1
|
Kim JS, Park M, Park S, Chae J, Hong YH, Park KS, Sung JJ, Choi SJ. Prognosis of amyotrophic lateral sclerosis patients after tracheostomy invasive ventilation in Korea. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:271-281. [PMID: 38340017 DOI: 10.1080/21678421.2024.2314064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
Background: Tracheostomy invasive ventilation (TIV) is applied to a subset of amyotrophic lateral sclerosis (ALS) patients; however, its frequency and impact on prognosis vary across countries. Methods: We conducted a nationwide retrospective cohort study using Korean National Health Insurance claims data. All patients diagnosed with sporadic ALS from 2012 to 2017 were included, with the observation period until 2020. The survival time between the TIV and non-TIV groups was compared using propensity score matching analysis, and prognostic factors were assessed within the TIV group. Results: This study included 3484 ALS patients (mean [standard deviation] age, 62.4 [11.9] years, 60.4% male), among whom 1230 (35.3%) underwent TIV. After 1:1 propensity score matching, the survival duration between the two groups was not significantly different (28 vs. 25 months, p = 0.057). Cox regression indicated that older age (hazard ratios [HRs] for each decade compared to <40 years: 3.89, 3.83, 5.30, 6.78, and 8.40 [≥ 80 years]; p < 0.005 for all) and lower income (HR, 1.28; 95% confidence interval [CI], 1.09-1.52; p = 0.003) negatively impacted survival, while gastrostomy (HR, 0.57; 95% CI, 0.50-0.66; p < 0.001) and supportive care services (HR, 0.43; 95% CI, 0.32-0.59; p < 0.001) were associated with prolonged survival. Conclusions: TIV was administered to more than one-third of Korean ALS patients without significant survival prolongation. Older age, lower income, lack of gastrostomy, and insufficient supportive care were independent poor prognostic factors for survival, underscoring the importance of comprehensive management for ALS patients.
Collapse
Affiliation(s)
- Jong-Su Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Minae Park
- Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Republic of Korea
| | - Sojeong Park
- Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Republic of Korea
| | - Juhee Chae
- Department of Neurology, Jeonbuk National University College of Medicine, Jeonju, Republic of Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Centre, Seoul, Republic of Korea
| | - Kyung Seok Park
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea, and
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Centre for Hospital Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
2
|
Munoz NR, Agwuegbo CC, Ghorbani A, Vincent Coralde JM, Abdelmalik R. Takotsubo Cardiomyopathy Induced by Stress From Amyotrophic Lateral Sclerosis and a Mechanical Fall. Cureus 2023; 15:e47068. [PMID: 38021968 PMCID: PMC10653622 DOI: 10.7759/cureus.47068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
Named after the Japanese octopus trap, Takotsubo cardiomyopathy is an acute myocardial condition characterized by a reversible ventricular dysfunction with ballooning of the left ventricle (LV) during systole. A catecholamine surge is likely the primary mechanism responsible for myocardial damage in this condition. The association between amyotrophic lateral sclerosis (ALS) and Takotsubo cardiomyopathy has not been well established. We present a unique case of Takotsubo cardiomyopathy diagnosed in a patient with ALS who presented after a fall with shortness of breath, generalized weakness, and hypotension. She was found to have troponinemia, elevated brain natriuretic peptide, and Osborn waves without ST-segment changes noted on electrocardiography (EKG). The diagnosis of Takotsubo cardiomyopathy was confirmed via transthoracic echocardiography (TTE), which revealed reduced left ventricular ejection fraction, apical ballooning of the LV, akinesis of the ventricular apex, and hyperkinesis of the base of the heart. Coronary angiography revealed no coronary artery disease. She was managed medically and was hemodynamically stable at the time of discharge.
Collapse
Affiliation(s)
| | | | - Ali Ghorbani
- Internal Medicine, Southwest Healthcare, Temecula, USA
| | | | | |
Collapse
|
3
|
Napoli G, Rubin M, Cutillo G, Schito P, Russo T, Quattrini A, Filippi M, Riva N. Tako-Tsubo Syndrome in Amyotrophic Lateral Sclerosis: Single-Center Case Series and Brief Literature Review. Int J Mol Sci 2023; 24:12096. [PMID: 37569475 PMCID: PMC10418501 DOI: 10.3390/ijms241512096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with variable phenotypic expressions which has been associated with autonomic dysfunction. The cardiovascular system seems to be affected especially in the context of bulbar involvement. We describe four new cases of Tako-Tsubo syndrome (TTS) in ALS patients with an appraisal of the literature. We present a late-stage ALS patient with prominent bulbar involvement that presented TTS during hospitalization. We then retrospectively identify three additional ALS-TTS cases reporting relevant clinical findings. TTS cardiomyopathy has been observed in different acute neurological conditions, and the co-occurrence of ALS and TTS has already been reported. Cardiovascular autonomic dysfunctions have been described in ALS, especially in the context of an advanced diseases and with bulbar involvement. Noradrenergic hyperfunction linked to sympathetic denervation and ventilatory deficits coupled in different instances with a trigger event could play a synergistic role in the development of TTS in ALS. Sympathetic hyperfunctioning and ventilatory deficits in conjunction with cardiac autonomic nerves impairment may play a role in the development of TTS in a context of ALS.
Collapse
Affiliation(s)
- Giovanni Napoli
- Neurorehabilitation, Neurology Unit and Neurophysiology Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (G.N.); (M.R.); (G.C.); (P.S.); (T.R.); (M.F.)
| | - Martina Rubin
- Neurorehabilitation, Neurology Unit and Neurophysiology Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (G.N.); (M.R.); (G.C.); (P.S.); (T.R.); (M.F.)
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Gianni Cutillo
- Neurorehabilitation, Neurology Unit and Neurophysiology Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (G.N.); (M.R.); (G.C.); (P.S.); (T.R.); (M.F.)
| | - Paride Schito
- Neurorehabilitation, Neurology Unit and Neurophysiology Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (G.N.); (M.R.); (G.C.); (P.S.); (T.R.); (M.F.)
- Experimental Neuropathology Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Tommaso Russo
- Neurorehabilitation, Neurology Unit and Neurophysiology Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (G.N.); (M.R.); (G.C.); (P.S.); (T.R.); (M.F.)
- Experimental Neuropathology Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Angelo Quattrini
- Experimental Neuropathology Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Massimo Filippi
- Neurorehabilitation, Neurology Unit and Neurophysiology Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (G.N.); (M.R.); (G.C.); (P.S.); (T.R.); (M.F.)
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, 20132 Milan, Italy
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Nilo Riva
- Neurorehabilitation, Neurology Unit and Neurophysiology Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (G.N.); (M.R.); (G.C.); (P.S.); (T.R.); (M.F.)
- Experimental Neuropathology Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, 20132 Milan, Italy;
| |
Collapse
|
4
|
Chen J, Song L, Yang A, Dong G, Zhao XM. Disrupted long-range gene regulations elucidate shared tissue-specific mechanisms of neuropsychiatric disorders. Mol Psychiatry 2022; 27:2720-2730. [PMID: 35379909 DOI: 10.1038/s41380-022-01529-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 03/03/2022] [Accepted: 03/16/2022] [Indexed: 11/09/2022]
Abstract
Neurological and psychiatric disorders have overlapped phenotypic profiles, but the underlying tissue-specific functional processes remain largely unknown. In this study, we explore the shared tissue-specificity among 14 neuropsychiatric disorders through the disrupted long-range gene regulations by GWAS-identified regulatory SNPs. Through Hi-C interactions, averagely 38.0% and 17.2% of the intergenic regulatory SNPs can be linked to target protein-coding genes in brain and non-brain tissues, respectively. Interestingly, while the regulatory target genes in the brain tend to enrich in nervous system development related processes, those in the non-brain tissues are inclined to interfere with synapse and neuroinflammation related processes. Compared to psychiatric disorders, neurological disorders present more prominently the neuroinflammatory processes in both brain and non-brain tissues, indicating an intrinsic difference in mechanisms. Through tissue-specific gene regulatory networks, we then constructed disorder similarity networks in two brain and three non-brain tissues, highlighting both known disorder clusters (e.g. the neurodevelopmental disorders) and unexpected disorder clusters (e.g. Parkinson's disease is consistently grouped with psychiatric disorders). We showcase the potential pharmaceutical applications of the small bowel and its disorder clusters, illustrated by the known drug targets NR1I3 and NFACT1, and their small bowel-specific regulatory modules. In conclusion, disrupted long-range gene regulations in both brain and non-brain tissues contribute to the similarity among distinct clusters of neuropsychiatric disorders, and the tissue-specifically shared functions and regulators for disease clusters may provide insights for future therapeutic investigations.
Collapse
Affiliation(s)
- Jingqi Chen
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, 200433, China. .,MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200433, China. .,Zhangjiang Fudan International Innovation Center, Shanghai, China.
| | - Liting Song
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, 200433, China.,MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200433, China
| | - Anyi Yang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, 200433, China.,MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200433, China
| | - Guiying Dong
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, 200433, China.,MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200433, China
| | - Xing-Ming Zhao
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, 200433, China. .,MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200433, China. .,Zhangjiang Fudan International Innovation Center, Shanghai, China.
| |
Collapse
|
5
|
Brylev L, Fominykh V, Chernenkaia V, Chernenkiy I, Gorbachev K, Ataulina A, Izvekov A, Monakhov M, Olenichev A, Orlov S, Turin I, Loginov M, Rautbart S, Baymukanov A, Parshikov V, Demeshonok V, Yakovlev A, Druzhkova T, Guekht A, Gulyaeva N. Stress load and neurodegeneration after gastrostomy tube placement in amyotrophic lateral sclerosis patients. Metab Brain Dis 2021; 36:2473-2482. [PMID: 34559375 DOI: 10.1007/s11011-021-00837-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Abstract
Dysphagia and progressive swallowing problems due to motoneuron death is one of amyotrophic lateral sclerosis (ALS) symptoms. Malnutrition and body weight loss result in immunological disturbances, fatigability and increase risk of secondary complications in ALS patients, percutaneous endoscopic gastrostomy tube (PEG) placement representing a well-recognized method for malnutrition correction and potentially increasing life expectancy. However, despite nutritional correction, occasional rapid neurological deterioration may develop after PEG placement. We have hypothesized that this decline can be a result of exteroceptive stress during PEG placement and promote neurodegeneration in ALS patients. Intravenous sedation may decrease stress during invasive procedures and it is safe during PEG placement in ALS patients. The aim of the study was comparing different PEG placement protocols of anesthesia (local anesthesia or local anesthesia plus intravenous sedation) in ALS from perspectives of stress load and neurological deterioration profile. During 1.5 years 94 ALS patients were admitted; gastrostomy was performed in 79 patients. After screening according to inclusion and exclusion criteria, 30 patients were included in the prospective consecutive study. All patients were divided in two groups, with local anesthesia and with combination of local anesthesia and intravenous sedation. Routine biochemical indices, neurodegeneration and stress markers were measured. The age of ALS patients was 61 ± 10 years; 20 patients were included at stage 4A and 10 at stage 4B (King's College staging). PEG was placed at average14 months after the diagnosis and 2.2 years after first symptoms. Mean ALS Functional Rating Scale-Revised was 27.8, mean forced vital capacity of lung 46.3% (19-91%). After one year of observation only 8 patients survived. Mean life duration after PEG was 5 months (5 days-20 months). Comparison of two PEG placement protocols did not reveal differences in survival time, stress load and inflammation level. Higher saliva cortisol levels, serum cortisol, glucose, C-reactive protein and interleukin-6 were detected after PEG placement, confirming considerable stress response. PEG is a stressful factor for ALS patients, PEG placement representing a natural model of exteroceptive stress. Stress response was detected as increased cortisol, C-reactive protein, interleukin-6, and glucose levels. Intravenous sedation did not increase the risk of PEG placement procedure, however, sedation protocol did not affect stress load.
Collapse
Affiliation(s)
- L Brylev
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
- "Live Now" Charity Foundation for supporting people with ALS and other neuromuscular disorders, Moscow, Russia
| | - V Fominykh
- Bujanov Moscow City Clinical Hospital, Moscow, Russia.
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia.
| | - V Chernenkaia
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - I Chernenkiy
- Bauman Moscow State Technical University, Moscow, Russia
| | - K Gorbachev
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - A Ataulina
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - A Izvekov
- Mukhin Moscow City Clinical Hospital, Moscow, Russia
| | - M Monakhov
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - A Olenichev
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - S Orlov
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - I Turin
- Moscow City Clinical Hospital №40, Moscow, Russia
| | - M Loginov
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - S Rautbart
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - A Baymukanov
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - V Parshikov
- "Live Now" Charity Foundation for supporting people with ALS and other neuromuscular disorders, Moscow, Russia
| | - V Demeshonok
- "Live Now" Charity Foundation for supporting people with ALS and other neuromuscular disorders, Moscow, Russia
| | - A Yakovlev
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - T Druzhkova
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - A Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - N Gulyaeva
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| |
Collapse
|
6
|
İşcan D, Karaaslan MB, Deveci OS, Akıllı Eker R, Koç F. The importance of heart rate variability in predicting cardiac autonomic dysfunction in patients with amyotrophic lateral sclerosis. Int J Clin Pract 2021; 75:e14536. [PMID: 34132003 DOI: 10.1111/ijcp.14536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/13/2021] [Indexed: 10/21/2022] Open
Abstract
AIM Amyotrophic lateral sclerosis (ALS) is a progressive disease characterized by degeneration in the upper and lower motor neurons of the corticospinal tract, brain stem, and spinal cord. Recent studies have revealed that the disease does not present solely with motor neuron involvement. Accordingly, the aim of this study is to investigate the presence of cardiac autonomic impairment in patients diagnosed with ALS. MATERIAL AND METHOD A total of 61 patients, who were diagnosed with ALS according to the Revised El Escorial Criteria (R-EEC), were included in this prospective study, in addition to the 29 healthy individuals, who were included in the study as controls. In order to assess the cardiac autonomic involvement, the presence of orthostatic hypotension was investigated, and transthoracic echocardiography and 24-hour electrocardiogram (ECG) using a Holter monitor were performed. RESULTS Orthostatic hypotension was detected in 14 (22.2%) patients. Holter electrocardiogram results of the patient group revealed statistically significantly lower heart rate variability (HRV) indicators in the time domain (SDNN, SDANN, SDNN index, rMSSD, and pNN50) and in the frequency domain (high frequency [HF], low frequency [LF], and very low frequency [VLF]) than those of the control group (P < .05). CONCLUSION Contrary to the popular opinion, cardiac autonomic dysfunction in patients with ALS can occur at any stage of the disease. Therefore, it is recommended that the patients are evaluated via periodic examinations during the follow-up period for cardiac autonomic involvement.
Collapse
Affiliation(s)
- Dilek İşcan
- Department of Neurology, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | | | - Onur Sinan Deveci
- Department of Cardiology, Çukurova Unıversity Faculty of Medicine, Sarıçam-Adana, Turkey
| | - Rabia Akıllı Eker
- Department of Cardiology, Çukurova Unıversity Faculty of Medicine, Sarıçam-Adana, Turkey
| | - Filiz Koç
- Department of Neurology, Çukurova University Faculty of Medicine, Sarıçam-Adana, Turkey
| |
Collapse
|
7
|
Chun W, Kim Y, Park SH, Choi SJ. Thromboembolic complications following intravenous immunoglobulin therapy in immune-mediated neurological disorders. J Clin Neurosci 2021; 90:311-316. [PMID: 34275568 DOI: 10.1016/j.jocn.2021.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 05/24/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Minor adverse events of intravenous immunoglobulin (IVIg) include flu-like symptoms, eczematous skin reaction, electrolyte disturbance, and transient leukopenia. On rare occasions, serious complications such as aseptic meningitis, arrhythmia, decrease in blood pressure, and thromboembolic complications (TEC) have been described. The current study aimed to understand the frequency and clinical features of TEC related to IVIg administration in patients with immune-mediated neurological disorders. METHODS We conducted a retrospective chart review of hospitalized patients with immune-mediated neuromuscular or neuroimmunological disorders treated with IVIg from January 2018 to March 2020 in a single tertiary hospital. RESULTS During the study period, 61 patients were treated with a total of 364 IVIg infusions over 84 treatment courses. Among them, we identified 3 TEC cases that occurred during or after the completion of IVIg therapy: two patients with myasthenia gravis (F/60 and F/80) and one patient with Guillain-Barré syndrome (F/79) had undergone arterial TEC (two for ischemic stroke and one for pulmonary thromboembolism). The rates of TEC per patient, per treatment course, and per infusion were 4.91% (3/61), 3.57% (3/84), and 0.82% (3/364), respectively. CONCLUSION The risk of developing TEC upon receiving IVIg infusions is generally low in patients with immune-mediated neurological disorders; however, IVIg-related TEC should be cautiously monitored for in critically ill elderly patients with vascular risk factors, especially those suffering from myasthenic crisis.
Collapse
Affiliation(s)
- Woochang Chun
- Department of Neurology, Inha University Hospital, Incheon, Republic of Korea
| | - Yongchan Kim
- Department of Neurology, Inha University Hospital, Incheon, Republic of Korea
| | - Soo-Hyun Park
- Department of Neurology, Inha University Hospital, Incheon, Republic of Korea; Department of Critical Care Medicine, Inha University Hospital, Incheon, Republic of Korea
| | - Seok-Jin Choi
- Department of Neurology, Inha University Hospital, Incheon, Republic of Korea; Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
| |
Collapse
|
8
|
Kläppe U, Chamoun S, Shen Q, Finn A, Evertsson B, Zetterberg H, Blennow K, Press R, Samuelsson K, Månberg A, Fang F, Ingre C. Cardiac troponin T is elevated and increases longitudinally in ALS patients. Amyotroph Lateral Scler Frontotemporal Degener 2021; 23:58-65. [PMID: 34151677 DOI: 10.1080/21678421.2021.1939384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: To test whether high-sensitivity cardiac troponin T (hs-cTnT) could act as a diagnostic or prognostic biomarker in ALS, comparing hs-cTnT to neurofilament light (NfL). Methods: We performed a case-control study, including 150 ALS patients, 28 ALS mimics, and 108 healthy controls, and a follow-up study of the ALS patients, during 2014-2020 in Stockholm, Sweden. We compared concentrations of hs-cTnT in plasma and NfL in the cerebrospinal fluid between cases and controls. To evaluate the diagnostic performance, we calculated the area under the curve (AUC). Hazard ratios (HRs) were estimated from Cox models to assess associations between hs-cTnT and NfL at ALS diagnosis and risk of death. The longitudinal analysis measured changes of hs-cTnT and NfL since ALS diagnosis. Results: We noted higher levels of hs-cTnT in ALS patients (median: 16.5 ng/L) than in ALS mimics (11 ng/L) and healthy controls (6 ng/L). Both hs-cTnT and NfL could distinguish ALS patients from ALS mimics, with higher AUC noted for NfL (AUC 0.88; 95%CI 0.79-0.97). Disease progression correlated weakly with hs-cTnT (Pearson's r = 0.18, p = 0.04) and moderately with NfL (Pearson's r = 0.41, p < 0.001). Shorter survival was associated with higher levels of NfL at diagnosis (HR 1.08, 95%CI 1.04-1.11), but not hs-cTnT. hs-cTnT increased (12.61 ng/L per year, 95%CI 7.14-18.06) whereas NfL decreased longitudinally since ALS diagnosis. Conclusions: NfL is a stronger diagnostic and prognostic biomarker than hs-cTnT for ALS. However, hs-cTnT might constitute a disease progression biomarker as it increases longitudinally. The underlying causes for this increase need to be investigated.
Collapse
Affiliation(s)
- Ulf Kläppe
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Sanharib Chamoun
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Qing Shen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anja Finn
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Björn Evertsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Psychology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Psychology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Rayomand Press
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Kristin Samuelsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Månberg
- Division of Affinity Proteomics, Department of Protein Science, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Caroline Ingre
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
9
|
George AA, Mishra AK, Sargent J. Letter to the Editor Regarding “Pipeline Embolization in Patients with Posterior Circulation Subarachnoid Hemorrhages: Is Takotsubo Cardiomyopathy a Limiting Factor?”. World Neurosurg 2020; 144:303-304. [DOI: 10.1016/j.wneu.2020.08.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
|
10
|
|
11
|
Finsterer J, Stöllberger C. Commentary: Takotsubo Cardiomyopathy-Acute Cardiac Dysfunction Associated With Neurological and Psychiatric Disorders. Front Neurol 2019; 10:1163. [PMID: 31736867 PMCID: PMC6834785 DOI: 10.3389/fneur.2019.01163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/15/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Josef Finsterer
- Krankenanstalt Rudolfstiftung, Messerli Institute, Vienna, Austria
| | | |
Collapse
|
12
|
Galli M, D'Amario D, Andreotti F, Porto I, Vergallo R, Sabatelli M, Lancellotti S, Meleo E, De Cristofaro R, Crea F. Sustained safe and effective anticoagulation using Edoxaban via percutaneous endoscopic gastrostomy. ESC Heart Fail 2019; 6:884-888. [PMID: 31184800 PMCID: PMC6676270 DOI: 10.1002/ehf2.12434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/22/2019] [Indexed: 12/11/2022] Open
Abstract
Extensive data support the safety of direct oral anticoagulants compared with vitamin K antagonists in patients with non‐valvular atrial fibrillation, leading to a significantly increase in the use of these compounds in clinical practice. However, there is no compelling evidence supporting the use of direct oral anticoagulant in individuals who are intubated or have a percutaneous endoscopic gastrostomy (PEG): patients with several co‐morbidities are underrepresented in clinical trials, so the best long‐term strategy for anticoagulation is difficult to ascertain. The aim of the present report was to evaluate the safety and efficacy of edoxaban administered via PEG in a patient with heart failure and a history of atrial fibrillation affected by amyotrophic lateral sclerosis (ALS). A 71‐year‐old man with atrial fibrillation, advanced ALS, type II diabetes mellitus, and hypertension presented to the emergency department with dyspnoea and tachycardia. Because vitamin K antagonist and rivaroxaban 15 mg were dropped because of difficult international normalized ratio control (time in therapeutic range <30%) and severe haematuria, respectively, edoxaban 30 mg (crushed pill) daily was administered based on the patient's weight of 58 kg. Mean edoxaban plasma concentration–time profiles were measured, as anti‐Xa activity, 2 h before and at 2, 6, and 22 h after drug administration and then compared with the pharmacokinetic profile of edoxaban 30 mg in healthy subjects. An additional testing of steady‐state peak plasma concentration of edoxaban after 10 days and a 30 day follow‐up were evaluated. The values of the pharmacokinetic parameters, analysed with a non‐compartmental analysis by PKSolver module, showed that Cmax and AUC0→t were only slightly higher than those observed in healthy subjects, while the half‐life and observed clearance were significantly longer and lower, respectively, than in normal subjects. Steady‐state peak plasma concentration of edoxaban was very similar to the levels reported in healthy subjects, and neither relevant bleeding nor thromboembolic event was reported at a 30 day follow‐up. These results support safe and effective anticoagulation with edoxaban 30 mg but suggest caution with the use of full dose of edoxaban (60 mg daily) in this kind of patients. We report, for the first time, a safe and effective anticoagulation based on the administration of edoxaban 30 mg daily through PEG in a patient with advanced ALS, acute respiratory, and heart failure, presenting with Takotsubo syndrome and atrial fibrillation.
Collapse
Affiliation(s)
- Mattia Galli
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00167, Rome, Italy
| | - Domenico D'Amario
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00167, Rome, Italy
| | - Felicita Andreotti
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00167, Rome, Italy
| | - Italo Porto
- Cardiovascular Disease Unit, Ospedale Policlinico San Martino, IRCCS, University of Genoa, Genoa, Italy
| | - Rocco Vergallo
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00167, Rome, Italy
| | - Mario Sabatelli
- NEuroMuscular Omnicentre (NEMO), Serena Onlus Foundation-Pol. Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Catholic University of the Sacred Heart School of Medicine, Rome, Italy
| | - Stefano Lancellotti
- Institute of Internal Medicine & Geriatrics, Haemostasis and Thrombosis Center, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Area of Hematology, Catholic University of the Sacred Heart School of Medicine, Rome, Italy
| | - Emiliana Meleo
- NEuroMuscular Omnicentre (NEMO), Serena Onlus Foundation-Pol. Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Catholic University of the Sacred Heart School of Medicine, Rome, Italy
| | - Raimondo De Cristofaro
- Institute of Internal Medicine & Geriatrics, Haemostasis and Thrombosis Center, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Area of Hematology, Catholic University of the Sacred Heart School of Medicine, Rome, Italy
| | - Filippo Crea
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00167, Rome, Italy
| |
Collapse
|
13
|
Morales-Estrella JL, Aboussouan LS. Sleep Disturbances in Patients with Disorders of the Nerve and Muscle Diseases. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00140-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
14
|
Izumi Y, Miyamoto R, Fujita K, Yamamoto Y, Yamada H, Matsubara T, Unai Y, Tsukamoto A, Takamatsu N, Nodera H, Hayashi S, Oda M, Mori A, Nishida Y, Watanabe S, Ogawa H, Uehara H, Murayama S, Sata M, Kaji R. Distinct Incidence of Takotsubo Syndrome Between Amyotrophic Lateral Sclerosis and Synucleinopathies: A Cohort Study. Front Neurol 2019; 9:1099. [PMID: 30619056 PMCID: PMC6300466 DOI: 10.3389/fneur.2018.01099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 12/03/2018] [Indexed: 01/18/2023] Open
Abstract
Takotsubo syndrome (TTS) is an acute cardiac syndrome characterized by regional left ventricular dysfunction with a peculiar circumferential pattern, which typically results in apical ballooning. Evidence indicates a pivotal role of catecholamines in TTS, and researchers have discussed multiple hypotheses on the etiology, including multivessel coronary spasm, myocardial stunning, excessive transient ventricular afterload, and cardiac sympathetic overactivity with local noradrenaline spillover. Although central nervous system disorders, such as stroke and epilepsy, are known to trigger TTS, the incidence and clinical features of TTS in neurodegenerative disorders are poorly understood. Here, we retrospectively examined TTS cases in a single-center cohort composed of 250 patients with amyotrophic lateral sclerosis (ALS) and 870 patients with synucleinopathies [582 patients with Parkinson's disease (PD), 125 patients with dementia with Lewy bodies (DLB), and 163 patients with multiple system atrophy (MSA)] and identified 4 (1.6%, including 2 women) cases with ALS and no cases with synucleinopathies. Two ALS patients underwent autopsy and the pathological findings were compatible with the chronological changes identified in catecholamine-induced cardiomyopathy. A literature review identified 16 TTS cases with ALS, 1 case each with PD and DLB, and no cases with MSA. When current and previous TTS cases with ALS were concatenated: 55% (11/20) were female; 35% (7/20) had a bulbar-onset and 45% (9/20) had a limb-onset; the mean age of TTS onset was 63.3 ± 9.0 years and the mean interval time from ALS onset to TTS development was 4.9 ± 3.0 years; no (0/16) patients developed TTS within 12 months after ALS onset; 50% (10/20) underwent artificial ventilations; the mortality was 17% (3/18); and most cases had precipitating factors, and TTS development was associated with gastrostomy, tracheostomy, or infections in 45% (9/20) of the patients. This study demonstrated that ALS is a considerable predisposing factor of TTS and that synucleinopathies rarely cause TTS. The distinct TTS incidence between ALS and synucleinopathies may be due to cardiac sympathetic overactivity in ALS and may also be affected by cardiac sympathetic denervation in synucleinopathies. Moreover, the etiology of TTS in ALS may be reasonably explained by the two-hit theory.
Collapse
Affiliation(s)
- Yuishin Izumi
- Department of Clinical Neuroscience, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Ryosuke Miyamoto
- Department of Clinical Neuroscience, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Koji Fujita
- Department of Clinical Neuroscience, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yuki Yamamoto
- Department of Clinical Neuroscience, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Hirotsugu Yamada
- Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tomoyasu Matsubara
- Department of Neuropathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Yuki Unai
- Department of Clinical Neuroscience, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Ai Tsukamoto
- Department of Neurology, Tokushima Hospital, Yoshinogawa, Japan
| | - Naoko Takamatsu
- Department of Clinical Neuroscience, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Hiroyuki Nodera
- Department of Clinical Neuroscience, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Shinya Hayashi
- Department of Internal Medicine, Kaminaka Hospital, Naka, Japan
| | - Masaya Oda
- Department of Neurology, Mifukai Vihara Hananosato Hospital, Miyoshi, Japan
| | - Atsuko Mori
- Department of Neurology, Itsuki Hospital, Tokushima, Japan
| | | | - Shunsuke Watanabe
- Department of Pathology and Laboratory Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Hirohisa Ogawa
- Department of Pathology and Laboratory Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Hisanori Uehara
- Division of Pathology, Tokushima University Hospital, Tokushima, Japan
| | - Shigeo Murayama
- Department of Neuropathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Ryuji Kaji
- Department of Clinical Neuroscience, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| |
Collapse
|
15
|
Damian MS, Wijdicks EFM. The clinical management of neuromuscular disorders in intensive care. Neuromuscul Disord 2018; 29:85-96. [PMID: 30639065 DOI: 10.1016/j.nmd.2018.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 11/30/2018] [Accepted: 12/13/2018] [Indexed: 12/11/2022]
Abstract
Life-threatening neuromuscular disorders affect a small, but growing group of patients in the intensive care unit who present special management problems, as well as great therapeutic opportunities. In inflammatory conditions, a cure is often possible, and for chronic, genetic or degenerative conditions, achieving the previous level of function is the target. Neuromuscular experts and intensivists need to cooperate closely to achieve the best possible outcomes. They need to acquire a very specific set of skills, including both a thorough understanding of the mechanics of ventilation as well as familiarity with the diagnostic categories of genetic and of autoimmune diseases. This review of the clinical management of adult neuromuscular disease in the ICU aims to provide an overview of the most important conditions encountered in the ICU and a practical approach to their diagnosis, monitoring, and treatment.
Collapse
Affiliation(s)
- Maxwell S Damian
- Neurology and Neurointensive Care, Cambridge University Hospitals and Ipswich Hospital, Hills Road, Cambridge CB2 0QQ, UK.
| | - Eelco F M Wijdicks
- Neurology Division of Critical Care Neurology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
16
|
Finsterer J, Stöllberger C. Takotsubo in amyotrophic lateral sclerosis. J Neurol Sci 2017; 379:339-340. [DOI: 10.1016/j.jns.2017.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 05/09/2017] [Indexed: 12/11/2022]
|
17
|
Response to the letter to the editor regarding an article, “Takotsubo cardiomyopathy in amyotrophic lateral sclerosis”. J Neurol Sci 2017; 379:341-342. [DOI: 10.1016/j.jns.2017.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 05/09/2017] [Indexed: 11/20/2022]
|