesion
load and the presence of atrophy of the cervical cord. Over the 12-month
study period, 15 of 19 patients deteriorated clinically. However, an
increase in motor response latencies occurred only in the four patients who
had developed new cord lesions. The results suggest that prolonged CMCT is
related to spinal cord lesion load and that, over time, changes in the CMCT
occur only when spinal cord lesion load increases. Clinical change in
progressive multiple sclerosis may therefore occur without either the
development of new lesions on MRI scans or an increase in motor conduction
time. This suggests that clinical deterioration in these patients may occur
by a mechanism other than increasing demyelination. This may be progressive
axonal degeneration.
ARTICLES
Central motor conduction time in progressive multiple sclerosis. Correlations with MRI and disease activity
NMR Research Unit, National Hospital for Neurology and Neurosurgery, London, UK.
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