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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
Validation
Diseases presenting
"prior electrical stimulation over the cutaneous nerve of the left index finger"
symptom
adrenomyeloneuropathy
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