Transcranial magnetic stimulation after conditioning stimulation in two adrenomyeloneuropathy patients: delayed but facilitated motor-evoked potentials.

[adrenomyeloneuropathy]

Two male patients were diagnosed with adrenomyeloneuropathy . Their chief problems were progressive spastic paraparesis , sensory impairment , hyperpigmentation and testis atrophy . Transcranial magnetic stimulation (TMS ) does not easily elicit motor -evoked potentials (MEPs ) in patients with a central nervous system dysfunction , even though a few methods , such as contraction of the target muscles and the Jendrassik maneuver (JM ), are used in the attempt to facilitate them . In these two patients , we used a conditioning method (prior electrical stimulation over the cutaneous nerve of the left index finger ) in order to facilitate MEPs , elicited by TMS , in the left tibialis anterior muscle . In patient 1 , facilitation of MEPs was present at conditioning-test (C-T ) intervals in the range 60 -220 ms , with the maximal MEP recorded at C-T 160 ms ; in patient 2 , it occurred in the C-T interval range 110 -140 ms , with the maximal MEP recorded at C-T 130 ms . By means of conditioning electrical stimulation , we can facilitate MEPs elicited by TMS in those subjects in whom MEPs are minimal or difficult to elicit even using the conventional JM or muscle contraction . The facilitation of MEPs by conditioning stimuli allowed us not only to assess central motor conduction time , but also to demonstrate the preserved continuity of the corticospinal tract in these two patients .

Diseases
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Diseases presenting "adrenomyeloneuropathy" symptom

adrenomyeloneuropathy

x-linked adrenoleukodystrophy

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