• Melina Pazian Martins, Fabrício Diniz de Lima, Tauana Bernardes Leoni, Martinez Alberto R M ARM Department of Neurology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil., Nubiato Crespo Agricio A Department of Ophthalmology and Otorhinolaryngology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil., Paulo André Teixeira Kimaid, Anamarli Nucci, Mamede de Carvalho, and Marcondes C França.
• Department of Neurology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil.
• J. Neurol. Neurosurg. Psychiatr. 2020 Jul 1; 91 (7): 730-732.

BackgroundBulbar involvement is a hallmark of amyotrophic lateral sclerosis (ALS), but surprisingly very few studies have addressed the frequency, pattern and clinical relevance of laryngeal involvement in the disease.MethodsTwenty-six patients with spinal-onset ALS underwent nasofibroscopy (NF), followed by laryngeal electromyography (LEMG). We also studied resting activity and motor unit potentials of the genioglossus and masseter muscles.ResultsTwenty-four patients presented neurogenic changes in at least one laryngeal muscle. There were fibrillation and/or fasciculation potentials associated with chronic neurogenic changes in the same muscle in 16 patients; of these, 9 had no alteration in the genioglossus. We found no patient with tongue neurogenic changes and normal LEMG. NF was abnormal in 14 patients; in the remaining 12, LEMG identified neurogenic changes in 11 of them.ConclusionLEMG is able to identify laryngeal denervation in patients with ALS, sometimes before clinical manifestations are noticed. This technique may be a useful diagnostic tool for selected patients with suspicion of ALS.© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

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