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Awaji ALS criteria allows earlier diagnosis

NEW YORK (Reuters Health) – The Awaji criteria might be more useful than the well-established revised El Escorial criteria (rEEC) for diagnosing amyotrophic lateral sclerosis (ALS), according to a new meta-analysis.

In a report online August 13 in Archives of Neurology, researchers say “the Awaji criteria have a significant clinical impact allowing earlier diagnosis and clinical trial entry in ALS.”

What the Awaji ALS criteria basically add to the rEEC is fasciculation potentials as evidence of acute denervation in the presence of chronic neurogenic changes on needle electromyography, Dr. Joao Costa, of the University of Lisbon in Portugal and colleagues note.

Their analysis included eight studies comparing diagnostic accuracy with the two sets of criteria in nearly 1,200 patients with suspected ALS.

Overall, application of the Awaji criteria led to a 23% increase in the proportion of patients classified as having probable or definite ALS. The diagnostic sensitivity for ALS was 81.1% with the Awaji criteria compared to 62.2% with the rEEC, yet there was no drop in specificity with the Awaji criteria.

The researchers stress that using the Awaji criteria instead of the rECC led to a 56% reduction in the number of patients who would fail to meet eligibility criteria to enter a clinical trial.

The diagnostic accuracy of the Awaji criteria was higher for bulbar- than limb-onset disease. According to Dr. Costa and colleagues, the diagnostic odds ratio “clearly supports the Awaji criteria, in particular in patients with bulbar-onset disease.”

“In patients with spinal-onset disease, in whom weak limb muscles usually present signs of ongoing denervation, the advantage of the Awaji criteria is less marked,” they add.

The researchers also note that a large European study that will further address the issue of accurate early diagnosis is in progress. “Meanwhile,” they say, “patients and physicians should benefit from using the Awaji algorithm added to the rEEC.”

The study did not receive commercial support and the authors have no relevant disclosures. They did not respond to a request for comment.


Arch Neurol 2012.