Split-hand index for amyotrophic lateral sclerosis diagnosis: A frequentist and Bayesian meta-analysis

Lu, Wei-Zhen; Lin, Hui-An; Hou, Sen-Kuang; Lee, Cheng‐Fan; Bai, Chyi‐Huey; Lin, Sheng Feng

doi:10.1016/j.clinph.2022.08.020

Cited by 5 publications

(3 citation statements)

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“…Further studies gave similar results, but using heterogeneous cut-off values (from <5.2 to >10, Table 1 ) ( Kuwabara et al, 1999 ; Corcia et al, 2021 ). A recent meta-analysis of available studies identified a cut-off of < 7.4 in patients with a disease duration of 8–20 months ( Lu et al, 2022 ). SI resulted significantly reduced in more than 60% of patients with ALS who did not meet Awaji diagnostic criteria, suggesting a diagnostic role of SI in the earliest stage ( Schelhaas et al, 2003 ; Menon et al, 2013b ; Menon and Vucic, 2014 ).…”

Section: Split-hand Signmentioning

confidence: 99%

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Split phenomena in amyotrophic lateral sclerosis: Current evidences, pathogenetic hypotheses and diagnostic implications

2023

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Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease and has emerged among the disorders with the largest increasing incidence in Western countries. Although the diagnosis is based on clinical grounds, electromyography (EMG), and nerve conduction studies (NCS) play a crucial role to exclude other potential etiologies of lower motor neuron (LMN) dysfunction. Based on clinical grounds, a peculiar pattern of dissociated atrophy of the intrinsic hand and foot muscles, termed the “split-hand” (SH) and “split-leg” (SL) signs, has been described in a significant proportion of subjects with ALS, even at the early stages of the disease, when symptoms are focal. These signs are rare in neurological and non-neurological diseases other than ALS. In this review, we discussed current evidences concerning SH and SL signs, their pathogenetic hypotheses and neurophysiological findings. We also analyze whether SH and SL signs can be reliable markers in the differential diagnosis and in the prognosis of ALS.

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Section: Split-hand Signmentioning

confidence: 99%

“…Therefore, these indexes should be evaluated just in an extensive neurophysiological and clinical investigation ( Corcia et al, 2021 ). Overall, SH seems a valuable tool in the diagnosis of ALS, but larger and longitudinal studies are required to identify a proper age-related neurophysiologic index ( Lu et al, 2022 ).…”

Section: Split-hand Signmentioning

confidence: 99%

Split phenomena in amyotrophic lateral sclerosis: Current evidences, pathogenetic hypotheses and diagnostic implications

2023

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“…The SHI has exhibited good sensitivity and specificity in distinguishing ALS from ALS mimic disorders, albeit with variable cutoff values ranging from 5.2 to 10 ( 8 , 16 ). In a recent meta-analysis, a cutoff value of 7.4 was proposed for the SHI in patients with a disease duration of 8–20 months ( 17 ). Several neurophysiological indices based on CMAP amplitudes of different muscles have been proposed for assessing the SH sign, with the most commonly used being APB CMAP /ADM CMAP and FDI CMAP /ADM CMAP (with cutoff values of 0.6 and 0.9, respectively) ( 1 , 8 , 14 , 16 , 18 ).…”

Section: Introductionmentioning

confidence: 99%

Neurophysiological indices for split phenomena: correlation with age and sex and potential implications in amyotrophic lateral sclerosis

Zoccolella,

Milella,

Giugno

et al. 2024

Front. Neurol.

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BackgroundSplit phenomena (SP) are characterized by patterns of differential muscle wasting and atrophy, which are highly prevalent in amyotrophic lateral sclerosis (ALS) patients. Several neurophysiological indicators, including the split-hand index (SHI), split-leg index (SLI), and split-elbow index (SEI), have been proposed to assess SP. Nevertheless, their cutoff values and the impact of age and sex on these measures remain unclear.MethodsWe prospectively collected neurophysiological data from 300 healthy adult subjects. The following indices were measured from compound muscle action potentials (CMAPs): SHI [abductor pollicis brevis (APBcmap) x first dorsal interosseous (FDI)cmap/adductor digiti minimi (ADMcmap)], SEI (BICEPScmap/TRICEPScmap), SLI (extensor digit brevis (EDB)cmap/abductor Hallucis (AH)cmap), and the neurophysiological ratios APBcmap /ADMcmap and FDIcmap/ADMcmap. Multiple linear regression analysis was used to investigate the association between age, sex, CMAPs, and neurophysiological indicators.ResultsThe median SHI was 10.4, with a median APBcmap/ADMcmap ratio of 0.9 and a median FDIcmap/ADMcmap ratio of 1.2. The median SEI was 1.6 (IQR:1.1–2.4) and the median SLI was 0.7 (IQR:0.5–1.0). Negative associations were observed between age, most of the CMAPs, and all the neurophysiological indices, except for SLI. The male subjects exhibited significantly higher CMAP values for the first dorsal interosseous (FDI), biceps, and SHI compared to the female participants.ConclusionOur findings highlight the importance of age- and sex-adjusted normative data for SP indices, which could enhance their diagnostic accuracy and clinical utility in patients with ALS. The SL index appears to be the most reliable indicator, as it showed no significant association with age or sex.

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Contribution of neurophysiology to the diagnosis and monitoring of ALS

Vucic,

de Carvalho,

Bashford

et al. 2024

International Review of Neurobiology

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Split-hand index for amyotrophic lateral sclerosis diagnosis: A frequentist and Bayesian meta-analysis

Cited by 5 publications

References 60 publications

Split phenomena in amyotrophic lateral sclerosis: Current evidences, pathogenetic hypotheses and diagnostic implications

Split phenomena in amyotrophic lateral sclerosis: Current evidences, pathogenetic hypotheses and diagnostic implications

Neurophysiological indices for split phenomena: correlation with age and sex and potential implications in amyotrophic lateral sclerosis

Contribution of neurophysiology to the diagnosis and monitoring of ALS

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