Sensitivity of Awaji Criteria and Revised El Escorial Criteria in the Diagnosis of Amyotrophic Lateral Sclerosis (ALS) at First Visit in a Tunisian Cohort

Abstract

Background. Amyotrophic lateral sclerosis (ALS) is a fatal disease whose diagnosis and early management can improve survival. The most used diagnostic criteria are the revised El Escorial criteria (rEEC) and Awaji criteria (AC). The comparison of their sensitivities showed contradictory results. Our study aimed to compare the sensitivities of these two criteria in the diagnosis of definite ALS, at first visit, in a Tunisian hospital cohort. Materials and Methods. This was a retrospective study including 173 patients diagnosed with ALS at the Department of Neurology of the Razi Hospital between January 2003 and April 2018.After studying the clinical features of the disease in our study population,each patient was categorized according to the rEEC and AC based on data collected in his medical record during his first visit to our department. Then, we compared the sensitivities of these two criteria in the diagnosis of definite ALS. Results. Our Tunisian cohort was characterized by a slower disease progression. The sensitivity of the AC (69.4%) was significantly higher than that of the rEEC (40.5%) ( p < 0.001). When the clinical signs evolved for less than 6 months, the sensitivities were 61% for AC and 12% for rEEC ( p < 0.001). After 24 months of disease progression, the sensitivities were 78.2% for AC and 69.1% for rEEC ( p = 0.063). It was impossible to categorize seventeen patients by the two criteria. Conclusion. Our study demonstrated that patients in AC are more sensitive than rEEC in the early diagnosis of ALS in our Tunisian cohort. However, this superiority is gradually reduced during the evolution of the disease.

Machine learning classificatory as a tool in the diagnosis of amyotrophic lateral sclerosis using diffusion tensor imaging parameters collected with 1.5T MRI scanner: A case study

“…The study involved 47 patients with clinically definite, probable, or possible ALS according to [6]. The average duration of the disease, i.e., the time from the onset of the first paresis to the time of the study, was 31 months.…”

“…Until recently, the revised El Escorial criteria and the Awaji criteria remained the "gold standard" for the diagnosis of ALS [6]. In 2019, ALS experts established new Gold Coast criteria, which a large cross-sectional study confirmed to be more accurate and sensitive than their predecessors [7].…”

The diagnostic role of abductor pollicis brevis -first dorsal interosseous (APB-FDI) index in diagnosing Amyotrophic lateral sclerosis (ALS) and comparison of its diagnostic performance with other tests demonstrating split hand phenomenon among Bangladeshi population

“…1 (10) In this study total of 28(65.1) had definite ALS and presented with median (IQR), 6(5-10) months of illness. They were generally cervical phenotype, 31(72.1%), and they had ALS functional rating score, median (IQR) of 27 (25)(26)(27)(28)(29)(30)(31)(32). (Table 2).…”

“…The copyright holder for this preprint this version posted August 8, 2023. ; https://doi.org/10.1101/2023.08.04.23293649 doi: medRxiv preprint the life expectancy of ALS patients [29]. The most used diagnostic criteria are the revised El Escorial criteria (rEEC) and Awaji criteria (AC), has sensitivity ranges from 40-70%, which increases with the progression of the disease [30]. Electrophysiology may help diagnose early ALS, as some electrophysiologic findings may appear earlier.…”

Moderne Diagnosestellung der Amyotrophen Lateralsklerose – ein Update der Diagnosekriterien

“…Beim Vergleich der Awaji-Kriterien mit den revidierten El-Escorial-Kriterien zeigte eine Metaanalyse eine verbesserte Sensitivität der Awaji-Kriterien (81,1%) im Vergleich zu den revidierten El-Escorial-Kriterien (62,2%) bei vergleichbarer Spezifität 24 . Bezogen auf die Kategorie „sichere ALS“ zeigte eine Untersuchung in einer tunesischen ALS-Kohorte eine signifikant verbesserte Sensitivität der Awaji-Kriterien im Vergleich zu den revidierten El-Escorial-Kriterien für die Frühphase der Erkrankung (61 vs. 12,2%) und sowohl für den spinalen (70,2 vs. 39,8%) als auch bulbären (65,6 vs. 42,1%) Erkrankungsbeginn 25 . Der Unterschied war nicht mehr vorhanden, je länger die Erkrankung andauerte (mehr als 24 Monate: 78,2 vs. 69,1%).…”