Phrenic nerve stimulation is more sensitive than ultrasound measurement of diaphragm thickness in assessing early ALS progression

Pinto, Susana; Alves, Pedro Nascimento; Swash, Michael; Carvalho, Mamede de

doi:10.1016/j.neucli.2016.08.001

Cited by 30 publications

(23 citation statements)

References 16 publications

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“…A follow‐up study by Pinto et al . (2017) described 40 patients with ALS at baseline and 4 months later . Neither diaphragmatic thickness nor pulmonary function testing changed significantly over this time.…”

Section: Diaphragmatic Ultrasound In Alsmentioning

confidence: 98%

Ultrasound in the Diagnosis and Monitoring of Amyotrophic Lateral Sclerosis: A Review

Hobson‐Webb

Simmons

2019

Muscle and Nerve

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Neuromuscular ultrasound is complementary to electrodiagnostic (EDx) testing and is useful in enhancing the diagnosis of mononeuropathies, peripheral nerve trauma, and demyelinating polyneuropathies. There is increasing interest in using ultrasound both to aid in the diagnosis of amyotrophic lateral sclerosis (ALS) and to monitor its progression. In this article we review the relevant literature on ultrasound in ALS. Ultrasound is more sensitive than EDx in identifying fasciculations in patients with ALS. It can detect decreased muscle thickness, increased muscle echointensity and echovariance, and reduced peripheral nerve size in these patients. Ultrasound is also a helpful tool in assessment of diaphragm function. Although additional studies are required to define the exact role of ultrasound in the evaluation and monitoring of ALS, it can improve the diagnostic yield in patients when ALS is suspected, but insufficiently supported, by clinical and EDx examinations. Muscle Nerve 60: 114–123, 2019

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Section: Diaphragmatic Ultrasound In Alsmentioning

confidence: 98%

Ultrasound in the Diagnosis and Monitoring of Amyotrophic Lateral Sclerosis: A Review

Hobson‐Webb

Simmons

2019

Muscle and Nerve

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“…All included studies were observational: one was cross-sectional (Pinto et al, 2016), four were prospective cohorts (Jenkins et al, 2016;Pinto et al, 2017;Singh et al, 2011;Yamauchi et al, 2014), one was retrospective cohort (Pinto et al, 2012), and one was a case-controls study (Sathyaprabha et al, 2010). For Bokuda et al (2014) only the abstract was available and it was not possible to assess if the cohort was either retrospective or prospective.…”

Section: Methodsmentioning

confidence: 99%

Prognostic value of phrenic nerve conduction study in amyotrophic lateral sclerosis: Systematic review and meta-analysis

Silva

Rodrigues

Duarte

et al. 2020

Clinical Neurophysiology

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To assess the prognostic value of phrenic nerve conduction (PNC) in amyotrophic lateral sclerosis (ALS). Methods We conducted a systematic review to identify studies reporting on PNC, and mortality and/or forced vital capacity (FVC) in patients with ALS. We searched Medline, EMBASE, and Web of Science. Two independent authors selected studies and extracted data. Risk of bias was assessed using the QUIPS tool. Hazard-ratios and correlation coefficients were pooled using a random effects generic inverse-variance model. Evidence quality was evaluated with GRADE. Results In the pooled analysis, patients with CMAP-amplitude equal or below 0.4mV are 2.021 more likely to die over the studied period (95%CI 1.161 to 3.522; I 2 =55.9%; 338 participants). CMAP-amplitude showed a moderate positive correlation with FVC (r=0.400, 95%CI= 0.226 to 0.550; I 2 =69.77%; 381 participants). However, there was a weak negative correlation between CMAP-latency and FVC (r=-0.235; 95%CI=-0.447 to-0.024; I 2 =15.92%; 112 participants). Conclusions There is moderate-quality evidence that CMAP-amplitude of the PNC is correlated with FVC. Results favour a predictive value for mortality, but the risk of bias is high. Significance PNC is a simple test that should be considered to assess respiratory function in ALS, especially in patients with bulbar involvement or cognitive impairment. Highlights 1-Investigation of phrenic nerve conduction is a simple and quick test 2-Phrenic nerve amplitude probably predicts survival and is probably correlated to FVC

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“…Significant correlations have been found between these measurements and FVC, SNIP, and the amplitude of the motor response of the phrenic nerve (62–64). However, ultrasound studies are less sensitive than phrenic nerve motor responses in assessing early deterioration of the diaphragm in ALS (65).…”

Section: Assessment Of Respiratory Dysfunction In Alsmentioning

confidence: 99%

Diaphragmatic Neurophysiology and Respiratory Markers in ALS

2019

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The main reason for short survival in amyotrophic lateral sclerosis (ALS) is involvement of respiratory muscles. Severe compromise of diaphragmatic function due to marked loss of motor units causes poor inspiratory strength leading to symptomatic respiratory fatigue, and hypercapnia and hypoxemia, often firstly detected while sleeping supine. Weakness of expiratory muscles leads to cough weakness and poor bronchial clearance, increasing the risk of respiratory infection. Respiratory tests should therefore encompass inspiratory and expiratory function, and include measurements of blood gases during sleep. Non-volitional tests, such as phrenic nerve stimulation, are particularly convenient for investigating respiratory function in patients unable to perform standard respiratory function tests due to poor cooperation or facial weakness. However, SNIP is a sensitive test when patients with bulbar involvement are able to perform the necessary maneuvers. It is likely that central respiratory regulation is disturbed in some ALS patients, but its evaluation is more complex and not regularly implemented. Practical tests should incorporate tolerability, sensitivity, easy application for regular monitoring, and prognostic value. Impending respiratory failure can cause increased circulating inflammatory markers, but molecular assessment of respiratory distress requires further study. In future, home-monitoring of patients with accessible devices should be developed.

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Phrenic nerve stimulation is more sensitive than ultrasound measurement of diaphragm thickness in assessing early ALS progression

Cited by 30 publications

References 16 publications

Ultrasound in the Diagnosis and Monitoring of Amyotrophic Lateral Sclerosis: A Review

Ultrasound in the Diagnosis and Monitoring of Amyotrophic Lateral Sclerosis: A Review

Prognostic value of phrenic nerve conduction study in amyotrophic lateral sclerosis: Systematic review and meta-analysis

Diaphragmatic Neurophysiology and Respiratory Markers in ALS

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