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Prognostic Usefulness of Motor Unit Number Index (MUNIX) in Patients Newly Diagnosed with Amyotrophic Lateral
Barbara Risi1,2,3, Stefano Cotti Piccinelli1,3, Stefano Gazzina4
1Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy.
Abstract:
The MUNIX technique allows us to estimate the number and size of surviving motor units (MUs). Previous studies on ALS found correlations between MUNIX and several clinical measures, but its potential role as a predictor of disease progression rate (DPR) has not been thoroughly evaluated to date. We aimed to investigate MUNIX's ability to predict DPR at a six-month follow up.
Methods:
24 ALS patients with short disease duration (<24 months from symptoms' onset) were enrolled and divided according to their baseline DPR into two groups (normal [DPR-N] and fast [DPR-F] progressors). MUNIX values were obtained from five muscles (TA, APB, ADM, FDI, Trapezius) and averaged for each subject.
Results:
MUNIX was found to predict DPR at follow up in a multivariable linear regression model; namely, patients with lower MUNIX values were at risk of showing greater DPR scores at follow up. The result was replicated in a simple logistic regression analysis, with the dichotomic category "MUNIX-Low" as the independent variable and the outcome "DPR-F" as the dependent variable.
Conclusions:
our results pave the way for the use of the MUNIX method as a prognostic tool in early ALS, enabling patients' stratification according to their rates of future decline.
Insights
The MUNIX technique can predict Amyotrophic Lateral Sclerosis (ALS) progression. Lower MUNIX values in early ALS indicate a higher risk of faster disease progression, aiding patient stratification.
Area of Science:
- Neurology
- Neurophysiology
Background:
- The Motor Unit Number Index (MUNIX) estimates surviving motor units (MUs).
- Previous studies linked MUNIX to ALS clinical measures, but its predictive value for disease progression rate (DPR) remains unevaluated.
Purpose of the Study:
- To assess MUNIX's potential as a predictor of DPR in early Amyotrophic Lateral Sclerosis (ALS).
- To investigate if MUNIX can stratify ALS patients based on future disease progression.
Main Methods:
- 24 early-stage ALS patients (disease duration <24 months) were analyzed.
- Patients were grouped by baseline DPR (normal vs. fast progressors).
- MUNIX values were measured in five muscles and averaged per subject.
Main Results:
- MUNIX significantly predicted DPR in a multivariable regression model.
- Lower MUNIX values correlated with higher DPR at six-month follow-up.
- Logistic regression confirmed that "MUNIX-Low" predicted fast progression (DPR-F).
Conclusions:
- The MUNIX method shows promise as a prognostic tool for early ALS.
- MUNIX can potentially stratify patients based on their predicted rate of decline.
- This aids in personalized treatment strategies and clinical trial design for ALS.
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