Can lesions to the motor cortex induce amyotrophic lateral sclerosis?

J Neurol. 2014 Feb;261(2):283-90. doi: 10.1007/s00415-013-7185-7. Epub 2013 Nov 20.


A recent staging effort for amyotrophic lateral sclerosis (ALS) has demonstrated that the TDP-43 neuropathology may initiate focally in the motor cortex in the majority of patients. We searched our data bank for patients with lesions of the motor cortex which preceded disease onset. We performed a search of our patient- and MRI-data bank and screened 1,835 patients with amyotrophic lateral sclerosis for frontal lobe/motor cortex lesions. We found 18 patients with definite ALS who had documented and defined lesions of the motor cortex, which preceded the initial ALS symptoms by 8-42 years. In the vast majority (15/18) of the patients, the onset of ALS was closely related to the focal lesion since it started in a body region reflecting the damaged cortical area. The findings suggest that initial lesions to the motor cortex may be a contributing initiating factor in some patients with ALS or determine the site of onset in individuals pre-disposed to ALS.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls
  • Adolescent
  • Adult
  • Age of Onset
  • Aged
  • Aged, 80 and over
  • Amyotrophic Lateral Sclerosis / etiology*
  • Autopsy
  • Brain Injuries / complications
  • Brain Injuries / pathology
  • Disability Evaluation
  • Female
  • Frontal Lobe / injuries
  • Head Injuries, Penetrating / complications
  • Humans
  • Image Processing, Computer-Assisted
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Motor Cortex / injuries*
  • Motor Cortex / pathology
  • Neurologic Examination
  • Neuropsychological Tests
  • Retrospective Studies
  • Seizures / etiology
  • Seizures / therapy
  • Temporal Lobe / injuries
  • Young Adult