Affiliations: [a] Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| [b] Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
Correspondence to: Lawrence Korngut, MD, MSc, FRCPC, Associate Professor (Neurology), Director, Calgary Neuromuscular Program, 480060, 4th Floor Administration, Clinical Neurosciences, South Health Campus, 4448 Front Street SE, Calgary, AB, T3M 1M4, Canada. Tel.: +1 403 956 2464; Fax: +1 403 956 2992; E-mail: [email protected].
Abstract: Background:Serological testing is routinely performed in the work up for a diagnosis of Amyotrophic Lateral Sclerosis (ALS) to exclude pathologies with similar clinical phenotypes. Objective:To determine the proportion of serological workup that changes the primary diagnosis and/or clinical management for patients presenting with signs of ALS. Methods:A retrospective chart review was conducted on patients from the Calgary Neuromuscular Intake Clinic in which the neurologist working diagnosis post-assessment is ALS. Charts from 2012 to 2016 with completed standard serological workup were reviewed. The proportion of abnormal results per investigation was determined and whether it resulted in a change in diagnosis and/or clinical management. Results:A total of 276 charts were reviewed and 85 met full inclusion criteria. Serum creatine kinase (35%), vitamin B12 (18%), complete blood count with differential (11%), and parathyroid hormone (10%) were the among the investigations that had a proportion of abnormal results greater than 5%. Only 6% of patients had an abnormal result that qualified for a change in their clinical management none of which changed the primary diagnosis of ALS. Conclusions:Standard serological investigations in the work-up for a patient with ALS may have low utility from a diagnostic and management perspective.
Keywords: Motor neuron disease, amyotrophic lateral sclerosis, serologic tests, diagnosis