Structural and morphological brain exploration of posture in patients with amyotrophic lateral sclerosis

La sclérose latérale amyotrophique [SLA] est une pathologie idiopathique à issue fatale caractérisée par la dégénérescence progressive et sélective des motoneurones du système nerveux central et périphérique. La SLA n’est pas exclusivement identifiée comme une maladie de la voie pyramidale, mais considérée plus largement comme une pathologie neurodégénérative multisystème. L’étude des mécanismes posturaux dans cette population n’a pas fait l’objet d’une grande attention. Dans ce travail de thèse, une exploration en imagerie cérébrale multimodale (imagerie en tenseur de diffusion [DTI] et morphométrie basée sur le voxel [VBM]) est proposée chez des patients SLA avec instabilité posturale [AIP] et stables [SIP] en vue de vérifier l’intégrité morphologique et structurelle des régions corticales et sous-corticales posturales. La comparaison entre les sujets contrôles et les patients SLA a démontré une augmentation significative du volume de la substance grise au niveau du noyau caudé chez les patients stables (SIP vs contrôle p<0,001 ; SIP vs AIP p<0,01). L’évaluation structurelle a révélé une diminution de la fraction d’anisotropie [FA] au niveau de l’aire motrice supplémentaire [AMS] dans les deux groupes de patients par rapport aux contrôles (contrôle vs SIP p<0,05 ; contrôle vs AIP p<0,001). Au niveau du noyau caudé, le groupe AIP a présenté une diminution de la valeur de la FA par rapport aux sujets contrôles (p<0,001) et aux sujets SIP (p<0,05). Ainsi, ces résultats contribuent à une meilleure caractérisation et compréhension des atteintes corticales et sous corticales des régions qui interviennent dans la posture chez les patients SLA.The Amyotrophic Lateral Sclerosis [ALS] is an idiopathic pathology with a fatal outcome. It is characterized by a progressive and selective degeneration of motor neurons in the central and peripheral nervous system. ALS is no longer exclusively identified as a disease of the pyramidal pathway, but it is considered more broadly as multisystem neurodegenerative pathology. However, the analysis of postural processes in these patients has not been well studied in the literature. Multimodal brain imaging (Diffusion Tensor Imaging [DTI] and Voxel Based Morphometry [VBM]) exploration was performed for ALS patients with postural instability [AIP] and without postural instability [SIP] to test the morphometric and structural integrity of postural cortical and subcortical regions. A significant increase of gray matter in caudate nucleus volume has been noticed for stable patients (SIP vs controls p<0.001, SIP vs AIP p<0.01). The structural evaluation revealed a decrease of the Fractional Anisotropy [FA] at the Supplementary Motor Area [SMA] level in both groups of patients compared to controls (controls vs SIP p<0.05, controls vs. AIP p<0.001). At the caudate nucleus, the AIP group showed FA value decrease compared to controls (p<0.001) and SIP subjects (p<0.05). Thus, these results would contribute to a better characterization and understanding of the cortical and subcortical impairments of the postural regions in ALS patients

Adaptive functional reorganization in amyotrophic lateral sclerosis: coexisting degenerative and compensatory changes

International audienceBackground and purpose: Considerable functional reorganization takes place in amyotrophic lateral sclerosis (ALS) in face of relentless structural degeneration. This study evaluates functional adaptation in ALS patients with lower motor neuron predominant (LMNp) and upper motor neuron predominant (UMNp) dysfunction. Methods: Seventeen LMNp ALS patients, 14 UMNp ALS patients and 14 controls participated in a functional magnetic resonance imaging study. Studygroup-specific activation patterns were evaluated during preparation for a motor task. Connectivity analyses were carried out using the supplementary motor area (SMA), cerebellum and striatum as seed regions and correlations were explored with clinical measures. Results: Increased cerebellar, decreased dorsolateral prefrontal cortex and decreased SMA activation were detected in UMNp patients compared to controls. Increased cerebellar activation was also detected in UMNp patients compared to LMNp patients. UMNp patients exhibit increased effective connectivity between the cerebellum and caudate, and decreased connectivity between the SMA and caudate and between the SMA and cerebellum when performing self-initiated movement. In UMNp patients, a positive correlation was detected between clinical variables and striato-cerebellar connectivity. Conclusions: Our findings indicate that, despite the dysfunction of SMAstriatal and SMA-cerebellar networks, cerebello-striatal connectivity increases in ALS indicative of compensatory processes. The coexistence of circuits with decreased and increased connectivity suggests concomitant neurodegenerative and adaptive changes in ALS

Extrapyramidal deficits in ALS: a combined biomechanical and neuroimaging study

International audienceIntroduction Extrapyramidal deficits are poorly characterised in amyotrophic lateral sclerosis (ALS) despite their contribu-tion to functional disability, increased fall risk and their quality-of-life implications. Given the concomitant pyramidal and cerebellar degeneration in ALS, the clinical assessment of extrapyramidal features is particularly challenging.Objective The comprehensive characterisation of postural instability in ALS using standardised clinical assessments, gait analyses and computational neuroimaging tools in a prospective study design.Methods Parameters of gait initiation in the anticipatory postural adjustment phase (APA) and execution phase (EP) were evaluated in ALS patients with and without postural instability and healthy controls. Clinical and gait analysis parameters were interpreted in the context of brain imaging findings.Results ALS patients with postural instability exhibit impaired gait initiation with an altered APA phase, poor dynamic postural control and significantly decreased braking index. Consistent with their clinical profile, “unsteady” ALS patients have reduced caudate and brain stem volumes compared to “steady” ALS patients.Interpretation Our findings highlight that the ALS functional rating scale (ALSFRS-r) does not account for extrapyramidal deficits, which are major contributors to gait impairment in a subset of ALS patients. Basal ganglia degeneration in ALS does not only contribute to cognitive and behavioural deficits, but also adds to the heterogeneity of motor disabilit