Our research focuses on obtaining a better understanding of the pathophysiology of ALS and to exploit neurophysiology to the maximum benefit regarding diagnosis and prognosis of ALS. A multidisciplinary approach using examinations from other neurological specialties is applied. 

Special focus areas are 1) the investigation of possible sensory involvement in ALS, or in a subgroup of ALS patients, and 2) the clinical implementation of sensitive and convenient electrophysiological markers for upper motor neuron degeneration and progression of lower motor neuron loss. 

Motor and sensory nerve systems

The motor and sensory systems are systematically compared by a broad range of different techniques, with the sensory system being assessed by nerve conduction studies, laser evoked potentials (LEPs), quantitative sensory testing (QST) and skin biopsies. The motor system is assessed by quantitative electromyography (EMG), such as motor unit potential (MUP) and peak-ratio analysis. In addition, a wide range of motor unit number estimation (MUNE) techniques, including MUNIX, multiple point stimulation (MPS) and CMAP scans are applied to evaluate their diagnostic and prognostic potential (Furtula J et al. 2012). 

Objective markers for upper motor neuron degeneration 

Detection of upper motor neuron signs in addition to lower motor neuron signs is essential to establish the diagnosis of ALS according to the current criteria (Brooks et al. 2000). However, when quantitative markers of lower motor neuron degeneration are well established, quantitative markers of upper motor neuron affection are inadequate. Therefore, in ALS patients with predominating lower motor neuron dysfunction and upper motor neuron signs appearing late in the course of the disease, or not at all, the initial diagnosis of ALS becomes difficult. 

The development and implementation of objective, subclinical markers of upper motor neuron loss, such as motor evoked potentials using triple stimulation technique (TST) and diffusion tensor MR tractography, is a focus area at our department. Furtula et al. 2013. 

Contacts 

Anders Fuglsang-Frederiksen, Professor, MD, DMSc andefugl@rm.dk
Birger Johnsen, Associate Professor, MD, PhD birgjohn@rm.dk
Hatice Tankisi, Associate Professor, MD, PhD hatitank@rm.dk
Kirsten Pugdahl, MSc, PhD kirspugd@rm.dk
Baris Isak, MD bariisak@rm.dk