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Here, we aimed to find out whether PN atrophy is related to respiratory function and 12\u2010month survival. Moreover, we investigated the relevance of VN and spinal accessory nerve (AN) atrophy in ALS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This prospective observational monocentric study included 80 adult participants (40 ALS patients, 40 age\u2010 and sex\u2010matched controls). The cross\u2010sectional area (CSA) of bilateral cervical VN, AN, and PN was measured on high\u2010resolution ultrasonography. Clinical assessments included the Amyotrophic Lateral Sclerosis Functional Rating Scale\u2013Revised (ALSFRS\u2010R), the Non\u2010Motor Symptoms Questionnaire, and handheld spirometry of forced vital capacity (FVC). One\u2010year survival was documented.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The CSA of each nerve, VN, AN, and PN, was smaller in ALS patients compared to controls. VN atrophy was unrelated to nonmotor symptom scores. PN CSA correlated with the respiratory subscore of the ALSFRS\u2010R (Spearman test, <jats:italic>r<\/jats:italic>\u2009=\u20090.59, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), the supine FVC (<jats:italic>r<\/jats:italic>\u2009=\u20090.71, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), and the relative change of sitting\u2013supine FVC (<jats:italic>r<\/jats:italic>\u2009=\u2009\u22120.64, <jats:italic>p<\/jats:italic>\u2009=\u20090.001). Respiratory impairment was predicted by bilateral mean PN CSA (<jats:italic>p<\/jats:italic>\u2009=\u20090.046, optimum cutoff value of \u22640.37\u2009mm<jats:sup>2<\/jats:sup>, sensitivity\u2009=\u200992%, specificity\u2009=\u200956%) and by the sum of PN and AN CSA (<jats:italic>p<\/jats:italic>\u2009=\u20090.036). The combination of ALSFRS\u2010R score with PN and AN CSA measures predicted 1\u2010year survival with similar accuracy as the combination of ALSFRS\u2010R score and FVC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Ultrasonography detects degeneration of cranial nerve motor fibers. PN and AN calibers are tightly related to respiratory function and 1\u2010year survival in ALS.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.16127","type":"journal-article","created":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T13:29:55Z","timestamp":1699363795000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Ultrasonic detection of vagus, accessory, and phrenic nerve atrophy in amyotrophic lateral sclerosis: Relation to impairment and mortality"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6280-785X","authenticated-orcid":false,"given":"Uwe","family":"Walter","sequence":"first","affiliation":[{"name":"Department of Neurology Rostock University Medical Center  Rostock Germany"},{"name":"Deutsches Zentrum f\u00fcr Neurodegenerative Erkrankungen Rostock\/Greifswald  Rostock Germany"},{"name":"Center for Transdisciplinary Neurosciences Rostock Rostock University Medical 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Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"B\u00f6hmert","sequence":"additional","affiliation":[{"name":"Department of Neurology Rostock University Medical Center  Rostock Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1133-9216","authenticated-orcid":false,"given":"Alexander","family":"Storch","sequence":"additional","affiliation":[{"name":"Department of Neurology Rostock University Medical Center  Rostock Germany"},{"name":"Deutsches Zentrum f\u00fcr Neurodegenerative Erkrankungen Rostock\/Greifswald  Rostock Germany"},{"name":"Center for Transdisciplinary Neurosciences Rostock Rostock University Medical Center  Rostock Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Hermann","sequence":"additional","affiliation":[{"name":"Deutsches Zentrum f\u00fcr Neurodegenerative Erkrankungen Rostock\/Greifswald  Rostock Germany"},{"name":"Center for 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