Awaji criteria are not always superior to the previous criteria: A meta-analysis

Introduction: Recently, some authors have claimed that the Awaji criteria (AC) are not always more sensitive than the revised El Escorial criteria (rEEC) in amyotrophic lateral sclerosis (ALS). Methods: A meta-analysis examined 2 prospective and 7 retrospective studies, which included 1,121 ALS patients, to compare AC and rEEC for early diagnosis of ALS. Results: AC led to an 11% greater likelihood of being classified into the categories "clinically definite" or "clinically probable", while if confined to the "clinically probable - laboratory supported (LS)" category, this effect was 40% higher with the rEEC (95% cnfidence interval, 3-82%; I2=98%). Specifically, AC downgraded 20% of the rEEC "clinically probable - LS" category to the AC "clinically possible". Conclusions: Despite overall superiority of AC, this meta-analysis shows that it is not always more sensitive than rEEC. These results are related to the requirement for 2 upper motor neuron signs in the AC "clinically probable" category.