Ultrasound Detection of Vagus Nerve Atrophy in Bulbar Amyotrophic Lateral Sclerosis

Holzapfel, Klaus; Naumann, Markus

doi:10.1111/jon.12761

Cited by 22 publications

(36 citation statements)

References 17 publications

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“…Hence, normal values of CSA in ALS patients point to a lack of significant cardioautonomic dysfunction. Whilst Grimm and colleagues also did not find sonographic differences of the VNs in ALS in a smaller study [39], a small difference in the VN CSA was recently observed in mainly bulbar affected ALS patients [40]. Of note, there was no difference between ALS patients with and without bulbar onset.…”

Section: Discussionmentioning

confidence: 91%

“…However, numerous recent studies that addressed autonomic (dys) function or imaging in ALS patients were carried out on patients with a shorter disease duration [31,33,40] (in subgroups [44]) or on patients that were less severely affected as indicated by a higher score on the ALS-FRS [12,33,40]. Thirdly, our study was monocentric and included ALS patients of central European origin.…”

Section: Discussionmentioning

confidence: 99%

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Multimodal assessment of autonomic dysfunction in amyotrophic lateral sclerosis

Weise

Menze

Metelmann

et al. 2021

Euro J of Neurology

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Background and purpose Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with predominant progressive degeneration of motor neurons and motor deficits, but non‐motor symptoms (NMS) such as cognitive and behavioural deficits are frequent and underestimated in current diagnostic pathways. Autonomic dysfunction has occasionally been described, although its frequency and relevance are unclear. The aim of this study was to investigate the role of the autonomic nervous system in ALS using a multimodal approach. Methods Thirty‐seven ALS patients and 40 healthy sex‐ and age‐matched controls were included. NMS were studied with the NMS assessment scale for Parkinson's disease and an autonomic subscale was calculated. Cardioautonomic innervation at rest and whilst standing was assessed by different parameters of heart rate variability. Morphological changes (cross‐sectional area) of the vagus and median nerves for control were measured with high‐resolution ultrasound. Results Non‐motor symptoms in general were more frequent in ALS patients and correlated inversely with the ALS Functional Rating Scale whereas the autonomic subscore of the NMS assessment scale for Parkinson's disease did not differ between the two groups and was not related to functional impairment. Cardioautonomic assessment solely revealed an increased heart rate at rest in ALS patients, whereas the other heart rate variability parameters did not differ from controls. Structural sonographic investigation of the vagus and median nerves was similar in both groups. Conclusions Using a multimodal approach evidence was found for a rather mild cardio‐sympathetic overactivity in ALS patients. Overall, autonomic dysfunction seems to be subtle and is not related to the functional state of ALS patients.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Multimodal assessment of autonomic dysfunction in amyotrophic lateral sclerosis

Weise

Menze

Metelmann

et al. 2021

Euro J of Neurology

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“…Atrophy of VN has been described previously in patients with exclusively bulbar ALS, evident either clinically or electrophysiologically. 29,30 In these studies, VN atrophy was attributed to the involvement of the nucleus ambiguous in the brainstem. The nucleus ambiguous hosts somatic motor neurons distributed to pharyngeal and laryngeal muscles that are responsible for the functions of swallowing and speech.…”

Section: Discussionmentioning

confidence: 99%

Autonomic dysfunction in amyotrophic lateral sclerosis: A neurophysiological and neurosonology study

Papadopoulou

Bakola

Papapostolou

et al. 2022

Journal of Neuroimaging

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Background and Purpose: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder affecting upper and lower motor neurons. Some ALS patients exhibit concomitant nonmotor signs, and thus ALS is considered a multisystem disorder. The aim of this study is to investigate autonomous nervous system involvement in ALS. Methods:We investigated 21 ALS patients and 28 age-matched controls. ALS patients were assessed for disease severity with the Revised-ALS Functional Rating Scale (ALSFSR) and for the presence of autonomic symptoms with the Composite Autonomic Symptom Score scale. Sympathetic nervous system was evaluated by sympathetic skin response (SSR) and parasympathetic nervous system by ultrasonography of vagus nerve (VN) at the level of the thyroid gland.Results: SSR latencies were shorter and SSR amplitudes were higher in controls compared to ALS patients. The cross-sectional area (CSA) of the VN was significantly smaller in ALS patients (mean CSA right/left: 1.73±0.62 mm 2 /1.47±0.53 mm 2 ) compared to controls (mean CSA right/left: 2.91±0.79 mm 2 /2.30±0.80 mm 2 ), right: p <. 001, left: p <. 001.There was a significant negative correlation between disease duration and CSA of left-VN (r = -0.493, p = .023). This correlation was attenuated between disease duration and CSA of right-VN (r = -0.419, p = .059). ALSFSR-R was positively correlated to CSA of right-VN (p = .006, r = 0.590). CSA of VN did not correlate with bulbar involvement. Conclusions:This study confirms the presence of autonomic dysfunction in ALS patients and provides evidence of VN atrophy that correlates with disease severity and duration and is independent of bulbar involvement. Degeneration of dorsal nucleus neurons of the VN is hypothesized.

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“…Regarding the left VN, the mean value ranged between 1.85 6 0.48 and 2.10 6 0.50 mm 2 at the level of CCA bifurcation 2,9,32 and between 1.80 6 0.40 and 2 6 0.30 mm 2 at the level of thyroid gland. 2,8,30,31 In addition, at the level of thyroid cartilage, the mean value 17,19 ranged between 1.12 6 0.52 and 5.50 6 1.60 mm 2 and between 1.50 6 0.63 and 2.40 6 0.70 mm 2 in some studies 7,33 that did not specify the exact site of measurement. The overall mean CSA of left VN was 2.03 mm 2 .…”

Section: Discussionmentioning

confidence: 99%

Sonographic Reference Values of Vagus Nerve: A Systematic Review and Meta-analysis

Abdelnaby

Elsayed

Mohamed

et al. 2021

Journal of Clinical Neurophysiology

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Purpose: To establish the first comprehensive and standardized set of vagus nerve (VN) sonographic reference values across all the published studies that can be used to standardize and guide clinical practice and research.Methods: This systematic review includes all possible available data from a total of 27 studies and 21 of them were included in the meta-analysis having a total of 864 participants. Results:The overall mean cross-sectional area ranged from 2.29 to 2.76 mm 2 for the right VN and from 1.83 to 2.23 mm 2 for the left VN with 95% confidence interval. Sonographic reference values of VN at common carotid artery bifurcation, thyroid gland, and cartilage as well as other anatomic landmarks were provided. Conclusions:The mean cross-sectional area of the right VN of 2.53 mm 2 and the left one of 2.03 mm 2 can be considered as sonographic reference values in healthy adults. This review provides these reference values to be considered in the further sonographic evaluation of VNs.

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Ultrasound Detection of Vagus Nerve Atrophy in Bulbar Amyotrophic Lateral Sclerosis

Cited by 22 publications

References 17 publications

Multimodal assessment of autonomic dysfunction in amyotrophic lateral sclerosis

Multimodal assessment of autonomic dysfunction in amyotrophic lateral sclerosis

Autonomic dysfunction in amyotrophic lateral sclerosis: A neurophysiological and neurosonology study

Sonographic Reference Values of Vagus Nerve: A Systematic Review and Meta-analysis

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