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Neurology Research International
Volume 2019, Article ID 7397491, 5 pages
Research Article

Nine Hole Peg Test and Transcranial Magnetic Stimulation: Useful to Evaluate Dexterity of the Hand and Disease Progression in Amyotrophic Lateral Sclerosis

1Department of Neurology, Cantonal Hospital Winterthur, Winterthur, Switzerland
2Department of Neurology, Spital Linth, Uznach, Switzerland
3Neuromoscular Disease Unit/ALS Clinic, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
4Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
5Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria
6Department of Chemistry and Applied Biosciences, ETH Zürich, Zürich, Switzerland
7Institute of Radiology and Nuclear Medicine, Clinical Research Unit, Hirslanden Hospital St. Anna, Lucerne, Switzerland
8Department of Medicine, University of Fribourg, Fribourg, Switzerland

Correspondence should be addressed to David Czell; hc.xmg@llezc.divad

Received 29 July 2019; Revised 9 September 2019; Accepted 20 September 2019; Published 7 November 2019

Academic Editor: Mamede de Carvalho

Copyright © 2019 David Czell et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with involvement of the upper and lower motor neurons. Since the loss of fine motor skills is one of the earliest signs of ALS, the hypothesis was tested if the nine hole PEG test (NHPT) and transcranial magnet stimulation (TMS) with resting-motor threshold (RMT) could be useful in monitoring disease progression. Methods. We examined 28 ALS patients and 27 age-matched healthy controls. ALS patients and healthy controls underwent the nine hole peg test (NHPT) and TMS with RMT. Measurements in patients were repeated after three and six months. Results. At baseline, the median NHPT durations were 1,4-fold longer (), and TMS scores showed a significant 0.8-fold smaller score in ALS patients compared with healthy controls (). The comparison of three and six months versus baseline revealed significant differences for NHPT durations and ALSFRS-R in patients, whereas TMS scores did not significantly differ in the patients. Conclusion. NHPT seems to be a good tool to evaluate dexterity of the hand and the progression of the disease in ALS patients. TMS RMT to the hand muscles seems to be poorly qualified to evaluate the dexterity of the hand function and the course of the disease.