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Year : 2005  |  Volume : 53  |  Issue : 2  |  Page : 201

Invited Comment

Department of Neurology, Oberarzt der Klinik und Poliklinik für Neurologie, der Johannes-Gutenberg Universität Mainz, Langenbeckstr. 1, 55101 Mainz, Germany

Correspondence Address:
P P Urban
Department of Neurology, Oberarzt der Klinik und Poliklinik für Neurologie, der Johannes-Gutenberg Universität Mainz, Langenbeckstr. 1, 55101 Mainz
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Source of Support: None, Conflict of Interest: None

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How to cite this article:
Urban P P. Invited Comment. Neurol India 2005;53:201

How to cite this URL:
Urban P P. Invited Comment. Neurol India [serial online] 2005 [cited 2020 Jul 8];53:201. Available from:

The pyramidal tract is frequently affected in multiple sclerosis (MS) and impaired motor performance is a major cause of disability in MS. Pyramidal tract function can be assessed using transcranial magnetic stimulation (TMS), yielding motor-evoked potentials in cranial nerve innervated, arm and leg muscles. Among the evoked potentials, TMS has been shown to be the single most sensitive parameter in patients with MS for diagnostic purposes.[1] The most sensitive parameter in single pulse stimulation is the delayed central motor conduction time (CMCT). The chance of obtaining pathological results increases continually from the cranial nerves to the upper and lower limbs, parallel to the increasing length of the examined corticobulbar and corticospinal tracts. The sensitivity further increases when the interhemispheric inhibition between the motor cortices (transcallosal inhibition) is taken into account[2] or when a triple stimulation paradigm is applied.[3]

The authors of the present study summarize their experience of investigating 30 patients with clinically definite MS and 30 healthy controls using TMS. They found abnormalities in at least one of several TMS parameters in 86.7% of the patients, confirming the results of previous studies.[4],[5] They also demonstrated a significant correlation between CMCT and the degree of pyramidal signs. On follow up, mean CMCT improved significantly in MS patients who improved clinically. Thus, the authors conclude correctly that TMS is a highly sensitive technique to evaluate corticospinal conduction abnormalities in MS that may have no clinical correlate and may monitor pyramidal function during the course of the disease. In future studies, it would be of interest to monitor short-term and long-term treatment effects (steroids and immunomodulating drugs) by TMS.

 » References Top

1.Beer S, R φsler KM, Hess CW. Diagnostic value of paraclinical tests in multiple sclerosis: Relative sensitivities and specifities for reclassification according to the Poser Committee criteria. J Neurol Neurosurg Psychiatry 1995;59:152-9.  Back to cited text no. 1    
2.Schmierer K, Niehaus L, R φricht S, Meyer BU. Conduction deficits of callosal fibres in early multiple sclerosis. J Neurol Neurosurg Psychiatry 2000;68:633-8.  Back to cited text no. 2    
3.Magistris MR, Rosler KM, Truffert A, Landis T, Hess CW. A clinical study of motor evoked potentials using a triple stimulation technique. Brain 1999;122:265-79.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Mayr N, Baumgartner C, Zeitlhofer J, Deeke L. The sensitivity of transcranial cortical magnetic stimulation in detecting pyramidal tract lesions in clinically definite multiple sclerosis. Neurology 1991;41:566-9.  Back to cited text no. 4    
5.Ravnborg M, Liguri R, Christiansen P, Larsson H, Sorensen PS. The diagnostic reliability of magnetically evoked motor potentials in multiple sclerosis. Neurology 1992;42:1296-301.  Back to cited text no. 5    


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Online since 20th March '04
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