Utility of repetitive nerve stimulation test for ALS diagnosis.
OBJECTIVE
Decremental responses in the repetitive nerve stimulation (RNS) test in amyotrophic lateral sclerosis (ALS) patients have been reported, although their possible diagnostic role has received little investigation. We investigated their diagnostic role in differentiation between ALS and cervical spondylotic amyotrophy (CSA), an important ALS mimic especially in Japan.


METHODS
Patients were prospectively enrolled and the diagnosis was confirmed by follow-up. RNS was performed on the abductor pollicis brevis (APB), upper trapezius (trapezius) and deltoid muscles.


RESULTS
Enrolled subjects consisted of 53 ALS and 37 CSA patients. Abnormal decremental responses (>5%) were observed in 32%, 51% and 75% of ALS patients and 3%, 0% and 20% of CSA patients for the APB, trapezius and deltoid muscles, respectively. The sensitivity for 23 ALS patients with upper-limb onset was 78% for the trapezius and 100% for the deltoid muscles.


CONCLUSIONS
An abnormal decremental response in the trapezius muscle was 100% specific to ALS in comparison with CSA: abnormal decrement in this muscle would strongly suggest ALS. No decrement in the deltoid muscle might exclude ALS in patients having symptoms with upper-limb onset.


CONCLUSIONS
RNS is useful in differentiation between ALS and CSA.
Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan.
Yuki
Y
Hatanaka
Department of Neurology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
Mana
M
Higashihara
Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan.
Takashi
T
Chiba
Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan.
Yosuke
Y
Miyaji
Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan.
Yasuomi
Y
Kawamura
Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo, Japan. Electronic address: sonoom@med.teikyo-u.ac.jp.
Masahiro
M
Sonoo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000175:diagnosis*; D057645:Deltoid Muscle / Q000294:innervation / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009134:Muscular Atrophy, Spinal / Q000175:diagnosis*; D064171:Superficial Back Muscles / Q000294:innervation / Q000503:physiopathology; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*
Amyotrophic lateral sclerosis; Cervical spondylotic amyotrophy; Deltoid; Repetitive nerve stimulation; Upper trapezius