Kai F Loewenbrück1,2, Robin Werner3, René Günther3,4, Markus Dittrich3,5, Robert Klingenberger3, Heinz Reichmann3, Alexander Storch6,7, Andreas Hermann7,8. 1. Department of Neurology, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany. kai.loewenbrueck@uniklinikum-dresden.de. 2. German Center for Neurodegenerative Diseases (DZNE), 01307, Dresden, Germany. kai.loewenbrueck@uniklinikum-dresden.de. 3. Department of Neurology, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany. 4. German Center for Neurodegenerative Diseases (DZNE), 01307, Dresden, Germany. 5. Department of Neurology, Elblandkliniken, 01662, Meissen, Germany. 6. Department of Neurology, University of Rostock, 18147, Rostock, Germany. 7. German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, 18147, Rostock, Germany. 8. Department of Neurology, Translational Neurodegeneration Section "Albrecht Kossel", University of Rostock, 18147, Rostock, Germany.
Abstract
OBJECTIVE: To investigate diagnostic accuracy of a nerve ultrasound (US) protocol that is individualized to a patient's clinical deficits for the differentiation of amyotrophic lateral sclerosis with predominant lower motoneuron disease (ALS/LMND) and multifocal motor neuropathy (MMN). METHODS: Single-center, prospective, examiner-blinded, diagnostic study in two cohorts. Cohort I (model development): Convenience sample of subjects with ALS/LMND or MMN according to revised El-Escorial or EFNS guidelines. Cohort II (model validation): Consecutively recruited treatment-naïve subjects with suspected diagnosis of ALS/LMND or MMN. Cutoffs for 28 different US values were determined by Receiver Operating Curve (ROC) in cohort I. Area Under The Curve (AUC) of US was compared to nerve conduction studies (NCS). Diagnostic accuracy of US protocols, individualized according to clinical deficits, was compared to former rigid non-individualized protocols and to random examination site selection in cohort II. RESULTS: 48 patients were recruited. In cohort I (28 patients), US had higher ROC AUCs than NCS, US 0.82 (0.12) (mean (standard deviation)), NCS (compound muscle action potential (CMAP) 0.60 (0.09), p < .001; two-sided t-test). US models based on the nerve innervating the clinically most affected muscles had higher correct classification rates (CCRs, 93%) in cohort II than former rigid protocols (85% and 80%), or models with random measurement site selection (66% and 80%). CONCLUSIONS: Clinically guided US protocols for differentiation of ALS/LMND from MMN increase diagnostic accuracy when compared to clinically unguided protocols. They also require less measurements sites to achieve this accuracy.
OBJECTIVE: To investigate diagnostic accuracy of a nerve ultrasound (US) protocol that is individualized to a patient's clinical deficits for the differentiation of amyotrophic lateral sclerosis with predominant lower motoneuron disease (ALS/LMND) and multifocal motor neuropathy (MMN). METHODS: Single-center, prospective, examiner-blinded, diagnostic study in two cohorts. Cohort I (model development): Convenience sample of subjects with ALS/LMND or MMN according to revised El-Escorial or EFNS guidelines. Cohort II (model validation): Consecutively recruited treatment-naïve subjects with suspected diagnosis of ALS/LMND or MMN. Cutoffs for 28 different US values were determined by Receiver Operating Curve (ROC) in cohort I. Area Under The Curve (AUC) of US was compared to nerve conduction studies (NCS). Diagnostic accuracy of US protocols, individualized according to clinical deficits, was compared to former rigid non-individualized protocols and to random examination site selection in cohort II. RESULTS: 48 patients were recruited. In cohort I (28 patients), US had higher ROC AUCs than NCS, US 0.82 (0.12) (mean (standard deviation)), NCS (compound muscle action potential (CMAP) 0.60 (0.09), p < .001; two-sided t-test). US models based on the nerve innervating the clinically most affected muscles had higher correct classification rates (CCRs, 93%) in cohort II than former rigid protocols (85% and 80%), or models with random measurement site selection (66% and 80%). CONCLUSIONS: Clinically guided US protocols for differentiation of ALS/LMND from MMN increase diagnostic accuracy when compared to clinically unguided protocols. They also require less measurements sites to achieve this accuracy.
Authors: Kai F Loewenbrück; Julia Liesenberg; Markus Dittrich; Jochen Schäfer; Beate Patzner; Beate Trausch; Jochen Machetanz; Andreas Hermann; Alexander Storch Journal: J Neurol Date: 2016-01 Impact factor: 4.849
Authors: Kai F Loewenbrück; Markus Dittrich; Josef Böhm; Jürgen Klingelhöfer; Petra Baum; Jochen Schäfer; Heinz Reichmann; Andreas Hermann; Alexander Storch Journal: J Neurol Date: 2017-11-28 Impact factor: 4.849
Authors: H Stephan Goedee; W Ludo van der Pol; Jan-Thies H van Asseldonk; Hessel Franssen; Nicolette C Notermans; Alexander J F E Vrancken; Michael A van Es; Stavros Nikolakopoulos; Leo H Visser; Leonard H van den Berg Journal: Neurology Date: 2016-12-07 Impact factor: 9.910
Authors: Bas A Jongbloed; Wieke Haakma; H Stephan Goedee; Jeroen W Bos; Clemens Bos; Jeroen Hendrikse; Leonard H Van Den Berg; W Ludo Van Der Pol Journal: Muscle Nerve Date: 2016-10-01 Impact factor: 3.217
Authors: T W Rattay; N Winter; B F Décard; N M Dammeier; F Härtig; M Ceanga; H Axer; A Grimm Journal: Eur J Neurol Date: 2017-07-05 Impact factor: 6.089
Authors: Ingrid J T Herraets; H Stephan Goedee; Johan A Telleman; Ruben P A van Eijk; J Thies van Asseldonk; Leo H Visser; Leonard H van den Berg; W Ludo van der Pol Journal: Neurology Date: 2020-01-20 Impact factor: 9.910