Awaji ALS criteria increase the diagnostic sensitivity in patients with bulbar onset.

Abstract

OBJECTIVE:

To assess whether Awaji criteria improve the sensitivity of diagnosis for amyotrophic lateral sclerosis (ALS). In Awaji ALS criteria, fasciculation potentials are regarded as evidence of acute denervation in the presence of chronic neurogenic changes on needle electromyography.

METHODS:

We reviewed clinical and neurophysiological data of 113 consecutive patients who were suspected as suffering ALS. The six muscles (trapezius, biceps, first dorsal interosseous, T10-paraspinalis, vastus lateralis, and tibialis anterior muscles) were examined by EMG, focusing on the presence of fasciculation potentials. The sensitivity of revised El Escorial (R-EEC) and Awaji criteria was compared.

RESULTS:

Probable or definite ALS was diagnosed in 61% of the patients by R-EEC and 71% by Awaji criteria. By applying Awaji criteria; (1) 17 of the 44 patients categorized as possible ALS by R-EEC reached to probable/definite ALS, 11 of whom had bulbar onset, (2) in 48 patients with bulbar onset, the proportion of probable/definite ALS increased from 59% to 82%, (3) in 62 patients with limb onset, the proportion of probable/definite ALS was 61% (63% by R-EEC).

CONCLUSIONS:

Awaji criteria improve the sensitivity of ALS diagnosis in patients with bulbar onset, but not in those with limb onset.

SIGNIFICANCE:

Accepting fasciculation potentials as evidence of acute denervation increases the diagnostic sensitivity of ALS, particularly in patients with bulbar onset, and contributes to early diagnosis.

• Authors: Yu-ichi Noto, Sonoko Misawa, Kazuaki Kanai, Kazumoto Shibuya, Sagiri Isose, Saiko Nasu, Yukari Sekiguchi, Yumi Fujimaki, Masanori Nakagawa, Satoshi Kuwabara
• Journal: Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology (Clin Neurophysiol) Vol. 123 Issue 2 Pg. 382-5 (Feb 2012) ISSN: 1872-8952 [Electronic] Netherlands
• PMID: 21764635 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Amyotrophic Lateral Sclerosis (diagnosis, physiopathology)
• Bulbar Palsy, Progressive (diagnosis, physiopathology)
• Early Diagnosis
• Electromyography (standards)
• Female
• Humans
• Male
• Middle Aged