Correlations Between Median Nerve Sonography and Conduction Study Results and Functional Scales in Amyotrophic Lateral Sclerosis


We aimed to compare the sonographic measurement of median nerve cross-section area (CSA) in patients with Amyotrophic Lateral Sclerosis (ALS) and healthy individuals. The effect of duration of the disease on correlations between paraclinical findings and ALS functional rating scale (ALSFRS) were secondarily aimed to be evaluated. The cross-sectional study was approved by the Ethical Committee of Iran University of Medical Sciences and conducted between January 2017 and December 2018. We evaluated the median nerve surface area by means of sonography in 35 ALS patients and 35 healthy controls. Compound muscle action potential (CMAP) amplitudes during nerve conduction study and ALSFRS were recorded by the same trained specialist. Data were analyzed using SPSS software version 18. We did not find a significant difference between CSA in ALS patients and the normal population (P>0.05). Comparing to normal individuals, the mean CMAP decreased significantly in ALS patients (6.6±3.07 mV versus 10.25±2.2 mV, P<0.001). ALSFRS correlated with both CSA of the median nerve at the wrist (P:<0.001, r:0.78) and the CMAP (P:<0.001, r:0.74) that were confirmed by regression models designed to consider the effect of disease duration on these correlations. CSA was not different between ALS patients and the normal population, but CMAP decreased in ALS patients. ALSFRS correlated with both CSA and CMAP of the median nerve.

1. Cartwright MS, Walker FO, Griffin LP, Caress JB. Peripheral Nerve and Muscle Ultrasound in Amyotrophic lateral sclerosis. Muscle Nerve 2011;44,346-51.

2. Cartwright MS, Shin HW, Passmore LV, Walker FO. Ultrasonographic reference values for assessing the normal median nerve in adults. J Neuroimaging. 2009;19:47-51.
3. Nodera H, Takamatsu N, Shimatani Y, Mori A, Sato K, Oda M, et al. Thinning of cervical nerve roots and peripheral nerves in ALS as measered by sonograghy. Clin Neurophysiol 2014;125:1906-11.
4. Erisela Qerama, Simon stergaard Wehrs, Sara Silkær Bak, Maria Thelin Johansson, Anders Fuglsang-Frederiksen. P231 High resolution ultrasound of peripheral nerves in amyotrophic lateral sclerosis. Clin Neurophysiol 2017;128: e252-3.
5. Schreiber S, Abdulla S, Debska-Vielhaber G, Machts J, Dannhardt-Stieger V, Feistner H, et al. Peripheral nerve ultrasound in amyotrophic lateral sclerosis phenotypes. Muscle Nerve. 2015;51:669-75.
6. JunTsugawa, Yu-ichi Noto, Thanuja Dharmadasa, Nidhi Garg, Matthew C.Kiernan. Median/ulnar nerve ultrasound cross-sectional area ratio in ALS. Clin Neurophysiol 2018;129:2
7. Ríos-Díaz J, Del Baño-Aledo ME, Tembl-Ferrairó JI, Chumillas MJ, Vázquez-Costa JF, Martínez-Payá JJ. Quantitative neuromuscular ultrasound analysis as biomarkers in amyotrophic lateral sclerosis. Eur Radiol. 2019;29:4266-75.
8. Maathuis EM, Drenthen J, van Doorn PA, Visser GH, Blok JH. The CMAP scan as a tool to monitor disease progression in ALS and PMA. Amyotroph Lateral Scler Frontotemporal Degener 2013;14:217-23.
9. Mori A, Yamashita S, Nakajima M, Hori H, Tawara A, Matsuo Y, et al. CMAP decrement as a potential diagnostic marker for ALS. Acta Neurol Scand 2016;134:49-53.
10. Ren YT, Cui F, Yang F, Chen ZH, Ling L, Huang XS. [An analysis of characteristics of nerve conduction in 154 cases of amyotrophic lateral sclerosis]. Zhonghua Nei Ke Za Zhi. 2016;55:755-8.
IssueVol 57, No 11 (2019) QRcode
Amyotrophic lateral sclerosis (ALS) Median nerve Cross-sectional area Compound muscle action potential (CMAP) ALS functional rating scale (ALSFRS)

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How to Cite
Deilami P, Ghourchian S, Haghi Ashtiani B, Esmaeili S, Bahadori M, Shojaei SF, Babaei MR, Raeesmohammadi L, Afrakhteh M, Zamani B. Correlations Between Median Nerve Sonography and Conduction Study Results and Functional Scales in Amyotrophic Lateral Sclerosis. Acta Med Iran. 2020;57(11):658-662.