Are we really closer to improving the diagnostic sensitivity in ALS patients with Awaji criteria?

Abstract

The Awaji criteria, recently introduced to increase diagnosis sensitivity in amyotrophic lateral sclerosis (ALS), equate the diagnostic significance of neurogenic electrophysiological changes to clinical signs of lower motor neuron dysfunction. They also increase the electrophysiological significance of fasciculation potentials (FPs). The aim of our study was to analyse whether the new parameters improve diagnostic sensitivity in ALS patients primarily diagnosed with the El Escorial criteria. Medical and electrophysiological records of 135 consecutive patients with ALS and 25 patients with progressive muscular atrophy (PMA) who underwent electrophysiological examination of at least three anatomical regions were analysed retrospectively. Results showed that implementation of the Awaji criteria increased the level of ALS diagnosis sensitivity in 5.9% of cases – 1.5% due to the new role of FPs potentials and 4.4% because of equalization of clinical and EMG findings. In 4% of patients the ALS diagnosis was, however, changed from laboratory-supported probable ALS to possible ALS. In conclusion, our study confirms that Awaji modifications are able to improve the diagnostic certainty in a few ALS cases. Although the new approach to FPs markedly increases the number of involved muscles, it only slightly raises the number of involved regions.

Key words::

• EMG
• neurophysiology
• clinical trials

Declaration of interest: The study was partially supported by a grant (MG, MK-K) from an EU Joint Programme. Neurodegenerative Disease Research (JPND) project. The project is supported through the following funding organizations under the aegis of JPND – www.jpnd.eu: France, Agence Nationale de la Recherche; Germany, Bundesministerium für Bildung und Forschung; Ireland, Health Research Board; Italy, Ministero della Salute; The Netherlands, The Netherlands Organization for Health Research and Development; Poland, Narodowe Centrum Badańi Rozwoju; Portugal, Funda çãoa Ciênciaea Tecnologia; Spain, Ministerio de Ciencia e Innovación; Switzerland, Schweizerischer Nationalfonds zur Förderung der wissenschaftlichen Forschung; Turkey, Tübitak; United Kingdom, Medical Research Council.

This study was supported also by a statutory grant to the Department of Neurology, Medical University of Warsaw from the Ministry of Science and Higher Education.

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.