BACKGROUND/ AIM: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease affecting upper and lower motor neurons, causing progressive atrophy of muscles, hypertonia, and paralysis. This study aimed to evaluate the current evidence and effectiveness of ultrasound in investigating nerve cross-sectional area (CSA) of peripheral nerves, vagus and cervical roots in those with ALS compared with healthy controls and to pool the CSA measurements. METHODS: A systematic search was conducted on Cochrane, Clarivate Web of Science, PubMed, Scopus, and Embase for the mesh terms nerve, ultrasonography, and amyotrophic lateral sclerosis. A quality assessment was performed using the New-Ottawa scale. In addition, a double-arm meta-analysis using Review Manager 5 software version 5.4 was performed. RESULTS: From the seventeen studies included in this review, the overall mean difference showed that individuals with ALS had a significantly smaller CSA in comparison to healthy controls for median, ulnar, C6 root, and phrenic nerves. However, no significant difference in the CSA was found in radial, vagal, sural, and tibial nerves. DISCUSSION: This study confirmed results of some of the included studies regards the anatomic sites, where nerve atrophy in ALS could be detected to potentially support the diagnosis of ALS. However, we recommend further large, prospective studies to assess the diagnostic value of these anatomical sites for the diagnosis of ALS. CONCLUSIONS: Our findings confirmed specific anatomic sites to differentiate ALS patients from healthy controls through ultrasound. However, these findings cannot be used to confirm the ALS diagnosis, but rather assist in differentiating it from other diagnoses. TRIAL REGISTRATION: Retrospectively registered on July 30th 2024 in PROSPERO (PROSPERO (york.ac.uk)) with ID574702.

Department of Neurology RWTH Aachen University Pauwels Street 30 52074 Aachen Germany

Department of Neurology Wake Forest School of Medicine Winston Salem North Carolina USA

Department of Psychiatry and Psychotherapy 3 University of Ulm Ulm Germany

Department of Psychiatry School of Medicine and Health Sciences Carl von Ossietzky University Oldenburg Oldenburg Germany

Department of Public Health Theodor Bilharz Research Institute Giza Egypt

Faculty of medicine Alexandria University Alexandria Egypt

Faculty of Medicine Assiut University Assiut Egypt

Faculty of medicine Cairo University Cairo Egypt

Faculty of Medicine Mansoura University Mansoura Egypt

Faculty of Medicine Masaryk University Brno Czech Republic

Faculty of Medicine October 6 University Giza Egypt

Faculty of Medicine Suez Canal University Ismailia Egypt

Faculty of Pharmacy Clinical Department Alexandria University Alexandria Egypt

Faculty of pharmacy University Grenoble Alpes La tronche France

Microbiology Department Faculty of Science Tanta University Tanta Egypt

Neurology Department University of Greifswald Greifswald Germany

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