Nerve ultrasound in amyotrophic lateral sclerosis: systematic review and meta-analysis.

Ramy Abdelnaby, Ahmed Samy Shabib, Mostafa Hossam El Din Moawad, Talal Salem, Merna Wagih Youssef Awad, Peter Dawoud Awad, Imene Maallem, Hany Atwan, Salma Adel Rabie, Khaled Ashraf Mohamed, Hossam Abdelmageed, Ali M Karkour, Mohamed Elsayed, Michael S Cartwright
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Abstract

Background/ aim: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease affecting upper and lower motor neurons, causing progressive atrophy of muscles, hypertonia, and paralysis. This study aimed to evaluate the current evidence and effectiveness of ultrasound in investigating nerve cross-sectional area (CSA) of peripheral nerves, vagus and cervical roots in those with ALS compared with healthy controls and to pool the CSA measurements.

Methods: A systematic search was conducted on Cochrane, Clarivate Web of Science, PubMed, Scopus, and Embase for the mesh terms nerve, ultrasonography, and amyotrophic lateral sclerosis. A quality assessment was performed using the New-Ottawa scale. In addition, a double-arm meta-analysis using Review Manager 5 software version 5.4 was performed.

Results: From the seventeen studies included in this review, the overall mean difference showed that individuals with ALS had a significantly smaller CSA in comparison to healthy controls for median, ulnar, C6 root, and phrenic nerves. However, no significant difference in the CSA was found in radial, vagal, sural, and tibial nerves.

Discussion: This study confirmed results of some of the included studies regards the anatomic sites, where nerve atrophy in ALS could be detected to potentially support the diagnosis of ALS. However, we recommend further large, prospective studies to assess the diagnostic value of these anatomical sites for the diagnosis of ALS.

Conclusions: Our findings confirmed specific anatomic sites to differentiate ALS patients from healthy controls through ultrasound. However, these findings cannot be used to confirm the ALS diagnosis, but rather assist in differentiating it from other diagnoses.

Trial registration: Retrospectively registered on July 30th 2024 in PROSPERO (PROSPERO (york.ac.uk)) with ID574702.

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肌萎缩性脊髓侧索硬化症的神经超声:系统回顾和荟萃分析。
背景/目的:肌萎缩侧索硬化症(ALS)是一种影响上下运动神经元的神经退行性疾病,会导致肌肉进行性萎缩、张力亢进和瘫痪。本研究旨在评估超声检查周围神经、迷走神经和颈根神经横截面积(CSA)的现有证据和有效性,与健康对照组进行比较,并对 CSA 测量结果进行汇总:在 Cochrane、Clarivate Web of Science、PubMed、Scopus 和 Embase 上以神经、超声波和肌萎缩侧索硬化症为关键词进行了系统检索。采用新渥太华量表进行了质量评估。此外,还使用 Review Manager 5 软件 5.4 版进行了双臂荟萃分析:结果:在纳入本综述的 17 项研究中,总体平均差异显示,与健康对照组相比,ALS 患者的正中神经、尺神经、C6 根神经和膈神经的 CSA 明显较小。但是,在桡神经、迷走神经、苏拉神经和胫神经方面,CSA 没有发现明显差异:本研究证实了部分纳入研究的结果,即在 ALS 中可检测到神经萎缩的解剖部位,从而为 ALS 的诊断提供潜在支持。然而,我们建议进一步开展大型前瞻性研究,以评估这些解剖部位对 ALS 诊断的诊断价值:我们的研究结果证实了通过超声波可将 ALS 患者与健康对照者区分开来的特定解剖部位。然而,这些发现不能用于确诊 ALS,而是有助于将其与其他诊断区分开来:该试验于 2024 年 7 月 30 日在 PROSPERO (PROSPERO (york.ac.uk))进行了追溯注册,注册号为 ID574702。
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14 weeks
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