title: Awaji ALS criteria increase the diagnostic sensitivity in patients with bulbar onset.
abstract: OBJECTIVE
  To assess whether Awaji criteria improve the sensitivity of diagnosis for amyotrophic lateral sclerosis (ALS). In Awaji ALS criteria, fasciculation potentials are regarded as evidence of acute denervation in the presence of chronic neurogenic changes on needle electromyography.
  
  
  METHODS
  We reviewed clinical and neurophysiological data of 113 consecutive patients who were suspected as suffering ALS. The six muscles (trapezius, biceps, first dorsal interosseous, T10-paraspinalis, vastus lateralis, and tibialis anterior muscles) were examined by EMG, focusing on the presence of fasciculation potentials. The sensitivity of revised El Escorial (R-EEC) and Awaji criteria was compared.
  
  
  RESULTS
  Probable or definite ALS was diagnosed in 61% of the patients by R-EEC and 71% by Awaji criteria. By applying Awaji criteria; (1) 17 of the 44 patients categorized as possible ALS by R-EEC reached to probable/definite ALS, 11 of whom had bulbar onset, (2) in 48 patients with bulbar onset, the proportion of probable/definite ALS increased from 59% to 82%, (3) in 62 patients with limb onset, the proportion of probable/definite ALS was 61% (63% by R-EEC).
  
  
  CONCLUSIONS
  Awaji criteria improve the sensitivity of ALS diagnosis in patients with bulbar onset, but not in those with limb onset.
  
  
  CONCLUSIONS
  Accepting fasciculation potentials as evidence of acute denervation increases the diagnostic sensitivity of ALS, particularly in patients with bulbar onset, and contributes to early diagnosis.
authors.affiliation: Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan. y-noto@koto.kpu-m.ac.jp
authors.forename: Yu-ichi
authors.initials: Y
authors.lastname: Noto
authors.forename: Sonoko
authors.initials: S
authors.lastname: Misawa
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Kanai
authors.forename: Kazumoto
authors.initials: K
authors.lastname: Shibuya
authors.forename: Sagiri
authors.initials: S
authors.lastname: Isose
authors.forename: Saiko
authors.initials: S
authors.lastname: Nasu
authors.forename: Yukari
authors.initials: Y
authors.lastname: Sekiguchi
authors.forename: Yumi
authors.initials: Y
authors.lastname: Fujimaki
authors.forename: Masanori
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuwabara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000175:diagnosis* / Q000503:physiopathology*; D010244:Bulbar Palsy, Progressive / Q000175:diagnosis / Q000503:physiopathology; D042241:Early Diagnosis; D004576:Electromyography / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged