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Roll SC, Takata SC, Yao B, Kysh L, Mack WJ. Sonographic reference values for median nerve cross-sectional area: A meta-analysis of data from healthy individuals. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2023; 39:492-506. [PMID: 37654772 PMCID: PMC10468154 DOI: 10.1177/87564793231176009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Objective Establish median nerve CSA reference values and identify patient-level factors impacting diagnostic thresholds. Methods Studies were identified through a robust search of multiple databases, and quality assessment was conducted using a modified version of the National Institute of Health Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A meta-analysis was performed to identify normative values stratified by anatomic location. A meta-regression was conducted to examine heterogeneity effects of age, sex, and laterality. Results The meta-analysis included 73 studies; 41 (56.2%) were high quality. The median nerve CSA [95% CI] was 6.46mm2 [6.09-6.84], 8.68mm2 [8.22-9.13], and 8.60mm2 [8.23-8.97] at the proximal forearm, the carpal tunnel inlet, and the proximal carpal tunnel, respectively. Age was positively associated with CSA at the level of proximal carpal tunnel (β=0.03mm2, p=0.047). Men (9.42mm2, [8.06-10.78]) had statistically larger proximal tunnel CSA (p = 0.03) as compared to women (7.71mm2, [7.01-8.42]). No difference was noted in laterality. Conclusion A reference value for median nerve CSA in the carpal tunnel is 8.60mm2. Adjustments may be required in pediatrics or older adults. The diagnostic threshold of 10.0mm2 for male patients should be cautiously applied as the upper limit of normative averages surpasses this threshold.
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Affiliation(s)
- Shawn C. Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Sandy C. Takata
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Buwen Yao
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Lynn Kysh
- Institute for Nursing and Interprofessional Research, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Wendy J. Mack
- Division of Population and Public Health, University of Southern California, Los Angeles, CA, USA
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Fan J, Li Y, Niu J, Liu J, Guan Y, Cui L, Liu M. The cross-sectional area of peripheral nerve in amyotrophic lateral sclerosis: A case-control study. Clin Neurol Neurosurg 2023; 231:107847. [PMID: 37364449 DOI: 10.1016/j.clineuro.2023.107847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/30/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE A growing body of literature recognises the importance of peripheral nerve ultrasound in neuromuscular disorders. Several attempts have been made to differentiate amyotrophic lateral sclerosis (ALS) from multifocal motor neuropathy (MMN) using peripheral nerve ultrasound. A much-debated question is whether the cross-sectional area (CSA) of peripheral nerve in ALS patients is significantly smaller compared to healthy controls. This study aims to determine the CSA of peripheral nerves in patients with ALS. METHODS One hundred and thirty-nine patients with ALS and 75 healthy controls were recruited. Ultrasound of the median, ulnar, and trunks of the brachial plexus and cervical nerve roots was undertaken in ALS patients and controls. RESULTS Compared to controls, ALS patients had mild reductions of the median nerve, most sites of the ulnar nerve, trunks of the brachial plexus and cervical nerve roots. Another important finding of this study is that the median nerve tends to have a more significant reduction than the ulnar nerve in ALS patients, especially at the proximal. CONCLUSIONS Ultrasound could be sensitive to nerve motor fibre loss in patients with ALS. CSA at the proximal Median nerve may be a promising biomarker in patients with ALS.
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Affiliation(s)
- Jing Fan
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Yi Li
- The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jingwen Niu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Jingwen Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Yuzhou Guan
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China.
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Sato M, Nakamura T, Nagashima K, Fujita Y, Ikeda Y. Prolonged distal latency of the median motor nerve is associated with poor prognosis in amyotrophic lateral sclerosis. Neurol Res 2020; 43:191-198. [PMID: 33054692 DOI: 10.1080/01616412.2020.1834291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A nerve conduction study (NCS) is routinely undertaken for the differential diagnosis of amyotrophic lateral sclerosis (ALS). Prolonged median motor distal latency (MMDL) has been reported in a subset of patients with ALS. This study aimed to investigate the clinical importance of NCS characteristics in patients with ALS. A total of 75 patients who underwent NCS were enrolled in this study. The frequency of ALS patients with prolonged motor DL was higher in the median than ulnar NCS. The multivariate analysis revealed that shorter diagnostic latency, prolonged MMDL, and higher disease progression rate were significantly associated with poor prognosis. When ALS patients were divided into two groups according to the cut-off value (4.2 ms) of the MMDL, the group with prolonged MMDL had lower ALS functional rating scale and frontal assessment battery scores, upper limbs subscore, and shorter survival time than the group with shorter MMDL. In conclusion, patients with ALS that have prolonged MMDL may have upper limb dysfunction and shorter survival. MMDL can be a useful prognostic marker for patients with ALS. Abbreviations: ADM = abductor digiti minimi; APB = abductor pollicis brevis; ALS = amyotrophic lateral sclerosis; ALSFRS-R = revised ALS Functional Rating Scale; CI = confidence interval; CMAP = compound muscle action potential; CTS = carpal tunnel syndrome; DL = distal latency; ΔFS = disease progression rate; FAB = frontal assessment battery; FVC = forced vital capacity; HR = hazard ratio; MCV = motor nerve conduction velocity; MMDL = median motor distal latency; MMSE = mini-mental state examination; NCS = nerve conduction study; PaCO2 = partial pressure of arterial carbon dioxide; SBMA = spinal and bulbar muscular atrophy; SCV = sensory nerve conduction velocity; SD = standard deviation; SMA = spinal muscular atrophy; SNAP = sensory nerve action potential; SOD1 = superoxide dismutase 1; UMDL = ulnar motor distal latency.
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Affiliation(s)
- Masayuki Sato
- Department of Neurology, Gunma University Graduate School of Medicine , Maebashi, Japan
| | - Takumi Nakamura
- Department of Neurology, Gunma University Graduate School of Medicine , Maebashi, Japan
| | - Kazuaki Nagashima
- Department of Neurology, Gunma University Graduate School of Medicine , Maebashi, Japan
| | - Yukio Fujita
- Department of Neurology, Gunma University Graduate School of Medicine , Maebashi, Japan
| | - Yoshio Ikeda
- Department of Neurology, Gunma University Graduate School of Medicine , Maebashi, Japan
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Barnes SL, Simon NG. Clinical and research applications of neuromuscular ultrasound in amyotrophic lateral sclerosis. Degener Neurol Neuromuscul Dis 2019; 9:89-102. [PMID: 31406480 PMCID: PMC6642653 DOI: 10.2147/dnnd.s215318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 06/14/2019] [Indexed: 12/20/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disorder characterized by dysfunction at multiple levels of the neuraxis. It remains a clinical diagnosis without a definitive diagnostic investigation. Electrodiagnostic testing provides supportive information and, along with imaging and biochemical markers, can help exclude mimicking conditions. Neuromuscular ultrasound has a valuable role in the diagnosis and monitoring of ALS and provides complementary information to clinical assessment and electrodiagnostic testing as well as insights into the underlying pathophysiology of this disease. This review highlights the evidence for ultrasound in the evaluation of bulbar, limb and respiratory musculature and peripheral nerves in ALS. Further research in this evolving area is required.
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Affiliation(s)
- Stephanie L Barnes
- Department of Neurology, Concord Repatriation General Hospital, Concord, NSW, Australia
- St Vincent’s Clinical School, School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia
| | - Neil G Simon
- St Vincent’s Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Schreiber S, Debska-Vielhaber G, Abdulla S, Machts J, Schreiber F, Kropf S, KÖrtvelyessy P, KÖrner S, Kollewe K, Petri S, Dengler R, Kunz WS, Nestor PJ, Vielhaber S. Peripheral nerve atrophy together with higher cerebrospinal fluid progranulin indicate axonal damage in amyotrophic lateral sclerosis. Muscle Nerve 2017; 57:273-278. [PMID: 28472860 DOI: 10.1002/mus.25682] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2017] [Indexed: 01/13/2023]
Abstract
INTRODUCTION We aimed to investigate whether sonographic peripheral cross-sectional nerve area (CSA) and progranulin (PGRN), a neuritic growth factor, are related to each other and whether they interact to predict clinical and paraclinical measures in amyotrophic lateral sclerosis (ALS). METHODS We included 55 ALS patients who had forearm median and ulnar nerve CSA, cerebrospinal fluid (CSF) PGRN, and serum PGRN measures available. CSF PGRN was normalized against the CSF / serum albumin ratio (Qalb ). Using age, sex, height, and weight adjusted general linear models, we examined CSA × CSF PGRN interaction effects on various measures. RESULTS There was a medium-effect size inverse relationship between CSA and CSF PGRN, but not between CSA and serum PGRN. Lower CSA values together with higher CSF PGRN levels were linked to smaller motor amplitudes. DISCUSSION In ALS, the constellation of peripheral nerve atrophy together with higher CSF PGRN levels indicates pronounced axonal damage. Muscle Nerve 57: 273-278, 2018.
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Affiliation(s)
- Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - Grazyna Debska-Vielhaber
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - Susanne Abdulla
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - Judith Machts
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - Frank Schreiber
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany.,Institute of Control Engineering, Technische Universität Braunschweig, Braunschweig, Germany
| | - Siegfried Kropf
- Institute of Biometry and Medical Informatics, Otto-von-Guericke University, Magdeburg, Germany
| | - Peter KÖrtvelyessy
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - Sonja KÖrner
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Katja Kollewe
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Reinhard Dengler
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Wolfram S Kunz
- Division of Neurochemistry, Department of Epileptology, University Bonn Medical Center, Bonn, Germany
| | - Peter J Nestor
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
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