# Introducing a revised version of the Kumamoto scale as an easy-to-use clinical tool for monitoring multisystemic changes in hereditary transthyretin amyloidosis

## TL;DR

This paper introduces an updated version of the Kumamoto scale, a clinical tool for monitoring multisystemic changes in hereditary transthyretin amyloidosis.

## Contribution

The revised Kumamoto scale includes minor adjustments to improve sensitivity and precision for clinical monitoring of ATTRv amyloidosis.

## Key findings

- The revised Kumamoto scale includes defined bedside instruments for sensory and motor levels.
- Constipation was added as an indicator of autonomic dysfunction.
- The scale remains reliable and easy to use for clinical monitoring.

## Abstract

Hereditary transthyretin (ATTRv) amyloidosis is a rare but life-threatening multisystemic disease. Multiple disease-modifying treatments are now available and standardised instruments for early detection and disease monitoring are essential. Still, validated and easy-to-use tools for clinical follow-up are scarce.

The Kumamoto scale was first described in 1997 as a method for systematically evaluating patients with ATTRv amyloidosis and has been used in clinical trials since. A panel of amyloidosis experts from Sweden, Denmark, and Norway discussed the strengths and limitations of the Kumamoto scale at the Nordic Amyloidosis Day at Arlanda in 2023, and it was decided to revise and improve the scale that has been used in routine clinical monitoring of patients in Sweden since 2020. Our aim is to introduce the revised version of the Kumamoto scale as a useful clinical monitoring tool.

Minor adjustments were applied to make the scale more sensitive and precise. Bedside instruments for sensory examination were defined as well as the sensory and motor levels. Constipation was added as a sign of autonomic dysfunction. The subtotal and total scores remain unchanged.

We believe that the revised Kumamoto scale is a reliable and easy-to-use clinical tool for monitoring ATTRv amyloidosis.