Nimeshan Geevasinga1, Clement T Loy2, Parvathi Menon1, Mamede de Carvalho3, Michael Swash4, Maarten Schrooten5, Philip Van Damme6, Malgorzata Gawel7, Masahiro Sonoo8, Mana Higashihara9, Yu-Ichi Noto10, Satoshi Kuwabara10, Matthew C Kiernan11, Petra Macaskill2, Steve Vucic12. 1. Western Clinical School, University of Sydney, Sydney, Australia. 2. School of Public Health, University of Sydney, Sydney, Australia. 3. Hospital of Santa Maria and Instituto de Medicina Molecular and Faculty of Medicine, University of Lisbon, Lisbon, Portugal. 4. Hospital of Santa Maria and Instituto de Medicina Molecular and Faculty of Medicine, University of Lisbon, Lisbon, Portugal; The Royal London Hospital and Queen Mary School of Medicine, University of London, London, UK. 5. Neurology Department, University Hospitals Leuven, Leuven, Belgium. 6. Neurology Department, University Hospitals Leuven, Leuven, Belgium; KU Leuven - University of Leuven, Department of Neurosciences, VIB - Vesalius Research Center, Experimental Neurology - Laboratory of Neurobiology, Leuven, Belgium. 7. Department of Neurology, and Neurodegenerative Diseases Research Group, Medical University of Warsaw, Warsaw, Poland. 8. Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan. 9. Department of Neurology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan. 10. Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. 11. Brain and Mind Center, University of Sydney, Sydney, Australia. 12. Western Clinical School, University of Sydney, Sydney, Australia. Electronic address: s.vucic@neura.edu.au.
Abstract
OBJECTIVE: To determine the utility of the Awaji criteria in diagnosing amyotrophic lateral sclerosis (ALS) and to propose a novel modification so as to enhance sensitivity based on results of individual patient data (IPD). METHODS: Individual patient data were available from 8 studies comparing the diagnostic accuracy of Awaji and revised El Escorial (rEEC) criteria. The sensitivity of a novel updated Awaji criteria, incorporating a "probable-laboratory supported" category, was also tested. RESULTS: Individual patient data were available from 1086 patients, consisting of 881 ALS and 205 patients with disorders mimicking ALS. Summary sensitivities based on random effects logistic regression modelling disclosed a higher sensitivity of the Awaji criteria (0.70, 95% confidence interval [CI] 0.51-0.83) and updated Awaji criteria (0.73, 95% CI 0.56-0.85) when compared to rEEC (0.58, 95% CI 0.48-0.68). Paired analysis revealed higher sensitivities of Awaji criteria in 4 studies, and of updated Awaji criteria in 7 studies, when compared to rEEC. CONCLUSION: Individual patient data analysis established a higher sensitivity of Awaji criteria when compared to rEEC. The updated Awaji criteria enhanced the diagnostic sensitivity in limb-onset ALS. SIGNIFICANCE: The updated Awaji criteria should be considered in clinical practice and future therapeutic trials.
OBJECTIVE: To determine the utility of the Awaji criteria in diagnosing amyotrophic lateral sclerosis (ALS) and to propose a novel modification so as to enhance sensitivity based on results of individual patient data (IPD). METHODS: Individual patient data were available from 8 studies comparing the diagnostic accuracy of Awaji and revised El Escorial (rEEC) criteria. The sensitivity of a novel updated Awaji criteria, incorporating a "probable-laboratory supported" category, was also tested. RESULTS: Individual patient data were available from 1086 patients, consisting of 881 ALS and 205 patients with disorders mimicking ALS. Summary sensitivities based on random effects logistic regression modelling disclosed a higher sensitivity of the Awaji criteria (0.70, 95% confidence interval [CI] 0.51-0.83) and updated Awaji criteria (0.73, 95% CI 0.56-0.85) when compared to rEEC (0.58, 95% CI 0.48-0.68). Paired analysis revealed higher sensitivities of Awaji criteria in 4 studies, and of updated Awaji criteria in 7 studies, when compared to rEEC. CONCLUSION: Individual patient data analysis established a higher sensitivity of Awaji criteria when compared to rEEC. The updated Awaji criteria enhanced the diagnostic sensitivity in limb-onset ALS. SIGNIFICANCE: The updated Awaji criteria should be considered in clinical practice and future therapeutic trials.
Authors: Michael J Strong; Sharon Abrahams; Laura H Goldstein; Susan Woolley; Paula Mclaughlin; Julie Snowden; Eneida Mioshi; Angie Roberts-South; Michael Benatar; Tibor HortobáGyi; Jeffrey Rosenfeld; Vincenzo Silani; Paul G Ince; Martin R Turner Journal: Amyotroph Lateral Scler Frontotemporal Degener Date: 2017-01-05 Impact factor: 4.092
Authors: Mehdi A J van den Bos; Nimeshan Geevasinga; Mana Higashihara; Parvathi Menon; Steve Vucic Journal: Int J Mol Sci Date: 2019-06-10 Impact factor: 5.923
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