The RMT tested on the upper extremity that was involved earliest in ALS and FAS patients was investigated. Amyotrophic lateral sclerosis (ALS) is a relatively rare disease with a significant phenotypic variation often leading to misdiagnosis [].Bilateral flail arm syndrome also known as 'man-in-barrel syndrome' (MIBS) is one of the rarest and atypical presentation of regional ALS. National Library of Medicine The demonstration of the involvement of the cerebral tracts according to the neuropathological ALS-propagation pattern supports previous studies which showed corticospinal tract pathology in pure lower motor neuron variants of ALS [36, 37]. In previous study, post mortem findings of one patient diagnosed with “FAS” revealed evidences of upper motor neuron lesions showing degeneration of the pyramidal tracts and motor cortex, accompanied with loss of spinal anterior horn cells and motor neurons of brain stem; while these changes were not found in another FAS patient, except obvious loss of spinal anterior horn cells[11]. In the current study, we sought to further delineate electromyographic changes in sensory and motor conduction of the median nerve in four FAS patients and also described one representative case of FAS in a 63-year old Chinese male patient who was . 2014 Sep;23(3):253-7. doi: 10.5607/en.2014.23.3.253. Journal of Neurology 2021 Mar;43(3):191-198. doi: 10.1080/01616412.2020.1834291. Accessibility Han X, Zhan F, Yao Y, Cao L, Liu J, Yao S. Ann Clin Transl Neurol. This is a preview of subscription content, access via In this group, 40 patients presented with bilateral paresis in the arms at date of MRI, while unilateral arm symptoms at date of MRI were observed in 3 patients. Previous studies show the level of excitatory neurotransmitter in cortex and CSF is increased, and hyper-excitability of motor cortex is an important feature in early ALS[16–20]. A total of 578 patients were diagnosed with motor neuron disease. When the (FA based) ALS staging categorization was performed for the flail arm syndrome patients, 69% could be categorized into ALS stages, similar to previous studies [14]. At the time of data analysis, 12 patients had died with a mean survival of 40.6 ± 12.4 months. Since the mean age of patients with FAS was 59 years, these findings may have been attributable to patient age, as the elderly are known to have higher prevalence rates of lumbar or thoracic radiculopathy. 2001 Jun;21(2):177-87. doi: 10.1055/s-2001-15263. and transmitted securely. In summary, the tract-of-interest-based DTI analysis demonstrated in vivo the same stereotypical pathoanatomical patterns in the brains of flail arm syndrome and ´classical´ ALS patients, thereby confirming the clinical approach that this syndrome is a restricted phenotypical variant of ALS [10], in accordance with the latest proposal for a revision of the El Escorial criteria [5, 39] and with a current proposal for clinical diagnosis [4]. http://creativecommons.org/licenses/by/4.0/, Disease duration/months (mean ± std. The band pass filter was set in the same way as in motor nerve conduction studies. PLOS ONE promises fair, rigorous peer review, 2022 May;269(5):2619-2626. doi: 10.1007/s00415-021-10854-6. Unable to load your collection due to an error, Unable to load your delegates due to an error. Some researchers argue this syndrome is a variant of ALS, while others believe that FAS is an independent entity[3–5]. If the neurologist is suspicious of any form of disease, s/he will . CAS  Three patients with UL-ALS died during the study's observation period. Second, neuropathological confirmation of the TDP-43 propagation scheme in the central nervous system by autopsy results was not available. Understanding the physiopathology behind axial and radial diffusivity changes-what do we know? the contents by NLM or the National Institutes of Health. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. The male to female ratio was 4~10 to 1, in contrast to the reported ratio of 1.5 to 1 for the ALS population as a whole [3]. 2020. Sato M, Nakamura T, Nagashima K, Fujita Y, Ikeda Y. Neurol Res. Subjects and patient characteristics. Hiervon sind ungefähr zwei Drittel aller ALS-Fälle betroffen. FAS patients were younger (54.7 ± 9.3 versus 59.4 ± 12.2 years), male patients were predominantly affected (3.8:1 versus 1.9:1), and FAS patients showed a prolonged survival (53 versus 33 months) compared to classical ALS patients. Vulpian A (1886) Cours de pathologie expérimentale. In the tract-specific analysis according to the proposed sequential cerebral pathology pattern of ALS, the flail arm syndrome patients showed significant alterations of the specific tract systems that were identical to ‘classical’ ALS if compared to controls. Seattle. Compared with control group, there was no statistical difference of RMT in FAS patients (p = 0.841), but the level of RMT was significantly higher in ALS (p<0.05). Furthermore, there are no definitive diagnostic tests or well defined biomarkers for ALS at present [2], leaving neurologists to rely on only clinical history, physical examination, and neurophysiological evidence of lower motor neuron (LMN) involvement. doi:10.1371/journal.pone.0093932, Article  Open Access funding enabled and organized by Projekt DEAL. Impressum In a retrospective case note study of patients referred to a specialist clinic for motor neuron disorders we identified a subgroup of patients with severe wasting and weakness of the arms without significant functional involvement of other regions. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in Couratier P, Truong C, Khalil M, Devière F, Vallat JM. All patients diagnosed with 'motor neuron disease' in our ALS center from 2006~2011 who had initial complaints of bilateral upper limb weakness were selected for study inclusion. This movement, called paradoxical, means the . Rev Neurol (Paris). El Escorial revisited: revised criteria for the diagnosis of amyotrophic lateral sclerosis. Clinical heterogeneity in a family with flail arm syndrome and review of hnRNPA1-related spectrum. The flail-arm syndrome (FAS) (5), also known as Vulpian-Bernhardt syndrome (6), or brachial amyotrophic diplegia (7) is an ALS phenotype in 6 to 11% of ALS patients (8,9). This "flail arm syndrome" was identified in 39/395 (10%) of the subjects studied. A regionally similar but more pronounced AD and RD increase pattern was observed in the comparison of ‘classical’ ALS patients vs controls. Recently, structural and functional neuroimaging findings have greatly modified longstanding notions regarding the pathophysiology of ALS [11, 12]. We describe a case of a 65-year old patient diagnosed with amyotrophic lateral sclerosis. and transmitted securely. However, we did not find obvious increase or decrease of RMT in our FAS patients in this study. Flail arm syndrome was diagnosed in patients with paresis of both upper limbs and without bulbar and lower limbs symptoms during a time period of 12 months after their visit, as previously described [9]. 2006 Jun;162 Spec No 2:4S34-4S42. Maladies du système nerveux (Moëlle épinière). 8600 Rockville Pike The study protocol consisted of a T1-weighted 3-dimensional scan with 144 slices, TE/TR 4.2 ms/1640 ms, 256 × 256 pixels, slice thickness 1.2 mm, pixel size 1.0 mm × 1.0 mm. Other clinical characteristics and EMG findings did not show significant differences. Atrophy was more pronounced in the ‘classical’ ALS patients. Our results indicate that the MRC grades of the weakest muscles were significantly lower in the FAS group than in the UL-ALS group, and that this is a reliable way to discriminate between these groups diagnostically. Flail arm syndrome is a restricted phenotype of motor neuron disease that is characterized by progressive, predominantly proximal weakness and atrophy of the upper limbs. doi:10.1212/01.wnl.0000345041.83406.a2, Article  Kassubek J, Müller HP, Del Tredici K, et al. We retrospectively evaluated the clinical features of 42 FAS patients who were seen in the outpatient clinics of 4 German centers between 2000 and 2010 and compared them to 146 sex-matched control patients with classical spinal-onset ALS. 2), especially regional AD and RD increase bihemispherically in the frontal lobes and RD increase in the CST. To identify alterations along these tracts, tract-wise fractional anisotropy statistics (TFAS) [31] was performed by statistically comparing the FA values in the respective tracts between two subject groups by Student’s t-test for FA values ≥ 0.2 (see above); as the subject groups were large enough to show a Gaussian distribution of FA values, the use of Student’s t-test was justified. Therefore, it might be too early to believe that there are sufficient definite pathological evidences of obvious involvement of pyramidal tracts, motor cortex in FAS patients. H-PM: study concept and design, data analysis and interpretation of data, critical revision of manuscript for intellectual content. The baseline demographic and clinical characteristics of the patients studied are reported in Table 1. Below is the link to the electronic supplementary material. The site is secure. For full functionality of this site, please enable JavaScript. The .gov means it’s official. The study was supported by the German MND Network and the German Department of Education and Research (Bundesministerium für Bildung und Forschung, BMBF). Introduction. Flail arm syndrome (FAS), also called man-in-barrel syndrome, or brachial amyotrophic diplegia, is a slowly progressive sporadic motor neuron disorder, characterized by severe flaccid paralysis and muscle wasting in both arms symmetrically, while relatively sparing the legs and bulbar parts, and with few signs of upper motor neuron lesions[1]. Very sorry about your mom and grandmother, but with the flail arm variant as you know weakness and atrophy track together and bilaterally. WBSS of FA maps [p < 0.05, false-discovery-rate (FDR) corrected] demonstrated clusters of regional FA reductions for flail arm syndrome patients vs controls as well as for ALS patients vs controls predominantly along the corticospinal tract (CST), Cluster results of WBSS of FA maps (thresholded at FDR-corrected p < 0.05), MNI Montreal Neurological Institute brain atlas, FDR false-discovery rate, CST corticospinal tract. In addition, one patient showed significant reduction in the conduction velocity and motor nerve action potential amplitude. HHS Vulnerability Disclosure, Help your institution. All human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. MRC, Medical Research Council; UMN, upper motor neuron; EMG, electromyography. In a sense, this result is not surprising. Flail arm syndrome (FAS) is a variant of motor neuron disease which is characterized by progressive, predominantly proximal weakness and atrophy of the upper limbs (UL). At the time of data analysis, 24 patients had died with a mean survival of 30.2 ± 15.8 months. Nerve conduction studies in amyotrophic lateral sclerosis. The .gov means it’s official. This conclusion is supported by the fact that the patient group in the present imaging study is representative of the flail arm syndrome phenotype, including male preponderance and a slower disease course (Table ​(Table1).1). Performed the experiments: HY ML. HY received the funding. BDNF ALS Study Group (Phase III). Although UMN signs tend to be more frequent in UL-ALS than in FAS, many FAS patients also had UMN signs. Imaging the pathoanatomy of amyotrophic lateral sclerosis in vivo: targeting a propagation-based biological marker. However, there were significant differences between FAS and ALS patients, in terms of clinical features, as well as of neurophysiological studies. The comparison at the group level by WBSS of AD and RD maps for the flail arm syndrome patients vs controls demonstrated several clusters of regional alterations at p < 0.05 (corrected for multiple comparisons) (Fig. Apart from the 3 main ALS subtypes, other forms have been recognized but relatively inadequately studied. Median slope of ALS-FRS-R reduction over disease duration was − 0.43/month (90th percentile, range − 0.08; − 2.03). In our study, we have the very similar findings, confirming that male predominance is an important feature of FAS, though the underlying mechanism is still to be determined. Hu MT, Ellis CM, Al-Chalabi A, Leigh PN, Shaw CE. There was obvious male predominance in the FAS patients, with only one female patient in six FAS patients, very different from that of in ALS patients. Fourth, we have not paid sufficient attention to fasciculation potentials in the EMG study. Müller HP, Turner MR, Grosskreutz J, et al. An official website of the United States government. The occurrence rate of UMNS in FAS patients seems strikingly high, very different from other studies and our result[1, 3, 11]. Atypical motor neuron disease and related motor syndromes. Brachial amyotrophic diplegia: a slowly progressive motor neuron disorder. The simultaneous presence of spontaneous denervation potential (fibrillations and positive sharp waves) and enlarged motor unit potentials (MUPs) on EMG was considered as evidence of LMN involvement. Fasciculation potentials are relevant for the diagnosis of ALS. Although FAS has been described in several reports, the current study was the first to compare FAS and UL-ALS regarding clinical features including EMG findings. National Library of Medicine Because of its . Lyrica Side Effects. The online version contains supplementary material available at 10.1007/s00415-021-10854-6. There was no obvious upper motor neuron signs in FAS. To whom correspondence should be addressed. Therefore, the weakness and atrophy of hands in FAS might not have a cortical basis. To be eligible, subjects had to fulfill the following criteria: no clinical diagnosis of frontotemporal dementia (FTD), no mutations of major genes related to motor neuron disease (if known), and no other major systemic, psychiatric or neurological illnesses. Corticoefferent pathways in pure lower motor neuron disease: a diffusion tensor imaging study. FOIA BDNF ALS Study Group (Phase III). PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US. Amyotrophic lateral sclerosis—a model of corticofugal axonal spread. The compound muscle action potentials (CMAPs) of abductor pollicis brevis (APBs) and abductor digiti minimi (ADMs) were recorded using pairs of surface electrodes, with recording electrode placing on the belly of muscles while reference electrode on the distal tendons. Since there was no obvious UMNS, no split-hand phenomenon, and no obvious changes of RMT and CMCT in FAS patients, the development of FAS might be probably not originated from motor cortex. PubMed Central  Distribution of staging categorization in flail arm syndrome patients and ‘classical’ ALS patients. Among 7 FAS patients who had proximal dominant weakness, 6 were classified as having MRC grade 2 at shoulder abduction, and 1 as MRC grade 3. © 2023 Springer Nature Switzerland AG. The relationship between FAS and ALS is still unclear. This concept of ‘restricted’ phenotypes also includes flail arm syndrome, which often begins with asymmetric predominantly proximal deficits of the arms [5]. An official website of the United States government. The latency of motor conduction of bilateral median nerves was markedly prolonged. EMG and nerve conduction studies (NCS) were performed on this patients at the initial visit only. Table 1 showed the clinical and demographic features of our subjects in this study. Gorges M, Del Tredici K, Dreyhaupt J, et al. Does sporadic amyotrophic lateral sclerosis spread via axonal connectivities? Accessibility Hecheng Yang, The remaining 11 patients could not be classified. Bookshelf We believe that the reasons for this are as follows. ALS-FRS-R revised ALS functional rating scale. doi: 10.1097/MD.0000000000033565. de Carvalho M, Chio A, Dengler R, Hecht M, Weber M, Swash M. Neurophysiological measures in amyotrophic lateral sclerosis: markers of progression in clinical trials. Diffusion tensor imaging and tractwise fractional anisotropy statistics: quantitative analysis in white matter pathology. Braak H, Neumann M, Ludolph AC, et al. The site is secure. http://creativecommons.org/licenses/by-nc/3.0/. Funding: This work was supported by innovation fund of Peking Union Medical College (No. The authors would like to thank the Ulm University Center for Translational Imaging MoMAN for its support. Further mandatory criteria for inclusion were negative tests for other neuromuscular diseases and for infections of the central nervous system, and the presence of routine MRI scans that excluded any brain or spine abnormalities which might indicate a different etiology of the clinical symptoms. Flail arm syndrome (FAS), an atypical presentation of amyotrophic lateral sclerosis (ALS), is characterized by progressive, predominantly proximal, weakness of upper limbs, without involvement of the lower limb, bulbar, or respiratory muscles. All ALS patients met revised El Escorial research diagnostic criteria for clinically definite or probable ALS[7]. In flail arm it will stay isolated to the one area for considerable time and is considered to have a significantly slower progression than classical ALS. Of the remaining 22 patients, 5 had brachial plexitis, 4 had cervical radiculopathy, 2 had Charcot-Marie-Tooth disease (CMT1A), and 11 were classified as having disease of unknown origin. https://doi.org/10.1007/s00415-015-7993-z, access via This work was supported by Grant No. In contrast, there seems little involvement of motor cortex in FAS patients. Eur J Neurol 11(8):567–568. All control individuals lacked a family history of neuromuscular disease and had no history of neurologic, psychiatric, or other major medical illnesses, and were recruited among spouses of patients and by word-of-mouth. This means that at least 10 (50%) patients had an UMN sign. Man-in-the-barrel syndrome, a symmetrical proximal brachial amyotrophic diplegia related to motor neuron diseases: a survey of nine cases. The https:// ensures that you are connecting to the Contributed reagents/materials/analysis tools: XL JF BC HY. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). J Neurol Neurosurg Psychiatry 66(5):581–585, Katz JS, Wolfe GI, Andersson PB, Saperstein DS, Elliott JL, Nations SP, Bryan WW, Barohn RJ (1999) Brachial amyotrophic diplegia: a slowly progressive motor neuron disorder. The Seoul National University Hospital ALS center is located in downtown Seoul and serves a diverse community of patients from the metropolitan area. Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. (23 ème Lecon; Affections systématiques de la substance grise de la moëlle épinière (Suite). The maximum SI of two sides was chose to be represented as the SI of one individual. Prognostic factors in ALS: A critical review. Winklewski PJ, Sabisz A, Naumczyk P, et al. The differences in clinical and neurophysiological findings between FAS and ALS, argue against they are the same disease entity. sharing sensitive information, make sure you’re on a federal volume 263, pages 390–395 (2016)Cite this article. HHS Vulnerability Disclosure, Help The center of magnetic coil was placed over C7 cervical spine to stimulate cervical nerve roots of lower segment to acquire the peripheral part of latency of MEPs responses. doi:10.1111/j.1468-1331.2004.00841.x, Brooks BR, Miller RG, Swash M, Munsat TL (2000) El Escorial revisited: revised criteria for the diagnosis of amyotrophic lateral sclerosis. Comparison between Flail Arm Syndrome and Upper Limb Onset Amyotrophic Lateral Sclerosis: Clinical Features and Electromyographic Findings. The DTI study including the tract-of-interest-based analysis showed a microstructural involvement pattern in the brains of flail arm syndrome patients, supporting the hypothesis that flail arm syndrome is a phenotypical variant of ALS. No significant FA alterations were found if group comparisons for the reference paths were performed. Mean disease duration in the flail arm syndrome group was 20 months (range 4 to 66 months), and age of onset of the motor disorder was 62 ± 11 years. The precentral gyrus shows grey matter atrophy both in ALS and in flail arm syndrome patients compared to controls. Dysmyelination revealed through MRI as increased radial (but unchanged axial) diffusion of water. FAS is characterized by relatively symmetric involvement of proximal muscles of both arms without obvious muscle weakness of legs or bulbar sites[6, 10]. The aim of the current study was to compare the clinical and EMG findings of patients diagnosed with FAS with those of patients diagnosed with UL-ALS. All participants provided written informed consent for the study protocol according to institutional guidelines which had been approved by the Ethics Committee of Ulm University, Germany (No. ORIGINAL COMMUNICATION Clinical features and differential diagnosis of flail arm syndrome Annemarie Hu¨bers1 • Viviane Hildebrandt1 • Susanne Petri2 • Katja Kollewe2 • Andreas Hermann3,4 • Alexander Storch3,4,5 • Frank Hanisch6 • Stephan Zierz6 • Angela Rosenbohm1 • Albert C. Ludolph1 • Johannes Dorst1 Received: 26 October 2015/Revised: 1 December 2015/Accepted: 8 . Keywords: All authors declare that they have no conflict of interest. The flail arm syndrome (also known as the Vulpian Bernhardt variant and sometimes referred to as man-in-the barrel syndrome or brachial amyotrophic diplegia [9]) is clinically defined as an initially localized variant with a mainly LMN presentation; it is dominated by severe atrophy of the proximal or distal upper limbs with the arms hanging flaccidly on either side [34]. The hyper-excitability of cortical motor neurons supposedly produce metabolic impairment of lower motor neurons projected, and lead to both upper and lower motor neurons injury[14]. There are few reports about this phenotype. Über die DGN arrow_forward. CMCT = MEPs total latency—peripheral motor conduction time. There are few reports about this phenotype. The STROBE checklist of this study. Forty-three flail arm syndrome patients (32 males, 11 females) were included who met the diagnostic criteria for flail arm syndrome as proposed by Wijesekera and colleagues [].Flail arm syndrome was diagnosed in patients with paresis of both upper limbs and without bulbar and lower limbs symptoms during a time period of 12 months after their visit, as . Despite a uniformly fatal outcome, patients with ALS display a wide range of survival times from a few months to several decades [1]. Flail Arm Symptom Checker: Possible causes include Hemiballismus. In the subgroup analysis, survival was 24.3 ± 6.6 months in upper limb onset (not fulfilling the criteria of flail arm syndrome) and 35.7 ± 19.5 months in lower limb onset. The software Tensor Imaging and Fiber Tracking (TIFT) [22] was used for data analysis; details of the algorithms have been described in detail previously [13, 14, 23]. As for the drug trials and drug treatment in the future, our study indicates that FAS patients should be separated from ALS patients. Although the reasons underlying this difference are not clear, a potential explanation may be that LMN degeneration in patients with FAS was limited to the upper limbs, but had spread to 2 or more regions in those with classic ALS. doi: 10.7759/cureus.28159. Hu MT, Ellis CM, Al-Chalabi A, et al. This site needs JavaScript to work properly. Forty-three flail arm syndrome patients (32 males, 11 females) were included who met the diagnostic criteria for flail arm syndrome as proposed by Wijesekera and colleagues [].Flail arm syndrome was diagnosed in patients with paresis of both upper limbs and without bulbar and lower limbs symptoms during a time period of 12 months after their visit, as . In addition, when the FAS group was categorized according to the revised El Escorial criteria, 8 patients were classified as clinically probable-laboratory supported ALS and 3 as possible ALS [10]. The mean value of CMCT in healthy control was 8.4±0.3ms, while that of in FAS and ALS was 7.9±0.29ms, and 10.0±0.8ms, respectively. One sided limb onset (arm) sporadic PMA/MND - now 90% left arm and 90% right arm, plus other bits including both shoulders and also some breathing issues - Campaign contact Winchester and Southampton branch, and trustee of the Association. There are many clinical features of flail arm syndrome (FAS) that are different from amyotrophic lateral sclerosis (ALS), suggesting they are probably different entities. Brooks BR, Miller RG, Swash M, Munsat TL World Federation of Neurology Research Group on Motor Neuron Diseases. All participants provided written informed consent for the study protocol according to institutional guidelines which had been approved by the Ethics Committee of Ulm University, Germany (No. government site. Cosottini M, Giannelli M, Siciliano G, et al. Citation: Yang H, Liu M, Li X, Cui B, Fang J, Cui L (2015) Neurophysiological Differences between Flail Arm Syndrome and Amyotrophic Lateral Sclerosis. Advanced neuroimaging approaches in amyotrophic lateral sclerosis: refining the clinical diagnosis. Kassubek J, Müller HP, Del Tredici K, et al. doi:10.1212/WNL.0b013e31824e8f53. Between the 2 groups, there were no statistically significant differences in LMN signs on EMG. Wijesekera LC, Leigh PN. Diagnostic utility of Gold Coast Criteria in amyotrophic lateral sclerosis. Two patients had a marked reduction in median sensory nerve action potential amplitude. Natural history and clinical features of the flail arm and flail leg ALS variants. Compared with control group, the RMT and SI in ALS group were both significantly increased to higher level. The flail arm syndrome patients were compared with a group of 43 ‘classical’ ALS patients (29 male/14 female, age 64 ± 11 years) and with a group of 40 age- and gender-matched controls. Bookshelf PubMed Central  HHS Vulnerability Disclosure, Help Analyzed the data: HY LC. PLoS ONE 9(4):e93932. Ultimately, these findings should encourage future studies across the phenotypical spectrum of ALS to contribute to our understanding of potential modifiers of the clinical presentations in ALS. Johannes Dorst. The motor evoked potentials (MEPs) were performed using a figure “8”-shaped magnetic coil with diameter of 96mm, connecting with transcranial magnetic stimulator (Magventure, Magpro, Denmark) with maximal stimulus output (MSO) intensity of 2.2 Tesla. These six FAS patients in this study progressed very slowly, and the symptoms and signs were still confined to bilateral upper extremities 18 months after disease onset. sharing sensitive information, make sure you’re on a federal A large-scale multicentre cerebral diffusion tensor imaging study in amyotrophic lateral sclerosis. Cornblath DR, Kuncl RW, Mellits ED, Quaskey SA, Clawson L, Pestronk A, Drachman DB. In contrast, 31 out of 41ALS patients presented definite UMNS with or without probable UMNS, while the remainders of 10 ALS patients showed probable UMNS. 1999 May;66(5):581-5 Bivariate data analysis was conducted to assess factors associated with FAS and UL-ALS, and categorical variables were analyzed using chi-square and Fisher's exact tests. Google Scholar, Meyer T, Munch C, van Landeghem FK, Borisow N, Dullinger J, Linke P (2007) Progressive muscle atrophy. The pairs of surface electrodes for documenting MEPs of ADMs were the same pairs used in motor nerve conduction studies. These results indicate that FAS might have a very different pathophysiological basis from ALS. Clinical features of flail arm syndrome.
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