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. 2018 Jul;25(7):907-e66.
doi: 10.1111/ene.13638. Epub 2018 Apr 16.

Assessment of bulbar function in amyotrophic lateral sclerosis: validation of a self-report scale (Center for Neurologic Study Bulbar Function Scale)

R A Smith  1 , E A Macklin  2   3 , K J Myers  1 , G L Pattee  4 , K L Goslin  5 , G D Meekins  6 , J R Green  7   8 , J M Shefner  9 , E P Pioro  10
Affiliations

Assessment of bulbar function in amyotrophic lateral sclerosis: validation of a self-report scale (Center for Neurologic Study Bulbar Function Scale)

R A Smith et al. Eur J Neurol. 2018 Jul.

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] Eur J Neurol. 2018 Oct;25(10):1303. doi: 10.1111/ene.13802. Eur J Neurol. 2018. PMID: 30192063 Free PMC article. No abstract available.

Abstract

Background and purpose: Impaired bulbar functions of speech and swallowing are among the most serious consequences of amyotrophic lateral sclerosis (ALS). Despite this, clinical trials in ALS have rarely emphasized bulbar function as an endpoint. The rater-administered Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) or various quality-of-life measures are commonly used to measure symptomatic benefit. Accordingly, we sought to evaluate the utility of measures specific to bulbar function in ALS.

Methods: We assessed bulbar functions in 120 patients with ALS, with clinicians first making direct observations of the degree of speech, swallowing and salivation impairment in these subjects. Clinical diagnosis of bulbar impairment was then compared with ALSFRS-R scores, speech rate, time to swallow liquids and solids, and scores obtained when patients completed visual analog scales (VASs) and the newly-developed 21-question self-administered Center for Neurologic Study Bulbar Function Scale (CNS-BFS).

Results: The CNS-BFS, ALSFRS-R, VAS and timed speech and swallowing were all concordant with clinician diagnosis. The self-report CNS-BFS and ALSFRS-R bulbar subscale best predicted clinician diagnosis with misclassification rates of 8% and 14% at the optimal cut-offs, respectively. In addition, the CNS-BFS speech and swallowing subscales outperformed both the bulbar component of the ALSFRS-R and speech and swallowing VASs when correlations were made between these scales and objective measures of timed reading and swallowing.

Conclusions: Based on these findings and its relative ease of administration, we conclude that the CNS-BFS is a useful metric for assessing bulbar function in patients with ALS.

Keywords: Amyotrophic Lateral Sclerosis Functional Rating Scale Revised (ALSFRS-R), bulbar function; Center for Neurologic Study Bulbar Function Scale; amyotrophic lateral sclerosis; patient-reported outcome.

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Figures

Figure 1
Figure 1
Center for Neurologic Study Bulbar Function Scale self‐report scale.
See this image and copyright information in PMC

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