ABSTRACT
Objective: To compare the diagnostic sensitivity of muscles in different regions on electromyography (EMG) to optimize and the muscle selection of needle electromyography in amyotrophic lateral sclerosis (ALS). To compare the diagnostic performance of revised El Escorial criteria (rEEC) and Awaji criteria (AwC) in ALS. Methods: Totally 198 ALS patients were recruited from ALS Clinic of The First Affiliated Hospital of Xi'an Jiaotong University and diagnosed with rEEC and AwC diagnostic criteria. Needle EMG was detected in muscles of bulbar, cervical, thoracal, and lumbosacral regions. Results: The muscle sensitivity in ALS regions (with or without clinical involvement) was consistent with that in the regions without clinical involvement. The diagnostic sensitivity of muscles were presented as follows: tongue (54.7% vs. 39.2%), trapezius (44.2% vs. 30.2%), lower orbicularis oris (33.2% vs. 20.7%), sternocleidomastoid (20% vs. 13.2%) in bulbar region, the first dorsal interosseus (93.8% vs. 77.3%), abductor pollicis brevis (92.8% vs. 72.7%), biceps (82% vs. 50%), deltoid (82% vs. 45.4%) in cervical region, thoracic paraspinal muscle 10 (86.5% vs. 85.3%) and rectus abdominis (49.5% vs. 49.3%) in thoracal region, the tibialis anterior (74.6% vs. 46.3%), and gastrocnemius (53.4% vs. 19.7%) in lumbosacral region. The diagnostic rate at AwC standard (75.3%) was significantly higher than that at rEEG standard (24.2%) (McNemar test P<0.001). Conclusion: The muscles of clinical affected region should be detected first, followed by the non-affected region in clinically suspected ALS. The tongue in bulbar region, the first dorsal interosseus in cervical region, thoracic paraspinal muscle 10 in thoracal region, tibialis anterior in lumbosacral region are recommended to detect in EMG protocol. The AwC criteria are suggested in ALS clinical diagnosis.