Neurological Sciences

, Volume 40, Issue 10, pp 2065–2071 | Cite as

Diaphragm ultrasonography in amyotrophic lateral sclerosis: a diagnostic tool to assess ventilatory dysfunction and disease severity

  • Ferdinando SartucciEmail author
  • Alessio Pelagatti
  • Michela Santin
  • Tommaso Bocci
  • Cristina Dolciotti
  • Paolo Bongioanni
Original Article



Respiratory failure represents an unavoidable step in patients with amyotrophic lateral sclerosis (ALS) and other motor neuron diseases (MND). The development of diaphragm ultrasonography (DUS) provides an alternative useful and risk-free tool to supply clinical, functional, and neurophysiological assessment of respiratory muscle weakness. Our aim was to evaluate if sonographic changes (thickness and echogenicity in the costal portion of the diaphragm, at rest and during respiratory movements) may be used in ALS patients to assess disease severity over time, to rule out any risk or discomfort due to traditional neurophysiological investigations.


Twenty ALS patients (mean age, 64.6 ± 10.5 years) were enrolled and data were compared with age-matched healthy volunteers; DUS data were correlated with respiratory function and disease severity scale. Examinations were performed using Telemed Echo-wave II or Esaote MyLabGamma devices in conventional B-Mode.


Mean resting thickness was reduced in all cases; changes in thickness during inspiration and expiration were also reduced (p < 0.0001) and lost in severe cases (n = 3). In bulbar-onset disease, respiratory scores were strictly correlated with the difference in diaphragm thickness between full inspiration—and expiration—as well as on the diaphragm thickness in expiration (p < 0.001).


DUS represents a simple, painless, and risk-free tool; moreover, it provides useful functional and structural insights to the understanding of diaphragm function and the degree of respiratory failure in ALS.


Neuromuscular ultrasonography (NMUS) Diaphragm assessment Respiratory function Amyotrophic lateral sclerosis (ALS) Motor neuron disease (MND) Prognosis 


Authors’ contribution

All the authors have contributed to the conception and design of the study, analysis, and interpretation of data and drafting of the manuscript.

Compliance with ethical standards

Ethical publication statement

We confirm that we have read the journal’s position on issues involved in ethical publication and affirm that this study is consistent with those guidelines.

Disclosure of conflicts of interest

The authors declare that they have no conflict of interest.

Supplementary material

10072_2019_3938_MOESM1_ESM.doc (41 kb)
ESM 1 (DOC 41 kb)


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Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Department of Clinical and Experimental Medicine, Neurology - Neurophysiopathology UnitPisa University Medical SchoolPisaItaly
  2. 2.Integrated Care Department of Medical SpecialtiesAzienda Ospedaliero-Universitaria PisanaPisaItaly
  3. 3.CNR Neuroscience InstitutePisaItaly
  4. 4.Acquired Severe Brain Injuries Department SectionCisanello University HospitalPisaItaly
  5. 5.Neurorehabilitation UnitUniversity of PisaPisaItaly
  6. 6.“Aldo Ravelli” Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health SciencesUniversity of Milan & ASST Santi Paolo e CarloMilanItaly

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