Awaji criteria improves the diagnostic sensitivity in amyotrophic lateral sclerosis: A systematic review using individual patient data

Nimeshan Geevasinga; Clement T Loy; Parvathi Menon; Mamede de Carvalho; Michael Swash; Maarten Schrooten; Philip Van Damme; Malgorzata Gawel; Masahiro Sonoo; Mana Higashihara; Yu-Ichi Noto; Satoshi Kuwabara; Matthew C Kiernan; Petra Macaskill; Steve Vucic

doi:10.1016/j.clinph.2016.04.005

Awaji criteria improves the diagnostic sensitivity in amyotrophic lateral sclerosis: A systematic review using individual patient data

Clin Neurophysiol. 2016 Jul;127(7):2684-91. doi: 10.1016/j.clinph.2016.04.005. Epub 2016 Apr 16.

Authors

Affiliations

¹ Western Clinical School, University of Sydney, Sydney, Australia.
² School of Public Health, University of Sydney, Sydney, Australia.
³ Hospital of Santa Maria and Instituto de Medicina Molecular and Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
⁴ Hospital of Santa Maria and Instituto de Medicina Molecular and Faculty of Medicine, University of Lisbon, Lisbon, Portugal; The Royal London Hospital and Queen Mary School of Medicine, University of London, London, UK.
⁵ Neurology Department, University Hospitals Leuven, Leuven, Belgium.
⁶ Neurology Department, University Hospitals Leuven, Leuven, Belgium; KU Leuven - University of Leuven, Department of Neurosciences, VIB - Vesalius Research Center, Experimental Neurology - Laboratory of Neurobiology, Leuven, Belgium.
⁷ Department of Neurology, and Neurodegenerative Diseases Research Group, Medical University of Warsaw, Warsaw, Poland.
⁸ Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan.
⁹ Department of Neurology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
¹⁰ Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
¹¹ Brain and Mind Center, University of Sydney, Sydney, Australia.
¹² Western Clinical School, University of Sydney, Sydney, Australia. Electronic address: s.vucic@neura.edu.au.

PMID: 27212114
DOI: 10.1016/j.clinph.2016.04.005

Abstract

Objective: To determine the utility of the Awaji criteria in diagnosing amyotrophic lateral sclerosis (ALS) and to propose a novel modification so as to enhance sensitivity based on results of individual patient data (IPD).

Methods: Individual patient data were available from 8 studies comparing the diagnostic accuracy of Awaji and revised El Escorial (rEEC) criteria. The sensitivity of a novel updated Awaji criteria, incorporating a "probable-laboratory supported" category, was also tested.

Results: Individual patient data were available from 1086 patients, consisting of 881 ALS and 205 patients with disorders mimicking ALS. Summary sensitivities based on random effects logistic regression modelling disclosed a higher sensitivity of the Awaji criteria (0.70, 95% confidence interval [CI] 0.51-0.83) and updated Awaji criteria (0.73, 95% CI 0.56-0.85) when compared to rEEC (0.58, 95% CI 0.48-0.68). Paired analysis revealed higher sensitivities of Awaji criteria in 4 studies, and of updated Awaji criteria in 7 studies, when compared to rEEC.

Conclusion: Individual patient data analysis established a higher sensitivity of Awaji criteria when compared to rEEC. The updated Awaji criteria enhanced the diagnostic sensitivity in limb-onset ALS.

Significance: The updated Awaji criteria should be considered in clinical practice and future therapeutic trials.

Keywords: Amyotrophic lateral sclerosis; Awaji criteria; El Escorial criteria; Meta-analysis.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adult
Aged
Aged, 80 and over
Amyotrophic Lateral Sclerosis / diagnosis*
Case-Control Studies
Female
Humans
Male
Middle Aged
Neurologic Examination / methods*
Neurologic Examination / standards
Sensitivity and Specificity
Severity of Illness Index