Single-pulse transcranial magnetic stimulation in amyotrophic lateral sclerosis.

INTRODUCTION: Transcranial magnetic stimulation (TMS) is one of the best methods to identify changes in the corticospinal tract. We used single-pulse TMS at the beginning of the disease and in the follow-up in a group of patients with amyotrophic lateral sclerosis (ALS). METHODS: We evaluated the corticospinal tract in the bulbar, upper, and lower regions in 55 patients with ALS, and we monitored them for a period of 24 months. Data were correlated with clinical scales. RESULTS: An increase of central motor conduction time (CMCT) was the most sensitive marker of upper motor neuron involvement. The resting motor threshold, CMCT, and the central silent period increased linearly with disease duration and upper/lower motor neuron involvement. DISCUSSION: Transcranial magnetic stimulation could be an essential neurophysiological technique in the early phase of ALS because it has been shown to be useful in detecting subclinical upper motor neuron involvement. Multiple evaluations of several regions increase TMS sensitivity.

[Rhabdomyolysis and arterial hypertension caused by apparent excess of mineralocorticoids: a case report]. / Rabdomiolisi e ipertensione arteriosa da apparente eccesso di mineralcorticoidi: descrizione di un caso clinico.

We report the case of a 61-year-old man who was referred to our Institution because of severe hypokalemia, rhabdomyolysis and high blood pressure. Severe hypokalemia may lead to rhabdomyolysis. The plasma aldosterone concentrations were low and the plasma renin activity was suppressed. A diagnosis of apparent mineralocorticoid excess, attributable to licorice and grapefruit juice ingestion, was made. Glycyrrhizic acid and glycyrrhetinic acid, its hydrolytic product, in licorice extracts, and polyphenols, in grapefruit juice, can inhibit 11 beta-hydroxysteroid dehydrogenase type 2, the enzyme that converts cortisol to cortisone. Moreover, having suspended licorice and grapefruit juice ingestion, the plasma K+ levels and blood pressure values progressively and simultaneously returned to normal. We would like to stress the diagnostic weight of a careful history taking.