Correlation Between Neurophysiological Indicators And Creatine Kinase And The Prognosis In Amyotrophic Lateral Sclerosis

Objective: To explore the relationship between neuro-electrophysiological indicators,creatine kinase(CK)and the prognosis of amyotrophic lateral sclerosis(ALS),and to explore preliminarily the predictive value of neuro-electrophysiological indicators combined with CK on the prognosis of ALS patients.Materials and Methods: ALS patients were recruited between April 2016 and June2022 from the outpatients and inpatients in the Department of Neurology,Sichuan Provincial People’s Hospital.The gender,age of onset,site of onset,duration and revised amyotrophic lateral sclerosis functional rating scale were recorded.Baseline serum CK and neuro-electrophysiological parameters of median nerve,ulnar nerve,common peroneal nerve,tibial nerve and superficial peroneal nerve were collected,including nerve conduction velocity,terminal motor latency,amplitude,negative wave area,duration,Fwave outflow rate and F-wave conduction velocity.Patients were followed up by telephone and the primary outcome event included death or tracheotomy.Binary Logistic regression was used to analyze the relationship between neuro-electrophysiological parameters and disease progression rate.Gender,site of onset,age of onset,and revised ALS functional score being used as covariates,Cox regression analysis and Kaplan-Meier survival curve were used for survival analysis.Receiver operating characteristic curve was used to analyze the predictive value of CK combined with neuro-electrophysiological parameters for ALS prognosis.Results: A total of 114 ALS patients were included in this study.In these ALS patients,the mean age of onset was 59.35±11.46 years old,76 male patients(66.7%).The median disease duration was 27 months,and 89 patients(78.1%)had limb onset.105 patients with median nerve and ulnar nerve electrophysiological data,96 patients with common peroneal nerve and tibial nerve electrophysiological data and 105 patients with baseline CK data were statistically analyzed.The results of binary Logistics regression analysis showed that the larger of compound muscle action potential(CMAP)amplitude and CMAP negative wave area of the median nerve,ulnar nerve and tibial nerve,the ALS disease progression is the slower.The larger of neurophysiological index of the median nerve and tibial nerve,the ALS disease progression is the slower(P<0.05).Multivariate Cox regression analysis showed that the smaller the CMAP amplitude,CMAP negative wave area,neurophysiological index of the median nerve and CMAP negative wave area of the ulnar nerve,have caused higher the risk of death(P<0.05).Univariate analysis showed that in ALS patients with lower limb onset,smaller the CMAP negative wave area of the common peroneal nerve had the shorter survival time than those in larger area(P=0.011).Multivariate analysis showed that serum CK was not significantly associated with prognosis in ALS patients.CMAP negative area combined with CK in median nerve is not more effective than single index in predicting the prognosis of patients.Conclusion: The CMAP negative wave area of the median nerve,the ulnar nerve and the common peroneal nerve,and SNAP negative wave area of the ulnar nerve may be used as an electrophysiological index to predict the prognosis of ALS.