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Hobson E, McDermott C. Advances in symptom management and in monitoring disease progression in motor neuron disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 176:119-169. [PMID: 38802174 DOI: 10.1016/bs.irn.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
The aim of supportive management of motor neuron disease is to improve survival, promote good quality of life and patient independence and autonomy whilst preparing for future progression and the end of life. Multidisciplinary specialist care aims to address the multifaceted and interacting biopsychosocial problems associated with motor neuron disease that leads to proven benefits in both survival and quality of life. This chapter will explore principles, structure and details of treatment options, and make recommendations for practice and for future research.
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Affiliation(s)
- Esther Hobson
- Sheffield Institute for Translational Neuroscience, Division of Neuroscience, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
| | - Christopher McDermott
- Sheffield Institute for Translational Neuroscience, Division of Neuroscience, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom.
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Boostani R, Olfati N, Shamshiri H, Salimi Z, Fatehi F, Hedjazi SA, Fakharian A, Ghasemi M, Okhovat AA, Basiri K, Haghi Ashtiani B, Ansari B, Raissi GR, Khatoonabadi SA, Sarraf P, Movahed S, Panahi A, Ziaadini B, Yazdchi M, Bakhtiyari J, Nafissi S. Iranian clinical practice guideline for amyotrophic lateral sclerosis. Front Neurol 2023; 14:1154579. [PMID: 37333000 PMCID: PMC10272856 DOI: 10.3389/fneur.2023.1154579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegeneration involving motor neurons. The 3-5 years that patients have to live is marked by day-to-day loss of motor and sometimes cognitive abilities. Enormous amounts of healthcare services and resources are necessary to support patients and their caregivers during this relatively short but burdensome journey. Organization and management of these resources need to best meet patients' expectations and health system efficiency mandates. This can only occur in the setting of multidisciplinary ALS clinics which are known as the gold standard of ALS care worldwide. To introduce this standard to the care of Iranian ALS patients, which is an inevitable quality milestone, a national ALS clinical practice guideline is the necessary first step. The National ALS guideline will serve as the knowledge base for the development of local clinical pathways to guide patient journeys in multidisciplinary ALS clinics. To this end, we gathered a team of national neuromuscular experts as well as experts in related specialties necessary for delivering multidisciplinary care to ALS patients to develop the Iranian ALS clinical practice guideline. Clinical questions were prepared in the Patient, Intervention, Comparison, and Outcome (PICO) format to serve as a guide for the literature search. Considering the lack of adequate national/local studies at this time, a consensus-based approach was taken to evaluate the quality of the retrieved evidence and summarize recommendations.
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Affiliation(s)
- Reza Boostani
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nahid Olfati
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hosein Shamshiri
- Department of Neurology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zanireh Salimi
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzad Fatehi
- Department of Neurology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Arya Hedjazi
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Atefeh Fakharian
- Pulmonary Rehabilitation Research Center (PRRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
- National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Internal Medicine, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Ghasemi
- Department of Neurology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Asghar Okhovat
- Department of Neurology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Keivan Basiri
- Department of Neurology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahram Haghi Ashtiani
- Department of Neurology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Behnaz Ansari
- Department of Neurology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- AL Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholam Reza Raissi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Payam Sarraf
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Movahed
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Akram Panahi
- Department of Neurology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bentolhoda Ziaadini
- Department of Neurology, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
- Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Yazdchi
- Department of Neurology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jalal Bakhtiyari
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahriar Nafissi
- Department of Neurology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Harbottle J, Carlin H, Payne-Doris T, Tedd HMI, de Soyza A, Messer B. Developing an intrasalivary gland botox service for patients receiving long-term non-invasive ventilation at home: a single-centre experience. BMJ Open Respir Res 2022; 9:9/1/e001188. [PMID: 35190461 PMCID: PMC8862502 DOI: 10.1136/bmjresp-2021-001188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 01/31/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Sialorrhoea is a debilitating symptom in neurological disease and there is a growing literature for the use of intrasalivary gland Botulinum Toxin (botox) injections in its management. However, provision of intrasalivary gland botox remains inconsistent and sialorrhoea is often poorly controlled in motor neuron disease (MND). Sialorrhoea in association with bulbar dysfunction can cause intolerance of non-invasive ventilation (NIV) and respiratory infection, so its treatment is critical within a home ventilation service (HVS). This treatment can also be used to enable tracheostomy cuff deflation to facilitate weaning from ventilation. We report on the outcomes of intrasalivary gland botox in our HVS. Methods In 2015, we set up an intrasalivary gland botox service for patients under our HVS. Under ultrasound guidance, we injected submandibular gland (SMG), parotid gland (PG) or both. Results 109 intrasalivary gland botox procedures were performed in 72 patients. Diagnostic groups included MND 32 Cerebral Palsy 8 and Weaning 14. Glands injected were, SMG (6%), PG (47%) and both (47%). The majority (84%) received the Dysport preparation with mean dose 273 units. 94% were ultrasound guided. 81% of injections resulted in a positive treatment effect, with 47% patients requesting repeat injections. Complications were angioedema (0.9%) and worsening dysphagia (3.7% following SMG injection). Mean survival following treatment was 40 months with 53% patients still alive. Conclusions Intrasalivary gland botox appears effective across a range of neurological conditions requiring long-term NIV with few complications. Dysphagia may be an important complication of SMG injection. A randomised controlled trial may help establish the evidence base.
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Affiliation(s)
- Jessica Harbottle
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | - Hannah Carlin
- Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Thomas Payne-Doris
- North East Assisted Ventilation Service, Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | - Hilary M I Tedd
- Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Anthony de Soyza
- Population Health Science Institutes, Newcastle University, Newcastle upon Tyne, UK
| | - Ben Messer
- North East Assisted Ventilation Service, Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
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Thick Mucus in ALS: A Mixed-Method Study on Associated Factors and Its Impact on Quality of Life of Patients and Caregivers. Brain Sci 2022; 12:brainsci12020252. [PMID: 35204016 PMCID: PMC8869921 DOI: 10.3390/brainsci12020252] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 11/17/2022] Open
Abstract
In this explorative mixed-method pilot study, we set out to have a closer look at the largely under-recognized and under-investigated symptom of thick mucus in patients with ALS and its impact on patients and relatives. Thick mucus is a highly distressing symptom for both patients and caregivers. It complicates the use of non-invasive ventilation and is therefore an important prognostic factor of survival. Methods: In our preliminary study, we used a cross-sectional design, including ten ALS patients with thick mucus who were matched to ten ALS patients without thick mucus. Lung function tests and laboratory and sputum analysis were performed and questionnaires administered in order to determine associated factors of thick mucus accumulation. In a qualitative study using semi-structured interviews, we analysed the impact of thick mucus on patients and caregivers. Results: Reduced respiratory parameters as well as a higher degree of bulbar impairment were associated with the presence of thick mucus. Quality of life of patients and caregivers was strongly impaired by thick mucus accumulation. Conclusions: Thick mucus in patients with ALS has a strong impact on quality of life. Reduced cough flow and severely impaired bulbar function appear to be indicative parameters. We suggest that healthcare providers actively explore the presence of thick mucus in their patients and that it becomes included in commonly used screening tools.
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Sanabria V, Romariz S, Braga M, Foresti ML, Naffah-Mazzacoratti MDG, Mello LE, Longo BM. Anticholinergics: A potential option for preventing posttraumatic epilepsy. Front Neurosci 2022; 16:1100256. [PMID: 36909741 PMCID: PMC9998514 DOI: 10.3389/fnins.2022.1100256] [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] [Received: 11/16/2022] [Accepted: 12/30/2022] [Indexed: 03/14/2023] Open
Abstract
Interest in the use of anticholinergics to prevent the development of epilepsy after traumatic brain injury (TBI) has grown since recent basic studies have shown their effectiveness in modifying the epileptogenic process. These studies demonstrated that treatment with anticholinergics, in the acute phase after brain injury, decreases seizure frequency, and severity, and the number of spontaneous recurrent seizures (SRS). Therefore, anticholinergics may reduce the risk of developing posttraumatic epilepsy (PTE). In this brief review, we summarize the role of the cholinergic system in epilepsy and the key findings from using anticholinergic drugs to prevent PTE in animal models and new clinical trial protocols. Furthermore, we discuss why treatment with anticholinergics is more likely to prevent PTE than treatment for other epilepsies.
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Affiliation(s)
- Viviam Sanabria
- Department of Physiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Simone Romariz
- Department of Physiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Matheus Braga
- Department of Physiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maira Licia Foresti
- Department of Physiology, Universidade Federal de São Paulo, São Paulo, Brazil.,Instituto D'Or de Pesquisa e Ensino, São Paulo, Brazil
| | | | - Luiz Eugênio Mello
- Department of Physiology, Universidade Federal de São Paulo, São Paulo, Brazil.,Instituto D'Or de Pesquisa e Ensino, São Paulo, Brazil
| | - Beatriz M Longo
- Department of Physiology, Universidade Federal de São Paulo, São Paulo, Brazil
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Vaudroz V, Kiliaridis S, Antonarakis GS. What can a dentist learn from an astrophysicist? A photographic evaluation of the long-term impact of amyotrophic lateral sclerosis on the orofacial sphere, using the example of Stephen Hawking: A historical case report. SPECIAL CARE IN DENTISTRY 2021; 42:216-224. [PMID: 34671991 PMCID: PMC9297872 DOI: 10.1111/scd.12665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
Abstract
Aims The present historical case report aims to characterize the long‐term orofacial repercussions of amyotrophic lateral sclerosis (ALS), a rare neurodegenerative disease with poor prognosis and relatively short life expectancy following initial diagnosis. Methods Here we focus on the long‐term orofacial evolution seen in the example of Stephen Hawking, one of the greatest personalities in the scientific world, using publicly‐available photographic documentation. The fact that Stephen Hawking lived several decades following his diagnosis of ALS presents one with a unique opportunity to characterize and follow‐up the evolution of the ALS on the orofacial sphere. Through this article, we want to show him and his family, and all those living with this disease, our deepest respect, without intending in any way to intrude or misuse the privacy of the late universally‐respected astrophysicist. Results Photographic documentation analyzed longitudinally shows changes towards the development of a Class III malocclusion, lower incisor protrusion, and a concave profile. Moreover, tooth wear has occurred, accompanied by posterior tooth loss and aberrant tongue and lip posture. Conclusion The causes of such changes remain speculative but could be due to changes in the soft tissue equilibrium, changes in head and tongue posture, loss of oral function, respiratory needs, and a general deterioration of dental health. Our sincere thanks to the Hawking family who took the time to read the article and approve its publication for scientific and educational purposes. We are also deeply grateful to them for providing us with some photographs from their family collection.
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Affiliation(s)
- Vincent Vaudroz
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, 1 rue Michel-Servet, Geneva, 1206, Switzerland
| | - Stavros Kiliaridis
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, 1 rue Michel-Servet, Geneva, 1206, Switzerland.,Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Freiburgstrasse 7, Bern, CH-3010, Switzerland
| | - Gregory S Antonarakis
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, 1 rue Michel-Servet, Geneva, 1206, Switzerland
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Singh H, Nene Y, Mehta TR, Govindarajan R. Efficacy of Botulinum Toxin for Treating Sialorrhea in Neuromuscular Conditions. Front Neurol 2020; 11:513. [PMID: 32587569 PMCID: PMC7297943 DOI: 10.3389/fneur.2020.00513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/08/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Drooling related to bulbar weakness and dysfunction is a common concern in patients with neuromuscular disease. While there are numerous medications to manage sialorrhea, they are often limited by side effects and lack of efficacy. Botulinum toxin has shown to benefit ALS patients in a few studies, but there is scant data on the benefit in other neuromuscular conditions. Objective: To assess the effectiveness of Botulinum toxin in reducing sialorrhea in patients with various neuromuscular disease. Design/Methods: 25 patients (19M, 6F; 54.36 ± 17.09 yr) with documented neuromuscular illness and concern for drooling was followed for 6 weeks after Botulinum toxin injection. These patients had one of the following diagnoses: Duchenne muscular dystrophy (3), myotonic dystrophy (3), oculopharyngeal muscular dystrophy (1), inclusion body myositis (2), primary lateral sclerosis (1), amyotrophic lateral sclerosis (9), spinal muscular atrophy type 2 and 3 (2), spinal-bulbar muscular atrophy (2), and Becker's muscular dystrophy (2). A subjective drooling scale (1: markedly worse, 5: markedly better) and drooling thickness score (0=normal, 100=thick) was calculated on these patients prior to the injection and 4 and 6 weeks after the injection. Botulinum toxin 20-30 units were injected into bilateral parotid gland (70% of the dose) and submandibular gland (30% of the dose). Results: The drooling thickness score at before the injection was 75.2 ± 10.46. At 4 and 6 weeks, average scores reduced to 47.2 ± 6.14 and 18.8 ± 5.26, respectively (p < 0.05). The average pre injection perception about drooling was 3.0 (p < 0.05). The average change in perception was +0.84 and +1.28 at 4 and 6 weeks, respectively, (p < 0.05) implying significant improvement. There were no reported adverse effects. Conclusion: This study provides preliminary evidence for the use of botulinum toxin for refractory sialorrhea for a variety of neuromuscular conditions.
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Affiliation(s)
- Harsh Singh
- Department of Neurology, University of Missouri, Columbia, MO, United States
| | - Yash Nene
- Department of Neurology, University of Missouri, Columbia, MO, United States
| | - Tejas R Mehta
- Department of Neurology, University of Missouri, Columbia, MO, United States
| | - Raghav Govindarajan
- Assistant Professor of Neurology, Department of Neurology, University of Missouri, Columbia, MO, United States
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Mcdermott C. Developing the evidence base for the management of drooling. Dev Med Child Neurol 2020; 62:270. [PMID: 31583676 DOI: 10.1111/dmcn.14373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Christopher Mcdermott
- Sheffield Institute for Translational Neuroscience, Department of Neuroscience, University of Sheffield, Sheffield, UK
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Morgante F, Bavikatte G, Anwar F, Mohamed B. The burden of sialorrhoea in chronic neurological conditions: current treatment options and the role of incobotulinumtoxinA (Xeomin®). Ther Adv Neurol Disord 2019; 12:1756286419888601. [PMID: 31819763 PMCID: PMC6883364 DOI: 10.1177/1756286419888601] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/08/2019] [Indexed: 12/11/2022] Open
Abstract
Sialorrhoea is a frequent symptom of neurological diseases (e.g. Parkinson’s
disease, motor neuron disease, cerebral palsy, and stroke) and is defined as
excessive saliva accumulation leading to unintentional loss of saliva from the
mouth. Sialorrhoea increases the overall burden on the patient and their
caregivers, the impact of which can be both physical and psychosocial.
Treatments for sialorrhoea range from lifestyle and behavioural guidance, to
medications, surgery or radiation. Nonpharmacological interventions include
advice on posture, swallowing control, cough management, dietary changes, eating
and drinking techniques, and behavioural modification; however, these
conservative measures may be ineffective for people with progressive
neurological conditions. The pharmacological treatment of sialorrhoea is
challenging because medications licensed for this purpose are limited, but
treatments can include anticholinergic drugs and botulinum toxins. Surgical
treatment of sialorrhoea is typically reserved as a last resort for patients.
IncobotulinumtoxinA (Xeomin®) is the first botulinum toxin type A to receive US
and UK marketing authorization for the symptomatic treatment of chronic
sialorrhoea due to neurological disorders in adults. In this review, we discuss
and compare the frequency and method of administration, location of treatment
delivery, approximate annual costs and main side effects of botulinum toxin and
different anticholinergic drugs. Management of patients with chronic
neurological conditions requires input from multiple specialist teams and thus a
multidisciplinary team (MDT) approach is considered fundamental to ensure that
care is consistent and tailored to patients’ needs. To ensure that adult
patients with neurological conditions receive the best care and sialorrhoea is
well managed, we suggest a potential clinical care pathway for sialorrhoea with
a MDT approach, which healthcare professionals could aspire to.
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Affiliation(s)
- Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom; Department of Experimental and Clinical Medicine, University of Messina
| | - Ganesh Bavikatte
- Department of Rehabilitation Medicine, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Fahim Anwar
- Department of Rehabilitation Medicine, Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Biju Mohamed
- Department of Medicine and Gerontology, University Hospital of Wales, Cardiff, UK
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Leighton D, Newton J, Colville S, Bethell A, Craig G, Cunningham L, Flett M, Fraser D, Hatrick J, Lennox H, Marshall L, McAleer D, McEleney A, Millar K, Silver A, Stephenson L, Stewart S, Storey D, Stott G, Thornton C, Webber C, Gordon H, Melchiorre G, Sherlock L, Beswick E, Buchanan D, Abrahams S, Bateman A, Preston J, Duncan C, Davenport R, Gorrie G, Morrison I, Swingler R, Chandran S, Pal S. Clinical audit research and evaluation of motor neuron disease (CARE-MND): a national electronic platform for prospective, longitudinal monitoring of MND in Scotland. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:242-250. [PMID: 30889975 DOI: 10.1080/21678421.2019.1582673] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Launched in 1989, the Scottish Motor Neuron Disease Register (SMNDR) has provided a resource for prospective clinical data collection. However, in 2015 we aimed to evolve a system to allow: i) A patient-centered approach to care based on recognized standards, ii) Harmonized data sharing between Scottish health professionals in "real-time", iii) Regular audit of care to facilitate timely improvements in service delivery, and iv) Patient participation in a diverse range of observational and interventional research studies including clinical trials. Methods: We developed a standardized national electronic data platform-Clinical Audit Research and Evaluation of MND (CARE-MND) which integrates clinical audit and research data fields. Data completion pre- and post-CARE-MND were compared, guided by recently published National Institute for Clinical Excellence (NICE) recommendations. Statistical difference in data capture between time periods was assessed using Z-test of proportions. Results: Data field completion for the historical 2011-2014 period ranged from 4 to 95%; median 50%. CARE-MND capture ranged from 32 to 98%; median 87%. 15/17 fields were significantly more complete post-CARE-MND (p < 0.001). All MND nurse/allied health specialists in Scotland use the CARE-MND platform. Management of MND in Scotland is now coordinated through a standardized template. Conclusions: Through CARE-MND, national audits of MND care and interventions have been possible, leading to protocols for harmonized service provision. Stratification of the MND population is facilitating participation in observational and interventional studies. CARE-MND can act as a template for other neurological disorders.
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Affiliation(s)
- Danielle Leighton
- a Centre for Clinical Brain Sciences , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , University of Edinburgh , Edinburgh , UK.,c Department of Neurology , NHS Lothian, Western General Hospital , Edinburgh , UK.,d Department of Neurology , NHS Greater Glasgow & Clyde , Glasgow , UK
| | - Judith Newton
- a Centre for Clinical Brain Sciences , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , University of Edinburgh , Edinburgh , UK.,c Department of Neurology , NHS Lothian, Western General Hospital , Edinburgh , UK
| | - Shuna Colville
- a Centre for Clinical Brain Sciences , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , University of Edinburgh , Edinburgh , UK.,c Department of Neurology , NHS Lothian, Western General Hospital , Edinburgh , UK
| | - Andrew Bethell
- e Department of Neurology , NHS Highland , Inverness , UK
| | - Gillian Craig
- f Department of Neurology , NHS Tayside , Dundee , UK
| | - Laura Cunningham
- d Department of Neurology , NHS Greater Glasgow & Clyde , Glasgow , UK.,g Department of Neurology , NHS Lanarkshire , Glasgow , UK
| | - Moira Flett
- h Department of Neurology , NHS Orkney , Kirkwall , UK
| | - Dianne Fraser
- i Department of Neurology , NHS Grampian , Aberdeen , UK
| | - Janice Hatrick
- d Department of Neurology , NHS Greater Glasgow & Clyde , Glasgow , UK
| | - Helen Lennox
- j Department of Neurology , NHS Ayrshire & Arran , Ayr , UK.,k Department of Neurology , NHS Dumfries & Galloway , Dumfries , UK
| | - Laura Marshall
- l Department of Neurology , NHS Forth Valley , Stirling , UK
| | | | - Alison McEleney
- c Department of Neurology , NHS Lothian, Western General Hospital , Edinburgh , UK.,m Department of Neurology , NHS Borders , Melrose , UK
| | - Kitty Millar
- n Department of Neurology , NHS Western Isles , Stornoway , UK , and
| | - Ann Silver
- d Department of Neurology , NHS Greater Glasgow & Clyde , Glasgow , UK.,g Department of Neurology , NHS Lanarkshire , Glasgow , UK
| | - Laura Stephenson
- b Euan MacDonald Centre for Motor Neurone Disease Research , University of Edinburgh , Edinburgh , UK.,c Department of Neurology , NHS Lothian, Western General Hospital , Edinburgh , UK
| | - Susan Stewart
- i Department of Neurology , NHS Grampian , Aberdeen , UK
| | | | - Gill Stott
- c Department of Neurology , NHS Lothian, Western General Hospital , Edinburgh , UK.,m Department of Neurology , NHS Borders , Melrose , UK
| | - Carol Thornton
- i Department of Neurology , NHS Grampian , Aberdeen , UK
| | | | - Harry Gordon
- a Centre for Clinical Brain Sciences , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , University of Edinburgh , Edinburgh , UK.,c Department of Neurology , NHS Lothian, Western General Hospital , Edinburgh , UK
| | - Giulia Melchiorre
- a Centre for Clinical Brain Sciences , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , University of Edinburgh , Edinburgh , UK.,c Department of Neurology , NHS Lothian, Western General Hospital , Edinburgh , UK
| | - Laura Sherlock
- a Centre for Clinical Brain Sciences , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , University of Edinburgh , Edinburgh , UK
| | - Emily Beswick
- a Centre for Clinical Brain Sciences , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , University of Edinburgh , Edinburgh , UK
| | - David Buchanan
- a Centre for Clinical Brain Sciences , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , University of Edinburgh , Edinburgh , UK
| | - Sharon Abrahams
- a Centre for Clinical Brain Sciences , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , University of Edinburgh , Edinburgh , UK.,c Department of Neurology , NHS Lothian, Western General Hospital , Edinburgh , UK
| | - Anthony Bateman
- a Centre for Clinical Brain Sciences , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , University of Edinburgh , Edinburgh , UK.,c Department of Neurology , NHS Lothian, Western General Hospital , Edinburgh , UK
| | - Jenny Preston
- j Department of Neurology , NHS Ayrshire & Arran , Ayr , UK
| | - Callum Duncan
- i Department of Neurology , NHS Grampian , Aberdeen , UK
| | - Richard Davenport
- a Centre for Clinical Brain Sciences , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , University of Edinburgh , Edinburgh , UK.,c Department of Neurology , NHS Lothian, Western General Hospital , Edinburgh , UK
| | - George Gorrie
- b Euan MacDonald Centre for Motor Neurone Disease Research , University of Edinburgh , Edinburgh , UK.,d Department of Neurology , NHS Greater Glasgow & Clyde , Glasgow , UK
| | - Ian Morrison
- f Department of Neurology , NHS Tayside , Dundee , UK
| | - Robert Swingler
- a Centre for Clinical Brain Sciences , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , University of Edinburgh , Edinburgh , UK
| | - Siddharthan Chandran
- a Centre for Clinical Brain Sciences , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , University of Edinburgh , Edinburgh , UK.,c Department of Neurology , NHS Lothian, Western General Hospital , Edinburgh , UK
| | - Suvankar Pal
- a Centre for Clinical Brain Sciences , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , University of Edinburgh , Edinburgh , UK.,c Department of Neurology , NHS Lothian, Western General Hospital , Edinburgh , UK.,l Department of Neurology , NHS Forth Valley , Stirling , UK
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Oskarsson B, Gendron TF, Staff NP. Amyotrophic Lateral Sclerosis: An Update for 2018. Mayo Clin Proc 2018; 93:1617-1628. [PMID: 30401437 DOI: 10.1016/j.mayocp.2018.04.007] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/12/2018] [Accepted: 04/13/2018] [Indexed: 12/11/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease affecting motor neurons and other neuronal cells, leading to severe disability and eventually death from ventilatory failure. It has a prevalence of 5 in 100,000, with an incidence of 1.7 per 100,000, reflecting short average survival. The pathogenesis is incompletely understood, but defects of RNA processing and protein clearance may be fundamental. Repeat expansions in the chromosome 9 open reading frame 72 gene (C9orf72) are the most common known genetic cause of ALS and are seen in approximately 40% of patients with a family history and approximately 10% of those without. No environmental risk factors are proved to be causative, but many have been proposed, including military service. The diagnosis of ALS rests on a history of painless progressive weakness coupled with examination findings of upper and lower motor dysfunction. No diagnostic test is yet available, but electromyography and genetic tests can support the diagnosis. Care for patients is best provided by a multidisciplinary team, and most interventions are directed at managing symptoms. Two medications with modest benefits have Food and Drug Administration approval for the treatment of ALS: riluzole, a glutamate receptor antagonist, and, new in 2017, edaravone, a free radical scavenger. Many other encouraging treatment strategies are being explored in clinical trials for ALS; herein we review stem cell and antisense oligonucleotide gene therapies.
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Niedermeyer S, Murn M, Choi PJ. Respiratory Failure in Amyotrophic Lateral Sclerosis. Chest 2018; 155:401-408. [PMID: 29990478 DOI: 10.1016/j.chest.2018.06.035] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis is a progressive neuromuscular disease characterized by both lower motor neuron and upper motor neuron dysfunction. Although clinical presentations can vary, there is no cure for ALS, and the disease is universally terminal, with most patients dying of respiratory complications. Patients die, on average, within 3 to 5 years of diagnosis, unless they choose to undergo tracheostomy, in which case, they may live, on average, 2 additional years. Up to 95% of patients with ALS in the United States choose not to undergo tracheostomy; management of respiratory failure is therefore aimed at both prolonging survival as well as improving quality of life. Standard of care for patients with ALS includes treatment from multidisciplinary teams, but many patients do not have consistent access to a pulmonary physician who regularly sees patients with this disease. The goal of this review was to serve as an overview of respiratory considerations in the management of ALS. This article discusses noninvasive ventilation in the management of respiratory muscle weakness, mechanical insufflation/exsufflation devices for airway clearance, and treatment of aspiration, including timing of placement of a percutaneous endoscopic gastrostomy tube, as well as secretion management. In addition, it is important for physicians to consider end-of-life issues such as advanced directives, hospice referral, and ventilator withdrawal.
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Affiliation(s)
- Shannon Niedermeyer
- Duke University Hospital, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Michael Murn
- Duke University Hospital, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Philip J Choi
- Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan, University of Michigan Medical Center, Ann Arbor, MI.
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Nakayama R, Nishiyama A, Matsuda C, Nakayama Y, Hakuta C, Shimada M. Oral health status of hospitalized amyotrophic lateral sclerosis patients: a single-centre observational study. Acta Odontol Scand 2018; 76:294-298. [PMID: 29278008 DOI: 10.1080/00016357.2017.1420228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the intraoral conditions and oral function of patients with amyotrophic lateral sclerosis (ALS). MATERIAL AND METHODS This single-centre, cross-sectional observational study included 50 ALS patients, who were treated with tracheostomy positive-pressure ventilation (TPPV) while hospitalized. The disease duration, TPPV duration, current number of teeth, number of occlusal units, number of decayed/missing/filled teeth, community periodontal index, bleeding on probing, dental calculus, maximum mouth opening, salivation rate, tongue anomalies (atrophy or hypertrophy) and tongue coating were determined for each patient. Differences in intraoral conditions according to disease duration or TPPV duration were statistically analysed. RESULTS The maximum mouth opening was low in the included patients, with a mean distance of 13.7 ± 7.4 mm. Furthermore, the maximum mouth opening showed a significant negative correlation with both disease duration and TPPV duration. No statistically significant differences were found between any other intraoral parameters and disease duration or TPPV duration. CONCLUSIONS Severe dental disease is uncommon among hospitalized ALS patients who receive oral care by nurses; however, mouth opening is very restricted in these patients. Early intervention for restricted mouth opening, directed by a dentist or dental hygienist, is essential in this population.
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Affiliation(s)
- Rena Nakayama
- Orofacial Pain Management, Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akira Nishiyama
- Orofacial Pain Management, Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Chiharu Matsuda
- ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Yuki Nakayama
- ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Chiyoko Hakuta
- Oral Health Sciences for Community Welfare, Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiko Shimada
- Orofacial Pain Management, Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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