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Kathleen M. Zackowski, PhD; Prachi Dubey, MD; Gerald V. Raymond, MD; Susumu Mori, PhD; Amy J. Bastian, PhD; Hugo W. Moser, MD

Arch Neurol. 2006;63:74-80.

Background  Gait abnormalities and sensorimotor disturbances are principal defects in adrenomyeloneuropathy (AMN). However, to our knowledge, their association with overall impairment and neuroanatomical changes has not been defined.

Objectives  To understand how sensorimotor impairments create mobility deficits and to analyze how these impairments are related to specific metrics of axonal integrity.

Design  Cross-sectional study assessing impairments, including vibration sensation, strength, spasticity, and global measures of walking and balance. Fractional anisotropy was measured to evaluate the integrity of the corresponding brainstem tracts.

Participants  Men with AMN and healthy control subjects.

Results  Individuals with sensory loss only showed minimal walking deficits. Concomitant strength and sensory loss resulted in slower walking, with abnormal knee control; increased spasticity led to an exaggerated trunk motion and a knee-flexed (crouched) posture. Hip strength was an independent predictor of walking velocity in subjects with AMN. Subjects with sensory loss only had greater sway amplitudes during standing balance testing, which did not worsen with additional impairments. There were significant associations among sway amplitude, great toe vibration sense, and dorsal column fractional anisotropy. Brainstem fractional anisotropy in AMN was significantly negatively correlated with impairment, indicating that overall tract integrity is associated with sensorimotor abnormalities in AMN.

Conclusions  Impairment measures capture specific abnormalities in walking and balance that can be used to direct rehabilitation therapy in AMN. Tract-specific magnetic resonance imaging metrics, such as fractional anisotropy (used herein to evaluate structure-function relationships), significantly reflect disease severity in AMN.

Author Affiliations: Kennedy Krieger Institute (Drs Zackowski, Dubey, Raymond, Mori, Bastian, and Moser) and Departments of Physical Medicine and Rehabilitation (Drs Zackowski and Bastian), Neurology (Drs Raymond, Bastian, and Moser), and Pediatrics (Drs Raymond and Moser), The Johns Hopkins University; Baltimore, Md.

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