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Utility of Dissociated Intrinsic Hand Muscle Atrophy in the Diagnosis of Amyotrophic Lateral Sclerosis
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Quantifying the split-elbow sign: a comprehensive study in amyotrophic lateral sclerosis.

Sheng-Yi He1, Wei-Chen Cai1, Wei-Ming Su1

  • 1Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.

Frontiers in Neurology
|December 19, 2024
PubMed
Summary
This summary is machine-generated.

The split-elbow sign (SES) shows potential as a biomarker for amyotrophic lateral sclerosis (ALS). Quantified SES indices, particularly motor unit number index (MUNIX), aid in diagnosing ALS and assessing disease progression.

Keywords:
amyotrophic lateral sclerosisdiagnosisneuroelectrophysiologysplit-elbow indexsplit-elbow sign

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Area of Science:

  • Neurology
  • Biomarkers
  • Amyotrophic Lateral Sclerosis (ALS)

Background:

  • The split-elbow sign (SES), indicating preferential biceps brachii dysfunction over triceps, is a recognized clinical feature in amyotrophic lateral sclerosis (ALS).
  • Quantification of the SES index and its diagnostic utility in ALS have not been thoroughly explored.

Purpose of the Study:

  • To investigate the split-elbow index (SEI) using compound muscle action potential (CMAP), motor unit number index (MUNIX), and echo intensity (EI) in ALS patients.
  • To evaluate the diagnostic performance of SEI in distinguishing ALS from controls and its correlation with disease progression.

Main Methods:

  • The study included 70 ALS patients, 41 disease controls, and 40 healthy controls.
  • SEI was calculated by dividing biceps brachii values by triceps values for CMAP, MUNIX, and EI (SEICMAP, SEIMUNIX, SEIEI).
  • Receiver operating characteristic (ROC) curves were used to assess diagnostic performance.

Main Results:

  • SEICMAP and SEIMUNIX were significantly reduced in ALS patients compared to controls (P < 0.0001).
  • SEIEI was significantly elevated in ALS patients (P < 0.0001).
  • SEIMUNIX showed a significant decrease with disease progression (P < 0.001), and its ROC analysis yielded the highest AUC (0.846). A combined SEI approach achieved an AUC of 0.90.

Conclusions:

  • SES indicators show promise as significant biomarkers for ALS diagnosis.
  • Quantified SEI metrics can aid in assessing disease progression and potentially serve as diagnostic biomarkers in ALS.