Neuromuscular magnetic stimulation counteracts muscle decline in ALS patients: results of a randomized, double-blind, controlled study View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2019-12

AUTHORS

Antonio Musarò, Gabriella Dobrowolny, Chiara Cambieri, Emanuela Onesti, Marco Ceccanti, Vittorio Frasca, Annalinda Pisano, Bruna Cerbelli, Elisa Lepore, Gabriele Ruffolo, Pierangelo Cifelli, Cristina Roseti, Carla Giordano, Maria Cristina Gori, Eleonora Palma, Maurizio Inghilleri

ABSTRACT

The aim of the study was to verify whether neuromuscular magnetic stimulation (NMMS) improves muscle function in spinal-onset amyotrophic lateral sclerosis (ALS) patients. Twenty-two ALS patients were randomized in two groups to receive, daily for two weeks, NMMS in right or left arm (referred to as real-NMMS, rNMMS), and sham NMMS (sNMMS) in the opposite arm. All the patients underwent a median nerve conduction (compound muscle action potential, CMAP) study and a clinical examination that included a handgrip strength test and an evaluation of upper limb muscle strength by means of the Medical Research Council Muscle Scale (MRC). Muscle biopsy was then performed bilaterally on the flexor carpi radialis muscle to monitor morpho-functional parameters and molecular changes. Patients and physicians who performed examinations were blinded to the side of real intervention. The primary outcome was the change in the muscle strength in upper arms. The secondary outcomes were the change from baseline in the CMAP amplitudes, in the nicotinic ACh currents, in the expression levels of a selected panel of genes involved in muscle growth and atrophy, and in histomorphometric parameters of ALS muscle fibers. The Repeated Measures (RM) ANOVA with a Greenhouse-Geisser correction (sphericity not assumed) showed a significant effect [F(3, 63) = 5.907, p < 0.01] of rNMMS on MRC scale at the flexor carpi radialis muscle, thus demonstrating that the rNMMS significantly improves muscle strength in flexor muscles in the forearm. Secondary outcomes showed that the improvement observed in rNMMS-treated muscles was associated to counteracting muscle atrophy, down-modulating the proteolysis, and increasing the efficacy of nicotinic ACh receptors (AChRs). We did not observe any significant difference in pre- and post-stimulation CMAP amplitudes, evoked by median nerve stimulation. This suggests that the improvement in muscle strength observed in the stimulated arm is unlikely related to reinnervation. The real and sham treatments were well tolerated without evident side effects. Although promising, this is a proof of concept study, without an immediate clinical translation, that requires further clinical validation. More... »

PAGES

2837

Identifiers

URI

http://scigraph.springernature.com/pub.10.1038/s41598-019-39313-z

DOI

http://dx.doi.org/10.1038/s41598-019-39313-z

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1112397686

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30808899


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283 DAHFMO-Unit of Histology and Medical Embryology, Sapienza University of Rome, Laboratory affiliated to Istituto Pasteur Italia – Fondazione Cenci Bolognetti, 00161, Rome, Italy
284 rdf:type schema:Organization
285 https://www.grid.ac/institutes/grid.7841.a schema:alternateName Sapienza University of Rome
286 schema:name DAHFMO-Unit of Histology and Medical Embryology, Sapienza University of Rome, Laboratory affiliated to Istituto Pasteur Italia – Fondazione Cenci Bolognetti, 00161, Rome, Italy
287 Department of Molecular Medicine, Sapienza University of Rome, 00161, Rome, Italy
288 Department of Physiology and Pharmacology, Sapienza University of Rome, Laboratory affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, 00185, Rome, Italy
289 Department of Physiology and Pharmacology, Sapienza Univesrity of Rome, Rome, Italy
290 Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161, Rome, Italy
291 Rare Neuromuscular Diseases Centre, Department of Human Neuroscience, Sapienza University, Rome, Italy
292 rdf:type schema:Organization
 




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