G.P.291: Peripheral nerve and spinal root ultrasonography in amyotrophic lateral sclerosis

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High-resolution ultrasound has been used to evaluate several neuromuscular conditions. We can find some reports of muscle ultrasonography. Previous reports have documented muscle ultrasonography can clearly visualize fasciculation, one of characteristic features of amyotrophic lateral sclerosis (ALS), and can contribute to the diagnosis of ALS. But there are few reports of nerve ultrasonography in ALS. The aim of this study was to evaluate if ultrasonography can detect any characteristic findings of peripheral nerves and ventral spinal roots in ALS. Four patients with ALS (2 men and 2 women, mean age 67.0 years) underwent nerve ultrasonography to measure the cross-sectional area (CSA) of median and ulnar nerves at 4 levels, and the CSA and the diameter of C5, C6, C7 ventral spinal roots. They were also examined nerve conduction study (NCS). We investigated the correlations between findings of ultrasonography and physiological parameters. The CSA of median nerve was larger in the wrist than in the forearm, and the CSA of ulnar nerve was larger in the elbow than in the other levels. There was no difference between the CSA in the ALS patients and that in controls in reported. But the diameter and the CSA of ventral spinal roots were smaller in the ALS patients than those in the controls. On the other hand, the distal motor latency (DL) of median nerve was prolonged in all patients, the DL of ulnar nerve was prolonged in 2. The compound muscle action potential (CMAP) amplitude of median nerve was reduced in 2 patients. The latency of F wave and sensory NCS were normal in all patients. Nerve ultrasound demonstrates distal nerve and ventral spinal root atrophy in ALS and should be further explored as a disease biomarker.