Ultrasound methods in the diagnosis, monitoring and prognosis of amyotrophic lateral sclerosis: muscle sonography

Bulgarian Medical Journal, 2025, 19(2), 30-43.

P. Antimov

Clinic of Neurology, UMHAT Aleksandrovska, Department of Neurology, Medical University ‒ Sofia

Abstract. Ultrasound techniques are increasingly being utilized in the diagnosis, monitoring, and prognosis of amyotrophic lateral sclerosis (ALS). The primary advantages of ultrasound diagnostics include high sensitivity in detecting fasciculation, identification of muscle atrophy, increased echogenicity, and altered echovariability. These characteristics complement and expand the capabilities of electromyographic examinations (EMG), enhancing diagnostic accuracy, particularly in the early stages of the disease. Ultrasound diagnostics have led to significant advancements in the approach to ALS by providing valuable insights into the structural and functional properties of muscles and peripheral nerves. Data from various studies highlight that ultrasound can identify fasciculation in anatomical regions that are difficult to assess using standard electrophysiological methods, such as the tongue and paraspinal muscles, thereby improving the sensitivity of the diagnostic process. Despite its advantages, ultrasound cannot fully replace electromyographic studies but rather serves as a complementary tool. A combined approach incorporating both ultrasound and electrophysiological assessment provides a more comprehensive evaluation of active denervation and structural muscle alterations, thereby increasing diagnostic precision. The application of ultrasound in clinical practice holds significant potential; however, further studies are necessary to standardize protocols and refine result interpretation. The integration of ultrasound diagnostics as a routine method may contribute to earlier disease detection, more precise monitoring of its progression, and ultimately, an improvement in therapeutic strategies and the quality of life of patients with ALS.

Key words: neuromuscular ultrasound, amyotrophic lateral sclerosis, diagnosis

Address for correspondence: P. Antimov, MD, Clinic of Neurology, UMHAT Aleksandrovska, 1 Sv. G. Sofiyski St., Bg – 1431, Sofia, e-mail: , ORCID: https://orcid.org/0000-0003-3843-3402