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Neurophysiological indices in amyotrophic lateral sclerosis correlate with functional outcome measures, staging and
Andrea Barp1, Andrea Lizio2, Francesca Gerardi2
1NEuroMuscular Omnicentre, Fondazione Serena Onlus, Piazza Ospedale Maggiore 3, 20162 Milano, Italy; Neurorehabilitation Unit, University of Milan, Italy.
Objective:
This study examined neurophysiological (NI), split-hand (SI) and split-leg (SLI) index in patients with amyotrophic lateral sclerosis (ALS), and their correlation with functional status, disease duration, staging and survival.
Methods:
Eighty-two patients underwent nerve conduction study to analyze NI, SI and SLI. Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R), disease progression rate (ΔFS), Milano-Torino (MiToS) and King's staging systems, Forced Vital Capacity (FVC), and survival data were collected.
Results:
Both NI and SI indices were significantly associated with ALSFRS-R, MiToS, King's and FVC. Slow progressor patients (ΔFS < 0.5) reported a significantly higher NI and SI values compared to both normal (0.5 ≤ ΔFS < 1.00) and fast progressors (ΔFS ≥ 1.0). After dichotomizing patients in slow progressors (ΔFS < 0.5) and not-slow progressors (ΔFS ≥ 0.5), a combination of SI index and disease duration revealed to be the best prediction model to discriminate patients in accordance with their disease progression (c-index: 0.92), leading to a new prognostic index: the 'Split-Hand prognostic index' (SHpi).
Conclusion:
SI and NI are correlated with functional status and FVC. SHpi index could represent an useful tool to discriminate patients in accordance with their disease progression.
Significance:
These data provide novel evidence of neurophysiological indices as promising biomarkers in ALS.
