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However, the resulting body of literature shows opposing results, leaving considerable uncertainty on the clinical benefits of VN ultrasound in ALS.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Relevant studies were identified up to 04\/2024 and individual patient data (IPD) obtained from the respective authors were pooled with a so far unpublished cohort (from Munich). An IPD meta-analysis of 109 patients with probable or definite ALS (El Escorial criteria) and available VN cross-sectional area (CSA) was performed, with age, sex, ALS Functional Rating Scale-revised (ALSFRS-R), disease duration, and bulbar phenotype as independent variables.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Mean age was 65\u00a0years (\u00b1\u200912) and 47% of patients (\u00b1\u200912) had bulbar ALS. Mean ALSFRS-R was 38 (\u00b1\u20097), and mean duration was 18\u00a0months (\u00b1\u200918). VN atrophy was highly prevalent [left: 67% (\u00b1\u20095), mean CSA 1.6mm<jats:sup>2<\/jats:sup> (\u00b1\u20090.6); right: 78% (\u00b1\u200921), mean CSA 1.8 mm<jats:sup>2<\/jats:sup> (\u00b1\u20090.7)]. VN CSA correlated with disease duration (mean slope: left \u2212\u00a00.01; right \u2212\u00a00.01), but not with ALSFRS-R (mean slope: left 0.004; mean slope: right \u2212\u00a00.002). Test accuracy for phenotyping bulbar vs. non-bulbar ALS was poor (summary receiver operating characteristic area under the curve: left 0.496; right 0.572).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>VN atrophy in ALS is highly prevalent and correlates with disease duration, but not with ALSFRS-R. VN CSA is insufficient to differentiate bulbar from non-bulbar ALS phenotypes. Further studies are warranted to analyze the link between VN atrophy, autonomic impairment, and survival in ALS.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00415-024-12601-z","type":"journal-article","created":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T19:03:15Z","timestamp":1722452595000},"page":"6255-6263","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Diagnostic accuracy and confounders of vagus nerve ultrasound in amyotrophic lateral sclerosis\u2014a single-center case series and pooled individual patient data meta-analysis"],"prefix":"10.1007","volume":"271","author":[{"given":"Katharina J.","family":"M\u00fcller","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz L.","family":"Schmidbauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja","family":"Sch\u00f6necker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Kamm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johann O.","family":"Pelz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Korbinian","family":"Holzapfel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Papadopoulou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Bakola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Tsivgoulis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Naumann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Hermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe","family":"Walter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Dimitriadis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Reilich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8183-8133","authenticated-orcid":false,"given":"Florian","family":"Sch\u00f6berl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,31]]},"reference":[{"issue":"10360","key":"12601_CR1","doi-asserted-by":"publisher","first-page":"1363","DOI":"10.1016\/S0140-6736(22)01272-7","volume":"400","author":"EL Feldman","year":"2022","unstructured":"Feldman EL et al (2022) Amyotrophic lateral sclerosis. 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MLS received financial support by Deutsche Forschungsgemeinschaft (DFG, TRR 274). UW received grants from the German Federal Ministry of Education and Research (BMBF) and Merz Pharmaceuticals, speaker honoraria from Bristol-Myers Squibb, Canon Medical Systems, Daiichi-Sankyo, Merz Pharmaceuticals, and Pfizer Pharma, and compensation from Thieme as joint Editor-in-Chief of the European Journal of Ultrasound, all outside the submitted work. AH has received personal fees and non-financial support from Biogen and Desitin during the conduct of the study outside of the submitted work. Received funding from the Schilling Stiftung f\u00fcr medizinische Forschung im Stifterverband, VDI\/BMBF, target ALS foundation outside the submitted work. FS received financial support by Deutschen Gesellschaft f\u00fcr Muskelkranke (DGM) and honoraria for advisory boards of Alexion, Amylyx and Alnylam.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"Ethical approval for collecting data in the Munich cohort was obtained from the local ethics committee (protocol number 23\u20130833).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical standard"}}]}}