Kreple Collin J, Gajagowni Saivaroon, Jockel-Balsaratti Jennifer, Bucelli Robert C, Miller Timothy M
Department of Neurology, Washington University in St. Louis School of Medicine, Saint Louis, Missouri, USA.
Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Muscle Nerve. 2023 Nov;68(5):771-775. doi: 10.1002/mus.27956. Epub 2023 Aug 11.
INTRODUCTION/AIMS: Analysis of biofluids, especially cerebrospinal fluid (CSF), is critically important for amyotrophic lateral sclerosis (ALS) research. Collection of CSF is typically performed by lumbar puncture (LP). Previous studies have demonstrated the safety of LPs in patients with other neurodegenerative diseases, such as Alzheimer's disease, although there are no published studies of the safety of LPs in patients with ALS. We performed a retrospective analysis of complications resulting from LPs.
This is a retrospective study of LPs performed between 2015 and 2021 on a total of 233 participants (healthy controls [n = 63], ALS [n = 154], and disease controls [n = 16]) as part of clinical research studies at the Washington University ALS Center. We used bivariate logistical analyses looking for associations between participant characteristics and adverse events (AEs), and likelihood ratio tests were used for significance testing.
We found an overall AE rate of 21.03%. AEs included headache, back pain, vasovagal syncope, and severe headache requiring epidural blood patch. Participants with ALS were not more likely to experience post-LP AEs compared to controls (odds ratio [OR] 0.61 [0.32-1.18]). Post-LP headaches were significantly less likely in participants with ALS (OR 0.36 [0.15-0.83]).
Our findings demonstrate that LP is a safe procedure for participants with ALS, with a similar or lower rate of AEs than in participants without ALS.
引言/目的：生物流体分析，尤其是脑脊液（CSF）分析，对于肌萎缩侧索硬化症（ALS）研究至关重要。脑脊液采集通常通过腰椎穿刺（LP）进行。先前的研究已证明腰椎穿刺在患有其他神经退行性疾病（如阿尔茨海默病）的患者中是安全的，尽管尚无关于腰椎穿刺在ALS患者中安全性的已发表研究。我们对腰椎穿刺引起并发症进行了回顾性分析。
这是一项对2015年至2021年间在华盛顿大学ALS中心作为临床研究一部分对总共233名参与者（健康对照者[n = 63]、ALS患者[n = 154]和疾病对照者[n = 16]）进行的腰椎穿刺的回顾性研究。我们使用双变量逻辑分析寻找参与者特征与不良事件（AE）之间的关联，并使用似然比检验进行显著性检验。
我们发现总体不良事件发生率为21.03%。不良事件包括头痛、背痛、血管迷走性晕厥以及需要硬膜外血贴治疗的严重头痛。与对照组相比，ALS患者发生腰椎穿刺后不良事件的可能性并不更高（比值比[OR] 0.61 [0.32 - 1.18]）。ALS患者发生腰椎穿刺后头痛的可能性显著更低（OR 0.36 [0.15 - 0.83]）。
我们的研究结果表明，腰椎穿刺对于ALS患者是一种安全的操作，不良事件发生率与非ALS参与者相似或更低。
