Diaphragmatic CMAP amplitude from phrenic nerve stimulation predicts functional decline in ALS
Objective To evaluate phrenic nerve motor amplitude (PhrenicAmp) as an independent predictor of functional decline in amyotrophic lateral sclerosis (ALS). We also assessed both PhrenicAmp and forced vital capacity (FVC) as predictors of functional loss in patients with bulbar dysfunction. Methods We...
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| Veröffentlicht in: | Journal of neurology 2020-07, Vol.267 (7), p.2123-2129 |
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| creator | Miranda, Bruno Gromicho, Marta Pereira, Mariana Pinto, Susana Swash, Michael de Carvalho, Mamede |
| description | Objective
To evaluate phrenic nerve motor amplitude (PhrenicAmp) as an independent predictor of functional decline in amyotrophic lateral sclerosis (ALS). We also assessed both PhrenicAmp and forced vital capacity (FVC) as predictors of functional loss in patients with bulbar dysfunction.
Methods
We included consecutive ALS patients with PhrenicAmp and FVC at baseline. Participants were evaluated with the revised ALS Functional Rating Scale (ALSFRS-R) at inclusion and at, at least, one subsequent follow-up visit. The outcome measure of functional decline was the percentage reduction in ALSFRS-R from baseline. Bulbar dysfunction was defined by the presence of any relevant symptom on the ALSFRS-R bulbar sub-score. Correlations and mixed-effects regressions were used to study the relationship between functional decline and both PhrenicAmp and FVC baseline evaluations.
Results
A total of 249 ALS patients were included; 64.2% of these had bulbar dysfunction. At inclusion, significant correlations were found between PhrenicAmp and FVC (
p
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| doi_str_mv | 10.1007/s00415-020-09818-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmed_primary_32253508</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2387256465</sourcerecordid><originalsourceid>FETCH-LOGICAL-c441t-274b1cc9624007302c13d58a2a0034818aa215e1765da74b58fe708e7786e0483</originalsourceid><addsrcrecordid>eNqNkU-L1EAQxRtR3HH1C3iQBi_CEq3-l_Qch-iqMKKgXg09ncraS9KJ3YnifnprNusKHsRTN1W_V9R7xdhjAc8FQPUiA2hhCpBQwNYKW1zdYRuhlSyENtu7bANKQ2GU0SfsQc6XAGCpcZ-dKCmpDHbDvrwMbvqa3MXg5uB5_W73gbth6sO8tMi7NA6c2hipFzF9R57nMCw9wWPkU8I2-Dnzbon-WHE9b9H3ISIPke_2Hx-ye53rMz66eU_Z5_NXn-o3xf7967f1bl94rcVcyEofhPfbUmoypkB6oVpjnXRAHsiac1IYFFVpWkessR1WYLGqbImgrTplz9a5Uxq_LZjnZgjZY9-7iOOSG6lsJU2pS0Po07_Qy3FJtDpRWlRWKm2OA-VK-TTmnLBrphQGl342Appj-s2afkPpN9fpN1ckenIzejkM2N5KfsdNgF2BH3gYu-wDRo-3GN3HSK1KK-kHog7zdcz1uMSZpGf_LyVarXQmIl5g-mPyH_v_As-lrzI</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2417823458</pqid></control><display><type>article</type><title>Diaphragmatic CMAP amplitude from phrenic nerve stimulation predicts functional decline in ALS</title><source>MEDLINE</source><source>SpringerNature Journals</source><source>Web of Science - Science Citation Index Expanded - 2020<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /></source><creator>Miranda, Bruno ; Gromicho, Marta ; Pereira, Mariana ; Pinto, Susana ; Swash, Michael ; de Carvalho, Mamede</creator><creatorcontrib>Miranda, Bruno ; Gromicho, Marta ; Pereira, Mariana ; Pinto, Susana ; Swash, Michael ; de Carvalho, Mamede</creatorcontrib><description>Objective
To evaluate phrenic nerve motor amplitude (PhrenicAmp) as an independent predictor of functional decline in amyotrophic lateral sclerosis (ALS). We also assessed both PhrenicAmp and forced vital capacity (FVC) as predictors of functional loss in patients with bulbar dysfunction.
Methods
We included consecutive ALS patients with PhrenicAmp and FVC at baseline. Participants were evaluated with the revised ALS Functional Rating Scale (ALSFRS-R) at inclusion and at, at least, one subsequent follow-up visit. The outcome measure of functional decline was the percentage reduction in ALSFRS-R from baseline. Bulbar dysfunction was defined by the presence of any relevant symptom on the ALSFRS-R bulbar sub-score. Correlations and mixed-effects regressions were used to study the relationship between functional decline and both PhrenicAmp and FVC baseline evaluations.
Results
A total of 249 ALS patients were included; 64.2% of these had bulbar dysfunction. At inclusion, significant correlations were found between PhrenicAmp and FVC (
p
< 0.001), as well as between each respiratory measure and ALSFRS-R (all
p
< 0.001). The functional decline at first (median 3 months) and second (median 6 months) follow-up visits was significantly correlated with baseline values of both respiratory evaluations (all
p
< 0.01) in the entire ALS population, but only with baseline PhrenicAmp (all
p
< 0.05) in bulbar dysfunction cases. Regression analysis revealed that PhrenicAmp (all
p
< 0.05), but not FVC, was a significant independent predictor of functional decline in ALS patients and in those with bulbar dysfunction.
Conclusion
Baseline PhrenicAmp is an independent predictor of functional decline in ALS, whether or not bulbar dysfunction is present.</description><identifier>ISSN: 0340-5354</identifier><identifier>EISSN: 1432-1459</identifier><identifier>DOI: 10.1007/s00415-020-09818-z</identifier><identifier>PMID: 32253508</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Action Potentials - physiology ; Aged ; Amyotrophic lateral sclerosis ; Amyotrophic Lateral Sclerosis - complications ; Amyotrophic Lateral Sclerosis - diagnosis ; Amyotrophic Lateral Sclerosis - physiopathology ; Clinical Neurology ; Deglutition Disorders - etiology ; Deglutition Disorders - physiopathology ; Diaphragm - physiopathology ; Disease Progression ; Electric Stimulation ; Female ; Follow-Up Studies ; Humans ; Life Sciences & Biomedicine ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Neurology ; Neuroradiology ; Neurosciences ; Neurosciences & Neurology ; Original Communication ; Phrenic nerve ; Phrenic Nerve - physiology ; Salivary Gland Diseases - etiology ; Salivary Gland Diseases - physiopathology ; Science & Technology ; Speech Disorders - etiology ; Speech Disorders - physiopathology ; Vital Capacity - physiology</subject><ispartof>Journal of neurology, 2020-07, Vol.267 (7), p.2123-2129</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020</rights><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>6</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000524368200001</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c441t-274b1cc9624007302c13d58a2a0034818aa215e1765da74b58fe708e7786e0483</citedby><cites>FETCH-LOGICAL-c441t-274b1cc9624007302c13d58a2a0034818aa215e1765da74b58fe708e7786e0483</cites><orcidid>0000-0002-1574-6476 ; 0000-0002-0727-5897 ; 0000-0003-2111-4579 ; 0000-0002-8717-8914 ; 0000-0001-7556-0158 ; 0000-0003-4660-6051</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00415-020-09818-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00415-020-09818-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27929,27930,28253,41493,42562,51324</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32253508$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Miranda, Bruno</creatorcontrib><creatorcontrib>Gromicho, Marta</creatorcontrib><creatorcontrib>Pereira, Mariana</creatorcontrib><creatorcontrib>Pinto, Susana</creatorcontrib><creatorcontrib>Swash, Michael</creatorcontrib><creatorcontrib>de Carvalho, Mamede</creatorcontrib><title>Diaphragmatic CMAP amplitude from phrenic nerve stimulation predicts functional decline in ALS</title><title>Journal of neurology</title><addtitle>J Neurol</addtitle><addtitle>J NEUROL</addtitle><addtitle>J Neurol</addtitle><description>Objective
To evaluate phrenic nerve motor amplitude (PhrenicAmp) as an independent predictor of functional decline in amyotrophic lateral sclerosis (ALS). We also assessed both PhrenicAmp and forced vital capacity (FVC) as predictors of functional loss in patients with bulbar dysfunction.
Methods
We included consecutive ALS patients with PhrenicAmp and FVC at baseline. Participants were evaluated with the revised ALS Functional Rating Scale (ALSFRS-R) at inclusion and at, at least, one subsequent follow-up visit. The outcome measure of functional decline was the percentage reduction in ALSFRS-R from baseline. Bulbar dysfunction was defined by the presence of any relevant symptom on the ALSFRS-R bulbar sub-score. Correlations and mixed-effects regressions were used to study the relationship between functional decline and both PhrenicAmp and FVC baseline evaluations.
Results
A total of 249 ALS patients were included; 64.2% of these had bulbar dysfunction. At inclusion, significant correlations were found between PhrenicAmp and FVC (
p
< 0.001), as well as between each respiratory measure and ALSFRS-R (all
p
< 0.001). The functional decline at first (median 3 months) and second (median 6 months) follow-up visits was significantly correlated with baseline values of both respiratory evaluations (all
p
< 0.01) in the entire ALS population, but only with baseline PhrenicAmp (all
p
< 0.05) in bulbar dysfunction cases. Regression analysis revealed that PhrenicAmp (all
p
< 0.05), but not FVC, was a significant independent predictor of functional decline in ALS patients and in those with bulbar dysfunction.
Conclusion
Baseline PhrenicAmp is an independent predictor of functional decline in ALS, whether or not bulbar dysfunction is present.</description><subject>Action Potentials - physiology</subject><subject>Aged</subject><subject>Amyotrophic lateral sclerosis</subject><subject>Amyotrophic Lateral Sclerosis - complications</subject><subject>Amyotrophic Lateral Sclerosis - diagnosis</subject><subject>Amyotrophic Lateral Sclerosis - physiopathology</subject><subject>Clinical Neurology</subject><subject>Deglutition Disorders - etiology</subject><subject>Deglutition Disorders - physiopathology</subject><subject>Diaphragm - physiopathology</subject><subject>Disease Progression</subject><subject>Electric Stimulation</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Life Sciences & Biomedicine</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neurology</subject><subject>Neuroradiology</subject><subject>Neurosciences</subject><subject>Neurosciences & Neurology</subject><subject>Original Communication</subject><subject>Phrenic nerve</subject><subject>Phrenic Nerve - physiology</subject><subject>Salivary Gland Diseases - etiology</subject><subject>Salivary Gland Diseases - physiopathology</subject><subject>Science & Technology</subject><subject>Speech Disorders - etiology</subject><subject>Speech Disorders - physiopathology</subject><subject>Vital Capacity - physiology</subject><issn>0340-5354</issn><issn>1432-1459</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkU-L1EAQxRtR3HH1C3iQBi_CEq3-l_Qch-iqMKKgXg09ncraS9KJ3YnifnprNusKHsRTN1W_V9R7xdhjAc8FQPUiA2hhCpBQwNYKW1zdYRuhlSyENtu7bANKQ2GU0SfsQc6XAGCpcZ-dKCmpDHbDvrwMbvqa3MXg5uB5_W73gbth6sO8tMi7NA6c2hipFzF9R57nMCw9wWPkU8I2-Dnzbon-WHE9b9H3ISIPke_2Hx-ye53rMz66eU_Z5_NXn-o3xf7967f1bl94rcVcyEofhPfbUmoypkB6oVpjnXRAHsiac1IYFFVpWkessR1WYLGqbImgrTplz9a5Uxq_LZjnZgjZY9-7iOOSG6lsJU2pS0Po07_Qy3FJtDpRWlRWKm2OA-VK-TTmnLBrphQGl342Appj-s2afkPpN9fpN1ckenIzejkM2N5KfsdNgF2BH3gYu-wDRo-3GN3HSK1KK-kHog7zdcz1uMSZpGf_LyVarXQmIl5g-mPyH_v_As-lrzI</recordid><startdate>20200701</startdate><enddate>20200701</enddate><creator>Miranda, Bruno</creator><creator>Gromicho, Marta</creator><creator>Pereira, Mariana</creator><creator>Pinto, Susana</creator><creator>Swash, Michael</creator><creator>de Carvalho, Mamede</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature</general><general>Springer Nature B.V</general><scope>AOWDO</scope><scope>BLEPL</scope><scope>DTL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1574-6476</orcidid><orcidid>https://orcid.org/0000-0002-0727-5897</orcidid><orcidid>https://orcid.org/0000-0003-2111-4579</orcidid><orcidid>https://orcid.org/0000-0002-8717-8914</orcidid><orcidid>https://orcid.org/0000-0001-7556-0158</orcidid><orcidid>https://orcid.org/0000-0003-4660-6051</orcidid></search><sort><creationdate>20200701</creationdate><title>Diaphragmatic CMAP amplitude from phrenic nerve stimulation predicts functional decline in ALS</title><author>Miranda, Bruno ; Gromicho, Marta ; Pereira, Mariana ; Pinto, Susana ; Swash, Michael ; de Carvalho, Mamede</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c441t-274b1cc9624007302c13d58a2a0034818aa215e1765da74b58fe708e7786e0483</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Action Potentials - physiology</topic><topic>Aged</topic><topic>Amyotrophic lateral sclerosis</topic><topic>Amyotrophic Lateral Sclerosis - complications</topic><topic>Amyotrophic Lateral Sclerosis - diagnosis</topic><topic>Amyotrophic Lateral Sclerosis - physiopathology</topic><topic>Clinical Neurology</topic><topic>Deglutition Disorders - etiology</topic><topic>Deglutition Disorders - physiopathology</topic><topic>Diaphragm - physiopathology</topic><topic>Disease Progression</topic><topic>Electric Stimulation</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Life Sciences & Biomedicine</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neurology</topic><topic>Neuroradiology</topic><topic>Neurosciences</topic><topic>Neurosciences & Neurology</topic><topic>Original Communication</topic><topic>Phrenic nerve</topic><topic>Phrenic Nerve - physiology</topic><topic>Salivary Gland Diseases - etiology</topic><topic>Salivary Gland Diseases - physiopathology</topic><topic>Science & Technology</topic><topic>Speech Disorders - etiology</topic><topic>Speech Disorders - physiopathology</topic><topic>Vital Capacity - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Miranda, Bruno</creatorcontrib><creatorcontrib>Gromicho, Marta</creatorcontrib><creatorcontrib>Pereira, Mariana</creatorcontrib><creatorcontrib>Pinto, Susana</creatorcontrib><creatorcontrib>Swash, Michael</creatorcontrib><creatorcontrib>de Carvalho, Mamede</creatorcontrib><collection>Web of Science - Science Citation Index Expanded - 2020</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Miranda, Bruno</au><au>Gromicho, Marta</au><au>Pereira, Mariana</au><au>Pinto, Susana</au><au>Swash, Michael</au><au>de Carvalho, Mamede</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diaphragmatic CMAP amplitude from phrenic nerve stimulation predicts functional decline in ALS</atitle><jtitle>Journal of neurology</jtitle><stitle>J Neurol</stitle><stitle>J NEUROL</stitle><addtitle>J Neurol</addtitle><date>2020-07-01</date><risdate>2020</risdate><volume>267</volume><issue>7</issue><spage>2123</spage><epage>2129</epage><pages>2123-2129</pages><issn>0340-5354</issn><eissn>1432-1459</eissn><abstract>Objective
To evaluate phrenic nerve motor amplitude (PhrenicAmp) as an independent predictor of functional decline in amyotrophic lateral sclerosis (ALS). We also assessed both PhrenicAmp and forced vital capacity (FVC) as predictors of functional loss in patients with bulbar dysfunction.
Methods
We included consecutive ALS patients with PhrenicAmp and FVC at baseline. Participants were evaluated with the revised ALS Functional Rating Scale (ALSFRS-R) at inclusion and at, at least, one subsequent follow-up visit. The outcome measure of functional decline was the percentage reduction in ALSFRS-R from baseline. Bulbar dysfunction was defined by the presence of any relevant symptom on the ALSFRS-R bulbar sub-score. Correlations and mixed-effects regressions were used to study the relationship between functional decline and both PhrenicAmp and FVC baseline evaluations.
Results
A total of 249 ALS patients were included; 64.2% of these had bulbar dysfunction. At inclusion, significant correlations were found between PhrenicAmp and FVC (
p
< 0.001), as well as between each respiratory measure and ALSFRS-R (all
p
< 0.001). The functional decline at first (median 3 months) and second (median 6 months) follow-up visits was significantly correlated with baseline values of both respiratory evaluations (all
p
< 0.01) in the entire ALS population, but only with baseline PhrenicAmp (all
p
< 0.05) in bulbar dysfunction cases. Regression analysis revealed that PhrenicAmp (all
p
< 0.05), but not FVC, was a significant independent predictor of functional decline in ALS patients and in those with bulbar dysfunction.
Conclusion
Baseline PhrenicAmp is an independent predictor of functional decline in ALS, whether or not bulbar dysfunction is present.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>32253508</pmid><doi>10.1007/s00415-020-09818-z</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-1574-6476</orcidid><orcidid>https://orcid.org/0000-0002-0727-5897</orcidid><orcidid>https://orcid.org/0000-0003-2111-4579</orcidid><orcidid>https://orcid.org/0000-0002-8717-8914</orcidid><orcidid>https://orcid.org/0000-0001-7556-0158</orcidid><orcidid>https://orcid.org/0000-0003-4660-6051</orcidid></addata></record> |
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| source | MEDLINE; SpringerNature Journals; Web of Science - Science Citation Index Expanded - 2020<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /> |
| subjects | Action Potentials - physiology Aged Amyotrophic lateral sclerosis Amyotrophic Lateral Sclerosis - complications Amyotrophic Lateral Sclerosis - diagnosis Amyotrophic Lateral Sclerosis - physiopathology Clinical Neurology Deglutition Disorders - etiology Deglutition Disorders - physiopathology Diaphragm - physiopathology Disease Progression Electric Stimulation Female Follow-Up Studies Humans Life Sciences & Biomedicine Male Medicine Medicine & Public Health Middle Aged Neurology Neuroradiology Neurosciences Neurosciences & Neurology Original Communication Phrenic nerve Phrenic Nerve - physiology Salivary Gland Diseases - etiology Salivary Gland Diseases - physiopathology Science & Technology Speech Disorders - etiology Speech Disorders - physiopathology Vital Capacity - physiology |
| title | Diaphragmatic CMAP amplitude from phrenic nerve stimulation predicts functional decline in ALS |
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