Fasciculation frequency at the biceps brachii and brachialis muscles is associated with amyotrophic lateral sclerosis disease burden and activity

Abstract

Introduction Fasciculations are most commonly seen in the biceps brachii muscle in amyotrophic lateral sclerosis (ALS). In this study we have explored the association between fasciculation frequency in a single location—biceps brachii and brachialis muscles (BB), and disease burden and activity. Methods Sonographic muscle studies were performed in 90 ALS patients, 47 of whom were seen in subsequent follow‐up. The association between fasciculations frequency at the BB and ALS Functional Rating Scale—Revised (ALSFRS‐R) and manual muscle testing (MMT) scores was determined. Results High fasciculation frequency at the BB, where detection rate was the highest, was associated with shorter disease duration, greater muscle thickness, higher MMT scores, and faster rate of decline in ALSFRS‐R initially, and MMT subsequently. Discussion High fasciculation frequency at the BB as determined by sonography, is associated with less impairment at time of examination, and a more active disease with a more rapid progression.

Fasciculation differences between ALS and non-ALS patients: an ultrasound study

“…Fasciculation was not only more common in ALS patients, but also associated with disease burden and activity. Avidan et al [ 10 ] reported that high fasciculation frequency at the biceps brachii and brachialis muscles, where detection rate was the highest under MUS, was associated with less impairment at time of examination, and a more active disease with a more rapid progression. This finding showed that fasciculation frequency might provide prognostic information.…”

“…The advantages of non-invasiveness and easy operation provide muscle ultrasonography (MUS) with unique advantages in the observation of fasciculations. Moreover, recent studies have shown that MUS has higher sensitivity in detecting fasciculation compared to EMG and qualitative physical assessment [ 7 – 10 ]. Currently, research on fasciculation under ultrasound has focused chiefly on scanning time, firing frequency, and distribution [ 11 – 14 ].…”

The Sensitivity of Quantitative Sonographic Assessment of Muscle Thickness for Amyotrophic Lateral Sclerosis Diagnosis

“…Patients and healthy subjects underwent sonographic muscle examination by a single examiner, who was aware of their diagnosis, although masked to any additional clinical data such as neurologic examination findings and ALS Functional Rating ScaledRevised score. However, as fasciculations are seen in most patients with ALS during MUS, 21 this would likely unmask the examiner even if unaware of the subject category initially. In addition, we have not studied patients with neuromuscular disorders mimicking ALS and therefore cannot determine MUS ability to differentiate between ALS and ALS mimics.…”

Bedeutung der Muskelsonographie in der Detektion von Faszikulationen bei der ALS

“…kortikaler Hyperexzitabilität [12,36]. Die Zahl der Faszikulationen eines Muskels steigt mit beginnendem Kraftverlust bis zu einem MRC-Wert von 3/5 zunächst leicht an, und fällt dann in höhergradig paretischen Muskeln rasch ab [12,37]. Automatisierte Analysen von Faszikulationen in Muskelsonographie-Aufnahmen werden zukünftig zusätzlich untersuchen, ob sich weitere sonomorphologische Parameter eignen, um Faszikulationen bei ALS und anderen Erkrankungen zu unterscheiden oder als Verlaufsparameter zu etablieren, befinden sich allerdings noch in der Entwicklung [38,39].…”