Poređenje dijagnostičkih kriterijuma kod bolesnika sa amiotrofičnom lateralnom sklerozom – doprinos elektromiografskih nalaza

  • Aleksandra Dominović-Kovačević University Hospital Clinical Centre Banja Luka, Clinic of Neurology, Republic of Srpska, Bosnia and Herzegovina
  • Duško Račić University Hospital Clinical Centre Banja Luka, Clinic of Neurology, Republic of Srpska, Bosnia and Herzegovina
  • Sanja Grgić University Hospital Clinical Centre Banja Luka, Clinic of Neurology, Republic of Srpska, Bosnia and Herzegovina
  • Zoran Vukojević University Hospital Clinical Centre Banja Luka, Clinic of Neurology, Republic of Srpska, Bosnia and Herzegovina
  • Sladjan D Milanović University of Belgrade, Institute for Medical Research, Belgrade, Serbia
  • Tihomir V Ilić University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy, Clinic of Neurology, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP160115330D
Ključne reči: amiotrofijska lateralna skleroza;, elektrofiziologija;, elektromiografija;, testovi, prognostička vrednost;, osetljivost i specifičnost.

Sažetak


Uvod/Cilj. Dijagnoza amiotrofične lateralne skleroze (LS) zasniva se na kombinaciji kliničkih znakova i elektro­fizioloških korelata patološkog procesa koji se odvija u osnovi. Novi elektrofiziološki kriterijumi, Awaji-Shima (AS), dodatno kvalifikuju kompleksne fascikulacije i neurogeno izmenjene potencijale motornih jedinica kao znakove aktivnih lezija perifernog motornog neurona, nasuprot ranije važećim revidiranim El Escorial kriterijumima (rEE). Cilj ovog istraživanja bio je da se utvrdi klinički značaj i prednosti primene AS kriterijuma, kod obolelih od ALS. Metode. 30 bolesnika (59,2 ± 10,9 godina, od kojih 57%  sa spinalnom formom bolesti) sa klinički suspektnom ALS, praćeno je od vremena postavljanja dijagnoze do postizanja kategorije definitivne dijagnoze ili smrtnog ishoda. Kod bolesnika su obavljane klinička evaluacija i elektromiografski (EMG) pregledi u tromesečnim intervalima. Rezultati. Primjenom AS kriterijuma, nakon 6 meseci praćenja, kategorija verovatne ili pouzdane dijagnoze postignuta je kod svih bolesnika sa ALS, izuzev jednog (96,6%), nasuprot rEE kriterijuma (33.3%). EMG nalazi bili su pozitivni u ≥ 2 telesna regiona kod 80% bolesnika primenom AS, odnosno 67% primenom rEE. Kompleksne fascikulacije zabeležene su posebno učestalo u malim mišićima stopala (37–40%). Zaključak. Primenom AS kriterijuma kategorija vjerovatne ili pouzdane dijagnoze ALS postiže se za 2,7 meseca ranije, u poređenju sa rEE, na šta posebno utiče veća učestalost pozitivnih EMG nalaza. Ranije utvrđivanje dijagnoze donosi perspektivu veće zastupljenosti obolelih u farmakoterapijskim studijama sa novim terapeutskim agensima.

Reference

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Objavljeno
2020/12/01
Broj časopisa
Vol. 75 Br. 5 (2018): Vojnosanit Pregl 2018; May Vol. 75 (No. 5): p. 435–540.
Rubrika
Originalni članak