Noninvasive ventilation (NIV) appears to improve survival and quality of life in patients with amyotrophic lateral sclerosis (ALS), but little is known about predictors of NIV tolerance. NIV use was assessed and clinical predictors of tolerance were investigated, using predictive modeling, in ALS patients diagnosed and followed in our clinic until death over a 4-year time period. Patients were prescribed NIV based on current practice parameters when respiratory symptoms were present or forced vital capacity was less than 50%. We prescribed NIV in 52% (72) of patients. For those prescribed NIV, information regarding tolerance was available for 50 patients, with 72% (36) tolerant to its use. Tolerance was six times more likely in limb-onset than bulbar-onset ALS patients, with a trend toward reduced tolerance in those with lower forced vital capacity at NIV initiation. Age, gender, and duration of disease were not predictors of NIV tolerance. We conclude that a majority of ALS patients who are prescribed NIV can successfully become tolerant to its use.

Little is known about the complications of needle electromyography (EMG) performed on anticoagulated patients, and no guidelines exist regarding its performance. We conducted an anonymous survey of academic EMG laboratories in the U.S. to understand current practices and complications with regard to anticoagulated patients and those receiving antiplatelet medications. Forty-seven (78%) of 60 EMG laboratories responded to the survey. Four laboratories (9%) reported at least one hemorrhagic complication requiring medical or surgical intervention in an anticoagulated patient, whereas none reported a hemorrhagic complication in patients receiving antiplatelet medications. Ten (21%) reported willingness to evaluate cranial, paraspinal, and all limb muscles in anticoagulated patients. This survey suggests that hemorrhagic complications from needle EMG of anticoagulated patients are rare. It also suggests that needle EMG of patients receiving antiplatelet therapy is not associated with increased reports of hemorrhagic complications.

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