Diagnostic accuracy and confounders of vagus nerve ultrasound in amyotrophic lateral sclerosis-a single-center case series and pooled individual patient data meta-analysis.

Autor: Müller KJ; Department of Neurology With Friedrich Baur Institute, LMU University Hospital, LMU Munich, Munich, Germany., Schmidbauer ML; Department of Neurology With Friedrich Baur Institute, LMU University Hospital, LMU Munich, Munich, Germany., Schönecker S; Department of Neurology With Friedrich Baur Institute, LMU University Hospital, LMU Munich, Munich, Germany., Kamm K; Department of Neurology With Friedrich Baur Institute, LMU University Hospital, LMU Munich, Munich, Germany., Pelz JO; Department of Neurology, Leipzig University Hospital, Leipzig, Germany., Holzapfel K; Department of Neurology and Clinical Neurophysiology, University of Augsburg, Augsburg, Germany., Papadopoulou M; Department of Physiotherapy, Laboratory of Neuromuscular and Cardiovascular Study of Motion, University of West Attica, Athens, Greece., Bakola E; Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece., Tsivgoulis G; Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece., Naumann M; Department of Neurology and Clinical Neurophysiology, University of Augsburg, Augsburg, Germany., Hermann A; Deutsches Zentrum Für Neurodegenerative, Erkrankungen Rostock/Greifswald, Rostock, Germany.; Center for Transdisciplinary Neurosciences Rostock, Rostock University Medical Center, Rostock, Germany.; Translational Neurodegeneration Section Albrecht Kossel, Department of Neurology, Rostock University Medical Center, Rostock, Germany., Walter U; Deutsches Zentrum Für Neurodegenerative, Erkrankungen Rostock/Greifswald, Rostock, Germany.; Center for Transdisciplinary Neurosciences Rostock, Rostock University Medical Center, Rostock, Germany.; Department of Neurology, Rostock University Medical Center, Rostock, Germany., Dimitriadis K; Department of Neurology With Friedrich Baur Institute, LMU University Hospital, LMU Munich, Munich, Germany., Reilich P; Department of Neurology With Friedrich Baur Institute, LMU University Hospital, LMU Munich, Munich, Germany., Schöberl F; Department of Neurology With Friedrich Baur Institute, LMU University Hospital, LMU Munich, Munich, Germany. florian.schoeberl@med.uni-muenchen.de.
Jazyk: angličtina
Zdroj: Journal of neurology [J Neurol] 2024 Sep; Vol. 271 (9), pp. 6255-6263. Date of Electronic Publication: 2024 Jul 31.
DOI: 10.1007/s00415-024-12601-z
Abstrakt: Background: Several single-center studies proposed utility of vagus nerve (VN) ultrasound for detecting disease severity, autonomic dysfunction, and bulbar phenotype in amyotrophic lateral sclerosis (ALS). However, the resulting body of literature shows opposing results, leaving considerable uncertainty on the clinical benefits of VN ultrasound in ALS.
Methods: Relevant studies were identified up to 04/2024 and individual patient data (IPD) obtained from the respective authors were pooled with a so far unpublished cohort (from Munich). An IPD meta-analysis of 109 patients with probable or definite ALS (El Escorial criteria) and available VN cross-sectional area (CSA) was performed, with age, sex, ALS Functional Rating Scale-revised (ALSFRS-R), disease duration, and bulbar phenotype as independent variables.
Results: Mean age was 65 years (± 12) and 47% of patients (± 12) had bulbar ALS. Mean ALSFRS-R was 38 (± 7), and mean duration was 18 months (± 18). VN atrophy was highly prevalent [left: 67% (± 5), mean CSA 1.6mm 2 (± 0.6); right: 78% (± 21), mean CSA 1.8 mm 2 (± 0.7)]. VN CSA correlated with disease duration (mean slope: left - 0.01; right - 0.01), but not with ALSFRS-R (mean slope: left 0.004; mean slope: right - 0.002). Test accuracy for phenotyping bulbar vs. non-bulbar ALS was poor (summary receiver operating characteristic area under the curve: left 0.496; right 0.572).
Conclusion: VN atrophy in ALS is highly prevalent and correlates with disease duration, but not with ALSFRS-R. VN CSA is insufficient to differentiate bulbar from non-bulbar ALS phenotypes. Further studies are warranted to analyze the link between VN atrophy, autonomic impairment, and survival in ALS.
(© 2024. The Author(s).)
Databáze: MEDLINE
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