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Reassessing the Diagnostic Utility of the Split Hand Index in Amyotrophic Lateral Sclerosis Patients—The Divide by Zero Problem

We set out to assess the diagnostic utility of the split hand index (SHI) for amyotrophic lateral sclerosis (ALS) and also to see if and how it can be applied to severely atrophied muscles, a frequent finding in this setting. We enrolled 38 patients from our clinic, 19 diagnosed with ALS and 19 cont...

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Autores principales: Antonescu, Florian, Butnariu, Ioana, Adam, Marin, Antonescu-Ghelmez, Dana, Tuță, Sorin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9503317/
https://www.ncbi.nlm.nih.gov/pubmed/36135994
http://dx.doi.org/10.3390/neurolint14030059
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author Antonescu, Florian
Butnariu, Ioana
Adam, Marin
Antonescu-Ghelmez, Dana
Tuță, Sorin
author_facet Antonescu, Florian
Butnariu, Ioana
Adam, Marin
Antonescu-Ghelmez, Dana
Tuță, Sorin
author_sort Antonescu, Florian
collection PubMed
description We set out to assess the diagnostic utility of the split hand index (SHI) for amyotrophic lateral sclerosis (ALS) and also to see if and how it can be applied to severely atrophied muscles, a frequent finding in this setting. We enrolled 38 patients from our clinic, 19 diagnosed with ALS and 19 controls, matched for age and sex. The SHI was calculated, on both sides, for all the patients. We calculated a SHI of 0 when the abductor pollicis brevis muscle (ABD) or first dorsal interosseous muscle (FDI) compound muscle action potentials (CMAPs) were unobtainable, and we allotted a value of 0.1 mV to abductor digiti minimi muscle (ADM) CMAP, for mathematical purposes, when the value would have been 0. The means differences were large between groups, with a significant variance heterogeneity. We performed a ROC analysis and obtained an accuracy of 0.83 for a SHI of 7.2, p-value < 0.0001. In conclusion, we reaffirm the utility of the SHI in the diagnosis of ALS, especially in limb onset cases, and we think that it can be safely extended to severely atrophied muscles with absent or very low CMAP values, without endangering the sensitivity or specificity.
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spelling pubmed-95033172022-09-24 Reassessing the Diagnostic Utility of the Split Hand Index in Amyotrophic Lateral Sclerosis Patients—The Divide by Zero Problem Antonescu, Florian Butnariu, Ioana Adam, Marin Antonescu-Ghelmez, Dana Tuță, Sorin Neurol Int Article We set out to assess the diagnostic utility of the split hand index (SHI) for amyotrophic lateral sclerosis (ALS) and also to see if and how it can be applied to severely atrophied muscles, a frequent finding in this setting. We enrolled 38 patients from our clinic, 19 diagnosed with ALS and 19 controls, matched for age and sex. The SHI was calculated, on both sides, for all the patients. We calculated a SHI of 0 when the abductor pollicis brevis muscle (ABD) or first dorsal interosseous muscle (FDI) compound muscle action potentials (CMAPs) were unobtainable, and we allotted a value of 0.1 mV to abductor digiti minimi muscle (ADM) CMAP, for mathematical purposes, when the value would have been 0. The means differences were large between groups, with a significant variance heterogeneity. We performed a ROC analysis and obtained an accuracy of 0.83 for a SHI of 7.2, p-value < 0.0001. In conclusion, we reaffirm the utility of the SHI in the diagnosis of ALS, especially in limb onset cases, and we think that it can be safely extended to severely atrophied muscles with absent or very low CMAP values, without endangering the sensitivity or specificity. MDPI 2022-09-01 /pmc/articles/PMC9503317/ /pubmed/36135994 http://dx.doi.org/10.3390/neurolint14030059 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Antonescu, Florian
Butnariu, Ioana
Adam, Marin
Antonescu-Ghelmez, Dana
Tuță, Sorin
Reassessing the Diagnostic Utility of the Split Hand Index in Amyotrophic Lateral Sclerosis Patients—The Divide by Zero Problem
title Reassessing the Diagnostic Utility of the Split Hand Index in Amyotrophic Lateral Sclerosis Patients—The Divide by Zero Problem
title_full Reassessing the Diagnostic Utility of the Split Hand Index in Amyotrophic Lateral Sclerosis Patients—The Divide by Zero Problem
title_fullStr Reassessing the Diagnostic Utility of the Split Hand Index in Amyotrophic Lateral Sclerosis Patients—The Divide by Zero Problem
title_full_unstemmed Reassessing the Diagnostic Utility of the Split Hand Index in Amyotrophic Lateral Sclerosis Patients—The Divide by Zero Problem
title_short Reassessing the Diagnostic Utility of the Split Hand Index in Amyotrophic Lateral Sclerosis Patients—The Divide by Zero Problem
title_sort reassessing the diagnostic utility of the split hand index in amyotrophic lateral sclerosis patients—the divide by zero problem
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9503317/
https://www.ncbi.nlm.nih.gov/pubmed/36135994
http://dx.doi.org/10.3390/neurolint14030059
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