Neue Überlegungen zur klinisch-neurophysiologischen Diagnostik der ALS. Die „Awaji-Kriterien”

Zusammenfassung

Im Dezember 2006 traf sich eine Expertengruppe aus EMG- und ALS-Spezialisten in Awaji Island, Japan, mit dem Ziel, neue Überlegungen zur Rolle der klinisch-neurophysiologischen Diagnostik bei der ALS anzustellen. Zunächst wurde der Nutzen der konventionellen Elektromyografie und der Elektroneurografie bestätigt. Ferner wurde empfohlen, dass bei der Frage, ob ein Muskel von der ALS betroffen ist, Denervierungszeichen im EMG gleichwertig zu entsprechenden klinischen Veränderungen beurteilt werden sollen. Weiter wurde empfohlen, dass Faszikulationspotenziale im klinischen Kontext der ALS in gleicher Weise wie positive Wellen und Fibrillationspotenziale als Zeichen der aktiven Denervierung gewertet werden sollten. Die besondere Bedeutung von sog. instabilen Potenzialen von motorischen Einheiten wurde herausgestellt. Zusammenfassend würden diese Überlegungen die Diagnosekategorie der „labor-unterstützten, wahrscheinlichen ALS” in den revidierten El-Escorial-Kriterien überflüssig machen. Bezüglich des Nachweises der Beteiligung des oberen Motoneurons war die Meinung, dass weitere Studien zur Bewertung neuer Varianten der transkraniellen Magnetstimulation wie z. B. der Triple-Stimulations-Technik notwendig sind.

Abstract

In December 2006 an expert group of EMG and ALS specialists met in Awaji Island, Japan, to reconsider the role of clinical neurophysiology in the diagnosis of ALS. First, the importance of conventional electromyography and electroneurography was confirmed. Furthermore, it was recommended that electromyographical signs of denervation should be regarded as being equivalent to clinical signs.It was also recommended that fasciculation potentials in the clinical setting of an ALS should be regarded as an indication of active denervation similarly to positive waves and fibrillation potentials. The special diagnostic impact of unstable motor unit potentials was stressed. In summary, these considerations would render the diagnostic category of “laboratory-supported probable ALS” superfluous. Concerning the involvement of the upper motoneuron, the experts’ opinion was that further studies to evaluate new variations of transcranial magnetic stimulation such as the triple-stimulation technique are necessary.

Schlüsselwörter

amyotrophe Lateralsklerose - El Escorial Kriterien - Elektromyografie - transkranielle Magnetstimulation

Key words

amyotrophic lateral sclerosis - El Escorial criteria - electromyography - transcranial magnetic stimulation

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